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Home My WebLink AboutBLD-19-003473 •_ : pF'YAR y0ffice Use Only O y� Amomrt 5 .. s- - - Penni: 74'3180 drys Bern z�� . insuu dste EXPRESS BUILDING PERMIT APPLICAT ON_ c Ely 67. s., TOWN OF YARMOUTH , Yarmouth Building Department i. 1146 Route 28 DEC 06 2018 South Yarmouth,MA 02664 (508)398-2231 Ext. 1261 Dw'l �i.j'�stbF':91 [0T CONSTRUCTION ADDRESS:—d.,9, '12,) -J1 Kates Path - - - ASSESSOR'S INFORMATION: Maps Parce[ OWNER.Kings WayCondo Assoc C/O Barkan PropertyManagement 64 Kings Circuit,Yarmouth Port,MA 02675.617.532-8610 NAME PRESENT ADDRESS - TEL. it c:ONTRAcToe: Primetoucll,Services l6':Tech circlet Suite 102.Natick.MA01760 508-652-9170 NAME MAILING ADDRESS TEL D Residential 0 Commercial Est Cost of Construction S Tlemelmprevemeotcmmraeter•Lie..# 155695 .Construction Supervisor Lie.n 068912 Workman s Compensation Insurance (cheek one) II I am the homeowner 0 lam the sole.propdetoi' ie f dative Worker's Compensation lassuance - `insurance CompntyNames 'StarInsurance Co 'Worker's Comp.Policy# WC045249e WORK TO BE PERFORMED Tent _ Duration (Fire Retardant eertificateattached?) . Wood Stove Siding; #of Squares 20 Replacement windows;# Replacement doors: # Roofing: if of Squares ( )Remove existing,(max.2 layers) Insulation, Old Kings Highway/Historic Dist. ( )Replacing like for like Pool fencing elle nerds wilbedisposed eat: C.L:Noonan Trucking, PO Box 400.'Nett Bridgewater,MA ' - Location of Fatally e'I declmevniler,penalttas efpeilaryBust The stnlmnmuterein contained are true and correctlo the best et any knowledge and belief'I mdlastaad that any falx answer(s) bejmtanew for dauied at-vocation&anylicense and larpuseoution'unde M.G.L.CI.261,Section 1. Applicant'sSignature: - .4fs5 l7 Date: 12'1812016 Owners Signature(or attachment) / Date: Approved By: _/ .14 . Build,: at(a•esig ee) / EMAIL ADDRESS: • Zoning District Historical Distaick fi Yes 0 No Flood Plea Zone: ❑ Yes Li No Water Resource Protection District: Within 100 ft.of Wetlands: _ 0 Yes 0 No 0 Yes 0 No The Commonwealth of Massachusetts ' i--,J DepartlaentofIndttstrial Accidents ce" Office of Investigations. 40 :� ' 600 Washington Street Boston„MA 02111 • www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Primetoueh Services • Address: 16 Tech'Circle City/State/Zip: Natick, MA 01760 Phone#:508-652-9170 Are you an employer? Check the appropriate box: 4. Q I am a general'contractor andI' Type of project(required):,. T.Q I atm a employer with go, employees(full and/or Reit-time).* have hired.the sob-contractors ti Qom'co tructeore 2.0 I am a sole proprietor or partner- listed on the attached sheet 7. Q Remodeling ship and have no employees .These sub-contractors have S .0 Demolition working for me in any capacity. employees and l have workers' 9. Q Building addition [No workers' comp.insurance comp.insurance.: 10.0 Electrical repairs or additions required.] 5. [] We are a corporation and its p 3.0 I am a homeowner doing all work officers have exercised their. 11.0 Plumbing repairs or additions anyselt [N°worIcers'comp. right ofexemption per MGL 12.D Roofrapaus instuance required.]t e. 152,§I(4),and we have no employees.[No workers' 13.J Other Siding repaiis comp.time 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 hire outside contractors must submit a new affidavit indicating such. tcontmetors 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'camp.policy nnmba. I am an employer that isproviding-workers'compensations rsuranrafor my employees Belowis the rite y arndfo&site informatit; Inaaranee companyName: Star insurance.Company Policy#or Self-ins.Lic.#: WC0452496 Expiration Date: 4/1/2019 Kates Path Yarmouthport,MA 02675 Job Site Address: City/State/Zip: - —Attach:a-copy-of-the-tvorkers' compensation-poiicy-dedmratton-page(showing-the policy-number-and erpiratlon-date).- Farlrnexo seermu coverage as required meet Section 25A ofMGL c.152 can leadto the imposition of adruinal penalties of a fine up to 51,500.00 and/or one-year imprisonment,as well aseivil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 aday.against the violator. Be advised:hat-weepy ofMisstatement-narybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: ,11""— Date: 8177201S' Phone dk ., SO8-652-9170 Official ase only. Do not write inthisarea, to be completed by city or town ofclat City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Deportment 3:City/Tont Clerk-'4.Electrical Inspector 5.Plumbing Inspector £.:Other Contact Person: Phone i 0Office of'Consumer Affairs and Business Regulation/ 1.0 Park Plaza-Sime 3470' BoStOn.Masa chusetts 021I6 Home intpravemei DeltractarRegistration `..z..-=— =mss r;'i 4, ... • ; Type: Supplement Card M : ,./, P.RIMETOUCH SERVICES INC tit% Pat-f: -t. ,..,...w-..1 r Registration 155685 3"/tzza•r 12:-1.72.7-.21:'.. tratiorc 04!3012019 • B HURON DRIVE i -._. •-.,3 �__ ,� NATICK.MA 01760 V. y_- '0{ i. "S :`?1'•-•• .. r' --J ,ter •.=. t_... Update Address and return card. Mark reason for change. SCA i+.a x10-Orn Q Address.CIRenewal. Li Emplorseat CLOOd,Crd. e2 ti:lbfwivromag of lttigw.:axtvetti DNleaef tassainerMtairabi BosinessPtejutuba Si-1 a 140MEIMPROVEMERT'CONTRACTOR liegtStratlon vane lorin5lvlduril'uee'Onty iii -'TYPE Suadement Card before tiro eaphMfon tate.:O found return to: I 1 'Otace of Cwnumer Affairs and Business Regulation , ,rISS&85 04/94�2df9 10 Park Plaza-Suite 5170 IME TOUCH SERVtG`ES IMC . Boston,MA 02115 aMl'TH ,``�iiE,ccG; --•- , i�"' rte, B HURON DRIVE . MOO(MA‘01760 `... , d Wet valid atithout,signature�: nersectetary • , . \ Commonwealth of Massachusetts .�� Division of Professional Licensure • Board of Building Regulations and Standards Constriettdn i$itptrvisor t, CS-068912 c: '.."-1 f Sires:09/03/2020 MATTHEW 71)NNEf W'l-4 1 13 DANA PARR, HOPEDALE MA 51747 ""'. t`1' Commissioner • 1 .�1 PRIMTOU-01 LBROWN ACRO" CERTIFICATE OF LIABILITY INSURANCE DATE(MWODIYYYY) 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 CT Loretta Brown FBincure,LLC -- -'-• - " ' --- •-- 128 Dean Street ;INC,No,EMS(508)824-86661240 I FAX Taunton,MA 02780 E'1'1A LBIO_wn lnSUre.COrn " —INo): INSURERISI AFFORDING COVERAGE_ __ Wile I/ .._ . . ......—_____ INSURER A.:Selective Ins Co of SC ._. , 19259 WSURED • INSURER B:Selective Ins Co of Southeast __,_ 39926 Prime Touch Services Inc INsuRERc:Star Insurance Company 18023 16 Tech Cr Ste 102 INSURER 0: Natick,MA 01760 -- • • • • • INSURERS: INSURERF: 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. ILTR TYPE OF INSURANCE INS)aWVOI POLICY NUMBER IMWDOYIYYYYI IMWOD POLICYEXPLIMWS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 • CLAIMS-MADEI.X.I OCCUR X S 1916323 10/15/2018 10/15/2019 DAMAGE To RENTED 500 ggg I X Blkt Add'I Ins PttENLSES.IEaassvrrenn) IS MED EXP Mnyonepemon) ,S ISr OO X Bikt Waiver •. •, ( PERSONAL B ADV INJURY ,S• . 1,000,000 GEN'L AGGREGATELIMIT APPLIES PER. GENERA!,AGGREGATE S 3,000,000 POLICY?XJ;' I I LOC I _ ... .3,000,000 p.PROgucts•COMPArp sup'; OTHER. • - ...,.. . B AUTOMOBILE LIABILITY I • I COMBINEDSINGLELIMIT S 1,000,000 ANY AUTO A 9092598 10/1512018 10/152019 BODILY IN.I9RY(Per person) S ` OWNED 'SCHEDULED • ' • AUTOS ONLY I X'AUTOS� oo BODILY INJURY(PE tcc i) S _._ ._ X AUTOS ONLY IX AUTOSONiY PROPERTY ccRlE ni)AMAGE S i I Hired PD I S 75,000 A X uesssuALWS X I OCCUR .5 5,000,000 ETON OCCURRENCE EXCESS S CLAIMS-MADE X S 1916323 i 7011512018 18/15!2879 ..._ 5000,000 DED I X.RETENTIONS 0. i. _ ` C WORKERS COMPENSATION I X J BTATUTE I ...ETH- . !AHD EMPLOYERS'LIABILITY :ANY PROPRIETORPARTNERIEXECUTNE YIN WC0452496 04/O1I2018'04I012019 EL EACH ACCIDENT 7r000,000 • •OFFICERAIEMBER EXCLUDED? I N I NIA 7 000 K a,de , (Mandatory In NH) E L.DISEASE.EA EMPLOYEE ,f ____ svlbe under _ 7,000 DESCRIPTION OF OPERATIONS below I I E L.DISEASE•POLICY LIMIT S 7,000,000 A Equipment Floater iI S 1916323 10/15/2018 10/15/2019 Leased Equipment 100,000 . II • I DESCRIPTION OF OPERATIONS/LOCATIONSI VEHICLES(ACORO 101,AddlBene Remsds Schedule,may be attached H nen span Is required) Painting and Carpentry Contractor.Leased Equipment coverage is Actual Cash Value-Special Form with 3500 Deductible. ID a:614010.431 Forms D07300 1/16(Blkt Al ongong ops,PM)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 ACCORDANCE WITH THE POLICY PROVISIONS. c/o Compliance Depot PO Box 115006 Carrollton,TX 75011 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) It 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 1 A 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 Atka Gerald A. Meaney, VP Barkan Management Company, Inc. Agent for Kings Way Condominium