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HomeMy WebLinkAboutBLD-19-001578 P/ Ll i/ 9/5/4 ONE & TWO FAMILY ONLY-BUILDING PERMIT Town of Yarmouth Building Department 1146 Route 28, South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 �� .t' Massachusetts State Building Code,780 CMR Building Permit Application To Construct, Repair, Renovate Or Demolish _�-0 a One-or No-Family Dwelling RECEIVED • 'Reis Section For Official Use Only Building Permit Number. 7912)-19-MI 5g.Date Applied: riPtil filT7 B I I;r• Serirs T " � ! d. �j Rp J � 6=Jg BUILDING OEPA TFC MENT Building Official(PrintName) • • Signature', ' .. ey' ..—.7.D.,.{.7_ • • .SECTION 1:Slat INFORMATION. . 1.1 Property Address: . 1.2 Assessors l\1ap&Parcel Numbers 022r.,-T,.„b,,e (.f-tte) yin-vsavie.r /33 1V/ 1.1 a Is this an accepted street?yes >o no_ 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 L6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Publiy�� Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system' Check if yes❑ •SECTION 2i'PROPERTY O WNERSBIP' 2.1 Owner'of Record: 12o✓4 , ,c294ui,l k '' onnev err' /"ra /lgCr Name(Print) City,State, / , f GreerttelA Cs re% 77ii99yas93 [prikk. t a.'E.:10 en.-, No.and Street Telephone Email Address . '' SECTIO3:.DESCRIPTION OF pROPOSED'iORI{t(c N heckali that apply) • - New Construction❑ Existing Building 0 Owner-Occupied 0 Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑ Demolition 0 Accessory Bldg.0 Number of Units Other Specify:fpf/,n rpey Ph r Brief Description of Proposed Work'-: - p, A - - y Me b.... D Idwir, kJ,ti,.lew-/ irnet flied er r- . . , • , SECTION 3f ESTIIYIATED CONSTRUCTION COSTS. .:.% Item Estimated Costs: (Labor and Materials) , ' Official Vse 9,2171.1:..T. a'.' 1.Building $ L/YOD .-1.Bwldmg Pe rait'Feer$1 TO. Indicate hew fen i¢determined- 2.Electrical $ • 0 Standard Citya wn Application Fee''r', :. ' i R•'EC'E E1. V E D ❑.TotalProjectCosta-(Item6)xmultipiier... ; x- ,qR 3.Plumbing $ 2: OtherFees: $ OCT. O 3 2018 4.Mechanical (HVAC) $ List ' . Me 1 5.Mechanical (Fire -. -,.•• y.��* �•-PAR7M6N7 Suppression) $ ' ClieckNO:.• • Check Amount Caih.Amouut' ' 6.Total Project Cost $ p� m 6 Paid Full ,••. ' 0 Odtstanding Balance Dile: 115- ' 4 • SECTION 5:.CONSTRUCTION SERVICES . 5.1 Construction Supervisor License(CSL) License Number Expiation Date Name of CSL Holder LIst CSL Type(see below) No.and Street Type Description TI Unrestricted(Buildings up to 35,000 cu.ft.) Civ/Town,State,ZIP R Restricted I&2 Family Dwelling M Masonry RC RooSng Covering • WS Window and Siding • SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(NC) BIC Company Name or RIC Registrant Name HIC Registration Number Expiration Date No.and Street Email address City/Town,State,ZIP Telephone SECTION 6:WORKERS' COMPENSATION INSTANCE 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 ❑ No ❑ SECTION 7a:OWNER AUTHORIZATION TO BE COME'LE 1 E1)WHEN • • OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT . I,as Owner of the subject property,hereby a,rhorize • 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. a.�,-;d ^c-keo%kr/C , 9%AP Print Owner's or Authorized Assent's Name(Electronic Signature) Date 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(BIC)Program),will not have access to the arbitration program or guaranty find under M.G.L. c. 141k.Other important information on the BIC Program can be found at www.mass.eovIota Information on the Construction Supervisor License can be found at www.mass.eov/dos 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.ft.) 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" • e = _ Department offndirstrfalAccidents e_tel 5. 1 Cone ess Street,Suite 100 • • tJ•`f= Boston, MA 02119-2017 • www.mass.;ov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Eleetricians/Plnmbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): 2 eveck "le // enakt it; Addres _ • City/State/Zip:y, m - AAl 0a2/7 S-Phone#: 779 9993• 93 • Are you an employer?Cheek the appropriate box: Type of project(required): l.❑I am a employer with employees(full and/or part-time)." 7. 0 New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in any capacity.[No workers'comp.insurance required.] 8• Remodeling am a homeowner doing an work myself.[No workers'comp. insurance required.]t 9. ❑Demolition 4.❑I ant a homeowner and will be hiring contactors to conduct all work on my property. I will 10 0 Budding addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 5.0 I am a general contactor and I have hired the sub-contactors listed on the attached sheet 12.❑RoofPlumr ng repairs or additions These sub-contractors ees ontractors have employand have workers'comp.insurance.t 13.p repairs rt 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14Other g&phot!P. t /I al 152,§1(4),and we have no employees.[No workers'comp.insurance required.] hettr J *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information t Homeowner 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 dr the sub-contractors and state whether or not those entities have employees. If the 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 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 cern),under the pains and penalties ofperjury that the information provided above is true and correct Signature: /✓ Date:9/rAp Phone T:7,y99y7f13 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 4: F'YR TOWN OF YARMOUTH ,M • o RS c BUILDING DEPARTMENT • ;• �� 1146 Route 28, South Yarmouth, MA 02664 S08-398-2231 ext. 1261 3 . • HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: • DATE: • JOB LOCATION: 6: ..4 6 .eta aL, NAME STREET ADDRESS ECTION OF TOWN "HOMED• • 1. 'y i NAME HOME PHONE WORK PHONE PRESENT MAILING ADDRESS aceen kir( et reja 03r7 S 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 assessory 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 buildine 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. ,g- HOMEOWNER'S SIGNATURE .d e4,-,-1,1 APPROVAL OF BUILDING OItICIAL 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 ves, 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. `"cam cds Check one: Signature of Owner or Owner's Agent own ' Agent h:homeowarlicexemp • 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, §250(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 it political subdivisions shall . enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting 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 burn 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. r 617-727-1900 ext. 7406 or 1-377-NLASSAFE Fax# 617-727-7749 Revised 02-23-15 www.mass.govidia TOWN OF YARMOUTH , _ jt a BUILDING DEPARTMENT `ij 4," 1146 Route 28,South Yarmouth,MA 02664 • So,C.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 1113, I hereby certify that the debris resulting from the proposed work//demolition to be conducted atof oc ,And 6,-p jp 9Cv'niit caner /74 Work Address 61175 Is to be disposed of at the following location: !'.nrr,mlri. Alf,A. io /ARe4 Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. N 1/CAP Signature of Application Date Permit No. • ,,.<, : _ . 6ur� °F TOWN OF YARMOUTH RECEIVED QL •..�`4A.' ti R;; x 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451 _ Telephone(508)398-2231 Ext. 1292—Fax(508)398-0836 SEP 7 2018 • RECEI\IOLLD KING'S HIGHWAY HISTORIC DISTRICT COMMITT5rEjKIA HJWAY Lu SEP 1 1 2018 APPLICATION FOR CERTIFICATE OF EXEMPTION TOWN CLERK Aeggitj9r s:1?efpb7)mp41g for the issuance of a Certificate of Exemption under Sections 6 and 7 of Chapter 470 of Acts of 1973, as amended, for the proposed work as described below and on plans, drawings, or photographs accompanying this application. Type or print legibly: Address of proposed work:022-- 6-recn /,on a' C7 re le Map/Lot# . Owner(s): l,Ovr r.{ h ea vy hyteI fC I Phone#: 77 V 99 y 3S'93 All applications must be submitted by owner or accompanied by letter from owner approving submittal of application. Mailing address: Year built: //J o2 Email: bee"r dim Ls.✓t iLr f�fiohar/ • Got++ Preferred notification method: . Phone Email Anent/Contractor: / Phone#: Mailing Address: • Email: Preferred notification method: Phone Email Description of Proposed Work(Additional pages may be attached if necessary): ,cn/.oce c..SO/f/'IhS•G✓indsr,r 4/1 of f lb d er•f id/ /1e(✓ Tc1Xt,.,.. w,nrte,.ul atnd u/..,Cert ]Civ- fcvCI ic,re4 AgncL in.oiiv ivvfe — /0 w,edews ,mar tniuir,1 p..rorr + 4 Li,PI' (✓;// Rep/n to c/ ✓lliCerJ' An /on-cls "eat, and Rep/nes oZ iniiCer7I 4.-',f-1 MCS'-' ones Signed(Owner or agent): a�„r21-71"-y7 / Date: 9Met� > Owner/contractor/agent is aware that a permit may be required from the Building Department.(Check other departments,also.) > This certificate is good for one year from approval date or upon date of expiration of Building Permit,whichever date shall be later. For Committee use only Date: /-",/ r Approved _Approved with changes /a p P R etfiE D Amount c91) Reason for denial: �i 1 Cas j1: /L/94 SEP 10 201$ . / YARMOUTH Rad by. 4/1/ OLD KING'S 11101 WAY Date Signed: n2a/S' Signed: UZ � APPLICATION? 8 - E0 9 6 V5.2017 9/7/2018 (75,999 unread)-davemichalowski@yahoo.com-Yahoo Mail Find messages,documents,photos or people REc Ctc1 E�y7, . F Back a <a a► N Archive h Move Ql Delete © Spam - JGr ` 2018 YARMOUTH Inbox 999+ (No Subject) 2 Yahoc/Inbox r OLD KING'S HIGHWgy ,4 I david michalows �Y 'eIi, david michalowskl 22 greenland circle Replac Sep 7 at 10:07AM liH�� Starer: a (774)994-3593 -WISP . i david michalowskl<davemichalowskt@ Sep 7 at 10:07 AM To:david michalowski 22 greeNand circle Replacing 10 windows for main house.Porch has 6 sliders.replacing 2 T•en sliders with new ones and Less Adding 4 double hung windows In place of the other 4 sliders. Will frame In the open area where the windows will go on the porch with 2 Views Hide by 4's doubled up and ?be.; 16 inches apart on center. Will use'/:inch plywood on the outside of the house for around the windows APPROVED And then will cover plywood area with home wrap and window tape along tea " the windows outside edge, Use cedar shingles painted to match the home color grey and use existing SEP 10 2018 white him to maintain same Outside look as the rest of the house.On the inside of the home will YARMOUTH insulate the wails with r-13 OLD KING'S HIGHWAY Folders Hide Insulation,cover with%Inch plywood then tongue and groove ship lap wood and stained to match the iv,w ':wet Interior wood look along with adding white window trim to match the existing porch look RECEIVED a <a ••• SEP 112018 TOWN CLERK Of SOUTH YARMOUTH, MA • 18 - EU 96 Update time zone httpsl/mail.yahoo.coMdffolders/1/messages/119077 1/1 TOWN OF YARMOUTH • > REVIEWED FOR BUILDING AND ZONING CODE COMPLI. 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