The URL can be used to link to this page

Home My WebLink AboutBLD-19-002339 i•office Use Only �pf Y_yR i.Z C•, Permit py1,�...� Amount _I ��+•�,a $ -Permit expires 180 days from .E'-• .issue date • BLb--4fl-v o x33 EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH RECEIVED Yarmouth Building Department 1146 Route 28 OCT 19 2018 South Yarmouth,MA 02664 (508)398-2231 Ext. 1261 BUILDING DEPARt/ENT 006-4-A/ By 1 CONSTRUCTION ADDRESS: /3 5 MI V ASSESSOR'S INFORMATION: Map: ZS Parcel: 34 OWNER 5g9iyL4* /✓Aiau/l-c Gil -73O-/CZ& NAME t, PRESENT ADDRESS TEL. # CONTRACTOR:SRV 4-0 NtGU, D�C /2.q PA-Lt/ -& si A-RC/MCnw Am-0247-f ' / NAME MARINO ADDRESS TEL.# • I/Residential 0 Commercial c- Est.Cost of Construction$ - $ Ce?0 Home Improvement Contractor Lic.# /Ir"/ l2 Construction Supervisor Lic.14 C5-01 2 53 Workm ary s Compensation Insurance: (check one) VI am the homeowner 0 I am the sole proprietor 0 I have Worker's Compensation Insurance Insurance Company Name: Worker's Comp.Policy# • WORK TO BE PERFORMED Tent _ Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares ( )Remove existing* (max.2 layers) Insulation Old Kings Highway/Historic Dist ( )Replacing like for like Pool fencing Pt'wo/fhbu of- C,K154-i`ZA8 9 4-uCf+2e 'The debris will be disposed of at: agnbrice Wif'STG 5672.f'C6'$$ Location of Facility • I declare under penalties of perjury that the statements herein contained are true and correct to the best of my knowledge and belief. I understand that any false answer(s) will be just cause for d- I. or revocationat,/ of my license and for prosecution under M.G.L.Ch.268,Section 1. Applicant's Sip ature: ►. /v' Date: - Owners Sig ature(oratta 'meat) /I 7'r" Date: Imo./9 . /8 9 /8 •/9. Approved By: Date: Bu' •ing Official or•e EMAIL ADDRESS: Zoning District: _ Historical District: 0 Yes 0 No Flood Plain Zone: 0 Yes 0 No Water Resource Protection District: Within 100 fL of Wetlands: 0 Yes 0 No 0 Yes 0 No _ The Commonwealth of Massachusetts t —a—_ • Department of Industrial Accidents c_ or 1 Congress Street, Suite 100 = t_E Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): S�5074-N NiacOl//'C Address: /1-9 �A-G/�/� 9 City/State/Zip: 4-17-Li NG Tom 07 4,�- 4 Phone#: Gt? —?5c) ' 14‘2 D Are you an employer?Check the appropriate box: Type of project(required): 2.0 l am a employer with employees(full and/or part-time).* ' 7, ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3.Ellam a homeowner doing all work myself[No workers'comp.insurance required.]t 9. ❑Demolition 10 ❑Building addition 4,❑I ern a homeowner and will be hiring contractors to conduct all work on my property, I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance? 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑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 roust 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 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 under,,the pains and penalties of perjury that the information provided above is true and correct. Signature: S /l/�Gf/r r/rte Date: /O • j/. Z4)/a' Phone#: CP" — 93 0 —/6 7 10 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.tecit TOWN OF YARMOUTH BUILDING DEPARTMENT N : roc” » 1146 Route 28, South Yarmouth,MA 02664 508-398-2231 ext. 261 _ BUILDING DEPARTMENT TOTAL DEMOLITION SIGN-OFF FORM State Building Code (780 CMR) Chapter 33, Section 3303.6-Service Connections "Before a building or structure is demolished or removed, the owner or agent shall notify all utilities having service connections within the structure, such as water, electric, gas sewer and other connections. A permit to demolish or remove a building or structure shall not be issued until a release is obtained from the utilities, stating that their respective service connections and appurtenant equipment, such as meter and regulators, have been removed or sealed and plugged in a safe manner." "All debris shall be disposed of in accordance with 780CMR 111.5." Building or Structure Location: 13 5 00--1*i )S Map: 2 S Lot: 3 G Owner's Name:5R.D AR k+cvcovicAddress: 129 PAUneRS' Phone: C/4- -930-162' Contractor's Name: 54ME Address: Qu ��o Phone: Eversource: Date: Orj - .( -1012. By: Title: National Grid: Date: 0 . 23, . jo I S By: Title: Water Dept.: Date: Jo//!//Q By: � b,4'm/We; ' - Title:Cpr Board of Health: Date: vi /t%tt7t B Vie' > pa,u eW %4v Condition: & rrf%'9 370 Fire Dept.: Date: /0 /9//4 /��n. cm id By: `R > Title:j f r/A J7 Historic Commission: Date: By: Title: Conservation: Date: / 5-e fr By:' 7 41 Comcast: Date: Q 4. .011 'o 3/15 of-YAR z� ,-7)---, b Town of Yarmouth 01 „= Conservation Commission "`",°;, Building Permit Sign-off Application `E'� °*wms C TO BE FILLED OUT BY APPLICANT: d1 Building Site Location: 135- V Oce -1g AVE Map # 2 S Lot(s) # 3 G Property Owner: S RD /4-1•) Hit CVOiJ/C Applicant: cga):A-iv N I C It 0 li i C Applicant Address: /29 P11-1.2UEl/' 5 / A-R{_i hi G7z)N /to+-324?4 Telephone: pa- —£3O '4C Date Filed /°• 1(. 20187 Proposed Project Description: F., ! // � Vett-ro L&4 ate s uely 2•e' G2tr/ lad ,l ull! uetc,. /ou-e Plans: SW1tC, S 5-1-rpnbL5{r l55 0t,Qq Si , 6/511g TO BE FILLED OUT BY CONSERVATION ADMINISTRATOR: Do You Have A Valid Permit Front The Conservation Commission For The Proposed Project? boA 2 Comments from Conservation Cosrniss'on: Approved onditionally Approve Rejected All work related debris shall be taken offsite or disposed in a legal upland location At the end of each day, the area shall be clean and no debris shall be in the Resource Area Refer to: SE83- or DOA permit Conservationonemission Sign-off Signature:Zal-a% e- Date: tom i'O sc:Y}ham TOWN OF YARMOUTH .• .c HEALTH DEPARTMENT PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant.: Building Site Location: (1 C ,4 OGS/ r -,i iSl Proposed Improvement: p e w P.,;oS 4 O e 5-Ao a01 r Applicant: SR D,7A-N AltCt Od r C Tel. No.: 6/7- - `730—/C24) Address: I LI /P.1-1-144ev' 51- A-t^Gu4L't4 £/4 4L4,-74 Date Filed: /o• tl. 20/e **/fyou would like e-mail notification of sign off please provide e-mail address: Owner Name: 5l^1�,7r7Lt Al CG ot/iC/ r Owner Address: /2�/ T a t to e N SA sb tcq.'�vnt '1' Owner Tel. No.:C/�' Q30—/CZe) U oy 4-.}ci 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. i REVIEWED BY:A se*/ DATE: /64 t//`-A C Zrenri°Nti/ ---- PLEASE NOTE ,, ,, 1711-12 AS y6' 01 • .y • TOWN OF YARMOUTH ;r,. � WATER DEPARTMENT -1�''- i ! kI y: 99 Buck Island Road M� sE 4'• West Yarmouth, MA 02673 Telephone: (508) 771-7921 • Fax: (508) 771-7998 • BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET • Bldg. Site Location / 3 5` '9C, -//q • 4-Ver� // p. . Proposed Improvement: Rc Ivo 6.51, of! clruckne ett4I et/1 (e tfPu/ G2u4u-L' • Applicant: SIZDJA- 1N• . 1IC GCOV/ C Address (Pi (D,ttu,,err Sr Tel. #: C( -730_laJ Date Filed: /0 J/. 2-Ji8 Artito X'A 02444 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) Boder 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... 5. aAcac ..(C %v . (1- 2O/S Signature of applicant Date • PLEASE NOTE: COMMENTS: • .107//r • Reviewed by: Water Division Date 0 . . .. . • EVERSGURCE a „E ENERGY SW 330,Westwood,MassachusettseZ,9e 06/21/218 Srdjan Hickovic 129 Palmer St, Arlington,MA 02474 RE: 135 Ocean Ave,Yarmouth,MA 02664 Work Order#:2277610 To Whom It May Concern: At Eversource,we're committed to delivering great service. This letter serves as confirmation that,as of 05/24/18 there is no electric service provided by Eversource to the above address. Based on this information,there is no electric power at this address and you may proceed with the demolition. If you have any questions,please contact me at(781)441-3318. • Sincerely, Ted Hooker-Humphries Customer Service Engineer I ESSC Eversource 247 Station Dr,SW 330 Westwood;MA 02090 Phone: (781)441-3318 Fax: (781)441-8765 Email: ted.hooker-humphries@eversource.com nationalrid May 241h, 2018 135 Ocean Ave. South Yarmouth This letter is to notify you that after our investigation it has been determined that the gas service 135 Ocean Ave,South Yarmouth was found to be cut-off on 05/23/2018. This letter DOES NOT preclude the excavator or homeowner from calling 811 before commencing any work. State law requires anyone planning underground excavation work to notify local utilities by calling 811 to get your underground lines identified for you prior to doing any digging. The call to 811 Is the LAW and must be made in advance of starting work.This confirmation letter of a gas cut-off DOES NOT relieve the excavator of making the call to 811. It is a State Law requirement. If you have any questions, please feel free to contact me at 781-907-3728 Thank you, Cat getiut, Colin Galvin nationaigrid Gas Connections coli n.galvin@nationalgrid.com 781-907-2958 • gomcast April 4, 2018 RE: 135 Ocean Ave South Yarmouth, MA 02664 This letter is to inform you that there is no Comcast service running to the address listed above. John Mawhinney Technical Operations Supervisor Cape Cod, MA. 508-760-3400 ext 5633003 _ VUIIIIIIUIIWtdIIII UI IVIdS dtJIUalla I Division of Professional Licensure Fernmeneyeadirty toraawArear t g Board of Building Regulations and Standards Office of Consumer Affairs&Business Regulation COnstc•oCtt6z %b rvisor HOME IMPROVEMENT CONTRACTOR /I YPE LLC Z' ' *-� CS-092531 P EF ires: 10/11/2019 Reoistratfdn Exoiratioq ; 1 9. A739� 12/05/2018 f ' f 3 ,G Iri --t ``./�./ SRDJAN NICKOVIC�,'l37r C NICKOVIC COiNSTRUC ION'I.1-C 129 PALMER SJ t y!' ,. N( - - ARLINGTON A�/02474-' .N SRDJAN NICKOVIC ',/ \D O_,.- Ii '1_ '11 129 PALMER ST 02474"i➢' - U"`�7 _ 6 MI USR7110-1‘‘ i OURuA.a ARLINGTON,MA 02474 UndersecretaryCommissioner (V,.�_—_ . st a. • i