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HomeMy WebLinkAboutBLDSM-23-005065 r a- lei(- d/I&/Z3 RECEIVED �__k,,�, SHEET METAL PERMIT .4*+ .- k Commonwealth of Massachusetts MAR 14 2023\M�T,= E=E Town of Yarmouth Building Department -- -- ' _. ' BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664-4492 BY -_ Date: 3/1 "/ Zoe 3 Permit#: 0( , 5( 1 o3,3-'G b5N?S Estimated Job Cost: Z S, 100 Permit Fee: $ Plans Submitted: /NO Plans Reviewed: YES/ NO Business License# 31,- '1 3S-- Application License# 2 86 Business Information Property Owner/Job Location Information Name: 1, i tZ Z, i-t U/k C. Name: n ,-- (-c,-- 1 -+6c t, D a it '7 Street: i z;. 5 Street: tti 7 City/Town: 'II 4 — o I' © 2(00i City/Town: t..-cs f i ,vA-t0_, 4 _Telephone: co It 3(,3 - "go& ) Telephone: cot - 1-7v - 2,1 6., Z Photo I.D. required/Copy of Photo I.D. attached: YES/ NO Staff Initial: J-1/M-1 unrestricted license 1-2/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 1( Retail—Industrial Educational_Institutional Other__ Square Footage: under 10,000 sq. ft. X over 10,000 sq. ft. Number of stories: Sheet metal work to be completed: New work V Renovation:_HVAC:aC Metal Watershed Roofing:__ Kitchen Exhaust System: Metal Chimney/Vents: Air Balancing:___ Provide detailed description of work to be done: ti S N- \ I 51 N-5 Lti: -1,o —� -3 S 1-t, G, �r.L. ,Cy }o ‘ ,,p,7L1 lie- `, f -f- Go 2,,,d GC,, z cdAA ce 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 f- 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 74-- Agent Signat wner or Owner's Agent By checking here- ,I hereby certify that all of the details and information 1 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 '1`Signature of Licensee'\ City/Town: Journeyperson Permit#: Journeyperson-Restricted License Number: Check at www.mass. ov/d I Fee: $ 3 1` Inspector Signature of Permit 1' of Permit Approval b 88 4 a3a �a 3 x G z 4 Ff U E O L �m ig 1 H 1 g i g' i •••• c. �1 . M iiii_ 1lli:HJJfl 1 gIVAttt III! gill 8 f€'E,.ekVY".8&�iiii a.� 33sTss s Y O Dig elitx t€tiimi; sisei at sggblis aott.ItLi €list ec atP� § i — asap a .li t 1 '4,1. 5 a 11 s I Im U 4 � � m toe§pc € '. 0 11 ' 3 E Q 4$Y`x €Sa.a nan$$ r,Fe 6a3sas$:as3: Sea== w c CI CO Z " O x- W _ 0 § t ''' - ''''**6 -to i I 1 2 inyira. s' pa % k4 I' Q � 2 w e _ 9E Z .4 2•P iii a NIIh bl N gM 1 § mg 1, % 1, s11 IKzIJ I g o g t r rt; Y.° mkt, I I i Qr3 ' i E4 I,.''a' it 1 C j 1 W 8 ,-; g _ wa cn v i O ,7O' ;6 (( dj1 — s�I 1 11 it li I 111: ?'1 -!-11 t: I.' ;: $ g 3 a Y b 4.1 .. 1 p i 1 ! — /°Al - G V8§ 1 s4 on --1 914 &F f _ _ v g' E 5s s s 4ig��g$ sgls E�? x Uj 1I 1 8g 5 a 3 = 1 1 €I ji . '+ i r=� s 1 ; 'ill 1 ,. gh � r= t ' Va = �$ F. n ' i s ' l ee ,s$„ $ § aa12 8 s i ;I „ m I ! 1"Ia fi 8 f33Y RV a$ 3 ; = E Lo t =x h3M2 _II &$$F. I 'Fi !Y$ 5•g`; $ ® s `! "" g8ti p8GC9mV8 _E �a_ !. v ii a FiFF ii s ie W1 e y 1orii1d8 .0tflz3& 1 iNsi i I 4 $ 3 . 5 ,/"'1 DATE(MMIDDlYYYY) ACOROP CERTIFICATE OF LIABILITY INSURANCE 04/12/2022 THIS TIFICATE 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). CONTACT Tina Reeves PRODUCER NAME: Dowling&O'Neil Insurance Agency PHONE (800)640-1620 FAX (AIC,No,Ext); (A/C,No): E-MAIL treeves@doins.com 9731yannough Road ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Hyannis AMA 02601 Hartford Casualty Ins.Company 29424 INSURER INSURED INSURER B: NGM Insurance Company 14788 Air Rite HVAC Inc. INSURER C: 330 Elliott Rd. INSURER D: INSURER E: Centerville MA 02632 INSURER F: COVERAGES CERTIFICATE NUMBER: CL224406798 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 ADDL SUER POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD NAM POLICY NUMB /Y ER (MM/DD/YYYY) (MM/DDYYY) EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED- PREMISES(Ea occurrence) $ 1,000,000 CLAIMS-MADE X OCCUR 10,000 MED EXP(Any one person) $ A 08SBAAR7BPZ 04/13/2022 04/13/2023 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:X PRO OQ00 POLICY JECT LOC PRODUCTS-COMP/OP AGG $ 2,O $ OTHER: COMBINED SINGLE LIMIT $ 1,000,000 AUTOMOBILE LIABILITY (Ea accident) BODILY INJURY(Per person) $ ANY AUTO B OWNED X SCHEDULED M1T8454A 04/13/2022 04/13/2023 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS PROPERTY DAMAGE $ XHIRED X AUTNONOS-OWNEONLY D (Per accident) AUTOS ONLY $ EACH OCCURRENCE $ 2,000,000 X UMBRELLA LIAB OCCUR A EXCESS LIAB CLAIMS-MADE 08SBAAR76PZ 04/13/2022 04/13/2023 AGGREGATE $ 2,000,000 10,000 $ DED l XI RETENTION$ PER OTH- WORKERS COMPENSATION XI STATUTE I I ER AND EMPLOYERS'LIABILITY Y 1 N E.L.EACH ACCIDENT $ 500'000 ANY PROPRIETOR/PARTNER/EXECUTIVER/MEMEXCLUEXCLUDED? I N I N/A 08WECAR7EUL 04/13/2022 04/13/2023 500,000 A (MandatorydERMEMBH) EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ in NH) If yes,describe under E.L.DISEASE-POLICY LIMIT $ 50 0,0 00 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements.Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. 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. Town of Yarmouth 1146 Route 28 AUTHORIZED REPRESENTATIVE ` :16 r 4w South Yarmouth MA 02664 I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD MASSACHUSETTS DRIVER'S LICENSE "%[1551 NUMBER 08/22/2022 S47935760 8712512027 P 3 07 - 125/1981 0 ss 12 NONE NONE 2 FABIO GIACOMO a 330 ELLIOTT RD CENTERVILLE,MA 02632-3661 1BEYEB BRO 5DO03/2212o22 Rev 0L2212a 07/25/81 COMMONWEALTH OF MASSACHUSETTS DIVISION OF OCCUPATIONAL LICENSURE BOARD OF SHEET METAL WORKERS ISSUES THE FOLLOWING LICENSE MASTER—UNRESTRICTED F FABIO G ZOCANTE 330 ELLIOTT RE) CENTERVILLE,MA 02632-3661 8586 07/28/2024 247474 LICENSE NUMBER EXPIRATION DATE SERIAL NUMBER