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HomeMy WebLinkAbout22-EB015 27 Essex Way ApprovedSherman, Lisa From: RICHARD GEGENWARTH <r.gegenwarth@comcast.net> Sent: Tuesday, February 15, 2022 2:25 PM To: Sherman, Lisa Subject: Re: 22-EB015 27 Essex Way 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. I approve this as a like for like. Richard On 02/15/2022 12:44 PM Sherman, Lisa <lsherman @ yarmouth.ma.us> wrote: JAPk----- ROVED Hi Richard, FEB I S X2022 YAR10OUTH [OLD KING'S HIGHWAY Like for like window replacement request for 27 Essex Way; please see attached. Please let me know if you need any additional information. Thanks Richard, Lisa Lisa Sherman Office Administrator Old Kings Highway Committee/Yarmouth Historical Commission Town of Yarmouth 508-398-2231, ext. 1292 Isherman@yarmouth.ma.us 1 DIs— „A ECEIVED FEB 15 2022 YAHMOUl ti i,n,nin i ,in, /'7P AOV FEB 1 4 2022 YARMOUTH EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Ext. 1261 Office Use Only Permit# Amount 6- 0, o c-) Permit expires 180 days from issue date CONSTRUCTION ADDRESS: C S ASSESSOR'S INFORMATION: C Map: Parcel: OWNER: J CA NAME PRESENT ADDRE TEL. # CONTRACTOR: Pa nic 31-{ - $s NAME MAILING ADDRESS TEL. # Residential O CommeercialQQ Est. Cost of Construction Home Improvement Contractor Lie. #__%(05 86 Construction Supervisor Lie. # _ do Workman's Compensation Insuranheck one) p 1 am the homeowner tU(.1 am the sole proprietor p 1 have Worker's Compensation Insurance Insurance Company Name: Worker's Comp. Policy# WORK TO BE PERFORMED Tent L Duration (hire Retardant Certificate attached?) Wood Stove Siding: # of Squares Replacement windows: # Roofing: # of Squares (❑) / t. /R�emoove existing* (max. 2 layers) Old Kings HighwaylHistoric DisDC7) Replacing like for like 'The debris will be disposed of at: ./ f J 6eco Location of Facility Replacement doors: # tnsulationll Pool fencing,-. I declare under penalties of perjury t 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 rev c ion my ease and for prosecution under M.G.L. Ch. 268, Section 1. Applicant's Signature: ` Date: Owners Signature (or attachment)__ j' --, _ Cl c 4 _Date: Approved By: Date: Building Official (or designee) EMAIL ADDRESS: Zoning District: Historical District: E Yes No Flood Plain Zone: Yes No Water Resource Protection District: Within 100 R. of Wetlands: Yes No Yes No �P-fl ot5 D. The Commonwealth ofMassacliusetts PROVED Department oflndustrialAccidents I Congress Street, Suite 100 t EB 14 2022 Boston, MA 02114-2017 A Y RMDUTH www.mass.gov/dia 11%60W ftthtPMkation Insurance Affidavit: Build ers/Contractors/Elec TO BE FILED WITH THE PERMITTING AUTHORITY. Name (Business/Organization/Individual): Address: P.C. I� 0 X -?q City/State/Zip:I - Are you an employer? Check the appropriate box: 7-S--- Are S RECEIVED FEB 15 2022 ARMOUTH *�r„c insfl'lui'n`l eP;rs.PHWAY Please Print Legibly Phone #: 7 7`/ --S 3 — ��_ l .F1I am a employer with employees (full and/or part-time).* 2'&m a sole proprietor or partnership and have no employees working for me in any. ccapacity. [No workers' comp, insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 4.01 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 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' camp. insurance.; 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c, 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 7. E] New construction 8ADlemodelina 9. ❑ Demolition 10 Building addition I I.QElectrical repairs or additions 12. ❑ Plumbing repairs or additions 13. ❑ Roof repairs 14. [Other *Any applicant that checks box 91 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 # or Self -ins. Lie. #: 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 er he 'ns and penalties of perjury that the information provided above is true and correct Si nature: Date: a �y a-0 Official use only. Do not write in this area, to be completed by city or town off ciaL City or Town: Permit[License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6. Other 15 �� --uContact Person: Phone #: FEB 14 2022 YARMOUTH Commonwealth of Massachusetts . Division of Professional Licensure Board of Building Regulations and Standards Consit�}+����lvisor CS -0131040 fJ f 0ires: 04/04/2022 PATRICK H JACOBS 28 WHITTIE"RIVE _ DENNIS MA t1T638 COMmissioner Office of Cons umer Affairs & Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE; Individual i Prat' iratl n ' 165888 05/14/2022 PATRICK JACOBS D/B/A P. JACOBS CUSTOM CARPENTRYAND ?` REMODELING � � - PATRICK JACOBS 28 WHITTER DR. DENNIS, MA 02698/✓r 41rlL-��cLTias' Undersecretar., ECEIVEO FEB 15 2022 YARMOU-fI-, From: Scott Ford scottford03@gmail.com Subject: Re: Estimate 647 from P. Jacobs Custom Carpentry & Remodeling, Scott Ford Date: February 11, 2022 at 9:28 AM To: patjacobs78@yahoo.com Hi Pat Please except this note is my authorization and confirmation that your company has been awarded the business per the attached quotation. Thank you again and have a great day Scott Ford On Wed, Feb 9, 2022 at 11:52 AM <q_gtjaGobs78@yahoo.com> wrote: Dear Scott Ford, The estimate you requested is attached. Please review it and feel free to contact us it you have any questions. We look forward to working with you. Sincerely, P. Jacobs Custom Carpentry & Remodeling JP ,V FEB 14 2022 YARMOUTH...,.,, ECE1VFn FEB 1 5 2022 i-F"VIVUi r, �_ 60s✓ A APPI C FEB 0o YAR OLD Kid' CD OD FEB 15 20 YARMOU . KING'S HI! v cc ro y ro O. 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