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HomeMy WebLinkAboutBld-20-000934 Office Use Only 1 O •yR1i` Permit# I �� S� I ,;ye C3 Amount 1 ' H t4 sAi-a 4. Z. b Permit expires 180 days from 4„.x..,�n« ,�� issue date %'i 60)-at12--93' EXPRESS BUILDING PERMIT APPLICATION R E C E I V E D TOWN OF YARMOUTH Yarmouth Building Department AUG l 6 2019 1146 Route 28 South Yarmouth,MA 02664 i aBy J �_. (508) 398-2231 Ext. 1261 _ CONSTRUCTION ADDRESS: ASSESSOR'S INFORMATION: IMap: I Parcel: '1 / OWNER: tQl^tl�w(t15i0 13TGlkei�il0.Ll+P QK W �l0.`�'Y,OI4/1 5J�'�� t 'tP�`NA PRESENT ADDRESS TEL. # C PA) Id so% 'a�q ' 1 ► 1oCONTRACTOR: Z� Lten 1 (h `�3 D�`E€S��d TEL.# NAME 0 ccATT ►"O /piii D4-1� 4 Residential 0 Commercial Est.Cost of Construction$ ( D 0 O Home Improvement Contractor Lic.# I(QC(`i 4-1 Construction Supervisor Lie.# ©et S t5 S I Workman's Compensation Insurance: (check one) D I am the homeowner ❑ I am the sole proprietor have Worker's Compensation Insur`an'cen. / O tD : Ca b'k t t�-1`i 1t'e S tXan C Worker's Comp.Policy V O( COI (p tP Insurance Company ame: • WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# Replacement doors: # Remove existing*(max.2 layers) Insulation Roofing: #of Squares ( ) y ) Old Kings Highway/Historic Dist. ( )Replacing like for like Pool fencing • *The debris will be disposed of at: ill 214.€RcL NJ ' ckAi m 0`" 1 , R 0 a-i�--1 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 for prosecutionti under M.G.L.Ch.268,Section 1. Applicant's Signature: W� C��nd\�1 Q Date:_ o * 1*' 9 Owners Signature(or attachment) 6 11/ I CAA E_1 Date: Approved By: Datc: R /4i�" 1 Build' (or designee) MAIL ADDRESS: 9..��"I Lty-{b U ld to S (.3 Y/"teut :Cowl Zoning District: Historical District: 111 Yes No Flood Plain Zone: 2 Yes 2 No Water Resource Protection District: Within 100 ft.of Wetlands: Yes _ No Yes 0 No �..411 EFFIBUI-01 CFOGARTY A�R� CERTIFICATE OF LIABILITY INSURANCE DATE M/2019 YY) 3/1/2019 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(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 af1CT R3 gers&Gray Insurance Agency,Inc. PHONE Fax 44 Rte 134 An,Ho,E d):(800)553-1801 I(A/C,N0):(877)816-2156 South Dennis,MA 02660 , (1 mail@rogersgr'ay.com INSURERS)AFFORDING COVERAGE NAIC S INSURER A:Employers Mutual Casualty Company 21415 INSURED INSURER B:National Liability&Fire Insurance Company 20052 Efficient Buildings LLC INSURER C: 973 Reed Road INSURER D North Dartmouth,MA 02747 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. INSR UCY EXP LTR TYPE OF INSURANCE INSD INVD POUCY NUMBER (MWDD Y I (Y EFF NMIDD/YYYYI UMITS A X COMMERCIAL GENERAL LIABIUTY EACH OCCURRENCE $ 1,000,000 pi( CLAIMS-MADE OCCUR 5D1803119 9/1/2018 9/1/2019 pREMISrES,EaEnoel $ 500,000 — MED EXP(Anyone person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X 128, ❑X LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: A $ AUTOMOBILE LIABILITY COMBINED(SINGLE UMIT $ 1,000,000 ANY AUTO 5Z1803119 9/1/2018 9/1/2019 BODILY INJURY(Per person) $ OWNED SCHEDULED A ONLY X 'AM �N.pyyNED BODILY INJURY(Per accident). $ X AUTOS ONLY X AUTOS ONLY FrOP&cf Y 4AMAGE $ _ $ A X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS UAB CLAIMS-MADE 5J1803119 9/1/2018 9/1/2019 AGGREGATE $ 2,000,000 DED X RETENTION$ 10,000 B WORKERS COMPENSATION X STATUTE TUTE 'n H. $ AND EMPLOYERS'LIABILITY Y/N ANY CPRROPRIIETgO�RR/PARTNER/EXECUTIVE n V9WC011676 312/2019 312I2020 E L.EACH ACCIDENT $ 500,000 (Mandatory in NH)EXCLUDED? N/A E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE RISE Engineering THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 5 Dupont Ave ACCORDANCE WITH THE POLICY PROVISIONS. South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE 1 4 -,04:el 7� ACORD 25(2016/03) 01988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DocuSign Envelope ID:E8C193EA-2B53-4065-BDAE-F02DA5D41397 Customer Name:Nancy Risk) CONTRACT Email:nwr523@cox.net Phone:508-771-6412 Premise Address:8 Tabernacle Park,West Yarmouth,MA 02673 Mailing Address:8 Tabernacle Park,West Yarmouth,MA 02673 RIsE Project ID:3862014 Date:July 31,2019 ENGINEERING' RISE Engineering 5 Dupont Avenue,Suite 2 South Yarmouth,MA,02664 Applicable Customer Required Actions: Notes: • Storage Removal Crawl space Measure Description Location'; Quantity Unit Total Cost Customer Cost DUCT INSULATION 10 SF $40.00 $10.00 Duct Sealing-4 Hours(not insulated,up to 200') 1 each $337.28 $0.00 AIR SEALING 10 hr $800.00 $0.00 WEATHERSTRIP DOOR&ADD SWEEP 3 each $240.00 $0.00 COMMON WALL:2"RIGID BOARD 40 SF $154.00 $38.50 VENTILATION CHUTES 46 each $160.54 $40.13 SHEATHING ACCESS 1 each $35.00 $8.75 PULL-DOWN STAIR:THERMADOME,BUILT-UP 1 each $237.65 $59.41 INSULATED BATH EXHAUST HOSE 2 each $120.00 $30.00 CRAWLSPACE WALL R10 RIGID BOARD 238 SF $963.90 $240.98 REMOVE EXISTING INSULATION-CRAWLSPACE 80 SF $77.60 $77.60 INSULATE BULKHEAD DOOR 1 each $110.00 $27.50 Total: $3,275.97 Program Incentive: -$2,743.10 Customer Total: $532.87 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Five Hundred And Thirty-Two And 87/100 Dollars $532.87 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. —DocuStgned by: DO NOT SIGN THIS CONTRACT IFTHERgAit`fetitY BLANK SPACES sibtSfilA, L orl.,s a,„ RIsE-Atimapitalip brst®7t9g3 7/31/2� 19 14:13 PM EDT Sign Date Page 1 of 2 Commonwealth of Massachusetts ° Construction Supervisor �' Division of Professional Licensure Uhrestricted-Buildings of an Board of Building Regulations and Standards less than 36,000 cubic feet(991 cubic group meers)of enclosed contain • Constraketibetispervisor 3 space. • i CS-095581 Expires:05/12/2020 WILLIAM CAt:LAHAN ITS QUINCY SHORE DR 4 r B81 _ a "« r _ - 1 QUINCY MA 0201, •: :''ram"' ° Failure to o - p possess a current edition of the Massachusetts ,rp •- State Building Code is cause for revocation ofthis license. - . Commissioner d•¢•1 Forinfom1attonaboutthisftC ____. - - —- _ Calf(6?T}T2T-3200 or visitwww.mass govldp! Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, M_,----chusetts 02118 Home Improvem --‘-_:' itractor Registration } ' Type: Supplement Card EFFICIENT BUILDINGS LLC JAI -p- -<<r j Registration: 169944 973 REED ROAD •r a Expiration: 08/18/2021 NORTH DARMOUTH,MA 02747 I K,- , : ili- + I w' scA 1 0 20M-05/17 Update Address and Return Card. Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only RPE4Loolement Card before the expiration date. If found return to: istratioh Expiration Office of Consumer Affairs and Business Regulation08/18/2021 1000 Washington Street -Suite 710 EFFICIENT BU, Boston,MA 02118 W ILLIAM CALLAk1A1 /) (A) 973 REED ROAD ,,�•a.i-/ GC/20a ck NORTH DARMOUTH,MA 02747 UndersecretaryNot valid without signature