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HomeMy WebLinkAboutBLD-20-5003 ry AOY:• .944e„� Offic]e�U)se%Only peo OI ` - Amount MATTA M CSC._ 4`°""•"°"Q Permit expires 180 days from issue date EXPRESS BUILDING PERMIT APPLICt Y= *�` - TOWN OF YARMOUTH — 4 -- .= n Yarmouth Building Department 1146 Route 28 `' 1:. 31'' . . South Yarmouth, MA 02664 (508) 398-2231 Ext. 1261 i.„.. 7. ,1-,:4,-iii CONSTRUCTION ADDRESS: 75 Meadowbrook Road ASSESSOR'S INFORMATION: Map: Parcel: OWNER: Ernest Mac Fadgen 75 Meadowbrook Road 5087908494 NAME PRESENT ADDRESS TEL. # CONTRACTOR: Scott Veggeberg 101 Station Landing Medford MA 781-305-3319 NAME MAILING ADDRESS TEL.# 'Residential G Commercial Est.Cost of Construction$ 2897 Home Improvement Contractor Lic.# 181138 Construction Supervisor Lic.# 103832 Workman's Compensation Insurance: (check one) I am the homeowner I am the sole proprietor '77 I have Worker's Compensation Insurance Insurance Company Name: NF Employers Insurance Company Worker's Comp.Policy# 4001017 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 Oki Kings Highway/Historic Dist. ( )Replacing like for like Pool fencing *The debris will be disposed of at: 2510 B Cranberry Highway Wareham 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: Date: Owners Signature(or attachment) see attached Date: 3/9/2020 Approved By: _—6.4.-___-- Date: 3 —10—1,6 Building Officia or designee) EMAIL ADDRESS: Zoning District: Historical District: Yes No Flood Plain Zone: Yes No Water Resource Protection District: Within 100 ft.of Wetlands: Yes No Yes No The Commonwealth of Massachusetts Department of Industrial Accidents �= f` Office of Investigations 600 Washington Street Yq4 /": Boston, M4 02111 = tivx w.nurss.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization Individual): Homeworks Energy Address: 101 Station Landing Ste 110 City/State/Zip: Medford MA 02155 Phone#:(781)305-3319 x5007 Are you an employer?Check the appropriate box: Type of project(required): am a employer yrith 200 4. ❑ I am a general contractor and I employees(full and/or part-time).' have hired the sub-contractors 6. ❑ New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. [7]Remodeling ship and hale no cntploy ees These sub contractors hale s. ❑ Demolition working for mc.in any capacity employees and have yyorkers' 1 ). ❑ Building addition (No workers' comp. insurance comp insivan e.+ reyuired.1 5. ❑ We are a corporation and its 10.1] Electrical repairs or additions 3.El I am a homeowner doing all work officers have exercised their I I.❑ Plumbing repairs or additions mysell. (No yurrkers' comp. right of exemption per M(il. 1 1. ❑ Roof repairs insurance required.I c. 15' §1(4),and yti e have no employees. (No workers- 13.❑ other Weatherization comp. insurance required.) any applicant that checks box„I must also fill out the section below showing their workers'compensation policy information. 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 shossiug the name al-the sub-contractors and state whether or not those entities has c employees. If the sub-contractors have employees,they must provide their workers'cornp,policy number. I an:an employer that is providing workers'compensation insurance far my employees. Below is the polio'and job site information. Insurance Company Name: Safety Indemnity Insurance Company Policy#or Self-ins. Lie.4:4001017 Expiration ix,E Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of M(il,c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the limn ota STOP WORK ORDER and a fine of up to$250.00 a day against the violator. He advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certifi'under the pains and penalties of perjury that the information provided above is true and correct. St natttrc. - Date,: Phone#:(781)305-3319 x5007 / wxpermitting@homeworksenergy.com 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#: HOMEENE-01 LLARIVIERE ACORU CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDWW) 12/19/2019 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 CONTACT Lisa Lariviere NAMF• Foster Sullivan Insurance Group,LLC PHONE(A/C,No,Eel): (978)686-2266 301 Fin,No):(978)686-6410 Main Street North Andover,MA 01845 AE-nnRMAILes certificates fostersullivangroup.com F INSURER(S)AFFORDING COVERAGE NAIC# INSURER A;Homeland Insurance Company NY 34452 INSURED INSURER B:Safety Indemnity Insurance Company 33618 Homeworks Energy Inc. INSURER C:NH Employers Insurance Company 13083 Homeworks IIC LLC 101 Station Landing Suite 110 INSURER D: Medford,MA 02155 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 ADDL SUER POLICY EFF POLICY EXP 1 TR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIODIYYYY) (MMIOD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE X OCCUR 7930060650002 4/1/2019 4/1/2020 PDRAIGSERa ETrDence) $ 500,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER_ GENERAL AGGREGATE $ 2,000,000 POLICY I JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER B AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT 1,000,000 (Ea accident) S ANY AUTO 6244378 4/1/2019 4/1/2020 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY X AUTOS BODILY INJURY(Per accident) S X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) S S A UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 2,000,000 X EXCESS LIAB CLAIMS-MADE 7930060660002 4/1/2019 4/1/2020 AGGREGATE s 2,000,000 DED X RETENTIONS 0 C WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER YIN ECC-600-4001017-2020A 1/1/2020 1/1/2021 1,000,000 ANY EXCLUDEDXEGUTIVE N N/A E.L.EACH ACCIDENT S (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Evidence Only CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Homeworks EnergyInc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 101Station Landing Ste 110 Medford,MA 02155 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD . /r ls�rrrr.rr rrri f rrrli r ' . 1 .:rfr ,i::rr!J Office of Consumer Affairs and Business RegLliation 1000 WashingtrTli Street-Suite 711) Boston,Massachusetts 02118 Haire Improvement Contractor Registration Tv pa f.cr(sdr3ticn i' etn ion 13113f1 ZONE WORK%ENERGY,r•iC. E.+pftavxt a3:023 U21 a1 STATUN LANDINS S'%E"t} ►lEDEORD.MA 0215.1 UP+irete Addnca and P.atwn Card. Mot of Consuf&of Wads i fhoporof fteaud&OOn NONE i ettouEMBN1'rAINTRAcT oq Itegiotralato v011d to"100N Waal usa oft( TYPE:Cwiiiiretr, brince the Ion Ullico of C otwurmar Ariairs and Bealnass Reguiptian on date.if found rotor-Ito R431 Q )C�r i8r�.58 730:2 202= tow yi(RhY :NN sot•Soils Tie 1OW!E.'.O4R3 ENf`RCY.NC Bottom,Mir p21I MAX',EGe3EBEP.':, ..—. / C1s An7N1.AtirdNi;sie, valid without signature • 'p..uf, N nan t;2.1s5 �ttn.#N.erar�zus 1" r COftrnicnwk Altai .ts aA+ftUS@NrS Construction Sup*,nsur Specialty t3rirSea?rt ,ti Pi fe' tii nAr r Pnsurr, Aaar-t .1 tlii11rl1r1tj Rajxilalu ns anti;tanriardt Restricted to CSSL-IC-Insulation Contractor SSL,..103832 ixp'res. 10/1.;'2021 SCOTT VECorfEBt RG S COVINOTON ST#1 BOSTON MA 02127 • Failure to possess a en ration of the Massachusetts / State Building Code is c zr revocation of this license. :.:1mrrlitoti;01vet �y`-r *� ! For intor w &bout this ticense L Call(617)727-3200 or visit www.mass.govtdpt 00:.e c•f Consumer Altars and Gustness Rey.fatipn 1000 Wash.cytuti Set-Suite 71.! os:or, tk,Aassar:husets 021-8 F-miIt-ripro,:efr,ert Contrnntnr E• klEDF3PD tiprEtte AtIctrozs r 7.attt ,:kr,cs, cons,,.attatt,..S Ensosstes Rr poly Ifln HOVE WEMTCflNTRACOfL n 0d41, id ua, t nip xr,,e5tn data,I`g.:urt,..”p,,,to ftc.T_W.t.tvz fasIL'aEm art,-,of Cu nsntnct aPan s and 6.s.ine.i.Potaulart,,n ft I dE3 Was hi..KrIs s,.10'1C aasto Mk O2s t — s Not valio wrthnut signature r Construction Su pecialty SSLiC 1,1st.itat.ri C,, CtOr 2021 SCOTT VEGGEBERG 8 COVINGTON ST 01 BOSTON MA 02127 Cf (loll of the Massachusetts Failure to poses a State Building Code I.. r revocation of this license. For WISH tt1,1 ktaUt this license Call(617)727 .3 2(10 ot visit www.mass.govtdp1 • Insulation/Air Sealing Permit Authorization { t Specialist: Curtis Bridge Company: HomeWorks Energy Email: Curtis.Bridge@homeworksenergy Address: 101 Station Landing I yaneWorks Cell: 5083641715 Medford,Ma 02155 Phone: 781-305-3319 Customer: Ernest Fadgen Address: 75 Meadowbrook Road Email: N/A West Yarmouth MA 02673 Site ID: 3986688 Phone: (508)790-8494 I, the owner of the property identified above hereby authorize HomeWorks Energy Inc., or their Partner to act on my behalf in obtaining any building permit that maybe required to perform insulation and/or Weatherization work on my property and all matters related to the work authorized by said permit if one is obtained. Any related permit application cost will come at no additional charge provided that the agreed Weatherization work is completed. Customer 7 Signature: Date: 2/25/2020 Ernest Fadgen PLAN VIEW • Nam es<rf Site ID: - a' .;< a Finished Sq. Ft: //S o Phone: Year of House: 7 3 Electric Acct#: / ~i 2.4-0,' n Address: 75 McA3owhcc #of Floors: / Gas Acct#: aS`41 a c' �: / -+ rtie<1 . f„,.,44ti unit#:o rt #Occupants: l Housing Type? /'S4.*14.h. DUCTWORK INSPECTION Ducts Insulated?❑ out Linear Ft. uct Square Ft. i I uct Air Sealing Hours s uct Insulation t n uct Insulation Removal . 12 ti BASEMENT INSPECTION Existing Spec'ing Ln/Sq.Ft. `.2 — • Bsmt Wall AG Crawl Ceiling Crawl Rim Joist BsmtRJw/Sill Pies �¢�S Bsmt RJ NO Sill Va'or Barrier' sqft. Bsmt Door' Y N Blower Door? WALLS&GARAGE Drill Location? Siding Cell.Height Existing _Spec'ing Sq.Ft. Framing Exterior Wall 1 F(r, x x Balloon/Platform Exterior Wall 2 x x Balloon/Platform Overhang x x Garage Wall x x Balloon/Platform Garage Ceiling x x 0 E2 z 0 Insulation Removal Sgft. Sweeps: WX Stripping: WORK SPEC'D BUT NOT CONTRACTED 'OAD BLOCKS PRESE MANDATORY) Attic Basement/Crawlspace Other: K&T Y i11" Moisture Y fjj.ombustion Sfty Y Kneewall Overhang/Garage Asbestos Y /010 old>100 sq.ft Y PA;;► 0 Detector Missing Y Ductwork Exterior Walls Vermiculite YEi ructl Concerns Y 'W0" her: Notes for Lead Veenndor/WorkffNot Contracted: ()/,Sf "triJr' wof met ( c'/i /' c41, PIA ct t KW WALL AND KW FLOOR Blind Spec? ❑ '4--"— OR r KW SLOPE AND GABLE END Blind Spec? El hy? Why? FRAMING EXISTING, SPEC'ING SO.FT. FRAMING EXISTING SPEC'ING SQ.FT. ALL X X SLOPE X X cc x x GABLE X X 1-'., •CCESS X TRANS X X z o a RANS X X ATTIC S_ •TTIC SLOPE x X LOPE x x EXISTING VENTING? Z EXISTING VENTING? EXISTING PIPES?Y/N KW Venting Vert BF BF Hose Damming Sheathing Aaess Temp Access KW Venting Vent 8F Temp Access Y r L KNEE WALL MANi)ATOI Y 01 q k i A/5 --1 (":„.............) q// c){3 c...._ 2Z - fo C fif t, � Z C� rt I . L i f 1; C r' }-ts o b 2- 7-1 !'10 R,j \ X j f j r.— � i'v,./.0 !'I insulated Wall X < Reed light a m:.Hose[ Vent BF iaFV l ci im.RH j Damning Ir Root t IiBv Al,Handier® Temp Access Poll Down DS Hatch EJ Wall Hatch e/ Door o/ r Root Vent 8RV BAS Vol: X .0058 9(I story) 2 X x/li ATTIC 1 Blind Spec? x x ATTIC 2 Blind Spec? 0 x(IS.a(2 story)1 o Existing Spec'ing Sqft Existing Spec'ing Sqft 13.ti(3 story) G Unfloored `F•GV {" ("13 /®ate Unfloored Floored Floored cusses ctW ng ,... f e>f'dln�—tl-on•�Duct Work Cath Slope Cath Slope2 / , >b C°83 None / Air Sealing Hours Walls Walls 'R Access _ /.Ayr ^•`/ /" Access Venting Propavents Vent BF BF Hose Damming Venting Propavents Pint BF BF Hose Damming o WHF Box: .� ';r //' p c:7e, Temp Access: to to Sheathing Access: R.L.Covers:_ Sq.Ft/300• (Exist NFA Venting). (Needed Sq.Ft/300= (Exist NFA Venting). (Needed I Existing Venting? WC� NFAv<nnng) Existing Venting? NFA Venting) Roof Type: Page 1 c HomeWorks 4ve , ' PARTNER 101 Station Landing Ste 110,Medford,MA 02155 (781)305-3319 ext.120 Customer Name:Ernest Fadgen Email:Not provided Phone:508-790-8494 Premise Address:75 Meadowbrook Rd,Yarmouth,MA 02673 Mailing Address:75 Meadowbrook Rd,Yarmouth,MA 02673 Project ID:3990732 Date:Feb.25,2020 Job Description Measure Description Location Quantity Unit Total Cost Customer Cost AIR SEALING Other 9 hr $720.00 $0.00 VENTILATION CHUTES Other 96 each $335.04 $83.76 ATTIC DAMMING- R-38 FIBERGLASS Other 26 SF $63.96 $15.99 ATTIC HATCH:SEAL& INSULATE Other 2 each $120.00 $30.00 ATTIC FLAT- 9"OPEN R-33 CELLULOSE Other 1056 SF $1,584.00 $396.00 TEMPORARY ATTIC ACCESS THRU ROOF Other 1 each $92.42 $23.10 Project Total $2,915.42 Weatherization incentive ($1,646.57) Air sealing incentive ($720.00) Total Contractor Price and Payment Schedule HomeWorks Energy, Inc.agrees to perform the above described work,furnishing the material and labor specified for the listed tota price. Payment of the balance of the customer contribution is expected upon completion of the work. Customer Signature: V z t 4Ca G Ctir •lef Date: Z'/ Z,5 � r/ I /� Customer Phone: • Specialist Signature: �-c z r jig--' Date: 202-0 UMITED TIME OFFER: III The prices and incentives in this contract are subject to change it accordance with the sponsoring utility MassSave Home Services Program offers. Proposals can be sent to:tnboxPHomeWorks£nergy.com Page 2 c Atft HomeW � mass save PARTNER 101 Station Landing Ste 110,Medford,MA 02155 (781 J 305-3319 ext.120 Customer Name:Ernest Fadgen Email:Not provided Phone:508-790-8494 Premise Address:75 Meadowbrook Rd,Yarmouth,MA 02673 Mailing Address:75 Meadowbrook Rd,Yarmouth,MA 02673 Project ID:3990732 Date:Feb.25,2020 Total Program Incentive -$2,366.57 Customer Total $548.85 Total Contractor Price and Payment Schedule HomeWorks Energy, Inc.agrees to perform the above described work,furnishing the material and labor specified for the listed tota price. Payment of the balance of the customer contribution is expected upon completion of the work. Customer Signature:62.4t4keee., j Date: ZA=Z0 Customer Phone: .�. � / 05-A4 Specialist Signature: C�`G'``r r,(.� Date: ZO JuMITT TV OFFER: The prices and incentives in this contract are subject to change it accordance with the sponsoring utility MassSave Home Services Program offers. Proposals can be sent to:tnbox@HomeWorksEnergy.com