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HomeMy WebLinkAboutBLDX-25-584 applicaiton 0 1r44: pm Use()My [, � _ ` Amount c:.7 2,,j d �y :�COAPORATE�l EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth,MA 02664 (508)398-2231 Ext. 1261 CONSTRUCTION ADDRESS: U I 6-r(Aise 1 ,,,, yi-/-01a.)-p_ hn_79 OWNER: F 0`4_ 4're`t`te 6 6—/1.4. e Ln /4+7/'1Od 'i• NAME ,PRESENT ADDRESS pp TEL. 6 CONTRACTOR: .1:7 ellA--,Py 'r'f SLf v0 --5i i- f? Y4{-- b'r✓I NAME MAILING ADDRESS TEL.4 s 0,c_ 76) 2 7v7 EMAIL: It/' 1 ki°475nf 66 ) liitivt€-}) ,idX1--, c.+ d Residential ❑Commercial t_ C"Est.Cost of Construction$ I d/ 7U0' Homeowner is Applicant? Yes No `/ Home Improvement Contractor Lic.# t‘-(3 e S 3 Construction Supervisor Lie.# 55 3 r t WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate required) Wood Stove Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares 3v 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: i tir/41 J)/4 to ' 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 revocation f my license and for prosecution under M.G.L.('h.268,Section I. r l / Applicant's Signature: Date: J ! 7` Owners Signature(or attachment) Date: Approved By: Date: irrrallinrarIWINnEmin Building Official(or designee) IT r r, Rev 6/24 MAY 07 2025 a ; . B L EPARTMENT By _ Keating Construction Home improvement contractor registration: DATE 143053 Quotation# 54 Lower Brook Rd So. Yarmouth MA Phone (508) 760 2702 timkeating66L hotmail.com Proposal for: Job name/locatior Ron+Gail Charette,Ronald W Charette Jr and Lindsey Firempong Same 61 Grouse Ln West Yarmouth Ma We hearb submit s ecificatons and Strip roof shingles off entire house Install Certainteed ice +water shield on all lower edges and valleys Install Certainteed Roof Runner Paper Install new vent pipe flanges and 8 inch white drip edge Remove Cupola on garage and re install after roof completion Install Certainteed Landmark Pro Max Def Moire Black shingles six nails per shingle Install ridge vent on entire peaks Remove back 3 skylights and fill hole in with plywood included On schedule for spring 25 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$18,700.00 $500.00 deposit due $5700.00 due at start of job ? Acceptance of Proposal: G� Date of acceptance: �— 7� �-=1' �k / Z/L}.3 Acceptance of Proposa : Date of acceptance: S 0 01 The above prices, specifications and conditions are satisfactory and are hereby accepted. e 14'4 e I ' Commonwealth of Massachusetts Construction Supervisor Specialty IP Division of Occupational Licensure Board of Building Regulations and Standards Restricted to: CB V Constructi upr Specialty CSSL-RF-Roofing CSSL-WS-Windows and Siding CSSL-099351 e`,tpires:05/11/2026 TIM B KEATIOG r;, 54 LOWER OOK ROAD O SOUTH YARUTH MA 02664 0 r ?b41O/1\73�l )0 Failure to possess a current edition of the Massachusetts State ' Building Code is cause for revocation of this license. Commissioner C i ., 5�` Contact OPSI:(617)727-3200 or visit www.mass.gov/dpl/opsi 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 Expiration: 06/13/2026 D/B/A KEATING CONSTRUCTION .. 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 TIMOTHYK01 AREGULA AcoR CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 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 (508)771-8381 j ( ): FAX, ,No):(508)771-0663 34 Main St. West Yarmouth,MA 02673 INSURER(S)AFFORDING COVERAGE NAIC INSURER A:Nautilus Insurance Company 17370 INSURED I4SURER B:Continental Casualty Company 20443 TIMOTHY KEATING DBA KEATING CONST INSURER C: _ 54 LOWER BROOK RD INSUFtERD: 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 PA ID CLAIMS. INSR TYPE OF INSURANCE ��SUM POLICY NUMBER (M POLICY EFF - POLICY EXP LTRlit 1MID WDD/YYYY) (MM/DD/YYYY) UNITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR NN1675006 3/19/2024 3/19/2025 DAMAGETORENTED 50,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ GEM.AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JECT LOC PRODUCTS-COMP/OP AGO $ 2,000,000 OTHER: $ AUTOMOBILE LIABLRY COMBINED SINGLE LIMIT (Ea accident)--..__. ANY AUTO BODILY INJURYkPer person) $ OWNED SCHEDULED AUTOSR ONLY AUTOS BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS ONLDY PROPERTY accident) DAMAGE UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXLtSS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION X PER UTE OT H- AND EMPLOYERS'LIABLITY ER Y/N 0224N372 3/9/2025 3/9/202f $ 100,000ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT NIAFICR EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 1 00,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.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 Cape Symphony THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P 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 i J Office of Investigations ,y' 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): I 1 `P4 TI r1J Address: q t,( ()to y f J— I City/State/Zip: Yt/rri OJ* 114,4 ()7Gd7 Phone#: sy4-- ?6y 2 )4)7 Are you an employer?Check the appropriate box: Type of project(required): 1.11 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. El New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Ef Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in anycapacity. employees and have workers' P Y 9. ❑Building addition [No workers' comp. insurance comp. insurance.* required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12 ❑ Roof repairs insurance required.]' 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: (AM Policy#or Self-ins. Lic. #: O 2 2-Li N 7 L Expiration Date: .T/ / Z Job Site Address: 6 l (-to JIB City/State/Zip: y4r'rr1G?lit 6t 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 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 and the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: 1S /7 /2 Phone#: 5 vs:- 7A Z )G9 G 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): 11:1Board of Health 2❑Building Department 3❑City/Town Clerk 4.12 Electrical Inspector 5.0Plumbing Inspector 6.0Other Contact Person: Phone#: