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HomeMy WebLinkAboutBld-20-001632 4. Qf A,+t TOWN OF YARMOUTH Building Department BUILDING ,. (508)398-2231 ext.1261 0 y' PERMIT NO BLD-20-00163s V..... PERMIT 114: ; 44, ISSUE DATE a09/24/2019 JOB WEATHER CARD .- - APPLICANT „HENRY E CASSIDY 1 PERMIT TO , New AT(LOCATION) 6 THRUSH TRAIL,YARMOUTH, MA 02675 1 ZONING DISTRICT R-40 Bldg.Type: Residential SUBDIVISION MAP BLOCK LOT 1144.41 BUILDING IS TO BE: CONST TYPE V B ] USE GROUP R-3 REMARKS Repairs install insulation in existing house(508-275-1814) CONTRACTOR LICENSE ICS-100988 Construction Supervisor HENRY E CASSIDY L HENRY CASSIDY "`"" WEST YARMOUTH, MA 02673 AREA(SQ FT) 550,249,920. EST COST($) 4000.00 1 PERMIT FEE($) 35.00 J OWNER ELIZABETH HARTSGROVE BUILDING DEPT BY ADDRESS RUSH TR T- e I 1YA_ OUTH PORT MA 02675-2257i PHONE THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR IDE ALK 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: i 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. �t;�0 j Perm ft.o -ea:1(32 De a 0�,. �� �(j(/"rib) Amount n TAGH SE,4 °"'E°` `ff41 iPermit expires 180 days from ;i issue date EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department ( 3 -i) 1146 Route 28us "v South Yasouth, MA 02664 yi -- ` ' ' z ,�J . (508)398-2231 Ext. 1261 , *P3'75/7 CONSTRUCTION ADDRESS: /v 7', /s- 1.24/,L ASSESSOR'S INFORMATION: ` Map: Parcel: OWNER: Yf/ ',4ie7-4 /14.er.SiP-& 1:SENT 7;171 .e7700d NAME P SENT ADDRESS TEL. # CONTRACTOR:+le, �s#Sf/o), /A nz� Z.e/D�v c ,f ,,,f, 'IDG ft ,4 g 7/7.9 0/ NAME // MAILING ADDRESS ✓ TEL.# (residential 0 Commercial Est. Cost of Construction$ 1-B O Od, O Home Improvement Contractor Lic.# /J 3 3/ 7 Construction Supervisor Lic.# /'mod �' e Y Workman's Compensation Insurance: (check one) ❑ I am the homeowner ❑ I am the sole proprietor -I-tfave Worker's Compensation Insurance9 Insurance Company Name: if 7/64/1%e. 48/27r�� Worker's Comp.Policy# W`7O a / C. 4, 0WORK 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 e------ • Old Kings Highway/Historic Dist. ( ) Replacing like for like Pool fencing `The debris will be disposed of at: 79'fZ/f D// fi (J`yj 14. 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 revocation of my license d for prosecution under M,G.L.Ch.268,Section 1. r Applicant's Signature: ' Date: V/7//9 Owners Signature(o atrachn nt Date: 66 Approved By: Date: - ,'c 0 c Building.Official EMAIL ADDRESS: Zoning District: Historical District: 0 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 • Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards ConstrytCti&I itttparvlsor CS-100988 at Iryires: 11/11/2019 e . a HENRY E CASSIDY t 8 SHED ROWS WEST YARMOUTH MA •.t373 Commissioner CL 7(� 0/1?/2 '/U(ealfr � r:)^%cec CrJ.eef) 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, Otfioe of Consumer Affairs&Business Regulation • HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Corporation before the expiration date. If found return to: Registration gxolratlon 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 SO.YARMOUTH,MA 02664 Undersecretary a I lth t sign r r.---- -- The Conrnwnwealth of Massachusetts r , Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers pplicant Information Please Print Leeeibly me (Business/0rganization/Individual): Cape Cod Insulation Inc. ddress: 18 Reardon Circle ty/State/Zip: South Yarmouth, MA 02664 Phone#: 508-775-1214 you an employer?Check the appropriate box:4. t am a tenernl contractor and IType of project(required): 1 am a employer with 48 ❑ bemployees(full and/or part-time).• have hired the sub-contractors 6. ❑ New construction 1 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' P h• 9, ❑ Building addition [No workers' comp. insurance comp. insurance.: required.] S. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12 ❑ Roof repairs insurance required.]I c. 152,§1(4),and we have no employees.[No workers' 13. Other Weatherization • 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 art doing all work and then hire outside contractors must submit a new affidavit indicating such. ' :Cunuacton 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. lithe 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 ti or Self•ins.Lic.