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HomeMy WebLinkAboutBLD-23-00729 e Lk r"01>, ` y "`'' Office Use Only p O / I Z/Z 7 Pennit# 416q a O t )H1 Amount ..—d.�- x., MA1Th CSC�) � �a,Yce% Permit expires 130 days from issue date 6L v -02.3 ded 7d1 EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department RECEIVED 1146 Route 28 South Yarmouth, MA 02664 AUG 112022 (508) 398-2231 Ext. 1261 --BUILDING BUILDING DEPARTMENT CONSTRUCTION ADDRESS: 22 r057C . sy. 1 ) 40E ---___ ASSESSOR'S INFORMATION: i Map: Parcel: OWNER:E U.e--IJ VJ -t-t.--,`"' 22 Qj ps:_ +-1-,3- 63`. "4.-1Ui9-.71-1JI t (D -F'7 NAME PRESENT ADDRESS TEL. # 4173 S 7 675 CONTRACTOR: IfiS .1 ZOO C.OG. VI.- j I, 1 C-01-1.t ti- J'Vr O2& ' ' NAME MAILING ADDRESS ' TEL.#so% sog 4tIt Residential El Commercial Est.Cost of Construction$ /7/ 'fOi) Home Improvement Contractor Lic.# Ccf..r I Construction Supervisor Lic.# Oe(ct. 'b7 Workman's Compensation Insurance: (check one) 0 I am the homeown7r CI I am the sole proprietor nilave Worker's Compensation Insurance i� 1� P Insurance Company Name: CZ AM.48(11, Worker's Comp.Policy#b ?2-0 s t0 :SS 22 WORK TO BE PERFORMED Tent —1 Duration (Fire Retardant Certificate attached?) Wood Stove ED Siding: #of Squares - Replacement windows:# Replacement doors: # Roofing: #of Squares 241 (a Remove existing*(max.2 layers) Insulation 1 I Old Kings Highway/Historic Dist. wJ Replacing like for like Pool fencing n {The debris will be disposed of at: 4442-14": ` i 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 cause for denial or-re oration of my lice se aqd for prosecution under M.G.L.Ch.268,Section I. Applicant's Signature: k Date: '1 `{ I I 22- Owners Signature(or attachment) Date: Approved By: ,....t, — Date: - I Q`" kZ Building Official(Or designee) EMAIL ADDRESS: Zoning District: Historical District: Yes " No Flood Plain Zone: Yes 7. No Water Resource Protection District: Within 100 ft.of Wetlands: T. Yes No 11 Yes 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,1f /;- L�•:,f»_ �� JM !.r J j vv �� �`J c./f fit:i f��.�1-r�c,Cifii�/�' U ! _��(/1::! •flit P � ' r�! 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 YARMOU T HPORT, MA 02675 • Update Address and Return Card. SCA 1 .. 201.:-0=i17 ' ' Office of Consumer Affth's&Business Regulation - 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 7?0 OLIVER KELLY Boston,MA 02116 _c_(;OLIVER M.KELLY .t' yQ a , , 6 RHINE RD. :: YARMOUTHPORT,MA 02675 Not valid without signat4ire Undersecretary The Commonwealth of Massachusetts _ A. Department of Industrial Accidents _�. 1 Office of Investigations -,�r— : . . , Lafayette City Center --' . 2Avenue de Lafayette, Boston,MA 02111-1750 :_ wwwmassgov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ` Please Print Legibly 4 CName(Business/Organization/Individual): t C-{ Wv r- Address:sine an-U1/4?w�1 C- �,y- f s\ Q -e t S cz5 V L �../ 4 b City/State/Zip: #: Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with , 4. 0 I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. 0 New construction 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. (i Demolition working for me in any capacity. employees and have workers' 9. 0 Building addition [No workers' comp. insurance comp.insurance. required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL yp 12. Roof repairs insurance required.]t c. 152,§1(4),and we have no 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. f� � � �� � r Insurance Company Name: w ��t-� "„��� Policy#or Self-ins.Lic.#: (.(jS CO?_--0 zj O j S 5 tO - <- Job Site Address: ©-S ` City/State/Zip: 0• l R-' ..?r 0 2 613 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 i (Signature: 0 ` Date: i I ( 7_ Phone#: &l. t464-16 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 5Elumbing Inspector 6.00ther Contact Person: Phone#: AcoRL CERTIFICATE OF LIABILITY INSURANCE DATE(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 HONE (508)775-1620 FAX E-MAIL I(NC,Nop ADDRESS: lullivan@dolns.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 INSURERC: INSURER D 8 RHINE RD INSURER E: 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 ADDL SUER LTR TYPE OF INSURANCE 1NSD D POLICY NUMBER POLICY EFF POLICY EXP (MMlDDlY1rYY) (MMIDD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS MADE OCCUR DAMAGE 1 O RENT 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 LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE UABIUTY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED r SCHEDULED _AUTOS AUTOS N/A BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS ^ AUTOS (Per accident) S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ ,DED ! I RETENTIONS $ WORKERS COMPENSATION I PER OTH- AND EMPLOYERS'LIABILITY Y/N N./ !STATUTE _ ER 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 $ 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.govfwd/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 I MA 02347 Daniel M.Crowley,CPCU,Vice President—Residual Market—WCRIBMA 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014/01) The ACORD name and logo are registered marks of ACORD KELLY ROOFING PH. 508 509 4640 8 Rhine Road MA C.S.L.#099167 Yarmouthport MA H.I.C.R.#128957 MA 02675 INSURED July 23, 2022 Proposal submitted to Ellen Cullen of 22 Frost Ave. West Yarmouth, MA. We propose to supply all materials and labor required to remove and replace the existing Double layered 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 and In All Valley Areas. 4I5 4 ss 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 Ail 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 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. Obtaining of Town Building Permit. �` p At a total cost of6,8000L— Apr) I'," s 95-0.06 Payment Schedule; Balance upon Completion Proposal Submitted by:Oliver Kelly .,duq 1, 2022 Proposal accepted by: Ze..--d ���G�.J Date. / /2022 This proposal is valid for 30 days from date above, please Cell = 973-561 Ca733 Acaa-c £aa1 •x,t dr sc ess cida.4,1s . t .44QL you—. KELLY ROOFING PH. 508 509 4640 8 Rhine Road MA C.S.L.#099167 Yarmouthport MA H.I.C.R.# 128957 MA 02675 INSURED July 25' 2022 Proposal submitted To Carol Craig of 5 Harvest Hollow, Harwich MA We propose to supply all materials and labor required to remove and replace the existing Asphalt roof at the address above. 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 installed on all eaves. 5" On All Rakes. All Roof Decking Secured Ice and Water damage protection membrane to be installed over first six feet of all eaves. Remainder of Roof Deck to be Covered with Synthetic Underlayment Install Certainteed Landmark limited lifetime warranty Architect style Shingles, Using all Certainteed Starters and Cap Shingles to maximize available warranties, (Color to be Specified) All shingles to be storm nailed (6) Repair all flashings as necessary. Install Certainteed Filtered ridge Vent on All Ridges with hand Nailed Caps Replace all Plumbing Vent Pipe Boots With new. Complete Clean up off all areas including all gutters and all nails after project complete. Obtaining Of Town Permit At a total cost of$14,800 Payment Schedule; Balance upon Completion Proposal Submitted by: Oliver Kelly Proposal accepted by: au.e Date. 17 I -Z9 /2022 Best Contact Phone Number-02I % Dom$ d� v This proposal is valid for 45 days from date above, please call to verify thereafter.