The URL can be used to link to this page

Home My WebLink AboutBld-50-003003 Y. Office Use On1 41s.,,y� O' Permit • l ' Amount�b r. hwrr ,�c�. u '.Permit expires 180 days from :'-:1":;=.: ['issue date 8u�-19'Ob30a-3 EXPRESS BUILDING PERMIT APPLICAT ! r F . E D TOWN OF YARMOUTH .. Yarmouth Building Department 1146 Route 28 NOV 21 2019 South Yarmouth, MA 02664 r ._ (508) 398-223�t'1 �� S e . 12614_0 __. '3Ey �C a Q r CONSTRUCTION ADDRESS: 7 l ASSESSOR'S INFORMATION: Map: Parcel:- OWNER: (3ui �ki0Q JJ J tom& Aktt; , )kT 4 `'� A 4 Oa)) NAME PRESENT ADDRESS TIf # (�: CONTRACTOR: t..Ly r tr0 G"' t� .- i, 1Li l 1►k �. rU,Ci 1.r1A M vd-rj 7c NAME MAILING ADDRESS ' TEL E Residential 0 Commercial Est Cost of Construction$ in Qa Home Improvement Contractor Lic.# 1,i 6 1 5 , Construction Supervisor Lic.# 6c:i c it-7 • Workman's Compensation Insurance: (check one) 7 0 I am the homeowner 0 I am the sole proprietor E I have Worker's Compensation Insurance Insurance Company Name:4CFE. 4M.6-'1' lC.l Worker's Comp.Policy L.U Orb q OC4`,E� 0}`?iI WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares tO Replacement windows:# Replacement doors: # Roofing: #of Squares ( r//)Remove existing* (max.2 layers) Insulation Old Kings Highway/Historic Dist. ( )Replacing like for like Pool fencing *The debris will be disposed of at q 1 A ;: ti� "1c 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 a ration of my license and fo 'on under M.G.L.Ch.268,Section 1. !! Applicant's Signatur •` f if�Date: ( tq f Owners Signature(or attachment) Date: Approved By: Date: 1� ('� Building Official(or design EMAIL ADDRESS: Zoning District Historical District 0 Yes 0 No Flood Plain Zone: ❑ Yes 0 No Water Resource Protection District: Within 100 ft of Wetlands: 0 Yes 0 No 0 Yes D No The Commonwealth of Massachusetts t"'�w �g'/. Department of Industrial Accidents '"• - I Congress Street,Suite 100 �'E1='f= Boston,MA 02114-2017 ' =t www mass gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information . /` Please Print Legibly Name (Business/Organi tion/lndividual): 1\''C.�LA 2 -)tl Cr1 Address: U 1, t✓, City/State/Zip:A --MA7J P 5 Phone e#: % 50°1 4(-t t j) Are you an employer?Check the appropriate box: Type of project(required): 1.r l'am a employer with 1 employees(full and/or part-time).* 7. ❑New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.0 tam a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 0 Building addition 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[ oOf repairs These sub-contractors have employees and have workers'comp.insurance.: 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.0 Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#i must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is prov' ' g workers'compensation insurance for my employees Below is the policy and job site information. (31-m,i'61_ Insurance Company Name: \L,/u-NV L(F� � Policy#or Self-ins.Lic.#: (0(o�V, ,3 ¶ t:.0%f )) l)V kppiration Date: _ - i 0 Job Site Address:55 ' CVS5 Alf City/State/Zip: 0 J fr! OZ b1-3 Attach a copy of the workers'compensation policy declaration page(showing the policy nu ber and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereb • ider the pains and pe ' perjury that the information provided above is true and corr aSignatu e.' Q--i \•- W Date: t_ (C\ Phone#:r 5QC1 V Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: t.F.Z 6,4Ackmar,,,,e,k).e/4/- Office of Consumer Affairs and Business Regulation 1000 Washington Street-Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Individual OLIVER KELLY Registration: 128957 8 RHINE RD Expiration: 06/13/2021 YARMOUTHPORT,MA 02675 Update Address and Return Card. SCA 1 1S 20M-05/17 ‘Re; 6zw,wweivv..441ty".414261442r..44,14; Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Individual before the expiration date. If found return to: Registration`. Office of Consumer Affairs and Business Regulation 128857;_:=:_- 06/13/2021 1000 Washington Street -Suite 710 OLIVER KELLY -_-' `::. Boston,MA 02118 OLIVER M.KELLY - - 8 RHINE RD. .,,...(4., k• YARMOUTHPORT,MA 02675 Undersecretary Not valid without signature Commonwealth of Massachusetts •Division of Professional Licensure Board of Building Regulations and Standards Construction•Supervisor Specialty CSSL-099167 Expires:09/28/2021 OLIVER M KELLY 8 RHINE ROAD YARMOUTH PORT MA 02675 • Commissioner AWRD® CERTIFICATE OF LIABILITY INSURANCE DATE 4/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.Th CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIE BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZE REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pollcy(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 NAYS, Linda Sullivan DOVVLING&O'NEIL INSURANCE AGENCY ( (508)775-1620 IAX A/C.Nob ADD a ADR Ess: Isullivan@doins.com 973 IYANNOUGH RD INSURER(S)AFFORDING COVERAGE NAIC s HYANNIS MA 02601 INSURER A: ACE AMERICAN INSURANCE CO 22667 INSURED INSURER B: KELLY ROOFING INC INSURER C: I I INSURER D: 8 RHINE RD INSURERE: I YARMOUTHPORT MA 02675 INSURER F: I COVERAGES CERTIFICATE NUMBER: 402283 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. CY EXP LIR TYPE OF INSURANCE INSD wvi, POLICY NUMBER HAMODATTYYY) (MWDD//YYYYY) LIMITS COMMERCIAL GENERAL LIABILnY EACH OCCURRENCE $ CLAIMS-MADEAMAGE TO n OCCUR PREMISES(EaE NTED occurrence) $ MED EXP(Any one parson) S N/A PERSONAL&ADV INJURY $ GEM_AGGREGATE UMIT APPLIES PER GENERAL AGGREGATE S POLICY 7 7 LOC PRODUCTS-COMP/OP AGG $ OTHER $ COMBINED SINGLE UMIT AUTOMOBILE LIABILITY COMBINED accident) $ - ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULEDAUTOS AUTOS N/A BODILY INJURY(Per accident) $ HIRED AUTOS AUTOS NON-OWNED (PROP DAMAGE $ er accident) UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLA Ms-MADE N/A AGGREGATE $ DED RETENTIONS _�/ $ WORKERS COMPENSATION X STATUTE ER AND EMPLOYERS'LIABILITY ANYPROPETOR/PARTNER/EXECUTIVE YIN RI EL.EACH ACCIDENT $ 500,000 A (OFFI��EM in BE EXCLUDED? WA WA WA 6S62UB8H08580919 05/10/2019 05/10/2020 EL DISEASE-EA EMPLOYEE $ 500,000 If yes describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY UMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is 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.govilwd/workers-compensationfrnvestigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Dennis - Building Department ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 2060-485 Main Street AUTHORIZED REPRESENTATIVE South Dennis MA 02660 `.�, -( L�- i. I Danieel M.Croy,CPCU,Vice President—Residual Market—WCRIBMA 401988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD From: j jovan J_JovanRR@msn.com Subject: Re: 35 Massachusetts Ave. Roof Date: Nov 4, 2019 at 6:00:05 PM To: Oliver Kelly kellyroofing@icloud.com From:Oliver Kelly<kellyroofing@icloud.com> Sent:Thursday,October 31,2019 6:59 AM To:j jovanrr@msn.com<j jovanrr@msn.com> Subject:35 Massachusetts Ave.Roof Jon, Please see a roof replacement proposal attached below, Regards, Oliver Kelly Sent from my iPad KELLY ROOFING PH. 508 509 4640 8 Rhine Road MA C.S.L. # 099167 Yarmouthport MA H.I.C.R. # 128957 MA 02675 INSURED �0 October 31 ' 2019 ` h, gib iLl Proposal submitted to Mr. of 35 Massachusetts We propose to supply all materials and labor required to r existing Asphalt roof at the address above. Protect all walls, Windows, shrubs, plants etc. during roof 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 install( valley areas and around all protrusions Remainder of Roof Deck to be Covered with Synthetic Ur Install Certainteed Landmark limited lifetime warranty Arcl rertnirtte nrl Ctnrtnre onrl ran Chinnlac to msvimi7a avails JI1Q11 ttuou VmQ1 Lc: QI IV VQ`./ % I III 1y1VV7 tV I I IW11 I I111.14.0 SA If SAUL All shingles to be storm nailed (6) Repair all flashings as necessary. Install Certainteed Filtered ridge Vent on All Ridges with h Replace all Plumbing Vent Pipe Boots With new. Complete Clean up off all areas including all gutters and Repair Storm Damage to Deck and Fascia on Small rear Replace Flashing where roof meets wall on same roof arc Obtaining Of Town Permit At a total cost of $4,700 Additional Repairs at additional cost may be required to r( Payment Schedule; Balance upon Completion Proposal Submitted by: Oliver Kelly Proposal accepted by: k• l Best Contact Phone Number: • tr-74 Waininofoeveadi 6,4AckmaciaaezZ, Office of Consumer Affairs and Business Regulation 1000 Washington Street-Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Individual OLIVER KELLY • Registration: 128957 8 RHINE RD Expiration: 06/13/2021 YARMOUTHPORT,MA 02675 Update Address and Return Card. SCA 1 0 20M-05117 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Individual before the expiration date. If found return to: Reeistration_% Expiration Office of Consumer Affairs and Business Regulation 06/132021 10001Nashington Street -Suite 710 OUVER KELLY <__- Boston,MA 02118 OUVER M.KELLY. 8 RHINE RD. g(,,,wmllC.�iGGrk' �•—�: YARMOUTHPORT,MA 02675 Undersecretary Not valid without signature Commonwealth of Massachusetts -Division of Professional Licensure Board of Building Regulations and Standards Construction Supervisor Specialty CSSL-099167 Expires:09/28/2021 OLIVER M KELLY 8 RHINE ROAD YARMOUTH PORT MA 02675 • Commissioner 4,44:01.r, Ark-'4------