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HomeMy WebLinkAboutBLD-23-002104 Pm /D /z/ze ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department 1146 Route 28,South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 Massachusetts State Building Code,780 CMR o�o Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: f3 Lt) - -bba 16L1 Date Applied: Building Official(Print e) Sign tune Date SECTI N 1: TE INFORMATION 1.1 Pro erty Address:/� 1.2 Assessors Map&Parcel Numbers RECEIVED. 11 A, t)oirraVIA ) 04873 m 1.1 a Is this an accepted street?yes no Map Number Parcel Number -OCT 18 2022 1.3 Zoning Information: 1.4 Property Dimensions: l BUILDING DEPARTMENT Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) By 1.5 Building Setbacks(ft) • Front Yard Side Yards Rear Yard Required I Provided Required f Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: Outside Flood Zone? — f Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP` 2.1 .Owner'of Record: e\aCt-ret \ACCIAt VCA,f4fwnJittet .Jk tq (Ditil 3 Name(Print) r SD City,State,Z1P �fo.I and Street Telephone-54� Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building Owner-Occupied ❑ Repairs(s) 0 Alteration(s) ❑ I Addition 0 Demolition ❑ Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work': Seit • i� SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ '3 Nb 3,00; I. Building Permit Fee:S_O, ndicate how fee is determined: ❑ Standard City/Town Application Fee 2.Electrical $ 3 0 Total Project Cost (Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: e,0 ad 3DO 111149 5.Mechanical (Fire $ Suppression) Total All Fees:$ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ (3 N6-� 00 ❑paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) v j0. / J4. (, License Number Expiraon Dato 11 Name of CSL Holder / („C -Iien (-itin4 ,(A ti List CSL Type(see below) ��N000.//and Stre J (�C,V Type Description 5}10" � 0V, b Ti i Unrestricted(Buildings up to 35,000 Cu.ft.) City/Town,State,Z ` o R Restricted lea Family Dwelling NI Masonry RC f Roofing Covering { WS Window and Siding 5)7g 3_ 7 � SF Solid Fuel Burning Appliances — .Qll���lci�9k�/� //3 �j^-R✓W�n I Insulation Telephone E ail address ,Caw."-- D I Demolition Registered Home Improvement Contractor C) /�'�Ia-o �V1� rv, HIC Registration Number Ex_li irati n Date HIC Coo,t,,, mm•N e or HIC Registry t hl'une 1� N a d Street Yite „eas/I�i VilintY �7 n✓11Y1 .Cdawl el,-- /14,1 micro 1711-75 3`its 1 Email address City/Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6)) - Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issua ce of the building permit. Signed Affidavit Attached? Yes No 0 SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize Sly" = �.,_+i. tre,ev ce,s to act on my behalf,in all matters relative to work authorized by this building permit application. 1 t Cia,,4,44A- tr £e (E /O ) 2 o zit,Pratt Owner's Name ectronicSignature) Date • SECTION 7b: OWNER'R'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. /: ,—/2—.7-1922_ Print Owner's or Authorized v is Name(Electronic S' azure) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will nor have access to the arbitration program or guaranty fund under M.G.L.c. 142A. Other important information on the HIC Program can be found at www.mass.sov/oca Information on the Construction Supervisor License can be found at www.mass.aov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/'oaths t Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" Comrnonweattn of Massachusetts GanshlCtian Supernsar Division of Professional Litensure Urxestricted Bisidiregs of,try use group which contain 8oaro of Guiding Regutaboris and Standards less than 35,000 cubic feet(981 cubic meters) of enclosed C ons f ruJCt1 OP4n+isor sq&Ce. CS-040622 Crtres:08/01'2023 STEPHEN A SSELLY 77. 16 PARKWAY ROAD STONEHAM 021$0 Failure to possess a current edition of the Massachusetts Cornrrussiorier '. M»Llut State Building Code is cause for revocation of this license. For iriforrfation about this license Call(61T)T2T-3200 or visit wwwmass,govtdPl THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street-Suite 710 Boston,Massachusetts 02118 Home Improvement Contractor Registration _.