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Home My WebLink AboutBld-20-001694 f ^ Office Use Only 414 P' ;. o"V -0--d/d I l7 ` - 2.5 2I i; Amount c-acco 4r_to Permit expires 180 days from ..:; .., issue date EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth,MA 02664 (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: 111 Old Town House Road ASSESSOR'S INFORMATION: Map: 87 Parcel: 196 OWNER: Juliana Biega 111 Old Town House Road (774) 994-0231 NAME PRESENT ADDRESS TEL. # CONTRACTOR: Enda S Garry 346 Western Ave#2 Lowell,MA 01851 617-908-0242 NAME MAILING ADDRESS TEL.# Xtesidential 0 Commercial Est.Cost of Construction$ Z/500 Home Improvement Contractor Lic.# 191498 Construction Supervisor Lic.# CS-113557 Workman's Compensation Insurance: (check one) ❑ I am the homeowner I am the sole proprietor XI have Worker's Compensation Insurance Insurance Company Name: western world Worker's Comp.Policy# NPP8517412 WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares 30 ( X)Remove existing*(max.2 layers) Insulation Old Kings Highway/Historic Dist. ( )Replacing like for like Pool fencing 'The debris willbe disposed of at: Republic Services 61 Commonwealth Ave, South Yarmouth, MA 02664 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 rev atio of • and for prosecution under M.G.L.Ch.268,Section 1. a Applicant's Signature: Date: `-z3 -'1 z;Owners Signature(or attachment) J Date: 1/ II, Approved By: Date: i Building ic; r ignee) L ADDRESS: Zoning District: Historical District: Yes I No Flood Plain Zone: _ Yes r No Water Resource Protection District: Within 100 ft.of Wetlands: Yes No Yes r No The Commonwealth of Massachusetts .....-- Department of Industrial Accidents Office of Investigations G =M` 600 Washington Street •r Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Greater Boston Roofing Corp Address: 346 Western Ave Unit 2 City/State/Zip: Lowell, MA 01851 Phone #: 978-905-5045 Are you an employer?Check the appropriate box: Type of project(required): LE I am a employer with 4 4. I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction listed on the attached sheet. 7. ❑ Remodeling 2.El I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in anycapacity. employees and have workers' P h'• 9. ❑ Building addition [No workers' comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions q ] 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.E Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other 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. :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. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: AIM Mutual Policy#or Self-ins.Lic.#: VWC1 00602284820 1 9A Expiration Date: 01/24/2020 Job Site Address: 111 Old Town House Road City/State/Zip:Yarmouth, MA 02664 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that 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: .� Lcieloiif. �� Date: 8/20/19 Phone#: 978-905-5045 l// 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#: •4•• Yiv...i.iv;;i•r•ii .� ii•;,:n•YI/ i 1/. Commonwealth of Massachusetts Olga oftb ptarrMfaksr4BusinessRegulation ® Division of Professional Licensure HOME IMPROVEMENT CONTRACTOR Coroorehon Board of Building Regulations and Standards Construction Supervisor 191498 04/232020 CS-113557 • GREATER BOSTON ROOFING CORP . E Aires: 10/06/2022 ENDA S GARRY 278 K STREET ENDA(3ARHY NO2 • 278KSTN2 BOSTON MA 02127 BOSTON,MA 02127 C Undersecretary Commissioner — Construction Supervisor Unrestricted-Buildings of any use group which contain - — _ _ less than 35,000 cubic feet(991 cubic meters)of enclosed " _ • space. Registration vdid for individual use only before the expiration date. If found return to: Office of Consumer Affairs end Business Regulation One Ashburton Place-Suite 1301 Boston,MA 02108 Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license Call(617)727-3200 or visit www.mass.gov/dpl Not vs, without signature DATE • ACo® CERTIFICATE OF LIABILITY INSURANCE 03/05/2019 YY) `i 03/05/2019 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 POUCIES 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 Global Help Center Inc NAiIIE!LCT TATIANA SALES 1252 LAWRENCE ST SUITE C2 PHONe 978-421-7769 1 FAX 978-710-5581 Lowell MA 01852 I/I($.No.Eat): IA/C•No): ADDRESS:ghclowell@hotmail.com INSURERIS)AFFOROING COVERAGE NAIC I INSURER A. WESTERN WORLD - -_.__..._.---- --- -- ----- - ---------------- INSURED GREATER BOSTON ROOFING CORP I, a:NAUTILUS INS 27 JACKSON ST APT 123 INSURER C:AIM MUTUAL INS CO LOWELL MA 01852 INSURER 0: 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. LTR TYPE OF INSURANCE ,,,L,+ '(MPWDOlvyCY F POLICY EXP -... u++l POLICY NUMBER IMMIDO/YWYI (MMIDO�YYYYI LIMITS be COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 'DAITAGEYO7tENTE e -. I CLAIMS-MADE ✓ OCCUR PREMISES(Ea otWrienuj S 100,000 MED EXP(AnLr one person) S 5,000 A NPP8517412 01/25/2019 01/25/2020 PERSONAL S ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE S 2,000,000 b- POLICY 0 jERei 0 LOC PRODUCTS.COMP/OP AGG I S 1,000,000 OTHER: S AUTOMOBILEUABILITY Ull� 1r COMBINED SINGLE LIMIT S (Ea accident) ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED BODILY INJURY(Per accident); S AUTOS ONLY r� AUTOS HIRED NON-OWNED PROPERTY DAMAGE S AUTOS ONLY I— AUTOS ONLY (Per accident) $ u UMBRELLA LIAB se OCCUR L_JLJ EACH OCCURRENCE 1 S 2r000,000 B EXCESS LIAB CLAIMS-MADE ANA047621 01/25/2019 01/25/2020 AGGREGATE s 2,000,000 DED I-1 RETENTION S 11 '' j S WORKERS COMPENSATION UTAT;MUTE L_1 OTH- ER AND EMPLOYERS'LIABILITY 'ANYPROPRIETOR/PARTNERIEXECUTIVE YIN EL.EACH ACCIDENT $100,000 'oFFICERMIEMBERexcLUDED? n NIA' 'VWC10060228482019A 01124i2019 01I2412020 - 100000 C I(Mandatory In NH) E.L.DISEASE-EA EMPLOYEES + II yes describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S CIO DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached I more space Is required) THIS W.C.POLICY DOES NOT COVER ANY OTHER STATE THAN MA. CERTIFICATE HOLDER CANCELLATION S SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE TATIANA SALES Wi1', 01988-2015 ACORD CORPORATION. All rights reserved. 4CORD 25(2016103) The ACORD name and logo are registered marks of ACORD Produced using Forms Boss Web Software.www.FormsBoss.com(c)Impressive Publishing 800-208-1977 9/20/2019 Estimate Print Preview Greater Boston Roofing 09/20/2019 346 mAve � ` Lowell11 MA MA 01852 Phone:617-744-9690 GREATER BOSTON Fax:978-418-0233 ROOFING Company Representative Stephanie Benitez Phone: (978)930-6722 stephanie.benitez@greaterbostonroofing.com 221R-111BIEG Juliana Biega Job:2062:221R-111BIEG Juliana Biega Sunrun Solar 111 Old Town House Road Yarmouth, MA 02664 (774)994-0231 Roofing Section •Strip existing shingles down to bare wood,Inspect integrity of roof decking thoroughly. (**IF UNUSABLE OR ROTTEN WOOD IS FOUND DURING INSPECTION IT WILL BE REPLACED AT A PRICE OF$60 PER SHEET OF PLYWOOD SHEATHING OR$4 PER LINEAR FOOT OF LEDGER BOARD**) •Install ice&water shield to first 6-feet on eaves,3-ft in valleys and immediately surrounding all protrusions •Install synthetic vapor barrier underlay •Install all new white 8"non-vented drip edge on perimeter •Install manufacturer suggested starter course of shingles on eaves and rakes •Install GAF Timberline HD 50 yr.Lifetime/architectural shingles in color of your choice •Install ridge vent •Cap ridge vent properly with manufacturers suggested cap •Properly flash any protrusions and all new pipe flanges •Install new lead flashing around chimney •Maintain a clean job site throughout project,with meticulous dean up of site upon completion •Submit project for manufacturer's extended warranty upon completion of project ***ESTIMATE/CONTRACT PRICING INCLUDES THE TOTAL COST ASSOCIATED WITH MATERIALS,LABOR, PERMIT COST,AND ANY DUMPSTER/REMOVAL FEES INVOLVED IN COMPLETING THE PROJECT*** Qty Unit GAF Timberline HD 30 SQ •Color of your choice •50 yr./Systems Plus Lifetime Warranty Ice and Water Shield 0 RL Vapor Barrier 3 RL Drip Edge 0 PC GAF ProStart Starter Shingle 0 BD GAF Cobra Snow Country Ridge Vent 0 LF GAF Seal-A-Ridge Hip and Ridge Cap 0 BD Roofing Coil Nails 2 BX Chimney Lead Flashing 0 EA Pipe Flashing(up to 4") 0 EA Company Provided Lead Cost 0 SQ TOTAL $12,500.00 1/2 9/20/2019 Estimate Print Preview *Any work related structural deficiencies or work required to complete project to Massachusetts Building Code not covered in this estimate will require Change Order.Roof decking replacement cost will be billed at$60 per sheet of plywood or$4 per linear foot of ledger board. lz3 1 �' Company Authorized Signature Date /....Z3 Customer Signature Date Customer Signature Date 2/2