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HomeMy WebLinkAboutBLD-19-2960 IOffice Onlya o1.rf its tlP LDS /Y-ea Q1�'.,I C O - Amount F .unn . \""""� (v4. ' Permit expires 180 days from :. issue date I, EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth,MA 02664 (508)398-2231 Ext. 1261 CONSTRUCTION ADDRESS: tc �'I I G e-r c. ti"-"t Li• yc e hO/IAN) "IA iC UZ(Di 3 ASSESSOR'S INFORMATION: Map: o� V Parcel: J 5y OWNER: "Pk 110/1q;110/1q;Q/1q; 75 05An- l/, 12 yAet,outt1 0g73CqI')6h10— owl! TNI ANE PRESENT ADDRE S TEL # / CONTRACTOR: GF(•ea'.4-4- flv. IcQi�S WC Cr, "Ito Y4 40,t/It«,,•1x Ykrl61rn 1 V295"i o NAME MAILBIG ADDRESS ('EL# of‘idential 0 Commercial�lEst.Cost of Construction S t'e U U 0 Home Improvement Contractor Lie.# ) , ) 7 1-1 Construction Supervisor Lie.# CS69 Crn Workman's Compensation Insurance: (check one) ❑ I am the homeowner L r�❑,,I am the sole proprietor )(have Worker's Compensation Insurance �/f(Jlc Q Insurance Company Name: ' 1± Nit ins✓/4114 Worker's Comp.Policy# V 9uC /J/ / 7/ 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 pie Old Kings Highway/Hiistorie Dist. ( )Replacing like for like I r//, Pool fencing *The debris will be disposed of at: /Il iSC, tiff OIA 1 )4� &1 ae //i" 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 oca'on of my license and ffoorrprossecution under M.G.L.Ch.268,Section I. Applicant's Signature: (/l/•t (w� (j Date: /1/7 11/ Owners Signature(or jtt chment) .- /�� i � •j. Date: Approved By: ' ( '/ Date: h/ /Y_c-- t wilding Official(or designee) EMAIL ADDRESS: REEVED \ Zoning District: [ C i Historical District: 0 Yes 0 No Flood Plain Zone: 0 Yes ❑ No + nr•• Water Resource Protection District: Within 100 ft.of Wetlands: I 1 3 Lu 13 ❑ Yes ❑ No ❑ Yes 0 No ___ ' BUILDING DE PAR-IMCiVf • /- EFFIBUI.01 MOODS '4�R� CERTIFICATE OF LIABILITY INSURANCE 08%31/218 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT•AFFIRMATNELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES 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 ADDIT)ONAL 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 NAIMTACT Rogers&Gray Insurance Agency,Inc. PHONEFAX 434 Rte 134 (NC,No,Eaq: I(AIC,No):(B77)818-2156 South Dennis,MA 02660 PADuhrtbs.mail©rogersgray.com . 4 INSURERS)AFFORDING COVERAGE NAICS • INSURER A:Employers Mutual Casualty Company 21415 INSURED INSURER a:National Liability&Fire Insurance Company 20052 Efficient Buildings LLC INSURER C: PO Box 248 INSURER o: , ,, Bridgewater,MA 02324 INSURER E: • MSURER F: COVERAGE 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 DOCUMENTWITH RESPECT TOWHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDmONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. •LTR TYPE OP INSURANCE R ADSL BURR POLICYNUMBER POLICYIAMDAMF AM/DDYEIP LIMITS JNSD YdI OLICREP RPOLICY EXP YI A X COMMERCIAL GENERALUAMUTY EACH OCCURRENCE. 5 1,000,000 CLAIMS-MADE pi DA OCCUR 5D1803119 09/01/2018 09/01/2019 MAGETORENTFA s 500,000 • — MED CCP aPerm v)one 5 10.0011 PERSONAL a ROY INJURY S 1,000,000 GENT.AGGREGATE LMITAPPUES PER: GENERAL AGGREGATE 5 2,000,000 HPOLICY a X LOG 2,000,000 JECT PRODUCTS 3 OTHER- 3 A AUTOMOBILE LIABILITY 1Maa.ccideDSINGIE LIMB 5 1.000,000 ANY AUTO _ • 521803119 09101/2018 09/0112019 Boons*nuRY(Porpenon) S — en AA�UUT�TFEOppSS ONLY X AUTOS II�/�WWNNEEOpp Per INJURY(Per AaMm4 S _ X M/RTOS ONLY X tAtil S ONLY lrer 'de GE S S A X UMBRELLA LIAR X OCCUR EACH OCCURRENCE S 2,000,000 EXCESS URI NMSMAnE 5.11803119 09/01/2018 0910112019 AGGREGATE g 2,000,000 C OED X RETENTIONS 10,000 $ B ANDKERS COMP NNMLRY X I STATUTE I IOFB AAQNN�YCcPRpOPRIIMETORIPARTNER)EXECUTIVE Ya V9WC9589T1 03/0212018 03102YL019 500,000 fogrprying^m EXCLUDED' NIA Et ACCIDENT S If .A deacdbe under , EL.DISEASE-EA EMPLOYEES 500,000 DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT 5 500,000 DESCRIPTION OP OPERATIONS/LOCATIONS IVEHICLES(ACORD 101,AddIond Ramada Schedule,nay be attached Van spae•I.myths:) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE RISE ETI ineerin THE EXPIRATION DATE TTJEREOT(f NOTICE W01 BE DELIVERED IN 9 g ACCORDANCE WITH THE POLICY PROVISIONS. 5 Dupont Ave South Yarmouth,MA 02664 ACUTHOR,Q\DJREPRESSEENTA7IVE �a ACORD 25(2016103) 01988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD • DoaiSign Envelope ID:80Al2A08-27D847C8-9OFF-00853FOCEFD2 Page 1 oft Customer Name:Philip B Renzi CONTRACT Email:Phiiph.renzi@gma8.com `1 Phone:401-640-0014 Premise Address:25 Niagara Lane,West Yarmouth,MA 02673 RISE, ProjectID;3550650 Date:Sept.7,2018 ENGINEERING' t 1i e p e n ry f Jn'tv_:.a d.-v____ RISE Engineering 5 Dupont Avenue,Suite 2 South Yarmouth,MA,02664 Job Description Measure Description Quantity Unit. L Total Cost Customer Cost AIR SEALING 4 hr $320.00 $0.00 VENTILATION CHUTES 52 each $181.48 $45.37 4'x 16°SOFFIT VENTS 8 each $231.28 $57.82 REMOVE EXISTING INSULATION-INCENTIVIZED 175 SF $169.75 $42.44 ATTIC FLAT-R-38 UNFACED FIBERGLASS 716 SF $1,761.36 $440.34 PULL-DOWN STAIR:THERMADOME,BUILT-UP 1 each $237.65 $59.41 VENT BATH FAN THRU ROOF 1 each $118.75 $29.69 CRAWLSPACE:MAKE ACCESS DOOR 1 each $250.00 $62.50 CRAWLSPACE WALL R10 RIGID BOARD 464 SF $1,879.20 $469.80 CRAWLSPACE:10 MIL GROUND COVER 932 SF $904.04 $0.00 Total: $6,053.51 Program Incentive: -$4,846.14 Customer Total: $1,207.37 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF "'One Thousand,Two Hundred And Seven And 37/100 Dollars $1,207.37 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. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES DocuSigned by rpoaapned by: ./i r1241 eyigeative u terrArtritnektire 9/11/2018 I 4:29 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 •` CammonweaBAorMassachusetts • -%. Corestrnctfanslfifertdsor .tl. OtvlslonofProfessfonatiteartsnra - unre3trteted-iuttgravy :Itch l Board of Building Regulations end standards . less than 35,000 cubic feet(991 cubic mc • eters)of enosed • j Con-�,f tjri Scrervisor y re • CS-095581 aspires:05112/2020 WIWAMCAj JfJ-;'Y.--. �.., -IraGUWCyttnoREOR'^ 3 - . ' • B81 :. ti`r ,f,t - I QUINCYMA 02111- - • } 'fax ' Far�8et0 .s ., Possess aCwrerdedfficnoftheMas •. . State Building Code is cause for revoptonof this lcense. ._ - For information &lease v. '(:omrrrissionet- - _.-.- `. Can(017)7273280arviattsnew.massgov/dpi • • Office of Consumer Affairs and Business Regulation • -.•: ; One Ashburton Place-Suite 1301 •• • Boston, Massachusetts 02108 • • Home Improvement Contractor Registration i • • • - Type Supplement Card EFFICIENT BUILDINPS LLC Registration 169944 P.O.sox 246 - - Expiratiorc 08/18/2019 BRIDGEWATER,MA.02324 • Update Address and Return Card. S At a miov�trr p // • 0Fri�'or OotsmnerAtiaits Business Regulation . HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE Supplement ted before the expiration date. Bfound retruntee Registrationratio Office of lbnsumerAffairs and Business Regulation 169944 , 08/1812019 OneAshbuttvn Plan-tufts 1301 • EFFICIENT BUILDINGS LLC Boston,MA 02108 • • WI LI M AM C `^'&fYGy`� BRroGEWATER,MA 02324 ST Not Dales without signature Undersecretary a % $ . . - • _ \ The Commonwealth of Massachusetts :a 49 Department of Industrial Accidents t Hieel= 1 1 Congress Street,Suite 100 --131:1•7 Boston,MA 02114-2017 www mass.gov/dia a 4 Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print LeEibIv Name(Business/Organization/Individual):Efficient Buildings, LLC Address:973 Reed Road City/State/Zip:N. Dartmouth, MA 02747 Phone#:(508)279-1110 Are you an employer?Cheek the appropriate box: Type of project(required): I.Q I am a employer with 16 employees(full 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. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3.0 1 am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. CI Demolition 10❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.1:Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0 1 am a general contractor and I have hired the subcontractors listed on the attached sheet 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.0 Other Insulation 152,$1(4),and we have no employees.[No workers'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. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information Insurance Company Name:EMC Insurance Company Policy#or Self-ins.Lic.#:V9WC958971 Expiration Date:03/02/2019 Job Site Address:25 Niagara Lane City/State/Zip:W,Yarmouth, MA 02673 Attach a copy of the workers'compensation policy declaration page(showing the policy number and 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. 1 do hereby certify under[//�jjhe pains Ii of perjury that the information provided above i/s true and correct. • Signature: �i�iVR� ��/ld� Date: /1/7/i le Phone#:(508)279-1110 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#: DocuSlgn Envelope ID:80Al2A08-27D8-47C6-90FF-00853FOCEFD2 Permit Authorization mass save Form y Site ID: 3433922 Customer. Philip B Renzi ), Philip Renzi ,owner of the property located at: (Owners Name,printed) 25 Niagara Lane West Yarmouth. MA 02673 (Property Street Address) (CM) 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. �ooay s .dby: Owner's Signature! luti' rtkvi 138AF78EDS714481._ Date: 9/11/2018 14:29 PM EDT • 04000 0e0 Saeaeaffi4I*GO a Off 444414 tt 041B 2/.0 telt*St*a 400400 to 04041414448.4440400041 FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contract Date Name: RISE Engineering Phone: 401-784-3700 Email: For Office Use Only Rev 102015 M._ ... _._..., _:.,....,