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. EXPRESS BUILDING PERMIT APPLICATI EC }
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TOWN OF YARMOUTH qtr, :0
2018
Yarmouth Building Department I
1146Route 28 Bu 4t9qc
South Yarmouth, MA 02664 By .
/yy� (5008))398-22233�11Ext.
.11261 n�, '
CONSTRUCTION ADDRESS:91 �Pt ��G^i�U�J`L So • t(4Q p c9j
ASSESSOR'S INFORMATION: •
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Map: (� Parcel: f`l� '_
OWNER PE. DQ o Sri QAa. za+ Qcx "IJ
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NAME RESENT ADDRESSn� TEL #ttt sac
CONTRACTOR: ILEO-`i 11-CCS"—t• % t )e PO 14 oan( 0Z.lbl")S
NAME MAILING ADDRESS TEL#fig firs 4b�
Q Residential 0 Commeer�rcc�i�aal�l//��,, Est Cost of Construction$goo �r1
Home Improvement Contractor Lie.# l(9'IS-7 Construction Supervisor Lie.# c l t b7
Workman's Compensation Insurance: (check one) /
0 I am the homeown 0 I the sole proprietorttI have Worker's Compensation Insurance •` �///�Q gy�pp'�
K Worker's Comp.Poli sJ vISJUJOO
Insurance CompanyName:
WORK TO BE PERFORMED
Tent _ Duration (Fire Retardant Certificate attached?) Wood Stove
Siding: #of Squares Replacement windows:# Replacement doors: #
'Roofing: #of Squares 26 ( Remove existing. (max.2 layers) Insulation
Old Kings Highway/Historic Dist. ( )Replacing� like for llikep Pool fencing
*The debris will be disposed of at 2A-ty1L—
Location of Facility
I declare under penalties of perjury that the statements herein contained are true and correct to the best of my Imowledge and belief. I understand that any false answer(s)
will be just cause ford .'. o 'cation of my license air ;on under M.G.L.Ch.268,Section 1. % ^,�
Applicant's Signamr.S i _la�1_ Date: LO' 146
Owners Signature(or attachment) Date: Q Q
Approved By: - i Date: C/ 02°YV
Buil.'.. affil:r designee) EMAIL ADD'a
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Zoning District
Historical District 0 Yes 0 No Flood Plain Zone: 0 Yes 0 No
Water Resource Protection District: Within 100 ft.of Wetlands: '
0 Yes 0 No 0 Yes 0 No
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Office of Consumer Affairs and Business Regulation
• 10 Park Plaza- Suite 5170
Boston, Massachusetts 02116
Home Improvement-Contractor Registration
tion
T Individual--_
11' -=-=717-2- 2 Registration: 128957
OLIVER KELLY
tit:: F—s i,, Expiration: 06/13/2019
8 RHINE RD
— 4.
YARMOUTHPORT,MA 02675 ' _ 7
= c 1
.� Update Address and return card. Mark reason for change.
SCA 1 0 20M-05/11
� Address r1 P.npuno r1 Fmolnvmsnt Q Lnst Card_
C92e Roauuuanaxv,/N yeller re%,.,em .
Office of Consumer Affairs&Business Regulation
, HOME IMPROVEMENT CONTRACTOR Registration valid for Individual uss only
kirk TYPE:IndMNdual before the expiration date. If found return to:
_"Registration Fxniratlon Office of Consumer Affairs and Business Regulation
._- 128952. 06/13/2019 10 Park Plaza•Suite 5170
di vER KELLY, i - '-- Bosteicsu• 02116
"
OLIVERM KELLY1:
� s •
8RHINE RD.
