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HomeMy WebLinkAboutBLD-19-002988 E office Use y :g YARD E C E / E D �Permitlf �-/1a`f, , z`P�" ! NOV 14 2018unt �S,c.�--� -cla' Permit expires 180 days fromLR2 u IISciyCJEEA Rj T 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: g._0 &C.-4_0 V\ fig r )' ASSESSOR'S INFORMATION: Map: 37 Parcel: 3 0 !( OWNER: 1-C./.sei �VsrctJ- pRyppRSA.-Ss^" L �"/")) 31S-7FI 1 NAME Mif&Fq MV1LtRITty Construction L. CTOR: PO Box 52 NAME �gf9A 3§, MA 02670 TEL# sidential CO7 ❑Commercial Cell (508) 249:62E4 fonstruction s ' CSL-58633 H1C-169393 Home Improvement Contractor Lic.# /Construction Supervisor Lic.# Workman's Compensation Insurance: (check one) C3iI 0 I am the homeowner 0 I am the sole proprietor have Worker's Compensation Insurance Insurance Company Name: Worker's Comp.Policy# 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 Old Kings Highway/Historic Dist. Diist.�( )Replacing like for like Pool fencing J 'The debris will be disposed of at 'ey.0 Location of Facility I declare under penalties of perjury that the statem - ein co . -• e true and correct to the best of my Imowledge and belief. I understand that any false answer(s) will be just cause for denial or revocation of m . ... ... .I.. : ecu:•• ter M.O.L Ch.268,Section 1. Applicant's Signature: \\ Date: III Y hiF Owners Signature(or attachment) c191/2-CL L, N Date: Approved By: /�!r Date: A- 15- l Building Official(or designee) 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 313 •Wi DocuSIgn Envelope ID:043378A4-EA69-4AEB-9F14-7B118CB9F9C7 sisrtl Permit Authorization mass save Form ( i -cvto 1a „ -3� Site ID: 3419433 Customer: Terri Furget Terri Furget ,owner of the property located at: (Owner's Name,printed) 20 Braun Road 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 a building permit to perform Insulation and/or weatherization work on my property. Docu919n.d by: Owner's Signature: Eta- I ®_ 91E930EF20e5135... Date: 10/31/2018 1 8:51 AM EDT FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date Name: RISE Engineering Phone: 401-784-3700 Email: Page 1 of 1 For Once Use Only Rev.102015 ,r WAG Wen a aIc aCAje f I . �' ' Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 • • Boston,' ` usetts 02116 Home Improveactor Registration f • ft-, g ^.; . If11Ivldtral MICHAEL MCCARTHY Registration: 1 393 r. P.O.BOX 52 f , Expiration: 0BII15/2010 • WEST DENNIS,MA 02870 �. • zlr s <*,/ 1,i,......;14, •••• 0' Update Address and return card. Mark reason for.changs.' SCA 1 Q 201A-05H1 —.------ _.... •r1 AAdrres rl Renewal nElnployment in Lost Card Wo'nn onviea4(cybeaddac4adeaa , • ±. Office of neumerAft&re&Business Regulation-. HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only "AirTYPE:Individual before the expiration date. If found return to: EEglmtlffi Office of Consumer Affairs and Business Regulation . 169393 0WJ15r1019 to Park Plaza-Suite 6170 ICHAFI MCCAf17 fi � -1';} Boston,MA 116 `'•Y ilir4 'iii) MICHAEL F.M •; ,per .1.--------.. SOUTH DENNIS,MA 12111111undersecretary Not valid without signature . ,®i Corrvnonwealth of Massachusetts DkrisionorProlessipnallkensure Michael McCarthy `SsBoard of Building Reguia0ons and Standards MOCarthy Construction y`ypgrvisor I CS-056633 Has sucasaluiy Completed the Natlonsl Fiber^ f Cellulose Tralnktg Cone I.-. 17i fres^04!10/2020 , 2SA1 day otAugust 2011 MICHAEL J fui'CCA • • POBOX62 1 WEST D o _�0� ENMS MAn 02676r ;t ') 1 -YNIaS pleRlal hear• . ly .. .%:1�'`t� t aNebrMaM - NATIONALFl/aR ^ � '^ - - Commissioner ./I NeteaarwMraeho_ad • OSHA 001558712 •...: .. . eaktiventl wdes.laa ♦b U.S.Department of labor <. Occupational Safely and Health Administration - ti ^ .. ThKa4aL • Michael McCarthy , -Y`� fit` F:» x NIS Soe»ssheycnnp011 lted a 1fie Ooa,parlomal Safey and Hitt iLeCommaae ' Course reaoamoes.riy TywoCouaeln 3a aomaordaRYtmand9lwunmfaeldulna 4 , Safety b Healt r, r i I I g 1 I fig $] e i iiii 11 I 1 � � . to 11500015000 IV 1 A I A ; 1 i a rl i Pt' ` 4 a %. v % l -a t 1 4 t. ; Es I.. 'iiiiji d iUj i I_ I fly. • ijIi ' J! -IofII i �I . i pist.101 I i er; tit! ' -. 1 i 'r i gal - 11 I ' f- tIl , i I I AkflIi1ifiIJIIij 1111 \ 1e is r hil 1 I ra ? pijiIlllllllli lilaJ4j III4tUJBJJt' jibs l �_ 1111111 �" MCCART9 OP ID:TR COo CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDIYYYY) • 03/01/2018 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 508-398-6060 %Iry Dennis Office Dryden&Sullivan Ins Agency PNONE 508-398-6060FAK 508.394.2267 ofDennis Inc. (A/C,No,Mity I(AIC,No): 485 Route 134 PO Box 1497 So.Dennis,MA 02660D as: Bryden&Sullivan Insurance INSURER(S)AFFORDING COVERAGE NAIC s INsuRERA:National Liability&Fire Ins INSURED Michael McCarthy Construction INSURER B: PO Box 62 West Dennis,MA 02670 INSURER C: INSURER 0: 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 AU.THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. MSR TYPE OF INSURANCE AODL SUBR POLICY EFF POLICY EXP ITR Mi0 min POLICY NUMBER IMMNDIYYYI (MM/DO/WY11 LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S CLAIMS-MADE nOCCUR PREMISES(FREo RENTED $ MED EXP(Any one arson) $ PERSONAL a ADV INJURY I _ GENT.AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S HPOLICY 0 ja U LOC PRODUCTS-COMP/OP AGO $ OTHER: $ AUTOMOBILE LIABILITY (Fa a dentSINGLE LIMIT) — ANY AUTO BODILY INJURY(Par weal $ _ AUgTEOS ONLY _ SCHEDULED AUTOS pBppOpDILY INJURYNJryDD (Per accident) S AUTOS ONLY _ AUTOS ONLY (Per0irlentIGE 1 _ S _ UMBRELLA UAB _ OCCUR EACH OCCURRENCE _EXCESSIJAB CLAIMS-MADE AGGREGATE S DED I RETENTION$ S A WORKERS COMPENSATION X PER 0TH- AND EMPLOYERS'LIABILITY STATURE ER ' ANY PROPRIETOR/PARTNER/EXECUTIVEY/N V9WC747574 12/15/2017 12/15/2018 1000000 OFFICER EMIER EXCLUDED? LY NIA E.L.EACH ACCIDENT $ 1,000,000 1live.. 1n r�+�N11 E.L.DISEASE-EA EMPLOYEES _ II e dePeribe TIONOFw 1,000,000 DESCRIPTION OF OPERATIONS below FJ„I1SEASE-POLICY LIMIT $ • DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD¶01,Additional Remarks Schedule,may be attacked Ifmon apace Is required) Michael McCarthy,President,has opted to exclude himself for Workers Compensation benefits CERTIFICATE HOLDER CANCELLATION • CAPELIG SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Cape Light Compact Box 427 AUTHORIZED REPRESENTATIVE Barnstable,MA 02630 1 CA ACORD 25(2016/03) C 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD MMCCARTHY CONSTRUCTION CO. MMC Dater f 11 mjmccarthyconst©gnail. cornBuilding Commissioner Building Department PO Box 52 T°'"�">aF '�}(Z,ul�u West Dennis,Ma SLO' t 9 - 0 Zg 4 02670 To whom it may concern, This affidavit is to certify that all work completed for Permit Location: 2-0 3„2j% 3 Has been inspected by a certified Building Performance Institute(BPI)inspector. All work performed meets or exceed Federal and State requirements. Sincerely yo rs;. %1 y Michael McCarthy C L42o1g BUILDING pp-ME ©y --- NT