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Home My WebLink AboutBLD-23-002658 C(d I t .6 — e'► t I1/CS L,-- . �r4 4 , II �2 e,v /ems.. R E C E_I V E D Once Use Only 'tiC ;Permit# l j gU a _ y; NOV 14 2022 ;Amount 5D—' Permit expires 180 days from : LD G C BUI P r Ts"22�s"" a issue date By: &v D -.23-M621,5i EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth,MA 02664 (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: 15 Olcl Cec1C7•-y- Lo r SOU . r ' Y r►ma U l r t "' 02�oC��ASSESSOR'S INFORMATION: Map: Parcel: C� u OWNER: 'Ili c l�''l Dates 1 J� 0 I� CI eC.J'G�-1( Lill - 5c - "1 -0 6� 1 NAME l (� + PRESENT ADDRESS n , TEL. # CONTRACTOR: v C% .\ P. lea S IGt' o (3 Davao 1a-(�lY 1�r 4 568-2-2-/- 6 k k 7 NAME MAILING RESS TEL.# Residential 0 Commercial ` �/ q C' Est.Cost of Construction$ I 0 cZ`ZL D. o C' Home Improvement Contractor Lic.# 1_,Rd\V 1A tic..) 1 b It3 Construction Supervisor Lic.# 0 >1S f Workman's Compensation Insurance: (check one) 0 I am the homeowner IC am the sole proprietor 0 I have Worker's Compensation Insurance Insurance Company Name: N/^ Worker's Comp.Policy# WORK TO BE PERFORMED Tent E Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of SquaresD�(Ly. (`c7 . Replacement windows:# Replacement doors: # � Roofing: #of Squares�f (❑ (�l )Remove existing*(max.2 layers) Insulation I WOld Kings Highway/Historic Dist. Replacing like for like Pool fencing I a-POavetc i)-J(j -Z2 *The debris will be disposed of at: bain ie 1 s CY I S VP . 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 revocation of m license and for prosecution under M.G.L.Ch.268,Section 1. /u Applicant's Signature: / � ;a441- Date: )/—/ / -2-Q LZ' Owners Signature(or attachment) ,,e,ttei 47 � Date: �G —/f/ d G�Approved By: Date: // .-7 Building Official(or design E AIL ADDRESS: �L Zoning District: Historical District: Yes No Flood Plain Zone: 7 Yes No Water Resource Protection District: Within 100 ft.of Wetlands: Yes No 1 Yes 12 No . The Commonwealth of Massachusetts 1. _ /, Department of Industrial Accidents 1 Congress Street, Suite 100 i= Boston, MA 02114-2017 7 1 • ` ,,.. www.mass.gov/dia \Yorkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Lezibly Name (Business/Organization/Individual): 6Nr(dX P. e j j• Address:13q �ccel AL, _. ( y�l-bn r`i1h . City/State/Zip: Hb11 '` Phone#: 5 d 2 I - LS 7 Are you an employer?Check the appropriate box: Type of project(required): I.❑I am a employer with employees(full and/or part-time).* 7. 0 New construction 2.121 am a sole proprietor or partnership and have no employees working for me in 8. a Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.01 am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10['Building addition 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 11.❑Electrical repairs or additions proprietors with no employees. 12.0Plumbing repairs or additions 5.0I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.1=Iwe are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§I(4),and we have no 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: 4 /� / ` Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: (5 «I C.e0.7,-{ LA 5. yulyvt C J`M ► 1Y1. City/State/Zip: C% 2. 6v(:9 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 under the pains and penalties of perjury that the information provided above is true and correct. Signature: �' d Date: /l -/c - 162 L- Phone#: .9 UJ-_2 Z/ - 6 J'i 2 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#: Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Individual Registration: 186988 FRANCIS CESTARO Expiration: 06/21/2023 2555 HERRING BROOK RD ' �:.F EASTHAM,MA 02642 I, _ - !i 14't T j Update Address and Return Card. SCA 1 0 20M-05/17 u atio Office of Consumer Affairs&Business Reg n Registration valid for individual use only HOME IMPROVEMENT CONTRACTOR TYPE:Individual before the expiration date. If found return to: Registration Expiration Consumer Affairs and Business Regulation 186988 06/21/2023 1000Office Washingtonof Street -Suite 710 Boston,MA 02118 FRANCIS CESTARO aC1/ gC ''t1 FRANCIS M.CESTARO / - 2555 HERRING BROOK RD Not valid w out signature EASTHAM,MA 02642 Undersecretary • 11/1422,2:28 PM Details Licensee Details Demographic Information Full Name: GERALD P CESTARO, SR Owner Name: License Address Information 'City: Charlton State: MA ipcode: 01507 Count : United States License Information License No: CS-088485 License Type: Construction Supervisor Profession: Building Licenses Date of Last Renewal: 5/3/2022 Issue Date: 5/9/2010 Expiration Date: 5/9/2024 License Status: Active Today's Date: 11/14/2022 Secondary License Type: Doing Business As: Status Change Reason: License Renewal Prerequisite Information No Prerequisite Information No Available Documents https://madpl.mylicense.comNerification/Detai ls.aspx?result=a8d 1003a-3250-4a89-a582-ed88f6f070b8 1/1 a a y* c ' a flj4v ' " , ,. , 114 3 I o. 1.: ' 01-13.:.117';',iii,,,,ii'-: • .:: • '''''':'--• . '',:'t ?,',- ,:..; :If' ,'''''',$,' ''''' ' ":- .w w - '. ma C F „g . -• ,.:.,."- , :•,'"'1,::- /ilk .. • 3 � k� ; .. - '-it r N- t ... Clarke, Kristin From: Sherman, Lisa Sent: Wednesday, November 16, 2022 9:07 AM To: Clarke, Kristin Cc: Sherman, Lisa Subject: 15 Old Cedar Lane Hi Kristin, I just spoke with Francis Cestaro about the white cedar shingle replacement at 15 Old Cedar Lane. Since it's a like for like replacement, it's OK with OKH. Please let me know if you have any questions. Thanks Kristin, Lisa Lisa Sherman Town of Yarmouth Administrator, Old King's Highway Historic District and Yarmouth Historical Commission 508-398-2231, ext. 1292 Isherman@yarmouth.ma.us 1