Loading...
HomeMy WebLinkAboutBLDX-25-871- . RECEIVED 'arnarEiscOnly o y =UL Arnoemt �l` r�**�cnrtac 44/1 61, °Av°RpTEo`b > BUILDING DEPARTMENT -..._ %' By ----------' EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth'1uhdlag Department artment 1146 Route 28 South Yarmouth, MA 02664 (50)398-22R1 1 €t_ 1261 CON nits''UON ADI + I t ( h rt`15* t4c,t-i ?? 6 7 G 7 J OWNER: M4 Pe 5C 1 k C°/1Ti1. t-o/t-t 14(1/ 0- NAME PRESENT ADDRESS p TEL. h CONTRACTOR: �/ M 1(�S �l S y L-p wc"�l�s.¢l J� V4i1.10,/\- NAME MAILING ADDRESS TEL.4 Sc) t✓ C EMAIL: i et^ ►1 ec,is 6 t/0 G` hp rh4 4 1,e0-- Residential O Commercial L Est.Cost of Construction$ , S D C Homeowner is Applicant? Yes No Home Improvement Contractor Lic.# i 10 6 l Construction Supervisor Lic.# 9c 7.5 l WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate required) Wood Stove Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares Z-1/ 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. y41(111041/1 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. t understand that any false answer(s) will be just cause for denial or revocation of m 'cense and for prosecution under M.G.L.Ch.268,Section I. Applicant's Signature: Date: 7/ 3 / 2 S— Oweers Signature(or attachment) Date: Approved By: Date: Building Official(or designee) Rev 6/24 iy 3 .Ky pp pp • .. .. .. ,leeeL la# „ r p 5n. : e.w.t tiv1r 1:: q.,.WI, P.'...r,r.,z-.:r:•:Ir-rr., u>:.:oil .unoieib!Mile findo,lea�19.. TIMOTHYK01 AREGULA ACOR[3 I MM/D(DATE D/YYYY) CERTIFICATE OF LIABILITY INSURANCE MMJD 25 i 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 1 34 Main St. (A/C, No, Ext): (508) 771-8381 taC, No):(508) 771-0663 West Yarmouth, MA 02673 E DRESS: T INSURER(S) AFFORDING COVERAGE ' NAIC # , 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 ADDCSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INst WVD POLICY NUMBER LMM/DD/YYYYI (MM,DD/YYYYj. LIMITS A 1 X COMMERCIAL GENERAL LIABILITY ! EACH OCCURRENCE $ 1 ,000,000 , 1I CLAIMS-MADE i X OCCUR NN1675006 3/19/2024 3/19/2025 DAMAGE TO RENTED 50,000 1 PREMISES �Ea occurrence) $ MED EXP (Any one persons $ 5,000 I _ _ PERSONAL & ADV INJURY $ _ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2'000,000 POLICY E SECT LOC PRODUCTS -COMP/OP AGG $ 2,000,000 OTHER: $ COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY .tea accident) —_-- _ $ ANY AUTO BODILY INJURY (Per person) __$ OWNED i SCHEDULED ` AUTOS ONLY 1___ _; AUTOS , BODILY INJURY Leer accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY I--i AUTOS ONLY ! (Per accident) $ I $ I UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE l i I AGGREGATE j $ j DED RETENTION $ j !1 $ B WORKERS COMPENSATION ` X ' PER ! ! OTH- AND EMPLOYERS' LIABILITY STATUTE-__--__ , ER _--_ ANY PROPRIETOR/PARTNER/EXECUTIVE Y, N 0224N372 3/9/2025 3/9/2026 E.L. EACH ACCIDENT . $ 100,000 Mandatory in NH) EXCLUDED? _IV I N ! A j If yes, describe under _E.L. DISEASE - EA EMPLOYEE $ 100,000 _ -____ DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ SOO,000 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 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 1 9.--A726-- 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 ' Mi - Lafayette City Center _l', 2 Avenue de Lafayette,Boston,MA 02111-1750 -" '-t www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information /, Please Print Legibly Name(Business/Organization/Individual): �i(71 /t f /7 Address: S t,/ 1-0we C 15i00 ' if't City/State/Zip: VQ/di1 vh1 Iv]/o-1),24'b Phone#: se g- 760 2jd? Are you an employer?Check the appropriate box: (req1.®i am a employer with I 4. Eli am a general contractor and 1 Type of project ructio red): employees(full and/or part-time).* have hired the sub-contractors 6. 0 New construction 2.❑I am a sole proprietor or partner- listed on the attached sheet. 7. el Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp.insurance.: 9. ❑Building addition required.] 5.❑We are a corporation and its 10.1=I 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.]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 wakets'compensation policy information. f 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.It the subcontractors 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: C N.i Policy#or Self-ins.Lic.#: ()Z2L(N 3'7 2 Expiration Date: 3/ '/Z DJ Job Site Address: I ' C lit.'s(wit et- µG// K C City/State/Zip: y4f►'/O� J}-� 144 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$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 uncle the pains and of perjury that the information provided above is true and correct. Signature: � Date: 71.3/z/— Phone#: SO k 760 27 )2 Official use only. Do not write in this area,to he completed by city or town official. City or Town: Permit/License# Issuing Authority(check one): t'-1 i❑Board of Health 2❑Building Department 3❑City/Town Clerk 4.0 Electrical Inspector S0Plumbing Inspector 6.00ther Contact Person: Phone#: 9 f Commonwealth of Massachusetts Construction Supervisor Specialty ;;®� Division of Occupational Licensure `` Board of Building Regulations and Standards Restricted to: H CSSL-RF-Roofing Construct) r Spec!a!.- CSSL-WS-Windows and Siding 4. CSSL-099351 pires: 05/11/2026 TIM B KEATI¢1G m 54 LOWER BROOK ROAD O SOUTH YARI9UTH MA 02664 ?• it ?PA,. b�Ol j"v`t"l, • Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Commissioner 21 /4!� Contact OPSI:(617)727-3200 or visit www.mass.govldpl/opsi - - - ,IM 10 ritisswnommo0 Looitsquoo0 to noidivte - ,•,,!,:,no• enntannte bris 2”::.11611101 gnibliu8 10 01808 '-. '"..'.:.; "!•C'"..t• 19.00Aqd0/021•1.T,J,12r103, . . ...4,. , cn:nao i.,..f..--(10 c -,.,,... i. .....,.., teceen-Jeeo ai!tinax fa-PT -. _.74 ,i. 543WOJ w' •-t: '•-' - • , N4-it-Atii-f-111.YORMAN 1-6 It."-- -?- - •t. ..' ' ,.., tit i ienoleeimmo3 I 1 J 1 Jt. t t THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration sit ' ? Type: Individual TIMOTHY KEATING Registration: 143053 D/B/A KEATING CONSTRUCTION •10 �1111 : Expiration: 06/13/2026 54 LOWER BROOK RD. =pm ,,,, SO. YARMOUTH, MA 02664 �-- � wr�r.rw ter. 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 54 TIMOTHY BROOK RD. '' "i (1 G` may SO. YARMOUTH, MA 02664 Undersecretary Not valid without signature Keating Construction Home improvement contractor registration: DATE May 19, 2025 143053 Quotation# 1 54 Lower Brook Rd So. Yarmouth MA Phone(508) 760 2702 timkeating66@hotmail.com Proposal for: Job name! location: Mr Paige Same 18 Christopher Hall Rd Yarmouth Port Ma 02675 We hearb submits ecificatons and Strip roof shingles off entire house Install Certainteed ice + water shield on all lower edges and in valleys Install Certainteed Roof Runner Paper Install new vent pipe flanges and white 8 inch drip edge Install Certainteed Landmark 30 yr architectural shingles Install ridge vent on entire peaks Remove and replace all rake boards with Azek trim Remove gutters on back roof and side left roof replace facia with Azek 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$17,500.00 FLEAsE No GLt4A41 Gons-ir-zAc---bot. tie (.' 113 balance due at start of job Acceptance of Proposal Date of acceptance: ,)61,-I ]. „2, 5/ Acceptance of Proposal: Date of acceptance: The above prices, specifications and conditions are satisfactory and are hereby accepted. , ••• , ." ...A01 rt t n e 3 giii.lc.944 131:361/100 tnernevc)-h.:, tarriofi secrt.t tt Aooi8 liiiorrnsY o. . • : - /-#,‘;rn iseogIng tvisq :fpr1 :!,-.31•811 ) 8 ritJormsY tiirdue yetseri itrW . . . • • • ' . : • •: . . .-;.. ". ••1'• 4.010.„. liSiZfli 1c1C'3c!' 1P.)e9#nieile0 listen! ...? 3oq V . • pr.esr-th, 8• C4 fir) iV !"-;,•71t..11 • 7./ i; • ChAZ771 S & Ni bnh'i • , )tire7 Alsci noeistIL-i- _ .V „ ;. • , • A• ".:14 • • b t-J16 _ - e : Jr-to.ttrup.101, T. 'TT;0- • t)..;; 1 jOi" `SaJLIJ.V brj.t.If)54 • ' 7: •If' 7‘• 7 • . '- '2' • t 7JC " 7 f•:‘ .7;4' FYN:. iatall;.;1 ytiVtge satxwfrq - -• sub saristed Flt • . 4 •,:ri‘;.WO _ •:*. • • •; • :•. 7.:• '10C1t;;.' OdE f •