Loading...
HomeMy WebLinkAboutBLD-23-005928 , ca-aiec e,eer-cirk.. Office Use Only ' o Permit#Cr7 -tLi 3 c.; O H. Amount 3� s4 T• .. _� T�«n*5 d` Permit expires 180 days from r+:_ issue date -- 6I'D - a3 -665g28 EXPRESS BUILDING PERMIT APPLICATIll1 TOWN OF YARMOUTH R E C E I V E D Yarmouth Building Department --- 1146 Route 28 APR 2 4 2023 South Yarmouth,MA 02664 (508)398-2231 Ext. 1261 BU len _ T CONSTRUCTION ADDRESS: 32 Forest Gate, Yarmouthport ASSESSOR'S INFORMATION: Map: 14-3 { Parcel: C32F OWNER: Terrence Milka 32 Forest Gate, Yarmouthpta- 860-550-1475 NAME PRESENT ADDRESS v .,V TEL. it CONTRACTOR: Sprinkle Home Ir 199 Barnstable Road, Hyarin\5 508-775-1778 Ext. 10 NAME MAILING ADDRESS V W V 1 TEL.it ❑Residential ❑Commercial / Est.Cost of Construction S , c2 eo, ) �� /Home Improvement Contractor Lie.#4Q d3 75 7 Construction Supervisor Lie.#CS-006643 Workman's Compensation Insurance: (cheek one) 0 I am the homeowner 0 I am the sole proprietor 121 I have Worker's Compensation Insurance Insurance Company Name: AIM Mutual Worker's Comp.Policy#WCC50050167472023A WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows: # Replacement doors: # 1 Roofin • #of Squares ( )Remove existing*(max.2 layers) Insulation Old Ki s Highway istorie Dist. Replacing like for like Pool fencing i,PP *The debris will 41,15445.4.1Yarmouth Landfill Location of Facility I declare under penalties oItio •t t. ems 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 deni rmy license and for prosecution under M.G.L.Ch.268,Section I. l Applicant's Signature. /__�_ _....._._._kk �c Lk'X"t' 7) Owners Signature(or attachment) tG L Date: Approved By: __.. "... _ Date: - ?Z Building Of15__' x ee) E L ADDRESS: Zoning District: I listorical District: Yes "i No Flood Plain Zone: Yes . No Water Resource Protection District: Within 100 ft.of Wetlands: i Yes ' ; No Yes No . The Commonwealth of Massachusetts , ik Department of Industrial Accidents W 0 1 Congress Street, Suite 100 < Boston, MA 02114-2017 .' 'Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): Sprinkle Home Improvement Address: 199 Barnstable Road City/State/Zip: Hyannis, MA 02601 Phone #: 508-775-1778 Are you an employer?Check the appropriate box: Type of project(required): 1.01 am a employer with 5 employees(full and/or part-time).' 7. ❑New construction 2.01 am a sole proprietor or partnership and have no employees working for me in 8. D Remodeling any capacity.[No workers'comp.insurance required.] 9. (]Demolition 3.01 am a homeowner doing all work myself. [No workers'comp.insurance required.]t .. ill El Building addition 4.01 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.QElectrical 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.Q Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.17We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other Replace door 152,§1(4),and we have no employees,[No workers'comp.insurance required.] I *Any applicant that checks be R 1 ,;,us'.also fill out the se iiou below showing their workers'compensation policy information. J..pp..,,w...,..,.C..ww 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: AIM Mutual toirrc rIntin1 A7A7'01101A 1/1/2024 Pviicy#or Sei ins. Lic.#: •• '"' '' "'""` Expiration Date: Job Site Address:32 Forest Gate City/State/Zip: YARMOUTHPORT,MA 02675 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 certi d hP gins and penalties of perjury that the information provided above is true and correct. Signature: > Date: 4/24/2023 Phone#: 505-775-1778 Official use only. Do not write in this area, to be completed by city or town officiaL 1� 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#: , ii7iiL iEo k . 7 f/ \/\ � . y }#\ \}\ , f!