HomeMy WebLinkAboutBld-20-002211 --Uticea ►vizi 11,
6 ' 44 TOWN OF YARMOUTH Building Department BUILDING
(508) 398-2231 ext.1261
PERMIT NO BLD-2o 00,2211 PERMIT
2404,
, , t ISSUE DATE 10/21/2019 JOB WEATHER CARD
APPLICANT HENRY CASSIDY - PERMIT TO New
AT(LOCATION) 147 NAUSET RD WEST YARMOUTH, MA 02673 s ZONING DISTRICT R-25 Bldg.Type: Residential i
SUBDIVISION MAP BLOCK LOT 49.28 µ BUILDING IS TO BE: CONST TYPE i V B i USE GROUP R-3
"_w.._n ..,.�. _ _, .__w __ .m . . _.T._._ r., ____m CONTRACTOR
I REMARKS Repair-Install Insulation(508-775-1214) s
,...._. .. , . is
s LICENSE 1153567
Horne Improvement I`.
I CAPE COD INSULATION, INC !
HENRY CASSIDY ;
�__�.,_�. — .�_.._.4 41— n�—.�.o. �_ws,. �_ ..a... ._4 ,., 18 REARDON CIRCLE I
AREA(SQ FT) s 265,628 880 EST COST($) 46000 00 1 PERMIT FEE($) L35.00 ISO.YARMOUTH, MA 02664 ,
OWNER WARREN ROYALyG s BUILDING DEPT B,1F
ADDRESS C/O PHELAN TIMOTHY 174 LOWELL ST wi i s 1
DUNSTABLE MA 01827 �� PHONE j
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREE % sEY OR SIDEWALE4✓�'R ANY PART THEREOF, EITHER TEMPORARILY
OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERT T 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:
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.
'4
0 Permit/4
O '9 ''Amount co--
"°°°°""°'� d Permit expires 180 days from
issue date
a - 37--1
EXPRESS BUILDING PERMIT APPLICATION
TOWN OF YARMOUTH
Y armoutit Building Department
1146 Route 28
South Yarmouth, MA 02664
(508)398-2231 Ext. 1261
CONSTRUCTION ADDRESS: 4-7 ./t/f}Uss-r' /e1
ASSESSOR'S INFORMATION:
Map: Parcel:
OWNER: �l9.i/ ir9 ,L-7/9 J,4GJ'1 e 9 ?> 777J NAME PRESENT ADDRESS TEL. #
CONTRACTOR// / C/z,��y��fi1f� f P Zit12�0, lily ye ie � �J���J✓z.r
NAME / MAILING ADDRESS / TEL.#
Oesidential 0 Commercial Est.Cost of Construction$ li 4 P d,
Home Improvement Contractor Lie.# /4,� S/i 7 Construction Supervisor Lic. # /f> 6 f 62.
Workman's Compensation Insurance: (check one)
0 I am the homeowner 0 I am the sole proprietor .I have Worker's Compensation Insurance
Insurance Company Name: � 4,JV71 1,B 7 Worker's Comp.Policy# Lev C J D/ 3 4 f 00
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: i2 �l�JrL! L m
�� 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 revocat n of my license an. for prosecution under M.G.L.Ch.268,Section 1.
Applicant's Signature: /% .% / Date: /G,/,)/79
Owners Signature(or attachmen Date:
Approved By: <f y Date:
Building cial esignee) EMAIL RESS:
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
•
•
Commonwealth of Massachusetts
) sion of Professional Licensure
Board of Bullding•Regulatlons and Standards
Construtt ri tttpgrvlsor
•1
CS•100988 "f"' ' , EXpires: 11/11/2019
HENRY E CAt+BIDY` 'a , = :_
8 SHED ROW^ ' f r.Ji
•
WEST YARMOG7;.I MA,58,73
Commissioner
•
•
L.7ZI �J KW/Pea e& (' :. r Cl.•,Jc%CG►! 1r1•Pl J
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: 123562
18 REARDON CIRCLE Expi Expiration: 12/14/2020
SO.YARMOUTH, MA 02664
Update Address and Return Card.
„ 1,1'i 20M•05157
Office of Consumer Affairs&Dullness Regulation
• HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only
TYPE:Corporation before the expiration date. If found return to:
Registration Expiration Office of Consumer Affairs end Business Regulation
153887 12/14/2020 1000 Washington Street-Suite 710
CAPE COD INSULATION,INC ' "` Boston,MA 02118
HENRY E.CASSIDY 64-cd?-f ---
18 REARDON CIRCLE
SO.YARMOUTH,MA 02664 Undersecretary a Ith t sign r
•
The Commonwealth of Massachusetts
- _ Department of Industrial Accidents
- Office of Investigations
- - 600 Washington Street
- Boston,MA 02111
www.mass.gov/dia
or ers' ompensation Insurance Affidavit: Builders/ContractorslElectricians/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:
, 1 am a general contractor and I Type of project(required): .
1.� 4
1 am a employer with 48 0 �
employees(full and/or part•time).' have hired the subcontractors 6. 0 New construction
2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. employees and have workers'
[No workers' comp. insurance comp.instu'ance.t 9. Building addition
ur
required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions
1❑ 1 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
.m self right of exemption per MGL
Y (No workers'comp. 12.0 Roof repairs
insurance required.]t c. 152,§1(4),and we have no
1 employees.[No workers' 13. Other Weatherization
comp,insurance required.]
'Any applicant that checks box HI must also till out the section below showing their workers'compensation policy information.
j 'Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tC'nnuacuon that check this box must attached an additional sheet showing the name ot'the sub-contractors and state whether or not those entities have
employees. If the sub-wniractcm have employees,they must provide their workers'comp,policy number.
I . , _____ _.__ ...-. -----____--
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 rE or Self-ins.Lit.#;•W/ /C IQ0136900 Expiration Date:06/30/2020
•Job Site Address: 4'7 I '4 J 221 ydiffriee)111,- e1'1 r City/State/Zip: '`l L f3Attach a copy of the workers' compensationplicy 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
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
Inves i ations of 'lA for in trance covera_e verifi ation, -_ • _
I do hereby certify under the pains and penalties of perjury that the information provided above
v is true and correct.
Signature: 1447
r7 Ca4'a4' Date: /P/////9
• Phone Iv 508-775-1214
r
Offices use only. Do not write in th5 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#:
1
CAPECOD•27 AMAHl fi
CERTIFICATE OF LIABILITY INSURANCE DATE IMMIUDNYYY)
06/05/2018
/IcATElSIssUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS !1 DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
IS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
ATIVE 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 require an endorsement, A statement on
this certificate does not confer rtghts to the certificate holder In lieu of such endorsement(s),
PRODUCER CO TACT —I
tog ors &Gray Insurance Agency,Inc. PHpNE FAx
134 Rte 134 nit,Eat)t (A/o,No).(877) 816.2156'
south Dennis, MA 02660 _miss:mall p rogersgray,com
'Nat/REM)AFFORDING COVERAGE NAIC ir
••r INSURER A,West American insurance Company (14393 _j
INSURED I suRERa1Safety Indemnity Insurance Company 33618 _I
Cape Cod Insulation,Inc, INSURER C I Endurance American Specialty Insurance Company 41718
18 Reardon Circle INSURERD:AtIantIc Charter Insurance Company ' 44326
South Yarmouth,MA 02664
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER• REVISION NVIMBER:
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, _J
nSR ADDL CUBIT POLICY EFF POLICY EXP
NLT S TYPE OF INSURANCE IN WVD POLICY NUMBER l AMIDUlYYYY
A X COMMERCIAL GENERAL LIABILITY Limo LIMITS
EACH OCCURRENCE $ 1,000 000i
CLAIMS•MADE X OCCUR BKW(19) 63328281 04/01/2018 04/01/2019 DAMP S E Euroeas.,L $ 100,0001
MED EXP(Any one person) $ 5,0001
PERSONAL 8 AM/INJURY $ 1,000,0001
GEN'L AGGREQ4E LIMIT APPLIES PER: GENERAL AGGREGATE $ • •2,000,0001
X POLICY j�T Li L00 PRODUCTS•COMP/OP AGO 1 2,000,0001
x see holder doecrip of operations ;
OTHER: .--, $
B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000:
_IE.a_a_WsterlD $
•r_ ANY AUTO S p 6232707 04/01/2018 04/01/2019 BODILY INJURY(Per parson) $
AAUTOS ONLY X AUTOSULEO _j
IRED ON OWN p pBOODILY INNRY(Per accident)_ $
• X AVTpS ONLY X AVTOS OY (Pvecc tlenl)AMAGE $
----I
C' •• UMBRELLA LIAB X OCCUR $
EACH OCCURRENCE $ 2,000,000
X EXCESS LIAB CLAIMS•MAOE EXC10006636003 04/01/2018 04/01/2019 AGGREGATE $ 2,000,000
DED RETENTIONS
D WORKERS COMPENSATION PERr $
AND EMPLOYERS'LIABILITY I STATUTE I I ER
ANY PROPRIETOR/PARTNER/EXECUTIVE Y WCE00431903 06/30/2018 06/30/2019
OFFICER/MEMBHR EXCLUOEO? N 1 A E.L,EACH ACCIDENT $ 1,000,000
(Mandatory In NNH)
•• II Yyes,describe under E.L.DISEASE•EA EMPLOYEE $ 1,000,000;
DESCRIPTION OF OPERATIONS below "'•
E.L.DISEASE•POLICY LIMIT, $ 1,000,000•
// •
/ •
!
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may bo attached II mote apace le roqutred)
Norkers Compensation Includes Officers or Proprietors.
additIonal Insured status Is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder.
Excess 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 ^�
DocuSign Envelope ID:AEEDAICO-2AB6-4641-928E-AA168F9C734A
\Ult
RISE
ENGINEERING
OWNER AUTHORIZATION FORM
I, Jean Phelan
(Owner's Name)
owner of the property located at:
47 Nauset Road
(Property Address)
West Yarmouth, MA 02673
(Property Address)
hereby authorize � �-� C—czn d_ Tc S-\c a\/>
(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.
Doou5gnod DYt
1Signature
10/3/2019 I 9:54 AM EDT
Date
RISE Engineering,a Division of Thielsch Engineering, Inc.
5 Dupont Avenue I South Yarmouth, MA 02664 1508-568-1926
www.RlSEenglneering.com