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HomeMy WebLinkAboutBLD-19-001126 .y`°�l � Office Use Only '2 } Permitq o 3cS O y: i F Amount Permit expires 180 days from (A` J In "i- uedate RE EIVED EXPRESS BUILDING PERMIT APPLIC • TOWN OF YARMOUTH AuG 23 2018 Yarmouth Building Department 1146Route 28 BUIL ' t. !a• I. To South Yarmouth,MA 02664 sv: Mir (508) 398-2231 Ext. 12E1 CONSTRUCTION ADDRESS: //o 9 Pt'uer7eQt/axC /v. 74Ornt ctse2.174.19 Oa693 ASSESSOR'S INFORMATION: Map: Parcel: OWNER: /70-Ai h Rea 76 9 SYver 4l'Lt tae 9n-293- 93 NAME//�jPRESENT ADDRESS TEL. q CONTRACTOR: A;14-ytq'Ja14y clvt 4loCrow fk, /,'k/ cM/4Cd2)a COF-561-61ae NAME MAILING ADDRESS TEL.q p idential ❑Commercial Est.Coat of Construction S 6 9/7r 'TSS Home Improvement Contractor Lic.# „AP 19 7C1.7 Construction Supervisor Lie.# 10..7,1 6 Workman's Compensation Insurance: (check one) 0 I am the homeowner 0 I am the sole proprietor Dl have Worker's Compensation Insurance t Insurance Company Name: /bt't fly '2i u R'a a / Worker': Comp.Policy* ws 5165'?p'71z/ WORK TO BE PERFORMED Tent _ Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares ( )Remove existing*(max.2 layers) Insulation x Old Kings Highway/Historic That. ( )Replacing like for like Pool fencing 'The debris will be disposed of a t/ Pet Atopent ELS di 777//aC'i'vet )u9 0)1 a-0 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 answers) will be just cause for denial or revocation of my Iicel7;e ynrDfor pp/��ec�uy/i under M.O.L.Ch 268,Section 1. Applicant's Signature: PQ�/C/., r // Date: Sid d lir Owners Signature(or attachment) lee a /5 . ! Date: -1:7},7.//7 Approved By: % ` 11-- Date: • •ing 0' _ (or designee) EMAIL aDRESS: Zoning District: Historical District 0 Yes 0 No Flood Plain Zone: 0 Yes C No Water Resource Protection District: Within 100 ft.of Wetlands: 0 Yes 0 No ❑ Yes 0 No • RISE Engineering R I S Ei 5 Dupont Avenue,South Yarmouth,MA 02664 ENGINEERING CONTRACT - WZ 508568.1926 X-6610 FAX 508.568.1933 Page 1 PROGRAM MS CONTACT IS ENTERED INTO BETWEEN usE CLC-NES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTOMER PHONE DATE CLEAT S WORK ORDER JOHN BELL (978)273-5593 08/10/2018 258764 03602 baNVN.e liNEEI !CLUNG sTITESr 169 Silverleaf Lane 3 Leblanc Drive !LANCE WY,S CATGV WILN&u,Y,SLATE,ZIP West Yarmouth, MA 02673 Peabody, MA 01960 DESCRIPTION QTY COST INCENTIVE TOTAL ATTIC FLAT-R-38 UNFACED FIBERGLASS 779 $1,916.34 $1,437.26 $479.08 • Provide labor and materials to install a 12"layer of R-38 unfaced fiberglass batts to an attic space. ATTIC FLAT-R-19 FACED FIBERGLASS 770 $1,309.00 $981.75 $327.25 Provide labor and materials to Install a 6"layer of R-19 faced fiberglass batts to attic space. ATTIC HATCH:SEAL&INSULATE 1 $60.00 $45.00 $15.00 Provide labor and materials to Insulate the back of an attic hatch with 2"rigid Insulation board.Weatherstrip the perimeter. VENTILATION CHUTES 54 $188.48 $141.35 $47.11 Provide labor and materials to Install ventilation chutes In the rafter bays to maintain air flow. VENT BATH FAN THRU ROOF 4 INCH 1 $118.75 $89.06 $29.69 Provide labor and materials to Install an insulated exhaust hose with roof mounted flapper vent to exhaust existing bathroom fan(s). HOME AIR SEALING 10 $800.00 $800.00 Provide labor and materials to seal areas of your home against wasteful,excess air leakage.Materials to be used to seal your home can include caulks,foams and other products. Primary areas for sealing Include air leakage to attics,basements,attached garages and other unheated areas(windows are not generally addressed.) A reduction In cubic feet per minute(cfm)of air infiltration will occur,but the actual number of cfm is not guaranteed. At the completion of the weatherization work,and at no additional cost to the homeowner,a final blower door and/or combustion safety analysis will be conducted by the sub-contractor. BASEMENT CEILING ENCAPSULATED R19 FG BATT 1,070 $2,525.20 $1,893.•0 $631.30 Provide labor and materials to Install R-19 encapsulated fiberglass t ii P(initials) insulation to the basement ceiling.There will be some exposed fiberglass fibers where the contractor will have cut the end of the batts,the installation is not 100%encapsulated. RISE Engineering RI S EN 5 Dupont Avenue,South Yarmouth,MA 02664 ENGINEERING CONTRACT - WZ 5064684926 X-6610 FAX 506-568-1933 Page 2 PROGRAM TWE CONTRACT IS ENTERED INTO BETWEEN RISE CLC-HES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTOMER PAONE DATE CLIENTS WORK ORDER JOHN BELL (978)273-5593 08/10/2018 258764 03602 SERVICE STREET SLUNG STREET 169 Silverleaf Lane 3 Leblanc Drive SERVILE UTY,STATE.DP &LUNG CITY,STATE,9P West Yarmouth, MA 02673 Peabody, MA 01960 DESCRIPTION QTY COST INCENTIVE TOTAL YOUR INCENTIVE EXPLAINED For eligible measures,the Cape Light Compact is offering an Incentive of 75%,with no limit,and an Incentive of 100%for the Alr Sealing measures. • Total: $6,917.75 Program Incentive: $5,388.32 Customer Total: $1,529.43 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WRH ABOVE SPECIFICATIONS.FOR THE SUM OF • e Thousan• Five Hundred Twenty-Nine&43/100 Dollars $1,529.43 UPON RECEIPT OF YOUR RISE ENGIN B INVOICE,GUSTO R AGREES TO REMIT AMOUNT DUE IN PULL.INTEREST OF IY WILL BE CHARGED MONTHLY ON ANY UNPAID BA ANCE AFTER IS DAYS., REVERSE FOR OLPO_,ANT INFORMATION ON GUARANTEES,RIGHTS DF RECISION,SCHEDULING,AND CONTRACTOR REGIETIATIdN N /`1r, ` S NbC., �• RII / I l t.,S.!R�'IUNC / ()LICA— NOTE: NM TCONTRACT MAY BE WITHDRAWN BY US N . .- .WITWN DATE DP ACCEPTANCE bit."9 � IC) bRI 30 DAYS ACCEPTANCE OF CONTRACT ONE ABOVE PRICES,SPECIFICATIONS ANO CONDITIONS ARE SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTNORDFD TO DO THE WORK AS SPECND:D.PAYMENT WILL BE MADE AS OUTLINED ABOVE S RISE ' ENGINEERING' OWNER AUTHORIZATION FORM I, Jetsam .t&ckvA 4\1 , (Owner's Name) owner of the property located at: 169 Silverleaf Lane (Property Address) West Yarmouth, MA 02673 (Property Address) hereby authorize S 4c-11-404 POOP 'tn t . , (Subcontractor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my property. This form is only valid with a signed contract. AthinJ 6 640, 1 Owner's Signature X Blioi g Date RISE Engineering, a Division of Thielsch Engineering, Inc. 5 Dupont Avenue I South Yarmouth, MA 02664 l 508-568-1926 www.RISEengineering.com • The Commonwealth of Massachusetts -= t Department oflndustrialAccidents _•i != 1 Congress Street,Suite 100 • Boston,MA 02114-2017 wwwmass.gov/dta Workers'Compensation insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual): In sulate2Save Inc. Address:410 Grove Street City/State/Zip: Fall River MA 02720 Phone#: 508-567-6706 Are you an employer?Check the appropriate box: Type of project(required): I.© I em a employer with 20 employees(Ml and/or part-time).* 7. 0 New construction 2.01 am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.(No workers'comp.insurance required) 3.0 I am a homeowner doing all work myseiC[No workers'comp.insurance required-]t 9. ❑Demolition 10 0 Building addition 4.01 am a homeowner and will be hiring contractors in conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 50 I am a general contractor and I have hired the sub-contractor listed on the attached sheet, 13.[DRoof repair These sub-contractors have employees and have workers'comp.insurance? 6.0 We area corporation and its officers have exercised their right of exemption per MOL c. 14.0 Other Insulation 152,11(4),and we have no employees.[No workers'comp.insurance required.] 'Any applicant that checks box k I 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 contractor 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 andfob site information. Insurance Company Name: Liberty Mutual Insurance - Policy#or Self-insLie.#: XWS 56418741 Expiration Date: 12/10/2018 t ` Job Site Address: !�p f /�ever/etaLaa e . City/State/Zip: GO t 90 N Ivou-921 mit 4.24 13 Attach a copy of the workers'compensation policy declaration page(showing the policy numbe nd expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.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 san a t es of perjury that the information provided above is true and correct $ifmature: Date: eF//a a/el Phone#: 508-567-6706 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: w �pt vnzoQncvea/t% olao4 oacfitoeft 3:.■� Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Masic.Jusetts 02116 Home Improvemen, tractor Registration Type: Corporation L Registration: 180747 INSULATE 2 SAVE , INC. ` =L J •�� Expiration: 12/28/2018 410 Grove St a 1� Faliriver, MA 02720 �� a T o c Z. Tr Illie 07 m VNI ' Update Address and return card. Mark reason for change. 3CA1 a 20M 05/11 ------....-.,__...�._p__._—_._._—__._._... - ____C Address_0 Renewal 0 Employment 0 Lost Card &lie ontmo'wgsa/tA otebeaaurcAule/Pm -- Office of Consume Affairs&Business Regulationkg. HOME IMPROVEMENT CONTRACTOR Registration validforIndividualuseonly . TYPE: found before the expiration date. If return to: rf— alstr? Office of Consumer Affairs and Business Regulation 'pe180747ort Excli>atfsn 10 Park Plaza-Sults 5170 lfh 080747 y 12/26/2018 Boston,MA 02116 INSULATE 2 S`A�VE y iNC:I t1 Roland Langevat. ilii 74.1:J ,�J 410 Grove St R Avis je a/ f— //1 /G 1' Fall:I er,MA 02720,; Undersecretary Not valid without signature rig'. Commonwealth of Massachusetts N. tVf arDivision of professional Licensure JJ Bod of Building Regulations and Standards i Construftteil$ilpgrvisor :a. 4 get" , ,,"'" "* 0, *spires:08/2412019 I ROLANDt.ANGEVIN 7r` 14 1 ' NMOHCRES7.,ROAD's,.#'9 `. `4 nit'' FALL RIVERA162720j s s' '1'0 .9:Cdt . 4Z: I el:Commissioner Isar 4C9Roa CERTIFICATE OF LIABILITY INSURANCE. 04l=:r �-� 03/07/19 TOSS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON TIE CERIIFtc_/TEHOLDER,7 ifs CEtTIFICATEDOESNOTAFRRMATIVELYORNEGATWELYAMEND,EXT D OR ALTER THE COVERAGEAFFORDED13Y.THEPDuaES BECOME THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE essume INSURERS),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: lithe certificate bolder is anADDi11ONAL INSURED,the po8cy(es)must haveADDITIONALINSURED previsions orbea dorsad. ' certain It SUBROGATION E WAIVED,subject to the tents and conditions of the po0o'yl policies may require an endorsement.endorsement. � on' Astatentthis dh911cete does not confer rights to the certificate holder In Btu of such endorsement(s). mecum 0}4,a., NATE Anthony F. Cosrdei tro Insurance PHONE Ise 503.677.0487 I l mac,Nek 503-677-0409 171 Fall River,MA 02721 ISLRI IIFFORINNOCOVERAGE NAICI DA Liberty Mutual insipid INSURED INSURER a: Insulate 2 Save,Inc. INSURER c: • ' 410 Grove St wsuusRD: Fall River,MA 02720 PSL E: INSURER F: COVERAGES • CERTIFICATE NUMBER: REVISION NUMBEFb THS I510CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAAISABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TMS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AU.THE TERMS, excursions AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. T moat'tO. TR TYPE Cr INSURANCE NOD avvD POLICY RIMER a r YY 111 C M LIlits _ X.CAaaIOU;IAL GETfEW.LLAeetrr PACS OCCURRENCE ' s 1.008.000 S' I C l MADE ©OCCUR o ) • f '398.800 • . — Nap owPao Rawaram) S L000 A _ Y Y BIOS 59418741 12/10117 12110/18 PERSONAL LADY SORY s - 1;000,800 GEM-AGGREGATE LUT APPLIES PER GENERAL AGGREGATE $ ' 2000,000 X POLICY 9,EjcT El LOC PROMO'S.omPN1P�G 's : . 2008800 • AI)f0Y08tl.E UNAJTY CiglABINED SQRGLG Lan I • . 1800,000 . ANY AUTO BOMYINJURY ear peso). I .AY X AUT se*tbuLEa y y BAA 58418741 12110/17 12/10118 MOLYNUURYIPraom oq s ' _ AUTOSX �OWx AUT m (PrainC, I $ X UmMIE tAU16 X DccuR EACH C _ $ 2.000.000 A OCCSSSUAe cumswcc V Y USO 56418741 - 12/10/17 12/10/13 AGGREGATE' s. 16000 DED! • 1 RETENTICNs •WORKERS COMPENSATION ' y� I I AND QBIXITERTUABCITY YIN � 11E F A VE❑ N/A XW358418141 12/10/17 12/10/18 EL EAaTPC:CO@RT s ' 500,000 syaAaaaitWS EL DISEASE.EAEMRSTrt $ . 506008 Drwraa 7TONbil OFOPENA7ION9 blow EL DISEASE.POUCYLAe7 s • '580880 DESCRIPTION W OPERATIONS/LOCATIONS/VERU$(AeoRD 101,Additional Rrar(s SthsSM cry be atlashed amore span Is nehad) • CERTIFICATE HOLDER CANT ELATION - . $8OULDANY OF THE ABOVE modem POUCESBE CARCO-LEO BEFORE. ' THE flCPBtATION DATE THS NOTICE f+IptBEDB.IKRED'm- ' Proof of Insurance ACCORDANCE ram THE POLICY PROVISOS AUIMCRf�D.� Z.„.0/1---H. // // dert ACORD2SI20161EIS) T1N:ACORDmireand0 --; 4i 5ACOIDCORPORATIOSL-Atsightsnserved. bgo we registered marks ofACORD