HomeMy WebLinkAboutBLD-19-001451 e. -// ?n,J
•
ONE & TWO FAMILY ONLY-BUILDING PERMIT
Town of Yarmouth Building Department /or r
1146 Route 28,South Yarmouth,MA 02664-4492
508-398-2231 ext. 1261 Fax 508-398-0836 I, -
Massachusetts State Building Code,780 CMR
Building Permit Application To Construct, Repair;Renovate Or Demolish 6I64-4-I 120
a One-or Two-Family Dwelling
RFCFIVED
This Section For Official Use Only
Building Permit Number: B O- /9-57) pis/ Date Applies _ 018
Blinding Official(Print Name) • �igaature eY O NG O 1{nMENT
•• .SECTION 1:STTE INFORMATION. •
It Rro&rtA qy j v� 1.2 Assessors me, Parcel Numb
1.1a Is this an accepted street?yes_ no Map Number / Parcel Number
13 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 c.40,§54) 1.7 Flood Zone Information: • 1.8 Sewage Disposal System:
Public Private❑ Zone: _ Outside Flood Zone?
Check f yes': Cl On site disposal s rte (i •
SECTION 2: PROPERTYOWNERSHL''R F C E I V:kr. [)
' f Rec d:2.1tPr � AftNn
ob � A • /
Name(Print) City,State,ZP EP
2 201
1a14fl7 OoirtWS s<t 9�
No.and Street Telephone B ILOIta s
SECTION,3:.DESCRiPTION OF PRQPOSED WORK=(c at apply) • '
New Construction 0 Existing Building❑ Owner-Occupied ❑ I Repairs(s) ❑ Alteration(s) ❑ Addition C,
Demolition ❑ Accessory Bldg. 0 Number of Units_ I Other &Specify: N er.44.
Brief Description of Proposed Work': a / It. 4 / ' 't L.a u
. . . . • . SECTION4:,EST i 1ATED CONSTRUCTION COSTS. :, .. .
Item Estimated Costs: - • ' .. .
(Labor and Materials) _.... : , '..: �.omeia Tsse Only
1.Building $ -7,0.80 .1.Buildme Permit'Fee:$.W 1 .. Indicate how fie is determined:
2.Electrical $ • IIStandard CityiTQwaApplicationPee• .• `,4,• : '•
❑.Total Project Cost'(Item,6)x multiplier... : . ' .s•• -
3.Plumbing $ 2. Other:Fees: $ . 355.::. —
. 7
4.Mechanical (HVAC) $ List ' ...: :. :.. ..:.:. . r.• . •• .
5.Mechanical (Fire i•.,. .:.. ;
Suppression) $ Total All Fees:$:
• ,, n- CheckN6.,• • chick Amain: Cash.Amount • '
6.Total Project Cost: $ p Paid iiFull .... `b OdistandingBalance Due: 45
SECTION 5:.CONSTRUCTION SERVICES
5.1 c (on Sup�ervisor License(CSL) C-5
C_ Ito Nig
2-i
p2o p ,�pl' nY/ ore- License Number Expiration
Date
Name of CSL Holder l
o ltiz i i m n List CSL Type(see below) (A,
vend Street`p'v''I 1 r Type •. Description
ojo'�(,.1 e n n 1O, 0 t � U Unrestricted(Buildings up to 35,000 cu.R)
Ci /fo State, l./� ./ /�G"� V u R Restricted leFamilyDwelling
City/Town, P
M Masonry
RC Roofing Covering •
WS Window and Siding
/ n 12 ��,,./�p /� �" ton SF Solid Fuel Burning Appliances
'( �� ) c l Redia I iQn,�1'V,er ton I Insulation
elephone Email addre D Demolition
5.2 Registered Home Improvem nt Contractor()3IR615
C) + 15 3 • 'n/3O/r P
die S \4on'e inVrot ri1nel I ICRegistration Number Expiration Date
Tett
�t 11Tfiame4me ,C / Name
S felearc --p-0,29/603
,"l ^ -Cenicere,er;ai€ mail`l, Cam
j P�Q YYl bl D�
o.and$t;e / �/ b_//'03 Email address
�t7f!K-rl' S!i
itytTown,State,ZIP Telephone
SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.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 Q4 No ❑
• SECTION 7a:OWNER AU IHORIZATION TO BE COMPLETED WHEN
• • OWNER'S AGENT OR CONTRA—C(T"O�R+APPLIESSFFOR
�,BUILDING PERMIT
I as Owner of the subject property,hereby authorize 'TO'S]9,9 I et-&1 t-
to act on my behalf in all matters relative to work authorized by this building permit application.
