HomeMy WebLinkAboutBLD-19-000053Use Only
expires 180 days from
pbl-D4 q
EXPRESS BUILDING PERMIT APPLICATION _
TOWN OF YARMOUTH E C g r
Yarmouth Building Department
1146 Route 28 :nw
02 2 18 t
South Yarmouth, MA 02664 J
(508) 398-2231 Ext. 1261 ,,, t; A? —Jkl
CONSTRUCTION ADDRESS: L(iC3 S 9 A- AVQ,, ` a- -
ASSESSOR'S INFORMATION:
Map: IParcel:cc (�� -7
OWNER_WO1�jGlll►�iL 1GP�IlS i� J 1C�i- !P 918-YY3-
NAME rig n y� PRESENT ADDRESS
9 /',,,, //� TEEL� #
CONTRACTOR-- 1� I L ttatG'1 6y �*/CA1Sc W''✓ WlU!'� �/�V/
1
(S Residential ❑ Commercial Esc Cost of Construction S / of ,` 0 �
Lia {
Home Improvement Contractor # 1 ` I R 1'] Construction Supervisor Lic. # 10 `W10
Workman's Compensation Insurance: (check one)
0 I am the homeowner Q�� ❑ I am the sole proprietor I have Worker's Compensation Insurance
ey � r^ p� p/
Insurance Company Name: P7! G44" Z Worker's Comp. Policy# t ` Cyc ss- 6,e4
Tent Duration
Siding: # of Squares
WORK TO BE PERFORMED
(Fire Retardant Certificate attached?)
Replacement windows: #,
Roofing: # of Squares ZZ ( /<) Remove eristing* (max. 2 layers)
Old Kings 13ighway/Historic Dist ( ) Replacing like for like
"The debris will be disposed of at
Wood Stove
Replacement doors: #
Pool fencing
Insulation
U Location of Facility
I declare under penalties of pedury 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 came for denial or r7,o qct of my license and for prosecution under MO.L Ch. 268, Section 1. a
Applicant's Signature:
Owners S'.
Approved
Zoning District:
Historical District: ❑ Yes ❑ No Flood Plain Zone: ❑ Yes ❑ No
Water Resource Protection District Within 1001 of Wetlands:
0 Yes 0 No 0 Yes 13 No
The Commonwealth of Massachusetts
Department oflndustrialAccidents
I Congress Street, Suite 100
Boston, MA 02114-2017
www mass.aovldza
lVorkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Name (Business/Organizatlon/Individual):
wlN'sl�w
City/State/Zip:
lam— Phone#:- S'baP-30' 2Z(f
Are you an employer? Check the appropriate box:
1. C�T-am a employer with _employees (full and/or part-time).*
2. ❑ I am a sole proprietor or partnership and have no employees working for me in
any capacity. [No workers' comp. insurance required.]
3. F1 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 contactors either have workers' compensation insurance or are sole
proprietors with no employees.
5.❑ 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, in=mce.t
6. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c.
I V— § 1(4). and we have no employes. [No workers' comp. insurance required]
Type of project (required):
7. ❑ New construction
S. ❑ Remodeling
9. ❑ Demolition
10 ❑ Building addition
repairs
14.❑ Other
•Arty applicant that checks box #1 must also fill cut the section below showing their workers' compensation policy information.
t Homeowners who submit this aMdavit 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 shat showing the name of the sub -contactors and state whether or not those ercities have
employees. If the sub -contactors have employees, they must provide their workers' comp. policy num er.
I am an employer that is proviaTng workers' compensation insurance for my employees. Below is the policy and job life
information A
Insurance Company
Policy # or Self -ins. Lic. #: Rt
Expiration Date: (Z 2-0 I tk
Job Site Address: limo J �Ve City/State/Zip: v' C�1tt s t w
Attach a copy of the workers' compensation policy declaration pave (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 foam 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
cemjyl �zeQains and penalties of perjury that the information provided above is true and correct
360- - ---.
Official use only. Do not write in
this area, to be completed by city or town offciaL
City or Town:
Issuing Authority (circle one):
1. Board of Health 2. Building. Depart
ment
6. Other
3. City/Town
Permit/License #
11.❑Electrical repairs or additions
12.E] Plumbin.g repairs or additions
13. []Roof
Clerk 4. Electrical Inspector 5. Yltrmbing. Inspector
Contact Person: Phone
' Information and Instructions
Massac6tisetts 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 ajoint 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 whb 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 license or permit to operate a business or to construct baildin;s in the commonwealth for any
applicantwho 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/License 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 "lob 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
Boston, MA02114-2017
Tel. # 617-727-4900 ext 7406 or 1-877-MASSAFE
Fax 4 617-727-7749
Revised 02-23-15 www.mass.gov/din
D0
Roofing and Siding
of Cape Cod, LLC
4
Bei
68 Winslow Gray Rd
West Yarmouth, MA 02673 508-360-2749
e-mail: rsocc@vahoo.com
roof ingandsidingofcapecod.co m HIC REG
#170787; LIC # 102600
Name: CONSTANTIVE DIGENIS
Address: 228 S.SEA AVE
City: W,YARMOUTH
State:
ZIP:
Job Address:
Town:
ob Phone:978 443-2614
Other Phone: Email:
CJDIGENIS@GMAIL.COM
Estimator: SCOTT DICKSON
We hereby submit specifications and estimates to fumish 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 INCLUDE GARAGAND 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.
0
3. After removal of roof, wood deck will be inspected for splitting, rotor 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 & Water 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 full 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 eave 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 AL
Roofing Contractors Association. Secure new roof with 50% more nailing, upgrade minimum L
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 manufacturer's
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 lead 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. See 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 II solid vinyl ridge vent with external baffle will be fastened over the
021
opening in the deck. Shingle caps will be cut, installed and fastened over the vinyl ridge vent into
the decking with 2 '/1 inch coated roof nails. Shinglevent II comes with a 30 -year material
warranty from Air Vent, Inc. Shinglevent II 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 conjunction with eave 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 (NBCA)
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 permits required by the Town.
CertainTeed warrants that its shingles will be free from manufacturing defects. Below are highlights
of the warranty for LandmarkTm. See CertainTeed's Asphalt Shingle Products Limited Warranty
document for specific warranty details regarding this product.
• Lifetime, limited transferable warranty
• 10 -year SureStartTM warranty (100% replacement and labor costs due to manufacturing defects)
• 10 -year StreakFightefm warranty against streaking and discoloration caused by airborne algae
• 15 -year, 130mph wind -resistance warranty
with Lifib-Time W
Labor-
Ijacceptanitial here
BETTER: Landmark-, w1
Labor and M erials: $10400.00
"Ii-"'merranty
Sh���les
PROS CONIF WITH A 20YR LAB MATERIAL NON PRORATED
WARRANTY T ALUE AT NO ADDED COST TO YOU
n ,�s
Ifacceptable, initial here
and
PREMIUM COME
WARRANT TY� here
Ifaccept initial here
1500.00
A $1000.00
6
Color co vicS%N� �E y
�iiFi Lii e -Time Warranty J
LABOR AND MATERIAL NON
Color
COST TO YOU
Job is estimated to commence approximately —4 _ weeks after deposit received unless otherwise noted
here: o 37,-0" /�
f "
Work is scheduled to be substantially completed in approximately: a., days If acceptable, (both) initial
here: )IN RX
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
ROOFING AND SIDING OF CAPE COD, LLC will provide cleanup on a continuing basis and all debris
will be removed from site. All products installed by ROOFING AND SIDING OF CAPE COD, LLC
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.
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 debris should be expected and any items in the attic should
be removed. ROOFING AND SIDING OF CAPE COD, LLC is not 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 alteration or deviation from above specifications involving extra costs will be executed only upon
written orders and will become an extra charge over and above the estimate. All agreements contingent
upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary
insurance upon above work. Workmen's Compensation and Public Liability Insurance on above work to
be taken out by ROOFING AND SIDING OF CAPE COD, LLC. Owners who secure th r own
construction -related permits or deal with unregistered contractors will be ex de from ac ss to the
guaranty fund.
This Contract not valid unless signed by Corporate Officer:
Acceptance of Estimate
L%
The above prices, specifications and conditions are satisfactory and are hereby accepted. ROOFING
AND SIDING OF CAPE COD, LLC is auth zed to do the work as specified.
c1gaSjT
Payment will be made as su
1/3 Deposit ✓
1/3 Beginning of work 1/3
upon completion
W ne
ii
. l.1...
1111111111111111M (
a
lw
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.
0
Massachusetts Department of Public Safety
® Board of Building Regulations and Standards
License: CS -102600
Construction Supervisor
DZMITRY LABKOVICH
69 WINSLOW GRAY RD
WEST YARMOUTH MA 02673
l!G%Gf lli'-a. Expiration:
Commissioner 03127/2019
CoNuuorbnenl//,a�(a.UnrIbJet(1
Office of Consumer Affairs Business Regulation
HOME IMPROVEMENT CONTRACTOR
TYPE: LLC
Registration Expiration
170787 - 12118=19
ROOFING AND SIDING OF CAPE COD, LLC.
DZMITRY LASKOVICH _
68 WINSLOW GRAY RD
W. YARMOUTH, MA 02673
Undersecretary
S -r .-s..�-......-,m•,--� a.m.•„ +.. m..s--... _.. u -.n w. ..P..,r,n...w.n ...-n_........ ... ,..>.•...... ... i. nx ..,
w4,wtlJ. •�.nw�y _ •^••••.•••WwuIWWLPi.i
rrpm[
CERTIFICATE
CKA6tTTENEOlV F LIABILITY INSURANCE1•
pXIl Lm[ o
sufP AlN11tfM OX ALTtft NS COVE
Of TOfCnoMvmmcG"nArrODEa by T"t pO ats
AKRO
ilei! NSENAKt ODES NOr CCNSarUTE A CONTRACT BETWEEN T1E IYSVNG NSW EA YI AVIwONZED
RCVME&LFaTATrv*0-lNROP410ER, ANP TK CCRTSR'itl lttl DFS —
IIAiURIAM: EYs asrLNYPFt BOM,Y NAPJ7tRRAL INSW W.� i P^nan �fK,T�rXnIV N,a lrlBi[ca�t[AtlnPf lwFa�•f„PIgN bNP 1
TNP 1nNP WientlOmflMr F>iTY-HiWnOY[tN IMVr^un n ..ry
E4J6 MY7EfiNATIGt:dL hEYi EFJ.:LM:3 LLC
o J
Pi§\.M.faFS NP VA<Z1W _ Rw......e\X:pxF`6�rlM1ai=tL<W
,,._... -
,iGWiWP.1W1MM1 sRKaL
KWFO
Fucf}�asaTavoFcaseeoauc
wXYff1L, .,
.. chi �• '+ ..�-. BfY5sIt7F NUMBER
COYERAOfY FEa11EKATE NVMBER _ 1
a�IY 1011. (.(R-"iY l•Wi r'M PJ ..RT I!i4
..F1SiTLrKrt''arsIYYIYYM(+tti'niWM1:2 ry. (I~M1Y!J4FV1�♦wM".M n{aA t,?1fgMM1
nd',. nr'? yyttd-vsA•n"ryy M'Y n8'Xx•441 TugTN}! Av.E M:+,`a✓E:1 A, T•K Yi)I £�{: G{S,:vi irP rf x{ v St :41,<, ".'`
CLa•f1:ATE WnE4144.EP Oi wTP£ ••T t»'•.`•: vnP.X:P n[!`:r •.<-•"•r••_•.{•• i
X+aR1•••'n.•p^(Y4^'t 4:�:SK S:•:"'w� _�/-ixj 1:TY' V• of
L o.Aww.wrx ,ccs •�. i
r
-r vL,.cne•,•f.ovr,u+. xlXa. i ..fiv;y r.a,..-.... f
n:
E a_••: •,N `e �tJiU NA � nMn:F m ♦ {{
rr RL`
NRaBLX WP 'Y.O}• i y^.~ a�'A£Y�9 4
F.rFMt+[ amrPaY'e TtA J.
t M Ve'pNW ♦' !,
r KA }
M tMrcAav'TPRM+xW,rtGlaT":h♦aNnENf JRNPrw Irw>PaI.F YYPM WMww^mam.Nr�P[PYwI (
WYNrsfiYnCn^FN<„MY14A10[N, FwseLtwxl xns•n wNP...ra nrto F`J.v..F:vPf^�.N"s'^`w[JeC�']4... arnaP •/vn. w�rawMx� S?*9
t1Y,^PW`bn+♦Yq Fn peaW�TYMY,aMNae`+wv'w, Wafx wP`fr Xiv WX'af r[,t e�iw �.
iM1N pr WwNnrX X:X•R'a[{nfM MPk^TP.in:a CnrJP UN FOt1nA(Mn TnwN nIJMF nnPNMe.i`rY+T lH mntfb�.vY CVY-J'v. Fr'.
1TM CMa�d RNPni9tW 41 vnsMx Mi T^rtMM,MIt•FS•W.N.uW in M^u:AVMJ.W qY M:.4i°`ST YTS`w.li d.NAA'f+wpn�iP E}
�, $WS.9IXX Y'Iaw i•31\P'PVN6MYLMfC.il•C^`apiMnra'Sfr'TRYS
d
Rt os€c.cen b 7
s++un,WscY n,F aeaas rr*<*ar.^aa<ra e[e+a�r`IT-'nrrrnS i
Tn[ tb'M!@T DAg' FN[Fu np14f1 A'a[ 1! 4L•rtltd N 5
A<'•LNWN££R'4RSMd JQULY,[ONLCML I
Roc'i'rw 8 Srf,rti at Ca;o Cua LLC
6[ WXN v[ (YTI R.1ntl a.T.:K�iv `ca`Fi.v^•x tp
6
�, w�,-y^�••+^....... M4 i.:t] j?q,.gl fillmrv:.w:.l t.a i.wa.H-Lraysax^.+-f•"rYVA .
a:lwfzzr[AcaaocaRrowpraaL, am;nn RYNreY£.
�;" lTNACCRDmn[P•k LFpl Psn raq�KPnamrksW ACOR6
C ACOXDM¢Pl iYtj
1 1