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Home My WebLink AboutBLD-19-004057 • of'°''?R Office useOnly Pwuut.emnes l80.days from : EXPRESS BUILDING PERMIT APPLICATI j C E,I V E D . TOWN OF YARMOUTH Yarmouth BnildiagDepanment JAN 09 2019'. ' 1146 Route 28 South Yarmouth,MA 02664 BUI • = L�1_1 (508)398-2231 Ext. 1261 BY CONSTRUCTION ADDRESS: J S POJY 1°A. . 9 . 10,111406011ny4/1 001,07..3 ASSESSOR'S INFORMATION:. Map: Parcel oWxER: b V1ald, -rats If j fa 3A PQ,mf-l- YZd_ 171 - 65L11255a PRESENT coxrRACTOR: R h a/nd La.ngtth 1 rciiO GrD2e S4, llHivef I ii as . o3149-1. ViOlt S `(Residential 0 Commercial Est Cast of Construction S LI)loc 0• UJ Home Improvement Contractor Lit.X 1 6 O•-'�6 Ll' - Construction Supervisor Lic,# V 31310 I Workman's Compensation Insurance; (check one) Q I am the homeowner 0 Iam the sole proprietor 0 I have.Worker's Compensation:Insurance �1 . Insurance Compaty Name: LI heal MUL UMA Worker's Comp.PoEey# XW S . t0C I P t N WORK TO BE PERFORMED Tent . Duration (Fire Retardant Certificate attached'!) Wood Stove. Siding #of Squares Replacement windows:# Replacement doors: # Roofing: it of Squares ( )Remove existing*(max.2 layers) insulation Old Kings flighway/fiistoric Dist. ( . )ReplacinglaJrlike for like Pool fencing *ThedeM;swiaMdisposed ofat: IOrO Airptrw- l�(A. Fall KiYtvrry4 na•7aQ . I:ocaton of Facility I declare under penalties ofperjiay that the statements herein contained are true fed correct to the best tf my knowledge and belief Imtderstatd that any false aswer(s) will be just cause for denial orrevocation of my license and for prosecution under Mkt.Ch.268,Section I: Applicant's Signature; - - Date pp Owners Signature(or attachment) 1 ,� .411.../CADate/31/!J/y Approved By / ?ate'. IA-7.717 .. .B g. dal or designee) EMAIL.ADDRESS: Zoning District: • Historical District Q Yes 0 No . Flood Plain Zona 0 Yes .D No Water Resource Protection District Within 100 ft,of Wetlffiids'. 0Yes 0 N 0. YM 0 No • DEBRIS FORM. In accordance with the provisions of MGL c.40,s:54,a condition of Building Permit Number is that the debris resulting from this work shall be disposed of In a property licensed solid waste disposal facility as defined by MGL c.111,s.150A. This Debris will be disposed of in: Republic Services Dumpster: 1080 Airport Rd Fall River, MA 02720 (LOCATION OF FACILITY) #1 / (/-- Signature of Permit Applicant ta\ lel 1s Date IF DUMPSTER IS USED IN EXCESS OF SiX (6) CUBiC YARDS A PERMIT FROM THE FiRE DEPARTMENT IS REQUIRED • FOR COMMERCIALL,INDUSTRIAL,INSTITUTIONAL AND MULTI-FAMILY RESIDENTIAL OVER 20 UNITS DEMO, RENOVATIONS OR ALTERATIONS OF THE EXISTING BUILDING: CIRCLE ONE °HAVE YOU SUBMITTED THE AGO6 NOTIFICATION TO THE MASSACHUSETTS DEP? YES - NO • h • iN The Commonwealth of Massachusetts ei Department oflndustrialAccidents ti._ n'- 1 Congress Street,Suite 100 Et-vi41=e 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 Leeibly Name(BusinessfOrganization/ndividuaq: Insulate2Save Inc. Address:410 Grove Street City/State/Zip: Fall River MA 02720 Phone it; 508-567-6706 Are your an employer?Check the appropriate box: Type of project(required): 1.0 1 am a employer with 20 employees(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 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 01 am a homeowner doing all work myself.[No workers'comp.insurance required.l r 9. El Demolition 3 4.01 am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 0 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.[3 Plumbing repairs or additions S.0 lam a general contractor and 1 have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insurance.' 6.0 We are a corporation and its officers have exercised their right of exemption per MOL e. 14.Qx Other Insulation 152.*1(4),and we have no employees.[No workers'comp.insurance required.] •Any applicant that checks box a I must also fill out the section below showing their workers'compensation policy Information. t Homeowner 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. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and fob site Information. Insurance Company Name: Liberty Mutual Insurance Policy#or Self-ins.Lie.#: XWS ,56418741 Expiration Date: 12/10/2019 Job Site Address:33 itrfne 4 IC(I. City/State/Zip:WrajblilljIM 6319/3Attach 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 certify under the gys ane ties of perjury that the information provided above is true and correct Signature: Date: i aI l C l i 2 phone#: 508-567-6706 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#: - Acorn:* CERTIFICATE OF LIABILITY INSURANCE DATE7(MMDDIYYYY) 2/10/18 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 CUNIALI NAME: Anthony F.Cordelro Insurance PHONE Nw up. 508.677.0407 i r(ac,Ne): 508-677-0409 171 Pleasant Street :sic hsousa@cordeiroinsurance.com Fall River,MA 02721 INSURER(S)AFFORDING COVERAGE NAIC I INSURER A: Liberty Mutual Insurance INSURED INSURER B: Insulate 2 Save,Inc. INSURER C: 410 Grove SL INSURER D: Fall River,MA 02720 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. 1LTR TYPE OF INSURANCE ADULCUBN POLICY EFF POLICY EXP INS° WVD POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) LIMITS X COMMERCIAL GENERALLIABILRY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE El OCCUR PREMISES(Ea occurrence) _ S 300,000 MED EXP(My one person) S 5,000 A _ Y Y BKS 56418741 12/10/18 12110/19 PERSONAL INJURY S 1,000,000 GENMAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY El;ERCT 0 LOC PRODUCTS•COMP/OP AGO $ 2,000,000 OTHER' S AUTOMOBILELIABILT' COMBINED SINGLE LIMIT $(Ea accident) 1,000,000 _ ANY AUTO BODILY INJURY(Per person) S A — AWNED X AUTOS SCHEDULED AUTOS ONLY Y Y BAA 56418741 12/113/18 12/10/19 BODILY INJURY(Per accident) S eHIRED ye NON-OWNED PROPERTY DAMAGE S AUTOS ONLY _ AUTOS ONLY (Per accident) _ S X UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 2.000,000 A EXCESS LIAB CLAIMS-MADE Y Y USO 56418741 12/10/18 12/10/19 AGGREGATE _ $ 2,000,000 DED RETENTIONS 10,000 5 WORKERS COMPENSATION PEROTH- AND EMPLOYERS'LIABILITY STATUTE X ER A OFFICER/MEMBER EXCLUDED ANY ?ECUTIVE Yrl N/A Y XWS 56418741 12/10/18 12/10/19 E.L.EACH ACCIDENT S 500,000 (Mandatory In NH) E.L DISEASE-EA EMPLOYEE S 500,000 If yes,describe under DESRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT 5 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHCLES (ACORD 101•Additional Remarks Schedule,may ba ttached N more apace Is required) Proof of Insurance CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE • THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Proof of Insurance ACCORDANCE WITH THE POLICY PROVISIONS.• AUTHORIZED REPRESEN /' /Z______, I 019'p-2015 ACORD CORPORATION. All rights reserved.I ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD • ..moi coo/22/27cvurleAa a tteae Office of Consumer Affairs and Business Regulation 1000 Washingt Street- Suite 710 Boston, Maga usetts 02118 Home ImprovemerW __tractor Registration )M / Registration: 180747 INSULATE 2 SAVE,INC. M Expiration: 12128/2020 410 GROVE ST FALLRNER,MA 02720 st , tiP TSS. l t 11111 v Update Address and Return Card. WA 1 0 20M 05/17 Office of Consumer Affairs&Busbies*Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TY t m before the expiration date. If found return to: B.ffiL Excitation Oma of Consumer Affairs and Business Regulation rt1807'i1r71. g2/28/2020 1000 Washington Street•Sults 710 INSULATE 2 SA I44 }}�+�- Boston,MA 02118 C47( ,, . /�/.J4 410 GROVE ST `�",k-<",k � " l �� FALLRIVER,MA 02720 Undersecretary Not valid without signature rcCommonwealth of Massachusetts `% 1 117DivisionDsion of Professional Licensors • Board of Bunting Regulations and Standards ConstwcttEni'tbper sor ilk CS-103851 y`Y .„ w fplres:08/24/2019 ti =ROUND LAIGEV7N of r �. ..c 84 HIGHCRESt AD I„fi ». N t FALL RNER MA12MQ bid I Commissioner 4.�”' f. RISE Engineering \kV cT -wz. ' RISE _ . 5 oupoM Avenue,,South Yarmouth,MA ovum cONTRA ENGINEERING' 508-566-1926X•6197 FAX 505.568.1933 Page 1 PROGRAM 1101COMMACT IS 11170.20�r r au u CLC-NES MSc yaE0ouc. (508)209.0118' 11/19/2018 127515 07503 1 RONALD TA$HJIAN I West Yarmouth,MAi 02673 Plymouth,Ma 02360 IIOTY COST INCENTIVE TOTAL ,.. DESCRIPTION 1. STORAGE-ATTIClamuls) Homeowner Is responsible for the removal of the stored items (I.ill I - •' ' blocking the installation of weathedzation work in the aNc-;Removal �- • " ''- ". must occur prior to the scheduled work start. ATTIC DAMMING-R-38 FIBERGLASS 150 $369.00 $276.75 $92.25 Provide labor and materials to instal a tY layer of R-38 unlaced • fiberglass baits for damming purposes. ATTIC FLAT=8'OPEN R-30 CELLULOSE 560 $806.40 $604.80 $201.60 Provide labor and materials to install an 6'layer of R-30 Class I Cellulose to open ante space. VENTILATION CHUTES. 54 $188.46 $141.35 $47.11 Provide labor and materials to install ventilation chutes In the rafter bays to maintain airflow. - - SOFFIT VENT34Xi6 � 9 5260.19 $195,14 $65.05 Provide labor and materials to instal 4'X 16"rectangular aluminum soffit vents to increase ventilation in attic areas.Specify color.White or t Gray. HOME AIR SEALING 3 $240.00 $240.00 '- Provide labor and materials toseal areas ofhome our :a against Y wasteful,excess air leakage.Materials to be used to seal your home can Include caulks,foams and other products. Primary areas for sealing Include air leakage to attics,basements,attached garages and other unheated areas(windows are not generally addressed.) A .. ,,,; ; • '77 reduction In cubic feet per minute(cfm)of air infiltration will occur,but the actual number of cim Is not guaranteed. :' ., At the completion of the weatherization work,and at no additional cost to the homeowner,a float blower door and/or combustion safety analysis will be conducted by the subcontractor. ,+.: ,.. I CRAWLSPACE WALL RIO RIGID BOARD - - 480 $1 944.00 $1,458.00 $486,00 Provide labor and materials to Instal R-10 rigid Thermaxinstdation to the crawlspace perimeter wall up to the sill and against the band Joist: • CRAWLSPACE MAKE ACCESS DOOR• .1 -$25000 $)g7.50 . Provide labor and materials to frame and construct a pressure-treated $62.5o crawlspace access door.Access to be Insulated 14112'rigid Thermax i 1ois, " ' s _ - i. ;) board and sealed alba edoe with weathers = ,L, 4.r f ° - P.,ik kd .lh' . RISE Engineering RISE IS S Dupont Avenue,South Yarmouth,MA 02664 ENGINEERING - - -CONTRACT--WZ 509.563.1926X4197 FAX 608-666-1833' CONTRACT VVZ L Page 2 PROGRAM TMRCONTRACT EEN2RED INTO BOOWSER RESe CLC-HES -ENDINFERnq ANDIHE CUSIDMER FOR WORK AS OESCRHSED EELOW W9TOYTFR PXONE DATE CLIENTS WORK OWDER RONALD TASHJIAN (508)209-0118 11/19/2018 127515 07503, SERVICE STNEET BELINO SYHEE, 33 Pamet Road 37 Boulder Ridge SMILE ERIC SYAiE,31P BRLW41.Itt,LIAiEbP West Yarmouth;MA 02873 Plymouth,Ma 02360 DESCRIPTION - OTT COST INCENTIVE TOTAL INCENTIVE;75% For eligible measures,the Cape Light Compact is offering an incentive of 75%,with no limit,and an incentive of 100%for the Air Sealing measures. • ,C1.i Z CC Total: $4,058.05 Program Incentive: $3,103.54 . . Customer Total: $954,51 WE AGREE HERESY TO FURNISH SERVICES•CDMPEETENACCORDANCE WITH ABOVE SPECIFICATIONS.FOR TRE DVMCS' ***Nine Hundred Flfty•Four&511100 Dollars $954.51 UPON SWEPT NYOVR Rhee INEEWpO IMAM CUSTOMER AGREES TO ROW AMOUNT DUE MNL4INTFREST OF IM WILLBECNAROED MON/HLVONAW UNPAID BALANCE AFTERS), EEE Co ERBF IMPORTTAA�lNNTT MYORMAIRIN ON DDARMIEISJOGHTS OF RECYgKIICMEDqRP Y44ACONTRACTOR RE4LLM TDR. til Air a 14 , O, _ THIS M. Cf TAYaEWODRAWN NDYwsAYIT EREOUTFOWRNIN 'SATE aACCEPTANCE WI// 741 //7 1 kis N DA 1222. ACCEPTANCE OF CCNTIDICT.THE MUM PRCES:SXCINC*TNMM AND CONWTiOIa ME SATISFACTORY 10 LsAIO ARE IEREBY ACCEPTED.YOU AREAUIHORIEEB TO DO THE WORN AS SPECIFIED.PAYMENT FALL BE MADE AS OUDAO:D ABOVE RISE ENGINEERING OWNERAUTHORIZATION FORM I, Ronald Tashjian (Owner's Name) owner of the property located at 33 Pamet Road - (Property Address) West Yarmouth, MA 02673 (Property Address) hereby authorize IVhC14,1r e a SO v-e (Subcoltractor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my property.This form is only valid with a signed contract. t�� t Owner's Signature Ib / l' Date RISE Engineering,a Division of Thielsch Engineering,Inc 5 Dupont Avenue I South Yarmouth,MA 02664 1505-56&1926 www.R I S E e n g i n e e ri n g.co m