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HomeMy WebLinkAboutBLD-23-002856 ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department 1146 Route 28, South Yarmouth,MA 02664-4492 lit 508-398-2231 ext. 1261 Fax 508-398-0836 Massachusetts State Building Code,780 CMR \ e ,' Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only RE E a V E D Building Permit Number: 61>-23-52 Date Applied: •-•' --(0:7 - 1-- - rNO 22 202 ] Building Official(Print Name) Signature Di t_DING DEPARTMENT SECTION 1:SITE INFORMATION . 1.1 Pro erty Addr ss: 1.2 Assessors Map&Parcel Numbers . (/ Vi RSl(.t) r u9s1- •c((y4 - _ 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: Zone: _ Outside Flood Zone? Public❑ Private 0 Check if yes❑ Municipal 0 On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: sh 16,11v„ D bri erv___ LA.)fM-- Paltlitk_ f M. YA-- 60-(1Z-7- Name(Print) uity,State,Zl 3q P Th-q?6--c( c( i 3 4- i\0- 1 No.and trees Telephone E ail Address SECTION 3:DESCRIP ON OF PROPOSED WORK2(check all that apply) New Construction 0 I Existing Building f Owner-Occupied ❑ I Repairs(s) ❑ Alteration(s) Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other ❑ Specify: Brierc Description of oposed Work': C i, -(15 S U.)�- �y�t Q �19L W uV �/ & tt ;%it\r-44-1R-1- rim jec r ----- .1 SECTION 4: ESTIMATED CONSTRUCTION COSTS. Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building S �C Q 1. Building Permit Fee:$ )Si) .Indicate how fee is determined: ' v l ❑Standard City/Town Application Fee 2.Electrical $ 0 Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 4 D() D 2. Other Fees: $ /5-6 de 4.Mechanical (HVAC) $ List: dice 5eq q 5.Mechanical (Fire $ Suppression) Total All Fees:$ I Q I a- Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ ElPaid in Full 0 Outstanding Balance Due: 0 SECTION 5: CONSTRUCTION SERVICE 51Construction Supervisor License� (CSL) - ring F ' v License Number Expiration Date Name of CSL Holder List CSL Type(see below} 3e Faro 3 l No.and Street Type Description viyizt_ ipor vvv U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted l&2 Family Dwelling City Torrn,State,ZIP 0.:;-33 NIlviasonry RC j Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 5 /k-83r)-3 S d3ic I Insulation Telephone Email ddress COku,D Demolition 5.2 Registered Ho Improvement Cnntz actor CHIC) I Rl s ) i anyjestrNe 11 HIC Registration Number piration Date � - u�t4e 0� ale b `' 'as �A p•a�-- and Street b ab% 3 'U 1/ 4/'C1 � � '� lSJ ,g � Email address CityYTo Sta e,ZIP Telephone SECTION 6:WORKERS' COMPENSATI INSURANCE AFFIDAVIT(M.G.L. c.152.§ 25C(6)) Workers Compensation Insurance affidavit must b completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issua e of the building permit. Signed Affidavit Attached? Yes No 0 SECTION 7a: OWNER AUTHORIZATION TO BE COMP PLETED 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 cont. .d in this application is tru accurate to the best of my knowledge and understanding. 11' ,-- //// /070—.0.1-- Print vmer'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 find 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" oD 61447ff L1Ies' 5qan i 5 h 6L v1 lbi/li I ci wn n mq 027 O aolf-Ay §TOWN OF YARMOUTH 1146 Route 28, South Yarmouth, MA 02664 508-398-22* 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 37 Ci)- m_ u_)26.K_' L g6 ' t Work Address Q71c_9773 Is to be disposed of oat the following location: O V(" C`ick 6 —�� V\Nq" Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150 Si ature of Application Date Permit No. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations (, ,,_..i, �=, Lafayette City Center �I/� 2 Avenue de Lafayette, Boston,MA 02111-1750 M ;< www mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Long Roofing, LLC Address:300 Myles Standish Blvd City/State/Zip:Taunton, MA 02780 Phone il:781-2961-4442 Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with 25 4. ❑ I am a general contractor and I 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors listed on the attached sheet. 7. 0 Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers' comp.insurance comp.insurance.$ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.❑ Other 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: Chesapeake Employers Insurance Company Policy#or Self-ins.Lic.#:c 110'39 Expiration Date: 1/1/23 Job Site Address: 3 I ;)(\Q,(i)P - j City/State/Zip:W Pr Attach a copy of the workers' compensation policy declaration page(showing the policy number an expiration date. 6�u Z3 Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well rs civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that c.i copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify u er the pains and pen tie of perjury that the information provided abov is tr and correct. Signature: Date: ii ! 0 Phone#: 78 1-4442 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(check one): 10Board of Health 20 Building Department 3.0City/Town Clerk 4.0 Electrical Inspector 5.1alumbing Inspector 6.0Other Contact Person: Phone#: Office of Consumer Affairs and.Business Regulation 1000 Washington Street.- Suite 7.1.0 Boston, Massachusetts 02118 Home improvement Contractor Registration Type: LLC LONG ROOFING LLC Registration: 187510 8530 CORRIDOR RD,SUITE 200 Expiration: 04/20/2023 SUITE.200 SAVAGE,MD 20763 Update Address and Return Card. Office of Consumer Affairs&Business Regulation HOME.IMPROVEMENT CONTRACTOR Regisbation.valid.for individual use only TYPE:LLC before the expiration date. If found return to: Registration Expiration Office of ConsumerAffairs and Business Regulation 187510. 04/20/2023 1000 Washington Street -Suite 710. LONG ROOFING LLC Boston,MA.02118 JOHN F.DEPAOLA SR. t f • ."1(L----- 8530 CORRIDOR RD,SUITE 200 son.(CG f-,. G SUITE 200 Und , Motvali out:signature. ersecreta . SAVAGE,MD 20763 ry • - Commonwealth of Massacf usetFs :`f Division of Professional kicensure., Board of Building R� ulations and Standards Cons 1,-#44i >5p �`` ti Vsor CS 17554Q �. l t x ,� z..t��, F�pires 12/29/2024: AS ._B IDG. A Ra , i� C t ,tom A 2333 � s . s 4rSSt"Td(N kx: • Commissioner p� W . _____.......IN LONGFEN-04 DHARRIS '4�ORo CERTIFICATE OF LIABILITY INSURANCE DAT11/16122 ) 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 License#0C36861 CONTACT Danielle Harris Lanham-Alliant Ins Svc Inc PHONE FAX 9901 Business Pkwy Ste B (EA/C No,Ext): (A/C,No)_ ADD Lanham,MD 20706 RESS_danielle.harris@alliant.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Everest National Insurance Company 10120 INSURED INSURER B:Selective Insurance Companyof America �1.2572 Long Roofing LLC INSURER C:Burlinncton Insurance Company._ 23620 300 Myles Standish INSURER D:Chesapeake Employers'Insurance Company111039 Blvd,Taunton,MA 02780 INSURER E_Crum&Forster Specialty Insurance Company 144520 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 ADDLISUBR' I POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD I WVD I POLICY NUMBER 1(MM/DOM'YY) (LJ f /Yyyy) LIMITS A I X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 RMSEs(Eaorence) $CLAIMS-MADE I X I OCCUR CF4GL01198211 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIESPER: GENERAL AGGREGATE $ 2,000,000 POLICY XJ JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: EBL AGGREGATE $ 2,000,000 COMBINED SINGLE LIMIT 1,000,000 B AUTOMOBILE LIABILITY (Ea accident) $ ANY AUTO S 242806802 12/31/2021 12/31/2022 BODILY INJURY(Per person) $ AAUTOSDONLY X AUTOSULED BODILY INJURYOo (Per accident) $ X HIRED X NON-OWNED PI: dent)AMAGE $ AUTOS ONLY -AUTOS ONLY $ C I UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 ' X I EXCESS LIAB CLAIMS-MADE 600BE00525-02 12/31/2021 12/31/2022 AGGREGATE $ I DED RETENTION$ Aggregate $ 5,000,000 D WORKERS COMPENSATION X STATUTE ERH I AND EMPLOYERS'LIABILITY YIN 8005584 1/1/2022 1/1/2023 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE N N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? 1,000,000 (Mandatory in NH) I E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $ E Pollution Liability CPL-113887 12/31/2021 12/31/2022 1,000,000 i i 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 Town of Yarmouth ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE IMR /& I ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Page 1 of 9 • Measure Sheet LONG HOME PRODUCTS Bath Measure Sheet Diane OBrien 37 Pinewood Rd West Yarmouth MA 02673 11/12/2022 Existing Wet Area Specifications Job Type Tub to Shower Priority 1 Tub Cast Iron Bath Location 1st floor Walls Thinset Tile �� C Y Shower Pan N/A Ceiling Textured MEASURE bWa End Cm.Malang Floor Tile Unit Shut Off Basement CCam loWal�° °No -Flow Crown NO U.Tay MTWPao m Gang Window Main Water Shut Off Basement Molding E-Mar lete6p CI Yes No _* E-G-Camnbwq,taw Outside tdpedLAPa *ma Existing Bench Seat NO Drain Location Right N-4400.lSDY6110 Edge of Moran Needed On Outside Corner Needed On I-GmnbEdge NTWPod °G°E Plumbing Wall B d-6au...Q.SSYb W& °Nme • ' m-Mark "B°" `°ieWetV/0 Curb NO None 0° �F Window NO O (MG el) E O H 7 Measure Sheet Corner to Wall End - Left- Measure Sheet A 36 to towel bar Corner to Wall End - Right- Measure Sheet B 36 Floor to Ceiling - Left- Measure Sheet C 88 1/2 Top of Tub/Pan to Ceiling - Measure Sheet D Na Floor to Ceiling - Right- Measure Sheet E 88 1/2 Corner to Edge of Tub/Pan - Measure Sheet F 29 Corner to Corner- Measure Sheet G 58 1/2 Middle of SD Wall to Edge of Tub/Pan Measure Sheet H 29 Corner to Edge of Tub/Pan - Measure Sheet I 29 Measure from Drywall to Drywall -Measure Sheet J 59 This space intentionally left blank MA HIC #187510 Page 6 of 30 Long Roofing, LLC • 30b Myles Standish Blvd Taunton MA, LONG HOME 02780 (800)470-LONG • (240) 473-1400 • LongRoofing.com PRODUCTS By Long Roofing, LLC Diane OBrien (774)470-2968 Date: 11/09/2022 37 Pinewood Rd dgobrien3@gmail.com Product Specialist: Mason Moynihan West Yarmouth MA 02673 The Buyer(s) listed above hereby jointly and severally agree to purchase the goods and/or services listed herein, in accordance with the prices and terms described in this "Agreement." Dumpster Required NO I confirm that the above information is accurate Are there electric lines within 3 feet of where LHP will be performing work? NO Preferred Method of Contact Phone Phone/Text/Email 774-470-2968 home 518-209-0200 cell Total Purchase Price $18,859 Deposit with Order $6,287 Amount Due on Substantial Completion $12,572 Amount Financed $0 Form of Deposit Credit Card The Estimated Date of Commencement of the Work Is 8-12 Weeks The Estimated Completion Date Is 12-16 Weeks I am aware that the above dates are an ESTIMATE v,fa The Project Is Contingent Upon Obtaining N/A THERE ARE NO ORAL AGREEMENTS Promotion Selected(Cannot be combined with other offers) Cash Discount Customer Promotion Acknowledgment D.` It is agreed and understood by and between the parties that this Agreement, constitutes the entire understanding between the parties, and there are no verbal understandings, changing or modifying any of the terms of this Agreement. Buyer(s) hereby acknowledge that Buyer(s) has read Agreement and has received a completed, signed and dated copy of this Agreement, including the two accompanying Notice of Cancellation forms, on the date first written above. Buyer(s) acknowledge that they were orally informed of their right to cancel this transaction. 9.\)) ,g (-4.)u-e Mason Moynihan Diane OBrien 11/09/2022 11/09/2022 Date Date