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HomeMy WebLinkAboutSM-19-3595 5-024 ice. w/ corrirto i,1.7 131 l? i.:::..-.. •-•• . 1 \. lQ GEC 102018 �00.. tNU UEPARTMtNT dY SHEET METAL PERMIT ` u&�I' 1= Commonwealth of Massachusetts Town of Yarmouth Building Department 1146 Route 28, South Yarmouth, MA 02664-4492 /�G Date: LJ�c,en.,�.e.- /01 2.01 $ Permit#: /3(. fig) �/ Estimated Job Cost: .2Is, boo Permit Fee:$ Plans Submitted YES NO Plans Reviewed: YES/ NO Business License # Application License# 771 Business Information Property Owner/Job Location Information Dila•'$('n 33y - 7,34-3 Name: Qin., -061./..kSooflv..,, Name: Run/+ EI-tnpcc ri Street:lq-1-3- cc P rnvry`� cy� 47-,L Street: /1 Lon ct� Qom Dru 4c_ City/Town:toast Loeiroi k b o -1B93 City/Town: Socrit, Ya.rmoujh PIA Telephone:14o1 til 2.3- igoo Telephone: Photo I.D. required/Copy of Photo I.D.attached a 0 Staff Initial: J-1 a unrestricted license J-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_ Multi-family_ Condo/Townhouses_ Other_ Commercial: Office_Retail_Industrial_Educational_Institutionalr _Othe Square Footage: under 10,000 sq.ft.1 over 10,000 sq.ft._Number of stories: 1 Sheet metal work to be completed: New work V Renovation:_HVAC:_Metal Watershed Roofing:_ Kitchen Exhaust System: Metal Chimney/Vents:_Air Balancing:_ Provide detailed description of work to be done: "?\o_,+.0n A. V,2.1) ba-e-L 1,1-4-L.11 O n Q2. 4-b . 2n s-LU fU k-J S , , cio-cd• 3 c rt ttc.J. boak -{-o � Cps.p 24n -oM c.-��n� k o-w.-- c-.t.Q ti _.4.:...,-io h ro.-,en Ii rts- 0.A r-.e-i_y:.r. nQ INSURANCE COVERAGE: I have a current liability insuynce policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes No If you have checked Lei, indicate the type of coverage by checking the appropriate box below: A liability insurance policy v Other type of indemnity_Bond OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waives this re t. tie 62 Check One Only Owner Agent Signature of Owner or Owner's Agent By checking here-a 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 Progress Inspections Date: Comments: • Final Inspections Date: Comments: Type of license: By: _ Master Title: Master-Restricted t signature of Licensee'1' City/Town: Journeyperson Permit tt: Journeyperson-Restricted License Number: Fee: $ Check at www.mass.gov/dpi /X-i3- 1F ( inspector Signature of Permit t of Permit Approval A a 9uniVnofbfb� aDf1 35t FW 'to 1--� 1 y 0.t' ',Mn 0. Yn a .,WTI u :`_..=-� f ' 4Zy9 . . 2- •_z Za ' i$ NU. :W4y+ IDzagn i .2'O pepAUG Kio Z a tv- :.iu } • `� • N a. e 'y. ark. • u. z j 4 . . nK L *.� f e 4Beacon tz�7 y Mutual Insurance Co. Renewal Notification July 30,2018 Southern Mechanical,LLC Energy One&Energy One LLC 197 JP Murphy Hwy West Warwick,RI 02893-2382 Policy Number. 0000081393 Policy Effective Date: 08/10/2018 Account Number: 20509764 Dear Policyholder. Enclosed is your renewal policy for the extension of the above Workers'Compensation Policy. If you have a direct billed policy,your renewal premium must be received on or before the effective date of the policy to ensure continual coverage. Please allow five days for mailing In order for the premium to be received at our post office lock box. If you select Beacon Pay As You Go,you must sign up for payroll reporting and authorize EFT payments prior to the effective date of the policy. This renewal policy uses the expiring policy payroll and data for determination of the renewal premium. All payroll and coverage Is subject to a premium audit initiation by the Beacon Mutual Insurance Company and is subject to change at that time. Non-Renewal Notice; We are obligated to inform you that this notification also serves as a notice of non-renewal in the event that the premium is not paid on or before the effective date of this policy. If payment is not received notice will be issued to the Rhode Island Department of Labor and Training as well as any and all Workers' compensation certificate holders. Beacon Pay As You Go: If payment under the Terms and Conditions of Beacon Pay As You Go Is defaulted,a cancellation notice will be generated and earned premiums will be determined.Cancellation Notice will be issued to the Rhode island Department of Labor and Training. Please review the policy carefully and contact your agent to discuss any changes required. Sincerely, • .Cam.Gi.s.Itt Underwriting Department ilia Beacon Mulual Insurance Company One Beacon Centre,Warwick,RI 02886-1378 I beawntnulual.com Underwriting:401.825.2667 1 Toll Free:1.888.886.4450 BE_o0_00 02 V4 WP1 WralYMTM45O�", - " PM S MOWN SAO Intl• f0]lN 45_x4 a pumaIF xe.i„,.„.0I '�-- aM Eaten xa.. o. 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