Loading...
HomeMy WebLinkAboutBld-20-002130 `rO e it#W T/V / r C /l - '0-31,Amount O • rNAT7A ,, 4 fSE "`°"'•"°"�c d Permit expires 180 days from l issue date EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department Qt1 1 r; 20 1146 Route 28 South Yarmouth, MA 02664 4arzti 044 (508) 398-2231 Ext. 1261 1� CONSTRUCTION ADDRESS: %.>7Q ifjn or I4 y(h olv ASSESSOR'S INFORMATION: ,�^ -� Map: ✓ jf� -Parcel: ] �/ �j OWNER: c3C an i\ gi VA 1 i G e Cot, �r TEL. #7?-1 Lk(L1� l0 86 NAME PRESENT ADDRESS CONTRACTOR: l � 1 VII A a ((~ r r �,h rigy eI o)tig NAMMAILING ADDRESS TEL.# ❑Residential ❑Commercial Est.Cost of Construction$ !idaV,06 / - 1 Home Improvement Contractor Lic.# Construction Supervisor Lic.# CS—���i� Workman's Compensation Insurance: (check one) ❑ I am the homeowner ❑ I am the sole proprietor ❑ I have Worker's Compensation Insurance� ��^ �+� /� �( �� C`� Insurance Company Name: AVVI Worker's Comp.Policy# W 1J i -Sc •5"2O 61°1 1 WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares 4 9 Replacement windows:# 7 Replacement doors: # Roofing: #of Squares ( )Remove existing* (max.2 layers) Insulation Old Kings Highway/Historic Dist. ( )Replacing like for like Pool fencing _ *The debris will be disposed of at: 3"' . _. ) 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 understand that any false answer(s) will be just cause for denial or revocation of my license and for prosecution under M.G.L.Ch.268,Section 1. Applicant's Signature: .. / Date: MA Owners Signatur: (or attach'i ent) Date: Approved By: a Date: 70 4/ 7 —/ 5 Building Official(or EMAIL ADDRESS: Zoning District: Historical District: VYes ❑ No Flood Plain Zone: ❑ Yes ❑ No Water Resource Protection District: Within 100 ft.of Wetlands: 0 Yes 0 No ❑ Yes ❑ No The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 .•‘f 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): Ary- Address: 19 h Clt ��de One_ City/State/Zip: WeS1-11-arLoiell Phone #: 917i4 $ 16 6 iyg Are you employer?Check the appropriate box: Type of project(required): l. I am a employer with o2 employees(full and/or part-time).* 7. El New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. 11;1•4<modeling any capacity. [No workers'comp. insurance required.] 3. I am a homeowner doing all work myself. 9. ❑ Demolition ❑ _ y [No workers'comp. insurance required.]` 10 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.❑ Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 6.❑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.❑Other 152,§1(4),and we have no employees. [No workers'comp. insurance required.] *Any applicant that checks box R1 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: d Policy#or Self-ins. Lic. #: VOIiie— 5030-311913 79019 Expiration Date: Job Site Address: gt;1N )11C:t. On] ' City/State/Zip: &W./Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiratioft,C\-- 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 under the pains and penalties of perjury that the information provided above is true and correct. Signature: ` . _=�..__..._._... --- - Date: jolt 16 19 Phone 4: J- 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#: C f.,.3.,:v .,,...„ TOWN OF YARMOUTH':c 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451 REC _ �•l VED I Telephone(508)398-2231 Ext. 1292—Fax(508) 398-0836 'P '' ' " D KING'S HIGHWAY HISTORIC DISTRICT COMMI EE P`�N 2 2019 Y P r JVIUU 111 NW; APPLICATION FOR OLD KING'S HIGHWAY CERTIFICATE OF EXEMPTION Application is hereby made for the issuance of a Certificate of Exemption under Sections 6 and 7 of Chapter 470 of Acts of 1973, as amended, for the proposed work as described below and on plans, drawings, or photographs accompanying this application. Type or glint legibly: t i � p Address of proposed work: ),q l kd k i Ltd ,c .-. �3., y /mou Yw P i-Map/Lot# lO(o / g ID Owner(s): -JoL� \\\ob e. $ Phone#: 11 LI—/4 Cr` 0 All applications lQmust ibe submitted by owner or accompanied by letter from owner approving submittal of application. Mailing address: f. 1 W/6 �.r,(\= )/C„��&JIk Fort- Year built: /94 Email: J1,,,,,..,_ i ; btbi.' 'S( ` L0 ,C,,,t Preferred notification method: Phone `,7�mail .sr,_ l Agent/Contractor. \ -- Phone#: Mailing Address: Email: Preferred notification method: Phone Email Description of Proposed Work(Additional pages may be attached if necessary): q See, - ,}-aLh.2.4t 9 • - Rry(cc re W�roc(car... A- c )S :a`r,✓ : :L <<iwG S HiGHwAy___j 4/Z 1 1 11 , Signed(Owner or agent): � ' �-- Date: > Owner/contractor/agent is-'that a permit may be required from the Building Department(Check other departments,also.) > This certificate is good for year from approval date or upon date of expiration of Building Permit,whichever date shall be later. For Committee useonh(: Dat:nt tp.d/•19 / Approved Approved with changes� Denied �/ c90 �L I: : 46-AIL h'(-{ GG,�I rldizett-d A . Cas �1//3 ���/i�ul�/i c..- ..-C�n.; ...tom ...de- ialo-e-dve ,/ Rcvd by: Cyv d�� _b %/b, .144 ;���4a�v7 1/Qif ot r 7/ 7. 4.. --eCiiv . Date Signed: 0 V241 Signed: if 7 • L 0 6 APPLICATION# V5.2017 RP 47* tip' i,�lvlt,11 i ; Work Description »_,a r:fp s+�C�r,� �, rr,; I am requesting the following materials be used to renovate the exterior of 29 White Rock Rd. The renovations are strictly cosmetic,the structure itself will not be altered in any way.The renovation will consist of trim/window replacement and new siding for front and gables. The rear of the home does not need to be renovated at this time. The following is a list of materials I am requesting to use for the renovation. I. White Azek Trim-All existing trim on the exterior of the home,front and sides to be replaced with white Azek trim. II. Anderson 400 Series Windows-I am requesting to replace existing windows with double hung,black Anderson 400 series windows.I am also requesting the window grilles be either„.4.e er4(preferred) over This will include 3 j(e-4, windows on the south gable,one on the north gable and 2 on the front of the home.The front of the home contains a bay window which I would also like to replace with either double hung windows or the Anderson 400 series.eeseme __. windows.This area of the home although in the front does not directly face the street.Below are images of the current bay window and the proposed window. Existin: bay window from street ;'_01`,1"11' SOLI!t ',, ' cif'. Existing bay window Proposed replacement r,Rt I1it)Iii All newly installed windows to be incased with white 1 x4 Azek trim. III. Siding-Existing cedar shingles on the front of the home to be replaced with fiber cement board(Hardie Board).North and south gables to be sided with a pre- . • dipped white cedar shingle.All siding to be Cape Cod gray in color with a 4.5 - Q �l inch reveal. /Y jD I"7 ✓ f1 E7.\IN! CE._r=? U .5":t; 4 -E ,' , -,1:, ^, Z � 1. v i t st `, 7b� Division of Professional Licensure fit. rill Board of Building Regulations and Standard Constr t p rvisor { • rj CS-112010 Ncyires: 10/04/2021 KYLE FANNING P y� ' PO BOX 467 % iR 4, EAST HARWICHAMA 0 ` `l • t1 ' CoCf miSI!sioner Cipro, Linda From: John tibbetts <jhn_tibbetts@yahoo.com> Sent: Wednesday, October 16, 2019 1:40 PM To: Cipro, Linda Subject: 29 White Rock Rd. Attention!This email originates outside of the organization. Do not open attachments or click links unless you are sure this email is from a known sender and you know the content is safe. Call the sender to verify if unsure.Otherwise delete this email. I John Tibbetts am in agreeance with Parr building and remodeling to perform the proposed work at 29 white rock road J. ------45 ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MWDD/YYYY) V 10/16/2019 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 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 Benson Young&Downs Ins CONTACT Kathy Jones 15 Briar Lane (AIC Ne Flit). 508-432-1256 WC Ne)_508-430-1532 P 0 Box 717 EDORILSS: kathyjones©byandd.com Wellfleet MA 02667-0717 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Associated Employers Ins Co 40959 INSURED INSURER B:Penn America Insurance Company 32859 Parr Building&Remodeling LLC INSURER C: 19 Wayside Drive INSURER D: West Harwich MA 02671- 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 POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE mien wvn POLICY NUMBER (MMIDD/YYYY) IMM/DD/YYYYI LIMITS B X COMMERCIAL GENERAL LIABILITY PAV0216685 07/11/2019 07/11/2020 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 100,000 CLAIMS-MADE X OCCUR PRFMISFS(Fa occurrence) $ MED EXP(Any one person) I$ 5,000 I PERSONAL&ADVINJURY I$ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Fa accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILYINJURY(Peraccident $ —AUTOS ONLY AUTOS ) HIRED NON-OWNED PROPERTY DAMAGE —AUTOS ONLY —AUTOS ONLY (Per 8rzident) $ — UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETFNTION$ $ A WORKERS COMPENSATION WCC50050203682019A 04/25/2019 04/25/2020 X ;MUTE EMPLOYERS'LIABILITY /N STATUTE FR ANY PROPRIETOR/PARTNER/EXECUTIVE 111 Y E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? I I N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more apace Is required) Residential Carpentry CERTIFICATE HOLDER CANCELLATION Al 008861 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF YARMOUTH THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN BUILDING DEPT ACCORDANCE WRH THE POLICY PROVISIONS. 1146 ROUTE 28 SOUTH YARMOUTH MA 02664- AUTHORIZED REPRESENTATIVE I 2 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD