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HomeMy WebLinkAboutBLD-22-000225 U. .Y444 ' q�' Office Use Only '� '„ t:�! c $ ' I II It - Permit# • �.wTr n s 4... Amount t�+v.wuw�fed: Permit expires 180 days from issue date EXPRESS BUILDING PERMIT APPLICATION, -CZZ S TOWN OF YARMOUTH REEIVED Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 Fti---L u8 2Q22 (508) 398-2231 Ext. 1261 121 MA-6A BUILDING DEPARTMENT CONSTRUCTION ADDRESS: By. ASSESSOR'S INFORMATION: Map: Parcel: Cooperative Bank of Cape Cod 121 MA-6A OWNER: 598 568 3365 NAME PRESENT ADDRESS Patrick Clifford 714A Route 6A Yarmouth Port,MA 02675 TEL. # CONTRACTOR: 3-WY. I — V 73 NAME MAILING ADDRESS TEL.# ❑Residential a Commercial Est.Cost of Construction$4880 Home Improvement Contractor Lic.#184383 105951 Construction Supervisor Lie.# Workman's Compensation Insurance: (check one) 0 I am the homeowner 0 I am the sole proprietor 0 I have Worker's Compensation Insurance Insurance Company Name: Worker's Comp.Policy# WORK TO BE PERFORMED Tent El Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows: # Replacement doors: # Roofing: #of Squares5 (J)Remove existing* (max.2 layers) Insulation ri ! 1 Old Kings Highway/Historic Dist. (fJ)Replacing like for like Pool fencing I l s if - Yarmouth Dump *The debris will be disposed of at: Location of Facility I declare under penalties of perjury that the statements herein contained are 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 license ec 'o nder M.G.L.Ch.268,Section I. Applicant's Signature: a, 2 Date: 7` Owners Signature(or ttachment) Date: _ Approved By: Date: , Building Official esi e) MAIL ADDRESS: Zoning District: Historical District: Yes No Flood Plain Zone: E Yes E. No Water Resource Protection District: Within 100 ft.of Wetlands: i Yes C No Yes _ No The Official Website of the Executive Office of EOHED. the Divsion of Professional Licensure. and the Division of Standards sr Public Safety 6 # Mass 4m, Masa Gov dome State Agenc es Licensee Details Demographic Information Full Name: PATRICK CLIFFORD Owner Name: I icense Address Information City: Dennis State: MA Zipcode: 02638 Country: United States License Information License No: CSSL-105951 License Type: Construction Supervisor Specialty Profession: Building Licenses Date of Last Renewal: 5/23/2022 Issue Date: 6/6/2012 Expiration Date: 6/2/2024 License Status: Active Today's Date: 6/9/2022 Secondary License Type: Doing Business As: Status Change Reason: License Renewal Prerequisite Information Licensee: CLIFFORD, PATRICK Relationship: Attribute Of License No: CSSL-105951 No Available Documents Class wnitiow I 2011 Commonwealth of Massachusetts Site Policies I Contact U. m m 0 C Y. M CC CD o = o R d \ 0 CO N N O C+ CO .,I- d d i ID 0 H C J r O ,Q W O O 0 C = I tic T. Q.O O a 0«mn 4. to !9 C•C,W = (1) -- 5 cc cc ..s. ,. t \\., 44 fq sv � I 0 � U O 0 0 0o�` asw to __I •� O 0) N ` U O 9, , xO GOrmW Q� II _ N. ( C u I, lIS G C O Otil RI C ff+ i L�-1 G C 0 CON N C - O LA7 O 0 v C N " a �' o �aM q�� W 0 _ N �� N E a� LL� o z v D � �m vzQ v .= O amaac cN �[ O Nal0O Cr g O N Z R o p a o mU9N in _1 Q3O • C U o Q_QZ W ' 0 2 03 00x 0 o i-ea z E d l O. J ONZ-I -Im a CO 7 _= ww co zc0 aC.) oU cV LIJo gas >I oCC c) Oas' v z< c ,.. I —0 9 a cuJ drU CC to i-mz o 0cc LT °oN =To U O = 0 u"000 _1.11 0 Cr �z 05 1 Ya 0 00 W CC Q Z Q m W I Rrd A �® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 06/06/2022 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 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: Pedro Silva UNIVERSAL INSURANCE AGENCY ,PAHic°,Nro,Ext): (508)752-9333 FAX (A/C,No): ADDARESS: psilva©universalinsagency.com 374 BELMONT ST INSURER(S)AFFORDING COVERAGE NAIC# WORCESTER MA 01604 INSURER A: LM INS CORP 33600 INSURED INSURER B: ABET CONSTRUCTION INC INSURERC: INSURER D: 123 MORAINE ST APT 2 INSURER E: BROCKTON MA 02301 INSURER F: COVERAGES CERTIFICATE NUMBER: 781590 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 LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO- POLICY JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION N.( PER H_ AND EMPLOYERS'LIABILITY Y/N "` STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBER EXCLUDED? N/A N/A N/A WC533SB20C8D012 06/05/2022 06/05/2023 I(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 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 Hytech Roofing ACCORDANCE WITH THE POLICY PROVISIONS. 201 Pleasant St apt 1 AUTHORIZED REPRESENTATIVE Brockton MA 02301 Daniel M.Crow ey,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 • The Commonwealth of Massachusetts man04 alkomenomm. Department of Industrial Accidents ie1 1 Conaz gress Street, Suite 100 _gig.= Boston, MA 02114-2017 NW/ 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): HyTech Roofing Solutions Address:714A Route 6A City/State/Zip:Yarmouth Port, MA. 02675 Phone #:508 776 7173 Are you an employer?Check the appropriate box: Type of project(required): I.❑l am a employer with employees(full and/or part-time).* 2.0I am a sole proprietor or partnership and have no employees working for me in 8.. ❑Rem delinruction any capacity.[No workers'comp.insurance required.] ❑Reoeling 3.0I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 4.0 I am a homeowner and will be hiring contractors to conduct all work on my roe I will 10['Building addition ensure that all contractors either have workers'compensation insurance or are sole proprietors with no employees. 11.QElectrical repairs or additions 5.(I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 12.Q Plumbing repairs or additions These sub-contractors have employees and have workers'comp.insurance.t 13. Roof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§I(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. 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 pol cy 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 p ' s and pen es of perjury that the information provided above is true and correct. Si nature: 7/6/22 5 776 7173 Date: 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): I. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: MA HIC license 184383 MA CSL License 105951 ArleCh iikanfing 508-77 - 714A Route 6-A Yarmouth Port, MA 02675 Roof Replacement Proposal Provided on: 6/15/2022 Customer: NAME: Cape Cod Cooperative Bank- TEL: 598 568 3365 Yarmouth Branch STREET: 121 MA-6A CELL: CITY: Yarmouth Port, MA, 02675 EMAIL: ppiekarski@mycapecodbank.com HyTech Roofing Solutions hereby proposes to perform the following services in a neat and professional manner and in accordance with the manufacturer's specifications and local building codes Asphalt Roofing: Remove and haul away all layers of existing roofing materials from the entire roof deck area of the detached garage at the back of the property Supply and Install Inspect and Re-Nail Any loose or popped plywood or boards on the Entire Roof Deck Area of the House Supply and Install CERTAINTEED LANDMARK SERIES LIFETIME WARRANTY, CLASS A FIRE RATED, COPPER/CERAMIC STONES for PROTECTION AGAINST ALGAE CONTAMINENT, 235-300 POUND, EXTRA HEAVY WEIGHT, 130 MPH WIND WARRANTY, CATEGORY III HURRICANE, STORM/HURICANE NAILED (6 NAILS PER SHINGLE), MULTI-LAYERED, LAMINATED ARCHITECTURAL STYLE,FIBERGLASS BASED ASPHALT SHINGLES. COLOR: Moire Black MA HIC license 184383 MA CSL License 105951 Supply and Install 8" WHITE ALUMINUM DRIP EDGE on the entire roof eaves. Supply and Install 8" WHITE ALUMINUM DRIP EDGE on the entire gable end rakes of the roof. Supply and Install CERTAINTEED WINTER-GUARD (Ice & Water Shield) WATERPROOF UNDERLAYMENT SYSTEM 3 feet coverage on the entire roof eaves Supply and Install CERTAINTEED ROOF-RUNNER synthetic underlayment paper on the entire roof deck area of the house as required per manufacturers specifications. Supply and Install CERTAINTEED SWIFT START adhesive asphalt starter strips on all eves and Rakes with a '/Z inch overhang. Supply and Install CERTAINTEED FILTER RIDGE (SHINGLE VENT II) ridge vent on the entire ridge area of the roof using the 3"hand nailing method. Supply and Install CERTAINTEED HIP AND RIDGE CAPS on the entire ridge/hip area of the roof using the 3" hand nailing method Supply and Install ALUMINUM & NEOPRENE SOIL PIPE FLASHINGS Clean and Remove Debris from the work area after the job is complete Pricing: Good Better Best Brand: Landmark Landmark-PRO Landmark Premium Recommended for Inland Inland High Wind On the Water Weight: 235 Lbs. 250 Lbs. 300 Lbs. Warranty Period: 40 years 50 years 50 years Algae Protection: 10 years 15 years 15 years Max-Def Colors: NO YES YES TOTAL Investment: $4,720.00 $4,880.00 $5,760.00 Please Check C. " El Selection MA HIC license 184383 MA CSL License 105951 f i ,, ;' ' •a e �. is ., . 2 a .# : i ' .gip. . .• ?'" , o-+ a i , M "`.4 iip, 1 9F -!„+ r N • MA HIC license 184383 MA CSL License 105951 POSSIBLE EXTRA CARPENTRY:Any rotted or otherwise deteriorated trim boards,plywood sheathing,missing metal flashing,side walling or any other carpentry needing replacement will be done and charged for as an Extra: materials plus labor at the rate of $90.00 per hour. PAYMENT SCHEDULE: A deposit of one half is due at the signing of this roof proposal and the final payment for the balance is due immediately upon completion. WORK SCHEDULE:All work is normally scheduled for completion within 30 days of acceptance and receipt of deposit providing the materials are available. RIGHT TO CANCEL:All sales are final after a 3 day cooling off period. Customer can request to cancel the contract in writing within 3 days of signing for a full refund of deposit.HyTech Roofing Solutions,LLC reserves the right to cancel the contract and return deposit at any time before materials are delivered on site. NON-PAYMENT: In the event of non-payment balances overdue by 30 days will be subject to a 12% interest rate per annum.If arbitration is needed to collect unpaid balances then the signee of this contract will be liable for all reasonable court costs and fees.Warranties do not take effect until all balances are paid in full. 2022 INFLATION CLAUSE: Due to unstable market conditions all prices are subject to any unforeseen increases regarding materials,disposal,and delivery charges that occur after the time that this quote is provided. Please Make Checks Payable to: HyTech Roofing Solutions HyTech Roofing Solutions Warranties the Shingles and Labor for 20 years. HyTech Roofing Solutions -Carries Workman's Compensation and Public Liability Insurance on the above work -Handles all permitting and planning involved with the above proposed work TOTAL INVESTMENT: $4,880.00 (Enter Total Amount Including All Selected Options) DATE OF ACCEPTANCE: 06/28/2022 ACCEP 1'ED BY: SUBMI I1'hD BY: Pit, � /ea, . Cape Cod Cooperative Bank- Yarmouth rick Clifford —Alex Yaskavets Branch MA CSL license 105951 MA HIC license 184383 Sherman, Lisa From: RICHARD GEGENWARTH <rgegenwarth@comcast.net> RECEIVED Sent: Wednesday,August 10,2022 12:37 PM To: Sherman, Lisa Subject: Re:22-EB091 121 Route 6A AUG 10 2022 BUILDING DEPARTM By._Attention This email originates outside of the organization. Do not open attachments or click links unless you are sure this email is from a known sender and you know the content is safe. Call the sender to verify if unsure. Otherwise delete this email. Looks like a good approach. I approve. Richard On 08/10/2022 11:50 AM Sherman, Lisa<Isherman@yarmouth.ma.us>wriotqcb--.7i77-7-1 11/ 11, /AUG I 0 202? Hi Richard, YARIVIOuTH OLD KING'S HIGHWAY There is a shed behind the CC Cooperative Bank branch at 121 Route 6A and they want to replace the roof on the shed to match the roof on the bank branch. CertainTeed Landmark-Pro "moire black". Please let me know if you need any additional information. Thanks Richard, Lisa Lisa Sherman Office Administrator Old Kings Highway Committee/Yarmouth Historical Commission 09),,E6611 Lisa From: Hy/ecx Roofing Solutions <pathck@phvtech000tconn> Sent: Wednesday, - �*n VVednesda�Auouy 1O'20229:O1AK4 To: Sherman, Lisa Subject: Cooperative bank roof AttentiomYr This email originates outside of the organization. Du not open attachments or click links un| sure this emmai|is from ahnoxvn sender and you know the content/saofe Call e�oVoua'e � {)themv|medelete this enmaU. 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