HomeMy WebLinkAboutBLDSM-19-001073 a
RECEIVED
or r'_ SHEET METAL PERMIT AUG 22 2018
Commonwealth of Massachusetts
Town of Yarmouth Building Department Bua 5 „,_
1146 Route 28, South Yarmouth, MA 026644492
Date: Edda//6 Permit#: �LLlsm-14—Colo'73
Estimated Job Cost: $ 1&,900. Permit Fee: $
Plans Submitted: YES/NO Plans Reviewed: YES/NO
Business License# (:)17) Co$ 709(o Application License# q 12a
Business Information Property Owner/Job Location Information
N v qt.)o 10ci po(i+-TA a D134)
Name: He4 -i.t#C.0.4. Co»cep{-s Name:L1/45 learn GIovc-R
Street: 9?.O_ box 047 Street: 71 SI vet iesc Rd
City/Town:txryart„o.�l, Yn 0263 City/Town: tp.yarmotJJl,, fl' 4 .
Telephone: 508' 99 ss LP- q Telephone: 7? 4 - S, 3 G,
Photo I.D. required/Copy of Photo I.D. attached: S NO Staff Initial:
1-1/ rrestricted license
J-2/M-2 restricted to dwellings 3 stories or less and commercial up to 10,000 sq.ft./2
stories or less
Residential: 1-2familyV Multi-family_ Condo/TownhousesOther_
Commercial: Office_Retail_Industrial_Educational Institutional_Other
Square Footage: under 10,000 sq.ft.✓i over 10,000 sq.ft. Number of stories:
Sheet metal work to be completed:
New work✓ Renovation: HVAC:/ Metal Watershed Roofing:
Kitchen Exhaust System: Metal Chimney/Vents:_Air Balancing:_
Provide detailed description of work to be done: )(1 T F l oo r
h k
ins \ G.o,oba )
' o cc,t I,.SI, tcc• nc41 u, l 44 $ COrn4•� a .s/ 4'onS
IC- Cat 1ST ?loot onlc,l ail eluc7' v4-ed »suitfeel I•o cod,,c
Ron ool's c Lc�cgylL .c eoAc
2e4 T to) f
a 40b0 7570 1lec4- ?,, .., P c I bobaocc a por\' u ' A
OIAUC_- Fes 4— nix deal
INSURANCE COVERAGE:
I have a current liability insurance policy or its equivalent which meets the requirements of
M.G.L. Ch. 112 Yes 'i' No
If you have checked Ye, indicate the type of coverage by checking the appropriate box below:
A liability insurance policy / Other type of indemnity Bond_
OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by
Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waives this
requirement.
Check One Only —
C� Owner Agent
Signature of Owner or Owner's Agent
By checking here—) 17,I hereby certify that all of the details and information I have submitted for entered)regarding this application are true
and accurate to the best of my knowledge and that all sheet metal work and installation performed under the permit issued for this application
will be in compliance with all pertinent provision of the Massachusetts Building code and Chapter 112 of the General Laws.
Inspections shall be called for prior to insulation installation.
Duct inspection required prior to insulation installation: Yes_No
Progress Inspections
Date: Comments:
Final Inspections
Date: Comments:
Type oflicense:
M
By: ✓ Master
Title: Master-Restricted Signature of Licensee'P
City/Town: Journeyperson
Permit#: Journeyperson-Restricted License Number: 4 13 a
Fee: $ Check at www.mass.gov/dpl
da-
4'Inspector Ignature of Permit 4
of Permit Approval
4%fl CERTIFICATE OF LIABILITY INSURANCE DATEoryDM
ID
30/18
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 pollcy(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 CertIOCato does not confer rights to the certificate holder In lieu of such endorsement(s).
PRODUCER CON/ACT
NAME: JIM HINDMAN
Schlegel&Schlegel Ins Broker `E[p(H�NNEqE)dl: 508-771-8381 (FAX
A/C.No): 508-7714663
34 Main Street DD .
ARR.Ess schlegeilnsurance@gmall.com
West Yarmouth,MA 02673
INSURER(S)AFFORDING COVERAGE NAL a:
INSURER A: PHENIX MUTUAL
INSURED INSURER a: LM INSURANCE COMPANY
Nunzio L Jr Napolitano INSURER C:
HEATING&COOLING CONCEPTS INSURER D:
PO BOX 247
YARMOUTH,MA 02673 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 OFANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCEAFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
'IN EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
Tv TYPE OF INSURANCE I 'AVD POLICY NUMBERPOLJCYEFF POMCY EXP
MED (MN/DOM'YY1 (N M/OD/1'YYY) LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 100,000
UAMAGb IU RbN r ED
CLAIMS-MADE X OCCUR PREMISES(Es=wends) $ 50,000
MED EXP(Ary one Perm) $ 5,000
A _ CPP0703689 02/28/18 02/28/19 PERSONAL&ADV INJURY_ s 1,000,000
GEHLAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000
POLICYO•
�JELOC PRODUCTS•COMP/OP AGG $ 2,000,000
OTHER: S
AUTOMOBILE LIABILITY COMBINED SINGLE UNIT $
—
(Ea accident) _
— Y AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS ONLY — AUTOS PROPERTY DAMAGE
$
—
HIRED NON-OWNED
_ AUTOS ONLY _ AUTOS ONLY (Per accident)
$
UMBRELLA UAB OCCUR EACH OCCURRENCE _ S
—
EXCESS UAB CLAIMS-MADE AGGREGATE $
OED I RETENTIONS $
WORKERS COMPENSATION PANNE EMPLOYERS'LIABILITY Y/N x STATUTE I I ER
ANY PROPRIETOR/PARTNER/EXEC/ME EEACH ACCIDENT $ 100,000
B OFFICER/MEMBER EXCLUDED? Y❑ Et WC-0212304 05/08/18 05/08/19
(Mandatory In NH) EL DISEASE-EA EMPLOYEE S 100,000
M yes,describe under
DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ 500,000
•
DESCRIPTION OP OPERATIONS/LOCATIONS 1 VEHICLES(CORD I01,Addltlmal Remarks Schedule,may be•eached it mora apace Is required)
NUNZIO NAPOIJTANO HAS ELECTED NOT TO BE COVERED UNDER HIS CURRENT WORKER COMPENSATION POUCY
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
IN HAND ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESEN
I
®19 2 15 ACORD CORPORATION. All rights reserved.
ACORD 26(2016/03) The ACORD name and logo are registered marks of RD
. .... ,
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":t'COMMONWEALTH OF MASSACHUSETTS -7
-DIVISION OF PROFESSIONAL LICENSURE
SHEET.METALWORKERS
ISSUES THE FOLLOWING UCENSE (. ,-.. •I.. 5
"(T •
..:-. .:MASTER-UNRESTRICTED ..-
. . .
NUNZIO L NAPOUTANO -'.--• ;.4!
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W YARmgypi,MA 02673-3207. '.:‘,,c2-. .1 ft ..4.--/ •
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