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Home My WebLink AboutBLD-23-005921 O�•Y.q C. +i°l?L"-r-- it.LI//a eJ Office Use Only .,.` Pen ' t# / ,34/8/ 0 M Amount '�57QZ Tw.ttA , `st 4 4.`"'""`°¢ c"� Permit expires 180 days from issue date 6 uc -0.3 _bOSgZI EXPRESS BUILDING PERMIT APPLICATIONE C E I V p TOWN OF YARMOUTH Yarmouth Building Department APR 2 4 2023 1146 Route 28 South Yarmouth, MA 02664 BUILDING DEPARTMENT (508) 398-2231 Ext. 1261 By ------__ CONSTRUCTION ADDRESS: 7 Low Fj ti(. w .0s, ASSESSOR'S INFORMATION: Map: /5/ Parcel: 75— OWNER: cJ d it el 4iIflki 37 L.l7vt ce ik/ OrNAME PRESENT ADIoRESSp yerr/i-ici,TEL. # CONTRACTOR:'gel 1'4,1.'l (s'7' 1 09 ' y f/4/I 11 f L /'.,a 5- 'i 5 a 37/6 6 NAME'' MAILING ADDRESS TEL.# I9'Residential 0 Commercial Est.Cost of Construction$ ,rD/ Qd d, 07) Home Improvement Contractor Lic.# I?9 4 0 7 Construction Supervisor Lic.# ($ //CJ /9/ Workman's Compensation Insurance: (check one) 0 I am the homeowner 0 I am the sole proprietor have Worker's Compensation Insurance Insurance Company Name: ,,, '` (Qk -_�s„ (0. Worker's Comp.Policy#'yl�C . 55C y)( — _ct &3 J WORK TO BE PERFORMED Tent n Duration (Fire Retardant Certificate attached?) Wood Stove 0 Siding: #of Squares L i Replacement windows: # Replacement doors: # Roofing: #of Squares a v (Remove existing* (max.2 layers) Insulation n F ►1) Old Kings Highway/Historic Dist. eplacing like for like Pool fencing n apy�2/v3 *The debris w if disp6sed of at: yor/Y161-4v1 aymp 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 unde stand that any false answer(s) will be just cause for denial or rev ion of my license and for pr cution under M.G.L.Ch.268,Section 1. Applicant's Signature: - Date: { 02 V c(Q 3 Owners Signature(or attachment) Date: Approved By: 6it.," Dater '-. Building Official(or ee EMAIL AD 0 0.: Zoning District: Historical District: Yes No Flood Plain Zone: I Yes I No Water Resource Protection District: Within 100 ft.of Wetlands: 1:.i1 Yes ' No Yes -.-. No The Commonwealth of Massachusetts �? Department oflndustrialAccidents 1 Congress Street, Suite 100 \, Boston, MA 02114-2017 : ,,,5v• www.mass.go v/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): 6-re Go 2,.); Cv o1'l ruf Address: a,(') {--AUv\ L City/State/Zip:_SNv 1 YUk.(4v� coEc.`( Phone #: �� 3 Z y 6 6 Are you an employer?Check the appropriate box: Type of project(required): 1. m a employer with employees(full and/or part-time).* 7. New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in ca aci 8. G❑' emodeling an y p ty.[No workers'comp,insurance required.] 3. I am a homeowner doingall work myself. t 9. ❑Demolition ❑ y [No workers'comp.insurance required.] 4.❑I am a homeowner and will be hiring contractors to conduct all work on myproperty. I will I O Building addition ensure that all contractors either have workers'compensation insurance or are sol 11.QEIectrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5.01 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.t 13•El Roof repairs 6.1:=1We are a corporation and its officers have exercised their right of exemption14.QOther per MGL c. 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. 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: ( ôcjr 4(A h O )04 � vier q Policy#or Self-ins.Lic.