HomeMy WebLinkAboutBLD-19-000060 . 1
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ONE & TWO FAMILY ONLY- BUILDING PERMIT
Town of Yarmouth Building Department
1146 Route 28, South Yarmouth,MA 02664-4492
508-398-2231 ext. 1261 Fax 508-398-0836 F
Massachusetts State Building Code,780 CMR
Building Permit Application To Construct,Repair, Renovate Or Demolish
a One-or Two-Family Dwelling
•(� This S on For Official Use Only
Building Permit Number: (YD4(1-,IVDU 01 u ' ' .Date Applied: •
' Building Official(Print Name) • Signature'„ ., Date
• SECTION 1:SITE INFORMATION • P C FE 1 tti. E i J l
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
39 lJPsl W( Jtlls ?.p
1.1a Is this an accepted street?yes 7` no Map Number Parcel Number AUb 21 2)18
1.3 Zoning Information: 1.4 Property Dimensions:
pep u�4tit JT
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft V�`�+ �vt=�} —�- ---
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
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Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public CI Private CI Municipal_ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 21 PROPERTY O WNERSHIP'
2.1 Owner'o Record:
Onw O ?JQrS t nMA 0710.1"ZNamee(Prim) V Vey W1 City,State,ZIP
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29 ,1� F
No.and Street y Telephone Email Address
' SECTION 3:DESCRIPTION OF PROPOSED WORK'(chep all that apply)
New Construction Cl Existing Building❑ Owner-Occupied ❑ Repairs(s) El Alteration(s) I Addition ❑
Demolition El Accessory Bldg.❑ Number of Units_ Other El Specify: —
Brief Description of Proposed Work': </timatQ 4 0.5107 14#11 ft like 111.1114; buil/ E 0
JUN 28 2018
SECTION 4:ESTIMATED CONSTRUCTION COSTS. t•
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Item Estimated Costs: Official'use n ', -- "
(Labor and Materials) •
1.Building $ 4 O( 1.'Building Permit Fee:$IcO Indicate hOw fee is determined:
2.Electrical $ 57)0 'h-Standard City/Toyn ApplicatioaFee . : ' .. . ':
$ jr - Do ❑Total Project Costs,(Itp;6);multiplier... : ' • •x '
3.Plumbing 2. Other Fees: $ • "j 5 0�/
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire
Suppression) $ Total All Fees:$
�� Check No. • Check Amount: ' Cash Amount.'• '
6.Total Project Cost: $ i J W 01' ❑Paid in Full. 19,Ontstanding Balance Duei I�
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SECTION 5:.CONSTRUCTION SERVICES
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• 5.1 Construction Supervisor LiFense(CSL) Cs- 51 I 1 • R•Za
1144441 L17e1 V`).,) License Number I_ ExpirationlDate
Name of CSL Hold
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w,JtCv 4, i I,l List CSL Type(see below)
No.and Street Type .. Description
CLAkiffrAN
n_ t/)9 633 U Unrestricted(Buildings up to 35,000 cu.ft)
AM R Restricted l&2 Family Dwelling
City/To State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
q b WPsw 'J SF Solid Fuel Burning Appliances
�� �9(? 9N5 cvc�kA, Insulation
Telephone Email address , GMM I.Coni D Demolition
5.2 Registerfdme I provement Contractor(HIC)
hi GHQ 2•ZN 2
Ik.LAL1 U�N HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
No.and Street
Email address
City/Town,State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AB'N'1LAVIT(M.G.L.c.152.§ 25C(6))
Workers Compensation Insurance affidavit must be 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 0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
' ' OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
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I,as Owner of the subject property,hereby authorize I'1;diq I LIN JQil/
to act on my behalf;in all matters relative to work authorized by this building permit application.
'('s Name �2r56102/3- 1
Print Owner's Name ectron' Signature) Date
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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 information
contained in this applicationistrue and accurate to the best of my knowledge and understanding.
M:Gf�l4j I ONdAon) 6.2% . ib
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
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NOTES: •
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A,Other important information on the HIC Program can be found at
www.mass.eov/oca Information on the Construction Supervisor License can be found at www.mass.aov/dps
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"
p0 The Commonwealth of Massachusetts
= _ < Department of Industrial Accidents
idl_ 1 Congress Street,Suite 100
ir SRW Boston, MA 02114-2017
,_,,.� www.mass.gov/dia
\Yorkers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): ;JAW I l
Address: 17 c aAlki 4,; D i1-, •
City/State/Zip:c IL4in ( MA 02(e 33 Phone #: SOS 9_8q 29*
Are you an employer?Check the appropriate box:
Type of project(required):
1.0 I am a employer with employees(full and/or part-time).*
7. 0 New construction
2.II am a sole proprietor or partnership and have no employees working for me in ,
anycapacity. 8. Remodeling
ap ty.[No workers'comp.insurance required.]
