HomeMy WebLinkAboutBLD-23-000728 CAid X-- a Office Use Only r//Z/ Permioci,# £.JIOL <_ r r Amount (j 1ll✓✓/ e 1.6 ;�,�,K• �� Permit expires 180 days from \* A7S3—'5" issue date OCP — 3 edd 7Z EXPRESS BUILDING PERMIT APPLICATIMCEIVED TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 2S AUG 112022 South Yarmouth, MA 02664 — (508) 398-2231 Ext. 1261 �� BUILDING DEPARTMENT V v CONSTRUCTION ADDRESS: 3 ;/� Mt"i.A.�S - s�k4 001-1) ASSESSOR'S INFORMATION: Map: Parcel: OWNER:WA U 12P�JACAP-P- 70 J A N)k)o T [20 3, NAME �g PRESENT ADDRESS TEL. # J/' "7 ,S Z L(i7$ CONTRACTOR: S 1 RooC-4G \ C- ,ql to,) d Par MA- o2 .c NAME MAILING ADDRESS I TEL.#5,v Residential 0 Commercial Est.Cost of Construction$ 1 U 0 03 Home Improvement Contractor Lic.# t2.% 6 Construction Supervisor Lic.# Q( s.b. r Workman's Compensation Insurance: (check one) 0 I am the homeowner 0 I am the sole proprietor Oil have Worker's Compensation Insurance i IS Insurance Company Name: ° S2.t�1 4t2�5 _ '�' �'`�. 4,,,F.a Worker's Como_Policy# WORK TO BE PERFORMED Tent Ei1 Duration (Fire Retardant Certificate attached?) Wood Stove E. Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares `L_i'Remove existing*(max.2 layers) Insulation El I I Old Kings Highway/Historic Dist. 4 Replacing like for like Pool fencing I *The debris will be disposed of at: {4t0 'k �111_A.ra c-sw - 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 answers) will be just cause for denial ocation of my licensed for prosecution under M.G.L.Ch.268,Section I. r ' U, Applicant's Signature: Date: Q Y` l' Owners Signature(or attachment) Date: a -./ 4-- o� Approved By: Date: Building Official(or designee) EMAIL ADDRESS: —r Zoning District: Historical District: Yes No Flood Plain Zone: ' _- Yes No Water Resource Protection District: Within 100 ft.of Wetlands: _ Yes No I Yes No DATE Acc Rom' CERTIFICATE OF LIABILITY INSURANCE 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 DOWLING &O'NEIL INSURANCE AGENCY NAE Linda Sullivan , Fax PHONE N , 1. (508)775-1620 Nok E-MAIL (/ ADDRESS: Iullivan@doins.com 973 lYANNOUGH 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 ADDLIfSUBR LTR TYPE OF INSURANCE ,INSD I WyiL POLICY NUMBER (MMOIUDO//YYCY YY) IMMIDDIYYXYPYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE g CLAIMS-MADE OCCUR DAMAGE I O HLN 1 ED PREMISES(Ea occurrence) $ • MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT I LOC PRODUCTS-COMP/OP AGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED r— SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE _ AUTOS (Per accident) $ • UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ ,DED J RETENTIONS _ WORKERS COMPENSATION L X PERTUTE OTH- AND EMPLOYERS'LIABILITY Y I N ANYPROPRIETOR/PARTNER/EXECUTIVE STA ER A OFFICER/MEMBEREXCLUDED? WA N/A N/A 6S62UB8H08580922 05/10/2022 05/10/2023 E.L.EACH ACCIDENT $ 500,000 (Mandatory in NH) It yes,describe under E.L.DISEASE-EA EMPLOYEE $ 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A • L t 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 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 ar e The Commonwealth of Massachusetts _ 7 Department of Industrial Accidents _r,��,_ Office of Investigations Lafayette City Center ' 2 Avenue 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): ��L: 11�(tiv(.'"' - Address: C� '1-- wU� City/State/Zip:��f � k.QS jt Y #: �U (-� �c2 ' {CJ — Are y u an employer?Check the appropriate box: Type of project(required): 1 CI I am a employer with , 4. 0 I am a general contractor and I 6. []New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition workingfor me in anycapacity. employees and have workers' P tY 9. 0 Building addition [No workers' comp. insurance comp.insurance. t required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.J R of repairs insurance required]t c. 152,§1(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'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. :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. --CC � nn Insurance Company Name:A( L �� \., L��YL_<<:-+' ' . S CP2t.)`(' % ri 5 . tO - Policy#or Self-ins.Lic.#: �� �j� E piration Date:; Job Site Address: 5 , ., i' 7 IltiCity/State/Zip: `Ymviatry 4 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 e ins andpenalties of perjury that the information provided above is true and correct. / Si ature: ` ° Date: 1 0 ( 2 Phone#: 0 �'J l tA ! LW 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 30City/Town Clerk 4.0 Electrical Inspector 50Plumbing Inspector 6.DOther Contact Person: Phone#: 677) P (90/12/2Z0/4(11- ff ' fi e% cG�lam/ZCC c' 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 Co 20M-05/17 Office of Consumer Aft`irs business K�gufrtion 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 128957 06/13/2023 1000 Washington Street -Suite 710 Boston,MA 02118 OLIVER KELLY OLIVER M.KELLY i / • QC2-C2 8 RHINE RD. � Not valid without signat re YARMOUTHPORT,MA 02675 Undersecretary Commonwealth of Massachusetts 5 Division of•Professional Licensure Board of Building Regulations and Standards ConstructipirStip/& pr Specialty CSSL-099167 E spires:09/28/2023 OLIVER M KELLY . 8 RHINE ROAD i YARMOUTH P9RT MA 02675 ft. n n Commissioner d'u4` 1;. i1C.vncJiR- 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 8, 2022 Proposal submitted to Mr. John Verhoff of 15 Pump House Lane, West 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, 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$19,500 To Replace existing skylights with Velux MO4 Fixed Units ( Non Opening)Add $1,000 Per Unit For Opening Units Add $1200 Per Unit To Add A Factory Installed Remote Operating Solar Blind To A Unit Add $460 For Solar Remote Operating Venting Units Without Blinds Total Cost Is $1975 Per Unit All Pricing Includes Any Necessary Interior Trim And New Exterior Flashing Kits All Solar Options Qualify For 2022 Tax Credit of 26% (Approx $320 Per Fixed Unit with a blind, Approx $600 Per Solar venting Unit, Approx $720 Per Solar venting unit with a blind.) Proposal Submitted by: Oliver Kelly Proposal accepted by: 12 :/! Date. _ /C / �_ /2022 { Best Contact Number : ,; This proposal is valid for 45 days from date above, please Call to verify thereafter.