HomeMy WebLinkAboutBLD-15-00425111
WSo G
EXPRESS BUILDING PERMIT APPLICATION
TOWN OF YARMOUTH
Yarmouth Building Department
1146 Route 28
South Yarmouth, MA 02664
(508) 398-2231 Ext. 1261
CONSTRUCTION ADDRESS: _ Z:� U H + 1� N r
ASSESSOR'S INFORMATION:
Map: -Z 9 'Parcel: Z
Unim use umy
Pamit�`D��
Fee S.
Permtt expires 6 moaft from
Issue date.
u -,e\ Nev-"
/SrGws)
OWNER. _wI I►%0..w. t`1 �-- _ S `( lMGss
NAME PRESENT ADDRESS 7u- # C Z-7 7 /
TRA CONCTOR: s a� ivt D y q A '-9 y 96
NAME MA LINO ADDRESS TEL #+
_Residential fomtnenc—ia7lp•) r� f ,. t E:t Cost of Construction S _ (�c� � /n� 416
home Improvement Contractor [ ic. / 1 Construction Supervisor Lief v i7 [� •�
Workman's Compensation Insbrmuee: (check one
rf• 1 nun the sole propnetoo 1 have Worker's Compensation Insurance
Insurance Company Name- � . _ Worker s Comp. Policy#
WORK TO BE PERFORMED
❑ Tent (Fire RetardaekChttifip'� attached) / ❑ Wood Stove Shed
Siding: # of Squares r �% yr • C RepLacement windows: #
Replaceneat doss: #
❑Re -roof: #ofSquaes j rJIawladon
() Stripping oid shatglea• ()going over • . NO ( C7 K H Ut-
i �t e,�reriL D: SinY-{ . /
`layers orexistisS root Old King: HighwayflRstor'cDiatrict bO �&3/AS
RooftnVSkHng (Uke for like)
*The debris vein be disposed of u: #44 it
Location of Facia
I declare under of t
P�� Pm1my that the statements herein contained are true and wrtect to the bear of cry "ledge aad/beRef ' I vuckrstaod that any lulu answer(s)
will be just cause for denial or tr�f .11c a aced for prosecution under K" (X 269. Section 1.
A (. ,A
Applicant's Sianao�re Date•.
f Of
Owners Sigmtors (or atmchmerK) Data• / -
Approved By _ Dare•.
Butidmg orticiai (or design«)
PEE P P A Zu15 `
Zonin; Distrk fk t
meal District Yes No
r Resource Protection District:
Yes No
Flood Plain Zone: Yes No
Within 100 tt. of Wetlands:
Yes No
O=' �_
�/j� 3Ot
t ;
The Commonwealtl't ofMassaehusetts
Department oflndusi rid Accidents
Of ee of Invesdgadony
600 Washington street
Boston, MA 02111
►vww.massgov/dia
Iftlltnsn/ T.. t'n�w.satw�
Worker' Compensation Insurance Affidavit: Builders/Contractors/Electricisns/Plumbers
Name(Htuiaas/Oryanirat+oallndividual):
— — — - ...` runts.,
Are you as employer? Check the appropriate box:
L I am a employer with 4. 0 I am a Seneral contractor and I
employees (&U and/orpart-time).have hired the
2.,® I am a sole proprietor or partner- listed on the attached sheet
ship and have no employees These sub -eons actor haw
working for me in any capacity.
[No worker' comp. insurance
required]
3. ❑ I am a homeowner doing all work
myself [No workers' comp.
ins%nance required.] 7 t
3a.13 I am a homeowner acting as a
general contractor (refer to #4)
employees and have workers'
comp. iaitrancmt
5. ❑ we are a corporation and its
officers have exercised their
right of exemption per MCI,
c. 152. 41(Q. and we have no
employees. [No workers'
comp. insurance nwaired_1
ry
Type of project (required):
6. 0 New eomMuction
7. 0 Remodeling
8. ❑ Demolition
9. 0 Building addition
10.0 Electrical repairs or additions
If -[3 Plumbing repairs or additions
12.0 Roof repairs
13.gOther d I
*Any applicant that cheeks box it meta also ml out the aectioa below showing Oak wotksysff
�
Homeowner who submit this" a they am doing all work and then hire oumde woea� MM submit a now affidavit indicating su&
lCoonsetor that Cheek this bmt must attached a additional sheet showing dw same of dw and sofa wbobworam thong entitles have
en*oy If the anb.00ntraCmn have eWloyas, they nest puovida then, wmtW Comp• policy atmebe,.
an air employer that is proridlna workers'rompersadon bssaraiseefor my tmp/oym Belotr it dFe
lnformwdo s PO&7 and job rile
Insurance Company Name:
Policy g or Self -Ins. Lic. #. Expiration Date -
Job Site Address: City/Sutemp:
Attach a Copy of the workers' Compensation policy declaration page (showing the policy number and expirstlos date).
Failure to secure coverage a regWred under Section 25A of MOL c. 152 can lead to the imposition of aimimi penalties of a
fuse ltP to Si,500.00 and/or one-year imprisomr)ent, as well as civil peaslda is the Coma of a STOP WORK ORDER and a fine
of UP to 5250.00 a day against the violator. Be advised that a copy of this statement >� be forwarded [o the Office of Investigations of the DIA for insurance coverage verifiatmn
h"'rAY cam' , /�/ / / A ofpedwy fl oat the btforaaetdon pr+ovWd above Is t>rate and eorrnt
081kla1 we only. Do not write In L% em% to be compk*d by city or tower o07daL
City or Town: Permitildcense 0
Issuing Authority (circle one):
1. Board of Health 2. BuMnf Department 3 Cityrr en is
6. Other own er 4. Electrical Inspector S. Plumbing Inspector
Contact Pesos: Phan #:
1"f Massachusetts - Department.of Public Safety
" Board of Building Regulations and Standards
Conctructiun Superi kor
License: CS-080546
WILIAA111 J KACZO
39 CHESTNUT St j c
SEEKONK NIA 0277f
Expiration
dt Commissioner 0612612015.
Office of Consumer Affairs & Business Regulation - Mass.Gov
Page 1 of 1
The Official Website of the Office of Consumer Affairs & Business Regulation (OCABR)
Consumer Affairs and Business Regulation
Home Consumer Rights and Resources Home Improvement Contracting
HIC Registration Complaints
=#179752
Name
WILLIAM KACZOWKA
Address
39 CHESTNUT ST
City, State Zip
SEEKONK, MA 02771
Expiration Date
09/08/2016
Complaints Details
No comp:alals iOuad fo this royis'U—zM .
("Vo fro M P t.a-% rn rx
You can also view arbitration and Guaranty Fund history.
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® 2012 Commonwealth of Massachusetts.
Mass.GovO Is a registered service mark of the Commonwealth of Massachusetts.
e� ) F
d
Nov �
Home Improvement Contractor
Registration Home Page
httpJ/services.oca.state.ma.us/hic/licdetails.aspx?tKtSearchLN=81687 2/20/2015
. • Vision Government Solutions
Pagel of 3
151 BAYVIEW ST
Location
151 BAYVIEW ST Assessment $310,100
Mblu
28/ 29/ / / PID 1289
Acct#
1289 Building Count 2
Owner
KACZOWKA WILLIAM 3
Current Value
Assessment
Valuation Year
Improvements
Land
Total
2015
$187,700
$122,400
$310,100
Owner of Record
Owner KACZOWKA WILLIAM 3
Sale Price $400,000
Cc -Owner KACZOWKA NOREEN A
Book & Pape 16774/ 248
Address 39 CHESTNUT ST
Sale Date 04/18/2003
SEEKONK, MA 02771
Ownership History
Ownership History
Owner Sale Price Book & Page Sale Date
MCMAHON THERESA3 $99 16694/196 04/03/2003
MCMAHON WILLIAM) $0
Building Information
Building 1 : Section 1
Year Built:
1930
Living Area:
1248
Replacement Cost:
$167,581
Building Percent
68
Good:
Replacement Cost
Less Deoreelation:
5114.000
Building Attributes
Field
Description
Style
Ranch
Model
Residential
Grade:
Average
Stories:
1 Story
Occupancy
Exterior Wall 1
Aluminum Sidng
Building Photo
(http:ffimages.vgsi.coMphotos/YamwuthMAPhotos//\00\00
\60/93.3pg)
Building Layout
http://gis.vgsi.com/yarmouthma/Parcel.aspx?Pid=1289 2/23/2015
. Vision Government Solutions
Page 2 of 3
Exterior Wall 2
Roof Structure:
Gable/Hip
Roof Cover
Asph/F GIs/Cmp
Interior Wall 1
Plastered
Interior Wall 2
Interior Fir 1
Hardwood
Interior Fir 2
Carpet
Heat Fuel
Gas
Heat Type:
Steam
AC Type:
None
Total Bedrooms:
3 Bedrooms
Total Bthrms:
1
Total Half Baths:
0
Total Xtra Fixtrs:
Total Rooms:
Bath Style:
KRchen Style:
Building 2: Section 1
Year Built:
Living Area:
Replacement Cost:
Building Percent
Good:
Replacement Cost
Less Depreciation:
1930
1200
$106,171
68
$72,200
Building Attributes: Bldg 2 of 2
Field
Description
Style
Duplex
Model
Residential
Grade:
Below Average
Stories:
I Story
Occupancy
Exterior Walt 1
Wood on Sheath
Exterior Wall 2
Roof Structure:
Gable/Hip
Roof Cover
Asph/F GIs/Cmp
Interior Wall 1
Plywood Panel
Interior Wall 2
Interior Fir 1
Pine/Soft Wood
Interior Fir 2
Heat Fuel
Gas
Heat Type:
Hot Water
AC Type:
None
Total Bedrooms:
4 Bedrooms
Building Sub -Areas Legend
Code Description
Gross
Area
Living
Area
BAS First Floor
1248
1248
FEP Porch, Enclosed, Finished
351
0
UBM Basement, Unfinished
1248
0
f
2847
1248
Building Photo
(http://Images.vgsl.com/photos/YarmouthMAPhotos//\00\01
\05/38.Ipg)
Building Layout
http://gis.vgsi.com/yarmouthma/Parccl.aspx?Pid=1289
2/23/2015