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BLD-23-005887 1 • o ce Use Only /� .p1'Y'�(�ai" t -Z3 003119 • O*7 4..., o ,�t�� y Amount �'� "' `cam" ;Permit expires 180 days from issue date EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth,MA 02664 (508)398-2231 Ext. 1261 CONSTRUCTION ADDRESS: 33 Oval Drive ASSESSOR'S INFORMATION: Map: Parcel: OWNER: Bradford Wallace 33 Oval Drive 781-831-1234 NAME PRESENT ADDRESS TEL. CONTRACTOR: Michael T McMahon 2 Fuller Street 781-831-1234 NAME MAILING ADDRESS TEL.# CI Residaitial El Commercial Est..Cost of Construction$ 3500.00 Home Improvement Contractor Lie.# 161816 Construction Supervisor Lic.# CS-Q68111 Workman's Compensation Insurance: (check one) 0 I am the homeowner D I am the sole proprietor XI have Worker's Compensation Insurance Insurance Company Name: Aim Mutual Insurance Worker's Comp.Policy# VWC-100-6014109 WORK TO BE PERFORMED Tent ❑ Duration (Fire Retardant Certificate attached?) Wood Stove ❑ Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares (0)Remove existing*(max.2 layers) Insulation 1 I ri Old Kings Highway/Historic Dist. Replacing like for like Pool fencing ❑ *The debris will be disposed of at: Waste Stream Recycling 16 Copicut Road Assonet Location of Facility I declare under penalties ofperjury that the l , k n, herein contained are true and correct to the best of my and belief. I understand that any false answer(s) will ba just cause fir denial or revocation.x / and for prosecution under M.G.L.Ch.268,Section 1. Applicant's Signature: Date: 4/20/2023 Owners Signature(or attachment) S T H E D Date.: Date: / -- r-3 Approved By: Building Official(or desi EMAIL ADDRESS. Zoning District RECEIVED Historical District: r Yes No Flood Plain Zone: L Yes G No -__---_——__t.-- Water Resource Protection District: Within I00 ft.of Wetlands: APR 24 2023 u Yes LI No CT Yes No BUILDING DEPARTMENT f Customer Name:Bradford Wallace CONTRACT ..................... Email:dwallace33@outlook.com Phone:508-320-4670 Premise Address:33 Oval Dr,Yarmouth,MA 02673 RISE Mailing Address:33 Oval Dr,Yarmouth,MA 02673 ProjeDate: t 4801694 Date:April 3,2023 ENGINEERING Effir iv rot;fnr_r --1 RISE Engineering 765 Attucks Lane, Hyannis,MA,02601 Applicable Customer Required Actions: Notes: • Storage Removal STORAGE NEEDS TO BE MOVED SO THE WORK CAN BE DONE IN THE ATTIC. _Inh Ilocr•rirtinn AIR SEALING 8 hr $754.64 $0.00 ATTIC FLAT-4"FLOORED R-13 DENSE CELLULOSE 728 SF $1,375.92 $343.99 ATTIC FLAT-10"OPEN R-37 CELLULOSE 110 SF $202.40 $50.60 ATTIC DAMMING-R-38 FIBERGLASS 70 SF $169.40 $42.35 COMMON WALL:2"RIGID BOARD 70 SF $303.80 $75.95 PULL DOWN:THERMADOME 100% 2 each $506.42 $0.00 4"-VENT BATH FAN TO ROOF OR ALTERNATIVE 1 each $130.63 $32.66 4"x 16"SOFFIT VENTS 6 each $185.10 $46.27 WEATHERSTRIP DOOR&ADD SWEEP 1 each $57.92 $0.00 VENTILATION CHUTES 6 each $20.94 $5.23 Total: $3,707.17 Program Incentive: -$3,110.12 Customer Total: $597.05 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Five Hundred And Ninety-Seven And 05/100 Dollars $597.05 1%WILL BE CHARGED UPON UNPAID BALANCE AFTER 30 DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,U RILL. TS OF REC OFMONTHLY ON IS ON SCHEDULING, ND ANY CONTRACTOR REGISTRATION. (70:' tia satioya. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPAC ra fo„f Ida/kw j'''�) ��iiJJ��(I/ii Customer Signature RISE Representative 04-11-2023 Sign Date Page 1 of 2 Page 1 of 3 Document Rat TPOM8-BFNMH-SSYUQ-FYV2T Permit Authorization mass - Form Site ID: 4745164 Customer: Bradford Wallace Bradford Wallace ,owner of the property located at: (Ownees Name,printed) 33 Oval Dr 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. n j Orezafoni w"aurilact Owner's Signature: o4-11-2o23 Date: 1-1*.ie.ttea 44-zset.emsoi*---a,savv-a-tz'u.saAit atos.a.s.e.&emvsefrati6t1,soot-e. -t-:** FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: M.T.McMahon and Son,Inc. 2 Fuller St. Carver,MA 02330 Participating Contractor Date Name: RISE Engineering Phone: 508-568-1926 Email: Page 1 of 1 For Office Use Only Document Ref:TP0M8-BFNMH-SSYUO-FYV2T page 1 of The Commonwealth of Massachusetis Department of Industrial Accidents Office of Investigations 7L-1�1-►��®rE Lafayette City Center •" `� 2 Avenue de Lafayette, Boston,MA 02111-1750 www.mass.govldia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/organization/individual): MT McMahon and Son, Inc. Address:2 Fuller St. City/State/Zip:Carver, MA 02330 Phone#:781-831-1234 Are you an employer? Check the appropriate box: Type of project(required): 1.al am a employer with 15 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ElNew construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have 8. Q Demolition workingfor mein anycapacity. employees and have workers' p ty. # 9. [ Building addition [No workers' comp.insurance - comp.insurance. required.] 5. ❑ We are a corporation and its 10.0 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' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152,§1(4),and we have no Weatherization employees. [No workers' 13 Other 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. :Contractors 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 isprovding workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name:AIM Mutual Insurance Policy#or Self-ins.Lie. #:VWC-100-6014109-2013A Expiration Date: 12/8/2023 Job Site Address: 33 Oval Drive City/State/Zip: Yarmouth, MA. 02673 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 MOL 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 urance coverage verification. I do hereby certify and and penalties of perjury that the information provided above is true and correct. Si e: Date: 4/20/2023 Phone#: 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): 10Board of Health 20 Building Department 30-City/Town Clerk 4.0 Electrical Inspector 5OPlumhing Inspector 6.0 Other Contact Person: Phone#: CERTIFICATE OF LIABILITY INSURANCE 12107122 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 or be If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statermint on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER WArMp Thompson Insurance Ply iNEa.Extl 781-335-1890 I No): 781 and Financial Services ADDRESS: ICIPITarrs.corrr 389 Union Street Weymouth,MA02190.318 INSURE AFFORDING COVERAGE MANc* INSURER A: Commerce Mapfre INSURED INSURERS: AIM Mutual MT McMahon and Son Inc. INSURER C Nautilus 2 Fuller st Carver,MA 02330 INSURER D:: Evanston INSURER E: INSURER F: t COVERAGES CERTIFICATE NUMBER: REVI 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 CONDmONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR wooLHuaR EFF POLE IMPLTR TYPE OF INSURANCE map%AND POLICY NUMBER (MY%mr) (MMtDOVYYYYI ursrs X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE '$ 1,000i000' CLAIMS-MADE Z OCCUR `PR t•XmaocT rr PREMISES(Eaoaarrrerkoa) :$ 50,000= MED EXP(Any one person) $ S,000: A Y 8008030009088 09/18122 0911E423 PERSONAL&AD INJURY E$ 1,000,000 GEN'L AGGREGATE pLIMIT_APPLIES PER: GENERAL AGGREGATE $ 2,000.000E X POLICY I 'JECTEl LOC 'PRODUCTS-COMP/OPAGD '$ 2,000,000 OTHER: '$ AUTOMOBILE LIABILITY COaMB1ED SINGLE LIMIT ;$ 1.000.0001 ANY AUTO BODILY INJURY(Per person) $ — OWNED A AUTOS ONLY X AUTOSULED Y BMJZ(P 08131122 08/31/23- 'BODILY INJURY(Per accident) $ k HIRED X NON-OWNED PRO PERTYDAMAGE $ _AUTOS ONLY AUTOS ONLY (Per 9odtl�rt) . $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 2,000,00O — C EXCESS LIAR' CLAIMS-MApE Y AN078737 12J19122 12F19/23 AGGREGATE 4$ M DED RETENTION$ i$ WORKERS COMPENSATION rPER OTH- AND EMPLOYERS IJABILITY X1 STATUTE ER ANY PROPRIET(�RIPARTNER/EXECUTNE�Y YIN E L EACH ACCIDENT 1$, 500,00ir B OFFICER/MEMBEREXCLUDED? L�J NIA VWC-10041014109.2013A 12l08122 12/08/23 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 500,000, It yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE 'POLICY LIMIT '$ NAM Contractors Pollution Liability Condition Limit 2,000i0 F D CPLMOL104901 12/14/22 12114/23 , DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES(ACORD 101,Add/Venal Remarks Schedule,may be attached V more space is required) s 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. AUTHORIZED REPRESENTATIVE , ,. • I 988- ACORD CORPORATION. AR rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD • icevient TIME COMMONWEALTH OF MASSACHUSETrS Office©f Consumer Regulation #massmusaus HOME IMPltO' A' .. CTOR olviek+s at Psaims471,al *Ad Standard"'Boatel of Built . r �� "rj C;S-08a111 1 eea•D8#17t2022 MICHAEL T.MCMA iA T a s it _ t• 2 FULi.ER y j y # ��' MICHAEL T.MGMA «• t y ` J'S+4�itC ' 2 FULLER ST `D -=- '..' wn lG- 0,004.' CARVER,MA 02330' * Undersecretary Comm nev 8sw,iba. • tiv isopitha valid for individual use only the expiration date. If found return to• O of Consumer affairs and Bust n emaaasses 1000 Washington Street-Suite 710 Boston, dads kensa MA ti21t8 �to possess a ioaoilhsN f Yit T a+Aldt ......./6" Not valid without signature I 8122122,4:04 PM Gmal Fwd:acetonic Patient React from neouit for your°PSI license(CS-068111) Your Receipt» Psdd T8 Name:Massachusetts Division of Professional Llcensure-Office of Public Safety and Inspections Address 1: 1000 Washington Street Address 2:Suite 710 City: Boston State:Massachusetts Zip:02118 Payment On Behalf Of First Name:MICHAEL Last Name:MCMAHON Address 1: 2 Fuller St. Address 2: City:Carver State:MA Zip:02330 Phone:(781)831-1234 Description ID Amount; Renewal Fee CS-088111 $100 00 Receipt Date:7128/2022 2:48:59 PM EDT Convenience Fee: invoice Number e0855422 28c35 Total Amount Paid:$= 0225 BillingInformation MCredit l Debit Card Inform aka Name Michael McMahon Card Type MasterCard' Email mcmahoninsulation©gmail.cnm Card Number *'"*'*" """9677 Street 2 Fuller St. City Carver State/Territory MA ZIP 02330 Important information» Please verify the information shown above.Your payment has been stnenitted to the Office of Public Safely and inspections. • This payment will appear on your statement as"NCCURT`MA OPSIONLit E-PAY". • For license renewals:your rend request is now complete.Your renewal will be Processed In the order It was received.If OPSI needs ad itional documentation,a notice will be sent to your a or maWmg adtkess on file.Ott nrriss,you can toper*to receive a new license within 34 weeks.You can also check the status of your license at htitps:iht►adpi.mylicense.comNerfication/. • if you have a question regarding your license,please contact the agency at817-727-3200. • Please note that although the system mayshow that your payment transaction was successful upon submission,your payment Will be considered a pending transaction until proof of availablefunds in your account has been co,*med Payments that are denied by EPAY will incur an additional$23 fee to process. assmail;state.ma.us.Please • For refund policies,contact the Division of Professional Uce nsure at DPL-DL-Accounting@rnassmailstate.ma.us. your invoice number and license number in your emit. tttoe:/imal;pocgle.tOrrthr181riu1+Of?I9e2492d8ivkptrcir 1741434i1 d963A17414?38441-.• 1t1 DEBRIS DISPOSAL AFFIDAVIT In accordance with the provisions of M.G.L. c. 40,s, 54,Building Permit was issued with the condition that all debris resulting from this work shall be disposed of in a properly licensed solid wastes disposal facility as defined by M.G.L c. 111 s. 150A. The debris will be disposed of in: Waste Stream Recycling Name of Waste Facility 16 Copicut Rd,Assonet,MA 02702 Address of Waste Facility 111.5 Debris: As a condition of issuing a permit for the demolition, renovation, rehabilitation or other alteration of a building or strucnot C.40&54 requires that the debris resulting therefrom shall be disposed of in a properly licensed solid waste disposal facility as defined by M.G.L.c. Ill s.150 A.Signature of the permit applicant, date and number of the building permit to be issued shall be indicated on a form provided by the Building Department and attached to the office copy of the building permit retained by the Building Department.If the debris will not be disposed of as indicated. the holder of the permit shall notify the building official,in writing,as to the location where the debris will be disposed. 780 CMR-6th Edition • Signature of Permit Applicant 4/20/2023 Date