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Home My WebLink AboutBLD-19-2540 -. t Office Use Only z 2 4 'SO Pcrmitif C_ „�.r„i Amount 5`� 4. a Permit expires 180 days from .•. ,;:-., issue date t; 13(-b-.lq-ooas4D EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department - 1146 Route 28 South Yarmouth,MA 02664 (508)398-2231 Ext. 1261 CONSTRUCTION ADDRESS: 34 Baxter Avenue ASSESSOR'S INFORMATION: Map: 37 Parcel: 18 OWNER: Mary Bagarella same 508-367-2211 NAME PRESENT ADDRESS TEL. # CONTRACTOR:William McCluskey/Cape Save 7-D Huntington Ave, S.Yarmouth 508-398-0398 NAME MAILING ADDRESS TEL.# ■Residential ❑Commercial Est.Cost of Construction$ 5000 Home Improvement Contractor Lie.# 171380 Construction Supervisor Lic.# TC 102776 Workman's Compensation Insurance: (check one) ❑ I am the homeowner 0 I am the sole proprietor I I have Worker's Compensation Insurance • Insurance Company Name: Employers Mutual Casualty Company Worker's Comp.Policy# 5D77852 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 .r . ation of my license and for prosecution under M.O.L.Ch.268,Section I. Applicant's Signature: ,, Date 10/24/18 Owners Signature(or attachmen . s . i 'a i Date: Approved By: /�'��`aat G Date: �Ci 7ce_, .. ,. .m. % :cud(.r designee) y'• LADDRESS: ...t. Zoning District: OCT25.7°18 . I Historical District: 0 Yes 0 No Flood Plain Zone: 0 Yes 0 l� V Water Resource Protection District: Within 100 ft.of Wetlands: 0 Yes 0 No 0 Yes 0 No UILDINr Or-c`r,.rC:�'=:,.1 • /—"N • CAPESAV-01 HWOODS ACORO' CERTIFICATE OF LIABILITY INSURANCE DA /19/D"Y'•Y) 4i..----4i..---- 100/19/2017 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: If the certificate holder Is an ADDITIONAL INSURED,the pollcypes)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)leu of sucCChppeeN77ndorsement(s). PRODUCER _Mr" ., ., ' Rogers&Gray Insurance Agency,Inc. PHONEFAX 434 Rte 134 _ (MC,No ,Ed): I(V ,Nol:(877)816-2156 South Dennis,MA 026606:mall@rogersgray.com 1 . . ' . - . - INSURERS)AFFORDING COVERAGE NAILS INSURER A:Employers Mutual Casualty Company 21415 INSURED - ... _.. . - . INSURER a: ' Cape Save,Inc - ' INSURER C: - - 7 D Huntington Ave - - -. . .. !SURER D, South Yarmouth,MA 02664 !SURER 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 - • ADDLSUBR POLICY EFF POLICY EXP I TR TYPE OF INSURANCE INFO VIVO POLICY NUMBER M WDOVITYl MMMILYYYy1 OMITS A X COMMERCIAL GENERAL UABIUTY • EACH OCCURRENCE } 1,000,000 CLAIMSMADE X OCCUR . 5D77852 10/16/2017 10/16/2016 DAMAGETORENTED 600,000 PREMISES(Fa ocwnence) $ 10.000 _ .. ' .. . MED EXP(An One Penon) $ PERSONAL&APV INJURY $ 1,000,000 • GE 'L AGGREGATE LIMIT APPLIES PER: ` ' GENERAL AGGREGATE 3 2,000,000 POLICY � LOC - PRODUCTS-COMP/OP AGG 1 2,000,000 I. 1—X1 OTHER: - ' EBL AGGREGATE i 2,000,000 A AUTOMOBILE LIABILITY /ECOMBINED ANGLE LIMIT 1 1,000,000 X ANY AUTO ' ' .' 5277852 • 10116/2017 10/1612018 BODILY INJURY(Per person) $ OWNED — SCHEDULED .. AUTOSRRFE�� ONLY AAUUTTOpS ., pBOO�DILY INJURY flier accident) } _ MS ONLY', _. PATO praPE'Eeltll MAGE- S , $ A X UMBRELLA WB X OCCUREACH OCCURRENCE } 2,000,000 EXCESS UAB CLAIMS-MADE 5J77852 - - " 10/16/2017 10/16/2018 AGGREGATE } 2,000,000 DED X RETENTION} 10,000 • . i A ANDPoEMPLO ERS LIABILITY X PER ERµ ANY PROPRIETOR/PARTNER/EXECUTIVE YIN 51177852 10/1612017 10/16/2016 500,000 ApFFF) ERA) M PARTNER/EEXCLODEDL. NIA E.L EACH ACCIDENT •' } 'I,ianadatpryyIn R ) 500,000 X danrnhe levier EL DISEASE-EA EMPLOYEE i DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1 500.000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(AGGRO 101,AddIdorW Rennes Schedule,Ray be attached'more space Is regahed) • CERTIFICATE HOLDER CANCELLATION • 'SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cape Light Compact Joint Powers EntityTHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Housing Assistance Corporation • .ACCORDANCE WITH 711E POLICY PROVISIONS. 460 W.Main St Hyannis,MA 02601 AUTHORIZED REPRESENTATIVESE ,a ACORD 25(2016/03) ®1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD •-. "" The Commonwealth'of Massachusetts ' ' "- � =r e? Department of Industrial Accidents ' e 1 Congress Street,Suite 100 r - Boston,MA 02114=2017 • www,massgov/dtd r i , Workers'Compensation Insurance Affidavit Builders/Contractors/Electr(ctans/Plumbers.'L TO BE FILED WITH THE PERMITTING AUTHORITY. ! Applicant Information Please Print Legibly' Name(Business/Organization/Individual):Cape Save Inc - - - '• Address:7-D Huntington Avenue City/State/Zip:South Yarmouth, MA 02664 " phone/i:508-398-0398 Are you an employer?Check the appropriate box: . _ Type of project(required): 1.p I am a employer with 15 employees(full and/or pan-time).' - . . - ,:7. ❑New construction .:j 2.111I am a sole proprietor or partnership and have no employees working for me in g, Remodeling ". any capacity.[No workers'comp.insurance.required.] - .. 3 E lam it homeowner doing all wok myself.(No workers'comp.insurance required.]r ,9. ❑Demollhon 4.01 am a homeowner and will be hiring contractors to Conduct all work on my property. I wilt 10❑Building additiOtl.,_, ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions • , 4! proprietors with no employees. . ,.. . -a r._ . 12.❑Plumbing repairs or additions 5.0 lam a general contractor and 1 have hired the sub-contractors listed on the attached sheet. 13. ,O airs These subcontractors have employees and have workers'comp.insurance.: ❑ repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c, 14.['Other Insulation . 152,*1(4),and we have no employees.[No woken'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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. _ _. Insurance Company Name: Employers Mutual Casualty Company • Expiration Date:' 10/16/2018 Policy#or Self-ins.Lic.#: 5D77852 - p' _ . , ' Job Site Address: 14 Baxter 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: 1 do hereby certify under th pains and penalties of perjury that the information provided above is true and correct Signature: �\ Date: 10/24/18 Phone#:508-398 0398 \\ Official use only. Do not write in this area,to be completed by city 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 5.Plumbing Inspector 6.Other Contact Person: Phone#: Office of Consumer Affairs and Business Regulation One Ashburton Place- Suite 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration } Type: Corporation '- . Y, -- Registration: 171380 CAPE SAVE INC. 1>l t , .-.�L Expiration: 03/13/2020 7-D HUNTINGTON AVENUE 1„f € , _ SOUTH YARMOUTH,MA 02664 V••••?: - f••••••-•&-.e:-..1 ' r1 4, tri ' Update Address and Return Card. • SCM O 20M-0917 - _ CYie'armmoaury/!/e./ofim cAwe/4 . �_ _ ' _ _ . _ _ --- Mica of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:Corporation before the expiration date.If found return to: peoistration :.— 1 Office of Consumer Affairs and Business Regulation 171380 : is ' 03/13/2020 One Ashburton Place•Suite 1301 :. . CAPE SAVE INC ,,,44,,j, Boston,MA 02108 WILLIAM MCCLUSKEY ',,,<% \2.G --- 7-D HUNTINGTON AVENUE-' SOUTH YARMOUTH.MA 02664 n Not valid w •,... A Ignature Undersecretary Commonwealth of Massachusetts vi Division of Professional LicensureConstruction Supervisor Specialty Board of Building Regulations and Standards RestrictIn: CSSL-ICd to: Contractor Construd�ooc-Sllp{v aor Specialty • t CSSL-102776 > yr'''''-r".91., E'Aires 06/28/2019 WILLIAM J MCCL',VSKEY?-� 1v �,..i�'", RI, 37 NAUSET ROA " b a WEST YARMOUTH MA 02673 ..yam. "' tnKs=1 t0-ZJ .-Failure to possess a current edition of the Massachusetts /2 _ State Building Code is cause for revocation of this license. Commissionerair ��✓ DPS Licensing Information visit:WWW.MASS.GOV/DPS JIOME OWNER WEATHERIZATION WORK PERMIT; PLEASE COMPLETE AND SIGN THIS FORM AS THE APPLICANT HOMEOWNER. '"`ma i y -bona )e- hereby consent to and agree that weatherization work may be done by the Weatherization Program of Housing Assistance Corporation on the property located at (-•( xicei Nit W The weatherization work done will be based on programmatic priorities and availability of funding and it may include all or some of the following measures: Weather stripping; air sealing; attic& basement Insulation; exterior wall Insulation; ventilation measures In consideration of the weatherization work to be done at my home I agree to the following: 1. I give permission to Housing Assistance Corporation to access the property with such equipment and materials as may be necessary to perform weatherization. 2. The Housing Assistance Corporation reserves the right to Inspect the fuel or utility bill for the weatherized unit on an ongoing basis for no more than five (5) years after the weatherization work Is completed. I have read the provisions oft�greement an. live my conse Home Owner(signature) // SAP a.._ . _1 _ Home Owner email: - Date: qZ8h Agent(signature) Date: Agency Approved Weatherization Company Cape Save Inc. All Cape Energy Alternative Weatherization Cape Cod Insulation ape Save Cazeault Frontier Energy Solutions Lohr Home Improvement / Agency Signature: < �r( „4 .(' iv Date: lb' lb '1O For Natural Gas Customers: I have received the National Grid Discount Rate Application form from my auditor. Customer Initials