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Home My WebLink AboutBLDX-23-15128 01.$� Office Use Only 4" s- , c 'r0 ' .AN�' ,, X"Z3 IS/ �** w Amount Permit expires 180 days from issue date EXPRESS BUILDING PERMIT APPLICATI a TOWN OF YARMOUTH RECEIVED Yarmouth Building Department ------ i_____ 1146 Route 28 _: ...... ,, ► South Yarmouth, MA 02664 AUG 0 ZQ23 (508)398-2231 Ext. 1261 -- E3UILDING DEPARTMENT By. CONSTRUCTION ADDRESS; 0 &II CZOAJ •ASSESSOR'S INFORMATION: IMap: I Parcel: I OWNER: .(C�I .D 5A)t CL.1 121 `FiC,0-+O a NAME PRESENT ADDRESS � � � �`l ivaitkoo-T140,25: �pTEL. # g� 20( `Lt(5( CONTRACTOR: NAME QOC uG % �tU A46 Q i vi 61s �� MAILING ARESS TEL.# s0 Is SOS! �((i t' "'"`esidenu& ❑Commercial Est.Cost of Construction$ /(I 2o0 Home Improvement Contractor Lic.# inq5, Construction Supervisor Lic.# 099/67 Workman's Compensation Insurance: (check one) 0 I am the homeowner ❑ I am the sole proprietor I have Worker's Compensation Insurance Insurance Company Name:4(,L, I(,qN "' 111 Worker's Comp.Policy# WORK TO BE PERFORMED Tent II Duration (Fire Retardant Certificate attached?) Wood Sto ve 0 Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares 24. (k Remove existing*(max.2 layers) E("'� Insulation El 1 l Old Kings Highway/Historic Dist. Replacing like for like n Pool fencing *The debris will be disposed of at: _1 tOJ 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 deni: or iiih non o my lice= . prosecution under M.G.L.Ch.268,Section 1. Applicant's Signature: _ i '_----_ Date: _S5: 4 Owners Signature(or attachment) Date:_ Approved By: -- Building Of�ici:,r des'; ee) EMAIL ADDS �_ Date: Zoning District: Historical District: E Yes 2 No Flood Plain Zone: 2 Yes E. No Water Resource Protection District: Within 100 ft of Wetlands: Yes 2 No 2 Yes 2 No KELLY ROOFING PH. 508 509 4640 8 Rhine Road MA C.S.L. #099167 Yarmouthport MA H.I.C.R. # 128957 MA 02675 INSURED July 21'2023 Proposal submitted to Mr. Richard Snelly of 129 Beacon Street, South 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 over first six feet of all eaves, in all Valley Areas and around all Protrusions. 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) Repair all flashings as necessary. Install Certainteed Filtered Ridge Vent on All Ridges with Hand Nailed Caps Replace all Plumbing Vent Pipe Boots With new. Complete Clean up off all areas including all gutters and all nails after project complete. Obtaining Of Town Permit At a total cost of$11,200 For Landmark PRO Shingles Add$750 For Landmark Premium Shingles Add $1,900 Payment Schedule; Balance upon Compl on Proposal Submitted by liver Kelly Proposal accepted by: Date. / $ /2023 Best Contact Phone Number: r16. f This proposal is valid for 45 days from date above, please Dxic r0 31=< < 2 r m D i - 1c Cm33 4 40311 -o ' ENV XI j—ias-iiD jICA 0 lc g --.\ 13 . . 0 m 00 K v ° * c O a ° sa3 z f gel - 9. i RI 0 8 CD ID co a ag° co K o N ' c D CS al. M 0,•� Win. C � ?:-1 t!i aD V W I 0 c I . a 0-F oo R. V) c $a to �Va 0 a a 1 c - 3 A m a Commonwealth of Massachusetts Division of Professional Licensure IP Board of Building Regulations and Standards Constructi {igpr Specialty CSSL-099167 kLt, crpires:09/28/2023 OLIVER M K,ELY e 8 RHB+IE RON4 1 YARMOUTH VRT " Commissioner f. , U • • The Commonwealth of-Massachusetts Department of IndustrialAccitlents ,: -' " -,/ Office of Investigations ` t.-._; - Lafayette City Center ' ;,' 2Avenue de Lafayette, Boston,MA 02111-1750 /i"`.t`-sr:'7 wtmmas .gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electt icians/Plumbers Auulicant Information Please Print Legibly Name(Business/. _.:,. ion/individual): tKS UV`1 (2c 3 C,.- Address: % Wi ... P,,CAC) 021 < 14le 104'c 'hone#: Sc)/ i- itot Are , an emplheck the appropriate box: 1.�1 I am a employer with 4. 0 I am a general contractor and I Typeof project(required): employees(full and/or part-time).* have heed the sub-contractors 6. 0 New construction 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 8. []Demolition employees and have workers' working forme in any capacity. [No workers' comp.insurance comp-insurance.I 9. El Building addition ❑ required.] 5. 0We are a corporation and its 10.0 Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their 1 1.0 Plumbing myself. [No workers' comp. right of exemption MGL repairs or additions insurance required.]t c. 152,§1(4),and we have no 12.�Roof repairs 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'compensation t Homeowners who submit this affidavit' ga Percy�!. :Contractors that check this box must attached sheet showingck the and then hire outside contractors must submit a new affidavit indicating such. employees. If the sub-contractors have Warne of the sub-contractors and state whether or not those entities have �P�'Y�,�Y must provide their workers'comp.policy number. numbber. 1 am an employer that is — — p y providing workers' policy compensation insurance for my employees. Below is thtPolicp and job site S Insurance Company Name: 1G `'Q•lC. Policy#or Self-ins.Lic.#: 6 0 d q5L1O 465 2 Expiration Date:5 .1.0. 2o2 Job Site Address: SO- 0fili /7 City/State/Zip; 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 fine up to$1,500.00 and/or one-year imprisonment,as well as civilofaS Wof ORK criminalORDER penalties of a of up to$250.00 a day against the violator. Be advised that a copypenaltiesin the form of a STOP WORK and a fine Investigations of the DIA for insurance coverage verification. of this statement may be forwarded the Office of I do hereby certify under pains arul penalties of perjury that the information provided above is true and corr Si D- Date; Phone#: �J Official use only. Do not write in this area,to be completed bycity or town of�icnat _ City or Town: Issuing AuthorityPermit/License# (check one): 10Board Health of Hee 20 g Inspector of alth wing Department 3OCity/Town Clerk 4.Q Ejectrical Inspector 5�"luntbing Contact Person: Phone#: A CERTIFICATE OF LIA BILITY INSURANCE I DATEDMOOOmr kir- THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLD R.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORD BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING ISURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADOMONAL INSURED,the policyfiessi If SUBROGATION IS WAIVED,subject to the terms and motions of I must have ADDITIONAL i an en dorse rrn orseme n. or be endorsed. this certificate does not confer rights to the certificate holder in lieu of such 'certain policies may requirent A statement on CONTACT PRODUCER �s). DOWLING&O'NEIL INSURANCE AGENCY Linda Sullivan 508 775-1620 FAX 973 IYANNOUGH RD A-MA IsuIivaHOGOIGs.Com INS INSURERS AFFORDING COVERAGE -- �— ' /WC NIHYANNIS MA 02601 PRIMER ACE AMERICAN INSURANCE CO 22667 INSURED KELLY ROOFING INC INSURER II: INSURER C: 8 RHINE RD M+suRERo: YARMOUTHPORT ARE: • COVERAGES CER MA 02675 POURER F TIFICATE NUMBER: 890308 REVTHIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUREDN NAMED ABOVEe OR 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 eNSR AOOL TYPE OF INSURANCE SI• , '`. POLICY EPF POLICY p COIMAERCMIGENERALl1 own _1R uu t_.._.r:•A1ul Lawn C7.AIMS MADE . OCCUR EACH OCCURRENCE $ 'DAMAGE TO RENTED PREMISES(Ea occurrenoel $ LIED EXP(M m Y e person( ; N/A GEML AGGREGATE LIMIT APPLIES PER PERSONAL d AM INJURY 3 POLICY JECOT LOC GENERAL AGGREGATE S OTHER PRODUCTS•COMNOP AOG $ AUTGMOWLE LWIL/TYI $ ANY AUTO {E8 GQiO S LI IT $ AUTOS ONLY SCHEDULED BODILY INJURY(Per person) $ AUTOS NIA AUTOS ONLY ED NON-OWNED BODILY INJURY(Per accident, $ AUTOS ONLY PROPERTY DAMAGE • (Per accIaan0 3 UIMORELIA LIAR OCCUR ;i Excess LIAO _—J CLAIMSAIADE EACH OCCURRENCE ; N/A AGGREGATE s ' 0 RETENTION AND EMPLOYER,LIABILITY v $ WORKERS COMPENSATION AND EMPt IETORSPAS EFLExECUTIVE YIN '% STATUTE ERH A OFF • ICER/MEMBER t EXCLUDED? N/A WA WA 6S62UB8H085 0923 05l10/2023 05/10/2024 E L EACH ACCIDENT $ 500,000 Mandelory In NM) i/yyees,describe under DESCRIPTION OF OPERATIONS WoeE.L.DISEASE-EA EMPLOYEE$ 500,000 E L DISEASE-POKY LIMIT ; 500,000 N/A DESCRIPTION OF OPERATIONS J LOCATIONS t CompensationOPEROPERATIONS will beLes warm let AddNbrlN ROWarkS Sclredlde,' w+N+Iel.d M WOO le reqY1re01 Workers' paid to Massachl�etts employees do s� .to benefitsefs in states other than Massactts only.Pursuant to Endorsement WC 20 03 06 B.no husetts if the Insured hires,or has hired those employees outside of Massac�us�etts�n to pay This certificate of insurance shows the issue date of o r of policy in force on the date that this certificate was issued(unless the expiration date on the above issue Search tool at this certificate Insurance). The status of this Coverage can be monitored daily by accessingpolicy precedes the -CompensationlinvestigationsJ. the Proof of Coverage-Coverage Verification CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCMS BE CANCELLED BEFORE Town of Mashpee THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 16 Great Neck Road North ACCORDANCE WITH THE POLICY PROVISIONS. Mashpee AUTHORIZED REPRESENTATIVE MA 02649 •. ' ' ` Daniel M.Crowley,CPCU,Vice President-Residual Market- ACORD 25(2016103) 0198s 2015 ACORD C WCRIBMA ACORD name and are registered mamma of 015 AC CORPORATION. All rights resented.