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Home My WebLink AboutBLDSM-23-000600 RE 1V" D �r' . SHEET METAL PERMIT C rl Commonwealth of MassachusettsG A 0 2 2022 Town of Yarmouth Building Department --- BUILDING DEPARTMENT g 1146 Route 28, South Yarmouth, MA 02664-44921_oY-_ - - Date: `1121 f1),)-)- // Permit#: BLDSin- 2 3 --CLOCoOO EstimateJob Cost: $ oS di✓ •� Permit Fee: $ Plans Submitted: YES/NO Plans Reviewed: YES/ NO Business License# S 618 Application License# 6 3'a Business Information Property Owner/lob Location Information Name: c e '" ;i vl "` r Li ' Name: \16I'Lin N car fo Street: Jt i S J"� Street: 'Z la Ce��' y City/Town: i` �l _ City/Town: �C1UII-a � 0 i7 Telephone: .. '� r 1 Telephone: 17`t -� 1 -b Y7 L p �� p Photo I.D. required/Copy of Photo I.D. attached: (YES/ NO Staff Initial: J-1 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 V Multi-family Condo/Townhouses Other Commercial: Office Retail Industrial Educational Institutional Other st Square Footage: under 10,000 sq.ft. ✓ over 10,000 sq.ft. Number of stories: Sheet metal work to be completed: New work V Renovation: HVAC: V Metal Watershed Roofing:_ Kitchen Exhaust System:__Metal Chimney/Vents: Air Balancing Provide detailed description of work to be done: AC�® DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 44.......----, 09/30/2021 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 Debi James NAME: Leonard Insurance Agency,Inc PHO No,ail: 428-6921 FAX No): (508)420-5406 (A/C,N683 Main Street E-MAIL debi@leonardagency.com ADDRESS: Suite B INSURER(S)AFFORDING COVERAGE NAIC# Osterville MA 02655 INSURER A: Hartford Underwriters Ins Co. 30104 INSURED INSURER B: Hartford Acc&Indemnity Co. 22357 Bourque Heating&Cooling Co.,Inc.&B&L Equipment INSURER C: Hartford Insurance Group 00914 PO Box 770 INSURER D: Associated Ind.Of MA-ARWC 26158 INSURER E:Mar stony Mii15 MA 02648-0770 INSURER F: COVERAGES CERTIFICATE NUMBER: 21-22 Master 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 SUIdR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MM/DD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 1,000,000 CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 10,000 A 08SBAANOY24 10/01/2021 10/01/2022 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X PRO LOC PRODUCTS-COMP/OPAGG $ 2,000,000 JECT C 1HER: $ AUTOLIOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ B OWNED X SCHEDULED I 08UECBC0923 10/01/2021 10/01/2022 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS .— N// WIRED +.,�' NON-OWNED PROPERTY DAMAGE $ /1 AUTOS ONLY XI AUTOS ONLY (Per accident). 1 i PIP-Basic $ 8,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000 C ^ EXCESS LIAB CLAIMS-MADE 08 SBAANOY24 10/01/2021 10/01/2022 AGGREGATE $ 3,000,000 DED RETENTION $ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N 1,000,000 D ANY OFFICER/MEMBER N/A 173568 10/01/2021 10/01/2022 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? 1000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ , If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Data Breach-Defense&Liability A Coverage 08SBAAN0Y24 10/01/2021 10/01/2022 Limit $50,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) HVAC Installer in MA 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 th ACCORDANCE WITH THE POLICY PROVISIONS. 1146 Rte 28 AUTHORIZED REPRESENTATIVE # S Yarrn0uth MA 02664 r r -c-- I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2018/03) The ACORD name and logo are registered marks of ACORD { *471 ' d DIVISI tN OF PROFESSIONAL LICENSURE BOARD OP SHEET METAL WORKERS ISSUES THE FOLLOWING LICENSE BUSINESS ROBERT G BOURQUE` BOURQUE HEATING AND COOLING CO INC PO BOX 7TO MARSTONS MILLS,MA 02648 '`; 398 05t25l2D23 28644 LICENSE NUMBER EXPIRATION RATE SERIAL NUMBER DIVISION QF OCCUPATIONAL LICENSURE BOARD ` SHEET METAL WORKERS ISSUES THE FOLLOWING LICENSE MASTER-UNRESTRICTED z ROBERT G BOURQUE 14 CROOKED CARTWAY MARSTONS MILLS MA 02648-'I008 6435 0512812024 256638 LICENSE NUMBS' EXPIRATION DATE 4 _SERIAL NUMBER The Commonwealth of Massachusetts Department of Industrial Accidents 7=,. Office of Investigations Lafayette City Center SitiN—=-- 10.1.7.r v/ 2 Avenue de Lafayette,Boston, MA 02111-1750 s,. www.mass.gov/dia u• Workers' Compensation Insurance Affidavit: General Businesses Applicant Information Please Print Legibly Business/Organization Name:Bourque Heating & Cooling Co., inc. Aldress:1199 Pitchers Way City/State/Zip:Hyannis, MA 02601 Phone #:508-790-2887 Are you an employer? Check the appropriate box: Business Type(required): 1 Mil I am a employer with 10 employees (full and/ E Retail or part-time).* 6. LI Restaurant/Bar/Eating Establishment 2.1 I am a sole proprietor or partnership and have no 7. El Office and/or Sales (incl.real estate, auto,etc.) employees working for me in any capacity. . [No workers' comp. insurance required] 8 E Non-profit 3,E We are a corporation and its officers have exercised 9. El Entertainment their right of exemption per c. 152, §1(4),and we have 10.[—Manufacturing no employees. [No workers' comp. insurance requiredr* 11"E Health Care 4.El] We are a non-profit organization, staffed by volunteers, with no employees. [No workers' comp. insurance req.] 12.0 Other HVAC sales/service *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. **If the corporate officers have exempted themselves,hut the corporation has other employees,a workers'compensation policy is required and such an organization should check box#1 I am an employer that is providing workers'compensation insurance for my employees. Below is the policy information. Insurance Company Name:Associated Industries of MA -ARWC Insurer's Address:54 Third Ave, PO Box 4070 City/State/Zip: Burlington, MA 01803 Policy#or Self-ins. Lie. #173568 Expiration Date:10/01/2022 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage es required under§ 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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 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. I do hereby certify, under the pains and penalties of perjuty that the information provided above is true and correct. 9/30/2021 Signature. r.i.z.„4„...") Date: 508-790-2887 Phone#: Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority(check one): 1.r:Board of Health 2.0 Building Department 3.0 City/Town Clerk 4.0Licensing Board 50 Selectmen's Office 6.00ther Contact Person: Phone#: .\81=Av mass goy dia ) h I $er) ; ''''- $ t A .v 508-790-2887 (TEL) 508-771-9696 (FAX) 07/29/2022 To Whom It May Concern: Enclosed is a permit application along with a a check and self addressed envelop so that the permit may be bmailed back to Bourque Heating & Cooling. Please feel free to contact our office at 508-790-2887 if you have any questions. Thank you Lise Bourque Offices: Mailing: 1199 Pitchers Way PO Box 770 Hyannis, MA 02601 Marstons Mills, MA 02648 INSURANCE COVERAGE: I have a current liability insur yice policy or its equivalent which meets the requirements of -- M.G.L. Ch. 112 Yes No If you have checked es 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 toes 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-) ,t 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 IDate: Comments: Type of license: By: Master ' Title: Master Restricted Cit /Town: ifSi:nature of Licen e Journe •erson Permit#: Journe •erson-Restricted License Number: r Check at www.mass.:ov/d•I • 1` Inspector Signature of Permit"I` of Permit Approval 64.-bSifi -023 66Q,bto RECEIVED 111:1-TIFFREE ENFAGY SEP 0 8 2022 BBy.___UILDING DEPARTMENT Residential Energy Code Compliance Test Tested By: Conor D. McInerney - BPI Cert #5023242 Date: 8/29/22 Site Information Site Address: 76 Center St, Yarmouth MA Contact: Bourque Heating & Cooling Email: joann@bourqueheatingandcooling.com Phone: 508-790-2887 Test Type: Code Compliance Duct Test Test Results: Passed Duct Test Total Leakage CFM: 25.8 CFM FRONT ELEVATION 3 +k'd.., £vv r: c x z "iKx . r , ,,...�,.q � 3b.ma�c.s ai7'k ;,., yv y€' '3a' ,, .s�" ; .e a �;#it . 9 �<4 3 � 4 * y - � ,.N,a>.'.`� nd sb-.4 ^§' - • • i �" 1.- ilk 4e,t'y ik�._ ""^H. g Y .� 45 � "' S. IH; -a",. ,�, - ,r ''o :- ./7 1.111kr - „ _a x n x��aYiiN Via ajar ". 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