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HomeMy WebLinkAboutBLD-19-001639 oe•Y4TOWN OF YARMOUTH Building Department d BUILDING �s 4 (508) 398-2231 ext.1261 \\ p " • y PERMIT NO BLD-19-001639 G PERMIT �;'` ,;�� ISSUE DATE 09118/2018 JOB WEATHER CARD • APPLICANT HENRY CASSIDY PERMIT TO : New AT(LOCATION) 114 CEDAR ST,SOUTH YARMOUTH,MA 02664 I ZONING DISTRICT 1 1 Bldg.Type: Residential SUBDIVISION MAP BLOCK LOT I.034.160 BUILDING IS TO BE: ICONST TYPE V B USE GROUP ,R-3 REMARKS Repair:Install Insulation(508-775-1214) CONTRACTOR LICENSE 1153567 (Home Improvement CAPE COD INSULATION,INC HENRY CASSIDY AREA(SQ FT) [33,613,200. 0EST COST($) 8100.00 PERMIT FEE($) 35.00 18 REARDON CIRCLE SO.YARMOUTH,MA 02664 OWNER AYOUB MARY T BUILDING DEPT BY ADDRESS I,9 VINCENT ST [CAMBRIDGE IMA 02140-2618 _ ;)att� a Y PHONE THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDE K OR A PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE APPROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM MINIMUM INSPECTIONS REQUIRED FOR ALL APPROVED PLANS MUST BE RETAINED ON WHERE APPLICABLE SEPARATE CONSTRUCTION WORK: 1)FOUNDATIONS OR JOB AND THIS CARD KEPT POSTED UNTIL PERMITS ARE REQUIRED FOR FOOTINGS.2)PRIOR TO COVERING STRUCTURAL FINAL INSPECTION HAS BEEN MADE.WHERE ELECTRICAL PLUMBING/GAS MEMBERS(READY FOR LATH OR FINISH COVERING) A CERTIFICATE OF OCCUPANCY IS AND MECHANICAL 3)FINAL INSPECTION BEFORE OCCUPANCY 4) REQUIRED,SUCH BUILDING SHALL NOT BE INSTALLATIONS. REFER TO DETAILED INSPECTION SCHEDULE OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTIONS APPROVALS OTHER: I WORK SHALL NOT PROCEED PERMIT WILL BECOME NULL AND VOID IF INPSECTIONS INDICATED ON THIS CARD UNTIL THE INSPECTOR HAS CONSTRUCTION WORK IS NOT STARTED WITHIN SIX CAN BE ARRANGED FOR BY TELEPHONE APPROVED THE VARIOUS MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED OR WRITTEN NOTIFICATION. STAGES OF CONSTRUCTION AROVF ' of it '. r of i \ • I Oflloe Uso Only S o." 4` ! C irern111fl , •� �� iv • • ' Amount_ �a° ,� m (el/tat/4 ea�pe nod t" fuIthOh . GO armll eaplror 180 days hon • Yasuo dole • EXPRESS BUILDING PERMITAPPLI�C •'• : •V TOWN OF YARMOUTH Yarmouth Building Department SEP 18 2018 1146 Route 28 BUILDING DEPARTMENT South Yarmouth, MA 02664 Sy: — ,/� ��(508) 3982231 Ext, 1261 3CJ'- I CONSTRUCTIONADDRZ3$I' iY Star JCO-CV �' "bol (p3, ASSESSOR'S INrO1V4ATIONI Mapi I Parcell J owNERI EA 0 • NAMS 6 l'AeSENT ADDRBSS 7- 0;s-- 3/ TE 'HmyCoseldyCepOodlnetlon II 608.775. 1214CONTRACTORI ...; fl Residenllal C Commercial Eel.Coal of Conatruotton$ 23/451D• 4-3 Home Improvemnt Conlraetokldio H 153567 Conelrvotlon SuperYlsor lAlo,8 1 °0988 Wurkman'e Cumpensatlon,Jnauranoal Mock one) th 0 I ame hemeow ' \ C I am the solo proprietor D I have Worker's Componaetlon Insuranos ineuranocCompsnyNamo, Atlantic Charter Insurance' PoWCE004319 Worker's Comp iloyf 0 ,, WORI TOBEPERrOPJ 0 "Tan! Duration ____ (Rive Retardant Certificate attached?) . .Wood Stove s�`Sldlnot if of Squares t,„Roplaoement windows! H� Replacement d or H Roofing! HofSquaras ( ) Remove 4%Idtlll 2layers), gr �' fi ZS S" (moo, •.e' Old ging,' HI hwa allstorlo Met, ` 5 �Ci �� Yn n -'���— . C g y ( pRoplaoing Ilko for like � cin � r�go �nC � :fil'4 „ 0 {� eT111debrlitrlllbsdlspcsedofolr U (, aL r (/l am 6 �� f�-"' 4f/..66- ' the 'S#4GC. I, L4011011 of pno Ity — I 011Munderpolialna of Moly Ihal the;Women heroin�telned ore true full cowl to Ibe Volt of my knowledge and leollof. I understand thee my(else one wor. will bo PA mil for dsnlel or revocation of my Homo and for proaeovtlon tinder MAIL!Ch,24$,Seollon I. Anplleenraslaaehuq Henry Cassidy • fe: �Il ;kli;rl;'1r :ria f8 rg "td'i linin oil"nt1w Dale! Orvumv Slgnmure(or allashmenl) Approved Bye _���'�re Dntol _ .0a'a .-r.- or , . . shoo .e ,• ; I Dolor // y� • Zoning Dietrich HlalovioRl D140'1011 CI Yoa 11 No Floo Pialn Zone! 'li Yea o No Walor Rosouroo Proleolion Dlslrleli Within 100 R, of Wetlands! , ok l7 Yee CI No J Yes Cl No ,, ,., The Commonwealth of Massachusetts t;.Nt=Rr Department of Industrial Accidents . . =;;ra 1 Congress Street, Suite 100 `a =;�,i__t^" Boston,MA 02114-2017 • ia 1•co 01. \Yorkers' Compensation Insurance Affidavit:Builders/ Contractors/Electricians/Plumbers, TO BE FILED WITH THE PERMITTING AUTHORITY, Applicant Information Please Print Leeibly Name(Buslness/OrganizatIon/Individuaq: Cape Cod Insulation Address: 18 Reardon Circle City/State/Zip: South Yarmouth,MA 02664 Phone#: 508-775-1214 M you an employer?Check the appropriate box: I, I am a employer with 98 Type of project(required): © employees(full and/or part.time),e 7. New construction 2,01 am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.(No workers'comp,insurance required,) 3,01 am a homeowner doing elwork myself.(No workers'comp.Insurance required.)t 9• 0 Demolition 4,0 I am a homeowner and will be hiring oontracton to conduct all work on my property. 1 will 10 Building addition ensure that ill contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. S,01 am s general oontnetorend I have hired the aub•contncton listed on the attached sheet. 12.0 Plumbing repairs or additions These sub-contractors have employees and have workers'comp.insurance,: 13.0 Roof repairs 6.0 We vs s corporation end Its officers have exercised their right of exemption per MOL e, 14. ✓�Other Weatherization 152,11(4),and we have no employees,(No workers'comp,Insurance required.) *Any'patient that cheeks box Yl must also fill out the section below showing their workers'compensation policy Information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside cont eoton must submit a new affidavit Indicating such. 1Contr otors thatchesk this box must attached en additional sheet showing the name of the subcontractors and state whether or not those entities have employees, If the sub-oontrectcrs have employees,they must provide their workers'comp.policy number. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and Job site ' information. Insurance Company Name: Atlantic Charter Policy#or Self-ins,Lk,#: WCE00431902 Expiration Dates 06/30/22�0Vi ' C&t _ Job Site Address: / Qr - City/State/Zip: fd'i-`moi k ca-1$'IA Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL o. 152, §25A is a criminal violationpunishable by a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties In the form of a STOP WOR,it'ORDER and a fine of up to$250.00 a day against the violator,A copy of this statement may be forwarded to the Office of Idvestigations of the DIA for insurance coverage verification, I do hereby certify under the pains and penalties of perjury that the information provided above Is true and correct jiianature: Henry Cassidy .;, 4-"fit•.».--- -_LL' .�—,» C /i V/17phone#: 508-775-1214 Date: I Official use only. Do not write In this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): • 1.Board of.Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5,Plumbing Inspector 6,Other Contact Person: Phone#: 1 l s• Commonwealth ol Massachusetts l�� Dlvlalon of Prolesslon'el licensure ,Bonrd of Building Re9ulaIIons and Sinndnrds Cons&:Ctw,rl'1§U'nyrvlscr <1 • • C8.100968 ,,..,. ' 1,F,..:0 E,I Ires: 11/11/2019 • • . HENRY ECA sioy..„.-16,,V! . , ( 8 SHED ROW e. • ' sir e C'r WEST YARMoGT,\M(�,'A,,S76 ?.?' Commla;loner M C2 . • � e �cviton Quoecd% o� k S\liI, • lar Office of Consumer Affairs and Business Regulation (y 10 Park Plaza • Suite 5170 Boston, Maggidobusetts 02116 Home Improve;me,,fr+ o.y.4ractor Registration ,.,1 .. rr::J ". ''"' r� Type: Corporation r! ::!;;;,;�1': I ,( ; t'4�;+ ;,',� 1' Registrallon: 163597 Cape Cod Insulation, Inc +i;::;? Jp,/�f•;1::;' 'w Expiration: 12/14/2018 18 Reardon Circle e t..:• r :- So. Yarmouth, MA 02664 `;' ', ^: ', . '"` r"1 Ild. �.....) Update Addroea and return nerd, Mark reason for change. ;cm (1 aon+,oenr _,..,.•._17•.Ad nama••r�.A.sna.it;r:_t�?rnplo`/manl.ClAnat.^r.rr • 2, �an�reo+aruvt/&o`eS�(rra0av/(ndo ,r. Met of Consumer Mels&Business Regulation HOME IMPROVEMENT CONTRACTOR kjItiffifs Ragblrallon velltl for Individual use only � Typo: Corporationbalers the explratlon date, II Ioun• urn lot 'I ,y,,,,�• FxoirntIon 011loe 0?Consumer Alialrs end'; al is Regulatlon v•�r- 10 Park Plass• 16170 "t;t kt. .fl9. B� 1El14/2018 , • ...ti . , ,tri Boston,MA • Cape Cod Instil l oft'\4 Y. l i • Henry Cassldy'�?, 'ti 1Ay liradt 18 Reardon Clrc�' , �1,� �'," �,�.cC,�f—•^ • • So.Yarmouth,MA;,,•1•1:14 1 . ,rio • i/P�_ /Ira! _ •''' Undersecretary t al • 'evhout sle !situ•: • • -.--- 1 CAPECOD-27 AMAHLER A`�RD• VYY CERTIFICATE OF LIABILITY INSURANCE Dm(MMIDO/ Y) 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 pollcy(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 URA CT Rogers&Gray Insurance Agency,Inc. PHONE FAX 434 Rte 134 (A/C,No,Ex!): (ac,No),(877)816.2166 South Dennis,MA 02680 't1&ss:mall@rogersgray.com INSURERIS)AFFORDING COVERAGE NAIC N INSURER A:West American Insurance Company 44393 INSURED INSURERB:Safety Indemnity Insurance Company 33618 Cape Cod Insulation,Inc. INSURERC;Endurance American Specialty Insurance Company 41718 18 Reardon Circle wsusses:Atlantic Charter Insurance Company 44326 South Yarmouth,MA 02664 INSURER E: INSURER F t 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. INSR ADDL SUER EXP LTR TYPE OF INSURANCE _MD W1/11. POLICY NUMBER (MM/DDppp'YYYI ISSM/LDDY I LIMITS A X COMMERCIAL OENERI�AL LIABILITY EACH OCCURRENCETp $ 1,000,000 CLAIMS.MADE I I OCCUR BKW(19)63328281 04/01/2018 04/01/2019 pREMIG$ES fFnoNOfT,prrence) $ 100,000 — MED EXP(Any one person) $ 5,000 PERSONAL 8,ADV INJURY $ 1,000,000 GEN'LAGGR A E LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY j I Loo- PRODUCTS•COMP/OP AGO $ 2,000,000 X OTHER sae holder descdp of operations S B AUTOMOBILE LIABILITY vtia Ng,?NGLE LIMIT $ 1,000,000 ANYAUTO _ 6232707 04/01/2018 04/01/2019 BODILY INJURY(Per person) I • OWNED SCHEDULED AONLY X 1pp� oN pV�NEp BODILYRRINJURYii (Per accident) $ " X AUTOS ONLY X AUTOS ONLY rPengig AMA°E $ $ C UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 2,000,000 X EXCESSLIAB CLAIMS•MADE EXC10006635003 04/01/2018 04/01/2019 AGGREGATE i 2,000,000 '• DED RETENTION$ p S D WORKERS COMPENSATION PER ERH • AND EMPLOYERS' ARTNITY WCE00431903 06/30/2016 06/30/2019 ANY PROPRIETOR/PARTNER/EXECUTIVE VI1,000,000 �FFICERIM MBE(t EXCLUDED? NIA E.L.EACH ACCIDENT $ (mendatory�n ( 1,000,000 If yyes descdbe under E L.DISEASE•EA EMPLOYEE 5 DESCRIPTION OF OPERATIONS below El,DISEASE•POLICY LIMIT $ 1,000,000 DESCRIPTION OP OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more specs 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 Llabllity 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 C I � L [ss'1^'� ACORD 25(2016/03) ®1988.2015 ACORD CORPORATION. All rlohts reserved. 1 ' RISE ENGINEERING' OWNER AUTHORIZATION FORM 1, Nancy Ayoub (Owner's Name) owner of the property located at: 14 Cedar Street (Property Address) Bass River, MA 02664 (Property Address) hereby authorize L• p C Cock_ S(1S3koAi U/, , (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. AOwner's Signature J/� a', • C . 20le / \ Date RISE Engineering,a Division of Thielsch Engineering, Inc. 5 Dupont Avenue I South Yarmouth, MA 02664 I 508-568-1926 www.RlSEengineering.com •