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= ° c�;. � 62�20Permit expires 180 days from
;+,s s w. P �� ;issue date
�._. r " ,: I-A c I N,E NT
EXP - - PERMIT APPLICATION
TOWN OF YARMOUTH
Yarmouth Building Department
1146 Route 28
South Yaiuuouth, MA 02664
(508) 398-2231 Ext. 1261
CONSTRUCTION ADDRESS: I if Con.-►�-y O e. Yo..�(,�.�t,;,�vt,v1- / M A 3.LC7 S
ASSESSOR'S INFORMATION: /
�qA Map: I S( 1 Parcel: I q n,
OWNER: Ck&-A tt_ M (t C°"t-7`j' a, le o1 NA O,2 75 Ce I'7 —30(o—'623t
NAME r r1 PRESENT ADIIRESS p a i y�_ TEL.� #
CONTRACTOR: N .1 C(a „, 0,is,A C w 17w�( (1'ry V2oac t c l2'C 6(6.TEL.
MA 0)31 9�4—J`13-°49.6
l Residential ❑Commercial R�5 Est.Cost of Construction$ L5V t c,%o,o`'
Home Improvement Contractor Lic.# C S" WI‘Er2-9 Construction Supervisor Lic.# ( t S 3 9 3
Workman's Compensation Insurance: (check one)
I am the homeowner ii I am the sole proprietor 0 I have Worker's Compensation Insurance
Insurance Company Name: FYSSOOCzJ..ePlicfc1S 1/lSi+,CL-y C-e Worker's Comp.Policy# WGC—SoU — $07'03�q-20 ct A
WORK TO BE PERFORMED
Tent Duration (Fire Retardant Certificate attached?) Wood Stove
Siding: #of Squares 1 r Replacement windows: # ( V Replacement doors: # LI
Roofing:fi #of Squares ( )Remove existing* (max.2 layers) Insulation
V Old Kings Highway/Historic Dist. ( t()Replacing like for like Pool fencing
*The debris will be disposed of at: te(,(✓.,01,`^ a... `1
Locati n of Facility
I declare under penalties of perjury that the state nts herein con ine 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 rev ion of icens d ecution under M.G. .Ch.268,Section 1.
Applicant's Signature: Date: 2— 3—)-c.r)-=>
Owners Signature(or achment) Date:Approved By: 4 Date: r✓/
Building Offici or d nee) EMAIL ADD
Zoning District:
Historical District: ❑ Yes E No Flood Plain Zone: E Yes E. No
Water Resource Protection District: Within 100 ft.of Wetlands:
❑ Yes ❑ No E Yes _ No
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite I00
Boston, MA 02114-2017
• '•,<•" www.mass.;o v/dia
'Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): TA„, C(oL,essy i9t64 CAC mey4L -
Address: 12. 0- ..e, c(rck
City/State/Zip: 6r ,...•,s�cr /1')P- 02-‘3) Phone #: '77(4 Sb3 OL-UA
Are you an employer?Check the appropriate box:
Type of project (required):
I.❑ I am a employer with employees(full and/or part-time).* 7. ❑ New construction
2.2 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
C doing y [No workers'comp. insurance required.]t
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.❑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.i
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:
Policy 4 or Self-ins. Lic. m: Expiration Date:
Job Site Address: City/State/Zip:
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 th s and pe i perjury that the information provided above is true and correct.
Signature: Date: 3—
Phone4: rfqt - C43 - 0414
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 4:
f
, o� YAR TOWN OF YARMOUTH
'�``. ».as 4.`' 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451RECEIVED
'�/��y
Telephone(508) 398-2231 Ext. 1292-Fax (508) 398-0836 N LJ
OLD KING'S HIGHWAY HISTORIC DISTRICT COMMITT E
AN302020
RECEIVED Ut U KyARmouTH
ING'S HIGHWAY
APPLICATION FOR AY
JAN 7 2020 CERTIFICATE OF EXEMPTION
Applic8Milittglmatte for the issuance of a Certificate of Exemption under Sections 6 and 7 of Chapter 470 of
Acts of Mtiiiiell, ffmthe proposed work as described below and on plans, drawings, or photographs
accompanying this application.
