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Home My WebLink AboutBLD-19-003202 RecT ��`""""'.c= { Permit expires 180 days from BUILDING DEPARTMENT ��issue date Ely: EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth,MA 02664 (508)398-2231( Ext. 1261 CONSTRUCTION ADDRESS: 3t /rildvlFlo it) )/lt Y//N'WQ'L pig otc,cy ASSESSOR'S INFORMATION: rr Map: 40) Parcel: /Ag OWNER:J)Iwlotut ',nnwcar. 71t Jv'ue nA iepotiKt )tA02V&W C-zch237- 5'77') NAME ,J p PRES ADDRESS • TEL # CONTRACTOR: 1::1-' •-;e.....1- &4c11ITL/G 913 pud4Oc4n, l 411101717 (/40027Q^h/0 Al NAME U MAI INO ADD 9 ) TE # /is Residential 0 Commercial all /'/' Est.Cost of Construction S 1'706 q� (/1 Home Improvement Contractor Lie.# / L / 'T 7 y Construction Supervisor Lie.# ('.5 n / 515? Workman's Compensation Insurance: (check one) ❑ I am the homeowner ❑ 1 am the sole proprietor QC,have Worker's Compensation Insurance q Insurance Company Name: ENit C „4-4,5-,,........,,,t Worker's Comp.Policy# 1294.../615717/ 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 te_.., Old Kings Highway/Historic Dist. ( )Replacing like for like �g�P,o/ool fencing *The debris will be disposed of at /' AG Oirf� t)S1 a utt,„ eget • �'l 04� Location of acility U 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. revocafi.y.f y license and f. c '.n under M.O.L Ch.268,Section 1. �i Applicant's Signature: , _ / ., _ Date: /Se Owners Signature(.4lIe Date: /� Approved By: 4'.4 -'--- Date: ZG 72 Building cia i rgnee) L ADDRESS: n l/7C 1� /rl/Ji .S tV, �,/. , Zoning District: -�ft—�, ,/ Historical District: 0 Yes 0 No Flood Plain Zone: 0 Yes 0 No Water Resource Protection District: Within 100 R.of Wetlands: 0Yes 0No 0Yes 0 No ACORO' EFF(BUI-01 HWOODS `O CERTIFICATE OF LIABILITY INSURANCE °"'E'MM°D"'"'1 08/31/2018 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 POUCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: H the certificate holder is an ADDRIONAL 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 CON€ACT Rogers 4Rte 8,GrayInsurance Agency,Inc. (AM,N4 Est)' FAx )(87T)816-2156 34 I(AIC,xe: South Dennis,MA 02660 Mass;mail@rogersgray.com i - nLSURERI3)AFFORDING COVERAGE NAI:e • msuRERA:Employers Mutual Casualty Company 21415 INSURED INSURER a:National Liability&Fire Insurance Company 20052 Efficient Buildings LLC INSURER e: PO Box 246 INSURER 0: . Bridgewater,MA 02324 INSURER E: INSURER P: 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 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 ADDL SUER LTR TYPE OF INSURANCE MSD WVD POLICY NUMBER PDDDYEFF PWDDLYT P IMMTNYY /OYYI MMIDDIYYYYI LIMITS A X COMMERCIAL GENERAL WBTLRT EACH OCCURRENCE S 1,000,000 CLAIMS-MADE O OCCUR 09/01/2018 09/01/2019 p�R SESDfEaENTEinncei S soo,00d - — MED EXPLAnr one person) $ 10.000 — PERSONAL a ADV INJURY 3 1.000.000 LSEM.AGGREGATE LIMITAP�P,�LIIE��S PER GENERAL AGGREGATE $ 2.000,000 —1 PDucr QX Du Loc PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER • A AUTOMOBILE LIABR.nY rW EDSINGLE UNIT 1,000,000 DIf —• ANY AUTO - 511803119 09/01/2018 09/01/2019 BODILY INJURY Trsenon) s AUTOS SD Y X OpWWLNE�Dp - X AUTOS ONLY X AEUTrO50NLY pR IVINJUrmAGERY(Per accident) $ EPrnU S _ $ A X UMBRELLA LUIS OCCUR EACH OCCURRENCE S 2,000,000 EXCEssuae CLAIMEMADE 5,11803119 09/01/2018 09/01/2019 - DED I X RETENTIONS 10,000 AGGREGATE s $000,000 B WORKERS COMPENSATIONS AND EMPLOYERS'LIABILITY X PERATUTE I ER ANY PROPRIETOR/PARTNER/EXECUTIVE YIN V9WC958911 03/02/2018 03/022019 500,000 WFICER yEMNn)EXCLUDED? D NIA EL EACH ACCIDENT 3 ( andata NNNNN NYes,devsOs tnlw EL DISEASE-EA EMPLOYEES 500,000 DESCRIPDON OF OPERATIONS below EL DISEASE-POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS/LOCATORS/VEHICLES IACORD tel,Additional Remarks Schedule,may be atdehed N mon space Is Tidea) CERTIFICATE HOLDER CANCELLATION • SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE FOSE En ineeriTHE EXPIRATION DATE THEREOF, NOTICE WILL SE DELIVERED IN S Dupont Ave ACCORDANCE WITH THE POLICY PROVISIONS. South Yarmouth,MA 02664 AUTHORIZED V I CZ/,Y�srty L ACORD 25(2016103) ®1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DoorSign Envelope ID:8011 E881-E7E2-4ACE-938E-5FB7388CFD13 Page 1 of 1 Customer Name:Blanche Finegan CONTRACT Email:Not provided \\ Phone:508-237-5774 %-• � Premise Address:31 Melville Road,South Yarmouth,MA 02664 RISE ID: Date:Oct.2 2601830 ENGINEERING Eft icicnrignereired. RISE Engineering 5 Dupont Avenue,Suite 2 South Yarmouth,MA,02664 Job Description MeasureCescription -T ,Quantity Unit Total Cost Customer Cost AIR SEALING 7 hr $560.00 $0.00 WEATHERSTRIP DOOR&ADD SWEEP 2 each $160.00 $0.00 ATTIC FLAT-10"OPEN R-37 CELLULOSE 552 SF $861.12 $86.12 VENT BATH FAN THRU ROOF 1 each $118.75 $11.87 VENTILATION CHUTES 27 each $94.23 $9.42 Total: $1,794.10 Program Incentive: -$1,686.69 Customer Total: $107.41 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF "'One Hundred And Seven And 41/100 Dollars $107.41 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 Paq„w M �ec„spo"e M rk Cobra" A. ViM.eAk °ftMfMgbntative I19l3R4E9r nature 10/3/2018 13:47 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 • � Commonwealth of Massachusetts Construction Supervisor Y7. DivisionofProfessionalLicensure UO��« -�gdtngsofanyusegroupwhichco�rtain less than 35,000 cubic feet(991 cubic meters)of enclosed Board of Building Regulations and Standards ' Constructton Supervisor f space. • CS-095581 Expires:05/12/2020 • 1NIWAM CAI. AHAN 1.'2. -- ITSQUINCYSHOREDR ..% AT, 681 .: ,fit QUINCY MA 021(1 - - s-_.r1 i �. Failure to possess a current edition of the Massachusetts . * 'r, StateBuild a 4 n9 Code is cause for this semis license. For Information about this license Commissioner. - �._ CaO(817)727.3200 or visitwwwmassgov/dpi • • c� O/M a 0,90/Serdnadeldea 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 08118/2019 • BRIDGEWATER,MA 02324 Update Address and Return Card SCAt C zmsosnr V mnwn fnraf/ai cj'r&(a rax✓L- Office of ConsumerMaYst Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:Suppleme t Card before the expiration date. if found return to: Renistratlon Expiration Office of Consumer Affairs and Business Regulation 169944 . 08/182019 One Ashburton Place-Suns 1301 EFFICIENT BUILDINGS LLC Boston,MA 02108 / 300 ELM ST \2CG�P-- C�,.C/'^'___'-/ l�G`^ fYGW 300 ELM ST C.� Not valid without signature BRIDGEWATER,MA 02324 Undersecretary The Commonwealth of Massachusetts pg,E&51 •I Department of Industrial Accidents _ 1 Congress Street,Suite 100 7.7! Boston,MA 02114-2017 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): I.0 I am a employer with 16 employees(MI and/or part-time)/1 7. 0 New construction 2.0 I 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.]r 9. ❑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 11.0 Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors 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.r1Other 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:31 Melville Road City/State/Zip:S.Yarrnouth,MA 02664 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 penal 'es of petjury that the information provided above is true and correct Signature: LN'it C Cy( Date: /////o% Phone#:(508)279-1110 Official use only. Do not write in this area,to be completed by city or town ofeiaL 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#: DocuSign Envelope ID:8011EB61-E7E2-4ACE-936E-5F67368CFD13 • ,r-- Permit Authorization mass save Form Swing through intorgy nLA..y Site ID: 3458548 -- _Customer: Blanche Finegan - ---_____ -_ I Ralph Di Monte ,owner of the property located at: (Owner's Name,primed) 31 Melville Road 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. ,,rr""oocrem..e by Owner's Signature w ViM.ot&#t, 8103420589304E2... 10/3/2018 1 3:47 PM EDT Date: FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: t Cir%cls -.,\ otX?iii No. j1L le j7illi Participating Contractor Date Name: RISE Engineering Phone: 401-784-3700 Email: For Office Use Only Rev.102015