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HomeMy WebLinkAboutBld-20-1397 Office Use Only . 4.?. Permit# ; 't\ Ye,633.4,474*-rwocs,cyjs, ( Amount Permit expires'1801/45dayssfrom issue date EXPRESS BUILDING PERMIT APPLICA ,•;1E C E I V E D TOWN OF YARMOUTH Yarmouth Building Department SEP 1146 Route 28, South Yarmouth, MA 02664 Buctei) T T (508) 398-2231 Ext. 1261 By 1 1 2019 CONSTRUCTION ADDRESS: ASSESSOR'S INFORMATION: Map: Parcel. 351— r•-. NAME S SS TE 14 ----- _ CON TOR. . "'' 'kloCidential 7 NAME 0 Commercial AD .. # • 1)/ tt)-)Cti elik-C7b qi Est.Cost of Construction, (71, ,,,,„ 00 Home Improvement Contractor Lie.# )(C'JC:it ( ( Construction Supervisor Lie.# fc3c- ct/ Workman's Compensation Insurance: (check one) LI I am the homeowner 3 I am the s proprietor - (have Worker's Compensation Insurance Insurance Company Name: kikk Worker's Comp.Policy )13 0 bOL S---31_1-0 0 t 9,6 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 Kings Highway/Historic Dist. ( )Replacing like for like Pool fencing *The debris will be disposed of at:1 35 cli A44,A , Location of Facility I declare under penalties of perjury that the statements herein contained are true and cornet to the best of my knowledge and belief I unders d t an false answer(s) will be just cause for denial or revocation of my license and for prosecution under M.G.L.Ch.268,Section 1. , .. Applicant's Signature: -'110 ' . Date: Owners Signature(or attachment) Date: Approved By: Date: C\ •-• I 1 -11 , Building 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 DocuSign Envelope ID:1E851BAF-300C-4F99-8B95-E1BED8537B4C Permit Authorization mass save Form Site ID: 3780805 Customer: Donna Bowse Donna Bowse ,owner of the property located at: (Owner's Name,printed) 12 Beaver Brook Road West Yarmouth, MA 02673 (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. DocuSigned by: Owner's Signature: AQ -758C7693F26948E Date: 8/5/2019 I 10:38 AM EDT FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date Name: RISE Engineering Phone: 401-784-3700 Email: Page 1 of 1 For Officia use Only Rev.102015 Itg The C.tttnrttottweajth al ri,lassacltuselts p Department of Ittdustrial Accidents (' i I Congress Street,Shale 100 k �y Boston,n HA 02114-2017 E), 1, !5tf! , v fir ✓ rvnvrittzaass.t;ttvlditt 5}'c •lsers`Contlwnsatit;n 1iisutiinci. Aftidatit:t?,uilders/Contrtutorsflsiectrieians%Ptturskers, t'(.)ill,I•ll I It Vsl Ili I f11'. Ph.RAtr y1 r'yG At,EHOht'T'l', } _ Please Print Legibly Applicant Information a NITnIC flit s ne'. (h'gamzst,aninda.`clualj: 04-i , ‘.),,, r4� 4)1t/1.J0.Q.Sy_.1 ..__._. _... ( l'r Sl.11t„! E ` i2 L� L1.1 t�7 Phone, R "f..: ! _ C t.. .? Arr tin a-i employer (.hech the appropia ne not: Type of project(required): i "' I tth.a e, tytf ss th ,t.0... ._ertp t,+xas t::V.r i��..., ciii Emtd4' IL New construction 0 I ain a si4c propnctor ate partnership and have no c npr as'u:+yoy k,irg fit:rtt Fitt 8, Pl Remodeling owe«apum) [Nit workers" wino in5017n0, ittOttifttil' 9, 0IDentohnon t uin a homeowner acting all work myself;No Work s comp,;An tratuc ruqu red I' to D building addition d[1.l,ara a homeowner nod will I./chitin vonuxatuts to+rrnulust all work on my properly 1 will etisa,re that all aaruraktors either have,workers'c n npenuatian ura unnnee.or are neiie I LE E lectricat repairs eu additions prnprienars with no employees. 12 0 Plumbing repairs or additions. 1. S Li t aniA p,.r.,.ti'e'nua:i ai and 1 t`Asc h reahy.t ,a,I .'It'!,,,It.., i t i ,h ,nark.l shcct. J( I 3 C�l�nul"rep jitti I 'lie 7 is n oc in,-havt: n pi„e i I ,it ! r U lt'etoe a n or,i,t u,a its tff i ti i ' to w I n .b 1 nl t n p t\lo s I?,', It ,rnci,v h.tresy`) ituas+�cs N rl; s : 1 , ,_ , d; I i ,any alii,la ant that el.ccks box It I nun also fall cut Ihocse non n its t utti'it ttetr worker.; compensation polo t rtnnnntit•n l'I-Iniree wnorx will.)submit this affidavit indicating they are_doing:all work and then hire otirstdc crmtrhetorn must summm a new affidavit-uadie ic'ryl Midi ;Contractors that elteoir this turxanust attached an additional.liner.ahowath the haute or OW sub-eoutrasitltSn#ai state whethrt itt not thirst uinhieee have cnrplaveeN, 'if thcsuh=citrtractora have eenployees.they must;any iue their ssoikt t`coop.policy:acitctlej t am an employer that ispiwviding workers"camped canon insurance Jiff inn'ernpltryees. Beton,is the policy anti job site , information. In,,u!anct Comout's INanre:AA[ .t (�'�i.._. .- �- .--).._}),-�`3 ,. .. ... ,.._. ,._os' if' .-.)t.\-_.__.��_._:..v-_.__ t,,Ilea•,;or Sell.ink llac,t ,f�EJ�,,t." ;L..3-- '`�..I c31 J C70)� L'xpiratit,n)date. 3 i { I9( ..ob Site Address: ,.._ tlaiatdip ,,. ,. V14 ''(-4—� � . .. � Attach 3 copy of the wort m;pettsatian policy declaration page(showing the policy nu bet-and capitation date). Failure to sei,eure coverage sus required under hint,c. 152 '25A is a criminal v'iolttion punishable bye line lip to S1,500.O0 and/or rile-yea inlprisoninent,as well as cavil penalties,in the form area STOP 44'X)R .ORIYF R and a fine ofupto$250 Of/a day against the violator,A copy of this scat:tnc:rt rnay tic tu°s;:urt:(;d to Lie Oilier of investigations of the DIA lur insurance coverage verification. t rk,hereby eertiff''under titoi '.and penoltie.v of perjury tha(than in./Orinnotion provided alp ' i, le atul tweet. 4t�tart 1: C)nt 1 . . Official use only. Do ItOt write in this area,to he completed toy city Or town afficinl. 0 City or Town: —...._.. .�..___. _ Permit/License N' __ _. .. r .__m._.. _ i` Issuing,authority(circle one); I Board of health 2.Building Department 3.('itsPl'own Clerk 4. 1 lerctrival inspector 5. Plumbing inspector o.Other Contact Person: Phone tm.._�. _ „.,_ — t Construction Supervisor Specialty Cornmonwerattr,u;massacnu setts hiz#ictr#to: Division of Protesseoaal rcensure L,'S,St.Ac-insulation Contractor Some of$orithtio"^fie,}x�lataoris.�nct Stannares S -f4z}dti Ero,rev,02st7,2020 FRANCIS,S SKEMAN 502 HARWICHRO MONSTER MA 02401 failure to possess a ccafcta t edifon of the Massachusetts Slate Building Code is cause for revocation aegis license. far fartxrfah'on about Oafs demist Call(€17)77-1204 or visit www„rn CoH xr'tnusslonv ✓�a }`F�ir�rrnrcr. <r,✓,l/t.'t r!rr�srvfr��r:�J Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TY1 corporation before the expiration date. If found return to: Regisf tdn • Expiration Office of Consumer Affairs and Business Regulation . 09/07/2020 1000 Washington Street-Suite 710 FRONTIER ENBil aC NS Boston,MA 02118 2i W FRANCIS SHEET- N' x --- 502 HARWICH RD BREWSTER,MA 02631 Undersecretary Not valid signature ACC)RE) CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/Yl'YY) 03/18/2019 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 policy(ies) 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 NAME; Rogers and Gray Processing ROGERS& GRAY INSURANCE AGENCY INC PHONE ,Ext): (508)398 7980 FAX No): E-MAIL ma ro ers ra ADDRESS: � 9 9 Y•com 434 ROUTE 134 INSURER(S)AFFORDING COVERAGE NAIC# SOUTH DENNIS MA 02660 INSURERA: AIM MUTUAL INS CO 33758 INSURED INSURER B: FRONTIER ENERGY SOLUTIONS INC INSURER C: INSURER D: 139 QUEEN ANNE ROAD UNIT 6 INSURERE: HARWICH MA 02645 INSURER F: COVERAGES CERTIFICATE NUMBER: 379170 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 SUER POLICPOLICY NUMBER (MMIDDY EFF POLICY EXP TYPE OF INSURANCE INSD LTR INSD WVD /YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: OMBINED AUTOMOBILE LIABILITY (Ea accidentSINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS N/A BODILY INJURY(Per accident) $ AUTOS NON OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) I $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X STATUTE OTH- ER AND EMPLOYERS'LIABILITY Y I N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBER EXCLUDED? NIA N/A N/A VWC10060153152019A 03/14/2019 03/14/2020 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 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/Iwd/workers-compensation/investigations/. 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. Frontier Energy Solutions Inc 139 Queen Anne Road Unit 6 AUTHORIZED REPRESENTATIVE Harwich MA 02645 Daniel iel M.CroVvey,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD einuLetk c'/iz + t`Y4.it .. TOWN OF YARMOUTH Building Department BUILDING (508) 398-2231 ext.1261 ' - PERMIT NO BLD-20-001397 PERMIT ce , " JOB WEATHER CARD �, ,v, ISSUE DATE 09/11/2019 APPLICANT -FRANCIS SHEEHAN PERMIT TO New AT(LOCATION) 12 BEAVER BROOK RD,WEST YARMOUTH, MA = ZONING DISTRICT R-40 I Bldg.Type: ;Residential SUBDIVISION MAP BLOCK LOT 1058.359 I BUILDING IS TO BE: CONST TYPE V B USE GROUP R-3 CONTRACTOR REMARKS Repair-Install Insulation(774-237-0410) 1 + LICENSE 160854 I 'Home Improvement #' ;;FRONTIER ENERGY SOLUTIONS ' `FRANCIS SHEEHAN '502 HARWICH RD AREA(SQ FT) r 398,486,880.1 EST COST($) ;4600 00 s PERMIT FEE($) ;35 00 s 1 I aro BREWSTER MA 02631 OWNER ;FIORE ROBERT A BUILDING DEPT BY { ADDRESS ( 32 QUAIL HOLLOW 'ENFIELD 1CT 06082 ' HONE I THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDE OR NY 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. 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: 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.