HomeMy WebLinkAboutBLD-19-2671 •
✓ ' ONE & TWO FAMILY ONLY-BUILDING PERMIT Pilrfatf / 6t
Town of Yarmouth Building Department
..-
t .0........,
1146 Route 28,South Yarmouth,MA 02664-4492
s 508-398-2231 ext. 1261 Fax 508-398-0836E
Massachusetts State Building Code,780 CMR
Building Permit Application To Construct Repair, Renovate Or Demolish
a One-or Two-Family Dwelling _
RCCF t x: ')
• This Section For Official Use Only
Building Permit Number:BLD'/q- IV d&9 j.Date Applied: ,
M SQ�r'S 11 -18 Ct3LT 11.10\
•BuildmgOfficial(PrintName) • Si•gnatu•re. • .BUiLoiP �'•<„r NIL NT
DI —
SECTION 1:S u E INFORMATION •
1..1PPrropgrty,Address:rnaI� St 1.2 Assessors Ma &ParcelNumberrs
1.1a Is this an accepted street?yes no • Map Number b Parcel Numb
1.3 Zoning Information: 1.4 Property Dimensions: ppyy
Zoning District Proposed Use Lot Area(sq 13) Frontage(ft) RCC : I V E L►
•
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear YardLV 6 216
Required Provided Required Provided Required PG D PARTMENT
I Br
1.6 Water Supply:(M.G.L e.40,I54) L7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private 0 Zone: _ Outside Flood Zone? Municipal❑ On site disposal system 0
Check if yes❑
. q
4 ' . • SECTION 2i PROPERTY O�4R'NERS1DP1. :
21 / . r yd SDOI-h Mt /, '
•
Name(Print)
Eta!
l(Print) City,State,ZIP
260 Abi }-h Main $J- 1112-123Sir �_ [1l(A Mail•c
No.and Street Telephone Email Ad
SECTION3:DESCRIPTION OF PROPOSED WORK'(check all that apply) '''
New Construction 0 Existing Building 0/Owner-Occupied^❑/Repairs(s) F Alterations) PtAddition 0
Demolition PI/Accessory Bldg. 0 Number of Units_ Other 0 Sp ' . •
Brief DesciipiionofPro osedWore: L. 0 ,(' e U0
' ting ni t_ _'1 t , ■J
r n1lAL `1aa pa ► I r'1 sr' rum 40a iii;l7 I a ,( .
N►�- 1a0.�PniPA rent ��l lit. N ukt s ltn 0(1 try
. • .. SECTION_4::ESTItii IATED CONSTRUCTION COSTS. ...
Item Estimated Costs:
(Labor and Materials) _. , OfpaaitThe Cly,_
1.Building I $ 5'1 00 D :1.Building Peffiit'Fee;$:&OO Indicate hone fee is determined:
2.Electrical $ gO O •P Standard CitytTown Application Feet'r'. :: ' •'.:•.-•';•:i ....4I:.:
❑.TotalProjebtCost3(Itemp.)xmultiplier_. • ••• ' x
3.Plumbing $ 500 2, Other:Fees: $ • 3S!. . . -
4.Mechanical (HVAC) $
5.Mechanical (Fire
All F
Suppression) $ Total All $
/- 'l aeckN6:.• . Check Amount Cash Amount
6.Total Project Cost l0
$ / 0D v 6 Paid mPUU In Outstanding Balance Due: I GS
SECTION 5:.CONSTRUCTION SERVICES
Y, 5.1 Construction npervlsor License(CSL)
is
S License Number Expiration Date
'I Name of CSL Ho der
i List CSL Type(see below)
No.and Street Type . Description
U Unrestricted(Buildings up to 35,000 cu.R)
City/Town,State,ZIP R Restricted 1&2 Family Dwelling '
. M Masonry _
RC Roofing Covering •
WS Window and Siding
SF Solid Fuel Bunting Appliances
I Insulation
Telephone Email address D Demolition
5.2 Re red Home Improvement Contractor(MC)
HI✓CCompany Name orHICRegistrant Name HICRegisCatioaNumber Expiration D=e
No.and Street
Email address .
City/Town,State,E12 Telephone
SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(14LG.L.c.152.§ 25C(6))
Workers Compensation Insurance affidavit mustbe 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 .......... CI No...........Cl
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLE LED 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. matters relative to work authorized by this building permit application.
•
lir I0ia3115
Owner s Nam clonic Sigaatr re) e
• ' SECTION 7b: OWNER'OR AUT±i0RIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
4.5A- 1-411 101230
Print Owner's or Authorized Agent's Name(Electronic Signature) • ate
. NOTES:
1. An Owner who obtains a building permit to do his/her own worst,or an owner who hires an unregistered contactor
(not registered in the Home Improvement Contractor(MC)Program),will not have access to the arbitration
program or guaranty fiord under M.G.L.c. 142k Other important information on the IEC Program can be found at
wwwr.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dos
2. When substantial work is planned,provide the information below:
Total floor area(sq.R) i # (including garage,finished basement/as,decks or porch)
Gross living area(sq.R) 1 Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number ofhalf/baths Q
Type of heating system Number ofdecks/ orches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
rimpartment oflndustrialAccidents
'• ' �y . 1 Congress Street,Suite 100
•
Boston, MA 02114-2017
<k NO • www.massgav/ilia
Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information
Please Print Legibly
Name 50(Business/OOr�rg(Business/Organization/Individual): ,]�� I+�
al(Business/Organization/Individual): �
Address: N. maxi Sl
•
City/State/Zip: 5•y aimowt Phone#: 114 Ai a 334/5
Are you on employer?Check the appropriate box:
Type of project(required):
1.0l am a employer with employees(full and/or part-time).*
7. em construction
_.�I sole proprietor or partnership and have no employees working for me in
capacity.[No workers'comp.insurance required.] 8. eodzling
3. I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. aDemolition
4.0 I ant a homeowner and will be hiring contractors to conduct all work on my property. I will 10 0 B Ildtng addition
ensure that all contractors either have workers'compensation insurance or are sole 11.reElectrical repairs or additions
proprietors with no employees. -
5.❑I am a general contractor and!have hired the sub-contractors listed on the attached sheet 12.L" I'lambing repairs or additions
These sub-contractors have employees and have workers'comp.insurance.: 13.0 Roof repairs
6.0 We are a corporation and its oacers have exercised their right of exemption per MGL a 14.0 Other
152,§l(4),and we have no employees. [No workers'comp.insurance required.]
*Any applicant that checks box#1 must also 511 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.
tContractors that check this box must attached an additional sheet showing the name of the subcontractors 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 nails providing workers'compensation insurance for my employees. Below is the policy and job site
information,
Insurance Company Name:
Policy k or Self-ins.Lic.n: 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.
1 do hereby certzfy under the pat and penalties of perjuzy that the information provided above is true and correct
Signature: �r Date: ROIIg
• Phone#: 31 / jszl-16
Official use only. Do not write in this area, to be completed by city or town offzciaL
•
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#:
•
• BUILDING DEPARTMENT
�. '� 1146 Route 28, South Yarmouth,MA 02664 508-398-2231 ext. 1261
•_
' HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
•
DATE:
JOB LOCATION: L•150-141A I 990 N Maul &1' aOona f
NAl � o V STREET ADDRESS SECTION OF TOWN
"HOMEOWNER" (MN
NAME a r,1 0 PHONE WORK PHONE
PRESENT MAILNG ADDRESS t
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 R.5.1.3.1)
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 stuctures. 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 R5.1.3.1)
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. 1
HOMEOWNER'S SIGNATURE Aai--- f.1lam
APPROVAL OF BUILDING OH ICIAL
INSURANCE COVERAGE:
I have a current liability '• ance policy or its substantial equivalent, which meets the requirements of MGL
Ch.142. Yes No
If you have checked ve , • . e indicate the type coverage by checking the appropriate box_
A liability insurance policy Other type of indemnity Bond
OWNER'S INSURANCE WAIVER I am aware that the licensee does not have the insurance coverage requiredby
Chapter 142 of the Mass. General Laws and that my signature on this permit application waives this requirement
Check one:
Signature of Owner or Owner's Agent Owner Agent
h:homeownriice xemp
•,ter _ _ �j� BUILDING DEPARTMENT
. F j "£ 1146 Route 28,South Yarmouth,MA 02664
Irja"r .. 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,
[hereby certify that the(� debris resulting from the proposed work/demolition to be
conducted at 25S &avM tau V^}'
Work Address
Is to be disposed of at the following location: I tlaincQ Ui 1)31X03&L 0413
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
)01 24
S gnature o • s .lication Date
Permit No.
