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HomeMy WebLinkAboutBLD-19-002022 •• eltc4! /05/6 ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department of "r 1146 Route 28,South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 �M,' • '. Thtt Massachusetts State Building Code,780 CMR Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling RECEIVED This Section For Official Use Only Building Permit Number: -87,7)—/9 C0[1022...1late A U T 040181 cQA I•s .. 9m:2' k. . BUILDING DEPARTMENT Building Official(Print Name) Signature,,.., SECTION 1:SITE INFORMATION • APv rUAe�dndr , 6mo•ftarteao 1.B2 Al sofsessrors Map&Parcel Numbers 0 33 I.1 a Is Jan 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 c.40,§54) 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 2: PROPERTY OWNERSIIIP1. 2. Owners of Re An�t/a e4 id CO( Neecd'ham, nen- Oawe ) — Name( mt City,State,ZIP 8 Wstn$ " — ` I lBI -$o -oGct arcplarncox@ Ver No.and Street Telephone Email Address SECTION 3:.DESCRIPTION OF PROPOSED WORK2(check all that apply) ' • New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify: Brief Description of Proposed Work'': / . /M a •i . I x . / meq • 40. A t .a AJ c _ ' a i • I. SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: official'use Only (Labor and Materials) 1.Building $ :d Building Permit Fee:'$.I Sf7.. Indicate how fee is determined: 2.Electrical $ al Standard Cityffown Application Fee ❑Total Project Costs gcm 6)x multiplier x • 3.Plumbing $ 2: Other Fees: $ J 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire Suppression) $ Total All Fees $ 1� ' A CheckNo • Check Amount Cash Amount ' '7 6.Total Project Cost: $ / 334"OD ❑Paid in Full. . . . 119 Outstanding Balance Due: I tSECTION 5:.CONSTRUCTION SERVICES 5.1 Construction Supervisor ,License e((CSL) CS — 00786 c Wog 12,0 Name John R• �J License_ Number OJ Expiration ate Name of CSL Holder , U /\ ? ort 'pre MC List CSL Type(see below) r- No. dStreet • Type . .• Description C� YF U Unrestricted(Buildings up to 35,000 Cu.ft.) City(1•o State ZI s O R Restricted I&2 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) C' Cod (;u -kres 9�2on a—e 6 y. Hip° pan rame or trant Name HIC Registration Number pua a Daze , c Jo( u `� � c tq u�krs 92 @ tins. 3 s— a-P� "� ' i 0 _n V4 ,. .�l n : 'r0 mail address C,Yyytai' Lon City/Town, State,ZIP / Telephone t (J ' 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 ❑ No...........❑ • SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHFN r 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. Ai&,`o•Ictto Cox 1oloti18 • Print Owner'SWLme(Electronic Signature) D e • SECTION 7b: OWNER'.OR AUTHORIZED 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. X 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)Program),will not have access to the arbitration program or guaranty fund under M.G.L. c. 142A.Other important information on the HIC Program can be found at www.mass.eov/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 bathrooms Number of halfbaths 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 Commonwealth of Massachusetts IE`'-fi Department of IndustrialAccidents -�i[l= 3 1 Congress Street,Suite 100 -.7,140._—=8' Boston, MA 02114-2017 ''..'cit-,17,14- 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): 00 l _Q4 ( 9od:f-Cc1 Inc . Address: I?. 0. /, sip p City/State/Zip: Al Yarn/DU-4A- /31k Phone#: 3/5"-- '8s - istpio Are you an employer?Check the appropriate box: Type of project(required): p7.511\am a employer with employees(MI and/or part-time).* 7. 0 New construction 2.01 ant a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 3. I am a homeowner doing all work elf o workers'comp. 9. Demolition ❑ g myself[N insurance required.]? 10 0 Building addition em a homeowner and will be hiring contactors to conduct all work on my property. 1 will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions propnelnrs 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 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§I(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 contractors must submit a new affidavit 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 ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.L^^ 'S ic._#: Expiration Date: Job Site Address: txCity/State/Zip: a.,/armoU-ikt MA Attach a copy of the worke ' compensation policy declaration 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 cer '1 under t e .ains and penalties of perjury that the information provided_ab ye is true and correct nature: //w- P 3' i Date: /// 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): I.Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ° r o TOWN OF YARMOUTH vg c BUILDING DEPARTMENT , - ,x 1 146 Route 28,South Yarmouth,MA 02664 �? 508-398-2231 ext. 1261 Fax 508-398-0836 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.GL Chapter 40,Section 54 and 780 CMR, Chapter 1, Section 1115, I hereby certify that the debris resulting from the proposedoswork/demolition to be '' conducted at of $�� { j Rd. CSD, yvrnoa* , . W Address Is to be disposed of at the following Iocatio nom. Y4"1044 34hSF(? 5/41;') Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter I11, Section 150A. I, .ture of Application Date Permit No. • • • Ae1 EP CERTIFICATE OF LIABILITY INSURANCE I DA'E`MWD°r 10/0212018 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(les)must have ADDITIONAL INSURED provisions or bs endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement cn this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER Compnet Insurance Solutions CONTACT David Bedard 91 Clemenee Street PHON8 508397-7906508-730-6580 Providence RI 02903 (AIC.Na Exth I iaAXc.Nor. EDW LSa: dbedard©compnet-Insurance.com INSURER(S)AFFORDING COVERAGE NAIC e INSURER AI HARTFORD UNDERWRITERS INS CO INSURED Cape Cod Gutters INSURER B: POBox 571 West Yarmouth MA 02673 INSURER CT INSURER D INSURER E; INSURER P; 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 POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. WM— — AD'''OOOQQQTTTTTTTT{TT{SU - POLICY EFF POILILW/P �- LTR TYPE OF INSURANCE NaDtriNQ POLICY NUMBER IMM/DDIYYYTI IMMIPDIYVYYI NEMS COMMERCIAL GENERAL LIABILITY ,u'I EACH OCCURRENCE $ ICLANS-MADE O OCCUR DAMAGtTORERTE6— PREMISE$.gap urrgoce).._ $__„ — MEDEXP(Any one mem) $ PERSONAL S AOV INJURY $ — �GGEETN1.AGGREGATEUNITAPPLIESPER: GENERAL AGGREGATE 5 H _ POLICY EiESC ID LOC PRODUCTS-COMP/OP AGO 5 OTHER: � �i't � i AUTOMOBILELIABaU 1rY �l COMBINED SINGLE LIMIT $ Ms Evident) ANY AUTO BODILY INJURY(Per person) $ OWNED — SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per 5 HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Ass accident) S u 1J5 — UMBRELLA LAB OCCUR EACHOCDURRENCE I 5 EXCESS UAB CLAIMS-MADE AGGREGATE $ — DED I I RETENTIONS 5 WORKERS COMPENSATION AND EMPLOYERS LIABIIJTY I STATUTE I I ER ANYPROPRIEORMARTNENEXEcvnvE /N 1K492132 07/18/2018 07/18/2019 EL EACH ACCIDENT $1,000,000 OFFICERIMEMBEREXCLUDEDT N NlA _ peandHery in NH) E.L DISEASE-EA EMPLOYEE 51,606,606 IT yn,&waft under (DESCRIPTION OF OPERATIONS below ) n , Et DISEASE-POLICYLIMR i 1,000,000 JRCI^I�'I` DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,AddHI,wl Renurb SdwdWP,may be asaehed M mon apace le M1qulrsI Installation and cleaning of outdoor gutters • • CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Angela Cox THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED Ih 2 Sqaunto Rd ACCORDANCE WITH THE POLICY PROVISIONS. 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CERTIFICATE OF LIABILITY INSURANCE • DATE(MMIDDIYYYY) • 10/01/2018 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 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 NAME: Dowling&O'Neil insurance Agy PHONE 508 775-1620 FAX 5087781218 WC,No,Exp: (AIC,No): 973 lyannough Road E-MAIL P.O.BOX 1990 ADDRESS: Hyannis,MA 02601 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:NOM nem..»C.^WY 14788 INSURED INSURER B: Cape Cod Gutters Inc. INSURER C: P.O.Box 571 West Yarmouth,MA 02673 INSURER D: INSURER E: 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 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. LTR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LIMITS JNSR WVD POLICY NUMBER (MMIDDIYYY't) (MMIDONYYY) A GENERALLIABILIY MPP48O1H • 06/1212018 06/1212019 EEpAAqCCL1H��OEECCCT��UR��RENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES(EaEONcMOnce) 1500,000 CLAIMS-MADE n OCCUR MED EXP(My one person) $10,000 _ PERSONAL ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN?.AGGREGTE LIMIT APPLIESLII PER: PRODUCTS•COMP/OPAGG s2,000,000 I POLICY FTI( jE r- A LOC •$ •' AUTOMOBILE LIABIUTY COMBINED SINGLE LIMIT (Ea accident) $ _ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per acUdenp $ AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS $ AUTOS (Per acddenP I UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE _ AGGREGATE $ DED RETENTIONS $ WORKERS COMPENSATION NCSTATU• OTH- AND EMPLOYERS'LIABILITYTORY LIMITS ER ANY PROPRIETORIPARTNERIEXECUTIVEYIN E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes describe under DESCRIPTION OF OPERATIONSbelaw E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is requlred) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained In the certificate of Insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION Angela Cox SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 9THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2 Squanto Road ACCORDANCE WITH THE POLICY PROVISIONS. South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE _ Prime, e. 7 C.. - C 1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD 85219973/M219972 LS1 Cape Cod Gutters PROPOSAL Dave Franklin P.O Box 571 West Yarmouth,MA 02673 Phone(315)985-5440 Customer Job Location Name Angela 2 Sgaunto Rd Address 8 Whiting Way South Yarmouth City Needham REVISED ON 9/25/18 Line 1- * Install new Thermal Tru doors on the front of house and a steal door on back storage area. *Install a 6'Harveys sliding patio door where the four windows are on back porch area w/grids and screen *Frame in existing door on back porch and make into double window w/grids *Full view storm door w/screen to be install on front of house. Remove existing steps. *Finish off walls where we are going to frame window and door w/Beadboard paneling. Line 2- *Install all new windows in the house w/new construction style Harveys replacement windows all windows will have grids.Exterior will be re trimmed out in Azek vinyl board. Line 3- *All Exterior Fascia's,Soffits,freeze boards are to be re trimmed out in Azek vinyl board. Also,all Gable trim and corners are to be re trimmed out in Azek vinyl boards. Line 4- *Install all new.032 gage white seamless gutters and new down spouts on whole house front and back.We will be installing leaf guards in all gutters. Line 5- *Triple window in the front will he staying hut we will get new sashes with the grids and install. *There will be small plat forms built to step into back doors. * Build a cover for back crawl space entrance. *Install new lights on front and move back light. Line 6- All work will be performed in a timely manner property will be kept clean of debris. All workmanship and materials will have a 20-year warranty. Start Date-10/8/18 Approximately Sub Total-$41,334.00 Deposit-$14,050.00 Balance due upon completion job-$27,284.00 Date- 9 2-9 j lasao- Customer Date 9/24/18 Dave Franklin Data?lade& An je14 Co o! Stauht'o gcl S yarw,okt-ii 15_1..t. . optn;K IA tb V w &iclows .._owl Swacher K we • 31 i • • , 4% . , 1 a V `. c' TOWN OF YARMOUTH i REVIEWED FOR BUILDING AND ZONING CODE COMPLI- 'ti ANCE. ERRORS OR OMMISSIONS DO NOT RELIEVE THE APPLICANT FROM THE RESPONSIBILITY OF'AS BUILT' COMPLIANCE. DATE: (0"C-11 .6, r BUILDING 0 I V eeu�L 6P�e„i�s 73 "X 6bf y r P44-ic ELYt TAII USE. txis r- AXi Flkis FILE COPY • gk..t stuns N Nif :..\/ . ,. 1 .. Pell�7d1„/. i Cape C®d' (Outten Cell 315-985-5440 CapeCodGutters92@gmail.com CapeCodSeamlessGutters.com - id 7.o• :„ � � ta. a Ea 774470.5871