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HomeMy WebLinkAboutBLD-23-002909 • *-"` A' f �„-C -<"�- Office Use Only y Q / /36lz l 372f I ^ j, Perntitn ': •rn`av ur���' Amount .5 u.i u '-ti- }-i'/e' Permit expires ISO days from r_ issue date q EXPRESS BUILDING PE' IT APPLICATION :� Dd �t TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 RECEIVE South Yarmouth,MA 02664 (508) 398-2231 Ext. 1261 NOV 2 8 2022 CONSTRUCTION ADDRESS: ' 4 \ &.... . , `{ -.----__. ' ,�v`fv II: �ING DEPARTMENT ASSESSOR'S INFORMATION: I Map: I Parcel: OWNER: lki (� `kb-V1-E(— ta° ln Pt5.i vreL�• I��M'`'v Q40. t�- ��NNrAME (� PRESENT ADDRESS ( l TEL. # 6 )z (j �tff CONTRACTOR:I( LJ 1 L ' V--v3G c Quit j _ L{.Yv O 7 %`3c ( t I Lr3(4 tO NAME MAILING ADDRESS TEL.4 EI Residential 0 Commercial Est.Cost of Construction S 53IO Home Improvement Contractor Lie.# 1955i 67 Construction Supervisor Lic.# tom`(ci 1.b7 Workman's Compensation Insurance: (check one) ❑ I am the homeown r 0 I am the sole proprietor I have Worker's Compensation Insurance Insurance Company Name: 4i4A-J2A.C41 Worker's Comp.Polic fJS�Z�J keg t�l U i7. DV�(� WORK TO BE PERFORMED Tent I I Duration , (Fire Retardant Certificate attached?) Wood Stove ❑ Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares 12-- (El)Remove existing*(max.2 layers) Insulation t El Old Kings Highway/Historic Dist. (0)Replacing like for like Pool fencing U tit A,k'Tim debris will be disposed of at: ; �-�-' f IAt.C-c 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 • riocation of my ii e. d for prosecution under M.G.L.Ch.268,Section 1. Applicant's Signal e. T -2 Date: 2 C. Zz Owners Signat`-r or at ch n /, Date: 2 Approved By: f.�' // 2 Building Official or ee Date: ( ) EMAIL ADDRESS: Zoning District: { Historical District Yes No Flood Plain Zone: _= Yes = No Water Resource Protection District: Within 100 ft.of Wetlands: 17 Yes No I_ Yes 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 September 12, 2022 Proposal submitted to The Owners of 184 South Sea Ave, 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. All debris to be removed to town transfer. Install 8" White Aluminum Drip Edge 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. Remainder Of Roof To be Covered With Synthetic Roof Underlayment. Install limited lifetime warranty Landmark 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. This proposal is based on their Limited Lifetime Warranty Landmark Series Shingle Replace plumbing vent pipe boots with new. Repair all fleshings 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. Replace Rubber Membrane Roof Over Low Pitched Area to Rear Right Of Property Replacing Cedar Shingles To Facilitate Same Obtaining of Town Building Permit. At a total cost of$5,300 Payment Schedule; Balance upon Completion Proposal Submitted by: Oliver Kelly Proposal accepted by: ' Date./ /f 12022 A 120 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/OD/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 /Am.No.Exit: (508)775-1620 A N,): ADDRESS: Iullivan@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 INSURERE: YARMOUTHPORT MA 02675 INSURER F: COVERAGES CERTIFICATE NUMBER: 775624 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 ADM SUER POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) UNITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL 8 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 I SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS I i (Per accident) I I $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE I N/A AGGREGATE $ I I DED I RETENTION$ I $ WORKERS COMPENSATION (x PER I OTH- AND EMPLOYERS'LIABILITY Y/N X STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBEREXCLUDED? N/A N/A NIA 6S62UB8H08580922 05/10/2022 05/10/2023 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 I N/A 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 Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street AUTHORIZED REPRESENTATIVE Hyannis . k}�_( i_L Sl' 1 MA 02601 Daniel M.Cr y,CPCU,Vice President—Residual Market—WCRIBMA a 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD /GG C_90722/22072CP-eCGGGi e} f%IJCG.J4CG6fZCGjee '4. Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Individual OLIVER KELLY Registration: 128957 Expiration: 06/13/2023 8 RHINE RD YARMOUTHPORT,MA 02675 Update Address and Return Card. SCA 1 << 20M-05/17 .777e Y� „/i/. /6,e'•,,,/, .//�° . Office of Consumer A irs&Business Ifegdl5tion 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 OLIVER KELLY Boston,MA 02118 OLIVER M.KELLY , 001 8 RHINE RD. -j YARMOUTHPORT,MA 02675 Not valid without signatt re Undersecretary Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards � I;t Constructiom'Stip:61Nipr Specialty • CSSL-099167 .xpires:09/28/2023 OLIVER M KELLY 1 8 RHINE ROAD YARMOUTH P.9RT MA 02675 ()I • ..�� t��y-L1 -. , Commissioner Ole f. �riCthvt it ACCORD 0 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDM(YY) 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 (MC. (508)775-1620 FAX (A/C, E-MAIL ADDRESS: Isullivan@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 INSURERE: YARMOUTHPORT MA 02675 INSURER F: COVERAGES CERTIFICATE NUMBER: 775626 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 ATYPE OF INSURANCE INSO WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS (MM/DD/YYYY) (MMlDD/YYYY) 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 $ POLICY PRO- 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 UAB OCCUR EACH OCCURRENCE $ EXCESS LIAB I CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION V PER OTH- AND EMPLOYERS'LIABILITY /� STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE Y!N 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 $ 500,000 If yes,describe under 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 Dennis ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 2060-485 Main Street AUTHORIZED REPRESENTATIVE South Dennis MA 02660 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 F. Office of Investigations — `'_ ' LafayetteCity 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): . [m �>. Address:`o , . LAD City/State/Zip:4 v j ' MA- 02.1WG Phone#: 50 _ Are you an employer?Check the appropriate bog: �� ���y ,- rl 1.L1 I am a employer with i 4- ❑I am a general contractor and I Type of project(required): have hired the sub-contractors employees(full and/or part-time).* 6 ❑New construction 2.El I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have ito employees These sub-contractors have 8.working for me in any capacity. employees and have workers' 9. ❑Demolition [No workers' comp.insurance comp.insurance.; 9. []Building addition 3.❑ required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions I am a homeowner doing all work officers have exercised their I I•❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL insurance required.]t c. 152,§1(4),and we have no I2 Q Roof repairs 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. *Contractors that check this box must attached an addition]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: i; ' .`1 F Policy#or Self-ins.Lic.# t:a % d O bS O 22 Expiration Date:. ( ', Job Site Address: J $ 'ul SEY' 416.. .yi 32 Attach a copy of the workers'compensation policy declaration pagee City/State/Zip; �✓,�?/iLF;1��� /�,/l- d expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead tong ttithe imposition of policy numbera 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 and penalties of perjury that the information provided above is true and correct: Si ture:k Date: ll ' Phone#: j l,60 �� 11 Official use only. Do not write in this area,to be completed by city or town official . _ City or Town: Issuing Authori Permit/License# ly(check one): I0Board of Health 20 Building Department 3DCity/Town Clerk 4.❑El'ectrica Inspector 6.00ther l Inspector S�lnmbutg Contact Person: Phone#: