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''r F: = Via,: ". ., . m •. ,.M. W _ .. . +•�, 'a 'tie^ ..^.,,„-,„-; °""X' ,. • 'y .. ,. ... „ .n • ${9 g' S'd r,"sh• .. f�' • g" t • � kf SECTION 10h OWNER/AUTHORt ED AGENT DECLARATION 1 Owner/Authorized Agent hereby declare that the taternents and information on the forgoing application are true and acurate,to the best of my knowledge and belief. Signed under thepains andpenury.g penalties of print Name arum ot gent Data Section 11 -ESTIMATED CONSTRUCTION COSTS torn Estimated Cost Polars)le be 0Drnpletedby pecan Ott Butkiing C1b,c a teectareew mvsoi s,dire Protection BaotBaat1+24,.5+E+5i 7.'rout irefitf+x graumgm cooler Check Below } Conservation-Cornrriission Filing applicable) Cl Old Icings Highway&Historical Commission approval (it applicable) 6 ' . The Commonwealth of illassachasetts n in c 1 .' .Department of Inditstrial Accidents U I Congress Street,Suite 100 Boston,MA 02114-2017 www.moss.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/ElectriciansfPlumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Please Printibly Applicant Information Name(BusinessiOrgartizatiorvindwiduan: e rne-r 8 0 I Address: 2 ) gIA: City/State/Zip: 61. 4.47...,it_ . Pone#: Are you an employer?Check the appropriate host ' ,,,.. - , Type of project(required): 1 B1 11:a employer with 15 employees(rut 4/or Pan-time)* 7. 0 New const-uction 2 0 I am a sale proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity (No workers'camp insurance required.) 9. 0 Demolition 3 0 I am a homeowner doing all work myself[No 4Mb:re comp.Insurance required j t 4 0 1 eari a horneawrier and volt be hiring contactors to conduct all work on my property. I will 10 0 Building addition 11.0 Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or am sole peoprietixs with no employees, 12.Ej Plumbing repairs or additions 5.0 I em a general contractor and I have hired the sub-contractors listed on the attached sheet 13.E3 Roof repairs These subtontractor have employees and have workers'comp.irisurenee.: 1 e ki ..•6 El We are a corporation and its officers have exercised their right of exemption per hitGL e. 14. Other r p r 152,§1(4),and we have no employees.[No workers'comp.insurance required.) CAers,"14 ill_ Any applicant that checks box#1 must also 511 out the section below showing their workers'ectopensetion policy information. *Homeowners who submit this affidavit indicating they are doing ail 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: A.:17.,40( Policy#or Self-ins.Lk.* Lou e,C-500•.5-4.3 D..1 c)1.4-2ogiA Expiration Date: ie,7/41/0....)...... Job Site Address: j ie./0 .,.4141,4,1 e, el c. City/State/Zip: S.)41i 0 ,64,4 ..41:t Attache copy of the workers compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 15;§25A is.atriminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cern),under the poi and p Signature: f perjury that the information provided above is true and correct. ..,.......,,etor - Date: -- '' ,....... Phone#: „... , . .. . Official 14,e only. Do not write In this area,to be completed by city or town offidaL City or Town: Permit/License# Issuing Authority(circle one): _ I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6,Other Contact Portnnt Phone 4: ,. . . . .. . ...., . 0 §TOWN OF YARMOUTH 1146 Route 28, South Yarmouth, MA 02664 44 50 -398- '2231 ext."1261' x 508-398-0836 Office of the Building Commissioner ,A BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Ai 44 Pursuant to M.G.L.C .40, §54 and 780 CMR-Section 105.3.1.#4. I hereby certify that the debris resulting from the proposed work/demolition to be li conducted at /0( ,r -+„..'A. f.e' Work Address Is to be disposed of oat the following locatio : A 11 G2 t h.-el,,' t Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch.. 111,§150A. t Signs e of Application Date Permit No. [ . j. A ., „�„ , , , Ala,,,,corn DATE IMMMtDoNYyrI ,,,,,, i +aTE OF .� �tla'!.UJ�4 .r� 12/10/21 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 pollcy(lesy must have ADDITIONAL INSURED provisions or be endorsed. ,t If SUBROGATION IS WAIVED,subject to the terms arid 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 endorrsement(s). PRODUCER..... G4H7ALT NAME: Williams and Alley Insurance Agency,Inc. PI NE 781-665.7000 I lA ,NOI: 78 1 482 7001 837 Mains Street ADoREss' Insurance swilliamsandaltey.com PO Box 760967 I Melrose,MA 02176 INSURERS}AFFORDING COVERAGE SAW 0 INSURER A; ATLANTIC CASUALTY INS INSURED M INSURER B COMMERCE INS BERNARDO CONSTRUCTION LLC mimes: FAIRWAY 28 PARISH ROAD INSURER 0; P.O.BOX 271 GEORGETOWN,MA 01833 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 ADIXT3U13N POLICY EFF POLICY EXP I. LIMITS LIR TYPE OF INSURANCE ytso wva. 'POLICY NUMBER (MMJDOfYYYY)IM!MDINYYYYI X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE s 1,000,040 DAMAGE IO RT:.NI U CLAIMS-MADE` ©OCCUR ,PREMISES 1E0 I # 100,000 M€p_EXP{Any ails perMnnl ! 5,000 — A t281004432-1 . I Q/27/21 10/27122 PERIONAL a ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES(('""'''�� PER GENERAL AGGREGATE $ 2,000,000 POLICY Ej JEECT Ej LOC PRODUCTS-COMP,/OP AGO. $ 2,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLEtt 'I - ANY AUTO BODILY INJURY(Per person) $ 250,000 B —OWNED '—' SCHEDULED RST030 12/22/20 12/22/21 BODILY INJURY(Pm de,tI sc t 600,000 AUTOS ONLY AUTOS PROPERTY DAMAGE HIRED NON-OWNED PR } f ,_,AUTOS ONLY AUTOS ONLY S •..... UMBRELLA LI AO OCCUR EACH OCCURRENCE $ EXCESSLIAB ,___.CLAIMS-WOE AGGREGATE # DED I RETENTION s {y $ WORKERS COMPENSATION STATUTE IERH- AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNER,EJIECUT1VE • E L EACH AcciceNT S 500, C 000 OFFICERrMEMBEREXCLUDED1 ©NIA WCC-600-6021086-2021A 10/09/21 10/09/22 (Mandatory In NH) E L DISEASE-EA EMPLOYEE s 500,000. nyaM Semite axe E L DISEASE-POt ICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS Dalc+v _ DESCRIPTION OF OPERATIONS t LOCATIONS!VEHICLES(ACORD 101,Additions!RMatr.Hts$afiaduta,May tea Mtech*d If more*Ns*to rDquIt*d) CERTIFICATE HOLDER i CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN WESTON ASSOCIATES ACCORDANCE WITH THE POLICY PROVISIONS. 170 NEWBURY STREET BOSTON,MA 02116 AUTHORIZED REPRESENTATIVE S4041,ahl W. 1 01888.2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORO SEACOAST STRUCTURAL ENGINEERS LLC PAUL F. KIRBY,PE Ro.1.1 xelk.r.\Ho August 9,2021 John Matlack Weston Associates. Inc. 170 Newbury Street Boston,MA. 02116 Re: 2"Floor Ceiling and Attic Review Swan Pond Village Jr 1100 Alewife Circle South Yarmouth, MA Project No. 013-21 Dear Mr.Matlack: Wearepleaedtoprovideourre:iewof the second-floor ceiling finish attachment to the atticandro:fstructureofheswnpondyillagetodetermine ifthe2ndfloorceingrnsh damage is present and repairs are required.This review concerns Building Blocks 9 through 13 ceilings over a second-floor bedrooms. To assist in our review our office was provided a complete set of record construction drawings which included structural framing plans of all the buildings in the complex. The buildings consist of multi-unit wood framed 2 story townhouse style units and 2 story quad units(2-2nd floor units over 2-1st floor units. The area of concern is the roof framing over the second-floor bedrooms. The photos below depict a gypsum ceiling (gwb) that has deflected and separated from the roof framing in a few of the units with the fasteners pulled through the gypsum finish. The attic appears to have been insulated with a cellulose fiber insulation. The photos do not indicate structural failure of the roof framing. Review of the available drawings indicate that the structure is a 2-story wood framed multi- unit building with a wood truss roof. The roof trusses are standard pitched roof gable style roof forming the roof profile and attic/ceiling structure over the bedrooms. The trusses are spaced at 2'-0"on center and the gypsum ceiling finish is screwed or nailed directly to the bottom chord of the trusses.Based on our distussions the attic is considered an uninhabited space with no plywood on, the top of the truss bottom chords for storage of tenant belongings.Attic storage is not allowed in any of the buildings at this development. The International Building Code 2015(IBC2015)has been invoked by the Commonwealth of Massachusetts Building Code and has been consulted to evaluate the ceiling attachments for this unit. Chapter 25 Gypsum Board. Gypsum Panel Product and Plaster of IBC2015 was consulted to determine the minimum requirements for the ceiling attachment. While the IBC was not the code requirement at the original construction in 1976, it is applicable for repair of the building. The IBC2015 does not specifically state that wood strapping be i installed between the the installed strappinggypsum finish,however it is common construction practice to install to the bottom of the trusses prior to applying the gypsum finish.The strapping is meant to allow the truss deflection and let the finish to move somewhat independently with the strapping, distributing the deflections throughout the ceiling evenly. requires that the finish be attached to the framing at a maximum of 7"on center t The code nails or screws.The code does allow the '''72 gypsumenter using ng imumsheathing to be supported by framing at 24"on center however this is the code maximum. On July 30 through 31 2021 we visited the site to review the existing ceiling finish and attic areas of the second-floor units to look for,signs of ceiling sag and gwb detachment. The buildings and grouped in blocks referred-to as 9 -13 Block. Each block consists of'a few 1 multi-units buildings with 2 story townhouses and 1-story quad units(2-second floor over 2 first floor units). The interior of the selected units were reviewed and the attics accessed through the hallway scuttle. The attic of each unit was covered with 12"to 14"of blown- in cellulose insulation. The roof truss bottom chords were covered by the insulation. Selected trusses were inspected to determine the gwb finish was securely attached and in contact with the truss framing. Tight contact with the truss indicates the truss has not deflected excessively and the gwb is intact. The table below summarizes our findings for the inspected units with recommendations for repair if required. k;; 4 Unit No. Findings Recommendations -, Building 9 Block 901 No issues noted. gwb ceiling is tightly No repairs are required. secured to the truss framing. 902 No issues noted. ceilingis tightly No repairs q .. gwb g y are required. secured to the truss framing. 903 Quad No issues noted. gwb ceiling is tightly No repairs are required. secured to the truss framing. 905 Quad No issues noted. gwb ceiling is tightly No repairs are required. secured to the truss framing. 907 No issues noted. gwb ceiling is tightly No repairs are required. secured to the truss framing. 908 No issues noted. gwb ceiling is tightly ' No repairs are required. secured to the truss framing. 909 No issues noted. gwb ceiling is tightly No repairs are required. secured to the truss framing. 910 No issues noted. gwb ceiling is-tightly , No repairs are required. secured to the truss framing. 911 No issues noted. gwb ceiling is tightly No repairs are required. secured to the truss framing. 912 No issues noted. gwb ceiling is tightly No repairs are required. ' secured to the truss framing. 1 913 Quad No issues noted. gwb ceiling is tightly No repairs are required. secured to the truss framing. 915 Quad No issues noted, gwb ceiling is tightly No repairs are required. secured to the truss framing, 917 No issues noted. gwb ceiling is tightly No repairs are required. secured to the truss framing. 918 No issues noted. gwb ceiling is tightly No repairs are secured to the truss framing. required. 919.. No access to the unit. 920 No issues noted. gwb ceiling is tightly No repairs are required. secured to the truss framing. 921 N o issues noted, gwb ceiling is tightly No repairs are required. secured to the truss framing. 922 No issues noted. gwb ceiling is tightly No repairs are required. secured to the truss framing. 923 No access to unit. 924 No issues noted.gwb ceiling is tightly No repairs are required. secured to the truss framing, 925 Quad No issues noted.gwb ceiling is tightly No repairs are required. secured to the truss framing. 927 Quad No issues noted.gwb ceiling is tightly . No repairs are required. secured to the truss framing. 929 The ceiling is bowed in the back Removed bowedldetach gwb bedroom near the hallway wall. The finish section.Re-attach new screws attaching the gwb finish appear finish to match with#6 screws at to be partially pulled through. 6''on center 930 There were no issues regarding the Investigate roof leakage and gwb ceiling finish. It was noted that remove mildew from the surfaces of mold was forming on the ceiling near the gwb finishes. the exterior wall in the bedrooms.This seems to indicate roof leakage at the exterior soffits 931 No issues noted.secured to the truss f-amin is tightly No repairs are required. ceiling g 932 No issues noted.gwb ceiling is tightly No repairs are required. secured to the truss framing. • 4. `',./.4e441.4fr AW,,Au AO 4 A44444 .4,44 7, Jr,' 40440,0 ''*tOgo5.4#0g : Ak-f- .* f4''44' 64' 464444'P $400,400-I, "It 4x04,0,1' „e •41,,(.0 ofv#, fiese.gmott .-A1,1•44, 0,01013-40er tocaowst foit,40,0",,,,orNm On.e.„4", 4W01-00, OamW^ 4147f6C PAA' ,-40 ,bp er4t, *r **rose Awe iieMa6 e‹t1 opsv- 'Astww. W4-trn,04; /**410005,,e44 low", —,t4.-o4*msoroz°`Atrr Sp04,14, Maw T;r4votov 1 '146,10 Pteggt4ef 00,4VerWArVZ ItiollOtt=*19`WOO,. f4e." '.400,04e4Prw Ifaelle.11001t,VrtkoMulfe',Awe IkgrIKOP PeroVieixVc loak'tte" AW,',0-476 • 1.• ottWorP,toAr 4441**Aorre , , .tottx Ager e„,,Cap •',me Building 10 Block 1001 Quad No Issues not ,gwb ceiling is tightly No repairs are--reqaired secured to the truss framing, . 1003 Quad No issues noted gwb ceiling is tightly No repairs are required. secured to the truss framing. 1016 Quad No issues noted, gwb ceiling is tightly No repairs are required_ secured to the truss framing, 1018 Quad No issues noted, gwb ceiling is tightly No repairs are required. secured to the truss framing. 1024 Quad A bow it the gwb finish at the'alcove Removed bowed/detach gwb next to th living room at the center of finish section.Re-attach new the ceiling light finish to match with f/6 screws at 6"on center 1026 Quad No issues noted,gwb ceiling is tightly No repairs are required. secured to the truss framing. Building 11 Block 1102 Quad The gwb ceiling is bowed near the Removed bowed/detach gwb front hallway wall. The gap between finish section,Re-attach new the truss and the finish was estimated finish to match with 116 screws at to be approximately I Y2'. 6"on center 1104 Quad No issues noted,gwb ceiling is tightly No repairs are required, secured to the truss framing. 1112 Quad There was a bow in the ceiling at the Removed bowed/detach gwb wall of the front bedroom to hallway, finish section.Re-attach new There was a crack and bow in the finish to match with#6 screws at ceiling at the corner of the kitchen to 6"on center, living room.There was another bow in the middle of the ceiling ceiling. 1114 Quad No issues noted,gwb ceiling is tightly No repairs are required, secured to the truss framing. 1122 Quad No issues noted,gwb ceiling is tightly No repairs are required, secured to the truss framing. 1124 Quad No issues noted.gwb ceiling is tightly No repairs are required, secured to the truss framing. 'WNW von Building 12 Block 1201 No issues noted.gwb ceiling is tightly No repairs are required. secured to the truss framing. 1202 Quad No issues noted.gwb ceiling is tightly No repairs are required.' secured to the truss framing. 1204 Quad No issues noted.gwb ceiling is tightly No repairs are required. secured to the truss framing. 1206 No issues noted. gw•b ceiling is tightly No repairs are required. secured to the truss framing. 1207 No issues noted.gwb ceiling is tightly No repairs are required. secured to the truss framing. 1208 Quad No issues noted. gwb ceiling is tightly No repairs are required. secured to the truss framing. 1210 Quad No issues noted.gwb ceiling is tightly No repairs are required. secured to the truss framing. 1212 No issues noted.gwb ceiling is tightly No repairs are required. secured to the truss framing. 1213 No access-dog 1214 No issues noted.gwb ceiling is tightly No repairs are required. secured to the truss framing. 1215 Quad No issues noted.gwb ceiling is tightly No repairs are required. secured to the truss framing. 1217 Quad A crack in the gwb ceiling was noted at Rout crack and patch with gypsum the left party wall. s joint compound. 1219 No issues noted.gwb ceiling is tightly No repairs are required. secured to the truss framing. 1220 The ceiling was inspected from the No repairs are required interior of the unit and no issues were noted. The attic could not be access due to extreme clutter in the unit. 1221 Quad No issues noted. gwb ceiling is tightly No repairs are required. secured to the truss framing. 1223 Quad No issues noted. gwb ceiling is tightly No repairs are required. secured to the truss framing. 1225 The ceiling was inspected from the No repairs are required interior of the unit and no issues were noted. The attic could not be access due to extreme clutter in the unit.