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HomeMy WebLinkAboutbld-23-003419 (2) ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department 1146 Route 28,South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 ± '•Il Massachusetts State Building Code,780 CMR Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling _ f ''\\ This Section For Official Use Only k E C EI V E D Building Permit Number: g(,V- .. 3T I I Date Applied: �22 Building Official(Print Name) i ature,---;:.,e. ii.k...6/4_ , \ E BUILDING DE-pDaiMEN' SECTION 1:SITE INFORMATION 0.--y — - • 1.1 PEOrrtadd essl , / r s p,t 1.2 Assessors Map&Parcel Numbers 1.1 a is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required I Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,Q 54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private❑ Zone: Outside Flood Zone? — Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP` ry� - 2.116,�ane 10 ord:r I(I�,l n . yQ/� �'0 t , ca(e(e 41 Name Print) j-, Ci ,State,ZIP �r i_ PiCkei1 l .s- r 21 q.113g bdlcviiii, e Cum-ccd,r1J No.and treet Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK"(check all that apply) New Construction Cl 1 Existing Building Owner-Occupied I Repairs(s) Alteration(s) 0 I Addition 0 Demolition 0 I Accessory Bldg. 0 Number of Units Other 0 Specify: r Brief Description of rop ed Work2 t-:� f5oi tt { �` lc `�j p { vArc,h/ n_cte7 SECTION 4:ESTIMATED CONSTRUCTION COSTS. • Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ ( s�10 1. Building Permit Fee:S 1 c 0 Indicate how fee is determined: 2.Electrical $ (Standard City/Town Application Fee 0 Total Project Costa Item 6)x multiplier . x 3.Plumbing $ 2. Other Fees: $ �� 1 �l 4.Mechanical (HVAC) $ List: J 5.Mechanical (Fire $ Suppression) Total All Fees:$ / 5 / A j Check No. Check Amount: _Cash Amount 6.Total Project Cost: $ j ❑Paid in Full Elil Outstanding Balance Due: 1\') SECTION 5: CONSTRUCTION SERVICES 5.1 Cons ct' n Supervisor License(CSL) I 1 / Jtt . jYinoNic t l� ll�p3 `3 so�7 License Number Expiration Date Name of SL Ho r W 4 V l ll� -t cak (?.QL- List CSL Type(see below) N .did jStreet r � CI,O / Type ( Description k���/lV D� {b U ( Unrestricted Buildings up to 35,000 cu.ft.) City/To ,State,ZIP R Restricted l&2 Family Dwelling 0 /0 M Masonry l ,wv r �jJ n'P.. l RC I Roofing Covering WS Window and Siding 4O1 • 6o Li b o SF Solid Fuel Burning Appliances I Insulation Telephone Email address i D ! Demolition 5.2 R gistered Home Improvement Contractor(HIC) f 11 C<q-C1 S•y' 9/3 HIC�r�p n e o gistrant Name HIC Registration Number Expiration Date VAPpG(pA. n Q/� /� III St mos h o erh, 1 '`W (/M ��I • g S3- i tp s, Email "'�•�� City/Town, State,ZIP Telephone t� 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 l No U . SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMITI,as Owner of the subject property,hereby authorize ..),Riff b 11 4 o l r S to act on my behalf,in all matters relative to work authorized by this building permit application. DO/Q1/I'V•A(--0-44 k.'IN' ! )/')6'i a Print Owner's 'ame(Electronic Signature) Date • SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this plication is true and accurate to the best of my knowledge and understanding. je.,./f, v' n no-YS Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: I. 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.zov/dns 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" §TOWN OF YARMOUTH 1146 Route 28, South Yarmouth, MA 02664 508-398-22311 ext.