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HomeMy WebLinkAboutBLD-23-000103 • RECEIVED 51i0 6 20221/4 7 a�. BUIL_DI ARTMENT ,�� D �e ceo - Office g. Got 1146 Jute 28, c 7ZP 02664 APPLICATION FOR FIRE PROTECTION PERMIT Date sl I to 13 PERMIT NUMBER 1. D -Ci30 I D3 Projected Start Date: ,\ b 13'D Date of issue In accordance with the provisions of 780 CMR and M.G.L. Chapter 148, as provided in Section This application is hereby made by N,i (-fr -cam (Full name ofperson,Firm or Corporation) V Address ) 4.4 LtS 1 car< Ikan-k > (Contact#5-111-.731- 036 3 Email \ \-c �.e_. t o Cie...) •4.'SC A'-j 4 LAM Owner of property C A-P-c- Co b E Job Location S y Sit cA4 f\ i-- k y�1 rifria4-6 (Street&City or Town) For permission to (state clearly purpose for which permit is requested) `i ell‘a t( (Nt Ci cack roi `0`-( )kr» Name of competent operator (if applicable) 10 "� lbtC Cert. or License No. ( O6 45 0 Estimated Cost of Construction: 9 66 0 By (S nature of'Applicant) Building Official: / Date: ) 1}-',�d• FEE: $50.00 �.,.No NEWTSEC-01 SROGERS AFRO' DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 7/6/2022 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 ZIES 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 PRODUCER NAME: FBinsure,LLC PHONE (508)824-8666 (NC 508 880-0142 (A/C,No,Ext): (NC,FAX No): 128 Dean Street Taunton,MA 02780 AD E-MDREAILSS:info@fbinsure.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Scottsdale Insurance Company 41297 INSURED INSURER B:Commerce Insurance Company 34754 Joseph Teixeira dba Newtext Alarms INSURER C:FirstComp Insurance Company 27626 26 Grandwood Dr INSURER D: Forestdale,MA 02644 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF ICY IOD INDICATED. NOTWITHSTANDING ANY REQUUIREM NTHN LISTED HAVE BEEN, TERM OR CONDITION ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT T ISSUED TO THE INSURED NAMED ABOVE FOR THE O WHICHRTHIIS 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 SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE W INSD VO (MM/DD/YYYYI (MM/DD/YYYYI 1,000,000 A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE X OCCUR CPS7487525 12/8/2021 12/8/2022 PREMISES(Ea oocu encel $ 100,000 MED EXP(Any one person). $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 1,000,000 X POLICY PRO- JECT I LOC PRODUCTS-COMP/OP AGG $ $ OTHER: COMBINED SINGLE LIMIT B AUTOMOBILE LIABILITY (Ea accident) $ 100,000 ANY AUTO RNV244 4/27/2022 4/27/2023 BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ 300,000 AUTOS ONLY X AUTOS PROPERTY DAMAGE 250,000 X HIRED X NON-OWNED (Per accident) $ $ AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ _ $ C WORKERS COMPENSATION STATUTE PER I 1 ERH AND EMPLOYERS'LIABILITY Y/N WCO218079-01 9/6/2021 9/6/2022 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N N/A 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below 1 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) A Workers Compenstion certificate is attached. 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 Route 28 South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD yam" f ,�. E .">....., ..''''''7:-.:'..•,;:iif:'7,':-'-':DC19',. MSAM: t..�a.:x ...?.._.,r^:: a ii"'k.. .:.ii .. s1 .Rv .... N S ISSUES [ H .-,',, _.,max a/INS .ICENS . k E � CONTRACTOR N 8 Z J SEP I TEIXEIRA ), 0 NEWTEX I 2 CRAN W D DR z FORESTDALE, MA A HU ETTS 02644 . 7168 C 0 1 11202 264200 A DTE . RIAL NUMBER!RLICENSE NUMBER EXPIRATION .iO:���A T� �� M.,:';A:WHAZIC--.+4,',. '..AH'-,,•'„---..-!„.4- tip DIVISION OF OCCUPATIONAL LICENSURE BOARD OF ELECTRICIANS Y ISSUES THE FOLLOWING LICENSE ui ‘). cc REGISTERED SYSTEM TECHNICIAN JOSEPH TEIXEIRA 0 26 GRANDWOOD DR iLt Vii F RESTDA E, . MAS ACHUSETTS 02644 w - : 6 5 C /31/1 025 :265572