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HomeMy WebLinkAboutBLD-19-003042 r 7 Of Y�k Office Use Only *4. 0 I Permit# 0 H IAmount S-0 A" !Permit expires 180 days from issue date In' EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH RECEIVED Yarmouth Building Department 1146 Route 28 NOV 16 2018 South Yarmouth,MA 02664 (508)398-2231 Ext. 1261Jiq ` T t/1 CONSTRUCTION ADDRESS: �lI UI14N� AVE. 9. YR- ve.f)-1 f ti a erS,/__ ` �1_L. ASSESSOR'S INFORMATION: • Map: Parcel: OWNER: H17RIvsR)N KHJL5P- '71 DIPIU6 f VF• S. yitgriOt/TH,tf 11. 5P3 -797-704 NAME PRESENT ADDRESS TEL. # CONTRACTOR: rfnNEW 3 FP RYAil 67 SEA ci. HYA NNIS, N A SbS -776-Z9o0 NAME MAILING ADDRESS TEL# sidential ❑Commercial Est.Cost of Construction$ 4r coo Home Improvement Contractor Lie.# IS 32D Z Construction Supervisor Lie.# 1061 0 2 Workman's Compensation Insurance:: (cFjeck one) ❑ I am the homeowner &Tim the sole proprietor 0 I have Worker's Compensation Insurance /�r ' Insurance Company Name: A r ce 6 ��— Worker's Comp.Policy# -` 5 Doq`p"f,`S 1 U WORK TO BE PERFORMED Tent _ Duration �q (Fire Retardant Certificate attached?) Wood Stove Sid' :• #of Squares Z7 Replacement windows:# Replacement doors: # Roofing: • of Squares a 0 ( ,/)Remove existing'(max.2 layers) Insulation_ Old Kings Highway/Historic Dist. ( )Replacing like for like Pool fencing l` 'The debris will be disposed of at: T Q f tt4g t , i412- Location of Facility I declare under penalties of perjury that .e state,Q is erein 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 revoc:.. of my/�n• nd for prosecution under MEL.Ch.268,Section 1. Applicant's Signature: 4 I_ I Date: /I . I b . /S1 Owners Signa i re(or attachment ., Date: Approved By: ,. - / Date: 11 - l 4- )pp Building Official(or designee) — — MAIL ADDRESS: Zoning District: Historical District: 0 Yes 0 No Flood Plain Zone: 0 Yes ❑ No Water Resource Protection District: Within 100 ft.of Wetlands: 0 Yes 0 No 0 Yes 0 No • ` r The Commonwealth ofMassachusetfs i!_9fi=(, • Department of industrial Accidents =itnl� ' Office of-Investigations in:r-r "' . 600 Washington Street • , Boston,AU 02111 wwwartass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers •Applicant Information Please Print LeEibly • Name(BusinewOrganimtionM`dividual): P-Y t+'�•Vn 4f-ryfl l) Address: (,7 Soto ,....,kc City/state/zi.: ' t ' • . d : Phone#: .5—a : —7 7 i- ar OD ' Are you an employer? heck the appropriate box: Type of project(required): • 1.[J fl a employer with 4. 0 I am a general contractor and I employees(full aod/or -time).' have hired the sub-contractors 6. ❑New conshvction ' 2.❑ I'am a sole proprietor or partner. listed on the attached sheet. , T. 0 Remodeling • ' ship and have no employees These sub-contractor have 8. 0 Demolition working'for me in shy capacity. employees and have workers' • [Na workers'comp,insurance- comp.insurance9. 0 Building addition required.) 5.Q We are a corporation and its 10.0 Electrical repairs or additions • 3.0 lam a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself.[No worker'comp• right of exemption per MGL insurance required.)t c.152,fl(4),and we have no 12. of repairs • • employees.[No workers' 13. Other . • comp.insurance required.) . *Any applicant that checks box al must also fill out themodem below showing their workers'compensation policy Information. • t Homeowners who submit this affidavit Indicating they are doing as wade and then hire outside contractors must submit a new atridavk indicating nrch tcentmcton that deck this boa mug attached an addstidml sheet showing the name of the sobconeacmn andstate whether or not those entities have employees.Mlle subcontractors have an/dorm they must provide their worker'comp.policy mhmber. • • /am an employer that is providing workers'compensation Insurance for my employees Below It the policy andJob site I Information. I Insurance Company Name: Policy 0 or Self ins.Lic.11: . Expiration Date: Job Site Address: Ciry/Statelzip: • i 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 MDL c.152 can lead to the imposition of criminal penalties of a fine pp to 51,500.00 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. Be advised that a copy of this statement may be forwarded to the Office of • •Investigations of the DIA for insurance coverage verification. f do hereby certify an/al tis=l 7 u , .penalties o perjury that the informationtrue and • provided above Zris correct — •. ante- 4 • // /_, .�A/ ..te• II . [ 6 , • •,,,e • a . - > ,If a b • Official use only. Do not write hi thli area,to be completed by city or town official City or Town: Permlt/License A ' 'sluing Authority(circle one): 1.Boardof Health'2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.