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HomeMy WebLinkAboutBLD-22-007224 • ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department 1146 Route 28,South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 Massachusetts State Building Code,780 CMR Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling RECEIVED This Sectio For Official Use Only Building Permit Number: .Rl ) _ c Date Appli : III N 1 4 ?022 }^" c ,�c5 fit" ��/,� (,'f 2 � 1.4 BUILDING nFp MENT Building Official(Print Name) • fgnature Date __ SECTION 1:SITE INFORMATION / _ 1.1 Property Address:. S /i 1.2 Assessors Map&Parcel Numbers `" - -Y3 ram, !5 y - • 1.1 a Is this an accepted street?yes no Map Number Parcel Number MI ( '/3 1.3 Zoning Information: 1.4 Property Dimensions: 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 Water Supply:(M.G.L c.40,i 54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP` 2.1 Owner'of Record: Name(Print) City,State,ZIP 4/3 Pk y L-s5 (-77 • ;: ,2 317 R,ei2bt �-/C`,:)7, m 1,7 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK"(check all that apply) New Construction 0 Existing Building❑ Owner-Occupied 0 I Repairs(s) Cl Alteration(s) ❑ I Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: ,; - , _ _77 SECTION 4:ESTIMATED CONSTRUCTION COSTS. Item Estimated Costs: Official Use Only (Labor and Materials) I.Building $ c;,2_,.. -j 1. Building Permit Fee:$ r)70_Indicate how fee is determined: 2.Electrical $ . )f) 'a Standard City/Town Application Fee ❑Total Project Costs(Item 6 x multiplier x 3.Plumbing $ 7 2. Other Fees: $--% � (0.7 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire . OC r?( \/, Suppression) $ All Fees: -Total $ V Check No. Check Amount Cash ' _.t unt: 6.Total Project Cost: $ 99 4r ❑Paid in Full idl Outstanding Balance r e: ,/ 1 5 \vi/ SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) • n 2723 j0'7 , . License Number Expiration Date Name of CSL Holder 6 2 List CSL Type(see below) , No,and Street Type Description (:—)41CL.-o..,_ (-6, A-_ ©as` ( II Unrestricted(Buildings up to 35,000 cu.ft) City/Town,State,ZIP Restricted 1 c&2 Family Dwelling NI Masonry RC I Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances Telephone /( l ;} 4`r I Insulation P Email address D I Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Company Name or HIC Registrant Name HIC Registration Atumberl Expiration Datz!' • Na.and Street r-tom 7e�° '. c _ - 'Email address City/Town,State,ZIP Telephone h i ) l Z it.pe r'1 k Yll t Et re") 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 this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes 12' 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 to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date • SECTION 7b: OWNERI 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. 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 IIIC Program can be found at www.mass.gov/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.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft,) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" • The Commonwealth of Massachusetts 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 Legibly Name (Business/Organization/Individual): , I r, to �`L � - `o E._.%. it Address: J fC ' City/State/Zip: s:�c�,�-w-tL•22. �_., Phone#: �s:, -, ‘; —171 v Are you an employer?Check he appropriate box: /' Type of project(required): 1. I am a employer with G v -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. 0 Remodeling any capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doingall work myself. 9. ❑Demolition y [No workers'comp.insurance required.] 4.0 t am a homeowner and will be hiring contractors to conduct all work on myproperty. I will 10 0 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.0 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.: 13.❑Roof repairs 6.❑We arc 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. f 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.#: ,2.53/ _. / Expiration Date: 6-,'?/fii3.4as, Job Site Address: f?) t `�' ^�"� . 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 hereby certify under,the pains and penalties of perjury that the information provided above is true and correct. Signature: Cam- k Date: -e `v2— Phone#: — - 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#: §TOWN OF YARMOUTH 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 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 ' /3 /fin ,I,s�-' -Lr? . Work Address Is to be disposed of oat the following location: �2e� � Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. /1/ 4. /q �,� Signature of Application Date Permit No. Commonwealth of Massachusetts Division of iµ Professional Licensure Board of Building Regulations and Standards Cons CS-076571 it WILLIAM A�rvisor LSC �> Expfres: 09/09/2023 66 CARAVEL`DR ITZ HATCHVILLE 02536 _ oj.4S�1:14) Commissioner G ia� THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE:Supplement Card Office of Consumer Affairs and Business Regulation Registration Expiration 1000 Washington Street -Suite 710 160266 07/06/2024 Boston,MA 02118 CAPE&ISLANDS KITCHEN&BATH REMODELING,INC. J 1 WILLIAM SCHMITZ k. 2 j 99 STATE ROAD %l L.���G/ c (,,1 G SAGAMORE BEACH,MA 02562 Undersecretary Not valid without signature ® DATE(MM/DD/YYYY) AC RL CERTIFICATE OF LIABILITY INSURANCE 06/24/2021 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 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 CONTACT NAME: Linda Sullivan THE HILB GROUP OF NEW ENGLAND LLC PHONE o.Ext): (508)957-4239 FAX (NC, ADDARESS: Iullivan@doins.com 120 Turnpike Rd INSURER(S)AFFORDING COVERAGE NAIC# Southborough MA 01772 INSURERA: LM INS CORP 33600 INSURED INSURER B: CAPE & ISLANDS KITCHEN & BATH REMODELING INC INSURER C: DBA C&I KITCHENS INC INSURERD: 99 STATE ROAD ROUTE 3A INSURER E: SAGAMORE BEACH MA 02562 INSURER F: COVERAGES CERTIFICATE NUMBER: 668952 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) j COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE PREMISES S l RENTED (Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY S GENII AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ JPRO- POLICY LOC PRODUCTS-COMP/OP AGG $ OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS N/A BODILY INJURY(Per accident) $ AUTOS NON OWNED PROPERTY DAMAGE $ _ HIRED AUTOS AUTOS (Per accident) S UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTIONS $ WORKERS COMPENSATION X STATUTE OTH- ER AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBER EXCLUDED? N/A N/A NIA WC531S369904021 07/03/2021 07/03/2022 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/Iwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Yarmouth ACCORDANCE WITH THE POLICY PROVISIONS. 1146 Route 28 AUTHORIZED REPRESENTATIVE South Yarmouth MA 02664 C� I Daniel e M.Cro y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD CAPE &ISLAND KITCHEN AND BATH REMODELING INC. 99 State Road, Route 3A Sagainore Beach, MA 02562 afi3O Flooring: • Supply and install Armstrong Rigid Core floating flooring at this time. a Material allowance; $5.50 per sq. ft. • Supply and install in kitchen area only. Not laundry area. Back splash: • Supply and install new tile splash. Optional but carried in contract at this time. • Tile allowance for material: $8.00 per sq.ft. (L • Must select grout color. ,., • Please select tile from either Bellew Tile or Best Tile. • If owner chooses not to do a tile splash? Deduct$1,400.00 • At which point a stone splash must be added on other contract. TBD. General: • Provide all necessary permits. • Provide dumpster on site. • Remove cabinets and tops., • Remove appliances as needed. • Remove and replace new kitchen window as per plans. c(\ a Window allowance: $750.00. Model to be determined. COS a Supply and install new double active door on washer dryer area. - • If owner decides to not have door 1 front of laundry deduct$500,00 • Demo 2 walls in kitchen and open wall in back for laundry connections. • Frame laundry closet areas as per plans. • Remove flooring and base board moldings in kitchen only. • Remove return wall. • Close of window to the right of laundry closet/ a Insulate exterior wall in kitchen. • Blue board and plaster walls and repair others. • Replace interior trim where needed. • Patch exterior siding at location of old window next to laundry and kitchen as needed. Note: If you select real oak hardwood flooring?Additional cost to be added to contract: $500.00 Total job: $49,875,00 Will provide schedule based upon cabinet availability. Payment schedule &terms: • Deposit required upon signing contract: $6 100, 49Z7 Checks &Wire transfers are accepted as well as AMEX, MasterCard, Discover &Visa. A 3.5% service fee adjustment will be added to all credit card transactions. Page 2 of 3 CAPE &ISLAND KITCHEN AND BATH REMODELING INC. 99 State Road, Route 3A Sagamore Beach, MA 02562 Please acknowledge&initial aa• X Payment schedule: . • Deposit required upon signing contract: $5,000.0 • Payment required upon demolition and prep work: $10,000.00 • Payment required upon completion of rough inspections and plaster: $20,000.00 • Payment due upon completion of flooring installation: $10,000.00 • Final payment due upon completion of work: $4,875,00 Not included: •-----Kitchen sink • Kitchen faucet • Appliances • Cabinets and tops We propose to furnish material and labor in accordance with the above specifications for the sum of TOTAL OF$49,875.00 All material is guaranteed to be specified. Any unforeseen shall be discussed with owner prior to execution (i.e.house out of level, bringing any non-obvious work up to code,or faulty wiring,framing,insulation in walls). All work to be completed in a workmanlike manner according to standard practices.Any alterations or deviation from above specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate.All agreements contingent upon strikes, accidents,delays or damages beyond our control(including weather).Owner to carry fire,tornado,and other necessary insurance.Our workers are fully covered by Workers Compensation Insurance."Covid Awareness Clause"Due to the uncertainty of material costs and availability,Cape&Island Kitchens/Remodel,reserves the right to alter pricing to contract to accommodate"Todays Pricing"whether it is"More or Less"from original contract. In the event that it is necessary to pursue any legal action to collect any outstanding balance the customer shall be responsible for the total balance plus all legal costs. ACCEPTANCE OF PROPOSAL: SIGNATURE X DATE itet0/)(D I a;(P- Michael Heinrichs Page 3 of 3 ;�•° CAPE & ISLAND KITCHEN AND BATH REMODELING INC. 99 State Road, Route 3A f £ r Sagamore Beach, MA 02562 vo 4 1 _ 1(0. / Do f$ Phone: (508) 888-4762 Fax: (508) 833- 1442 Contract Date: 10-22-212/6 0/ To: Robert Reed U, 17 ,, 43 Phyllis Road, ' I � S. Yarmouth, Ma. 508-280-2317 Rdrbrt321@gmail.com Cape & Island Kitchens & Bath Remodeling Inc.will provide the following renovations as per plans provided. Included in this proposal are as follows with respective allowances: Plumbing: • Provide all rough and finish plumbing as required for new plans. • Provide all disconnects and reconnects including new laundry location. • Provide new water supply lines, shut off valves and pvc trap and drains. • Connect all owner supplied appliances. • See other contract for sink. • No faucet allowance carried. • Provide water line for new frig. • Provide all rough and finish inspections. Electrical: • Provide all rough and finish electrical required for new plans. • Provide all necessary disconnects and reconnects as needed. • Install al owner supplied appliances. • Provide all new receptacles above counter topo area. • GPI receptacles. • No upgrade to existing service panel. • Provide laundry connections. • Supply and install a total of[9}recessed ceiling lights @$250.00 per light installed. • Supply and install a total of[6] under cabinet lights @$250.0 per light. • Both lighting allowances are optional but included at this time. A credit of$250.00 will apply for any not being used. • Page 1 of 3 • 1 -.1 > 0 "T) I-11 ' • A,-- ? ' 'ft ) • Crd CA G 9."4 Z 0- / IS ..... ,__. --E3 --..- FTI rn 1_7 < ...1 . rrl mr, ". t Es 1 i = ti 0 C 11. pa.6, v)..= P c•0 Nc i • a'a-ti , .„ , 1 • co c ,b 0 i II.74 , „„ - in 3 i — c • ..-..• r - , co CL w . 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