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HomeMy WebLinkAboutBLDX-25-1092 applicaiton RECEIVED - /*It , vo, ' thmeAlt-DY-a5--1C1 .4' @ ' 1 AU6 212025 "PoRAlo`b BUILDING DEPAR WC:NT By EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Inrinnuttt tinitifing Department 1146Routta28 South Yarmouth,MA 02664 (SOK)198-2234 at uAT hil- .4iie 44 I NI 'TO c v, i(f.c,-. 2 2 i W(---.,ther f-/Pe 17(onli-lc OWNER: NAME PRESENT ADDRESS TEL. if 1..7.437vait.lioCt. -ri rfri ke7L-,/, ft/ i.f.,11. -gaiziill (2 y47,,,,,,,I, „„t () iy,, -.NAME MAILING ADDRESS TEL-# SU"7,0 0 7 ' EMAIL: --ri e4 k-Pc`fi,) Zi6 1/0trIlt-T` ( . c a P-. e, Oa II Resident rai II Commesciat I Est.Cost of Construction$ /0/Q..>0 Homeowner is Applicant? Yes Ne"Ni Home Improvement Contractor Lie,# / LI 3 c)-(3 J i/ Cuustroctios Supervisor lir,# WORK TO RE PERPORMED Tent Duration (Fire Retardant Certificate required) Wood Stove -...=4.1. Siding: #of Squares _i_ , Replacement windows:# Replacement doors: # -i'V e 1..e• Ljf/s Roofing: #of Squares„............. Insulation I emporary Mobile Home. . temporary Construction Trailer Demolition—interior only "Demolition Raze Structure Solar System BS System — Chimney-- Pence *Please submit utility disconnect letters for electric&gas—structures over 75 years old require historical review *The debris will 1)c:disposal of at Y4(MO Taara. gem 43...PwRey dte7are ii,Ii17- i:',,a16e-.at itz =y iStaidtz•A'''''' e'0i ItMein121"tai"'4 an itnC,Zne4Aleal6,: At-beat ef tny IctowlAg.t=Al....elle 1—nz,---..=1±at any use azkawez(:; will be just cause for denial or revoca- n of my and for prosecution under M.G.L.Ch.268,Section I. Apriimra''r Signature-, Date-. Z./I/ Z r owztr,-,Eign..stwe l,atr trbtteluinie-4 11-2:t2: Approved By: Date: --- Bead*Oftiiiii4AN iiiiii142-0- — Rev 6124 _ . Keating Construction Home improvement contractor registration: DATE July 2, 2025 143053 Quotation# 1 b4► ower brook Hd So. Yarmouth MA Phone (508) 760 2702 timkeatina66@hotmail.com Prnnncal fnr: !rah name/Inratinn• Joe Dillon Same �7 t*nrrk nt .vn Yarmouthport Ma 02675 2n? 111 17g? vvc ileaf uy auunui JFJCl.1111 atuIl gnu QeScrption Strip clapboard siding off left and right front gables Install Typar house wrap Install new window cap Install Clear Cedar sidewalt Ali debris and trash will be removed and disposed of properiy (inky itomc cnarifiari ahnva ara inrilirlari in thic nrnnncal_ nu...a . ..a a: �..a. i : I..:., i I WLLGU rvvuu I QII is i vt n Vluucu n I u ua NruNuaal. Materials guaranteed by manufacturers. Workmanship guaranteed by Keating Construction for 10 years. We propose to hereby furnish labor and material for the sum of $8,950.00 Option to use finger jointed primed clapboard $2000.00 extra Acceptance of Proposal: �� �" �" Date of acceptance: /J9I z Auuepiaiu:e ui riupusai. uaie ui acceptance: The above prices, specifications and conditions are satisfactory and are hereby accepted. ,--•-p� T!!!OTl1YKn1 AREGII_n A ACO�!EY I DATE(MMIDD/YYYY) �� CERTIFICATE OF LIABILITY INSURANCE ailelc ITHIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE nf1FS MAT AFFIRMATIVFI V OR NFPATIVFLY AMFNfI FXTFND OR AI TFR THE CAVFRA(;F AFFf)RnFn RV THE POI IeIFS 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 poiicy(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 fills certifcate does not Gooier rigsris io rue cerhilcale iiosuer in lieu of such endorsernerriis). PRODUCER I CONTACT +Aa.r_+.--...once *-_-elo o,'U I F I Otf/.YC I FAX .eva w..,a,..,.,.,,.,.wov,.�u f�:go,E4i,ISM) /f 1-M381! I WC,MbAb98) Ill-0013 34MainSf West Yarmouth,MA 02673 E-MA LSS:_ INSURER(S)AFFORDING COVERAGE NAM INSURER A:Nautilus Insurance Company 17370 INSURED Belli it a i Continental Casualty Company 20443 TIMOTHY KEATING DBA KEATING CONST NSURERC: 5 I OWFR BROOK Rr SOUTH YARMOUTH,MA n�a°A Yi SI1RERD: INSURER E: INSURE-it 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=LIED ui_MAY 2E..T UN, THE,.'NEUR NCE AFFORDED oY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE T`r9Mc5, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. P SR 'ADDL SUER ' POLICY EFF POLICY EXP I I TYPE OF INSURANCE IN84 RAM POLICY NUMBER (Ir1efL1r1/YYYY! rAfMIPR/YYYYl LIMITS A COMMERCIAL GtNbRAL LIABILITY EACH OCCURRENCE b 1,000,0001 I DAMAGE TO RENTED 50,000I 1 CLAIMS-MADE X OCCUR �'NN1675006 � 3/19/2024 3/19/2025 PP.EM!sES lE^ �..�1 5 MED EXP(Any one person) $ 5,000 I PERSONAL It ADV!`:.FURY GENTAGGREGATE OMIT APPLIES PER GENERAI AGGRFGATF $ 2,000,000 POLCY i i JEL¢T LOC 1 PRODUCTS-c:::,:a loom AGO ; 2,000,000 OTHER: I S AUTCEICE;:.0, �.7Y I COMBINED SINGLE LIMIT ((FAaccigym _i__ ANY AUTO 1 BODILY INJURY(Per personj_ S OWNED I SCHEDULED MN OS ONLY AU I US 'SSROUILY INJURY SYer aco oemI� i AU I OS ONLY _RED U NON-OWNED1 (Per accidRent?AGE S I I $ UMBRELLA LAB I OCCUR 1 EACH OCCURRENCE S RACESS LAB CiAiMS-iviADE I AGGREGATE S DED RETENTIONS I S o ANDEMP..,4:4 S'LIASE JI. I X I STATUTE ERu AND EMPLOYERS`LIAB�ifY YIN 0224N372 3/9/2025 3/9/2026 I E.L.EACH ACCIDENT $ 100,000 ANY PROPRIETOR/PARTNER/EXECUTIVE + OFRCFR/MEMRFR FXCI-IIDEM N l N I A (Mandatory in NH) I El.DISEASE-EA EMPLOYEES 11Nl,Vuir If yes,describe under 500,000 i DESCRIPTION OF OPERATIONS below i I E.L.DISEASE-POLICY LIMIT s i i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES,'�ACORD 101,Additional Remarks Schedule,mat be attached if more space Is roqulred IIroUI COV ERAGE V ERAGE s3 uwis I ED TO THE I cRIP13,CONDITIONS,IOIr3,EXCLUGiORG,v I HER LITA i A T ION3 MD ENoola3aIEl T 3 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 ACCORDANCE WITH THE POLICY PRO:'!S!.^.NE 2235 Iyannough RD West Barnstabie,MA 02668 At:THOME::REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD iSic arid logo are registered marks of ACORD The Commonwealth#/Massachusetts DeparfvvItt of d Accide 17; ?' Office of Investigations t �` ' Lafayette City(enter z 2 Avenue de Lafayette. Boston,MA 02111-1750 '„ ).4 www mass gov/dia ' Workers'CuCouifsefiSatiiiii Iosorarset Affidavit auiidi s/CuutractursiEleetrkiauS/i i ianbers Applicant Information Please Print Le2ilbly Name(Business/Organization/Individual): r 011 Ke,'ii.'i j ` Address: 5y L v:Ue.,- 13/0J1- 1.'1 City/State/Zip: YG /Mail- 01A 0L'61 Phone#: SOS Zoo 720? Ai%you of eiuployei?Check the appropriate bob. Type of project(required): 1.Dt 1 am a employer with / 4. 0 I am a general contractor and I 6: New construction employees(full and/or part-time).* have hired the sub-toriiraetors 2.CI I am a sole proprietor or partner listed on the attached sheet. 7. Pi Remodeling ship and have no employees These sub-contractors have 8. 0- Demolition working for Irte in any capacity. employees and have workers' Yc 0-Fitnifting acict tion [No workers' comp. insurance comp. insurance.* required.] 5. 0 We are a corinoration anri 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 0 Root repairs insurance ref-piked.]t c. 152,§1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] 1 'Any applicant thatchecics box#I•must also,till out the section'below showing their workers'compensation policy intormation. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. leontractors that check this box must attached an additional sheet showing the name of the enh.rrmtractors and ovate whether or not th..r Pntit;Pe have employees. It the suh-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'eompensatton insiwenee for sty employees, Below rs the polity ands sate information. Insurance Company Name: C /VA P(ilicy#di Self-iiis.Lie.#: 0 Si C-(., ,T7 Z E p1tation Date: S/ 7'/ ?6 Job Site Address: Z Z l -Paz he---,4- e' City/State/Zip'. yG(eVi)i'h PO/1 i,t 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 fig insuiaftce coverage-verifieatiott. 1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct ✓ Signature: V` -- Date: 4j(Z i 1 Z Phone#: C 0 <s" ?C.o w 7 t, , �� tom`,:_ r n . .t II lijJEcial use only. Do not write in this area,to be completed by city or town official. II II II City or Town: Permit/License# II II Issuing Authority(check one): II II II 1❑Board of Health 20 Building,Department II 3nCitv/Tnwn Clerk 4.0 Electrical Inspector 5 Eiinmhim, (E 11 II inspector 6.bother II li ifI Ij �.uuiaci Fer'auu; Phone 4; II II Commonwealth of Massachusetts Construction Supervisor Specialty Division of Occupational Licensure `• Board of Building Regulations and Standards Restricted tn• Constructs Mf r Specialty CSSL-RF-Roofing 44W� P tY rcSL_wS.Windows and Siding CSSL-099351 w scpires: 05/11/2026 TIM B KEATIVG A 54 LOWER BROOK ROAD O SOUTH VADIaf111T1-1 MA 1126 ? l0*1 III �MOI`,v3.0. Faihura to nnceace a current edition of ha Massachusetts State Building Code is cause for revocation of this license. Commissioner _S.,.4.21,41.4 Contact OPSL(617) 32CC or visit w.w.mass.90v/dr!opsi • cazr•oaa3zJ ozUJlsose • eauzD. .t d G yh B..q ot&IIq.aB 1 Biqa DvqmovM M how�iou.w=.UV 04l".3aaec^. THE. COMMONWEALTH CIF M.ASSACFIUSEETTS Office of Cosurner Affairs and E3usiiies ; Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration I wlwtiRil�Mi4MiMi M w 4 M . i . � �� O"" 1' �e: Individual r -7:-_ egistr� tic►n: 143053 T I A10TH'Y KEATING � A �.� � .' ,� � ,, �.S �ri , Expire titan: 06/ I3/2026 D/Ei/A. KEATING CONSTRUCTION . • *., 54 LOVVE=R BF:O0K RD. „ 44, SO. YAR MOUTH, MA 02E664 ,, y : *«0. , Ar."' No1/4114: - -',10160.00p- dei/41,11trimmommomismommummagrammer.................v moneminnmaremar maliwinsmapr ssomm..........1.................~.. %. . Updatia Address and Return CIird. THE C DMMCINWEALTH OF MASSAC HUSETTS Office of Consumer Affairs & Bus;iness Regulation Regic:tration valid for irdividL;al use only.before the HOME IMPROVEMENT CO VTRACTOR expiration date. If found return to:: TYPE: lnc!ividua Office of Consumer Affairs and Business Regulation .g[Wigan. t Exp1iiou 1000 Washington Street - Suite 710 = A� Bost,)n, M/k 02118 1��305�3.. .., :,. �Oo/1� /2026 r TIMOTHY KEATING ,.- z ,:4: DiB/A K1EATIN43 COLS STRUC1`IO ' JQ l.'� \' l.W k TIMOTHY B. KEATING V.., '1 ;-$c: c7 . P, Yfr.:01(1.40L, 5 LOWER BROOK RD. .;i..z, , , �!.i u � ht tiR w.r•••1.�A ow�r.r.�►.rw�r•w.!0w�r.-r1��...►wr.�.�_w�.��r•.�.rw�w.m�w��r�._+rr�r. SOJ. YAF:MOU--"H, MA, 02664. . -,. r `.i,;� ', �r........r.�_,r...._.r�..�..� IJndersecre1ari IVot valid without signature e•