HomeMy WebLinkAboutBld-20-002076 ;Y Ir officc t ise Only
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EXPRESS BUILDING PERMIT APPLICATION
TOWN OF YARMOUTH
Yarmouth Building Department
1146 Route 28
South Yarmouth;MA 02664
(508)398-2231 Ext. 1261
CONSTRUCTION ADDRESS: 1`V W►n3li0 w 6r gd , vV• _
ASSESSOR'S INFORMATION:
1 Map: sr Parce! 1
NAME P ESENTADDD/RREE—SSSS�J STEL-. # Q '7�/ 2
C()tiTRACTCIR: `V ell d M:�Ait ADDRESS 1V Rd "kn, �I'EL. �L T"t 4 1-1 3
Residential Commercial
l,2 Est.Cost of Constriction$ I l S60 1
Home Improvement Contractor Lie.# t C�4"3 3 Construction Supervisor Lie.4 t 0 S 1
Workman's Compensation insurance_ (check one)
[am the homeowner I am the sole proprietor I have Worker's Compensation Insurance /
Insurance Company Name: f-/IV- , \ Worker's Comp.Policy# V V�... /�,6 O G 9_S
WORK TO BE PERFORMED a0/9 49
Tent — Duration (Fire Retardant Certificate attached?) Wood Stove
Siding: #of Squares Replacement windows:# Replacement doors: #
Roofing: #of Squares 25 (\/)Remove existing*(max.2 layers) Insulation
Old Kings Highway/Historic Dist. ( )Replacing like for like Pool fencing
*The debris will be disposed of at: a► u/t"
Location of Facility
I declare under penalties of perjury that the statements herein contained are true and correct to the best of my knowledge and belief. I undcrstarrd that any false answerls i
will be just cause for denial or revocation of my likens n for _ecrttion der M.G,L.Ch.268,Section 1. �j /a
Applicant's Signature: . Date: .10/ 15._i_..L.. 1_
Owners.Signature(or attachment) C � Date:
Approved Ay: --- t Date: ,V 'IS- ''Sty
Building Crucial to designee) 1;MAIl ADDRESS: �l,�.. M
rxiffiCkag)_
Zoning District:
Historical District: Ycs No Flood Plain Zone. Yes No
Water Resource Protection District: Within 100 fl.ofWetiand ,
Yes No Yes No
L
The Commonwealth of Massachusetts
i -"= `/ �� - \Department of Industrial Accidents
=�11 1 CongvetsStreet,Suite 100
7.4-1 4==" Boston, 112114--2017
_ ti
� ; ►www.mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/PIumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information - 0
Address: Please Print Legibly
Name{Business/Organizarion/Individual): TQ� &C)
„"'""""""'...Ill
\02 L�
City/State/Zip: 1 �1s � 6)y�� Phone#: 9:513 44 (o *(V3
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. ❑New construction
f
?❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling
any capacity.[No workers'comp.insurance required.t.-
3. I am a homeowner doingall work myself 9. ❑Demolition
❑ [No workers'comp.insurance required.]t }
4.0 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
• •. 'etors with no employees.
12.0 Plum ' g repairs or additions
5 g I am a general contractor and I have hired the sub-contractors listed on the attached sheet Roof repairs
• e sub-contractors have employees and have workers'comp.insurance.: p
6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. l 4.❑Other
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 roust attached an additional sheet showing the name of the sub-contractors and state Whether or not those entities have
employees. if the sub-eantiaetort.have employees,they must provide their workers'comp.policy mrm►v.rI .
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 S1,500.00
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+he DIA for insurance
coverage verification.
I do hereby certify under the pains and pen ' o erj hat th ' ation provided above is true and correct.
Signature: .{ .{ Date: O
Phone#: 5V2
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License it
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
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FOR°PERIGEESCONEREDONINSUREITSMMES-
HYtHCH ROOFING SOLUAONS IS LISTED AS AN ADDITIONAL
CEIT RRATE HOLDER CANCELLATION
31E0111DAIOOFTIEATENEDISS POUCESBECANDELLED BEFORE
WE MEAT=OWE WEREOE,BDIICEMRLDECE.NERED■
11YiBCN ROOFING 9OI ID7101t6 ACCOt�Ni EVIMTIEP urarrI I
12 BALD WIN RD
DENNIS MI►02638
HYTECHROOFNGSOLUTIONS, ODJVM BI.IS
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0 18884045ACORDCORPORA7gN,Ai deft reserved.
