HomeMy WebLinkAboutBLD-19-985 a
s.a•......„.:w......«..,.�.,..w....«..... ......rx.umr.avxw..«.,a...,. . ...,u...w....> Auu....b.-u...w.... wrnr...nurwaw�sxua.wY.wYs_� cm...•.w..i.+wew .,.mrw+ »anx•.M •w.e._ i.Y..r.uwu
c nnCe Cmn.k or
U,,,,„ ce:I:a(hey
tin i
k.
t t ' 1
Pemm t.pirc,Is6 dam hem
- - issue este / X:
EXPRESS BUILDING i'L RMi I'AI'1'LICAlJON m.._.._. . x-- •
-
- TOWN OF YARMOUTH - l'
Yarmouth Building Department - •.------. 1
1146 Route 28 - - .1— j
South Yarmouth,MA 02664 . '; ' 7 °u1;u i
(508)398-2231 Ext. 1261 �E,)r
CONSTRUCIIOY ADDRESS:tJw. •,ar_r).7) - w.'sr YGpncte 'y l ,lgsasz t
ASSLSSOR'S I\CORhL1?70N;
Map: Parcel: -
- O"alt;.._CObLit 4 _......5110 MA1°raSs Ul f}#1S_ —IP
5111R_76F 47/J . ry:
CtNTRACTOR; 1'i arS6nN Pew}•( lh.r.1lkn1 ”
._ ....5J` ) 7.1',t),t}'•�14� Puy) gni'Pk) e3-nt.
NA+Ie J V yp u ,A '1 ADDRtSS TCI 1 r?')'f-'14(�13 t,C,
O Raidemial- - , . lffommerelal Est.Cost of Construction S a 5000 •"t/_-._, -
Home Improvement ContnaorLie:ft ' - —c - Construction Supervlor Lle..- i—a4 /ter ii2g6d
• - Wockman'a Compensation Insurance: (check one) ' -
1 am the homeowner r 1 am the sole proprietor .( Matte's
Wmker s Compensation Insurance i o '
IRS' t
ga ' Company-ComName: I nOM( LACA
C ) •3f1/ • Matte's Comp .Policy# WC-c3r1,�b1 0� 1°1
WORK TO RE PERFORMED
'Tent _ Duration - (flue Retardant Certificate attached?) Wood Store.
tSiding: aofSquares (2) '-:Replaccneentmindowscp . - . . Replacementdlwn: if ' . - •
Roofing: #of Squares t eS _ (tel Reinore existing'(max.2 layers) - - Insulation
. ; Old Kings Digliway/Ilistorie Dist, ( )Replacing like for like Pool tension • ,
•me dcbth ulilbeditposcd orae: (9evocs' -. 1•/i52US4't, - .Y ..
location or Utility _..._.,
- . - - I deelut soler penalties a yahoo that the umenrttns baths contained are tragi and correct to Me best of my knowledge and bare[ IondmtandOwl airy fahe enrxr.(s) -
_ Mll be just woe for*Mal et M»twion • t lice and lb:prorcnnioawide.M.O.E.Ch.268,Section I. - -
'Apph.amY SiBnuwt .%'• �R /i 4 / Oar V �
, Pi 10
-Al atnt�enalme let atbebm - _ �-e;" ,i-.,--,r . .. • aawC. .6 -.
MPm,edfht - Q >", ,►` Dao . `/8
dos8 ts(r<ln)( • algace) 1 MAIi AlinRtss
_, _ IIIW.n;ent r)i,lriac s Ye,• .No •I loud Pinta Xanr i !Yes No ,•
• Water Resource Prounion D'eaein• - Within 100 a of Wedvwts: '- . - -
r
�� ealth of Mass -- — _
Division of Professional Massachusetts --
Boartl of Buildingnal Licen �e ,"_ -Regulations sure aiizuioi eoeez// / .
COnstryni�n-SU ns and Standards j _- Office of Coesumer Afiairsg���^es
CS-042560 P�fVisor I •
t1tfL_• HOME IMPROVEMENT CONT e9�lation
•
1 i i : ' . r:'` TYPE: RACTOR
•
.. ", EX ire I Intlividual
,P s:01/06/20 R i ra i
DAVID A CLEARY — 20 i 111235--, it tl n
411 PINEC " DAVID A CLEgRY_'_z•. _ 10018
E FALMOUTH�Sr BEACH DRi D/B/A D.C.BuildetS
•
MA
DAVID CLEARX:;'' r '., '
02536 s";' 411 Pinecre MADC, Undersecretary,
nde e ,.
yy�� E Falmouth, Beach ' a `""fr
-
Commissioner /� MA 02536—
IUndersecret •..
Unrestricted- Construction Supervisor __ -- --- ` �./rr�o%O
less than 35,000 c Buildings of any :-- -"
cubic feet(991 cubic mete which contain ��—! dr°` ,wrwrwr r cONT�CTOR
un
space. sl of enclosed Office of G ImpliO�MENT
CONT
tiOWIE IMPR Individual
:,r,.-E^ a • TYPE:
tio
t11r23» lyoazola
•
to :-
DAV•
ID A CLEARY C
Possess a c DB/A D.C.BuiW? - ..
eeretaIl
State Failure to
ng Code current edition oft DAVID CLEAR
- h Dr, •
is cause for revocation Massachusetts
q11 Pinecrest MBA o36.— Unders
Call(61)j27� �1On about this license this license. , E Falmouth, M1
Or Visit wwWmass.gov/dpl .
r
•
•
•
•
.
�e r�oeaftI mmoset oilb1Yan acAare't .-
Office of Consumer Affairs&Business Reg ation
•, i HOME IMPROVEMENT CONTRA OR . . License or registration valid for Individual use only
a a Type: Corporation before the expiration date. If found return to:
•�, 'jiegls�ration x•I : 1• Office of Consumer Affairs and Business Regulation
,�' =^*` ,, .€ .-11-_185836 08/ t 018 10 Park Plaza-Suite 5170
Boston,MA 02116
LEON PINSONNEALT'-v, ,
BUILDERS INC 1\ 4t 1-___I ' p
. --7
LIONEL PINS B LT . t Oi�O��,_— l{� i*,/ t fir
541 THOMAS B LANDERS RD. a ///��/'� ��"
EAST FALMOUTH, MA'02576 Undersecretary Not valid without signature
' DATE(MMND/YYY'n
ACORDa CERTIFICATE OF LIABILITY INSURANCE TE(MWDD1B
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 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 LON TACT
NAME; Susan Lafleur
THOMAS J WOODS INSURANCE AGENCY INC 'I,"$"r;` Em• (508)755-5944ISAfi
I,C N.�;
MPRF33' Slafleurewoodslnsurance.COm
20 PARK AVENUE N$URERIS)AFFORDNG COVERAGE _UACs
WORCESTER MA 01813 INSURER At LM INS CORP 33800
INSURED INSURERS:
LEON PINSONNEAULT BUILDERS INC INSURER C: .
INSURER D:
14 OPEN HEARTH DR crush e t
WEST WAREHAM MA 02578 INSURER P:
COVERAGES CERTIFICATE NUMBER: 298968 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED MOVE 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 SM POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE JD wen POUCY NUMBER INM@WYYYYI IMMNDIYY'IYI LATS
JCOMMIERCIALOENERALLNeILRY EACH M/VATOOCCURRENCE $
DAMA4ETORENtC
CLAIM-MADE OCCUR PREMISES 1occurrence) $
Mpw
a occurrence)
MEDEXP(M1 eem) $
N/A PERSONAL 4ADV WORT $
OEM.AGGREGATE LMITAPPLES PER. GENERAL AGGREGATE _ $
RPOLICY IRJOE& u LOC PRODUCTS-COMPIOP AGO {
OT"EIt ' 5
AUTOLIOSLE LIABILITY ( O occident)
INGLE LIMIT $
ANY AUTO SONY INJURY rye Ninon) $
— ALL OWNED SCHEDULED— AUTOS — AUTOS N/A GODLY INJURY(Per laced) S
_ MIRED AUTOS _ AUTOS
ED Eddn PERTY OE {
$
_ UMBRELLA LIAR OCCUR EACH OCCURRENCE 3
_
EXCESS CAE__CLAIMS-MADE N/A AGGREGATE s
DED IRETFNTON{. �/ q. _�^—o _
IAM EM � $�� –
WORKERS COMPENSATION XIP` ur! I I ETll-
RPLOYERS'LMladTY
ANYPROPRIETawPARTNEwEFEIXRLE
A NE YIN ElEACHACCIDEM {_1,000.000
A OFFICER/MENSES EXCLUDED? WA WA WC531S618501018 02/25/2018 02/252019 --'
IMandel.rY le NH) E L DISEASE-EA EMPLOYEE S 1,000,000
II ea desalt»ender
DESCRIPTION OF OPERATION$below E L DISEASE.POLICY LMT s 1,000,000
N/A
DESCRIPTION OF OPERATIONS I LOCATIONS?VEHICLES(ACORD 10/,Addldanel Remarks Schedule,may be attached IIIc,•spew le r.av"ed)
Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B.no authorization Is given to pay
claims for benefits to employees in states other than Massachusetts If the Insured hires,or has hired Biose employees outside of Massachusetts.
This certificate of Insurance shows the policy In force on the date that this certificate was Issued(unless the expiration date on the above policy precedes the
Issue date of this certificate of Insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage•Coverage Verification
Search tool at www.mass.govAwd/workers-compensatioMnvestigatlons/.
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
Avm^oRITEOREPwENTATrve
South Yarmouth MA 02664 Daniel .Or y,CPCU,Vice President–Residual Market–WCRIBMA
I
01988.2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD