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HomeMy WebLinkAboutBLD-19-699 • \omo:Oar Only I O lPermlla�• —�� Pmit expires Io dogs Promrb G� isse dte • EXPRESS BUILDING PERIYII APPLICATION TOWN OF?ART/MUTH - ,., r. B V --•, • Yarmouth Building Department ' °i -_�— D 1146 Route,28 South Yarmouth,MA 02664 AUG, 03 2018 (508) 398.2231 Ext, 1261 IMP)) C /_ T ' /6 P'e,Q fin kiy L.;J-'--:----PJ1�C�x CONSTRUCTION ADDRESSIa „ ----- ASSESSOR'SINFORMATIONI I parcel: I I Map; �' • 72c 2 3/7c,4a OWNER: : : ��� PRES=NTA DR> Tet, II HenryoaaeldyCep Cod lnsutetion lemordonCNN SouthYermoush 5084754 214 • CONTRACTOR:TrorAILING AOOT@SS TEL,H R Residential 0 Commercial Bet,Cost of Conetruotlon$ 2/0/2,O Homo Improvement ContrnotoyL1o,N 153567 .Construction5upervlsorLilo, H 100988 Workmen's Compensation lnsuremel (roheok one) 0 I aro dm:bomnowne'r„^^ 0 I am the solo proprietor 14 I have Worker e Compensation I mica CE0043190 ., Ineuranee Company Nemo: Atlantic Charter Insurance' Worker's Camp,PolloyH WORKTO BE PERFORMED ' "Tent laDuration (Fire Retardant Certificate attaehed7) •Wood Stove ";Sldingl N of Squaros • a,,,Replaoement windows: H Replacement doors: H • Roofing: Hot Squares ( )Remota existing" (max,2,layers). Insulation Jr _Old Kings Hlghway/Hlstorie Dist, ( )Replacing Iiko for Ilko Pool fencing I. ' J. aTdd debris wlll'bt dlepoud of on i Location of Facility I deolaN under penoltlea of porjulthat the tonics heroin d for ntainol aro r otrue a cl 0 re Oh,the stoolmy knowledge and boiler, I understand Ihst Fly false 0 aclllbeNit oausvCOT denlelcr , ••;,;,,,,74rproM, „I„wi,,,y pmS'IIit�6r,I,N.„,path /1 Applloent'eglaneLtIc taiumuu,{nota Datvl Osn to$I nme. (or allnehme.t) Onto: / G �� Dale: cC ' gtie Approved By: Euildln• a Alo� [i #01: ‘ EMAIL ADDRUSSt +Y w •r-----�.., • Zoning District: Historical District: 0 Yo Cl No Flood Plain Zonol 0 Yes 0 'No Water Resource Protection District: Within 100rft of Cletia dNo ` 0 ?vs CI No - _v _0 - q o- h v ' .. m v a Cr _o ea > o. m o O N aC j - ' V 1 6_S G b N O .- I 2- C v e O O ' N eb y O 2` O .� i SI v o - m _ID- o aS i'o N ^� 'o 0..i JC ! � . c .o _ m o ao e 0 0 v o p o .0. 0 c a, uu m c a C a� m a E. ^' I _ v o -o - n o _ Pc o m '� E. 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" rt .� �snO - f <`�''° z ¢ v ze BO II II D -D �Eo�. o -- s � A m4- e j o v - o i` = o o a s _ i.. ---- 1 CAPECOD-27 AMAHLER ACERTIFICATE OF LIABILITY INSURANCE DATE(MM/DO/WWI _ 06/05/2018 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(leu of such endorsement(s). PRODUCER h5011.‘" — Rogers&Gray Insurance Agency,Inc. PHONE (NG,No,Lan (NC,Ne):(877)816.2156 434 Rte 134 South Dennis,MA 02880 Sal mail@rogeregray,com INSURERISI AFFORDING COVERAGE NAIC P INSUPERAIWest Amerlean_Insurance Company 44393 INSURED M INSURER 9'Safety Indemnity Insurance Company 33618 Cape Cod Insulation,Inc. INSURER C Endurance American Specialty Insurance Company 41718 18 Reardon Circle INSURERo,Atlantic Charter Insurance Company 44326 South Yarmouth,MA 02664 INSURER E; INSURER F1 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. (NSR ADDL SUER LTfl TYPE OF INSURANCE (OED WVD POLICY NUMBER (MMlnn EFFI ile'MY LIMITS A X COMMERCIAL GENERAL LIABILITY 1,000,000 CLAIMS-MADE El OCCUR EACH OCCURRENCE 3 BKW(19)63328281 04/01/2018 04/01/2019 PRFMIFFS(pFenrrurrngp)_} 100,005 MED EXP(Any one person) } 6,000 PERSONAL a ADV INJURY 3 1,000,000 LAGGR GAT LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY g& u LO'a• 2,000,000 X OTHER.see holder tlucdp of operations PRODUCTS•COMP/OP AGO 3 B AUTOMOBILE LIABILITY S COMBINED SINGLE LIMIT 1,000,000 ANY AUTO Fa acclaenll } — 6232707 04/01(2018 04/01/2019 BODILY MJVRY(Perpereonf�{ ••• 1AM( TU OS ONLY X EoTH�jpgVULLEOp n• X A� ONLY X AUTOe ON�Y BODILY OOPERNYU AMRY(AGE Per accident) E �fgor ecce enl $ — O. UMBRELLA LIAll X OCCUR 3 EACH OCCURRENCE $ 2,000,000 X EXCESS LIAO CLAIMS•MADE EXC10006835003 04/01/2018 04101/2019 AGGREGATE 2,000,005 ,. DED I RETENTIONS { — D WORKERS COMPENSATION EE pp77 i AND EMPLOYERS'LIABILITY STATIITF I I fRH ANY PROPRIETOR/PARTNER/EXECUTIVE n WCE00431903 06/30/2016 08/30/2018 OFFICEro/MAI REXCLUDED? NIA E.L.EACH ACCIDENT $ 1,000,000 ,,�mAandalo NNHH�) II ea describe under EL DISEASE•EA EMPLOY $ 1,000,000 DESCRIPTION Of OPERATIONS below E L DISEASE•POLICY UMI $ 1,000,000 /1 ,. // _ ', DESCRIPTION OF OPERATIONS(LOCATIONS I VEHICLES (ACORD 101,Addlllonei RemarksSchedule,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 Llablllty when required by written contract or agreement with the Certificate Holder. Excess LiabIlity Is follow form, CERTIFICATE HOLDER 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 26(2016/03) CI 1988.2015 ACORn rnacnlaa Tlnm AN rl..l./n rnnn..�.1— ' al \.: U C • l e. Commonwealth of Massachusetts lDivision of Professional Licensure •Bonrd of Building Re urations and Standards Con s`rFCttl{'t$Iln�rvlsor Cs.100988 it ' 8,1t Iros; 11!1112019 ` iii HENRYaCAtsioY1f'p" ' . sc.,- C8SHED ROW eiG . lAt _ WEST YARMOS MA`a0r acis/ ti :t%lltt.@10.0 • Commissioner l/sw S� billei Office of Consumer Affairs and Business Regulation 10 Park Plaza • Suite 5170 Boston, Masi"d busetts 02116 Home improveme?. +,C.o tractor Registration Cape Cod Insulation Inc <''` ' i `''' ' . 6 TYPe, Corporation r •:i , F I i, Re xpiration: 123387 18 Reardon'Clrcle r.:,,::-" Expiration: 12/14/2018 • So, Yarmouth, MA 02684 vi ...t,..:. • 0411•�•�L.4C ;one s! hanr.oanrb. -t^•..)'• Update Address end return card, Mark reason for change, • 1111....._._.._.,___..._.._........_..---_....__......_............ . ._. 92a mroewervurala v� ""-""^•••-d7..Adr„IaLna..CC.n•snrtv;n:_L',l",.tr ! n �r� usine,reourac�alatio P oymant.n.Lpgt•„R,rd.. Office of Consumer Metre&evilness Regulation rlAl; HOME IMPROVEMENT CONTRACTOR 4 o en ' If .0(¢r Ty"pel Corporation Registration valid for Individual use only t 1! before the expiration date, If faun• a urn tot Exolrailon 10 Office of ConeumerAfletraand : ep'Regulotlon {ryfl'� 5�0aa7 10 Pork Plaza. : •,�t,th, ,1.;�, trlYe 12/14/2018 ea170 Cape Cod Ins0l tl'`fl i c rV ';: r..t Boston,MA . Henry Cod In t4I \`"f o �; 18 Reardon Circ19' !).(t• e/ 2 cC. % So,Yarmouth,MA''::-. .10.- t• ��a;/1, a er • • i 5 Undor ry 0_,,, /if _ � htsl, at • • • • \\ ; Crisea 480 West Main Street Housing I F+, Hyannis, MA 02601-3898 Assistance' tin Tel:(508)771-5400 Fax(508)790-2425 Corporation TTY on all lines Cape Cod Free Weatherization ! Your tenant has requested and is eligible for weatherization of your rental home through the Weatherization program at Housing Assistance Corporation. An average weatherization job is worth $4,500 and these services are provided at no cost to you. The following weatherization measures are applied to the typical job: air sealing in the attic and basement, insulation in the attic, basement and walls, weather-stripping doors. Bath fans may be installed if necessary. We will test the efficiency of the refrigerator. All work is professionally done by licensed and experienced contractors. HAC will conduct a final inspection to make sure that all work is completed in compliance with quality work standards. Prior to the work being done you will receive a letter from HAC showing the actual measures that will be installed and the total dollar value to the work. To-confirm your ownership of the property, we will pull the appropriate town assessor's report. If necessary, we may ask for a copy of your tax bill or deed to prove ownership. The work on your rental property will begin when we receive the signed copy of the attached Agreement. If we do not receive the Agreement, HAC will conduct an energy audit but no weatherization work can be done without the signed Agreement. During the energy audit we will install energy efficient light bulbs and will test the efficiency of the refrigerator. If you have any questions please contact Suzanne Smith at 508-771-5400, ext. 123 or ssmith©haconcapecod.org - LANDLORD: .fah.4 INS- . TENANT: i CA )IYtra oilasucstic, r;°ta WL2UWk- R 1,, ''tP�i cjnenfK cl etri eru7y` //n&co--6,Cot email: real t� it\Dino email: ). ea_k.C.Ld-gel (_f, r►'ut.411 ,c2 PHONE:(home) PHONE:(homf e)) 1-14 (cell) (cell) 1-14 Ot F P,11 r ] T 3 14. The Parties acknowledge that this 9 Agreement Is under seal. It is Intended by the Parties that the Tenant or any successor Tenant Is the Intended beneficlaot of the Agreement and shall have a right of enforcement: B'vi Ida 10 0e®4./4 Property Owner's Signature: //i�, £4 pttzz Date ate fre Phone: 7Z©- Z?iF-'7000 Address: (09Z Wil-OWT 74& "Foctiezia, Het 02:770 Tenant Signature Date Agency Approved Weetherization Company Adam T. Incorporated / All Cape Energy / Alternative Weatherization Cape Cod Insulation / Cape Save / Cazeault Frontier Energy Solutions / Lohr Home Improvement / Tupper Construction Agency SignatureDate b -a.I r