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HomeMy WebLinkAboutBLD-23-005615 RECEIVED APR 10 20230ND& TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department .., BUILDING DEPARTMENT 1146 Route 28,South Yarmouth,MA 02664-4492 BY 508-398-2231 ext. 1261 Fax 508-398-0836 Massachusetts State Building Code,780 CMR Building Permit Application To Construct,Repair,Renovate Or Demolish a One-or Two-Family Dwelling This rSection_For 7Official Use Only F Building Permit Number: L.J)— 2 3^�J_►pate Applie • -2-23 rr �AC-5 Building Official(Print Name) ignature Date SECTION 1:SITE INFORMATION 1.1 Property Address:269 OId Main Street,South 1.2 Assessors Map&Parcel Numbers 1.1a Is this an accepted street? 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 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 ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record:Robert and Pat Newell City,State,ZIP South Yarmouth,MA 02664 Name(Print) 508-243-7776 Telephone billfeder@comcast.net No.and Street 269 Old Main Street Erna')Address SECTION 3:DESCRIPTION OF PROPOSED WORK2 check all apply) New Construction❑ Existing Building X Owner-Occupied X ❑ I irs(s) Alteration(s) ❑ Addition ❑ Demolition 0 Accessory Bldg. ❑ Number of Units I Other 0 Specify: Brief Description of Proposed Work2:Due to water damage,replace wiring,insulation,plaster,trim and flooring in affected areas igliving room.den.dining room and three bedrooms: SECTION 4:ESTIMATED CONSTRUCTION COSTS. Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $60,000 1. Building Permit Fee:$,)00 Indicate how fee is determined: IN Standard City/Town Application Fee 2.Electrical $3,000 ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $0 2. Other Fees: $ 3� 4.Mechanical (HVAC) $0 List 5.Mechanical (Fire . Suppression) $0 Total All Fees:$ Check No. Check Amount: Cash nt: 6.Total Project Cost: $63,000 Cl Paid in Full Outstanding Balance D e: Err • SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number CS-105323 03/14/2024 List CSL Type U Expiration Date Name of CSL Holder William Feder No.and Street 48 Square Rigger Lane Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted l&2 Family Dwelling City/Town,State,ZIP: Hyannis,MA 02601 ivl Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name Sunrise Resoraiton Co.Inc. 190352 01-18-2024 No.and Street 480 Route 6A 508-8333-911 Email address: billfeder@comcast.net City/Town,State,ZIP East Sandwich.MA 02537 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 X No 0 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 m e alf,in all matters relative to work authorized by this building permit application. Zjee attached contrac, Print Owner's Name(Electronic Signature) Date SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION By entering my name bel v,I hereby attest under the pains and penalties of perjury that all of the information c tamed in this a e and accurate to the best of my knowledge and understanding. P ' s or Aut oriz Agent's Name(E ectronic 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?lox 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.eov/dps u2. 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 r-- iDepartment of lndustrialAeciderzts '�MII= 1 Congress Street, Suite 100 = s� Boston,MA 02114-2017 s.,.•'� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individua]): S Li.,,.._1",.�_ FrF 1.-4 � ,o— Cj - .,t�_ Address: ( (Fl) V. 64 City/State/Zip: E_ Ss� /14 tl— Phone #: 51 g,5 3 _-'3 I /( Are you an employer?Check the appropriate box: Type of project(required): I.❑I am a employer with employees(full anchor part-time).* 7. ❑New construction 2.0 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.[No workers'comp.insurance required.]t 9. El Demolition 1 am a homeowner and will be contractors to conduct all work on myI Q ❑ Building addition 4. ❑ hiring property. 1 will ensure that all contractors either have workers'compensation insurance or are sole 11.0 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. These sub-contractors have employees and have workers'comp.insurance.t 13.0 Roof repairs n t 6 We are a corporation and its officers have exercised their right of exemption per NIGL c.X14.El Other ��1 t/'s 152,§I(4),and we have no employees.[No workers'comp.insurance required.] 'Any applicant that checks box At 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 ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information.sncC -W I /Pb', — Policylnsurance Company Name:#or Self-ins.Lic.#: W L-1 f 0 003 I3 d D Expiration Date: 9-/ -a --; Job Site Address: J, )p h x'L` ``•IS.�`q,'1!j,l,,'A City/State/Zip:cb, „.trIn a /Q Q�,hC LAttach a copy of the workers' compensation policy declaration page(showing the olic minir and ex iration date . P yP ) 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 he cert nder the p its and penalties of perjury that the information provided above is true and correct. Signature: � —2-3 Date: Phone#: S - 13 " i 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 Occupational and S an Beard of Building Re ulations and Standards IT' YFltSOY C;onS 9®u3 CS-105323 spires 0311412024 WILLIAM M DER 48 SQUARE. IGGE:R LANE > p HYANNIS Mffi2601 : ?p • Cormnissioner IGiefQa< . t7�vnc61.; Construction Supervisor Unrestricted -Buildings of any use group which contain Tess:than 35,000 cubic feet(991 cubic meters)of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license Call(617)727-3200 or visit wwwmass.gov/dpl THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street-Suite 710 Boston,Massachusetts 02118 Home Improvement Contractor Registration Type: Corporation SUNRISE RESTORATION COMPANY INC. Registration: 190352 P.O.BOX 802 EXpiration: 01/1 8120 24 EAST SANDWICH,MA 02537 Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs 8 Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE:Corporation Office of Consumer Affairs and Business Regulation jeaislrauon lamAtion 1000 Washington Street -Suite 710 190152 01/18/2024 Boston,MA 02118 Jf RISE RESTORATION COMPANY INC. !. !AM FEDER 10UTE 6A -SANDWICH.MA 02537 /7: Undersecretary validvd signature §TOWN OF YARMOUTH 1146 Route 28, South Yarmouth, MA 02664 508-398-223!