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HomeMy WebLinkAboutBLD-19-000805 • . E c ?/is// ONE& TWO FAMILY ONLY-BUILDING PERMIT Town of Yarmouth Building Department / n ..� 1146 Route 28,South Yarmouth,MA 02664-4492 / '.- ' 503-393-2231 ext.1261 Fax 508-398-0836 ^ ` Massachusetts State Building Code,780 CMR . / S-39S-0836it- - MassachusTo Construct,Repair,Renovate Or Demolish t :..7s ' D a One-orTwvo-FamAyDwelling -.Lit{s 7(y dl lf` 1 r, )11 P� This Section PorOfAeial Use Only _ Building Permit Number ._ /�/, /�'-IDDf[ $j Date Applied: 1i• ----- - _ , IMPART TENT M . AO •. ) -71F4 Building Official(Prim Nana) Signamua bate .. SECTION Is SITE INFORMATION - 1.1 Property Address: 1.2 Assessors Map&Pared Numbers /33oreecod C.e..r.1e /34 .o a/3-)L 1.1a Is this an accepted street?yes no Map Number Parcel Notate( 1.3 Tiring Information: IA Property Dimensions! IIA- 1114. Zoning District Proposed Use Lot Am(KM . frontage(f) 1.S Building Setbacks(ft) Front Yard Side Yards Yew Yard ' Required I Provided Required Provided Required 'melded 01r- - }lIA is)re. DI t• • 0)1. Alli* 1.6 Water Supply:(M.O.L c.40,$34) 1.7 flood Zone Informations 1.S Sewage Disposal Systems Pablieft Private Zone: — Outside Flood Zone? Omit Ify AimtFeipe!O Altaltadl stow, SECTION 2s PROPERTY OWNEISIIIP'. 2.1 Owners of Record: Nate- '1\'amf 9�� City, ?oak_/414 X675 1� 3e+t-Waa C;erJb)mPrint) 1 Sag-SS1.9 0 _Yam31441aatt .eo. No.and Street Telephone Frush Malars • . ' " SECTION 3:.DESCRIPTION OF PROPOSED WORK!(chick all that Apply) - New Construction OExisting Building 0 Owner-Occupied 0 I Repairs(s) O .I Aheratlon(s% Addition CI Demolition 0 , Accessory Bldg,0 I Number of Units I Other 0 Specify` Brief i on of proposed Work2: T'anen i) 0.P ',leo Kf Q - er d; velot_tcf., o ' , SECTION 4t ESTk 1ATED CONSTRUCTION COSTS Estimated costs: , , _ ; Item (Labor and Materials) •. s:. CMlitiial Us?OAlj';'- = .._ „ '...' 1.Building ' $ /a,voo. 1:Building Permit Pe!.3 159 .indicate how fes is determine& 2.Electrical 8 Standard City/TownApplkatital i.'i;,: ,.;;. • 2 a'D O Total Project Cod11tam 6 xmukiplier x 3.Plumbing $ f Dov • 2:OOxrPses: f 4.Mechanical S.Mechanical (Fire _ • Suppression) S 0 Toln1 A11 Feeai i I '1 1- f„ S 6) 6.Total Project Cost: S Cheek No. : • Chick Amount - , ' Mount:_ /S,ODD 4OPaid InPull. . " ®AutstandingSWIM Dar JI5_ - ( AUG 08 cilia 1 °/ �A' 3 1 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) f, /9/959 =J / I Aran- 4 1`'1 ae. LiemnssNewiter a Name of CSL Holder /1 %CA? ( nos i� CSL Type(me w) N DeAsiffitiOti u . Urifsriaesd gtauidthr sive tor is sl9!_ y_i U Ma oa451 - restrictwi IA2Pari1vllsioniag C own,state,ZIP M Mev NC l$ re citta • W3 Window tact'Si&ii • SP Solid Pawl Hann A�liamaes Sag 97'4o i At r.... .Js.diste rnaie..n l Insataeioa Telephone Email address ly Deniotinen _ 5.2 Registered Home Improvement Contractor(MC) / � 4 _3-1 -ao/- M!To. and Jr o,1d ' a o mute . Zai HIC Registration Number HI CompmyName orHICNam Dna Lo t-CooJ�cefMie�er-AnASGJust nc-oPgag Coin Isle.and Street Email address t.�a•s tae/' MA or,313 5ofi776 Loa? City/Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AF1PtDAVIT(MAL .,(,1524 25C(71 Workers Compensation Insurance affidavit must be completed and submitted with this appli(atism Mare to provide this affidavit will result in the denial of the Issuance of the building permit, . • Signed Affidavit Attached? Yes Jr- No O SECTION 7a:OWNER AUTHORIZATION TO RE COMnLttID WIIEM - • OWNER'S AGENT OR CONTRACTOR A!PLWS FOR IWUILUIMO MIT I,as Owner of the subject properly,hereby authorise /Z?Poie 1 t8 t!.C le. to act on my behalf,in all matters relative to work authorized by this building panni(application. 5 N-c -Q, • 9- Prim Owner's Name(Electronic Signature) Vats SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the informsdion contained in this ia lc Is true and accurate to the best ofmy knowledge and understanding • Print Owner's or A t gem's Name(Electronic Signature) Vats NOTES: 1. An Owner who obtains a building permit to do hiaiber own work,or an owner Cites en imfegisMsfetl(oniwsetor (not registered hi the Home Improvement Contractor(WC)Program),will Id have seals lathe sbitratatn program or guaranty fund under M.O.L.c.142A.Other important Information on the IIIC Prom can be fated at www.mass.(ov/oc;Information on the Construction Supervisor License can be found et ottttatutorldou 2. When substantial work is planned,provide the Information below Total floor area(sq.ft) (including garage,finished basemen lstttics,decks or pont) Gross living area(sq.ft.) • Habitable room count - Number offireplaces Number of bedrooms Number of bathrooms Number ofhalf/baths - - Type of heating system Number of decks/perches Type of cooling system Enclosed Open - • 3. "Total Project Square Footage"may be substituted for"Total Project Cost" • • • The Commonwealth of Massachusetts • s c . ' Department oflndustrialAccidents • _ a; ' 1 Congress Street,Suite 100 ' — tt2 • Boston,MA 02114-2017 ` www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Ayr,l• a:Int Information • Please Print Legibly Name iBusiness/Organization/individual): Meyer and3 BijjVecS, nit, Address: 7.0:fi09.. 635 City/State/Zip:_l` • DA r! Znichq Phone#: 53_ -77-6.r.„(),17. Are you an employer?Cheek the appropriate box: Type of project(required): l l am a employer with o1. employees(full and/or part-time).• 7. ❑ ew construction 2I sin a sole p:opcctor or partnership and have no employees working for Incin I�J 8. Remodeling any capacity.[No workers'comp.insurance required.] 3.0I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. Demolition 10 0 Building addition 4❑I am a homecwner 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 i I.❑Eldctrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0 I am a genei al contractor and I have hired the sub-contractors listed on the attached sheet. 13.0ROOirepairs These sub-contractors have employees end have workers'comp.insurance.] t 6.0 We are a corporation and its officers have exercised their right of exemption per MGL C. I4. Other 152,h14i,and we hate no employees.[No workers'comp.insurance required.] • *Any applicant that checks box nil must also fill out the section below showing their workers'compensation policy information. t Homeowners u ho submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContrnet,ns that check this box must attached an additional sheet showing the name of the sub-contractors and state whether of not those entities have employees. If the sub-couiractors have employees,they must provide their workers'comp.policy number, I am on employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Namet_ Fr Q_-- e-ii C-, Intel'- \.-,• l ,(� Policy,forSelf ins.Lie.#:11351- • 0050tC5jQU •1ZOI3A ExpirationDate:_lO/,fl(� �] Job Sate Address: /J-- pfeu •t�¢.) City/State/Zip:l1�{,i swzp44t peak )` la. 0f iC Attach a copy of the workers'compensation policy declaration page(showing the policy umber and xpiration 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 cover:rne verification. Ida l:ordby certify under the pal es and penalties of perjury that the information provided above is true and correct. Sergi nonage t...c� L -�'' • Date: c—A -/X Phone#• S =--4ft`t. Oficial 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 tai iiealth 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.f Ihcr----- • Contact Person: Phone#: . • , • e o .1.4 '+ TOWN OF YARMOUTH 'e' l-,�, BUILDING DEPARTMENT N Y-1� t 1146 Route 28,South Yarmouth,MA 02664 . 508-398-2231 at.1261 Fax 508-393-0836 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 worWdemolition to be conducted at /5 -►SoxzJcod ce.ets L/At#DA POSL Work Address Is to be disposed of at the following location: ! o4( l/aei moi c#w p Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. I Signature of App c Date Permit No. • • --..'s-mill MEYEAND-01 KSEARS ACORO' ' ,CERTIFICATE OF.LIABILITY INSURANCE CAT!(MM/°DmYn �� 11/16/2017 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: H the certificate holder Is an ADDITIONAL INSURED,the pollcyQes)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject:to the terms and conditions of the policy,certain policies mayrequIre an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONOT • 1 Rogers&Gray Insurance Agency,Inc., • PH/c°M,,?o Ext); . I jet No);(877)816.2166 SouRteenn i,, mai( ro era ra o South Dennis,MA 02660 Wain, 9 9 Y-4 (D • INSURER(S)AFFORDING COVERAGE I NAIC0 • - • *INSURER A:Atain Specialty iheurance Company 17169 INSURED . . • INSURERI;Arbella Protectlon•Insurance Company,Inc. 41360 Meyer&Sons Builders,Inc. • INSURER c:Associated Employers Insurance Company 11104 322 Lower County Road , INSURER 0: Dennis Port,MA 02639, '' ;,INSURERe: • • .. . INSURER P: • COVERAGES 'CERTIFICATE NUMBER: 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 ISESCRIBED'HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. • 'NSA ADDLISUBR POLICY EFF POLICY EXP' ' LIMITS ITR TYPE OF INSURANCE INSO WVD POLICY NUMBER WM/DD/errn IMMIDDIYYYY) Al X i COMMERCIAL GENERALLIABILIT I I EACH OCCURRENCE $ 1,000,000 • I I CLAIMS-MADE n OCCUR .1 • CIP249032002 . 02113/2017102/13/2018 'CAIaAGE TO RENTED 100,000 PREMISSEESS IFe oaunenu) $ �y I • MED EXP one Dereon) $ 5,000 1 1 1 PER$ONAL&ADV INJURY $ 1.000,000 GENT.AGGREGATE LIMIT APPLIES PER •. I ' GENERAL AGGREGATE $ 2,000,000 X I POLICY j116 X LOC I I - { i PRODUCTS;COMP/OPAGG $ 2,000,000 I OTHER' • $ COMBINED•• SINGLE LIMIT B AUTOMOBILE LIABILITY • o• I I ( kecudenn $ ANY AUTO _SS EEpp 1020058645 . ' 09/06/2017109/O6/20'f5 BODILYINJURY(Perperson) $ RDpTO��SPONLY X AUpTNOpSyOVLEDO • BODILY 0.OPERINJURY TY DAMAGE aitlentl $ 1,000,000 �AUTUS ONLY X AOTOS ONt Y • . (Per accident) • $ 1i • $ • UMBRELLALIAB _ OCCUR EACH OCCURRENCE LS EXCESS LIAR CLAIMS-MADE .I' • • AGGREGATE $ DED RETENTIONS I • ' $ C WORKERS COMPENSATION I .• . X Pull ETH- AND EMPLOYERS'LIABILITY 'YIN • ANY PROPRIETOR/PARTNER/EXECUTIVE I. WCC-500.5016594.2017A 10/28/2017 10/28/201a f• EACH ACCIDENT $ 500,000 O0F�FICERIM Meep EXCLUDED? n NIA SOO,DOO IMantlato 'In NH) • • EL DISEASE•EA EMPLOYEE $ DS4uOOPERATIONSDBIOW • I .1..L.DISEASB-POLICY LIMIT $ 500,000 • I _ i •I I V DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICL!S.(ACORD 101,Additional Remarks Schedule,may be attached If more apace Is regU)red) • • CERTIFICATE HOLDER CANCELLATION .. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ' a THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN • ACCORDANCE WITH THE PdLIPY PROVISIONS. • • - • AUTHORIZED REPRESENTATIVE • _ 1 lir^ -`_ ACORD 25(2018!03) m 1988.2016 AdORD CORPORATION. All rights reserved. •The ACORD name and logo aro registered marks of ACOR• D •' • . , . :.. A • '{ER & SONS n n _. . Yarmouth Building Department 1. '\;r. & Mrs. Barnsley, as owner(s), hereby authorize Trevor Meyer of Meyer and Sons. l: :. re act as agent on behalf of the organization for all matters relative to the proposed n:im ation at 13 Boxwood Circle Yarmouthport MA. / 71 . /%% G //� 0 01 i :,n : Date Massachusetts Department of Public Safety Construction Supervisor t'sii` s Board of Building Regulations and Standards Restricted tb: Unrestricted-Buildings of any use group which contain License: CS-101957 less than 35,000 cubic feet(991 cubic meters)of Construction Supervisor • enclosed space. • TREVOR J MEYER •• e 322 LOWER COUNTY ROAD .141(1. 1 Ar DENNISPORT MA 02639' • • • Failure to possess a current edition of the Massachusetts Expiration: State Building Code Is cause for revocation of this Ilcehse. ' Commissioner 09/27/2016 DPS Licensing information visit: WWW.MASS.GOV/DP$ • • • • • • .• F . . i • • • • • • • • 27k / Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, MassacJ usetts 02108 Home Improvemenf'Contractor Registration IY 3 ;--_= Type: Corporation MEYER AND SONS BUILDERS,INC. . � i. Registration: 187252 JA Expiration: 03/19/2019 P.O BOX 635 —'}? J � SOUTH YARMOUTH,MA 02664 __' 4 -r F!+t__ as7 a i�s Update Address and Return Card. SCA1 0 201.4-05/17 &ge 9?o nonoaea,nalAofc /ca(/aaaacAaoelA Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:Corooration before the expiration date. If found return to: Aealstratioq\ Expiration Office of Consumer Affairs and Business Regulation 187257---,: 03/19/2019 10 Park Plaza-Suite 5170 MEYER AND SO 6Ugbh S 1t c. Boston,MA 02116 TREVOR J.MEYER,a ":v ii-; \R..G�' /�-- 322 LOWER COUNTY RQAD. (_.) a DENNISPORT,MA 02639/ Undersecretary Not valid liaut signature Office of Consumer Affairs&Business Regulation-Mass.Gov Page 1 of 2 rdi Mass.gov Office of Consumer Affairs and Business Regulation (OCABR) HIC Registration Complaints Registration # 187252 Registrant Meyer and Sons Builders, Inc. Name Trevor Meyer Address 322 Lower County Road City, State Zip Dennisport, MA 02639 Expiration Date 03/19/2019 Complaints Details rNo complaints found for this registrant. 1 You can also view arbitration and Guaranty Fund history. Back To Search Site Policies Contact Us https://services.oca.state.ma.us/hic/licdetails.aspx?txtSearchLN=187252 8/9/2018 Office of Consumer Affairs&Business Regulation- Mass.Gov Page 2 of 2 ©2012 Commonwealth of Massachusetts. Mass.Gov® is a registered service mark of the Commonwealth of Massachusetts. https://services.oca.state.ma.us/hic/licdetails.aspx?txtSearchLN=187252 8/9/2018 k . a • TOWN OF YARMOUTH REVIEWED FOR BUILDING AND IONING CODE COMPLI- ANCE. ERRORS OR OMMISS10NS DO NOT RELIEVE THE APPLICANT FROM THE RESPONSIBILITY OF'AS BUILT' COMPLIANCE. DATE: BUILDING ICIAL • FILE COPY • M ' -- . -- - --_ 705:'- - '- --`__'- _'- __38". . 14---28.• - - - 3g- - -e - 39• 21• r -104?--_--F -36"---T--_27-- --27•---0-__27•- _*-_21• 2T__'• Iii. ... ...... . .. .,.•_ , . Gall 2.Welter RAMSLEY 4 - - ---a-- 13 Boxwood Circle W9715 ; W3933 kW3933 1 W2133FR333 .,.._.� • • ro Yarmouth Port,SAA - W361524 FS . —w--w—, N rr.+.oe .JT. B27RT -4, B2? 1 BWB21F3303 N' ' Diamond Vibe calm-Mcple-Nabastx 5•Pieu Drawer Fronts 34•REP. Is �P 4 a • Countertop: chimney hood suggestionsWeston*Weston*satons Royal Reel haw N a Possibly Sink keeem9aehwesher urw rausaad ovd aaa- •y- -+= i /�� w/Inm9rel Drain Board new hedge,micro mow m led Orth • .H 11 Yr' with dram board on the Left range I-' • end vent add two racesse& • I•;--a_ SQ RANGE iI AN N _ _ a e .;-. 1 �J - T — It - m - ADn27 0.)P —y`-L3Dn1Q F330 t f... -- --__.s'n . „ 2)/1a326,1 stone's Witte 1 • Ai > Ar 1B• I N .I1/:- '- I +1sr •1r. -- . _ " 1"' .'^aa., t -33.,.._----33:--- ,_ _.. z7. ' --123•-- /1 oy 18•--/---30•---s-18•-k. .fink'-------78•`-- --- - _ - ss:' -------129:"------- -.TOW •• Designer:Gail O'Rourke - !This is an original design and must Designed-7/31/201R WHITE WOOT)KITCI TENSw.0E1-4sy 1 not be released or copied unless Printed:7/31/2018 Sandwich,MA/Falmouth,MA L .applicable t'ec has been paid or Joh Email:(jai Ciai l(hwhitelvoodk itchen.comiorder placed. 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