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HomeMy WebLinkAboutBld-20-3559 V.Yilivt . TOWN OF YARMOUTH Building Department BUILDING ,t, - "4r4 (508) 398-2231 ext.1261 ` C PERMIT NO BLD 20 003559 PERMIT "*T �[ 7 ' ISSUE DATE 12/23/2019 JOB WEATHER CARD APPLICANT FRANCIS SHEEHAN PERMIT TO : New AT(LOCATION) 14 BREWSTER RD,WEST YARMOUTH,MA 026 ZONING DISTRICT R 25 Bldg.Type: Residential SUBDIVISION MAP BLOCK LOT 1029.143,.., „ .. w1 BUILDING IS TO BE: CONST TYPE - B USE GROUP R-3 ! i REMARKS Repair-Install Insulation (774-237-0410) CONTRACTOR LICENSE 1160854 , ;Home Improvement i I 1 1FRONTIER ENERGY SOLUTIONS 3 _ _ €FRANCIS SHEEHAN ,. . ., ry v J 1502 HARWICH RD AREA(SQ FT) 227 688 120. EST COST($) 2700 00 PERMIT FEE($) 35.00 $ . _, BREWSTER, MA 02631 = OWNER ROSE ERIC E TRS � --- BUILDING DEPT BY i ADDRESS [ROSE BARBARA J 56 OAKLAND ST FA-TICK MA 01760 /PHONE , THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWAL 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: 1 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. OfnCC Use Only 44 Penrtit# Amount > -` Permit expires 180 days from — issue date EXPRESS BUTTDING PERMIT APPLICtTI TOWN OF Y .RMOUTH Yarmouth Building Department a DEC '> ZU1B 1146 Route 28 South Yarmouth,MA 02664 : `r3 r.:�� (508)398-2231 Ext. 1261 �= CONSTRUCTION ADDRESS: ASSESSOR'S INFORMATION: Map: Parcel:I i '3 OWNER: • (, 1' P D S TEL. CONTRACTOR;- . T>•"` # 1fdResidential 0 Commercial Est Cost of Construction$ 7(X) Home Improvement Contractor Lie.# j(4i0 i4 Construction Supervisor Lie.# /04S-944 Workmen's Compensation Insurance: (check one) _,,,�^ 0 I am the homeowner 0 I am the sole proprietor Qeertave Worker's Compensation Insurance Insolence Company Name Worker's Comp.Poli �T 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 Higliway/Historic Dist. ( )Replacing like for like Pool fencing 'The debris will be disposed of at:ISCI r..e J } (' :' 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 ofm $.e d fp.r prosecution under lvt G.L.Ch,268,Section 1. Applicant's Signature: * Date: �/(9L4I' r Owners Signature(or attachment) Date: Approved By: Date:- J Building Official(or designee) EMAIL ADDRESS:riirn o`Kezio J Zoning District Historical District: 0 Yes 0 No Flood Plain Zone: 0 Yes C No Water Resource Protection District: Within WO ft.of Wetlands: 0 Yes 0 No 0 Yes 0 No RISE ENGINEERING OWNER AUTHORIZATION FORM I, Barbara Rose (Owner's Name) owner of the property located at: 14 Brewster Road (Property Address) West Yarmouth, MA 02673 (Property Address) hereby authorize (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. This form is only valid with a signed contract. Owner's Signature Date RISE Engineering, a Division of Thielsch Engineering, Inc. 5 Dupont Avenue I South Yarmouth, MA 02664 1508-568-1926 www.RlSEengineering.com �'•' . CIa commonwealth ttj't a, t�1ttrs its ritiFtil i 1 Co4,01Pe'J;i:,i tr±f s,$s a JOD h ",€ wwtt'r. ie . wtiftta `"`, WAWkete Ct r rctt afi*i LOOT a ri e Astieteint,Au litters/Con tract o#^afgl callcti %Pl'tinitsei's: "r 4 O UUE"F-ri 1 ri1tiIT/i'l ih PEAMi71"1NG AtIlltRITV. Applicant lnafotuia n - Please Print L bly� ` e Name 4r insvorgi ontirtlivuluao:k.l 4 � +fie - a tkJ1...=+ C it "#iittg • t how .; f holm �� , , "7� e Type of project(required):�.. ., ._,.. tAre,yousn employer Cheek theatiP A yp P I r�. m a emptoyer wait A ex ptoyees mull t*taa go-rant * 7 0 New construction 2.040 ri a saki g etpoe..tarot jstettleislOp ottOttave fro€avtoyees terataag..for lac ie S. 0 Remodeli ng eay aeons:lNotoine..l siaa tc mowe4I 9 DOkilatiOOR ):0140y.hroneovriel Oohs all more myself f No workers'ccinip in mrac c.se iredj a 1 addition �� 4,ElTarn a`ltoteetlele r e/r be,ltiritift ptutttitatsta l#s�oarlugt dr'Wtit: tit Iai4E+rtya.t Will enureeisroon it 'set iwyorse.�rkerttson;protatiOrtlesiitatteseut "ett I t. ] 1 ,tte.replirS-or'additions prryfieites'"wltirtuieaigt rte.'s. )2.0"la)uralt repairs or-additions s..01,40411.0104 connote and yip ve tnnot Me sa,-taaoraerkas hKae 9 an rlte arn+, r d.xt>eatt, f 3 .-RoOf rap ifr$ ThesoritakiNalloars -cn plo e,aad hay,' eti.er'kid" iniurdh ".• e.E3 we wee e arpara{tan suet its ratt'tteers he e exti isixd tiara,'i;rhs of exemptrzu-gel'MGh e. t=,f 101,aria we have no cmpltwecs 'Plc workers'ramp aworm-requat ai 'Aatry gptrliueot""rbu11 chtekS iitrx s1 ituS1 dIsc,titl out rita s:eiatan hefo °ad;;via is their workers'carrtmereta+fawn policy ant'branenee. .. �Nion+eu>lners"o 414bOt 300 a +rvltuYdtbsu C1iUYsrotlatng;kir worker tfreA ttK4 atrtarda cpnegatt-rye must aubmrt a ntw atfdtt.•4 indicaritig=*Lich: 7Coranietro that cltc! C.iliis try;inusttAditte hCd1 n ad*rii il,,}aaier shawirap"diie:atone of*staVveriuir laukaird ttauc.vih lice"es?rnoi those entitice have 4:011.*py,:ux,3t'tti tHc raeitlt�ipvc', ,. ,O, ., 0 '. :C.1Irevasafa**1 OOtC°t'pn, Ii9t1r zu+it " ' 1 on employer glut ,jtr a#t t+g► orkerr'ram' e';st in tat rrr eE ftr'my employees. &Me is mh t potr'cy con-1,iti#sty , lrrsul�nce Company k�r i iw -- ' " ir��, t�i `" �y - _"._ Policy or Self-ins,Lie ,,C i 3 I ,31 9 ) /11" Expirationhate; pi 6(0 Joh SiteAdr ss: � 1 ...,, yiStatrwf '.Pt, Attrrtti:a iya*rthe Alines*cdinpetten t fto a el ,'"gq >ahoitiptA the polity pith r'it' 'e' , atititti date). failure to satire doverage as required x nder°MCI,.c. t 12,, 5 .is a Cri nir'ai vialritioff,uttlshttb y a.fine up to S;1,5O0.0O antlitir unneyear iinpri onnient,as well risisivil penoft ee in the form-of a S'1'ORVOMC OfOgiR.and a frtreo op to 9;Q6 a Piltle V_Cillatok,,A copy of this statement May tio4O sdrded to the Otter:of 1rree ttgations atilt D1A tor idsttattce ' covera c veriflt a tom 1 r o heraelly coil" 'tin-dirt 41-4 penattie. of perli�rry t int die information'provided trove'3 fruit- i tru er Date:. 1 irlat �e l',tntt� ..��� '+- � __-may--"w - ,...� Ofciut use only. .0o AO write Err this wet',tel by completed 6y city or fowl'ojJieirr/, : Ci y or Town:_ __ _ _ Permit/License es issuing Authority(rite otre)s ' 1.good o1' eal"h 2 Buitding:1)epartment 3.Cijy/Thwn Clerk 4,Electrical Inspector 5.Plumbing inspet<tor 6.Other__ Contact Permits: Phtitt i.:. _ . P. a i I o c .`' .1 liii > ® `a- t► 05 y m 13 t iJ liii � dVC az id 1)1E11 6 a I O CD i le ,gig . 3 , 2d o . a: IPiii1I*1Ih L m ACo® 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). CONTACT R ers and GrayProcessing PRODUCER NAME: ROGERS&GRAY INSURANCE AGENCY INC PH,iNONo.Ext: (508)398-7980 iac,No): ADDRESS: mail@rogersgray.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 INSURER E: 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. ADDL SUBR POLICY EFF POLICY EXP LT !NM MDR LIMITS INSR OF INSURANCE !NM POLICY NUMBER (MWDDIYYYY) (MMIDD/YYYYI COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(My one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRODUCTS-COMP/OP AGG $ PRO- POLICY POLICY T LOC $ OTHER: COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY (Ea accident) BODILY INJURY(Per person) $ _ ANY AUTO ALL OWNED — SCHEDULED N/A BODILY INJURY(Per accident) $ NON-OWNED AUTOS PROPERTY DAMAGE $ _(Per accident) HIRED AUTOS ^AUTOSTOS $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ OT WORKERS COMPENSATION X STATUTE ERH- AND EMPLOYERS'LIABILITY Y/N E.L.EACH ACCIDENT $ 1,000,000 W ANYPROPRI ETOR/PARTN ER/EXECUTIVE A OFFICER/MEMBEREXCLUDED? N/A WA N/A VC10060153152019A 03/14/2019 03/14/2020 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 (Mandatory In NH) If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS/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/lwd/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 Coy,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