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HomeMy WebLinkAboutBld-20-037 Office Use Only oi'YA/4', Permit* s �! O'. O `r em�� H.: Amount ,.JJ ,,,�,T” u Permit expires 180 days from : '�a.K.,u�G� issue date C k 1SDlo EXPRESS BUILDING PERMIT APPLICATION — 7 TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth,MA 02664 (508)398-2231 Ext. 1261 CONSTRUCTION ADDRESS: 1 Vra,to riSu C►1 L_i, 5. L.ar moU# 'i , ►4.4 il Oa(o'V- ASSESSOR'S INFORMATION: IMap: Parcel: U / 2�— OWNER: c 1 t , 3 1 4 rQ 2 Vcr� L n 5. " (krp- AJ�O1'S1pJ ' n 35 '�� "� PRESENT ADDRESS TEL. # s eg.a"'�Q. 1(l 0 V e•Fric.ie„+ as ReecLQ d.N 11at rrtot7�� tti114 a�1 th`7 CONTRACTOR:Al EL tq N17 C(�, lQ 110.11en it s id r►1_M5 TEL.# MAIL ADDRESS Xsidential 0 Commercial Est.Cost of Construction$ 9 s 00 a Home Improvement Contractor Lic.# (Q "{44 Construction Supervisor Lic.# LS "" 0q6-513 I Workman's Compensation Insurance: (check one) ❑ I am the homeowner 0 I am the sole proprietor I have Worker's Compensation Insurance rr Vran a Com (^y Name:1 ii-4`4.'Ft r'e- S Worker's Comp.Policy# V"LWC I I tD� Insurance Company 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 • A L�L t � Q I -13 R Rc1. N I�tr ocM\ 1 f tI oar 4D *The debris will be disposed of at: 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 dennial•orr revocation of my license and for prosecution under M.G.L.Ch.268,Section 1. (� r �i • ( Applicant's Signature: W L.X a ..Let Ain C & O_4_ Date: (1) 1 ' Owners Signature(or attachment) 5 �E. f CH Lb Date: Ce l `aQ4. 141 Approved By: ✓ Date: ' 4--IS Building Official(or desi EMAIL ADDRESS: Zoning District: Historical District: 0 Yes ❑ No Flood Plain Zone: C, Yes C No Water Resource Protection District: Within 100 ft.of Wetlands: u Yes 0 No 0 Yes ❑ No ACORO` EFFIBUI-01 CFOGARTY `..�-- CERTIFICATE OF LIABILITY INSURANCE DATE(MNNDD/YYYy) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.ITHIS 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 pollcy(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 te Rogers&Gray insurance Agency,Inc. P"� � 434 Rte 134 N,E,d):(800)553-1801 South Dennis,MA 02660 I(NC,No):(877)816-2156 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. AINSR ADDL SUER TYPE OF INSURANCE -INSD WVD POLICY NUMBER POLICY!(M LICDY I LIMITS X COMMERCIAL GENERAL LIABILITY (MM/OD MID I CLAIMS MADE I X OCCUR EACH OCCURRENCE $ 1,000,000 501803119 9/1/2018 9/1/2019 DAMAGE TO RENTED PREMISES(Ea octxlrrencel $ 500,000 MED EXP(Any one person) S 10,000 GEN'L AGGREGATE LIMIT APPLIES PER: PERSONAL&ADV INJURY S 1,000,000 7 POLICY�X P x LOC GENERAL AGGREGATE $ 2,000,000 OTHER: PRODUCTS-COMP/OP AGG $ 2,000,000 A AUTOMOBILE LIABILITY $ COMBINED SINGLE LIMIT $ 1,000,000 -- ANY AUTO 5Z1803119 Ma=Me th AUTOS ONLY X SCHEDULED 9/1/2018 9/1J2019 BODILY INJURY(Per person) $ ���� AUTOS X AUTOS ONLY X gsVOi�NED BODILY INJURY(Per accident) $ tJLY PpRROPERTY DAMAGE (Peracadenq $ A X UMBRELLA LIAR X OCCUR $ EXCESS LIAR CLAIMS-MADE 5J1803119 EACH OCCURRENCE $ 2,000,000 DED I X I RETENTION$ 10,000 9/1/2018 9/1/2019 AGGREGATE $ 2,000,000 B WORKERS COMPENSATION a AND EMPLOYERS'LIABILITY - W- AND CPRRO/P�REIETOR1pARTNERIE)(ECU7IVE Y/N VgWC011676 X I STATUTE I I ER If y(Manti ory 1a�M EXCLUDED? El N/q 3J2J2019 312/2020 EL.EACH ACCIDENT $ 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-EA EMPLOYEE $ 500,000 E.L.DISEASE-POLICY LIMIT $under 500,000 DESCRIPTION OF.OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may tre attached if more apace Is required) CERTIFICATE HOLD R CANCELLATION RISE En inesrin SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE g g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN S Dupont Ave ACCORDANCE WITH THE POLICY PROVISIONS. South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) .--.._ ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DocuSign Envelope ID:E9B08A29-6EE4-413A-BAA4-323828F93C71 Customer Name:Kevin Galligan CONTRACT Email:kkgalligan2@comcast.net Phone:508-561-1735 Premise Address:31 Brae Burn Lane,South Yarmouth,MA 02664 RISE Mailing Address:31 Brae Burn Lane,South Yarmouth,MA 02664 Project ID:3833370 Date:June 7,2019 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 15 hr $1,200.00 $0.00 ATTIC DOOR: INSULATE&WS 1 each $110.00 $27.50 WEATHERSTRIP DOOR&ADD SWEEP 1 each $80.00 $0.00 ATTIC DAMMING-R-38 FIBERGLASS 150 SF $369.00 $92.25 ATTIC FLAT-12"OPEN R-42 CELLULOSE 1480 SF $2,486.40 $621.60 COMMON WALL:2"RIGID BOARD 140 SF $539.00 $134.75 INSULATE BULKHEAD DOOR 1 each $110.00 $27.50 4"x 16"SOFFIT VENTS 9 each $260.19 $65.05 8"x 16"SOFFIT VENTS 4 each $115.64 $28.91 DRYER-VENT TO OUTSIDE 1 each $147.00 $36.75 FINISHED CEILING ACCESS 1 each $135.00 $33.75 INSULATED BATH EXHAUST HOSE 2 each $120.00 $30.00 SHEATHING ACCESS 1 each $35.00 $8.75 VENTILATION CHUTES 64 each $223.36 $55.84 CRAWLSPACE:R-30 FG BATTS 1078 SF $2,468.62 $617.15 Total: $8,399.21 Program Incentive: -$6,619.41 Customer Total: $1,779.80 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***One Thousand,Seven Hundred And Seventy-Nine And 80/100 Dollars $1,779.80 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. Docusigned by: DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES 1. _-Docusigned by: \--AA1 Et/4/6E1044A... `---2A41 DA3EC3AB4AB... RISE Representative Customer Signature 6/12/2019 18:37 AM EDT Sign Date Page 1 of 2 • Commonwealth of Massachusetts Construction Supervisor Unrestricted_Buildings of any use group which contain Division of Professional Licensure less than 35,000 cubic feet(991 cubic meters)of enclosed Board of Building Regulations and Standards Construction-Supervisor space. • CS-095581 _ E pires:05/12/2020 • WMLUAM CALLAHAN 176 QUINCY SHORE DR 1 r 1381 ` QUINCY MA 02171 - ' `y Failure to possess a current edition of the M State Building Code is cause for rev ashis license.For information about thisreof vocation license' Commissioner `_ Call(617)727-3200 or visitwww,rnass govidpl CL • gJ 4ceirxwvinonweaa C.),/� esaciteti 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 P.O.BOX 246 Expiration: 08/18/2019 BRIDGEWATER,MA 02324 Update Address and Return Card. SCA 1 O 201.1-05117 — '`fir mmamafealfA c ^/la..tafa..ell' Office of Consumer Affairs Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Supplement Card before the expiration date. If found return to: Registration Exoiration Office of Consumer Affairs and Business Regulation 169944 08/18/2019 One Ashburton Place-Suite 1301 EFFICIENT BUILDINGS LLC Boston,MA 02108 W ILEAM CALLAHAN 2��(1 ,, ( ji7pallui7 `� //p/JWST C �C ,�/ BRIDGEWATER,MA 02324 Undersecre3' Not valid without signature The Commonwealth of Massachusetts 1.....=7,tiw-A 1, Department of Industrial Accidents _As=.-- 1 Congress Street,Suite 100 _ �_ Boston,MA 02114-2017 www.mass.gov/dia imik 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. 1.3 New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. El Remodeling any capacity.[No workers'comp.insurance required.] 3.0I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. El Demolition 10 0 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 11.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑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.: 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[✓ OtherInsulation 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. 1Contractors 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 Job Site Address:31 Brae Burn Lane City/State/Zip:S Yarmouth, MA 02664 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 enalties of perjury that the information provided above is true and correct Signature: (lLJ2..QC*__kEL4'\ Date: (Y • l CI • I / 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#: DocuSign Envelo•e ID:E9808A29-6EE4-413A-BAA4-323828F93C71 Permit Authorization mass save Form Site ID: 3817612 Customer: Kevin Galligan Kevin Galligan I, ,owner of the property located at: (Owner's Name,printed) 31 Brae Burn 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. —DocuSigned by: kliti ;,w 1 Owner's Signature: I't �± ` —2A41DA3EG3AB4AS... 6/12/2019 I 8:37 AM EDT Date: FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Dat Name: RISE Engineering Phone: 401-784-3700 Email: Page 1 of 1 For Office Use Only Rev. 102015