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HomeMy WebLinkAboutBLD-19-003354 'Office Use Only °1YA �c REC �� VE ° NEW „) sy 0 � DEC0 3 213113 Amount N� "*-”' d. Permit expires 180 days from 7 EPART .Par' , issue date jn7a f•, EXPSS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth,MA 02664 2 (508)398-2231 Ext. 1261 CONSTRUCTION ADDRESS: 36 3avail Ave. W- yeti( u-4., P14- ASSESSOR'S INFORMATION: I Map: Parcel: OWNER: Pox:4 IowexS 36 Saco( 11-Ife .lnt. Tr((mad( Ityi9 cn -36v -SSS / NAME n PRESENT ADDRESS TEL V CONTRACTOR:A(MM Sala.ryttn 7 Sea s'1 • Yvan/1 l,it> OUVI Si) - 776 - 290 0 NAME MAILING AD ESS TEL P a•Residential ❑Commercial Est.Cost of Construction S 61 CO O Home Improvement Contractor Lie.# I S 3 20 2 Construction Supervisor Lic.# (t) 6(O 2 Workman's Compensation Insurance: (chick one) ❑ I am the homeowner Qin the sole proprietor ❑ I have Worker's Compensation Insurance Insurance Company Name: - Worker's Comp.Policyft WORK TO BE PERFORMED Tent _ Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares j . ( t....)-ttemove existing*(max.2 layers) Insulation_ Old Kings Highway/Historic Dist. ( )Replacing like for like Pool fencing 'The debris will be disposed of at: Ya rmtlu,tt, Location of Facility I declare under penalties of perjury that e stat n/ 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 fo • •':I or rev ati n fm f pros, 'm under M.G.L Ch.268,Section 1. Applicant's gnature: X ,�i /`^ /1 Date: N. 0 3 , )3 Owners S gnature(or attach t) - / Date: Approved By: - Date: Building Official • EMAIL ADDRESS: Zoning District: Historical District: ❑ Yes ❑ 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 Massac.husetts r _`rye=Et Department fIndustrial Accidents a =:el_ 11 Congress Street,Suite 100 k =_i� = ; Boston,I MA 02114-2017 / .0.` www}massgov/dia Workers'Compensation Insurance Affidavit:Builders/ContnMors/Electricians/PIumbers. j TO BE FILED WITH TIHE PERMITTING AUTHORITY. Applicant Information n Please Print Legibly Name(Business/Organization/Individual): Af Mf t1 CP IJJ pyyi Wit Address: 6 7 S epL e City/State/Zip: 'µiCtinn:7iNF3- 't5it0 / I Phone#: 5-vt -176 - 29(x0 An you an employer?Check the ( appropriate box: Type of project(required): YP (req rte: I. am a employer with employees(full and/or part-tkne)1e 7. Q New construction ZQ I am a sole proprietor or partnership and have no employees working forme in - 8- ❑Remodeling any capacity.(No workers'comp,insurance required.] IlIl 3.p I am a homeowner doing en work myself no workers'comp.insurance 1 9. ❑Demolition required.] 4.0 I am a homeowner and at be hiring contactors to conduct all work on my property. 1 wnl 10 O Building addition ensue that an contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees, 12.n Zdombing repairs or additions 5.❑Iamageneral contractor and Ihave hvedthe sub-contredorsI' on the attached sheet LxOO These sub-contracbn have employees end have workers'comp.itmamnee•t 13. frepairs 6.0 We an a corporation and its officers have exercised their right of exemption per MGL c. 14.0 Other 152,11(4),and we have no employees.[No workers'comp.insureoce required] *Any applicant that checks box#1 must also 5ll out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they we doing all world and then hire outside contactors 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 snot those entities have employees If the subcontractors have employees,they must provide tEheMworkers'comp.policy number. I ant an employer Mat is providing workers'compensafionS insurance for my employees. Below is the policy and Job site information. lIr Insurance Company Name: Policy#or Self-ins.Lie.#: I Expiration Date: IJob 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 as required under MGL c. 152,§ 5A is a criminal violation punishable by a fine up 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$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. � I do hereby un the v '� caih , ,penalties of perjury that the Information provided above Is true and correct. Signature: I Date: 1 a • 3 1 O Phone#: 'co$ -776- ' J 1 Ofjtclal use only. Do not write In this area,to be completed by city or town ofJidaL City or Town: i I 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 I Contact Person: Phone#i 1 . COREN & COREY " The Roofers 4667 SEA STREET APT# A4, HYANNIS MA 02661 PHONE 1-508 .775-8240 CERTAINTEED LANDMARK LIFETIME- ALGAE RESISTANT ARCHITECTURAL STYLE RE - ROOFING PROPOSAL September 29 2018 DAVID TO RS 36 SCHOLLVE. EM: towers296®gmail.com W.YARMOUTH,MA Te l: 508-360-5581 COREYCOREY hereby proposes to perforin the following services in a neat and professional manner and i accordance with the manufacturer's specifications and local building codes. ' Remove and Haul Away MI of the Old Asph!It Roofing Shingles(One Layer)from the Entire House Only and Old Lead Flashing from the Entire Chimney.Re Nail All Plywood Sheathing as needed. Supply and Install ALL NEW 12"LEAD FLASHING ON THE ENTIRE CHIMNEY USING ONE CONTINUOUS LEAD ON THE SIDE AND COUNTER FLASHING ALL THE SHINGLES WITH ALS JMINUM/LEAD FLASIHNGS UNDERNEATH Supply and Install CERTAINTEED LANDMARK 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 HI HURRICANE,STORM/HURICANE NAILED (6 NAILS PER SHINGLE), MULTI-LAYERED,LAMINATED ARCHITECTURAL STYLE,FIBERGLASS BASED ASPHALT SHINGLES. COLOR: BIRCHWOOD Supply and Install 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 Ill CERTAINTEED'S "ROOF RUNNER" SYNTHETIC ROOFING PAPER Supply and Install AIR VENT SHINGLE VENT II RIDGE VENT on the Entire Ridge. Supply and InlIstall ALUMINUM & NEOPRENE SOIL PIPE FLASHINGS Clean and Refnove Debris from work area after job is completed. ii TOTAL INVESTMENT ------ $6,500.00 COREY & COREY " Tithe Roofers 1 POSSIBLE EXTRA CARPENTRY: Any Rotted or Otherwise Deteriorated Trim Boards,Plywood Sheathing,lylissing Metal Flashing,Side Walling or Any Other Carpentry Needing Replacement will be done hnd charged for as an Extra:Materials Plus Labor at the Rate of$60.00 per Hour(For Each Laborer In+olved). PAYMENT SCHEDULE: A Deposit of Ons c Half is due at the Signing of this Roof Proposal and the Final Paym nt for the Balance is Due Immeiately Upon Completion. WORK SCHEDULE: All Roof Work is Sch"eduled 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. I Please Make Checks Payable to: CORjEY & COREY COREY & COREY Warranties the Shingles and Labor for 10 years. CERTAINTfEED Warranties the shingles andlabor 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. CERT ED Warranties the Shingles to be Algae Resistant for a Full 10 Years. COREY & COREY (carries Workman's Compensatio 4 and Public Liability Insurance on the above work DATE OF ACCEPTANCE: /0. C. 18 ACC ' D BY: SUB ! t : f 'I go / _i h DAV( D TOWERS lir A ' ETV• ' YAN HOMEOWNER CORE " & COREY HIC # 183202 CSSL# 106102 A`�b® CERTIFICATE OF LIABILITY INSURANCE DATE(MMa1OWYYY) 09/132018 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: ifthe 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 certificate holder In lieu of such endorsement(s). PRODUCER CONTACT Ashley Paiva NAME: Eastern Insurance Group • PHONE EMI: (508)997-6061 FAX 508990-2731 (EM I(Are.Ne): ( ) 439 State Rd. t RA L apaiva@easteminsurance.com P.O.Box 79398 INSURER(S)AFFORDING COVERAGE NMC e - North Dartmouth MA 02747 INSURER A: Arbella Protection Insurance 41360 INSURED INSURER B: • Armen 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 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. INSRLTYPE OF INSURANCE IN DsMD POLICY NUMBER POLICYEFFMWDCYExP LIMITS (MOLIC EFF (POLICY EXP X COMMERCIAL GENERALLIABLITY • EACH OCCURRENCE $ 1'000'000 l�y� DAMAGE TO RLN fE0 I CLAMS-MADE 1'1 OCCUR PREMISES(Ea occurrence) S 100 000 _ — MED EXP(Ary one person) $ 5,000 A ' 952004644104 09/18/2018 09/18/2019 PERSONAL AAD/INJURY $ 1,000,000 — GENT-AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2'W'® 1 POLICY❑JJECT 0 LOC PRODUCTS-COMP/OPAGG $ 2,000,000 '—il OTHER: _ • AUTOMOBILE LIABILITY (CEOMBI�NEDMSINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ — OWNED — SCHEDULED BODILY INJURY(Per accident/ $ _ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA A — OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I J RETENTION 5 ��11 $ KE WORRS COMPENSATION ISTARTUTE IX ERµ AND EMPLOYERS'LIABILITY A ANYPROPRIEIORMj1RTNERIE%ECIfTNE YO NIA 952004644101 09/162018 09/18/2019 EL.EACH ACCIDENT $ 1,000,000 R/MEMNER EXCLUDED? (Mandatory In NH) EL.DISEASE-EA EMPLOYEE $ 1,00000 Mew,describe underDESC1,000,000 DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT $ DESCRIPTION OP OPERATIONS I LOCATIONS/VEHICLES(AGGRO tat,Additions RemmMke Schedule.may M aesdi d N more spore Y 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 1 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2011/03) The ACORD name and logo are registered marks of ACORD J. gi , , ,. /9�� acidezatee • • Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 Home Improve ' Ill V entContractor Registration ' 6 ARMEN SAFARYAN :+ Type Individual Registration: 183292 67 SEA ST APT A4 Expiratlorc os/13/2o1s HYANNIS, MA 02601• , ' 1 S ° '" '+T , Updat,"7-1-----.eand return card. See rantwonerectliartedet74.16104.1/94 - Moe of ConsumnarAlfeae&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE'Irxfnddual Regtstretlon valid for Individual use only ._ _. Exbefore the expiration date. If found return t0: t Regiesgai ! p ffi Office of Consumer Affaks and Bolan-.11 Regulation ,�0W132019 , 10 Park Raza-Suits 51 . IMEN SAFAi?YAN Boston,MA 02118 /WA COREYCOREY j MEN SAFARI&AN' z SEA ST APT Aa »5' i ANNIS,MA 02601 `{ - I lag 1 undersecretary i Not valid thout m.n7 re i f. i ®, Massachuse}ts Department of Public,Sat Board ofBuilding Regulations and Standards .License:CSS -108102 Construction Superinsor Specialty j G . ARMENSAFARYAN . I BT SEA STREET APT A4 "MANN'S MA 02801 • l'.. •I-. . . i rcX.uv. qra., Comhilasloner Expiration: j l10/0212020 . . ,