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Bld-20-001034 ` •��.'' 0 f Permit# O . : y `3 Amount ' TTAGH CS[ � ',' Y°°"""�� Permit expires 180 days from B _, I LQ 3y j issue date W EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH RECEIVED x aruiouth Building Department 1146 Route 28 L,__kUG 2 3 2019 South Yarmouth, MA 02664 (508) 398-2231 Ext. 1261 B 04___,'et ' CONSTRUCTION ADDRESS: ais— 6d/i/41/0i0" ,,Adlo ASSESSOR'S INFORMATION: Map: Parcel: OWNER: �a4 09 L4Ld/ver _e9.1fe it/.J-�.3--Z //7 NAME ! �/"" PRESENT ADDRESS TEL. CONTRACTOR: )4 ,,i,J 'xis, /f%A0,q,Zelo), 0, /A.v.ho ��i �,?,6/Z6�NAi� / MAILING ADDRESS TE .# 1sidential 0 Commercial Est. Cost of Construction S Ce O 4v, d Home Improvement Contractor Lie.# 4 3' „5.--z 7 Construction Supervisor Lic.# AOd Workman's Compensation Insurance: (check one) 0 I am the homeowner 0 I am the sole proprietoret/ e Thave Worker's Compensation Insurance Insurance Company Name: 1f771A/re C'2,rei 1 ! Worker's Comp.Policy# A/Gs f 00/.74 I p e7 WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove Siding: # of Squares Replacement windows: # Replacement doors: # Roofing: t? 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: /iv/t les! —4 cr Loc ion of acilitty 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: VZ 3f17 Owners Signature(o a ach ent) . Date: Approved By: Date: 4/3 V/ uilding 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 • 1 RISE ENGINEERING" OWNER AUTHORIZATION FORM I, Donna Lowney (Owner's Name) owner of the property located at: 24 Wharf Lane (Property Address) Yarmouthport, MA 02675 (Property Address) hereby authorize CapG CA 1 k s v I 44-1 c" (Subcontra&tor) 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 L.„ 19 Date RISE Engineering, a Division of Thielsch Engineering, Inc. 5 Dupont Avenue I South Yarmouth, MA 02664 1508-568-1926 www.RlSEengineering.com .A, CAPECOD-27 THORNE ..--- CERTIFICATE OF LIABILITY INSURANCE °ATE`MM'°°"YYY' 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 the certificate holder Is an ADDITIONAL INSURED,the pollcy(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 Ileu of such endorsement s), ! PRODUCER C TACT Good 'Rogers&Gray Insuranco Agency, Inc. PhONE 434 Rte 134 FAx South Dennis, MA 02660 (A c,No,Ext):(800) 553-1801 (NC,No):(877) 816-2156 miss,mail@rogersgray.com INSURER(S)AFFORDING COVERAGE NAIL a INSURER A:West American Insurance Company 44393 INSURED _ INSURER B:Arbella Protection Insurance Company, Inc. 41360 _ Cape Cod Insulation, Inc. INSURER c;Endurance American Spoclalty Insurance Company 41718 18 Reardon Circle South Yarmouth, MA 02664 INSURER D;Atlantic Charter Insurance Company _44326 INSURER F.: L INSURER F; _----- --j COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: y 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.IN$R ADDL SUER T TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF POLICY EXP A X COMMERCIAL GENERAL LIABILITY (MMInD/YYYY) ft,�Ml��� rl '1• LIMITS EACH OCCURRENCE $ 1,000,000; CLAIMS-MADE L XIOCCUR BKW 53328281 4/1/2019 4/1/2020 DAMAGE TO RENTED 100,OO1)' -'�EWIES_(Easc_CVfronce) $._ I MED EXP(Any one parson) 1$_____ 15,000, J PERSONAL 4A vINJURY $ 1,000,000,: GGEEN'L ADORE,GGG E LIMIT APPLIESPER: SENERALAGGREGATE $ 2,000,OOOj 1C I POLICY 1 Fite' _l LOC _ I I OTHER: PRODUCTS-COMP/OP AGG $ '. 2,000,0D0' s�AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000' _(Fa accident) $ ANY AUTO 1020081008 4/1/2019 4/1/2020 • OWNED I SCHEDULED BODILY INJURY(Par parson) $ X )AUTOS ONLY X )AUTOSSWN BODILY INJURY(Per occident) $ _�IVOS ONLY X OS ON1Yp * PROPERTY DAMAGE _(Per accident) $ I i C UMBRELLA LIABX OCCUR $ • EACH OCCURRENCE $ 2,000,000! I X EXCESS LIAB CLAIMS•MADE EXC10006635004 4/1/2019 4/1/2020 --_I DOD I I RETENTION$ AGGREGATE 2,000,0001 D WORKERS COMPENSATION ."'i._- AND EMPLOYERS'LIABILITY • PER OTH- ANY PROPRIETOR/PARTNER(EXECUTIVEsTALUIE Y'N WC100136900 6/30/2019 6/30/2020 1,000,000i - ER ________ OFFICER/MEMgER EXCLUDED? N/A E.L.EACH ACCIDENT $ (Mandatory In NH) 1,000,000 yes,describe Under E.L.DISEASE•EA EMPLOYEE- DcSCRIPTION OF OPERATIONS below E.L.DISEASE-POLITY LIMIT $ 1,000,0001 / J DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more space Is required) • CERTIFICATE HOLDER 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 ` -,--,,,..„,:i,2 7 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION, All rights reserved, The • 1,4A t r r •t�' ,'r ra The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www,mass.gov/dla Workers' ompensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Utibly Name (Business/Organization/Individual): Cape Cod Insulation Inc. Address: 18 Reardon Circle City/State/Zip: South Yarmouth, MA 0266'4 Phone #: 508-775-1214 Are you an employer?Check the appropriate box: � 4, t Itm a �enerui contractor and I Type of project(required): I.M I am a employer with 48 ❑ b employees(full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2.❑ l am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition workingfor me in anycapacity. employees and have workers' P b 9, ❑ Building addition (No workers' comp. insurance comp. insurance.: required.) 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3,❑ 1 am a homeowner doing all work officers have exercised their 1 1.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152,§1(4),and we have no Weatherization employees.[No workers' 13. Other comp. insurance required.) 'Any applicant that checks box NI 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. • ;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. it•the sub-cvntraourm have employees,they must provide their workers'comp.policy number. l am 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 ri or Self-ins.Lic.#: WCIQ0136900 Expiration Date:06/30/2020 ' Job Site Address:21- 4J/ifigIC tom �U 044 41'1 d 0/4 City/State/Zip: irk 4 0 4 6 - Attach a copy of the workers' compensation polic(eciaration'page(showing the policy number and expiration date), failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a line 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. Be advised that a copy of this statement may be forwarded to the Office of Investi'anions of the,DIA for insurance coverage verification, l do hereby certify under the pains and penalties of perjury Thai the information provided abort%is true and greet. S ignatur5; 14447a-a4" Date: 4// I — Phony ii: 508-775-1214 J Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/Licease tt Issuing Authority(circle one): I. Board of Health 2. Building Department 3.City/Town Clerk 4, Electrical Inspector 5. Plumbing Inspector• 6,Other • • Contact Person: Phone#: 1 • Commonwealth of Massachusetts Division of Professional Licensure Board of Building•Regulations and Standards Construettd ISOpervlsor • CS-100988 .(,���x"-Jy( S:XJpires: 11/11/2019 ,` 11 C(f;Td to ! 14 Ips, HENRY E CASSIDY {� ',� ; • 8 SHED ROW=^ 1� t�k447 WEST YARMOCn HI MA 0y73 � !al I IsI.Iol" Commissioner i L� �l� I../it/2?/>?('%It'l'�CL �� 1177._-7'�/1:i,1Clrr.%C'•��i Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Corporation CAPE COD INSULATION, INC Registration: 153567 • 18 REARDON CIRCLE Expiration: 12/14/2020 SO•YARMOUTH, MA 02664 Update Address and Return Card. Office of ConsumerAffalrs&Business Regulation • HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:Corporation before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 153567 12/14/2020 1000 Washington Street-Suite 710 CAPE COD INSULATION,INC • Boston,MA 02118 it HENRY c.CASSIDY REARDON CIRCLE C,) SO.YARMOUTH,MA 02664 Undersecretary a I Ith t sign r nn. �/! ,l „r 'Y', .. TOWN OF YARMOUTH Building Department Q k BUILDING ,. (508) 398-2231 ext.1261 O ; PERMIT NO BLD 20-001034 PERMIT �' mAtr..,t § 44' JOB WEATHER CARD ISSUE DATE 08/26/2019 • APPLICANT HENRY CASSIDY PERMIT TO New AT(LOCATION) 24 WHARF LN,YARMOUTH PORT MA 02675 1 ZONING DISTRICT R 40 1 Bldg.Type: Residential SUBDIVISION MAP BLOCK LOT :121 47 BUILDING IS TO BE: CONST TYPE V B USE GROUP `R 3 1..M � ....«mow... .HH�.r�»........, .......... .. ...........>...,. ...»,.... ...,..m+ .,v ........,...,.„. ..,.....v..,..,. �. .v....« n ,....w..,„..,....„.,.., .......�...... I REMARKS Repair-Install Insulation(508-775-1214) € CONTRACTOR LICENSE 1153567 ;Home Improvement ' ';CAPE COD INSULATION, INC HENRY CASSIDY ' 18 REARDON CIRCLE AREA(SQ FT) 1 081 551 24` EST COST($) £600 00 1 PERMIT FEE($) 135.00 S0 YARMOUTH, MA 02664 OWNER jDUMAS LINDA G BUILDING DEPT BY ADDRESS !C/O GRANT JACK, 161 MAIN ST ' I IYARMOUTH PORT IMA 102675 4 1Q (/ O E 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 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. OCCUPIED UNTIL FINAL INSPECTION HAS OCCUPANCY 4)REFER TO DETAILED INSPECTION BEEN MADE. SCHEDULE 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 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.