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HomeMy WebLinkAboutBLDR-25-181 application ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department de Yq-4 1146 Route 28, South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 'a O Massachusetts State Building Code,780 CMR -- Building Permit Application To Construct, Repair, Renovate Or Demolish 4 ,q� a One-or Two-Family Dwelling RPORATEO This Section For Official Use Only Building Permit Number: I --ZS © I Date Applied: Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: Q 1.2 Assessors Map&Parcel Numbers 2 Coily-tiro" dr vL `11 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: 1){ $t s+ 1 .- o-,.poc- ,M4- aZ7s Name(Print) Olty,State,ZIP 2 Corkr,c ss ra-4 '�evk., ,8 . 068 - Z`izy re, v'.s4odn 7G Q. Ao L . ).cam No.and Streetu Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: R E C E I V E D 1 Brief Description of Proposed Work': p,QAMO Z .e 'C s�t�,1 t3,Y`O19"wts ) F- r retriA4 tb d�Siya spec{ c 4-€4.4111, AlAlf MAY 2 2J25 4t._ yot SECTION 4:ESTIMATED CONSTRUCTION COSTS BUILDING DEPART Estimated Costs: BY' �� Item (Labor and Materials) Official Use Only 1.Building $ 70 t z (j _ 1. Building Permit Fee:$ Indicate how fee is determined: 0 Standard City/Town Application Fee 2.Electrical $ 7i 1ip O ❑Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ i 8 J — 2. Other Fees: $ S lD 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Total All Fees:$ Suppression) Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ 9G t Ar/ _ 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) �s- o98oLo �rs/Z.� t cd rt% �y,� License Number Expirat on Date Name of CSL Holder 6D ', List CSL Type(see below) V No.and Street T se Description J ,Y�fq _ — O Z to 5 40 Unrestricted(Buildings up to 35,000 Cu.ft.) � Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding 3 to z -a�8 SF Solid Fuel Burning Appliances �ff ' qq 1 f N10P2.-e11 p�-t_sef I Insulation Telephone LI Email addressQ COJ"c1r D Demolition 5.2 Registered Home Improvement Contractor(HIC) 13 y 1 i J, -I tee C V r�N12(h/"` y4 3 / / HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name _ No.and Street Email address New-- 1MA- z413Z Ct /'Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes No 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER'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 his application is true and accurate to the best of my knowledge and understanding. `" S1 Z12 Print e s or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. 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 not 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.gov/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" l ne c.ommonweaun of Massachusetts Department of Industrial Accidents to = f Office of Investigations • = _ 600 Washington Street :4 Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidaivit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): L�T L C (, frt44 V (!- T/(Z(J"'e f EL Address: po oa I City/State/Zip:0-2A4 ` i l Jt 0 Z‘A3Z-Phone #: Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 3 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in anycapacity. employees and have workers' p ty 9. ❑ Building addition [No workers' comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other 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: kid e �U d /c/j/iL.ifi�' C Policy#or Self-ins.Lic.#: I1 We- 7 y3 S Expiration Date: 2-49 Job Site Address: 2 (O c'tSl d7w/ Di'V(, City/State/Zip: Ye,'' v act" /1-• D 2�7s Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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 S250.00 a day against the violator. Be advised that 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 Signature: Date: '6-1/4-� Phone#: S�6 '‘, L - 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#: Ate R® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 02/01/2025 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: Paychex Insurance Agency, Inc. PAYCHEX INSURANCE AGENCY, INC. (A/CONE FAX EXtl: 877-266-6850 X.No): 225 KENNETH DRIVE E-MAIL ROCHESTER, NY 14623 ADDRESS: FlexCerts@paychex.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:NorGUARD Insurance Company 31470 INSURED INSURER B: KEITH C GILMORE ENTERPRISES LLC INSURER C: PO BOX 17 CENTERVILLE, MA 02632 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP W LIMITS LTR INSD VD POLICY NUMBER IMM/DD/YYYYI (MM/DD/YYYYI COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE l RENTED PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATEP $ _ I POLICY JECT L LOC PRODUCTS-COMP/OP AGG $ OTHER AUTOMOBILECOMBINED SINGLE LIMIT LIABILITY $ (Ea accident) ANY AUTO BODILY INJURY(Per per•,son) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ ' AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X I PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 50,000 A iOFFICER/MEMBER EXCLUDED? N NA N KEWC677438 02/04/2025 102/04/2026 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 50,000 If yes,describe under DESCRIPTION OF OPERATIONS below , E L DISEASE-POLICY LIMIT $ 50,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION Keith Gilmore Enterprises,LLC Box 17,Centerville, MA 02632 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Centerville,MA 02632 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 727.zo_7) ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD g YA TOWN OF YARMOUTH Office of the Building Commissioner F .�-4"i 1146 Route 28, South Yarmouth, MA 02664 ;, OpAt EO It 508-398-2231 ext. 1260 Fax 508-398-0836 DEMOLITION DEBRIS DISPOSAL APPLICATION Pursuant to M.G.L. c.40 §54 and 780 CMR Section 105.3.1 #4. I hereby certify that the debris resultin from the proposed work/demolition to be conducted at. Z Ccmr 1 "- 014-1 VC Work Address Is to bedisposed of at the following location: / * / •- Te A45 Fen/ :1-41`ri') Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, §150A. f/7jj Z ignature of Applicant Date Permit No. jI ' ' ' I rrl c) I I- T W m R- it m g m to N r it N N t N R x . cr) m _. ..._ o rt �— o O - • Cn .r ▪ j V 1 V . m on ) ..41." 'IF < ( n L .: C.) \ :� -It co 1 ; CD m co K it co In K k t. D _Th _. 1 _ s ) _.1 ,.,,, u.„ .. cn 0cc, / -r. a \ ...., 0 %C, cp v 0 le: X N� N N � ' h% mC �l p % 1. a C. t m IND F 73 0 C m m I 2x6 2 5'-0' 5'-10' 5'-8 3/4' Existing Bedroom 5066 Bypass I I 2' 10 1/2' Cbset I j 36'x60" Tub-Shower 36"x68" Shower W/Bznch 3'-0" @. i i New Bath 1 1 2'-0' ,~ 8-6 1 22 3/ ' Z666L -� ? 42' Knee WaU 11'-7 1/2' 1266RH '0' Vanity VanityExisting Window Walk In Closet — ..,1:;• 2' 0' 8' 0" 7'-6' Existing Hall Linen + New Bath ... Cbset 2666LH 0 �� I I 4066 Bypass Move Existing Door R E (; E ' D Existing Laundry Existing Bedroom MAY 0 z zoz5 r BUILDING ' / er DE►'AR7MFN7 pro posec yew -c B Vcsfer Bcf �roo Ts Scale 1/4"=1'0" -- Keith C. Giknore Enkerorises LLC CjPeter 8 Mary 5tanley ProjeEf: Bath Remodel �ev(ei°n�= Date: 3-21-25 Page i 2 is8) P�Ba R GY.Al4 912 2 Congressional Drive P.508-420.9934 F'Sea-4za-'ss Yarmouth Port, MA Drawn 13Y: ,{:a•,� C. �a/...., 141. 1 i= ropo5at Keith C. Gilmore Enterprises, LLC HIC#134443 i P.O. Box 17, Centerville,MA 02632 MA CSL#98047 Phone: 508-420-9934 Fax: 508-420-9935 Date: 4-1-25 Project#STA02 Client Name: Peter&Mary Stanley Phone#508-868-2924 Billing Address: 2 Congressional Drive,Yarmouth Port,MA 02675 Alt.#508-954-9078 Fax# Project Address: Same as billing. Email : peterstanley76@hotmail.com Email : mks051085@aol.com Project Description: Permit and perform work for remodeling of two bathrooms and three closets according to designs dated 3-21-25.Project scope includes all demolishion of all flooring, wall and ceiling fmishes,fixtures (salvage two toilets),one window, 6 doors,trims,plumbing, electrical, moving of hvac,and insulation.Framing of all new partition walls,new doorways,window ro as needed,two Velux 10" Sun tunnels and ceiling modifications. Install of rough and finish plumbing and electrical. Install of new ceiling and exterior wall insulation. Install of half wall bath areas bead board with chair rail trim.Install of plaster to remaining walls and ceiling areas. Install of new masonite solid core interior doors to plan.Install of one new Anderson TW2642 tempered glass 6 over 6 GBG white double hung window. Install new interior trims to match existing profiles. Install new bath floor tiles and master shower floor and wall tiles.Hall bath will have a Kohler acrylic 4 piece tub-shower unit. Install client selected plumbing fixtures and salvaged toilets. Install client supplied choice of closet shelving and bathroom hardwares. Prep and paint all new plaster,beadboard,doors, and trims with two coats latex paint(deep colors may require extra cost).Install pre-finished hardwood flooring to the new closet areas.Install of new vanities,tops and shower glass doors. Project Task Items: Project management and permitting total. $ 11,165.00 In house project demolition, framing,door,window and sun tunnel installs,trim installs, cabinetry installs, hardware installs,and wood flooring installation. $ 39,464.00 Plumbing estimated budget. $ 18,100.00 Electrical estimated budget. $ 7,760.00 Insulation estimated budget. $ 840.00 Plaster&painting estimated budget. $ 11,322.00 Cabinetry estimated budget. $ 1,612.00 Solid surface tops estimated budget. $ 1,612.00 Glass shower doors estimated budget. $ 4,276.00 Total $ 96,151.00 Initials 4 00/ NOTICE OF CONTRACT Notice is hereby given that by virtue of this contract dated 4-1-25 between Burt Peltz of 412 Prince Hinckley Customer-Homeowner(s) Residential address of Customer And Keith Gilmore Enterprises of: P.O.Box 17,Centerville,MA,02632 Contractor Address of Contractor's business Said contractor agrees to furnish or has furnished labor and/or materials for the erection, alteration,repair or removal of a building, structure, or other improvement on a lot of land or other interest in real property described on the previous estimate page [s] of this proposal. Said work to be performed in a timely and workmanlike manner on or before the Spring-Summer Season 2025 with permitting at the property located at: LEGAL DESCRIPTION OF THE PROPERTY 2 Congressional Drive Yarmouth Port MA 02675 Property address including street number Town State Zip **Note:material availability,weather conditions,and permitting may affect scheduling and some delays are unavoidable.We will do our best to schedule work as conveniently as possible. Owner is responsible for moving all personal objects,furniture,fixtures,and other similar objects from work area. All items on or against walls should be considered for removal during any exterior and/or siding work to guard against damage.In the case of any roofing and/or ridge venting,dust and debris should be expected and any items in the attic should be removed and/or covered.Keith C.Gilmore Enterprises is NOT responsible for any damages if said items remain in place.In the event of rot repairs,roof repairs,or any related work requiring immediate attention,we will proceed without customer approval or when appropriate,with verbal authorization. Curtains,drapes,and window&door treatments may need special removal,reinstallation,or replacement by customer due to sizing on door and window replacements.This is NOT included in this proposal. Keith C. Gilmore Enterprises is NOT responsible for any damages that may occur during construction to landscaping or any finish ground work,plantings,asphalt or stone driveway,etc.Flowers and shrubs against house may need to be repaired or replaced by homeowner. Any alteration or deviation from specifications contained in this proposal involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate except as specified above.All agreements are contingent upon strikes,accidents,and/or delays beyond our control.Owner agrees to carry fire, tornado,homeowners,liability,and other necessary insurance for the work,and owner's property. The Customer states that they are the legal owner of the property described above or acting for,on behalf of,or with the consent said owner. Page 1 of 2 Initials 71( PAYMENT TERMS The amount or estimated amount of said contract is $96,151.00. Customer agrees to pay the Contractor according to the following termD CC 0 211 $11 165.00 Due at schedulin: $37,464.00 Due as invoiced in weekly production installments $ 2,000.00 Due as invoiced by completion $45,522.00 To be paid directly to subcontractors-vendors by client Description of payment terms All work will cease under this contract if payments are not made pursuant to the terms described herein. Workmanship issues must be documented by the Customer,in writing,to the Contractor within fourteen(14)days that Homeowner knew or should have known. There will be no refund for special-order materials and/or any other non-stocked items after three days from approved proposal.Any other refunds shall be calculated and/or determined by Keith Gilmore Enterprises. The Contractor retains all legal remedies available if the Customer fails to pay including the recording of a mechanic's lien on the property pursuant to M.G.L.254,§5 to secure the payment of all labor,including construction management and general contractor services and materials,including those furnished by Keith Gilmore Enterprises. Customer guaranties the payment of all sums owed to the Contractor. Customer understands that any debt to Contractor over 30 days past due is subject to a 11/2%finance charge per month(APR 18%). Customer agrees to pay all legal fees and costs incurred in the collection of any money owed to Contractor. Customer acknowledges that Keith Gilmore Enterprises has a reasonable expectation of payment from the Customer for any materials furnished by Keith Gilmore Enterprises as part of this project between the Customer and Contractor notwithstanding any payments to or disputes with the Contractor. This Notice of Contract is to be construed and interpreted according to the laws of the Commonwealth of Massachusetts. The undersigned acknowledge that they have read and understood all of the enclosed terms and that their signatures appear freely and voluntarily below: 1-// 21zeZ' � z f Autho ' ed A t* Date Contractor �ate Page 2 of 2 Initia� / Commonwealth of Massathusetts Division of Occupational Licensure Board of Building Re ulations and Standards ConstJ� rvisor CS-098047 44.'z 4 * fires: 07/15/2025 KEITH C " s - i PO BOX 17 z er i‘hoioddi CENTERVILL* 1 O Commissioner \ e'wNu•.=-�-- -* \/ `I t)c\ THE COMMONWEALTH OF MASSACHUSETTS , Office of Consumer Affle4,10 Business Regulation 1000 Washing T"t f7t.--Suite 710 Bosto '118 Home Im•ro 77.-" _= ='==-•istration V ~ Type: LLC •KEITH C.GILMORE ENTERPRISES,LLC. _�� E_ .alion: 134443 PO BOX 17 - E lion: 11/15/2025 CENTERVILLE,MA 02632 >��- - . _ lc. \.. -...:-.._-:ILT, --.. Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Aft &Business Regulation i Registration valid for individual use only before the HOME IMPROV �7,:.ONTRACTOR I expiration date. If found return to: T '• I Office of Consumer Affairs and Business Regulation 1000 Washington Street-Suite 710 I '_7VI Boston,MA 02118 KEITH C.GILMORE I .. KEITH C.GILMORE •T-�t.._.._ l K /IN 28 HIDDEN VALLEY R�.z � '— VI MARSTONS MILLS MA 67 '"-. , Undersecretary Not valid without signature