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Home My WebLink AboutBLD-19-002248 B Office Use Only / rOg.Y",} 8 e ,Z: 5 Permit# .i pI :e y . Amount N l •T bad t-S Permit expires 180 days from - Is - te•ate • BUS—IG -OW3- EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department RECEIVED 1146 Route 28 South Yarmouth, MA 02664 OCT 16 2018 (508) 398-2231 Ext. 1261 13 Vitt Ze ASSESSOR'S INFORMATION: I (J CONSTRUCTION ADDRESS: eu eitS- ,- to Map: Parcel: y OWNER: ! 1tn$ '\O5P\ a1 LLQ almt. 1 s-- , I{� o0 N PRESENT ADDRESS /,,, , �'�7,,�, TEL # �[ 7/� CONTRACTOR: I)M( LAI UAV(C�t 6g U(fl$cam^' t-r nA- l S�e 56o -Z! ( I NAME MAILING ADDRESS TEL.# M ❑Residential QCommercial Est Cost of Construction$ 'g SOO 03 Home Improvement Contractor Lic.# 1707 7 Construction Supervisor Lic.# th Z 600 Workman's Compensation Insurance: (check one) 0 I am the homeowner I am the sole proprietor IA have Worker's Compensation Insurance/ /fit � � Tor Insurance Company Name: �J r`'t Worker's Comp.Policy# y<L wL s733-61'‘ WORK TO BE PERFORMED Tent _ Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares 10 /(7)Remove existing* (max.2 layers) Insulation Old Kings Highway/Historic Dist ( )Replacing like for like Pool fencing ath'The debris will be disposed of at 41-2-A- 1 Location of Facility I declare under penalties of perjury that the statements 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 or revocation o 7 4 neniee and for prosecution under M.G.L Ch.268,Section 1. r Applicant's Signature: /*PiO 7 Date: /%'6/� Owners Signatu e(or attachment) V '74 Date: —// _ Approved By: Airtait Date: /a —/8 _ Buildin_ re I, M. or de ignee) E all ADDRESS: • Zoning District: Historical District: 0 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 e) J"M.�5 iii=P Department of Industrial Accidents el- ay 1 Congress Street, Suite 100 _ Ff_ f Boston, MA 02114-2017 -pp, www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information �7 Please Print Legibly Name (Business/Organization/Individual): F ,oSoc . Address: 6',g U ais 671.- --- c W• t City/State/Zip: Vkz[,[c/4 Phone #: 50e 169'27 '9 Are you an employer?Check theappropriate box: Type of project(required): L I am a employer with 3 employees(full and/or part-time).* 7. ❑New construction 2. 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. I am a homeowner doingall work myself. t 9. ❑ Demolition ❑ ys [No workers'comp.insurance required.] 4.01 am a homeowner and will be hiring contractors to conduct all work on ray property.ro I will 10 ❑ building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contactor and I have hired the sub-contractors listed on the attached sheet 13.E]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. 14.0 Other 152,§1(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 subcontractors have employees,they must provide their workers'comp.policy number. Iam an employer that is providingworkers'compensation insurance for my employees. Below is the policy and job site information- Insurance G �7 Insurance Company Name: ►I-}I�l",EILL* 0 `fit f Policy#or Self-ins.Lic•#: 'tZG-IC 42-r6Sic Expiration Date: 12//0/6- Job Site Address: c 1' ''Un- 2g W. yt{f�1Rt..-- 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 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 istrueand correct Signature: �H' Date: /0�Jb/ fid' Phone#: Ate • _77r/r 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/ own Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: • 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 contract 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." MGL chapter 152,§25C(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 cbnstruct 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 contacting 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 for 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 bum 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 r ' Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 02-23-15 www.mass.gov/dia • • Acceptance of Estimate The above prices, specifications and conditions are satisfactory and are hereby accepted. ROOFING AND SIDING OF CAPE COD;LLC is authorized to do the work as specified: Payment will be made as such: 1/3 Deposit � �-!.P .UQ �l .t I/l,Qi of ° a Iffy' '' pi 1/3 Beginning f work 1/3 upon completion Date: Signatures: Note: No work shall begin prior to the signing of the contract and transmittal to the owner of a copy of such contract. You, the buyer