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Home My WebLink AboutBLD-19-001580 RECEIVED Office Use Only ag Y9R o r p.-i9- ov f _4' t • -.04 s SEP 14 2ot8 Amount 73 t."� e-d' L:BfliWCIEPARTM" • Permit expires 180 days from }..*.:: issue date EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508)398-223 Y 1 Ext. 12611 CONSTRUCTION ADDRESS: e2 6 Co WI.e ( Cl cR C( t&r Wt oui1, Pohl 0 2 6 7 5 ASSESSOR'S INFORMATION: JJJ Map: Parcel: OWNER: S0. ( v t, i pCr Q- 6 Ca wi.elo+ 61z.4 So6 - �$G2 006o NAM PRESENT ADDRESS TEL. II 'J CONTRACTOR: 5i s 3) CSntzu YCSOUZxS/its g) GwIQ:I 'fin.. CO$ 5C-lacl3 �� NAME MAILING ADDRESS TEL ll 0 Residential 0 Commercial Est.Cost of Construction S (•C 5 , b/� /c 5 Home Improvement Contractor Lie.# I It 1 1 7 C'( Construction Supervisor Lic.# 1 0 0 0 I Workman's Compensation Insurance: (check one) ❑ I am the homeowner 0 I am the sole proprietor VI have Worker's Compensation Insurance Insurance Company Name: ethcA-V'-€ ('Q h 5 I k7ri. ro • Worker's Comp.Policyil WORK TO BE PERFORMED Tent _ Duration 1 (Fiire�Retarr ant Certificate attached?) Wood Stove Siding: #of Squares ( ' LhI/JeRep/fi8nm not windows:� # Replacement doors: # Roofing: #of Squares 2- 6 ( v)R movf a eaisti g(max. layers) Insulation Old Kings Highway/Hisltoric Dist. ( )Replacing like for like Pool fencing Hi 'The debris will be disposed of at: l,1 Le 1 )-1, 401 -e I-5 c( (5 p o 5 `su I 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 bejust cause for denial or revo ation of my licen - . d for prosecution under M.G.L Ch.268,Section I. Applicant's Sign re: op, L ��t �) Date: et-- �i11 (2•40I Owner Signe ure(or til. ! t��1/ Date: r12� Approved By: / ' l' V Date: 9`V/6-- Building official or lay ee EMAIL ADDRESS: • Zoning District: Historical District: 0 Yes 0 No Flood Plain Zone: 0 Yes 0 No Water Resource Protection District: Within 100 ft.of Wetlands: 0 Yes 0 No 0 Yes 0 No • / - Commonwealth of Massachusetts Orvision of Professional Licensure Board of Building Regulations and Standards Construction-SLpe;visor Specialty • CSSL•106031 Ebpfres: l0/05/2018 y ! SILAS MSOl12A 20 COOK CIRCLE HYANNIS MA 02601 'te NC'y �wrr/,,..., " „Commissioner, Vas" ' ' • HIC Registration Complaints Registration 181774 • Registrant STRONG CASTLE BUILDING INC. Name SILAS DESOUZA Address 20 COOK CR City, State HYANNIS, MA 02601 Zip Expiration 10/01/2019 Date Complaints Details No complaints found for this registrant. You can also view arbitration and Guaranty Fund history. Back To Search httpsi/services.oca.state.ma.us/hidlicdetails.aspx?txtSearchLN=181774 1/2 TE A�® CERTIFICATE OF LIABILITY INSURANCE DA o(M11a/1De) 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(ies)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 NAMEACL JIM HINDMAN Schlegel 8 Schlegel Ins Broker ac No.Ext): 508.771-8381 (ac,No): 508-771-0663 34 Main Street ADDRESS: schlegelinsurance@gmail.com West Yarmouth,MA 02673 INSURER(S)AFFORDING COVERAGE NAIC Ii INSURER A: ENDURANCE INSURED INSURER B: STRONG CASTLE BUILDING INC INSURER C: 20 COOK CIRCLE INSURER D: HYANNIS,MA 02601 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 1 DL bUBRVVVD POLICY NUMBER POLICY EXPPOMM/DDYLIMITS (MD WVD (MOLICY EFF (POLICY X COMMERCIAL GENERALLIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGt 1UREN I ED CLAIMS-MADE El OCCUR ' PREMISES(Ea occurrence) $ 500,000 MED EXP(Any one person) $ 10,000 A CBC20002371900 08116/18 08/16/19 PERSONAL BADV INJURY $ 1,000,000 GGEEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 POLICY PRO ❑ ,. PRODUCTS•COMP/OP AGG $ 2,000,000 _II JECT