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Home My WebLink AboutBLD-23-005730 BLD-23-005730 - 18 ARROWHEAD DRIVE YPORT Help File Date: 04/13/2023 Application Status: Description of Work: RETROFIT Application Detail: Detail Application Type: Residential Express Permit Address: t$:' G#1 Y Owner Name: SAMUEL&LILY HAMMOND Owner Address: 18 ARROWHEAD DR,YARMOUTH PORT,MA 02675-2401 Application Name: 18 ARROWHEAD DRIVE YPORT Parcel No: 115.110 Contact Info: Name Organization Name Contact Type Relationship Address Contact Primary WILLIAM J MCCLUSKEY WILLIAM J MCCLU... Applicant 7-D HUNTINGTON... Licensed Professionals Info: Primary License Number License Type Name Business Name Business License# Yes 171380 Home Improvomen... WILLIAM J MCCLU., CAPE SAVE INC Job Value: 51,476,00 Total Fee Assessed: $35.00 Total Fee Invoiced: $35.00 Balance: 60.00 Custom Fields: ADDITIONAL INFORMATION Total Job Cost Type 3476 USE GROUP AND CONSTRUCTION TYP Construction Type Use Classification WORKERS COMPENSATION INSURANCE Workers Compensation Insurance Insurance Company Name Workers Comp I have Workers Comp Insurance EMPLOYERS MUTUAL CASUALTY COMPANY 5D77852 TENT Tent No WOODSTOVE Wood Stove No CHIMNEY REPAIR Chimney Repair Detailed description of work No SHED Shed No *12,3, SIDING Re-Side No WINDOWS AND DOORS Replace Windows and/or Doors No FENCE Fence Fence for Pool Enclosure Fence over 6 F[ No Linear Feet Fence Height ROOF Re-Roof No INSULATION Installing Insulation Yes SOLAR SYSTEM INFORMATION Solar Service ID Meter ID • Type of Use Job Cost Total Inverter P+ Number of PV Modules Number of Inverters Total Roof Area Roof Coverage Type of Roof Roof Material Roof Layers DEMO Demolition Detailed description of work No OTHER Other Detailed description of work GENERAL DETAILS Construction Debris will be taken to(Name of Disposal Facility) Electrical Drop within Area of Work? YARMOUTH TOWN DUMP No Gas Meter or Regulator within Area of Work? No ZONING INFORMATION Zoning District Historic District Historic District Historic Building Endangered Species Zone Description Supplier Wetland Description Total Land Area INSPECTION RESULTS Inspection ID Inspection Type Inspection Result Inspection Date Result Comment Inspector Record ID Record Type Workflow Status: Task Assigned To Status Status Date Action By Application Acceptance. ....... Linda Cipro Initial Review Linda Cipro Building Review Tim Sears Issuance Linda Cipro Inspection Tim Sears Close Out Linda Cipro Condition Status: Name Short Comments Status Apply Date Severity Action By Application Comments: View ID Comment Date Initiated by Product: ACA Scheduled/Pending Inspections: Inspection Type Scheduled Date Inspector Status Comments Resulted Inspections: Inspection Type Inspection Date Inspector Status Comments The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 =Er 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):Cape Save Inc Address:7-D Huntington Avenue City/State/Zip:South Yarmouth, MA 02664 Phone #:508-398-0398 Are you an employer?Check the appropriate box: Type of project(required): 1.0 t am a employer with_20 _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. Ei Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.0 i am a homeowner doing all work myself.[No workers'comp.insurance required.] 10 Building addition 4.0 lam 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 I 1.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.E3 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. I 1E:Roof repairs These sub-contractors have employees and have workers comp.insurance.; 14.00tber Insulation 6.0 We are a corporation and its officers have exercised their right of exemption per MG1_c. 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. 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. /am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Employers Mutual Casualty Company Insurance Company Name: Policy if or Self-ins. Lie.#: 5D77852 Expiration Date:10/16/2023 Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under N46Le?f51,'§25A is a criminal violation punishable by a tine up to S1,500.00 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 certift under th pains and penalties of perjury that the information provided above is true and correct. Signature: \ / Date: 3/28/2023 Phone#:598-398-0398 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): I.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Ac o® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDrtYYY) �- 3/27/2023 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 RogersGray, Inc.-Kingston Branch PH PHONE 63 Smith Lane (A/C.No.Ext1:508-746-3311 FAX ,No):877-816-2156 Kingston MA 02364 E-MAIL ADDRESS: mail@rogersgray.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Employers Mutual Casualty Co 21415 INSURED CAPESAV-01 INSURER B:Union Insurance Company of Pro 21423 Cape Save, Inc 7 D Huntington Ave INSURER C:Tokio Marine Specialty Insuran 23850 South Yarmouth MA 02664 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:729014574 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 LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DDY/YYYYY) (MM/DD/YYY XYY) LIMITS A X COMMERCIAL GENERAL LIABILITY 5D77852 10/16/2022 10/16/2023 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $500,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO- GENERAL AGGREGATE $2,000,000 JECT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY Y Y 5Z77852 10/16/2022 10/16/2023 COMBINED SINGLE LIMIT $1,000,000 X ANY AUTO (Ea accident) BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ X HIRED WNE AUTOS ONLY X AUTOS ON-O ONLDD PROPERTY DAMAGE (Per accident) $ $ A X UMBRELLA LIAB X OCCUR Y Y 5J7785222 10/16/2022 10/16/2023 EACH OCCURRENCE $2,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $2,000,000 DED X RETENTION$1 n,nn $ B WORKERS COMPENSATION Y 5H77852 10/16/2022 10/16/2023 X MUTE EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRI ETOR/PARTNER/EXECUTI VE OFFICER/MEMBEREXCLUDED? N N/A E.L.EACH ACCIDENT $500,000 (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE $500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 C Pollution Y Y PPK2527254 3/10/2023 3/10/2024 Per Incident 1,000,000 Aggregate 1,000,000 Deductible 5,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) When Required by Written Contract the following Applies: General Liability—Additional Insured Ongoing(CG 71743 10/13),Additional Insured Completed(CG 71743 10/13)Primary and Non-Contributory Basis(CG 7578 02/19),Waiver of Subrogation(CG 7578 02/19) Automobile—Additional Insured(CA 7450 11/17),Waiver of Subrogation(CA 7450 11/17) Excess/Umbrella Additional Insured follows form over underlying General Liability and Automobile Liability,Waiver of Subrogation(CU7460 12/15) Pollution-Additional Insured,Primary and Non-Contributory Basis&Waiver of Subrogation(PIC-EVCP-001 7/22) Workers Compensation-Waiver of Subrogation(WC 00 03/13 04/84) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Evidence of Insurance AU D REPRESENTATIVE jormiwi 7 ACORD 25(2016/03) The ACORD name and logo are registered ma s8of ACORD CORPORATION. All rights reserved. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washingtonreet-Suite 710 Boston Massachusetts 02118 Home Improvement Contractor Registration • _ ,Type: Corporation CAPE SAVE INC. Registration: 171380 7-D HUNTINGTON AVENUE • EriFation: 03H312024 SOUTH YARMOUTH,MA 02664 � • ' Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs,&Business Regulation Registration valid for individual use only before the HOME IMPROVEM CONTRACTOR expiration date. If found return to: TYPE:e'oFporation Office of Consume►Affairs and Business Regulation Recarattig a": Exphati°^ 1000 Washington Street•Suite 710 111$B0 ",93t1312024 Boston,MA 02118 CAPE SAVE INC. WILLIAM MCCLUSKEY':' 7-D HUNTINGTON AVENUE`"��: "� SOUTH YARMOUTH,MA 02864 Undersecretary Not valid with ' i ure � ZdS -:':7$ " . Dciozmion " s �� fi �Ord of Building R Construct 76. ,..- 72T: ' 4 '1,44:7-'' if';':,1:'• L ite!: `?7•;;;.,•::!,61:1"44211;.:(11)1:''213:2::,'\.! -. imoa-0,, .,L',(9, .1,-:!;., ,4,-,,, ,,,tioitei,:)„,-,, ,--,,,,,, 4.i,-,i,iwk wiLLIANI- - - ,..:.-, [,-;, --:.,.:- iini. ,,„„.f.7... 0,0,,,!„4. ?.„ t:-.}..t WEST V / A fi,. ,..i,,,, ,, -,.-,..4'.7.".: A,,-- ,:::.;., ,. , ...„. zit' t' 7 Commissioner, Permit Authorization mass .ve Form Site ID: 4790135 Customer: Sam Hammond I, Sam Hammond ,owner of the property located at: (Owner's Name,printed) 18 Arrowhead Dr 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 perform insulation and/or weatherization work on my property. Owner's Signature: C d Date: 2023-03-31 FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date Name: RISE Engineering Phone: 508-568-1926 Email: Page l of 1 Document Ref NXYP3 97L3K SCSID-2MKPJ i r r Office Use Only Page 1 of 2 i-i:3\'.,3 ,.,,.. i!liti:-;.;*"t7,-' ,,,,,, ,,4,4,, , +.. gl. I ; i I . . 1 # A , i 4 7 Signature Certificate Rcy'Q=orco m=raoe, NXYP3-97L3K-SGSID-ZMKPJ 5 • 3 4 ' 1 44, . ,.. ,p 4 Signer Timestamp Signature 'Atti $ .* 4, 44t: I ..i. ,,.. 1 1 ' Sam Hammond e , Email:shammond151@gmail.com ‘+ 3/,..k I Sent: 31 Mar 2023 00:54:31 UTC ''k.catt(liatataotio, , , . . , ... i Viewed: 31 Mar 2023 082217 UTC -t. ...4 s '4'4104: I Signed: 31 Mar 2023 08:27:22 UTC , ' , • • :,4 Recipient Verification: IP address:96.81.76.137 ' • , ' 1 I rEmail verified 31 Mar 2023 08:22:17 UTC Location:Hyannis,United States , 1 ' ..: i ..- oc.4‘ 4444,, i ', ';,• i cv 4: DOCJI1 44{1•.•-onok;ted by al po,tie.,==.••:- ,"trif'$;,'4" 31 Mar 2023 08:27:22 UTC +Ad, #44• , i % . ‘, 4 • I Page 1 of 1 ko, , 4,4 , A I Vo.‘>q I :4,4k 4 qk 4 1 I V I X A 1 ''..4./A 1 I t : 1 1.. . . .:!.,/ ' •i-:,' 4: ' 4 •: 3404,s, 1 i 4 tt, i ,• V . Ai; 1 4 V 1 Iill 44+'•;" 1 V +g ,.. . •••V •.,.2,„ st , A , 4 4 , ›;" I ,4+410i ' It: ! A 4 4 • Signed with PandaDoc 4 4 4. .. ,.- ,,,,t . • El• ' CI — i ',, - ' . „, . . . . PandaDoc is a document workflow and certified eSignature .17:I. ,:.•*.k. •*.: '4,'Po.!, 1 =•=, ', ,‘ ,, solution trusted by 40,000+companies worldwide. I i 0 <3 43 .,\,, i -..•;' . :-:-.5,:, .„' El ' .4„, : 1 ••••—•, - . 1 # 1 I -,e,,' ,,A,,, ,. „*„..'A.,,... — .....4.....04*„..,*.......44,...0.,..!........-.....„.:,...„ „•44,...4.......... .. .. f,',„ ::„....No‘tt,"...;4:%.: :...,-:4-. ''. >''''',:„:4,;.'''., l'",„:::. ^-,. ... .",,,,..4. 4 MASTER DISCLOSURE & RISE PREPARATIONS ENGINEERING' REQUIREMENTS RISE Engineering 765 Attucks Lane, Hyannis,MA,02601 Customer Name:Sam Hammond Email:Shamrnond151@gmail.corn Phone:774-722-3861 Premise Address:18 Arrowhead Dr,Yarmouth,MA 02675 Project ID:4790135 At your Home Energy Assessment your Energy Specialist has reviewed and identified applicable cost-effective opportunities,potential health and safety concerns as well as any customer required actions to facilitate improvements in your home. The following conditions were noted at the time of the Home Energy Assessment: CUSTOMER PREPARATION REQUIREMENTS E Storage Removal ❑Flooring Removal ❑CO Detector Other ❑ El Platform Buildup Customers are responsible to complete any noted required actions in order to be eligible for program weatherization work at their home.The participating Contractor will be confirming the completion of these required actions prior to scheduling an installation date. Hosneowneris rostionsilfilio71,tfteremovalof n items,steeredr�r 4 a edzatio=measure Il workork trs%will need the „ " e e The ,ce/wil r ~ :e feared Safely l rtni their t to aril aiatert s rninAh t irl: �tf a trr ve ty -; specific urns,pleease'bri them tt theattention attat-16,40,your subcontractor"when t V.7T. Initial here This notice does not constitute an endorsement or warranty regarding the presence or absence of other real or potential health and safety hazards that may exist at this address or premises. If you have questions regarding this information,or to schedule a follow-up inspection after the noted conditions have been corrected, please call our Customer Service at 508-568-1926. Customer Signature: Satu ifacutuotcd Date: 03-31-2023 Energy specialist: Robert Brancato Phone:508-568-1926 Email: Page 1 of 1 Document Ref NXYP3-9713K.5GSID-ZMKPJ Page 2 of 2