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HomeMy WebLinkAboutBld-19-006809 •Y`qR Office Use Only Permit# O r>� . H '2� u Amount '—'r ` MATTACH CS ^ - �,"�vAmat.o.',rd -'Permit expires 180 days from lissue date 8u. --1,q-caRCet, EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH RECEIVED Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 .IUN 03 2019 (508) 398-2231 Ext. 1261 Buis NAp� CONSTRUCTION ADDRESS: i 6A . j I�� ✓�/140 kf "l-E 490K 1 ey - ASSESSOR'S INFORMATION: Map: Parcel: )) �� � q S / LC )3 /- /9'-( N r SENT ADDRESSES ,y� TEL. # tea(/ CONTRACTOR: F8,o e/'< 1 36 � All0-4 Vi y W-OrjA~� (S 4360`3J /�� NAME1 MAILING ADDRESS TEL.# Residential 0 Commercial Est.Cost of Construction$ / t Home Improvement Contractor Lic.# /2 9/B Construction Supervisor Lic.# 65— !08 &ts'9 Workman's Compensation Insurance: (check one) 0 I am the homeowner ❑ I am the sole proprietor have Worker's Compensation Insurance !� Insurance Company Name: .+C (IXl/7 Worker's Comp.Policy# W V ©3 (3V-3 WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares ` J Replacement windows:# Replacement doors: # Roofing: #of Squares 6.10 ( )Remove existing* (max.2 layers) Insulation � p 1I%�Uld Kings Highway/Historic Dist. ( )Replacing like for like Pool fencing 14.)ed4hereci kieod Al Ax 11.0.C., *The debris will be disposed of at: ,60,4( 71 ado P054 t A46-1+ Location of Facility I declare under penalties of perjury that the s ents 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 denial or revocati y license and for prosecution under M.G.L.Ch.268,Section 1. Applicant's Signature: Date: 06423// / Owners Signature(or attachment) Date: Approved By: < < ✓� Date: �— 3 "j Buildin • r designee) EMAIL SS: Zoning District: Historical District: ❑ Yes 0 No Flood Plain Zone: 0 Yes ❑ No Water Resource Protection District: Within 100 ft.of Wetlands: 0 Yes 0 No 0 Yes ❑ No 1 � The Commonwealth of Massachusetts Department oflndustrialAccidents We- 1 Congress Street, Suite 100 _ f- Boston, MA 02114-2017 5.•`' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): 6-50 /vJ C. Address: 38 ai641_Jf (VACD (JJj4 City/State/Zip: ` one #: / S —3 Vr Are you an employer?Check the appropriate box: Type of project(required): IX I am a employer with 0 3 employees(full and/or part-time).* 7. E New construction 2.E I am a sole proprietor or partnership and have no employees working for me in 8. ❑ Remodeling any capacity. [No workers'comp. insurance required.] 3. I am a homeowner doing all work myself. 9. ❑ Demolition ❑ y [No workers'comp.insurance required.]` 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 ❑ Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑ Electrical repairs or additions proprietors with no employees. 12.E Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.E Roof repairs These sub-contractors have employees and have workers'comp.insurance.= , / 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.El Other p j ii&/s ofig„ 152,§1(4),and we have no employees. [No workers'comp. insurance required_] jj *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: AIL Policy#or Self-ins. Lic. #: (Da(ZY Expiration Date: Oile3/7/J97 Job Site Address: 10 go V 6 /-t/ tr►:�!//./?d } City/State/Zip:,3 ft f3�r l� V Attach a copy of the workers' compensation pilicy 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 certi;fy under s and penalties of perjury that the information provided above/ is true and correct. Date: ` Signature: OA/O32/9 Phone#: (se5; 30--3 7 J 2 Off cial 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#: AcQ CERTIFICATE OF LIABILITY INSURANCE DATE(M"u°D,YYYY' L.------ 02M 5/19 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: If the certificate holder is an ADDMONAL INSURED,the pollcy(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 NAPE GT PAUL SCHLEGEL FAX Schlegel&Schlegel Ins Broker PHON crsitit �), 508-771-8381 Nuc,No 508-771-0663 34 Main Street West Yarmouth,MA 02673 AD SS: schiegelinsurance@gmaii.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: NGM INSURANCE COMPANY 14788 INSURED INSURER B: ATLANTIC CHARTER FABIO INC INSURER C: 38 WENWARD WAY INSURER D: WEST YARMOUTH,MA 02673 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 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 POUCIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRT TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF POLICY EXP (MM/OD/YYYY) (MAr/D[OYYYY) UMITS X COMMERCIAL GENERAL UABIUTY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE 17 OCCUR PREMISES(Ea oxurtence) $ 500,000 MED EXP(Any one person) $ 10,000 A MPS6863R 11/19/18 11/19/19 PERSONAL&ADV INJURY $ 1,000,000 GEM_AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ITJEOT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE UABIUTY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY _ AUTOS ONLY (Per accident) $ $ X UMBRELLA LAB — OCCUR EACH OCCURRENCE $ 3,000,000 A EXCESS LIAB CLAIMS-MADE CUT6863R 09/08/18 09/08/19 AGGREGATE $ 3,000,000 DED RETENTION$ $ WORKERS COMPENSATION X PER ER U OTH- AND EMPLOYERS' ►BIUTY Y/N B AFYI ANY PROPRIETOREXCLUDED?PROPRIETOR/PARTNER/EXECUTIVE NIA EL.EACH ACCIDENT $ 100,000 (Mandatory in NH) WCV00935903 09/09/18 09/09119 ff yes,describe under E.L.DISEASE-EA EMPLOYEE $ 100,000 DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) FABIO PRETTI HAS ELECTED NOT TO BE COVERED UNDER HIS CURRENT WORKERS COMPENSATION POLICY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN TOWN OF BARNSTABLE ACCORDANCE WITH THE POLICY PROVISIONS. ATT BUILDING DEPARMENT 200 MAIN ST.HYANNIS,MA 02601 AUTHORIZED REPRESENTATIVE DAIANE BENFICA I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016//03) The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts �� Division of Professional Licen E. Board of Building Regulations and Standards Construction Supervisor CS-108659 _ Expires:04/19/2021 FABIO PRETTI , , 38 WENDWAN)WAY - at WEST YARMOUTH Mk 02673 Commissioner -ci/e t,,,„,iiin <rnerr///r f^ftet.;crrfin.le<Li - Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Individual before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 182418 06/18/2019 10 Park Plaza-Suite 517r- FABIO PRETTI Boston,MA 02116 D/B/A FABIO HOME IMPROVEMENT FABIO PRETTI \,Q CC... 38 WENDWARD WAY J YARMOUTH,MA 02673 Undersecretary Ni thout signature Fabio-1nc. i + f CSL 108659 HIC 182418 Proposal Date: 05/06/19 To: Mark & Karin Loewen 585 Old Jail Ln, Barnstable, MA 02630 Work to be performed at: 138 Route 6A, Yarmouth Port, MA 02673 Scope of work: • Summer kitchen $6,000 o Take off ceiling; o remove couple floor boards to have access to sill; o Jack up and level back and side (east)wall. • Roof insulation $8,000 o blow in insulation on roof rafters where existing insulation is missing. • Side porch $8,000 • remove existing door and frame opening to fit a window; • install new window matching the existing ones; o install rubber roof on porch roof; o (owner will do all demolition). • Exterior trim spot replacement $25,000 o spot replace rooted exterior trims using pine wood and galvanized nails or screws, trying to match existing trim. o Glue and/or caulk joints. • Re-roofing(entire house and garage) : $38,400 1. strip old shingles; (we cover walls,windows and plants surrounding working areas,but some plants may be damaged were we need to place ladders in working areas); 2. check decking for imperfections; (any imperfections are considered a unforeseen condition and will become a extra charge of$70/htworker plus material); 3. install drip edge on eaves; 4. install certainteed winterguard waterproofing shingle underlayment or equivalent, 18"on eaves, 18" on rakes, 36" on valleys, and were else necessary; 5. install felt paper#15 or equivalent; 38 Wendward Way W. Yarmouth—MA 02673 508-360-3412 • F f _ „4- a no • r CSL108659 HIC 182418 s ? 6. install rake flashing; 7. install (architectural) asphalt shingles Timberline HD, Weathered wood color; 8. install ridge cap; 9. unforeseen condition and will become a extra charge of$75/h/worker plus material) and will be done upon signed change order or owner authorization ; 10. Clean up all debris resulting from demolition; 11. all material will be furnished by Fabio Inc; 12. (owner is aware that we may need to place a 30 yard dumpster plus a portable toilet on location during performance of the work). Total: 38,400.00 All material is guaranteed to be as specified, and the above work to be performed in accordance with the specifications submitted and completed in a substantial workmanlike manner for the sum of : ($ 85,400.00 ) with payments to be made as follows: Deposit: $ 35,000 deposit $ 20,000 roofing completion $ 30,400 at work completion General Provisions: Fabio Inc will be responsible for all permits for the work above. Any alteration or deviation from the above specifications,including but not limited to,any such alteration or deviation involving additional material and/or labor costs,will be performed only upon a written order or owner authorization for same,signed by Owner and Contractor,and,if there is any charge for such alteration or deviation,the additional charge will be added to the Contract Price of this Contract. If payment is not made when due,Contractor may suspend work on the job until such time as all payments due have been made.A failure to make payment for a period in excess of 4(four)days from the due date of payment shall be deemed a material breach of this Contract. Unforeseen Condition: Unanticipated or unexpected circumstance or situation that affects the final price and/or completion time of this contract or project,will became an extra cost,and will be charged a rate of$75.00h/worker plus materials. Acceptance of contract Name: c_ Title: Date: / Signature: 38 Wendward Way—W. Yarmouth —MA n9R7A cnst_zan221101'1