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HomeMy WebLinkAboutBld-20-003103 /.2-74h 9 ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department 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 a One-or Two-Family Dwelling This Section For Official Use •my Building Permit Number:Z34-9-"a0 eb 3/O3 Date App d: �v i •, - lc.ok5 Building Official(Print Name) ignature Date •j ei'Ale PONT ‘29/ilf>0S SECTION 1:SITE INFORMATION 1.1 Pert c t. ("0-(-- / 1.2 s esso s Map&Parcel Numbers 1.1 a Is this an accepted street?yes 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 pply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public Private❑ Zone: _ Outside Flood Zone? Municipal.la-On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: peNfs� i02it- BGG/4- Soa I NA— Name (Print) City,State,ZIP 8 rz( 7- r u� fi67) see•o2�n 5oI ' ) zzi No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK"(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: ,Q FPMR- AU F -ft) pR • All m° DP e i (N Y.< GZa .,Ea,►u v44 fk.lrriD,J -7/.4am/( .ves-J .5lobtk_ e4)16 rcl��.�0:✓1 �IJ�%s� FeoJ-t` DcaR Ale c✓ rr -Ph ,..su(i.nua/N v ) Awl j 2ds, ff•r� r AlriAzO2r SECTION 4:ESTIMATED CONSTRUCTION COSTS. Estimated Costs: Item Official Use Only (Labor and Materials) 1.Building $ 7gad, 1. Building Permit Fee:$' )0 Indicate how fee is determined: r 41t Standard City/Town Application Fee 2.Electrical $ 3 0 Total Project Cost (Item 6)x multiplier. . . x 3.Plumbing $ a?077U 2. Other Fees: $ 4.Mechanical (HVAC) $ List 5.Mechanical (Fire Total All Fees:$ Suppression) Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ "?� _ i'� 0 Paid in Full 119 Outstanding Balance Due: 16S O N. SECTION 5: CONSTRUCTION SERVICES i 5.1 Construction Supervisor License(CSL) co 7 Y9 l S--w "Zv • 41 '( 1/L 1,L.)'\kP 1-J License Number Expiration Date Name of CSL Holder p, List CSL Type(see below) a it"X- I2 2.— rDL' �) No.and Street Type Description 3 6L��_s - . () Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry a L63+ RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances l�r ��i 6 Y3 7 I Insulation -1 Telephone Email address D Demolition 5.2 Registered Home Improvement!Contractor(HIC) /ZT1- r� 7_Lf_t/ tjAtot '#✓ �S�y{�-r ' /;Q't A vr s i HIC Registration Number Expiration Date . HIC Company Name or HIC Registrant Name 2Zerl./G/%w/ 6.. 4c' No.an_Street D Q I't S M A- 02660 Email address City/Town, 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 (9 No ❑ 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 A 1?4C u e.(7 I)a c - to act on my behalf,in all matters relative to work authorized by this building permit application. 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. 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 M.G.L. c. 142A. Other important information on the HIC Program can be found at www.mass.gov/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" TOWN OF YARMOUTH • - s'� .yg c BUILDING DEPARTMENT • Y zteo y 1146 Route 28, South Yarmouth,MA 02664 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 1, Section 1113, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at y it f- ?ice _5, Work Address Is to be disposed of at the following location: `( 41414d" k '3 5141 Said disposal site shall be a licensed solid waste facility as defined by I1'.G.L. Chapter 1 I I, Section 150A. / O✓jI Signature of Application Date Permit No. The Commonwealth of hicissachasetis '� 1 � Dep7rlierent gfInduslrielAccfdents L =et 1 Congress Street,Suite 100 .Boston,MA 021144011 rr www.nwssgov/die Workers°compensation insurance Affidavits Bufdem/Contraeten/LrlectrieienslPhtmbers. TO BE FILED WillmE PEWIT/TING AUTHORITY Anolicant Information Please Print Leadbly Name Businessiorgeaatimendividaal): Whalen Restoration Services Address: 22 American Way City/Matti/Zip: South Dennis, MA. 02660 phone if: 508 760 1911 Aro you on employer?Check the appropriate box: Type of project(required): - Lai I am a employer with 2 S employees MIandlorp time),* 7. 0 New construction 2aIama sole proprisWror partnership and have no employees working for me in `et 0 Remodeling soy capacity.VD workers'comp.Insurance required.] 3.01 ama komesweer doing ell work nsysel£[No workers'amp.insurance required.]4 9. ®Dtilnolltioa • 4.01 am ah maowneraad will Ito biting;oontrature to conduotati walk on my property. I will 10® addition ensure that all centmotors either have workers'compensation insurance or em Bole 11.0 Electrical repairs or additions Anion with no employees. 12.0 Plumbing repairs or additions S.®I am a general aoatraetarand I have hired the aub.eontsactare listed on the attached sheet. These sub•contreetors have employees p ° 13.®Raof repairs p yeas and have workers'comp.irouuautce" _ 6.0We area caratian and have exercised their rightofexemptionperMGLa. 14.�Other r �Q IQ-��✓� S arp 152,11(4),and wo have no employees.[No workers'comp.insurance required.] , saw omitcantthet checks box ski moat also fill out the section Novi showing Vicky/takes'compensation policy inibrmaaon, tamale=vADsubmitthisaffidavitindicatlnBihayaeedoingallworkandthenhheowaldecononerersmu tanewsfUavitindioedngsuch. tConbactors full abeokthis boxmust attached en additional sheet showing*:name of the aub.eontraotmeand state whether ornot those entities have e,,,,ogees.tithe subcormactors have employees,theymintprovidetheir workers'camp.policy number. lass an employer that Is providing worrefs'conwennsafion t aaerrairceforaey employees below is the policy andJobsite hformadon. Insurancekmumnocompopirinc Ace American Insurance Company Policy#Of fiats.Lis.#:__6 5B89454219 Expiration Data 4/1/20 Job Site Address; Cr6%7. /T Z&- 010 r 0 -D - CIty/State/EIpS' !9-/Le(e "( ' Attach.a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MOL c 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one year bnprisonment,as wall as civil penalties in the fond of a STOP WORK ORDER aid a fine of up to$250.00 a day against the violator.A copy ofthis statement may he forwarded to the Office of Investigations oldie DIA for insurance coverage verification. d a hereby age underthe pains andparnaliles of perJ�ray addle the informaion provided above is true i d correct �: u� D, . // A/ phnrse : r : • Official use only. Do not write in this area,to be completed by►sky or town official City or Town: Permit/License a Issuing Authority(circle one): 1.Board of Health 2.B©rlding Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other . Contact Person: Phone : Commonwealth of Massachusetts Division of Professional Licensure "" "" r`"u ,/a/r C�%%��c%c/ls I Board of Building Regulations and Standards Office of Consumer Affairs&Business Regulation Construction Supervisor HOME IMPROVEMENT CONTRACTOR TYPE:Corporation Registration Expiration CS-074928 Expires 10 081102D2�t 129244 07/29/2021 WHALEN RESTORATION SERVICES INC. WILLtAM WHALEN. 122 POND STREET BREWSTER MA,02631 . WILLIAM WHALEN 22 AMERICAN WAY • SOUTH DENNIS,MA 02660 Undersecretary Commissioner Registration valid for individual use only before the expiration date. If found return to: Construction Supervisor Office of Consumer Affairs and Business Regulation Unrestricted-Buildings of any use group which contain 10 Park Plaza-Suite 5170 less than 35,000 cubic feet(991 cubic meters)of enclosed Boston,MA 02116 space. Not valid without signature Failure to possess a current edition oftb,%Massachusetts State Building Code is cause for revocation of this license. For information about this license Call(617)727-3200 or visit www.mass.govldp1 • • • • Restoration Services Inc. Fire,Smoke, Soot,Water&Mold Remediation Services Cleaning • Deodorization • Reconstruction PAYMENT SCHEDULE PREPARED FOR Denise Sorabella 844 Route 28,Unit 6D South Yarmouth,MA 02664 The following payment schedule is part of the contract submitted to: Payment#1: To allow the ordering of all materials,signing of subcontractor labor agreements,application of building permit,and commencement of demolition and debris removal. Payment#2: Upon completion of rough carpentry and framing, installation of windows and doors, and completion of rough electrical and rough plumbing. Payment#3: Upon completion of insulation installation, drywall hanging and finishing,and completion of interior trim work. Payment#4: Upon installation of all flooring and completion of . interior painting,finish electrical,finish plumbing, kitchen installation, post construction cleaning,final town inspections, and to the owner's satisfaction. TOTAL: .-z 3 V1dr-c •t> Contractor's Signature Denise Sorabella 114 Owner's Signature Date t1 'I t q Date I / 22 American \Vay. South Dennis. MA 02660 Phone: (508) 760-1911 • Fax:(508)760-9995 • 1-800-244-2598 • E-mail: infolu whalenrestorations.com Web Page: http:vwww.whalenrestorations.com �'!"."