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Home My WebLink AboutBld-23-001776 C cu Lti-A— ► vat-3 6-3 5 1011i1Z 2 RECEIVED ONE & TWO FAMILY ONLY- BUILDING PERMIT -, . 3 Q 2022 Town of Yarmouth Building Department 1146 Route 28,South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 C< . A•TM E NT : ' Massachusetts State Building Code,780 CMR `` Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: (5t t) ._„50 _6A1171O Date Applied: Building Official(PrintDame) t nahire Date SECTION 1:SI INFORMATION 1.1 ProgyrtyA.,ddres I.2 Assessors Map&Parcel Numbers 1.1 a Is this an aLcepted 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,Q54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: Outside Flood Zone? — Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Qwner'of Record 7 r 3e // rG-v"P�t C e� �y�J rvNoe/f'rJ Name(Print) City,State,ZIP 3z Cq, /(//g-e 7)21-(?69135k No.and Stria Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK-(check all that apply) New Construction❑ I Existing Building 0 Owner-Occupied 0 I Repairs(s) ❑ Alteration(s) 0 I Addition 0 Demolition ❑ I Accessory Bldg. 0 Number of Units Other RI Specify: 02:;.6— Brief Description of�Proposed Work': , 9 d d 514, SECTION 4:ESTIMATED CONSTRUCTION COSTS. Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ r/, 1. Building Permit Fee:$ .50 _Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $ 3 ❑Total Project Cost (Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: C 3 53) 5.Mechanical (Fire $ . Suppression) Total All Fees:$ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ �� ❑Paid in Full 0 Outstanding Balance Due: 0 0 "tit j � hm 0 pU/'2 .i s ;-ssud SECTION 5: CONSTRUCTION SERVICES /� 5.1� tr ction upkf ervpor �License(CSL) ( 17i' ."/Qa License Number Expiration Date Name of CSL991der 1 i/l , 'e f/ . List CSL Type(see below) v 6 No.and Street ,� Type Description �f� -T�( ��— (a/ 2 U Unrestricted(Buildings up to 35,000 cu.ft.) City/Town,State,ZIP R Restricted l(k2 Family Dwelling M Masonry RC I Roofing Covering WS Window and Siding OG�✓ ffil SF Solid Fuel Burning Appliances /v UCJ/ /d _ I Insulation Telephone Emaii address D Demolition 5.� 7rvemitconactorile e I pro e V ZZ ` m ..6v7 HIC Registration Number Expiration bate Hroripany N,4eor 1-1Lc Registryil Nan5 f'f•e-4-) A-//"-- Ni 3 rz e.etc �l,Z 3,/ o5 Email address City/Town,State,Zip Telephone 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 ' No ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILD PERMIT I,as Owner of the subject . ..erty,hereby authorize .0 / r to act on my be.- .•. ers relative to work auth,j ed by this building pe ...lication. �� ® - Z z ze______ -t Owner's Name(Electronic Signature) Date r 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 contain d in this application is accurate to the best of my knowledge and understanding. Print er's or Authorized Agent Name lectronic Signature) Date NOTES: 1. 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.gov/dps 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" Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Individual JOHN DUDLEYRegistration: 157108 D/B/A UNITED HOME EXPERTS Expiration: 09/04/2023 60 PLEASANT ST STE 1 ASHLAND, MA 01721 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: Reaistratlpn f.A ration Office of Consumer Affairs and Business Regulation 157108 00/04/2023 1000 Washington Street -Suite 710 JOHN DUDLEY Boston, MA 02118 D/B/A UNITED HOME EXPERTS Z/7 JOHN C.DUDLEY 60 PLEASANT ST STE 1 Asi�taaaD� 01721 �"a'�``��__�'��- !gnats() Not valid without , Ignat 'Mass acAuse[ia, 4; } figAT )C:rsot Bruidea gPrEqeoQwts aderSa E[p►res: CS•393790 JoHAl C DUQLEY OW 10+20Z3 60 PLEASANT ST- SUITE 1 ASHLAND MA 01721 Ccmmtssioner Construcban Supervisor Unrestricted -Bui}dings of any use group which contain less than 3&00m cuibi:.feet(941 cubic meters)of enclosed space. Failure to possess a current edition of the Massactnusetts State Building Code is cause for revocation of this license. For information about this license Call(6171727 320D or visit www.niass,gov dpi A � � DATE(MMIDD/YYYI) R � CERTIFICATE OF LIABILITY INSURANCE 8-8-22 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 Mrac Larocque East Douglas Insurance Agency,Inc. PHONE FAX 306 Main Street (A/C.No.Extl: 508 476 2101 (A/C,No).508 476-1296 E-MAIL PO Box 1370 S: info@eastdouglasinsurance.com Douglas,MA 01516 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: COMMERCE INS CO 34754 INSURED United Home Experts,Inc INSURER B: NAUTILUS INSURANCE COMPANY 17370 60 Pleasant St. Ste 1 ASSOCIATED INDUSTRIES OF MA MUT INS 33758 Ashland,MA01721 INSURER C: INSURER D: 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 SUER POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MMIDD/YYYY) B ✓ COMMERCIAL GENERAL LIABILITY NN1397537 04/21/2022 04/21/2023 EACH OCCURRENCE $ 1,000,000 DD CLAIMS-MADE ✓ OCCUR PREMISES SES(Ea occurrence)AGE TO $ 100,000 MED EXP(My one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 ✓ POLICY JET LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY BDGTQN 04/15/2022 04/15/2023 COMacBciderINEDrt)SINGLE LIMIT $ 1,000,000 (Ea ANY AUTO BODILY INJURY(Per person) $ OWNED / SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY 1 V AUTOS / HIRED NON-OWNED PROPERTY DAMAGE $ V AUTOS ONLY ✓ AUTOS ONLY (Per accident) $ B ✓ UMBRELLA LIAB I OCCUR AN1259404 04/21/2022 04/21/2023 EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000 DED i RETENTION $ _ $ _ . - , c WORKERS COMPENSATION WCC5005010274012022A 08/15/2022 08/15/2023 PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if meta space is required) CERTIFICATE HOLDER CANCELLATION Town of Ashland 101 Main Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ashland,MA01721 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORED REPRESENTATIVE 4 I t ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 1 sir - -4 a , 4t IThe Commonwealth ofMassachusetts l Department of IndustrialAccidents 1 Congress Street,Suite 100 Boston,M4 02114-2017 .. www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Name (Business/Organization/Individual).UNlTED HOME EXPERTS Please Print Legibly Address:60 PLEASANT ST City/State/Zip: SHLAND,MA ,01721 Phone #:5088818555 Are you an employer? heck the appropriate box: 1.❑✓ I am aemployer ith 9 Type of project(required): employees(full and/or part-time).* 7. 2.0 I am a sole propri tor or partnership and have no employees working for me in ❑New construction any capacity.[No orkers'comp.insurance required.] b• D Remodeling 3.EI I am a homeowne doing all work myself. [No workers'comp.insurance required.]t 9. ❑Demolition 4.❑I am a homeowne and will be hiring contractors to conduct all work on my property. I will are sole10 Q Building addition ensure that all con actors either have workers'compensation insurance or proprietors with n employees. 11.0 Electrical repairs or additions 5.0 I am a general con ctor and I have hired the sub-contractors listed on the attached sheet. 12. Plumbing repairs or additions These sub-contrac ors have employees and have workers'comp.insurance.' 13. Roof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14•Qbther 152,§1(4),and wehave no employees.[No workers'comp.insurance required.] *My applicant that check,box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submi this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check thi-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-con.actors 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 I\ame:A I M Policy#or Self-ins.Lic.#:WCC5005010274202EA Expiration Date:08/15/202 j Job Site Address: Ca. Po ectc Attach a copy of the workers'comp nsation policydecl City/State/Zip: _0 _ aration 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 cavil penalties i;.th-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 andpenalti ofperjury that the information provided above is true and correct. Si ature: \ 6\\ Phone#:5088818555 Date: f, Z �,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): I.Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Ins ector 6.Other P Contact Person: Phone#: §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 j?i ‹rzci 1 g�Pcf r5e /2�Address Is to be disposed of oat the following location: 6 '2 apo eK, evf Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. el ?2. 2Z Signa re of Application Date Permit No. • a Bid Date: _,__ United NOOM experts Fall Workers Compensation Corers I Se CONTRACT PRICE Job Name Gene.South Yarmouth 51.000.000-Liability Ins Coverage 14000 Owner: Evens Gene &United Painting Co..Inc- 1Mustrt leading Warranties JOB PREFIX* Company: 60 Pleasant St.Suite 1 Flexible Payment Plans mailable A092122P06 Street Address: 32 Captain Bearse Road Ashland.MA 01'21 Family Owned and Operated City,St.Zip: South Yarmouth.MA.02663 508-881-8555 FAX 508-881-5584 .ter H/C License a 15'105 Phone 8: 774-268-1354 w ww.UnitedHomeExperts.com MA Cons.Supervisors License E-mail: RI REG 0 22948 RRP Deense GNAT-_8008-1 Fed ID a 04-35415_I i Quantity Nr esi.tiug asphalt shingle,and Install new asphalt shingle..uuderlayntent.flashing. 20.25 .loci pi apes sentilation:On ens C°ruing system. Roofing Brand if apphcablet: oxen,C oraing.Architectural Brand i if applicable Brood I if applicable• Brand i if applicable): Total Cost of Labor and\Ialrl ial': 9,I00 A nonrefundable deposit of 1 3 of ALL ACCEPTED PROJECTS is due upon roatrart authorization with 1 J of EACH PROJECT due upon half of completion of EAC H PROJECT.and the balance of EACH PROJECT due upon completion of EACH PROJECT along ugh an,additional work requested by customer. PAYMENT TERMS: LIENS DISCLOSURE: State law requires us to inform the property owner of contract liens.A lien or security interest has NOT been placed on the residence.Any contractor.supplier.or subcontractor may lieu the real property if the property owner or the general contractor fail to pay for goods or services delivered or installed at the work location, Some contractors and suppliers automatically send letters of notification similar to this notice.At the owner's request.we will provide original lien release documents from anyone who provides said materials or service. NOTICE OF CANCELLATION: The property owner may cancel this transaction at any tune prior to nudmght of the third business day after the date of the contract without any penalty or obligation and has been notified in writing of such. NOTICE: All home improvement contractors and subcontractors shall be registered and that any inquiries about a contractor or subcontractor relating to a registration should be directed to:Consumer Information Hotline-Office of Consumer Affairs and Business Regulation-10 Park Plaza.Room 5170.Boston.MA 02116-617-9'3-8'87. 888 283-3757 or visit the OCABR websiteat hhrp:wwvw.mass.gov ocabr PER'IJT: A building pemut is required for work being done on the property listed above.The owner has authorized United Home Experts to obtain such permits as the owner's agent for any work requiring a permit Owners who secure their own construction-related permits or deal with unregistered contractors shall be excluded from access to the Guarantee Fund. SCHEDULE: The following schedule will be adhered to unless circumstances beyond the contractor's control arise. Proposed Work Start Date: Oct 19.2022 Proposed Completion Date: Dec 20.2022 41111 X Contractor Sig ranee: 4. G ' 2 Contractor Signature Date BBB X Customer Signature. Authorized Agent t 1