The URL can be used to link to this page

Home My WebLink AboutBLD-19-1564 #19 . . oF•�q,,, BUILDING PERMIT APPLICATION 2c ; 'tr APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE,OCCUPANCY OF, • •• OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING. •v ^ E• ...1'�. , 4 Town of Yarmouth Building Department ��•1 Hca' 1146 Route 28 • Yarmouth. MA 02664-1492 Tel: 508-398-2231 ext. 1261 Fax 508-398-0836 ei •r Office Use On �Ao,7! Planning Board Information Assessors Department Information Permit WOW—/9- dtB • Plan Type Map Lot Permit Fee $ �l Endorsement Date -3`Z/ 1), sioDU Recording Date New Deposit Feed. $ 11441 Date_ Plan No. 1.4 Property Dimensions: Net Due $ Other Lot Area(at) Frontage ON Lot Coverage This Section for Office Use Only Building Permit Number. Date Issued: • Signature: • "7-7---1-=- --e 9. , ,-/g Certificate of Occupancy Building Official Date is Is not required Section 1 - Site Information 1.1 Property Addresslri 1.2 Zoning Information: \* c sit V . u Rah,* is 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.B.L,c.40.S 54) 1.5 Flood Zone Infomation: Comment= Public Private Zone: BFE ' Section 2- Property Ownership/Authorized Agent 2.1 Owner of Record: U;\iS k , ..._.klaala fpr r1U ��1t Mailing Address: -�--- ��--t>5-641 Signature Telephone Telephone Email Address: �� 2.2 Authorized Agent: V 1�tV�l� �r�1\iF�.n� Q'� V `1 ?( \?'(A1� ��u�, , t1-7 1y Hams(print) Mailing Address: (finSignature Telephone Fax * e i Email Address: Section 3-Construction Services 3.1 Licensed Construction`' Supervisor. Not Applicable %ueM\ ��t2�tt1 V")0A ‘ �w1 (� Z It ,_v K ( 7 License Number Address tJ l CkR¢l �� {J/ Z y7j CS ISS tura 5(1#' 2 ^)-6)40 -h"1 u'sk 414;100a" Expiration Date elephone Email Address: 1\`3k'o 1 of 4 • ' , . Section 6 - Descric,tionzli Proposed Work(check all applicable)] - New Construction ❑ (for multiple family only) No.of Bedrooms (for multiple family only) Na.of Bathrooms Existing Bldg. ❑ Pepair(s) 0 Alterations ❑ Addition ❑ r - Accessory Bldg. ❑ Type Demolition Other Specify: Brief Description of Proposed Work: C; .` ^'f fflrr, T rnfi')e 7. U* Lb ‘toakit,, ct\LP 00.Ait-PS ,--'VA P,LWbrXl4 Section 7- Use Group and Construction Type Building Use Group (Check as appficapable) Construction Type • A ASSEMBLY ❑ A-1 0 A-2 ❑ A-3 ❑ 1A ❑ _ A-4 ❑ A-S ❑ 15 ❑ B BUSINESS ❑ 2A ❑ E EDUCATIONAL ❑ 28 ❑ F FACTORY ❑ F-I ❑ F-2 ❑ 2C ❑ H HIGH HAZARD ❑ 3A ❑ 1 INSTITUTIONAL ❑ I.1 ❑ 1-2 ❑ 1.3 ❑ 3B ❑ M MERCHANTILE ❑ 4 0 • R RESIDENTIAL ❑ R-1 ❑ R-2 ❑ R-3 ❑ sA ❑ S STORAGE ❑ S-1 ❑ 5-2 9 55 0 . U UrILITY ❑ SPECIFY: M MIXED USE ❑ SPECIFY: S SPECIAL USE ❑ SPECIFY: Complete this section if existing building undergoing renovations:additions and/or 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(sf) 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 . la --in rAAe \ k\-t± cam--- • t `Rf1\` , as Owner of the subject property, hereby authorize to act on my behalf, in all matters r1 to work authorized by this building permit a plicatio . Signature of Owner Date • 3 of 4 OVER SECTION 10b\ at OW�`t\N`EFU AUTHORIZED AGENT DECLARATION •. (" 1, u \ � t'fZcc OA , as Owner/AuthonzedAgent -^", -` It. 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 VI3)I)} 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) S.Fire Protection 6.Total.(I+2.3.4+5) 7.Total Square Ft.U>n.-imam&irons) Check Below 0 Conservation-Commission Filing (if applicable) ❑ Old Kings Highway&Historical Commission approval (if applicable) Pt• • 4 o1 4 The Commonwealth of Massachusetts '" _ fi Department of Industrial Accidents Office of Investigations 600 Washington Street • Boston,MA 02111 WNW"11. www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/PIumbers Applicant Information Please Print Legibly Name (susmessiorganization/rndividual): tt$ \ \ 4C,i`,(\ Address: 20 %risk 9i'1 city/state/zit: toss : , ,, G Phone#: ; - ' -(4 0 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): employees(frill and/or part-time).* have hired the sub-contractors . 6 ❑New construction 2.l2 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' [No workers'comp.insurance comp,ink trane�: 9. 0 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 Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance 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 contractor(refer to#4) comp.insurance ]. - tAny applicant that checks box 61 must also fill out the section below showing their workers'compensation`poucy bfo®ailor- • Homeowners who submit this affidavit indicating they are doing all work and then hire outside contactors toast submit a new affidavit indicating such. tContracton 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. lithe sob-connamms have employees,they must provide their workers'comp,policy numb= lam an employer that is providing workers'compensation insurancefor my employees. Below is the policy and job site information, Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/4: 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pants and penalties of pedury that the information provided above is true and correct Sit�atvre;� Date: �/3110 • Phone#: t')AQ-240 -4a/-In • Official use onlyy. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: _ —=10WN-OF-YARMOUTH-- �•', --.:rfr C BUILDING DEPARTMENT o �+I ' H 1146 Route 28,South Yarmouth,MA 02664 N "' _ '� 508-398-2231 ext. 1261 Fax 508-398-0836 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 1113, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at 1\\ '6(Y7Q) CA1((Yq(1(t tOktt. 0?-i401{ Work Address Is to be disposed of at the following location: 01; (n1(-0r(fl1 (l9. Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Signature of Application Date Permit No. otgky TOWN OF YARMOUTH ii • o2c,; -)e HEALTH DEPARTMENT r '' ��•��$ PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: �1 Building Site Location: 111 RovC\e 24) S.'\Gmvvk1 cA,t%k.. O.iA,4 Pier 1 I Proposed Improvement: thU k i t %,, , 4. \JeW cksitixik cxx- , • ,(n., Applicant:S& \\ 3 l \t,k� Tel.No.: 5 -Z96 -(2116Address: �t�kiapi 41 (.R,'At' \\\t ft, 0202- Date Filed: q48 J "Ifyou would like e-mail notification of sign off,please provide e-mail address: Owner Name: WitQ,(\ c)c.\t\ \'1\c),` ,� \ \n Owner Address: tit\ w7�' �a, OcAt \'. v[�, ()7 I,5 Owner Tel.No.:'Sb$-zWW1 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: ip" DATE: //c//`j PLEASE NOTE COMMENTS/CONDITIONS: RMOU . MGL AND FIRE a ger-H TOWN OF YARMOUTH • REVIEWED FOR CODE COMPLIANCE. 10 ERRORS OR OMMISSIONS DO NOT RELIEVE THE APPLICANT FROM THE RESPONSIBILITY OF'AS Blip-pOMPLIANCE. DATE: 5't IIQ' uI PECTO YARMOUTH FIRE PREVENTION 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 I ;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 I; 13.7 x *LPG Storage Chapter 148;sec 9,10,28&527 CMR l;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 Copy to Fire Prevention Entered in Firehouse Q Final Inspection 1 W d J / 96" / co O a F .6- 1 1 " 0z� X12" 31 2 .' / 22 /13;6" / 16" / NN AMN Q a 6 Z U i / 24" / 72" / o o ' o m z aw s 2Ou-W m O Oti: 1-(±) d _ ; F ..._. _ ._ _� -u.-. - ac U O _� s _ _ r o •• E N 03 O W N ,i MBWTR .:: -1 >.. o ii A c OIL.WELLWORTH y o n w N O) CO X CO • StP 062016 K O 1 HEALTH DEPT. r N. 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 jobO^O applicable fee has been paid or job conditions. 2020 order placed. PEIR 7 CONDO BATHS All Drawing#: 1 No Scale. ---1- -,---- 1 L.... I I I 1 ' 1 llTl • 1_ i I - - - - - - -- - 1 - L , ik-4-r , II k I I I1 ____ II _:_s oics. _ __ ±IT , ,„ . , /8 1 ___ _ _ __. _ _1 11 . . . 1 - II_ P 1 H 1 . 11 - I 1 - _ 1 • • _i _ 1 11 -.7. 1 1_1 11 ,._ , 1 _i L _ 1- irr1i 'l 1 1 II I ._ _ I_ iIils — _I I 1 l 1 1 - 1 I 1 1 I ii 1 1.1 II I id ' ' : ! II , 1 1 1 1 _ • a 11 _11 J1 . osi 01 '11 11 I1 ' H I _ I 1 1 1 _ 1 J , - - 1 , I 1II I I 1 , —1 1 1 1 1 1 i ii 1 5 - I. - I 1 H- il TH - 1 H -11 - —1 1 1 1 1 1 H ,- | • | - _ _ -_ _ - � _ __ | `-- _ -|- - --- - - - _ __ _� - I |_ -- ' - - l�-- � - � '-' - ' -- -' i _ _ | -_ | | | 1- .. ._| _|__ _ | |- - - - ' - -- --- - - - .- ' - | | eo - - -- -- || - '- -- - - - -- - -/ -- l - | � | � * Int:'- - - '' // - - -- ' ----- - --'--- ' - | • 1 .- 1 . i | | -'� - - _ _| -- - - ` 'J! 1 i | __ _ _ / � ' | � *s�__ _ _ _ i � - - ~ i - � | 7� � 1 '-----� | |1 --�- - | � i | - H i | ' �l` • | � � I - I - -! ' � - I e, e_� I 111 1 1 I _ | 11,..,,,..• - | ' | - | ! | | | � | | . ! / ( ' | 1 1 | 1 � | - | III » | | '' • | | | | • / 111 ~ - I - - -- .11 irti I ---- '/ | | - � | i | i -'- | | / } ' - - - _| � | 1 i | | ' I ' l ' ,| | | | |i -' - ' / | / | ' 1/ / i ! ' � i | I � | ' � i I / "! I | / ' | � ' - - 1 ,| | | � /|� ' | Ls _ | � ' { | ' | H � 1 _- . _ / i I —- - 11II -/ | i � Vl ' | i � — � |' / — � �i | | | | | | ' | / / - |, —| 1 - | | | / I / / ' - | - I ' !� | ' I | | / | | |I 1I I I 1 | i |. | | / | i |� | | � | ' ' i | - i � � | | |1 ^ i | | |! | | | i | | | l / | | | | ' | | | I |