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HomeMy WebLinkAboutBLD-18-6104 • of•'''gR BUILDING PERMIT APPLICATION �L. 107`4 �F So APPUCATION TO CONSTRUCT,REPAIR, RENOVATE, CHANGE THE USE,OCCUPANCY OF, •'' • • ,t ••• C OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING.11 ..§ Town orYarnututh Building Department `�\+:,•i 1146 Route 28 • Yarmouth, MA 02664-4492 Tel: 508-3984231 ext. 1261 Fax 508-398-0836 /�Officee Use Only/// Planning Board Information Assessors Department Information PermitX.0— 0 GP-)tQdt Plan Type Map tat Permit Fee $ sbo Endorsement Date a Recording Date New Deposit Recd. $39D Date_ Plan No. 1.4 Property Dimensions: Net Due $ L}6 S Other Lot Area(sf) Frontage(ft) Lot Coverage This Section for Office Use Only Building Permit Number. Date Issued: Signature: J /G '30"it Certificate of Occupancy Building O tai Date- is Is not required Section 1 - Site Information 1.1 Property Address: 1.2 Zoning Information: 41 I/6 frU-rEr028 2 . Zoning District Proposed Use 1.3 Building Setbacks(ft) ' Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided ' 4c1) 4 2 C 80 -± A1/14 41t4 1.4 Water Supply(M.O.L C.40:"S 54) 1.5 Rood Zone Information: Comment= Public Private Zone: BEE • Section 2- Property Ownership/Authorized Agent 2.1 Owner of Record: O4 Van RMPSei • L C r e s IN if ci(j- (print) ailing Address: v{ u9y777/y23Sr Or - , eteph Signature one Telephone Email Address: 2.2 Authorized Agent k.G4 Liu-13 • e(print/ , Mailing Address: i _ 81,--7 "(it • Signatur; Telep one Fax / Email ddress: I Nin► Section 3-Construction Services LS 6}{t)d DA51144 ( Licenssedd Construction supervisor Not Applicable ❑ rQ/2U-r Upo17QC` situ 3 A 12 © , 7/ License/ /Numberr ' e► T ) I&49 ( w r GS SCD 29� (508) gQ140.a�cv2�lc.�nnTss �l rr�yy �r Expiratioignat a lephone t\ — t i erz.c ti E D ren OC^T 3 0185 APR 2 6 2018 s C^" ARTM1 ofENT - 7 1G DEPA 6Cr . B . — _ _ 9v OVER • 3.2 Registered Home Improvement Contractor. y/ I ' w'' / O '.t Company Hams I j' / t Not Applicable i . .• Mo uQ Coo lion 12, in /�/n ^ � 1 �6R-7714 y� �l� •' r Regi trJ�[tlon m r A, nolo p(5o8) 66-7_7 9 4Expiry?",li � / hbn 1n g Tele e / l I, Section 4-Workers'Compensation Insurance Affidavit(M.G.L c. 152 S 25C(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial o he issuance of the building permit. - Signed Affidavit Attached Yes ... No • Section 5- Professional Design and Construction Services-for Buildings and Structures Subject • to Construction Control Pursuant to 780 CMR 116(containing more than 35,000 c.f. of enclosed space) Section 5.1 Registered Architect Not Applicable ❑ Hams(Rsgistrantls Registration Number Address Expiration.Data Signature Telephone Section 5.2 Registered Professional Engineer(s) • Hams Area of Responsibility Address Registration Number Signature Telephone Expiration Date Hams Area of Responsibility • Address Registration Number Signature Telephone Expiration Date Hama Area of Responsibility . Address Registration Number Signature Telephone Expiration Date Hams Area of Responsibility Address Registration Number Signature Telephone Expiration Date Section 5.3 General Contractor 090 U(t / n /fsil r-f(1. t C1/ Not Applicable ❑ ompany Hams //' ,tf�0/%V,1 /1/(NLIQLMCA-2 kbfr Person Responsible r Construction V ,,Th i UAL Or267 2. Add \.f 5 ) 8f,S--77g•-t • at Signure /, I Telephone 2 of 4 • • • Section 6- Descri, I. of Proposed Work(check all applicable) ; New Construction if (tor multi family only) No.of drooms (for multiple family only) No.of Bathrooms • • Existing Bldg.,i/i Repair(s) t(J Alterations (Q Addition ❑ Accessory Bldg. 0 Type Demolition Other Specify: Brief Description of Proposed Work: rNai( &Mill N lr fella? 'FAlt+,t) N •1IcS 7)&04- ( 14A10lw-t�y EP10 1114 F-4 Pt Section 7- Use Group and Construction Type Building Use Group(Check as applicapable) Construction Type • A ASSEMBLY ❑ A-1 ❑ A-2 ® A-3 ❑ IA ❑ A1 wir A-5 ❑ 15 ❑ B BUSINESS ❑ 2A ❑ - E EDUCATIONAL ❑ 2B 0 F FACTORY ❑ F-1 ❑ F-2 ❑ 2c ❑ H HIGH HAZARD ❑ 3.A ❑ I INSTITUTIONAL ❑ I.1 ❑ 1.2 ❑ 1-3 ❑ 38 ❑ M MERCHANTILE ❑ 4 ❑ R RESIDENTIAL ❑ R-1 0 R-2 0 11-3 0 SA ❑ S STORAGE ❑ 5-I ❑ S-2 ❑ 5e I� U UTILITY ❑ SPECIFY: • M MIXED USE ❑ SPECIFY: S SPECIAL USE 0 SPECIFY: IComplete this section iifxisting building undergoing.renovations:additions and/or change In use. Existing Use Group: J' Proposed Use Group: Existing Hazard Index 780 CMR 34 Proposed Hazard Index 780 CMR 34 Section 8 Building Height and Area • Building Area Existing(if applicable) Proposed Number of floors or stories include basement levels Floor Area per Floor(sf) Total Area All Floors(sf) Total Height(ft) Section 9 -STRUCTURAL PEER REVIEW (780CMR 110 11) Independent Structural Engineering Structural Peer Review Required Yes No SECTION 10a OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I71---DM 7 , , A /•/� n / %/�.,',fltn1 , as Owner of the subject property, hereby authorize .0439 Ul d P 1t (" ,Qj/1 1IDNPW C.04/17-41414n half, in a m er relative work authorized by this building permit a••lic- !on. e ° � ' nature of Owner Date 3 of 4 OVER SECTION 10b OWNER/AUTHORIZED AGENT DECLARATION 1. ours- Dc>Do-02 g :?� as • ner/Authorized Agent • hereby declare that the statements and information on the forgoing application a - •- - - --• - -, o the best of my knowledge and belief. Signed under the pains and penalties of perjury. 6—00 1ur' V9 fi '> Print N (71 71913 / i° Si ature of Owner ent Date Section 11 - ESTIMATED CONSTRUCTION COSTS Hem Estimated Cost(Dollars)to be ' completed by permit applicant 1.Building 2.Electrical 3.Plumbing/Gas • 4.Mechanical(HVAC) S.Fire Protection 6.Total:(1+2+3+4+5) 404.17 41- 7.Total Square Ft.tier nn..mcem.&&nomel Check Below ❑ Conservation-Commission Filing (if applicable) ❑ Old Kings Highway&Historical Commission approval (if applicable) • • • • • 40( 4 .. .. • The Commonwealth of Massachusetts ___=fit Department of Industrial Accidents =•=W'=••_.• Office of Investigations r:iiv— .600 Washington Street - • '''I— `` Boston,MA 02111 '..'•• •www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information -- J Please Print Legibly Name (Business/Organization/Individual): It ( Can t tti(y l el4- Address: )A 64TH-p5 waif ) City/State/Zip: Ui. - f1-A- WWF 1 � Phone#(90) " /q —175 9 Are you an employer?Check the appropriate box: — 4. Type of project(required): I , I am a employer with ❑ I am a general contractor and I r employees (full and/or part-time).* have hired the sub conhactors . 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. 0 Remodeling ship and have no employees These sub contractors have g• 0 Demolition working for me in any capacity, employees and have workers' [No workers' comp. insurance comp.insurance.= 9. 0 Building addition required:] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their . 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §I(4),and we have no _ 3a.❑ I am a homeowner acting as a employees.[No workers' 13.0 Other • general contractor(refer to#4) comp.insuranCe ]. 'Any applicant that checks box#1 most also fill out the section below showing their workers'compensationpolicy information. t Homeowners who sobmit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tCantraetnrs 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-contactor 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,. ,Q�/� // Insurance Company Name: rmaveLeRs / Policy#or Self-ins.Lic.#: i Nuts --aC 9% 1100 -9.IS Expiration Date:tr/ IS,// Job Site Address:4 qi S 1- a 5 10. t e+9.4u �,f 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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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 clay against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby :57 under the pains and pe allies of perjury that the information provided above is true and correct Sicmature: -ea /-\,------ Date `t 3//e Phone#: o€'9 61),--77 51/41 . 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#: Information and Instructions ;s • t, Massachusetts General Laws chapter 152 requuu,all emPloyt'ss to provide mss'compensation for their ens:doyen. • u defined as"...every person in the service of another under any cont t of hire, Pursuant to this statute,an employee� 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 oft deceased employer,or the receiver or trustee of an indiridml,partnership,association or other legal entity,employing employ. However the owner oft dwelling house having not more than three apartments and who reside therein,or the occupant of the dwelling house of another who employs persons to do reunt.n.n,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 152,125C(6)also states that"every state or local!iceman;agency shall withhold the isaana or renewal of a license or permit to operate a badness or to construct balldingt la the commonwealth foray applicant who has not produced acceptable evidence of compliance with the Inman coverage required • Additiasnity.MGL chapter 152,125C(7)stases"Neither the commonwealth roc any of its political subdivisions shall • enter into any contact foe the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contacting authority." • Applicants , • Please fill out the workers'compeasatica affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(a)aame(s),address(es)and pboae nambet(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Pumashipe(LIP)with no employees other than da members or partners,are not required to carry workers'compensation insurance. If an LW oc LIP does have -eacloyees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial • • Accidents fur confirmation of instance coverage. Aha be sure te sign and data the affidavit The affidavit should be returned to the city or town that the application for the permit or Sas is being requested,not the Dep.rtme3 of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtains wadeer' compensation policy,please call the Departmat at S flambe:listed below. Self-instned companies should enter their self-imrmaece license number on the spa-option lira City or Town Otadab • Please be sure that the affidavit is complete and printed legibly. The Department has provided i 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 Pleas be sure to fill in the permit/license number which will be used as a reference amber. In addition,an applicant that mrd submit multiple part/icense applications in any given year,need only submit one affidavit indicating=rent policy infamadoa(if necessary)sal under"lob Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that baa been officially stamped or narked 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 tacit be filled out each yea.Where a home owner or citizen is obtaining a license a permit not related to any business or commercial veal= (i.e. a dog license or permit to bum Ieaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give m a call. the Department's address,telephone and fax amber: The Commonwealth of Massachusetts Department of Industria!Accidents Office of Investigations • • 600 Washington Street Boston,MA 02111 Tel. it 617-727-4900 ext 406 or 1-877-MASSAFE. Fax irk 617-727-7749 • Revised 11-22-06 • www.mass.gov/dia og'Y = TOWN OF YARMOUTH 4 �sZ* J. t BUILDING DEPARTMENT ' o -t.°• y 1146 Route 28,South Yarmouth,MA 02664 Fsa�47---;" / 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 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted ate-it/1(c cp©u b2,6 Work Address Is to be disposed of at the following location: V.911,1.P ©'F `4 QUri# Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. . er 111, S-ction 150A. V7e ign. re of Application Date Permit No. Sears, Tim From: Sears,Tim Sent Monday, May 7, 2018 3:04 PM To: moudourisconstruction@gmail.com' Subject: 415 Route 28 George, I have reviewed your application for 415 Route 28 and there are some items to address; 1. What is this space going to be used for?The plan is not labeled as far as the use of that room. 2. What type of foundation is under the area that is proposed to be closed in?The code requires continuous footings under all exterior walls. Please update your application and submit for review Thank you Timothy Sears CBO Building Inspector Town of Yarmouth 508-398-2231 Ext. 1259 mailto:tsears@varmouth.ma.us 1 • YARMOUTH WATER DIVISION • 99 BUCK ISLAND ROAD • WEST YARMOUTH, MA 02673 PH.: 508.771.7921 FAX: 508-771-7998 BUILDING PERMIT APPLICATION • DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET Bldg. Site Location to lR% z W. V Proposed Improvement: 1 atcARaSI f btcH, Pc1414 f t cx9 W Applicant: , movrxvos owsrpsC,17OV7 /Ac. Address 1a2A57ted; Alletti Ni Tel. #: 509779'JSY Date Filed: 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... knano i (L— 111 I0 760 nature of applicant Date PLEASE NOTE: COMMENTS: • R viewed by: Water Div Date G'J' tr.Troneme,iiurp/U o/O/7(a.unr/erre. Office of Consumer Affairs&Business Regulatlon .Y � r HOME IMPROVEMENT CONTRACTOR -' � p TYPE:Corporation tad • •Rmistration U pY, `$ 139811 08/24/2019 MOUDOURIS CONSTRUCTION INC •. • ri GEORGE M.MOUDOURIS C\E-C`i ... 12 ATHENS WAY ' -,— W.YARMOUTH,MA 02673 y Undersecretari i f •• ' Commonwealth of Massachusetts • -�j Division of Professional Licensure Board of Building Regulations and Standards Construction'Si pervisor • CS-066290 • Ekpires:07/12/2019 GEORGE MOUDOURIS•4 C 12 ATHENS WAY t • WEST YARMOUTH MA 02674 • Commissioner se:Y!+h TOWN OF YARMOUTH 3 ,r HEALTH DEPARTMENT PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Building Site Location: lf16J l •ge, W )4-iz_m aunt Proposed Improvement: e{,O b IS1. ReCffbJ/ VC gffirriPekGD3S1A- )r./ Applicant: Mit tS Ca!\7-StaQC1100/ I kit. Tel. No.:Se j 77f3 Y ,6 Address: [Z ATI )L. GUM" Uva A-1_1V Date Filed: * Ifyou would like e-mail notification of sign off please provide e-mail address: Owner Name: DAV LI9 DEM r c ) l k L �Ll t`-� � Owner Address: /1-16—/1-16— 94- 05 W t y./t4'� v/ 1 ' Owner Tel. No.: 771-yb.S.- 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: ( t/CO Gk,l `Y DATE: /P PLEASE NOTE COMMENTS/CONDITIONS: frafaig d,cli fraf 4 rff_CX•9 $4 7 —0 IF• • LOCUS PLAN- RFCORO LOCUS IHFOATION meat SCALENO P,Me a.m_mm as roma — u as vmeca .a m,Aa.,e a - i 436 Res 1.0013CC RAN Mac an.PAW ft - O r .r®"vac Wal. mew e ace ce a s « --.A_ 0 .r.w uric A®V.mwm / _ ___ ma �4j ma.mmn MM at 4.1 pp WSJ s v / - (44/46 s Sraa wN mM i M s v ma�i iquueu'v, comma mom.. ma_ l'-�,..ROU TE. 2B '• ar�'' sinclue W, ..M;¶...Tric1 MO �s 1. - r- aa...� no \'it - ' !w .L"•,m •• PARKING SPACES PRO\1DE)r m • • 00030 1/140 INCIS M arca m mammy ass -.7 :,ma �` i.�Y um imalan is 1 [.; Yy+ Ma SITE PIAN 1'»Y�t 1!T'i— -a—`— I ._..�.... _ OF LAND� � L�—(. X I I / T, a'•'e.BM--I I evaeaa ate. TO ACCOMPANY • ii•� — I / / l[t/ rT I a.m.".." A b •+ 1 e/ a,.,B ia1 Cl t 644•431013 BUILDING • In` r:; r MOW '"'a PERMIT L. 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'/. fly _ r- Y . . • 2 . 14 1 : � h t j l r?�_ Zona.. �r _ _ >ro ¢ 'vim j 3 XF t t :it' s , 4 c a t ,a f jlwa, ..g••. fF (S`.- `£47 ! 'YET ! r MACINNES CONSULTING, LLC PO Box 1182, East Sandwich, MA 02537 (508)274-2091 shawn©macinnesconsulting.com RECEIVED October 24,2018 OCT 2 2018 BUILDING DEPARTMENT Georg Moudouris Moudouris Construction 12 Athens Way West Yarmouth, MA 02673 RE: Foundation Design Proposed Porch Renovation 415 Route 28 West Yarmouth, MA 02673 Dear Mr. Moudouris, This letter is in reference to the foundation design for the proposed enclosure of the existing porch as shown on the attached. The contractor shall install nine 10"diameter Sono-Tube concrete piers spaced as shown on the attached sheet in order to meet the requirements of the State Building Code and the 110 MPH Exposure B Wood Frame Construction Manual. Footings shall be 10"Sono-Tubes with Tube Base 24" Bigfoot base,with four feet of. frost protection and Simpson ABU66 post base with 5/8"diameter threaded rod embedded in the pier six inches minimum with epoxy. Use 16d nails through padding into beam. Space footings a minimum of 6'-0"on center. Please contact Maclnnes Consulting if you have any questions or require additional information. Sincerely, �`H Dr Ltii 1v Sq s`& SHAWN Oyu\ MaciNNES ' CIVIL :. H, 0.41328 O� es . - / �SSiONAL E?`'lay Shawn Maclnnes, P.E. License#41328 • o "� o m o Na I� " W 04) w .. 5i. Oo j h t't SONO USES W!TUBE BASE 24 BIG FOOfiBASE - W14.FROST PROTECTION AND ABU66 POST BASE W r, DIA.THREADED ROD EMBEDDED IN PIER 6"MIN N EPDXY; PAD INNER SIDE OF BASE.USE 16 D , " " ` ILS THROUGH PADDING INTO BEAM,SPACE•- "' OOTINGS 6 FEET ON�CENTE R MAXIMUM(TY - 1 VEL"L k'4l.EN � - + Ors aY ag j YNcLesr 6k;5.-fn; ¶'Qtl.u wSIsr•,�wl,/D(f,,, �t w t- iLc.:J .i .'V. ocuc S 1)Do' , A".Q>tf.'. . .....c:-....- df 4 r 1 11,' 1:14ti't ; 2T tit ; yY k i9.. FY +rrt1 1,U r c Y a w na.;41$41, i I}1'. 4 t t14IRS ° - ao c JJJ/// t x ' ft 1 l II ' , rQ pp , • , tti 00 �_�'] r I' ' 4 10I-.1 t �� yo Q1 4C s • o ‘''.!:f.--- l',3,-* "1 •rti {1�"li ttjl�ts rt i,j11lo i �, c8 �n "�� t `Ill�� t�i ' gc 11 r os o so o o la o $ on 1-0 ° 4 1 . _ . _. . ._..... • , r . . • II. , TOWN OF YARMOUTH REVIEWED FOR BUILDING AND ZONING CODE COMPLI- . , ANCE. ERRORS OR CMMISSIONS DO NOT RELIEVE THE ' APPLICANT FROM THE RESPONSIBILITY OF'AS BUILT' It COMPLIANCE r• 1 cFledt fr. 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