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HomeMy WebLinkAboutBld-20-003157 L) P 4 M L7 ONE & TWO FAMILY ONLY-BUILDING PERMIT Town of Yarmouth Building Department op 1146 Route 28,South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 Massachusetts State Building Code,780 CMR Building Permit Application To Construct,Repair, Renovate Or Demolish l5 a One-or Two-Family DwellingL 's Section For Official Use Only ilding P it N er: - - Date Applied: a IA I et • Building Office t as Signature Date _ SECTION 1:SITXt INFORMATION CP:1-, .VS 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers /0 MAIN S4 1.1a Is this an accepted street?yes V no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private CI _Zone: Outside Flood Zone? Municipal 0 On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP1 2.1 Owner'of Record: BitiA►J D ve- So�-j'�► YArr,ovill MA 04 Name(Print) City,State,ZIP 101 NOPFL MAiN S4 <or.?l2 'i5of 8ASSRi(ealol@cOAKAd.pet No.and Street Telephone Email Address SECTION 3:.DESCRIPTION OF PROPOSED WORK2(check_all that apply) New Construction 0 Existing Buildings Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg.0 Number of Units j Other ❑ Specify: Brief Description of Proposed Work2: S'�R� goo; . ts's all 2ce r w,.¢ei AosiAI/ P-«,.,Araik Roe. y sys4e,m 5G SECTION 4:`ESTIMATED CONSTRUCTION COSTS. :. Item Estimated Costs: Official ie 0i1y (Labor and Materials) • 1.Building $ 15,000 - :I Building Permit Fee;$ . Indicate how fee is determined: $ ❑Standard City/Town Application Fee: 2.Electrical C1.TotalProject Cost'(Item,6)x m er... . 3.Plumbing $ 2. Other Fees: $ - 4.Mechanical (HVAC) $ 5.Mechanical (Fire $ ; Suppression) Total All Fees:$ Check NO.. Check Amount Cash_Amount: 6.Total Project Cost: $ 1$000- p Paid'inFull 0 Outstanding Balance Due: SECTION 5:.CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) /0la8s N l ek Te RI ti-s kG y License Number Expiration Date Name of CSL Holder List CSL Type(see below) 41( E4jewoo i Aye No.and Street n Type Description CA A 034,4_ /S� Oa 90s U Unrestricted(Buildings up to 35,000 Cu.ft.) Ti�7 R Restricted l&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances Sod3y/ h33' TSMI QE,psf G*sfpela�Aoe�t'N;.c4A I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) y7� /Mb a CAS CARS? NIC4 IQOotiry HIC Registration Number Expiration Date HIC Company Name or HIC Reg' t Name 7 01 7reAt ves sS/a.w/ At,i TS.tii a e EAsl eoAsimc iAbteh,.corn No.and Street Email address lslebaer,MA 01S70 S68-341/ -8337 Cityffown,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes No 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT .. I,as Owner of the subject property,hereby authorize FAS4 f Ai i McIA/ Rao) to act on my behalf in all matters relative to work authorized by this building permit application. erlAA) Q✓ ///i2)19 Print Owner's Name(Electronic Signature) Date • • SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. Nut [ed,;ApA II/at/it Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under N.G.L.c.142A.Other important information on the HIC Program can be found at www.mass.eov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" �o TOWN OF YARMOUTH . :y BUILDING DEPARTMENT • �, '•i = ), 1146 Route 28,South Yarmouth,MA 02664 �,�•.:vs�' 508-398-2231 ext. 1261 Fax 508-398-0836 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L Chapter 40,Section 54 and 780 CMR,Chapter I,Section 1113, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at /6I Ivoet'1 MAIN Work Address Is to be disposed of at the following location: I 4 4 /44 ,i fj 4i s j i f 44.`//S c-1 ✓.'v4 Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section I50A. Signature of Application Date Permit No. EAST COAST East coast Metal Roofing,LLC. 411 701 Treasure island Rd Webster,MA 01570 ETA' RO' F' NG Tel:844-611-3267' eastcoastmetalroof ng.com REQUIRED PERMITS Registered Home Improvement Contractor MA #184472 Registered Home Improvement Contractor CT#HIC.0644642 Rhode Island Registration #40663 Homeowner Information Name: PjtttV\ CUiLiC Address: 10 i\inkrAle% ma,r► SA-- City. fAV\ Y4(nraMeN Zip: (1)r)� Phone: �a a► �- I/5 0$ Required Permits: The following building permits are required and will be secured by the contractor as the homeowners agent and I/We as Owners of the subject property, hereby authorize East Coast Metal Roofing, LLC.to act on my/our behalf,. in all matters relative to work authorized by the building permit application: • Owner's Signature Date 101 NI Owner's Signature Date Owners who secure their own permits will be excluded from the Guaranty Fund provision of the MGL Chapter 142A This permit notice forms a part of the Purchase and Installation Contract of the same date. COAST METAL ROOFING,LLC EAST COAST 701 Treasure Island Rd,Webster,MA 01570 METAL ROOFING Visit our website at Ea�`e�Met,, 'n&om NAME __...__,.��..,. c_ o J/ cr\ .\ �ibo,;. (-Purchaser) '°`ADDRESS _ . _ I l Al. fi4:1 S'+ .. Sails Y�rmoAh (-premise, taTYnlDwN SDV�� Y�fmo04.h zsaoDE D�rQ�Oy_ MAILING ADDRESS .r( S a w\'c, f I VP CODE COWW— � NAME grign DA C WORK CELL Sot d 1.J 9LV_. The Purchase*is the registered owner of the Premises and hereby contracts with East Coast Metal Roofingr7 LLC.(the'Corttracto authorizing the Contractor to furnish all necessary materials and labor to install,construct and place the improvements according to the following specifications. terms and ..•- -•-(the Specifications')on or at the Premises: ,, Brnko v PROFILE LATE!RUBBER/PVC COLOR Z-ex,tta C 124j h' -v,4 4,90.k4 -sir lack. wry _+0 hit ovl kt norHome m m ,,.,tW.n o tt, et ,ikelf 9anotl.e, S4cle a uli-v/S all(' CkScOs-4 - Mw Pitt 044- ,eta ks — 2&q'tS 1 v-ev>jt- p boo}— - Fig11 l srnakt chid —t Ch%mv"1 - tC� c& Lr- 3rt'' 60.4 - /3rtick4 s 4( .T' rtistc utie — ( 5nfa.• _.4 _....rdS —Q/"Nr: '-ipttfin s ADDMONAL s11aCINCOVIONS YES NO ROOFING MATERIAL YESS//NO ROOfINLG_MATERWL Rubber/PVC Low Color ! — Supply adequate electrical power u Slope Roofing / // Rash S * rV/ Woric with the Contractor to fix damage unmated — _L dung installation at a cost agreed to by the parties. Rash Vents* L�f ? 5i% tL Sloe& Plywood for rot repair mkt dyne f2.50 sqf t• Respect the work site. In the interests of everyone% /_ Ridge Vent safety.Purchaser will not use or borrow Contractor's k — Underlayment w s .: bu y equipment or tools and will not access or interfere with the protect during nstallatlon,Skilled professionals Snowguards it W should be hih ed for any work that requires access to or traversing your roof ROOF REMOVAL LOCATION FOR DELIVERY J —/ strip existing roof(F of layers�) W ondi_ 124 sett 1>ri Haul away roof debris and pay refine fees. Starty Date* _(e-/ o LAIIMMONW — Supply 1/ Wyk 9` /� Substantial Completion Ddte* l �. `' _ tAe C LOCATION FOR MN: lJ/ti 4 C1(.i' C) circumstances m beyond the�oR"�x�o.—contro� tmerAu r ��" Ake THK t:oNTRACT lNCWDES 4 t1 p, is (* " to4.,v ymnJ- c. tel,4— CQ/� THE ALUMINUM SHINGLE COMPANY LIFETIME UMITEDY _{ WARRANTY,SO YEAR TRANSFERABLE,NON-PRORATED FOR MATERIALS MANUFACTURED BY THE ALUMINUM SHINGLE COMPANY,PLUS 10-YEAR LIMITED LABOR WARRANTY PROVIDED BY EAST COAST METAL ROOFING. ._ .._ Contract Price S 15 000 SPECIAL il4STRUCTIONf ___--- _ Sales Tax S Fkhancing Requested YES NO-OAC Total Contract Price$ interest Rate 3.5%to 10.5% Less 1/3 Down Payment $ c,OOd Progress Payment $ S,()DD Payment not to exceed f Total Balance on Completion $ 000 MAKE ALL CHECKS PAYABLE TO:EAST COAST METAL ROOFING,LLC. You may cancel this agreement If It has been signed by a party thereto at a place other than an address of the editor,which may be his main office of branch thereof,provided you notify the seller in writing at his main office or branch by ordinary mail posted,by telegram sent or by delivery,not cater Men midnight of the third business day following the signing of this agreement See the attached notice of cancellation form for an explanation of this right. IN WITNESS WHEREOF,the Purchaser and Contractor have hereunto sioned their names at the Premises,this 117 day Of ikii y011 EAST COAST METAL ROOFING LLC. Do not sign this contract K there are any blank specie. Per. Purchaser. Signature /► n. Q V1i4�/ Signatur • Print Name C�1,a i A- ota i Signature TNANK YOU Poe YOIMI WUNaN - ,.___ ___ This is not a eted%Vanaaction R financing is arranged,the Purchaser agrees to sign and provide al necessary okxumherde nghund by.1,, Mimed**on request In order addition*terms conditions. lo complete the Arland* NI surplus materialise*property oftits Cantagar See reverse of contract for The Commonwealth of Massachusetts 1, " 1. Department oflndustrialAccidents `�tr I' 5 1 Congress Street,Suite 100 Boston,MA 02114-2017 —,, www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Anulicant Information Please Print Leeibly Name(Business/Organization/Individual):East Coast Metal Roofing, LLC Address:701 Treasure Island Rd City/State/Zip:Webster, MA 01570 Phone#:508-341-8339 Are you an employer?Check the appropriate box: Type of project(required): I.❑I am a employer with 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.] 3.0I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 10 Q 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.❑Plumbing repairs or additions 50 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. p ®Roof repairs These sub-contractors have employees and have workers'comp.insurance. 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.['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. 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 job site information. C Insurance Company Name: .5C e Af/*cl,ed _ Policy#or Self-ins.Lic.#: LL Expiration Date: Job Site Address: /0/ Non1h MAIN FT City/State/Zip: SoxH1 yArmOvii1,MA 02 6611 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$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct. Signature: Date: Phone#:508-341-8339 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Q°1---Ae ��w)ecrid ? oacAueéi Office of Consumer Affairs and Business Regulation One Ashburton.Place-Suite 1301 Boston, Massachusetts 02108 Home Improvemertt=Coltractor Registration Types Corporation _ Registration_ 184472 EAST COAST METAL ROOFING,LLC r g- 701 TREASURE ISLAND RD ( -r Expiration.—s� 01/7912020 WEBSTER.MA 01570 1t+ tea „ Update Address and Return Card. SCA I 0 20U49.r (52r fnMwlnwrwra//A n!^fiatsa Awjn'i Office of Consumer Mlaha&Business Regulation NOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:Caporation before the expiration data. R found return to: gaaltiasta Office of Consumer Afhlrs and Business Regulation -_154472 01/19/2020 10 Park Pim-Suits 5170 EAST COAST METAL.ROOI INo.LLC Boston,MA 0211$ PAUL LECHIARA \Ie'_CG�.� /4 Q 701 TREASURE ISLANo_filD WEBSTER,MA 01570 UndersecretaryNot valid signature axy� pia. . 44.uu� 4 Aco Ii' CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) `...� 04/03/2019 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 CONTACT Kevin Pires NAME: Platinum Insurance Agency,Inc. ipi.No.Erd): (401)272-5900 FAX Nol: (401)272-5901 1990 Pawtucket Avenue E,gppr ss. kpires@platinumins.com East Providence,RI 02914 INSURER(S)AFFORDING COVERAGE NAIC# Phone (401)272-5900 Fax (401)272-5901 INSURER A: Western World Insurance Company INSURED INSURER B: RGSW,LLC. INSURERC: 41 Edgewood Avenue INSURER D: Beacon Mutual Insurance Company INSURER E: Cranston RI 02905 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 ADDLSUBR POLICY EFF POLICY EXP LIMITS LTR; INSR WVD, POLICY NUMBER IMM/DD/YYYYI IMM/DD/YYYY) © COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 ❑ CLAIMS-MADE © OCCUR DAMAGES(RENTED 50 000•00 PREMISES(Ea occurrence) $ ❑ MED EXP(Any one person) $ 5,000.00 A NPP8514354 04/05/2019 04/05/2020 ❑ PERSONAL&ADV INJURY $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000.00 © POLICY ❑ PRO- JECT ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000.00 ❑ OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ❑ ANY AUTO BODILY INJURY(Per person) $ ❑ OWNED AUTOS ONLY ❑ AUTOSULED BODILY INJURY(Per accident) $ ❑ HIRED ❑ NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) ❑ ❑ $ ❑ UMBRELLA LIAR ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAR ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N STATUTE ❑ER ANY PROPRIETOR/PARTNER/EXECUTIV E.L.EACH ACCIDENT $ 100,000 D OFFICER/MEMBER EXCLUDED? E Y N/A 0000076113 03/16/2019 03/16/2020 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 500,000 If yes,describe under E.L.DISEASE-POLICY LIMIT 100,000 DESCRIPTION OF OPERATIONS below El. DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE East Coast Metal Roofing THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 701 Treasure Island Road Webster,MA 01570 AUTHORIZED REPRESENTATIVE ,^? 7_, ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03)QF The ACORD name and logo are registered marks of ACORD