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Home My WebLink AboutBLD-22-007383 ' iLL - Office Use O nly. i4Viii : Permit# / pilw 9,2t I /tf Amount J •0� d r, nwri.., . cx ,s y ° Permit expires 180 days from issue date 61,D eta -6673 3 EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department RECEIVED 1146 Route 28 -M--- South Yarmouth, MA 02664 FJUN 24 2022 (508) 398-22 1 Ext. 1261 CONSTRUCTION ADDRESS: 15 /Qa (1 G DEPARTMENT ASSESSOR'S INFORMATION: Map: I Parcel: OWNER: .,,r`"'e IS L.LW At WSJ . .L -b-6-1 NAME 'L(� ((PRESENT ADDRESS TEL. # 274, 25-15 , CONTRACTOR:X L-P1 PWc-N,.Ze,- IG1 wL as, . 4.P(A : IN fl -3S SOR5SOCI Li u 0 NAME MAILING ADDRESS TEL.#,-771( Z7(, ZS 5,6 V Residential ❑Commercial Est.Cost of Construction S/O/S OD Home Improvement Contractor Lic.# [Thai 5lj Construction Supervisor Lic.# poi't e b7 Workman's Compensation Insurance: (check one) 0 I am the homeown r 0 I am the sole proprietor I have Worker's Compensation Insurance Insurance Company Name: QieAJ Worker's Comp.PoIic,#6 62-0 <6 vlU U cam? t tC(L� i WORK TO BE PERFORMED Tent E Duration (Fire Retardant Certificate attached?) Wood Stove E Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares 2'1 ( .)Remove existing*(max.2 layers) Insulation 7 11 Old Kings Highway/Historic Dist. 0)Replacing like for like Pool fencing ri `The debris will be disposed of at: 1 �sJ�" 1 11-1"t\I- 1L Location of Facility I declare under penalties of perjury that the statements he ' 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 ' 1 re ation of my Ii nse• d for prosecution under M.G.L.Ch.268,Section 1. Applicant's Signatu -2- Date: Owners Signature(or attachment) Date: 2 Approved By: Date: Z 2 Buildi tci or designee) 72EMAIL RESS: Zoning District: Historical District: Yes No Flood Plain Zone: _. Yes _ No Water Resource Protection District: Within 100 ft.of Wetlands: Yes No 2 Yes :. No .11 1.16 r0/22/22074epedio-///e-0:44_exo„4.(4,e/x.)_ 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 Co 20M-05/17 Office of Consumer Af rs• us ness�t'egguiaion 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 12895T'- 06/13/2023 1000 Washington Street -Suite 710 OLIVER KELLY Q0-C2 Boston,MA 02118 OLIVER M.KELLY J 8 RHINE RD. YARMOUTHPORT,MA 02675 Not valid without signat re Undersecretary Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Construction:81101414pr Specialty CSSL-099167 %' spires 09/28/2023 OLIVER M KELLY -v • 8 RHINE ROAD � `: YARMOUTH P))RT MA1'5 � Y h(?/S1•t_tl}$`� Commissioner drl,dta ,". timr A- Ai. AcRD® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD(YYYY) 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 POUCIES 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 poiicy(fes)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 NC TACT ANE: Linda Sullivan DOWLING&O'NEIL INSURANCE AGENCY PHONE FAX LAIC.No.�: (508)775-1620 FAQ, ,: hss: 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 INSURER C: INSURER D: 8 RHINE RD INSURER E: 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. NOTIMTHSTANDING 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 POUCIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADM SUBR LTR TYPE OF INSURANCE JNSD VO POLICY NUMBER (MPOLICY EFF PODGY WDW tMEXP YYYYI MIOD/YyyY1(Y) LIMITSW 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 APPUES PER: GENERAL AGGREGATE $ POLICY JET LOC PRODUCTS-COMP/OP AGG $ OTHER: - $ AUTOMOBILELIABIUTY COMBINED SINGLE LIMIT $ (Ea accident) _AUTO BODILY INJURY(Per person) $ ANY OWNED AUTOS �_AUTOS SCHEDULED N/A BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE ,._ — AUTOS $ (Per accident) • . $ UMBRELLA LIAR �- OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ WORKERS COMPENSATION $ AND EMPLOYERS'UABIUTY Y/N X ST TUTS ER ANYPROPRIETOPJPARTNEA OFFlCERIAAEMBEREXCLUDERJE CUTIVE N!A NIA WA OFFICER/MEMBER tory in NH) 6S62U88H08580922 05/10/2022 05/10/2023(Mand EL EACH ACCIDENT $ 500,000 If yes,desalts under EL DISEASE-EA EMPLOYEE $ 500,000 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 steadied 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 POUCIES 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 I Daniel M.Crowley,CPCU,Vice President—Residual Market—WCRIBMA ACORD 25(2014101) The01988-2014 ACORD CORPORATION. All rights reserved. ACORD name and logo are registered marks of ACORD • _ The Commonwealth of Massachusetts ''w vt Department of Industrial Accidents c.' �= Ti l Congress Street,Suite 100 lei1= " Boston,MA 02114-2017 -, - -s www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. . TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibly 'onf)ndividual): Vlc Z6:QC t.,,wr (Kw,Name(Bns;nessf• ::s��,:, L Address: 1 l i 1Af.c, ID City/State/Zip4WD tt 4.kilt D2165 Phone#:5 Y 5cst 4 fp`-0 Are employer?Check the appropriate box: Type of project(required): 1. Ism a employer with employees(full andlorpert-titer)= 7. [3 New construction 2.01 am a sole luolsietor or partnership and have no employees wonting forme in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 3.0 I an a homeowner doing all work myself.[No workers'gip.insurance required.]* 9_ ❑Demolition 4.0 I a a homeowner and will be hiring contractors to conduct all work on my property. I will I O 0 Building addition m ensure that all con ractors either haveworhaxs'compensation insurance ce or are sole 11.n Electrical repairs or additions proprietors with no employees. t 12.t3Plumbing repairs or additions ID I sins general contractorand 1 have hired the sub-contractors listed at the attached sheet These sub-contractors have employees and have workers'camp insurance? 13. oof repents 6.0 We are a corporation andits officers have exorcised eir right of exemption per MGL c. 14.0 Other 152,i l(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box tI 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. tConttactars that cleckthis box must attached an additional sheet showing the mane of the sub-contractors and state whether or not those entities have employees. If the- tors have employees,they must provide their workers'comp.policy number. I am an employer that isp idrng workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: C W_ zai 4_ Policy#or Self-ins.Lic.#:` S 6 2.0 i)tOS 0 7 Expiration Date: -° i 0 a 202'� Job Site Address: l0 5)LL(1.0 PA , City/StatelZip /4(2.11:2-J___M___MA- Attach a copy of the workers'compensation policy declaration page(showing the policy number and expte). 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 It- . ail er the pains and penalties of perjury that the information provided above is true and correct. Siatu 1 gn 'n , ' Date: 6k2- 2: Phone#: 5Dg SO9 (4b O • n Official use only. Do not write in this area,to de completed by city or town official: •- 1 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#: KELLY ROOFING PH. 508 509 4640 8 Rhine Road MA C.S.L.#099167 Yarmouthport MA H.I.C.R.# 128957 MA 02675 INSURED April 26'2022 Proposal submitted To Debbie Briddon of 15 Sullivan 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 retained on all eaves and 5"White Drip Edge On all rakes. Ice and Water damage protection membrane to be installed over first six feet of all eaves. Remainder of Roof Deck to be Covered with Synthetic Underlayment Install Certainteed Landmark limited lifetime warranty Architect style Shingles, Using all Certainteed Starters and Cap Shingles to maximize available warranties, (Color to be Specified) All shingles to be storm nailed (6) Install Certainteed Filtered ridge Vent on All Ridges with hand Nailed Caps Replace all Plumbing Vent Pipe Boots With new. Repair/Replace All Flashings As Necessary, Including chimney. Complete Clean up off all areas including all gutters and all nails after project complete. Obtaining Of Town Permit At a total cost of$10,500 To Replace Shed Roof Add$400 Payment Schedule; Balance upon Completion Proposal Submitted by:Oliver Kelly Proposal accepted by: Ld 0 &-Date. 5/ I y /2022 Best Contact Phone Number: This proposal is valid for 45 days from date above, please call to verify thereafter. 1 .4 I