The URL can be used to link to this page

Home My WebLink AboutBld-20-000161 Ivry. 1IY� Orllob Uso Onl( —,H.,:,() l�arn411H �- � I Amo�ril 1 Parmli c��nilos 180 co„ C..D— 2D-�1 lob l;is„19 d�to , EXPRESS BUILDING PERMYztT APPLICATION .TOWN OF YARMOUTH Yarmouth Building DepRrtroent 1146 Route 28 • South Yarmouth, MA 02664 ` (S08) 398,2231 Ext, 1261 CONSTRUCT10NADbR 551' �� cf�� IIIIIIiIIII�IIIVY ,V4 /SSMOR'S f'1PORMATIONI { Mapl Pa4'oall OWN8R1 T _ f9'27 �e_910 y� PENT AOR�SS •O� 7 CONTRACTORI Henry Celbldy Cepa Cod InJulellon T� l0 Rutoion Circle 3oulh Yermovih 508,775, 12 'a R4sldonl1R1 0 Conlmerolal U, Cos4 of Conslruotlon `.5-- o ° � 153567 iiomo Improvomnt ContrR9fo,j;�ii H Collahl'uo(lon 5uprylsor L,lo, a 100988 Wurkmen'y CumpansallorLInourerim ('oheok one) 0 1 amlhbhomeowrror^n C1 I rim tho solo proprlolor 0 1 hevo Woi'kol''s Componsailon Insuran9a InsuraneeComp4nyNamol Atirantic Charter Insurance' W° ,� Worker's Comp, laolloyN 004,, . 90�• r, WO C TO BE Pi ' 'ORMMD '''Ten( 4 Duration (Piro Rolardant Cortlfioace 000hed7) . I Wood S4ovo �SIdiug] NofSqunros I,;,Ropinvamat windows] H ---- noplaoamonl doom kl Roofing] k of 5quaras ( ) Ramova exIs4ing* (MAXI 2 lnyers), 7nsula110r1 Old Kings Hlghwayallstorlo Din ( )11oplaoing llko rot' Iiko Pool lancing ' ITd dbbrli 1YI11'1;q dltporbd of oil Moll of Noll1 � 2 i 1 Win IInd6(PCi1C1 1 or pc,/ Ihat We )4 , 111/4ro111 onlolnod 4/4 Iruo alb 99rr491 to Iho V9oI of m T lvlll b0)W4 94l'.'4(Or dbnlo �;� •- , ir'� d for rorooulion undar MIOIL y know�adga and ballot, lu�dcrslru�d shot u,y rr;so 5,.- ''�anr a s�J p ,,��1, 4�ill�„I,,I�I� o � 2�a,so9uo11 ll Applloanl d$Ignelllrbl A/ �v ,I el'17�i ilci'uel'vri4 )',;1;r,s �, 1I�,wo1„ ililnAwr bae] o1Y1ISI'J 3lgnalu b(or AllA hm4o4 IIIIIIIIM/ y Approvod gyi /�` DnI4l :u . hp •- o a or os gno9 ;. • .,io e I Dalol — 'i—f l v vYMw _ � nq HlsloPlonl Dl4rlotl CI YoaI.) Hoolt Plood ?kin zonal '3 Yc s 0 N,o Wnto1' Rosouroo Pro!coilon hlalrloll W1111In 100 Ri of Wetlands] i (I Yos C1 No J Yos (1) No DocuSign Envelope ID:8FDAF8B1-00B1-436C-9D8B-EDED7F2512C3 Permit Authorization maSS save Form Site ID: 3844777 Customer: Nate Weeks I,Nate weeks ,owner of the property located at: (Owner's Name,printed) 79 Homestead Lane Yarmouthport, MA 02675 (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. p—Docu3i�y: Owner's Signature: `-9DAF 1!:C62D49 ... Date: 7/4/2019 I 7:37 AM EDT FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: NPF 6.0-b —disc(C4 /Ovi 7/1 X. Participating Contractor Datb Name: RISE Engineering Phone: 401-784-3700 Email: Page 1 of 1 For Office Use Only Rev.102015 .1 • ,-"^,1 CAPECOD•27 AMAHLE,E ,ORD. CERTIFICATE OF LIABILITY INSURANCE CATE(MMIDD/YYYY) ..L...--' 06/05/2018 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(los)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 NakeCT Zoc ors&Gray Insurance Agency, Inc. PHONE FAX t3 Rte 134 (A/C,No,Eel): (A/C,No):(877) 816-2156 south Dennis, MA 02660 FA'IOiss:mali@rogersgray.com INS ER(SI AFFORDING COVERAGE NAIC a , INSURER A:West American Insurance Company 44393 __ INSURED INSURER a:Safety Indemnity Insurance Compg y 33618 Cape Cod Insulation, Inc. JN_$URER c;Endurance American Specialty Insurance Company 41718 16 Roardon Circle INSURER 0 Atlantic Charter Insurance Company 44326 South Yarmouth,MA 02664 INSURER S: 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. NSR ADM.SUER POLICY EFF POLICY EXP I TR TYPE OF INSURANCE INSD V�Q, POLICY NUMBER IMMIDDIY YI (MMIDDIYYYYI LIMITS A X COMMERCIAL OENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 i1 CLAIMS•MADE X)OCCUR BKW(19) 53328281 04/01/2018 04/01/2019 pR M 5 OREtLEED v1 _T 100,000I I I MED EXP(Any one person) $ 5,000' PERSONAL BADVINJURY $ 1,000,000, GENII-AGGRE ATE LIMIT APP IES PER: 0 GENERAL AGGREGATE $ .2,000,0001 X POLICY I 1 JEGT LOO' nPRODUCTS.COMP/OP AGO $ 2,000,0001 .--- TX---- see holderdeecrtp of operations J I OTHER: B I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000', _(Ea_acctsten.0 $ I ANY AUTO 6232707 04/01/2018 04/01/2019 BODILY INJURY(PerpersonI b I • OWNED ONLY X $CCHE UyLNEEO . ' X AbRIODS ONLY X AUTOS ONLY _BODILY INJURY AMAGE accident) $ pR p (Per eccidenl) I 1 _ C I s' UMBRELLA LIAE X OCCUR EACH OCCURRENCE $ 2,000,0001 X EXCESS LIAR ' CLAIMS•MADE EXC10006635003 04/01/2018 04/01/2019 AGGREGATE $ 2,000,00011 DED RETENTION$ D WORKERS COMPENSATION PER $ ! • AND EMPLOYERS'LIABILITY WCE00431903 STATUTE ERH ANY PROPRIETOR/PARTNER/EXECUTIVE YIN 06/30/2018 06/30/2019 1,000,000i QFFICER/M MBER EXCLUDED? N I A E.L.EACH ACCIDENT $ (Aandatory In NH) 1,000,000' II yes,describe under E.1.01SEASE•EAEMPLOYEE $ • DESCRIPTION OF OPERATIONS below ' 1,000,0001E.L,DISEASE•POLICY LIMIT $ 'I DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may bo attached II more apace le required) Norkers Compensation Includes Officers or Proprietors. ,ddItIonal Insured status Is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder. Excoss Liability Is follow form, CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 1 7,e t' Commonwealth of Massachusetts Division of Professional Licensure Board of Building•Regulations and Standards ConstRtctt ri i�itj>ervlsor CS-100988 Lyires: 11/11/2019 HENRY E CASSIDY • 8 SHED ROW% ; {, .. • WEST YARMOG7;H MIS 0 •6,73 •` :. ! Commissioner 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; 153587 18 REARDON CIRCLE Expiration: 12/14/2020 SO.YARMOUTH, MA 02664 Update Address and Return Card. 20M-O5 >, %rvranrnrr• .r/,% ,�. /.ri.i•iri./rr•ir//' Office of ConsumerAff&Us&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:Corporation before the expiration date. If found return to: Registration ExpJratlon Office of Consumer Affairs and Business Regulation 153567 12/14/2020 1000 Washington Street-Suite 710 CAPE COD INSULATION,INC Boston,MA 02118 HENRY E.CASSIDY � -- 18 REARDON CIRCLE C\ V SO.YARMOUTH,MA 02664 Undersecretary a 1th t sign r The Commonwealth of Massachusetts - - - Department of Industrial Accidents Office of Investigations - 600 Washington Street Boston,MA 02111 www.mass.gov/dla or ers ompensation 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 02664 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 lama general contractor and t employees(full and/or part•time).' have hired the sub-contractors 6. 0 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 8. ❑ Demolition workingfor me in anycapacity. employees and have workers' �' 9. 0 Building addition [No workers'comp. insurance comp.insurance.: required,] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.❑ lam a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.0 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#I must also till 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 ;Conracuxs that check this box must attached an additional sheet showing the name ot'the sub-contractors and state whether or not those entities have cmployees. 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: Atlantic Charter Policy it or Self-ins.Lic.#: WC100136900 Expiration Date:06/30/2020 Job Site Address: v./> ity/State/Zip: !fi/ D Z G /ff Attach a copy of the workers' compensation policy dec tion'page(showing the policy dumber 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 tine 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 Inves i rations of the 'IA fir' ce cavera_e veri t anon. l do hereby eertift under the pains and penalties of perjury that the information provided abavr is true and correct Signature; 1447 Date: r9//7 —' Phone 4: 508-775-1214 OicT l 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#: 411111111111111