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HomeMy WebLinkAboutBLD-23-005988 C U.I'l.Lf/1 5-l)J 2' Office Use Only P. Permit# s,.= 0 44 t* • Amount SO.O ) r,,, ,o` :' Permit expires 180 days from issue date 6 D —a3— 005-q -eS2- EXPRESS BUILDING PERMIT APPLICAT C v F TOWN OF YARMOUTH Yarmouth Building Department A� ��� 1146 Route 28 1\ South Yarmouth, MA 02664 .___- (508) 398-2231 Ext. 1261 BUILDING DE�ARTMF_NT R v'. i (NO6 �1CONSTRUCTION ADDRESS:_,j — CCU•C) �J,u3C1` —. '(O`S ASSESSOR'S INFORMATION: A e Map: ! Parcel: ®� r_ J OWNER:Vi�' ! W � t _ gA `Tr; Q- iCA---- L CT( 50 qPAAitt;)-(fll-k 'i"Vl OZt7V / NAME {{ P SENT ADDRESS TEL. # CONTRACTOR: D` 1 L i°'tJ ti ljh , �� MA ©2b/C NAME MAILING ADDRESS C TEL.# Sod( LaoLc-0 `Residential 0 Commerci /Est.Cost of Construction$ / 9 96,_l rli Home Improvement Contractor Lic.# l 255C1 67 Construction Supervisor Lic.# 0 9 % f! 4;7 Workman's Compensation Insurance: (check one) 0 I am the homeowner 0 I ri the sole proprietor 2'I have Worker's Compensation Insurance Insurance Company Name: ( �},- ( Worker's Comp.Policy# 6s 2.66€40 t70G WORK TO BE PERFORMED /// Tent n Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares 211 ()Remove existing*(max.2 layers) Insulation El I I Old Kings Highway/Historic Dist. CI)Replacing like for like Pool fencing I 1 'The debris will be disposed of at: ' i'"'kl 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 answer(s) will be just cauxP for rl.• 4 ,ion of my li -ale prosecution under M.G.L.Ch.268,Section 1. Applicant's Signature: . � S3 511P-16-- Date: "t 'f `•2,Th Owners Signature(or ttachme t) Date: �Li • 2 7-1-5 /mot, Date: `� "l Approved By: Building Official(or EMAIL Zoning District: Historical District: Yes No Flood Plain Zone: Yes 7 No Water Resource Protection District: Within 100 ft.of Wetlands: Yes No 1 Yes No F0/22/740-/411}eadi G>4/g 71 'c)-6/4 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. 1 0 20M-05/17 � .%�r ;iniriiv/ii�rrrlfifrl 8/rr:•'rr�� Office of Consumer rs usmess 1 6gu1ition Registration valid for individual use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: TYPE:Individual Repistration Office of Consumer Affairs and Business Regulation Exam ration 128957 06/13/2023 1000 Washington Street -Suite 710 Boston,MA 02118 OLIVER KELLY OLIVER M.KELLY /�6�- 8 RHINE RD. / Not valid without signat re YARMOUTHPORT,MA 02675 Undersecretary • • Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards ConstructietiAAtapr Specialty CSSL-099167 ccpires:09/28/2023 ` OLIVER M KIg.LY, 8 RHINE ROAR YARMOUTH VR o"`iF^ ) To/sN-a_►o���c Commissioner diaa fi. 1: Cvnc AC RE7 CERTIFICATE OF LIABILITY INSURANCE DATE GOND ) a2 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 INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or 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 KANE Linda Sullivan DOWLING&O'NEIL INSURANCE AGENCY PHONE 6.„. (sob)775 T6zo Ax __WC 11491- __-__ . E-MAIL ag isulfivan ns.Com ADDRESS: ---- ! .- ----__ _ - _- -_ _. 973 IYANNOUGH RD NSURERIS)AFFORDING COVERAGE • NAIC I HYANNIS MA 02801 _INSURErtw; ACE AMERICAN INSURANCE CO —_-- 22667 NSURED INSURER B KELLY ROOFING INC INSURER C: INSURER D: 8 RHINE RD INSURER E YARMOUTHPORT MA 02675 INNSURER F COVERAGES CERTIFICATE NUMBER: 872358 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 *MR TYPE OF INSURANCE 14D MD POLICY NUMOER (MM OIADOL SUM I R I1 YYYY) NA MODrYYYY) LIMITS COMMERCIAL GENERAL UABS.ITY EACH OCCURRENCE S DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES tEa occ urrencel , S MED EXP(Any one perms) S N/A PERSONAL A ADv INJURY , S GENL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE • S POLICYPRO- JEcT LOC PRODUCTS-COMP)OP ACC, S OTHER GOWNED SINGLE LIMIT 3 AU40MOe1LE LIABR ICY I !Ea accuoentl ANY AUTO ! BODILY INJURY(Par person) $ — OwNED SCHEDULED N/A BODILY INJURY[Per eccidenh1 $ AUTOS ONLY NON-O PROPERTY DAMAGE HIRED . AUTOS NON-OWNED L Y , Ter acooem) S AUTOS ONLY AUTOS ONL Y UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESSUA CLAIMS MADE N/A AGGREGATE , S DED RETENTION S X S WORKERS CO ENSATION STATUTE ERH- AND EMPLOYERS'LJABKnY YIN E L EACH ACCIDENT S 500.000 ANYPROPRIE 1pRWARTNER.EXECUTIVE A DEFICE IMEMEREXCLUDED7 ; WA NIA 