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Permit expires 180 dass from
issue date
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EXPRESS BUILDING PERMIT APPLICATION
TOWN OF YARMOUTH
•
Yarmouth Building Department
1146 Route 28 DE) 1 1 An
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South Yarmouth. MA 02664
(508) 398-2231 Ext. 1261
CONSTRUCTION ADDRESS: 14_ Orditici ,th
ASSESSOR'S INFORMATION: f i
l Map: I Parcel:
OWNER:IVO( OA/Aqui/A letitta, Cozzi itiormict 1.41 5-01 4.*5 141-93.
NAME PRESENT ADDRESS TEL CONTRACTOR:Thfrick Ctifford g.... adtA)ida__Demis RR 44-6 4i 1
NANIE iwAlL i G ADDRESS TEL 4
esidential)( El Commercial Est,Cost of Construction s q5 co
Home Improvement Contractor Lic.# tigit4g. Construction Supervisor Lie.# tOek9 S 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: elkOeMeX 1410 Lite Worker's Comp,WORK TO TO BE PERFORMED
Tent Duration (Fire Retardant Certificate attached?) Wood Stove
Siding: #of Squares Replacement windows:# Replacement doors: #
Roofing: #of Squares 02 ( j)Remove existing* (max.2 layers) Insulation
Old Kings Highway/Historic Dist. ( )Replacing like for like Pool fencing
*The dchns Will be disposed of at di aatiti Rati)
Location of Facili
I declare under penalties of perjury that the statements herein contained arc true and correct to the best Olin)knowledge and belief I understand that an raise ansv,cri,)
will he just cause for denial or revocation of my license and for prosecution under M(.1.. Ch.268,Section 1
Ar c)Applicant's Siginto•. :or ..r .:17 -.,_ Date 10114 l
014 ners Sigtore(or attar eat) 4111110ferlIM i Date:
'-
Approved By
Builfrrig r ..— I-N1411,ADDRESS
t „CD
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Zoning District:
Historical District- _ Yes No Flood Plain/one. Yes No
Water Resource Protection District: Within 100 ft of W etlands•
Yes No Yes No
l The Commonwealth of Massachusetts
t {. =f. Department of Industrial Accidents
E. —'- •• 1 Congress Street,Suite 100
c Boston, MA 02114-2017
•
www.mass oov/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): 4:120'� 1
( rganization/lndividua!): TP�� 1t �� S
Address: a ecedwm. Rr/
City/State/Zip: Deno S MY? Phone#: 5118 7-fi) 74 3
Ate you an employer?Check the appropriate box Type of project(required):
1.❑I am a employer with employees(full and/or part-time).' 7. ❑New construction
?❑I am a sole proprietor or partnership and have no employees working for me in 8. EI Remodeling
arty capacity.[No workers'comp.insurance required]
3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.)t
9. ❑Demolition
4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will
10 D Building addition
ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions
!- •. prietors with no employees.
12.0 Plumbing repairs or additions
. I am a general contractor and I have hired the subcontractors listed on the attached sheet 13. oaf 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 14,Q Other
gh pti per MGL c.
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.
tContractors 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 jab site
information.
Insurance Company Name:
Policy#or Self-ins.Lie,#: 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 the DIA for insurance
coverage verification.
I do hereby certify under the pains and pen of perjury that the information provided above is true and correct
Signature: it:2Date:
Phone#: ?-(JO *T 1U f t
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#:
ojeglickoackzejede&
Office of Consumer Affairs and Business Regulation
One Ashburton Place- Suite 1301
Boston, Massachusetts 02108
Home Improvement Contractor Registration
Type: LLC
HYTECH ROOFING SOLUTIONS LLC. 1843133
12 BALDWIN RD 01/04/2020
DENNIS,MA 02638
Update SCA 1 s3 20�A-05n7
Address and Return Card.
•
cA +e�cou r, lr/c",1'la.dwelk
Office of Consumer Affairs&Business Regulative
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only •
TYPE:LLC before the esg3kation date. If found return to:
ExPlration Office of Consumer Affairs and Business Regulation
184383 01104/2020 10 Park Nara-Suite 5170
HYTECH ROOFING SOLUTIONS LLC. Boston,MA 02116
PATRICK CLIFFORD /.4degglf
12 BALDW IN RD
DENNIS,MA 02638 Undersecretary Valid without signature
Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
Constructiort-'SUpeivisor Specialty
CSSL-105951 Expires:06102/2020
if
PATRICK CLFFORD •• C
12 BALDWiN ROAD
DEf1 IS MA 02638 .i
Commissioner CI".
1 ' CERTIFICATE OF LIABILITY INSURANCE. I °'°E�"""'"
MIS CEI[IMI ATE IS ISSUED ASA OF orONLYAND SNORISME UPON THE ow!!iq
CENI IEDOESNOTAF AFFIRMATIVELY HOLoLICES
BEIM'MIS CERTIFICATE OF INSURANCE DOES NOT E ACONTRACT RA BOW CDNB�Re ISSUING IN UR BY k AL HORIDE
REPRESEMATIVE BE�wr-.sr THE OR PRODUCER.AND THE ti3t7EicATEHOLDER.
INPORTANSE Elbe eer6Ncale holder isa ADCMONAL INSURED.Ilse p most ha eADINIEN LINSARED
provisions or endorsed. '
WSUBROGE11101111SEPPIED.s do Eve len=and aooNrioos alike poiex w es ilai.policies wry req e a.eodoonoloa.A slaibeseeet on
Isis ce.iicaie does not cooks*Oft lo lie ceilieaie Udder hi lies afsach eadoinenseiew.
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COVERAGES CERTIFICATE NtNNTEt REVISION NUMBER
THE IS TO0317FY THAT THE PataesOFNNRANCE LISTED BELOWHAYEBEENESUE)ronEM SUREDNAIEDABOyEFORMEpaUCrPHbOD
ANY 1sirEmeioRCOIOITIom°FMBCOMRACiORrn162nommen.MOTHRBSPeCT70waCHTH5
CH IFICATEamBEISSIMORINC(F R MAN.DE INSURANCEAIRIFEED BY DEREICSDESCREBDI9 EINISSUBJECT TOALLTHEIERIE
EXCUISICHSAIDCOlE IONStFSUCH POUCH UNITS SHORN NAY HAVE BEEN REDUCED D BY PAMCtAMS.
DISH 'UR TYPE OFRiININCENIELpro MUMMERPOW(EFFinn POULY�
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ECINISSINDE El OCCUR P B E IEsam:mvA s learn.
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PFR801NLRAWENANY s UNIL000
oen.mionairoELITAPPIESPI3tOBEINLARGREGRIE $ 2,001U100
CRIER
RillouoaRELINSUIV $—
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ELI76EASE-POUCTLINT s 1.1119.11110
08 CRIPEONaFOPERMIN/ NOORotn.Art"mIRm.wakbeii+a.ayti..O.awi.mspece sanquisi -
FOR OPERATION'S COVERED ONi rSFOUCNS.
HYTECH ROOFING SOUITDONS IS USTEDAS MI ADDITIONAL INSURED.
C8t7RCATE HOLDER CANCBmoTION
SHOUDAMrOFYIEABOYEW.Ci1EED POLICES EECAINB ADBEFORE
TIE E7 IRER=OKIE MENEM 110110EVILiEEOBBIBI®■
ENTICE ROOFING solufoNs ACE:0107iAlICE111ili TIE POI If:YPMOIlIR1Ol15
12 BALMS'RD
MINIS NA EMS NIIIIONNEDREPRIBINOMIE
HVIECH ROOMINGSOUITIONS. OUYIA ELLIS
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O191111,2015ACORDCORPORA ,QL MIS
ACORD 2 a1 3) The ACORD anneaad logo ate Isgisieed mots ofACORD
sot.e.4.4
SO.I: _ 7 6 717
12 Baldwin Rd. Dennis, MA 02638
ROOF REPLACEMENT PROPOSAL
Provided on: 9/27/2019
Customer:
NAME: Ivor Overmeyer TEL: (508)775-7497
STREET: 14 Orchid Ln CELL: (774)810-6974
CITY: West Yarmouth,MA,02673 EMAIL: ��hhhc57®gmaiLcom
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.Atleast 5 sheets will need to be
replaced,which will be included in this quote,anything over 5 sheets
will be charged as an `Extra'.
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:
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 end rakes of
the rooL
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,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 A 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 AND RIDGE CAPS on the entire ridge/hip area
of the roof using the 3" hand nailing method
Supply and Install ALUMINUM&NEOPRENE SOIL PIPE FLASHINGS,and black
aluminum fan vents
Clean and Remove Debris from the work area after the job is complete
PrI_cin 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 50 years
Algae Protection: 10 years 15 years 15 years
Max-Def Colors: NO YES YES
TOTAL Investment: $9,250.00 $9,500.00 $10,820.00
Please Check ❑
Selection
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 Warranties the Shingles and Labor for 20 years.
CERTAINTEED Warranties the shingles and labor 100%for the First 10 Years
and the Shingles your LIFETIME if the shingles becomes defective.
CERTAINTEED Warrants the Shingles up to a
CATEGORY III HURRICANE-130 MPH WIND WARRANTY.
CERTAINTEED Warrants the Shingles to be 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 INVESTMENT:
(Enter Total Amount Including All Selected Options)
DATE OF ACCEPTANCE: /a//
ACC a' fB . SUBMITTED BY:
vor ert a er Patrick Clifford—Alex Yaskavets
MA CSL license 105951
MA HIC license 184383