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HomeMy WebLinkAboutBLD-23-002035 Oi..yRR r cy I(/ ,Q I_ Office Use Only �'� C ii I �� �� I Permit# C�iT'r 3 30 / OU. . ' .....3 I 'Amount 6. v . MATTACII CS[J 4^4...„„`S'E Permit expires 180 days from issue date I31/D—a3-60203.5 EXPRESS BUILDING PERMIT APPLICATI 0 TOWN OF YARMOUTH I R E C E R E D Yarmouth Building Department ! 1146 Route 28 [. OCT 17 2022 7 South Yarmouth, MA 02664 (508) 398-2231 Ext. 1261 BUILDING DEPARTMENT / By: __ G CONSTRUCTION ADDRESS: 4 oo)C/ylor e%ef n C `� ASSESSOR'S INFORMATION: Map: Parcel: OWNER: 6 (i�/t� Ih2,v' n S /i7 lGr�v/-�-o �6 Qq/`i �f0— S 2/3 N l/ !� PRESENT ADDRESS / TE . # CONTRACTOR: ���1 y ►) 0 t0V 7 z 4n c%or�h �- ,111 Od63 j ((-b��4$s-!,/OG NAi Y lJ MAILING ADDRESS TEL.# d Residential ❑Commercial Est.Cost of Construction$ 4JO�� — Home Improvement Contractor Lie.# 1 g)4?9 Construction Supervisor Lic.# /" t 006 Workman's Compensation Insurance: (check one) � � ❑ I am the homeowner 0 I am thesole proprietor EI'I have Worker's Compensation Insurance Insurance Company Name: Taw e/Glrs Worker's Comp.Policy# 6///i6'04' ti. 04?3a„2 WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# 13 Replacement doors: # I Roofing: #of Squares ( )Remove existing* (max.2 layers) Insulation Old Kings Highway/Historic Dist. ( )Replacing like for like Pool fencing 'The debris will be disposed of at: TO u.,n o / /a r/i-0 k 1k S,/ o .,/ al r/"--Q Location of Facility / I declare under penalties of perjury that the statements herein co tained 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 m pro ution under M.G.L.Ch.268,Section 1. Applicant's Signature: Date: /O//3-/otD.. Owners Signature(or attachment) S 4--t 0 I Date: Approved By: Date: /o �7- --� Building Official(or design EMAIL ADDRESS: Zoning District: Historical District: 0 Yes ❑ No Flood Plain Zone: 0 Yes ❑ No Water Resource Protection District: Within 100 ft.of Wetlands: © /d 1/t- ❑ Yes 0 No 0 Yes 2 No id/4?� '� The Commonwealth of Massachusetts I o _ L Department of Industrial Accidents _filliIc 1 Congress Street, Suite 100 _.o w. z, Boston, MA 02114-2017 �,.•`'y www.mass.;ov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): ig,e'Q Ifcp✓ E'?-f .2-i/'/J7 r;. 7 S h C Address: -?( /i,c <<...,r 1i7 . City/State/Zip: a. i /UI A p 6 - Phone #: (COSI%YS - /(9( Are you an employer?Check the appropriate box: Type of project(required): 1.51 am a employer with Z- 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. remodeling any capacity. [No workers'comp.insurance required.] 3. I am a homeowner doing all work myself. 9. ❑ Demolition ❑ y [No workers'comp. insurance required.]' 4.❑I am a homeowner and will be hiring contractors to conduct all work on mYP property. I will 10 ❑ Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑ Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp. insurance.: 13.❑Roof repairs 6.E 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. 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: / Y'{ veil-C,vr- Policy#or Self-ins. Lic. #: /t1t.! 0 4/4. ,093 p(Gk. Expiration Date: 7( /.z.3 Job Site Address: 17 A r1a'r.s /h City/State/Zip: YG.v n,..or,...4- Q V C`4-3 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 pain es of erjury that the information provided above is true and correct. S i an ature: Z._ /� Date: / //. 420 (s Phone#: J6 s--- /v 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#: • • Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Cons•q0t iA4Prvisor CS-114006 pires: 10/25/2022 EVGENIY BRONOV 72 ANCHOR LANE COTUIT MA 02635 ____________,l * ` • '15ti..1``l- Commissioner • • • • • r ACO DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 07/01/2022 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 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 Benson Young&Downs Ins CNAME- ONTACT 56 Howland Street PHONE�F„). (508)487-0500 , FAX No).(508)487-4135 PO Box 559 ADDRIFss• commercialteam@byandd.com Provincetown MA 02657-0559 INSURERISI AFFORDING COVERAGE NAIC iF INSURER.Atlantic Casually Insurance Co 442846 INSURED INSURER B:Arbella Protection Ins Co '41360 Bronov Enterprises Inc tNsuRER c:Travelers Indemnity of America 25666 72 Anchor Lane INSURER D: Cotuit MA 02635- INSURER E INSURFR 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.UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1NSR ADDL'SUER POLICY EPP r POLICY EXP f LIMITS LTR TYPE OF INSURANCE IIJcn win POLICY NUMBER IMM/DD/YYYYI INIM/DD/YYYYI A X COMMERC4AE GENERAL LIABILITY M2050015190 07/02/2022 07/02/2023 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PRFM SFS( RENTaorfEr nrP) $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENILAGGREGATE LIMIT APPLIES,PER: GENERAL AGGREGATE $ 2,000,000 X PRO- I POLICY ,jEQ LOC PRODUCTS-COMP/OP AGG $ 2,000,000 DTHFR $ B AUTOMOBILE LIABILITY 1020102822 12/29/2021 12/29/2022 COaMBINED SINGLE LIMIT $ ( accident) ANY AUTO BODILY INJURY(Per person) $ 500,000 ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ 1,000,000 AUTOS AUTOS X ' NON-OWNED i PPROPEER� DAMAGE '$ 250,000 HIRED AUTOS AUTOS $ I i 1 UMBRELLA,LAB, OCCUR EACH OCCURRENCE $. EXCESSUAB CLAIMS-MADE AGGREGATE DFD RETENTION S S C WORKERS COMPENSATION 6HUBOG14209322 07/03/2022 07/03/2023 X STATUTE 0TH AND EMPLOYERS'LIABILITY ,�.i.tl, 500 000 ANY PROPRIETOR/PARTNER/EXECUTIVE 1 1 N/A i E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? 500,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 1111,Additional Remarks Schedule,may be attached if mom space is required) Carpentry&Remodeling Operations and Cleaning Service. OFFICER OLGA BOCHKO IS EXEMPT FROM WORKERS COMPENSATION INSURANCE POLICY; I CERTIFICATE HOLDER CANCELLATION _ Al 008861 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF YARMOUTH THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN BUILDING DEPT ACCORDANCE WITH THE POLICY PROVISIONS. 1146 ROUTE 28 SOUTH YARMOUTH MA 02664- AUTHORIZED REPRESENTATIVE I Fax:(508)398-0836 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Corporation Registration: 182479 BRONOV ENTERPRISES INC Expiration: 06/25/2023 72 ANCHOR LANE COTUIT, MA 02635 Update Address and Return Card. Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE: Corporation before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 182479 06/25/2023 1000 Washington Street - Suite 710 BRONOV ENTERPRISES INC Boston, MA 02118 EVGENIY BRONOV 72 ANCHOR LANE /( li. COTUIT, MA 02635 Undersecretary Not valid without signature Bronov Enterprises, Inc. 72 Anchor Lane, Cotuit MA 02635 (508) 685-4106 jay@BronovErtterprises,Com, WWW.BrortovEnterprisec OWROWOO.WWWWWWWWOOOOWOOOOWROA OW*ssa.s.,..r*e ass,MAW ffiVI Am ow Nosy..ww ewe m sees.samemo*MAn PROPOSAL 1 0 . 0 6. 2 02 2 to Woiner Family Location : 4 Coachmans Road West Yarmouth MA WE HEREBY SUBMIT SPECIFICATIONS AND ESTIMATES FOR: EXTERIOR HOUSE REMODELING • Replace old pine trim boards with new AZEK PVC trim boards on Corner Boards, Rakes, Fascia, Soffit, Freeze and around all windows, doors and garage door. • Replace all windows around the house with new Harvey windows. Inside casing painted, outside trim. * Replace old slider with new Harvey slider. tBronov Enterprises. Inc. guarantees that ad components irtst441privertry Awe do not hesitate to cad Bronov Enterprises, Inc. with any questions or concerns 4,414.4. • 4.4.4. Bronov Enterprises, Inc. 72 Anchor Lane, Cotuit MA 02635 (508) 685-4106 lay OBronovEnterprises.Com, WWW.BronovEnterprises.Com • Replace old storm doors (3 units) with new Andersen Full view Retractable Screen storm doors. • Replace garage door and motor. • Repoint masonry bricks (bricks on step and around concrete landing) on a front step and resecure existing railings. • Install seamless gutters and reuse existing downspouts. • All grounds to be cleaned up on a daily basis. All bushes, shrubs, and flowers to be protected. Homeowner is asked to supply electrical power if needed. • CBr011tne Enterk -ts.es,jnc. guarantees t ,qt, dream .'ntsintage, eprTercy l' ase do not hesitate to cainBronov Enterprises, Inc with an questions or concerns Bronov Enterprises, lii 72 Anchor Lane,Cotuit MA 02635 (508) 685-4106 Jay@l3ronovEnterprisesC0111,WWW.BronovEnterprises,Corn Mtlt/M/1./.111.1.10.1141410111MMOMIHNONIVO.1.1.. ma,paw we Si.f Ai MOMS.55.7.109.ens, ns• agn ore Trim work: $16, 500 . 00 Harvey Windows: $15, 600 . 00 Harvey Slider : $2, 650 . 00 Storm doors : $2, 400 . 00 Bricks repainting on Front Step: $800 . 00 Garage door: $2, 970 . 00 Gutters : $900 . 00 Permit/Disposal fee : $850 . 00 n'PAvn Tr"'T"'°' HARVEY WINDOWS/SLIDER: $42 , 670 , 00 Discount: $1 , 670. 00 TOTAL : $41 , 000 . 00 OrOnov'En tetpriso; Inc. guarantees that aft components instaffei roperrv--- Please do not hesitate to calb13ronov Enterprisys, Inc, with any questions or concerns 811,03110J Ao suopsonb kuv yip 3111 'Yas:taiam 7 itouwg)Trt, ol aivpsati JOU op ?y-v?h,r, 413do,uip31,vist4 sluntothaol nv ivy; faaritumu, .° 14,1' 'S'aS,IALtidllist',, ,i,ouatal 1770 i mra (------ -iturls4smtbajtij AOU01$1. -"ZrZ-I/ --AQ i zvaCI Ar/1/1 , II, all Input's „la- 04SD3 •aduindador uodn moloo us asedid •uonaidnioo rocald oath%%gz( .41.411 NtOpUtM uldoxa pzumsn!Imp ur uonm otud lg niatuXud sszu2oid(yogz(z lIsodop%05.0 :SMad,,INHVVd, IfiCiy& stidialtr4A0uolg.mtivim ituoysaspdIalugAouoaftXPI 90TirS89 (809) 9C9Z0 VW 1711.10 latriel 101-Pirkt Z )ill 'cSsuit. iuri Aotiaig , o•..,.. ,,,,,, 44e,,,0 0 4 . .