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Home My WebLink AboutBLDX-26-139 yA rt + Office Use Only .,0 ?4.j7� i 1 } `` :�1 MAR 02 2026 Pemut# —o1(O—(3� i t 4 fI u -- -.�' ., Amount c°R .-1 L' EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth,MA 02664 (508)398-2231 Ext. 1261 CONSTRUCTION ADDRESS: 140 union St OWNER: natasha cash Cot C f Gc 12 / NAME PRESENT ADDRESS TEL. # CONTRACTOR: richaRD CAZEAULT 198 FIVE CORNERS RD CENT 508 737 4804 NAME MAILING ADDRESS TEL.# EMAIL: CAZEAULT77@COMCAST.NET /❑Residential ❑Commercial ElEst.Cost of Construction$9000 Homeowner is Applicant? Yes No Home Improvement Contractor Lic.#168607 Construction Supervisor Lic.#cs-100393 WORK TO BE PERFORMED Ei Tent Duration (Fire Retardant Certificate required) Wood Stove Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares 12 Insulation Temporary Mobile Home Temporary Construction Trailer Demolition—Interior only *Demolition Raze Structure Solar System ESS System Chimney Fence *Please submit utility disconnect letters for electric&gas—structures over 75 years old require historical review *The debris will be disposed of at: yarmouth Location of Facility I declare under penalties of perjury that the ments herein contained a e and correct to the best of my knowledge and belief. I understand that any false answer(s) will be just cause for denial or revocation l se an r on under M.G.L.Ch.268,Section 1. ' 3/2/26 Applicant's Signature:_ Date. Owners Signature(or attachment) e f Corm-(! C-'-- Date:3/2/26 Approved By: Date: Building Official(or designee) Rev 6/24 � The Commonwealth of Massachusetts Department of Industrial Accidents _ ►' Office of Investigations �0�� Lafayette City Center ir=1. / 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 Name (Business/Organization/Individual): r cazeault roofing & repairs Address: 198 five corners rd City/State/Zip:centerville ma Phone#:508 420 5482 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. El New construction 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.t required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no re roof �/'p h4-bh/7) 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. tContractors 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: Policy#or Self-ins. Lic. #: Expiration Date: Job Site Address: / 5 �ti� St / ' A f City/State/Zip:p A iV/\ Ci /State/Zi :02675 _ 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 ins an en ties of perjury that the information provided above is true and correct Signature: Date: 3/2/26 Phone#: 508 4205482 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): 10Board of Health 20 Building Department 3EICity/Town Clerk 4.0 Electrical Inspector 5E'lumbing Inspector 6.0Other Contact Person: Phone#: do/N, CA ZEAULT\ ROOFING & REPAIRS PROPOSAL Proposal No. 25-62525 June 25, 2025 To: HAC Cash Work to be performed at 1 Jeanes Path Yarmouth port MA We hereby propose to furnish the materials and perform the labor necessary for the completion of: NEW ROOF (Front roof only) 2 Layers Remove existing shingle roof 1. Install drip edge 2. Ice &Water First 3 ft,valleys and penetrations 3. Cover roof with Rhino paper 4. Re-roof with Lifetime architectural shingle 5. Install ridge vent 6. Flash all pipes and penetrations 7. Remove all rubbish from project Labor and Materials $9,000 All material is guaranteed to be as specified, and the above work to be performed in accordance with the specifications and completed in a substantial workmanlike manner for the Sum of Nine Thousand Dollars $9,000 with payment as follows: Nine Thous; :d Dollars $9,000.due upon completion Respec ' • Ofs'u , Rid: P. Caz ault,Jr. HIC# 168607 CSL#100393 19: Five Corners Road Workmans Comp and Liability with Centerville, MA 02632 Leonard Ins of Ost (508) 420-5482 Acce ance f Pro osal No. 25-62525 T ove ces pe ' cati s and conditions are satisf. tort' . d ar her y accepted. Y ork as specified. Payment i e b v . Signature Date *Removal of additional layers of roofing not forseen wi res tin additional fees of$125 per Sq *All quotes are valid for 20 days 1a Commonwealth of Massachusetts > Division of Occupational Licensure Board of Building Re ulati n►s and Standards Const . rvisor CS•100393 spIres: o21U3/Zo2$ ,...„,.....,...„iI RiC HARD P 198 FIVE C :1...- I , , . Y .. .i..: , CENTERI/IL ,.. r , 4 Commissioner ,...csimi,.e f 1 ,�...- AUTO • THE COMMONWEALTH OF MASSACHUSETTS • Office of Consumer Aff =� ;• Business Regulation 1 Federal uIlte 720 Bost - 110 Home Irrl •.- ion » dam. V. z z; 7. t a ° Type:• 18860uel �s S�T' ' �o ��. } d w RI HARD P Cc7GAULT JR Its —' *,! b a}� £k c wn DiB/ARCAZFAULTROOFlNQ&REPAIRS _ y ''''"Li, ° r ; t TR RICHARD CORNERS RD `� — // r7 s a CENTERVR LE,MA D2Eaz � / meo • I �e rr �' r 4t� fyy �a ''a x'! *�; v qL "`.sK fir. 1 e{ .'•°�,11 ,C a�, v.yx � MARC _Sy Updals Address end MllRllCud - V �Oa1 � p i , s, C -coMxwNWEA- _MAssn f ll k a s �1 f x .. �,a�.; TRe LTH OF_ . ceusens I I p r DRks of Consumer _ E EueMeas RepulaYen RapbpetJon veed tar N Adual uw only IxterNhs g�''< f , .t.1 ^s �p k� HOI! i s�hedon dala Iffound rstam to: I a , ! 26rfk- f° ;£;tr ; �.. i i 'fl; a".t� ! Federal6lrM-S�d1e770udBuelneseReguWlon x ...r, u..., z" � ^-s+rs EoMae.MAfoffO • I RICHARD PCAZEA D/WA R CAZEAULT 40.1, i, + • 7,14 RICHARD P.CAZEAU J '=c .J ,0 , i iBe R1fE CCRWER3 U CENTERVIU.E,MA Underserretery I t'btYdld Signature t 0 s ACCORD CERTIFICATE OF LIABILITY INSURANCE DATE 3/ MIS 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 POUCHES BELOW. This CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT REI1.THE.ISSUING Ui84RERf8)r,AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if the cartMcate holder is an ADDITIONAL INSURED,the polcy(tes)must have ADDITIONAL INSURED provisions or be endorsed. I SUBROGATION IS WAIVED,subject to the toms and cardigan of the policy,certain policies may require an endorsement A statement on this certMcate does not confer rights to the certificate holder in lieu'Mauch endorsement(s). PRODUCER CONTACT POINT INSURANCE INC "Art MILFORD OFFICE MGR 207 MAIN ST itte.tit 508 4225370 I M.Nok 508-422.5371 MILFORD MA 01757 ADORat MATEUSWOINTINSURE.COM • OSURERiai*FFORDING COVERAGE MAR:• INSURER A:Utica First Insurance Co. 1532E AC PRO BUILDERS INC SOURER :Berkshire Hathaway Guard Insurance 26 SMITH STREET BNURERC: ATTLEBORO MA 02703 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER 154031638 REVISION NUMBED THIS 13 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TIE INSURED NAMED ABOVE FOR TIE POUCY PERIOD INDICATED. NOTIMTHSTANDINO ANY REOURE ENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO IM4CH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY TIE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL TIE TERMS a�OOCCLUSIONS AND CONDITIONS OF SUCH POLICIES.WAITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTa- TYPE INSURANCE RED WAD, POLICY RUINER S A DWFTWO, UNITS A X COMMERCIAL GENERAL UAIUJTY ART3001573370 3t17,2025 3t17t 2O EACH OCCURRENCE $1,030,000 DAMAGETOCtAaaHMADE'OCCUR SS( occonswe) 350,000 LIED UP(Any me penal) $5,000 PERSONALS AEI INJURY $1,000,000 S��E'''�� .AGGREGATE LIMIT APPUESPErk GENERAL AGGREGATE SZ.000,03D 4 POUCY❑ l.0 PRODUCTS-COMPAP AGO s2,000,000 AUTOIIOe1LEUAeaflY COMBINED Mtl th LR1rT 5 ANY AUTO BODILY INJURY(Per parson) f —OARED SCHEDULED BODILY INJURY(Per oxidant) $ AUTOS ONLY AUTOS MIRED NONOSNED PROPERTY SAWA*AUTOS ONLY Mew&SddeW $ $ _U U OCCUR EACH OCCURRENCE $ e use CLAMS#MDE AGGREGATE S