HomeMy WebLinkAboutBLD-19-1507 #9 • .• _ pf•YgR BUILDING PERMIT APPLICATION
• .2e ; k APPLICATION TO CONSTRUCT,REPAIR,RENOVATE. CHANGE THE USE,OCCUPANCY OF,
• 1 OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING.
• • e.\..�. I�... _. Town oFMtrmouth Building Department
• IS,%•...,.•'6C1 1146 Route 28 . Yarmouth, MA 02664-4492
Tel: 508-398-2231 at. 1261 Fax 508-398-0836
-
RD—eget,
C� (�ice Use Only r] Planning Board Information Assessors Department Information:
Permit No. /�at'e Plan Type Map La
Permit Fee $ Endorsement Date 72/�1-/
/ � Recording Date New
Deposit Recd. $L br-1 Date_ Plan No. 1.4 Property Dimensions:
Net Due $�// '� Other Lot Area(sf) -
Frontage(It) Lot Coverage
This Section for Office Use Only
Building Permit Number. Date Issued:C
Signature: •✓ / ! —i -!,F Certificate of Occupancy ,
Building Official Date is Is not required
Section 1 - Site Information
1.1 Property Address: '7r/ 1.2 Zoning Information:
vc ' C\\tk is Z*, Rcxh,4 o .
Zoning District Proposed Use
1.3 Building Setbacks(ft) .
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.4 Water Supply(MALL.c.40.S 54) 1.5 Flood Zone Information: Comments
Public Private Zone: BEE: • '
Section 2- Property Ownership/Authorized Agent
2.1 Owner f Records
11�;1RSn t ; " t�,�y1�,} -
t) �1 CS—n r a( � Mailing Address:
11/, J
Signature Telephone Telephone Email Address:
2.2 Authorized Agent
1' I1c1\o%\\k!t1N;E�tAe)�` '1`\ A )\10, uT 7_9__
Marne(print) Mailing Address:
1, Signa" hire Telephone Fax 4-
Email Address: I
Section 3-Construction Services
3.1 Licensed Construction Supervisor Not Applicable ❑
? Ai\ U'ssc
km y „l.'UI-` `_ At Wk 0\Sz rA7 License Number
Address R2l 'cap V (-S j ,�sj
4 ar_2 g/)—(e iI/V 1 - T UiQ 4' ihor9f`(Ai Expiration Date
i tune Telephone Email Address: kA3u ')
' Section 6 - Descric,t5onzii Proposed Work(check an applicable)
' New Construction ❑ (for multiple family only) No.of Bedrooms (for multiple family only) No.of Bathrooms
Existing Bldg. ❑ Repair(s) ❑ Alterations ❑ Addition ❑
-Accessory Bldg. ❑ Type Demolition Other Specify:
Brief Description of ProposedtWork: " ��
` ^'f herr\ r'rnn)PAr. rC astA\eh \ALP c`L'1. cr-7 , i LYAhrin4
P-\ kkAtK&5 - 'Cexr X4 t1(\ c(LV'(`P tOCIAmS
Section 7- Use Group and Construction Type
Building Use Group(Cheek as appficapable) Construction Type
• A ASSEMBLY ❑ A-1 ❑ A-2 0 A-3 ❑ 1A ❑ -
A-4 ❑ A-5 ❑ 190
B BUSINESS 0 2A ❑
E EDUCATIONAL 0 2s ❑
F FACTORY ❑ F-1 0 F-2 0 2C ❑
H HIGH HAZARD 0 3A 0
I INSTITUTIONAL 0 1.1 0 1-2 0 1-3 ❑ 3B ❑
M MERCHANTILE ❑ 4 0
R RESIDENTIAL 0 R-1 ❑ R-2 0 R-3 0 5A 0
5 STORAGE ❑ S-1 ❑ S-2 0 50 ❑
U UTILITY ❑
SPECIFY: •
M MIXED USE 0 SPECIFY:
S SPECIAL USE 0 SPECIFY:
Complete this section if existing building undergoing renovations:additions and/or change In use.
Existing Use Group: proposed Use Group:
Existing Hazard Index 780 CMR 34 Proposed Hazard Index 780 CMR 34
Section 8 Building Height and Area •
Building Area Existing(if applicable) Proposed
Number of floors or stories
Include basement levels
Floor Area per Floor(sf)
Total Area All Floors(sf)
Total Height(ft)
Section 9- STRUCTURAL PEER REVIEW (780CMR 110 11)
a
Independent Structural Engineering Structural Peer Review Required Yes»......» No
SECTION 10a OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT .
I, 'tet 'rl CA 1 -�' C �p— �`�4f1 , as Owner of the subject property,
hereby authorize \ to act on
my behalf, in all mattersieeiat' to work authorized by this building permit a plicatio .
Signature of Owner Date
•
3 of 4 OVER
ia ,
SECTION 10b OWNER/AUTHORIZED AGENT DECLARATION
(
I, „f1 �� t�L�1ie-0I , as Owner/Authorized Agent g
hereby declare that the statements and information on the forgoing application are true and acurate,to •
the best of my knowledge and belief.
Signed under the pains and penalties of perjury.
Print Name
)J)1�
Signature of Owner/Agent Date
Section 11 - ESTIMATED CONSTRUCTION COSTS
Item ' Estimated Cost(Dollars)to be
completed by permit applicant
1.Building
/OC &5
2.Electrical
3.Plumbing/Gas
4.Mechanical(MVAC)
S.Fire Protection
S.Total.(1+2+3+4+5)
7.Total Square Fl.Mr..mens&seen
Check Below
❑ Conservation-Commission Filing
(it applicable)
•
❑ Old Kings Highway&Historical
Commission approval
(it applicable) •
•
4 o14
_) . The Commonwealth of filassachusetts
v=_— Department of Industrial Accidents
• t
` • _ _=�•=fOffice of Investigations
__�_ 600 Washington Street •
_r
-.:::_-r. E.` Boston,MA 02111
•www mass gov/dia
Workers' Compensation Insurance Affidavit Builders/Contractors/EIectricians/Plumbers
Applicant Information Please Print Legibly
Name usmess/Ora nintionandividnai): \k 1\\ '&tQY\
Address: Q() tot, tip
City/State/Zi.: ,ss, IL, a• Phone#: 1 - , I -C a b
Are you an employer?Check the appropriate box:
1.0 I am a employer with 4. 0 I am a general contractor and I Type of project(required):
2.1employees(fall and/or part-time).* have hired the sub-contractors . 6. ❑New construction
I am a sole proprietor or partner- listed on the attached sheet 7. 0 Remodeling
ship and have no employees These sub-contractors have g. 0 Demolition
working forme in any capacity, employees and have workers'
[No workers'comp. insurance comp.insurance.t 9• ❑Building addition
required:] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions
3.0 I am a homeowner doing all work officers have exercised their . 11.0 Phbing repairsor additions .
]m
myself [No workers' comp. right of exemption per MGL 12.0 Roof iepairs
insuance required.]t c. 152, §1(4), and we have no
3a.0 I am a homeowner acting as a employees.[No workers' 13.0 Other •
general contactor(refer to#4) comp.insurance required.].
•
*''`�'applicant that checks box#1 mast also tin out the section below showing their workers'CC -•
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors amat submitsnew affidavit indicating such.
:Contractors that check this box must attached an additional sheet showing the tnum of the sub-contractors and state whether or not those entities have
employees. If the sub-eoottactois have employees,they must provide their workers' oli
e°mP•policy camber.
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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that 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;� •
Date: 000
Phone#: c)Qi-Lgo - C,iLin.
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.Blinding Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
'_�o .—+Yy ----< -- '1'UWN-ON-YAKMOUT-H— - - — — —
', _• • r.�e C BUILDING DEPARTMENT
• a — H 1146 Route 28,South Yarmouth,MA 02664
tl
- ' "� ;.3 e? 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 780 CMR,Chapter I, Section 1113,
[hereby certify that the debris resulting from the proposed work/demolition to be
conducted at -'��� 2# \e7q) S>titt\tiliNtAit ()nitIj •
Work Address
Is to be disposed of at the following location: Or; trial EVhl (19.
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
Signature of Application Date
Permit No.
=ptARy TOWN OF YARMOUTH
gc;4 ; `Oy HEALTH DEPARTMENT
• '''••••% $ PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: lit gout 2?) S.'q(muw ,hA. 02.1a4-1 Pier '7
1
Propose Improvement: >U\► t t.. A r
Je�.1 thl* i o c4 • \n
Applicant:�,6�, .61\)1/4{,� '' Tel.No.: -5(k-Z 96 -L,2116
Address: \lo bi CvAt'o\\\t W. 0147 2- Date Filed:
*Tyou would like e-mail notification of sign off please provide e-mail address:
Owner Name: %A(Q.(\ 0C.i\L tj)
Owner Address: VIC\ thaytTec a. or-ma2$. O?4D115 Owner Tel. No.:Tj7A'ZS8-419
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: grit/F f DATE: /Caa/P
I PLEASE NOTE
COMMENTS/CONDITIONS:
RM�Uj MGL AND FIRE
yP H TOWN OF YARMOUTH
REVIEWED FOR CODE COMPLIANCE.
' . i ERRORS OR OMMISSIONS DO NOT RELIEVE
Q *�1� THE APPLICANT FROM THE RESPONSIBILITY
OF"AS BUFF'FFOMPLIANCE.
DATE:. c' GIIQ
YARMOUTH FIRE PREVENTION VI PECTO'
Commercial Construction Building Transmittal
Project Name: Pier 7 Address: 711 Route 28
Contact Name: Randall Henderson Phone: 508-280-6240
Y NO NA Subject Regulation
S
x Access for Fire Apparatus 527 CMR 1; 18.2.4.1
x Building Numbers MGL Chapter 148;sec 59
x *Flammable gas/liquid storage 527 CMR 1;42.2.2.1
x Fire Lanes 527 CMR 1;22.3
x *Service Stations 527 CMR 1 ;16.2.3,16.2.3.1,30.3.2
x *Hazardous Materials Storage 527 CMR. 1;60.1
x *Kitchen Exhaust Systems* 780 CMR,527 1;50.1
x Extinguishers 527 CMR 1; 13.6,Chapter 148;sec 28
x Fire Alarm Systems/CO detection* 780 CMR,Chapter 148;,527 CMR 1; 13.7
x *LPG Storage Chapter 148;sec 9,10,28&527 CMR 1;69.1
Use and Occupancy(FH Building Class) 780 CMR;302.1
Sprinkler Systems* 780 CMR&Chapter 148 sec 26 A-I
x Storage inside/outside Buildings 527 CMR 1; 10.19.4,4.4.3.1.1,19.1.2,34.1.1
*Upholstery 527 CMR 1;20.6.2.5
*Trash Containers 527 CMR 1; 19.1.1, 1.12
x Any Hazard to the Public Chapter 148;sec 28
*Curtains,Draperies,Blinds 527 CMR 1; 12.6.2
*YFD permit required-depending on occupancy and submittal
*Per 780 CMR 901.5, contact Yarmouth Fire Department for acceptance test.
*Per 527 CMR 1 13.1.8, a permit is required from the Fire Department to shut down any
fire protection system.
Description of planned project/other requirements: Bathroom Remodels only not
affecting fire alarm system/sprinkler system
Plan Reviewed By: Lieutenant/Inspector Scott Q.Smith Date: 9/6/2018
Copy for Applicant CI Copy to Building Department Il Copy to Fire Prevention
Entered in Firehouse El Final Inspection
W
SXJ
/ 96" / = s _9m
f— ti,
a $,_o
1 n v p
X12" 31 2" / 22 6" /13;6" ; 16" / r ogz �LI
ii-
. NN 1.41g
� w
/ 24" / 72" / LLc7o8W 1=
Z moo S
o��wr` m
LOL oKF-" \
o IN
�i
03
N N } '�IVI BWTfR : 1 -DI ® o
TOIL.WELLWORTH y W
\ / n i J rn
o
COIcam
"cr W
Sti' 0 6 2018 E O
r
:Ti HEALTH DEPT.
.; .. ______-----1
N. \ N. N. N.
All dimensions size designations This is an original design and must Designed: 8/1/2018
given are subject to verification on not be released or copied unless Printed: 8/3/2018
job site and adjustment to fit job ^O^O applicable fee has been paid or job
conditions. 1 1 order placed.
PEIR 7 CONDO BATHS All Drawing/I: 1 No Scale.
_ Ell EMI _ _Aci_s_j _ . _ .. .. __ ._
Nil ''''''1 r I
II 1: : i
I l
J !
eono .
- El
-116
- - ! I !
! I
i' 1all 1 -Er:
1 1--_ ill. . V? !
I ! I ' 1 „
• t. , 1 1 Ell
_ - 14- = -i - -I Pti- 1 I- I I I
- - IJ 1 - -I I !
■ I .L--! _ I - ' 1 i
! ! is 5�, ! 1 -
■ - ! i ! 11 .111 I 1 I - - --
• LL_ _ _-- jLt _ so I H-- - +
- I - I I I i --
- ■ � - I I- - I
- - , - I
! —J 1 I I -
I ! IIH
NI II illI I 1- 1 - -- Il H I 1III I I 1 1
- - -- ---- '-� --- - -- - - / '
| � | | ( /
\
'� 1 - _ - -- ' --. ------ ��- --�\ -- -__-_ --^
�_ � � ' _ �� � _ � _ ___ _ __ .
. . --/'----- - ! �-v � k - ' | -- |� _ ^ |
| � | / | ' ' ` -'
� |
' � � - .--- � _ ' - '-- -- -- �� -
' |�� �� ----' - � - - IL--1 . 1 .
'|
-
---_
�---'_--
-''--_------'
-
_--_-
-'-----
-'------'--_''
_�----�-'-
-
I I -~�--| - - -. .
| l _ | - ' H • /°/.2 //
| |
- | _-1 I - i | |
-- �� | . | -- -
| HI - ._ ___/ ' � - ` . - -
' � , | / - ~� | - | |
| | i � _ ' '-
|| ' ' _ _ __ --| . -'
`~ | li _ - || � . - --| - l - -_
l | kl 1 HI i _ | | | ! . �-- �~ | / | | /| | - 1 ' •-!-- -_ _ 1 ^ -' 1 | ' / . .. . .| | 1 1 | ' � | - }
' 11111 ' | " 111
| |
-, | �) !
/ �, / - - -
• | . . .
ii .! | | | 1 - i ' - | | ' I . / ' 1 ' �' | ii | - | | | 1 | | | / / • __ | ' | ' ' .
1.
H ! 1 | | | 0t5* | ! / ~ ' | i
! � | ' -� / ' | || | /- � I . ',� | | . / -I' | � | /|. | - --| / - 1 , 1 ,4 $1101: | I ' | / - I| _ | [
•
-
` | 1 1 / i i 1 _ I /! | | 1 -|| - '
|| || ! || /' I 1 | 1 1 / . | 1 . - i |
1 ~ | I !. | i | | / | | ' ' !| | | ! | ' |// ^ | | -
� � | } - 1 | | |
| . ,| 1 1 1 1
.- -
1 , 1 1
1
| / | ! I | | | | | | 1
| | | |