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HomeMy WebLinkAboutBld-20-004251 ...Kw , s i ice Use Only RECEIVED �j,o„�f FEB 3 2020 Permit ex ' _ p ires ISO days from BUILDING'DEPARTMENT issttedete By: EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTI Yarmouth Building Department 1146 Route 28 South Yarmouth,MA 02664 (508)398-2231 Ext. 1261 CONSTRUCTION ADDRESS:1 Chas m be,l ,n e - • /C\ Charnbel to i C-� ASSESSOR'S INFORMATION: Map: Parcel: 3 OWNER: Col leer) 'Al-hsb n g3tarre. 12 1- ubbards-I-on VA 0145,a 5089541 48, NAME PRESENT ADDRESS TEL # CONTRAACTOR:N.ofthew ZU ,I ,382Ot7-iarnordli1 V ttimbertar�dfl a4 1(.r,5'IQ'��� NAME MAILING ADDRESS TEL.#)(Residential D Commercial 11 ff Est.Cost of Construction$ 524 4r,.�S8 Home Improvement Contractor Lie.# ( 0 l.) 1 LP Construction Supervisor Lie.# 115509 Workman's Compensation Insurance: (check one) Li I am the homeowner 0 I am the sole proprietor XI have (W Worker's Compensation Insurance f Insurance Company Name: Fmpl D'lC S N 1.U "U4.( /�la 1 � 61,0 t f/Worker's Comp.Policy# qS o 2.z WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# Replacement doors: # Roofin , #of Squares *g" q ( )Remove existing*(max.2 layers) Insulation Old Kings Highway/H.istoric Dist. ( )Replacing like for like Pool fencing The debris will be disposed of at: 330 i t(,i Ur 2 S4 A i ho t'C M P b2.1 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•r cation of my license and for prosecution under M.G.L.Ch.268,Section 1. Applicant's Signature:' /� Dater �l ggigD a n (.0 Owners Signature(or attachment) ��1 C. ts" Date: Approved By: .!� � Date: Lk- Q Building Official(or designee) EMAIL ADDRESS: Zoning District: Historical District: Yes `' No Flood Plain Zone: :s Yes No Water Resource Protection District: Within 100 ft.of Wetlands: i..1 Yes C" No Yes I No Customer Name:Colleen Altison CONTRACT Email:altisonc@outlook.com Phone:508-954-6948 SPremise Address:7 Chamberlain Court,West Yarmouth,MA 02673 MailingAddress:93 Barre Road.Hubbardston,MA 01452 Project E s.- ID:3968384 Date:Jan.17,2020 ENGINEERING EfficJency Ener„i ed. • RISE Engineering 5 Dupont Avenue,Suite 2 South Yarmouth,MA,02664 Job Description AIR SEALING 8 hr $640.00 $0.00 PULL-DOWN STAIR:THERMADOME. BUILT-UP 1 each $237.65 $59.41 ATTIC FLAT-R-30 UNFACED FIBERGLASS 415 SF $796.80 $199.20 BASEMENT CEILING:ENCAPSULATED R19 FG BATT 643 SF $1,517.48 $379.37 BASEMENT SILLS:R19 FG BATT 88 SF $192.72 $48.18 COMMON WALL:2"RIGID BOARD 55 SF $211.75 $52.94 COMMON WALL:FG BATT+2"RIGID 18 SF $94.50 $23.63 CRAWLSPACE WALL R10 RIGID BOARD 144 SF $583.20 $145.80 KNEEWALL:FG BATT+2"RIGID BOARD 12 SF $63.00 $15.75 KW SLOPE:FIBERGLASS R30 56 SF $109.20 $27.30 KNEEWALL SLOPE:2"RIGID BOARD 56 SF $215.60 $53.90 CRAWLSPACE:10 MIL GROUND COVER 252 SF $244.44 $0.00 REPOSITION EXISTING INSUL 235 SF $58.75 $58.75 VENT BATH FAN THRU ROOF 1 each $118.75 $29.69 VENTILATION CHUTES 46 each $160.54 $40.13 Total: $5,244.38 Program Incentive: -$4,110.33 Customer Total: $1,134.05 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***One Thousand,One Hundred And Thirty-Four And 05/100 Dollars $1,134.05 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 c RISE epresentat a Gusto r Signature 1- l�—a a Sign Date Page 1 of 2 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 2 of 2 • GUARANTEES: All materials are guaranteed by the contractor to be as specified. All work to be completed in a workmanlike manner according to standard practice. Any alteration or deviation from specifications on contract involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements are contingent upon strikes, accidents, or delays beyond our control. In the event that work cannot be completed due to unforeseen existing conditions, the work will not proceed and a written agreement will be executed for the deduction of this work from the specifications on the contract. Customers to carry fire, tornado, and other necessary insurance. Our workers are fully covered by Workman's Compensation Insurance. Any defect in materials, manufacture, design, or installation found within one (1) year from date of the installation shall be remedied without charge and within a reasonable period of time. SCHEDULING: Work will begin based upon sub-contractor availability and permissible weather conditions. We will contact you to set a date and time. NOTICE TO MASSACHUSETTS CUSTOMERS: The Commonwealth of Massachusetts,Board of Building Regulation and Standards requires that you be notified of the following: "All home improvement contractors and subcontractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Director, Home Improvement Contractor Registration One Ashburton Place, Room 1301 Boston,MA 02108 Phone(617) 727-8598 Any and all necessary construction related permits are included in this contract. It shall be the obligation of the contractor to obtain such permits as the customer's agent. Customers who secure their own construction-related permits or deal with unregistered contractors will be excluded from access to the guaranty fund." NOTICE TO BUYER: 1. You are entitled to a copy of this agreement at the time you sign it. 2. The seller has no right to enter unlawfully your premises or commit any breach of the peace to repossess goods purchased under this agreement. 3. You may cancel this agreement if it has not been signed at the Main Office or a Branch Office of the Seller provided you notify the Seller at his Main Office or Branch Office shown in the agreement by registered or certified mail, which shall be posted not later than midnight of the third calendar day after the day on which the Buyer signs the agreement, excluding Sunday and any Holiday on which regular mail deliveries are not made. 4. No lien or security interest is placed on the property as a consequence of this contract if payment is made in accordance with contract terms. Permit Authorization Form Site ID: 3914888 Customer: Colleen Altison SD Inc? /9 I l- ;So c) ,owner of the property located at: (owner's Name,printed) 7 Chamberlain Court West Yarmouth, MA 02673 (Property Street Address) (MO 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; Date; 1- 17ao FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: 5C EnErg , If)c tiactiatt Participating Contractor Date Name: RISE Engineering Phone: 401-784-3700 Email: Page 1 of 1 For office Use Only Rev.102015 . no debris i.nsui at1Ln only DEBRIS FORM • In sc with the provisions of MGL c40,s.54,a contrition of Building Permit Number �f 1ram*� is that the debris Ong from this work shah be disposed of in a properly licensed solid waste disposal facility as defined by PALL c.111,s.150A. 'fhb;Debris will be disposed of in: 330 Yi efD r Rd S i-e h . e boro h'1 A 02103 (LOCATION OF FACILITY) A). 