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HomeMy WebLinkAboutBld-20-002035 -o1•Y.qR ;/k r R r�! OC: Permit#.tigi 0 1 I Amount `C` TTA ;Permit expires 180 days from u GZ3S {issue date EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 - . .�,�,g South Yarmouth, MA 02664 `�' (508) 398-2231 Ext. 1261 �� CONSTRUCTION ADDRESS: �4, C / , J'7 e G/7/', J o2 �I ASSESSOR'S INFORMATION: ��Maap: Parcel: OWNER: itjGflic2 GZi1LitZ/7i7/ NAME PRESENT,A�DDREESS 1� TEL. # CONTRACTOR: ,�/I'Y///y ✓Gil2 %eI4 z /e/� /gar oaf/ /�ytst/9/J/J� AMA d.l b O/ NAME ✓ MAILING ADDRESS TEL.# 379 8 .`e9 2 2 3 Residential 0 Commercial Est.Cost of Construction$ 3, /2 5 Home Improvement Contractor Lic.# /69/4p Construction Supervisor Lic.# 047 70 2.9 Workman's Compensation Insurance: (check one) 0 I am the homeowner 0 I am the the sole proprietor I have Worker's Compensation Insurance Insurance Company Name: AW/42/ ._f/L,Q. �j • Worker's Comp.Policy# /Q,avC.79©2•0-f WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# .3 Replacement doors: # Roofing: #of Squares ( )Remove existing* (max.2 layers) Insulation Old Kings Highway/Historic Dist. ( )Replacing like for like Pool fencing ?a-1741:f *The debris will be disposed of at: s 'Cr X��.O 7. / Location of Facility I declare under penalties of perjury that the statements he A 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.• . ,.-fa for prosecution under M.G.L.Ch.268,Section 1. Applicant's Signature: — Arg Date: id if/9 Owners Sign. I • Date: Approved By: Pt"-9 Date: /d•//.j Building Official(or design e) MAIL ADDRESS: Zoning District: Historical District: 0 Yes ❑ No Flood Plain Zone: 0 Yes n No Water Resource Protection District: Within 100 ft. of Wetlands: 0 Yes 0 No 0 Yes E. No Ynanr 4/64C`, The Commonwealth of Massachusetts r Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 �.�,5.•`'c www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information /^Please/Print Legibly T„7 Name (Business/Organization/Individual)): GLPo2T 0106' A'£//QLI � G e Address: 6t9 iofia A.1 47/4 0266/ City/State/Zip: ��S' �/r �IA Phone 4: 5'&6r• 19, . AS-2 3 Are you an employer?Check the appropriate box: Type of project(required): LE I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.VfI am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers'comp. insurance required.] 8. El Remodeling 3. I am a homeowner doing all work myself. 9. E Demolition ❑ y [No workers'comp. insurance required.]` 4.❑I am a homeowner and will be hiring contractors to conduct all work on property.mY I will 10 El Building addition 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 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.t 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other 4A4 /4HP E► 3 152,§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 must attached an additional sheet showing the name of the sub-contactors 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: An ate,011 Policy#or Self-ins.Lic. tt: awe 79L9 7 1 Expiration Date: 05, 04, s020 Job Site Address: cC' g City/State/Zip: j/ y114, 14 i W 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 certify r t ain nd penalties of perjury that the information provided above is true and correct. Signature: Date: fa. li /9 Phone#: 5 Of 29/:aS,Z Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License gr 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#: • Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Const\roASsri7 i so r CS-097029 IJT - tA;ires: 10/08/2020 I Igh C DMITRY MAZHEIKA 60 JOSIAH'S FrH \ WEST BARNS AFLE '::nzser -1/-0/ :c4-1*.-Ao"t‘ CZ. ' • Commissioner Office of Consumer Affairs&Business Regulation HOME IMPROXEMENT CONTRACTOR il:1;;C04/16/2020 BELPORT&nit Expiration LtWtidELING,LLC. LT MAZHEIKA DZMfl 60 JOSIAHS PAT62"-e-CGet—;4 WEST BARNSTABLE,-MA 02668 Undersecretary 7ACIIVII This proposal is valid only for 30 days from the signed date.Payment is due upon receipt of an invoice. All invoices are to be paid in full due to completion of work. A payment not paid when due will be subject to interest at the rate of 1.5% per month.The Customer shall be liable for all costs of collection including interest and reasonable attorney fees. Warranties contained herein will not be honored and will become void The above prices,specifications and conditions are satisfactory and are hereby accepted. BelPort Building & Remodeling,LLC is authorized to do the work as specified. Note: No work shall begin prior to the signing of the contract and transmittal to the owner of a copy of such contract.You,the buyer may cancel this transaction at any time prior to midnight of the third business day after the day of this transaction. TOTAL $3,125.00 Accepted By Accepted Date Fox Wood L frY1LHYu1d ct l..I.. 4 1 J MK t ... 4, c 248 Camp Street West Yarmouth Mass. 02673' October 2, 2019 Alena Manni Foxwood Unit J-2 248 Camp Street West Yarmouth, MA 02673 Dear Pam, The board of trustees is in receipt of your request to replace / perform work within your unit at Foxwood Condominium in accordance with the rules and regulations or by-laws of the condominium association. After reviewing the work requested,the following is provided: WORK TO BE COMPLETED: Replacement of three (3)windows. Window to be replaced with a "Full Frame Window" • 2nd Floor—Master Bedroom—2 double hung windows, 6 over 6 configuration. • 2nd Floor—Bedroom-double hung window, 6 over 6 configuration. All as indicated on Belport Building and Remodeling,dated 9-20-2019. DOCUMENTATION: 1. A copy of the BUILDING PERMIT HAS NOT been received. 2. A copy of the PROFESSIONAL license HAS NOT been received for the installer. 3. A copy of the certificate insurance naming FOXWOOD CONDOMINIUM as an additional insured HAS NOT been received. 4. Proof of workman's compensation HAS NOT been received. CONDITIONS 1. Copy of Certificate of Insurance listing Foxwood Condominium Association as an additional insured. (must be received 7 days prior to work start date) 2. Copy of carpenters professional license to be provided(must be received 7 days prior to work start date 3. Copy of building permit(can be provided the work start date) 4. Two business day advance notice of work start date. 5. Carpenters ID verification(done at start of work) 6. Window sills must be installed on finished work. 7. Work area to be left in free of debris. 8. All materials to be taken off the property and not placed in dumpsters on the property STATUS: CONDITIONALLY APPROVED — Subject to #1-4 as listed Should the work completed and/or item installed not conform to this submission,the board of trustees will require removal/correction to comply with this approval. If you have any questions,please contact Shaun Horan at 508.775.6880 or John Pupa at 508.420.0047. Cordially John J. Pupa Business/Financial Manager Foxwood Condominium Attachments: Belport Building and Remodeling Proposal dated 09-20-2019 BeIpolt Bulrsng a Remodeling.LLC P.O.BOX 2881 Wm+� nr Location: Hyannis,MA 02601 US (fur -Master bedroom 2nd Level-2 windows 508.298.2523 -Kids bedroom 2nd level-1 window belportbuildirg@live.com BLLPORT httpJ/www.belportbuilders.com 2.Instal New 3 Windows • \(i.l'RI\tul)I-I.I"(,.I I(. 3.Install New PVC Azek Exterior Trims To Match with existing 4.Window Insulation ADDRESS ESTIMATE if 1109 5.Install Interior window trims to match with existing Alena Manni DATE 09/20/2019 6.White Cedar Siding:Tie-into existing as needed 248 Camp Street,Unit J2 EXPIRATION DATE 10/20/2019 Painting 1 450.00 450.00 West Yarmouth,MA 02673 Exterior&Interior Painting: -All Newly Installed trims: Prep,sand,2 coats finish to match with existing -Walls:touch up around new windows ONLY NOT INCLUDED IN THIS AGREEMENT OR BY OTHERS -Unforeseen Problems that arise due to defects in the existing plumbing, electrical or Structural systems,such as rot or items or not to code,will be assessed and priced as needed. GENERAL CONDITIONS - All utility expenses 1)BelPort Building&Remodeling to carry both Liability and Worker's Terms of payment for work above will be made as: Compensation Insurance. -50%Deposit 2)All building materials,fasteners and debris removal will be furnished by -50%Upon Completion BelPort Building. 3)BBR to use existing on-site electricity. Warranty terms:1 year 100%labor and materials warranty and duration of 4)BBR will provide cleanup on a continuing basis. warranty are prorated labor and materials for the life of the installed 5)All affected Construction areas will be cleaned at the end of materials. construction. Solaria Peml 1 75.00 75.00 Job Is estimated to commence approximately 2-4 weeks after deposit Town of Yarmouth Express Building Permit received. Windows SUBMIT SPECIFICATIONS AND ESTIMATES FOR: 1 2,600.00 2,600.00 WEHEREBYWork is scheduled to be substantially completed in approximately 1-2 WE To Remove 3 existing wood DH Windows&Replace with Harvey Classic working days. DH Any work above and beyond the specifications outlined in this proposal will Windows Specs: be performed at$65.00 per man hour plus materials or priced on request. Double Glazed,Double Low-E RS,Argon Filled All additional work,Including travel time and lumberyard runs will be Base Color=White subject to extra charge. Double,Sash Limit Devices=Night Latch All products installed by BelPort Building&Remodeling,LLC will be to Full Screen,Full Screen Mullion,Fiberglass Mesh,Screen Shipping manufacturer's specifications. Separate Contour In-Glass,Colonial,Match Frame,Painted Grille-No,3W2H All work will be performed by insured professionals.Any alteration or Integral L Fin,Receiver Pocket deviation from above specifications involving extra costs will be executed Complete Interior Trim Kit=Yes,ITK Finish=Primed Pine,ITK Casing only upon written orders and will become an extra charge over and above Profile=2 1/2"Colonial,ITK Setup=Stool and Apron,Stool Type= the estimate. Standard,Stool Cap Thickness=5/8",ITK Extension Jamb Depth=4 9/16"Drywall NOTE: All balances due upon completion.Balances over 30 days subject Labor&Materials Allowance:$2600 to a 1.5%monthly finance charge(18%per annum)and any charges Incurred during collection. Scope of work: There are important additional terms and conditions to this contract. 1.Remove existing windows with all exterior and interior trims `c) ACo O® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 10/11/2019 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 CONTACT NAME: Deborah Kelly LEONARD INSURANCE AGENCY (aCNNo.Est): (508)428-6921 FAX (AIC,No): E-MAIL ADDRESS: DeborahK@Leonardagency.com 683 MAIN STREET SUITE B INSURER(S)AFFORDING COVERAGE NAIC# OSTERVILLE MA 02655 INSURER A: AMGUARD INSURANCE CO 42390 INSURED INSURER B: BELPORT BUILDING AND REMODELING LLC INSURER C: INSURER D P 0 BOX 2881 INSURER E: HYANNIS MA 02601 INSURERF: COVERAGES CERTIFICATE NUMBER: 459930 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 S POLICY EXP LTR TYPE OF INSURANCE INSD VD POLICY NUMBER (MM/DDY/YYrr w ) IMM/ODIYYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- CT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) _ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X PEATUTE EOTH AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBER EXCLUDED? N/A N/A N/A R2WC062905 05/04/2019 05/04/2020 (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 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/Iwd/workers-compensation/iinvestigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Yarmouth • ACCORDANCE WITH THE POLICY PROVISIONS. 1146 Rte 28 AUTHORIZED REPRESENTATIVE S Yarmouth MA 02664 j" C� Daniel M.Craw ey,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD