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Home My WebLink AboutBld-20-004889 C `� ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department ov kt 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 RECEVVEP.,. This Section For Official Use Only Building Permit Number s)" di C `/ I Date App ' AR J , r',J 2: Building Official(Print Name) Signature SECTION 1:SITE INFORMATION. 1.1 Property Address: 1.2 Assessors ll*p&Parcel Nu bers r' I 6 WO 12 Lake Road, West Yarmouth �j 1.1a Is this an accepted street?yes no Map Number PakVi Number 1.3 Zoning Information: 1.4 Property Dimensions: 0.16 acres 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 l Private El Municipal_ Outside Flood Zone? Municipal❑ On site disposal system IZI Check if yes® SECTION 2• . PROPERTY O WNERSIii1P1 2.1 Owner'of Record: Alan Wenk Mashpee, MA 02649 Name(Print) City,State,ZIP 35 Santuit Pond Way#4D 203-214-8315 alanchris04Ayahoo.com No.and Street Telephone F.mnil Address SECTION 3: DESCRIPTION OF PROPOSED WQRw2(check all<`that apply) • New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) ❑ Alteration(s) l Addition 0 Demolition 0 Accessory Bldg.0 Number of Units Other ❑ Specify: Brief Description of Proposed Work2: Bath Remodel SECTION 4 :ESTIIVTATED: ON.STRUCTIQ.$COSTS. Estimated Costs: Item `':011 cial use Onl (Labor and Materials) ;;=1 Building Permit Fee:$ Indicate how fee is determined... 1.Building $ 11,865.00 � 2.Electrical $ Si Standard City/Town Application Pee others 'C]Total Project Cose.(Item 6)':x multiplier x 3.Plumbing $ others 2. OtherFees::$ 1 4.Mechanical (HVAC) $ Ltst 1 ' 5.Mechanical (Fire Suppression) $ Total All Fees $ Check No Check Amount: Cash Amount: 6.Total Project Cost: $ 11,865.00 6 Paid inFu11- ®Outstanding Balance Due:. 10 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 015649 06/09/2020 • Robert K Stello License Number Expiration Date Name of CSL Holder List CSL Type(see below) U 310 Commerce Park, P.O. Box 776 No.and Street Type Description South Chatham, MA 02659 U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1842 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering • WS Window and Siding SF Solid Fuel Bunting Appliances 508-432-2218 mcaplice@stelloconstruction.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) Stello Construction Enterprises, Inc. Robert K Stello 192090 06/07/2020 Company Name or HIC Registrant Name HIC Registration Number Expiration 192090 Date 310 Commerce Park,P.O.Box 776 mcaoliceesteI oconstruction.com No.and Street Email address South Chatham,MA 02659 508-432-2218 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 O 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 Stello Construction Enterprises, Inc. to act on my behalf,in all matters relative to work authorized by this building permit application. See Attached Print Owner's Name(Electronic Signature) • Date SECTION 7b:OWNER1 OR AUTHORIZED AGENT DECLARATION By i .:i g my name below,I hereby attest under the pains and penalties of perjury that all of the information co I • . in this p' do a and accurate to the best of my knowledge and understanding. k 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 tanned,provide the information below: Total floor area(sq.ft.) 2,305 (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) 1,585 Habitable room count 5 Number of fireplaces 1 Number of bedrooms 4 Number of bathrooms 3 Number of half/baths 1 Type of heating system gas Number of decks/porches. 1 Type of cooling system gas Enclosed 0 Open 1 3. "Total Project Square Footage"may be substituted for"Total Project Cost" The Commonwealth of Massachusetts _w-- Department of Industrial Accidents __ i.� Office of Investigations . 600 Washington Street Boston, MA 02111 .Y �—� � www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Stello Construction Enterprises, Inc. Address: P.O. Box 776 City/State/Zip: South Chatham, MA 02659 Phone #: 508-432-2218 Are you an employer? Check the appropriate box: Type of project(required): 1.111 I am a employer with 10 4. all I am a general contractor and I 6. []New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. $ 7. X Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. n We are a corporation and its officers have exercised their 10.1 I Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work right of exemption per MGL 11.7 Plumbing repairs or additions myself [No workers' comp. c. 152, §1(4), and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.0 Other 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Zurich American Policy#or Self-ins. Lic. #: 6ZZUB-921X274-4-02 Expiration Date: 09/01/2020 Job Site Address: 12 Lake Road City/State/Zip:West Yarmouth, MA Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cert y nder the p u i an nalties of perjury that the information provided above is true and correct. Signature: e • Date: —� Phone#: 508-432-2218 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"• 'Y441t 4 TOWN OF YARMOUTH o BUILDING DEPARTMENT o x•i , y 1146 Route 28,South Yarmouth,MA 02664 N%"• b wry? 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 12 Lake Road Work Address Is to be disposed of at the following location: S & J Exco, South Dennis, MA Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Cha r 111, Section 150A. 3 .3 Signature of Application Date Permit No. 0 &/te lG'orn man wealth op.'IL¢dd(Wluuet4 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:Corporation 1 Reel_ 2#�0fjofl Fmiration ! 192090 06/07/2020 STELLO CONSTRUCTION ENTERPRISES,INC _. ROBERT K STEL40 ""'� IT 310 COMMERCE PARK N SOUTH CHATHAM,MA 02659 Undersecretary Commonwealth of Massachusetts ®P Division of Professional Licensure • Board of Building Regulations and Standards ConstrUctiori'Supervisor ' CS-015649 Eitpires: 0610912020 ROBERT K STELLO .% `, , • PO BOX 776 +'` SOUTH CHATHAIVI MA 02659 ` .'is -,-• - 4•- -- • \ . Commissioner • Z. 7--- O ` '� is-- , - k , , . . , ,, J c Q F I: 0.-- r G le- cel, ; I t�l g-- L S. ,Y" , , t tic p t f::::.. ...... 4 P g 11 e G t c...,-- s— v , t, f F....R.. F „,, a P 7<., E F i--7__ PR- p::::::. D c: .,. .),_ ...., :,... (..., -32 :a- ,9 ''.0 a c,,i5„ ____., , ,_, __.,,, (........... % i.„-:_-, =, -._:, L, , f- 7 rn CO o _M r i �., z r - - f 'n1 71 O5 i= a �.J D r s -2 r; inalelm Cr, r� u c ter. r m MqR,04-2020 12:19 MARK T. VOKEY INS. AGENCY 5089459368 P.01 . ' 7 IS DATE(MM}ODM/YY) A�CORD CERTIFICATE OF LIABILITY INSURANCE a3104/2020 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 INSUKER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the tens 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 NAME: Craig Vokey _ CRAIG S VOKEY DBA MARK T VOKEY INSURANCE Aii°Nr o.eis}j5O8)945-3535 IFAX {A .No,: ,E1421.e4. oraig@vokeyinsurance.com P 0 BOX 1247 NSURER(S)AFFORDING COVERAGE RAE it WEST CHATHAMR _ MA 02669-1247 gamma: AMERICAN ZURICH INSURANCE COMPANY 40142 INSURED INSURER S: STELLO CONSTRUCTION ENTERPRISES INC INSURER C: INSURER D PO BOX 776 INSURER E: SOUTH CHATHAM MA 02659 INSURER F: COVERAGES CERTIFICATE NUMBER: 511909 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 OF INSURANCE APPL SUER POLICY OF POLICY EXP UNITS LIE , *ISO,Moro POLICY NUMBER �/MMroWYVYYI IMMIDO/YV YI - 1 COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ PREMISES(Ea oeearrre ) S —~ CLAIMS-MADE OCCUR �— MED EXP(Arty one person) S — N/A PERSONALS ADV INJURY 5 PER:GENtL AGGREGATE LIMIT APPLIES �OENERALAGGREGATE $ , POLICY u C LiLOC PRODUCTS-COMP/OPAGO $ _.