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HomeMy WebLinkAboutBLD-23-000970 1 lei-. ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department 1146 Route 28,South Yarmouth,MA 02664-4492 l 508-398-2231 ext. 1261 Fax 508-398-0836 Massachusetts State Building Code,780 CMR Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only RECEIVED Building Permit Number: V LD —O bdglo Date Applied: Auo 2 3 2022 Building Official(Prfrl€Name) ignatur Djte SECTION 1:SI INFORMATION nUILDIN 3 DEPARTMENT 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers I By. 23 Captain Nickerson Rd, Yarmouth MA 02664 1.1 a Is this an accepted street?yes ✓ no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: ^ /�a Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) oC U 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided f Required Provided 1.6 Water Supply:(M.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: Michael Carey Yarmouth MA 02664 Name(Print) City,State,ZIP 23 Captain Nickerson Rd, (508)221-5748 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction❑ Existing Building 0 I Owner-Occupied 0 Repairs(s) ®' Alteration(s) 0 I Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2:Entire home Re-roof. Number of Total roof squares-21 SECTION 4:ESTIMATED CONSTRUCTION COSTS • Item Estimated Costs: (Labor and Materials) Official Use Only 1.Building $ 15,238.00 1. Building Permit Fee:$ 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: SQ.V D ofdi 3bopu2 5.Mechanical (Fire $ Suppression) Total All Fees:$ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ 15,238.00 0 Paid in Full ©Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS O40622 Sunrun Installation Services- Stephen A. Kelly 08/01/2023 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 U t Unrestricted(Buildings up to 35,000 cu.ft.) City/Town,State,ZIP R Restricted 1&2 Family Dwelling 1vf Masonry RC f Roofirig Covering WS Window and Siding SF Solid Fuel Burning Appliances 978-793-7881 eastmapermits@sunrun.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) Sunrun Installation Services- Stephen A. Kelly HIC-180120 10/13/2022 HIC Company Name or HIC Registrant Name HIC Registration Number Expiration Date 695 Myles Standish Blvd, eastmapermitsasunrun.com No.and Street Email address Taunton MA 02780 978-793-7881 City/Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(iVI.G.L.c.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 No 0 SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERiIIIT 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. Michael Carey See Attached Contract 08/22/2022 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. 08/22/2022 Print Owner's or horized Agent's Nam Electronic 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.mass.aov/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" COntfoOnWe. Construction Supervisor ith.If Massacttc:setis U. S of thy";tee w which contain �ivtaian of Profess€esru�!l)eersuce aoatd at$ui4dmg Rego401,0n3 ar*.ta Standards teas titan ax,iaw cubic feet t'SS1 ,taac Teeters)of enclosed Vie. CS-040622 €Jtypires.02:W 2121 STEPHEN A OILY ti PARKINA r STOINIStA 1 0219116 Failure to posses*■current edition at the Massachusetts Stela Suadasa Code is cause tor:evocation of dris Acmes_ CommissionerL `crn%tea.- Far istoosidiom about Mrs Scone Cal$17)T17 l or visa irmarnassoovitipi Office of Consumer Affairs and Business Reguiatic n 1000 WasF ngton Street-Suite 7 i0 Boston.tvtassaachusetts 021 Home improvement Contractor Registratcn Type Si..:ppferre-'Card SLPdRI.iff rN5—ALLA7 ON SEi5V CES NC' Eeba rt '5,'31222 2.25 3LSk S'PEET SUi7E,4 SAN 7RAN CISC3.CA 34 54 UDSffi=;Address are Nefurr Card. CIA01.X i.8(3tb1IIW Agora 4.33484H61 Se¢uat do 4Cdolt 7tPRO'iE11EN':oN-RACTOR Regesvar,or-vaf-rE for ovfrrdira+ase 3.114 >u;czmc Card More Jx:avuarmn la`s. r oor d retard:a- Icciadacca F•Rertrnrt ?Mae. Consumes Attars and Busasess Regulation 'COO tiasrorgr.7r,Stsw_er-&ere's 3..APU", 8as5w1.VA.V14 --E,P HEN 47f r 4 125 alzH NEEr E 4 ,. ,.. tto?. ra.4;stt<'t out sive e =RL OSCO CA?4'u'2 Jederesr�•etarr Stephen A Kelly 200 Research Dr Wilmington MA 01887 TEL: 978-793-7881 Email: northmapermits@sunrun.com ,_--, SUNRINC-02 TWANG ACORN DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 9/10/2021 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 Alliant Insurance Services,Inc. PHONE 1 FAX 575 Market St Ste 3600 (A/C,No,Ext): (A/c,No): San Francisco,CA 94105 E-MAIL ss: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 IMM/DDIYYYY) IMM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE X OCCUR LA21CGL2303211C 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 JEL'T LOC PRODUCTS-COMP/OP AGG $ 2,000,000 X OTHER:Retention:$100,000 Per Project Agg $ 10,000,000 AUTOMOBILE LIABILITY (Ea acIcidenNEDt)SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS y�/� p BODILY INJURY(Per accident) $ AUTOS ONLY AUUTOS ONLY (Per PROPERTY DAMAGE $ $ 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$ $ I C AND EMPLOERS YERS'LIABIUON TY X STATUTE ERH v/N WC614287600 10/1/2021 10/1/2022 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE n, N/A 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 $ DESCRIPTION OF OPERATIONS/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. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Yarmouth ACCORDANCE WITH THE POLICY PROVISIONS. 1146 Route 28 South Yarmouth,MA 02664-4492 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents '711, A 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): Sunrun Installatioa_S ryices/ 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): 1.® I am a employer with 50 4. ❑ I am a general contractor and I 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. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LE Plumbing repairs or additions myself. [No workers' right of exemption per MGL 5 comp. 12.® Roof repairs insurance required.] + c. 152, §1(4),and we have no employees. [No workers' l3.0 Other comp. insurance required.] *Any applicant that checks box#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 Policy#or Self-ins. Lic.#:WC614287600 Expiration Date: 10/01/2022 Job Site Address: 23 Captain Nickerson Rd, City/State/Zip:Yarmouth MA 02664 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. Sitnature: Date: 08/22/2022 Phone#:978-793- 881 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): I Board of Health 2❑Building Department 3E1City/Town Clerk 4.1:Electrical Inspector 5.0Plumbing Inspector 6.0Other Contact Person: Phone#: Ll VI:UJIyiI CIIVCIUf a lu.U UOJDC V\ .)JC-'+OCJ-O I I�-VOCD'+JD/VI UV Sunrun BrightSaveTM Agreement Michelle Fantoni 23 Captain Nickerson Rd, Yarmouth, MA, 02664 Take Control of Your Electric Bill $0 25 Years $ 138 $0 .280 Deposit due Agreement Term Length Monthly Bill for Year Year 1 Cost per kWh Today (2.9% annual increase One (plus taxes, if applicable; (excluding upfront in monthly bill) includes $7.50 discount for payment, if any) Auto-Pay enrollment) WE'VE GOT YOU COVERED WITH OUR WORRY-FREE SERVICE c;,-) fin We provide hassle-free We monitor the system We warrant, insure, Selling your home? design, permitting. and to ensure it runs maintain and repair We guarantee the buyer installation, properly, the system. We will qualify to assume also provide a 10- your agreement, year roof warranty. A SOLAR SYSTEM DESIGN FOR YOUR HOME You get a 5.47 kW DC Solar System With 15 Solar Panels and 1 Inverter(s) Which will produce an est. 5,932 kWh in its first year And offset approx.105% of your current, estimated electricity usage YOUR SALES REPRESENTATIVE Adrian Cada adrian.cadar�@sunrun.con 508) 360-854: "u""Oly"cl',"lupV'^^""""C) ."^-U"=D°"=,,,,, By signing be|ow, you acknowledge that yoo have reviewed and received a complete copy of the Aoreonnent without any blanks. Such AgreemnantshaU be the complete understanding be�xeonthe P8�ieS. " SUNRUNI PN SERVICES |NC. rEBF2CECBD959438 PhntNxnne: oani Newman Date: 7/28/Z023 Title: proJpct- npprprions Federal Employer |dgnUho8UO0 Number: 26'2841711 IF YOU CHOOSE TO PAY BYCHECK. MAKE CHECKS OUT TOSUNRUN INC. NEVER K4AKEACHECK OUT TO A SALES REPRESENTATIVE. OUR SALES REPRESENTATIVES ARE NOT AUTHORIZED T[) RECEIVE CHECKS IN THEIR OWN NAMES. YOU MAY CANCEL TO MIDNIGHT E" " E~~""VE DATE. P oEn� n��E��UUA��HED0WOTU��ES ��F ����0W��EL TENTH EXPLANATION ��F ��U��� ����� Customer Holder Secondary Account Holder (OptiOna|) L-�"�*�;M�Uf�e KXicheUe Fantmli — Signature 7/Z8/2O3Z � Date —� — Print Name Email Address : carey3616@ao| .com K0aiUngAddneaS� 23Captam Nickerson Rd Ya'nnouUh, K1A02884 Phone: (508) 221-5748 f»,of scvch as��.��m����m.�e����� Sales Consultant rAW Bu 2nvSun/U17aCc/-eC �d /�3///2neS6/�*c/1��6g/�e/n6vr/aco; D�7g/n 0/{�/ 7(�/�1a/uf1��//ob��,�(//�e �cvn*owv/&r'S S�671/81,11r* 0//617y?qgtspen7etff ' Adrian cadar / Print Name 458401I482__-. Sun/un |Dnumber | 8uonun |nstaUahoo Services /nc. 1225BushSt^ecL Suite 1400 Sari Francisco, (�AS4l04 H/C 18Ol2DContrad Version: 2020O/V1 Generation Date: 7:23/2O' 2 Proposal ID: 'PK4NS Version 20C>1V1 � ONE or TWO FAMILY— BULDING PERMIT APPLICATION REGULATORY APPROVALS NOTICE Address of Proposed Work: 23 Captain Nickerson Rd, Yarmouth MA 02664 Scope of Proposed Work: Entire home Re-roof. Number of Total roof squares-21 Date: 08/22/2022 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 Ac nowledgement: 08/22/2022 Applicant' ignature Date Rev.Jan. 2019 §TOWN OF YARMOUTH 1146 Route 28, South Yarmouth, MA 02664 508-398-223t1 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 23 Captain Nickerson Rd, Yarmouth MA 02664 Work Address Is to be disposed of oat the following location: Sun Run 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. 08/22/2022 Signa e of Applicat. n Date Permit No.