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HomeMy WebLinkAboutBLDTR-23-002468 mg ) RI- //-4- z� og Yq� TOWN OF 1 .1RM[Ol"TH .c - ! ,! o BUILDING DEPARTMENT Permit Number 6LD 72-,720- 3� 4 c 1146 Route 28. South Yarmouth. N1.�► 02664 `� lyE Date Issued e�(1,,2-Liefel> v„'�_ ....v4�' 508-398-2231 ext. 261 Fax 508-398-0836 Expiration Date C/ o'5- 54O RECEIVED TRENCH PERMIT --�" Pursuant to G.L. c. 82A §1 and 520 CMR 7.00 et seq.(as ante d dt4OV 02 2022 THIS PERMIT MUST BE FULLY COMPLETED PRIOR TO CONSIDERATI 'BUILDING DEPARTMENT Name of Applicant (• /3�,,.(,, cono Phone Cell "— --�_ I'll t/u J�l� s �A9 6,93y Street Addressa 3 i!h�7 ri S..e Ad City/Town MA ZIP qa iv,o41 c1 _ 0 7S . Vine of Excavator Of scent from applicant) Phone CeII Street Address City/Town MA ZIP Name of Owner(s)of Property el hi, cod ko.3d s +Ei„e Phone Cell Street Address tc-e ficy viskre--�P " $ (31� 62Y� 117-1 Cvs� �e v City)Town !MA 1 ZIP 1‹iirskpr e g44 022, /3604,/la Other Contact I Permit Fee Received No( 1 Yes( ) Description,location and purpose of proposed trench: Please describe the exact location of the proposed trench and its purpose(include a description of what is(or is intended)to be laid in proposed trench(eg;pipes/cable lines etc..)Please use reverse side if additional space is needed. t'I2 Sr`9 /l geri- L 6- - i -01,i,tiri 64 rem 004) ena Insurance Certificate If: (4/ C C_€040 C4 eyo O 70 / -'OHO 9 /� �/ J Name and Contact Information of Insurer: Policy Expiration Date: 3 a?.. Dig Safe ff: 3O?,v r 1 1 O _ M r Name of Competent Person I as defined by 520 CMR 7.02): Lid I II ky. Iof2 a . '•n +�i i , - b... ,._.._.'--\ ••�.5cirtu i 3{ N t i y: r..t- . '1 Sii'i 4i; a, . ' {a :n ',',. �'�sM``;.. - egg1. .q 4iit�.1l1 : i e:1"p!fi"j°. - ffsfi , I f. art n: i k Y [ T.. .T. n,' '3 i�' b 5 i,: c = y 4 ; .., 54ttt3•t � . ' r !Q3_)a"3' '!" Ci #?" g' fi,') r {: 9� .'" :.e.• lx 1tTfT ke t.r$17ri'„ s1„ ' F}.• > „-. - . r • - t::tl t. , .. 3 _). ,3 i ` t. r'.A:4, 1i. (( ‘' 1 • • A. sf r,-.. xg to fi-Ain A94kl s;, !r` iid w'At;5 ":s � - 4,-, J .-« °c t , {.1.7 • "t kf.7-re. 44„1 wr6 3[i 4,r'r%r-i..rol .. >Y31Td:: 1 =! 7 4` t 9•ri,y' ;y*.Y im • {",it-,t'ar s. '# ,X^:'. ';,tt .'-,:.,,ii'd.,t.t:{ :.i,,,g1 le , ; t r,. y) +i . $ice # 1 j Massachusetts Hoisting License tI I1 r ,‘)a v ` 113 I a)3 G/8'oaa. License Grade: t4 E -a R ^ G. cci Expiration Date: BY SIGNING THIS FORM, THE APPLICANT,OWNER, AND EXCAVATOR ALL ACKNOWLEDGE AND CERTIFY THAT THEY ARE FAMILIAR WTTH,OR,BEFORE COMMENCEMENT OF THE WORK,WILL BECOME FAMILIAR WITH,ALL LAWS AND REGULATIONS APPLICABLE TO WORK PROPOSED.INCLUDING OSHA REGULATIONS, G.L. c. SZA, 520 CMR 7.0 et seq., AND ANY APPLICABLE MUNICIPAL ORDINANCES, BY-LAWS AND REGULATIONS AND THEY COVENANT AND AGREE THAT ALL WORK DONE UNDER THE PERMIT ISSUED FOR SUCH WORK WILL COMPLY THEREWITH IN ALL RESPECTS AND WITH THE CONDITIONS SET FORTH BELOW. THE UNDERSIGNED OWNER AUTHORIZES THE APPLICANT TO APPLY FOR THE PERMIT AND THE EXCAVATOR TO UNDERTAKE SUCH WORK ON THE PROPERTY OF THE OWNER, AND ALSO, FOR THE DURATION OF CONSTRUCTION. AUTHORIZES PERSONS DULY APPOINTED BY THE MUNICIPALITY TO ENTER UPON THE PROPERTY TO MONITOR AND INSPECT THE WORK FOR CONFORMITY WTPH THE CONDITIONS ATTACHED HERETO AND THE LAWS AND REGULATIONS GOVERING SUCH WORK. THE UNDERSIGNED APPLICANT,OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY ------ REIMBURSE THE MUNICIPALITY FOR ANY AND ALL COSTS AND EXPENSES INCURRED BY THE MUNICIPALITY IN CONNECTION WITH THIS PERMIT AND THE WORK CONDUCTED THEREUNDER, INCLUDING BUT NOT LIMITED TO ENFORCING THE REQUIREMENTS OF STATE LAW AND CONDITIONS OF THIS PERMIT,INSPECTIONS MADE TO ASSURE COMPLIANCE THEREWITH,AND MEASURES TAKEN BY THE MUNICIPALITY TO PROTECT THE PUBLIC WHERE THE APPLICANT OWNER OR EXCAVATOR HAS FAILED TO COMPLY THEREWITH INCLUDING POLICE DETAILS AND OTHER REMEDIAL MEASURES DEEMED NECESSARY BY THE MUNICIPALITY. THE UNDERSIGNED APPLICANT,OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO DEFEND, INDEMNIFY, AND HOLD HARMLESS THE MUNICIPALITY AND ALL OF ITS AGENTS AND EMPLOYEES FROM ANY AND ALL LIABILITY, CAUSES OR ACTION,COSTS,AND EXPENSES RESULTING FROM OR ARISING OUT OF ANY INJURY, DEATH, LOSS, OR DAMAGE TO ANY PERSON OR PROPERTY DURING THE WORK CONDUCTED UNDER THIS PERMIT. APP ICANT SIGNATURE _DATE EXCAVATOR SIGNATURE(IF D RENT) DATE OWNER'S SIGNATURE(IF DIFFERENT► 4k _DATE: `1 For Vii3/1'uw n saw—Di slit write in thi.11esI : • PI MTT APPRO%E:D BYFri.l ITTING r HORIT bate AfidIcaOsis f cvwnmc»S or Armin at. _ — • • 2of2 • • • t o. ; , - 3t . i3 ; '•' _,' J • Y rt. ti n I a�RD® CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDIYYYY) 12/13/2021 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 poli cy(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). tODUCER CONTACT NAIVE: IogersGray, Inc.-Kingston Branch PHONE FAX 3 Smith Lane w,.No.Ext);508-746-3311 (Arc,No):877-816-2156 .ingston MA 02364 AgRD ess: mail@rogersgray.com INSURER(S)AFFORDING COVERAGE _ NAIC# INSURER A:West American Insurance Company 44393 SURE° REIDILLA-01 INSURER B:Arbella Protection Insurance Company,Inc. 41360 ;eid&Laurence Ellis dba Ellis Brothers Construction 3 Enterprise Rd, P.O. Box 59 INSURER c:Associated Employers Insurance Company 11104 armouthport MA 02675 INSURER D: INSURER E: INSURER F: OVERAGES CERTIFICATE NUMBER:2114965942 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. A TYPE OF INSURANCE ADDL y VD POLICY NUMBER MIDPOLICY EFF POLICY EXP (MMfDD/YYYI') (MMIDDIYYYY) LIMITS X COMMERCIAL GENERALLIABILRY BKW58371201 311/2021 3/1/2022 EACH OCCURRENCE $1,000,000 GE TOTED CLAIMS-MADE X OCCUR PRREMI ES(Ea occurrence) $100,000 MED EXP(Any one person) S 15,000 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 X POLICY PRO- I 1 OC L PRODUCTS-COMP/OP AGO $2,000,000 JECT OTHER: $ AUTOMOBILE UABILIIY 1020002607 6/9/2021 6/9/2022 (CamBiNED SINGLE uMrr $ ANY AUTO BODILY INJURY(Per person) $250,000 OWNED SCHEDULED BODILY INJURY(Per accident) $500,000 AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE S 100,000 AUTOS ONLY AUTOS ONLY (Per accident) S UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE S DED RETENTION$ $ WORKERS COMPENSATION WCC-500-5000706-2021A 12/3/2021 12/3/2022 PER AND EMPLOYERS'LIABILITY TH- STATUTE FOR Y f N ANYPROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $100,000 OFFICER/MEMBEREXCLUDED? N 1 A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY UMIT $500,000 SCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) trtificate holder is listed as additional insured under General Liability for on-going operations when required by written contract or agreement. ERTIFICATE 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. Town of Yarmouth 1146 Route 28 ALIT D REPRESENTATIVE South Yarmouth MA 02664 i ©1988-2015 ACORD CORPORATION. All rights reserved. :ORD 25(2016/03) The ACORD name and logo are registered marks of ACORD • Commonwealth of Massachusetts // Division of Professional Licensure . / . HC(JOINiettOhrer H r-028673 ic.,pires:12/30/2022 LAURENCE SEWS JR1_ 8 NORTH ST r DENNIS POR1 MA 02639� — t Commissioner d- �' K. ► - i V s Hoisting Engineer ) Restricted.to: HE-24-Excavators DIG SAFE Ca. II Center.{ggg Sy{4-7233 in case of accident call: (508)820-1444 Contact OPSI:(617)727�200 or visit Www mass.goWdpf/opsi 6 SYRITHAS WAY Location 6 SYRITHAS WAY Mblu 26/86/// Acct# 3296 Owner CAPE COD KOTTAGES LLC Assessment $439,200 PID 3296 Building Count 1 .urrent Value Assessment Valuation Year Improvements Land Total 2023 $171,100 $268,100 $439,200 Iwner of Record Iwner CAPE COD KOTTAGES LLC Sale Price $530,000 are Of Certificate ddress 94 N ELM ST STE 209 Book&Page C228530/0 WESTFIELD,MA 01085 Sale Date 12/14/2021 Instrument 00 Qualified Q wnership History Ownership History Owner Sale Price Certificate Book&Page Instrument Sale Date APE COD KOTTAGES LLC $530,000 C228530/0 00 12/14/2021 ICKIE RICHARD W $0 D572355/0 01/08/1993 CKIE RICHARD W $136,000 /0 1N 01/08/1993 !ilding Information Building 1 : Section 1 Year Built: 1957 Living Area: 1,208 Replacement Cost: $244,359 3uilding Percent Good: 70 Replacement Cost _ess Depreciation: $171,100 Building Attributes Field Description Building Photo Style: Duplex Model Residential •e.-- T,- ?b trc k ,.'• - ✓•� - may r m. Grade: Average ; , :� y�ti *r i F.. . P Stories: 1 Story Y ` � v.: ti Occupancy 2 a ; tom -': , I. ..4.3_ a 1' ,t r 6; Exterior Wail 1 Wood Shingle ' - I .. a ' r F Exterior Wall 2 Clapboard ? i z .- II,.", 'Nil ;fit Y ti t Roof Structure: Gable/Hip Roof Cover Asph/F Gls/Cmp • -- r . .,,`. Interior Wall 1 Drywall/Sheet (h ttps://images.vgsi.com/photos2/YarmouthMAPhotos/A00101117144.jpg) Interior Wall 2 K PINE/A WD Interior Fir 1 Carpet Building Layout Interior Fir 2 Heat Fuel Gas Heat Type: Hot Air-no Duc 22 AC Type: None Total Bedrooms: 3 Bedrooms 2 22 Total Bthrms: 2 WDK 2u Total Half Baths: 0 10 WDK Total Xtra Fixtrs: 5 10 Total Rooms: Bath Style: Old Style (ParcelSketch.ashx?pid=3296&bid=3434) Kitchen Style: Old Style Building Sub-Areas(sq ft) Legend Num Kitchens 02 Gross Living Code Description Area Area Cndtn BAS First Floor 1,208 1,208 Num Park WDK Deck,Wood 290 0 Fireplaces 1,498 1,208 Fndtn Cndtn Basement Extra Features Extra Features Legen� Code Description Size Value Bldg# EOS Encl Outs Shwr 1.00 UNITS $0 1 Land Land Use Land Line Valuation Use Code 1040 Size(Acres) 0.12 Description TWO FAMILY Frontage 0 Zone Depth 0 Neighborhood 0070 Assessed Value $268,100 Alt Land Appr No Category Dutbuildings Outbuildings Leg n No Data for Outbuildings ✓aluation History Assessment Valuation Year Improvements Land Total 2023 $171,100 $268,100 $439,200 2022 $151,900 $240,600 $392,500 2021 $123,100 $226,100 $349,200 (c)2022 Vision Government Solutions, Inc.All rights reserved.