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HomeMy WebLinkAboutBLD-19-001644 Of•YAk TOWN OF YARMOUTH Building Department �� BUILDING .2•$ - 4' (508)398-2231 ext.1261 a 1.4; G yl °1/4%.? PERMIT 0 y PERMIT NO !BLD•19-001644 4.c,‘;*`;�;5 ISSUE DATE ;09/1812018 JOB WEATHER CARD • APPLICANT ;HENRY CASSIDY PERMIT TO New AT(LOCATION) 110 CYGNET RD,WEST YARMOUTH,MA 02673 1 ZONING DISTRICT I I Bldg.Type: Residential SUBDIVISION MAP BLOCK LOT 048.54.1 BUILDING IS TO BE: CONST TYPE V B USE GROUP R-3 REMARKS Repair:Install Insulation(508-775-1214) CONTRACTOR LICENSE 153567 Home Improvement CAPE COD INSULATION,INC HENRY CASSIDY 284,621,040. EST COST($) (32000 —1 PERMIT FEE($) 35.00 18 ARDOCIRCLE AREA(SQ FT) I 0• SO..YARMOUTH, TH,MA 02664 OWNER MORIN ROBERT J BUILDING DEPT BY ADDRESS MORIN DOREEN M,58 DILLA ST LMILFORD 1MA 101757 Bias/dettep/{ PHONE THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SI ALK OR ANY 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: ' 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 AN • ON f0 1oA C ON 11 !oA c. Ms apt:vimJo 'U 001 ultilIM lloPRIa 00110a10•14 06J0°t°U d617M •• • .. 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'gtnotuag,. 41nog I 82 otnog 9411 Wacuidudaa hJp11na cooulau,L ' ciamaaau xl.novRidA 3o t4Mo1, • ° IZddY "'' 1411 d OMICIIIIE $s iiaxa • ' hho9 too--bl—a ig 91up onttj II a .lIOAJ tX p bat togdx9 IIWJI4 �1 � str-lunotuyt ( ' ",+� NIItulodl 0 � dlu0 oe(t couJO ` s' JO I �r'IN • .• RISE ENGINEERING' OWNER AUTHORIZATION FORM 1, Robert J Morin (Owner's Name) owner of the property located at: 10 Cygnet Road (Property Address) West Yarmouth, MA 02673 (Property Address) hereby authorize Cc T (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. 0010111 ' Prer-AcA Owner's Signature 9 'Nag g Date RISE Engineering,a Division of Thielsch Engineering, Inc. 5 Dupont Avenue I South Yarmouth, MA 02664 1508-568-1926 www.RlSEengineering.com pis _ The Commonwealth of Massachusetts 'l `yy�t et Department of Industrial Accidents ==inn= 1 Congress Street, Suite 100 y' Boston,MA 02114-2017 -.0* www.mass.gov/dla Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Numbers. TO BE FILED WITH THE PERMITTING AUTHORITY. • Applicant Information Please Print Le¢ibly Name(Business/Organizationiindividual): Cape Cod Insulation Address: 18 Reardon Circle City/State/Zip: South Yarmouth,MA 02664 Phone#: 506.775-1214 Are you an employer?Cbeekthe appropriate boat 1 Urn s employer wish as Type of project(required): employees(full end/or parttime), 7. 0 New construction 2.01 am a sole proprietor or partnership and have no employees working forme In 8. 0 Remodeling any capacity.(No workers'comp,insurance required,) 3.01 am a homeowner doing all work myself.[No workers'comp.insurance required)? 9. ❑Demolition 4.0 I am s homeowner and will be hiring contractors to conduct all work on my property. !will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11,0 Electrical repairs or additions proprietors with no employees. 5,01 am a general contractor end I have hired the sub'eontractor:listed on the attached sheet. 12.0 Plumbing repairs or additions These sub-contractors have employees and have workers'comp.insurenee,t 13. Roof repairs 6.0 Wean corporation end Ito officers have exercised their right of exemption per MOL a. 14. Other W eatherization 152,11(4),and we have no employees,(No workers'comp,Insurance required.) *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they ere doing all work end then hire outside contractors must submit a new affidavit indicating such. tContreoton that check this box must attached en additional sheet showing the name of the sub-contractors and state whether or not thou entities have employees. If the subcontractors 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 SelNns.tic.H: WCE0L0431902 Expiration Date 06/30/2011 ( Job Site Address: /0 gine Pk, City/State/Zip: t' �4 ni g//114Attach a copy of the work r ' compensation policy declaration page(showing the policy numbs and expiration date). Failure to secure coverage as required under MGL c. 152, §25A Is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORZ•'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 Itivestigations of the DIA for Insurance coverage verification, 1 do hereby certify under the pains and penalties of perjury that the information provided bov Is true and correct Henry Cassidy `t'^ --.w.....,...._..,..., q d j;ianaturo: -� Date: 1 lb ��0 Phone#: 508-775-1214 Official use only. Do not write In this area,to be completed by city or town offciaL City or Town; Permit/License# • Issuing Authority(circle one): • 1.Board of jlealth 2. Building Department 3.City/Town Clerk 4. Electrical Inspector Sc Plumbing Inspector 6.Other Contact Person: Phone#: • • ..