HomeMy WebLinkAboutBLD-19-002597 L DEC 10 220_18
•
RE-INSPECTIONS •
ALL RE-INSPECTIONS - $80.00 ✓
DUPLICATE WEATHER CARD -$60.00
ADDRESS: /0 / /21141-6
DATE: /' /op 1
ISSUED TO:
c1O/lAfi
•
REASON FOR RE-
INSPECTION:
C .
:f1GDEPT.: /.
OCCUPANCY PERMIT:
PLUMBING & GAS
FT,FCTRICAL:
OTHER
v M ilk lie
I.
• ONE & TWO FAMILY ONLY-BUILDING PERMIT
Town of Yarmouth Building Department a `r
1146 Route 28, South Yarmouth,MA 02664-4492 .
508-398-2231 ext. 1261 Fax 508-398-0836 :MI" ,
Massachusetts State Building Code,780 CMR �.
Building Permit Application To Construct, Repair, Renovate Or Demolish
a One-or Two-Family Dwelling
• This Section For Official Use Only RCC ; IV E D
Building Permit Number: j j.I • p -Lam: ,Date Ap lied:
tl-G- a : 380
Building Official(Print Name) Signature : . . BLAMING::)EPARTMENT
SECTION 1:SITE INFORMATION.
1.1 Property Address: 1.2 Assessors Map&Parcel bers
1 lol Pvt4lteS Throe_ 4rnr,ttoo t7'1 "k(OQg3
1.1a Is this an accepted street?yes ✓ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
/1, too Cep Il
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.40,454) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone?
Public V Private 0 Municipal 0 On site disposal system I:Er
Check if yes❑
SECTION 2: PROPERTY OWNERSIDI''
1 Owner'of Record: t,
—rah t-v Vt lot Pitt/lien 1D1z. 1( wwwliT ..
Name(Print) City,State,ZIP -M
' ;� L.A) 7A656oru CI l�-qq0-4I34 SAV2Rt2230Co'- 1/
No.and freet 0/7 Telephone Email Address
SECTION 3:.DESCRIPTION OF PROPOSED WORK-2
(check all that apply )
. New Construction 0 Existing Building❑ Owner-Occupied 0 Repairs(s) 0 Alteration(s) ❑ Addition 0
Demolition 0 Accessory Bldg.0 Number of Units_ Other 0 Specify:
Brief Description of Proposed Work2:
V -1 ir,t •i\. r "-/IA��-.., 9 it •
A• f -d IA) iv (stn ;nV(-Er./len AddedssL4 -t- icaC1,1 , .A
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item it,t��� Estimated Costs: Official' • Only
(Labor and Materials) . RFc F•�•v D
1.Building $ 1- Building Permit Fee:$1 S0 Indicate ho - . .
2.Electrical $ Ili Standard City/Town Application l c i N •'` . i
❑.Total Project Cost' tem 6)x multiplier QV O 2O
3.Plumbing $ 2. Other Fees $ 311.1
4.Mechanical (HVAC) $ List v . r_�=P
5.Mechanical (Fire
Suppression) $ Total All Fees $
C/ 6.Total Project Cost: $ 3 p 00 CheckNo:jCheck Amount CashAmouht - '
1 0 Paid in Full it Outstanding Balance Due: I I S—
SECTION 5:.CONSTRUCTION SERVICES
5 5.1 Construction Supervisor License(CSL)
License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
No.and Street Type .. .. Description
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 Registration Number Expiration Date
BIC Company Name or HIC Registrant Name
No.and Street
Email address
City/Town,State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE Alt!DAVIT(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 COMPLETE])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: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 in this application is true and accurate to the best of my lmowledge and understanding.
I Zahn —1-; A•1Erat Ib -Zz- l8
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered stered 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.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
i a=
✓ _� )_ i Department of Industrial Accidents
z:1111_ 1 Congress Street,Suite 100 .
='I_f=11 Boston,MA%Ca www.mass.gov/dia
Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): J a),'VI T. iCV Dal(
Address: 161 Flag 11(b 'b 2t c
City/State/Zip: SD ki crfrabt.3'T(ti "nitp Phone#: q- - t} 90 -4-1 4
Are you an employer?Check the appropriate box:
Type of project(required):
1.0 lama employer with employees(full and/or pan-time)." 7. O New construction
2.0 I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling '
any capacity.[No worken'comp.insurance required.]
3. 1 am a homeowner doing all work myself.(No workers'comp.insurance required.]t 9. E]Demolition
4..II am a homeowner and will be hiring contractors to conduct all work on myproperty. I will 10 Building addition
ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions
proprietors with no employees.
