HomeMy WebLinkAboutBLD-19-001884 •
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Office Use Only
"rp C ?Permittt
atf C 27 216 -"
, SEP Amoun5 b
`;`-0�"+°'•'; .41
MINT Permit expires 180 days from
gUla.3. r'issue date
eY Et.D- 1G -Cbie-
EXPRESS BUILDING PERMIT APPLICATION
TOWN OF YARMOUTH
Yarmouth Building Department
1146 Route 28
• South Yarmouth,MA 02664
• L 1 (5508)3'98-223e1 Ext. 1261 /f/ 1� (� L
CONSTRUCTION ADDRESS: i / att.-1 z V 'yT'r,e-4• YQ({1tatCP 1 o it/ v / O
ASSESSOR'S INFORMATION:
Map: Parcel:
OWNER:Jrz–ed yof Cc. It Can -ev Cif" a,uacoM ro ' . spa- ego- 7w ?
NAME �yPREE^SENT ADDRESS 11,, TEL _
CONTRACTOR:j1 ' r . /i. of �/ Sea ) 7 . �• y '7 NNN I '03 -27 ` - zero 0
NAME 1 MAILING ADDRESS TELT
sidential ❑Commercial Est.Cost of Construction$ Qi 0 CJ J
rc
Home Improvement Contractor Lic.# / p 320 2 Construction Supervisor Lie.# / 0 Z
Workman's Compensation Insurance: (chneL one)
0 I am the homeowner tram the sole proprietor 0 I have Worker's Compensation Insurance
Insurance Company Name: Worker's Comp.PolicyN
WORK TO BE PERFORMED
Tent _ Duration (Fire Retardant Certificate attached?) Wood Stove
Siding: #of Squares Replacement windows:# Replacement doors: #
Roofing: #of Squares EC) ( L.). a hove existing*(max.2 layers) Insulation
Cid Kings Highway/Historic
�Dist.
,,(�,f)/-R pllaaccingg like for like Pool fencing
*The debris will be disposed of at: i a((A•.v_s^'T i, /y0
Location of Facility
I declare under penalties of perjury 1� the sta Alen - in co taine�d correct to the best of my knowledge and belief. I understand that any false answer(s)
will be just cause for denial or •, on of , ce e: • for. ..ec ti-n u r M.G.L.Ch.268,Section I. p �7
Applicant's Signature: , 1 . • , L Date: ( — 2 /-f —/
Owners Signature(or attaciment Date: �J
Approved By: Date:
j'd•ing p'iit(or designee) EMAI ' a DRESS:
Zoning District:
Historical District: 0 Yes 0 No Flood Plain Zone: 0 Yes 0 No
Water Resource Protection District: Within 100 ft.of Wetlands:
❑ Yes 0 No 0 Yes 0 No
•
The Commonwealth of Massachusetts
n�_= t Department ofIndustrial Accidents
Vl� Office of Investigations
— —, 600 Washington Street
t —t= Boston,DIA 02111
4, •�s� w ww.massgolldia
Workers' Compensation Insurance Afldasit:Builders/Contractors/Electricians/Plumbers
Applicant Information /f Please Print Legibly
Name Busmen'Organizatiaa'inaisiddua : air Wi v e 4 ry 6`in
Address: C t .004 T T aft• A I'1 1
City/State/Zip: 14 yet n f1 t'S , /`/f) o2401 Phone 4: Co B — 77 6 - 2 Q 67 0
Are you an employer?Check the appropriate box:
,..,, / 4. I am s general contractor and I Type of project(required):
1.Ly'i am a employer oath 0
employees(full at part-time)a have hired the sub-contractors 6. ❑New construction
listed on the attached sheet. 7. ❑Remodeling
2.❑ I am a sole proprietor or partner-
ship and have no employees These arab-contractors have 8. 0 Demolition
working for mem any capacity. employees and have workers'
[No workers'comp.insurance comp.insurance.: 9. ❑Building addition
rimed_] 5.❑ We area torp„sation 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 workers'comp. right of exemption per MGL �7�,
,nsurre required]t c. 152,§1(4),and we have no 12"�'—'"_ repa°s
an
employees.[No workers' 13.0 Other
comp.insurance required.]
'Any applicant that checks box#I must also all out the rection below showing their rakers'compensation policy information
I Homeowners who submit this affidavit indicating they m doing all work and than baa outside contractors most submit a new affidavit indicating such.
:Contractors that check this box mug attached an additional sheet showing the name of the sub-conmcto s and state whea,a a not those entities have
employees. lithe mbKOntractm have employees,they must provide their wakes'comp.policy number.
I am an employer that is pro iding workers'compensation insurance for my employees Below 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 S 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 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA f coverage verification.
l do hereby cern)"in/er t 'n and penalti ofperjuvy that the information prodded above is true and correct
Signature.rd,...;;
� . Date- 7—7 7—/
Phare tt: ////SO% - 77 - 220
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.Citytrown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other •
Contact Person: Phone#:
6
•
. -/MelzdI62eC✓S, , 4
Office of Consumer Affairs and Business Regulation
One Ashburton Place- Suite 1301
Boston, Massachusetts 02108
Home Improvement_Coljtractor Registration
/ Type: Individual
Registration: 183202
ARMEN SAFARYAN i� r Expiration: os/13/2019
67 SEA ST APT A4 =f
HYANNIS, MA 02601
a te-
ve��a
r - Update Address and return card.
SCA 1 0 20M-05/17
•
S FAM,nonmreadee tieauadtGJa/t
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
TYPE:Individual before the expiration date. if found return to:
Office of Consumer Affairs and Busine?- Regulation
Reaistratron- Est/Ireton I
1 . ,-09/13/2019
10 Park Plaza-Suite 517
(�,_—}r.__yyd Boston,MA 02116
ARMEN SAFMYAN i, I
D/B/A COREYAI'ID COREY)... ( tiff
ARMEN SAFARYAN i=a`
67 SEA ST APT A4,_.,: j' aA
HYANNIS,MA 0260;01>" Udersecretary Not valid without w n Ture
Massachusetts Department of Public.Safety.
�• Board of Building Regulations and Standards
.License: CSSL-106102
Construction Supervisor Specialty
ARMEN SAFARYAN
67 SEA STREET APT A4..z.., ,
HYANNIS MA 02601
•
•
</trSG/ �%,T! a• Expiration:
'Commissioner 10102/2020 •
.x,
•
•
COREY v , COREY
" The Roofers "
67 SEA STREET APT#A4, HYANNIS MA 02601
PHONE -508 -775-0240
CERTAI TEED LANDMARK
LIFETIME ALGAE RESISTANT
ARCHI ECTURAL STYLE
RE - ROOFING PROPOSAL
June 16,2018
JACK JOYCE
14 CENTER STREET EM:jackjj98@hotmail.com
YARMOUTH PORT,MA Tel: 508-280-7102
COREY & COREY hereby proposes to p rform the following services in a neat and professional
manner and in accordance with the manufac 's specifications and local building codes.
Remove and Haul Away All of the Old Asph It Roofing Shingles(One Layer)from the Whole House.
Supply and Install CERTAINTEED LAN MARK AR: LIFETIME WARRANTY, 10 YEAR SURE
START PROTECTIO , CLASS A FIRE RATED, COPPER/ CERAMIC
STONES for a FULL 1 YEAR WARRANTY AGAINST ALGAE
CONTAMINENT,240 OUND,EXTRA HEAVY WEIGHT, 130 MPH WIND
WARRANTY,CATEG RY HI HURRICANE.STORM/HURICANE NAILED
6 NAILS PER SHINGLE MULTI-LAYERED,LAMINATED
ARCHITEC ' • S YLE,FIBERG ASS BASED ASPHALT SHINGLES.
COLOR: - ic, kis a a
Supply and Install 8"WHITE ALUMINU DRIP EDGE on All of the Eaves and Rakes.
Supply and Install CERTAINTEED ER-GUARD (Ice& Water Shield)WATERPROOF
UNDERLAYMENT S (S_TEM on the Entire Roof Surface
Supply and Install AIR VENT SHINGLE VENT H RIDGE VENT on the Entire Ridge.
Supply and Install ALUMINUM&NEOP NE SOIL PIPE FLASHINGS
Clean and Remove Debris from work area er job is completed.
