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Home My WebLink AboutBLDX-23-3993 .pg•Y Office Use Only s,t�� 'r4 Permit# �r 1'`"�� O +`y H Amount il ) trb �. Permit expires ..:..:�,; ... 180 days from issue date ` 1)K -.Z3 3993 EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 RECEIVED .. � .._ South Yarmouth,MA 02664 (508)398-2231 Ext. 261 MAY 16 2023 CONSTRUCTION ADDRESS: 1 S9j3j',i4 ` V BUILDING DEPARTMENT ASSESSOR'S INFORMATION: Map: Parcel: OWNER: NASkU, Jkk 1,TVDC.-0, 4CS co.9QA. s3 �� Jy�((mNAME( [� (('P�READDRESS TEL # 774 2'3$ 0 DrV CONTRACTOR: S 0 t 't tAtA4e gAzt.LCiariaO 7 MA 024115 NAME MAILING ADDRESS TEL.# Sol 4640 Residential ❑Commercial ESL Cost of Construction$ga 010 Home Improvement Contractor Lic.# t2-Sq Si Construction Supervisor Lie.# CAS t b 7 Workman's Compensation Insurance: (check one) 0 I am the homeowner 0 I am the sole proprietor III-have Worker's Compensation Insurance Insurance Company Name: CC )Q� Worker's Comp.Policy ��7OWS%t k)S 5 t3 0 WORK TO BE PERFORMED Tent El Duration (Fire Retardant Certificate attached?) Wood Stove ED Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares tO ([ Remove existing*(max.2 layers) Insulation i i 11 Old Kings Highway/Historic Dist. Cp Replacing like for like Pool fencing Ti 'The debris will be disposed of at: qAt1"4-31-1�� 111 6* — 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 rev*— f my license and for prosecution under M.G.L.Ch.268,Section 1. Applicant's Signal Date: 5 ( t N Owners Signature(or attachment) Date: Approved By: Date: n �j /� Building Official(or designee) EMAIL ADDRESS: � r' c 4n q `if 1�/ L, LE Zoning District: Historical District: Yes No Flood Plain Zone: I Yes 1 No Water Resource Protection District Within I00 ft.of Wetlands: Yes No Yes 7 No , e KV-12/220-/Wieadi 0-//g0:44-aaG4-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. 4 1 0 20M-05/17 ,,/ // .%' Knin,,,wva-al/fhlf 14 Bua4J os IzE r tion Office of consumer rs g HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Individual before the expiration date. If found return to: Registratiord Expiration Office of Consumer Affairs and Business Regulation 128957 06/13/2023 1000 Washington Street -Suite 710 Boston,MA 02118 OLIVER KELLY. QC)---S2—, OLIVER M.KELLY s RHINE RD. Not valid without signet re YARMOUTHPORT,MA 02675 Undersecretary $ Commonwealth of Massachusetts • WI Division of Professional Licensure Board of Building Re ulations and Standards Construct'�144:14 Specialty f CSSL-099167 ' ,Air spires:09/28/2023 ` OLIVER M%fL.Y s 8 RHINE RO q r r, e. YARMOUTH R I ' V r 'f)1SSl:1 "1r'`- . Commissioner Baia K. iitn i Of ice of Investigations 1_, Lafayette City Center 2Avenue tie Lafayette, Boston,MA 02111-1750 a n+.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly • Name(Business/Organization/Individual): ( SLR. ( GCcUCS— Address: S Ku.1/4.4.4c LA-to City/State/zip:_h2 w, 14.A. .-C OURS" Phone#: j $S LIbtto •Areryou an employer?Check the appropriate box: 1.IfI am a employer with l 4. 0 lam a general contractor and I T of project(required); employees(full and/or part-time).* have hired the sub-contractors 6 fl New consttnction listed on the attached sheet. 7. []Remodeling 2. I am a sole proprietor or partner- ship and have no employees These sub-contractors have g. [j Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance comp-insurance.: 9. Q Building addition required) 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.Q I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL I2.®Roof repairs insurance required.]t c. 152, §I(4),and we have no employees. [No workers' 13.0 Other comp insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers' f l caneowmrs who submit this affidavit indicatingtheycompensation policy submit aan vn �g all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and crate whether or not those entities have employees. If the sub-contractors have employees,they must provide their wakrr,'comp.policy number. I am an employer that is providing workers'on insurance for my employees. Below is the policy and job site information. Insurance Company Name: (rNoAejLACA-N1 Policy#or Self-ins.Lie.#: 65(21.1 8555 c CC 2:1 Expiration Date: 5` z,j lob site Address: 1$4) G^ . StASzat /j City/State/Zip: O2 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 under the pains and penafties of perjury that the information provided above is true and correct Sie}rature: 0-LakDate: 5 CS' 2 o 23 Phone#: SOS 5D61 'fMo Official use only. Do not write in this area,to be completed by city or town official 41 City or Town: Permit/License# Issuing Authority(check one): 1DBoard of Health 21JBui ding Department 3.0City/Town Clerk 41:I Electrical Inspector 50Plunibing c Inspector b.[]Other Contact Person: Phone#: KELLY ROOFING PH. 506 SOB 4640 8 RHINE ROAD MA C.S.L. 1009167 YARIAOUTHPORT MAH.I.C.R1127 MA 0267S INSURED. KeerroofnglIticsou0 corn May 6. 2023 Proposal submitted to The Owners Of Unit 16. Seaside Cottages, 13S South Shore Drwr. Sough Yarmouth. MA We propose to supply all maibsrrs*and tabor required to remove and replace the existing AaphaA Roof at the Address Above Protect al was. Windows. shrubs. pisnts etc diving roof strip Al debris to be removed to town trarielir. S'Alurranurn Dm Edge to be installed on all eaves. S'On Rakes. All Roof Decking to be Seou►ed_ toe and Water damage protection membrane to be installed on find Sox feet of al Eaves., In Valley Areas and round al protrusions Remainder of root deck to be covered IMVI synthetic undertayntiermr_ halal Smiled Weems warranty architect style Shingles. cola to be We the edwood Al shingles to be storm nailed (61 We giiw use Certarrte.d products. eke proposal is based on their Standard Landmark Lem e d Uleame Warranty Shingle, Using ate Carter ieed Starter and Ridge Shin* Products To Maximize Avaiab4 Warranbes. Revhcy plumbing verve pipe boots weli new R«parhieplace Al Flast ngs As Necessary hstaS Certaireeed Filtered Ridge Vert min hard naied caps. Complete Clean up off all areas ric ii%ig all putters and M nags after pro ect cbrr+pels At a total cost of i4.600 Proposal Submitted by: Okver Kelly Proposal accepted by 1 Best Contact Phone _�.: °a'' ° ;2023 proposal s raid 130 days from date above, please call to verify thereafter