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BLD-19-1850
• office Use Only Y t .: �S., Permit% o t,sk . yv Amount Nfi Permit expires 180 days from issue date ab-cq-ooi . c) EXPRESS BUILDING PERMIT APPLICATICdlt C E I V E 0 TOWN OF YARMOUTH Yarmouth Building Department SEP 27 2018 1146 Route 28 South Yarmouth,MA 02664 Bul I ,.V a' TVLlr, . ( 508)398-2231 Ext. 1261 By: CONSTRUCTION ADDRESS: 4 1p�'e.N5.1 -4- St 5. (gon'1Jv 1tt ASSESSOR'S INFORMATION: Map: Parcel: e OWNER: PAttj{. ColCttilciv% VA (IG.5gh t Si. S. VIvrtdi-lt NAME PRESENT ADDRESS TEL. ii CONTRACTOR: ULJ.tkcart a Tent' 'i4 Pqr tSS \ hMethink lai... S. Otf1n.S NAME MAILING ADDRESS TEI 503 -',3q,"-etODD Vesidential ❑Commercial Est.Cost of Construction$ 6 cot.,,0 0 Home Improvement Contractor Lie.# Construction Supervisor Lie.# Workman's Compensation Insurance: (check one) ❑ I am the homeowner ❑ I am the sole proprietor E have Worker's Compensation Insurance Insurance Company Name: L'CS W M S..Ygnt t (° Worker's Comp.Policy# MA/(. 331 47 Z 7 Ot5 \C,,.1�,,`r'`!1\ tt WORK TO BE PERFORMED Tent Duration w V it —to'? (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares ( )Remove existing*(max.2 layers) Insulation Old Kings Highway/Historic Dist ( )Replacing like for like Pool fencing 4,oX`70 t 2o' *0 * lei Xtko ►„edt°6„g *The debris will be disposed of at: Location of Facility 1 declare under penalties of perjt� t.. n herein contained are true and correct to the but of my knowledge and belief. 1 understand that any false answer(s) will be just cause for denial y • license and for prosecution under M.G.L.Ch.268,Section 1. Applicant's Signature: / Date: I / c 7/ Z ut �/ — Owners Signature rirachment) 5C<- 011 1wC Date: l( Z7/td Ib Approved By CC 4- Date: -f ' 17 -/8 Building Official(or designee) EMAIL ADDRESS: Zoning District: Historical District: ❑ Yes 0 No Flood Plain Zone: II Yes 0 No Water Resource Protection District: Within 100 ft.of Wetlands: 0 Yes 0 No 0 Yes 0 No UNDER-1 OP ID:MIKE ' ACORD, CERTIFICATE OF LIABILITY INSURANCE DATE (UI%D e PRODUCER Phone:617.479-5500 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION DPS Insurance Group,Inc. Fax:617-479-8761 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Granite Ave.,Suite 2 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 500 500on,MA ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 02e6 Daniel P Sullivan COMPANIES AFFORDING COVERAGE COMPANYArch Insurance Company INSURED Undercover Tent&Party COMPANY Tony Prizzl b Quincy Mutual 31 American Way South Dennis,MA 02660 COMPANY C Wesco Insurance Co COMPANY D COVERAGES 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. TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MMDD/YY) DATE(MMDD/YY) GENERAL LIABILITY BODILY INJURY OCC S A COMPREHENSIVE FORM PRPKG0008601 11/21/17 11/21/18 BODILY INJURY AGG S PREMISES/OPERATIONS PROPERTY DAMAGE OCC S _ UNDERGROUND PROPERTY DAMAGE AGG $ EXPLOSION&COLLAPSE HAZARD _ PRODUCTS/COMPLETED OPER BI 6 PO COMBINED OCC S _ CONTRACTUAL BI 6 PD COMBINED AGG S INDEPENDENT CONTRACTORS PERSONAL INJURY AGO S BROAD FORM PROPERTY DAMAGE — _ PERSONAL INJURY AUTOMOBILE LIABILITY BODILY INJURY B _ANY AUTO AFV206208 11/21/17 11/21/18 (PER PERSON) 6 ALL OWNED AUTOS(Private Pass) BODILY INJURY XALL OWNED AUTOS (PER ACCIDENT) S (Other than Pnvate Passenger) X HIRED AUTOS PROPERTY DAMAGE S X NON-OWNED AUTOS GARAGE LIABILITY BODILY INJURY 6— PROPERTY DAMAGE S 1,000,000 . COMBINED EXCESS LIABILITY EACH OCCURRENCE S UMBRELLA FORM AGGREGATE S - OTHER THAN UMBRELLA FORM S WORKERS COMPENSATION AND X ITORY LIMI S I I ER , EMPLOYERS LIABILITY EL EACH ACCIDENT S 1,000,000 — C THE PROPRIETOR/ INCL WWC3314727 11/21/17 11/21/18 EL DISEASE-POLICY LIMIT S 1,000,000 PARTNERS/EXECUTIVE — OFFICERS ARE: EXCL EL DISEASE-EA EMPLOYEE S 1,000,000 OTHER A Equipment Floater PRPKG0008601 11/21/17 11121/18 Equipment 600,000 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS Party Goods Rentals CERTIFICATE HOLDER CANCELLATION PAIGECO should any oftile above ascribed policies be cancelled before the , EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL Paige Coleman 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, 214 Pleasant Street South Yarmouth,MA 02664 but failure to man such nonbe e an impow no obligation or Itslry bll of any Mind upon the company,Its agents or nspnaantativees. AUTHORIZED REPRESENTATIVE i ,./�'L"^ y`w ACORD 25-N(1/95) ©ACORD CORPORATION 1988 The Commonwealth ofMasaehusettr e :_y = ! Department ofIndustrial Accidents • _::m- s 1 Congress Street,Suite 100 cvBoston,.M4 02114-2017 www.t .gov/dla % orkers'Compensation Insurance Affidavit:BsdMerslContractors/ElecSdans/Plambers. TO BE FILED WITH THE PERMITTING AUTHORITY. AoDiiant Information Plan Print lendbt,y Name(Bminesslorpani:aaa,qndividttor Undercover Tent& Party Inc. Address: 31 American Way City/State/ZIp: South Dennis MA 02660 Phone#: 508-398-9000 An yea as employers Cbuk the appropriate hen bpe of Project(required): 1.®i sate employer with 20 etoployea(M1 ao&orpestaime).• 7. 0 New construction 2[]Iemaids prowiecrormrtnenhipand have noemployees matins fctwin 8. QRemodeling any apathy.(No worker'camp.=um=:squint] 9. D Demolition 101m a haaeawnerdans ell work myaelt[No wakes'comp.bream required] iii❑Building addition <.p I am ahmnow n w4 will he hiring contract a to;cod a all wad on my p opmty.t will awe tint adcontnice.aldahare woekara•competed=insane oriesole 11.0Electtieelrepairs oradditions pmprielo tai h m employees. 120Pbmmbhhgrepairs or add:loi s S.OI en a seam eanoaaor=Man hied the nib.aoetracers Brad onthe maehed that Thee subcontractors s haemployees and taw waters'camp.Menneat 13.0 Roofrepairs 6.0 We an aoapaetbn and In offkas here starched the right otwmpdm pp e. pi.®other Tent Install 152,I I(4)ard we ham no employees(No worker'temp.tmwnnaoroquired.] ' 'Any sppiiamt at dm=box al must also WI out de sectionbelowWeans their ratan'oompeweion poky kribandion. t Homeowners who submit this ads*indimdest they aro doing all work and them hire outside women mat sdadt a rrw amdavk bdiemieg suck :Caotretmn dot check this box mutt attached an additional Ins dew=the ansa at the subeaaracmn and state whether anot thosa=titles has employees. lteasubcaaamahare*Wayea.they maWovide their`u 'soRpolicTaamber. I amen employer thatbproviding workers'conpensadon buuraneefor my emgrloyea. Below G thepolicy arced fob site information. Insurance company Name: Wesco Insurance Co. Policy 4 or Self-las.Lk.d: W WC3314727 Expiration Date; 11/21/18 lob Site Address: Z-14 21445a,'$ SF City/State/Zip: S. Awe.,hi Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MOL a 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 3250.00 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 ertlfy under the pains and penalties of perjury that the florntalon provided abort is true and ob,ma $i stun: /4241:4 2- Date: `t f2 I/tom IS Floret 508-398-9000 Official use only. Do not write In this area,to be completed by city or town official City or Town: Permit/Licensetx Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.PlambIng Inspector 6.Other Contact Persons Phone th •..—t rtr;,..A. - ..A. r..7‘...4.....,-A" NDERCOVER TINT 000 or i, ---t°-/ _.....,.-0 ..... .....,. .„.„ i _ ...- „ MICA '(Sq.:AN:NT thill N 1P3•1Vit.,P it:Ila tti? .).:0,3* 11111:el .‘gi‘L '..i'l•Nk *.,-,-.45,, 0,ke:.4.-.*-4,ii,tie.L it N7—cjii N 11 v'4•4\"..iits.„:44141.470.H'itimotiot..‘10:1.0110.6trictiNillits,44,77...7..1/2,100.11/4_41 No;-4":„:44 'n4 ki:,,,ye,),is":?al, • - N --0•Ni.42-'4 \ 1 p 6.cet N., vim crenT el awl. ii4iale um, 4411 linwskis ilz*Olii111 11144, II CRT Ito 11=11 Iltirfrill 111r2claill 113 I ^:11 rt.II 11,,f- ZII Craig Illki MI irmzEii ol ...-7-). iirio ii.,4fs --7.11 II-ram 11;47211 II at'.111 ILes '51i Ilr:ell 11WeJ1 IlltrYSII Ilti I all 111Piall Ertl Ertl _Ili:: tralaratr.-a.Li''''''- :-F,A TT era 111111MMEmseMPin IIIMME2ltailr"Sati: lailtt 71 ton"2Imidgmi'aS',57111i 1itig k .! •1 I!20 Etuz- E---- -t Paige Coleman 1Irll 111111elts fit L' dulrat I — — 214 Pleasant St ut.------7. . 111111211REP -- — - South Yarmouth I-4-a,-- 4----4=47F-t---Itr--.44rfirs-- 47.-4-ret n ._... Cri il iit7; '"47I 11 Ill"•t Vit3niTig 1.11-• rIll n"Call n II II .....-. — 6•t :. III III BICCISOctober 6th, 2018M -:-.....r. CATERER --r.A. -,--- 'It'll II"" .II II*-4111 lir Cape Cod Celebrations --t4: o 11-:-.-n: le si:*--kin ii?...,a.-= FOOD — !el:Stmg g1, ll't--ZIO II at-rLIC • 1”•,''",--'11 11 ..--.XII 111-rMII — ; AND 1111111al BAR — . -, • • ` ( 1 ..�V8 . V. . Z .` i }/:\ .NIA l/. .V • . ;\• If.. . .I•.tt• .• )t, 1--N • r ..... 1 "� ' Certificate icate of ,flame te�iztarfce set.. Date Manufactured AZTEC TENTS Invoice Number. 0214472-IN ;_ 2665 COLUMBIA ST Customer P.O.: • Ea 9/15/2015 TORRANCE,CA 90503` (800)228 3687 Customer Number. UNDE026 : I; This Is to certify that the materials described below have been flame retardant L"""°' !a urea. treated(or are inherently flame retardant). •c",'^,:':C. Bran »N z..--- Fay.a - -• • y1' .4) Ouroml,Comb. um T..11,14,16.l5 F419.01 �y '' l s''�'n� p>V V `` pl Coated Nana Cur./Inv.1691/loge F-570.01 'T 1' ` 1 V 16f 1','/F Iy OFK Clear Vinyl 16011 209a F593.01 Undercover Tent& Party /"J IW OAF F593.o1 31 American Way 4 o..;;r+: FEeared 6� FtlySeun WarF-434.61 _`= South Dennis, MA 02660 Fred a5o: F444 o1 (:,-�Y q'$F:j f Fared Rai-i unit P-5 .11 ',S �i.,._...,..._ b' OA FTM9ah. Phil-Tex unit F-500.01 11 r6,-740 �`, I we Tern Deco Cloth/Vela. FSa01 OP ^t Snyder womertwn Flwot ID Vantage Ambit SUMMI, F-368 OS ,r Certificatiorashereby-madathat theartir•m<rlascribed-below.hereofare made—-_.n..a.g. - ..ag, aisiahn s from a flame-retardant fabric or material registered and approved by the I�faa . "�' j; California State Fire Marshal for such use.The fabric has been tested and Lac=aiaZ amallltia Tr.Ventage wb on/ •st Me F069.1 passes NFPA 701 Large Scale.See chart to right for trade name of flame-resistant fabric or material used and additionally referenced on the label of 1,: the fabric panel. `.z THE FLAME RETARDANT PROCESS USED WILL NOT BE REMOVED BY WASHING + 4_ David Bradley General Manager-Manufacturing k. l Name of Applicator or Production Superintendent The of Aiplicator or Production Superintendent .1 a s, • x �4 t 4 J 's 4 _' i" i:, 4/, ?! ,'444 / t)a : I`P'414 t, 'ice 4'61.,-9' 'f ', .� .t TF -r is 9 d Mr �r�� fi iir��'l .d i#4r . ITEM CODE ITEM DESCRIPTION UNIT ORDERED PRODUCED Z21740CE4035 #40x40 2pc Std Top Only CLR EACH 1 1 ATC Style Lace Blockout White Trim #Canvas Bags# Z21740CM2035 #40x20 Std Middle Top Only CLR EACH 2 2 • ATC Style Lace Blockout White Trim #Canvas Bags# ' - Z21730CE3035 #30x30 2pc Std Top Only CLR EACH 1 1 ATC Style Lace ---Blockout Whlte Trim- --_ - .. _..-. .. _ #Canvas Bags# Z299F00110 Rafter Slide Intermediate 40X EACH 4 4 Z29900140 40x Std.Frame Assembly cable EACH 5 5 s. • 3,,, r �, i ',�L'`b h`. tl ii3G'�h i::l� fll�:i 4filc`J y'}" Certificate of flame tezi�tance a< PAGE: 1 t;rs 1 Date Manufactured AZTEC TENTS +' 4 2665 COLUMBIA ST INV NUMBER: 0200956 �pitit08/23/2013 :x,; "�' ; TORRANCE,CA 90503 P.O. NUMBER: *:-rr :Iias,itr l (800) 228-3687 CUSTOMER NO: UNDE026 dt,, This Is to certify that the materials described below have been flame retardant 814 .11›. 1 it treated (or are Inherently flame retardant). „de, f 6- v W:pY" %nJJO MUE,Gpuae Name F-222 02e la A 1,i:,.v1 UNDERCOVER TENT Ft PARTY Bruin d. bmTp,l,1..1a16 .901 kVA,. 31 AMERICAN WAY Coaled;flocs o.0 vin 16°.,x°y s)a 02 9 South Dennis, MA 02660 AFF Clear Vinyl169•/la°• F593.01 :61 DAP F-591.02 b'''G''''�' Earn• 9&Po 1d95•t•en INx I..N.al '3.e . r F•am R•rminlnt 50x 8-M..08 .Y.f Mi1110•T•.tlla rnll u - — 2 _ T Ones 850001 �i'i;,,, - wEitar L•ti OMl vim F.sM al �"`•-�" SMQM Wtn•np•n 8-1.0.01 Tj�•} 4... Td V•nl•°• FInY•I SunIrsi. F-368 OS 1i'. ertification Is hereby made that the articles described below hereof are made ,„ ; , ears° 813'00 rom a flame-retardant fabric or material registered and approved by the id Vantage vanguard W81•n F.06901 .„,J alifornia State Fire Marshal for such use.The fabric has been tested and TdV•nt•9• W61•n/Co6ilin• 8.069.02 ` y? asses NFPA 701 Large Scale. See chart to right for trade name of n d•9 oan•Mn B16J3,81515 v°.m q„lame-resistant fabric or material used and additionally referenced on the label h^4% IiS- of the fabric panel. . ., '',` s. THE FLAME RETARDANT PROCESS USED WILL NOT BE REMOVED BY WASHING �' a fOl' ., •di.:- 2. ? . David Bradley General Manager-Manufacturing !` , 1 Name of Applicator or Production Superintendent Title of Applicator or Production Superintendent 4011. 1' 1164 , v-,51(,”', 1 . .a.ci444 ti {r cs +J $ro 'iA1 „t kA.r ah nTPef �'12,4:26t.'15:' $:' tl':�u " .,64'444 i �tl4� A �n W } 644 &s!'A 001A % Awn �� -0� q � 1'f" � ^ ;(' 1; ITEMS MANUFACTURED TYPE PRODUCED 20x20 2pc Std Top Only CLR S 1 ATC Style Lace Blockout White Trim 26(20 Std Middle Top Only CLR 5 2 ATC Style Lace Blockout White Trim 30x30 2pc Std Top Only CLR 5 1 ---ATC Style Lace-- ---- —._..—_. _- Blockout White Trim 30x15 Std Middle Top Only CLR 5 2 ATC Style Lace Blockout White Trim 30x10 Std Middle Top Only CLR S 2 ATC Style Lace Blockout White Trim • QUOTE: #15527-7 Page 1 of 2 EVENT DAY: Saturday DATE: 10/06/2018 RCOVETENT EVENT TIME: R DELIVERY: THU 10/04/2018 SUBJECT TO CHANGE t C/aee `..]ante et PartyAcceaioriee PICKUP: MON 10/08/2018 SUBJECT TO CHANGE • SALES PERSON: BH PURCHASE ORDER#: 31 American Way South Dennis,MA 02660 ORDER DATE: 11/07/2017 TERMS: Phone:(508)398-9000 Fax:(508)398-9091 Website: www.undercovertentcom BILL TO: SHIP TO: JAMIE BOHLIN PAIGE COLEMAN 214 PLEASANT STREET 214 PLEASANT STREET SOUTH YARMOUTH MA 02664 SOUTH YARMOUTH MA 02664 TEL: FAX: !TY ITEM DESCRIPTION PRICE TOTAL 1 40X70 FRAME TENT-CLEAR TOP 3,500.00 3,500.00 1 15X40 FRAME TENT-WHITE(CATERING TENT) 600.00 600.00 20X40 FRAME TENT-CLEAR TOP 1,050.00 1550.00 30X40 FRAME TENT-CLEAR TOP(50%CANCELATION OPTION) 1,500.00 1500.00 3 7X20 SOLID SIDE WALL(CATERERING TENT) 25.50 153.00 22 8X20 CLEAR SIDE WALL(OPTIONAL TO TIME OF DELIVERY) 32.00 704.00 I 30'WHITE GUTTER 33.00 33.00 1 15'WHITE GUTTER 18.00 18.00 • 10 4X4 BIUAX FLOOR / BAND RISER PANELS(8X20) 30.00 300.00 2,640 VANEER WOOD-TENT FLOORING(40X70) 2.50 6,600.00 300 VANEER WOOD-TENT FLOORING(20X40) 2.50 2,000.00 2,800 BISTRO LIGHTING-ROUND CLEAR BULB-PRICE PER TENT SQ/FT 0.45 1,260.00 300 BISTRO LIGHTING-ROUND CLEAR BULB-PRICE PER TENT SQ/FT 0.45 360.00 • 220 PERIMETER SWING LIGHTING(40X70) 1.20 264.00 120 PERIMETER STRING LIGHTING(20X40) 1.20 144.00 2 300 WATT PAR LIGHT FIXTURE(CATERER) 50.00 100.00 3 100 LB.PROPANE TANK 90.00 270.00 1 ELECTRICIAL SERVICES-CALL ROGER LING-508-400-2233 0.00 0.00 1 40LB.PROPANE TANK 65.00 65.00 1 80,000 BTU HEATER-CANCELLATION POLICY-5 DAYS PRIOR TO EVENT 150.00 150.00 • THIS IS A QUOTE ONLY SUB TOTAL: 19,921.00 ICIAL INSTRUCTIONS: SALES TAX: 1,229.44 DELIVERY: 40.00 LABOR: 0.00 TOTAL' 21,190A4 7 OOd :ustomer Signature Date Customer is responsible for obtaining necessary permits and markings of any private underground utilities. Undercover Tent and Party,Inc.will contact Dig Safe for your site in regards to the marking of public utilities. Customer has read and agreed to the terms and conditions as specified in attached documents.