Loading...
HomeMy WebLinkAboutBLSM-23-2 (2) RECEIVE_ D ►i,. SHEET METAL PERMIT Commonwealth of Massachusetts MAY 10 2023 \WOn:Cx.tl nC.' Town of Yarmouth Building Department - M . BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664-4492, BY — Date: 5/o Z 3 Permit#: l &Sin-0?3 - - Estimated Job Cost: $ Za , ou Permit Fee: $ tp n. (Z C, 60 yp 0Z Plans Submitted: YES /ND Plans Reviewed: YES / 10 Business License# Application License# Business Information Property Owner/Job Location Information Name: j, 1x Zc.,,,,, ta,1.,,„, Name: W"19 41<... s Street: yt,,j ini .,,* t4- Street: /py i Mg _2( City/Town: F.,it „— ire, City/Town: 'jo/r,,,,,„A-N 1 tilWr Telephone: c�t-.(,,-?y -y 3 G si- Telephone: Photo I.D. required/ Copy of Photo I.D. attached: YES / NO Staff Initial: (3/ M-1 unrestricted license ��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: l/Metal Watershed Roofing: Kitchen Exhaust System: Metal Chimney/Vents:_Air Balancing: Provide detailed description of work to be done: rticta G #ah y ' r6271 , ( - � e LS(S t1 f YAM . t • . ,t.._. P. . f .. • 4� INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes V 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-5_,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 T Inspector Signature of Permit T of Permit Approval DATE(MM/DD/YYYY)A�--� �..�- CERTIFICATE OF LIABILITY INSURANCE 08/03/22 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: Anthony F.Cordeiro Insurance Agency jA/CONNo,Eel): 508-677-0407 FAX No): 508-677-0409 171 Pleasant Street E-MAIL Fall River,MA 02721 ADDRESS: rpaulino@Cordeirolnsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Arbella Mutual Insurance INSURED INSURER B: Triangle Refrigeration Inc INSURER C: Thomas D.Richardson Jr. INSURER D: 425 Pleasant Street Suite 22 Fall River,MA 02721 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 ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 A X X 8500068855 08/01/22 08/01/23 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ A AWNED x AUTOS SCHEDULED AUTOS ONLY X X 1020075329 08/01/22 08/01/23 BODILY INJURY(Per accident) $ xHIRED x NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE X X 4600068856 08/01/22 08/01/23 AGGREGATE $ DED X RETENTION$ 10,000 $ WORKERS COMPENSATION x PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBER EXCLUDED? N/A X 4220075105 08/01/22 08/01/23 (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) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Proof of Insurnace ACCORDANCE WITH THE POLICY PROVISIONS. } AUTHORIZED REPRESENT J r j a / / a'- I /' t ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD torvinionwesith of Massachusetts Division of Professional ticensure Refi t i`tiniti rt RT-172421 Efipirlts-0713112023 RYAN T RIC ++ 1 414 KATHLEEN A' SOMERSET r.14 O27 CanmisSianOrr C 1;,, COMMONWEAI-T 0 DIVISION OF OCSC PATIIONAL t-10Et SIRE SHEET METAL WORKERS ISSUES THE FOLLOWING LICENSE JOURNEYPERSOPI-UNRESTRICTED RYAN RICHARDSON 474 KATHLEEN AYE SOMERSET,MA 02720 01122�24 305867 9506 sEt�� �NUMBER L CENSE NUMBER EXPIRATION OATG " +TAT D 5 LICENSE D211x019 .,5 III-, 888 M . «� 07134/88