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Home My WebLink AboutBLD-23-001423 O�•Y�R '"I Office Use Only '$�. . '`''c C. L� \LL ;Permit# �I f�/J ®U "' ' i AS ' y .net to 1 i, . 'l� (Amount�® MATTA n fSE� .) ..`°""'.Q:� 1 Permit expires 180 days from do Riz_5 I issue date cEIVED EXPRESS BUILDING PERMIT APPLICATI TOWN -- TOWN OF YARMOUTH SEP 14 2022 Yarmouth Building Department 1146 Route 28 BUILDING DEPARTMENT South Yarmouth, MA 02664 By --- (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: 2C1 &� -,2 tv . /1Rt- V'\ T' O2 ' ASSESSOR'S INFORMATION: ^,t p Map: Parcel: � OWNER: A'/_ al,e0e12....._ Z:4 �6!-mot-(.N . —171-1'.212-(-) 0NAME PRESENT ADDRESS TEL. # CONT CTOR: I lr•1 N tC.d W� rT.) ft & C&2 N V� r p �j(.,� S ^ - 7 5- 7 NAME MAILING ADDRESS TEL.# IAA- 62�3'�7 esidential ❑Commercial Est.Cost of Construction Z-5 i 3 O •0 U Home Improvement Contractor Lie.# I618S I Construction Supervisor Lic.# C S- 11618 Workman's Compensation Insurance: (c�Weck one) 0 I am the homeowner ' rl/jam the sole proprietor 0 I have Worker's Compensation Insurance Insurance Company Name: Worker's Comp.Policy# WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove � Siding: # of Squares Replacement windows:# l ) Replacement doors: # Roofing: #of Squares ( )Remove existing* (max. 2 layers) Insulation Ve Old ings Highway/Historic Dist. ( )Replacing like for like Pool fencing t.ppave0 -it/-Z2 *The debris will be disposed of at: `rr)'`- A ge Location of Facility I declare under penalties of perjury that the statements he ein containe e 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 for p sec . r M.G.L.Ch.268,Section I. Applicant's Signature: Date: yity tZ2_ Owners Si re(or attachment) Date: //>/Z Z. Approved By: Date: Building Official(or designee) EMAIL ADDRESS: I Zoning District: Historical District: 0 Yes ❑ No Flood Plain Zone: 0 Yes ❑ No Water Resource Protection District: Within 100 ft.of Wetlands: 0 Yes 0 No 0 Yes ❑ No p01.'YRR 1 Office Use Only (Permit# ( 1 i t2V d1 /t �' (Amount 5® O MATTA n CS[ c iPermit expires 180 days from issue date EXPRESS BUILDING PERMIT APPLICATIO ' C 1 \ E TOWN OF YARMOUTH SEA 14 2022 Yarmouth Building Department 1146 Route 28 BUILDING DEPARTMENT South Yarmouth, MA 02664 BY _-- _ (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: ' 2(1_ ee,, /....t\ • `78R..1---v.A-AN \-.)\A 02-Car) ASSESSOR'S INFORMATION: WD1aua0a2____ Map: Parcel: OWNER: �I 34 2.�(N . —7L\"2,12-� C3 NAME PRE$ T ADDRESS TEL. # r D CONT CTOR: N`I t 3 tc�WlAKIK) '�Qts& G82 N1,,y0 --)— `J�(�"3O ' S 7cS 7 AME MAILING ADDRESS TEL.# esidential � �ZL3�1 ❑Commercial�/ Est.Cost of Constructio Z�r UU • O U Home Improvement Contractor Lic.# 16` /e)S i Construction Supervisor Lic.# C S- I'6'78 5 Workman's Compensation Insurance: (c feck one) ❑ I am the homeowner ' r am the sole proprietor ❑ I have Worker's Compensation Insurance Insurance Company Name: Worker's Comp.Policy# WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows: # l J Replacement doors: # Roofing: #of Squares ( )Remove existing* (max. 2 layers) Insulation Old Kings Highway/Historic Dist. ( K Replacing like for like Po I fencing b\L- 4M12NN(V) "PI 1. 0- 1 `A (AAV\ r 1+ Ai/ 11 L "The debris will be disposed of at: C'( Location of Facility I declare under penalties of perjury that the statements he ein containe a 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 for p sec ' r M.G.L.Ch.268,Section I.— 7 A ` q yL t� Applicant's Signature: �� —.._-- ` Date: r ' 2— Owners SiQ re(or attachment) Date: Approved By: Date: Building Official(or designee) EMAIL ADDRESS: Zoning District: Historical District: ❑ Yes ❑ No Flood Plain Zone: ❑ Yes ❑ No Water Resource Protection District: Within 100 ft.of Wetlands: 0 Yes 0 No 0 Yes ❑ No Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:Individual Registration Expiration 187851 05/21/2023 DOMINIC WATKINS D/B/A WATKINS WORKS DOMINIC WATKINS i2 544 MAIN ST. [�aG�oss� APT 4 Undersecretary DENNISPORT,MA 02639 • Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards ConstMt$1116i pe,rvisor CS-110783 ' ;., ' 6pires: 11/25/2022 DOMINIC WRKINS 1a • P.O. BOX 68 ;f11111 DENNIS POR'LJVIA i C1SS.1 r] Commissioner daea, �' bigkoi • Estimate 5 � Estimate Number:1300 "y Name: Cate Van Gelder Project Description: Address: 24 Skipper Ln Yarmouth,MA C)Z co�i S Phone number: 774 212 6363 gwe,' 73)aaraem.ort Email: catevangelder@gmail.com Licensed& Insured. 508-360-5757 Date:10/26/2021 Replace all windows including bay window(8) $15/86.00 400.04$ /Marvin Elevate White interior finish/White exterior finish 6/6 Grilles,Interior/Exterior window trim(8) 1 All new exterior trim including but not limited to $11414.00 Door trim Rake boards Garage Trim Corner Boards Freeze/Facia/Bed Molding Replace gutters $1200.00 ,2,e 0 Transfer Station FEE TBD Building Permit FEE TBD Labor&Materials Special Notesf Jnstroottons - Total �$2+8,4Q0<t)Q All material is guaranteed to be as specified and the work to be performed in accordance with this description above and completed in a substantial work like manner for the sum of ag1yoo with payment as follows. Payment schedule: 50% On Acceptance$14250.00 25% When windows install complete$7,100.00 25% Balance on job completion$7,100.00 plus fees Respectfully submitted:Dominic Watkins Date submitted: 10/26/2021 This proposal may be withdrawn by us if not accepted within 45 days. Any alteration or deviation from above specifications involving costs over and above the estimate will be executed only upon written and approved change order.All agreements contingent upon accidents or delays beyond our control. Mailing address:P.O. box 682 Dennisport Ma, 02639 Like us on Facebook,WatkinsWorks Building and Remodeling Please Confirm the acceptance of this estimate by signing this document and sending email confirmation. Signatuu �, b'L77-/� print name Date The Commonwealth of Massachusetts Department of Industrial Accidents ' 1 Congress Street, Suite 100 Boston, MA 02114-2017 \two."' www.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/6Organization/Individual):, I )(I l N LLt)1/4.3 kts ,l� Address: 3)( (b 2- • 41 City/State/Zip:�N�1 � Phone #: .S-06 CPC) 7 Are you an employer?Check the appropriate box: Type of project(required): 1. I am mployer with employees(full and/or part-time).* 7. 2 am a sole proprietor or partnership and have no employees working for me in - New construction any capacity. [No workers'comp.insurance required.] 8• [ Remodeling 3.0 I am a homeowner doing all work myself. [No workers'comp. insurance required.]t 9. - 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. l l.[ Electrical repairs or additions 5.[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.E 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#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: Policy#or Self-ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: 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 h`ereby nrti der the pains nd p alt o.fP .lry perjury that the information provided above is true and correct. Sianatur • Date: cl one#: G C-C) 5 7 0 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#: