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Home My WebLink AboutBLD-23-001608 �,-i$•p1' RR t in 67 /z7 /32 Office Use Only y J �• �� R E C E 1 9/ E D Permit# E II ��,5 l MATTALM f3E 3 _ Amount Sl/ �PoCA�.ffC�4 SEP 23 2022. � _ ,J' ;Permit expires 180 days from 'issue date BUILDING DEPARTMENT E3y. V I f j .1- Z3`�t1pO' EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Ext. 1261 0 6 le L/CONSTRUCTION ADDRESS: LP CANIACh 11,_ ,T-5f)/104JA, )((,) S jz'nci'i&. A.R4tinbalt. rfk !l ASSESSOR'S INFORMATION: Y017_ Map: Parcel: v`J� 395-d 2,0 Ce DOWNER: MP In f ' ( CA, A46 , t/0 � (.C�1 v 1 N ,PRES T ADDRESS TEL. # CONTRACTOR: ki4C AKA dad/ . gO47— MAILING ADDRESS i 6 f TEL.# •�rt E9'Residential ❑Commercial Est.Cost of Construction$ ?10 e C� V/Home Improvement Contractor Lic.# Construction Supervisor Lic.# al ( --1 ' Workman's Compensation Insurance: (check one) ❑ I am the homeowner*ft❑ I am the sole proprietor ' I have Worker's Compensation Insurance , �+Insurance Company Name: i7& Worker's Comp.Policy#ti % -ssei 1'% `ZOZ 18 WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# 4 Replacement doors: # Roofing: #of Squares ( )Remove existing* (max. 2 layers) Insulation Old Kings Highway/Historic Dist. ( )Replacing like for like Pool fencing *The debris will be disposed of at: 1r) 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 o revocation my license and for prosecution under M.G.L.Ch.268,Section 1. / ✓ Applicant's Signature: Date: 42.-ja— vAwners Signature(or attachment .,/ Date: /S%' Approved By: Date: ��7— K_ Building Offici or gnee EMAIL ADD S: Zoning District: Historical District: ❑ Yes ❑ No Flood Plain Zone: ❑ Yes ❑ No i Water Resource Protection District: Within 100 ft.of Wetlands: 0 Yes 0 No 0 Yes U No • \ The Commonwealth of Massachusetts iri, Department of Industrial Accidents 1 Congress Street, Suite 100 < Boston, MA 02114-2017 .._•` www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print LeaibI' Name (Business/Organizati n/Individual): itiPr L / a / X_ / q' Address: ��r-VQ-5 City/State/Zip: 1iC1 L ,( 1 � 46 1 Phone #: `I Q4tg q Are you an employer?Check the appropriate box: Type of project(required): 1.Z(am a employer with Z employees(full and/or part-time).* 7. [ N..ew construction 2_• I am a sole proprietor or partnership and have no employees working for me in any capacity.[No workers'comp.insurance required.] 8• Remodeling 3.Q I am a homeowner doing all work myself. — 9. _ Demolition y [No workers'comp. insurance required.]t — 4.111 ProPrtY I am a homeowner and will be hiring contractors to conduct all work on mye I will 10 _ Building addition • 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. These sub-contractors have employees and have workers'comp. insurance.: 1 •[Roof repairs 6.[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: ea • ,t/a .... le_ aorikpf-f,i Policy#or Self-ins. Lic. #: 1 --gr qff`"5 r5 Expiration Date: Vv. zg' Job Site Address: (0 64",ativididd_ City/State/Zip: �� fAtta �� -�- ch a copy of the workers' compensation policy declaration page(showing the policy numb 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 under the p 'nss and penalties of perjury that the information provided above is tr 'and correct. Signature: Date: 1 i77 a— Phone#: , Y.g.-(1:— %`fqq 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#: ,677e 6,74/220-74(0--ead10-/ ci,e 3 4-a el((J-e/X,I- Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Individual 00- Registration: 132560 ROGER E. BYAM �m �m Expiration: 02/26/2023 D/B/A BYAM CONSTRUCTION , p P.O. BOX 1793 HYANNIS, MA 02601 i b Update Address and Return Card. SCA 1 0 20M-05/17 I. Commonwealth of Massachusetts • � lj Division of Professional Licensure Board of Building Regulations and Standards Consti f tlAbOrvisor ii • CS-075376 ; ' 1pires.07/03/2023 ROGER E By AM i, PO BOX 1793 'f 1 NO HYANNIS MA 2, #i }� tit! OISSItICPS 00 k Commissioner dais. K. bi , r RECEIVED SUN 0 B 2022-1 iNsuLATioN 4 MO,04 A. 14.A.MOS %,013.(,0 1-800-696-6611 Town of ‘4.0a4 Regulatory Services Services Building Division C 4 Address: /66, eat 14 y Address: Date: - Dear Building Inspector Please accept this letter as documentation that Cape Cod Insulation, Inc. performed insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. Property Owner Property Address Village Ota,, I fti eirterApi. VA/0 ye • riAet otii.4°7( Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings 3? / ) ()() Slopes 04- / )(,) Floors ) Walls ) i / ) zio „, 4010.444.4-4 431 Energy Work Performed Sincerely .7(17 Henry E Cassidy Jr, President Cape Cod Insulation,Inc,