HomeMy WebLinkAboutBLD-19-2131 .21A; 1/4/j/4--
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* ONE & TWO FAMILY ONLY-BUILDING PERMIT
`.. Town of Yarmouth Building Department __ow et
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
. This Section For Official Use Only
Building Permit Number: ? Z>_/9-d7) a/3,/Date Applied: .
• e l r. SQitc , : . k1,13°
Building Official(Print Name) Signature' - , Date
SECTION 1:Slit INFORMATION . .
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
/7 Fred, b rva4. lel Sir )fcib
1.1a Is this an accepted street?yes_ no • Map Number Parcel Number
13 Zoning Information: 14 jro errtyDimensions:Er /
04 t
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.40,554) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public D� Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system V
Check if yeses
SECTION 2: PROPERTY OWNERSHIP` P_ J D-
2.1 Owner'rof Record: A� .
Name(Print)
S oft— / ` gmemo yit/M d,+ A LIM4 •.
J City,State,ZU I NOV -16 2018
/, fresh b�aoJ /2J _
No.and Street Telephone Email k �+pyAR'fMENT
SECTION 3:.DESCRIPTION OF PROPOSED WORT{ (check all that apply - -0 1 A— ---
New Construction 19'I Existing Building l' Owner-Occupied 0 Repairs(s) 0 Alteration(s) ❑ Addition 0
Demolition ❑ I Accessory Bldg. ❑ Number of Units_ Other 0 Specify. •
Brief Description of Proposed Work2: )to Cp n (i../a - a, rpLJ e to
Peal twin I 6otiP-1 of eta ' r )rci.t, Ori >(
SEG"LION.4::EST-MATED CONSTRUCTION COSTS. :.
Item Estimated Costs:
(Libor and Materials) Officialfse Oily .: '`' :
1.Building $ i 6sp 0 :1:Building Permit Fee:.$:(5'a.. Indicate how fee;Ls determined:
t 4 Standard City/Tot ApplicationFee ` . _'..:.':: •I:
2.Electrical $ 8 S o p .
❑.TOtal project Costa(It 6ya multiplier... • . x -
3.Plumbing $ 610 0 0 2: OtherFees: $'- -3 • --
4.Mechanical (HVAC) $ List
5.Mechanical (Fire - _ -
Suppression) Total All Fees:$ . .
'Check Nd. • Check Amount Cash.Amount- J '
6.Total Project Cost: $ ds-SVd OPaid-mFuA ` a0'1. •: w•Ht s. , l'
•
10 f 10 2018
BUILDING DEP. i: T
B
SECTION 5:.CONSTRUCTION SERVICES
Si Construction Supervisor License(CSL) DO(3 a ( 7 MI
o. Cro 'vt License Number Expiration Date
Name of CSL Holder D . 1
3 / I.t t & -e r� List CSL Type(see below)
No.and Street :. Type . .. Description
Lo,q tLl ,AI . ars U Unrestricted(Buildings up to 35,000 cu.R)
tty/1'own,State,ZIP R Restricted l&2 Family Dwelling
M Masonry
RC Roofing Covering •
�
/ WS Window and Siding
r37�Syt7 SF Solid Fuel Binning Appliances
g
►�5cro n.e.00�took •rov'& I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) ' 7 ZZ7 Y $ IZ 7/L0
74 'rJi Q µ'ms ETC Registration Number Expiration Date
HIC Company Name or HIC�,Registrant Name
376 (atre here ri f r canis t teo4.1ebk.
N, .and freer I'
.50-et n. 0 CC 5 531 737/51.10Q Email address
Ma-
--City/Town,State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(IYI.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
Sied Affidavit Attached? Yes ❑ No ❑
SECTION 7a: OWNER AUTHORIZATION TO BE_COMPLEID FWHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT ..
I,as Owner of the subject property,hereby amhorize \ .4 7- Cr ,w s h
to act on my behaalt,in all matters relative to work authoriz d by this building permit application.
5HSet L A
Print Owner's Namelectronic 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 in this application is true and and accurate to e best o y knowledge and understanding.
c s «� Q 1(. Jl/11At,,
Print Owner's or Auth d Agents Name(Electronic Sine) • Date
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 find under M.G.L.c. 142A Other important information on the HIC Program can be found at
www.mass.eov/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
Nnwher 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"
% _agrt Department of IndustrialAccidents
•
g.-F.41.€--- 4 . 1 Congress Street,Suite 100 •
•
=__�_ Boston, MA 02114-2017
l�*. .at • www.mass.gav/dia
•
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information t Please Print Legibly
Name(Business/Organization/Individual): (cont Co%ts47t't civ,
Address: 376 144.e.S lint I •
City/State/Zip: 1),n9k At, Oa 5'6 3 Phone#: sear 777 /CYO
•
Are you an employer?Check the appropriate box: •
Type of project(required):
I.0 I am a employer with employees(MI and/or part-time).* •
7. ❑New construction
2.01 am a sole proprietor or partnership and have no employees working for me in 8. [remodeling
any capacity.[No workers'camp.insurance required.]
3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition
4.0 I am a homeowner and will be hiring contractors to conduct all work an property. I will 10 Building addition
ensure that all contractors either have workers'compensation insurance or are sale 11.0 Electrical repairs or additions
prieton with no employees.
12.0 Plumbing repairs or additions
5. am a general contractor and I have hired the sub-contractors listed on the attached sheet
I
These sub-contactors 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'comp.insurance required.]
'Any applicant that checks box 41 must also 611 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'ttnrhed an additional sheet showing the name at the sub-contractor,and state whether or not those entities have
employees. Lf 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 b the policy and job site
information.
Insurance Company Name: i YYkve(r
Policy#or Self-ins.Lic.#: 100— talc-v-76 `Zo13 A. Expiration Date: s-/if hit
lob 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 veriE
I do hereb ,cerci* and the pains and penalties of perjury that the information provided above is true and correct
Signature: ! t Date: /0/31/8'
Phone#: (Off 737 '3Rn
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 Deparlinent 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
_o` TOWN OF YARMOUTH
. o"- . € 5 BUILDING DEPARTMENT
�, al
1146 Route 28,South Yarmouth,MA 02664
• C-3,"---'n s 508-398-2231 ext.1261 Fax 508-398-0836
•
BUILDING DEPARTMENT
DEMOLITION DEBRIS DISPOSAL AFFIDAVIT
Pursuant to MEL Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 1115,
I hereby certify that the debris resulting from the proposed workidemolition to be
conducted at /2 rite,c A ,b rcr)f-. Ja-I
Work Address
Is to be disposed of at the following location: y4'W1OLi-i.t r.4,pe'S eV
Said 8•••osa1 site shall be a licensed solid waste facility as defined by M.G.L.
r-0: Appirecdel 50A.
An D d
S7;I .tore of Application Date
Permit No.
0`7%i4 TOWN OF YARMOUTH a11gEOWED
isf
c HEALTH DEPARTMENT D
o- i' Oei 031018
PERMIT APPLICATION SIGN OFF TRANSMITTAL .HEET
HEALTH DEPT.
To be completed by Applicant:
Building Site Location: 17 Peck /, ere it Poe /
Proposed Improvement: CO11 (/tie-4ara toss{ Lin civ t bc/r�l t / / crfAi
IA-f t l S--/e er Se AAP S
Applicant: C(OtAtVC Tel./N9.:3�Y JaSry/5`t/Q
Address:376 I-4.1teS rt der• 5i4N,1do4 /Va. DZS-(,3 Date Filed: ✓°/3/tc4-
••Ifyou would like e-mail notification of sign off please provide e-mail address:
Owner Name: Re6P✓4 /Sac r.-t 09t1e(/0
Owner Address: f7 nest, 6 r-0 k- 12 CI / So, NZ-. Owner Tel. No.: 99f ( .
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 decles,sheds, windows, roofing;
(3.) If necessary, Title 5 application sii nib by licensed installer
with fee.
REVIEWED BY: 1)7U1/4) DATE: /a! ✓//c9
PLEASE NOTE
COMMENTS/CONDITIONS:
t4-ck,sc 3e) t 5 Ivy a, 3 „Bedvoo
5-94-tc ► -/s�- / ? ?y t' - 3 d eine
/1 B
ACORD • CERTIFICATE OF LIABILITY INSURANCEDin MMIDD »
kasms/••••` • - - 10/02/18 _
THIS CERTI1CATE 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 poliey((es)must have ADDITIONAL INSURED provisions or 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 M Ileu of such endorsement(s).
PRODUCER - NAME: JIM JIMHINDMAN
•Schlegel&Schlegel Ins Broker P,yG N 508-7714381 F
34 Main Street E,n uL We,sic* 508 771-0663
West Yarmouth,MA 02673 AODREss: schlegelinsurance@gma0.com
INSURERS)AFFORDING COVERAGE RAC 3 '
INSURER A: NGM INSURANCE COMPANY 14788
INSURED . INSURER B: TRAVELERS
Patrick S Cronin INSURER C:
376 Lakeshore Dr INSURER D t
•
Sandwich,MA 02563.2745
INSURER E:
INSURER F: •
. COVERAGES CERTIFICATE NUMBER: 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. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OFANY CONTRACT OR OTHER DOCUMENT%MTH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCEAFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES UMTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR TYPE OF INSURANCE sun JUBA POLICY EFF POLICY EXP
INSD woo POLICY NUMBER (LIM(DO'YYYY) (MMIDEFTWO LIMITS
>( COMMERCIAL GENERAL VABILRY
EACH OCCURRENCE 3 1.000,000
CLAMS-MACE Li OCCUR PREM SES(ERcNlu� l 3 500,000 '
MED EXP(Anyone person) 3 10,000
A _ • MPT13260 10116/17 10/16/18 PERSONALSADVINJURY 3 1,000,000
•
GENLAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000
POLICY❑JE6T Ei LOC • PRODUCTS-COMP/OPAGO 3 2,000,000
OTHER S
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
(Ea aoOaen:l
ANY AUTO BODILY INJURY(Per person) S
OWNED — SCHEDULED BODILY INJURY(Per accident) S
AUTOS ONLY NUTOS
HIRED NON-OWNED PROPERTY DAMAGE 3
_ AUTOS ONLY AUTOS ONLY - (Per ewdentl • .
