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HomeMy WebLinkAboutBld-20-002388 Y9 piu�cc vsc vuly R Cr" �� • - o •Wit# ;?a O . ' '!�l, . H. Amount =N MATTA n cx : M`°',0f0fiSCO'S cad !Permit expires 180 days from - = := l issue date EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Ext.i 1261✓ CONSTRUCTION ADDRESS: a(' � ,,,,,€ I'V4t ele,441� b' /7,i�� 67Y ASSESSOR'S INFORMATION: r Map: Parcel: OWNER: Att- L f Cjelor, IAA ,;e/lett 1 A`4 v"• �Q"Y`z� g/6 Z NAME PRESENT ADDRESS TE . # CONTRACTOR: ^'4S /—A -t v /�'��n d ; 067.2 ME ; AI7Z - MAILING ADDRESS T9L.# /e Cc29 esidential ❑Commercial Est.Cost of Construction$ Home Improvement Contractor Lic.# Construction Supervisor Lic.# cT1r/,T Workman's Compensation Insurance: (check one) ❑ I am the homeowner ❑ I am the sole proprietor have Worker's Compensation Insurance //` ,yy �'' 14/60 Insurance Company Name: �`7C''t'� •''�"�� L�l� B'j Worker's Comp.Policy# � 5-Y 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: rLoc on 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 ense and o prosecution under M.G.L.Ch.268,Section 1. Applicant's Signa . Date: /c -� 7 Owners Signa re(or • achme Date:Approved By: Date: /4) Buildine esignee) EMAIL ADDRESS: Zoning District: Historical District: 0 Yes ❑ No Flood Plain Zone: ❑ Yes 0 No Water Resource Protection District: Within 100 ft.of Wetlands: 0 Yes 0 No 0 Yes ❑ No The Commonwealth of Massachusetts ` L/1i-W ► Department oflndustrialAccidents - 1 Congress Street, Suite 100 4 _ 1= Boston, MA 02114-2017 ,�;,s www.mass.gov/dia «Yorkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): /„v''*S X44*-Y Address: ,4. 4 a ) 1. City/State/Zip: „,,, „/� ,i4 0172 Phone #: ye v.i67r Are you employer?Check thpropriate box: Type of project(required): i. am a employer with employees(full and/or part-time).* 7. _New construction 2.❑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 all work myself. 9. _ Demolition ❑ doing y [No workers'comp. insurance required.] 4. I am a homeowner and will be hiring contractors to conduct all work on m YP property. I will 10 ❑ Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.C Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions f.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp. insurance.: 6.E 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. 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. r Insurance Company Name: 1�. T-LrI t rd.4/6 i Policy#or Self-ins. Lic. #: °Ito/ twto&J Expiration Date: 5")`71' Job Site Address: 4' 1 Z 46- City/State/Zip: f/ 1444 Attach a copy of the workers' coation policy declaration page(showing the policynumbera expirationQa date). OW 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 an penalties of perjury that the information provided above is true and correct. 7 Signature: Date: /d--,, F" )7 Phone#: cog .94 /jj�3) 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#: Thomas Home Improvements LLC.Proposes to perform the following work: Location of proposed work: Mr.& Mrs.Crowley 45 Prospect Avenue West Yarmouth, MA 02673 Date on which construction should begin: November 2019 The homeowner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that cannot be avoided by the contractor shall not be considered as a violation of this contract. The contractor agrees that when such delays become known to the contractor,the contractor will advise the homeowner as soon as possible. The homeowner hereby acknowledges that in certain remodeling work,the demolition process may reveal defects in the existing structure which must be repaired,creating additional work which may need to be carried out in order to complete the work described in this contract. In such case the homeowner agrees that the duration of the work and the schedule date of completion may differ,and that such variation is not to be considered a violation of this contract. Cost for labor and materials under this contract: $3,900.00 30 yr.GAF/Elk Timberline HD Architectural shingle(Life Time Limited Warranty) Proposal to install SBC grade A white cedar siding shingles on all back areas as discussed would be $3,475.00 In the event that while stripping the roof or siding we find rot that needs to be replaced,the homeowner then has to agree and authorize any replacement or restoration. Then in addition to the above contract price,the homeowner agrees to compensate the contractor for any repairs or restoration at the hourly rate of$65.00 for a carpenter and$45.00 for a carpenter's laborer,plus the cost of materials. -Roof to be stripped and cleaned of all old shingles and debris -Roof to be papered with weather watch leak barrier,installed with Timberline architectural shingles using galvanized nails. (Storm nailed) -All new 8"drip edge and pipe flanges to be installed -Cobra ridge vent to be installed on all ridges -Timberetex premium ridge cap to be installed -SBC cedar shingles to be installed in accordance to all manufactures warranty specifications -A 10-yard dump trailer will be needed on site;and will be removed at completion of the job -Contractor will be responsible for all building permits needed at the property NOTICE REQUIRED BY LAW With the agreement of the contract$500.00 of estimate is due. Further payments under this contract are as follows: 1/2 of the estimate due at the start;and remainder due at completion of the job. Balance of all materials and labor shall be payable in full upon completion of work described in this contract. Payment as agreed upon shall be made when due. Any payments which are delayed shall be subject to a finance charge of 1.5%per month. The contractor warranties the workmanship completed under this contract for a period of ten years from the date of completion. During the stated warranty period the contractor shall be responsible for the service of the repair or adjustment, but the contractor shall not be responsible for the normal maintenance,repair due to abuse, misuse,and or normal wear and tear,which shall be the responsibility of the homeowner. All warranties for the materials supplied by the contractor shall be passed directly to the homeowner. The homeowner may be required to register or mail in such warranty card or evidence of ownership in order to activate such warranties. Homeowner failure shall not create any responsibility for the contractor under the warranty provisions;the choice of repair of replacement shall be at the discretion of the contractor. The homeowner acknowledges that the form,content,and notices contained in this contract are intended to comply with the applicable portions of the Mass.General Law Chapter 142A, and regulations promulgated there under. In the event of any instance of non-compliance,only such portion shall be invalid and the remainder of this contract shall be in full force effect. In addition,any such portion not in compliance shall be read and interpreted so as to have its intended meaning to the maximum extent allowed under such law and regulation. Signed as a sealed instrument on this date: • ! DATE(MMIDDIYwY) AC UI CE tT(FICATE OF LIABILITY INSURANCE TESAWzo19 THI$CERTIFICATE IS ISSUED AS A j TTER Of INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS - .AM CERTIFICATE DOES NOT AFFIRMA Y OR NEGATIVELY END, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INS NCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,ANC THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder felon ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject tO the terns and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to Ihe certificate holder in lieu of such endorsement(s). PRODUCER wifeJen Davis Mark Sylvia Insurance Agency,LLC i PRONE (508)957-2125 PAx Not (508)967 2781 404 Main Street. markkmarksyNiainsurance.com Centerville,MA 02632 j INSURERS)AI oameG COVERAGE Nnrc 0 eNURERA: Farm Family Casualty Insurance • INSURED • ' RgUREL B: Thomas Home Improvements.LC ENSURER C PO Sox 177 INSURED: Centerville,MA 02632 INSURERS: COVERAGES CERTICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OOOFFF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NO1WTHSTANDING ANY RE UIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY P AIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL.THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH CIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE SUER ruin POLICY RUINER AS&.farreY APVI LIMITS X COMMERCIAL GENERAL uAMRJTY EACH OCCURHEKE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE Ei OCCUR PREMISES teaccwrerwel 1100,000 MED EXxP Wit one person) t 5,000 A „ '1 N 2001X1416 5101/2019 5/01/2020 PERSONAL aA,vINJURY S 1,000,000 GEWL AGGREGATE� pcR, GENERAL AGGREGATE $ 2,000,000 POLICY T El LOC PRODUCTS-COMP/OP AGO I2,000,000 OTHER $ ISJ AUTOMOBILE UATY .CEOMe k$INGLE LIMIT $ ANY AUTO BODILY WJURY(Per person) $ — OWNED SCHEDULED BODILY INJURY(Par sadden° $ AUTOS ONLY AUTOS HIRED NON-OWED— AUTOS ONLY — t Eck $ $ UMBRELLAUAB OCCUR EACH OCCURRENCE $ EXCESS UAS CLAMS, DE I AGGREGATE • $ DED I RETENTION$ T me $ WORKERS COMPENSATIONI I MUTE E E p RA AND EMPLOYERS'LIABILITY AANY ROPRIMBE°RR Y AAA N 2001Vi18053 510112018 5/01/2020 ILL EACH ACCIDENT S 1,000,000 (Mmdetory In NH) EL.DISEASE-EA EMPLOYEE $ 1,000,000 DESCR PTION OF OPERATIONS below Iii EL DISEASE-POLICY LUST $ 1,000,000 DESCRIPTION OF OPERATIONS t.LOCATIONS/VmIICl4(ACORD let,Additional Reseda SoheddS nay be Meshed Swore own le requited) Carpentry i Insurance coverage is limbed to the terms,londitions,exclusions,other limitations and endorsements: Nothing contained in the certificate of insurance shall be deemed to have altered,waived or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER • CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Barnstable Building i A WITH THE POLICY PROVMEONS. 200 Main Street • i 11Irr11DRQlD IIQ'RESEUTA7NE • ,' I Hyannis MA 02601 Fax: Email: ©1986.2018 ACORD CORPORATION. All rights reserved. ACORD 26(2016103) The ACORD name and logo.are registered marks of ACORD V VI 111,,V,I VW can„VI IYIa3Dab11YOCL la, Ae ammanaveailit o/c h'aauac%iaae14 I Division of Professional Licensure Office of Consumer Affairs&Business.RegulaUon Board of Building Regulations and Standards i+ HOME IMPROVEMENT CONTRACTOR TYPE:Corporation Contructio*S1.104fAsor Specialty Registration Expiration 185422 06/08/2020 CSSL-099913 Spires 04/1,3/2020 TROY THOMAS HOME IMPROVEMENTS,INC. ' u y • TROY A THOMAS / 1 499 NOTTINGHAM DR '� '" -, 0 ,— ••. ,, d TROY THOMAS CENTERVILLE M 2632 N• . F, 499 NOTTINGHAM DR. ��""`� ^.. .. 1 44 "' R CENTERVILLE,MA 02632 >!�`s'j.l��z. Undersecretary ' Commissioner cz.,