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Home My WebLink AboutBLD-23-005919TOWN OF YARMOUTH Building Department (508) 398-2231 ext.1261 PERMIT NO ISSUE DATE APPLICANT BLD-23-005919 04/27/2023 JOSE OLIVIERA BUILDING PERMIT JOB WEATHER CARD PERMIT TO Repair A I (LUCA I ION) 488 ROUTE 28, WEST YARMOUTH, MA 02673 ZONING DISTRICT Bldg. Type: Commercial SUBDIVISION MAP BLOCK LOT 031.78 BUILDING IS TO BE: CONST TYPE REMARKS Repairs - strip and replace 32 squares of roofing -- (508-922-4455) AREA (SQ FT) 4,288,307,76 EST COST($) 13392.00 PERMIT FEE ($) 90.00 OWNER HOLIDAY VAC CONDO ASSOC INC V B USE GROUP R-3 CONTRACTOR LICENSE 142908 Home Improvement METROWEST CONTRACTING ASSOCIATES, INC. JOSE OLIVIERA 11 WALNUT DRIVE ADDRESS , P O BOX 940 BUILDING DEPT BY FAYVILLE, MA 01145 SOUTH YARMOUTH MA 02664 /�zc.oC PHONE THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK 06 ANY PART THEREOF, PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, APPROVED BY THE JURISDICTION. STREET OR ALLEY NOT SPECIFICALLY PERMITTED UNDER THEBUILDING CODE, MUST BE GRADES AS WELL OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM MINIMUM INSPECTIONS REQUIRED FOR ALL APPROVED PLANS MUST BE RETAINED ON CONSTRUCTION WORK: 1) FOUNDATIONS OR JOB AND THIS CARD KEPT POSTED UNTIL WHERE APPLICABLE SEPARATE FOOTINGS. 2) PRIOR TO COVERING STRUCTURAL FINAL INSPECTION HAS BEEN MADE. WHERE PERMITS ARE REQUIRED FOR MEMBERS (READY FOR LATH OR FINISH COVERING) A CERTIFICATE OF OCCUPANCY IS ELECTRICAL PLUMBING/GAS 3) FINAL INSPECTION BEFORE OCCUPANCY 4) REQUIRED, SUCH BUILDING SHALL NOT BE AND MECHANICAL REFER TO DETAILED INSPECTION SCHEDULE OCCUPIED UNTIL FINAL INSPECTION HAS INSTALLATIONS. BEEN MADE. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTIONS APPROVALS THER: 'ORK SHALL NOT PROCEED PERMIT WILL BECOME NULL AND VOID IF INSSECTIONS INDICATED ON THIS CARD VTIL THE INSPECTOR HAS CONSTRUCTION WORK IS NOT STARTED WITHIN SIX CAN BE ARRANGED FOR BY TELEPHONE PROVED THE VARIOUS MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED OR WRITTEN NOTIFICATION. rAGES OF CONSTRUCTION ARrn/F RECEIVED APR 2 4 2023 SUI`� Office Use Only Permit# Amount 90' oo Permit expires 180 days from issue date jq �-/) - 43 -AA gC1l q EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: �.._ !�j�-ice 5� �1` 7 � oy7 �! nxA- o 2 3 ASSESSOR'S INFORMATION: Ivlap: Parcel: j OWNER: . ( P61 0 &AaA7 NAME PR ENT ADDRESS TEL. # / CONTRACTOR :�02� %biO4i l.�lrC-i 4 �CJ �' 4y�� ' V7 "+ AZo �y✓y 5D $ �] �i I V J C/ NAME MAILING ADDRESS TEL. # ,o ❑ Residential ® Commercial Est" Cost of Construction't Home Improvement Contractor Lic. # [ Z q'a D Construction Supervisor Lk. # C!s cj ci a T Workman's Compensation insurance: (check one) ❑ 1 am the homeowners ❑ I am the sole proprietor If I have Worker's Compensation Insurance Insurance Company Name: 01 'l`q 1 1 17 Vf q f N1 S " Worker's Comp. Policy#_ A W-C, � pro 20Z 20 Z Z4 Tent F— 1 Duration Siding: # of Squares WORK TO BE PERFORMED ("ire Retardant Certificate attached?) Replacement windows: # Roofing: # of Squares 3 Q — (®) Remove existing* (max. z layers) Old Kings Highway/Historic Dist. q::p Replacing like for like *The debris will be disposed of at:� Wood Stove_ Replacement doors: # Insulation Pool fencing Location of Facility I declare under penalties of •r" y that the statements herein contained are true and correct to the best of my knowledge and belief. 1 understand that any false answer(s) will be just cause for den" I r cation of my license and for prosecution under M.G-L_ Ch. 268, Section 1" l Applicant's Signature: Datc: 7 f( 12— Owners Signature Approved By: Building 7-1 I0kVIVA N Date: t / � 2 Zoning District. Historical District: Yes No Flood Plain Zone: Yes No Water Resource Protection District: Within 100 ft. of Wetlands: Yes No I Yes No The C.'ommonwealln uJ Department of Industrial Accidents I Congress Street, Suite 100 Boston, MA 02114-2017 �M 4, I www.mass.gov/dia «Yorkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY.A licant Information Please Print Legibly c rr�hC�I�• oGiPs7h Name {Business/4rgariization/lndividual}: Ft1e2o�rf�7 4rc - _ — -- - Address: 0 b City/State/Zip: ,�,f -T rt-r oLo �` ` d NFL Phone #: A.re you an employer? Chec the appropriate box: l:R I am a employer with employees (full and/or part-time).* 2.❑ I am a sale proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3,❑ I am a homeowner doing all work myself. [No workers' comp- insurance required.] t 4.❑ I am a homeowner and will be hiring contractors to conduct all work on my praperty. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5,❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub-contractprs have employees and have workers' camp. insurance.$ 6.❑ we are a corporation and its officers have exercised their right of exemption per MOL c. 152, 31(4), and we have no employees. [No workers' comp, insurance required.] Type of project (required): T ❑ New construction 8. ❑ Remodeling 9. ❑ Demolition 10 ❑ Building addition 11.❑ Electrical repairs or additions 12.F] Plumbing repairs or additions 13. ❑ Roof repairs 14. EROther � *Any applicant that checks box # i must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing a31 work and then hire outside contractors must submit a new affidavit indicating such. tCaritractors 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' camp. 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: V`l Expiration Date: [� j 8 Z� ZZ�2Z r l 01 Z Policy # or Self -ins. Lic. #: -� Ora Job Site Address: Yh'IN--\ S City/State/Zip:lr}�7� y°� 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 venuuauon. I do hereby der the7painsnd penalties of perjury that the information provided above is trod and correct. Signature: V Date: �� Phone #: 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 Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone##: THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affati`s;& Business Regulation HOME IMPROVEMENtCONTRACTOR METROWESTCONTFiACTfNO_ASSOCIATES, INC. w' x JOSE A. OLIVIERA 11 WALNUT DRIVE FAYVILLE, MA 01145 Undersecretary Commonwealth of Massachusetts + t4 Division of Professional Licensure Board of Building Regulations and Standards Constrtidt%i gtjpjrvisor 9 CS•097476 expires: 04126/2023 JOSE A OLIVEIRA P O BOX 65 s �` SOUTHBOR60H MA O'€772 Commissioner'cJ�a- CERTIFICATE OF LIABILITY INSURANCE DATE(MWGVrr`YYY) 0412412023 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 1NSURER(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 cndorscd. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement an this certificate does not confer rights to the certificate holder In Ileu of such endorsoment(s). PRODUCER POINT INSURANCE INC CONTACT NAME: BRUNO ROZEMBARQUE PHONE 617 783-1160 FAX �EI.CyFtv._EaII• A1, E-MAIL bruno@pointinsuro.com 1103 COMMONWEALTH AVE BOSTON MA 022151111 INSURERS AFFORDING COVERAGE NAIC# INSURERA: AIM MUTUAL INS CO 33758 INSURED METROWEST CONTRACTING ASSOCIATES INC INSURER III; INSURER C: INSURER D : 11 WALNUT DR INSURER E : FAYVILLE MA 01745 INSURER F : 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 ArFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL TI IE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE POLICY NUMBER MI VDT Y EFP MM DCo YY LIMITS COMMERCIALGENERALUAMLITY EACH OCCURRENCE $ PRFk1SFS Ea occurrence S CLAIMS -MADE 71 OCCUR MEO EXP [Any ana person) S PERSONAL BAOV INJURY ^� NIA AGGREGATE LIMIT APPLIES PER: GENEnALAGGREGATE S GEN'L POLICY ❑ PLC6 PRODUCTS- COMPIOP AGG S LOG g OTHER AUTOMODILEDABIDTY COMBI NED SINGLE LIMIT Ea ncadanl $ ANY AUTO BODILY INJURY (Per person) $ AUTOS ONLY AUTOSULEp NIA BODILY INJURY tPnr acrJdxnl) S "RED NON•OWNEO AUTOS ONLY AUTOS ONLY PROPERTY DAMAOE par aearMnt $ $ Vm6RELL4 LIAR OCCUR EACHCCCURRENCE $ EXCESS LIAR CLAIMg•MApE NIA AGGREGATE $ DED I I RETENTICNg IS WORKERS COMPENSATION X _ /� STATUTE ERII AND EMPLOYERS'UABILITY Y/N E.LEACH ACCIp—eNT g 1,000,000 A OFFICEHlMEMBERE%CLUllEDEXECllT1VE N7R WA WA AWC40070382022D22A 0511012022 Db11012023 E.LDISEASE- EAEMPLOYEE $ 1,000,000 (Mandalory In NH) If yyas. describe undnr E.L.DISEASE -POLICY LIMIT $ 1,000,000 I) SCRIPTIONOFOPERATIONSb0cns NIA DESCRIPTION OF OPERATIONS I LOCATIONS IVEHIGLES (ACORD 101, Additional Ramarki Schadulo, may be aHached 11 Moro spat:o Is roqulrad) Workers' Compensation benefits will be paid to Massachusetts employees only. Pursuant to Endorsement WC 20 03 06 B, no authorization is given to pay Balms for benefits to employees in states other than Massachusetts if the insured hires, or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued (unless the expiration date on the above policy precedes the issue dale of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage - Coverage Verification Search tool at www.mass.govAwdlworkers-compensatiOrVinvestigations/. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Yarmouth Town Hall ACCORDANCE WITH THE POLICY PROVISIONS. 1146 MA-28 AUTHORIZED REPRESENTATIVE \ r; , South Yarmouth MA 02664 — `'""l " �ti I Daniel M. €;ro,Gvjey, CPCU, Vice President— Residual Market— WCRIBMA 0 1988-2015 AUUKU L5 (2016103) The ACORD name and logo are registered marks of ACORD All rights