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HomeMy WebLinkAboutBLD-23-006058 C of Permit expires 180 days from 5/y� C issue date 1/6°.5-4 ` Bti-a3 -O a&asp- EXPRESS BUILDING PERMIT APPLICAT TOWN OF YARMOUTH V E D Yarmouth Building Department 1146 Route 28 MAY 0 2 2023 South Yarmouth,MA 02664 (508)398-2231 Ext. 1261 BUILDING DEPARTMENT QBy' CONSTRUCTION ADDRESS: ,C� N7t/04/ goo ., A SSESSOR S INFORMATION: /n Map: Parcel: OWNER: CV-O LE r6 tQjJ AM t% AtTrt.l©r.}-( Q.QAD :0.44-I 4,,›Nr1 AAA- y2(67 NAME PRESENT ADDRESS TEL. # CONTRACTOR:Ott JCR—jE.u,-( ) Qu is QQAD, '(AttMw vnt() 02b75- r NAME MAILING ADDRESS TEL.# S' te L ''c7 Residential OCommcrcial Est.Cost of Construction S P100 Home Improvement Contractor Lit.# '2$9>7 Construction Supervisor Lic.# CACl I b7 Workman's Compensation Insurance: (check one) 0 I am the homeowner 0 I am the sole proprietor 1 have Worker's Compensation Insurance Insurance Company Name: AC 1tC1116 Worker's Comp.Policy#( S203 S LLD SS(609 27, WORK TO BE PERFORMED Tent El Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares 1 f jLJ (['Remove existing*(max.2 layers) Insulation n ri Old Kings Highway/Historic Dist. CI Replacing like for like Pool fencing n *The debris will be disposed of at 1 -'M < l - ,i' 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 revocation of I' and for prosecution under M.G.L.Ch.268,Section 1. Applicant's Sign Date: S.'Z' 2' Owners Signature(or attachment) 172) Dates Approved By: i Date: 5J— Building Official(or designee MAIL ADDRESS: Zoning District: Historical District: Yes I No Flood Plain Zone: Yes I No Water Resource Protection District: Within 100 ft.of Wetlands: Yes 1 No _ Yes = No �/e F61/2-4/2-46wevello-//gct,44, e/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. 41 0 20M-05/17 . � nvrrniiu ear / flo e r/ Office of Consumer rs u ness nag ca tion 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 Q0--S2—d YARMOUTHPORT,MA 02675 Not valid without signet re Undersecretary • • i IP Commonwealth of Massachusetts Division of Professional Licensure . a • Board of Building Regulations and Standards ` Construct'�l��"�+Jt pj Specialty CSSL-099167 .*' IZt/pires:09/28/2023 ,` OLIVER M K LYh 464 r 8 RHINE RO , YARMOUTH R ? ',y : a• °A\-.10 Commissioner ( i,i t fi. I7Zvnr i • DATE(MM/DD/YYYY) AcoRCP 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 (aC"No.�): (508)775-1620 FAX (A/C, E-MAIL ADDRESS: Isullivan@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: 775625 REVISION NUMBER: I 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 OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP W LIMITS LTR INSD VD POLICY NUMBER (MM/DD/YYYYI (MMIDD/YYYYI 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 UABIUTY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ — ALL OWNED SCHEDULED. AUTOS AUTOS N/A BODILY INJURY(Per guide d) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS _ AUTOS (Per accident) UMBRELLA UAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'UABILJTY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBEREXCLUDED? 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 Bourne ACCORDANCE WITH THE POLICY PROVISIONS. 24 Perry Ave AUTHORIZED REPRESENTATIVE Boume MA 02532 Daniel M.Crowey,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 2Avenue de Lafayette,Boston,MA 02111-1750 '`• ``•� www.mass.goov/dia Workers'Compensation Insurance Affidavit;Builders/Contractors/Elech-icians/Pitunbers Applicant Information Please Print Legibly t Name(Business/thgaaimticmllndividusry 't tiU.`' ,84 -1.1ZG— Address: S QszAb City/State/Zip: CY1 7S Phone#: a>2 $z>S Li bib) Are ou as employer?Check the appropriate box • * Typeproject of I.II am a employer with ( 4. ❑ I am a general contractor and' (required): employees(full and/or part-time).* have�d the sub-contractors b ❑mew construction 2.0 1 am a sole proprietor or partner- listed on the attached sheet '- ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp.insurance comp•insurance.. required] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself it workers' comp. right of exemption per MGL insurance required.]t c. 152,§1(4),and we have no 12' RRoofrepares employees. [No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their weekers'compemation policy information- 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 have employees,they must provide their walxra'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: ( Ackkz.-.0..A.CA4`1 Policy#or Self-ins.Lic.#: 65(01.0 t:79)iftf)856 bCk zZ Expiration Date: 5`l'J- Job Site Address: /g 04nto.v ' S -City/State/Zip: t✓, 4i/vi d TI( /I,Q 02673 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 np 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 earth under the pains and penalties of perjury that the information provided above is true and correct. Signature: (a- Date: S 2 2 0 23 Phone#: t',' 509 4-CAO 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): 10Board of Health 20 Building Department 31JCity/Town Clerk 4.❑Electrical Inspector 5E}lnmbing ' Inspector 6.0Other Contact Person: Phone#: KELLY ROOFING PH. 508 509 4640 8 Rhine Road MA C.S.L. #099167 Yarmouthport MA H.I.C.R. # 128957 MA 02675 INSURED March 31'2023 Proposal submitted to Victoria Evans Of 18 Anthony Road, West Yarmouth MA We propose to supply all materials and labor required to remove and replace the existing Asphalt Roof 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 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 deck to be covered with synthetic underlayment. Install Certainteed Landmark limited lifetime warranty Architect style Shingles, color to be Specified Using All Certainteed Starter and Cap Shingles To Maximize Available Warranties. All shingles to be storm nailed (6) Replace plumbing vent pipe boots with new. Repair/Replace all flashings as necessary. Install Certainteed Filtered ridge vent with hand nailed caps. Install Rubber Membrane Roof Over Garage Dormer Roof, Installed Over 1/2" Fiber Board With White C4 Aluminum Drip Edge Complete Clean up off all areas including all gutters and all nails after project complete Obtain Town Work Permit. At a total cost of$13,900 (Entire Roof) For Older Section Of Roof Only Total Cost $6,400 To Replace Existing Rake Boards With Composite Trim Boards 1 x3"Over 1 x8"Add $2,500 Fastened With With Hidden Screw System. Payment Schedule; Balance upon Completion Proposal Submitted by: Oliver Kelly Proposal accepted by: e„1tt Date. K / 7 /2023 Best Contact Phone Number: 7 7-?/ p837 This proposal is valid for 30 days from date above, please call to verify thereafter. )14 Artwiy