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HomeMy WebLinkAboutBLD-23-002421 opC /2/)/ ONE & TWO FAMILY ONLY- BUILDING PERMIT RECEIVED Town of Yarmouth Building Department • 1146 Route 28, South Yarmouth,MA 02664-4492 \ l 2 22 508-398-2231 ext. 1261 Fax 508-398-0836 �: 'rr4 r 1 PARTMENT_ 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 1 Building Permit Number:6CO-2,3—0()IL 2I Date Applied-' //f Z Z Building Official(Print Name) ignature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers t o 7 L e_tu,S cod 1.1 a Is this an accepted 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,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private 0 Zone: Outside Flood Zone? — Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 wner'of Record: j i avIi k) LA-'' , L.L,5 \/r. S MDu ?YI, I''4- Name(Print) City,State,ZIP /07 L ctu:S r'd- 4 . .7 E V p w11-60 yi91100.cily No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction❑ Existing Building❑ I Owner-Occupied 0 I Repairs(s) ❑ Alteration(s) El I Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other ❑ Specify: Brief Description of Proposed Work2: e-eMtZI tL /-1,1 t,-;5 t:1-) 0— riri f 4(0 d1T Rim T/1'# df-'' SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: (Labor and Materials) Official Use Only 1.Building $ 1. Building Permit Fee:$ \SO _Indicate how fee is determined: 2.Electrical $ 81 Standard City/Town Application Fee 0 Total Project Cost3(te 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ < 1 1 W 4.Mechanical (HVAC) $ List: .,' r 5.Mechanical (Fire — • ( Suppression) $ Total All Fees:$ v�a 1,,) Check No. Check Amount: Cash ount: M 6.Total Project Cost: $ �1,50 0 0 Paid in Full C14 Outstanding Balance D e: /a S ddTT 'TJ f � �''ar pp tt t r:w•••, tiF e`... `� it `.._ 7af.R4;; -v.,..£6 .L it SSIS t { ,4e� at.1orf a 'F • r` �. Sly'' ':'•1 f xr" t " e eel) k 4 _ _ .. _. , .. a ?- , i .6.. SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) PA,U 6 u k: kci-f) V' License Number Expiration Date Name of CSL Holder n. � 7)inc) List CSL Type(see below) 6Cl f- ,O No.and Street Type Description �/� (( Lt'1 M YJ Z Ly U i Unrestricted(Buildings up to 35,000 cu.ft.)City/Town,State,ZIPI ` ( Restricted I&2 Family Dwelling l Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 0 ' 3& 7 ? / I insulation Telephone Email address D Demolition . 5.2 Re istered Home Improvement Contractor(HIC) l�v c�r� ,sfruc; iJ Nv LLC _ 1 r� z� pzfr HI ppny Name or HIC Registrant Name C m HIC Registration Number Expiraa tion Date 7 p4uco/4-ffi- , &_sp &_/-ft,vc. erio,,, No. t Street Email address V/4 rM01A-cl , hd 02. b C Lj 5O83b/.3'79 City/Town,State,ZIP I Telephone I 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 b' No. .U SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN I PERMIT AGENT OR CONTRACTOR APPLIES FOR BUILDING PERT I,as Owner of the subject property,hereby authorize C '7 VG-' CO ili f e`Y 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: OWNER1 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 accurate to the best of my knowledge and understanding. 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.sov/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" *-\ The Commonwealth of Massachusetts aLtsm`'=t Department of Industrial Accidents -j� i'� 1 Congress Street, Suite 100 1� Boston,MA 02114-2017 www.mass.gov/ditz \1 orkers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual). V Co ,4S / t (.-4 C 4 '0 Address: P-0 eU X , r :4 City/State/Zip: S- I,/rim o Y�/ Al 4l 02 bGrPhone 1�: 50 3 E, 1 i ;3 Are you an employer?Check the appropriate box: Type of project (required): i.rdasm a employer with G' employees(full and/or part-time).* 7. ❑New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in • any capacity.[No workers'comp. insurance required.] 8. remodeling 3.01 am a homeowner doing all work myself. (No workers'comp.insurance required.]t 9. ❑ Demolition 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will t0 ❑ Building addition ensure that all contractors either have workers'compensation instil ance or are sole 11.[ ElectricaI repairs or additions proprietors with no employees. 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 12'❑Roofr Plumbing repairs or additions These sub-contractors have employees and have workers'comp. insurance.t 1 •[Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL C. 14.0 Other 152,§I(4),and we have no employees. [No workers'comp.insurance required.] *Any applicant that checks box m1 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: 0 i? (- Policy 1 or Self-ins.Lic.4: P4-Luc j 1 --0 7 7 L Expiration Date: ////3/2 Job Site Address: 1 C7 ZQ i S ^e , City/S ! Attach a copy of the workers' compensation policy declaration page(showing the tpo icy numberate/Zip: and expido d / ). expiration date). Failure to secure coverage as required under IVIGL 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: 1.--, C------ , Date: /Q////L Phone T: 909 .12 ,9-7 Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License r . 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#: • ice: z • • • • • y+ §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 (0 7 L k' Work Address Is to be disposed of oat the following location: yi9 r M D U`TO C LA i'-r9 - Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. Signature of Application Date Permit No. to- c`.4f1 1.4 -• il• .7-7- 11; .`! ••• • e • • ; ?: . ; • • v •", • , e . • • , , -4" . _ . " • "` jf.!; . . , . ACC DATE(N SIDO'Yrff, CERTIFICATE OF LIABILITY INSURANCE 03114122 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 po4icy(iesi 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 endorsementlsj. PRODUCER ` ,ONTACF JIM HIAIDMAN MANE: Schlegel&Schlegel Ins Broker PHONE gar EAt 508-7714301 ,Not 500.771-0663 34 Saar+, Street al Icon West Yarmouth. MA 02673 INIRMEMMWOROMIGCOVERAGE RAW s INSURER A: NOM INSURANCE n SiAlED INSURER II: NOR GUARD INSURANCE - PAV CONSTRUCTION LLC mean c:• . J4 PO BOX 983 p SOUTH YARMOUTH.MA 02664 IIIdtINLE1 RE c -- —. INIIM!RF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: ra= 'ram,,CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED LAMED ABOVE FOR THE Petro,PERK IND GATED. NOTWITHSTANDING ANY REQUIIEAENT,TERM OR CONDITION OF AMY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TIHK CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCI.ISIONS AND CONDITIONS OF SUCH POLICIES,UNITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS. ftni LIMITS — TYPE OF IISU ONCE '.`"`j':"� /OUCT INISIaER T 1 .�„� 111 COMMENCIAL GENERAL IT EACS orxtme ICE f 1.0000.000 + r+a• , ;3+;3• 500,U00 CLAIMS-MADE ®OCCk1RIWI oGc+rFeere i f FASO EIP(fry or«e penortl $ - 10.000 02/22/22 02/22/23 PERSONAL 5 RSV INJURY f 1.000.000 A QF IE/ 4 AGGREGATE $ -_ 2.000 000 GEW4 ABATE UNIT APPLIES PER: n C Prt96t TS-GASP ffr kpd ;N 2.000.000 IIII POLICY❑ I�WC I AUTOMOBILE U*ItIIY tEa.Gale rtt . oFAY AUTO Y FYJI lFt f(Per perserr) .>t MK SGIEDULEO, eotst.y.owitte(Per arfxierr) S - WrOS OW DM AUTOS i a iy •�' .ar S 1111 HIRED AUTOS ONLY = AUTOS ONLYIII y $ NMBPELLA UAB I:OCCUR Mil i ME Ns 1111 EXCLI.LIAR TENU'I$ CLAIMS- - 1 WORKERSDEC RE rf ONLERS COMPENSATION • STATUTE I ER MVO EMPLOYERS'L/A[N.RY YIN ip TpCCwE EL EACH ACCIDENT f 100+000 B Of �R EXIUDEtY? PAWC980772 'E L DISEASE-EA ' r' 100,100 MenaM tt eseesrlDe E,L WEAK•POLICY Y LAST ; --___0 of OPERATIONS Wow OESOMPT10M OF OPERATIONS F LOCATIONS r VEHICLES IACONO MI,Adolligessal Re+ w5e fidiedMit may be oltodsrod It ri,4�t wpm Is reolvekin CORPORATE OFFICERS HAVE EKLECTED TO BE COVERED UNDER THE WORKERS COMPENSATION POLICY INSURANCE COVERAGE IS LIMITED TO THE TERMS.CONDITIONS EXCLUSIONS AND OTHER LIMITATIONS AND ENDORSEMENTS Of THE POLICY I ( CERTIFICATE HOLDER CANCELLATION M$OULO ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF NOTICE WILL BE DELIVERED Ill ACCORDANCE WITH THE POLICY PROVISIOPtS AUINO ZZcti RE.i REsueri 1WE 1.... 1 t 1988-2015 ACORD CORPORATION All rights reserved ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration .,. „ es PAV CONSTRUCTION LLC. VINO Registration: 190522 0111111111111100..40 Expiration: 02/01/2024 P.O BOX 983 - - -•- • SOUTH YARMOUTH, MA 02664 """" ""' ma .111111011. � d4 coo. , 111111111 Update Address and Return Card. 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: LLC Office of Consumer Affairs and Business Regulation Registration Expiration 1000 Washington Street -Suite 710 190522 02/01/2024 Boston,MA 02118 PAV CONSTRUCTION LLC. PAVLIN PESHEV 84 LAKEFIELD RD. aC � SOUTH YARMOUTH,MA 02664 Undersecretary Not valid without signature 117. Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Construction Sttp'ei /igor,1 & 2 Family CSFA-106424 spires: 04/29/2023 PAVLIN PESHEV 84 LAKEFIELD ROAD SOUTH YARMOUTH MA 02664 -- tom ilk' Commissioner / 44- (S.P.AA lallil T RtC T UTN l_I I; HOME IMPROVEMENT CONTRACT This Horde Improvement Contract(the"Contract")is entered into this seventh day of October 2022, between Steven Willis (the"Homeowner"), for work to be performed at 107 Lewis road,W.Yarmouth,MA 02673 (the"Home" or"Premises")and PAV Construction LLC, do Pavlin Peshev, Registration No. 190522, SSN: XXX-XX-7139, (the"Contractor"), with a mailing address of P.O. Box 983, S.Yarmouth, MA 02664, subject to the following terms and conditions: 1. Scheduling of Services. (i) Work under the Contract is scheduled to begin on November 15th of 2022. (ii) Work under the Contract is scheduled to be substantially completed and final inspections completed on January 15th 2023 2. Scope of Services and Materials. *Remove and dispose existing plumbing fixtures,electrical,Sheetrock,insulation and tile. *Installation of new construction Harvey transom Tempered window and repair siding. ($1,200.00) *Rough in plumbing per code. *Rough in electrical per code to include outlets per code,arc fault circuit breakers. *Vent bathroom fan outside. *Installation of curb-less shower pan in bathroom. *Preparation for of walls with 1/2" curdi board ,waterproof walls. *Installation of customer supplied tile on bathroom floor,shower floor and walls. *Installation of one recessed in wall niche. *Installation of moisture resistant sheetrock on all bathroom walls and ceilings. *Installation of customer supplied vanity. *Installation of Window trim,baseboards. *Installation of bead board up to 4' from floor,1/4" Mdf panels 2" O.0 bead. Install chair rail. *Apply one coat of primer and two coats of finish paint on all walls,ceilings and trim work. Initials:= / P.P - 1 - • IPAVI IMItCti IrnCMKIN LI-G HOME IMPROVEMENT CONTRACT *Installation of bathroom fixtures,towel bars,toilet paper holders etc. *Finish plumbing: Installation of customer supplied vanity faucets,shower/tub trim and heads. *Finish electrical. Installation of 3-4" recessed lights,l-Panasonic bathroom fan/light combo,installation of two dimmer switches,installation of 1 customer supplied vanity light and one vanity light switch. *Installation of low iron clear glass sliding door for new bathroom. Venting of existing microwave is not included and is to be determined after walls are opened. 3. Fees and Costs. (i) An initial deposit of six thousand four hundred and fifty dollars($6,450.00)is required under the Contract to be paid by Steven Willis in advance of the commencement of work. The deposit shall not exceed the greater of 33%of the total contract price or the actual cost of any materials or equipment of custom or special order which must be ordered in advance of the commencement of work. (ii) The second payment of ten thousand seven hundred and fifty dollars ($10,750.00) is required under the Contract to be paid by Steven Willis when demolition of exiting bathroom is complete. (iii) The final payment of four thousand three hundred dollars($4,300.00)is required under the Contract to be paid by Steven Willis when the project is completed to the satisfaction of the Parties pursuant to the agreed upon written plans and specifications. (iv) Total Fee for Scope of Services and Materials (¶ $21,500.00 (v) Please note, any work above and beyond the scope of service and specifications listed above will be performed at an hourly rate of$85.00 per construction worker at the Home, in addition to the cost of the materials requested. As the Contractor cannot plan for additional,to-date-unspecified work, the total fee listed above could increase beyond the stated figure. Any changes to scope of work and changes from original plan in the process of remodeling causing inability for employees to preform work while waiting for change orders or decisions to be made will be charged $85.00 per hour per man for construction workers,$220.00 per hour per man for plumbers,$180.00 per hour per man for electricians .Any cancellation for employees and subcontractors due to missing supplies or change orders caused by homeowner will result $250.00 charge per cancellation. LAIN Initials:= / RP - 2 - gi4k41 [3 NSTIITCTHA[LII:. HOME IMPROVEMENT CONTRACT If any provision of this Contract is held invalid, the remainder of the terms and conditions of this Contract shall not be affected thereby, and all other parts of this Contract shall nevertheless be in full force and effect. Executed in Duplicate: [DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES] Zammesivaif P1VLIU PISHd Steven Willis Pavlin Peshev (Reg. No. 190522) Homeowner PAV Construction LLC Contractor • LS/v Initials: / P.P - 7 - . I PI-opeg 6eTp ro o f r ko c L (o 7 Lews ad . ki isrK04`cli \G 1 /I -- — — — — — — — - (- --, _ '.gi' _ _ _ _ 0 0 0 C ) t i I-, - - -c. - .4 CID I JLw vtl-Vi Yi '�?+tw Tt;`,w. t- .4 Qe fkArc i_>aS,:vv- 3 boor IA;;% n p0c : d©e r• i a, 3 4 1 (. t,,...---)�� i �4 rQ T �� cn ,., a i C..) & c'TWQ'- ei'-,,,, F, : iiLT" 4k\---), — —--- _ - -- 83" _ — -- — — — — — #'Lb..) Gusgi-SS 51e0Ivor i Oww sNe<5-roc4A • r.J.- u2a4Te tKieror Li/Et( Li,;;tf 215 .Fr' 6 , F -T '�.2rC�ci1-SS ��}P r �!' r�' �-:�, ;,�__± .; � -TALL (DOT" 4-103 Su0 Wt-r- to pcitl. door- v eoc4.c- 4og • 4 kt2Z( . &perm M f-ti-to 4 Peu, K%htu4-<3 , ''oa¢w jt.40•11)- C:Ldss ,docr s s�� a= M (I)(I) _.. O7 a w --_- 1 ..A ----................4.0=3 I V. A; 1 " N Sei O h CL �N.1 Q � /6/ ` Q NI N i N 1 co a