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Home My WebLink AboutBLD-23-005470 p.e•Y.qR 1Otttce Use Only -171' >';- ! O Permit# Ou 4l'` . H Amount j G MATTA ,, 5. „�..Z') 1 -J ' Permit expires 180 days from JU)y--b J , jissuedate r EXPRESS BUILDING PERMIT APPLICATIONR E CE I V E D TOWN OF YARMOUTH Yarmouth Building Department r APR 03 2023 1146 Route 28 _ .. South Yarmouth, MA 02664 BUIIFDI ` 141 q By: (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: 6 4 /i iv,s e,4 k 1" yt n v4k ) MA oat 3 ASSESSOR'S INFORMATION: Map: Parcel: OWNER: r"IS ! x j-(1\-A.M 3 PRESENTNAME' I AD L t'Si� ,'? ( -J iIVM L i 1 RES L. # 1 alp • CONTRACTOR: 1 d nn NS D (� 1, / N VIE � 1 � S�LING��ADDRESS CQM I'c�v��/ �u�EL.# err �� 1635� ce<ecidential ❑Commercial Est.Cost of Construction$ d vie J Home Improvement Contractor Lic.# / j Cj)3 Construction Supervisor Lic.# Om/3 Workman's Compensation Insurance: (check one) ❑ I am the homeowner 0 I am the sole proprietor have Worker's Compensation Insurance ,� Insurance Company Name: iinr^ e.M�„, (� ur� jj rt _ 6, Worker's Comp.Policy ddd/ d�7 3 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: 1" 4 1 t' MAN)NQ 44 if's, --..(•,e,s4 Ch. 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 or revocation of my license and for prosecution under M.G.L.Ch.268,Section 1. Applicant's Signature: \.. ../\„..,,, Date: 5- I(/-(,t s Owners Si ature(or attachment 2 Date: Approved By: 16 Date: /—: 3 P -S Building Official des' ee) EMAIL SS: Zoning District: Historical District: ❑ Yes ❑ No Flood Plain Zone: ❑ Yes ❑ No Water Resource Protection District: Within 100 ft.of Wetlands: 0 Yes 0 No D. Yes ❑ No -Azek PVC trim to be installed on exterior of windows&primed pine ready for paint on interior -A 10-yard dump trailer will be needed on site;and will be removed at completion of the job -Contractor will be responsible for all building permits needed at the property NOTICE REQUIRED BY LAW With the agreement of the contract$500.00 of estimate is due. Further payments under this contract are as follows: 1/2 of the estimate due at the start;and remainder due at completion of the job. Balance of all materials and labor shall be payable in full upon completion of work described in this contract. Payment as agreed upon shall be made when due. Any payments which are delayed shall be subject to a finance charge of 1.5%per month. The contractor warranties the workmanship completed under this contract for a period of ten years from the date of completion. During the stated warranty period th2 contractor shall be responsible for the service of the repair or adjustment,but the contractor shall not be responsible for the normal maintenance,repair due to abuse,misuse,and or normal wear and tear,which shall be the responsibility of the homeowner. All warranties for the materials supplied by the contractor shall be passed directly to the homeowner. The homeownern2y be required to register or mail In such warranty card or evidence of owoership in order to activate such warranties. Homeowner failure shall not create any responsibility for the contractor under the warranty provisions;the choice of repair of replacement shall be at the discretion of the contractor. The homeowner acknowledges that the form,content,and notices contained in this contract are intended to comply with the applicable portions of the Mass.General Law Chapter 142A, and regulations promulgated there under. In the event of any instance of non-compliance,only such portion shall be invalid and the remainder of this contract shall be in full force effect. In addition,any such portion not in compliance shall be read and interpreted so as to have its intended meaning to the maximum extent allowed under such law and regulation. Signed as a sealed instrument on this date: Date: d Cr3 1 Homeowner ' Contractor l �� --/11 11flMAv ■ • ■■•v..