The URL can be used to link to this page

Home My WebLink AboutBLD-23-001943 O�'YA.Qc '(� 'I 1 z� 'Office Use Only • `� '�' " h res {Permit# eta Ou. 1l''/S`` . H Amount SD, d e o L MA4ACn s ;l 7 '-0" ..-- rd 'Permit expires 180 days from issue date OLD _23 —601614-3 EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH R E C F I V D Yarmouth Building Department - ' 1146 Route 28 OCT 122022 South Yarmouth, MA 02664 (' (508) 398-2231 Ext. 1261 sul� aiNc DE ARTMENT CONSTRUCTION ADDRESS: /11 J !/e47 " ew� 1/ pt.L e-c,e ASSESSOR'S INFORMATION: Map:�„ Parcel: g OWNER: /) t' "",� Ci' .e.(� D v 25 3sg 8 — 2.8 6/g NAME PRESENT ADDRESS TEL. # CONTRACTOR: '! vL l (/p4 Love � . 0.- NAME MAILING ADDRESS TEL.# f/- krAesidential ❑Commercial Est. Cost of Construction$ ` �� U Home Improvement Contractor Lic.# ( !2.-7 76. Construction Supervisor Lic.# a `!/ 3 o. c Workman's Compensation Insurance: (check one) ❑ I am the homeowner ❑ I am the sole(� proprietor I have Worker's Compensation Insurance �-�^�' Insurance Company Name: pt�-JC,��d 1/0Y`1 Worker's Comp.Policy# l.'le_S'II�II/J OL)�' Z-- U WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows: # Replacement doors: # Roofing: #of Squares IC ( )Remove existing* (max.2 layers) Insulation Old Kings Highway/Historic Dist. ( )Replacing like for like Pool fencing *The debris will be disposed of at: P1S D Cs L Location of Facility I declare under penalties of perjury the s to ents herein contai e 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 rev c on o license and for pr ution under M.G.L.Ch.268,Section I. p� Applicant's Sib ature: �� Date: /CY/ 2 Zo Q-a_ Owners Signature(or attache r ‘' Date: Approved By: Date: , `! Building Official esi' EMAIL ADDRESS: Zoning District: Historical District: 0 Yes 0 No Flood Plain Zone: 0 Yes 0 No Water Resource Protection District: Within 100 ft.of Wetlands: 0 Yes 0 No 0 Yes 0 No • `,-- The Commonwealth of Massachusetts 1` c Department of Industrial Accidents 1 Congress Street, Suite 100 414, � Boston, MA 02114-2017 rz 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): API „.1 '9�12 it 6,0-1,-/C-4 Address: 1..0 If C:..;✓]171-e4—L�� `/` cir,j City/State/Zip: / 11- 4 S /''tills Phone #: 22 0`—/ 7-- 7 4 Are you an employer?Check the appropriate box: Type of project(required): l. m a employer withpasyees(full and/or part-time).* 7. New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. E Remodeling any capacity.[No workers'comp. insurance required.] 9. [ Demolition ` 3.0 I am a homeowner doing all work myself.[No workers'comp. insurance required.] 10 Building addition 4.❑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 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.El Roof repairs These sub-contractors have employees and have workers'comp.insurance.x 6.❑We area 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.] *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. f f Insurance Company Name: v 6( /[ J(16`4''i ( ®1-5 Policy#or Self-ins.Lic. #:(,��c.� �. , (, -? (2._ Expiration Date: 02//// � / 7 `� 0v� Job Site Address:_ t . eL 2 �� City/State/Zip: W !/", '- 4- ,—€.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 o - statement ma .; forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify - se he .ai and penalties o 'perjury that the information provided above is true and correct. Signature: Date: /O / 2 Phone#: gr 210 ,_/75 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#: INV /V' Estimate B E L ISLANDS Date Estimate Home Improvement 7/27/2022 2070 Bel Islands Home Improvement 204 Cinderella Terrace Name/Address Marstons Mills, Ma ,02648 Ed Wienberg 14 Steven Dr, Belislandsroofingandsiding.com West.Yarmouth,ma 508-280-1794 508-364-6909 Terms Project Rate Total To upgrade shingles to Landmark Pro will be extra charge$650 POSSIBLE EXTRA: Any rotted plywood,trim boards,lead flashing or other carpentry needing replacement will be done and charged for as an extra at rate of$75.00 per hour.plus 15%mark up materials Bel ISlands Home Improvement Guarantees the labor for Lifetime of roof and against Blow-offs for 15 Years. Bel Islands Home Improvement:Carries Worksman's Compensation and Public Liability Insurance on the above work, certificate available upon request Optional 0.00 0.00 New Velux M06 fixed skylight installation with nee flashing kit. (Labor/materials)-$1150 Permit 200.00 200.00 Dumpster 550.00 550.00 Total $11,050.00 / age 2 i Commonwealth of Massachusetts IPDivision of Professional Licensure Board of Building Regulations and Standards co nstryttlhAbpervisor CS-111305 expires:06/01/2023 ANDRE YARMALOVICH "204 CINDERELLO TERRACE " C MARSTONS MILLS MA 02648 r • Commissioner djaia K. g .- THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:"Individual Registration gpiration 172476 07/01/2024 ANDREI YARMALOUICH D/B/A BEL ISLANDS HOME IMPROVEMENT ANDREI YARMALOVICH 204 CINDERELLA TER. .,'a MARSTONS MILLS,MA 02648 Undersecretary