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Bld-20-001186
Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 9/24/19 Town of Yarmouth Regulatory Services OCT 01 2U1q Building Division 1146 Route 28 South Yarmouth,MA 02664 RE: Building Permit BLD-20-001186 TO: Building Inspector(s), This affidavit is to certify that all work completed for 140 North Dennis Road has been inspected by a third party Certified Building Performance Institute(BPI)Inspector. Kitchen ceiling:Added R-30 cellulose 2" storey ceiling:Added a layer of R-19 fiberglass blanket,and crisscrossed with a layer of R-30. Exterior walls: Dense packed cellulose to R-13 (2"storey gable ends& dining room; right front corner has no wall cavity) Exterior gable ends in knee wall attics: Installed 1"T max& dense packed cellulose to R-13 behind it Open slopes in knee wall attics: Installed 1"T max and dense packed cellulose to R-15 behind it. Floor above full basement: Installed R-19 fiberglass blanket All work performed meets or exceeds Federal and State Requirements. Sincerely, \\\\V William J. McCluskey Office Use Only pg'Y' 1Q '7,, Permit# O ;14' 03 Amount 55 Permit expires 180 days from issue date Bc --b— II o EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth,MA 02664 (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: 140 North Dennis Road ASSESSOR'S INFORMATION: Map: 118 Parcel: 23.1 OWNER: Elizabeth Pagos same 978-397-5359 NAME PRESENT ADDRESS TEL. # CONTRACTOR:William McCluskey/Cape Save 7-D Huntington Ave, S. Yarmouth 508-398-0398 NAME MAILING ADDRESS TEL.# ■Residential 0 Commercial Est.Cost of Construction$ 5000 Home Improvement Contractor Lie.# 171380 Construction Supervisor Lic.# IC 102776 Workman's Compensation Insurance: (check one) U I am the homeowner 0 I am the sole proprietor ■ I have Worker's Compensation Insurance Insurance Company Name: Employers Mutual Casualty Company Worker's Comp.Policy# 5D77852 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 X Old Kings Highway/Historic Dist. ( )Replacing like for like Pool fencing *The debris will be disposed of at: Yarmouth 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 ' ation of my license and for prosecution under M.G.L.Ch.268,Section 1. Applicant's Signature: Dater 8/27/19 Owners Signature(or attachmen attached Date:Approved By: q Date: / , ----P Building Official(or EMAIL ADDRES Zoning District: 9 Historical District: 3 Yes No Flood Plain Zone: 2 Yes ❑ No 1 ' AUG 3 0 2019 Water Resource Protection District: Within 100 ft.of Wetlands: 1 Eli Yes LI No 0 Yes 3 No 1 B U I i o �.N CAPESAV-01 HWOODS ACORD" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) `•--/ 09/26/2018 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(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 lieu of such endorsement(s). PRODUCER ACT Rogers&Gray Insurance Agency,Inc. PHONE FFAX_ 434 Rte 134 ,(A/C,No,Ext): %(NC,No):(877)816-2156 South Dennis,MA 02660 _1 :mail@rogersgray.com 1 INSURER(S)AFFORDING COVERAGE NAIL# INSURERA;Employers Mutual Casualty Company 21415 INSURED INSURER B:Union Insurance Company of Providence 121423 Cape Save,Inc INSURER C 7 D Huntington Ave i INSURER D: South Yarmouth,MA 02664 INSURER E: , 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. INSRT TYPE OF INSURANCECEBI ADDLI.. - POLICY NUMBER POLICY EFF J�IJC��Y) — 1S UNITS 1,000,000 A I X CLAIMS-MADE X I OCCUR 5077852 10/16/2018 iEACH OCCURRENCE $ LTRINSD'WVD (MMIDDIYYYYI' COMMERCIAL GENERAL 10/16/2019 FRM sEs cEaENTED occurrence) $ 500,000 MED EXP.jArhy one person $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000'OOO POLICY rX PR LOC • 2 OOO,OOO JEL�T PRODUCTS-COMP/OP AGG $ ' EBL AGGREGATE $ 2,000,000 OTHER: I A AUTOMOBILE LIABILITY COMBINED etSINGLE LIMIT $ 1,000,000 X ANY AUTO __ 5Z77852 10/16/2018 10/16/2019 BODILY INJURY Y(Per person'_ $ OWNED 1 SCHEDULED AUTOSREp ONLY ! AUTOS yy p BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS ON Y S�e�PaERTYrrtOAMAGE $ 1 1 $ A X UMBRELLA LJAI3 1 X OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS LIAR ;CLAIMS-MADE ,5J77852 10/16/2018 10/16/2019 AGGREGATE $ 2,000,000 ,DED X RETENTION$ 10,000 I $ B I WORKERS COMPENSATION X STATUTE ER _ AND EMPLOYERS LIABILITY Y/N_ 10/16/2019 500,000 FFl RIM EXCLUDED? f - i -EL.-EACH ACCIDENT - $ �_ ANY gglyMPROPRInvg EXCLUDE/EXECUTIVE i _ 500,000 FIMBNENR N N/A O1 E.L.DISEASE-EA EMPLOYEE$ If yes describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Cape Light Compact Joint Powers Entity are included as Additional Insured for General Liability,Automobile Liability&Excess as required by a signed written contract or agreement with the Named Insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cape Light Compact Joint Powers Entity THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 261 White's Path,Unit 4 South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE/ W...—"" i 4 ",---IrSOZel ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts -, 1 /. Department of Industrial Accidents Congress Street,Suite 100 kf=11,t;}�_ " Boston,MA 02114-2017 ww».massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual):Cape Save Inc Address:7-D Huntington Avenue City/State/Zip:South Yarmouth, MA 02664 Phone#:508-398-0398 Are you an employer?Check the appropriate box: Type of project(required): LID I am a employer with 20 employees(full and/or part-time).* 7. El New construction 20 I am a sole proprietor or partnership and have no employees working for me in 8. El Remodeling any capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance ] 9. Demolition❑ required. ' 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 0 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. j 3.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.13 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.['Other Insulation 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t 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. 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: Employers Mutual Casualty Company Policy#or Self-ins.Lic.#: 5D77852 Expiration Date: 10/16/2019 Job Site Address: 140 North Dennis Road city/State/zip:South Yarmouth Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under th pains and penalties of pedury that the information provided above is true and correct Signature: Date: 8/27/19 Phone#:508-398-0398 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 Contact Person: Phone#: 4 l// /fito rbev Q IrafoAaoett Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Type: Corporation CAPE SAVE INC. Registration: 171380 7-D HUNTINGTON AVENUE Expiration: 03/13/2020 SOUTH YARMOUTH,MA 02664 SCA �; 2onwsn r Update Address and Return Card. r fir‘61arrersanr«ea/tAof"'IIa ciujelta Office 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 EXISratl2r1 Office of Consumer Affairs and Business Regulation 171380 03/1312020 One Ashburton Place-Suite 1301 CAPE SAVE INC. Boston,MA 02108 WILLIAM MCCLUSKEY �R CGQ��--— 7-D HUNTINGTON AVENUE SOUTH YARMOUTH,MA 02664 Undersecretary Not valid gnature Commonwealth of Massachusetts Construction Supervisor Specialty VAC Division of Professional Licensure Restricted to: Board of Building Regulations and Standards CSSL-IC-Insulation Contractor Constructiott:SliMvispr Specialty CSSL-102776 E5pires:06/28/2021 WILLIAM J MCCLU i 37 NAUSET ROAD ` WEST YARMOUTH 3 -% s Failure to possess a current edition of the Massachusetts Commissioner 4/4.;„44.„414",,,-1.--- - State Building Code is cause for revocation of this license. DPS Licensing information visit:WWW.MASS.GOV/DPS HOME OWNER WEATHERIZATION WORK PERMIT: PLEASE COMPLETE AND SIGN THIS FORM AS THE APPLICANT HOMEOWNER. I L.C4bo(\ ' ., h hereby consent to and agree that weatherization work maybe done bythe Weatherization Programof Housing og ous ng Assistance Corporation on the property located at: 1 D 3 DO\k - IctiNOK The weatherization work done will be based on programmatic priorities and availability of funding and it may include all or some of the following measures: Weather stripping; air sealing; attic&basement insulation; exterior wall insulation; ventilation measures In consideration of the weatherization work to be done at my home I agree to the following: 1. I give permission to Housing Assistance Corporation to access the property with such equipment and materials as may be necessary to perform weatherization. 2. The Housing Assistance Corporation reserves the right to inspect the fuel or utility bill for the weatherized unit on an ongoing basis for no more than five (5) years after the weatherization work is completed. I have read the provisions of this agreement and give my consent. Home Owner(signature) FI4POl ,Ci 17 Date: g/I5/2Oi9 Home Owner email: Agent:(signature) Date: Agency Approved Weatherization Company: Advanced Windows Inc All a Energy Alternative Weatherization Cape Cod Insulation ape Save M.T. McMahon & Son Inc. Frontier Energy Solutions Lohr Home Improvement Cazeault Agency Signature: notk Date: For Natural Gas Customers: I have received the National Grid Discount Rate Application form from my auditor. Customer Initials v. 1.19