HomeMy WebLinkAboutBLD-19-001827 ONE & TWO FAMILY ONLY-BUILDING PERMIT
Town of Yarmouth Building Department or
1146 Route 28,South Yarmouth,MA 02664-4492 pit
508-398-2231 ext. 1261 Fax 508-398-0836 EL ¢
Massachusetts State Building Code,780 CMR
Building Permit Application To Construct,Repair,Renovate Or Demolish
a One-or Two-Family Dwelling
:' ! This Section For Official Use Only
Building Permit Ntmtber, 15/ebl lt1"i'bD C RRT 1Dato Applied ''- -" P -, v
i kat
. `
Building Official(Print Dime) slgaature _,.�:..:.::.:... .....:..: .. ',;'_SEP-_,21:41t€{ll8.'
SECTION It SITE INFORMATION.: .
11 Property Address: � � tt 1.2 Assessors Map&ParcelNumre ILDINGDEPARTMENT
AS rint1rltn IA ti&I \PPMU ''L _ --
1.1a Is this an accepted a et?yes_ no - Map Number Parcel Number
1.3 Zypht!Information: (A._ 1.4 Property Dimensions:
ZoningDistrict Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft) •
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private O Zone. — Outside Flood Zone? Municipal O On site disposal system 0 •
Check if yes0
: ._, ..,- :!, : .SECTION'2' PROPERTY Q`WNERSIDP!. • • : .: '..- :
11 1 Owner'of,Recondt
1 0101�U �^X� • h. . V `' 1l ail. 1t% .2 1c `l
)arl iN wa.y '► Z(Oq— �11Q 3
No.and Street \J • Telephone Email Address
• ' ,
SECTION 3q bESCR1'TION OR pRQPOSEII WQRK2.(chk;ecapt'thaapply).;.s,". :,.,
New Construction 0 ' Existing Building 0 Owner-Occupied 0 Repairs(s) 'on(s) 0 Addition 0
Demolition CI Accessory Bldg.0 Number of Units_ Other`
Brief Description of Proposed Workr: ll.. sy V\iiAO Air ctal;no, tGitir \NstkkaIIDA,
';N: ,;: : SECTION'4 ESTIMATEDCONS''1t:UCrIOiNCOST5:,;;a.::_;:: } ::;-1-.;;;;'1-'..4;:.;:t: -
Item Estimated Costs: -,>r;,-.--:!.?..(?,:,:;.;,.;J. ==! f."p�t ‘..-.7-.,.; �'' ` ,r.
(Labor and Materials) =;;i '' ;;.. `:':.`:-- 0 ;f njq_yfzii-?-.r.;_` ' '`.V.
1.Building $ aR-.)_7
7 ( '.j.Boil.
ilthng C ovap ppp. ateltbw fee is d `etemunet
2.Electrical $ ;•. _ ',
UtotaiRrojeetcostWtemOlt'muhiplier:;te : itt ; ;.:t ,: '
3.Plumbing $ _'SLI.' ,: .— :":4
8 'Z;r'Othe'C,Fees:.�S� �-_. ..._ -_.,;r.; i j -. �:;'-'�`'
4.Mechanical (HVAC) $ T;isef . . -«-- ,'-j„�i::. ; :,<.i;."1,:, W: 4,9 '.4
5.Mechanical (Fires,'L'^;..:`5•ii.?�sc,j/,,j:4 .;nt.
sr.r�.a.'.:3s;tl::F:yr,- .k,', •:
a.. ,_.`.
�, .''
Suppression) Teta1AllFees p >' ;:, r
'CheCiiite.:T-=r ChiekAmotiit :': .-•.- CaiiAmonn}:: . '
6.Total Project Cost $ 77 I 7::'O Otrtstandiug nata ibe Duet-, ':-;-•••'. -
. - _ ' SECTION 5:.CONSTRUCTION SERVICES . . . .
I CIAConstruction opervisor License(CSL)
11'I1� '.au /0(NV License Number Expiration Date
arae of CSL Holder /� /1' / 1
1'7 c' (('1v_Ai S\_, _ _ • e y I ListC .. (see below) �J
and Street 11(.Y� Cr�( Gam) _ �
611
t)
Restricted 1812 Family Dwelling
Citefown,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
C y.03.� 1 ' SF Solid Fuel Burning Appliances
') • I Insulation
Telephone Email address D Demolition
5.2 Xtgbtered11Hom ImprovementContractor(HIC) I f „/';/1 W I t
•
I- • C1t-/\i' (3u-1\6021A 1( ` RIC JlRegistrationitrl `N'umber irati Date
4�C CAmpanx Name or HIC Registrame
NQ//an''QSSS�''((��(0.2d 0a�� n /�
UUC�'IA \-(Y)41^ rm— 27(11 Email address .
�Yty/fown,State,ZIP I Telephone ,
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(MG.L.c.152.§ 25C(6))
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 0 No 0 .
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
• OWNER'S AGENT OR CONTRACTOR APPLIES
S1FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize PTh(y1 l/4 4\'1 , (.S.to a my behalf in all relllative ttoo ork authorized by this building permit applicatioo4
Print er's Name(Electronic Signature) Date
SECTION 7b:OWNER'ORADTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information •
• ed in this application is true and accurate to the best of my knowledge and understanding.
7(77/1/4 et-X2C-geCt 144"
7
9./p .) f-- .
Print Owner's or Authorized Agent's Name(Electronic Signature) Date •
NOTES: ..
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(WC)Program),will not have access to the arbitration
program or guaranty find under M.G.L.c. 142A.Other important information on the BIC Program can be found at
www,mass.eov/oca Information on the Construction Supervisor License can be found at www.mass.2ov/dns
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths '
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for'Total Project Cost"
EFFIBUI-01I
‘.....--- CERTIFICATE OF LIABILITY INSURANCE cam
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• 4-.— _ 03!02!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 NEGATIVED AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES'
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT ONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED 1
I REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. . ( I
IMPORTANT: If the certificate holder Is an ADDITIONAL INSIjRED,the policypes)must have ADDmONAL INSURED provisions or be endorsed.:
If SUBROGATION IS WAIVED, subject to the terms and con'ktllitions of the policy,certain policies may require an endorsement A statement on'
this certificate does not confer rightsto the certificate holder I lieu of such endorsement(s)., !
;PRODUCER CONLFCT -
i Rogers&Gray Insurance Agency,Inc. . r PHONE-. -' TFAX
;434 Rte 134 1)nrc,/1.0/Par _ . •------•--- ..mac,N 2(877)816-21561
iSouth Dennis,MA 02660 - --- ----
111Trss:mail�rogersgrap.Com
INSURER(S)AFFORDING COVERAGE_—_ i NAIcg
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amuses
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INSURED I
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IN_ a;Nati Ina1 LiabO"ity_&Fire Insurance Company 1 120052_ _
Buildings LLC INSURER C_ —.'
Bridgewater,NIA 02324
! CERTIFICATE NUMBER: ENSURER E: •
COV F AGES _ I ' ' REVISION NUMBER_
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTE a BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD;
I INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR ONDmON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MA PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS,'
EXCLUSIONS AND CONDITIONS OF SUC POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _
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LTRI TYPE OF INSURANCE •_ :sD POLICY'JIR.iSER POLICY EFP i PODGY EXP __. ._ .. _._ ____ _ .
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)GEftLAGOR-GATE WIT AP?IES PER I 1 --T-- '---
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�_�r '^ Loc I I �PRoDt Ts.COt:PICPacc s ..2.000,000
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A IAUTO.MOSILE mammy 1 ----.I-I COt:�91NEp SRIG;.E Littli��s.—
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(. ANY AUTO _ _I ; 521803113 10910112017109/61/2018
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• AND ELIPLOYERS LIAsiuTY r viP-cR IOTH.t
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'DESCRIPTION OF OPERATIONS belts '_4I 500,000
•LS_"SE•POUCYIIMIT S
1 ) i 4
; II
I
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 10L Additional Romanis Schedule,may be attached If man space Is requited)
I '
'
I
1 1
CERTIFICATE HOLDER CANCELLATION' ' '
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
RISE Engineering ' THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
5 Dupont Ave I ,ACCORDANCE WITH THE POLICY PFt(1VI510NS.
I South Yarmouth,MA 02664
I AUTHORIZED REPRESENTATIVE '-
ACORD 25(2016103) 0 1988-2015 ACORD CORPORATION. All rights reserved:
he ACORD name and lo-o ae registered marks of ACORD I
I
I
DocuSign Envelope ID:64228CC8393C-4DD3-9602-1686343F2C67
Page 1 of 1
Customer Name:Michael Watts CONTRACT
-- -- --� - Email:michael60watts@gmall.com
Phone:508-269-9683
R ' Premise Address:38 Marlin Way,South Yarmouth,MA 02664
Project ID:3445225
Date:July 31,2018
ENGINEERING-
RISE Engineering
• 5 Dupont Avenue,Suite 2
South Yarmouth,MA,02664
Applicable Customer Required Actions: Notes:
• Storage Removal Storage In attic will need to be removed
Job.DescripUon
Measure Description . , Quantity Unit: . Total Cost Customer Cost
ATTIC FLAT-10"OPEN R-37 CELLULOSE 864 SF $1,347.84 $336.97
ATTIC DAMMING-R-38 FIBERGLASS 48 SF $118.08 $29.52
. BASEMENT SILLS:R19 FG BATT 78 SF $170.82 $42.70
WEATHERSTRIP DOOR&ADD SWEEP 1 each $80.00 $0.00
AIR SEALING 11 hr $880.00 $0.00
VENTILATION CHUTES 58 each $202.42 $50.60
Duct Sealing-8 Hours(insulated,up to 200') 1 each $674.56 $0.00
PULL-DOWN STAIR:THERMADOME,BUILT-UP 1 each $237.65 $59.41
INSULATED BATH EXHAUST HOSE 1 each $60.00 $15.00
Total: $3,771.37
Program Incentive: -$3,237.17
Customer Total: $534.20
WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF
"'Five Hundred And Thirty-Four And 20/100 Dollars $534.20
UPON RECEIPT OF YOUR RISE ENGINEERING INVOICE,CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL.INTEREST OF 1%WILL BE CHARGED MONTHLY ON
ANY UNPAID BALANCE AFTER 30 DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND
CONTRACTOR REGISTRATION.
Sett.cOacuagMd by: DO NOT SIGN THIS CONTRACT IF T�tEF E A�E ANY BLANK SPACES
F ocu ,an. yy
DebtAlta
raw
41
ito
�� Attu e `d'3flidot e3TQ1Peture
8/1/2018 112:02 PM EDT
Sign Date
NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND
30 DAYS CONDITIONS ARE SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE
AUTHORIZED TO DO THE WORK AS SPECIFIED.PAYMENT WILL BE MADE AS
OUTLINED ABOVE
I• �< %, Construction Supervisor 1•
Commonwealth of Massachusetts ± Unretbicted.Buildings of any use
i �. Division of Professional Licensure group which contain
Board of Building Regulations and Standards less than 35,000 cubic feet(991 cubic meters)of enclosed
Constraettorf Supervisorspace.
I
CS-095581 Expires:05/122020 ' I
IMWAM CALLAHAN:.2` ` E.
{q.e
176 QUINCY SHORE DR .
r . BBi 3. ;.�a
QUINCYMA 0211,1. ;~ .,
r•71.- -i..J� c;,s Failure to possess a current edmon of the Massachusetts '
•
-:e4�' State Building Code Is cause for revocation of this license.
For Informat•ion about this license
Commissioner ✓'"" `� �` Call(017)727-9200 or vish www.tnass govidpt
Q/ie 0,69,...„,,,,44 t PAZadaciuMeta
Office of Consumer Affairs and Business Regulation
• One Ashburton Place-Suite 1301
- • Boston, Massachusetts 02108
• Home Improvement Contractor Registration
Type: Supplement Card
• Registration: 169944
EFFICIENT BUILDINGS LLC.. Expiration: 06/182019
P.O.BOX 246
BRIDGEWATER,MA 02324•
.
•
Update Address and Return Card.
SCAT 0 zwornr —'—'-----'-'-----"__.—.�—
a9nsuaninewe /Ain Clln,.rnriseft
Office of Consumer/Wanes Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only
TYPE:Suoolement Card before the expiration date. If found return to:
Registration )jjcoiratiot Office of Consumer Affairs and Business Regulation
169944 : 08/18/2019 One Ashburton Place-Suite 1301 .
EFFICIENT BUILDINGS ILC Boston,MA 02108
WILLIAM CALLAHAN . &L$t', eairrse
300 ELM ST
BRIDGEWATER,MA 02324 Undersecretary Not valid without signature
.X The Commonwealth of Massachusetts
1_z) =
mite / Department of Industrial Accidents
= _ h. 1 Congress Street,Suite 100
rezte " Boston,MA 02114-2017
`'-�e=,s www massgov/dia
Workers'Compensation Insurance Affidavit General Businesses.
TO BE FILED WITH THE PERMITTING AUTHORTIY.
Applicant Information / Please Print Lettibly
Business/Organization Name Ph C�c7�4))di€r , , .
Address: - I�3 V to . ea(1
, City/State/Zip:f\ ,D(N \. / niY) �ilone#:
Are 47 i employer?Check the appropriate box: Business Type(required):
I'M am a employerwith 13 employees(full and/ 5. 0 Retail
or part-time).* 6. 0 Restaurant/Bar/Eating Establishment
2.0 I am a sole proprietor or partnership and have no 7. 0 Office and/or Sales(incL real estate,auto,etc.)
employees working for me in any capacity.
[No workers'comp.insurance required] . 8. 0 Non-profit
3.0 We are a corporation and its officers have exercised 9. 0 Entertainment
their right of exemption per c..152,§1(4),and we have 10.0 Manufacturing C
no employees.[No workers'comp.insurance mph'edit*
4.0 We are a non-profit organization,staffed by volunteers, 1 L ' Care / 1r 'Hin i A/U
with no employees.[No workers'comp:insurance req.] 1 ►I 0.,er •
*Any applicant that checks box al must also fill out the section below showing beim, .. compensation policy Information.
**If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an
.organization should check box dL
• I am an employer that Lsworkers'compensation in cefor my employees. Below Is the policy information.
Insurance Company Name: C \ KISl)(lj'((J ( tO i—'•
Insurer's Address. `' kiI(1 (A,Cu-
City/State Lip&Ld\ "` '1 Jen) t —
--'
Policy#or Self-ins.Lic.# \'l /V li ` ) I ) Expiration Date: 3 . 2 .1 c
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage astequired under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to 51,500.00 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 ,under the pains �eyna/ltiess ofperju�ry�that the Information provided(above is true andtecorrectco
Signature:`' V r�1// ,t,t / 4t—ea IJ+ Date: / ' ! 7 l O
Phone#: q �• t�.-G • il , a
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.Licensing Board S.Selectmen's Office
6.Other
Contact Person: Phone#:
www.masagov/dia
• oF'YAR,y TOWN OF YARMOUTH
t- c BUILDING DEPARTMENT
c)tayr+� ;€ 1146 Route 28,South Yarmouth,MA 02664
Cs3 C- 508-398-2231 ext. 1261 Fax 508-398-0836
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't k Oei I N l V , ybJm0o\k __
Work Ad rens
Is to be disposed of at the following location: t 3 1 N) (200-a
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
17X—Ca-an 9 -/ 9/1-
Signature of Application D
Permit No.
•
DocuSign Envelope ID:64228CC8-393C-4DD3.9602-1686343F2C67
4 Permit Authorization
mass save Form
1...n. ,r-et:k (NMn.M;q'+e V
Site ID: 3440431 Customer: Michael Watts
I,
Michael watts ,owner of the property located at:
(Owner's Name,printed)
38 Marlin Way South Yarmouth, MA 02664
(Property Street Address) (City)
hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed
below to act on my behalf and obtain a building permit to perform insulation and/or weatherization
work on my property.
Doeualoned er.
Owner's Signature:F41 taiitijt
6-981,e'se"s,
Date: 8/1/2018 I 12:02 PM EDT
01.: Sani'x R.y`a ;Ji';I;ti k •'Y dYTa eo-�;..H t1 e's
FOR OFFICE USE ONLY
We have assigned the following Mass Save Home Energy Services Participating Contractor to the
above referenced project:
Participating Contractor " / / Date
Name: RISE Engineering
Phone: 401-784-3700
Email:
For Ma Use Only
Rev.102015