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Home My WebLink AboutBLDX-26-609 application RECEIVED Office Use Only AfIV\ J U N 12 2026 Permit#�jI DX' O—�q� 1 _ F:M Amount V(/ t(JV BUILDING DEPARTMENT 'L ryC-RPORmEO`y� By' t 4/L.Cr EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: 108 Bray Farm Rd. North, Yarmouth Port Ma 02675 OWNER: Taylor Bray Farm P.O. Box 66 Yarmouth Port, Ma 02675 508-326-5430 NAME PRESENT ADDRESS TEL. # CONTRACTOR: Undercover Tent and Party 112 Great Western Rd. Unit 1 South Dennis MA NAME +^ ,C� MAILING ADDRESS TEL.# EMAIL: I�� l . onto ph9 _ -/+ omCc,4S 1 i ❑Residential )i Commercial Est.Cost of Construction$ `p3,000 Homeowner is Applicant? Yes No XX Home Improvement Contractor Lic.# Construction Supervisor Lic.# 40 X 60 WORK TO BE PERFORMED Tent X Duration 06/18 to 06/22 (Fire Retardant Certificate required) Wood Stove Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares 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: 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 of my ease and for prosecution u der M.G L.Ch.268,Section I. / 1,Applicant's Signature: aireft> Date: /)/ Owners Signature(or attachment) Date: Approved By: Date: Building Official(or designee) Rev 6/24 qcesPR o® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDITTTY) 05/18/2026 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 KimberlyTetreault NAME: Insurance Marketing Agencies AC, Nei:NE (617)479-5500 FaX (617)479-8761 EAC,No Eat: W4 South Shore ADDREBs: KlmbedyTetreault(gimaagency.com 400 Crown Colony Dr.Suite 103 INSURER(S)AFFORDING COVERAGE NAICO Quincy MA 02169 INSURER A: Arch Insurance Company 11150 INSURED INsuRERB: Wesco Insurance Co 2538 Undercover Tent 8 Party,Inc. INSURER C 112 Great Western Rd Unit 1 INSURER 0 INSURER E South Dennis MA 02660 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2632752346 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 MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AU.THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL9UBR POUCY EFF POLICY EXP LTR TYPE OF INSURANCE IyBD WVD POLICY NUMBER (IMOD/TM) (MMATO/YYYY) UNITS X COMMERCIAL GENERALLIABILITr EACH OCCURRENCE $ 1,000,000 DAMAGE10 REM EO 300,000 CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ — MEDEXP(Any one person) $ 10,000 A PRPKG0008609 11/21/2025 11/21/2026 PegsoNuanov lrvduav $ 1,000,000 GEN-'L AGGREGATE LIMITAPPUES PER: GENERAL AGGREGATE $2,000,000 POUCY jECT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ AUTOMOBILE UABIUTY COMBINED SINGLE LIMIT $ 1,000,000 (Ea weld.) X ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED PRAUT0004903 11/21/2025 11/21/2026 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ _AUTOS ONLY _AUTOS ONLY (Per amid.) PIP-Basic $8,000 UMBRELLA LAN OCCUR EACH OCCURRENCE $ EXCESS LSE CLAIMS-MADE AGMDFGATE $ r DES I RETENTION$ WORKERS COMPENSATION I PERTUTE ER 1OTH- AND EMPLOYERS'LIABILT' V/N STA B ANY PROPRIETOrWARTNERIEXECUTVE NIA WWC3814197 11/21/2025 11/21/2026 E.L EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED'! (Mandatory In NH) E.L DISEASE-EA EMPLOYEE $ 1,00000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ Per Occurrence $1,200,000 A Blanket Equipment Coverage PRPKG0008609 11/21/2025 11/21/2026 Deductible $2,500 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks schedule,may be attached A more space Is required) RE:June 20,2026 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Taylor Bray Farm ACCORDANCE WITH THE POLICY PROVISIONS. 108 Bray Farm Road North AUTHORRED REPRESENTATIVE Yarmouth Port MA 02675 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD _ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations . 1=' Lafayette City Center 2 Avenue de Lafayette. Boston,MA 02111-1750 www.mass.gov/dia Workers'Compensation Insurance Affidavit: General Businesses Applicant Information Please Print Legibly Business/Organization Name:UnderCover Tent and Party Inc _ --_ Address:112 Great Western Rd, Unit 1 City/State/Zip:South Dennis, MA 02660 Phone#:508-398-9000 Are you an employer?Check the appropriate box: Business Type(required): 1. I am a employer with 10 employees (full and/ 5. ❑ Retail or part-time).* 6. ❑Restaurant/Bar/Eating Establishment 2.❑ 1 am a sole proprietor or partnership and have no 7. El Office and/or Sales(incl.real estate,auto,etc.) employees working for me in any capacity. [No workers' comp. insurance required] 8. ❑Non-profit 3.❑ We are a corporation and its officers have exercised 9. ❑ Entertainment their right of exemption per c. 152,§1(4),and we have 10.0 Manufacturing no employees. [No workers' comp. insurance required]** 11 Health Care 4.0 We are a non-profit organization,staffed by volunteers, Rentals with no employees. [No workers' comp. insurance req.] 12.� Party Other *Any applicant that checks box 111 must also fill out the section below showing their workers'compensation policy information. "If the corporate officers have exempted themselves.but the corporation has other employees,a workers'compensation policy is required and such an organization should check box NI. I am an employer that is providing workers'compensation Insurance for my employees. Below is the policy information. Insurance Company Name:Wesco Insurance Insurer's Address:420 Maple Ave City/State/Zip: Yukon, OK 73099 Policy#or Self-ins. Lic. #WWC3814197 Expiration Date:11/21/2026 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under§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,under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: 1 / o? 3 / 41 6 Phone#: 508-398-9000 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): I.OBoard of Health 2.0 Building Department 3.0 City/Town Clerk 4.0 Licensing Board 5.0 Selectmen's Office 6.DOther_ Contact Person: Phone#: www.mass.gov/dia IMPORTANT DOCUMENT Certificate of(Frame Tvistance Dee of Shipment ISSUED BY 5222018 , i.:4.; •4,-,,,'i.:-,t,,?:. .,.:.';4-14 , &‘141r4r)tirlrfi.lE • tr4C Nm....40,..v SO-66:4833 TII EVANSVILLEI INDIANA 47723 MANUFAC RERS OF THE FINISHED TENT PRODU SCRIBE This Is to certify 11'41 the rria'• " HEREIN to tena dasmbed are inherently name retarciari and were SuppPed 810213C UNDERCOvER. TENT ta PARTY I'M 31 ANT . 1C,A,N WAY Sarill ZEVN5S MA, 025M USA FLAIME RETARDANIT 44,e-oisvallor iiiirr,-,,i,fier. SistirkER MFG 1,C,t5Tk7.1-4 ,, F.-14001 Ci 1 & -SiFPA 701 a .AS-111 m *- Eitil :CLA , t-111, .,-,,.;, 2100/ .1-11rs iii",6cs641151,:t.Z.17,1e4r4. _ Fabric meets rmnt of Certifiagion is hereby made that: The articles described on this Cediicate have bees treated with a flame-retardant approved Chemical and the appliceon of said chemical was done in conformance with California Fire Marshall Code. Flame Retardant Process Used Will Not Be Removed By Washing And is .Effective For the Life Of The Fabric Senal * B.150200 en ' ' irilittz e fwv certhed CENTURY 40Y1 X SO SUYD ER'ON Yt WiTHO UT WEB.1731.1YS TWO POLES 7/1 - ft. , '; 4 • tePt Finicst f‘..! grted me o App ANCHOR INDUSTRIES otc for of Flarne Re55 . Naf tca- Taylor BrayFarm 40x60 & 20x40 Tents ..., , . ..., ci, , . . , ... ... _ ,..„„ 4i , .. .. s e APB, h 2'1: ' IIIP, 411; i4 ., New_k gta < ^" �- Am"81 8mat .• 4.7,, y1 \ ' .. .. ir • 106iiiray f ark ..1 RdN,Yarm•_ihF,t,-i. " i. ill* P "A) r ' Ste" n