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HomeMy WebLinkAboutBLD-23-005863 /YI � �- m l �/P y Office Use Only og' aR; /J/ "j"3 Permi# �t 30 y� O ' 4 -,.Amount 4 %Permit expires 180 days from • issue date &! -073•-M5g&_3 EXPRESS BUILDING PERMIT APPLICATION 10 TOWN OF YARMOUTH Yarmouth Building Department R C - 1146 Route 28 - - South Yarmouth, MA 02664 APR j2O2e2j E 3 (508) 398-2231 Ext. 1261 46 Almira Rd BUILDING DEPARTMENT CONSTRUCTION ADDRESS: By ASSESSOR'S INFORMATION: Map: 68 Parcel: 10061 OWNER: William MacKenzie 46 Almira Rd : 774-212-0905 NAME PRESENT ADDRESS TEL. # CONTRACTOR: Adam Glenn 238 Essex Street Whitman,MA 02382 781-205-4516 NAME MAILING ADDRESS TEL.# 0 Residential ❑Commercial Est.Cost of Construction$5,000'00 Home Improvement Contractor Lic.# 181138 Construction Supervisor Lic.#CSSL-1 106148 Workman's Compensation Insurance: (check one) G I am the homeowner n I am the sole proprietor a I have Worker's Compensation Insurance Insurance Company Name: Federated Mutual Insurance Company Worker's Comp,Policy# 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 Pi I 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. 1 understand that any false answer(s) will be just cause for denial ��orrevocation of my license and for prosecution under M.G.L.Ch.268,Section 1. Applicant's Signature: C-E'' �""r t " Date: 4/17/2023 Owners Signature(or attachment)Federat d ance Company Date: Approved By: Date: Building Official des' ee E ADDRESS: wxpenuitting@homeworksenergy.com Zoning District: Historical District: Li Yes No Flood Plain Zone: " Yes L. No Water Resource Protection District: Within 100 ft.of Wetlands: EL Yes J No Ui Yes 7 No The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Lafayette City Center 1` 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/lndividual): 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. ❑ 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. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance.: 9. ❑ Building addition comp. insurance 10.0Electrical repairs or additions required.] 5. ❑ We are a corporation and its 3.❑ I am a homeowner doing all work officers have exercised their 11.❑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 13. Other Weatherization 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. 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: 46 Almira Rd 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 und r the pains and p 's of perjury that the information provided above is true and correct, Signature: Date: 4/17/2023 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 3❑City/Town Clerk 4.0 Electrical Inspector 5Elumbing Inspector 6.0Other Contact Person: Phone#: E(MINDOPNW) '4u CERTIFICATE OF LIABIUTY INSURANCE �'12/30/2022 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 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 pollcOes) must have ADDITIONAL-INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the tams 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 MUM CUENT CONTACT CENTER HOME OFFICE P.O.BOX 328 wc.No.ESO:888-333-4949 NE FAX ND):507-446-4664 OWATONNA MN 55060 ADDRES S:CUENTCONTACTCENTERBFEDINS.COM INSIMER(S)AFFORDING COVERAGE NAIC# INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 419-899-0 INSURER B: HOMEWORKS ENERGY,INC. INSURER C: 101 STATION LNDG INSURER D MEDFORD,MA 02155-5134 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 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.UNITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INNOLSR BUBR SAM POLICY NUMBER dM Y EFF atiONDUCOTATy I LIMITS X COMMERCIAL GENERAL UABIUTY EACH OCCURRENCE�pq $1,000,000 lCLAIMS-MADE X OCCUR �S fie mncel $100,000 MED EXP(AD onN Pewee EXCLUDED A N N 1847909 01/01/2023 01/01/2024 PERSONAL BADVINJURY $1,000,000 ,AWL A00RgpNE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X I I POLICY 1.P1EttrLOC PRODUCTS-COMP/OP AGO $2,000,000 OTHER: AUTOMOBILE LIABILITY C OMBINiEDSSINGLE UNIT $1,000,000 X ANY AUTO BODILY INJURY(1'Y penal) — A OWNED AUTOS ONLY -,EDULED N N 1847908 01/01/2023 01/01/2024 BODILY INJURY IF.,ea3Md HIRED AUTOS ONLY NON-OWNED PROPERTY DAMAGE _AUTOS ONLY IFer accident X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $1,000,000 A EXCESS LIAB CLAIMS-MADE N N 1847911 01/01/2023 01/01/2024 AGGREGATE $1,000,000 DEO I !RETENTION WORKERS COMPENSATION X PER STATUTE 07H- ER AND EMPLOYERS'LABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $500,000 A OFFICER/MEMBER EXCLUDED? _NIA N 1847910 01/01/2023 01/01/2024 IMarwMlory In NH) E.L DISEASE-EA EMPLOYEE $500,000 IT yes,describe under E.L DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS below $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,AMSonel Remarks Schedule.may be Awned if were apse is regime) 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 DELIVERED IN A CERTIFICATE HAS BEEN FILED WITH EACH OF YOUR CERTIFICATE ACCORDANCE WITH THE POLICY PROVISIONS. HOLDERS. AUTHORIZED REPRESENTATIVE Ktov, 0 19E62015 ACORD CORPORATION.AR rights reserved ACORD 25(2018/03) The ACORD mane and logo a'.registered mats of ACORD Q Id 110 , . . . E Ca'PI IX ikktit‘ts- L1Jfa) O 2 1 = NN-- W�. - l, NON � E S. las +Aag a � x <C c - � N ,. mw - �� � A U) 'yam s #1 11111t1,1 w -a •i0 e c CmmY o i i d> CO "Ce GE . O, 4. 0 m m C m W = tD p O Zw xmg t c t. Z N s : { {� W Z O F 4 aX+"" } F ZW W�� Mc) 2 W zo E- O WO Qo0 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—6th Edition Cat b.1° Signature of Permit Applicant 4/17/2023 Date Page 1 of 2 1 fl) HomeWorks 101 Station Landing Ste 110, — j� mass saw MedforcL MA 02155 tnePARTNER (781)305-3319 Customer Name:William MacKenzie Email:Not provided Phone:774-212-0905 Premise Address:46 Almira Rd,Yarmouth,MA 02664 Mailing Address:46 Almira Rd,Yarmouth,MA 02664 Project ID:4786027 Date:March 20,2023 Job Description AIR SEALING Other 10 hr $943.30 $0.00 ATTIC FLAT-9"OPEN R-33 CELLULOSE Other 1204 SF $2,119.04 $529.77 ATTIC DAMMING- R-38 FIBERGLASS Other 54 SF $130.68 $32.67 6" - VENT BATH FAN TO ROOF OR ALTERNATIVE Other 2 each $313.50 $78.37 6" HOSE ONLY Other 2 each $67.20 $16.80 VENTILATION CHUTES Other 72 each $251.28 $62.82 Recessed Light Enclosure Other 5 each $250.00 $0.00 4"x 16"SOFFIT VENTS Other 13 each $401.05 $100.26 Project Total $4,476.05 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:lnboxtHomeWorksfnergy.com Page 2 of 2 r H •>ilf .? 10: Station Landing Stella, 117c�SS Medford,MA 02155 PARTNER (781)305-3319 Customer Name:William MacKenzie Email:Not provided Phone:774-212-0905 Premise Address:46 Almira Rd,Yarmouth,MA 02664 Mailing Address:46 Almira Rd,Yarmouth,MA 02664 Project ID:4786027 Date:March 20,2023 Weatherization incentive ($2,462.06) Air sealing incentive ($1,193.30) Total Program Incentive -$3,655.36 Customer Total $820.69 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. /(1 hia- kpv,L. 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:InboxxHomeWarksEnergy.com Insulation/Air Sealing Permit Authorization Specialist: Ryan Mgrdichian Company: HomeWorks Energy Email: ryan.mgrdichian@homeworksenergy.cc Address: 1o1 Station Landing Cell: 8603947804 Medford,Ma 02155 Phone: 781.305.3319 Customer: William MacKenzie Address: 46 Almira Rd Email: bcmak@comcast.net South Yarmouth, MA,02664 Site ID: 4766485 Phone: 7742120905 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: bcmak@comcast.net Customer 4/ Q Signature: Date: 3/20/2023 William MacKenzie For Condo Owners: If you have property oversight by a condo associationt, 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 companyt 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 t Other unit owners may sign when there is no association. kl,�" >c)t.) - 3 PLAN VIEW z Name: lal;111`c1,1 �Krie �'Coto � Site 10: °`l±lnished Sq. Ft: � `'l a Phone: (ri o�212-0 9OS' Year of House: 1' 1 '- Electric Acct#: �$'t� ��Z� Address: L-((t I+hi'rct Itot '�( #of Floors: Gas Acct#:dSLt ,�^z•-+l I`t"�Fx? i Cti 14rh4Jz19‘i Ma (n.. nit#: #occupants: 2_ ? E It .. '` p Housing Type, DUCTWORK INSPECTION Ducts Insulated?Cl t s uct Linear Ft. ,.--..-._.. s uct Square Ft. r -. ,C,.,, Duct Air Sealing Hours A 5 (Li(' r, z L tilt s uct insulation t 1 Duct Insulation Removal too 4' 7 w cj L C"toJtYt ZK BASEMENT INSPECrION %t - � I CIS`'..L.. ‘t (3Me Existing Spec ing Ln/Sq.Ft. C(C(LIM fr -I 4 'Bsmt Wall AG -.----..._f,u --i 1 ,- Crawl Ceiling tt , Crawl Rim Joist l BsmtRlwl Sill' �-l`3 �` #-Vt• # 1".14-it,lef- L Bsmt RJ NO Sill 4_.._. ,^,� - v,� Vapor Barrier -: t r Bsmt Doorli 1 Y/N Blower Door? WALLS&GARAGE Drill Location? Siding Cell.,Height Existing Spec'in Sq.Ft, Framing Exterior Wall 1 raao L Si^f _.. ------ V % - +y 1t $-(o ,# 2 x 4 A So Balloon/P orrr9 Exterior Wall 2 x x Balloon/Platform Overhang x x Garage Wall f £ 1?,` ., x x Balloon/Platform Garage Ceiling1 x x, w 0 LA'- ()pc. ;t l� -s t v�b (ct,,,i'vi5ittC{ vtn ,}.}Et x.x. 131'1 r v lsui it Retnava`$s Sq x W S pp T WORK SPEC'D BUT NOT CONTRACTED OAD BLOCKS PRESE ANDATORY) Attic Basement/Crawlspace Other: K&T Y I Moisture Y j ombustion Sfty Y Kneewall Overhang/Garage Asbestos Y N 'Mold>SOO sq.ft Y./ 0 Detector Missing Y Ductwork Exterior Walls r Vermiculite Y/ Structl Concerns Y I ther: Notes for Lead vendor/Work Not Contracted: KW WALL AND KW FLOOR Blind Spec? 0 - .— O R > KW SLOPE AND GABLE END Blind Spec? 0 . 1J[1 ry Why? '�` At5 1NXa FXISTItjC SPEC iNG SQ.Ft i 10 ./, ti FRAMIN EXISTING SPF�CING lItVVV (1 Id1 J ALL X X f t4 r SLOPE X X F ': LOOR x s s F ,! IN GABLE X X :, •CCESS X aL TRANS x X rh w ', or, BANS x X 4 # r A U:1. � ¢ r ,TTIC apl= - SLOPE '' 4 n sLOPE X X x x it 0.,,,,,,.;-,. .,n„rq i EXISTING VENTING? EXISTING VEN?1N . EXISTING PIPES? Y!N `*,.. .ems+`, ? iM Von Vpxt Of Of HOW Dam r Shta!tung At Tel,*keel Alaint OF Tema Access ,,�s"a£'9 F t s-P�4 5 'f �,r. ss �' c9�k .7' � �'+ ,41--7 ,1° ,�` ' r ..R i.. 7 m '.k"x, ,-. KNEVAIALi.MANDATORY e'T; OD : Allt. rayci Tt�fix.; 2 C'.1 CI. i i s' as, Etas$ y: ,Z8 Q 7 Z PI20P t c$' y Z,C 6 4 _ . _ pact s t:xG14 - 130K )c5 .. i.,.. ,,,t....._. ... ...1 i%....— 2-1. ---1 , hmulated Wag X X Reed Light 0 Ins.Hasa 1=1 Vent BF c'xim. !ramming L2"Rao!V t 22RV Air Handler® Tema Access 0 poll Dawn ES J Hatch Watt Hatch ^/ Doom/ B-kWVelt BAS Vol: X .0058 4-x(cpx( c ATTIC 1 Blind Spec? 0 x x ATTIC 2 Blind Spec? © XOA 1stow) a r) = Existing Spec'ing Sgft Existing Spec'ing Sgft ct2 "' .r Unfloored .1c U1tfYoo d Multipliers Floored — trusts toss:. ng ._�> Floored r €tri ' Mixed;nsulation , et Work >6"Loose 'ergtel Slope ' Cath Slope :Walls - Walls Air Sealing Hours Access I ��... ": Access 4 sr I 0 Venting Propavents Venlitia BF Hose Dammin; Venting' pavents • :F BF Hose Dammi i C M t •x ., q'..,z k t #' is II C 2z, _z a '=w lac" ,s ar + � + { + '� a tipt ; � _ � J"s � " b � � � t! � 4``- �,� '� la •§ t y y't,,w� y §� `-x ac ,-�b+ux.J�'n�� 4�`�� E. . ,- _. .___. i.Ft,3PI_ ...,a.._ ____16au.Nc4tMniSnF,) _�.___tNtt^dcd 'Sa.Ftr3i7J=. Gam- �' y'.�., #:WSW= ExistingVenting? UFAVentmg) - ,. {L'xitt.HFAYMdnq)* Wended g Existing Venting? H.A Vrn27ng) Roof Type, j ( I„ I J