Loading...
HomeMy WebLinkAboutBLD-19-001258 • 6 , e F/ '/,r • ONE & TWO FAMILY ONLY-BUILDING PERMIT Town of Yarmouth Building Department or y 1146 Route 28,South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 L.. f Massachusetts State Building Code,780 CMR ` Building Permit Application To Construct,Repair, Renovate Or Demolish a One-or Two-Family Dwelling ' . This Section Fo Official Use Only • Building Permit Number. -3/.0 /�f-Cfp /oil .Date Applied: R E G E E D •�I� .Ars ..• • a•:, - . ..3°-11 . 'AU �#2 6� 18 Building Official(Print • Stgaature, .. Yate SECTION I:SILL INFORMATION. • • BUILDING. DEPARTMENT , l.l3�rppet$y Add s:_ Wi � n 1.2 Assessors ry1>}p`Parcel Numbers ! _ `�D �� hill tC°'. �/..7 1.1 a Is this an accepted street?ye _ no Map Number Parcel Numb 1.3 Zoning Information: 1.4 Property Dimensions: R E C Et` V E ✓Zoning District Proposed Use Lot Area(sq ft) Frontage(e) ,vOff ..t' 1.5 Building Setbacks(ft) • Op,t,t 2 5 2C18 Front Yard Side Yards Rea LDING DEPARTMENT Required Provided Required Provided Required BY' 't 1 . 1.6 Water Supply:(M.G.L c.40,154) 1.7 Flood Zone Information: • 1.8 Sewage Disposal System: Public kt Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ • ' . • SECTION 21 PROPERTY OWNERSl3tEt - 2.1 erl of Re rd: ICZiv.f rtanit5 6-46 6.,Lo \-e_ yEr ..A:.��a-A44 02C75-- �IJame(Print' City,State,ZIP ✓ Sp`6'IC4-' kt eker52( Csw..[aSIL.<.c No. and Street Telephone Email Address ' . . ' ' SECTION 3:.DESCRIPTIQN OF PROPOSE])WORK'(cher$all that apply) • " New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) .431 Addition 0 Demolition 0 Accessory Bldg. ❑ Number of Units_ I Other ❑ Spe;ify: • Brief Descri,ToticinofProposedWorld: 9 r t .. p.�•C • J.. , Q`ls C,pl-Z.•vt• fay.. A I .OeS All frrS5.4r 1i 4Lt ' CI V • SECTION;4::ESTIMATEDCONSTRUCTIQNCOSTS. p �� Item Estimated Costs: OfficrallJse Onl (Labor and Materials) y 1.Building $ :1::ButldingPermitFee.;$:91 .. Indicate how fiefs•determined: 2.Electrical g • ■Standard City/TownApglicationFee `;`. : .:'.. ',t: .. '::; : • ❑.Total Project Cosl3,(Itteem,6).x multiplier... • : x_r 3.Plumbing $ 4.Mechanical (HVAC) $ List ' 5.Mechanical (Fire .: .. .. . - Suppression) $ Total All Fees:$ . . Check Nd:.• . Check Amount Cash.Amount. . 6.Total Project Cost $ �j/ 0 6 Paid:mull . . ' 4 Outstanding Balance Due: 5 g— • . . SECTION 5:.CONSTRUCTION SERVICES 5.1 Construction Supervisor Lice (CSL) Qg 'o R OV1. jb 4'?.- 14 • .&_l.54)1 . V-` . License Number Expiration Date • Name of CSL Holder II9 2( DeiseNn NS A List CSL Type(see below) ( No.and Street TAe, .. Description • Het r, on y/�r!C In. o'z44 5 ( UJ Unrestricted(Buildings up to 35,000 Cu.ft.) . 1 i� t "-f R Restricted I°u2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering • E WS Window and Siding • �� ✓ /� SF Solid Fuel Burning Appliances t) �agt16 -1,i-)en µA ` Ca. r+C�o...ge I Insulation .Y Telephone Email address .\.rb,t„ D Demolition m 5.2 Registered Home Irovement ContractoriHI4 �G t'�31 i1 Cer- 7-'DIY HIC Registration Number Expiration Date cv HIC Company Name or HIC Regiutrant Name /toy ori-e.5 `(/e N .and Street rW Old VV kik 01.14 � 54'etGPS1'0,0 O, Email address ity/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 athis affidavit will result in the denial of the Issuance of the building permit — Signed Affidavit Attached? Yes No...........❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLE 1Ell WARN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT .. cI,es Owner of the subject property,hereby ammihorize w to act on my behalf,in all matters relative to work authorized by this building permit application. V Jo / o Print Owner's Name(Electronic Signature) Date • • SECTION 7b: OWNERRORAUTHORIZED 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 e and accurate to the best of my knowledge and understanding. \SA-).eef tvt o `iZe(-Ili Print Owner's or Authorized Agent's Name(Electronic Sitmanae) • 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(HIC)Program),will not have access to the arbitration prom=or guaranty fiord 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.gov/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 ofMassachasetts e Department oflndustrialAccidents irr:ra717=2-r-- 600 Office of Investigations • `• Washington Street _ Boston,ALI 02111 wwwanass.gov/dla Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Am►licant Information Please Print Leglbly Name(BustnestfOrganimtion/individual): I\,Lu1•C> I NCS • Address: IC071 Oji nec/"Piev- City/State/Zip:-t-1-IQevvlCg�, n A • Phone#: `S.— P45. 0 ) Are you an employer?Check the appropriate box Type of project(required)'. 1,8a I am a employer with i O 4. 0 I am a general contractor and I 6. []New construction employees(full and/or part-time).* have hired the sub-contractors 2.0 I am a sole proprietor or partner- listed on the attached sheet. T. 0 Remodeling ship and have no employees 'These sub•contractorshave 8. 0 Demolition working forme in tory capacity. employees send brie workers' [No workers'conn.insurance comp.humance.t 9. 0 Building addition required.] 5.0 We area corporation and its I0.0 Electrical repairs or additions 3.0 I am a borneowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself.No workers'comp. right of exemption per MGL 12.13oof repairs Insurance required.]t 0.152,¢1(4),and we have no employees.[No workers' 13.0 Other _ comp.insurance required) _ *Any sppliantthat checksbox ftMatalso IIDout Omsection below showbiz t eiraortaecompasatloa pulley Information. tNomeowners who submit this Math indicating they are doing all writ and then hire outrideeootracton most submit a new Affidavit indicating such. :Contractors that checkt is box must ataehed an additional sheet stewing the name of the subcontractors and sate stadia or not those entitles have employeea.Ifthe sub•conaama•tatemployees,emymsstprovkisthen wordless'comp.policy ambit Iorn an employer that it providing workers'compensation insurancefar my employees Below b the polity and fob she Informed" Insurance Company Name•.44 -co.Pta--veil EYLC.N_611P-17-a t..ic-f. Or> Policy to;Self-ins.Lk# WCY' .mZ�c?�, I( tC Ie'Pt Expiration Date: -4 tril1cj Job Site Address: City/StatetZip: 1 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Pasture to secure coverage as required under Section 25A of MGL c,152 can lead to the hnposltion of criminal penalties of a fine up to 31,500.00 andtor one-year imprisonment,its well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 6250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the ptA for insurance coverage verification.. • Ida hereby coteunder thepains and penalties ofperJary that(Sc Wormed=provided above b tore and correct Sirutattra c�L4l� hr G.lbtt�� nate• Phone#: .�bt`3 - yi4� • 07(•7 Of)7ctal use only, Do not write in this area,to hecongleted by city or town offldai City or Town: Pcntlt/Lteeuse# 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#t _° "'peg TOWN OF YARMOUTH _ BUILDING DEPARTMENT A a `."- -3 1146 Route 28,South Yarmouth,MA 02664 • s• � 508-398-2231 ext. 1261 Fax 508-398-0836 1./• • BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 1115, I hereby certify that the debris resulting from the proposed work/demolition to be • conducted at 'fl 4J ( , �t,, i4 iP J fAnert {� 1,,_� Work Address ` yyy��� Is to be disposed of at the following location: /t_E.) iC k 4- Said dispos.. ite shall be a licensed solid waste facility as defined by M.G.L. Chapte 11, :ection 150A. ..., 4 - 21- l .frir e of Application Date Permit No. GENERAL A. Both Parties are expressly prohibited from assigning this Contract or any rights or interest flowing therefrom. Assignment will only occur with the express written consent of both Parties. B. This Contract contains the entire agreement and understanding between the Parties and supersedes any prior or contemporaneous written or oral Contracts,representations, and warranties between them respecting the subject matter of this Contract. C. This Contract will be interpreted and enforced under the laws of the State of MA,without regard to conflict of laws. IN WITNESS WHEREOF,the Parties hereto execute this Contract: CLIENT CONTRACTOR Authorized(_(q,y- Signature Authorized Signature KellyMouks'1ul25,2018)) Name and Title Name and Title Kelly Brooks Client License Number: MA HIC# 183111 CSL Number: CS-109029 • ©Copyright 2013 Docstoc Inc. 5 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement:Contractor Registration ' • '- j(Tel Type: Corporation , Ml1TOINC. � ;✓• Registration: 183111 1621 ORLEANS RD. Expiration: 08/27/2019 1I ., HARWICH,MA 02645 ,; kLI Vii! SCA 1 C» 20M-05/11 - --- Update Address and returncard. Mark reason for change. .AAdrwau TZ Rpnaw j r 1 Fmnlnyrn.n/_n (924.'6110 mei netleedd oiclia.uadraeta Office of Consumer Affairs&Business Regulation '✓� HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only •, TYPE:Corporation before the a,. ion date. If found return to: A ;at01 lon 9 Office of onsu er Affairs and Business Regulation 18 10 Pat Plaza- •trite 5170 iritITO INC. 6osOn,MA 02 6 JASEN MUTOe 1621 ORLEANS RD. Y HARWICH,MA 02645' Undersec �At vail, without signature retary l.'assacliusett§fiepktment of Public Safety ' y, Board of BLiiktfny Req:u:ations'and Standards License: CS-10902$ Construction Supei'visor " JASENMUTO '" 1 ' �M s -+ 284 D COMMERCE PArtir s t SOUTH CHATHAM MA 02669 • �/l y t ""- ✓�— + ' Expiration: ! 1 4 , • CommlAslon,.r 10/32/2618 • • 011.1' TOWN OF YARMOUTH •* sib WATER DEPARTMENT h �4 99 Buck Island Road M1}TILNEE West Yarmouth, MA 02673 • Telephone: (508) 771-7921 • Fax: (508) 771-7998 BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET Bldg, Site Location 5' �jc v.ln�0.� n� Map #: Lot #: Proposed Improvement: g21-tax + Q-Q 4e k OAS ^ Applicant: 3G. - ■s ado C-- w'1/4- / 1 a Address 10Orltavrj makr` Tel. #:,>oriS qt-{3-O26b Date Filed: 'ed.-2:P- 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 Departm : Determines Compliance to State and Town Requirements for Personal, Safety, Property Protection;, i.e. Smoke Detectors, Sprinkler Systems, Etc... /7:„ /6 -29- r4 Sintur f applicant Date • PLEASE NOTE: COMMENTS: • Reviewed by: Water Division Date • • of att TOWN OF YARMOUTH HEALTH DEPARTMENT •.•�� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: �1 Building Site Location: 5C at,Propo (N/1./s [mait -e •Q ` cJ�_ 0 a e)L, ecelao_c_ c't.4OC ` W ` 1 (N- L -- 'oC4 g„-c:EA.v. K. Applicant: t] Szse- A r s _ Tel. No.: -941ecr3ccs Address: I C2 I Art..— a neLvi.0 A- Date Fi1ed4c294f **If you would like e-mailnotificationof sign off please provide e-mail address: Owner Name: E--L) \ /�g Cooks Owner Address: Clic C ,c�-•^ C�'C'i.\ e Owner Tel.No.:Seco-961-1-13g1 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: ADATE: - Z�— (69PLEASE NOTE COMMENTS/CONDITIONS: �_ �rvcy 7 e cfr ra....t i e ii e � • : a r'- ! : 'Se d ! Ir = `gym $$ 114 ii F 1 Bs ziii h A lij ! fl!FiII1PIffrEt[___ leil i li g sci El 1 i 1 g i pi t-, 1 ', ; ^A- t !i ; r ri ') ... - 1 0 - 1 s 48 g. :--3, : 1 :; : 1 tii • i a; li 4 . lial , , , „ 1 1 blici 7. z i I • .g 1 g i i i g ill li -411 , gip 1 a 111 INI6 ci � . yfes lbls a ,. wwS "1 .. .. S o li .ES �}� � ag�W�t'�= � � F � eE I I A — -_m !! ifl ' X1-11. m ---- - 1-- -- irt- '6 P iiii al WViz 1 iiig e lig i ri r gi Ei V kiii ass giII li ; �+ El 8 I II t _. RECEIVED ^ -- I, d 11 T oL - ---v- AUG 2 9 2018 L yr l(.°2 Gala6tialaT 2-L,-7q HEALTH DEPT 1311-1. ;AR* i VALE KAZf.I>✓5 �i //O�00 / H I Tor n& cicada,. 0 � 3 ' 02- ! O-36 LOAD c I n/ o� I ! • r� � IS gtxil I9 VeC- �� %I84otL.`1 3X ti 47 .E `� it (A1��1/] /i��1� AY'1 , p MBP. %/"l�\ V 1 1 — _ 101011 2b �°L3l �Y AIT r r /'/� 11 -4 'y V �/�l rS YRNeWpJ I 1' atm, zo' 11,‘ �1 /--- talo Res>:Rg . < .1 CAPV4A wu I -N /obi. I. .4 MMCF¢. heRVte& 1 I - I r i 1 Io010 O ID'6' . o 'ilit I ) - I ' T4Nk -I x 11 t 31/ sEpric lit:. GR°PoED , ` • FAMIW - .. I • H V A _O �1 VWI:LLU.ILI 33r,_ PIT W ; T.14 . L 7 ` 01 0 . L __ -_ 4, _t- za• J` . N rize -WORK MU..T CRQ�,NFOR ALL /9't _ TI 5 t RO Imo' ' N BY ' S,& ' i CATION , co ., 11,2171,zl�� Z !TOWN e— S/ 7, / y 1' 1(j o ':RMOUn A RDEP , ` 'V z3° Ze' .a4' "� NO,Oa ' V160 MINIMUM OLItt PIIJCa 5E"f6ACKl SC,MS 1114 2,,, • - 'jD/ PRoNIT=_ 6 ' _ 91 oom _20' -- RC,AIt _ l 1 TOP •F -A •AtIOt4 MANHOLE 4 L07ER TO tixTENP TO FtNISN GRA yeMO. 2% t,LE .. !_4. o. y WITHIN ONE FOOT OF FIN19H GRA17@ o.V e12 _ LEAC.N AREA `!, r 14- 3' 2" of pEA �TaNI FoR^I ;11. ' ' • IN) Z4j VIA.COVarc �Ol5tRl6vTlol� IMI'612VIoLl 5 COVER_ To IIpox 15TZILEV9i. PR5vcNT Vit.'ex, F12OM Mw.i¢_ F---LieN LT SIN, " t ' IN! s •N6 ,ti+- p 6Merl_ . . , /iFEAE _CtpAW. - LMlht, •1 CN c7 v� LINA ' r 14N r_ MIN. - FOoT / y ....scot,:. 3/q'-I/2DIA. -Zoo I - \ 96.58 ` ': I LEAcI-ImwAoNFo INVERT IOOq Lt INVERT142 M1r1 if 9 6.So 411 DIA:PVc. c. 3e, AgLK INVBRT PIPE Vs�`?It3 (WATeRTIG1-IT ) 94.0° /Ur' 0 50.0 0:. ebYi ° II No GARGA6E GRINDER wVelzr a; o° . tip° n/ '' SYSTEM D GTA-rpm__ 14:1, 13/4 - ', =-�.-'i'mihl / 1 • orataint. • I. : 1 OEStc Ni C tAPUTATIONG : SEPTIC- SYSTEM CON STR utiloN I 5H ALL CONFORM -TO THE4MA55. N(-W' ,IZ of 6EDROOAA : _ .3_ .... _ _ ekiv1RONMENTAL CODE TITLE. -g i -Icri `t. Rev leer? 7- I--77 c THE TOWN . ,I / '-- 1 ' ecA1'Lo OF 14EAL--i1-F R�ULATIONS I ( DESllahl �LO�t/ = 3Q�P� <1' r, LEAckkUN� QATE. - _< 2MnJ�, I SEPTc- TAN[, oISTRIt3l�TioN 6oX No , a'�° 1 REQ O. 1-EAC-1-1 . CApA c.'Ty ......3c2 PV Pv_ AND LE-ACI-► Ilex PIT To f3S of • `c/r,��; -` C2EII.IForLcEb CoNcRG�re. : i \`�%r'':` • ±Z1 YQ _ MI/J . GONGIZI.Tt 5TiZENICATA �0OPSI I i _ PROPOSED USAcA-1 CAPACI Ty 0 �re� 2 PSI x.3114-j'7, I 2r5(�1�-03) + 1.0 Cf-?.� N 10 L•OAOIh4CI "-a- - S Nor To t3E LOCA V S. [Ic P LANL I ll.�J/� / ��- 1/E4IO1N LOA2IIJIG? L_I E. O I ;�) GEORGE rtiN •n • LOT-I% ,4ut4wkAL.-eJ wA71 i LOW.1R. - LO CA-II O N • _ _ _ — -YA annoy-n.4 n.4 xis. 0000_ ALL PIPES S it C3E VJATEIzTi c kT K:.. P� e • REFERENCE : fLAIJJa?I4 ZO-L Pae t�_ _ 1 � .0/ST 4- 0 1 SYST-EM TO 13g- Ot4I rl RM SASS \SURVE DARNS. Reca. of PESOS 1 -fEG'S : CAS" N1 •- I.e,.vc"'- - �0(C• PaTh�i oR-T - - — — - - (Lo cg FRS- �� ` b�Te: a -IA' -�►9_ FI►.E" - 12.--13L. — 9 '� of 7S. ' /y 7 ' PV/SED -_)/14f„79 • , ENGINEERING � / � Cm [t DESIGNING BUILDING 1 1 14EAL"(e1-k A( -i APPROVAL- lAi. I DENNIS, MASS. 385 m2831 ...----77.7.-:,......777777.7777 t _ L f 1,-r-:-::',„0'7'.€1.1c.... M { t , f f^. 1 � 9 I x J 4 :Ld3Q 1411r13Fi 3 Sdo ONIaiins � i1If 9102 6 zn� = _ -3O n&NO3 - .11lfi8 SY.d0A111181SNOdS3213H!W021d 1NYOI1d4Y °' 3H1.3A31138ION 0(1 SNOISSIrtIO O S2102i2i3 BONY -� a� g 11dW0O3003 ONINOZ ONY 0N1011118 80d 0�M3Vt3211 IJ. ;+ HlfiO!NUV�l d© NM01 <- ,�-s�`thap 6ugslxa aye se suolsua ilp awes aye oi �linq'6u1aq si pep Me`N 4s!o1Aaena uo sdilo SZ'H tt Iap,116 o s4sod 'sisod:o4 sfuigooj �D ;su011�auuoD'�232N 5-& vik9 1�: -1 1 _deep ,b aae s6uggooj'