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ONE & TWO FAMILY ONLY- BUILDING PERMIT
Town of Yarmouth Building Department .. a `r
1146 Route 28,South Yarmouth,MA 02664-4492
508-398-2231 ext. 1261 Fax 508-398-0836 F %
Massachusetts State Building Code,780 CMRm�
Building Permit Application To Construct, Repair, Renovate Or Demolish
a One-or Two-Family Dwelling R CE:.f
• ' This Section For Official Use Only , - "�-
Building Permit Number: ; ,p- , ' m : Date Applied: S - _ N 1 t ,
-00
•
Building Official(Print e) - . ignature, - -, -�. )a7 NIEN
SECTION 1:SITE INFORMATION . ., ��
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
16 GRFYHAMPTON ROAD 76 32
1.1a Is this an accepted street?yes X no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions: r
R40 RESIDENTIAL NO CHANGE +I- 14,810 SF 133 FT
• 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:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP' ., '
2.1 Owner'of Record:
WILLIAM J MORAN NANTUCKET,MA 02554
Name(Print) City,State,ZIP
•
3 SKYLINE DRIVE 508-982-3533 APPRAISER@WJMORAN.COM
No.and Street Telephone Email Address
. " . SECTION 3:DESCRIPTION OF PROPOSED WORK' check Ml that a ly) •
New Construction 0 Existing Buildingcaner-Occupied Repairs(s) lb Alteration(s) Ball Addition ❑
Emolition ) Accessory Bldg.0 Number of Units 1 Other 0 Specify:
Brief Description of Proposed Work2: 'TW O C'e h Si' vc-t- `O Iy t g <keel
SEE EXISTING PERMIT,AMEND TO INCLUDE DEMO EXISTING DECKING AND REPLACE WITH COMPOSTIE DECKING AND RAILS
5FE PI AN ATTACHED
FQUlJ7 L/)-Nb tN et
SECTION 4'ESTIMATED CONSTRUCTION COSTS •-i,t;,'�,;.-,.,;_;, :- '
Item Estimated Costs: Official Use Only
1.Building $7,000 1. Building Permit Fee:$/j o-;Indicate how fee is determined:
2.Electrical $
0 Standard City/Town Application Fee r,.,:C "' '' :,:
OTotalproject Costs��t�6 xmultiplier "''-' ' x''' •..
3.Plumbing $ 2. Other Fees: $ �/ 0 :.,.' :_ .
4.Mechanical (HVAC) $
S.Mechanical (Fire
Suppression) $ Total All Feesf$ t . :—. ��
Check No: :; - Check Amount: ' ' Cash Amo .'
6.Total Project Cost: $ 7,000
O Paid in Full: . ❑Outstanding Balance Due:,..,:#251/He-
_e .
t
I
No
ONE or TWO FAMILY —BUILDING PERMIT
APPLICATION REGULATORY APPROVALS NOTICE
AMEND EXISTING PERMIT
Address of Proposed Work:
Scope of Proposed Work: 1.REMOVE EXISTING CONTRACTOR DUE TO INJURY,REPLACE WITH HOMEOWNER
2.REMOVE EXISTING DECKING AND REPLACE WITH TREX DECKING
SEE PLANS ATTACHED.
Date: 6/7/2018
Based on the scope of work described above,the applicant is required to obtain approval
sign-offs from the following departments as checked-off below: INITIALS
Health Dept.—508-398-2231 ext. 1241
Conservation Comm.--508-398-2231 ext. 1288
Water Dept.— 99 Buck Island Rd.phone no.508-771-7921
Old Kings Hwy.Hist. Comm.---508-398-2231 ext. 1292
Engineering Dept.—508-398-2231 ext. 1250
Fire Dept.—Kevin Iluck/James Armstrong,96 Old Main St. SY
Note: Please call Fire Department for an appointment.508-398-2212
Other
Appropriate plans and/or application shall be provided to each of the departments
checked-off above. Each of these regulatory authorities has their own requirements
outside the jurisdiction of the Building Department. All applicable approvals shall be
obtained prior to submitting a building permit application to the Building Dept.
Thank you for cooperation.
Receipt Acknowledgement:
6(24 4 NCririA- 6/7/2018
Applicant's Signature Date
Rev. Dec. 2015
The Commonwealth of Massachusetts'
M�i_ Department oflndustrialAccidents
r t =s!it 1 Congress Street,Suite 100
Boston,MA 02114-2017
.,;, www mass.gov/dia
Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITII THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): /h Cite mannan et.) /2:1)/
City/State/Zip: Phone#:
Are you an employer?Check the appropriate box:
Type of project(required):
1.0 lam a employer with employees(full and/or part-time).* 7. Q New construction
2.0 lam a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling
any capacity.[No workers'comp,insurance required.]
3.®I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. Demolition
4.0 l am a homeowner and will be hiring contractors to conduct all work on roe I will 10 ❑Building addition
ensure that all contractors either have workers'compensation insurance or are sole
p H.0 Electrical repairs or additions
proprietors with no employees.
12.0 Plumbing repairs or additions
5.❑I 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.Q Roof repairs
6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.®Other Demo&Replace
WIt.OmpOsitO Maui!'
152,$1(4),and we have no employees.[No workers'comp.insurance required.]
*Any applicant that checks box N1 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.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature: 6/7118
Phone#:
508-982-3533 Date:
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):
I.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
SECTION 5: CONSTRUCTION SERVICES
Si•
Construction Supervisor License(CSL) 1
License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
No.and Street ' Type , Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
City/Town,State,ZIP R Restricted I&2 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(HIC)
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 AFFIDAVIT(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 ❑
, SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
• OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING 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 Signature) Date
SECTION 7b:OWNER1 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 application is true and accurate to the best of my knowledge and understanding.
WILLIAM J MORAN 6/7/18
Print Owner's or Authorized Agent's Name(Electronic Signature) Date •
NOTES:
I. 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.uov/oca Information on the Construction Supervisor License can be found at www.mass.gov/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"
•
.1
To: Town of Yarmouth, Building Department
From: William Moran, Property Owner
16 Greyhampton Rd
West Yarmouth,MA 02673
Date: 6/7/2018
Re: Permit Change
1. Due a devastating injury to the contractor on the open permit, I request to amend the permit to
replace the current contractor with my name as owner of the property.
2. Upon completion of the project, it is my intent to utilize the property as my primary residence.
i
Sincerely,
i4.
Locus ;
NOT NOT NOT NOT I
vy}°`.
OFFICIAL OFFICIAL OFFICIAL OFF ¢ L / "-/ •
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- O1•Y'4R TOWN OF YARMOUTH
••, A.teas0 BUILDING DEPARTMENT
.,� � 1146 Route 28, South Yarmouth,MA 02664 508-398-2231 ext. 1261
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
DATE:
16 Greyhampton Rd,West Yarmouth
JOB LOCATION:
NAME STREET ADDRESS SECTION OF TOWN
"HOMEOWNER" William Moran 508x982-3533
NAME HOME PHONE WORK PHONE
PRESENT MAILING ADDRESS 16 Greyhampton Rd,West Yarmouth,MA 02673
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 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. � �
oc >J NOW- 6/1/2018
HOMEOWNER"S SIGNATURE
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 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 ' .
Massachusetts
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 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 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 1-877-MASSAFE
Fax# 617-727-7749
Revised 02-23-15 1 www.mass.gov/dia
a?c 10 Y l 30tST L f6 O Ceitt€ ..
APPLICANT'S COPY Dr‘ iRceok ea, t�r'CtlCQAu
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REVIEWED FOF B AWING AND,.ON NG CODE CU')iL
kNCE. ERRORS 0?OMM!SSIQNS 00 NOT RELIEVE h-
Ate ib im colkp�
APPLICANT FRC h. THE RESPON IBI.ITY OF �^�,1{ G �_^^A
PPLICANTF. AS B� _. klg.A .fe b D�Am-
DATE: 6 ^i /..
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I
16 GREYHAMPTON ROAD
I
PROPOSED AMENDMENT ATO PERMIT
17'
W 151
14' 2 42' g
o Study
E
Kitchen Bedroom Bathe Bedroom
"a
I_I r
14' Q_ a r
/// QYwr�,'ev; o Bedroom
—
A. Living 15'
a" Formerly
9'
'per$ I
ro sem „ N �'1 / I I "'I
Garage
+ AL eck
Fa
14' Patio
_,... i
/-1\
1 , .. ) ,
•
..... 1,
,/ ] f N,
aaila
Tur#lmml ot.a node,K Area Calculations Summary
Living Area Si. ......,:.:«_:.:mss..:- .. _ .... ..: _. . . Calealatian Detalla,�'.. _ .._,.. ... ...
1st Floor ..................�.�....2252 Sq,R�._........ .....,..,.....�.... 24 x 15. 360
17 x 6 - 102
14 x 14- 196
24 x 33- 792
II 26 x 23- 598
12x17- 204
Total Wing Area(Rounded): 2252 Sq ft
9 a,_'''...».;.»., n+-"r"`re"'W.«e..n—,ane.,"'"7"stenoill,""ern""raum ..w..r.�s--..
on•8vin Areae,._...,._....,....w.�,....M.�..m...._.:...:,...__.�...... ., ..._.._...�.,a... ....•w..W.,..._.....,.._.:W .W.., .,..:., :;.a_,..� . ,,c -....:..,,.`.... -
Porch 24.5 Sq R 7 x 3.5 -24.5
Porch TOTAL Sketch affrAtiby ala mode,Inc.1.800alamode 14 x 19- 266
2,c 10 P t ooist @ tel o ceitteeg.
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co(mee�a.�FO �e. RTOWWED N OF YG oRYOU20111\G T COMP I-
`Qyiip� - . . At CE. ERRORS C R )MM!SSIONS C 0 JOT RELIEVE IF E nM►9'S4��e
Al PLICANT FRO?, T 1E RESPONSI;IU TY OF'AS BUI '
corite"
:CM.pLIANCE ��
DATE: a � LO ��� (1rv�1K�11
E 0 _DING OFFIC gftl e�5 4, op CQ ..
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16 GREYHAMPTON ROAD
PROPOSED AMENDMENT TO PERMIT
17' Ew 15' m
14' T 42'
LLKitchen Bedroom Bath Bedroom
a Study
a
n o i—i a
St
r 1a / 1 e�ItFaR o
'l
i Bedroom
L — - ScAlti Livfng 15'
N Formerly41 9 n �+I
ri pt, Garage
eck
74
ti
la Patio
Yr
I� ube ,,,. __7_ft'- -11IINI�II
,,,s,
„a,
........
i hoe,
i !IUUU Ill
,cv'
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TOTS X1ch by it a"lode,Inc. Area Calculations Summary
Living Area,_ - Calculation Details -
......._.,...._.,_._........._..................:.......-_.,.....»..... ......,«., ....._..,......_..__._.._.... .�_3....
1st Floor 2225252 Sq ft 24 x I5 = 360
17 x 6 = 102
14 x 14= 196
24 x 33= 792
26 x 23= 598
12 x 17= 204
Total Living Area(Rounded): 2252 So ft
Non-Ilving Area-^ .,..-,.N,,.. .. ... ., _.>...2 -.-,.,,. -•- —..., . ,..,. _._._. ,.
_.......,._......._....._..,._. .. .,, ._._._._..... 4. .._ .,_ . ....._�.._._ ...._..._
Porch 24.5 Sq R 7 x 3.5 == 24 24.5
Porch TOTAL Sketch sgby ala mode,inc.1-800-alamode 14 x 19= 266
Y
`V
pets-Y4TOWN OF YARMOUTH Building Department BUILDING
a•E0 (508)398-2231 ext.1261
0 t y PERMIT NO +BLD-17-002.664 v PERMIT
��••.;�,;s\ ISSUE DATE ;721o7no16 JOB WEATHER CARD
APPLICANT ;NIALL J HOPKINS 1 PERMIT TO : Alteration
AT(LOCATION) 116 GREYHAMPTON RD,WEST YARMOUTH, MA 0 I ZONING DISTRICT 1R-40 I Bldg.Type: (Residential
SUBDIVISION MAP BLOCK LOT 076.32 BUILDING IS TO BE: CONST TYPE V B USE GROUP 1R-3
REMARKS Alteration-per approved plans dated 11/22/16&per 780CMR,MSBC,TOY CONTRACTOR
Bylaws,replace rear slide with windows, replace garage door with French LICENSE CS-084916
doors,frame garage floor,finish into a three season room,add bathroom to Construction Supervisor
rear room,remove door add window interior demo front steps as per plans NIALL J HOPKINS
MALL HOPKINS
AREA(SQ Fl) 645,123,600. EST COST($) 7500.00 PERMIT FEE($) 350,00 SO.YARMOUTH,MA 02664
OWNER MORAN WILLIAM J
BUILDING DEPT BY .
ADDRESS ,3 SKYLINE DR �
NANTUCKET MA 02554-2850 moo_.G-a PHONE
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR
PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE
APPROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE
OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM
MINIMUM INSPECTIONS REQUIRED FOR ALL APPROVED PLANS MUST BE RETAINED ON WHERE APPLICABLE SEPARATE
CONSTRUCTION WORK: 1)FOUNDATIONS OR JOB AND THIS CARD KEPT POSTED UNTIL PERMITS ARE REQUIRED FOR
FOOTINGS.2)PRIOR TO COVERING STRUCTURAL FINAL INSPECTION HAS BEEN MADE.WHERE ELECTRICAL PLUMBING/GAS
MEMBERS(READY FOR LATH OR FINISH COVERING) A CERTIFICATE OF OCCUPANCY IS AND MECHANICAL
3)FINAL INSPECTION BEFORE OCCUPANCY 4) REQUIRED,SUCH BUILDING SHALL NOT BE INSTALLATIONS.
REFER TO DETAILED INSPECTION SCHEDULE OCCUPIED UNTIL FINAL INSPECTION HAS
BEEN MADE.
POST THIS CARD SO IT IS VISIBLE FROM STREET
BUILDING INSPECTIONS APPROVALS
Rough Frame Frame Insulation
Inspector Date Inspector Date Inspector Date
Rough Frame
Inspector Date
WORK SHALL NOT PROCEED PERMIT WILL BECOME NULL AND VOID IF INPSECTIONS INDICATED ON THIS CARD
UNTIL THE INSPECTOR HAS CONSTRUCTION WORK IS NOT STARTED WITHIN SIX CAN BE ARRANGED FOR BY TELEPHONE
APPROVED THE VARIOUS MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED OR WRITTEN NOTIFICATION.
STAGES OF CONSTRUCTION AROVF
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TO THE BEST OF MY INFORMATION. "AS-BUILT" PLOT PLAN
• KNOWLEDGE, AND BELIEF THE YARMOUTH MASS. •
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PLAN HAS BEEN 'LOCATEpa
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GROUND AS INDICATED '� DATE M4 ' J, zoco SCALE V " 3a'
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� SWEETSER ENGINEERING'
f j �.,;. ..• f� 235 GREAT YVESTERN ROAD
� .,� !i P.O. BOX 713 •
DATE PROFESSIONAL LAN' :- • S DENNIS,' MASS. •
OR. )98-3822 • 02660 (FAX) 398-3063 •