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HomeMy WebLinkAboutBLSM-25-45- RECEAVAEUI : AK SHEET METAL PERMIT ! 04 2025 o SEP 0 N Commonwealth of Massachusetts Bull 1;1-7 Dit « SLAT 0 = y Town of Yarmouth Building Department "�mactrAcsizzlic 1146 Route 28, South Yarmouth, MA 02664-4492 --�Y` L� �_ \i" ,6'° � ?-iO /22/Licl,, eaoRnsEo�,;y Date: 9/4/25 Permit#: r 5111 , _ ((S Estimated Job Cost: $1000.00 Permit Fee: $ Plans Submitted: YES/NO No Plans Plans Reviewed: YES/ NO Business License# 9815 Application License# Business Information Property Owner/Job Location Information Name:Northstar HVACR Name:Town of Yarmouth Street:95 Camelot Drive Street:74 Town Brook Rd City/Town:Plymouth MA City/Town:Yarmouth Telephone:508-888-3692 Telephone:774-212-7104 Photo I.D. required/Copy of Photo I.D. attached: YES/ NO Staff Initial: J-1/ M-1 unrestricted license J-2/ M-2 restricted to dwellings 3 stories or less and commercial up to 10,000 sq. ft./2 stories or less Residential: 1-2 family_ Multi-family_ Condo/Townhouses Other Commercial: Office Retail Industrial X Educational Institutional Other Square Footage: under 10,000 sq. ft. X over 10,000 sq. ft. Number of stories: Sheet metal work to be completed: New work Renovation: X HVAC:_Metal Watershed Roofing:_ Kitchen Exhaust System:_ Metal Chimney/Vents:X Air Balancing:_ Provide detailed description of work to be done: _ Install flu piping for existing waste oil heater and tie back into existing stack going through roof. INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes x No If you have checked Yes,indicate the type of coverage by checking the appropriate box below: A liability insurance policy x Other type of indemnity Bond OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Jon Townsend Owner x Agent Signature o ner or Owner's Agent By checking here4 X I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installation performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Inspections shall be called for prior to insulation installation. Duct inspection required prior to insulation installation:Yes_No Progress Inspections Date: Comments: Final Inspections Date: Comments: Type of license: By:Bill LaForce x Master Jon Townsend Title:Senior Project Manager _Master-Restricted 'f'Signature of Licensee 1` City/Town:Plymouth,MA Journeyperson Permit#: Journeyperson-Restricted License Number:Bats Fee: $ _ Check at www.mass.gov/dpl T Inspector Signature of Permit'r of Permit Approval �....4 NORTREF-06 BMETIVIER '`,��R0 CERTIFICATE OF LIABILITY INSURANCE DATE E(MMID25 ) 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 311 Plymouth St (Arc,No,Ext):(781)293-6331 (A/C,No): Halifax,MA 02338 ADDAIL RESS: INSURER(S)AFFORDING COVERAGE NAIC B INSURER A:Selective Insurance Company of the SE 39926 INSURED INSURER B: Northstar Refrigeration,Inc. INSURER C: 95 Camelot Drive INSURER D: Plymouth,MA 02360 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 ADDL SUBR POLICY NUMBER I POLICY EFF POLICY EXP LIMITS LTR INSD WVD IMMIDDIYYYYI IMMIDDIYYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR S 2110816 5/11/2025 5/11/2026 DAMAGE TO RENTED 500,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY X JECT X LOC PRODUCTS-COMP/OPAGG $ 3,000,000 OTHER: $ COMBINED SINGLE LIMIT 1,000,000 A AUTOMOBILE LIABILITY (Ea accidentl $ — ANY AUTO A 9104619 5/11/2025 5/11/2026 BODILY INJURY(Per person) $ OWNED SCHEDULED _ AUTOS ONLY X AUTOS BODILY INJURY(Per accident) $ X AUTOS ONLY X NO-O ONEY PROPERTY DAMAGE (Per accident) $ $ 'A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESSLIAB CLAIMS-MADE S 2110816 5/11/2025 5/11/2026 AGGREGATE $ DED X RETENTION$ 0 Aggregate $ 5,000,000 A WORKERS COMPENSATION STATUTE ERH AND EMPLOYERS'LIABILITY YIN WC 9084568 5/11/2025 5/11/2026 1,000,000 ANY OFFICER/MEMBER EXCLUDED?PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Equipment Floater S 2110816 5/11/2025 5/11/2026 Installation Floater 250,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Evidence of Insurance ONLY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ‘. • 'r 4.y COMMONWEALTH OF MAgtACHUSETTS*-':- DIVISION OF OCCUPATIONAL LICENSURE BOARD OF .. ..... ....• SHEET METAL WORKERS ::. :i, ::. •::::,.. :7.: , ..•.b. •••••••..• .....• ISSUES THE FOLLOWING LICENSE : •:::•-•'''': ii;:ir . •••:•-::::. ::::: ..... ..-- . - :::.:::::: ..-:::.•::: :::•..:.. MASTER7UNRESTR1CTED ii.... la f z JON M TOWNSENa:::- ! 0 ',:•cn -, .--. ..... ....... . .:::::. :,:.:. •• . ..:•:: :::: :i ::: 95 CAMELOT PR:.: : i ci) UNIT 1 ". • '/: -:'. ... . . ::.. : . ..::: . • . . .: . . . • ' ' • i z PLYMOUTH, MA 0236040. 24 ..... .. . :.. .. . ' ..-- i:::.i::ii: ::.ii:; .•:i-:: :.:-:.:::i::.: --:.:!:. . . . . . ... •-: A 7:* :.: :•:•::'::. ......'..*" 9815T-:::.:: '1- h ' ''' '' :02/28/2027 :::-.- .i::.:.::':' 721154 .... ... .•:::: LICENSE NUMBER EXPIRATION DATE SERIAL NUMBER