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Home My WebLink AboutBLD-19-003919 Office Use Only ,,..k.: YAR,trO, Permit# u :alit./A C Amount SO- ` 1 N� cid Permit expires 180 days from issue date I�0—I l�– "E-4 -I EXPRESS BUILDING PERMIT APPLICA I ---- TOWN OFYARMOUTH JAM 03 j",o Yarmouth Building Department 1146 Route 28 Bud , a ,- P Ii7/,�',"7(�/ Vr l.�-. South Yarmouth,MA 02664 (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: 12 SN b il{I tiA an 0,f__/15,t Da- S . 1 ASSESSOR'S INFORMATION: • - Map: Parcel: f OWNER: �T tAt.1ek LAO 2 i le ` 2/C- 11,$S NAME PRESENT ADDRESS TEL. # CONTRACTOR:5t01r GM ES o RU. 00% 61,4 SAC H0L.= ]tilt. 50x-333-Ij'3z __ NAME MAILING ADDRESS TEL.# Gittidential 0 Commercial Est.Cost of Construction$ 5 50 -w Home Improvement Contractor Lic.# 1416#.52 Construction Supervisor Lie.# 10t C, Workman's Compensation Insurance: &heck one) 0 I am the homeowner 01 am the sole proprietor 0 I have Worker's Compensation Insurance Insurance Company Name: Worker's Comp.Policy# WORK TO BE PERFORMED Tent _ Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# I 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 yfvunourrik t rm l Fd I 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 den'. . vocal* of my license and for prosecution under M.G.L.Ch.268,Section 1. T Applicant's S': atur' / I Date: V , 3r 201G� ni Owners S';nature(or ttach , •. t� :,;/%), _ Lu .A Date: �i7'n .. 20 /9 Approved : : .4 401.2 e.C_ Date: / • I ./�l Iuil•uig 0: m. �� 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 :#anogd :uos10d;as;uo3 a aopadsui Slnid utqu •c ao;aadsui trap:pa13 •t yaaiJ umo•1/,C;lJ '£ 3 uam;.zedaQ Suipiinfi 'Z gllEag;o pizog sog./ :(auo apna) &4laoq;ny Sumssi #asuao]slmaad :nmo•1•ao£i) 7vptfjo ueaoj Jo dip rfq papiduloa aq o; 'vane sryj u:d UM lou oa •rfjuo asn mobilo cc_si -925 :#auogd f'! —1 :;;sa :anususis 7JaJJov puv am/n adogv pap ioJd uopvuu ojui ay;jvy;rf.n[Jad jo sapjvuad pup sumd az Ja u • no rfgaaay op I •uogsoguan anuanoo aousansul Jo;y1Q aqa;o suo12 t sanu];o aoti}o atg of papsemao;aq but;uama;s;s slog;o ridoo y•Jolsiotn atg;sureos iCsp 00'0SZs o;do;o our;s pu2'113010}1110M d01s s;o talo;aq;rat sauisuad limo ss nom ss yuatmiosudun Jna&-auo Jo/pus 00.00S`I S o;do aug s Aq aigsgslund uogsiotn isultnuo s sl ycz§ `ZSi 'o 'IrJyi aapun pannbaa ss aoEaanoa aanoas o;aznired •(a;tp nousndt;put aagmnu&aiiod aq;omAmogs)ancd uoguaspap,Caiiod noussnadmoa ,saaaiaom aq;;o ddoa u gaE4y :dIZ/a3s1S/A10 :ssaxppy qof :mu nousaldx3 :#'on•srn- as Jo#,Bohol :atuBN Arndmop aaua:n=1 •uopvuuojuz ajts gofpun (fogod azp sj Mojag •saarfojduJa fiu dajaouv.nsuj uogvsuachuod,S1aa/Joot Zuipmoid sz mg Ja&jduua tin uuv 'nqumu lagod'dwoa•S OM amp app&oid ssnm/am'saaAojdwa ansy slons13uorgns;yin -saa&ojdma any sagpua;soul 101110;apatite.2121S pus slolasauoo-qns;gi;o sumo az Sujmoys its jeuopjppe us pagaein isms xoq sup spays stip Stonszmopt 'yaps Smltotpu untpuga Maus 1!wgns 15nu siontxmo3 2pysl110 1111.1 uagl pus apom us Salop an Adz Ilmieojpul slAEpan sup smlgns owls.snumoawoH vopsu