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HomeMy WebLinkAboutBLD-19-001191 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 508-398-0836Islulassachusetts nlldin,Cote,780 CMRi -CEDsx RkilddegFermh 4pplacaof To To CoCo nstruct,Reprab Renovate&Demolis 6�lq-0�q l a One-or 11vo-FamityDtvellirrg R E C i 6 V This Section For Official Use Only BuldingPenmitNumbcr. I Date Applied: AUG ' 7 2018 1.EPARTMENT Baaedi4g0+ 1(pr ) 9'1 n- Run pnad:11:1;T[1.1�TOMMATIOTI 3S_ 1.1 P periy�}ddress• t/ 1.2 Assessors Map&Parcel Numbers y74Kr,ru A,4,4Qa PaceeiNaaber 1.1a is this an accepted street?yes no NuQ1� 1.3 Zoning Information: 1.4 Property Dimensions: Toning bind* Proposal Use Let Ares(sgft) Frontage(ft} 1S Building Setbacks(ft) Front Yard Side Yards Rear Yad Required I Provided Required j Provided Required 1 Provided 1.6 Water Supply:(PLUS e.40,454) 1.7 Flood Zone Information: 1.8 Sewage Disposal l System: Public0 Private0 Zona — utsidifyes0 Rood a MnnicipaIO onsttcdisposal syn.= 0 CheckSECITON 2: PItOYMTY OWNEIt:ine 2.1 Ownertofleeord: p I/ &GP4j6ri6 Y trio/St A4 0266q Nome y,/ n Pi City,Stat,ZIP 9 Tat QMrt Pa9 Telephone Email Address No.and Street • SECflON 3:DESCRIPTION OF PROPOSED WORK'(cheek all that apply) New constmctlonO I Existing&aiding Et I Owner-octivpied Et (Repairs(s) U Alteration(s) 0 1 Addition a Demolition 0 Accessory Bldg.0 Number of Units1Other 0.Specify: Brief Description of Proposed WVor1 . SECTION 4:ESTIMATED CONSTRUCTION COSTS item ' Estimated Costs ' 104SeialT)se Only (L(Labor and Matr ials) 1.Building s 1. Building Permit Fee:S Indicate how fee is determined: 0 Standard City/Town Application Fee 2.Electrical S G TotalProleet Costs(item 6)x multiplier . x 3.Plumbing $ 2. Other Fees $ , 4.Mechanical (HVAC) S List ' • • " .... S.Mechanical (Fire $ S Total Feer$ ' Suppression) Check No. Cheek Amount Cash Amomrt 6.Total Project Cost: W CC 0 Paid in Pull II Outstanding Balance Dur__-.._ SECTION 5: CONSTRUCTION SERVICES - 5.1 CoastruedonSopervtsorLicense(CSL) /� ,// �) (5-k5Sc,7t II/7/17me,,4 eco r m:, License Number Expiration Date Name of CSL Holder ^ ' 784 1.5 /!c� LS CSL Type(we below) 11 t No.and Street / 1)4e . in ` 1 n�,% A.. b? 3 C� U _ Unrestricted(Buildings up to 35,000 cu.ft) I yN- 0 R Restricted L&2 Fam Dt !Thtg Cit/foOn,Stem,WI' M Mommy RC Roofing Covering WS J Window and Siding SF Solid Fuel limningAppliances ?7N-W3-WhO Acker-6j,e//y�diMa;l,Con I " Imnlat m refephaee Email ad S"s✓ D_ Demolition Si. Registered gistereedHorneImproveae/at Costraetor(BIC) 1'J n h (.OI 5Ttc4G K C), 2re4 RIC Registration Number I ira-on Date Inc[:inert any Blame or RIC lac ' ant Name �t,, �g / uM ' Ll fit, / J s! n INSX/ to Li/NXCR - tr1 4e/Me er@ AON&AS4K ,/9,4,6.0•4l No g.yinvoe.1hma 0236.2 FmwFeddress elan,State+ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(GLC..a 1St f 25C(6)) . Waiters Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide . this affidavit will result in the denial of the Issu yff the building permit. Signed Affidavit Attached? Yes No.... ... t7 - 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 autbot ed by this building path application. C.74ry L�C,rrit1'�SNn hint Owner's Ndme(Electronic Signature) Data SECTION 7b:OWNER*OR AUTHORIZED AGENT DECLARATION IBy entering my name below,I hereby attest under the pains end penalties of perjury that all of the information contained in this application is true and accurate to the • of my know ge and understanding. ya Prat Owner's ar Authorized Agent's Name(Clete sic Sign are) ate NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (pot registered in the Home Improvement Contractor(WC)Program),wiSladbave access to the arbitration program or guaranty fund umderM.O.L.e.142A.Other important information on the HIC Program can be found at www snaas.govloea Information on the Concoction Supervisor License can be found at www.masa.rov!dps 2. When substantial work is planned,provide the Information beim: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) , Gross living area(sq.ft.) Habitable room cotmt Number of fireplaces Number of bedrooms Number of bathrooms Number of half baths Type of beating system Number of decksf porches Type of cooling system Enclosed Open 3. 'ToS Project Ssare FOOtIgC may be substituted(OrToDIProJed Cast ift 310,00 . c ' a TOWN OF YARMOIJTE �} 5.:; ,. ,� BUILDING DEPARTMENT rt..1 \) 1146 Route 28,South Yarmouth,MA 02664 508-398-2231 ext.1261 Fax 508,398-0836 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L.Chapter 40,Section 54 and 7&0 CMR,Chapter 1,Section 111.5, I hereby certify that the debris resulting fromtheproposed woes/demolition to be conducted at 9 70 Q 4413 &J lQ gr,",,,./A A Work Address Is to be disposed of at the following location: 196 SocaM /11e4 hhw QG! P(yr,OJ..N) //4 Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Odle e/240 Signature of Application Date Permit No. • DowSign Envelope ID:4F1A8E12-IACA•488E-6A90-05C803BOSEF7 NA, :17/1, Permit Authorization • . Gr . frr mass save Form Site ID: 3415021 Customer. Gary Garafano I, (Veit cf U n.1`--T41a0 ,owner of the property located at: (owners Name,printed) 97A Run Pond Road South Yarmouth, MA 02664 (Property Street Address) (City) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. w Owner's Signature: rti.C± Date: 8/6/2018 i 8:32 AM EDT .assess.saes.•eesesessesesessssseeeceeesesessesSig sesseeee esessseses FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project Participating Contractor Date Name: RISE Engineering Phone: 401-784-3700 Email: For Office Use Only Rev.102015 M' /t 'x` The Commonwealth of Massachusetts te,_= t Department of Industrial o — r r,.f: til ' 1 Cong,ressStree,.SatQ 0 • V="17-4.,g., ,,a • Boston,MA 02119--2017 a www.mass.gov/ila Workers'Compensation gip IlTI'DtIGAUTHORITY.Builders/Contractors/Electricians/Plumbers. TO B$I ens Please Print Legibly Aooucant Information � Name ssKkgeiradeartadiviriaap: /)I P H Cv as is t...471;54 It)G Address: Pa Pio t'' toW I • 'City/State/Zip: 1/ .. . __ Ai . .. _ Phone #: 7-7il2‘, ^GC42 Are you foyer?Cheektneappropriate boss Type of project(required): !. nn a employer with 1 employees(lilt and/orpatb'tlme).e 7. 0 New construction 2.ElI am a sole proprietor or partnership and have no employes working for me in 8. Q Remodeling any capselot.Dib wars'mock lane mocked) a 9, f i}7emoIit3on . 3.91 amaomeovmerclot%artWorkmyself.tkoerrten`eomp.Mterencerequired.)t 10©Building add tion 4.0I am a homeowner andwill be hiring contactors to conduct all work on my property.1 win 11.0 Electrical repairs or minions that all contactors either have workers'compcusatlot trounce or are sole propdetme with no employees. • 12.0 Plumbing repairs or additions . S.01amageneralcoaosetermidIharohiedtheaub•eonuactonlistedontheattachedsheet 13.(] ofrepain Eaveemployeesendbaveworkers'comp.Insurance? - )) 11% These subcontractor' 14. Other �NShl4/iat-) 60 5e, e MO. pd I n and iis(art heve exercised*tiniest of commotion per MOI.a 1 5372,$:(`.�and n wa .m cres. atiters'samp.'foawas!utttpdrsd.3 . *Any applicant that checks box f1 must also fill out the secnonb9ew ttnevithsardn*oWaen totepernaue raicy Infomettiaa. ' t gomeownen who sutra this ttse rit!ndio°ting they ere doing all work and then hire outside contractors must submit a new affidavit lndtcedng such. :Contractors that check this box must attached an additional sheet showing ho ingthe stem,of policytractus and state whether or not those anetiea have . employees.tithe sub-contractors Imre maployem,they must _.._ a ... l am an employ F employer that Is rovidingworkers'compensation Insurance for nary employees Below is the policy and job site otom 1 /'/�r�,t M Lima / htctaance Company Nanta: Arm • Expiration Date: ' a ,/u Pnlicyi3�t'Setf--ins.Lin#: [J!•1GPLA'lfal9i937 ar".LC717�. '�' 'r ' Job Site Address: ?q ua AP/ R i City/State!Zip: Mt0110e f it i /4402 y Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to seethe coverage as required under MOL a 152,125A is a criminal violationpmdshable 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 igainst the violator.A copy of this statement may be forwarded to the Office ofmnvestigations of the DIA for insurance covesge vu ninon. -- - I do hereby cent,un, ' the pa ' •ena des of pednry that the tnforrnafion provided above is true and correct ♦ ate rases• Phone#: 77t/ X43- 10/C0 • Official use only. Do not write In this area,to be completed by dry or town ofJidaL t City or Town: • Pe•.mstti.Eeease L.... Issuing Authority(circle one) • d L Board of Health 2.Building Department 3.CitY/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other________________ ' Contact Parson: Phone#: • • ONE or TWO FAMILY —BUILDING PERMIT APPLICATION REGULATORY APPROVALS NOTICE Aidressof PreposedWorrk: cl?CI L & Rd • Scope of Proposed Work: 19f"r .Sea cad i)s4/414 (ra,J94s P Date: 812 1063 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: $ IITIAts Health Dept—58S-398-2231 eat 1241 Conservation Comm—50S-3)3-2'!31 ext.12lili Water Dept.— 99 Buck Island Rd.phone no.508=771-7921 OW Sings Hwy.Hist Comm.—508-398-2231 est.1292 Engineering Dept.-5399-2231 ext.1250 The Dept.we a Huekfdames Armstrong,96 Old It/lain St.SY Note:Please call Fire Department for an appointment.50S-39S-2212 Other Appropriate plans and/or application till be provided to each of the departments checked-off above. Path cf these regulatory. authorities has daer.own ruprirements outside the.jurisdiction of the Building Department. AU applicable apprev is shall be obtained prior to submitting a building permit application to theBnii,tingDept Thank you for cooperation. Receipt Acknowledgement 62&4'49 Applicant's Signature Date Rev.Dec.2015 .e71C Wanvn rrveafiA o/vi2uo-rxclu4eiI• Office of Consumer Affairs and Business Regulation One Ashburton Place-Suite 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Types Corporation Registratiorc 183807 MDH CONSTRUCTION INC. - Expiratiorc 11/1 512 01 9 PO BOX 8413 PLYMOUTH,MA 02362 Update Address and Return Card SCA i 0 20M-05/17 Office et Ceremony Mar Business Rqulatten HOME IMPROVEMENT CONTRACTOR Rcybbatiun valid for kpdridted use only TYPE:Caromaiar before the expiration date. If found return to: 8.521.15=211 Expiration Office of Consumer Affairs and Business Regulation 183907 11/15/2019 • 10 Park Plaza-Suite 5170 MDH CONSTRUCTOR INC. Boston,MA 02116 rarA MATTHEW HARRIS98A ESTA RD / A PLYMOUTH,MA 02360io MIS)efsignature Undersecretary Cartenomrealth of Massachusetts OMsron of Profescronal Licensure Board of Budding Regutations and Standards Construction Supervisor CS-105579 • Expir 1?107/1.419 MATTHEW°HARRIS . PA ESTA ROAD PLYMOUTH MA023 r ' • Commissioner t/AL o r CERTIFICATE OF LIABILITY INSURANCE DATE(MM DD YYY) nc 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: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCERimn. T Christopher Jordan Professional Insurance S Ris'k'Brokerage,LLC u�GNo.E,4781)826-7175 ' a,'C..a4,4781)826-7484_, 31 Schoosett St.Suite 309 E-MAL ordan� Irbinsurance.com AODRLss:.._C] P Pembroke MA02359 __,_,-_. ___insuRERtstarroi ano covtRAGE._,-_-,_-_; sac e.— _ • INSURER A• AIM MUTUAL_ '33758 INSURED _m_ WSURER 8;.,_The Main Street America Group .14788 MDH Construction,Inc. • INSUREgg:Penn America Insurance Co 32859_ PO Box 6413 INSURER O. Scottsdale Insurance CO !41297 Plymouth MA 023621----- INSURER F• i COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED 10 1 HE 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 DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIFS.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. __ INSR i'--- --'ADDL3UOR--���^---- ! POLIco-Y tPOLICY EXP T LIMITS LTR TYPE OP INSURANLE --R -�-- ...ND WPOLICY NUMBER i$MDO/YYWI1 IYM DD/YYYY1' IX+COMMERCIAL GENERAL LIABILITY i , ' 'EACH OCCURRENCE i$1,O09,000 ^^ DAMAGE TO RENTEDi11UQ000 C 1 CLAPAS MAUL i X 'OCCUR I 1 I `,PRLMISES.LEARcaaresea _. ; XL.I ISO FORM CG0001 1 X ;X PAV0168733 .05115118 '05115119 j MED EX! Any put poser));$5,000 tX,� Contractual Liability_�.�__ i L ' I !PERSON: aacy,INWRY I;1,000,000 '2 1L AGGREGATE LIMIT APPLRS PER 1 ; `GENERAL ACOREGATE I$2,000,000 I.._S AMC,'I^ ' 4 t i LOC II I PRODUCTS_COATf AGG j 72.pOO,OOg , I IoniE1' ' _s _- AUTOMOBILE Wle1UTY ! Si — • B 1--^ANY AUTO 'BUbAY INJURY(PM pe.rpnf l$'j ALL OWNED scHFnuIED X X �M3F0206P 106/18/18 06/18/19 ,BOOSYINJURYIPet.cwdec)l$ AUTOS IX . NON.OW4ED 1 FROPFRTY DAMAGE IS _X I HIRFDALTOS ' X • AUTOS I I Loner ArcelmD _ X ISOCA0001 I is XJ UMBRELLA wB 11 X OCCUR i I EACH OCCURRENCE 10,000,000 4_ D I IEXCESS LIAO ' LCLAIMSMADEIX X :XBS0099982 ,05/15/18 105/15/19 AGGREGATE •$1,000,000 ___ 'DEO I X I PETENTION$10,000 I $ 'WORMERS COMPENSATION I , e • 'Pt R I ,OTR- :ANDEMPLOYERYLIABILITY I I X�BSAILlTE --=E9 ---._. __._... YIN . )ANY PROPRIETORPARTNFRE%ECUTNE I EL EACH ACCIDENTTSSDO.000 A IOErIe,LRAIEMBFR EXCLUDED') CNJ NIA X VWC10060193752017A 09/04117 109/04/18 FELDISEASE E�EMPt9!FETs 500,000 'Mandalay m NH) 1 , _ ir to aean'be u"M I i AFI DISEASE.-POLICY LIMIT 1500,000 DL7,,:rvI ION OF OIN RATIONS heeler I I • I I Comprehensive Ded $500 B I Auto Physical Damage 'M3F0206P '06/18/18 106/18/19 1,Collision Deductible 5500 I . DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORO WI,Addlton.IRental'.Schedule,may be attached If mon.pace s required) . CERTIFICATE HOLDER CANCELLATION SHOULD MY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE //'/� ,J 41/ <DA> 01988.2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD