Loading...
HomeMy WebLinkAboutBLD-19-1562 #17 Of•Y4R BUILDING PERMIT APPLICATION $e 'iQ APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE, OCCUPANCY OF, i , OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING. O „ Z Town of Yarmouth Building Department • \MT TKH(Lf� \.. ..,••11. 1146 Route 28 . Yarmouth. MA 02664-•1492 Tel: 508-398-2231 ext. 1261 Fax 508-398-0836 — Perk'p7Gf707� Office Use OnlyPlanning Board Information Assessors Department Information: g.-�9- 00'4&_ Plan Type Map Lot Endorsement Date -2./ I I? Permit Fee $ J / V Recording Date New Deposit Recd. $ 114 Date_ Plan No 1.4 Property Dimensions: Net Due $ Other , Lot Area(sf) Frontage(ft) Lot Coverage This Section for Office Use Only Building Permit Number Date Issued: Signature: t/,c. 9-n -/a 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(MSL.C.40.S 54) 1.5 Flood Zone Information: Comment* Public Private Zone: BFE: ' Section 2- Property Ownership/Authorized Agent 2.1 Owner pf Reeordt U k\tS ON_ tt ___.. s q Mailing Address: Signature Telephone Telephone 7 Email Address: / 2.2 Authorized Agent Vtai'\\t)\\\\Qft\gct:ac\ V)Z4)\°`1 i? \9:0\\\ A, )T ?J_ Ha''"-,ms (��print) Mailing Address: Signature Telephone FaxeI Email Address: Section 3-Construction Services 3.1 Licensed Construction Supervisor Not Applicable 0 c\veA.c\\ .%Mt�v(4A- IkO‘k/ 5\ C O kshkk U t License Number Address �� (- ,1 �r•/'� /, S-6695S i tural _2 0C1—t, 40 n &`'�l hD17�U'11 Expiration Date elephone Email Address: 1\� \� ,-^on.:ti Proposed Work(check all applicable)] „i ❑ (for multiple family only) No.of Bedrooms (for multiple family only) No.of Bathrooms „Lig. ❑ Repair(s) 0 Alterations ❑ Addition 0 , essory Bldg. 0 Type Demolition Other Specify: Brief Description of Proposed Wolk q �k C1 lonfrl Tfirr • C- .rintc Lln h.,�S ¶c`ULP cbArtiS �ilz., ffW"1 A-\\ ‘0,K , - c'w wXA ty, cure loci,-;0A; Section 7- Use Group and Construction Type Building Use Group(Check as applcapable) Construction Type • A ASSEMBLY ❑ A-1 ❑ A-2 ❑ A-3 ❑ IA 0 Al ❑ A-5 ❑ 1B ❑ B BUSINESS ❑ 2A ❑ . E EDUCATIONAL ❑ 23 ❑ F FACTORY ❑ F-1 ❑ F-2 9 2C ❑ H HIGH HAZARD ❑ 3A ❑ I INSTITUTIONAL I] I-t 9 I-2 9 1.3 0 3B ❑ M MERCHANTILE ❑ - 4 0 R RESIDENTIAL ❑ R-1 ❑ R-2 9 R-3 9 SA ❑ S STORAGE ❑ S-1 9 5-2 9 5e 0 U UTILITY 9 • . SPECIFY: _ M MIXED USE 9 SPECIFY: S SPECIAL USE 9 SPECIFY: Complete this section if existing building undergoing renovations:additions andfor 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 (7B0CMR 110 11) et 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, i r� c.. ETNA 4\C. cycs . ti q/t ,as Owner of the subject property, hereby authorize to act on • my behalf, in all matters resat' to work authorized by this building permit aplicatio . • • �� 2-2 Signature of Owner Date 3 of OVER j The Commonwealth of Massachusetts It Department of Industrial Accidents _.=u'. Office of Investigations • - � —i .600 Washington Street • Boston,MA 02111 •www.mass.gov/ria Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/organization/individoal): \\ �,smipA iNtA • Address: 90 %ct( tin City/State/Zi.: ,� ,. 0' Phone #: ; — . e —(4 0 Are you an employer?Check the appropriate box: 1.0 I am a employer with 4. 0 I am a general contactor and I Type of project(required): employees (fall and/or part-time).* have hired the sub contractors . 6. 0 New constuction 2.1M 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 for me in any capacity, employees and have workers' urance comp.insurance.: [No workers'comp.ins9. 0 Building addition required:] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.❑ 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 12.0 Ftoof 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 required.]. 'Any applicant that checks box#1 must also fin out the section below showing their workers'compcnsation`policy information. t Homeowners who submit this affidavit indicating they aro doing all work and then hire outside coot:actors must submit a new affidavit indicating such. tContraetan that check this box must attached an additional sheet showing the name of the sub-contracton and state whether or not those entities have employees_ lithe 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 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 $250.00 a clay against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct • Si • pynaturi;� Date: tfrl //e Phone#: c)17i-L40 —(, j/ IOfficial use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): • 1. Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 0°=-"4 — -<— TOWN-OH YARMOUTH-- — -- – - ' o4.ry" a Aio BUILDING DEPARTMENT an °¢ y 1146 Route 28,South Yarmouth,MA 02664 �.3'� 508-398-2231 ext. 1261 Fax 508-398-0836 ✓' BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 1115, 1 hereby certify that the debris resulting from the proposed work/demolition to be conducted at—1A ttkc\7Q) S Ai`(Yq(llIA*01lk. 0?-004 Work Address Is to be disposed of at the following location: Or) tricot-kw (0, Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. P1300 Signature of Application Date Permit No. • ✓ . of ky TOWN OF YARMOUTH di . s_�` HEALTH DEPARTMENT s " zi^^ PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Building Site Location: lit (Zov-V 2b S.`\Utrok-A\,h1a. o2-(411-1 Pur 17 I Propose Improvement: it.G\► rt t,, is ,1 .1 -tyau t 0 . Vie Applicant: ) %¶ Tel.No.: :1C0-2 9b -(4,210 Address: !OA %n cver\ \*t\tJ wk, 024072. Date Filed: i)(�1 it "•Ifyou would like e-mail notification of sign off please provide e-mail address: 1 Owner Name: %, 12,("'"\ OS-\t\\\r 0 Owner Address: r\0( TeC 1W. O'AVd K JK, 02.(0(15 Owner Tel.No.:56$-?2O-l4 9 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: - 1,//,// DATE: 7/C//8 PLEASE NOTE COMMENTS/CONDITIONS: MGL AND FIRE J .004 TOWN OF YARMOUTH REVIEWED FOR CODE COMPLIANCE. ,SS ERRORS OR OM MISSIONS DO NOT RELIEVE THE APPLICANT FROM THE RESPONSIBILITY ;' OF*AS BU T' OMPLIANCE. DATE: rl't&fr ierr YARMOUTH FIRE PREVENTION I 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 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 I; 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 Scat Q.Smith. Date: 9/6/2018 Copy for Applicant 0 Copy to Building Department II Copy to Fire Prevention Entered in Firehouse (--1 Final Inspection S1 J '"J / 96" / = 8 ,N oda O LL O 1 „ u �2L X12" 31 2 / 22136" /13;6" / 16" / ` 2wm g . 24" 72" Lo- ° a 0 uj oo- r W K LL U 1 LJ as z -"- - :LC V W W C.3<C J d .,.....-L,.. _ te a o <\ IM - o CO © - N N ; VV MBWTR :; 1 —11 O N TOIL.WELLWORTH D w ,r �—� a)o :_ n\ O CO XI W • SLP 062018 K 0 1 = • r HEALTH DEPT. \ \ \ 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 St job ^O2O applicable fee has been paid or job conditions. �'L/. 1 order placed. -� PEIR 7 CONDO BATHS All Drawing#: 1 No Scale. i 4 i- .H i ----- ■ ■r ■■ 4� 1 1 i si --: 1 ii —I -- • %__ __ _ i 1 i 1 1 „ 1 II 1 _ _ = l 1 _ _ TI1 111____ ed,ss. 1 1 1 _ 1 1 - ■ ■__i_ -- �- C- • , 1 1 1 1 ■ — 1 "I!iIj _ — 1•LSI I — i 1 - ! 1 - I 1 1 I ■ rl - - - I I, I 1 — I I i , _ _I - I _HAL _, . 1 . 1 , . . , I II ■ - I- I I 1 I -iI I - - 1 I - I - I I I .I aX! iJ:f: 1 - -- 1—' —1— — — - 1 I- - - __ - — 1 1 1 1 1 1-1— I — I 1 - - 1 -- 1 1 = - JL1 I I a - I-. 1 -I- -} - -- H 1 111111 I - j - -- 1 1 ‘• II 1111 IIII � I11 III 111111 1it