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HomeMy WebLinkAboutBLD-19-000474 Lii7 /,f- ONE & TWO FAMILY ONLY-BUILDING PERMIT A Town of Yarmouth Building Department " i -.. 1146 Route 28,South Yarmouth,MA 02664-4492 t+ -' ! \ t 508-398-2231 ext. 1261 Fax 508-398-0836 t. ■ Massachusetts State Building Code,780 CMR Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling . This Section For Official Use Only BuildingPermitNumber: BO-19 6 * 979 Date Applied: ' • / . • &(lin i rut( *- • _.. ./ 7 Building Official(Print Nagy tgnature �'/�� . Date • • .SECTION 1:Sit E INFORMATION • • 1.1 Property Address: 1.2 Assessors 19t&Parcel Numbers ribrAflo34 p/cf /� /4/ I.1a Is this an accepted street?yes ,----- no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required ' Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L e.40,I54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ • Check if yes!: . • ' . • SECTION 21 PROPERTY OWNERSETP1 2.1 Owner'of Record: . 11 els 1÷11‘SP,' garniMirt /11 14 076'9 . Name(Print) Crtt ,State,ZIP 94 Ca..1p ty4 No.and Street Telephone Email Address . ' SECTION 3:.DESeR1PTIQN OF t?ROPOSED WORI2(check all that apply) • '' New Construction❑ Existing Building El Owner-Occupied ❑ I Repairs(s) GrfAlteration(s) 0 Addition ❑ Demolition 0 Accessory Bldg.0 Number of Units_ Other ❑ Specify: Brief Description of Proposed Wore: S/5 t?i - 2- petit resiti-eri cid A^ (lc134- Fp C i I( 01I+it SECTION;41,RSTIhi ATEDCONSTRUCTIONCOSTS. . Item Estimated Costs: -..' .: :• (Labor and Materials) .!• , 0 �� se Onty,.. s- 1.Building $ SO . 1:Bmld ns Peffi $, Iit'Fee- ndict is determined: 2.Electrical $ ❑Standard CityPtewnApplication J. ' ❑.Total Project Cost3(IIttem�l4).x mill 'lien.. : • •x'• - 3.Plumbing $ 2: Other.Fees: $ • Jy ().. 4.Mechanical (HVAC) $ 5.Mechanical (Fre $ Suppression) PetalAll Fees:$ --r' ' • '. t',i.e.-- .CheckN6;• • Check Amount: Cash Amount 6.Total Project Cost I $ 5„,,,, ❑Paid in-Full . . . 0 Outstanding Balance Duel SECTION 5:.CONSTRUCTION SERVICES . • • 5.1 Construction Supervisor License(CSL) 67(.S 0 '7 I+^ I I • PA(At, //nal,/l License Number an Date • Name of CSL Holder • G ./ J List CSL T e 2 4 / r r.tt h o&r4I L �1 Yp (see below) No.and Street Type _ Description tfN'tOJ l Pa ni IC 07-6 7 s U Unrestricted(Buildings up to 35,000 Cu.f.) ty/lown,State,ZIP R Restricted 1 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 2060 ��letll Fn14'€rpt/StS HIC Registration Number ICComganyName or e trantName Expiration Date net< r borate,- No. y No.and Street Email address 1 ' " ' f7dr'f rttfl 07/75 City/Town, State, .= Telephone SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(1,1GL.c.152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit Signed Affidavit Attached/ Yes d No...........❑ • SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WITRN • OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize to act on my behalf;in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date • SECTION 7b: OWNER ORAU'iHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. Print Owner's or Authorized Agent's Name(Electronic Signature) • Date NOTES: • 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Prosram),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142k Other important information on the HIC Progam can be found at www.mass.sov/oca Information on the Construction Supervisor License can be found at www.mass.sov/dos 2. When substantial work is planned,provide the information below: Total floor area(sq.R) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" _� ••� ....•....O,.rvcu.us urriwsacrsusETES t• � t Department of Industrial Accidents %:71111,—= • 1 Congress Street,Suite 100 " SIVE E Boston, MA 02114-2017 `��.a' www.mass.gov/dia 'Workers' Compensation Insurance Affidavit: Builders/Contractors/EleCtricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual):4L 6s-I LiDrnt fru•pd•bx_tat.�-(,.1,11$ Address: ' 5 peg p o" t-0, 1 IV . City/State/Zip:a nice t/ie - rill 01.33 z Phone#: 7 7 V 7.. .2M 3 7 Are you an employer?Cheek the appropriate box: Type of project(required): 1.�a employer with Z employees(full and/or pan-time)! 7. 0 New construction 2.❑I 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 l am a homeowner doing all work myself.[No workers'comp. insurance required]: 9. ❑Demolition 4.0 I am a homeowner and will be hiring contractors to conduct all work on property. I will 10 ❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet 12.0 Plumbing repairs or additions These sub-contractors have employees and have workers'comp.insurance.t 13.5repaiis to We are a corporation and its officers have exercised their right of exemption per MGL c. 14•LJ mer F4 Ft- rti ti,� 152,§1(4),and we have no employees. [No workers'comp.insurance required] *Any applicant that checks box#1 must also 511 out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit 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 sheet showing the name df the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. �. � � � Insurance Company Name: a'Y..GCC.rt sic /ri Sci/AncC_ Policy#or Self-ins.Lic.th $/44 PPS°31106 Expiration Date: ‘/2v// Job Site Address: 4 6 Cav."-6/, S b City/State/Zip:.st...entOzAJLt "a. 0.246/ Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MOL 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 cerci underthen e Wes of perjury that the information provided above is true and correct Sisn re: Date: 7- /3-/e Phone ': - Official use only. Do not write in this area, to be completed by city or town offrciaL City or Town: Permit/License Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town CIerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: Office of Consumer Affairs&Business Regulation-Mass.Gov Page 1 of 2 Mass.gov Office of Consumer Affairs and Business Regulation (OCABR) HIC Registration Complaints Registration # 120659 Registrant DAVID LINNELL Name DAVID LINNELL Address 2 CHEQUAQUET WAY City, State Zip CENTERVILLE, MA 02632 Expiration Date 02/18/2020 Complaints Details No complaints found for this registrant. You can also view arbitration and Guaranty Fund history. Back To Search Site Policies Contact Us https://services.oca.state.ma.us/hic/licdetails.aspx?txtSearchLN=120659 7/24/2018 • • A CERTIFICATE OF LIABILITY INSURANCE DATE osns/zo1ITs 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 policy(ies)must be endorsed. If SUBROGATION IS WANED,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). PRODUCER CONTACT NAME; Larissa Camba LEONARD INSURANCE AGENCY INC No Ws (508)428-6921 Fa.Ne): E-MAILEADDRESS' Larissa leonarda ency com 683 MAIN STREET SUITE B INSURER(S)AFFORDING COVERAGE RAE# OSTERVILLE MA 02655 INSURER A: ACADIA INS CO 31325 INSURED INSURERS: HERBST HOME IMPROVEMENTS LLC INSURERC: INSURER D: PO BOX 254 INSURER E: FORESTDALE MA 02644 INSURER F: COVERAGES CERTIFICATE NUMBER: 286507 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITSLTRnem wyn POLICY NUMBER (MM/BD/TWIT) (MMIDDIYYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE f _ DAMAGE 10 REN rED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ _ MED EXP(Any one person) $ N/A PERSONAL SAOV INJURY $ GEN'L AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE § RPOLICY❑jEa LOC PRODUCTS•COMP/OP AGO $ OTHER' f AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ — AONED SCHEDULED AUTOS WTOS NOTOS N/A BODILY INJURY(Per accident) $ HIRED AUTOS _ NON-OWNEDUTOS (Per aced DAMAGE f - f ent) UMBRELLA LIAB OCCUR EACH OCCURRENCE f EXCESS LUB CLAIMS-MADE N/A AGGREGATE f DED RETENTION§ X f WORKERS COMPENSATION STATUTE ETµ AND EMPLOYERS'LIABILITY A OFFICER/MEMBEREXCLUDED]ECUTNELEACH ACCIDENT s 500,000 E Y® N/A N/A MAARP303406 06/20/2018 06/20/2019 (Mandatory In NH) E.L.DISEASE•EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may he attached I/more space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B.no authorization is given to pay claims for benefits to employees In states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of Insurance shows the policy In force on the date that this certificate was issued(unless the expiration date on the above policy precedes the Issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/twd/workers-compensationfinvestigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Yarmouth ACCORDANCE WITH THE POLICY PROVISIONS. 