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��F�, SHEET METAL PERMIT
4' ,4L Commonwealth of Massachusetts
\°azar{•' Town of Yarmouth Building Department
Date: \\r 5/ Ia Permit#: 73LDSM- /9-einc, 97
Estimated Job Cost: $ 20a° Permit Fee: $
Plans Submitted: YES/DPC. Plans Reviewed: YES/NO
Business License# 3S8 G Application License#
Business Information Property Owner/Job Location Information
Name: Alm Z.k 1-I1/44AC Name: 9AuCc...5)ol0c
Street: 33 o LI) *kt- SA Street: c13 5A-ark Ca(t-1 L^i
City/Town: 5. yPaM o..Mx City/Town: 4 st1.4-o..-}k. '?oQ*'
Telephone:5Q9 -36.0 -7602, Telephone: 508 -3 6-) - (83 r _
Photo I.D. required/Copy of Photo I.D. attached: YES/ NO Staff Initial:
J-1/ M-1 unrestricted license
/ M-2 restricted to dwellings 3 stories or less and commercial up to 10,000 sq.ft./2
stories or less
Residential: 1-2 family ultl-family_ Condo/Townhouses Other_
Commercial: Office Retail Industrial Educational Institutional Other
Square Footage: under 10,000 sq. ft&over 10,000 sq. ft._Number of stories:
Sheet metal work to be completed:
New work enovation:_HVAC:_ Metal Watershed Roofing:
Kitchen Exhaust System:_Metal Chimney/Vents: Air Balancing:
. Provide detailed description of work to be done:
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I RECEEIIVEE-D ,
I ''NOV 65 201
1 3::0.0ING OtPARTMENT
By
•INSURANCE COVERAGE:
I have a current liability insurance p y or its equivalent which meets the requirements of
M.G.L. Ch. 112 Yes o
If you have checked yes, indicate the type of coverage by checking the appropriate box below:
A liability insurance policy C er 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
Owner gent_
r • ( Owner's Agent
ecking here-* ,I hereby certify that all of the details and Information I have submitted(or 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
Date: Comments:
Date: Comments:
Type of license:
By: _ Master
Title: Master-Restricted t Signature of licensee t
City/Town: Journeyperson
Permit#: Journeyperson-Restricted License Number.
Fee: $ Checkatwww.mass.gov/dpi
T Inspector Signature of Permit'I`
of Permit Approval
Clients:21832 2AIRRI
iACORD. CERTIFICATE OF LIABILITY INSURANCE DATE'1oA9/201YYY)
/zola
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(les)must be endorsed.H SUBROGATION IS WANED,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 o1 such endorsement(s).
PRODUCER en E:ACT
N M
Dowling&O'Neil Insurance Agy PHONE
we.No,Flo 508 775-1620 FAX
(A/C.No):5087781218
973 lyannough Road ` E-MAIL
ADDRESS:
P.O.Box 1990 INSURERS)AFFORDING COVERAGE NAICS
Hyannis,MA 02601 oesuNERANINA mowers compere 14788
INSURED INSURER B:
Alr Rite HVAC Inc.
INSURER C:
330 Elliot Rd.
INSURER D,
Centerville,MA 02632
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 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. UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
/NSR ,TYPE OF INSURANCE AWO
ADDLSUBR POUCY EFF POLI EXP LIMITS
LTR )NSP WVD POUCY NUMBER (M /YYYY) (IM ,,
V YYY)
A GENERALUABILTTY MPT8454A 04/13/2018 04/13/2019 pEpAAqCAlHHp��OEECCCTppURRENCE SI,000,000
X COMMERCIAL GENERAL LIABILITY PREMISESIEeo¢wmrce) s500,000
CLAIMS-MADE a OCCUR MED EXP(Anyone person) S10,000
PERSONAL S ADV INJURY sl,000,000
GENERAL AGGREGATE s2,000,000
GEN&AGGREGATE UNIT APPLIESPLIEPER: PRODUCTS•COMP/OP AGG s2,000,000
—1 POLICY I AI FCo-T JAI LOC $
A AUTOMOBILE UABIUTY M1T8454A 05/182018 04/132019(E�,MBB4EED SINGLE uurt 61,000,000
_ ANY AUTO BDOLY INJURY(Per person) $
ALL ED X SCHEDULED BODLY INJURY(Per sodden) $
X HIRED AUTOS X NON-AAWNED -PROPERTY DAMAGE
_ AUTOS (Per=Mere) •
$
A X UMBRELLA UAB X OCCUR CUT8454A 05/182018 04/132019 EACH OCCURRENCE s2,000,000
EXCESS GAB CLAIMS-MADE AGGREGATE s2,000,000
DED X RETENTION$10000
A WORKERS COMPENSATION WCT8454A D4/13/2018 04/132019 X OTOr WOMII S gr.
AND EMPLOYERS LIABIIET
OFFICEOPRIIMOR/PARTNER/EXCLUDEEECUTIVEn N/A E.L.EACH ACCIDENT 8500,000
(IyMeedelay In Nil) E.L.DISEASE-EA EMPLOYEE $500,000
descnbe under
DESCRIPTION OF OPERATIONS bete EL DISEASE•POLICY LIMIT $500,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Sd,eduK N mon space le required)
Insurance coverage Is limited to the terms,conditions,exclusions,other limitations and endorsements.
Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the
coverage provided by the policy provisions.
CERTIFICATE HOLDER CANCELLATION
Town of Yarmouth SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
1146 Route 28 ACCORDANCE WITH THE POLICY PROVISIONS
South Yarmouth,MA 02664
AUTHORIZED REPRESENTATIVE
®1988-2010 ACORD CORPORATION.All rights reserved.
ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD
#S220428/M220427 RPSW1
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