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Home My WebLink AboutBld-20-007151 Y` Office Use Only I : . i>J .> 1,Uij 4;Wt i� eV 9's 'i Amount <Z"""" c,' Permit expires 180 days from issue date EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth,MA 02664 (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: /`7 T M(Vi 6 L E t E:1 ►R Y L"J S. Y/}e m o u T L/, N ASSESSOR'S INFORMATION: Map: Parcel: OWNER:C4)111 VIM t M/-KG_It-1e-TiN/'(- MccSS (S 1 k(r16LE-13c-RRX LAI. VI)-RN00-41. Cv8-392-6792 NAME PRESENT ADDRESS TEL. # CONTRACTOR:f-RIMR;RI SA-FfRY/ $J 67 SEA- S'i HVAtt)NIS NIA d2‘o ' ca-z-726-296 o NAME MAILING ADDRESS TEL.# LtIteliciential 0 Commercial Est.Cost of Construction$ G, co 0 Home Improvement Contractor Lic.# tB 3 2 0 2 Construction Supervisor Lic.# / G 6 t 0 2 Workman's Compensation Insurance_: (ptteck one) L I am the homeowner L4 am the sole proprietor [1 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 Replac ment windows:# Replacement doors: # CRoofing: #of Squares 7 ( )Remove existing*(max.2 layers) Insulation Old Kings Highway/Historic Dist. ( Replacing like for like Pool fencing *The debris will be disposed of at: 7/! A 7 0 V THi H 4 Si Location of Facility I declare under penalties of perjury that the st is herein contained are true and correct to the best of my knowledge and belief I understand that any false answer(s) : ::a:e ill be just denial or revo of i nse and for prosecution under M.G.L.Ch.268,Section 1. : 4 Date: / Owners Signature( attachment) Date: Approved By: �mot.. Date: 6 - 10 JIB Building Official(or dgnee) EMAIL ADDRESS: Zoning District: Historical District: = Yes No Flood Plain Zone: Yes No Water Resource Protection District: Within 100 ft.of Wetlands: Yes No 1 Yes No The Commonwealth of Massachusetts i zrommt, � 1, Department of Industrial Accidents i,I 1 Congress Street,Suite 100 g_ 8 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leiubly Name(Business/Organization/Individual):ARMEN SAFARYAN Address:67 SEA ST APT. A4 City/State/Zip:HYANNIS, MA 02601 Phone#:(508)776 2900 Are you an employer?Check the appropriate box: Type of project(required): 1. am a employer with I employees(full and/or part-time).* 7. 0 New construction 2.01 am a sole proprietor or partnership and have no employees working forme in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. El Demolition 10 Q Building addition 4.❑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. 12.0 Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance.; 13.CROof repairs 6.0 We are a corporation and its officers have exercised their right of exemption 14.0Other gh mp per MGL c. 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 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: Policy#or Self-ins.Lic.#: Expiration Date: Job 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,§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 un he itifa penalties of erjury that the information provided above is true and correct Signature: °- 07 0_ /7 g Date: Phone#:(508) 6 Official use only. Do not write in this area,to be completed by city 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#: ' (t3r 460,72,7,,anteij4. , ,,Aaorja,a0ezjeleZ, . !.. 1 • Office of Consumer Ofairs and Business Regulation One Astibtiram Place-Suite 1301 Boston, Massachusetts 02108 Home Impro100044:0Ontractor Registrahon 7.7-z..71,7-77:2-_-:,.-•::.-_-____. • - -::.-_-_ : --,-- - ;- - ,. -:, Typec Indual !.--i ;., -::: - -::. :::.-,-: -.•.- RegiStraitOre 183202 ARMEN SAFARYAN __:-- ---i-• - ,---_ -. ---•_ Schalk= ostisratne 67 SEA ST APT A4 ,.-.•• - r-li - . • : .-. ---.. • HYANNIS, MA 02601 • . . _ . - - Update Address and return card. t 201445/17 ---..- - - - - i . 3 Me glommewatweityfi..iigamvwfwAsex ' Meat ConnaneridtairsA Bushman Regtdation f HOME IMPROVEMENT COPITRACTOR i tElitiOn Valid tor individual use only TYPE Individual - ! the expiration date. If found rebun or • - : of Consumer Maks andeusiti4Resdation ', Ilesafejba-.: MOW= • - itePark Plaza-Sults -1-13 -kf:::&-.09/13/2019 • ! Roston.MA 02118 rl FtPREN SAFfo•-__.. ..4---...: i EVA COR - OVIT,, . il iltilB4 SAFACDAW-tlgr ,' d.., - (ANN'S,MA 02iti:-5- : PiOt VtAidlthil Undemeofetaly •1 - • . - I • iir:tiff likssachusetta Ciepartment of Public.Safeti . Board of_Buinfit------------- g Ril'.---7----------gul oati ns and Standards .tense:csey_40e102 Construction Supervisor Speci2ity i ARMEN 64 .i.o•'. - -°,* _ erseasTREEr; • A4 HYMNS Mil - 1 , . • . .• : i - ' - • ; i Expiration: comniissi..her 10/.02/28'40 : i ! ; fr, .;. . AC o CERTIFICATE OF LIABILITY INSURANCE I DATE("""°°"YYY) 09/13/2018 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),AUTHORRED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)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). PRODUCERCW4Ti.kCTAshley Paiva Eastern Insurance Group PHONEvC� (508)997-6061FAX439 State Rd. e�r/►aNO'mod): (A/c Not (508)990-2731 apaiva@easteminsurance.com P.O.Box 79398 ADDRESS: INSURERS)AFFORDING COVERAGE NAIC p 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 UnitA4 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. LTR TYPE OF INSURANCE ADDL-' '•' POLICY EFF POLICY E)IP INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000.000 CLAIMS-MADEOCCUR DAMAGE l 0 REN rED PREMISES(Ea occurrence) $ 100,000 A MED EXP(Any one person) $ 5.000 — 9520046441 04 09/18/2018 09/18/2019 PERSONAL&ADV INJURY $ 1,000,000 GENt AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑Te,-- ❑LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) BODILY INJURY(Per Person) $ OWNED — SCHEDULED _ AUTOS ONLY ._ AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ $ UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY Y/N I STATUTE I)ER ANY PROPRIETOR/PARTNER/EXECUTIVE 1,000,0� OFFICER/MEMBER EXCLUDED? ❑ N/A 9520046441 04 09/18/2018 09/18/2019 E.L.EACH ACCIDENT $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is 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 i ACORD 25(2018/03) The01988-2015 ACORD CORPORATION. All rights reserved. ACORD name and logo are registered marks of ACORD cOREy & cOREy " The Roofers 67 SEA STREET APT#A4, HYANNIS MA 02601 PHONE -508 -775-8240 CERTAINTEED LANDMARK LIFETIME - ALGAE RESISTANT ARCHITECTURAL STYLE RE - ROOFING PROPOSAL April 24,2019 WILLIAM AND MARGARET ANNE HEUSS 15 THIMBLEBERRY LANE EM: mizzentopwm@gmail.com SOUTH YARMOUTH,MA Tel: 508-398-6792 COREY & COREY hereby proposes to perform the following services in a neat and professional manner and in accordance with the manufacturer's specifications and local building codes. Supply and Install ALL NEW 5/8 CDX PLYWOOD ON THE ENTIRE SUNROOM ROOF, ADDING ALL THE NECESSARY RAFTERS TO THE ROOF SECTION 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,235 POUND,EXTRA HEAVY WEIGHT, 130 MPH WIND WARRANTY,CATEGORY III HURRICANE,STORM/HURICANE NAILED (6 NAILS PER SHINGLE), MULTI-LAYERED,LAMINATED ARCHITECTURAL STYLE,FIBERGLASS BASED ASPHALT SHINGLES. COLOR: HEATHER*LEND ON THE ENTIRE SUNROOM ROOF Supply and Install 8"BROWN ALUMINUM DRIP EDGE on All of the Eaves and Rakes. Supply and Install CERTAINTEED WINTER-GUARD (Ice & Water Shield) WATERPROOF UNDERLAYMENT SYSTEM on Roof Eaves Supply and Install CERTAINTEED'S "ROOF RUNNER" SYNTHETIC ROOFING PAPER Supply and Install NEW RUBBER EDGE TAPE with CLEANER PRIMER BETWEEN THE SUNROOM ROOF AND THE EXISTING RUBBER ROOF ON THE BACK Clean and Remove Debris from work area after job is completed. TOTAL INVESTMENT $6,500.00 COREY & COREY " The Roofers " OPTIONAL ADDITIONAL WORK: Supply and Install ALL NEW AZEK RAKE BOARDS AND FASCIA BOARDS ON THE ENTIRE SUNROOM ONLY- --------------------__--$1,000.00 POSSIBLE EXTRA CARPENTRY: Any Rotted or Otherwise Deteriorated Trim Boards,Plywood Sheathing,Missing Metal Flashing,Side Walling or Any Other Carpentry Needing Replacement will be done and charged for as an Extra: Materials Plus Labor at the Rate of$60.00 per Hour(For Each Laborer Involved). PAYMENT SCHEDULE: A Deposit of One Half is due at the Signing of this Roof Proposal and the Final Payment for the Balance is Due Immediately Upon Completion. WORK SCHEDULE: All Roof Work is Scheduled for Completion Within 90 Days of Acceptance and 50% of the Deposits Received are Non-Refundable After a Three Day Cooling Off Period from the Date of Signing. Please Make Checks Payable to: COREY & COREY COREY & COREY Warranties the Shingles and Labor for 5 years. CERTAINTEED Warranties the shingles and labor 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. CERTAINTEED Warranties the Shingles to be Algae Resistant for a Full 10 Years. COREY & COREY carries Workman's Compensation and Public Liability Insurance on the above work DATE OF ACCEPTANCE: -s•. l• t� ACCEPTED BY: SUB Y: /671AZI-4le,t, WILLIAM AND MARGARET HEUS5 ARM FARM HOMEOWNER COREY & CORE HIC # 183202 CSSL# 106102