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HomeMy WebLinkAboutBLD-23-005993 Y'9R x; I 51dh23 Office Use Only `� Permit L 7 i q 0 0u y Amount 35,Ob G MATTA M LSt kV a.00na'" �„000 Permit expires 1 80 days from issue date BLD - 23 -405c1c43 EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH RECEIVE s' Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 APR 2 7 2023 (508) 398-2231 Ext. 1261 �/ BUILDING; nEPAk 1 Vim- CONSTRUCTION ADDRESS: I° I �t G�,nr� eV ASSESSOR'S INFORMATION: Map: pl. Parcel: lei '` OWNER: ZaVi ( S\V Llti (0 C 174 OA hh �(Y�jLHA( l f D 141 -�'t IS�1-5e�O�17 NAME PRESENT AID RESS TEL. # CONTRACTOR: �W/I tPgle j� ' oh�) �U I�` Odium d4y J /lT 7 NAME MAILING ADDRESS TEL.# Residential ❑Commercial Est.Cost of Construction$ ,�( V 114 1 tO 7 Home Improvement Contractor Lie.# ` C 'g [9 Construction Supervisor Lie.# rs"07 p to Workman's Compensation Insurance: (check one) ❑ I am the homeowner 0 I am the sole proprietor I ` have Yt Worker's,- Compensation Insurance i,,, Insurance Company Name: frim �"k iktue.( ci✓d}'1t L ((SY W -1�� Norker's Comp.Policy# Faot OQ f -a•il WORK TO BE PERFORMED Tent Jt Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows: # Replacement doors: # Roofing: #of Squares (E)Remove existing*(max.2 layers) Insulation I I nOld Kings Highway/Historic Dist. (Q)Replacing like for like Pool fencing El *The debris will be disposed of at: t(1( ,(i(•0tir 'ra".c Fu ck/ /.>O) WrofGI v! ( ;Ir`ciaf ' it (�l 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. I understand that any false answer(s) will be just cause for denial or revocation of my license and for prosecution under M.G.L.Ch.268,Section I. Applicant's Signature: Date: /aza3 Owners Signature(or attachment) ( e �lE dl Date: Approved By: ` Date: /-;;2- Building Official(or d O EMAIL DRESS: Zoning District: Historical District: Yes No Flood Plain Zone: Yes No Water Resource Protection District: Within 100 ft.of Wetlands: Yes No Yes No ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `--- 11/14/2022 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 RGI -Kingston#90 PHONE FAX 410 University Ave Arc,No,Ext):800-553-1801 rAic,No):877-816-2156 E-MWestwood MA 02090 ADDRESS: mail@rogersgray.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Selective Insurance Co of the Southeast 39926 INSURED AIRTIGH-01 INSURER B:A.I.M. Mutual Insurance Company 33758 Air Tight Insulators, LLC and Jonathan N.Whipple 137 John Vertente Blvd INSURER C:Selective Insurance Co of South Carolina 19259 New Bedford MA 02745 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1156885472 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. TR TYPE OF INSURANCE NSD LUBR T POLICY NUMBER POLICY EFF POLICY EXP LIMITS (MM/DD/YYYY) (MM/DD/YYYY) I C X COMMERCIAL GENERAL LIABILITY ' Y Y S 2336538 6/14/2022 6/14/2023 EACHOCCURRENCE i$1,000,000 1 DAMAGE TO RENTED CLAIMS-MADE X OCCUR i I PREMISES(Ea occurrence) 1$500,000 MED EXP(Any one person) $15,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 PRO- 1 X POLICY JECT I LOC 1 PRODUCTS-COMP/OP AGG $3,000,000 OTHER: $ A AUTOMOBILE LIABILITY Y Y A 9106667 5/2/2022 5/2/2023 COMBINED SINGLE LIMIT $1,000,000 I (Ea accident) ANY AUTO I BODILY INJURY(Per person) $ OWNED SCHEDULED 1 X BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY I (Per accident) _ $ C UMBRELLALIAB X OCCUR Y , Y S 2336538 6/14/2022 6/14/2023 EACHOCCURRENCE $1,000,000 