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HomeMy WebLinkAboutBldsm-20-00334 - of ►- SHEET METAL PERMIT Commonwealth of Massachusetts Town of Yarmouth Building Department 1146 Route 28, South Yarmouth, MA 02664-4492 Date: Permit#: E(,D 1 oio—'33Zc/ Estimated Job Cost: $ Permit Fee:$ �/ Plans Submitted: YES/NO Plans Reviewed: YES/NO Business License# q8 Application License# 64 3( Business information Property Owner/Job Location information Name: $,F 4 " " Lr " Name: L VL LOP 0 Street: f [` iit S vi J Street: 1C 3,Iti' l cia. City/Town: (�[t y/1i�15 City/Town: \ram r i1/1401 — , UV Telephone:6-68-1iO-2,881 Telephone: 1 ) 5 6 6 Photo 1.D. required/Copy of Photo 1.D. attached: e/NO Staff Initial: J-1 CVI3. 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_Institutional Other Square Footage: under 10,000 sq.ft. over 10,000 sq.ft. Number of stories: Sheet metal work to be completed: New work '/Renovation: HVAC:/Metal Watershed Roofing:_ Kitchen Exhaust System: Metal Chimney/Vents:Air Balancing:^_ Provide detailed description of work to be done: Tit 11(4eA bti ieo vu t to)fyr o d U ik INSURANCE COVERAGE: I have a current liability insura ce policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes V 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 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 requirement. Check One Only Owner Agent Signature of Owner or Owner's Agent By checking here ,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 i/ No Progress Inspections Date: Comments: Final Inspections Date: Comments: Type of license: By: ✓ Master Title: Master-Restricted '1`Signature of Licen e City/Town: Journeyperson �� 5 Permit#: Journeyperson-Restricted License Number: Fee: $ Check at www.mass.gov/dpl T Inspecto ignature of Permit 1' of Permit Approval tr: is ,:4 ` }: S i Wyk � t 1�1 t t 1 k �� 't�" rlit }� L A\ 1��L�1 L ih l •' 1*'V ik44i, t 1 4 l , .y�,� ;4��\�,k,, ,y lit,,,,,(� t��} P f, '°b ,t do a^ Y '��cM'� tk a�,j i�r i�ld .t iw v -.,,`1,,Avvt ( +, �\ §, tt�alrsv t r .`'��`14c�43n r x 1` :��,t'ilf� {;ki fit '+ x�r 7#k¢ 11.°fi ��1�',OVIW _`4rii thg. �ppF t tidi k, ,�,; .4 'F . �5 t� 4 ti t 1,1t"' ti 1 � ,e ninUtn is xk by`01�,t T t t y ii i,,;Irp y t,3 Ak., a 44, e 4t'Y l�axv 11s •1',,�°'�Y•Sx i etc FL by i F,`�� 1AiLL »lr°!t C ,I i�c V5i r gm t r . } ii4, t - x� 4 F t 4 f i,,,c 1 1 : fay t, .4 � i1 0,1 4: k � v t ' ; ,.CO MON1 IEALTl f O F;M��AkSSi ±f 1 Si TTS.:: "'\, DIVISION',OF PROFIESSIONALILICIENS,URE SHEET METAL WORKERS f< ISSUES TiE FQLLOWIIIG LICENSE MASTER-UNRESTRICTED ROBE iT G BOURQUE 14 CROOKED CARTWAY MARSTONS MILLS,NSA 112548 t0O8 ' r 6435 05/28/2420 453 4 LICENSE,NUMBER ,, EXPIRATION DATE 5ERlA1 NUMBER DMSION,OF PROFESSIONAL LICENSURE .BOARD SHEETME ALiNOItIGI . iSSUES'1'IHE m NG L(CENS'E Sll4ES9 }) ,J2 i G rl 4 „ ROBERT .G7 C30URQ�3Et� E HEATi G AND C€IOLiNG t:O ;�'� 4 P 3 BO T7O �, � " i� ►r S NSMIU 64s ti 398 O6d'25120Zt 51897°2 LSCETISE NUMBER EXPIRATION DATE SER?AL NUMBER ACo® CERTIFICATE OF LIABILITY INSURANCE DATEIMMIDDIYYYY) 4/ 09/27/2019 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 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 - 6OrlTALT Deborah Kelly NAME: Leonard Insurance Agency,Inc re PHHOONE (508)428-6921 FAXwc, (508)420-5406 683 Main Street l deborahk@Ieonardagency.com ADDRE j ) ADDRESS: Suite B INSURERS}AFFORDING COVERAGE NAIC C Osterville MA 02655 INSURER A: Chubb Group 12777 , INSURED INSURERS: Chubb Bourque Heating&Cooling Co.,Inc. INSURER C: Chubb B&L Equipment LLC INSURER D P.O.Box 770 INSURER E Marstons