-1261 Fax 508-398-0836 Office of the Building Commissioner BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Ch. 40, §54 and 780 CMR- Section 105.3.1. #4. I hereby certify that the debris resulting from the proposed work/demolition to be conducted at ( 41- p!Ct c/S, Work Address j ppSeyous , Macrwl [lIs to be dis osed of oat the location: ct�jI IC P following Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. S. ture of Application Date Permit No. Page 1 of 11 CT Reg#0605216 MA Reg#146589 RI Reg#26463 HOME SOLUTIONS 26 Cedar St Woburn, MA 01801 800-242-9974 Federal ID #20-2625129 Luxury Contract Customer Information Dorothy Larkin (508) 398-9386 (Home)<br>(508) Date: 11/04/2022 88 Captain Nickerson Rd 776-8553 (Primary Mobile) Rep: Joshua Moss South Yarmouth MA 02664 bdlarkin@comcast.net Office#800-242-9974 Location Agreement NEWPRO hereby agrees that it will,for the consideration hereinafter mentioned, furnish all labor and material necessary to install the goods purchased by Owner in accordance with the terms described on the following pages of this agreement (collectively, this "Agreement") at the premises located at: 88 Captain Nickerson Rd South Yarmouth MA 02664 Custom Shower Details Package: Tub to Shower(Custom Acrylic/Spray Foam) Wall Color: White Size - Drain: 60"L x 30"W - Right Wall Style: Smooth Base Color: White Walls To Ceiling: Yes Threshold: Single Fixtures Align Valve&Trim ONLY QTY 1 Chrome Multi Function Hand Shower w/Slide Bar&Elbow QTY 1 Chrome Moen 5' Straight Shower Rod QTY 1 Chrome 18" Grab Bar QTY 2 Chrome Liquid Accents 24" Grab Bar QTY 1 Chrome Liquid Accents Accessories Single Tier Corner Shelf Smooth QTY 2 White This space intentionally left blank Page 2 of 11 LH Bench Shower Seat Textured Top w/Smooth Sides QTY 1 White Custom Panels Ceiling Panel(38" x 65" w/2" Bend) Smooth QTY 1 White Labor Remove Cast Iron or Steel Tub QTY 1 Tub will NOT be removed in one piece Wall Repair(As Needed) QTY 3 Installation & Promotion Details Newpro will remove any demoed or installation debris from the property in relation to this contract. All promotions were applied at the time of purchase and can not be combined with any future offers. Payment Total Price: $15,101 Deposit: $700 Due Upon Completion: $14,401 Payment Method: Finance Estimated Start&Completion Estimated Start: 14 to 16 weeks Estimated Completion: 2 to 5 days Customer understands they will be contacted to set a firm installation date once all product is received. State MA Year Home was Built 1970 LSWP NO This space intentionally left blank Page 3 of 11 Renovate Right Pamphlet Receipt Dorothy Larkin 88 Captain Nickerson Rd South Yarmouth MA 02664 Your family's health and safety is our top priority! I hereby acknowledge receipt of the pamphlet, "Renovate Right." This pamphlet informs me of the potential risk of lead hazard exposure from renovation activity to be performed in my home. I confirm that I have received this pamphlet before any work began on my home. QiF . Dorothy Larkin 11/04/2022 Date Residential Exemption Clearance Form ENVIRONMENTAL PROTECTION AGENCY RENOVATION, REPAIR, AND PAINTING RULE Dorothy Larkin 88 Captain Nickerson Rd South Yarmouth MA 02664 The type and scope of the planned remodeling project is described further herein. On behalf of Newpro, the undersigned individual hereby states that the following exemption from the Renovation, Repair, and Painting Rule is applicable to the planned remodeling project: Work Performed on Paint-Free Surface. To exempt the work area as paint-free, BOTH of the following must be completed: On behalf of Newpro, the undersigned individual has personally examined the specific areas upon which the remodeling work will be performed, as well as any adjacent or adjoining areas (interior and exterior)that are expected to be impacted by the remodeling work. Upon such examination the undersigned has determined that there is no painted surface that will be disturbed, damaged, or otherwise affected or impacted by the planned remodeling project; AND By initialing after this line, the undersigned states that to the best of his and/or her knowledge, the areas upon which the planned remodeling project will be performed do not appear to contain any painted surfaces that will be disturbed, damaged, or otherwise affected or impacted by the planned remodeling project. Customer Initials NEWPRO Representative: I