Loading...
HomeMy WebLinkAboutBld-20-002998 o o rLN "j a 1i Amount nwr i--I Permit expires 180 days from ?j U 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: e2 3 LCIA/I.S Q eL , Q / V W 1 r ---/-71;t3S ASSESSOR'S INFORMATION: / Map: Parcel: OWNER: Pea. €1—iCe_ Zan rerle 703 s /5 (, � 6. © NAME PRFNT ADDRESS TEL. # CONTRACTOR: NAME ILING ADDRESS Car•ey 6Z� d �O� S gi°4 �y TEL. So' 77 S�a4 O N4esidential 0 Commercial Est.Cost of Construction$ /lj _S 0 Home Improvement Contractor Lic.# /O 2 a2 0*2 Construction Supervisor Lic.# /°6/ D Z. Workman's Compensation Insurance: (check one) ❑ I am the homeowner C, I am the sole proprietor khave Worker's Compensation Insurance Insurance Company Name: 4 ee//q Pro /2C71 i oet Worker's Comp.Policy# We SO o SO/3—& /.2 0/3/ft WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove � LSiding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares ( V/)Remove existing*(max.2 layers) Insulation Old Kings Highway/Historic Dist. ( )Replacing like for like Pool fencing *The debris will be disposed of at: ?at 114 0 v 74 t)Location of Facility I declare under penalties of perjury„,at the erein 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 re/ration of d or prosecu.on under M.G.L.Ch.268,Section 1. / Applicant's Signature: 4111 - Date: // 02D. l� Owners Signature(or attachment) Date: Approved By: � i Date: /-22 Building Offi ' (or ign EMAIL DRESS: Zoning District: Historical District: Yes No Flood Plain Zone: Yes I No Water Resource Protection District: Within 100 ft.of Wetlands: Yes :_ No 1 Yes I No mut Massachusetts Department of Pubiic.Safety Board of Building Regulations and Standards .License: CSSL-106102 Construction Supervisor Specialty ARMEN SAFARYAN - 67 SEA STREET APT A4 HYANNIS MA 02601 • . /.?rofe,t, •..;- a Expiration: Commissioner 10/02/2020 Q. 0/P/KA Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Individual Registration: 183202 ARMEN SAFARYAN Expiration: 09/13/2021 D/B/A COREY AND COREY 67SEASTAPTA4 HYANNIS,MA 02601 Update Address and Return Card. SCA 1 0 20M-05117 dRe numweedd alQ.ffastada5et Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Individual before the expiration date. ff found return to: Registration Bxpirafion Office of Consumer Affairs and Business Regulation 183202 09/13/2021 1000 Washington Street -Su 710 ARMEN SAFARYAN Boston,MA 02118 DB/A COREY AND COREY • ARMEN SAFARYAN 67 SEA ST APT A4 HYANNIS,MA 02601 Not valid ignature Undersecretary DATE A D CERTIFICATE OF LIABILITY INSURANCE 9/13/2 019 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 REACT Ashley Paiva Eastern Insurance Group LLC PIIONn EMI: (800)333-7234 No)_ 233 Nest Central St 6mmspapaivageasterninsurance.com INSURER(S)AFFORDING COVERAGE NAIC X Natick MA 01760 INSURERAArbella Protection Ins. Co. 41360 INSURED mummR B Associated Employers Insurance Armen Safaryan, DBA: Corey and Corey INSURER c: 67 Sea Street INSURER 0: Unit A4 INSURER E: Hyannis MA 02601 INSURER F: COVERAGES CERTIFICATE NUMBER2019-20 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 ER TYPE OF INSURANCE ADDL SUM POLICY EFF POLICY EXP W LTR INSD VD POUCY NUMBER (W411DIVYYYYI 1MAWDIYYYY) UNITS X COMMERCIAL GENERAL LABILITY EACH OCCURRENCE S 1,000,000 DAMAGE TO RENTED A CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 100,000 9520046441 9/18/2019 9/18/2020 MED EXP(Any one person) S 5,000 PERSONAL&ADVINJURY S 1,000,000 GENL AGGREGATE UMIT APPUES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE UABIUTY COMBINEDSINGLE OMIT $ ANY AUTO BODILY INJURY(Per person) $ — ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ _AUTOS _AUTOS NON-OWNED PROPERTY DAMAGE _ HIRED AUTOS ^AUTOS (Per accident) S S UMBRELLA UAB _ OCCUR EACH OCCURRENCE S — EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTIONS S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT 8 1,000,000 OFFICERIMEMBER EXCLUDED? N N/A B (Mandatory in NH) WCC50050150912019A 9/18/2019 9/18/2020 E.L.DINE-EA EMPLOYEE S 1,000,000 If yesdescribe OPERATIONS belowe under DESCRIPTION OFEL DISEASE-POUCY UMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Display Only THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE John Koegel/APAIVA 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 ornem i COREY & COREY "THE ROOFERS" ROOFING,SIDING& MORE 67 SEA STREET#A4, HYANNIS, MA 02601 PHONE: (508) 776-2900 ROOF REPAIR PROPOSAL October 16,2019 FABRICE LANGRENEY 29 LEWIS BAY BLVD EM: fabrice@bringcom.com W.YARMOUTH,MA TEL: 703-915-6860 COREY & COREY will 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 of the Old Red Cedar and Asphalt Roofing Shingles from the Front Upper Left Roof Section.Re Nail All Plywood Sheathing as needed. Supply and Install N .:vv :. 1v zb 1a _� =< :VLEVIDN \1 -COITAL V xisrt 11 KELP over'/: " s- K ;t.716iPie: i.01T,3 LA l'IVIL INT Held Down with Plates and Rubber Coated Screws on the Shallow Pitched Area of the Roof Section Supply and Install NEW 18" BLUE LABEL RED CEDAR PERFECTION SHINGLES with STAINLESS STEEL NAILS Supply and Install CERTAINTEED WINTER-GUARD (Ice& Water) WATERPROOF UNDERLAYMENT SYSTEM on THE ENTIRE ROOF AREA Supply and Install NEW RED CEDAR BOARDS on The Ridge Supply and Install NEW COPPER PIPE FLASHINGS Clean and Remove the Debris from work area after job is completed. TOTAL INVESTMENT $11,500.00 COREY & COREY "THE ROOFERS" ROOFING,SIDING& MORE 67 SEA STREET#A4, HYANNIS, MA 02601 PHONE: (508) 776-2900 ROOF REPAIR PROPOSAL POSSIBLE EXTRA CARPENTRY:1: Ran:,:eci or aerwise Deteriorated Trim Boards, Plywood Sheathing, Missing Metal Flashing, Side Walling or Any Other Carpentry Replacement\ 1 be dolt 'and i_'1^ � ' �.c 7 i `oi c S al, Extra: Materials Plus Labor at Rate i,. v 60.06 oo, Hour i' 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 Scheduled for Completion Within 90 Days of Acceptance and Deposits Received are Non-Refundable After a Three Day Cooling Off Period from the Date of signing. Please Make Checks Payable to: COREY & COREY COREY & COREY Warranties Material and Labor for 5 years. COREY & COREY carries Workman's Compensation and Public Liability Insurance on the above work DATE OF ACCEPTANCE: ACCEPTED BY: SUBMITTED BY: {, - ABRI E LANGRENEY ARMEN SAFARYAN N COREY & COREY r,. HIC # 183202 CSSL# 106102 • • • The Commonwealth of Massachusetts `"=i� l=_'/ Department oflndustrialAccidents G ��= y 1 Congress Street,Suite 100 =-Act_- ` Boston, MA 02114-2017 Yr,4=4y00 wlvw th►tass gov/din Workers'Compensation Insurance Affidavit:Builders/Contractors/EIectricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Anolicant Information Amen � � Please Print Legibly Name(Business/Organization/Individual): h'r+M e rI S c�„j -4E.. .s.�(, r(r ,P.,A Cole s+i CI Co r, -7 Address: 6-7 7 -- -e& fie / "i 7 .-xe ., • City/State/Zip: //yc,�e,,.s NI Phone#: O X 77 c2 (f 0 Are you an employer?Cheek the appropriate box: Type of project(required): l am a employer with employees(full and/or part-time).* 7. 0 New construction 2.�1 am a sole proprietor or partnership and have no employees working for me in 8. []Remodeling any capacity.[No workers'camp.insurance required. 3.0 I am a homeowner doing all work myself[No workers' t 9. ❑Demolition comp.insurance required.] 4.0 I am a homeowner and will be hiring contractors to conduct all work on 10 0 Building addition ensure that all contractors either have workers'compensation insurance or � ' I will p with no employees. are sole 11.0Electrical repairs or additions 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, These sub-contractors have employees and have workers'comp.ittsuranee t 13.BYRoof repairs 6.0 We are a corporation and its officers have exercised their rightof14.0 Other 152,§1(4),and we have no exemption per MM.c. employees.[No workers'comp.insurance required.] *Airy 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. Lithe 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: 4 6�// Pro 7/r L T, 0 K7 Policy#or Self-ins.Lic.#: A/C C „CO D `t7/ O r1.2 G/f44 Expiration Date: .�_ / A. - a 0 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$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 - ; «; ,. D and pities o thatf "gins of the information provided above is true and correct. Signature:(7 - ( //_' (" "1'4 l/�l Date: /tl- 42 0 •4_5 Phone#: So �' `7 .7,,, Pa 4 0 Official use only. Do not write in this area,to be comp/Ptad by city or town official City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: