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Home My WebLink AboutUntitled (3) o1'Y' . Z2IL Office Use Only j C� .„ +if. Permit# 4..4,1: AmountSi . i„ . ,�, ��.5,,�; Permit expires 180 days from issue date 13 lib- 0.3-603 Lils-7 EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH RECEIVED Yarmouth Building Department 1146 Route 28 DEC 2 2 2022 South Yarmouth,MA 02664 J (508) BUILDING 398-2231 Ext. 1261 G DI^PAR7 MEN T CONSTRUCTION ADDRESS: „w ASSESSOR'S INFORMATION: Map: Parcel: OWNER: hi//Li 'i. I XCI RF 4 ' I I ZOIL N PRESENT,'DRESS TEL. # s ♦ CONTRACTOR: A !i CA/..:. — ' • f/ . I //✓,...i /I / t, ,4 11_ !. hr r.- i MAIL aDREel S EL.# di Residential 0 Commercial Est.Cost of Construction$ iterh �/ ` Home Improvement Contractor Lie.# / 2, L Construction Supervisor Lie.# 41 010 Workman's Compensation Insurance: (check one) 0 I am the homeowner 0 I am the sole proprietor have Worker's Compensation Insu e ��,y� S,�� p� /j ' fi�—S(nS"$0224I4'1—ZD Z24 Insurance Company Name:�'yt3-i�,:• e��'GS- ( �• Worker's Comp.Policy# WORK TO BE PERFORMED Tent El Duration (Fire Retardant Certificate attached?) Wood Stove El Siding: #of Squares Replacement windows;# Replacement doors: #Roofing: #of Squares / e ( nRemove existing*(max.2 layers) Insulation I 1 I I Old Kings Highway/Historic Dist. a)Replacing like for like Pool fencing I I *The debris will be disposed of at: 7-Eve 6il6kati / r/` "�-- The P �<� j 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 a revocation of ,license and for prosecution under M.G.L.Ch.268,Section 1. Applicant's Signature: Zf‘ !I 4 A ate: /Z. Z.Z.Jzz. Owners Signature(or attachment) Date: / Date: / - Approved By: `—� Building ial esignee) EMAIL aii SS: Zoning District: Historical District: 0 Yes 2 No Flood Plain Zone: 2 Yes 0 No Water Resource Protection District: Within 100 ft.of Wetlands: Yes 01 No 0 Yes CI No _ The Commonwealth of Massachusetts flip-8 Department of Industrial Accidents '" =e?a1= 14 1 Congress Street,Suite 100 KIJ a' 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 Pr' t Legibly Name (Business/Organi • ndividual): /,r 4 Ir�'v� ��Y` � (Itrihtr- Address: p�j..e) . g / 3 City/State/Zip: /L.1-1LL1 irI — Phone#: ' 6/' 264,41.14q Are you an employer?Check the appropriate box:1.0I am a employer with Type of project(required): employees(full and/or part-time).* 7. El 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. ❑Demolition 3.DI am a homeowner doing all work myself[No workers'comp.insurance required.)t 4.0I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 0 Building addition ensure that ail contractors either have workers'compensation insurance or are sole 11.Q Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.0I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.1ZiRoof 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. J 44,9igle6 nInsurance Company Name:1�`:7, �'�E �_ �tiet ( Policy#or Self-ins.Lie.#: /J()- � Expiration Date: /Z ?I Job Site Address: U i.h,1`V 1�--f/111�`/�7'1. S1Vf' 41A.9i__city/StateIZip: �r . 4 ., I' ,l.c. 4/11L--- Attach a copy of the workers' compensation policy declaration page(showing the policy number a d expiration I ate). 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$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi underthe and penalties of perjury that the information provided ab ve is true and correct. Signature: /4ff'v' Date: ZZ iti, Phone#: Permit/LicenseOfficial use only. Do not write in this area,to be completed by city or town official City or Town: Issuing Authority(circle one): 1.Board of Health 2.Building 1epartment 3.City/Town Clerk 4. Electrical Inspector 5.PlumbingInspector Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home ImprovemenContractor Registration Type: Individual 71 Registration: 132560 ROGER E. BYAM pIT Expiration: 02/26/2023 D/B/A BYAM CONSTRUCTION jy P.O.BOX 1793 HYANNIS, MA 02601 Update Address and Return Card. SCA 1 0 20M-05/17 .('wee g9�ri��zona�easo/./ga JezeiceJel4, Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:,•," ividual before the expiration date. If found return to: Registratiotiy Expiration Office of Consumer Affairs and Business Regulation 13256 = 02/26/2023 1000 Washington Street -Suite 710 ROGER E.BYAM °Tip l$ Boston,MA 02118 D/B/A BYAM CONST,RU - 1, aS K ROGER E.BYAM 124 SEA ST. HYANNIS,MA 02601 Not valid without signature Undersecretary Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Consgrout 2ilAii isor CS-075376 � 00 fpires:07103/2023 ROGER E BVAM PO BOX 1793 HYANNIS MA 2801 'r Y+.q 7g, gig, � UIS'S:1`,1 Commissioner (y,��• L7L�nc 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 , 2020: Mary Jane Benoit 388 North Main St. So. Yarmouth, Ma. 339-206-1264 The following are the specifications an II 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 „ax.„1, ga4A.,) a/ly,, ///tvy; Roger Byam / Byam Construction