certify under penalty of law that the above information is true and complete to the best of my knowledge as of the date first written above. Joshua Moss 11/04/2022 Date This space intentionally left blank Page 1 of 15 CREATE A 5 STAR EXPERIENCE FOR EVERY CUSTOMER ASK FOR A REVIEW" - e: HOME SOLUTIONS Luxury Work Order Customer Information Dorothy Larkin (508) 398-9386 (Home)<br>(508) Date: 11/04/2022 88 Captain Nickerson Rd 776-8553 (Primary Mobile) Rep: Joshua Moss South Yarmouth MA 02664 bdlarkin@comcast.net Rep#800-242-9974 Bathroom 1 Details None Package Includes Selected Base, 3 Walls, 1 Corner Trim, Floor Repair if needed Shower Measurements Package Tub to Shower(Custom Acrylic/Spray Foam) Wall Color White Size - Drain 60"L x 30"W - Right Wall Style Smooth Threshold Single Walls to Ceiling - Room Height Yes- 87 Base Color White Left Side Wall Width 60 Opening Length x Existing Base Width 60" x 30" Left Surround Width 32 Trim Skirt YES Right Side Wall Width 36 Right Surround Width 32 Fixtures Align Valve&Trim ONLY QTY 1 Chrome TRM-M-2191-C Multi Function Hand Shower w/Slide Bar&Elbow QTY 1 Chrome Moen MHS-3667EP-C 5' Straight Shower Rod QTY 1 Chrome SRS-60-C 18" Grab Bar QTY 2 Chrome Liquid Accents LAGB-18-C 24" Grab Bar QTY 1 Chrome Liquid Accents LAGB-24-C This space intentionally left blank Page 2 of 15 Accessories Single Tier Corner Shelf Smooth QTY 2 White CC-ST W LH Bench Shower Seat Textured Top w/Smooth Sides QTY 1 White LBS-LH-W Panels Ceiling Panel(38" x 65" w/2" Bend) Smooth QTY 1 White Labor Remove Cast Iron or Steel Tub QTY 1 Tub will NOT be removed in one piece Wall Repair(As Needed) QTY 3 Installation Instructions Left Wall Wall Repair- 18" Grab Bar - Bench Seat Back Wall Wall Repair-24" Grab Bar Right Wall Valve - Shower Fixture- Drop Ell - Wall Repair- 2 Corner Shelves - 18" Grab Bar Pre-install Checklist Variance Required NO Property Type Single Family Parking Options Large Driveway Fixture Install Handheld w/Drop Ell (No Shower Head) Curtain Rod or Glass Doors to be Installed Straight Curtain Rod Bath Location 1st Floor Existing Base Type Cast Iron /Steel Existing Walls Tile Is there access behind wet wall or below base? YES Below Base Ceiling Panel/Soffit YES Window Within Wet Area NO Wainscoting /Accessories NO Second Full Bath NO Additional Items to be Installed None Are there any existing problems with the plumbing? NO his space intentionally left blank Page 14 of 15 Image: 1.12 4. `.iL-Ea i ,.., , .-dar ty. ,.. „........-...,J, ----,; ; IF .� n w r Y. § ' - f" s r 'fC s - 3 4t ` r* y, s•, i -- �. "mk 4`y''* <. � ma " lle J ., J k' i € Y t . Via:.- ..y '`.n•SC b Page 15 of 15 Image: 1.13 a rt}s'': . x- a 4,,: ,1=°ale '' * ,Wx--.:- ,',� .h Y � ate- v €r'`' " € xr i 1� 5 , a� r , ;, . mI ' rp (. ' 4 r x k h �4 1 4"'sT .R w S. N: 1 , _:74:.,:::IX; '-'117;'?' , , k 2Ale ,f141k, - -; it , . Y4J 5 s, ,, l , mod„ Ra.- 2f , ive Ott _ _ - fare k j,z X • Office of ConsumerAffaiis and Business Regulation • 1000 IrVashingrori Sleet-Suite 710 Boston,Massachusetts 02118 Home Improvement Contractor Registration Types Supplement Card NEP/PRO OPERATING.LLC. Registration: 146599 Ex 26 CEDAR S T. Expiration: 0.5.11)4'D?' ht/OBURN,MA Otaot Update Addn~s and Reram Can. 3ece ofCoammarMinas E Posing Reputation HOME IMPROVEMENT CONTRACTOR Registration voila for individual use only T'PC Suoolrmont Card h afore the expiration date.If found return m: _Reoisrrarrnn 5oirahon (Wane or Consumer AT f.irs and BusSnc;:Rasutation 1400B9 U5/04/2023 -MOO Washington Sirnet-Suite770 1PP.0 OPT ATedo.LLC Boston,n7A 7 8 7,itri S'e C.ONNORS , /�1/�� tea..ST. ,..r z, - ss-�f G TURN.LiA OtBOt Undefsecreary /. Without signature 117 Commonwealth of Me, Division of Occupational ..;ure f Board of Building�``R�le,gulations and Standards •i. • Consttt[feCr'ain SWr;visor .F CS-110763 1.tpires:05/05/2024 t_ JEFFREY COJVNORS • 1' 64 OLD FlEL9 RD • '' SOUTH BERIfIJ/CK ME D3908 :r. r ip J / - 1 - 4 • Commissioner •�,!r, f. D•':to,za. : i•1 Page 1 of 1 ACORO� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) �� 11/23/2022 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). PRODUCER CONTACT John Beam Willis Towers Watson Northeast, Inc. NAME: c/o 26 Centur Blvd PHONE 1-877_945-7378FAX Y (NC.No.EMl: (A/C,No): 1-888-467-2378 P.O. Box 305191 E-MAIL ADDRESS: corn Nashville, TN 372305191 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: North Pointe Insurance Company 27740 INSURED INSURERS: Praetorian Insurance Company 37257 NewPro Operating LLC 26 Cedar Street INSURER C: Starr Indemnity & Liability Company 38318 Woburn, MA 01801 INSURER D: General Casualty Company of Wisconsin 24414 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:w2674230o 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE 1N5D WVD POLICY NUMBER (MMlpD/YYYIfl (MMlDD/YY1^n LIMITS X COMMERCIAL GENERAL LIABIUTY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED 1,000,000 PREMISES(Ea occurrence) $ A MED EXP(Any one person) $ 20,000 171000062 11/23/2022 11/23/2023 PERSONAL&ADVINJURY $ 2,000,000 GENII AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 POLICY f 1 PECOT- X LOC PRODUCTS-COMP/OP AGG $ 4,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 2,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED 161000714 11/23/2022 11/23/2023 BODILY INJURY(Peraccident) $ AUTOS ONLY _ AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ $ X UMBRELLA LIAB X OCCUR C EACH OCCURRENCE $ 5,000,000 EXCESSLIAB CLAIMS-MADE 1000579769221 11/23/2022 11/23/2023 AGGREGATE $ 5,000,000 DED RETENTIONS $ WORKERS COMPENSATION MUTE EMPLOYERS'LIABILITY YIN X I STATUTE ER D ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED? N/A 152000448 11/23/2022 11/23/2023 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 D Building CFE1386721 11/23/2022 11/23/2023 Blanket Limit $26,273,652 Business Personal Prop Blanket Limit $32,049,560 Business Income & Extra Blanket Limit $17,008,332 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE: HomeRenew Group Holdings, L.P. acquired NewPro Operating, LLC, NewPro Plumbing, LLC and they are now under HomeRenew Group Holdings, L.P. Insurance Program, effective 05/10/2022. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Evidence of Coverage ©1988-2016 ACORD CORPORATION. All rights reserved. Lrytutrnertt of inuustrtutncctuents 1 —;.t !+�_ ' Office of Investigations .41 EnvIll t Lafayette City Center 2 Avenue de Lafayette, Boston, MA 02111-1750 ' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/OrganizationAndividual): NEWPRO OPERATING LLC Address:26 CEDAR STREET City/State/Zip:WOBURN, MA 01801 Phone#:781 - 933 - 4100 Are you an employer? Check the appropriate box: Type of project(required): 1.0 I am a employer with 20 4. 0 I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7, emodeling ship and have no employees These sub-contractors have 8. Demolition working for me in any capacity. employees and have workers' 9. El Building addition [No workers' comp.insurance comp. insurance.t required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152, §1(4),and we have no 13.0 Other 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: GENERAL CASUALTY COMPANY OF WISCONSIN Policy#or Self-ins. Lic. #:152000448 Expiration Date: 11 - 23 - 2023 Job Site Address: 0 00-ipl lc b vsen` City/State/Zip: S Orhti'i1�1-Ott' C)CeGli 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 cent ' under h 'us and penalties of pointy that the information provided above is true and correct Signature: Date: Y V Phone#: 7 3 - 4100 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License # Issuing Authority(check one): 10Board of Health 20 Building Department 30City/Town Clerk 4.0 Electrical Inspector 50Plumbing Inspector 6.DOther Contact Person: Phone#: 3 " 1 `*'House to Garage requires Fire Fated Door that meetslocal and/or State Code Requirements ***See Photos on Next Page*** Page 18 of 19