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HomeMy WebLinkAboutBld-20-001183 41 • -- Office Use Only .To' R4q---- I ` =Permit# O . • . Pi Amount L.5 (-J MAT n CS[ ' - �'v.��� rd: Permit expires 180 days from issue date eJ—D-2(711g3 EXPRESS BUILDING PERMIT APPLICATION '- .. IED TOWN OF YARMOUTH _ " ' E Yarmouth Building Department 1146 Route 28 AUG 302019 South Yarmouth, MA 02664 (508) 398-2231 Ext. 1261 1 7(7sO1rA CONSTRUCTION ADDRESS: O Co-vt#t 1 p.,, P Y ASSESSOR'S INFORMATION: Map: Parcel: OWNER:f-e.le,?!..,-4;/,_ C r-7 i'H NAME PRESENT ADDRESS TEL. TEL. # CONTRACTOR: /97- -d... .... YR_Ark?ii"[� c./ ICI' �2)e—C:,®v /7 c NAME MAILING ADDRESS TEL.# residential 0 Commercial Est.Cost of Construction$ 1 0:7 7. Home Improvement Contractor Lic.# f?2 (1 Construction Supervisor Lic.# CSC- /</- ci) Workman s Compensation Insurance: (check one) am the homeowner 0 I am the sole pr 'eto j❑ I have Worker's Compensation Insurance Insurance Company Name: 6 `" Worker's Comp.Policy# WC5 2 c6rJ WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares /6 S.._ ( )Rem existing* (max.2 layers) Insulation V Old Kings Highway/Historic Dist. )Replacing like for like Pool fencing *The debris will be disposed of at: V"-12-h t. Location of Facility 01,ty.,t/i I declare under penalties of perjury that the : : ents herein 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 revocation. p license and for prosecution under M.G.L.Ch.268,Section 1. Applicant's Signature: Date: ©p/J y 60/1 Owners Signature(or a clime. Date: Approved By: ✓ Date: F 7-3 -/ Building Official esi ee EMAIL ADD . Zoning District: Historical District: 0 Yes 0 No Flood Plain Zone: ❑ Yes ❑ No Water Resource Protection District: Within 100 ft.of Wetlands: 0 Yes 0 No 0 Yes ❑ No - The Commonwealth of Massachusetts Department oflndustrialAccidents k._�A= 1 Congress Street, Suite 100 it =g`_ Boston, MA 02114-2017 ',.w 55.•� www.mass.gov/dig tan Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print LeEibly Name (Business/Organization/Individual): A f,J ke.. „f&& Address: 20 e7 i 04 `;— �� Ge--- City/State/Zip:/14.01-tsiv,H s. "tie)//9,f Phone #: ,c 2 3'0 /• 9' Are you employer?Check the appropriate box: Type of project(required): i. I am a employer with'L.... -employees(full and/or part-time).* 7. construction❑New onstru ion 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. ❑ Remodeling any capacity.[No workers'comp.insurance required.] 3. I am a homeowner doing all work myself. 9. ❑ Demolition ❑ y [No workers'comp. insurance required.] 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.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.E 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.❑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. 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: r t e #,, bi,f ,Policy#or Self-ins.Lic.#: '- K/ e` 0/5' Expiration Date: `L 9 Job Site Address: 6 ,s-i.e-it City/State/Zip: "'/2 p, --4 Paf,/..- Attach a copy of the workers' compensation poliery 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 and r the pai s d penalties of perjury that the information provided above is true and correct. Signature: OP/3 9/' i(i j Date: Phone#: 67)>?' 2 1? 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 CIerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: Estimate AV,1 I i div„\ BEL ISLANDS Date �# Home Improvement 3124n019 958 Bel Islands Home Improvement 204 Cinderella Terrace Name/Address Marston Mills, Ma,02648 Rebecca Griffin 8 Gannet Road, Belislandsroofingandsidingcom Yarmouth Port,ma 508-280-1794 508-364-6909 Terms Project Description Qty Rate Total Bel Islands Home Improvement-ROOFING PROPOSAL- 6,600.00 6,600.00 ,labor/materials( architect shingles)-Main house upper sections only BEL.Islands Home Improvement hereby propose to perform the following services in a neat professional manner in accordance with manufacturers specifications and local building code , .t Strip existing roof shingles(1 layer of shingles) and remove all debris.Any more layers of roofmg needed to be stripped-it will be additional charge. and install: New Shingles:Certainteed Architectural Landmark shingles with lifetime warranty, 10 years Algae Resistant, 110 MPH Wind Warranty,240 Lbs weight/square-(Every shingle will be nailed by the code with 6 nails-storm nailing system) install: , . 8"Aluminum Drip Edge install: Certainteed ice and water shield to eves,valleys,rakes,and skylights and low pitch areas (18,'on rags and skylights and 3 ft on eves and valleys to prevent ice dams) install Certainteed Swift Start-with self-adhering asphalt starter course on all eves and rake edges install Aluminum&Neoprene Soil Pipe Flashing Install: Synthetic underlayment paper(Rhino) install Pre-cut Certainteed Hip&Ridge shingles and new rid a vent Total