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BLD-22-006770
AGENCY CUSTOMER ID: LOC#: AWRD® ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED Stephens Insurance,LLC t Restaurant anagehmentices,LLC POLICY NUMBER 3038 Sidco Drive Nashville TN 37204 Various CARRIER NAIC CODE Various EFFECTIVE DATE:8/1/2022 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 28 FORM TITLE:Evidence of Commercial Property(03/16) ADDITIONAL INTEREST: Town of Yarmouth ADDRESS: 1146 Route 28 South Yarmouth MA 02664 DEDUCTIBLES: $100,000 Per Occurrence All Other Perils except: $500,000. Aggregate Deductible All Other Perils $100,000 Per Occurrence Earth Movement, except as follows: 2% of the Total Insurable Values at the time of the loss at each Location involved in the loss or damage arising out of Earth Movement in New Madrid Earthquake Zone Counties and subject to a minimum deductible of $250,000 any one occurrence. 2% of the Total Insurable Values at the time of the loss at each Location involved in the loss or damage arising out of Earth Movement in Pacific Northwest Earthquake Zone Counties and subject to a minimum deductible of $250,000 any one occurrence. 5% of the Total Insurable Values at the time of the loss at each Location involved in the loss or damage arising out of Earth Movement in California and subject to a minimum deductible of $250,000 any one occurrence. $100,000 Per Occurrence Flood, except as follows: As respects locations wholly or partially within Special Flood Hazard Areas (SFHA) , areas of 100-year flooding, as defined by the Federal Emergency Management Agency (if these locations are not excluded elsewhere in this policy with respect to the peril of flood) , the deductible shall be the maximum limit available from NFIP whether purchased or not, subject to a minimum of $500,000 per building, $500,000 contents of any one building and $100,000 per occurrence as respects any other loss including Business Interruption and Time Element. $100,000 Per Occurrence for Wind/Hail, except as follows: 5% of Total Insurable Values at the time of the loss at each Location involved in the loss or damage arising out of a Named Storm (a storm that has been declared by the National Weather Service to be a Hurricane, Typhoon, Tropical Cyclone, Tropical Storm, or Tropical Depression) in Florida Counties of Palm Beach, Broward, and Miami-Dade, regardless of the number of Coverages, Locations, or Perils involved (including but not limited to, all Flood, wind, wind gusts, storm surges, tornados, cyclones, hail or rain) and subject to a minimum deductible of $250,000 any one occurrence. 3% of Total Insurable Values at the time of the loss at each Location involved in the loss or damage arising out of a Named Storm (a storm that has been declared by the National Weather Service to be a Hurricane, Typhoon, Tropical Cyclone, Tropical Storm, or Tropical Depression) in Tier 1 Counties, except Florida Counties of Palm Beach, Broward, and Miami- Dade, regardless of the number of Coverages, Locations, or Perils involved (including but not limited to, all Flood, wind, wind gusts, storm surges, tornados, cyclones, hail or rain) and subject to a minimum deductible of $250,000 any one occurrence. WAITING PERIODS: 24 Hour Waiting Period - Service Interruption, Ingress/Egress, Civil/Military Authority, and Contingent Time Element Loss Payee(s) and/or Mortgagee(s) Interest Clause ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ATTACHMENT 69576539 122-23 Property - REMAINCO w $100K Ded RGS (In Prog 1 Shirley Simmons 1 8/3/2022 12)47:18 PM (CDT) 1 Page 4 of 5 AGENCY CUSTOMER ID: LOC#: .AR D® ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED Stephens Insurance,LLC Restaurant Growth Services,LLC Attn: Risk Management POLICY NUMBER 3038 Sidco Drive Nashville TN 37204 Various CARRIER NAIC CODE Various EFFECTIVE DATE:8/1/2022 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 28 FORM TITLE:Evidence of Commercial Property(03/16) ADDITIONAL INTEREST: Town of Yarmouth ADDRESS: 1146 Route 28 South Yarmouth MA 02664 Holders of Certificates of Insurance issued against this policy that are shown as Additional Insureds, Mortgagees and/or Loss Payees are added to this policy as interest mayappear as -res ects the --_ PP P property listed on the certificate, as required by lease, contract or agreement. The Insurer may cancel this Policy and/or the interest of the Lender or Mortgagee under this Policy, by giving the Lender or Mortgagee written notice 30 days prior to the effective date of cancellation, if cancellation is for any reason other than non-payment (10 days) . TERRORISM: Carrier: Indian Harbor Insurance Co. (AXA XL) NAIC #36940, A XV Rated Policy # US00075939SP22A Policy Term: 8/1/2022 - 8/1/2023 Limit - $100,000,000 Deductible - $25,000 EQUIPMENT BREAKDOWN: Carrier: The Hartford Steam Boiler Inspection and Insurance Company NAIC #11452, A++ X Rated Policy #FBP2256920 Policy Term: 8/1/2022 - 8/1/2023 Limit: $100,000,000. Deductible: $25,000. ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORDCORD CORPORATION. All rights reserved. 69576539 1 22-23 Property ProgShirleyATTACHMENT P y - REMAINCO w $100K Ded RGS (In I Shirle Simmons 8/3/2022 12:97:18 PM (CDT) I Page 5 of 5 D.'fir" X oms ° a;,$t '7T ' ' 3 a:, to $ R. NJ':Q d • I4' I. a . _ e b *•'fir*.� -' �,. ,' n " Fo: 2 Zia' ` ,..,... - ♦ r -I, s ,-e;riy q k'1::.‘i.,., \, .. .,,...„.„,,,,, - ''''''' '.' " � ? n a A ,._. a ter:; - £z, .i:; Y x ..„+' :s , ..:am '. • `F kCF fs y' tf�+ f h t i .W AII 10 if ' .. '''': ♦ s h� r i „; , ,� 7a -' ' .k ,5,::,i'A': .. ...„ 4„ ,..-„4.-„ .,., ... *5:?. �`i x '' ,,-, ". ,--——°4Y Vie, v '."" k F- . _., are, ,» - .. n t r f .. f ' 3: Y et f • ,',' .k, 't. A;':?..,-,77tt. l't #x' k' Y ,e.. f $ D • 1. • i `� � �' i .t t. r� illa a• ,1.', ',,e4.,:.§,..?.. :,-.•.---',tii-1.--",-*,„'„.1!$:;:iii,:‘,1irL,,;„-",„ —'i-.„ : 31 .F €-.,, {3 s a' eJ J s> T j gin^ e • 14 • ` j . a .,.E g ,d a'7. fit,r t r- t F e ks °<<. 4 -A , •i `I t', It r ':' i s ,7 4 7 4fil . ^w tea ., k I k • � �k { V, 'i ' ' . .,,,, , : :i.,.. * I - uk x $ ''',, ."..I,Ai* i ,, ',. , .'4,et.'",‘ '1',';',,,, to/ ",!".., %,, / * \ %, '',".-0 i i, illii 4 " „. _ Imo ., , tt, .,,, ,,,...4,1....t ., .1 ,4y . . •'' t,4'!,•.;4.•• - •.", ..' • . '4.1'4 ••••,''4it '' : ,., 1 I� +yam ! " � ' %i Ir fi / ' ( 1°1'1--; ,f li'#4'41t4'.''''':.':-ti'''''it;ti''.*:;:;,i,'2 4...";:vir,:;.---..7:::7;10.1;1'*11-06‘071111111111P'0":4 ,., ,,,i A _1-.1 1:- 4.1:4:1-'1:1°1' -1- as ILL '''.4:lr:'' i'i'''''';:iiiv:04,t1b hi:::::::;- '' ' ' i , . 