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HomeMy WebLinkAboutBLDSM-22-007419 guest house RECEIVED Job# Commonwealth of Massachusetts vActilfd JUN 23 2022 uf' G&7 , as 11. Sheet Metal Permit BUILDING DEPARTMENT �ny/�� y� By _---- — -- —. -'— /2 Permit# 13 t l'.22 W7t4 19 D ate: Estimated Job Cost: $ 1 5,000 Permit Fee: $4 Plans Submitted: YES X NO Plans Reviewed: YES NO Business License# 160 Applicant License# 2967 Business Information: Property Owner/Job Location Information: Name: W Vernon Whiteley, Inc. Name: Donahue PO Box 1266 45 Mooring Lane ._.c oe --c-\.k"c p Street: Street City/Town: West Chatham MA City/'Town: Yarmouth Telephone: 508)945-1100 Telephone: 508-428-4097 Photo I.D. required/Copy of Photo I.D. attached: YES X NO Staff Initial J-1 / t nrestricted 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 X Multi-family Condo/Townhouses Other Commercial: Office Retail Industrial Educational Institutional Other Square Footage: under 10,000 sq. ft. X over 10,000 sq. ft. Number of Stories: I Sheet metal work to be completed: New Work: Renovation: X HVAC X Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: Renovation, new HVAC duct work • INSURANCE COVERAGE: I have a current liability insurance 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: A liability insurance policy ElOther type of indemnity ❑ Bond El 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 this bow 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 installations 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. Duct inspection required prior to insulation installation:YES NO Progress Inspections Date Comments Final Inspection Date Comments Type of License: By ®Master Title ❑Master-Restricted City/Town DJourneyperson Signature of Licensee Permit# ❑Joumeyperson-Restricted License Number: 2967 Fee$ ❑ Check at www.mass.qov/dpl Inspector Signature of Permit Approval -N .., k i 1 DOSING RESIDENCE PROPOSED ACCESSORY APARTMNT - • _ r 1, , : i fa. / I 1 1 1 r-r-'.F— ---'— (:•1 li ',i " 1 1 I1 '2' 111 i i N i . 3i ii i , . , j, . _._ i___ )ip v me 11 .1'1!1:3 i 1 , 2 1 _L /1 _ ii ‘; I joil 1.! i M s 1 r 111 0 •,' 19 II 7 i , 1. , I I k I - —1 : -•\ 1 1 ,i,i El ri 'gq , Ile I I ., 1 , itr NI 1 1 I i DMA 01. WIC. (.1.74,k It „S 7, N 1 11 1 1 11! g I I - 7 i- 4'-.—, - .-----.. c)•,c. ."?. ti1511 c__?.• • „ ...t. 43 EXISTING RRESIDENCE PROPOSED ACCESSORY APPARTMENT 4 4 4 4 / .. IHI III I " - 61 11 1 1 4 1 m a i P I PROPOSED ACCESSORY APARTMENT TOTHE DONAHUE RESIDENCE II 15 45 MOORING LANE SOUTH YARMOU TH,MA Cata AroNtecture hterlors Where visions take shape 111.0117N11111.1,1.1111.VAINCOTINVIT WOWS P SM11.0.12 WIACCATALVIMADVIIRS.C. 06,91.714.0.12.47.374.1 AP ISVIMA sumo.aaosunowro.Val.1.31111.1.01.603 edeys emel,suotsv,waLIM vw 1-unowavA Hinos 3NV1 9N1d0OW Sty 111 I 0 illi 5.10UKUI eX•301#404 • et, 30N3C11$321 311HVN00 3H1 01 !E I a 0 i MED N ri 1N3W12NdV AtIOSS330V 03S0dOdd g ,?,.. tt i g 1 1 4t 1$ 1 i i .r.<:....:.›.i. Vk. 1 i 1 1 6 :1 :i. .• I a 1 1 : - ' I F ,,/ as ' A / 11111 I M.. .. I ‘1.1.1111111111.111.11.1C'. 0..;. . N.' • 1 1 OM MI 11 ^1•11111 111.111111... I on F Iss I 1 t 1 il i . ii tu 1 , t • J '-''' a t ... I 1 r. . . li I 1 i' El I • [ _I... . .. f . I . II ../ i 1 , ,, ,•,. . . . . .. it 4 ? • % A. 4 I , - - 11431/1/2MV MOSSMV 01S0dald 33N301S3110NI1SOG I .c. Li i E 1 I m -.......... ACCP CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 9/17/2021 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: RogersGray, Inc.-Kingston Branch PHONE FAX 63 Smith Lane (A/C.No.Ext):508-746-3311 (A/C,No):877-816-2156 Kingston MA 02364 nooREss: mail@rogersgray.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Arbelia Protection Insurance Company,Inc. 41360 INSURED WVERNON 01 INSURER B:A.I.M.Mutual Insurance Co. 33758 W.Vernon Whiteley Plumbing&Heating P.O. Box 1266 INSURER C: West Chatham MA 02669-1266 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1593043253 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 SUBR POLICY EFF POLICY EXP W LIMITS LTR INSD VD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY Y Y 8500052832 10/1/2021 10/1/2022 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 POLICY X LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY Y Y 1020006346 10 10/1/2021 10/1/2022 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) A X UMBRELLA LIAB OCCUR Y Y 4620086300 10/2/2021 10/2/2022 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED X RETENTION$1n/inn $ g WORKERS COMPENSATION Y WMZ-800-8007752-2021A 10/1/2021 10/1/2022 X AND EMPLOYERS'LIABILITY Y/N STATUTE OTH- ER ANYPROPRIETOR/PARTNER/EXECUTIVE N N/A E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? - (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) When Required by Written Contract the following Applies: General Liability—Additional Insured Ongoing,Primary and Non-Contributory Basis,Waiver of Subrogation(30AP2037 04/21)and Completed Operations (30AP2039 04/21) Automobile—Additional Insured,Primary and Non-Contributory Basis,Waiver of Subrogation(26AP1034 11/19) Workers Compensation—Waiver of Subrogation(WC000313 04/84) Excess/Umbrella—Additional Insured and Waiver of Subrogation(CU0001 04/13),Primary and Non-Contributory Basis(32AP1123 01/19) 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 Main Street, Route 28 South Yarmouth MA 026640000 AU DREPRESENTATIVE USA 7 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts �,_. Department of Industrial Accidents ►!_' —4l Office of Investigations — ss= Lafayette City Center r+ r' !`�'= s 2Avenue de Lafayette, Boston,MA 02111-1750 •4�Va www.mass.gov/din Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lcg bly Name(Businessmrganiaetionilndividwl):W Vernon Whiteley Plumbing&Heating, Inc Address:28 Vifaage Landing/PO Box 1266 City/State/Zip:West Chatham, MA 02669 Phone#:50B-945-1100 Are you an employer?Check the appropriate box: Type of project(required): 1.® 1 am a employer with 70 4. 0 1 am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition employees and have workers' working for me in any capacity. 9. 0 Building addition [No workers' comp.insurance gyp.insurance.: required.) 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ 1 am a horneovmer doing all work officers have exercised their 1 i.®Plumbing repairs or additions myself. [No workers' comp right of exemption per MGL 12.0 Roof repairs insurance required]t c. 152,§1(4),and we have no employees.[No workers' 13.❑Other comp. insurance required.) -*Any applicant that checks box 01 must also 111I out the section below showing tick workers'compensation policy information. 4 Homeowners who submit this affidavit indimeing they are doing all work and then hire outside contractors must submit a new affidavit indicating such. =Contnietars that check this box must attached an additional sheet showing the name of the sub-contractors and slur*whether or not those entities bum employem lithe wit-contracbrs have employees.they must provide their workers'camp.policy number I am an employer that isproviding,mothers'compensation insistence for my employees. Below is the policy and f eb site information. Insurance Company Name:A.I.M Mutual Insurance co. Policy#or Self-ins.Lic.#:WMZ-800-8007752-2021A Expiration Date:1Oil/2022 Job Site Address:- AU locations in Yatmoudi,MA City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S 1,500.00 and/or one-year imprisonment,as well as civil penahies in the form of a STOP WORK ORDER and a fine of up to S250.00 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. /de hereby c the pains and aides of perjury that the igjbrrnotion provided above is Irate arid corned Sivatttre: �-'� Date: to...Y- 2j Phone#: 508-945-1100 • Of jicial are only. Do not write in this area,to be completed by clay or town official. City or Tows: Permit/Licease# Issuing Authority(chicken): 1❑Hoard of Health Building Department 31JCity/Town Clerk 4.❑Electrical Inspector SiTh'Iumbing Inspector 6.0Other J Contact Person: Phone#: E...,, - -: •,'.11,=. 1.-2_4.1;?•-•.==' '..-.: .--, DIVISION OF PROFESSIONAL. LICENSURE '''.7.".3,77'',7-----;',:F*1,j,";7,,i:,,=:-r-_.'7'.'"'-:•-:',";• -7:-';'.;--....:'.."''' a ' '-- ''-' - I- ---.:4,.:''-.:•'''''-l'''i;''IT"tXtf.":-:--:k;i • ;;,- -1--- '''•I,l' _ •. ,,„z.--4==7.....-1;.-. " --''.., "-='':_l' -'5,i'S= ',1=1-:,'7.1",':=. 1,,,,..,:=7,-d •,.-.-,1:7=,..1-2=:,.--,-,,Asir-,;-_tigE ,,-: ',':',-(.".;.„f t: ; .. .„1-i,;.- it 1,,i t ..,,,-,:,-..,:. 9,:i.,„-.,4i.,,-,74155-5,;..z, ,;,..,t-..:;;=::=,-=,,,l` \.' • ,. 'l-,--: ' .' ..,,&,,_.,.' :- "4.4;.'"'=.4,-,.:kifif.,..-;i.:---.'=:!':'=. ='="-- ci, == =. ==• '-i , ' = . '''' • .1b•kilfT .-r!'"`„.-',7f1-1" - '`J -',1..J.-' '.. 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I I '3 1 1 1 INSURANCE COVERAGE: I have a current liability insurance 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: A liability insurance policy ❑x 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 0 Agent 0 Signature of Owner or Owner's Agent By checking this box®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 installations 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. Duct inspection required prior to insulation installation:YES NO Progress Inspections Date Comments Final Inspection Date Comments Type of License: By ®Master Title /' �t�A El Master-Restricted "� — City/Town ❑Journeyperson Permit# Signature of Licensee ❑Jou rneyperson-Restricted Fee$ License Number: 2967 Check at www.mass.gov/dpl 04.7' ?— Inspector Signature of Permit Approval RECEIVE ® Massachusetts i r Job# Commonwealth of ,JZq�� l'J , JuN 23 zoZ2 �t cy,-1 -as1 1 _ Sheet Metal Permit BUILDING DEPARTMENT '2 Permit# 13�m-'22 7419 BY ate: Estimated Job Cost: $ 15,000 Permit Fee: $ti° Plans Submitted: YES X NO Plans Reviewed: YES NO Business License# 160 Applicant License# 2967 Business Information: Property Owner/Job Location Information: Name: W Vernon Whiteley, Inc. Name: Donahue PO Box 1266 45 Mooring Lane .1Ci --\--\ cQ Street: Street: West Chatham MA Yarmouth City/Town: City/'Town: 508)945-1100 508-428-4097 Telephone: Telephone: Photo I.D. required/Copy of Photo I.D. attached: YES X NO staff Initial J-1 / ) estricted 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 X Multi-family Condo/Townhouses Other Commercial: Office Retail Industrial Educational Institutional Other Square Footage: under 10,000 sq. ft. X over 10,000 sq. ft. Number of Stories: I Sheet metal work to be completed: New Work: Renovation: X HVAC X Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: Renovation, new HVAC duct work