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HomeMy WebLinkAboutBLD-23-005473 Office Use Onlly /_Permit# Li ?I7,C7 (:: :o Amount Permit expires 180 days from issue date --Z3 -00 5 (-73 EXPRESS BUILDING PERMIT APPLICAT ll ► TOWN OF YARMOUTH RECEIVED Yarmouth Building Department 1146 Route 28 L APR 03 2023 South Yarmouth, MA 02664 (508) 398-2231 Ext. 1261 ".._.___. BUILDINGG DEPARTMENT By: CONSTRUCTION ADDRESS: 9 Cross St Yarmouth MA 02664 ASSESSOR'S INFORMATION: Map: Parcel: OWNER: Celeste Silva 9 Cross St Yarmouth MA 02664 508-330-5997 itiite Energy 88 Arch gt Xpt 3ira is Liver TEL. # CONTRACTOR: Services, LLC Ma 02724 774-360-7658 NAME MAILING ADDRESS TEL.# Email: eliteenergyservicesllc@yahoo.com g 424.58 l Residential El Commercial Est.Cost of Construction$ Home Improvement Contractor Lic.# 195944 Construction Supervisor Lic.# CS-113671 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 Name: Atlantic Charter Insurance Company Worker's Comp.Policy# WCV01488803 WORK TO BE PERFORMED Tent El Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares (El)Remove existing* (max.2 layers) Insulation Fl I l Old Kings Highway/Historic Dist. Replacing like for like Pool fencing *The debris will be disposed of at: New Bedford Waste Services 1245 Shawmut Ave New Bedford MA 02746 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 re ation of my license and for rosecution under M.G.L.Ch.268,Section 1. 7 Applicant's Signature: Date: 3 /2?/� Z3 Owners Signature(or attachment) FL i0'SE S TJ -17E-6 Date: Approved By: Date: _yam 2-3 Building Official(or designee) MA ADDRESS: Zoning District: Historical District: E Yes No Flood Plain Zone: '. Yes No Water Resource Protection District: Within 100 ft.of Wetlands: Yes Ci No ❑ Yes El No B .i Commonwealth ` ,.,ssachu�setts s® Division of Pro?vsionat Licensure oard of Building Regulatwns and Standards ConstruCtiOn SUpervlsor CS-113671 Expires:061107,2023 STEVEN P HEBERT 225 SHOVE STREET APT4 , c FALL RIVER MA 02724 ,f Commissioner ,:.., Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: LLC Registration: 195944 ELITE ENERGY SERVICES, LLC Expiration: 06/13/2023 225 SHOVE ST FALL RIVER, MA 02724 Update Address and Return Card. Office of Consumer Affairs& Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE: LLC before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 195944 06/13/2023 1000 Washington Street - Suite 710 ELITE ENERGY SERVICES, LLC Boston, MA 02118 STEVEN HEBERT 225 SHOVE ST °°� ' , .c fSts FALL RIVER, MA 02724 Not valid without signature Undersecretary A C� DATE(MM/DD/YYYY) ��. CERTIFICATE OF LIABILITY INSURANCE 03/08/2023 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 NAME: Loretta Brown F B I N S U R E LLC sac°NNo,EMI' (508)824-8666 FAX No): E-MAIL ADDRESS: IOrettata fbinsure.Com 128 DEAN ST INSURER(S)AFFORDING COVERAGE NAIC TAUNTON MA 02780 INSURERA: ATLANTIC CHARTER INS CO 44326 INSURED INSURER B ELITE ENERGY SERVICES LLC INSURERC: INSURER D: 88 ARCH STREET APT 3 INSURER E: FALL RIVER MA 02724 INSURER F: COVERAGES CERTIFICATE NUMBER: 868837 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 EFF POLICY EXP LT ADDLTYPE OF INSURANCE INSD WVDSUBR POLICY NUMBER IMPM/DDY/YYYYI (MMIDDIYYYY) UMITS LTR INSD WVD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE TO $ CLAIMS-MADE OCCUR PREMISES(EaENTED occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- j LOC PRODUCTS-COMP/OP AGG $ OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS N/A BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X STATUTE OTH- ER AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBEREXCLUDED? N/A N/A N/A WCV01488803 02/28/2023 02/28/2024 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B, no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/Iwd/workers-compensation/investigations/. 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 AUTHORIZED REPRESENTATIVE South Yarmouth MA 02664 Daniel M.Cro Ij y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD i—� ELITENE-01 LBROWN AicoRO CERTIFICATE OF LIABILITY INSURANCE DATE D/YYYY) �.� 3/8/2/8/2023 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 Loretta Brown NAME: FBinsure,LLC jA/cNNo,Ext):(508)824-8866 FAX 128 Dean Street (Arc,No):(508)880-0142 Taunton,MA 02780 E-MAIL oREss:lorettagifbinsure.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Selective Insurance Company of South Carolina 19259 INSURED INSURER B:Commerce Insurance Company 34754 Elite Energy Services LLC INSURER C:Evanston Insurance Company 35378 225 Shove St Apt 4 INSURER D: Fall River, MA 02724 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 POUCY EXP UNITS LTR INSD WVD (MMIDD/YYYYI (MMIDDIYYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR S2574612 2127/2023 2/2712024 DAMAGE TO RENTED 500,000 PREMISES(Ea occurrence) $ X Blkt Add'I Ins MED EXP(Any one person) $ 15,000 X Blkt Waiver PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) _ ANY AUTO BDJH26 3/11/2023 3/11/2024 BODILY INJURY(Per person) $ OWNED X SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ RRE� oN WN p PROPERTY DAMAGE X AUTOS ONLY X AUTO ONLY (Per accident) $ $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE S2574612 2/27/2023 2/27/2024 AGGREGATE $ 1,000,000 DED i X RETENTION$ 0 $ WORKERS COMPENSATION STATUTEPER ER AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ FFICER/MEMBER EXCLUDED? N I A Mandatory in H) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C Pollution Liab CPLMOL107350 7/13/2021 7/13/2023 Per Occurrence 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Professional Insulation/Winterization Services Contractor.Pollution Liabil ty coverage includes a$2,000,000 Aggregate and$1,000 Deductible. CERTIFICATE HOLDER CANCELLATION I 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 AUTHORIZED REPRESENTATIVE TI 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 Print Form Department of Industrial Accidents "" /j♦ Office of Investigations MOW 1 Congress Street, Suite 100 ~4 r•.lid! '1 Boston, MA 02114-2017 •t7 _ Y www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Elite Energy Services , LLC Address:225 Shove St City/State/Zip: Fall River Ma 02724 Phone #:774-360-7658 Are you an employer? Check the appropriate box: Type of project(required): 1.® I am a employer with 19 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. El Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingforme in 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 employees. [No workers' 13.10 Other Insulation comp. insurance required.] *Any applicant that checks box#1 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. :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 is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Atlantic Charter Insurance Company Policy#or Self-ins. Lic.#:WCV01488803 Expiration Date: 2/28/2024 Job Site Address:9 Cross St City/State/Zip:Yarmouth MA 02664 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. I do hereby certify under the pains and penalties of penury that the information provided above is true and correct. cam.. 4 3/28/2023 Signature: Date: Phone #:774-360-7658 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#: Customer Name:Celeste Silva CONTRACT Email:celeste.silva@staples.com Phone:508-330-5997 Premise Address:9 Cross St,Yarmouth,MA 02664 RISE Mailing Address:9 Cross St,Yarmouth,MA 02664 Project ID:4785512 Date:March 20,2023 ENGINEERING RISE Engineering 765 Attucks Lane, Hyannis,MA,02601 Job Description Measure Description Location Quantity Unit Total Cost Customer Cost AIR SEALING 18 hr $1,697.94 $0.00 Recessed Light Enclosure 6 each $300.00 $0.00 Duct Sealing -6 Hours (not insulated, over 200') 1 each $522.54 $0.00 ATTIC DAMMING- R-38 FIBERGLASS 80 SF $193.60 $48.40 ATTIC FLAT-8"OPEN R-30 CELLULOSE 1750 SF $2,940.00 $735.00 CRAWLSPACE CEILING THERMAX 528 SF $2,418.24 $604.56 CRAWLSPACE: INSULATE DOOR 1 each $66.00 $16.50 INSULATED BATH EXHAUST HOSE 4" 1 each $28.00 $7.00 VENTILATION CHUTES 74 each $258.26 $64.56 Total: $8,424.58 Program Incentive: -$6,948.56 Customer Total: $1,476.02 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***One Thousand, Four Hundred And Seventy-Six And 02/100 Dollars $1,476.02 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. O NOT SIGN THIS CONTRACT IF THERE ARE ANY B SP -� ____ RISE Representative Customer Signatur 3.- aD 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 Permit Authorization mass save Form Site ID: 4747099 Customer: Celeste Silva a41c4/0 ( S4114 , owner of the property located at: (Owner's Name,printed) 9 Cross St Yarmouth, MA 02664 (Property Street Address) (City) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf d o tain a building permit to perform insulation and/or weatherization work on my property. / Owner's Signature: 4 Date: 3%. FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Elite Energy Services 3/28/2023 Participating Contractor Date Name: RISE Engineering Phone: 508-568-1926 Email: Page 1 of 1 For Office Use Criy RPv. 10201