HomeMy WebLinkAboutBLD-19-000700 / .
• [[ t/
a r{II
One Use
_seOnly
� yqC
�
C µ '0
e;h"• Ivwu7h() ilIPAomrmotliH3
S�
from�Permit sx oa ISO days
amedete
EXPRESS BUILDING P•ERMYIt • APPLI9ATION V E.
TOWN OF YARMOUTH
Yarmouth Building Department
1146 Route 28 A116 0 3 2018
South Yarmouth,MA 02664 `���Jy��
(308) 398.2231 Ext, 1261 a" ' 1likil aUrs_ I
CONSTlWCTION ADDRESS!' 34 .6),-i.,5 t ,f
ASSESSOR'S INFORMATION!
Map! I Panel:
0wmillsr4 NAMri / elzlJ/4.f6 : .. - ?J: 4
PR: BIT • PDR' ' TE , •
CONTRACTOR! Henry CoaeldyCeps Cod tnsuletlon itMurdonCircliWill Yumoulh 608.775.1214
NAME MAILING ADDRESS
p Residential 0 Commerolal Esti Cost otConstruotion$ ,701"47 ,
153567
HomeImprovement Conlrncto�aldo'N Construction SuparYlaorLiu,N 100988
Workman's Compensation Insurenoel (theok one)
0 I am the homeowner' CI I am the sole proprietor 10 I havo Workor`e Componsatlon Insurance
insuranceCompanyNeme; AtIantic Charter Insurance' Worker's Comp.PolicyN WC 00431901.,
— WORK TO BE PECRFOR1VI6D •
In
"Tent Duration (Firs Retardant Certificate attached?) .
Wood Stove
';eSldingl N ofSquaros ,,„Replacement windows! N Replacement doors! N
Roofing! N of Squares ( ) Remove existing* (max,2 layers).
Insuiaflon
dr Old Kings HIghwayfHistorlo Dist,
( )Raplaoing llko tor like Pool fencing
•'•„ • 1T1ddebMvelllbtdhpondofoh f
t. VaL ,.. / ....
• Locatlou of Fool Ity
I declare under pickles of per) . that!ha, tom •ns heroin •ontolnod are true;AO ooneot to the Veil of my Imowled8a and ballot I underalnnd that any TMso ons+vor(s)
will 1)0 PSI nun for denial v•g, �i 41;.1,
�nae end for pro •n under M O L,Oh,205,3eoslon I,
Applloanl'131gaAl+ • ' .b Titirnitrceimioufd p
Dacesl1/O
Owner SO re(or AIM meat
Approved Cy; / • /' Dntol
8t ' Ill `' o ate' 1` EMAIL AOORSSSI Dalot , ��,/
ZssB
Historical Distrion Cl Yes1) Nook Flood Plain Zones 0
Yes 0 No
Wator Rosouroe Pioteollon Districts Within 100 ft,of Wetlands; e N,
• 0 Yes CI No 0 Yes 0 No
•
._""•"„"luosaad yatyuop
oload'cu1ayllettunIdaS+A0100dtul.leolal0a12 '6 alatlpUMo,L/�110 'e1vatulteda0luIP11n6 'Z411ea A0P1toa'1
•
moo Ip.
asuaol�glutuad I(ouo sloulo) Mlaotony 110141• Rums so1x10
7n1oWo unto) do 0 di Pala)duroo 911 o iniu 4,11!1 u1 min{Jou oq 11)uo Drn)apV/0
, 2 .a 1800
1 M IMA•t•M,.yfunn+nnn,rv„�1'17 Irl i • 1'.
'Swop pun 9n1) s)mop pp mud ko
_.. ND dofl!)0111 JnN1 sln/lad fo 4,9 O / p/✓�
•
)Ifoued pi/Hp S I/J 19pu•. 1D0 AQBrDIIOp/
,a,nsul1oi �a ot{y Jo ruoll9x{4sotiu1lo aol}yp oyy of PtPusnuoJ act Am lu3wayels s -____--•----1.__....__...� .__ _
,tiu oy do Jo tut;of a put �a4�0 'uopto9µ*A t8aladoo ^ ,,,
t0/\ dole 1,0 uuoJ sql ul salyisuod IIAIO 4,n II M ra two tu dotµdutil n d�odo•mrpu1 .,,,.:
•OOS'IS of do sup s Aq olgaysiund uolyelol Isulwlla e sl Ym IZSt 'o
'P„u idxa pus Atgwnu,(011od aql litiuss)slid aoNedtloap,fel ,d aollssuadwlaboo 164,0*104 etla Jod,fdoaol gogay
� ,n! Id12/a12y6/�i10 /d el"
703 - ' uttaPPy cis sot
b102/OE/80 0!111 uoNea{dxg •
•
2061E60080M IfE'0I1 'rulJlt8lo"opod 1, , ,.,,,,•
'IS 9°/Faro r<O11od DNl I) MOD1191,140.141) 10111)1{0 OPUg1�d IouroH,Suadwoo toapinstry
..--... .........._. _..._1--$._ rlNl,lof amivihr1! wo....------- O._ kb 14_.._.! ,
d 1✓ ) ",,,
1 1ms'uaduroo ar�ds/uo,M$tryplAovd u7 rnt0 uD6o)dauD �urc/
IAN ttpput uoy11ou 10 111014/1\11014 �c 4wnu 011•• I.woe ito0M 1114141A* term 4i ua o uro iA uowtau
P lotouwet.ent ay1J9 sono iv,lulmoyalttyt lauopplppt kt worm um xo t �4�con utAoldwt
Om troolpul IIAIPWtvo U 1114401 unw Dlolotquoo 1Plnne IN U$41pv Y114M In ltllep alp/,t 2u tt u
n !ul_aallod WO ttutdwoo,ua NMI a Ira N IP 11Item It1 x...;Nwi oyi,ui*d i y1
yflUMo aMotqualoua Ino l
IU et flow I x•• 1�oty91t4t1uto Iddtduy,
ope2la—ay t9M •ttp0 / '6l 010Wiiduouwa tjl'dwoo,uar�oM4 'taafo(dwoouaAt4IMP�'))CI'201
J My oto pttl01axt c1/414 utewo tll pm uopuodtoa t to IM p.9
shads!Joos{Diet t'aoutmtul'dwoe,utryoM lay put teHXoldwa oAtq ugo1 uoagatutyj
IPP2 Do sllvdot Sulgwnld C]'Z 1 Imo mom NI 40 pun uolatquoo.4nt co P01Iy IAN1 put 101114 9 0 1 IVIW't WI I Q'9
P2210 cllpdal IA01Aoa12 []'l t cufoldva ou sIIouPdold
IPII l 0 01
llama to aawnth� poo o1 Ue otquoo lu y l�ola ticpvi a o In mi tmtut
uopippa 8a n Iikx I 'AAdud,aw uo loM Nly 4 IIIM Pup lautiotwoy s un I❑Y9
1('pttlnbutouamtul'dwoo,uaytoM0147iapxwlhan119lulopnumoawoytwaCQ't
uoI1110UuoQ Q '6
Su11apoulo� (] g ballade.' aouuntulI 'dwao ,tnKtomoft)'hlsamodwt
uopon tlruoo Ma}y 0 ' el twlo) Ippon ttt�foldu a au tAt4 Pu+ dlquouttpd,o loyppdad 1101 o tut I[J't
I(Paulnbau) loajoxd Jo ad t� 41(pwllautdlo/pua ilru)taa,(oidwa" '"b k pr iiibldwt awl l�'I
laoq utildo4,ddt t4I slttgo 110,0114011 us 144 JAY
I, ei.-9.LhAeog' IN auoNd119920 w 1Nlno — t{lnog Idl2/a1a1S/X1I0
eto41O tIOPasql 81 Isralppy
. r., - uoivaimuj pop 0 Eo I& PIvIPuvuon1Z1wtJo/scavitn8) MIN.. '8 . „4 ..1,1t i .t > n . .I. 1, ;;-
ikudRtoH,Llab 0141J44vNllid 2111 11,11)A calk' aa os,
'tlagwnloutiolu40al2/tuoloeuluop/tuaplinaltimPUJy toueunsul voile cue dwoo atutala m
btp/ao8',mow1MMM O•�--►'L
C
L:OtaniZoT'W Iuo'so� a
on a/1n, 'faad o ssad2uoo I 1
sippoylA9iJsapuzio)uaull,tzdaq r SpareY,� =1
swamp:amn fo s/1lvan1koun.uoo au1 '-•_ �
1 , ,,,, 11••••••••••••• ,
..--- 1 CAPECOD-27 AMAHLEP
A�oRo CERTIFICATE OF LIABILITY INSURANCE
DATE(MMIDDIYYYY)
06105/2018
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder In lieu of such endorsement(s).
PRODUCER goitc7
Rogers&Gray Insurance Agency,Inc. PHONE FAX
434 Rte 134
(A/C, leq: I/AIC,No): 877)616.2156
South Dennis,MA 02660 Miss,
INSURER'S)AFFORDING COVERAGE NAIC a
INSURER A:West American Insurance Company 44393
INSURED ' INSURERBISafety Indemnity Insurance Company 33618
Cape Cod Insulation,Inc. INSURER c:Endurance American Specialty Insurance Company 41716
18 Reardon Circle INSURER o:Atlantic Charter Insurance Company 44326
South Yarmouth,MA 02664
INSURER!:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSRTTYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP
IVSD WAAL POLICY NUMBER IMMIDD/YYYYI IMMIOD/YYYY) LIMITS
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE } 1,000,000
CLAIMS-MADE QX DAM
OCCUR BKW(19)63328281 04/01/2018 04/01/2019 ACETORENT rDence) I 100,000
MED EXP(Any one person) S 5,000
—
PERSONAL SADV INJURY S 1,000,000
SNL AGGRFOATE LIMIT APpUE LOo-PER: GENERALAGGREGATE S 2,000,000
X POLICY U Ta u2,000,000
set holder tlocnp of operationsPRODUCTS•COMP/OP AGO }
X OTHER:
S
E AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT1,000,000
(Ea accident) _
S
ANY AUTO _g 6232707 04/01/201e 04/01/2019 BODILY INJURY Demon) S
—
AUTU pTU OIqp�ONLY X AUCHEpDUULLED p _
X AM ONLY X Man? pBgOqDILY INJURY(Per acclden0 I _
(POrr ace nIQAMAGE
}
$
C UMBRELLA LIAR X OCCUR EACH OCCURRENCE S 2,000,000
X EXCESS LIAR CLAIMS•MADE EXC10006635003 04/01/2018 04/01/2019 AGGREGATE $ 2,000,000
•.. DED RETENTIONS
D WORKERS COMPENSATION p $
AND EMPLOYERS'LIABILITY �Iyyyy'.��r�[qqqq��,I PER
FRH
ANY PROPRIETOR/PARTNER/EXECUTIVE U WCE00431903 06/30/2018 06/30/2019 1,000,000
FILE Rd M )EXCLUDED? u NIA EL EACH ACCIDENT $
ands ory n 1,000,000
If q9ea dents under E.L.DISEASE•EA EMPLOYEES 1,000,000
- DESCRIPTION OF OPERATIONS below
• _ EL.DISEASE-POLICY LIMIT S
/,
. /
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required)
Workers Compensation Includes Officers or Proprietors.
Additional Insured status Is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder.
Excess Liability Is follow form.
•
CERTIFICATE.1106DER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
•
AUTHORIZED REPRESENTATIVE
•
ACORD 25(2016/03) ®1988-2015 ACORD CORPORATION. All rlahts reservort.
A
i (1
l��s' Commonwealth of Massachusetts
Division of Proles floral Licensure
•Bonrd of Building Regulations and Standards
Con s`itj:CtRtri'l li)mrvlsor
't `
CS•100966 ,S' o.tJ1.71; E�Ires; 11/11/2019
•
•
HENRY E CA JSIDy, JI1���Qir
SSHEDROW.% :N,,af�,' ( * ..1
•
WEST YARMOUTH MA...0, Oa N°
tt'll,nr:to\\� Z.
Commissioner w l/st^- 4.--•
S� �
.0y
. l e2e (PCL?Yf/1?Zt24vec1G�t'Xi��//?i G i
minx t
, ,` Office of Consumer Affairs and Business Regulation
10 Park Plaza • Suite 5170
Boston, Mas,,t tiusetts 02116
Home Im roveme:.t+so ractor Registration
h'rra:::a::-'^4:y^
.e. 1
'/ `. 2,.:;: `;`•::_'iE. y.ir%`;. ) ' Type: Corporation
Cape Cod Insulation, Inc ::,.-' /I Registration; 183697
iii ",:"F. .1• ..4�N:' I
18 Reardon•Cirole - '"o-.+ + ( Expiration: 12/14/2018
So, Yarmouth, MA 02664 ' 1 "-:
•/, ,':�1•�I.�•�µ ..:,ATI
ices <) aon+•oer+r C.:.. . Update Address end return nerd, Mark reason for change,
92s S'orro-nroocrourele•ei �] Ad s.aa..0 .fi.xatt.urn._Llp�t +
Office of Consumer Affairs&Business Regulation
A)„ (9 HOME IMPROVEMENT CONTRACTOR '
01110/.rT izal Corporation before the n valid for Individual use onlir
y
t1cc; rgigtretlon before the expiration date. If foun•
��**a„"" ,a� EX@li:Il114D Office of Consumer Affairs end : e tot
""'r'� .@0 B7 10 Pork Plaza• eg Regulation
. .. •I;.;.,, ,. e 12/14/2018
Mill ice:.�r„ ea170
Cake Cod Ins01�11°'1�l pit {.; 11 Boston,MA
Henry Cassidy'1,, .C;, ` ..;
19 Reardon Clrot0' �r� r,' R..cc. • /
So.Yarmouth,MAt•020$S �% C� P ••
Vndor ° . �ha
t al • — hout el? at
• •
•
u
•
Cape Light S
Compal:.
5 Dupont Avenue South Yarmouth, MA 02664
OWNER AUTHORIZATION FORM
I, JUSTIN OCONNOR
(Owner's Name)
owner of the property located at:
36 Locust Street
(Street)
South Yarmouth, MA 02664
(Town, State, Zip)
hereby authorize
(Subcontractor)
an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building
permit and to perform work on my property. This form is only valid with a signed contract.
The Permit will be secured by the insulation contractor, at no additional cost. It is the homeowner's
responsibility to close out this permit by contacting their municipality at the completion of this work.
-Ctom mer Signature
7. 22-( • 1 $
-Sign Date
07/24/2018