HomeMy WebLinkAboutBLD-19-3429 .,, ',Office Use Only
- , Og'Ydi
• d '%. 'Permit#
O Shy H - (Amount 50
!Permit expires 180 days from
issue date
BLO-la- 073499
EXPRESS BUILDING PERMIT APPLICATION
• - TOWN OF YARMOUTH RECEIVED
Yarmouth Building Department
1146 Route 28
South Yarmouth, MA 02664 ' DEC 05 1018
(508) 398-2231 Ext 1261'
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, :outccin "
CONSTRUCTION ADDRESS: 44 do too* tal , 4Q.r tot 4 -
ASSESSOR'S INFORMATION:
�J, 'fin- Map: Parcel: U,, — r-1
OWNER:LI�(1etie ( ICCtoo 41t(o LObtau4 . arrnej7RTESOS.'\5`l' �1
{{ NAME ` /n� �tt _ M�
CONTRACTOR7kertA�,�pC. �O�p)Ggab (leY nv Sk l.e. t n SOS-3Co3-9445
NAME MAILING ADDRESS tpTEL.
A/ oav3a r�
tesidential 0 Commercials" Est.Cost of Construction$ aa, o)o
Home Improvement Contractor Lie.# llo wiz Construction Supervisor Lie.# CS- OCY'1'T t 4
Workman's Compensation Insurance: (check one)
❑ I am the homeowner ❑ l am the sole proprietor
''� fel have Worker's Compensation Insurance
Insurance Company Name:Rgset GM!`Oucreorr)S. CO Worker's Comp.Poiicy#1AQCcCiAtki 454 (PA
(WORK TO BE PERFORMED
Tent _ Duration (Fire Retardant Certificate attached?) :. ' • Wood Stove
Siding: #of Squares ,• ••y Replacement windows: #. • • Replacement doors: #
Roofing: #of Squares JO w ( )Remove existing* (max.2 layers) , ' Insulation'
Old Kings Highway/Historic Dist. ( ✓Replacing likeli� for like Pool fencing
*The debris will be disposed of at: 1QrYY16 p��T�"Q,YC7"C er
Location of Facility
1 declare under penalties of perjury that the statements herein contained are true and correct to the best of my knowledge and belief. 1 understand that any false answers)
will be just cause for denial or io .f se and;.r prosecution under G.L.Ch.268,Section 1.
A / /!�d /(
Applicant's Signature: _ //, '�/. ,/ t.��. . �� .Date: 8` �
Owners Si: attire(or attachment M_ Date:
Ss Y
Approved BY: � Date: I3- —I F
Building Offici>S designee) EMAIL ADDRESS:
Zoning District: _ r
Historical District: ❑ Yes ❑ No Flood Plain Zone: ❑ Yes ❑ No
Water Resource Protection District: Within 100 ft.of Wetlands: _
0 Yes , ❑ No 0 Yes ❑ No
IP.
'\ The Commonwealth of Massachusetts
t� nt=fit Department oflndustrialAccidents
• '
Congress Street,Suite
Is_' t 1 Boston, MA 02114-2017 100
* I.,4 www.mass.gov/dict
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): Ike r 4.f\SSoc t O kS Inc .
Address:--POOX. cta3
City/State/Zip: Ce,n .)II�eM{
A3 , Phone#: S03• 3coa- aa 41t
Are you an employer?Check the appropriate box: _ •, ,•;
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•VCommonwealth of Massachusetts
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Division- of Professional Licensure
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Board of Building Regulations and Standards
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•
t , Office of Consumer Affairs and Business Regulation
10 Park Plaza- Suite 5170 •
Boston, Massachusetts 02116
. Home ImprovemetWpntractor Registration
Type: Corporation
c Registration: 162600
BAKER &ASSOCIATES INC __
Expiration: 03/2512019
P.O. Box 923 - }
Centerville, MA 02632 _ ,
Update Address and return card. Mark reason for change.
SCA1 0 aId-OS n 0 Address 0 Renewal 0 Employment 0 Lost Card
I/iir 1:f-all!, bn ellia r/ Y/.wider,"
`A,
Office or Consumer Analn a�Buabess Regulation
:B.
ke3Y HOMEIMPROVEMEPY7' atoll ACTOR Registration e �ation datfor e If found retudual use rn to:
TYPE:Corporation Office of Consumer Affairs and Business Regulation
� Redistration +fotrationto park plaza•Stilts 5170
," 1628E)0 03!25!2019 Boston,MA 02116
BAKER&ASSOCIATES INC.
MARK BAKER •
521 Shootilyhg M Rd (\
Centerville,MA 02632 Undersecretary Not valid without signature
•
•
CIIent#:9742 2BAKERAS
• ' ACORD N CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYYI
04/24/2018
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 an ADDITIONAL INSURED,the policy(Ns)must be endorsed.M 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 CONTACT
Dowling&O'NeII Insurance Agy NNAAMM LEA:508 775-1620 FA/C.se): 5087781218
973 lyannough Road E-MAIL
P.O.Box 1990 ADDRESS:
Hyannis,MA 02801 THEOREMS)AFFORDINGCOVERAGE - /WCF
INSURER A:NTHI Imam DKr 14788
INSURED - INSURER.:Aere,Nr,dEeLerarvrrCompany - 11104
Baker&Associates,Inc.
P O Box 923 INSURER C:
Centerville,MA 02632-0071 INSURER o:
INSURER E:
INSURER F:
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 POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDn1ON 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.
LTR TYPE OF INSURANCE
JNSR VND POLICY NUMBER MEDF� LIMITS
A GENERALUAB TTY MPJ7223M 04/19/2018 04/19/2019 EACH OCCURRENCE $1,000,000
X COMMERCUL GENERAL LIABILITY PREMISES(Eroci Dw,ral *500,000
CLAIMS-MADE n OCCUR MED EXP(Myon parson) 510,000
PERSONALS ADV)N)URY *1,000,000
GENERAL AGGREGATE 52,000,000
GGEEINL AGGREGAATTELIMIT APPLIES( PER: - PRODUCTS-COMP/OP AGO *2,000,000
I POLICY I I PiXt I I LOC • $
AUTOMOBILE LABILITY COMBINED SINGLE WAFT
(Ea occident)
_ ANY AUTO BODILY INJURY(Per person) $
ALL
_ A AUT
DEED _ SCHEDULED
BODILY INJURY(Per acldant) $
HIRED AUTOS — NON-OWNED - PROPERTYDAMAGE 5
UMBRELLA UAB _ OCCUR EACH OCCURRENCE
EXCESS UAB CLAIMS-MADE - AGGREGATE $
DED RETEN1ON$ $
B WORKERS COMPENSATOR WCC50050024542018A 04/23/2018 0412312011X To WE 5 yr
-
AND EMPLOYERS'LIABBRY
ANY PROPRIETOR/PARINER/FXECOTNE•••IN E.L EACH ACCIDENT *500,000
OFFX:ER AEMBER EXCLUDED? M/A
Tyr In E.L DISEASE-EA EMPLOYEE *500,000
te under
DESCRIPTION OF OPERATIONS below E.L DISEASE•POLICY LIMIT $500,000
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(AlIsdB ACORD 101,AddMene Rourke Schedule,Nmen space b rrqulad)
•
(See Attached Descriptions)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHOR®REPRESENTATIVE
•.s9 .ade.
O 1988-2010 ACORD CORPORATION.All rights reserved.
ACORD 25(2010/05) 1 of 2 The ACORD name and logo are registered marks of ACORD
#52109241M210923 RPJZ1
, •
Authorization Form:
I L. at#t. Mee", / , as owner of the subject
propertj, hereby authorize Baker &Associates to act on my behalf, in all matters relative to
work authorized by this building permit application for
Address of property: 46 Lookout Road
Yarmouthport, MA
Signature of owner /!Y
Print Name A//ntWt. m C(4V
Date: 71k
I. G
°, A s 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451
• Telephone(508)398-2231 Ext. 1292-Fax(508)398-0836
REGEIV KING'S HIGHWAY HISTORIC DISTRICT COMMITTEE CEIVE'D
NOV 2 2.i113DEC 5.1078
APPLICATION FOR
s/MM HIGHWAY CERTIFICATE OF EXEMPTION SOU H ARMOU H
cation is hereby made for the issuance of a Certificate of Exemption under Sections 6 and 7 of Chapter 470 of A
Acts of 1973, as amended, for the proposed work as described below and on plans, drawings, or photographs
accompanying this application.
Type or print legibly: V ^�
Address of proposed work:� 4 Loo ou� a-"IQn not*k po rt Map/Lot#e+�e
Owner(s):_Lghe tie r cct� Phone#:SDA 454 5&n7
All applicatio�n1s must be submitted b+owner or accompanied" by letter from, owner approving submittal of application.
Mailing address:410 LOOt.OVt LICLe not*\taf#r MA. Year built:
Email: LM'(n C 1O4§CofvtCQ.` . ne..4 Preferred notification method: Phone tie Email
• Agent/Contractor IJQ ergs RS5ac(ake.STinC . Phone#:50221-a&e 'MAS
Mailing AddressTPO O$. 42,3 QeurlerutUe tmA 0.345.5a
Email: 1106 @ bak ereCeleP. COM Preferred notification method: Phone Ve Email
Description� eof Proposed Work(Additional pages may be attached if necessary):
moos exAsiIno. Pog rno.tanca anti i-eil Ce. In LA-k.
;nab *o mat;CJK, h Qe
t (o —as ebset,i blame, - - --
��' - 'fes'�-t�.. ,
Quoteve Oaten, ►1c�; . y-� � a
DEC - 5 213
YA MOUTH
K HIGH'IVAY
Signed(Owner or agent): Q-- Date: 1e / / .
> Owner/contractor/agent is aware that a permit may be required from the Building Department.(Check other departments,also.)
to This certificate is good for one year from approval date or upon date of expiration of Building Permit,whichever date shall be later.
For Committee use only:
Date: lR�g Approved Approved with changes _Denied
Amount cRCReason for:.dsaial:
Cas S : 7'733 Vt *1/4./ `J CY/ecr7V5cl b PZ�1'yi t 6.. r.. .-�tncr-f-4
Rcvd by: Q J
Date Signed: ,'as- / o Signed: Y '/.f—GL V��, OAF/ APPLICATION# 8 — E 1 2 7
V5.2017 (//�� ./2 712