3.9 t am a homeowner doing all work myself. t 9. Demolition
y [No workers'comp.insurance required.]
4.❑I am a homeowner and will be hiring contractors to conduct all work on myproperty. I will 10 ❑ Building addition
ensure that all contractors either have workers'compensation insurance or are sol
P 11.0 Electrical repairs or additions
proprietors with no employees.
12.❑Plumbing repairs or additions
5.91 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.insurance) 13.0 Roof repairs
6.0 We are a corporation and its officers have exercised their right of exemption per MOL c. 14.0 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 contractors 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'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 DIA for insurance
coverage verification.
Ido hereby cer 'y rind to pains and penalties of perjury that the information provided above is true an(d�carted.
Signature: Date: " 2/�j ' l )
Phone#: V
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#:
• icydriR, TOWN OF YARMOUTH
" 7! c BUILDING DEPARTMENT
1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1261
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
DATE:
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JOB LOCATION:
NAME STREET ADDRESS SECTION OF TOWN
"HOMEOWNER"
NAME HOME PHONE WORK PHONE
PRESENT MAILING ADDRESS
CITY OR TOWN 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,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 assessors'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.
HOMEOWNER"S SIGNATURE
APPROVAL OF BUILDING OI-t ICIAL
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 yes,please 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
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
h:homeownrlicexemp
Information and Instructions ' .
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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,§25C(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 contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting 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 tot 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 the 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"Job 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 future 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 l-877-MASSAFE
Fax# 617-727-7749
Revised 02-23-15 www.mass.gov/dia
o 'Y TOWN OF YARMOUTH
<s- ! �c BUILDING DEPARTMENT
' o ''€ y. 1146 Route 28,South Yarmouth MA 02664
e63-4:—:"6131 508-398-2231 ext. 1261 Fax 508-398-0836
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BUILDING DEPARTMENT
DEMOLITION DEBRIS DISPOSAL AFFIDAVIT
Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter I, Section 1115,
[hereby certify that the debris resulting from the proposed work/demolition to be
conducted at 3W Li/4f itj J c, Q-D
Work Address
Is to be disposed of at the following location: T011° Of OgliJ t( 'rI/A-SW rj1:41,2n
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
ap r 1 , ection 150A.
4,-2870
Sign Lure of Application Date
Permit No.
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I' A Z nMww,vvw%i'r� 1 grminr%rdr//r c• Commonwealth of Massachusetts
Division of Professional Licensure .
Office of Consumer Affairs&Business Regulation , ®� Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR Construttidri lStlpervisor I
TYPE:Individual `
RegIstfatlorl, Expiration
'177949- =� 02/242020 CS-087537 Ex ires: 01/19/2020
Cu «-.=j;a6 l ,171 1,
MICHAEL LONDON',E I`:' a l' 1I �f
ju =_�: F"I'--1 t. MICHAEL LONDON
• i ;-?_-;f-1 i 15 COUNTRYSIDE DR II;.; •
1r`~��" ''• CHATHAM MA 02633 •
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MICHAEL LONDON-= =',r 6P-cf-D-S'-'- ' tft „
15 COUNTRYSIDE
CHATHAM,MA 02633 Undersecretary
Commissioner ei
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' ," I2/U3/ZUII U7:Ilam I I AU35 Face UI/UL -
®eancnnd. Double 1.314"x 9-1/4"VERSA-LAM®2.0 3100 SP Floor BeamlF1301
Dry)1 span I No cantilevers 10112 slope November 29.201716:39:59
, BC CALLS Design Report
Build 8080 File Name: Ayers Residence
Job Name: Ayers Residence ' Description:beam replacing wag
Address: 34 Westwoods•Kingsway Specifier.
City,State,Zip:Varmouthport,MA 02675 Designer: BC
Customer. Randy Smith Company: Shepleys
Code reports: ESR•1040 Misc..
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1.0000
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Total Herbront.i Product Length a 10-0000
Reaction Summary(Down I Uplift)(Ira)
twinelive Dead Snow wind Roof Live
BO,3.12' Z400/0 647/0
91,3-12• 2,400/0 64710
Load Summary UseDead Snow Wind Roof live TMS.
Tao Pnevtption• ' • Lead Typ. • ' Ref. Start End 180% ' SO% ' 115% 150% 123%
1 Standard Load • Un(.Ares(Ib/6.2) L 00-00-00 10-00-00 40 10 12-00-00
Controls Summary Value • LAA0cwable Dunton Can Location
Poe.Moment 6,935 ft-lbs 52.3% 100% 1 05-00-00
End Shear 2,399 lbs 39% 100% 1 01-00.12
Total Load Dell. I./465(0.246") 51.6% Ns 1 05-00-00 • ' 1.1thy.+}
Live Load Deft L1591(0.194'] 61% Ns 2 05-00-00
Max Del. 0.248• 24.6% Na 1 . 05.00.00 .
Span I Depth 12.4 We We 0 00-00-00
Squash Blocks Valid
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Mow
Bearing Supporta Dim.IL awl Value u, ort Mow Member Materiel ( .. .{ .
B0 Post 3.12'43.1/2' 3,047 lbs Na 33.2% Unspecified (_--•
81 Post 3-1/2"x 3.12' 3,047 lbs n/a 33.2% Unspecified
Notes
Design meets Code minimum(1f240)Total load deflection criteria.
Design meets Code minimum([/360)Live load deflection alter,.
Design meets arbitrary(11 Maximum Total load deflection criteria.
Calculations assume member Is fully braced.
Design based on Dry Service Condition.
Feet o'er Menufacturer:SImpaon Strong-Tie,Inc.
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®Soloecasasde Double 1-3/4"x 9-1/4"VERSA-LAM®2.0 3100 SP Floor Beam1FB01
B�ZCCALC®Deaign Report 81;Solos
11 span I No cantilevers10/12 slope November 28,2017 18:39:69
Build 6080 Fte Name: Ayers Residence
Job Name: Ayers Residence Description:beam replacing wall
Address: 34 Weatwoods•Kingswey Specifier.
City.State,Zip:Yarmouthpwt,MA 02875 Designer, BC •
Customer. Randy Smith Company. Shepleys
Code reports: ESR-1040 Misc:
Connection Dl gram • Disclosure
• — i--a Completeness and accuracy of Input must
DepuNrce0viy enydn•wnorreuldny0n
I I • OulDulas evloenq•fsuaa0ady 1pr
T 1 �' r• •F : � particular application.output here based
} . I on bolding codo-•ccepled&k
in
e
L• • properties and analysis methods.
inetallanon of Boos Cascada engineered
wood products must be in accordance with
current Inwalu0on Guide and appbable
• building codes.To obtain Installation Guide
e minimum•1.12'e a 6.1/4" or elk avestions,please cull
b minimum•6- d•12- (800)232 0188 bales Installation.
*minimum:1- BC CALM,BC FRAMERS.AJS'-
ALWOISTS.SCRIM BOARD'" et*.Install Screws With screw heads In the loaded ply. 50155 GLUCAN^'.SIMPLE FRAMING
Member has no side loads. SYSTEMS•VERSA-LAMS.VERSA.RIM
Connectors are;SDWZ2338 PLUS®,VERSA-RIMS.
VERSA-STRANOID.VERSA-ST are
trademarks d Bobo Cascada Wood
Ptoduols L.LC.
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(Master Suite
KINGS MY 11 I •
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.. Eliminate the
LivIn9 8 u n all door between
16'x1
` u:>•eerd ce;t;rq I'
Room t
� the existing
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}:itches) and
u- n. j
!I h,aiiFeay. •
Foyer GvA
1 9meM1IETA ova LW
1.Y It
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-Zeii
Kitchen "— 90" ceiling
This Wall Dinin ,I.,,, over current kitchen
• Rbeing_ i L
Removed ���'"�
_ i There
will be
Faj&lyibreaKfast a post here
ivaulted ceiling
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Garage
I'
Right First Floor — _ -.
I TOWN OF YARMOUTH
REVIEWED FOR BUILDING AND ZONING CODE COMPLI- 1
ANCE. ERRORS OR OMMISSIONS DO NOT RELIEVE THE (�
APPLICANT FROM THE RESPONSIBILITY OF'AS BUILT :y ALE. C
PI
COMPLIANCE.
DATE: M-3-#/a
BUILDING BING OFFICIAL
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Guest Suite wises
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