HomeMy WebLinkAboutBLD-18-007262EXPRESS BUILDING PERMIT APPLICATION'
TOWN OF YARMOUTH
Yarmouth Building Department
1146 Route 28
South Yarmouth, MA 02664
(508) 398-2231 Ext. 1261
CONSTRUCTION ADDRESS:
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it expires 180 days from `.
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C dED
JUN 21 2018
Map: / 7 Parcel:
owNER: �AtASrctwrrl�e QJr.�IS 2ZX S S'e,.a- Pte- R1g�4u 3 -261(
N (AME PRESENT pADDRESS j � I��I,,�� TEL #OX-360-2W19
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CONTRACTOR: LJ►�tttRy KOy(G1 G8 Wi090o`� Utltt4 b ST, -360 2 9
NAME MAILING ADDRESS V TEL 7# ,
6'Residential ❑ Commercial EsL Cost of Construction S E �wLln./.- (21Home Improvement Contractor Lie # (n,31 Construction Supervisor Lie # �flUl.Vu
Workman's Compensation Insurance: (check one)
❑ I am the homeowner ❑ I am the sole proprietor ° Q. I have Worker's Compensation Insurance gg {- b
Insurance Company Name: � T'�e-e•w,a-+J(P Worker's Comp. Policy# 1?2 (-o �J 60kj
WORK TO BE PERFORMED
Tent _ Duration (Fire Retardant Certificate attached?) Wood Stove
Siding: # of Squares Replacement windows: # Replacement doors: #
Roofing: # of Squares_ (,C) Remove existing* (max. 2 layers) Insulation
Old Kings Highway/Historic Dist. ( ) Replacing like for like Pool fencing
'The debris will be disposed of at D—tym Vii^
Location of Facility
I declare under penalties of perjury that the statements herein contained are true and comet to the best of my knowledge and belief. I understand that any false answer(s)
will bejust cause for denial orrevo��p,9/j�nof(my�license and for prosecution under M.G.I. Ch. 268, Section 1.
Applicant's Signature: y�(�UAk.LT Date:
Owners Signature (or attachment) Date:
Approved By: Dom:
Building Off�iiSl (o/ rgnee) EMAIL AD SS:
Zoning District:
Historical District: ❑ Yes ❑ No Flood Plain Zone: ❑ Yes ❑ No
Water Resource Protection District: Within 100 ft. of Wetlands:
0 Yes 0 No 0 Yes 0 No
The Commonwealth of Massachusetts
Department oflndustrialAccidents
I Congress Street, Suite 100
Boston, AM 02114-2017
www.mass.gov/dia
NVorkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Name (Business/Organization/Individual):
Address:
L0
City/State/Zip: (2 ft" I
Are you as employer? Check the appropriate box:
Phone #:_ SD9-36017 V
I .� I am a employer with 3 employees (full and/or part-time).*
2.� I am a sole proprietor or partnership and have no employees working for mein
any capacity. (No workers' comp. insurance required.]
3. ❑ I am a homeowner doing all work myself [No workers' comp. insurance required.] t
4. ❑ I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers' compensation insurance or are sole
proprietors with no employees.
5.7 I am a general contractor and I have hired the sub -contractors listed on the attached sheet
These sub -contractors have employees and have workers' comp, iasraance.t
6.❑ We are a corporation and its officers have exercised their right of exemption per MGL c.
152, §1(4), and we have no employees. [No workers' comp. insurance required]
Type of project (required):
7. ❑ New construction
8. ❑ Remodeling
9. ❑ Demolition
10 ❑ Building addition
11.❑ Electrical repairs or additions
12. ❑ Plumbing repairs or additions
13.0 Roof repairs
14.❑ Other
Any applicant that checks box 9 must also fill out the section below showing their workers' compensation policy information.
YmHomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
Contracrs 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 subcontractors have employees, they must provide their workers' tomp. policy number.
'am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy # or Self -ins. Lic. #:_ LWLg ssG d'�o Expiration
U
lob Site Address: 77
R S �nt � p� ''I 1/ I
�AVe City/State/Zip: w • J (1 �—
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 the pains and penalties of perjury that the information provided above is true and correct
Offrcial 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
00 /(S
Contact
Phone
*Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or
renewal of a Iicense or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub -contractors) name(s), address(es) and phone numbers) along with their certificate(s) of
insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised -that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should
be returned to the city or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy, please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant
Please be sure to fill in the permit/licease number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current
policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or
town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit.
The Department's address, telephone and fax number.
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
r Boston, MA 02114-2017
Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax # 617-727-7749
Revised 02-23-15 www.rnass.gov/dia
HOURng ano Sidifig
ui Gape GUU. LLC:
4'
BBB
68 Winslow Gray Rd
West Yarmouth, MA 01673 508-360-2749
e-mail: rsoccCcDyahoo.com
roof ingandsidingofcapecod.co
m HIC REG #170787; LIC #
102600
Name: CONSTANTIVE DIGENIS
Address: 228 S.SEA AVE
City: W,YAR111OUTH
State:
ZIP:
05/20/18
Job Address:
Town:
lob Phone -.978 443-2614
Other Phone: E-
mail:
Estimator: SCOTT DICKSON
We hereby submit specifications and estimates to famish and install new roofing as follows
UPPER AND LOWER ROOF ON MAIN HOUSE/UPPER FLAT ROOF IN BACK WILL GET FULL
ICE AND WATER BEFORE SHINGLES ARE INSTALLED.. WITH 5 PLYWOOD BOARDS
REPLACED INCLUDED IN COST/ANY EXTRA PLYWOOD WILL BE CHARGE AT 100.00 PER
SHEET //THIS PRICE DOES NOT INCLUDE GARAGE OR BREEZE WAY
1. Strip existing roofing and remove debris. Calculated (1 layer). Anymore layers of roofing needed
to be stripped will be additional.
2. All gutters will be cleaned out, grounds cleaned up and nails extracted with magnets. We utilize
magnets so as to minimize your exposure to personal injure and/or property damage from nails
left behind at the job site.
- I --
3. After removal of roof, wood deck will be inspected for splitting, rot or other deterioration. Owner
will be advised of need for wood replacement prior to commencement of wood replacement work.
4. Along all eaves of house. Ice &\'Vater Shield waterproofing underlayment (36 " wide) will be
directly adhered to the wood deck. Waterproofing underlayment is installed to eaves to protect
against interior leakage and subsequent damage from wind -driven rain, ice and snow dams, and
freeze back conditions.
5. Install waterproofing underlayment in fidl width (36 wide) to all valleys and 12" to all rake edges.
Install waterproofing underlayment at all vent pipe collars and any other projections and
skylights. Underlayment adds additional protection against leakage at critical terminations. Over
remainder of house synthetic roofing paper will be installed and nailed to the wood deck.
6. Install new white drip edge to all perimeter cave edges. Drip edge is installed to protect from
leakage and rot and to provide a neat and clean perimeter profile.
7. All existing vent pipes will receive new aluminum vent pipe flashings with neoprene gasket
collars, or copper if doing red cedar roof.
8. At all cave edges or roof, shingle starter strip will be cut an installed with sealing strip at lower
edge of roof in accordance with manufacturer's specifications. This provides a watertight and
wind -resistant termination for your roof.
9. Storm nailing: Because we live in a severe storm region, additional (storm) nailing is strongly
recommended by Roofing and Siding of Cape Cod, LLC, the manufacturers and the National
Roofing Contractors Association.• Secure new roof with 50% more nailing, upgrade minimum
standard (4) four nails per shingle to (6) six nails per shingle, 1 '/4 " long. Nails will be galvanized
with a rust -inhibitive coating. If red cedar roof, then using stainless steel fasteners.
10. Shingle installation: Supply and install roofing shingles according to the manufacturers
specifications, according to the below selected material and warranty. All work to be performed
by insured professionals.
11. Install waterproofing underlayment surrounding chimney. Underlayment will extend up vertical
portion of chimney a minimum of (2) two inches. Caulk all ]cad flashings together around
chimney with Dymonic caulk. This is not a guarantee but a maintenance procedure. We cannot
guarantee chimney from leakage with roof job only. Sec chimney proposal if applicable. We
cannot guarantee existing skylights or venting units unless we replace them with new ones.
12. At peak of roof, an approximate (3) three -inch -wide continuous gap will be cut out of deck. Air
Vent, Inc. Shinglevent 11 solid vinyl ridge vent with external baffle will be fastened over the
opening in the deck. Shingle caps will be cut, installed and fastened over the vinyl ridge vent into
the decking with 2 %: inch coated roof nails. Shinglevent II comes with a 30 -year material
warranty from Air Vent, Inc. Shinglevent 11 vinyl ridge vent provides you home with the
necessary exhaust ventilation to prolong the life of the shingles and the wood sheathing to ensure
a properly balanced ventilation system if used in coniunction with cave intake ventilation, and
provide cooler attic temperatures in the summer and less moisture -laden damaging air in the
winter.
The above s specifications are required to meet the National Roofing Contractors Association (NRCA)
roof standards, as well as to meet manufacturer's specifications for warranty requirements. Touch-up
painting may be required and is not included in this proposal.
Roofing and Siding of Cape Cod, LLC warranty: products and workmanship (100"/ Labor and
Materials) for 10 (ten) Years after installations.
Roofing and Siding of Cape Cod, LLC will obtain necessary pen -nits required by the Town.
CertainTeed warrants that its shingles will be free from manufacturing defects. Below are highlights
of the warranty for LandmarkTM. See CertainTccd's Asphalt Shingle Products Limited Warranty
document for specific warranty details regarding this product.
Lifetime, limited transferable warranty
10-ycar SureStartT"u warranty (100% replacement and labor costs due to manufacturing defects)
10 -year StreakFighterl "' warranty against streaking and discoloration caused by airborne algae
15 -year, 130mph wind -resistance warranty
GOOD:Landmark,ime Warranty
Labor and Matcrit�s: $5700.00
/fnreeplahle, inirinlhere Colorh1dt,Z R�,4
BETTER: Landmark -PRO, with Life -Time Warranty
Labor and Materials: $6350.00
PROS COME WITII A 20YR LABOR AND MATERIAL NON PRORATED
WARRANTY THIS IS A $500.00 VALUE AT NO ADDED COST TO YOU
lfacceptahle, initial here
Color
BEST: Landmark -PREMIUM, with Life -Time Warranty
Labor and Materials: $7000.00
PREMIUM COME WITH A 50YR LABOR AND MATERIAL NON PRORATED
WARRANTY THIS 1S A $1000.00 VALUE AT NO ADDED COST TO YOU
lfacceptable, initial here Color
job is estimated to commence approximately _4_ weeks after deposit received unless otherwise noted
here:
SN-Irt On )title 21
Work is scheduled to be substantially completed in approximately: ._ days If acceptable, (both) initial
here:
Start and completion times are approximate and subject to change due to, but not limited to, the following
circumstances: weather delays, additional work on previous jobs, permitting delays, etc.
This is the entire agreement. Any discussions or verbal agreements are superseded by this agreement.
Such agreements, even those of the smallest nature, must be in writing to be recognized.
Any work above and beyond the specifications outlined in this proposal will be priced on request. All
additional work, including travel time and lumberyard runs, will be subject to extra charge. In the event
of rot repairs, roof repairs or any related work requiring immediate attention, we will proceed without
customer approval.
We look forward to working with you; please call if you have any questions.
Sincerely,
ROOFING AND SIDING OF CAPE COD, LLC
5'1.x (<) rlalfs 4o be used per 5i6ir)g4 at no -ex ft"'?
Maw ,
ROOFING AND SIDING OF CAPE COD, LLC will provide cleanup on a continuing basis and all debris
, LLC
will be removed from site. All products installed by ROOFING AND SIDING OF CAPE COD
will be to manufacturer specifications. All work will be performed by insured professionals.
All material is guaranteed to be as specified and the above work to be performed in accordance with the
drawings and/or specifications submitted for above work and completed in a substantial workmanlike
manner. There will be no refund for special -order windows, doors or any other non -stocked materials
after three days from approved proposal. All warranties will be null and void if account is not current
and paid in full.
-4—
Owner to move all personal objects, furniture, etc., from work areas. All items against walls should be
considered for removal during any exterior siding jobs, additions, etc. to guard against damage. In the
case of any roofing and ridge venting. dust and debrishould be
should be removed. ROOFING AND SIDING OF CAPand any items in the attic
E COD, LLC is not expected responsible for any damages
if said items remain in place.
Curtains, drapes and window and door treatments may need proper reinstallation or replacement by
customer due to sizing on any window or door replacements and is not included in jobs contracted with
ROOFING AND SIDING OF CAPE COD, LLC
Any osts will be
only
alteration or deviation from
orders and will become an extra ve charge over and 'abecifications ove the estimate. All agreements contingent
t
upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary
Ce on
insurance upon above work. workmen's be taken out by ROOFING AND SIDING rk to
POFaCAPE COD, LLC. Owntion and Public Liab, ItYns wh`secure secure their
construction -related permits or deal with unregistered contractors will a ex luded rom access4o the
guaranty fund. 1
This Contract not valid unless signed by Corporate Officer. l
Acce lance of Estimate
The above
arc
AND SIDINGOF CAPE COD, SLLC conditions autauthorized to do the k as tisfactory anspecified.by accepted. ROOFING
—5—
Payment will be made as such:
1/3 Deposit —%- I, 900. C 0
1/3 Beginning of work --.:AV 19 0. 60
1/3 upon completion -4-1'9 Co. 00
Date: 111Y1P S
c
Signatures: 1' (�
Note: No work shall begin prior to the signing of the contract and transmittal to the owner of a copy of
such contract. You, the buyer may cancel this transaction at any time prior to midnight of the third
business day after the day of this transaction.
"- G —
Massachusetts Department of Public Safety
®� Board of Building Regulations and Standards
License: CS-102600
Construction Supervisor
DZMITRY LABKOVICH'•i"
68 WINSLOW GRAY RD,,-,'-0i _
WEST YARMOUTH MA 02673',
;rztX"�t,' i.��rz•--- Expiration:
-6ommissioAer 0312712019
I
ff�r f Consumer
Business
Regulation Office of Consumer Affairs $Business Regulation
j HOME IMPROVEMENT cowi-RACTOR
TYPE: LLC
Registration Expiration
i 170787 12/18/2019
ROOFING AND SIDING OF CAPE COD, LLC.
i
I DZMITRY LABKOVICH
68 W INSLOW GRAY RD
W. YARMOUTH, MA 02673 Undersecretary ;
III