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HomeMy WebLinkAboutBLDSM-23-001103 I RECEIVE ::�' OF Y .-,i; SHEET METAL PERMIT AUG 25 202? 1104 ! ''' Commonwealth of Massachusetts Bu1LD ° 1,• ''� y Z.71, Town of Yarmouth Building Department Date: 61iti/a i a 2 Permit#: IJI•Wiill-a3-CU it)3 , Estimated Job Cost: $ 2 ' v..) J Permit Fee: $ SO . 66 e./44¢r10914 Plans Submitted: YES/ NO Plans Reviewed: YES/ NO Business License # NI ne Application License # Business Information Property Owner/Job Location Information Name: JAcII O'C1/4►'+'1d Name: L y {A 1 ( rv�)Wl Street: I$ as (1N Se )),qU £Y• Street: V.' •QUrC h 20• City/Town:ca, 'Ja w;6'IN City/Town: r M +4- �� Telephone: '�'U6• �,33 ^Jy Z V Telephone , 3 Photo��I.`D. required/ Copy of Photo I.D. attached: YES / NO Staff Initial: J-1 /�� I) unrestricted license 4O(J3 J-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: 0^ �A5 WAr/h !'91r H 03-)Stil S L,.).j 'Vv 'Pt, c v )f NS- • INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes)d No If you have checked Yes, indicate the type of coverage by checking the appropriate box below: A liability insurance polio 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 Date: Comments: Date: Comments: Type of license: By: Master Title: Master-Restricted '1` Signature of Licensee 'f` City/Town: Journeyperson Permit#: Journeyperson-Restricted License Number: Fee: $ Check at www.mass.gov/dpl '1` Inspector Signature of Permit '1` of Permit Approval ACORO� DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 6/23/2022 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 NAME: Eastern Insurance Group LLC PHONE g00.333 7234 (NC,No):781-586-8244 233 West Central St (NC.No.EIW; Natick MA 01760 ADE DRESS: CSR24CL@easteminsurance.com INSURER(S)AFFORDING COVERAGE NAIC 1t INSURER A: Nautilus Insurance Co 17370 INSURED - _ — - - JACK00001 INSURERS: _Jack O'Connor -- Jack O'Connor Plumbing& Heating INSURERc: 15 Jan Sebastian Way INSURERD: Bldg A, Unit 5 INSURERE: Sandwich MA 02563-2354 j INSURER F: COVERAGES CERTIFICATE NUMBER:1378670798 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 j - ADDL SUER POLICY EFF—r POLJCY EXP LTR TYPE OF INSURANCE INSD YWVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY NN1421392 6/16/2022 6/16/2023 EACH OCCURRENCE $1,000,000 DAMAGE TO CLAIMS-MADE L i OCCUR PREMISES(EaENTED occurrence) $100,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEM_AGGREGATE LIMIT APPLES PER: GENERAL AGGREGATE S 2,000,000 PRO- X POLICY JJECT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ i AUTOS ONLY AUTOS -HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE S DED I RETENTIONS $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY .f/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE N/A El.EACH ACCIDENT S OFFIC ER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I 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. EVIDENCE OF INSURANCE AUTHORIZED REPRESENTATIVE °.3*2021"/N.<;:) ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD • , �{"7 Y- !:. .'A f4 ..,Zt . , T .{at'.\u i`0 IF jt. a. fir.- 6., i' ..,..`{' S} .:4� 04 "a 9-i'T it -; irYv.: ,. •. _ .:: - .._.. {r§.. } .c„ -'.2 . ..7 _ .:t: Aft', - -!1 1. . ,'-i. s" ; 4"3" ,:o, 30A1-, :u' , a. b Z.. s',•5•,.r ',it', _ , .� _, y , h tt i,'��'.:15(, ,:�.'^�4 !I�e ,'.i?f iL��;; i �'d 4:#'s6 ..,...'7. .:.' " , '''.aa+ ,} —C"'' r ..v? n i •- c�t��w�...,,..� .; ;` Y t x +�t 1y$7tS}�fTB `i`''• tmivoii ,`1.evtt, .2. '}i..,. 5 • .:t. .. ;:i , :- .7 .. tZi':' .,t z., a f -` Jxi#Tp 1"`tY i r-t3 trks.rtiotg.:,s,: A 3 4govoltibitn +i#;;pl gf`ri r O'`s t e . _ b'i„`t e.} ^Z. i ,V -y Qrs } a.. , 41T ADM", C -''3-..a W 1 1 :, 51 Jr;- - - - ., " 1 MBE: .S"}. j.j4. .3/ rj3*.. t! ',} t41314.3"1 tµ_ . "1 -.,3i: ,S, . .*i !i: t,... ., . Pt,: .-1i.tTS STA _l. �• aay.$) t. e. a< R ,[yr,p• r _ a? t�a 3tC3 s, e r"a..''sb:,f K ha 2.1 - rn. ,. i 4 r 3 _. '� P,.. .i.?tea}�y}p _: i I } • • f ii at te,,a N4a., } Fi. gg :: 7O_M OMMONWEALTH OF MASSACHUSETTS. DIVISION OF OCCUPATIONAL LICENSURE BOARD OF SHEET METAL WORKERS ISSUES THE FOLLOWING LICENSE MASTER-UNRESTRICTED 1:1; JOHN C O'CONNOR15 JAN SEBASTIAN DRSTE A5 SANDWICH,MA 02563-2370J 6009 01/28/2024 194154 LICENSE NUMBER EXPIRATION DATE SERIAL NUMBER