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Home My WebLink AboutBLD-19-002830 Office Use Only O4 YAR . 4.41 is ! 4O Permitl! CO�J• Il'/g Amount `�f --_� -crd,, Permit expires 180 days from e - (b _ICI 4:6,..e.3 O issue date EXPRESS BUILDING PERMIT APPLICA lb. C E I V E D TOWN OF YARMOUTH NOV 0$ 2018 Yarmouth Building Department 1146 Route 28 BUI 0 4 •e •4 'TMENT South Yarmouth,MA 02664 ny. a_ _• (508) 398-2231 Ext. 12611 CONSTRUCTION ADDRESS: 5L{ aet..3bttOGe JA- W• \lA.f),I1Aarm EW\ 0tQhV2) ASSESSOR'S INFORMATION: • �+ ' y Map: Parcel: ' OWNER: GIEJ6 t.ELAILEk7 54 �AowS::,.LvI) s'. Pa, 1n\. 4 QJTI( ,(-4A 001b23NAME ^^ , PRESENT ADDRESS �fADDRESS ,/ TEL CONTRACTOR: A1 L Vnn __ ,^� wa 6 QC� Y�T� 1 Pozr MA 02.61S NAME MAILING ADDRESS TEL lj.-_% So_i �rC!' / t./_tro ❑Residential 0 Commercial Est.Cost of Construction$ 33 00 Home Improvement Contractor Lic.# id 867 67 Construction Supervisor Lic.# 099/b7 Workman's Compensation Insurance: (check one) 0 I am the homeowner/ 0 I am the sole proprietor 0 I have Worker's Compensation Insurance/ p Q�l Insurance Company Name:4&. /e.4 A Worker's Comp.Policy# bShj U p�WO�S U o a ft 1111 WORK TO BE PERFORMED Tent _ Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares �t Replacement windows:# Replacement doors: # Roofing: #of Squares 10 ( )Remove existing* (max.2 layers) Insulation Old Kings Highway/Historic� Dist. ( )Replacing like for like Pool fencing *The debris will be disposed of at: Ia 1O t/r e 4 nl y 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 license and for pr:.yy. on under M.G.L.Ch.268,Section I. Q� Applicant's Signatu - 2i , e Date: 11.7 -1 U Owners Si: attire 4.chmena' - Date: Approved B•. Ii "T`�L�� - Date: //'f'f/ Building 0. .i- -r•.ee) EMAIL ADDRESS: Zoning District: Historical District: 0 Yes ❑ 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 • • • L : ill . flftJi .• . • j.)359- it ' i c ig 1.1 6 • ., .1 i 1 : a . 1.• . li • il• 11ti • 44 - LI . 9 , . li if 1 . �� . 1 i . ,, '111 . '3 — I t ii 1 1.; gE u . iti i 8 4.ci . 4. iti '• • ill ' 1 ' a iit d lilt • • I . g. 4, • ii . la' c- . .% 42c.) i 1 1 ' tis! 4 —i,' t 1is1 ! p . y 3 , , , ,,, itkr N1 , �1 1 41 1 i 1 P t [ESA "set '.1. g II ; pi Ohl 1 p ,,, r .11, , ,, g ' wy • • ill � ,�, t. Hit. ili ii j I h . ii it.lithilip , ala b . . KELLY ROOFING PH. 508 509 4640 8 Rhine Road MA C.S.L. #099167 Yarmouthport MA H.I.C.R.# 128957 MA 02675 INSURED September 5'2018 Proposal submitted to Mr. Steve LeBaron of 54 Trowbridge Path West Yarmouth MA. We propose to supply all materials and labor required to remove and replace the existing asphalt roof on the garage and breezeway at the address above. Protect all walls, Windows, shrubs, plants etc. during roof strip. 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 first Six feet of all eaves, in all valley areas and around all protrusions. Remainder of roof deck to be covered with synthetic underlayment. Install limited lifetime warranty Architect style Shingles, color to be specified, All shingles to be storm nailed (6) Replace plumbing vent pipe boots with new. Repair/Replace all flashings as necessary including Chimney. Install Certainteed Filtered ridge vent with hand nailed caps. Complete Clean up off all areas including all gutters and all nails after project complete At a total cost of$3300 Payment Schedule; Balance upon Completion Proposal Submitted by: Oliver Kelly Proposal accepted bySaet 71,4Date?//7/2018 This proposal is valid for 45 days from date above, please call to verify thereafter. /1/0ulli •3 14, 4. O?(c r ' ao ;A Sr #/6so. '3rs �e �poo2wy ouaea dVbArmac el *,17-4 Office of Consumer Affairs and Business Regulation - 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 • Home Improvement Contractor Registration /-,7 Type Individual • OLIVER KELLY i- t ;E -/ cj Registration: 128957 -i L-' Expiration: 06/13/2019 8 RHINE RD YARMOUTHPORT,MA 02675 TJ i- I Update Address and return card. Mark reason for change. scat 0 20M-05/II n Addr..e — �f-c,--a.gn m.nt C Last Card Office?eBusiness Regulation 7An HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only aa . TYPE:IndMdual before the expiration date. If found return to: 'r" Registration Expiration Office of Consumer Affairs and Business Regulation E'tt\ 128957 06/132019 10 Park Plaza-Suite 5170 "" Boston;MA 02116 rn IVER KELLY i �) ,,r"'^'*Y a OLNER M.KELLY � .�"' .. 9 RHINE RD. Not valid without signature d YARMOUTHPORT,MA 02675 Undersecretary-..._• 9 'y Commonwealth of Massachusetts '�I Division of Professional Licensure • Board of Building Regulations and Standards Construction•SUp4Msor Specialty CSSL-099167 h Eltpires:09/28/2019 OLNER M KELLY i ' 8 RHINE ROAD, ' YARMOUTH PORT MA 02675 '` T AN M n /ale � ' t Commissioner ✓" " .s... i ACORD CERTIFICATE OF LIABILITY INSURANCE DAT WD (MM/DYa 01 • 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(les)must 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: Linda Sullivan • AX DOWLING&O'NEIL INSURANCE AGENCY P"O"„E=n (soft)775 1620 i . Nn,: oonEss: Isullivan@doins.com 973 1YANNOUGH RD INSURER(S)AFFORDING COVERAGE NAIC I 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: _ YARMOUTH PORT MA 02675 INSURER F: COVERAGES CERTIFICATE NUMBER: 316737 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 OFINSURANCE i ADDL SUER POLICY EFF POUCY EXP UMC LTRWan wins POUCY NUMBER IMMNLVYYYYI IMMDNYYYYI COMMERCIAL GENERAL LIABILnY EACH OCCURRENCE $ DAMAGETO RENTED CLAIMS-MADE ❑OCCUR PREMISES Ea occ,s ante) $ _ • MED EXP(Any one person) $ — • N/A PERSONAL SADV INJURY $ ' GERI_AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ _ POLICY El jE7 D LOC RPRODUCTS-COMP/OP AGO S • OTHER: $ AUTOMOBILE LIABIUTY COMBINED SINGLE LIMIT $ (Ea Ment) ANY AUTO BODILY INJURY(Per person) $ — AOWNED SCHEDULED AUTOS N/A BODILY INJURY(Per accident) $ _ AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS _ AUTOS (Per accident) 1 $ UMBRELLA LIA8 _ OCCUR EACH OCCURRENCE $ EXCESS UA8 CLAIMS-MADE N/A AGGREGATE $ DED RETENTIONS $ WORKERS COMPENSATION X STATUTE W- AND EMPLOYERS'LIABILITY A OFFCER/MEMO XCLUDEDXXECUIVE WA WA WA 6S62UB8H08580918 05/10/2018 05/10/2019 E.L.EACH ACCIDENT $ 500,000 (Mandatory In NH) E.L.DISEASE•EA EMPLOYEE $ 500,000 r yes,desc ib under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMB $ 500,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached It more apace le required) 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 this 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.mass.gov/IwdAvorkers-compensation/investigations/. • CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN David Bernstein Builders ACCORDANCE WITHTHE POLICY PROVISIONS. 139 Nantucket Drive • ' AUTHORIZED REPRESENTATIVE Chatham MA 02633 j I Daniel ..Crro v'eey,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