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Home My WebLink AboutBLD-23-003396 CO, 1zleo! 7/2_ p4''YRR Office Use Only Oy Permit# Cit-il'l d MAnA PIcs;,' Amount.50.O6 ta.a.u' ,a Permit expires ISO days from issue date ile EXPRESS BUILDING PERMIT APPLICATION _�3 �� TOWN OF YARMOUTH Yarmouth Building Department I CEIVE 1146 Route 28 South Yarmouth, MA 02664 DEC 19 2022 (508)398-2231 Ext. 1261 CONSTRUCTION ADDRESS: 7 Capt ain BI ount Road, S. Yarrrout h, Ma 02-664 BUILDING DEPARTMENT By ASSESSOR'S INFORMATION: Map: Parcel: owNER:J oanneSant ino 7 Capt ain BI ount Rd 41 (617) 217-1201 NAME PRESENT ADDRESS TEL. # CONTRACTOR: AI d6 Mazza) 157 P ine BI off Rd, Bre ist a 5083603835 NAME MAILING ADDRESS TEL.# ❑Residential ❑Commercial Est.Cost of Construction$ /1 t,p/ 7. 7 Sr' Home Improvement Contractor Lic.#170232 Construction Supervisor Lic.#CS 117432 Workman's Compensation Insurance: (check one) 0 I am the homeowner 0 I am the sole proprietor p I have Worker's Compensation Insurance Insurance Company Name: 9Md f f y' ,0Ork( Worker's Comp.Policy# N(;-V'O I5-b9 61O I WORK TO BE PERFORMED Tent E Duration (Fire Retardant Certificate attached?) Wood Stove 1 1 Siding: #of Squares Replacement windows:#10 Replacement doors: # Roofing: #of Squares (El)Remove existing*(max.2 layers) Insulation L ( I I Old Kings Highway/Historic Dist. (Q)Replacing like for like Pool fencing IT *The debris will be disposed of at: CapeCod Disposal dimpst a on t twit e 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 or revocation of my license and for prosecution under M.G.L..Ch.268,Section 1. Applicant's Signature: 'Cii— 12.192022 Date: Owners Signature(or (hutment At t a c fei Date: Approved By: E . Building Official(or ,, gn EMAIL ADDR Date: Zoning District: Historical District: Yes No Flood Plain Zone: Yes No Water Resource Protection District: Within 100 0.of Wetlands: Yes No Yes No The Commonwealth of Massachusetts }N-Ali — Department of Industrial Accidents I Congress Street,Suite 100 c 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 Print Legibly Name (Business/Organization/Individual): Al dsandra MAZLEO Address: 157 P i ne BI off Rd City/State/Zip:Brenst e-, Ma 02631 Phone#: 5083603835 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 any capacity.[No workers'comp.insurance required.] 8. 0 Remodeling 3.01 am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. El Demolition 40I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 0 Building addition ensure that all contractors either have workers'compensation insurance or are sol 1 l.[]Electrical repairs or additions proprietors with no employees. 5.01 am a general contractor and I have hired the sub-contractors listed on the attached sheet 12.®Plumbing repairs or additions These sub-contractors have employees and have workers'comp.insurance.t ; •❑Roof repairs 6.0We 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. 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: At I antic Curt er Policy#or Self-ins.Lic.#: VCV 015093)1 03.20.2023 Expiration Date: Job Site Address:? Capt din BI ount Rd Sout hYarrmut h02664 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 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: C/4 Date: 12.192022 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): 1.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: 01 ACc'RD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDOIYYYY) --' 06/01/22 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 NAME: EACT JIM HINDMAN PHONE _ —_ '� _` _._... __ _ __ �_ ______ Schlegel&Schlegel Ins Brokers,Inc. N Exer 508-771-8381 I tArc,No): 508-771-0663 34 Main Street ampEss, schlegelinsurance@gmail.com West Yarmouth,MA 02673 ___ ( INSURERISI AFFORDING COVERAGENAIC ar __I INSURER A: NGM_ INSURED ;INSURER B ATLANTIC CHARTER — — MAZZEO CONSTRUCTION LLC j INSURER C 157 PINE BLUFF RD - -- ---- - BREWSTER,MA 02631 !INSURER f INSURER E. INSURER F: I 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"'HE POLICIES DESCRIBED HEREIN IS SUBJECT TO Al.L THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HM E BEEN REDUCED BY PAID CLAIMS INSR )RODE UBR! I POLICY EFF i POLICY EXP TYPE OF INSURANCE i POLICY NUMBER_ Ir LTR IINSD I WVD I1(MM100lYYYY)((MMlDDIYYYY� LIMITS X COMMERCIAL GENERAL LIABILITY j I EACH OCCLRRENi;E i S 1,000,000 I DAMAGE 1 O RENTED CLAIMS-?.9ADL ;X OC C'JR t-PREA+:SES Ea rc.�rr rN; $ 500,000 I I.'ED EXP eAny one person, $ �10,000 A _ MPJ9994A 03/19/22 03/19/23 fPERSONAL&ADV INJURI $ 1,000.000 GEN'L AGGREGATE OMIT APPLIES PER GENERAL AGGREGATE j$ 2,000,000 E O, 7 LI LOC j I PRODUCTS-COMP:OP AGG tI 5 2,000,000 POLL.^_ OTHER. _ I _—. I I f$ �~ AUTOMOBILE LIABILITY I COMBINED S NGLE LIMN f$ ( t E. at IIIa,'I j ANY ALTO =BODILY INJURY,Per person) S II OWNED SCHEDULED ! 4 BODILY LNJUR'-Pnr ir::,Cen! $ AUTOS ONLY AUTOS I .. HIRED I NON-OWNED I PROPERTY DAMAGE _I AUTOS ONLY [_J AUTOS ONLY Per ar,drntl $ I $ UMBRELLA LIAB I OCCUR EACH OCCURRENCE '$ I EXCESS LIAB I CLAIMS-9IADE AGGRE9AT'E i$ I DED , 1 RETENTIONS _ H WORKERS COMPENSATION 1 � I $ iAND EMPLOYERS'LIABILITY YIN i STATUT'c I IER ANY t>ROPRic'Tt R PARTNER'EXECUTIVE I E-L.EACH ACCtDIL?r S 100,000 B °OFFICER MEMBER EXCLIIDED 1 ! Si r A! WCV01509901 03/20/22 03/20/23 (Mandatory In NH) ` '' I EL DISEASE•EA EMPLOYEE $ 100,000 I',.es desonhe finder DESCRIPTION D% OPERATIONS beioa, _ E L DISEASE-POUCY LIMIT $ 500,000 xDESCRIPTION OF OPERATIONS;LOCATIONS t VEHICLES (ACORD 101.Additional Remarks Schedule,may be attached if more space is requeredl CORPORATE OFFICERS HAVE ELECTED TO BE COVERED UNDER THEIR CURRENT WORKERS COMPENSATION POLICY INSURANCE COVERAGE IS LIMITED TO THE TERMS,CONDITIONS,EXCLUSIONS AND OTHER LIMITATIONS AND ENDORSEMENTS OF THE POLICY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN TOWN OF BREWSTER ACCORDANCE WITH THE POLICY PROVISIONS. BUILDING DEPARTMENT BREWSTER MA AUTHORIZED REPRESENTATIVE r G 1988-2019 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD re - Commonwealth of Massachusetts Division of Occupational Licensure i Board of Building Re9iulations and Standards Cons uc' rt f k ervisor .j' CS-117432 •‘ Empires : 04/05/2026 .1 ALEKSANDR BOZENA MAZZEO f 157 PINE BLUFF ROAD BREWSTER MA 02631 / VOW P. .tiOI lci,13 , Imp ^ `/ ,- n� �^ • -o►MbsIM;w__a- .' \I r I / l; '1-4 / I? wVViiiiiii%iJ►iVii�.i Lil (� / ). lJ -N// r .�/ 44 Construction Supervisor Unrestricted - Buildings of any use group which contain less than 35 ("0 cubic feet (991 cubic meters) of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this License Call (617) 727-3200 or visit vwvw.mass.gov/dpi A Office of Constaner Affetret St Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE: Rectistfation Expiration I On? I i . , MACHNIV, E. MA Y6 Uidersecretary Registration valid for individual use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 1000 Washington Street -Suite 710 Boston,MA 02118 Not valid with ut signature • DocuSign Envelope ID:4A8EB877-5D6C-4EAC-BC92-5B9EF7599508 ESTIMATED PROPOSAL Mazzeo Construction LLC DATE: OCTOBER 7, 2022 CSL 102587; HIC184186 MazzeoconstructionCC@Rmail.com 157 Pine Bluff Rd,Brewster Ma 02631 TO Customer ID#7CPR22 7 Captain Perry Rd. South Yarmouth, MA 02664 DESCRIPTION UNIT PRICE LINE TOTAL Windows replacement 8 double hanged Windows replaced with Andersen 400 series- 1.14,000.00 1 Labor and materials-8,000.00 Living room picture window removed, frame in for new 4 double hanged units-$4000.00 Frame in and install new awning window-$1000.00 The garage octagon windowinstallation- $1,000.00 2. Portable toilet and dumpster fee 2.$1,500.00 3 Windows by Shepley-Andersen 400 series 3.$12,617.78 SUBTOTAL $28,117.78 15%OVERHEAD $4,217.68 TOTAL $32,335.45 DocuSign Envelope ID:4A8EB877-5D6C-4EAC-BC92-5B9EF759950B Thank you for allowing MAZZEO Construction LLC the opportunity to provide you with proposal for your project. Our office stuff and the crew team will strive to commucicate with you on a daily basis to update you on the progress of the project.Our goal from start to finish is to provide you with an"Excellent Experience" PLEASE CAREFULLY REVIEW ALL OF THE ITEMS,AREAS AND COMPONENTS THAT ARE INCLUDED TO ENSURE THAT THERE IS NO MISUNDERSTANDINGS AS TO THE SCOPE OF THE PROJECT.'nits is ESTIMATED COST OF rtIF PROJECT ,NOT A FIRM COST.PLEASE ALLOW INCREASE,OR DECREASE IN PRICE 15-20".IN CASE OF UNEXPECTED OBSTICLES,OR LOWER COST OF LABOR. Upon job approval,a deposit of$2000.00(non refundable),AND 50%deposit towards the windows order($6,308.89).Two weeks prior the project begins additional$12,000.00 is required for materials acquisition and labor. All change Orders and/or Additional Work Authorizations shall be in writing and signed by both Owner and Contractor and charged at a Rate of$$75.00 per man hour. Balance due at completion of project.Any alteration or deviation from above specifications involving extra costs will be executed only upon written order, and will become an extra charge over and above the estimate. All agreements contingent upon accidents, or delays beyond our control. Materials are not included and will be added as an additional charge,only materials provided is paint. Aproximate cost of materials as of 09.03. 2022 and it may change.Materials only estimated as listed. Labor estimated based on$75.00 a man hour.It's an estimated cost of the project not a contracted firm number. agreements contingent upon accidents,or delays beyond our control. Acceptance of Proposal / DocuSigned by: Quotation prepared by:Aleksandra Mazzeo 10/7/2022 "• erc18 M20300401_. This is a quotation on the goods named, subject to the conditions noted above: /— ocu Igne y: To accept this quotation, sign here and return: / 10/7/2022 suoisiE6256455... Thank you for your business!