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Home My WebLink AboutBld-20-000381 ese Only I / •Y �v19°)°� A InitiPR RECI EDJ Z !; t C Amounto t' . y 1 ' L----1 1 permit expires 180 days from MA, A M 4Si � �o c� 'issue date BUILOINO DEPAI-ITM NT By:. EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth,MA 02664 (508) 398-2231 Ext. 1261 R'Oe MarI CONSTRUCTION ADDRESS: `Sg N -tn4�v c...Ke...$a ' Mar � rWr A- Oa(e b y' ASSESSOR'S INFORMATION: IMap: 3__.. I Parcel: N7 OWNER:RIC.t'N4rCI.Sulltvar% Sg N&tnA-vcACei flue 5. Liarmo4 11414 (Apo./ Cc o8)a31•LI; 73 NAME PRESENT ADDRESS , TEL. # 11 (^ 1 RJ3 Qee� . N *mo Y 'H CONTRACTOR:Wv.e...hi Bt,a.l lirf(� 011 I t t►�h�Anci ncu't ar _;117 U AILING ADDRESS TEL.#( )a-i 4 .11 I D Residential 0 Commercial Est.Cost of Construction$ S/DO0 Home Improvement Contractor Lic.# U.. °t q 44 Construction Supervisor Lic.# C,5-0 E55'' Workman's Compensation Insurance: (check one) 1 I am the homeowner 7.7.1 I am the sole proprietor /'I have Worker's Compensation Insurance No��tonal Licebt VI*4 & f'tI Sn5t)ranc.e.co. Vq W C O I ��](p Insurancecompany Name: Worker's Comp.Policy# 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 Pool fencing • *The debris will be disposed of at: 1-1S ke A,. 'bAr4 ok. ' - ' I 'v` 14 D i:0, Li -7 Location of Facility , I declare under penalties of perjury that the statements herein contain. • - e and correct to the best of my knowledge and belief. I understand that any false answer(s) will be just cause for denial or revoca ion of my license. d for, ecution u I er M.G.L.Ch.268,Section 1. , • I n • ' 016 Applicant's Signature: — , '_ .CAI' f, , 1_1 /� Date: iftlultr H€ , Date: _ Owners Signature r attachme Approved By: .� / Datc: 7 '2 7 7Y Building Official(o Y EMAIL ADDRESS: Zoning District: Historical District: 0 Yes E No Flood Plain Zone: 2 Yes E No Water Resource Protection District: Within 100 ft.of Wetlands: Yes No Yes 2 No EFFIBUI-01 `--� CERTIFICATE E CFOGARTY A RTIFICATE OF LIABILITY INSURANCE I DATE 11201 YYY) 9 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 POUCIES 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. this SUBROGATION d0 es notYconfEer rights tott e certificate holderholder and in lieu of such endorysement(s)�licies may require an endontement. A statement on PRODUCER Rogers&Gray Insurance Agency,Inc. "ap � 434 Rte134 PHONE South Dennis,MA 02660 ,No,Ehd):(800)553-1801 allo):(877)816-2156 �:mall@rogersgray.com INSURER(S)AFFORDING COVERAGE NAIC S INSURED INSURER A:Employers Mutual Casualty Company 21415 INSURER B:National Liability&Fire insurance Company 20052 Efficient Buildings LLC 973 Reed Road INSURER C: North Dartmouth,MA 02747 INSURER D INSURER E: COVERAGES INSURER F: CERTIFICATE NUMBER: MBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURREVISION D 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 TYPE OF INSURANCE ADDL SUER POLICY EFF EXP A X COMMERCIAL GENERAL LIABILITY POLICY NUMBER LIMITS CLAIMS-MADEC OCCUR 5D1803119 EACH OCCURRENCE S 1,000,000 9/1/2018 9/1/2019 PREMISES(Es ococa ence) S 500,000 MED EXP(Any one person) S 10,000 GEN'L AGGREGATE LIMIT APPLIES PER: PERSONAL 8 qDV INJURY S 1+000,000 POLICY XA P (X I LOC GENERAL AGGREGATE $ 2,000,000 OTHER: PRODUCTS-COMP/OP AGG S 2,000,000 A AUTOMOBILE UABIUTY $ 4NYACRO (Esaa accidOMBINED ent)SINGLE LIMIT $ 1,000,000 OWNED SCHEDULED 5Z1803119 9/1/2018 9/1/2019 AUTOS �R�E� ONLY X AoitilEs LE BODILY INJURY(Per person) $ X AUTODS ONLY X AUTOS ONLDY pBRODILY INJURYp (Per accident) $ (Per accIde c)AMAGE $ A X UMBRELLAUAB X OCCUR $ EXCESS UAB CLAIMS MADE 5J1803119 EACH OCCURRENCE $ 2,000,000 9/1/2018 8/1/2019 DED X RETENTION$ 10,000 AGGREGATE $ 2,000,000 B WORKERS COMPENSATION $ A D EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTNE Y/N V9WC011676 X 1 ER aeda oryFln IjCLUDED7 N/A 3/2/2019 3/212020 $ 500,000 y E.L.EACH ACCIDENT DESCRIPTION OF OPERATIONS below EL.DISEASE-EA EMPLOYEES 500,000 EL DIS SE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION RISE En ineerin SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 5 Dupont Ave g ACCORDANCE WITH THE POLICY PROVISIONS. South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE I ��vzr/ �i ACORD 25(2016iO3) 888-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Customer Name:Richard Sullivan CONTRACT Email:rj.sullivan@comcast.net Phone:508-237-4273 Premise Address:58 Nantucket Avenue,South Yarmouth.MA 02664 RISE Mailing Address:PO BOX 454,West Chatham.MA 02669 Project ID:3835825 Date:June 12,2019 ENGINEERING" RISE Engineering 5 Dupont Avenue,Suite 2 South Yarmouth,MA,02664 Job Description Measure Description Location Quantity Unit Total Cost Customer Cost AIR SEALING 9 hr $720.00 $0.00 VENTILATION CHUTES 46 each $160.54 $40.13 WEATHERSTRIP DOOR&ADD SWEEP 1 each $80.00 $0.00 BASEMENT SILLS: R19 FG BATT 136 SF $297.84 $74.46 4"x 16"SOFFIT VENTS 8 each $231.28 $57.82 ATTIC DAMMING-R-38 FIBERGLASS 225 SF $553.50 $138.37 PULL-DOWN STAIR:THERMADOME,BUILT-UP 1 each $237.65 $59.41 VENT BATH FAN THRU ROOF 1 each $118.75 $29.69 ATTIC FLAT- 13"FLOORED R-42 DENSE CELLULOSE 735 SF $1,712.55 $428.15 Total: $4,112.11 Program Incentive: -$3,284.08 Customer Total: $828.03 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Ei• ,t Hundred And Twenty-Eight And 03/100 Dollars $828.03 UPON RECEIPT OF Y R RISE ENGINE /G INVOICE,CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL.INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY UNPAID BAL CE FTER 30 DAYS EE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR GIST ATION. DO NOT SIGN THIS CONTRACT ICTHERE ANY BLANK ACES RISER:. esenr: we Customer Sign ture h-5 I/2 Sign Date NOTE THIS C INTRACT M Y'-E WITHDRAWN BY US IF NOT EXECUTED WITHIN ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND 30 DA S 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 Page 1 of 1 • Commonwealth of Massachusetts Construction Supervisor • Division of Professional Licensure _ 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 Constricti'oriSu space. peNIS4P • CS-095581 Empires:05/12/2020 WILLIAM CALLAHAN 175 QUINCY SNORE DR + t B81 Nork: QUINCY MA 02171. - m ! 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 Call(617)727-3200 orvisitwww,mass.gov/dpl • Q� WOZONNiatniffieCtaQ 6-adf 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• Expiration: 08/18/2019 P.O.BOX 246 BRIDGEWATER,MA 02324 Update Address and Return Card. scat 0 30F.M-05t17 �Ae' arn/no/taQSW/en/iaelarkttel4 Office of ConsumerAffairs`&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Supplement Card before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 169944 08/18/2019 One Ashburton Place-Suite 1301 EFFICIENT BUILDINGS LLC Boston,MA 02108 W ILUAM CALLAHAN Ga,� f 300 ELM ST �� ► ( J $a7 aiagew. BRIDGEWATER,MA 02324 Undersecretary Not valid without signature The Commonwealth of Massachusetts ► = iiii 1 Department of Industrial Accidents ;,�= 1 Congress Street,Suite 100 '-`c,��i Boston,it MA 02114-2017 ��" www mass goy/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 an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with 25 employees(full and/or part-time).* 7. El 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 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. El Demolition 10❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole MO 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.❑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.['Other Insulation 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 and job site information. Insurance Company Name:National Liability& Fire Insurance Company Policy#or Self-ins.Lic.#:V9WC011676 Expiration Date:03/02/2020 S. gr-mot.)-i k1 1419 Job Site Address: -' ) E. Mein l.},UE v fk-O P City/State/Zip: _ Oe_(p(plt 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 penalties of perjury that the information provided above is true and correct. Signature: W C cLQ..Q C Date: —1 • 1 L' 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#: • Permit Authorization mass save Form Site ID: 3788596 Customer: Richard Sullivan ,owner of the property located at: (Owner's Name,printed) 58 Nantucket Avenue 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 props y. Owner's Signature: Date: U I FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: • (40 is Participating Contractor D e Name: RISE Engineering Phone: 401-784-3700 Email: Page 1 of 1 For Office Use Only Rev.102015 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 dis solid waste disposal facility as defined by MGL c.111,s. 150A. posed of in a properly licensed This Debris will be disposed of in: { 73 kZQ Ti) , �, G L/)l l e ;zt/-)9607)- l'Yl/-1 71-7 7 (LOCATION OF FACILITY) Signature of Permit Applicant */dj, 1 Date IF DUMPSTER IS USED IN EXC S OF SIX 6 CUBIC YARDS A PERMIT FROM THE FIRE DEPARTMENT IS REQUIRED FOR COMMERCIAL,INDUSTRIAL INSTITUTIONAL AND MULTI-FAMILY RESIDENTIAL OVER RENOVATIONS OR ALTERATIONS OF THE EXISTING BUILDING: 20 UNITS DEMO, **H V YOU SU Mf�l E T A CIRCLE ONE QO6 NOTIFICATIOa r0 THE MASSACHUSETTS DEP? YES NO