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HomeMy WebLinkAboutBLD-23-006021 pF'Y�9ur� Office Use Only O ..` AL ,r Permit# {� r :'' 4. Amount J Permit expires 180 days from issue date RECEIVED 1.-D-02.5 -6O6162 E► PRESS BUILDING PERMIT APPLICATION MAY 01 2023 TOWN OF YARMOUTH Yarmouth Building Department BUILDING DEPARTMENT 1146 Route 28 1. eY South Yarmouth, MA 02664 (508)398-2231 Ext. 1261 CONSTRUCTION ADDRESS: 32 Bettys Path ASSESSOR'S INFORMATION: IMap: I Parcel: I OWNER: Richard Arseneaux 32 Betty Path 781-831-1234 NAME PRESENT ADDRESS TEL. CONTRACTOR: Michael T McMahon 2 Fuller Street 781-831-1234 NAME MAILING ADDRESS TEL.# OResidential OCommercial Est.Cost of Construction$ 3500.00 Home Improvement Contractor Lie.# 161816 Construction Supervisor Lic.# CS-068111 Workman's Compensation Insurance: (check one) O I am the homeowner 0 I am the sole proprietor X I have Worker's Compensation Insurance Insurance Company Name: Aim Mutual Insurance Worker'sComp.Policy# VWC-100-6014109 WORK TO BE PERFORMED Tent ,❑ Duration (Fire Retardant Certificate attached?) Wood Stove ❑ Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: El #of Squares (❑)Remove existing*(max.2 layers) Insulation I El Old Kings Highway/Historic Dist. CT Replacing like for like Pool fencing_El `The debris will be disposed of at: Waste Stream Recycling 16 Copicut Road Assonet Location of Facility I declare under penalties of perjury that the herein contained are true and correct to the best of k-now will be just cause for denial or revocation o' • 1 :{ my ledge and belief. I understand that any false answer(s) Applicant's Signature: ar� - and for prosecution ands M.G.L.Ch.268,Section I. Date: 4/5/2023 Owners Signature(or attachment) SE Tik H E D Date: Approved By: Date: 5—'/—2- Building Official(or designee EMAIL ADDRESS: Zoning District: Historical District: r Yes ' No Flood Plain Zone: Yes C No Water Resource Protection District: Within 100 II.of Wetlands: U Yes U No L. Yes No aY Customer Name:Richard Arseneaux CONTRACT Email:rsarseneaux@comcast.net Phone:508-394-4004 Premise Address:32 Bettys Path,Yarmouth,MA 02673 IE Mailing Address:32 Bettys Path,Yarmouth,MA 02673 Project ID:4814965 Date:April 18,2023 ENGINEERING' Efficency RISE Engineering 765 Attucks Lane, Hyannis,MA,02601 Applicable Customer Required Actions: Notes: • Storage Removal Homeowner is responsible for the removal of any items stored in the areas where weatherization measures will be installed.The workers will need the space cleared to safely bring their tools and materials into these work areas. If you have any questions or specific concerns, please bring them to the attention of your subcontractor when they call. .Inh Ila¢rriptinn imp .m ; e. Location AIR SEALING 2 hr $188.66 $0.00 ATTIC HATCH: INSULATE ONLY 2 each $70.00 $17.50 WEATHERSTRIP ATTIC HATCH 2 each $50.00 $0.00 BASEMENT SILLS: R19 FG BATT 11 SF $26.07 $6.52 KNEEWALL:2"RIGID BOARD 118 SF $512.12 $128.03 WALLS:WOOD-SIDED 4"CELLULOSE 900 SF $2,079.00 $519.75 TRANSITION FLRD 36 LF $492.48 $0.00 Total: $3,418.33 Program Incentive: -$2,746.53 Customer Total: $671.80 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Six Hundred And Seventy-One And 80/100 Dollars $671.80 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 ARE ANY BLANK SPACES RISE Representative Customer Signature 2023-04-22 Sign Date Page 1 of 2 Document Ref:QMT2P-ZEBY5-FBACC-PDXWU Page 1 of 3 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 2 of 2 DoornentRell-QMT2R•ZEBY5-MACCP'OXINU; Page of 3 Permit Authorization mass saw Form . . . Site ID: 4790741 Customer: Richard Arseneaux I, Richard t Arseneaux ,owner of the property located at: (Owner's Name,printed) 32 Bettys Path 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 obtain a building permit to perform insulation and/or weatherization work on my property. Owner's Signature: Rthhan,(4IPMeatfir Date: 2023-04-22 FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: M.T.McMahon and Son,Inc. 2 FLINN'St Carver,MA 02330 Participating Contractor Date Name: RISE Engineering Phone: 508-568-1926 Email: Page 1 of 1 For Office Use Only � tys }r,. fi ;»� .:1: •P i ♦t i!;;;; ♦ ♦;;:'i't i i ♦P a, ii' ir•i• ♦ •;s i"i•s ii iii ills it. ;•Oviis♦;Oi•;♦P ♦ i r4 iii .'•�. i..#0, ,a N+"�+.!�tr.+ :!i��+��+t.*��i!4,,t4,!+.!..! :y::t��::t4.�J:•►s+:;��i4�i�44.-t i��bt.,„t--t.1.P40.?•ti,,t��!?��iyi a t:�:t���,,���i±��! �4.444•,:,�.P��titvi • ee ,P. + Signature Certificate .:. •♦.• AOO, .•..., Reference number:QMT2P-ZEBY5-FBACC-PDXWU 1+++*, P144 ••••• Signer Timestamp Signature •:•:, � �__ _.� _�__ -___ __ .__ •P.•*� Richard Arseneaux %4 Email:rsarseneaux@comcast.net ,...o. a♦+�; Sent: 19 Apr 2023 12:41:28 UTC �j► �y� eta *•', i•e'. Viewed: 20 Apr 2023 12:26:20 UTC `"•"�♦Q•`�► mil• : +�+�' +r�. •Signed: 22 Apr 2023 13:10:51 UTC •Ji, +*` Recipient Verification: +.'+' .���., IP address:66.31.196.135 ;:4*4; •+•P••, ✓Email verified 20 Apr 2023 12:26:20 UTC Location:South Yarmouth,United States •; 404 +:+;•: Document completed by all parties on. •A* ;•*•; 22 Apr 2023 13:10:51 UTC •+++, • • .o. lOs, 'P••' Page 1 of 1 .44'.+++. 0 4,444. y'+P�� ... ,•�+ s•i' 1441. 411.4 'e a +iP°°+r 404+ '.4,, •e.r »e:4 +•a +�+� ,.4..` :'00, Signed with PandaDoc `.°i'. :. PandaDoc is a document workflow and certified eSignature = ' ., P•':, +;+;; solution trusted by 40,000+companies worldwide. �' . ''- !+♦•' Via♦• ••• +♦it�s i 4 i�ti i+i�i�i�i.tt.;.;t1.,tti'+ititititi iti tti'i it+'+t•itititi�Pi Oiti•4i;'i i..i;i4i*-iti;i is;;;;i.-s�i�:;i•:44;*;i'i♦4 i i i i.i i':'i'• •v-•• '•+V+"' +��4!. :?:♦.a♦ ♦.�«O:: :4t 1.♦��•_,.w �a a....�•�.s;. ♦;it.4 .QP.:t:..tet:•.•t+!+!4:14-t �t!,!P�.t:•Pe ttee%t!i!o!i!%e.'+..,+i,:!...4, •iii.♦..'i•i'e'iSDo•♦.i400♦ i:♦•sii••i'ys' •'!. ;':1•...� .'•:i:�.';:AO'.'l.1:::••;':1:..:';".'�1::::i'.Y':;:i'i:s:sr':.;;;:•. *.4Plo•♦ --•'0.4.1~ +•;•-•-.:oJA�♦••'•-•. �'►i::o:-o-♦:000io•-•-•♦♦•o♦•o•1♦•.•♦♦0•.♦+.•♦♦-•♦se+•♦•♦»♦•4-�100♦+♦+♦♦o0»♦0»00♦♦1♦+�♦�♦�♦+♦oi .•�•• .+ee, 4 °+++� +•e;: Signature Certificate e•• '...4 Reference number.QMT2P-ZEBY5-FBACC-PDXWU "+' ii: Signer Timestamp �+�.;. Signature '04 .+++; '4,4' '!•+, Robert Brancato _._ ;+v; ••• %4, Email:rbrancato@riseengineering.com +.e .+e4• Sent: 19 Apr 2023 12:41:28 UTC •••. +so; Signed: ++. ,•••. 9 19 Apr 2023 12:41:28 UTC .+i'•' ••„ IP address:66.31.214.93 ;.���•; 4044, Location:Hyannis,United States .••s••' •••... Richard Arseneaux ,..' !••••, Email:rsarseneaux@comcast.net ,y+�•:••o. Rtcltar ( t�uea 4, Sent: 19 Apr 2023 12:41:28 UTC ` /�y •i•i' ••• Viewed: Nq .:. +,, 20 Apr 2023 12:26:20 UTC N'7 ;°;+; ;•++;, Signed: 22 Apr 2023 13:10:51 UTC �'O: �++off to++'. ,••, Recipient Verification: °+` IP address:66.31 196.135 ••0: 4:`•:; ✓Email verified 20 Apr 2023 12:26:20 UTC Location:South Yarmouth,United States :°; •♦•o. ••o, • !s°e•; Document completed by all parties on: �•�e; *;•,. 22 Apr 2023 13:10:51 UTC ;.;+; VA' Page 1 of 1 .+•+•. J+°. .•••. ++1! ,+e. Viri !A' :++•• •+oos +a+••+.' ,+e. ,e• '4.4' ,::::::::::::,,,,, :4:+6. 4 4. ••, •o+ .••• ,••+••, Signed with PandaDoc °o+. ,•••, .++ .••• PandaDoc is a document workflow and certified eSignature �' �� '•,,,�`•`°` .•• '+•," solution trusted by 40,000+companies worldwide. I I . .•e•;' .e • • .♦♦.•1.�..•♦ii r♦�i�»».i s i i1.1♦;;♦»••: .wi♦♦ii4♦.♦._ -..a♦♦ !•.•f♦!4-i i 4:+i i.t♦i i ii•..r ii+•♦ +•i♦iii!6»0»... .-.. -- ,...__._ _.._ _. _ +••♦♦♦+.♦i•ii;i•i;i♦ii;i ioi••o.i;i•♦ce+♦+i••;i ins.'+♦,.•4 The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations NMI- Lafayette City Center 2Avenue 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): MT McMahon and Son, Inc. Address:2 Fuller St. City/State/Zip:Carver, MA 02330 Phone#:781-831-1234 Are you an employer? Check the appropriate box: 1.ElI am a employer with 15 4. ❑ I am a general contractor and I Type of project(required): 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. D Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.t 9 ❑Building addition required.] 5. 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.D 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 employees. [No workers 13.0 Other Weatherization comp. insurance required.] *My 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: AIM Mutual Insurance Policy#or Self-ins. Lic. #:VWC-100-601410972013A Expiration Date: 12/8/2023 Job Site Address: 32 Bettys Path City/State/Zip: 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 urance coverage verification. I do hereby certify unde • / ns and penalties of perjury that the information provided above is true and correct. Signature: Date: 4/27/2023 Phone#: 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): 1 Board of Health 20 Building Department 3.DCity/Town Clerk 4.D Electrical Inspector 5 lumbing Inspector 6.0Other Contact Person: Phone#: A,ccoRvar CERTIFICATE OF LIABILITY INSURANCE DATEGIMIDD/YYyy) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDERR,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 REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder an ADDITIONAL INSURED,the.policy(lee) INSURER(S),AUTHORIZED If SUBROGATION IS WAIVED,subject to the terms and conditions of th policy, must have es m y requi INSURED endorsemente or ae,endorsed. o this certificate does not confer rights to the certificate holder in lieu of such endarsement(t(s) may an A statement on PRODUCER Thompson Insurance NAME: and Financial Services PHONE . 781-335-18 E„ty 389 Union Street IArc star 781-335 9782 Weymouth,MA 02190.316 A o itlaffnfins-com INSURERS)AFFORDING COVERAGE KAMA INSURED INSURERA: Commerce Mapfre MT McMahon and Son Inc. INSURER e: AIM Mutual 2 Fuller St. INSURER C: NautilUS Carver,MA 02330 INSURER D Evanston INSURER E: COVERAGES CERTIFICATE NUMBER: INSURER F: RTHIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVEE FORTHE 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, LTR TYPE OF INSURANCE S )MID POLICY NUMBER MUM mins x COMMERCIAL GENERAL UABILITY ______ICLAIMS MADE n OCCUR EACH OCCURRENCE $ '4000 000 PREMISESt EarrUamar $ 50,000 A Y 8008030009088 MED EXP(My one person) $ 5,000- GEN'L AGGREGATE LIMIT APPLIES PER: 09/15/22 09/16/23 PERSONAL&ADV INJURY $ 1,000„000 X POLICY n PECT I ,Loc GENERAL AGGREGATE $ 2,000,000 OTHER: PRODUCTS-COMP/OP AGG $ 2,000,000 AUTOMOBILE LIABILITY 1 ANY AUTO COMBINED SINGLE LIMIT $_ BODILY accident) 1,000,000 A AUTOS ONLY SCHEDULEDT Y BHJZQP BODILY INJURY(Per person) .$ HIRED 08/31/22 08/31/23 BODILY INJURY(Per accident) $ x AUTOS ONLY x AUTOS ONLY PROPERTY AGE $ X UMBRELLA LIAR X OCCUR (Per accident) C EXCESS UAB CLAIMS MADE Y AN078737 ,EACH OCCURRENCE $ 2,000,000 12/19/22 12/19/23 AGGREGATE $ 2,Hf ,©00 DED I I RETENTION$ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY $ ANY PROPRIETOR/PARTNER/EXECUTIVE YI N XI PSTEARTUTE I I EpH- B OFFICER/MEMBEREXCLUDED? n NIA VWC-100.6014109-2013A 12/08/22 12J08/23 If yes, describecr in NH) E.L.EACH ACCIDENT $ 500,QOt- DESCRIPTION OF OPERATIONS below E.L.DISEASE-EA EMPLOYEE$ 500,000 EL.DISEASE-POLICY LIMIT 0 500,000 D Contractors Pollution Liability Condition Limit CPLMOL104901 12/14/22 12/14/23 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 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 PROS AUTHORIZED REPRESENTATIVE • 988- ACORD CORPORATION, AS rights reserved. ACORD 25(2016/03) The ACORD name and lo go are registered marks of ACORD • THE COMMONWEALTH OF MASSACHi1SETTS Office of Consumer - &Business Regulation HOME a'P 4« CTpR commonwealth of alasseclunetts Division of Professional Licensors L .e s.,,, i Board of CouMay and Standards 4 toIsar t 4 �g Jf s MICHAEL T.MC NIA _r, cS-068111 eras:oaryaxlf"z 81 11� tit 2izY FUiJ.E:R78 £ MICHAEL T.MCMA • - ,, . s� 2 FULLER ST - ,0/ 4iC1 CARVER,MA 02330 P41 Undersecretary Commissioner arta ve„,ihz ..ti uruatridad-Buildings Many use group vddch oases► less than 31,000 cubic feet 4947 cubic meters)of arrdoead Nam Registration valid for individual use only before the expiration date. If fotmd return to: Office of Consumer Affairs and Business Regulation 1000 Washington Street -Suits 710 Boston,MA 02118 Failure to possessscurrent edMast oftheMassachusetts slateBu ngcodeisNUNtofrevoadsnFor Inhumation stisidlids ofthistioeure --�/ t yr + O Cell Pi Not valid without signature 3 al Cl, N C W N N O. O Ul cn 0 .-..`:5 mz 3 n W Q-CD Lo 0 N CD cn CD ro Z ea '� i) �� =ccnsv ��oZ I-, JCD _ �.� am •• o a 3 CD �' 5 :0 a) r c 4 a CD d m CD P. A ot y CD n pD01 D .0 ID O iWp W (D ' V 0 ..< Q p (D Ov N o v coo CD 0cn Cl, c I I CD Oo CO o D°�W n 3 0 _,c.(n a Cn CDN5.0 - CD OCp OD CD CD r s N = CD co ono Z oCD 7 0— Z eacoi o -0m CD I D Cl)co C � ' n�mpr v m � ax ili i� m _v a) v c p N o CD 0 0 (n o �� Cl, CD Cl) • cy,coCD 0 w N 0 N�Nt0n W N N 0 c 0 cn c CD y. 0 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: Waste Stream Recycling Name of Waste Facility 16 Copicut Rd,Assonet,MA 02702 Address of Waste Facility 111.5 Debris: As a condition of issuing a permit for the demolition, renovation, rehabilitation or other alteration of a but#ing or structure.1N.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 Signature of Permit Applicant 4/27/2023 Date