- Type Supplement Caro SUNRUN INSTALLATION SERVICES INC 1 -- Registration- 180120 21 WORLDS FAIR DR Expiration 10I132024 SOMERSET,NJ 08873 --' �•' Update Address and Return Cord THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affair&Business Regulation Registration valid for individual use only before toe HOME IMPROVEMENT CONTRACTOR expiration date.If found return to: TYPE Supplement Card Office of Consumer Affairs and Business Regulation flawatamen ' Esaitation 1000 Washington Street•Suite 710 1llOt20' 10/132024 Boston,MA 02118 SUNRUN INSTALLATION SERVICES INC. STEPHEN KELLY 225 BUSH STREET .y ,,:{ .mica/ SUITE 1410 SAN FRANCISCO,CA 94104 Undersecretary N t vald without gnature Stephen A Kelly 695 Myles Standish Blvd Taunton MA 02780 TEL: 978-793-7881 Email: eastmapermits@sunrun.com ___..--.4,N SUNRINC-02 LWANG2 ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD YYYY) �-� 8/31/2022 P 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 1 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 License#0C36861 CONTACT NAME: Walter Tanner Alliant Insurance Services, Inc. PHONE FAX 560 Mission St 6th Fl (NC,No,Ext): (A/C,No): San Francisco,CA 94105 ADDAIL REss:Walter.Tanner@alliant.com INSURER(S)AFFORDING COVERAGE NAIC It INSURER A:Evanston Insurance Company 35378 INSURED INSURER a:James River Insurance Company 12203 Sunrun Installation Services,Inc INSURER C American Zurich Insurance Company 40142 775 Fiero Lane,Suite 200 Ph#805-540-7643 INSURER D: San Luis Obispo,CA 93401 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP UMITS LTR INSD WVD IMM/DD/YYYY) (MM/DOIYYYY► A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE X OCCUR MKLV5ENV103749 10/1/2022 10/1/2023 DAMAGETORENTED 1,000,000 PREMISES fEa occurrence) $ ' MED EXP(Any one person) $ 5,000 ! PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY X JEIf LOC PRODUCTS-COMP/OP AGG $ 2,000,000 X OTHER:Retention: $100,000 Per Project Agg $ 5,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED _ AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ AUTOS ONLY NON-OWNEDUUT PROPERTY DAMAGE $ (Per ccident) $ B UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 X EXCESS LIAB CLAIMS-MADE 001072261 10/1/2021 10/1/2022 AGGREGATE $ 4,000,000 DED RETENTION$ i $ C WORKERS COMPENSATION X PERTUTE ERH AND EMPLOYERS'LIABILITY WC614287601 10/1/2022 10/1/2023 I 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE YINN N/A E.L.EACH ACCIDENT $ OpFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation Policy WC614287601 Deductible:$1,000,000. Re:Permitting within jurisdiction. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Yarmouth ACCORDANCE WITH THE POLICY PROVISIONS. 1146 Route 28 South Yarmouth,MA 02664-4492 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Lafayette City Center 2 Avenue de Lafayette, Boston,MA 02111-1750 }-� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Sunrun Installation Services/ Stephen Kelly Address:225 Bush St STE 1400 City/State/Zip:San Francisco CA 94104 Phone#: 978-793-7881 Are you an employer?Check the appropriate box: Type of project(required): 1.El I am a employer with 50 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. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' comp. insurance.* 9• ❑ Building addition [No workers' comp. insurance required.] 5. ❑ We are a corporation and its 10.11 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' right of exemption per MGL Y comp. 12.®Roof repairs insurance required.] ' c. 152, §I(4),and we have no employees. [No workers' 13.❑Other comp. insurance required.] *Any applicant that checks box NI must also fill out the section below showing their workers'compensation policy information I.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 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: American Zurich Insurance Company Policy#or Self-ins. Lic. #:WC614287601 Expiration Date:10/0112023 Job Site Address: // “A_C4A,r\ �{. t City/State/Zip: G(4113 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 MGL 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 form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify under the pains and enalties of perjury that the information provided above is true and correct. Sienature: u. Date: /O —17 —aOo�e� Phone#: 978_793-7881 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License#_ Issuing Authority(check one): 1❑Board of Health 20 Building Department 311City/Town Clerk 4.0 Electrical Inspector 5E2Plumbing Inspector 6.0Other Contact Person: Phone#: §TOWN OF YARMOUTH 1146 Route 28, South Yarmouth, MA 02664 508-398-223'1 ext. 1261 Fax 508-398-0836 Office of the Building Commissioner BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Ch. 40, §54 and 780 CMR - Section 105.3.1. #4. I hereby certify that the debris resulting from the proposed work/demolition to be conducted at // 4e, — -4 4-16 /3 Work Address Tv -44 Is to be disposed of oat the following location: 95 z we 4 / � n Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. 4Arew 4-1 / _/ tea Signature of Application Date Permit No. UUIiUJlyll CI vtllupe IU.u/u000Co-r LMI,-44JD'4-oU1 M-co'+P QUD.7o I/U 1 Sunrun BrightSaveTM Agreement Charles Hickey 11 Lincoln Ave, Yarmouth, MA, 02673 Take Control of Your Electric Bill $0 25 Years $ 178 $0 .280 Deposit due Agreement Term Length Monthly Bill for Year Year 1 Cost per kWh Today (3.5% annual increase One (plus taxes, if applicable; (excluding upfront in monthly bill) includes $7.50 discount for payment, if any) Auto-Pay enrollment) WE'VE GOT YOU COVERED WITH OUR WORRY-FREE SERVICE (7) Ai& fir) We provide hassle-free We monitor the system We warrant, insure, Selling your home? design. permitting, and to ensure it runs maintain and repair We guarantee the buyer installation. properly. the system. We will qualify to assume also provide a 10- your agreement. year roof warranty. A SOLAR SYSTEM DESIGN FOR YOUR HOME You get a 8.39 kW DC Solar System With 23 Solar Panels and 1 Inverter(s) Which will produce an est. 7.650 kWh in its first year And offset approx.95% of your current, estimated electricity usage YOUR SALES REPRESENTATIVE Aarron Wagstai aarron.wagstaff sunrun.con (801) 971-5681 IJUI.Uouyr l CI I VCIUpe I LI.U I UDODCo-FLMl.-4o D4-OJ I M-LO4MOUDUO I I L By signing below, you acknowledge that you have reviewed and received a complete copy of the Agreement without any blanks. Such Agreement shall be the complete understanding between the Parties. SUNRUN I IN,LA ,pN SERVICES INC. Signatur coin ~`� F9A27AE333064FF.. Print Name: Collyn Balderama Date: 9/30/2022 Title: Project operations Federal Employer Identification Number: 26-2841711 IF YOU CHOOSE TO PAY BY CHECK. MAKE CHECKS OUT TO SUNRUN INC. NEVER MAKE A CHECK OUT TO A SALES REPRESENTATIVE. OUR SALES REPRESENTATIVES ARE NOT AUTHORIZED TO RECEIVE CHECKS IN THEIR OWN NAMES. YOU MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE TENTH EFFECTIVE DATE. PLEASE REVIEW THE ATTACHED NOTICES OF CANCELLATION FOR AN EXPLANATION OF THIS RIGHT. Customer rPr co Holder Secondary Account Holder (Optional) C —.C39Fgt§rAt - Charles Hickey Signature 9/30/2022 Date Print Name Email Address*: hickeymm63@gmail.com Mailing Address: 11 Lincoln Ave Yarmouth, MA 02673 Phone: (508) 737-5718 *Etna,/addresses will be used by Sunrun for official correspondence, such as sending monthly bills or other invoices. Sales Consultant By signing below/acknow/edge that/am Sunrun accredited that I presented this agreement according to Cao&wam Code of Conduct, and that/obtained the homeowner's signature on this agreement. O-eLAAAA, 3ZAg l aoea� �'f iced 1 tUC. Aarron� wagstaff Print Name 7377667073 Sunrun ID number Sunrun Installation Services Inc. 1 225 Bush Street, Suite 1400, San Francisco, CA 941041 888.GO.SOLAR I HIC 180120 Contract Version: 2020Q1 V1 Generation Date: 9r30 2022 Proposal ID: PK49CFDAA11 K-H Version 2020Q1V1 21