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HomeMy WebLinkAboutBld-20-003608MIL II/ 1([3 J 1D TOWN OF YARMOUTH Building Department k . ,.; (508) 398-2231 ext.1261 BUILDING i � .. PERMIT ' PERMIT NO BLD-20 003608 �' JOB WEATHER CARD ' , "t"r ' ISSUE DATE 01/02/2020 APPLICANT Paul Eaton PERMIT TO Repair IAT(LOCATION) 35 GENERAL LAWRENCE RD SOUTH YARMOU ZONING DISTRICT i Bldg.Type: !Residential ° SUBDIVISION MAP BLOCK LOT 078 285 _ i BUILDING IS TO BE: [CONST TYPE ;'1 rv, USE GROUP f F CONTRACTOR 1 REMARKS Install 7.245 kw solar panels on roof.Will not exceed roof panel,but will add I I �MA.�a.......Ww. .u....,...m4__..,_,. .� 6"to roof height.23 Total panels. E LICENSE s `=,Construction Supervisor 't Trinity Solar 4 _ . .._. s Paul Eaton I ..�.� q, "M" 20, Patterson Brook Rd Unit 1 AREA(SQ FT) L721,048 680. EST COST($) 29000 00 PERMIT FEE($) 0 00 4 `;W Wareham MA 02576 OWNER TIERNEY EDWARD D I BUILDING DEPT BY ADDRESS !TIERNEY MEGGAN M 35 GENERAL LAWRE !SOUTH YARMOUTH MA 02664 /%�'' HONE THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE APPROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM INSPECTIONS REQUIRED FOR ALL APPROVED PLANS MUST BE RETAINED ON WHERE APPLICABLE CONSTRUCTION WORK: 1)FOUNDATIONS OR JOB AND THIS CARD KEPT POSTED UNTIL SEPARATE PERMITS ARE FOOTINGS.2)PRIOR TO COVERING STRUCTURAL FINAL INSPECTION HAS BEEN MADE. REQUIRED FOR ELECTRICAL MEMBERS(READY FOR LATH OR FINISH WHERE A CERTIFICATE OF OCCUPANCY IS PLUMBING/GAS AND COVERING)3 FINAL INSPECTION BEFORE REQUIRED,SUCH BUILDING SHALL NOT BE MECHANICAL INSTALLATIONS. OCCUPIED UNTIL FINAL INSPECTION HAS OCCUPANCY 4)REFER TO DETAILED INSPECTION BEEN MADE. SCHEDULE POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTIONS APPROVALS OTHER: WORK SHALL NOT PROCEED PERMIT WILL BECOME NULL AND VOID IF INPSECTIONS INDICATED ON THIS CARD UNTIL THE INSPECTOR HAS CONSTRUCTION WORK IS NOT STARTED WITHIN CAN BE ARRANGED FOR BY TELEPHONE APPROVED THE VARIOUS SIX MONTHS OF DATE THE PERMIT IS ISSUED AS OR WRITTEN NOTIFICATION. STAGES OF CONSTRUCTION NOTED ABOVE. , -/ 7 ® DATE(MM/DD/YYYY) ACORD CERTIFICATE OF LIABILITY INSURANCE 12/20/2018 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 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 CONTANAME:CT Mark Grasela Arthur J.Gallagher Risk Management Services, Inc. PHONE 4000 Midlantic Drive Suite 200 (A/C.No.Ext):856-482-9900 (A/C,No):856-482-1888 Mount Laurel NJ 08054 ADDRESS: CherryHiii.BSD.CertM@AJG.Com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:HDI-Global Insurance Company 41343 INSURED TRINHEA-03 INSURER B:Liberty Insurance Underwriters Inc 19917 Trinity Heating&Air, Inc. DBA Trinity Solar 28 Patterson Rd w SURER c:American Guarantee and Liability Ins Co 26247 Wareham, MA 02571 INSURERD: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER:411228819 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. ADDL SUBR POLICY EFF POLICY EXP ILTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDDIYYYY) (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY EGGCR000065618 12/31/2018 12/31/2019 EACH OCCURRENCE $2,000,000 DAMAGE RENTED X PREM SESO(Ea occurrence)CLAIMS-MADE OCCUR $500,000 MED EXP(Any one person) $0 PERSONAL&ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY X PE-. LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: A AUTOMOBILE LIABILITY EAGCR000065618 12/31/2018 12/31/2019 COMBINED SINGLE LIMIT $2,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ _ AUTOS ONLY — AUTOS ONLY (Per accident) B UMBRELLA LIAB X OCCUR 1000231834-03 12/31/2018 12/31/2019 EACH OCCURRENCE $21,000,000 A — EXAGR000065618 12/31/2018 12/31/2019 C X EXCESS LIAB CLAIMS-MADE AEC 1448324-00 12/31/2018 12/31/2019 AGGREGATE $21,000,000 DED RETENTION$ _ $ A WORKERS COMPENSATION EWGCR000065618 12/31/2018 12/31/2019 PER STATUTE ERH AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED?(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 A Automobile EAGCR000065718 12/31/2018 12/31/2019 All Other Units $1,000/$1,000 Comp/Collusion Dad. Truck-Tractors and Semi-Trailers $5,000/$5,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Evidence of Insurance CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Evidence of Insurance AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Ar t Department o f Industrial Accidents 1 Congress Street,Suite 100 sr "4t t " " Boston,MA 02114-2017 - v wwrv.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Apnlicant.lnfrsrmation Please Print Lettibly Name(Business.Organization,Individual). Trinity Heating&Air DBA Trinity Solar Address: 2211 Allenwood Rd: City/State/Zip;: Wall,NJ 07719 Phone#: (732)780-3779 Are you an employer?Check the appropriate box: Type of project(required): L i am a employer with 300 _employees(full and'or part-time),* 7„ ❑Nets construction 2 I am a sole proprietor or partnershipand have no employees workingfor me in •❑ P P � P 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] ..0 I am a homeowner doing all work myself.[No workers'comp.insurance requited.] 9. El Demolition I❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole l 1.FtElectrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5:❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet, 13.❑ p Roof repairs These sub-contractors have employees and have workers'comp..insurance.t 6.0 We area corporation and its officers have exercised their right of exemption per MGL e. 14,❑ •11?CC' 152.§I(4),and we have no employees.[No workers'comp.:insurance required.] *Any applicant that checks box:<I must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such, -Contractors that cheek this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: HDI-Global Insurance Company Policy#or Self-ins,Lie.#: EWGCR000065618 Expiration Date: 12/31/19 35 General Lawrence Road South Yarmouth, MA Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MOI.,c. 152.§25A is a criminal violation punishable by a fine up to$1,500,00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250,00 a day against the violator,A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do here • of under the pains and penalties of perjury that the information provided above is true and correct. Signatti tv r�.. Dattn 12/31/2019 Phone"#i )291-0007 Official use only. Do not write in this area,to he completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: tet/ Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Supplement Card TRINITY HEATING&AIR,INC. Registration: 170355 D/B/A TRINITY SOLAR Expiration: 10/11/2021 2211 ALLENWOOD RD WALL,NJ 07719 SCA 1 0 20M-05/17 Update Address and Return Card. Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE SUpolement Card before the expiration date. If found return to: Registerion Expiration Office of Consumer Affairs and Business Regulation 170355 10/11/2021 1000 Washington Street -Suite 710 TRINITY HEATING&.AII ,INO. Boston,MA 02118 D/B/A TRINITY SOLAR PAUL EATON 20 PATTERSON BROOK ROAD UNIT 10 Si, ,Ay , "s "` WEST WAREHAM,MA 02576 UnderSBCreta Not valid without signature ry Commonwealth of Massachusetts Construction anyupeNiou Division of Professional Licensors Unrestricted-Buildings of use group which contain i�d Board of Building Professional and Standards less than 38,OO11 cubic feet(991 cubic meters)of enclosed Constr ti` Upervisor space. -, CS-088720 '' , I Pares 04/10/2020 PAUL A EATON s 4 7 MARBLE Sc, ,f `, APT.310E ;.• Z. WHITMAN MA OitifiA *" . Js Fallnre to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license Commissioner Call(fi17)727=3240 or visit www mass govldpl CIL t l