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Home My WebLink AboutBLD-23-005963 RECEIVED 'Office Use Only �. APR 2 2023 Permit# �1 //cc,Dg O _ H 4 Amount q ,� . ;� MyA,TTA 11 c : BUILDING DEPARTMENT Permit expires 180 days from s •v ;: By— — issue date PLC -023 -- 5O59&..3 EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: 495 Station Avenue. South Yarmouth, MA ASSESSOR'S INFORMATION: Map: Parcel: OWNER: Warren Woods 495 Station Ave. (508) 737-1192 NAME PRESENT ADDRESS TEL. # CONTRACTOR: Supreme Systed 788 Sheridan St. Chicope% (413) 331-4490 NAME MAILING ADDRESS TEL.# ❑Residential 0 Commercial Est.Cost of Construction$ 183,190.00 Home Improvement Contractor Lic.# 184080 Construction Supervisor Lic.# 106059 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: Worker's Comp.Policy# WORK TO BE PERFORMED Tent U Duration (Fire Retardant Certificate attached?) Wood Stove 1-1 Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares 150 (0)Remove existing*(max.2 layers) Insulation I r l I I Old Kings Highway/Historic Dist. (Q))Replacing like for like Pool fencing n *The debris will be disposed of at: CL Noonan - Bridgewater 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 revocatio licens for prosecution under M.G.L.Ch.268,Section I. Applicant's Signature: Date: 4 la Owners Signature(or attachment) Date: Approved By: Date: / 7 2 3 Building Officia es' e) EMAIL ADDR Zoning District: Historical District: Yes "1 No Flood Plain Zone: Yes No Water Resource Protection District: Within 100 ft.of Wetlands: Yes No 2Yes No The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Imp Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individua[): Supreme Systems Inc Address: 788 Sheridan Street City/State/Zip:Chicopee MA 01020 phone#: 413-331-4491 Are you an employer?Check the appropriate box: Type of project(required): 1.01 am a employer with 15 employees(full and/or part-time).* 7. ['New construction 2.0I 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. ❑Demolition 10❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insurance? 6.0We are a corporation and its officers have exercised their right of exemption per MGL c. 14.El 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: Brier Payne Meade Policy#or Self-ins.Lic.#: 5092135967 Expiration Date: 5/1/2024 Job Site Address:495 Station Avenue City/State/Zip: S.Yarmouth, MA 02664 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 un pain d penalties of perjury that the information provided correct.above is true and / Signature: Date: 44 Jaq f a 3 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): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: SUPRhM1 ROOFING. DONE. RIGHT. PROPOSED PROJECT AGREEMENT: PROPOSAL DATE: 03/20/2023 PROPOSAL NUMBER: #3382-2704 PREPARED FOR: Warren Woods PREPARED BY: Joshua Batchelor Senior Estimator (413)210-3757 supremeroofing.com ( Offices In Texas, Massachusetts, Oklahoma and Colorado Agreement Page 2 of 7 SUPREME ROOFING. DONE. RIGHT. PROJECT PROPOSAL COMPANY PROPOSAL DATE: 03/20/2023 Supreme Systems Inc PROPOSAL NUMBER #3382 -2704 788 Sheridan Street Chicopee, MA 01020 PROPOSAL FOR: LOCATION: Warren Woods 495 Station Ave. 495 Station Ave. 495 Station Ave. South Yarmouth, MA South Yarmouth, MA After a thorough evaluation of the roof and roof system components at your 495 Station Ave.property in Yarmouth,MA.we are pleased to provide the following proposal for the approximate 15,000 square foot roofing roject: • Install temporary safety equipment to provide a safe and secure construction site for our roofing professionals as well as your employees and the general public.This equipment will meet or exceed OSHA and company set safety pnlides(Supreme Roofing provides an on-site full- time Superintendent on all projects). • Completely slice existing EPDM membrane into 10'x'0'grids and leave in place. • Furnish&Install one(1)layer of mechanically attached 1/2"high density coverboard over sliced membrane. • Furnish&Install new'G"per foot polyiso tapered crickets in between scupper locations to direct storm water to scuppers and alleviate existing ponding water. • Furnish&Install new fully adhered.060 black EPDM membrane along wlth.all terminations and fleshings and ensure it is done in strict accordance with manufacturers specifications. • Furnish&Install manufacturers EPDM walkway pad at service sides of roof top equipment and roof access points.(93LF covered) • Fabricate&Install perimeter edge sheet metal coping fleshings constructed of 24-gauge Kynar coated steel and a continuous retaining clip constructed of 22-gauge galvanized steel.(color to be selected from standard color chart) • Fabricate&Install thirteen(13)new scuppers constructed of 24-gauge galvanized TPO coated metal. • Fabricate&Install new counter fleshings at roof top equipment constructed of 24-gauge galvanized steel. • Clean up)and remove all related debris from jobsite and dispose of properly in an approved container.(dumpsters to be supplied by SupremeR • Provide building owner with a 20-year manufacturer's warranty. • Provide building owner with a 2-year Supreme Systems Inc.workmanship guarantee. TOTAL: $183,190.00 X Lump Sum Payment Terms To Be 50%Upon Arrival,40%Upon Completion,10%Upon Warranty Price Breakdown: Labor:-$65,300.00 Materials:•$105,000.00 Equipment:-$12,890.00 supremeroofing.com I Offices in Texas, Massachusetts, Oklahoma and Colorado Agreement Page 3 of 7 SUPREMEG) ROOFING. DONE. RIGHT. X Tax Included PROPOSAL PRICING IS GOOD FOR 30 DAYS. ADD: Price To Replace Any Existing Wet Or Damaged Insulation: $4.50/Sq.Ft. ADD: Price To Replace Any Rotted Or Damaged Steel Decking:$8.50/Sq.Ft. ADD:,Price To Replace Any Rotted Or Damaged Wood Blocking:$5.50/Bd.Ft. Upon execution as provided below,this agreement,including the following pages attached hereto(collectively, the "Agreement")shall become a binding and enforceable agreement between both parties hereto.Customer,by execution of this Agreement,acknowledges that it has reviewed and understands the attached terms and conditions and has the authority to enter into this Agreement. CO, - TOR: CUSTOMER: „IJibI, c.v... l�, / T t. _, I Signa e/Aut oozed Representative Signature/Authorized Representative 1 Joshua Batchelor 413 210-3757 /4/77 KW, .J_ C'"--"J")1 Name(Print/Type) Phone Namem (Print/Type) PO 03/2012023 1///t`'f147 3 Date Date supremeroofing.com I Offices in Texas, Massachusetts, Oklahoma and Colorado 0 NI 1.r.itistilikotrINN,::,:- ittxu4440,-- ,„,,,v::"Antip, - tift , ,. _, ,,, T,,,,,,,,,,t,"4- 0-,4L , ,„„„„„„„ i.- a CI t� !!\ i 3 sow 4 iii a itts) 66 3 6 0) 0 IC i 414* fliji CO) inj aim _NO NNW 0 In y 4•;,i emir 0 4 . Ihne 3it 0 12--- rtitil Pil ',f , ,, 0 c ?urn toll 2 mit ' Q 0 a} ' E --mil 03 4/...* i grif tit as 2 z › 416 c - , 1-4 . I 01 tn tg) ct CO" 0 II I 44--c) zo ea- co „. 0 Mil _,...___, _00 ni u9 a on" :„.,:,, „,,;:,::. % .,.._ ,.., :: co THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affair attcI Business Regulation 1000 Washingt #,, -Suite 710 Boston mssactaus st (J 118 Home Improtren ent"{bra ractor Registration xr Type: Corporation " e station: 184080 SUPREME SYSTEMS,INC. 7,:—_, Expiration: 11/06/2024 788 SHERIDAN ST CHICOPEE,MA 01020 k Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for Individual use only before the HOME IMPROVER ,N, CONTRACTOR expiration dale. If found return to TYPE &oration Office of Consumer Affairs and Business Regulation ReoistiaHon fjtiair8t(yJ1 1000 Washington Street-Suite 710 184t 80 'I 11106/2924 Boston,MA 02118 SUPREME SYSTEMS INC u JON HAMBLEY 788 SHERIDAN ST %2 '4 CHICOPEE,MA 01020 Undersecretary Not valid without signature