__... OTHER: _ AUTOMOBILE LIABILITY acdN�EDS SINGLE LIMIT s —ANY AUTO BODILY INJURY(Per mew) $ AU OWNED AUTOS N/A N/A BODILY INJURY(Per accident} $ NON-OWNED PR 5PERfY DAMAGE $ HIRED AUTOS AUTOS _(Per accident? _� $ UMBRELLA UAB OCCUR EACH OCCURRENCE $— EXCESS UAE CLAIMS-MADE N/A AOOREOATE S DED RETENTIONS S WORKERS COMPENSATION X15TATU'I'E I I ER AND EMPLOYERS'LIABILITY ANYPROPRIETORIPARTNER/EXECUTivE Y!N E.L.EACH ACCIDENT S 1,000,000 A OFFICERIMEMSEREXaf_UCED? NIA N/A WA 6ZZUI3921X274419 09/01/2019 09/01/2020 (Mandatary In NH) ESL,DISEASE-EA EMPLOYEES 1.000,000 If ea, IPTI lbe under DESCRIPTION OF OPERATIONS Selow _ EL DISEASE•POLICY LIM17 S 1,000,000 • N/A ! _ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(AGM]roi,Additional Remarks Schedule,may be attached it more space Is mqulred) Workers'Compensation benefits will be paid to Massachusetts employees only,Pursuant to Endorsement WC 20 03 06 a,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.govfwd/workers-cOmpensationfinvestigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL. BE DELIVERED IN Town of Yarmouth Building Inspector ACCORDANCE yf(7H THE POLICY PROVISIONS. 1146 Main Street AUTHORI7.EPREPRESENTATNE South Yarmouth MA 02664 ` i 1 EL- I Daniel M.Crowey,CPCU,Vice President—Residual Market—WCRIBMA 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD MAR.-04-2020 12:20 MARK T. 'JOKEY INS. AGENCY 5089459368 P.02 A �� CERTIFICATE OF LIABILITY INSURANCE DATE/04►2 20Y) 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 pollcy(les)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(,). PRODUCER 508.945-3535 CO ACT Mark T.Vokey Insurance Agency PHONE 508.945-3535 FAX 508-945-9368 28 Village Lndg,P,O.Box 1247 (A/C-No.Et* (A/C,No): West Chatham,MA 02669-1247 oRESS: INSURER(SII AFFORDING COVEW10E NAt(e INSURER :Scottsdale Insurance Company „__ _ Nag�RE ,Iry--SURER B 1.110 n tr%4Ctfon Elnt.,Inc. — _ — K to a,President INSURERC • bOX 776 So,uth Chatham,MA 02659.0776 -INSURER D: INSURES INSURER P: COVERAGES 9gRT)FICATE NUMBER: REVISION NUMBER; _ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW NAVE 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, NUMB POLICY EFF POLICY EXP I TYPE OF INSURANCE ADM SUM POLICY NUMBER fMNNDDI CIYYY h LIMITS lira NM wue rl• D 1,OQQAOQ A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ (`�� DAMAC3E TO RENT6P 100,000 cLaM3-MADE Fin I OCCUR NCS0038115 09/01/2019 09l01/2020 PREMISESfFeOCCunRricp)_- $ NIEE EXP(Any one aeracn) 1,...._ Excluded REj?$QNAL$ADV INJURY $ ,_ — 1,000,000 l`EN'L AGGREGATE PLI$Q 1MIT APP ES PER' _GENERAL ACGR99ATE $ 2,000,000 POLICY n I LOC PRODUCTS•COMP/OP_A00_1 2,000,000 OTHER a4 . s AUTOMOBILE LIABILITY (Oalaaecci eOISINGLE LINK $ iAANY AUTO __ BODILY I JQRY(Pa"p acre) $A OS ONLY T SCHEDULEDUS pODILY INJURYTYD (Per eccid rill,L H�REp_ iititi tV PEQ WanrIIMAGE $.—„— AUTOSONLY AUTOS ONLY $ UMBRELLA LIAB OCCUR ,,EACH, OCCURRENCE —„-,$ EXCESS LIAR CLAIMS-MADE AGGREGATE $ GED RETENTION$ $ WORKERS COMPENSATION m PER [ OTH _ AND EMPLOYERS'LIABILITY .STATUTE ,_..-_��— .�. Y/N ANY PROPRIETORIPARTNERIEXECUTIVE H E.L.EA,QN ACCIDENT $ --,-- OfFICER,MEMBcR EXCLUDED? N IA )Mandatory in NM) E.L.DISEASE-EA EIRLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E L DISEASE•POLICY LIMIT w- DESCRIPTION OP OPERATIONS I LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Ia requlred) CERTIFICATE HOLDER CANCELLATION YARMOT2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Yarmouth Building Insp 1146 Main Street AUTHORIZED REPRESENTATIVE South Yarmouth,MA 02664 .— - 1°C° 42nu''" 1 . ACORD 26(2016/03) 01968-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD TOTAL P.02