12.0 Plumbing repairs or additions
5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet .
These sub-contractors have employees and have workers'comp.insurance.: 13. Roof repairs
6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.0 Other
152,§1(4),and we have no employees.[No workers'camp.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'komp.policy number.
I 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.Lic.#: Expiration Date:
v Job Site Address: !0 ( P.Y1-&r; ll 11A -De-. So ' Q'Ri wt. City/State/Zip: C( A-rY14-00-01
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$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereb!y it.der , ins and p•nalties of perjury that the information provided above is true and correct
JSignature: `` ' * Date: \0\ \Jeb
Phone#: S"R 'IS 4\_+'
Official use , Do not write in this area,to be completed by city or town official
City or Town: Permit/License# •
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone It:
•
• • h---)
telk TOWN OF YARMOUTH
,t. 'eft) BUILDING DEPARTMENT
c`*- � 1146 Route 28, South Yarmouth,MA 02664 508-398-2231 ext. 1261
n
HOMEOWNER LICENSE EXEMPTION /
PLEASE PRINT: V
DATE:
JOB LOCATION: IDI 9h4 I Uz)1)C- So L(- rini-017l'\ •
NAME A STREET ADDRESS SECTION OF TOWN
"HOMEOWNER" C&tn —1 -4-r 1ct • ,q1 .--2416-41.34
NAME HOME PHONE WORK PHONE
PRESENT MAILING ADDRESS 1 O 1 Plu{1 bch --ne-
50 ti1fxcty iL)L YIJL0. cnt <--u• ,
CITY OR TOWN STATE ZIP CODE
The current exemption for 'Homeowner' was tended to include owner—occupied dwellings of one or two units
and to allow such homeowners to engage ani dividual for hire who does not possess a license,provided that such
homeowner shall act as supervisor. (State Bu lding Code Section 116R5.1.3.1)
/
Definition of Homeowner
Person(s)who owns a parcel of land on which h$/she resides/or ntends to reside,on which there is or is intended to
be, a one or two family attached or detached structure ass ssory to such use and/or farm structures. A person who
constructs more than one home in a two-year perid shajfnot be considered a homeowner;such"homeowner"shall
submit to the building official,on a form acceptable tithe building official,that he/she shall be responsible for all
such work performed under the building permit. ( fiction 110 R5.1.3.1)
The undersigned `homeowner' assumes resp sibiliiy for compliance with the State Building Code and other
applicable codes,by-laws, rules and regulaf ns.
The undersigned 'homeowner' certifies that he / she _\Ystands the Town of Yarmouth Building Department
minimum inspection procedures ani} requiremen . and . .t\he / she will comply with said procedures and
requirements.
HOMEOWNER"S SIGNA '/ !I� S
APPROVAL OF BUILDG 0 .� • •
INSURANCE COURAGE:
I have a current liility 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 INSURANCE WAIVER:.I am aware that the licensee does not have the insurance coverage required by
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:homeownrlicexemp
TOWN OF YARMOUTH
vg a BUILDING DEPARTMENT
•
• F, •. T`-1 — 1146 Route 28,South Yarmouth,MA 02664
• `� 508-398-2231 ext. 1261 Fax 508-398-0836
BUILDING DEPARTMENT
DEMOLITION DEBRIS DISPOSAL AFFIDAVIT
Pursuant to M.GL Chapter 40,Section 54 and 780 CMR, Chapter 1, Section 1113,
I hereby certify that the debris resulting from the proposed work/demolition to be
(/ conducted I� 301 .11-: /et-4 e 1A->a ,
Work Address
Is to be disposed of at the following location: a a_S —Cte‘ L. L
•
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
a. • tare of App[i 1riiy n Date
l Permit No.
•
• Information and Instructions •
• Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contact of hire,
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 of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,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,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required.",
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall •
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and,if
necessary, supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
• Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a 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.
. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked 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 must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
•
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100 •
Boston, MA 02114-2017
Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax# 617-727-7749
Revised 02-23-15 www.mass.gov/dia
• .0y:Y 4.4r TOWN OF YARMOUTH
= • c HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: /U / P L IA // IS 1 ewe So '/ciei 4ctTt(4 psis S
Proposed Improvement: f;E'.L() V')rIllir M
i i��11od&-L k tTC tJ
Applicant: -17)1/1('{—aa/1 Vl T A.,RI21C.(� •
Tel. No.:CM-L O- t 34-
Address: /01 p H(J) -m2 so • LCCAVbao-rh Date Filed: /O -.13- (O
••lf you would like e-mail notification ofsign off please provide e-mail address: 'SAVER` 12,23 ea-l•
&O
Owner Name: J7)tl%& T. A V BM(
Owner Address: (o 1 Pi/al I ZILh t 2 Sb, Lf ethin YL�wner Tel. No. %m -t(QO_U l 3'/-
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: ef.-----
DATE: Ie --)•• - litPLEASE NOTE
COMMENTS/CONDITIONS, 1cits)et RY net e..‘ t.ii 3 .- cv-oc&ti
w ,.H 401_7.(t. />r tiidelate, Sayntc c_ / C 61. w
•
TOWN.OF•YARyyMeOUTH
1146 Route 28,,South Yarmouth, MA 02664
508-398-2231. ext.1261'Fax508-398-0836
701"" ":4" �&i i�A`�`F M il
Office of thevBailding,Commissioner
P1 TALC H L45E'^.2 i
John T Avery
48 Derby Ln
Tyngsboro, MA 01879 November 1, 2018
RE: 101 Phyllis Drive—permit application
Dear Mr. Avery,
I have reviewed your application for 101 Phyllis Drive,and regret to inform you that your permit has been denied for
the following reason;
• You do not meet the definition of a homeowner under the building code
HOMEOWNER.Person(s)who owns a parcel of land on which he or she resides or intends to reside, on which
there is, or is intended to be, a one-or two-family dwelling, attached or detached structures accessory 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.
You will need to have a licensed contractor apply for this permit.
You also may appeal this decision to the Board or Building Regulations and Standards within 45 days of this letter.
Very Truly
Tim Sears CBO
Local Inspector
Town of Yarmouth
•
TOWN OF ARLINGTON
•
BUILDING DEPARTMENT
31 snow muse 731-3164393
ARUMTos,MA rax77/61-316-21321102471 IJP. r
•
emoseglwar
RICHARD.1.VALLAREW
BUILDING INSPECTOR
14SPECTIonuaERVICK mvMAAYneTw,A1A.w
('ommmmtrall4 of AlassatluisNls
Department of
•
Public Safety ----------- -----__----
!� Co,nmonwealm ol Massad,usetta
® ®I Division of Regulations
and Sun
T I- Board of Bidding Regulations and Standards
Buildin$i ilspecto)jflcation •
"Local Msgeto(j.
Certified Building Official 80-1422 > it Eaflires:17/312020
Richard J.Vallardli - 7 d„k. - _ r.U-.
Local Inspector RICHARDSP
33 ALTONBTREE7
ARLINGTON MA•pu7i` `` IV -
9Comm. /�I,Ins lot' `
c.,,,..0__
tasner VCommissioner Adminislmblr
✓fie e"../w..7...flft
e, Board of Building Regulationand Standards
• 4[-
j
t One Ashburton Place-Room 1301
Boston,Massachusetts 02108
Construction Supervisor License
License CS: 17585
. - Restriction: 00
B9gWEc 8/21/1952
Exe ralon: 8212009 Tr/2113
RICHARD J VALLARELLI `-, --
10 RADCLIFFE RD -— — -. -- - - —
ARLINGTON,MA 02174 .
Update Address and ratan card Mort reason for change
or6ra+0 aHasmerw -i Address i i Renewal 'i Lest Card
Cipro, Linda
From: Sears,Tim
Sent: Tuesday, November 6,2018 10:11 AM
To: Cipro, Linda
Subject: FW: Phyllis Drive
Attachments: Rick's License etc.pdf
FYI
From: Rick Vallarelli [mailto:RVallarelli@town.arlington.ma.us]
' Sent:Tuesday, November 6, 2018 9:48 AM
To:Sears,Tim<tsears@yarmouth.ma.us>
Cc:javery1223@aol.com
Subject:Phyllis Drive
Hi Tim,
As requested please find my current Building Official Certification information attached. I appreciate your help regarding
my friend Jack Avery's property at Phyllis Drive. I take full responsibility for the construction work and am willing to be
the builder of record for this project. My phone number is: 781-956-2591 (cell) 781-316-2591 (office)
Thank,you.
Rick
Richard 3 Vallarelli
Building Inspector,Town of Arlington
Massachusetts
1
___ - TOWN OF YARMOUTH
I eCZ j REVIEWED FOR BUILDING AND ZONING CODE COMPLI-
ANCE. ERRORS OR CMMISSIONS DO NOT RELIEVE THE
f DI - •
: APPLICANT FROM THE RESPONSIBILITY OF'AS BUILT'
d --,6X 1 COMPLIANCE. p
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HEALTH DEPT.
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