TOTAL INVES MENT --- $9,000.00
CORE & CO ? EY
" T e Roofers "
OPTIONAL ADDITIONAL RECOMMEN 1 ED WORK:
Supply and Install 3/S CDX PLYWOOD 0 DR THE EXISTING ROOF BOARDS ON TWO STORY
ROOF SECTION ONLY $3,000.00
POSSIBLE EXTRA CARPENTRY: Any Ro ted or Otherwise Deteriorated Trim Boards,Plywood
Sheathing,Missing Metal Flashing,Side Wailing or Any Other Carpentry Needing Replacement
will be done and charged for as an Extra: Matdrials Plus Labor at the Rate of S 60.00 per Hour.
TO REMOVE EACH ADDITIONAL LAYE OF SHINGLES WILL BE EXTRA$75.00 PER
SQUARE.
PAYMENT SCHEDULE: A Deposit of One alf is due at the Signing of this Roof Proposal and the
Final Payment for the Balance is Due Immed ately Upon Completion.
WORK SCHEDULE: All Roof Work is Sche uled for Completion Within 90 Days of Acceptance and
Deposits Received are Non-Refundable After a Three Day Cooling Off Period from the Date of signing.
Please M ke Checks Payable to:
COREY & COREY
COREY & COREY Warranties the Shingles and Labor for 5 years.
CERTAINTEED Warranties the shingles and 1 bor 100% for the First 10 Years
and the Shingles your LIFE if the shingles becomes defective.
CERTAINTEED Warranties the Shingles up t a
CATEGORY III HUR CANE-130 MPH WIND WARRANTY.
CERTAINTEED Warranties the Shingles to be Algae Resistant for a Full 10 Years.
COR Y & COREY
carries Workman's C:mp; sation d Public Liability Insurance on the above work
DATE OF ACCEPTANCE: I I
ACCEPTED BY: SUBMITTED BY:
OF JAC4pO YS ARMEN SAFARYAN
HO •WNER COREY & COREY
HIC # 183202
CSSL# 106102
4
s►CCPRO° CERTIFICATE OF LIABILITY INSURANCE DA`E`MMOOff""'
09/132018
This CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOTAFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES
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 polioy(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 PHONE Fm, (508)997-6061 I No): (508)990.2731
439 State Rd. E-MAIL a aiva easteminsurance.com
ADDRESS: P
P.O.Box 79398 INSURERS)AFFORDING COVERAGE NAIL•
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 INSURER F:
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.
INSR TYPE OF INSURANCE 1150 W R POLICY NUMBER POLICY EFF POLICY LINTS
INSO WS (POLICY EFF PPOLICYYYPI
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000
DAMAGE TO RENTED 100,000
CLAIMS-MADE OCCUR PREMISES(Ea occurrence) _ S
MED EXP(Any one person) S 5,000 _
A 952004844104 09/18/2018 09/18/2019
PERSONAL 8.ADV INJURY f 1,000,000
GENL.AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2.000.000
X POLICY ❑JECT ❑LOCPRODUCTS-COMP/OP AGO $ 2,000,000
OTHER: S
AUTOMOBILE UABIUTY COMBINED SINGLE LIMIT $
_ (Ea ecadenn
ANY AUTO BODILY INJURY(Per parson) f
OWNED SCHEDULED
AUTOS ONLY AUTOS BODILY INJURY(Par accident) f
HIRED NON-OWNED PROPERTY DAMAGE s
_ AUTOS ONLY _ AUTOS ONLY (Per eaident)
f
UMBRELLA LIAB OCCUR EACH OCCURRENCE
EXCESS LIAB CLAIMS-MADE AGGREGATE S
DED I RETENTION S S
WORKERS COMPENSATION PER OTH-
AND EMPLOYERW LIABILITY STATUTE /V ER
A ANY PROPRIETOR/PARTNER/EXECUTIVEY❑ N 9520048441 04 091182018 09/18/2019 ELEACH ACCIDENT $ 1,000.000
OFFICER/MEMBER EXCLUDED? 1,000,000
(Mandatory In NH) E L DISEASE•EA EMPLOYEE f
N yes,desaRm under 1.000,000
DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICYLIMIT S
•
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD tat,Addmomal Remarks SeSduls,may M attached X more spam 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.
AUTHORIZED REPRESENTATIVE
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