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HomeMy WebLinkAboutBld-20-000912 Office Use Only fl ot 12•ofY :. 0, Permit# C y (per _ H f Amountsri '` MAT n S ' _�3,4` ,"'s a: Permiw . - 80 days from issued w EXPRESS BUILDING PERMIT APPLICATI 1': E C E 1 V E D TOWN OF YARMOUTH Yarmouth Building Department AUG 19 20�9 1146 Route 28 South Yarmouth, MA 02664 BUILDING DEPARTMENT (508) 398-2231 Ext. 1261 By CONSTRUCTION ADDRESS: 13 CVOGD Q ih) ASSESSOR'S INFORMATION: Map: Parcel: ^ C' (� OWNER: / ( 'V1- c C CAM- (( ) 6 c''" L 41L m( g l G cam NAME ` PRESENT ADDRESS TEL. �y TEL. # CONTRACTOR: 00144-5 17 AI T vl � kg) OC J2( 7 e/t U7 t uri(J r NAME MAILING ADDRESS TEL.# -�q C R5esidential 0 Commercial Est.Cost of Construction$ 0 00 y Home Improvement Contractor Lic.# O& ? C)& 3 Construction Supervisor Lic.# tc 2 C K. Workman's Compensation Insurance: (check one) 1 ❑ I am the homeowner 0 I am the sole proprietor� AI have Worker's Compensation Insurance Insurance Company Name: �L"UCS Worker's Comp.Policy# WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# Replacement doors: # Roofmg: #of Squares j b ( )Remove existing* (max.2 layers) Insulation Old Kings Highway/Historic Dist. ( )Replacing like for like Pool fencing *The debris will be disposed of at: CP/2 1 0-61'1 tA.i 1 / Location of Facility I declare under penalties of perj the sta menu he in contain 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 vocati n of m I. ense an for pro 'on under M.G.L.Ch.268,Section 1. Applicant's Signature: Date:Date: it 1/(9 Owners Signature(or attachment) Date: Approved By: Date: ,?1/7 Building ci des' ee) EMAIL DRESS: Zoning District: Historical District: 0 Yes 0 No Flood Plain Zone: 0 Yes ❑ No Water Resource Protection District: Within 100 ft.of Wetlands: 0 Yes 0 No 0 Yes 0 No _-"N HALLM-1 OP ID: PN '4 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 05/30/2019 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 781-233-1855 ACT Peter A. Rossetti Ins.Agcy. Peter A.Rossetti Ins.Agcy. PHONE 781-233-1855 1 FAX 781-231-3752 436 Lincoln Avenue (A/c,No,Eat): (A/C,No): Saugus,MA 01906 n i SS:pnickerson@rossettiinsurance.com Peter A.Rossetti Ins.Agcy. INSURER(S)AFFORDING COVERAGE NAIC S INSURER A:Commerce Insurance Company 34754 INSURED INSURER B:Travelers Hallmark Homes Associates Inc. Western World Dave Tomoliilo INSURER C: 77 Alexander Rod Unit 14 Billerica,MA 01821 INSURER D: 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 TYPE OF INSURANCE ADDL SUER POUCY NUMBER POUCY EFF POLICY EXP LTR INSD WVDIMM/DD/YYYYI IMM/DD/YYYYI LIMITS C )( COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR NPP1490445 06/11/2019 06/11/2020 DAMAGE TO RENTED 50,000 PREMISES IEa occurrence) 5 MED EXP(Any one person) S 1,000 X per project 1,000,000 PERSONAL 8.ADVINJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY j8T LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: Emp Ben. $ NA A AUTOMOBILE UABIUTY COMBINED SINGLE LIMIT 1,000,000 (Ea accidenll $ — ANY AUTO BBXN23 04/23/2019 04/23/2020 BODILY INJURY(Per person) 5 OWNED SCHEDULED AUTOS BODILY INJURY(Per accident) $ _ ONLY AUTOS R X X AUTOS ONLY X VMS PROPERTY DAMAGE _ U S ONLY (Per accident) $ $ — UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE 6KUB-5B29684-3-19 03117/2019 03/17/2020 1,000,000 OFFICER/MEMBEER EXCLUDED? 121 J N/A E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached I more space is required) CARPENTRY SERVICES. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE INSPECTIONAL SERVICES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Serving Greater Boston for Over 25 Years! HALLMARK Dave Tomolillo 11AI.,NI%Pk 11(,,1E,RF1101)11_INC. CSL#: 064063 HIC#: 158936 Standards& Quality are our Priority! Solar Five Quote — Re-Roof July 10,2019 Alex Silva 18 Woodbine Ave Yarmouth,Ma 02673 (774)836-4240 verasouza_vini@hotmail.com Roofing Specification: • Remove old comp shingles down to the existing roof sheathing • Remove all nails and replace up to 32 square ft.of plywood,if needed • Additional plywood will be charged at$55.00 per sheet • Apply 6'of Water Shield along the lower eaves • Install new vent pipe water diverters where needed • Apply synthetic underlayment as protective base • Install 8"aluminum drip edge along entire roofline perimeter • Includes [32'] roof ridge ventilation system and[32'] color matching caps • Apply Water Shield around the chimney • Re-lead perimeter of[1]chimney with new lead • Install new secondary chimney step flashing • Removal of roofing debris by dumpster • Total number of roof squares [10] • Owens CorningTM TruDefinition®Duration®30-year Architectural shingles. • Providing all Insurances,Licenses and Permits Materials and Labor: $4000.00 Dumpster: $500.00 Chimney: $350.00 Permits&Admin: $150.00 Quote Total: $5000.00 4-9A4, 1).%,‘ a Hallmark Homes Associates,Inc.• 77 Alexander Rd 414,Billerica,MA 01821• (781)838-0789• www.HallmarkHomesRemodeling.com Front Of House � AC AC JJ I —1J L__J+ Oo 0 • 4 s . r • vmpi Hallmark Homes Associates,Inc.• 77 Alexander Rd#14,Billerica,MA 01821• (781)838-0789• www.HallmarkHomesRemodeling.com MASSACHUSETT DRIVER'S ----� t LICENSE i;+.. *o ,\Nt i If - ?: t7,515975 _ 7a 9iS / wlw.massrmv.com ImM 1 11 n. !0/98/2017-1 TIC. r �Ir 0315/1961 ` r,,,f. . .,i...V --ix! � NO EI• NONE Ew. . 1 ,� 1'T M0L L , 9 • DA It F tiONE sns�eNrs. Resrwcnors. ! r ri ' a77AL • NONE sal ,)''STE'1 ,A' , • a. ' i:u,,` ‘;_BILLE ICA;MA 18214065' • usexM ism.5%06" i - 5De OF2017,RerfO 03/15/61; cllaxcD�noofrr;ssPawreaow veRnw�xnRk Commonwealth 0(IMassahusetts Division of Professional L-(censure Unrestricted Board of Building Regitl tions and Standards Construction Supervisor -Buildings of any use group which contain Construction*"up(h..rvisor • less than 3 000 cubic fee is meters)of enclosed CS-064063 I ,space. E�cpires:03/15/2020 DAVID TOMOLILLO 77 ALEXANDER RD STE 1, �„ �� • BILLERICA MA 01821. n A I 4 Failure to possess a current edition o e Massachusetts Commissioner (/ 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 I ' r�,4r Fr�nmewrpreil/ f n//(farrrr'uJelk, Office of Consumer Aifai &Business Regulation HOME IMPROVEM NT CONTRACTOR Registration valid for individual use only TYPE:C rooration before the expiration Registration Expiration ation date. If found return to: 158936 03/1 y/2020 Office of Consumer Affairs Business Regulation One Ashburton Place- e 130 HALLMARK HOMES ASSOCIATES INC. Boston, 108 f • DAVID TOMOLILLO I JQ..0 77 ALEXANDER ROAD SUITE#14 ; i U BILLERICA,MA 01821 • Undersecretary Ot valid Ou signature 1 i , I OSHA/��{ oavyalbna! 16olety end Health I . Adminiabalfan. i t r',' .f tStiFiA I Dttonaflanal j - - d+/olyand N.N. { : 4mninky,rellen This Card acknowledges that the rec pleat ha -fully completed a ' 30-hour Oxupatlonat Safe nd Healt '"' re' r`trlfryg Curse i COpational icinSafety S-f and' This card acknowledges that the recipient has successfully completed a ea�ti� 10-hour'Occupational Safety and Health Training Course in David Tanolillo Construction Safety and Health ,,I _________________DAVID TOMOLILLO Ii M i Jessie Vieira ; i . _ `;' (Trainer name-print or type) .• 8 oU o e H (Goatee end'date}j ARMANDO GAI_ I. TAN (Trainer name-print or type)`- '- ---_ ? 2 j j ! (Course end date) i r' • _ The Commonwealth of Massachusetts t^w,>=ice 1, Department of Industrial Accidents _:i:l_ 1 Congress Street,Suite 100 % =.;tiff ;" Boston,MA 02114-2017 -,` 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):Hallmark Homes Associates, Inc. Address: 77 Alexander Rd. Suite 14 city/state/zip: Billerica, MA 01821 Phone#: (781) 838-0789 Are you an employer?Check the appropriate box: Type of project(required): 1.®I am a employer with 2 employees(full and/or part-time).* 7. 0 New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. El Remodeling any capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required]t 9. ❑Demolition 10❑Building addition 4.0 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.Q Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.ri Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.0 We are a corporation and its officers have exercised their light of exemption per MGL c. 14.El 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 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 employee& Below is the policy andJob site information. Insurance Company Name: The Travelers Policy#or Self-ins.Lic.#: 6KUB-5B29684-3-14 Expiration Date: 03/17/2020 Job Site Address: 18 Woodbine Ave city/State/Zip:Wayland, Ma 01778 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$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verificati$. _ I do hereby c- , r the ', and, "7 of perjury that the information provided above is true and correct r Signature: br ' ��� Date: 8/14/19 Phone#:(781) 838-0789 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#: