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Home My WebLink AboutBLD-22-006403 *6 •Vititie TOWN OF YARMOUTH Building Department BUILDING (508) 398-2231 ext.1261 ° PERMIT ..""� 4 4 PERMIT NO ALD-22-006403pwM ®Rm£ JOB WEATHER CARD ISSUE DATE ®05/05/2022 Flm . ..m. — APPLICANT John Carvalho PERMIT TO . m_ Repair w ..m AT(LOCATION) 8 VIKING ROCK DR,SOUTH YARMOUTH,MA 026 - ZONING DISTRICT I Bldg.Type: [Residential SUBDIVISION MAP BLOCK LOT 101.108 BUILDING IS TO BE: LCONST TYPE i V B USE GROUP R-3 REMARKS Repair-Strip and re roof 25 sq(978-490-6619) CONTRACTOR LICENSE 202919 Home Improvement John Carvalho 15 Newfield Lane Yarmouthport, Ma 02675 AREA(SQ FT) 664,115,760. EST COST($) 15000 00 _ PERMIT FEE($) 50.00 -1 -oy-- - µ_a_O2 ---_---°--_ ' OWNER COSTA MANUEL C BUILDING DEPT BY ADDRESS COSTA TINA,8 VIKING ROCK DR .,, ,,. SOUTH YARMOUTH MA 02664� 1 - PHONE THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, OR SIDEWALK ANY PART THEREOF, EITHER TEMPORARILY PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST APPROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM MINIMUM INSPECTIONS REQUIRED FOR ALL APPROVED PLANS MUST BE RETAINED ON WHERE APPLICABLE SEPARATE CONSTRUCTION WORK: 1)FOUNDATIONS OR JOB AND THIS CARD KEPT POSTED UNTIL PERMITS ARE REQUIRED FOR FOOTINGS.2)PRIOR TO COVERING STRUCTURAL FINAL INSPECTION HAS BEEN MADE.WHERE ELECTRICAL PLUMBING/GAS MEMBERS(READY FOR LATH OR FINISH COVERING) A CERTIFICATE OF OCCUPANCY IS AND MECHANICAL 3)FINAL INSPECTION BEFORE OCCUPANCY 4) REQUIRED,SUCH BUILDING SHALL NOT BE INSTALLATIONS. REFER TO DETAILED INSPECTION SCHEDULE OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTIONS APPROVALS OTHER: IVORK SHALL NOT PROCEED PERMIT WILL BECOME NULL AND VOID IF INPSECTIONS INDICATED ON THIS CARD UNTIL THE INSPECTOR HAS CONSTRUCTION WORK IS NOT STARTED WITHIN SIX CAN BE ARRANGED FOR BY TELEPHONE 4PPROVED THE VARIOUS MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED OR WRITTEN NOTIFICATION. STAGES OF CONSTRUCTION ARf1VF a nn, ,/� .0 L-•// A-, , ., ,e4,4 . volin car va l40 Cp kt S)C,VthI4 t ingt I/. t'/P7 Office Use Only „k.. *0 Pcrn'iit# 0 .5D.,1 Permit expires 180 days from issue date RECEIVED MAY �}5 2022 PRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department .,2Z_00 D3 B U'tly :,.. E►vr 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: g Vda V:tokl 4KAG 4sti,, U;ui'4 y0&M, /s'!4. (9,2�1�17 ASSESSOR'S INFORMATION: Map: Parcel: OWNER: -rmk, t t t aAnuQ CI SA. 4n c as 41..12est 599 oa NAME PRESENT ADDRESS TEL. # CONTRACTOR: (Jo (14 Va//11 I heiekid 404t1 i V ,► Ott f7`r9 fro cd/f N MAILING ADDRESS Residential 0Commercial Est.Cost of Construction$ / 09.00 Home Improvement Contractor Lie.# ad'1 9 Construction Supervisor Lie.# CS —/d f f fe4 Workman's Compensation Insurance: (check one) �/ 0 I am the homeowner 0 I am the sole proprietor 11'I have Worker's Compensation Insurance Insurance Company Name: Jd X/kkite* W€S,t Worker's Comp.Policy# WORK TO BE PERFORMED Tent El Duration (Fire Retardant Certificate attached?) Wood Stove ❑ Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares 25 ([emove existing*(max.2 layers) Insulation El n Old Kings Highway/Historic Dist. &}Replacing like for like Pool fencing n *The debris will be disposed of at: r/./- h,,,,,,A,A. b(4,1( kiii ocati of Faeitl { �a I I declare under penalties of perjury: ;a 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 or ree . en of m t se and for prosecution under M.G.L.Ch.268,Section 1. Applicant's Signature: .0.. • Dace.! Air l OwmeraSlgnature(or f meat) Date: Approved By Date: " Building Official(or design EMAIL ADDRESS: Zoning District: Historical District: 0 Yes 2 No Flood Plain Zone: 'D Yes 0 No Water Resource Protection District: Within 100 ft.of Wetlands: i_: Yes 0 No 0 Yes Il No The Commonwealth of Massachusetts 1 ;=, _P Department of Industrial Accidents _�e1lIItia 1 Congress Street, Suite 100 ',!�— Boston, MA 02114-2017 www mass.gov/dia 1.1 Workers' Compensation Insurance Affidavit: Builders/Contractors/ElectricianslPlumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): J4pnCM.1 ft//tp Address: /'' NC(tfirI City/State/Zip: )utciJ41i /Opt Ng 0.205 Phone#: pi f Q0 4P6l9 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. 0 Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.01 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.❑Electrical repairs or additions p�prietors with no employees. 12.❑Pl bing repairs or additions 5.uV'I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. oof repairs These sub-contractors have employees and have workers'comp.insurance.; 6.1=Iwe 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#I must also fill out the section below showing their workers'compensation policy information. f 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. n•' Insurance Company Name: Jw�h( AWN W.t " _ Policy#or Self-ins.Lic.#: 60 P06 — '/Nqt//a3 ,4-'PI Expiration Date: e r'/7Z,-2 ID-- Job Site Address: 8 V( /€,.C. - ga'#C City/State/Zip:4A V lt�rWAI 0246 4/ Attach a copy of the workers' c pensation policy declaration page(showing the policy number fnd 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 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 r the 'ns and penalties of perjury that the information provided above is true and correct Signature: �/ Date: 'i )07- - Phone#: Q7g WI lt(jl9 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#: • �....• LCTCONS-01 KLEBLANC Ar....9)21fr CERTIFICATE OF LIABILITY INSURANCE DATE D/YYYY) /5/2022 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 CONTACTNAME: AX)A MetroWest AHONE /C,No,Ext):(413)788-9000 i FAX No):(413 886-0190 E-MAIL ADDRESS:info@axiag roup'net INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Kinsale Insurance Company INSURED INSURER B:Chubb Insurance Group 41386 LCT Construction&Service Inc. INSURER C: 4 Evergreen Lane INSURER D: Hopedale,MA 01747 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 NUMBER M/POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MDD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 0100058934-4 11/21/2021 11/21/2022 DAMAGE TO RENTED 100,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JECOT- X LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ COMBINED AUTOMOBILE LIABILITY Ea aco dent)SINGLE LIMIT $ ANY AUTO 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$ $ B WORKERS COMPENSATION PER EATUTE ERH AND EMPLOYERS'LIABILITY Y/N 6S62UB-4N44123-A-21 8/17/2021 8/17/2022 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A 500,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Carvalho Construction ACCORDANCE WITH THE POLICY PROVISIONS. 15 Newfield Lane Yarmouth Port,MA 02675 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts Division of Professional Licensure 11 Board of Building Regulations and Standards Constz4iff$44AtiOrvisor CS-101942 r)pires:08/04/2022 JOHN M CAJ w4, 15 NEWFIELD!, YARMOUTH P41121' 1, 5 - i_v OfS\-1 3 0 Commissioner c>°cra YEimata... -7:1 oft: Office of ConsumerAffairs&Business Regulation HOME IMPRCOEMENT CONTRACTOR Registration valid for individual use only TYPErCorporation before the expiration date. If found return to: ssbsun Expiration Office of Consumer Affairs and Business Regulation 08/24/2023 1000 Washington Street -Suite 710 CARVALHO CO INC. Boston,MA 02118 JOHN M.CARVALlola---- 15 NEWFIELD LANE /7‘'('‘#4. YARMOUTH PORT,MA 02675 secreta Not valid witteasignafure Underry