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Home My WebLink AboutBLDX-23-15518 C /�+ pp��- s' Office Use Only 3 •x v t,. v Permit# _ Amount O ^�1 " H.M , d4' OCT 2 5 2023 Permit expires 180 days from 3 M°" r"f issue date BUIL tN TMENT By _ EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department BC \f — 2,3— IS5 I (c' 1146 Route 28 South Yarmouth, MA 02664 GI y / , ,nn(508) 398-2231\- Ext. 1261 r' /�1� 'n ADDRESS: 1 r eoCi 1�' .-Q 1Z W e JT 1044 I ' `V r a- u l l (7CONSTRUCTION ASSESSOR'S INFORMATION: Map Parcel: 2 OWNER:7 , r`L i.RAwiz` elYett q W) :oht-MC tzC vc\ LCSdr- y /V("ttl4-I mo NAME PRESENT ADDRESS TEL. # ,�rrl t .Ligt 0 -S CONTRACTOR: 111 V, NAME MAILING ADDRESS TEL.# 0 Residential 0 Commercial �� Est.Cost of Construction$ --� i �' t' Home Improvement Contractor Lic.# Construction Supervisor Lic.# r Workman's Compensation Insurance: (check one) I am the homeowner 0 I am the sole proprietor ❑ I have Worker's Compensation Insurance Insurance Company Name: Worker's Comp.Policy# WORK TO BE PERFORMED Tent L Duration (Fire Retardant Certificate attached?) Wood Stove Nei 1 Siding: #of Squares Replacement windows:# Replacement doors: # ( Roofing: #of Squares (❑)Remove existing* (max.2 layers) Insulation El nOld Kings Highway/Historic Dist. Ot Replacing like for like Pool fencing El 24*The debris will be disposed of at: 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. Date: e06 Applicant's Signatu =. (�(Z I Z�� f1�� Date: Owners Signs re(or att , 1 P. �� /� Date: Approved By.; ---,we.; EMAIL ADDRESS: l3uildi i_� o d .ignee) Zoning District: Historical District: Yes E. No Flood Plain Zone: E Yes C No Water Resource Protection District: Within 100 ft.of Wetlands: Yes I No I Yes ❑ No The Commonwealth of Massachusetts t=,fit. Department of Industrial Accidents i,t SE Fitta: 1 Congress Street, Suite 100 Boston, MA 02114-2017 • —\tir ..5"' ww».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): 1 r\M®v 19(pe� ,,y_,.Address: 1 �COekk 61 E °-a Ci /State/Zi S \r Z ' P �I ��+ Ll�� N1 Phone #: L00-5 -`Illd - 037-2 Are you an employer?Check the appropriate box: Type of project(required): 1.0I am a employer with employees(full and/or part-time).* 2.0I am a sole proprietor or partnership and have no employees working for me in 8.. 0 Rem delinruction any capacity.[No workers'comp.insurance required.]is ❑Reoelig 3.0I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. El Demolition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my I will 10 []Building addition ensure that all contractors either have workers'compensation insurance or are sol proprietors with no employees. I l.QElectrical repairs or additions 5.0I am a general contractor and I have hired the sub-contractors listed on the attached sheet 12.QPlumbing repairs or additions These sub-contractors have employees and have workers'comp.insurance.: 13.❑Roof repairs 6.0We are a corporation and its officers have exercised their right of exemption per MGL c. I4.❑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. 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 employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: q wC Ih� ite, vo City/State/Zip:Vi CS-N INAVI4 t M M 6*7 3 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 certi-' unde tlye pains and penalties of perjury that the information provided above is true and correct Si nature: Phone#: (, ( j( Date: 1(0I Z S I7(02 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#: EVERS.. URCE Total Amount Due $l62i9111: O!' 31:1! Account Number: 1427 846 0135 by 10/10/23 Statement Date: 09/15/23 Amotif.„...,,, it Due On 09/10/23 $351.75 Service Provided To: Last Payment Received On 09/01/23 -$351.75 TAYLOR PIPER 13alance Forward $0.00 Total Current Charges $162.90 0:=4, .:Arl!!!iyi,11057421110'.0m1r114 PAIMAiz';'"" ,P414:3**M-7- ',:i4r,444"*;,-%''•'4'J, , :,,k'f,,A*'', " -'",", , 1 ''! .',,,,,,,:::.:14,v;7774;v:;,cJilkomai Le,-.' i re vw; ,,,."—,,,;•,,,i i---!;•,),,'"PeD,„',':,,:,:••: -„-N4W%;, ,,y ,,,k7,i,,,,„0 ,-,,r,-,„Mi,,,,.,. it*Aiii,,V Milikli** iiii <=iiiiik,':',Nriiiiiiiiii6gAigte tAriginigt# 74Areet: li' '' "'"1,- ' ';,'Miaiiii: freg::L,4,,;:4614.7(„';,;,r'', ;!'''