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HomeMy WebLinkAboutBLDF-25-20 RECEIVED MAY 20 2025 •, BUILDING DEPARTMENT / prYry c` Z. .,t. tos. Re atrunevuieam offaddadueidz. 1146 Roae 28, s OM 02664 APPLICATION FOR FIRE PROTECTION PERMIT Date :cs- 0 - : S PERMIT NUMBER Np r Projected Start Date: 0 5"- - S Date of issue In accordance with the provisions of 780 CMR and M.G.L. Chapter 148,as provided in Section rJ This application is hereby made 7)4by SC-�2SNPAe h0,1 / ,,((�� (Full name of person,Firm or Corporation) Address /o2-t7 S i�� �`b' Sc ?AILr10,-c t-,:t L, /04 0 66 54. (Contact#) -3 9Cf-off f Email Owner of property PPi+lroi,e Qe.f`t‘dey,te Job Location ice-1 s C`�rck (Street&City or Town) For permission to(state clearly purpose for wAich permit is requested) 5 t le 4-i?•r,'( lr>y,oxa t* c � rtr Name of competent operator(if applicable) ,6o LCert. or License No. l- �(�� Estimated Cost of Construction:4 50 0 v- By (Si to of Appliceint . Building Official: / Date: '� d,` FEE: $50.00 1s COMMON i _; TH OF MA 'AC US TT rc Commonwealth of Massachusetts DIVISION OF OCCUPATIONAL LICENSURE , Division of Occupational Licensure BOARD OF ELECTRICIANS SecuritA fern1/ *1.icense ISSUES THE FOLLOWING LICENSE N.V SS-003436 �� , * P l spires: 11/20/2026 REGISTERED SYSTEM CONTRACTOR 5 q : i m _ ROBERT K BOUCHER N.RB�T i�O i 1265 ROUTE 28 S Entkloyed by: ,` S YARMOUTH,MA 02664-4455 '., SELF ?1 .0 ill, ''s0/.01,1,1-)' iiii. . A 11 1317 C 07/31/2025 291777 Commissions= S" w" "s"— I ICENSENUMBER EXPIRATION DATE SERIAL NUMBER ft COMMON ' LTH OF MASS. HU _.OMMO W TH OF A CHUSETTS DIVISION OF OCCUPATIONAL LICENSURE DIVISION OF OCCUPATIONAL LICENSURE BOARD OF BOARD OF ELECTRICIANS ISSUES THE FOLLOWING LICENSE ELECTRICIANS REGISTERED SYSTEM TECHNICIAN cc ISSUES THE FOLLOWING LICENSE REG ,'w i SYSTEMS CONTRACTOR BUSINESS ROBERT K BOUCHER 1265 ROUTE 28 v, SEASIDE ALARMS INC I z S Y ROUTE 28 ,X 1 V1 E. S YARMOUTH,MA 02664-4455 463 D 07/31/2025 291784 ? 4177 Cl 07/31/2025 391646 LICENSE NUMBER EXPIRATION DATE SERIAL NUMBER LICENSE NUMBER. EXPIRATION DATE SERIAL NUMBER AC CERTIFICATE OF LIABILITY INSURANCE DATE(MMIODIYYYY) 03/27/2025 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 Emily Montgomery NAME: The Hilb Group New England,LLC PHONE (800)640-1620 FAX (A/C.No,Ext): (A/C,No): dba Dowling&O'Neil E-MAIL emontgomery@hilbgroup.com ADDRESS: 973 lyannough Road INSURER(S)AFFORDING COVERAGE NAIC N Hyannis MA 02601 INSURER A: SiriusPoint Specialty Insurance Corp 16820 INSURED INSURER B: Safety Indemnity Insurance Co 33618 Seaside Alarms,Inc. INSURER c: Hartford Fire Insurance Co 19682 1265 Route 28 INSURER O: INSURER E: South Yarmouth MA 02664 INSURER F: COVERAGES CERTIFICATE NUMBER: 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-SUER POLICY EFF POLICY EXP LIMITS LTRINSD WVD POLICY NUMBER (MM/DDIYYYY) (MM/DO/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 DAMAGETO N CLAIMS-MADE X OCCUR PREMISES Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 A ESP-SP-AL-GL-0000009-01 03/26/2025 02/25/2026 PERSONAL BADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- POLICY X JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER, AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) S B — OWNED ./ SCHEDULED 6222107 02/25/2025 02/25/2026 BODILY INJURY(Per accident) S _ AUTOS ONLY /' AUTOS HIRED NON-OWNED PROPERTY DAMAGE X AUTOS ONLY X AUTOS ONLY (Per accident) $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 1,000,000 A X EXCESS LIAB CLAIMS-MADE ESP-SP-AL-SX-0000007-01 03/26/2025 02/25/2026 AGGREGATE S 1,000,000 DED RETENTION$ S WORKERS COMPENSATION X STATUTE ER OTH AND EMPLOYERS'LIABILITY Y/N C ANY PROPRIETOR/PARTNER/EXECUTIVE N NIA OSWECAE7ZU7 02/25/2025 02/25/2026 E.L.EACH ACCIDENT S 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 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 thecoverage 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. AUTHORIZED REPRESENTATIVE I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD SEASID CA Inc LMS is 1265 Rt.28•S.Yarmouth, MA 02664 www.seasidealarms.com DAX FERRIS Sales Representative License#1317C 508-394-0599 UL Certified MA Toll Free 800-244-0599 Central Station Fax 508-760-2830 24 Hr.Monitoring Dax@seasidealarms.com