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HomeMy WebLinkAboutBLD-23-005991 R E C E I V C D C" 1U- Office Use Only 5-) ) 1z..3 Permit# [APR 2 7 2023 TCA MATTA M 5.Sty 4"' BUILDING DEPARTMENT Permit expires 180 days from By issue date &[-D az3--ad5'/II EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: e i \A--k�-�� JA c \ A-"l ASSESSOR'S INFORMATION: Map: Parcel: OWNER: ViM NO -L C�1 \X-1E J WA- f Ceti- `AI 9577 NAME PRESENT ADDRESS TEL. # CONTRACTOR: ARNoLD M-ILKc -Loci Zv )CM'- s (017 0978 NAME MAILING ADDRESS TEL.# ($Residential ['Commercial Est.Cost of Construction$ A k / 1 5° ' 0 d Home Improvement Contractor Lic.# 19' t' 3 Construction Supervisor Lic.# C S 0 g g U 3 Workman's Compensation Insurance: (check one) 0 I am the homeowner ❑ I am the sole proprietor lehave Worker's Compensation Insurance Insurance Company Name: A /(-1 Worker's Comp.Policy# v rtd.t. . l00-(000t,Q -20ZZ.G WORK TO BE PERFORMED Tent E1 Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares CT Replacement windows:# Replacement doors: # Roofing: #of Squares (❑)Remove existing*(max.2 layers) Insulation I I E101d Kings Highway/Historic Dist. 0)Replacing like for like Pool fencing n *The debris will be disposed of at: OS./4 L Location of Facility I declare under penalties of perjury e statements 'ned 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 ion of my li and r prosecution under M.G.L.Ch.268,Section 1. Applicant's Signature: Date: Owners Signature(or attachment) '(=L_ 4 7 7/-IC/1t,t) Date: Approved By: Date: 7 � Building Official(or designee) MAIL ADDRESS: Zoning District: Historical District: Yes No Flood Plain Zone: Yes No Water Resource Protection District: Within 100 ft.of Wetlands: Yes No Yes No (�� rn The Commonwealth of Massachusetts N41E r��z/(lr Department of rnductria! ccidents 1 Congress Street, Suite 100 j 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 (BusinessiOrganization/individual): ,4 R/-1 cc D m 1.L.l . Address: 2 o 9 E TO City/State/Zip: hc).GtAl is A%4 D`oZl (Q() Phone #:(P -1 3\Z 0 9 7 Q Are you an employer?Check the appropriate box: Type of project(required): I.EI am a employer with ' employees(full and/or part-time).* n,._... __ _ i. Uivcw consuucuvu 2.❑I 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 doingall work myself. t 9. ❑Demolition ❑ y [No workers'comp.insurance required.] 4.EI am a homeowner and will be hiring contractors to conduct all work on m YP property.e I will 10 El Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.n1 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.( i i.D. Itooi repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.©Other s 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. 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: A V TU A L .� /�l (Q Policy#or Self-ins. Lic. #: VVAC"100'(ac0(4,93 ,`Zo 41 — 6 Expiration Date: Job Site Address: v7 Elk( u/4 y City/State/Zip:YA RAIDU7H /A Attach a copy of the workers' compensation policy declaration page(showing policy and t date). r-- page the number expiration 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$250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify • • , ;• ns and se, es of. jury that the information provided above is true and correct. Cionaturee• j" Date: Pho .// Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: STEPHANIE&JOHN NOEL 87 WENDWARD WAY WESTYARMOUTH MNA 617-418-9577 johnnynoeljr24@gmail.com Arnie's Structures Unlimited 6, F -3 v ,; 1£ Roofing • Skylights • Siding •Windows • Fine Woodworking SIDING Remove existing vinyl siding and discard EXISTING WINDOW TRIM,RAKE BOARDS,FACIA,SOFFIT AND FREEZE BOARDS TO REMAIN Install water proof hose wrap to striped sections Install Certainteed outside corner posts Install Certainteed inside corners Install Certainteed triple five cedar impressions Re flash existing decks Install exterior light blocks to all lighting Install dryer vent Tie new siding at exterior shower Remove construction debris We propose to furnish and install ail labor and materials to complete work in accordance with these specifications,and subject to the conditions found on both sides of this contract,for the sum of:$ 19,750.00 Payment o be ma�e as follows:$4,900.00 down payment remaining balance upon completion Work , `ibelin oh or about six weeks and be completed by five to eight days. Owner / // By ARNOLD MILKS 3/12/2023 Ownirr 5 i4' `"--- Arnie's Structures Unlimited Date pfgcceptance: t-' J. 7 Z Massachusetts Registration#198773 You may cancel!his contract after signing it within three business days,provided you notify the seller in writing. Owner is'responsible for all expenses and legal fees incurred in collection of any overdue amounts. STEPHANIE&JOHN NOEL 87 WENDWARD WAY 000111111111114114Illkirlk h WEST YARMOUTH MA 617-418-9577 johnnynoeljr24@gmail.com Arnie's Structures Unlimited ;4 Roofing • Skylights • Siding •Windows • Fine Woodworking I. Work area to be done is:ENTIRE HOUSE 2. Cover house,walks&shrubs with tarps to protect against damage. 3. Strip off all layers of old roofing in the work area.Renail any loose sheathing. 4. Install ice and water shield to entire roof deck 5. Install 8-inch white aluminum drip edge around roof perimeter. 6. Install new flashing collars around the plumbing pipes. 7. Remove rear left plumbing pipe and close in hole 8. Replace the lead flashing at base of the chimney. 9. Install new step flashing under the lead at base of the chimney 10. Install new bathroom vent. II. Install CertainTeed roof shingles.LANDMARK PEWTERWOOD 12. Install CertainTeed Shingle Vent II ridge ventilation to all peaks 13. Clean out gutters&downspouts&remove exterior roofing debris including magnetic pickup of stray nails.Cleanup of any roofing debris in the attic is not included. 