Loading...
HomeMy WebLinkAboutBLD-23-00512811CW/ " Office Use Only k? " 513hL 3 Permit# l' //Na re 9Q 4-2)p '.„3\ 1; y Amount... 4M.,n• ,car Permit expires 180 days from issue date B (,1) a3 -00512-g EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department RECEIVED 1146 Route 28 South Yarmouth, MA 02664 MAR 17 2023 508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: 154 Center Street #4 BUILDING DEPARTMENTBy ASSESSOR'S INFORMATION: Map: 140 Parcel: 50/C4 OWNER: David Holt 207 Coachman Drive 508-333-6077 NAME PRESENT ADDRESS TEL. # CONTRACTOR: Lewis and Weldc 111 Airport Road 6173594666 NAME MAILING ADDRESS TEL.# B Residential 0 Commercial Est.Cost of Construction$ 11,846.00 Home Improvement Contractor Lic.#154680 Construction Supervisor Lic.#097094 Workman's Compensation Insurance: (check one) 0 I am the homeowner 0 I am the sole proprietor 0 I have Worker's Compensation Insurancee Insurance Company Name: Selective Insurance Company of America Worker's Comp.Policy#9084610 WORK TO BE PERFORMED ') 4 Lh 1 '1f Tent1:1 Dur ion Demo of unit#4 Fire Retardant Certificate attached?) Y, '' ' Stove Siding: #of Squares Replacement windows: # eplacement doors: # Roofing: #of Squares 0)Remove existing*(max.2 layers) Insulation 17 Old Kings Highway/Historic Dist. d Replacing like for like Pool fencing I I approved Li 413 Pina Sanatation SevicesThedebriswillbedisposedofat: 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. 1 understand that any false answer(s) will be just cause for denial or revoca 4 ns and for prosecution under M.G.L.Ch.268,Section 1. Applicant's Signature: . - Date: .3 ef/23 Owners Signature(or attachment) ,• .A Date: Z 17 Approved By: Date: 4:- A Building Official "r" ` EMAIL ADD'401 Zoning District: f Historical District: Yes No Flood Plain Zone: LiYes [3 No Water Resource Protection District:Within 100 ft.of Wetlands: ibi El Yes 0 No Yes 1.1 No The Commonwealth ofMassachusetts h !1 Department of Industrial Accidents itil= 1 Congress Street, Suite 100 Ji!. i_ Boston, MA 02114-2017 wwK.mass.gov/diaIMP Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): Lewis and Weldon Address: 111 Airport Road City/State/Zip:Hyannis/MA/02601 Phone#: 6173594666 Are you an employer?Check the appropriate box:Type of project(required): 1. I am a employer with 9 employees(full and/or part-time).* 7. New construction 2.0I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.]9. ErDemolition3.111 am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 Building addition 40I 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.QElectrical repairs or additions proprietors with no employees.12.['Plumbing repairs or additions 5.1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairsThesesub-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,§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. Ifthe 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 andjob site information. Insurance Company Name: Selective Insurance Company of America Policy#or Self-ins.Lic.#: 9084610 Expiration Date: 5/10/2023 Job Site Address:154 Center Street#4 City/State/Zip: Yarmouth Port, MA 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 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 ofthe DIA for insurance coverage verification. I do hereby c ' Alandpenalties ofperjury that the informationprovidedabove is true and correct Signature: Date:3/15/2023 Phone#: 6173594666 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.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person:Phone#: 14 LEWIAND-01 MJACKSON DATE(MWDD/YYYY)RLs CERTIFICATE OF LIABILITY INSURANCE 7/12/2022 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 POUCIES 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 gleCT FBinsure,LLC P" c° N a ):(508)82448666 I FAX No):(508)880-0142 128 Dean Street Taunton,MA 02780 Maas:infoOtbinsure.com INSURERS)AFFORDING COVERAGE NAIC# INSURER A:Selective Insurance Company of America 12572 INSURED INSURER B:Selective Insurance Company of South Carolina 19259 Lewis and Weldon Custom Cabinetry LLC INSURER C: 111 Airport Road INSURER D: Hyannis,MA 02601 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER tMA/ D/YYYY) IMMIDO/YYYYI LIMITS A X COMMERCIAL GENERAL LIABIUTY EACH OCCURRENCE $ 1,000,E CLAIMS-MADE X OCCUR S 2443341 5/10/2022 5/10/2023 PREES(Ea o Ei°renoe) $ 1,000,000 X Blkt Add'I Ins MED EXP(Anm one person) $ 15,000 X Blkt Waiver PERSONAL 8 ADV INJURY $ 1,000,000 GEM_AGGREGATE p UMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY n JE Ti LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: COMBINED SINGLE LIMIT 1,000,000AAUTOMOBILEwauTYEaaccident) ANY AUTO A 9108697 5 10/2022 5/10/2023 BODILY INJURY(Per person) $ OWNEDAUTOSONLY X AUUTNOSSuLNEDp BBOODDILYINJURY(Peraccident) $ X AUTOS ONLY X AUTOS ONLY P ) GE A X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS UAB CLAIMS-MADE S 2443341 5/10/2022 5/10/2023 AGGREGATE 1,000,000 DED X RETENTION$ 0 B WORKERS CONDENSATION X STATUTE ER1 AND EMPLOYERS'LIABILITY YIN WC 9084610 5/10/2022 5/10/2023 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $ OEFICERM BM EXCLUDED? N N/A 500,000 1IMann YY E.L.DISEASE-EA EMPLOYEE $ If yes,desabe 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)Custom Cabinet manufacturer,installation,and general contractor for residential building construction. FOR INFORMATIONAL PURPOSES ONLY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE Lewis and Weldon Custom Cabinetry LLC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INACCORDANCEWITHTHEPOLICYPROVISIONS. 111 Airport Rd Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE 4777 840•000 ACORD 25(2016/03) 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 55/5/2021 Office of Consumer Affairs&Business Regulation-Mass.Gov r Mass.gov Office of Consumer Affairs and Busines Regulation (OCABR) I U (.4j v jj ir 4 O W Q W tiggF zf og HIC Registration Complaints gig Wta00„ 06 Za— Registration # 154680 ij W Registrant LEWIS &WELDON CUSTOM CABINETRY, t LLC. P Name CLARENCE HART JR. Address 111 AIRPORT RD City, State Zip HYANNIS, MA 02601 Expiration Date 03/28/2023 Complaints Details No complaints found for this registrant. You can also view arbitration and Guaranty Fundjoistary. Back To Search 1/2 httpsJ/services.oca•state.ma.usmkJlicdetails.aspx?bctSearchLN=154680 am w of ss ar 1_. 4 s 3 t 4 f i`rz fi its Atil a, r v qir .. - EVERS=URCE Eversource Energy 247 Station Dr,Westwood,Massachusetts 02090-9230 ENERGY March 17,2023 David Holt 154 Center St 4 Yarmouthport,MA 02675 RE: ADDRESS REMOVAL To Whom It May Concern: At Eversource,we're committed to delivering great service. This letter serves as confirmation that,as of March 17,2023 the electric service to above address has been removed. Based on this information,there is no electric power at this address. If you have any questions,please contact me at(781)441-3206 Sincerely, eeevzaa Eversource Electric Service Support Center TOWN OF YARMOUTH l l l r is i 1148 ROUTE 28,SOUTH YARMOUTH,MA 02664-4451 Telephone(508)398-2231 Ext.1292-Fax(508)398-0836 2" 11PR25Pqi:{)1R,zt APR ftiEb3K1 G'S HIGHWAY HISTORIC DISTRICT COMMITTEE y YLDARMOUTHG' HIGHWAYAPPLICATION FOR CERTIFICATE OF APPROPRIATENESS Application is hereby made for issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts of 1973 as amended,for proposed work as described below&on plans,drawings,photographs,&other supplemental info accompanying this application. PLEASE SUBMIT 4 copies OF SPEC SHEET(S),ELEVATIONS,PHOTOS,&SUPPLEMENTAL INFORMATION. Check All Cateaories That Aoaly:Indicate type of Building: Commercial X Residential 1)Exterior Building Construction: X New Building Addition Alterations Reroof Garage Shed Solar Panels Other: New building to replace existing fire damaged unit#4 2)Exterior Painting: Siding Shutters X Doors xTrim Other: Arbor/Trellis 3)Signs/Billboards:New Sign Change to Existing Sign 4)Miscellaneous Structures: Fence Wall Flagpole Pool Other: NA Please type or print legibly: Address of proposed work: 154 Center Street unit#4 Map/Lot# 50/C4 Owner(s): David Holt Phone#:508-333-6077 All applications must be submitted by owner or accompanied by letter from owner approving submittal of application. Mailing address: 207 Coachman Drive, Bamstable Year built Email: brendanl©lewisandweidon.Com Preferred notification method: Phone Email Agent/contractor: Lewis and Weldon Custom Cabinetry LLC Phone#: 6173594666 Mailing Address: 111 Airport Road, Hyannis MA 02601 Email: brendanlftlewisandweldon.com Preferred notification method: Phone X Email Description of Proposed Work: II 0/Ilia e s'ns C z .Q c.ES'i APR 4 2OZ3 iAiMOu-rH OLD KING'S HIGHWAY Signed(Owner or agent):Date: 5--23 Ownerlcontractodagent is aware that a permit is required from the Building Department.(Check other departments,also.) D If application Is approved,approval is subject to a 10-day appeal period required by the Act. D This certificate is good for one year from approval date or upon date of expiration of Building Permit,whichever date shall be later. D All new construction will be subject to inspection by OKH.OKH-apprord plans MUST. vailable on-site for framing&final inspections. For Committee use only: Approved Pved with-4d Modifications Denied Revd Date: 71?'. Reason for Denial; Amount `?5;GO j} re Wit 'Signed: a . L Rcvd G.,1by:e 1 Date Signed: di ‘r . 1 APPLICATION#: Aril' EVE RS=URGE 247 Station Drive Westwood,MA 02090 ENERGY Request for Shut off and Removal of Service I/we 1 0 }/cam property owner/s of: Please type or print legibly) C Nri 2 S! CA( tor 1-f /(4G 1 `( fe L-c' c 6 Service Address Town Zip code Hereby request the electric service and meter(s) be shut off and removed for the purpose of demolition and/or major renovation. The electric service is (please circle one): OVERHEAD _ UNDERGROUND Eversource Electric meter# The earliest business day Eversource can remove service is: 31l fzd?2 (ASAP is not a date) Removal may take up to 10 business days from date requested. Current Mailing Address: 7— treat,ti AAA-- GOY' Current Phone Number/s: Email/fax confirmation to: cf- O ners Signature Owner's Printed Name If you have any further questions, please call 1-888-633-3797 Please complete and return to Eversource Electric EMAIL TO: MANewService@eversource.com f I ti I. . {:-' (fiftki Ii , j t TOWN OF YARMOUTtI 3*7 . A . WATER DEPARTMENT a I.! ,, 99 Buck Island Road r.n.n cj/Z West Yarmouth. MA 02673 tele phone: 15081 771-7921 • Fax: t5081 771-7998s:::i BUILDING PERMIT APPLICATION FOR WATER DEPARTMENT SIGN OFF TRANSMITTAL FORM BUILDING SITE LOCATION: I S y Cen'-r S4--ee f PROPOSED WORK:D.e 0440' " n c , ?u, 11 . 4, APPLICANT: Daurai dal ADDRESS: 2 0-7 C 0 ex di iacvt ii4h-c l gAr 51.454 I< UZ G. . E TELPHONE: SO 8-333-6,,a"?`T RESIDENTIAL AND 'OR COMMERCIAL BUILDING Water Department: Determines Compliance of Water Availability and or existing location Engineering Department:Determines Compliance for Parking and Drainage Conservation Commission: Determines Compliance to Wetlands Act; i.e. If lots)border any type of wetlands.streams,ponds.rivers,ocean,bogs.boys.marshland,ETC... Health Department: Determines Compliance to State and Town Regulations. i.e. requirements for Septage Disposal and other Public Health Activites Eire Department: Determines Compliance to State and Town Requirements for Personal Safety. Property Protections, i.e.Smoke Detectors. Sprinkler Systems,etc yf 3-2ff- 23 I :ANT SI . Ai 'RE DATE OFFICE USE:COMMENTS ON PERMIT APPROVAL OR DENIAL YL JP I5 etspotu5,1siE 4 iv . r-tu-r et& - 4-z: p4+4/N -40vi , PUuM 6tq / C,c vt TEA UM,- 044 v b i S COrk rNc.C r C ci rA " "H Akre_ mcrel, Ri'` 3),: 'v/W2-3 REVIEWED BV WATER DIVISION(SIGNATURE) 160