HomeMy WebLinkAboutBLD-19-003472 •
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EXPRESS BUILDING PERMIT APPLICATIONr
TOWN OF YARMOUTH i 6: t C E ! " ED
Yarmouth :B nrding Department'
1146 Route 28' DEC 06 2018
South Yarmouth,MA 02664
(548)39&,223I Ext. I261- suit
CONSTRUCTION ADDRESS: /9/ ,' Kates Path
ASSESSOR'S INFORMATION:
Map: Parcel
OWNER:'Kings Way Condo Assoc.C0013aekam'Propetty'Managemerit 64'Kings Circuit,Yarmouth Port blA 02675 617.532-8610
NAME
PRESENT ADDRESS TEL s -
CONTRACTOR: Primetouch'Services 18 Tech Circle.Suite 102..Natick..MA 01760 508-652-9170
NAME - MAILING ADDRESS TEL if
❑Residential 10 Commercial Est.Cost of Construction$
Home Iaproveoeat Contractor Lie.# 155685 Coastr ctfon Supervisor Cie.N - 068912
Walnmen's Compensation Insnrance; (check one)
❑ I am the homeowner LI Cam the sole proprietor : )? [have Worker's Compensation Insurance
Insurance Company Name: Star insurance Co Worker's Comp.Policy* WC0452496
WORK TO BE PERFORMED
Tent Duration Wire Retariant Certificate attached") Wood Stove
Siding: #of Stp arts a0 Replacement windows:* Replacement doors: #
Roofing: #01 Squares { )Remove existing*(maz2layers) Insolation_
Old Kings Highway/Historic Dist. ( )Replacing like for like Pool fencing
*The debriswdf be diayostd Or CL Noonan Trucking,PO Box 400 West 9rtdgewater,Mit
L Gentles of Facility
[declare under penalties of perjwy that the statements herein contained arc time end:correct aa the begot am knowledge andbelict I:undeistaod;t that any false answer(s)
wilt he just cause for denieta revocation of my license and for prosmureav nmder.M.G.'L CM 26S,Section K
Applicant's Signature: �%+ Date: t2f62O1fr
Owners Signature(or attachment) Date:
Approved By: Zai/ �.n Date: t —G
'Death .if; ii
,"rondos:nee) i ADDRESS: -
_ Zoning Oaten at
Historieal District: 0 Yes. 0 No Flood Plain Zone: P Yes ii.No
Water Resource Protection District: Within 100 ft of Wetlands:
❑ Yes 0 No 0 Yes 0 No . .
•
gab
7 VW': OificeofConsumer, Affairs and Business Regulation:,.
to Park Plaza-Stn'te 5170
Boston, Massachusetts 02116.
Nome.lmprovemeq1intractor,Registration
{ .r -- . .:::::j: '-, Type: Supplement Card
P.RIMET000H8ERVICESINC it,.:--•-•-f ::. _ /. r, Reglstratiorc 155885
t w 1-7÷:---7-z4,,,mo/
B HURON DRIVE ,y .� +'i E>�iraGorc tW311120t9
NATICK,MR 01760' 7,-- T {
( . rAl
'
�) �'_= ,
c,i?y....- ,"tri Update Address and return card. Mark reason for change.
9G11 eY 2MFe5+tt
���'} • a Address 4a Renewal.°E apforied,Ll Loeteard
dile iarWMfmaikC p !LIEN.urJ m
'� 'Mooed CossaraertakerskausinareltegutaUse
'`—. .4MOMEtMPROVEMENT CONTRACTOR Registration valid for.tndWkdual'eseofly
'.,- to"—� j •'T»'f~swore/ern ant Card .Aatoretheexpiretiontints..Mround return to
. ,.yam, fl '€ Once of Consumer Affair*and Business Regulation
• p,_tr —1 O$f3Qr2019 10 Park Plaza-Sults 5170
•�IME TOUCH S.. •ER1R SNC . Bestcn t A 02116
BHUROM DEWS
ftATlcK MA O176D ,Urtder9eCretary 'NCt valid ewltltout signature=
' t w
Commonwealth of Massachusetts
Tr Division of Professional Licensure
2:. T. 14-:.- ' 1: 1 ligl
Board of Building Regulations and Standards
ConstrQCtt6rf Ittipervisor
1-
CS-068912 ;5 M "'+ E plres:09/03/2020
MATTHEW/TUME:HAN-i j .t
13 DANAPARK, r /
HOPEDALE MA 81T4T ,, ��
ttb/sti t%L*S
Commissioner L/'^'
The Commonwealth of Massachusetts • •
t, Department of Industrial Accidents
j Office of Investigations
6/10°Washington Street
-‘- Ban,MA 02111
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www.mass.gov/dia •
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name t'errsnessrorgan;:ationrrndirntuaD: .P,rimetouch 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):..
1. ✓0 I am a employer with. 504 4: Q I am a general contractus and I
6.employees(full andlor part-time).* have hired the sub-contractors ' 0 New constrnctiarr
2.0 T am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling
ship and have no-cmpioyees These sub-contractors have gti 0Demofikon_
working for mein any capacity. employees and have workers'
[No workers' comp.insurance comp.insurance.) 9: Q Building addition
required.] 5. 0 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 ILO Plumbing repairs or additions
myself.[Noworkers'comp. ghtof exemption per MOL . 12.0Roofsepairs
insurance required.)t c. 152,i 1(4),and we have no
employees.[No workers' 43.12)Other Siding 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 hire outside contractors must submit a new of idavit 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 emplayees,.th y must on:widatheir wodars'comp.policy numb=
lam air emp toyer at is providing worlcerCcompersatoninsurance formyemployees. Below istilepolieyandjahsite
information
Insurance Company Name: Star tnsurance-Company:
Policy#or Self-ins.Lic.#: WC0452496 Expiration Date: 4/1/2019
Kates Path Yarmouthixttt,MA 02675
Job Site Address: CitylStatrlZip: . .. . . .. . . . . . .
Attach a4:opy-of-the-worken1-compensation-politydeclarationpage{showing-the politJwumber-andtexpiration-date).—
Failure tosecure coverage es required under Section 25A of MOL c.152 can lead to Te'imposition of criminal penalties of a
fine up to$1;500.00 and/or ane-year imprisonment,as well as civil penalties in the form of.a STOP WORK ORDER and a fine
ofnp to 5230.00 a day against the violator. Be advised theta copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
.1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature: ,/,4"------^"C",_ Date: 8/7/2018.
Phone if; 508-652-9170 .
Official use onlj. Do not write in this area, to be completed by city or town official
•
City or Town: Permit/License#
Issuing Authority/curie one):
1.Board of1ealth'2.BmidingDepartmerrt 3. City/Town Clerk 4 lectricalInspector 5:Plumbing inspector
6.Other
•CcmtnetPerson: Phone#:
V
• 4.
...---"'"1 PRIMTOU-01 LBROWN
A`FRS CERTIFICATE OF LIABILITY INSURANCE DATE IMMIODNYYY)
1 0/12/2018
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 or 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
FBinsure,LLC •wry
' IFA%
u�No.Ext:(508)824.86661240 I ArG No
120 Dean Street ( _._•__ ,_„ I_ ,_.1:
Taunton,MA 02780 - rgpf kstLBrOWflI fbinsure.com _ __
•
_ INSURERISI AFFORDING COVERAGE_ HAICI
.. _ . . . ._... ____ INSURER A:SEIOCtive Ins CO of SC _ 19259
INSURED INSURER a:Selective Ins Co of Southeast _ 39926
Prime Touch Services Inc INSURER c:Star Insurance Company _____ 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 POUCY 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.
_—
MR AWL SUER POLICY EFF POLICY
TYPE OF INSURANCE
LTR IVSD WYD� POLICY NUMBER IMMIOD/YYYYI IMMlOD/YYYY1 LIMITS
A X COMMERCIAL GENERALUABILITY 1,000,000
r-- EACH OCCURRENCE $
t I CLAIMS-MADE I X I OCCUR X S 191632310/15/2018 10!1512019 DAMAGE TO RENTED 500,000
X B(kt Add'I Ins I engMiQEs(Eaassvlronce) s _
MED EXP(Any rmepMmn) •S 15,000 •
X Blktwaiver PERSONA; r,ADV INJURY ,}., 1,000.000
GENt AGGREGATE LIMIT APPLIES PER. 3,Og0,000
POLICY PRO' I I GENERALAGGREGATE •E, *LW.
__
I Ta LOC I PRggUCTS•COMPIOP AGG'f 3'000,000
,.._ _.I.
OTHER.
B AUTOMOBILE LIABILITY ICOOMroED SI LIMIT S 1,000,000
reasn)ANYAVTO A 909259$ 10/1512018 10/1512019 BODILY INJURY(Per personl 1
AUgqTppOO�S ONLY IX SCHEDULED
X AUTOS ONLY X NON WNE • 1 ... .,.MJURY(Per.....accident) S _ ..._
I AUTO ONLQ F OPERTY DAMAGE
tPer accdenlI) . S
I , Hired PD ,t 75,000
A X UMBRELLA DAB X I OCCUR _1 5,000,000
EACH OCgVRRENCE __
I EXCESS LIAR CLAIMS-MADE. X 5 1916323 i 10/15/2018 10/15/2019 . 5 000,000
•". + ...�. ..• , I AGGREGATE r
DED I X,RETENTIONS D. 1
S
C LAND EMPL EMPLOYERS'
A LII I X 1 STAME I ..E@H_
:AND EMDLOYERS'LIABILITY •
:ANYPROPRIETORIPARTNEREXECl1TIVE YIN WC0452496 04/01/2018 04/01/2019 EL EACH ACCIDENT 1,000,000
• •OFFICERINEMBER EXCLUDED? I N I MIS 1' ,000,
(Mandatory In NH) E L.DISEASE_EA EMPLOYEE ,S _1 ___000
Ilya unser .
Il .
DESCRIPTION OF OPERATIONS below I i E L.DISEASE•POLICY LIMIT s - 1,000,000
A Equipment Floater ) S 1916323 10115/2018 10/15/2019 Leased Equipment 100,000
I � • I
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD sot Addlmonel Remarta Schedule.may be attached N moo Space N re ulrerq
Painting and Carpentry Contractor.Leased Equipment coverage is Actual Cash ValueSpeclal Form with 3500 Deductible.
IDM:614010.CIL Forms C07300 1/16(Blkt Al ongong ops,MC)and C07921 11/14(Mkt Al completd ops)are attached.
•
CERTIFICATE HOLDER CANCELLATION
•
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Barkan Management Company inc
Wo Compliance Depot ACCORDANCE WITH THE POLICY PROVISIONS.
PO Box 115006
Carrollton,TX 75011 AUTHORIZED REPRESENTATIVE
Wa X. 3hmin,,
I
ACORD 25(2016/03) 01988.2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
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fir a foil
KINGS WAY CONDOMINIUM TRUST
64 Kings Circuit
Yarmouth Port,DIA 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