X EXCESS LIAB J CLAIMS-MADE AGGREGATE $1,000,000 DED RETENTION$ $ g WORKERS COMPENSATION N ECC-600-4001090-2022A 6/14/2022 6/14/2023 X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBEREXCLUDED? N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $1,000,000 1 I 1 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 7300 06/22)and Completed Operation(CG 7921 06/22) Primary and Non-Contributory Basis(CG 7300 06/22),Waiver of Subrogation(CG 7300 06/22) Automobile—Additional Insured, Primary and Non-Contributory Basis,Waiver of Subrogation(CA 7809 11/17) Excess/Umbrella—Additional insured follows form over underlying General Liability and Automobile Liability(CXL 4 04/03) Thielsch Engineering,Inc and all divisions are included as additional insured as cited above. 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. Thielsch Engineering, Inc. 195 Francis Avenue Cranston RI 02910 AU ED REPRESENTATIVE 04004si 7 ©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 { Office of Investigations Lafayette City Center 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/Individual):AIR TIGHT INSULATORS LLC Address:137 JOHN VERTENTE BLVD City/State/Zip:NEW BEDFORD, MA 02745 Phone #:774-628-9367 Are you an employer? Check the appropriate box: Type of project(required): 1.❑■ I am a employer with 15 4. ❑ I am a general contractor and I 6. Nev❑ construction employees (full and/or part-time).* have hired the sub-contractors listed on the attached sheet. 7. ElRemodeling 2.❑ I am a sole proprietor or partner- 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 comp. insurance. 9. ID Building addition required.] 5. 0 We are a corporation and its 10.❑ Electrical repairs or additions q ] officers have exercised their 11. Plumbingrepairs or additions 3.❑ I am a homeowner doing all work ❑ p myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no 13.El OtherWEATHERIZATION employees. [No workers' comp. insurance required.] *Any applicant that checks box 41 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 COMPANY Policy ft or Self-ins. Lic. #: ECC-600-4001090-2022A Expiration Date:06/14/2023 Job Site Address: /0 / City/State/Zip: YaYr 0),EY4,/1 4v?' * 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of pe jury that the information provided above is true and correct. Signature: - Date: Phone#: 774-628-9367 Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority(check one): 10Board of Health 20 Building Department 30City/Town Clerk 4.0 Electrical Inspector 51.11umbing Inspector 6.❑Other Contact Person: Phone#: \ \ . . f a _ / \ ! k g ct th a 7 =a ® � � \\/ ) / ix = w = E =moo « § c \° c 7 9 a to ƒ ® & 6B 2 §�j/ ^ . 13) o moo « 3 m 00_ / H\\ )2]§ . u) , ~ �® kit m ? 2,aR= 2 3 � � 0 £222\ \ LL 2 222 ;a � Eo 2 q n _ & c . . . 77A2« 2 3 s2. cc3 2°% 0 2 t 0 ca < C 2 E //k) C \ \ : a) § £ \ 0 \ a. 2cRCO / 1 / oo Q = 2 7 U E[ §k % ) w 0 I N �§ / I Cl) o< « © U) § � Er 0 j < 0' 48 0O ¥ 0� eg s_ uQ \\< \£ w\ = ] /j$ � t0��� �</ / § 2 -0' k u c //W § & w re n }a\ ± �§ °° o § I< 7 7¥ �jx �/ I <</ 0 0 §2e E /\§ $ %<$ Commonwealth of Massachusetts tilDivision of Occupational Licensure Board of Building Regi lations and Standards Constorl visor CS-078683 - , g"` »_ fires: 12/04/2024 JONATHAN [ak "'� 14 LYNDALE%AVE WEBSTER Wk. 01570 ., ./, 1, 1jifJ., 1J . 1% is ' ,- 1 ,a. DocuSign Envelope ID:987FD918-9482-4258-8E87-FF3D66207F8A Customer Name:Ronald Shepard CONTRACT Email:rpshepard@gmail.com Phone:413-262-5806 Premise Address:101 Diane Ave,Yarmouth,MA 02664 R I S E Mailing Address:101 Diane Ave,Yarmouth,MA 02664 Project ID:4742682 Date:Feb.6,2023 ENGINEERING RISE Engineering 765 Attucks Lane, Hyannis,MA,02601 Applicable Customer Required Actions: Notes: • Other Basement sills must be exposed in order to have perimeter air sealed and insulated properly.Any wood panel still covering sills must be removed prior to the contractors arrive. Roadblocks: Notes: • Combustion safety-spillage or draft test fail Your water heater is venting the exhaust fumes into the air which can make its way into your home.Work cannot proceed until we know this is corrected. Have a licensed plumber correct this issue and sign the incentive form we will provide you in order to remove this barrier. Job Description Measure Description Location Quantity Unit Total Cost Customer Cost AIR SEALING 14 hr $1,320.62 $0.00 ATTIC DAMMING-R-38 FIBERGLASS 74 SF $179.08 $44.77 ATTIC FLAT-10"OPEN R-37 CELLULOSE 1438 SF $2,645.92 $661.48 BASEMENT SILLS RIGID INSULATION 8 SF $34.72 $8.68 BASEMENT SILLS: R19 FG BATT 176 SF $417.12 $104.28 OVERHANG 10"DENSE R-32 CELLULOSE 16 SF $66.08 $16.52 4"-VENT BATH FAN TO ROOF OR ALTERNATIVE 1 each $130.63 $32.66 INSULATED BATH EXHAUST HOSE 4" 1 each $28.00 $7.00 KITCHEN EXHAUST-ELECTRIC ONLY 1 each $192.50 $48.12 Total: $5,014.67 Program Incentive: -$4,091.16 Customer Total: $923.51 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Nine Hundred And Twenty-Three And 51/100 Dollars $923.51 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. Page 1 of 2 DocuSign Envelope ID:987FD918-94B2-4258-8E87-FF3D55207F8A DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES DocuSigned b �---DocuSigned by: r°" 5Lur1 �pa;st�tative 6taersEagaature 2/15/2023 ( 10:52 AM EST 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 2 of 2 DocuSign Envelope ID:987FD918-94B2-4258-8E87-FF3D66207F8A Permit Authorization mass save Form Site ID: 4708572 Customer: Richard Shepard Ronald Shepard I, ,owner of the property located at: (Owner's Name,printed) 101 Diane Ave Yarmouth, MA 02664 (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. ,.----DocuSigned by: Owner's Signature: rbinaa Sa ,`---E4213646CE 854F3... Date: 2/15/2023 1 10:52 AM EST FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: 7-(r/649/44A4/; Participating Contractor Date Name: RISE Engineering Phone: 508-568-1926 Email: Page 1 of 1 Fcr'vffie Use Oriv Customer Information RISE ENGINEERING 5 Dupont Avenue South Yarmouth,MA 02664 Customer Name:Richard Shepard Email:rpshepard@grnail.com Phone:413-522-4340 Premise Address:101 Diane Ave,Yarmouth,MA 02664 Project ID:4708572 Recommendations Description Qty Existing Conditions KITCHEN EXHAUST-ELECTRIC ONLY 1 MARKED"KV"ON SKETCH OVERHANG 10"DENSE R-32 CELLULOSE 16 ORANGE-RIGID SILL BLOCKER THEN DENSE PACK ATTIC DAMMING-R-38 FIBERGLASS 74 RL's,KV,BF's,AROUND PORCH,GARAGE DROP INSULATED BATH EXHAUST HOSE 4" 1 LIGHT GREEN 4"-VENT BATH FAN TO ROOF OR ALTERNATIVE 1 DARK GREEN VENT THRU GABLE BASEMENT SILLS: R19 FG BATT 176 PINK ATTIC FLAT- 10"OPEN R-37 CELLULOSE 1438 YELLOW BASEMENT SILLS RIGID INSULATION 8 RED AIR SEALING 14 2HRS BASEMENT,12HRS ATTIC 11' / 11 X a BULK '-' "v 7' 5' :1M 16' X 12` X 26' nammem.�� r ( 6' / X 24' X X 1 KY R. iL 1-4 .� b m UNCONDITIONED ry 12' m X 12' X GARAGE er PORCH o C 40' X X Page 1 of 1