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Home My WebLink AboutBLDX-26-929 applicaiton O¢y9 RECEIVED_ Office Use Only i�, 0`. Permit#1—We—ti act AU6 17 2026 kg,---- 1 Amount�'' �t� r i BUI ING PRT E f°RPORosof` By. EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: /f C/ fp,/j/` /.. `A `" 7A"..4A V/�- '4 L74,V OWNER: / ' 1. 4, "�'4 N.) it7 �e6deNA E PRESENT ADD SS TEL. # CONTRACTOR: 77/ AS ��0 /`d'pox ' e �'� (--- NA E/ MAILIN ADDRESS ` /'1 TEL.#—` EMAIL: 4;44^S/jd tei rG / Alt p—et, 4 l y..iozi" a-i v Yr � °° esidential 0 Commercial Est.Cost of Construction$ � Homeowner is Applicant? Yes No Home Improvement Contractor Lic.# 001/,kji' Construction Supervisor Lic.# Q 7177 r WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate required) Wood Stove Siding: #of Squares y" 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: of Z,i /4""' Location of Facility 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 of y license and for prosecution under M.G.L.Ch.268,Section I. .�[ Applicant's Signature:_ 74.2-'/ Date: V -/ ve Owners Signature(or attachment) Date: Approved By: Date: _ Building Official(or designee) Rev 6/24 The Commonwealth of Massachusetts Department of Industrial Accidents -"0 Office of Investigations 1el_ 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 Name(Business/Organization/Individual): Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): I.❑ 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.❑ 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 12.0 Roof repairs insurance required.]t c.152,§1(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 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 ojjicial. City or Town: _Permit/License# Issuing Authority(check one): l❑Board of Health 20 Building Department 3❑City/Town Clerk 4.1=1 Electrical Inspector 5EIPlumbing Inspector 6.DOther Phone#: Contact Person: The Commonwealth of Massachusetts Department of Industrial Accidents 1.1:;)--7�_r; Office of Investigations _ Lafayette City Center ""ri 2 Avenue de Lafayette, Boston MA 02111-1750 / -c -= www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): - d in ell s /7d, .e v-(to<Ns S Address: ç? 6' . O)(: 1 '4 City/State/Zip: v.1\-e, "-a Phone #: sbE 7),3J /I 3 Are you an employer? Check the appropriate box: Type of project (required): 1 . Di 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' [No workers' comp. insurance comp. insurance.t 9. [' Building addition. ❑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 13.❑ Other employees. [No workers' comp. insurance required.] *My applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. 1 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: ri- ri-„,„.. . 1,--, 6/,„., 14,., -c . , Policy # or Self-ins. Lic. #: a ) 6'0 Expiration Date: J 0L I /--AN't Job Site Address: 7/4-7S 4'it ei, City/State/Zip: .W'S . I/A(404411 rl44113 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: `')LI "' ' Phone #: ]( /7 J`r 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 3❑City/Town Clerk 4.❑Electrical Inspector 50Plumbing Inspector 6.0 Other Contact Person: Phone #: 1 ®ACQRD CERTIFICATE OF LIABILITY INSURANCE DATE(MMfDDIYYYYI I `../ 05705/2026 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 1 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 he 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 root confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Donna Ostrowski _ ___ Mark Sylvia Insurance Agency, LLC PpubHONE str (508)957-2125 is,No): (508)957-2781 _ 404 Main Street ADpRess: mark@marksylviainsurance.com Centerville,MA 02632 INSURER(S)AFFORDING COVERAGE I NAIC a — INSURERA: Farm Family Casualty Insurance 1 INSURED INSURER B: Thomas Home Improvements LLC INSURER C: _ PO Box 177 INSURER 0: Centerville.MA 02632 INSURERE: 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. iADOLISUBRI POLICY EFF POLICY EXP TYPE OF INSURANCE ylSp I wvo POUCY NUMBER ;IMM/DDIYYYYI 1 IMM/DDIYYYY)1LIMITS X COMMERCIAL GENERAL LABILITY 1 EACHDAMAGEOCCURRENCETORENTED i$ 1,000,000 j 1 i I ! i CLAIMS-MADE LX I OCCUR ! PRESS FR,F Occutn,,e) ,$ 100,000 ! MED EXP(Any one person) I S 5,000 A 1 j N N 2001 X 1416 5/01/2026 5/01/2027 PERSONAL&ADV INJURY I$ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: i j GENERAL AGGREGATE [$ 2,000,000 ; I X POLICY`J JECT i I LOC i I PRODUCTS-COMP/OP AGG I$ 2,000,000 I OTHER: I `$ AUTOMOBILE LIABILITY y i COMBINED SINGLE LIMIT ,$ '(Ea accident) __— ! 'ANY AUTO s I BODILY INJURY(Per person) I$ I OWNED SCHEDULED i J • BODILY INJURY(Per accident) $ AUTOS ONLY I— 'AUTOS HIRED r NON-O M'IED PROPERTY DAMAGE ) AUTOS ONLY L ;AUTOS ONLY i ;(Per accident) $ S 1 y i 1 1 i UMBRELLA MB OCCUR i `EACH OCCURRENCE I$ 1 EXCESS UAB !CLAIMS-MADE ' I AGGREGATE $. -- ___I 1 DED I RETENTION$ ! ! :$ !WORKERS COMPENSATION ; ; I PER 1 1OTH- STATUTE ER AND EMPLOYERS'LIABILITY y/N + I ANY PROPRIETOR/PARTNER/EXECUTIVE { I E.L.EACH ACCIDENT $ 1,000,000 A l OFFICER/MEMBER EXCLUDED? N I N f A i N 2001 W8053 l 5/01/2026 : 5/01/2027 (Mandatory in NH) ( k I E.L.DISEASE-EA EMPLOYEE $ 1,000,000 I tf er DESs,describeCRIPTION OF O # } E.L.DISEASE-POLICY LIMIT I$ 1,000.000 - DESCR{PT10N OF OPERATIONS below ` 1 S I l I • DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES(ACORD 101.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 have 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: (e)1988-2015 ACORD CORPORATION. All rights reserv'ea. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Home Improvement Contractor Registration Card Registration valid for use type,only before the expiration date, Type: Limited Liability Company(LLC) Number: 213005 Expiration: 08/22/2028 = Issued to: Thomas Home Improvements, LLC Troy A Thomas 499 Nottingham Drive Centervfille, MA 02632 J Office of Consumer Affairs&Business Regulation LayJa R. D'ErTliJia 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 ; OMAS HOME IMPROVEMENTS P11. 508.328. 1635 Exterior Remodeling Experts BBB. ACCREDITED BUSINESS: Web: www.thomashomeimprovements.net Fully Licensed & Insured F.O. Box 1"77 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) / jvat q Marguerite Cadman(Homeowner) (;,,,Le.