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Home My WebLink AboutUntitled V[ /zii?/��(� Offer Use Only 3 V Permit# /�'/�f�— 13 1J _wyL 1G=3+Lf ,0 ��. Amount • s,�,�e O days from .4 C ,permit expires 180'.1;► issue date ,,, ,..,". `�: 6 lib-- a.3-0®3 L W-7 DING PER EXPRESS BUIL MIT APPLICATION TOWN OF Yp,RMOUTH RECEIV Yarmouth Building Department F��C 2 _ ��Q22 1146 g Route South Yarmouth,MA 02664BUILDING Dp RTMENT (50g) 395-2231 Ext. 1261 CONSTRUCTION ADDRESS: ASSESSOR'S INFORMATION: Parcel Map' , ' I - IZ TEL. # N 4•. /, ,' 2oT*p I 4,4... ir , •A th 1 i i1 a...d 4: i A I /✓L , PRESENT :'DRESS a big OWNER: hi /IL.I ,_" i L .1 , � ! ' 4 CONTRACTOR: L MA Est.Cost:::tiii11 134 $______V-761----re___ Home Improvement.Contractor Lic.# J �7�- Workman's mCompensation nerurance: (check e sole proprietor one) have Worker's Compensation Insur e -20`"'' [] I am the homeowner 0 Policy# /� Worker's Comp. Insurance Company Name: • WORK TO BE PERFORMD Wood Stove Tent nDuration_____--- (Fire Retardant Certificate attached?) Replacement doors: # Replacement windows#____ --[K. Insulation Siding: #of Squares ___---- * max.2layers) Remove existing Roofing: #of Squares-- Pool fencin Old Kings Highway/Historic Dist. Replacing like for like ii EALC d that any false answer(s) g13--_ disposed of at: Luc tion of Facility *The debris will be oknowledge and belief. I understand ed are true and correct to the best Section 1. rJ perjury that the statements herein contained under M.G.L.Ch.268, (.- penalties is p�j license and for prate: I declare under revocation of will be just cause for denial Date: _�iy�I s, Applicant's Signature: Date: ` Owners Signature(or attachment) SS: EMAIL Approved By: ial esignee) Building �; No District: ne: Yes Zoning y No Flood Plain Zo Yes '- Wetlands: Historical District: Within t00 ft.of � Yes � No Resource Protection N District: 1 Office Use Only '75 4 ., •Y ,Permit# gi 0}+ t�t O ;� p .' H Amount (f ,. """'�M^w^.1, o7, : *Permit expires 180 days from "n issue date 6 0— a3- 0.3 Liqs7 EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH RECEIVED Yarmouth Building Department 1146 Route 28 DEC 2 2 2022 1 South Yarmouth,MA 02664 (508) 398-2231 Ext. 1261 BUILDING DEF AR1 MENT -4,4 CONSTRUCTION ADDRESS: 3 V g ki ff i.4 f 5" d l' ASSESSOR'S INFORMATION: Map: Parcel: OWNER: e -r- dta 33 / IZ(jLj N PRESENT DRESS TEL. # CONTRACTOR: — 1 A MAIL Dj13, S EL.# QResidential Cl Commercial Est.Cost of Construction$ ; Home Improvement Contractor Lic.#/32, i Construction Supervisor Lic.# 6/01l Workman's Compensation Insurance: (check one) 0 I am the homeowner 0 I am the sole proprietor C4ve Worker's Compensation Insur e � Sr e &i)ZZG74'-2riZZ4 Insurance Company Name:� Cr.`c/ ikl _ S.. ( �• Worker's Comp.Policy# WORK TO BE PERFORMED Tent U0, Duration (Fire Retardant Certificate attached?) Wood Stove 0 Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares f e (Remove existing*(max.2 layers) Insulation 1-1 l l Old Kings Highway/Historic Dist. C3)Replacing like for like Pool fencing El 7.--'The debris will be disposed of at: ` Ewe) . / U / 4/4 Locition 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 revocation of license and for prosecution under M.G.L.Ch.268,Section I. �� Z�/i1_ ate: Applicant's Signature: Date: Owners Signature(or attachment) /� � �G � Date: te Approved By: Building cial esignee) EMAIL SS: Zoning District: Historical District: a Yes 71 No Flood Plain Zone: 7 Yes L7 No Water Resource Protection District: Within 100 ft.of Wetlands: Yes '? No i:� Yes No ` \ The Commonwealth of Massachusetts 1_*ram.,f1, Department of Industrial Accidents ;ie►l� I Congress Street, Suite 100 "�_i 1'" Boston, MA 02114-2017 �^„�,�= www mass.gov/dia .. Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. AQplicant Information Pleea-�see Pr' t Legibly Name (Business/Organi • ndividual): ,t/f�Jr Address: e4 X J3 City/State/Zip: // L1-1LLS j /,4- Phone#: c.4—41-` 'q Are you an employer?Check the appropriate box: Type of project(required): 1.❑I am a employer with 1/ 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 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 9. 0 Demolition 3.❑I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.QElectrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions 5.0I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.WiRoof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[]Other 152,§I(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. i'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:46tJW&d 6101Mg..6 -- / ( 6,Jjam /Ott/ Policy#or Self-ins.Lie.#:bj� - -- ç ;!2:g`� -76 Expiration Date: tr gtS Job Site Address: t.3 U 1 /tLM�--alkiat C S(1J i6h--City/State/Zip: bo. ai 44 --- of the workers' compensation policydeclaration page(showing the policy number a d expiration •ate). Attach a copy p P g 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 under the and penalties of perjury that the information provided ab ve is true and correct Signature: IfW I/ Date: ZZ 71, Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# ItAuthority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Q74 ro-n-m-i-ko-/-mo-ea410-/ 4- Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement ctractor Registration Type: Individual Registration: 132560 ROGER E. BYAM ' t>, /� Expiration: 02/26/2023 D/B/A BYAM CONSTRUCTION , , , 1 ; , , ,:, P.O.BOX 1793 u1 t ,,, HYANNIS, MA 02601 a 0; i r ..e e , Update Address and Return Card. SCA 1 0 20M-05/17 , .7Z Wi 6y.l. �raef i Office of Consumer Affairs&Business Regulation 9 HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE/Individual before the expiration date. If found return to: Registrationn:.\ Expiration Office of Consumer Affairs and Business Regulation 1326611 =- - 2/26/2023 1000 Washington Street -Suite 710 Boston,MA 02118 ROGER E.BYAM ' . •, r D/B/A BYAM CONS 1,£ � } ROGERE.BYAM �, 124 SEA ST. " a.4 Not valid without signature HYANNIS,MA 02601 Undersecretary Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Constlwd't MiiAp,rvlsor J. CS-075376 6pires:07/0312023 ,, ROGER E BYAM MI MI ri PO BOX 1783 \, RI • -, HYANNIS MA4)28 "" '"� " Commissioner , ' K OEkn I BYAM CONSTRUCTION Roger E. Byam P.O. Box 1793 Hyannis, Ma. 02601 508 - 364 - 4499 MA. C.S.L. 075376 Home Imp. Contractors License # 132560 Proposal and Contract Submitted to : Nov. 13 , 2022 Mary Jane Benoit 388 North Main St. So. Yarmouth, Ma. 339-206-1264 The following are the specifications an terms for the Roof Replacement at the above address. . , _, Payment terms $ 3,975.00 deposite due upon acceptance of contract to supply materials and equipment to the site. $ 1,500.00 payment due upon 50% completion. $ 1,500.00 payment is due when above specified terms are fully complete, not including any unspecified supplemental work. Any additional extraneous repair work deemed necessary by the Customer and Contractor (additional repair or replacement of framing members, sheathing , and trim , siding ect.) shall be performed upon a time and materials basis of $ 95.00/Hr. plus the cost of materials. Acceptance of Contract : Mary Jane Benoit .4 Ay_rii g-44A,) ige:--,-7_-ai-24-) //://,V2, Roger Byam I Byam Construction