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HomeMy WebLinkAboutBLDX-25-446 application n Y cb •.4 Any 50 a° `4RBP8RA7E0�6� EXPRESS BUILDING PERMIT APPLICAT N " F TOWN OF YARMOUTH �+ Yarmouth Building Department 1146 Route 28 APR 11 2025 South Yarmouth,MA 02664 �,�_____- - --- (508)398-2231 Ext. 1261 BUILvI �. l=L�-n���''�=PST CONSTRUCTION ADDRESS: ('� &'y5-�f C�7 ii Y t ��� OWNER: 4e, 1 117 A G 1'S I/ ?el ieC l/`� y�/MlitJl L NAME PRESENT ADDRESS TEL. CONTRACTOR: 7 t1 lie( /"'.(7 -51/ "Orijr L33"(/2)2' Ut1 Gi''/ V Zeir' �� NAME MAILING ADDRESS TEL.# So� 7/0 09eF EMAIL: ' /ai i t'J?''J /9 6a-..,) /l0— W 17 Residential ❑Commercial L Est.Cost of Construction$ /47 SU Homeowner is Applicant? Yes No Home Improvement Contractor Lic.# l t,/3 S i Construction Supervisor Lic.# ' J-57 WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate required) Wood Stove Siding: #of Squares Replacement windows:# Replacement doors: # Rooting: #of Squares ' 7 Insulation Temporary Mobile Home Temporary Construction Trailer Demolition—Interior only *Demolition Raze Structure Solar System ESS System Chimney Fence *Please submit utility disconnect letters for electric&gas—structures over 75 years old require historical review *The debris will be disposed of at: '14(141 1 Location of Facility I declare under penalties of perjury that the statements herein contained are true and correct to the best of my knowledge and belief. 1 understand that any false answer(s) will be just cause for denial or revocation of y license and for prosecution under M.G.L.Ch.268,Section I.Applicant's Signature: Date: `ZC /6/ (2, Owners Signature(or attachment) Date: Approved By: Date: Building Official(or designee) Rev 6/24 , , 19/3 1, Keating Construction Home improvement contractor registration: DATE April 5, 2025 143053 Quotation# 1 54 Lower Brook Rd So. Yarmouth MA Phone (508) 760 2702 timkeatirig66(a�hotmail.com Proposal for: Job name/ location: Sheila Pallis Same 479 Higgins Crowe! Rd W Yarmouth Ma 02664 We hearby submit specificatons and a, , K Description Strip roof shingles off entire house Install Certainteed ice +water shield on all lower edges and in valley Install Certainteed Roof Runner Paper Install new vent pipe flanges Install white 8 inch drip edge Install Certainteed Landmark 30 yr architectural shingles Install ridge vent on entire peaks All debris and trash will be removed and disposed of properly Only items specified above are included in this proposal. Chimney flashing replacement is not included in this proposal Rotted wood repair is not included in this proposal. Materials guaranteed by manufacturers. Workmanship guaranteed by Keating Construction for 10 years. We propose hereby to furnish materials and labor for the sum of$7,950.00 1/3 balance due at start of job Acceptance of Proposal: $c• L Date of acceptance: 5,20 Acceptance of Proposal: Date of acceptance: The above prices, specifications and conditions are satisfactory and are hereby accepted. ---...s TIMOTHYKO1 AREGULA ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 44.----- 3/6/2025 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 NAME: World Insurance Associates,LLC PHONE 508 7T1$381 Fax 508 771-0663 34 Main St. (EA/cq,tNo,Eat):( ) (NC,No):( ) West Yarmouth,MA 02673 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC C INSURER A:Nautilus Insurance Company 17370 INSURED INSURER B:Continental Casualty Company 20443 TIMOTHY KEATING DBA KEATING CONST INSURER C: 54 LOWER BROOK RD INSURER D: SOUTH YARMOUTH, MA 02664 INSURER E: 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 IADDL SUBR1 POLICY NUMBER POLICY EFF POLICY EXP LTR INSD WVD IMM/DD/YYYYI (MM/DD/YYYY) UNITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 1NN1675006 3/19/2024 3/19/2025 DAMGEOEENccuTErDnce) $ 50,000 I ',. MED EXP(Any one person) $ 5,000, PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,OOO fPOLICY JE8, LOC I PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY (Ea SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY(Per persona_ $ OWNED SCHEDULED AUTEO�S ONLY _ AUTOS BODILY BODILY INJURY(Per accident) $ AUTOS ONLY NON-OWNEDT ONY i E�RMe^t AMAGE $ UMBRELLA(JAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE I AGGREGATE $ _ DED RETENTION$ $ B WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY Y/N 0224N372 3/9/2025 3/9/2026 STATUTE ER 100,000 ANY PROPRIETOR/PARTNER/EXECUTIVE ' N N/A E.L.EACH ACCIDENT $ r OFFICER/MEMBERaatry H EXCLUDED? 100,000 E.L.DISEASE-EA EMPLOYEE $ If E descN under E.L.DISEASE-POLICY LIMIT $ 500 000 DESCRIPTION OF OPERATIONS belowr i i I 1 i i DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Addklonal Remarks Schedule,may be attached If more space is required) INSURANCE COVERAGE IS LIMITED TO THE TERMS,CONDITIONS,EXCLUSIONS,OTHER LIMITATIONS AND ENDORSEMENTS OF THE POUCY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cape Symphony THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 2235 lyannough RD West Barnstable, MA 02668 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD The Commonwealth of-Massachusetts Department of Industrial Accidents �'� 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 LL Please Print Leiibly Name (Business/Organization/Individual): I M •PS-€—Clf Address: $ y 1,0 lac r Or'odyr f City/State/Zip: r D✓t 11 y Phone#: s'� 7�� 24 72 Are you an employer? Check the appropriate box: Type of project(required): 1.❑I I am a employer with ) 4. ❑ I am a general contractor and I 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. [v7 Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.* required.] 5. We are a corporation and its 10.0 Electrical repairs or additions officers have exercised their 11. Plumbing repairs or additions 3.❑ I am a homeowner doing all work myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] .r c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any 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. tContractors 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: G (7 Policy#or Self-ins. Lic.#: D?Z c Au 37 2 Expiration Date: 3 /5 l 2/ Job Site Address: L/ T SI i n/ r/j�rw`/ / City/State/Zip: W Y4;r,� XI 4 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 line up to S1,500.00 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 DIA for insurance coverage verification. I do hereby certify under he pains and penalties of perjury that the information provided above is true and correct. Signature: Date: vj(' /i' / 2.1'— Phone#: S 0 e- -)60 )D 7 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❑Board of Health 2❑Building Department 312City/Town Clerk 4.1:Electrical Inspector 5EIPlumbing Inspector 6.0Other Contact Person: Phone#: THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Individual Registration: 143053 TIMOTHY KEATING D/B/A KEATING CONSTRUCTION Expiration: 06/13/2026 54 LOWER BROOK RD. SO. YARMOUTH, MA 02664 Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE: Individual Office of Consumer Affairs and Business Regulation Registration Expiration 1000 Washington Street -Suite 710 143053 06/13/2026 Boston,MA 02118 TIMOTHY KEATING D/B/A KEATING CONSTRUCTION TIMOTHY B.KEATING 54 LOWER BROOK RD. SO.YARMOUTH, MA 02664 Undersecretary Not valid without signature Commonwealth of Massachusetts Construction Supervisor Specialty £qt Division of Occupational Licensure Board of Building Regulations and Standards Restricted to: t H CSSL-RF-Roofing construct �upel r Specialty CSSL-WS-Windows and Siding IP CSSL-099351 ,t,' spires: 05/11/2026 TIM B KEATG A 54 LOWER Bf#OOK ROAD p SOUTH YAR UTH MA 02664 O 1ty ?Er O 4bt.I,E+dli)') Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. CommissionerE Ws.___ Contact OPSI:(617)727-3200 or visit www.mass.gov/dpl/opsi