Type or print legibly:
Address of proposed work: I if Co .,A.)r r Or, �c,/i .)�. ��t4 Ai 4- a M p/L# 4 S( / 116l
Owner(s): CKc.,A'c. '�" AA006y 61 LCG.( 4- '7 Phone#: C(rl — 5Oc, - fsZ3 fr
All applications must be submitted by/owner or accompanied by(letter from owner approving submittal of application.
Mailing address: 1 . Cov,,,,cf /
Or. /'f`yw(w•e;,,_'Tt�p
, .,,(\- Pti f cL2 c 75' Year built: V `( '�"
Email: Cv,. C-Cc.d 117 I I S3 ( 50-' .tt , (..c' '• Preferred notification method: r?( Phone Email
Agent/Contractor: C InC AIi1^� fe�hc,�e�i,.1 Phone#: 7/7 1 --5 6 3--v`-i1--C
g l ( (r<,,.,sk - 0 26 3I Mailin Address: (� U► i:. t c'i<e t s �.
Email: C14.C,10,AA :4� fc.t4\cic tt; C,,,) yr�►cA,61, eferred notification method: Phone Email
Description of Proposed Work(Additional pages may be attached if necessary): { `� ,
��C c 1(�t {Z C•Lc,r c_.'l� c l._lcf 3 +C,e..l�>' si�iv.c.�, 1 ,Cc tnCC v.c
�Q 4100<5 i Ai-c- c o r 1 i\/_e- t,.>t'nn-ex C e Y01 '
047 w t.,n c1,--). c`v‘G ` i + U t '1 o r cl�ri��ny r�3
'FfcA\ MD:.. c, svJ ws 40 Mu C't ✓lay.�,c �v.,n7 ,....+,c, G vi iNn.y Tfu✓xf lJclac.,"
Signed(Owner or agent): ` Date: i--4 '9 `-2-02U
> Owner/contractor/agent is aware that a permit may be required from the Building Department.(Check other departments,also.)
> This certificate is good for one year from approval date or upon date of expiration of Building Permit,whichever date shall be later.
For Committee use only:
Date: I itkUt2,45 , /Approved Approved with changes Denied
Amount AC) Reason for denial:
Cash/CK#: lb7a JAN 31 2020
Rcvd by: e3rA/
YARMOUTH
OLD KIN '
-- ' ADate Signed: 1/5//la""a Signed: iJ' 6 J
i / APPLICATION#: 3 DO 7
vs.2017
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f ilgr ! ?� Classic-Craft Oak 36"x80" Single Door w 2 Sidelites ��,a.
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Configuration Options Hide
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APPROVED o
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T 17
JAN 3 1 2020 r --� 171
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YASMO!NTH �, 0 M
OLD KING'S HIGHWAY c r �v
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I_.. nII 0002 2 TW210410-2 (AA-AA) Bay Window Replacements
I-1 I---�- RO Size=5'11 7/8"W x 5'0 7/8"H Unit Size=5' 11 3/8"W x 5'0 7/8"H
I
I- ! 400 Series
`—'---
,. Composite Unit,White/Pre-finished White, High Performance Low-E4 Top/Bottom`High Performance Low-E4 Top/Bottom Glass, Finelight
J I
Grilles-Between-the-Glass Top/Bottom*Finelight Grilles-Between-the-Glass Top/Bottom, Mulling Location: Factory(Direct), Mull Type: Narrow Mull, Mull
Priority:Vertical
Insect Screen, White
Viewed from Exterior
Zone:Northern
Unit U-Factor SHGC ENERGY STAR®Certified
--- -----------------------------
1 0.30 0.28 No
2 0.30 0.28 No
j Quote#: 24110 Print Date: 12/17/2019 Page 1 Of 3
iQ Version: 19.2
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John Clohessy Dba
Chc building and remodeling
12 Oriole Cr;Brewster;Ma 02631
Csl#096829
Hic#195393
Contract and payment structure for Work at Charlie and Mary McCarthy front renovation.
This document is a contract for work proposed at the residence of Charlie and Mary McCarthy located
at 18 Conway dr, Yarmouthport,Ma 02675.Scope of work has been laid out in signed estimate that is
to accompany this signed contract.Scope of work to include replacement of 6 windows and 3 doors on
front/road facing elevations of street.Replacement of all clap board siding on front elevations of house
and siding of 4 front cheek walls.Trimming of all windows and replacement of any trim rot below soffit.
Painting of all associated trim work and re installation of 4 new customer provided electrical fixtures.
Contract includes removal and disposal of 1 existing drained and unwired hot tub;along with the
framing and filling in of existing opening.
Customer has a 3 day right of refusal effective as of the date contract is signed.
All work is to be conducted under the guides of Massachusetts state building codes.Contractor will
obtain all necessary permits to preform work.Work will be preformed in a timely and safe manor
commiserate with weather.Work is scheduled to begin in the end of march/beginning of April 2020.
All products to be used are laid out in above mentioned estimate.Any work not mentioned in signed
estimate will be the customers financial responsibility.Any unforeseen problems relating to estimate/
contract(i.e.rot;improper existing construction techniques)will be brought to homeowners attention
as soon as possible and handled on a time and material basis with customer consent.
Allwork is tc.,_..4:....,........................ ......._
to the best of contractors ability.
C..ntr"cter...iii werii with c..ctr. ' r -hrm s.zmrrny to f-r:iit,te re wiring of new doors and
windows.
All new windows and doors replaced will be insulated.
Contractor is responsible for removal of all demolition and debris and providing a temporary
restroom for workers.
Payment schedule for work of existing contract($49,136.02)as follows
Deposit$31,500.00
Second payment due upon complete installation of all windows and doors and exterior trim$8500
^f il :.1: ..
'___ ..
-r�.. _�' .r.__..... - _. .•.� »�i finish paint work
Any changes to this contract and scope of work requiring plans or additional permits,labor,sub
contractors,or expenses beyond the scope of this contract and estimate 1039 will done at owners
expense.Customer will be provided with work orders from contractor.
This contract shall insure the benefit of,and be binding upon,the parties hereto,and each of them,
and there perspective directors,officers,subsidiaries,affiliates,attorneys,agents,employees,
representatives,successors,heirs and assigns.
When the terms of the original contract along with all Change work orders have been completed;this
job will be complete and final payment will be due and payable that day.
Customers signature Date 'I" //6Z°
Contractors signature Date
F�� n iI 41-
Office of Consumer Affairs and Business Regulation
1000 Washington Street - Suite 710
Boston, Massachusetts 02118
Home Improvemea Contractor Registration
Type: Individual
JOHN CLOHESSY = ` Registration: 195393
D/B/A CHC BUILDING AND REMODELING : Expiration: 04/25/2021
12 ORIOLE CIRCLE
BREWSTER,MA 02631l
Update Address and Return Card.
SCA 1 L$ 20M-05/1717 2p 9� p
✓Z (Jib monevelLd o/.✓//I aJdacitede '
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
TY E;Individual before the expiration date. If found return to:
Reai l oiration Office of Consumer Affairs and Business Regulation
19,039 -7-2.1 04/25/2021 1000 Washington Street -Suite 710
JOHN CLOHE S =/ Boston,MA 02118
D/B/A CHC BUIL !I r•AIt�, MODELING
JOHN M.CLOHESSV _t
12 ORIOLE CIRCL � CG•� i
BREWSTER,MA 0261' Not valid without signature
Undersecretary