---- 1 CAPECOD-27 AMAHLER A� CERTIFICATE OF LIABILITY INSURANCE DATE IMMDO/YY8'Y) 0610512016 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 ACT Rogers&Gray Insurance Agency,Inc. PHONE FAX 434 Rte 134 (A1C,No,Eat): lac,No):(877)616.2166 South Dennis,MA 02880 iirgAss.mall@rogersgray.com INSURERS)AFFORDING COVERAGE NAIC ff INSURER A:We8t American Insurance Company 44393 INSURED ' INSURERSISafety Indemnity Insurance Company 33618 Cape Cod Insulation,Inc. INSURER C(Endurance American Specialty Insurance Company 41718 18 Reardon Circle INSURER D: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. NOR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP I TR , I O_yyyp POLICY NUMBER IMMIDDIYVW I IMMIQDlYYYVI LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE EjOCCUR BKW(19)53328281 04/01/2018 04/01/2019 DAMAGE TO RENTED 100,000 PREMISES fEeoccurrencel $ _ — MED FXP(Any one person) E 5,000 — PERSONAL SADV INJURY S 1,000,o00 SIM AGGREE LIMIT APPLIES PER: GENERAL AGGREGATE E 2,000,000 X POLICY LI26t I (LOP PRODUCTS••COMP/OPAGG S 2,000,000 X OTHER:see holder descrp of operatIons _ B AUTOMOBILE LIABILITY COMBINEDSINGLE LIMIT E I aecdtleml $ 1,000,000 _ ANY AUTO 8232707 04/01/2018 04/01/2019 BODILY INJURY(Per person) E AUTOIS ONLY X Era) pR i I. X AU ONLY X AUToSONLV pBROPWATTeir G accident) I _ (Por ace' entQAMAGE S $ C UMBRELLA LIAR X OCCUR EACH OCCURRENCE E 2,000,000 X EXCESSLIAB CLAIMS-MADE EXC10006635003 04/01/2018 04/01/2019 AGGREGATE E 2,000,000 •• DED RETENTIONS D WORKERS COMPENSATION p E AND EMPLOYERS'LIABIUTY PER FRµ • ANY PROPRIETOR/PARTNER/EXECUTIVE ff WCE00431903 08/30/2018 08(30/2019 1,000,000 lM n atyi9r jEXCLUDED? NIA EL EACH ACCIDENT E If yes describe under E.I.DISEASE•EA EMPI OYEF, E 1,000,000 DESCRIPTION OF OPERATIONS below E L.DISEASE•POLICY LIMIT 1 1,000,000 • • / DESCRIPTION OF OPERATIONS I 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 Liablllty 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 25(2018/03) ©1988.2015 ACORD CORPORATION. All riahts reserved. I U t'' • l °• �r Commonwealth olMassechueells \ lDivision of Proleaslonel licensure .Board of Bulluing Fte�g/pul#.ttions end Standards Cons`;41,CttOri%truly]sof <1 • Cs.100988 ,S' Uniil E'pIres: 11111(2019 • . '..;,11,40..• , . HENRYECA�SICY.u �f' 8 SHED ROW• • ' �� ,, • `•• t WEST YARMOG•T}{MA. 9 978 ?t Commissioner V / M 't"' . e\:9 Office of Consumer Affairs and Business Regulation 10 Park Plaza • Suite 6170 Boston, Ma tabrusetts 02116 Home Improveme:rno graotor Registration ( • ;',t;1.•,t:,.p.'-•:::..•.. Typo: Corporation '' ',::4 .11 •r ";ik 1' Registration: 153587 Cape Cod Insulation, Inc 0, ;: ; /fu,,•,^';ilvr: , Expiration: 12/14/2018 18 Reardon Circle c\ ?:',r.:"tr',,! , ::. M E, So, Yarmouth, MA 02684 1, ' 4,1`I•,i\....f. • `••...) y.. Update Address end return oartl. Mark reason for change. . p aont.ou° (7..�s1 ;a.es..(+.R v ....0 eohi. .�._._(}��..._._......... . _.....___ .._........... . .....,.._._.... 2nr.ltfu!_R. trplo.lmant.Ll A nat..,nrd . — �o IZVfl i016iVQI1/f Y V`c2 rraurr.�rraattu 'Wiles of Consumer Nldrs&'Minn;Regulation lit ot • HOME IMPROVEMENT CONTRACTOR Registration velldfor Individual use only °+ Von Corporation before the expiration dale. If lour\• . urn tot k y,,r ` !y.7,�, Exnlrnllen 011loeof'DoneumarAffair, and'; el $5 Regulation `� 3' , l;�' •0. ey, 12!1912018 10 Park Plasa• 06170 , } �t'i' i ' Boston)MA • Cope Cod insolat'\\IHI i5�s 1;? Ii • Henry Cassidy V,`\ ,t1';J i ,, 18 Reardon Circ' ; ill.'/it R•CGe•�• So.Yarmouth,MA ,Q ,`t}; •;ti /'/ C ' Ai/�� �� Undersecretary if-t al • "hout sle alu