S
UMBRELLA LAB OCCUR EACH OCCURRENCE $
EXCESS UAB CLAIMS-MADE AGGREGATE S
DED I I RETENTIONS , 3
WORKERS COMPENSATION PER 0TH-
ANDEMPLOYERSLABILITY I STATUTE I ER
ANY PROPRIETORPARTNEMEXECUTNEY/N E.L FACHACCIDENT $ 100,000
B OFFICEoY In NER MtUDEDT ❑Y N/A VWC.1°O.6o15576-2013A 05/04118 OSN4A9
(Mandatory In NN) EL DISEASE-EA EMPLOYEES 100,000
Ifym desalsunder
DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LMT S 500,000 •
DESCRIPTION OF OPERATIONS I LOCATORS/VENIGLES(ACORO 101,AddUtonM Remarks Shcedule,may be attached If mons spats Is req,Mrec
PATRICK CRONIN HAS ELECTED NOT TO BE COVERED UNDER HIS CURRENT WOPRKERS COMPENSATION POLICY
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF.NOTICE WILL BE DELIVERED IN
TOWN OF YARMOUTH ACCORDANCE WITH THE POLICY PROVISIONS.
BUILDING DEPARTMENT
YARMOUTH MA - AUTHORED REPRESENT/WYE
pscroninsouilook.corn /�
I I ,^ /
01958.2015 ACO RPORATTON. All rights reserved,
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
.uu,1VUAC,uu V1 uuxua
17
1 Division of Professional Licensure
• Board of Building Regulations and Standards
Con strutCt6Sr{%iipfrivisor
......
�
CS-081321 > , •;_. a Espires:07/15/2019
i' i .
PATRICK S CRONIN 't c. ," I
378 LAKESHORE DR ' 1 9 % • r
376 LAKESHORE DR )C 1}• EA e
SANDWICH MA-62663'.,• 0 as "'-*'
Commissioner ✓ '
,574 rimmAernroiGery✓feadkraarer4e/y
Office of Consumer affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only •
nddMdual before the expiration date. If found return to:
Fxnirattlon Office of Consumer Affairs and Business Regulation
1172274 08/27/2020 1000 Washington Street-Suite 710
PATRICK CR6NIN 1P`--,-.-.7----au- Bosto 02118
;II ‘-1p
PATRICK CRO trr__,=:17„/„,,,,c, at --Clal. n ,(/6/(_J
376 LAKESHORE DRIVE,"'" Not valid without signature SANDWICH,MA 02563 undersecretary g
•
•
Sears, Tim
From: Sears,Tim
Sent Monday,October 15, 2018 10:45 AM
To: 'pscronin@outlook.com'
Subject: 17 Freshbrook Rd
Pat,
RECEIVED
I ha reviewed your application for 17 Freshbrook Rd,and the addition o a •edroom requires up:ras ing smoke/co
ectors in the house. Please submit a floor plan with the smoke/co detetto . rrt4 f dQac29
Thank you BUILDING DEPARTMENT
BY.
Timothy Sears CBO
Building Inspector
Town of Yarmouth
508-398-2231 Ext. 1259
mailto:tsears@varmouth.ma.us
1
TOWN OF YARMOUTH
• t5 L o rG ,f f(`_ �( REVIEWED FOP,BUILDING AND ZONING CODE CO►dPLI
/ RECEIVED ANCE. ERRORS OROZ.tISSIONSDONOT RELIEVE THE
I APPLICANT FROM THE RESPONSIBILITY OF'AS BUILT'
/�y� S / r„ 5 A acS-c' OCT 03 2018 COMPLIANCE, p
/ DATE: 11-►3 - 10
/ HEALTH DEPT.
UILDINO
::1-9,6 /2 /6a
70
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LOT NO. : 0/73 ADDRESS: 17 FRESHBROOK ROAD
OWNERS NAME: CONSTANCE CARPFNTFR
SEWAGE PERMIT NO. :98-522 NEW: REPAIR: Y.
DATE ISSUED:12/15/98 DATE INSTALLED: I- (S-99
INSTALLERS NAME:ELLIS BROTHERS CONST CO.
wat
INSTALLATION OF: ISoo .ca— a,3 y'cXsnaa
WATER TABLE: L374 FINAL INSPECTION BY: null-
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