Loading...
HomeMy WebLinkAboutBLD-23-006012 � i. 01'•Y,r 1'1 P 1 Office Use Only -7 x. t r?�iti 0 J/p2/0 1 Permit# 1! / 0�, { Amount 35.0 cs- "tom..,..R ,u Permit expires 180 days from issue date 6I D- 023-JO&d/2— EXPRESS BUILDING PERMIT APPLICAT ' c E I V TOWN OF YARMOUTH Yarmouth Building Department MAY 01 2023 1146 Route 28 South Yarmouth, MA 02664 BUILDING DEPP. ZTMENT (508) 398-2231 Ext. 1261 By CONSTRUCTION ADDRESS: 25 SQUIRREL RUN STREET ASSESSOR'S INFORMATION: Map: 123 Parcel: 75 OWNER: VINCENT PIZZO,25 SQUIRREL RUN STREET,YARMOUTH, MA.02675 802-440-2931 NAME PRESENT ADDRESS TEL. # CONTRACTOR: MATTHEW RUSSELL- 3820 DIAMOND HILL ROAD,CUMBERLAND,RI 02864. 401-651-0003 NAME MAILING ADDRESS TEL.# O Residential 0 Commercial Est.Cost of Construction$6,182.82 Home Improvement Contractor Lie.# 195309 (EXP..04/18/2025) Construction Supervisor Lic.# 106162(EXR 04/26/2025) Workman's Compensation Insurance: (check one) 0 I am the homeowner 0 I am the sole proprietor El I have Worker's Compensation Insurance Insurance Company Name: ARGONAUT INSURANCE CO Worker's Comp.Policy# WC928938765994 WORK TO BE PERFORMED Tent El Duration (Fire Retardant Certificate attached?) Wood Stove Li Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares (❑)Remove existing*(max.2 layers) Insulation P1 I I Old Kings Highway/Historic Dist. D Replacing like for like Pool fencing I *The debris will be disposed of at: SC ENERGY,330VICTOR ROAD,ATTLEBORO,MA.02703 Location of Facility I declare under penalties : .: that the statements herein contained are true and correct to the best of myknowledge and belief. I understand that any false answer(s) will be just cause for d- :1 1 ocatio i my license and for prosecution under M.G.L.Ch.268,Section 1. g I/, Applicant's Signature: Date: 4/26/23 PLEASE SEE ATTACHED OWNER AUTHOR! TION TRACT Owners Signature(or attachment) Date: Approved By: Date: v i---:.2 Building Official(or deli. EMAIL ADDRESS: ARYANN(c@5CENERGYINC.COM Zoning District: Historical District: Li Yes Li No Flood Plain Zone: C Yes r No Water Resource Protection District: Within 100 ft.of Wetlands: i�; Yes 1.1 No Li Yes No AC R® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) ‘....•-" 12/28/2022 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 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 Rosalynn Davila Loiselle Insurance Agency PHONE (401)723-8510 FAX (401)728-1820 279 Dexter Street INC.DRS Est): (Arc,No): ADDRESS: rosalynn(�loiselleinsurance.com P.O.Box 1148 INSURER(S)AFFORDING COVERAGE NAIC• Pawtucket RI 02862-1148 INSURERA: Employers Mutual Casualty Co 21415 INSURED EMC Prop&Cas Ins Co 25186 INSURER B: 5C ENERGY,INC. INSURER c: Argonaut Insurance Co ARGO 330 VICTOR RD-BUILDING A INSURER D: RISCO RISCO INSURER E: ATTLEBORO MA 02703-6294 INSURER F: COVERAGES CERTIFICATE NUMBER: Master:2022 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 ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSO WVD POLICY NUMBER (MM!DDJYYYY) (MM!DDJYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1'000'000 CLAIMS-MADE 1-1 OCCUR DAMAGE TO RENTED 500,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 10,000 A 5D98024 12/27/2022 12/27/2023 PERSONAL&ADV INJURY $ 1,000,000 GEM_AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2'000'000 POLICY n jE Q IT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ 20,000 B OWNED X SCHEDULED 5Z98024 12/27/2022 12/27/2023 BODILY INJURY(Per accident) $ 40,000 AUTOS ONLY X AUTOS HIRED v NON-OWNED PROPERTY DAMAGE X AUTOS ONLY AUTOS ONLY (Per accident) $ 5,000 Uninsured motorist BI $ 1,000,000 X UMBRELLA LIAB — OCCUR EACHOCCURRENCE $ 3,000,000 A EXCESS LIAB CLAIMS-MADE 5J98024 12/27/2022 12/27/2023 AGGREGATE $ 3,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION ‘/ PER OTH- AND EMPLOYERS'LIABILITY Y!N /". STATUTE ER C ANY PROPRIETOR/PARTNER/EXECUTIVE N/A WC928938765994 12/27/2022 12/27/2023 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? 1 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1'000'000 D Contractors Pollution Liability CPLMOL107038 06/16/2021 06/16/2023 Aggregate $250,000 Eeach Occurrence $500,000 DESCRIPTION OF OPERATIONS r LOCATIONS!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 PROVISIONS. AUTHORIZED REPRESENTATIVE 411-4' ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents 77:41:,ye,]= 1 Congress Street, Suite 100 •=�4 ,=:31tira7 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):5C Energy, Inc Address:330 Victor Rd. Bldg A City/State/Zip:Attleboro, MA 02703 Phone#: 774-203-3704 Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with 25 employees(full and/or part-time).* 7. ❑New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 3.0I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 10 El Building addition 4.0 I am 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 11. Electrical repairs or additions proprietors with no employees. 12.['Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.� p Roof repairs These sub-contractors have employees and have workers'comp.insurance? 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.['Other Insulation 152,§1(4),and we have no employees. [No workers'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. tContractors 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: ARGONAUT INSURANCE COMPANY Policy#or Self-ins.Lic.#: WC928038765994 Expiration Date:12/27/2023 X Job Site Address: 25 SQUIRREL RUN City/State/Zip:YARMOUTHPORT, MA.02675 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal 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$250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi u er thep ins and penalties of perjury that the information provided above is true and correct. Signature: Date: 4/26/23 Phone: 774-203-3704 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: � �� t., • si n' o cup to censure o B, g , n and S . s • C L �62 • �.. ` B� ' ' `"' `w "'' `" h$� ��' • k 1! 4 • - f to ypj F� i s a cunn elan of Mas u "C � r � th 'license,. •.....„.. .•„-• '. '.. ciiii•;•:.4.tri....7271,4200..60:..4iiiiid'wooilto:rtnitiss..,:••••9 ... „, •• . ,.., lies co 3 ® � � 2 `c =0j V � �" '1 a ri i � �1 .2 ca c z Slcci li 8ze,g..si.....24,2" t. - iii ,_,„ . „, g . _ , .. I e3 O U 2. 0 w '� _ Eli, h In Permit Authorization mass save Form Site ID: 4800434 Customer: Vincent Pizzo 1, Vincent Pizzo ,owner of the property located at: (Owner's Name,printed) 25 Squirrel Run St 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. li&Cek 11°.Paea Owner's Signature: Date: 04-19-2023 FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: 5C ENERGY INC. 4/26/23 Participating Contractor Date Name: RISE Engineering Phone: 508-568-1926 Email: Page 1 of 1 For Office Use Only Customer Name:Vincent Pizzo CONTRACT Email:vinnca@comcast.net Phone:802-440-2931 Premise Address:25 Squirrel Run St,Yarmouth,MA 02675 Mailing Address:25 Squirrel Run St,Yarmouth,MA 02675 Project ID:4810683 Date:April 12,2023 ENGINEERING RISE Engineering 765 Attucks Lane, Hyannis,MA,02601 Job Description • :, s ?„ t 3..': a �`.„`� „ ix :•;•4 "s COMMON WALL:2"RIGID BOARD 175 SF $759.50 $189.87 ATTIC HATCH:INSULATE ONLY 3 each $105.00 $26.25 WEATHERSTRIP ATTIC HATCH 3 each $75.00 $0.00 TRANSITION FLRD 12 LF $164.16 $0.00 ATTIC FLAT-9"OPEN R-33 CELLULOSE 392 SF $689.92 $172.48 AIR SEALING 7 hr $660.31 $0.00 ATTIC DAMMING-R-38 FIBERGLASS 50 SF $121.00 $30.25 VENTILATION CHUTES 42 each $146.58 $36.64 Recessed Light Enclosure 1 each $50.00 $0.00 WEATHERSTRIP DOOR 3 each $95.43 $0.00 CRAWLSPACE WALL R10 RIGID BOARD 724 SF $3,315.92 $828.99 Total: $6,182.82 Program Incentive: -$4,898.34 Customer Total: $1,284.48 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***One Thousand,Two Hundred And Eighty-Four And 48/100 Dollars $1,284.48 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. jereiR ia4//Jrjirk DO NOT SIGN THIS CONTRACT IF THERg ARE ANY SLAWS SPACES IhReet4) Paola RISE Representative Customer Signature 04-19-2023 Sign Date 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 1 of 1 Document Ref:08M2M-HUYHZ-6VQSR MP4BU Page of4 RISE ENGINEERING GUARANTEE All materials are guaranteed by the contractor to be as specified. All work to be completed in a proficient manner according to standard practice.Any alteration or deviation from specifications on contract involving extra costs will be executed only upon written orders, signed by the client,and will become an extra charge A` over and above the contract. In the event that work cannot be completed due to unforeseen existing conditions,the work will not proceed and a written agreement will be executed for the deduction of this work from the specifications on the contract.All agreements are contingent upon strikes, accidents, or delays beyond our control. Customer is to carry fire and other necessary insurance. All workers are fully covered by Workers' Compensation Insurance. Any defect in materials, manufacture, design, or installation found within one(1)year from date of the installation shall be remedied without charge and within a reasonable period of time. yQy SCHEDULING: Work will be scheduled based upon sub-contractor availability and permissible weather conditions. NOTICE TO MASSACHUSETTS CUSTOMERS: The Commonwealth of Massachusetts, Board of Building Regulation and Standards requires you be notified of the following: "All home improvement contractors and subcontractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Director, Home Improvement Contractor Registration 1000 Washington Street, Suite 710 Boston, MA 02118 Phone(617)973-8787 Any and all necessary construction related permits are included in this contract. It shall be the obligation of the contractor to obtain such permits as the customer's agent. Customers who secure their own construction-related permits or deal with unregistered contractors will be excluded from access to the guaranty fund." NOTICE TO BUYER: 1. You are entitled to a copy of this agreement at the time you sign it. 2. The seller has no right to enter unlawfully your premises or commit any breach of the peace to repossess goods purchased under this agreement. 3. You may cancel this agreement if it has not been signed at the Main Office or a Branch Office of the Seller provided you notify the Seller at his Main Office or Branch Office shown in the agreement by registered or certified mail, which shall be posted not later than midnight of the third calendar day after the day on which the Buyer signs the agreement,excluding Sunday and any Holiday on which regular mail deliveries are not made. 4. No lien or security interest is placed on the property as a consequence of this contract if payment is made in accordance with contract terms. Z 1 I • Ih d O1i0 co g g_ : " 0Dx ran)) Fcp.: cio- t..,r(z—'1t7z.-..,-,-.7I,--.:-.4-=1ea.11.s= ocC _sue TScpo 2. 0 hh: ., tt k \ z F— � e 3 i � of a * ..:7 Z of a 3— .=0E , gpm C C) E I wiiti o . ., i_. .,.., Ul ei i% ri 4 ... v 8-g., - , "2 e to ,. ao �� t '�o tr..;5R F.12 , , il Xi R. crE II1 NO DEBRIS INSULATION ONLY DEBRIS DISPOSAL AFFIDAVIT In accordance with the provisions of M.G.L. c. 40, s. 54, Building Permit # n/a 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: 5C Energy, Inc. Name of Waste Facility 330 Victor Road, Attleboro, MA 02703 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 /29/ 61414061-- Signature of Permit Applicant 4/26/23 Date