The URL can be used to link to this page

Home My WebLink AboutBld-20-003583 ervicu:i / /�. �, .,D . .i4i, TOWN OF YARMOUTH Building Department BUILDING * rill 10,40 PERMIT (508) 398-2231 ext.1261 } PERMIT NO BLD 20-003583 " Yr: ''' JOB WEATHER CARD ,., 4 n ISSUE DATE 12/24/2019 APPLICANT HENRY CASSIDY PERMIT TO New AT(LOCATION) 118 PINNACLE LN,YARMOUTH,MA 02675 ZONING DISTRICT 1R 40., Bldg.Type: Residential LL SUBDIVISION MAP BLOCK LOT 135.174.1 BUILDING IS TO BE: [CONST TYPE IV,B miUSE GROUP [R-3 i CONTRACTOR REMARKS Repair-Install Insulation(508-775-1214) „ ., nn., _. _„w_,.. .r . ._. i I ± LICENSE 153567 1 I iHome Improvement ;CAPE COD INSULATION, INC 2 q ':HENRY CASSIDY e v 3118 REARDON CIRCLE AREA(SQ FT) 3 908,813,0� EST COST($) 4000.00 P PERMIT FEE($) t35 00 1 'SO YARMOUTH,MA 02664 1 OWNER SHERMAN DOUGLAS D J BUILDING DEPT BY 1 ADDRESS S-HERMAN LAURA A, 18 PINNACLE LN 1 L i `YARMOUTH PORT MA (02675_..4 w 6v HONE B 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. OCCUPIED UNTIL FINAL INSPECTION HAS OCCUPANCY 4 BEENMADE. TO DETAILED INSPECTION BEEN MADE. SCHEDULE 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. �0PermitN • C r''' ?t • _ Amount ��' MATTA M '61, �c5),'to•#<##Ito°c Permit expires ISO days from z =issue date J z L`35A-3 EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508)398-2231 Ext. 1261 .CONSTRUCTION ADDRESS: f z r/A7 44/r' Z,<i ! ASSESSOR'S INFORMATION: Map: Parcel: OWNER:%,4LJ/ 0 .S. s1 'S',,,Q /2 3.�,7 NAME PRESENT ADDIrESS TEL. # CONTRACTOR:r In l /4).5/.4,r/cm]. AP'Aft f�,r.P C //epgigaz.,71L �J-. k 275 l ZNAME MAILING D TEL.# Residential 0 Commercial Est. Cost of Construction$ .4 D 0 O Home Improvement Contractor Lie. # /J' L5'y'4 T Construction Supervisor Lie, # / S Q r r Workman's Compensation Insurance: (check one) 0 I am the homeowner 0 I am the sole proprietor ie.I have Worker's Compensation Insurance Insurance Company Name: )1/f9'A7 JiC C44/i a< Worker's Comp.Policy# It)C/c.O/3 to 9(.-3 e..5 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: „),A2,0d ' e.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 revoction of my license and for prosecution under M.G.L.Ch,263,Section I. i/i i Applicant's Signature: i i Date: `z/Ti j / 7 Owners Signature(or attachme . Date: Approved By: ✓—.1 Date: / -, ,Z ii 'ff Building Official(or designee ,l EMAIL ADDRESS: r R E0 ! 't,E Zoning District: - ._, _a I Historical District: 0 Yes 0 No Flood Plain Zone: 0 Yes 0 Nol _ , F DECEL 42019 . Water Resource Protection District: Within 100 ft. of Wetlands: 0 Yes 0 No 0 Yes 0 No __-__ j�r _� //� .e t •—� ®� Commonwealth of Massachusetts Division of Professional Licensure Board of Building Reg.ulatlons and Standards Constr4,1 trodidt5'{�P,rvisor /I, C. CS•100988"' ;a • �• • Expires: 11/11/2021 ipt HENRY E CASIDYtf; 8 SHED ROW '\ WEST YARMODUTH 1 3? t' a, 4'CJ i S's:1:1(1 • ' xt t C Commissioner / .J(�/>T%�7('%l•ll�'C'CGI�� R,� a.J,)CGr!161Jf.'7.�J" Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Typo: Corporation I�l.ATION, INC Registration; i6.3687 CAPE COO INS 18 REARDON CIRCLE Expiration: 12/14/2020 SO,YARMOUTH, MA 02864 • . ;� 1,6 20h4•0/1r Update Address and Return Card. rr office of ConiumorAffalra&Duolnesa Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:Corporation before the expiration date. If found return to; Registration $xpiratlon Office of Consumer Affairs and Business Regulation 163667 12114/2p20 1000 Waehlnpton Street butte 710 CAPE COD INSULATION,INC Boston,MA 02118 J HENRY E.CASSIDY \�. 18 REARDON CIRCLE (� SC).YARMOUTH,MA 02664 Undersecretary • a Ith t sign r • • The Conrnwnwealth of Massachusetts i.a 1 .1 k' .• Department of Industrial Accidents Office of Investigations , ' 600 Washington Street Boston, MA 02111 ,;,t,.,„`t., T;.,.•i ;,: www,mass.gov/dla Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/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 yuu un employer?Check the appropriate.box: 1. am a employer with 48 4, ❑ l am a general contractor and I Type of project(required): employees(full and/or part-time).'' have hired the subcontractors 6. ❑ New construction 2,❑ l am a sole proprietor or partner- listed on the attached sheet, ?, ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' (No workers' comp, insurance comp. insurance.: 9, El Building addition required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3,❑ I am a homeowner doing all work officers have exercised their 1 l.❑ Plumbing repairs or additions myself.(No worker,' comp. right of exemption per MOL • [IC Roof repairs insurance required:] t c, 152,§I(4),and we have no employees. (No workers' 13. Other Weatherization comp. insurance required.) 'Any applicant that checks box NI must also nil out the section below showing their workers'compensation policy lot rmation, Homeowners who submit this affidavit Indicating they are doing all work and then hire outside contractors must submit a new affidavit Indicating such. • :C'onuucton char check this box must attached un additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contraciurs have employees,they must provide their workers'comp,policy number, l am an employer that Is providing workers'compensallan insurance for my employees, Below is the pollcy and Job sire • Infatuation. Insurance Company Name: Atlantic Charter Policy//or Self-ins, Lie. #t:'WC 100136900 Expiration Date:06/30/2020 Job Site Address,:I 4,' y ,O)eU7 City/State/Zip: ,/yt ? 0 4-7-7 t. ' Attach a copy of the workers' compensation policy deelaration'page(showing the policy number and expiration date). Failure to secure coverage as required under Section.25A of MOL a 152 can lead to the impositioi bf criminal penalties of a flue 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 DlA for insuuanee coyentae verification. _ • (do hereby certify under� the pains and penalties of perjury Brat the Information provided above is true and correct. 8ibnnitore: _7 r�7 ��Zcuc Date /2/i 72f Pht�nc k; 508.775-1214 0 rc a use only. Do not wr e n t us area, to ?comp etc y e ty or town official. City or Town: Permit/License a Issuing Autbority-(circle one): I. Board,pf Health 2. Building Department 3,City/T'own Clerk 4.Electrical Inspector 5. Plumbing Inspector. 6. Other At Dprelin Phone#: AC 0" CAPECOD-27 THORNE i........----- CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDlYYYY) 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(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 rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT Good Rogers&Gray Insurance Agency,Inc. PHONE 434 Rte 134 (A/c,No,Ext):(800)553.1801 I Fax South Dennis,MA 02660 M 1 mail r (ac,No):(877)816-2156 dFOD�t�ss: @ ogersgray.com - INSURER(SI AFFORDING COVERAGE NAIC# INSURER A:West American Insurance Company 44393 F INSURED INSURER B:Arbella Protection Insurance Company,Inc. 41360 Cape Cod Insulation,Inc. INSURER c:Endurance American Specialty Insurance Company 41718 18 Reardon Circle INSURER a:Atlantic Charter Insurance Company 44326 South Yarmouth,MA 02664 INSURER E: 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. NSR TYPE OF INSURANCE ADOL SUER I. - POLICY EFF POLICY EXP) LIMITS LTR INSD WVD f IIIDD (( /ID A X I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS•MADE X'OCCUR BKW 53328281 4/1/2019 4/1/2020 DAMAGE TO RENTED 100,000 PREMISES(Ee occurrence) $ __ MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APELI S PER: 2,000,000 X POLICY 11 JECT 1i LOC GENERAL AGGREGATE $ OTHER: PRODUCTS-COMP/OPAGG $ 2,000,000 B j AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 ANY AUTO 1020081008 _(Ea accidaot1. $ OWNED ' SCHEDULED 4/1/2019 4/1/2020 BODILY INJURY(Per person) $ AUTOSE� ONLY X AUTOOSW�ED X AUTOS ONLY X A�OS ONLY PRBOOPERTYDILY UDAMAGERY(Per accidanp $ (Per acciden!) $ C UMBRELLA LIAR X OCCUR $ • EACH OCCURRENCE $ 2,000,000 X EXCESS LIAB CLAIMS•MAOE EXC10006635004 4/1/2019 4/1/2020 AGGREGATE $ 2,000,000 DED 1 I RETENTION$ D WORKERS COMPENSATION _ $ AND EMPLOYERS'LIABILITY r PERSTA 1OTH- j ` ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N WC100136900 6/30/2019 6/30/2020 I STATUTE ER FFICER/MEMBgER EXCLUDED? L I N/A E.L.EACH ACCIDENT $ 1,000,000 (Mandatory In NH) f yes,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/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION I 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 ( 1,-#,SA.P.Z.e2 Za"A-A--...."------------ ACORD 25(2016/03) ©1988.2015 ACORD CORPORATION. All rights reserved. The ACC)Rfl name anri Inn,.,..,-.,..,...----'-__..._ . ..,--- RISE ENGINEERING OWNER AUTHORIZATION FORM 1, LAURA SHERMAN (Owner's Name) owner of the property located at: 18 Pinnacle Lane (Property Address) Yarmouthport, MA 02675 (Property Address) hereby authorize C e) A ' -�S . A rY t, (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. v Hers If/nature t 2-o Date RISE Engineering,a Division of Thielsch Engineering,Inc. 5 Dupont Avenue I South Yarmouth, MA 02664 1508-568-1926 www.RlSEengineering.com