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HomeMy WebLinkAboutBLDSM-23-003354 RED EIVED o ► SHEET METAL PERMIT I DEC 1 S 22 .��.. .,�. V Commonwealth of Massachusetts Town of Yarmouth Building Department ° Hy'J' 1146 Route 28, South Yarmouth, MA 02664-4492 Date: P-( 0-' a-Oa-a- /n Permit#: i3/D -tit 3_ 05a { c_ Estimated Job Cost: $ 1�, OOO. Permit Fee: $ Plans Submitted: YES/ O Plans Reviewed: YES/ NO Business License# St" o Application License# ,f3( Business Information ,�� Property Owner/lob Location Information Name: ff f i " 00 J Name: \Arse S `��i4 iiL./ &- be i Street: L[ i�J:5 J Street: 1 ,Ut.iJl y' City/Town: 4P14 City/Town: S.0 l .aiv Telephone:6 1 0-2,8 81 Telephone: so8-7 - 0 ai'fU Photo I.D. required/Copy of Photo I.D. attached: YES/NO Staff Initial: 1-1 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: I Sheet metal work to be completed: New work V Renovation: HVAC: ,, Metal Watershed Roofing:_ Kitchen Exhaust System: Metal Chimney/Vents: Air Balancing: Provide detailed description of work to be done: 1 Vld 1!Z (4; \i(vil izZel flt.thtl S'uppi tretwvt citsl-eAni y 614) U(- 1 co INSURANCE COVERAGE: I have a current liability insura ce 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:at 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-9 /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 I"Signature of Li 'e'Ir City/Town: Journeyperson Permit#: Journeyperson-Restricted License Number: 'D Fee: $ Check at www.mass.gov/dpl '1` Inspector Signature of Permit'' of Permit Approval The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ,\ Lafayette City Center 2 Avenue de Lafayette, Boston, MA 02111-1750 www.mass.gov/dia Workers' Compensation Insurance Affidavit: General Businesses Applicant Information Please Print Legibly Business/Organization Name:Bourque Heating & Cooling Co., Inc. Address:1199 Pitcher's Way City/State/Zip:Hyannis, MA 02601 Phone#:508-790-2887 Are you an employer? Check the appropriate box: Business Type(required): 1. I am a employer with 10 employees (u11 and/ 5. C Retail or part-time).* 6. Restaurant/Bar/Eating Establishment 2.(J I am a sole proprietor or partnership and have no 7, — Office andlor Sales (incl. real estate, auto, etc.) employees working for me in any capacity. [No workers' comp. insurance required] $ Non-profit 3.P We are a corporation and its officers have exercised 9. E Entertainment their right of exemption per c. 152, §1(4),and we have 10.F Manufacturing no employees. [No workers' comp. insurance required]** 11.0 Health Care 4.❑ We are a non-profit organization, staffed by volunteers, with no employees. [No workers' comp. insurance req.] 12.0 Other HVAC sales/service *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. **If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an organization should check box rl. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy information. Insurance Company Name:Associated Industries of MA-ARWC Insurer's Address:54 Third Ave, PO Box 4070 City/State/Zip: Burlington, MA 01803 Policy#or Self-ins. Lic. #173568 Expiration Date:10/01/2022 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under r 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify, under the pains and penalties of perituy that the information provided above is true and correct. � £ / �...,� _Date: 9/30/2021 Signature: Phone#: 508-790-2887 Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # issuing Authority (check one): l.[]Board of Health 2.1::Building Department 3.0 City/Town Clerk 4.❑Licensing Board 5.0 Selectmen's Office 6.❑Other Contact Person: Phone#: w,uw.mass.govidia - y ® DATE(MMIDD/YYYY) A�)Ro CERTIFICATE OF LIABILITY INSURANCE 09/26/2022 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 CONTACT Jenn Harney NAME: Leonard Insurance Agency,Inc PHONE Eat): (508)428-6921 FAX No): (508)420-5406 683 Main Street E-MAILDRESS: ) @ genc enn leonarda .corn AD y Suite B INSURER(S)AFFORDING COVERAGE NAIC# Osterville MA 02655 INSURER A: Hartford Underwriters Ins Co. 30104 INSURED INSURER B: Hartford ACC&Indemnity Co. 22357 Bourque Heating&Cooling Co.,Inc. INSURER C: Associated Ind.Of MA-ARWC 26158 INSURER D: PO Box 770 INSURER E: Marstons Mills MA 02648-0770 INSURER F: COVERAGES CERTIFICATE NUMBER: 22-23 Master REVISION NUMBER: THIS IS 0 CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICAT.D. 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 SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DDIYYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,00Q,000 �/ DAMAGE IOREN ILL) 1,000,000 CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 10,000 A 08SBAANOY24 10/01/2022 10/01/2023 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,000 POLICY P 0 r I LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: DBPCL $ 50,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ g OWNED X SCHEDULED 08UECBC0923 10/01/2022 10/01/2023 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY /� AUTOS ONLY (Per accident) PIP-Basic $ 8,000 UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION I PER I IOTH- AND EMPLOYERS'LIABILITY STATUTE t ER C Y N ANY PROPRIETOR/PARTNER/EXECUTIVE N NIA WCC-500-5025836-2022A 10/01/2022 10/01/2023 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mand.,toryinNH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes, escribe under DESC-IPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTIGN OF OPERATIONS/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. 1146 Rte 28 AUTHORIZED REPRESENTATIVE S Yarmouth MA 02664 _ f ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD kil _54 �s� 3... �y ~ 'RSA a-E (� O2M8-t 08 OC 09222Q}e Rava117 010 DIVISION OF PROFESSIONAL LICENSURE BOARD OF SHEET METAL WORKERS ISSUES'THE FOLLOWING LICENSE BUSINESS ROBERT G BOURQUE BOURQUE HEATING AND COOLING CO INC W, PO BOX 770 MARSTONS MILLS,MA 02648 398 05/2512023 28644 LICENSE NUMBER EXPIRATION DATE SERIAL NUMBER COMMON EALTH OF ACH DIVISION OF OCCUPATIONAL LICENSURE BOARD OF SHEET METAL WORKERS ISSUES THE FOLLOWING LICENSE MASTER-UNRESTRICTED ROBERT G BOURQUE 14 CROOKED CARTWAY41.1 MARSTONS MILLS,MA 02648-1008 1661 6435 0512812024 256638 ucENsE BER EXPIRATION DATE SERA NUMBER Page 1 Residential Heat Loss and Heat Gain Calculation 12/10/2022 In accordance with ACCA Manual J Report Prepared By: Snow and Jones, Inc. Yarmouth Branch For. Bourque Heating &Cooling 9 Rowley Lane (Jim Saben Residence) Yarmouth Port, MA Design Conditions: Yarmouth Port Indoor: Outdoor. Summer temperature: 70 Summer temperature: 95 Winter temperature: 70 Winter temperature: 0 Relative humidity: 50 Summer grains of moisture: 91 Daily temperature range: Medium Building Component Sensible Latent Total Total Gain Gain Heat Gain Heat Loss (BTUH) (BTUH) (BTUH) (BTUH) Whole House 1,158 sq.ft. 19,913 5,796 25,709 45,566 (2 tons) Main Floor 19,913 5,795 25,708 45,566 Living Room 253 sq.ft. 4,500 1,301 5,801 10,239 Dining Room 140 sq.ft. 3,586 1,301 4,887 8,081 Kitchen 182 sq.ft. 3,759 1,061 4,820 6,813 Hall 48 sq.ft. 125 0 125 702 Bathroom 78 sq.ft. 637 160 797 2,353 Bedroom 1 110 sq.ft. 1,448 470 1,918 3,541 Bedroom 2 143 sq.ft. 2,820 711 3,531 6,059 Bedroom 3 160 sq.ft. 2,500 631 3,131 5,948 Bathroom 2 44 sq.ft. 538 160 698 1,830 Whole House 1,158 sq.ft 19,913 5,796 25,709 45,566 (2 tons) HVAC-Calc Residential 4.0 by HVAC Computer Systems Ltd. 888 736-1101 Load calculations are estimates only,actual loads may vary due to weather and construction differences. .., 4,4,,, ,TiN , tv, 1 1 !#)rN ' =r 508-790-2887 (TEL) 508-771-9696 (FAX) 12/12/2022 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