opn Aogod uopssuadwoo,slnpom aagi Sul/ous mopq uopoas aqi;no jig osis until j#xoq spays;etp sutaydde,Soy, [-paitnbal aauemsul'dump•sarpot oty] saaAojdwa ou anti an pus'&)i§'usI .0 Ion lad uopduaxa;o 1 4u amp pasjalaxa aneu Lm aa S'41j put uotmvodloo s an P`CQ I'q(n aag10 Ern a 'g saredaa;oog❑ £i t aouemsut'dump•S1a)j1om;nu pus saaAojduta ansy sloloeauoo-qns asaq•I, 7aays pagoeae atp uo p;istj slonsauoo-qns:us psag anti I pus 4OiOEnua°jtaauaS s tug I❑'S suouipps Jo s.rpdaa atnqumid❑ti saa co dwa CuI Limn sacnudold suoiupps 10 saredaa iso1110a13❑ i i ;jot ale to aauemsal uopEsuadwos,sasupot any Jagila 51%OEgno3 us Imp 011151.12 PI. g ❑ 01 li!M I .41200.20 Am uo 1pom jje nnpuoo 01 S1oiDEauoa Euu1g aq IL 'put raumoawoq a till I❑'t uo Iu.PP E oni to uouHomaQ ❑ •6 i['paimbai:outman dwoa•Sfl m jloopt]31asA to vontut Salop laUMoawoq a WI I❑'E ['pannbai aoutinsuj'du=•sn1)lom oly]'Au sdso lus oulppomag 0 g ul 211110.1 Support saaAojdwa ou say pus djgsnuund io iolaudoid a1os s wt j t nogotll;suoa maty❑ 'L y'(awip- nd 10/pus mu)saaAojdwa glue ia lojdwa e mn j :(paainbaa);aafold;0 ad Sy :xoq alsudoidds au;IN zaadojdwa us nob Lay 'LEE51 —“k .4(2.G :# ;wood J'3Z9 ' Vj NNW ;JVs h°IS 9c12. ' 4 :ssa.ippy 7 ft' rie}c7 9nl2 07 (A ,,,e :(itnptArpu1/0otatziu1210/ssamsng) ai.1JEM A[gpari ;mad assail uouswao;u];uuallddy 'AIMOHlire ON1WW2I3d 3H.L H.LIM arai al 01 •saagmnid/suEpupal3/sJopEa;uo3/saapling :;lnspg;y aausansuj uoi3usuadmoj ,saay,zo_t v/p/loo•ssvzu•dtdtat �' LIOZ-67IZ0 TJLB `uojsogF ` _ . 001 aFins'FaaJ�,g ssaJauod r g BO=— si sjuappavpyisnpuljomaullivdaa .11_ _ ar i s#asnyvvssvyy,jo zinvadzuoutuwap ata • �� f- Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Ptirsuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership, association, corporation or other legal entity,or any two or more of the foregoing engaged in ajoint enterprise, and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contact for the performance of public work until acceptable evidence of compliance with the insurance ' requirements of this chapter have been presented to the contacting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 r Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia • Commonwealth of Massachusetts ® Division of Professional Licensure Board of Building Regulations and Standards Constrtct!or Supervisor • CS-042957 Ekpires: 09/20/2020 9 eC, 1.4.. : hbi 1^ 2 IL 19:4 J SCOTT CIMENO -.^'1 - - PO BOX 564 , • SAGAMORE MA 02561 • Commissioner �/"' Office of Consumer Affairs & Business Regulation- Mass.Gov Page 1 of 2 W Mass.gov Office of Consumer Affairs and Business Regulation (OCABR) HIC Registration Complaints Registration # 161550 Registrant CIMCO CONSTRUCTION INC. Name J.SCOTT CIMENO Address 37 YEARLING RUN RD City, State Zip BOURNE, MA 02532 Expiration Date 10/26/2020 Complaints Details ,No complaints found for this registrant. -] You can also view arbitration and Guaranty Fund history. Back To Search Site Policies Contact Us https://services.oca.state.ma.us/hic/licdetails.aspx?txtSearchLN=161550 1/3/2019