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HomeMy WebLinkAboutBLD-23-000995 RECEIVED AUG 17 22 ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department I P 1146 Route 28,South Yarmouth,MA 02664-4492 EPA TMENT 508-398-2231 ext. 1261 Fax 508-398-0836 Massachusetts State Building Code,780 CMR o� o Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: 4 as-3 -00/i co5 Date Applied: I rN Se cs Building Official(Print Name) • Signe re Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 12 Gill Ave, Li a Is this an accepted street?yes ✓ no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (IvM.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: Outside Flood Zone? — Municipal 0 On site disposal system 0 Check if yes!: SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Paola Lima Yarmouth MA 02673 Name(Print) City,State,ZIP 12 Gill Ave, 508-367-0094 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 I Owner-Occupied 0 E Repairs(s) t Alteration(s) 0 I Addition 0 Demolition ❑ I Accessory Bldg. 0 Number of Units Other ❑ Specify: Brief Description of Proposed Work':Scope of Work-Array section tear off. Total roof squares-6 SECTION 4:ESTIMATED CONSTRUCTION COSTS. Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 4375.00 1. Building Permit Fee:$j") Indicate how fee is determined: 2.Electrical $ 0 Standard City/Town Application Fee ❑Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: et* L2Q,3 5.Mechanical (Fire $ . Suppression) Total All Fees:$ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ 4375.00 ❑Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-040622 Sunrun Installation Services- Stephen A. Kell 08/01/2023 p ., License Number Expiration Date Name of CSL Holder 695 Myles Standish Blvd, List CSL Type(see below) U No.and Street Type Description Taunton, MA 02780 I1 ( Unrestricted(Buildings up to 35,000 cu.ft.) City/Town,State,ZIP R Restricted 1&2 Family Dwelling M Ivlasonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 508-367-0094 eastmapermits©sunrun.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC 180120 Sunrun Installation Services- Stephen A. Kelly 10/13/2022 HIC Com any Name or HIC Registrant Name I IIC Registration Number Expiration Date 695 Myles Standish Blvd, eastma ermits sunrun.com No.and Street p Taunton, MA 02780 978-793-7881 Email address City/Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e.152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes Gil No 0 SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize Sunrun Installation Services to act on my behalf,in all matters relative to work authorized by this building permit application. *Paola Lima See Attached Contract 08/15/2022 Print Owner's Name(Electronic Signature) Date • SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. 08/15/2022 Print Owners or A orized Agent's Name lectronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.rnass.eov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" Commonwealth or MassacfttMsettg Cotelitrtictit Supervisor NIV Division of Professional LiceMNsatre U -&airbags Many use group which contain Board of Building Regulations and Standards ices Tart 35,000 cubic rent 1991 cubic meter%)al ertciosed space. CS-040622 Ei`p=res:08101 2023 STEPMEN A 1E1.LT ii P*RKWA1 ST EHAM i lain r� 7iir>!ice' Flair*W prisms a current edition of the Massachusetts Coinmisaiorter '' Stye Par i amelion about ade is cause tar for this license. Cod pin mat O or vied.r«wreassg0VIdp+ Office of Consumer Affairs and Business Regulation 1000 Washington Street-Suite 710 Boston,Massachusetts 02118 Home Improvement Contractor Registration T•fp.e Supplement Card Regrstrabon. ia0=20 SUNRUN INSTALLAT-`ON SERVICES NC Ezysraton 10/'312022 225 BUSH STREET SUITE"400 SAN FRANCISCO,CA 3404 Update Address and Return Card died of Co tele w&Matra&eurneree Raguiabon HOME IMPROVEMENT CONTRACTOR Regrstraton void for indnldual use an y TYPE Sutva=,er.t Cars before Ile expration dale. If found return io. itetematioa Lusa= Office of Consumer Adams and Busaress Reputation 180t20 'a•?22022 1000 Washu+pton Street-Suite 7f0 SuNRUN INSTALLATION SERVICES NC Briton..MA 02116 3-EP+IEN KELLY 225 ausH SUITE 1400 .. : ..� Not id without sign e SAN FRANCISCO.CA 34104 JUndersecretary Stephen A Kelly 200 Research Dr Wilmington MA 01887 TEL: 978-793-7881 Email: northmapermits@sunrun.com �.--.4„,i SUNRINC-02 TWANG CERTIFICATE OF LIABILITY INSURANCE DATD/YYYY) ilia `..-•—� 9/10/210/2021 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 Walter Tanner NAME: Alliant Insurance Services,Inc. PHONE FAX 575 Market St Ste 3600 (A/C,No,Ext): (A/C,No): San Francisco,CA 94105 E- L ADDRESS:Walter.Tanner@alliant.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Navigators Specialty Insurance Company 36056 INSURED INSURER B:James River Insurance Company 12203 Sunrun Installation Services,Inc INSURER C:American Zurich Insurance Company 40142 775 Fiero Lane,Suite 200 Ph#805-540-7643 INSURER D: San Luis Obispo,CA 93401 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MM/DDIYYYYI (MMIDDIYYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE X OCCUR LA21CGL230321IC 10/1/2021 10/1/2022 DAMAGETORENTED 1,000,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY X Yllef LOC PRODUCTS-COMP/OP AGG $ 2,000,000 X OTHER:Retention:$100,000 Per Project Agg $ 10,000,000 AUTOMOBILECOMBINED SINGLE LIMIT LIABILITY (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ AUTOS ONLY NON-OWNEDUUTS PROPERTY accidentDAMAGE $ $ B UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 X EXCESS LIAB CLAIMS-MADE 001072261 10/1/2021 10/1/2022 AGGREGATE $ 4,000,000 DED RETENTION$ $ C WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE YIN WC614287600 10/1/2021 10/1/2022 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1000000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ ' ' DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation Policy WC614287600 Deductible:$1,000,000. Re:Permitting within jurisdiction. Abreu,Joao;221R-104ABRE,104 Rogers Dr.,Stoughton,MA 02072. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Stoughton THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9 ACCORDANCE WITH THE POLICY PROVISIONS. 10 Pearl St. Stoughton,MA 2072 AUTHORIZED REPRESENTATIVE i ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD , -a-7 The Commonwealth of Massachusetts Department of Industrial Accidents t ``- Office of Investigations _ f i �� ;` Lafayette City Center w 2 Avenue de Lafayette, Boston,MA 02111-1750 ; - , www.mass.govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Sunrun Installation Services / Stephen Kelly __ _ Address:225 Bush St STE 1400 City/State/Zip:San Francisco CA 94104 Phone#: 978-793-7881 Are you an employer?Check the appropriate box: Type of project(required): I.® I am a employer with 50__ _ 4. ❑ I am a general contractor and I 6 ❑New construction employees (full and/or part-time).* have hired the sub-contractors 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. ❑ Demolition and have workers' working for me in any capacity. employees9. ❑ Building addition [No workers' comp. insurance comp. insurance. 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 I LEI Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.Z Roof repairs insurance required.]' c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box t I 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: American Zurich Insurance Company WC614287600 Expiration Date:10/01/2022 Policy#or Self-ins. Lic.#. _ _-� Job Site Address: 12 Gill Ave, City./State/zip: Yarmouth MA02673 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 perjury that the information provided above is true and correct. Signature: _ _ 41 Date: 08/15/2022 Phone#: 978-793-7881 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❑City/Town Clerk 4.0 Electrical Inspector 5E:Plumbing Inspector 6.0Other Contact Person: Phone#: §TOWN OF YARMOUTH 1146 Route 28, South Yarmouth, MA 02664 508-398-223!1 ext.-1261 Fax 508-398-0836 Office of the Building Commissioner BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Ch. 40, §54 and 780 CMR- Section 105.3.1. #4. I hereby certify that the debris resulting from the proposed work/demolition to be conducted at 12 Gill Ave, Yarmouth MA 02673 Work Address Is to be disposed of oat the following location: Sunrun Dumpster-695 Myles Standish Blvd,Taunton MA 02780 Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. a 08/15/2022 Signature f Applicatio Date Permit No. ONE or TWO FAMILY— BULDING PERMIT APPLICATION REGULATORY APPROVALS NOTICE Address of Proposed Work: 12 Gill Ave, Yarmouth MA 02673 Scope of Proposed Work: Scope of Work- Array section tear off. Total roof squares-6 Date: 08/15/2022 Based on the scope of work described above,the applicant is required to obtain approval sign- offs from the following departments as checked-of below: Health Dept. —508-398-2231 ext. 1241 Conservation—508-398-2231 ext. 1288 Water Dept. —99 Buck Island Road, 508-771-7921 Old Kings HWY. Hist. Comm. —508-398-22631 ext. 1292 Engineering Dept.—508-398-2231 ext. 1250 Fire Dept. —Kevin Huck/Scott Smith, 96 Old Main Street, SY Note: Please call Fire Department for an appointment. 508-398-2212 Other Appropriate plans and/or application shall be provided to each departments checked-off above. Each of these regulatory authorities has their own requirements outside the jurisdiction of the Building Department. All applicable approvals shall be obtained prior to submitting a building permit application to the Building Dept. Thank you for your cooperation. Receipt Acknowledgement: 08/15/2022 Applicant's gnature Date Rev.Jan. 2019