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HomeMy WebLinkAboutExp Bldg 79 499 Route 6A Approved•Y.q� 7 iOfiee Use Only /y�- / q /ct 'Permit# K- ld r Amount i l 4d_ �+wwt• V 1 �\ Permit expires 180 days from ll d �� i # issue date EXPRESS ]BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department FBUILDJNG V E 1146 Route 28 South Yarmouth, MA 02664 DEC021 (h508) 398-2231 Ex/t. 1261 CONSTRUCTION ADDRESS: J�� ,A t G!"��''lo} /fir �'i L �jRTMENT ASSESSOR'S INFORMATION: w � e� , Map: Parcel: R EC E ` "' OWNER: ��� r, �l ,, �;s 1j,,; ee4- 64 DEC 0.9 2021 NAME PRESENT ADDRESS TEL. # YANMuU ; r. CONTRACTOR: �/ �� n�� h�� 5 �G.�U1 r j �r� f z� i. Oi ©1(fPIG'S 1 IIGi 1�.AY �)"IuJ/ NAME MAILING ADDRESS TEL. # 7e6! esidential ❑CommercialEst. Cost of Construction $__ '!/ f SLi Home Improvement Contractor Lie. # 36S,3 1 cI J 6 S 1? Construction Supervisor Lie, # s Workman's Compensation Insurance: (check one) ❑ I am the homeowner © I am the sole proprietor vb I have Worker's Compensation Insurance Insurance Company Name: C- !�!Worker's Comp. Policy# S L) l' a WORK TO BE PERFORMED APPROVED Tent Duration (Fire Retardant Certificate attached?) W d SU 4C -1 D 20z Siding: # of Squares Replacement windows: # Replacement d`9ors: # Roofing: # of Squares L (U Remove existing* (max. 2 layers) Insulation Old Kings Highway/Historic Dist. Replacing like for like Pool fencing ' P l S /sl�l✓ /rZ i..��.J S �r.c e *The debris will be disposed of at: Y6,"il-J L� A Location of Facility 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 or revo ion of m license and for prosecution under M.G.L. Ch. 268, Section 1. Applicant's Signature: ���' ;Y _ Date: Owners Signature (or attachment) Date: Approved By: Date: Building Official (or designee) EMAIL ADDRESS: Zoning District: Historical District: C Yes =i No Flood Plain Zone: C Yes C No Water Resource Protection District: Within 100 ft, of Wetlands: -I Yes fl No ❑ Yes 0 No �xf 6 111 071 Sherman, Lisa From: RICHARD GEGENWARTH <r,gegenwarth@comcast.net> Sent: Thursday, December 9, 2021 3:14 PM To: Sherman, Lisa Subject: Re: 499 Route 6A - roof replacement ..................................................................................................................................................................................................................................................................................................................................................................................... Attention! This email originates outside of the organization. Do not open attachments or click links unless you are sure this email is from a known sender and you know the content is safe. Call the sender to verify if unsure. Otherwise delete this email. :........................................................................................................................................................................................................................................................................................................................................................... agree, it is a like for like (and black too) Richard On 12/09/2021 1:02 PM Sherman, Lisa <lsherman@yarmouth.ma.us> wrote: Hi Richard, Attached please find a request to replace the roof at 499 Route 6A. Like for like; black roof replaced with same. Please let me know if you have any questions. Thanks Richard, Lisa Lisa Sherman Office Administrator Old Kings Highway Committee/Yarmouth Historical Commission Town of Yarmouth 508-398-2231, ext. 1292 I APPROVED DEC 1 0 2021 YARMGJ-rH 0(e The Commonwealth of Massachusetts Department of lndustriulAceidents 7DEC CEIVIEE P I Congress Street, Suite 100 Boston, MA 02114-2017 0 9 2021 www mass.gov/dia iAR,vIOUTh l Workers' Compensation Insurance Affidavit: Builders/ContractorslElectricians U Khs G -S HIG_._HW_Y . Y TO BE FILED WITH THE PERMITTING AUTHORITY. Name (Business/Organization/Individual): Address: 5y f3ro j P City/State/Zip: f z` U Z(d y Phone #: s-11- �� d Are you an employer? Check the appropriate box: L[nl am a employer with % _employe -..s (full and/or part-time).' 2_❑I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself [No work=, comp. insurance required.] t 4.01 am a homeowner and wr11 be hiring contractors to conduct all work on my property. I will ensure that All contractors either have workers' compensation insurance or are sole proprietors with no employees. 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, uhsurance.t 6.❑We are a corporation and its off cern have exercised their right of exemption per MCL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required_] DEC Z 0 2021 i Type of project (required): 7. []New construction K-0 Remodeling 9. ❑ Demolition 10 ❑ BuiIding addition I I.