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HomeMy WebLinkAboutBLD-23-005471 :01 Y9 ii Office Use Only 1 Permit* Z J)58r OH i Amount 3 S d[) ,t; Permit expires 180 days from : ..: issue date /3 -a3 -60 51 1 EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department RECEIVED 1146 Route 28 South Yarmouth, MA 02664 APR 0 3 2023 (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: By 171 Wendward Way BUILDING—DEPARTMENT DEPARTMENT ASSESSOR'S INFORMATION: Map: 29/ 6/// Parcel: 1340 OWNER: Peggy Scott 171 Wendward Way (504) 352-0039 NAME PRESENT ADDRESS TEL. # 235 Essex Street Whitman,MA 02382 781-205-4516 CONTRACTOR: Adam Glenn NAME MAILING ADDRESS TEL.# 0 Residential ❑Commercial Est.Cost of Construction$ Si'3 8a b Home Improvement Contractor Lic.# 181138 Construction Supervisor Lic.#CSSL-I 106148 Workman's Compensation Insurance: (check one) t. I am the homeowner I am the sole proprietor 6 I have Worker's Compensation Insurance Insurance Company Name: Federated Mutual Insurance Company Worker's Comp.Polic}# 1847910 WORK TO BE PERFORMED Tent Duration _ (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares ( )Remove existing*(max.2 layers) Insulation I I l l Old Kings Highway/Historic Dist. ( )Replacing like for like Pool fencing *The debris will be disposed of at: Not Applicable 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 revocation of my license and for prosecution under M.G.L.Ch.268,Section 1. Applicant's Signature: C� �'° Date: 3/28/23 Owners Signature(or attachment)Federatedd Mutu Insurance Company Date: Approved By: Date: Buildin (or designee) EMAIL ADDRESS: wxpermittin g@homeworIcsenercry.corn Zoning District: Historical District: Yes No Flood Plain Zone: Yes No Water Resource Protection District: Within 100 ft.of Wetlands: Yes No . Yes No 1 • y. % • 11111116'•••• • . ACCORD CERTIFICATE OF LIABILITY INSURANCE DATE 12/dOrzurt 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 POUCIES 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 FEDERATED MUTUAL INSURANCE COMPANY NAME: CLIENT CONTACT CENTER PHONE HOME OFFICE:P.O.BOX 328 LAIC,No,Est):888-333-4949 !FAX No):507-446-4664 OWATONNA,MN 55060 ADDRESS:CLIENTCONTACTCENTERCdiFEDINS.COM INSURER(,)AFFORDING COVERAGE NAIL# INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 419 i399-0 INSURER B: HOMEWORKS ENERGY,INC. INSURER C: 101 STATION LNDG MEDFORD,MA 02155-5134 INSURER CI: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:0 REVISION NUMBER:1 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 CONDI-ION 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 POUCY NUMBER POLICY EFF POLICY EXP LIMITS LTRINSR YAMIMMIDDIYYYYI IMMIDDIYYYYI X COMMERCIAL GENERAL UABIUTY EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR PRE MES IEa osarrrensaI $100,000 MED EXP(My one parson) EXCLUDED A N N 1847909 01/01/2023 01/01/2024 PERSONAL&ADVINJURY $1,000,000 GEN'L AGOR GATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY £COT- LOC PRODUCTS-COMPIOP AGO $2,�A00 OTHER: AUTOMOBILE LIABILITY IECOMBINEDt SINGLE LIMIT $1,000,000 e eee.den X ANY AUTO BODILY INJURY(Pet person) —A OWNED AUTOS ONLY AUTOOSULED N N 1847908 01/01/2023 01/01/2024 BODILY INJURY(Per ecddan4 HIRED AUTOS ONLY NON-OWNED PROPERTY DAMAGE AUTOS ONLY (Per acddant) X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $1,000,000 A EXCESSLIAB CLAIMS-MADE N N 1847911 01/01/2023 01/01/2024 AGGREGATE $1,000,000 DED RETENTION WORKERS COMPENSATION X IPER STATUTE( I OTI ER AND EMPLOYERS'LIABILITY E.L.EACH ACCIDENT ANY PROMEMBER(EXCLUDR1EXEcunvE NIA N 1847910 01/01/2023 01/01/2024 - $500,000 A OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $500,000 (Mend/dory In NH) If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY UNIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Addition/0 Remarks SCedule,may be attached it more space is required) THIS COPY IS NOT TO BE REPRODUCED FOR ISSUANCE OF CERTIFICATES. CERTIFICATE HOLDER CANCELLATION 01 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN A CERTIFICATE HAS BEEN FILED WITH EACH OF YOUR CERTIFICATE ACCORDANCE WITH THE POUCY PROVISIONS. HOLDERS. AUTHORIZED REPRESENTATIVE O 1986-2015 ACORD CORPORATION.ILO rights reserved. ACORD 25(2015/03) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations .�► Lafayette City Center 2 Avenue de Lafayette, Boston,MA 02111-1750 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Homeworks Energy Address: 235 Essex Street City/State/Zip:Whitman, MA 02382 Phone #: 508-644-8197 Are you an employer? Check the appropriate box: Type of project(required): 1.0 I am a employer with 500+ 4. 0 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. 0 Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity. employees and have workers' 9. El Building addition [No workers' comp. insurance comp. insurance. required.] 5. 0 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 is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Federated Mutual Insurance Company Policy#or Self-ins. Lic. #:#1847910 Expiration Date: 1/1/2024 Job Site Address: 171 Wendward Way 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 and r the pains and pees of perjury that the information provided above is true and correct. Signature: �"`�' `r Date: 3/28/23 Phone#: 508-644-8197 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 30City/Town Clerk 4.0 Electrical Inspector 5Elumbing Inspector 6.0Other Contact Person: Phone#: Commonwealth of Massachusetts Construction Supervisor Specialty Division of OCcuDational Licensure Rest rcted to Board of Budding Ragulations and Standards CSSL aC •:nsulattun Coot acto1 Construtir Specialty 4' - 'p CSSL-106148 ` ' :fr. fires. 07/30/2024 ADAM GLENN v� -' 19 CHARGE PO ,. 1 il:c. zu, W WAREHAM MA 1 - ,+ .,� E. ?4, ., • Failure topossess a current edgion of the Massachusetts 'r, I State uildrng Code is cause for revocation of this license. For information about it this license Commissiortcr f,' 701144.., CaH1617) 727-3200w or visit ww mass.govidpt THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Roston, Massachusetts 02118 Home Improvement Contractor Registration ___ ---+ Type: Corporation 2 *. Registration: 181138 HOME WORKS ENERGY, INC. . . Expiration: 03/02/2025 101 STATION LANDING STE 110 ,� MEDFORD, MA 02155 OHM OF ogIONIMINOMMOO 1:= .1011.1041111111 v" '14 , ss@ 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:Corporation Office of Consumer Affairs and Business Regulation Registration Expiration 1000 Washington Street -Suite 710 181138 03/02/2025 Boston,MA 02118 HOME WORKS ENERGY,INC. ADAM GLENN (31/PLA C�� �101 STATION LANDING STE 110 Gam,,.0.« Qom" , ��- MEDFORD,MA 02155 Undersecretary Not valid without signature Page 1 of: • HomeWorks 101 Station Landing Ste 110, (" f118SS SaVl2 Medford,MA 02155 1 i Energy PARTNER (781)305-3319 Customer Name:peggy scott Email:peggyscottlmt@yahoo.com Phone:504-352-0039 Premise Address: 171 Wendward Way,Yarmouth,MA 02673 Mailing Address: 171 Wendward Way,Yarmouth,MA 02673 Project ID:4516252 Date: March 22,2023 Job Description (Measure Description Location Quantity Unit Total Cost Customer Cost CRAWLSPACE: R-19 FG BATT Other 1064 SF $2,287.60 $571.90 AIR SEALING Other 9 hr $848.97 $0.00 INSULATE BULKHEAD DOOR Other 1 each $68.83 $17.21 ATTIC FLAT-9" OPEN R-33 CELLULOSE Other 864 SF $1,520.64 $380.16 ATTIC HATCH: INSULATE ONLY Other 1 each $35.00 $8.75 4" x 16" SOFFIT VENTS Other 9 each $277.65 $69.41 ATTIC DAMMING- R-38 FIBERGLASS Other 60 SF $145.20 $36.30 VENTILATION CHUTES Other 57 each $198.93 $49.73 Project Total $5,382.82 Total Contractor Price and Payment Schedule HomeWorks Energy, Inc.agrees to perform the above described work,furnishing the material and labor specified for the listed total price. Payment of the balance of the customer contribution is expected upon completion of the work. Customer Signature: Date: Customer Phone: Specialist Signature: Date: LIMITED TIME OFFER: The prices and incentives in this contract are subject to change in accordance with the sponsoring utility MassSave Home Services Program offers. Proposals con be sent to:Inbox@HomeWorksEnergy.com Page 2 of: 4(r':/a41r5 HomeWorks 101 Station Landing Ste 110, Energy fl7aSS PARTNERsaveMedford,MA 02155 (781)305-3319 Customer Name:peggy scott Email:peggyscottlmt@yahoo.com Phone:504-352-0039 Premise Address:171 Wendward Way,Yarmouth,MA 02673 Mailing Address:171 Wendward Way,Yarmouth,MA 02673 Project ID:4516252 Date:March 22,2023 Weatherization incentive ($3,400.39) Air sealing incentive ($848.97) Total Program Incentive -$4,249.36 Customer Total $1,133.46 Total Contractor Price and Payment Schedule HomeWorks Energy, Inc.agrees to perform the above described work,furnishing the material and labor specified for the listed total price. Payment of the balance of the customer contribution is expected upon completion of the work. ,lam 'i9G 3/22/2023 Customer Signature: Date: Customer Phone: 3/22/2023 Specialist Signature: Date: LIMITED TIME OFFER The prices and incentives In this contract are subject to change in accordance with the sponsoring utility MassSave Home Services Program offers. Proposals con be sent to:Inbox@HomeWorksEnergy.com Insulation/Air Sealing Permit Authorization Specialist: Ryan Mgrdichian Company: HomeWorks Energy Email: Ryan.Mgrdichian@homeworksenergy.c, Address: 101 Station Landing Cell: 860.394.7804 Medford, Ma 02155 Phone: 781.305.3319 Customer: Peggy Scott Address: 171 Wendward Way Email: peggyscottlmt@yahoo.com W Yarmouth, MA 02673 Site ID: 4514347 Phone: (504) 352-0039 I, the owner of the property identified above hereby authorize HomeWorks Energy Inc., or their Partner to act on my behalf in obtaining any building permit that maybe required to perform insulation and/or Weatherization work on my property and all matters related to the work authorized by said permit if one is obtained. Any related permit application cost will come at no additional charge provided that the agreed Weatherization work is completed. In the event that a permit is pulled on your home for insulation and/or weatherization work, you may be required to have a final inspection of the work scheduled and performed by the building inspector in your town. If required by the town, you will be notified by HomeWorks Energy that an inspection is necessary with instructions on how to complete this process to close out your permit. Email: peggyscottlmt@yahoo.com Customer Signature: /vim c5rd,1 Date: 6/9/2022 Peggy Scott For Condo Owners: If you have property oversight by a condo association*, please have the association's authorized person(s)complete and sign the section below. Please email this document to wxpermitting@homeworksenergy.com once completed. We, being the duly authorized representatives of the association Name of association or management company or management company have reveiwed the plans and specifications for improvements to the address specified above. We further acknowledge that the above listed owner has given notice that they intend to seek permits and to carry out the proposed work. Signature of representative Date Print Name 0 ther unit owners may sign when there is no association. 3 54. N0 S.p vn-il- l.be litrrOl%O(/'' -2 ----- - PLAN VIEW bt—S'\-S(k (lc# Z Name:Pe See H- c7Co`�( 5� Site ID: 45l L{39-1 Finished Sq. Ft: I e Phone:(504)3S1-00301 Year of House: CsZ #: V1V I 1 �`� Electric Acct (`{3 j 3 x Address:J I-1 \ litiehdwc.,.c-( (Jay #of Floors: I Gas Acct#: os`ig2`l 1�321 I4-fiuKA-Lx AN # Occupants: 2 Housing Type?V^'NC kk- DUCTWORK INSPECTION Ducts Insulated?ri Duct Lin er.Zt. 3F-- Duct Square Ft.--------,..„.._ Duct Air Sealing Hours (PV'<- Duct Insulator - - ----___, r� Duct Insulaton Removal `5 1t -- (S ( 1/1^ (126‘t i BASEMENT INSPECTION 2 r a f1lS tE -7 • ('3 (r- ( idn Existing Spec'ing !n/Sq. Ft m Bsmt:gall AG ---------, —,— 07 S ¢ S>(.r,S c l4.a.i,15 Crawl Ceiling ,V)/'e } tq �( `( 4 ® �oLy QL+ 0p0� Crawl Rim Joist I/JD/sc4 �4_/s 132 f-t- BsmtRJw/Sill - Bsmt RJ NO Sill } -- ._ , . Vapor Barrier soft, Bsmt Door fo(A Y/N Blower Door? WALLS&GARAGE Drill Location? Siding Ceil. Height Existing Spec'ing Sq. Ft. Framing Exterior Wall 1�'�_ x x Balloon/Platform Exterior Wall x x Balloon/Platform Overhang _� x x Garage Wall f ---- `____ x x Balloon/Platform Garage Ceiling ,-----/' ct x EE litAARS UA- 2 2 - F6g x NI W insulation Removal ,— Sqft Sweeps:—______"._ WX Stripping: WORK SPEC'D BUT NOT CONTRACTED AD BLOCKS PRESENT (MANDATORY) Attic Basement/Cra lspace Other: K&T Y/J1OStUreN Y/ )Combustion Sfty Y Kneewall Overhang/Garage Asbestos Y N Mold>100 sq. ft Y CO Detector Missing Y Ductwork Exterior Walls Vermiculite Y NjStructl Concerns Y AjOther: Notes for Lead Vendor/Work Not Contracted: j U t�l — I O T f p., QCrs ,d/ot• (( jOr q I (C cii, hr ? - ¶ i wI IPosis-e. KW WALL AND KW FLOOR Blind Spec? ;_I OR - - ---► KW SLOPE AND GABLE END Blind Spec? ❑ h< hy? RAVING EXISTING SPEC'ING 5Q.FT. ERA I G EXISTING SPEC'ING SQ.FT. WALL X SLOPE x X F_ODR X GABLE X X oa CCESS X vd TRANS X X I • TRANS X X 55 ATTIC N-+ TTICSLOPE X X ,�3SLOPE wX X EXISTING VENTING? w, EXISTING VENTING? EXISTING PIPES? Y/N m KW Ve,:;nyr. Vent BF BF Hose Damming Sheathm�r,a.‘sess Temp At cett kW Vergrt Vem Br Temp Acre s KNEEWALL MANDATORY No Kw ' - eisAicti J 2 12`Aiv- Gv- (L.'r') C 0 rc 1 110447VE 4 (le i rvs neg.C. 2cX 3 3� ie oIeIGc r,a,t:Ar() 1 s° f r o — , 7-w ©A/S Io�Y # V c-trn r//// 3103( (�p+6r$ 8' 4( • a�( o13CIy2T �/ , D "d'( j4Cvt 77 /'' .;/// 0 4 x It,' S'.Q. x 1 ap 57 {ro1*''ir \.., .„.. Insu aced Watt 'i X Prcd bghc 0 ins.Hose BF�Vent BF 1RF�V Jt Cnim.CN!Damming :I"Root V Of BAS Vol' x .0058 Al Handler AHI Temp Actess.J Pull Oran rtI': Hatch Walt Hatch "/ Door e/ H"Roo`Vent tR% _ s29rv) I Xto 4 V ATTIC 1 Blind Spec? 0 x ATTIC 2 Blind Spec? 0 X(1s.e23(1(I stpry)) o Existing Spec'ing Sq ft Existing Spec'ing Sq ft 13.6f3 Multipliers 5 Unfloored J2.i ie1`At &v,1 Unfloo Trusses Cross Batring d ti"'% S A S 24J Floored Mixed insulation Duct Work Floored >6"Loose None • Cath Slope Cath Slope Air Sealing Hours Walls Walls q Access T P��� Access `Ventingareats Vent BF BF Hose Damming Vennng Pr vents nt BF•BF Here` Damming oVJHF Box4vKIV � huh ( TempAecess:_'`u 11M/I'''''siX9 aSheathing Acces: N • , + vi R.L.Covers: c„.Fy 31,- ((xist.NFA Venpnrl- It:ceded Se.F/3C:- tAiss.NFA Venting)_ (Needed r,FAVe,nnW WA venting) Root Type:A h� or Existing Venting? Existing Venting? l� P 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 waste disposal facility as defined by M.G.L c. 111, s. 150A. The debris will be disposed of in: HomeWorks Energy Name of Waste Facility Not Applicable - No Debris 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—6t''Edition 644A `fi e- Signature of Permit Applicant 3/28/23 Date