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HomeMy WebLinkAboutBLDR-24-278- ONE&TWO FAMILY ONLY-BUILDING PERMIT Town of Yarmouth Building Department 1146 Route 28,South Yarmouth,MA 02664-4492 508-398-2231 ext.1261 Fax 508-398-0836 'f��'�%' Massachusetts State Building Code,780 CMR Building Permit Application To Construct,Repair,Renovate Or Demolish a One-or Two-Family Dwelling This'' Section For Official Use Only Building Permit Number: i3( -Z4-c(7 t& Date Applied: � / ` / - dye Py. Building Official(Print N e) • rgnature // Date SECTI 1:SITE INFORMATION vVV R E C E I V ~ D • 1.1 Property.n,ddress• 1.2 Assessors Map&Parcel Nur�be s 61 ON-i l6'' RdrtA PS I eltirptlJA IAY a 0 2024 1.1 a Is this an accepted street?yes ✓ no Map Number Parcel Numb 1.3 Zoning Information: 1.4 Property Dimensions: BUILDING DEPART ENT Zoning District Proposed Use Lot Area(sq ft) Fronts jrffj--" 1.5 Building Setbacks(ft) t .. 4/ Front Yard Side Yards Rear Yard 1 Required Provided Required Provided Required Provided (lv/\\ A, 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: V Zone: Outside Fiord Zone? Public❑ Private❑ — Municipm CI On site disposal system CI1 Check if ycs❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 wner'ofRecord: mg27a.rtar 0 tedif,ZIP �o u e,, tilt 0.1-b i.3 Name(rint) City,State,Z 1 C -o-i 61511, byK 01b1) No.and Street Telephone Email Address M '‘'' SECTION 3:DESCRIPTIONIII OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building er I Owner-Occupied IlYrRepairs(s) 14�Alteration(s) El Addition 0 (� \ Demolition CI Accessory Bldg.0 I Number of Units Other 0 Specify: .. iNN t. c Brief Description of Proposed Work': Cr rs �r ii' N ae-lt ra((c /1Vp/act errys t-ss a../ SECTION 4:ESTIMATED CONSTRUCTION COSTS. Item Estimated Costs: OffcialUse Only (Labor and Materials) I.Building $ []77 (7L 1.Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ) Cl Standard City/Town Application Fee — ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2.Other Fees: $ 4.Mechanical'(HVAC) $ List: 5.Mechanical(Fire . ' Suppression) $ Total All Fees:$ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $a(o1 �7,(.Q 0 Paid in Full ❑Outstanding Balance Due: • • . . • . . 4i0S 0 YAM , . . SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) C'sc I —i D5 q3 3 0 6�93�py I r f 1[u` 5m License Number Expiratio Dat Name of CSL Holder P.0 , Q�/„ of gs i List CSL Type(see below) No.and Street ( Type Description I\iant1,i T 1�'& U Unrestricted(Buildings up to 35,000 Cu.ft.) City/Town,State,ZIP / r1 LJd� R Restricted l&2 Family Dwelling 1vI Masonry RC Roofing Covering WS Window and Siding ,r 2 CA PC •(." P'btAileI P4 (' SF Solid Fuel Buming Appliances �7I6 14bC+ �4) grreil(. (.Dry I Insulation Telephone Email address D Demolition 5.2 �ReegisteredHome Improvement Contractor(HIC) T `Lk.)( S in 1+h HIC Registration Number Expiration Date HIC Corn any Name or HIC Registrant Name ti J-1E�' (OLD hlei/Q/c'id No.and Street Enfail address l hZn ii,j/,l-f; d a(S5 9/711-36e�-9/e5'7 City/Town,State,ZIP Telephone I) //7RQ.//, ( } SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT I.G.L.( c.152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide f this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes ✓ ❑ No .❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDINGPERMIT I,as Owner of the subject property,hereby authorize '1r i 4. 1 i ► . Sr L4 to act on my behalf,in all matters relative to work authorized by this building permit application. „1-13 i4 ill C C0 nice! Print Owner's a(Electronic Signature) Date • SECTION 7b: OWNER1 OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. `CP V l,Nc Srn L Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will nor have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.nov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq. ft.) . Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" Cape Cod Pro Builders West Yarmouth, MA May 29, 2024 RE: 9 Chilton Rd. West Yarmouth, MA Mazzamaro Job Description: Removal of deck, including debris, trash and deck boards Removal of stairwell and re-installment steps with new handrails new composite decking .olit -- 4.440- aikdir eit„ i 0, •--6. 7iii 40", oi, ' "0-'"I"r r""-.. . , .40". goihm.L k .00;141 • -,..%,-. ' Office tise Only , oir . 011')A ii Ptrrnit, ',t 44*g' t 40' tt t AnIrttint *.''. 0 ' •1'4 A ..w.r.a..1.../.,,,,,,........11.0 tdp\ ,)• tt J.•.Z. 1.01" 14.:"...1%."."1".• ' 'Prrtrt tt rxrtiveg 130 dtyi friurn ' 1441 ...4, , ...., i 4alit date ,. ixe v " A ,. . LIMN( ; 4 IX PRESS ittil 4 , 1)1.' 10111 API I 1("A'FION i ( )%vc ( )I yAR7..1( ); I 11 *sr rittiiittli Building 1)eliiirttnerit 11,16 R(itilc 28 S(nitit Yarn-multi, MA l)2664 ( t)8) 198-2231 fixt. 1261 A.2) Tit 9 Chilton Rd. West Yarmouth CI)NSON k i)l)11/ SS: ..,- ASSt i)R'S i\i (')•K\°, ‘110N M..*.o., o....--,.,4..... A 44.••q 44,A A 4,0 A r .1.•,.......A....M.,,......**I Map. Parcel: ........_____ owNi.A. Jeff Mazzamaro 9 Chilton Rd. West Yarmout 954-648-0960 ,• .1. ... d•u•veraw, * “ ..-.q.-a v r ..,.- ,. si ...,...,,,,.• •• •.*- m.,.........,„..,..,.,,, '‘.- ''' .".* ''''- •.......".- ,r.,e• , , NAME PitiLSENr A Dr)tii.SS CONT.R AC"r C)R CC Pro Builders 299 Route 28, West Yarmot. 774-368-9657 ....___ ... — Tr..i.• gg Nt-'1/4ILIN(;ADDliESS ,..' El Itt.-shscritild, 0 Ct)rarncrial E 26 0 st. Cost of Construction S ) 00,00 lionlc improvement Contractor Lic. # 134560 Construction Supervisor 1.ic. t/CSSL.105933 ik „ , Worizritul s Comt,-n-,^ s.-at an ion Insurec: (cllec,. one) , • •• 0 I arn the homet)v.ricr 0 I am the sole, proprietor 0 1 have Worker's Compensation Insurance ' insura7ict-. COMPLIZIY NilITIC: Bryden & Sullivan worker's Comp. 1 oliorf , 25674 .....___. _ ., WORK TO BE PERFORMED Tent Duration_ 11 , (Fire Retardant Certificate attached.) Wood Stove El _ Siding: # of Squares windows: .,w Replacement rr Replacement doors: # ' - Roofirit'• PI- of CLI ua res ([1) Reniove existing* (max. 2 la)ers) Insulation 1-1 - , -- [1 (LI Old Kings ilighwav/Historic Dist. ) Repl Pool fencing LI acing like for like ,,___ , i .„ Coastline Disposal dCbIl$ Ve<II bc disNstd of at: Location of Facility ; -,, . ;',,z- •,,,,•-v,1/4-tv 1clecia-c.IMAICT'-- ptlos of perjury that Lilt st..aernents herein contained arc true.and-correct to the test of my knov.ledgc. anLI belief 1 u:iderstand tha,..1:: .....ss,. —. .... , ' v4311 btiy4 tili10.1f01 dcizial o- *.ation of my license and for prosecution under ,M.C3,1„. Ch. 268,Section 1. 0 , . . Date' gr.,!....t.L.,.. 