1 / ' 4 / ,, - s.,,,, ',.;',..,i,., l : 6 1S. ' ',f/ -,,,ti, , '.„, `> t T.. kk''. A I ba.M,a toil%) ' rry,y�, k rya ,. M 4 ) • M`"� r1.- ��v�. re:fab 6 1193 Ashley Blvd. Rear • New Bedford, MA 02745 • Phone: 833-807-3322 Bob Fair 174 Bay View St West Yarmouth, MA 02673 Print-date: 6-2-2022 re:fab was born from the notion that every property deserves to be at its best.Always. Providing specialty commercial and residential painting and renovation services. as well as custom maintenance plans, re:fab allows New England facility managers and homeowners to relax, knowing that our in-house team of experienced and licensed professionals are re:vamping their property. Understanding that every project is unique drives our customized process,which includes a free consultation so we can understand your specific needs and challenges and put together the best approach for your project. Cost Breakdown Code Description Price Demo Removing Shower at bathroom $4,050.00 Removing old Subfloor on first floor Dumpster Dumpster for demo of jobsite. $1,125.00 Permit Fees Carpentry Padding 1ft floor framing to Ivl as close as possible $4,350.00 installing 3/4 cdx plywood with glue down Electrical Bringing kitchen and electrical up to Code $15,625.00 installing all new outlets and switch at first floor and second installing customer supplied fans at living room installing electrical to new island installing new undermount lights on cabinets installing new recess lights damage from moister Installing gfi breakers at panel for code Installing New smoke alarms per code Installing new thermostat on 1st floor Plumbing Work to be performed on First level only $10,950.00 Accommodate new 1/2"x 3/8"angle stops for the following 1-kitchen sink 1-bathroom lavatory 1-floor mounted toilet Total of 5 angle stops Install and accommodate EXISTING drains and water lines for the following fixtures • 1 -tub install(Shower Stall 4ftx4ft) 1-Symmons tub and shower valve SUPPLIED and installed 1-floor mounted toilet install(toilet not included Unless specified ) :wax ring , Jonny bolts ,flexible supply line included 1-lavatory install(Combo kit vanity white or grey shaker 1-kitchen sink install with dishwasher hook up(kitchen sink,faucet,dishwasher not included unless specified)no garbage disposal 1-Remove and replace up too 40'of baseboard elements and covers on first floor only Drywall Installing (57)Sheets of sheetrock 4'up around house. $7,500.00 Materials (57)Sheets of 3/8 Sheetrock $1,125.00 (5)4.5 Gal All Purpose Compound (8)Joint Tape Carpentry Installing $5,600.00 1 bifold door at laundry room 72x78 1 louver door 36x78 boiler room installing 3 doors at bedrooms and bathroom installing 3inch baseboard around whole first floor includes bedrooms living room bathrooms and hallways Paint Prime new sheetrock $8,125.00 2 coats to walls trim doors Painting all wood windows to White 2 coats on ceiling and walls Paint Spec of Ben moor ultra-spec Trim work regal select Ceiling flat ultra spec Flooring Installing 13 cap a tread $10,000.00 Life proof Chiffon Lace Oak 8.7 in.W x 47.6 in. L Luxury Vinyl Plank Flooring(20.06 sq.ft./ case) Carpentry Installing cabinets $7,175.00 Grey Shaker cabinets to match existing kitchen Granite Installing up to 41 sq of countertop allowance of Ivl 1 granite with stainless sink bowl $3,587.50 Carpentry Delta Greenwich 3-Piece Bath Hardware Set with Towel Ring Toilet Paper Holder and 24 in. $1,600.00 Towel Bar in Brushed Nickel Medium Rectangle White Beveled Glass Contemporary Mirror(40 in. H x 32 in. W) Broan-NuTone80 CFM Ceiling Bathroom Exhaust Fan with Light Motion Activated Single-Handle Pull-Down Sprayer Kitchen Faucet in Brushed Nickel Aquatic Everyday Acryl 48 in.x 35 in.x 72 in. 1-Piece Shower Stall with 2 Seats and Center Drain in White Plumbing Remove and dispose of existing 40 gal water heater $12,636.98 Remove and dispose of existing atmospheric boiler Install a Navieen tankless NCB 240-combi 95%efficient Wall hung tankless boiler and water heater(combi ) Direct vent Qualifies for a$2750.00 rebate through ma save All associated materials included for Navieen Install all new circulator pumps !Wiring to be done by Refab ! All ,pipes ,fittings , hangers and controls included Thermostat supplied by others(if applicable ) Wall for tankless boiler to be built by Re:fab Total Price: $93,449.48 A material deposit of$28,000.00 is required at the start of the project and at 50%$28,000.00 the remaining balance is due upon completion. Thank you for choosing re:fab to estimate your project. If you have any questions please feel free to reach out to Matt Ferreira (508)863-5965 Signature: • Print Name: Date: '' 0 _S —:111�1 ' mk\*.: � • 1���,� •lint•Z \. tit..', 1101 - _= 1s . - _ r ,,, .:„........„_........,..„___- -',-,--..-----:-------- -------_ .__..._1._ _rn: i,.., , .., ii: __,,,.,:,, . ... ... - \ ' ....".w. 1,!,-7! - - , ... . i : ,,,,.. , f i 1 I. 9 g hiD , .,.., ...... iw.n ntP*+Mw[vn s I 'f zFr �y : 1 ' , . , '' ,, i,t t rn Ey y y�L r. 4 _-11 — ,. .t.........r... roP' i wa ' Vld A p - y, -w s; mob , , 1 1 ii.:ir'1A E,tl .,. Y•; ..:,£''i+A },.y..., 49�`a.` in a .."a, .,. '"".. SYr:z+34. ...i Ill up- a qaq G ! ,ns-emu -',Ink �, - : III' ail ' . 1114 .i _ .__ - s II , i 1 ,.- ,----- I i . - � � ,----„ - ,,....._iiiiikiiiiil ..� ` z :`s �►— t es °a s4* tsh ka � -: x :, � ,-,' - - s t gr' ' `4".' i..,a �`� , e"` ' fir .q '4'.;; .ec- a:3{-. -- i • t `,- • .i _ .ayr 0-4:C� Y ,,, t,- -_,._.- Q�d �.,.�' - z. t _ ----_,j 1 \ / .1 - 14./ v- ....................,„ )t 're vit:': i tr k. / 0 @1! C iii.N•- r---f 6 ...... - ) U T I-1 4 " WINDMILL (PRIVA 7.1,F1 '' 0 1 -3 7 4of ,„,..C..? 1 i ..., ir-R E C E I V E D 1 I -I it-- 4•-i <1 1 i IrMAY 23 2022 S w 4t., . 1 . • 1 i A t r-kiff, 4-4 /At C i -÷;- f.z;tif L DINiabg13-ARTMENT 1 i I 1 1 „,...) : ..-f . , } I . ! i I ! i A ( 1 +1 < -.21. •V‘ _a 1 i Ni- Livi',K., JD . i x , 4,1 ,d- C._-7 1 — if) 1 _ 4/ 4 1, c-T--(4) 0 4) 01-73) 72 - el, (..... T1 E.- I t,/1- ,..-----/1 , _e,i______1 4 z, (1) I 1 ')_ ' _________ r rzi,Iv il,. ,c, 1-, -4,--- I i TOWN OF YA 11' -,T-irl t 1 4 REVIEWED F3R r -. "..V,' -")MPLI- ANCE. Er.;RCRS 0,- L ' .:VE THE APPLICANT FROM THE.-...:....',..)1 '‘.1i.i.. 16 BUILT" .-T COMPLIANCE. / / DATE: )%korn. / 1_. ___... .-----.•.,-- BUIL FICIAL — 1/ 0 -7 v A.1 t) r, -ovi•-; c1 , 7 . 1 i" Li u--,,I 1-2,t- k- •4‘ 1, V,: ,,,,„4:;I:_',-,r ;• -:,,, ler I‘,1 L L ‘2_t c).1',t l'Q C 14 11 N/1 i_1/,' -77 2 .. • .'-1 -2-- •(/`‘.r--_1,,,f7,. 11 !iJ . ��Au c 44� 2 - 3� x cow G. C 4(4 / Amu_- ,_Q_C r,j G To t-CeC-4tV n v 9'P- GA TA Lt9 C . 144- t ku Ri-`a-e cv G owe = 3 << C c A-+2 t cps T /\,U r,U Q v / 0 `-7" -. FC) (WPC) VI/Aa_ 'rA C (AJC STA Airpc.,v() C N G • T1 /k i\i 0 kA (EA--fit c Go 2‘/C-- (41/ Lt.( -4: A(J ti Cis u 1 Q j r�� r �. ( V r177c. C.�Y��l-S�S�r -ram '�Aiv ) `z 2 F-vevt>ATuqN -11- 2 ' b S 4l1 Gq ko! C-C /Q d--, ( #d ft tC)91-- cs ! A. ■ A t Y f , , .__Y- _....s.--...—...,... �.4- _ _ _.—._ __._.. _. e A o— i -.. .- � f "� J 'y7 :,.; w 4- j ) {�:.1'.ss -+ 7 ) .*-.t'S`. - - , . C. ..tom d. ' r '= ',I .;1.-:.^*. Y' f, ms. f 1_ -rt , / +1 . , ; , • , i _ ) ' a� 1J r x -. � ':? 4� ;.. •.ter ' _Jt'# t _ `ti • • •V y _ ; it Y d- • c. i. t•.-L� ' a s v • 'it t ., — t 1 . .. - ,� - s ,x! S 3 -i--- P- ..,. "T ,r j i fit'` 1 0 4 N 7 ® DATE(MM/DD/YYYY) ACORO EVIDENCE OF COMMERCIAL PROPERTY INSURANCE 8/3/2022 THIS EVIDENCE OF COMMERCIAL PROPERTY INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE ADDITIONAL INTEREST NAMED BELOW.THIS EVIDENCE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS EVIDENCE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE ADDITIONAL INTEREST.PRODUCER NAME, PHONE COMPANY NAME AND ADDRESS r�l.N: "� D CONTACT PERSON AND ADDRESS tAlc.No.Exfl: 15013773435 Various S1111pCenternStreetCeSuit 100 s AUG U 8 2022 Little Rock,AR 72201 Shirley Simmons www.stephensinsurance.com 'BUILDING DEPARTMENT FAX E-MAIL IF MULTIPLE COMPANIES,COMPLETE SEP FORM FOR EACH (A/C,No):15012104625 ADDRESS: Shirley.SimmonsCa7stephens.com �3i; — _ CODE: SUB CODE: POLICY TYPE AGENCY Commercial Property CUSTOMER ID#: NAMED INSURED AND ADDRESS LOAN NUMBER POLICY NUMBER Restaurant Growth Services,LLC Various Attn: Risk Management 3038 Sidco Drive EFFECTIVE DATE EXPIRATION DATE Nashville TN 37204 CONTINUED UNTIL 8/1/2022 8/1/2023 TERMINATED IF CHECKED ADDITIONAL NAMED INSURED(S) THIS REPLACES PRIOR EVIDENCE DATED: PROPERTY INFORMATION (ACORD 101 may be attached if more space is required) ❑ BUILDING OR ❑ BUSINESS PERSONAL PROPERTY LOCATION I DESCRIPTION Re:NinetyNine#20050,14 Berry Ave.West,Yarmouth,MA 02673 including the Temporary Outdoor Dining Area. 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 EVIDENCE OF PROPERTY INSURANCE 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. COVERAGE INFORMATION PERILS INSURED BASIC BROAD / SPECIAL COMMERCIAL PROPERTY COVERAGE AMOUNT OF INSURANCE: $25,000,000 DED: 100,000 YES NO N/A 21 BUSINESS INCOME 12 RENTAL VALUE ,/ If YES,LIMIT: Included / Actual Loss Sustained;#of months: 12 BLANKET COVERAGE If YES,indicate value(s)reported on property identified above:$ See Attached TERRORISM COVERAGE ,/ Attach Disclosure Notice/DEC IS THERE A TERRORISM-SPECIFIC EXCLUSION? ✓ IS DOMESTIC TERRORISM EXCLUDED? ✓ LIMITED FUNGUS COVERAGE ✓ If YES,LIMIT:10,000,000 DED:100,000 FUNGUS EXCLUSION(If"YES",specify organization's form used) ✓ REPLACEMENT COST ✓ AGREED VALUE ✓ COINSURANCE ✓ If YES, EQUIPMENT BREAKDOWN(If Applicable) ✓ If YES,LIMIT:See attached DED:See attached ORDINANCE OR LAW -Coverage for loss to undamaged portion of bldg ✓ If YES,LIMIT:See attached DED:See attached -Demolition Costs ✓ If YES,LIMIT:See attached DED:See attached -Incr.Cost of Construction ,/ If YES,LIMIT:See attached DED:See attached EARTH MOVEMENT(If Applicable) ✓ If YES,LIMIT:See attached DED:See attached FLOOD(If Applicable) ✓ If YES,LIMIT:See attached DED:See attached WIND/HAIL INCL YES ❑ NO Subject to Different Provisions: ✓ If YES,LIMIT:See attached DED:See attached NAMED STORM INCL lZ YES ❑ NO Subject to Different Provisions: / If YES,LIMIT:See attached DED:See attached PERMISSION TO WAIVE SUBROGATION IN FAVOR OF MORTGAGE HOLDER PRIOR TO LOSS 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. ADDITIONAL INTEREST CONTRACT OF SALE LENDER'S LOSS PAYABLE LOSS PAYEE LENDER SERVICING AGENT NAME AND ADDRESS MORTGAGEE NAME AND ADDRESS Town of Yarmouth 1146 Route 28 South Yarmouth MA 02664 AUTHORIZED REPRESENTATIVE Stan Payne ©2003-2015 ACORD CORPORATION. All rights reserved. ACORD 28(2016/03) The ACORD name and logo are registered marks of ACORD 69576539 122-23 Property - RFMAINCO w $100K Ded RGS (In Prog I Shirley Simons 18/3/2022 12:47:18 PM (CDT) i Page 1 of 5 AGENCY CUSTOMER ID: LOC#: 5 RD®A ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED Stephens Insurance,LLC Restaurant Growth Services,LLC P Attn: Risk Management POLICY NUMBER 3038 Sidco Drive Nashville TN 37204 Various CARRIER NAIC CODE Various EFFECTIVE DATE:8/1/2022 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 28 FORM TITLE:Evidence of Commercial Property(03/16) ADDITIONAL INTEREST: Town of Yarmouth ADDRESS: 1146 Route 28 South Yarmouth MA 02664 PROPERTY INSURANCE COVERAGE LAYERS: Layer 1 - Primary $5,000,000 Participants Lexington Insurance Company, Policy #006893418, NAIC #19437, A XV Rated Allied World Assurance Company (U.S.) , Inc., Policy #0311-4222-1A, NAIC #19489, A XV Rated StarStone Specialty Insurance Company, Policy #H75949221CSP, NAIC #44776, A- XII Rated AXIS Surplus Insurance Company, Policy #EAF647308-22, NAIC #26620, A+ XV Rated Steadfast Insurance Company, Policy #CPP-1368804-00, NAIC #26387, A+ XV Rated Layer 2 - $20,000,000 XS $5,000,000 Participants Landmark American Insurance Company, Policy #LHD926439, NAIC #33138, A+ XIV Rated ARCH Specialty Insurance Company, Policy #ESP1013735-00, NAIC #21199, A+ XV Rated Hallmark Specialty Insurance Co. , Policy #73PRX22AF4E; NAIC #26808, A- VIII Rated Blanket Coverage with $705,113,316. Total Insured Value COVERAGE: Building, Personal Property, Business Interruption, Extra Expense & Loss of Rents subject to policy terms, conditions and exclusions. PERILS: All Risk of Direct Physical Loss or Damage including Flood & Earthquake; Excluding Terrorism and Boiler & Machinery. (Separate Policies issued for Boiler & Machinery and Terrorism - See page 5 of certificate. ) Occurrence Limit of Liability - Included but limited to actual adjusted amount of loss, less applicable deductible; or Policy Limit. Valuation: Replacement Cost; Actual Loss Sustained for Time Element and as more fully defined in the Policy Form. PROGRAM SUBLIMITS: $50,000,000. Earth Movement for all Locations Combined (Annual Aggregate) , except; $ 15,000,000. Earth Movement in California, Pacific Northwest, and New Madrid Earth Movement Zones, (Annual Aggregate) ; $ 50,000,000. Flood (Annual Aggregate) , except; $ 15,000,000. Flood for locations in Zones A&V, Annual Aggregate Included Business Interruption, including rental value $ 10,000,000. Contingent Time Element (Direct Only) $ 25,000,000. Extra Expense/Expediting Expenses $ 10,000,000. Course of Construction 25% of loss subject to a maximum $10,000,000 as respects Debris Removal $ 10,000,000. Valuable Papers and Records $ 10,000,000. Accounts Receivable $ 20,000,000. Maximum on Newly Acquired or Constructed Property; Max 180 Days Included Electronic Data & Media $ 25,000,000. Service Interruption (24 Hour Qualifying Period) (Including Transmission & Distribution Lines within 5 Miles) ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ATTACHMENT 69576539 122-23 Property - REMAINCO w $100K Ded RGS (In Prog I Shirley Simmons 18/3/2022 12:47:18 PM (CDT) I Page 2 of 5 AGENCY CUSTOMER ID: LOC#: ACO ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED ReStephens Insurance,LLC Attn:aRsk an gewthmentices,LLC POLICY NUMBER 3038 Sidco Drive Nashville TN 37204 Various CARRIER NAIC CODE Various EFFECTIVE DATE:8/1/2022 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 28 FORM TITLE:Evidence of Commercial Property(03/16) ADDITIONAL INTEREST: Town of Yarmouth ADDRESS: 1146 Route 28 South Yarmouth MA 02664 Included Protection and Preservation of Property/Emergency Removal $ 5,000,000. Professional Fees $ 15,000,000. Unintentional Errors or Omission $ 1,000,000. Fine Arts $ 5,000,000. Property in Transit $ 5,000,000. Leasehold Interest $ 500,000. Spoilage $ 10,000,000. Limited Pollution Coverage (Annual Aggregate) $ 10,000,000. Miscellaneous Unnamed Locations $ 100,000. Plants, Lawns, Tree or Shrub, except $25,000. for any one (Defined Cause of Loss) $ 250,000. Fire Brigade Charges/Fire Department Service Charges $ 10,000,000. Fungus, Molds, Mildew, Spores, Yeast (Annual Aggregate & covering Ensuing mold, only) $ 250,000. Reclaiming, Restoring, or Repairing Land Improvements Included Sewer Backup $ 1,000,000. Signs/Fences $ 1,000,000. Exhibits and Shows 180 Days Ordinary Payroll (if reported within TIV) TIME LIMITS: Extended Period of Indemnity - 365 Days Civil or Military Authority - 30 Days; Within 5 Miles Ingress or Egress - 30 Days; Within 5 Miles ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ATTACHMENT 69576539 122-23 Property - REMAINCO w $100K Ded RGS (In Prog 1 Shirley Simmons 8/3/2022 12.47:18 PM (CDT) 1 Page 3 of 5 _R - :ONE & TWO FAMILY ONLY- BUILDING PERMIT ti Town of Yarmouth Building Department � 1 1146 Route 28, South Yarmouth,MA 02664-4492 / • jU 12 2022, 508-398-2231 ext. 1261 Fax 508-398-0836 L i Massachusetts State Building Code,780 CMR ` `*� _ IVED BUILDI G DEPART. I 'n Permit Application To Construct, Repair, Renovate Or Demolish ._. - sY. ---- a One-or Two-Family Dwelling , u 2022 'I ''\\ This Section For Official Use Only Building Permit Number: _b1.0-2 DDateApp ' ; DING DEPARTMENT f 11r� t S J'i\- ),.k Building Official(Print Name) ignature Date 35—,co SECTION 1:SITE INFORMATION �,� 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers e..0 '' v. 174 BayView Street West Yarmouth, MA 02673 1.1 a Is this an accepted street?yes V no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: 5,227 Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required I Provided Required Provided Required Provided 1.6 Water Supply: (Mv1.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public Private 0 Zone:alc is Outside Flood Zone?4 kA. ‘3 Check if yes❑ Ivtunicipa1/41 On site disposal system El SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Bob Fair West Yarmouth, MA 02673 Name(Print) City,State,ZIP 174 Bay View Street 508-740-2950 bfair@jewellinsurance.com No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 1 Existing Building Owner-Occupied 0 Repairs(s)9 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify; Brief Description of Proposed Work2: Supporting existing floor joist with n@w sono tube and installing new plywood on subfloor. Sheetrock _ 4'AFF, plumbing and electrical per code and installing new flooring cabinets and bathroom fixtures to house due to water main flood that occured in the offseason. SECTION 4:ESTIMATED CONSTRUCTION COSTS. Item Estimated Costs: Official Use Only (Labor and Materials) I.Building $ 65,690.71 I. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ 16,100.00 0 Standard City/Town Application Fee ❑Total Project Costa Item 6)x multiplier x 3.Plumbing $ 10,612.00 2. Other Fees: $—•3L 4.Mechanical (I-1VAC) $ 13,350.00 List: 5.Mechanical (Fire $ • Suppression) Total All Fees:$ ,, D 6.Total Project Cost: $ 105,752.71 Check No. Check Amount: ash Amount: ❑Paid in Full 14 Outstanding B ante Due:3 C 4.- Rood c., - 1)k ry o CCG /1CU VW 0LS C ` D SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-112275 5/27/22 Matthew Ferreira License Number Expiration Date Name of CSL Holder 111 Park St New Bedford MA 02745 List CSL Type(see below) U No,and Street Type Description New Bedford MA 02745 U Unrestricted(Buildings up to 35,000 cu.ft.) City/Town,State,ZIP R Restricted 1&2 Family Dwelling IVI Masonry RC f Roofing Covering • WS Window and Siding SF Solid Fuel Burning Appliances 508-863-5965 Mattf@gorefab.com i Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor CHIC) 191897 Matthew Ferreira 5/21/22 HIC Compan•Name or HIC Registrant Name HIC Registration Number Expiration Date 111 Park St Na.and Street MattfAgorefab.com New Bedford MA 02745 508-863-5965 Email address City/Town, State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e.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 No fl 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 Matthew Ferreira(re:fab) to act on my behalf in all matters relative to work authorized by this building permit application. t566 5/10/22 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 ail of the information contained in this application is true and accurate to the best of my knowledge and understanding. 7"Zatt our�G42¢D2CL 5/10/22 Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: I. 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.gov/oca Information on the Construction Supervisor License can be found at www.mass.aov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) 1,929 (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft,) 1929 Habitable room count Number of fireplaces Q Number of bedrooms 5 Number of bathrooms 2 Number of half/baths 0 Type of heating system Number of decks/porches 1 Type of cooling system Enclosed Open 1 3. "Total Project Square Footage"may be substituted for"Total Project Cost" §TOWN OF YARMOUTH 1146 Route 28, South Yarmouth, MA 02664 508-398-22311 ext. 1261 Fax 508-398-0836 Office of the Building Commissioner BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Ch. 40, §54 and 780 CMR- Section 105.3.1. #4. I hereby certify that the debris resulting from the proposed work/demolition to be conducted at 174 Bay View Street West Yarmouth, MA 02673 Work Address Is to be disposed of oat the following location: Hiller Disposal 7 County St, Lakeville, MA 02347 Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. 71//2tt�ZQ.e-v-�c2Aev , 5/10/22 Signature of Application Date Permit No. • 1 \ • The Commonwealth of Massachusetts 1 / Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 ..s�•'y www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le.ibly Name (Business/Organization/Individual): re:fab Address: 1193 Ashley Blvd Rear New Bedford, MA 02745 City/State/Zip:New Bedford, MA 02745 Phone#: 508-863-5965 Are you an employer?Check the appropriate box: Type of project(required): l�I am a employer with 10 employees(full and/or part-time).* 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. ❑Re Remm delinruction any capacity.[No workers'comp.insurance required.] 8• ® odeling 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. Demolition 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 1 ❑ Building addition ensure that all contractors either have workers'compensation insurance or are sole proprietors with no employees. 1 1.❑Electrical repairs or additions S. I 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 13. Roof repairs 6.0 We 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 m I must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing ail 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: Eastern Insurance Group Policy A or Self-ins.Lic. Expiration Date:BKA55824277 12/1/2022 Job Site Address: 174 Bay View Street City/State/Zip: West Yarmouth, MA 02673 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: PQi-4-0-4 LQi Date: 5/10/22 Phone#: 508-863-5965 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#: ACo® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) �� 1/21/2022 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 holJler 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 Eastern Insurance Group, LLC. PHONE Jay Aguiar FAX 233 West Central Street (A/C.No.Exa:800-333-7234 (NC,No):781-586-8244 Natick MA 01760 E-MAIL ADDREss: jaguiar@easterninsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:AMERICAN FIRE&CAS CO 24066 INSURED 181071 INSURER B:Ohio Security Insurance Co 24082 ProGroup Network Inc&J M C F Inc. dba ProGroup&Certa Pro Painters INSURERC:United States Fire Insurance Company 21113 DBA Renovate Residential; ProGroup Contracting INSURER D:Homeland Insurance Company of New York 34452 1193 Ashley Blvd, Rear INSURER E:Ohio Casualty Insurance Company 24074 New Bedford MA 02745-2419 INSURER F: COVERAGES CERTIFICATE NUMBER:2077263764 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 LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF POLICY EXP (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A X ' COMMERCIAL GENERAL LIABILITY BKA55824277 12/1/2021 12/1/2022 EACH OCCURRENCE $1,000,000 DAMAGE TO IRENTED' CLAIMS-MADE X OCCUR PREMISES Ea occurrence) $300,000 X ! XCU MED EXP(Any one person) $15,000 '` CONTRACTUAL LIAB PERSONAL&ADV INJURY $1,000,000 w'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY —_J JE� I LOC PRODUCTS-COMP/OP AGG $2,000,000 _ OTHER: EMPLOYEE BENEFITS $1,000,000 B AUTOMOBILE LIABILITY BAS55824277 12/1/2021 1211/2022 Eeaccident)SINGLELIMIT $1,OOQ000 X ANY AUTO BODILY INJURY(Per person) $ OWNED I SCHEDULED I 'AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ I I HIRED I NON-OWNED PROPERTY DAMAGE '.:AUTOS ONLY AUTOS ONLY (Per accident) $ $ E X 1 UMBRELLA LIAB X OCCUR US055824277 12/1/2021 12/1/2022 —� EACH OCCURRENCE $10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000 DED X 1 RETENTION$1DPnn $ D . FKERSCOMPENSATION 408-742506-9 1/1/2022 1/1/2023 X PER OTH- cC EMPLOYERS'LIABILITY Y/N STATUTE ER - AivYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 IOFFICER/MEMBEREXCLUDED? N N/A (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 D CPL PER OCC&AGG 7930044140006 12/1/2021 12/1/2022 $5000 DED/CLAIMS MADE $1,000,000 A INLAND MARINE BKA55824277 LEASED/RENTED EQUIP Installat.on Floater 12/1/2021 12/1/2022 $250,000 Limit $250,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Additional Insured coverage is provided with respect to General Liability,for ongoing and completed operations on a primary and non-contributory basis,Auto Liability and Excess Liability where required by written contract. A waiver of Subrogation applies under General Liability,Auto Liability,Workers'Compensation and Excess Liability where required by written contract. EVIDENCE OF INSURANCE 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. FOR INFORMATIONAL PURPOSES ONLY AUTHORIZED REPRESENTATIVE yid, ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD THIS CERTIFICATE SUPERSEDES PREVIOUSLY ISSUED CERTIFICATE ro coo03 E -0__ It" Cn !r G r -ID -1 tC il O O R 3 w (1-1 b. 1 A. O-p i y'� 13 * C A �.. ro I� Cn� Cn Cn v, ui -«Q.. 02 ,CD Z O et)co cici0 0 A Q cn �o D i 06O ' i m 1 Cl)CS 0 0 0 T I n >6)W(7 v. 0� .-. _.CA . rn O CW�s cn fDap N �. o Z cn �n(j. c n o n CCI) 1 I 2 t y Dmm o 5 co f Q c - Q v,. -am07 M : c p cn � , m o r -+ : Cr? D CD cn O .-..70.. O L. f. I 1 I --�N= ' ' I NNC3 NNN0 NJ� -+ i . o ' O I O ! in • Z-'5 _. D= _ w orl ar * F-i -71 cona a 2 m O p 0 1 r 7J XI ma m - = x 0 CC �' D m O m o U -p Z 0 * ~' D �FiHonm TOOK g �r . , r � 11 N O ''3r I !! 3nixi 0 23 ir'--11, '1r1 =� c D -4 D 0 H m �c m O n O? -4CD m - nC Q� C:) O' _ CO CD D sv • .013d 0 0 3 ,..54 - gm II , ._ iwpI( t: 3 K —. .,...... m IIIII lliDcCn � v r 0 .e.(1) to ;:.;. Ziti It-'41,1fL--iii, L----" e-) 0 '.z 0 = O �CL m o o O 0 ='.d 0.Q mm (ass) D s cnN �D - cD CD _ ^ Q? � c m-m -+ � v � 2 — N �wC c m = o N D) (n (I S. CD o. n y a. - I c O N 1-5�I 0 m oN m D G N) O ry 21 7 N C Z 7 C) d O. -•--- •• .W)4ddL ld t1J_LYN ric7,7.77:1.?Zrfn LBSI,E utinillfaxa Igiprirsifiati EnPll#P4,; :3dILL BaLoNitiiNciD j.NardaflOelifil 3i4t0F4 uogririevid ssmsne 7 uircity AslinaUtia a3WCI frife,"mar wiree# Ciyilwiveweanti Dr Massachubetts • 13trunion of Professional Lrcansure Board cf Buildnvo Rions and Slandanic Ctlf1StrliCtir,i1 SUPerviSor C5-112275 Expires: 051278'2022 mATTNEW FERREMA 11JPPKcT NEW SE C ORO hiA 02740 Commissipner Sears, Tim From: Sears, Tim Sent: Wednesday, June 1, 2022 9:03 AM To: _ 'mattf@gorefab.com' Subject: 174 Bayview St Attachments: work in flood zone packet.PDF Matthew, I have reviewed your application and there are some items needed. N1. Health Department sign off V. Floor plan submitted is not clear, need to submit plan that is darker and able to read writing This property is in a flood