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Home My WebLink AboutBLD-23-001293 Cji j/ „ ,J / 1 Office Use Only o�•Y,gR4 g// j z/Z i permit# C 0.161 d ,�$ ' ,5,;! ' Amount 50•,0 1C „nrr�on esE '� iPermit expires 180 days from �`°'°°""`°�Q��d I issue date B'D — 023 —OO/?43 EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department RECEIVED _. _ 1146Route28 South Yarmouth, MA 02664 ° SEP 0 9 2022 (508) 398-2231 Ext. 1261 BUILDING DEPARTMENT ,y� - � ay: CONSTRUCTION ADDRESS: III /V c'C/ ; i ASSESSOR'S INFORMATION: Map: Parcel:OWNE R: C!i 4 A"J -^, ,Sa.✓l Ae6 PRESENT`ADDRESS eh a s)1,6-Nook NAME ADDRESS /l TEL. # 7 CONTRACTOR: AVYLJ .l,,,,)1/ 2 vA' iie-� l (1 ( t'rru;`H 3 3 O 8Ogh NAME / MAILING ADDRESS TEL.#:14 // e 2 sidential ❑Commercial Est.Cost of Construction$ / 4V'Vd Home Improvement Contractor Lic.# /G/ 75- 8 Construction Supervisor Lic.# 695'Vg28 Workman's Compensation Insurance: (check one) ❑ I am the homeowner D-- am the sole proprietor ❑ I have Worker's Compensation Insurancce // Insurance Company Name: /^I9 v c/' 6�'S Worker's Comp.Policy# V?" VAIp9/OS 2 X 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. ( ep icing liike1 423 Pool fencing *The debris will be disposed of at: A✓ernU &2,5�', Location of Fa lity 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: 9'� 9/2 Z Applicant's Signature: [ Owners Signature(or attachment) Date:e/ � Date: r`/ �' i�& Approved By: EMAIL ADDRES Building Offici J- des -- — / Zoning District: Historical District: 0 Yes D. No Flood Plain Zone: 0 Yes 0 No Water Resource Protection District: Within 100 ft.of Wetlands: 0 Yes 0 No 0 Yes ❑ No The Commonwealth of Massachusetts r Department oflndustrialAccidents ZIG 1 Congress Street, Suite 100 Boston, MA 02114-2017 _sr,y,�" www.mass.gov/dia \Yorkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): ,/)J(ii (` ./-tik E'. , / , 4 f Address: 3/2. Sk , -I 14 City/State/Zip: 4 /. ` .// ,,ii/ Phone #: (`( 36.6 - A 0 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.❑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. _ 12.0 Plumbing repairs or additions 5.❑I 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.: 14.❑Other 6. We are a corporation and its officers have exercised their right of exemption per MGL c. 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: �f/9✓J/4e. 0'S' Policy#or Self-ins.Lic. #: 616 i/AJ %I je,r^2 c)z Expiration Date: 34.1(93 Job Site Address: ill n2ri City/State/Zip: b/11�'4 `r I the workers' compensation policydeclaration page(showing the policy numl5er and expiration date). Attach a copy of p 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: Date: / ft cii- Phone#: W-3C. 6 ---gtY? 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#: [Type her MID CAPE ROOFING ' (ti 312 Skunknet Road ag6e4-4t)v �VJ Centerville,EVaA 02632 508-385-8801/508-360-8097 oZZr Barry Merrill&Paul Merrill [Type here] Job Site Address Mailing Address Name: �/; �.4 h . d'r'° Name: ice/ j ,%._t�, � n, 7, s ,.,re '-J Street: ill 1 i„„.c.�, >4�e p� Street: /1 it a-,A, -/ 4,a- City: ,.__ y/Av,,4 ei City: 7,,�1 �y,� l ,r.,�-Telephone: -- j'�'. >;fi 7.�f Telephone; � We hereby propose_to furnish_all the materials and all the labor necessary for the completion of: roof replacement ofthe dwelling at the above address. Mid Cape Roofing proposed to remove and dispose of the existing roof. The roof will be replaced with CertainTeed Landmark shingle ` Aluminum drip edge wilLbe-installed along the gutter line. Ice.&Water Shield installed on bottom edges to protect ice-back-up. 15 pound felt paper-will also be applied. The shingles will be installed using 6 roofing nails(1% inch). New pipe ventcollars:will be installed. Ridge vent will be installed along the=ridg-eline of the roof to provide proper venting of the attic space. Mid Cape -Roofing guarantees the workmanship for a period of 10_years. All walls and landscaping will be-protected from'damage;the property willbe raked and cleaned of ail debris. All material is guaranteed to be as specified andthe_above work is to be performed in accordance with specifications submitted for above-work and completed in a substantial workmanlike manner for the sum of: $)a,a qO -Ali discounts have been applied. Payment made as-follows: q02 yd Deposit of: $ �� day job is started and remainder paid on completion. ✓ Any alteration or deviation troT"m fie`a-fiov°specifications_irivolving extra costs will become an additional charge over and above the estimate and will be discussed with the homeowner. Respectively Submitted by Mid Cape Roofing NOTE: This proposal may be withdrawn by Mid Cape Roofing if not accepted within 30 days. Acceptance of Proposal The above prices,specifications and conditions are satisfactory and are hereby accepted. Mid Cape Roofing is hereby authorized to perform work as specified with payments made as outlined above. Accepted: ' /; (�r7rt'. ar;',"-� ., ` k ,� �eaA44.64 1cc c% $/,1cet _ Commonwealth of Massachusetts ® Division of Occupational Licensure Board of Building Re ulations and Standards Cons iorlirSrvisor CS-054428 b 4 spires:05/21/2024 BARRY B M RI ( I r, . <312 SKUNN TTft� �, t - �, CENTERVILL` .M/ ` ; Q I''�i'it.vAN3'� Commissioner ccc K. bl&c> , { , 64W.,?rv'if rrasf< /(72,744C7e(iJPffl u ' Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE;Individual Registrat pr Expiration 161458 12/01/2022 BARRY MERRILL , II` BARRY MERRILL 312 SKUNKNET ROAD" (,nr,,(4( ' CENTERVILLE,MA 0`2632 Undersecretary