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HomeMy WebLinkAboutBLD-23-006013 0Tt'YAR FI E 4 E V V D `�/02110 Office Use Only • Pennit# L'1/f41(9 0 0 H MAY 0 1 2023 Amount 3. MATT M CS � �g) Permit expires 180 days from BUILDING DEP ARIMENT issue date By --------_..._-.-_.---------- EXPRESS BUILDING PERMIT APPLICATION a3 ���� TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: 55 Prospect Ave Yarmoth MA, 02673 ASSESSOR'S INFORMATION: Map: Parcel: OWNER: Andre Biscoto 55 Prospect Ave Yarmoth MA, 02673 NAME PRESENT ADDRESS TEL. # CONTRACTOR: James Dimopoulos 32 Middlesex St Haverhill, MA 01835 978-203-6736 NAME MAILING ADDRESS TEL.# ❑Residential 0 Commercial Est.Cost of Construction$ yj? -3, Home Improvement Contractor Lic.# 167375 Construction Supervisor Lic.# 104464 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: HUB International NE Worker's Comp.Policy# WC100142002 WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares ( )Remove existing*(max.2 layers) Insulation 7 Old Kings Highway/Historic Dist. ( )Replacing like for like Pool fencing *The debris will be disposed of at: G Mello Bin Haverhill, MA Location of Facility I declare under penalties of perjury that the statemen rein ontained 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 mvd f prosecution coder M.G.L.Ch.268,Section I. Applicant's Signature: Date: 04/27/23 Owners Signature(or a achment) Date: 04/27/23 Approved By: Date: 5 /z 3 Building Official(or de ee) EMAIL ADDRESS: Zoning District: Historical District: Yes No Flood Plain Zone: Yes No Water Resource Protection District: Within 100 ft.of Wetlands: Yes No Yes No 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): Dipietro Home Energy Solutions dba Revise Address:32 Middlesex St City/State/Zip: Haverhill, MA 01835 Phone#:(978)203-6736 Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with 30 4. [] I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6 ❑New construction listed on the attached sheet. 7. Remodeling 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. Building addition required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3. I am a homeowner doingall work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other Weatherization 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. +`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: HUB International NE Policy#or Self-ins. Lic. #:WCI00142002 Expiration Date:04/20/2024 Job Site Address: 55 Prospect Ave City/State/Zip:Yarmoth MA, 02673 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 herebycertifrunder the a' and e p penalties of perjury that the information provided above is true and correct. Signature: _ "' Date: 04/27/23 Phone#: (978)203-6736 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 31:City/Town Clerk 4.0 Electrical Inspector 5Elumbing Inspector 6.DOther Contact Person: Phone#: A�oRoi CERTIFICATE OF LIABILITY INSURANCE DATE(MWDD/YYYY) 04/14/2022 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 NAME: Emily Costello Costello Insurance Group PHONE (978)374-6352 FAX (A/C,No,Eat): (A/C,No): (978)521-5127 2 S.Kimball St. ADDRIesS: ecostello@costelloinsurance.com PO BOX 5248 INSURER(S)AFFORDING COVERAGE NAIC# Bradford MA 01835 INSURER A: Colony Argo Insurance INSURED Commerce Insurance Co.INSURER e: 34754 Dipietro Home Energy Solutions,Inc. INSURER C: DBA Revise INSURER D: 32 Middlesex Street INSURER E: Bradford MA 01835 INSURER F COVERAGES CERTIFICATE NUMBER: CL2241402385 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 AUUCJUIbH POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM!DDIYYYY) (MMiDD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE 10 HEN i a) CLAIMS-MADE X OCCUR PREMISES Ea occurrence) $ 50,000 MED EXP(Any one person) $ 10,000 A PACEP308383 04/25/2023 04/25/2024 1,000,000 PERSONAL 8 ADV INJURY $ GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JE LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: pollution $ 2,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 ANY AUTO (Ea accident} BODILY INJURY(Per person) $ B OWNED SCHEDULED HS6326 05/09/2023 05/09/2024 BODILY INJURY(Per accident) $ AUTOS ONLY X AUTOS X AUTOS HIRED ONLY X AUTOS O NON-OWNENLYD PROPERTY DAMAGE (Per accident) $ Medical payments $ 10,000 X UMBRELLA LIAB X OCCUR 3,000,000 EACH OCCURRENCE $ A EXCESS LIAB CLAIMS-MADE EXC4245322 04/25/2023 04/25/2024 AGGREGATE $ 3,000,000 DED X RETENTION$ 10,000 WORKERS COMPENSATION $ PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE $ 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) CERTIFICATE HOLDER CANCELLATION Town of Yarmouth 1146 Route 28 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN South Yarmouth, MA 02664 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Gin el 65 M t;,' ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD '___1 DIPIEHO-01 CWOODSIDE AiCOfRO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDmYY) 4/19/2023 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 License#1780862 LionE CT Anya Toteanu HUB International New England PHONE FAX 300 Ballardvale Street (NC,No,Ext): I(NC,NO: Wilmington,MA 01887 Mu;anya.toteanu@hubintemational.com INSURE 8 AFFORDING COVERAGE NAIC# r INSURER A:Inds ndence Casualty Insurance Com n 11984 INSURED INSURER B: Dipietro Home Energy Solutions,Inc.,Joseph A.Dipietro Heating&Cooling,Inc INSURER c: 32 Middlesex Street INSURERD: Haverhill,MA 01835 INSURERS: 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. E _- POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILT RXCLUSIONMS ACPE INSURANCE RAN CONDITIONS ADDL sUeR'', LTR TYPE OF INSURANCE 'INSD SUER POLICY NUMBER POLICY EFF POLICY EXP IAL ERAL (MMlDDIYYYY)JMMIDD/YYYY) UNITS COMY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DPAMAGE ETEMISES E occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN't.AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JE p LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMB(Ea cid n�INGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS��� ONLY AUUTNOpSyyN BODILY INJURY(Per accidentL $ AUTOS ONLY AUTOS ONLYEp (Per as ER DAMAGE $ $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED 1 RETENTION$ A WORKERS COMPENSATION _ $ AND EMPLOYERS LIABILITY X STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE YfN WCI00142002 4/20/2023 4/20/2024 1,000,000 MFFICER/MEMBE�EXCLUDED? N N!A E.L.EACH ACCIDENT $ andatory in NH) 1'000'000 If yes,describe under E L.DISEASE-EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 , I , DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) cievmmedianzeoth CANCELLATION 1146 Route 28 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE South Yarmouth, MA 02664 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ?"-- '9::?:1.4—)—- ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD m rn m x<to Cl) !-N 0 O R7 U C_ O = a 0 `0 0 "0 < cnK car- p o mz3 x« cam �- s v 3 Z FZ• 6 ?WI t a 21 g e r ro 0 al mA DIn = 'i0 - ;1--I cFM = -.230 _ il aoMC0m' .-t 4* _ �nmg c) 0 aOaD; cn m 0 c w c-) s cry CD 1 54) k 0m O 0 m 5- n 5 .. 