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Home My WebLink AboutBLD-23-005946 a `� Office Use Only � = ca-i C i Permit# Q �f O y: / )C� MATTACM escj�' Amount - ''" Permit expires 180 days from issue date EXPRESS BUILDING PERMIT APPLICATION 3 1),O 5*I& TOWN OF YARMOUTH Yarmouth Building Department ' E D E I V C D 1146 Route 28 -"�'" - °�-- - South Yarmouth, MA 02664 e APR 2 6 2023 (Q 7q — (508) 398-2231 Ext. 1261 BUILDING DEPARTMENT CONSTRUCTION ADDRESS: 67/ ,�� jl`e a By__ ASSESSOR'S INFORMATION: Map: Parcel: OWNER: 1v /kcila03 45 i.M 4_,te.pdv/a3 ar//di/e. .2, 77y -6or-,55-002- NAME PRESENT ADDRESS TEL. # CONTRACTOR: 4/f,'4a/a Olo►Nt e i'.a 3 ev,Illy Or //CasI n /4 O 3,5 6 7J/G'/'g-d'3 33 NAME MAILING ADDRESS TEL.# ❑Residential Commercial Est.Cost of Construction$ i7 /y adoHome Improvement Contractor Lic.# /5.-/p 2 y Construction Supervisor Lic.# /00Yere Workman's Compensation Insurance: (check one) ❑ I am the homeowner ❑ I am the sole proprietor / _ '�I have Worker's Compensation Insurance Insurance Company Name: /Q� V 4U 4' h.f G Worker's Comp.Policy# dWC4/0670.3l040c34,1A WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows: # Replacement doors: # Roofing: #of Squares /0 . ( )Remove existing* b (max.2 layers) Insulation Old Kings Highway/Historic Dist. ( )Replacing like for like Pool fencing *The debris will be disposed of at: CCcur►l e y (jVV{'re eiti a N,TQ/ £ay Aa1 ,r/J ' Location of Facility /' /"r/� I declare under penalties of perjury that the statements herein contained 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 my license and for prosecution under M.G.L.Ch.268,Section 1. Applicant's Signature: L/ :;?'0"---7 �b Date: /� Owners Signature(or attachment) 3 Date: Approved By: st ' Date: /2 7 Building Official(or ign EMAIL ADDRES Zoning District: Historical District: ❑ Yes ❑ No Flood Plain Zone: a Yes No Water Resource Protection District: Within 100 ft. of Wetlands: ❑ Yes ❑ No ❑ Yes No • The Commonwealth of Massachusetts ► =A ►= 1 Department of Industrial Accidents 1'= _ _; 1 Congress Street, Suite 100 o = `=t Boston, MA 02114-2017 :._•`4 www.mass.gov/dig \Y orkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): .] dj;t�G Xe7,44 tYO Address: l47et ,7r �/. C`�-5 -► MA 0a3 5-1‹ City/State/Zip:,orf4 63 / li4 0.23S�6Phone #: p 3 Are you an employer?Check thepropriate box: Type of project(required): 1. I am a employer with employees(full and/or part-time).* 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. ❑Rem delinruction any capacity.[No workers'comp.insurance required.] 8• ❑ eolig 3.0 I 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 mYproperty. I will 10 El Building addition ensure that all contractors either have workers'compensation insurance or are sole proprietors with no employees. 1147 Electrical repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 12.El Plumbing repairs or additions These sub-contractors have employees and have workers'comp. insurance.; 13.❑Roof repairs 6.0 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. 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: ,Z 1/YlV Y Vc4,I v e Co Policy#or Self-ins.Lic. #: 4 li.iC L j O ej 3 ( Qtl?..10 Expiration Date: 7/9S- a3 Job Site Address: '/1 !'