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Home My WebLink AboutBLD-19-003184 - - •..ce Use Only '. O �+ = �.*�, . �H f Amount e r, Permit expires 160 days from - z►: .a issue date EXPRESS BUILDING PERMIT APPLICA ]}JN C E I V E CI TOWN OF YARMOUTH Yarmouth Building Department NOV 21 2018 1146 Route 28 South Yarmouth, MA 02664 . )EPAR*4.! KC() / (508)3L98-223111 Ext. 1261 `y/ CONSTRUCTION ADDRESS: 40 M ,, )Ie sf� eOU c( (24'mo�� ASSESSOR'S INFORMATION: •1 D , / IMap: Parcel: /1 OWNER: s'c&a ccf p0 NAME PRESENT ADDRESST - # CONTRACTOR: thee-CO jilet r. d� kil( R) Rc. 1�GYa0'lf't�r 9s'/69'O/OZ IL NAME MAI14G ADDRESS I 'Csidential 0 Commercial p (,2 Est Cost of Construction S 6� /00.00 Home Improvement Contractor Lie.# '/6 h 0 "I s Construction Supervisor Lie.# /0 6 0 7 O Workman's Compensation Insurance: (check one) 0 I am the homeowner 0 I amnVA AAAA -sole proprietor VI have Worker's Compensation Insurance Insurance Company Name: IT (weird_ Worker's Comp.Policy# q 40 4 2 3 WORK TO BE PERFORMED Tent _ Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares 45- ( )Remove existing* (max.2 layers) Insulation Old Kings Highway/Historic Dist. ( )Replacing like for like Pool fencing *The debris will be disposed of at -.- V"�'US ( IS 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 of my lic¢ eand fyypprr prosecution render MG.L Ch.268,Section 1. q Q' Applicant's Signature: y�� ` Date: - A l I O• I I ' [� Owners Signature(or attachment) CO vt f K.eit� ' Date: r � Approved By: .-tt Date: // 'all 1d Building Official or designee) EMAIL 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 _,~ ,,,• Department of Industrial Accidents el s Office of Investigations • . f 600 N!as/iiington Street • Boston,MA 02111 • .,. www.mass.gov/dia • . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly • . Name(Business/Organizationandiv1idual): Care od KU t7�f WI p roVe4c.iw- • Address: pill" lKI * PO V.CL Rd �" . City/State/Zip: VV .�1t'X•VN�ltid _ Phone#: 503`(6 9OI d 2 , e ou an employer?Check Vie appropriate box: Type of project(required): 1.al I am a employer with /0 4. ❑ I am a general contractor and I 6. 0 New construction employees(fiill and/or part-time).* have hired the sub-contractors ' 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. 0 Remodeling ship and have no employees These sub-contractors have g. 0 Demolition working'for me in any capacity. . employees and have workers' 9. 0 Building addition [No workers' comp,insurance comp.insurance.: required.] 5. 0—We are a corporation and its —10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their •11.❑Plumbing repairs or additions myself [No workers'comp. • right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no C employees,[No workers' 13.❑Other VV Oil comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policyinfbrniation. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors mutt 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. It 61 , nc ,/ r • Insurance Company Name: f/"v,",L1,/ ctt/t�' d Policy#or Self-ins.Li/c.#: 9 "/7 O '"2 3 Expiration Date: 046/031/4 9 • Job Site Address: '1 0 l e ` - Cityistate/Zip: S S.Y new Attach a copy of the workers'c pensation policy declaration page(showing the policy number and expiration date). Failure to secure Coverage as required under Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civifpenalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violater. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. • Ido hereby certify under the pat and pe ties ofperjury that the information provided aboveisa and correct . Sismature: Date: 1"I SI 12 Phone#: 90846 901oz Official use only. Do not write in this area,to be completed by city or town official City or Town: . Permit/License it Issuing Authority(circle one): • 1.Board of Health 2.BuildingDepartment 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other . • Contact Person: Phone#: • • • MWDDITY TE ACRD CERTIFICATE OF LIABILITY INSURANCE DAosrlsrzo aWl 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 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 NAME CONTACT Linda Sullivan DOWLING & O'NEIL INSURANCE AGENCY PHONE CNo.Fall. (508)775.1620FAX Nd) E-MAIL Isu lliva n@doins.co m 973 IYANNOUGH RD INSURER(S)AFFORDING COVERAGE . NAIL* HYANNIS MA 02601 INSURER A: AMGUARD INSURANCE CO • 42390 INSURED INSURER B: ._. --_:_ CAPE COD HOME IMPROVEMENT INC INSURERC: • INSURER D_. 27 MILL POND ROAD INSURER E: WEST YARMOUTH MA 02673 INSURER F: I COVERAGES CERTIFICATE NUMBER: 281511 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM CR 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. ' - __ .. - - R INSRADDLSUB _..... ... POLICY EFF —-POLICYEXP LTR . TYPE OF INSURANCE P150 WW POLICY NUMBER (MMIDDIYYYY)•(MMIDD/YYYYI' LIMITS I COMMERCIAL GENERAL LIABILITY i i I EACH OCCURRENCE 5 i `- ' 'DAMAGE TO RENTED -- 1 CLAIMS MADE - i OCCUR _PREMISES(Ea occurrence) 5 MED EXP(Any one person) $ 1 N/A PERSONAL a ADV INJURY $ GENL AGGREGATE UNIT APPLIES PER I GENERAL AGGREGATE 5 L_.I POLICY_ JE P LOC PRODUCTS•COMPIOP AGG 5 • 'OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMB $ ANY AUTO BODILY INJURY(Per person) $ '---1 ALL OWNED 1I SCHEDULED I ,.._DI__..—_—__eracci___._—_—_._______.._.._.__.. I - I AUTOS _ AUTOS N/A BODILY INJURY(Per accident) 5 r I NON-OWNED PROPERTY DAMAGE $ i I HIRED AUTOS F '1 AUTOS • _Mei accidenq. I $ I - UMBRELLA LIAR OCCUR ,EACH OCCURRENCE •$ EXCESSLIAB I CLAIMS-MADE. N/A AGGREGATE 5 I I DED RETENTIONS 5 .WORKERS COMPENSATION XSTATUTE• , _ERH A A(Mane I MEMNEREXC UD EXCLUDED', NIA NIA R2WC940123 06/03/2018 06/03/2019-EL EACH ACCIDENT 5 1,000.000 AND EMPLOYERS'LIABILITY YIN o In E L DISEASE•EA EMPLOYEE 5 1.000,000 If yes describe under OESCRIPTIONOFOPERATIONSbelow EL DISEASE.POLICY LIMIT 5 1,000,000 . N/A . _ _- -- - ---- -- -- - - --._. - ------_ _------- ---- -- DESCRIPTION OF OPERATIONS f LOCATIONS(VEHICLES(ACORD 101.Additional Remarks Schedule,may ba attached I more space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only. Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of Insurance shows the policy in force on the date that this certificate was Issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage car be monibred daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/Iwd/workers-compensationfnvestlgationsl CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Anatoli Sivitski ACCORDANCE WITH THE POLICY PROVISIONS. i 222 Buck Island Road 6-8 AUT•CRIZED REPRESENTATIVE West Yarmouth MA 02673 Daniel M.C"Tee-- M.Crowley.CPCU,We President—Residual Market—WCRIBMA • C11988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD /e Voirtmaitt«eah .. of .draooaeueaeJS Office of Consumer Affairs and Business Regulation One Ashburton Place- Suite 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Type: Corporation Registration: 168043 ro • . I••;MF IMPROVEMENT:INC. Expiration: 12/06/2016 t1'lLIi$1"ND _.. ,.