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HomeMy WebLinkAboutUntitled .og•Y,�,4.. Office Use Only l 'j! Pennit# Q/) 0 V� y: Amount %% t Permit expires 180 days from issue date 13 L—b —013 _i 21960 EXPRESS BUILDING PERMIT APPLICA • �► E e TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 JUN 28 2023 South Yarmouth, MA 02664 L___ (508) 398-2231 Ext. 1261 BUILDING DEPARTMENT ,j J ©y CONSTRUCTION ADDRESS: � � d�/Utif� ASSESSOR'S INFORMATION: I , � D�Map: Parcel: y� OWNER: 1 AOI\ 'f/ S r v€I,I 22-C�IAUg&p I/RiSt L(/\2 ��` Cc- 7 NAME 1 PRESENT ADDRESSQ /�-' /�/� TEL. # /n CONTRACTOR:- I�J Jl , gUl 1/a�INZ GO` LL Lia?nik)tv�Vr7ut• t7t Sv8.3 6. I. O24X/ NAME MAILING ADDRESS TEL.# 0 Residential 0 Commercial Est.Cost of Construction$ 16630,6D Home Improvement Contractor Lic.# l l O�a'7 Construction Supervisor Lic.# ® L g 8u3 Workman's Compensation Insurance: (check one) 0 I am the homeowner 0 I am the sole proopriietorI vA I have Worker's Compensation Insurance 7 Insurance Company Name: (- 6 ZTt I r ►6 V Worker's Comp.Policy# V V G�— 3) J' 3 l9 ?t ( ' 0'" -7 WORK TO BE PERFORMED Tent fi Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares I -1 (J)Remove existing*(max.2 layers) Insulation I I I I Old Kings Highway/Historic Dist. cp Replacing like for like Pool fencing 17 , 'The debris will be disposed of at: � �� E].��� `yr& Zl7v 1024th 24. S 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 rev tion of my license and for prosecution under M.G.L.Ch.268,Section 1. Applicant's Signature: Date: ' l'7,)3 Owners Signature(or attachment) Date: Approved By: Date: 7 Building Official(or designee) EMAIL ADDRESS: /i.' ) Fe f �}n v/ fie 1911! 1 1 Zoning District: ('6l _ Historical District: Yes No Flood Plain Zone: Yes No Water Resource Protection District: Within 100 ft.of Wetlands: Yes - No Yes No c its' ink • • • i . 6/12/23,10:37 AM image0.jpeg t g^ylge -y YY 1' a e X^$. d; tix* �a5' �f f. at; -'r� i..:*' X fy�r€.k4 aa .cr �-.., '' THOMAS R.DANEHY GENERAL CONSTRUCTION 32 ARCADIA ROAD BILLERICA MA.01821 978"337=9753 THOMAS MELIDEO �M. 22 CLOVER RD WEST YARMOUTH MASS THE FOLLOWING PROPOSAL DESCRIBES THE WORK TO BE DONE,MATERIAL TO BE USED AND A PRICE BASED ON THESE DETAILS.PLEASE REVIEW THIS PROPOSALAND SIGN BELOW IF YOU ARE IN AGREEMENT.I HAVE E ENCLOSED TWO COPIES,PLEASE SEND ME A SIGNED ONE AND KEEP THE OTHER FOR YOUR RECORDS. JOB SITE SAME t* 1 REMOVE AND DISPOSE OF ALL EXISTING ROOF SHINGLES 2 INSTALL 9 FT.OF ICE AND WATER SHIELD 3 COVER REMAINING ROOF DECK WITH SYNTHETIC ROOFING PAPER r 4 INSTALL WHITE ALUMINUM DRIP EDGE ON ENTIRE ROOF PERIMETER 5 INSTALL NEW PLUMBING FLANGES ,: 6 FLASH ALL CHIMNEYS(NEW LEAD CUT IN) 7 INSTALL 30 YEAR ARCHITECTURAL SHINGLES 8 INSTALL NEW RIDGE VENT 9 REMOVE ALL JOB RELATED DEBRIS NOTES ANY DAMAGED LUMBER BEYOND 32 BOARD FT.WILL INCUR AN Re ADDED EXPENSE TO BE DISCUSSED AT TIME OF DISCOVERY TO BE PAID IN FULL PON COMPLETION. $9,980.00 SIGNATURE 4 RESPECTFULLY SUBMITTED, THOMAS R.DANEHY 4 �wc https://mail.google.com/mail/u/0/?tab=rrn&ogbl#inbox?projector-1 1/1 _ _ The Commonwealth of Massachusetts 1"_- . i'fi Department of Industrial Accidents :and=.