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HomeMy WebLinkAboutBldsm-23-004578 / RECEIVED i i FEB 14 2023 -- Y, SHEET METAL PERMIT ¢ 144A N, Commonwealth o Massachusetts(-- gui I-mgr WTI-CMEESE Town of Yarmouth Building Department 1146 Route 28, South Yarmouth, MA 02664-4492 Date: a f 13/9-1 Permit#: e,b5 YYl -c3.3-ouLks-7 cr- Estimated Job Cost: $ -LSD 0 . 00 Permit Fee: $ 00 .DV Plans Submitted: YES/ NO Plans Reviewed: YES/ NO Business License # (a).5.3 Application License# Business Information Property Owner/Job Location Information Name: 1 01-4. 17-eet-ip I n Name: Dou'i -irk DOV7(Its Street: 9-a 00.vl4 I2r7d 9 e (f Street: 44 4 1 c-8 City/Town: gi([dcl/e l'0 KO ` if/t4- City/Town: So 0-4. iy(,i rmo vftit (/i/l u - Telephone: c 5 o - g4-7- Q>(Q 9-3 Telephone: Photo I.D. required/Copy of Photo I.D. attached: YES/ NO Staff Initial: J-1/ M-1 unrestricted license 1-2/ 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: ri p10-6 t V i,cf"m q i, ��1 suppi v 7sorS )v {7 -i- l� fil -C s-Lr tip 1/0-1/(4,1- 1 von n-u c ti vti g., -ex1H-111 y --e)ha I/st-s /11s-1--4.tl1ril ne to Sa rtdWIC.b cC J—iim har p} _ _ • I ir,.„171.%1 T12, - 1 ._ 1.-;r11:17,.71 C1 - c 1 • • :',6Eir:11(Ati‘??..1711Z1V8 :f3r-i6f4 • a (1'.:}f1(4` 2 -M \ ;.,• . _ _ ' tkOjkit '1:1! lyw • : , _ . . - _ INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes ✓ 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 No Progress Inspections Date: Comments: Final Inspections Date: Comments: Type of license: By: Master Title: Master-Restricted T Signature of Licensee T City/Town: Journeyperson Permit#: ,/ - Journeyperson-Restricted License Number: Fee: $ / Check at www.mass.gov/dpl • 01, Inspecto Ignature of Permit of Permit Approval Please visit our web site at http://www.mass.gov/dpl/boards/SM • ANDREW XENAKIS 22 CAMBRIDGE ST STE C (SM) MIDDLEBORO,MA 02346-2090 Commonwealth of Massachusetts V`•" Division of Occupational Licensure RefritottiUU&.actor RC-019547 C cp i res:06/22/2024 ANDREW XE dAKIS 22 CAMBRIDGE ST,UNIT C MIDDLEBORO MA 02346 i_ - vim t ii v'77:'1 wavc Fold,Then Detach Along All Perforations 9 COMMONWEALTH OF MAS A H SETTS DIVISION OF OCCUPATIONAL LICENSURE BOARD OF SHEET METAL WORKERS ISSUES THE FOLLOWING LICENSE JOURNEYPERSON-UNRESTRICTED ANDREW XENAKIS —, 22 CAMBRIDGE ST N STE C 0 MIDDLEBORO, MA 02346-2090 6053 06/28/2024 215172 LICENSE NUMBER EXPIRATION DATE SERIAL NUMBER AFRO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 02/13/2023 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 Marsh Affinity ty PHONE AX Marsh Affinity (A/C,No,Ext): 800-743-8130 (A C,No): a division of Marsh USA Inc. E-MAIL ADDRESS: ADPTotalSource@marsh.com PO Box 14404 Des Moines,IA 50306-9686 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: New Hampshire Insurance Co. 23841 INSURED INSURER B: ADP TotalSource II,Inc. INSURER C. 5800 Windward Parkway INSURER D: Alpharetta,GA 30005 Alternate Employer: INSURER E: Total Temp Inc INSURER F: 22 CAMBRIDGE STREET Middleboro,MA 023460000 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 EXP TYPE OF INSURANCE ADDISUBR POLICY NUMBER MMIDD/Y'f Y) (MMPOLICY EFF LDDYIYYY1') LIMITS LTR INSD WVD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED $ PREMISES(Ea occurrence) MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO JECT LOC PRODUCTS-COMP/OP AGG $ 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 PER OTH- AND EMPLOYERS'LIABILITY Y/N X STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 2,000,000 OFFICER/MEMBER EXCLUDED? NIA WC 053426809 MA 07/01/2022 07/01/2023 A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 2,000,000 f yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) All worksite employees working for Total Temp Inc paid under ADP TOTALSOURCE,INC.'s payroll,are covered under the above stated policy.Total Temp Inc is an alternate employer under this po icy.22 Cambridge Street CERTIFICATE HOLDER CANCELLATION Town of Yarmouth 1146 Route 28 South SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Yarmouth,MA 02664 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE e • Loco ACORD 25(2016/03) ©1988-2015 ACORD CORPO ION. All rights reserved. The ACORD name and logo are registered marks of ACORD 7s 77 •. • 3." .