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BLD-19-001633 p4-Y44, TOWN OF YARMOUTH Building Department BUILDING .F - '�0 (508) 398-2231 ext.1261 • i PERMIT NO BLD-19-001633 a��\ PERMIT Nc�:• nn;5 ISSUE DATE 09/18/2018 JOB WEATHER CARD r.< APPLICANT HENRY CASSIDY PERMIT TO 7 New AT(LOCATION) 18 CYGNET RD,WEST YARMOUTH, MA 02673 I ZONING DISTRICT I I Bldg.Type: !Residential I SUBDIVISION MAP BLOCK LOT 048.53 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 AREA(SQ FT) 208,739,520. EST COST($) 4-8-8-CrOCI PERMIT FEE($) 35.00 18 ARU CIRCLE SO..YYARMMOOUTH,MA 02664 OWNER Robert Morin BUILDING DEPT BY ADDRESS ,8 CYGNET RD ,,��„„, A ,j!P WEST YARMOUTH MA 02673 �'X/� (1(,te+y/7� 'IDI' HONE 5085601912 THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY O SIDEWALK OR 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 • O:Y�` 10Mo:col/sly Only �, -,. s O ��eC� WA i Amount_3� a,n aParmh asplrot 180 days from iliuuodmt .. 8t b.'lel —oul (033 • EXPRESS BUILDING PERIYIti APPL.I jam-- TOWN OF YARMOUTH t i V �C� Yarmouth Building Department J I 1146 Route 28 1 SEP 18 2018South Yarmouth, MA 02664 ( 08) 3982231 MO, 1261 BUILDING DEPA RTME i I %Ad- lid- tY — j CONSTRUCTIONADDAE551' CO - gV1/11071 ASSESSOR'S INPORMATIONI ` �jjp`�j /�/J�I Magi I Paroeli OWNER! - HAMS ( Y "vvyrt, 5 5- 5.60. /eiz t'RE55NTADDRBSS TEL, CONTRACTOR! ir- HanryCauldyCapsCudinsulatlon II/tuition VIM, 3ovlhYarmouth 50$.775.1214 AILINC ADDRESS TEL.N ip Retldentiai 0 Commerolal W.Coat of Conatruotlon$ Horne Improvement Oentrnctokblo.lt 153587 Conah'uotlonSupervisor Llo,N 100988 Workmen'?Cumpenantion ln,uranoel (check ona) 0 I am the homaowrror" El I am tho tole proprietor W I hey*Workov'a Componaatlon IWorkert CompImmo*InsuraneeCompanyNamot Atlantic Charter Insurance' . Po11oyN vimWCE004319rvt , • ORK WTO HE pERF0 ,ORM D . Tan! ° Duration (Fin !Warden{ Corbiticate attached?) . M„Wccd Stove ` SIdingl N otSquaroa ,,,.Replaooment Yelndotval N Replacement doom' N Rootlngt N ot$quarea ( ) Ramona existing* (max, 2layera). a �z R 38 4 c�a 6atgu)stlon Old Kings Highway/Historic Dist, 5hAvibolfaenci g� �oarA ( )•Replaoing Ilk;for Ilk; v� 1 • f c70-ohS ate. �-Z/' b 3byrr/� tae: ''•' ,, '+ TN Maiwlll'btdhposadOen • _ is Hi. r• CV ! ' l�74k ��P(r! pV defr I. , Location of Fat Ity 4 a�� i I de;Iara under psi hies of porjuly that Iha ilaPolnellla heroin•untolned tic True NW;carom to Iho boat of my knowledge and boiler. I undonlnnd Ihsl any felt;oniWor(t Will bs)wI own fortieth)or revoonlion of my Hoant,and for prose oullon undtr M.O.L.Ch lea,Section I, Applleanl;elanolur,t Herr Cassidy f: III,,, ;f' Itp?rL,:klfd mlmi ,n"f,1 Dotal ii io OWna9 Slanmuri(or allaehmeot) /` Approv;d NIl '� Da WI :II • ng i-ir ;time(Teat Into :• . ,' ; 1 Dalot / .. • Zllg Hlctorloal Dh,trlots CI Yea fl Nooh Mood Plain Zonol 0 Yet 0 •No Wator Rosouroa Proleolton Dlttrlotl WIIhin 100 ft. of Wetland,; e w • (') Yet CI No 0 Yo; CJ No _ The Commonwealth of Massachusetts M y�,= Department ofIndustrial Accidents f. ==r1= g 1 Congress Street,Suite 100 Boston, MA 02114-2017 • 'ket..011. www.mass.gov/dla Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH TUE PERMITTING AUTHORITY. ' Applicant Information Please Print Leeibly Name(Business/Organization/Individual): Cape Cod Insulation Address: 18 Reardon Circle City/State/Zip: South Yarmouth,MA 02664 Phone#: 508-775-1214 An you an employer?Check the appropriate bon i. t em a employer with 4a Type of project(required): © employees(full and/orperttime),a 7. 0 New construction 2.0 I am a sole proprietor or partnership and have no employees working forme In g. Q Remodeling any capacity.(No workers'comp,insurance required.) SO am a homeowner doing all work myself(No workers'comp.insurance required.)t 9. El Demolition 4,0 I am a homeowner and will be hiring contractors to conduct ei work on my property. I will 10 0 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. SC am a general contactor and I have hired the sub'contr'actors listed on the attached sheet. 12.0 Plumbing repairs or additions These subcontractors have employees end have workers'comp.Insurance,: 13.Q Roof repairs 6.0 We an a corporation and its officers have exercised their right of cxempdài,per MOLe, 14.Other Weatherization 152,11(4),and we have no employees.(No workers'comp.Insurance required) 'Any applicant that checks box al must also Ell out the section below showing their workers'compensation policy Information. t Homeowner:who submit this affidavit Indicating they are doing all work end then hire outside contractors must submit a new afAdevit Indicating such. tConnotors that check this box must attached an additional sheet showing the name of the eub•oontraotors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 1 amen 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.Lie.#q/0-ei WCE00431902 Expiration Date 06/30/2011 ,gyp_ Job Site Address: 0 City/State/Zip: W yavm'n//� ,Attach a copy of the Wecompensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL e, 152, §25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment, es well as civil penalties in the form of a STOP WOR)4•'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 itrrfivestigations of the DIA for Insurance coverage verification. 1 do hereby certify under the pains and penalties of perjury that the Information provided a ove I true and correct. Hen Cassid ter"^ •+ -... ........M. �y Signature: ry y ."-•••-• Date: q l0 jq phone#: 508-775-1214 J Official use only. Do not write In tilts area,to be completed by city or town official. City or Town: PermlULicense# Issuing Authority(circle one): • 1.Board of.Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S, Plumbing Inspector 6.Other Contact Person: Phone#: • ..----"1 CAPECOD-27 AMAHLER A�oROe CERTIFICATE OF LIABILITY INSURANCE 006/05IDD/YYYY) 0610512018 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 EDF' Rogers&Gray Insurance Agency,Inc. PHONEFAX (AIC,No,Fall: No):(877)816.2156 4$4 Rte 1$4 South Dennis,MA 02660 Mu;mail@rogersgray.com INSURERISI AFFORDING COVERAGE NAIC e INSURER A:West American Insurance Company 44393 INSURED INSURERs:Safety Indemnity Insurance Company 33618 Cape Cod Insulation,Inc. INSURERC:Endurance American Specialty Insurance Company 41718 18 Reardon Circle INSURER 0:Atlantic Charter Insurance Company 44326 South Yarmouth,MA 02664 INSURER E I INSURER F: 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. ILTR TYPE OF INSURANCE ADDL;UBR POLICY EFF POLICY EXP INSD wVD POLICY NUMBER -IMMIDoPre n IMMIDDfYYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEi4 1,000,000 CLAIMS-MADE �X OCCUR BKW(19)63328281 04/01/2018 04/0112019 PgFM SESQFeoaurPencel ; 100,000 MED EXP(Any one careen) ; 5,000 PERSONALS ADV INJURY $ 1,000,000 OEM.AGGR A ELIMIT APPLIES PER: GENERAI AGGREGATE 2,000,000 POLICY jE I I L00• PRODUCTS COMP/OP ! 2,000,000 X OTHER:see holder dourly of operations _ $ B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 IFa eccldenU f _ —• ANY AUTO SCHEDULED 62$2707 04/0112018 04/01/2019 BODILY INJURY(Per person) I AUpTEOpS ONLY X AUTpSWT�Ep BODILY ll X AUTOS ONLY X AUTOS ONLY ,,,,:ERNYU AMAGE accident) $ _ IPer eca�enlQ ; ; D UMBRELLA LIAa X OCCUR EACH OCCURRENCE ; 2,000,000 X EXCESS LIAO CLAIMS-MADE EXC10008635003 04/01/2018 04/01/2019 AGGREGATE $ 2,000,000 '• DED RETENTION! D WORKERS COMPENSATION E p = AND EMPLOYERS'LIABILITY STATUTE FRH • ANY PROPRIETOR/PARTNER/EXECUTIVE ff WCE00431903 06/30/2018 06/30/2019 1,000,000 OFFICE�tIMEMBF_rt EXCLUDED/ NIA EL EACH ACCIDENT $ 1 andaeryInNH) 1,000,000 II ea,deaprlbe under E.L.DISEASE•EA EMPLOYEE S • DESCRIPTION OF OPERATIONS below EL.DISEASE•POLICY LIMIT $ 1,000,000 •/ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached U mere apace 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 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 25(2016/03) 651988.2015 ACORD CORPORATION. All rlahts reserved, I C • l °• commonwealth ol Massachusetts l�� Division of Professional Licensure •Bonrd of Building Re 9ulatlone and Slenderds Cons`,�:OthS,rl'1S1 pprvlsor i/• CS•100988 ,:,,' tp,,,j i, E tress 11(11/2019 . v ':,:,.14,401.• HENRY ECA�SIDY, ++ptlj!: 0 8 SHED ROW•, • '•q• 'i r 'r • WEST YARMOG,T, MA,',0978 s� Commissioner • CAC ,/ J S'" 926 3az 2oaveoeo/4lv Z • • vl Office of Consumer Affairs and Business Regulation 10 Park Plaza • Suite 6170 Boston, Ma?% b�iusetts 02118 Home Improveme: .o• lractor Registration JJ `''eI '::`1''1,I :t 1; p 1,• Registration; 83687 tion r I r.n.s Cape Cod Insulation, Inc /t,,;!';r:;:':• t Expiration: 12/14/2018 18 Reardon Circle . , �':'a;,",,,, L G So, Yarmouth, MA 02604 k;,' •' u nn:k'c yr ..` Ye� 'i,:r rv� 't•••••1'•� Update Addrose end return card, Mark reason for change. .•-• '\ ichr .. 0 soM.oM❑ — _pp�� (�j...,..._.........NON � _/.�... --.,_......,..... . ......,..-,_,........O..Ad anm..riR.jna,r;nt_f;1..Prplo/man6.tllaatCrrr C. Orrice of Consumer Metre&Rusin's,Regulation M i Registration valid for Individual use only �1HOM6IMPROV6MENT CONTRACTOR` v.' T•rfp'ol Oorporellon before the expiration dale. If loun• • urn tel yuylrl`'t il TxnlrntIQJ 011lo,of Consumer Affair;and'' el •n Regulation ' i'.µSr,tt•i, ,e7 12!14/2018 10 PorkPlaaa• - e6170 , -i\�0ti0\I,•t'is,' Boston,MA • . Cope Cod InsOl$t 'is! o< t�11 e•\ // • Henry 066610.c` 'a � ' '41 . 18 Reardon Gird\ i, li; R.cc0 So,Yarmouth,MA,t eti 4 C� • 1/s_t _. % Ell'P i Undersecretary t al • 'mahout sla a1u ot RISE ENGINEERING" OWNER AUTHORIZATION FORM 1, Robert J Morin (Owner's Name) owner of the property located at: 8 Cygnet Road (Property Address) West Yarmouth, MA 02673 (Property Address) hereby authorize L C ' , (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. (D t . fo-v, Owner's Signature 9 . /'4 Ip Date RISE Engineering, a Division of Thielsch Engineering, Inc. 5 Dupont Avenue I South Yarmouth, MA 02664 1508-568-1926 www.RlSEengineering.com