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HomeMy WebLinkAboutBld-20-002999 O _ —1 * *I Amount T MA,T M f AV -.'^'r'D'3,:? Permit expires 180 days from issue date EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH ,..k, ,. 1 Yarmouth Building Department 1146Route28 r+k,' I• South Yarmouth, MA 02664 �=- 508 398-2231 Ext. 1261 O y _ CONSTRUCTION ADDRESS: y7 0/cl /ya.i,7 Y r e Q't ASSESSOR'S INFORMATION: /{�J Map: Parcel: OWNER: 14-a.V...Qait /�ectIfoil SIDRSC 8a0x NAME PRESENT ADDRESS TEL. # CONTRACTOR: /Qr m e n ga 7 l'I C 7�e at -Sfr e Q 7/ ,Q 4 N,,,,,,,,,..5 -To 8 7 TS�'.2 cr, NAME MAILING ADDRESS TEL.# L9 Residential 0Commercial Est.Cost of Construction S `5�© D o 7 Home Improvement Contractor Lic.# /83 a D Construction Supervisor Lic.# /0 670 ..L Workman's Compensation Insurance: (check one) , ❑ I am the homeowner yy�� E I am the sole proprietorpr I have Worker's Compensation Insurance Insurance Company Name: / i- ee/AL /:^o 7 1 VI C II)D yV Worker's Comp.Policy# /Al cc So oSO/S'D.g/.2O,3, WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# Replacement doors: # \fRoofing: #of Squares /4' ( 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: s/a.r MI 0 Li T1A O u m p Location of Facility I declare under penalties of perju that th' : ents herein contained are true and correct to the best of my knowledge and belief. 1 understand that any false answer(s) will be just cause for denial or r atio, /' , license and for prosecution under M.G.L.Ch.268,Section 1. Applicant's Signature: Date: //• 0 • /`I Owners Signature(or attachment) h Date: Approved By: Date: //r 2 Building Official des' ee) EMAI DRESS: Zoning District: Historical District: = Yes No Flood Plain Zone: -: Yes i No Water Resource Protection District: Within 100 ft.of Wetlands: Yes _i No Li, Yes No COREY & COREY " The Roofers " 67 SEA STREET APT#A4, HYANNIS MA 02601 PHONE 1-508 -775-8240 CERTAINTEED LANDMARK LIFETIME - ALGAE RESISTANT ARCHITECTURAL STYLE RE - ROOFING PROPOSAL August 20,2019 MAUREEN DALTON A 47 OLD MAIN STREET EM: mmoe885@aol.com ►'�-z N-40M1' S. YARMOUTH,MA Tel: 508-564-8202(C ) SV &).S v'Y.¢i 5 ' s (140i( 1 Sn i- 0 isle. COREY & COREY 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 of the Old Asphalt Roofing Shingles (One Layer)from the Entire House Only.Re Nail All The Existing Sheathing as needed. Supply and Install CERTAINTEED LANDMARK AR: LIFETIME WARRANTY, 10 YEAR SURE START PROTECTION, , COP P EHJ CERAMIC MIC ONES for a FULL 10 YEAR WARRANTY AGAINST ALGAE CONTAMINENT,235 POUND,EXTRA HEAVY WEIGHT, 130 MPH WIND WARRANTY,CATEGORY III HURRICANE,STORM/HURICANE NAILED (6 NAILS PER SHINGLE), MULTI-LAYERED,LAMINATED ARCHITEC URAL STYLE,FIBERGLASS BASED ASPHALT SHINGLES. COLOR: eObblesfione Ara4 Supply and Install 8" WHITE ALUMINUM ._.3_y on All of the Eaves. Supply and Install CERTAINTEED WINTER-GUARD WATERPROOF UNDERLAYMENT SYSTEM on Roof Eaves& Valleys Under the Step Flashings,on the Skylights and Chimneys. Supply and Install CERTAINTEED'S"ROOF RUNNER" ROOFING PAPER Supply and Install AIR VENT SHINGLE VENT II on the Entire Ridge. Supply and Install NEW ALUMINUM & NEOPRENE SOIL PIPE FLASHINGS Clean and Remove Debris from work area after job is completed. HOUSE ROOF INVESTMENT ----------- - $9,000.00 ma to }oust on COREY & COREY " The Roofers " Supply and Install 3/8 CDX PLYWOOD ON THE ENTIRE TWO STORY MAIN HOUSE ROOF $3,000.00 RE-ROOFiNG THE SHED WILL BE ADDITIONAL $3,500.00 TO INSTALL 3/8 CDX PLYWOOD OVER THE BOARDS ON THE SHED ROOF WILL BE . D : I N: L $1,500.00 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(For Each Laborer Involved). 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 the Roof Work is Scheduled for Completion Within 90 Days of Acceptance and the 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 the Shingles and Labor for 10 years. CERTAINTEED Warranties the shingles and labor 100% for the First 10 Years and the Shingles your LIFETIME if the shingles becomes defective. CERTAINTEED Warranties the Shingles up to a CATEGORY III HURRICANE-130 MPH WIND WARRANTY. CERTAINTEED Warranties the Shingles to be Algae Resistant for a Full 10 Years. COREY & COREY carries Workman's Compensation and Public Liability Insurance on the above work DATE OF ACCEPTANCE: 1 I ill ACCEPTED BY: SUBMITTED BY: MAUREEN DALTON ARMEN SAFARYAN HOMEOWNER COREY & COREY HIC # 183202 14ini thOM 5-Xs-5_i t rj( CSSL# 106102 oett 5bcs- �%1i11 1PY n li'4---C tree bothi - lives in S Ytr,nuull'l6117. 6-6-) • The Commonwealth of Massachusetts 1=:.1, Department of Industrial Accidents 1 Congress Street,Suite 100 ''1`'=�=1= '" Boston,MA 02114-2017 •Y „14* www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/EIectricians/Plumbers. TO BE FILED WITH THE PERMTITING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual): h`r+m t%e? S 6i 11\,.A C ,re y psi ci Co r Address: C 7 • e& '/r a / - 7 . ,9 �� y� � ram' City/State/Zip: /7 /1 Phone#: O d 7 7. c2 tf 0 Are you as employer?Check the appropriate box: �.,j Type of project(required): 1. am a employer with employees(full and/or part-time).* ? 1 am a sole 7. New construction proprietor or partnership and have no employees working for me in 8. 0 Remodeling any arty.[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself[No workers'comp.insurance required.]t 1• ❑Demolition 4. I am a homeowner and will be 0 ❑Building addition ❑ g contractors to conduct all work on my property. I will 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 5.0 t am a general contractor and I have hired the sub-contractors listed on the attached sheet Thesesub-contracxos have employees and have workers'comp.insurance.t 13.aiRoof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGI,c. 14.0 Other 152,§1(4).and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box t 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'c.// Pr() T1 Policy#or Self-ins.Lie.#: /,e/C t= 'O 0 C O/ O??%2 G/3/'Expiration Date: .3_ /p . 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 andfor 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 ' . 'tins/nsand penalties of per,that the information provided above is true and correct Signature: I �� N�`� Date: . a 0 . /`n Phone#: .Cf V 7..5 Pa L1 0 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): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: t Massachusetts Department of Public.Safety. Board of Building Regulations and Standards •License: CSSL-106102 Construction Supervisor Specialty �• ARMEN SAFARYAN 67 SEA STREET APT A4 HYANNIS MA 02601 • 'Vri`z Expiration: Commissioner 10/02/2020 Q %e ( Ora/ladelaCkad6 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 67 SEA ST APT A4 HYANNIS,MA 02601 Update Address and Return Card. SCA 1 a 200M�M-0�-0511�7p 32e ipommantuea//Ai o/'Ceassackuiela Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Individual before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 183202 09/13/2021 1000 Washington Street -Su 710 ARMEN SAFARYAN Boston,MA 02116 D/B/A COREY AND COREY ARMEN SAFARYAN 67 SEA ST APT A4 HYANNIS,MA 02601 Undersecretary Not valid ignature DATE(MWDDNYYY) '4`��® CERTIFICATE OF LIABILITY INSURANCE 9/13/2019 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 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 MiTACT Ashley Paiva mese Eastern Insurance Group LLC NE WC.No.Ext): (800)333-7234 FAX No)_ 233 West Central St ADDimss, INSURER(S)AFFORDING COVERAGE NAIC S Natick MA 01760 SrsuaerAArbella Protection Ins. Co. 41360 INSURED IN8URER B Associated Employers Insurance Armen Safaryan, DEA: Corey and Corey INSURERC: 67 Sea Street INSURER D: Unit A4 INSURER E: Hyannis MA 02601 INSURERF: COVERAGES CERTIFICATE NUMBER:2019-20 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POUCIES 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 IS SMVO POLICY NUMBER /DD YYYYY) UIMTS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE X OCCUR DAMAGEPREMISES l(Ea occurrence) $ 100,000 9520046441 9/18/2019 9/18/2020 MED plp(Any one ) $ 5,000 PERSONAL BADVINJURY $ 1,000,000 GEM.AGGREGATE LIMIT APPUES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE UMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ — ALL OWNED —SCHEDULED BODILY INJURY(Per accident) $ AUTOS — AUTOS NON-OWNED PROPERTY DAMAGE $ — HIRED AUTOS —AUTOS (Per ao ident UMBRELLA UM _ OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION PER WORKERS COMPENSATIONTH- AND EMPLOYERS'LIABILITY ATUTE ER Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE /A El EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N N B (Mandatory in NH) N0050050150912019A 9/18/2019 9/18/2020 E.L.DISFA.SF-EA EMPLOYEE $ 1,000,000 DESCRI OF OPERATIONSbelow E.L.DISEASE-POLICY UNIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/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 POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE John Koegel/APAIVA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD IMS025 rm14n1,