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HomeMy WebLinkAboutBld-20-000950 • QQ :;! � :,Permit# • �./� 1Amount CaS "ATTAGH CSf 6),t.OnailL0.1,d !Permit expires 180 days from o— �� J� /'��r�) , issue date G EXPRESS BUILDING PERMIT APPLICA Ir F j T v E -I TOWN OF YARMOUTH ---- �_ x armoutn Budding Department 1146 Route 28 AUG 21 2019 South Yarmouth, MA 02664 B u it0, (508) 398-2231 Ext. 1261 �; _l/ f A �] �� CONSTRUCTION ADDRESS: p7.w ./2i'J e ,01 ASSESSOR'S INFORMATION: Map: Parcel: OWNER: , f? 7t1 h e z/pi eif e �� ffoii e- 7 ,- 4,/a - NAME ESENT ADDRESS TEL. # CONTRACTOR:�eA40/ Art:/L/ /PR; /(p`,c-j9/ZeltOLA G//eX4,-- YDI-2ri ✓D J' 77.51 Z h' NAME // MAILING ADDRESS TEL.# / efesidential 0 Commercial Est. Cost of Construction$ ��7 QQ, Q Home Improvement Contractor Lic.# 45-35 /7 Construction Supervisor Lic. # ,zp < 1P0 Workman's Compensation Insurance: (check one) ❑ I am the homeowner 0 I am the sole proprietor lave Worker's Compensation Insurance Insurance Company Name: f7/ey_ /C aeft Worker's Comp.Policy# 1,41CIO 0/JG po v 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 Highway/Historic Dist. ( )Replacing like for like Pool,fencing *The debris will be disposed of at: y,9.,07), c7 - ...1.20?i • 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 answers) will be just cause for denial or revoc 'on of my license d for prosecution under M.G.L.Ch.268,Section 1. Applicant's Signature: Date: V.9// r Owners Signature or attachme Date: \ Approved By: tJ�L, Q Date: v - 0..\-1 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: Yes 0 No C Yes ❑ No I RISE ENGINEERING' OWNER AUTHORIZATION FORM I, THEODORE ELDREDGE (Owner's Name) owner of the property located at: 26 Rose Road (Property Address) South Yarmouth, MA 02664 (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's Signa Date RISE Engineering,a Division of Thielsch Engineering, Inc. 5 Dupont Avenue I South Yarmouth, MA 02664 1508-568-1926 www.RlSEengineering.com • Commonwealth of Massachusetts i kf Division of Professional Licensure " � Board of Bullding.Regulatlons and Standards Con str tct rl ISO pv•vlsor • CS-100988 • t J; ,'t t;X/pires: 11/11/2019 y HENRY E CA$SIDY r {� r� •;w • 8 SHED ROW t r "' • WEST YARMOG771 M4,06,79 Commissioner / Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Corporation CAPE COD IN6ULATION, INC Registration; 153567 • 15 REARDON CIRCLE Expiration: 12/14/2020 SO,YARMOUTH, MA 02664 Update Addrees and Return Card.�� Office of ConsumerAffalrs&Business Regulation • HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Corporation before the expiration data. 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 , i HENRY E.CASSIDY 18 REARDON CIRCLE �� ^^ sa.YARMOUTH,MA 02664 Undersecretary a 1 Ith t sign r �� CAPECOD-27 v THORNE .,.. CERTIFICATE OF LIABILITY INSURANCE DATE(Mh1/DDYYYY) j _ 7/16/2019 1 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS j 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(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may roquiro an endorsement. A statement on 1 this certificate dons not confer rights to the certificate holder in lieu of such endorsement(s), PRODUCER C N ACT Good II Rogers 8,Gray Insurance Agency, Inc. ,PHONE 434 Ste 134 FAx --- (A/C,No,EXt):(800) 553.1801 [IA,c,NoI:(877) 816-2156 South Dennis, MA 02660 M,Riss,mall@rogersgray.com mall@rogersgray.com INSURERIS)AFFORDING COVERAGE NAIC a INSURER A:West American Insurance Company 44393_______INSURED INSURER 6:Arbeila Protection Insurance Company, Inc. 41360 1 Cape Cod Insulation, Inc. — INSURER C;Enduran�e American Specialty Insurance Company 41718 _ __ 18 Reardon Circle INSURER Charter Insurance Company 44326_ South Yarmouth, MA 02664 INSURER E; - INSURER F: • r 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'rHE TERMS 1 EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRT ADDLIS�UO/^R TYPE OF INSURANCE INSD Y"'-" POLICY NUMBER POLICY EFF POLICY EXP ---- A X COMMERCIAL GENERAL LIABILITY (MPAIDDlYVWI IMINDDMlYYI LIMITS CL�I,MS•MADE X II OCCUR EACH OCCURRENCE ¢ 1,000,OOOI BKW 53328281 4/1/2019 4/1/2020 DAMAGE TO RENTED 100,000' -PfiEtdGT?RE -fc enu) $ j1 MED EXP(Any one parson) $ 15,0001. _PERSONAL&ADV INJURY S 1,000,0001 j_GFN'L AGGREGATE LIMIT APPLIES PER: 2,000,000, X JEC� ( J LOC SiENERAL AGGREGATE g POLICY( I PRODUCTS•COMP/OP AGO $ 2,000,000] OTHER: t3 AUTOMOBILE LIABILITY $ COMBINED SINGLE LIMIT 1,000,000 ANY AUTO _(Pa accident) g • 1020081008 4/1/2019 4/1/2020 BODILY INJURY(Per person) $ _ AUTOSFF���g ONLY _Al SCHEDULED X AUTOS ONLY X gONOOWNF[D ,, BODILY INJURY{Per eccident)i g S0 Y PROPERTY DAMAGE 1~ I _ $(Par accident) 1 — . 1 UMBRELLA LIAR .�X I OCCUR L ; b-x i---- ,S LIA9 1.CLAIMS•A1ADE EXC10006635004 EACH OCCURRENCE $ 2,000,OU01 4/1/2019 4/1/2020 AGGREGATE 2,000,000 I 1 DED I I RETENTIONS D WORKERS COMPENSATIONP r $ AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE IY/N WC100136900 6/30/2019 6/30/2020 STATUTE �RH (Mandatory In OFFICER/MEMBER EXCLUDED'? I N/AE L.EACH ACCIDENT $ 1,000,U001 In NH) es,describe under E.L.DISEASE-EA EMPLOYEE G 1,000,0001 DESCRIPTION OF OPERATIONS below `— _ E.L.DISEASE-POLICY LIMIT $ 1,000,0001 i • --L • // • DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER N E ATiON --- 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 `: :'ACORD 25(2016/03) l ©'988.2015 ACORD CORPORATION. All rights reserved. l The ACoRn Hama .,,,-II.,..., #, , � N3tt a Gt, The Commonwealth of Massachusetts ft,r'}r, ,t' „.,��1,,. Department of Industrial Accidents it c,,4110,rlhe�i .,:,t�... t,, .A, , ti. Office of Investigations ` '`-. ''� {ts to " 600 Washington Street 4 T A Y Q'4;,ix) , t ",� 1 1F ,'; lF�r r�,.=, ��, Boston, MA 02111 t,� ^�R 3:4 Z')}''` www.mass ov/dia Workers' otnpensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Let ibly Name (Business/Organization/Individual): Cape Cod Insulation Inc. Address: 18 Reardon Circle City/State/Zip: South Yarmouth, MA 02664 Phone ii: 508-775-1214 Are you an employer? Check the appropriate box. , 1ama general contractor and 1 Type of project(required): 1.�'I am a employer w 4 with 48 ❑ employees(full and/or part-time).* have hired the sub-contractors 6, ❑ New construction 2 ❑ 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 working for me in arty capacity. employees and have workers' 9. Ei Building addition (No workers' comp, insurance comp, insurance.t required.] 5. [i We are a corporation and its 10.0 Electrical repairs or additions 3 ❑ I am 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 employees.[No workers' I3. Other Weatherization comp. insurance required.] 'Any applicant that checks box NI must also fill out the section below showing their workers'compensation policy information. 'Fianeowners 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 nam of the sub-contractors and state whether ur 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 silo information. Insurance Company Name: Atlantic Charter Policy i+or Self-ins, Lic. ;..WCI0O136900 _ _ Expiration Date;06/30/2020 Job Site Address;„ ,on, 2d.S to /pc/ /AAZ /041/.4City/State/Zip: 4 'Z Gl,1— pAt►ach a co y of the workers' compensation polio y declaration'page(showing the policy dumber and expiration date). I-ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the•DIA for insurance covers a verification. ______.__ - _„rT—__________ I do hereby certify under the pains and penalties of perjury that the information provided aboi4 is true and )rrect. Signature; 1 'a ����izQ�� Pate: 0 1/4 f _ Phone u: 508-775-1214 - Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License k Issuing Authority(circle one): I. Board of Health 2. Building Department 3,City/Town Clerk 4, Electrical Inspector 5. Plumbing Inspector' 6.Other •[ 1 Contact Person: Phone#: ___. } . . - c trACtidtk i)4l1q cif**Y.4 ;. TOWN OF YARMOUTH Building Department BUILDING ;; $ _ 'fin (508) 398-2231 ext.1261 0i PERMIT NO BLD-20-000950 PERMIT `*.4. "` ' ISSUE DATE 08/21/2019 JOB WEATHER CARD APPLICANT HENRY CASSIDY PERMIT TO 41 New AT(LOCATION) 126 ROSE RD, SOUTH YARMOUTH, MA 02664 i ZONING DISTRICT €R 40 i Bldg.Type: Residential SUBDIVISION MAP BLOCK LOT 1060.82 BUILDING IS TO BE: [CONST TYPE I LV B USE GROUP R 3 i REMARKS Repair-Install Insulation(508-775-1214) CONTRACTOR : I 1 LICENSE 1153567 I i iHome Improvement CAPE COD INSULATION, INC ,HENRY CASSIDY 1 - i 18 REARDON CIRCLE AREA(SQ FT) 360,502,5604 EST COST($) 31500 00 PERMIT FEE($) 35.00 i L. 3,SO.YARMOUTH, MA 02664 OWNERELDREDGE THEODORE R s ?} BUILDING DEPT BY 3 ADDRESS lOBRIEN SIOBHAN E,26 ROSE RD LSOUTH YARMOUTH MA 102664 ` //n e HONE 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. 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.