LOC OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ _ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ — OWNED SCHEDULED BODILY INJURY(Per accident) $ _ AUTOS ONLY _ AUTOS HIRED NON.OWNED PROPERTY DAMAGE $ AUTOS ONLY — AUTOS ONLY (Per accident) $ UMBRELLA LIAB — OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTIONS $ WORKERS COMPENSATION AND EMPLOYERS'IJABIUTY Y I N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE❑ N/A EL EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E L DISEASE-EA EMPLOYEE $ DyedSCRIPTION RIPTIOe under DEOf OPERATIONS below E L DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached N more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN SALLY WIPER ACCORDANCE WITH THE POLICY PROVISIONS. 26 CAMELOT ROAD YARMOUTHPORT MA 02675 AUTHORIZED REPES: TA1IVE IN HAND, I c• 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered - of ACORD • ---1 WILSCON-01 JWINTERS sa` O!/2O CERTIFICATE OF LIABILITY INSURANCE DATE 05110DDIYTTT sllonata 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(ies)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 INONTACT TRU Insurance Agency,Inc. 1 PHONEHO -- • —�— ---- - FAX - - -- - - - 30Main St (eA�H:,No.Ball:(781)281_9688_____._----._ 1.(A'c,No): #16 • .ADDRESS: . _ ___.__.__ Ashland,MA 01721 I-_._ _ INSURER'S)AFFORDING COVERAGE_,._ _ HNC F .... __.1 INSURER A:Arch Insurance_Company_ - _ --- INSURED _INSURER B&Travelers Insurance Com an P Y _ _ .__ 25658 _..._ Wilson Construction Services Inc 36 Oliver St.APT Framingham,MA 01702 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 --- ADIS SUER - - ( POLICY EFF ' POLICY EXP I - - - - - — --- -- _ MR..; TYPE OF INSURANCE IN YIYn POLICY NUMBER 'neiso/YYYY1'IMMrnorrreY1; LBWS A X COMMERCIAL GENERAL LIABILITY •1 I EACH OCCURRENCE_ .. 3• 1,000,000 I if-- ,CWMSMADE ; XI OCCUR �AGL0027451-07 • I DAMAGETO RENTED 100,000 03/16/2018•03/16/2019!pPEMl5ES4EP acwrtaeee)_,f 1 I 1 IMED EXP(My one person)_1 1 10.000 I 1 _ ._.... . .... i L PERaONAL a ADV INAIRY_I f_ ._ 1,000,000 _J- I 2,000,000 •GEM AGGREGATE APPLIES PER: GENERAL AGGREGATE._ _;3 I I POLICY in I I { _ 1,000,000 I. JECT t-._ 1 LOC 'PRODUCTS•CMIP:OP AGO;$ .. - l OTHER' I $ IAUTOMOBRE UMMUTY I I ;CCIABNED SINGLE LVOT IEa acodeld) _ ;5 _ ____ _ _ , =ANY AUTO }g�II iBOOIIY INJURY(PMpereer,) JS OWNED t_ IAlITO5l1LED I I .___ _ __. • t AUTOS ONLY -"1 pN OµNFp 1 BODILYpIWuRAY1,I(APGer�accident);f_ .__ L_ 1" ONLY L_._I AUIOSUHIY i lP�E��+)._ —_ ' '3 UMBRELLA(IAB I (OCCUR I I EACH OCCURRENCE_ $ _ . . _. _. 1 I EXCESS use I CLAIMS-MADE I j AGGREGATE _ ,f r_ _ _t __— . . __ . ._ ___ I 'RETENTIONS I1 $ B RANO EMPLOYS ERS NLIABI Itt YIN I X!STATUTE_. ._'En , _ _ ,ANY PPOPPIETORPARTNERE%ECUirvE 6HUB•2E81710-0.18 03117/2018103/17/2019 1,000,000 :Oraz.o'EMBER EXCLUDED' Y' N/A I i E.3/EACH ACCIDENT__ __,f _ 1 1 E.L DISEASE•_EA EMPLOYEE,f 1,000,000 If yes.!ewe*under i El.DISEASE•Pd.ICY LIMIT3 1,000.000 DESCRIPTION OF OPERATIONS Mow , I 1 1 I I I DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES ACORO 101.Addb Monal Remarks Schedule.may .DacMd H n owe by Neer WORKERS COMPENSATION INSURANCE COVERAGE APPLIES TO THE WORKERS COMPENSATION LAWS FOR THE STATE OF MA. Job:Peter Kennedy•Jobsite:406 MIstic Drive,Marston Mills,MA CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Strong Castle Building THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVEREO IN ACCORDANCE WITH THE POUCY PROVISIONS. 20 Cook Circle Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE • ACORD 25(2016/03) ®1988.2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD