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Home My WebLink AboutBLD-19-3148 Ot.Yle ' -14 ///�i/ic t* \v ONE & TWO FAMILY ONLY-BUILDING PERMIT • oc . Town of Yarmouth Building Department :•• 1146 Route 28 • South Yarmouth, MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 Massachusetts State Building Code, 780 CMR E V E D APPLICATION TO CONSTRUCT,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMIL alENC This ction For Official Use 0 514g4f118 Building Permit Number. = -/9- 0 A a Date AppliS e I Mo. •41...L 7 / /1—40-1.1 BUILDING DEPARTMENT Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers: 16 SWORDFISH DRIVE,SOUTH YARMOUTH MA 02664 lila Isthis anaccepted address? Yes_ No_ MapNuter Parcel Number 1.32oning Information: 1.4 Property Dlmenslons Zoning paid Proposed Use tote axes(sqp Frontage IN 1.3 Building Setbacks(It) Front Yard Side Yards Rea Yard Required Provided Required Provided Required Provided 1.6 Water Supply(M.O.L e.40,f54 1.7 Flood Zone Information: 1.6 Sewage Disposal System: Public CI Private I] Zone: Outside Flood Zone? Municipal ❑ On Sfe disposal system O (Teck Ifyes 0 SECTION 2:PROPERTY OWNERSHIP 2.1 Owner of Record: JIRIAN KOELBEL SOUTH YARMOUTH MA 02684 Name(Print) sly,Slate.LP 16 SWORDFISH DRIVE (,d3 9S3 3°3Z °KDFcgao 4h4.44 cask Number end Street Telephone Erni M AIN SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all tat apply) New Construction ❑ Existing Bulldog ❑ Owner-Occupied ❑ Repak(s) ❑ Mtaration(e) IS] Mdtico ❑ Demditon ❑ Accessory Bldg. ❑ Number of Units Other ❑ Sperry: BdM Description of Proposed Workn Remove bathtub,relocate toilet,end build shower pursuant to plans. SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated tests. 1, Official Use Only (Labor and Mated ds)) ,f� ll 1.Buildup f p,Ooo,,0 1.Bonding PwmlFee:3 indicate how fee is determined: i V 2.Electricalf *Standard COyITovm Application Fee ❑Total Prosect Item multiplier...____x____ 3.Plumbing _ $ z coo.oa 260 sttirer Fees:$ 4.Mechanical(HVAC) f 5.Mechanical(Fire Suppressbn) S Total all Fees:$ / Check No. Check Amount$ cash Amount S i 6.Total Protect Cost $ 10.000.00 ❑Paid in Full 1110vIstandIng Balance D�00 — ......----1 DEG 0420181 ll� 1of2 �� l r BUILDING DC_Pi+RThili::NT 1 By: • • a SECTION 5:CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor: CS•103617 31/17/2019 pABLO C.MAR1INF2 License Number Expiration Date Name of CSL Hober List CSL Type(see below) 40 SMITH STREET Tone Description No.and Street U Unrestricted(Mange up to 35 a.R) HYANNIS.MA 02601 R Retitled 182 Family Dwelling City/Town,Stale,ZIP M Masonry RC Rod Covering WS Whdowand Saing 00612743963 glimb512e0vehoo.com SF Silt FUN Burning Appliances Telephone Email Address Insulation • 0 oemoltlon 5.2 Registered Home Improvement Contractor(HIC) 142802 55/19/2020 CUERVO BUILDING&REMODELING HIC Registration Number bpi/Mice DNs Hit Company Name or HMC Registrant Name cllmb512slvahoo,com Email Mbess 49 SMITH STREET No.and Street HYANNIS,MA 02601 • 15081274-3983 City/Town.Slaw,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M,G.L. e.152.526C(6)) Workers'Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide this affidavit will result In the denial Dr the issuance of the building permit Signed Nfldavlt Attached Yes • ® No O • SECTION 7s-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,BRIAN KOELBEL as Owner of the subject property, hereby authorize pABLO C.MARTINEZ to act on my behalf, in all matters relativ /. • Kills by this building permit application. r (/7 /7,13 dir Sig-,a um of Owner 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 knowledge and understanding. pABLO C.MARTINEZ ) 1/1/it Pent Owner's orAuthorized Agents Date NOTES 1.An owner who obtains a building permit to do hitcher own work,or an owner who hires an unregistered contractor(not registered In the Home Improvement Contractor(HIC) Program),wit 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.dovlett. Information of the Construction Supervisor License can be found at www.mass.govMgs. 2.When substantial work is planned,provide the information below: Total floor area(sq.I) (IncNdng garage,finished basemenvattics,decks or porch) Habitable room count Gross tying area(sq.It) Number of bedrooms Number of fireplaces Number of half/baths Number of bathrooms Number of decks/porches Type of heating systems Enclosed Open Type of coding system - - a Tots Project Square Footage'may be substituted for'Total Project Cost' • 2 o12 The Commonwealth of Massachusetts Department of Industrial Accidents kr) 1 Congress Street, Suite 100 %b�p5 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): PABLO C.MARTINEZ Address:49 SMITH STREET City/State/Zip: HYANNIS,MA 02601 Phone#:J508)2744983 Are you an employer/Check the appropriate box: Type of Project(required): 1. ❑ I am an employer with employees(full and/or part-time)• 7. ❑ New Construction 2. a lam a sole proprietor or partnership and have no employees working for me in any capacity. a, 121 Remodeling (No workers'comp.insurance required.) 3. ❑ I am a homeowner doingall work myself. 9. ❑ Demolition yae (No woken'comp.insurance required.)} 10. ❑ Building Addition 4. ❑ I am a homeowner and will be hiring contractors to conduct all work on my property.I will ensure that all contractors either have workers'compensation insurance or am sole proprietors 11. ❑ Electrical repaint or additions with no employees. 12. ❑ Plumbing repairs or additions 5. ❑ I am a general connector and I have hired the sub-contractors listed on the attached sheet 13. ❑ Roof repairs These subeuntractors have employees and have workers'comp.insurance.: 14. ❑ Other 6. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c.152, {I(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. tHomeowners 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:A.I.M. Policy#or Self ins.Lic#:VWC10060160852018 Expiration Date:0813012019 Job Site Address:16 SWORDFISH DRIVE City/State/Zip:SOUTH YARMOUTH,MA 02684 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$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereberthe t""""`T'ies of perjury that the information provided above is true and correct. Sienature: I VW—NMI Date: ft/17/8 Phone#:(508)274-3983 Oficial use only.Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: of.YA� TOWN OF YARMOUTH • • '; )c Building Department �� wis 1146 Route 28 • South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 140, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at 16 SWORDFISH DRIVE, SOUTH YARMOUTH, MA 02664. Work Address Is to be disposed of at the following location: TOWN OF YARMOUTH LANDFILL Said disposal site shall be a licensed solid waste facility as defines by M.G.L. Chapter 111, Section 150A. 2AL k t/l,`., , / i /i1/8 Signature of Applicant Date Permit No. CUERVO &s,fl s _ � } = 0 ' - 10' it 10' e ( _ K' _ a i 0 i ! 2,e____5, 2„r_--5, } M. Dmnvie -isiatt.i. ft- FOS A- 1 TOWN OF YARMOUTH ` left REVIEWED FOR BUILDING AND ZONING CODE COMPLI. ANCE. ERRORS OR OM MISSIONS DO NOT RELIEVE THE APPLICANT FROM THE RESPONSIBILITY OF'AS BUILT' COMPLIANCE. ALE COPY DATE: /I-3'Y& _ T BUILDING 0 • M Registration valid for individual use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation One Ashburton Place•Suite 1301 Boston,MA 02108 No valid thout signature • Commonwealth of Massachusetts �.� Division of Professional Licensure Board of Building Regulations and Standards Constrylctto'$opervisor CS-103617 Lrxpires: 11/17/2019 a i PABLOC MARTINEZ -4 ze 49 SMITH ST % / HYANNIS MA 02601 a' ^� Commissioner VL