—r 1 Congress Street,Suite 100 :r= .i i:1,- 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 li,eeibly Name(Business/Organization/Individusi):Feltonville Building Company, LLC Address:483 Main Street City/State/Zip: Hudson MA 01749 Phone/i: 508-361-0296 Are you an employer?Cheek the appropriate box: Type of project(required): 1.0 I am a employer with employees(fall and/or pan-time).' 7. ❑New construction 2.0 I am a sole proprietor or partnership and have no employees working forme in 8. Remodelin arty capacity.[No workers'comp.insurance required] ❑ g 3. lam a homeowner doing all work 9, 0 Demolition ❑ n8 myself:[No workers'comp.insurance required.]; 4.0 lam a homeowner and will be hiring contractors to conduct all work on m y property. I will 10 El Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.O Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.0 lam 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.In Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.El Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] 'Any applicant that checks box S t 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 him outside contractors must submit a new affidavit indicating such. :Contractors that check this box most attached an additional sheet showing the name of the sub-contractors and stale whether or not those entities have employees. lithe sub-contractorslave employees,they must provide heir workers'c_-- — 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: Liberty Mutual Insurance Company Policy#or Self-ins.Lic.#: WC2-315-319361-047 Expiration Date: 717/20 Z j Job Site Address:liC lAAL ' L City/State/Zip: 0z&73 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 a pains and penalties of perjury that the information provided above Is true and correct. �.� Date: 6 .24. .3 Phone#: 978-337-9753 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#: e �{S ff7 S -�ffiT rT�4e. _ .._gym .. e i.F \ .1.444 e{ < _ ..... �.._. ..1. �.<. -._ 0y��,, M ;(i:2{r C+ ;C'w''#L.... .., i , , • .., `^!,. - .d. ,..,.^,44",e^.C4')-' Y ettr?..3 'Y" '.71 E F, , ;'f`F .T,ti ¢. . ws i,.:YF; ^C3',t�: e F a. v a:r •.^t C ' I C. , � x k � `'b tie �-! � 4 `'- issx t. 4, F 41,p _. -. >J' t . f..,--t }iv.-`'4 '3e r .trttif - x .., 1r x - -;:., fi t= y <3 t CF 1 Construction Supervisor Unrestricted-Buildings of any use group which contain Commonwealth of Massachusetts less than 35,000 cubic feet(991 cubic meters)of enclosed ® Division of Occupational Licensure space. • Board of Building Regulations and Standards Con tr l S ervisor CS-049843 ` "Um_ttpires: 09/22/2024 IAN B MAZMNIAN.: 483 MAIN STi_ AD HUDSON MA'V1749 Failure to possess a current edition of the Massachusetts rb , State Building Code is cause for revocation of this license. C. i fa.ratatioa..about t :i ���I l frd1�J Call(617)727-3200 or visit www.mass.govldpl lllllll "'11,1 uy Registration valid for individual use only before the expiration date. if found return to: J Office of Consumer Affairs and Business Regulation THE COMMONWEALTH OF MASSACHUSETTS 1000 Washington Street -Suite 710 Office of Consumer Affairs&Business Regulation Boston,MA 02118 HOMEIMPROVEMENt' ONTRACTOR Re•istratt"." ::: :tion 19049T: ' x Z' -a 24 FELTONVILLE BUILDW4 r rt 1 Not valid without signature IAN MAZMANIAN --� •`/ 483 MAIN ST ,Yf. `i' HUDSON,MA 01749 '-f_et Undersecretary