HomeMy WebLinkAboutBLD-19-002561 ta.d /030 / ECEIV �p-
tCT 15 2018
• ONE & TWO FAMILY ONLY-BUILDING PERMIT _
Town of Yarmouth Building Department o. D .RVI MEL N 7
1146 Route 28,South Yarmouth,MA 02664-4492 -
508-398-2231 ext. 1261 Fax 508-398-0836 !lzf•_ f tt'
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
Building Permit Number:74/)-/5'£oZ Sb/' I Date
Applied:
I
' 1 SZArs U=30 la
Building Official(Print Name) Signature Date '
SECTION 1:SITE INFORMATION, .
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
4(eupkVt
wtwer 11AI' /4.2 9 CSL_._ -1
1.1a Is this an accepted street?yes ✓ no� Map Number Parcel N ' F C E V E D
1.3 Zoning Information: 1.4 Property Dimensions:
s r-�e [Cr4Zoning District Proposed Use Lot Area(sq ft) Frontage )
1.5 Building Setbacks(ft) r -L fWPAR-MENT
.;
Front Yard Side Yards R Y„tard._ILDi1----
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 i3 Private O Zona _ Outside Flood Zo Municipal C On site disposal system C
Check if yes
SECTION 2:PROPERTY OWNERSHIP'
2.1 Owner'rt of ord: '
A•einsuly M44
Name(PPrhft) A Ce �D City,Stale,ZIP / O/s
45-
//2' IjArn n4/ui RtIMJ Way
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK;(check all that apply)
New Construction 0 Existing Building ISY---Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg.0 Number of Units_ Other li 4pecify: D. ek'
Brief Description of Proposed Work:
,3u j/d h?w d nck "ii sa.a..t Evo/jorir,.L as
tact.S 119 /l1 0 ellaProx t 4,13- in, - x -
. i,.= SECTION df ESTIMATED CONSTRUCTION COSTS :e?:-... 42 ;
Estimated Costs: - w
Item Official Vie 011137-.2; '
(Labor and Matenals)
I.Building $ ',1. Building Permit Fee:$HOZ Indicate how fee is determined,
'0 Standard::CitytTcwn Applicat-toil Fee ''u ,
2.Electrical $ Cl Total Project Cost?(Item 6)x multiplier, it
3.Plumbing $ 2 OtherFees. $
4.Mechanical (HVAC) $
, a s ,;,
5.Mechanical (Fire $ "
Suppression) Total All Fees.$.
CheckNo ':,Check Amount— Cash Amount:,
6.Total Project Cost: $ l Z� 2-57> 0 Paid irFull ' 4 e Outstanding Balance Due:" yr—
SECTION 5:.CONSTRUCTION SERVICES .. . r
' 5.1 Construction Supervisor License(CSL) 09s(,33 8120120
/
C.kns�e{•i.Gy" Vincei-d License Number Expiration Date
Name of CSL Holier CS
(1- 3L11 e� L Awl
List CSL Type(see below)
No.and Street h ,pe Description
/Q� �� 07464' U Unrestricted(Buildings up to 35,000 cu.R)-r141-044-0[411(
)
/1j ( R Restricted 18a Family Dwelling
City own,State,ZIP M Masonry
• RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
-212- 0q3 s i aPo evavi n cehl•coni I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) /o iota •
C A eea,ine. HIC Registration Number Expirati n Date
1-HC CoyNameorHICR Name
o k k
/it S /1 gniAlo Cit-v/Acad cores
No.and Street Email address
C •ypriwi*GNKt i44 024464 X74-2/2•,938
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 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 C. /1 • Vt Nce 1'5 !n&
to act on my behaiZZ,in 7'Tr.-all matters relative to work authorized by this building permit application.
StecU. G442
Print Owner's Name(Electronic Signature) Date
• • SECTION 7b:OWNER1 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'inthisapplicationais true and accurate to the best of my knowledge and understanding.
011'7 /O/Zh
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
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.gov/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
Department oflndustrialAccidents
=9ellil= 1 Congress Street, Suite 100
• 'EP Boston, MA 02114-2017
.�, www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information /e Please Print Legibly
Name(Business/Organization/Individual): C./�. V ince:- /, Inc.
Address: a Sf ll Bsvpk /coo"
City/State/Zip: S •raoa.# A4,4 0z4064 Phone#: 774-212 -MIS
Are you an employer!Check the appropriate box: Type of project(required):
I.❑I am a employer with employees(full and/or part-time).• 7. 0 New construction
2.0 I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling
any capacity.[No workers'comp.insurance required.]
