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Home My WebLink AboutBLD-19-1847 i r -of Yak Office use Only 1 t Permitil t � x N ; Amount - 3S-- , .. �!', Permit expires 180 days from issue date EXPRESS BUILDING PERMIT APPLICATIOiNP TOWN OF YARMOUTH RECEIVE () I Yarmouth Building Department 1146 Route 28 J South Yarmouth,MA 02664 SEP 26 2018 (508)398-2231 Ext. 1261 I . Bueai • ;•t t• u CONSTRUCTION ADDRESS: 10 Woodbine Avenue ar '+ ASSESSOR'S INFORMATION: Map: 37 Parcel: 109 OWNER: Aidan McEvoy same 508-948-8754 NAME PRESENT ADDRESS TEL 0 CONTRACTOR:William McCluskey/Cape Save 7-D Huntington Ave, S. Yarmouth 508-398-0398 NAME MAILING ADDRESS TEL 0 I Residential El Commercial Est.Cost of Construction S 2600 Home Improvement Contractor Lie.# 171380 Construction Supervisor Lie.# IC 102776 Workman's Compensation Insurance: (check one) ❑ I am the homeowner 0 I am the sole proprietor ■ I have Worker's Compensation Insurance Insurance Company Name: Employers Mutual Casualty Company Worker's Comp.Policy# 51377852 WORK TO BE PERFORMED . Tent _ Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares ( )Remove existing*(max.2 layers) Insulation X Old Kings Highway/Historic Dist. ( )Replacing like for like Pool fencing *The debris will be disposed of at: Yarmouth 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 re ation of my license and for prosecution under M.G.L Ch.268,Section I. Applicant's Signature: 0 �� Date: 9/25/18 Owners Signature(or athehmen attached // Date: Approved By re.: ✓! . Date: (G -•A.6 I Building Offici (or designee) EMAIL ADDRESS: Zoning District: Historical District: ❑ Yes 0 No Flood Plain Zone: O Yes ❑ No Water Resource Protection District. Within 100 R of Wetlands: 0Yes 0No 0Yes 0 No /'"1 CAPESAV-01 HWOODS ACORO' CERTIFICATE OF LIABILITY INSURANCE DATE/ 1/4.---- CERTIFICATE 17 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 POUCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: It 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 CONTACT . -NAME: Rogers 8.Gray Insurance Agency,Inc. PHONE FAX 434 Rte 134 _ WC,No,Ea): (AC,Nob(877)816-2156 South Dennis,MA 02660 -as;mall@rogersgray.com - - • - INSURER(S)AFFORDING COVERAGE NAIC 0 INSURER A:Employers Mutual Casualty Company 21415 INSURED - - INSURER a: - - - ' ' Cape Save,Inc - NSURERC: 7 D Huntington Ave . _ - _ INSURER D: - - ' South Yarmouth,MA 02664 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF MSURANCE NSD 1MM POLICY NUMBER IMINDONYYY1 IMWDDITYYM LIMITS A X COMMERCIAL GENERAL LABIUM' EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 6D77852 10/16/2017 10/16/2018 gnsF41FRENTEr eMA) $ 600,000 • MED EXP(Any one Peron) ' $ 10,000 PERSONAL&ADV INJURY S 1,000,000 GEM AGGREGATE pUMITRpAPPLIES PER - GENERAL AGGREGATE $ 2'000'000 POUCY X JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER; - - - - EBL AGGREGATE' S 2,000,000 A AUTOMOBILE I airyC COMBINED SINGLE LIMIT $ 1,000,000 X ANY AUTO - 6Z77852 10/16/2017 10/16/2018 BODILY INJURY(Per person) $ , OWNED — SCHEDULED AUTOS ONLY _ AUTOSAU .,t.�E • . . . pBOODILY INJURYTy (Per accident) $ _ —i AUTOS ONLY — AUT'0`ONLY .. B'erOam00ra) "M,E $ Pa S A X UMBRELLA LIAS X OCCUR EACH OCCURRENCE S 2,000,000 EXCESS LIAB CLAIMS-MADE 6.177652 - 10116/2017 10116/2018 AGGREGATE S 2,000,000 DED X RETENTION S - 10,000 - $ A WORKERS COMPENSATION - PER 0TH- ANDEMPLOYERS'LIAaWTY X STATUTE ER ANY PROPRIETORIPARTNER/EXECUTIVE YIN 5H77852 10/16/2017 10/16/2018 ELEACHACCIDENT $ 500,000 OEFIERn. CFyMER BFznn UDED? , 1N N/A • 500,000 �X tleernM unser -- ' EL DISEASE-EA EMPLOYEE S DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT S 500'000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached S nor apace M required) - CERTIFICATE HOLDER CANCELLATION " SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cape Compact Joint Powers EntityTHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Housinge Light Compact ce Corporation ACCORDANCE WITH THE POLICY PROVISIONS. 460 W.Main St Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE - ACORD 25(2016/03) 01988.2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 1 . Tlie Commonwealth of Masiaohusetts - --• • - • .- - - 'B,. 1-- g!L:., • �1.., :i-,, :, ,Department ofIndzstn'alAccidents ;r'.; '.r, . y ,, ' 'a,.• €-_til=1, ..+::21•1., r 1 Congress Street,Suite 1002 • t' ;� t Boston,MA 02114-2017 - . "1/4,=,,,:e„, '}(.c, • ; ,www mass.gov%dia __ _, Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers: • ' !' " '.' TO BE FILED WITH THE PERMITTING AUTHORITY. ' + Applicant Information - Please Print Leeiblp' ; Name(Business/Organization/Individual):Cape Save Inc Address:7-D Huntington Avenue " " ' ' ''' City/State/Zip:South Yarmouth,MA 02664 ' ' Phone#:508-398-0398 • Are you an employer?Check the appropriate box: ,; . . Type of project(required): ICI I am a employer with--15 - employees(full and/orpart-tune).' - - - - 7. ❑New construction • -- ' -- -- , 2.01 am a sole proprietor or partnership and have no employees working forme ii - 8. O Remodeling. : ' '. - . any capacity.No workers'comp.insurance required.] , . _, ' ' . • ' 9. 0 Demolition.r '•3.01 am a homeowner doing as work myself.(No workers'comp.insurance required.]? . .. . . ; 4.01 am a homeowner and will be biting contractors to conduct all work on my property. I will , _ 10 0 Building addition •. ensure that all cont either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions , proprietors with no employees. ,r , ., 12.❑Plumbing repairs or additions SC lam a general contractor and I have hired the subcontractors listed on the attached sheet 13.0 Roof repairs • , These sub-contractors have employees and have workers'comp.insurance.* ' ' '6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.['Other Insulation 152,11(4),and we have no employees.[No workers'comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. --.• -- t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such - :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have . • employees. If the sub-contractors 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 andjob site information. .. . ' Insurance Company Name: ' Employers Mutual Casualty Company • • A • • Policy#or Self-ins.Lie.#: 5D77852 . _- - Expiration Date:! 10/16/2018 - •- - - Job Site Address:'10 Woodbine Avenue City/State/Zip:West Yarmouth" ' ' • '`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 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 WORK 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 Investigations of the DIA for insurance coverage verification. .. . ..... . • I do hereby certify under tth pains and penalties of perjury that the information provided above is true and correct. ' Signature: \\ Date: 9/25/18 Phone#:508-398-0398 \\ Official use only. Do not write in this area,to be completed by city or town ofrciaL .., . , _ City or Town: Permit/Licerise# .Issuing Authority(circle one): • • , ,r 1.Board of Health 2.Building Department 3.City/I'tiwn Clerk 4.Electrical Inspector 5.Plumbing Inspector,, . • 6.Other -. . ..- . . .... Contact Person: Phone#: Q9L Wcu u o/c! d�;1u • Office of Consumer Affairs and Business Regulation One Ashburton Place- Suite 1301 4 Boston, Massachusetts 02108 . Home Improvement'Contractor Registration -- - ----.1) r:-,f•tea.:`:-. <. . ;:r i`;tiF:=�=�=;:�,-�- ;;..--.'_�-_'`-�; Type: Corporation ''+ =•1•_-:5_:_ i i T?,,. - Registration: 171380 i.--74.:::>'; CAPE SAVE INC. 'tI .0 _•.__ p Expiration: 03/13/2020 7-DHUNTINGTONAVENUE j;;f t'-- -#_s' _ SOUTH YARMOUTH,MA 02664 VA .,.°� t^+°^,-'_ -- `\:rh '`_ =I 4. - - ^ 1, Update Address and Return Card. SCM 0 20M-O5/f7 e V'rmmronaunf//c nia tra edrAu4eiA - -... _..r.___.�.� -__._____—, Office of Consumer Attain&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:Ccrporaticn before the expiration date. if found return to: peolstration--- Exolration Office of Consumer Affairs and Business Regulation 171.380 f- - -1 03/13/2020 - One Ashburton Place-Suite 1301 Boston,MA 02108 CAPE SAVE INC.:". - ,_�,f . „� . WILLIAM MCCLUSKEY r:+,_-:' -\ -tole--- 7-D HUNTINGTON AVENUE' U Not VBII W I r18ture • SOUTH YARMOUTH,MA 02664 Undersecretary 8 • ' @c�( Commonwealth of Massachusetts 'TrDivision of Professional Licensure .. Construction Supervisor Specialty Board of Building Regulations and Standards Restricted to: CSSL-IC-Insulation Contractor Constructioc, r Specialty f CSSL-102776 >' ?m`°"'."r, Ejpires:06/28/2019 �i Z'•'-.,"F� µq1 .w«.,, .-,a 7. WILLIAM J MCCLJSKEY: fJ f r 37NAUSETROADj '1!; .f C \t, r•A WEST YARMOUTH MA 02673 A- 4 . trills oot" _. • Failure to possess a current edition of the Massachusetts ,.._ State Building Code Is cause for revocation of this license. Commissioner CA DPS Licensing information visit:W W W.MASS.GOVIDPS Permit Authorization wAvYi mass saver Form Sw,�praq�.,rgy emcMnry Site ID: 3550684 Customer: Aidan McEvoy I, Adam j dam M ey ,owner of the property located at: (Owners Name,p inted) 10 Woodbine Avenue West Yarmouth, MA 02673 (Property Street Address) (City) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain uilding permit to perform insulation and/or weatherization work on my property. `/ — Owner's Signature:)4- 1, �� Date:)(- 9 " 1)=17 FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: ct. Sat Participating Contractor Date Name: RISE Engineering Phone: 401-784-3700 Email: For Office Use Only Rev.102015