Loading...
HomeMy WebLinkAboutBLD-18-0009472 ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department 1146 Route 28, South Yarmouth, MA 02664.-4492 of 508-398-2231 ext. 1261 Fax 508-398-0836 Massachusetts State Building Code, 780 CMRe Building Permit Application To Construct, Repair, Renovate Or Demolish a One- or Two -Family Dwelling This Section For Official Use Only Building Permit - - Date Applied wildiugOfficial(PrintName) Signature _. Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map &Parcel Numbers /;I 1v Q411 a1QLC 'D0 4 Map Number Parcel Number 1.1a Is this an accepted street? yesj< no 1.3 Zoning Information: 1.4 Property Dimensions: KAtEmtou ({ I W"6 Zoning District Proposed Use Lot Area (sq ft) Frontage (ft) 1.5 Building Setbacks (ft) Front Yard Side Yards Rear Yard Required provided Required Provided Required Provided 1.6 Water Supply: (1vLG.L c. 40, §54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public ❑ Private ❑ Zone: _ Outside Flood Zone? Check if yes❑ Municipal 13 On site disposal system ❑ SECTION 2: PROPERTY O�VNEERS>�t Ownerof Record, A)O -Ce s v�4 /'' nJaC'� Lis M , rJ �.- D � . �2Ko J M,+ - Name (Print) cm, State: /1 �i N.6l�fr r/�eE�e �2i"V 7 -319-S YlleslaLlgnl 'HM/L •C _ No. and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORle(check aIl that apply) New Construction ❑ Exisiing Building $, Owner -Occupied ❑ Repairs(s) ❑ Alteration(s) Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Spe (i E 9 V E D Brief Description of Proposed Worle: L Ann 21 ?gni7 BUILDING DEPARTMENT . SECTiON 4:: ESTIMILTFD CON.STRIIGTIQIV•COST Item Estimated Costs: 'Of£tc'ialUse'Oitly':r''c`,...' :...._ aborandMaterials) ;.' : >' ''' 1. Building $ )0oo 0.:1. BuildmgFe itFee:-$ ") Indicateiiowfee-Udetetmiried 'Standard City/TtiwnAppfi_c'atioriFee.'-.- 2. Electrical $ ❑.T6talPr6jectCos ainuliipliei 3. Plumbing $ 4ep . 2; Other Fees. - _ .. . . J 3... -.. List 4. Mechanical CHVAC) $ 5. Mechanical (Fire TotalA712ees: pc�A ommt .. Cash tm aPaidhrF�a,1T-r.�l'O;uts1i14naBalaiica.Dn:- Suppression) $ 6. Total Project Cost $ 2,C108 � SECTION S: / r—Name nstruction Supervisor License (CSL) f CSL Holder State, uic uv 5.2 Registered Home Improvement Contractor (HiC I Company Name or F.L SER,l:10ES License Number 'Expiration DateDate List CSL Type (see below) Type Description SF I Solid Fuel MCRe� beon um r FSP Date Email address CitylTown, State, 22TG.L. c 152. g 25C(6)) SECTION 6: WORKERS' COMPENSATION IN.S RANCE, h AVIT (Mlication Fa lure to provide Workers Compensation Insurance affidavit must be completed and submitted with this app this affidavit will result in the denial of the Issuance of the building permit No ........... ❑ Signed Affidavit Attached? Yes C ^TTS A mrnv -P( RE COMPLETED WHEN 1, as Owner of the subject property, hereby authorize_ Qermit aPP lication. to act on my behalf, in all matters relative to work authorized by this blEdino p Date print Owner's Name (Electronic Signature) TION SECTION 7b: OWXERl OR AIITHORIZED AGENT DECLARA naYies of perjury that all By entering my name below, I hereby attest under the pains and ped contained in this application is true and accurate to the beat of my kMowledge and understandinformation ng. of the hr4141JI/A / G Date owner's or Name (Electronic Signature) a 1VV 1L�% ermitto do his/her own wo k or an owner who hues an mree stere contractor 1; . An Ownex who obtains a b rildin, P C Pro am will not have access to the arbitration (not registered in the Home Improvement Contractor (HI) gr )+ program or guaxmty fund under M.G.L. r. 142A. Other imposbat information on the HIC Program cube found of w �v m_ ars_ aov/oca Information on the construction Supervisor License can be found at www.m� s 2 When substantial work is fanned Provide the nformation b glow: (includizlggarage, finishedbasementlattics, decks of porch) otal floor area (sq. ft)1 Habitable room count Gross living area (sq. ft.) Number of bedrooms Number offireplaces f — Number ofhalfbaths D Number of bathrooms y Number of decks/ porches �— Type of heating system i . Gi EnclosedOpen Type of cooling system 3. "Total Project Square Footage" may be substituted for "Total Project Cost' Name The Commonwealth of Massachusetts Department oflndustrialAccidents 1 Cone ess Street, Suite I00 Boston, MA 02114-2017 www. mass.; ov/dia vr'orkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le blF Address: E d���,J6Q/e �JA-c vc City/State/Zip: qwyyo d A H - Are you an employer? Check the appropriate box: Phone #: j 1 j- 3 9 9 %c I.❑ I am a employer with employees (full and/or part-time).* 2.❑ I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp, insurance required] Ir❑ I am a homeowner doing all work myself [No workers' comp. insurance required.] r 4.® I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 4M am a general contractor and I have hired the sub -contractors listed on the attached sheet These sub -contractors have employees and have workers' comp. insumnce.t 6.❑ We are a corporation and its officers have exercised their right of exemption per MGL C. 152, 31(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 7. ❑ New construction $. ® Remodeling 9. ❑ Demolition 10 ❑ Building addition I I.❑ Electrical repairs or additions 12. ❑ Plumbing repairs or additions 13. ❑ Roof repairs 14. ❑ Other ;Any applicant that checks box kl must also fill out the section below showing their workers' compensation kpolicy information - Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating auc *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 h employees. If the sub -contractors have employees they must provide their workers' camp. policy number. I am an employer that is providing workers' compensation insurance for nV employees. Below is the policy anal job site informadon. Insurance Company Policy # or Self -ins. Lic. Expiration Date: Job Site Address: City/State/Zip: 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 fie 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. do hereby certify under the pains and penalties of perjury that the information above is true and correct v Date: 01,05 Phone #: �f%` p ' �/� � -50 q 9 Official use only. Do not write in this area, to be completed by city or town official, City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town CIerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone ..Y 6`r MATT MC�Ct ti's 6 TOWN, OF YARMOUTH BUELDING DEPARTMENT 1146 Roue 28, South Yarmouth,1VlAk 42664 508-398-2231 ext. 1261 PLEASE PRINT: DATE: 1.� JOB LOCATION:(_Y NAME "HOMEOWNER" — A)Vrxa a 5 NAhE PRESENT MAILING ADDRESS CITY OR TOWN HOMEOWNER LICENSE EMOTION 46q OF TOWN P I L U/-3 Kf ,5 077 HOME PHONE WORKPHONE STATE ZIP CODE The current exemption for `Homeowner' was extended to include owner — occupied dwellings of one or two units and to allow such homeowners to engage an individual for hire who does not possess a license, provide_ d that such homeowner shall act as supervisor. (State Building Code Section 110 R5.1.3.1) Definition of Homeowner: Pers on(s) who owns a parcel of land on which he / she resides or intends to reside, on which there is oris intended to be, a one or two family attached or detached structure assessoryto such use and / or farm structures. A person who constructs more than one home in a two-year period shallnotbe considered a homeowner; such "homeowner" shall submit to the building official, on a form acceptable to the building official, that he / she shall be responsible for all such work performed under the building permit (Section 110 85.1.3.1) The undersigned `homeowner' assumes responsibility for compliance with the State Building Code and other applicable codes, by-laws, rules and regulations. The undersigned `homeowner' certifies that he / she understands the Town of Yarmouth Building Department minimum inspection procedures and requirements and that he / she will comply with said procedures and requirements. HOMEOWNER"Sr jmo APPROVAL OF BUILDING OFFICIAL INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL Ch.142. Yes No If you have checked, please indicate the type coverage by checking the appropriate box. A liability insurance policy . Other type of indemnity Bond 0 WNER' S INSURANCE WAVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent ILYVl.41GV W111YliGSG1$FJ TOWN OF YARMOUTH BUrLDING DEPARTMENT o - y 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1261 Fax 508-348-0836 V BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at_ tatnf' a.� e U Work Addre Is to be disposed of at the following location: \/(jrmc�u+-\ -towh zxa�, Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Signature of Application Permit No. 7-1-0 Date otky TOWN OF YARMOUTH HEALTH DEPARTMENT PERMIT APPLICATION SIGN OFF TRANSMI To be completed by Applicant: Building Site Proposed Nl N LL AUa q 2 2017 um� 6 Applicant: 4&/AC(. t;, S M(J &J4 S}; A 4 Tel. No.: �v - Og - S09'i Address: 19 N i 6 N (i N(a ALE Ilii: V (, SOU -0 Y&7 -MW 1 At MQF O Z64 Date Filed: **Ifyou would like e-mail notification ofsign of please provide e-mail address: Owner Name: Q N AC6 I S M&i� tvA, 4 Owner Address: Z1 A/iCA1;A GAL6 '�'Z ,SpU;�1 �(�1MDU tll� Owner Tel. No.:18;-381-5049 ©1,664 ...............................................................................................................................................................-............................................................................................................................................................................................... RESIDENTIAL AND/OR COMMERCIAL BUILDING HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. REVIEWED BY: Please submit three (3) copies of plans, to include: (1.) Site Plan showing existing buildings, water line location, and septic system location; (2.) Floor plan labeling ALL rooms within building (all existing and proposed) — ' Note: Floor plans not required for decks, sheds, windows, roofing; (3.) If necessary, Title 5 application signed by licensed installer with fee. PLEASE NOTE /� �caC�e - S 4u..0 1C✓ A� 1 1744 Zdy-e�1�..- f �K r IG JL l' --mak 9/8h� LOT N0.: g',-- ADDRESS : 4fT-ju&Atg, Di 014NERS NAME: SEWAGE PERMIT NO.: iZ- :�-.NEW: REPAIR: ✓ DATE ISSUED: DATE INSTALLED: INSTALLERS NAME: -ZC. L. INSTALLATION OF: ��"oe6itt�ibt� 1.�cobkt_Gt�E+� -io WATER TABLE: n '�,-FINAL INSPECTION BY: C r� QPrf&PWtP4roG DRAWING OF INSTALLATION ON REVERSE SIDE: I 0 TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-395-2231 ext. 1261. Fax 508-398-0836 FINISHED BASEMENT LIGHT AND VENTILATION WORKSHEET Ft. 134S Required Sq. Ft. of G14ss (b) 54,E IRC - 2009 R 303 7'1,6V (b) Amount of Glass Rec b. 59,60 55 fE 66ASS lvim90L,US : Z 5, 5 X50%= Z9,v0(c) Vent area required C. rv� aQo.vS ' 90o,21 20, 4/ SS f Mechanical Ventilation 0.35 Changes per hr. (a) or 15 c.f.m. per person, whichever is greater (a) Based on net floor area Ventilation system design to have capacity to supply airflow from table 403.3 Artificial Light An average illumination of 6 foot candles over the area of the room at a height of 30" above the floor is considered acceptable, except for bathrooms and toilet rooms should be 3 foot candles at 30" above floor TOWN OF YARMOUTH REVIEWED FOR BUILDING AND ZONING CODE COMPLI- ANCE. ERRORS OR OIIMISSIONS DO NOT RELIEVE THE APPLICANT FROM THE RESPONSIBILITY OF'AS BUILT' AUG '62017 COMPLIANCE. DATE: 8 ' ' )�%ZT� = :':i ^iP7 14b BUIL OFFI 5 25\ FILE COPY x I Ib � \ maIii EXERCISE ROOMHOUSOHEN� cr ytis �MACHINE x ATH. ° "O LAUNLAUND. AA i i PtO 9' tpx10' \e 5" 5" 5" 5" 5' i UP LEGEND: EXISTING WALL LAYOUT - NEW PLAN NEW WALL PAGE RESIDENCIAL PLAN 01/02 OWNER DATE JUNE/2017