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HomeMy WebLinkAboutBLD-23-005000 pu //t& 3 ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department ` .)\I 1146 Route 28, South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 t.. Massachusetts State Building Code,780 CMR Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family o Dwelling '"� � �\ n This Section For Official Use Only Building Permit Number: «J ,3 C.p(J Date Applie . 3/10/2024 , R F-C E I E D Building Official(Print Name) • ' Signature MAtel 0 4123 SECTION 1:SITE INFORMATION BUILDING DEPA'TMENT 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 135 West Yarmouth Rd,West Yarmouth,MA,02673 By. 1.1 a Is this an accepted street?yes x no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: 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 Provided Required Provided I 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: _ Outside Flood Zone? Check if yes❑ Municipal 0 On site disposal system El SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Robert&Claire Whitty West Yarmouth,MA,02673 Name(Print) City,State,ZIP 135 West Yarmouth Rd No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK(check all that apply) x New Construction 0 ! Existing Building IN I Owner-Occupied ❑ I Repairs(s) 0 Alteration(s) ® I Addition 0 Demolition ❑ Accessory Bldg. 0 I Number of Units 1 I Other 0 Specify: Brief Description of Proposed Work2: Bathroom remodel(new shower,new tile floors&vanity)in same footprint. 0, Z Ii 1 o tx 1 SECTION 4:ESTIMATED CONSTRUCTION COSTS. No 1 1 a Item • Estimated Costs: .0 I" (Labor and Materials) Official Use Only 1.Building $ 1. Building Permit Fee:$ ��0 Indicate how fee is detemline x 2.Electrical $ 4�Standard City/Town Application Fee J ❑Total Project Cost3(Item 6)x multiplier x �' m 3.Plumbing $ 2. Other Fees: $ .j' 9a ----�-- 4.Mechanical (HVAC) $ List: �� 5.Mechanical (Fire . Suppression) $ Total All Fees:$ , ��i Check No. Check Amount: Cash ount:, ' 6.Total Project Cost: $ 16,000 ID Paid in Full 6�Outstanding Balance D : i'� \ V SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-115191 8/5/2024 Name of CSL Holder License Number Expirationto e Mark Rocha Jr List CSL Type(see below) lJ No.and Street Type Description 25 Blackthorn Path U Unrestricted(Buildings up to 35,000 cu.ft.) City/Town,State,ZIP R Restricted l&2 Family Dwelling Forestdale,MA 02644 M MOB` • RC Roofing Covering WS Window and Siding 774-327-0459 SF Solid Fuel Burning Appliances mrocha@efwinslow.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) Elisha F Winslow IV 132379 1/17/2025 HIC Company Name or HIC Registrant Name HIC Registration Number Expiration Date 8 Reardon Circle mrocha efwinslow.com Na.and Street @efwinslow.com Yarmouth,MA,02664 508-394-7778 Email address City/Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.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 ® No Cl 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 EF Winslow Plumbing&Heating to act on my behalf,in all matters relative to work authorized by this building permit application. Robert&Claire Vi 'text here Print Owner's Name(Electronic Signature 3/10/20 24 Date SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. Print Owner's or Authorized 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 an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty find under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.00v/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.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed . Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" • The Commonwealth of Massachusetts `l Department of Industrial Accidents 1! 1 Congress Street, Suite 100 e Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. ,I,.pplicant Information Please Print Legibly Name (Business/Organization/Individual): Mark Rocha Jr Address: 25 Blackthorn Path City/State/Zip:Forestdale, MA, 02644 Phone#: 774-327-0459 Are you an employer?Check the appropriate box: Type of project(required): 1.12 I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. El Demolition 4❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Et Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 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.insurance.: 13.0Roof repairs 6.❑We area corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 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: Arrow Mutual Liability Insurance Policy#or Self-ins.Lic.#: 2019A Expiration Date: 1/1/2024 Job Site Address:135 West Yarmouth Rd City/State/Zip:W.Yarmouth MA 02673 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 under the ains and penalt' of perjury that the information provided above 's true an correct Signature: Date: 3 ?q5Zi3 Phone#: 774-327-0459 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#: '`� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 3/10/2023 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). PRODUCER CONTACT RogersGray, Inc-Kingston Branch NAME: 434 Route 134 PHONE (A/c.No.Ext):80 0 553-1801 FAX No):877-816-2156 South Dennis MA 02660-1601 E-MAIL ADDRESS: mail@rogersgray.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Arbella Protection 41360 INSURED EFWINSL-01 INSURERS:Arrow Mutual Liability Insuran 13374 E. F.Winslow Plumbing&Heating, Inc. 8 Reardon Circle INSURER C: South Yarmouth MA 02664 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1962839109 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 ABbiJ IJBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY Y 8500069272 12/1/2022 12/1/2023 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $100,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY X PE X LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY Y 102007840205 12/1/2022 12/1/2023 COMBINED SINGLE LIMIT $1,000,000 ANY AUTO (Ea accident) BODILY INJURY(Per person) $ OWNED x SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ $ A X UMBRELLA LIAB X OCCUR 4620088355 12/1/2022 12/1/2023 EACH OCCURRENCE $2,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $2,000,000 DED X RETENTION$1n,nnn $ B WORKERS COMPENSATION 2019A 1/1/2023 1/1/2024 X PER R I J OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE E ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE $500,000 DESCRIPTION OF OPERATIONS below _ E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACOI:D 101,Additional Remarks Schedule,may be attached if more space Is required) Plumbing&Heating Contractor. Central Vacuum is a division of E F Winslow Plumbing&Heating Inc. When Required by Written Contract the Following Applies: General Liability-Additional Insured Ongoing(30AI'2195 04 21)and Completed Operation(30AP2195 04 21) Primary and Non-Contributory Basis(30AP2195 04 21),Waiver of Subrogation(30AP2195 04 21) Automobile—Additional Insured,Primary and Non Contributory Basis,Waiver of Subrogation(26AP1034 11/19) Workers Compensation—Waiver of Subrogation(Cndorsement#4) Excess/Umbrella—Additional insured follows form over underlying General Liability and Automobile Liability No Residential Exclusions CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. TOWN OF YARMOUTH 1146 ROUTE 28 SOUTH YARMOUTH MA 0266' AUT ED REPRESENTATIVE i 7/..a4.„ I _.. ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) 1 CORD name and logo are registered marks of ACORD • UM/1 1$ 11 Valiff ....4 41111111111.1111 111.k. OM kko-Variberar r 4, 41 k & k r . , t . . --.'r tAiar k• k*•• ..... ..... kkk.k- .0-, •+-- k-.. ... THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs & Business Regulation registration valid for ir HOME IMPROVEMENT piration date. If foun - .,...11, . TYPE: ation , Fice of Consumer Aff: _____ .. R,1!i II f.f.i.l!1 t -:-Sitsk tion )0 Washington Street , f 4 02 "to ..1 I 'i ston, MA 02118 E.F.•: F WINSLOW PLU 114,14. ....14-.11.,V,`. of , INC a .... mc ri '2; ii". 44'. •"'":'742,34 * 4—""*..... 4 :LISHA F. WINSLOW .4,fa 741,(%/04 , i - , 4,,..,eit.rokr[ •3 REARDON CIRCLE ,. ' , SOUTH YARMOUTH, MA It?p,,.. 6;.._,. ..,,A,--' Undersecretary ‘ Not valid wi A ,---- Commonwealth of Massachusetts ill Division of Professional Licensure Board of Building Regulations and Standards � Cons tr 6/i O Erviso '1 CS-- 1 1 5 1 9 1 � ;:gin ,. rot"MARK A RSA xs, Tres: 08/05/2024 v. 25 BLACKTHORN 7 f,.,! FORESTDAL q # .`* 'y S " . • xq Com missiorr di ed. K. ul .a., §TOWN OF YARMOUTH 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext.-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 135 West Yarmouth Rd,West Yarmouth,MA,02673 Work Address Is to be disposed of oat the following location: Yarmouth Disposal Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. 3/10/2024 Signature of Applic 'on Date Permit No. E. . Wins1 w Quote Number: 30779 t (� Work Order Id: I' !. 599498 1 Date: 01/11/2023 f r Submitted By: Propo al To: Cal 1 1I Service Location: GLENN WHITT CLAIRE OP Page: 1 of 4 WHITTY, WHITTY, CLAIRE* 135 WEST YARMOUTH RD. 135 WEST YARMOUTH RD. WEST YARMOUTH MA 02673 (:) () 9 WEST YARMOUTH MA 02673 7711132 Thank you for giving EFW the opportunity to provide you with an estimate. We look forward to working with you, and to show you our professional workmanship. Please do not hesitate to contact me if you have any questions or concerns. DIRECT LINE: 508.258.5225 or EMAIL: glennraymond@efwinslow.com Option# 1 WE WILL PROVIDE THE FOLLOWING PLUMBING AND CARPENTRY SERVICES FOR THE 1ST FLOOR HALL BATHROOM: *REVISED;2-9-23 **PLUMBING** *WE WILL SUPPLY AND INSTALL THE FOLLOWING FIXTURES; *1 KOHLER BALLAST SHOWER BASE K-1936-0,ACRYLIC,WHT.32"X60". *1 KOHLER DEVONSHIRE SHOWER VALVE#TS396-4G-CP,CHROME WITH ROUGH-IN VALVE. *1 KOHLER DEVONSHIRE TRANSFER VALVE#T376-4G-CP,CHROME WITH ROUGH-IN VALVE. *1 KOHLER PURIST SUPPLY 9D K-22172-G-CP, *1 KOHLER PURIST MULTI-FCTN. HANDSHOWER KIT K-22178-G-CP WITH HOSE AND SLIDE BAR. *1-42"GRAB BAR CONCEALED FLANGES,BRUSHED STAINLESS FINISH,PLACED ON A DIAGONAL ON THE BACK WALL. *1-18"GRAB BAR ON THE VERTICAL,RIGHT END OF SHOWER. *FIXTURES TO BE VERIFIED BY OWNER. *INCREASE THE SHOWER DRAIN SIZE IN THE BASEMENT,REPIPE AS NEEDED PER CODE. *NEW WASTE PIPES TO BE PVC. *REPLACE THE OLD EXISTING WATER PIPES IN THE VALVE WALL DOWN TO THE BASEMENT. *NEW WATER PIPES TO BE TYPE L COPPER TUBING. • *REMOVE W.C. BEFORE DEMO, RESET W.C. AFTER THE NEW SHOWER IS INSTALLED. *WE WILL INSTALL A TEMPORARY CURTAIN ROD IF WE NEED TO WAIT FOR THE GLASS DOOR TO ARRIVE. *INCLUDES PLUMBING PERMIT. **CARPENTRY** *PROVIDE DEMO OF EXISTING TUB AND SURROUNDING WALLS AS NEEDED,THE EXISTING 8 Reardon Circle, South Yarmouth, MA 02664 • Phone 508-394-7778 • Fax 508-394-8256 www.efwinslow.com CE, win S.1 W I Quote Number: 30779 Page: 2 of 4 Option# 1 (Continued) BATHROOM FLOOR AND TILE CEILING ABOVE THE SHOWER IS*PROVIDE DUST PROTECTION TO HELP MINIMIZE DUST AND DIRT INTO REMAIN. *INSTALL NEW BACKER BOARD WALLS FOR A SOLID TILE BACKER THE FINISHED ROOMS, WATER HOT PROTECTION. WATER PROOFING AROUND THE NEW SHOWER WATER PROTECTION. "`INSTALL A 1/2"-34" FILLER AT THE BOTTOM OF THE SHOWER BASE AND WALLS FOR ADDED INSTALL BLOCKING FOR THE GLASS SHOWER DOOR AND GRABBBE FLOOR IF NEEDED. *INSTALL GRAB BARS,OWNER TO VERIFY EXACT LOCATIONS, BARS. *PATCH SHEETROCK,COMPOUND TO A SMOOTH FINISH IF NEEDED. *TOUCH UP PAINTING TO BE PROVIDED BY OTHER. *AN ALLOWANCE OF$2,800,00 IS INCLUDED IN THIS PROPOSAL FOR A BYPASS SHOWER DOOR INCLUDING INSTALLATION. *ESTIMATOR TO SCHEDULE AN APPOINTMENT WITH GLASS DOOR COMP FOR THE DOOR SELECTION. ANY AND HOMEOWNER *TILE MAN* *PROPOSAL INCLUDES TILE LABOR. *OWNER TO SELECTAND PURCHASE TILE,GROUT AND TWO VARIFIED BY OWNER. , CORNER SHELVES,LOCATION TO BE *TILE TO BE INSTALLED FROM THE TOP OF THE SHOWER BASE UP TO THE CEILING INCLUDE A TILE BOARDER APPROX.AT EYE LEVEL,OWNER TO VERIFY LOCATION. *FANCEY MOLDINGS,TILE INSTALLED ON AND WILL REQUIRE ADDITIONAL MATERIALS AND LABOR.A DIAGONAL,MARBLE OR STONE SURFACE MATERIALS ;PLEASE NOTE; *UNFORSEEN ROT DAMAGE TO BE REPAIRED AT AN ADDITIONAL COST IF INCLUDES;TILE LABOR WATERPROOFING,HARDI BOARD INSTALL INCLS,DOOR AND INSTALL NEEDED. Initial: / Total A r Option# 2. 8 Reardon Circle, South Yarmouth, MA 02664 • Phone 508-394-77 78 ° Fax 508-394-8256 www,efwinsiow,com • k Ff �EsS s, .� �Is ' 74 5i#S : t 1 ,,a1ift. lr ,? ra fit' hr z1 ',h rr+ S i y, ,�p-r � c S -f t t 1 y i !� f 5 J4Af j S ict_.. 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