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HomeMy WebLinkAboutBLDX-25-495 application iI ! j yam Alt \ Office Usei7tellr ,� ,off Permit# l d"l65 .0 .x Amount 0.0 i) `c°RPOR RiE�ab9/i EXPRESS BUILDING PERMIT APPLICATIO E C E I V E D , TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 APR 212025 South Yarmouth,MA 02664 (508)398-2231 Ext. 1261 By- BUILDING DEPARTMENT CONSTRUCTION ADDRESS: _( (1 v✓I bet- (ram' V. /siti ,�/v✓ i UV t OWNER: To e (14 CPw 3 y C-iih4-7 h,- Cr- 1, l�Z f NAME PRESENT ADDRESS (�TEL. # CONTRACTOR: /e k i//'f SY Lower- (�n lwb- lei'C V e-21'I )/1— I/YJ'_OE111 ` NAME // MAILING ADDRESS TEL# EMAIL: It /'`' i r f &N6.71me;t • 0-1,1 ea i Residential ❑Commercial L.Est.Cost of Construction$ I�� .S(ICJ Homeowner is Applicant? Yes No Home Improvement Contractor Lic.# I(17, 57 Construction Supervisor Lie.# qC 757 WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate required) Wood Stove Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares Z 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: Y ^7M U a.) rty 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. I understand that any false answer(s) will be just cause for denial or rev tion of license and for prosecution under M.G.L.Ch.268,Section I. Applicant's Signature: Date: t 7 j Z Z / Z J Owners Signature(or attachment) Date: Approved By: Date: Building Official(or designee) Rev 6/24 • Fa # Acit • • Keating Construction IFIP Home improvement contractor registration: DATE February 21,2025 143053 Quotation# 1 54 Lower Brook Rd So.Yarmouth MA Phone(508)760 2702 timkeating66@hotmail.com Proposal for: Job name/location: Joe Janacek Same 34 Chamberlin Court West Yarmouth Ma 02673 We hearby submit specificatons and Description Strip roof shingles off entire house and garage Install Certainteed ice+water shield on all lower edges,valleys and around chimney Install Certainteed Roof Runner Paper Install new vent pipe flanges Install white 8 inch drip edge () .i. / Install Certainteed Landmark r architectural shingles Install ridge vent on entire peaks Remove 4 skylights on upper back roof frame opening fill with plywood sheet rock on inside $2,000.00 extra 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$16,600.00 1/3 balance due at start of job Acceptance of Proposal: Date of acceptance: 1 Li( a "G l Acceptance of Proposal: Date of acceptance: The above prices,specifications and conditions are satisfactory and are hereby accepted. 1 1 q J rho 5 S 5� ( S��'' srCfo �" CAT)�;tt L� ACC S �� 3S _ 3 f ��� - ZS Zc/ / r ry s h � ' � - 3 f gil U � Of (' S z 2 7 vim '"' �� ' hS UStf Z� �] iY,‘,� Z Dvan , too C)e(v.-- _ . 59ZL1rf� ,I3 6 ' '9 L, Jc k%/1 ‘VI 00 A ,k1 v 1 ' ra`1 .' ) (J.)) )4- ,o Q ' / rd 7\ y, i })k (r vv "� 1 A --.' [-4 ' A cl 2 \,, L,Nni„,6 z_______ 7,454J u 0)0 ti -V('°-b _ gt t) d :11-'1 ) Z9 � � (i 5 ,,/,1)f ,)J TIMOTHYKO1 AREGULA ,4coRo CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) �---� 316/2025 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 FAX 34 Main St. (A/C,No,Ext):(508)771-8381 (A(C,No):(508)771-0663 West Yarmouth,MA 02673 Egg; INSURER(S)AFFORDING COVERAGE NAIL 0 , INSURER A:Nautilus Insurance Company 17370 INSURED INSURER B:Continental Casualty Company 20443 TIMOTHY KEATING DBA KEATING CONST INsuRERC: 54 LOWER BROOK RD INSURERD: 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. KNR TYPE OF INSURANCE ADDLISUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (�IIDD/YYYY) (MM/DO/YYYY) A X COMMERCIAL GENERAL L ABLITY T EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR NN1675006 3/19/2024 3/19/2025 DAMAGEES(E TOa $ RENTED 50,000 PREMIS occurrence) MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ja LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ NED AUTOMOBILE LIABLITY (EaMBI accident)INGLE LIMIT ANY AUTO BODILY INJURY(Per personj t$ OWNED SCHEDULED _ AUTOS�E ONLY AUTOS BODILY R INJURY(Per acddent)1$ AUTOS ONLY _ AUTOS ONLY I (Parr Pa cMe t�AMAGE $ — $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION • X ;MUTE EMPLOYERS'LIABILITY STATUTE I ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 0224N372 3/9/2025 3/9/2026 E.L.EACH ACCIDENT $ 100,000 FFICER/MEMBER EXCLUDED? PI N/A 100,000 Mandatory In NH)If yes,describe under E.L.DISEASE-EA EMPLOYEE{$ 500,000 I DESCRIPTION OF OPERATIONS below El.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I 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 OF THE POLICY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Cape Symphony 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 ofInvestigations t, 1- Lafayette City Center 2 Avenue de Lafayette, Boston, MA 02111-1750 www.massegov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information J� Please Print Legibly Name (Business/Organization/Individual): 1 `i'7 ,` T44l>S Address: 9.7 L eux7.-• greit- City/State/Zip: Vilf %J Z !�Z�� Phone#: Sd 7t50 7 0 Are(you an employ r?Check the appropriate box: Type of project(required): 1.4. I am a employer with I 4. ❑ I am a general contractor and I 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 wnrkingg fnr!TIC in any cararity. employees and have workers' 9 ,. [No workers' comp. insurance comp. insurance. + Y. L I Building addition ;,.,,,a] 5. n We are a corporation and its 10.0 Electrical repairs or additions 3.❑ [am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself [No workers' comp. right of exemption per MGI, ,—, y r 12.0 Roof iepaits 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 woitcers'compensation policy information. 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 mployees. If the sub-contractors have employees,they must provide their workers'comp.policy number. r am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site reformation. ,�[ lacy Company Name: - � "1 ' cy#or Self-ins. Lic. #: 65 22 tf_') 77 2 Expiration Date: ,VW 7' lob Site Address: 367 ( 2 e•"7 h,r 7,-L' C/ City/State/Zip: V '-' / 1 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 S 1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine 3f 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 the ins and penalties of perjury that the information provided above is true and correct. Signature: Date: zy/ 2 L/ 2fs Phone#: SO e-' )07.6 ? 7 0. < 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 31:City/Town Clerk 4.0 Electrical Inspector 5E'lumbing - 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 1,0 Type: Individual TIMOTHY KEATING Registration: 143053 D/B/A KEATING CONSTRUCTION i` 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 111 Division of Occupational Licensure Board of Building Regulations and Standards Restricted to: CH(Ifp CSSL-RF-Roofing Coltstructi 'CPr Specialty CSSL-WS-Windows and Siding CSSL-099351 4 4pires: 05/11/2026 TIM B KEATIIG v, 54 LOWER BROOK ROAD Q SOUTH YARIiUTH MA 02664 O ?Ix h >v� Ot�Vd11D Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Commissioner ev sue_ Contact OPSI:(617)727-3200 or visit www.mass.gov/dpl/opsi