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HomeMy WebLinkAboutBLD-19-001826 • ONE & TWO FAMILY ONLY-BUILDING PERMIT Town of Yarmouth Building Department or ict‘ 1146 Route 28,South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 at4114) . Massachusetts State Building Code,780 CMR Building Penn it Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling RECEIVE51 —- -1 Building PeriaitNumbe,r:N Nici•-•,otfi-afr;;I.: pide 410;d: ' ' • 1-- :•• • - Epf 2 41201b - .13640 rfiBuildingomclalginel ': : ;': :-;.. -.ame) 0 -.....-/"7 /.e. - _,, „ . 1 ••:.:SECTIoN It SITE INFORMATION .'.• • - . . : - 2 : 1.elroperty Addrqs: 30 t. L 1.2 Assessors Map&Parcel Numbers DeNjist. tore b,A4Ainelu 1.1a Is this an accepted street?yes no . Map Number Parcel Number 1.3 ZcettInformatIon: 1.4 Property Dimensions: Zoning District Proposed Use . Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) E Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (ivi.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private CI Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yesCI 2,_...1. Owner'of Record: -V4V5 LAO-Nays 0 N ) 3OVW-IpOkfrot‘kilA MI. ame(Prmt • ity,State,Z ) DetS\Se_ VriND (03 -313-ciSTh Nb.and Street Telephone Email Address :•':',: ; .. ' .:.• : SECTI01,7?:.DESCRO!TIO OF ritOPOSth WORIC2.(check all that apply) :.,'':.-;•..: .:...,.. .::, New Construction CI Existing Building 0 Owner-Occupied 0 Repairs(s) Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg.0 Number of Units OtheIL.fSCiTfeclfr I A>51)1/41(11S10 . Brief Description of Proposed Work2: 1 task‘0,1%) . fli r kiti er 'INStA 41'1A5 (ltd. .cid,. • -•:...:: ' . .. ,..,::•FigcnOriii tarKkrE0,.e.010ticili*COOSq44c:cii• -s42•411.:-;:;-....::''. ItEstimated Costs: it.z.,i:..1-.,---.:- .7!;..,:1::.;';',...t:1 lifE,,:latrata-i-iis$,I:r.4-,:if,;92,...: em (Labor and Materials) -..,: ..::'•.!)..:-.1iNCl.:AT''.1':.':.;'-'.—. -, ' '". •7-7 /1 )•:L:i ti7.K1'!!P4i.b 1.Building - $ r;70 ,i,.,)Building paizieol-,,';ir,*:Indicate Net leo is deterinine& .171 Stindaid teity/Ta*:f.ApPlioatind Pek.,.1?..L.F4t;jfT3;L:tV..:: ?:-1,•:*: 2.Electrkal $ tiNtitiPro'' jeek13;sittlierni5iX innhiPlier.JC.:.C.:.:‘,Wikej-+ 3.Plumbing $ 2otherPees $ ; r 4.Mechanical (HVAC) $ 1 „ vi..t.,:g1:1-","!:4:4'Vli:it.:4!•.3,57 -1.;;;fr,:.10;),. .'3.tis4,0'4C.1;.4,":t..::::4,”;:t ..':: 5.Mechanical (Fire Suppression) $ mita peek v.;::...-4: -t:17 .::::,1:-, : r:::";.M.5:7 :.:2-:,:tc! :,t1:%; thd'aiistec;:-::,:..1! Clieck:Alioniiiv: taslimniiiii:::.:'•:: 6.Total Project Cost: $3-7 6 \ -.6 Pad inFiilli :::;..;',I,C.,0 OtitStli-lialt Bilaike Dtiei-cr;::1;.:,-, ' • . ' - _. SECTION 5:.CONSTRUCTION SERVICES • .. . . • • 5.1- (/� l � / � 1Construction Supervisor rLicense(CSL) /" t _f rFE/ Sl.".'. � 7 C3 L V I III License Number 1 Expiration Date N eofCSLHolder / Vh Dr , List CSL Type(see below) LI lro ?tar r)( , N G2(7l _ U Unrestricted(Build gs up to 35,000 cu.R) Restricted I&2 Family Dwelling CitState, M Masonry RC Roofing Covering WS Window end Siding —r`).�.