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Home My WebLink AboutBLD-19-003834 • i. ' of,Y'�k Office Use Only P F. .4:4.., ! O p Permitk t ,� 1 � Amountj — 1. e�' �Permit expires 1 BO days from 1 tissuedate &(h--tG -1:03 R E EXPRESS BUILDING PERMIT APPLICATI --. TOWN OF YARMOUTH Dee �... Yarmouth Building Department 1 kd13 . ' 1146 Route 28 awi. ;; - South Yarmouth,MA 02664 ar, y c:-r, 7; (508)(398-2231 Ext. 1261 14 ,( CONSTRUCTION ADDRESS: /^/(0Odeit Q Q S ' in/MO 14i ‘ ASSESSOR'S INFORMATION: /) / -( Map: Parcel: G nry/v,' OWNER: 8 `1VG.I.� LA000S . �1 Mile (13 ( 'v / 3-3- N PRESENT ADDRESS TEL. # CONTRACTOR: NAME Nat\t\} lg tf(1)/(H n M MOADD E S"n 6 a' TEL# -27c/ " /// o ( 11 ❑Residential ❑Commercial En.Cost of Construction S 7 2 7 I (2) 99 �1�i55 Home Improvement Contractor Lie.# Construction Supervisor Lia# C S- 0 15 Workman's Compensation Insurance: (check one) 0 I am the homeowner pi t/ •(A0 II�am the sole proprietor Elave Worker's Compensation Insurances Insurance Company Name: • . (a/(_Q 10..1_,„, Worker's Comp.Policy# \/ 96.) Q c /.Jr1, 77 WORK TO BE ' RFORMED Tent _ Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares ( )Remove existing*(max.2 layers) Insulation /l Old Kings Highway/HistoriccDDisst. ( )Replacing like for like Pool fencing ll` *The debris will be disposed ofa (�lCl 6,i \An 973 �k(4 �Q(, `i(X�W - Locatio not- �1/��/� ter.., )/yL`��l 1 declare under penalties of perjury that the statements herein contained are true and correct to the best of my knowledge and belief. (1 uunddeerstand that any false answer(s) will be just cause ford . or -voc:tion of my lick and for pc secution under M.O.L.Ch.268,Section 1. G Applicant's Sign: ../k 0.1111111, Date. /2 17 • /� Owners Sig tare(or Mtn 4 meet) s e_et - !/L.-- Date: `�� Approved B • ��—ai�+�I/�— Date: /f'2/�/�. Building OffIcW EMAIL ADDRESS: Zoning District: Historical District: ❑ Yes 0 No Flood Plain Zone: 0 Yes 0 No Water Resource Protection District: Within 100 ft.of Wetlands: 0 Yes 0 No 0 Yes 0 No • • ...........41, EFFIBUI-01 HWOODS A`oRo- CERTIFICATE OF LIABILITY INSURANCE DATEMMM]DmYY) 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 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 CONTACT NAME: Rogers&Gray Insurance Agency,Inc. PHONE I(FRAC,Ne):(B77)816-2156 434 Rte 134 (MC,No,Ext): South Dennis,MA 02660 E{'t*' mail//f�ro e ADDRESS: V 9 r39i'8)l.com INSURER(S)AFFORDING COVERAGE NAIC 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 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. INBR ADDL SUER ITR TYPE OF INSURANCE INSO WVD POUCY NUMBER POLICY EFF POLICY EXP IMMIDO/YYYYI IMMIDDM'YY) UNITS A J( COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE _$ 1.000,000 CLAIMS.MADE I-(OCCUR 5D1803119 09/01/2018 09/012019 DAMAGEs(DFR NoTEE°D ) $ 500,006 MED EXP/My one person) S 10,006 PERSONAL 8ADV INJURY S 1,000,006 GENI AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE _$ 2,000,006 POLICY�X j n LOC PRODUCTS-COMP/OP AGO S 2,000,000 OTHER: $ COMBINED SINGLE LIMIT 1,000,000AAVTOMOBBEIABILRY ( accident) S ANY AUTO 521803119 09/01/2018 09/01/2019 BODILY INJURY(Per person) $ OWNED ONLY X AAUTOS�� _ ��pE waves � EEpp pBRODILY INJURY(Per accident) $ X AUTOS ONLY X AUTOSOs (PmeaatDAMAGE S - S A X UMBRELLA LIAR X OCCUR EACH OCCURRENCE 3 2,000,005 EXCESS MEI CLMMSAMADE 5.11803119 09/01/2018 09/01/2019 AGGREGATE _3 2,006,606 DED X RETENTIONS 10,000 B WORKERS COMPENSATION S AND EMPLOYERS'LIABILITY X STATUTE ERS ANY PROPRIETOR/PARTNER/EXECUTIVE Y N V9WC958971 03/02/2018 03/02/2019 EL EACH ACCIDENT 500,000 qq��FICEWMEMgER EXCLUDED( N/A E 500,000 (mandatory In NH) If deaWbe under E.L.DISEASE•EA EMPLOYEE 5 DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT 5 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached II mon space N required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE RISE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN RISE EngineeringM Ave ACCORDANCE WITH THE POUCY PROVISIONS. DuSouth Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE • I �jrwrr!i < 1----- ACORD 25(2016/03) 01988.2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD • a Customer Name:Eileen Woods CONTRACT. — - - Email:evroods2006@comcast.net Phone:781.439-8477 � ' Premise Address:76 Neptune Lane,South Yarmouth,MA 02664 Proieet 10:3585246 Date:Oct.29,2018 ENGINEERING' RISE Engineering S Dupont Avenue,Suite 2 South Yarmouth,MA,02664 Job Description - Measure Description Location'.:. -::Quantity.. -Unit: '. Total Cost Customer Cost `. 4"x 16"SOFFIT VENTS 11 each $318.01 $79.50 VENTILATION CHUTES 72 each $251.28 $62.82 AIR SEALING 15 hr $1,200.00 $0.00 CRAWLSPACE:10 MIL GROUND COVER 1512 SF $1,466.64 $0.00 BASEMENT SILLS:R19 FG BATT 152 SF $332.88 $83.22 COMMON WALL:2"RIGID BOARD 404 SF $1,555.40 $388.85 ATTIC FLAT-8'OPEN R-30 CELLULOSE 1328 SF $1,912.32 $478.08 ATTIC HATCH:SEAL 8 INSULATE 1 each $60.00 $15.00 ATTIC DAMMING-R-38 FIBERGLASS 1 SF $2.46 $0.61 INSULATED BATH EXHAUST HOSE 1 each $60.00 $15.00 VENT BATH FAN THRU ROOF 1 each $118.75 $29.69 Total: $7,277.74 Program Incentive: -$6,124.97 Customer Total: $1,152.77 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF "'One Thousand,One Hundred And Fifty-Two And 77/100 Dollars $1,152.77 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 AR ANY BLANK SPACES RISE Representative Customer Signature i'/ /.Je"t Sign Date NOTE: ! • rACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN ACCEPTANCE OF CONTRACT•THE ABOVE PRICES,SPECIFICATIONS AND 30 DA //,, CONDITIONS ARE SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE Jtj y AUTHORIZED TO DO THE WORK AS SPECIFIED.PAYMENT WILL BE MACE AS /L . cJ,? �'\\b/�.i r.� OUTLINED ABOVE V U/! Page ort Commonwealth of Massachusetts Construction Supervisor • Et Division of Professional Licensure Unre3trided-Buildings of any use group which contain • Board of Building Regulations and Standards tessthan 35,000 cubic feet(991 cable meters)of enclosed ' - Constrtict?nn'Supervisor ? • space. • • • CS-095581 -. Eaplres:05112/2020 WILLIAM CALLAHAN..c - - 'r 1T8 QUINCY SHORE DR • B61 • ,r • QUINCY MA 021t1; • Failure to possess a current edition of the Massachusetts ..,�• .'-�' •� - State Building CodeIs cause for revocation of this license. :. C For Information about this license Comm[ssioner l eL Cali(817)72T3Y00 or visit www.massyov/dpi • • Q9LcQ ea.a 0tPg t 46 t A�,�ede1 • Office of Consumer Affairs and Business Regulation • . One Ashburton Place-Suite 1301 , • Boston, Massachusetts 02108 Home Improvement Contractor Registration • Type: Supplement Card • Registration: 169944 EFFICIENT BUILDINGS LW.. Expiration: 08118/2019 P.O.BOX 246 BRIDGEWATER,MA 02324 • Update Address and Return Card. Silt a zacanr a antnronrmwfiif/ rand Office of Consumer Attains 6 Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:Supplement Card before the expiration data. Hfound return to: Reolstration Exoiratiort Office of Consumer Affairs and Business Regulation 169944 08/1812019 One Ashburton Place-Sults 1301 . EFFICIENT BUILDINGSLLC Boston,NIA 02100 WILUAMCALLAHAN - \ - 300 ELM ST (� BRIDGEWATER,MA 02924 Undersecretary Not valid without signature • . The Commonwealth of Massachusetts I_- 1=fit Department of Industrial Accidents =1fil1=• I Congress Street,Suite 100 e _Tanfir Ow Boston,MA 02114-2017 .._,,.s, 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 gap(Business/OrganiizzatioWinndividual): (`r/, U 1 1 O Address:9 73 I`QQb U L'bc, City/State/Zip:a Qi( nUlt-i(TOO 741 Phone#: 50 R 7q-l n i 6 A itt i an employer? ee a appropriate box: Type of project(required): 1.1111 'a employer withemployees(full and/or part-time).* 7. 0 New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in • any capacity.[No workers'comp.insurance required.] 8. ❑Remodeling 3.0 I am a homeowner doing all work myself[No workers'comp.insurance required]t 9. ID Demolition 4.01 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.❑Electrical repairs or additions proprietors with no employees. 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet 12.0 Plumbing repairs or additions These sub-contractors have employees and have workers'comp.insurance.t 13.11 AROOF[e/paiIS L„ 6.0 We are a corporation and its officers have exercised their right of exemption per MGI.c. 1 /,•' .er(N(U(� 152,§I(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 subcontractors 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: ( ( )J)UCG/\ja (3 A"A � nn Policy ft or Self-ins.Lie.#: V£ co( CJ ytq, t Expiration Data- .3/7/ 1 ^p �I r / nig Job SiteAddress� 0 IV�}1"`)no � � City/State2ip:S��(y'(yN(�, V § �'f Attach a copy of the workers'compensation policy declaration page(showing the policy numb r 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 7 lilunder the pains d�/penalties of perjury that the information provided above is true and correct signature: Date: 17'1 1--,/ phone#: 0 ;9. /// A 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#: • "47- .1 i - Permit Authorization mass save Form Sx:ma•:m;..r..e.+.+c,rr..,,encs Site ID: 3580047 Customer: Eileen Woods I, j/n. — £' />.G n/S- ,owner of the property located at: (Owner's Name,printed) 76 Neptune Lane 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. Owner's Signature: Date: /i — e?— a a J5/ FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Dato Name: RISE Engineering Phone: 401-784-3700 Email: Page 1 of I Rev.102015 For Office Use Only