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•
.. • . SECTION 5: CONSTRUCTION SERVICES
i 5.1 Construction Supervisor License(CSL)
License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
No.and Street Type Descr prion
U Unrestricted(Buildings up to 35,000 cu.ft)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC 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 Company Name or HIC Registrant Name HIC Registration Number Expiration Date
No.and Street Email address .
City/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
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes 0 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:OWNERS OR AUTHORIZED AGENT DECLARATION .
By entering my name below .ereby attest under the pains and penalties of perjury that all of the information
contained in .' '.. true and accurate to the best f my lmowledge and understanding.o
/04 ///
y
•
Print , . . . .. d Agent's Name(Electronic Signature) Date
NOTES: ..
. ty;-.- ho 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/ocg 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"
•
• The Commonwealth of Massachusetts
Department oart
De
_il= p flndustrialAccidents
I Congress Street,Suite 100
9a�3� Boston,MA 02114-2017
www.tnass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Eleetrlcians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information �— Please Print Legibly
Name(Business/Organization/Individual): . 7-- y a•a,,,ntY
Address: 7 fgedic ✓6s ,Cc/ •
City/State/Zip: l✓ jC,, i / 42(027 Phone#: 77V-4510 /977
Are you an employer?Check the appropriate box:
Type of project(required):
1.0 am a employer with employees(MI and/or part-time).* 7. 0 New construction
2.01 am a sole proprietor or partnership and have no employees working for me in g. 0 Remodeling
any capacity.No workers'comp.insurance required]
3. I am a homeowner doingall work myself. t' 9. ❑Demolition
❑ ys (No workers'comp,insurance required.]
4.'M 1 am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 ®Building addition
ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions
proprietors with no employees.
12.❑Plumbing repairs or additions
5.01 em a general contractor and I have hired the sub-contractors listed on the attached sheet. •
These subcontractors have employees and have workers'comp.insurance.: 13.5a Roof repairs
6.0 We are a corporation and its officers have exercised their right of exemption per MGL a 14.❑Other
152,11(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 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.
.1 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.Lie.11: Expiration Date:
Job Site Address: 7 /%Cao c J iek/ City/State/Zip:42 y-09u/h /MA OZro77
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 it true and correct.
Signature:
Date:
Phone#:
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 Yqitt TOWN OF YARMOUTH
0s‘.
ay BUILDING DEPARTMENT
N� 1 1146 Route 28, South Yarmouth,MA 02664 508-398-2231 ext. 1261
HOMEOWNER LICENSEEXEMPTION
PLEASE PRINT:
DATE:
JOB LOCATION: 7 /Zka%44,42./t ,ec/ sri4.
NAME..
STREET ADDRESS SECTION OF TOWN
"HOMEOWNER" T4AC•-4,4C -l,aynona 77v-z..54,-/&en
NAME HOME PHONE WORK PHONE
PRESENT MAILING ADDRESS 9 n7c�cA-L
Li 1/c ma.' /HA oLeo 73
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 building permit. (Section 110 85.1.3.1)
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/pc"
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 yes,please indicate the type coverage by checking the appropriate box.
A liability insurance policy Other type of indemnity Bond
OWNER'S INSURAN 0'.WAIVER I am aware that the licensee does not have the insurance coverage required by
Chapter 142 of the eneral Law d that my signature on this permit application waives this requirement.
•�i ne:
•gn ft- of or Owner's Agent ne Agent
h•
ern
ti• xemp
°`rte TOWN OF YARMOUTH
„ o HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: 7 Ain nao& &M aoK RAJ 1✓. %l RRAl0vf/. /7A
Proposed improvement: 4p.,,vr 2 pO.z` .CjLr ON i/zow.r 0/ L- yrscri.ta-
t- $P4 SrvcA fie ASA
Applicant: flit: F /�4S ae.q 20/S Tel. No.: 77 t/-28G-/g77
Address: 7 /yr Anes✓13 R o»c X.9/ 1,2 7Anevoarii / bra Date Filed:
**Ifyou would like e-mail notification of sign off please provide e-mail address:,TE/'LR;9. n FS/y f.t A.It-e6fn,tx. e oy
Owner Name: fe Afr 2),r smlait a es ,/
Owner Address: 7 /'1_ 9 o OGJ B a o o/< Au /4/. YA.U+•o“re Owner Tel. No.:775/ •Z 6y6•/f77
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: ket DATE: /Qe-9lf
PLEASE NOTE
CO MENTS/CONDI IONS:
61 �.s Jr,y,c 9 /4o%o r — .
Brandolini, Jim
From: Brandolini,Jim
Sent: Wednesday, October 24, 2018 2:24 PM
To: 'Jeff DES'
Subject: RE:7 Meadowbrook
Thanks Jeff. I will approve the application now. When you pick up the permit, please draw in the window on the plans
we have.
Jim
From:Jeff DES [mailto:jeffrey.desmarais@gmail.com)
Sent:Tuesday,October 23,2018 5:54 PM
To: Brandolini,Jim<JBrandolini@yarmouth.ma.us>
Cc:Grylls, Mark<mgrylls@yarmouth.ma.us>; Cipro, Linda <Lcipro@yarmouth.ma.us>; Fallon, Rosa
<rfallon@yarmouth.ma.us>
Subject: Re: 7 Meadowbrook
Hi Jim,
The master bedroom has a window on the gable end. I'm sorry that it was left out of the plans.We were not planning on
changing that window as of this point.Would you like me to send a new set of plans with the window? Let me know
when you have a chance.
Thanks again!
Jeff D.
Sent from my iPhone
On Oct 23,2018, at 5:20 PM, Brandolini,Jim<JBrandolini@varmouth.ma.us>wrote:
Jeff:
I'm in the process of finalizing the application review for 7 Meadowbrook. I have one question; does the
left side bedroom have an existing gable window. I see the right BR has one, but the left side is not
depicted.
Thanks.
Jim
1
��AFE`CO� Cape Cod Insulation,Inc. Estimate
rS ""'; 18 Reardon Circle Print Date:/0/16/20/8 Page/of2
F't' IO Estimate#: 602089.00
11"1“4"1" ■.t South Yarmouth,MA 02664 Date: 10/16/2018
Atl/ Terms: Net 30
mit P. 508-775-1214
y Pla
F. 508-778-5735 Po#:
Plan ID:
• 46 6f i : . Sales Rep: Christopher Legere
sAna,n w
� W:ww .capecodinsulation.com Phone#: 508-775-1214
Email: chnslegere@capecodinsulation.com
Customer Name: Job Name:
Desmarais,Jeff 7 Meadowbrook,New Dormer
7 Meadowbrook Rd. 7 Meadowbrook Rd.
West Yarmouth,MA 02673 West Yarmouth,MA 02673
jeffrey.desmarais@gmail.com jeffrey.desmarais@gmail.com
P:774-286-1877 P:774-286-1877 A: F:
Description = ==,J;
DORMER INSULATION PACKAGE: Package Accepted(please circle one): YES / NO
2nd Floor Roofline w/8.5"R38 nominal fill Agribalance Spray Foam Insulation
New 2x6 Dormer Walls Exterior w/5.5"RZY✓ IGaft Faced Batts Installed (16 OC)
DORMER INSULATION PACKAGE TOTAL: $3,175.00 (Package Is Included In Total)
•
vie -•e- - 'tr.°.° Estimate
CAPE=COD Cape Cod Insulation, Inc.
y ys,+ , ra„r Print Date:10/16/20!8 Page 2 oft
18 Reardon Circle
L " �,� Estimate#: 602089.00
1r" "n South Yarmouth,MA 02664 Date: 10/16/2018
nn
NTerms: Net30
P: 508-775-1214 Po#:
immi F: 508-778-5735 Plan 1D:
x' xL�aa..-fir•. E: Sales Rep: Christopher Legere
r `I" av 6!!1 i `' Phone#: 508-775-1214
,yodea' W:www.capecodinsulation.com
Email: chrislegere@capecodinsulation.com
Customer Name: Job Name:
Desmarais,Jeff 7 Meadowbrook,New Dormer
7 Meadowbrook Rd. 7 Meadowbrook Rd.
West Yarmouth,MA 02673 West Yarmouth,MA 02673
jeffrey.desmarais@gmail.com jeffrey.desmarais@gmait.com
P:774-286-1877 P:774-286-1877 A: F:
Thank you for your business)
CCI
Cape Cod Insulation Inc.expects ell areas being insulated to be broom clean and free of debris,prior to work commencing.Itis the responsibility of the
customer to heat the building to at leas)50 degrees to avoid foam shrinkage.Spray foam Insulation cannot be installed when the exterior surface
temperature is below 32 degrees. When installing spray foam Insulation, it Is Imperative that you consult with your I-NAC contractor as CCI Is not
responsible for Improperly sized HVAC units and the damage that may occur. Customer Is responsible for removing or covering anything that you don't
want covered with overspray. CCI In not responsible for the damage that may occur from overspray.
It is recommended that house be evacuated for 48 hours after the spraying of foam Insulation.CCI Is not responsible for any health Issues due to
Inhalation of spray foam insulation.
*No other trades can work on-site while Cape Cod Insulation,Inc Is Spraying foam products.Respirators are required while foam products are being
sprayed.
Cape Cod Insulation,Inc.Is fully protected by Worker's Compensation,Liability and Automobile Insurance.Materials are guaranteed by the
Manufacturer and CCI's workmanship Is guaranteed for 1 year. All agreements are contingent upon strikes,accidents or delays beyond our control.
