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BLD-23-003427 po i ) ► GI )z3 ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department oF...'y 1146 Route 28,South Yarmouth,MA 02664-4492 `� 508-398-2231 ext. 1261 Fax 508-398-0836 `;'E* Massachusetts State Building Code,780 CMR Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: eth--2)3-bei 21 Date Applied: E- jiM zRA[5 - I -) -,,3 REC: En/ ED Building Official(Print Name) Signatu e bate " SECTION 1:SITE INFORMATION DEC ? 0 2022 1.1 Property Address: 1.2 A se„r_s l�I'l t&Parcel Numbers '2 S (ova R0�7 ..__RIl1i DING DEPARTMENT 1.1 a Is this an accepted street?yes no Map Number Parcel Number L Hv ______ _ _______- 1.3 Zoning Information: 1.4 P o erty ►mensions: Q es- 13,7-3 Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Vat Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public Private❑ Zone: — Outside Flood Zone? Municipal 0 On site disposal system Check if yes❑ SECTION 2: PROPERTY O WNERSF11P' 2.1 Owner'of Record: /i o1A/l+ .TP riso'✓ i /rge_-ro , A/,i. Oz y Z Name Print) City,State,ZIP 23 !}) A-'i`oA) R b ' 4I7 - Ze/- 9Y63 R0Ai 4-e.5bttAro,tie¢"s_ (b cc No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction El I Existing Building❑ Owner-Occupied ❑ I Repairs(s) 0 Alteration(s) ❑ I Addition 0 / Demolition 0 Accessory Bldg. 0 Number of Units Other Specify: t,rr/t,-' ,''"('/e- e t"/',Fa h S Brief Description of Proposed Work2: i it.it.r/fre- D.ey 0 4/( W of D.4-4.•€.6-€n oFil--e-o c. if--5 51100a( oA( i=/cbi€ p1A- J - 6' iy / i(e #,•, z,k,-),, 2oa.ic — /.3.¢s42c,,,,.rt- ' (oo A. 20 ✓'{re.r xip-- ;tom e 4-�3,, . ,v4-,-r--0 fa, _..,, -ref- SECTION 4:ESTIMATED CONSTRUCTION COSTS. • Estimated Costs: Item (Labor and Materials) Official Use Only 1.Building $ 6 1. Building Permit Fee:S b.00 Indicate how fee is determined: 00 Standard City/Town Application Fee 2.Electrical $ I. 2-0 ❑Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ IS DC) °0 2. Other Fees: $ .3 5,6Z 4.Mechanical (HVAC) $2_5 'b " ' List: i',r l RO45.Mechanical (Fire $ Suppression) Total All Fees:$ \% Check No. Check Amount: Cashrunt) 6.Total Project Cost: $7s vv�. ❑Paid in Full WI Outstanding Balance C / (5 -1- SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSI,) GS 0/V ci ZIP% 5.-/O ` W / /r l l `^ �,t`r Al License Number Expiration Date Name of CSL Holder r 2_2— f > S - List CSL Type(see below) A/ No.and Street Type Description (,32-r wS Ty-_,1 t it . ,-------,..-2,-, Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry Z)2- 063 RC Roofing Covering T$A vise k (ra WS Window and Siding /` SF Solid Fuel Burning Appliances T l(f 0'0 T Z l•PS/UI t70 wS, Lo I Insulation Telephone Email address D Demolition 5,2 Registered Home Improvement Contractor(HIC) /2-9 y 9 z1-z3 HIC Company Name or HIC Registrant Name HIC Registration Number Expiration Date z z_ 44-erue117.-1 C•v .41-y • _Sivkx fr,✓ s InMkS- LOu.t No.and Street. d i ./i/,t/i S /f{qC_ 5 Z 6 6D Email address City/Town,State,ZIP Telephone N j [X )IS-R)/tk _thcLiff-)Ps--604-id nS SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide L this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes No •❑ . 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 kl"'r4 c-lie b0 C-- • - to act on my behalf,in all matters relative to work authorized by this building permit application. jQ7?