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HomeMy WebLinkAboutBLD-23-004923 .O�.yAR 0,6 11 -e r va7,O Office Use Only� 's" - • iPermit# L f- j*�' 1g19 04 Ic - J00, ]Amount ,• MATTA e1 C " "t"....To p E 'Permit expires 180 days from I issue date EXPRESS BUILDING PERMIT APPLICAT �L D-�3 -DQq Z�3 TOWN OF YARMOUTH ' RECEIVED Yarmouth Building Department 1146 Route 28 MAR 03 2023 South Yarmouth, MA 02664 3c ,oQ (508) 398-2231 Ext. 1261 BUILDING DEPARTMENT Veil arkwel BY ---CONSTRUCTION ADDRESS: r� e-R l V e ASSESSOR'S INFORMATION: Map: 3 4 Parcel: a 16, dr OWNER: Püiii 0 At OYY1 l S Adle.P.,•erloa._ 6t-z3s 1? tie, Pikzoy NAME PRESENT ADDRESS TEL. # ,pry �,� /� n J /),� CONTRACTOR: -\OCR/ �T o(l 1 1 Wt t s Pak\ 6,. .(.7-4-,),9g6"-Lil ll/q NAME MAILING ADDRESS 121 esidential Face G, ❑Commercial Est.Cost of Construction$ I (Q 4 i, 66 Home Improvement Contractor Lic.# Construction Supervisor Lic.# Workman's Compensation Insurance: (check one) 0 I am the homeowner 0 I am the sole proprietor 0 I have Worker's Compensation Insurance Insurance Company Name: Worker's Comp.Policy# WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares i ( )Remove existing* (max.2 layers) ' I Insulation Old Kings Highway/Historic Dist. ( )Replacing like for like 11 fencing ' 'The debris will be disposed of at: � u Loci—on of Facili Yaiwbuk I declare under penalties of perjury that the statements herein contained are true and correct to the best of my knowledge and belief. I understand that any false answer(s) will be just cause for denial or revocat'on of my licens and for prosecution under M.G.L.Ch.268,Section I. Applicant's Signature: lkUi(2,_ 1 p M - Date: Ca 3 Owners Signature(or attachment) 1: e � ,„ _ Date: JP Approved By: Date: Lfrzt ,,), 3 Building Official(or designee EMAIL ADDRESS: Zoning District: Historical District: 0 Yes No Flood Plain Zone: Yes ❑ No Water Resource Protection District: Within 100 ft.of Wetlands: 0 Yes 0 No 0 Yes _ No • ESOS t:t AAM • • c•- w, THE HARTFORD BUSINESS SERVICE CENTER THE — 3600 WISEMAN BLVD HARTFORD SAN ANTONIO TX 78251 March 3, 2023 PAULA MCKENNA 2 BASS RIVER PKWY SOUTH YARMOUTH MA 02664-6033 Account Information: Contact Us Policy Holder Details : BENNETT FENCE AND ARBOR Need Help? COMPANY, INC Chat online or call us at (866) 467-8730. We're here Monday - Friday. Enclosed please find a Certificate Of Insurance for the above referenced Policyholder. Please contact us if you have any questions or concerns. Sincerely, Your Hartford Service Team WLTR005 DATE(MM/DD/YYYY) `'� 'Rr' CERTIFICATE OF LIABILITY INSURANCE 03/03/2023 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 be endorsed. If SUBROGATIONIS 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: HARTFORD FIRE INSURANCE CO PHONE (877)287-1316 FAX 76250768 55 FARMINGTON AVENUE (A/C,No,Ext): (A/C,No): E-MAIL ADDRESS: HARTFORD CT 06105 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Hartford Insurance Company of the Midwest 37478 INSURED INSURER B: BENNETT FENCE AND ARBOR COMPANY, INC INSURER C: 377 WHITES PATH SOUTH YARMOUTH MA 02664-1214 INSURER D: 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 SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD IMM/DD/YYYYI (MM/DD/Y YYY1 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" LOC PRODUCTS-COMP/OP AGG JECT OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) HIRED NON-OWNED PROPERTY DAMAGE AUTOS AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS- AGGREGATE MADE DED RETENTION$ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY Y/N E.L.EACH ACCIDENT $100,000 A PROPRIETOR/PARTNER/EXECUTIVE N/A 76 WEG RQ7016 06/30/2022 06/30/2023 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $100,000 (Mandatory in NH) If yes,describe under E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Those usual to the Insured's Operations. CERTIFICATE HOLDER CANCELLATION PAULA MCKENNA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 2 BASS RIVER PKWY BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED SOUTH YARMOUTH MA 02664-6033 IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE c7f �GIDL > ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 26(2016/03) The ACORD name and logo are registered marks of ACORD `.� -- -- -—- - - — - - — — — - - ---— —- — - -- 3/3/2U23 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 RogersGray,A Baldwin Risk Partner PHONE FAX 410 University Ave (wc.No.Ext): 800-553-1801 (A/C,No):877-816-2156 E-MAWestwood MA 02090 ADDRESS: mail@rogersgray.com INSURER(S)AFFORDING COVERAGE NAIL# License#:PC-514062 INSURER A:Massachusetts Bay Insurance Co 22306 INSURED BENNFEN-01 INSURER B:Arbella Protection 41360 Bennett Fence and Arbor Company, Inc. 377 White's Path INSURER C: South Yarmouth MA 02664 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:858391294 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 SUER POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DDMfYY) A X COMMERCIAL GENERAL LIABILITY LDNH13401303 12/16/2022 12/16/2023 EACH OCCURRENCE $1,000,000 DAMAGE TO CLAIMS-MADE X OCCUR PREMISES(EaENTED occurrence) $100,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY PRO JECT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: _ $ B AUTOMOBILEUABIUTY 1020010414 10/1/2022 10/1/2023 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED x SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE _ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLAUAB OCCUR T EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABIUTY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE N/p E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ DESCRIPTION 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 ACCORDANCE WITH THE POLICY PROVISIONS. Paula McKenna 2 Bass River Park Way AU ED REPRESENTATIVE South Yarmouth MA 02664 �- --� owzdi (E)19RR-2015 ACORD CORPORATION. All rights rasprverl_ `S t`tt 5 A4' �CCONSERVATION1D y OFFICE .r -- '' odirienzaPyarmouth.ma.us \''', .y Yarmouth Conservation Commission Administrative Review Applicant Information: Name: ' at Da 0. ( S A,(E_Aq,,6 f)C.L Mailing Address: , SVh J tel) LC 2. OW lT,'� J li- (IA bb 1 �} -.� V t_ � ^� /� 'err"' Phone: (62 11J 4X(,l J '..- ( \ tGCli Email: 0I c 1 e����C' J �� co r 1� � )�-'U I hereby authorize the individual members of the Yarmouth Conservation Commission and its agents)to enter upon the property listed below for the purpose of gathering information regarding this Administrative Review form. J� Property/Location of Work: ��.°� � QOJ'\ LCCLE)} �� .i'i 3 ,4,ti Street Namee and Number ( l Signature: �.�x l.C_.-.,.:J \,l)C.110,�,1'll�Lr.� 1. r 1 Detailed Description and Reason for Proposed Work: _ ��, C.1 '� 4, LO tilt } L Ct' et ic' i )O ` tLj) O +se4k-A ()A ( 1k _-R-0 0 ov 4a4,,thAf , oki\A , (T7e,occocij 1C yI'l SvNe6 '.5<' e 5h..0-c 16 tz01-3 Closest Distance to Resource Area:` Proposed Start Date: 1\C.it L.. �e;) 3 Company too do Work: /� j� Name: ' AVeiA1' F' �1�{C�aA1 VA('ei 1 AL., Address: 3- 1- tV vIt Q *tt 's,, , f f 11/J l J1{f) 5;1101.01 Phone: (.930 - 99 9C Email: f)-)CCAD a) t X 0o e. Rfet c , co)) Administrative Approval: 1 ') 1S0`-. C\ VI/P7,7"--- S),,Ne el yv.V s lu Se co to k,1 GoCkoreA 10 ca (;�4(\cl a r 4-o0ACkoi- (Un This approval is valid for one year. This Approval does not grant any property rights or any exclusive privileges;it does not authorize any injury to private property or invasion of property. Yarmouth Conservation Commission-1145 Route 28,South Yarmouth,MA 02664•(508)398-2231•Ext 1288 — — -------- T N. �"y t $ of E! k 2 t T � ' mho zp 25 h = ii: ii — .i S el '''.4 i ii 1 i # k : 4 *f i V— 0 i ` iL 4Y 1 to tThc g 41: Firi :X 1( P ': 1 1 1111111 4 1 I i h 6.,2140 a , 50 4 it I '63 en ,g 4. rii! 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