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HomeMy WebLinkAboutbld-23-002821 / /;) "i/2 i/z Z A ,YAR Office Use Only . ''. tO : �+ ,- /H ` NABA M £3 � Peritf a� , a 56 Amount /©j,t '�° I n Permit expires 180 days from C�/I _Qc to 5 Woo/ issue date / EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department RECEIVED 1146 Route 28 South Yarmouth, MA 02664 NOV 212022 (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: t"t5a'(S (,JA,,� BUILDING DEPARTMENT ASSESSOR'S INFORMATION: ��,�,� Map: Parcel: OWNER: � __ v e7 C;m SLels .'-t,AQ.,,,o, 07 Sk4 '126 1827 NAME PRESENT ADDRESS L. is CONTRACTOR: '' r '- f kf-i)„ -it'.1„ +}�.k.\a;ULo .() ihttri_AA-c,x)-1-(k �7 tArr� 2. _ r 1 Fe,J �.i���.` NAME MAILING ADDRESS ' TEL.ft � ( ti 1 ���„ rI Ei (: E Residential 0 Commercial Est.Cost of Construction$ n/b Home Improvement Contractor Lic.# 12`61S7 Construction Supervisor Lic.#07 t ' 67 Workman's Compensation Insurance: (check one) 0 I am the homeowne4c4 ❑ I am the sole proprietor I have Worker's Compensation Insurance Insurance Company Name: -• �I. �a•t Kati Worker's Comp.Policy#%L% i.)Cle3 `? 5 O^l 27, WORK TO BE PERFORMED Tent 0 Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares / Replacement windows: # c`aC,it.ttu1 s Replacement doors: # Roofing:Aof Squares t f;s ( ')Remove existing* (max.2 layers) Insulation 171 I _I Old Kings Highway/Historic Dist. Replacing like for like Pool fencing n *The debris will be disposed of at: aA-y!45)-2-' 1 1'C'.1"::';1='�tf's- 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.•. or prosecution under M.G.L.Ch.268,Section 1. ii / Applicant's Signature:iy�� l]r C 0 C)W t`W. Date: / 2` 22_ Owners Signature(or attachment) e e / •A772 Date: Approved By: Date: /, - r Building Ofcia -.I-.c ' ee) EMAIL A :SS: Zoning District: Historical District: Yes No Flood Plain Zone: _ Yes I No Water Resource Protection District: Within 100 ft.of Wetlands: Yes No Yes No 6-7 Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Individual Registration: 128957 OLIVER KELLY Expiration: 06/13/2023 8 RHINE RD YARMOUTHPORT,MA 02675 Update Address and Return Card. SCA 1 Cr 20M-05/17 iiiv/6”e r/� // ��irJ:iirr� r/�•. Office of Consumer Af(51rs&Business(#6gulrtion g HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Individual before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 128957 06/13/2023 1000 Washington Street -Suite 710 Boston,MA 02118 OLIVER KELLY OLIVER M.KELLY , 8 RHINE RD. '� ' •1" 04 Not valid without signat re YARMOUTHPORT,MA 02675 Undersecretary Commonwealth of Massachusetts • Division of Professional Licensure Board of Building Regulations and Standards ConstructiSotr'Supervilspr Specialty • CSSL-099167 Expires:09/28/2023 OLIVER M KELLY ,Y ,, r. 8 RHINE ROAD YARMOUTH P9RT MA`02675 1 /i \� !1/SS..L.10` Commissioner dluA fi. 1:16 ACO/?OO® DATE(MM/DD/YYYY) C 3 CERTIFICATE OF LIABILITY INSURANCE o5(MM/DDNY 2022 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 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 DOWLING & O'NEIL INSURANCE AGENCY PHOE fA/CNNo,Ext): (508)775-1620 1 FAX No): A DD E-MAIL Iullivan@doins.com 973 IYANNOUGH RD INSURER(S)AFFORDING COVERAGE NAIC X HYANNIS MA 02601 INSURERA: ACE AMERICAN INSURANCE CO 22667 INSURED INSURER B: KELLY ROOFING INC INSURERC: INSURER D: 8 RHINE RD INSURERE: YARMOUTHPORT MA 02675 INSURER F: COVERAGES CERTIFICATE NUMBER: 775628 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 -ADDU,SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD VI/VD POLICY NUMBER (MM/DD/YYYY) IMM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE ! $ DAMAGE RENTED I CLAIMS-MADE OCCUR PREMISESO(Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO JECT LOC PRODUCTS-COMP/OP AGG $ OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULEDAUTO AUTOS N/A BODILY INJURY(Per accident) $ HIRED SAUTOS NON OWNED PReOPEERT DAMAGE AUTOS UMBRELLA LIAB OCCUR I EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED , , RETENTION$ $ WORKERS COMPENSATION I PER 1OTH- AND EMPLOYERS'LIABILITY X STATUTE ER Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBER EXCLUDED? N/A N/A N/A 6S62UB8H08580922 05/10/2022 05/10/2023 (Mandatory in NH) E.L DISEASE-EA EMPLOYEE $ 500,000 If yes.describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS I 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.gov/Iwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Lakeville ACCORDANCE WITH THE POLICY PROVISIONS. 