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HomeMy WebLinkAboutBLD-22-006407 i -C • Put 1 I z21irL - ONE& TWO FAMILY ONLY- BUILDING PERMIT RECEIVED Town of Yarmouth Building Department or 1146 Route 28,South Yarmouth,MA 02664-4492 r MAYE. 5 Z022 508-398-2231 ext. 1261 Fax 508-398-0836 41 ,+ r, Massachusetts State Building Code,780 CMR E3 u i D Ming Permit Application To Construct,Repair, Renovate Or Demolish 6y_ a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: I? i)-2,Z—OC Y b7 I Date Applied: 1 1Y" CAN ICJ Building Official(Print Name) Si „''1Ck W• Sgnature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 85 Wanno Road 135 167.1 1.1 a Is this an accepted street?yes V no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Residential 40511 NA Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) -1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required I Provided Required NA Provided Required Provided NA NA NA NA i NA 1.6 Water Supply:(M.G.L c.40.§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public tx Private 0 Zone: _ Outside Flood Zone? Check if yes} Municipal❑ On site disposal system X SECTION 2: PROPERTY OWNERSHIP 2.1 Owner'of Record: Jane McColl Yarmouthport, MA Name(Print) City,State,ZIP 85 Wianno Road 617-510-0564 janemorrismcco1l88©gmail.com No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK=(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 I Repairs(s) I Alteration(s) 0 I Addition 0 Demolition ❑ Accessory Bldg. 0 Number of Units I Other ❑ Sec Specify: Brief Description of Proposed Work2: Water Damage repairs. Includes kitchen, garage, 2nd second floor hallway and room above garage. Work to include insulation, sheetrock, carpentry/trim,floors and paint. Plumbing and electrical inspected as needed. SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Labor and Materials) Official Use Only 1.Building $ 189,500.48 I. BuildingPermit Fee:$ Q Indicate how fee is determined; 2.Electrical $ 18,317.18 ❑Standard City/Town Application Fee 3.Plumbing $ ❑Total Project Cost' Item 6) multiplier x 14,081.73 2. Other Fees: $ •V`' -- 4.Mechanical (HVAC) $ 2,394.83 List:-------_________ ‘c, p }�- 5.Mechanical (Fire Su eSS]OA Total All Fees:$ 6.Total Project Cost: $ 224,495.22 0 Paid in Full Check No. Check Amount '\`O nceh unt: ❑Outstanding Balance D,e: i 6, _r (,)2W Z2 5 .T' . SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) Clarence Hart Jr. 097094 07/16/2022 Name of CSL Holder License Number Expiration Date 11 Percival Drive List CSL Type(see below) U No.and Street Type Description West Barstable, MA 02668 1141 1 Unrestricted(Buildings up to 35,000 cu.ft.) City/Town,State,ZIP Restricted leaFamily Dwelling M Masonry • RC Roofing Covering WS Window and Siding 6173594666 brendanl@Iewisandweldon.com SF Solid Fuel Burning Appliances Telephone I Insulation Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) Lewis&Weldon Custom Cabinetry 154680 03/28/2023 HIC Company Name or HIC Registrant Name HIC Registration Number Expiration Date Clarence Hart Jr. and Stree brendanl@lewisandweldon.com 1i'7 Airpor4 Road, Hyannis MA 02601 6173594666 Email address City/Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(MVI.G.L.c.152.§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes X No p . SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize Lewis&Weldon Custom Cabinetry to act on my behalf,in all matters relative to work authorized by this building permit application. Jane McColl 1Print Owner's Name(Electronic Signature) April to 2022 Date SECTION 7b:OWNER:OR AUTHORIZED AGENT DECLARATION By entering my n...e • low,I hereby attest under the pains and penalties of perjury that all of the information contained . • .,'on is true and accurate to the best of my knowledge and understanding. it MI \ April 15, 2022 Print Owner' •uthorize. Agent's Name(Electronic Signature) Date NOTES: I. An Owner who obtains a building permit to do his/her own work,or an owner who hires au unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.eov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) 2417 Gros living area 1815 (including garage,finished basement/attics,decks or porch) Number of fireplaces 1 Habitable room count 6 Number of bathrooms 2 Number of bedrooms 3 Type of heating system gas Number of half/baths 1 Number of decks/porches 1 Type of cooling system gas Enclosed Open V 3. "Total Project Square Footage"may be substituted for"Total Project Cost" J ! \ • The Commonwealth of Massachusetts 1r =:'M1_ Department ofIndustria/Accidents Y_ 1 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass. ov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. A 'leant Information Name(Business/Organization/Individual): e y Please Print Leoibl S An� �a�/o/! Address: /// I,;e and Q AI City/State/Zip: //,in,;,f Ai 601401 Phone#: 6/7•35"9-4/GL4 Are you an employer?Check the appropriate box: 1 Type of project(required): .21 am a employer with 9 employees(full and/or part-time).* 2.❑I am a sole proprietor or partnership and have no employees working for me in 7. 0 New construction any capacity.[No workers'comp.insurance required.] 8. Remodeling 3.ElI 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 my property. I will 10❑ ensure that all contractors either have Building addition workers'compensation insurance or are sole l 1.[]Electrical repairs or additions proprietors with no employees. 5.0 I 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. 12'❑Plumbing repairs or additions 13.❑Roof repairs ees p Y insurance.* 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. ❑ 152,VOX and we have no employees.(No workers'comp.insurance required.] 14' Other *Any applicant that checks box g I 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 indicatingsuch. *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 subcontractors have employees,they must provide their workers'comp. er. I art an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site Insurance Company Name: Selective Insurance Company of America Policy#or Self-ins.Lic.#: WC 9084610 Expiration Date: 04/15/22 85 wanno Road A Job Site Address: Attach a copy of the workers'compensation policy declaration page(showing the City/State/Zip nu ber andte,expiration da Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine upto$1 5 te) and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of upto$250 dayagainst 00.00 .00 gainst the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance a coverage verific.a:, 1 do hereby certi to •er the A'P, and penalties operjurythat the information provided above is true and correct. f Si•nature: ec .� -, Phone#: 61735'`4666 Date: 4/15/22 Official use only. ►o not write in this area,to be completed by city or town official City or Town: Issuing AuthorityPermit/License# (circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbin6. g Inspector Contact Person: Phone#: • §TOWN OF YARMOUTH 1146 Route 28, South Yarmouth, MA 02664 508-398-22311 e4-1261 Fax 508-398-0836 Office of the Building Commissioner • BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Ch. 40, §54 and 780 CMR- Section 105.3.1. #4. I hereby certify that the debris resulting from the proposed work/demolition to be conducted at 85 Wianno Road Work Address Is to be disposed of oat the following location: Pina Sanatation 53 Bowdion Road, MA 02649 Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. l §150 • . 4/15/22 Signature f Application Date Permit No. �.,,,,, LEWIAND-01 MBOLLINO '4`�R�} CERTIFICATE OF LIABILITY INSURANCE DATEGAIN°°""'Y) 5/10/2021 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 policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and condkions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in Neu of such endorsement(s). PRODUCER CNTCT 12nen' tre Wc°No,E (508)824$666 nc,No (508)880-01428DaS t Taunton,MA 02780 ss:infogifbinsure.com INSURERS)AFFORDING COVERAGE NAIC a INSURER A:Selective Insurance Company of America 12572 INSURED INSURER B:Selective Ins Co of SC 19259 Lewis and Weldon Custom Cabinetry LLC INSURER C: 111 Airport Road Hyannis,MA 02601 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED 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. LINTR TYPE OF INSURANCE INSD WVD POLICY NUMBER ( /rall�OIDO EXP l.MTB A X COMMERCIAL GENERAL LABILITY EACH OCCURRENCE ; 1,000,000 CLAIMS-MADE n OCCUR $ 2443341 5/10/2021 5/10/2022 PREABSETOiE EN EDncel $ 500,000 MED EXP(Any one person) $ 15,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEM%AGGREGATE UMIT APPUES PER: GENERAL AGGREGATE ; 2,000,000 51 POLICY X 111 n LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: EMPLOYEE BENEFI $ 2,000,000 A AUTOMOBILE LIABILITY (COOMBIINaccidEDD SINGLE LIMIT $ 1,000,000 ANY AUTO A 9108697 4/25/2021 5/10/2022 BODILY INJURY(Per person) ; OWAAUTTOS ONLY X EDULED AIMS AUTOS ►(�D BODILY�INJURY M(Per accident), $ X AUTOS ONLY X AUTOS ONLY (PeraCdderlt) E _ ; A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE S 2443341 5/10/2021 5/10/2022 AGGREGATE $ 1,000,000 DED X RETENTION; 0 ; B WORKERS AND EMPLOYERS' X ST TUTE OTH- ER ANY F��PRERO�P,IRpIE�,�T�OR�/PARTNER/EXECUTIVE YIN WC 9084610 5/10/2021 5/10/2022 500,000 (Maud=in NH)EXCLUDED? n N/A E.L EACH ACCIDENT $ 500,000 �"y"��1 E.L DISEASE-EA EMPLOYEE ; DESCRIPTION OF OPERATIONS below EL DISEASE-POUCY LIMIT $ er 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101.Additional Remelts Schedule,may be attached If more space Is required) Custom Cabinet manufacturer,installation,and general contractor for residential building construction CERTIFICATE HOLDER CANCELLATION — SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Lewis and Weldon Custom Cabinetry LLC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 111 Airport Road ACCORDANCE WITH THE POUCY PROVISIONS. Hyannis,MA 02601 AUTHORIZED REFRESENTATNE 177te.41.411- ACORD 25(2016/03) 01988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards ConstR &St rvisor i, E C S-097094 pi res:07/16/2022 CLARENCE ICI H , _- 11 PERCIVAL WEST BARNSxi►BI `, Commissioner dyi Kj, (7F.m(.Ita. 5/5/2021 Office of Consumer Affairs&Business Regulation-Mass.Gov M ass.gov Office of Consumer Affairs and Busines , . Regulation (OCABR) \ w 0 o N >' �3 =z � 9� z �- 4 �vp o a d Ew aizog O HIC Registration Complaints I ` 'D1U `_c. c. oa WoM S= �, ui Registration # 154680 co re a z Registrant LEWIS & WELDON CUSTOM CABINETRY, LLC. Name CLARENCE HART JR. Address 111 AIRPORT RD City, State Zip HYANNIS, MA 02601 Expiration Date 03/28/2023 Complaints Details No complaints found for this registrant. You can also view arbitration and Guaranty Fund history. 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