Loading...
HomeMy WebLinkAboutBLD-23-005994 /Y�q,, / I J / i1&/00 Office Use Only OFF �*'its'; Permit#• O ^y4H Amount 3 j-�� 4tofto ne" c, Permit expires 180 days from issue date L1L7 - 023- 0.5-clq EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH R E C E , V F D Yarmouth Building Department 1146 Route 28 272023 South Yarmouth, MA 02664 (508) 398-2231 Ext. 1261 rAPR BUILDING DEFARTME-NT 1' CONSTRUCTION ADDRESS: 51 South Sea Ave — -----__------__ ASSESSOR'S INFORMATION: Map:31/ 194/ / / Parcel: 2297 OWNER: Richard Wright 51 South Sea Ave 617-224-6190 NAME PRESENT ADDRESS TEL. # CONTRACTOR: Adam Glenn 235 Essex Street Whitman,MA 02382 781-205-4516 NAME MAILING ADDRESS TEL.# 0 Residential 0 Commercial Est.Cost of Construction$3000 Home Improvement Contractor Lic.# 181138 Construction Supervisor Lic.#CSSL-I 106148 Workman's Compensation Insurance: (check one) I am the homeowner I am the sole proprietor 0 I have Worker's Compensation Insurance Insurance Company Name: Federated Mutual Insurance Company Worker's Comp.Policy# 1847910 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 571 I I Old Kings Highway/Historic Dist. ( ) Replacing like for like Pool fencing *The debris will be disposed of at: Not Applicable 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 1. Applicant's Signature: C111 ' "'j Date: 4/24/2023 Owners Signature(or attachment)Federated Mutual Ins esr..o y Date: Approved By: f � Date: Building Official(or designe EMAIL ADDRESS: imemitting@homeworkseneroy.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 The Commonwealth of Massachusetts Department of Industrial Accidents - Office of Investigations - r Lafayette City Center J 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): Homeworks Energy Address: 235 Essex Street City/State/Zip:Whitman, MA 02382 Phone #: 508-644-8197 Are you an employer? Check the appropriate box: Type of project(required): 1.0 I am a employer with 500+ 4. 0 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. 0 Remodeling 2.El I am a sole proprietor or partner- ship and have no employees These sub-contractors have g. 0 Demolition workingfor me in anycapacity. employees and have workers' P h' 9. Building addition [No workers' comp. insurance comp. insurance.: required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all 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 Weatherization employees. [No workers' 13.11 Other 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: Federated Mutual Insurance Company Policy#or Self-ins. Lic. ft:#1847910 Expiration Date: 1/1/2024 Job Site Address: 51 South Sea Ave City/State/Zip:Youth,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 und r the pains and pe es of perjury that the information provided above is true and correct Signature: —1 Date: 4/24/2023 Phone#: 508-644-8197 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 3tCity/Town Clerk 4.0 Electrical Inspector 59l'lumbing Inspector 6.DOther Contact Person: Phone#: '4 DATE CERTIFICATE OF LIABILITY INSURANCE 12 1213012022 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 POUCIES 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 poiicy(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 Iorsernent(s). PRODUCER CONTACT FEDERATED MUTUAL INSURANCE COMPANY NAME: CLIENT CONTACT CENTER PHONE HOME OFFICE:P.O.BOX 328 (A/C,No,EXt):888-333-4949 (Arc,No):507-446-4664 OWATONNA,MN 55060 E-ADDRESS:CLIENTCONTACTCENTERAFEDINS.COM INSURER(Sl AFFORDING COVERAGE NAIC# INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 419-899-0 INSURER B: HOMEWORKS ENERGY,INC. INSURER C: 101 STATION LNDG MEDFORD,MA 02155-5134 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:0 REVISION NUMBER:1 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 SUER WV POLICY NUMBER IMPOLICY EFF POLICY EXP LIMITS LTR INSR D IMMIDDIYYYY) MIDDIYYYY) X COMMERCIAL GENERAL UABIUTY EACH OCCURRENCE $1,000,000 I I DAMAGE TO RENTED $100,000 CLAIMS-MADE X 1 OCCUR PREMISES(Ea occurrence) MED EXP(My one person) EXCLUDED A N N 1847909 01/01/2023 01/01/2024 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE OMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO- POLICY PRO JECT l LOC PRODUCTS-COMP/OP AGG $2,000,000 X OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE OMIT $1,000,000 (Ea acddand X ANY AUTO BODILY INJURY(Per person) OWNED AUTOS ONLY SCHEDULED A _ _AUTOS N N 1847908 01/01/2023 01/01/2024 BODILY INJURY(Per accident) HIRED AUTOS ONLY NON-OWNED PROPERTY DAMAGE AUTOS ONLY (Per accident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $1,000,000 A EXCESS LIAB CLAIMS-MADE N N 1847911 01/01/2023 01/01/2024 AGGREGATE $1,000,000 BED ( RETENTION WORKERS COMPENSATION X PER STATUTE OTH- ER AND EMPLOYERS'LIABILITY Y I N EACH ACCIDENTANY PROPRIE TOR/PAR7NERlEXECU7IVE � E.L. $500,000 A OFFiCER/MEMBER EXCLUDED? I NIA N 1847910 01/01/2023 01/01/2024 E.L.DISEASE-EA EMPLOYEE $500�000 (Mandatory In NH) If yes,describe under E.L DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) THIS COPY IS NOT TO BE REPRODUCED FOR ISSUANCE OF CERTIFICATES. CERTIFICATE HOLDER CANCELLATION 01 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN A CERTIFICATE HAS BEEN FILED WITH EACH OF YOUR CERTIFICATE ACCORDANCE WITH THE POUCY PROVISIONS. HOLDERS. AUTHORIZED REPRESENTATIVE402/401,14.,4 t 7 O 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marts of ACORD c. .. w Z u 0 ?. G C G E - 4' h. Ale VI c a U _ Q � L' Ty ... L. i C u tr W O G (.4 (NI 13 i 7 et 4.0 M O �cON N w c to N G. 03 O M mI. pwI . U�o Q 13 o c c U a � + W O oo w �� co U ° '= O o fl u -irt ,v' « � � O 740 Cn in 0 VJ VJ L {.. i W �+ I. re • 1 4 ..2 . i i i 1 1 il E,. `. l0 7 .0 0.1 .w+ il 0 co flu h p"Cl p t Q Z V pO �� ,ff g� Hill Z E J. 1 1010 I r Q ED- I • V) O O x.'It ppm c `\If 01 U 1 0 W _ u) mo c (0)::: !: :. CNC-N-111,). 1'i 1 '''''-'14:::4:/: < 7 0-..:-.- -9 pill=t11't.. '!,.?... ttl °" W Q 0 X W• U Li w YJQ Wa Da;�co Z L i.1 co Z m y RM > Q +C3 _ ILI CO d .3 �` Q o• c Ls d w 3 c, F- p W z o d cl 2 owo uwi as O w vp • z t _.-2 w m = zp2 w O Qo2 DEBRIS DISPOSAL AFFIDAVIT In accordance with the provisions of M.G.L. c. 40, s. 54, Building Permit 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: HomeWorks Energy Name of Waste Facility Not Applicable - No Debris 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-6th Edition Signature of Permit Applicant 4/24/2023 Date Insulation/Air Sealing Permit Authorization Specialist: Ryan Mgrdichian Company: HomeWorks Energy Email: ryan.mgrdichian@homeworksenergy.cc Address: 101 Station Landing Cell: 8603947804 Medford,Ma 02155 Phone: 781.305.3319 Customer: Richard Wright Address: 51 South Sea Avenue Email: rjwiron53@gmail.com Yarmouth, MA,02673 Site ID: 4794721 Phone: 6172246190 I, the owner of the property identified above hereby authorize HomeWorks Energy Inc., or their Partner to act on my behalf in obtaining any building permit that maybe required to perform insulation and/or Weatherization work on my property and all matters related to the work authorized by said permit if one is obtained. Any related permit application cost will come at no additional charge provided that the agreed Weatherization work is completed. In the event that a permit is pulled on your home for insulation and/or weatherization work, you may be required to have a final inspection of the work scheduled and performed by the building inspector in your town. If required by the town, you will be notified by HomeWorks Energy that an inspection is necessary with instructions on how to complete this process to close out your permit. Email: rjwiron53@gmail.com Customer Ong ) / ,,,; Signature: f/ Date: 4/6/2023 Richard Wright For Condo Owners: If you have property oversight by a condo associationt, please have the association's authorized person(s)complete and sign the section below. Please email this document to wxpermitting@homeworksenergy.com once completed. We, being the duly authorized representatives of the association Name of association or management companyt or management company have reveiwed the plans and specifications for improvements to the address specified above. We further acknowledge that the above listed owner has given notice that they intend to seek permits and to carry out the proposed work. Signature of representative Date Print Name t Other unit owners may sign when there is no association. tb" Cc sA\ilik L 2i -ts —� '— PLAN VIEW Name: tom. Is CLAtio r' Site ID: t 1,1- — a�1 2\ Finished Sq. Ft: ck 1 Phone: Z.{6("'l)2.Z` -Ca :,r� Year of House:t w cj ta4 Electric Acct#: I'-t2'-y'Z2o' c\ Address: 5 L Q '4k s ,k, ,rt #of Floors: t Gas Acct#: Q5 112? 1 \202_ °{Cis d Nt4 l 1'�1, Unit n. t #Occupants: t Housing Type? ktr DUCTWORK INSPECTION Ducts Insulated?� r(tkw! 1-3 (aL-' at D/1't ,,- k e5° VIS Duct Linear-t II uct Square Ft. 1kuct Air Sealing Flours1\\\)1\Px Duct insulation (pc w! ; Duct Insulation Removal ! i -C, BASEMENT INSPECTION 2., :E I ns y Spy La/Sq. Ft. plc- 2''I tar -c tlI1rs - vs gSmt Wall A �° 1 + 54U c f Crawl Ceiling l ' 2,1,4i Crawl Rirn Joist I 4- Esmt RJ vil Sill R--1 l ' 12.9 rr .1 85mt RI NO Sill 1 ; Vapor Barrier ,----.soft, Ssmt D,.>e-'----.._. lc- - V Yf N Blower Door? WALLS&GARAGE Drill Location? Siding 'Cell.Height ( Existing Sppee,',ing ( Sq.Ft, Framing Exterior Wail 1 w$, l'�S(L I 1 I 12—\3 {*J I ----- 2 '1 x1(t Balloon t7 rm Exterior'.Vall 2 x x Balloon/Plat-form l Overhang I i x x Garage Wall t; x x Balloon/Platform Garage Ceiling - x x r z ...z. T____Ie 1„I ( .5 X w (9° G 2 I I CD 150 4 cifbir Pt— "_J"\r,, ut _or.F frovl t v:ee*F4 ;sue ' WX Stripping:--*_ WORK SPEC'D BUT NOT CONTRACTED MAD BLOCKS PRESENT? MANDATORY) Attic Easement/Crawlspace Other: K&T Y Ni riv?oisture Y Of Combustion Sfty IY C ' Kneewall Overhang/Garage Asbestos Y/ rvlold:100 sq.ft Y/ CO Detector Missing IY N Ductwork Exterior Walls n�Veri i i Le v / Sts uctl Concern Y/{�Other: Notes for Lead Vendor/Work Not Contracted: r crre_cro-c., c~ I ye! .70 r i KW WALL AND KW FLOOR Blind Spec? <--` OR - KW SLOPE AND GABLE END BEind Spec? 0 NANGEXIcTING S"f y'1'd .FT Kikijf 'ANIING 'EXISTING SP£C'NG SO.FT WALL X X W SLOPE ,x; F.OQR x / GABLE. x :L CCF55 X > '` -BANS x X ; z Pal s j } x py TIC `.' A` , 1 rr -4AT`:s;[ SLOP£ x x ,,,, , r. N S_OPE x X EXISTING VENTING% " ii EXISTING VEN—ING? EXISTING PIPES? YIN ,' in'' ~c1::G �s hntt .. .r -.s; kr er �^c«A.ccs, ' KNEEWALL MANDATORY , 1 a • 2 x I2-i,{12' C.V. • 12' oG( ( a !) . 445 T` DJhL : Zv e7P10," 14 f p,v‘ht'rce. =; r a a(L ve. i 9 GAr.4.c.` 2 FLQor QF ® Aig �79 z F c+r�s Cl 3- °gc 7( 2.z cs , 54 pito,t. rS 0 V& Ji g.c, ro 64 ,c,v c F 3C 4 I-:.;aced Wall X X Fred Ugh,.O t.s 4ccel fkF I vent H :FR'1 • ...x .— ,2 v"A„.',_2 ..•u. _ter, ;,`toAceess C„1!ccwm ds: s•A,e., a ... ..3.: , -"co,:,, s x+ r. ..,a. `�: BAS Vol: x .0058 E ;: 2 x(g xl to ATTIC 1 Dune Spec? 0 x ATTIC 2 Blind Spec? X 412 s ors. 2 Existing pec i ,_ ` �+ _3.E(3ston;) e Sq Existing Sn ec nE, so ft noored j2"rtixo I Multipliers 5 U ' t, u 3 ( ^ J E0 kt Linfloored 1 Trusses Cross 8amng Floored G.`44. C5 AA - 2r . Floored V u..!nsvlais0. Duct Work Cath Slope , r-- - Cath Slope r ' J it None v Air Sealing Hours Walls -- -� 1------- '..-^ Waits I • Access T.-I,D J —~ Access 1 � L n3r1 Propa _•t; _ tV"1` L-Lne 1 P.. .^-' " r c; e t;iv I;z s Dar 'nr. calr r I ii-r n y .-- J a. 1 Sli a .In ._A. ..a: VI r -nI ^t L.c0;'e's:✓ :o.:'J 3(1':- ._. it. 1: FI.C,, t .r 3 : ...:. .t.•✓ . ;.; - o :A Jcnttr;s) Roof TYpe;1 Li- Existing Venting? Ex!srng.Venting Page 1 of 2 {�;t 101 Station Landing Ste 110, y Medford,MR 02155 Energy mass A save (781)305-3319 Energy �s Customer Name:Richard Wright Email:Not provided Phone:617-224-6190 Premise Address:51 S Sea Ave,Yarmouth,MA 02673 Mailing Address:51 S Sea Ave,Yarmouth,MA 02673 Project ID:4805166 Date:April 6,2023 Job Description Measure Description Location Quantity Unit Total Cost Customer Cost AIR SEALING Other 8 hr $754.64 $0.00 COMMON WALL-4" CELLULOSE Other 160 SF $369.60 $92.40 ATTIC FLAT-3" OPEN R-11 CELLULOSE Other 764 SF $977.92 $244.47 VENTILATION CHUTES Other 54 each $188.46 $47.12 6" - VENT BATH FAN TO ROOF OR ALTERNATIVE Other 1 each $156.75 $39.19 Project Total $2,447.37 Weatherization incentive ($1,269.55) Air sealing incentive ($754.64) Total Program Incentive -$2,024.19 Total Contractor Price and Payment Schedule HomeWorks Energy, Inc.agrees to perform the above described work,fu rnis hi ng the material and labor specified for the listed total price. Payment of the balance of the customer contribution is expected upon completion of the work. Customer Signature: Date: Customer Phone: Specialist Signature: Date: LIMITED TIME OFFER The prices and incentives in this contract are subject to change in accordance with the sponsoring utility MassSave Home Services Program offers. Proposals con be sent to:Inbox@Horn eWorksEnergy.corn Page 2 of x` HomeWorks '� © r c 101 Station Landing Ste 110, ffl €`� L/ �r1 .7 mass save Medford,MA 02155 11` Energy PARTNER �781)305-3319 Customer Name:Richard Wright Email: Not provided Phone:617-224-6190 Premise Address:51 S Sea Ave,Yarmouth,MA 02673 Mailing Address:51 S Sea Ave,Yarmouth, MA 02673 Project ID:4805166 Date:April 6,2023 Customer Total $423.18 Total Contractor Price and Payment Schedule HomeWorks Energy, Inc.agrees to perform the above described work,furnishing the material and labor specified for the listed total price. Payment of the balance of the customer contribution is expected upon completion of the work. a'114 R Customer Signature: f ---- — ------ Date:Customer Phone: Phone: Specialist Signature: _— Date: LIMITED TIME OFFER The prices and incentives in this contract are subject to change in accordance with the sponsoring utility MassSave Home Services Program offers. Proposals con be sent to:lnboxC HomeWorksEnergy.com