Loading...
HomeMy WebLinkAboutBLD-19-003830 i Office Use Only pf'Ygk �. Permit# � aAl C OIAmount - 3.5 N trt't •�'+••'%`�' r Permit expires 180 days from 4 I issue date Scb_lei--38317 EXPRESS BUILDING PERMIT APPLICATI • TOWN OF YARMOUTH j ;f C Yarmouth Building Department ( uJ 1146 Route 28 i - 1 2018 South Yarmouth,MA 02664 (508)398-2231 Ext. 1261 r r.inicz i)FF'ARTMENT r CONSTRUCTION ADDRESS: / b I f r e' f2 as 5 Y4,e•4v t,)11t n^A o z r,Z7 ASSESSOR'S INFORMATION: rt�� Map: Parcel: OWNER: D41%.: et OlatiOSu lc ti re, tedS• (�r...o.+`I'1r ItAsq 6266y (c-5-7)p41 - 2037 NAME/' PRESENT ADDRESS TEL II • CONTRACTOR: £(! 'C;tnf g,,;/J;�r L u 773 aeeil lt.A 4.)2b-/n o ✓ltA /)27Y1 4-4 tic-N I Q NAME LING ADDRESS TEL# etdesidential ❑Commercial Est.Cost of Construction S '3 v U. /�1' (, Home Improvement Contractor Lie.# / b / 7 7 if Construction Supervisor Lie.# C S d 9 Cr D 1 Workman's Compensation Insurance: (check one) 0 I am the homeowners 0 I am the sole proprietor ACJ have Worker's Compensation Insurance ,n Insurance Company Name: E,4"C 2 5 vre..•stt Worker's Comp.Policy# yq(Nc- 950p 7�l 7/ WORK TO BE PERFORMED Tent _ Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:it Replacement doors: # Roofing: #of Squares ( )Remove existing*(max.2 layers) Insulation __-- Old Kings Highway/Historic Dist.t(� ( )Replacing like for like /4,1 Pool fencing 'The debris will be disposed of at /A15V C ilp)YLI )Q4.r ,L(1I Location of Facility 1 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• revocation of my license an. '• /sec tion under M.G.M.G.L.Ch.268,Section I. Applicant's Signature: art ' ,//r '7 •!/ Date: �-2-4 c/iL Owners Signature •rattachn+nt) . /iii .eder. Date: Approved By: '~ ; ' Date: /2• Z/•/(� Building Official(or•- : cc EMAIL ADDRESS: Zoning District: Historical District: 0 Yes ❑ No Flood Plain Zone: 0 Yes ❑ No Water Resource Protection District: Within 100 ft.of Wetlands: 0 Yes Cl No 0 Yes . 0 No • • i.., EFFIBUI-01 HWOODS Ai`� CERTIFICATE OF LIABILITY INSURANCE LY °A08/ming"8 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 BYTHE 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 ban ADDITIONAL INSURED,the policy(fes)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 WAFT Rogers&Gray Insurance Agency,Inc. PHONE (NC 434 Rte 134 INC,NIA Eat: I IaG NV):(877)816-2156 South Dennis,MA 02650 ADDRESs•mail©rogersgray.com IJI I R$SURER(S)AFFORDING COVERAGE HAMS INSURER A:Employers Mutual Casualty Company 21415 INSURED INSURER B:National Liability&Fire Insurance Company 20052 Efficient Buildings LLC INSURER C: _ PO Box 248 INSURER o: ,,, Bridgewater,MA 02324 IRslnIt E: • INSURERP: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THEINSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTOAILTHETERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE um W p POLICY NUMBER AW POLICY Ent �m A X COMMERCIAL GENERALLNBALTY IAIMIDOM/YY1 IMMIDOIYYYY) EACH Oa:UR - s 1,000.000 CLAIMS-MADE n OCCUR 5D1803119 09/01/2018 09101/2019 PREMISEFSOF(a,°a°Imncel 5 500,000 - .. MED ExP(Am onepenonI s 10.000 PERSONAL LT ADV INJURY 5 1.000,000 GENT.AGGREGATE le APPLIES PEC GENERAL AGGREGATE J 2,000,000 POLICY®JECT ❑X LOC - PRODUCTS-COMP/OP AGG S 2.000.000 ` OTHER' 5 A AUTOMOBILE LIABILITY CaOMBIdengSINGLE LIMB 5 1,000,000 _ ANY AUTO person)5Z1803119 09101/2018 09/01/2019 BODILY INJURY S AU�ppTEEOpSpONLY X Nry..pryR-.O�° - pHRODLY INJURYperwrlde,q S X lam ONLY X AIL: ONLY IPeraO maeM) UE S S A X UMBRELLA LIAR IX OCCUR EACH OCCURRENCE $ 2,000.000 EXCESS UAB rCLAMS-MADE 5J1803119 09/01/2018 09/01/2019 AGGREGATE $ 2,000,000 DEO I X I RETENTIONS 10,000 $ B WORKERS NO COMPENSATIONEMPLYS' A X I AME I I OFR ANY CcPRRROPREIIETORPARTNERIEXECUTWE Y/❑N V9WC958971 03/0212016 0310212019 EL FAa1„comm. 5 500.000 Q FIQEmryIngig EJICLUme n N/A Mn) EL DISEASE-EA EMPLOYEE S 500.000 It yes,describe under i 500.000 DESCRIPTION OF OPERATIONS belay EL.DISEASE-POLICY InLIY 5 • DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Addienal Remade Schedule,/nay bealtached If mere spacers required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE RISE Engfneeling ACCORDANCE WITH THE POLICY PRO NO SCE WILL BE DELIVERED IN 5 Dupont Ave South Yarmouth,MA 02664 AUTHORIZED REPRESENTAIVE r'• T ACORD 25(2016103) 0)1988-2015 ACORD CORPORATION. Al rights reserved. The ACORD name and logo are registered marks of ACORD DocuSign Envelope ID:6844F7E0-E5EF-424A-A94A-C580A7DCAA8A Page 1 of 1 Customer Name:Demilare Oladosu CONTRACT Email:Darexbala@gmail.com Phone:857491-2037 Promise Address:818 Tern Road,South Yarmouth,MA 02664 ProjeDate:Oct.ID3578153 Date: ct.18,2018 ENGINEERING Eliciencyperthe d. RISE Engineering 5 Dupont Avenue,Suite 2 South Yarmouth,MA,02664 Job Description . .r Measure Description" Quantity '. Unit-- Total Cost ` -Customer Cost 1 AIR SEALING 10 hr $800.00 $0.00 KNEEWALL:2"RIGID BOARD 160 SF $616.00 $154.00 KNEEWALL FLOOR-10"DENSE R-32 CELLULOSE 150 SF $324.00 $81.00 KNEEWALL HATCH:INSULATE&WS 2 each $85.00 $21.25 BASEMENT SILLS:R19 FG BATT 70 SF $153.30 $38.32 CRAWLSPACE:10 MIL GROUND COVER 400 SF $388.00 $0.00 CRAWLSPACE WALL R10 RIGID BOARD 320 SF $1,296.00 $324.00 Total: $3,662.30 Program Incentive: -$3,043.73 Customer Total: $618.57 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF 'Six Hundred And Eighteen And 57/100 Dollars $618.57 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. -Docusbned by , DO NOT SIGN THIS CONTRACT IF THERE liALAN,K SPACES kr. (91 %kw. �Pdtati 937E SBRBQ3... RISE Representative Customer ignat5ure 10/19/2018 I 8:03 AM 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 Supervisor1 ' Unre3Mated-Buildings of any u j ®� Division of Professional Licensure group which • Board of Building Regulations and Standards less than 35,000 cubic feet(991 cubic meters)of enclosed Constraotfoupervisor ? space. n S • CS-095561 Expires:05/1212020 WIWAM CALLAHAN _ t 175 QUINCYSHORE DR * t QUINCY MA 021t1 - f'Y � f ,,. ' Failure to possess a clnmnt edition of the Massath.jn •rt•.. State Eullding Code is cause for revocation of this license. . Ci � Q For information about this Uctse Commissioner l/N"� Call(817)7274200orvisit www.mass.goy/dpi • Vim C6Pointo4uvecta t PAzona(.'t�24�%Jefit.Cl' 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. SCAt Q tat.slrc nse ' RgO e ofCoumr�lrszBusiness elation HOME IMPROVEMENT CONTRACTOR . Registration valid for Individual use only TYPE:Supplement Card before the expiration date. If found return to: fleglstratioq Expiration Office of Consumer Affairs and Business Regulation 169944 08/1812019 Ona Ashburton Place-Suite 1301 EFFICIENT BUILDINGS LLC - Boston,onMA 02108 WIWAMCALLAHAN `,per _„_ ( )JAIJ (J J 300 ELM ST (�-"•'.'3 �v`^'LY{'La✓r BRIDGEWATER,MA 02324 UndersecretaryNot valid without signature • - - • . • The Commonwealth of Massachusetts tE—_LT_ Department of Industrial Accidents (: 11111= 1 Congress Street,Suite 100 Boston,MA 02114-2017 1/47-", www.massgov/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 it:(508)279-1110 Are you an employer?Check the appropriate box: Type of project(required): LQ 1 am a employer with 25 employees(Ml and/or part-time).• 7. ❑New construction 20 I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3.01 am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. Demolition 4.0 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 I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.0Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 14.0Other Insulation 6.❑We are a corporation and its officers have exercised their right of exemption per MGL C. 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 andJob site information. Insurance Company Name:EMC Insurance Company Policy#or Self-ins.Lic.#:V9WC958971 Expiration Date:03/02/2019 Job Site Address:18 Tern Rd City/State/Zip:S.Yarmouth,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 PJ_ fres fperjury that the information provided above is true and correct Signature: 6/6/11Date: I2//9,1 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#: DowSign Envelope ID:6844F7E0-E5EF-424A-A94A-C580A7DCAA8A : Permit Authorization mass save Form t r.amgn tsv'wr rs.nor r'fr n • Site ID: 3551260 Customer: Damilare Oladosu Nr. of adosu ,owner of the property located at: • (Owner's Name,printed) 18 Tern 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. DoeuSldmd by. Owner's Signature: [nw. lea 930-5e45857ee23_ Dater 10/19/2018 I 8:03 AM EDT = y « +. t .; e5 < y>± dF x.ii F 4t(-1' e“.r. t .:a 8:: . t FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: E���citN,f put'(ci'k\to LLC I0 ) Y /la- Participating Contractor Date r • Name: RISE Engineering Phone: 401-784-3700 Email: Fur CBice Use Cell Rev.102015