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Home My WebLink AboutBLD-19-003475 . • OF. qct 1-Office Use Only . t Y `tr0 - PcmtitA O H � (Amount , �„ t A'sr i- e.,/ Permit mitts 180 days from ! EXPRESS BUILDING PERMIT APPLICATIO T CL V E D TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 DEC 06 2016 :South Yarmouth,MA 02664 `�,,j// (508)398-2231 Ext. 1261 e I ii �( 4 �I CONSTRUCTION ADDRESS:3lor381i 914 Z W,L16 Kates Path �% ASSESSOR'S INFORMATION: Map Parcel OWNER:Kings Way Condo Assoc:C )Barkan Property Management 64 KingsCircuit,Yarmouth Port,MA 02675 617532-8610,. NAMIi PRESL2NT ADDRESS - TEL CONTRACTOR:- Primetouch Services.16Tech Circle:Suite 102:Natick,MA01760 508-652-9170 NAME MAILING ADDRESS - TEL# ❑Residential g Commercial Est.Cost of Construction S if OA O Rome Improvement Contractor Lime 155685 ConstructionSupervisorLic..N 068912--" Workman'sCompensalionInsurance; (cheek one) ❑ Tarn the homeowner- - 9 Jam the sole proprietor % I have Worker's Compensation Insurance Insurance Company Name- Slat insurance Co - Worker's Comp.Polly* WC0452498 WORK TO BE PERFORMED Tent _ Dorattom (Fire Retardant certllkateattached?'), Wood Stove • Skiing;.#of Squares 3o Replacement windows:# Replacement doors: ft Rooifeg:.#of Squares:. ( )Remove existing"(masa Z layers)- Insulation Old Kings Highway/Historic Dist. ( )Replacing like for like Pool fencing 'The debris w4 bc®epasedefat. - 'CI/Noonan Trudking/PO'Box 400.West Bridgewater,VA 'Location of Facility I declare under sororities ofperjury that the atatements herem contained aro true and correct m't a bestarmy knowledge and belief l endastaadthat any false aaswe$s) win be jmtcame for denial denial nrrewecation of net license and for prosecution under MDL Ch 268 Section.L Applicant's Signatory /�'"� - Date: '1290'2018 . Owners Signature(or attachment) Date: Approved Dy' di'��C / Date /02 6 %tel Suit pun deck) Ct.ADORESS: - r Zoete:Distria: IlisooricaiDistrice: ❑ Yes ❑ No Flood Plata Zone: ❑ Yes ❑ No Water Resource Protection District: Within 100 ft.of Wetlands: - ❑ Yes 0 No 0 Yes 0 No t • The Commonwealth of Massachusetts • • Department oflndtsstrial Acc dents Office:of Investigations • e �g 600 Washington Street Boston MA 02111 • www fnass.gov/dia • Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Pltimbers Applicant Information Please Print Legibly Namefttusiressorganizauonnndividual): Primetouch'Services Address: 16 Tech Circle City/State/Zip: Natick, MA 01760 Phone#:508-652-9170 Are you an employer? Check the appropriate box: Type of project(required): 12 I am a employer with sow; 4 El am a general contractor and I' 6 Q New constmetion employees(fill and/or part-time).* have hired the sub-contractors- 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodel ng ship and have no employees These sob contractors have 8, Q Demolition workingforme in anyaci employees and have-workers' capacity. insurance.; 9. Q Building addition [No workers' corap•comp.insurance required.] 5.. o We are a corporation and its 10.0 Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself jNo workers'`camp. tight,of exemption per MGL 12.❑ Roofrepairs insurance req ]t c, 152,§1(4),and wehaveno employees.:[No workers' 1342 Other 1(I09 repairs 'comp..insurance required.] "Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. • t Homeowners who submit this affidavit indicating they are doing all work and then biro outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-eontmetms breve employees,they must provide their workers'comp,policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy axdjohsite information rna„ran r-companyNamet : Star Insurance Company Policy#or Self-ins.Lic.#: WC0452496 Expiration Date: 4/1/2019 Job Site Address: Kates Path Yannouthport,MA 02675 City/State/Zip: .-. —Attach a-Attach -the-•workers'—compensation-policy-declarat tm,page(showing-the polieraumbea-amdtxpiration-date)..- Failure to secure coverage as required under Section 25A vfMOL v. 152 can lead to the imposition of criminal penalties of a -fine tip.lo$1,500.00 and/or one-year imprisonment,as well as civil penalties is the form of a STOP WORK ORDER and a fine clip to$250.00:a day against the violator. Be advised thata copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cerafy under the pains and penalties of perjury that the information provided above is true and correct Signature: Date- 817/201ff Phone#: 508652-9t70 Official use only. Do not write in this area, w be completed fry city or town official • City or Town: Permit/License# Issuing Authority(circle one): L Board'of Health 2 BoildingDepamtmment 3.City/Town Clerk 4.Electrical Inspector• 5.'Pbmxnbiag Inspector 6.Other Contact Person: ' Phone it: . Site (pciffi:oluvea/,t'A ^jno aa�cAuaa f oat , F( , Office•ofConsumer Mfrs and t TO Park Raza-Suite 517Q Boston, Mas 3chusetts 02116 Homs i.mpravemeatractor Registration i �- i f, Type Supplement Card N., -:•_ t, z . -. ..--'1 PRIMTOU-01 I BROWN A O�REY CERTIFICATE OF LIABILITY INSURANCE •• DATE(MWDD"YYY) 10/12/2018 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 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 certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER .far? Loretta Brown FBinsure,LLC PHONE - FAX 126 Dean Street Arc No,Eau:(508)824-8666 1240 (AIC Not: Taunton,MA 02780 - I I ogtsy.LBisvo-s lnsure.com — __ INSURERS)AFFORDING COVERAGE_ -_ RAIC e .._ . . ._... __.___ INSURER A:Selective Ins Co of SC _ .___ 19259 INSURED INSURER B:Selective Ins Co of Southeast 39926 Prime Touch Services Inc INsuRERc:Star Insurance Company 18023 16 Tech Cr Ste 102 INSURER D: Natick,MA 01760 _. . . . INSURERS: . 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. __ INSR 4bDLISUBRr POLICY EFF POLICY UP LTR TYPE OF INSURANCE 11150 vivoi POLICY NUMBER IMMIDDMYYYI IMMIOSN'(YYYI LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 IClAIM3-SHOE � X.I OCCUR X DAMAGE TO RENTED I S 1916323 10/15/201810/15/2019 PluMISFs(Ltamirence) 5 500,000 IX Blkt Add'I Ins MED EXP(Any onepenon) is 15,000 X BIM Warier 1�000,000 .... .._—... PEREDNry,4 ABV INJURY ,S, ___ GENL AGGREGATE LIMIT APPyES PER. GENERAL,AGGRETE •S 3,000,000 POLICY i XJ)Epp1 ILoo . 3,000,000 OTHER. ?RCOUCTS•COMP/OP AGO.I.$ S B AUTOMOBILE LIABILITY • I COMBINED` ESINGLE LIMIT S 1,000,000 . ANY AUTO A 9092598 10/15/2016 10115/2019 BODILYINJyRY(Per person) S t, AUTOS ONLY I X 'SCHEDULED • qq�� .IOW Ep BODILY INJURY(pea accident) S _ __ X ALT0.R ONLY I X AUTOS ONIF i (Perxc l n1)AGE $ I I Hired PD I s 75,000 A X UMBRELLA LIAR X I OCCUR EACH OCcVRRENCE ,S 5,000,000 EXCESS UAB CLAIMS•MADE. X ' S 1916323 ; 1011512018 10/15/20191 5,000,000 AGGREGATE _ DED I X•RETENTIONS O. $• C I WORKERS XATUTE I �@N• ANMCOMPENSATION ERS'wm _ l ANY PROPRIETOR/PARTNER/EXECUTIVE YIN WC0452496 04/O1n018 04/01!2019 EL EACH ACCIDENT 1,000,000 OFFICER/MEMBER EXCLUDED? I N I MiA —.$ 1,000,000 (Mandatory In NH) E L.DISEASE:EA EMPLOYEE f ____ ti dntab.under . -- DESCRIPTIONOFOPERATIONSbelow ( i EL.DISEASE•POLICY LIMIT S 1,000,000 A Equipment Floater i S 1916323 10115/2018 10/15)2019 Leased Equipment 100,000 . I _ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLESACORD 101,Additional R.mMks Schedule,may be attached NN.Mspaee b required) Painting and Carpentry Contractor.Leased Equipment coverage is Actual Cash Value-Special Form with$600 Deductible. ID 4:614010.CIL Forms C07300 1/16(Blkt Al ongong ops,MC)and C07921 11/14(Blkt Al completd ops)are attached. CERTIFICATE HOLDER CANCELLATION • SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Barkan Management Company Inc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN c/o Compliance Depot ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 115006 Carrollton,TX 75011 AUT ORQED REPRESENTATIVE WAX. ahs, ACORD 25(2016/03) 01988.2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD KINGS WAY CONDOMINIUM TRUST 64 Kings Circuit Yarmouth Port,MA 02675 December 5, 2018 Matthew Linnehan Primetouch Regional Manager 16 Tech Circle, Suite 102 Natick, Ma 01760 Re: Siding Replacement—Kings Way Condominium Dear Matt: Please accept this letter as authorization to proceed with the cedar shingle siding replacement on the predetermined buildings at Kings Way Condominium per the attached contract and bid form between KWCA and Prime Touch.. Should you have any questions,please feel free to contact me. Sincerely, KINGS WAY CONDOMINIUM ASSOCIATION Asa a Gerald A. Meaney, VP Barkan Management Company, Inc. Agent for Kings Way Condominium