Loading...
HomeMy WebLinkAboutBLD-19-921 a .�,., +r •Permit# it,. C\ 'Fees 3S_ cta�t f,$ t Permit expires 6 months from:. • C,� T�± BU— I 'issue date. EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH R c— --- Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 AUG 15 (508) 398-2231 Ext. 1261 atf2Ut8I li ' i.. ,y CONSTRUCTION ADDRESS: CP A t/OA-y ASSESSOR'S INFORMATION: Map: C,.,(,k Parcel: S-3II. / OWNER: k_ �,► * •.t S I t.A• AlLi ! Ot)(44 � /W(9 � 7 3 NAM IF SENT( 1ADDRESSanj-Q;210 TEL. # CONTRACTOR:: OA) SW/C(l�u.ntit.N ,&� NAME // rrna4 4Thcj " Residential 0 Commercial �s-(/- 0 Est,Cost of Construction$ ��/ — Home Improvement Contractor Lic.# Q�J Construction Super'9sor Llc.# tet' ' Wor)m:an's Compensation Insurance: (check one) 0 I am the homeowner 0 I1ant the sole proprietor - a�ve �ker's Compensation Insurance Insurance Company Na'me:A(� l'1 i ) k U r/Y1WoorInsuranceLKtiorker's Comp.Policy#/OD— (Da S31 C-9a cf WORK TO BE PERFORMED 0 Tent (Fire Retardant Certificate attached) C Wood Stove Shed Sidmg: is of Squares Replacement ' doves:# 0 Replacement doors: # 0 Re-roof #of Squares elation ()Stripping old shingles" ()going over layers of existing roof 0 Old Kings Highway/Historic District '�/� "�'-�('�/�/) } j�Roofmg/Siding(Like for Like) 'The debris will be disposed of a\.�'1 � �.�' 'CQ + NAA {-t 0141_- ce4'¶ Location of Facility ))) I declare under penalties of perjury that the statements herein contained are true end oorr%t to the best of my knowledge and belief I understand that any false answer(s) will be just cause for denial or revocation of m. 'tens and for prosecution under MO.L.Ch.268,Section 1, f I Elf' Applicant's Signature Date: Owren Signature(or attachment) �;� u • el Date: Approved By: ��IDat;. O75-4Y70/ _ Building Off (o/--igoee) 1101 Zoning District: Historical District: 0 Yes C No Flood Plain Zone: 0 Yes 0 No Water Resource Protection District: Within 100 ft.of Wetlands: C Yes 0 No 0 Yes 0• No 3/0I • �kgof� Permit Authorization i mass save Form Saw so t'wOwah ent_sw tPt on,wy Site ID: 3390918 Customer: Alta High I, A\ q I-I 19.1/4 ,owner of the property located at: (Owner's Name,printed) 16 Benjamin Way West Yarmouth, MA 02673 (Property Street Address) (City) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. Owner's Signature: �fl t-tr� f 1 (\f`q L Date: LI 4 U • I P ///] aa ea a a a a as a+e'a'aa a a a a aataar{:au as as a a a a a Naa a aae a a a a a aAa a a a a U atA'Y.a a a a a a a a ma as FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date Name: RISE Engineering Phone: 401-784-3700 Email: For Office Use Only Rev. 102015 • •„•L "N z., /hr Commonwealth 0/.ldn:cnedu)e Uc !,-=:'- „iltr'7.1=`- ;, Repan:ntnl,d lndaitrial.tc'cident, I Com;ren Street, Suite 100 ' T_ Boston, MA 0.114.10/7 lic-C'”' �3 1 a ` �.• ion.:rruu's.,;o rill a e — Workers' ('umiu•n.a lien Inc ura ora \INA.it: Buildr n'l nnlractan.l !writ is ns,Pin mhers . 11)lir iii rli 51II II1'111' Pt NNW 11Nt. 11 1111 0111 \piI,yanl h!fnrniJli,in •, Iilratel[Inl I to Oils Y` N:Irrii i:Larrna..n/,.n:.l uta..is! , 'la•i. .r.".1 .. Ea.K: ..1alaic 'I'.f.1�5 '3,'i. Addrra: \•L.- .. ...•.1 ,.