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HomeMy WebLinkAboutBLD-22-007037 pig/l&i +W lv/e 7/Ge_ ONE &TWO FAMILY ONLY-BUILDING PERMIT Town of Yarmouth Building Department 1146 Route 28,South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 E' Massachusetts State Building Code,780 CMR '—` ` Building Permit Application To Construct,Repair, Renovate Or Demolish ":4~ I v E D a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Sit 22-f07a32 Date Applie • t3 tJ L B4NG;LD E PA R T M E N T Building Official(Print Name) Signature Date 3 5-, SECTION 1:SITE INFORMATION • 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers t2q cici C ,-FT W�q G�-ee-P C,,-c\e Ct 0 0 CA 0 ,'1 • 1.1 a Is this an accepted street?yes 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 Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c,40,5 54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public. Private 0 Zone: — Outside Flood Zone? Municipal 0 On site disposal system Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' k61 Owner'of Record: e.,:� e �,,,,e M` � o� \1 5tc, �� ��I �aV, t..-: 4 , e 2 6 b Name( t) City,State,ZIP P--c'1' ee-, C ,.c e 57ti -7`1`1-2.).72\ COMe1..cict,NL, ,.1 ,kNrJ-7'6,ca +<-, No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction❑ Existing Building . Owner-Occupied g I Repairs(s)X Alteration(s)C Addition 0 Demolition iO Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work'•Vie. o ',I a i A .1 cl k ,`'q 1 4Yl e, -I , 5 4 ,., 1 -r `51 \l � , .zr, oC-*5 w --,C1.-z,5-p 5 i dc-, P;--- SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 1. Building Permit Fee:$ I rj© Indicate how fee is determined: 2.Electrical $ NIStandard City/Town Application Fee 0 Total Project Cost3(Item 6 x multiplier x 3.Plumbing $ 2. Other Fees: $ 3cC, Ke2.,g 4.Mechanical (HVAC) $ List: - 5.Mechanical (Fire _ Suppression) $ Total All Fees:$ - , Check No. Check Amount: Cash ounce (ti21- 6.Total Project Cost: $ l i/ 0 0, A, ❑Paid in Full IN Outstanding Balance ue: I V) �� '?3 / SECTIONS: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number Expiration Date Name of CSL Holder List CSL Type(see below) No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP NI Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Cornpan Name or HIC Registrant e HIC Registration Number Expiration Date 5 v Ye S4 . b'PC5/ 5Lor ��a �, 1ae , Cc*., No,and Str t Email address W¢s-41j e.,4 2311 ‘BL -521-L7oU City/Town,State,Z2 Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(IYI.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 d/1'` No 0 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 to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) 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. e 1-11 r c...1 \•% 5/2'i)2 2 Print Owners or Authorized Agent Name(Electronic Signature) Date NOTES: 1. 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 fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.aov/oca Information on the Construction Supervisor License can be found at www.mass.eovIdes 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 Cosf' TOWN OF 'YARMOUTH .e- .r Necyk ( • _.) i BUILDING DEPARTMNT 1146 Route 28,South Yannouth,MA 02664 S08-398-2231 ext. 1261 HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE: ,-,JOB LOCATION: (34 NAME Li<L0 N7.,:f ADDRESS SECTI OF TOWN "HOMEOWNER" cl I ‘e - 19 ,... N v OME PIIQNE , WORK PHONE , PRESENT ly141LUGDRESS 1 0!____i_, !-' 4_,..,A.D' 2 c A) --CITY OR;1 -------"Q---5---"------ WN STATE ZIP CODE The current exemption for Homeowner' was extended to include owrierciweilinsis of one Or two units and to allow such homeowners to engage an individual for hire who does not possess a license, rov'ded that such homeowner shall act as su ervisor (State Building Code Section 110 R5.1 2.l) ._.______________Q____.• Definitionof Homeowner. Person(s)who OWns a parcel of land on which he/she resides or intends to reside,on which there is or is intended to be,a one or two family attached or detached structure assessory to such use and for farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner;such"homeowner"shall submit to the building official,on a form acceptable to the building official,that he!she shall be es arr.__p_jaiu___;,e for au such work erfo ed under the buildi peimit. (Section 110 R5.1.3.1) The undersigned 'homeowner' assumes responsibility for compliance with the State Building Code and other applicable codes, by-laws,rules and regulations. The undersigned homeowner' certifies that he/ she understands the Town of Yarmouth Building Department minimum inspection procedures and requirements and that he I she will comply with said procedures and requirements, ..--" HOMEOWNER"S SIGNATIJP APPROVAL OF BUILDING OFFICIAL INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL Ch.142. Yes No If you have checked ves.please indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of indemnity Bond OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass.General Laws and that my signature on this permit application waives this requirement. 1' - '' ' 711,0_,g,__ __ , , Check one: • , _________ :kg-nature of Owner or Owner's Agent VOwner Ageut hlorceownrlicexemp The Commonwealth of Massachusetts iv 'I Department of Industrial Accidents Weis tee.; 1 Congress Street,Suite 100 li j Boston,MA 02114-2017 15. 9. ...,.•• www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/OrganimtionlIndividuan:_George P.McLoughlin Address:16 Stop River Road City/State/Zip:Norfolk Ma.02056 Phone#:978 799 8721 Are you an employer?Check the appropriate box: Type of project(required): tam a employer with employees(full and/or pan-time).* 7. 0 New construction 2.0 i am a sole proprietor or partnership and have no employees working for me in 8. El Remodeling any capacity.[No workers'comp.insurance required] 9. 0 Demolition 3.0 lam a homeowner doing all work myself.[No workers comp insurance required.]t 10 0 Building addition 4.0 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 il 1.0 Electrical repairs or additions proprietors with no employees. 12.1:IPlumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.DRoof repairs These sub-contractors have employees and have workers'comp insurance.: I 4.['Other 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 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 /Homeowners who submit this affidavit indicating they arc doing,all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that cheek 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. Jam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: _ City/State/Zip: __ _ _ 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 andlor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 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 pains and penalties of perjury that the information provided above is true and correct. +I, - _Ato Signature,' ei Phone#, •78 799 8721 , . 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.Cityfrown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: The Commonwealth of Massachusetts Department of Industrial Accidents STRl I Congress Street,Suite Boston, 100 MA 02114-2017 s:r www.mass.gov/dia Workers'Compensation Insurance Affidavit;Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual):George P. McLoughlin Address:16 Stop River Road City/State/Zip:Norfolk Ma. 02056 phone#:978 799 8721 Are you as employer?Check the appropriate box: Type of project(required): t.Q i am a employer with _____._employees(full and/or part-time).* 7. D New construction 2.0 am a sole proprietor or partnership and have no employees working for mein 8. ✓�Remodeling any apacity.[No workers'comp.insurance required.] 3.01 am a homeowner doing all work myself.[No workers'comp.insurance required,]t 9. 0 Demolition 4.0 I am a homeowner and will be hiringcontractors to conduct all work on my10 Building addition property. Iwill ensure that all contractors either have workers'compensation insurance or are sole 1.i.[]Electrical repairs or additions proprietors with no employees. I2.Q Plumbing repairs or additions 5.0 t 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. I3.DROof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.El Other 152,11(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also till 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: Policy#or Self-ins,Lic.it: Expiration Dater_ Job Site Address: City/State/Zip: 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 isa 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 pains and penalties of perjury that the information provided above is true and correct. Signature 71 /` / GG ,� Date: 6-/-5j2 Phone#: •78 799 8721 tYficial 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#: • The Commonwealth of Massachusetts 9 Department of Industrial Accidents 4 1 Office of Investigations - ,IN Lafayette City Center 2Avenue de Lafayette, Boston, MA 02111-1750 iiiij www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):Bath Fitter Bridgewater Address:25 Turnpike Street City/State/Zip:West Bridgewater Ma 02379 Phone#:508-521-2700 Are you an employer? Check the appropriate box: Type of project(required): 1.❑■ I am a employer with 25 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or listed on the attached sheet. 7. ■❑Remodeling partner- shipand have no employees These sub-contractors have 8. El Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other 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:Arch Insurance Company Policy#or Self-ins. Lic. #:ZAWC15806603 Expiration Date:1/1/2023 Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that 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 pains and penalties of perjury th!t e inform r ion provided above is true and correct. Signature: Or rate: 1/1/2022 Phone#: 508-521-2700 l Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(check one): 10Board of Health 20 Building Department 3.DCity/Town Clerk 4.0 Electrical Inspector 5E'lumbing Inspector 6.0Other Contact Person: Phone#: ___"'...„1 NATIBAT-01 AJIMENEZ ,4 © CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 12/21/2021 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 Johnson,Kendall&Johnson,Inc. PHONE 109 Pheasant Run (A/C,No,Est):(215)968-4741 1(A/C,No):(215)968-0973 Newtown,PA 18940 E-MAILDRESS:info@jkj.com k'.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Hartford Fire Insurance Co. 19682 INSURED INSURER B:Zurich American Insurance Co. 16535 BATH FITTER BRIDGEWATER,dba Bath Fitter INSURER C:Arch Insurance Company 11150 25 Turnpike St. INSURER D: West Bridgewater,MA 02379 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER IMM/DD/YYYYI IMM/DD/YYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE X OCCUR 39UEEEB1605 6/30/2021 6/30/2022 DAMA SET(Ea occu encea $ 300,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JECOT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY CO(Ea accident)SINGLE LIMIT $ 1,000,000 X ANY AUTO BAP4845884-02 6/30/2021 6/30/2022 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ C AND EMPLOYERS COMPENSATION Y/N X STATUTE EORH ANY PROPRIETOR/PARTNER/EXECUTIVE ZAWCI5806603 1/1/2022 1/1/2023 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBERo EXCLUDED? N N/A E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) BFU 375-Bath Fitter Bridgewater,Inc.dba Bath Fitter,25 Turnpike St.West Bridgewater MA 02379 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE To whom it may concern. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ♦ / I ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD °I.Y,944 TOWN OF YARMOUTH '.,;14:1tP BUILDING DEPARTMENT a,„.aiwfti•A� , 1146 Route 28,South Yarmouth,MA 02664 Qtrz ,3E,ra 508-398-2231 ext. 1261 Fax 508-398-0836 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT • Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR,Chapter 1, Section 111.5, . I hereby certify that the debris resulting from the proposed work/demolition to be conducted at G 9 0,vpp ,, �' *-e C% _c 1 P a r' n-, c ti 4 Work Addre's Is to be disposed of at the following location: Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. 5S' atur f Application /`� 2 Date Permit No. -a L as U L c Nd o c\IN 'a O `zt N y till 2- O it i O Urno CO Q +' 0 Cs w A i 2 L. C N C C co C a3+ y y+ Q) >,� o. L C �/ �-- C m a) LL o • a) a) r 0) W mm 0 � :4 ' � a) > i .0 = Nct E. aji— 3 m 1 O 40 , - I, 7:3 CD N U CU MRE _ 't- iv G = c d a c •� o (/) 1-+ v� E d -- O < • 2 E w .ao ,- m° a) u c > > oo = cn a • oom � U a) E U o) ca O 0 Z M c Ce N o U W Z.C co Q rni L 0 a V o N w . 2 ;� N QW QQ � F- = Z c < 3W oZ(X1- 1 mQ( rn OOI- CO c�o w yZa W o W = Y0 .&- woc 1- EL- mxm ` W mpawIn U O' F- E cr ~ y ,- a cc W ~ a W QmW NWc Y � Q �000NS WmU ow II o2 WI F~- Y0 of HQ �UatY O Wm ZZm = Q ZDF- m J ~Q W ma C9N � Bath Fitter Bridgewater inc. 25 TURNPIKE Si; TYPE,Contract BAT WEST SIRIMEWATER MA,02379 F I T T E R* DATE:21322-03-24 REP#:37 -L1 SSOKRRX2_JCL Tel:508-521-2700 Fax 508-588.4303 SPU375tbathfitter m CUSTOMER BILLING ADDRESS SERVICE ADDRESS Diane McLoughlin 99 Chipping Green Circle, 9 Chipping Green Circle, Yarmouth,Massachusetts,02664 Yarmouth,Massachusetts,02664 i Tel: 617-821-9225 Tel: Email: dmcioughlinl@comcast.net I DESCRIPTION OTY PRICE Shower/FSSB/Rectangle White 321N X 601N/Left Hand Drain 1 INCLUDED -)i " with Front Open e One Piece Seamless Wall/ White 90IN X 1321N(88-5/8IN X t IN CLUDED Savona Subway Tile Pattern 131-3/81N) Ceilings i Flat White _....... ------....—....-- 36IN X 60lN 1 INCLUDED Organizational Items(Corner White 1 INCLUDED Shelf/Oxford Corner Tower Shelf with Foot Rest � i Faucets/Moen Tub&Shower Brushed nickel/2.5 GPM Shower 9 INCLUDED Faucet Set/Voss M-Core Faucets/Moen Valves/M- /N/A N/A 1 INCLUDED Core Valve U140CIS/ ," PLU0662 — : , Doors&Curtains/Doors/ Brushed nickel/Clear 60lN 1 INCLUDED I,. Prestige for Shower Drains/Shower/Grate Brushed nickel �— INCLUDED ,,,; , a PLU450,PLU452,PLU453 Permit 1 INCLUDED Relocate Drain — —„ 1 INCLUDED Remove and Dispose Door — t INCLUDED I N/A • 114 Bath Fitter Bridgewater Inc. 25 TURNPIKE ST, E3AT WEST BRIT EWA"T'Ert,MA,02379 DATE:Contract FITTER* DATE:2022-03-24 Te1; -521.27,0 Fax:508-58 -43D3 BFU 5@batt fitter.corrt REF 4:37.5 L]5DKR7(2-J L DESCRIPTION... OTY PRICE Remove Existing Tub and Wall INCLUDED Wall Repair 3 walls of repair 1 INCLUDED NOTESSub Total $11086.00 This is a conversion 1st floor customer knows we are out 18 weeks billing address 16 stop river rd.Norfolk Ma.02056 d TOTAL - 11,086. Deposit/Payment $1,000.00 -; Balance due on completion $10,086.00 ' /Balance Financed Cash I understand that Bath r tt and its rep entat ensare net qualified t dvise me meld d'tinto t days I rovidihavesbean p d econ t t ctieasgoption to addtionaicostay followingfollowing{attached}terms andc dnrona establ hmyrights tl bhgation d rthis ag aarrtant,inctutlrng those prowdad for by the applrcablecnnsumar prataction legislation.Esttmatevaiid far SD : - � 4E1:)T 122 4 15. 32EDT Jerry Close Signature of Property Owner or Duly Authorized by Property Owner Bath Fitter Bridgewater Inc. 214 Bath Fitter Bridgewater Inc.(Bath Fitter®")-Terms and Conditions—Massachusetts I. Contract Doeumentl.The contract documents consist of this agreement (the Wall,floor or ceiling"Agreement"(,the attached Order,all written mrdificatons of the Agreement or thedamages damagess could include,nc ,the tnuned rt work area may occur Order pursuant to Section 6 below,any required notices and any during installation.faj Such aintsj art coy then eon valon,the loosening of separate warranty exicrasting materials.er Bic paints or a ot causal the removal information provided by Bath Fined(collectively,"the Contract Documents"). p° i by and replacement of 2. existing they appear, Bath over,to cannothecasebe held responsible for these cocoons, Scotts of Work. Bath Fitted agrees to provide all the labor and to do all the things should appear.Moreover,in the of bath liner or wall only installations, necessary for the proper installation and completion of the project set forth in further damage may occur to the existing bathtub or wall tiles; Bath Fitted is not detail on the attached Order(the"Project"). responsible for minor damag es,due to imperfections in any bathtub or wall file that agrees that Bath Fitted have complete use of and access to the may residt from the Bath Fitted installation, and Owner remains responsible 3. Access.Owner Project location during regular business.hours.upon reasonable advance notice to to maintain the grout/silicone l existing walls,Should Bath Fitted be required to and appliances front the send a technician fora aenice call that is the result of inadequate maintenance,Owner Owner.Owner shall remove all obstacles suchas furniture installation area and Owner shall provide all heat and lighting for Bath Fitted to will be invoiced at the current service rates. performs the Project.During the installation Bath Fitted.shall properly dispose of remnants and scrap material relating to the Project.If a defect is alleged in either 17. Colors.Marbled colors or patterns may vary.Bath Fitter*cannot guarantee the workmanship or product,immediate notification must be made and Bath Fitteri9 consistency of the color patters throughoutu .the tub,walls or accessories. must he allowed ready access in order to assess andiia make any repair of the alleged Lg, Rath Flvnore porn to Sor end or T trance, ui ,1 --n of laabll'rr- Bath de fens. Fitter*is not responsible for legal encumbrances,building/zoning code violations, 4. Eats-tins Plumbing,It is expressly understood by the parties that neither Baal plumbing or structural deficiencies,or the discovery of or removal.of asbestos.maid. Fluent?)nor any Bath Frtterk employee,agent or subcontractor is a licensed architectleadtpaint or other hazardous or toxic substances or materials.if Owner breaches the or professional eagineer.Bath.Fitterdl is not responsible for inspecting,servicing,or Contract nietlt ly terminate merits,or if Rath Contract Documents any orate above,Flash Fitted may modifying your existing plumbing Femmes and facilities.Because the existing immediately e y e discretion, the e work ants without further obligation to Owner plumbing at the project location may be old,corroded or an need of repair or or,in its entire discretion,discontinue work on the Project pending peeper cure of the replacement,Bath Fitted cannot be responsible for damage to the chronic finish. breach antYor applicable Fitted on by properly qualified firms m.Owner's expense. blocked drain or plumbing below or behind the tub,including shut-off valves,or for Owner agrees to pay Bath Fitten4u the costs of adorn,pluslc,labor and services provided any damage caused by faulty plumbing,Bath Fitter recommends replacing old by Bath Fitterb through the date/time of termination, any other amounts allowed fixtures when installing a new wall system under applicable law. 5. Contract Price.Owner agrees to pay Bath Fitted,the amount set forth on the IF BATH FITTERik IS UNABLE TO COMPLETE.THE PROIF.CT FOR.ANY LL attached Order,unless otherwise mutually agreed upon between the parties hereto by REASON UNRELATED TO OWNER.BATH FIT'IE POST LIABILITY F t I ERR virtue of a written change order, BE LIMED BE TO A REFUND OF O OWNER'S DEPOSIT.BATH EHIERR 6. Change Orders. Any alteration or deviation front. the above contractual CANNOT BE HELD RESPONSIBLE FOR CLAIMS OF INCONVENIENCE OR specifications that results in a revision of the contract price will be executed only ANY quHER.HARM. upon the parties entering in to a written change order detailing such changes and the 19. Consequential for special,Damara.Beth quenti will that be table to thepunitive Owner a any third resulting change to the contract price.Each change order shall.become part of the party for indirect,consequential,exemplary or punitive.damages or Contract Documents.All work shall be performed under the snore terms and l arising out of or related to the Project or these Contract Do ao such s,even if the parties conditions as specified herein unless mutually agreed in.writing have knowledge of such damages or castsand.whether or pot such damages or costs 7. Method of Payment.The method of payment of the contract price shall be as net are foreseeable. forth in the attached Order.Immediately upon completion of the Project,the Owner 20, Warranty,Co The tonly Do warranty offered on the material you to with the Contract Documents is the manufacturer's ,Forsiil isd accordance agreespay to Bath Fitted the balance of the total agreed upon price,less the initial wnRapati n datei is offered,ar m like deposit.If payment is rot made,all discoi nts will be reversed and an adjusted invoice above iwa antiessare a 12-month le an ily from installation date is only.The will be sent to Owner.Owner shall indemnify and reimburse Bath Fittes'E fin all above warranties are not transferable and.are for your personal benefit.only.The reasonable casts of collection associated with Into payment or nonpayment including warranties offered in relation to this Agreement and the.lens-dies set forth therein but not limited to reasonable attorneys'fees A late charge of I�.'/.per month shall arc exclusive and in lieu of all other rtttranties,remedies and conditions,whether be added to all overdue balances(nominal annual percentage rate of IB%).There oral,written,statutory,express or implied.Bath Finer disclaims all statutory and implied warranties,including without imitation,legal warranties of quality and will be a S25.00 fee fur any returned check. S. Payment Options,Bath Fitted offers third party financing for qualified buyers.If fitness fora particular purpose and warranties against hidden or latent defects.Bath you choose to finance your purchase and your application is approved, Fitter limits the reddur ther and remedies of such warranties to the duration of the a third party warranties contained therein, finance contract will prevail and may provide for a different monthly.payment 21. Integration and Seyerabillty. The Contract Documents contain the entire amount and tern than shown in the Contract Documents.The option of financing may only be selected at the time you place yourank:r: agreement between the parties here'°:and supersede all prior oral or written 9. Permits.Owner shall famish and pay for,at they ownunderstandings:Should any pan of the Contract.Documents for any reason be found expense taxes,permits and invalid,such a determination shall not affect the validityof remaining licenses,including without limitation,local and municipal permits and licenses, any g portion of required by law or any applicable regulations towith Contract other,xwneAgr Ifthe t Order and this Agreement are in any way inconsistent these Contract Documents. You herebyagreeperform tbewok in accordance with each this Agreement shall govern. Fitter armkst,of,Documents and a to defend,i darmify and hold Bath. 22. Amrlieable Law and Disrute Resolution.The Contract Documents shall be against any claims liability,suits damages,expenses, governed and construed in accordance with the laws of the Stale of Massachusetts, costs(including reasonable attorney fees),fines and pismires attributable to your For anyclaims failure to comply with the above oblgotion In all instances where Bath Fitter would dispute or other matter o controversy arising fur:t or Fitted ay determine,in its discretion,it would provide any of the alsovementionet permits or thesesubmit bon t the isattoaDocuments or the breach of any which thereof,approved by may licenses, it will notify you and the permit/license fee includingre urectt the thepff Office o private arbitration Affairs firmd has been onCBy the administrative costs will be added to the contract Bath Fitted cannot be held Directorsc of lberequired of Consumerosubmit mi to such BusinesstiRegulation provi a in MGI,, responsible for any permit related delays. Chapt- be held. and Owner shall be to to such.arbitration as provided in MGL, 142A.The non-prevang party in the 10. Delays.Although Bath Fitter&makes every effort to do so,Bath. Fitter*.cannot pasrreasonable attorney fees ncosts,and pesesitration shall pay the prevailing. guarantee that your installation will be completed in one day.In addition,on occasion Bath Fitted will he forced.to postpone the start date of a project whether due to -03?4TCI5�:4';?58�DTz scheduling conflicts,labor or material shortages.It is Bath Fitter to policy to notify / the customer as soon as any change is known.You will be informed of the reason for2022-0&24 the delay and the revised installation date.If the installation is delayed or takes more. Owner's0 Signature Date than one day,Bath FinerS>cannot be held responsible for any reimbursement, 2622-03_.4TI5:47:52LDT discount,or any other type ofcompensation YP to you for claims of inconvenience s any other harm.Unnecessary delays experienced by our technician caused b•Ownera0224I3.24 y will result in an additional.charge. BathFatetdG Signature Date . MAY CANCEL THIS �3• Use of E-m.0 for Customer Feedback time to time,Bath Fitters(or any of ill, NOTICE OF CANCEI,I ATION THE OWNER its third party strategic partners and service providers)may wish to contact you at the TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD(3a) e`manl address set forth on the attached Order.You hereby authorize Bath Fi email BUSINESS DAYAFTER THE DATE OF THIS AGREEMENT.BECAUSE BATH partnersds Ft l t ERR°PRODUCTS WILL BE CUSTOM MADE FOR YOU.BATH hit1.ERE (or any of its third party strategic and service providers)to use your eilma tocommnnrcae with you for the purpose of improving Beth FitlerQl's products, CANNOT REFUND YOUR DEPOSIT AFTER THE CANCELLATION PERIOD and HAS EXPIRED. services a marketing,including obtaining your feedback and conducting customer 12, HOME SOLfCITA'f1ON.YOUMAY CANCEL THISAGREEMENT IF fT HAS research and satisfaction surveys. BEEN SIGNED BY A PARTY THERETO AT A PLACE OTHER THAN AN Ise agree with the grants army e-mail for These proposes ADDRESS OF THE SELLER, WHICH.MAY BE HIS MAIN OFFICE ORsu 24, Lien"Mato,tradesman law lien rights to builders.Any construction contactor, BRANCH THEREOF,PROVIDED YOU NOTIFY THE SELLER IN WRITING the property eord material discharged uppfier who is en paid can recant a lien on AT HIS MAIN OFFICE OR BRANCH BY ORDINARY MAIL POSTED,BY theome a se being improved If not TELE(aRAM SENT OR BY DELIVERY,NOT LATER THAN MIDNIGHT OF Rggtste a sera'All like a tors an c on the propz payment, mechanics'lien will THE THIRD BUSINESS DAY FOLLOWING THE SIGNING OF THIS 25. sad anyatq ui All contractors and subcontractors must.be registered by the OCABR, AGREEMENT SEE THE ATTACHED NOTICE OF CANCELLATION FORM and any inquiries about.a contractor or subcontractor reining to a registration should FOR AN EXPLANATION OF THIS RIGHT. be directed to OCABR. 13. Force Maieure Beth Fitter$shall not be held liable for any lines,damage or delay Do not sign this Agreement if there are any blank spaces m correction with this agreement dire to delays in transportation of materials, I understand lb trid agree to the derma and r datede¢r above,accidents,theft,fire,labor disputes,insurrection,acts of God, Contra limitation the tatrls.of the a date. Order a including without beyond Bath Fitter'R1's control. or any other cause22224)224 and all other Contract Documents of same date. 14. Bpmoval of Existing F inarl.Bath Fitter is not responsible for the removal and/or Dated at yer,rbuae ,Massachusetts on the 24a' day of Mash reinstallation of fixtures,including electrical fixtures.Bath Fitter will not.remove 2022- atd'o reinstall any of your existing fixtures,including,without limitation,shower �,� 6EDT In the event that the doors will no longer fit Bath Fincrk cannot be held ZYIGG-t } 6� T responsible for any reimbursement,discount,or any other type of compensation to ^.�. you for replacement of these fixtures. Signature of.Property(Tuner or Duly Authorized by Property Owner 15. Mold.Mold occurs naturally in almost all indoor environments.Mold spores enter Diane tc asiglain homes through doorways,windows and a variety of other ways.A Bath Fitterg installation may include the removal of wet,loose,defective,discolored or odorous 99 Chi Name tiptin Green C(hyper or Daly Authorized by Property Owner(Pirate Print/surfaces and the washing of remaining surfaces with a household bleach solution. Yaa h..Masaachusens,02664 Bath Fitted-and its representatives make no warranty or representation of any kind, express or implied,regarding the presence or absence of mold,or regarding the byelfcetiveness ot'any biocide designed for reducing the presence,effect or growth of Address afPropaty Owner or Duly Authorized Pro mold,and make warranty rvnanly or representation with respect to,and cannot be held Bath Filter Bridgewater Inc. PertyOw'ner responsible for,the presence of mull.in your home subsequent.to the Bath I'ttmR'hnvtallatinn. //4,sy�l�l 7. 3EDT 16. installation.If,during the installation phase,Bath Fitted is required 10 perform Per: � ` � repairs to existing walls,additional charges will apply at the current service rates. Name ofism s ConsWtam. 3'4 NOTICE OF CANCELLATION FORM FOR HOME SOLICITATION SALE Date of Transaction: 2022-03-24 Ref SI: 375-L15DKRX2-JCL Date this contract is signed: 2022-03-24 Ref it: 375-L15DKRX2-JCL You may cancel this transaction,without any penalty or obligation,within three business days from the above date. If you cancel,any property traded in,any payments made by you under the agreement,and any negotiable instrument executed by you will be returned within ten business days following receipt by the seller of your cancellation natlte, and any security interest arising out of the transaction will be cancelled. If you cancel,you must make available to the seller at your residence,In substantially as good condition as when received,any goods delivered to you under this agreement;or you may,if you wish,comply with the instructions of the seller regarding the return shipment of the goods at the seller's expense and risk. If you do make the goods available to the seller and the seller does not pick them up within twenty days of the date of your notice of cancellation,you may retain or dispose of the goods without any further obligation.If you fail to make the goods available to the seller,or if you agree to return the goods to the seller and fag to do so,then you remain liable for performance of all obligations under the contract. To cancel this transaction,mail or deliver a signed and dated copy of this cancellation notice or any other written notice,or send a telegram,to: Bath Fitter Bridgewater Inc. 25 TURNPIKE ST, WEST BRIDGEWATER,MA, 02379 Not later than midnight of 2022-03-29 I hereby cancel this transaction. Date: Signature of Property Owner or Duly Authorized by Property Owner: 414 a George and Diane McLoughlin 99 Chipping Green Circle South Yarmouth MA 02664 Yarmouth Building Department Attn: Rosa Fallon RE: Building Permit Application Rosa, Based on our phone conversation yesterday, 6/2722 in regards to the status of the building permit application that we recently sent to the Yarmouth Building Department for the proposed work on the subject property,this letter confirms our intentions of making 99 Chipping Green Circle our primary residence in the near future. As requested, enclosed are revised Pages 2 and 3 of the building permit along with the homeowners license exemption form for your consideration. Any additional questions or concerns please feel free to contact me at 978-799-8721. • Regards gorge Loughlin SECTION 5: CONSTRUCTION SERVICES ... 5.1 Construction Supervisor License(CSL) License N'timbe: Expiration Date I Name of CSL Holder I List CSL Type(see below) I No.and Street ' Type Description II Unrestricted(Buildings up m 35,000 cu.ft) R Restricted 1,10 Family Dwelling City/Town,State,'1.1P M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Bunting Appliances 1 Insulation Telephone Email address D Demolition . ' 5.2 Registered Home Improvement Contractor(HTC) i HIC Registlition Number Expiration Date HIC Company Name or HIC Registrant Name No.and Street l Email address Ci /Town State,ZIP Telephone I ---1 SECTION 6:WORKERS CONTPENSATION INSURANCE AFFIDAVIT(M.O.L,c.152.§25C(6)) Workers Compensation Insuraucc 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 Aracheri? Yes.......... No „ . ....1:3 - --H________ SEC IION 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 to act on my behalf,in all matters relative to work authorized by this building permit application. _ Print Owner's Name(Electronic Signature) Dote • ---____1• SECTION 7b:OWNERI OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby arrest under the pains and penalti of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. k .......4-\1‘‘'.... 6/3/2 a.Print Owne r Authorized Agent's Nairm4Electonic Signature) Date NOTES: I. All Owner who obtains a building permit to do his/her own work or an owner who hues au unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A,Other Important information on the RIC Program can be found at www.mass.gov/oca L.:formation on the Constructiou Supervisor License can be found at www.mass.eov/dps 2. When substantial work is planned,provide the information below: Total Eoor area(sq.II) (including garage,finished basement/attics,decics or porch) Gross living area(so.ft.) Habitable room count Number of fireplaces Number or 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" — ........ __,