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HomeMy WebLinkAboutBld-20-003584 QUrn ) )zf - 61'"Y44,ol . rTOWN OF YARMOUTH Building 398-2231 Department 1 BUILDING "� � " PERMIT NO BLD-20 003584 PERMIT IL"oc,. "" JOB WEATHER CARD ISSUE DATE 12/24/2019 „ - APPLICANT HENRY CASSIDY PERMIT TO New AT(LOCATION) 380 LONG POND DR SOUTHYARMOUTH,MA 0� ZONING DISTRICT ;R-40 IR-40 1 Bldg.Type: ;Residential SUBDIVISION MAP BLOCK LOT [569.46 BUILDING IS TO BE: L2ONST TYPE ]IV B USE GROUP 1R-3 . . ..., .rvw CONTRACTOR REMARKS Repair-Install Insulation(508-775-1214) 1 # LICENSE 153567 s `Home Improvement I ;;CAPE COD INSULATION, INC • HENRY CASSIDY ..,. _.n_.__.. __ 18 REARDON CIRCLE AREA(SQ FT) 398,486 880EST COST($) 9000 00 PPERMIT FEE($)ry 135 00 ,...F ISO.YARMOUTH, MA 02664 ? OWNER [GRAY MICHAEL � BUILDING DEPT BY ADDRESS GRAY WENDI,380 LONG POND DR y i SOUTH YARMOUTH 1MA 02664 11 j i � HONE THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWA K ORT 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. �'- .t.„\%0 1Permit# C J C ._i' O i.e.— Amount iU �, `°•�• '� � it Permit expires 180 days from z • >issue date J az--0-0,14)---3S.E5 V EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH • Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: J ,c O.t/9 //1G/d/ ',' ASSESSOR'S INFORMATION: / Map: Parcel: OWNER: .ev ii4S _.,5-Y),!g Q 4 J4-144 '. 77 5 e 2 'kip NAME PRESENT ADDRESS TEL. # CONTRACTOR:OPP C;;;-/ Zti/S/>%.•,'T'/0/[f /egeree,,a C /✓' 7/1IJIIJU71t �J..S2`_`I 1 2 NAME MAILING D TEL.# pirResidential 0 Commercial Est. Cost of Construction$ 70 e, L' Home Improvement Contractor Lic. # /`c.'S�r 7 Construction Supervisor Lie,# / iy Q r rY Workman's Compensation Insurance: (check one) 0 I am the homeowner 0 I am the sole proprietor tk(I have Worker's Compensation Insurance Insurance Company Name: )-//9'1/7i6' c44/4am< Worker's Comp.Policy# Ai C/ 0/3 Z., f d ' 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: 7.4:0l41O L_ . (J r 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 revo tion of my I'cen e and for prosecution under M.G.L.Ch.268,Section 1. ri i = Applicant's Signature: h� ,,,ow Date: /��� ` --// Owners Signature(or attach ant) Date: Approved By: ff� Date: )L�a ' —'5 Building 0 tcial(or desigtrtT EMAIL ADDRESS: Zoning District: Historical District: 0 Yes 0 No Flood Plain Zone: 0 Yes 0 No -�' i Water Resource Protection District: Within 100 ft, of Wetlands: DEC 9 20i9 0 Yes 0 No 0 Yes 0 No 1 j ,---- J B r#' iVT 71 �r RISE z ENGINEERING OWNER AUTHORIZATION FORM i EMILIE SHERMAN Tz°N'RN`C 'v rL-.,ra— ‘SLr.' mj (Owner's Name) owner of the property located at: 380 Long Pond Drive (Property Address) South Yarmouth, MA 02664 (Property Address) hereby authorize C ie ( O (Subcontractor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my props is form is ly v ' h a signed contract. Ow is re It 19 Date RISE Engineering,a Division of Thielsch Engineering,Inc. 5 Dupont Avenue I South Yarmouth,MA 02664 1508-568-1926 www.RlSEengineering.com • i.` • ~ Commonwealth of Massachusetts y r Division of Professional Ucensure Board of Building Regulations and Standards Constrit$Uit5' ,qv isor / C: CS•100988 •a $ i spires 11/11/2021 i HENRY E CAO SID � t �f 8 SHED ROM \1:1 WEST YARMO11TH'My• �1 3., �' 9 f Commissioner T 1 eJ/(�(� .J�/� /l'%��%%�l r�CCI�/� � �.,r(%�%l;J�JCGt!�lrJ•E.��I+J Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type; Corporation CAPE COD INSl1LATION, INC Registration; 18.3887 18 REARDON CIRCLE Expiration; 12/14/2020 SO,YARMOUTH, MA 02884 • '.y y zom,Jy;, Update Address and Return Card, /64)/7017 vi//,) rr office of CorrwmorAffelre a Dullness Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:Corporation before the expiration date. If found return tot Rsglstratlop Expiration Office of Consumer Affairs and Business Regulation 163667 12/14/2026 1000 Waehington Street•Butte 710 CAPE COO INSULATION,INC "" Boston,MA 02118 r l r HENRY E.CASSIDY 18 REARDON CIRCLE S0,YARMOUTH,MA 02664 Underseoretery a It t sign r The Commonwealth of Massachusetts Department of Industrial Accidents rf Office of Investigations • , 600 Washington Street Boston, MA 02111 www,mass.gov/dia oricers' Compensation Insurance Affidavit: Builders/Contractors/'Electricians/Plumbers Applicant Information Please Print Letibly 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 un employer? Check the appropriate.box: 1. I am a employer with 48 4, ❑ I am a general contractor and I Type of project(required): employees(full and/or part-time).* have hired the subcontractors 6, ❑ New construction 2,❑ I am a sole proprietor or partner- listed on the attached sheet, 7. ❑ Remodeling • ship and have no employees These subcontractors have g, ❑ Demolition working for me in any capacity. employees and have workers' (No workers' comp. insurance comp. insurance) 9, ❑ Building addition required,) 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself,(No worker✓.; comp. right of exemption per MOL • 12.0 Roof repairs insurance required,)t c, 152,§I(4),and we have no �f Weatherization employees, [No workers' 13.{/-� Other comp. insurance required.) �.An>applicant that checks box NI must also till out the section below showing their workers'compensation policy information, Homeowners who submit this affidavit indicating they are doing all work and then hire outside convectors must submit a new affidavit Indicating such. :Convectors the:check this box must attached en additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contracture have employees,they must provide their workers'romp,policy number, !am an employer that Is providing workers'compensation insurance for my employees, Below Is the policy and Job site • Information, Insuruncc Company Name: Atlantic Charter Policy lI or Self•ins, Lie. ft: WCI00136900 Expiration Date;06/30/2020 • Job Site Address; . /State/Zip; 12f Atwell a copy of the workers' compensation policy dec7ation'page(showing the policy number and expiration date). Failure to secure coverage as required under Section.25A of MCL a. 152 can lead to the imposition of criminal penalties of a flue up to SI,500,00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine oI'up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investivations of the DlA or instuance covers e verification,!, _ I do hereby certify under the pairs and penalties of penury that the Information provided J aboved is true and correct, 1i6Iiawre: ���KiLl/ e441-414 / -- Date ' / '/2- / i _ Phtanc✓t: 508-775-1214 Official use only, Do not write in this area, to be completed by city or town official, City or Town: Perrolt/Licease# issuing Autbority-(circle one): I. Board.pf Health 2, Building Department 3.City/Town Clerk 4,Electrical inspector 5. Plumbing Inspector- 6. Other • Phone#: /^....,,-4 Parcel n, AC R CAPECOD-27 THORNE .......--- CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDVriY) 7/16/2019 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 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 Ileu of such endorsement(s). PRODUCER CON/ACT Good Inc. NAM Rogers&Gray Insurance Agency, 434 Rte 134 PHONe South Dennis,MA 02660 (A/C,No,EXt):(800)553-1801 I(FA,No):(877)816-2156 Pdt"Dbss:mailkrogersgray.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:West American Insurance Company 44393 INSURED INSURERB:Arbella Protection Insurance Company, Inc. 41360 Cape Cod Insulation,Inc. INSURER C;Endurance American Specialty Insurance Company 41718 18 Reardon Circle INSURER D:Atlantic Charter Insurance Company I44326 South Yarmouth,MA 02664 INSURER E: --I 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. HER ADDLSUER LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF POLICY EXP A IMM/�D/Yl'1 /) IMMlDD/YYYYl LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS-MADE ��OCCUR EACH OCCURRENCE $ 1,000,000 BKW 53328281 4/1/2019 4/1/2020 DAMAGET(?Ea occurrence) i 100,000 • MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGRE ATE LIMIT AP LI SPER: 2,000,000 X POLICY 1I 28: LOC GENERAL AGGREGATE $ OTHER: • PRODUCTS-COMP/OPAGG $ 2,000,000 I COMBINED SINGLE LIMIT $ B AUTOMOBILE LIABILITY (Ea accident) $ 1,000,000 ANY AUTO 1020081008 4/1/2019 4/1/2020 O 7U OSDONLY X SCHEDULED BODILY INJURY(Per person) $ AUTOS RREE WORM? BODILY INJURY(Per accident $ X AU70S ONLY A�TOS O Y '' PROPERTY DAMAGE {per accident) $ , I C UMBRELLA LIAB X OCCUR $ X EXCESS LIAB CLAIMS-MADE EXC10006635004 EACH OCCURRENCE $ 2,000,000 4/1/2019 4/1/2020 AGGREGATE $ 2,000,0001 DED I 1 RETENTION$ D WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY GTH- ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N WCI00136900 6/30/2019 6/30/2020 STATUTE I I ER OFFICER/MEMBER�ManchaInNH)EXCLUDED? I N/A E.L.EACH ACCIDENT $ 1,000,000 t0 In NH) I!yes,describe under• E.L.DISEASE•EA EMPLOYEE $ 1,000,000 DESCRIPTION 9F OPERATIONS below 1 E.L.DISEASE•POLICY LIMIT $ 1,000,000 l DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more apace Is required) CERTIFICATE HOLDER CANCELLATION 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 L. I C .,--- ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACC)Rr)name ar+rl In.,....-..- t.-a-- --_-,.. , .