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Home My WebLink AboutUntitled (2) put 121 zzi Office Use Only 3 go o1..y '` `mil__ .Permit# CO *,1k C O ,� . Amount d.0 MATT n 6 •+wr•,,,r.a c` Permit expires 180 days from 4 issue date r&& b - a3-6031 L,"7 EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH R E C E I V E Yarmouth Building Department 1146 Route 28 DEC 22 2022 J South Yarmouth,MA 02664 (508) 398-2231 Ext. 1261 BUILDING DL-PARTMENT CONSTRUCTION ADDRESS: .3184 �()�. c i 1/�!J ASSESSOR'S INFORMATION: , 7 1/� Map: Parcel: OWNER: /4//L4 /✓L l �'I , '4 i-Ogg N• PRESENT • )DRESS TEL. # sir CONTRACTOR: A /l":. _ I ►/ . I iL ..„; /i / ► .l ,�_ v "1 IA I MAILI • •D' S L.# QResidential 0 Commercial Est.Cost of Construction 7 Home Improvement Contractor Lic.# /32 1 UfCD Construction Supervisor Lic.# 0 Ov Workman's Compensation Insurance: (check one) 0 I am the homeowner 0 I am the sole proprietor 04ve Worker's Compensation Insur e Insurance Company Name:45C� £t$/)Ib4th / rOZZ� -20 zz• 8_ l �- Worker's Comp.Policy# WORK TO BE PERFORMED Tent E Duration (Fire Retardant Certificate attached?) Wood Stove El Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares /( ([Remove existing*(max.2 layers) Insulation El I I Old Kings Highway/Historic Dist. ®Replacing like for like Pool fencing El V-- *The debris will be C JJ 1 disposed of at: Ske E O1 14( P Loc(tion 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.Applicant's Signature: ate: /Zy Z jilt Owners Signature(or attachment) Date: f/J e�.� /77 Date: / -7.26 --4-;Approved By; Building is.. tesignee) EMAIL SS: Zoning District: Historical District: it Yes C No Flood Plain Zone: 7 Yes L No Water Resource Protection District: Within 100 ft.of Wetlands: ri Yes 1' No L Yes 0 No . The Commonwealth of Massachusetts a.Pg c, 7 Department of Industrial Accidents _11.17E 1 Congress Street,Suite 100 "`_:I Z' Boston, MA 02114-2017 '�_ www mass.gov/dia .. Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Pr' t Legibly Name (Business/Organi ' ndividual): /1 rti�� L*4 ( 'L# 1L_,-- Address: j'fô , / , ., City/State/Zip: Le-ILLS j /r16C Phone#: 6/' 26 -liq q Are you an employer?Check the appropriate box: Type of project(required): 1.❑I am a employer with employees(full and/or part-time).* 7. New construction par tnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.0I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10❑Building addition 4.❑T 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.QEIectrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.01 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance? 6.0We are a corporation and its officers have exercised their right of exemption per MGL c. 14.QOther 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:4'/ a --tic J 2/'?t (j Policy#or Self-ins.Lic.#:bj�� -- vv12q�"1-7O� Expiration Date: it M Job Site Address: �3 0 7 ii4nett.itht C 1° ity/State/Zip: h. 004 4/j --- Attach a copyof the workers' compensation policydeclarationthe policy number aitd expiration date). P page(showing 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: 4-K- 114 Date: Zl 72 Phone#: 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 i t bing Inspector 1 Other l/e ro/2- /%C'Ch /I%o/� CGc i4- Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Individual Registration: 132560 ROGER E. BYAM r -f Expiration: 02/26/2023 D/B/A BYAM CONSTRUCTION P.O. BOX 1793 HYANNIS, MA 02601 ' k t , Update Address and Return Card. SCA 1 0 20M-05/17 A Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:,Kvidual before the expiration date. If found return to: Registratiot Expiration Office of Consumer Affairs and Business Regulation 1325O r- - /26/2023 1000 Washington Street -Suite 710 ROGER E.BYAM Boston,MA 02118 D/B/A BYAM CONS'f '✓ ROGER E.BYAM ` 124 SEA ST. 404. HYANNIS,MA 02601 Not valid without signature Undersecretary Commonwealth of Massachusetts IF Division of Professional Licensure Board of Building Regulations and Standards Constit f IllAiiP isor CS-075376 � , spires:07/03/2023 ROGER E BY,�1M �i PO BOX 1783r �att HYANNIS MAQ28tfiA lQKti 17W°‘ Commissioner f• 11 541 • 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,.E g,24,_,) G&,�,,-7.� > /7 /, Roger Byam I Byam Construction