Loading...
HomeMy WebLinkAboutBLD-23-003193 e l.-0 - 6d I(/ 3 1':: , Office Use Only lljC? Permit# ^� ZQ • )y, DEC 09 2022 Amoun I#®-Ob i,tn rA--nentcsi/�4� ';`S �-' � ' _ Permit expires 1 SO days from BUILDING DEPARTMENT issue date h3 y--- 0 EXPRESS BUILDING PERMIT APPLIGATIS N C TOWN OF YARMOUTH Yarmouth Building Department of 1146 Route 28 South Yarmouth,MA 02664 ` (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: 7,LA/ w_p cdaikl 1 /i�' J �1 i12S _ ASSESSOR'S INFORMATION: I Map: I Parcel: OWNER. (; 5 �A.iLS La) k Y t.A CLCLA-o '`4 ?t OA u_bic L t 644 ict NAME PRESENT ADDRESS TEL. R CONTRACTOR:Kal i D 2 (.- C , Q ui D - `{.Pei. VISS 02.6--1 � osoc{ t-i toil° NAME MAILING ADDRESS TEL.# ii1 Residential ❑Commercial Est.Cost of Construction S 10 -1 Home Improvement Contractor Lie.# !Mg S/ Construction Supervisor Lic.# CAC:i 1.b7 Workman's Compensation Insurance: (check one) ❑ I am the homeown r ❑ I am the sole proprietor I have Worker's Compensation Insurance Insurance Company Name: L,Q1Gq- Worker's Comp.Polte} 6S6Zu (1/0 '5(?7i'Cl iZI WORK TO BE PERFORMED Tent L Duration (Fire Retardant Certificate attached?) Wood Stove r Siding: #of Squares Replacement windows:# 02 <54,y4AG .5 Replacement doors: # .flue- r COt() L,aue tJdvirS Roofi a: #of Squares 1V (E)Remove e ' ting`(max.21 ers) Insulation 7 biz& CptAck 6960,e Stit,Afif Old Kings Highway/Historic Dist L . (0)Replacing like for like Pool fencing f v it- 14- ,` ft fv'�t�u - ()L . 'The debris will be disposed of at: f A J'k)-, 'M ~ t t`L'e� Location of Facility !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 • I revocation of my Ii rose- d for prosecution under M.G.L.Ch.265,Section I. Applicant's Signat e. r Date: - '0 ZZ Owners Signature(or attachment) Date: 2 Approved By: Date: / 2-2- Building ial sio ) EMAIL AD S: Zoning District: Historical District 2 Yes - No Flood Plain Zone: _: Yes _ No Water Resource Protection District: Within 100 ft.of Wetlands: I Yes - No __ Yes : No °-'' • The Commonwealth of Massachusetts ate ; r- ._ Department of Industrial Accidents '�'I: , __ Office of Investigations i -- t� , Lafayette City Center ;, 2 Avenue de Lafayette, Boston,MA 02111-1750 www mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/ElectricaansfPiumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): � i -''�'-1.•'> = E- __ Address:S c ,S City/Stn a/Zip:ti J eQ MA, Q 1S Phone#: 5o c 464 Are you an employer?Check the appropriate box: Type of project(required): 1. %I I am a employer with 1 4. 0 I am a general contractor and I 6. El New construction employees(full and/or part-time).* have hired the sub-contractors 2.Cl I am a sole proprietor or partner- listed on the attached sheet 7. D Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' $ 9. 0 Building addition [No workers' comp.insurance comp.insurance. 10.0Electrical repairs or additions required.] 5. ❑ We are a corporation and its P 3.❑ 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 12.E Roof repairs - insurance required.]t c.152,§1(4),and we have no employees. [No workers' 13.171 Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the sir+ion below showing their workers'cu.rfp.,rr,ation 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: Ill CIZ t l Policy#or Self-ins.Lic.#: 5b 0 z.,' o S O 2.. Expiration Date:.6-00'2P- 3 LA Job Site Address: "[LAD `)`j -XL- Fes)• .qif-9-(`-k. City/State/Zip::tV ilk L1 44-CCQ•1S 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 rind penalties of perjury that the information provided above is true and correct ��� ,T `'„ Signature: , Date: -� lI 1 / - Phone#: 54' 50& 'S koWi 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): • i❑Board of Health 20 Building Department 3DCity/Town Clerk 4.1:3Eiectrical Inspector criPlumbing 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 November 15'2022 Proposal submitted to Mr. Chris Larson of 426 Weir Road, Yarmouthport 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 around all protrusions. Remainder of roof deck to be covered with synthetic underlayment. Install limited lifetime warranty 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. Replace plumbing vent pipe boots with new. Repair/ Replace all flashings 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 At a total cost of$8,400 To Replace Existing Skylights With Velux MO8 Units Add $1350 per venting Unit Or$1050 Per Non Venting Unit Includes New Exterior Flashing Kits And Any Necessary Interior Trim. Payment Schedule; Balance upon Completion Proposal Submitted by: Oliver Kelly Proposal accepted by: C - .� Date. /j / c;7,7 /2022 This proposal is valid for 30 days from date above, please call to verify thereafter. Best Contact Number: 4 Y s 9 - �' J//G C//22/22O/mefeadi� �/ a34CGriem;�et7/(1 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 io 20M-05/17 .47e liviinioiiii•rii�//i //ii:d rr/ -'i//� . Office of Consumer A irs&Business i14guff tion Registration valid for individual use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: TYPE:Individual Registration ration Expiration Office of Consumer Affairs and Business Regulation 128957 06/1312023 WOO Washington Street -Suite 710 Boston,MA 02118 OLIVER KELLY OLIVER M.KELLY �� �• (2...(Q 8 RHINE RD. ' " Not valid without signat i % re YARMOUTHPORT,MA 02675 Undersecretary Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Constructio�rSi�tiei�lib�r Specialty CSSL-099167 Expires:09/28/2023 OLIVER M KELLY , { 8 RHINE ROAD j YARMOUTH PART MA 02675 s1.1;1>/SS.lall\\ t Commissioner !;. CimzA AO RE, CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDffYYY) 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 PHONE (A/CC.No.ExU: (508)775-1620 A/C,No): E-MAIL ADDRESS: )ullivan@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: 775631 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. 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 LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS 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 $ PRO- POLICY JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION v PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRI ETOR/PARTNER/EXECUTI VE A OFFICER/MEMBER EXCLUDED? N/A N/A N/A 6S62UB8H08580922 I 05/10/2022 05/10/2023 E.L.EACH ACCIDENT $ 500,000 (Mandatory in NH) If yes,desc be under E.L.DISEASE-EA EMPLOYEE $ 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A i I DESCRIPTION OF OPERATIONS/LOCATIONS/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 Yarmouth ACCORDANCE WITH THE POLICY PROVISIONS. 534 Winslow Grey Road AUTHORIZED REPRESENTATIVE South Yarmouth MA 02664 C Daniel M. CroWy, CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD