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HomeMy WebLinkAboutBLD-19-2148 • prt YqR TOWN OF YARMOUTH Building Department +� A ' (508) 398-2231 ext.1261 BUILDING \�\\ p�'",..a t!, C PERMIT NO ,BLD-19-002148 t�y'p'�p\ PERMIT cc' zy ISSUE DATE 10/16/2018 MM JOB WEATHER CARD • APPLICANT - ;Craig P Bishop PERMIT TO • Repair AT(LOCATION) 112 WIDGEON LN,WEST YARMOUTH,MA 02673 I ZONING DISTRICT 1 Bldg.Type: 'Residential SUBDIVISION MAP BLOCK LOT 058.306 BUILDING IS TO BE: CONST TYPE USE GROUP REMARKS Repair:Air Sealing&Weatherization CONTRACTOR LICENSE CS-109777 Construction Supervisor CRAIG BISHOP Craig Bishop AREA(SQ FT) 455,376,240 EST COSTS) 1786.50 PERMIT FEE(5) 35.00 378 Route 130 Sandwich,MA 02563 OWNER LUCCA SALVATORE J BUILDING DEP Y ADDRESS MACKENZIE JEAN, 12 WIDGEON LN J_ WEST YARMOUTH MA 02673 ✓-41 PHONE THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK 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 ARr1\/F The Commonwealth of Massachusetts o� i y Department oflndustrialAccidents ra•'le I Congress Street,Suite 100 _etry=s, Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information M�!' ���yy Please Print t eoibly Name(Business/Organ¢acion/lndividuall:, i�"-.�",v�+'��'':—+' b/it?x� Y { i C Address: 37`'� F l A...V,,l t '7� • City/State/Zip: .Q{)9 65r(0.S Phone#: 714.-(9Q, —rX) ) I Are you an employer?flak the appropriate box: y� r Type of project(required): IXf am a emylgxr with_IR employees(fill end/orpmktime).' „'� 7. 0 New construction 2.0 I am a sole proprietor or partnership and have no employees working forme in 8. ❑Remodeling any capacity. NO workers'comp.insurance required.] 9. ❑Demolition 3 1 am a homeowner doing all yank myself.[No workers'comp.bmuanee required]' J.❑I am a homeowner and well be hiringcontractors to conduct all work on10 0 Building addition my property. I will ensue that all contractors either have workers'compeniaoon insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. S.Q I 12.0Plumbing repairs or additions am a general contractor and I have hired the sub-contractors listed ont the attached sheet. These subcontractors have employees and have workers'comp.insurarre.r 13. Roof repairs C,r (�/t 6.0 We aa corporationandtsofficershaveexercisedtheirrightofexemptionperMac. 14. other kr T are 152,§10),and we have no employees.[No workers comp.insurance requited] P\Z�r e•�„lr', tC"[/l•y\ •Am applicant that checks box al must aho fill out the section below showing their workers'compensation policy infomiaiion. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside cone sum must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the subcontractors and sure whether or not those entities have employees. tribe subaormaerors have employees,they mum provide their workers comp.policy number, I am an employer that is providing workers'compensation insurance for my employees. Below it the policy and job site information. L ' _ �- Insurance Company Name: 3CJk :I-Nal 1. )phtJklcy 4 t—cce, S.1f 1Suucctnce ry Polity#or Self-ins.Lic.#_\—l�c gal t3L(3 Expiration Date:'' `Q 115 ' 9019 Job Site Address: 2 ‘J1/41% City/State/Zip:W•trernoln M(1 C Xk513 Attach a copy of the workers' pensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MCL a 152,§25A is a criminal violation punishable by a fine up to S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fete of up to 5250.00 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 calif•under the pains an atria ofperjury,t t the information provided above is true and correct Sienanue: i— Date: LC)t.1On Phone#: Official use only. Do not write in this area,to be completed by dry or town official City or Town: Permit/License# 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 I TE s i iEl 11 igA .� ._n . ID lb .t o tm la IIII fd `' II ;._Jib! toll a Li tis1 ti ai- s, d lt I .fir• .. . • • ' Womsnenwecta riltictekiacofoteaf Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:LLC before the expiration date. If found return to: Registration LR.grattE Office of Consumer Affairs and Business Regulation 1855it-e. 07/04/2020 • One Ashburton Place-Suite 1301 CAPE COD ENEFIGYOOLUTiONS LLC Boston,MA 02108 CRAIG BISHOP tr-fi2 ot valid without signature SANDWICH,MA 02563 Undersecretary • • . .... • • • . . .• • • • 1 •. • • 1 • „. A ORO CERTIFICATE OF LIABILITY INSURANCE DATE z) 1/2D1B 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 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 Christian Barber, CIC NAME: The Oceanside Insurance Group (AIC.No.Fs&ONE (508)775-0500 FAX No):(508)790-7955 E-MAIL ADDRESS: 52 West Main Street • INSURER(S)AFFORDING COVERAGE NAICH Hyannis MA 02601 INSURER A:S tars tone Specialty Insurance INSURED INSURER B:Commerce 34754 • Cape Cod Energy Solutions, LLC mums Liability & Fire Insurance PO Box 159 INSURERD: INSURER E: Forestdale MA 02644-0159 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1862106099 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. !LTR I TYPE DF INSURANCE IANRD I YWO POLICY NUMBER R I(POLICY M DDIITYYYI (MMI)DIYYYY)Y EXP I LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 DAMAGE TO RENTED 100,000 A CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ G85591180AEN 6/14/2018 6/14/2019 MED EXP(Any one person) $ 5,000 • _PERSONAL 8.ADV INJURY_ $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X POLICY a JE° fl LOC PRODUCTS•COMP/OP AGG .$ 2,000,000 OTHER: Each CPL Pollution Condition S 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO • BODILY INJURY(Per person) S ALL OWNED $ SCHEDULED AUTOS AUTOS BBXP90 10/4/2017 10/4/2018 BODILY INJURY(Per acddent) S _ a. X NON-OWNED PROPERTY DAMAGE -HIRED AUTOS AUTOS (Per accident) PIP-Basic S 8,000 X UMBRELLALIAB _ OCCUR EACH OCCURRENCE $ 2,000,000 A EXCESS LIAR CLAIMS-MADE AGGREGATE S DED X RETENTIONS 10,000 G8S604180AEM 6/14/1018 6/14/2019 S WORKERS COMPENSATIONX PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY MandatIETOPROPRIETOR/PARTNER/EXECUTIVE ❑y R!A • Et EACH ACCIDENT S 1,000,000 C ( o.yIn NH) ARTNDV9WC921663 6/15/2018 5/15/2019 E.L.DISEASE•EA EMPLOYEE S 1,000,000 II yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES (ACORD lot,Additional Remarks Schedule.may be attached If more space Is required) Insurance coverage is limited to the terms, conditions, exclusions, other limitations and endorsement of the policy. Nothing contained in the certificate of insurance shall be deemed to have altered, waived, or extended the coverage provided by the policy provisions. • CERTIFICATE HOLDER CANCELLATION lcipro(3yarmouth.ma.us SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Yarmouth - THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1146 Route 28 ACCORDANCE WITH THE POLICY PROVISIONS. S. Yarmouth, MA 02664 AUTHORIZED REPRESENTATIVE C Barber, CIC/MARIE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) 141 ( N 16 Q 'q v O W IA N CC 64 M 11 co O O g f$ y.- O LciO y 0 W w V N ., o w 1 .N in 8 8 8 8 R U O . ' 1 I ( N C S • g i C tA 0 ..o dUll m rn 0 J � N -0 g �_NN 0 (p cz,3 00f1 R.0aNt ° N C G 9 QQ!! p I 0 1 0y e. o O2 .G y« to (� ab IP a' H - 08 'c IL .'fo .c coma fi E 0 N1' 44% 0 i 9 o ° 3v � � n 62too' EoVya oc: .Z t; c yarn D ,g g LL - ? oco= :4= ,L. 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