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ACORO0 DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 05/28/2024 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(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 this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Joanne Ainswoth BRYDEN&SULLIVAN INSURANCE AGENCY INC PHONE No.Ext): (508)775-6060 FAX No): E-MAIL ) swo@ry ainrth b denandsullivan.com ADDRESS: 88 FALMOUTH RD INSURER(S)AFFORDING COVERAGE NAIC# HYANNIS MA 02601 INSURER A: TRAVELERS PROPERTY CAS CO OF AM 25674 INSURED INSURER B CAPE COD PRO BUILDERS&REMODELING LLC INSURER C: INSURER D: 299 RTE 28 INSURER E: WEST YARMOUTH MA 02673 INSURER F: COVERAGES CERTIFICATE NUMBER: 1011956 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 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. INSR LTR TYPE OF INSURANCE `NSD„DL SUBR POLICY NUMBER YYPOLICY EFF POLICY EXP LIMITS (MM/DD/ YY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY LJ PRO- JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: COMBINED SINGLE LIMIT $ $ AUTOMOBILE LIABILITY (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N X STATUTE ER ANYPROPRIETOR/PARTNER/EXA OF CER/MEMB REXCLU ED?ECUTNE N/A N/A N/A 7PJUB0W70160723 09/21/2023 09/21/2024 E.L EACH ACCIDENT $ 100,000 (Mandatory in NH) EL.DISEASE-EA EMPLOYEE $ 100,000 It yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only. Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage- Coverage Verification Search tool at www.mass.gov/Iwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Yarmouth ACCORDANCE WITH THE POLICY PROVISIONS. 1146 MA-28, AUTHORIZED REPRESENTATIVE S Yarmouth MA 02664 Daniel M.Crowley,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts • Department of Industrial Accidents _earl- 1 Congress Street,Suite 100 =' �= Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le¢ibiv Name(Business/Organization/Individual):Cape Cod Pro Builders and Remodeling Address:299 Route 28 City/State/Zip:West Yarmouth,MA 02673 Phone#:774-368-9657 Are you an employer?Check the appropriate box: Type of project(required): 1.01 am a employer with employees(full and/or part-time).* 7. ❑New construction 2.1=II am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 0I am a homeowner and will be hiring contractors to conduct all work on mY PPant ro 1 will 10❑Building addition 4 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 5.12I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.1=1We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§I(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: Bryden&Sullivan Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address:9 Chilton Rd City/State/Zip:W. Yarmouth, 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 c••tf der the pains and penalties of perjury that the information provided above is true and correct Signature.i_ _-- Date:5/29/2024 Phone#: 774-368-9657 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#: 1 y yxy•. ( V ' Massegov C�ofa <` .'.. " , 11 .4°,4 I rc.' ,07.1, ve , . ' C'1 ,, ca , , ,, ,,,,,,,4 w I 1 CA 1 I 0 0 i voj J 0 0 1 %.„:or ' : /,,,,.. ,,,,„,„ ..,_ „.„, , . . i.v,, ,f : ,..p, ,,,"%. , ., A „ , I 05,--„ A,,,I 1.1 i CI 4,, g ( CABR) HIC Registration Complaints Registration # 134560 Registrant T&T ROOFING, LLC Name TREVOR SMITH Address 2 LITTLE ISLE L.N. City, State Zip NANTUCKET, MA 02554 Expiration Date 01/20/2026 Complaints Details No complaints found for this registrant. You can also view arbitration and Guaranty Fund history. Back To Search Site Policies Contact Us © 2018 Commonwealth of Massachusetts. 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