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HomeMy WebLinkAboutBLD-23-002351 Office Use Only °rx Permit# /9'9' o - y Amount 5,0, -ft.gto � Permit expires 180 days from .:•.::' issue date 8&D— c23 — aoa.35/ EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department R E C F g V E 0 1146 Route 28 South Yarmouth, MA 02664 OCT 3 1 2022 (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: 53 Lake Road West Yarmouth, MA 02673 BWLDINC e- ASSESSOR'S INFORMATION: Map: Parcel: OWNER: Patricia Brophy 53 Lake Road West, Yarmouth, MA 02673 508-577-6742 NAME PRESENT ADDRESS TEL. # CONTRACTOR: Brian Waterman 238 Center Street, Middleboro, MA 02346 508-317-8010 NAME MAILING ADDRESS TEL.# XResidential 0 Commercial Est.Cost of Construction$ 15,098.00 Home Improvement Contractor Lie.# 176476 Construction Supervisor Lic.# CS-107681 Workman's Compensation Insurance: (check one) 0 I am the homeowner 0 I am the sole proprietor XI have Worker's Compensation Insurance Insurance Company Name: Hannon-Murphy Insurance Associates Worker's Comp.Policy# 6S60UB1 K28063322 WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares 14 (®)Remove existing*(max.2 layers) Insulation n 1 1 Old Kings Highway/Historic Dist. Replacing like for like Pool fencing I I *The debris will be disposed of at: New Bedford Waste, 48 Cranberry Hwy, Rochester, MA 02576 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 revocation of my license and for prosecution under M.G.L.Ch.268,Section 1. Applicant's Signature: 944Clfli Date: 10/20/2022 Owners Signature(or attachment) See signed estimate Date: Approved By: Date: _ Building Official(or d ee EMAIL ADDRESS: Zoning District: Historical District: .1 Yes No Flood Plain Zone: ❑ Yes No Water Resource Protection District: Within 100 ft.of Wetlands: Yes l No ❑ Yes No The Commonwealth of Massachusetts 11101. ,"" Department of Industrial Accidents ammo Office of Investigations 600 Washington Street • Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Brian Waterman, Waterman Building and Remodeling Address:238 Center St City/State/Zip: Middleboro, MA 02346 Phone#: 508-317-8010 Are you an employer?Check the appropriate box: Type of project(required): 1.21 I am a employer with 6 4. ❑ 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. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' comp.insurance. 9. El Building addition [No workers' comp.insurance required.] 5. ❑ 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.❑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 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. tContractors 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'camp.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: Hannon-Murphy Insurance Associates Policy#or Self-ins.Lic.#:6S60UB1K28063322 Expiration Date:04/08/2023 Job Site Address: 53 Lake Road West City/State/Zip: Yarmouth, MA 02673 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 certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: '7' 642. 4-111.241- Date: 10/20/2022 Phone#: 508-317-8010 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#: 10/15/2022 Waterman Building&Remodeling LLC Claim Information Waterman Building&Remodeling Waterman P.O.Box511 Middleboro,MA 02346 Building&Remodeling Phone:508-317-8010 Company Representative Andy Cannon Phone:(774)992-3201 andy@watemianbuilders.com • Patricia Brophy Job:Patricia Brophy 53 Lake Road West Yarmouth, MA 02673 (508)577-6742 Asphalt Roofing Section *Acquire Building Permit(All work will be done by Massachusetts code and guidelines). *Remove all roof shingles and underlayment(One layer included.Additional layers will be an extra cost of$70.00 per sq.per layer.)(14 Sq.). *Dispose of all waste from job(All disposal fees included). *Clean out all gutters and downspouts. *Magnetize all grounds around building and driveway. *Clean up job site area of all roofing debris. *All new 8"aluminum drip edge at eaves and rakes. *Install 6'(Owens Coming Weather Lock G)ice and water shield at eaves and 3'in valleys. *Install 2'of ice and water shield around all roof penetrations. *(Owens Corning Pro Armor)Synthetic roof underlayment on all other roof areas. *New pipe flange on waste stack vents. *Install(Owens Coming Ridge Cat ridge vent)where applicable. *All new(Owens Corning Pro Edge)hip and ridge caps(90 LF). *Install(Owens Corning Starter Strip Plus)along eaves and rakes. *Install new Owens Corning Duration Series Shingle.6 nails per shingle with 130 mph wind rating. *New roof will include Owens Corning System Protection Roofing Limited Warranty(limited lifetime warranty). *All workmanship will have 25 year guarantee by Waterman Building and Remodeling. *Install all new lead flashing around chimney. *Install cricket on backside of chimney. *Remove old hot water vent. *Remove existing gutters.