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Home My WebLink AboutBLD-23-000936 r'"pF'YAR-- e( t1_e- p y�� ige., -`�Office Use Only '� .-. ! �,• ;perm. f`si-7" 31-k I i Amount ®.ad esc -,%44Orrara[o��Q,C??, i 1Permit expires 180 days from !issue date _ Q�j�1�,h FIVED EXPRESS BUILDING PERMIT APPLICATI (114 C TOWN OF YARMOUTH Yarmouth Building Department AUG 22 1012 1146 Route 28 South Yarmouth, MA 02664 BUILDING DEPARTMENT (508) 398-2231 Ext. 1261 By: CONSTRUCTION ADDRESS: " 1 I/II l G-YL 6 ,qI . 4...4) S...0. Amo o ASSESSOR'S INFORMATION: Map: Parcel: OWNER: CJ t 6U G A) g-,2„....4,) I./�YVT 8.O A./LjJ . , J()_ f,4. ,,,,, o9+6b y N RESENT ADDRESS L. # �_ �'?3473St5 CONTRACTOR: Lf c/G"Y( i6 1 At 'u 6 PA t—/A dot) 4Opci— NI 0267 ' NAME MAILING ADDRESS TEL.# 5 cw q , I 1/47 B'Res / i' C idential ❑Commercial Est.Cost of Construction$ [�+40 0 d 1 Home Improvement Contractor Lic.# l 2 V 6 5? Construction Supervisor Lie.# ®q /67 Workman's Compensation Insurance: (check one) ❑ I am the homeowner ❑ I a the sole proprietor i>or I have Worker's Compensation Insurance Insurance Company Name: �ri; /� ( Worker's Comp.Policy# 6s 6z u6%Ho (J 5 o 0 7 WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares 4'O ( Remove existing* (max. 2 layers) Insulation 17 Old Kings Highway/Historic Dist. ( ✓)Replacing like for like PAof fencing OV- 1)7Z / L,�� F�1� Lt�cc G �4��>✓ � t10 *The debris will be disposed of at: Location of Facility I declare under penalties of perjury that the statements herei, ontained 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 ocation of my licen - :j o irosecution under M.G.L.Ch.268,Section I. c ' c Applicant's Signature: 4 1 Date: Z'� - 22 • 2Q Owners Signature(or attachment) Date: Approved By: 114 Date: /9. t % �Building Official(or desig EMAIL ADDRE Zoning District: Historical District: ❑ Yes ❑ No Flood Plain Zone: ❑ Yes ❑ No Water Resource Protection District:• Within 100 ft.of Wetlands: • Yes 0 No 0 Yes 0 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. Kellyroofing@icloud.com July 11, 2022 Proposal submitted to Mr. Steven Perlman of 4 Centerboard Lane, South Yarmouth MA. We propose to supply all materials and labor required to remove and replace the existing Asphalt Roof on The House at the address above. Obtain Town Permit. 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 on installed on all eaves. 5" White Drip Edge To Be Installed 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 limited lifetime warranty Architect style Shingles, color to be specified.. 004714 r 6o:Joao, All shingles to be storm nailed (6) We generally use Certainteed products, this proposal is based on their Standard Landmark Limited Lifetime Warranty Shingle. Using all Certainteed Starter and Ridge Shingle Products 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 $18,900 ��/ foie �Vt Proposal Submitted by: Oliver Kelly 0 9' / �f Z-v L7� Proposal accepted by: _ \A-i Date. July/ 1 e I 2022 .//,/c.e..,,k Best Contact Number : 1 '13 - 4-i7-7 - ' 5i5 m4.4' Le P. r 1 en mot..i'1 S }-e✓e i1 C' YN,N.-et 1 .Cofr-. Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Constructiotr`'3IIp149liSpr Specialty CSSL-099167 �� • Expires:09/28/2023 OLIVER M KELLY 8 RHINE ROAD YARMOUTH P9RT MA 02675 71, f iss1:10- - F es° V Commissioner o L fi. tJtvnc coy 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 Ca 20M-05/17 Office of Consumer Affairs.&business u6fiur1tion HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only before the expiration date. If found return to: TYPE:Individual Registration Expiration Office of Consumer Affairs and Business Regulation 128957 06/13/2023 1000 Washington Street -Suite 710 Boston,MA 02118 OLIVER KELLY C.C2. OLIVER M.KELLY8 RHINE RD. `/� �c//-- Not valid without signal re YARMOUTHPORT,MA 02675 Undersecretary Aco OR ° CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 1..�� 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 NC No,Et- (508)775-1620 FMVC,Nov AX E-MAIL ADDRESS: Isuliivan@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 INSURERS: 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. 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 ADD/SUER POLICY EFF POLICY EXP LIMITS LTR ,JNSD WVD POLICY NUMBER (MWDD/YYYY) (MM/DDIYYYY) COMMERCIAL GENERAL LABILI Y EACH OCCURRENCEGE $ ED CLAIMS-MADE OCCUR PREMISESO(EaEN1 occurrence) $ MED EXP(My one person) $ N/A PERSONAL 8,ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S I PRO- POLICY LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT I$ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULEDAUTOS AUTOS N/A BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS (Per accident)• S UMBRELLA LIAB OCCUR I EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE N/A AGGREGATE S DED + RETENTION$ $ WORKERS COMPENSATION X AND EMPLOYERS'LABILITY STATUTE ERH Y/N 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 S 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A L _I I 1 1 . DESCRIPTION OF OPERATIONS I 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 Lakeville ACCORDANCE WITH THE POLICY PROVISIONS. 346 Bedford Street AUTHORIZED REPRESENTATIVE Lakeville MA 02347 Daniel M.Crowley,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 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations .f!4 Lafayette City Center sa 4 --; ' 2Avenue de Lafayette, Boston,MA 02111-1750 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): AL' C- 1�1V�,— QJE. C `.� Address: V ' .(City/State/Zip: i P.- 0 #: So cn �O c-1 H 6 V Are ypu an employer?Check the appropriate box: Type of project(required): 1. 4.I am a employer with ' ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.Q I am a sole proprietor or partner- listed()lithe attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ElDemolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp. insurance comp,insurance.t required.] 5. ElWe are a corporation and its 10.❑Electrical repairs or additions officers have exercised their 11.0 Plumbing repairs or additions 3.Q I am a homeowner doing all work myself. [No workers' comp. right of exemption per MGL 12.2112—oof repairs insurance required.]t c. 152,§1(4),and we have no p employees. [No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 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. tContractors 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:A nn ,.cc(. E Amic,...,0_,LAK. ,_,Policy#or Self-ins.Lic.#: � (F-� t./d j j l�0 �%Expirt n Date:. 5 ' 10 - Job Site Address: - ( e-6)V - `-4)0.4.- i'r`"� City/State/Zip:g0- �` cl/� a 02bb 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 and. ''ins and penalties of perjury that the information provided above is true and correct. Signature: ` • ( 2z....( �'CDate: _ Phone#: o e6 S 1 LLbu Q 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 3.0City/Town Clerk 4.0 Electrical Inspector 5.0Plumbing Inspector 6.DOther Contact Person: Phone#: