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Home My WebLink AboutBLD-19-1174 i'OBce Use Only -cit .:Lei Iso— •r ' H Amount r . ../. ',CC_ Na1 Penult expires 180 days afm :: ,:f....... 'issue date EXPRESS BUILDING PERMIT APPLIC •' = . E I V E D TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 AUG 27 2018 South Yarmouth,MA 02664 (508)398-2231 Ext. 1261 Bui • rill. • ' f` / Dv: G C. ' CONSTRUCTION ADDRESS: 2 p etc Pion el . VenvitAy'IllP,rf ASSESSOR'S INFORMATION: Map: /S / Parcel: /36 OWNER: Je4n ene Corn try 25' (e .4(,,;o, P kic On c.tityci t NAME t PRESENT ADDRESS TEL. II coNTRAcroR:e r Al Ir2c-f'n f SY towe, &vd a fit IGr nw/c. yttA Otetrr NAME MAILING ADDRESS TEL# fade /60 r•OZ 9 ta &)Residential El CommercialCommercial 2 Est.Cost of Construction S9,5 oo Home Improvement Contractor Lie.# 1417613 Construction Supervisor Lic.# ¢f 1J 1 Workman's Compensation Insurance: (check one) ❑ I am the homeowner i I/am the sole proprietor ❑ I have Worker's Compensation Insurance Insurance Company Name: t,/i t4 Worker's Comp.Policy# 1 S S 4✓(3 022 k N? )2/y WORK TO BE PERFORMED Tent _ Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacementpwindows:# Replacement doors: # Rooting: #of Squares Z t'/ ( ✓)Remove existing*(max.2 layers) Insulation ,' Old Kings Highway/Historie Dist. (Replacing like for like Pool fencing 'The debris will be disposed of at Y U'{z ivt 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 mot ion of my license and for prosecution under M.G.L.Ch.268,Section 1. Applicant's Signature: k—e#.— -- Date: p-/ 2e) 1 Owners Signature(or attachment) Date: Q 1 c Approved By .-_�, / Date: // --Ot? /6 • Building Official(or d�4� EMAIL ADDRESS: Zoning District: Historical District: 0 Yes CI No Flood Plain Zone: ❑ Yes 0 No Water Resource Protection District: Within 100 ft.of Wetlands: ❑ Yes ❑ No ❑ Yes 0 No .Q AC D CERTIFICATE OF LIABILITY INSURANCE DATE (MWDE 6) 3/ 18 THIS CERtFICATE 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 TIE COVERAGE AFFORDED BY THE POUCHES BELOW. 1145 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°es) mat 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 NAME:AJULI MCDOWELL Schlegel S Schlegel Ins Broker PHONE IAX (508) 711-0663 Nn PHI. (508) 771-8381 fAK' No�; 34 Main Street .Mu Mass achlegelinsurance8gmail.com West Yarmouth, MA 02673 INSURERS)AFFORDING COVERAGE MAIC• INSURER A:MOUNT VERNON RIMMED INSURER B;CNA TIMOTHY I(EATING DBA KEATING INSURER C: CONSTRUCTION 54 LOWER BROOK RD INSURER D: INSURER E: SOUTH YARMOUTH, MA 02664 INSURERF; 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. NOTWITHSTANDNO ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY TIE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONATIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR _ADL SUER--__— POLICY EPP POLICY EJP—____.._____—____..____ LTR TYPE OF INSURANCE INSR 1YYD POUCY MUMBER PMWPYYVY) (Mimi UMTS A GENERALLMBIlITY GL 2548741 3/20/18 3/20/19 EACH OCCURRENCE $ 1.000.000 ED X COMMERCIAL GENE PALLIABIUTY DAMAGE TO DfEs ace noel $ 500.000 CIARSMADE L X OCCUR - NED DP(Ary onepersm) $ 10.000 PERSONAL&ADV INJURY $ 1.000.000 GENERAL AGGREGATE $ 2,000.000 GENII.AGGREGATE LINTAPPLES PER PRODUCTS•COMPIP AGO $ 2,000,000 —1 POLICY n.FERC n LOC $ —. AUTOMOBILE LIABILITY (Es awned)ned51NGLLLMR IL PNYAUTO BODILY INJURY(Per poison) $ ALLONPED SCHEDULED - BOGEY INJURY(Peraccident) $ AUTOS AUTOS NAMAGE HIRED AUTOS AUTOS (Per PROPERTY 3 _ $ UM39ELLA1UI9 OCCUR EACH OCCURRENCE IL EXCESS LIAR CLAMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION 6S59UB0224N37214 3/9/18 3/9/19 TnRYIMIT¢ Dirt AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVEY/N EL.EACH ACO CENT $ 100,000 OFFICERMEMBER EXCLUDED? N N/A (Merebry bIn NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 REySeA oesaef under DESCRIPTgN OF OPERATIONS below EL DISEASE-POLICY LMR $ 500.000 CESCRIPTION OF OPERATORS/LOCATORS(VEHICLES (Attach ACORD101,AdlaaOal Renarb Schedule,Emma swat bngdna) TIMOTHY IDEATING HAS ELECTED TO BE COVERED UNDER HIS CURRENT WORKERS CONfPENSATION POLICY • CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED N ACCORDANCE WITH THE POLICY PROVISIONS. AUIHORTED REPRESENTATIVE I ®1988 21 t COR a ORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of A a - I Phone: Fax: E-Mail: The Commonwealth of Massachusetts t� l/ Department of Industrie.lAccidents Congress Street, n15LFI 1 Boston,MA 02114- 100ite 2017 wwwmass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual): j'I.1 ice {i I f Address: Sy I-owec &co Li j2) City/State/Zip: Vlrn]ol}z ir,A Phone#: So ch f 'Co Z, d Z Art you as employers Cheek the appropriate box: Type of project(required): 1.4 am a employer with I employees(full and/or part-time).* 7. 0 New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. Eld Remodeling any capacity.No workers'comp.insurance required] 3.0 I am a homeowner doing all work myself[No workers'comp.insurance required.]r 9. ❑Demolition 4.0 I am a homeowner and will be hiring contractors to conduct ail work on ury property. twill 10 in Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 50 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance 6.0 We are a corporation and its officers have exercised their right of exemption per MOL c. 14.❑Other 152,;1(4),and we lune no employees.No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowner who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tCont actors that check this box mus attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-oontracton have employees,they must provide their workers'comp.policy number. I am an employer thesis providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: C 4/4 Policy#or Self-ins.Lie.#: 6S-o R 072 Mw3 7 2► y Expiration Date: 71 1' /, Job Sitc Address: lb t t ap,•.u.. 17 City/State/Zip: nIaditee/1` /74/1"Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.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 Signature: N Date: Ff 12 7 /1 r Phone#: SdS-- 760 27UL Official use only. Do not write in Mis area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other • Contact Person: Phone#: Keating Construction Home improvement contractor registration: DATE August 11, 2018 143053 Quotation# 1 54 Lower Brook Rd So.Yarmouth MA 02664 • Phone(508)760 2702 timkeatinQ662'hotmail.com Quotation valid until: November 11,2018 Proposal for. Job name/location: Jeanette Camey Same 28 Campion Rd Yarmouthport Ma 508 362 9459 We hearby submit specificatons and dt5CaL,` ,3rae'� s�f.M , iiMe Y��", ;➢,`A^tf,i msµ€ t!,�'•. . $:wa Strip roof shingles off entire house Install water and ice shield on entire decking Install new vent pipe flanges Install new white 8 inch drip edge Install Certainteed Landmark 30 yr architectural shingles Install ridge vent at all peaks ' Option toinstall 2 new color power venting Velux Skylights $1500 each Option to install 2 new manual venting Velux Skylights,$750 each All debris and trash will be removed and disposed of properly Only items specified above are included in this proposaL Chimney flashing replacement is not included in this proposal Rotted wood repair is not included in this proposal. Materials guaranteed by manufacturers. Workmanship guaranteed by Keating Construction for 10 years. We ro ose Hereby furnish material p p s and labor for the sum of: $9,500.00 - to Senior Citizens discount included , 1/3 payment due at start of job and remainder upon completion Acceptance of Proposal. a 2 _eve'? Date of acceptance: Acceptance of Proposal Y �— a Date of acceptance: a-) 2r/ The above prices, specifications and conditions are satisfactory and are hereby accepted. . t • • • • } . ... " / c. Commonwealth of Massachusetts e Why meneneeh.G n/b//nuar/ra 11 i®1 Division of Professional Licensure Office of Consumer Affaib&Business Regulation • Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR ConstructiotiS'tIMM r Specialty TYPE:Individual - 1-•/•• . pealstratloq Exo32020 • CSSL-099351 rS' .:. ,,- �d[�ires•05/11/2020 143053 Of�113/200 Iel TIMOTHY KEATING DB/A KEATING CONSTTIM B KEATING 4 ` kit #—. tic - 54 LOWER BRIgOIC�RQAD ,e t- -, i TIMOTHY B.KEATING - \ yam_, SOUTH YARMOUATF7!Ig1�A61k 54 LOWER BROOK RD. • (� ° ,t7)IPSI4C� SO.YARMOUTH,MA 02664 Undersecretary ��✓ cl— ✓1 Commissioner