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EXPRESS BUILDING PERMIT APPLICATION
TOWN'OF YARMOUTH lirl 'I :qii 1
Yarmouth Building Department
1146 Route 28
South Yarmouth, MA 02664 C -.1:1- 1, 9 a---1
(508)398-2231 Ext. 12451
CONSTRUCTION ADDRESS: 36 IV . _WAilmPtIg.•
ASSESSOR'S INFORMATION: ,
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I Map: I Parcel:
1 I
OWNER:___6_,Wyokyre/Acif art ,_s3.6.tcf,A,4?fyRd 10.1WD315
NA _ ESENT SS TEL, #—
CONTRACTOR:Rola_ ejA, rd(ro la, ..A.12.etwii\ -..a sefi *1-(0 'cc
NAME MAILING ADDRESS TEL # -
'= esidential 0 Commercial Ea Cost of Construction$ (0 550
Dome Improvement Contractor Lie.# 1°84523 Construction Supervisor Lic.# 1 le•16 ;76 I _
Workman's Compensation Insurance: (check one)
I am the homeowner ' I am the sole proprietor : I have Worker's Compensation Insurance
Insurance Company Name: FkIVALX 113LLC Worker's Comp,Policv4V n906036q3127,0igfr
WORK TO BE PERFORMED
Tent Duration (Fire Retardant certificate attached?) Wood Stove
Siding: #of Squares Replacement windows:# Replacement doors: #
Roofing: #of Squares TJ (I)Remove existing*(max.2 layers) Insulation
Old Kings Highway/Historic Dist, ( )Replacing like for like Pool fencing
*The debris will be disposed or ar ox-v.oukt._
8
Location of Facility
I declare under penalties of perjury that the statements herein contained arc true and correct to the best or my knowledge and bald I understand That an'false mswerts)
will he just cause Inr denial or revocation of ow license and to prosecut = der M.D.L.Ch.268,Section 1
411P ,
Applicant's Stanature: 4..-,..,-;-,,,„...-;,,,e1.40--,‘,. iiir,-,1%. _ Daw _14,„at iq
,
Owners Sig. tore(or t • men-trAnini , i Date:
Approved Bv.
Date. ‘,_!J 441
Building("to, E's., ' .) EMAIL ADDRESS. rii, , _twin
.. .I.VA‘
— ---,.
Zoning District_
historical District: ± Yea _ No Flood Plain Zone: - Yea I No 1 r
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(A 0
Water Resource Protection District: Within 100 ft,of Wetlands: i
Yes : No i Yes No
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The Commonwealth of Massachusetts
a ='—, - j Department of Industrial Accidents
r _nrl= a 1 Congress Street,Suite 100
°t1F._'_4 Boston,MA 02114-2017
Y''-'�` 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): -�erl. o jc ,cdo WA-5m q
V
Address: i.9Z RD 01911 t) Ilk Rid
City/State/Zip:
W3V\V\1S (Mk- 0,1,02 Phone#: ,5-b 1T6 *11-3
Are you an employer?Check the appropriate box: Type of project(required):
1.0 I am a employer with employees(full and/or part-time).* 7. 0 New construction
11 ?0 I am a sole proprietor or partnership and have no employees working for me in 8. El Remodeling
any capacity.[No workers'comp.insurance required.]
9. ❑Demolition
3.0 I am a homeowner doing all work myself.[No workers'comp,insurance required.]t
10[j 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 worloers'compensation insurance or are sole 11.❑Electrical repairs or additions
proprietors with no employees.
12.0 PI robing repairs or additions
I am a general contractor and I have hired the sub-contractors listed on the attached sheet
513. Roof repairs
These sub coot actors have employees and have workers'comp_insurances
6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.. Other
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
*Any applicant that checks box#I 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 roust 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 S250.00 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 under the pains and penalties of perjury that the information provided above is true and correct
Signature: ft....e- a4( ,01--
Date:
` T-6 13 Phone#:
Official use only. Do not write in this area,to be completed bycityor town official
I mP ff '
1 City or Town: Permit/License#
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
1 6.Other
r
Contact Person: Phone#:
1
i
i
Q./40 Woriremoweiverid 0./°Q.Azorkzek,,,o,a.
Office of Consumer Affairs and Business Regulation
One Ashburton Place-Suite 1301
Boston, Massachusetts 02108
Home Improvemek Contractor Registration
Types LLC
HYTECH ROOFING SOLUTIONS LLC. 184.383
12 BALDWIN RD 01/04f20'Zp
DENNIS,MA 02638
Son 0 zow osn� Update Address and Return Card.
4:92e iueaxaneial?A c/ /laiiachwe//.t
Office of Cimstiniermtairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR Rion valid for indvidual use only
TYPE:LW before the expiration date. ff istmd return to:
Registration- ExpirationOffice of Carswner Affairs and Business Regulation
184383 01/04/2020 10 Park Plaza-Suite 5170
HYTECH ROOFING SOLUTIONS LLC. Boston,MA 02116
PATRICK CUFFORD _ \J2 C
/04,~-1/ v.
12 BALDWIN RD •
DENNIS,MA 02638 UndersecretaryNot valid without signature Commonwealth of Massachusetts
Division of Professional Licensure
• Board of Building Regulations and Standards
Construction-Stip-6i4isor Specialty
CSSL-105951 EApires:06/02/2020
_
PATRICK CLFFORD •.
12 BALDWIN ROAD -
DENNIS MA 01638
Commissioner l
'��,,.�� CERTIFICATE OF LIABILITY INSURANCE. I °'°s'"'°°""""
TINS CERTIRCATEIS ISSUED ASANATTER OFIi�ORINR7EON ONLTANDCONFERSNO RIGHTS UPON T1iEe111/19
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BRAVA THIS CERTIFICATE CONDUCT BETS THE ISSUING 3CATEOF INSURANCE DOES NOrCONSIITUWE A NS
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Kim ce iiealsholderisanAINITIO AL INSURED.Repai must have AacnlDmm.ammo
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this ced ands does me confer lights bSecediinie hoicks in Neu of suds endorsements).
PRCIetICER
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COVERAISES li1FE NINNBEIt REVISION NUMBER
THIS IS TOCBZIIFY7HIE<THE POLICIES OF INSURANCE USI®E.OWHAVESEEN ISSUED TO ME*CURED PU1®ABDME FOR THE POLICY PERIOD
INDICATED.NOTWIGISWEINGANY REDUREIENX 1BiMOR CONDITION WANT OONERscrCROMER DOCUMENT%NTHl .TTONHICBMIS
CERFIFE1TE WC(BEISSUEDOR MAY PB FAIN.TIE INSURANCEAFFORDEDBYTIEPOLCESDESCRIBEDHE3RE I N IS SUBJECT TONI THE TERNS
EXCURIONSMD OONDIT/CNSUFSUCH ROUGES.LINTS ROAN IMYwive BEEN REDUCED BY PAID CURIO.
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IND pep MUM 11OM9t POUCIEFF imoorrem � LEIS
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A meow pmso emon s 5,000
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GEMAGGREGNIE MTN"MS PER
GOIEWLAGGREFIAIE minx l -L Eluoc $ 2,�.eoo
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FOR OPERATIONS COVERED CON I 5 POLICIES.
HYTECH ROOFING SOLUTIONS IS USTEDAS AN A0UII10NAL Nam.
CERTIFICATE ATE WIDER CANCELLATION
E010LLDANYOFTHEsABOYE DESCINBED POLICIES ECAI CB1®IEFORE
THE OWIA7l0NOA7EMENEM11011SEINILEOE UIENEDN
NYTECH ROOFING SOLUTIONS Atx a1DAMCEMRITIEPOLEt7PlRMSI011�
12 BAIU1 RD
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HYTECH ROOFINGSOLUTIONS, GUM HLIS
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019SB2015 ACORD COiiPORIITION.AI rids removed.
ACORD 26(0761113) The ACORD naneand logo axe segineed moles ofACORD
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508AP7764.71173
12 Baldwin Rd. Dennis, MA 02638
ROOF REPLACEMENT PROPOSAL
Provided on: 8/27/2019
Customer:
NAME: George Joyce&Mary Yerardi - TEL
STREET: 36 County Rd - - CELL: (781)7714315
--— —
CITY: West Yarmouth,MA,-O*73 EMAIL chiPi0Yee*Yaboo:iom
HyTech Roofing Solutions 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 layers of existing roofing materials from the entire roof deck area of
the house.
Supply and Install Inspect and Re-Nail Any loose or popped plywood or boards on the
Entire Roof Deck Area of the House
Supply and Install CERTAINTEED LANDMARK SERIES LIFETIME WARRANTY,
CLASS A FIRE RATED, COPPER/CERAMIC STONES for
PROTECTION AGAINST ALGAE CONTAMINENT,235-300
POUND,EXTRA HEAVY WEIGHT, 130 MPH WIND WARRANTY,
CATEGORY HI HURRICANE,STORM/HURICANE NAILED(6
NAILS PER SHINGLE),MULTI-LAYERED,LAMINATED
ARCHITECTURAL STYLE,FIBERGLASS BASED ASPHALT
SHINGLES. COLOR:
Supply and Install 8"WHITE ALUMINUM DRIP EDGE on the entire roof eaves.
Supply and Install NEW .060 BLACK EPDM RUBBER ROOFING MEMBRANE
Replacing the two flat roof areas,on the back side of the house and
front porch.All rubber roofing is to be glued and pressed down
securely using all proper LOW-VOC primers and adhesives.This also
includes the installation of the following components: Y2"fiberboard
insulation board installed on the entire flat roof area fastened with 3"
plates and rubber roofing screws,C-6 WHITE ALUMINUM DRIP
EDGE installed around the entire outside perimeter of the rubber roof
Dap.
7"EPDM RUBBER ROOFING SEAM COVER TAPE will be
used to cover all seams and perimeter termination edging.
ADDITIONAL INVESTMENT: $2,550.0 14111
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Supply and Install Rebuild this euhre balk tread using similar materials to existing,but
with only one opening door instead of two.
aci ITIONAL INVESTMENT: $7: i.00 I-(
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POSSIBLE EXTRA CARPENTRY: Any rotted or otherwise deteriorated trim boards,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
S 60.00 per hour.Damaged Plywood will be replaced at a rate of S90 per sheet.
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 normally scheduled for completion within 30 days of
acceptance and receipt of deposit providing the materials are available.
Please Make Checks Payable to:
HyTech Roofing Solutions
HyTech Roofing Solutions Woes- -Shingles and Labor for 20 years.
CERTAINTEED Warranties the shingles and labor 100'/®for the first 10 Years
and the Shingles your I FETIME_if the shingles beco es defective.
CERTAINTEED Warrants the Shingles up to a
CATEGORY 111 HURRICANE-130 MPH WIND WARRANTY.
CERTAINITEED Warrants the bungles to be Alga Resistant.
HyTech Roofing Solutions
-Carries Wo an,s Compensation and Public Liability Insurance on the above work
-Handles all permitting and planning involved with the above proposed work
is-certified directly by ert teed,and primes ail warranty paperwork involved
TOTAL INVESTMENT:
(Enter Total Amount Including All Selected Options)
DATE OF ACCEPTANCE:
ACCEPTED : : SUBMITTED BY:
4Vd
11:44 tie y ` e ,..
vera L' Patri 1rfford Alex Yaskavets
CSL 11 se 105951
• HIC li nse 184383