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Home My WebLink Aboutnew contractor information 102323 lox pi ff-. j3i - THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs & Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE: Corporation ' RECEIVE Registration Expiration 202390 06/23/2025 I OCT 23 2023 CRAFTED CONSTRUCTION, INC. BUILDING DEPARTMENT By JORDAN RACE 18 STEEPLE STREET ,/,„,,,c,,.(a.g,(,(,fre% MASHPEE, MA 02649 Undersecretary -p, Commonwealth of Massachusetts Division of Occupational Licensure Board of Building RN ulations and Standards � /( t T #ems 0 £p.c F $.' '?k. ..,; _ or C 9 r -_ , E ,pires: 03/05/2025 JORDAN T FACE 118 OLD DAlit ROAD =p BOURNE MA' 2532 1- r .4 of .v&v Commissioner djd, K. Y&fv)iit ),_ epat_ie _ ___, : 0 rdec ,7-1 e,c nc_F...../___ed earifirricifNi d/Z6 77y d(,0 -(,9 D Clarke, Kristin From: Kreative Barns <kbarnsinc@gmail.corn> Sent: Thursday, October 19, 2023 10:15 AM To: Clarke, Kristin Subject: Request to cancel permit BLDR-23-11058 Attention!:This email originates outside of the organization. Do not open attachments or click links unless you sure this email is from a known sender and you know the content is safe. Call the sender to verify if unsure.Y are Otherwise delete this email. Good morning Kristin, As I mentioned on the phone we are looking to withdraw the permit for 120 Pine Street for an addition 22x17 as the customer has changed his mind and is no longer moving forward with the project. We have not done any work on this job site. Please confirm briefly you have received this message and the permit has been canceled. If anything is needed on our end, please let us know! Thank you! Have a wonderful day! Warm regards, Teodora 508-292-8436 Kreative Barns Inc. www.kbarnsinc.com R E CF : V E OCT 2 3 �023 BUILDING DEPART MEN MENT 1 To Town Of Yarmouth /Att. Rosa Fallon I, Konstantin B. Aleksandrov, request a building permit# 23-11058 issued June 29 2023 to me for an addition at 120 Pine Street, Yarmouth Port, MA to be transferred from my name to a new contractor who will be performing the work with the following details Name: Jordan T. Race CSL:097991 —expiration —3.5.2025 HIC: Crafted Construction Inc. Registration —202390—Expiration 6.23.2025 Thank you very much Sincerely, Konstantin Aleksandrov --7 October 23 2023 RECEIVE ® OCT 2 3 Z0?3 BUILDING/DEPgRrMENT .4coad CERTIFICATE OF LIABILITY INSURANCE DATE ITFMS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RKG1f18 UPON THE CERTIFICATE HOLDEFL 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 1 REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pollcy(Ies)must have ADDITIONAL INSURED t If SUBROGATION IS WAN policies may require an WAIVED,subject to the terms and conditions of the policy,certainorovb�or be endorsed. �._ this certificate doss not confer rights to the certificate holder In lieu of such endorsement(s). endendorsement. A statement on MBA S ALL K LOVELETTE INSURANCE AGENCY INC PHONE nA Kimberly Fitzgerald WC No.Exq: (508)7754559 PAK INC.X396 MAIN STREss. klm t�i lovelettens.Com Noy INSURER/S)AFFORDING COVERAGE AMC* WEST YARMOUTH MA 02f173 mum*A: AMERICAN ZURICH INSURANCE COMPANY I 40142 CRAFTED CONSTRUCTION INC I I INSURER C i PO BOX 719 INSURER D INSURER E: MASHPEE MA 02649 INSURER F: I COVERAGES CERTIFICATE NUMBER: 919986 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 C(NNDMON 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. ORR OR TYPE OF INSURAIsCE o sr,SUM POLICY EFT IMF i oF�n hairs gm ii ! POLICY MJA®ER OOMIERCHE GENERAL U AIRUTY ClA1FA5#1Al>E ( OCCUR EACH OCCSES'I-RHNC —.E $ j OAMAGETOirErTto -- I PREMISES a oms ) s }IMEDErP(Any one Penn) s I— {IPERSONAL LADY N S GEHrL AGGREGATE UMrr APPLIES PER n LOC I GENERAL AGGREGATE FGUCY i i I 1 r OMER PRODUCi9.CDIMPR7PAOG $ AUTONDE tELSWIUrY COMBINED SINGLE laUT ANY AUTO (Ea ae4We,� s SCHEDULED BODILY INJURY(Per person) S AHIRED UTOS ONLY AUTOS NIA BODILY INJURY(Per acoeer!} S AUTOS ONLY NON-OWNED AUTOS ONLY (Per S " UMBREA,LI LLAB 1 r occuR S OCCURRENCE S MESS LIAR 17 CLAIMSMADE N/A EACH MESS $ WO+A'BB�Ca/EIN RETENTiON s -- ` :AOGLVFGATH _. S AAwrepHopromeuPPATMENTEXECUTTVE AND EMPLOYERS'UAMUTY Y)N XIATLrrE r DPlivielsfary� hNeEROLCLUDEm �]Na► WA 6Z2UB5R98485123 j 07/30/2023 07J0 2024 EL EXii AC � s 100,000 Idres d°s°Sen NIS ��r li + EL DISEASE-EA EMPLOYEE $ 100,000 OrRIPrgN OF OPERATIONS below >EL°SEAS.POLICY user s 500.000 I N/A I DESCRIPTION OF OPERATIONS I LOCATIONS I VBICLF3(ACORD 101,AddN cna RenWMs Schedule, may be attached nmw..peo,Is ngrYedl Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay daims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the issue date of this daily accessingeheirarion datefCoverage e the -Coverage poky precedes the certificate of insurance).e). The status of this coverage can be monitored bythe Proof of Venfication Search tool at www.mass.gov/M,dM,p�ers-.ompBnsatloMnvestiga60rTs/. CERTIF1CAtTp HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN Town of Yarmouth ACCORDANCE WITH THE POLICY PROVISIONS. 1146 RT 28 South YartT)outh AUTHORIZED REPRESENTATIVE MA 02664 `- ` Daniel M.Croy,CPCU,Vwe President-Residual Market-WCRIBMA ACORD 25(2018/03) The ®1 -2015 ACORD CORPORATION. All rights reserved. ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents Y 14. Office of Investigations Lafayette City Center 2 Avenue de Lafayette, Boston,MA 02111-1750 '" '� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):Crafted Construction Inc. Address:PO Box 719 City/State/Zip:Mashpee, MA 02649 Phone#:774-269-6950 Are you an employer?Check the appropriate box 1.0 I am a employer with 11 4. 0 I am a general contractor and I Type of project(required): employees(full and/or part-time).* have hired the sub-contractors 6 New❑ construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. Demolition working for me in any capacity, employees and have workers' [No workers' comp. insurance comp. insurance. 9 �■ Building addition required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.D 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.] *My applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t 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:American Zurich Insurance Company Policy#or Self-ins. Lic. #:6ZZUB5R98485123 07/30/2024 Expiration Date: Job Site Address: 120 Pine Str Yarmouth Port,MA 02675 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$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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the for insurance coverage verification. I do hereby certif u the ains penalties of perjmy that the information provided above is true and correct. Signature: Date: 10/23/2023 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): 10Board of Health 20 Building Department 3,OCity/Town Clerk 4.0 Electrical Inspector 5E'lumbing Inspector 6.DOther Contact Person: Phone#: