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HomeMy WebLinkAboutBLD-19-003474 • • r • •• Of •Y`1R :Office Use Only 5. •�k r C .Permit 90 Pmni'espira I ao days from iA ":«Te.hK' k im ie date I BCD - I G--cotrr3'ri EXPRESS BUDRMIO � TOWN OF PEYARMOUTH YarmILouth Build ING ng DeparTtmentAPPLICA iGECc 0 6 I 1146 Route 28 2018/ j .South Yarmouth,MA 02664 '1A (508)398-2231 Ext..1261 Nr CONSTRUCTION ADDRESS: WW q./ 3D 3q Kates Path ASSESSOR'S INFORMATION: Map: Parce4 OWNER.Kings Way,Cando Assoc C/O Barkan Propert$tanagement 6416ngsCircuit,Yatmooth Port,MA 02675 617.532-8610 NAMi.E PRCSCNT ADDRESS I'Et:. ip CONTRACTOR Pdmetouch Services 16 Tech Circle;Suite 102r Natick.MA 01760 508-652-9170 NAME MAILING ADDRESS : TEL Il U Residential 18 Commercial Est Cost of Construction$ /, CO TIame`Atnproveaseat Contractor Lie.Id 155685 - Construction Supervisor Lic.41 068912 Workman's Compensation Insanmee:•(check one) ElIamDie bomeowner 0.1 am The sole proprietor IF.-I Lave WorkeesCompeusetioat Insttranoe. Insurance Company Name: Star insurance Co Worker's Comp.Policy* WC045249e WORK TO BE PERFORMED Teat Durationv (Fire Rtita.rdant Certificate attached?),: Wood Stove Sfding N of Squares 30 Replacement windows:* Replacement door& #f Roofing„ #A of Squares'- ( )Remove existing!(mat.:Tlayers) Insulation Old Kings Highway/Historic Dist. ( )Replacing like for like Pool fencing *The debris will be disposed of at. C.L.Noonan Trucking,PO Box 400.1Mest Bridgewater,MA Locution of Facility 1 declare ander penalties ofperjmy that the smtanents herein contained we arse and correct to the best ofawlmowledge and bet I understand that any false answer(s) will be jest casausee far deaial sr revocation at my license and md fprosecutian antler MQ.L.Ch.26S,Scetioa 1. Applicant's Signature: Date: 1216)2019 Owners Signature(or attachment) Date: �I Approved By: tl . E Date: ,/f-�G � . Bedding ( si ) E A ADDRESS: Znnutflistritt: 6CstoricalDistrict U Yes i3 No Flood Plain Zone: t7 Yes U. No • Water Resource Protection District: Within 100 ft.of Wetlands: ❑ Yes D No 0 Yes U No The Commonwealth of Massachusetts ,t Depa tnzei:tofIndusttieIelccidenf5 � Office ofInvestigations 600-Washington Street • Boston,BM 02111 wwlp.mass.gov/dia • Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information ' Please Print Legibly Name(Business/Organization/ndividual): Prirnetouch Services Address: 16 Tech'Cirele City/State/Zip: Natick, MA 01760 Phone#:508-652-9170 Are you an employer? Check the appropriate box: 1.2 I am a employer with so+, Q I am ageaeral contractor andf' Type of project(required): employees wen and/or part-time).' have hired the sub-contractors �. ❑New aonsttrcti ata 2.Q I am a sole proprietor or partner- ship listed on the attached'sheet. 7. Q Remodeling ship cad have no employees Theseab-contractorshave 8. 0 Demolition working for mein any capacity: employees'and have:workets' 9. Q Building addition [No workers' comp.insurance coWe p.insurance.: topr10.0 Electrical repairs or additions required.] 5. 0 We are a corporation and its 3.0 I am a homeowner doing all work officers have exercised their . .11.0 Plumbing repairs or additions 'myself IND workers'catty. right ofexempfreper MOL . 12.QRoafsepaus instance required.]# c. 152,§1(4),and we have no employees.[No workers' 132_1 Other,,,slding vee is comp.insurance required.] *Any applicant that checks box g1 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 hire outside contractors must submit a new affidavit Indicating such. tContmctors 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-contractors have employees,they must provide their workers'coact policy number. Itmrateemployertimeisprovidingaorkers'compensaxtaw•insuraneeformyemployees Below is the.policy anrffohsite inrformauon hammy=company Name: Star insurance Company Policy#or Self-ins.Lic.#: WC0452496 Expiration Date: 4/1/2019 Kates Path Yarmouthpott,MA 02675 Job Site Address: City/State/Zip: Attacb=a;eopy-of-.thezwerkers4tompeusatien-policy-deatration page;(showingthe-police uumberand-expiration-date). Failure to secure coverage m required nnder,Sectiom 2SA of MGL x. 152 can lead to the imposition of criminal penalties of a fine vp to$1,500.00 and/or are-year imprisonment,as well as civil penal&es in theform•of a,STOP WORK/ORDER and a fine of up to$250.00 a day against the violator. Be advised that 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: Date: 8/7/2018' Phone#: 508-652-9170 Offc of ase only. Do not write in this arca, to be completed by city or torten oficiat • 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*: • ..• • �p:. • L Wom , ca/A o/Q, aclu.�aeCtr� '' a Office of:Consumerr.Affairs and Business Regulation ' . .nom a' 10'Park Plan..-SUiL5170 Boston, MasSachusetis 02116' Name impravemeclJ phtractor Registration r;� _1c... et� ; lI Type Supplement Card P.RIMET000HSERVICESINC SI:li: '.._f rtrt-E==1iw( ` Registration: 155685 8 HURON OPINE 7 —+��='L. � �, 'E>piraGorc 04/3012019 NATICK,MA 01780 ; r, . Update Address and return card. Mark reason for change. sat-0 20M-BS/11 - 'D Address'-I:Cleanest.CiEmploymsnL 0 LostCard �r Fd �r oroea at Cooamng:nf Cis et a me neer nmulaiiaa • ; ^ HOME IMPROVEMENT CONTRACTOR Registration valid for Individual mete,/ •"TYPE;SIWenierdCaM before The expiration datelf'found return tot f- Aedstrellon E Mat of Consumer Affairs and Business Regulation p r�FI55 cs , 04/3012019 10 Pat Plaza-Suits 5170 IME Tot1CH segvi es iMC . Boston,MA 0211e E.+f 5 HURON DRIVE iAN Cir / �r BHURDN DRIVE • , ; - o NATICK.MA Ora 'Notveltd without signature'. • p , Commonwealth of Massachusetts U; Division of Professional Licensure • Board of Building Regulations and Standards Con struCtrOrl-s pervisor •rl CS-068912 :L.5 «a ' ''�;�I E�ires:09/03/2020 MATTHEW T LJNNEHAN I I j 1S DANA PARK,, HOPEDAtE MA 01747 " `` • trllt\IlotS ,«r Commissioner > • �wmrk PRIMTOU-01 LBROWN i4 aRO CERTIFICATE OF LIABILITY INSURANCE DATE 10/12/2018Y' 10112/2018 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: N 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 T Loretta Brown FBPHO€E`._ 128 Dean LLC PHONE --.. I FAX __—' -- 128 Dean Street .(AIC,Na E%0:(508)824-8666—1240-- (A'C,Nol: Taunton,MA 02780 rMoa"Ls ,LBrown9`itbinsure.com — __ INSURER(S)AFFORDING COVERAGE_ —. RAM* . .- . . • ••••-. _________ INSURER A:Selective Jos Co of SC .__-. 19259 INSURED INSURER a:Selective Ins Co of Southeast ___ 39926 Prime Touch Services Inc INsuRERC:Star Insurance Coippany 18023 16 Tech Cr Ste 102 INSURER D: Natick,MA 01760 — • . . . INSURER E: INSURER F: I 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. NSR —__.. .._. ._ .__ TYPE OF INSURANCE AODL'SURR' IMMI�DOYI YTYI IMMO POLICY LIMITS LIR - INSD WYO( POUCY NUMBER A X COMMERCIAL GENERAL UABILm EACH OCCURRENCE S 1,000,000 CLAIMS-MADE I X.I OCCUR X S 191632310/15/2018 10!1512019 DAMAGE TO RENTED SOO,000 X Bikt Add'I Ins • EnEMISES Lamy/Nonce) S _ _ MED EXP(Any onependn) I S 500 X BMW- fiver—aePERSON$LAADM INJURY ,S. 1,OOD,000 GENt AGGREGATE LIMIT APPLIES PER. GENERAL.AGGREGATE ,S. 3,000,000 POLICY XJ JEqL r I Loc ' PRODUCTS•COMPIQP RGO. S 3,000,000 OTHER. . r. .. B S AUTOMOBILE LVABILm I I MBBI i ANGLE LIMIT _ 1,000,000 ANY AUTO A 9092598 10/15/2018 10/15/2019 BODILY INJVRY(Per penenl $ OWNED 'SCHEDULED _ AUTOSgq�EppONLY I X'AUTOS BODILY Nu!!!Leer tet rnl) S X At1TOS ONLY X AUTOpWgEe I PROPERTY DAMAGE - I S ONL IF.er![Coen!)_, _ $ I I Hired PD ,s 75,000 A X UMBRELLA LIAR XI OCCUR 5,000,000 EACH OG1GRRENCE .; ___ I EXCESS LIAR CLAIMS.MADE X IS 1916323 i 10/15/2018 10/15/2019 6,000,000 --- -• 1 , AGGREGATE DED I X,RETENTIONS O. ..- .._ .._L.. S C 'WORKERS COMPENSATION ;x J I PER I OTH• I AND EMPLOYERS'LIABILITY • STATUTE FR ZANY PROPRIETOR+PARTNERIE%ECUTNE YIN WC0452496 04/01/2018 04/01/2019 EL EACH ACCIDENT 1,000,000 OFFICERAAEMBER EXCLUDED? I N I NIA -,� 1,000,000 (Mandatory In rip E L.DISEASE:EA EMPLOYEE S ____ ayes,,tewlbwnder . __ DESCRIPTION OF OPERATIONS bebw I 1,000,DOO E L. POLICY LIMIT A Equipment Floater ( S 1916323 10115/2018 10/15/2019 LeasedsedEquipment 100,000 • 1 I I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be auaehed N morn spier Ie requited) Painting and Carpentry Contractor.Leased Equipment coverage is Actual Cash Value-Special Form with$500 Deductible. ID B:614010.43L Forms CG7300 1/18(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 do Compliance Depot ACCORDANCE WITH THE POLICY PRO1910N3, PO Box 115006 Carrollton,TX 75011 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) _ ©1988.2015 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 Gerald A. Meaney, VP Barkan Management Company, Inc. Agent for Kings Way Condominium