Mils MA 02648 INSURER F: COVERAGES CERTIFICATE NUMBER: 2019-20 Master All Lines REVISION NUMBER: a 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, ICY EXP L R T TYPE OF INSURANCE yyy0. POUCY NUMBER a woorYYYY)'. MMMM mD/YYYI') UNITS 0. COMMERCIAL GENERAL LIABIUTY EACH OCCURRENCE $ 1,000,000 DAMAGE 104}3'li'Ef;1 I CLAIMS-MADE X OCCUR PREMISES LEa acWrralce).d+.. $ 50,000 MED EXP(Any one person) $ 10,000 A D949064647 10/01/2019 10/01/2020 PERSONAL&ADV INJURY— $ 1,000,000 GENt AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 n PRO- Ei POLICY I I JECT LOC PRODUCTS-COMP/OP AGO $ 2,0D0,000 ` OTHER. ,.$. . AUTOMOBILE LIABILITY ..... _ �... 'COMBINED SINGLE LMI *$ 1,000,000 /Eaacadenti --.,.ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED 73611221 10/01/2019 10/01/2020 'BODILY INJURY(Per accident) $ AUTOS ONLY /� AUTOS X~'HIRED — NON-OWNED :PROPERTY DAMAGE AUTOS ONLY X AUTOS ONLY (Per acgdenl} $ $ X UMBRELLA LIAB X OCCUR( y 3,000,000 -.. „� `„_, EACH OCCURRENCE $ A EXCESS JAB CLAIMS MADE D949064635 10/01/2019 10/01/2020 AGGREGATE $ 3,000,000 DED >4 RETENTION$-10,000 ' $ WORKERS EOMPENSATION PER 1 0TH AND EMPLOYERS'LIABILITY YIN I STATUTE I ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N I A E.L EACH ACCIDENT 5 (Mandatory in NH) E.L DISEASE-EA EMPLOYEE :S If yes,describe under .-° -..,'.. DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS r LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Yarmouth ACCORDANCE WITH THE POLICY PROVISIONS. 1148 Rte 28 AUTHORIZED REPRESENTATIVE S Yarmouth MA 02664 1 ! f I dM'�rt G.OG. ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD • ACORD® CERTIFICATE OF LIABILITY INSURANCE DATE(MOD/TM') 05/16/2019 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 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). CONT PRODUCER NAMEACT Rogers and Gray Processing ROGERS&GRAY INSURANCE AGENCY INC iAlc°Nro.Ext): (508)398-7980 FAX (A/C, E-MAIL mail©rogersgray.com ADDRESS: � ger sgray.com 434 ROUTE 134 INSURER(S)AFFORDING COVERAGE NAIC# SOUTH DENNIS MA 02660 INSURERA: CONTINENTAL CASUALTY CO 20443 INSURED INSURER B: BOURQUE HEATING &COOLING CO INC INSURERC: INSURER D: PO BOX 770 INSURER E: MARSTONS MILLS MA 02648 INSURER F: COVERAGES CERTIFICATE NUMBER: 403610 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR JMSD WVD POLICY NUMBER (MM/DD/YYYY) IMM/DDIYYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE TO RENTED $ CLAIMS-MADE OCCUR PREMISES Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS N/A BODILY INJURY(Per accident) $ AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X STATUTE OTH- ER AND EMPLOYERS'LIABILITY A OFFICER/MEMBEREXCLUDED?ECUTIVE E.L.EACH ACCIDENT $ 1,000,000 N/A N/A NIA 6S59UB5B39530A19 05/17/2019 05/17/2020 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only. Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/Iwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Yarmouth ACCORDANCE WITH THE POLICY PROVISIONS. 1146 Route 28 AUTHORIZED REPRESENTATIVE South Yarmouth MA 02664 (3—k) L` Daniel M.Crey,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD n tp O III 0 a 0 0. N G. O 508-790-2887 (TEL) 508-771-9696 (FAX) 12/05/19 To Whom It May Concern: Enclosed is a permit application along with a check and self addressed envelope so that the permit may be mailed back to Bourque Heating & Cooling Co., Inc. Please feel free to contact our office at 508-790-2887 if you have any questions. Thank you Lise Bourque Offices: Mailing: 1199 Pitchers Way PO Box 770 Hyannis, MA 02601 Marstons Mills, MA 02648