❑Electrical repairs or additions 12. F1 Plumbing repairs or additions 13. [] Roof repairs I4. ❑Other 1 *Any appiicant 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 them 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 wormers' comp. policy number. I am an employer that is providing workers' Compensation insurance for IM employees. Below is thepolicy and job site information. Insurance Company Name:__ ,/- ./I% A Policy # or Self -ins. Lie. #: Expiration Date: > l `i Job Site Address: `1 6d, City/State/Zip: ,c,-­L&w3 GG LC ,7 r Attach a copy of the workers' compensation policy declaration page (showing the policy n ber 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 certip undo the pains and penalties of perjury that the information provided above is true and correct. Date: ! Z4 z/ Phone #: d S 7 G (I Z 2 1- Z Official use only. Do not write in this area, to be completed by city or town offcirrl City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2, Building Department 3. City/Town Clerk 6. Other Contact Person: 4. Electrical Inspector 5. Plumbing Inspector q _f Phone #: Home improvement contractor registration: i K.3uo,3 54 Lower Brook Rd So- Yarmouth MA 02664 Phone (508) 760 2702 timkeatin 6 hotmail.com Proposal for: Linda Dellinger .^— n- .a r Yarmouth Ma 02675 603 801 7500 We hearby submit and RECEOVED DEC 0 9 2021 YAiuvjvLi`j Strip roof shingles off left side of main house and lower back ro Install water and iceof shield on lower edges. valleys and chimneys Install new vent pipe flanges and 30 lb tar Paper on deckin Install new white 8 inch drip edge g Install Certainteed Landmark 30 Yr architectural shingles Install ridge vent on all Oeaks 11 debris and trash will be removed and disposed of properly MATE Quotation # Job name/ location: Same September 24, 2021 1 AP ROvir DEC Y 0 2021 Dr n u AT; qu oq ply items specified above are included in this proposal. limney flashing replacement is not included in this proposal fted wood repair is not included in this ro aerials guaranteed by manufacturers. Workmanshipl35.00 per hr � materials if needed guaranteed by Keating Construction for 10 years. Propose hereby to furnish materials and labor for the sum of: lior Citizens discount included $4, Sv0.00 payment due at start of job and remainder upon completion eptance of Proposal: �ptance of Proposal.�� Date of acreLance: 7x� p Date of acre t above prices, specifications and conditions aresatisfy P ance: story and are hprah,, acoRa CERTIFI GATE OF LIABILITY( INSURANCE DATE I1fM0DIYYYYi THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER TIfiS1 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 poiicy(,as) must have ADDITIONAL INSURED provislorrs or be endo►sad. 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 endomernent(s), iODUCER iChlegei S Schlegel Ins Broker NAE; JIM HINDMAN 4 Main Street 508-771-8381 Arc No : 508.777-0663 fest Yarmouth, MA 02673 AWRESS: sehlegelinsuraneeaom:li e -nm SURED TIMOTHY KEATING DBA KEATING CONSTRUCTION S4 LOWER BROOK RD SOUTH YARMOUTH, MA 02664 INSURER A: MOUNT VERNON INSURER B: CNA INSURER C; INSURER D: INSURER E: Cove RAGE ]VERAGES CERTIFICATE NUMBER: INSURER F REVIS ON THIS IS TO CERTIFY THAT THE POLICIES QF INSURANCE LISTED BELOW HAVE BEEN ]SSUED TO THE INSURED NAME ABOIV'E FOR NUMBER: POLICY PERIOD NDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS ERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCI! POLICIES- LfMITS SHOWN MAY HAVE�11EENEDEICED BY PAID CLAIMS. t TYPE OFtNSURANCE i PDLICYNUN9ER X COMMERCIAL GENERAL LIABILITY MNlbD M�jpDfYyyY LtAIITS I I EACrt OCCURRENCE S j CLAIMS -MADE OCCUR f -- ! I( I I GL 2548741 03120121 I MED EXP jAnoncL pmson $ -- 03/20/22 PERSONAL & ADV INJURY S 1, GEN'L AGGREGATE LIMIT APPLIES PER: POLICY FO- ❑ LDC I I GENERAL AGGREGATE f 2, OTHER. PRODUCTS - COMPIOP AGG S 2,, AUTOMOBILE LIABILITY $ COMBINED SINGLE LIMIT ANY AUTO Ea accident S OWNED SCHEDULED I BODILY INJURY (Per person) S AUTOS ONLY AUTOS HIRED NON -OWNED BODILY INJURY {Per accidertq S AUTOS ONLY AUTOS ONLY Oatt aenIDAMAGE s UMBRELLA LIAS OCCUR S EXCESS LFAS EACH OCCURRE SCE y CLAIMS -MADE AGGREGATE DED RETENTIONS WORKERS COMPENSATION i AND EMPLOYERS' LIABFUTY Y f N PEATUTE ANY PR0PRIET0RjPARTNERIEXECUT#VE P GRH- OFFICERiMEMBER EXCLUDED (Mandatory In NH) N I A B$59UBO224N37220 03/09121 E L EACH ACCIDENT S 1 03109/22 If yyees, describe under D£SCRIPTPDN OF OPERATIONS helaw E -L- DISEASE - EA EMPLOYE S ') E -L. DISEASE - POLICY LIMIT ; $ 'R)PTION OF OPERATIONS 1 LOCATIONS f VEHICLES (ACORD 101. Additional Remarks Schedule, may be attached if more spate in required) S OTHY KEATING HAS ELECTED TO BE COVERED UNDER HIS CURRENT WORKERS COMPENSATION POLIC QEC 0 9 90?.1 a nFICATE HOLDER Ce1rr I:l t erinu TOWN OF YARMOUTH BUILDING DEPARTMENT YARMOUTH MA 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WMTH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATkVE exQ 61i '04 --7y M ZD 25 (2016103) The ACORD Warne and logo are r (D1988.204#A RD CORPORATION. All rights reserved. g registered marks of ACOR eine \ 0 $M/00 }) g\ �m4 > _-- \� k� tom §/ Z-jm3 C) m o#«0(D �2� ƒk�� $�nmx x\o�a z 5' « maf 2 \ �- >®& ( A of \ 2f\ 7 2 �a R ECF.|VF-n )LEUD\// APPR�VFE DEC 102021 YKRP2� H ?y b(P & y 01C