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Bld-20-004747
ice Use Only ' —940 -ay ' ' �::c�" o,, _ 0 !�'► '.i Amount tA 41"47.14wm GC?; Permit expires 180 days from issue date EXPRESS BUILDING PERMIT APPLIC*Tget 1 'I E ID TOWN OF YARMOUTH r _....--- -m 1, Yarmouth Building Department s ,4 ' ��,?;; 1146 Route 28 ' South Yarmouth,MA 02664 i`G i N r =Pi‘R 1 MI:N I i (508) 398-2231 Ext. 1261 '� CONSTRUCTION ADDRESS: y�r--! 1 l C l C"} ` 'R `'" ` �,' tA 4k 1 v? I S- 1 6J ASSESSOR'S INFORMATION: Map: Parcel: /. ',OWNER: " t CL 4t , / , U C IA 1 V LS he�� WJ/ C'U' I� �s, NAME PRESENT ADDRESS Y TEL. # CONTRACTOR:;* X7�1S -)L vo-tr �J 15 •� :c_�1 V� S• ►�.wa �5c:� ,.- 292- t%2_ NAME MAILING ADDRESS TEL.# "Residential 0 Commercial Est.Cost of Construction$ I q 00 0 Home Improvement Contractor Lic.# t C1 cj b 0, Construction Supervisor Lic.# i t n J G 4 4 2_ Workman's Compensation Insurance: (check one) ❑ I am the homeowner ❑ I am the sole proprietor )(I have Worker's Compensation Insurance �7 Insurance Company Name:5.5OL 1 Cx*C 8,„„kr INS* Worker's Comp.Policy#uXL.';SCE-;>C i-e a( (-ZC Ilk WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares I 0 Replacement windows:# Replacement doors: # Roofing: #of Squares ( )Remove existing*(max.2 layers) Insulation I/ Old Kings Highway/Historic Dist. ( )Replacing like for like Pool fencing *The debris will be disposed of at: raj'64Q k ee--- at 51 e_, Location of Facili 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 'on of y license and for prosecution under M.G.L.Ch.268,Section 1. Applicant's Signature: Date: 2 . 45'. .02_ Owners Signature(or attachment) Date: Approved By: � Date: 27—i 2V Build' (o designee) ADDRESS: 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 . �-, =�I Department of Industrial Accidents i = "mil_ 1 Congress Street, Suite 100 Boston, MA 02114-2017 .�_ wwx.mass.gov/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):J7C`+LCk...tS Address: IS- v i CAI IAA City/State/Zip<, i2uk,..4-t 1 oN-, cacol Phone#: - 2 ? - LS6 2, Are you an employer?Check the appropriate box: Type of project(required): 1.7-I am a employer with 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.] 9. ❑Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 Building addition 4.0 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. 12.0 Plumbing repairs or additions 5.0 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.t 13. Roof repairs) �` y 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.2 Other 5i iL4 to I4 '�>JA� 152,§1(4),and we have no employees.[No workers'comp.insurance required.] ( 1 *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:- jC C.r Ake C° E"` Lei`lE 11,1/4, ter vtc e_ Policy#or Self-ins.Lie.#: U)CC.1 o0 Sb 2. 0 2. ( 7 c J 1 qA Expiration Date: - • L®2_0 Job Site Address:157 C i Ce e 11 ,C4• City/State/Zip:3A �v� N OX 5- 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. 1 do hereby certi egudfr the pains and penalties of perjury that the information provided above is true and correct Signature: Date: Z • 2.) . ZC ZC Phone#: 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): I.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: '!`-��1 BANDDPR-01 CREMIE • AC-ORE) DATE(MM/DD/YYYY) katim...-- CERTIFICATE OF LIABILITY INSURANCE 4/10/2019 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 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). CQN PRODUCER N ME:TACT — --- Rogers&Gray Insurance Agency,Inc. PHONE FAX 434 Rte 134 (NC,No,Ext):(800)553-1801 (A/c,No):(877)816-2.156 South Dennis,MA 02660 a DREss:mail rogerSgray.com INSURER(S)AFFORDING COVERAGE NAIC#__ INSURER A:Selective Insurance Company of South Carolina 19259 _ INSURED INSURER B:Associated Employers Insurance Company 11104 Cape Property Pros,LLC INSURER C: 15 Nautical Lane INSURER D: South Yarmouth,MA 02664 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 TYPE ADDL SUBR POLICY EFF POLICY EXP LIMITS OF INSURANCE INSD WVD POLICY NUMBER IMM/DD/YYYYI fM /Y M/DDYYY1 1'000'000 A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE r X OCCUR S2378076 4/5/2019 4/5/2020 DAMAGES(RENTED 500,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) ' $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 X POLICY J JE T LOC PRODUCTS-COMP/OP AGG $ 3,000,000 I OTHER: $ 1 COMBINED SINGLE LIMIT I AUTOMOBILE LUIBILITY III ICI (Ea accident) $ ANY AUTO I BODILY INJURY(Per person) '$ OWNED I SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS ',' 'I, I D NON WNED PfReraodideRAMAGE $ HR ( ) E T ONLY AUTOS ONLY AUTOS $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION X STATUTE ERH AND EMPLOYERS'LIABILITY WCC-500-5020217-2019A 4/5/2019 4/5/2020 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE YY N/A E.L.EACH ACCIDENT $ RFFICERIMEMBER EXCLUDED? 500,000 AAandatory In NH) E.L.DISEASE-EA EMPLOYEE1$ If yes,describe under EL DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below E.L.. I DESCRIPTION OF OPERATIONS/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 DELIVERED IN Cape Property Pros,LLC ACCORDANCE WITH THE POLICY PROVISIONS. 15 Nautical Lane South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE 7)_i Ze ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DocuSign Envelope ID:EDDCBB9C-66D9-4921-BBA7-120199B3AEB9 Cape Property Pros LLC Estimate 15 Nautical Ln Date Estimate# S. Yarmouth, Ma, 02664 2/15/2020 211 4 Name/Addres Michael Stucchi 157 Eileen St. Yarmouth Port,MA 02675 Account# Project Description Obtain permits with the town of Yarmouth Deliver Dumpster to Job site. Strip existing Siding/shingles from the two gable ends,back side of the house and the 2 small sections on the front of the house where meets clap board(cheeks) Remove and replace the rake boards on the two gable ends of the house with Azak boards Dispose of all debris install weather resistant barrier,Tyvek/Typar, to all sides where new shingles to be installed. Tape seems with special Weather res tape. Install new Shingles on the two gable ends,back side of house and front sections where removed. Shingles to be Double coated,prestained in Cape Cod Gray color,matching existing color as good as possible. Clean job site from all debris. Customer agrees to pay according to the following schedule: 25%is due immediately upon execution of this agreement in order to schedule a project date. 25%will be due 2 weeks prior project starting date in order to purchase needed materials and supples and deliver to job site. 25%towards mid project and last payment due immediately upon project completion. citt DocuSiyned by: A Sfigid B1 ECB909E42D456... Total Date Signed Customer Signature Phone# Fax# E-mail Web Site 508-292-1562 508-694-6671 Boris@CapePropertyPros.com www.CapePropertyPros.com rage i DocuSign Envelope ID:EDDCBB9C-66D9-4921-BBA7-120199B3AEB9 Cape Property Pros LLC Estimate 15 Nautical Ln Date Estimate# S. Yarmouth, Ma, 02664 2/15/2020 211 Name/Address Michael Stucchi 157 Eileen St. Yarmouth Port,MA 02675 Account# Project Description Total Date Signed Customer Signature Phone# Fax# E-mail Web Site 508-292-1562 508-694-6671 Boris@CapePropertyPros.com www.CapePropertyPros.com Page 2 DocuSign Envelope ID:EDDCBB9C-66D9-4921-BBA7-120199B3AEB9 • Cape Property Pros LLC Estimate 15 Nautical Ln Date Estimate# S. Yarmouth, Ma, 02664 2/15/2020 211 Name/Address Michael Stucchi 157 Eileen St. Yarmouth Port,MA 02675 Account# Project Description You May cancel this transaction,whitout any penalty or obligation,whithin three(3) Total $14,880.00 business days from the date originally signed.To cancel this transaction,you may fax or email a signed and dated copy of this cancellation notice or any other written notice to"Cape Porperty Pros LLC" Date Signed Perstompaigoature 2/23/2020 l(l Stualki 01CCG909E42D456... Phone# Fax# E-mail Web Site 508-292-1562 508-694-6671 Boris@CapePropertyPros.com www.CapePropertyPros.com rage Division of Professional Licensure �� (a�1.r2oserrreat�^z of✓v�aa�zaucvey Board of Building Regulations and Standards Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR', Constructionr 1 & 2 Family WE:LLC Expiration (.SPA-106442 E �ires: 08/24/2023 -_ 09/05/2021 21 BORCHO B J�VAN xis CAPE PROPE` 15 NAUTICAL!LN< t t ' S YARMOUTFNA t BORCHOJOVA • 10/1,p 1,10*" 15 NAUTICAL LN ��.//a-0004 SOUTH YARMOUTH,VA'12664 Undersecretary Commissioner iti"...,(4)1(44-0.- --- • • i" • • .::tit..Y? , TOWN OF YARMOUTHfi s 5f $� 1146 ROUTE 28 SOUTH YARM TH �OU MA 02664-4451 FEB 2 6 2020 Telephone (508) 398-2231 Ext. 1292—Fax(508) 398-0836 RECEI9V6KING'S HIGHWAY HISTORIC DISTRICT COMMITT; /ING s HIGHWAY APPLICATION FOR FEB 1 7 ?On CERTIFICATE OF EXEMPTION TOWN CLERK Appl llipf}.{isA wirrwitif�r the issuance of a Certificate of Exemption under Sections 6 and 7 of Chapter 470 of Acts of 1973, as amended, for the proposed work as described below and on plans, drawings, or photographs accompanying this application. Type or print legiblyj Address of proposed work: •S 7 , .(i 14 - Map/Lot# Owner(s): I-1 tC..L tiee, 5 ..)C.C- E Phone#: n — .? 412k. All applications must be submitted by owner or accompanied by letter from owner approving submittal of application. Mailing address: Year built: Email: Preferred notification method: Phone Email Agent/Contractor: L+ 0 Bo.---e_k3 TUOAO / Phone#: c te: _- 2 i 2"_ 1.- Mailing Address: Email: V2;S e i 0 fcKC... C�Prefe ed nbtification method:__C-7Phon Email Description of Proposed Work(Additional pages may be attached if necessary): '% ,.kit,i'kC--E '5 . 613 66i' . &A .-tLk _ .)--1,Nc. _ szt,- . \- K"-' , .-se -t i Ilk,- .)- 1,e_ E.1186 okAA u4syvk. Cic�.1-,5 c vZ 8Lid ` �`1 S- E c f lit) uj L.) M C .i. C> A y.lo, c.LA . Signed(Owner or agent): Date:02 ZOZ,O 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: a�(�•,� 0v Approved Approved with changes Denied Amount Reason for denial: CC��,�l APPRO E Cash/CK#: /�// Rcvd by: 4 l/ FED 2 7 2023 YAHMOU fH OLD KING'S HIGHWAY t Date Signed:2 2 7Aci� Signed: J APPLICATION#: uIQ L-76 J " V52017