ACORD 26 MINGO The ACORD naaeaad logo"se mid' end marts afACORD
Q./A, Wornrnoewea/ C%ilezQoacAaoea
Office of Consumer Affairs and Business Regulation
One Ashburton Place-Suite 1301
Boston, MaSSachusetts 02108
Home Improvement Contractor Registration
Types LLC
HYTECH ROOFING SOLUTIONS LLC. 184383
12 BALDWIN RD 01/04/2020
DENNIS,MA 02638
SCA1 0 zowa osn7 Update Address and Return Card.
C7 eWomeArzweivectid erCitaaadeAteilt
Office of Consualh:s&Business Regulation
HOME IMPROVEMENT CONTRACTOR Registry valid for individual use only
TYPE LLC before the expiration date. tf found return to:
Regisbation Expiration Office of Consumer Affairs and Business Regulation
184383 01104/2020 10 Park Plaza-Suite 51T0
HYTECH ROOFING SOLUTIONS LLC. Boston,MA 02116
PATIO CUFFORD ,
ioterrir
12 BALDWIN RD �s
DENMS,MA 02638 Not valid without signature
Undersecretary
Commonwealth of Massachusetts
Division of Professional Licensmae
wf Board of Building Regulations and Standards
Construction:Slipewisor Specialty
CSSL-105951 empires:06/02/2020
FAIRER CLFFORD
12 BALDWIN ROAD
DEMOSMA 02638 • +
Commissioner al-
RtiEnna
508-776-7173
12 Baldwin Rd.-Dennis, MA 4)2638
ROOF REPLACEMENT PROPOSAL
Provided on: 5/8/2019
Customer:
NAME: Sean Driscoll TEL: (765) 9-5751
STREET: 396 Wittglotrgrarrd CELL:
TY EMA�I newsie78� r�[ m rmouth A02673
HyTech Roofing�Solutions •hereby proposes to perform the following •services •in a neat and
professional mannenand in accordance with the ufacturer's ecitications-and-local- wilding 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 III HURRICANE, STORM/HURICANE NAILED (6
NAILS PER SHINGLE), MULTI-LAYERED, LAMINATED
ARCHITECTURAL STYLE,FIBERGLASS BASED ASPHALT
SHINGLES. COLOR: C Olavt,J,t
Supply and Install HICKS VENTILATED ALUMINUM DRIP EDGE on the entire roof
eaves.
Supply and Install 8" WHITE ALUMINUM DRIP EDGE on the entire gable and rakes of
the roof.
Supply and Install CERTAINTEED WINTER-GUARD(Ice& Water Shield)
WATERPROOF UNDERLAYMENT SYSTEM 3 feet coverage on the
entire roof eaves,in valleys,on top of soil pipes and vents,under step
flashings, and running up the walls of the chimney
Supply and Install CERTAINTEED ROOF-RUNNER synthetic underlayment paper on
the entire roof deck area of the house as required per manufacturers
specifications.
Supply and Install CERTAINTEED SWIFT START adhesive asphalt starter strips on all
eves and Rakes with a 11 inch overhang.
Supply and Install CERTAINTEED FILTER RIDGE(SHINGLE VENT II) ridge vent on
the entire ridge area of the roof using the 3" hand nailing method.
Supply and Install CERTAINTEED HIP AMilittficE CAPS on the entire ridge/hip area
of the roof using the 3"ha dd nailing meth
Supply and Install UMINUIVI&NEOPRENE SOIL PIPE F\LAS4411INGS
Cr
_and Remove r from the k area after the job is complete
Pritittgi Good Better Best
Brand: Landmark °" Landmark-PRO Landmark Premium
Recommended for Inland Inland High Wind On the Water
Weight: 235 Lbs. 250 Lbs. 300 Lbs.
Warranty Period: 40 years 50 years 50years
Algae Protection: 10 years - 15 years 15 years
Max-Def Colors: NO YES YES
TOTAL Investment: $10,800.00 $11, b0.00 N/A
Please Check
Selection
Exclude CertainTeed Extende tar warren for an additional $800 savingLLI
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.
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, rr n ties-the;Shingles and Labor for 20 years.
CERTAINTEED Warranties the shingles and 1'abof 100% for theTFirst 10 Years
and the Shingles your LIFETIME,i the shingles become defective.
CERTAINTEED Warrants the Shingles up to a
___._....... .........
CATEGORY III HURRICANE-IN...MPH WIND WARRANTY.
Eiali NTEED mid the Shingles to It Algae Resistant.
HyTech. Roofing Solutions
-Carries Workman'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 Certainteed, and processes all warranty paperwork involved
TOTAL 1NV LSTMENT __(Enter Total /Amount Including All Selected Options)
DATE OF ACCEPTANCE: (C7
ACCEPTED BY: SUBMI Fl ED BY:
an Driscoll
Patrick Clifford—Alex Yaskavets
MA CSL license 105951
MA HIC license 184383