346 Bedford Street AUTHORIZED REPRESENTATIVE Lakeville MA 02347 el Daniel M.Crowley,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014/01) The ACORD name and logo are registered marks of ACORD C�® DATE(MM/DD/YYYY) A CERTIFICATE OF LIABILITY INSURANCE 05/17/2022 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 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 DOWLING & O'NEIL INSURANCE AGENCY PHONE(A/C.No.E,ctl: (508)775-1620 FAXNo): EMAIL ADDRESS: isumvan@doins.com 973 IYANNOUGH RD INSURER(S)AFFORDING COVERAGE NAIC# HYANNIS MA 02601 INSURER A: ACE AMERICAN INSURANCE CO 22667 INSURED INSURER B: KELLY ROOFING INC INSURERC: INSURER D: 8 RHINE RD INSURER E: YARMOUTHPORT MA 02675 INSURER F: COVERAGES CERTIFICATE NUMBER: 775629 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'1 ]ADDLISUBRI POLICY EFF POLICY EXP LTR I TYPE OF INSURANCE INSD WVD POLICY NUMBER IMM/DD/YYYY),IMM/DD/YYYYI; LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) _ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) UMBRELLA LAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS MADE N/A AGGREGATE $ DED j RETENTION$ $ WORKERS COMPENSATION V PER OTH- AND EMPLOYERS'LIABILITY Y/N /� STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBER EXCLUDED? N/A N/A N/A 6S62UB8H08580922 05/10/2022 ! 05/10/2023 (Mandatory in NH) E L DISEASE-EA EMPLOYEE $ 500,000 If yes.descnbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 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.gov/Iwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Mashpee ACCORDANCE WITH THE POLICY PROVISIONS. 16 Great Neck Road North AUTHORIZED REPRESENTATIVE Mashpee MA 02649 Daniel M.Crowley,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014/01) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts 4- ' Department of Industrial Accidents r_� Office of Investigations c 11 '= ? Lafayette City Center '..L: 2 Avenue de Lafayette, Boston,MA 02111-1750 'Tzi:` www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): € N. -- - Address: 0- City/State/Zip:4 v J it , MA, O"2. a S Phone#: . O 5091 .,.',/.2,,,z-.2..;0. A,rree you an employer?Check the appropriate box: Type of project(required): 1.11 I am a employer with l 4- ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees Thee sab-coOiraelois have g- ❑Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp.insurance. $ 9. ❑Building addition required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions m self. [No workers' comp. right of exemption per MGL yp 12. ✓✓' Roof repairs - insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp.insurance required.] *My applicant that checks box#t must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they arc doing all work and then hue 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 providing workers'compensation insurance for my employees. Below is the policy and job site information. n " A Insurance Company Name: ilCii, 4/e ii/l. - Policy#or Self-ins.Lic.#: (35(02.0 O'&a aOR 2.2.. Expiration Date: 6 o IQ, Job Site Address: L...-1 `'i' L (.. City/State/Zip: O- ,kukot-j111 ;)M 02- ( Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fuze 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: (( . I .21 I ! O 4 i4 U Phone#: `j 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): 11:1Board of Health 20 Building Department 31:City/Town Clerk 4.❑'Etectrical Inspector 5Ek'lumbing Inspector 6,EJOther Contact Person: Phone#: KELLY ROOFING PH. 508 509 4-640 8 Rhine Road MA C.S.L. #099167 Yarmouthport MA H.I.C.R. #- 128957 MA 02675 INSURED June 06' 2022 Proposal submitted to Janet Reardon of 7 Chesleys Way South Yarmouth, MA. We propose to supply all materials and labor required to remove and replace the existing Double Layered asphalt roof on the house 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, 5" On Rakes Ice and Water damage protection membrane to be installed on first six feet of all Eaves and In All Valley Areas. Remainder Of Roof To be Covered With Synthetic Roof Underlayment. Install limited lifetime warranty Landmark Architect style Shingles, color to be specified. All shingles to be storm nailed (6) We Generally Use Certainteed Products with All Accessories to maximize available warranties. This proposal is based on their Limited Lifetime Warranty Landmark Series Shingle Install Rubber Membrane Roof over 1/2" Fiber Board On Rear Dormer Roof With C4 White Drip Edge On All Edges. Replace plumbing vent pipe boots with new. Repair/ Replace All Flashings As Necessary. 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 $8,850 To Replace Existing Skylights With New Add $1600 Per Manual Venting Unit, $1450 Per Non Venting Unit Includes New Exterior Flashing Kits, Any Necessary Interior Trim And Extra Flashing To Integrate units Into New Rubber Roof. Solar Options Available Include Solar remote controlled venting at a Cost of $2000 per unit X and /or Solar Remote controlled factory installed blinds at an additional cost of $450 on any unit. All Solar Options Qualify Total Unit Costs For A 2022 Tax Credit Of 26% Payment Schedule; Balance upon Completion Proposal Submitted by: Oliver Kelly Proposal accepted by: 6 Date. / / 2022 9-2-2022 Best Contact Number: 8149261827 This proposal is valid for 30 da from date above, please call to verify thereafter.