■ra. HOME IMPROVEMENTS P11. 508.328. 1635 Exterior Remodeling Experts . BBS.r Web: www.tnomasnomeimprovements.net P.O. Box 177 Fully Licensed & Insured enterville, MA 02632 Construction Supervisor Lic #999!3 THOMAS HOME IMPROVEMENTS LLC. PROPOSES TO PERFORM THE FOLLOWING WORK: Location of proposed work: Mr.& Mrs.Thierry 87 Lewis Road West Yarmouth,MA 02673 • Date on which construction should begin: March/April 2023 The-homeowner hereby aacknowiedges and are that the scheduling dates are approximate and that such delays that cannot be avoided by the contractor shall not be considered as a violation of this contract. The contractor agrees that when such delays become known to the contractor,the contractor will advise the homeowner as soon as possible. The homeowner hereby acknowledges that in certain remodeling work.the demolition prorPcc may reveal defects in the existing structure which must be repaired,creating additional work which may need to be carried out in order to complete the work described in this contract. In such case the homeowner agrees that the duration of the work and the schedule date of Completion may differ,and that such variation is not to be considered a violation of this contract. Cosa for labor and materials under this contract: S2,430.00 Proposal to install 2 Harvey Tribute Premium New Construction Double Hung Windows In the event that while removing the windows we find rot that needs to be replaced,the homeowner then has to agree and authorize any replacement or restoration. Then in addition to the above contract price,the homeowner agrees to compensate the contractor for any repairs or restoration at the hourly rate of$75.00 for a carpenter plus thn cost i terial� - r'� - •�� ,wlaace saes_ Thank You for Giving Us the Opportunity to Help You Improve Your Project Comrt►ar►weatth of Massachusetts zonal Licensure �• � Divisiar►of Occupat' Board of Building R ' s and Standards ra.a.�,..m ,grata t? TTr Specta,ty ' � � fires 04J13/2{124 CSSL-099913 , � y 'TROY A TH'. S 488 NOTTI CENTERVILL'AMA �$ Commi'SSi0ner THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation HOME IMPROVEMENTCONTRACTOR TYPE;Corporation Raegigrativei Expiration 1 O54t,i V601,424 TROY THOMAS HOME P4PROVEMENTS,tNC TROY THOMAS 1 499 NOTTiNGHAM DR . CENTERVILLE,MA 02B32 Undersecretary The Commonwealth of Massachusetts 2 1v Department of Industrial Accidents `" 1 Congress 'tree, Suite 100 4. ='�•.. Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH TUE PERMITTING AUTHORITY. Applicant Information Please Print Leg Name (Business/Organization/Individual): -nnAS 414c V,,e ,te isitiJi Address: P.d• tc . i 3.7. City/State/Zip: ( -�,/1� J y1�t�1 gad Phone#: Ps' P? ''J1 Are you an employer?Chec he appropriate box: t Type of project(required): 1_MP am a employer with employees(full and/or part-time).' 7. Q New 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• �� emodeling 3.DI am a homeowner doing all work myself[No workers'comp.insurance required.]t 9 L_1 Demo1[tiOn 4.0I am a homeowner and will be hiring contractors to conduct all work on m YProPe I will 10 Li Building addition property. ensure that all contractors either have workers'compensation insurance or are sole proprietors with no employees 11.®Electrical repairs or additions 5.0i am a general contractor and I have hired the sub-contractors listed on the attached sheet. 12.®Plumbing repairs or additions These sub-contractors have employees and have workers'comp.insurance.t 13.0 Roof repairs 6.11 'e are a corporation and its vfficea s have exercised their right of exemption per NICiL c. 14.rl Other 152,§I(4),and we have no employees. [No workers'comp.insurance required.] 'Any applicant that checks box#I 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:_ i�t f.'rva t _, 6,.. tie !/-= GZi: 6 Policy#or Self-ins.Lic.#: ' A)?i O S jj �CIa` I Expiration Date: c.-- 1 c2,42/3 Job Site Address: t3)- k-w,K &.e Ci /State/Zi ek A,,,,a..Attach a copy of the workers' compensation policy declaration page(showingthe policy numberride 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 S i ature: /J.v „�, Date: y-jo-MO3 Phone#: 5&5' ?a %/3 S 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.CitylTnwn Clerk 4. F'leetrical insnPrtor Plumbing Inspect 6.Other b or - dr - Contact Person: Phone#: ki.......--- CERTIFICATE OF LIABILITY INSURANCE 05 /2022 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. I IMPORTANT: If the certificate holder€s an ADDITIONAL INSURED, the poticy(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 • I this certificate does not con ar rights to the certificate holder In lieu of such endorsement(s). PRODUCER I CONTACT I NAMIo: Donna Ostro vski Mark Sylvia insurance Agency. LLC PHONE Eat); (5o8)B57-2125 rAx: IA" Nok t3 i'-'- 404 Main Street tt.E t mark@marksyiviainaurance.com Centervitle.MA 02632 1 INSURER(S)AFFORDING COVERAGE 4..,7 x I111I $V-2nn: Farm Farrihi f co, lh 4neurnnr, INsURSO @!SURER S: Thomas Home Improvements LLC INSURER e I PO Box 177 INSURER D Centerville,MA 02632 I INSUP.ER E I INSURER F: COVERAGES CERTIFICATE NUMBER` REVISION NUMBER, I THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INStUREu NAMED A :,E. "- INDICATED. NOTWITHSTANDING ANY REQUIREMENT; TERM OR CONDITION OF ANY CONTRACT OTHER C CC J.P,- .. CERTIFICATE MAY BE ISSUED OR MAY PERFAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN kr s _F_ . EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED 3Y PAID c,._.AI14.a. INSR IADDLjSUBRj LTR TYPE OF INSURANCE I-• POLICY EFF POLICY E VV i wish ttVn I POLICYNUMBER !ta StD^rYYYi 'rQM t' YYY+ 3 COMMERCIAL GENERAL LIABILITY _ �(CLAIMS-MADE 1 t OGLUR 3 A , N N 2001X1416 OW 5/01/2022 a ' GEM_AGGREGATE LIMIT APPLIES PER: 1 X POLICY PROCT- I i dcRP dE LOC IOTHER: c AUTOMOBILE LIABILITY iomel.�3ED S€N O;.E L'lttT $ • ANY AUTO SODLY Pe e's;:.. $. OWNED f— 1 SCHEDULED AUTOS ONLY I AUTOS u , HIRED I NON-OWNED �£ s $ AUTOS ONLY I AUTOS ONLY :°:uE a ,tee,a--,,,den:.; $ UMBRELLA LIAR OCCUR EXCESS LIAB CLAIMS-MADE i A3uREL4.TE „, i (LIED I I RETENTION$ 4 ,WORKERS COMPENSATION ffi A IAND EMPLOYERS'.LIABILITY ' /"�_ _ ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N »...._ OFFICER A4EMBER EXCLUDED, Y l N 1 A l N 2001W8053 t 1(Mandatory inNH) 5/0112022 S.O ,`2023 yun,w:su- .ar,d r E. DESCRIPTION OF OPERATIONS below ( ( _ I DESCRIPTION OF OPERATIONS l LOCATIONS/VEHICLES (ACORD 101,Ad:Ede el Remarks Schedule,may of be "..h Mf It P.!^('! is rlkct,Elreef5 Carpentry Insura.Ce coverage is.,limited.to the terms,conditions,exclusions,other limitations and enoinrsementc_ Nctnang e,n.sinec'r++sa certa{ira..-= shall be deemed to have altered,waived or extended the coverage provided by the policy proovisn;:os. CERTIFICATE HOLDER !!CANCELLATION t I SHOULD ANY OF THE ABOVE DESCRIBED' POLICIES 6t GAi'►Cci.i.En`a BEFORE TTown of Barnstable Building Dept. THE{,.EXPIRATION a I ITH Drug DOIIHERPROOvISrmi NOTICE WILL BE DEL 4ERED li 200 Main StreetICY AUTHORIZED REPRESS AWE H•annis MA 02601 Fax: Email: ACORD 25(2016/031 The ACORD name and logo are registered marks of ACORD ACORD CORPORATION. ORPORATN All rights reserved.