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Home My WebLink AboutBld-20-000380 i `ice Use Only ®tb- 1O -O Og YyR • 'emus# yt C' Amounts V 1 T(e�` l Permit expires 180 days from ''`�4TTA M fisCJ :� aK.nw � issue date EXPRESS BUILDING PERMIT APPLIC ! �; TOWN OF YARMOUTH • Yarmouth Building Department JUL 2 9 2019 1146 Route 28 South Yarmouth,MA 02664 BUIL I EP RTMENT (508) 398-2231 Ext. 1261 By. .� (1 Ui 'Oe..s4-�,ac-mot?E'�, 10414 Dc �� 3 CONSTRUCTION ADDRESS: L`� "f'Z-��-�l� � ' ASSESSOR'S INFORMATION: I Map: / 1 Parcel: 1/2, 1 OWNER:Q4etclq bet.v1.a,,0 45-lin.ra+tonLn W y0.rinot 4h h l4 )3 SZA.3fo.354 PRESENT ADDRESS Vt cramlimp. Al r�ntot7N, f�114 �4"1 Ham•a�9 • i 1 CONTRACTOR: i►\in w+ Co iWm-, ci3 4e R� a , TEL.# / O NAME MAILING ADDRESS Z Residential 0 Commercial Est.Cost of Construction S c21 W Home Improvement Contractor Lie.# °"[Lf Construction Supervisor Lie.# CS 0 et 5 5I Workman's Compensation Insurance: (check one) 0 11 am the homeowner 1 D I am the sole proprietor ;�:'1 have Worker's Compensation Insurance Na�Compa Nam b m l t�'y `E -'t r•-e. =nSOrcLII Ce Co Worker's Comp.Policyi V a�G 01 i(off� Insurance Company Name: 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: 6-13 cR e La P.A N L..c4 OLD I A- 0 a-11F7 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 prosecution under M.G.L.Ch.268,Section 1. Applicant's Signature- t1 •1 1 ,i, I — Date: Owners Signatu' (or attachm•,t) l , Lb Date: r�-� Approved By: / — Date: /• 2- y Building Official(or designee) MAIL ADDRESS: Zoning District: Historical District: 2 Yes 71. No Flood Plain Zone: Yes No Water Resource Protection District: Within 100 ft.of Wetlands: Yes r2 No = Yes 2 No - AC 0, EFFIBUI-01 CFOGARTY `..---- CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 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 PRODUCER Rogers&Gray Insurance Agency,Inc. PHONE Ext):(800)553-1801 aSouth Dennis,MA 02660 'NOS No):(877)816-2156 ,w,*-kss:mail@rogersgray.com INSURERS)AFFORDING COVERAGE NAIC# INSURED INSURER A:Employers Mutual Casualty Company 21415 INSURER B:National Liability&Fire Insurance Company 20052 Efficient Buildings LLC INSURER C: 973 Reed Road North Dartmouth,MA 02747 INSURER D: INSURER E: COVERAGES INSURER F: 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 ADDL SUBR TYPE OF INSURANCE INSD yyyp POLICY NUMBER POLICY EFF POLICY EXP X COMMERCIAL GENERAL LIABILITY fMMIDDryYYY) fMMR)D/YYYY) LIMITS A CLAIMS MADE Fin OCCUR 5D7803119 EACH OCCURRENCE S 1,000,000 9/1/2018 9/1/2019 PREMISES(OERaE"ocTEi ence) S 500,000 MED EXP(Any one person) S 10,000 GEN'LAGGR ATEURMITAP LI SPER: PERSONALBADVINJURY S 1,000,000 POLICY JECT LOC GENERAL AGGREGATE S 2,000,000 OTHER: PRODUCTS-COMP/OP AGG 2,000,000 A AUTOMOBILE LIABILITY $ _ (Ea as deentNED SINGLE LIMIT $ 1,000,000 ANY AUTO 5Z1803119 AUTOS ONLY X SCHEDULED 9/1/2018 9/1/2019 BODILY INJURY(Per parson) $ ��p AUTOS X AUTOS ONLY X pOTp ONLY BODILY INJURY(Per accident) $ (PeOPr accide PRERTY pAMAGE nt) $ A X UMBRELLA LIAB X OCCUR $ EXCESS(JAB CLAIMS MADE 5J1803119 EACH OCCURRENCE $ 2,000,000 DED X RETENTIONS 10,000 9/1/2018 9/1/2019 AGGREGATE $ 2,000,000 B WORKERS COMPENSATION $ UTY PRt I E IPARTNER/E)CECUTNE 3/2/2019 3/2/2020 X,gTEIZTUTE 1 ER AND EMPLOYERS'UABI FIE M EXCLUDED? a N/A EL.EACH ACCIDENT $ 500,000 FI gory n ) If es,describe under E.L.DISEASE-EA EMPLOYEES 500,000 SC IPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached Ir more space Is required) CERTIFICATE HOLDER CANCELLATION RISE Engineering SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 5 SE nAve THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. South Yarmouth,MA 02664 AUTHORIZF_D REPRESENTA17VE I: ',..... . e7rr:r6L,.....s...__......._ ACORD 25(2016/03) The ACORD name and logo are 01988-2015 ACORD CORPORATION. All rights reserved.registered marks of ACORD Customer Name:Patricia Daviau CONTRACT Email:davpat42@comcast.net Phone:508-364-3578 R I S E Premise Address:45 Vacation Lane,West Yarmouth,MA 02673 Mailing Address:45 Vacation Lane,West Yarmouth,MA 02673 Project ID:3834733 ENGINEERING" Date:June to,2019 RISE Engineering 5 Dupont Avenue,Suite 2 South Yarmouth,MA,02664 Applicable Customer Required Actions: Notes: • Storage Removal STORAGE HAS TO BE ROMVED BEFORE INSULATION WORK Job Description 'Measure Description Location Quantity Unit Total Cost Customer Cost KNEEWALL SLOPE:2" RIGID BOARD 220 SF $847.00 AIR SEALING $211.75 2 hr $160.00 $0.00 KNEEWALL SLOPE:6"FIBERGLASS R19 60 SF $101.40 INSULATE BULKHEAD DOOR $27.50 1 each $110.00 $27.50 Total: $1,218.40 Program Incentive: -$953.80 Customer Total: $264.60 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Two Hundred And Sixty-Four And 60/100 Dollars $264.60 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 ARE ANY BLANK SPACES • RISE Representative /tG<iQ �� Customer Signature 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 Page 1 of 1 • Commonwealth of Massachusetts Construction Supervisor • Division of ProfessionalMassachusetts Licensure Unrestricted-Buildings of any use group which contain Board of Building Regulations and Standards less than 36,000 cubic feet(991 cubic meters)of enclosed Construction-Supervisor • space. • CS-095581 E4pires:05/12/2020 ■ AOLLIAM CALLAHAN l LAHAN 175 QUINCY SHORE 881 QUINCY MA 02171: t,.,; w { Failure to possess a current edition of the Massachusetts . I State Building Code is cause for revocation of this license.I For information about this license _ Call(617)727-3200 or visit www.mass govldpi Commissioner � . _ _ Q9 ea a ?P.ArZ 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 LLC Expiration: 08118/2019 P.O.BOX 246 BRIDGEWATER,MA 02324 • Update Address and Return Card. SCA 1 %: Z0M-05/17 J/4 amstonraewl!/or/t:'�('a,ra�rrsell 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 ILLIAM CALLAHAN . ,�,,~ aim", 300 ELM ST ��N" .•` BRIDGEWATER,MA 02324 Undersecretary Not valid without signature '' The Commonwealth of Massachusetts iy 1, Department of Industrial Accidents =b 1 Congress Street,Suite 100 t' ••= " Boston,MA 02114-2017 °M, —,o 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 (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. 0 New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doingall work myself. t 9. ❑Demolition y [No workers'comp.insurance required.] 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 El 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. These sub-contractors have employees and have workers'comp.insurance.: l 3.aRoof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.E✓ 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. tContractors 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 Li&.-' ( ) P W NA V'f►-1ot)+k /iti 14 Job Site Address. V(��"tt 0 y L an,' City/State/Zip:- --- • 0 acv-73 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: L)� g �'1 CCL.Q_Q 0—A.U'^1 Date: -1 ' 1 —1 • II 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: 3830712 Customer: Patricia Daviau I, PCtirlc, I CI Oct vi4V owner of the property located at: (Owner's Name,printed) 45 Vacation Lane West Yarmouth, MA 02673 (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: ifefr4;44.4.„<AS Date: &- lO-. 13 FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: C01bB3 v Participating Contractor v ITte Name: RISE Engineering Phone: 401-784-3700 Email: Page 1 of 1 Rev.102015 For Office use Only 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 solid waste disposal facility as defined by MGL c.111,s.150A. of in a properly licensed This Debris will be dis posed of in: (LOCATION OF FACILITY) i 7 Signature of Permit Applicant 471/9-b 9 Date 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 20 UNITS DEMO RENOVATIONS OR ALTERATIONS OF THE EXISTING BUILDING: CIRCLE ONE 1 **H VE YOU SUB ITTED THE AQ06 NOTIFY TIO TO TH �eSACHUS ETf5 DEP YES NO • - 1