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EXPRESS BUILDING PERMIT APPLIC
TOWN OF YARMOUTH
Yarmouth Building Department
I 146 Route 28
South Yarmouth , MA 02664
(5 0 )398-2231 Ext. 1261
NL{IL ADDRESS
E Commercial Est, Cosr ofConsrructiorl $
Permit expires 180 days from
issu€ date
EIVED
MAR 0l eOet
BUILOING DEPARTM8y
CONSTRUCTIOJ\i ADDRISS:
AS SESSOR'S TiVFOR\{A,TION:
N
CONTRACTOR:
ntu+^ B) //a'ra--
L-*'+T(
A,a,niur
44ua ,r
Workmar's Compensarion hsurance: ,,7i{( eck one): I am the homeo',mer Y I am the sole
Home Improvement Contractor Lic. #t,
Insurance Company Name
Constructiort Superyisor Lic. #
pro tor a I have Worker's Compensation Insurance
Worker's Comp. Polic)d
\\'ORK TO BE PER-FOR\IED
(Fire Rctardant Certifi cate attached?)
Replacement windolvsi
Roofing: # ofSquares_ ( ) Remole existing+ (max.2layers)
_ Old Kings Highway/Historic Disr. ( ) Replacing like for like Pool fencing
.The debris will be disposed ofar 0
LocrtioI of F t
I declate undcr penaltics of perjury rhar the herein contained are true and cofiect to thc best ofmv knowledse and beliei I undersland that any false arsrver(s)will bejust cause for denial oa ocation ofmv se and for prosecution under lv{.G L. Ch. 268, Section I
Applicant's Signature
01 !ers Signalure (or rftachment
Date
DRESS
Approved By
Water Resource Protection District
a Yes iNo
Within 100 ft. of Wetlalds
! Yes I No
Date:
Date:Buildhg Offi cia.l (or desi gnec)EiVL{IL -ADDRESS
Zoning District:
Historical District: - Yes - No Flood Plain Zonet , Yes lNo
OWNER:
Wood Stovc
Insulation
Tcnt _ Du rrtion_
Siding: # ofSquares _
ba
,#/ Reptacement door r., *-.<f'
I
Map: I Parcel:
.Firefox
Byam Construction
Ro erE Bvama
about:blank
P.O. Box 1793
Hyannis Ma.02601
Ph.364-364-4499
Proposal and Contract
Ian.22.2024
The following are the the terms and specifications for
the Window and Door Renlacement rrroiect at the
I of5
above address.
12312024.8.51 AM
NIA. C.S.L. # 07s376
H.I.C. License # 132560
Submitted to :
Ed Kuczynski
135 South Shore Drive
frnits 7,7A.&3Q
So. Yarmouth. Ma.
781-482-4330
Materialstotal- $7 75.00
Installation Laborr lnclutllng debris dlsoosal , -$ 8"600.00
Proiect Total $ 15,975.00
unforeseen alt'or cementvf additio sidin shea
or framins membens dectucd necessarv hv the c stomer and con I raclor " shnll
be oerfo on a time and materirls basis of S 95.00 ner hour plus the cost
Payment Terms:
$ 7.975.00 due unon scceDtatrce of contract to suonlv materitls and
$2-000 .00 Da ent is due unon 25 7o com n of the Droiect.
$ 2.000.00 oavment is dueuDOn 50 o/o comnletion of the rrroiect.
$ 2.000.00 navment is due uuon 75 9/o comnletion of thc nroiect.
3 of 5 112312024.8:51 AM
of materials.
eouipmetrt to the site.
$ 2.000.00 oavment is due uoon the full completion ofthe nroiect. not
includins any addltional sunplemcntal work.
f-irefox about:blanl(
I accept the term s of this n roiect :
Ed Kuczynski
D^
€1,*J-
Roger Byam i Byam Construction
S-\
nt In ti
Name lBusin gantza n4ndividual):
Address:
The Commonwealth of Massacl,usefls
D ep artment of In d ustrial Accide ntsI Congress Street, Suite 100
Boston, MA 02114-2017
\\:orkers, compensation ,r,,.",""'##;frfl,t;{XY!JJa,,r,^"r,*n rectricians/plumbers.
TO BE FILED WITH TIIE PEfu}lITTING .A.IITHORITY.
ease b
, /*--
-7
Cily/Statelzip:f t Phone #:.71
Type of project (required)
T constructio n
odelingRem
1
8
Y. L_l Demolttron
10 E Building addition
I t.E Electrical repairs or additions
12- ! Plumbing repairs or additions
13. ! Roof
t4.E Other
t Any applicant thar check box#l must a.lso fill our the sectjon bclow showing their workcrs,compensation policy infornlation"Honoeo$tcrs who subhit this affidavii indicarin g they are doing all work and thcn hiE outside conEactors must submit a ncw affidavir indicating suclltconfactors tllat chcck this box rllust atrachcd an additional shc.t showing thc nalne of tha sub-cooE-actoc ard state whethcr o. not thosc cntities havcemployees. lf thc suEcodtractors have cmployccs, thry must providc their workcrs'comp. poliry number
a cmployer with 7 crnployees (full and./or pan-rime).r
I am a sole propaietor or parmcrship and have no cmployecs working for me inany capacity. [No workers'comp. insuraacc required.]
I arll a homcowner doing all work nysclf [No workcrs,comp. insurance rcqufed.] I
I am a homeorrncr and will be hiring conuacroE to co[duct a.ll work on my propcrty. I willcnsurc that all conE-actors eithca have workers, compcnsation insurarca "i "i.,li
-
proprictors with no crnployecs.
I am a gencral conEiac1or and I havc hircd thc sub-.coN-acrors lisred on the attachcd sbccrThcse sub-conta.ao6 have employecs and havc workcrs, comp. h";;;i-*- -'-
We arc a coapoiation and its officcE havc cxercised thcir right ofexemptjon p.a MGL c.l52, gl(4), and r,,/. hav. no cmployccs. [No workers, compi inst*n"" lqui.iJ.t ---
4
I
2
o employer? Ch th. approprirt. bOI:*cyy'z
Iffrun'
I am an emploler that is provi
infornntion-
Insura:rce Compaay Name:
Poticy # or Self-ins. Lic. #:
tt, orkers' co mpens ation ins for m1t employees. Below is the pohcy andjob site
a uL(iration Date
Job Site Ad&ess:City/State/Zip:
Attach a copy of e workers' compensation policy declaration page (showing the policy number d expiration date).
Failure to secure cover€e 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 tle form of a STOP WORK ORDER and a frne of up to $250.00 a
day against the violator. A copy of this statement may be forwarded to the Office of Investigations ofthe DIA for insurance
covenge verification.
I do hereby und.er t.dins and. penalties ol petjury that the inJotmation provided ab trud and cofiect.e
Phone #:
Official we on$, Do not y)rite in this area, to be completed b! city or town ofJicial.
Issuing Authority (circle one):
1. Board of Heatth 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Ptumbing lnspector
6. Other
Phone #:-
City or Town:Permit/License #-
l/L---'-
THE COMMONWEALTH OF MASSACHUSETTS
Otlice of Consumer Aff Business Regulation
1000 Washi - Suite 710
Bosto 118
Home lm istration
ttIlt Type:lndividual
132560
02126f2025ROGER E. BYAM
D/B/A BYAM CONSTRUCTION
P.O. BOX 1793
HYANNIS, MA 02601
THE COMMONWEALTH OF MASSACHUSETTS
Orllcc ot Conaumer A & Bualnsar Rrgulatlon
HOi'E IMP
IOGER E, BYAM
l/B/A BYAM
Updlte Addr..a rnd Rchlm Crrd.
Rrglttnuon vElld lor lndlvldull uaa only bdor. lha
axdtrdon drta. It iound r.turn to:
Ofilc. ol Conrum, At alrs and Bualnaaa R.gu|ltlon
i00O Wr.hlngton stlot . Sult! 710
Bottor, MA mllS
$
/.**.i fu^naIOGER E. BYAM
I24 SEA ST.
IYANNIS, MA @60I Undarsecretary Not wlthout slgnatur€
U Commonwealth o, Massachusetts
Oivision of Occupational Licensure
Board o[ Burldino Reoulations and Standards
consqidr$ gllge.ryisor
=\ ':t
cs-075376
ROGER E
FO BOX I
HYAN}IIS
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3.'.
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res:07i03/2025
Commissioner a::*L"V;/L,*
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