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Home My WebLink AboutBLD-23-006064 ; t fil 3-/W020 1 ( K:..ilt4 0 . ,, • Office Use Only Perm itii a-44-02Y 1 itj Amount 7 57 tid 1 ,-iA .,..5)..a 4.r„..,... ,,::., Permit expires 180 days from issue date 6CD -.23 _NR,066114 EXPRESS BUILDING PERMIT APPLICATIOR E C E I V E D TOWN OF YARMOUTH Yarmouth Building Department MAY 02 2023 1146 Route 28 South Yarmouth, MA 02664 BUILDING DEPARTMENT By (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: ,--- r. 4.. _ /is ),1--- yet-E....0_4.r I, ASSESSOR'S INFORMATION: / Map: 1i Parcel: OWNER: 0 1'1 9V....0-al NAi 1 -1/ PRESENT ADDRESS TEL. # ‘/ CONTACTOR: /4-14 keil 7/41e 1/1/14 LOil/a-t (567-ZgO-7 -7Ji2 z-1 NAME MAILING ADDRESS TEL# Residential OCommercial Est,Cost of Construction$ C-S— 03 Home Improvement Improvement Contractor Lic.# /9-.2 9' ?---6 Construction Supervisor Lic.# 9.- 9 6LS70 Workman's Compensation Insurance: (check one) 0 I am the homeowner 0 I am the sole proprietor have Worker's Compensation insurance A Insurance Company Name: 2? f. -.1-, ll/C76)44 hlf Worker's Comp.Policy#\-111C{,„c— ?--ots ri..e„.... WORK TO BE PERFORMED Tent El Duration (Fire Retardant Certificate attached?) Wood Stove Eli i i ing: #of Squares /0 Replacement windows: # Replacement doors: # oofin I. #of Squares ir ( ) Remove existing* (max.2 layers) Insulation n II Old Kings Highway/Historic Dist. Replacing like for like 1E( Pool fencing El D e-t-, _c c -,-„ t-,-./_ , *The debris will be disposed of at: __ Location of Virility I declare under penalties of perjury that the s• e ems herein con fined 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 ion o.1 license and fo osecution under M.G.L.Ch.268,Section I. Applicant's Signature: Date°. ' Ol/2> Owners Signature(or ttach nt) Dte: 0 VO r/Q)•, Approved By: st- 4 Date.: &---;/-7‘-2---- Building Offici desi al r gnee) El‘,1 .A RESS: a Zoning District__ Historical District: Yes No Flood Plain Zone: Yes No Water Resource Protection District: Within 1(10 ft.of Wetlands: Yes No Yes No Done Bel Islands Barnstable.pdf°pen LIT Fo dalire Ds. ® [lb AC ROr CERTIFICATE OF LIABILITY INSURANCE °a THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIN .y. .M CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSUtERISI,AUTHORIZED REPRESENTATIVE OR PRODUCER.AND THE CERTIFICATE HOLDER. IMPORTANT:N fee cMMule MAW ban ADDITIONAL INSURED.the peliry(b)must have ADDITIONAL INSURED provision or be endorsed. N SUBROGATION IS WANED.suSIM to the terms and conditions of Om po;NT.C.TTMC wads,may require an endorsement.A statement an the cRHXkIte dose not confer rights to the C.HORcate holder M INN of such edo ernonds). °nO01@"BRYDEN 8 SULLIVAN INS T 88 FALMOUTH RD nt mr HYANNIS.MA 02601ARNIM— eemEq;lAFFORdNa CPYERACRE IMMO cnuRER".CM InSuLance COrporeoprl _.. 33600 sE SWAMIS BEL ISLANDS HOME IMPROVEMENT LLC 4 CIN LTR enuvu< MARSTONS MILLS MA 02698 '.. -- -- SOMMp: .... POWER COVERAGES CERTIFICATE NUMBER:72957275 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN LSSUED 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 WHRCH THIS CERTIFICATE MAX BE ISSUED OR MAY PERT.THE INSURPHCE AFFORDED 0Y THE POLICIES DESCREED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LARDS SHOWN MAY HAVE BEEN REDUCED BY PNO CLAIMS TrrEwxrmAxcE.. ."""L"�" rIXCYMWf" MAN Em valcvw _. LInTS.. .. ..... MID WA, CLATIMSLAIALLE OCCUR. MEADS.LEE Suwon.. 1 ALITCYGOILILASILIT• SNPLE Lee fiCELS1.411 cLxnK MLDE xr.KEGATE i NT ; A IDEOwrMsxaATlorl : WC5.31S615682-013 2/11/2023 2/11202a�:AIDEBLOYERO tMM.rtY v rmmcN.wKE,EVn Rx xl A. NXcerJ..E Ni oHe IrMMsterE ;5500000g000 L C9 0 OF OPERATIC.e.w. DISEASE LIMEY LVeT s500000 WORKERS COMPENSATION INSURANCE COVERAGE APPLIES ONLY TO THE WORKERS COMPENSATION LAWS OF THE STATE OF MA. TIes certdcale cancels and supersedes all pre iwsly issued cerldeale;.only as awry mete to avrnerS oarnpensallon Coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DERFINDDO POLICES BE CANCELLED BEFORE TOWN OF BARNSTABLE THE EXPIRATION DATE THEREOF.NONCE MALL BE DELIVERED 200 MAIN ST. ACCORDANCE WITH THE POLICY PROVISIONS. HYANNIS MA 02601 MINKMZEIHNIKMON1x0Vt sae Saab F 1111.4ili At8RB trtlRPINtAtROI4 RH 8{i(IM IN*NWWI: AE8148 i81i8i 16I t6Y AG8Rt 009 HH8 ity8 lift Ftig1Elplitl l6dtie e)A68RB Estimate BELISLANDS date Estimate Homeimprovement 4/29/2023 2392 Bel Islands Home Improvement 204 Cinderella Terrace Name!Address Marstons Mills, Ma,02648 Rongjjan Liu 5 Fishing Brook Rd, Belislandsroofingandsiding.com South Yarmouth,Ma,02664 508-280-1794 508-364-6909 Terms Project Description Qty Rate Total New Siding installation(Labor/materials) 10,250.00 10,250.00 1. Strip old sidewall shingles 2.Supply and install proper underlayment(typar paper) 3.Supply and install new white cedar shingles Permit 250.00 250.00 Dumpster 650.00 650.00 • Total $20,650.00 Page 3 L. Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Construd'ti6n'S�'upervisor CS-111305 Ecpires:06/01/2023 ANDRE YARMALO 204 CINDERELLO MARSTONS MILLS at-O 48 tJ Commissioner - w 6 f, (4.6 THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE tritlivdUal Registration 5 i n 172476' 0101/2024 ANDREI YARMALOUIOH D/B/A BEL ISLANDS HOME IMPROVEMENT ANDREI YARMALOVIGH' 204 CINDERELLA TER. MARSTONS MILLS,MA 02648 ' Undersecretary • The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 • Boston, MA 02114 2017 ,,. 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/Individual): 471 e.e. ' i� Address:ji0t4 A O ,1/ City/State/Zip: /I'll/ fiir4 Phone#: c Are y an employer?Check the appropriate box: Type of project(required): I. I am a employer with _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.] $. ❑Remodeling 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. El Demolition 4.0I am a homeowner and will be hiring contractors to conduct all work on my roe I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.QElectrical repairs or additions proprietors with no employees. 5_0I am a general contractor and I have hired the sub-contractors listed on the attached sheet 12.ORoofr Plumbing repairs or additions These sub-contractors have employees and have workers'comp.insurance.* 13.0 Roof repairs 6.1=1We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§l(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'camp.policy number. I am an employer that is providing workers'compensation insurance for information f my employees. Below is the policy and job site Insurance Company Name: v' �l�I'L b)-0'I 41-fte Policy#or Self-ins.Lic.#: ti✓� (5 `��,SZ'(' .7---C ris Expiration Date: `�///eoJob Site Address: iBroo � r-�l City/State/Zip: ` R Attach a copy of the workers' co ensation 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 certi un he airs and e', . P p i es of perjury that the information provided above is true and correct Si• ature: ,�A ''s. Date: 0 �� W ZS Phone#: ! — �S Official use only. Do not write in this area,to be completed by city or town official City or Town: Issuing Authority(circle one): Permit/License# I. Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#•