HomeMy WebLinkAboutBLD-19-2277 • : ONE & TWO FAMILY ONLY—BUILDING PERMIT
Town of Yarmouth Building Department /or
1146 Route 28, South Yarmouth MA 02664492
508-398-2231 ext. 1261 Fax 508-398-0836
Massachusetts State Building Code,780 CMR
Building Permit Application To Construct, Repair, Renovate Or Demolish iC ez I It
a One-or Two-Family Dwelling e 0
• • This Section For Official Use Only • NOV O U 2018
Building Permit Number:BL7 —f°t 7277.Date Applied: a • °Uul,UtNG Oa
-. ---:�_� RTMFNT
. I I P^ SRA C3 • �, � ..: : . i t.'—V , -``
Building Official(Print Name) • Stgn•-�. ., . . . Date
.SECTION 1:SITE INFORMATION
' 1.1 f rop rty Address: 1.2 Assessors Map&Parcel Numbers
JACKSOM ,k vat U L
1.1a Is this an accepted street?yes lie no Map Number63 Parcel N
13 Zoning Information: 1.4 Property Dimensions: P'` C I E D
Zoning District Proposed Use Lot Area(sq fi) Frontage ) NOV 0 6 20 8
1.5 Building Setbacks (ft)
Front Yard Side Yards Rep $ gLDING DEFAft MENT
Required Provided Required Provided Required Provided .
1.6 Water Supply:(MG.L c.40,t 54) 1.7 Flood Zone Information: • 1.8 Sewage Disposal System:
Public Private❑ Zone: _ Outside Flood Zone?
Check if yes❑ Municipal 0 On site disposal system 0 •
. ' . SECTION2i PROPERTYOWNNRRRS131P`
2.1 Owner of Record: „a
Joi n1 tg SJAti ftudet E Kotcn/ Gm2k$1/21)
KY 4-4 03 S1
Name(Print) City,State,ZIP µ •C
33 t wt-) 1Vaa.3 Oi t�x/trWn) lam, bob 3 Sto'"14-5a J FLAVEu. I ®
No.and Street Telephone Email Address
SECTION 3:.DESCRIPTIQN OF PROPOSED WORK2(cheek all that apply)
New Construction 0 Existing Building er Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units_ Other 0 Specify:
Brief Description of Proposed Work': Fs t1/47tSt4. BASEMAE}t3r • -11-4...S uDdt4e u/Y1rS
Cant?LE-4-40> 15y OW arses W l'c4 mg' 'Ise•re-Pt wt.l et--
SECTION.4::ESTWATED CONSTRUCTION COSTS. -
Item Estimated Costs:
(Labor and Materials) Offiraal'Use Only
1.Building ' $ :1.:Bttlding Permit Fee;$•x„00.. Indicate how fee,is determined-
2.Electrical $ • OStandard City/TQwhApphcationFeu'.. _'...—:! ..` `:a;• :
l7.Total Project Cost!.(Item.6)x multiplier... : : ` s
3.Plumbing $
4.MechanicalList: '
(HVAC) $ .: :. :... ..:.:. , .. •
5.Mechanical (Fire -`•
Suppression) Total All Fees:$
Clieck Nb • . Check Amount • Cash Amount: • '
6.Total Project Cost S O Paid In'Full
Outstanding Balance Due: I t;S
r
' • SECTION 5:.CONSTRUCTION SERVICES
• 5.1 Construction Supervisor License(CSL) F4
'Ghat b . 20
Dj
1 t-na NOT�V License Number Expiration Daze •
Name of CSL Holder
( tj D DEpc List CSL Type(see below)
• No,and Street "'T Type . Description
Penly is max 11/1 C} U Unrestricted(Buildings up to 35,000 Cu.ft)
�Z ! R Restricted lea Family Dwelling
City/Ibwn,State,ZIP M Masonry
RC Roofing Covering •
3 WS Window and Siding
714r 211-'2 IOS SF Solid Fuel Burning Appliances
CL1 ler czis l Caro hIY!/cn[st1® I Insulation
Telephone ago%A,t L,•c address D Demolition
5.2 Registered Home Improvement Contractor(HIC) i�
1D.41.% itt N7a tat/ 1 eg SQfo l O,C�.
BIC Company Name or HIC Registrant Name HIC Registration Number Expiration Date
I e 2,1 paT 9tt T"
No.and Street
]
att.S 'P�''� milk TT* 212 2.542Emaladdress
City/Town,State,ZIP Telephone CAgOE D1281rN1CbA1 1tC TaleestA14•Caw(
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 � 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 QAfaSSO er.A3S.T lltC-R LTV
to act on my behalf,in all matters relative to work authorized by this building permit application.
gee- ActrAt—G-te
Print Owner's Name(Electronic Signature) Date
SECTION7b; OWNER'.ORAU'IHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in ryQ.pplication is true and accurate to the best of my knowledge and understanding.
Print Owner's or Au 'orized Agent's Name(Electronic Signature) • Date
•
• • NOTES:
1. An Owner who obtains a building permit to do hisher own work, or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Progam),will not have access to the arbitration
progam or guaranty fund under M.G.L. c. 142A.Other important information on the HIC Progam can be fiiand at
www.mass.eovIota Information on the Construction Supervisor License can be found at www.mass.eov/des
2. When substantial work is planned,provide the information below:
Total floor area(sq.R) (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
• t = �t Department of Industrial Accidents
Eitpi'=` 1 Congress Street, Suite 100
331(_ Boston, MA 02114-2017
www.mass.gov/dia
Workers'Compensation Insurance Affidavit:General Businesses.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print LeEibly
Business/Organization Name:Dream Construction, Inc.
Address: 150 Depot Street
City/State/Zip:Dennisport, MA 02639 Phone#:508-258-8385
Are you an employer?Check the appropriate box: Business Type(required):
1.❑,r I am a employer with 3 employees(full and/ 5. 0 Retail
or part-time).* 6. Restaurant/Bar/Eating Establishment
2.❑ I am a sole proprietor or partnership and have no 7, ❑Office and/or Sales(incl.real estate,auto,etc.)
employees working for me in any capacity.
[No workers'comp.insurance required] 8. 0 Non-profit
3.❑ We are a corporation and its officers have exercised 9. 0 Entertainment
their right of exemption per c. 152,§1(4),and we have 10.❑Manufacturing
no employees.[No workers'comp.insurance required]** 11.❑Health Care
4.❑ We are a non-profit organization,staffed by volunteers,
with no employees.[No workers'comp.insurance req.] 12.N Other Construction
"My applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
"*If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an
organization should check box#1.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy information.
Insurance Company Name:A.LM. Mutual Insurance Company
Insurer's Address:54 Third Avenue
City/State/Zip: Burlington, MA 01803-0970
Policy#or Self-ins.Lic.#VWC-100-6016187-2017A Expiration Date:10/05/2018
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 day 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 ce under the pains and penalties of perjury that the information providedtrue above is and correct.
Signature: Date: &/1:1/2-C Y)
phone to:508-258-8385
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.Licensing Board 5.Selectmen's Office
6.Other
Contact Person: Phone#:
www.mass.gov/dia
• WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY
INFORMATION PAGE
A.t.M. Mutual Insurance Company
• 54 Third Avenue, Burlington, Massachusetts 01803-0970
(800)876-2765 NCCI NO 26158
POLICY NO. VWC_I00_6016187-2017A
PRIOR NO. VWC-100-6016187-2016A
ITEM
1. The Insured: Dream Construction Inc
DBA:
Mailing address: 150 Depot Street FEIN:'-'5011
Dennisport,MA 02639-0000
Legal Entity Type: Corporation
Other workplaces not shown above: See Location
2. The policy period is from 10/05/2017 to 10/05/2018_ 12:01 a.m.standard time at the insured's mailing address.
3. A. Workers Compensation Insurance:Part One of the policy applies to the Workers Compensation Law of the
states listed here: MA
B. Employers'Liability Insurance:Part Two of the policy applies to work in each state listed in item 3.A. •
The limits of liability under Part Two are: Bodily Injury by Accident $ 100,000 each accident
Bodity Injury by Disease $ 500,000 policy limit
Bodily Injury by Disease $ 100,000 each employee
C. Other States Insurance: Coverage Replaced by Endorsement WC 20 03 06 B
D. This Policy includes these Endorsements and Schedules: SEE SCHEDULE
4. The premium for this policy will be determined by our Manuals of Rules,Classifications,Rates and Rating Plans.
All information required below is subject to verification and change by audit.
Classifications Premium Basis Rates
Code Estimated Per$100 Estimated
No. Total Annual Of Annual
Remuneration Remuneration Premium
INTRA 576519
INTER SEE CLASS CODE SCHEDU_E
Minimum Premium $500 Total Estimated Annual Premium $8,161
GOV GOV Deposit Premium $6,387
STATE CLASS
MA 5645 State Assessments/Surcharges
$7,785.00 x 4.5600% $355
This policy,Including all endorsements,is hereby countersigned by e— 09/07/2017
Authorized Signature Date
Service Office: Bearingstar Insurance
54 Third Avenue 111 Toney Street
Burlington MA 01803 Brockton,MA 02301
WC 00 00 01 A(7-11)
Includes copyrighted material of the National Council on Compensation Insurance,
used with its permission.
0, Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License: CSFA-106016
Construction Supervisor 1 8,2
Family ,
DIMITAR NOTEV t.,
150 DEPOT STREET
DENNIS PORT MA 020.39 ..4 , ?(;. ,'
/l%''Jr •, .07 d.— Expiration:
Commissioner 01/13/2015
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'. 0t•t - : ' TOWN OF YARMOUTH
• 2 c BUILDING DEPARTMENT
#r, . � 1146 Route 28,South Yarmouth,MA 02664
��._.'. �4. 508-398-2231 ext. 1261 Fax 508-398-0836
•
•
BUILDING DEPARTMENT
KIA
NO '!.l E-u) v ba ic
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
Work Address
Is to be disposed of at the following location:
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
Signature of Application Date
Permit No.
•
July 10, 2018
Yarmouth Town Hall
1146 Route 28
South Yarmouth, MA 02664
To Whom It May Concern:
We, John Flavell and Jan Marie Newton,owners of 16 Jackson Avenue,West Yarmouth,
authorize Dream Construction, Inc.,dba Notev Building&Remolding, to act on our behalf on
all matters related to the building permit application for the renovations at our residence.
Sincerely,
n Flavell
Tax Mane Wenn 0110.R011
Jan Marie Newton
Of0ce of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only
TYPE"Oaporation before the expiration b olratioq date. H found return to:
10/17/2020 0ae of Consumer Affairs and Business Regulation
r„.112§2.962, 1000 Washington Street•Suite 710
• DREAM CONSTOLDJNNQQ ..0 Boston,MA 02118
D/B/A NOTEV BUILDING&REMODELING
'
DIMITAR NOTEVi\` '��' ;/ �R r.c°,e
150 DEPOT STREE l tp
DENNIS PORT,MA 02639 Not valid without signature
Undersecretary
` .. -
•
September 10,2018
Yarmouth Town Hall
1146 Route 28
South Yarmouth,MA 02664
To Whom It May Concern:
Per your request:
1. The ceiling height in the basement is 7'4"
2. The windows size is 36"W x 36" H
Dimitar Notev
Dream Construction, Inc.
•
• • of=Y'9k TOWN OF YARMOUTH
`� '! ° HEALTH DEPARTMENT
0! 1 z'
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�' PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: ...tACK6c;.( Aunt c.tcer Vetaene -ral
Proposed Improvement: LEZ AL%ZE Fr �EVtot)S RQVcxrA'Role
c 1N\ 'g,lk t , Vedvicak ?AV c1Jc&- wifota
c-to7 .T5 usic
Applicant Jc>lrt14.VLOWELL % b, {WI antrinCMCRonr Tel.No.: 5og.ase.B385
Address: l So .PES, DaWs4.4flac. vilA a`3wate Filed:
**Ifyou would like e-mail notification ofsignoff please provide e-mail address:
Owner Name: FI-/3k Vat. `u wwtemi
Owner Address: Owner Tel. No.: 120C, .55014gO
$33 W L+v{Rc*.Q p4cSI A— Wlo t-t* tt l;c51
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: re4l-� DATE: / Dr//r/49-
PLEASE NOTE
COMM.�NTS/CONDITIONS:
Aec1 sed, c f-icp A --_r a -hreer /'-i' t8
Sears, Tim
• From: Sears,Tim
Sent Monday, October 29, 2018 11:39 AM
To: 'capedreamconstruction@gmail.com'
Subject: 16 Jackson Ave
Dimitar,
�1
I ha a reviewed your application for 16 Jackson Ave,and there is one item to address;
. The bedroom shown on the basement plan needs to have a code compliant emergency and escape opening
shown on the plan
Please submit updated plan for review
Thank you
Timothy Sears CBO
Building Inspector
Town of Yarmouth
508-398-2231 Ext. 1259
mailto:tsears@varmouth.ma.us
1
a W , , FILE COPY TOWN OF YARMOUTH
,LI yl
m g REVIEWED FOP.BUILDING AND ZONING CODE CO dPLI-
o ANCE. ERRORS OR OMMISSIONS DO NOT RELIEVE THE
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