•Plumbing Inspector • 6.Other Contact Person: • • Phone k: . COREY & COREY R " The Roofers " 67 SEA STREET APT#A4, HYANNIS MA 02601 PHONE 1-508 -775-8240 f CERTAINTEED LANDMARK LIFETIME - ALGAE RESISTANT ARCHIITECTURAL STYLE RE - ROOFING PROPOSAL September 4,2018 HARIKIRIN KHALSA 71 DIANE AVE. EM: dmpinge@gmail.com S.YARMOUTH,MA Tel: 774-287-2233 $0 g 7?7 7 r4'4' COREY & COREY hereby proposes tooperform 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 (Both Layers)from the Whole House. Re Nail All Plywood Sheathing as needed. Supply and Install CERTAINTEED LANDMARK AR: LIFETIME WARRANTY, 10 YEAR SURE START PROTECTION,CLASS A FIRE RATED, COPPER/ CERAMIC STONES for a FULLrk10 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,FIBERGLASS BASED ASPHALT SHINGLES. •gy COLOR: m . Co ion S//q e Supply and Install 8" WHITE ALUMINUM/HICK'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 INVESTMENT ----- $9,500.00 COREY & COREY " The Roofers " 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 S 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 Immediately 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 5 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 III HURRICANE-130 MPH WIND WARRANTY. CERTAINTEED Warranties the Shingles to be Algae Resistant for a Full 10 Years. COREY & COREY carries Workman's Compensatio4 and Public Liability Insurance on the above work DATE OF ACCEPTANCE: 9/7/18 ACCEPTED BY: SUBMITTED BY: HARIKIRIN KHALSA ARMEN SAFARYAN HOMEOWNER COREY & COREY HIC # 183202 CSSL# 106102 . i AC CERTIFICATE OF LIABILITY INSURANCE DA TE 8"" 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 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 certifleate holder in lieu of such endorsement(s). PRODUCER CONTACT Ashley Palva NAME: Eastern Insurance Group PkirNc Ern: (508)997-6061 fes,Not (508)990-2731 439 State Rd. E-MAIL apaiva©easteminsurance.com ADDRESS: P.O.Box 79398 INSURER(%)AFFORDING COVERAGE NAIL North Dartmouth MA 02747 NSURERA: Arbella Protection Insurance 41360 INSURED INSURER B: Annan Safaryan INSURER C: DBA Corey and Corey INSURER D: 67 Sea Street Unit A4 INSURER E: Hyannis MA 02601 INSURER F: COVERAGES CERTIFICATE NUMBER: 2018-2019 REVISION NUMBER: THIS 15 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. INS TYPE OP INSURANCE ADDLSUbR POUCYEFF POLICY EXP INSD WVU POLICY NUMBER IMWDDIYYYyT (MMIDDNYYIT LIMITS X COMMERCIAL GENERAL LIABILITYEACH OCCURRENCE $ 1.000,000 DAMAGE rO RENTED 100,000 CLAIMS-MADE OCCUR PREMISES(Es ocanrence) $ _ MEDEXP(Any am Mew/ S 5.000 A _ 9520046441 04 09/18/2018 09/18/2019 PERSONAL 6 ADV INIURY $ 1.000,000 GENT_AGGREGATE LIMIT APPLIES PER: GENERN.AGGREGATE s 2.000,000 X POLICY ;Pa LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT r (Es achene ANY AUTO BODILY INJURY(Per semen) $ — OWNED —SCHEDULED AUTOS ONLY AUTOS BODILY Nc INJURY aJdenl) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per Stamm) $ UMBRELLA LMB OCCUR EACH OCCURRENCE s _ EXCESS UAB CLAIMS-MADE AGGREGATE $ Gm I I RETErmm t I WORKERS COMPENSATION I EATUTE I�I•,,,AII r AND EMPLOYERS'LIABILITY ERN- YIN A ANY OFFICER/MEMBER EXCLUDED?PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A 9520046441 04 09/18/2018 09/18/2019 EL.EACHACCDENT $ 1'000.000 (Mandalay In NIq EL DISEASE-EA EMPLOYEE $ 1.000.000 If yes,describe under DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT $ 1,000.000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Addlsonal Remora Schedule,may be attached N mere space Is required) 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 ®1986-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 Home Improveme_ntCohractor Registration Type: Individual ARMEN SAFARYAN W 7/�= R 'strati • 1832 illa 02 egExpiration:• 09/13/2019 67 SEA ST APT A4 HYANNIS, MA 02601 70 et) 1.11 e V`bh Update Address and return card. SCA I 0 20M-05/17 Ocoee of Consumer Attain&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for IndMduat use only TYPE:IndMdual before the expiration date. H found return to: po istratlofj Exolrafian Office of Consumer Affairs and Buslne j< Regulation 10 Park Plaza-Suite 517• 183202 309/13/2019 (,-I x13— -=-164.1 Boston,MA 02116 ARMEN SAFARYANl,sr 3, r DB/ACOREYANDcoREY ' tif ARMEN SAFAR•ANiPt �� I ' I la 67 SEA START Art.,-7,4% HYANNIS,MA 02641--- s Undersecretary Not valid w thou! •n S • ure VMassachusetts Department of Public,Safety • Board of Building Regulations and Standards .License: CSSL-106102 Construction Supervisor Specialty ARMEN SAFARYAN 67 SEA STREET APT A4""-1 I HYANNIS MA 02601 • . / •',Oaf; 41,17aExpiration: Commissioner 10/02/2020