HomeMy WebLinkAboutSM-19-3559 •
RECEIVED
4 171
DEC 12 2011b
� * SHEET METAL PERMIT __JJ
d 1 ' `;u Commonwealth of Massachusetts 6uiitiiiac o=PnizTnnENT
c
'""° Town of Yarmouth Building Department
Date: \WIZ/ 10 Permit#: ,$Li5i /9-ad3ss`1
Estimated Job Cost:$ ,COD Permit Fee: $
Plans Submitted: YES/NC Plans Reviewed: YES/ NO
Business License# aSSc. Application License#
Business Information Property Owner/Job Location Information
Name: P l a Z% k Lk/AC Name:
Street: -75. ° (-tea ILC) Street: 3'-t .��4o.y 2d =
City/Town: Cerci - I.:4-' 1k �� r^A City/Town: 0°. - 'I-ea-J.-42I--4L-,
Telephone: S -3,,0 -16C, 2. Telephone:
Photo I.D. required/Copy of Photo I.D. attached: YES/ NO Staff Initial:
..-
/-175M-1 M-1 unrestricted license
1-2/ M-2 restricted to dwellings 3 stories or less and commercial up to 10,000 sq. ft./2
stories or less
Residential: 1-2 family Z-Pctl-family_ Condo/Townhouses Other=
Commercial: Office Retail Industrial� Educational_Institutional_Other_
Square Footage: under 10,000 sq.ft. over`er 10,000 sq. ft._Number of stories:
Sheet metal work to be completed:
New work Renovation:_HVACZ---Metal Watershed Roofing:
Kitchen Exhaust System:_Metal Chimney/Vents:_Air Balancing:_
Provided-tailed descri•tion of work to be done: L, _ 1
P--± .> L t--cit.--L V-+., • - •51L 1-‘1-e. f\ „ ,c,`
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INSURANCE COVERAGE:
I have a current liability ins a e€policy or its equivalent which meets the requirements of
M.G.L. Ch. 112 Yes No
If you have checked yes, indicate the type of coverage by checking the appropriate box below:
A liability insurance policy_Other type of indemnity_Bond
-- - OWNER'S INSURANCE WAIVER:I am aware that the licensee fines not have the insurance coverage required by
Chapter 112 of the MassaI u -. eneral Laws,and that my signature on this permit application waivPSthis
requirement
-1515,7 Check One Only/
Owner [/Agent_
•- re of Own- or Own-r's Agent •
By checking here4 ,I hereby certify that all of the details and Information I have submitted(or entered)regarding this application are true
and accurate to the best of my knowledge and that all sheet metal work and installation performed under the permit Issued for this application
will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws.
Inspections shall be called for prior to insulation installation.
Duct inspection required prior to insulation installation: Yes No
Date: Comments:
Date: Comments:
Type of license:
By: _ Master
Title: Master-Restricted T Signature of Licensee t
City/Town: Journeyperson
Permit#: Journeyperson-Restricted License Number:
Fee: $ Check atwww.mass.gov/dpi
'I` Inspector Signature of Permit 1`
of Permit Approval
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ClientS:21832 2AIRRt
ACORD. CERTIFICATE OF LIABILITY INSURANCE 0 )
08/282018
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(les)must be endorsed.N 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 ERNTACT
ME:
Dowling&O'Neil Insurance Agy PHHppNE pm; 7751620 FAX
(Arc,r8-):5087781218
(ArC,Nq
973 lyannough Road E-MAIL
ADDRESS:
P.O.Box 1990
- _ - INSURER(S)AFFORDING COVERAGE NAIC
Hyannis,MA 02601 INSURER A:NOM,e^M„aCOMM" - 14788 - - -
INSURED INSURER B:
Air Rite HVAC Inc.
INSURER C:
33B Old Maln Street
INSURER 0:
South Yarmouth,MA 02664
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POUCIES 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 CONTRACTOR 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 POUCIES. UMITS SHOWN MAY HAVE BEEN REDCUCED BY SUCFF H CLAIMS.
ILTR TYPE OF INSURANCE INS Wyp POLICY NUMBER (1 WDD/1'TYY) (MIAT/D EXP
WAIS
A GENERALUABIUTY MPT8454A 04/13/2018 04/13/2019 EACH OCCURRENCE $1,000,000
PRE
X COMMERCIAL GENERAL LIABILITY MISES IEeoNocurence) $500,000
CLAIMS-MADE n OCCUR MED EXP(My one person) $10,000
PERSONAL SADV INJURY $1,000,000
GENERAL AGGREGATE $2,000,000
GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS•COMP/OP AGG $2,000,000
-1 POLICY I iE& LOC $
A AUTOMOBILE LIABILITY M1T8454A 05/162018 04/13/2019 aMBINEDS $ )
INGLE LIMIT 1 000t000
eCC�Oentl
ANY AUTO BODILY INJURY(Per penton) $
—
ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS X
X HIRED AUTOS X AUTOS D PROPERTY DAMAGE $
AUTOS (Por accident)
$
A x UMBRELLALIAO It OCCUR CUT8454A 05/18/2016 04/13/2019 EACHOCCURRENCE $2,000,000
EXCESS UAB I CLAIMS-MADE AGGREGATE s2,000,000
DED X RETENTION$10000 s
A WORKERS COMPENSATION WCT8454A 04/13/2018 04/132019 X rOGAT�S
1FORµ
AND EMPLOYERS'LIABILITY
ANY PROPRIETOR/PARTNER IEXECUflVEY/N E.L.EACH ACCIDENT s500,000
OFFICEREMBER EXCLUDED? n N/A
(Mandatory In NM E.L.DISEASE-EA EMPLOYEE $500,000
11 yes,describe under
DESRIPTIONOFOPERATIONS below E.L DISEASE•POLICY LIMIT $500,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Mich ACORD 101,Additional Remarks Schedule,It more space le required)
Insurance coverage Is limited to the terms,conditions,exclusions,other limitations and endorsements.
Nothing contained In the certificate of insurance shall be deemed to have altered,waived,or extended the
coverage provided by the policy provisions.
CERTIFICATE HOLDER CANCELLATION
Town of Yarmouth SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN
1146 Route 28 ACCORDANCE WITH THE POLICY PROVISIONS.
South Yarmouth,MA 02664
AUTHORIZED REPRE
ESSEN
TATIVE
j I tiy-a-�
01988-2010 ACORD CORPORATION.All rights reserved.
ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD
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