„, z Print Owner's Name(Electronic Signature) ate • SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. (((I tA)( 6 bc-c._ 2 Z-- 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.aov/oca Information on the Construction Supervisor License can be found at www.mass.eov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) I Z L{`2 (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) " u, Habitable room count J" Number of fireplaces 1 _ Number of bedrooms Number of bathrooms I Number of half/baths t Type of heating system Fe)k C e 0 A-Cg Number of decks/porches 1 Type of cooling system C .11/4.tt,o,A-t A-(L Enclosed Open / 3. "Total Project Square Footage"may be substituted for"Total Project Cost" /—.."1 WHALRES-01 CWOODSIDE ACORD DATE(MM/DD/YYYY) �� CERTIFICATE OF LIABILITY INSURANCE 12/19/2022 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 License#1780862 CONTACT John Powers NAME: HUB International New England PHONE 508 945-7866 �FAX 265 Orleans Road (A/C,No,Est):(508) (A/C,No): North Chatham,MA 02650 E-MAILADDREss,John.Powers@hubinternational.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Acadia Insurance Company 31325 INSURED INSURER B:Chubb Insurance Company of Puerto Rico Whalen Restoration Services Inc. INSURER C: 22 American Way INSURER D: South Dennis,MA 02660 INSURER E: INSURER F: 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 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD (MM/DD/YYYY) IMM/DD/YYYYI- A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR CPA 5427058-12 4/1/2022 4/1/2023 PREDAMAGEES TO(Ea RENTEDoccurrence) $ 100,000 MIS MED EXP(Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JECT PRO- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: - ' COMBINED $ A AUTOMOBILE LIABILITY (Ea accident SINGLE LIMIT $ 1,000,000 ANY AUTO MAA 5427059-10 4/1/2022 4/1/2023 BODILY INJURY(Per person) $ OWNED SCHEDULED _ AUTOSE� ONLY X AUTOS BODILY INJURY(Per accident) $ X AUTOS ONLY X AUUTOS ONLY PROPERTY DAMAGE (Per accident) $ $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE 5427060-12 4/1/2022 4/1/2023 AGGREGATE $ 1,000,000 DED X RETENTION$ 10,000 $ B WORKERS AND EMPLOYERS'LIABILITY STATUTE EH R ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 6S62UB5B89454222 4/1/2022 4/1/2023 E.L.EACHACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Ronna Johnson ACCORDANCE WITH THE POLICY PROVISIONS. 25 Cove Road West Yarmouth,MA 02673 AUTHORIZED REPRESENTATIVE gimp'?AV-9— ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD fl (.(lmrnonWeuttn of iviuss'acnusetts 1.9 De a ment of Industrial Accidents 'tµ L ffice of Investigations afayette City Center 2 Avenue d4.._ .afayette, Boston,MA 02111-1750 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): WHALEN RESTORATION SERVICES INC Address:22 AMERICAN WAY City/State/Zip: SOUTH DENNIS, MA 02660 Phone#: 508-760-1911 Are you an employer? Check the appropriate box: Type of project(required): 1.0 I am a employer with 25 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.t 9 ❑ Building addition required.] 5. 0 We are a corporation and its 10.❑ Electrical repairs or addition: 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or addition: myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.X.Qther comp. insurance required.] 0Ai4-7;i6;L *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: ACE AMERICAN INSURANCE COM NAIC#22667 Policy#or Self-ins. Lic. #:6S62UB5B89454222 Expiration Date:04/01/2023 Job Site Address: L c226 t� WEST �Co� City/State/Zip: B 2 �-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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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 fin of up to$250.00 a day against the violator. Be advised that 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: /6 27� Date: Phone#: - K3 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License # Issuing Authority(check one): 1OBoard of Health 20 Building Department 3DCity/Town Clerk 4.0 Electrical Inspector 50Plumbing Inspector 6.0Other Contact Person: Ts• • A TOWN OF YARMOUTH BUILDING DEPARTMENT M TVACrtC�C' a� 1146 Route 28, South Yarmouth,MA 02664 508-398-2231 ext. 1261 HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE: JOB LOCATION: Z� ` PV� GO � �2ow` G, . NAME STREET ADDRESS SECTION OF TOWN "HOMEOWNER" / ovIv - `Ibkksok; - ' 17 2,?I- 9.'Y43 NAME HOME PHONE WORK PHONE PRESENT MAILING ADDRESS 43 /l'1 bk) iZ..f.D • w,9-rC 4,.,y— cLt 4- 0 2 L 7 CITY OR TOWN STATE ZIP CODE The current exemption for `Homeowner' was extended to include owner—occupied dwellings of one or two units and to allow such homeowners to engage an individual for hire who does not possess a license,provided that such homeowner shall act as supervisor. (State Building Code Section 110 R5.1.3.1) Definition of Homeowner: Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is or is intended to be, a one or two family attached or detached structure assessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner;such"homeowner"shall submit to the building official,on a form acceptable to the building official,that he/she shall be responsible for all such work performed under the building_ permit. (Section 110 R5.1.3.1) The undersigned `homeowner' assumes responsibility for compliance with the State Building Code and other applicable codes, by-laws, rules and regulations. The undersigned 'homeowner' certifies that he/ she understands the Town of Yarmouth Building Department minimum inspection procedures and requirements and that he / she will comply with said procedures and requirements. HOMEOWNER"S SIGNATURE /144-e -bUG--' APPROVAL OF BUILDING OF414iCIAL INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL Ch.142. Yes No If you have checked ves, please indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of indemnity Bond OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent h:homeownriicexemp 12/28/22,4:25 PM Mail-Sears,Tim-Outlook 25 Cove Sears, Tim <tsears@yarmouth.ma.us> Wed 12/28/2022 4:25 PM To:jbaylis@whalenrestorations.com <jbaylis@whalenrestorations.com> JIJ 1 attachments(391 KB) work in flood zone packet.PDF; Jay, /have reviewed your application and this property is in a flood zone. Attached is a packet to review, we need the cost worksheet filled out along with the contractor and owners affidavits notarized and returned. The final affidavit will be required at the time of final inspection. Timothy Sears CBO Deputy Building Commissioner Town of Yarmouth 508-398-2231 Ext. 1259 mailto:tsearsjyarmouth.ma.us RECEIVED L±!i1 112023 BUILDING DEPARTMENT By _ https://outlook.office.com/mail/sentitems/id/AAQkADE3MDQ5NWZmLTkOYzItNDIwNi1 iMDQxLWNkMGQyNmE4NzE5NAAQAGCcUWTztz9FsoJHwRY... 1/1 hnaBaylis r .Prom: Bill Whalen Sent Tuesday, September 6,2022 1:55 PM To: John Baylis Subject FW:Your OPSI License has been renewed From: NoReplyLicensing(REG) <noreplylicensing@state.ma.us> Sent: Friday,August 26, 2022 12:20 PM To: Bill Whalen<BWhalen@whalenrestorations.corn> Subject:Your OPSI License has been renewed THE COMMONWEALTH OF MASSACHUSETTS DIVISION OF OCCUPATIONAL LICENSURE Office of Public Safety and Inspections www.mass.gov/dpl/opsi August 26, 2022 WILLIAM WHALEN 122 Pond Street BREWSTER MA 02631 Your license CS-074928 has been renewed. The status of the license can reviewed on our verification site at https://madpl_mylicense.com/Verification The physical copy of your license will be printed shortly and mailed to the address above. Please allow two weeks for LISPS to deliver the license. If you do not receive it, reply to this email. Regards, Licensing Unit • Commonwealth of Massachusetts e Division of Professional Licensure Board of Building Regulations and Standards r:s •fiL 7`� C CS-074928 Expires:08/10/2022 WILLIAM WHALEN 122 POND STREET - BREWSTER MA 02631• ' Commissioner ufG� CJ�enJ . Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration • Type: Corporation Registration: 129244 WHALEN RESTORATION SERVICES INC. Expiration: 07/29/2023 22 AMERICAN WAY SOUTH DENNIS,MA 02660 Update Address and Return Card. Office of Consumer Affairs.8 Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Corporation before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 129244 07/29/2023 1000 Washington Street -Suite 710 .}WHALEN RESTORATION SERVICES INC. Boston,MA 02118 WILLIAM WHALEN 22 AMERICAN WAY SOUTH DENNIS,MA 02660 Undersecretary Not valid without signature 1///14le/I.... Restoration Services Inc. Fire,Smoke.Soot,Water&Mold Remediation Services Cleaning . Deodorization . Reconstruction Specializing hi Fire Restoration — 'a.00 Work Guaranteed Access5 Authorization and *Erect Payment Request Form I (we) authorize WHALEN RESTORATION SERVICES to perform work as per estimate at property located at AS- (DL&.Q. 'c\ , to repair damage caused by on As owner(s) of this property, I (we) understand that I (we) must authorize this work. I (we) hereby authorize WHALEN RESTORATION SERVICES to perform this work and accept responsibility for payment upon completion. I (we) authorize and direct my Insurance Company, Claim # , Policy# . to make payments directly to WHALEN RESTORATION SERVICES, Insurance Claim specialists, for doing this work and to that extent I (we) assign the benefts applicable to this loss to WHALEN RESTORATION SERVICES. I (we) acknowledge receipt of a copy hereof: z0 2 a OWNER YinflAk4k1 ATE/ ' SIGNED W ' •o TORA i r0 • _ OWNER SIGNED 22 American Way.South Dennis.MA 02660 Phone:(508)760-1911 . Fax:(5081 760-9995 . 1-800-24 r-2598 E-Mail:kspelmanuhwhalenrestorarions.com Web Page:http: ,wtti-_whaienrestorations.cotn §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 2 S C Work Address Is to be disposed of oat the following location: ?:117-4(actiVic Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. Ill, §150A. /G /PC Signature of Application Date Permit No. • Substantial Improvement Worksheet for Floodplain Construction (for reconstruction,rehabilitation,addition,or other improvements, and repair of damage from any cause) Property Owner: �Q Ai/Q- (�/1 f1 s0/(,!' Address: 2-5" 60 1/a R.> - W— y</t2lHauc-'/A- Permit No.: Location: Description of improvements: pg yia,u.j(— l'NsL.0 fro-0D /[)U/z /a✓¢/!.- -.V6-S PTeserat Market Value of.structure DAILY(market ap tsaior.adusted assessed value,BEFORE improvement,orf darrraged, before The damage accursed),net. $ 2 S/ 6 Uo • Cf3S3 0vemer1t S . 7 a a} } $J t t'} y 'h F• -. t. -tx :} ,r-:?''F ,n1 .a ^s k k c r� + Ir�i WUUQi }�1]R".,er 3dllV1 rirrSl�o e�'S�� tee t` ? [ - } ! - ak } io Most of41.0*vemer4l07=Cost to li3epa�r� yi•i,y� s } {� ` !�'w�.. ,tl,�+ a gtY' ,.;r E r. t' ,a•r % If ratio is 50 percent or greater(Substantial Improvement),entire structure including the existing 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: Date: TOWN OF YARMOUTH 47\ U9‘ BUILDING DEPARTMENT ` , �T $ .1146 Route 28, South Yarmouth, MA 02664 s. Telephone 508-398-2231 ext. "1261 Fax 508-398-0836 Contractor's Affidavit: Substantial Improvement or Repair of Substantial Damage Property Address: Z c C /2 U /t/1fou Parcel ID Number: iu'" f y( g3/l Owner's Name: /2bPGcQ _I?)41( LI Contractor: PH (ei-/ tesp rfl?2) NS Se..ev - Contractor's License Number: (-5 r ?7 ( i Date of Contractor's Estimate: 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. Contractor's Signature Date: PeG Z I CA "\ . -3 Notarized: ( , , - HELENA ALYCE TERRIO Notary Public rMassachusetts / / Vj , ` (C Ci�'�„ ,,,-j ' My Commission 5xpires (w/J Jd �N'//,/� �'"R=`" � Jul 4, 202E li4(71911 Restoration Services Inc. Fire,Smoke.Soot,Water&Mold Remediation Services Cleaning . Deodorization Reconstruction Specializing hi Fiirre Restoration - Afl W4.rk abilaranteed Access, Au hor Lath•,n and IINrrecct Payment `"eq uest Form (we) authorize WHALEN RESTORATION SERVICES to perform work as per estimate at property located at A..5*-- CQ , to repair damage caused by on As owner(s) of this property, I (we) understand that I (we) must authorize this work. I (we) hereby authorize WHALEN RESTORATION SERVICES to perform this work and accept responsibility for payment upon completion. (we) authorize and direct my Insurance Company, Claim # , Policy# . to make payments directly to WHALEN RESTORATION SERVICES, Insurance Claim specialists, for doing this work and to that extent I (we) assign the benets applicable to this loss to WHALEN RESTORATION SERVICES. I (we) acknowledge receipt of a copy hereof: 1 1 OWNER ( \-k- VW)� `) di\ • ATE►/ r SIGNED t • TORAT(Or • OWNER SIGNED 22 American Way.South Dennis.MA 02660 Phone:(508)760-1911 . Fax:(508)760-9995 . 1-800i 244-2598 . E-Mail:ksnelmanEtthalenrestoratiens.com Web Page:http://wwww°halenrestoeations.cotn MainL.',,;I 2_ 5 L o V E ICU . vl� t��*�I Il { 6'U1��71...- 1 P{k,t s • 6ik-- L- i-lt(f: vokti.5 t,rSal,nt -t�.�,,\P-Tve - DK\Iu/A-It Fib:-ku� S u ' F ►t o; r kill- -1 Ina,45 - Dell ,A 11' 11„ 1 �' ii�n 1 � a i- '„�.�_5,6„�- , i„-1 i I 0 11' 5" •�2�6" 4'7„--•• 24' 1" ,n. � �- 3'4�� , , ,, , I L JJ tr,/od. k `� dub (3)�r Laug m r 'ry Bat �.uiT I'6"ipathroom°` r Kitchen/Dining Room Rear Bedroom 4 'l�b�-�b�tEfL�,t�7S 0-3'1„--I Entry I-3,8,, T 5„ I �1 14'9" y'I Hallway s �-/ 14'5' \yam -��„ 5. y' . o 11'7" 1 3' 1"T' 4' -I 4'9' c Fs N o of D k k i-,,4'1-� L t)�,C w li tt 1\1 O 1 D iZ K ■ r it'll" 1 _ T ~2,- ' Front Bedroom )se j 1 Middle Bedroom 11 Living Room oo set- .C. / `IIJI� f•----_12'4„1 1 -1---n 8,9„--- : 5 I' i,‘ g, 1 7,„5,c. ,' . 1- J 1- R. I f�S U $ 12' 10„ I 11'5„ I 5'8„ ( j_i- lipQ1FAI q 1. RF"iE,,,, _ OOMPLI- M _, , - ' At - 'aiM'SSIONS DO NOT RELIEVE THE Ai- _. 1E RESPDNSIBILIT OF'AS BUILT' ir CO.,., Main Level (�,��y-� f au; 'FICIAL JOHNSON REPAIRS] ! h1n (ki Q SD�t�b�J3 12/16/2022 Page:2 B:'semen' 54' Clvl\-uil 5pi\LE Nt< 'tF1 N 00 Base nt/Cr awlsp ce N REPIK,E_ it-e)( b iktra�l )3q ofltt S 1 Basement JOHNSON REPAIRSI 12/16/2022 Page: 1