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HomeMy WebLinkAboutBLD-23-005475 I,`�a Office Use Only � \ � Permit# eaid17 7 OI- l 1H Amount,35.10D MA_TT 1, c.1t,$ \"�« c! Permit expires 180 days from issue date 13LD-023 -6b54 5 EXPRESS BUILDING PERMIT APPLIC •. r: E i V D TOWN OF YARMOUTH Yarmouth Building Department [ PR0 3 2�23 1146 Route 28 South Yarmouth, MA 02664 --- BUILDING DEPARTMENT (508) 398-2231 Ext. 1261 By. CONSTRUCTION ADDRESS: 104 Iroquois BLVD West Yarmouth MA 02673 ASSESSOR'S INFORMATION: Map: Parcel: OWNER: Monica Green 3 Autumn LN Halifax MA 02338 774-259-4367 Vie Energy 88 Arch Sitpt 3�alsiiver TEL. # CONTRACTOR: Services, LLC Ma 02724 774-360-7658 NAME MAILING ADDRESS TEL.# Email: eliteenergyservicesllc@yahoo.com 4 345.22 ®Residential 0 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 Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows: # Replacement doors: # Roofing: #of Squares (0)Remove existing* (max.2 layers) Insulation L'�I I I Old Kings Highway/Historic Dist. Replacing like for like Pool fencing I I *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 rev ation of my license and for prosecution under M.G.L.Ch.268,Section 1. kip 6 Applicant's Signature: Date: .3/2 p AO Z 3 Owners Signature(or attachment)PILGAS►% SLR — Fci /I Date: y Approved By: v Date: 2-3 Building Official(or des ee) EMAIL ADDRESS: Zoning District: Historical District: Yes No Flood Plain Zone: L Yes , No Water Resource Protection District: Within 100 ft.of Wetlands: Yes UI No Yes No a jf a ` '� .. 1. Commonwealth of Massachusetts ® Division of Professional Licensure Board of Building Regulations and Standards ConstroCtiOn Supervisor Cs t I,h,+ Expires:06/07/2023 STEVEN P HEBERT 225 SHOVE STREET APT 4 FALL RIVER MA 02724 • Commissioner •44.. .__it - i 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 Y��„n.o✓.' ( "� FALL RIVER, MA 02724 Not valid without signature Undersecretary AC� 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 CNTNAMEACT Loretta Brown FBINSURE LLC ,PANic"No,Ext►: (508)824-8666 FAX (A/C, E-MAIL ADDRESS: IreG tta fbinsure.com 128 DEAN ST INSURER(S)AFFORDINGCOVERAGE NAIC# TAUNTON MA 02780 INSURER A: ATLANTIC CHARTER INS CO 44326 INSURED INSURER B: ELITE ENERGY SERVICES LLC INSURER C: 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 POUCY EXP LT ADDLTYPE OF INSURANCE INSD SUER POLICY NUMBER (MMMIPOLDIDYD/YYYY) (MMMIDDIYYYY) LIMITS LTR INSD WVD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE TO RENTED $ CLAIMS-MADE OCCUR PREMISES Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO JECT 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 ERH AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBER EXCLUDED? N/A NIA N/A WCV01488803 02/28/2023 02/28/2024 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,descr be 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 CAS Daniel M.Cm 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 --'.40 ELITENE-01 __ LBROWN ACORD 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 I N_AM ---- --- -._— FBinsure,LLC 128 Dean Street (A/MCC�,No,Ext):(508)824-8666 1 FAX No):(508)880-0142 Taunton,MA 02780 DRESS:loretta@ffbinsure.com H 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (.MM/DD/YYYY) (MM/DDIYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR S2574612 212712023 2/2712024 PRDAMAGEMISEES(TO Ea RENTEDrrence) $ 500,000 occu X Blkt Add9 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 JEITT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ I COMBINED SINGLE LIMIT 1,000,000 B AUTOMOBILE LIABILITY (Ea accident) $ ANY AUTO 1 BDJH26 3/11/2023 3/11/2024 BODILYINJURY(Perperson) $ OWNED AUTOS ONLY AUTOS X SCHEDULED BODILY INJURY(Per accident) $ X HIRED X NON WNED PReOPPEERTtDAMAGE $ AUTOS ONLY AUTO ONLY / $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,0001 EXCESS LIAB CLAIMS MADE S2574612 2/27l2023 2/27/2024 AGGREGATE $ 1,000,000 _ DED X RETENTION$ 0 ' $ 1 PER WORKERSOTH- COMPENSATION STATUTE ER AND EMPLOYERS'LIABILITY Y/N i E.L. ANY PROPRIETOR/PARTNER/EXECUTIVE EACH ACCIDENT $ (Mandatory In NHR EXCLUDED? N/AI E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C Pollution Liab I 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 Liability coverage includes a$2,000,000 Aggregate and$1,000 Deductible. 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 AUTHORIZED REPRESENTATIVE 1.44 .X. 'i3) ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Customer Name:Monica Green CONTRACT Email:cgreen33@comcast.net Phone:774-259-4367 Premise Address:104 Iroquois Boulevard,West Yarmouth,MA 02673 RISE Mailing Address:3 Autumn Lane,Halifax,MA 02338 Project ID:4789974 Date:March 23,2023 ENGINEERING RISE Engineering 765 Attucks Lane, Hyannis,MA,02601 Applicable Customer Required Actions: Notes: • Storage Removal Prior to insulation start date, please remove all old • Other fiberglass in the crawlspace ceiling. Also, please remove all items stored in the attic. Job Description ., Measure Description location Quantity Unit Total Cost Customer Cost ATTIC DAMMING- R-38 FIBERGLASS 6 SF $14.52 $3.63 CRAWLSPACE: R-19& RIGID BOARD 440 SF $2,961.20 $740.30 ATTIC FLAT- 15"OPEN R-52.5 CELLULOSE 70 SF $156.80 $39.20 ATTIC FLAT- 14" FLOORED R-49 DENSE CELLULOSE 25 SF $84.75 $21.19 SLOPE-7" DENSE R-22 CELLULOSE 200 SF $504.00 $126.00 WALLS:VINYL SIDED 4"CELLULOSE 154 SF $355.74 $88.93 ACCESS: ROOF STRIP UP TO 5 FT 1 each $208.97 $52.24 ACCESS: ROOF STRIP BEYOND 5 FT 4 each $59.24 $14.81 Total: $4,345.22 Program Incentive: -$3,258.92 Customer Total: $1,086.30 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS. FOR THE SUM OF ***One Thousand And Eighty-Six And 30/100 Dollars $1,086.30 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 THERE ANY A ES • RIS presentative Customer Signature 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 40018, Permit Authorization mass save Form Site ID: 4298474 Customer: Monica Green z:_L Ct 44n , owner of the property located at: (Owner's Name,printed•) 104 Iroquois Boulevard West 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 obta a building permit to perform in ion and/or weatherization work on my property. Owner's Signature: Date: 1— 4).3- a,3 FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above reverenced project: Elite Energy Services 3/28/2023 Participating Contractor Date Name: RISE Engineering Phone: 508-568-1926 Email: Page 1 of 1 Fer Office Use Orly Rev i n7m The Commonwealth of Massachusetts Print Form ,I Department of Industrial Accidents Officefli of Investigations c\,„ 1 Congress Street, Suite 100 Boston, MA 02114-2017 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 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 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 workingfor me in anycapacity. employees and have workers' p ty• 9. 0 Building addition [No workers' comp. insurance comp. insurance.: required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.0 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 Insulation employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 1.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: 104 Iroquois Boulevard City/State/Zip:W. 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 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 perjury that the information provided above is true and correct. Ai...4444 Date13/28/2023 Signature: I 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#: