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Home My WebLink AboutBLD-19-004096 0 I I q Office Use Only U Y R Permit# is S} 0 i Ut) { 0wits l �u//�H. Amoa�e 4` . *, . 'Permit expires 180 days from i. issue date t. EXPRESS BUILDING PERMIT APPLICA ti" C E I V E D TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 JAN 14 2019 South Yarmouth,MA 02664 - BUILDING DEPARTMENT ___—. (508)398-2231 Ext. 1261 B,.: r'- , t4 dr bc? I '1_.,CONSTRUCTION ADDRESS: —r x .,...„ y„ ASSESSOR'S INFORMATION: Map: 1 33 Parcel: i -7 OWNER: u' Lot) Lo t -r_.:- Z I � ' li ' t 'orf- N' E PRESENT ADDRESS(� TEL # CONTRACTOR: Peter 1L, E•c—II S4 Hookers boat_ Y/0 r4- C n '737-47-TS NAME MAILING ADDRESS TEL I ' OD I'Cidential 0 CommercialEst.Est.Cost of Construction$ (-100O3, , Home Improvement Contractor Lie.if 1 9 O 1jlv1 23-1 Construction Supervisor Lic.I C5 0 8-.5 0 7/ Workman's Compensation Insurance: (check one) ❑ 1 am the homeowner 0 I am the sole proprietor 0ilhave Worker's Compensation Insurance Insurance Company Name: 4550 t. e.0-+-e c/. . .salt P iD y r r 9 Worker's Comp.Policy# (&)CC Sooco I ZZ CO 70/84 WORK TO BE PERFORMED Tent _ Duration O (Fire Retardant Certificate attached?) Wood Stove A"0 Siding: #of Squares J Replacement windows:# A.) 0 Replacement doors: # A)0 Roofing:. #of Squares PO ( )Remove existing*(max.2 layers) Insulation N_ Ye.. Old Kings Highway/Historic 1Dist. ( �eplacing like for like Pool fencing /w •The debris will be disposed of at: S 4-_J �( r7 Location of Facility I declare under penalties of pe ' that the statements herein contained are true and correct to the best of my knowledge and belief. I understand that any false answer(s) will be just cause for denial o ocation of my license and for prosecution under MG.L Ch.268,Section I. ii /Li Applicant's Signature:' J/J //(//�� _ _- ! Date: I I p1 Owners Signature(or attachment) � D-i-)) o a'G�"' Date: I/ / L�//1 Approved By: (....77--..,-:.- f l Date: -/1t ''11J Building Official(or detTgnee) EMAIL ADDRESS: /;ening District: / Historical District: IY Yes 0 No Flood Plain Zone: 0 Yes 6'No Water Resource Protech istrict: Within 100 ft.of Wetlands: 0 Yes No 0 Yes V No Th• Commonwealth of Massachusetts Department oflndustrialAccidents F_=_ielld- 44 1 Congress Street,Suite 100 ? a Client#:45578 2KIMBALLAP ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMND/YYYY) 7/15/2018 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(les)must 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 CONTACT NAME: Dowling&O'Neil Insurance Agy _LAI;NA Eat:508 775-1620 FAX 973 lyannough Road EMAIL (NC,Ne): 5087781218 ADDRESS: P.O.Box 1990 INSURER(S)AFFORDING COVERAGE NAICS Hyannis,MA 02601 INSURER A:Wa4arswadd 13196 INSURED INSURER B:Maadand Emplaynaanunn eCampnp 11104 A.P.Kimball Construction LLC INSURERC: 84 Homers Dock Road Yarmouthport,MA 02675 INSURER D: INSURER E: INSURER F: 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. LTR TYPE OF INSURANCE NSB SUER WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS POLICY YYYII (POLIO YYYY) A GENERAL LIABILITY NPP1490240 04/30/2018 04/30/2019 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PFEMISES(TppEeoMm,Enence) $50,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $5,000 X BI/PD Ded:1,000 PERSONAL a ADV INJURY $1,000,000 _ - GENERAL AGGREGATE $2,000,000 GENL AGGREGATE LIMIT APPUES PER PRODUCTS•COMP/OP AGO ,1,000,000 AI POLICY I I JEQ I I LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ _ ANY AUTO BODILY INJURY(Por person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ — HIRED AUTOS _ AUTOS (Per acdden0 _ $ UMBRELLA LIAB — OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ — B- WORKERS COMPENSATION WCC50050122502018A 07/09/2018 07/09/2019 X TORYIAMFIS FRµ AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNER/EXECUTNE Y/N EL.EACH ACCIDENT $500,000 OFFICEFUMEMBER EXCLUDED? N NIA (Mandatory hi NH) E.L.DISEASE.EA EMPLOYEE $500,000_ N yea.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,K more space Is 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 POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1146 Route 28 ACCORDANCE WITH THE POUCY PROVISIONS. South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE ®1988.2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S2158591811215850 RPCC1 C74. rwnwnonanrl/Ol op rtazachette!s - - Office of Consumer Affairs B Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:LLC before the expiration date. If found return to: Aeaistratiof-\ Expirgen Office of Consumer Affairs and Business Regulation 178472= _-04/15/2020 One Ashburton Place-Suite 1301 AP KIMBALL CONSTRUCTION,LLC Boston,MA 02108 PETER KIMBALL 61Z-telt" ilk/ / b .4( 84 HOMERS DOCK RD YARMOUTH PORT,MA 02675 undersecretary Not valid without signature siaumoawoq gum sloequoa moA uo pasn Jagwnu pue aweu agl sagolew aleogf.ao moA uo Jagwnu DIH pue aweu ei.n Ze 1 Ajpaa 01 anus ag , Massachusetts Department of Public Safety Board of Building Regulations and Standards License:CS-085071 Construction Supervisor -7 fi rw PETER V KIMBALL 84 HOMERS DOCK ROAD"""7 q ^ YARMOUTH PORT MA 02675, V /hi 7c-at) t/za._ Expiration: Commissio er 03/29/2019