HomeMy WebLinkAboutBldsm-23-004369 Y
of rq; SHEET METAL PERMIT
R F �/ n
4 r a ;_, p E LJ,, ; ,,'kt +. g'�': Commonwealth of Massachusetts ----.._. p
. Town of Yarmouth Building Department 7
y . F
Fg 072023
J� DUILDING L R rMENT
Date: Permit#:et/hill—Z3 -1 t c` BY
Estimated Job Cost: $ I $OO Permit Fee: $ 51,A)
Plans Submitted: YES / NO Plans Reviewed: YES/ NO
Business License # 36 � 1 Application License #
Business Information Property Owner/Job Location Information
Name: &,OU`ne_ Ca�liAl.. Name: CCI�Am )-5 Cr OW
Street: I205 cik\ e Ro( Street: 1 6 d- G id- 1-4a,',1 54-
City/Town: Ct9V 1V)((e /T/- City/Town: 5 Gk G� d�i0 �
Telephone: 77y_364 v�
_22a3 Telephone: a-51 767 44. 43?--
Photo I.D. required/ Copy of Photo I.D. attached: lip- / NO Staff Initial:
J-1 / M-1 unrestricted license
J-2//(11I-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. I/ 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:
10-diek_ bit Vail-- /« ) al-1b(
a a.,1 / d-eu-'Aa
3744'. 4,37- 636y
INSURANCE COVERAGE:
I have a current liability insura ce policy or its equivalent which meets the requirements of
M.G.L. Ch. 112 Ye No
If you have checked Yes, indicat he type of coverage by checking the appropriate box below:
A liabilityinsurance policy " Other type of indemnity
yp 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 No
Date: Comments:
Date: Comments:
Type of license:
By: Mastery
tu
Title: 17 Master-Restricted T Sign re of Licensee '(`
City/Town: Journeyperson
Permit#: Journeyperson-Restricted License Number:
Fee: $ Check at www.mass.gov/dpl
1` Inspector Signature of Permit
of Permit Approval
COMMONW oCLCH OAFIMNSSACH UN S
DIVISION OF BOARD OF
SHEET METAL WORKERS
ISSUES THE FOLLOWING LICENSEuli
MASTER-RESTRICTED
z
IAN J WAARAMAA
1205 OLD STAGE RD ww
CENTERVILLE,MA 02632-2052
m
25353 1212812024 406208
LICENSE NUMBER
EXPIRATIONDATEA ii,i2I
C
,,:;/§ERIAL NUMBER;
MASSACHUSL'i ' DRIVEE�RRS
, , , FOR FEDEF ICL ro
y "
����� 212812021 w.. 31595
y ( 4L3°12*Mr 1 Ot1988
1, NONE
y i '',
a IAN JAMES tto
' i ;'1203 QLp STAGE
C RviLLE, 02032•2O52
1:: HAZ 3
1 IE(M n oT".-01" -' 1 / $88
soo waisn wvrurm+� t
/ 7 ® DATE(MMIDD/YYYY)
Acc o CERTIFICATE OF LIABILITY INSURANCE
02/06/2023
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 CONTACT
NAME:
PAYCHEX INSURANCE AGENCY PHONE FAX
(A/C.No,Ext): (A/C,No):
225 Kenneth Drive E-MAIL
Rochester, NY 14623 ADDRESS:
—
INSURER(S)AFFORDING COVERAGE _ NAIC#
INSURER A: NorGUARD Insurance Company 31470
INSURED INSURER B:
Ian Waaramaa
DBA/TA Genuine Heating &Cooling INSURER C:
1205 Old Stage Rd INSURER D:
Centerville, MA 02632-2052 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.
INSRF POLICY EXP
LT ADDLTYPE OF INSURANCE INSD wvoSUBR POLICY NUMBER (MM/DD/YYPOLICY FYY) (MMIDDIYYYY) LIMITS
LTR INSD WVD
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE
DAMAGE TO RENTED
CLAIMS-MADE OCCUR PREMISES(Ea occur ence) $ 0
MED EXP(Any one person) $ 0
PERSONAL&ADV INJURY $ _ 0
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ O
POLICY PRO JECT LOC PRODUCTS-COMP/OP AGG $ 0
OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
(Ea accident)
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)
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION$ $
WORKERS COMPENSATION A STATUTE ERH
AND EMPLOYERS'LIABILITY
ANYPROPRIETOR/PARTNERIEXECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000,000
A OFFICER/MEMBEREXCLUDED? Y N/A IAWC333008 09/04/2022 09/04/2023 - -
(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
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
Employees: Full Time: 0; Part Time: 0 Governing Class Description: HEATING/AC DUCT WRK-SHP&OUTSDE&DRVR
Exclusions:
Ian Waaramaa;
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
South Yarmouth, MA 02664 AUTHORIZED REPRESENTATIVE ��/
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