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Home My WebLink AboutBld-20-002982 Office Use Only " , �al0 `OD%,9 ,. o 0 'A\F. aw Amount 6627 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: 32 Schooner St West Yarmouth ASSESSOR'S INFORMATION: Map: Parcel: OWNER: MANUEL SILVA 4 MILLSTONE DR BRIDGEWATER, MA 02324 774-836-2501 NAME PRESENT ADDRESS TEL. # CONTRACTOR: BelCape Construction, INC 42 Woodbury Ave Hyannis, MA 02601 508-685-9720 NAME MAILING ADDRESS TEL.# Residential 0 Commercial Est.Cost of Construction$ 6,200.00 Home Improvement Contractor Lic.# 182457 Construction Supervisor Lic.# 106040 Workman's Compensation Insurance: (check one) 0 I am the homeowner 0 I am the sole proprietor XI have Worker's Compensation Insurance Insurance Company Name: AmGuard Worker's Comp.Policy# R2WC085768 WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares 6 Replacement windows:# Replacement doors: # Roofing: #of Squares ( )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&J Expo Dennis Location of Facility I declare under penalties of perjury that atements he jn 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 o d for prosecution under M.G.L.Ch.268,Section 1. Applicant's Signature: Date: 11/21/2019 Owners Signature(or a hment) Date: Approved By: Date: 11 a '15 Building Official(or esignee) EMAIL ADDRESS: belcapeconstruction@gmail.com Zoning District: Historical District: ❑ Yes C7 No Flood Plain Zone: C Yes No Water Resource Protection District: Within 100 ft.of Wetlands: Yes L7 No C Yes C No 4 Curtains, drapes and window and door treatments may need proper reinstallation or replacement by customer due to sizing on any window or door replacements and is not included in jobs contracted with BELCAPE CONSTRUCTION,LLC Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders and will become an extra charge over and above the estimate.All agreements contingent upon strikes,accidents or delays beyond our control.Owner to carry fire,tornado and other necessary insurance upon above work. Workmen's Compensation and Public Liability Insurance on above work to be taken out by BELCAPE CONSTRUCTION,LLC.No lien or security interest will be placed on the residence as a consequence of the contract Owners who secure their own construction-related permits or deal with unregistered contractors will be excluded -•m : - •• the guaranty fund. / This Contract not valid unless signed by Company Represen �/ " Acceptance of Estimate The above prices,specifications and conditions are satisfactory and are hereby accepted.BELCAPE CONSTRUCTION,LLC is authorized to do the work as specified. Contract total: $ 6 i 2- Qv,O If acceptable, initial here: Payment will be made as such: 14 Deposit 1/3 S Start day payment 1/3: S Zr ( av • 2 t — Upon completion 1/3: S Date: Signatures: Note:No work shall begin prior to the signing of the contract and transmittal to the owner of a copy of such contract You,the buyer may cancel this transaction at any time prior to midnight of the third business day after the day of this transaction. AcceptedAcceptedBy: 4 /1't-- Date:*)1)Ia THIS PAGE IS PART OF AND IN CONFORMANCE WITH PROPOSAL: 32 Schooner St West Yarmouth r w Commonwealth of Massachusetts V .1' Division of Professional Licensure Board of Building Regulations and Standards • Constructioo-SUp r / spr Specialty CSSL-106040 ices: 05/14/2020 ANATOLI SIVITSKII ' 27 MILL POND20 WEST YARMOCJTI MA 0673 lay ill< Commissioner Clow. ilvk 'M tyz, rae-aii,o/ ez-r)r)aci4e4e./.4 Office of Consumer Affairs and Business Regulation One Ashburton Place- Suite 1301 Boston, Machusetts 02108 Home Improvem e . tractor Registration ! Type: LLC x : • Registration: 182457 BELCAPE CONSTRUCTION LLC ry a 42 W OODBURY AVE Expiration: 02/05/2020 HYANNIA,MA 02601 tr. 77. ;t Update Address and Return Card. SCA 1 0 20M-05117 Ke'nuNtvKl4 e)/ 17.i a444.1e/Gi Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only 'OPE:LLC before the expiration date. If found return to: R ! Office of Consumer Affairs and Business Regulation POW 02/5O20 10 Park Plaza-Suite 5170 BELCAPE CO U' Boston,MA 02116 ARLOU DZIANIS , 42 WOODBURY AVE,n` HYANNIA,MA 02601 Undersecretaryo't valid without signature The Commonwealth of Massachusetts Department of Industrial Accidents _ C 1 Congress Street,Suite 100 ". _ Boston, MA 02114-2017 •,,�t;1s 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): BelCape Construction, INC Address: 42 Woodbury Ave Hyannis, MA 02601 City/State/Zip: Phone#: 508-685-9720 Are you an employer?Check the appropriate box: Type of project(required): IX I am a employer with 3 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. EI 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. 0 Demolition 10 ❑Building addition 4.❑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.❑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 suet. 13.Q Roof 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 per MGL c. 14.XOther Siding 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 employees. Below is the policy and job site information. Insurance Company Name: AmGuard Policy#or Self-ins.Lic.#: R2WC085768 Expiration Date: 02/12/2020 Job Site Address: 32 Schooner St CitylState/Zip: West Yarmouth, MA 02673 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 certi un th ains d penalties of perjury that the information provided above is true and correct. Signature: Date: 11/21/2019 Phone#: 85-9720 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#: AC RN CERTIFICATE OF LIABILITY INSURANCE DATE(IM AE(IM 19 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFRRMATNELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN TIE ISSUING I (S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND TIE CERTIFICATE HOLDER. IMPORTANT: If the certMca a holder is an ADDITIONAL INSURED,the polcy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the tense 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 ems). PRODUCER CCSW4T Victoda Sharapova ALD Insurance Agency Inc. mute PHONE617-787-7877 FAX 617-787-7876 Avenue 80A Brighton bile"'eat WC.Nark Alston,MA 02134 ADDRESS RXRURO S)AFFORDINGCOVERAGE RISC. epauRstA, ATLANTIC CASUALTY INS CO 42846 s+eumm Belc pe Cor ion Inc Y---- e1ulRER AMGUARD INSURANCE COMPANY 42390 42 WoodbwyAve IAsuReec: Hyannis,MA 02601 INSURER D: INSURER!: NOUN*F: COVERAGES CERTIFICATE NUMBEIiv REVISION NUMBER: THIS IS TO CERTIFY THAT THE POUCES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TIE INSURE NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIRENAENC,TERM OR COMMON OF ANY CONTRACT OR OTHER ER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY TIE POLICES DESCRIBED HEREIN IS SIJB.ECT TO AU.THE TE RIMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. WEIR POLICYLIR TYPE OF INSURANCEi PO INVD IECYM$ IYOO YY�YYI IM POUCYI RIB A ✓c omma:1AL(E NERAL LusIu1Y y 1261002952 02/06/2019 02/06/2020 EACH occunnnecE s 1,000,000 DPJAAGE RENTED n AmLcuann OCCUR PREMISES a oMararros) s 100,000 MED ESP(Any ens person) $ 5,000 PERSONAL&ADV INJURY S 1,000,000 OWL AGGREGATE LAST APPUESPER: j GENERAL AGMEGATE s 2,000,000 POLICY( ra: LOC PRODUCTS-C R PADS s 2,000,000 OTHRk $ AUTOMOBI E LNBInY Me SINGLE LEST $ ANY AUTO BODILY IN Y(Perperson) S AUTOS HIRED ONLY AUTOS PROPERTY OANIAGE s AUTOS ONLY ` AUTOS ONLY ParaKddenD S UMBRELLA LIAR " OCCUR EACH OCCURRENCE s "CMS LIAR CLAMAS LrADE AGGRB ATE $ ow 1 I RETENTION: B WORIODDI COEl'EEATION R2WC085768 02/12/2019 02/12/2020 j �ATum AND EMPLOYERS'LIABILITY IN ANY PROPRIETOR/PARTNER/EXECUTIVEY ,N r A E L EACH ACaOerr $ 1.000,000 Plyaanesd,. in NH) I E.L DISEASE-EAedPLOYEE $ 1,000,000 xDirSCR1PtEON OPERATIONS below I EIDOSE-POLICYUAW S 1,000,000 CESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101.AddabrW Rau.rb Sishodals,mry be aW.Ir.d a mom.p b ed) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE Wal BE DELIVERED N ACCORQANCE WITH THE POLICY PROVISIONS. 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