zone, please review attached packet and fill out the cost worksheet(demo costs must be included) and return with contractor&owner affidavits signed & notarized. Do not submit the final cost affidavit that is saved for the end of project. Please submit these items for review This email is considered a written denial of your permit application per Section 105.3.1 of the Massachusetts State Building Code. Section 105.3.2 states in part that "an application for a permit for any proposed work shall be deemed to have been abandoned 180 days after the date of filing, unless such application has been pursued in good faith" You may appeal this denial to the Building Code Appeals Board in accordance with M.G.L. c. 143 §100, within 45 days of this notice. Timothy Sears CBO Deputy Building Commissioner Town of Yarmouth 508-398-22 31. Ext. 1259 mailto:tsears@yarmouth.ma.us I 1 / ---------- Replacement Cost Las Depreciation: $240,200 Building Photo - ------ Building Attributes Field Description Style: Conventional Model 1 Residential Grade: 'Average Stories: 1.5 — -- Occupancy Exterior Wall 1 Vi.00d Sningie Exterior Wall 2 Roof Structure: Gble/Hip ,:i es.vQslioorntphc -,':'/v•-,rr--,',. -,'`.1,;'-..otes/Al„L i32.39',4- .:pg) Roof Cover t---phIF CisiCmp ----- — ___ Interior Wall 1 E:yvvali/Sheet _ Interior Wall 2 WDK I Interior Fir 1 Caroet • ____ _______________ 12 Interior Flr 2 He _________ at Fuei .-,_ ,_,5 28--- BA g BAS WDK Heat Type: r .we, TQS col) BAS 0 i ;1e-5 6So:Y1-• 6IZ a 1....3g Total Bedrooms: r.led[ocm6 2 Sfii%C S 31 31 i Total Half Baths: C .„.... C- P.0°1 - , __.... . ........__ J‘i Total Xtra Fixtrs: 41 • 41 . . .. „._ I Total Rooms: lq CeL\ Bath Styie: -,,,-,ag:.,- K0%,,,flel i Kitchen Style: ,,io.:ern Cndtri . .... l i\Lir.-:.•:--a:-6: Fire.olac\is 17 12 , Frothcridtn (ParceiS.etch.ashx?pid=1C, '..:::O=.1:363) Baseme n Building 8. Areas(sq ft) Legend 1 i Gross , Living Coc i Descrion i Area Area ,-. --1- , BAS ! First Floor 1 1,406 1,406. 4-- TQS !Three Quarter S._-y 697' 672 WOK Deck,Wood 732 0 2,835 1,929 Extra Featires - Extra Features _ ___ __ Lec,end ., .L...., .,, ,,---" rnent Cos`: - , Less;Dapreciatior.: Photo Fie ,.i.sc=',:::;c:' 1 ' r _- ;..,..r.- 1:vic;....c....; Stor;es: i cx:er,Ci.-Wail 1 excer:,..„wail 2 ,.. . Rccf c;tucture: c wCig 2 1 1,2! c--- ' ... , ..._„Jail WOK\N.,,-,,•':‘,., ' 2a , ......,, .,. .•• -, aid\ RA-1 „... „... To --,„ ..- . .....„. -.„----- \_ ____ --,---- :1;;;-(7, , ,....... - ' t-- 13i\\ 31 \ 41 ----"-"'"' e 41 ...7. k -:•"-'.....:...,...._;aths: Os, - ,...:_. F:xtrs: ) i '------) I .:,...--.— or- 6::.,;'.•::::::':' r----...\ '\67\ 17 _. _ -'.. sf.F'-!oar . .Three,...,.....,..,.„.-- ,.. k Vt..t.:-' .,.s Ext 7'''''':''Jes 7-- ot,' TOWN OF YARMOUTH 1�o , : c HEALTH DEPARTMENT ` PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To he completed by Applicant: Building Site Location: 11 vatA.t -Y l Ix(toPLAL' Proposed Improvement: `' 4.R.'(4=(t ; (,„ kuA Applicant: (Y\!\''C T \-t Tel. No.:50 163 5 CS Address: `\\ 001 Date Filed: `/ -5)c) **If you would like e-mail notification of sign off please provide e-mail address: (t)o }� CCab Owner Name: `No ke,.0 - sa,C k J Owner Address: V \ii & , ` osC .I .,„rno, Owner Tel. No.: Oc(j'1110'a'j5C RESIDENTIAL AND/OR COMMERCIAL BUILDING HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. Please submit three (3) copies of plans, to include: (1.) Site Plan showing existing buildings, water line location, and septic system location; (2.) Floor plan labeling ALL rooms within building JUN 0 3 2022 (all existing and proposed) — Note: Floor plans not required for decks, sheds, windows, roofing; HEALTH DEFT. (3.) If necessary, Title 5 application signed by licensed installer with fee. REVIEWED BY: DATE: - PLEASE NOTE COMMENTS/CONDITIONS: I S C 7cjr , 11/A3 13 e i V o toot beck �f /1 iC t; =t � 1)-eci (ti y' c j c-te.e 1 (`1t�C..)S1 r ` (..3 t t t -r .s e ( ( t i-►j 4 et ?t`e t S u a4-42-e Del e I/ti Gl C-c Fro vkl cr f 1(1? ` l©ci,2 M , o el I I O M I41111110111, O O WYf' C f , . i I [ \ ,, i,:::ip i .,,...„ _ , (N N +i I m V : li 4, ,., ___,- „I z =Q- N m y Q • c) in m CN 4.. d 4 i '� o00r z O ro ©, •-t ...Z.0 o ~ Q N o C.O Q v, o,r, W N W.-_-.____— _ -V o R O er 0 O ''.� u x Nso;a e [� C —s1 u/:N C) N O O N ^ N - O Q _ .__ A 1 F. ^ OO O aW z E U V v IV .'rn' �I� _ tn Z VN < 8 _� 4 o_ 00 1L _____ D.� A. o�; Q air 'oY O F— > O O N o p L rJ U v Z Q cC' y [L:x F C`.' > a c0i u= ` c c I '� I� Q s I V J o It c o E. cc Q y u s7 W O .°° = a_ z V > Q u c+ ec S V " o ?� ti i u 0 a .e 3 c u It R u qS A a a V ° zQ ° ; aQ co R 0Zm > ° ctl V Q s 'v 0 �I h N N t L C i. C ,, v v j G.` .i rn U 0` 0` o o ri F >� 03 On T X ° c Gz7 -- L , rn x x C 0 ti :a "' m :a cl 2 2 v • crj [ncCa55 _ 2v 0 0 0 0 0 :a � 3:0 m 1 :�0 Q=p 174 BAYVIEW ST Location 174 BAYVIEW ST Mblu 20/48/// Acct# 1305 Owner JEWELL RONALD Assessmevrt,t. $601,230 PIE, 1305 Building Ciurra Current Value Assessment Valuation Year Improvements Land Total 2022 $240,200 $361 000 Owner of Record Owner JEWELL RONALD Sale Price $100 REILLY SANDRA Certificate Care Of Book&Page 27534/0102 Address 10 HILLTOP LN FRAMINGHAM, MA 01701 Sale Date 07/11/2013 Instrument Qualified Ownership History Ownershi_ Owner Sale Price Certificate Book&Page JEWEL'_-RCNALD g_.__ Instrument Sale Date $100 27534/0102 1F 07/11/2013 JEWELL RONALD $100,; f � 2751510269 ( 1 J 07/02/2013 JEWELL RONALD $i 37,500 2645'J/0205 1A � 06/27/2012 JEWELL FRANCIS L l � $100 2137C10222 1 N 09/22/2006 JEWELL FRANCIS L ___ $0 1275/0511 10/15/1964 Building Information Building 1 : Section 1 Year Built: 1930 Living Area: 1 92c Replacement Cost: $333568 Building Percent Good: 72 Sample Notice for Property Owners, Contractors, and Design Professionals TO: Property Owners, Contractors,and Design Professionals FROM: Mark Grylls Town of Yarmouth, Building Commissioner SUBJECT: Notice for Work on Existing building in Special Flood Hazard Areas Substantial Improvement/substantial Damage Worksheets The community's floodplain management regulations and code specify that all new buildings to be constructed in Special Flood Hazzard(SFHAs) (regulated floodplains) are required to have their lowest floors elevated to or above the base flood elevation (BFT). The regulations also specify that substantial improvement of existing buildings (remodeling,rehabilitation,improvement,or addition) or building that have sustained substantial damage must be brought into compliance with the requirements for new construction. Please note that a building may be substantially damaged by any cause, including fire,flood,high wind,seismic activity,land movement,or neglect It is important to note that all costs to repair a substantially damaged building to its pre-damage condition must be identified. There are several aspects that must be addressed to achieve compliance with the floodplain management requirements. The requirements depend on several factors,including the flood zone at your property. The most significant compliance requirement is that the lowest floor, as defined in the regulation/code,must be elevated to or above the BFE. Please plan to meet with this department to review your proposed project,to go over the requirements, and to discuss how to bring your building into compliance. Our regulations define these terms: Substantial Damage means damage of any origin sustained by a structure whereby cost of restoring the structure to it's before damaged condition would equal exceed 50 percent of the market value of the structure before damage occurred. Substantial Improvement means any reconstruction, rehabilitation, addition, or other improvement of a structure, the cost of which equals or exceeds 50 percent of the market value of the structure before the "start of construction" of the improvement. This term includes structures that have incurred "substantial damage," regardless of the actual repair work performed. The term does not, however,include either: n• Requirement for application for Permits for Substantial Improvements and Repair of Substantial Damage Please contact the Town of Yarmouth, building Department(508-398-2231 Ext. 1261) if you have questions about the substantial improvement and substantial damage requirements. Your building may have to be brought into compliance with the floodplain management requirements for new construction. Application for permits to work on exiting building that are located in special Flood Hazzard Areas must include the following: Ni• Current photographs of the exterior(front, rear,sided) /■ If your building has been damaged, include photographs of the interior and exterior; provide pre-damage photos of the exterior, if available ■ Detailed description of the proposed improvement(rehabilitation, remodeling, addition. etc.) or repairs ■ Cost estimate of the proposed improvement or the cost estimate to repair the damaged building to its before-damage condition • Elevation certificate or elevation survey si • You may submit a market value appraisal prepared by a licensed professional appraiser or we will use the�tax assessment value of the building • Owner's affidavit(sign and dated) " ■ Contractor's affidavit(signed and dated) . Substantial Improvement Worksheet for Floodplain Construction (for reconstruction, rehabilitation,addition,or other improvements, and repair of damage from any cause) Property Owner: Bob Fair Address: 174 Bayview St Permit No.: Location: 174 Bay View Street West Yarmouth MA 02673 Description of improvements: Remodel after water meter broke and flooded Present Market Value of structure ONLY;(ra arket appraisal or adjusted_ assessed value .BEFORE►nprovement,or.iPdama9ed before the. amage occurred;not including land value 40,20 $$2 0 Gast of Improvement Act al cost f the construction"(see items to ncludelexclude); ,$ 9344 92 include volunteerlatroranddonated supplies*' Ratio ,Cost of improvement(or Cost•to Repair} 1�0 39 % Market Value: . . If ratio is 50 percent or greater(Substantial Improvement),entire structure including the existing dN•13 ru building must be elevated to the base flood elevation(BFE)and all other aspects brought into compliance. Important Notes: 1. Review cost estimates to ensure that all appropriate costs are included or excluded. 2. If a residential pre-FIRM building is determined to be substantially improved, it must be elevated to or above the BFE. If a non-residential pre-FIRM building is substantially improved,it must be elevated or dry floodproofed to the BFE. 3. Proposals to repair damage from any cause must be analyzed using the formula shown above. 4. Any proposed improvements or repairs to a post-FIRM building must be evaluated to ensure that the improvements or repairs comply with floodplain management regulations and to ensure that the improvements or repairs do not alter any aspect of the building that would make it non-compliant. 5. Alterations to and repairs of designated historic structures may be granted a variance or be exempt under the substantial improvement definition)provided the work will not preclude continued designation as a"historic structure." 6. Any costs associated with directly correcting health,sanitary,and safety code violations may be excluded from the cost of improvement. The violation must have been officially cited prior to submission of the permit application. Determination completed by: Matthew Ferreira (Per Yarmouth Assessors Database) Date: 6/2/2022 4 Costs for•Substantial Improvements and Repair of Substantial Damage Included Costs Items that must he included in the costs of improvement or costs to repair are those that are directly associated with the building. The following list of costs that must be included is not in- tended to be exhaustive, but characterizes the types of costs that must be included: ■ Materials and labor,including the estimated ■ Structural elements and exterior finishes value of donated or discounted materials (cont.): and owner or volunteered labor l Windows and exterior doors ■ Site preparation related to the improvement or repair (foundation excavation,filling in Roofing, gutters, and downspouts basements) ■ Hardware ■ Demolition and construction debris disposal ' Attached decks and porches ■ Labor and other costs associated with ■ Interior finish elements, including: demolishing,moving, or altering building components to accommodate EJ Floor finishes (e.g.,hardwood,ce- improvements, additions, and making ramic,vinyl,linoleum, stone, and repairs wall-to-wall carpet over subflooring) ■ Costs associated with complying with any E Bathroom tiling and fixtures other regulation or code requirement that is triggered by the work,including costs ■ Wall finishes (e.g.,drywall, paint,stuc- to comply with the requirements of the co,plaster,paneling,and marble) Americans with Disabilities Act (ADA) • Built-in cabinets (e.g., kitchen,utility, ■ Costs associated with elevating a structure to entertainment,storage, and bathroom) an elevation that is lower than the BFEEl Interior doors ■ Construction management and supervision ■ Contractor's overhead and profit • Interior finish carpentry II Sales taxes on materials El Built-in bookcases and furniture ■ Structural elements and exterior finishes, El Hardware including: El Insulation • Foundations (e.g., spread or continu- ous foundation footinperimeter walls; ■ Utility and service equipment,including: P chainwalls,pilings, columns, posts, etc.) HVAC equipment • Monolithic or other types of concrete Plumbing fixtures and piping slabs • Electrical wiring, outlets, and switches 11 Bearing walls, tie beams, trusses Light fixtures and ceiling fans • Joists,beams, subflooring, framing, ceilings Security systems Interior non-hearing walls • Built-in appliances El II Exterior finishes (e.g.,brick, stucco,sid- Central vacuum systemsing, painting, and trim) ■ Water filtration,conditioning,and re- circulation systems 4 of 7 SAMPLE NOTICE FOR PROPERTY OWNERS, CONTRACTORS, AND DESIGN PROFESSIONALS t. Excluded Costs Items that can be excluded are those that are not directly associated with the building.The fol- lowing list characterizes the types of costs that may be excluded: ! Clean-up and trash removal ■ Outside improvements,including I Costs to temporarily stabilize a building so landscaping, irrigation,sidewalks,driveways, that it is safe to enter to evaluate required fences,yard lights,swimming pools, repairs pool enclosures,and detached accessory structures (e.g.,garages,sheds. and gazebos) I Costs to obtain or prepare plans and ® Costs required for the minimum necessary specifications work to correct existing violations of health, t Land survey costs safety, and sanitary codes I Permit fees and inspection fees ■ Plug-in appliances such as washing ▪ Carpeting and recarpeting installed over machines.dryers,and stoves finished flooring such as wood or tiling SAMPLE NOTICE FOR PROPERTY OWNERS, CONTRACTORS, AND DESIGN PROFESSIONALS 5 of 7 TOWN OF YAHVIOUTH BUILDING DEPARTMENT MATTA YSE= t 1146 Route 28, South Yarmouth, MA 02664 Telephone 508-398-2231 ext. 1261 Fax 508-398-0836 Owner's Affidavit: Substantial Improvement or Repair of Substantial Damage Property Address: 174 Bay View Street West Yarmouth, MA 02673 Parcel ID Number: 1305 Owner's Name: Bob Fair Owner's Address/Phone: 174 Bay View Street West Yarmouth, MA 02673/ r0 _lyd Contractor: Matthew Ferreira (fed_S-ab) Contractor's License Number: CS-112275 Date of contractor's Estimate: 5/3/2022 I hereby attest that the description included in the permit application for work on the existing building all improvements, rehabilitation, remodeling, repairs, additions, and other forms of improvement. I further attest that I requested the above-identified contractor to prepare a cost estimate for all of the work, including the contractor's overhead and profit. I acknowledge that if, during the course of construction, I decided to add more work or to modify the work described, that the Town of Yarmouth will re-evaluate its comparison of the cost of work to the market value of the building to determine if the work is substantial improvement. Such re- evaluation may require revision of the permit and may subject the property to additional requirements. I also understand that I am subject to enforcement action and/or fines if inspection of the property reveals that I have or authorized repairs or improvements that were not included in the description of work, and the cost estimate for that work that were basis for issuance of a permit. Owner's Signature' � ' � `\\\4\ecne Bor9e,',i �� css3oN., s '/: Date: I'a :V0`S 01 1202E+o. Notarized: / �`�: • 0,i;•.. Y \? OB ///SACHUS-\"`" } .. b ,,,,--r,-f]vq-,4,, TOWN OF YARMOUTH 0 :° BUILDING DEPARTMENT t. `''�_ /4South Yarmouth, MA 02664 .�. ���� 1146Route28, , , • Telephone 508-398-2231 ext. 1261. Fax 508-398-0836 Contractor's Affidavit: Substantial Improvement or Repair of Substantial Damage Property Address: 174 Bay View Street West Yarmouth, MA 02673 Parcel ID Number: 1305 Owner's Name: Bob Fair Contractor: re:fab Contractor's License Number: cs-112275 Date of Contractor's Estimate: 5/3/2022 I hereby attest that I have personally inspected the building located at the above-referenced address by the nature and extent of the work requested by the owner, including all improvements, rehabilitation, remodeling, repairs, additions, and any other form of improvement. At the request of the owner, I have prepared a cost estimate for all of the improvement work requested by the owner and the cost estimate includes, at a minimum,the cost elements identified by the Town of Yarmouth that are appropriate for the nature of the work. If the work is repair of damage, I have prepared a cost estimate to repair the building to its pre-damage condition. I acknowledge that if, during the course of construction, the owner requests more work or modification of the work described in the application,that a revised cost estimate must be provided to the Town of Yarmouth,which will re-evaluate its comparison of the cost of work to the market value of the building to determine if the work is substantial improvement. Such re- evaluation may require revision of the permit and may require revision of the permit and may subject the property to additional requirements. I also understand that I am subject to enforcement action and/or fines if inspection of the property reveals that I have made or authorized repairs or improvements that if inspection of the property reveals that I have made or authorized repairs or improvements that were not included in the description of work and the cost estimate for that work that were basis for issuance of a permit. Ar Contractor's Signature ! Date: C)a/30, : ,Go oy7. Notarized: i. i , m ti TOWN•OF,YARMOUTH 1146 oute 28,SotithNartuouth, MA. 02664 508-398-2231 ext .261 Fax 508-398-0836 Office of the uil4ing Cow issioner FINAL COST AFFIDVIT FOR WORK IN FEMA FLOOD ZONE To the Building Commissioner, In accordance with 780 CMR Section 109 of the Massachusetts State Building Code, the total estimated cost of construction, including all related costs* of the building at ; s-t and constructed,reconstructed, altered,repaired, or extended under building permit no.6L0-a a- 00 b 1 O amounts to $ A 3, 'a I, M.c.4\t W RCCz.0 ,being referred to as the owner/agent identified below,do solemnly swear that the statements made herein are strictly true, correct and made in good faith *Related construction costs include all work done with or concurrently with the work contemplated by the building permit including construction, reconstruction, repairs, demolition, HVAC work, etc. Furnishings and portable equipment are not part of the total construction costs. 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