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Home My WebLink AboutBLD-19-003203 • M1 orY4-4 RECEIVED ;og% eye�use onlyJT 71st c ) • :r - "I�yi' NOV 26 2018 Amount 3's d . 4 Permit expires 180 days from f_ Is .. DEPAR' +issue date EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH • Yarmouth Building Department 1146 Route 28 South Yarmouth,MA 02664 (508)398-2231 `Ext. 1261 J CONSTRUCTION ADDRESS: Z$ R e Jy (201., L.v.yit/'M ti(•tit, 441? V Z c 7 Y ASSESSOR'S INFORMATION: J (thee GMap: 2`. 1, Parcel:: )7 oWNER: {2bht.r_ ?rt NrrQf ) b.) Yettt"�DTh ✓r1! B OZC73 (So)4 J-71'9i NAME f [f PRESENT/ADDRESS/� 1 ) TEL L# (� CONTRACTOR: (:, *tIfi,k BO/like? 773x J tit 05004-ntA1 koG/9,S ELN iz7/,)' NAME MAILING sidential 0 CommercialiaEst.Cost of Construction s 7 SOD —^ Home Improvement Contractor Lia I (c) / /EJ. Y q i Construction Supervisor Lie.N- C S" 6 F531- YL I Workman's Compensation Insurance: (check one) ❑ I am the homeowner ❑ I am the sole proprietor /� ( have Worker's Compensation Insurance ms g�'J 1 Insurance Company Name: E)Lt< y.•iYt/fx-s-t,-. CA 4 Worker's Comp.Policy# y /W6 7�a / / / WORK TO BE PERFORMED Tent _ Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# Replacement doors: # t , Roofing: #of Squares ( )Remove existing*(max.2 layers) Insulation De Old Kings Highway/HistoricDist. ( )Replacingalike for like)(-,/�t, Pool fencing 'The debris will be disposed of at 46C D3/9441 Fe-W Location of Facility I declare under penalties of perjury that the statements herein contained arc 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 revoc: 'in if my licenserd fo .rosec 'ion under M.O.L Ch.268.Section I. /�, Applicant's Signature: � L/I Date: I/ //‘//f Owners Signature `�teaiilii i Date: //-26 Approved By: - ign M // Date: ��eY Building Official(or 1gn EP ADDRES • • Zoning District: Historical District: 0 Yes ❑ No Flood Plain Zone: ❑ Yes 0 No Water Resource Protection District: Within 100 ft.of Wetlands: 0 Yes 0 No 0 Yes 0 No •/'M EFFIBUI-01 HWOODS A • RO' CERTIFICATE OF LIABILITY INSURANCE 08/3/2016 • 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 - 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(les)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 Beu of such endorsement(s). PRODUCER Mr' Rogers&Gray Insurance Agency,Inc. .aPHHONE South D434 Rte ennis,MA 02660 u Riff:mail�rogersgrey.com I FAX • WG Na):($Til]B16-2156 j INSURERSI AFFORDING COVERAGE NAI:S • INSURER A:Employers Mutual Casualty Company 21415 INSURED INSURER a,:National Liability&Fire Insurance Company 20052 Efficient Buildings LLC INSURER C: PO Box 246 INSURER D: , Bridgewater,MA 02324 INSURER E: INSURER F: COVERAGES 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 CONDfIION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO AU.THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPEOFINSURANCE ADDL SUBR POLICYNUMBER POUCY EFF POLICY EXP LMS LTRMD MNDLMM/DD/YYYYI IMM/DDIYYYYI A X COMMERCIAL GENERALUABUT( EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE D OCCUR 5D1803119 09/01/2018 09/01/2019 DAMAGETORENTED 500,000 PREMISES IEa attTsrerXa) f MED EXP(Are onepersa,) $ 10,000 — • PERSONAL a ADV INJURY $ 1,000.000 GEN,-AGGREGATE UNIT APPUES PER: GENERAL AGGREGATE $ 2'000.000 s ❑X SM POLICY u LOC . PRODUCTS-CTOMP/OPAGG $ _ 2.000,000 OTHER: $ A ADTOMOSILE motor CCOE MeMMac�INdeenMSINGLE UNIT S. 1,000,000 ANY AUTO5Z1803119 09/01/2018 09/01/2019 BooILYmum, s ' — OWNED X _ AUTOS _ — AUTOS ONLY DINJURY(Per _ X CEOONLY X AOpIR pPtaPFMS4 MACE f S A X UMBRELLA LIAR I XI OCCUR EACH OCCURRENCE f 2.000,000 EXCESS UAB '1�1 CLAIMS-MADE 541803119 09/01/2018 09/01/2019 AGGREGATE _ f 2,000,000 DED I X RETENTIONS 10,000 S B WORKERS COMPENSATION L&YNY 'PER I &H- AND STATUTE ER ANYPROPRIETOWPARTNER,EXECU11VE. Y/11 V9WC958971 03/02/2016 03/02/2019 EL.EACH ACCIDENT S 500,000 OF]ICEEMBER EXCLUDED? NIA500.000 11��LLDD • yyBB0.0.EEaatt YAt NNMH) EL DISEASE-EA EMPLOYEE S DESCRIPTION OFclesotbe FOOPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000 DESCMPTION OF OPERATIONS t LOCATIONS/VEHICLES(ACORD 1Y1,Ad.NNan1 Ramo SPNGWa,mry be attached I more span S muted) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE WSE E Ineerin THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN n9 g ACCORDANCE WITH THE POUCY PROVISIONS. 