/ WHALRES-01 JPOWERS AU-ORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM1DDIYYYY) 4✓"' 11 n 8/2019 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(les)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 License#1780862 Uau'gACT John Powers HUB International New England (NPHONE FAX 265 Orleans Road C,No,Ext}:(508)945-7886 (Arc,No): North Chatham,MA 02650 it ass:John.Powers@hubinternational.com INSURER(S)AFFORDING COVERAGE NAIC II INSURER A:Philadelphia Indemnity Insurance Company 18058 INSURED INSURER B: Whalen Restoration Services Inc. INSURER C: 22 American Way INSURER D: South Dennis,MA 02660 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 SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD two IMMIDD/YYYY1 IMM/DD/YYYY1 A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE I X I OCCUR PPK1960640 4/1/2019 4/1/2020 DAMGESO EoNccTuErDrenrat $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 -1 POLICY jla n LOC PRODUCTS-COMP/OP AGO $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY (COMBINED SINGLE LIMIT $ ANY AUTO PHPK1960653 4/1/2019 4/1/2020 BODILY INJURY(Per person) $ AURTEO�S ONLY X NAUUTNOEWLLEEDp pBODILY INJURY(Per accident) $ 1'0110'000 X AUTOS ONLY X worm (PRerOaEIDAMAGE $ $ A X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS UAB CLAIMS-MADE PUB669584 4/1/2019 4/1/2020 AGGREGATE $ DED X RETENTIONS 10,000 $ 1,000,000 AND EMPLOYOERS'COMPENSATION YIN PER ERH ANYICPROI PROPRIETOR/PARTNER/EXECUTIVE PARTNER/EDED?ECUTIVE NIA E.L.EACH ACCIDENT $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ Il yes,desc lbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Pollution/Environm PPK1960627 4/6/2019 4/6/2020 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 Denise Sorabella THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 844 Route 28,Unit 6D South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE ?r9FA --1 ACORD 25(2016/03) Co 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AC� DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 11/18/2019 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 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 Ileu of such endorsement(s). PRODUCER CONTACT NAME: John Powers HUB INTERNATIONAL NEW ENGLAND LLC PHONE No.Eaty (506)945.0446 FAx E-MAIL fAIC.Nol: ADDRESS: john.powers@o hubintemationai.com 600 LONGWATER DRIVE INSURER(S)AFFORDING COVERAGE NAIC S NORWELL MA 02061 INSURER A: ACE AMERICAN INSURANCE CO 22667 INSURED INSURER B: WHALEN RESTORATION SERVICES INC INSURER C: INSURER D: 22 AMERICAN WAY INSURER E: SOUTH DENNIS MA 02660 INSURER F: COVERAGES CERTIFICATE NUMBER: 474548 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 ADM8U8R POLICY EFF POLICY EXP LTR INSO WVD POLICY NUMBER (MM/ODIYYYYI IMMIDD/YYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS MADE pi OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL dADV INJURY. $ GEM AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JEOT I I LOC PRODUCTS-COMP/OP AGG $ OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED — SCHEDULED AUTOS N/A BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per acddentl $ $ UMBRELLA LIAB _OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ CEO RETENTION$ $ WORKERS COMPENSATION X STATUTE OTH- ER AND EMPLOYERS'LIABILITY YIN A OFFICRERIMEMBERXCLNUDED9ECUTIVE NIA NIA NIA 6S62UB5B89454219 04/01/2019 04/01/2020 E.L.EACH ACCIDENT $ 1,000,000 (Mandatory In NH) E.L.DISEASE•EA EMPLOYEE $ 1,000,000 If yea describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was Issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/Iwd/workers-compensation/investigatIons/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Denise Sorabella ACCORDANCE WITH THE POLICY PROVISIONS. 844 Route 28 Unit 6D AUTHORIZED REPRESENTATIVE South Yarmouth MA 02664 CL54 Daniel M.Cr y,CPCU,Vice President—Residual Market—WCRIBMA 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Main f°;'ve1 , t t •C; Vie, ° Y"� - a - ' REVIEWED FC" _7IN ANC 2Cv", , ,SE COOMPLI- ANCE. ERF.C'; CS:-:,!F D3 NOT .=LiE:dc THE APP'ICl1',T=ROM TH 'ON iBlLI i uF'AS BUT 41 COMPLIANCE. DATE: ) ' "n-GA� mt6. COP BuiLOir, o,FIJiAL • w i q D b IV R tv loth ri ono/T D l7 & - w i m h v vi 2 i P(It L C nit t►J•t' r I 4 7 50' v -CI 9'4" A-2'4' _• 12' 10" t-+--4' 10" a 18'8"` C1oses rn Bathroom,.eE--t o L _ 1 bed ^" 'r' Bed II Kitchen/Living/Dining Closet O v7 1 Hall Utili + ar 1 O .1 r -_ • O 4 c� 39'8„ • F i kE DE EFFEGTti Q 1.4 RT .- S Sty 1,t(F P D k1T z_01.l b D M i T b b S aa.A G E-LL A E J# e C LiNiii . DPEI1 Et4TI,2FL uN.iiT to F Autiitij-.� I� NE Lel IcnJ I P/Dl)vc/5 /Da 0 R S 4-S Ni Otc a l ZIAi B Aa-Ix.- 11ALR Pltowtti.44 — Eis,L'i-R(2. As( - LA Rkbe 4 JJ DT141C.S • Main Level SORABELLA-SKETCH 1,1 E V./ 2.1.1.(vti Is,'4''DU — b - va A l C - 6-i•Au cxS-Z.Ar$(I4.TS 11/19/2019 Page: 3 0 o" r- s- • a �.`\ c- • i i N 14'4" 15' N "