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HomeMy WebLinkAboutB-19-2698 ONE & TWO FAMILY ONLY- BUILDING PERMIT , Town of Yarmouth Building Department :'or r 1146 Route 28,South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 Massachusetts State Building Code,780 CMR Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling �T,his Section or Official Use Only Building Permit Number: e of Date Applied: 0 9� K t t+' .v' E D clo�R(>C (jli9l0 i e) mss .-Sign / �� OCT 3 0 20'8 Building 0 cffiiai(PnntNarbe) signature,. •, ' Date • '•,SECTION 1:SITE INFORMATION ` • BUILDINGDEK:Afit MENT 1.1 Property Address: 1.2 Assessors Map&Parcel Numbe By. 3q simir ey- 4. �/ z Z 1.1a Is this an accepted street?yes ✓ no Map Num er Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: P — 3 , 43 . Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 41,. Private 0 Zone: — Outside Flood Zone? Municipal❑ On site disposal system K Check if yes❑ , SECTION 2;':PROPERTY O'WNERSHIP1 2.1 Owner'of Record: �►vec DM/ritylWili - 1640444 - , 114% o 7075 Name(Print) City,St te,ZIP T c nt>— zii r___ No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORKS(check all that apply) New Constriction❑ Existing Building Ltt Owner-Occupied 0 Repairs(s) 0 Alteration(s) A Addition 0 Demolition 0 Accessory Bldg.0 Number of Units_ Other ❑ Specify: Brief Description of Proposed Work': /� ge'Ft2rliia -/,nr 4 isrmi- 2e4NUtfe . Otyts-4- ( a..-L biler4r1n etc= fl9tie ?)Pn LCA tt7 iV1 nS ciec rtr , t � a--r41---v- • ,. SEC ON 4:ESTIMATED CONSTRUCTION COSTS , Item Estimated Costs: • ."'Offieial"Use Only (Labor and Materials) , .. , 1.Building $ /1 0 O J • 1 Building Permit Fee:$ 1 5°Indicate how fee is determined: ❑Standard Crty/Town Application Fee} ,^ 2.Electrical $ 5 v v a b' r CI Taal Project Cost.(Item 6)x multiplier x 3.Plumbing $ 0 r 0 0 ) 2. Other Fees $ 3.5----` 4.Mechanical (HVAC) $ t S 0 J List.," .. 5.Mechanical (Fire $ Suppression) Total All Fees S. 6.Total Project Cost: $ Check No Check Amount: Cash Amount: 33t a 0 b Paid in Full ❑Outstanding Balance Due: ' ( i 6 - - SECTION 5:.CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) cc- QG a 03 420 Y/I(c( .� ` License Number on ' Name of CSL of er 70-0 �' ('�'ll't g List CSL Type(see below) No,and Street U Type... ,, Description . s G VOA Wit A- U Unrestricted(Buildings up to 35,000 cu,ft) 'T V' W�/ �/ R Restricted 1&2 Family Dwelling Catyfrown, tate,ZIP M Masonry RC Roofing Covering WS Window and Siding (� SF Solid Fuel Burning Appliances Ys38 7gO6ri iniunnantim 0 $411. Mtn I Insulation Telephone EmMI address D Demolition 5.2 Registered Home Improvement Contractor(HIC) l /S � J IM la e� talk-licit itl I f1 t HIC Re •stration Number E irati n Date �`Company Name r HIC Regi tram Name ?co N t4114r0 Q jh1 i0 /f19o? 4lsJ1. Paw No.and Street..,t, C, yfiraWt t U'%�- 2eGy ��i 737 3 Smalladdress 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 K 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 10(rt f t (c1/1Q-1 to act on my behalf in all matters relative to work authorized by this building permit a plication. • `f erre\° : Print Owner's Name(Electronic Si att re) Datil • • SECTION 7b: OWNER!OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information • contained• this application is true and accurate to the best of my knowledge and understanding. /U e Print is or Authorized Agen (Electronic Signature) D tte • 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 program or guaranty fund 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.aov/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" t i ..tts • The Commonwealth of Massachusetts / ' • Department of Industrial Accidents V :Vi_; Office ofInvestigadons • =Tier-. 600 Washington Street '� Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information q 6 ' PleasetaaPrint Legibly Name(Bu ine:s/Organizaton/Individual): gip Sky Eatejirec,& _Lae. Address: ?DV II: /?9*/ 4. S. y City/State/Zip: S- ' t tf iJ WU M ft (phone#: cVf — 737-036 3 Are you an employer?CAA the appropriate box: Type of project(required): I.a I am a employer with / 4. ❑ I am a general contractor and I employees(MI and/or part-time).* have hired the sub-contractors 6. 0 New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ®Remodeling ship and have no employees These sub-contractors have S. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp.insurance. requ ] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doingall work officers have exercised their 11.0 Numbing repairs or additions myself.[No workers'comp. right of exemption per MOL insurance required.]t c. 152,41(4),and we have no 12.0 Roof repair 311.0 I am a homeowner acting as a employees.[No workers' 13.0 Other general contractor(refer to#4) comp.insurance required.] 'Any applicant that checks box HI must also fill out the section below showing theirworkess'compensadd4oicy inlbuiation. t Homeowners who submit this affidavit indicating they as doing as work and then hire outside eonnaeton must submit a new affidavit indicating such. tContncan that check this box must attached an additional sheet showing the came of she subooatrecmn and state whether as not those entities have employees. If the subcontractors have employees,they must provide their workers'comp.policy number. fans an employer that is providing workers'compensation insurance for my employees Below is the policy and Job site Information Insurance Company Name: 0010:4 _Eris. P D- Policy#or Self-ins.Lic.It: WI✓x i)4P !Or A' Expiration Date: /0/4,1 Job Site Address: '? S.A?1vheor �. j S City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy num er and expiration date). Failure to secure coverage as required tinder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 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 cent,under the pains and penalties ofperfary that the information provided abort e and correct Signature: iktit Date: (/71 f/ Phone#: Sec$ 737 134,3 Official use ont,t 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#: i I oF'Y�R,� TOWN OF YARMOUTH . • r. e 0 BUILDING DEPARTMENT Ni tat. a $ 1146 Route 28,South Yarmouth,MA 02664 C3 erre 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 at 3 q %mWgrc,I. C,-{a OI& Work Address Is to be disposed of at the following location: 'IVW& 4 trayIY)Wk Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. /094 Si nature of Application Date Permit No. • Commonwealth of Massachusetts JU Division of Professional Licensure Board of Building Regulations and Standards ConstructIon Supervisor CS-062043 Expires:05/1712019 MICHAEL W HARNEY '' ' 1 At' 200 NORTH MAIN STREET SOUTH YARMOUTH MA 02604 Commissioner Cis e orinonw.ra//AI q/'C l(auaAinN//3 Office of Consumer Maksa Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:Corporation before the expiration date. M found return to: Reolstratlon , Lailration Office of Consumer Affairs end Business Regulation 141530 •:_�;_.04/26/2020 One Ashburton Place•Suite 1301 MW HARNEY CONSTRUCTION INC Boston,MA 02106 MICHAEL W • 1 \2_G(�7., 200 N.MAIN STREET -•, U S.YARMOUTH,MA 02654..- undersecretary Not valid without sign e ACORD" CERTIFICATE OF LIABILITY INSURANCE DATE A orz9rzo a THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAMEJamesDebt James LEONARD INSURANCE AGENCY IPIV�C.NN0.Em; (508)428-6921 IA/ ,No): ADORERS debt©leonardagency.com 683 MAIN STREET SUITE B INSURER(S)AFFORDING COVERAGE NAIL OSTERVILLE MA 02655 INSURER A: ACADIA INS CO 31325 INSURED INSURERS: MW HARNEY CONSTRUCTION INC INSURER C: • INSURER D: 200 NORTH MAIN STREET INSURER E: SOUTH YARMOUTH MA 02664 INSURER F: COVERAGES CERTIFICATE NUMBER: 331159 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTMTHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAD CLAIMS, INSRSPOLICY TYPE OP INSURANCE INeD Wyn POLICY NUMBER IFTADDfYYYYI I LTR MwoorrYYYI LUTE COMMERCIAL GENERAL LUSIJTY EACH OCCURRENCE S CLAIMS-MADE ❑OCCUR DAMAGE TO RENTED PREMISES Ma oocurrenoe) f MED EXP(Any one person) f _ N/A - PERSONAL SADV INJURY f GEN.AGGREGATE LIMIT APPLIES PER: • GENERAL AGGREGATE f POLICY EST ❑LOC PRCOl1CTS-COMP)OP AGO f OTHER: f AUTOMOSRE UABIJTY COMBINED SWGLE LIMIT $ IEP accident) ANY AUTO • —1 • BODILY INJURY(Per person) I — ALL OWNED SCHEDULEDOS UN/A BODILY INJURY(Per accident) $ — HIRED AUTOS NON-OMIED PROPERTY DAMAGE f _ AUTOS (Per Bodden° f ' UMBRELLA LIAR _ OCCUR EACH OCCURRENCE — f EXCESS LNB CWMSMADE N/A AGGREGATE f DED RETENTIONS • S WORKERS COMPENSATION v PER OTH- AND EMPLOYERS'LIABILITY YIN ra STATUTE ER A OFFICER/MEMBEREAEXCLUD Dpi cuTlvE' wA N/A N/A MAARP300075 10/02/2018 10/02/2019 E.L.EACH ACCIDENT $ 100,000(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 lives, CRdeecdh under DESIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 • N/A DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached amore spec*Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 0306 B,no authorization Is given to pay claims for benefits to employees in states other than Massachusetts If the Insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy In force on the date that this certificate was Issued(unless the expiration date on the above policy precedes the issue date of this certificate of Insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.masa.govfiWMrorkers-compensatlonfinvestigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of YarmouthACCORDANCE WITH THE POLICY PROVISIONS. • 1146 rte 28 AUTHORIZED REPRESENTATIVE • South Yarmouth MA 02684 t Daniel M.C y,CPCU,Vice President—Residual Market—WCRIBMA 8a 1888-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD ty It , • • (012nF VRANlNCa; II • l-Xd - K- but _ pIIWS-op_2,,t a . "ti ,- \ j S \ . � � ..IM Cn,��`y i\, At nt ii A • - ti LIBFILE COPY TOWN 0 � M0 RA501.14EEPOPORRSBOURtOMMGASDJSO0NOORDEU@VOMTNE I,FPLICANT FROM THE RESPONSIBILITY OF 'AS BUILT' COMPLIANCE.. , . LATE. 2`' ---:ulLoING OFFICIAL r,•opa tinssq�4 N j°e' uctt6sFFG I 9 CUAOA- m .. \ _ e .-0;00 4.00 es iJO4P j I/-0' ll ee 7-0,(ziaa PROPOSED MODIFICATIONS MICHELE CUDILO, RE(' P I Gn 1 ) Consulting Setrudtural Engineer • ,' `-f At Ic:FATt�.el �c f:: cCTtc- - Centerville, Massocnusetta 02632-1979 (508)771-7601 t I h ('' 39 SUMMER ST. Drawn By: MC Date: 09/11/18 Drawing Scole:ItciAS NOTED Rev. QO IO. 1e` SK- A . YARMOUTHPORT, MA if File Name:HAGOPIAN Project No.2018-249 11 1M '�P- ,4AAA t g) •t cntiet - --1$s, -1 al 'p • I / Iy j I i I I N rl ti l y ! J p � -11 C x. r��r. t- . *. q-11 Mrt s� �� < l I I y x .9 t V M _Nol -Se RtN- I Q iI cp[d ;ti ��� p4 4. OF MSA XMIGHELE cuoto \� hw STAUCT c r/ . 4", '� 1No 374�•, SStpNAI • • F1zDrl I --- / P 2� � kri ' -,-� air , u A lr-o . PROPOSED MODIFICATIONS MICHELE CUDILO, P.E. jig/7440fE • _ Consulting Structural Engineer i', f F?�Mt�"" 1 " ! F-�•CJ� Centerville, Massachusetts 02632-1979 (508)771-7601 if Drawn By: MC Date: 09/11/18 Drawing 39 SUMMER ST. . . . YARMOUTHPORT, MA Scale:/ts(AS NOTED Rev:-/N o 111/24)21 3 SK-2• File Name:HAGOPIAN Project No.2018-249 i. j (e)t t ..u9e>- ¶tFit . j i i iI 1 • • t 1 3' I Ot —..3 Oat k i t o M � ' f-3-3 01)144. -- AbD 614-- 1.1 3e) `Exp. /�Z>Ix71�4bv,L.Tt4iS51 Q 1 4boLTJ r'/{sI�ETrs:eft, . j -g1) "t41d, woOP �N^. � 1 f eA ' ��,. ; 1 N I wN 1 • ; (e) 4xs - - f . i p 3 ii O . z �aof MASS4,y a coot.RAS m ���"� o SZNOGy'77� cc o c�T 11 i ou gFo1slE�act SSIONPI . j t, 1 i I ;1108/141/414f% ,.. . ii PROPOSED MODIFICATIONS MICHELE CUDILO, P.E. °l 3/iS G1) �Ml� N� Consulting Structural Engineer { m ' f -M. / Z FL. Centerville, Massachusetts 02632-1979 (508 771-7601 Drown By: MC Date: 09/11/18 Drawing 39 SUMMER ST. Scale:lr�a�AS NOTED Rev./11 0 lt7lysilg . 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