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Home My WebLink AboutBLD-19-001883 • RECEIVED •Y'41ci 'Office Use Only � si„ e SEP 27 2018 PertniUl 0 ',Ishii 1.3 Amount d •� \n c•:. 'r BU el�, [t AlTMENT te"`"`a a'd' By: ' t'jr�l_ I Permit expires 180 days from issue date EXPRESS BUILDING PERMIT APPLICATION • TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth,MA 02664 y� (508)/398-2231 Ext. 1261 CONSTRUCTION ADDRESS: /J ,n/ettn t . sq S- Ve#//12.8-Pz.R) 19--, ASSESSOR'S INFORMATION: _ fit ' Map: g �y Parcel: n/ OWNER: Shu o4 .71 o A M ti p da tat). A ). Vey f,1W D`S So - G ? 2- ?z 7 2 NAME //n/J�� PRESENT ADDRESS TEL # CONTRACTOR:A04i(M Soma/yah 67 Seek p- /7/'�y0Rft4 j!/� col-7? 6. 290 0 NAME / MAILING ADDRESS / ' TEL# esidentiat 0 Commercial Est Cost of Construction$ f� ) It 0 Home Improvement Contractor Lie.# /1 3 2-e) 2 Construction Supervisor Lie.# /0 6/D 2. . Worktt)art'spompensation Insurance: (check one) am the homeowner 0 1 am the sole proprietor 0 I have Worker's Compensation Insurance Insurance Company Name: Worker's Comp.Policy# WORK TO BE PERFORMED Tent _ Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares 20 ( LIVecnove existing (max.2 layers) Insulation_ Old Kings Highway/Historic Dist. ( ) laReplacing�� '^ like for like Pool fencing 'The debris will be disposed of at 7a v yt'L(L(l_C r f Y / 'T Location of Facility I declare under penalties of perjury that the en ents 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 X' a I Date: /— Z O l or rev tion o'nti e se and.for pprosecution under M.O.L.Ch.268,Section I. (� ,S{ Applicant's Signature: / Owners Signature(or attachment) chment) VS_ Date: Approved By: - Date: re Brra (ordesi_ ce) EMAIL ADD:... Zoning District: Historical District: ❑ 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 The Commonwealth of Massachusetts Department of Industrial Accidents P .— I - Office of Investigations ivat l s -g— 4 600 Washington Street e ': =1 Boston,MA 02111 a`:•—"', wwts:mass.gor/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Rusioess'Orgmintiaa7ndividual): ofp VWI Ch cS 0z---nt r ya-h Address: ( 7 3e4, if City/StateiZip:jy eth4(5t hi/4 O2LD/ Phone it: $ -77‘•- 79'D 0 Are you an employer. Check the appropriate box: d. I amscontractor and I Type of project(required): 1.[4�I�am a employer with ❑ general 6. New construction employees(full and/or part-time).• have hired the subcontractor ❑ 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These verb-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurancecomp.insurance.: 9. 0 Building addition required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself.[No worker'comp. right of exemption per MOL 12.0.2161repairs insurance required]t e.152,§I(4),and we have no employees.[No workers' 13.0 Other comp.insurance required.] Any applicant that checks box el must also fill out the section below showing their worker'compensation policy Information I Homeowoes who submit this affidavit indicating they me doing all watt and then bite outside contractors est submit a new affidavit indicating such :Contract=that check this box must attached an additional sheet showing the an of the sub-counactors and ran whether or not those mitt base employees.Tithe cab contncton ham employees,they must provide their workers'comp.policy number. lam an employer that is providing workers'compensation insurance for my employees Delon is the polity and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address. City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby reu e s and penalties ofperjury that the information provided above is true and correct SiQuatnre• Date; 9 ? 7,1 $ Phone#: 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!rown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: 6 COREY & COREY " The Roofers " 67 SEA STREETAPT#A4, HYANNIS MA 02601 PHONE -508 -775-8240 CERTAI TEED LANDMARK LIFETIME - ALGAE RESISTANT ARCHITECTURAL STYLE RE - ROOFING PROPOSAL August 8,2018 STUART JOHN'S 8 JAMES ST. M: stugat@yahoo.com S.YARMOUTH,MA Fel: 508-694-7277 COREY & COREY hereby proposes toonn the following services in a neat and professional manner and in accordance with the manufac er's specifications and local building codes. Remove and Haul Away All of the Old Asphalt Roofing Shingles(One Layer)from the Whole House Only and Lead Flashing from the Chimney Supply and Install ALL NEW LEAD FLASHING ON THE ENTIRE CHIMNEY Supply and Install CERTAINTEED LANDMARK PRO: LIFETIME WARRANTY, 10 YEAR SURE START PRO CTION,CLASS A FIRE RATED, COPPER/CERAMIC STONES for a FULL YEAR WARRANTY AGAINST ALGAE CONTAMINENT,250,POUND,EXTRA HEAVY WEIGHT,130 MPH WIND WARRANTY,CATEGORY III HURRICANE,STORM/HURICANE NAILED (6 NAILS PER SHINGLE), MULTI-LAYERED,LAMINATED ARCHITECTURAL SE,FIBERGLASS BASED ASPHALT SHINGLES. COLOR: COBBLESTONE GRAY Supply and Install HICK'S VENTED DR P EDGE on All of the Eaves. Supply and Install 8"WHITE ALUMI DRIP EDGE on All of the Rake Boards. Supply and Install CERTAINTEED WI ER-GUARD (Ice & Water Shield)WATERPROOF UNDERLAYMENT S STEM on Roof Eaves&Valleys Under the Step Flashin y:,on the Skylights and Chimneys. Supply and Install CERTAINTEED'S"R I OF RUNNER"SYNTHETIC ROOFING PAPER Supply and Install AIR VENT SHINGLE NT II RIDGE VENT on the Entire Ridge. Supply and Install ALUMINUM& NEO'RENE SOIL PIPE FLASHINGS Clean and Remove Debris from work area er job is completed. TOTAL DIVES MENT $8,500.00 COREY & C " he Roofers " , POSSIBLE EXTRA CARPENTRY: Any R tied or Otherwise Deteriorated Trim Boards,Plywood Sheathing,Missing Metal Flashing,Side Willing or Any Other Carpentry Needing Replacement will be done and charged for as an Extra:Ma4erials Plus Labor at the Rate of$60.00 per Hour. PAYMENT SCHEDULE: A Deposit of OnHalf is due at the Signing of this Roof Proposal and the Final Payment for the Balance is Due Imme iately Upon Completion. WORK SCHEDULE: All Roof Work is SchLUled for Completion Within 60 Days of Acceptance and Deposits Received are Non-Refundable After a Three Day Cooling Off Period from the Date of signing. Please ake Checks Payable to: COR Y & COREY COREY & COREY Warranties the S gles and Labor for 10 years. CERTAINTEED Warranties the shingles and abor 100% for the First 10 Years and the Shingles your LI TIME if the shingles becomes defective. CERTAINTEED Warranties the Shingles up o a CATEGORY III HUCANE-130 MPH WIND WARRANTY. CERTAINTEED Warranties the Shingles to Algae Resistant for a Full 15 Years. COR Y & COREY carries Workman's Compensation and Public Liability Insurance on the above work DATE OF ACCEPTANCE: P- 10• 18- ACCEPTED - 1O. 18- ACCEPTED BY: SUBMITTED :Y: STUA JOHNIS AAI SAFAR AN HOMEOWNER COREY & COREY HIC # 183202 CSSL# 106102 SZ r�� / d am Office of Consumer Affairs and Business Regulation One Ashburton Place- Suite 1301 Boston, Massachusetts 02108 Home Improvemen _Cohtractor Registration `- = Type: Individual Registration: 183202 ARMEN SAFARYAN =7')roc- ' Expiration: 09/13/2019 • 67 SEA ST APT A4 == HYANNIS, MA 02601 -.3 „TAT • cncr " _ 0 141M f�see Update Address and return card. SCA 1 0 20M-0S/17 refimenememaceyedeafJein Mee of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:Individual before the expiration date. H found return to: Resists roFt�. Ezoirfdion Office of Consumer Affairs and Busine.- Regulation x183202 —_ Og(13/201 g 10 Park Plaza-Suite 517. Ia-i.__c•+�-.__if/0 Boston,MA 02118 ARMEN SAFARYAN;s_2i(,I 27 D/B/A COREY:AND COREY I ( I Off f ' TL ( . 'ARMEN SAFARYAN»=_Y 67 SEA ST APT A4-7, y i HYANNIS,MA 0260ii- ap - Undersecretary " Not valid without sr: ure Massachusetts Department of Public.Safsty. s\ U. Board of Building Regulations and Standards .License: CSSL-106102 Construction Supervisor Specialty ARMEN SAFARYAN 67 SEA STREET APT A4 ""�'� HYANNIS MA 02601 . • ''/2rcA L) �: tn.— • Expiration: 'Commissioner 10/02/2020 ' 4 A4 CERTIFICATE OF LIABILITY INSURANCE DATEMFJDDIYYYY) 09/132018 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 polloy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,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 Ashley Paiva NAME: Eastern Insurance Group PHO Ho (508)997-606t (AIC.No): (508)990.2731 439 State Rd. E-MAIL a aiva easteminsurance.com ADDRESS: P P.O.Box 79398 INSURER(S)AFFORDING COVERAGE NAM• North Dartmouth MA 02747 INSURER A: Arbella Protection Insurance 41360 INSURED INSURER B: Armen Safaryan INSURER C: DBA:Corey and Corey INSURER D: 67 Sea Street Unit A4 INSURER E: Hyannis MA 02601 INSURERF: COVERAGES CERTIFICATE NUMBER: 2018-2019 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. ITR TYPE OF INSURANCE IN5D ADDL BURR POLICY NUMBER POLICYEFF POLICY UP LIMTS INSD NIU (POUCYEFF (POLICYEYII X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE f 1,000,000 ®OCCUR DAMAGE TO RENTED 100,000 CLAICLAIMS-MADE PREMISES(Es TED lel S MED EXP(Any one penon) __ f 5.000 A _ 9520046441 04 09/18/2018 09/162019 PERSONAL SADV INJURY $ 1.000.000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE _ 2,00000 X POLICY JECT LOCPRODUCTS-COMP/OPAGG f 2,000,000 _ OTHER' f AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT f (Ea acddent) ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED BODILY INJURY(Pr aaYdent f AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE-- AUTOS AMAGEAUTOS ONLY _ AUTOS ONLY (Per accident _ S UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB I CLAIMS-MADE AGGREGATE f DED I RETENTION f _ f WORKERS COMPENSATION I PER %/IOTH- ANDEMPLOYERS'UABIUTY YIN STATUTE nI ER A ANYCER/MEMBER/PARTNER/EUECUTIVE ❑ NIA 9520046441 04 09/18/2018 09/182019 EL EACH ACCIDENT $ 1.000,000 (Mandatory In NH) EXCLUDED? 1,000,000 If ye.deso M E.L DISEASE-EA EMPLOYEE f If yee.describe Under 1,000,000 DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD/01,Addabne Remark,Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Display Purposes Only ACCORDANCE WITH THE POLICY PROVISIONS. 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