14. Quality workmanship guarantee. 15. Pull town permit 16. Replacement of rotted or damaged wood will be an additional cost of$6.75 a linear foot for I"x 8"boards 17. We will provide proof of licensure,HIC registration and insurance of Liability and Worker's (injury)Compensation. We propose to furnish and install all labor and materials to complete work in accordance with these specifications,and subject to the conditions found on both sides of this contract,for the sum of$6,400.00 Payment to be ade as follows:$2,500.00 down payment remaining balance upon completion Work ma31 gin orVlor about four weeks and be completed by one to two days. Owner ((, 1 , By ARNOLD MILKS 3/12/2023 Owner �_._ >i�' '`j Arnie's Structures Unlimited Date of iayceptance: Ll l 717 Z 3 Massachusetts Registration#198773 \iYou may cancel fhi},contract after signing it within three business days,provided you notify the seller in writing. Owner is responsible for all expenses and legal fees incurred in collection of any overdue amounts. ACc RL1 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIWYY) 04/27/2023 I THIS CERTIFICATE ISSUE" AS A MATTER 'IF INF"IR AATI^N rINLY AN" CO":FERS NO RI IHTS I IID"N THE r'EPTICI,ATE 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(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions 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 00498-001 NAME CT Branch 498-1 Randolph Insurance Agency Inc PHONE 78 FAx (A/C.No.Ext): ( 1)963-3303 (A/C.No.: 901 North Main Street AFMAIL DDRESS Randolph, MA 02368 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: A.I.M.Mutual Insurance Company 33758 INSURED INSURER B: Arnold Milks Arnie's Structures Unlimited INSURERC: 209 Setucket Rd S Dennis, MA 02660 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 B��YppF�PAID CLAIMSS, INSR TYPE OF INSURANCE INSit POLICY NUMBER (MM/DDCyy D/YY(Y) (MNOI/LDD p rrm) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO- LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) I UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ DED RETENTION $ $ yypRKER oMp N pT�pN l yy�g �J AND ET LIABILITY X I TORY LAMITS I I ER ANYICRO.RRIETORR/ARTNER//RECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000.000.0� A (Mandatory in NH) Y N/A VWC-100-6006938-2023A 4/812023 4/8/2024 E.L.DISEASE-EA EMPLOYEE $ (Mandatory� �b �d 1,000,000.00 DUSCRI ION 6 PERATIONS below - E.L.DISEASE-POLICY LIMIT $ 1,000,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) "Proof of Coverage" Worker's Compensation Coverage Applies to Massachusetts Employees Only The workers compensation policy does not provide coverage for Arnold Milks CERTIFICATE HOLDER CANCELLATION Arnold Milks dba Arnies Structures Unlimited 209 Setucket Road SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE South Dennis,MA 02660 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE it ©1988-2010 ACORD CORPORATION.All rights reserved. jl ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD AMR CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) the.....---- 02/13/23 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(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions 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). CON VA= PRODUCER NAME: Matthew I.Fleischmann Randolph Insurance Agency,Inc PHONE 781-963 3303 FAX 901 North Main Street Arc. o,Ext): (A/C,No 781-961-4124 PO Box 137 ADDRESS: MFlleischmann@Randolphlnsurance.com Randolph, MA 02368 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Ohio Security Insurance Co INSURED INSURER B: A.I.M. Mutual Insurance Co. Arnold Milks d/b/a INSURER C: Arnie's Structures Unlimited 209 Setucket Road INSURER D South Dennis,MA 02660 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. INSR mewl POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER (MM/DD/YYYY) (MMIDD/YYYY) LIMITS © COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 111.1 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ 300,000 III MED EXP(Any one person) $ 15,000 A 1111 BKS(24)52490834 02/10/23 02/10/24 PERSONALS ACV INJURY $ 1,000,000 GENII AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1,000,000 X POLICY n PRO- I�I JECT I I LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY , AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ _ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ WORKERS COMPENSATION $ PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER B OFFICER/MEMBER EXCLUDED?PROPRIETOR/PARTNER/EXECUTIVEI Y NIA VWC E.L.EACH ACCIDENT $ 100,000 (Mandatory In NH) -100-6006938-2022A 04/08/22 04/08/23 If yes,describe under E L DISEASE-EA EMPLOYEE $ 100,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 600,000 DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Residential Carpentry. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Arnie's Structures Unlimited ACCORDANCE WITH THE POLICY PROVISIONS. 11 Nash Lane So.Weymouth,MA 02190 AUTHORI ' NTATIVE ca ja440,04.7yoet,04. / ; ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Commonweahh of Massachusetts 117. Dtvtston of Occupahonai Licensure Board of Building Re a)4S�ms 4nd Standards C8-088043lres: 12/22/2023 ARNOLD P FOLKS 11 NASH LANE WEYMOUTH IA., 02370 • Commissioner c'-r" l: THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type Individual ARNOLD MILKS Registration. 198773 11 NASH LANE Expiration 06/15/2024 WEYMOUTH, MA 02190 Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE: ndividual Office of Consumer Affairs and Business Regulation FIN istretloq )cxgiradgn 1000 Washington Street -Suite 710 198773 06/15/2024 Boston, MA 02118 ARNOLD MILKS 1ARNOLDMILKS 1 11 NASH LANE WEYMOUTH, MA 02190 " i 140.4 Undersecretary ' Not valid without signature