Loading...
HomeMy WebLinkAboutBld-20-001276 (2) .• ,(I?4' g'vA 1offtoe Vsa Only 0 PormilN r r ` !6 Amount `— hhIp Permit explras 180 days from4 rG ���104� T lssuo dole • EXPRESS BUILDING P'ER1VZIT APPL.ZcAYgi;1 ._._' TOWN OF YARMOUTH Yarmouth Building Department 1140 Route 28 CEP 6 2019 South Yarmouth, MA 02664 — ; (308) 398.2231 Ext, 1261 1 v` CONSTRUCTIONADbRE$S1' .. �/['' L�/Zf '/tha/ ♦/+[/' /iy ASSBSSOR'S tNRORMATION► Map: Paroeit ) OWNBRI 7,,Oc / - io'&72''c4 l ' 7,7; / 71� q PR T A DRBSS TBL,CONTRACTORI Henry Ceeeldy Cep,Cod Insuletlon IenrardonClrele sovlhYermovlh 508.775. 1214 O T , R Residential 0 Commercial est. Cost of Conntruotlon$ e a e. ', D Homo Improvement ContrnotoreLlo,N 153567 Coltstruetivn SuperYisor Lilo, y 100988 Wurkmsn's Cumpensatloninsuranoel (oheok one) 0 I run the homeowr.r"" C1 I am the solo proprietor 0 I hevo Workces Companeetion Insurance lnsuraneeCompenyName; Atlantic Charter Insurance' , 'WCE004319 Workor s Comp, Polloyg ., ••, VYORRC TO BE PERFORMED °`''Tent Duration (Fire Retardant Certifioato attaohed7) . 1',`Siding! #ofSqunros S,,Roplaoement windows) # eplaoement doors)R Wood orsiSto N,w_, • # Roofing! #of Squares ( ) Remove existing* (Mx, 2 layers)• Insulation Old Kings HlghwayfHlstorio Dist, ( )•Roplaoing ilko toy like Pool fencing •'' ' ►TIle dobrlt will'kl disposed of ott iI. I• Locution of Foci Ity 1 Johan,under perioltler Om) Iha Ills s> •na, s heroin ontoined ore Iruo told oorreot to the bast of my knowledge find it I understood the)any ralso ons,voiis will be Jut caws for denlal v on •. ) re turd for rosy aullon�uyder M,O,L,Oh,208,Scollop I. rife. .r p Applloenlle Slgnalurei Ca S �� b 1"I Ii 1 11 Irit�r'Ha° I,t6 fir,wn,a in{i,a yr D,101____97Zkjg Ownerr Slgnnlure(or eltnohmeot) Onto' Approved eyl Dalai -- --"77. Bonding 0Mo1 ).41- oo I • ,VVV1�1 —`N,' •IM111 Zoning District' Hlstorlonl Dlstrlotl CI Yon 1',1 No Flood Plain Zonal .J Yas 0 'No Watch Ronouroe Protoollon r)Islricl: Within 100 ft, of Wetlands; w. l't Yes CI No J Yen C1 No ,, ti, DocuSign Envelo e ID:BA72F60D-AA59-4EA4-957F-78DD9F8639FE Permit Authorization mass save Form SaJ YMou '±,ortergY ell,ct*nc'y Site ID: 3593533 Customer: Paul Spuria Paul Spuria ,owner of the property located at: (Owner's Name,printed) 38 Merrymount Road West Yarmouth, MA 02673 (Property Street Address) (City) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. e—DocuSipned by: Owner's Signature: PAUL Spunet. `-931A59CF3830425... Date: 8/28/2019 1 11:05 AM EDT FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: CAPE Ce) Zi,c(i r 4T!/g1 -zf/! Participating Contra ctor Date Name: RISE Engineering Phone: 401-784-3700 Email: Page 1 of 1 For Office Use Only Rev.102015 otAidika•ow.* .a Commonwealth of Massachusetts fl• Division of Professional Licensure Board of Building•Regulatlons and Standards Constrytctrd Itdpervlsor CS•100988 X Tres: 11/11/2019 HENRY E CASSIDY ,r �• 8 SHED ROW i yt 1,?I'S� ± `� [�i•• WEST YARMOIr .t ,T,75` ! • try/c�'I.1ltiZ\ w "1,�vr? »a, Commissioner 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: 153567 18 REARDON CIRCLE Expiration: 12/14/2020 SO.YARMOUTH, MA 02664 Update Address and Return Card. 20M Office of Consumer Attain d Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:CorporaUon before the expiration date, If found return to: Rogisntio f ExotrAtion Office of Consumer Affairs and Business Regulation 153567 12/14/2020 1000 Washington Street•Suite 710 CAPE COD INSULATION,INC Beaton,MA 02118 ff HENRY E.CASSIDY Q Gam _ 18 REARDON CIRCt.E SO.YARMOUTH,MA 02664 Undersecretary a ith t sign i _ ACORO' CAPECOD-27 THORNE �� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 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 lieu of such endorsement(s). PRODUCER Good Rogers&Gray Insurance Agency,Inc. O PHONE 434 Rte 134 (A/c,No,Ext):(800)553-1801 I FAX No):(877)816-2156 South Dennis,MA 02660 teolgiss:mail@rogersgray.com INSURER(SI AFFORDING COVERAGE NAIC# INSURER A:West American Insurance Company 44393 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 0: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. INSR ADDL SUBR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER IMM/DDY/YYYYI IMM/DD�I, LIMITS A X 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(Ea occurrence) $ MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT ATM S PER: GENERAL AGGREGATE $ 2,000,000 X 1 POLICY II JE& II LOC 2,000,000 PRODUCTS-COMP/OP AGG $ OTHER: B $ AUTOMOBILE LIABILITY (Ea aaciden SINGLE LIMIT $ 1,000,000 ANY AUTO _ 1020081008 4/1/2019 4/1/2020 BODILY INJURY(Per person) $ AUTOS ONLY X SCHEDULED oN yyNEp BODILY INJURY(Per accident)_ $ X AUPS ONLY X AUTO ONLY (POeOacadentp)AMAGE $ C UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 X EXCESS LIAB CLAIMS-MADE EXC10006635004 4/1/2019 4/1/2020 AGGREGATE $ 2,000,000 DED RETENTION$ D WORKERS COMPENSATION _ $ AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N WCI00136900 6/30/2019 6/30/2020 1,000,000 OFFICEJ2MI�n BER EXCLUDED? N/A E.L.EACH ACCIDENT $ + ,GOO ( soda o IVH) 1,000 000 If yes,describe under E.L.DISEASE-EA EMPLOYEE $ + 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 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 C :-)r--01-4-rie. .1 7/4led"'"---..---------- ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD a j ,Xy ,,. { ; The Commonwealth of Massachusetts ') r i Ch•.hA f i tX�, I0, 'or4 rt ,r. Department of Industrial Accidents h'' z > >x4 •l1Tfdtrl Y f� t r y 4., Office of Investigations "'S r ',Irk t,' 3 .,1 600 Washington Street xYs.°;' 4;"1",14 r= , Boston, MA 02111 lx 1 { l` �,fUWwww,mass.gov/dia Workers' ompensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Nume (Businesuorganlzatiun/individual): Cape Cod Insulation Inc. 1 Address: 18 Reardon Circle City/State/Zip: South Yarmouth, MA 0266-4 Phone #: 508-775-1214 Are you an employer? Check the appropriate box: Type of project(required): 1 VI am a employer with 48 4. ID am a general contractor and l employees(full and/or pantime). ❑ ' have hired the sub-contractors 6. New construction 2.❑ t am a sole proprietor or partner- listed on the attached sheet, 7. 0 Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition workingfor me in anycapacity. employees and have workers' p b insurance.: 9. ❑ Building addition (No workers' comp.comp. insurance required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3,❑ 1 am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.)t c. 152,§l(4),and we have no Weatherization employees.(No workers' 13. Other _ comp.insurance required.] 'Any applicant that checks box al must also fill 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 contractors must submit a new affidavit indicating such. • :Contractors that check this box must attached an additional sheet showing the pane of the sub-conuaetors and state whether or not those entities have employees. It the sub-conuaucm have employees,they must provide their workers'camp.policy number. . I am an employer that is providing workers'compensation insurance for my employees. Below is tire policy and Job she information. Insurance Company Name: Atlantic Charter Policy+h or Self•ins. Lic. h; WC1000136900 Expiration Date:06/30/2020 Job Site Address: yepi e/2lz e cJ>r, f�Ie,-141 City/State/Zip: W 4 7 G 54- Aiwa copy of the workers' compensation policy deelaration'page(showing the policy dumber 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 . line 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 _Inveslil:ations,afthe DIA force coveru.e verification. —.,_— _ -- /do hereby certify under the pains and penalties of perjury that the information provided abdvr is true and correct. S it~nature: 7447 ea44 Date: fli-4 y Phone i;: 508-775-1214 ' ' OJrcial use only. Do not write in this area,to be completed by city or town official City or Town: PermitiLicease t'i Issuing Authority(circle one): I. Board of Health 2. Building Department 3.City/fown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other- Contact Person: Phone 4: