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Home My WebLink AboutBLD-19-000695 Office Use Only r C E Amount 30--- =C`'3:;"*:J.,' Permit expires 180 days from __ - i issue date I EXPRESS BUILDING PERMIT APPLICATI/CN I e°IPECE ' TOWN OF YARMOUTH Yarmouth Building Department AUG 03 201$ 1146 Route 28 �y � '' South Yarmouth, MA 02664 °Y't` r,Ty' `1'``ur (508) 398-2231 Ext. 1261 '/ �/ CONSTRUCTION ADDRESS: /7---/9 #-exxI f�j(�j ist we ihte) 14/ Y QY✓I�,o GGAiC ASSESSOR'S INFORMATION: ` . Map: Parcel: OWNER: R go d oU'�- N PRESENT ADDRESS n / TEL # CONTRACTOR: £bpe(bd!Coke Tm provvemesf2l- fl Mi!/i�op,IV W MAILING ADDIetS 4jgv o tli, 50.065 o/022 Residential 0 Commercial / r� Est.Cost of Construction S %'22/0. 0 0 Home Improvement Contractor Lie.# /6 f 0 If $ Construction Supervisor Lie.# 70G 0 et 0 Workman's Compensation Insurance: (check one) 0 I am the homeowner 0 I am the sole proprietor VI have Worker's Compensation Insurance ,/ Insurance Company Name: 4m G uoArd Worker's Comp.Policy# 9 4'o /z3 WORK TO BE PERFORMED Tent _ Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares a3 ( >Remove existing*(max.2 layers) Insulation Old Kings Highway/Historic Dist. ( )Replacing like for like ///^/ Pool fencing / / t� *The debris will be disposed of at �� , /n) 5 Location of Facility I declare under penalties of perjury that the statements herein contained are true and correct to the best of my Imowledge and belief I understand that any false answer(s) will be just cause for denial or revocation of my lic I d for p j secution under MG.L Ch.268,Section 1. p Applicant's Si: / licw Date: aO/0.3/iaG ry . Owner gaamn(ora ..chmenn)/II A Date: 042/70.//6 Approved By. a / Date: 4 J ' ' IF Building Offi, aialt, a) EMAIL ADDRESS: Zoning District: Historical District: 0 Yes 0 No Flood Plain Zone: 0 Yes 0 No Water Resource Protection District: Within 100 ft.of Wetlands: 0 Yes 0 No 0 Yes 0 No ,- Commonwealth of Massachusetts ',.. 14 Division of Professional Licensure Board of Building Regulations and Standards Constructio tMp 4f"isor Specialty CSSL-106040 Expires : 05/14/2020 ii ANATOLI SIVITSKI , 27 MILL POND'RD ;, ' "��'0 k WEST YARMOGTH MA 02673 1'SS" f?IT�S CIAO .� t; Commissioner CIL ® ,.4 1 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDMYYY) O6/15/2018 : AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS (::❑ ! ' .RMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LG • OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED Yc'T" :;ER,AND THE CERTIFICATE HOLDER. polder is an ADDITIONAL INSURED,the policy(les)must be endorsed. M SUBROGATION IS WAIVED,subject to i I- policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the . endorsement(s). -F-:''-� - ' "' - CONTACT NAME: Linda Sullivan MWUN6dONi )( %NS()R/1NCEAGENCY `""c°Nr;F.D. (508)775-1620 WC. No): E-MAILDRSS: IsullIvan(doins.com INSURERS)AFFORDING COVERAGE NAIC f i's '^' . MA 02601 INSURER A: AMGUARD INSURANCE CO 42390 _ INSURER B: CAPECOP NOMt(wtPROVEMENT INC INSURER C: INSURER D: .. ", '-' INSURERE: MA 02673 INSURER F: CERTIFICATE NUMBER: 281511 REVISION NUMBER: :LICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS '. MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, ' SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADDLSUBR POUCY EFF POLICY EXP INSD WVD POLICY NUMBER (MWDD/YYYY) (MWDDNYYY) LIMITS EACH OCCURRENCE $ DAMAGE TO REN rE0 PREMISES(Ea occurrence) f MED EXP(My one person) $ N/A PERSONAL ADV INJURY $ GENERAL AGGREGATE f PRODUCTS-COMP/OP AGG $ $ --- COMBINED SINGLE LIMIT f (Ea accident) BODILY INJURY(Per person) $ N/A BODILY INJURY(Per acddent) f -D PROPERTY DAMAGE f (Per accident) f EACH OCCURRENCE S MADE N/A AGGREGATE f f X STATUTE ER" Y/N WAIS WA WA R2WC940123 06/03/2018 06/03/2019 EL EACH ACCIDENT $ 1,000,000 EL DISEASE•EA EMPLOYEE $ 1,000,000 E L DISEASE-POLICY LIMIT $ 1,000,000 N/A VEHICLES(ACOR0101,Additional Remarks Schedule,may be attached M more apace Is required) be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay :Stes other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. policy in force on the date that this certificate was Issued(unless the expiration date on the above policy precedes the - -ice). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification rkers-compensation/investigations/. 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. AUTHORIZED REPRESENTATIVE MA 02673 Daniel M.CroWfey,CPCU,Vice President—Residual Market—WCRIBMA 01988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD . P5ge tPdf,czoe Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, Massa°chusett's 02108 Home Improvemerij'Coi'tCactor Registration 1=F" , T Corporation __k=,t±r.- ,6 Registration: 168043 CAPE COD HOME IMPROVEMENT,INC. , rr-zr I!, k Expiration: 12/06/2018 27 MILL POND RD :i '- 1.. WEST YARMOUTH,MA 02673 1F,t 0-.... ,, 'Y 1 4'�—{�y%� Update Address and Return Card. SCA 1 0 20M-05/17 Clk t(gmmon4.eald einAuemieesein Wilco of Consumer Affairs&Business Regulation HOME IMPROVEM ENT CONTRACTOR Registration valid for Individual use only TYPE:,QOrooratian before the expiration date. If found return to: Registration',; Fxniration Office of Consumer Affairs and Business Regulation 168043--='--(= 12'06/2018 10 Park Plaza-Sul . - • CAPE COD HOME,IMPROEMENT,INC. Boston,MA , `• •. ANATOL!SIVI'I SKI 1;1,`.,Li'. • :./ \R,.CG.�r%s,7,-- 27 MILL POND RD. M ,,;` -,-',./.°7 ) Not valid wit outs nature WEST YAP.MQ'J iH,MA'02073 Undersecretary 9 4 .ems'c..ARE COD - _____CAPE COD HOME IMPROVEMENT TM 27 MILL POND ROAD,WEST YARMOUTH MA 02673 (617)710-1001,(508)469.0102 CAPECODINC@GMAIL.COM, WWW.ROOFCAPECOD.COM, WWW.FACEBOOK.COM/CAPECODHOME PROPOSAL 07.05.2018 TO RAY MORLOCK LOCATION: 17-19 NEW HAMPSHIRE AVE, WEST YARMOUTH WE HEREBY SUBMIT SPECIFICATIONS AND ESTIMATES FOR MAIN COMPOSITION SHINGLE ROOF. • REMOVAL OF ALL EXISTING ROOFING AND FLASHING MEMBRANES TO THE PLYWOOD DECK SURFACE. • REPLACEMENT OF ANY DAMAGED OR DETERIORATED PLYWOOD DECKING AT AN ADDITIONAL COST.DECKING WILL BE REPLACED IN WHOLE SHEETS ONLY IN ACCORDANCE WITH RECOMMENDATIONS BY BOTH THE NATIONAL ROOFING CONTRACTORS ASSOCIATION(NRCA)AND THE AMERICAN PLYWOOD ASSOCIATION (APA).NEW DECKING SHALL BE APA RATED FOR STRUCTURAL USE.DECK FASTENING WILL MEET OR EXCEED LOCAL BUILDING CODE REQUIREMENTS. • REPLACEMENT OF FOLLOWING FLASHING MATERIALS:STEP FLASHINGS,PIPE FLANGES,PERIMETER DRIP EDGE MATERIAL AND ALL SKYLIGHT FLASHING MATERIAL.ALL MATERIALS TO MEET OR EXCEED MANUFACTURER'S REQUIREMENTS. • ONE ROW OF ICE AND WATER PROTECTION MEMBRANE SHALL BE INSTALLED IN ALL VALLEYS AND AROUND THE CHIMNEY. • ONE ROW OF ICE AND WATER PROTECTION MEMBRANE SHALL BE INSTALLED ALONG ALL EAVES AND SHALL EXTEND PAST THE INTERIOR WALL LINE A MINIMUM OF 18INCHES TO PROVIDE PROTECTION AGAINST DAMAGE FROM ICE DAMS. INSTALLATION OF ONE LAYER OF ROOFING UNDERLAYMENT ON DECK SURFACE NOT COVERED WITH ICE AND WATER PROTECTION MATERIAL CI{/��CGr4c. 3L4C.14.. gti. • INSTALLATION OF NEW,ARCHITECTURAL-STYLE ALGAE-RESISTANT CERTAINTEED SHINGLES.SHINGLES WILL BE INSTALLED IN STRICT ACCORDANCE WITH THE MANUFACTURER'S SPECIFICATIONS AND SHALL BE FASTENED USING,$J,N NAILS PER SHINGLE. • COLOR OF ROOF PENETRATIONS AND FLASHINGS TO BE CHOSEN BY OWNER. • INSTALLATION OF A SHINGLE-OVER RIDGE VENT.VENT IN THIS AREA IS CONTINUOUS AND WILL CAPE COD HOME IMPROVEMENT"GUARANTEES THAT ALL COMPONENTS INSTALLED PROPERLY PLEASE FEEL FREE TO CALL CAPE COD HOME IMPROVEMENT" WITH ANY QUESTIONS OR CONCERNS PLEASE INITIAL THIS PAGE �/! ettat °mE® CAPE COD HOME IMPROVEMENT TM 27 MILL POND ROAD,WEST YARMOUTH MA 02673 (617)710.1001,(508) 469-0102 CAPECODINC@GMAILCOM, WWW.ROOFCAPECOD.COM, WWW.FACEBOOK.COM/CAPECODHOME PROVIDE MAXIMUM INTAKE VENTILATION FOR THE FULL ATTIC VENTILATION SYSTEM. • REPLACE ANY DAMAGE FASCIA-BOARDS OR RAKE-BOARDS AT AN ADDITIONAL COST. • ALL GROUNDS TO BE CLEANED UPON A DAILY BASIS.ALL BUSHES,SHRUBS,AND FLOWERS TO BE PROTECTED.HOMEOWNER IS ASKED TO SUPPLY ELECTRICAL POWER IF NEEDED. #17. MAIN ROOF AND HAY-WINDOW CERTAINTEED LANDMARK SHINGLES C/(A ?C04L SLACK LABOR AND MATERIALS; $2,950.00 DUMPSTER;$450.00 TOTAL: $3,400.00 #19. MAIN ROOF, HAY-WINDOW AND BUMP-OUT CERTAINTEED LANDMARK SHINGLES L//q,r, o4 L 8C.40C (INCL BLACKING OF 2 SKYLIGHTS AND REPLACING SIDING ON ALL 6 CHEEKS) LABOR AND MATERIALS: $5,390.00 DuMPSTER: $450.00 TOTAL: $5,840.00 GRAND TOTAL: $9,240.00 CAPE COD HOME IMPROVEMENT T"'IS PROUD TO PRESENT YOU WITH SUPERIOR 10 YEAR WORKMANSHIP AND SERVICE WARRANTY.THIS WARRANTY IS IN ADDITION TO,BUT RUNS CONCURRENTLY WITH ANY MANUFACTURERS'WARRANTIES.IT COVERS ALL SERVICE CALLS RELATED TO WARRANTY REPLACEMENT AND/OR INSTALLATION ISSUES FOR THE FIRST TEN YEARS AFTER PRODUCT INSTALLATION PAYMENTTERMS: 50%AT DEPOSIT: 50%UPON COMPLETION. CAPE COD HOME IMPROVEMENT TM GUARANTEES THAT ALL COMPONENTS INSTALLED PROPERLY I, PLEASE PEEL FREE TO CALL CAPE COD HOME IMPROVEMENT"4 WITH ANY QUESTIONS OR CONCERNS PLEASE INITIAL THIS PAGE ie Ott CAPE CAPE COD HOME IMPROVEMENT TM 27 MILL POND ROAD, WEST YARMOUTH MA 02673 (617) 710-1001, (508)469-0102 CAPECODINC@GMAILCOM, WWW.ROOFCAPECOD.COM, WWW.FACEBOOK.COM/CAPECODHOME JOB IS ESTIMATED TO COMMENCE APPROXIMATELY 2 TO 8 WEEKS AFTER DEPOSIT RECEIVED WORK IS SCHEDULED TO BE SUBSTANTIALLY COMPLETED IN APPROXIMATELY 1 TO 2 WEEKS. ANY WORK ABOVE AND BEYOND THE SPECIFICATIONS WILL BE PERFORMED AT 56.00$PER MAN HOUR PLUS MATERIALS OR PRICED ON REQUEST.ALL ADDITIONAL WORK,INCLUDING TRAVEL TIME AND WMBERYARD RUNS.MOVING ALL PERSONAL OBJECTS.FURNITURE,ETC.FROM WORK AREA.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 CAPE COD HOME IMPROVEMENT"'WILL PROVIDE CLEANUP ON A CONTINUING BASIS AND ALL DEBRIS WILL BE REMOVED FROM SITE(PROFESSIONAL CLEANING DOESN'T INCLUDE).ALL PRODUCTS INSTALLED BY CAPE COD HOME IMPROVEMENT"'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 TORE PERFORMED IN ACCORDANCE WITH THE DRAWINGS AND/OR SPECIFICATIONS SUBMITTED FOR ABOVE WORK AND COMPLETED IN A SUBSTANTIAL WORKMANUKE MANNER. OWNER TO MOVE ALL PERSONAL OBJECTS.FURNITURE,ETC.FROM WORK AREA.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.CAPE COD HOME IMPROVEMENT"'IS NOT RESPONSIBLE FOR ANY DAMAGES IF SAID ITEMS REMAIN IN PLACE. CAPE COD HOME IMPROVEMENT"'IS NOT RESPONSIBLE FOR ANY DAMAGES THAT MAY OCCUR DURING CONSTRUCTION TO LANDSCAPING OR ANY FINISH GROUND WORK,PLANTINGS,ASPHALT OR STONE DRIVEWAY. ETC.FLOWERS AND SHRUBS AGAINST HOUSE MAY NEED TO BE REPAIRED OR REPLACED BY HOMEOWNER. 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 PUBUC UABIUTY INSURANCE ON ABOVE WORK TO BE PLACED ON THE RESIDENCE AS A CONSEQUENCE OF THE CONTRACT.OWNER WHO SECURE THEIR OWN CONSTRUCTION-RELATED PERMITS OR DEAL WITH UNREGISTERED CONTRACTORS WILL BE EXCLUDED FROM ACCESS TO THE GUARANTY FUND. COSTS OFF COLLECTION.INCLUDING ATTORNEYS FEES WILL BE RECOVERABLE.IN THE EVENT OF NON- PAYMENT. WE LOOK FORWARD TO WORKING WITH YOU: PLEASE CALL IF YOU HAVE ANY QUESTIONS. alk CAPE COD HOME IMPROVEMENT iN GUARANTEES THAT ALL COMPONENTS INSTALLED PROPERLY 11111, PLEASE FEEL FREE TO CALL CAPE COD HOME IMPROVEMENT" WITH ANY QUESTIONS OR CONCERNS PLEASE INITIAL THIS PAGE 04 wispy.coal CAPE COD HOME IMPROVEMENT TM 27 MILL POND ROAD,WEST YARMOUTH MA 02673 (617) 710-1001, (508)469-0102 CAPECODINC@GMAIL.COM, WWW.ROOFCAPECOD.COM, WWW.FACEBOOK.COM/CAPECODHOME SINCERELY CAPE COD HOME IMPROVEMENT TN THIS CONTRACT NOT VALID UNLESS SIGNED BY ANATOLI"TOM'"SIVITSKI ACCEPTED BY ie.4'fdp> e-e9 ' /Ci� aotaCC6 SIGN i'( DATE rel/l� ACCEPTED = GOCT)Ca S(Vrh'k- e.6 \ 01 SI I/ , '�' IDATE ACCEPTED BY SIGN DATE CAPE COD HOME IMPROVEMENT TM GUARANTEE.THAT ALL COMPONENTS INSTALLED PROPERLY PLEASE FEEL FREE TO CALL CAPE COD HOME IMPROVEMENT" WITH ANY QUESTIONS OR CONCERNS /Iwo PLEASE INITIAL THIS PAGE �j((�` • The Commonwealth of Massadhusetts ' @'_ i11l_5�• Department oflndustrialAccidents € ==�'= .1 Congress Street,Suite 100 f -T Boston, MA 02114-2017 �,. www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print-Legibly ti Name (Business/organization/Individual): eafre al lion ze_i !7prove jne,t _ Address: 021- NU'J/ Poole( Cd City/State/Zip: ii. Yarn.LOU-4 , Phone #: 6.796'te 6 9otot Are you as employer?Check the appropriate boz: Type of project(required): I.❑[am a employer with employees(full and/or part-time).* 7. 0 New construction 2.01 am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doing all workmyself 9. ❑Demolition [No workers'comp.insurance required]: 4.0 I am a homeowner and will be hiring contactors to conduct all work on my property. I will10 Q Building addition __ ensure that all contactors either have workers'compensation insurance or are sole 11.❑ Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.❑I am a general contactor and I have hired the sub-contactors listed on the attached sheet These subcontractors have employees and have workers'comp.insurance.: 13. Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other 152,§1(4),and we have no employees.[No workers'comp. insurance required.] *Any applicant that Menlo box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this ai5davit indicating they are doing all work and then hire outside contactors must submit a new atadavit indicating such CCoraracmrs 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-contactors have employees,they must provide their workers'comp.policy number. lain an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. //�� 0 Insurance Company Name: him (Lail Policy#or Self-ins. Lic.#: I G'O1, Zs / �J W^Expiration Date: 0C/03/19 Job Site Address: /9--/9 A u) ga�npsetit/t AVE City/State/Zip: I i an o , Attach a copy of the workers' compensation policy aeclaration 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 Sisnlature: DI Date: Of'/03//e Phone#: 617 $ lie ®/OZ • 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#: