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HomeMy WebLinkAboutBLD-19-000642 i ' 6k t ONE & TWO FAMILY ONLY-BUILDING PERMIT ' Town of Yarmouth Building Department os 'r - . . 1146 Route 28,South Yarmouth,MA 02664-4492 ittitit% 508-398-2231 ext 1261 Fax 508-398-0836 Massachusetts State Building Code,780 CMR Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling . • This Section For,Official Use Only BuildingPermitNumber. 30-/9-DOIW)—Date Applied: a • . . • � • r• �tA� ..• ' , . .. • --16-18 Building Official(Print Name) Sigiatore. . . Date. . • - SECTION 1:SHE INFORMATION • 1.1 Pre Address: 1.2 Assessors p&Parcel Numbe 53 Woptr-ri=`rine Dan /Ot. // 1.1a Is this an accepted street?yes 1.7 no Map Number Parcel Numb R L C E ! V E Lr 1.3 Zoning Information: 1.4 Property Dimensions: I Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) LH 1 7 2018 1.5 Building Setbacks(ft) I Bili, �%- ! 1 ' Front Yard Side Yards Rear Yat `d=- - j -/�/ Required Provided Required Provided Required Provided 1.6 Water Supply: (MCI.c.40,§54) 1.7 Flood Zone Information: • 1.8 Sewage Disposal System: Public CI Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ • \ Check if yes❑ • ' • SECTION 2t PROPERTY O`VNERSBIP' . 2.1 Owner'of RJc0TC-r�d: CNARLcs e, V3r 3.TFVFi Ypep nnertl Cry 14A.. e?(r75 • iv Name(Print) City,State,ZIP 53 VVN 1r$"ciLt4b 548.36.4•703/ . st • . A ,; ._ . / . No.and Street Telephone .sail . '' SECTION 3:.DESCRIPTIQNOFPROPOSED WORlir(checkallthatapply) `' New Construction I Existing Building❑ Owner-Occupied ie Repairs(s) ❑ ( Alteration(s) ❑ Addition ❑ Demolition Ve Accessory Bldg. ❑ Ntber of Units___ Other ❑ Specify: . Brief Description of Proposed Workl: ni4raz p E)((ST l/1i 7 Lpy1 L_O Q•�_ in-i4 hr 4 . (_m ,I p ,VSs= C I I : �D i AN 0 L- . . v . r; ` r_.-i v 14 • i G • '. ., . : SECTION 4i ESTIhi IATED CONSTRUCTION COSTS. f ...�_�- . ., Estimated Casts: � � Itemd ?ciaUse Ony,':', ".. °.:nihc uEaai;i ,Lr�T i (Labor and Materials) :.:;.': : Of? l 1 1.Building $ 7m 3 Dri,f U:1: mldm .B ?Permit Per SII 5' Indicate how fee is deter�iied: 2.Electrical S en �9.Standard CitylT9wa App.&cation pee.` :, ' ":, 1: ' j1 !Ji'•oU ❑Total Project Co • ,tt p) multiplier... • . lx_ 3.Plumbing $ 2: Other.Fees: 5 4.Mechanical (HVAC) $ - 5.Mechanical (Fire Suppression) $ .Teti... Il Fee's:S ✓ 6.Total Project Cost $�� Check Nd: • Chick Amount: Cash.Amount_• • t0 6 Paidm'Fuf ` 511 Outstanding Balance Due15 • •- SECTIONS:.CONSTRUCTION SERVICES . ��• 5.1 Construction Supervisor License(Ca) License Number Expiration Date , Name of CSL Holder List CSL Type(see below) No.and Street Type Description U Unrestricted(Buildings up to 33,000 cu.ft.) City/Town,State,ZIP R Restricted 1 ea Family Dwelling M Masonry RC Roofing Covering . WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor CHIC) HIC Company Name or MC Registrant Name HIC Registration Number Expiration Date No.and Street Email address City/Town,State,ZIP Telephone SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6)) Workers Compensation Insurance affidavit mustbe completed and submitted with this application. Failure to provide • this affidavit will result in the denial of the Issuance of the building permit Signed Affidavit Attached? Yes ❑ No ❑ SECTION 7a:OWNER AU'lliORIZATION TO BE COB]PLE t LL WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUELDING PERMIT . I as Owner of the subject property,hereby authorize to act on my behalf in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Siamat*he) Date •SECTION 7b: OWNERl OR AU'ilORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding., CHA i-ea �-•S-r , 15 13 • 1F3 Print Owner's or Authorized Anent s Name(Electronic Signature) Date NOTES: • 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an lmregistered contractor (not registered in the Home Improvement Contractor(MC)Program),will not have access to the arbiaation prorogam or guaranty ford under M.G.L.c. 142k Other important information on the HIC Program can be found at www.mass.sov/oca Information on the Construction Supervisor License can be found at www.mass.eov/dns 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage'may be substituted for`Total Project Cost" ��_ _Department oflndustrialAccidents 2•isiort 2 . 1 Congress Street,Suite 100 • • L '� Boston, NIA 02114-2017 � .� www.mass.gov/dia %Yorkers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Apolicant Information • Please Print Legibly Name(Business/Organization/Individual): �L\PSJ E-1/2 I STEvC /2 Address: 53 LOl}ITt. We,c v ROAP t/ I Ne City/State/Zip:YAremOotie r:T. la 0261-shone#: 9oe 2z 4 Zsa L Are you an employer?Check the appropriate box: Type of project(required): L❑1 am a employer with employees(full and/or part-time).• 7. Erilew construction 2.01 am a sole proprietor or partnership and have no employees working for me in ny capacity.[No workers'comp.insurance required.] 8. 102/Demolition 3.V�I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. l�Demolition 4.01 am a homeowner end will be hiring contractors to conduct all work on my property. I will 1 ❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.V❑Electrical repairs or additions proprietors with no employees. 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet 12.❑Roof r- repairs or additions These sub-contractors have employees and have workers'comp.insurance) 13.❑Roof repairs 6.0 We are a corporation and its o6cers 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 511 out the section below showing their workers'compensation policy information. Homeowners who submit this asdavit indicating they are doing all work and then hire outside contractor,must submit a new ai5davit indicating such. :Contractors that check this box must aaached an additional sheet showing the name or the sub-contractors and state whether or not those entities have employees. If the subcontractors 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 Insurance Company Name: • 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 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 DLA for insurance coverage verification. Ido here. • •.. . . Joins • ,tom_ es of perjury that the information provided above is true and correct Sinn re: 44 Itini, C Date: ' '3 ( ' tA ✓ Phone,'.': 570 c3• c.di .988 O8 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 Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone At: es•r``Llt 1VVV IN 1111 YAICLV1VU1t1 $- BUILDING DEPARTMENT 1146 Route 28, South Yarmouth,MA 02664 508-398-2231 ext. 1261 HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: • ✓ DATE: • JOB LOCATION: .1EV.t l5 53 tiii i E?nck?O NAM STREET ADDRESS SECTION OF TOWN "HOMEOWNER" C,tis►? 5.5«llnds i 8,314:Tag( NAME HOME PONE WORK PHONE PRESENT MAILING ADDRESS 155 (04p InnIZ_�d0,p 'YikiZrincril ?Q i 4A n26 7 5 CITY OR TOWN STATE ZIP CODE The current exemption for 'Homeowner' was extended to include owner—occupied dwell inn of one or two units and to allow such homeowners to engage an individual for hire who does not possess a license,provided that such homeowner shall act as supervisor. (State Building Code Section 110 R5.1.3.1) Definition of Homeowner: Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is or is intended to be, a one or two family attached or detached structure assessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be 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 R5.1.3.1) 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. ��� e Agcsi HOMEOWNER'S SIGNA31 _ 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. eD No If you have checked vesplease indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of indemnity Bond OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by . = ^ • s. General Laws and that my signature on this permit application waives this requirement. Teta 1 Check one: Signature of Owner or Owner's Agent Owner Agent h:homeownriicexemp • Information and Instructions • '+^ Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§250(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contact for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contacting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es) and phone number(s) along with their certificate(s)of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial • Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at Me bottom • of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant . Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"lob Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for faMre permits or licenses. A.new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit The Department's address,telephone and fax number: • The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 • Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-NLASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia VT V 1\ :elSo BUILDING DEPARTMENT i £ 0-3 1146 Route 28 South Yarmouth MA 02664 • "---as GCS 508-398-2231 ext 1261 Fax 508-398-0836 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to MEL. Chapter 40,Section 54 and 780 CMR, Chapter I, Section 111 S, [hereby certify that the debris resulting from the proposed work/demolition to be conducted at L' k• r, ! A( •OT DRT NA , (5267-5- Work X75Work Address Is to be disposed of at the following location: A awl! ' X11 161J Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. 4Iej 1.;11.• Era stars 7. Signa a of Application Date Permit No. ot.-Y-_'.A TOWN OF YARMOUTH • .etn io �� HEALTH DEPARTMENT o �` �Vr PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Building Site Location: 3 a k s _ % is. 9 Pro.osedImprovement t. s • £ LA ' i. tC Applicant: aT=5 £/-0F fh Rz tP.117 Tel. No.:,.0Y4 , Address: �J3 1 t -)14-1- i K-0(D_ V 4p Date Filed:�, 7 c?,o, 43 **Ifyou would like e-mail— notification of sign off please provide e-mail address: (�r2�1 f lan gl bniv �.�C'1 Owner Name: lJF,�� j`� f Pl�,Al2L 1Srv.)51, �S) I Owner Address 55 L u-f ria i 1i D, \AgivrOdiltigeOwner Tel.No.:Spm 3,4 Vs/ 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. 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. REVIEWED BY:IQ CJCe(C�1.ttn=c/ DATE: / �-�� V PLEASE NOTE COMMENTS/CONDITIONS: • • YARMOUTH WATER DIVISION /645-1r 99 BUCK ISLAND ROAD WEST YARMOUTH, MA 02673 • PH.: 508.771.7921 FAX: 508-771-7998 • BUILDING PERMIT APPLICATION • DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET Bldg. Site Location , I TF jun vaAD —YR= star Proposed Im Po P rovement: '� /1��vr ,�einFnl l i Applicant: t L t .--_x)1-1 Address 53 tptilTZZAAD Tel. #: 503.111-1 .2S Date Filed: 7. 20 , RESIDENTIAL AND / OR COMMERCIAL BUILDING Water Department: Determines Compliance of Water Availability and or Existing Location • Engineering Department: Determines Compliance for Parking and Drainage Conservation Commission: Determines Compliance to Wetlands Acts; i.e. If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Ocean, Bogs, Bays, Marshland, Etc... Health Department: Determines Compliance to State and Town Regulations, I.e., Requirements for Septage Disposal and other Public Health Activities Fire Department: -------07 ermines Compliance to State and Town Requirements for Personal, .f-.. Property Protection;, I.e. Smoke Detectors, Sprinkler Systems, Etc... a !S Sigr a ap:icant Date PLEASE NOTE: • COMMENTS: • ItAC / Re creed Wate Won • Dae v4=Y'`1h4 TOWN OF YARMOUTH V ` x'r'r-4',03c 1146 ROUTE 23,SOUTH YAR31OUTII,MASSACIIUSETTS 02664-4451 JUL 3 l r.,,,,, ,, Telephone(503)393-2231 Ext. 1292 Fax(508)398-0336 JB OLD KING'S HIGHWAY IIISTORIC DISTRICT COMMITTEE OLDKING��OUTH SHIGHNAy AMENDMENT FORM ("MINOR CHANGE REQUEST") A minor change request must be submitted within one year of the original approval date or while the work is still in progress. Only a minor change may be approved by the Committee without the filing of a new application. PLEASE TYPE OR PRINT LEGIBLY Original Application #: !S'• L---2>e 7 Original Approval Date: 7—/ 7 / R Address of proposed work: .S3 OA,---e /40G,< fad- / Owner(s): (�FLZ�-r21 1=6 ( �L.�( i t /s+1rc Phone#:1S08 . .21-6.k. 2°i7 ) Ne Mailing address: S f / 7 LA S _ �. Email: 9‘r al/In P t A'IYJa rtlsvvA.neatPreferred notification method: Phone✓Email_USMail Agent/Contractor: f3OJYY\ P12- Phone#:'Opp. 3q..2c)3( Emaill� dA / . Ai" 7^, {„ / a Preferred notification method: Phone V Email Please describe proposed change(s)and attach plans/photos(as necessary): y •� JUl 3 2 ��� � ,ll) Tvy✓N CLERK Signed(Owner or A.- - ��[7 i-✓ Date SOUTH YARMO( { MA ✓ Approved by OKH Denied by OKH New C/A required? _Yes No NvA+ d Reason for Denial: �# FIC�Rv,..�� E JUL3j YARiviotlf OLD KING'S HIGHWAY Signed OKH Chairman (-7,‘". cS Date 7/3//2 0/1' AMENDMENT# 1 v — E 0 A 7 _ fl I 11/2015 * ,,,, TOWN OF YARMOUTH f.. 't .'; , - 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451 Telephone(508)398-2231 Ext. 1292-Fax(508)398-0836 ` `"'" 'vEOLD KING'S HIGHWAY HISTORIC DISTRICT CO , EEEg 172018 EGEIVED APPLICATION FOR TOWN CLERK CERTIFICATE OF EXEMPTION JUL 1 3 2018 SOUTH YARMOUTH, MA Application is hereby made for the issuance of a Certificate of Exemption under Sections 6 rtq g e{ gvsfy Acts of 1973, as amended, for the proposed work as described below and on plans, drawings, orphotographs— accompanying this application. Type or print legibly: \\ / Address of proposed work: S �I 4. ITETOn,L-R01?1..O Map/Lot# /6WS"7 Owners): `�(♦A(21 k 5 adi,=)m, ro T 6�11,/ Phone#: 5(3 6364 2P}3/ All applications must Tb�be submitted by ow j or accompanied by letter from owner approving submittalof application. Mailing address: kV 3 it(r-/e���17,312,Naso 1n2a7 I Year built: 11:78 Email: (�irA1�7�12I?U���. inaSYj ,j7F0CL, Preferred notification method: Phone _ ,f Email Agent/Contractor:r. 4 C.. ( P,Q 0 OWne-R_ �p Phone#:568 . ...04:, 2261 Mailing Address: 53 1_l )or Th o WI/. � II rzt.(QQ r p (C/ay 1 M/ cE.3 J u Email:_(�{>'c?f?/2/0[/9 , . �`D7. // Preferred notification method: Phone Email Descriptiontiof Proposed Work(Additional pages may be attached if necessary): V1CN 4NL f1-4C-E. T � Z LC--VEL9 K v )tfl 17CCte____ A5 0 o L cl>1 ASAcj p - � . =i► Signed(Owner or agent): ids Date: 7` iI ' 1.5- > Owner/contractor/agent is aware that a permit may be required from the Building Department(Check other departments,also.) > This certificate is good for one year from approval date or upon date of expiration of Building Permit,whichever date shall be later. For Committee use only: 1 Date: #7--/-3-1 ` Approved Approved with changes Py,fftl2ttiled - ALWED Amount (.20 Reason for denial: �/ JUL 1 7 r r—R Cashe9,f: 1 / v YAKtwtJurH Rcvd by: 41/ OLD/OA/66 HIGHWAY • Date Signed: .7A 7 '7-1 Signed: Z'���w��'v C U(• ✓ APPLICATION#: ik-bro(-)J VS 2017 R . Sears, Tim From: Sears,Tim Sent: Thursday,August 9, 2018 3:25 PM To: 'grampian@comcast.net' Subject: 53 White Rock Rd Charles, I have reviewed your application for 53 White Rock Rd,and there are some items to address; 1. The plans show mahogany posts embedded in concrete. Mahogany is not a preservative treated lumber and the code does not allow it to be used that way 2. All deck beams are required to be directly supported to the footing, not bolted to the side of a post 3. The end beam shown on the plan is a single,and are required to be double 2x Please update your plans and submit for review. Here is a link to the deck construction guide(2015 version)for your convenience; https://www.awc.org/codes- standards/publications/dca6 Thank you Timothy Sears CBO Building Inspector Town of Yarmouth 508-398-2231 Ext. 1259 mailto:tsears@varmouth.ma.us /dU6 10 2018 zPAI.lMLyT ' or a sus °`i' J• 1 RECEIVED JUL 1 2018APPROVED RECEIVED • TOWN CLERK JUL 17 2018 JUL 1 3 2018 SOUTH YARMOUTH, MA YARMOUTH YARMOUTH '} .,. _i • • KING'S HIGHWAY OLD KINGS HIG i , Yt tif.. • ^. to `^ �w `l' l' I •'Aa _ • } 4 ...`� Y,a �\. • r4ll�� til`�t if ' t • s n p( 4.0., 1/4:-,,.? ,v Y 'P,.. I I.�L a i. /•,iJv M i bac ? 4 4)1j�i, r hti• 1 :l ` v , 1 � 1 �\Ij r,* Kee. '• Idt� •. 44.11 DRi A ti i1 /1. f ,,,,,,1/4_,:.7,...:,. lf'�:Ai ,i. � .s •...:;z: ,,,„4 ^tisi._^i �• f' 4. A Zi'�f 4.` "�, .y'�`'4{, f ''.•' 6'*r rYSyy°y .4% 7J' 4.'.$ ••1� C ! S. {. 4 ` rhti'•• 4 \' i- �e rh +r.. y Q•1T • f 1.4 11.�'li 154, y t\ • )t:fp - 1'-O". . 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