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Home My WebLink AboutBLD-19-2495 -71/te .� 41 ��l7l1.I O ONE & TWO FAMILY ONLY-BUILDING PERMIT Town of Yarmouth Building Department 1146 Route 28, South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 Massachusetts State Building Code,780 CMR Building Permit Application To Construct,Repair, Renovate Or Demolish _ a One-or Two-Family Dwelling . This Section For .fficial � e Only _ :uildingP• Number:rpla'/9-�ac'9ct Date Applie ea.,/ dt/®� 4. g'/or Building Official(Print Name) '_ . .. . Sign e1%�� Date SECTION I:SITE INFORMATION, `.. 1.1 Przrfr� es, s: 4-cm �O4d to 1.1a Is this1.2 Assessors Map&Parcel Numbers `an accepteedd 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.O.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private❑ Zone: _ Outside Flood Zone? Municipal Cl On site disposal system ❑ Check if yes❑ SECTION 2f. PROPERTY OWNERSHIP' Owner'2.1 r'of�ecoid: 1 Ovine. � ''1)ord: O(.t J . VO Q'MCxt'-h , ma Name(Print) City,State,ZIP 3S 'Pot.t*l'n-4an (Rrr),Ck No.and Street Telephone Email Address SECTION 3:.DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied 0 Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition 0 Accessory Bldg.0 Number of Units_ Other ,j3 Specify: (Q b Brief Description of Proposed Work'': c412:: P —2 • SECTION 4:ESTIMATED CONSTRVCTIQN COSTS • Item Estimated Costs: Official i7se Only' ;` (Labor and Materials) 4 1.Building $ -7 1.•Building Permit Fee,$ Indicate how fee is determine& 2.Electrical $ CI Standard Cityfrown Application Fee ❑Total Project Cost3 aem multtpher x 3.Plumbing $ 2. Other Fees. $ n. 4.Mechanical (HVAC) $ Ltst: 5.Mechanical (Fire Suppression) $ Total All Fees $ Check No." Check Amount Cast l oEt: IVED 6.Total Project Cost: $ '3 000• ❑Paid imFull ❑Outstanding Balance Du , OCT • l i _ SECTION 5: CONSTRUCTION SERVICES . ' 5.1/�ConstructionSupervisor License(CSL) ) 69094 -1- y-let. 1. nu-6 Co nt\ QLs - . . /t t o , 7 License Number Expiration Date Name of CSL Holder Q...s 9 4E.y v F__ -1-C S� List CSL Type(see below) No.and Street G Type Description Neo ✓1 _ aft'OC(�f Ona U Unrestricted(Buildings up to 35,000 cu.ft.)City/fawn,State,ZIP R Restricted l&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding _ . SF Solid Fuel Bunting Appliances I Insulation Telephone Email address D Demolition 5. Registered Home Impproveement Contractor(HIC) S-46 3-21-lb pciAn ` eIrp_`Y at*t Oi HIC Registration Number Expiration Date HIdCq panyt_Q oflcSgistrantj3�oie 1 ett _ t t� `„ 1-JI-- '�" Email address UCittyt/Town,State,ZIP ((A Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.0 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 WHEN OWNER'S AGENT OR CONTRACTORAPPLIES FOR BUILDING PERMIT l I,as Owner of the subject property,hereby authorize tLk1t) ConSA-Que Vt a to act o y behalf,in all matters relative to work authorized by this building permit application. )6- 15- i r P ' wner's e(Electronic Signature) Date • • SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By enterin_my name below,I hereby attest under the pains and penalties of perjury that all of the information d?coni'' . this ..p •cis true and accurate to the best of my knowledge and understanding. lb_Is_1 F- P P '. t e •er's or .71orized 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.gov/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 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" oF'Ygkr TOWN OF YARMOUTH r. e O BUILDING DEPARTMENT N. N ''¢ $ 1146 Route 28,South Yarmouth,MA 02664 fs 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 111.5, I hereby certify that the rdeebris resulting from the proposed work/demolition to be conducted at 3 d re W h aria n '1Z to- 1 Work Address Is to be disposed of at the following location: ckk to d F t4 1-6 12-J (Odie Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. 76- 5- / g' gnature of Application Date Permit No. The Commonwealth of/Massachusetts t =�/ Department of Industrial Accidents "Sl� iii=M 1 Congress Street,Suite 100 �, {{=sq Boston,MA 02114-2017 ?I-47fwww massgov/dice Y-H1 Workers'Compensation FWITH Builders/Contractors/Electricians/Plumbers. TO BE FILED THE PERMITTING Please Print Le, bl A. .'leant Information Name (Business/Organization/Individual): \ Address: - City/State/Zip ') \ 8 IAC+ 70r2pne#: �eC - `COQ — L111 j LL_ Are you eo employer?Check the appropriate box: Type of project P (required): I.54arn a employer with em IOYe es fill and/or part-time).r 7. ❑New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in S. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 30 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 0 Building addition 4.1:II am a homeowner and will be hiring contractors to conduct all work on my property. I will 11.0 Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole 12.❑Plumbing repairs or additions proprietors with no employees. 3 Roof repairs 5.0 1 am a general contractor and I have hired the sub-contractors listed listed on the attached sheet .,LTJ'" These sub-contractors have employees and have workers'comp.insurance.: 14. Other ____-- 6.0 We area corporation and its officers have exercised their right of exemption per Met e. 152,§1(4),and we have no employees.[No workers'comp.insurance required_] kers'compensation policy n. 1 H0 applicant ownsoo checksmibox#1 aad fill out the iresection doing showing their work and then hire outside contractors must submit new affidavit indicating such. r Hotracwnen who this this mutaffidavit indicatingch diti' B name :Contractors that check this box must attached an additional sheet vshowing de them of the Po�nnramrber.and state whether o not those entities eve employees. If the sub-contractors have employ,they must P to employees. Below is the policy and Job siteI am an employer that is providing workers'compensation insurance for my emp y information. Insurance Company Name: , C- ' - ( - A q C• (�y F�1 2� . Ct3 Expiration Date: I -791 - I . Policy#or Self-ins.Lic.#: �^ Job Site Address: • • S. . tot t1 �- -- CiTy/State/Zip: VC? Y�C7 1LA� r t i n% Attach a copy of the workers' 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 againstthe violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certtfye .ains nd penalties of perjury that the information provided above is true and correct � .1 Date. 0— I5—Ii Si afore • 'hone#: • Official use only. Do not write in this area,to be completed by city or town official Permit/License# City or Town: Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone#: Contact Person: Page 1 of 13 1. 24 Ernest Street — New Bedford,MA 02745 (.7.=-7-"( - " Phone Number 508-509-4414 Fax Number 508-858-5048 CONS iIJCTiON; Email: info@coutoconsh-uction.com Customer Information Julie DeCoteau (774)216-1554 Date: 09/28/2018 38 Powhatan Rd julieadecoteau@yahoo.com Rep: Mathew Franco S Yarmouth MA 02664 Locations INCLUDED in scope of work to be performed All roofing portions Locations EXCLUDED in scope of work to be performed Shed in back Job Specifications Tear off up to 2 layers of existing roof system consisting of: Asphalt Roofing Package Standard Package Shingle Color Oxfpr�Grey Customer Initials ( WJ Repair and replace as necessary up to 64 LF/SQ ft.of decking consisting of Plywood CDX Install Drip Edge Install F8 drip edge to perimeter of roof surface Drip Edge Color White Ice and Water Shield: Install Ice and Water Shield along first coarse and penetrations Install Underlayment Install Standard Felt Underlayment to remainder of rood deck surface. Starter Strip Type Install standard starter Install New Shingle Style Tamko Install Ridge Vent attic ventilation system on all required areas (Length) 29 Ridge Vent Style Install Standard Ridge Exhaust Vent Hip and Ridge Cap Install Standard Hip and Ridge Caps at all pertaining hips and ridges Install Chimney Flashing (roof surface meets chimney) in all applicable areas. 1 Install Apron (horizontal) Flashing in all applicable areas. No Install Step (diagonal) Flashing in all applicable areas. No Warranties 30 Year Manufacturer Warranty With a 5 Year Workmanship Warranty Permitting Included \ \ \ N \ N 03 \, \, \ \ • \ \ , , \ \ \ . \\:: N\ NI \ , \ ?..\ \ \ \ \ \ a. . , , \ , I\ N ‘, \ ' ‘.. , \ •\ \\ , ' ;\\ \ N \ NI ce N3 ID 0 E als;" -1 allak CO ' lb \\N\ l \ \\\ \\\\\N \ N ' • \\\C\1>\: * \ \\\\ \ \NC\ \\\\ • \ \ N.• \ , 0 \ \ /4i„ / i/ �e>/`'(GGGJLtiCZ�C%6�2t%lf%7/L(I' �/• Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Type: Supplement Card Registration: 165756 COUTO CONSTRUCTION INC. Expiration: 03/21/2020 24 ERNEST ST. NEW BEDFORD.MA 02745 Update Address and Return Card. SCA 1 A 20M-0-05/11 �.// ( e monnommtea ��s 1Q4'[94J¢d//fett$ Office of Consumer Affairs 8 Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:Suoolement Card before the expiration date. If found return to: peaistratIon. pxoiration Office of Consumer Affairs and Business Regulation 165756:= --: 03/21/2020 One Ashburton Place-Suite 1301 COUTO CONSTRUCTION INC. Boston,MA 00022211/0088 DEREK COUTO ft,.0 -• moi% 24 ERNEST ST. Not valid wi 51 r18ture NEW BEDFORD,MA 02745 Undersecretary 9 Massachusetts Department of Public Safety '•®+ Board of Building Regulations and Standards • License: CS-109099 Construction Supervisor s `� DEREK O COUTO 19 HIGH KILL ROAD id,'tray'r DARTMOUTH MA 02747 14 ea: Commissioner Expiration: ` • 07/04/2019 • • ��® CERTIFICATE OF LIABILITY INSURANCE 1 onlMMeoIYYYn 03/28/2018 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(les)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(he certificate holder In lieu of such endorsement(s). PRODUCER CONTANAr OT Lisa Souza • BRANCO GARDNER INSURANCE MPNIOONr;nib (608)9007367 In.,: UMAIL Eae A : aDDRxme Ilaaggbrancogardnedneurance.com 48 STATE RD _ IN5WER(S)AFFORDING COVERAGE NAM/ N DARTMOUTH MA 02741INSURER At ACE AMERICAN INSURANCE CO I 22887 INSURED INSURER a: COUTO CONSTRUCTION INC HSUNERCI ' INMU1ER D I 23 ERNEST ST INSI MIAs, - NEW BEDFORD MA 02745 INSURER FL COVERAGES CERTIFICATE NUMBER: 260868 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED 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 ETR - TYPE OF INSURANCE AWED mR POLICY HUMBER POIaY POLICY►MWn - UMW COMMERCIAL GENERAL LIABILITY EAOTOOCUIRENCE a DAMAGE TO/IRMO I CWMS-MADE 0O«UR PREMISES EEeocOmRRN $ MED EXP(Any en mon) S N/A PERSONAL►ADVINJURY S OEM.- AGGREGATE pUMA�UAPPLIES PER OPERA.AGGREGATE $ RI POLICY O JECT ElLOC PRCOUCTS-COMP/OP AGO S —II O a L rtU SU:L!UNIT $AUT01aMLE WeI1LITY IEA IodeNRl ANY AUTO BOOIIY tram(PFIPesore e ME — OS ED —SCREWED N/A BODILY MAR(YfEHq $ NONOYMED PROPERTY DAMAGE tMUof e SIRED AUTOS _AUTOS eene• S J UNEMELIA LVA5 OCCUR EACHOca,RENCE S EXCESS LIAM CLAIMS-MADE WA AGGREGATE a DEO I I RETENTnNSV PP�E d WORK/IRS COMPENSATION X I$i/AiIVE I 168. AND ENPLOYERYLwMY YIN ANYPROPRETORWARTNER,EXECUtM El.EACHACDIENT S 100,000 A OFFWER(Mandalo.E NREXCLuDED7 wA ISA wA BS82UB4587P2831a 01/21/2018 01/21/2019 ELDISEASE-EA EYPLOYFE $ 10000 I yyµq Faults@under EL.DSEASE-raLICY LMR 5 600,000DESCRIPTION OF OPERATIONS bias - WA DESCRIPTION OF OPERATIONS a LOCATIONS I VEHICLES(ACORD 1H,AMENS R@a*dN SCANS may