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HomeMy WebLinkAboutBld-20-001831 ONE &TWO FAMILY ONLY—BUILDING PERMIT Town of Yarmouth Building Department 1146 Route 28,South Yarmouth,MA 02664-4492 508-398-2231 ext 1261 Fax 508-398-0836 Massachusetts State Building Code,780 CMR BuildingPermitApplication To Cons Repair,Renovate Or Demolish a One-or Two-Family Dwelling i W ,� / This Section For Official Use Only RECEIVED Building Permit Number: t 2t - 3 L r- Date Appli rr y OCT 0 3 2019 Building Official(Print Name) Signature -_-Dom.-- BUILDING DEPARTMENT SECTION 1:SITE INFORMATION By-1.1 MI ty 1.2 Assessors Map&Parcel Numbers z/ _ -3 1.1a Ls this an accepted street?yes no Map Number Parcel Number 13 Zoning Information: L4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,154) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP" 2.1 Owner' f Record: VVt rr i a`5 TS ON\01,1 Ycs re a<A j (ri. Name(Print) City,State,ZIP wk 1 J wuo& 1 -. 6--g.`%%o +i S k &, ; Qco446.53 %u.f No.and Street Telephone F.mnil Address SECTION 3:.DESCRIPTION OF PROPOSE_D WORK'(check allthat apply) New Construction 0 I Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 I Accessory Bldg.0 Number of Units Other ❑ Specify: Brief Description of Proposed Work2: S-tr'p c.r b._ re.Fta Le- �-' ( /fh t7 Tee( ✓�ov S�$1� aa, s SECTION:4:ESTIMATED C-ONS'i'1(UCTIQN COSTS. :. " • Estimated Costs: Item (Labor and Materials) _ :Official lise Only 1.Building $ /3 q c I Building Peimit Fee;$:: = Indicaie how fee is detemnined: ❑Standard Cityrrown_ ':::., • . 2.Electrical $ x m• ; 'er... : x ❑TotalProjeat Costa 3.Plumbing $ • 2. Other-Fees: $ . 4.Mechanical (HVAC) $ L 5.Mechanical (Fire Suppression) Total All Fees:$ Check Ind Check Amount Cash Amount - 6.Total Project Cost: S r 3 I get, ❑paid in-Full 0 Outstanding Balance Due: The Commonwealth ofMassachusetts 'i, s Department oflndustrialAccidentr :Ills= I Congress Street,Suite 100 _ t r Boston,MA 02114-2017 --:r ,�,:,' www,massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING ALTTHORIT'lr. Applicant Information Please Print Legibly Name(B IV04 St ,VA_ (cYnlifa Address: 6. A,f c/ec51 is City/State/Zip: eite41 IU(a `AA A Phone#: ..riD c� (QC Li " (--)S--O Are you an employer?Cheek the appropriate box: Type of project(required): l.❑I am a employer with employees(full and/or part-time).* 7. ❑New construction 20 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 9. ❑Demolition L� ngmyself.(No workers'comp.insurance required]t 4_ I am a homeowner and will be10 ❑Building addition ❑ 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 prop with no employees. 12.❑Plumbing repairs or additions $C` contactor and I have hired the sub-contractors listed on the attached sheet ❑ p employees and have workers'comp.insurance3 13. ROof re airs These sub-contractors have 6. We are a 14.[J Other c omoration and its officers have exercised their right of exemption per leIGL c. 152,31(4),and we have no employees(No workers'comp.insurance required.] *Arty applicant that Checks box f 1 must also fill our:the section below showing their waters'rss'compensation policy infinmatioa. t Homeowners who submit this affidavit ice iaaiog they are doing all work and then hire outside sanaarroas most submit anew ai$davit iodinating such *Contractors that check ihiii boat must anactint an additional sheet showing the omne of the sub-contractmrs and state whdher or not those entities have employees If the sr eoraxactocs have employee,they oast provide their workers'comp_policy number. I am an employer that is providing workers'compensation insurance for aq empoyee. Below is the policy and job site information. /� _ Insurance Company Name: -c 4 1,U1VY 1 Policy#or Self-ins.Lie.#: LI b6. l b 3 a oZ / 7 'O i q A Expiration Date: 3 - t'i • `,?d D-0 Job Site Address: W'16- l,J City/State/Zip: Y //4011tk 1104 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 o - 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 ag•\ e violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance .e -, . . . ,`t pII I do h a 1 .\ t• under the pains and penalties of perjury that the i nformttlion provided above is true and correct. Signature: i Date: lv' '3 - : -ulip :\ Phone�. Wig•��`� 1 t 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#: l�-� e � � �� � Q� �I-�..,,� U y� �, Y - SECTIONS:.CO S1R CIION SERVICES 5.1 Construction Supervisor License(CSL) (1\ C License Number Expiration Date Name of Bolder 17 List CSL Type(see below) v"c' ev Cre' No.and - Type Description IA/ W1Dvq (!44 k o r c� r U Unrestricted(Buildings up to 35,000 on.ft.)City/town,State,ZIP I R Restricted Iit2 Family Dwelling Masonry 4t1S. Roofing Covering WS Window and Siding .6 616-71 5 /MC. i�t I Solidn> Appliances Telephone lull address D Demolition 5.2 Registered Home Im rovement Contractor(HIC) (VW S koe Conk ' (A, C / 7a0 ®W Jzr, HIC Registration Number Expiration Date HIC pang Name o HIC Registrant Name cab I r�� Shy Q NQcRT. No.and S Email address City/Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes 0 No ❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPT•VS FOR BUILDING PERMIT -. I,as Owner of the subject property,hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date - • SECTION 7b:OWNER'.OR AUTHORIZED AGENT DECLARATION By . g name below,I hereby attest under the pains and penalties of perjury that all of the information application is true and accurate to the best of my knowledge and understanding. Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fiord under M.G.L.c.142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.eov/dps 2 When substantial work is planned,provide the information below: Total floor area(sq.II) (including garage,finishedbasement/attics,decks or porch) Gross living area(sq.ft.) Habitable roumm.count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open i 3. "Total Project Square Footage"may be substituted for"Total Project Cost" /� /act_ 00 _�� � TOWN OF YARMOUTH C. "• �� BUILDING DEPARTMENT • • �s 1146 Route 28,South Yarmouth,MA 02664 508-398-2231 ext. 1261 Fax 508-398-0836 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 40,Section 54 and 780 CMR, Chapter 1,Section 111.5, • I hereby certify that the debris resulting from the proposed work/demolition to be conducted at e 1J' �\� kl U t S4- yo,,,y1.01vv, ►Yl: Work Address Is to de disposed of at the following location: 5 'd disposal site shall be a licensed solid waste facility as defined by M.G.L. ter l l 1, Section 150A. JO— Si tare of Application Date Permit No. • YiT„ `.w e. O /",2)1 g q' " N o. . 0. gw it,,,,,,44 t � • F �..-...-,,......,.,.44t4,r,,...,.,,,. tii-. o y* -. a rn fr',\()1S1 �p l e Ili, c en G Kx ,^. t4,4 . N n1 0 o->F, t a.ze riS#a u a 1 n:...11:'..- '.....,r,....'•:-.1,,ct, -tii:-.' . ,i. X . • • . F ' I 3e 1 it -- I (MUN NIV " THIS CERTIFICATE IS ISSUED AS A MATTER OF MPORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS tERiwiCATE DOES NOT AFFIRMATNELY OR NEGATIVELY AMEND, MEND OR ALTER THE COVERAGE AFFORDED BY THE POUCES 118.0W THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING !EMMETT**, AUTHORIZED REPRESENTATNE OR PRODUCER,AND TIE CERTIFICATE HOLDER. MWORTANT: V the certificate holder Is an ADDITIONAL INSURED,the polcyges)must be endorsed. R SUBROGATION IS WANED,subject to Me Mime and conditions of the policy,certain pandas may require an endorsement. A statement on this certificate does not confer rights to the arBlea to holder to Neu of such reaONeEe dentine franc STEPHEN W GERSH INSURANCE AGENCY Kit (508)485-1926 EMAIL (A Nei =Ras 9 LIONUINENT AVENUE AsfoeONDCOVERAGE WC* _ MAR.BOROUGH MA 01752 NSURERA: AIN MUTUAL INS CO 33758 INURED INSURERS: POWER CONSTRUCTION LLC er:uaERC: INSURER D: 232 POND ST 3 WILMER E: NATItC MA 01760 ONIRIRERF: — COVERAGES CERTIFICATE NUMBER: 385527 REVISION'NIJMBEIt THIS N TO CERTIFY THAT THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY 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.UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID C�CLAIMppS. aosse- TYPEOFI INSURANCE jr� wm! POLICYNUMBER OAI YYYYYI ON(mO/YYYYI L ITS OOMIE EN RC1ALBERALUABeJTY e j EACH OCCURRENCE `s DAMAGE TO RENTED!PREMISES(Ea oxurence) t$ j MED EXP(My one person) !S ' WA 1 PERSONAL&MTV INJURY I s { GEM.AGGREGATE LIMIT APPLIES PER 1 GENERAL AGGREGATE ,$ 7-7 PODGY%PRO !JECT LOC 1 i }PRODUCTS•COMP/OPAGG s OTHER: j !s AUTOMOBILE LIABILITY 'VIMBIISEDSINGLE LAST I s ANY AUTO i BODILY INJURY(Per person) $ AU.OWNED 71 SCHEDULED AUTOS AUTOS i WA BODILY INJURY(Per accident) s HIRED AUTOS �-iI � e ! RTY DAMAGE f t (Per accident) i I 1t IJAe1RREU.A UA9 occuR °EACH OCCURRENCE s EXCESS LMB CLAS S#AADE j N/A i AGGREGATE 's DED I RETENTIONS pp i s WORKERS COMPENSATION g { X1 STATUTE 1 I EERA AND EMPLOYERS'UMBUTY YIN; MIYPROPRI I E.L EACH ACCIDENT !s 100,000 A ®`NUL(NIA? AWC40070322772019A 03/24/2019 03/24/Z020 I pYidNory in MO .EL DISEASE-EA BRUME S 100000 OoPHM11ONS Mom i d ea codex-POLICY user s 600.000 Y h u , NIA i i OEsCR7NINOPOPBAIUNOSS/LOOM=iV@NCIJ3 Cecoatie1.Af—A1seNANtsANdtis,nay be___N_Moore wom ompalsolt Workers'Compensator benefits nil be paid to Massachusetts employees only.Pursuant to Endorsement WC 2003 06 B,no authortzation is given to pay claims for benefits to employees in states other than Massachuserts lithe insured hies,or has hired those employees outside of Massachusetts. This certificate of linteaxse shows the palsy in force on The do/enmities oeetYirate was issued(unless the espialon dole on the above paltry precedes the nose dale of this cesfillicate of insurance). The states Gills coverage can be margined delyby accessing the Pied of Coverage-Coverage Vailltca0en Search tool at CERTIFICATE HOLDER CANCELLATION Sirtio,D ANY CF TIE ABOVE DESCRIBED POUCIESBECANCELLEDBEFORE TIE EXPIRATION GATE TIBIEOF, NOTICE WILL 8E DEUYERm m Northeast Roofing Contractors LLC ACtX>N�ANCEMIMTiEt10LICYPRDIASI0N5. PO box 143 AUTNOMIZEDREPRESEMAMIE HYanrisPolt MA 01672 D uel Nt Cr y,t�ICU.Vice Mindere—Residual Market—MAC 11 C 1l/6-2014 ACORD CORPORATION. Al rights reserved. ACORD 25(2014 01) The ACORD name and logo me registered marks of ACORD ____,......140 NORTH09 OP ID:WC ACORO (DATE MMDD/YYYY) (�� CERTIFICATE OF LIABILITY INSURANCE DATE 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 Segreve&Hall Insur.ASsoc.InC NAME: FAX One Tech Drive No Ext)978 975-1300 (NC,No):978 975-7596 Andover,MA 01810 E-MAIL Sean Segreve ADDRESS._____ INSURER(S)AFFORDING COVERAGE NAIC It INSURER A:Atain Specialty INSURED Northeast Roofing Contractor INSURER B:Commerce Insurance Co. 34754 Shane McGuire 9 Royal Crest Dr INSURER C Marlborough,MA 01752 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 ADB[UBRT POLICY EFF 1...POLICY EXP LTR TYPE OF INSURANCE 'INSD'WVD• POUCY NUMBER (MM/DO/YYYY) I(MMIDD/YYYY) , UNITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE '$ 1,000,000 CLAIMS-MADE X OCCUR 'CIP353069 02/09/2019 02/09/2020 DAMAGE TO RENTED $ 100 00 PREMISES(Ea occurrence) MED EXP(Any one person) ,S 5,000 I — i 1 PERSONAL&ADV INJURY_ 1$ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 'GENERAL AGGREGATE '$ 2,000,000 POLICY i LOC t I PRODUCTS-COMP/OP AGG ,$ 2,000,000 OTHER: ',! $ AUTOMOBILE LIABILITY , COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) B ANY AUTO IRXL738 02/21/2019 02/21/2020 BODILY INJURY(Per person) $ ALL OWNED r X,, SCHEDULED I BODILY INJURY(Per accident) $ AUTOS AUTOS i NON-OWNED I PROPERTY DAMAGE $ HIRED AUTOS .` AUTOS I (Per accident) ________ S j UMBRELLA UAB , OCCUR rEACH OCCURRENCE S EXCESS UAB CLAIMS-MADE ! AGGREGATE I$ DED RETENTIONS $ WORKERS COMPENSATION PER OTH- ANY PROPRIETORIPARTNER/E�ECUTIVE N/A STATUTE DER ANDEMPLOYERS'UABIUTY YIN OFFICER/MEMBER EXCLUDED. E L EACH ACCIDENT I. $ (Mandatory in NH) E.L.DISEASE EA EMPLOYEE $ If yes,describe under , I- — — DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 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 DEUVERED IN Town of Yarmouth ACCORDANCE WITH THE POLICY PROVISIONS. 1146 Route 28 South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Northeast Roofing Contractors LLC PPO MA lic#106123 HIC Lic#190720 RI #41897 P.O. Box 145 NRCL West Hyannisport, MA 02672 Phone:5087764916 Contact:Networks ROOFING ST Email:justin@northeastroofingcontractors.com CONTRACTORS LLC Customer Address Dimitrios Tsiakalis 8 Wildwood Path West Yarmouth, MA 02673 7747668360 ttsiakalis@comcast.net Quote#: 505 Date: Aug 5,2019 Description Total 1.Safety plan $0.00 1. Identify any hazards on site 2.Take preventive action on any risks 3. List assets needed to complete project in a safe manner 4. Protect property and public from demolition and site work 2. Property Protection $0.00 Cover the house,walkways,and shrubs in order to protect from roof debris. 3. Remove existing roof system $1,540.00 Rip 4. Ice and Water shield $1,246.00 Install ice and water shield up the first 6' up from the eve,valleys,cheeks and any penetration(including skylights,vents, pipes and around chimneys) 5. Install Synthetic Underlayment $240.00 Install Synthetic Underlayment to remaining roof areas. 6. Drip edge $525.00 Install 8 inch drip edge around the parameter of roof 7.Starter shingle $325.00 Install Certainteed starter around parameter of roof over the drip edge separated seams 8.Shingle Installation(LANDMARK HD PRO SHINGLES) $4,400.00 Install Certainteed Landmark shingles to manufacturer's specification (6 nails per shingle). 9.Chimney Re-flash $0.00 Northeast Roofing Contractors LLC I Phone:5087764916 Page 1 of 3 .. 0 Items continued... Rip out existing lead flashing and caulking. Install new 9" lead base flashing around chimney and weave between shingles. 10. Pipe Boots $30.00 Install new pipe collars around pipes 11.Ridge vent $1,008.00 Install ridge vent to 1/4 inch open ridge 12. Cap Application $763.00 Apply to the ridge of roof 4 nails per cap 13. Permit $200.00 Obtain permit from local town 14.Trim $0.00 Replace 2 small rotted second members 1x3, and one rotted rake tail 1x6x2 15.Soffit vents $420.00 Install soffit vents for air intake 16.Gutters $1,500.00 Remove and replace all existing gutters/downspouts, and replace with seamless white gutters and new downspouts. 17. Dumpster and disposal $800.00 Disposal of all debris 18.Warranty $132.00 50 year Certianteed Warranty 19.Warranty $0.00 15.Year workmanship warranty Total $13,129.00 Northeast Roofing Contractors LLC I Phone:5087764916 I Page 2 of 3 Terms and Conditions Scope of Work: Company will provide services as described in the attached quote. Company will provide all services, materials, labor,tools, and equipment needed for completion of services. Payment Terms:A down payment of 35% is due upon acceptance of quote.35% is then due the day the project starts.The remaining 30%is due upon completion. Change Order:Any deviation from the above quote involving a change in the scope of work or any additional costs will be executed only with a written change order signed and dated by both the Company and Customer.Any plywood replacement will cost$75.00 per 4x8 sheet and $7.00 per linear foot of spring board. Warranty: Company warrants all work will be performed in a good and workmanlike manner.Any warranties for parts or materials are subject to manufacturer terms on such products. Conditions:This proposal is valid for 30 days. Company reserves the right to withdraw this proposal or re-quote the project if contract acceptance is beyond 30 days. - • *' onto/ Name Date Name Date Name Date Name Date (ay 91A?) co /0 (- Northeast Roofing Contractors LLC I Phone:5087764916 l Page 3 of 3