\5;.71.:d 1 H.MA 02673 Update Address and Return Card. ... t.A.r:ndna v,//Lt/"/ii..n.:rn ea • caC,:.•'.t,t;i iaminess Regulation ;• ':rt lMP%OUI-441F77CONTRACTOR Registration valid for Individual use only • r."r•;C.-:••ttgn before the expiration date. 11 found return to: -14w:sr- lAU - Ezglgtion Office of Consumer Affairs and Business Regulation 2ta 1'206:22018 10 Park Plaza-Suit- • •1:_i•irtOVC1SCt4T,ICAC Boston.MA . • ill ;jt � f, Undersecretary Not valid without signature • r '- Commonwealth of Massachusetts lb r 1 it. _: F)+ Division of Professional Licensure • Board of Building Regulations and Standards Construction.S' p¢ rvisor .Specialty CSSL -106040 .,.`` , _ - Ekpires : 05/ 14/2020 t ANATOLI SIVITSKI • artrAi 27 MILL POND`-RD . ,; - '" , , 3 i 4n: 44 �� tom, ; WEST YARMO6TH. MA -02673it 1 ,0410. Commissioner aris la•s- 1-- • • SICOCAPE COD HOME IMPROVEMENT TM 27 MILL POND ROAD,WEsT YARMOUTH MA 02673 (617) 710-1001, (508) 469-0102 CAPECODINC@GMAIL.COM, WWW.ROOFCAPECOD.COM, WWW.FACEBOOK.COM/CAPECODHOME PROPOSAL • 1103.2018 TO RICHARD DOUCETTE LOCATION: 10 MAPLE ST, SOUTH YARMOUTH WE HEREBY SUBMIT SPECIFICATIONSAND ESTIMATES FOR MAIN COMPOSITION SHINGLE ROOF: • REMOVAL OF ALL EXISTING ROOFING AND FLASHING MEMBRANES TO THE PLYWOOD DECK SURFACE. • INSTAUAnON QI"'f2 CJ XPL W0OD DECKING WILL BE REPLACED IN WHOLE SHEETS ONLY IN ACCORDANCE WITH RECOMMENDATIONS BY BOTH THE NATIONAL ROOFING CONTRACTORS ASSOCIATION(NRCA)AND THE AMERICAN PLYWOOD ASSOCIATION(APA).NEW DECKING SHALL BE APA RATED FOR STRUCTURAL USE. DECK FASTENING WILL MEET OR EXCEED LOCAL BUILDING CODE REQUIREMENTS. • REPLACEMENT OF FOLLOWING FLASHING MATERIALS:STEP FLASHINGS,PIPE FLANGES,PERIMETER DRIP EDGE-- - --- MATERIAL AND ALL SKYLIGHT FLASHING MATERIAL.ALL MATERIALS TO MEET OR EXCEED MANUFACTURER'S REQUIREMENTS. • ONE ROW OF ICE AND WATER PROTECTION MEMBRANE SHALL BE INSTALLED IN ALL VALLEYS AND AROUND THE CHIMNEY. • ONE ROW OF ICE AND WATER PROTECTION MEMBRANE SHALL BE INSTALLED ALONG ALL EAVES AND SHALL EXTEND PAST THE INTERIOR WALL UNE A MINIMUM OF 18INCHES TO PROVIDE PROTECTION AGAINST DAMAGE FROM ICE DAMS. INSTALLATION OF ONE LAYER OF ROOFING UNDERLAYMENT ON DECK SURFACE NOT COVERED WITH ICE AND WATER PROTECTION MATERIAL • INSTALLATION OF NEW,ARCHITECTURAL-STYLE ALGAE-RESISTANT CE`R1`iRtkiD SHINGLES.SHINGLES WILL BE INSTALLED IN STRICT ACCORDANCE WITH THE MANUFACTURER'S SPECIFICATIONS AND SHALL BE FASTENED USING SI NAILS PER SHINGLE. M� • COLOR OF ROOF PENETRATIONS AND FLASHINGS TO BE CHOSEN BY OWNER. Orcn,lve__ct • INSTALLATION OF A SHINGLE-OVER RIDGE VENT.VENT IN THIS AREA IS CONTINUOUS AND WILL CAPE COD HOME IMPROVEMENTGUARANTEES THAT ALL COMPONENTS INSTALLED PROPERLY PLEASE FEEL FREE TO CACAPE COD HOME IMPROVEMENT TM WITH ANY QUESTIONS OR CONCERNS LL PLEASE INITIAL THIS PAGE tr. i CAPE COD HS'"'O"T""`"I CAPE COD HOME IMPROVEMENT TM 27 MILL POND ROAD, WEST YARMOUTH MA 02673 (617) 710.1001, (508) 469.0102 CARED ODINC@GMAIL.COM, WWW.ROOFCAPECOD.COM, WWW.FACEBOOK.COM/CAPECODHOME PROVIDE MAXIMUM INTAKE VENTILATION FOR THE FULL ATTIC VENTILATION SYSTEM. • REPLACE ANY DAMAGE FASCIA-BOARDS OR RAKE-BOARDS AT AN ADDITIONAL COST. • ALL GROUNDS TO BE CLEANED UP ON A DAILY BASIS.ALL BUSHES,SHRUBS,AND FLOWERS TO BE PROTECTED.HOMEOWNER IS ASKED TO SUPPLY ELECTRICAL POWER IF NEEDED. OPTION 1 CERTAINT • LA. •MARK SHINGLES 50 YEARS NON-PR'?TED TRANSFERABLE WARRANTY LABOR AN I• ATERIALS. .650.00 DUMPST--• $450.00 TOTAL: :. 6 100.00 OPTION 2 CERTAINTEED LANDMARK SHINGLES 40 YEARS PRORATED WARRANTY(10 YEARS NON-PRORATED PERIOD) LABOR AND MATERIALS: $5,150.00 DUMPSTER: $450.00 TOTAL: $5,600.00 *WE WILL MATCH OR OUTBID ANY LEGITIMATE COMPETITOR* CAPE COD HOME IMPROVEMENT TN IS PROUD TO PRESENT YOU WITH SUPERIOR 1 OYEAR WORKMANSHIP AND SERVICE WARRANTY.THIS WARRANTY IS IN ADDITION TO,BUT RUNS CONCURRENTLY WITH ANY MANUFACTURERS WARRANTIES.IT COVERS ALL SERVICE CALLS RELATED TO WARRANTY REPLACEMENT AND/OR INSTALLATION ISSUES FOR THE FIRST TEN YEARS AFTER PRODUCT INSTALLATION p CAPE COD HOME IMPROVEMENT T~GUARANTEES THAT ALL COMPONENTS INSTALLED PROPERLY PLEASE FEEL FREE TO CALL CAPE COD HOME IMPROVEMENT T• WITH ANY QUESTIONS OR CONCERNS PLEASE INITIAL THIS PAGE COD CAPE CAPE COD HOME IMPROVEMENT TM 27 MILL POND ROAD, WEST YARMOUTH MA 02673 (617) 710.1001, (508) 469-0102 CAPECODINC@GMAIL.COM, WWW.ROOFCAPECOD.COM, WWW.FACEBOOK.COM/CAPECODHOME PAYMENT TERMS: 30%AT DEPOSIT; 30%AT START; 40%UPON COMPLETION. JOB IS ESTIMATED TO COMMENCE APPROXIMATELY 2 TO B WEEKS AFTER DEPOSIT RECEIVED WORK IS SCHEDULED TO BE SUBSTANTIALLY COMPLETED IN APPROXIMATELY I TO 2 WEEKS. ANY WORK ABOVE AND BEYOND THE SPECIFICATIONS WILL BE PERFORMED AT 56.00$PER MAN HOUR PLUS MATERIALS OR PRICED ON REQUEST.ALL ADDITIONAL WORK,INCLUDING TRAVEL TIME AND LUMBERYARD RUNS,MOVING ALL PERSONAL OBJECTS, FURNITURE,ETC.FROM WORK AREA,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 CAPE COD HOME IMPROVEMENTMI WILL PROVIDE CLEANUP ON A CONTINUING BASIS AND ALL DEBRIS WILL BE REMOVED FROM SITE(PROFESSIONAL CLEANING DOESN'T INCLUDE).ALL PRODUCTS INSTALLED BY CAPE COD HOME IMPROVEMENT Im 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. OWNER TO MOVE ALL PERSONAL OBJECTS,FURNITURE,ETC.FROM WORK AREA.ALL ITEMS AGAINST WALLS SHOULD BE CONSIDERED FOR REMOVAL DURING ANY EXTERIOR SIDING JOBS,ADDTONS,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.CAPE COD HOME IMPROVEMENT TIA IS NOT ---- _ _ - _ - ' -----_ RESPONSIBLE FOR ANY DAMAGES IF SAID ITEMS REMAIN IN PLACE. CAPE COD HOME IMPROVEMENT TM IS NOT RESPONSIBLE FOR ANY DAMAGES THAT MAY OCCUR DURING CONSTRUCTION TO LANDSCAPING OR ANY FINISH GROUND WORK,PLANTINGS,ASPHALT OR STONE DRIVEWAY, ETC.FLOWERS AND SHRUBS AGAINST HOUSE MAY NEED TO BE REPAIRED OR REPLACED BY HOMEOWNER. 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 PLACED ON THE RESIDENCE AS A CONSEQUENCE OF THE CONTRACT.OWNER WHO SECURE THEIR OWN CONSTRUCTION-RELATED PERMITS OR DEAL WITH UNREGISTERED CONTRACTORS WILL BE EXCLUDED FROM ACCESS TO THE GUARANTY FUND. CAPE COD HOME IMPROVEMENT TM GUARANTEES THAT ALL COMPONENTS INSTALLED PROPERLY , PLEASE FEEL FREE TO CALL CAPE COD HOME IMPROVEMENT TM WITH ANY QUESTIONS OR CONCERNS PLEASE INITIAL THIS PAGE • "diaz" w, CAPE COD HOME IMPROVEMENT TM 27 MILL POND ROAD, WEST YARMOUTH MA 02673 (617) 710.1001, (508) 469-0102 CAPECODINC@GMAIL.COM, WWW,ROOFCAPECOD.COM, WWW.FACEBOOK.COM/CAPECODHOME COSTS OFF COLLECTION,INCLUDING ATTORNEYS FEES WILL BE RECOVERABLE,IN THE EVENT OF NON- PAYMENT. WE LOOK FORWARD TO WORKING WITH YOU: PLEASE CALL IF YOU HAVE ANY QUESTIONS. SINCERELY CAPE COD HOME IMPROVEMENT THIS CONTRACT NOT VALID UNLESS SIGNED BY ANATOL!"TONY' SIVITSKI ACCEPTED BY , Car C,ducc-'TI-e_ SIGN frf-DATE 77711 Vl� O 1c A ACCEPTED BY I U... (V ]� SIG � \ DATE `4AMIS ACCEPTED BY SIGN DATE CAPE COD HOME IMPROVEMENT T^M GUARANTEES THAT ALL COMPONENTS INSTALLED PROPERLY PLEASE FEEL FREE TO CALL CAPE COD HOME IMPROVEMENT TM WITH ANY QUESTIONS OR CONCERNS PLEASE INITIAL THIS PAGE