�//e) I ( � O SF Solid Fuel Burning Appliances / I Insulation Telephone Email address D Demolition 5 tared Home Im vementContractor(BIC) 6^ '• ' U.C HIC Registration Number Expiration Date C mp P�amSA S Registrant Came S flu 11iC1 an Stre britILK (Ter 6) 7c f ) . a) ;ii J Email address . City/Town,State,ZIP ., Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes O No...........17 • • • SECTION 7a:OWNER AUTHORIZATION,TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACT APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize� /�-` /t^ ,I d ( 1/ C to on my behalf,in all matters relative to work authorized by this building permit appl' 'on. ge t Owner's Name(Electronic Signature) Date • ' SECTION 7b:OWNER1 OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information • zuez72-1 co this application is true and accurate to the best of my knowledge and understanding. 91 c-/ Print Owner's or Authorized Agent's Name(Electronic Signature) Date • 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142k Other important information on the IBC Program can be found at www.mass.eov/oca Information on the Construction Supervisor License can be found at www,mass.Eov/dvs 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.R) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" II .�C® �, EFFteul 01 Hwroo�r s d..-- r CERTIFICATE OF LIABILITY INSURANCE I DATE O^..Spp vyyyl +.-- _ 03/02/2018 . THIS CERTIFICATE IS ISSUED AS k MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS; I 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),AUTHORREDI I REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOILDER, 1 I ' IMPORTANT: If the certificate holder Is an ADDITIONAL INS RED,the oli les must have ADDITIONAL INSURED provisions or be endorsed' If SUBROGATION IS WAIVED, subject to the terms and con i ions of the oli ) this certificate does not confer rights',to the certificate holder hi lieu of such endorsement(s).policiesin may require an endorsement A statement on' I PRODUCER , 'CONTACT — j43AeersRte 613drayInsurance Agency,Inc. ! • oar ' !South Dennis,MA 02660 j `( 'NP_�1_ - T(A,q Nat{577�816-2156 I j ARn es.mall D.ro9er'sgray.com` - -- .. I 1MSURER(SI AFFORDING COVERAGE .--T._..HMCO ' '---"-"' ----� overs Mutual Casual Co_ an 21415 I It/SURER mpI INSURED ! 1 mp._ .y�."-'------'-- INSURER_a:NaBonat Liabllit/�&Fire Insurance Comp4rry-120Q52 Efficient Buildings PO Box 246 , 0 i msuRER c_� I - Bridgewater,MA 02324 ' ' 1 - a_---- �INSURERO:_.._ _. _�_ - .___ _ MSURERF: - �— COVERAGES CERTIFICATE NUMBER: I REVISION NUMBER: i THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTE• BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD. INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THisI CERTIFICATE MAY BE ISSUED OR MA PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,i MAY 're�r,7mCmrn PAID CLAIMS _ EXCLUSIONS AND CONDITIONS OF SUC POLICIES.LIMITS SHOWN I Y HAVE BEEN_REDUCED BY !NSR . !A-Di TSUniY t rTRI TYPE OF CISUR/WCE INSO VYD POLICY 1eER POLJCY tee i POLICY EXP rr --.. ._ .- _—_ ____ _ .- ' ilL1GhPO,YYYY11 LRBTS A I X I COMMERCIAL GENERAL LIABILITY _.. -- EACH OCCIRERF2ICE 'S 1,000.000 . 1 _ CWLIS-N:.D-c (X I OCCUR .. • T L, ( 501803118 !09101!20117 09/0112018�F-susy�nSI_-Is..__-_ _ 500,000 i , i ! I_HEp FXP1ArhyaleFerson,- ,s 10000 GEt7L'G^RcGATc[�„rtAP.oLF.g�- I_PERSOWL_L AOVTLa,RY -s_.. _—.1,000,000 + I --�-- ---2,000,000 • POLICY XIP + ` 1 • 'DERMAL ACCATEGATE !S j [` ' E I I PROO:L TS••COL:PR P AGO 3 S 2000,0000 A LAuroatoalLE LmLDtm '-- • 15--- --- CDLIcIl1ED LT_GLE DlslT • I i ;TARED ISFa eacc¢n 1,000,000 .ra•Aura 5Z1803118 ;09/01!2017.0 ---- - 5` f' scdrDIAED I 9/01/2018 eosin*;runny P¢r s - - AUTOS OIJ!v I X ur08 �Epp C F'"'-3Oi�.._ -._._. _ I I c I HIIP ONLY i^ NOON nz ' i I POP RTYDFE1ILY %eCCa eeenti S -- he amdern s i I; I I l ._...._ __ I A I X I UMBRELLA!JAB I X OCCUR I ! S • j .EXCESS LIAa I 1 •• .FAIREGX],RRFI<CE s 2,000,000 __-..L._.d CLAWS-MADE 5J1803118 i 09/01/2017 09101/2018 r--' --"- i ICED?X T R-°TENncN s 10,000. I 1 AGGREGATE . .-.- s _ 2,000,000 . B I IVORKERS COMPENSATION ! -- v, s • ;AND EMPLOYERS'LIABILfTY, ! h PER ' IOTH.—I I ANY PP.OPRIETDRRARRFR/E`tECJTIYE Y/N IV9WC958971 03/02/2018;03/02/2019 1. ACHLRS:_ LIP,_ . __ I IaanG.ita".trafa EXCLUDED? I N/A ' , • EL EACH ACCICIM_ _ `_SOO,000 ry RVI L__. 1 5 IP Yes,des_:IGe ante: 44 F.L CISEABE•FA_ET.IP(:fT'E s — - 500,000 "DESCRIPTION OF OPERATIOPIS Delco h': 1 I I i. 1 ' + —, -) -�--- sEAs-.pnu::v uurt s 500,000 t' .i 1 - I ' I 1 ,DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES(ACORD 101,Additional Remade Schedule,may he attached if more space is moulted) I • L CERTIFICATE HOLDER 1 CANCELLATION , SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE FUSE Engineering 1 THE EXPIRATION DATE THEREOF, NOTICE WU. BE DELIVERED IN S Dupont Ave i ACCORDANCE WITH THE POLICY PRpVI5bNS. i South Yarmouth,MA 02664 i • AUTHORIZED REPRESENTATIVE H • • ACORD 25(2016103) I ©198&2015 ACORD CORPORATION. All rights reserved' The ACORD name and lo o are registered marks of ACORD• Page 1 of 1 Customer Name:Tyler Lachance CONTRACT Email:cookinh5@yahoo.com f,' Phone:603-313-9586mis R w Premise Address:8 Denise Lane,South Yarmouth,MA 02664 Projectemix ID:3454531 Date:Aug.17,2018 ENGINEERING RISE Engineering 5 Dupont Avenue,Suite 2 South Yarmouth,MA,02664 Job Description Measure Description Quantity • Unit Total Cost Customer Cost- CRAWLSPACE:10 MIL GROUND COVER 440 SF $426.80 $0.00 AIR SEALING 8 hr $640.00 $0.00 CRAWLSPACE WALL R10 RIGID BOARD 324 SF $1,312.20 $328.05 INSULATE BULKHEAD DOOR 1 each $110.00 $27.50 KNEEWALL SLOPE:6'FIBERGLASS R19 176 SF $297.44 $74.36 KNEEWALL SLOPE:2'RIGID BOARD 176 SF $677.60 $169.40 REMOVE EXISTING INSULATION-GENERAL 96 SF $93.12 $93.12 TEMPORARY ATTIC ACCESS THRU DRYWALL 1 each $74.19 $18.55 VENTILATION CHUTES 20 each $69.80 $17.45 Total: $3,701.15 Program Incentive: -$2,972.72 Customer Total: $728.43 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF "'Seven Hundred And Twenty-Eight And 43/100 Dollars $728.43 UPON RECEIPT OF YOUR RISE ENGINEERING INVOICE,CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL INTEREST OF IX WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER 90 DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. / A e D• OT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES A / ean. - RISE•e resentative Customer Sig7- 0VT /13 Sign Date N'TE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND 30 DAYS CONDITIONS ARE SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO THE WORK AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE • • I' Construction Supe Commonwealth of Massachusetts Supervisor ® Division of Professional LicensureUnre3trlcted-Buildings of any use group which contain i Board of Building Regulations and Standards • less than 35,000 cubic feet(991 cubicmeters)of enclosed Constrtiet!on` itpervisor 1 0Q' • CS-095581 - Expires:05/12/2020 WILLIAM CALLAHAN}r't s t __„ 175 QUINCY SNORE DR's' .% • ___ The Commonwealth of Massachusetts P^ —g!I Department ofIndustrial Accidents =icel- et 1 Congress Street,Suite 100 ti-lig 1 Boston,MA 02114-2017 ' .,a+ www.massgov/dia Workers'Compensation Insurance Affidavit:General Businesses. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeiblv . 1I Business/Organization Name: 110. I Ar Li I);ICI ri (1C " (1 Address: 017 3 a �(230.e ` 1 n /` City/State/Zip:M o �!k yN ' hone#: 'Sig p ' 4 ' ' I I U A a'n employer?Check the appropriate boa: Business Type(required): 1. .l' ..'a employer with ' employees(fill and/ S. ❑Retail or part-time).* 6. ❑RestaurantBar/EatingEstablishment 2.❑ I am a sole proprietor or partnership and have no 7. El Office and/or Sales(incl real estate,auto,etc.) employees working for me in any capacity. [No workers'comp.insurance required] 8. ❑Non-profit 3.❑ We are a corporation and its officers have exercised 9. 0 Entertainment their right of exemption per c..152,§1(4),and we have 10.❑Manufacturing no employees.[No workers'comp:insurance requited]'* 11.❑Health C 4.❑ We are a non-profit organization,staffed by volunteers, �r,_/,�� L\C1.12 IV l Ft `! with no employees.[No workers'comp;insurance req.] 12. then - *Any applicant that checks box#1 must also fill out the section below showing their work compensation policy information. "If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an ,organization should check box#1. , I am an employer that is ping workers'compensation insyrance for my employees. Below is the policy information. Insurance Company Name: (1 1 N SuR"(.Q ( 0� Insurer's Address:\R ' v\x I (crop S t/`� Hoof 'C'e4 9 City/State/Zip:_Brut �U.S'cn)iJ1 -- N-Ne- q // .Policy#or Self-ins.Lie.# V4 V Q `I ) ( '7 I Expiration Date: 'Q• l/— Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage astequired 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. 1 do herebye746ft, .ainsand. .a o perjury that the information prov dedabove is true and correct Si. attire- C-**1-"I `" p t / Date: / g' Phone#: 4 C� 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.Licensing Board 6.Selectmen's Office 6.Other Contact Person: Phone#: www.mass.gov/di■ • ``' k Permit Authorization mass save Form sacmgn.n+rewph ever, r f't3ene, Site ID: 3444370 Customer Tyler Lachance I, Ti-i(er (a d/ywc ,owner of the property located at: (Owner's Name,printed) 8 Denis'Lane 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. Owner's Signature- Date: © $ / ` 4// ig FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: (S4rrt , Participating Contractor f Date Name: RISE Engineering Phone: 401-784-3700 Email: For Office Use Only Rev.102015 p TOWN OF YARMOUTH BUILDING DEPARTMENT 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 780 CMR,Chapter 1, Section 111.5, I hereby certify that the debris resulting from the roposed// work/demolition to be conducted atR T� /L!!'l ttr Work Address Is to be disposed of at the following location: 923 V[- (±5 ) mou-L„Anit /YY! OZ. 1 `E . Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. qviatc_________ q ./ R .1 Signature of Application Date Permit No.