* ext.-1261 Fax 508-398-0836 Office of the Building Commissioner BUILDING DEPARTMENT P MOLITION 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 269 Old Main Street, South Yarmouth, MA 02664 Work Address Is to be disposed of oat the following location: Yarmouth Town Dump Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. 'gnature of Application Date Permit No. Sunrise Restoration Company, Inc. 480 Rte 6A,PO Box 802,East Sandwich,MA 02537 Home Improvement Contractor#: 190352 AUTHORIZATION TO PERFORM SERVICES AND R _ DIRECTION TO PAY C�.�-, ,-\; wf-P� ,herein referred to as"Customer,"authorizes Sunrise Restoration Company,Inc.herein referred to as"Sunrise,"to perform; Drying,demo and disposal of damaged items such as drywall or plaster,flooring,trim,insulation..., removing items such as cabinets as necessary and treating for mold. Obtain all necessary building permits. Rebuild all with Like Kind and Quality. .3 u to efhc pro a t:— �7 -23 2 _JC.��>� (."24e r�h�v Tel: J�.� c Customer authorizes `rl:..co-,5 .- (.{Lt- )� Insurance Company,herein"insurance Company,"to directly and solely pay'Sunris'e. If for any reason the check(s)from the insurance company should come to or be made payable to the Customer,Customer then agrees to pay Sunrise in full immediately upon receipt of said check(s). If the loss is not covered by insurance,Customer agrees to the pay the total amount to Sunrise upon receipt of the invoice for work performed. Customer agrees to pay Customer's insurance claim Deductible to Sunrise,the amount of which is stated in Customer's insurance policy. \ Insurance Company: .'1'''4.' pSS 6 c L 2 .- f r / Policy Number: Customer agrees that Sunrise is working for the Customer and not the Insurance Company or its agent/adjuster. Additional remarks: I have read this document and completely accept the terms contain within. Customer Signature Date 1 Print Customer Restoration Company,Inc.Signature Date �R cORE) CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 04/05/2023 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). ;ODUCER CONTACT Maureen Raymond NAME: 'i ie Hilb Group New England,LLC PHONE (800)640-1620 FAX (A/C,No,Extl: (A/C,No): cha Dowling&O'Neil E-MAIL mraymond@hilbgroup.com ADDRESS: 9 73 lyannough Road INSURER(S)AFFORDING COVERAGE NAIC# •yannis MA 02601 INSURERA: Arbella Protection Insurance Co 41360 ii,;URED INSURER B: Pennsylvania Manufacturers'Association Insurance Co Sunrise Restoration Company,Inc. INSURER C: PO Box 802 INSURER D: INSURER E: East Sandwich MA 02537 INSURER F: 0 OVERAGES CERTIFICATE NUMBER: CL234557430 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. NLICY EFF POLICY EXP 1_7:R ADDTYPE OF INSURANCE INSD wvoSUBH POLICY NUMBER MPMIDDIYYYY) (MM/DDIYYYY LIMITS I_'R INSD WVD_ ( I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENII AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO JECT LOC PRODUCTS-COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED x SCHEDULED 102011613902 03/09/2023 03/09/2024 BODILY INJURY(Per accident) $ AUTOS ONLY /� AUTOS XHIRED NON-OWNED PROPERTY DAMAGE $ _ AUTOS ONLY _ AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE- $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X STATUTE EOTH AND EMPLOYERS'LIABILITY Y/N 500,000 I ANY PROPRIETOR/PARTNER/EXECUTIVE .� NIA WCMA000343200 09/16/2022 09/16/2023 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 $ iSCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) " `Workers Compensation Information:Officers,William Feder&Jeffrey Sollows are excluded from coverage. I surance coverage is limited to the terms,conditions,exclusions,other limitations,and endorsements.Nothing contained in the Certificate of Insurance lall be deemed to have altered,waived,or extended the coverage provided by the policy provisions ERTIFICATE 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. 1146 Route 28 AUTHORIZED REPRESENTATIVE South Yarmouth MA 02664 s ©1988-2015 ACORD CORPORATION. All rights reserved. CORD 25(2016/03) The ACORD name and logo are registered marks of ACORD r ....- , p (j Vta ,V, C , r L i Level T '5'4"T] ;.. China Cloigt "6 i'5; T 1 T ifilli 1911 P Z 4'7" I.ight rycrn 1---- ' " ils_ I Guest Bedroom on- Dining Room - 1 Bathroom - 'I Cc II .-> Hallway ' . . 14'9" .--- 1 --:-.. %,." ,-, es, - 1 I Den • mil; (1\1)e/H' i ' (A h(414ing Room rn i6T-Troyer — — i 35'2" 1 VI fr Main Level ROBERTS_&_PATRICIA1 ' - -1 3/23/2023 Page:22 r OR(Y,' ISSU::.: LO '01 f.,.LLVE THE FROM THE RESPONSI LITY OF'AS BUILT" COMPLIANCE. 71 DATE:4 41-V1-3 BUILD1;IG , ir -...11 '‘.,...il .:...' U 2:1/ a* c,,(10 i l "lour I 18' 7" 1 '4' 1" 13' 6" �� o 7' gn—__I Cloni2 (1) Sewing Room _ , T 41. 7' Walk in-Closet d' i n 1, 14' 6" fFlaulaiT/ 15' 7" N i !,in O 1'12, o Front Left Bedroom Front Right Bedroom rri 1 4' 3"TI o_ 1 Closet (1)7' d' 1. ' 114' S" t , t - LEI 1 34' 6" 1 1 2nd Floor N)BERT C & PATRICIAI 3/23/2023 Page:23