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Home My WebLink About121 Camp St #82 B-09-819 Building PermitsSection 4 - Workers' Compensation Insurance Affidavit (M.G.L. C. 152 5 25U (U) 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 .......... Section 5 - Description of Proposed Work (check all applicable) New Construction ❑ No. of Bedrooms No. of Bathrooms Existing Bldg. ❑ Repair(s) ❑ Alterations ❑ Addition ❑ Accessory Bldg. ❑ Type Demolition Other Specify: Brief Description of Proposed Work: OZFlNsFC:e or Costs Estimated Cost (Dollars) to be Check Below completed by permit applicant ❑ Conservation -Commission Filing (if applicable) ❑ Old Kings Highway &Historical Commission approval (if applicable) To be Completed When for Building Permit Section 6 - Estimated Construction Item 1. Building 2. Electrical 3. Plumbing / Gas 4. Mechanical (HVAC) 5. Fire Protection 6.Tot al=(1+2+3+4+5) 7. Total Square Ft. (new houses & additions) Section 7a - Owner Authorization - Owner's Agent or Contractor Applies I as owner of the subject property to act on hereby authorize my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date Section 7b - Owner/Authorized Agent Declaration , as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. A—ffeC7-) Print name Sianature of Owner/Agent Date 9-15-99 2 of 2 t• ��C t V ♦• t V l i l l 1X lrl V V 1 1 1 oy BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM 'LEASE PRINT. Job Location: i Z/ C/I A1,P It/ - i1WaW6V 1Y Number Street Village Owner of Property: ` �' �` Construction Supervisor.��Z Name License No. Phone No. Address: 16 -<-> W4, iJ G I eCG,e� Myq 0 UbN Licensed Designee: (If other than Supervisor) Name 2.15 Responsibility of each license holder: License No. 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building and structures only pursuant to the state building code and all other applicable laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Any licensee who shall willfully violate subsections 2.15.1, 2.15.2 or 2.15.3 or any other section of these ntles and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes No If you have checked yam, please indicate the type coverage by checking the appropriate box. A liability insurance policy 0 Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 152 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Sopature of Owner Owner's Cwner J Agent J Si};nautre: Building Official Approval: - Horizon Partners, LLC 549 South Street Quincy, MA 02169 Phone (617) 376-0100 Fax (617) 376-0101 To: Town of Yarmouth Building Department Subject: Completion of Units 82 & 90 Mill Pond Village Date: February 10, 2009 From: Alan Perrault, Owner's Representative Horizon Partners, LLC was hired as Owner's Representative/Manager in February of 2008 by the Massachusetts Housing Finance Agency (MHFA) who became the Owner of the remaining real estate/assets at 121 Camp Street in Yarmouth when they foreclosed on same last Spring. Since that time, we've been helping MHFA stabilize the condo association by collecting delinquent association dues and getting miscellaneous. site related matters addressed. In this regard, MHFA wants to cap the 3 exposed foundations (we had obtained engineer's letter stating same could be done safely) and has hired a licensed contractor to complete the remaining items needed to obtain occupancy permits for Units 82 & 90. The licensed contractor who will be overseeing the remaining work on these two units is Matthew Dunhill of Swain Circle, Mashpee, MA. As Owner's Representative for this property, we authorize the Town of Yarmouth to issue the requisite permits necessary to Mr. Dunhill and his licensed plumbing, gas and electric sub -contractors to perform the remaining work needed on these properties to meet occupancy permit status. Sincerely 6LA Alan D. Perrault The Commonwealth of Massachusetts Department of Industrial Accidents • Offlce of Investigations UT 600 Washington Street Boston, MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Awlicant Information Please Print Legibiv Name (BusineWOrganizadon/Individual): M-o-lT �Ha ,l -�> (%A)H II -(-- Address: 16 `i t 2 6Gt7 City/State/Zip: /�1 f-/,�> , /M 0047111 Phone #: S- :5� wq/ Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. am a general contractor and I loyees (full and/or part-time).• have hired the sub -contractors 71a7mp 2. a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.$ required.] 5. We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, §1(4), and we have no employees. [No workers' comp. insurance reouiredl Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. Demolition 9. Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.0 Roof repairs 13.❑ Other 'Any applicant that checks box # 1 mutt 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 subcontractors and state whether or not those entities have employees. If the sub -contactors 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. M 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 S 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 correm Phone o: 57M 539 '79`71 use only. Do not write in this area, to City or Town: or town officiaL 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 #: i BUILDING TOWN OF Y A R M O U T H ELECTRICAL GAS 1146ROUTE28 SOUTHYARMOUTH MASSACHUSETTS02664-4451 PLUMBING Telephone (508) 398-2231, Ext. 261 — Fax (508) 398-2365 SIGNS BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at c1qNP :5 yf�/L Ori -MAR Work Address is to be disposed of at the following location: 1 ' 0 Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Signature of Applicant Permit No. 2 Date 7/2009 09:09 Bryden & Sullivan Insurance Donna Seviour-iJudy 112 - CORD CERTIFICATE OF LIABILITY INSURANCE OP ID DS DATE (MPA/DD/YYYY) PRODUCER Bryden & Sullivan Ins Agency of Dennis Inc. 485 Route 134, PO Box 1497 So. Dennis MA 02660 EILI- Phone: 508-398-6060 Fax: 508-394-2267 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A. Commerce Insurance Company 34754 INSURER 8: Richard K. Heiligmann INSURER C. 262 Wood Road INSURERD: South Yarmouth MA 02664 INSURER E. COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS LTR D'L INSRO I TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DO/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 300000 A X COMMERCIAL GENERAL LIABILITY XT7046 11/03/08 11/03/09 PREMISES(Eadccurence) $ 100000 10 CLAIMa MADE I X OCCUR �J HIED EXP (Anyone pe;5on) $ 5000 PERSONAL&ADVINJURY $ 300000 GENERAL AGGREGATE $ 600000 AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMP/OP AGG $ 300000 POLICY PRO- LOC []L AUTOMOBILE LIABILITY ANYAUTO COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY- EA ACCIDENT $ OTHER THAN EA ACC $ ANYAUTO $ AUTO ONLY: AGG EXCESSNMBRELLA LIABILITY EACH OCCURRENCE $ OCrUR ❑ CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ WC STATU- 0 H- WORKERS COMPENSATION AND TORY LIMITS ER E.L. EACH ACCIDENT $ EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L- DISEASE - EA EMPLOYEE $ OFFICER/MEM8EP EXCLUDED? Ifies, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS PLUMBING - RESIDENTIAL iriidridf:ird•Yiy!relmslde 111I1[111111=14wi\I1010 YARM003 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 50 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR TOWB OF YARMOUTH 1146 MAIN ST REPRESENTATIVES. AUTHORIZED REPRESENTATIVE S. YARMOUTH MA 02664 Dennis Office AUC)KU ZO (ZUUIIUS) %V vrcv %Iwr%rvrcnl IwIl Iwa I ,rlullglll U,lClll - LFUI).tl llllu"t 111 ruinic 3aici% --71.��/!! o�aoeaa/ivael1a ''� Board of Building Regulations and Standards Board of Building Regulations and Standards Construction Supervisor License i HOME IMPROVEMENT CONTRACTOR License: CS 64982 Registrar -= 125982 Restricted to: 00 Expiration: 4!$/2010 TYX 264908 MATTHEW M DUNHILL Type; Individual + 16 SWAIN CIR i MATTHEW M. Dt3NHILL ' . 44 MASHPEE, MA 02649 MATTHEW DUNMLL - - 16 SWAIN CIR•tr�W� Expiration: 7/3/2010 MASHPEE, MA 02649 Administrator • - (irmmissivncr Tr#: 28444 0 oR r TOWN OF YARMOUTH Building Department Town Hall •�,,,, a Yarmouth, MA 02664 (508) 398-2231 ext.261 BUILDING PERMIT TRANSMITTAL Temp Permit No.: T-09-204 Applicant Name: Horizon Partners, LLC Applicant Phone: 6173760100 Building Location: 0121 CAMP ST Unit 82 Owner's Name: MHFA Owner's Addres 1 Beacon Street Boston MA 02108 Owner's Telephone: (617) 854-1000 REVIEWED BY: (OFFICE USE ONLY Recorded By: Ic Permit Fee: $35.00 Deposit Rec: $35.00 Payment Type: Cash ChkNo.: 0 Net Owed: $0.00 Application Date: 2/19/2009 Issue Date: Expiration Date comments: Mapi11-0t: U44.21.1.0 permit transfer - new construction: 2 baths, 3 bedrooms, 2 diningroom, 1 kitchen, 1 livingroom as per plans dated 05/15/09. Refer to permit # B- 06-1399 1. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT: DATE: N/A: 5. BUILDING DEPARTMENT: DATE: N/A: 6. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE COMMENTS: RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: Date Printed: 2/19/2009 ONE & TWO FAMILY ONLY - BUILDING PERMIT O APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING �C Toi,cn ot' Yarmouth Building Department 0 MATTACHEESij1 146 Route 28 • Y i-motith, NIA 02664-4492 • 'Fcl: (508) 398-2231 x261 • Fax: (508) 398-0836 Office Use Only14ndorsement Planning Board Information Assessors Department Information: Permit No. 3 Daten Type Map Lot > Permit Fee $ 3 Sri Date,4rding Date New Deposit Rec'd. $ 3Sfnbaten�o1.4 Property Dimensions: Net Due $ er Lot Area (sf) Frontage (ft) Lot Coverage This Section for Office Use Only Buildin Permit Number- Date Issued: Signature: Bull ' icial Date Certifica�'S607- is upancy required Section 1 - Site InfortVation Use Group: R-4 Type: 5-B 1.1 Property Address: j21 C A or VN 1.2 Zoning Information: P2 -'ZS Zoning District 2_N Proposed Use 1.3 Building Setbacks (ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.4 Water Supply (M.G.L. c. 40. S 54) Public >4 Private 1.5 Flood Zone Information: Comments: Zone: BFE: Section 2 - Property Ownership/Authorized Agent 2.1 Owner of Record: j-i F f4 , Name rant) r* ex) 57 rev C�7'dy1/ /VJ� Mailing Address O-Z 1 O -' Signature G 1"7 Telephone $s � /wo j Fax 157 �o� � E-m it r,�I 2.2 Authorized Agent: DQr P> L LC 9 Sovt�j S� aulit ,+cq o Name (print) Mailing Address Signature �Telephone 7 ? X ol'6 0 Fax (vf7 S6-7 n ►g f E l.t tj '-�1J Section 3Construction Services 3.1 Licensed Construction Supervisor: ill DINGD ---PU Ah-i r t, G-- t S ��,r A) C4 "GC v �P License Number *W Z F(�/Q,.r MK Address C1� VwY Y I Expiration Date /0 Telephone sog`S"3 1 9'/ Fax Email — DNtiG AFL • Coo 3.2 - Registered Home Improvement Contractor Company Name M/ nJN�� Registration Number 1 ZS" r Addresf(f J�Vli g / !1} f lt' �' �,/ /r7� jl"! � �/A , ` /rff /� `Z I Expqtion �v Date Telephone S 8y1 Fax E-mail ccAf 1 of 2 OVER 5