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HomeMy WebLinkAboutBLD-23-003267 ' �0Y.yRR / Office Use Only / F" " . `� C���e l t� — 1 Permit# (7?� / ? ) /i3J lAmount 6-(J . N"e,, CSE a °"°°"""°.Q E� ;Permit expires 180 days from issue date BID-42-3--003o '? EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department RECEIVED 1146 Route 28 ----- --- w-�---- South Yarmouth, MA 02664 DEC 12 ZQ22 (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: V D JO r'2t4vta- 1)a.• BUILDING DEPARTMENT RY__ ASSESSOR'S INFORMATION: `,, ,e� tit.) Parcel: t�; OWNER: (OIJ 1 �1Iav C l i �!-' t ,-,,vl� t IZ, 503 J3 5 ( CJ to NAME / ,0,-,,,. PRESENT ADDRESS TEL. # CONTRACTOR: )Our)) / `e 3 avi 1(.9Cvc 51. bUG IQ 56g ( -i 33 SG 83 NAME MAILING ADDRESS TEL.# erResidential ❑Commercial Est.Cost of Construction$ tt Co / Home Improvement Contractor Lic.# t 9 19 27 Construction Supervisor Lie.# c^ 4 58 63 Workman's Compensation Insurance: (check one) ❑ I am the homeowner ❑ I am the sole proprietor I have Worker's Compensation Insurance c1 Insurance Company Name: CJ T(Llc/-4cj 5 Mt12 PHLt n 1 Worker's Comp.Policy# ! ` is��d b 7©(l/u,^9 It 022 A WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows: # Replacement doors: # Roofing: #of Squares ( )Remove existing* (max.2 layers) Insulation Old Kings Highway/Historic Dist. ( )Replacing like for like Pool fencing *The debris will be disposed of at: ►`( Ill r911Ni T E Z_ Cep OA ! 7 ' 'P' Ce 5'7 • a4 I )--,2/1/11 Loc on of acillty 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 deni or evocation of my license and for prosecution under M.G.L.Ch.268,Section 1. / Applicant's Signature: t Date: 2 I I �f` ( 2 2 Owners Signature(or attachment) K.,4144/1 P � Date: 1 2 j (Z / 2��j Approved By: Date: / t C— Building Offici r d ,ne-; EMAIL AD S: Zoning District: Historical District: 0 Yes .e No Flood Plain Zone: 0 Yes Zi No Water Resource Protection District: Within 100 ft.of Wetlands: 0 Yes 0 No 0 Yes ❑ No The Commonwealth of Massachusetts P _*,= = Department of Industrial Accidents _y�I= 1 Congress Street, Suite 100 �_ �� Boston, M4 02114-2017 4,,= www.mass.aov/dia UP s�y b \Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): 141-Ht Ho S" r Lt. L' Address: J )nu61Q5 (C ( b City/State/Zip:jG((S 616 o f Sl b Phone #: 5d ED c? 3 3 S6 E; 3 • Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity. [No workers'comp.insurance required.] 9. [ Demolition 3.0 I am a homeowner doing all work myself. [No workers'comp. insurance required.]t 10 ] Building addition 4.❑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 11.❑ Electrical repairs or additions • proprietors with no employees. - 12.Q Plumbing repairs or additions 5. am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.1 6.{:We are a corporation and its officers have exercised their right of exemption per MGL c. 14.7 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 ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. / Insurance Company Name: -(it MM(Z�5 r''I 0(P�'� y Policy#or Self-ins. Lic. #: AWC V ci Q 70 L/0 5 9 22. pzz A Expiration Date: tic) (1 w i Z Job Site Address: 2 5 ) D �- Olr1'Vj -9i2 City/State/Zip: 'la' it N(6 07h M ,li 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: " t I) v "t E( Date: i'fi Z / Z Phone#: 50 B ()3,3 7 6 S 3 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#: AcoRL' CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `... 12/06/2022 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 CONTACT NAME: Aida Bairns D FRANCIS MURPHY INSURANCE AGENCY INC (A/C,No,Ext): (978)568-8711 FAX No)___ E-MAIL abairo h om ADDRESS: @ ------P Y•c ...._ ___.. 133 MILFORD ST INSURER(S)AFFORDING COVERAGE NAIC# MEDWAY MA 02053 INSURERA: AIM MUTUAL INS CO 33758 INSURED INSURER B: DECKING SOLUTIONS INC INSURER C: INSURER D: 32 HEMLOCK ST INSURERE: DOUGLAS MA 01516 INSURERF: COVERAGES CERTIFICATE NUMBER: 840981 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 SUER POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1 I DAMAGE TO RENTED CLAIMS-MADE I I OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO i JECT I LOC PRODUCTS-COMP/OP AGG $ ---_._. OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS N/A BODILY INJURY(Per accident) $ - - HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ I WORKERS COMPENSATIONRETENTION$ $ AND EMPLOYERS' LIABILITY X STATUTE� 1 ER_ DED S' YIN — ANYPROPRIETOR/PARTNER!EXECUTIVE E.L.EACH ACCIDENT $ 1 000,000 A OFFICER/MEMBEREXCLUDED? N/A N/A N/A AWC40070405922022A 09/20/2022 09/20/2023 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 1 N/A DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only. Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/Iwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Karen Brunelle 25 Jo-anna Drive AUTHORIZED REPRESENTATIVE Yarmouth MA 02664 Daniel M.Crowley, CPCU,Vice President—Residual Market—WCRIBMA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Prepared For Arita Karen Brunelle t' "'�• "''� I 25 Jo-anna Drive ROOFS•SIDING•WINDOWS•DOORS•DECKS Yarmouth , MA RHINOSIDE.COM (508) 335-7849 Rhinoside Home Improvement Estimate # 1249 Date 11/15/2022 32 Hemlock St. Douglas, MA 01516 Phone: (508) 933-5683 Email: rhinosidehi@gmail.com Fax: (508) 381-0534 Web: www.rhinoside.com Description COMPLETE SIDING REPLACEMENT DESCRIPTION THE CERTAINTEED FAMILY OF PRODUCTS Designed to work together, the CertainTeed family of products provides countless options to create the space you've always dreamed about. As the industry's color leader,we're always listening to our customers'feedback and evaluating what colors to add and to which products. In 2019,we're excited to extend colors to a variety of products in the CertainTeed lineup. THE BEST VINYL SIDING IN THE INDUSTRY CertainTeed vinyl siding offers exceptional durability with an industry-leading spectrum of fade-resistant colors and classic clapboard, shiplap, beaded, shakes or shingle profiles in many styles,widths, and textures. DESCRIPTION OF THE PROJECT Blueskin®VP100 Self-Adhered Water Resistive Air Barrier Membrane Blueskin®VP100 is a premium, self-adhered vapor permeable,water-resistive barrier designed for wood-framed residential and multi-family construction. It protects buildings by eliminating air gaps and water and moisture intrusion and self-seals around nails and fasteners. Blueskin VP100 combines an engineered film and a patented, permeable adhesive technology with split-back Page L of 3 poly-release film. MONOGRAN VYNIL SIDING install new clap board vinyl double 4" over the whole house COLINAL WHITE ,FRONT OF THE HOUSE. color GRANITE GRAY, 3 SIZES WHITE VINYL SOFFIT "� Solid Soffit System A solid system in the soffit gives your home the best of both worlds -a beautiful, clean and stylish look, and the highest performance of any other Vinyl Siding and Accessories soffit. Install new soffit solid under the fascia wood front and back of the house or any place is required ALUMINIUM TRIM COIL.-i Bedeck a window, door or any other living area decor with a touch of style using this . PVC-Coated Aluminum Trim Coil.The trim coil installs easily using a hand brake tool The trim coil has a baked-on lomar white finish for low maintenance and rust-free aluminum construction for durability FASCIA `V Cover all espoused wood over the mentioned area white PVC Aluminum PREMIUN �/ E'- WINDOWS TRIM Cover all windows trim with PCV white aluminum premium...PREMIUN DOORS TRIM 7 Cover with PVC white aluminum all the doors trim premium...PREMIUN MISCELLANEOUS install new corners post on every corner of the house /7 features light block 67 water Hose Bibbs split block electrical outlet split blocks J channels for "� Page 2 of 3 utility trim aluminum flashing 47 start strips dryer vent Louver Vent DISPOSAL, CLEANING AND PERMIT ALL THIS INCLUDED LABOR AND MATERIAL Subtotal $24,654.00 Total $24,654.00 we appreciate your business Building America!! &A-46410 � L v -2- Dav Karen Brunelle ' c R( oGf2 Page 3 of 3 '1!:= - *' so,fl lJrrf II! RHINOSIDE 1 ROOFS • SIDING • 'WINDOWS • OOOi?S • I: RHINOSIDE.COM CONTRA(" This construction contract is entered into on December 6, 2022, 2022 by Mrs. Karen Brunelle and Rhino Site LLC. Contractor represented by Mr. David Mera. Remove and install new Monogram Vinyl Siding the Customer Wishes to obtain the Contractor's services to perform the following work: 1 - Remove the existing Siding 2.- Install new clap board vinyl double 4" over the whole house 3.-Color_front of the house COLONIAL WHITE 4.- Rest of the house GRANITE GRAY All the details of the work are attached on the estimate sheet# 1249 this contract is according to the estimate approved by you. The services are to be performed at the following address: 25 Jo-anna Drive, Yarmouth, MA 02664 The Contractor agrees to furnish labor, materials, and supplies necessary to perform the Services in accordance with the terms and conditions contained in this Contract. Upon completion of the Services,the Contractor will remove all materials, supplies, and other debris. In case of finding rotten wood, an extra cost will be charged. Remodeling Schedule. The Contractor will complete the Services in accordance with the following schedule. The Customer agrees that all dates are subject to change if Customer requests any changes or additions to the Services. Completion date further subject to weather conditions. Start Date: Full Completion Date: (508) 933-5683 0 rhinosidehi@gmail.com 004(508) 381-0534 www.rhinoside.com Payment Schedule. The Customer agrees to pay the Contractor the Total Payment specified below for the Services in accordance with the following schedule: Advance of the contract: $ 8,218.00 Upon execution of the Contract: $ 8,218.00 Upon completion of all Services: $ 8,218.00 TOTAL AMOUNT DUE: $ 24,654.00 The Parties agrees to the terms and conditions set forth as demonstrated by their signatures as follow: Contractor Customer Signed: Signed: By: David Mera Mrs. Karen Brunelle Project Manager Date: Date: (508) 933-5683 rhinosidehi@gmail.com ■6(508) 381-0534 www.rhinoside.com • Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Construt ilAii rvisor CS-115853 � � g pire : 12/01/2024 DAVID F MERA ' � gip. �. 24 ROLLING GREY APT D * MILFORD MA k" 4, )? . 01SS'rl • % Commissioner detiltf'. `l76riatsc., • THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs i Business Regulation HOME IMPROV CONTRACTOR TY C 1 441142424 RHOSITE LLC 1f.I . DAVID F.MERA OLIVQ, s 24 ROLLING GREEN DR, MILFORD,MA 01757 '°�+'"rt"C.i s Undersecretar y