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HomeMy WebLinkAboutBLD-20-002930 Office Use Only Sy .sl�rt-y� c d Q F . y;' ;Amount nwrr 1n es _ "�m.aw s�T$1 ?Permit expires 180 days from - :;=.: issue date EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 I( g01 South Yarmouth,MA 02664 (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: Q'q!i ( `Q../ c,04, S V moc • ASSESSOR'S INFORMATION: Q [ Map: Y�. Parcel: C f uT OWNER: ee/(4- 13/12l/ NAME/N,, ,, /�, (� D • PRESENT ADDRESS / TEL. # CONTRACTOR: r 424-01/'6 0-Tt U` o`�T , f Po e w yit-PYL{;7ty-4. �'ve o/az. NAME MAILING ADDRESS / TEL.# esidential ommercial' Est. Cost of Construction$ cie 000.00 Home Impro, ement Contractor o te 3 Construction Supervisor Lic.# 406 0 CI 0 Workman's Compensation Insurance: (check one) �' ❑ I am the homeowner ❑ I am the sole proprietor �'I have Worker's Compensation Insurance ���� Insurance Company Name: i t GC, Wed Worker's Comp.Policy# of�vC 62_ WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares 5 vrn ( )Remove existing* (max.2 layers) Insulation Old Kings Highway/Historic Dist. ( )Replacing like for like Pool fencing r nr *The debris will be disposed of at O't /d , ,D' a 1 Location 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 and f pros ution under M.G.L.Ch.268,Section I. / Applicant's Signature: Date: 11'J Ql79 Owners Signature(or attachment) �'`^ + �"I'" Date: j Approved By: A Date: r//�/ f .� Building Offici r de ' ee) E ADD . Zoning District: Historical District: ❑ Yes ❑ No Flood Plain Zone: ❑ Yes ❑ No Water Resource Protection District: Within 100 ft.of Wetlands: 0 Yes 0 No 0 Yes 0 No • _ `_ The Commonwealth of Massachusetts 7 i i'=—"—a Department of Industrial Accidents =A- 1 Congress Street, Suite 100 _ �_ Boston, MA 02114-2017 M:.5 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information PIease Print Legibly Name (Business/Organization/Individual): ad 1-evate 2,7 1-4M A`t Address: 0"M1 i f Acid p d City/State/Zip: W Ya -.i4o U Phone #: WSIWO%2 Are y u an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with /0 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.] 3. I am a homeowner doing all work myself. 9. El 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.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.: /W� 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. 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. Insurance Company Name: 4 YY1 Cita244 Policy#or Self-ins.Lic.#: 0 2-3 A62 Expiration Date: 0610372i. Job Site Address: 471/i' Al".AS City/State/Zip: . Yai-,H,o a _ 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 p nalties of perjury that the information provided above is true and correct. Signature: Date: -7'//ig///9 Phone#: i69 0/0 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 and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Corporation CAPE COD HOME IMPROVEMENT, INC. Registration: 168043 27 MILL POND RD Expiration: 12/06/2020 WEST YARMOUTH, MA 02673 Update Address and Return Card. Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Corporation before the expiration date. If found return to: Reaistration• Expiration Office of Consumer Affairs and Business Regulation 168043 12/06/2020 1000 Washington Street-Suite 710 CAPE COD HOME IMPROVEMENT,INC. Boston,MA 02118 • ANATOLI SIVITSKI 27 MILL POND RD WEST YARMOUTH,MA 02673 Undersecretary Not valid without signature DATE(M1A/DD/YYYY) .AFRO® CERTIFICATE OF LIABILITY INSURANCE 06(MMJDD19 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 lieu of such endorsement(s). PRODUCER CONTACT (Ape Linda Sullivan • DOWLING &O'NEIL INSURANCE AGENCY PHONE 508 775-1620 i FAX (AICE-MANLo.Fxt)• ( � _.... I(A/C,Not•—_-- _ — _ADPRESS: Isullivan@doins.com 973 IYANNOUGH RD - INSURER(S)AFFORDING COVERAGE NAICN HYANNIS MA 02601 INSURERA: AMGUARD INSURANCE CO I 42390 INSURED INSURERS: CAPE COD HOME IMPROVEMENT INC INSURERC: INSURER D: _ 27 MILL POND ROAD INSURER E: _ _ ____ _ WEST YARMOUTH MA 02673 INSURER F: COVERAGES CERTIFICATE NUMBER: 410125 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 --- --- lADDL.SUBR. ---- POuCYEFF POLICY EXP LIMn^S LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER IMM/DDMlYY1 (MM/DD/YYYY) I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE ,$ DAMAGE TO RENTED 7 CLAIMS-MADE , 'OCCUR PREMISES-(Ea_occurrence) $ MED EXP�Any one person) IS - — N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ _ POLICY JE r I LOC 1 PRODUCTS-COMP/OP AGG S {t OTHER: $ AUTOMOBILE LIABILITY • 'COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO . BODILY INJURY(Per person) $ ALL OWNED 1 SCHEDULED __ ;AUTOS AUTOS N/A BODILY INJURY(Per accident) $ ------ 1 NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS , .I AUTOS (Per accident) 1 _. I $ I UMBRELLA LIAB I !OCCUR EACH OCCURRENCE $ EXCESSLIAB , CLAIMS-MADE; r N/A AGGREGATE I$ DEC RETENTION$ $ WORKERS COMPENSATION X PER I OTH- AND EMPLOYERS'LIABILITY f STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE 1 . E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBEREXCLUDED? N/A N/A R2WCO23262 06/03/2019 06/03/2020-- - - - (Mandatory In NH) I N/A _E.L.DISEASE-EA EMPLOYEE S 1,000,000 1 yes,describe under i 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ I ' N/A DESCRIPTION OF OPERATIONS/LOCATIONS I 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/. I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ` THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Anatoli Sivitski 222 Buck Island Road 6-8 AUTHORIZED REPRESENTATIVE West Yarmouth MA 02673 Daniel M.Crowley,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. CAPE COD Home(® CAPE COD HOME IMPROVEMENT TM 27 MILL POND ROAD, WEST YARMOUTH MA 02673 (617) 710-1001 , (508) 469-0102 CAPECODINC@GMAIL.COM, WWW.ROOFCAPECOD.COM, WWW.FACEBOOK.COM/CAPECODHOME PROPOSAL 09. 16.2019 TO STEVEN BRANDER LOCATION: 941 RT 28, SOUTH YARMOUTH WE HEREBY SUBMIT SPECIFICATIONS AND ESTIMATES FOR MAIN COMPOSITION SHINGLE ROOF: • REMOVAL OF ALL EXISTING ROOFING AND FLASHING MEMBRANES TO THE PLYWOOD DECK SURFACE. • REPLACEMENT OF ANY DAMAGED OR DETERIORATED PLYWOOD DECKING AT AN ADDITIONAL COST.DECKING WILL BE REPLACED IN WHOLE SHEETS ONLY IN ACCORDANCE WITH RECOMMENDATIONS BY BOTH THE NATIONAL ROOFING CONTRACTORS ASSOCIATION(NRCA)AND THE AMERICAN PLYWOOD ASSOCIATION(APA).NEW DECKING SHALL BE APA RATED FOR STRUCTURAL USE.DECK FASTENING WILL MEET OR EXCEED LOCAL BUILDING CODE REQUIREMENTS. • REPLACEMENT OF FOLLOWING FLASHING MATERIALS:STEP FLASHINGS,PIPE FLANGES,PERIMETER DRIP EDGE MATERIAL AND ALL SKYLIGHT FLASHING MATERIAL.ALL MATERIALS TO MEET OR EXCEED MANUFACTURER'S REQUIREMENTS. • ONE ROW OF ICE AND WATER PROTECTION MEMBRANE SHALL BE INSTALLED IN ALL VALLEYS AND AROUND THE CHIMNEY. • ONE ROW OF ICE AND WATER PROTECTION MEMBRANE SHALL BE INSTALLED ALONG ALL EAVES AND SHALL EXTEND PAST THE INTERIOR WALL LINE A MINIMUM OF 1 8 INCHES TO PROVIDE PROTECTION AGAINST DAMAGE FROM ICE DAMS. INSTALLATION OF ONE LAYER OF ROOFING UNDERLAYMENT ON DECK SURFACE NOT COVERED WITH ICE AND WATER PROTECTION MATERIAL. • INSTALLATION OF NEW,ARCHITECTURAL-STYLE ALGAE-RESISTANT CERTAINTEED LANDMARK SHINGLES.SHINGLES WILL BE INSTALLED IN STRICT ACCORDANCE WITH THE MANUFACTURER'S SPECIFICATIONS AND SHALL BE FASTENED USING SIX NAILS PER SHINGLE. • COLOR OF ROOF PENETRATIONS AND FLASHINGS TO BE CHOSEN BY OWNER. • INSTALLATION OF A SHINGLE-OVER RIDGE VENT.VENT IN THIS AREA IS CONTINUOUS AND WILL PROVIDE MAXIMUM INTAKE VENTILATION FOR THE FULL ATTIC VENTILATION SYSTEM. • REPLACE ANY DAMAGE FASCIA-BOARDS OR RAKE-BOARDS AT AN ADDITIONAL COST. • ALL GROUNDS TO BE CLEANED UP ON A DAILY BASIS.ALL BUSHES,SHRUBS,AND FLOWERS TO BE PROTECTED. HOMEOWNER IS ASKED TO SUPPLY ELECTRICAL POWER IF NEEDED. CAPE COD HOME IMPROVEMENT TM GUARANTEES THAT ALL COMPONENTS INSTALLED PROPERLY PLEASE FEEL FREE TO CALL CAPE COD HOME IMPROVEMENT TM WITH ANY QUESTIONS OR CONCERNS PLEASE INITIAL THIS PAGE �� \ _ CAPE CAPE COD HOME IMPROVEMENT TM Home 27 MILL POND ROAD, WEST YARMOUTH MA 02673 (617) 710.1001, (508) 469.0102 CAPECODINC@GMAIL.COM, WWW.ROOFCAPECOD.COM, WWW.FACEBOOK.COM/CAPECODHOME MAIN RIGHT BUILDING (Bl) LABOR AND MATERIALS MIDDLE TALL BUILDING (B2) LABOR AND MATERIALS LEFT BUILDING. ASPHALT ONLY (B3) LABOR AND MATERIALS DUMPSTER TOTAL: $20,000.00 CAPE COD HOME IMPROVEMENT TM IS PROUD TO PRESENT YOU WITH SUPERIOR 1 0 YEAR WORKMANSHIP AND SERVICE WARRANTY.THIS WARRANTY IS IN ADDITION TO,BUT RUNS CONCURRENTLY WITH ANY MANUFACTURERS'WARRANTIES.IT COVERS ALL SERVICE CALLS RELATED TO WARRANTY REPLACEMENT AND/OR INSTALLATION ISSUES FOR THE FIRST TEN YEARS AFTER PRODUCT INSTALLATION PAYMENT TERMS: 30%AT DEPOSIT; 30%AT START; 40%UPON COMPLETION. JOB IS ESTIMATED TO COMMENCE APPROXIMATELY 2 TO 8 WEEKS AFTER DEPOSIT RECEIVED WORK IS SCHEDULED TO BE SUBSTANTIALLY COMPLETED IN APPROXIMATELY 1 TO 2 WEEKS. ANY WORK ABOVE AND BEYOND THE SPECIFICATIONS WILL BE PERFORMED AT 56.00$PER MAN HOUR PLUS MATERIALS OR PRICED ON REQUEST.ALL ADDITIONAL WORK,INCLUDING TRAVEL TIME AND LUMBERYARD RUNS,MOVING ALL PERSONAL OBJECTS,FURNITURE,ETC.FROM WORK AREA,WILL BE SUBJECT TO EXTRA CHARGE.IN THE EVENT OF ROT REPAIRS,ROOF REPAIRS OR ANY RELATED WORK REQUIRING IMMEDIATE ATTENTION,WE WILL PROCEED WITHOUT CUSTOMER APPROVAL. CAPE COD HOME IMPROVEMENT TM WILL PROVIDE CLEANUP ON A CONTINUING BASIS AND ALL DEBRIS WILL BE REMOVED FROM SITE(PROFESSIONAL CLEANING DOESN'T INCLUDE).ALL PRODUCTS INSTALLED BY CAPE COD HOME IMPROVEMENT TM WILL BE TO MANUFACTURER SPECIFICATIONS.ALL WORK WILL BE PERFORMED BY INSURED PROFESSIONALS. CAPE COD HOME IMPROVEMENT TM GUARANTEES THAT ALL COMPONENTS INSTALLED PROPERLY PLEASE FEEL FREE TO CALL CAPE COD HOME IMPROVEMENT TM WITH ANY QUESTIONS OR CONCERNS 4 4& ' PLEASE INITIAL THIS PAGE MOT CAPE CAPE COD HOME IMPROVEMENT TM 27 MILL POND ROAD, WEST YARMOUTH MA 02673 (617) 710.1001, (508) 469-0102 CAPECODINC@GMAIL.COM, WWW.ROOFCAPECOD.COM, WWW.FACEBOOK.COM/CAPECODHOME ALL MATERIAL IS GUARANTEED TO BE AS SPECIFIED,AND THE ABOVE WORK TO BE PERFORMED IN ACCORDANCE WITH THE DRAWINGS AND/OR SPECIFICATIONS SUBMITTED FOR ABOVE WORK AND COMPLETED IN A SUBSTANTIAL WORKMANLIKE MANNER. OWNER TO MOVE ALL PERSONAL OBJECTS,FURNITURE,ETC.FROM WORK AREA.ALL ITEMS AGAINST WALLS SHOULD BE CONSIDERED FOR REMOVAL DURING ANY EXTERIOR SIDING JOBS,ADDITIONS,ETC.TO GUARD AGAINST DAMAGE.IN THE CASE OF ANY ROOFING AND RIDGE VENTING,DUST AND DEBRIS SHOULD BE EXPECTED AND ANY ITEMS IN THE ATTIC SHOULD BE REMOVED.CAPE COD HOME IMPROVEMENT TM IS NOT RESPONSIBLE FOR ANY DAMAGES IF SAID ITEMS REMAIN IN PLACE. CAPE COD HOME IMPROVEMENT TM IS NOT RESPONSIBLE FOR ANY DAMAGES THAT MAY OCCUR DURING CONSTRUCTION TO LANDSCAPING OR ANY FINISH GROUND WORK,PLANTINGS,ASPHALT OR STONE DRIVEWAY,ETC.FLOWERS AND SHRUBS AGAINST HOUSE MAY NEED TO BE REPAIRED OR REPLACED BY HOMEOWNER. ANY ALTERATION OR DEVIATION FROM ABOVE SPECIFICATIONS INVOLVING EXTRA COSTS WILL BE EXECUTED ONLY UPON WRITTEN ORDERS,AND WILL BECOME AN EXTRA CHARGE OVER AND ABOVE THE ESTIMATE.ALL AGREEMENTS CONTINGENT UPON STRIKES,ACCIDENTS OR DELAYS BEYOND OUR CONTROL.OWNER TO CARRY FIRE,TORNADO AND OTHER NECESSARY INSURANCE UPON ABOVE WORK.WORKMEN'S COMPENSATION AND PUBLIC LIABILITY INSURANCE ON ABOVE WORK TO BE PLACED ONTHE RESIDENCE AS A CONSEQUENCE OF THE CONTRACT.OWNER WHO SECURE THEIR OWN CONSTRUCTION- RELATED PERMITS OR DEAL WITH UNREGISTERED CONTRACTORS WILL BE EXCLUDED FROM ACCESS TO THE GUARANTY FUND.COSTS OFF COLLECTION,INCLUDING ATTORNEY'S FEES WILL BE RECOVERABLE,IN THE EVENT OF NON-PAYMENT. WE LOOK FORWARD TO WORKING WITH YOU: PLEASE CALL IF YOU HAVE ANY QUESTIONS. SINCERELY CAPE COD HOME IMPROVEMENTTM THIS CONTRACT NOT VALID UNLESS SIGNED BY ANATOU"TONY"SMTSKI ACCEPTED BY 3{Ve SIGN 12DATE ` 1 5 ACCEPTED BY SI DATE ISitJ CAPE COD HOME IMPROVEMENT TM GUARANTEES THAT ALL COMPONENTS INSTALLED PROPERLY PLEASE FEEL FREE TO CALL CAPE COD HOME IMPROVEMENT TM WITH ANY QUESTIONS OR CONCERNS 117)---' PLEASE INITIAL THIS PAGE if cotrini()I1-.'it-'*alij) ry,' D !'s.11S":4-3i) c.) t :31` orel..; Slt-.L.6 ' ,) , , i'L' il --..K11 ,-.' • Boar("i . 1 BI , ii ( linf,..1 Rtliditct;‘, ', io4-1 ''--oPtii , ., of-istn,ictioil SLI7Jerviso - .-,, :-Jf-- ,: : :-7w:'.: i 7,7SSL - 1060410 !--- xDir,:ls )5 4 4202,"..‘ :Z- 4);;II\c' ANATOLI SIVITSKI 27 MILL POND RD ,„:,,,,:- - e• — ' ' '''' ,, ,I.:4 - WEST YARMOUTH MA 02673 . 2 uommissioner Ce4 4•A---• ___ y-, 0 ANATOLI SIVITSK$ 27 MILL POND RD WEST YAR O UTH MA 02673 �j �r