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"'nuai Circle Lilo- , Cusco Revise Energy planview Diagram Advisor Name: Addr mer '' 77,:x55 ta ` Qrrx,q� ess Town. v �� .4v< AnyIimitatians to access by truck? ySite I —_ �: greater of the two BAS n; _____ _(,3y3Q Use the when calculating for MVR 'L- CQ i of stories 1 1.5 2 2.5 3 BAS 1: 15 cfm X tt occupants,.nfactor - 7�j I n factor IS 16 15 .00583 X area X h �h X n-factor - jj t 14,4 13,7 BAS 2: 7 7 Z ) (1 lv�Q r Mechanical Ventilation Recommended:BAS*final CF M50> (0.7 X BAS) Mechanical Ventilation Required:(0 7 X 84 51>final CFM50 ig this part of a multi-unit worksco e? >6'Loose Insulation Cross-8att }6"Mix Looseix-batt Truss • P Y ort 1vS Multiplier? +Ynr$scope /,�, (�lam! re'�"'- '- rf��f� 3S?0 A,. (' ivy.s (Po (3 else✓' V �r c�`` ��1i �'� L7�i �j 1),,,, l2 1'��r ✓ 'r`i-�5, �� 6ao{� �S CD l2. , ,�- L�� t R J ?�''2�ZJ tu Z` �Se".1 j�v�J7r � �G4 ciP Crsk.,( tr" {-Pd l� Z5 2 tZs I �u of I' . 7 Z Any work sapped outside of best practices/approved by? / 7 2H w - - — _ t0/ , S�PAcr 5CV iti\i-i f4cL Ice 2�. nig / f.- 00 Area ^� _ Yr Built ( 1 gyp! Heat Yr Oa) t() DHW Yr Ventialtion SOFT 7SQFT!300 GY#"NA 40%Low/High Existing High Existing Low Rec Vents,# •'6/ Existing Propervents `G Required Propervents Soffit vent? Y N Ridge vent? Y N -STREET- _.(.... Gable vent?, Y N. Page of DocuSign Envelope ID:BD0A659B-42FE-4614-A2B8-24509B6D572D Page 1 of 2 Customer Name:Andre&Melissa Biscoto Email:Not provided Phone:786-804-3005 Premise Address:55 Prospect Ave,Yarmouth,MA 02673 Mailing Address:55 Prospect Ave,Yarmouth,MA 02673 Project ID:4813430 Date:April 15,2023 Job Description IMeasure Description Location Quantity Unit Total Cost Customer Cost AIR SEALING 6 hr $565.98 $0.00 ATTIC FLAT- R-30 UNFACED FIBERGLASS 380 SF $832.20 $208.05 12" MUSHROOM ROOF VENT 1 each $132.80 $33.20 BASEMENT SILLS: R19 FG BATT 88 SF $208.56 $52.14 CRAWLSPACE: R-19& RIGID BOARD 252 SF $1,695.96 $423.99 INSULATE BULKHEAD DOOR 1 each $68.83 $17.21 WEATHERSTRIP DOOR &ADD SWEEP 1 each $57.92 $0.00 ATTIC HATCH: INSULATE ONLY 1 each $35.00 $8.75 Duct Sealing -4 Hours (not insulated, up to 200') 1 each $348.36 $0.00 DUCT INSULATION 72 SF $288.00 $72.00 DocuSigned by: �WA "'� Lbrudot,t,DoocuSignedby: 5tart, SIt PJtSfb{D 4/15/2023 tort MALL 4/19/2023 EBF114142A5F478... Brenoon BO Kman DocuSign Envelope ID:BDOA659B-42FE-4614-A2B8-245o9B6D572D Page 2 of 2 Customer Name:Andre&Melissa Biscoto Email:Not provided Phone:786-804-3005 Premise Address:55 Prospect Ave,Yarmouth,MA 02673 Mailing Address:55 Prospect Ave,Yarmouth,MA 02673 Project ID:4813430 Date:April 15,2023 Project Total $4,233.61 Duct insulation incentive ($216.00) Weatherization incentive ($2,230.01) Duct sealing incentive ($348.36) Air sealing incentive ($623.90) Total Program Incentive -$3,418.27 Customer Total $815.34 —DocuSigned by: "--DocuSigned by: Ql StUAA Nato 4/15/2023 /_. 15b 4/19/2023 EBF114142A5F478... '-87DBOEC7753D446._. Brendon Borkman DocuSign Envelope ID:BDOA659B-42FE-4614-A2B8-24509B6D572D /mil/ Permit Authorization Form Site ID: Street Address: City: To be filled out by Subcontractor (if applicable) Contractor Name: Dipietro Home Energy Solutions DBA Revise Contractor Address: 32 Middlesex St Bradford Ma 01835 I Andre Biscoto a owner of the property listed above hereby authorize Revise Energy or my assigned subcontractor listed above to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property under the Mass Save Home Energy Services Program. pDocuSigned by: Owner Signature: Din 1 sofo "---EBF114142A5F478... Date: 4/15/2023