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Home My WebLink AboutBLDX-25-1214 (2) • Office U.Only Permit.X -la,ly pets C3 \mount o$O°o Y 3 EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth,MA 02664 (508)398-2231 Ext. 1261 CONSTRUCTION ADDRESS: OWNER: Sq•r ,`DS--C sc'`r, '•2J•o a\7 ,5 ,�rachr xb2.SSo-SoSCs _ \\stF 1'RI-SP\f\DDNISS TFL.. CONTRACTOR: \� O:JC.JC�-i 5l2 2.\. 2, �I0(Xt�l..:� ooS� �3`{-�i�� \ \I\III\G\DDRESS TEL.. �- - ----- EMAIL. \nrJe cc-A\99 „Jo.d• (Nec _Residential Commercial Est.Cost of Construction S SCZ Homeowner is Applicant? Yes No Home Improvement Contractor Lic.# Construction Su pen isor Lic.# C.J'"O>A`kTrk WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate required) Wood Stove Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares Insulation / Temporary Mobile Home Temporary Construction Trailer Demolition-Interior only V/ 'Demolition Raze Structure Solar System ESS System Chimney Fence *Please submit utility disconnect letters for electric&gas-structures over 75 years old require historical res less 'The debris will hedisposedofat. )Incrp,5:1_. 4O-s:'e bab c .<- ) "Ir r r` M Location of Facility I declare under penalties of perju ha the statements herein contained are true and correct to the hest of my knowledge and belief. I understand that any false answensl will be just cause for denial es°caln of my license and for prosecution under h1.Ii L Ch.26a•Section I. 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The Commonwealth of Massachusetts =1._= Department of Industrial Accidents _' Office of in vestigations Lafayette City Center 2 Avenue de Lafayette,Boston,MA 02111-1750 • www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly D 3"1 Name(Business/Organization/Individual): V\Drt.;me\V,. Address: City/State/Zip: "f Q r'h. Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑I am a employer with 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 working for me in any capacity. employees and have workers' insurance.: 9. ❑Building addition [No workers'comp.insurance comp. required.] 5.❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. workers' right of exemption per MGL 3s [No comp. 12.0 Roof repairs insurance required.]t c.152,§I(4),and we have no employees.[No workers' 13.0 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 anployees. 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: C•� s : Policy#or Self-ins.Lic.#: ti s1 4s 3- • -2 Expiration Date: Job Site Address: "1 S City/State/Zip: /cs.`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 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$250.00 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: C Z-v\• 2 Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(check one): i❑Board of Health 20 Building Department 3tCity/Town Clerk 4.0 Electrical Inspector 50Plumbing Inspector 600ther Contact Person: Phone#: / O C i MOL DOCTORS 572 Main Street (Route 28) West Yarmouth, MA 02673 Toll Free 855-MOLD DOC (665-3362) 508-534-9091 Remediation Plan For 205 Old Main Street S. Yarmouth, MA Jeremy Assessment Date: September 8, 2023 y'?J 6 - Prepared for: St. Davids Church Phone: 508-280-8801 Realtor Debbi McDevitt Hayes 508-280-8801 Email: dahays0l@gmail.com VISA IIIIIIEms' "� MasterCard ci15ic411."E'= Financing is also available, go to www.molddoctors.net for details INS IiT�lll CEI=-,. MRS j p ""�`°"E° AngiE list. ss k ft Tiilt:.I,..l. MOL ' DOCTORS 572 Main Street (Route 28) West Yarmouth, MA 02673 Toll Free 855-MOLD DOC (665-3362) 508-534-9091 Standard of Care Mold Doctors will provide all materials, equipment, and labor for a mold remediation. Mold Doctors will create isolation of the work area during the remediation process, when applicable. Mold Doctors will create negative air pressure to contain mold levels within the work area, when applicable. Mold Doctors will not be responsible for any mold regrowth. Homeowner responsible to address: moisture, water issue, leaking pipes, dehumidifier to control humidity, inadequate ventilation, improper venting, roofs leaking, etc. Price Match Guarantee The Mold Doctors will match all competitors' pricing, provided the scope of work is comparable to ours. Our pricing is the best in the industry, and some competitors' proposals will not reflect the work that is necessary to assure the home is properly remediated. Scope of Work Basement Level 4 Remediation Create chamber at top of stairs to the outside entrance with ramp Remove & discard bottom half of all drywall, entire wall on storage area right at bottom of stairs (remove rack)& floor to ceiling about 2-4 feet out from rear exterior Sweep& vac debris HEPA vacuum all surfaces to capture surface mold spores I Apply an EPA approved mold disinfectant to all surfaces & stain remover where needed Fog the basement using a Fungicide-Disinfectant-Deodorizing- Solution Place an air scrubber to capture airborne mold spores Price includes disposal Realtor discount applied Mold Doctors will provide a certificate of completion for basement based on Scope of Work Fully licensed, Insured and Bonded I 1/3 down remaining balance due on the completion of the work Total $4880.00 Michael J Martinello Customer 1204012 Wallace A Watson Jr. nu, , . ... ,.. . ,. .. ,. .. • . 1509007