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EXPRESS BUILDING PERMIT APPLICATION; a—r
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TOWOF YARMOUTH
Yarmouth Building DepartmentGEC 0 6 2(31B
1146 Route 28
South Yarmouth,MA 02664
4508)398-2231 Ext:1261 atl1�z
nv
coNSTRUCT1oNADDRESS: /0 f2 Kates Path
ASSESSOR'S INFORMATION:
Map: Parcels
OWNER:Kings Way Condo Acre'.CIO Barkers Property.Management 64 Kings Circus,Yarmouth Port,MR 02675 617-532-8610
—PRESENT ADDRESS—__ _. .. ______ ____TEL.i2__ _ __—___ .._ _
, CONTRACTOR? Primetouch Services.16'Tech Circle,Suite 102:Natick,MA01760 508-652.9170
NAME MAILING ADDRESS TEL.
❑Residential QI Commercial Est Cost of Construction S S Obb
'€inns Tmpmoveteent eestractor Lie.* 155685 Construction Supervisor lie.M 068912
Workman'aCompenstaionlnsurance: (cMckone)
04 am the homeowner U lam the sole piiopraetor Ihave Worker's Compensation Insurance
7nsunmce Company Name: stat insurance Co - 'Worker's Comp.Poticy$ WC0452498
WORK TO BE PERFORMED
Tent _- Duration (The Retardant Certificate attached':) Wood Stove
Siding; #of Squares Lc Replacement windiness# Replacementdbors. #
Roofing: #of Squares ( )Remove existing*(mux.2 layers) insulation
Old Kings Highway/Historic Dist, ( )Replacing like for like Pool fencing
*The debris wrn be disposed or at: et. Noonan l'rucking,:PO Box 400.West Bridgewater,MA
London of Facility I devise ender penalties of perjury that ihe statements heron contained amine and correct to the best of my knowledge and belief. I understand that any false answer(s)
will be just cause for dental torrevaeetion of my beers and for,puosecatiaa under MC:L:+Ct.2611,Section 1
Applicants Signature: /�'�' _ Date: 12182018
Owners Signature(or attachment) - Date; /
Approved,l3y: / Data. >/5—6
ELM or des%nte) EMAIL ADDRESS:
Zoafwg.Distaiet:
fitstoricalDistrict: 0Yes ❑ No FloodPltinZone: ❑ Yes 0 No
Water Resource Protection District: Within 100 ft.of Wetlands:
0 Yes 0 No 0. Yes 0 No
t.
The Cmnrnonwealth of Massachusetts
Department of Industrial AceWentS..
I *Ow 1, • Office of investigations
°r :✓ 60U Washington Street
'1,,-,. Boston'!1ALl 02111
• www.inass.gov/dia •
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/PIumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): 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):
1.0 I am a employer with 504 4. Q I am a general contractor and I'
employees(full and/or part-time).* have hired rhe sub-contractors ` ` 6• B New construction,
2.0 I am a sole proprietor or partner- listed on the attached sheet T. [Q Remodeling
ship and have no employees These sub-contractors have a: 0 15emoItiom
workingfoe mein an capacity. ..___ employees and have workers'
Y�P �" ; 9. [j Building addition
[No workers' comp.insurance comp.insurance.
required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions
officers have exercised their
3.0 1 tum a homeowner doing work ILO Plumbing repairs or additions
taysel£
p. , s'Comp. right of exemption;per MGL 110 Roofaepsirs
insuranee required.]t c. 152,11(4),mid we haven
employees.INo workers' .13.j Other 'Sitting Maks
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 walk and then hire 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. LE the sob-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers^campensationinsuraneefor my employees Below is the policy andfob site
information
Insurance companyNama Star Insurance Company
Policy#or Self-ins.Lic.#: WC0452496 Expiration Date: 4/1/2019
Kates Path Yamtouthport,MA 02675
Job Site AddressCity/Statr/Ztp: . .
—1sttaoh-aneopyt Dthe wor-kerstcompensation-pellet'-deelaration-page{sbow1ng-the-policy-nvmber-and-expiration-iate)..-
SFailttre to secure coverage as required under:Section,25A of MGL•c.152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or-one-year imprisonment,as well as civil penalties in the farm ofa STOP WORK ORDER and a fine
of up to 3250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby cerdfy under the pains and penalties ofperjury that the information provided above b true and correct
Signature: �:'^ '�.. Date: 8/7/2015
Phone# 508-652-9170
Official use only. Do not write in this area, to be completed by city or town Offerer
City or Town: Perrnit/License#
Issuing Authority(rirele one):
1.Board of Health 2.BuildingDepartment"3.'CltylfownClerk 4.- lectricalTnspertor 5.YlnmbingInspector
6.Other
ContaetPersotr. Phonei.'-.
(ffite ` of#9/16eutteizemeta,
ria
I Office of Consumer Affairs and Business Regulation
.�>
10 Park Plaza-Suite 5t7QN:
Boston, Massachusetts 02116'
Moine tmpraverne} Ant actor Registration
r'•l .^ r...�.-J_. -- •
i Type: Supplement Card
P.RIMET000HSERVICESINC '';;=-"" ,— _� R4, RegletratioM 155685
6 HURON DRNE t T_— i EXp1fOfC T.4/30/2019
PtATICK.MA 01760 ( t . fe 4 ( t
745
1=1-
{���A�'g•r lel
Update Address and return card. Mark reason for change.
test ti znera nr 0 Address Q Renewal.Q
F.lnployerertt L3 f.ostCard
.moeinf WAMPUM/Mena of bfr1.xurrr/t em
0111cout GasumeeARafs&BusursPojutsu . -. . .
;
110ME*MPIt011EMENTCONTRACTOR - RegtstratlonveBd1nrfrdhHdanlirsewnty
i� ---- •'TYPE 9uodamerftCartl - beforethsexpirationtlota If found return to:
I
BUISMOOSD. ists2itadhatt - - - _ -- - Office of Consumer Affairs and Business Regulation- - —_-- ------ -._ ------
2 -.41.55645 O4/34+2019 TO Pat Plaza-Subs 5170
TOUCH S171Nlctsit4C . Boston,MA 0211e
..:MATTHEW UNNEEtA• ° R CCb'.;p
HATICK,MAC 7
'Undersecretary Wet valid without sfgnatute
Commonwealth of Massachusetts
Division of Professional Licensure
• - Board of Building Regulations and Standards
ConstryettSA%ifp4rvisor
1
CS-068912 "'a E9ires: 09/0312020
MATTHEW 711NNEFUW 61-4 l ,
13 DANA PAM,
HOPEDALE MA g17q 'r.:,
Commissioner l .
•
•
•
�...'1 PRIMTOU-01 LBROWI1
A�RO CERTIFICATE OF LIABILITY INSURANCE OA10/12ODIYYYY)
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 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 of such endorsement(s).
PRODUCER FigieCT Loretta Brown
128 sure,LLC - PHONEnrc ,Ern:(508)6244668 1240 I FAX
Re
128 Dean Street - r(Eau _.__ _ _... .. 1.. .,-..F
Taunton,MA 02780 Veslisy iown(IDfbinsure.com __
•
•
•
INSURERi3)AFFORDING COVERAGE. — NAIC C
. . . . ..... __ INSURER A ._:Selective Ins Co of SC _ -. 19259
INSURED INSURER e:Se!ectIve 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:
• COVERAGE$ CERTIFICATE NUMBER. R.VISION 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.
LTR TYPE OF INSURANCE ADDL UMW POLICEEEE POLICY EXP
INSO NYO POLICY NUMBER IMWDD/YYYYI IMMl00lYYYYI MRS
A X COMMERCIAL GENERALUABILITY EACH OCCURRENCE S 1,000,000
r I CLAIMS-MADE [Xi OCCUR XS 1916323 • 10/15/2016 10/15/2019 DAMAGE TO RENTED
PREMISES IEa occurrence) f 500,000
X Stitt Add,Ins _M13 000
ED EXP/Any onepencn) f m
X Bikt WaNer I 1,000,000
I PERSQNALAACV WJURY ,5..
GENT AGGREGATE LIMITqp�APPLIES PER. GENERALAGGREGATE .t 3,000,06B
POLICY X]JECT r I LOC PRODUCTS•DDMP/OP AGO. S 3,000,coo
OTHER. • - .. t..
B AUTOMOBILE LIABILITY I i.COMBINED gSINGLE LIMIT S 1,000,000
ANY AUTO A 9092598 10/15/2018 10/15/2019• BODILY INJURY ENOperson) $
OWNED 'SCHEDULED -
AUgqT��O��f ONLY I X'AUTOS
W oo BODILY INJURY LPrr accts_ ) f
.X P�TOS ONLY IX A TVTV OSONEY PROPERTY DAMAGE r --
I I Hired PD '' m s 75,000
A X UMBRELLALWB X 1 OCCUR • EACHQCcVRRENCE i 5,000,000
I EXCESS UAB CLAIMS.MADE. X 'S 1918323 i 10/15/2018 10/15/2019 1 5,000,000
I , :A9GRgGATE
DED I X•RETENTION$ •• 0 t
C I AND COMPE IsAnoN I X 1 STATUTE I . 0Rµ
ZANY PROPRIETOR/PARTNER,E%ECIRNE I YIN - WC0452496 04/01/2018 04/01/2019 1000,000
•OFFICER/MEMBER EXCLUDED? N I EL EACH ACCIDENT 5
NIAm
(Mandatory In NH) E L.DISEASE_EA EMPLOYEES 1,000,000
If a,dwXlba under i _ ._
DESCRIPTION OF OPERATIONS below I E L.DISEASE•POLICY LIMIT S 1,000,000
A Equipment Floater I S 1916323 10/15/2018 10/15/2019 Leased Equipment . , 100,000
I I .
- DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLESACOR0101,AdilBonel Remarks achadual,may be attached II mor,soap Is reuIred)
Painting and Carpentry Contractor.Leased Equipment coverage is Actual Cash Value-Special Form with$500 Deductible. •
ID k:614010.CIL Forms CG7300 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
THE EXPIRATION 'DATE THEREOF, NOTICE WILL BE DELIVERED IN
Barkan Management Company Inc
do Compliance Depot ACCORDANCE WITH THE POLICY PROVISIONS.
PO Box 115008 .
Carrollton,TX 75011 AUTHORIZED REPRESENTATIVE
W',d1r.X3,L7,r
I
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 Linehan
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
Asti- a
Gerald A. Meaney, VP
Barkan Management Company, Inc.
Agent for Kings Way Condominium