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HomeMy WebLinkAboutBLD-23-006011 :04'.Yg41t �(r M \ Office Use/Only I 1 Permit# ( ii 75 t~O - H; Amount 3 s bb c',. Permit expires 180 days from :' .; issue date 61,-D -a3 ___0 tl,) 1l EXPRESS BUILDING PERMIT APPLICATI I TOWN OF YARMOUTFI ECEIVED Yarmouth Building Department MAY 0 12023 1146 Route 28 South Yarmouth, MA 02664 BUILDING DEPARTMENT (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: I I MANY OAKS CIRCLE ASSESSOR'S INFORMATION: Map: 117 Parcel: 32 OWNER: PETERVEYSEY.346 COMMONWEALTH AVENUE,APT BE BOSTON,MA.02115 415-205-5181 NAME PRESENT ADDRESS TEL. # CONTRACTOR: MATTHEW RUSSELL- 3820 DIAMOND HILL ROAD,CUMBERLAND,RI 02864. 401-651-0003 NAME MAILING ADDRESS TEL.# El Residential 0 Commercial Est.Cost of Construction$ 5,661.09 Home Improvement Contractor Lic.# I95309 (EXP.04/18/2025) Construction Supervisor Lic.# 106162(EXP.04/26/2025) Workman's Compensation Insurance: (check one) 0 I am the homeowner 0 I am the sole proprietor 0 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 El Siding: #of Squares Replacement windows: # Replacement doors: # Roofing: #of Squares (❑)Remove existing* (max. 2 layers) Insulation I I I I Old Kings Highway/Historic Dist. tJ Replacing like for like Pool fencing I I *The debris will be disposed of at: SC ENERGY,330 VICTOR ROAD,ATTLEBORO,MA.02703 Location of Facility I declare under penalties s ••. 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 ford= : / ocation, f my license and for prosecution under M.G.L.Ch.268,Section 1. tl, Applicant's Signature: Date: 4/28/23 PLEASE SEE ATTACHED OWNER AUTHORIZATIO &CONT T Owners Signature(or attachment) Date: Approved By: '6 Date: 5-�/ 'Z 3 Building Official(or designee) AIL ADDRESS: h'IFCfANN@5CENERGYINC.COM Zoning District: Historical District: Yes No Flood Plain Zone: Yes No Water Resource Protection District: Within 100 ft.of Wetlands: Yes No Yes No Co.trimotivfitmlth of Massat:_firiseits Division of Occupational Li(:eristire Board of Burkiiirig Regtiltifloris anti Standards Cortstrtictt r Si:iecialfy CSSL 106162 00))1res 04/26/2025 MATTHEW J flUSSELL 3820 DIAMOOID HILL RD CUMBERLAND RI 02864 Commissioner Or Coristructiori Su 4 ISO; Specialty Restficted to: CSSL-IC Ifistitation Contractor Failure to possess a current edition of the Massachusetts State Budding Code is cause for revocation of this license. For information about this license Call (617) 7274200 or visit www.inass.govidpi L as E yn 4 0 _ C I o i W m p I e it: co 1 -sue; To • Nr. co 0 }-.fie ils 0 O c & . W 3 CD fri '0 § CO rsi 4 ts ,▪u g r co Hilliri. . W C.' > 2 U) o o E z oom , m c �) g U• .� o �� Li./ 0 = 0 ,i _ glo -CS lig .... 0 l o a _� RN LLco oa 461- 5 4 .JO r C/)I IX • Oi * i 2 t IL JCt id04coWcc Q., u2� <IU W� x � �Z ti a V C iC cc � O O_ it) C 6, 13 y b.t!S oQ,r a 13 J.' I es r 5 c Ur o a c O . „w a W a A N an to c = .o ��o P. C CC © o o M. 4. • c eN C CT G3 a.. in � o � cats _ cn z- c g Q o > 2 m �� oco > HR o O Q cu .0 © g 4146 Ts O F- ! IH w Q *- O o o _ u W 0 _ ac i_ __..0 X 0 zcv ©� W8. oo°oo W0r33 2 I cin J¢C cc a 1� _ zQod dw r2 _ WLIE J o CO CL 1 ® DATE(MM/DD/YYYY) ACOREP CERTIFICATE OF LIABILITY INSURANCE 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 AXX,No: (401)728-1820 (A/C.No,Ext): ( ) 279 Dexter Street E-MAIL rosalynn©loiselleinsurance.com ADDRESS: P.O.Box 1148 INSURER(S)AFFORDING COVERAGE NAIC# Pawtucket RI 02862-1148 INSURERA: Employers Mutual Casualty Co 21415 INSURED INSURER B: EMC Prop&Cas Ins Co 25186 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. NSR ADDL SUBR POLICY EFF POLICY EXP ILTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM!DDIYYYY) (MMIDD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1'000'000 �/ DAMAGE TO RENTED 500,000 CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 10,000 A 5D98024 12/27/2022 12/27/2023 PERSONAL&ADV INJURY $ 1'000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- POLICY JT 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 BODILYINJURY(Peraccident) $ 40,000 AUTOS ONLY X AUTOS XHIRED •,,/ NON-OWNED PROPERTY DAMAGE $ 5,000 AUTOS ONLY AUTOS ONLY (Per accident) Uninsured motorist BI $ 1,000,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 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 X PER H STATUTE ER AND EMPLOYERS'LIABILITY Y!N 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE Y N!A WC928938765994 12/27/2022 12/27/2023 E.L.EACH ACCIDENT $ , OFFICER/MEMBER EXCLUDED? 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Contractors Pollution Liability D CPLMOL107038 06/16/2021 06/16/2023 Aggregate $250,000 Eeach Occurrence $500,000 DESCRIPTION OF OPERATIONS/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 j/,J�' �,,�()��y� L" t:fica`7 hL 1 ©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 a =`�_ 1, Department of Industrial Accidents 1- 1 Congress Street, Suite 100 glk _ i•�v i Boston, MA 02114-2017 es5. www.mass.gov/dia s 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. El Remodeling any capacity.[No workers'comp. insurance required.] 9. ❑Demolition 3.1:3 I am a homeowner doing all work myself.[No workers'comp.insurance required.]1 10 Q Building addition 4.❑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.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.' 14.['Other Insulation 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 152,§1(4),and we have no 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: ARGONAUT INSURANCE COMPANY Policy#or Self-ins.Lic. #: WC928038765994 Expiration Date:12/27/2023 X Job Site Address: I I MANY OAKS CIRCLE 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: 4/28/23 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#: mass save® Savings through energy efficiency PERMIT AUTHORIZATION FORM l Peter Veysey owner of the property located at: (Owner's Name) 11 Many Oaks Circle Yarmouthport (Property Street Address) (City) hereby authorize the Mass Save® Home Energy Services Program assigned Participating Contractor to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. This form is only valid with a signed contract. The permit will be secured by the subcontractor, at no additional cost. "P 4 °'/ a 4.11 Owner's Si ure q. ).3 Date FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: 5C ENERGY INC. 4/28/23 Participating Contractor Date RISE CONTRACT ,n r.MRrnEr-rnr�oc�moawv 1341 Elmwood Ave,Cranston,RI 02910 Federal ID#08-0405629 RI Contractor Reg#8186 401-784-3700 401-784-3710 fax MA Contractor Reg#120979 CT Contractor Reg#620120 CUSTOMER PHONE DATE CLIENT# WORK ORDER Peter Veysey (415) 205-5181 04/20/2023 306860 20007 SERVICE STREET BILLING STREET PROPOSED BY: 11 Many Oaks Circle 11 Many Oaks Circle Daniel Damery SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Program Yarmouthport, MA 02675 Yarmouth Port, MA 02675 CLC-HES Page 1 DESCRIPTION QTY COST INCENTIVE TOTAL INCENTIVE 75% For eligible weatherization measures,the Cape Light Compact is offering an insulation incentive of 75%, with no limit, and an incentive of 100%for the air sealing measures. You are eligible to apply for the 0% Heat Loan to finance your co-pay, applications must be submitted before the weatherization work begins. HOME AIR SEALING 13 $1,226.29 $1,226.29 Seal areas of your home against wasteful, excessive air leakage. Materials to be used to seal your home can include caulks, foams and other products. Primary areas for sealing include air leakage to attics, basements, attached garages and other unheated areas (windows are not generally addressed.) DUCT SEALING-ELECTRIC 4 $320.00 $320.00 Provide labor and materials to seal heating and/or cooling ducts within designated unheated areas. ATTIC DAMMING 120 $290.40 $217.80 $72.60 Provide labor and materials to install an approved damming material in the attic ATTIC FLAT-12"OPEN R-42 CELLULOSE 1,344 $2,688.00 $2,016.00 $672.00 Provide labor and materials to install a 12" layer of R-42 Class I Cellulose to open attic space. PULL-DOWN STAIR-THERMADOME 1 $253.21 $253.21 Provide labor and materials to install an easily moved, insulating cover for the attic access folding stair. The cover has integral weather- stripping to restrict air leakage. COMMON WALL-2" RIGID BOARD 25 $108.50 $81.38 $27.12 Provide labor and materials to install 2" rigid board to a common wall area.All seams will be sealed with tape. BASEMENT SILLS-R19 FIBERGLASS BATT 14 $33.18 $24.89 $8.29 Provide labor and materials to install R-19 unfaced fiberglass insulation to the perimeter of the basement ceiling at the house sill. 3/4 INCH CLOSED CELL FOAM PIPE INSULATION 65 $286.00 $214.50 $71.50 Provide labor and materials to install closed cell foam pipe insulation on 3/4"forced hot water heating pipes. VENTILATION CHUTES 104 $362.96 $272.22 $90.74 Provide labor and materials to install ventilation chutes in the rafter bays to maintain air flow from the soffit ventilation. RISE CONTRACT PN fMP'.0 EE�[1NED C7MPPNv 1341 Elmwood Ave,Cranston,RI 02910 Federal ID#08-0405629 RI Contractor Reg#8186 401-784-3700 401-784-3710 fax MA Contractor Reg#120979 CT Contractor Reg#620120 CUSTOMER PHONE DATE CLIENT# WORK ORDER Peter Veysey (415) 205-5181 04/20/2023 306860 20007 SERVICE STREET BILLING STREET PROPOSED BY: 11 Many Oaks Circle 11 Many Oaks Circle Daniel Damery SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Program Yarmouthport, MA 02675 Yarmouth Port, MA 02675 CLC-HES Page 2 DESCRIPTION QTY COST INCENTIVE TOTAL SOFFIT VENTS 8 X 16 3 $92.55 $69.41 $23.14 Provide labor and materials to install 8" X 16" rectangular aluminum soffit vents to increase ventilation in attic areas. Specify color: White or Gray. PIPE DISCLOSURE Due to the location of pipes in unheated area(s)we have suggested ri3stiais) that you consult with a licensed plumbing contractor for a more proactive measure(like relocating the plumbing inside your home's thermal envelope)to prevent the pipes from freezing in these area(s). By initialing you are agreeing to not hold RISE or its Participating Contractors responsible for any damage caused by freezing pipes in the areas where insulation is added. In cases where pipe tenting is applicable and attempted by the participating contractor, there is still no guarantee that pipe freezing will not occur. Total: $5,661.09 Program incentive: $4,695.70 Client Total: $965.39 I.DESCRIPTION OF WORK TO BE PERFORMED Contractor will perform or cause to be performed the above work at the Client's Address in a professional manner and in accordance with the terms of this Contract. II.PAYMENT Upon final inspection and approval by RISE,Client agrees to remit amount due in full.interest of 1%will be charged monthly on any unpaid.balance after 30 days.See attached terms and condition for important information on guarantees,rights of recision,scheduling,and contractor registration. • 111/1:1") RISE epresentative Client ' ature a , • Printed Name Date of Acceptance 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—6`h Edition 1,10- Signature of Permit Applicant 4/28/23 Date