Terms:Payment is due upon completion.Payment can be made by Cash or Check,No Credit Cards. Any checks returned for insufficient funds are
subject to a$25.00 service fee.Payments not received within 30 days are subject to 1.5%monthly finance charge.In the event that payment is not
received within 60 days of the Invoice your account will be turned over to our Attorney for collection.All collection costs,Including attorney fees,Incurred
by CCI will with be charged to customer.
Note:this proposal may be withdrawn If not accepted within 30 days.
Sales Rep Date
Acceptance of Proposal:CCI Is authorized to do the work as specified.
Customer Signature Date
AUTHORIZED SALES SIGNATURE DATE Subtotal: $3,175.00
GrandTotal: $3,175.00
SIGNATURE PRINT NAME DATE
•
Sears, Tim
From: Sears, Tim
Sent Monday, October 15, 2018 9:26 AM
To: jeffrey.desmarais@gmail.com'
Subject: 7 Meadowbrook
Jeff,
I have reviewed your application for 7 Meadowbrook Rd, and there are some items to address;
1. The energy form you submitted is from an older code.You need to submit either a Rescheck,or use the
prescriptive insulation values (R-21 walls, R-49 ceiling, R-30 floor)
Please update your plan and submit for review.
We also noticed that you have never closed out the permit for the garage addition.This needs to be taken care of as
permits expire,and you may incur more costs of reopening expired permits.
Thank you
Timothy Sears CBO
Building Inspector
Town of Yarmouth
508-398-2231 Ext. 1259
mailto:tsears@yarmouth.ma.us
1
RECEIVED
OCT 0 9 2� - RGY CONSERVATION APPLICATION FORM FOR
L E RESIDENTIAL NEW CONSTRUCTION and ADDITIONS
BUILDING DEPARTMENT 780 CMR Appendix J
BY Tc-an Jr'',, DAc.i n en•r Site Address: J /It Any tel-$'ton /20
Applicant Address: 7 '/'9•E no n w t{a optt(/2GCity/Town: 1 fA/- y/q n iyDie ilidn9
W YA if rtsou rw_ifl Use Group:
Date of Application: /O j 9, P
Applicant Phone: 77H- 284 -/977 Applicant Signature:
Compliance Path(check one):
Prescriptive Package(Limited to 1-or 2-family wood frame buildings heated with fossil fuels only)
Package(A through KK from Table J5.2.1b): " 'k , Heating Degree Days(HDD3 from Table J5.2.1 a: '
(For items d.through i.,fill in all values that apply from Table J5.2.1b:)
a. Gross Wall Area sq.ft f. Wall R-value R- 2 I
b. Glazing Area' ' c sq.ft. g. Floor R-value R-
c. Glazing%(too x b+a) 7 % h. Basement wall R-
d. Glazing U-value U- /' i. Slab Perimeter R- ,t/,i_
e. Ceiling R-value R- a 17' j. Heating AFUE
❑ Component Performance: "Manual Trade-Off"(Limited to wood or metal framed buildings only)
Climate Zone(from Figure J6.2.2) ❑ Zone 12 ❑ Zone 13 ❑ Zone 14
Attach Trade-Off Worksheet from Appendix I, [and HVAC Trade-Off Worksheet,if applicable]
❑ MAScheck Software
Attach Compliance Report and Inspection Checklist printouts
❑ Home Energy Rating System Evaluation
Attach Home Energy Rating Certificate(HERS rating score must be 83 or higher)
❑ Systems Analysis OR ❑ Renewable Energy Sources
Attach Mass Registered Architect or Engineer Analysis
ALTERNATIVE FOR ADDITIONS ONLY:
a.Gross Wall+Ceiling Area 4//2 sq.ft. b.Glazing Area' Z.9 sq.ft. c.Glazing%Goo x b+a) 6,,-S.1%
[' ADDITION with Glazing%(c.)up to 40%may use 780 CMR Table J1.1.2.3.1 below:
MAXIMUM U-value MINIMUM R-Values
Fenestration' Ceiling' Wall Floor Basement Wall Slab Perimeter,Depth
0.39' R-37 R-13 R-19 R-10 R-10,4 ft
I Glazing Area may be either Rough Opening or Unit dimensions.
2 Based on NFRC listing. Applies either to every unit,or to area-weighted average of all units.
3 R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the full R-value over the entire ceiling area
(i.e.-not compressed over exterior walls,and including any access openings.)
. ❑ "SUNROOM"addition(greater than 40% glazing-to-wall and ceiling gross area)
Attach"Consumer Information Form"from 780 CMR Appendix B.
Official's Name: Official's Signature:
Application Approved ❑ Denied ❑ Date of Approval/Denial:
Reason(s) for Denial: (provide additional details as needed on back side)
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