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Home My WebLink About0071 STANLEY WAY �. . �� . � :.. a d ue � , r � � , o f� - .. x .., ti .� � _ .. ... n ., .. o ,� � _ -._ �: ,. � � - �. r _ ., - ,. �.' .. - � �� ,. .:, _ � � .. o o .. .� .,. -, '.. �. ,� o- ,: .. - .. .. :,: .. _ _ ,JI _ .. �. � � ' .. �. -�� o _ ., ,. i� ... �. e ., „- :b - _ ., ,� �. .. p �. ,: . � - , � � o .. .. ,` _ ... o � �. _., _. �. �. .. .. � , _ c .. .. • r e �. F :� t. .. '. '.. a a �' �] e � I < � � n � _ ,. � ..' .. d � � o �{ a _ _ 0 3: i .. a ,. �. .. ' r ` - e � ,�� a '- 0 0 t.: � - n; _ I '� • ., ` Y � p � � P n"'w. 4 � .. .. �n ... -.. - - .. - � e � r ,� tt a 'r. �.i �. . _ ., � - � n np - o ' P ,. .. .. - �_. _ _ � .. .Y .�_ ,. o _. '.� v � � — r c� __ � � ... Application number....... ...... ..... ...... .... .ter _ Fee ..........6........ .d......................................... • "RNSTARM HAM a` JUL �0�9 Building Inspectors Initials....................................... fMAIN 0J, BARWABU Date Issued................................................................. Map/Parcel..... aF.- /„ .�............... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOW S/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: - -*7/ &,ke6& NUMBER ST ET VILLAGE Owner's Name: �y� /� �� Phone Number g)f as 1• a 33q Email Address: 3 Cell Phone Number Project cost $ Q,d0' Check one Residential_ Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK i ® Siding F Windows (no header change) # l Insulation/Weatherization Q Doors (no header change) # 2k Commercial Doors require an inspector's review ® Roof(not applying more than 1 layer of shingles) Construction Debris will be going to_ ,�, ,- S-M- Can CONTRACTOR'S INFORMATION Contractor's name Home Improvement Contractors Registration (if applicable)# (attach copy) Construction Supervisor's License # (attach copy) Email of Contractor _ Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. r APPLICATION NUMBER ............................................................ *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location (s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am -9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION ' Homeowner's Name: 51�c,v k 2�•,.�c1U Telephone Number Cell or Work number 50 g 22Y2-33') I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE ` Signature Date ?— S'--O All permit applications are ject to a bui ' g official's approval prior to issuance. i -. ... 2 Application number.. .... j q ...Z., Fee .......................... NAM -AUG 0 -Building Inspectors Initials.......... _ ................... Date Issued.............. ........................... Map/Parce',...... .................... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHEFJZATION PROPERTY INFORMATION Address of Project: _ -71 NUMBER STREET VILLAGE Owner's Name: ��A,—, -A,LA-A STt- Phone Number — Email Address: Cell Phone Number Project cost$ m Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK ❑ Siding ❑ Win_dows (no header change Insulation/Weatherization " ❑ Doors (no header change)# Commercial Doors require an inspector's review Roof(not applying more than 1 layer of shingles) Construction Debris will be going to �,j CONTRACTOR'S INFORMATION Contractor's name N Home Improvement Contractors Registration(if applicable) (attach copy) Construction Supervisor's License# (attach copy) hone number c'�-O Email of Contractor �E U>�QJZ�V3 6(�- `CW h b KSc)9 4 41L) ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER ............................................................ *For Tents Only* Date Tent(s) will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X I X , . X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:34pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 CMR and the Town of Barnstable. ,r Signature Date APPLICAN 'S SIGNATURE Signature Date '2� All permit applications are subject to a building official's approval prior to issuance. KELLY ROOFING PH. 508 509 4640 x 8 Rhine Road MA C.S.L. #099167 Yarmouthport MA H.I.C.R. # 128957 MA 02675 May 20'2019 Proposal submitted to The Owners of 71 Stanley Way Centerville 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-insiatled_on-all-eave:s � �� ". • �� • � , ,_ ._ _ _ ____. .. _ .•_ ._ Ice and Water damage protection membrane to be installed on first Six feet of all eaves, in all valley areas and around all protrusions. 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 with All approved Accessories to maximize available warranties. This Quote is based on their.Basic Limited Lifetime.Warranty Landmark Shingle Replace plumbing vent pipe boots with new. Repair/Replace all flashings as necessary including Chimney 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$9,900 *If There is an extra layer of,roofing ad6$1200* Payment Schedule; Balance upon Completion Proposal Submitted by: Oliver Kelly - Proposal accepted by4JA)� J t;C /�/Lc�'�j Date. LO /1r��/2019 This proposal is valid for 45 days from date above, please Owl Vve �\Aw (V)'RP� call to verify thereafter. f' Best Contact F 1i4'� W l�'L) out l,Lil.0 Lk T sInfo: S--Z/- kI3I i/)a sy�2q el; VA h9J e ,4 0- LAe4, AC-0 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYI() 07/02/2019 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 CONTANAME:CT Linda Sullivan DOWLING&O'NEIL INSURANCE AGENCY 508 775-1620 FAX No: E-MAIL ADDRESS: lsuilivan@doins.com 973 1YANNOUGH RD INSURERS AFFORDING COVERAGE NAIC Y 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 INSURERF: COVERAGES CERTIFICATE NUMBER: 420827 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 ADDL SUBR POLICY EFF POLICY EXP LIMBS LTR POLICY NUMBER MM/D MM/D COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR D AGE O RENTED PREMISES Ea occurrence $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY DPRO JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COEa accMBINEDident SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS AUTOS PROPERTY DAMAGE NON-OWNED Per accident $ HIRED AUTOS AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION V PER OTH- AND EMPLOYERIABILITY /� STATU S'L Y/N TE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBEREXCLUDED? WA WA WA 6S62UB8H08580919 05/10/2019 05/10/2020 (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/lwdtworkers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The Barnstable Insurance Company ACCORDANCE WITH THE POLICY PROVISIONS. 108 Route 6A AUTHORIZED REPRESENTATIVE Yarmouthport MA 02675 Daniel M.Crc y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department oflndustrialAccidents UW I Congress Street,Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. A licant Information Please Print Legibl Name(Business/Organ' 'on/Individua!): Address: trl City/State/Zip: 020Phone#: 5®8� c5oc q b� Are you an employer?Check the appropriate box: Type of project(required): LF1 I am a employer with, _employees(full and/or part-time).* 7. ❑New construction ❑1 am a sole proprietor or partnership and have no employees working for me in 8. Remodeling iry a capacity(No workers'comp.insurance required.) 5 3. I am a homeowner doing all work [N t 9. ❑Demolition ❑ g myself. o workers comp.insurance required.} 4.Q I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 ❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 5.❑I am a general contractor and I have hued the sub-contractors listed on the attached sheet 12.❑Plumbing repairs or additions These sub-contracbors have employees and have workers'comp.insurance.1 13..ERoof repairs 6_❑.We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no 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 contractor,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'cramp.policy number. I am an employer that is pro !ding workers'compensation insurance for my employees'. Below is the policy and job site information.Insurance Company Name: C Policy#or Self-ins.Lic.#:`U�� j� �� $� Expiration Date: 0 Job Site Address: City/State/Zip: 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 MGL c. 152, §25A is a criminal violation punishable by 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.-A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do here u the p ' and p es o perjury that the information prov' abov is true and correct Si ature. Date: LU Phone#: 0— Official use only. Do not write in this area,to be completed by city or town official City or Town: PermWLicense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#• .l Commonwealth of Massachusetts Division of Professional Licensure law Board of Building Regulations and Standards Constructi op,S'Uper-vl,sor Specialty CSSL-099167 k Eicpires: 09/28/2019 j' 1. OMER M KELLY f 8 RHINE ROAD' YARMOUTH PORT MA 02675 ¢� 14 AC, Commissioner Cep- Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 .Boston, Massachusetts 02118 Home Improvement3C.ontractor Registration ,. Type: Individual z' � ; Registration: 128957 OLIVER KELLY 8 RHINE RD _ _ t OExpiration: 06/13/2021 YARMOLITHPORT,MA 02675 L w± 3 Update Address and Return Card. SCA 1 20M-05/17 1,71 GCtJe`G.i Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:individual Registration EXDlration L28957 06/13/2021 OLIVER KELLYr tr