(dispose) *Install all new 5"aluminum seamless gutters and downspouts back to designated areas. *Install all new 5"stainless mesh leaf guards. *Remove existing rake boards on left gable wall only. *Install all new PVC rake boards back to designated areas. *Two sheets of plywood will be included with new roof installation.Any sheets in need of replacement above the listed amount will be an extra cost of$100.00 per 1/2"$120.00 per 5/8"installed.1"x8"x16'boards will be$75.00 per board.ALL LUMBER PRICING IS SUBJECT TO CHANGE DUE TO MARKET PRICING. With payments made as follows:$200.00 Deposit(DEPOSIT IS NON REFUNDABLE ADMINISTRATIVE FEE)with remainder of bill on completion • of work.Credit card payments will be an extra charge of 2.5%.Should Client default in any of the payment obligations contained herein,Client shall be responsible to pay all costs and expenses,including reasonable attorney's fees,which may arise or accrue in order to enforce this Agreement,whether pursued by filing suit or otherwise,and whether such costs and expenses are incurred with or without suit,or before or after judgment,including all appeals. Estimate valid for 30 days. $15,398.00 Sub Total' $15,398.00 Discount:Repeat Customer ($300.00) TOTAL $15,©98.00 b! A 41, Cannon 10/15/2022 Compan thorized Signature• ig Date ■-', a 10/15/2022 Customer Signature Date Customer Signature Date Commonwealth of Massachusetts fr A Division of Occupational Licensure Board of Building Regulations and Standards tobi,*41 .0„,voe Cons Ion rvisor CS-107681 spires: 04/28/2024 BRIAN WATEPtMAN 238 CENTERASTREET PO BOX 611 DIM DLEBOR0***:MA 02346 Att, e /A" Commissioner rif A A' " Office of Consumer Affairs and BUSiness Re—gUlation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Individual Registration: 176473 BIRIAN WATERMAN Expiration: 08/25/2023 D/B/A WATERMAN BUILDING AND REMODELING 299 MEADOW ST. CARVER,MA 02330 Update Address and Return Card. Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Individual before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 176473 08/25/2023 1000 Washington Street -Suite 710 BRIAN WATERMAP( Boston,MA 02118 D/B/A WATERMAN FILM DING AND REMODELING BRIAN WATERMAN ,/ 299 MEADOW ST. CARVER,MA 02330 Undersecretary Not valid without signature ACORE1 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDM'YY) 07/12/2022 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 NAME: Steven Murphy HANNON-MURPHY INSURANCE ASSOCIATES INC (A/C,No,Ext): (781)293-5500 FAX, No): E-MAIL h steve annon- ADDRESS: C ryan.com P 0 BOX 457 INSURER(S)AFFORDING COVERAGE NAIC# PEMBROKE MA 02359 INSURERA: HARTFORD UNDERWRITERS INS CO 30104 INSURED INSURER B: WATERMAN BUILDING & REMODELING LLC INSURER C: INSURER D: PO BOX 511 INSURER E: MIDDLEBORO MA 02346 INSURER F: COVERAGES CERTIFICATE NUMBER: 793677 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 INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DDIYYYY) (MMIDD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS N/A BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY _(Per accident1 $ UMBRELLA LIAB OCCUR EACH OCCURRENCE S _ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ _ WORKERS COMPENSATION X STATUTE ETH AND EMPLOYERS LIABILITY A OFFIC R ANYPROPRIETOR/PARTNER/EXECUTIVE M MBEREXCLUDED NIA N/A N/A 6S6OUB1 K28063322 04/08/2022 04/08/2023 E.L.EACH ACCIDENT $ 500,000 (Mandatory in NH) E L DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only. Pursuant to Endorsement WC 20 03 06 B,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.gov/Iwd/workers-compensation/investigations/. 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 ACCORDANCE WITH THE POLICY PROVISIONS. 1146 Route 28 AUTHORIZED REPRESENTATIVE South Yarmouth MA 02664 Daniel M.Cro4y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD WATEBUI-01 SMURPHY AC'O1?L7 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) �►.•--r' 7/12/2022 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 NAME: Hannon-Murphy Insurance Associates Inc I PHONE FAX PO Box 457 (A/C,No,Eat):(781)293-5500 (A/c,No):(781)293-7943 Pembroke;MA 02359 E-MAILDSS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Atlantic Casualty INSURED INSURER B:MAPFRE Citation 40274 Waterman Building and INSURER C:Nautilus Ins Co. Remodeling LLC 238 Center St Po Box 511 INSURER D: Middleboro,MA 02346 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 OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MM/DDIYYYY) (MMIDDIYYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE r X1 OCCUR M261001624-0 1/22/2022 1/22/2023 DANIAGETORENTED 100,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY (Ea accideat COMBINED SINGLE LIMIT 1,000,000 ANY AUTO BBXQ60 6/22/2022 6/22/2023 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY X AUTOS BODILY INJURY(Per accident) $ X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ $ C UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 X EXCESS LIAB CLAIMS-MADE AN1253818 1/22/2022 1/22/2023 AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY PER ERH YIN ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) i— E.L.DISEASE-EA EMPLOYEE,S If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I 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 Town of Yarmouth THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Route South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE )4, _ I ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD