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HomeMy WebLinkAboutBLD-23-000978 R [.Jf $�/2 7 Office Use �Only y C - ' ..', . ..R�'O` r' Permit i l�tjldF O "Tt0l . H! ;Amount /V.di) V'A MMAATTA M ESE �' 1 =S�o......0 Ems`.' iPermit expires 180 days from • j issue date BUD-023 - O DO TV- EXPRESS BUILDING PERMIT APPLICA ION TOWN OF YARMOUTH RECEIVED Yarmouth Building Department 1146 Route 28 A�� 2 3 2022 South Yarmouth, MA 02664 _ (508) 398-2231 Ext. 1261 BUILDING DEPARTMENT By._ CONSTRUCTION ADDRESS: 1 J t Li_O'UJ 5 ,J ,j (l r"it ASSESSOR'S INFORMATION: YY /n/� n yAciMap: Parcel: y� �.,p� �ry 41-34OWNER: ,J ( V o''[ r� NT)5DT2ESS/ Ij � ""�Vp3TL. (5, ELA'E�r -j'v� �" CONTRACTOR: NAME t �AA_ t6 t,il '` W O A'[9 / )3bz2- ?Y/2 mil.a26.13TEL. ❑Residential Commercial _ Est.Cost of Construction$ / 7 35-0, 0 Home Improvement Contractor Lic.# I q J 5-4.7- Construction Supervisor Lic.# — /0 69 Workman's Compensation Insurance: (check one) ❑ I am the homeowner ❑ I am the sole proprietor yI have Worker's Compensation Insurance �/ �j Insurance Company Name: r !(�'1I"1 itr y' (, L 111 T j Worker's Comp.Policy# ` c, 1 7r 2. WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows: # 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: J V t( 0-8 £2f V kr 0)/ 1 L t L le Location of Facility I declare under penalties of perjury that the statement .- ein 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 or revocation of my . d for prosecution under M.G.L.Ch.268,Section 1.Applicant's Signature: Date: c '/ 2:3 / ' 04 Owners Signature(or attachment) Date: Approved By: 5 - PP Date: Building Official(or gnee) EMAIL ADD 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 The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.ao v/dia inss e Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): Agi6 PLC— Address: t,, iG'1/'vl v ✓ W p9 City/State/Zip: t.:6° ' 'i"-tU��-� Phone #: ( "6)36 O Are you an employer?Check the appropriate box: Type of project(required): 1.E I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.E I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity. [No workers'comp. insurance required.]3.DI am a homeowner doing all work myself 9. ❑ Demolition ❑ y [No workers'comp. insurance required.]` 10 Building addition 4.11 I am a homeowner and will be hiring contractors to conduct all work on my property. I will . ensure that all contractors either have workers'compensation insurance or are sole 11.❑ Electrical repairs or additions proprietors with no employees. - 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.( Roof repairs These sub-contractors have employees and have workers'comp. insurance. ❑ 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.] ‘± i' T)i C^ 11 *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. �11 'C-• 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: ilfinkiti(I C L 'J/`- i Z1 Policy#or Self-ins. Lic. #: are/`' Expiration Date: Job Site Address:� 9ILL� City/State/Zip: j VU ,C i 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 ti pains and penalties of perjury that the information provided above is true'and Date: correct. Signature: �r/" /62 3/ 044 Phone#: ✓� Yit 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#: Commonwealth of Massachusetts 111 Division of Professional Licensure Board of Building Regulations and Standards Co nstructtorlSOpervisor CS-108659 icpires:04/19/2023 FABIO PRETTI 38 WENDWARD WAY ` WEST YARMOUTH MA 02673 lr" Commissioner -A f\ llexna-ca" Office of Consumer Affairs&Business Regulation 9 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 195577 05/12/2023 1000 Washington Street -Suite 710 Boston,MA 02118 FABIO INC FABIO PRETTI 'QWEPdDWARD WAY •Cw-g''' � ���4 of vaT out signature WEST YARMOUTH,MA 02673 Undersecretary ACGl ' DATE(MMIDDNYYYY) ��,,, CERTIFICATE OF LIABILITY INSURANCE 08/18/22 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 CONTACT Schlegel&Schlegel Ins Broker PAUL SCHLEGEL —P(H(CONE EA 508-771-8381 I A/C,No): 508-771-0663 MNIIL Exa: 34 Main Street ADDRESS: schlegellnsurance©gmail.com West Yarmouth,MA 02673 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: NGM INSURANCE COMPANY 14788 INSURED INSURER B: ATLANTIC CHARTER FABIO INC INSURER C: 38 WENWARD WAY INSURER D: WEST YARMOUTH„MA 02673 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. INTSRR ADDLSUBR POLICY EFF POLICY EXP LIMITS LTYPE OF INSURANCE INSD WyD POLICY NUMBER (MM!DDIYYYY) (MM!DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGL TO RENTLO 500,000 CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 10,000 A Y MPS6863R 11/19/21 11/19/22 PERSONAL&ADV INJURY $ 1,000,000 —" GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 2,000,000 PRODUCTS-COMP/OP AGG $ j POLICY E C f I LOC _ $ OTHER: COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY (Ea accident) BODILY INJURY(Per person) $ ANY AUTO OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per ascikrin $ UMBRELLA LIAB — OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I RETENTION$ WORKERS COMPENSATION X STATUTE I ERH AND EMPLOYERS'LIABILITY ESL.EACH ACCIDENT $ 100,000 ANY PROPRIETOR/PARLUDEDXECUTIVE' I N1 N/A WCV01414702 09109121 09/09/22 100,000 B (MandatorydERry NH) EXCLUDED? Y E`L.DISEASE-EA EMPLOYEE $ In and 500,000 If yes,describe under E_L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below — DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) FABIO PRETTI HAS ELECTED NOT TO BE COVERED UNDER HIS CURRENT WORKERS COMPENSATION POLICY INSURANCE COVERAGE IS LIMITED TO THE TERMS,CONDITIONS,EXCLUSIONS AND OTHER LIMITATIONS AND ENDORSEMENTS OF THE POLICY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. TOWN OF YARMOUTH ATT BUILDING DEPARMENT AUTHORIZED REPRESENTATIVE WILLIANA CASTRO ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD , _ _______ _ _ .,_ _ F . ' -,.-,,. Inc. . - c--- CSL 1081,59 H!C 195577 Cape Cod - MA Proposal Date: 06/01/2022 To: Irina MacPhee 08 South St Dennis Port — MA 02639 Work to be performed at: 259 Willow St West Yarmouth, MA Scope of work: 1. Exterior door replacement $ 17,350.54 o Furnish and replace all exterior doors (same to same); o install new exterior/PVC trim, and interior wood trim; c NO painting is included; c Dispose debris from demolition; Doors $ 7,750.54 Materials $ 1,200.00 Labor $ 8,400.00 Total: $ 17,350.54 • unforeseen condition and will become a extra charge of$90/h/worker plus material)and will be done upon signed change order; • clean up all debris resulting from demolition: • all material will be furnished by Fabio Inc; • full payment is expected at completion of work. • (owner is aware that we may need to place a dumpster plus a portable toilet on location during performance of the work) Duration of work: 02 weeks ( after permit issued /as weather allows) I. i 38 Wendward Way —W. Yarmouth —MA 02673 508-360-3412 /(27 • Inc CSL 1086,59 • ti (� HC 195577 ,' Cape Cod - MA Payments: All material is guaranteed to be as specified, and the above work to be performed in accordance with the specifications submitted for the above work and completed in a substantial workmanlike manner for the sum of: ($ 17,350.54 ) with payments to be made as follows: $ 8,000 -at contract signature (materials) $ 9,350.54 - at work completion General Provisions: If is there an alteration or deviation from the above specifications,involving additional material and/or labor costs,it will be performed only upon a written order for the same,signed by Owner and Contractor and,if there is any charge for such alteration or deviation,the additional charge will be added to the Contract Price of this Contract. If payment is not made when due,Contractor may suspend work on the job until such time as all payments due have been made.A failure to make payment for a period in excess of 4( four)days from the due date of payment shall be deemed a material breach of this Contract. o nr Name: A-Arct [ TitleP `� uv��s�,- -�. Date � / �� / �1� atku Signature: 38 Wendward Way—W. Yarmouth-MA 02673 508-360-3412 aree bio In , \ s' eii# CSL 116659 • ,,..: HIC 195577 4 Cape Cod - MA Proposal Date: 06/17/2022 To: Irina MacPhee Pastiche of Cape Cod Inc 08 South St Dennis Port — MA 02639 Work to be performed at: 259 Willow St Scope of work: 1. Roof Repair $ 6,550.00 c Strip a 3' area from the eave ends all around the building; c Replace vented drip cap; o Replace 3' weather guard membrane; install new weathered wood color asphalt shingles (new shingles may differ in color from existing ones, due to sum light discoloration); Total: $ 6,550.00 38 Wendward Way—W. Yarmouth—MA 02673 508-360-3412