#:t)( -506—S 0a I q'fa-c2On23 Expiration Date: 9/70/2t o?3 Job Site Address: 3 ''f 'eil 4 Cr. City/State/Zip: /a /,lnet-ilt//id." Qq)4?5 Attach a copy of the workers' codipensation policy declaration page(showing the policy ndmber 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 der the pains a penalties of perjury that the information provided above ' true a d correct. Signature: -� Date: L 64r 20D3 Phone#: 5LY 3c / 6,73C) 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#: , ° Y TOWN OF YARMOUTH Y .„, '4 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451 Telephone(508) 398-2231 Ext. 1292—Fax(508) 398-0836 OLD KING'S HIGHWAY HISTORIC DISTRICT COMMITTEE I APR 1 4 2023 j f�tltJil ice;r, APPLICATION FOR KINGS HIGHtN AY CERTIFICATE OF EXEMPTION Application is 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: _)--(p Q,i(�j,� 1) Map/Lot# Owner(s): J(,y 1(\ JV�( A,\( (Ar\ Phone#: All applications must be submitted by owner or accompanied by letter from owner approving submittal of application. Mailing address: 3-7 L117,, (/4,.� / Year built: 1{ 41 Email: Preferred notification method: Phone Email Agent/Contractor: ()e�'1 ��c ,,') &( ,U`'� ��jj Phone#: 77`� �� I� � ��, Mailing Address: 2ti ! l 1/6;)f, ./'�( 1/i? /4/7nci,-yy..,,t-, Email t':1 l`.' &r L,, fr , �.� ��b �Uf 1 Q>(G�1't Preferred notification method: I I Phone LJ Email Description of Proposed Work(Additional pages may be attached if necessary): - .(\sA (1 C�_5Th( ft c0[c 1') 1 te( ( S)1,Ay/0 6-e6(-6 - Ex .- K co (6 6f- ,T 5h U �;,10e. Ce d kr <;- h‘Ai 1 1425 ei S, Jfwa/l . Cv/o,- sec Cci _„c nor/ 6"(-ty Signed (Owner or agent): .. ✓� L }" � Date: J ,9%/iy_,.5 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: I / Date: f.fl/y j,� VApproved Approved with changes Denied Amount dO.00 Reason for denial: Cash/CK#: .5`rbe Rcvd by: L-1-5, Date Signed: 1/303 Signed: APPLICATION#:33 C L)_j`, `752 17 Sherman, Lisa From: Richard Ventrone <rav9463@gmail.com> Sent: Friday, April 21, 2023 10:07 AM To: Sherman. Lisa Cc: Richard A. Ventrone Jr. Subject: Re: 23-E030 37 Longfellow Drive 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. Sorry,this one slipped by.... APPROVED. On Apr 21, 2023, at 9:35 AM, Sherman, Lisa <LSherman@yarmouth.ma.us>wrote: n Hi Rick, APR 1 21123 Any thoughts on this one? Guy stopped by today to get a status.... ow KINGS vS H I GH'wAYI Thanks! Lisa From: Sherman, Lisa <LSherman@yarmouth.ma.us> Sent: Friday, April 14, 2023 8:48 AM To: Rick Ventrone <rav9463@gmail.com> Cc: Sherman, Lisa <LSherman@yarmouth.ma.us> Subject: 23-E030 37 Longfellow Drive Hi Rick, Resident would like to replace their roof with Georgetown Gray shingles and replace their cedar siding with cedar Cape Cod Gray, predipped. Mr. Grew dropped off a sample of the cedar shingles. It's wood, SBC cedar. Please let me know if you need any additional information. Thanks Rick, Lisa isa Sherman Town of Yarmouth I,John Moynihan, approve of Benjamin Grew of Grew Building Company to submit application of appcl for 3 ongfellow Dr. Yarmouthport. / / . 4 71 John Moyni n Date , APPROVED 1 r+riiv��1U \pi y t G,5 � r-s--""'" G OW KIN AF'R 2 1 ?IV? YAHl;IUU(t. 01 D KINGS HIGHWAY a - V3O Commonwealth of Massachusetts Division of Professional Licensure ' Board of Building Regulations and Standards Construction Supervisor CS-110491 Expires:09/27'2022 BENJAMIN GREW 20 ATLANTIC AVENUE SOUTH YARMOUTH MA 02664 Commissioner THE'COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation HOME IMPROVPEMENd vid CONTRACTOR TY• Real___stralion Expiration 199607 09/15/2024 BENJAMIN GREW BENJAMIN GREW _; 20 ATLANTIC AVE SOUTH YARMOUTH,MA 02664 Undersecretary