3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]1 9. Demolition
4.01 am a homeowner and will be hiring contractors to conduct all work on my property. 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.❑Plumbing repairs or additions
5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. Ro airs
f re
These sub-contractors have employees and have workers'comp.insurance.: 13.❑ pai
6.12‘are a corporation and its officers have exercised their right of exemption per MGL c. 14. the[
152,§1(4),and we have no employees.[No workers'comp.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'comp.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:
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.
I do hereby certify under the pains and penalties of perjury that the information provided abovecorrect
is true and
Signature: U/'f��/ Date: /D/2///8
Phone#: 174-2/2-093,
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/ own Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
o1"1-4k4r TOWN OF YARMOUTH
o BUILDING DEPARTMENT
• o a 1146 Route 28,South Yarmouth,MA 02664
V�"".gin, ` 4' 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 14 WilcArpvot" V, ea*
Work Address
Is to be disposed of at the following location: /1/21A--ca D r Sj•,is
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.
• \
• Commonwealth of Massachusetts - 1 Construction Supervisor
VA Division of Professional Licensure Unrestricted-Buildings of any use group which contain
Board of Building Regulations and Standards less than 35,000 cubic feet(991 cubic meters)of enclosed
ConstruCttOr)itbpervisor space.
P
CS-095633 Si ryIat t "keg:08/20/2020
HE I B J
CHRISTOPH�RAVII�EHT� t
F, -
17 rat HER
ROAD '
SOUTH YARMOUTH MA 0286{'/`"
til/C5=13CSt`
Faihue topossess a current edition of the Massachusetts
,y ,,r State Building Code is cause for revocation of this license.
t/�r/a/a" j/.1+�,•• For Information about this license
Commissioner Call(617)7273200 or visit www.mass.gov/dpi
nn (�' / ^—_--v-nuu,rsaa-v,,. e
,. wo ta-r.s,gnvyn
C920 CC nrnnawr44 rQQ/6 taar4nJrUJ
ekSk
Office of Consumer Affairs/1 Business Regulation
w� HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only
.,\TYPE:Caooration before the expiration date. If found return to:
I fleaistratlo0 Fmlratlon Office of Consumer Affairs and Business Regulation
.-r_u+ r 1182000 05/17/2019 10 Park Plaza•Suite 5170
CA.VINCENT,INC t '.'-5 Boston,MA 02118
CHRISTOPHER VINCENiI \ G(),s__ ���i4
17 STILL BROOK RO,J./ .' (,� "'� "'��//"��"YY
SOUTH YARMOUTH,MA 02664 Undersecretary Not valid without signature
+ y.
writing at his main office or branch by ordinary mail posted, by telegram sent or by delivery, not
later than midnight of the third business day following the signing of this agreement.
G:
8.3 It is the obligation of the Contractor to secure any and all necessary construction related permits.
Owners who secure their own construction-related permits or deal with unregistered contractors
shall be excluded from the guaranty fund provisions of M.G.Lc.142A.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES
In Witness Whereof,the parties have signed and sealed this Agreement in duplicate,each of which is
deemed to be an original,on the day and year first above written.
011(-- 9/4
Christopher A.Vincent Ralph Cap bo, Owner
President C.A.Vincent Ina
9 September 2018 0— Q 70/2-
Date Date
•
17 STILI BROOK RD,S YARMOUTH,MA 02664 I PH:(774)212-0938 FAX(508)394-0550 I INFO@CAVTNCENT.COM
PAGE 15 OFS
u uwur P"�AT;7"oi axu["rs J In
loaarcrovcmaw} 14
CS VINCENT
eurtm Mc•flM imo
MMM'.GNCEMT COM
2x10 @'Wax
s_._�_
/ . 2x10 PT ledger wl Ledgedoks each baj ...—
8 Simpson D7i2Z ..,
\
Ho
laj / —
...
(2)2x&beam y
Simpson Joist hanger each end NO
24"bigfoot w.10'die tube
TOWN OF YARMOUTH
I Il REVIEWED FOR BUILDING AND ZONING CODE COMPLI-
I I, ANCE. ERRORS OR OM.IISS:DNS DO NOT RELIEVE THE
F I APPLICANT FROM THE RESPONSIBILITY OF'AS BUILT'
COMPLIANCE.
- - - DATE:IO4O A
I I .. i
1 BUILDING OFFICIAL
[ a
I ie
l.
dia.tube
capa,bo
46 WMflower Village
Yarmouth Pon,MA
\ ---_— ---_—__i Project Overview
FILE COPY
1st Floor P"I