M attached V.Nn Mem M n4@eed) Workers'Compensation benefits Wil be paid to Massachusetts employees only.Pursuant to Endorsement WC 2003 08 B,no authorization Is given to pay claims for benefits to employees In states other than Massachusetts If the Insured hires,or has hired Base employees outside of Massachusetts. This certificate of insurance shows the policy In force on the date that this ceNBcate was Issued(unless the expiration date on the above policy precedes the Issue date of this certificate of Insurance). The status of this coverage can be monitored daffy by accessing Vie Proof of Coverage-Coverage Veriucalon Search tool at vnvw.mass.govAwdMmrkers-COmpensatioMlivestlgations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF YARMOUTH ACCORDANCEWITH THE POLICY PROVISIONS. 1148 Route 28 AUTHORIZED REPRESENT/01VE i_4)C4-9 So Yarmouth MA 02684 Daniel M.C ,CPCU,V1ce President-Residual Market-WCRIBMA OD 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 1 DATE WAVIONY/Y) ef213e CERTIFICATE OF LIABILITY INSURANCE I 03/19/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CEBELLOWORDED BY THE POUCIES CTHIS CERTIFICATE OF INSURANCE DOES TIFIATE DOES NOT AFFIMATIVELY OR ANOT TIVELY CONSTITUTE A CONTRACT BETW R ALTER THE EN THE ISSUINGCOVEGE F INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require en endorsement A statement on this certificate does not confer rights to the ' certificate holder In lieu of such endorsement(s). CUNTALT PRODUCER NAME: Lisa Souza C�..SCO Gardner Insurance i PNONE 508-990-7367 IIF IQ.Nol: 508-899-9621 _ 48 No 0-:11• 4B Siete Road ' Ilea®brencogardnedrlslrence.com INSURERS)WORDING COVERAGE NAIC I _North Dartmouth MA 02747 mum A: Western World Insurance Co INSURED INSURER a: Safely Insurance Co • INSURER C: Couto Construction IncI INSURERD: 23 Ernes(St. - INSURERS: New Bedford MA 02745 INSURER r: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THE POLICY PERIOD ITHIS IS TO CERTIFY TT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEENNDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTERAC OR THER DOCUMENT WITH RETO THE IED NAMED MOVE SPECT 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. INSRADDL SUOR 70LICYE F POLICY EXP LIMITS '... • LTR ME OP INSURANCE )Ns0 WOO POLICY NUMBER EirsDDIYYYY) 1gpp 000 X COMMEROAL GENERALWBIUff EACH OCCURRENCE $ • DAMAGETO WNW CLAIMS-MADE OCCUR PREMISES(Eo ouMMlu) $ 1.000,000 ® MED DIP(Py ono mon $ 60.000 A — X X NPP8326735 02/2412018 02/242019 pERSOWLa AW*13*! f 1,000,000 GENERALAGGRECATE S 2,000,000 CENL AGGREGATE UNIT APPLIES PER X POLCY® T ® PRODUCTS-COMWOP AGO f 2.000.000 f ' OTHER: GGMMNEUlfINULI LINO $ 1,000,000 AUTOMOBILE LIABILITY (Es ma:NM MY AUTO BODILY INJURY For person) $ _ B —AALLUTOSp %1J.lNEoIAE� 623482 09/25/2018 08/25/2019 POOLE INJURY(Pr MdEerl9 $ N0OWHEO • IPM PROPER DI # i HIRED AUTOS _AUTOS 8 EACH OCCURRENCE f UMBREl1J1 HMI OCCUR - ' MB EXCESS LCLAIMS-MADE • AGGRPEGGATE (��I f WDEO ORICE SCOMPENSATION RETENTION; I STATUTE I I ERS I MW EMPLOYERS'LIABILITY YIN EL EACH ACCIDENT f ANY PNOPRIETORRARTNEPoEXECUTNE OFRCEIWEMBER MMIGtelYM lull EXCLUDED? NIA EL DISEASE-EAEMPLOYEE I • Il yyeeae EeeMiOn uwNr EL DISEASE-POLICY LIMIT $ DEsLRIPTION OF OPERATIONS Wow • DESCRIPTION OP OPERATONSI LOCATIONS)VEHICLES(ACOID101,Additional Remits ScIMIIN,nay De Washed a mon spun I muted' CERTIFICATE HOLDER CANCELLATION SH D ANY OF THE ABOVE IBED E ELLED 1Route 28 THE EXPIRATION DATE THEREOF, NOTICE POLICIES WILLL BEC DELIVERED BEFORE 1146 28 ACCORDANCE WITH THE POLICY PROVISIONS. South Yarmouth Ma 02664 AUTHORIZED REPRESENTATIVE Usa Souza I ®1988-2014 ACORD CORPORATION.All rights reserved. ACORD 28(2014/01) The ACORD name and logo are registered marks of ACORD