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Home My WebLink AboutBLD-23-002534 .0- .x11�i,,� tI fl 1/ / 1 /Z)� Office Use Only . .... O Permit# Will* F O O. . .M Itt' 1 i Amount SV"�(J G Permit expires ISO days from issue date -01-3- LO.,Z 53LI EXPRESS BUILDING PERMIT APPLICATION TOWN OFYARMOUTH RECEIVED Yarmouth Building Department 1146 Route 28 NOV 0.2022 South Yarmouth,MA 02664 (508) 398-2231 Ext. 1261 BUILDING DEPARTMENT By: CONSTRUCTION ADDRESS: 6 C1 �. LSi..vqv'2 V4-0--mooty ASSESSOR'S INFORMATION: 1 Map: Parcel: OWNER:c 1)QiLlL ►\( j 0,4•2-,1.S -Vi.. Vre, 0 t 6 3`."( NAME PRESENT ADDRESS TEL. # CONTRACTOR: Ike ROOCNOG. Vac.. Zl li It ta_,tu 3Qc Jim" 02+r°oc ,,,,,,, NAME MAILING ADDRESS i TEL.#50% O'I 4. '—lt Residential ❑Commercial Est.Cost of Construction$ 73 lJ 0 O Home Improvement Contractor Lic.# teZ.�c{' ' Construction Supervisor Lic.# Oe(G. .,7 Workman's Compensation Insurance: (check one) �`°' 0 I am the homeown r 0 I am the sole proprietor (D"I h Worker's Comp.Policy# 2.t��t'5ave Worker's Compensation Insurance r , 14°T'5 ` 1C .` Insurance Company Name: 1\1 .te,44t WORK TO BE PERFORMED Tent 0 Duration (Fire Retardant Certificate attached?) Wood Stove El Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares let( (Remove existing*(max.2 layers) Insulation t 1 iiOld Kings Highway/Historic Dist. a)Replacing like for like Pool fencing I 1 'The debris will be disposed of at: 44 Y r.ave►a. 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. 1 understand that any false answer(s) will be just cause for denial or-re oration of my l ce e d for prosecution under M.G.L.Ch.268,Section I. / Applicant's Signature: Date: f'l i g I 2.2- Owners Signature(or attachment) / :::: •: yy PP Y �/"� �� Building Official(or desi e) EMAIL ADORES t - _ Zoning District: Historical District: ;_ Yes No Flood Plain Zone: Yes C No Water Resource Protection District: Within 100 ft.of Wetlands: 7 Yes No T.1 Yes No ,r The Commonwealth of Massachusetts s Department of Industrial Accidents �i ��_ Office of Investigatio �' '° _' Lafayette City Centers . fr 2Avenue de Lafayette,Boston,MA 02111-1750 -Y www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Annlicant Information Please Print Legibly Name(Business/Organization/Individual): G 3\AXr tle. Address: Z3.4,s+1 City/State/Zip: J'Il( ` Phone#: 50e. 509Z 4 64; Areu an employer?Check the appropriate box: Type of project(required): 4• El am a general contractor and I 1.I1 I am a employer with d employees full and/or * have hired the sub-contractors 6. ❑New construction ( part-time).* 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have - $. Q Demolition working for me in any capacity. employees and have workers' 9. Buildingaddition [No workers' comp.insurance comp.insurance. required,] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions officers have exercised their 11.0 Plumbing repairs or additions 3.❑ I am a homeowner doing all work myself. [No workers'comp- right of exemption per MGL 12.1Roofrepairs - insurance required.]t c.152,§1(4),and we have no employees.1No workers' 13.0 Other comp.insurance required] I[ *Any applicant checks box#1 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 providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: IICZ AMeale.A.L3 Policy#or Self-ins.Lic.#: 5(02.0&b 6 a oq Expiration Date:.6-(0'2 Job Site Address: l(,J L O-9 c /1 3 L4_4 City/State/Zip: lt-). Lt14-/244( 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 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 undo the pains and penalties of perjury that the information provided above is true and correct e a Signature:t a Date: C I ' _-t I PA ‘)-12—/-? Phone it: 45 4 1 U Official use only. Do not write in this area,to be completed by city or town official . City or Town: Permit/License# _ f Issuing Authority(check one): 11:3Board of Health 2O Building Department 30City/Town Clerk 41:111ectrical Inspector i rlPbtmbing Inspector 6.[JOther Contact Person: Phone#: r Commonwealth of Massachusetts 10.1 Division of Professional Licensure Board of Building Regulations and Standards Constructim'Sll}l.i i6pr Specialty CSSL-099167 . E I xpires:09/28/2023 OLIVER M KELLY � 8 RHINE ROAD YARMOUTH P.,RT MA 1�3 ' Commissioner d# f% T74+ck�a • 6/24/9740--,4e(ieadi o-/Yiect,..44acieic,ie/4- 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 C. 20M-05/17 ' Office of Consumer ''&uus ness I"C f1tion 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'. 06113/2023 1000 Washington Street -Suite 710 OLIVER KELLY Boston,MA 02118 OLIVER M.KELLY U t 8 RHINE RD. YARMOUTHPORT,MA 02675 Not valid without signat re Undersecretary DocuSign T:nvelope ID:DD39D0F2-100E-4471-BCF9-A562BAD4F671 KELLY ROOFING PH. 508 509 4640 8 Rhine Road MA C.S.L. #099167 Yarmouthport MA H.LC.R. # 128957 MA 02675 INSURED July 27, 2022 Proposal submitted to The Owners of 6 Rhode Island Ave, West Yarmouth MA. We propose to supply all materials and labor required to remove and replace the existing 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. Install 8"White Aluminum Drip Edge on all Eaves, 5"White Drip Edge to be installed on all 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 Replace plumbing vent pipe boots with new. Repair all fleshings 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. Obtaining of Town Building Permit. At a total cost of$9,300 Payment Schedule; Balance upon Completion Proposal Submitted by: Oliver Kelly i—oocuSlgn.d by: Proposal accepted Dyeart,t-t& Da1 /LV/2oZ22022 '—EEC66CA9256A424... This proposal is valid for 30 days from date above, please DocuSign Envelope ID:DD39D0F2-100E-4471-BCF9-A562BAD4F671 • - call to verify thereafter. Best Contact Number: