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HomeMy WebLinkAboutBld-20-004133 ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department .. r 1146 Route 28, South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 • Massachusetts State Building Code, 780 CMR = Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling -- -- h E C E I V E D is Section For Official Use Only Building Permit Number•, AO. /.3 3 Date A f 4._i 1 �� - 2t ____ 113:5 I , 111 5-QAcs ,.2------- ' ,^---"-" BUILDING-BF A-R-T-NEWT Building Official(Print Name) Signature By: Date SECTION 1:SITE INFORiMATION 1.1 Property Address: 1.2 Assessor &Parcel Numbers V5 tAktw- -, el-( ; 6 . 7r AV 1.1a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 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,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: Outside Flood Zone? — Municipal❑ On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP1 2. Owner'of Record r tI4?-ttvv rl'SA, L. `Yj f�Cd'--T1 �t� JZG' 6'y Name(Print) City, tate,ZIP t,9 L ue eat ia-->i SD$ 137 6 5`l8 i o.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'-(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 1 Repairs(s) Alteration(s) 1 Addition 0 Demolition ❑ Accessory Bldg. 0 Number of Units Other 0 Specify: recTD r,4 'i i Ci�J Brief Description of Proposed Work': P.es'i L'+;'a j ;Vic,..: qE.. i.i`t d r M,1& I p/ i f- IeS IDI-e g DOC Cr/4 Me, W,Pti t. .5, Sidiz) t, %r - .t-ff SHGti('3c w`i lgt,l!/Fir r'1d 1- Ai;Sn tit,-)i 14 • SECTION 4: ESTIMATED CONSTRUCTION COSTS. Estimated Costs: RECEIVED Item Official Use Only a (Labor and Materials) --� 1. Building 1. Building Permit Fee:$3 EQ Indicate how fee is.detr fk _ , ! t ,, •t,1 Standard City/Town Application Fee ti°" 2.Electrical $ 1 7 U L� 3 _ ___ / ❑Total Project Cost (Item 6)x multiplier x - ,;3 OUILDING EPARTNiENT 3.Plumbing $ 11�, 00 0 2. Other Fees: $ L 1-By 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees:$ �().0) Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ I • O,G' t 0 Paid in Full lil Outstanding Balance Due:31<-- , , SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Su ervisor License(CSL) PAUL,a> ESP €L'' License umber Expirationate Lo Name of CSL Holder pV• (I o f 0 5 List CSL Type(see below) C rj 4 7T t C-) No.and Street Type Description L /� ` At Dn . /l ��v U Unrestricted(Buildings up to 35.000 Cu. ft.) Citity/Town,State_ZIP i !� /� R Restricted 18c2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding 1 SF Solid Fuel Burning Appliances %O 367 6 -7 3 p4Uc©M p4 le i' ('s P6T0-;1. I Insulation -Telephone Email address t rr r') D Demolition 5.2 Re istered Home Improvement Contractor(HIC) (A � ] g&s22 2 0 2020 Y V e(9�I I K C t 0 LL(. HIC Registration Number Ex iration Date HIC Company Nazesr HIC Registrant Name No.and Street S A r.M D�Y s I 4- 0L, ``.t ( Email address I .. City/Town, State,ZIP Telephone SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(111.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 V No 0 SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize to act on my behalf, in all matt to work authorized by this building permit application. Print Owner Name(Electronic Signatur 13 Date l • SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this 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 fund 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.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics, decks or porch) Gross living area(sq.ft.) , Habitable room 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 3. "Total Project Square Footage"may be substituted for"Total Project Cost" ....\ The Commonwealth of Massachusetts _4 Department of Industrial Accidents y :: = t. 1 Congress Street, Suite 100 —'-oh = Boston, MA 02114-2017 it �, www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly I 1.t, i Name (Business/Organization/Individual): pAv COos � �� du L L c- , Address: c• (✓ CEO A 27 Cit /State/Zi � 02 ;V u 11 Y P:G . V� i' �`t D u' r1 , r4!4- Phone #: £c ?G 7 17 J Are you an employer?Check the appropriate box: Type of project(required): I.Vram a employer with Li 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. Ell Remodeling any capacity.[No workers'comp. insurance required.] r- 3.❑l am a homeowner doing all work myself [No workers'comp. insurance required.]r 9. C Demolition 4. I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11. Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp, insurance.: 1 •El Roof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§I(4),and we have no employees. [No workers'camp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. r 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 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: IJ P Y 6(A. / ) 1 Policy 4 or Self ins.Lic.#: PJ4w C v 7 7 L Expiration Date: /1 0,3/10 Job Site Address: 82) 1-q 14 e pi et) it d'. City/State/Zip: S.P¢TN(O1,curjt r i./ f 02 6 6 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). 7 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 o perjury that the information provided above is true and correct. Signature: VDate: U 2 ebto Phone#: 5D11 ;&) 7 ; 7 � 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#: • o�'YA��� TOWN OF YARMOUTH ° BUILDING DEPARTMENT �` MATTAG ECSE 1 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1261 HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DA'LE,: JOB LOCATION: (/L �:• reagiraillillir. •�► •� S SECTION OF TOWN "HOMF OWNEW N• i HOME PHONE WORK PHONE PRESENT MAILIN DRESS CITY OR OWN STA'1'B ZIP CODE The current exemption for ` .meowner' was extended to include owner—occupied dwellings of one or two units and to allow such homeowners o engage an individual for hire who does not possess a license,provided that such homeowner shall act as supervise . (State Building Code Section 110 R5.1.3.1) Definition of Homeowner: Person(s)who owns a parcel of land on hich he/she resides or intends to reside,on which there is or is intended to be, a one or two family attached or detach-. structure assessory to such use and/or farm structures. A person who constructs more than one home in a two-yea .eriod shall not be considered a homeowner;such"homeowner"shall submit to the building official, on a form accep..ble to the building official,that he/she shall be responsible for all such work perfoiriled under the building permit. , ection 110 R5.1.3.1) The undersigned `homeowner' assumes responsibil . - for compliance with the State Building Code and other applicable codes, by-laws, rules and regulations. The undersigned 'homeowner' certifies that he / she unde tands the Town of Yarmouth Building Department minimum inspection procedures and requirements and that e / she will comply with said procedures and requirements. HOMEOWNER"S SIGNATURE APPROVAL OF BUILDING OFFICIAL INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent, whic' meets the requirements of MGL Ch.142. Yes No If you have checked yes, please indicate the type coverage by checking the approp '.te box. A liability insurance policy Other type of indemnity Bond OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent h:homeownrlicexemp T §TOWN OF YARMOUTH 1146 Route 28, South Yarmouth, MA 02664 508-398-223'1 ext. 1261 Fax 508-398-0836 Office of the Building Commissioner BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Ch. 40, §54 and 780 CMR - Section 105.3.1. #4. I hereby certify that the debris resulting from the proposed work/demolition to be conducted at Work Address Is to be disposed of oat the following location: \hf 1- I'- 0 u-b M ULA.. it-r'r> Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. 1/ 2n/Lo Sign ture of Applicati n Date Permit No. PAV CONSTRUCTION 11C. P.O BOX 983 SOUTH YARMOUTH,MA 02664 US (508)367-9733 I I PAY' pavcompanies@gmail.com carsrrnacra�+uc_ http://www.pavconstructionilc.com Estimate ADDRESS ESTIMATE# 1232 Mattehw O'Neill DATE 08/29/2019 EXPIRATION DATE 09/29/2019 ' ACTIVITY WE HEREBY SUBMIT ESTIMATES AND SPECIFICATIONS FOR FIRE DAMAGE RESTORATION. 'Strip entire roof,re frame damaged roof rafters and ceiling joists,install 1/2"APA structural use rated plywood. 'Install CertainTeed landmark architecture shingles. Vent to code. Frame work$14,000.00 Roofing$9,000.00 *Remove and dispose all existing windows,install all new Anderson windows 400 series sizes like for like. Install Azek exterior trim,install pine colonial trim on the interior. Total windows$11,500.00 *Remove and dispose existing slider,install new Andersen 400 series slider sam size as existing. Total slider$3,800.00 *Remove and dispose existing front door,install new thermatru all fiberglass door with vinyl jambs. Total door$2,000.00 'Install new storm door. $600.00 *Remove and dispose all existing siding on entire house. *Install red cedar clapboard on front of house,Instal white cedar shingles on two gables and rear of house. Total siding$13,200.00 ELECTRICAL *Re wiring on entire house,all new breakers,wiring,outlets and switches up to code. Total$17,000.00 *PLUMBING Rough in plumbing for bathroom,kitchen and laundry. New vent pipe up to code. Finish plumbing on Kitchen&bathroom. ACTIVITY Total plumbing$10,000.00 *Install 3/4 subfloors through entire house. $5,000.00 'Install fiberglass insulation on all exterior walls *Install fiberglass insulation on ceiling joists. Total$8.740.00 *Bathroom Install new shower base,install 1/2 go board in shower surround walls,install 1/4 inch backer board. Waterproof shower walls and floor. *Install tile on shower floor,main floor and shower walls. 'Install new light fixture,fan,towel bars etc. Total bathroom$15,000.00 *Install sheetrock on all walls and ceilings,finish sheetrock,apply one coat of primer. Total$18,500.00 *Install red oak pre-finished hardwood floor throughout entire house. Total$14,300.00 *Install new interior doors and closet doors. Total doors$2,950.00 *Install baseboard throughout entire house. $3000.00 *Install new kitchen cabinets Total installation$3,500.00 (Price does not include kitchen cabinets and appliances,estimated kitchen and appliances$20,000.00)TBD. *Painting Two coats of paint on all walls and ceilings,2 coats of paint on all trim,doors and windows. $8,800.00 PLEASE NOTE,PRICE INCLUDES MATERIALS,DISPOSAL FEE,PERMIT FEE,LABOR. PRICE DOES NOT INCLUDE KITCHEN CABINETS,GRANITE,APPLIANCES,FAUCETS. PAYMENT TERMS 1/3 AT DEPOSIT. 1/3 AFTER MATERIALS ARE ORDERED. 1/3 UPON COMPLETION. ANY WORK ABOVE AND BEYOND SPECIFICATION WILL BE PERFORMED AT 60$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 SUBJECTED TO EXTRA CHARGE. IN THE EVENT OF ROT REPAIR,ROOF REPAIR OR ANY RELATED WORK REQUIRING IMMEDIATE ATTENTION WE WILL PROCEED WITHOUT CUSTOMER APPROVAL. PAV CONSTRUCTION LLC WILL PROVIDE CLEANUP ON CONTINUING BASIS AND ALL DERBIES WILL BE REMOVED FROM SITE. ALL PRODUCTS INSTALLED BY PAV CONSTRUCTION LLC WILL BE TO MANUFACTURER SPECIFICATIONS.ALL WORK WILL BE PREFORMED BY INSURED PROFESSIONALS. • ACTIVITY THIS CONTRACT NOT VALID UNLESS SIGNED BY PAVLIN PESHEV ACCEPTED BY 411I14./✓/ SIGN (h I J DATE TOTAL $160,890.00 Accepted By itu�1 Q Accepted Date 0/ —j/ �- *� l! f I�I- AS,,„ '31 'I /- -. a. Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Constructio 1 &2 Family CSFA-106424 �� • ' spires:04/29/2023 PAVLIN PESfjEV Iti,Aft • " 84 LAKEFIELD R r =1�ter " . SOUTH YARI,UTM'u.k i ° r•0 /it'/I)/S 1:101‘'' Commissioner •� •` 0 _. ___________,_______________ __ Office of Consumer Atfai&Business Regulation HOME IMPROVEMENT CONTRATOR(r— E:LLC lrg'..A./,.,,,;c--,-.=.._:-.-:.17-..-,!-..:4,-ft-''7-.r,'..3,7--'.-."„---,..7-.3-.,...-- 1,:l.,1. 0 PAV CONSTRINa /; PAVLIN PESHE1 i (�,,_ ,__ r- £t4 LAKEFIELD RD\n f' /�L C '�_— i SOUTH YARMOUTH MA'02664 CJ Undersecretary A .,..---N d` CERTIFICATE OF LIABILITY INSURANCE DATE`MMIDomwY) 11/13/19 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 POUCIES 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 MIYIVT JIM HINDMAN Schlegel&Schlegel Ins Broker PHONEiii6i No,Est,; 508.771.8381 FAX Not: 505-771-0683 34 Main Street lakes; schlegelinsurance4gmall.com West Yarmouth,MA 02873 INSURERS)AFFORDING COVERAGE NAIC• INSURER A s NOM INSURANCE INSURED INSURER B: NOR GUARD INSURANCE PAV CONSTRUCTION LLC INSURER C: PO BOX 983 INSURER D SOUTH YARMOUTH,MA 02884 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS INDICATED IS TO�NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF AERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE NY CONTRACN ISSUED T OR OTHER DOCUMENT THE INSURED NAMED AWITH RESPECT TO WHICH E FOR THE POLICY 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 ..pp� LTR TYPE OF INSURANCE INS Nyyyp POUCY NUMBER (�,gal" LIMITS X COMMERCIAL GENERAL UAIILUTY EACH OCCURRENCE $ 1,000,000 DAMAGt:TO RENTED 500,000 I CLAIMS-MADE 1 OCCUR PREMISES(Ea ocGurrenee) f_ MED ESP(Any roe person) $ 10,000 MPP93339F 02/22/19 02/22/20 PERSONAL&ADV INJURY $ 1,000,000 A 2,000,000 GENERAL AGGREGATE f t3EN'L YEGafiE LIMIT APPLIES PER 2,000,000 LC3C PRODUCTS.�tsMPrbP AGG $ POLICY JEC�fi C $ OTHER COMBINED SIkGLE LIMIT $ AUTOMOBILE UABILITY IEa acudsmt BODILY INJURY(Per person) $ —ANY AUTO OWNED —SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PITPERTY � ERTY DAMAB $ AUTOS ONLY AUTOS ONLY 1Per ,l $ --- UMBRELLA LIAR OCCUR EACH OCCURRENCE $ "— _ EXCESS UAB CLAIMS-MADE AGGREGATE $ BED l IRETENTION f TI4- WORKERS COMPENSATION t L EhCHLTEER AND EMPLOYERS'LIABILITY Y I N ACCIDENT $ 100,000 ANY PRO/RIETOR/PARTNERDEXECUTIVE[J N I A PAWC980772 11/13/19 11/13/20 100,000 B (Mandatory EXCLUDED? N E L.DISEASE=EA EMPLOYEE Ii_ !Ma^ I^NH► 500,000 II yyae_deacnkie un9el -E L.DISEASE•POLICY LIMIT DEl3CRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORO 101,Additional Remarks Schedule,may be attached II mote spice le requited) CORPORATE OFFICERS HAVE EKLECTED TO BE COVERED UNDER THE WORKERS COMPENSATION POUCY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. permits AUTHORIZED REPRE TIVE I 0 9 2015 ACORD CORPORATION. All rights reserved. ACORD 25(2018/03) The ACORD name and logo are registered marks of ORO sat # /o 4 - Ex..5140„24- bt,_, I MT], i.____ rill ... . , . . . . ,...< . 7-0 ..„.,._ 12 ,: , I 1 r. --.: a.- . LA)fri ,' 3 V __... ,_. )C3 (C3 2' - t= .- r, •0•1! *N. • ' ,4 C.:: 6-.: ,,,„ ., .,1 0 ig I -n. 6 .',.:(,), --,:2: '...--, . i---) __,. C7. 1, '- :-4-- , 5 -1--! cn f .. 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