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HomeMy WebLinkAboutBLD-19-2530 ,P x42.. /0/i/i— 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 Official Use Only Building Permit Number: tp-f9.OS r2,S36' .Date Applied • • 1 - SRAM's: ,j 1U x'31- IF Building Official(Print Name) Signature,_,..,. _ , , __ Date SECTION 1:SITE INFORMATION LI Property Address: 1.2 Assessors Map&Parcel Numbi rsR E C E I V E D 20 Red Jacket Rd., Yarmouthport, MA 02675 132 1.1a Is this an accepted street?yes X no_ Map Number Parcel b umer NOV el 2018 1.3 Zoning Information: 1.4 Property Dimensions: Residential Residential 12,632 LOIN DtPARTIVENT Zoning District Proposed Use Lot Area(sq ft) Frontag; 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.40,454) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 1$ Private Cl Zone: _ Outside Flood Zone?Check if ZesO Municipal 0 On site disposal system ¢j SECTION 2:. PROPERTY OWNERSIIIPI 2.1 Owner'of Record: Alan&Susan Salto Franklin, MA 02038 Name(Print) City,State,ZIP 8 Wyllie Rd. 617-901-1020 alan.sartotnewenglandcontrols.com No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK (check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 11I Addition 0 Demolition 0 Accessory Bldg.0 Number of Units_ Other D Specify. — Brief Description of Proposed Work: Bathroom renovation indudina s ower and floor refinishin.%lora."" '' i_ =._ Y CL lt2f72 f118 SECTION 4t ESTIMATED CONSTRUCTION COSTS( t•1 I ttlsi N S OP9ra1 rpt NT Item Estimated Costs: ly Oflicial'iTse�n (Labor and Materials) , 1.Building $22,094.50 1. Building PermttFee:$j S O ` Indicate how fee is determined:' 2.Electrical $ 1,659 00 Standard Cityll'own Application Fee u DTotalProjectCost':(Item, xmnlhpher x,�_ 3.Plumbing $ 3,895.00 2 Other Fees $ LSS.O j) 4.Mechanical (HVAC) $ N/A 5.Mechanical (Fire y' Suppression) $ N/A Total All Fees $ CheckNo: ' Check Amount: L Cash Amouat: 6.Total Project Cost: $ 27,648.50 Paid in Full Outstanding Balance Due: l 57— SECTION 5:.CONSTRUCTION SERVICES Si Construction Supervisor License(CSL) Richard Bryant CnseNu05/08/2020 License Nummberer Expiration Date Name of CSL Holder 63 Cranberry Lane List CSL Type(see below) U No.and Street Type . .• Description Brewster, MA 02631 U Unrestricted(Buildings up to 35,000 cu,ft.) Cid/Town,State,ZIP R Restricted,&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 508-362-9770 rbryant©capeassociates.com I Insolation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(MC) Cape Associates,Inc. 100110 06/08!2020 EEC Company Name or HIC Registrant Name HIC Registration Number Expiration Date PO Box 1858 rbryant@capeassoclates.com No.and Street Email address N. Eastham, MA 02651 508-255-1770 City/Town,State,ZIP Telephone 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 X No ❑ • . SECTION 7a:OWNER AUTHORIZATION.TO)IE COMPLETED WREN • OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT . . I,as Owner of the subject property,hereby authorize Cape Associates, Inc. to act on my behalf,in all matters relativeto work authorized by this building permit application. AIR n/ $ AR-ru ( / Print Owner's Name(Electronic Signature) Date SECTION 7b.:OWNER1,OR AUTHORIZED AGENT DECLARATION By entering my name below,I h . attest under the pains and penalties of perjury that all of the information contained in this a..:cay.. . e and accurate to the best of my knowledge and understanding. Id • td-• Of Print Owner's or . ized rent'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 pst_have access to the arbitration program or guaranty fund under M.O.L.c.142A.Other important information on the MC Program can be found at www.mass,zov/oc4Information on the Construction Supervisor License can be found at www.mess.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finivhed basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number ofbalf/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" • The Commonwealth of Massachusetts t. t _ _ i Department oflndustrialAccidents E, =j"r _ 1 Congress Street,Suite 100 =i:11. Boston,MA 02114-2017 .=-,� 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): Cape Associates, Inc. Address: PO Box 1858 City/State/Zip: N. Eastham, MA 02651 Phone#: 508-255-1770 Are you an employer?Check the appropriate box: Type of project(required): I.®lam a employer with 120 employees(full and/or pan-time).• 7. 0 New construction 2.0 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 ❑ Y [No workers'comp.insurance required.] 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 ❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.9 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.9 I am a general contractor and I have hired the sub-contractors listed on the attached sheet • These sub-contractors have employees and have workers'comp.insuce.t 13.❑Roof repairs ran 6.9 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,11(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box NI must also Ell out the section below showing their workers'compensation policy information. t Homeowner 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 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and Job site information. Insurance Company Name: New Hampshire Employers Insurance Company Policy#or Self-ins.Lic.#: ECC60040009182018A Expiration Date: 01/01/2019 Job Site Address: 20 Red Jacket Rd. City/State/Zip:Yarmouthport, MA 02675 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 verifica,• . I do hereby I a i�'er the pains and penalties of perjury that the information provided above is true and correct Ili Date: lo' 1.4-• t IS Phone#: 50: 462-9770 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/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: t.Y4R4P TOWN OF YARMOUTH • r. P BUILDING DEPARTMENT o4R-0,Ic y 1146 Route 28,South Yarmouth,MA 02664 "' ;, `, 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 debris resulting from the proposed work/demolition to be conducted at 20 Red Jacket Rd.,Yarmouthport Work Address Is to be disposed of at the following location: S&J Exco Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. t 11 Sign�t� �'w Application Date Permit No. 1 CAPEASS-01 KSEARS ACORO' • CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD YYYY) 4.------- 11/30/2017 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 WANED, 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). CRNTA PRODUCER NAME:CT Rogers&Gray Insurance Agency,Inc. PHONE 434 Rte 134 Eat): ro I(A .No):(877)816-2156 South Dennis,MA 02660 Miss,mail@rogersgray.com INSURER(S)AFFORDING COVERAGE NAIC N INSURER A:Arbelta Protection Insurance Company,Inc. 41360 INSURED INSURERB:Arbella Mutual Insurance Company 17000 Cape Associates,Inc. INSURER C:New Hampshire Employers Insurance Compan 13083 P.O.Box 1858 INSURER D: North Eastham,MA 02651 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. INSR ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD VND POLICY NUMBER IMM/DD/YYYYI IMM(DD/YYYY1 LIMITS A X COMMERCIAL GENERAL LIABIUTY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE n OCCUR 6500066794 01/01/2018 01/01/2019 DAMMGEOREONC<TNErenre) $ 300,004 MED EXP(Arty one person) $ 15,000 — PERSONAL S ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT�APPLIES PER: GENERAL AGGREGATE 3 2'000'000 POLICY X JECT LOC PRODUCTS-COMP/OP AGO $ 2'000'000 I OTHER: $ B AUTOMOBILE LIABILITY (EaMaccideDISING.E LIMIT $ 1,000,000 ANY AUTO 1020060911 01/01/2018 01/01/2019 BODILY INJURY(Per person) $ OWNED SCHEDULED ' AUTOS ONLY X AUUTNO{SULED BODILY INJURY(Per ac dent) $ X AU-OS ONLY X AUTOS ONLY S P�ECRd�IDA PRMAGE $ - F $ A X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 7,000,000 EXCESSLIAB CLAIMS-MADE 4600066798 01/01/2018 01/01/2019 AGGREGATE $ 7,000,000 DED X RETENTIONS 10,000 $ C WORKERS COMPENSATION PER ETH- ANDEMPLOYERS LUITNER/BIUTY ECC60040009182018A 01/01/2018 01/01/2019 500,000 ANYNPROPRIETOR/PARTNER/EXECUTIVE EXCLUDED?R/EXECUTIVE Y/N E.L.EACH ACCIDENT S (Mandato y In NH)EXCLUDED? N I NIA 500 000 E.L.DISEASE-EA EMPLOYEE $ If yes,describe under • 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If mon apace Is required) • CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Yarmouth ACCORDANCE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Main Street 1146 Route 28 ' South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE I jv sSl1 L/ "1444— ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD • • Cifle . O4n4nonweal Q/�. /KadoaclZ mein• Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Type: Supplement Card Registration: 100110 CAPE ASSOCIATES,INC. Expiration: 06/08/2020 PO BOX 1858 N.EASTHAM,MA 02651 Update Address and Return Card. SCA 1 0 20M-05/1177 ("11(6 n,,nonaneaS nn 114,uestlin.A•/6 Office of Consumer Malts 8 Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Supplement Card before the expiration date. H found return to: Reoistration., Expiration Office of Consumer Affairs and Business Regulation 100110 06/08/2020 One Ashburton Place-Suite 1301 CAPE ASSOCIATES,INC. Boston, • 0 108 ' RICHARD BRYANT \Q„� p__ i t 345 MASSASOIT RD [, u �` EASTHAM,MA 02642 Undersecretary t wail. without signature • lir , = Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Const ttttrt%i fIvisar ' f CS-082435 r 1. it, i,, fres: 05/08/2020 RICHARD M BRY v �� 63 CRANBERRY LARNE BREWSTER MA 02631', ket yam' q}{ 0 ' 1 Commisslonerr _ J r Cape Associates, Inc. zO t,ta TaLLe aot4 BUILDERS farnn *t+ebe4t T1'11Q oz Os' PROPERTY MANAGEMENT H SERVICES II PAINTING I - Myr 3e flras... Pi.„ -- -- - --- ... I■■-_ - - - a 11111011111i,'. Nil!! 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