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Home My WebLink AboutBLD-19-001811 P .0Wc,eUse Oily } OD YgR4. 120- /7-1 � // O � O Amount %ent""' '-a Permit expires ISO days from issue date EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth,MA 02664 (508)398-2231 Ext. 1261 CONSTRUCTION ADDRESS: 148 Pleasant Street ASSESSOR'S INFORMATION: Map: 51 Parcel: 83 OWNER: Erik Hunter 148 Pleasant Street,S.Yarmouth 720-940-7785 NAME PRESENT ADDRESS TEL # CONTRACTOR: McPhee Associates, Inc. P.O. Box 799,East Dennis,MA 02641 508-385-2704 NAME MAILING ADDRESS TEL.# XResidential 0 Commercial Est.Cost of Construction S 12,000 Home Improvement Contractor Lic.# 104158 Construction Supervisor Lie.# CS-097057 Workman's Compensation Insurance: (check one) 0 I am the homeowner 3 I am the sole proprietor X I have Worker's Compensation Insurance Insurance Company Name: Rogers &Gray Insurance Agency Inc. Worker's Comp.Policy# WCC50050020612017A WORK TO BE PERFORMED Tent _ Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# 4 Replacement doors: # 1 Roofing: #of Squares ( )Remove existing*(max.2 layers) Insulation No Old Kings Highway/Historic Dist. ( )Replacing like for like Pool fencing 'The debris will be disposed of at: S &J Exco Location of Facility I declare under penalties of perjury that the statements herein contained are true and correct to the best of my knowledge and belief. I understand that any false answer(s) will be just cause for denial or re �ion of fftmy ''cense and for prosecution under M.G.L.Ch.268.Section I. q J � Applicant's Signature: I "V +'r 1 Date: //a'i!!t�7 Owners Signature(or attachment) �.rCa5& f r.L,D.sr. Date: q ) r (� Approved By: t Date: �Ol ) /6 Building Official(or designee) EMAIL ADDRESS: mcphee@mcpheeassociatesinc.com Zoning District: RS-40 Historical District: ❑ Yes X No Flood Plain Zone: 0 Yes C No Water Resource Protection District: Within 100 ft.of Wetlands: 0 Yes 0 No 3 Yes 0 No • The Commonwealth of Massachusetts Department of Industrial Accidents =I• r'/ Office of Investigations ;!i=y 600 Washington Street s?!tom u� Boston,MA 02111 rvww.massgav/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): McPhee Associates, Inc. Address: 1382 Rte 134, P. 0 Box 799 City/State/Zip: E. Dennis, MA 02641 Phone 4: 508-385-2704 Are you an employer?Check the appropriate box: Type of project(required): I.® 1 am a employer with 20 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).` have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.t 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We area corporation and its 10.0 Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MOL 11.0 Plumbing repairs or additions myself.[No workers'comp. c. 152,§I(4),and we have no 12.0 Roof repairs insurance required]t employees.[No workers' comp.insurance required] 13.®Other windows&slider 'Any applicant that checks box III must also fill out the section tem showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they art doing all work and then hire outside contractor must submit a new affidavit Indicating such. Contractors that check this box must attached an additional sheet showing the name of the subcontractors end their workers'comp.policy Information. I am an employer that Is providing worAers'compensation insurance for my employees. Below Is the policy and Job site Information. Insurance Company Name: Associated Employers Insurance Company Policy h or Self-ins.Lic.s: WCC50050020612017A Expiration Date: 04/01/2019 Job Site Address: 148 Pleasant Street City/State/Zip:South Yarmouth,MA 02664 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to SI,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify tyedtrifie/pains and penaltiespeof perjury that the information provided above is true and correct. Signature: /L"`'v/ M Ma--tier Date: 9/21/18 Phone k: 508-385-2704 Official tae only. Do not write in this area,to be completed by city or town offlciaL City or Town: Permit/License if Issuing Authority(circle one): I. Board of Ilealth 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone if: MCPHASS-01 APEI I • ,a►`oszo CERTIFICATE OF LIABILITY INSURANCE DATE(MM/04/04!22018018Y) 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 S2aAC7 Rogers d Gray Insurance Agency,Inc. PHOONEFAX 434 Rte 134 INC,No,EMI: I(A/c,NP):(877)816-2156 South Dennis,MA 02660 FAMors�ss:mail@rogersgray.com INSUREWS)AFFORDING COVERAGE NAIC I INSURER A Selective insurance Company of South Carolina 19259 INSURED INSURER :Selective Insurance Company of the Southeast 39926 McPhee Associates Inc INSURER c:Associated Employers Insurance Company 11104 P.O.Box 797 INSURER 0: East Dennis,MA 02641-0797 INSURER E 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. INSR TYPE OF INSURANCE INSDL SWULBDR POLICY NUMBER POLICYEFFPOMM!DD EXP LIMITS _ rMOLIDYYEFF IPOLICYEYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1.000,000 CLAIMS-MADE ❑X OCCUR 52010213 01/01/2018 01/01/2019 p°i1RFMIE s EaENTEDm:el $ 500,000 MED DP one Person) $ 15,000 EX PERSONAL ADV INJURY $ 1,000,000 GENL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000.000 POUCY QX JECT [ J LOC PRODUCTS-COMP/OP AGO $ 2,000,000 OTHER $ B AUTOMOBILE LIABILITY TCa acaden SINGLE OMIT $ 1,000,000 tl — ANY AUTO _ A9095287 01/01/2018 01/01/2019 BODILYINJURY(per Person) $ AURTEOpS ONLY X AUTTTOpSWUry��p • pBpOORDILY INJURY(Peracddent) S X AUTOS ONLY X AUTOS ONLY (Perr aaccodeTnt) GE $ $ _ UMBRELLA LIAR _ OCCUR EACH OCCURRENCE • $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTIONS $ `' WORKERS `. N ION X TARF RAD EMPLOYERS'LIABILITY WCC50050020612017A 04(01/2016 04/01/2019 ANYPROPRIETOWPARTNER,EXECUTIVE EL EACH ACCIDENT $ 500,000 grad rtyEM REXCLUDED? N NIA E DISEASE-EA EMPLOYEE $ anmtory In�1) 500,000 Ndescribe under 500,000 DESCRIPTION OF OPERATIONS below E DISEASE-POUCY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached B more space le required) — CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE •For Information Purposes Only THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I �_i 74 µm ACORD 25(2016/03) ®1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD • r ca‘e Commanweeaa el Maes ommeib Massachusetts Department o!Public Safety it Division of Piepnsyydu�naoae ;�/} Board of Building Regulations and Standards . Beard a emldngaayewmao and stanaieea License,CS-070755 ConstfOstferltoperwiereConstruction Supervisor C547e52o • Egg fres.64.11Co2o PERRY . 7tr„0t • )« ownu sept £ ,7 POBO%STI r !'"1 BOX lel f a'-r - MARSTON5 MILLS MA 0262E '•i• �� Lawn wtskf016st .& " • inns:lair •�: uy + pits • 'Commissioner 0x1ao8' • • • rr Cwmwmveatth of Massachusetts Y � Massachusetts Department of Public Safety ® . Division of Professional Licensure �Frrf Board of Building Regulations and Standards • Board of Building Regulations and Standards Constiryctillydtk—icor License; CS-097057 e rt, • Construction Supervisor r ...f'. • CS-044510 3' �"""'"11 lres:04/2012020 r^r't* , t i'7 It. P" ,a^�'"°'�'^�"'9 ROBERT M MCPHEE ,-1 , 1: ,'t4:) r• LJ - CIL g,--- .:alt_, e')0fir,z..— Expiration: • e Commissioner J • 'Commissioner 11/29/2018 c_ x Cwidnonweatih of Massachusetts i c Commonwealth of Massachusetts i`FYfJf • Division of Professional licensors ' '` / Board Division of Professional Licensure Board of Building Regulations and Standards of Building Regulations end Standards Constrr t6ailp rvisor • Cons on 5'ipervisor rf 7 CS-099097 • ...cEs.�B Spires:07/18/2019 CS-698835 �' ,„„..-42 'into:08/16/2019 ''.�sie. • • St15AN£CO�_--- k 'r—' �. BERtNARDGtINEHAJN; I Y• ri" ` S f�er � PO BOX1127%r v t, -I 102 NORTH Wt} �� 2N ' PORESTDALE MA 0254f *` ` tfAR1A11CH MA 675;0(:4C� `l s . l[);o,j.�'"5, '+A C-4- • a- 4-- Comrnisoiener Commissioner ae ret'o iu ` °Meea Csum&AdansinneRegma'en HOME IMPROVEMENT CONTRACTOR Registration valid for Endtvtdtai use only TYPEt CatX>r85on before the expiration data Iffaund rotsntor Jneeastranu9 .gxerestion OBI=of Consumer Affairs and Business Regulation 10415.5:,.; 071122020 One Ashburton Place-Suite 1301 WTI IC AssoctaTEiNo- Boston 02108 • {�/� • ROBERT H.84CPHEE 'e' 6" — 75}'•�� .�-/Itlt9 ' PO BOX 79711332 RT 134 �,} s ' 1392 ROUTE 134 • Notvalid without signature E.DONS,MA 02641 Undersecretary September21, 2018 TO: TOWN OF YARMOUTH ATTN: Building Commissioner To Whom It May Concern: - This letter is to confirm that I, Erik Hunter, owner of the property at 148 Pleasant Street, South Yarmouth authorize McPhee Associates, Inc. to act on my behalf as the contractor for work to be performed at the above referenced address. Erik Hunter