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Home My WebLink AboutBLD-19-003600 �. - i • se Only }QF AR'SO �nu r /9— I�/r1711 C' l '€ �H,. 1 Amount I e <�d' Permit expires 180 days from 1 issue date EXPRESS BUILDING PERMIT APPLICATION" I. CEIVE a - TOWN OF YARMOUTH I F..-#7n-7, .10,.. Yarmouth Building Department DEC 12 2018 1146 Route 28 South Yarmouth,MA 02664 ,_,n r.�; DEPARTMENT `1 U (508)398-2231 Ext. 1261 — CONSTRUCTION ADDRESS: 'T ( far k. Ave (,). y rnn✓t', I MVl A 62 6 7 3 ASSESSOR'S INFORMATION: y ,(� Map: Parcel: n OWNER: FA' y La rt% 'i eCek AN( u.,/. YAeevnoI.. wI9 awn lib02-117 -9 703 NAME'E/� PPRESENT ADDRY'�E'S�p1 /� TEL 0 ��C//ONTRACTOR: c NAMEAG;t,.t k gvr l` ; 177 gIG1AJDRESS N,Dws,4Jt?►A 70027< —W V '64Residential 0 Commercial l Est.Cost of Construction$ G ZOO -- c Home Improvement Contractor Lie.# 1/. 9 /Olig Construction Supervisor Lie.# C5 -o9 rr0 1 Workman's Compensation Insurance: (check one) 0 I am the homeowner 0 I am the sole proprietor ❑ I have Worker's Compensation Insurance Insurance Company Name: E Yl*L( '-1 ns,rr ant,t Worker's Comp.Policy!! V y'(./C '5-/- 5''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 Old Kings Highway/Historic/ Dist. ( )Replacing like for like PoolNIA /fencing 'The debris will be disposed of at: A IsC- QI�SO DS k l get, $e d 4-,/, NI A 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 revocation of my license and Cd../411-46‘... for prosecution under M.O.L.Ch.268,Section 1, Applicant's Signature: b1�, ..14-.., Date: 1 z. / r/j/ Owners Signature(or ) ADDRESS: Date: fi p Approved Br . (or df signtt) Date: C --/i- �O Build'' If Zoning District: Historical District: ❑ Yes 0 No Flood Plain Zone: 0 Yes 0 No Water Resource Protection District: Within 100 ft.of Wetlands: 13 Yes. 0 No 0 Yes 0 No • /-••% EFFIBUI.01 HWOODS 4E R® CERTIFICATE OF LIABILITY INSURANCE 08/1/2011 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 lieu of such endorsement(s). PRODUCER COACT Rogers 8,Gray Insurance Agency,Inc. PHONE Fax 434 Rte 134 INC.Na Eat I We,sq:(8n)816.2156 South Dennis,MA 02660 ADpAR' .mail@rogersgray.com INN INSURERS)AprORDING COVERAGE I NNCN INSURER A:Employers Mutual Casualty Company 21415 INSURED msupsn B;National Liability&Fire Insurance Company 20052 Efficient Buildings LLC INSURER C: PO Box 246 INSURER o: ,,, Bridgewater,MA 02324 msuRERE: — INSURER?: - 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 CONDmON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO VV)'uCH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHETERMS, EXCLUSIONS AND CONDmONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. II TR TYPE OF INSURANCE Ms0 WW1 POLICY NUMBER POLICY ESP POLICY EXP LIMITS X COMMERCIAL GENERALUABNDY MLwDmm IMMIOBIYYYYI 1,000,000 EACH OCCURRENCE 3 CLAIMS-MADE QX OCCUR 501803119 09/01/2018 09/01/2019 PgirtiGSR(Eaamurtncel $ 500,000 . _ MED EXP(Anv enepersre 5 10,000 PERSONAL a ADV INJURY 3 1,000,000 — GENL AGGREGATEpUqNpII.T.APPLIES PER GENERAL AGGREGATE 5 2,000,000 POLICY Ell D inc 4. DUCTS-COMPlOPAGG_ 5 2,000,000 11/4 — OTHER' • 5 A AUTOMOBILE LABILITY FaaB�tlleral LIMIT $ 1,000,000 _ ANY AUTO 521803119 091012018 09/01/2019 BODILY INJURY(Pr person) 3 _ _ —SCEO ' AUTOS ONLY X AUTOS BODILY INJURY(Per erddeN S X ca.., X AUTO ONprerf " 5 _ S A X UMBRElA UAB X OCCUR EACH OCCURRENCE _ S 2,000,000 EXCESS UAB CLAIMS-MACE 5.11803119 09/012018 09/012019 AGGREGATE 5 2,000,000 DEO X I RETENTIONS 10,000 $ B WORKERS OYERS LIABILITY X I STAATUTE I FR AApN�Y GPRqOPRe�ETORR/PPARTNERIEXECUTNC Y!cuman ❑N NIA V9WC956971 03/02/2018 03/0212019 Et mai 5 500,000 ImantlaiDry in l'Nn( 500,000 Byes describe underELDISE_E-EA EMPLOYEES DESCRIPTION OF OPERATIONS below E.L.DISEASE-PC/MY UM" 5 500,006 . • DESCRIPTION OP OPERATIONSILOCATIORS/VEHICLES WORD?*Add/Bond Ramada Schedule,may be attached Nmere epee Is regWeed) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE RISE Engineering ACCORDANCEWITHTTHHE POLLICY PRTE OVISIONS.NS. WILL BE DELIVERED m • 5 Dupont Ave South Yarmouth,MA 02664 ' AUTHORISED REPRESEENTAT/IVEE.[r' ACORD 25(2016103) C)1988-2015 ACORD CORPORATION. AO rights reserved. The ACORD name and logo are registered marks of ACORD Page 1 of 1 Customer Name:Kathy Pares CONTRACT — Email:kparas217@gmail.com \11!// Phone:781-249-5703 RISE - Project ID:3567551Premise Address: 4 Part(Ave,West Yarmouth,MA 02673 Date:Oct.4,2018 ENGINEERING Efficiency!nrrtited. RISE Engineering 5 Dupont Avenue,Suite 2 South Yarmouth,MA,02660 Job Description Measure Description '- Quantity Unit Total Cost Customer Cost AIR SEALING 11 hr $880.00 $0.00 Duct Sealing-6 Hours(not insulated,over 200') 1 each $505.92 $0.00 WEATHERSTRIP DOOR&ADD SWEEP 3 each $240.00 $0.00 VENTILATION CHUTES 94 each $328.06 $82.01 8"ROOF VENT 4 each $348.60 $87.15 ATTIC DAMMING-R-38 FIBERGLASS 166 SF $408.36 $102.09 ATTIC FLAT-R-13 UNFACED FIBERGLASS 864 SF $1,313.28 $328.32 ATTIC FLAT-12"OPEN R-42 CELLULOSE 864 SF $1,451.52 $362.88 ATTIC HATCH:SEAL&INSULATE 1 each $60.00 $15.00 BASEMENT SILLS:R19 FG BATT 124 SF $271.56 $67.89 CRAWLSPACE:R-19&RIGID BOARD 72 SF $421.20 $105.30 Total: $6,228.50 Program Incentive: -$5,077.86 Customer Total: $1,150.64 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF "'One Thousand,One Hundred And Fifty And 64/100 Dollars $1,150.64 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 IIFFFJTTHHERE ARE ANY BLANK SPACES presen ne Cy`s erSignature _ j l Int I 1 / / Sign Date ( l �( 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 Conannweal[h of Massachusetts I conction SubtruSupervisor Dh4smoofProfessionalLicensure - Unrestricted-Buildings of any use group which contain �, Board of Building Regulations and Standards• less than 35,000 cubic feet(991 cubic meters)of enclosed IIII Constriction Supervisor •1 space. • • ••I CS-095551 Expires:05/12/2020 WIWAMCALLAHAN 176 QUINCY SHORE DR i "7 r . BIN • Lrrs f QUINCY MA 02171, •,t; Failure to possess a current edition of the Massachusetts • ' + State Building Code Is cause for revocation of this license. .. For Information about this license ,.. Commissioner Can(617)7274200 or visit www.massgoy/dpi • Q wommuntevectaiosamackedet4 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 0 =Lost* /737,cee mnnnnr`a//I etc ff.:;rrrvcrestal Oma of ConsumsrAffairs%Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Supplement Card before the expiration date. If found return to: Reeistratlon gxniratior Office of Consumer Affairs and Business Regulation 169944. 08/18/2019 Ona Ashburton Place-Suite 1301 EFFICIENT BUILDINGS LLC Boston,MA 02108 W ILL/AM CAUAHAN 300 ELM ST &I�'ti�•^� - r �"K"�tYLtr✓` BRIDGEWATER,MA 02324 UndersecretaryNot valid without signature I S r The Commonwealth of Massachusetts ICY= / Department of Industrial Accidents _TF1'= 1 Congress Street,Suite 100 : Boston,MA 02114-2017 a-F 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 ao employer?Check the appropriate box: Type of project(required): LEI am a employer with 17 employees(Poll and/or parttime).' 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 1 am a homeowner doing all work myself.[No workers'comp.insurance required.]: 9. ❑Demolition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10❑Building addition 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 1 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.Maher Insulation 152,§1(4),and we have no employees.No workers'comp.insurance required.] *Any applicant that checks box HI 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. /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:44 Park Avenue 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$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. !do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. �i Signature: .efi1�. ns . ( il—s-- Date: iZ/S//F Phone#:(508)279-1110 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: OH/L Permit Authorization ,.%)' rt.,Vii= mass save Form Soong.t'rwys+energy efficiency Site ID: 3461119 Customer Kathy Paras I, at14 1/ a f e.1 ' ,owner of the propertylocated at: t (Owner's Name,printed) 44 Park Ave West Yarmouth, MA 02673 (Property Street Address) (City) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform Insulation and/or weatherization work on my property. IOwner's Signature: X c Dates ( d `q—I t iroes'n4estgrea ! eowasko 4bF8 eeetentre^.5e3+4'i"dneett$n-se.!ffie+3temonettneffi • FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: • 4-41.;-(A^- 6 ' i);„ ccc. / o / y/i'' Participating Cont actor Date $ • Name: RISE Engineering Phone: 401-784-3700 Email: For Office Use Only Rev.102015