- ^ \ `ƒ\\} Iii )/ / t %( 7 |/ y2 ) q< p \ ! }yam p - 5 ƒ 2/ ° _\ƒII/ ] \ �\ §: £! I »8 0 3 z > \\}_ a{ / . |@3 \\ 4f6. d / a|R : ayQ ƒ¥ _ #4} ! ° /| d $( ƒ � a 2\ e » . ! »< . gym { � \ ƒ §»\ / . ' @©` f© ^} 2 1 \ i/ $ 0 - ! . ) 9 { i ! g SPRIN-1 OP ID:KFI ..cam CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDWYYYi � 04/11/2023 I 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(lee) 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 508-775-6060 NA4IpC7 Kelley A.Sullivan Bryden&Sullivan Ins Agency PHONE 508-775-6060 Fax 508-790-1414 88 Falmouth Road (rvc,No,Est): (A/c,No): Hyannis. MA 02601 links=: Kelley A.Sullivan INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:NGM Insurance Company 14788 INsu INSURER B:Associated Employers Insurance Sprinkle Home Improvement Inc. 199 Barnstable Rd INSURER C: Hyannis,MA 02601 INSURER 0: 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 I 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. INSRI IADDLISUBRI I POLICYEFF I POLICYEXP TYPEIs LTR OP INSURANCE INSD SIND POLICYNUMEER IMMRSDIVYYYI IMNIbSD/YVYY� A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR M PT2640X 07/0112022 07/01/2023 DAMAGE TO RENTED500,000 PREMISES(Ee occurrence} $ x Business Owners MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,D00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 1 POLICY 1 1 FELT I I LOC PRODUCTS-COMP?OP AGO $ 2,000,000 OTHER: $ COMINED A AUTOOBILE LIABIL:TY (Ea accidentSINGLE LIMIT $ 1,000,{IQ0 ."-' ANY AUTOEl M1T2640X 07/27/2022 07/27/2023 BODILY INJURY(Per person) $ AUTOS ONLY X AUTOSULED RREE CH 0 {y BODILY INJURY(Per accident) $ X AUTOS ONLY X AUTOS ONLY ( racc dent)AMAGE $ Psr $ A X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LiAB CLAIMS-MADE CUT2640X 07/01/2022 07/01/2023 AGGREGATE $ 1,000,II00 DED X RETENTION$ 10000 $ B WORKERS COMPENSATION X PER STATUTE 0TH ANDEMFLDYERa°LIABILII{ WCC50050167472023A 01/01/2023 01/01/2024 500,000 ANY PROPRIETOR/PARTNEPJEXECUTIVE ER Y/N E.L.EACH ACCIDENT $ FFICER{MEMBER EXCLUDED? N N/A 500,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ I(yes,describe under 500,000 DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached irmore space Is required) CERTIFICATE HOLDER CANCELLATION PROVINC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION HATE THEREOF, NOTICE vun L RF DEL!VEREn IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Kelley A.Sullivan ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORO name and logo-areregistered-marks of ACORD 6. For inside remodels(i.e. additions, kitchen&bath,basements,etc.),we will take reasonable care to keep construction related dust and dirt to a minimum, however,homeowner will be responsible for their own house cleaning at end of project. 7. All agreements are contingent upon strikes, accidents, or delays beyond Contractor's control. Should a contract be terminated or cancelled after the mandatory rescission period, contractor will recover costs including all time related to this job with a reasonable fee (including profit) for all completed work and materials purchased or ordered. 8. Homeowner is to carry fire, and other necessary insurance. Contractor's workers are fully covered by Worker's Compensation Insurance. 9. Fencing, carpentry, painting, plumbing, electrical, dry wells,etc.,and all other work necessary that is not contained in this contract, shall be the responsibility of the Homeowner. 10. For roofing,the above pricing is based on a single layer strip unless otherwise specified. Should there be an additional layer or layers of roofing they will be removed and disposed of at an additional cost. Re-leading of the chimney is not included in quote unless specified and will be bill additional, if required. 11. For Window installation, contractor is not responsible for removal or reinstallation of window treatments (i.e. curtains, blinds, etc.). 12. Contracts not fully executed within thirty days of contract date are subject to pricing adjustment if applicable: WARRANTIES The Contractor warrants that the work furnished hereunder shall be free from defects in workmanship for a period of two (2)years following completion and shall comply with the requirements of this Agreement. In the event any defect in workmanship, or damage caused by the Contractor, his subcontractors, employees or agents, is discovered within two years after completion of any job, including clean-up,the Contractor shall, at his own expense, forthwith remedy,repair, correct,replace, or cause to be remedied,repaired, or replaced such damage or such defect in workmanship as long as the owner has paid their agreed contract in full. The foregoing warranties shall survive any inspection performed in connection with the agreed upon work. All warranties for product supplied by the Contractor under this Agreement shall be those given by the manufacturers of such product,which shall be and hereby passed directly to the Owner. Such manufacturer's warranties, the Owner may be required to register or mail in a warranty card or other evidence of ownership and use of such product in order to activate such warranties. The Owner's failure to send in or register such documentation, which failure voids that manufacturer's warranty, shall not create any responsibility for the Contractor to warranty such product. Note: Any changes in the contract during the duration of the project which results in additional monies due will be paid in full to the contractor at the time of the change. I authorize Sprinkle Home Improvement to act on my behalf in all mat elative to the work to be performed on this job(i.e.permits, applications etc.) if nnsQssa . la I Homeowner Date( Contractor Signature Date Terrence Nii\ka Brad Sprinkle-Regtstraton number.. 1tt3-75-1 32 Forest Gate, Yarmouthport, MA 02664 0 TOWN OF YARMOUTH 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451 Telephone(508)398-2231 Ext. 1292—Fax(508)398-0836 ma KING'S HIGHWAY HISTORIC DISTRICT COMMITTEE APPLICATION FOR CERTIFICATE OF EXEMPTION ApplicaticWiS hereby made for the issuance of a Certificate of Exemption under Sections 6 and 7 of Chapter 470 of Acts of 1973, as amended, for the proposed work as described below and on plans, drawings, or photographs accompanying this application. Type or print legibly: Address of proposed work: 2X-4--, CY/CA<L, Map/Lot# ILI Owner(s): ‘K Phone#: le, - t .S All applications must be submitted by owner or accompanied by letter from owner approving submittal of application. Mailing address: '2-,A ,v,es'J 61,,k, )Int: dji,,AA. x Year built: '‘ Email: -A- i'vr P`VI-referred notification method: Phone Y:' Email Agent/Contractor e— 3Y-rya Phone#,‘ :-T,4 ) Mailing Address: Email: , ; /4- (a- C-LNer)Cx-L •rbt._._ Preferred notification method: Phone \`'4' Email Description of Proposed Work(Additional pages may be attached if necessary): Y26--PAA. Ctr LI 0-(4.)b-Signed(Owner or 4,ent): Date: 3 Owner/contractor/agent is aware that a permit may be required from the Building Department (Check other departments,also.) This certificate is good for one year from approval date or upon date of expiration of Building Permit,whichever date shall be later. For Committee use only: Date: tlid(0) 3 V Approved 40044;iVOP'"Ii; Denied Amount 420,a) Reason for denial: Cash/CK#: C h Rcvd by: Date Signed: LI/r714/ Signed: •45`ee 1,741 i APPLICATION IP 15(-"I V5 2017 TOWN OF VAR : 0 TH x`i 444 No 1146 ROUTE 28,SOUTH YARMOUTH,MASSACHUSETTS 02664-4451 Telephone(508)398-2231 Ext. 1292 Fax(508)398-0836 OLD KING'S HIGHWAY HISTORIC DISTRICT COMMTITEE WAIVER OF 45-DAY DETERMINATION The