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HomeMy WebLinkAboutBLD-23-004284 , la-c,t firi q---- 7S7SD R E C E I V- kr, TWO FAMILY ONLY- BUILDING PERMIT rJ Town of Yarmouth Building Department ort 'r AN 311013 1146 Route 28,South Yarmouth,MA 02664-4492 , 508-398-2231 ext. 1261 Fax 508-398-0836 ...:,�! 444ri ;�E BUILDING DEPARTMENT Massachusetts State Building Code,780 CMR By.- -- ---Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: 13 LC a 3 •0Ot4 . )'Date Applied: . ...:..:4-2 ye.......0, il‘ j/-2°. .0/3/23 Building Official(PrilftName) Signature Date SECTION 1:SITE INFORMATION • 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 23 Vermont Ave, West Yarmouth 16 17 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Residential Residential 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,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: — Outside Flood Zone? Municipal 0 On site disposal system B1' Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Peter Thompson Name(Print) City,State,ZIP Same No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 [ Repairs(s) 'Q( Alteration(s) 64/ Addition 0 Demolition ❑ Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: Replace existing decking and railings;Replace existing rubber roof and asphalt roof SECTION 4:ESTIMATED CONSTRUCTION COSTS. • Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $45,000.00 1. Building Permit Fee:S Indicate how fee is determined: 0 Standard City/Town Application Fee 2.Electrical $ 0 Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ /or— C L t.L(-��t / 4.Mechanical (HVAC) $ List: `�' 5.Mechanical (Fire $ . Suppression) Total All Fees:$ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $45,000.00 0 Paid in Full 0 Outstanding Balance Due: ' Ii. SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) MichaelCS-107347 9/9/23 Ferullo License Number Expiration Date Name of CSL Holder PO Box 549 List CSL Type(see below) U No.and Street Type Description Yarmouth Port, MA 02675 U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1342 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 508-$01-3532 ferulloremodeling@comcast.net I Insulation Telephone . Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) Michael Ferullo 171899 4/29/24 HIC Company Name or HIC Registrant Name HIC Registration Number Expiration Date PO Box 549 No.and Street ferulloremodeling a@comcast.net Yarmouth Port, MA 02675 508-801-3532 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 )2( No ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(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 application is true and a urate to the best of my knowledge and understanding. Michael Ferullo ./ 1 1/30/23 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/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" §TOWN OF YARMOUTH 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 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 43 Vermont Ave in West Yarmouth Work Address Is to be disposed of oat the following location: Town of Yarmouth Transfer Station Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. ". '+ 1 i4 1/30/23 Signature of Application Date Permit No. Owner Authorization Form Authorization must accompany application if the owner is not the applicant I, eTe,_ h1/O/Y2/�0.00 as owner of the property located at Authorize Michael Ferullo to file an application for a building permit. Authorization Michael Ferullo, Ferullo Remodeling Inc Name of Authorized Agent/Contractor Owner(s) — ignature S-7-022. Date _ The Commonwealth of Massachusetts Department of Industrial Accidents _;;el= - 1 Congress Street,Suite 100 ?T-{_ Boston,MA 02114-2017 www.mass.gov/dia \Yorkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual):Ferullo Remodeling Inc Address:PO Box 549 City/State/Zip:Yarmouth Port, MA 02675 Phone#:508-801-3532 Are you an employer?Cheek the appropriate box: Type of project(required): O I am a employer with 2 employees(full and/or part-time).* 7. New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ID Remodeling any capacity.[No workers'comp.insurance required.] 3.01 am a homeowner doing all work myself.[No workers'comp.insurance required.]+ 9. El Demolition 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will I 0 Building addition ensure that all contractors either have workers'compensation insurance or are sole MD Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.['Other 152,§1(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. 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:Star Insurance Company Policy#or Self-ins.Lic.#:WC0870985 Expiration Date:4/15/23 Job Site Address:23 Vermont Ave City/State/Zip: West 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 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'uunder he pai and penalties of perjury that the information provided above is true and correct. Signature: _- // Date: 1/30/23 Phone#:508-801-3532 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 Inspector 6.Other Contact Person: Phone#: P Commonwealth of Massachusetts f Division of Professional Licensure Board of Building Regulations and Standards Construatk At rrvisor CS-107347 , spires:09/09/2023 MICHAEL FERULLO 447 OLD CHATHAM RQ¢), SOUTH DENNIS MA 02660• r �\ �i}ltiti"•11����� . Commissioner da a i. bt& 'i: . THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE:Individual Office of Consumer Affairs and Business Regulation Registration Expiration 1000 Washington Street -Suite 710 171899 04/29/2024 Boston,MA 02118 MICHAEL FERULLO MICHAEL FERULLO YY2 REMINOLE DR ARMOUTH PORT,MA 02675 Undersecretary Not valid without signature • ACO® DATE(MM(DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 4/14/2022 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: AHT Insurance,A Baldwin Risk Partner PHONE FAX 458 South Ave (NC.No.Ext):800-648-4807 (A/C.No):781-447-7230 E4AAWhitman MA 02382 iESS: INSURER(S)AFFORDING COVERAGE NAIC 0 License*CA#0658748 INSURER A:Main Street America Assurance 29939 INSURED FERUREM-01 INSURERS:NGM Insurance Company 14788 Ferullo Remodeling, Inc.PO Box 549 INSURER C:Star Insurance Company 18023 Yarmouth Port MA 02675 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:752066350 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 INSR WVD POLICY NUMBER (MMIDD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY MPP6465G 4/15/2022 4/15/2023 EACH OCCURRENCE $1,000,000 DAMAGE TO CLAIMS-MADE X OCCUR PREMISES(EaENTED occurrence) $500,000 MED EXP(My one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY JEa LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ B AUTOMOBILE UABIUTY M1P6465G 4/15/2022 4/15/2023 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ C WORKERS COMPENSATION WC0870985 4/15/2022 4/15/2023 X STgTUTE ERH- AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500,000 OFFICER/MEMBEREXCLUDED? N N/A (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 DESCRIPTION OF OPERATIONS/LOCATIONS/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 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Ferullo Remodeling Inc PO Box 549Port Port MA 02675 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD THIS CERTIFICATE SUPERSEDES PREVIOUSLY ISSUED CERTIFICATE _ d i • • if • • a"Y st i 1