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HomeMy WebLinkAboutBLD-19-002299 it 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 ': Massachusetts State Building Code,780 CMR Building Permit Application To Construct,Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building PermitNumber: 7j e.D -19-pUJac",Ja Date Applied: • Maid, /.� Building Official(Print Name) / Signature , Date Sr ON I:SITE INFORMATION / 1.1 Pr perty Address: ddress: 1.2 Assessors &Parcel Number/ R E C E I V E D PoiN)C Oficb �p 1.1a Is this an accepted street?yes L.-•"*.no Map Number Parcel Num. 1 2 018 1.3 Zoning Information: 1.4 Property Dimensions: OCT 2 Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) X171 ''- PA . . rol7 i 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private 0 Zone: _ Outside Flood Zone? Municipal❑ On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP', 2.1 Owner'of Record: &a 'p i nit tCHELLC Jom&t: 5. "belanou-111- pevsc o2ca(QL{ 4 Name(Print) City,State,ZIP 7 e c- 20RD So8-Z%D-'MZ_ Sebe t Jampeetz$rtat ( •con. No.and Street Telephone Email Address SECTION 3:.DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition 0 Demolition 0 Accessory Bldg.0 Number of Units_ Other ❑ Specify: Brief Description of Proposed Work2: 7tEPLACr 0I-0 STEP/DECK_ W'TA NEW 0Nr` , AbN '$(A 1nt,-it'-QS Foe- A 1269--COLA SECTION4i ESTIMATED CONSTRUCTION COSTS. Item Estimated Costs: Official a Onl ' (Labor and Materials) y 1.Building $ d Building Permit Fee,$ /5 Indicate how fee is determined: 2.Electrical $ ❑Standard City/rQwnApplicationFee ❑Total Project Costs(It 6)x multiplier x 3.Plumbing $ 2 Other Fees: $ • 4.MechanicalList: (HVAC) $ 5.Mechanical (Fire Suppression) $ Total All Fees $ • ,/� CheckNti. Check Amount: Cash.Amount: 6.Total Project Cost $ ,/�.j 0 0 0 0 Paid in Full , . El Outstanding Balance Due: � • SECTION 5:.CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number Expiration Date Name of CSL Holder List CSL Type(see below) No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted I&2 Family Dwelling City/Town,State,ZIP M Masonry 1W Roofing Covering • WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) • HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name No.and Street Email address City/Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE ANtIDAVIT(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 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. G€or,_.F Jltmpee__ ib l8 i2at8 Print Owner's or Authorized Agent's Name(Electronic Signature) - ate . 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 HIC Program can be found at www.mass.gov/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.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" The Commonwealth of Massachusetts ' =Pr0= V t .;gj]hgt Department of Industrial Accidents . € = Idl= 1 . 1 Congress Street,Suite 100 %t—'I_�= Boston, MA 02114-2017 • �c.�.� • www.mass.gov/dia \Yorkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information at."bl Please Print Ley Name (Business/Organizatio ndivi G'>— JN e'V\Pee Address: 7 PA I N C (Loes p fb City/State/Zip: 5• **es will- riff 02W4Phone #: 512--280 q& Z, Are you an employer?Check the appropriate box: Type of project(required): I.0 I am a employer with employees(full and/or part-time).• 7. 0 New construction 2.01 em a sole proprietor or partnership and have no employees working forme in 8. .emodeling ' any capacity.[No workers'comp.insurance required.] 31 am a homeowner doingall work myself. t 9. 0 Demolition y [No workers'comp. insurance required.] 4.01 am a homeowner and will be hiring contractors to conduct all work on m property. I will 10 Q Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.01 am a general contractor and I have hired the sub-contractors listed on the attached sheet These sub-contractors have employees and have workers'comp.insurance.: 13.0 Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.0 Other 152,§I(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 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 anew affidavit indicating such tContractors 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 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$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify inder the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: IA) b ZOtg Phone#: Spg e0-1(0 ' itG Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# • Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: o .YAR TOWN OF YARMOUTH • }` 29, y` BUILDING DEPARTMENT \•* 1146 Route 28, South Yarmouth,MA 02664 508-398-2231 ext. 1261 HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE: (a ZO l$ JOB LOCATION: J uif11PE12- Flouse" 1 pktog £.mato S. yfx2MocC(M 02lilf NAME STREET ADDRESS SECTION OF TOWN "HOMEOWNER" CaI> Juvr9 5 -no-tMcr3v S1PE NAME HOME PHONE WORK PHONE PRESENT MAILING ADDRESS —1 P01 n>�. 20 Prd) S.`1/t2 t ten rM 024(et( CITY OR TOWN STATE ZIP CODE The current exemption for'Homeowner' was extended to include owner-occupied dwellinns 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 buildinnpermit. (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. Q./ 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,des,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 Chapt 14 of the Mass. General Laws and that my signature on this permit application waives this requirement. Check one: Signature o Owner or Owner's Agent weer ) Agent h:homeownrlicexemp 11' ,.. 3�o Y )i„ TOWN OF YARMOUTH c BUILDING DEPARTMENT . F�cs)."o ""� Z 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 I, Section 111_5, I hereby certify that the debris resulting from the proposed work/demolition to be P U conducted at -7 PFin36 20S, wink Address Is to be disposed of at the following location: J Ae1110 wit-f bt5 PoS AL AREA Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter ill, Section 150A. Signa of Application (9 B Zoe Date 2 Permit No. 00-44, TOWN OF YARMOUTH HEALTH DEPARTMENT o � � y PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: 'R-0 n n� Building Site Location: 7 ? b3E PiD S. $As��`Vvffl ont(01 Proposed Improvement: REB4(1_'(S S r6P/DEC's A LCrT Ha.s Doo(Zi Applicant: Coas),FFP.-Evi 31t iMPf�P , Tel. No.: 688 - 41127411272--i6' g Address: '7 1 9-nett, -1T MR a2GLek DateFiled:1, IZ 2otSt' •*/fyou would like e-mail notification of sign off please provide e-mail address: tJ aeo04re-1 Jon PearQ in e:t t ,corn, Owner Name: Gt'bt A1ieM6Ut-C J1MP02--- Owner Address: 7 Pf''NC (t - S.`tvewc0U L tM °OwnerTel. No.: -286-114212. RESIDENTIAL AND/OR COMMERCIAL BUILDING HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. Please submit three (3) copies of plans, to include: (1.) Site Plan showing existing buildings, water line location, and septic system location; (2.) Floor plan labeling ALL rooms within building (all existing and proposed)- Note:Floor plans not required for decks,sheds, windows, roofing; (3.) If necessary, Title 5 application signed by licensed installer with fee. REVIEWED BY: eie DATE: ld ()- PLEASE NOTE COMMENTS/CONDITIONS: • /cif • a.ygR TOWN OF YARMOUTH • ' ' }}� 4c WATER DEPARTMENT • _ y: 99 Buck Island Road f vnr ESEg. West Yarmouth, MA 02673 RECEIVE J Telephone: (508) 7714921 • Fax: (508) 771- 9 8 OCT 15 2018 BUILDING PERMIT APPLICATION BUILDING DEPARTMENT DEPARTMENTAL SIGN OFF TRANSMITTAL SHE L3Y --- Bldg. Site Location / Map �v`1/�� -� #: Lot #: Proposed Improvement: ¶Z L.UL V Sf CPI pgG _ TE' Kr f ctta.4 poop_ Applicant: CGEbPf tis ML CE-lEtt —, ' \su y PGre____ Address? PAttJC RD/S Tel. #: 5$-2Qb - t Q'j_ Date Filed: 1011212.01$ S. `(PcQMOu. {k RESIDENTIAL AND / OR COMMERCIAL BUILDING Water Department: Determines Compliance of Water Availability and or Existing Location Engineering Department: Determines Compliance for Parking and Drainage Conservation Commission: Determines Compliance to Wetlands Acts; i.e. If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Ocean, Bogs, Bays, Marshland, Etc... Health Department: Determines Compliance to State and Town Regulations, i.e., Requirements for Septage Disposal and other Public Health Activities Fire Department: Determines Compliance to State and Town Requirements for Personal; Safety, Property Protection;, i.e. Smoke Detectors, Sprinkler Systems, Etc... an/. ti lo 12 Zot: Signature of ap•-nt 'ate • PLEASE NOTE: COMMENTS: e�ettee . /0 ./..: A�c • Reviewed by: Water Division Date a • .' Ca. ElILE COPY V/ ..................2' & DECK • b © e 3 a' / .. � • , J• r4' . li "T '\ \' y yryii i, o \•\ q S,� ma AREA ®II 2 Q KITCHEN..." n ICI :le CEILMG :: Ytt `,` `\ ROM POST PL< t LIVING ROOM b 1. h ' \ 9 1 a. LT A fl Raaf:= -" WORK MUST CON' I RM TO ALL T Y A i; •'EGULATIONS '' - 1. YARMOUTH ' £R IGEN' DATE _ y DORMERS CENtERED IONwII.:: . EXISTING ASPHALT S o REVISED STEP/DECK S TOWN OF YARMOUTH REVIEWED FOR BUILDING AND ZONING CODE COMPLI- ANCE. ERRORS OR OMMISSIONS DO NOT RELIEVE THE APPLICANT FROM THE RESPONSIBILITY OF'AS BUILT' COMPLIANCE. DATE: /o-2.3--ic BUILOINACIAL, GEOFF AND MICHELLE JUMPER 7 PAINE RD. SOUTH YARMOUTH. 02664 a ' REPLACING EXISTION STEP/DECK WITH NEW COMPOSIT STEP/DECK LEDGER BOARD ON FOUNDATION A e % o 41*,, osiscs, • 0040N : /.. s...,... ,,,,, ,isit i. NINs% N.: 12"TUBES+BIG FOOT 4'DEEPTUBES ALL APPROPRATE JOISTS,SCREWS AND BOLTS. \ JOISTS 16"OFF CENTER COMPOSIT DECKING GEOFF AND MICHELLE JUMPER 7 PAINE RD. SOUTH YARMOUTH.02664 • 7 Paine Road S. Yarmouth • e Li • C . Ai y .'ter � d �•.. e\-4.' � *rte,,. el . .. ' '� '� • 4. -..e,-44)-1 �•S ` h A.{ � 5F'Mr `j" �Y }{.11µ�i Y1 1 -1" C £} °", 0 ' rJ '�'-� � i.:'x`•'. it , Y . `.I - pis ,. .? P'r' -. , -+1 --a-K-1 ' . „ `,� rte.^ fit"' r 'r :y ✓, •hit �, it * '+ .4.‘ t r i.fit' -� t t 4 1_$ L .1 e-. 4`" +3 •.. St _ wr:. ,�, L+ 5�,e✓ ;- v + �d...����jjjj•��� if, * #.. - /:•gin} weeny �C ..*.# 1 J Kilt. : -Mw4 .c 'A'.7 r•.•"'"n , 1, e ,. s, ��4,7 P° N- \-4E' �'r^,',�ti l= iR ,,,, ., . . S' �' 3'�'v. EXISTING LINES • LOT.pNO. : IS ADDRESS:y%, )+ P.I s, Jar OWNERS ONAME: 71 au 1 Mork, .I 1 SEWAGE PERMIT NO. :O'I-3St NEW: REPAIR: ✓ DATE ISSUED: Q-14-OtJ DATE INSTALLED: 134705/ INSTALLERS NAME: Cash's Trockh1vo TNr_ J INSTALLATION OF: 1,,..e, tr r .harv4c-- 1w?/ rnrc 'lATER TABLE: SII FINAL INSPECTION BY: 13G'PM. DRAWING OF INSTALLATION ON REVERSE SIDE: at.% �� z too n C1=31 DS=AG a t lig_ '11:1 A rep I - r; 43: `444 63_ ,t( R.srK 0: 39 _ 3 PS=S . �,_ . BS=d} ` ' 4 . `,. .. . �t k 36 • 51 Oder Dia Dome perl Yarmouth Health Department APPR I VED AraetiCe(. °id /D to 7r