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HomeMy WebLinkAboutBLD-23-005918 `Og.Y44.4 y,9� in / �! Office Use Only A.'4,14 .�,.� '!",O b7/01le Pennit# C''r41- 7U5 O `�� y`.1 Amount 43.' ,(/l) �L�1MArT N ui �J c� Permit expires 180 days from issue date (3(A) -o2 3 -AO 5 ci ie EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department RECEIVED 1146 Route 28 ��" South Yarmouth, MA 02664 APR 2 4 2023 (508) 398-2231 Ext. 1261 BUILDING DEPARTMENT CONSTRUCTION ADDRESS: 42 DEBS HILL ROAD ey__ ASSESSOR'S INFORMATION: Map: l 08 Parcel: 43/C3A OWNER: ABIGAIL CROWELL 42 DEBS HILL ROAD,YARMOUTH,MA.025755 508-364-6826 NAME PRESENT ADDRESS TEL. # CONTRACTOR: MATTHEW RUSSELL-3820 DIAMOND HILL ROAD,CUMBERLAND,RI 02864. 401-651-0003 NAME MAILING ADDRESS TEL.# D Residential ❑Commercial Est.Cost of Construction$ $4,059.22 Home Improvement Contractor Lic.# 195309(EXP.04/18/2025) Construction Supervisor Lic.# 106162(EXP.04/26/2025) Workman's Compensation Insurance: (check one) 0 I am the homeowner 0 I am the sole proprietor D I have Worker's Compensation Insurance Insurance Company Name: ARGONAUT INSURANCE CO Worker's Comp.Policy# WC928938765994 WORK TO BE PERFORMED Tent D Duration (Fire Retardant Certificate attached?) Wood Stove El Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares (❑)Remove existing*(max.2 layers) Insulation I"I El Old Kings Highway/Historic Dist. Replacing like for like Pool fencing I *The debris will be disposed of at: 5C ENERGY,330 VICTOR ROAD,ATTLEBORO,MA.02703 Location of Facility I declare under penalties i: 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 / . ocatio my license and for prosecution under M.G.L.Ch.268,Section 1. jI/ Applicant's Signature: Date: 4/20/23 PLEASE SEE ATTACHED OWNER AUTH TION&CONTRACT Owners Signature(or attachment) Date: Approved By: / � �� Date: Building Official(e/Ai y 'e) EMAIL AD SS: MARYANN@SCENERGYINC.COM Zoning District: Historical District: Cl Yes No Flood Plain Zone: [- Yes 7 No Water Resource Protection District: Within 100 ft.of Wetlands: Yes No Yes No ,43 4 3 Permit Authorization mass save Form ,r4 thm,av,0.P., 33y cr„ervz Site ID: 4752749 Customer: Abby Crowell 19 61 cro ue Ii ,owner of the property located at: (Owner's Name,printed) 42 Debs Hill Rd Yarmouth, MA 02675 (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 rform insulation and/or weatherization work on my property. Owner's Signature. Date: 3 FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: 5C ENERGY INC. 4/20/23 Participating Contractor Date Name: RISE Engineering Phone: 508-568-1926 Email: Page 1 of 1 For Office Use Only Customer Name:Abby Crowell CONTRACT Email:crowella7@gmail.com Phone:508-364-6826 Premise Address:42 Debs Hill Rd,Yarmouth,MA 02675 Mailing Address:42 Debs Hill Rd,Yarmouth,MA 02675 Project ID:4764333 Date:Feb.28,2023 ENGINEERING- RISE Engineering 765 Attacks Lane, Hyannis,MA,02601 Roadblocks: Notes: • Combustion safety- High CO Before weatherization can proceed,please have your furnace cleaned and serviced. .Inh fay. riptinn S ae 'L ifi,M «c .� <?� f �w at t x, i �x f S ��� � .� s�.e ����„�'3�°, *� ,��?^�".. �" ,x. G �ih, t ,., r sus � , ,, �' ?`� k•t� �,..9: AIR SEALING 9 hr $848.97 $0.00 PULL DOWN:THERMADOME 100% 1 each $253.21 $0.00 ATTIC DAMMING-R-38 FIBERGLASS 100 SF $242.00 $60.50 ATTIC FLAT-12"OPEN R-42 CELLULOSE 800 SF $1,600.00 $400.01 COMMON WALL:2"RIGID BOARD 68 SF $295.12 $73.78 4"-VENT BATH FAN TO ROOF OR ALTERNATIVE 2 each $261.26 $65.31 4"x 16"SOFFIT VENTS 12 each $370.20 $92.55 VENTILATION CHUTES 54 each $188.46 $47.11 Total: $4,059.22 Program Incentive: -$3,319.96 Weatherization Barrier Incentive: -$0.01 Customer Total: $739.25 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF '""'Seven Hundred And Thirty-Nine And 25/100 Dollars $739.25 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 THE ARE ANY BLANK SP ES RIS presentative Customer Signature aPe 3 Sign Date 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 1 of 1 RISE ENGINEERING GUARANTEE All materials are guaranteed by the contractor to be as specified.All work to be completed in a proficient manner according to standard practice.Any alteration or deviation from specifications on contract involving extra costs will be executed only upon written orders,signed by the client,and will become an extra charge over and above the contract. 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.All agreements are contingent upon strikes,accidents,or delays beyond our control. Customer is to carry fire and other necessary Insurance.All workers are fully covered by Workers' 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 be scheduled based upon sub-contractor availability and permissible weather conditions. NOTICE TO MASSACHUSETTS CUSTOMERS: The Commonwealth of Massachusetts, Board of Building Regulation and Standards requires you be notified of the following: "Alt 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 1000 Washington Street,Suite 710 Boston, MA 02118 Phone(617)973-8787 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. 4': The Commonwealth of Massachusetts t=Nor 1, Department of Industrial Accidents 1 Congress Street, Suite 100 , I js Boston, MA 02114-2017 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/Organization/Individual):5C Energy, Inc Address:330 Victor Rd. Bldg A City/State/Zip:Attleboro, MA 02703 Phone#:774-203-3704 Are you an employer?Check the appropriate box: Type of project(required): 1•1131 I am a employer with 25 employees(full and/or part-time).* 7. 0 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.]t 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 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance? 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[pother Insulation 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *My 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. 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: ARGONAUT INSURANCE COMPANY Policy#or Self-ins.Lic. #: WC928038765994 Expiration Date:12127/2023 X Job Site Address:42 DEBS HILL ROAD City/State/Zip YARMOUTH,MA.02675 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi u er the p ins and penalties of perjury that the information provided above is true and correct. Signature: Date: 4/20/23 Phone: 774-203-3704 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#: '� ® l,tew,"''''( DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 12/28/2022 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 Rosalynn Davila NAME: Loiselle Insurance Agency PAHOC.No.EMI: (401)723-8510 FAX No): (401)728-1820 279 Dexter Street E-MAIL rosal nn©loiselleinsurance.com ADDRESS: y P.O.Box 1148 INSURER(S)AFFORDING COVERAGE NAIC# Pawtucket RI 02 862-11 48 INSURER A: Employers Mutual Casualty Co 21415 INSURED INSURER B: EMC Prop&Cas Ins Co 25186 5C ENERGY,INC. INSURER C: Argonaut Insurance Co ARGO 330 VICTOR RD-BUILDING A INSURER D: RISCO RISCO INSURER E: ATTLEBORO MA 02703-6294 INSURER F: COVERAGES CERTIFICATE NUMBER: Master:2022 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 INSD ADDL swvD POLICY NUMBER UBR POLICY EFF POLICY EXP LIMITS (MMIDD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1'�'� CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $DAMAGE TO RENTED ., 500,000 MED EXP(Any one person) $ 10,000 A 5D98024 12/27/2022 12/27/2023 PERSONAL&ADV INJURY $ 1'0'°°° GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2'�'� POLICY n jEa n LOC PRODUCTS-COMPIOPAGG $ 2,0'" OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 — (Ea accident) ANYAUTO BODILY INJURY(Per person) $ 20,000 B OWNED x SCHEDULED 5Z98024 12/27/2022 12/27/2023 BODILY INJURY(Per accident) $ 40,000 _ AUTOS ONLY /� AUTOS HIRED v NON-OWNED PROPERTY DAMAGE $ 5,000 X AUTOS ONLY AUTOS ONLY (Per accident) Uninsured motoristB1 $ 1,000,000 X UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 3,000,000 A EXCESS LIAB CLAIMS-MADE 5J98024 12/27/2022 12/27/2023 AGGREGATE $ 3,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER , , C ANY PROPRIETOR/PARTNER/EXECUTIVE ( i N IA WC928938765994 12/27/2022 12/27/2023 E.L.EACH ACCIDENT $ 1 000 000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ , Contractors Pollution Liability D CPLMOL107038 06/16/2021 06/16/2023 Aggregate $250,000 Eeach Occurrence $500,000 DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached 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. AUTHORIZED REPRESENTATIVE f w {I ° Qi I . ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NO DEBRIS INSULATION ONLY DEBRIS DISPOSAL AFFIDAVIT In accordance with the provisions of M.G.L. c. 40, s. 54, Building Permit # n/a was issued with the condition that all debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by M.G.L c. 111, s. 150A. The debris will be disposed of in: 5C Energy, Inc. Name of Waste Facility 330 Victor Road, Attleboro, MA 02703 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 structure, M.G.L. c. 40 s. 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. 111 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 OhLLJL Signature of Permit Applicant 4/20/23 Date • Commonweal 'or'Massachusetts . s n of Occupatonat L ensure- , " � " - ns Standards C * a . ry y } Nree '1 r R Z.: '''''''':-''''totrnftliiiii.ort416r d' -,., . ..„‘. 4.0- - . ..... ,.. .....,, , ., ki.. ,,-,,,.,-, ,„, Alt to, w 4 • M �� n, M I S v p Foie to p�� .creon�' �uchu in Cod Ma r ofthis hie. Pawl" � � � �IW :,,,.-, - 414 4111,,,.' '' 74::121:''' .424*— "'' ar...-',',,..-visitt_ wq � I 1 i I I I I cl) i Ili 1 Z g .0 .. .. . i is E • Le 0 ,,. i t§i o .� ��+� . V S �� z 8 ,ct .62to IS o Is dz'g - - i• i Io,g- El ip !I AB i I , 8 i ge I S co 1 ii 1.2§t- I i I E L = . t I ig g tg � . 2. ® c c 8$mn _ � � ,... „,,,_.._,.....„..,, ..$ •� N c 1 . iiii 0 d _ = � y� 74. . . to i,,., ;, g �t_ ,%4 4 1, { k ',`r 1 1 big To +« < = , Ea .. 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