YARMOUTHPORT,MA'02675 Undersecretary Not valid without signature •
•
•
Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
ConstructioltSUppii1sor Specialty
•
CSSL-099167 : ti
Eyires:09/28/2019
P
OLIVER M KELLY ' :^a j = I, •
• B RHINE ROAD;
YARMOUTH PORT MA 02676 *` r
161c\-:.90•-
. •
Je
Commissioner c,L '7•"
a, '
® DATE(MMNOrTTY)
A�REP CERTIFICATE OF LIABILITY INSURANCE o5nerD IYY
18
T(IIS 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(les)must be endorsed. H SUBROGATION IS WANED,subject to
the terns 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: Joanna Bednark
DOWLING&O'NEIL INSURANCE AGENCY PHONE
WC.HO Ng,ESB; (508)775-1620 FAXWC.,MI:
E-MAIL
DRE bednark doins.com
973 IYANNOUGH RD NSURER(S)AFFORDING COVERAGE NAIC S
HYANNIS MA 02601 INSURER A: ACE AMERICAN INSURANCE CO 22667
INSURED INSURER B:
KELLY ROOFING INC INSURER C:
INSURER D:
8 RHINE RD INSURER E:
YARMOUTHPORT MA 02675 INSURER F:
COVERAGES CERTIFICATE NUMBER: 270693 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 AU.THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF NSURANCE ADOL SUER POLICY EFF POLICY ESP LIMITS
LTR NSD INVD (MVDI
POLICY NUMBER MOD/YYYY1 IMMYYTYI
CONMERCIALGENERAL LMBBITY
CLAIMS-MADE D OCCUR
EACIIOCCURRENCE $
DAMAGE TO RtMtD
PREMISES(EB occurrence) $
MED EXP(Any Orepe�) $
N/A PERSONAL&ADV INJURY $
GENT AGGREGATE LIMIT APPLES PER GENERAL AGGREGATE $
RPOLICY ELEPR8r. n LOC PRODUCTS-COMP/OP AGG $
OTTER: $
AUTOMOBILE MAaanY COMBINED SINGLE LIMIT $
(Ea accIdenl)— ,
ANY AUTO BODILY INJURY per penton) $
NJTOo(SMa AUTOS
outs N/A BODILY INJURY(Per accident) $
— NON-DAtED PROPERTY DAMAGE S
HIRED AUTOS _ AUTOS (Per acdd0M)
$
UMBRELLAUAS OCCUR EACH OCCURRENCE $ -
EXCESS LIAR CLAIMS-MADE N/A AGGREGATE $
DED I RETENTIONS - S
WORKERS COMPENSATION X STATUTEPERET
AND EMPLOYERS'LIABILITY
A IR
ICEwMEEMMBBERFCLUDE wA WA WA 6S62UBBH08580918 05/10/2018 05/10/2019 E.LEACH ACCIDENT S 500,000
(MendalayM NH) EL DISEASE-EA EMPLOYEE $ 500,000
a yea,deeabe under
DESCRIPTION OF OPERATIONS eebw EL DISEASE-POLICY Limn- S 500,000
N/A
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 107,Ad,eoaI Ra mart*&Mods ,may be neiMd 11mm specs Is ragalrad)
Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay
claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts.
This certificate of insurance shows the policy in force on the date that INs certificate was issued(unless the expiration date on the above policy precedes the
issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification
Search tool at www.masa.govAwd/workerscompensatioMnvestigationst
4
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WLL BE DELIVERED IN
Town of Mashpee ACCORDANCE WRITHE POLICY PROVISIONS.
16 Great Nedc Road North AUTHORIZED REPRESENTATIVE
Mashpee MA 02649 x C�
hP I Daniel M.Cro vy,CPCU,Vice President–Residual Market–WCRIBMA
®1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
KELLY ROOFING INC. MA CSL #99167 PH 508 509 4640
8 RHINE ROAD. MA HIC #128957
YARMOUTHPORT
MA 02675 kellyroofing@icloud.com
August 3' 2018
Proposal submitted to the owner of 87 Quartermaster Row South Yarmouth MA
We propose to supply all materials and labor necessary to remove and replace the
existing asphalt roof at the address above.
All debris to be removed to town transfer.
8" White Aluminum drip edge to be installed on all eaves.
Ice and water damage protection membrane to be installed on the first six feet of eaves
and around all protrusions.
Remainder of deck to be covered with #15 Felt Paper.
Lifetime limited warranty Architect style shingle to be installed, (Color to be Specified)
All shingles to be storm nailed. (6)
We generally use but are not limited to Certainteed Products.
www.certainteed.com click on residential roofing your proposal is based on the
Landmark series or similar by other manufacturers depending on your choice.
Bathroom vent pipe boots to be replaced with new.
Repair/Replace all flashings as necessary.
Install Shingle Vent II Ridge vent on all ridges with Hand Nailed Caps.
Protect all walls, windows, decks, plants, shrubs, etc. during roof strip.
Complete cleanup of area during and after procedure including all nails and cleaning of
gutters.
Obtaining of Town Permit.
At a Total Cost of $8400
Payment schedule: 50% at Project Start, balance upon completion.
Respectfully Submitted, Olil 7 ell /ten
Proposal accepted by �� Date V //7 /2018
If acceptable pleas, . • :n mit one copy to the address above, keeping a copy for
your records, this proposal is valid for 45 days from date above, please call to verify
thereafter.