APA- lig- Z45/i
Print Owner's Name(Electronic igaature) Date
• • SECTION 7b: OWNER'.OR AU•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. //
—Ed Seb% Pent 7g411
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(BIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the RIC Progam can be found at
www.mass.00v/oca Information on the Construction Supervisor License can be found at www.mass.eov/dos
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft) (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft) Habitable room count
Number of fireplaces Number of bedrooms
Number of barhrooms 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'
The COmrnonwealth of Massachusetts
f `t ,
Department oflndustrialAccidents
';i;;:,-. ,.; N;�: 1 Congress Street, Suite 100
Boston, MA 02114-2017 •
www.mass.gov/din
af„''A ms.9
. � ;Yorkers' Compensation Insurance Affidavit Builders/Contractors/Electricians/Plumbers.
"„k,;`,1/ 2-; -'• TO BE FILED WITH THE PERMITTING AUTHORITY.
A !leant Information O Please Print Letrib1V
`# N e1/4
(Business/Organization/Individual): 305a(1 '&ere,
Address:JOC l o-k-n 4rvrf 40 l3r 4�'7 e,0 nig 01 .5r4
City/State/Zip: Phone rt: 77 `l 9.d.6 t!Gd 2 7
Are you an employer?Check the appropriate box: Type of project(required):
I.®I am a employer with it employees(full and/or part-time).* 7, ❑New construction
i 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling
any capacity.[No workers'comp.insurance required.]
3. l am a homeowner doing all work myself t 9. ❑Demolition
❑ yes [No workers'comp. insurance required.]
4.1:1 m I aa homeowner and will be hiring contractors to conduct all work on my property. I will 1 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 contactor and I have hind the sub-contractors listed on the attached sheet.
These sub-contactors have employees and have workers'comp. insurance? 13.❑Roof repairs �I`ON !
14.®Other e✓iYl1G .SSI®(/r+
6.0 We are a corporation and its officers have exercised their right of exemptionMa
exemption per GL
152,§1(4),and we have no employees.[No workers'comp.insurance required-]
*Any applicant that checia box#1 must also 511 out the section below showing their workers'compensation policy information.
Homeowners who submit this affidavit indicating they are doing all work and then hire outside contactors must submit a new aMdavit indicating such.
=Contractors 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: C{/i ( j � Tdft1T t1 Cit°
Policy#or Self-ins.Lin.#: (Z.2.-wC p` 5 8 ..)-e)7 Expiration Date:2//1
Job Site Address: PI 0.4,tratn?ter< City/State/Zip:&f.PzU t1. P1 -- —
Attach a copy of the workers' compensation policy declarationpage-(showing-thepolicy n ber 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
Signature: til Date:7!/7 s// g
Phone#: . 7 9�f� 1(9ff 5
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#:
OF•Y`te TOWN OF YARMOUTH
• r ° BUILDING DEPARTMENT
• ; 1146 Route 28,South Yarmouth,MA 02664 508-398-2231 ext. 1261
•
• HOMEOWNER LICENSE EXEMPTION
• PLEASE PRINT:
•
DATE: •
Q/ /� ,�
JOB LOCATION: u l ce /�.1t1tn lark T
"HOMEOWNER" ��-�lb°,'T Le, S;715,),1— 7C SECTION OF TOWN
NAME HOME PHO t' WORK PHONE
PRES MAILING ADDRESS C-O.1 ' / �.� c Ce '
1�1�►b?�VJ�. / 1Lt�
CITY OR TOWN STATE ZIP CODE
The current exemption for'Homeowner' was extended to include owner—occupied dwellines of one or two units
and to allow such homeowners to engage an individual for hire who does not possess a license,provided that such
homeowner shall act as supervisor. (State Building Code Section 110 R5.1.3.1)
Definition of Homeowner.
Pers on(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is or is intended to
be, a one or two family attached or detached structure assess ory to such use and/or farm structures. A person who
constructs more than one home in a two-year period shall not be considered a homeowner,such"homeowner"shall
submit to the building official,on a form acceptable to the building official,that he/she shall be responsible for all
such work performed under the building permit.(Section 110 R5.1.3.1)
The undersigned 'homeowner' assumes responsibility for compliance with the State Building Code and other
applicable codes,by-laws,rules and regulations.
The undersigned 'homeowner' certifies that he/ she understands the Town of Yarmouth Building Department.
minimum inspection procedures and requirements and that he / she will comply with said procedures and
requirements.
HOMEOWNER"S SIGNATURE &—
APPROVAL
OF BUILDING OFFICIAL
INSURANCE COVERAGE:
I have a curre liability insurance policy or its substantial equivalent, which meets the requirements of MGL
Ch.142. es No
If you have chec ed ves,pleas indicate the type coverage by checking the appropriate box.
A liability insurance policy!!// Other type of indemnity Bond
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage requiredby
Chapter 142 of the Mass. General Laws and that my signature o this permit application waives this requirement.
Check e:
Signature of Owner or Owner's Agent Owne Agent
h:homeownrlicexemp
•
• 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."
MOL chapter 152, §250(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 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-contractor(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 far 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
Boston, MA 02114-2017
Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax# 617-727-7749
Revised 02.23-1S vw w.mass.govfdia
g'Y TOWN OF YARMOUTH
'- _ ° BUILDING DEPARTMENT
o d=, • r $ 1146 Route 28,South Yarmouth,MA 02664
s53, ,.- 508-398-2231 ext. 1261 Fax 508-398-0836
•
•
BUILDING DEPARTMENT
DEMOLITION DEBRIS DISPOSAL AFFIDAVIT
Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 1113,
1 hereby certify that
/that the debris resulting from the proposed work/demolition to be
conducted at 1 LN
Work Address
Is to be disposed of at the following location: S an D J eed
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
C-----
-1 /2/31a
tgnatnre of Application Date
Permit No.
•
YARMOUTH WATER DIVISION
99 BUCK ISLAND ROAD
WEST YARMOUTH, MA 02673
PH.: 508.771.7921
FAX: 508-771-7998
BUILDING PERMIT APPLICATION
DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET
• Bldg. Site Location e/ea ftm fixes -
mso
Proposed Improvement: /2 'K ( y Dec 4 .G l PA%G-f WOG/S C
Applicant: J.-05p 'n�. h •
Address,oC>cvizArai a
Bn� �i�rr~ p,Ei06 Tel. #: 7T`��403 • Date Filed:
•
gyp_
peCoce.c &uc+i'ccn-p rl".-P.0 —
emaa.P t RESIDENTIAL AND / OR COMMERCIAL BUILDING
v,ater Department. Determ nes Compliance of Water Availability and or Ex sting Location
Engineering Department: Determines Compliance for Parking and Drainage
Conservation Commission: Determines Compliance to Wetlands Acts; i.e. If Lot(s)Border any Type o'
Wetlands,Streams, Ponds, Rivers, Ocean, Bogs, Bays, Marshland, Etc
Health Department; Determines Compliance to State and Town Regulations, I.e., Requirements
for Septage Disposal and other Public Health Activities
Fre Department: Determines Compliance to State and Town Requirements for Persona,
4 Sa'e'v Prcr,a4y Protn.',0.. . r. C•- D.'. . ..
Es
`I ‘ r, ' ,, .A..•- � ��Yr
a��
� "/},
PLEASE NOTE:
COMMENTS:
•i/ o
„ey
Reviewed by:Water DM Ion ate
01.:_x...1 its TOWN OF YARMOUTH
f i HEALTH DEPARTMENT
ate .,A
.
''���•�V PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed byApplicant:
(r,,�
Building Site Location: g 1 Cahn in t rotti In
r0 6.,%\.,Proposed Improvement: 12.1.1 V`
Applicant: 3oSe2 l• ?exist Tel.No.: / ! `1 924 /403
Address: 1717 00)5tl e ztot SOLI' DQnn I s Date Filed:9iy/I R
**Ifyou would like notification-mail nottncation of sign offaplease provide e-mail address:
e-
Owner Name: I`'O BUT Lent
/ / Q
Owner Address: 1G(4' 001 t-( )`itrrn0u� Owner Tel.No.: 50 �.(7630
RESIDENTIAL AND/OR COMMERCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e.,Requirements
For Septage Disposal and other Public Health Activities.
Please submit three (3) copies of plans, to include:
(1.) Site Plan showing existing buildings, water line location,
and septic system location;
(2.) Floor plan labeling ALL rooms within building
(all existing and proposed)—
Note:Floor plans not required for decks,sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
REVIEWED BY:_ `ZO2 G t'l � DATE: 9 4
PLEASE NOTE
COMMENTS/CONDITIONS:
•
. -
1... - —___. -- .- - - : r, • • e: : . Tk-Tt'il'f:/•4472,`,4 1F-?::;IfiYti,if;`.!'A!-tii-4-yti. F.;14E-47*
-•-f ar,-,1„i 72 7.,.'"Li..T;C.:1:.74 - 4.-'**4 ''''.-44 r;1. 4-4' 7" ,:,1,,;',,17. .',. c r,ci. I i,..t • %,•-..i, ,,,,,„, ,,p,,.-tr.,. "Y;1-5,;;An. ;;;24: i;tra_te
.'' N7:.;..",..t-A "-<-21-77 * A tt."IV L
. 1,-4-!--;/."„t-Pg',Fitt-ii.-I%-a•t,-4tr_ri,r,,i-- ,-...-.. i.krez
kit.ir . : .. r .P. r r• .2 ; ''.'e' t,.T.'7;4'r"..:r'r't'rr..•••r,' •..C.' .'•rj 'r ';'7, 7';a '7.;1 1:.7'•LI r‘11''•f':.-. et. '...,;._ 2.::.4. ''''.-. .1'1;:. St.;;--:'.. ',..: i' '.'eN:-;:-:-;2:1;,.E.:4":.t^ti.d.Elti--,tt,,* .,,-tr- ,-,..---4,,
.-..--._.2. .. .. . 4-44,44444.41440„-J4...-;445.,-444.4P*.‘,4".444„
1
CS'112 '.4 4'4h.2414'414-4t<4.44!-34.1„'"4!.14,4.44. 0.-.441:45thrti
,
L
'.**.;Sir k7a--;,--j1:;3.-.:-..L',.q4:'-::'" ;-`47V-ffnr,girler'CACA•cer;;e17:1;"
?L..1 - " ! -: 2..., ., '4',4:1;ittlebets4;1';4%,;,,;(.;;•:.tl',,L,A'A tl 'A:Al.-Tr'4.:. i.i: 1,71: t' - ...- I
. .
. . -• ; ,-,-;/;- l'f.:.. fi-'4.ettaatt-P.-'4.4 41 :4„.,L
'- J.-. --'-':/-r- -2,--14."(i',..C•*--."-• • riii-isfkcie irklIkIir- -,4.
I _
.1 - EF,i-i 17-'--COPF S-
.
, ....t1-_,,,,---:',,4-trk:dlIF,,,t
.
. . ' '4. - , '.#;„W7 4„.-J-..4-,..,‘-.-.i4......:4,-
2-,Af•],-;,,,:_;,k::::-;--,:: ., ..:.:', rr,,T.i;',;,,:-:..- ,-...,,.:4.x,i'+.1fr..„, ",:, 1•,6 TO111 : F&Ft I:II, :::,-,‘...,7,2;
,:::.,ti' .:Zr. - -, -,,,s;,-,.',C.;1
, .. .
•:::-. ,' , —.et. ''t'L I-.1 -.-;--*:- .<44 erli WELT:IELD C-IA e1f:J.17
, ,,.., Tk•-1* IF‘iito .".
i.i.,., ,.. .:i,, - r.,. ....;._i_ iir,,,.-4k.),,, ,,,,A.z.,f„cle2,„&iiiis,-;,itz;•:ri:k:rik;
•-•!;t:- • `„flitkficiis:-tt-s.:Nr-ttIk-3-,„-sitit-
,.r. ,-.. , ,. -., .. kki,„-. r ,,t,10‘,••r X.r. 0;;Thr;;Irra...Arcyerri.4Yrrrreter‹-••.: i
' • ,•-•-r•• •W i ,•,.. r, ',SE, ,;740,1, ' :4;
t-,-,44,..kt,...-,
7.-„-...7.:: •— :,... --.,..;. .,...1-;...r- ,.g _;i:,-.,----._,. e4^:;,_,Ifntt, r-.-
2.t. --'-':-"---- 4-'-''''.'1,1,"-.'•''r;iarritci- 4. -•er,I,'.',/-t-4.,.,-•
..1•4„tf,.---a/ ..--.7% , :,,.rera,E.,- .0,1-..,.„-t-t-a,-4,444,-...4-4-'v,c...-4.4.•,-;;=::-
7-4444-.:4 .'44.-74.4,-- - 4)i 444•14;44-44-w""s4.4-44-`:72-14.„-''
r444'- '': -44*444.4a44. a-3-1 ,,,,'tt tr4'...•-';..; .
, .
•
i ger:7,... CW &‘ i:,..".,14-Vakt ttc4i
.t _•
. ' ' ,,.........n.
"-v 0 i r-1 '''''"'" 4,-;:‘-'10.1?-i;C:=•-°._ 'Z't,;"1.+;:.6%,134.4.:'9' I.'-•'-<.1'7.- -"-•
= i - . s)ci:C"..te-",;;;->air* C' -eatc:39 St .1 7 -... --•
C.,.::, .:::1 t:.n.TY 2--..;'..:1'. 021131202D
._...! :- e: i.--.n....-..'q •., .ZS 4,44. r'' ^
- rz,v 4441'9th'41.47:4444‘ ..41.4444.1.,
-•4-''-era 4 4.-+.. .1*-4&=.4
-;4 -, - -.I..I; 247,14y-S4.44.7;4:w.,.44 .4,41-•,,....t.r-A:$4444.4`...:2'‘
,,
-t-...2,--1,:li....:,.-,:i.,4 h:----44:-",i-4.- .44:4'•`4,.‘• 4.- i;=.44;4-,41:1:44--) r•I:v."...C'rr.,..4. •
G't'd ilenti :;:-.;IMPROVEMENT;;t;:ilC1selI;:?irSI6C1 I 07 1 Te SF;:d-?(4.fl:
l'ii TC
; c
Cnt; 1411 i.e ;I:i%:#5.:4'.44;;;:';L:I If S.?.;AHT 4,4;Fit..1 1.::::5e:14:4:1 Latlii•Ci';'"st:1!:1E-1t
r,s
1,4-4. nr4: -41 1.
L: ',"P..r.'1..C.;, V.. --;.,‘,42,t'l 4.:I-Ittvitri.,----.1
• , ;Li::
IiaI-a;:.•-i-r,i'sf.t.t-2,t-III-4i-- ,k1ri.', Ii -',kJ,-k toctertk-I-kr tt‘t„-- iik I
Typo
Exn;rtInn
,..--.'f7.41-C.I.?.,7.,;41-,.--54.-tr.siiki ,•'..;< '. ..;1°-h z-...'.7",—,,,...-1"--r=.c- .. ___Fr Pistrati:2n
--- __—____ r, ,,..i•- •-:.:54-.1.F:"-.:1:Trig4F—marr-a rift,--------tsr. .-
2--__.-t-4--- =T.:9''1 ,==`,-1.-f- '74' -,.`'"..;:-..t--,-,t ... .
10'22 ;_li_ii:2 -I i:et:4;"'; '..e‘.../44'.
:t-a 4.11,.. ;:f 1:W=.-..--a-.7. ;,t,,:-..t,-,1-t 44::;4444;;‘,4.4e4„...;:4,t,F.L_.,4,.i.• - - 1 6 ti...... ..
4-44t4-r-tte-_-_ftv.zrf."
rk...kkiNkkr-Itkykrit...---tirt.t-ii-glbrac- --iiii .
_ „„_ ,,,,.,,,,,-.. tra7;:itcAgy7;:- I --
t7',:‘,;13: "...AVM.a.•*-4,. a... :
' 7 1••••-:::::ftT*::7,PX* , 4.:2,it3 CZ:in kk,, ,1;;•;,-•;.A. ..„:.
71t- FA Ar.:ti-C7*:7'17;"Z;Yr-il!CAAIZACV-Z-7-:;: ;.. ;;;;A;ki1A;h Ei..1., pecere
„,
t% I, . "e' v",:- -ica,..i.•,-.",,a-,. - , -. -,4, 3,-.,'s Hon, 9,in-iprov.eirterit ,.......:, ,._ ._:.„, ....2_ _. iil.-.7-5L'..,„4-_: ;_2..-;"--4..14-0-,ici:atrtr...44a."„..-iiiticire:5
D ri--1, - -
- - - :-. ,4----4,‘-v-si.r.:,,,,:!-,artAtrd,-.,:r-2-2,.., , ,,
,,.._,, .,_.-,
-j. i-,n.r-t-core
• ,___----
...'"-:-.
Linde'SECI7ta ';'': .}-1:7;46.','PrA:01;;;A:011;;V:, 717;_i.,;AirAntlY;;;4,taktt-;;;Atecf
!.1 de yt-,,,vin rcarrn Rd_ _
.
..-I- -atfJf-ya•h4.14:ti-4 -1, -,,,..„ .•-aIIr..-.•-.1.t14-i7tr,,FA:,-..
i,I,•••••,,,‘,.-at il4.4_,/,4:02"'-' ..ge•t-a-1".2;:i.`.:4",-VP,--.V.t.,4'attr-f
' -' ' . e.,•:f4•4144-414.1:‘;44444-4 4,-.1?1,'4'44[*4 4-'1,44." 4.4.4444 ‘ -4- . • '
' r‘taf...„"f,*-1,!:Tii-dtr,la: "•-,3,,C' raTti ..-2
1 k,t-..&-tki ,,,kk-tli.I.,44ili ki.,ktriki,-.-.iII‘trtzkriIzitit.erc,k,-,-Li.
- NI ;t4tt,::::"4:„ta4V:Urt;14 4‘ -;:-: 9-----1.f:id MA 01,....100
ig,h1.
.
' --rent" ''''2k:I'‘‘,eSC:t.-1.P.z.'tt •''-i';r4%.44.444.444...t.,44,444-46.ek.‘444.44,444.444.-
•A 444141•1:4j,4 4 4."k'r''''".'.4 It4lat tr?,'S'41/I,
t. ''- ,I.frti..):a •,•'?..kt<1/4.4.-'tts-ta'-,I,Vciti.,'It
.,.,......, -
•
•
•
i .
•
c , l ® DATE(MwDDIYYYY)
A`�o CERTIFICATE OF LIABILITY INSURANCE 0DATE(M018
THIS CERTIFICATE IS ISSUED AS A MA EP OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELYOR 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(les)must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED,subject to the teens 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
ANASTASI INSURANCE AGENCY,INC. PHONE
Ne.EMTI IMC.Nox
PO Box 1261 E-MAIL
Charlton City,MA 01508 ADORES&
INSURER(S)AFFORDING COVERAGE _ .__—_ NAIC a___
INSURER A: AmGUARD Insurance Company 42390
INSURED INSURER B:
JOSEPH PECORE
PECORE CONSTRUCTION INSURER C:
106 TOWN FARM RD INSURER o:
BROOKFIELD, MA 01506 INSURERE:
INSURER F: •
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY 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 POUCIE$.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR AODLSU R POLICY EFF POLICY EXP LIMITS
LTR TYPE OF INSURANCE AMID WV) POLICY NUMBER (MMIDD/YYYY) IMMIDDIYYYYI
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 0
DAMAGE l0 RENTED
CLAIMS-MADE ❑OCCUR PREMISES(Ea occurrence) $ Q-
-. ___ .____.. .�__ MEDEXP(Any one person) S. ___- _0_
_ PERSONA.&ADV INJURY S 0
GENL AGGREGATE UMW APPLIES PER GENERAL AGGREGATE S 0
POLICY D 128: 0 LOC PRODUCTS-COMP/OP AGO S Q_
•
OTHER S
AUTOMOBILE LIABILITY COMBINED SINGLE OMIT $
_ (Ea accident)
ANY AUTO BODILY INJURY(Pot pawn) S
OWNED —SCHEDULED BOOILY INJURY(Per aocklene S
AUTOS ONLY __ AUTOS -----•-
HIRED NOROWNEO PROPERTYOAMROE $
AUTOS ONLY AUTOS ONLY (Per wdEen0
S
( UMBRELLA UAB OCCUR EACH OCCURRENCE S •
EXCESS LIAR CLAIMS-MADE AGGREGATE S
DED RETENTIONS S
WORKERS COMPENSATIONPER DTH.
AND EMPLOYERS LIABILITY 'STATUTEER _-
ANYPROPRIETORIPARTNER/EXECUTIVE YINEL EACH ACCIDENT S 1,000,000
A OFFICER,NEMBEREXCLUDEDT YY NIA R2WC958203 04/21/2018 104/21/2019
(Mandatory In NH) EL DISEASE-PA EMPLOYEES 1,000,000
II yea,deembe antler
DESCRIPTION OF OPERA710N5 below EL.DISEASE-POLN:Y LIMIT I S 1,000,000
I 11
DESCRIPTION OF OPERATIONS LOCATIONSI VEHICLES(ACORO 101,AddRbnal Remarks Schedule.may be attached If mem pace Is rnqulmd)
I
Exclusions:
JOSEPH PECORE;
The workers compensation policy does no'provide coverage for JOSEPH PECORE
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Yarmouth Town Hall ACCORDANCE WITH THE POLICY PROVISIONS.
1146 Route 28
South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE ' '
I �LFiae. diJCJ.«�JQ
®1988.2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016103) The ACO RD name and logo are registered marks of ACORD
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 # 186353
Registrant JOSEPH E.H. PECORE
DBA JOE'S HOME IMPROVEMENT
Name JOHN PECORE
Address 106 TOWN FARM RD
City, State Zip BROOKFIELD, MA 01506
Expiration Date 10/30/2018
Complaints Details
No complaints found for this registrant 1
You can also view arbitration and Guaranty Fund history.
Back To Search
https://services.oca.state.ma.us/hic/licdetails.aspx?txtSearchLN=186353 9/10/2018
f!
./2,
16 Congiorl on 16. 0-C deck's G lir c C `` ��<
-� l-retie 0 7° Kerne 4 ' s"
S -�r5 SBeep L(`' iLatl,'ill `5 1944-5
'7 ` 4
TOWN OF YARMOUTH
t/15 REVIEWED FOR BUILDING AND ZONING CODE COMPU-
_ q ANCE. ERRORS OR OMMISSIONS DO NOT RELIEVE THE
ei'I/1 ae APPLICANT FROM THE RESPONSIBILITY 'AS BUILT'
��i� iin 3 C`� "7`t~t 1 COMPLIANCE
� lti iE-t8
r.
C` ,- BUILDING
K Ii ( 1 •
��n FILE COPY
F
Pr°
er w/2 ol�e��
II
•
N
• \/
-- . .._ _ _
t2� ; I r JOS - --_- .....__ . .._ _
e1t1 ► 4hIome
VI= II"
ti
I 1
IZ' Sono iaiieS H 0eeP
It e
t
Z( �2