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Home My WebLink AboutBLD-19-001831 ONE &TWO FAMILY ONLY-BUILDING PERMIT Town of Yarmouth Building Department or 1146 Route 28,South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 Massachusetts State Building Code,780 CMR °- Building Permit Application To Construct,Repair,Renovate Or Demolish a One-or Two-Family Dwelling This Section Foral Use Only R E C E V E D ofSof BuidingPermitNamber: BI,D-tq-roi&S31.: .Date Applied: • BoildingOfficial(PrmtN�ne) ' SECTION 1:SITE INFORMATION • .- iry `— 1.„'lAV 11 or (ad 1.2 Assessors Map&Parcel Numbers I.1a Is this an accepted street?yesno Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.O.L c.40,454) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private O Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes0 ' • - , SECTION 2: PROPERTY OWNERSHIP' - 2.1 Owner'of Record: 161989 Manzi Fnct Falmrortl, Mr,n7c4R Name t) City,State,ZIP • 425 Pine Crest Beach Dr. 508-457-9707 N/A No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORKS(check all that a New Construction❑ Existing Building O, Owner-Occupied O Repairs(s) ($ Alteration(s) ❑ Addition 0 Demolition ❑ Accessory Bldg.0 Number of Units_ Other 0 Specify: Brief Dean iption of Proposed Work'': Repair exterior wall bumbed by vehical.Install new framing as needed,Install approximately 10 So.Ft.of R-19 fiberglass Insulation,6 Mil.Polly.sheeting,and drywall.Paint entire room. G . ”` -r SECTION4iESTIMATE))CONSTlIUCP1014COSTS- Item Estimated Costs: ;-;, ,:- 'roffl'aai`Uitbn�y,"' " "' (Labor and Materials) .,- :_:; > ^ ,, i., , . . Jho. .:,. .,• . ,;. 1.Building $ 3,800 1 Building Permit Fee:9 dicat w fee is determine& 2-Electrical S A Standard City/Iowii Appliostione ..,,, .:•::`?• '' O.Total Project Costa(Item 6)Y'muTtiplier.;: :]e • 3.Plumbing $ 0 2 other.Fees $ ,3'J:-' t i'�' 4.Mechanical (HVAC) S 0 Lick;•' .. ,;.:',,:.;} - .`: - '.`'.'• 'fir' 5.Mechanical (Firer r;rs<:;y:=; ;} :..: ;:. :> •,.,'.• ;. _. Suppression) 80 Total All Feesi$', ""'>'" :::';h:i. `„r: ; 6.Total Project Cost S 'CheckN61- Check'Ambuut:' ”. Cash Amour& 3,800 O Paid ins: ; ; ;;',p outstanding Balance . -. - .. SECTION 5: CONSTRUCTION SERVICES • 5.1 Construction Supervisor License(CSL) CS-108564 4/27/2019 Kian Ira Bonvan License Number Expiration Date Name of CSL Holder 57 Washington Bursley Way IistCSL Type(see below) U No.and Street :. ,Type.. Description Centerville, MA 02632 U Umestricted(Buildings up to 35,000 cu.R) City/town,State,31p R Restricted led Family Dwelling M Masonry RC Roofing Covering WS Window and Siding • SF Solid Fuel Burning Appliances 508-241-0982 CIBGinc@yahoo.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 180161 • 10/15/2018 Kinn Ira Bonvan HIC Registration Number Expiration Date MC Company Name or BIC Registrant Name 57 Washington Bunchy Way CI BGinc@yahoo.com No.and Street Email address Centerville. MA 02632 508-241-0982 City/Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.0.152.g 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes ($ No...........0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize to act on my behalf;in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date • • SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. Print Owner's or Authorized Agent's Name(Electronic Signature) D ._ . . . NOTES: • . 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.142A.Other important information on the MC Program can be found at www.mass.eov/oca Information on the Construction Supervisor License can be found at www.mass.eov/dns 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.it.) 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" • The Commonwealth of Massachusetts Department ofIndustrial Accidents "s4;SI 1 Congress Street,Suite 100 '14Boston,MA 02114-2017 '2,� a www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Eleetricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Let>tbly Name(Business/Organization/Individual): Cape& Islands Builders Group, Inc. Address: 57 Washington Bursley Way City/State/Zip: Centerville, MA 02632 Phone#: 508-241-0982 Are you as employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with I employees(full and/or part-time).* 2.0 1 am a sole proprietor or partnership and have no employees working for me in 7. 0 New construction 8. ❑Remodeling any capacity.[No workers'comp.insurance required] 3.0 1 am a homeowner doing all work myself[No workers'comp,insurance required.]t 9. ❑Demolition 4.0 I am a homeowner and will be hiring contractors to cont all work on my property. I son! 10❑Budding addition conduct ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. sub tame 12.❑Plumbing repairs or additions s. ❑ Then haveI have hired the tractors listed on the attached sheet employees and havea workers'comp.insurance.: 13.❑Roof repairs Th 6.0 We are a corporation and its officers have exercised their right of exemption per MGL a 14.®Otho[ Wall Repair 152,$1(4),and we have no employees.[No workers'comp.insurance required] 'Any applicant that checks box 91 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must 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 subcontractors 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 andJob site information. Insurance Company Name: A.E.I.M. Policy#or Self-ins.Lic.#: WCC50050133832018a Expiration Date: 05/13/2019 Job Site Address: 47 Ivanhoe Rd. City/State/Zip: West Yarmouth, MA 02673 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify un the p penalties of perjury that the information provided above is true and correct Simtature: Date: 09/24/218 Rhone#: 508-241-0982 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#: • oF'1Q TOWN OF YARMOUTH �� -r.Ge BUILDING DEPARTMENT o nAf',C F +� - 1146 Route 28,South Yarmouth,MA 02664 c% 448508-398-2231 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 proposed work/demolition to be conducted at 47 Ivanhoe rd.West Yarmouth, MA 02673 Work Address Is to be disposed of at the following location: Yarmouth Transfer Station Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. 09/24/2018 Signature of Application Date Permit No. • ory TOWN OF YARMOUTH o s,, ,t BUILDING DEPARTMENT t. �,� 1146 Route 28,South Yarmouth,MA 02664 S08-398-2231 ext. 1261 HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE: JOB LOCATION: NAME STREET ADDRESS SECTION OF TOWN "HOMEOWNER" NAME HOME PHONE WORK PHONE PRESENT MAILING ADDRESS CITY OR TOWN STATE ZIP CODE The current exemption for'Homeowner'was extended to include owner—occupied dwellings of one or two units and to allow such homeowners to engage an individual for hire who does not possess a license,provided that such homeowner shall act as supervisor. (State Building Code Section 110 R5.1.3.1) Definition of Homeowner: Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is or is intended to be,a one or two family attached or detached structure assessor),to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner,such"homeowner"shall submit to the building official,on a form acceptable to the building official,that he/she shall be responsible for all such work performed under the building permit.(Section 110 R5.1.3.1) The undersigned 'homeowner' assumes responsibility for compliance with the State Building Code and other applicable codes,by-laws,rules and regulations. The undersigned 'homeowner' certifies that he/ she understands the Town of Yarmouth Building Department minimum inspection procedures and requirements and that he / she will comply with said procedures and requirements. HOMEOWNER"S SIGNATURE APPROVAL OF BUILDING OFFICIAL INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL Ch.142. Yes No If you have checked ms,please indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of indemnity Bond OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass.General Laws and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent hhomeownrlicexemp • Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contact of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states`Neither the commonwealth nor any of its political subdivisions shall enter into any contact for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contacting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom • of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by The city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: • The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. # 617-727-4900 ext 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia • • C9IWOMIROMMietS fOgrea.tadteiet4 Office of Consumer Affairs Business Regulation HOME IMPROVEMENT CONTRACTOR ,Type: Corporation BealstratIon rxnlratlort 180181 10/14/2018 Cape&Islands Builders Group, Inc. $:;t, • Klan Bonvan 57 Washington Bursley Way Centerville,MA 02632.-, Undersecretary • • • •11 • • • • • •..• rscoaset4 Division of Prtifessional Licensure 4 guard o/Suilding Regulations and Standards Construction Supervisor DS-ti-yo'Act •aires 24k7r2019 • • KIANI3ONVAN •• ' - • 4_ la I') •• 57 WASHINGTON BUHSLEY WAY: CENTERVILLE MA 0263i - : 1,0t • '712% •• • '.nrrlfr :loner • v., • Fallon, Rosa From: TERESA MANZI <teresamanzi@comcast.net> Sent Wednesday,September 26, 2018 10:32 AM To: Fallon, Rosa Subject: Permit for ivanhoe kian bonban I ,teresa campedelli-manzi have accepted the proposal of kian bonban to repair the house in ifs entirety. Thank you. Teresa campedelli-manzi 1 �1 1 '— II i C r O r � "� Zot li Y Ael c > A ;z ow 2 l s a 3o 3 a D a A A 13'-511/1 ' �) '0" g Y 1 b \ I "w-°N °ii YARYOU i H REVIEWED FOR BUILDING AND ZONING CODE COMPLI- ANCE. ERRORS OR OMMISSIONS-DO NOT RELIEVE THE APPLICANT FROM THE RESPONSIBILITY OF 'AS BUILT' COMPLIANCE. DATE: -UILD G OFFICIA 8FILE COPY