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HomeMy WebLinkAboutBLD-23-003048 'r.-,,„ / �'^ 1/ Office Use Only ` S• `v 'Z 4 it I)C? Q� ' (d Pcnttitn` �� • :-n_r~sr%K�v`'' Amount L7 U, F• K Permit r-�3l �� expires ISO days from issue date EXPRESS BUILDING PERMIT APPLICATION TOWN OFYARMOUTH RECEIVED - Yarmouth Building Department 1146 Route 28 DEC 0 2 2022 South Yarmouth, MA 02664 (508) 398-2231 Ext. 1261 UILDING DEPARTMENT CONSTRUCTION ADDRESS: 5 S a.A.)_r_ii ,512 _ 50 Lit G..., ASSESSOR'S INFORMATION: �! i Map: !/� Parcel: I OWNER: its t �S 10U;1 CI dQtCJ-QitJ W 4 t t -- 1• \2 NAME ����� PRESENT ADbRESS TEL. # 7 c rj i1e7 T$(k) CONTRACTOR: ial Q?--v3 . c Qu w,.. a . L.P. IN 02,--is -ov SOci (-1(OLIO NAME MAILING ADDRESS TEL.f 0 1'i Residential ❑Commercial Est.Cost of Construction S 899-o Home improvement Contractor Lic.# 12 0tS7 Construction Supervisor Lic.# CA CI I.b7 Workman's Compensation Insurance: (check one) 0 I am the homeown r ❑ I am the sole proprietor I have Worker's Compensation Insurance Insurance Company Name: �.1CA.1.\ Workers Comp.Polies#bS6LV (? "v!U c�. r�r,4- k� [ i WORK TO BE PERFORMED . Tent Duration (Fire Retardant Certificate attached?) Wood Stove 0 , Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares 2-2. ((�)Remove existing`(max.2 layers)(El) y ) Insulation 11 Old Kings Highway/Historic Dist. 43 Replacing like for Iike Pool fencing EI `The debris will be disposed of at: ; ul.^7':tit ib-A- C-G�f}f� Location of Facility 1 declare under penalties of perjury that the statements he in 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 `vocation of my li ernse d for prosecution under M.G.L.Ch.268,Section 1. Applicant's Signat e. ).1eeq� 2 Z Date: \,%.-• Owners Signature(or attachment) i ��n / Date: Approved By: / t o /. : 1 2-2- Building Ogg designee) Date: . � ) EMAIL A DRESS: Zoning District: Historical District: ::: Yes No Flood Plain Zone. __ Yes : No Water Resource Protection District: Within 100 ft.of Wetlands: IT Yes No 1. Yes I. No • Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards CSSL-099167 Expires:09/28/2023 OLIVER M KELLY 8 RHINE ROAD YARMOUTH PORT MA 02675 • Commissioner J;u ''% , r,;t, (f t'J !I"G Li!<7 �f !/f� l:-j%" / i -(- �� Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration • Type: Individual OLIVER KELLYRegistration: 128957 8 RHINE RD Expiration: 06/13/2023 YARMOUTHPORT,MA 02675 Update Address and Return Card. SCA t ._ af)k ati' Office of Consumer Aff s&Business 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 716 OLIVER KELLY Boston,MA 02118 OLIVER M.KELLY YARMOUTHPORT,MA 02675 ✓J Undersecretary Not valid wsi�hout signafi tre c R® CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DD/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 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 Fax No.Ext): (508)775-1620 (A/C,No): E-MAIL ADDRESS: Isu llivan©doins.com 973 IYANNOUGH RD INSURER(S)AFFORDING COVERAGE NAIL# HYANNIS MA 02601 INSURER A: ACE AMERICAN INSURANCE CO 22667 INSURED INSURER B: KELLY ROOFING INC INSURERC: INSURER D: 8 RHINE RD INSURER E: YARMOUTHPORT MA 02675 INSURER F: COVERAGES CERTIFICATE NUMBER: 775E27 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 ADDL SUBRj LTR TYPE OF INSURANCE INSD VI/VDI POLICY NUMBER POLICY EFF POLICY EXP (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 $ GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE POLICY PRO- $ JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) BODILY INJURY(Per person) $ AUTOS AUTOS SCHEDULED OS N/A BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED AUTOS PROPERTY DAMAGE (Per accident) UMBRELLA LIAB OCCUR EXCESS LIAB EACH OCCURRENCE $ CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ WORKERS COMPENSATION �( I $ _ AND EMPLOYERS'LIABILITY Y/N " STATUTE 1 EERH ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBER EXCLUDED? N/A N/A N/A 6S62UB8H08580922 05/10/2022 05/10/2023 (Mandatory in NH) if yes,describe under E.L.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 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 Falmouth ACCORDANCE WITH THE POLICY PROVISIONS. 59 Town Hall Square AUTHORIZED REPRESENTATIVE w Ct. Falmouth MA 02540 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 IY fi l 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 P�`�� Please Print Legibly Name(Business/Organization/Individual): � k u� - LC-- Address: .. o City/State/Zip:9dA4aQJ11{ a MA- 02.07G Phone#: 3o 2. 5091 4 64: Are you an employer?Check the appropriate box: i.CI am a employer with ( 4• ❑I am a general contractor and I Type of project(required): employees(full and/or part-time).* have hired the sub-contractors 6- El New construction 2.El I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g- ❑Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance comp-insurance.$ 9- El Building addition required.] 5. ❑ 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 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 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 suck 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: F Z Policy#or Self-ins.Lic.#: S(02o 06 o46S oq 2.2.- Expiration Date:.6 v(0'' Z Job Site Address: 5:25 5C-X-)171A City/State/Zip: '(AD•M,X)T 4)44 U' 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 un qer the pains and penalties of perjury that the information provided above is true and correct Si tore Date: II II N 99- Phone#: ' '4 4, x �� t Official use only. Do not write in this area,to be completed by city or town official. Cityor Town: Permit/License# Issuing Authority(check one): 1DBoard of Health 2E1 Building Department 31:1City/Town Clerk 4.0Efectrical Inspector 5t}lnmbing Inspector 6.DOther Contact Person: Phone#: 1 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 November 29.2021 Proposal submitted to Tom Tully of 53 South Street.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. Protect all Walls.Windows, shrubs, plants etc.during roof strip. AU debris to be removed to town transfer. 8"White Aluminum Drip Edge to be installed on all eaves. 5"On Rakes. Ice and Water damage protection membrane to be installed on first Six foot of all Eaves.in all valley areas and over complete roar dormer roof. Remainder of roof deck to bo covered with synthetic underlaymont_ Install limited lifetime warranty Architect style Shingles,color to be specified. All shingles to be storm nailed(6) We generally use Cortaintood products,this proposal is based on their Standard Landmark Limited Lifetime Warranty Shingle. Using all Certainteod Starter and Ridge Shingle Products To Maximize Available Warranties. Replace plumbing vent pipe boots with now. Repair/Replace all fleshings as necessary. Install Cortainteed 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$8,900 Proposal Submitted by:Oliver Kelly Proposal accepted by: Date. f,1 1 30 /20.' Bast Contact Number: 9/4/ Q This proposal is valid for 45 days from date above,please Call to verify thereafter.