6S62UB8H08580922 05/10/2022 05/10/2023 EL.DISEASE-EAEMPLOYEE S 500.000 (Mandatory in NH) ItyesCRIPTIO 6erraNOPERATIONS OF OPERATIONS bbelowE L DISEASE-POLICY LIMIT $ 500.000 AS N/A DESCRIPTION OP OPERATIONS 1 LOCATIONS/VEHICLES(ACORD 101,Additional Ranarks Schedule.Ieay he aSaideed N mov1 space is reed)Workers`Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 outside B.no auth of Mo i aza_tion is given to pay claims for benefits to emt�y�in states other than Massachusetts if the insured hires,or has hired those employees This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expirationProof of on the above policy precedes the issue date of this certificate of Insurance). The status of this coverage can be monitored daily by accessingCoverage- on 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 ACCORDANCE WITH THE POLICY PROVISIONS. Mary Agnes Ford 39 Morning Glory Drive AUTHORIZED REPRESENTATIVE MA 02638 , Daniel M.Crowley,CPCU.Vice President-Residual Market-WCRIBMA South Dennis IP 198B-2015 ACORD CORPORATION. AN rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD l� ---'-" Office of Investigations t% - i Lafayette City Center —'` .., 2 Avenue de Lafayette, Boston,MA 02111-1750 ''- �f' www mass.gov/dia �Y�'i Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly r Name(Business/Organization/Individual): 'GLL1Le4-‘).--Ci— — Address: S LtTc_. Lort% City/State/Zip: ' t vkr-;AA i,P400.5::: 14A 02b'75 Phone#: 57 -b 10 •Are you an employer?Check the appropriate box: Type of project(required): 1.Bil I am a employer with t 4. al am a general contractor and I 6. El 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. 0 Remodeling ship and have no employees These sub-contractors have 8. D Demolition working for me in any capacity. employees and have workers' 9. []Building addition [No workers' comp.insurance comp. insurance. 10.❑Electrical repairs or additions required.] 5. We are a corporation and its 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.l Roof repairs insurance required.]fi c. 152, §1(4),and we have no 13.❑Other employees. [No workers' 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. Insurance Company Name:Ac.,-, A.,„,..--4.,c....s, Policy#or Self-ins.Lie.#: bS 31..t.3 ;, S55 Doc 'a- Expiration Date: 5-ko-23 Job Site Address: `"-/5 cA-1 1.k Pt-1.l - QACity/State/�ip:(s Q51)t,U MA 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 and penalties of perjury that the information provided above is true and correct. �� Signature: jj Date: Lt / 2b / 2 Cl 23 -y='�" Phone#: So 'tb o 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): IDBoard of Health 20 Building Department 31:City/Town Clerk 4.D Electrical Inspector 51:1lumbing Inspector 6.DOther 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 INSURED. Kellyroofing@icloud.com April 17, 2023 Proposal submitted t Mr. Ken Cowgill of 21 Georgetown Landing, So. Yarmouth MA. We propose to supp all materials and labor required to remove and replace the existing Asphalt Ro f at the address above. Protect all walls, Wi dows, shrubs, plants etc. during roof strip. All debris to be rem ed to town transfer. Retain Existing Vent d Aluminum Drip Edge on all eaves.5"White Aluminum Drip Edge To be Installed On All Rak . Ice and Water dama e protection membrane to be installed on first Six feet of all Eaves, In All Valley Areas and aro nd all protrusions. I Remainder of roof d ck to be covered with synthetic underlayment. Install limited lifetime warranty Architect style Shingles, color to be specified, All shingles to be sto m nailed (6) We generally use Ce ainteed products, this proposal is based on their Standard Landmark Limited Lifetime War anty Shingle. Using all Certainteed Starter and Ridge Shingle Products To Maximize Available Warranties. Replace plumbing v t pipe boots with new. Repair/ Replace all fl shings as necessary. Install Certainteed Fi ered Ridge Vent with hand nailed caps. Complete Clean up(Jiff all areas including all gutters and all nails after project complete. At a total cost of $14,300 (To Replace All Existing Vented Drip Edge On All Eaves With New Add $600) Proposal Submitted 11y: Oliver Kelly i Proposal accepted b : -' ' 1 Date. 7 / 3 /2023