20.)
;51
�tl�h TOWN OF YARMOUTH
; HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: ass N mal, 5k S .Yp,rrnool--lj
Proposed Improvement: fifi1she i' I, remuva
OJQsef ap 11 tong roan . * ,3 ,r1 - (�y , die
e .
Applicant: Lisa (SII Tel. No.: 77L1 a 33116
Address: 3O0 S S. NiM/fY1oU Ul Date Filed: 101R3//8
•"/fyou would like e-mail notification ofsign off please provide e-mail address:
Owner Name: LOCI—
Owner
—O CI— �I '
Owner Address: O(tvfl t/ (I,bO✓!i Owner Tel. No.: /II:,�vv a?/, irit
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: DATE: ic/�,3
PLEASE NOTE
COMMENTS/CONDITIONS:
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Panasonic Panasonic WhisperComfort-40/20 CFM-Spot Energy Recovery Ventilator •
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Model:FV-04VE1
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Product Description Reviews Product Q&A I Recommended Accessories 1 How-To Articles Manuals
Features Specifications
The Panasonic WhisperComfort FV-04VE1 Spot Energy Recovery General Information
Ventilator offers a revolutionary way to provide balanced ventilation
with a ceiling insert Energy Recovery Ventilator.The Panasonic Type ERV
WhisperComfort FV-04VE1 Spot Energy Recovery Ventilator is energy --- - ------- --------- - ------ ------------------
efficient and provides fresh ventilated air while maintaining Indoor air Product Line WhisperComfort
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FV-04VE1 Spot Energy Recovery Ventilator removes indoor stale air and Mount Type Ceiling
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run ensures chemicals such as volatile organic compounds and other Port Location Side
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Performance
Panasonic FV-04VE1 Features
• Balanced Ventilation Maximum Air Flow 40 CFM
• Whole House or Room Specific Energy Recovery ventilation
• Keeps air fresh in closed environments Electrical Data
Product Includes Power Consumption 23 Watts
• Grille ....... ...... ......__. ........... .......... .
• Three Suspension Brackets Voltage 120 Volts
• Three Screws Phase 1
• Switch Label
Frequency 60 HZ
Dimensions
Duct Connection 4 Inches
Product Height 9.38 Inches
Product Width 27 Inches
Product Depth 14.5 Inches
Product Weight 24 Pounds
Warranty Information
Parts Warranty 3 Years
• Motor Warranty 6 Years
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TOWN OF YARMOUTH
it} „� 'o BUILDING DEPARTMENT
0. ��/�1C. 1146'Route 28,South Yarmouth,MA 02664
1 w—' cs _? 508-398-2231 ext.1261 Fax 508-398-0836
FINISH 1-413 BASEMENT LIGHT AND VEN ILLATION WORKS H t ET
IRC -2009 R 303
S q. Ft. of Room(s) X 8% = (b)Amount of Glass Required
a ' b.
411 . 6 31, 41q ,
Required Sq. Ft. of Glass (b) X 50% = (c)Vent area required
b.• 31/e fi!� C.
Mechanical Ventilation
0.35 Changes per hr. (a) or
15 c.f.m. per person,whichever is greater
(a)Based on net floor area
Ventilation system design to have capacity to supply airflow from table 403.3 •
Artificial Light
An average illumination of 6 foot candles over the area of the room at a height of 30" above
the floor is considered acceptable, except for bathrooms and toilet rooms should be 3 foot
candles at 30" above floor
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