The URL can be used to link to this page

Home My WebLink AboutBLD-19-3964 YqR� Office Use Only k• ! O IPerm hit ' f' Kik I Amount O ^'+, '+ " es° /`/ r - 1 Permit expires 180 days from ay(/�() I� _� issue data—. ... x �fJld ! C o h E L EXPRESS BUILDING PERMIT APPLIC A T ON TOWN OF YARMOUTH '^N07 Yarmouth Building Department LLL I 1146 Route 28 au _5y1r South Yarmouth,MA 02664 `� C (508)398-2231 Ext.. (x11261 CuCu CONSTRUCTION ADDRESS: IQ Cr Set 6-a 'no,"l 1J, yecrrV� t ASSESSOR'S INFORMATION: L / Map: Parcel: / OWNER: pt a i k. 5-4 44-4�A U az O set kr," toad lu)4a , 7-190 -Se/( NAME• //- � / PRESENT ADDRESS / L TEL # CONTRACTOR: (4/A l/1//Q Were "' . 1(Z- .73 /4JJis /lI (J j Sd 3-—G 9 '/-Th/f J NAME MAILING ADDRESS TEL# ,$.Residential 0 Commercial Est.Cost of Construction S /elf Oa ' It I Home Improvement Contractor Lia# /9 3S-47 Construction Supervisor Lie.# C S -119/o_C. Workman's Compensation Insurance: (check one) 0 I am the homeowner 0 I am the sole propriiettor / have Worker's Compensation Insurance 7 �^ Insurance Company Name: 4-556 C /t!t I e y orees i�Worker's Comp.Policy!, air(.S-&< O I?Z2120 1Q' WORK TO BE PERFORMED Tent _ Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# 1-19 Replacement doors: # Roofing: #of Squares ( )Remove existing*(max.2 layers) Insulation Old Kings Highway/Historic Dist. ( )Replacing like for like Pool fencing 'The debris will be disposed of at: U m`"'") Oy \la /ill ea, /0,4,01 f 4 t/ Cy Location of Facility 1 declare under penalties of perjury that the statements herein containedMe true and correct to the best of my knowledge and belief. I understand that any false answer(s) will be just cause for denial revocatipn of my license an prosecution under M.G.L.Ch.268.Section 1. Applicant's Signature: W Date: 7/37n, Owners Signature r attachment) Date: Approved By: Date: I —i9 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 It of Wetlands: 0 Yes 0 No 0 Yes 0 No SANDD-2 OP ID:DS A`ORO' CERTIFICATE OF LIABILITY INSURANCE oA'y1912018 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. H the certificate holder Is en ADDITIONAL INSURED,the polcy(Ies)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). PRODUCER 508-775.6060 gOtcT Bryden&Sullivan Insurance Bryden&Sullivan Ins Agency PHONE 508475.8060 I FAX 508-790-1414 88 Falmouth Road (Ale,NP,EA: (A/C,Ref Hyannis MA 02601 Ugh Bryden£Sullivan Insurance INsURERIS)AFFORDING COVERAGQ RAMS Ep INSURER A:Mapfre Insurance 34754 su Medi gpins LLC INSURER :Associated Employers Insurance o Yarmaoouth, AA 02884 INSURER C: INSURER 0: INSURER!: INSURER P: 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 POUCY 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 AU.THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ 1 1NER j�STIR POLICY NUMBER POUCY Patty rye.yl UNITS ITR TYPE OF INSURANCE COMMERCIAL GENERAL LIABILITY JfMM n JACH OCCURRENCE JS f CLAIMS-MAO! OCCUR PRA Ml. RENT e) t _ MED EXP(Anr one Deem)• S 12E124,QNAL 6 AW INJURY_j GEAR AGGREGATELIMIT Li LRIMII.T Alert ES PE S R GENERAL AGGREGATE t _ RPOLICY❑JECT LOC PRODUCTS-COMP/OP AGO OTHER A AUTOMOBILE OITY (Fad INGIE LIMIT t _ 100,000 • — ANY AUTO BHMWLT 02/02/2016 02/02/2019 BODILY INJURY KW person) t _ AUTOS ONLY X AUTOHOS BODILYINJURY(Per e een t 300,000 X Nin OeLY Xkilanttic FAr°RESmdR,yea AGE ! 250,000 a UMBRELLA LAAO _ OCCUR EACH OCCURRENCE S _ EXCESS LAB CLAIMS- ADE AGGREGATE S i DED I RETENTIONS B WORKERS COMPENSATION I EPRTUTE I I�RTH- ANDEMPLOYERS'WBeILY STA � E ARTNERIEXECULNE WCC50050197212018 12104!20181210412019 E.L EACH ACCIDENT $ 500,000 FILE reirg EX0.UDED'/ Y NIA nYn,dnaIb.Buse EL DISEASE-EA EMPLOYEE $ 500,000 DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT S 500,000 DESCRIPTION OP OPERATIONS/LOCATIONS/VEHICLES IACONO 101,Addm cod Remake Schedule,mey M Aeaelme IF len limn le required) Certificate Issued for Insurance verification. CERTIFICATE HOLDER CANCELLATION HECH000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN HECH ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main St PO Box 638 AUTHORED REPRESENTATIVE West Harwich,MA 02671 Bryden&Sullivan Insurance ACORD 25(2016103) , C 1988-2015 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD • Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, M s chusetts 02118 Home Improvers tractor Registration =>k Type: Corporation SAND DOLLAR CUSTOMS LW �- if Registration: 193587 =_:'v__ Expiration: 10/29/2020 1851 FALMOUTH ROAD —' t= CENTERVILLE,MA 02632 = �_ Vzi Err.: t:=—_ e v .o V ma Update Address and Return Card. SCM 0 20M05/17 Mei"ommasee•eadIV o Offke of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE • •• :1• - - ... - - before tM expiration date. N found return to: „ • i t-i-a FxDIration Office of Consumer Affairs end Business Regulation mIT4 935tt 10/29/2020 1000 Washington Street-Suite 710 SAND Daunt. • 19 :L Boston,MA 02118 WALTER R.WA \2lat.--- �, I 1851 FALMOUTH ftEtA[5' (� _ r �� CENTERVILLE,MA 0 2 Undersecretary - Not v " • Ignature • c Commonwealth of Massachusetts laf Division of Professional Licensure Board of Building Regulations and Standards Constri tt6d%Bp;rvisor 1 CS-091653 Y 141 :i, Ld�ires:09/30/2020 WALTER R V RREN { 4�{ P. , 40ALEXAND DR a O YARMOUTH lPOPT ,MA 02675 >. '4 . stn/Sstir0t .„ .., -• +..�... Commissioner J • Manufacturing HARVEY ACKNOWLEDGEMENT i at BUILDING PRODUCTS Harvey Industries,Inc. 1400 Main Street.Waltham,MA 02451-1689 (781)899-3500 harveybp.com _ Dealer Quote Summary BILL TO: SHIP TO: WestBridgewater 10 TtanpIce Street WEST BRIDGEWATER,MA 02379-9100 Phone:(508)584-5300 Fax:(508)584-1139 HOME REMODELING HOME REMODELING plAlJ 1, I'II�I�II�m�IIIIII� 117 PLEASANT ST 117 PLEASANT ST 8 �Ib {I�Ib I��Iba111 STOUGHTON,MA 02072-2632 STOUGHTON MA 02072-2632 Phone: 781-589-7012 Fax: 7812970138 Phone: 781-589-7012 Fax (781)297-0138 QUOTE NBR CUST NBR CUSTOMER PO ENTERED DATE ORDERED ORDER TYPE 4510345 1009377 11/14/2018 Quote Not Ordered Cash ORDERED BY STATUS SHIP VIA DELIVERY AREA MARK None Whse Pickup WEST BRIDGEWATER WAREHOUSE CLERK JOB NAME COUPON MIC -Mike Carlson SHEYTANIAN I LINE# DESCRIPTION Q11 UNIT PRICE EXTENDED 10000-1 Vinyl Awning,Unit Size 23 x 22,RO 23.5 x 22.5 2 $288.88 $577.75 - Unit 1:U-Factor=0.26,SHGC=0.22,VT=0.38, HII-M-39-02003-00002,Size Options=Custom Size,New Construction, Operation/Vented As Viewed From Outside=Vent / Frame Width(Inches)=23,Frame Height(Inches)=22 y Double Glazed,Double Low-E RS,Argon Filled rl. Base Color=White,None Fiberglass Mesh Contour In-Glass,Colonial,Match Frame,2W2H Integral L Fin Adaptor,Receiver Pocket 4 9/16",Primed,4 Side Factory Applied I Ro?23.5 Overall Frame Width(Inches)=23,Overall Frame Height(Inches)=22, Overall Rough Opening Width(Inches)=23.5,Overall Rough Opening Height(Inches)=22.5 E.Star Zone:North=Yes,E.Star Zone:North-Central=Yes,E.Star Zone:South=Yes,E.Star Zone:South-Central=Yes Room Location: None Assigned I LINE# DESCRIPTION QT] UNIT PRICE EXTENDED, 11000-1 Classic DH,Unit Size 21.5 x 363,RO 22 x 37 7 $260.57 $1,824.00 Unit 1:U-Factor=0.25,SHGC=0.27,VT=0.48, HII-M-31-02273-00002,Size Options=Custom Size,New Construction, Fully Welded I n Frame Width(Inches)=21.5,Frame Height(Inches)=36.5 L Double Glazed,Double Low-E RS,Argon Filled � --L---_ Base Color=White,None Single,Sash Limit Devices=Night Latch I — Half Screen,Fiberglass Mesh 1 Contour In-Glass,Colonial,Match Frame,3W2H Integral L Fin Adaptor,Receiver PocketRod az 4 9/16",Primed,4 Side Factory Applied Overall Frame Width(Inches)=21.5,Overall Frame Height(Inches)= 36.5,Overall Rough Opening Width(Inches)=22,Overall Rough Opening Height(Inches)=37 Clear Opening Width=16.5,Clear Opening Height=13.125,Clear Opening Square Footage=1.5 E.Star Zone:North=Yes,E.Star Zone:North-Central=Yes Room Location: None Assigned Last Update: 11/14/2018 3:49 PM Page 1 Of 3 Printed:11/14/2018 3:50 PM • QUOTE NBR CUST NBR CUSTOMER PO ENTERED DATE ORDERED ORDER TYPE 4510345 1009377 11/14/2018 Quote Not Ordered Cash ORDERED BY: STATUS r SHIP VIA DELIVERY AREA MARK None Whse Pickup WEST BRIDGEWATER WAREHOUSE CLERK JOB NAME COUPON MIC -Mike Carlson SHEYTANIAN !LINE# DESCRIPTION QT1 UNIT PRICE EXTENDED 12000-1 Classic DH,Unit Size 27.5 x 36.5,RO 28 x 37 3 $264.59 $793.78 Unit 1:U-Factor=0.25,SHGC=0.27,VT=0.48, HII-M-31-02273-00002,Size Options=Custom Size,New Construction, Fully Welded Frame Width(Inches)=27.5,Frame Height(Inches)=36.5 Double Glazed,Double Low-E RS,Argon Filled m„ Base Color=White,None rc Single,Sash Limit Devices=Night Latch Half Screen,Fiberglass Mesh 1 Yi Contour In-Glass,Colonial,Match Frame,4W2H I Integral L Fin Adaptor,Receiver Pocket z 4 9/16",Primed,4 Side Factory Applied Overall Frame Width(Inches)=27.5,Overall Frame Height(Inches)= 36.5,Overall Rough Opening Width(Inches)=28,Overall Rough Opening Height(Inches)=37 Clear Opening Width=22.5,Clear Opening Height=13.125,Clear Opening Square Footage=2.05 E.Star Zone:North=Yes,E.Star Zone:North-Central=Yes Room Location: None Assigned {LINE# DESCRIPTION QT] UNIT PRICE EXTENDED, 13000-1 Classic DH,Unit Size 35.5 x 36.5,RO 36 x 37 1 $269.95 $269.95 Unit 1:U-Factor=0.25,SHGC=0.27,VT=0.48, HH-M-31-02273-00002,Size Options=Custom Size,New Construction, Fully Welded 1 11 Frame Width(Inches)=35.5,Frame Height(Inches)=36.5 Double Glazed,Double Low-E RS,Argon Filled ^' — ------ _ Base Color=White,None rc Double,Sash Limit Devices=Night Latch Half Screen,Fiberglass Mesh Il l Contour In-Glass,Colonial,Match Frame,4W2H Integral L Fin Adaptor,Receiver Pocket Ro s6- 4 9/16",Primed,4 Side Factory Applied Overall Frame Width(Inches)=35.5,Overall Frame Height(Inches)_ 36.5,Overall Rough Opening Width(Inches)=36,Overall Rough Opening Height(Inches)=37 Clear Opening Width=30.5,Clear Opening Height=13.125,Clear Opening Square Footage=2.78 E.Star Zone:North=Yes,E.Star Zone:North-Central=Yes Room Location: None Assigned Last Update: 11/14/2018 3:49 PM Page 2 Of 3 Printed:11/14/2018 3:50 PM QUOTE NBR , CUST NBR CUSTOMER PO ENTERED DATE ORDERED ORDER TYPE 4510345 1009377 11/14/2018 Quote Not Ordered Cash ORDERED BY ` STATUS SHIP VIA DELIVERY AREA MARK None Whse Pickup WEST BRIDGEWATER WAREHOUSE CLERK JOB NAME COUPON MSC -Mike Carlson SHEYTANIAN LINE# r DESCRIPTION r QT1 UNIT PRICE EXTENDED 14000-1 Classic DH,Unit Size 93.25 x 39.5,RO 93.75 x 40 1 $815.64 $815.64 Unit 1,3:U-Factor=0.25,SHGC=0.27,VT=0.48, HII-M-31-02273-00002,Size Options=Custom Size,New Construction, Fully Welded Unit 2:U-Factor=0.25,SHGC=0.27,VT=0.48 1I ■Ai ■A■ ■A■ a HII-M-31-02273-00002,Size Options=Custom Size,New Construction, a 1.1111111111111111114111111 Double Hung,Fully & •v• 1BAA Aw. g Welded I I IMBE Mli�llnil Unit 1,3:Frame Width(Inches)=31.875,Frame Height(Inches)=39.5 —313/5—or—31 WA—. Unit 2:Frame Width(Inches)=32,Frame Height(Inches)=39.5 Ru%mrr Double Glazed,Double Low-E RS,Argon Filled Base Color=White,None Double,Sash Limit Devices=Night Latch Half Screen,Fiberglass Mesh Contour In-Glass,Colonial,Match Frame,3W2H — - Integral L Fin Adaptor,Receiver Pocket 4 9/16",Primed,4 Side Factory Applied Overall Frame Width(Inches)=93.25,Overall Frame Height(Inches)= 39.5,Overall Rough Opening Width(Inches)=93.75,Overall Rough Opening Height(Inches)=40 Unit 1,3:Clear Opening Width=26.875,Clear Opening Height=14.625, Clear Opening Square Footage=2.73 Unit 2:Clear Opening Width=27,Clear Opening Height=14.625,Clear Opening Square Footage=2.74 E.Star Zone:North=Yes,E.Star Zone:North-Central=Yes Room Location: None Assigned **Note:Delivery charges may apply and are not Included on this quote. This quotation is based on our interpretation of the information provided. All quantities,sizes,extensions, 'SUBTOTAL: I $4,281.12 grand totals,and specifications should be verified by the contractor prior to his/her bidding or ordering of materials. Harvey Industries,Inc.,is responsible only for the items as quoted above. Any changes or TAX:. I $267.57 addendums will be subject to a requote. We propose to supply the materials as described above,subject to the terms and conditions as required by our credit department. The prices are guaranteed for 30 days from (ORDER TOTAL:I $4,548.69 the date of quotation unless otherwise noted. Delivery charges may apply and are not reflected on this quote.We appreciate the opportunity to quote this job. If you have any questions,please call your local warehouse. CUSTOMER SIGNATURE DATE Last Update: 11/14/2018 3:49 PM Page 3 Of 3 Printed:11/14/2018 3:50 PM • • __� The Commonwealth of Massachusetts =' _4'/ Department oflndustrialAccidents r :Id1 Congress Street,Suite 0 • _ a Boston, MA 02119 2017 "as. w,;,,� wwmass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. /Applicant Information Please Print Lefibly Name(Business/Organization/Individual): SO tref aro"a r" lv s,44Y7S I £ C Address:r,) e ",„/ City/State/Zip: Sc'. . 4/60 Phone#: svcF ' G PV-_r-die? Are you an employer?Check the appropriate box: Type of project(required): i.�a employer with / employees(5i11 and/or part-time).* 7. 0 New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. )emodeling ... - any capacity.[No workers'comp.insurance required.) 3. I am a homeowner doingall work _ -- - - 9. ❑Demolition ❑ myself[No workers'romp.insurance required.): 10 0 Building addition 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0 I am a gement contactor and I have hired the sub-contactors listed on the attached sheet 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.0 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 SI must also fill out the section below showing their workers'compensation policy information. t Homeowners 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: 4155aCf'nt� /o1-e4 Policy#or Self-ins.Lie.#: C✓C SO /7 7) /a) Q'/ R Expiration Date: /a/y/1 ? Job Site Address:,(p 3 0.00.1'vw t Ra Lit. 'o,(4tu- City/State/zip: `'J. (� 73 Attach a copy of the workers' compensation policy de aration 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$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Sienature: �f Date: (Z ( 3( / II Phone#: s d - o 9 et' - ee f ( Official use only. Do nor write in this area,to be completed by dry or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 0 Sand Dollar Customs LLC Estimate 23 Whites Path Suite G2 Date Estimate# South Yarmouth MA . 8 12018 206 02664 Name I Address Mark Sheylanian 26 Sagamore Road West Yarmouth Ma.02673 Project Description Qty Cost Total _r.---. r a...,, 1i IB - +lYA6 Door Landings: ASSN� Remove existing landings,install 12"sono tubes with concrete and install new 4x4 PT decks. 3i 1 each. Exterior Doors(2): tains gimp each Permits,Disposal,Insurance . 00 4t O$/ �� Aa CLAStN6 0c U IS SO yOV CAN 1STaaT Tl E- �oitie. `` FI �/ Mtc. cc it ( YL I IC you WouL> Luca t,ET ft V No uJ WILL 'BE• 71."31‘) CINi me CAee aN tl I lc- You I&UANr TO fit Op To Go (iv& ALL TIC ihrntLs tLrT4e aus6". Ct4cc_ ► 1.4tint•C- (Gtr-) Bt-Q- 3411 . t t{ANY /. 5 Total T Customer Signature �' ' Page 4