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Home My WebLink AboutBLD-19-002665 RECEIVED of Y'1RA_ NOV0018 off only t o fCD-/5 d,� 0 �'¢ $ BUILDING DEPARTMENT 1..Amount .ita ,rI By:s-V. Permit expires 180 days from • -<s:,'- r issue date EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth,MA 02664 ¶1 j. (508)398-2231p (Ext. 1261 �f J n CONSTRUCTION ADDRESS: ` 14 � ' YffrrYLO J, (.V, YQntvt-Mw -4 Port f rig ASSESSOR'S INFORMATION: P0 Map: Parcel: OWNER: DCM11@y1 P0-Y'C - eat-4 '1/�7Ei,w'Ya(h , 4, Por4-, IY0 Col -220 - ge.7 , NAME PRESENT ADDRESS TEL # coNfA TRACTOR: (Mu Sethyl( n 67 Spa 4 -F Myet1nrtS ft ii 503-776 -2700 NAME MAILING ADDRESS # TEL# e 1entiai 0 Commercial Est.Cost of Construction$ 91 7 c 0 3 Home Improvement Contractor Lie.# 18 2.0 Z Construction Supervisor Lic.# I O e li 2 l Workman's Compensation Insurance: (rck one) ❑ I am the homeowner rAram the sole proprietor ❑ 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 2. O ( L4 emove existing"(max.2 layers) Insulation_ Old Kings Highway/Historic Dist. (\J)Replacing like for like Pool fencing 'me debris will be disposed of at: 1 a 1(.. ?-4,,, 1/n- Location of Facility I declare under penalties of pepurylhat th s f is 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 re oc ion I.i•-in- : d for prosecution under M.G.L Ch.268,Section 1. Applicant's Signature: X ' Date: 11 • e2 • 1 9 Owners Signature(or attachment) - Date: Approved By: - Date: /711172-/S B ' i '•icial or designee) ,49.IL 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 r ' The Commonwealth oJMassaehuseus i7 a Department offnfustrtolAccidents • • Sill ma' Office of-Investigations =tiE_ 5 . 600 Washington Street • eG Boston,MA 02111 www mars gov/dia Workers' Compensation Insurance Affidavit:Builders!Contractors/Electriefans/P]umbers •Applicant Information /� Please Print Leeibly ' Name(Business/Organization/individual): /T r lrL{h1 sef� rya n Address: 67 DS ' d- , • City/state/Zip: P y etnvi i 5 ti f' _ Phone# S`o�' ^776- 27 o c� • Are you uaanemployer Check the appropriate box: . Type of project(required): • 1.t -Iem a employer with / 4. 0 I am a general contractor and I ' • employees(full and/or part-time).' have hired the sub-contractors 6. New constructionI• 2.0 I am a sole proprietor or partner listed the attached sheet • T. ❑Remodeling • ' ship and have no employees These sub-contractors have 8. 0 Demolition working for me in shy capacity. employees and have workers' • [No workers'comp,insurance• comp.insurance.= 9. 0 Building addition required) 5. 0 We area corporation and its 10.0 Electrical repairs or additions • 3.0 I ama homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions ' myself[No workers'comp. right of exemption per MOL ,,,, .ltso / insurance required.)t o.152,11(4),and we have no 12. pass • • employees.[No workers' 13.03.0 reOther • . • • comp.insurance required] . *Any applicant that checks box MI mud also fall out dissection below shining their wmkcn•compensation polity Infomation. • t Homeowner who submit this affidavit indicathrg they am doing all work and then hire outside contractors must submits new affidavit indicating such. :Contractors that check this boa must attached as additional sheet showing the mere of the sob contractors and sate whether or not those entities have . .employees.If the sub-connectors have employees they must provide the&waken'comp.policy number. • • • I am an employer that is providing workers'compensation insurance for my employee& Below Is the policy and Job site r brfomwtion. . Insurance Company Name: Policy H or Self ins.Lic.It: 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 is required under Section 25A of MOL c.152 can lead to the imposition of criminal penalties of a fine pp to$1,500.00 and/or one-year imprisonment,as well as civil penalties hi 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 for' c coverage verification. • Ida herebygc'ertify un the p p Idea perjury that the Information provided above k true and correct • $ianature: K Dates I`r. 0. i 9 . ?bone#: co? - 774- W0 • Official use only. Do not write in thti area,to be completed by city or town official City or Town: Permit/License fl Issuing Authority(circle one): 1.Board of health'2.Building Department 3.City/Town Clerk 4.Electrical Inspector S'Plumbing Inspector • , 6.Other 1 Coatact Person: • • Phonefi: • COREY " The Roofers " 67 SEA STREET APT#A4, HYANNIS MA 02601 PHONE 1,-508 -775-8240 CERTAIN1TEED LANDMARK LIFETIME - ALGAE RESISTANT ARCHITTECTURAL STYLE RE - ROOFING PROPOSAL August 4,2018 DAMIAN PARESEAU 974 WEST YARMOUTH RD. EM: 48fordfanatic®gmaiLcom YARMOUTH PORT,MA Tel: 508-280-8296 COREY & COREY hereby proposes to perform the following services in a neat and professional manner and in accordance with the manufacturer's specifications and local building codes. Remove and Haul Away All of the Old Asphalt Roofing Shingles(One Layer) from the Entire House Only. Supply and Install CERTAINTEED LAND K AR: LIFETIME WARRANTY, 10 YEAR SURE START PROTECTION;CLASS A FIRE RATED, COPPER/CERAMIC STONES for a FULL 10,YEAR WARRANTY AGAINST ALGAE CONTAMINENT,240 POUND,EXTRA HEAVY WEIGHT, 130 MPH WIND WARRANTY,CATEGORY III HURRICANE,STORM/HURICANE NAILED (6 NAILS PER SHINGLE), MULTI-LAYERED,LAMINATED ARCHITECTURAL STYLE,F ERGLASS BASED ASPHALT SHINGLES. COLOR: C'o/o n log S Ict:9-. Supply and Install 8" WHITE ALUMINUM/IIICK'S VENTED DRIP EDGE on All of the Eaves. Supply and Install CERTAINTEED WINTER-GUARD(Ice&Water Shield)WATERPROOF UNDERLAYMENT SYSTEM on Roof Eaves &Valleys Under the Step Flashings,on the Skylights and Chimneys. Supply and Install CERTAINTEED'S"ROOF RUNNER" SYNTHETIC ROOFING PAPER Supply and Install AIR VENT SHINGLE VENT II RIDGE VENT on the Entire Ridge. Supply and Install ALUMINUM& NEOPRENE SOIL PIPE FLASHINGS Clean and Remove Debris from work area after job is completed. TOTAL DIVES MENT $8,750.00 • CORE + & COREY " The Roofers " OPTIONAL ADDITIONAL WORK: RE-ROOFING THE GARAGE WILL BE ADDITIONAL-------------__$4,500.00 POSSIBLE EXTRA CARPENTRY: Any Rotted or Otherwise Deteriorated Trim Boards,Plywood Sheathing,Missing Metal Flashing,Side Walling or Any Other Carpentry Needing Replacement will be done and charged for as an Extra:Materials Plus Labor at the Rate of$60.00 per Hour. PAYMENT SCHEDULE: A Deposit of One Half is due at the Signing of this Roof Proposal and the Final Payment for the Balance is Due Immedi itely Upon Completion. WORK SCHEDULE: All Roof Work is Scheduled 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 Make Checks Payable to: COREY & COREY COREY & COREY Warranties the Shingles and Labor for 10 years. CERTAINTEED Warranties the shingles and labor 100% for the First 10 Years and the Shingles your LIFETIME if the shingles becomes defective. CERTAINTEED Warranties the Shingles up to a CATEGORY HI HURRICANE-130 MPH WIND WARRANTY. CERTAINTEED Warranties the Shingles to be Algae Resistant for a Full 10 Years. COREY & COREY carries Workman's Compensation and Public Liability Insurance on the above work DATE OF ACCEPTANCE: < • a 4 . 1 g ACCEPTED BY: SUBMITTED BY: La ✓(�(� DAMIA PARESEAU ARME AFARY HOMEOWNER COREY & COREY HIC# 183202 CSSL# 106102 ACOREP® CERTIFICATE OF LIABILITY INSURANCE DATE(MMJDDMYYY) 09/13/2018 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 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 Eastern Insurance Group PHONE Ear• (508)997E061 FAX (508)990-2731 (MC I(AC.MeI: 439 State Rd. E-MAIL apaiva@easteminsurance.com ADDRESS: P.O.Box 79398 INSURER(S)AFFORDING COVERAGE NAIC I _ North Dartmouth MA 02747 INSURER A: Amelia Protection Insurance 41360 INSURED INSURER B: Armen Safaryan INSURER c: DBA:Corey end Corey NSIIRER 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. ILSRR TYPE OF INSURANCE INSOL WVD POIJCY NUMBER PMIDDPI MMJODNXP LIIMTS (MOLIC -kW IPOLIDPOLICY DP Xi COMMERCIAL GENERAL LIABILITYEACH OCCURRENCE a 1.000.000 DAMAGE TO RLN IID QMS-MADE OCCUR PREMISES(Es om,Ience) S 1 AI00• 0 MED EXP(Any ane person) $ 5.000 A 9520046441 04 09/18/2018 09/18/2019 PERSONAL"ADV IN Joey _ a 1,000,000 GENT-AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000.000 • 1V POLICY❑JECi L]LOCPRODUCTS-COMP/OPAGO $ 2.000.000 OTHER: $ AUTOMOBIIEUA&LRT COMBINED SINGLE LIMIT S _ (Es accident) ANY AUTO BODILY INJURY peer person) $ OWNED —SCHEDULED BODILY INJURY(Par widen!) i AUTOS ONLY _ AUTOS _ HIRED NON-OWNED -PROPERTY DAMAGE AUTOSONLY AUTOS ONLY _ AUTOS ONLY (Par sodden.) _ $ . UMBRELLA LIAB OCCUR EACH OCCURRENCE _ 7: EXCESS UAB CLAIMS-MADE AGGREGATE DEO I RETENTION$ $ ANDBEMPLOYER?LIABILITY YIN RS COMPENSATION I eTATUTE MERµ A ANY PROPRIEmRNARTNERIEXECVTNE ❑ MIA 952004644104 09/18/2018 09/18/2019 EL.EACH ACCIDENT S 1,000.000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) EL DISEASE-EA EMPLOYEE $ 1000,000 It yes,dmcdbe under ' DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 1000.000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORO let,Additional Remarks Schedule,may be Noshed M mos spam S npuIW) 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 • ®1988.2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD er4 g� oa9,,A, , / 4- • Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 Home Improvem@r t~Contractor Registration '�`— _ __ Type: Individual �'� -= ARMEN SAFARYAN } --� Registration: 183202 Expiration: 09/13/2019 67 SEA ST APT A4 HYANNIS, MA 02601 - '31-_ i - "At iss°$ Update Address and return card. SCA 1 0 20M-0L17 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE IndMduai before the expiration date. H found return to: Aeatstr3ttori• Explratlo Office of Consumer Affairs end Busin- - Regulation 10 Park Plaza-Suite 5t 18--t .. ,-09/13/20199/132O19 �.,Jy Boston,MA 02116 ARMEN SAFARYANt., -�u D/B/ACOREYAND QoREY I ( ' I i1 I ARMEN SAFAFTYAN ?y , 67 SEA ST APT A4— �" � �— HYANNIS,MA 0260ii Undersecretary Not valid w thout •n S ure found return Department of Public.Safety - oard of Building Regulations and Standards .License: CSSL-106102 Construction Supervisor Specialty ARMEN SAFARYAN 67 SEA STREET APT At ' -'t,r HYANNIS MA 02601 fi Commissioner Expiration:10/02/2020 ..