�..._1, _...Cil CiO;State/ip mo i•',r:7 rl l Ph.me a 1 '1 ` ) • L ' Art yuu•n onplatrr^•(beck dor apu,pri.re Iwa: ..�.. _... i[ Type of project(required) i1Q.rj um 1cmp4r,ci,a i', IO___-ntpiaya.(colia.:.m 11.1,1:m-1' ;1 , LI Nc'.<cancruci, P I •I 201 iota atic p•uprotm ii.b+'1•"'iniriiJO..::mea i l,r.v.•a n 4 ii., .. \ 0 itelnocle Lig, J> capnan. 4b. ,l .nr, : Lei ,'wdl T.1' rt; :I •'n• ' 1 i) ❑I')vn•tI0 .011 0:arr.J 1-n•cmno..•....a. ii. o-•.c I! j,, .n.... :m1! n...,Ice•..i.,a-:1 I L1 10❑ ,.IJ:ng a.IJ1Ii'n i I 10l,ui.,1.•nt:set Jm,...! ,r tar;uia•..nac•o,+"J't!e' ••••••,.••••••,.In inci' i.a. I.. envJe!�el ....,.n...,.•.rn^•J_c .�.: r- er.a' �n:..Jerary >.evix I 'I Of.Ci'rIC:: repairs lir dddIllnL1 ' ,-,ria,.••,.V >n ri;Ip..:•' 11 n Ji>Ill ii:•,.1g ici:bile i!:'J.:,Ii::,r,s i p I A sr,r1:.iiii .t : .i. :Pvn tcA`w tr.i.:i, 'i du:.. he ii.:.'.,1d.c, ©J it..,i b•Luir', 1 1tm:vie;„trot lot::'iota:- ::•ird•r.r....Lei ,dr.,: / 4 1d flI Phei 1,-<;'‘."..„2-1.,,i,',7{.'I' : 1 n Die Jri a ,qx,o:v.a a.•:n-'✓swat luta oris.tJ Mt•i,i,g. ...:.n.:•t<,pr V.it.: i I151 i It! ml ac o,.‘0:,:^eia.•os :Nu a„vn . • ,i._':xeiey pm!, _ L_ ._._—_...._..—.._.._.__J 'An YWdu„ntut.toil.:v....i i,ice 4i:LI, ii,.i.cset.,•v, .•n.Anale tm•,raan...',.t•,pr,t+n.'n,atrt1M: taum '!imnenxnery w n:tm r:lir 111.::::It c.%r:•q rvt 7::' can„.1:w.:,al,r!.•r leu^n 1'.l.t..V;i,ul •u..0 suou:li a rr. YLJ.r'r r:a:EN JinL 'I OJn WO':that„it_1'In.•h.x'^,...'rt,,lu..a .!.iii.-rail a.,.: ..-..r.¢ilia itia. 'A i'lt%Li.Li.i ..w ;n mUu .r:• twit ha, rm,•leyee• Inix,.In.,.niuc.n sbn.r-„i•,ni.e.v. '' ...flu'0:: ..,.lie, n..net .tri' ;x 1¢.numn.^ _ /am an enptn.-r that o pea conn,yi w,,ken'unapt nwtien iii urine,fat my rrnplm;es fir/ow is the pato, and fah%Ire information. Irr::,t.line c'ivrfnny'4nrrd {�'1j`{ NJrU�I�.. i. i,ae.,Rt�' .�L ,C'.�7tnp� Policy ii Of Self-MI lLic 44 of�1).C."IIJ(0�'r~�\Ap( 1S-315', 1VA •''(oduun MP!. 41‘) ),91� ... !'.i0,1':to:\,Jdr:•ss-two._ Ct1\&I I3-1.N . . ('lv•,irate>!.I{+ I / / !M(Mi1-� lllath a cops of the .,orl.tre cune • s.nun polity iled.va lira p gr Homing tilt policy number and twin tion dale I F's...,:c':o,ee.t.r:urel,iu: a,-'cy.rr t I'1n4.1 WI. J Ii_t42iA. ...acc mina]sot,e'.r In 4nmlperl e Pya fine up lO S I.51Ip pb 41:4'04 miC•u.0 i:!.a':.<rkf .. cn' . ar! A. ...d a ra•r ::1': • the(rn:,.i.'S I OP'A iV\i,RI)I R aoJ a Ire ill un in$21'i 01 a ,....:r.:i:t'0''t,V-i.... • ir,r.::1::: .. t:•1C 'JI.\ '-v r•st ante .tat a�am.t Ito un•n,.y n � ,I �'J:ei,..,,... lr' .,. i .:O.et jal'.rc'neat.it:' _ ___ __ _ ____ tan Irrn'bl•[vrufl under the pain teanw no a/prnru'•;that Me•n/,.rniaf...;r J.-twirled ul'i>i is cru•an. 'arm h '11C:1'f.�•7_.. . \.,l!--'' .. ... _._ . _. _., _:yLl: • _..- 1'I�0Jlirint air nn/'c!),i nor''.rite in thin oreo. o h;rneripleits1 hr my or Inion n//l i•d._ TONS n „_ _ - . _- . Pet iu!61 lien's. ': . .. . __ . . .-_. II issuing Aniburin I circle noel. I. Board of)Ie al:h J. 13nl,dmg 1hpurlmrn: i t ll.'I awn l kik 4 fief it.tai inapcci•,i '. Plumhm^ iatpecirr • e �(aonia.t Peivort:__—Tse_-..a., _t. ==_I hnn .0 -rte...-._..— '_ • r a1 s Dc Construction Supervisor Specialty Restricted lata Cv.s'on vealtn oI Massae esufe CNd4C-Insulation Contractor Dw.sion o.arnlesAgnal LK en sure • Board et Bwldmq Regulations end Standards =.Pie"IiSO'JJF.c,a:; • t CSSL•10E94• Expires 02:17-2020 ?:n FRANCIS S SHEEHAN SO2 HARWICH RD BREWSTER MA 02631 Failure to possess a current ed*tion of the Massachusetts State Building Code is cause for revocation of this license. For Information about this license ✓1 Call 16171 7274200 or vise www"n ass.Sw/dpl Commissioner • f..e.n., u.'-..,/ . h Uflte of Consumer Affairs&Business Re2ulerion License or registration valid for individual use only - . HOME IMPROVEMENT CONTRACTOR before the expiration dale. if found return to: Registration: 160854 Type: Office of Consumer Affairs and Business Regulation Expiration:. 9!&2018 LLC lD Park Plaza-Suite 5ITO . . - 6oston,X14 02116 - - FRONTIER ENERGY SOLUTIONS FRANCIS SHEEH N � - /N_ 5C2 HARWICH RC f1 t/ BREWSTER 11.A C26311 ndrrsecrctrry Vit cal r • ithou ignature r .l • ' •^1 A�® CERTIFICATE OF LIABILITY INSURANCE OATE(MMIODIYYYYI 04/30/2018 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(ies) must 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 CONTACT NAME: Rogers and Gray Processing__t ROGERS &GRAY INSURANCE AGENCY INC (pJro„NNEp esod508)398-7980_ _1 jai,Nol._ E-MAIL DDRE mail@sooarsgray.com 434 ROUTE 134 INSURET(S)AFFORDING COVERAGE NAIL e_ SOUTH DENNIS MA 026.60 INSURER A: AIM MUTUAL INS CO 33758 INSURED INSURER B: FRONTIER ENERGY SOLUTIONS INC IN SURER CI _INSURER 0: 502 HARWICH ROAD INSURER E: -_--------__ ______.-_ BREWSTER MA 02631 INSURER F: ' COVERAGES CERTIFICATE NUMBER: 263414 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 Y EFT PAID CLAIMS. ____ ____ ILIR TYPE OF INSURANCE IAOUL wvgI POLICY NUMBER (MM/DDNYYYI I IMM!DDYYYY)EXP I LIMITS LTR (Li NSD WVO COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ -OAMAGE-TO REN-TEC CLAIMS-MADE OCCUR PREMISES(Ea pccurrenc $ MED EXP(Any one parson) $ N/A PERSONAL&AM/INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ • 1POLICY J CT LOC PRODUCTS•COMPIOPAGG $ OTHER If COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY iEa p¢Idend)___ ANY AUTO BODILY INJURY(Per Person) S - — ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS N NON-OWNEDTPROPERTYidem) GE $ _ HIRED AUTOS __ AUTOS (Per accident) $ UMBRELLA LIAR OCCUREACH OCCURRENCE_ _$__-_____ EXCESS LIAR CLAIMS-MADE N/A AGGREGATE $ r DED RETENTIONS $ WORKERS COMPENSATION XI PER IOTH- -- AND EMPLOYERS'LIABIUTY YIN L$TATUTE 1_1 LN _ _ _ - ANYPROPRIETORIPARTNEWEXECUTIVE EL EACH ACCIDENT ___ " S__1,000,000 A OFFICERIMEMBEREXCLUDEDT I�I N/A I N/A VWC10060153152018A 03/14/2018 03/14/2019 I Ilyes (Mandatory In NH) I I EL_DISEASE_EA EMPLOYEE$ 1,0_00,000 IR yes,describe under DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATORS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that This certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.govllwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Frontier Energy Solutions Inc ACCORDANCE WITH THE POLICY PROVISIONS. 139 Queen Anne Rd Unit 6 AUTHORIZED REPRESENTATIVE ,. iY Harwich MA 02645 Daniel M. row y,CPCU,Vice President—Residual Market—WCRIBMA ID 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD