The URL can be used to link to this page

Home My WebLink AboutBLD-23-12528 .y,9 Office Use Only t o RECEIVED Permit# �p)-/ O l' � H Amount JTd.0 t) G JUN N III -ero V V f• O 5 2023 Permit expires 180 days from BUILDING DEPARTMENT issuedate By - — 606ol3 /025,3-er' EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 l/ (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: I a 1/4 ir,•t ASSESSOR'S INFORMATION: J Map: Parcel: OWNER: P. C l✓ 9-44 y / /)L D- j2> wn rh✓/ NAME PRESENT AD RESS TEL. # CONTRACTOR: AM rtPS�(►f $ L h4i c Q' ✓ f �f4lt�r , kuit N E MAILING ADDRESS TEL.# SO,.- )j i 2 7d 2 dResidential 0 Commercial Est.Cost of Construction$ 7 2S0 Home Improvement Contractor Lic.# t t/ 3 OS 3 Construction Supervisor Lic.# �/l7 3r Workman's Compensation Insurance: (check one) 0 I am the homeowner ❑ I am the sole proprietor fei I have Worker's Compensation Insurance Insurance Company Name: L ,/V A Worker's Comp.Policy#CS 9!) i p Z C,(loll))? ) WORK TO BE PERFORMED Tent LI Duration (Fire Retardant Certificate attached?) Wood Stove El Siding: #of Squares Replacement windows: # Replacement doors: # Roofing: #of Squares W[ )Remove existing*(max.2 layers) Insulation I I Old Kings Highway/Historic Dist.'' d Replacing like for like Pool fencing *The debris will be disposed of at: Y41/h Location of Facility 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 revocation of my license and for prosecution under M.G.L.Ch.268,Section 1. Applicant's Signature: Date: 6' ,S4/ e,J Owners Signature(or attachment) Date: Approved By: Date: Building Official(or designee) EMAIL ADDRESS: `fi m keetsi/ti l0 dfina_ / Zoning District: Historical District: Yes No Flood Plain Zone: Yes No Water Resource Protection District: Within 100 ft.of Wetlands: Yes No Yes No V _ - 6/4/23:7:29 AM Mail-Tim Keating-Outlook , anir „Nit W „IL isossoi, 4%440/ 1111444* + , Keating Construction Home improvement contractor registration DATE May i. 2023 143053 Quotation U 54 Lower Brook Rd So Yarmouth MA 02664 Phone(508)760 2702 trrnkeatrns Cr( hotmari cpm Proposal for: Job name/location. Rick Stacy Same 18 Dayton Rd Yarmouth Ma 617 458 9643 We Nearby submit tons and Strip roof shingles off ertee house Install water and ice shield on lower edges and chimneys Install new vent pipe flanges and 30 lb tar paper on decking Install new white 8 inch drip edge Install Certainteed Landmark 30 yr architectural shingles Install ridge vent at all peaks Repair rotted rake tails and rake boards as needed for labor and materials with Axek 50$per hr plus rnatenais All debris and trash will be removed and disposed of properly Only items specified above are included in this proposal Chimney flashing replacement is not included in this proposal Rotted wood repair is not included in this proposal. $35 00 per hr + materials if needed Materials guaranteed by manufacturers Workmanship guaranteed by Keating Construction for 10 years We propose hereby to furnish materials arid labor for the sum of: $7,250.00 Senior Citizens discount included 1/3 payment due at start of job and re ainder upon completion Acceptance of Proposal: t/}c_4 Si?b. Date of acceptance: Acceptance of Proposal: Date of acceptance: The above prces specifications and conditions are satisfactory and are hereby accepted https://outlook.live.com/maiUO/id/AOMkADAwATYOMDABLTgzZDMIOTBmNC OwMAItMDAKAEYAAAOnEWrHInFNSajh%2FRx3%2FiFcBwAItCWpVhg... 1/1 ;.. Commonwealth of Massachusetts Division of Professional Licensure - Board of Building Regulations and Standards ,Constructieeff4160itspr Specialty CSSL-099351 I43pires:05/11/2022 TIM B KEATING , 64 LOINER BROOK t, 111 SOUTH YARM9UTH ^ - SNT.10 Commissioner ()et:A K. Weknat.k, Demographic Information EFull Name: Tim B Keating Owner Name: License Address Information City: South Yarmouth State: MA a ipcode: 02664 ountry: United States License information !License No: CSSL-099351 License Type: Construction Supervisor Specialty Profession: Building Licenses Date of Last Renewal: 5/24/2022 Issue Date: 6/4/2008 Expiration Date: 5/11/2024 License Status: Active Today's Date: 7/25/2022 Secondary License Type: Doing Business As: ,Status Change Reason: License Renewal Prerequisite Information !Licensee: Keating, Tim B 'Relationship: Attribute Of License No: CSSL-099351 Licensee: Keating, Tim B Relationship: Attribute Of License No: CSSL-099351 ____. No Available Documents THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Individual TIMOTHY KEATING Registration: 143053 D/B/A KEATING CONSTRUCTION Expiration: 06/13/2024 54 LOWER BROOK RD. SO. YARMOUTH, MA 02664 Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs 8 Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE:Individual Office of Consumer Affairs and Business Regulation Registration Iratio_n 1000 Washington Street -Suite 710 143053 06/13/2024 Boston,MA 02118 MOTHY KEATING B/A KEATING CONSTRUCTION MOTHY B.KEATING LOWER BROOK RD. ). YARMOUTH, MA 02664 Undersecretary Not valid without signature The Commonwealth of Massachusetts ft Department of Industrial Accidents 1 Congress Street, Suite 100 •• . Boston, MA 02114-2017 • www.mass _ .g W ov/dia orkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): -1.;:,-yi A -?C,, s Address: 5%' l — gf✓,; City/State/Zip: Yait'Ne",)/4 /11,j 0 Z6By Phone#: S'd 7G' 2 2e2 Are you an employer?Check the appropriate box: Type of project(required): 1.121I am a employer with / employees(full and/or part-time).* 7. ❑New construction 2.01 am a sole proprietor or partnership and have no employees working for me in 8. ig Remodeling any capacity.[No workers'comp.insurance required.] 3. I am a homeowner doingall work myself. 9. ❑Demolition ❑ y [No workers'comp.insurance required.]t 4.0I am a homeowner and will be hiring contractors to conduct all work on mY property. I will 10❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.11I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance.: 13. Roof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: (.11 ///1 Policy#or Self-ins.Lic.#: S 4 u 6v2.2 Li Al 3 7 2 2 3 Expiration Date: 3/S/2 Job Site Address: 1 c Oi y tpr / City/State/Zip: ��cf..,v7i) ' f A 9264 Attach a copy of the workers' compensation policy declaration page(showingthe policynumber and expiration b date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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.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 perjury that the information provided above is true and correct. Signature: / Date: C /S ?) Phone#: S v k 7 rid Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: A,��a DATE(MIAXID YYYY) �,,.� CERTIFICATE OF LIABILITY INSURANCE 03/17R3 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 INSUR D 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 1CORIACT NAME- PAUL SCHLEGEL Schlegel&Schlegel Ins Broker f A/( C,No,ExU. 508-771-8381 NE iAArG,No): 508-771-0663 34 Main Street 1 E-MAIL West Yarmouth,MA 02673 ADDREss: schlegelinsurance@gmail.com 'RERIS)AFFORDING COVERAGE 1 fir f _._ INSURER A: MOUNT VERNON INSURED INSURER B: CNA TIMOTHY KEATING DBA KEATING INSURER C; CONSTRUCTION 54 LOWER BROOK RD INSURER D SOUTH YARMOUTH,MA 02664 INSURER E: ( i 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 cOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM CR 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 POLICY EFF POLICY EXP LTR TYPE OF INSURANCE 1i f, . POLICY NUMBER {MM!ODNYYY) {MMIDOIYYYY) LIMITS Xi COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $_ 1,000,000 DAMAGE CLAIMS-MADE X DCCuR TPREMISES t aENTED occ,,rrence) S 500,000 ___ MED EXP(Any one person) $ 10,000 A NN 12325470 03/19/23 03/19/24 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERA!AGGREGATE s 2,000,000 - POLICY 1 PRO- POLICY _ LOC PRODUCTS-COM?;OP AGG $ 2,000,000 OTHER: $ r AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE ._AUTOS ONLY AUTOS ONLY (Per ac dem) $ UMBRELLA LIAB II OCCUR EACH OCCURRENCE i$ EXCESS LiAB 1 (CLAIMS-MADE AGGREGATE $ I DEO RETENTION$ ] I$ WORKERS COMPENSATION PER OTH- AND EMPI OYERS'LIABILITY YIN STATUTE _ ER B 'ANY YIPNOFRIE ER EXCLUDED XECUTIVE N 1 A • : M.ICE N 6S59UB0224N37223 03/09/23 03/09/24 E.L.EACH ACCIDENT $ 100,000 { o.y i..NH) IT yes des.-.n'ba under E L DISEASE-EA EMPLOYEE S 100,000 DESCRIPTION OF OPERAT-IONS below �E.L.DISEASE-POLICY LIMIT S 500,000 (I DESCRIPTION OF OPERATIONS 1 LOCATIONS VEHICLES(ACORO 101,Additional Remarks Schedule,may be attached if more space is required) TIMOTHY KEATING HAS ELECTED TO BE COVERED UNDER HIS CURRENT WORKERS COMPENSATION POLICY INSURANCE COVERAGE IS LIMITED TO THE TERMS,CONDITIONS, EXCLUSIONS AND OTHER LIMITATIONS AND ENDORSEMENTS OF THE POLICY 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. BUILDING DEPARTMENT YARMOUTH MA AUTHORIZED REPRESENTME @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD