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HomeMy WebLinkAboutBLDX-26-930 applicaiton RECEIVED ' Office Use Only og,---'Yak .._.. __.__. .fix °� AUG i 7 2026 Permit# X—ate— 4 0 Q , i Amount Jl./BUILNPi *4.;11:1",i, �-°RPORAto`b.,- BY�. dt. _ .1 411 41 -...J EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: � .,4/ 4j, /4/L/1460,-.(1,—.. OWNER: dvN�ME 4 f`s PRESEOf LES Ll 1/ TEL. # CONTRACTOR: Cyv./5 41.4.-Q ' ZE4 , 1r' )6JNAME , IJLING TEL.#) EMAIL: / lovFe ‘&4_,4,,,,f4, . I /'~ t! sidential ❑Commercial Est.Cost of Construction$ jr• ;f ) A J Homeowner is Applicant? Yes No Home Improvement Contractor Lie.# �/ 3,l )� Construction Supervisor Lic.# Q7i7/J WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate required) Wood Stove Siding: #of Squares ✓J Replacement windows: # Replacement doors: # Roofing: #of Squares 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: �"`^" 'Location ��K�"'�ad ty I declare under penalties of perjury that the statements herein contained are true 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 f my license and for prosecution under M.G.L.Ch.268,Section I. Applicant's Signature: Date:J /," 0)k-7 Owners Signature(or attachment) Date: Approved By: Date: Building Official(or designee) Rev 6/24 The Commonwealth of Massachusetts = / Department of Industrial Accidents Office of Investigations Lafayette City Center tit." 2 Avenue de Lafayette,Boston,MA 02111-1750 <444'; www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: City/State/Zip: 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' [No workers'comp,insurance comp.insurance.t 9. Building❑ addition required.] 5.❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑I am a homeowner doingall 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.]I. 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. 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: City/State/Zip: 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: 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): 10Board of Health 20 Building Department 31:City/Town Clerk 4.0 Electrical Inspector 5Eklumbing Inspector 6.0Other Contact Person: Phone#: '° The Com m on wealth of Massachusetts Department of Industrial Accidents , {1.il'";' - Of ice o Investigations (I �': Lafayette City Center �ii I M11 • 7,.... y ,r '•" / 2 Avenue de Lafayette, Boston, MA 02111-1750 www.mass.gov/dra Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): - frV 5 /4'vi.e i.ay.114,.,`,-/3 Address: P 0 . (zo i l': City/State/Zip: 6,4eA,,A1Vo..., 1 1f 6 ab' a Phone #: ;5b 7)(33 )13 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. El 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' 9. ® Building addition [No workers' comp. insurance comp. insurance. t required.] 5. ❑ We are a corporation and its 10.❑ 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.❑ Roof repairs insurance required.] t 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. 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. p y rikrUnPkf,an y .. Insurance Com Name: 1 lam; C.t i* ..�,'�`, e ' ) 0 O v Expiration Date: ) Policy # or Self-ins. Lic. #: a / 07OI- I Job Site Address: 7/-1/ 54iJ,e4. 41 f,- City/State/Zip: .lAi4) 1elyss4' rl4413 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 fme 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: __Pf---j1.4.1 Phone #: 9? ]HH'u /a1 -" 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 31:City/Town Clerk 4.0 Electrical Inspector 5.0Plumbing Inspector 6.0Other Contact Person: Phone #: v1 Il }t k .1 S i p a' 'i S 1, . I 'lV{' ' ' - .--- HOME IMP OV M T5 P11. 508.328.1635 Exterior Remodeling Experts BBB. `AtGROR1TEP ,?BUSINESS,= Web: www.thomashomeimprovements.net Fully Licensed & Insured P.O. Box 177 Construction Supervisor Lic #99913 Centerville, MA 02632 THOMAS HOME IMPROVEMENTS-PROPOSAL TO PERFORM THE FOLLOWING WORK: Location of proposed work: Marguerite L Cadman TRS 114 Springer Lane West Yarmouth, MA 02673 Date on which construction should begin: September 2026 The homeowner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that cannot be avoided by the contractor shall not be considered as a violation of this contract. The contractor agrees that when such delays become known to the contractor, the contractor will advise the homeowner as soon as possible. The homeowner hereby acknowledges that in certain remodeling work,the demolition process may reveal defects in the existing structure which must be repaired, creating additional work which may need to be conducted in order to complete the work described in this contract. In such a case the homeowner agrees that the duration of the work and the scheduled date of completion may differ, and that such variation is not to be considered a violation of this contract. Cost for Labor& materials under this contract: $8,890.00 Proposal to install standard eastern white pine rough faced siding on front&side garage walls. (Siding to match existing) Proposal to install AZEK PVC on both upper rake members & corner boards. In the event that rot/other unforeseen damage is discovered upon stripping the siding or trim the homeowner agrees and authorizes replacement or restoration. In addition to the above contract price, the homeowner agrees to compensate the contractor for any repairs or restoration at the hourly rate of$95.00 for a carpenter plus the cost of materials. Thank You for Giving Us the Opportunity to Help You improve Your Project • Siding&trim to be striped and cleaned of all old siding&debris. • 1x12 standard eastern white pine siding be installed in accordance with the best practices to ensure warranty. • AZEK PVC trim to be installed with CORTEX screws&plugs. • 10 Yard dump trailer will be needed on site;and be removed at completion of the project. • The contractor will be responsible for all building permits needed at the property. NOTICE REQUIRED BY LAW With the agreement of the contract$500.00 of estimate is due. Further payments under this contract are as follows: One-half of the estimates are due at the start,and remainder due at completion of the job. Balance of all materials and labor shall be payable in full upon completion of work described in this contract.Payment as agreed upon shall be made when due.Any payments which are delayed shall be subject to a finance charge of 1.5%per month. The contractor warranties the workmanship completed under this contract for a period of ten years from the date of completion. During the stated warranty period the contractor shall be responsible for the service of the repair or adjustment,but the contractor shall not be responsible for the normal maintenance,repair due to abuse,misuse,or normal wear and tear,which shall be the responsibility of the homeowner. All warranties for the materials supplied by the contractor shall be passed directly to the homeowner.The homeowner may be required to register or mail in such warranty card or evidence of ownership in order to activate such warranties.Homeowner failure shall not create any responsibility for the contractor under the warranty provisions;the choice of repair or replacement shall be at the discretion of the contractor. The homeowner acknowledges that the form,content,and notices contained in this contract are intended to comply with the applicable portions of the Mass.General Law Chapter 142A,and regulations promulgated there under.In the event of any instance of non-compliance,only such portion shall be invalid,and the remainder of this contract shall be in full force effect.In addition,any such portion not in compliance shall be read and interpreted so as to have its intended meaning to the maximum extent allowed under such law and regulation. Signed as a sealed instru en n this date:08/14/2026. Troy Thomas(Contractor) y �/ v Marguerite Cadman(Homeowner) .1 1 ACc7RD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYYI ‘1....f 05/05/2026 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 CONTNAME: Donna Donna Ostrowski Mark Sylvia Insurance Agency, LLC (���>u4,ExI):_ (508)957-2125 _-_-- I(AA/c,No): (508)957-2781 -__ 404 Main Street EMAIL ADpRESS_ mark@marksylviainsurance.com ks Iviainsurance.com mar Centerville, MA 02632 INSURER(§)AFFORDING COVERAGE t NAIC# ---- ------ ------- INSURER a : Farm Family Casualty Insurance INSURED • INSURER R : Thomas Home Improvements LLC INSURER C PO Box 177 INSURER o - ---- — ---- ----T--- - — : Centerville, MA 02632 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 I ;ADDL SUBRI ! POLICY EFF i POLICY EXP ; - — ------ -- - LTR I TYPE OF INSURANCE I INSD 1AlVD 1 POLICY NUMBER - (MM/DDIYYYYL j IMAA/DDIYYYY){ LIMITS •X I COMMERCIAL GENERAL LIABILITY I i iI EACH OCCURRENCE l $ 1,000,000 - DAMAGE TO RENTED CLAIMS-MADE j A I OCCUR ! ( PREMISES(Ea occurrence/ I $ 100,000 !- L_-J -_.�__ - j I I I MED EXP(Any one person) $ 5,000 , A I - -- — N i N 12001 X 1416 5/01/2026 5/01/2027 '' PERSONAL&ADV INJURY 1 $ 1,000,000 t GEN'L A.GGREGATE LIMIT APPLIES PER: j ) ( GENERAL AGGREGATE $ 2,000,000 I-X POLICY ! PRO- 1--1i 1 ` I ! I JECT i. i LOC ! I I ! PRODUCTS-COMP/OP AGG I $ 2,000,000 I I OTHER: I I : t $ t AUTOMOBILE LIABILITY i t ! I COMBINED SINGLE LIMIT ! $ t ' (Ea accident) t ' ! ` ANY AUTO s ; i BODILY INJURY(Per person) $ -- -- -- t ' OWNED ' -1 SCHEDULED I L-_ AUTOS ONLY i AUTOS t I I BODILY INJURY(Per accident)r$ I HIRED NON-OWNED I 4 ' PROPERTY DAMAGE fi - y ;__._J AUTOS ONLY i AUTOS ONLY s 1 (Per accident) i t $ i . UMBRELLA LiAB ti �� OCCUR ! S EACH OCCURRENCE U I EXCESS UA6 I ! ? i F_-�,- T.---- --- _ CLAIMS MADE} 4 ! I AGGREGATE $ I 1 DED RETENTION$ ! + __._ $ i I WORKERS COMPENSATION ; , ' PE-R OTH- AND EMPLOYERS' LIABILITY Y IN I I LSTA.TLITE ER ANY PROPRIETOR/PARTNER/EXECUTIVE i E.L. EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBER EXCLUDED? I N I I N(A I N 2001 W8053 5/01/2026 55/01/2027 (Mandatory in NH) t E.L. DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under - ----- - DESCRIPTION OF OPERATIONS below { ! E.L.DISEASE-POLICY LIMIT $ 1,000,000 • jj +jt i I 1 t 1 5 { i DESCRIPTION OF OPERATIONS►LOCATIONS 1 VEHICLES (ACORD 11)i. Additional Remarks Schedule,may be attached if more space is required) Carpentry Insurance coverage is limited to the terms, conditions, exclusions, other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to nave altered, waived or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Barnstable Building Dept, ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street , AUTHORIZED REPRESENTATIVE Hyannis MA 02601 Fax: Email: © 1988-2015 ACORD CORPORATION, An rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Hori` xi W, . verneot Contractor Reg[ Card qe, ._ J Registration valid for use type,only before the expiration date, ;i s Type: Limited Liability Company(LLC) Number: 213005 Expiration: 08/22i2028 ti issued to: . z ` 1 a T.x y Thomas Home improvements, LLC Troy A Thomas 499 Nottingham Drive 3 li Centervfille, MA 02632 .F,to-, f. ., `A:::;_ ,,;,x_ Office of Consumer Affairs&Business Regulation Layla R. D`Emilia 1 Federal St.,Suite 0720,Boston,MA 02110-2012 Undersecretary • Licensee Details Demographic Information Full Name: TROY A THOMAS Owner Name: License Address Information _ City: Centerville —; State: MA Zipcode: 02632 Country: United States License Information License No: CSSL-099913 License Type: Construction Supervisor Specialty Profession: Building Licenses Date of Last Renewal: 4/9/2026 Issue Date: 7/3/2008 Expiration Date: 4/13/2028 License Status: Active Today's Date: 5/4/2026 Secondary License Type: Doing Business As: Thomas Home Improvements Status Change Reason: License Renewal Prerequisite Information Licensee: THOMAS,TROY A Relationship: Attribute Of License No: CSSL-099913 Licensee: THOMAS,TROY A Relationship: Attribute Of License No: CSSL-099913 No Available Documents