1146 Route 28 AUTHORIZED REPRESENTATIVE South Yarmouth MA 02664 Daniel M.Cro y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) 'The ACORD name and logo are registered marks of ACORD yr Lx ;`b} y `"r 6R • w\ 1 . t ..u .. . _ is Z. 'v'`•"7 t .... ,. 1. ti+14 l• '7" ¢ r>' Thr ' * ' iti ci..r4tdsir '":s'• s, M� 14.' ,, jt, 44, 444* T Q i Ory. EtY { ��IiSI�� • a y♦ r� � 4st '744:1 ♦ li� �. .i �,,,7,,,,,„e n Ctw '1 . � Wby �f1 i ? -, 4"t 1.4 ln ^L, I4 t a 4 �ii i. 7' 4' MOyY l � � )' * 1.1� 14. *24 ;J' ,' .tp t `:'1142:M1*." ** et•: "x.t "k, ,tIo d ' p ? a...., , . e•• r COPY r OW N OF Ya�l�,��9Q�!'�'C�1 BFI E C O P� ANCIE. ERRO S ORI OMMISSIC�NSODO OT PD LIEVOEITHE APPLICANT FROM THE RESPONSIBILITY OF AS BUILT DATE: AN 1 / DATE: i1�/ �ILDING OFFICIAL '. Herbst Home Improvements LLC RE_ C E ! V E D 35 PEEP TOAD ROAD CENTERVILLE MA 02632 i � JUL 2'% 2018 . 774-238-2937 www.herbsthomeimprovements.com j D ,G E- ARTPA_NT PROPOSAL SUBMITTED TO: WORK PERFORMED AT • Cray mason .-• _._.J 96 camp street west yarmouth We herby propose to furnish the materials and perform the labor necessary for the completion of: New roof in damaged areas Left side and rear section Remove one layer of shingles • Inspect roofing deck for loose plywood Repair damaged roof boards and 3 rafters Install ice and water shield at eves and valleys Install new drip edge Install CertainTeed synthetic roofing paper Install CertainTeed Landmark shingles Replace all plumbing boots Install vent and CertainTeed cap shingles New siding damaged areas in rear Remover existing siding Remove all fasteners Install tvpar house wrap Install new cedar siding shingles Remove and install new fascia boards Remove and replace putters in damaged areas Clean all debris daily All material Is guaranteed to be as specified. The above work will be performed in accordance with the specifications submitted And completed in a substantial workman-like manner for the sum of:eight thousand seven hundred seventy five Dollars($8,775.00)with payments as follows:deposit of 3,000 and remainder upon completion *Any alterations from above proposal involving extra costs will be added under a separate written agreement and become an extr charge over and above said proposal. RESP TFULY SUBM TT D 5 '75 e/B -son Herbst ACCEPTANCE OF PROPOSAL The above price,specifications and conditions are satisfactory.I herby accept this proposal. You are authorized to do the work a payments will be as specified above. SIGNATURE: ( j.. 5-- ' /rS - *This proposal may be withdrawn by said company if not accepted within 30 days. r • , • . C ' tcelki.Saai'ricer.�ettiva" � .fl��' sgris. , . "�".� ri faCInj ,C, % Commonwealth of Massachusetts r ®t Division of Professional Licensure a^ •°IS Ito Board of Building Regulations and Standards Construction,SukerVisot1 & 2 Family r !a S t,Expires: 08/11/2019 ies�CSFA-071507 r r f' N . DAVID J UNNELL,JR ' P.O.BOX 31 ;- &L I) ier WEST BARNSTABLE MA 0268'` ;,,r� ' :1-0. ityj // "" i � '., 7e jy, r Commissioner r 7.7:097/1,4X0- ,...,.;.,,,Z-2,1,4I� �nts �� • ` >it 'r •lJrrk%✓' rVf r.rw rttT�ter " f . y *4r —•, ' r�n✓ 3' 'r� ' r iso ft• irr OtfieeorCoes unser Affairs& Business Regulation ' Yil'' r r7 Ft; IMPROVEMENT CONTRACTOR � 'n j ; Registration: '120659 Type: y,« y le lot Expiration: • 2)1912018 DBA ig.?o c JNNELL ENTERPRISES $ + , - 71- o 4 l DAVID LiNNELL ;~ rv.. . „ 159 FREE BOARD LANE • c; it - YARMOUTHPORT, MA 02675 Cadene<rctary ie,'," •'r r.>r,'