Loading...
HomeMy WebLinkAboutBld-20-001822 vn -e I0/z I 61" ``M+ TOWN OF YARMOUTH Building Department BUILDING (508) 398-2231 ext.1261 0 °1 ' . PERMIT NO BLD-20-001822 PERMIT "* 4 ` ' 4 ISSUE DATE 10/03/2019 JOB WEATHER CARD APPLICANT FRANCIS SHEEHAN PERMIT TO New AT(LOCATION) 26 OAK GROVE RD SOUTH YARMOUTH MA 02 j ZONING DISTRICT iR 25 I Bldg.Type: ?Residential SUBDIVISION MAP BLOCK LOT 1025.261 I BUILDING IS TO BE: CONST TYPE }IV B I USE GROUP 1R 3 REMARKS Repair-Install Insulation(774-237-0410) CONTRACTOR x I.w .. ..�� _ a r } LICENSE :160854 , Home Improvement ,$ FRONTIER ENERGY SOLUTIONS lFRANCIS SHEEHAN { 502 HARWICH RD :} AREA(SQ FT) ;246 680 280 EST COST($) [9600.00 I PERMIT FEE($) 135.00 ; , BREWSTER MA 02631 OWNER TOMALLEY GEORGE R _ BUILDING DEPT BY " ADDRESS lOMALLEY MARIANNE, 1385 CENTRE ST : IBOSTON IMA 02132 7714 g _BA PHONE THIS PERMIT CONVEYS �NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SID A K 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 OCCUPIED UNTIL FINAL INSPECTION HAS BEENMADE. SCHEDULE BEEN 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. -1Office Use Only ' 4. '97--'\ '\• 1 iPermiv: Te.`• .,:i.iitzst*)41 •C61\\,,..„/,'''`,..„0*%tV (\442) lAmount 3;- : 1 ..Permit expires 180 days from issue date ab_zo_k-c)_)- EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH . . ...,. . , . Yarmouth Building Department 1146 Route 28 , ' - • South Yarmouth, MA 02664 (508) 398-2231 Ext. 1261 i QU (_Y, 2019 *. CONSTRUCTION ADDRESS: D Go 0 A-ft__Grz....k../e,ILD '1 c -g'3 (to . .. ASSESSOR'S INFORMATION. I Map: 0 WNER:Cay,(-D' I 3 t c.PRESENT Q,D.114-pc,... '-- 1-- Li_tog:22y.--aiovi- (P-410- NA AU RE S TEL 4 CONTRACTOR:1 — - , f. lAs cii.,..x.iikott--60. 77 qa70(-llo NAMENi.",432,,, ,,,,- TEL.# tiResidential C.":Commercial Est.Cost of Construction$ 60o Home Improvement Contractor Lie.tt I(4/0$3(1`) Construction Supervisor Lie.# 10SCi 4-1 1 Workman's Compensation Insurance: (check one) 0 I am the homeowner 0 I am the sole proprietor iiii.f<ve Worker's Compensation Insurance . Insurance Company Name. 4 Worker's Comp.PolicytaC OrX001 S—S 6 ad i 4 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: t.ik..?-64.--' - ' e +1 t1LWS c_t- c-lif..- cactc 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 m ' d for prosecution under M.G.L.Ch.268,Section I. Applicant's Signature. c ' Date: i 0/31/ 1 _ Owners Signature(or attachment) ., Date: Approved 3-v: Date - /a.......3.....:4,- Building Of:" ' esim j eei . FM ADDRESS ADDRESS ouri 0 i fiev,...),,,,ci2.,, ,e,,wok: , Zoning District: Historical District: 2 Yes 0 No Flood Plain Zone: ff Yes if No 1 Water Resource Protection District. Within 1 Cii..)ft.of Wetlands: If Yes - No '`r es if No DocuSign Evvelope ID:5B01235D-05C8-4126-8286-20453650AA51 R ENGINEERING' OWNER AUTHORIZATION FORM 1, George °Malley (Owner's Name) owner of the property located at: 26 Oak Grove 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. DocuSigned bic 13E349062BEBE4F4. Owner's Signature 9/10/2019 1 8:03 AM EDT Date RISE Engineering, a Division of Thielsch Engineering, Inc. 5 Dupont Avenue I South Yarmouth, MA 02664 I 508-568-1926 www.RlSEengineering.com .t. . The (Pmmotthiectith of Massachusetts It2'7:7. r Department of In s % dustrial Accident 1 Congress Street,Suite 100 ,„:„.:',,. 6 .k.'" Boston, MA.02 114-2017 --7 4, ‘11.1?.!:t0S.107 Ivww,mass.gov/dia \Vorkere Compensation InsurillICC Affidavit:BnildursiCantractors/Plectriciaria/Plumbers, -IF TO Pl.Hi I I)1\I III Ill E PERMIT-1'1.NC,Al,IHORI'tY. Applicant Information Please Print Lily —...,_ Mime i,ncsitierorganizanoildnarv,dilarn A ddreNs: 1 ttv....t . City/S tateiZiptagit,... -) cy4d 0 A„via an employer?Check the appropdate box: Type of project(required): i l- i am.I.e0:OVV1 Se All ,,/C.),....,,_el-Tip!levett I.ii'j 1.,e,,,pail,:wiel.- 7 D New construction ........ 4.113 n'80 prop/lc:or enpartneJship and have no e npi.w,,•,.,v,,,,,:k,t,,, for we 1,, 8. 1-1 Remodeling :apneas [No v,;,11,,,!Ii e.1,11: iiIit,1,,,,b. 9. j Demolition 3 1_1 I nor a holneuesSICI 00111g:.id worK myself f No,vork:Ts',p:13. i,,tlan,,.tegwrcd J' 10 0 Building addition 1 4.ri,are a homeowner and will be hiring coralaeons to erne itiet all work'on Jny property I jval I ensure that all COntraaors either have work e, evapemat tonmuf lanee or an zo!t i 1.0 Eleatocal repairs Of additions ,s I proprietors ith nt)elt mps,yojcs„ 12.0 Plumbing repairs Or additions I II. S Ei,ant li JOJ'IlL'IljIWI e ltraaal nod WIn, kited Ihk,,.01.,,,te,rO,, ,,,,t !-On the On hod rhino. I, 13.0 Roar repairs 1 , I ' i,,s-ceilcieiis have enpirayees,rno,b ,,,(.:,.,,,,r,',,..1,111 :(;,ka-,,nc,.., . Li(hi tic 8:orr0m111,1,1 and its officer,, ',,ii-,: act. nor,,,,,,lit,,1,,:empt.on pal An,,vie!-;,,v no einpkry,.,,,:, N; ,,,0.1,;,...,,,,r1i1 !rii.::.1,1,...,,,Nuir.,.d' —, — — , ., , , , ...._ .,....... --... Any NVlifeWtt!Oat LI.C., k4 bOX el must also nu OW inv.s/A1,,,,,I,:,,t.,!',),1::!•;11,Cr,vorkeli ,,,urpcnsation pol,t1),1:1fOnNiticn. 4 HOMM,eilt,TS Wilt)sultan this affidavit indieaung they are do:a*a I work and Uwe hoc outside contractors Juosi satunti a new affidavit nuticating ouch. k.ontractors tha:cheek this box must attached an additional shoal show nu the name at th sah-ecsatactels and State whethe;ne not those cooties hove emplOyccs, litt1t1,'11b.00tVEr n000,hove employees,they mug pro ate their \NW k:'$*comp policy noinocr I am an employer that is providing workers'-campensution insurance for my employees. below is me policy ante/job site inftirmativn. Insurance Company Name:XTEIACI104te-T:-.)s. ...A.,a.......L...a0.0:x.o.8:121.4_,................_..,____ ,),),,,y,,or Self-ins,Lit:.AlOt,:f OC.,..,,,-.7(4P.,1 531590)9'Pr , Expiration Date: ,...,.5titi I 610 Job site A Mit' ) —,, Attach a copy c workers'cotnpensation po . c el, tiou page s owing the polk4 numb and expiration date), Failure to secure coverage as required under MCI.c 52, 25A is a comical violation punishable by a lift y to$1,500.00 and/or one.year imprisonment,as well as civil pepalt•es in the form of a STOP WORK ORDER and a fine of up to$25().00 a day against the violatot,A copy of this statement Ma..im. tie form awed to tile Office or inyesAil4atioos of the DIA lor insurance coverage verification. ---7-- I c/ce hereby certify under th .ai •and penalties of perjury that the information provided above is true and correct '.2>ignein.c„ - .. ' __. Doic _ i,„ /6.) 3 1. ___...) ... .) PlI0I1C N 77.ti ,-- ..d„. j--- ctit/..0 ......._ Official use only. Do not write In this area,to bc completed hy city or town official 1 City or Town: Pei iillt(LiCeMe h i i lssuiug Authority(circle One): I 1. Board of Health 2,Building Department 3.eily/Town clerk 4.Electrical Inspector 5.Plumbing Inspector to Other Contact Person: Phone#: — ........... .......... --- „ _ _... Constreistion Supervisor Specialty il:xee-e t e4 m of MassachusettsRrstriated to. �,.s,on n PPoteaSionai tatensure CS$E1C•ionization Contractor BBoard of Eu strut q RegOiatioraS-rind Wandaftn,. • CSSL 1059s4', EAper .Oa,17 2022 rt.Ail FRANCIS S SiEHAN Sd2 NARSNICM Pt) BREWSTER MA 0263s r failure to possess a currant edition of the Massachusetts State Ihritairtg Cods is cause for revocation 01this license.. for infarrnalion abaft this kena Gall f817)727-?Zq0 or vise w rinemess:gev/dpt Commissioner • r € .%% rr�r»>n,<sf�ir(i1� 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: Registratloft Expiration Office of Consumer Affairs and Business Regulation tf 1854 -- 09/07/2020 1000 Washington Street-Suite 710 FRONTIER ENEFtb)fSOLUTIONE Boston,MA 02118 FRANCIS SHEEHAN 502HARWICH RD � BREWSTER,MA 02631 Undersecretary Not valid =r t -ignature ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 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 lac No.EX I. (508)398 7980 FAX No): ADDRE mail ro ers ra com ADDRESS: @ g 9 y 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 INSURER E: HARWICH MA 02645 INSURERF: 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 EXP LT ADDLTYPE OF INSURANCE INSD SUER POPOLICY NUMBER (MM/DDY/YY/Y) (F MM/LDID/YYYY) LIMITS LTR INSD WVD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE 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: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ r ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS NON OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X STATUTE ERH AND EMPLOYERS'LIABILITY Y/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/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 Frontier Energy Solutions Inc ACCORDANCE WITH THE POLICY PROVISIONS. 139 Queen Anne Road Unit 6 AUTHORIZED REPRESENTATIVE Harwich MA 02645 Daniel M.CrqOey,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 W t`<-