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HomeMy WebLinkAboutBld-20-003240 k :b •Y -N Office Use Only \offI Pem�it# 1jg 1 Amount 0 III.NAT?A n sr/ v��Mrnrca�� '.,,Y 13 u) a 0—3 a y D Permit expires 180 days from issue date EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1; , 1146 Route 28 South Yarmouth, MA 02664 �� t i (508) 398-2231 Ext. 1261 C 111 22_ CONSTRUCTION ADDRESS: j 8 Fir`"A/&I CtT1 A 1I Cz- • ASSESSOR'S INFORMATION: Map: . Parcel: OWNER:JDI0u CI .sou i refA.liveri-- Akg, 5-o84,C//• 7t/7? NAME PRESENT ADDRESS f j /��r- TEL. # CONTRACTOR: O1 Ajc," ��I /1{ •i`t t 1 Le t y 11)1 so 8•Z 8o •o l f L � NAME MAILING ADDRESS TEL.# IIYResidential 0 Commercial Est.Cost of Construction$ 1S%q I Home Improvement Contractor Lic.# 168 b i b Construction Supervisor Lic.# o s 6 y r Workman's Compensation Insurance: (check one) L I am the homeowner i 1 am the sole roprietor Vi have Worker's Compensation Insurance Insurance Company Name:� rout `JDngcirit s, Co, Worker's Comp.Policy# ZD I oD 4b 70V? WORK TO BE PERFORMED Tent Duration rr (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares I b 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: Et. j�V S . r OT DB PI 4 Location of acility I declare under penalties of p ' r th• .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 r re ocat• ,f my license and for prosecution under M.G.L.Ch.268,Section 1. Applicant's Signature: Date: (1 'CI Owners Signa re(or att m nt)) Date: Approved By: Date: /a% /� ding Official(or designee) EMAIL ADDRESS: ! Zoning District: Historical District: - Yes No Flood Plain Zone: Yes No Water Resource Protection District: Within 100 ft.of Wetlands: -- Yes No Yes No The Commonwealth of Massachusetts = Department of Industrial Accidents 1 1 Congress Street,Suite 100 =1:44' Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeiblv Name (Business/Organization/Individual):Power Home Remodeling Address:2501 Seaport Drive City/State/Zip:Chester PA 19013 Phone#:508-280-0156 Are you an employer?Check the appropriate box: Type of project(required): l.1:I I am a employer with 30 employees(full and/or part-time).* 7. ❑New construction 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.] 9. ❑Demolition 3.El I am a homeowner doing all work myself.[No workers'comp.insurance required.]r 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 11.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0 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.t 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.0 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 en 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:Lacher Insurance Company • Policy#or Self-ins.Lic.#:2019756620967 (� Expiration Date:1/1/2020 Job Site Address: a ?Ghl k./ n— /41/G• City/State/Zip:kf. y�Yl44.10i T(-- M k1 Attach a copy of the workers'compensation policy declaration page(showing the policy num er 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 c rti un er epains and penalties of perjury that the information provided above is true and correct. Signature: Date: ( Z" ro l'1 Phone#:508-280-0156 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#: ACD® CERTIFICATE OF LIABILITY INSURANCE DATE/(MM/DDI9 Y) 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 NAME: Lacher&Associates Insurance Agency PHONE FAX Lacher Insurance Group A/C.No.Ext):215-723-4378 (A/C,No):215-723-5757 632 East Broad Street ADDRESS: lather@lacherinsurance.com Souderton PA 18964 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Pennsylvania Manufacturers 12262 INSURED POWERCL-01 INSURER B:Markel American Ins Co 28932 Power Home Remodeling Group, LLC 2501 Seaport Drive,4th Floor INSURER c:Endurance American Specialty 41718 Chester PA 19013 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:2064032166 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 EFF POLICY EXP W LIMITS LTR INSD VD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY1 A X COMMERCIAL GENERAL LIABILITY 301975-66-20-96-7 4/1/2019 4/1/2020 EACH OCCURRENCE $2,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $1,000,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: • GENERAL AGGREGATE $4,000,000 POLICY PRO LOC PRODUCTS-COMP/OP AGG $4,000,000 X JECT OTHER: $ A AUTOMOBILE LIABILITY 151900-60-20-96-7 10/1/2019 10/1/2020 (Ea aocdeDISINGLE LIMIT $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY u AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ _ AUTOS ONLY _ AUTOS ONLY (Per accident) B UMBRELLA LIAB X OCCUR MKLM7EUL100123 4/1/2019 4/1/2020 EACH OCCURRENCE $3,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $3,000,000 DED X RETENTION$0 • $ A WORKERS COMPENSATION 210975-66-20-96-7 10/1/2019 1/1/2020 XOTH- AND EMPLOYERS'LIABILITY STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBEREXCLUDED? NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT $1,000,000 C EXCESS LIABILITY ELD30000834201 4/1/2019 4/1/2020 EACH OCCURRENCE 5,000,000 OVER POLICY# AGGREGATE 5,000,000 MKLM7EUL100123 DESCRIPTION OF OPERATIONS I 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 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Yarmouth ACCORDANCE WITH THE POLICY PROVISIONS. 1146 Route 28 South Yarmouth MA 02664 AUTHORIZED REPRESENTATIVE USA efiO4„ ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD • . Commonwealth of Massachusetts MY' Division of Professional Licensure Office of Consumer Affairs&Business Regulation Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR ConstruCtibrYStp ,rvisor TYPE:Supplement Card • Registration Expiration CS-057645 • ires:09/18/2021 168616 03/17/2021 MARK E MORDINI ,,� ii POWER HOME REMODELING GROUP LLC. :,1 ., 18 NEWELL DR NORTH ATTLEBORO MA,92760` i, , ,'1i MARK MORDINI R,:.CG(%..e /\1 i/S� LIt1`-Y� +�t)� �r 4rir'si", , , 2501 SEAPORT DRIVE l , • CHESTER,PA 19013 Undersecretary l �___ I` Com missioner �...c • Construction Supervisor Unrestricted -Buildings of any use group which contain less than 35,000 cubic feet(991 cubic meters)of enclosed Registration valid for individual use only space. before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 1000 Was ' ton Street-Suite 710 • ' Bosto A g2118 • Failure to possess a current edition of the Massachusetts • of veil without signature State Building Code is cause for revocation of this license. For information about this license Call (617)727-3200 or visit www.mass.gov/dpl • • • National Headquarters John Carlson and Karen Sparre 2501 Seaport Drive,Chester,PA 19013 34-13176 888-736-6335 P� WWW.POWERHRG.COM • MA HIC#168616 .,Kon. ,„ PROJECT AMENDMENT Buyer(s)'information and Description of the Property: Project Number:34-13176 September 05,2019 John Carlson Date of Agreement Karen Sparre (508)641-3477(John's Cell) September 10,2019 P Date of Amendment 18 Bennett Ave (508)737-2553(Karen's Cell) hammerheadviking@yahoo.com West Yarmouth,MA,02673 E-Mail Address 1 County:Barnstable kjsparre@aol.com Township: E-Mail Address 2 This Amendment("Amendment")is to the CUSTOM REMODELING AND IMPROVEMENT AGREEMENT("Agreement")by and between Power Home Remodeling Group, LLC("Contractor"),and "Buyer(s)" listed above.Contractor and Buyer(s)hereby agree to amend and modify the Agreement as indicated below.Other than as specifically indicated below,all the terms and conditions of the Agreement will remain in full force and effect.This Amendment is subject to the terms and conditions of the Agreement.The following additions,alterations,or deletions to the products and services Buyer(s)ordered are being made: Previous Project Price: $23,202.72 New Project Price: $15,991.88 Previous Down Payments Required: $0.00 Additional Down Payment Required: Cn n Previous Down Payments Collected: Additional Down Payment Collected: Additional Down Payment Still Due: $0.00 • It is agreed and understood by and between the parties that this Amendment and the original Agreement constitute the entire understanding between the parties,and there are no verbal understandings changing or modifying any of the terms of this Amendment. Buyer(s)hereby acknowledges that Buyer(s)has read this Amendment and has received a completed, signed,and dated copy of this Amendment on the date written below. Additional Notes: Removed addition siding from contract, • I have read and received each page of this 2 page amendment. Power Home Remodeling Group Buyer(s) Buyer(s) /09/10/19 /09/10/19 /09/10/19 Signature of PHRG Representative Signature Signature Steven Baillargeon John Carlson Karen Sparre September 10, 2019 15:04 mill IIUhIID Illifill I III 1111 • National Headquarters John Carlson and Karen Sparre L Q 2501 Seaport Drive,Chester,PA 19013 34-13176 888-736-6335 POWER WWW.POWERHRG.COM • September 05,2019 MA HIC#168616 PRODUCT SPECIFICATIONS Buyer(s)'Information and Description of the Property: Project Number:34-13176 September 05,2019 John Carlson Date of Agreement Karen Sparre (508)641-3477(John's Cell) hammerheadviking@yahoo.com 18 Bennett Ave (508)737-2553(Karen's Cell) E-Mail Address 1 West Yarmouth,MA,02673 kjsparre@aol.com E-Mail Address 2 County:Barnstable Township: Buyer(s)listed above hereby jointly and severally agrees to purchase the goods and/or services listed on the accompanying specification sheets,in accordance with the prices and terms described in the Custom Remodeling and Improvement and the Product Specifications (collectively,this"Agreement"). Pre Installation Inspection Date:Your pre installation inspection is tentatively scheduled for Tue 9/10 between 2:25p and 3:25p. Siding/Trim-Cedar Tech Wall System Inclusions: Includes Raindrop Underlayment, PowerWall form-fit adhered insulation,all J-channel, starter strip, inside and outside corner posts where applicable,installation,clean up and haul away of all job related debris. To protect our clients, Power HRG includes at no additional cost,the removal and replacement of up to 320 square feet of soft or rotted plywood if needed.Any additional wood replacement needed,over and above the 320sq/ft we provide,will be done at a cost to the homeowner of$3.57 per sq/ft. It is agreed and understood by and between the parties that the Product Specifications,along with the Custom Remodeling and Improvement Agreement,constitutes the entire understanding between the parties,and replace any and all prior negotiations, representations,or agreements,either written or oral. The Product Specifications may not be changed, modified,or varied in any way unless such changes are in writing and signed by both Buyer(s)and Contractor. Buyer(s)hereby acknowledge that Buyer(s)has read the Product Specifications. I have read and received each page of this 2 page agreement. Po r ome Remodeling Group Buyer(s) Buyer(s) /09/05/19 /09/05/19 /09/05/19 Signature Signature of Re odeling Consultant Signature Signature Christopher Kelley John Carlson Karen Sparre YOU,THE BUYER(S),MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. September 05, 2019 22:11 II II III IIIIIIIIIIII iUIII II Page 1 of 2 National Headquarters John Carlson and Karen Sparre 2501 Seaport Drive,Chester,PA 19013 34-13176 888-736-6335 POWER.., WWW.POWERHRG.COM September 05,2019 r MA HIC#168616 Project Specifications • Siding/Trim: Existing siding front left back only 1 1325.0'x1.0' SIDING/TRIM: Models Cedar Tech Wall System Styles Dutchlap Types Quad 4.5"Configs None OPTIONS: Siding Color Greystone 1 Corner Post Color Aspen White/Removal Vinyl/Installation Details Special Options(ie.Firring Strips,Dormers,Twin Houses,etc)Firring Strips(over brick or stucco)No/ Dormers No 1 Twin House No I Three-Story House No/Close-in Exposed Rafters No/Close-in Open Porch No/Move Louver from Peak to Gable No/Additional Removal Yes: Cedar SidingfTrim: New addition siding front right back 1 775.0'x1.0' SIDING/TRIM: Models Cedar Tech Wall System Styles Dutchlap Types Quad 4.5"Con figs None OPTIONS: Siding Color Greystone/Corner Post Color Aspen White/Removal None/Installation Details None Siding/Trim: Louvers left and right side 2 1.0'x1.0' SIDING/TRIM: Models Trim&Accessories Styles Louvers Types Rectangle Configs None OPTIONS: Color Greystone/Installation Details None Siding/Trim: Shutters front only including addition area 4 1.0'x1.0' SIDING/TRIM: Models Trim&Accessories Styles Shutters Types No Hinge Configs Louver OPTIONS: Color Black/Installation Details None Siding/Trim: Front and back soffit existing home-8 inch 1 124.0'x1.0' SIDING/TRIM: Models Trim&Accessories Styles Soffit Types Standard Configs None OPTIONS: Color Aspen White/Removal Existing Soffit/Installation Details None September 05, 2019 22:11 11111111 111111111111111IIIII it Page 2 of 2