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HomeMy WebLinkAboutBLD-23-004481 . . t \ of �•9 BUILDING PtA { R,� DING PERMIT APPLICATION � �� pCC APPLICATION TO CONSTRUCT REPAIR, RENOVATE, CHANGE THE G:_Jli; OR DEMOLISH ANY BUILDING OTHER 99 y, THAN A ONE OR TWO FAMILY DWELLING.ANCY OF, b3 t'+- ^� t of Yarmouth Building Department Tel: 50�-39g.223I Yarmouth, A ( t>�i l-l ��I i)j,� ,offti!g use o ty 508-398-0836 t�,��t�y�, I Planning Board Information Assessors Department Information: Permit No. r o t D to Plan Type Permit Fee Endorsement Date Map Lot ---7:1-gDeposit Aec' d Recording Date�_ Dateii New Net Due nor.No. 1.4 Property Dimensions: 3�I.)J Other . Lot A Front— � ' This S Lot Coverage_ . for Office Use on Building Permit Number Signature; Date issued: B •'ng afficia) �'� '�`3 Ce 'floats of Occupancy. Section 1 - Data is Is not required Site Information 1.1 Property Address: pal r 1.2 Zoning Information: 1.3 Building Setbacks Zoning District (ft► Proposed Use Front Yard Required Side Yards Provided Rear Yard Required Provided 1.4 waters IIIIIIIIIIIIIIIIIIINEIIMIIIII Required 1 Provided ly(M.Q.L c.40.S 54) 1.5 Flood ood Zone information. s Private Comment Section 2 - Zone: SFE Property Ownership/Authorized Agent 2.1 •caner of Reco ,- . LI D., Cf. II,it i % e .tint) `./Ife �.�Jf --1 . / Mailing Address: S� N si��l Telephone Telephone 2. AUthOrit t,� a Email Address: T Nam.(pri I MAR Q 2 I ti G i5YZ Mailing Address: Signature , �� � j • UILD NG D. eieptidl- Section 3 - onstruction Services S Fax 3•1 Licensed Construction B Email Address: i Supervisor: Not Applicable (] r Address License Number Signature 3�_ chow-e ,e ;b CS 0qa1(� Telephone )30 our.eor, � Expiration Date ),�' Email Address: _ _a . • rN * • r• 2• ; • • 11A • • • • • ttci , •9,•r\ k'S'• - • . • • • , • 4, • ta I ‘ ( •1 " , , r r " ti A . , (tti • t 3.2 Registered Home Improvement Contractor. Company Nam• Not Applicable ❑ ' Address Registration Number Expi motion Date Signature Telephone • Section 4- Workers'Compensation surance Affidavit(M,G.L c. 152 S 25C(6) Workers Compensation Insuranc affidavit must be completed and submitted with this application. Failure to provide this affidavit will resul in the denial of the issuance of the building permit. Signed Affidavit Attached Yes No Section 5- Professional Design and Construction Services-for Buildings and Structures Subject to Construction Control Pursuant to 780 CMR 116(containing more than 35,000 c.f. of enclosed space) Section 5.1 Registered Architect: Not Applicable ❑ Name (Registrant): / Registration Number Address Expiration Dale Signature / Telephone Section 5.2 Registered Professional Engineer(s) Nam• Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Te�phone Expiration Date • Name / Area of Responsibility Address / Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Section 5.3 General Contractor 0 &_ OW- CO Co. I ne Not Applicable ❑ Company Ham• Person Re onsible or Construe'on • wee e o�- w Ii ik Ad 6b) C(3a OSSo n ure Telephone t J. • • 1Rf'• • Section 6 - Description of Proposed Work(check all applicable) • New Construction (] (tor multiple family only) No.of:edrooms Existing (for multiple family only) No.Of Bathrooms Bldg. ❑ Repair(s) ❑ Alterations '/ Addition ❑ Accessory Bldg. 0 Type --,__ Demolition Other Specify: Brief Desorption of Proposed Work: Section 7- Use Group and Construction Type Building Use Group(Check as applicapable) • A ASSEMBLY Construction Type ❑ ,A 1 ❑ A-2 ❑ A-3 ❑ to ❑ B BUSINESS A•4 El 5 ❑ 1B ❑ G E EDUCATIONAL 8 ❑ F FACTORY 2 ❑ H HIGH HAZARD F 1 F-2 ❑ 2C ❑ I INSTITUTIONAL ❑ 11 3A 0 ❑ 1-2 M MERCHANTILE (� ElI.3 0 3B ❑ 4 ❑ R RESIDENTIAL R 1 S STORAGE R-2 ❑ R-3 ❑ LA El U UTILITY S 1 S-2 ❑ 5B ❑ M MIXED USE SPECIFY: S SPECIAL USE ci ❑ SPECIFY': SPECIFY_ Complete this.section if existing building undergoing renovations;additions and/or change in use. Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34 Section 8 Building Height and Area • Proposed Hazard Index 780 CMR 34 Building Area Number of floors or stories Existing(if applicable) Proposed include basement levels I Floor Area per Floor(V) Total Area All Floors (sf) Total Height (ft) Section 9 - STRUCTURAL PEER REVIEW (780CMR 110 11) Independent Structural Engineering Structural Peer Review Required Yes SECTION 10a OWNER AUTHORIZATION -TO BE COMPLETED WHEN No OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, 1 , as Owner of the subject property, hereby authorize I�a1-I .�n Jt% lsDv\ behalf, in all matters relative to work authorized by this buildin to act on g permit application. i not e Owner �� J Date 4 te . . . .-.I. 4 • *1 ' o, ' ‘ . t r,,,- , %), . 4,!I *It •• : ' Akfi •14 •. Nk 4. k..kr7 ' ' N.! % y.., ..,4\ s , , . . s• • . , . , ... •,, . . • ••• ! • . • I ‘ • • . t• • r, \1„. •-)1 , sw•-ft...1 \ ,-...!-N t-,„ i 1, , • . . , i .......„,, „ . 1 . , • ‘ , • ..,-: ! •• .. , .., , • c. *.i• ), - l• i .i • , . 1 \ 1 . i-- *.- . .., „., - • . , SECTION 10b OWNER/AUTHORIZED AGENT DECLARATI beY ON I, c hereby declare that the statements and information the be , as Owner/Authorized Agent best of my knowledge a on on the forgoing application are true and acurate, to Signed under the g" `�d hnl1ef' pains and penalties cf perjury. • at riJ‘ Print Nam lsble) • Signs re of O er A nt 3 073 Section 17 - ESTIMATED CONS TRUCTION Date COSTS Estimated Cost(Dollars)to be t.Building completed by permit applicant a Electrical q gl v v�/ 3.Plumbing/Gas 4.Mechanical(HVAC) 5.Fire Protection • 7.Total Square Ft.(tkr ne..shcame&additog) Check Below ❑ Conservation-Commission Filing (if applicable) ❑ Old Kings Highway&Historical Commission approval (if applicable) t t §TO'WN'.OF:�YARMOUTH 1146 Route 28; SoutlkXarmouth MA 02664 508-398-223i ext. i261 Flix 508-398-0836 Office of the.:.Building�,Commissioner f BUILDING DEPARTMENT DEMOLITION DEBRIS ISPOSAL AFFIDAVIT Pursuant to M.G.L. Ch. 40, §54 and 780 CMR- Section 105.3.1. #4. I hereby certify that the debris resulting from the proposed work/demolition to be conducted at Sl 2- T Z- itA-rd - Work Address Is to be disposed of oat the following location: S c) C:xco $aid disposal site shall be a licensed solid waste facility as defined Ch. 111, §150A. by M.G.L. A Si afar - Applicat' Date Permit No. • A Y� �r TO' OF Y ARMOuTH . ;•;�• HEALTH DEPARTMENT �.�. PERMIT APPLICATION SIGN OFF TRANSMITTAL To he completed by Applicant. SHEET Building Site Locatio : /; IZ. Pro o l6 - / �ua' p sed Improvement: .{�Ir `t'1ff>I j t Applicant: Y- Address:v Tel. No..f lei Ha- 09(pcic jS� CS Date Filed: **lfyou would like e-mail notification ofsign off,please provide e-mail address.. Owner Name: J aj awl Owner Address: 5I e a� Owner Tel. No.: ................................................ .......................................... ........................... RESIDENTIAL AND/OR COMMERCIAL BUILDING HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; . For Septage Disposal and other Public Health Activities 1 e'' Requirements ww Please submit three (3) copies of plans, to includ • C��1yIC(D � � (1.) Site Plan showing existingbuildings e, 1•E13 O ZOZ3 and septic system location; g ' water line location, (2.) Floor plan labeling ALL rooms within building HEALTH DEPT. (all existing andproposed) Note: Floor plans not requiredor decks, (3.) If necessa s, sheds, windows, roofing; ry, Title 5 application signed by licensed installer with fee. .............................................. .. .. . . REVIEWED BY: .............................. DATE: COMMENTS/CONDITIONS: PLEASE NOTE a .:f �•� ROBEBOU-01 MVERTENTES .ACORv CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 11/30/2022 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 License#1780862 CONTACT Catherine Lawrence NAME: HUB International New England PHONE FAX 222 Milliken Boulevard (A/C,No,Ext):(508)235-2207 (A/C,No): Fall River,MA 02721 ADDRESS:Catherine.Iawrence@hubinternational.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Firemen's Insurance Company of Washington,D.C. 21784 INSURED INSURER B:Acadia Insurance Company 31325 Robert B Our Co.,Inc. INSURER C:Navigators Insurance Company 42307 24 Great Western Road P.O.Box 1539 INSURER D: Harwich,MA 02645 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. INSR TYPE OF INSURANCE ADDL SUBR W POLICY NUMBER POLICY EFF POLICY EXP LIMBS LTR INSD VD (MM/DD/YYYY1 (MM/DD/YYYYI 1,000,000 A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE X OCCUR CPA1301428-32 12/1/2022 12/1/2023 DAMAGE TO RENTEDaoccurrence) $ 1,000,000 PREMISES(E MED EXP(Any one person) $ 20'000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY X jECT X LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ COMBINED SINGLE LIMIT 1,000,000 A AUTOMOBILE LIABILITY (Ea accident) X ANY AUTO MAA1301425-31 12/1/2022 12/1/2023 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY _ AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ B X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 7,000,000 EXCESS LIAB CLAIMS-MADE CUA 5460543-12 12/1/2022 12/1/2023 AGGREGATE $ 7,000,000 DED RETENTION$ $ A WORKERS COMPENSATION X AND EMPLOYERS'LIABILITY STATUTE ER WPA0316767-23 1/1/2023 1/1/2024 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE N N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C Commercial Umbrella GA22EXC888710IV 12/1/2022 12/1/2023 each occ/aggregate 9,000,000 B Equipment Floater CIM5182149-18 12/1/2022 12/1/2023 Each occ/aggregate 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Project: Winterbottom.321 White's Path,Yarmouth,Ma. Town of Yarmouth is named as additional insured for the project referenced as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Yarmouth THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1146 Route 28 South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE 99' ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: ROBEBOU-01 MVERTENTES LOC#: 0 ACC)R O ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY License#1780862 NAMED INSURED HUB International New England R.B.Our Electrical&Plumbing LLC g 24 Great Western Road POLICY NUMBER P.O.Box 1539 SEE PAGE 1 Harwich,MA 02645 CARRIER NAIC CODE SEE PAGE 1 SEE P 1 EFFECTIVE DATE:SEE PAGE 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance ***Additional Policies*** Contractors Pollution Carrier: Illinois Union NAIC#33667 Policy#CPYG27416676004 Term: 12/01/2021-12/01/2023 $2,000,000 Each Occ/$2,000,000 Aggregate- Motor Truck Cargo Acadia Insurance Co Policy#CIM518214918 term: 12/01/2022-12/01/2023 Limit$500,000 Per Conveyance Installation Floater Acadia Insurance Co Policy#CIM518214918 term: 12/01/2022-12/01/2023 Limit$300,000 Per Jobsite Deductible$5,000 Professional Liability Ironshore Specialty Insurance Co Policy#DCP7BABOPFQ003 term : 12/01/2022 12/01/2023 $2,000,000 Each Claim/$2,000,000 Aggregate ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD _Il 1i / • The Commonwealth of Massachusetts �'=+� � Department of Industrial Accidents = 1 Congress Street,Suite 100 e,�il r' Boston, MA 02114-2017 ,;,�v,�' _ www.mass.g S� ov/dia orkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/PIumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual):k ) .f . Our CO . 1 , Address: %I L( e-reCUI PP,}-liCYl CC', City/State/Zip: (,Y1(Li Ri 09(di5 Phone #: `.�,f� ({.3 OS, Are you an employer?Check the appropriate box: Type of project(required): l.2farn a employer with employees(full and/or part-time).* 7, New construction 2.0 I am a sole proprietor or partnership and have no employees wcrking for me in 8. Remodeling any capacity. [No workers'comp. insurance required.) 3. I am a homeowner doing all work myself. t 9. C. Demolition ❑ g y [No workers'comp.;nsurance required.] 4.1 I am a homeowner and will be hiring contractors to conduct all work on m y property. I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑ Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet These sub-contractors have employees and have workers'comp.insurance.t 13• Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(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. t Homeowners who submit this affidavit indicating they are doing all wcrk and then hire outside contractors must submit a new affidavit indicating such_ tContractors that check 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: f) 61(in..5 I n3CL V( 1,'1Le Policy#or Self-ins.Lic.#: UV r A OS I �{' -7 L / 3 Expiration Date: / - I , )L/ Job Site Address: `� ),--,1 -4 0)77 City/State/Zip: 1 � p: /&A 0Ai7. Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL 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 hereby certi under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: c2'3I j Phone#: C-iM _L 1 Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: §TOWN OF YARMOUTH 1146 Route 28, South Yarmouth, MA 02664 508-398-22311 ext.-1261 Fax 508-398-0836 Office of the Building Commissioner BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Ch. 40, §54 and 780 CMR- Section 105.3.1. #4. I hereby certify that the debris resulting from the proposed work/demolition to be conducted at "5 a Work Address Is to be disposed of oat the following location: S 'eve l"i Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. LLe - 1/'L /3J3 S' nature of p ication Date Permit No. • Initial Construction Control Document r To be submitted with the building permit application by a Registered Design Professional for work per the ninth edition of the • qi.. .°�° Massachusetts State Building Code, 780 CMR, Section 107 Project Title:Cape Cod Inflatable Park-Hotel Lobby Date:1/31/2023 Property Address:512 Main St,West Yarmouth, MA Project: Check(x) one or both as applicable: New construction X Existing Construction Project description: I Bruce Hamilton MA Registration Number:5785 Expiration date:8/31/23,am a registered design professional, and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerningl: X Architectural Structural Mechanical Fire Protection Electrical Other:Plumbing for the above named project and that to the best of my knowledge, information, and belief such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I understand and agree that I (or my designee) shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official,I shall submit field/progress reports (see item 3.)together with pertinent comments,in a form acceptable to the building official. Upon completion of the work,I shall submit to the building official a'Final Construction Con of'I ocument'. Enter in the space to the right a"wet" or electronic signature and seal: • • Phone number: 603-878-4823 Email: bblinn@brharch.com �j�No.5T85 New Ipswich Building Official Use Only 'y NH p /1;113 Building Official Name: Permit No.: Date: Note 1. Indicate with an'x'project design plans,computations and specifications that you prepared or directly supervised.If'other' is chosen,provide a description. Version 01 01 2018 • vt1 043it1°.CI# ti:i R ; . Y • • j a 1 1 Comrranweattn of Massachusetts Division of professional LicenSt n Board of Building Regulations and Standards �ti�i rVjgor • Constrpctco. s Xptres.0610312023 ' CS-092761 } 4 I ABIGAIL O 12OSE 0 1 24 GREAT WESTERN . Nl �020,5:.' y 9. HARW{CH Ark xt.r;y';. A z� i VOIS41:i° , Commissioner 1 } I A I 1 i { • ~ I Construction Supervisor Unrestricted -Buittiings of any use group which contain less than 35,000 cubic feet(991 cubic meters)of enclosed space. j 1 • Failure to possess a current edition of the Massachusetts • • State Building Code is cause for revocation of this license. For information about this license Call(617)727-3200 or visit www.mass.goy/dpt �........4) ROBEBOU-01 MVERTENTES ACORO' CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) `� 11/30/2022 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 License#1780862 CONTACT NAME: Catherine Lawrence HUB International New England PHONE FAX 222 Milliken Boulevard (A/c,No,Ext):(508)235-2207 (A/C,No): Fall River,MA 02721 ADDRESS:catherine.lawrence@hubinternational.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Firemen's Insurance Company of Washington,D.C. 21784 INSURED INSURER B:Acadia Insurance Company 31325 Robert B Our Co.,Inc. INSURER c:Navigators Insurance Company 42307 24 Great Western Road P.O.Box 1539 INSURER D: Harwich,MA 02645 INSURERE: 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. INSR ADDL LTR TYPE OF INSURANCE JNSD SWVD POLICY NUMBER UBR POLICY EFF POLICY EXP LIMITS (MM/DD/YYYYI (MMIDD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS MADE X OCCUR CPA1301428-32 12/1/2022 12/1/2023 DAMAGE TO RENTED 1,000,000 PREMISES()=a occurrence) $ MED EXP(Any one person) $ 20,000 PERSONAL&ADV INJURY $ 1,000,000 GENIIAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY X JECT X LOC PRODUCTS-COMP/OP AGG $ 2,000,000 _OTHER: _ $ A AUTOMOBILE LIABILITY ! COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ X ANY AUTO MAA1301425-31 12/1/2022 12/1/2023 BODILYINJURY(Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS E BODILY INJURYp (Per accident) $ HIRED S ONLY AUTOS ONNLYY (Perr acEc dent)AMAGE $ $ B X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 7,000,000 EXCESS LIAB CLAIMS-MADE CUA 5460543-12 12/1/2022 12/1/2023 AGGREGATE $ 7,000,000 DED RETENTION$ $ A WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY YIN WPA0316767-23 1/1/2023 1/1/2024 STATUTE ER 1000000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ ' OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below C Commercial Umbrella GA22EXC8887101V 12/1/2022 12/1/2023 each occ/aggregate 9,000,000 B Equipment Floater CIM5182149.18 12/1/2022 12/1/2023 Each occ/aggregate 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Project: Winterbottom.321 White's Path,Yarmouth,Ma. Town of Yarmouth is named as additional insured for the project referenced as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Yarmouth THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN of Yam ACCORDANCE WITH THE POLICY PROVISIONS. 1146 28 South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE 99?134. -- ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID:ROBEBOU-01 MVERTENTES LOC#: 0 ACCPR O ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY License#1780862 NAMED INSURED HUB International New England R.B.Our Electrical&Plumbing LLC 24 Great Western Road POLICY NUMBER P.O.Box 1539 SEE PAGE 1 Harwich,MA 02645 CARRIER NAIC CODE SEE PAGE 1 SEE P 1 EFFECTIVE DATE:SEE PAGE 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance ***Additional Policies*** Contractors Pollution Carrier: Illinois Union NAIC#33667 Policy#CPYG27416676004 Term: 12/01/2021-12/01/2023 $2,000,000 Each Occ/$2,000,000 Aggregate- Motor Truck Cargo Acadia Insurance Co Policy#CIM518214918 term: 12/01/2022-12/01/2023 Limit$500,000 Per Conveyance Installation Floater Acadia Insurance Co Policy#CIM518214918 term: 12/01/2022-12/01/2023 Limit$300,000 Per Jobsite Deductible$5,000 Professional Liability Ironshore Specialty Insurance Co Policy#DCP7BABOPF0003 term : 12/01/2022 12/01/2023 $2,000,000 Each Claim/$2,000,000 Aggregate ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 2/15/23,8:54 AM Mail-Sears,Tim-Oudook 512 Route 28 Sears, Tim <tsears@yarmouth.ma.us> Wed 2/15/2023 8:54 AM To:ajour@robertbour.com <ajour@robertbour.com> Abby, I have re iewed your application for renovations and the proposed accessible bathroom does not meet the re irements of Section 30.7.1 of 521CMR Architectural Access Board. gdr_d \fir. Do PI ase submit updated plans for review. i^ 1\�� M2� i OvN R. This email is considered a written denial of your permit application per Section 105.3.1 of the Massachusetts State Building Code. Section 105.3.2 states in part that "an application fora permit for any proposed work shall be deemed to have been abandoned 180 days after the date of filing, unless such application has been pursued in good faith" You may appeal this denial to the Building Code Appeals Board in accordance with M.G.L. c. 143 §100, within 45 days of this notice. Timothy Sears CBO Deputy Building Commissioner Town of Yarmouth 508-398-2231 Ext. 1259 mailto:tsearsPyarmouth.ma.us https://outlook.office.com/mail/sentitems/id/AAQkADE3MDQ5NWZmLTkOYzItNDIwNi1 iMDQxLWNkMGQyNmE4NzE5NAAQANXj0V5ywsVCUV%2Fpl... 1/1