#: WCI00136900 Expiration Date:06/30/2020 _ i Job Site Address: lAra f/i 7 t8//,rn2 J c 2i City/State/Zip:XV d Z 6' 7 Attach a copy of the workers' compensation pot cf y declaration'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 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 I of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of ^_Investihations of the DIA for insurance coverawe verification. !do hereby certify under the pains and penalties of perjury that the injornratiou provided above is o —true and correccorrect.tr�c2a cc.eau_ Date; el*/ Signature: L�� a" .-- Phony$: 508-775-1214 r 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 Phone#: r,,,.r..,..Pvrc in. AC CAPECOD•27 THORNE —`' 1 CERTIFICATE OF LIABILITY INSURANCE DATE(Mh1IDD YYYY) 7116/20 I THIS CERTIFICATE IS IS UED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER 11HIS CERTIFICATE DOES NO AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFIC TE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PR DUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the Corti Icato holder Is an ADDITIONAL INSURED, the pollcy(lcs)must havo ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAI ED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not co for rights to the certificate holder in lieu of such endorsement(s). PRODUCER C TACT Good :Rogers &Gray Insurance Ag ncy, Inc, PIioNE 1434 Rte 134 A/C,No,lyxt: (800) 553.1801 I I Ax South Dennis, MA 02660 • liss:mall@rogersgray.com INSURERS)AFFORDING COVERAGE r1AIC e INSURER A:West American Insurance Company 44393_ INSURED INSURERB:Arbella Protection Insurance CompanyLlnc. 141360 __-_ Cape Cod Insula ion, Inc. INSURER C:Endurance American Specialty Insurance Company '41718 18 Reardon Clrcl INSURER 0:Atlantic Charter Insurance Company 44326_,_ South Yarmouth,;MA 02664 INSURER E: 1 -- -- --I-- 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, NOTWITHSTANCING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT IMTH 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. Iry sR rn TYPE OF INSURANCE ANSp WVBR D POLICY NUMBER POLICY EFF POLICY EXP ---- 11 A I X I COMMERCIAL GENERAL LIABILITY (MMIDD/YYYYI LIMITS EACH OCCURRENCE 1,000,000: CLa1MS.MADE 1 X OCCUR BKW 53328281 4/1/2019 4/1/2020 DAMAGE ,000 EBEWSE TO ENT ants) 116,o0U G J� r (_y one person) > I PERSONAL$ADVINJURY 1,000,0001 I- E I'L AGGREGATE LIMIT,.YPLIE.PC•R, GENERAL AGGREGATE 2,000,00O X 1 POLICY I PRO, _ LOC PRODUCTS•COMP/OP AGO 2,000,OOO OTHER: — -I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $—` 1,000,0001 (Ea a clden0 _ ANY AUTO 1020081008 4/1/2019 4/1/2020 BODILY INJURY(Per arson $ OWNED ' SOH•DULED _ AUTOS ONLY X AUTs S —` --- )( VA X NON••WNEp BODILY INJURY(Per accident) 5_—_________ _ AUTUS ONLY AUTO pNLY PROPERTY DAMAGE {Per accitlonl) $— —___._-__---- C UMBRELLA LIAR X I 0 CUR �— ^1,_EACH OCCURRENCEc 2,000 000 I_X Ex__, LIAR _CLAIMS•MApF EXC10006635004 4/1/2019 4/1/2020 AGGREGATE L. 2,000,000 ___ 1'�_�.DED_s I RETEN i ra 5 D WORKERS COMPENSATION 5 AND EMPLOYERS'LIABILITY —_—' -----, !ANY PROPRIETOR/PARTNEri:EXEC TIVE (Y/N� WCIOOI36900 STATUTE 1_ OTH• �FFICER/MEMgER EXCLUDED? I N/A 6/30/2019 6/30/2020 1(Mandatory In NIi) E.L.EACH ACCIDENT $ 1,000,000 III yes,describe under E.L.DISEASE••EA EMPLOYEE_._ 1,000,000' DESCRIPTION OF OPERATIONS bel.sv _ _ M,--_�__ E.L.DISEASE•Pou Y LIMIT $ 1,000,OUO DESCRIPTION OF OPERATIONS/LOCATIeNS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) , ------- CERT)FICATEHOLDER NCE CATION ~! 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 ' iI --",--.:.)---,.,...,.,_„..2 7 ......... ACORD 25(2016103) ©1988.2015 ACORD CORPORATION. All rights reserved, The ACnRrI Hama anrt Inn,,-,.,. .,...;..a."', -'__, ____ RISE ENGINEERING" OWNER AUTHORIZATION FORM I, Elizabeth Hartsgrove (Owner's Name) owner of the property located at: 6 Thrush Trail (Property Address) Yarmouthport, MA 02675 (Property Address) 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' nature September 12, 2019 Date RISE Engineering, a Division of Thielsch Engineering, Inc. 5 Dupont Avenue I South Yarmouth, MA 02664 1508-568-1926 www.RlSEengineering.com