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Home My WebLink AboutBld-20-004698 Office Use Only yt'�t '0... Permit# �v,,r 0 i y Amou \6)3 "»om°° '�. / i\'2 i- ,(-1 I Q 8- Permit expires 180 days from mol1 1 issue date EXPRESS BUILDING PERMIT APPLICA' ► T TOWN OF YARMOUTH Yarmouth Building Department Fl:J 5 LuJJ 1146 Route 28 South Yarmouth, MA 02664 I At - t r<i i,i`re T (508) 398-2231 Ext. 1261 I y' 7 Sullivan Rd W.Yarmouth,MA 02673 CONSTRUCTION ADDRESS: ASSESSOR'S INFORMATION: Map: Parcel: OWNER: David Bibo 7 Sullivan Rd W.Yarmouth ,MA 02673 NAME PRESENT ADDRESS TEL. # CONTRACTOR: Joseph Rennie/Stephen Duff Co 1586 Hyannis Rd. Barnstable, MA 02630 508-362-2707 NAME MAILING ADDRESS TEL.# ❑Residential 0 Commercial Est.Cost of Construction$ 5000.00 Home Improvement Contractor Lic.# 159942 Construction Supervisor Lic.# Joseph Rennie:CS-086728 Workman's Compensation Insurance: (check one) ❑ I am the homeowner / I am the sole proprietor i I have Worker's Compensation Insurance Insurance Company Name: Worker's Comp.Policy# WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares 2so Replacement windows:# 8 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: Yarmouth DPW 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 mylycense and for prosecution under M.G.L.Ch.268,Section 1. Applicant's Signature: �`r� Date: /2 /o o� Owners Signature or attachmen Date: '�/} Approved By: Date: 5 �— "`� Building Off esig ee) E DRESS: Zoning District: Historical District: E Yes No Flood Plain Zone: Yes No Water Resource Protection District: Within 100 ft.of Wetlands: ❑ Yes L' No Li Yes No • The Commonwealth of Massachusetts _ 1=Al mil Department of Indu.strial Accidents r _4e/I= a 1 Congress Street,Suite 100 _°4I- '' Boston, MA 02114-2017 4.�—s ww».mass.gov/dia .. Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERmrcriNG AUTHORITY. Aanlicant•Information Please Print Legibly Name (Business/Organization/Individual): Joseph A. Rennie Address: 4 Wayside Ln City/State/Zip: Sandwich,MA 02563 Phone#: Are you an employer?Check the appropriate box: Type of project(required): i. I am a employer with employees(full and/or part-time).* 7. El New construction 2. I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 3. I am a homeowner doing all work myself:[No workers'comp.insurance required.]t 9. ❑Demolition 10 Q Building addition 4.12 I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that ail contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.Q Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other 152,§I(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employee& Below is the policy and job site information. Insurance Company Name: AIIC Policy#or Self-ins.Lic.#: 1780862 Expiration Date: 01/26/21 Job Site Address: 7 Sullivan Ln City/State/Zip:W'Yarmouth,MA 02673 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: el44"1 Date:02120/2020 Phone#: 508-360-21 30/508-362-2707 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: • 0-ii Commonweafh of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards ConstFuCt 1 rvisor CS-086728 empires: 12/16/2021 ita JOSEPH A RAMIE 7. 4 WAYSIDE I4NE SANDWICH ,f'O/sue i .'c ' Commissioner _ ,...._______ _.„______. e'%An`lonw ,w ea/,tl.of-C,filetwachaella Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Individual before the expiration date. If found return to: Registron Expiration Office of Consumer Affairs and Business Regulation 159942" 06/10/2020 One Ashburton Place-Suite 1301 JOSEPH RENNIE Boston,MA 02108 JOSEPH RENNIE _ ,Q ,( ,�- =- 4 WAYSIDE LN. • C'""� SANDWICH,MA 02568 Not valid without signature Undersecretary • ice' RENNIEJO02 MWOLF A �" CERTIFICATE OF LIABILITY INSURANCE `" " o3/22/2019 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 petldy(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 License#1780862 COMTACT HUB International New England PHONE (An,No,E,m:(781)7923200 I to c,No):(781)792-3400 600 Lonrgwwater Drive Norwell,MA 02061-9146 Mass: INSURERS)AFFORDING COVERAGE — NAIC$ INSURER A:Associated Industries Insurance Company,Inc. 23140 INSURED INSURER B: Joseph A.Rennie INSURER C: 4 Wayside Lane INSURER D: Sandwich,MA 02563 INSURER E: -- INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. CT TO WI-IICH TI-NS CERTIFICATE MAY ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDEDG ANY REQUIREMENT, TERM OR CONDITION F ANY BY THE POLIO ES DESCRIBED CT OR OTI-ER HEREIN IENTS SUBJECTH T TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCIES.UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.; _ INSR ADDL SUER POLICY NUMBER f yYY)POLICY EFF I POLICY EXP IMMIDDNYYY) LIMITS LTR TYPE OF INSURANCE iNSD wVD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO REN I EL, $ CL MSMADE OCCUR PREMISES(Ea occurrence) MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEMAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ t POLICY l 17 LOC PRODUCTS-COMP/OP AGG $ $ OTHER: ( accident) BINED�SINGLE LIMIT I AUTOMOBILE LIABILITY she $ 1--- ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOSry��ONLY ` ANUpTNOSy�QED { PER MAGE $ __ AUTOS ONLY AUTOS ONLY $ UMBRELLA UAB OCCUR I EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE S • DEB RETENTIONS I I $ A R N PER AND BAPSI OTH- ER YIN WCC5005018295 01/26/2018 01/26/2020 El.EACH ACCIDENT $ 100,000 ANY PROPRIETOR/PACLUDE EXECUTIVE I N I NIA 100,000 QFFICER/MEMBE__EXCLUDED? EL.DISEASE-EA EMPLOYEE $ If desaibeln Wunder EL.�SEASE-POLICY LIINT $ 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town OF Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 367 Main Street Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE 1:, i. ' /...;"75-- ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Fallon, Rosa From: Daves Email <dbibo@comcast.net> Sent: Tuesday, February 25, 2020 2:15 PM To: Fallon, Rosa Subject: Stephen Duff Attention! This email originates outside of the organization. Do not open attachments or click links unless you are sure this email is from a known sender and you know the content is safe. Call the sender to verify if unsure. Otherwise delete this email. Rose, Steven Duff construction is authorized to perform work on my house at 7 Sullivan Rd in West Yarmouth. His representative Debbie can apply for the appropriate permits for the work they are doing. Get Outlook for iOS 1