/,4 lie .94" City/State/Zip: I/ et V.e,73 Attach a copy of the workers' compensation policy declaration page(showing the policy n umber and expirationdate. 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 pains and penalties of perjury that the information provided above is true and correct. Signature: L Date: / 7.</.2 3 Phone#: 7/9/ 3 3 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#: ` ;' r CERTIFICATE OF uaBILmr INSURANCE DATE 22 MS CERTIFICATE IS ISSUED AS A NATTER OF NVOR#NATION Y AND DER. TE NOT�Y OR NEQATRIELY ° , HOLDER.THE MEND,EETEiiD OR ALTER TIE COVERAGE AFFORDED BY THE POLICIES THIS Ci:NERCATE OF DOES NOT CONSTITUTE A CONTRACT BETWEEN TEE ISSUING WSURER(S), AUTHORIZED OR � ►TE . IMPORTANT: Sae cedlikele holder leas ADDITIONAL INSURED,the policyges)nand have ADDITIONAL SOURED provisions or be endorsed. it StNIRO6ATION IRS mem,soled be lthe buss and conditions of the policy,certain policies may require an endorsement. A statement on this esrtiliale does not eemilerdgllstlertieeaAillaie bolder in Nen of such endorseinentp3. PRODUCERCONTACT woe Chrhen McGoan JOHN P RUSSELL INSURANCE AGENCY INC la..ran: (781)3440098 1 WFAX C.Not aoseeoc 65 PEARL ST a AFFOR'Oea3CO VE RAGE woes STOUGHTON MA 02072 INSURER A: AIM MUTUAL INS CO 33758 INSURED ARL.IA�R RINIRERC: heehrteh:: MUM V: 3 EMILY DRIVE POURER E: EAST ON COVERAGES MA 02�t6 apa+�tF: Cl RIVICATE NUIMIElt 709688 REVISION NUMBER: THIS IS TO CERTNF,Y THAT THE POLICES OF INSURIIMIX LISTED BELOW HAVE BEEN ISSUED TO TIE MAD NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOLWAiI ISTANII NG ANYREQ0602mENI,,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCU ENT WITH RESPECT TO WHICH THIS CERIFICATE MAY THE ISSUED OR INKY PERIM TEE INSURANCE ADD Br.THE POLICESCESDSC IS SUEIJE Tn A jTi E,TERG, SU �I�CHPCU S LTR TOPEOFa1MahA10EINSR IMO POUQYNUMBER ,a1 UNITS caneeew.N NERALUAINIR r EACH OCCURRISICE ECAes+e� mat s WA ISM(Any ass meson) PREMISES lEstaxeseenoN PERSONAL&AOVINJURY $ serf AGNINEGATEUNITHWESFEM GENERAL AGGREGATE S _ POLICY , 1 ih3C PRODUCTS-CON I OPAGG $ ORMCONEINEDSINGLEUINT —AMIONONSEuNwegY ,eweseddese $ BODILY INJURY Mrsea $ m ONLY! ` WA INJURYSOIEOULED EfOOSLY �eracaden4 $ NONCIMED AUTOSOe.Y �,a.JroSONLY airr eee7dnse $ tNSRSEAUAB i _ $ OCCUR EACH OCCURRENCE F etMB CLAINSAVME S WA AGGREGATE $ OW I Inherhamses ivammessossemornow t i AN ORNATIENNUM 3 U Y YIN XI A�1JTE i ER A ieANTFROciummitiPARTNER1EXECUIIVE ENA Nr1 AwC400703i04721122A 07/25f2022 07/2513 EL EACH Accoerr s 100,000 Nimeeday �mar OFOPStA7EOhrSbebrsr ELDhS61SE-E�tE Q[flYE3E s 100,000 EL DISEASE-POUOYMST S 500000 WA oescarnostoFtwaranonstuscanossrvascuss*CORD 101,Addikerad RasadesSdesdule,ray Nestladnd Rime memIcnm6, Warbles CroupNsalio_bee_N_aibs paid toNN employees only.P to VC200308B.no aiingoeis given to pay clamsfor ben do empioyweasidesarNriNilieesar as fiallesinredlias,aiosiiwdtoseemplo ees Weide ri Massachuselts. This dlicals a nce wstGs poky in farce crofts c Odessa, paw �eissueaaisoftfiiscedRiaEs of insolence). The sfisofshc coi►by accessing the Proof of Coverage-Coverage Venlications tool at Solo propdeeor has set eluded oosemge. CERTIFICATE HOLGER CANCELLATION • swum BE FORE THE EXPIRATION DATE THEREOF. NOTICE SRL BE DELIVERED it ACCORDANCE TIMITEEPOLICYPROVEpNS. aunionamontrassairaawe ' O Dai*I N.Cto .cPCU.W:e President Residual Melloet—1IIICRIBMAA ACORD 25 .. 'fife ACORD name and logo are iegisf�l 1T iti�OO�ORATlDN.AN deft HY�served, April 17, 2023 Job Agreement Romeiro Roofing & Construction 3 Emily Dr North Easton MA 02356 781-844-8333 CSSI# 100466 HIC# 159274 Work to be performed for. The Lobster Boat Job Location: 681 MA Rte 28 West Yarmouth MA 02673 Job Description:New RPI(Roofing Products International) Royal Edge tapered,fully adhered,060 EPDM roof system is to be installed on entire ship portion of building C and a partial area on roof A as indicated on eagle-view report#51557183 (approximately 12.66 square) New roof deck will be cleaned and prepped for new roof installation Existing areas that puddle will be filled in with ISO board New tapered ISO(polisocyanurate)board will be fastened to roof deck with a 1/8-inch taper per ft to direct rain water to existing drains All ISO board 4ftx4ft sheets will be fastened to roof deck using 3-inch galvanized deck plates along with 2—6 inch#14 steel hex head screws(approximately 10-14 per 4ftx4ft sheet of ISO board) New ISO board will be 1/5 inch along eve and taper up to approximately 4 inches which will end at new parapet wall or sidewall New.060 adhesive gage EPDM(RPIRoyal Edge rubber roof membrane)will be fully adhered to ISO board using Low VOC bonding All seams will be cleaned and spliced using 3inch seam tape and low VOC activator New roof will be installed in the same manner on roof A(approximate 13ft x 8Ft x.5ft) A new double layer of uncured flashing will be fabricated and applied to all areas requiring EPDM flashing(units,curbs,hatches, etc...) New RPI pipe boots will be installed on all pipe penetrations under 6 inches All other penetrations will be flashed with 2 layers of uncured RPI EPDM flashing New wall cap(EPDM)will be installed(trim to be PVC inside and out New termination bars will be installed on outside and inside portion of parapet walls New termination bars will be fasten to parapet wall using 2-3 inch steel screws(approximately 1 every 6-inches) Rotted wood under roof drain will be repaired(rotted ceiling)rubber roof will be patched Other minor repairs will be performed throughout all flat roofs(pitch pockets,flashing and reinforcements) All siding will be protected as new roof is installed along with all walkways and bushes Roof will be made watertight at the end of each work day Premises will be cleaned and all debris associated with roof installation will be removed from property. A magnet will be used to collect discarded nails throughout property when job is complete RPI fully adhered to ISO board roofing system carries a 40-year material warranty Deposit $7,000.00 Final Payment when all penetrations, pitch pockets and flashing is complete $7,000.00 Total Job Cost$14,000.00 Estimated by,Al Romeiro Nikolaos Asimakopoulos Al Romeiro Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Requlations and Standards Construct) u iL per Specialty CSSL-100466 ze , '*; spires: 10/29/2023 ARLINDO F(to -`' 3 EMILY DR z NORTH EASitIN ; .7 'VOIJ,Nd`a:'3 • Commissioner e;fc E K. oit Q THE COMMONWEALTH OF MASSACHUSETTS vas; Office of Consumer Affalits&BusMess Regulstlon HOME IMPROVE ;CONTRACTOR BeghaTYPE:_ndiwdual E>t E i§9 74z`s 44i31' ^Fg ARLINDO ROMEIRO:� £- , ARLINDO ROMEIRO 3EMILYDR N.EASTON,MA 02356 Undersecretary