may cancel this transaction at any time prior to midnight of the third business day after the day of this transaction. The above s specifications are required to meet the National Roofmg Contractors Association (NRCA) roof standards, as well as to meet manufacturer's specifications for warranty requirements. Touch-up painting may be required and is not included in this proposal. Roofing and Siding of Cape Cod, LLC warranty: products and workmanship (100% Labor and Materials)for 10 (ten)Years after installations: GAF warrants that its shingles will be free from manufacturing defects. Below are highlights of the warranty for LandmarkTM. See Asphalt Shingle Products Limited Warranty document for specific war- ranty details regarding this product. We hereby submit specifications and estimates to furnish .. • install new Therma-Tru Smooth- Full Lite/2-panel,Blind inside Glass, Composite Jamb , iberglass Paintable DOOR with 20- year limited warranty including hardware as follow . 1. Remove exterior trim. 2. Remove interior trim. 3. Remove door frame back to studs. 4, Install new door, 5. Install new exterior trim usi, pvc. 6. All exterior fasteners to .e stainless steel. 7. Insulate perimeter o e door with foam. 8. Install new inte.•r trim using primed casing. Labor , d Materials: $1,490.00 If cceptable, initial here: NOTE: Not included drywall repair, framing changes or painting. No siding repairs unless cedar Job is estimated to commence approximately _4_ weeks after deposit received unless otherwise noted here: Work is scheduled to be substantially completed in approximately: _6_ days If acceptable, (both) initial here: Start and completion times are approximate and subject to change due to, but not limite to, the following circumstances: weather delays,additional work on previous jobs,permitting delays, etc. i ',b.4 1.- Roofing and Sidinc of Cape Cod,LLC ; rgiril BBB 68 Winslow Gray Rd et t West Yarmouth, MA 02673 508-360-2749 e-mall: rsocc@yahoo.com roofingandsidingofcapecod.com HIC REG #170787; LIC # 102600 JobAddL___: ___ __ _ ---- Name: Purvish Patel Town: Tidewater Inn Job Phone: 508-775-5400 Address: 135 Rte 28 Other Phone: City: West Yarmouth E-mail: info@huntersgreenmotel.com State: MA ZIP: 02673 Estimator: Dmitry Labkovich 06/04/18 We hereby submit specifications and estimates to furnish and install new roofing as follows: 1. Strip existing roofing and remove debris. Calculated (1 layer). Anymore layers of roofing needed to be stripped will be additional. 2. All gutters will be cleaned out, grounds cleaned up and nails extracted with magnets. We utilize magnets so as to minimize your exposure to personal injure and/or property damage from nails left behind at the job site. 3. After removal of roof, wood deck will be inspected for splitting, rot or other deterioration. Owner will be advised of need for wood replacement prior to commencement of wood replacement work. 4. Along all eaves of house. Ice & Water Shield waterproofing underlayment (36 " wide) will be directly adhered to the wood deck. Waterproofing underlayment is installed to eaves to protect against interior leakage and subsequent damage from wind-driven rain, ice and snow dams, and freeze back conditions. • 5. Install waterproofing underlayment in full width (36 wide) to all valleys and 6" to all rake edges. Install waterproofing underlayment at all vent pipe collars and any other projections and skylights. Underlayment adds additional protection against leakage at critical terminations. Over remainder of house roofing paper will be installed and nailed to the wood deck. 6; Install new white drip edge to all perimeter cave edges. Drip edge is installed to protect from leakage and rot and to provide a neat and clean perimeter profile. 7. All existing vent pipes will receive new aluminum vent pipe flashings with neoprene gasket collars, or copper if doing red cedar roof. 8. At all eave edges or roof, shingle starter strip will be cut an installed with sealing strip at lower edge of roof in accordance with manufacturer's specifications. This provides a watertight and wind-resistant termination for your roof. 9. Storm nailing: Because we live in a severe storm region, additional (storm) nailing is strongly recommended by Roofing and Siding of Cape Cod, LLC, the manufacturers and the National Roofing Contractors Association. Secure new roof with 50% more nailing, upgrade minimum standard (4) four nails per shingle to (6) six nails per shingle, 1 ''A " long. Nails will be galvanized with a rust-inhibitive coating. If red cedar roof,then using stainless steel fasteners. 10. Shingle installation: Supply and install roofing shingles according to the manufacturer's specifications, according to the below selected material and warranty. All work to be performed by insured professionals. 11. Install waterproofing underlayment surrounding chimney. Underlayment will extend up vertical portion of chimney a minimum of (2) two inches. Caulk all lead flashings together around chimney with Dymonic caulk. This is not a guarantee but a maintenance procedure. We cannot guarantee chimney from leakage with roof job only. See chimney proposal if applicable. We cannot guarantee existing skylights or venting units unless we replace them with new ones. 12.At peak of roof ridge Vent will be fastelied over the opening in the deek. Shingle caps will be installed and fastened over the vinyl ridge vent into the decking with coated roof nails. Ridge vent provides you home with the necessary exhaust ventilation to prolong the life of the shingles and the wood sheathing to ensure a properly balanced ventilation system if used in conjunction with eave intake ventilation, and provide cooler attic temperatures in the summer and less moisture-laden damaging air in the winter Timberline Ultra HD, with Life-Time Warranty g ..Labor and Materials: S19,800.00 (Left fuilding) If acceptable, initial her Color: Fox Hollow This is the entire agreement. Any discussions or verbal agreements are superseded by this agreement. Such agreements,even those of the smallest nature,must be in writing to be recognized. Any work above and beyond the specifications outlined in this proposal will be priced on request. All additional work, including travel time and lumberyard runs, will be subject to extra charge. In the event of rot repairs, roof repairs or any related work requiring immediate attention, we will proceed without customer approval. We look forward to working with you; please call if you have any questions. Sincerely, ROOFING AND SIDING OF CAPE COD,LLC ROOFING AND SIDING OF CAPE COD, LLC will provide cleanup on a continuing basis and all debris will be removed from site. All products installed by ROOFING AND SIDING OF CAPE COD, LLC will be to manufacturer specifications. All work will be performed by insured professionals. All material is guaranteed to be as specified and the above work to be performed in accordance with the drawings and/or specifications submitted for above work and completed in a substantial workmanlike manner. There will be no refund for special-order windows, doors or any other non-stocked materials after three days from approved proposal. All warranties will be null and void if account is not current and paid in full. Owner to move all personal objects, furniture, etc., from work areas. All items against walls should be considered for removal during any exterior siding jobs, additions, etc. to guard against damage. In the case of any roofing and ridge venting, dust and debris should be expected and any items in the attic should be removed. ROOFING AND SIDING OF CAPE COD, LLC is not responsible for any damages if said items remain in place. Curtains, drapes and window and door treatments may need proper reinstallation or replacement by customer due to sizing on any window or door replacements and is not included in jobs contracted with ROOFING AND SIDING OF CAPE COD,LLC Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control, Owner to carry fire, tornado and other necessary insurance upon above work. Workmen's Compensation and Public Liability Insurance on above work to be taken out by ROOFING AND SIDING OF CAPE COD, LLC. Owners who seeure their own construction-related permits or deal with unregistered contractors will be excluded from access to the guaranty fund. This Contract not valid unless signed by Corporate Officer: �� . • • • Q.6...72e Vim mon teiealde lleakced ttlein Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:LLC flealstration Expiration 170787 12/18/2019 ROOFING AND SIDING OF CAPE COD,LLC. DZMITRY LABKOVICH 68 WINSLOW GRAY RD C__) W.YARMOUTH,MA 02673 Undersecretary . \ alio Massachusetts Department of Public Safety it Board of Building Regulations and Standards License: CS-102600 Construction Supervisor DZMITRY LABKOVICH 1I, • • 68 WINSLOW GRAY RD • WEST YARMOUTH MA 02673 441 - Expiration: Commissioner 03/27/2019 • •