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HomeMy WebLinkAboutBld-20-001678 04 Nl .. . 4,if1 Amount Jv`�(/MATT' n 1 4, .t.4, „_„..,.". �/Vcs. <„ti,,�`3�;� � 1 L 4 Permit expires 180 days from issue date .,1v. Di_'-'1\ZT f'OFNT EXPRESS - i •G PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: /7a Cop Tai et_ f U: C l erG.s o:? Rd, S. , y,_ riot u i k. ASSESSOR'S INFORMATION: / //Map: �/� Parcel: OWNER: gten /moo lQ /V// C/76- .2 '7o 0 _ NAME PRESENT ADDRESS TEL. # CONTRACTOR: Co r ey :a-'?d Col,�/ C 7 Se 4._ -��+�¢¢ 7 *i4�j y,04„,„s 5 0�' 7 7.S A'.2 tt O 4 NAME c/ 'c MAILING ADDRESS 'CAEL.# Residential ❑Commercial V Est.Cost of Construction$ /0 7--S 0 Home Improvement Contractor Lic.# /8' 3 e2 0.2 Construction Supervisor Lic.# /0 6/ 0 6.2 Workman's Compensation Insurance: heck one) �� L I am the homeowner lam the sole proprietor �Y I have Worker's Compensation Insurance Insurance Company Name: 4 4ge/I a. ' O 7aC T j,r Worker's Comp.Policy# So°SO/S03 /a 0/s I WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares c2 0 ( Remove existing*(max.2 layers) Insulation Old Kings Highway/Historic Dist. (Replacing like for like Pool fencing *The debris will be disposed of at: Yal"Gyvi 0 ea. 7H 6ut-714 p Location of Facility I declare under penalties of perjury Z'the nts 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 o •v�O'on y s for prosec ion under M.G.L.Ch.268,Section 1. Applicant's Signature: Date: . 0?3 , t� Owners Signature(or attachment) Date: Approved By. Date: 7 2 f-/f Building Ofci e ' ee) EMAIL ADIDRESS: Zoning District: Historical District: = Yes No Flood Plain Zone: Yes I No Water Resource Protection District: Within 100 ft.of Wetlands: Yes No Yes No Massachusetts Department of Public.Safety Board of Building Regulations and Standards -License: CSSL-106102 Construction Supervisor Specialty ARMEN SAFARYAN 67 SEA STREET APT A4 HYANNIS MA 02601 . /Jrc C<{- ..7.'"a.4..._- Expiration: Commissioner 10/02/2020 Q L (690/M/12iO4tWeiCta OrgA6Madtadel6 Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Individual ARMEN SAFARYAN Registration: 183202 DB/A COREY AND COREYExpirati on: 09/13/2021 67 SEA ST APT A4 HYANNIS,MA 02601 Update Address and Return Card. SCA 1 0 20M-05/17 e c mmon(oetitl o/'n'64.sadnael Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Individual before the expiration data if found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 183202 09/13/2021 1000 Washington Street -Su 710 ARMEN SAFARYAN Boston,MA 02118 D/B/A COREY AND COREY ARMEN SAFARYAN 67 SEA ST APT A4 �.f�rGf.�.k" HYANNIS,MA 02601 UndersecretaryNot valid ignature EA 1 49 . A`oRD CERTIFICATE OF LIABILITY INSURANCE 9/13/2019 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 ADDITIONAL INSURED,the policy(ies)must 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 REACT Ashley Paiva Eastern Insurance Group LLC PHONE (800)333-7234 FAX No.Ext): INC.No): 233 West Central St A• i apava@easterninsurance.com INSURER(S)AFFORDING COVERAGE NAIC I Natick MA 01760 INsusesAArbella Protection Ins. Co. 41360 INSURED INSURER B Associated Employers Insurance Armen Safaryan, DBA: Corey and Corey INSURER C: 67 Sea Street INSURER 0: Unit A4 INSURER E: Hyannis 14A 02601 INSURER F: COVERAGES CERTIFICATE NUMBER:2019-20 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 INSR �SD W VD POLICY NUMBER IWNIDDIYY YYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMSADE I X I OCCUR DAMAGE TO RENTED M 100,000 PREMISES(Ea occurrence) $ 9520046441 9/18/2019 9/18/2020 MED DtP(Any OM PO MO) $ 5,000 PERSONAL 8ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X PoucY1 1.717a LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE UMIT $ (Ea accident) — ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS _ AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS AUTOS NON-OWNED R(Per ac RentDAMAGE) $ $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE EXCESS UAB CLAIMS-MADE $ AGGREGATE $ DED I I RETENTION$ WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY Y/N I STATUTE I I&TH- OFFICER/MEMBERE �EXCLUD D? N N I A XECUME EL.EACH ACCIDENT $ 1,000,000 (Mandatory In NH) 5CC50050150912019A 9/18/2019 9/18/2020 EL DISEASE-EA EAAPLOYEE $ 1,000,000 I desaibe under DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD t01,Additional Remarks Sdwdala,may be attached If move+Wcs is ) . CERTIFICATE HOLDER CANCELLATION ,a DESCRIBED SHOULD �VTIES BE CBCLEDisPlay Only THE EXPIRATION DAHEREOF, NOTICE WILLDEUVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE John Koegel/APAIVA ACORD 25(2014/01) The ACORD name and logo are ©1988-2014 ACORD CORPORATION. All rights reserved. INS025 rm,an„ 09 registered marks of ACORD • The Commonwealth of Massachusetts f, Department of Industrial Accidents r =u�� 1 Congress Street,Suite 100 . ==i "` , Boston,MA 02114-2017 �,I www mass govidia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Aunlicant Information Please Print Legibly Name (Business/Organization/Individual): d!'rw e- , ,S)bif ajr_L 62.0 b 8 4 Ca, ,c G r Address: e •-c e(c.., 1 7� ,1� City/State/Zip: ey 62 is. 'L L� 4 Phone#: -50 7 7S�_ . 0 Are you an employer?Cheeithe appropriate box: Type of project(required): i.1I am a employer with 1 employees(full and/or part-time).* 7. El New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 3.01 am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 10 0 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.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑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.Q Other 152,§1(4),and we have no employees.[No workers'comp.insurance required] *My 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. tContractors 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: jr, (�fj/2 r 1'0 , c/i-0 4 .2•i.c 1.t7Z6241...c E. _ Policy#or Self-ins.Lic.#: -33*2 D 0 4 6 4 4/0 4 Expiration Date: 3. l IS . of 0 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 ce nde ittss and penalties of perjury that the information provided above is true and correct. Sig . 4 1 - L Date: 3. 02-S• I r - Phone#: 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#: COREY & COREY " The Roofers " 67 SEA STREET APT#A4, HYANNIS MA 02601 PHONE 1-508 -775-8240 CERTAINTEED LANDMARK LIFETIME - ALGAE RESISTANT ARCHITECTURAL STYLE RE - ROOFING PROPOSAL July 27, 2019 STEPHEN DOYLE 172 CAPTAIN NICKERSON RD. EM: do lesm26 Y @gmail.com S. YARMOUTH,MA Tel: 617-642-7009 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. Remove and Haul Away All of the Old Asphalt Roofing Shingles from the Entire House. Re Nail All The Existing Sheathing as needed. Supply and Install CERTAINTEED LANDMARK AR: LIFETIME WARRANTY, 10 YEAR SURE START PROTECTION, for a FULL 10 YEAR WARRANTY AGAINST ALGAE CONTAMINENT,235 POUND,EXTRA HEAVY WEIGHT, 130 MPH WIND WARRANT CATEGORY III HURRICANE STORM �6 NAII,S PER SHINGLE �URICANE NAILED —.� MULTI-LAYERED,LAMINATED ARCHITECTURAL STYLE FIBERGLASS BASED ASPHALT SHINGLES. COLOR: t Supply and Install 8"WHITE ALUMINUM/HICK'S Supply and Install 8" WHITE ALUMINUM on All of the Eaves. Supply and Install CERTAINTEED WINTER-GUARD , on of the Rake Boards. WAT UNDERLAYMENT SYSTEM on Roof Eaves& Valleys Boards. Under the Step Flashings,on the Skylights and Chimneys. Supply and Install CERTAINTEED'S "ROOF RUNNER" Supply and Install AIR VENT SHINGLE VENT II ROOFING PAPER Supply and Install NEW ALUMINUM& NEOPRENE SOIL PIPE F ASHING the Entire�dge. Clean and Remove Debris from work area after job is completed. HOUSE ROOF INVESTMENT $10,750.00 COREY & COREY " The Roofers " RE-ROOFING THE SHED WILL BE ADDITIONAL $750.00 POSSIBLE EXTRA CARPENTRY: Any Rotted or Otherwise Deteriorated Trim Boards,Plywood Sheathing,Missing Metal Flashing, Side Walling or Any Other Carpentry Needing Replacement will be done and charged for as an Extra: Materials Plus Labor at the Rate of$ 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 the Roof Work is Scheduled for Completion Within 90 Days of Acceptance and 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 10 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: 2-- ACCEPTED BY: SUBMITTED BY: STEPHEN DOYLE ARMEN SAFARYAN HOMEOWNER COREY & COREY HIC # 183202 CSSL# 106102