HomeMy WebLinkAboutBLD-19-000920 + �9,OF Y� .Pemut#
il
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a�r /!; "Pemvt expires 6 months from+**+ ^7"•V, BL -'9 _ "„ o ;tissue date.
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EXPRESS BUILDING PERMIT APPLICATION__ _ _,
- TOWN OF YARMOUTH ' ; e n/ E D
Yarmouth Building Department i'"'
1146 Route 28 i ( AUG 15 2018
South Yarmouth, MA 02664 ;
(508) 398-2231 Ext. 1261 �/
CONSTRUCTION ADDRESS:_ O1 _ 'is
ASSESSOR'S INFORMATION:
I Map: '5/I (� I_PPaarcel: III 1 I
OWNER: i10II(02411 � t C )l 'cT1-e 0-1
NAME PRESENT ADDRESS TEL. #771f_ 3/^-Q7/0
0
'CONTRACT*' fi _.LLi . � .101_ MA As{�yI �/�p(( it 1
NAME � .r� " " `lC �''j.p mV
_tto" esidential 0 Commercial(( __�� 0 Est.Cost of Construction S 3 —C)
Home Improvement Contractor Lic.# ROCA, Construction Supervisor Lia# I VS90 1
Workman's Compensation insurance: (check one)
0 I am the homeown- 0 I am the sole proprietor _ e Worker's Compensation L-surance
Insurance Company N e' , 1 a _ sl sjai ' Worker's Comp.Polic40V'b 0I S 3 c--0(.11 k in-
WORK TO BE PERFORMED
0 Tent (Fire Retardant Certificate attached) C Wood Stove Shed
9 Siding: #of Squares 2 Replacement windows:#
0 Replacement doors: #
0 Re-roof #of Squares , Insula
()Stripping old shingles' ()going over layers of existing roof 0 Old Kings Pligltwayalistoric District
Roofing/Siding(Like for Like)
(4/ (('',� tri A f�
'The debris will be disposed of at:1 �-f 1 \;& —I I ' _ ALS2
1 Location cf facility
I declare under penalties of pequry that the . L..ex' •.ntained are u e and correct to the beat of my knowledge and belief. I understand that any false=weds)
will be just cause for denial or revocatio. of coy for prosecunen under M,O L.Ch.261,Section 1. 4114iisc
y -
Applicant's Signature: Date:-
, •
Owners Signature(or attachment) at_ iiiiet�.� Date: •
Approved By: _ Date: 8-45--..„9
Building 0:zf(7/ignee) I
Zoning District:__.___,___.
Historical District: ❑ Yes C No Flood Plain Zone: 0 Yes 0 No
Water Resource Protection District: Within 100 ft.of Wetlands:
❑ Yes ❑ No ❑ Yes 0- No
vni
Cape Light
Compact It
5 Dupont Avenue South Yarmouth, MA 02664
iC0'0•a '\
OWNER AUTHORIZATION FORM
1, MARTIN J MURPHY
(Owner's Name)
owner of the property located at:
34 Old Castle Road
(Street)
Yarmouth, MA 02675
(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.
-Customer S�' ature aa' 00S/ /�
Pe
-Sign Date
04/03/2018
i as
"" 7 he Commonwealth oil fressnchu rrttr
�=^sem-;y Deportment of Ireduntrial Accidents
,1( `'e"k - I Cori rrry Street, Suite 100
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! ( In or Town .—._ _. . . __
f.euiIL \nlburh, lcirrlt 6ne):
I.Board al li<'dal J. Bundnia!)cpartolrn: I I'Ilt I na•t I lock 4 hii•r•••:•I I oipr'tan a. l'lunihino Inspector
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Construction Supervisor Specialty
Commonwealth of Massachusetts Restricted to:
Division of processional Licensure OSSLIC-Insulation Contra or
Board e'Buildmg Regulations and Standards
.. J . ..:•Ja Sopen S0'3 ca . }'
CSSL.105941 Exp•tes 3217,2020
FRHATS SHRDH?N
502 HARWICH - ' I
RO
BRof nit EWSTER MA 02631 '• .; Failure is cause for ev Massachusetts
cense
r''''- State Building Code is causenfortrevocationthilicense
of this license.
- For information about tna
Q a--- Call(617)7273isa 200 or vwww.mass.gw/Cpl
Commissioner C".4
- Office.A Consumer Affairs S Rosiness Regulation License or registration salad for individual use ones
- before the espira Bron date. if found return to:
- HOME IMPROVEMENT CONTRACTOR
A �_ Registration: 160054 Type: Office of Consumer.lffairs and Business Regulation
Expiration: 9r&2013 LLC 10 Park Plaza-Suite 5170
"i,•~` - Boston,MA 02116
FRONTIER ENERGY SOLUTIONS
FRANCIS SHEEFAN
5C2 HARWICH RD - 1� ✓ _ I
BREWSTER.MA 02631 t ndnw-crrtary -. h halal rthou ignalurt
e •
A`COR oma® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY)
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: It 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 Proces sing
ROGERS& GRAY INSURANCE AGENCY INC PHOria.gm). (508)398.7980_ _ 1 j