Loading...
HomeMy WebLinkAboutBLD-19-2598 > iihl ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department or r 1146 Route 28, South Yarmouth,MA 02664-4492 r �' 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 _ IRECEIVELD This Section or Official Use Only Building PermittNumber: -/q-PV 2 57 Date Applied:' a 2018 -rah vi(S 'T . ��-,/-/a au �o' , al. 'a Building Official(Print Name) _ $ e tcRTME NT SE TION 1:SITE INFORMATION 1.1�Pr& f-terN Add&Ifllfres on 1.2 Assessors MapBc Parcel Num�lers, 1.1a Is this an accepted street?yes no� Map Number J b Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(R) 13 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.O.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private❑ Zone:_ Outside Flood Zone? Municipal 0 On site disposal system ❑ Check if yes❑ SECTION 2 PROPERTY OWNERSHIP' . 2.1 Owner'of Record: Ragiti KI a-tk1 W 16401Otii111479 ©167-3 Name(Print) City,State,ZIP 74 Net,/ nu P2 sog VII-A39 i-oh 0-di teck,m-0 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORKS(check all that apply) " New Construction 0 Existing Building Owner-Occupied k( Repairs(s) ❑ Alteration(s)'6k Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other ❑ Specify: Brief Description of Proposed wore: FINN{l¢f) 'ROOM(4A1 BRCS:0461T , . SECTION 4:ESTIMATED CONSTRUCTION COSTS ; . Item Estimated Costs: , (Labor and Materials) Official Use Only'" 1.Building $ I(I O 0 1. Building Permit Fee:$ I S 0 Indicate how fee is determined: 2.Electrical $ _5(16 $Standard City/Town Application Fee 1 0 Total Project Co&(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire Suppression) $ Total All Fees:$ Check NoCheck Amount Cash Amount: 6.Total Project Cost: $ j 0 Paid in Full iiil Outstanding Balance Due:'I X S • SECTION 5: CONSTRUCTION SERVICES ' 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 Cipdrown,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 HIC Company Name or HIC Registrant Name No.and Street Email address . 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 WNFN 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 JBy 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. i4t4i,V kraal /0-c23'! ' 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 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.zov/dps 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 • tp�_ 4eS't Department of Industrial Accidents t =9e11If= 1 1 Congress Street, Suite 100 e —4.:L= 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 Please Print Legibly ) Name (Business/Organization/Individual): IO,QAi/ijt NI- 6Eju' K/UAW Address: 76 /JT/lyd4 j p , City/State/Zip: (h. 4'4tlrl/LMA oad 7 3 Phone #: ,CO 8—3 1/f' 11 0-0 Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with employees(full and/or part-time).+ 7. 0 New construction 2.0 1 am a sole proprietor or partnership and have no employees working for me in $. ❑ Remodeling any capacity.[No workers'comp.insurance required.] 3.N Iain a homeowner doing all work myself.[No workers'comp. insurance required.]t 9. ❑ Demolition 4.E1 I 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.❑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.t 13.❑Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MOL c. 14.❑Other 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. IIdo hereby certify under the p 'its and penalties of perjury that the information provided above is true and correct Signature: J Date: /D V-3 - (7 Phone#: cS-,' ? - 3fit. jf000 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/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: as"'YRR TOWN OF YARMOUTH • o ,' ) BUILDING DEPARTMENT 1146 Route 28, South Yarmouth,MA 02664 508-398-2231 ext. 1261 • HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE: JOB LOCATION: X68 KW-0 16-Arm1lti pt. (11,kat10u7 NAME STREET ADDRESS SECTION OF TOWN "HOMEOWNER" Q MEkttItibil ,cfjg-GYt-/63V NAME HOME PHONE WORK PHONE PRESENT MAILING ADDRESS 76 4flIGQ/J MC, W,c'4f110W11i MI 52-673 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 R5.1.3.1) 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 structures. 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. HOMEOWNER"S SIGNATUREK,,,, �eAPPROVAL OF BUILDING OF INSURANCE COVERAGE: I have a current liability 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 o�"''R '1 WN Ur' YARMOUTH k' p BUILDING DEPARTMENT tl moi —y 1146 Route 28, South Yarmouth,MA 02664 N ^'* ^ � al' 508-398-2231 ext. 1261 Fax 508-398-0836 anon.° 6' 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 16IILM(o fi yid W,JO:Lig/ MA Work Address Is to be disposed of at the following location: YAPkou-t l 72AIJS1 fL s1AT(ow Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. 642//7 S g ture 6f Application / Date Permit No. • Jt-Yekk TOWN OF YARMOUTH • > ° HEALTH DEPARTMENT • PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Building Site Location: 76 7114(FOA/ Pk.. U/.tfgegitif Proposed Improvement: 41)0 WALLS iia0kS TO BWIL PVT OAS,rn O'cw/N6S TO U/6LC'6LT R�itM �- Ceel'LSE I0/( �A (S Atm Applicant: ,tOt,I /A/- -Ce03&ZrP!/L1- t/ Tel. No.: SO?-37y-floe Address: 7( $7c/(6OA) fl. (Al Yf W II'CI //-- /' Date Filed: /06 the **If you would like e-mail notification of sign off,'please provide e-mail address:Ara,K_R1k/L/(E4_ � Ind i (owi Owner Name: e/ams /If m E.CZ k 'e L6 IV OwnerAddress:Jf *(jt((()AI1a, G/, fAtffOuPh Owner Tel.No.:S-0 -'347y—V0,20 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: e _.— ' DATE: 10/ WO PLEASE NOTE COMMENTS/CONDITIONS: : t>_� 1 . 71i/lispe�� ,�erl�Energy Recovery Ventilator FV-04VE1 YEAWAIT/ON FAA Specification Submittal Data/Panasonic Ventilation Fan Two 4"ducts Description Grille: - UL listed ceiling or wall mount Energy Recovery •Attractive design using ABS material. a i. Ventilator provides a tempered air supply, •Attaches directly to housing with torsion humidity control,and a balanced amount of springs. ` _ • r exhaust to help maintain neutral pressure Warranty: fs `-# throughout the home.Panasonic ERV shall •All Parts:3 Years from original purchase date. -O. not be installed In a bathroom.Only one unit Is ,,, , ° needed for a 1,750 sq.ft.2 bedroom home to Architectural Specifications: uvr.s meet the ASHRAE 62.2 ventilation requirement. ERV shall be ceiling or wall mount type with no Motor/Blower. less than 40 CFM on the exhaust port,30 CFM on the supply port,and no more than 0.8 sone •Fully enclosed AC condenser motor rated for as tested in accordance with FM 915 and 916 continuous run, standards at 0.1 static pressure in inches water •Power rating shall be 120 volts and 60 Hz. gauge.Power consumption shall be no greater - •Two highly efficient blower wheels running on than 23 watts.Apparent Sensible Effectiveness single motor for lower power consumption and for heating shall be no less than 66%at 30 FV-04VE1 ck 1ni e.,.nor wall Coo ro,a Elbow°.,,r.,0,,4•,. CFM net air flow under 32°F(0°C)as tested in decreased raise. •Motor equipped with thermal cut-off fuse accordance with CSA-C439.Total Recovery control. Effectiveness for cooling shall be no less than 36%at 29 CFM net air flow under 95°F(35°C) ERV Core Technology: Housing: The supply port damper shall close below 20°F •Indoor and outdoor air passes through •Rust proof paint,galvanized steel body. (-7°C)to prevent freezing of the core.The motor Panasonic's capillary core technology. •Dual 4"Intake and exhaust ducts. shall be totally enclosed,AC condenser type This process tempers supply air while •Built In backdraft damper on exhaust duct. engineered to run continuously.Power rating transferring moisture and energy. shall be 120v/60Hz.Duct diameter shall be no •Built in Frost Prevention Mode prevents the •Filters on supply and exhaust air extend the less than 4".ERV can be used to comply with core from freezing.Frost Prevention Mode life of the ERV core. ASHRAE 62.2,LEED,IAP,California Title-24, is free of interaction and operates without •Expandable mounting bracket up to 16"on and WA Ventilation Code. intervention. center. Specifications:WhisperComfort FV-04VE1 a 0.50 S Air Volume Setting 40 CFM 20 CFM 10 CFM t Static Pressure in inches w.g. 0.1 0.1 0.1 1 0.40 —(Exhaust)N-04VE1 Exhaust Air Volume(CFM) 40 20 10 FV-04vg1 Supply Air Volume(CFM) 30 20 10 'p 0.30 —(SIPWy ) u, --20 Feet Noise(sones) 0.8 <0.3 WA —40 Feet Power Consumption(watts) 23 21 17 0.20 ''., --'60 Feet - --90 Feet Speed(RPM) 1479 1292 1095100 Feet Current(amps) 0.15 0.10 0.09 0.10 .;�' Power Rating(V/Hz) 120/60 – Apparent Sensible Effectiveness for Heating 66%at 30 CFM and 32°F(0°C) 0.00 '.,Krss'—- - 0 10 20 30 40 50 60 Total Recovery Efficiency for Cooling 36%at 29 CFM and 95°F(35°C) Airflow(CFM) For complete Installation Instructions visit us.panasonic.eom/ventfans Model Quantity Comments Project Location: Architect: Engineer: Contractor: Submitted by: Date: lc Eco Solutions North America Eco Products Division Two Riverfront Plaza Newark,NJ 07102 us.panasonic.com/venffans Ati Cul ul Panasonic VF11091SS-04VE1 ifffispei e°,Went Energy Recovery Ventilator FV-O4VE1 rerSpecification Submittal Data/Panasonic Ventilation Fan (Continued) Optional Accessories Optional Exterior Wall Cap 71� r Exterior Wall Cap FV-WCO4VE1 polypropylene wall cap with styrofoam adaptor allows both exhaust(from the right)and supply(from the left)airflow through a 5.5"-5.75"hole in the building envelope.The dividers inside the bottom portion of the Y shape chamber and the new wall cap help prevent cross contamination. Optional Elbow Exterior Wall Cap and Elbow Used •.'•Dia. Together .w..«. 5"DVpir.ia. spots /t vK 1 Ips ,r,� (nvc Klj % 8 Elbow FV-EBO4VE1 styrofoam elbow connects to the Y shaped adapter of the exterior wall cap to help simplify wall installation.The elbow also features double chambers for exhaust and supply air to help prevent cross contamination. • P is Eco Solutions North America Eco Products Division Two Riverfront Plaza Newark,NJ 07102 us.panasonic.com/venttans 00 .0. Panasonic VF11081sS-08vE1 Cr: AWL S1'/LCr;, ;k ` !'} v't: Bit LI! - _ / g1 I _ ..k S it r I /left a f.k'Llll.fll r A JJ (}A3f11E}1T 11, )`�,�� • W/Np6CJ I ' 1 1 I 1 c • --r---•• TOWN OF YARMOUTH • VLd I I a N0' (G r 1'/I T 1 REVIEWED FOR BUILDING AND ZONING CODE COMPLI • - (.t) C 16 H 7 it , ANCE. ERRORS OR OIV,LIISSIONS DO NOT RELIEVE THE R ()oil ,,-.. d.... 1,41/ A lig1/ APPLICANT FROM THE RESPONSIBILITY OF'AS BUILT' deur ,�:.i COMPLIANCE. ( [1l3uaII ? 1 DATE W-L-!8 A Jl - - - .J . •I IIA 1:4,•04. wit. BUILDI . �, I U` FILE COPY I ` 1 - �� y��A,„ �S�S (I) I �` � \P - . ... • , = . . • U.)° OCT9 Z��B r 111 E�(Ef�e I s }I., p cc) l • HEALTH DEPT. 0 (Baca gaLtau I. ri• 'w 0 Ol., . • )11:;(111 dr bt 76 / Me0n1 101C.. . W.OcekouMMM CPAwt. SJ240, ;,, ,. cr?In;vir— Qu Li IIEA0 I NW_ U NEW I j V h/ Nat'_'(Ltbflt" L • Lo E t 11 "T cR O'*� Rbc NrS i$\\\ ‘:..sal fAttfilD4Y,i: ' ' AILW WALLS b ' M CF�,v� c______[ LlGft �HuLe , ) • :-..... zt.T,5 ( . ' - e<ED -------4.0 ' . pyi l \ c)slzkiati)k.l';\,4,:bt‘ti \0:00) 1 . ---HAS______ 0 k).\\)js v - . . RECEIVED x / OCT 19 2018 .p..U Ulf( R�f�CSSA0 HEALTH DEPT. Of- u6Mr 0 l(114; - I 0 tiCti I- - . FF , 12 /'- k' NEW WALL ' • 'n d. 1 �. -- ' BA Ci l t ivr f fl itEad PL . CV yA,eicoueri6 1