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HomeMy WebLinkAboutBLD-23-005886 fl-f*YRR Office Use Only 0 0,. ' L7. - ; -QO:Sgo C': enni, t _ y: , wwrr s 'Z';' Amount Permit expires 180 days from issue date EXPRESS BUILDING PERMIT APPLICAT a if- TOWN OF YARMOUTH RECEIVED Yarmouth Building Department _--•.'_-_.._-.._.., 1146 Route 28 APR 2 4 2023 South Yarmouth, MA 02664 r (508) 398-2231 Ext. 1261 BUILDING DEPARTMENT ti CONSTRUCTION ADDRESS: ASSESSOR'S INFORMATION: Map: I Parcel: OWNER:— Q-'°{1' NA I J WAD PRESENT ADDRESS TEL. k CONTRACTOR: n YAv?frtj �C� 12-i �'��� /�U0 Ci MLIN�ADDRESS TEL.# esidential ❑Commercial A 0d0 �O�� Est.Cost of Construction$ Home Improvement Contractor Lic.# (�Q / /'723�; Construction Supervisor Lie.#l ) / ' Workman's Compensation Insurance: (check one) 0 I am the homeowner 0 I am the sole proprietor ❑ I have Worker's Compensation Insurance Insurance Company Nam • U /l� Worker's Comp,PoIicyr 1 OH I W WORK TO BE PERFORMED Tent El 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. (El)Replacing like for like Pool fencing *The debris will be disposed of at: ci 1 a PPP' Q_Q T) • Location of Facility i declare under penalties of pe•i at th•state eats herein contained are e ,d correct to the best of my knowledge and belief. I understand that any false answer(s) will be just cause for denial.r revo•.do . f m ic: se and for prosecutio i.. r _. h.268,Section 1. Applicant's Signature: ��/ f Date: Owners Signature(or attachment) N., � i 7 Z Date: / ' Approved By: ®Z-3 Building Official{or deli Date: EMAIL ADDRESS: Zoning District: Historical District: Yes No Flood Plain Zone: Yes No Water Resource Protection District: Within 100 ft.of Wetlands: v Yes 1; No u Yes _ No • • RISE --------------- CONTRACT 1341 Elmwood Ave,Cranston,RI 02910 Federal ID#08-0405629 RI Contractor Reg#8186 401-784-3700 : 401-784-3710 fax MA Contractor Reg#120979 CT Contractor Reg#620120 CUSTOMER PHONE DATE CLIENTS WORK ORDER Donna Corrigan (781) 859-7498 03/25/2023 533674 20002 SERVICE STREET BILLING STREET PROPOSED BY: 51 Cottage Drive 57 Dana Road Daniel Damery SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Pmgram West Yarmouth, MA 02673 Wellesley, MA 02482 CLC-HES Page 1 DESCRIPTION QTY COST INCENTIVE TOTAL INCENTIVE 75% For eligible weatherization measures,the Cape Light Compact is offering an insulation incentive of 75%,with no limit, and an incentive of 100%for the air sealing measures. You are eligible to apply for the 0% Heat Loan to finance your co-pay, applications must be submitted before the weatherization work begins. HOME AIR SEALING 5 $471.65 $471.65 Seal areas of your home against wasteful, excessive air leakage. Materials to be used to seal your home can include caulks,foams and other products. Primary areas for sealing include air leakage to attics, basements, attached garages and other unheated areas (windows are not generally addressed.) TRANSITIONS-OPEN 56 $383.04 $383.04 Provide labor and materials to air seal the open kneewall transitions of your home against wasteful, excess air leakage. WEATHERSTRIP AND ADD DOOR SWEEP ELECTRIC 1 $57.92 $57.92 Provide labor and materials to install Q-lon weatherstripping and a doorsweep to door(s)to restrict air leakage. ATTIC DAMMING 20 $48.40 $36.30 $12.10 Provide labor and materials to install an approved damming material in the attic ATTIC FLAT- 14"OPEN R-49 CELLULOSE 308 $665.28 $498.96 $166.32 Provide labor and materials to install a 14"layer of R-49 Class I Cellulose to open attic space. KNEEWALL-2"RIGID BOARD 217 $941.78 $706.34 $235.44 Provide labor and materials to install 2"rigid board to a kneewall area. KNEEWALL FLOOR-14"OPEN R-49 CELLULOSE 168 $362.88 $272.16 $90.72 Provide labor and materials to install a 14"layer of R-49 Class I Cellulose to an open kneewall floor. TEMPORARY ACCESS THRU DRYWALL 4 $340.00 $255.00 $85.00 Provide labor and materials to make a temporary access to an attic area. The opening will be closed with materials similar to those existing. Finish sanding and painting is not included. VENTILATION CHUTES 90 $314.10 $235.58 $78.52 Provide labor and materials to install ventilation chutes in the rafter bays to maintain air flow from the soffit ventilation. RISE w CONTRACT 1341 Elmwood Ave,Cranston,RI 02910 Federal ID#08-0405629 RI Contractor Reg#8186 401-784-3700 401-784-3710 fax MA Contractor Reg#120979 CT Contractor Reg#620120 CUSTOMER PHONE DATE CLIENT# WORK ORDER Donna Corrigan (781) 859-7498 03/25/2023 533674 20002 SERVICE STREET BILLING STREET PROPOSED BY: 51 Cottage Drive 57 Dana Road Daniel Damery SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Program West Yarmouth, MA 02673 Wellesley, MA 02482 CLC-HES Page 2 DESCRIPTION QTY COST INCENTIVE TOTAL INACCESSIBLE ATTIC AREA We have identified an opportunity to insulate an attic area in your (initials) home that is not presently accessible.We are making our recommendations based upon an educated understanding of your home's construction, but upon gaining access to this space, your home's work-scope might need to be modified. The insulation contractor will guide these changes and discuss them with you prior to proceeding. INACCESSIBLE ATTIC KNEEWALL AREA We have identified an opportunity to insulate an attic kneewall area in {initials) your home that is not presently accessible.We are making our ttc- recommendations based upon an educated understanding of your home's construction, but upon gaining access to this space,your home's work-scope might need to be modified. Your contractor and our RISE inspector will guide these changes and discuss them with you prior to proceeding. Total: $3,585.05 Program Incentive: $2,916.95 Client Total: $668.10 I.DESCRIPTION OF WORK TO BE PERFORMED Contractor will perform or cause to be performed the above work at the Client's Address in a professional manner and in accordance with the terms of this Contract II.PAYMENT Upon final inspection and approval by RISE,Client agrees to remit amount due in full.Interest of 1%will be charged monthly on any unpaid.balance after 30 days.See attached terms and condition for important information on guarantees,rights of recision,scheduling,and contractor registration. • RI Representati rent Sig re leo falosIP-61""Viall4140. Printed Name Date of Acceptance Aco CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) kiele....."-°-' 10/14/2022 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 RogersGray,A Baldwin Risk Partner PHONE FAX 410 University Ave (A/c,No,Ext1:800-553-1801 (A/C,No):877-816-2156 Westwood MA 02090 ADDRESS: mail@rogersgray.com INSURER(S)AFFORDING COVERAGE I NAIC# License#:PC-514062 INSURER A:Employers Mutual Casualty Co 21415 INSURED EFFIBUI-02 INSURER B:Tokio Marine Specialty Insuran 23850 Efficient Buildings Inc. 973 Reed Road INSURERC: North Dartmouth MA 02747 INSURER D: I INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:298022623 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 I ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD MD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y 6D48605 8/30/2022 8/30/2023 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $500,000 ' I MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY X JEt° 1 LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY Y Y 6Z48605 8/30/2022 8/30/2023 (Ea accident) LIMIT $1,000,000 ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURYaccident) AUTOS ONLY AUTOS (Per $ X HIRED X NON-OWNED I1 PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ $ A X UMBRELLA LIAB I X OCCUR Y 6J48605 8/30/2022 8/30/2023 EACH OCCURRENCE $4,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000 DED X RETENTION$1n nnn A WORKERS COMPENSATION $ Y 6H48605 8/30/2022 8/30/2023 X PER OTH- AND EMPLOYERS'LIABILITY Y 1 N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE N E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBEREXCLUDED? N/A (Mandatory in NH) I E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under I DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 B Pollution Liability PPK2477709 10/12/2022 10/12/2023 Occurrence $1,000,000 Aggregate $2,000,000 Retention $10,000 1I J DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) When Required by Written Contract,the Following Applies General Liability-Additional Insured Ongoing(CG 7174.3 1013)and Completed Operation(CG 7174.3 1013) Primary and Non-Contributory Basis(CG 7174.3 1013),Waiver of Subrogation(CG 75 55 0219) Auto Liability-Additional Insured(CA 7450 1117),Waiver of Subrogation(CA 74 50 1117) Workers Compensation-Waiver of Subrogation(WC000313 0484) Excess/Umbrella-Additional Insured follows underlying General Liability&Auto Liability(CU 00 01 04 13) Pollution-Additional Insured(PIC-EVCP-001 0722),Primary and Non-Contributory Basis(PIC-EVCP-001 0722),Waiver of Subrogation(PIC-EVCP-001 0722) National Grid and all divisions are are included as cited above 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. National Grid 40 Sylvan Road AU DREPRESENTATIVE Waltham MA 02451 - 7/440"-"......,,,,..._ ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts * li Ali i Department of Industrial Accidents 11111160111 1 Congress Street, Suite 100 ' Boston,MA 02114-2017 ~r www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/OrganizationIndividual): Efficient Buildings, INC 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): l.❑✓ I am a employer with 1 5 employees(full and/or part-time).* 7. ❑ New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 3.0I am a homeowner doing all work myself.[No workers'comp.insurance required.]I 9. El Demolition 10 Q 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 1 LE]❑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. These sub-contractors have employees and have workers'comp.insurance. 13.1=1Roof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.D Other Insulation 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. 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 an,an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Employers Mutual Casualty Company Policy#or Self-ins.Lic. #:6H48605 Expiration Date:08/30/2023 Job Site Address: 5 t cAe\e 1 z.ve City/State/Zip:Yarmouth ma 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 .y be forwarded to the Office of Investigations of the DIA for insurance coverage verificat.: . I do hereby ce fy unde the pains/a J,pent', of perjury that the • mation provided ab 'e 's true and correct. Date: Si. ature: � 1/0 L L/ Phone#: (50 279 11: 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#: pcoc. m xa)Q T [ C) CT < z 4_ ivy m m D(Dm O o,n y-4-n -+ 0 C � mm a -0� -C-p 3 Z Cm4 p m C C• 0_ _. _.. 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Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Re ulations and Standards • IT, Cz� Cons C3llsi3e`]Q'ViS£)i CS-117239 , Spires:03/15/2026 JOHN_LAVEl ry 110 FRANCI&rAVE a` SHREWSBURY MA 01 .-m..: Commissioner GCt ;", B'rnckca_ • THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs'and Business Regulation 1000 Washington&treet- Suite 710 • Boston, Massachusetts-02118 Home Improvement Cbntractar Registration Type: Out of State Corporation EFFICIENT BUILDINGS INC Registration: 208585 973 REED RD Expiration: 09/27/2024 DARTMOUTH.MA 02747 Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE:Out of State Corporation Office of Consumer Affairs and Business Regulation Registration - Exoiration 1000 Washington Street -Suite 710 206885 - 09127/2024 Boston,MA 02118 EFFICIENT BUILDINGS liVC` -l' _ - t---DocuSigned by; JIM REARDON }TAILS yt, _,„!.� 973 REED RD / 1 J 69W495 f1 DARTMOUTH,MA 02747 --'4 t 92C226691F4913. Undersecretary Not valid Without signature 4104k mass save Savings through energy efficiency PERMIT AUTHORIZATION FORM 1, Donna Corrigan owner of the property located at: (Owner's Name) 51 Cottage Drive West Yarmouth (Property Street Address) (City) hereby authorize the Mass Save®Home Energy Services Program assigned Participating Contractor to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. This form is only valid with a signed contract. The permit will be secured by the subcontractor, at no additional cost. • Ow is Signatur 6 drifill1241111°— f°4°. Date FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: r:ie.n-A \a► S n c_ 31z51 z-7) Participating Contractor LJ Date DEBRIS FORM In accordance with the provisions of MG!.c.40,s.54,a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c.111,s.150A. This Debris will be disposed of in: (LOCATION OF FACILITY) .011111 Sig —railrof Permit Applicant 111, l(D Date IF DUMPSTER IS USED IN EXCESS OF SIX 6 CUBIC YARDS A PERMIT FROM THE FIRE DEPARTMENT IS R UIRED FOR COIVIMERCIAL,INDUSTRIAL,INSTITUTIONAL AND MULTI-FAIVIILY RESIDENTIAL OVER 20 UNITS DEMO, RENOVATIONS OR ALTERATIONS OF THE EXISTING BUILDING: CIRCLE ONE "H VE YOU SUB MED TM A NOTI !CAM TO THE MASSACHUSETTS DEP YES NO