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HomeMy WebLinkAboutBld-20-000537 Details Page 1 of 1 Licensee Details Demographic Information Full Name: BRAULIO BRITO Owner Name: License Address Information City: South Dennis State: MA Zipcode: 02660 Country: United States License Information License No: CS-110548 License Type: Construction Supervisor Profession: Building Licenses Date of Last Renewal: Issue Date: 1/19/2017 Expiration Date: 5/23/2020 License Status: Active Today's Date: 7/30/2019 Secondary License Type: Doing Business As: Status Change Reason: License Issuance Prerequisite Information No Prerequisite Information No Available Documents https://madpl.mylicense.com/Verification/Details.aspx?result=c 145ee32-1 9c4-407a-ae3d-6... 7/30/2019 ,Y�R 4Office Use Only `�0 Z jirmit Q —00 d 7 O/1. .. ' _ 0-3 - Amount ir i ` '' 'TACM CSE d 4"�°°°•'�°"`E 3Permit expires 180 days from l issue date EXPRESS BUILDING PERMIT APPLICA'1'18lf C E I V E D TOWN OF YARMOUTH Yarmouth Building Department I JUL 30 2019 1146 Route 28 South Yarmouth, MA 02664 BUILDING DEPARTMENT By. (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: q Pin€ W Ogd Rd &t.A Yap»n q U1 t, ASSESSOR'S INFORMATION: Map: 01 ti Parcel: 67 OWNER: 'TOCLin Aar e`C ( °I Pin QWoOU ILL LODI. tl o-r'k0(J(L. S9BP)3 LI-6 it. NAME LL PRESENT ADDRESS TEL. # CONTRACTOR: If ro,U 1i a I'J!`l6 tQ -�C inftI� U-7G N 6D TEL.#i' -26 8 -02a NAME •,u1IGG L N\Residential ❑Commercial Est.Cost of Construction$ 2 D Co'43 Home Improvement Contractor Lic.# I 064 00 1 Construction Supervisor Lic.# CS- 110 5q$ Workman's Compensation Insurance: (check one) ❑ I am the homeowner z)I am the sole proprietor ❑ I have Worker's Compensation Insurance Insurance Company Name: ti&y jvi Worker's Comp.Policy# M P P-S 38 61 WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares 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: De m o e x r.)t I"!f t l�✓!'..In &Je FYI Qr�1.T ocation of Facility I declare under penalties of perjury that the statements 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 of my license d for prosecution under M.G.L.Ch.268,Section 1. Applicant's Signature: 84,01 � Date: C1/2 q jiq Owners Signature(or`a chment) Date: 01 L Pt Approved By: ` ` Date: 7 s -/� ding Official(or designee) EMAIL ADDRESS: / 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 2 No The Commonwealth of Massachusetts A__74 — 1 Department of Industrial Accidents -LT fill 1 Congress Street, Suite I00 = �_ �' Boston, MA 02114-2017 'M.�55.• www.mass.gov/dig Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print LeEibIy Name (Business/Organization/Individual): a n)r i'(, ,Sp r J C Address: Pi saya;. ,.d, City/State/Zip: 3 out k Den41:f 1.14 ©2tt0 Phone #: 7111-2 3-- 920 Are you an employer?Check the appropriate box: Type of project(required): I am a employer with employees(full and/or part-time).* 7. New construction 2.')C I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity. [No workers'comp. insurance required.] — 9. E Demolition 3._I am a homeowner doing all work myself. [No workers'comp. insurance required.]t _ 10 Building addition 4.0 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.T 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: a byl Policy#or Self-ins.Lic. n: tipps1s6,T Expiration Date: D elbo(t 1 Job Site Address: Q p vtl.woorL Rd: City/State/Zip: YGtwtoti k 144. 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 of perjury that the information provided above is true and correct. Signature: Date: 0 2Q /9 Phone#: 71 c( - eG i3 --0 ZoC 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#: Office of Consumer Affairs& Business Regulation- Mass.Gov Page 1 of 2 j Mass.gov Office of Consumer Affairs and Business Regulation (OCABR HIC Registration Complaints Registration # 187001 Registrant BRAULIO BRITO DBA BBRITO Services Name Braulio Brito Address 19 Saga Rd City, State Zip South Dennis, MA 02660 Expiration Date 02/14/2021 Complaints Details No complaints found for this registrant. You can also view arbitration and Guaranty Fund history. Back To Search https://services.oca.state.ma.us/hic/licdetails.aspx?txtSearchLN=187001 7/30/2(