applicant/applicant's agent understands and agrees that due to the current declared National and State public health emergencies the determination of our Application for a Certificate of Appropriateness/Demolition/Exemption may not be made within 45 days of the tiling of such application. The applicant agrees to extend the time frame within which a determination is to be made as required by the Old King's Highway Regional historic District Act. SECTION 9-Meetings, Hearings, Time for Making Determinations -As soon as convenient after such public hearing; but in any event within forty:five 05) days after the filing qf application, or within suckfurther time as the applicant shall allow in writing, the Committee shall make a determination on the application." Applicant understands that the review of this application will be scheduled as soon as the situation allows. (6-7? Applicant/Agent Name (please prinr) , Applicant/Agent signature Date: Li lik, rF/ FD A*P OVED ow Klp,Jus Hu,vvv, an KING'S Fosliww, Application#: co 3/2020 ' Sherman, Lisa From: RichandVentnone ^ev9463@gmaiicnm> Sent Wednesday,April 26,2OZ33:15PKH To: Sherman, Lisa Subject: Re:23-E03532 Forest Gate '74����AN������� Attent|mn|:This e.nai|originates outside of the organization. Dn not open attachments o,click links unless you are sure this ornail is from a known sender and you know the content is safe.Call the sender to verify if unsure, � Otherwise delete this ema|i � APPROVED. Dn Wed,Apr 26, Z02]at1:22PM Sherman, Lisa<LSherman4oYarnlouth. Da.1us^wrote: Hi Rick, Resident would like to replace the slider in the rear Oftheir house 8t32 Forest Gate, Please let me know /f you need any additional information. Thanks Rick, Lisa , � � / Lisa Sherman Town ofYarmouth Administrator,Old King's Highway Historic District and Yarmouth Historical Commission 508'398-2Z31.ext. 1292 |sherman(oyarmouth^rria.us � } 3E Sm I1k;i7 GSM f `\ 7, , £,, i „,,,,:::: „:,,;L::, '3 '-o.-,;-:- 2 f: 242',2; ,gm li r ---,,, - , :,k,,.:: '''--,- '1111 ,i ,,,,i, _ _ {a :r1,1',,i‘,:,c,,i',,,l,:loilliat,iiiiiill,1,2:179,,,,,i',1, 4 ...'r\ii NG {,.lcj mhif't Y....-j VVt- ..' .3 4 t,C`•_.a..,,A., - ', Harvey vinyl patio doe r i The Harvey vinyl patio door is solidly constructed and reinforced with heavy-duty aluminum for } added durability.Welded sash corners provide maximum strength while multi-chambered frame extrusions further increase their stability and therma pRE) Er)1 : efficiency.Includes a heavy-duty screen,and can be customized to suit your style.Available in over 25 ',:PR "A ,I exterior colors. •ENERGY STARS qualified with optional ENERGY zD It p I.,i,i§y,i,! STAR glazing package •Available with BetterGrainTM premium finish • Integral fin frame and screen track • Sloped sill design for drainage I • Fiberglass screen with extruded aluminum frame — • Corrosion resistant seacoast package available q 4a<. 4 `�ligilarltic la ,4r ,Q door While they can be used for other applir s g io door offers all the great desired,Vigilance patio doors were cre nal vinyl patio door,plus Ich as standard Double Low_E among the most stringent followed in r �g� ,� ., ��f y� ling glass.Add the ultimate in • ENERGY.STAR 'qualified with stand- , our optional High Performanc + Impact rated with DP50 performancd s at glass,two panes of Low- • Fiberglass screen with extruded alur a ro; jas between both air spaces. • Corrosion resistant color-matched hi _- ' ,' i Note;vigilance patio doors have limited options 2 ; C.:),(k Low-EtArgon+SunCiean `g t {� - �' 2x Low-FJKrypton+SunClea Harvey patio door- , fo , Patio door transoms allow us to factor � ; q: i - rs and remodelers to install ir:� single opening for a more aesthetically ; ivided Lite option for rectangle; • E: !! i Y STAR goptions • DP35 rating 1