5 Dupont Ave South Yarmouth,MA 02664 AUTNORQED REPRESENTATIVE I Alia--"------- ACORD 25(2016103) ®1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Page 1 or 2 " Customer Name:Robert Cart CONTRACT Email:bobecarr@yahoo.com Phone:508-665-7798 RISE Premise Address:28 Hedge Row,West Yarmouth,MA 02673 Date:ProjeAug.18,3455008 Date:Ag.18,2018 ENGINEERING" - EHiclencyEnergized. RISE Engineering 5 Dupont Avenue,Suite 2 South Yarmouth,MA,02664 Job Description Measure Description =; Quantity '' Unit . Total Cost Customer Cost PULL-DOWN STAIR:THERMADOME,BUILT-UP 1 each $237.65 $59.41 AIR SEALING 9 hr $720.00 $0.00 ATTIC FLAT-R-30 UNFACED FIBERGLASS 127 SF $243.84 $60.96 ATTIC DAMMING-R-38 FIBERGLASS 40 SF $98.40 $24.60 KNEEWALL:2"RIGID BOARD 20 SF $77.00 $19.25 KW SLOPE:FIBERGLASS R30 130 SF $253.50 $63.37 KNEEWALL SLOPE:2"RIGID BOARD 130 SF $500.50 $125.12 CRAWLSPACE WALL R10 RIGID BOARD 585 SF $2,369.25 $592.33 COMMON WALL:2"RIGID BOARD 48 SF $184.80 $46.20 CRAWLSPACE:MAKE ACCESS DOOR 1 each $250.00 $62.50 ATTIC FLAT-9"OPEN R-33 CELLULOSE 876 SF $1,314.00 $328.50 SHEATHING ACCESS 1 each $35.00 $8.75 DRYER-VENT TO OUTSIDE 1 each $147.00 $36.75 VENTILATION CHUTES 140 each $488.60 $122.15 Duct Sealing-8 Hours(insulated,up to 200') 1 each $674.56 $0.00 Total: $7,594.10 Program Incentive: -$6,044.21 Customer Total: $1,549.89 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF "'One Thousand,Five Hundred And Forty-Nine And 89/100 Dollars $1,549.89 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 ratS4("7 RIS se;fatly Customer nignature g r 19 I d Sign Date Commonwealth of Massachusetts r - Construction Supervisor { �� - . Division of Profess re. t Unrestricted-Buildings of any use group which contain Board of Building Regulations and Standards ! fess than 35,000 cubic feet(991 cubic meters)of enclosed Constructtort Supervisor ) space CS-095581 _ * Expires:05/12/2020 WILLIAM mammal A y 175 QUINCY SHORE DR i / - ... 681 i a QUINCY MA 0217 � "-' Failure to possess a current NI-Mon of the Massachusetts r- =�.... State Building Code Is cause for revocation of this license- For information about this license Commissioner V"^" Call(617)727-3200 or visftenvw.mass.gov/dpi • • Q9L WOirmiwitata ?c% dttlite Office of Consumer Affairs and Business Regulation One Ashburton Place-Suite 1301 - - Boston, Massachusetts 02108 Home Improvement Contractor Registration Type: Supplement Card EFFICIENT BUILDINGS LLC Registration: 169944 P.O.BOX 246 Expiration: 08/18/2019 BRIDGEWATER,MA 02324 Update Address and Return Card. SCA1 0 201405fi7 /97, ormome to/b r•r ilauadreseta Office of ConsumerAffairsa Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE Sunplernert Card before the expiration date. if found reuan to: Reolstratlon - ?nitration. Office e of Consumer Affairs and Business Regulation 169944 08/182019. One Ashburton Place-Suite 1301 EFFICIENTBUILDINGS LLC Boston,MA 02108 & ice/""'! �gi6)�44,WO1AM CALIAHAN 300 ELM ST . .. U BRIDGEWATER,MA 02324 Undersecretary Not valid without signature The Commonwealth of Massachusetts —Y=�+l Department of Industrial Accidents =5e1= 1 Congress Street,Suite 100 @i 0_3 Boston,MA 02114-2017 V' ,�a.� www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly 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?Check the appropriate box: Type of project(required): 1.91 am a employer with 16 employees(MI and/or part-time).• 7. 0 New construction 2.:11 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 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. Demolition 10❑Building addition 4.01 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 MO Electrical repairs or additions proprietors wrth no employees. 12.❑Plumbing repairs or additions 5.0 I ern a general contractor and I have hired the sub-contractors listed on the attached sheet 13.EI 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.mother 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:EMC Insurance Company Policy#or Self-ins.Lic.#:V9WC958971 Expiration Date:03/02/2019 Job Site Address:28 Hedge Row 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. I do hereby certify under the pains and penalties of perjury that the information provided abovelis true and correct Signature: L J r, C,Gt Gr 6/41 Date: I// t o r phone#:(508)279-1110 Official use only. Do not write In this area,to be completed by city or town ofciaL 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#: - Permit Authorization anrimass save Form Site ID: 3452787 Customer: Robert Carr (_o L e fr T U ri ,owner of the property located at: (Owner's Name,printed) 28 Hedge Row West Yarmouth, MA 02673 (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. • Owner's Signature: 10-44j C Date: 25 - 1 g -' mssa00ffi4Wfi044r4W0e0ai03043330e4803041.0*030**3**e 303830003W1443*43 3040W FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: L c c e, + LLC Si 1S 6y Participating Contactor ate Name: RISE Engineering Phone: 401-784-3700 Email: For Office Use Only 02015