The URL can be used to link to this page

Home My WebLink AboutBLD-18-001645 -�4'•Y.eOffice Use Only 'J.....;t:•-•O' . p • smi'I P $Amormt 1/450 . ' �; _i c-� Pemrit expires 180,days from issue date CEIV EXPRESS BUILDING PERMIT APPLICATI 1� E7------ED- "-f l - TOWN OF YARMOUTH SEP 18 2U"\ Yarmouth Building Department 1146 Route 28 tillet,y,., South Yarmouth,MA 02664 I-(508) 398-2231I` 1Ext. 1261 Q /� CONSTRUCTION ADDRESS: 12 Ciu fj w k UR�.� Yuri y�,iptictt P& ^ "-- ASSESSOR'S INFORMATION: U • r�Maap: _ /� Parcel: �/ y ry OWNER Amy C2ta fl L \ ? et-t (Agit_ bJ1 1 . ( � sb •1'.t{- {1� NAME �' PRESENTADDRESS 11 f,, 0 �j�'^ CONTRACTOR D ke w) ,fttjll�vtr,M 61 L)AJC k v Ro W5 3O -17(0 NAME MAILING ADDRESS TEL## p Residential 0 Commercial Est Cost of Construction S /f I Q a 0. OO Home Improvement Contractor Lie.# 1 l o (&rl Construction Supervisor Lie.# I.0260(3 Workman's Compensation Insurance: (check one) 0 I am the homeowner 0 I am the sole proprietor Ihave Worker's Compensation Insurance Insurance Company Name: echil vJet"II . Worker's Comp.Policy# (27 rW cgs"i " WORK TO BE PERFORMED Tent _ Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# Replacement doors: # , ' qgRoofing: #of Squares 2.y (?c)Remove existing*(max.2 layers) Insulation .wfi(�$Old Kings Highway/Historic D� ( 14Replacing like for like Pool fencing easy Jo'f a /p ° *The debris will be disposed of at `7�- _. Location of Facility I declare under penalties of perjury 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 cause for denial or /_o�f my licenseyenand for prosecution under MG.L Ch.268,Section 1. V /�, Applicants Signature: k /l 1 Date: i,//, Owners Signature(or attachment)) u — Date: Approved By: V T Date: �� r, ii,a i. ial(or designee) ' EMAIL ADDRESS: Zoning District: Historical District: 0 Yes 0 No Flood Plain Zone: ❑ Yes 0 No Water Resource Protection District: Within 100 R of Wetlands: 0 Yes 0 No 0 Yes 0 No graNThe Commonwealth of Massachusetts ,..1! g" �gam/ Department oflndustrialAccidents • € wipe- 1 Congress Street,Suite 100 i1!=_ 5 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 � 'J � Please Print Le?ibly (( Name (Business/Organization/Individual): kali 4 ,c10hNIc (Aill_ COO, LE'2� Address: 6 k OWLS 6., e- 0 N ti City/State/Zip:tit tt-Q, 1>$M I13 Phone#: rsictc•300. 27M Are yon as employer?Check theappropriatebox: Type of project(required): I.2 I am a employer with / employees(full and/or part-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.] 3.01 am a homeowner doing all work 9. 0 Demolition ❑ myself[No workers'comp.insurance requred.]t 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 0 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0 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. insurance= 13.0 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 checks box#1 must also fill 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 contactors must submit a new affidavit indicating such. tCormactors 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-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: itm(� �ldS211 */1s 1/ Policy#or Self-ins.Lich6.#: KL W C 1&- /�6,.9C I Expiration Date: 'Z jtO/I e Job Site Address: )& G4N 146.1.,t_ New ew City/State/Zip: P Attach a copy of the workers' compensation policy declara4on 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 certifyun4t�pains and penalties of perjury that the information provided ove�`true and correct Simlature: Q� IAAA $' / Date: / sic iP Phone#: .7011' 3‘017 . 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): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: 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 contact 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 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 license 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 contact for the performance of public work until acceptable evidence of compliance with the insurance • requirements of this chapter have been presented to the contacting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contactor(s)name(s),address(es) and phone number(s) 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"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 burn 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. # 617-7274900 ext. 7406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 02-23-15 www.mass.gov/dia i I Art Roofing and Siding of Cape Cod,LLC 0 BIM 68 Winslow Gray Rd West Yarmouth, MA 02673 508-360-2749 e-mail:rsocc@yahoo.corn roo fingandsidi ngofcapecod.com HIC REG #170787; LIC # 102600 Job Address: Name: Ann Crieger Town: Address: 18 Gunwhale Way Job Phone: 508-744-7102 City: Yarmouth Port Other Phone: State: MA E-mail: 2criegers@gmail.com ZIP: Estimator: Dmitry Labkovich 07/02/18 We hereby submit specifications and estimates to furnish and install new roofmg as follows: 1. Strip existing roofmg 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. 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 & 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. • Job is estimated to continence approximately 3_ weeks after deposit received unless otherwise noted here: Work is scheduled to be substantially completed in approximately: _3_ 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 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 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 docu- ment for specific warranty details regarding this product. • Lifetime, limited transferable warranty • 10-year SureStartrm warranty(100%replacement and labor costs due to manufacturing defects) • 10-year StreakFighterT"'warranty against streaking and discoloration caused by airborne algae • 15-year, 130mph wind-resistance warranty GOOD:Landmark, with Life-Time Warranty Labor and Materials: $9,980.00 n ,�bi t S� o y�� If acceptable, initial here LA Color liti BETTER: Landmark-PRO, 50 Year Non-Prorated Warranty Labor and Materials: $10,900.00 If acceptable, initial here Color BEST: Landmark-PREMIUM, 50 Year Non-Prorated Warranty Labor and Materials: $11,800.00 If acceptable, initial here Color 5% DISCOUNT if paying with check or cash. Different FINANCING options available. Instant approval. Job is estimated to commence approximately _3_ weeks after deposit received unless otherwise noted here: Work is scheduled to be substantially completed in approximately: _3_ 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 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 9112/2018 23 Rumson Way-rsocc.ma@gmail.com-Gmall • • Hi Dmitry- ,We'd like to move forward with you on the roof repair here. And we'd like to go with the BEST: Landmark-PREMIUM, with Life-Time Warranty level. When can you start? Also, could you also quote on a roof-repair/replacement job for the Cape Cod Theatre Company/Harwich Junior Theatre? It's a tall building - at 105 Division Street in West Harwich (on the Dennisport line, just south of Route 28)? I'd like an estimate for that as well. Kind Regards, Michele Michele Clarke 1203.912.0560t\A IV Er• ly U https://mail.google.com/mail/u/0/#inbox/16569a01fe9a36a2 1/1