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HomeMy WebLinkAboutBLD-23-005934 og''�RR RECEIVED /y3 °m�ri��o�c��'' Permit# yp5 411i 9 0 y, APR 25 2023 Amount 6-4,M wtrr' 3 s Permit expires 180 days from BUILDING DEPARTMENT issue date By: G-D -02-3 .dd 593 LJ EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: 22 Mackenzie Rd ASSESSOR'S INFORMATION: Map: Parcel: OWNER: Lourie Grosse 22 Mackenzie Rd (617) 590-7407 NAME PRESENT ADDRESS TEL. # CONTRACTOR: Alvaro Carrasco 784 N Cary St Brockton, M (508) 208-7151 NAME MAILING ADDRESS TEL.# ElResidential 0 Commercial Est.Cost of Construction$ 14,500 Home Improvement Contractor Lic.# 199914 Construction Supervisor Lic.# 100375 Workman's Compensation Insurance: (check one) 0 I am the homeowner 0 I am the sole proprietor El I have Worker's Compensation Insurance Insurance Company Name: AIM Mutual Insurance Worker's Comp.Policy#WCC50050287962023A WORK TO BE PERFORMED Tent I l Duration (Fire Retardant Certificate attached?) Wood Stove n Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares 16 (a)Remove existing*(max.2 layers) Insulation I I I I Old Kings Highway/Historic Dist. (J Replacing like for like Pool fencing n *The debris will be disposed of at: Troupe Waste Brockton, MA Location of Facility 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 revoc f my lic s and for prosecution under M.G.L.Ch.268,Section 1. Applicant's Signature: Date: 4/21/23 Owners Signature(or attachment) Date: Approved By: Date: '-2P'2 Building Offi ' or ignee) EMAIL DRESS: buildpermits@gmajl.com Zoning District: Historical District: 1 Yes No Flood Plain Zone: Yes 7 No Water Resource Protection District: Within 100 ft.of Wetlands: II Yes No - Yes No The Commonwealth of Massachusetts _-+ r - Department of Industrial Accidents 1 Congress Street, Suite 100 _ E� Boston, MA 02114-2017 Workers' www mass.gov/dia W Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): L&G Contracting LLC Address: 15 Caramel Cir City/State/Zip:Bridgewater, MA 02324 Phone#: (508) 933-0178 Are you an employer?Check the appropriate box: Type of project(required): I.❑✓ I am a employer with 2 employees(full and/or part-time).* 7. New construction 2.01 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. ID DemOlItioII 4.0 I am a homeowner and will be hiring contractors to conduct all work on property.m5' I will 10 0 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.01 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. ✓�Roof repairs 6.0We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§I(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. 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: AIM Mutual Insurance Policy#or Self-ins.Lic.#: WCC-500-5028796-2023A Expiration Date: 3/20/24 Job Site Address:22 Mackenzie Rd S Yarmouth, MA City/State/Zip: 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 verification. I do hereby certify under the 'ns and penalties of perjury that the information provided above is true and correct. Signature: Date: 4/21/23 Phone#: (508) 208-7151 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 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: A�oR� CERTIFICATE OF LIABILITY INSURANCE 04( 02`�' 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 poifcy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and renditions 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 CONTACT NAME: PATRICK F. MCGUIRL BAYSIDE INS UNDERWRITERS INC a°I (508)455-0017 71 County Street L-MAn. ea): u"vc,Na):(401)633-7000 Attleboro, MA 02703 ADDREsspmcguirl@bslui.com +sURER(s) AFFORDING COVERAGE MACS INSURER A:Norfolk a Dedham Ins. Co. INSURED L & G Contracting, LLC INSURER B:AIM Mutual Insurance 15 Carmel Circle INSURER C: Bridgewater, MA 02324 INSURER D: INSURER E: 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. MR ADDL TYPE INSURANCE pip wR POLICY NUMBER POLICY EFF POLICY-EXP GENERAL LWBaITY (MMlDDlYYY't (MM/ODIYWY) LIMITS EACH OCCURRENCE $ 1,000, 000 X COMMERCIAL GENERAL UABIUTY UAMAtit IU HEN PREMISES(Ea occurrence) $ 300, 000 CLAMS MADE ri OCCUR MED EXP(Any one person) $ 5, 000 A — R2355681A 03/17/2023 03/17/2024 PERSONAL&ADVNJURY s 1,000,000 GENERAL AGGREGATE $ 2,000, 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-CUMP/OP AGO $ 2, 000, 000 POLICY n IF a n we $ AUTOMOBILE LIABILITY COMBINEDSINGLE LIMIT(Ea accident) $ 1'000,000 — _ ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED 92385230A 02/28/2023 02/28/2024 A AUTOS X AUTOSBODILY INJURY(Per accident) $ X HIRED AUTOS X ANC NED PROPERTY DAMAGE — (Per accident) $ $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ _— EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED [ ►RETENTION$ $ WORKERS COMPENSATION WCSTATU OTH- AND EMPLOYERS'LIABILITY YIN X ITOAYLMITS I ER ANY PROPRIETORlpARTNERVEXECUTIVE mYCC-500-5028796-2023A 03/20/2023 03/20/2024 B OFFICERMEIUER EXCLUDED? a N!AMandatory EL EACH ACCIDENT $ 1,000,000 Iy it be under E.L.DISEASE-EA EMPLOYE ES 1,000, 000 DESCRIPTION OF OPERATIONS below E.L-DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule.if more space is required) Bridgewater Building Department is additional insured as required by written contract. CERTIFICATE HOLDER CANCELLATION Yarmouth Building Department THE EXPILD RATION OF ITHD ABOVE THEREOFDESCR,�NOD TIICCE WILL BE DELIVEREICIES BE CANCELLED D IN 1146 Rt 28 ACCORDANCE WITH THE POUCY PROVISIONS. S Yarmouth, 02264 AUTHORIZED REPRESENTATIVE HO 4CORD25(2070/05) ©1 988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD m 0 C m °c d o ,:r -a t = C o a y iv 0 T N 0 w N 5 O0i rn m ¢ +4-i WO 00 m O 0 C (n W .4.., co To ct • _Ct = N N. co co,. i 4 1-* CU 3 i=_®` _ = Q r+a) CD r wit 3 e i -2Q 10 = -El at ; ,„ v : < 3 >.2Coo �� o 01a� f rrt7 0 p��-a z 2 -,. r ----or----:- - 73 o— m _l i Fs # E ykF+ ,: o Q '1- ! 1' , 1 , t d,t d x=o p w < .c t " i�1 � ,'a oc mo.-m Z E CI) al Cv O O 0 = n 0 r CGI 1/4..., 0 p m _ G ,...., o c) ci, c ..:215 U E v'_ U 'F- d ap w o i ua = C L 1— V =ce C) c.v. 0 0 yc � Ai 0 CO wz -- co cm o 2m O2 w o C r) es Fca C <0 Z W.c . Ccc o u;2 as >a 0 CC lai py er QQ}Z m 0E- oQVO Oct Om 0' Lo jaz8 2U 11 co co a my O,_ OCr¢ON.m W o = Qcc OC 2 H0 0> O=Z 0 ccQ cc CC << Qmz J CO >M m <0 .:CN< it O N -s y c asco CO CD V tn= Z M U r 0 CIJ U1 lCO a CS _ f% • to Oar IL' 1Ifl -j' o > m U VCeZ 0 v ._ o QJ to W oQi. m E 4sip. V! L J L&G CONTRACTING LLC 15 Carmel Circle Bridgewater, MA 02324 (508) 933-0178 j gyoandGallocontracting@gmaj].com ,SHINGLE ROOF PROPOSAL PROPOSAL SUBMITED TO: ,1 d(./r i.e— r-oSs e DATE: 04-18-2023 EMAIL: 24 6 ) i c,'o( . PHONE—NUMBER: ( '? S70.7Ya? JOB LOCATION ADDRESS: 22 Mackenzie Road South Yarmouth, MA 02664 DETAILS: GAF PEWTER GRAY Timberline HDz SQ: 16_ ▪ WE WILL REMOVE EXISTING ROOF AND DISPOSE OF INTO DUMSIER. - WE WILL REPLACE WITH ALUMINUM DRIP,FLASHING,ICE WATER SHIELD,ACP 30N SGUARD UNDERLAYMENT, STARTER STRIP,RIDGE,AND_XX ARCHITECTURAL SHINGLES. WE WILL MAKE EVERY EFFORT NOT TO DISTURB ANY SHRUBS OR GARDENS SURROUNDING STRUCTURE. - WE WILL REMOVE ALL DEBRIS AND NAILS FROM WORK AREA. CONTRACT IS VALID FOR FIVE (5) YEARS FROM DATE OF COMPLETION FOR ALL LABOR (EXCLUDING MATERIALS). ESTIMATED TIME OF COMPLETION 10 DAYS (WEATHER PERMITING AND PENDING THE CONDITIONS OF EXISTING STRUCTURE ONCE SHINGLE HAVE BEEN REMOVED). EXTRA: CHIMNEY(S) X FLASHING LEAD RIDGEVENT X BOOTS PIPE DfL�� ANY DAMAGED FOUND ON STRUCTURE AFTER REMOVAL OF SHINGLES WILL BE DISCUSSED WITH PROPERTY/HOMEOWNER AND IS SEPARATE FROM THIS AGREEMENT.CONTRACT WILL INCLUDE DUMPSPER AND PERMIT OF CITY. COMMENTS/ADDITIONAL WORK: — Remove and Install 8 square of wood shingles, Reinstall exterior doors. Reinstall 2 windows. PROPOSE HEREBRY TO FURNISH MATERIAL AND LABOR-COMPLETE IN ACCORDANCE WITH THE ABOVE SPECIFICATIONS FOR THE SUM OF: Fourteen Thousand Five Hundred Dollars and No Cents. (S 14,500.00) PAYMENT AS FOLLOWS: 2 Payments ALL MATERIALS IS GUARANTEED T BE AS SPECIFIED ALL WORK TO BE COMPLETED IN A SUBSTANTIAL WORKMANLIKE MANNER ACCORDING TO SPECIFICATION SUBMITTED,PER STANDAR PRACTICES.ANY ALTERATION FROM ABOVE SPECIFICATIONS INVOLVING EXTRA COSTS WHL BE EXECUTED ONLY UPON WRITTEN ORDERS,AND WILL BECOME AN EXTRA CHARGE OVER AND ABOVE THE ESTIMATE.ALL AGREEMENTS ARE CONTIGENET UPON STRIKES,ACCIDENTS,OR DELAYS BEYOND OUR CONTROL OWNER IS TO CARRY FIRE,TORNADO,AND OTHER NECCFSARY INSURANCE,OUR WORKERS ARE FULLY COVERED BY WORKMAN'S COMPENSATION INSURANCE-NEITHER PARTY COMMENCES LEGAL ACTION TO ENFORCE ITS RIGHTS PERSUANT T THIS AGREEMENT,THE PREVAILING IN SAID LEGAL ACTION SHALL BE ENTITLED TO RECOVER ITS RESONABLE ATTORNEYS FEES AND COSTS OF LITIGATION RELATING TO SAID LEGAL ACTION,AS DETERMINED BY THE COURT OF COMPETENT JURIDICTION. AUTHORIZED SIGNATURE.' L&G CONTRACTING LLC Jimmy Layer ACCEPTANCE OF PROPOSAL:ABOVE PRICE,SPECIFICATIONS AND CONDITIONS ARE SATISFACTORY AND ARE BEREBRY ACCEPTED.YOU ARE AUTORIZED TO DO THE WORK AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE f p SIGNA V /`-_ DATE OF ACCEPTANCE: y— z 3