6-fideit Signature . ° Applicant I/ 6) / a0 ,20 Date jF DUMPSTER IS USED I41 OF SIX(6)IMIC YARDS A PERMIT FROM THE FIRE DEP IT IMENT 1SRE UIRED FOR COMMERCIAL,INDUSTRIAL,iNsmurioNAL BUILDING:MULTI-FAMILY RESIDENTIAL OVER 20 UNITS DEMO, RENOVATIONS OR ALTERATIONS OF THE EXISTING aRaE ONE ••f iAYE YOU SURNIIITUR THE ADOJINOJEFICATION TO THE NIMACHUSETTS DEP? YES NO DESCRIPTION OF WORK TO BE PERFORMED: USE GROUP: TYPE: i j W 3J on Commercial: Residential: X Mixed Use: Accessory: Maintenance: New Structure on vacant laud: Change of Use: Change of Occupancy: Addition: Alteration. Renovation: Repair: Demolition: Type of Fo on: n (Q Type ofFrame:Rio Wood: Manufactwed: Steel: Heat n to Gas: Oil: Electric: Other: #of units: OwnerOccupied:St,��f : n�a Structure#1 Dimensions: Square F ootage: Structure#2 : Square Footage. Structure#3 Dimensions:sions: Square Footage: Bedrooms#: Baths#: Number of Decks:.n i n Dimensions: Square footage: Number of Porches: ()10 Dimensions: Square footage: Garage: #of cars: Dimensions: Square fOotage: n 1 Cl Under: Ground level: Pool: Dimensions: SquareSquare . n I Q Above ground In gxound: Shed: n 1(1 Dimensions: Square footage: Detail Description: to u,A cLki on 1jt k. lee.. Comte n c - Estimated Value of Project: $ 5 241- , 38 l Official Use Only: 1 Revised 07/2015 1 ..-. The commonwealth of Massachusetts 1/4 1' vi, sl Depar tntenr of Industrial Accidents :. 11-...'-:. 1 Congress Street,Suite 100 ':f� _- Boston,MA 02114-2017 www ntass.govlrtlia Workers'Compensation Insurance Affidavit:Builders/contractors/Electricians/Plumbers. TO BE FILED PERMITTING AUTHORITY. tPlicltun iifbtk Please Print Legibly Name tausine worgiodzationnig sviduao:5G knere ,lne,,a...,. . „ .. _ __.., .. _-__.._ _�. Additss: 33 Yicr R� St O cuyis ateezipAbiebcro MA O270 3 Phone#; LC 7/2 `+D 5'2.'314 Ayc,,,t panete yens meekeleeaperoprtau pox. Type of project(required): t.l Yi tam A employer with of•.� ..employees(full and/or pan-time).' 7. ❑New construction 2 Y0 am a Boa proprietor or perinembip and have no employees working for me in 8. ElRemodeling any enmity.(tom workers'comp•insutmsoe requited.] 9. Q Demolition 3,01 an is}Iaineownerdoinit l wort myself INo workers'camp.insistence texittired j t 10❑Building addition 4.0 I our t homeowner and wd'l bahining eonitactors to condpct all wotkan my property. I will movie that all:aimraesen either have workers`aom ensation it191111111C0 or are sole 11.0 Electrical repairs or additions propriamw with ab employees. 12.0 Plumbing repairs or additions 3.01 no a general contract*midi have hired the-sub.conttaete4s listed on the attached sheet: 13.0 Roof repairs m esa earcolmactots h ave employees and have woricers''comp.insurances 14 Other klYDUiC Jt b,r) 6.0 We ameaorporatine and int oho bavemercised thcirr uhtof exemption per aMGL.c. 152,:1 (4),:and vie have no;amployees:(No waders'comp.insurance required.) "Any eppliotmt;lb et checks box itl;Cs ist also till out.*section below showing their mutters'compensation policy istormation. t Halreb0,1018 gib!,sAIMit thisattidaeltindiesaingtheyamdoingellworkandthenhug!dutsidocc actors Must Nthinitaitem_AffidavitLidicawigsuch- *ContraGti that-check dab box must_a tadod an additional Meet skowitaghe MUM of the sub-o eeaitota and state whether or not those entities have Rtbe'ttttrsc6o►e;ham ]oyes, lnttsC.• oxide their works 'comp icy number I am nweenOtnynr that ilfprevientgwaektaW'compatsaltion lnsnratce or my employees. Below is the policy and Job site inforstette insurance Ct1pa,ay Name:FrYl-Plaie rs Iv(u to as CaS► O-.Qtt CD _ , Policy#.orSelf'-ins..Lic.# 5 H q 6O 2 /_4 Expiration Date: I alai 1 A Jots:sitcAddr s:1 Cho mbar la i n• a. city./state/Zip:W•�rr 1t)U W MA: 12(0?3 mock'copy of the workers'compensation policy'declaration;page(showing the policy nu. and expiration date). Failure to secure coverage asrequired uuderMGL 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 S250.00 a day against:t the Violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage yetifcation. do hereby utter a and. ties thattlte in n adon provided above true and correct pains pens! of�i loettre Siattature: i (ii1 el Date: f aq�ao 90 7 , i,onc#; 17 240 5a 64 O, ltrt'use only: Do not'write in ash apieg,to be eo*plated by city or town ofjle City or Town: Permit/License# Issuing Mithortty( le ones. 1.Board of Health 2.Building Department 3:city/Town Clerk 4.Electrical Inspector S.Plumbing.Inspector 6.Other Contact Person::.. 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'tv".- = -,.,,*gr''.•• -.',-,-',..--,--,,..'•. , ,•",':.,,.,-4,-.:a ......., -...,„ ...1-0=':',..-'-7 ' -;-=1,-''•• ---.7- - ' -„--,--•,;.--„.-.,44v,-„,„:1-, -- • --,p0-,,,,,:-.•• . •.F."..,-,1,'-::',. •-:t."-• - '1ii•-‘4'14-'' • Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Constructi .`Shtior Specialty CSSL-106162 [empires: 04126/2023 MATTHEW J RUSSELL r 3820 DIAMOND HIL , D CUMBERLAND,RI 02864 ..-=200 Commissioner i,i4 ! Construction Supervisor Specialty Restricted to: CSSL-1C -Ins ; #ion Contractor Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license Call (617) 727-3200 or visit www.mass.gov/dpl .: !'�+eVxvvl. +r�{.fh ' rA ..•/.�';sl.1e; .!zCl!!':1Y"YE!.` l3 of Cansua Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TY Corporation before the expiration date. If found return to: Ecoirstiort Office of Consumer Affairs and Business Regulation 01/30/2021 1000 Washington Street-Suite 710 SC ENERGY Boston,MA 02118 WAITER R.Cl i W \ G I--- IC 1s GREYS-CONE Not valid without signature MIARBLEHEAD.AAA OW`i Undersecretary ACC01210 CERTIFICATE OF LIABILITY INSURANCE 4i22i oi9) 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 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 N ACT Rosalynn Davila AME:Loiselle Insurance Agency PHONE E.N. (401)723-8510 (Ac No). (401)728-1820 279 Dexter Street igkADDRESS:rosalynn@loiselleinsurance.com P. 0. Box 1148 INSURER(S)AFFORDING COVERAGE NAIC S Pawtucket RI 02862-1148 INSURER A:Employers Mutual Casualty Co 21415 INSURED INSURER B: 5C ENERGY, INC. INSURER C: 330 VICTOR RD-BUILDING A INSURERD: INSURER E: ATTLEBORO MA 02703-6294 INSURERF: COVERAGES CERTIFICATE NUMBER:Master 2018 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 -Pm&SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE LTR INSR WVD, POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY` LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 --- DAMAGE RENTED X COMMERCIAL GENERALLIABIUTY PR MISESO(Ea occurrence) $ 500,000 A CLAIMS-MADE D OCCUR 51398024 12/27/2018 12/27/2019 MED EXP(My one person) $ 10,000 PERSONAL &ACV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT.AGGREGATE LIMIT APPLIESPER: PRODUCTS-COMP/OP AGO $ 2,000,000 X l PIXJCY' I CaT 1i LOC $ COMBINED AUTOMOBILE LIABILITY Ea accident)SINGLE LIMIT $ 1,000,000 --A ANY AUTO BODILY INJURY(Per person) $ 20,000 ALL OWNED X SCHEDULED 5Z98024 12/27/2018 12/27/2019 BODILY INJURY(Per accident) $ 40,000 _ AUTOS AUTOS X AUTOS (PPRer aaccc�DAMAGE $ 5,000 X HIRED AUTOS Uninsured motorist BI split limit $ 1,000,000 /X UMBRELLALIAB _ OCCUR EACH OCCURRENCE $ 2,000,000 A EXCESS LIAR CLAIMS-MADE AGGREGATE $ 2,000,000 DED I X RETENTION$ 10,000 5,798024 12/27/2018 12/27/2019 $ WC OTH- A WORKERS COMPENSATION X TORY LIMITS ER AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE " N/A EL EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? SH98024 12/27/2018 12/27/2019 (Mandatory In NH) EL DISEASE-EA EMPLOYEE $ 500,000 If yes describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 5C Energy, Inc. 330 Victor Road, Building A Attleboro, MA 02703-6294 AUTHORIZED REPRESENTATIVE Rosalynn Davila/AHRIA i &tid I ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD