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HomeMy WebLinkAboutBld-20-000861 4 rywied , I i 5- ,, , TOWN OF YARMOUTH Building ng39 2 Department1 ex BUILDING ILA �: i PERMIT3 y: PERMIT NO BLD 20 000861 MAttACllt ' ISSUE DATE 08/15/2019 JOB WEATHER CARD APPLICANT HENRY CASSIDY PERMIT TO New AT(LOCATION) 1115 WINDMILL LN,WEST YARMOUTH MA 02673 ZONING DISTRICT Bldg.Type: Residential SUBDIVISION MAP BLOCK LOT [0[20.51 —I BUILDING IS TO BE: CONST TYPE `IV BIIII USE GROUP IR 3 . REMARKS Repair-Install Insulation(508-775-1214) CONTRACTOR I ` ' LICENSE :153567 � � s 'Home Improvement 1 ):CAPE COD INSULATION, INC , `'HENRY CASSIDY _,... m .._ 18 REARDON CIRCLE AREA(SQ FT) 1 322 561 800) EST COST($) [8000.00 1 PERMIT FEE($) €35 00I ISO YARMOUTH, MA 02664 OWNER DELANEY WILLIAM J � I BUILDING DEPT BY ADDRESS :DELANEY DIANE J,50 HIGH ST 'STONEHAM IMA 102180 I 134cicLIChi z.... M_.n.�_ .._.a.. _.,....,. .. .. THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWAL /ft7HONE R ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY ERMITTED 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 THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM INSPECTIONS REQUIRED FOR ALL APPROVED PLANS MUST BE RETAINED ON WHERE APPLICABLE CONSTRUCTION WORK: 1)FOUNDATIONS OR JOB AND THIS CARD KEPT POSTED UNTIL SEPARATE PERMITS ARE FOOTINGS.2)PRIOR TO COVERING STRUCTURAL FINAL INSPECTION HAS BEEN MADE. REQUIRED FOR ELECTRICAL MEMBERS(READY FOR LATH OR FINISH WHERE A CERTIFICATE OF OCCUPANCY IS PLUMBING/GAS AND COVERING)3)FINAL INSPECTION BEFORE REQUIRED,SUCH BUILDING SHALL NOT BE MECHANICAL INSTALLATIONS. OCCUPANCY 4)REFER TO DETAILED INSPECTION BEEN MAD UNTIL FINAL INSPECTION HAS BEEN MADE. SCHEDULE POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTIONS APPROVALS OTHER: 1 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 CAN BE ARRANGED FOR BY TELEPHONE APPROVED THE VARIOUS SIX MONTHS OF DATE THE PERMIT IS ISSUED AS OR WRITTEN NOTIFICATION. STAGES OF CONSTRUCTION NOTED ABOVE. riPermit# Amount •.•r— w ` MATTACn CSEJ� � `°^an..w"'� `Permit expires 180 days from issue date EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Y arn1outin nunamg Department 1146 Route 28 South Yarmouth, MA 02664 AUG 14 2019 (508)398-2231 Ext. 1261 B. i By: CONSTRUCTION ADDRESS: /r / //f j/) � er ASSESSOR'S INFORMATION: Map: Parcel: OWNER: W/ill iof „Pey ti ,'7? ,U 3 Y' / NAME / PRESENT ADDRESS TEL. # CONTRACTOR:C°,4,69 r'd /J'ipl677DN 7f, �J*,v C'i� /�/1��,�i i �'� 77. / ` - NAME MAILING DRESS esidential ❑Commercial Est. Cost of Construction$ d CJ CJ` d Home Improvement Contractor Lic.# fJl �` �� Construction Supervisor Lic.# / d P/'F'Y Workman's Compensation Insurance: (check one) 0 I am the homeowner 0 I am the sole proprietor e 1 have Worker's Compensation Insurance Insurance Company Name: 47--/4 / E2-�, &, e/7' Worker's Comp.Policy# 42(7 2 i/ 7 l 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. ( )Replacing like for like Pool fencing *The debris will be disposed of at: i9/-e�fe,6 71/ 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 or revoc tion of my license and for prosecution under M.G.L.Ch.268,Section 1. Applicant's Signature: Date: 5'1/7 Owners Signature(or attachment) Date: Approved By: Date: Building Offi ' or sign ) EMAIL SS: Zoning District: Historical District: C Yes ❑ 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 s® k; Commonwealth of Massachusetts Division of Professional Licensure Board of Building^Regulations and Standards ConstrmeitIni ItOp4rvisor • CS•100988 ') A E..X,pires: 11/11/2919 HENRY E CASSIDY ti 8 SHED ROW, C # WEST YARM0IIT,ht�14'1p o 073f ` ' t • Commissioner s ?/>?ft%?c'Or(2C>/`�� <�,./t /e)rfZ:JcJ r!Y1(t!r)•1.,��J Office of Consumer Affairs and Business Regulation • 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Corporation CAPE COD IN§U'LATION, INC Registration; 153567 • 18 REARDON CIRCLE Expiration: 12/14/2020 SO,YARMOUTH, MA 02664 o.+.p Up-date Address and Return Card. /,,;, ,/. Offlc©of ConsurnerAffa&re .Business Regulauan HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Corporation before the expiration date, if found return to: RoglstratIpq Expiration Offico of Consumer Affairs and Business Regulation 153567 12/14/2020 1000 Washington Street-Suite 710 CAPE COD INSULATION,INC Boston,MA 02118 r l- r HENRY E.CASSIDY 0.a_ • 18 REARDQN CIRCLE SO.YARMOUTH,MA 02664 Undersecretary a t fth t sign r C 3 Aa CAPECOD-27 THORNE .-- - CERTIFICATE OF LIABILITY INSURANCE DATE(MMIODYYYY) • 7/16/2019 _ 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 tho 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 I this certificate does not confer rights to the certificate holder in lieu of such endorsement(s), PRODUCER ACT Good — Rogers&Gray Insurance Agency, inc. PHONE FAX _. 434 Rte 134 .A/C,No Ext;(800) 553.1801 (A/C,No);(877) 816-2156 South Dennis, MA 02660 • Ats,mail rogersgray.eom INSURER(S)AFFORDING COVERAGE NAIC n INSURER A:West American Insurance Company_ 44393__ INSURED _ INsuRERB:Arbella Protection Insurance Company, Inc. 41360 ._j Cape Cod Insulation, Inc, INSURER C;Endurance American Specialty Insurance Company 41718 18 Reardon Circle INSURER D:Atlantic Charter Insurance Company 44326 ____ _ South Yarmouth,MA 02664 INSURER F.: 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 1 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 ADDL SUER POLICY EFF POLICY EXP _t TYPE OF INSURANCE INSD NWD POLICY NUMBER (MM/pD/YyYYI WMIDDIYYYY1. LIMITS A X COMMERCIAL GENERAL LIABILITY 1,000,000 { CLAIMS MADE j X 1 OCCUR EACH OCCURRENCE I BKW 53328281 4/1/2019 4/1/2020 PR AMSESO RENTED 100,000 j —_ MED EXP(Any one personL $ 15,000 PERSONAL&ADV INJURY S 1,000,000 _GEM.AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,0001 X POLICY r 506QF [ LOC t� __ PRODUCTS•COMP/OP AGG $ 2,000,000 OTHER l3 AUTOMOBILE LIABILITY �- TT COMBINED SINGLELIMIT 1,000,000 _ NE ANY AUTO 1020081008 4/1/2019 4/1/2020 BODILY INJURY(Per person) $ OWNED SCHEDULED _ AUTOS�E ONLY X 1 AUTOS W� BODILY INJURY(Per accident) $ ____ X AUTOS ONLY X A�OS ONLYp ,-, PROPERTY DAMAGE (Per accident) $ df UMBRELLA LIAR X OCCUR _ $ • X EXCESS LIAB CLAIMS MADE EXC10006635004 4/1/2019 4/1/2020 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 i Ir DED RETENTIONS --- D WORKERS COMPENSATION AND EMPLOYERS'LIABILITY STERATUTE FORH ANY PROPRIETOR/PARTNER/EXECUTIVE Y/rl WC100136900 6/30/2019 6/30/2020 1,000,000 (Mandatory OFFICER/MEMBER N EXCLUDED? ( 1 N/A E.L.EACH ACCIDENT $ f yqs,describe under E.L.DISEASE•EA EMPLOYEE 1,000,000 I.. DESCRIPTION<JF OPERATIONS below E.L.DISEASB PPOLICYLIMIT $ 1,000,000 /1 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,AddltIonat Remarks Schedule,may be attached If more space Is required) _ !' CERTIFICATE HOLDE�t . CANCELLATION • SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE For Information Only THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 1 ( ..."----„,...42 7 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION, All rights reserved._, The ACORn names °.+A Inn,, «i..<-- ___..,._ .. .. _ k, a i E l ;� � The Commonwealth of Massachusetts 1 taptihir �° ` e, Department of Industrial Accidents Oa* ,; Office of Investigations -1. 4. 600 Washington Street 3- 1- Boston, MA 02111 lkf Ar . www.mass.gov/dla Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers { Applicant Information _ Please Print Legibly Name (Business/Organization/individual); Cape Cod Insulation Inc. Address: 18 Reardon Circle City/State/Zip: South Yarmouth, MA 0.2664 Phone #: 508-775..1214 Are you an employer? Check the appropriate box: Type of project(required): 1.VI am a employer with 48 4, 0 1 am a general contractor and 1 employees(full and/or part time),• have hired the sub-contractors 6. [_j New construction 2,Q I am a sole proprietor or partner- listed on the attached sheet, 7, Q Remodeling ship and have no employees These sub-contractors have 8, [] Demolition working for me in any capacity. employees and have workers' g ❑ Building addition (No workers' comp. insurance comp,insurance.: required,] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3,❑ I am a homeowner doing all work officers have exercised their I L Plumbing repairs or additions myself. [No workers'comp, right of exemption per MGL 12,0 Roof repairs insurance required.]i c. 152,§1(4),and we have no employees.(No workers' 1334 Other Weatherization t comp. insurance required,] `Any applicant that checks box SI must also fill out the section below showing their workers'compensation policy information. 'Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. • tConrructors 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-cimust:am have employees,they must provide their workers'comp.policy number. I ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and Job site information. Insurance Company Name: Atlantic Charter Policy ti or Self•ins.Lie, #: ,WCi00136900 Expiration Date:06/30/2020 l City/State/Zip: Iv, © 3 G y 3 lob Site Address:A/r P!A/e ni Ili 4 J�id � /dAttach a co of the workers' com ensation olio ration' a e(showing the policy and expiration date). ,�. � � p5' p policy p g p Y p ) failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a tine up to$1,500.00 and/or one-year imprisorunent,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.violatdr.'Be advised that a copy of this statement may be forwarded to the Office of Invesi at'tans of the MA for insurance coverts a verification, --. ----•--- 1 do hereby certify under the pains and penalties of perjury that the information provided aboi4 is true and -)rrect Y7 a Si na : L� % � ZctcF�c _ Mono 4: ,508-775-1214 - Ofrcial 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): I. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector' 6, Other Contact Person: Phone#: DocuSign Envelope ID:4E180DC2-3885 4704-9481-62F15272F93F t4 RISE ENGINEERING OWNER AUTHORIZATION FORM 1, William Delaney (Owner's Name) owner of the property located at: 15 Windmill Lane (Property Address) West Yarmouth, MA 02673 (Property Address) cape cod Insulation hereby authorize (Subcontractor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my property.This form is only valid with a signed contract. Owner's Signature 8/7/2019 I 9:27 AM EDT Date RISE Engineering,a Division of Thielsch Engineering, Inc. 5 Dupont Avenue I South Yarmouth, MA 02664 1508-568-1926 www.RlSEengineering.com