. ,"`"",ige-- ",,,i,--,,, <• , ,',,,,ao, , ,M,M, ,..„, kWh/Day 20- II Cost of electricity from NEXTERA Cost to deliver electricity 15- . ENERGY SERVICES from Eversource " 0 1"04:'" -1, '•;:,,P.'' IR, mg 4,. ., . „. 10- q 'r ,"4: --, ''',i;--'", ' ' - , "',-„•!]z , „ „ „„ , wo isk,", ,, " ,mop: - • ist Aw. ,,,, gr.,:4 , :,:at Ar ' ti% Ilii faii • Ike $0 ' $34 ' 'i7 :US . $102 mia ikti* 'St: AN Mr ,,, Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep 74" 61° 56° 42° 37* 36 37* 43' 52° 57' 66' 73' 70° Your electric supplier is Average Temperature NEXTERA ENERGY SERVICES 20455 STATE HIGHWAY 249,SUITE 200 HOUSTON,TX 77070 ,' WWWNEXTERAENERGYSERVICES.COM This month your This month you used ,,,,,'° Billing for CAPE LIGHT COMPACT , average daily ‘;',ft%,,' ',',,00 0 / Ci (.3 electric use was than at the t ' ' I sametime , 1 last year 0 / News For You Energy supply rates have been lower this summer but are expected to go up again this winter with the market price of natural gas.We encourage you to take action to prepare now for the winter-and potentially higher energy prices-ahead.For help with your energy bill and ways to lower your energy use visit Eversource.com/manage-cost. Remit Payment To:Eversource,PO Box 56007,Boston,MA 02205-6007 EM_230910 TXT Please make your check payable to Eversource or to make your payment today visit Eversource.com. EVERSURCE If mailing your payment,please allow up to 5 business days to post to your account ::!"!: ,:,,i,li!,!:114,!imai:::aropshimioisigolootirostomosos Total Amount Due Account Number: 1427 846 0135 , ... ...., by 10/10/23 ::::agodisionsiou Amount Enclosed Eversource PO Box 56007 TAYLOR PIPER Boston, MA 02205-6007 9 WEDGEMERE RD WEST YARMOUTH MA 02673-3611 12 7 0000016290 10 70 1427 846 0135 ._ EVE RS� 4U RCE Total Amount Due Account Number: 1427 846 0135 by 10/10/23 $1 62.90 Customer name key:PIPE Statement Date: 09/15/23 Service Provided To: Electric Account Summary TAYLOR PIPER Amount Due On 09/10/23 $351.75 Last Payment Received On 09/01/23 -$351.75 '" Balance Forward MA 02673 Current Charges/Credits ''. L Cycle 10 Electric Supply Services $75.53 f 30 Days Delivery Services $87.37 a yy,,;,, ,, E . a= t ,,, Total Current Charges $162.90 Meter Current Previous Current Reading Total Amount Due $162.90 Number Read Read Usage Type 2291189 79120 78611 509 Actual , �a• Supplier(NEXTERA ENERGY SERVICES) ' Meter 2291189 Sep Oct Nov Dec Jan Feb Mar -' Generation Service Charge 509 kWh X.14839 $75.53 499 428 459 288 347 362 296 Apr May Jun Jul Aug Sep Subtotal Supplier Services $75.53 282 407 424 490 610 509 Delivery Contact Information (Rate 32 R1 RESIDENTIAL) Emergency:800-592-2000 Meter 2291189 www.eversource.com Customer Charge $10.00 Pay by Phone:888-783-6618 Distribution Charge 509 kWh X.08147 $41.47 Customer Service:800-592-2000 Transition Charge 509 kWh X-.00411 -$2.09 Transmission Charge 509 kWh X.03812 $19.40 Revenue Decoupling Charge 509 kWh X.00304 $1.55 Important Messages About Your Account Distributed Solar Charge 509 kWh X.00469 $2.39 THANK YOU FOR GOING PAPERLESS. Renewable Energy Charge 509 kWh X.00050 $0.25 Energy Efficiency(CLC) 509 kWh X.02830 $14.40 DIGGING?STATE LAW REQUIRES YOU OR YOUR CONTRACTOR TO CALL DIG Subtotal Delivery Services $87.37 SAFE AT 811 AT LEAST THREE BUSINESS DAYS PRIOR TO DIGGING.FOR Total Cost of Electricity $162.90 MORE INFORMATION VISIT DIGSAFE.COM.IMPORTANT SAFETY INFORMATION IS ALSO AVAILABLE IN THE"SAFETY"SECTION OF EVERSOURCE.COM. Total Current Charges $162.90 EM_230910.TXT Eversource is required to comply with Department of Public Utilities'billing and termination regulations.If you have a dispute please see the bill insert for more information. For an electronic version of this insert.residential customers go to Eversource.com/about-residential-bill and business customers go to Eversource.com/about-business-bill.Then select"Monthly Bill Inserts"from the page.Budget Billing is also available to pay a more consistent bill each month.Please see the Customer Rights Supplement for more information.