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HomeMy WebLinkAboutBLD-19-1527 #13 • - of•lift BUILDING PERMIT APPLICATION • ZE 4 APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE,OCCUPANCY OF, t ' t, ; - G OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING. . r- o .r �« .3' Town of Mu-mouth Building Department es%........-",td' 1146 Route 28 • Y rtnotith, MA 02664-1492 Tel: 508-398-2231 ext. 1261 Fax 508-398-0836 /T]�71/ Office Use Only � Planning Board Information Assessors Department Information: P�frttlf�0. q O1, /""-late_ Plan Type Map tot Permit Fee $ ^1 Endorsement Date 77�//q {� 6 v Recording Date New Deposit Recd. $ � Date_ moo No . 1.4 Property Dimensions: Net Due $ 6iOther Lot Area(sf) Frontage(It) Lot Coverage This Section for Office Use Only Building Permit Number. Data Issued: Signature: .---2:7--e-ci 5.12 -4E__ Cettficate of Occupancy Building theist Date is Is not required Section 1 - Site Information 1.1 Phoparty Address: �/1 1.2 Zoning Information: %ACV) 7 il�ftAk Viik ZWN;I\ 1.27 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(M.O.L c.40.S 54) 1.5 Rood Zone Information: Comments Public Private Zone: BFE Section 2- Property Ownership/Authorized Agent 2.1 Owner of Record: t1/4 \I\ Oti 1,1 at- `rt) Mailing Address: Signature Telephone Telephone 7 Email Address: I 2.2 Authorized Agent V' 1 S0,1,\\\ \•Ofti t%Er,t>,1\>,1\ Q') `1 ICZA9.,10h119,: , i)' 11.47-7 Name(print) Mailing Address: I Signa" tura Telephone 5 f : i I Section 3-Construction Services Fax Email Address I3.1 Licensed Construction Supervisor. Not Applicable 0 I c'cvt�.c\\ \ 4(C-104\ f o0 „,\Ay\ �„-` ,,,\i`�swk 0Z 0)7 License Number Address 'C.V�2l t/ CS 4bS tS i 5"21 Expiration Date i lure Telephone ��UV '�1m:n,(e L(�thor�CU11 Email Address: 1\`3U0) i t oto a._.._._.___.___. .............. .__. ...._.._. ._...,._...___..__.._..._ .. .._.___ .� _. .__..____......_ _._.�.______-_.._--_.._...____r .._..._OVER._. �.. • ' • , Section 6- Desgri ±!on.ri Proposed Work(check all applicable)! New Construction ❑ (for multiple family only) No.of Bedrooms (for multiple family only) No.of Bathrooms Existing Bldg. ❑ Repair(s) 0 Alterations ❑ Addition ❑ - 4 Accessory Bldg. ❑ Type Demolition Other Specify: Brief Description of Proposed Work: - e } Tr,miP\r. , y uc O ctiti ,—Y1Z ,bou �Ii� wk- lic{5 0 CP/T(4I\ Iocla1clu _ Section 7- Use Group and Construction Type Building Use Group (Check as applicapable) Construction Type • A ASSEMBLY 0 A-I O A-2 O A-3 O IA 0 - A-4 ❑ A-5 ❑ 18 ❑ B BUSINESS ❑ 2A 3 - E EDUCATIONAL 0 23 0 F FACTORY ❑ F-I 0 F-2 ❑ 2c 0 — H HIGH HAZARD 0 3A ❑ I INSTITUTIONAL 0 I-1 0 1-2 ❑ 1-3 0 3B 0 M MERCHANTTLE 0 4 0 R RESIDENTIAL 0 R.1 ❑ R-2 El R-3 IDSA 0 l S STORAGE ❑ S-1 0 5-2 ❑ SB ❑ U UTILITY 0 SPECIFY: ' M MIXED USE 0 SPECIFY: -S SPECIAL USE 0 SPECIFY: Complete this section if existing building undergoing renovations;additions andtor change iri 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(s0 Total Area All Floors(sf) Total Height(ft) Section 9 - STRUCTURAL PEER REVIEW (780CMR 110 11) d 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. —t rt C. , +.I.a C C o_e% - `Rf1 , as Owner of the subject property, hereby authorize ,` to act on mybehalf, l matters r-1.. ',! to work authorized by this building permit a plicatio . l Signature of Owner Date 3 o1 4 OVER SECTION \\.�1 Ob OWNER/AUTHORIZED AGENT DECLARATION I, \l('Aat\\ ` 'AtC,(s , as Owner/Authorized Agent `--'' ' 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 01)1f3 Signature of Owner/Agent Date Section 11 -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be completed by permit applicant 1.Building /0 on 2.Electrical 3.Plumbing/Gas 4.Mechanical(HVAC) 5.Ewe Protection 5.Total.(1+2+3 4+5) 7.Total Square F1.(sMw micas$setae) Check Below ❑ Conservation-Commission Filing (if applicable) ❑ Old Kings Highway&Historical Commission approval (if applicable) • • 4 of . . • of•,ryR BUILDING PERMIT APPLICATION **e ; 4r, APPLICATION TO CONSTRUCT,REPAIR, RENOVATE, CHANGE THE USE,OCCUPANCY OF, i ; ++ C OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING. f'\r._I1` _. Town of Yarmouth Building Department t b),W..,-,.•r 1146 Route 28 . Yarmouth, MA 02664-1492 Tel: 508.398-2231 ext. 1261 Fax 508-398-0836 — Office Use Only Planning Board Information Assessors Department Information: Permit No. Date_ Plan Type Map Lot Permit Fee $ Endorsement Date / Recording Date New Deposit Rec'd. $ Date_ Plan No. 1.4 Property Dimensions: Net Due $ Other Lot Area(et) Frontage(it) Lot Coverage • This Section for Office Use Only Building Permit Number. Date Issued: . Signature: Certificate of Occupancy Building Official Date is Is not required Section 1 - Site Information 1.1 Property Address: 1.2 Zoning Information: 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(M.O.L c.40.S 54) 1.5 Flood Zone informedom Comments • Public Private Zone: BFE: • Section 2- Property Ownership/Authorized Agent 2.1 Owner of Record: h;\I\ Oti %kt s-a4�< Mailing Address: Signature Telephone Telephone Email Address: 2.2 Authorized Agent V(1'W\\IA\ kh:P ;ccDet V \r +2 ?'CA\,4.ua, 37 is Nameam (print) Mailing Address: \'M Signature Telephone Fax Maii%Address: I Section 3 -Construction Services 3.1 Licensed Construction Supervisor Not Applicable i] CCA\C\ %4-\`‘4(L104‘ kAa\ (�lC„ ,_\ kk0 Z t t�7 License Number Address V Y_`C I k CS"MISS d —� -2 eo-4 U •CS muJt Q\irhor;t j Expiration Date 1 lure Telephone Email Address: i\`3u1V'tj _ • __1 oto ' • , Section 6- Descriptor;d Proposed Work(check an applicable)I New Construction ❑ (for multiple family only) No.of Bedrooms (for multiple family only) No.of Bathrooms Existing Bldg. ❑ Repair(s) ❑ Alterations ❑ Addition ❑ . p. Accessory Bldg. ❑ Type Demolition Other Specify: Brief Description of Proposed Work: . 1 L - "� 4 rn i tP)m1Y1Y\c- MAir 'Lb buA1AC • ct `kJl�19 CRA it--PS ,jeilQ L3cAAblY 4 Pt\ 'c \ta(4 5 - 'C?,uPiA\A tY\ `IMP x tO C A nye Section 7- Use Group and Construction Type Building Use Group(Check as appicapable) Construction Type . A ASSEMBLY C3 A-I El A-2 ❑ A-3 ❑ IA ❑ _ A4 ❑ A-5 ❑ IS ❑ B BUSINESS ❑ 2A ❑ E EDUCATIONAL ❑ 2a ❑ F FACTORY ❑ F1 ❑ F-2 ❑ 2C ❑ H HIGH HAZARD ❑ 3A ❑ I INSTITUTIONAL ❑ I.1 ❑ 1-2 ❑ 1.3 ❑ 30 0 M MERCHANTILE ❑ 4 ❑ R RESIDENTIAL ❑ R-I ❑ R-2 ❑ R-3 ❑ 5A ❑ S STORAGE ❑ S-1 ❑ S-2 ❑ 5B ❑ U UTILITY ❑ SPECIFY: • M MIXED USE ❑ SPECIFY: S SPECIAL USE ❑ SPECIFY: Complete this section if existing building undergoing renovations;additions and/or change hi 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(sl) Total Area All Floors(sf) Total Height(ft) Section 9 -STRUCTURAL PEER REVIEW (780CMR 110 11) 14 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, �t rl r�Z AL,d4 Qr--- .}A xt , as Owner of the subject property, hereby authorize to act on my my behalf, matters to work authorized by this building permit aplicatlo . '\% ' • c� 22 k t Signature of Owner Date 3 o1 4 OVER • f ' SECTION 10bOWNER/AUTHORIZED AGENT DECLARATION `� I, ).\\ AtINS.EV- M , as Owner/Authorized Agent hereby declare that the statements and information on the forgoing application are true and acurate, to 9 a the best of my knowledge and belief. Signed under the pains and penalties of perjury. c''tlX4 \ .c?xm • Print Name ))1B Signature of Owner/Agent Date Section 11 - ESTIMATED CONSTRUCTION COSTS Item • Estimated Cost(Dollars)to be completed by permit applicant 1.Building a Electrical 3.Plumbing/Gas 4.Mechanical(HVAC) 5.Fire Protection 5.Total-(I+2+3+4+5) 7.Total Square Fl.err new mann t Sddiemel Check Below ❑ Conservation-Commission Filing (if applicable) ❑ Old Kings Highway&Historical Commission approval (if applicable) • • 4 01 4 . .1.......‘ tn% ; The Commonwealth ofli3assaehusetts pa —•ft Department of Industrial Accidents ` �''-- Office of Investigations =_�i= .600 Washington Street ,_ Boston,MA 02111 •www.mess gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): V�t\\ Wibil\ppicitA Address: Q0 'cok 4 1 City/State/Zi.: ,,h: IL; ; t., O Phone#: , — g• —(a, b Are you an employer?Check the appropriate box: -___— I.❑ I am a employer with 4. 0 I am a general contractor and I Type of project(required): have hired the sub contractors . 6. 0New construction employees(fall and/or parttime).: 2.dI am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. 0 Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp.insurance.: 9. ❑Budding 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 Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.0Roof repairs insurance required]t c. 152, §1(4),and we have no 3a.❑ I am a homeowner acting as a employees.[No workers' 13.0 Other • general contractor(refer to#4) comp.insurance ]. - }Any applicant that checks box#1 must also fill outtheir w the section below showing orkers'compensatioapolicy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors limn 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-coneactms have employees,they must provide their workers'comp.policy number. /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 cee/rnfr under the pains and penalties of p9.)/300erjury that the information provided above is true and correct • Signature:/!� Date: 9.)/300 . Phone#: .1)Qi-240 -Gal.4O • 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#: ` 1'O W-N-014–YARIVIOU-T-H— — BUILDING DEPARTMENT . ''£ 1146 Route 28,South Yarmouth,MA 02664 °s), 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 1, Section 1113, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at--I\\ Qtke?Q) CAOIRAbl i1. OZ-W,l1 Work Address Is to be disposed of at the following location: GFS (r)1(m0t41101 Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. 000 Signature of Application Date Permit No. oF� 9k TOWN OF YARMOUTH kire- o HEALTH DEPARTMENT o 71'1 S •% PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Building Site Location: 111 (Zou\e 2? S. °Pratt k. OZWA Qlfr '7 1 Propose Improvement: i a t ►.. ; V1 r. \JQ\z t ( tn c • Applicant:�tc��` 1\\ ' e3t ( Tel.No.: 500—Z96 -G29a Address: \(�ppj %9 Ctc &'1U`\\t vmx, U 2422— Date Filed: gig it "Ifyou would like e-mail notification of sign off,please provide e-mail address: \ Owner Name: 2k\ 1�c,\t\\1np Owner Address: 110\ cSyit Pc 0cm,m vA, Q vis Owner Tel.No.:Tj6Qr28i ANI 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: 6Thi1!�//' DATE: //C�/8 f PLEASE NOTE COMMENTS/CONDITIONS: Mau, MGL AND FIRE .004 . TOWN OF YARMOUTH REVIEWED FOR CODE COMPLIANCE. ERRORS OR OMMISSIONS DO NOT RELIEVE Q THE APPLICANT FROM THE RESPONSIBILITY ' OF'AS BUT OMPLIANCE. DATE: C'r611;10 • YARMOUTH FIRE PREVENTION ECTO 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 E 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 Cl.Smith. Date: 9/6/2018 Copy for Applicant O Copy to Building Department II Copy to Fire Prevention Entered in Firehouse I—I Final Inspection , „., / 96" // gE E x 0— I— w it P CI cc . M 0 I-•6- 1 11 Al2"ts.• ....4 cp = ----31 ; " / 22.136" /131r / 16" / at 2— zaa wm a to g 6 >- .c 174 cizil* U. (2 .11 11 / / 24" , / - 72" 05,10LI tht, 5 Z P315 , Sj Li-0 LA- LU •••••• 0 C3 CI: 12-(2 1 . . . , m. IMP . 11, -, -1 ._ r © ., 03 0, • isAde-- fa% am %ad , , _ 2 N ,.. di. j....ji 01 L.WELLWORTH > -, .. _.. 0 r .,. ui .. __.2 , .... _ a .,,, o , N 1.5... 0 C..0 .. .. . . a) .. . ._, .....,.. Co ..,.. o .. ''• t. . > , .- - '1'1 0) Gi'iEtifAVLEID) . CO 7:1 , 0) 0 SIP 0 6 2018 K 1 , -,1 HEALTH DEPT. r. , t N. N ' N NN 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 applicable fee has been paid or job conditions. 2020 order placed. , . PEIR 7 CONDO BATHS All Drawing#: I No Scale. . . 11 . ► 11 I1 ! II -1II ► ! I ! I. - - ! 1 ! I I _ _ l 1 __ -- - 511 11 I 111 Iro 1 ._ - ti- . III z54I I `^- 1 1 . I1I ,51 . r - i - 1- OI'8 91- L H I - ' - -- - - - - - - - - I I - ! - I� - - ± H-t _ I -- - I4I - - -I- I - -- I -1 I I - - I I_ . I . - - _ . __ _ - . -- -- _ -. _ -- - -- - ._. ._ J . � I i � � IIII I I 1- 1 I - I I-- . - 1 - 4olx_$, ._ : . � , - - -T— � . HI I - 1 I . _ 1 11 1 I I-- 1_ 1 I . _ - ' 1 I i ! - I I _I .. o � I -. 1 S ' . 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