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Home My WebLink AboutB-14-841i, ;�. TOWN OF YARMOUTH Building Department BUILDING 71 `� (508) 398-2231 ext.1261 „ - _ _ _ _ _ _ _ • PERMIT NO B.14841__ PERMIT �a ISSUE DATE : 121912013 PROPOSED USE ;_ _ ........... APPLICANT .Cape Cod Insulation - '-" """' """ ' JOB WEATHER CARD PERMRTO Misclinsulafton ; AT (LOCATION) ZONING DISTRICTK2fl Bldg. Type: Residential 10089ACRES AVE SUBDIVISION MAP LOT BLOCK 1024.2 BUILDING IS TO BE: CONST TYPE 5 B USE GROUP R-3 LOT SIZE O Install insulation on erdsting house REMARKS np AREA (SQ FT) EST COST ($ $2,300.00 FgMIT FEE OWNER 1KIRKPATRICK. BARBARA A BUILDING DEPT BY ADDRESS 10089 ACRES AVE West Yarmouth MA 02673 INSPECTION RECORD Date Note Progress - Corrections and Remarks CONTRACTOR LICENSE 100988 Cassidy, Henry 18 Reardon Circle South Yarmouth MA 02664 5087751214 PHONE 15087757205 FIELD COPY d CAPE COD INSULATION 1-800-696-6611 Town of Yarmouth Regulatory Services Building Division Address — 1146 Rte 28 Address — Seuth Yarmouth, MA 02664 Date: 11 ZQ 1 I q Dear Building Inspector IR' L-:CE1tiv JAN 21 2014 Qur—� - N ivr oy Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed & completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute (BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. The work meets 780 CMR Mass State building codes; or Mass Save, Cape Light Compact specifications. Property Owner Property Address Village fires AVe- Oes l Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings ( ) (9) (33) Slopes ( ) ( ) ( ) ( ) ( ) Floors ( ) ( ) ( ) ( ) ( ) Walls ( ) ( ) ( ) ( ) ( ) Permit J O. _ —y ' --,,FeeS i. "Permit expires 6 months from , �..d..•' 2 iissuedate. EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH .Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Ext. 126/1��j CONSTRUCTION ADDRESS: W. ASSESSOR'S INFORMATION: k Map: Parcel: / OWNER: uli�� /�'� , lvY �'�l -5V- s` S 4N& PRErrSENTADDRES TEL # CONTRACTO f a Y, TAVAOI OG -jtp. �' ( MAILING ADDRESS TEL # esideatial ❑ Commercial ❑ Est. Cost of Construction S Home Improvement Contractor Llc. #FF� _ l��Li Construction Supervisor Lie. # Workman's Compensation Insurance: (check one) 0 ❑ I am the homeown ❑ I am the ole proprietor Er have Worker's Compensation Insurance Insurance Company Name: / � �' S�J �� Worker's Comp. Policy# "000-6 6qz-iI ❑ Teat (Fire Retardant Certificate attached) WORK TO BE PERFORMED ❑ Wood Stove Shed ❑Siding: #ofSquaress ❑ Replacement windows:# ❑ Re # Squares ❑ Replacement doors: # / -roof- of ( ) Stripping old shingles' sil- u�>a -on L4 aw �1� Old K�ingHighwayluiirstoric ()going over layers of exi•stin roofDistrict *The �V t p�Af fing/Siding(Like for Like) L 2 debris will be disposed of at: 6� •'� i VI V"►VW I /tJ" G K. 1eeat n of Facility I dxlare under lti penaes of pcpury that the statements herein contained arc true and correct to the best of my knowledge and belief I understand that any false answer(s) will be just cause for denial of revocatio licence and for prosecution under M.G.I. Ch. 268, Section 1. y Mill 'Oki/ Applicant's Signature: Date: Owners Signature (or attachment) Date. Approved By: Date. Building Official (or designec) Zoning District:--- • G Historical District: ❑ Yes K No Flood Plain Zones , Y l Water Resource Protection District: Within 100 ft. of Wetland: ❑ Yes ALNo 'K Yes ❑ • No 3/01 oF.Y, 3a 'y TOWN OF YARMOUTH _ c BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext.1261 Fax 508-398-0836 -BUILDING DEPARn ENT S Pursuant to M.G.L. Chapter 40. Section 54 and 780 CMR, Chapter i, Section 111.5, 1 hereby certify that the debris resulting from the proposed work/demolition to be conducted at � r''/ 0, b t Work Address Is to be disposed of at the following location: tt Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Signature f Application 2a l Date Permit No. V r Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Superviwr License: CS400988 \\ �% 1 IN HENRY E CASSIO 8 SHED ROW ;'14MV10 WEST YARR101" t � Expiration mm Coissioner 1111112015 VOYjI,fitcf/til"(1 (1'lC1, 0/C3�j Offfcc ofConsun7erAffairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Cotitractor Registration Registration: -' Type: Expiration: l.1U'E COD INSULATION, INC IIFNRY CASSIDY i Iti RFARDON CIRCLE So. YARMOUTH, MA 02664 I i 1 ..r•nruu,rrrr r�r/�ii lri/.ura11to'A4 u(h.: J A'unwmer Al lairs 1; IIusiItess Itegulatinu (suhtr IMPKOVEMkNT CONTRACTOR t �uyut7atwn 153567 Type: { jEApIfJ11U11. 12/15/2014 Private Corporalicn r,f10N.'INQ Io�a:u:�41Yt.iK1;11- �u111 MA UlGIi4 • IludrnrrrelurY a • 153567 Private Corpordliun 12/15!?t)14 Trill 23JUJ1 UpdatcAddress and return curd. Mark rcusun furchauge. 17 Address Q Rencwal (_1 I{ntployment I I Losilard Liccmr or registration valid for individul use only before the cspiratiun date. If round return to: Office of Consumer Affairs and Uusiucss Regulation 10 Park Plata - Suite 5170 8oslou, NIA 02116 A vithu t n:d re-_- _ -� 153567 Private Corpordliun 12/15!?t)14 Trill 23JUJ1 UpdatcAddress and return curd. Mark rcusun furchauge. 17 Address Q Rencwal (_1 I{ntployment I I Losilard Liccmr or registration valid for individul use only before the cspiratiun date. If round return to: Office of Consumer Affairs and Uusiucss Regulation 10 Park Plata - Suite 5170 8oslou, NIA 02116 A vithu t n:d re-_- _ -� Tire Commonwealth ofAfassachusetts a Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, b1A 02111 www.ma=gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le lbly flaunts(Busincss/Organization/Individual): �'i }/� �p �Gl f!/ �✓�'//I/r� _ Address:1F City/State/zip: Ae' G ,4 Phone #: .5� � Z Are you an employeri Check the appropriate box: 1. 1 am a employer with• .,�. 4. p y �' I am a general contractor and I Type of project (required): cmployces (full and#/pf part-time).* 2. ❑ 1 am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet. 6. ❑ New construction 7. ❑ Remodeling ship and have no employees These sub -contractors have g. Demolition working for me in any capacity. [No workers' comp. insurance employees and have workers' comp. insurance.t 9. [] Building addition required:] 5. We are a corporation and its 10.❑ Electrical repairs or additions 3. ❑ 1 am a homeowner doing all work officers have exercised their .1 LE] Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs ituurancc required.] t 3a.❑ I am a homeowner acting as a c. 152, § 1(4), and we have no employees. [No workers' general contractor (refer to #4) comp, insurance rt auiredl fADY APPLicant that checks box #1 must also fill out the section below showing their wodtm' compmutic policyiaformation. Homeowners who submit this affidavit indicating they arc doing all work and then hue outside contractors must submit anew affidavit indicating such tConzractors that chock this box mutt attached an additional sheet showing the name of the sub-comrscton sad state whether or not those entities have . cmploycea, if the sub -contractors have employers, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employeex 2relow is the policyand Job sire information. Insurance Company Policy p or Self -ins. Lic. Job Site Expiration Date`W :', �`o�,�,�/,� City/State/Zip: e ,✓Ip W 4fi Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL e. 152 can lead to the imposition of criminal penalties of a tine up to S 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 DIA for insurance coverage verification. I do hereby certify under the 14ndpenalties of perjury that the information provi r �ib�ov�e is true and correct. i ZY. �1 J�(/V IN c'l Date: Phone q: z '0ffleial 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): L Board of Health 2. Building Department 3. CityfTown Clerk 4. Electrical Inspector 5. Plumbing Inspector '6.Other Contact Person• Phone #-. ACQh ' CAPECOD-27 MYOUNG ___ CERTIFICATE OF LIABILITY INSURANCE DATEIMED AS A MATADYYYY) 7/812013 THIS CERTIFICATE IS ISSUTER OF INFORMATION ONLYANO 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 all ADDITIONAL INSURED, the policy(ies) must ba endorsed, If SUBROGATION IS WAIVED, subluctto thu tumis and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the curtihcatu holder In lieu of such endorsements . PNunuc- License # PC-514062 Rogers 8. Gray Insurance Agency, Inc. PHUNAUEA T Margaret Youn 434 Rtu 134 18a ti — lEhIll AIC,NoJ_, __. South Dannis,MA02660 ELAIL,,,,,,,,•„_,;,,_ --y e,�wlul Cape Cod Insulation, Inc. 18 Reardon Circle South Yarmouth, NIA 02664 COVERAGES ItIIS IS TO L INDICATED CtH11FICA1 EXCLUSION UEN[HAL A X tDM OEN't A AUTOMOe1 B l ANI ALL AUT X IIIRt X UMe Exct _I [xD WONKEN'3 AND EMPL ANY PHOPR Ur FIR0. I41kdalury k ii�> Ial l t>ES*HIP[i I I ucs cNIPrION OF' Wurkers Cornp Addtional Imur I CERTIFICATE NUMBER: GROUP_[_ REVISION NUMBER: r tx IIr T 1 HAl THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NOTV41THSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT VAT) I RESPECT TO "MCH THIS E MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, S AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CLAIMS tx3tEGATE AU10 D HEI.LA ]S OYERS'UABIUTV L Qr10FOPERATIONSbektw rnsatlon TYPE OF INSURANCE A= SUBS POLICYNUMBER MM I MMy UNITS LIAUILTY EACH OCCURRENCE f 1,000,00 MERCIALCENERALLIABILITY -MADE u OCCUR CBP8263063 4/1/2013 4/1/2014 Disocal0 EMI Faoca ence f 100,0 MED EXP aw _!nnL S 5,0 T _...-_ PERSONAL a AOV e4JURY f 1,000,00 ----- _ GENERAL AGGREGATE f $000,00 LIMIT APPLIES PER, _Y PRO. LOC PRODUCTS-COMPIOP AUG f 2,000,00 i LE LIABILITY ED X SCHEDULED AS AUTOS. X NON Sy"' AUTOS - 3MMOCKVMK 4/1/2013 - 4/1/2014 COMB*LED SINGLE LIMIT acodar 1,000,00 BODILY INJURY(P.pmsan) _ f !^ BOOILYIUMY(PsracddanU f DAMAGE$ � f� — UAe X OCCUR EACH OCCURRENCE f 1,000.00 LIAa CLAIMS -MADE ONJ453512 4/1/2013 4/1/2014 AGUREGATE `—• f 1,000,00 X RETENTION 10,000 - f - COMPENSATION IETOR/PARTNDED? CumvE YIN EXCLUDED? ❑ NIA CA00525904 613012013 6130/2014 A TAT - EL EACH ACCIDENT _ f 1,000,00 E.L. DISEASE• EA CMPLOYE f 1,000,00 IILIBERI kI NH) w urxbr E.L. DISEASE -POLICY LIMIT f 1,000,no OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD let, Addlnaml Remarks SdW4.146 Y more spw Is nq,dmd) includes Officers or Proprietors. ad status is provided under the General Liability when required by written contract or agreement with the Certificate Holdar. CERTIFICATE Cape Cod Insulation, Inc SHOULD ANY OF THE ABOVE 13ESCRIDED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS_ AUTHORIZED REPRESENTATIVE 9U ) 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD i i f OWNER AUTHORIZATION FORM (Owner's owner of the property located at (Property hereby authorize an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. /C, r Owners Signature 6