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Home My WebLink AboutBLD-23-003467 (t i i1 mzre_ Office Use Only 3 9 4 srl Y,2 CC Pennit# CO —Vag is v /� OL fir, ,'� ►I Amount S.�.a) � **.«„�,3 r , ,CV,• Permit expires 180 days from ;- issue date EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH RFCE1VED Yarmouth Building Department 1146 Route 28 DEC 2 2 2022 South Yarmouth,MA 02664 (508) 398-2231 Ext. 1261 soli piN PAR1 MENT CONSTRUCTION ADDRESS: ASSESSOR'S INFORMATION: Map: Parcel: OWNER: i.d/44 '/ ♦ / / l—Witt N PRESENT;'DRESS TEL. # CONTRACTOR: t !1 Cl4/.... — 0 \/ ,�3 //./...A /I / .4 4 i. !v it et IA MAIL - aD' S L # ,�esidentiai ❑Commercial Est.Cost of Construction$ ff��ryry -O-3 /� Home Improvement Contractor Lic.#/22 (.(CLJ Construction Supervisor Lic.# j l o Workman's Compensation Insurance: (check one) ❑ I am the homeowner 0 I am the sole proprietor CY have Worker's Compensation Insur e ('' � ,,, /� p Y �'yt3-St £fDIktit 8_ ( 4 p y'#LJ -01 q4�-20 Gz4Insurance Com an Name: Worker's Comp.Palic .- WORK TO BE PERFORMED Tent .Q Duration (Fire Retardant Certificate attached?) Wood Stove Ei Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares /( ( )Remove existing*(max.2 layers) Insulation I J I I Old Kings Highway/Historic Dist. at Replacing like for like Pool fencing I 1 *The debris will be disposed of at: (< 5E" O /��% (!/� / /! Loc(tion of Facility I declare under penalties of perjury that the statements herein contained are true and correct t 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 1. Applicant's Signature: ate: f l ri iii Owners Signature(or attachment) 7.-2 Date: /Approved By: .. i1 Date: /2 .—ram` Building cial o 'esignee) EMAIL A SS: Zoning District: Historical District: ❑ Yes `❑ No Flood Plain Zone: E Yes ❑ No Water Resource Protection District: Within 100 ft.of Wetlands: Yes 0 No ❑ Yes ❑ No . The Commonwealth of Massachusetts f ;: _AL Department of IndustrialAccidents " El*"= ' 1 Congress Street,Suite 100 �. F—a` Boston, MA 02114-2017 �4.o- wwn.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Aualicant Information / Please Pr' t Legibly Name (Business/Organi ndividual): /;r `.Ila4yt / //t*ii ahfr---- Address: je4 )Jfte I 3 City/State/Zip: $/S4'-1LLL j iY16 Phone#: 3S-4---4-14.4q Are you an employer?Check the appropriate box: Type of project(required): 1.0I am a employer with employees(full and/or part-time).* 7. 0 New construction 2.01 am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any acipAcity.[No workers'comp.insurance required.] 9. ❑Demolition 3.❑I am a homeowner doing all work myself[No workers'comp_insurance required.]t 10❑Building addition 4.0I 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 11.0 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.ViRoof 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.[]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. 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. � &,_uranceCompanyNme�� 7i -' --- _ y— (14tAtitei Policy#or Self-ins.Lic.#: — 1,Zq L `l-7OL4 Expiration Date:` iZ f Job Site Address: E Q 1 ��k+Y`1/i `/7�-- 0 1, UI/.1'� �x-'1r"F--Eity/State/Zip: % .4I %la, l�/ Attach a copy of the workers' compensation policy declaration page(showing the policy number a,d expiration s 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 under theand penalties of perjury that the information provided ab ve is true and correct ff 4 Signature: pix "- Date: Z'Z- 7.1 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): I.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massaphusetts 02118 Home Improvement,,tractor Registration Type: Individual 7! Registration: 132560 ROGER E. BYAM I Expiration: 02/26/2023 D/B/A BYAM CONSTRUCTION P.O.BOX 1793 r'S1 HYANNIS, MA 02601 1 � p ;, Update Address and Return Card. SCA 1 0 20M-05/17 ,Tee F o>,,A¢1� e , Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:, vidual before the expiration date. If found return to: Registration, Expiration Office of Consumer Affairs and Business Regulation 13266fX -- 2/26/2023 1000 Washington Street -Suite 710 - 7 ROGER E.BYAM sir' "" 1'E".r Boston,MA 02118 D/B/A BYAM CONST hf N 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 Const�iytt,tiAii rvisor i CS-075376 #,. sires:07/03/2023 ROGER E BYAM V$1.10' 1A PO BOX 1785. `t HYANNIS MA42604 $Its. ‘O1g71:1( Commissioner UlP d0• K. 17Evn • j . 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 , 202 Mary Jane Benoit 388 North Main St, So. Yarmouth, Ma. 339-206-1264 The following are the specifications ant 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 3_____ _ ige -_,,t ,:z,,,i1 g1-471,) -'0 ?--1,--1 --) /V/4 4.A?'e Roger Byam / Byam Construction