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HomeMy WebLinkAboutBLD-19-2591 A CERTIFIED AS BUILT IS REQUIRED a • • 12 611; BEFORE FINAL INSPECTION 1, 3/4 '—'_ > < I • ❑ o I • ^` W1 b yy - a � ;1; V Z I $ 8 Z d a 1 3 / W O .a a, oco L. % a1 d �j^ tt 0 41 0 00 Pti rai sa v o \` 0 0 •vo C:oC�(fj dU a a ^ p C '&..p:. 0HIILIII q 1 \ O.o qS l o pv, O h a o .`"i iid ti Y Or' u W. ❑ z lUL ' ' d o. P" ay c, F �p 7, 4 O \ O.c� a v c et 'i.` W 'a. 7 �T U.o W v �u 'C�ci :27-- �•' :o CP+_- p ,, �� ,a E • . ' Z P7 `� •9 y LL �te m� "" v' .o N A" O. d a 1, ., F V`❑ 0 •.a >" -. W o o W z ° iy z �3 \p� 7. x :? U ti ca 1 O g $ z O z oom .21° .0 :g.% • o o w Wtil -O .O� W G p 11flH pa 1 0 w. 'g w U, o o, o ... • A. A �. W !: j ' ' d fr9 befr 49 64 49 (4 • 0 5 .7 , _i O. c w .--� N z _ b C Pmy. `'�.' v P. C7 '1[ -.�. W d p .� :: 023 0. p ° 'W ❑ �Ol U' U c 1 g y d E a a, m a", _ car' o d r 'B Z �. v ,o% a", Q 0. c o d 0 1 I7- / E. o_ .- g Cs*.. & As to w v Po a 4I. Q Y a - in .� m � a i 4 o a a ❑ 3 °: v • U A gi Td �7 U U d V •° 'a Crl - m N .5 rx 3 O s e.1 5 • 3 9 d 8 0.l W a a F Fa .-i — ti N .i .i M Cl z z `,4 0 al .7 .. tV ri a h v1 • ~ SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) • A J� J 7`fus Go/240N / I4'tt h License Number Ex ration ate Name of CSL Holder 'j 1 S iAgsUl bk..gs, �i�- List CSL Type(see below) t5s lArekaj No.and Street \M�' Type Description / y Jt�r� O 24 ' 0 ✓r U Unrestricted(Buildings up to 35,000 cu.R) V 7Vl f� R Restricted I&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Regist ed Home Improvetgent Contractor(FITC) �0QOD►t/ T /3o4;Xn 2 20 BIC om any a or HIC Regi tNam BIC Registration Number pirati n Daze f nit;Osits _ecul No.etld.$tree, g ,\ �rs �� f 3/7$ Email address City/Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AAIIDAVIT(M.G.L.c.152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached/ Yes ❑ No ❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHFN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT . I,as Owner of the subject property,hereby authorize (.0 WON /fr 4ti to act on my behalZalin all matters relative to work authorized by this building permit application. CDD,vtOA �-lottwfiU /O—l7 -/0 Print Owner's ame(Electronic Signature) Date • • SECTION 7b: OWNER'.OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application• true and acc o the best of y knowledge and understanding. /0--/2- - Print Owner's or uthorized A ent's leen nic ignatur Date • NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the MC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dls 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" • The Commonwealth of Massachusetts 9_-Ls / Department oflndustrialAccidents ' k. e:"._tAIlis t. 1 Congress Street,Suite 100 '- =t ri: Boston,MA 02114-2017 �.,a • www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Nanle (Business/Organization/Individual): &14-001V 17k A Address: I7 1 .S a&j v14 0 City/State/Zip: ,C0/4 —Acct iii Phone#: 5 2' 3 G Y 3/9Q Are you an employer?Check the appropriate box: Type of project(required): 1.0 1 am a employer with employees(full and/or part-time)." 7, "ew construction 2.0 I am a sole proprietor or partnership and have no employees working for me in $, ❑Remodeling ' any capacity.[No workers'comp.insurance required.] 3. I am a homeowner doingall work 9. ® Demolition ❑ myself.[No workers'comp.insurance 4.❑I am a homeowner and will be hiring contracton to conduct all work on property. I will 10 ❑Building addition ensure that all contractors either have workers'compensation insurance or are sol p 11.E Electrical repairs or additions proprietors with no employees. 5.t4,a-i� 12.[/' f,Plumbing repairs or additions 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet These sub-contractors have employees and have workers'comp.insurance.[ 13. Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: 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. of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify a der •pains and p s of perjury that the information provided above is true and correct Signature: Date: fre, — /1-- —(5 Phone#: 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#: ti. : 34 o Tom' TOWN OF YARMOUTH �' b vg c BUILDING DEPARTMENT ,',`mow S ,Z 1146 Route 28, South Yalznouth,MA 02664 ��..o 508-398-M31 ext. 1261 Fax 508-398-0836 • BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 40,Section 54 and 780 CMR, Chapter 1, Section 1115, • I hereby certify that the debris resulting from the proposed woes/demolition to be conducted at Vi (9/1/4&a54 t/n / Work Address ray "Z Is to be disposed of at the following location: 4 1P5 Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 11, Section 150A. dp . /o —i ig Signature of Application Date Permit No. ./ t mon nit. Office of Consumer Affairs&Business Regulation h.: !..HOME IMPROVEMENT CONTRACTOR Registration: 130856 Type: rJe� Expiration: 4282018 DBA GORDON HATCH RESTORATIONS GORDON HATCH 175 SEARSVILLE RD. SO.DENNIS,MA 02660 undersecretary Corrrnonwealth of Massachusetts �. Division of Professional Licensure Board of Building Regulations and Standards Construction Supervisor CS-074258 Expires:04/23/2020 is GORDON M HATCH • 176 SEARSVILLE ROAD. SO DENNIS MA 02660 Commissioner l. " Ito • Farm Family Casualty Insurance Company Farm P.O.Box 656 Albany,New York 12201-0656 Family SELECT BUSINESS PACKAGE DECLARATION PAGE Policy Number: 2001X0609 Portfolio Number. Account Number. Name and Mailing Address of First Named Insured: JOHN W.KILEY P.O.Box 1189 DENNIS PORT,MA,02639-5189 Agent: 3020 MARK SYLVIA INSURANCE AGENCY LLC 404 MAIN ST CENTERVILLE MA.02632-2916 Agent Phone: 508-428-0440 Business Description: CARPENTRY Form of Business:Individuai/Sole Proprietor ...Transaction Type: Renew Policy Period: From 05-15-2018 To 05-15-2019 12:01 A.M.Standard Time at your mailing address shown above IN RETURN FOR THE PAYMENT OF THE PREMIUM,AND SUBJECT TO ALL THE TERMS OF THE POLICY,WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY PROPERTY COVERAGE TOTAL LIMITS OF INSURANCE Buildings $0 Business Personal Property $5,000 Business Income&Extra Expense Actual Loss Sustained Not Exceeding 12 Months Other Endorsements See Schedules LIABILITY COVERAGE General Aggregate Limit(Other than Products-Completed Opt) $2,000,000 Products-Completed Operations Aggregate Limit $2,000,000 Personal&Advertising Injury $1,000,000 EACH PERSON/ORGANIZATION Each Occurrence Limit $1,000,000 Medical Expenses $5,000 EACH PERSON Other Endorsements See Schedules PREMIUM Premium shown is payable at inception Total Premium $1,187.00 POLICY SUBJECT TO ANNUAL AUDIT:Yes The Declarations,Schedules and Forms and Endorsements Make Up Your Complete Policy. Refer to Schedule Of Forms and Endorsements. Process Date:03-26-2018 X-3842 0214 Page 1 of 5 2001X0,0,03.2820181t5ts4OG • • WETMGR2 OP ID: PS • ACORo' CERTIFICATE OF LIABILITY INSURANCE DATE(MM/ 018 ) 09/13/2018 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 She certificate holder Is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. It 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 508-385-2454 CONTACT E.J.McGrath Insurance Agency Edward J.McGrath Insurance PHONEFA% P.O.Box 1003 (A/C,No,Eat):509-385-2454 I p/c,Neg508.395.5991 Dennis,MA 02638 MA I ADD33• INSURER(S)AFFORDING COVERAGE NAIC* INSURER A:Ma pfre Insurance Company 23876 INSURED GWW Construction INSURER B:The Travelers Insurance Co. 01899 Greg Wetmore 93 Pond View Dr INSURER C: Brewster,MA 02631 INSURER D: 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 ADDL SUB0. POLICY NUMBER POLICY EFF POLICY EXP LIMITS ITR INSR Hewn (MM/DDR•YYYI (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE X OCCUR 8008030011865 12/29/2017 12/2912018 PREMISES(Ee occurrence, f 100,000 Business OwnersMED EXP(Any one person) S 5,000 _ PERSONAL&ADV INJURY f GENII AGGRE,A T'ELIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 I POLICY 15EaT n LOC PRODUCTS•COMP/OP AGG 3 2,000,000 OTHER' S COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea aaldentl ANY AUTO BODILY INJURY(Per person) — S OWNED SCHEDULED _ AUTOS ONLY _ AUTOS BODILY INJURY(Per accident) (PednDAMAGE AUTOS ONLY _ AUUpµ WOLpp errwet) f - $ _ UMBRELLA LIAR _ OCCUR EACH OCCURRENCE EXCESS LIA9 CLAIMS-MADE AGGREGATE S DED RETENTIONS S B WORKERS COMPENSATION PER X ERTH- AND EMPLOYERS'LIABILITY 6HUB1K240997 03113/2018 0311112019 100,000 ANY PROPRIETOR/PARTNER/EXECUTIVE EXCLUDED?ECMO NIA EL.EACH ACCIDENT S (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 N yes,describe under 500,000 DESCRIPTION OF OPERATIONS below EL DISEASE•POLICY LIMIT S PROPERTY 5,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached N mere apace is required) CERTIFICATE HOLDER CANCELLATION HATCGO1 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE Gordon Hatch CCORDANCEWIITHTHEP CYPROVISIONSDATE THEREOF, E WILL BE DEUVERED IN 175 Searsvilie Road S Dennis,MA 02660 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD • • • .44C11005ta OMIT IMM DD YYYYI CERTIFICATE OF LIABILITY INSURANCE 3/12/2018 THIS CERTIFICATEIS 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 con ttACr NAl.1E PAYCHEX INSURANCE AGENCY INC PHONE IAC.xo.Eu, (AC.Nui (888) 443-6112 210705 P:pF: (888) 443-6112ADDdEa1 PO BOX 33015 INSURENIO)AFFORDING COVERAGE NAe} SAN ANTONIO TX 78265 NSURERA „_ WORM. MEURER B mSURER C A AND E FORMS, INC. iNSURERO 32 GENERAL HOLNAY RD INSURER F SOUTH YARMOUTH PIA 02664 INSURLRP 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. l\SR n"PE Of L\S'PRE\t' ADD(MDRPILNTLTF ITR Ash RID PILRT'.\[lll)YR ,fIVDD 1l_IT PULR'1'E'YP LEVITY 11tV1)D1lTH COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS.MADE OCCUR DAMAGE TO RENTED -- PREMISES(Ea omanencel MED EXP(Any one person) PERSONAL S ADV INJURY ) GENT.AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE POLICY PRO- ' JECT❑ LOC PRODUCTS-COMP/OP AGG OTHER. AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ica accident) ANY AUTO BODILY INJURY(Per penton) 7 OWNED —SCHEDULED _ AUTOS ONLY AUTOS I BODILY INJURY(Per accident) HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY _ AUTOS ONLY Pe accident, UMBRELLA UAB OCCUR I EACH OCCURRENCE EXCESS LAB CLAIMS-MADE AGGREGATE DEC RETENTIONS -- , R'UP.4Y91 NNPEIECRU.\ PER OIN. .E\ULNno)IFSLL,aRM - STATUTE EA ANY PROPRIETORIPARTNEWEXECUTVEYM E L EACH ACCIDENT OFFICER/MEMBER EXCLUDED' SOO, OOO A (NalldtloryH NN) ❑ MAA - _ • - EL DISEASE-EA EMPLOYEE'500, 000 It yes.describe under DESCRIPTION OF OPERATIONS ONow EL DISEASE-POLICY LIMIT `500, 000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHILpBLRD 101,Additional Remarks Schedule,may be attached If mon space is required) Those usual to the Insured's Operations. CERTIFICATE HOLDER - - CANCELLATION I euros m Amy r.r T,.p- .......- ..---"1 KLINMAI 11P ID• I • A4.....--- CERTIFICATE OF LIABILITY INSURANCE DATE(MM DD YYYV) 12/12/2017 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 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(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 508-398-6060 2Up,CT Dennis Office Bryden&Sullivan Ins Agency PHONE 508.398.6060FAX of Dennis Inc. INC,No,EMI: I INC,No):508-394-2287 485 Route 134,PO Box 1497 lnc bas: So.Dennis,MA 02660 Dennis Office INSURERIS)AFFORD/NO COVERAGE NAIC0 INSURERA:NGM Insurance Company 14788 INSURED Matthew D Kline INSURFR B,The Hartford 22357 324 Oak Street Harwich,MA 02645 INSURER C: INSURER 0: INSURERS: 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 ADOL SUB I POLICY EFF POLICY EXP ITR TYPE OF INSURANCE loan wvO POLICYNUMBERIMMInYYYL,IMMInnrerm LIMITS A COMMERCIAL GENERAL LIABILITY IffEACH OCCURRENCE $ 1,000,00 1 CLAIMS-MADE E OCCUR I IMPT1893T 10/28/2017 10/28/2018 _DAMAGE TO RENTED 4 600,00 X Business Owners I MED EXP(Amon.person) $ 10,00 I PERSONAL&ADV INJURY $ 1,000,00 GE all AGGREGATE LqMOIT.APPLIES PER I GENERAL AGGREGATE $ 2,000,00 POLICY n JEC7 fl LOC ( PRODUCTS-COMP/OP AGG $ 2,000,00 OTHER* I $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT -(E&Agiden0 S AANY AUTO BODILY INJURY(Per person) $ III' AUTOS ONLY WNED -t SCHEDULEDTTNOy.JEBODILY INJURY(Pet accident) $ • III, AUTOS ONLY _ AU70n ONLQ PprLa,a�R�DAMAGE $ �1 S UMBRELLA LAB _ OCCUR EACH OCCURRENCE $ EXCESS UAB CLAMS-RADE I AGGREGATE $ DED RETENTION$ S B DPL �RSONPER STATI TF 0TH • ER AND 08WECAAOBVK 11/16(2017 11/16/2018 E.L EACH ACCIDENT S ANY PROPRIETOR/PARTNER/EXECUTIVEtri 100,00 OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NM) E.L.DISEASE-EA EMPLOYEES 100,00 If yes,describe under 500,00 DESCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT $ l DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional R.nrrks Schedule,may be attached If mon space l.required) CERTIFICATE HOLDER CANCELLATION HATCHGO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Gordan Hatch Hatch Restoration 175 SearSvllle Road AUTHORIZED REPRESENTATIVE Dennis,MA 02660 KUILU CA JCA tA-zi _ f e ACCornal CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 12/13/2017 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 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: !tithe certificate holder is an ADDITIONAL INSURED,the policyges)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 apizzo NBA INSURANCE AGENCY INC NAME: D(7d)871-5 PHONE FAX W6 NO FxtP (787)871-5414 (A/C,Ne): DDREas: tc@nbainsurance.com 145 WASHINGTON ST INSURER(S)AFFORDING COVERAGE NAICS NORWELL MA 02061 INSURER A: HARTFORD UNDERWRITERS INS CO 30104 INSURED INSURER B: FARRELL PAUL INSURER C: INSURER D i PO BOX 1011 INSURER!: DENNISPORT MA 02639 INSURER F: COVERAGES CERTIFICATE NUMBER: 222207 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. NOTIMTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT%ATH 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 ADDL SUeR - LTR TYPE OF INSURANCE MD 1WD POLICY NUMBER IMM/DDYEFF PM /YYYY) fMM/O POLICY EXP PA)DIDD/1'Yyp LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S CLAIMS-MADE ❑OCCUR DAMAGE rO RENTED PREMISES(Ea occurrence) $ MED EXP(My one person) $ _ N/A PERSONAL SADV INJURY $ _ GEM.AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ _ _ POLICY O jEaEll LOC PRODUCTS-COMP/OP AGG_ $ _ OTHER: y AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S (Ea epcidenn _ ANYAUTO BODILY INJURY(Per person) $ _ ALL SED _ SCHEDULED N/A BODILY INJURY(Per accident) $ HIRED AUTOS NON-0WNED PROPERTY DAMAGE _ AUTOS (Per accident) S _ S UMBRELLA UAB _ OCCUR _EACH OCCURRENCE S EXCESS LAB CLAIMS-MADE N/A AGGREGATE S DED RETENTIONS S WORKERS COMPENSATION �/ AND EMPLOYERS'UABILITY YIN X STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE RIrS E.L.EACH ACCIDENT S 500,000 A OFFICERM,EMBEREXCLUDED7 UM N/A N/A 6S60UB7H80588117 12/03/2017 12/03/2018 (Mandatory In NH) E.L.DISEASE•EA EMPLOYEE $ 500,000 S yea,describe uMer DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attecMd If more space Is resins) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees In states other than Massachusetts If the insured hires,or has hired those employees outside of Massachusetts. This certificate of Insurance shows the policy in force on the date that this certificate was Issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance. The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/hvd/workers-compensationfinvestigationst FARRELL PAUL has elected coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Hatch Restoration ACCORDANCE WITH THE POLICY PROVISIONS. 175 Searsville rd AUTHORIZED REPRESENTATIVE ca,f Ct- S Dennis MA 02660 I Daniel M.Cr y,CPCU,Vice President—Residual Market—WCRIBMA ®1988.2014 ACORD CORPORATION. All rights reserved. - y TOWN OF YARMOUTH �; °a HEALTH DEPARTMENT • o t; PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To bG complgled by Applicant:�/,.� Building Site Location: '/ G c�INPi J WAt /" Proposed Improvement: £iSet £cs &t 'c, &j rr � t.,., I S t rtiF 2 Fly t2 / -f_Tot(-c _cog Applicant: a,L.,i((r��' tea. //' £ Sog 4 � Tel. N .: g Address: /7 S J i °;ii t 144- �.a2/ut►I Date Filed: /0—/4—IS * Ifyou would like e-mail nolificalion of sign off please provide e-mail address: Owner Name: ib/t1iV fl �� h6tvt-zi / Owner Address: `{Z J `61,Q)S4 L✓e-af Owner Tel. No.:10& ?9' O`Zje9 RESIDENTIAL AND/OR COMMERCIAL BUILDING HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. Please submit three (3) copies of plans, to include: (1.) Site Plan showing existing buildings, water line location, and septic system location; (2.) Floor plan labeling ALL rooms within building (all existing and proposed)— Note:Floor plans not required for decks,sheds, windows, roofing; (3.) If necessary, Title 5 application signed by licensed installer with fee. REVIEWED BY: DATE: /°42-ah 6 PLEASE NOTE COMMENTS/CONDITIONS: / T• Vete cr adC fi ?- �.-e7 / -do e‘41 (/‘ 13 styli t rout( c,Sc To ! -v f-c l3-et rcr CA-d — Z bout.fru 3 Le -- 11 inn•-(_,C C L tot!raw c►oct 'ti ,>1 5r4/9t c do /04L/18 • Sears, Tim From: Sears,Tim Sent Thursday, November 1, 2018 9:38 AM To: 'hatchrestorations@com.net Subject: 42 Standish Way Corte/1/2S ) •h Gordon, I have reviewed your application for 42 Standish Way,and this property is located in a flood zone.We are going to need the flood elevation shown on the site plan. If the slab is below the flood elevation,then we would need updated plans showing compliance with the 9`"Edition of the Building Code. Thank you Timothy Sears CBO Building Inspector Town of Yarmouth 508-398-2231 Ext. 1259 mailto:tsears@yarmouth.ma.us • • 1 • 01.yqR TOWN OF YARMOUTH ' fki ` ° WATER DEPARTMENT _' '4 99 Buck Island Road vvirco West Yarmouth, MA 02673 .:::. Telephone: (508) 771.7921 . • Fax: (508) 771-7998 . BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET Bldg. Site Location y� z/ 14''(11 - I la— t 1 Proposed Improvement: �Q' /�dL. &C27' (j�q,q � Applicant: "�__ SAY"`_““" ( `` �� Address pi S L9f(irt, gel), Tel. #: SOS .4.130$___ Date Filed: /0 r /G /9 RESIDENTIAL AND / OR COMMERCIAL BUILDING Water Department: Determines Compliance of Water Availability and or Existing Location Engineering Department: Determines Compliance for Parking and Drainage Conservation Commission: Determines Compliance to Wetlands Acts; i.e. If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Ocean, Bogs, Bays, Marshland, Etc... Health Department: Determines Compliance to State and Town Regulations, i.e., Requirements for Septage Disposal and other Public Health Activities Fire Department: Determines Compliance to State and Town Requirements for Personal, J � Safety, Property Protection;, i.e. Smoke Detectors, Sprinkler Systems, Etc... .-/( -- / /6— �' Signature of applicant Date PLEASE NOTE: COMMENTS: Reviewed by:Water Division Date a Office of Consumer Affairs& Business Regulation- Mass.Gov Page 1 of 2 .Mass.gov Office of Consumer Affairs and Business Regulation (OCABR) HIC Registration Complaints Registration # 130856 Registrant GORDON HATCH Name GORDON HATCH Address 175 SEARSVILLE RD. City, State Zip SO. DENNIS, MA 02660 Expiration Date 04/27/2020 Complaints Details No complaints found for this registrant. You can also view arbitration and Guaranty Fund history. Back To Search Site Policies Contact Us https://services.oca.state.ma.us/hic/licdetails.aspx?txtSearchLN=130856 10/30/2018 A. �, co/c; °o. / e //j \3s,83�� billt *4V / / ° 19.69' \ /i // \�'9P . ''S `� \'c•‘ 114 C��� / °° 10.84' ti / A / , /„.„ NCS 19.7T �o 1':: `.,!'� t7.85' /›/\ \�� A •�• 11 k•- r , / \ / ." /' >`�`. `` o°o 35.78' / °°• o t \ <' , / • \ ,0 17.89' . $ RECEIVED N\ v;/ \ o°' /,�'° OCT 222018 ,� . 5 'ILII ` `.: ,' / I (�i► /. HEALTH DEPT. 19.69' iII1I��`.'" SEPTIC LOCATION ,y PER AS BUILT PLAN PROPOSED CONDITIONS oo. 35.78' 1°0°° CERTIFIED PLOT PLAN OF LAND IN YARMOUTH, MASS. 19.73' AS PREPARED FOR DONNA HORAN !°o. °°° T0: DONNA HORAN PLAN REFERENCE— ON THE BASIS OF MY KNOWLEDGE & PL.BK.47 PG.113 �;,, '�) �► INFORMATION, I FIND, THAT ASA i OEM 7.25 RESULT OF A SURVEY MADE ON THE PLAN SCALE— 1 =20 . 0" °s - LOT 212-213 �' 6' a PAUL GROUND TO THE NORMAL STANDARD DATE DRAWN— 10/14/18 �° `10.. 10,100 SQ. FT. ± OF CARE OF PROFESSIONAL LAND REVISED— 10/16/18 sw TSE 0.23 ACRES ± i ^,0 044. 402.00 PERIMETER �� SURVEYORS PRACTICING IN THE 4 �o °rt COMMONWEALTH OF MASSACHUSETTS, t,. ��Nbsu °P D SURVEY/ EXISTING CONDITIONS THE LOCATION OF BUILDINGS ARE AS SHOWN HEREON. FILE: 2379-00 10/16/18 .° . F.B.: EFB PAUL E. SWEETSER NOTES— PROF. LAND SURVEYOR DATE PROFESSIONAL LAND SURVEYOR REV. DATE— P.O. BOX 1146 DENNISPORT, MA 02639 / 1 \` k Vcods ‘ / 1 00 i +Iolli .T,� 4 // CfN G*. °O.IIIIIIIII ,,c, . Q J 0. S' // 4;"‘ / • c^ rJ //7 o X8.83' 1110 �, / j/ 0 19.69' \ // // \ \ Ills p \ 9} CJ 1�096 10.84' ti \ �j / oo I ��°o \\ \ \ r 43° ►� 19.77' 4 <o Air , zi/`\ •II ��`>`' (Ito 1.90° 17.85' Q o j// a X8.83' + / \ 4 / \� 9} N I\ �°0. 35.78' / mod \ 1 \ \ \ ,° 17.89' $ \ • \ // O° jb�oo°o SI / 19.69' III PROPOSED CONDITIONS r N. 7. ,�°o. 35.78' 100°° CERTIFIED PLOT PLAN OF LAND IN YARMOUTH, MASS. 19.73' AS PREPARED FOR DONNA HORAN ,�°°. v )°�o T0: DONNA HORAN PLAN REFERENCE— ON THE BASIS OF MY KNOWLEDGE & PL.BK.47 PG.113 11I �► INFORMATION, I FIND, THAT ASA P..0OFAFASS 7.25 RESULT OF. A SURVEY MADE ON THE PLAN SCALE— 1 "=20' a4 PAUL -74. LOT 212-213 6 GROUND TO THE NORMAL STANDARD DATE DRAWN— 10/14/18 t� �, yt 10,100 SO. FT. ± OF CARE OF PROFESSIONAL LAND 3 sw Ts .41 0.23 ACRES ± \ \ �SURVEYORS PRACTICING IN THE �` a' . sna 402.00 PERIMETER ,Pess'°re 4 COMMONWEALTH OF MASSACHUSETTS, Noauxt THE LOCATION OF BUILDINGS EXISTING CONDITIONS WORK MUST CONFORM TO ALL ARE AS SHOWN HEREON. T Y� & EGULATIONS3 ""� _ FILE: 2379-00 ���� Q.st 10/14/18 F.B.: EFB PAUL E. SU YARMOUTH WATER DEPT DATE NOTES— PROF. LAND RVEYOR DATE PROFESSIONAL LAND SURVEYOR REV. DATE— P.O. BOX 1 DENNISPORT, MA 02639 / / / •��� •/ / ,°°°° 4, it ® / O �� x .,``�� '�. • / / / e \N , 1� �°` 9.56. ( :,Q o. ��� z / \ G,, /// 9.53 �,%.`�3&yg,,3iy^` / / 19.69' x/9..26 / J2 ' i ,�`�3\' ���$ / // °d 0 / :\t. �' ;',1- ,/ \�� •• 0111) 0 4.02 °° 10.84' 4 \ , 8.91`. `oo° °o, \ . / ^;*22 0. 5. {L" x ¶.8c4a0 19.77' , `� `v 9.97 �iF°© ``\ ``` 9.56t °e° G� ``v x7.95 / cy- 7.06,7.85' Q GP/9/ PROPOSED TOP / ` ' y ` 4 OF SLAB ELEV. �// 9.53 X3883i rt. =11.5' / ��� 4.02 0°0, 6.92 35.78' No°o° 4 / / \ •�:• 8.9)``. `� 1' 17.89' °o \ \`.� " /' ► N ^ *22 4 5.64 ort1 6.51 yo ,II� �i�\?GF' \`` i ' II 9�< III* �+` es v SLP IIIA 7.06 SEPTIC LOCATION NI19.69' PER AS BUILT PLAN PROPOSED CONDITIONS ,if000e 6.92 35.78' ,°o°° CERTIFIED PLOT PLAN OF LAND I i 4• ARMOUTH, MASS. 4. 19.73' 4 AS PREPARED FOR DONNA HORAN ,o�44 6.51 �g'�°°° TO: DONNA HORAN PLAN REFERENCE- 7'25 ON THE BASIS OF MY KNO WLEDGE & PL.BK.47 PG.113 111 ► INFORMATION, I FIND, THAT AS A J.56k a4RESULT OF A SURVEY MADE ON THE PLAN SCALE- 1 "=20' o+� PoF LOT 212-213 GROUND TO THE NORMAL STANDARD DATE DRAWN- 10/14/18 /� •� tA 10,100 SQ. FT. ± OF CARE OF PROFESSIONAL LAND ?- 0.23 ACRES ± \ i ai da, - + "i 402.00 PERIMETER \ - 4 54 SURVEYORS PRACTICING IN THE o� ��, COMMONWEALTH OF MASSACHUSETTS, :4N�Ro��; EXISTING CONDITIONS THE LOCATION OF BUILDINGS ARE AS SHOWN HEREON. FILE: 2379-00 10/14/18 çIIi..c2!i4.i.Jk. F.B.: EFB PAUL E. SWEETSER NOTES- PROF. LAND SURVEYOR P.O. BOX 1146 DATE PROFESSIONAL LAND SURVEYOR REV. DATE- /1 3 is DENNISPORT, MA 02639 6 / /)c ac / 1�o tiV�� / / , A C.,.ss' c • ('' 0. S' / ,/// a8 , ,, ���1� / j// 19.69' \ / �� \,;' ,'S, ` �� 9° crk v r\°° 10L111" 84' ti ,< 19.77' 0. ( b 49;4)6 6) �p �`\ �\, �O 'Oi p9° F. S` i />/\ , ` ,S j VIll lit o° 17.85' Qom° _ 1 83n 1111 (� n �` \'' .' 4' 4, // / `V�� o. . °0 35.78' °o 17.89' / 1 \\ <;`` <\, S 'NA' . \ '°°$, �o RECEIVED \ e OCT \2! 2 2018 �"I' ��111 / 11 ► HEALTH DEPT. 19.69' 1011111:\eY SEPTIC LOCATION y PER AS BUILT PLAN 7. PROPOSED CONDITIONS R�`t°o°, 35.78' °°�° CERTIFIED PLOT PLAN OF LAND IN YARMOUTH, MASS. '` l s.73' 4 AS PREPARED FOR DONNA HORAN /�°o. :49 T0: DONNA HORAN PLAN REFERENCE— D ON THE BASIS OF MY KNOWLEDGE & PL.BK.47 PG.113 1► INFORMATION, I FIND, THAT AS A �/,_ LOT 7.25 I. 6' RESULT OF A SURVEY MADE ON THE DATEPLAN DRAWN—CLE— 1 ," 14 18 ���tHOF�gssN. �`G� to loo 212-213 T. ± / GROUND TO THE NORMAL STANDARD / / moo/ PAU 0.23 ACRES ± N. /� OF CARE OF PROFESSIONAL LAND REVISED— 10/16/18 S,, ER N 402.00 PERIMETER N�/// SURVEYORS PRACTICING IN THE i"'/ , . s'�044� COMMONWEALTH OF MASSACHUSETTS, `� �FESS��:p EXISTING CONDITIONS THE LOCATION OF BUILDINGS \f4, Ess tj ARE AS SHOWN HEREON. l�"�' FILE: 2379-00 10/16/18 c�� _ F.B.: EFB PAUL E. SWEETSER NOTES— PROF. LAND SURVEYOR DATE PROFESSIONAL LAND SURVEYOR REV. DATE— P.O. BOX 1146 DENNISPORT, MA 02639 Office of Consumer Affairs & Business Regulation-Mass.Gov Page 2 of 2 ©2018 Commonwealth of Massachusetts. Mass.Gov® is a registered service mark of the Commonwealth of Massachusetts. https://services.oca.state.ma.us/hic/licdetails.aspx?txtSearchLN=130856 10/30/2018 , S. ® / illr v\ lir; / / 2 ION xRI ° 1,. / / 7/ \ c �\ /� t"' 9.56 <�?>‘4.V �•, '<O> j // \ GJ`S' ,// 9.53 /' 38,,83ir\ �) / 19.69' x13.26 / \ ;�P2�'' ,' ' '3,��'\ �� ' / / o° F 0 / %� \<,�' L ' *22 4.02 10.84' tico 8.9)``o. 5. o. ^.` // . . `A x '.84a0 19.77' `, V 9.97 5�° <‘\ �` �` / {�•' ° 1iii1111te °i O \ °Qo�G�' , , x 7.95�/\ 9.56 \\ .may^ III.. V r��a° 2 °• ' ,7.85' Q Gp -.06 PROPOSED TOP • OF SLAB ELEV. // 9.53 �3$ 87x `� �, =11.5' x13.26/ ��%4'' � ••,3�`\` ASe 4.02 �o°o, 6.92 35.78' 1°°6 A. ./ , ° i . •i 8.91`. , 17.89' 4 / \ . \ `� ```��7 ' \ I 1Sr 11 1111 \C\ \;`��� 7.22 // 5.64 O.1Glj °6.51 tat I��I `. •i .. / II y>X� I'► 19.69' 0 7.06SEPTIC LOCAnON 4, 111)1 PER AS BUILT PLAN PROPOSED CONDITIONS "\\ °oo. s.s2 35.78' °o°° CERTIFIED PLOT PLAN OF LAND I i 4'1 ARMOUTH, MASS. 9/�l btlo0"� ,0 19.73' o 4 1 AS PREPARED FOR DONNA HORAN 4 �0 �� "b a. `Gil s.51 k.? TO: DONNA HORAN PLAN REFERENCE— , THE BASIS OF MY KNOWLEDGE & PL.BK.47 PG.113 .4< 12,192/ , 7 25 ` Ile 5.95 INFORMATION, I FIND, THAT AS A ✓,- (1� RESULT OF A SURVEY MADE ON THE PLAN SCALE— 1 "=20' �,��of�u�. LOT 21 —213 /. 6 GROUND TO THE NORMAL STANDARD DATE DRAWN— 10/14/18 /4G.� PAUL ' 10,100 SQ. FT. ± OF CARE OF PROFESSIONAL LAND (o A ) 5 �`' 0.23 ACRES ± \\ , 3 stir !rR 402.00 PERIMETER •• 4.54 SURVEYORS PRACTICING IN THE y0. 44 j ' COMMONWEALTH OF MASSACHUSETTS, 4' P.FFSS\O�c" K- EXISTING CONDITIONS THE LOCATION OF BUILDINGS 0suRvt�d ARE AS SHOWN HEREON. FILE: 2379-00 s F.B.: EFB PAUL E. SWEETSER 10/14/18 ç?. $? .IO.CR.dNOTES— PROF. LAND SURVEYOR DATE PROFESSIONAL LAND SURVEYOR REV. DATE— ii/5traP.O. BOX 1146 DENNISPORT, MA 02639