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HomeMy WebLinkAboutZP-18-298 - 0029 Whiteface Street 7/30/2018 (3)CITY OF SOUTH BURLINGTON ZONING PERMIT APPLICATION Applicant: -1 Application No: !/ [office use only] Applicant Mailing Address: ��A ;'drain '� �raei, at.eens kLACW W? 12yj"( I Applicant Email: Chime)�IGJ�� aOeXitlrAf llL�2f:CdM Daytime phone: Siff-3Oq-278 i Property Street Address: 2XI W kJ 4-Facx (- -ro►Q Bad'Jin iaN SIr OS40A VT 05403 Property Owner: M r1 skew 6 rdw N Parcel Size: Property Owner Mailing Address: 'jr me- as u%jelE- Tax Parcel ID No. t'7V-1-Vtk729 1. PROPOSED project including building dimensions (describe): R eS iA en�)tx) , non- S fLjuf q, ) 2. Present USE(S) of the property: ®Single family home on its own parcel ❑ Other (please state the USE per Land Development Regulations- retail, general office, multifamily residential, etc.): 3. List all present structure(s) on property (describe including dimensions or square footage of each): 4. Does the project include a proposed change of USE? � No (the property will still be used for the same purpose) ❑Yes (please state proposed changed or added USES per Land Development Regulations- retail, general office, multifamily residential, etc.): 5. ESTIMATED total cost of improvements (materials and labor): $ 22.0S0tQQ 6. Building footprint - i.e. size in sq.ft of main floor of house and all attached and detached structures including enclosed breezeways, garages, and sheds (describe): Existing: Proposed: 7. Total square feet of other impervious surfaces on site (i.e. driveways, patios, decks) Existing: Proposed: 8. ATTACH SKETCH PLAN OR SITE PLAN (not required if project consists ONLY of interior renovations or replacement of existing roof, siding, etc. in the exact same size) 9. APPLICANT/OWNER CERTIFICATION The undersigned property owner hereby consents to submit this application and understands that if the application is approved, the I Zoning Permit and any attached conditions will be binding on the property. * F ) etas c s`ee cx-4)y k ad p ra x�j Firm Property Owner Signature IPRINT NAME Date The undersigned applicant hereby affirms that the information presented in this application is true, accurate and complete. ca, r �� � 7l'�°7 I zo Applicant Signature PRINT NAME Date OFFICE USE ONLY — ADMINISTRATIVE OFFICER ACTION — OFFICE USE ONLY 9�/ DATE Received: lhu0 / FEE Received: $ D` 7 Identification of zoning district: ✓ Identification of proposed use: PROPOSED USE TYPE:. Permitted Conditional Date of SITE PLAN approval/denial Approval Date Denial Date Date of SUBDIVISION approval/ denial Approval Date Denial Date Date of CONDITIONAL USE approval/ denial Approval Date Denial Date Date of appeal VARIANCE approval/ denial Approval Date Denial Date Date of MISCELLANEOUS approval/ denial Approval Date Denial Date Provided applicant copy of URBEC or VCBE Standards Handbook orDNot Applicable FINAL ADMINISTRATIVE OFFICER ACTION �jZ O N I P I T APPROVED /Ell Ap roval D to Administrative Officer's Signature Permit EFFECTIVE date Permit EXPIRATION date DENIED REASON for DENIAL Denial Date Administrative Officer's Signature Notice of Appeal Rights: Any interested person may appeal this decision by filing a written Notice of Appeal with the clerk of the Development Review Board within fifteen [151 days of the date of this decision. The notice of appeal must be accompanied by a filing fee of $223.00. This permit does NOT authorize commencement of any development activity approved by the permit until the permit takes effect as set forth above. Site modifications and improvements made prior to this permit becoming effective may be subject to removal land site restoration if a timely appeal is commenced. NOTE: The applicant or permittee retains the obligation to identify, apply for, and obtain relevant state permits for this project. Call (802) 879-5676 to speak with the regional Permit Specialist. apex," r AUTHORIZATION "TO ACT AS AGENT FOR" I, t' (Ake—w griwo owner of the premises located at: �A) h; e#ac-e Se- Town of Tax Parcel hereby designate: Apex Saar Power , as my AGENT regarding my Permit Application for: Res 1enk;�xl + non- S�-ruci �r4� rP-ro�f3n� nro ; �—°°`"sue°° �i 1 1-71 1q .1; t�re�u►,. Date Signature DocuSign Envelope ID: 42987DE2-09FB-46FA-9365-AAA1822608DC apexroofin ,�• •�, g ADIVISIONOF APEX SOLAR PREPARED BY: Jeffrey Pignona 518-309-2786 jpignona@apexsolarpower.com PREPARED FOR: Matt and Tina Brown 29 Whiteface Street South Burlington VT, 05403 -Remove all existing roofing, including underlayment, ridge vent and drip edge PREFERRED CONTRACTOR 802-863-4184 vtbrowns@myfairpoint.net -Inspect and replace any rotten, damaged or deteriorated decking with 4- ply plywood at $2.00 per Sq. Ft. ($64 per sheet) first 2 sheets included -Re-nail all loose decking -Install new galvanized color coordinated drip edge on all eaves and rakes -Install 6 feet of OWENS CORNING WEATHERLOCK MAT ice and water barrier above all eaves and 3 foot in valleys -Install RHINO U20 synthetic roof underlayment to remainder of roof area -Replace all vent pipe flashing with aluminum/rubber gasket boots (paint pipes to coordinate with roof color) -Remove and replace chimney flashing with new color coordinated aluminum (if applicable) -Install OWENS CORNING ARCHITECTURAL TRUDEFINITION DURATION style shingles (color to be chosen by homeowner) -Install OWENS CORNING VENTSURE 4' STRIP HEAT AND MOISTURE ridge vent with color matched OWENS CORNING HIP AND RIDGE shingle cap -Clean and remove all job related debris from site. Sweep ground with magnet for stray nails daily -Includes OWENS CORNING PREFERRED PROTECTION 50 YEAR LIMITED WARRANTY -Includes 10 year workmanship warranty NOTE: -This quote is for the main house only- no outbuildings *An additional $2/sq ft will be charged for any roof deck replacement. *If additional layers of roofing are found underneath the visible layer, additional labor and dumping fees will apply. 50 % Balance due upon Procurement and Scheduling. 50 % Balance due on Date of Completion. 844-744-2739 1 64 Main Street, Queensbury, NY 12804 1 www.apexsolarpower.com STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1 a. Legal Name & Address of Insured (Use street address only) Demarse Electric Inc 64 Main Street Queensbury, NY 12804 Work Location of Insured (Only required if coverage is specifically limited to certain locations in New York State, i.e., a Wrap -Up Policy) 2. Name and Address of the Entity Requesting Proof of Coverage (Entity Being Listed as the Certificate Holder) City of South Burlington 575 DORSET STREET SOUTH BURLINGTON, VT 1 b. Business Telephone Number of Insured (518)309-2786 Ic. NYS Unemployment Insurance Employer Registration Number of Insured Id. Federal Employer Identification Number of Insured or Social Security Number 273913685 3a. Name of Insurance Carrier Hartford Underwriters Ins. Co. 3b. Policy Number of entity listed in box "la" 6560UB91`62512A17 3c. Policy effective period 4/13/2018 to 4/13/2019 3d. The Proprietor, Partners or Executive Officers are included. (Only check box if all partners/officers included) X all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box "3" insures the business referenced above in box "la" for workers' compensation under the New York State Workers' Compensation Law. (To use this form, New York (NY) must be listed under Item 3A on the INFORMATION PAGE of the workers' compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box "2". The Insurance Carrier will also notify the above certificate holder within 10 days IF a policy is canceled due to nonpayment ofpremiums or within 30 days IF there are reasons other than nonpayment ofpremiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.) Otherwise, this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in box "3c ", whichever is earlier. Please Note: Upon the cancellation of the workers' compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Linda Abodeely (Print name of authorized representative or licensed agent of insurance carrier) Approved by: ft�t 4- . ' tom• July 27, 2018 J (Signature) (Date) Title: President Telephone Number of authorized representative or licensed agent of insurance carrier: 518-793-3131 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2 (9-07) www.wcb.state.ny.us r. Workers' Compensation Law Section 57. Restriction on issue of permits and the entering into contracts unless compensation is secured. 1. The head of a state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, and notwithstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any compensation to any such employee if so employed. 2. The head of a state or municipal department, board, commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter. STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF INSURANCE COVERAGE UNDER THE NYS DISABILITY BENEFITS LAW PART 1. To be completed by Disability Benefits Carrier or Licensed Insurance Agent of that Carrier Ia. Legal Name and Address of Insured (Use street address only) lb. Business Telephone Number of Insured Demarse Electric Inc (518)309-2786 64 Main Street Queensbury, NY 12804 1 c. NYS Unemployment Insurance Employer Registration Number of Insured 1 d. Federal Employer Identification Number of Insured or Social Security Number 273913685 2. Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carver Coverage (Entity Being Listed as the Certificate Holder) Standard Security Life Ins. Co. of NY City of South Burlington 3b. Policy Number of entity listed in box "la": 575 DORSET STREET R16494-000 SOUTH BURLINGTON, VT 3c. Policy effective period: 10/1/2017 to 10/1/2018 4. Policy covers: Q All New York Disability Benefits Law a. of the employer's employees eligible under the b. Only the following class or classes of the employer's employees: Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS Disability Benefits ins nce co�veraage as desc ibed above. LP I j'a, " 1� Date Signed July 27, 2018 By ' ' (Signature of inAirance carver's authorized relfsentative or NYS Licensed Insurance Agent of that insurance carver) 518-793-3131 President Telephone Number Title IMPORTANT: If box "4a" is checked, and this form is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent of that carrier, this certificate is COMPLETE. Mail it directly to the certificate holder. If box 114b" is checked, this certificate is NOT COMPLETE for purposes of Section 220, Subd.8 of the Disability Benefits Law. It must be mailed for completion to the Workers' Compensation Board, DB Plans Acceptance Unit, 20 Park Street, Albany, New York 12207. PART 2. To be completed by NYS Workers' Compensation Board (Only if box "4b" of Part 1 has been checked) State Of New York Workers' Compensation Board According to information maintained by the NYS Workers' Compensation Board, the above -named employer has complied with the NYS Disability Benefits Law with respect to all of his/her employees. Date Signed By (Signature of NYS Workers' Compensation Board Employee) Telephone Number Title Please Note: Only insurance carriers licensed to write NYS disability benefits insurance policies and NYS licensed insurance agents of those insurance carriers are authorized to issue Form DB-120.1. Insurance brokers are NOT authorized to issue this form. DB-120.1 (5-06) Additional Instructions for Form D13-120.1 By signing this form, the insurance carrier identified in box' 3" on this form is certifying that it is insuring the business referenced in box "la" for disability benefits under the New York State Disability Benefits Law. The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed as the certificate holder in box "2". This Certificate is valid for the earlier of one year after this form is approved by the insurance carrier or its licensed agent, or the policy expiration date listed in box "3c ". Please Note: Upon the cancellation of the disability benefits policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of NYS Disability Benefits Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Disability Benefits Law. DISABILITY BENEFITS LAW §220. Subd. 8 (a) The head of a state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in employment as defined in this article, and not withstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that the payment of disability benefits for all employees has been secured as provided by this article. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any disability benefits to any such employee if so employed. (b) The head of a state or municipal department, board, commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in employment as defined in this article, and notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that the payment of disability benefits for all employees has been secured as provided by this article. ACORilr CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 07/27/2018 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 LOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED EPRESENTATIVE 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 CONTACT HOUse NAME: Hughes Insurance Agency, Inc. PHONE (518) 793-3131 FAX 518 793-3121 AIC No Ext : AIC, No : ( ) 328 Bay Road E-MAIL ADDRESS: PO BOX 4630 INSURER(S) AFFORDING COVERAGE NAIC # Queensbury NY 12804 INSURER A: Southwest Marine & General Insurance Company 12294 INSURED INSURER B : Preferred Mutual Insurance Co. 15024 Demarse Electric Inc & Apex Solar Power LLC INSURER C : 64 Main Street INSURER D INSURER E : Queensbury NY 12804 INSURER F : UUVtKAtitS CERTIFICATE NUMBER: 1 f-'Its (waster Pr%nctnW ul lu mco. 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 LTR TYPE OF INSURANCE AUDLSUBR INSD WVD POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MM/DDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS Fx_] 100,000 -MADE OCCUR PREMISES Ea occurrence $ MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 A PK201600005353 11/01/2017 11/01/2018 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 RPOLICY X PRO JECT ❑ LOC PRODUCTS - COMP/OP AGG 2,000,000 $ $ OTHER: i AUTOMOBILE LIABILITY SINGLE LIMIT $ 1,000,000 IANYAUTO Ee aBINEDt BODILY INJURY (Per person) $ B OWNED SCHEDULED AUTOS ONLY X AUTOS PCA0100717257 10/08/2017 10/08/2018 BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY X AUTOS ONLY X PROPERTY DAMAGE Per accident $ X UMBRELLA LIAB X OCCUR FACH OCCURRENCE $ 5,000,000 $ 5,000,000 A EXCESS LIAB CLAIMS -MADE UM201600002418 11/01/2017 11/01/2018 DED I X1 RETENTION $ 10,000 -AGGREGATE $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY y I N STATUTE ER E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? N IA E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS below Installation Floater A Leased Rented Equipment IM201400002607 11/01/2017 11/01/2018 Limit / $2,500 deductible 800,000 Limit / $1,000 deductible 200,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Subject to all policy terms, limitations and conditions: Certificate Holder is Additional Insured when required by written contract, agreement or permit. City of South Burlington 575 DORSET STREET SOUTH BURLINGTON W SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ��I fya..tu G� cncu. ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD