HomeMy WebLinkAboutBLD-19-2864 •
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1' nnittl "A 3/7
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 .�.��^ ■ `
Massachusetts State Building Code,780 CMR
Building Permit Application To Construct, Repair, Renovate Or Demolish
a One-or Two-Family Dwelling
3
This Section For Official Use Only m
73
Building P ( /)
Numbe� -/9� �/� /.Date Applied:
O
I/,�, SeArs rt �: . . .. 11 a 3 -/er m y
Building Official(Print Name) Signature,..., . . Date _ -ii y.
SECTION 1:SITE INFORMATION N
Z
a 0
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers r C
___34::a."3 -P.n,40
5 ' a s 3.(i
1.1a Is this an accepted street?yes_ no Map Number Parcel Number m N
1.3 Zo ng Information: 1.4 Property Dimensions: 0 PO
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) Z C
1.5 Building Setbacks(ft) G
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
30 S 3" c s' 5--��' Za 2.2--=--
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system ❑
Check if year!
jSECTION 2d PROPERTY OWNERSI q `
2.1 O!; %c-r-•- d: /with -7,46-2-7 -t-LG f EA)kV/4414,1Q'
ame(Print) , City,State,ZIP
30, 2,4-e_ y7 i
No.and Street Telephone Email Address
SECTION 3::DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building❑ Owner-Occupied 0 Repairs(s) 0 Alteration(s) k Addition ,
Demolition 0 Accessory Bldg.0 Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work2: a s - t • / .s.Y
Ulf / g5 ?-°� �E'/,ki i -
(l
SECTION 4i ESTIMATED CONSTRUCTION COSTS (35
Estimated Costs: �_
Item Official Use Onl b i
(Labor and Materials) r- ,•
1.Building $ C6/ ?o e �1 Building Permit Fee:$6 6 Indtcatt,h , e 8 mmed-;
CJ /�Standard City/I'gwnApplicatioP ea I
2.Electrical $ ' �;vd , 6� ,
❑Total Project Costs(Item x multiplier. r • i d 11
3.Plumbing $ Cu D6 2. Other Fees $ 5° OV
^1
4.Mechanical (HVAC) $ tV n 6G List ^i-
5.Mechanical (Fire
Suppression) $ M'-' Total All Fees:$
heckNo CheckAmouit `6aliz
6.Total Project Cost: $ 0 0 6 lji�
7 � D ❑Paid in Full �Ou;st�nd'iag�alaase�3uA����.
NOV 07 2018 i
Eita ? PARTMEN � ,
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'. SECTION 5:.CONSTRUCTION SERVICES . .
_ r
5.1 Construction Supervise !cense(CSL) (S n cal
//_ ao '/-/V-
5T 4 • License Number Expiration Date
Name of CSL Holder ,
G C p,` List CSL Type(see below) V
�•Q P I `v
No.and Street t1 'h'pe Description
�Ip,,� Lf Unrestricted(Buildings up to 35,000 cu.ft.)
W XACIAlte Q���, R Restricted 1,t2 Family Dwelling _
City/TState,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
2 /� SF Solid Fuel Burning Appliances
dgC1alt36Z Lew/IL/v(4 dia€5 I Insulation
elephant Emaildress 99AK./tti✓ D Demolition
5.2 Registered Home Improvement Contractor
((4IIC) , c1 l{a• y
ierAl S � c a QGLte.�t f%LG HIC Registration Number• Expi on Date ply e HIC 0 els" tee
No. d Street / 0 Email address
CityfTo' i State,ZIP „ 167,. Telephone
SECTION 6:WOCOMPENSATION INSURANCE AA'r'DWAVIT(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 aj‘ No ❑
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 ¶%(t Qp/i
to act on my eha
iters relative to work authorized by this buil g permit application.
/0 il/71/
V.
riot Owner's Name( 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 a..licati.. '. trued= .ccurate to the best of my knowledge and understanding.
/J' 2-'1G
Print Owner's o i nth. ed 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 find under M.G.L.c. 142A.Other important information on the RIC 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.R) . 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"
"A, The Commonwealth of Massachusetts
,,) f wore L Department of Industrial Accidents
C -=Mt= 1 Congress Street,Suite 100
Boston,MA 02119-2017
.„„kiz • www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY,
Applicant Information / 'n,',/ Please Print Legibly
Name (Business/Organization/Individual): /ales het t<Zcw•wv�i-mai t c&l
Address: fgV f�"r !l�rG o„ /
City/State/Zip: v,sinti, A At4 Phone#: saegz l3,(j
Are you an employer?Check the appropriate box: Type of project(required):
1.0 I am a employer with employees(MI 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. I am a homeowner doingall work 9. ❑ Demolition
❑ myself.[No workers'comp,insurance required.]t
4.0 l 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
These sub-contractors have employees and have workers'comp.insurance.t 13.0 Roof repairs
we are a corporation and its officers have exercised their right of exemption per MGL e. 14.0 Other
++''
2,§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.
tContractors 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 t pa'ns and pe.'ides of perjuty that the information provided above is true and correct
AfaSi'nature: Ayr is v
Date:
Phone#: g 241362—
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#:
•.) 01'WitTOWN OF YARMOUTH
r.l r c BUILDING DEPARTMENT
„g—
Te 4A.. ,,6y�4' 1146 Route 28, South Yarmouth,MA 02664 508-398-2231 ext. 1261
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
DATE:
•
JOB LOCATION:
NAME STREET ADDRESS SECTION OF TOWN
"HOMEOWNER"
NAME HOME PHONE WORK PHONE
PRESENT MAILING ADDRESS
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 them 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 lie / 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 SIGNATURE
APPROVAL OF BUILDING OFFICIAL
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
• 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 contract 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 Pot required to cony 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 bum 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
rL =°T Tit o TOWN OF YARMOUTH
s. c -, _ tit, c BUILDING DEPARTMENT
• F T� .I x 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.G.L Chapter 40,Section 54 and 780 CMR, Chapter 1,Section 1113,
[hereby certify that the debris resulting from the proposed work/demolition to be
conducted at 363 ?cvtc 5z, l,J,�AAAditit wY oui't
Work Address `��
Is to be disposed of at the following location: yea-m-4 (, 4((
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
Signa Application Date
Permit No. •
- a4FPpY�Sn.nMa}y 4.p+Ri
•
1A711 •
TOWN OF YARMOUTH} -7o WATER DEPARTMENT
n4tot e
•
• f �E'. y • 99 Buck Island Road
Cr. E ' \Vest Yarmouth, MA 02673
Telephone: (508) 771-7921 • Fax: (508) 771-7998
•
• BUILDING PERMIT APPLICATION -
DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET
Bldg. Site Location —Rik) e c( • Map #: Lot #:
Proposed Improvement: _a% ' 4 rjr X 761 -De c (`
Applicant: —S Lcs. /
Address •
#2,,:1147_c___7)4„YTel. #: 5a 92L(3 _(, Date Filed: o- z2_/8
-pre fi(obect
RESIDENTIAL AND / OR COMMERCIAL BUILDING
Water Department: Determines Compliance of Water Availability and or Existing Location
Engineering Department: Determines Compliance for Parking and Drainage -
Ccnce i3t;c1 :cmnT.'ss c-: Deters-'11es COmp!lar ce to Wetlands Acts; i.e. If Lots; So-der any TY e
,t
Wetlands, Streams, Ponds, Rivers, Ocean, Bogs, Bays, Marshland, Etc...
• Health Department: Determines Compliance to State and Town Regulations, i.e., Requirements •
for Septage Disposal and other Public Health Activities
Fire Department:. Determines Compliance to State and Town Requirements for Persona',
Safety, Property Protection;, i.e. Smoke Detectors, Sprinkler Systems, Etc .
- Z7- /6
S gnatur, a;dpl:cant Data
PLEASE NOTE:
COMMENTS: •
a
rLIZ:2:
y�l v�6//S
Reviewed by:Wa i ion
/ Date
• �� ' TOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: D Pt eke— S►•
t 111 "'/Z.Y D f�vP. Zt" a v Iq
Proposed improvement: a x2-10 ADbt -(ovti RX -0 '7ece
I-3;•t• -TIC-X.0 K..
Applicant: Sreathe Tel. No.:C C(z 2.l3 (2 Z
Address: 6, 11-04-2147e__ pat Date Filed:ft-Z—(8
•*/fyou would like e-mail nota kation of sign off please provide e-mail address:
iOwneOwner Name:C/( ' AI((—
Owner
r Address: 3a-,2_, -Pun, c ri Owner Tel. No.: C fn,2-z1,3 6 Z
__._...._._.__.._. __.._..__.._ __.._..._.._.._..__.._....._...__...._............_
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: DATE: ii/G /1 8
PLEASE NOTE
COMMENTS/CONDITIONS:
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3 Idva �
nc•eL,4o4 fStic ratn-w-0k (II6 ( Ie
1 G9?e If'nnnwttroen A laterUQC/sGoesa• 5 '.U11111N11WCOIIII UI MdbbOl11ubt11s
l®1 Division of Professional Licensure
Office of Consumer Affairs&Business Regulation - Board of Building Regulations and Standards
t, HOME IMPROVEMENT CONTRACTOR
tib Const ttit�t{1§Dp�rvisor
eo,, TYPE:LLC u
- fieaistraTY - ElcoiratloR /
l / ,. PIF S 175128,, 04/24/2019 CS-046420 `7 p_"'°:iia r0. .pires 11/14/2020
/ - ! LEWIS BAY MAN�AGF 110. - ^ Ijr f: JL i ( 1 4 d EDWARD T STAFFORD9 4
J! \\\--reit---_—_,r}7 - 64 HERITAGEVAIVE f
,f EDWARD STAFFORD j2 i' 62-CC-01--- W YARMOUTH M/4102671.0.; ��:'__ .
64 HERITAGE DR.N"'r s __ OAS I Ill} W.YARMOUTH,MA 02673
IA
Undersecretar
t Commissioner V'"e I
r .
C
•
;; Generated by REScheck-Web Software
Compliance Certificate .
Project McNiff
Energy Code: 2015 IECC
Location: West Yarmouth, Massachusetts
Construction Type: Single-family
Project Type: Addition
Climate Zone: 5 (6137 HDD)
Permit Date:
Permit Number.
Construction Site: Owner/Agent: Designer/Contractor:
303 Pine St
West Yarmouth,Ma 02673
Compliance;:Passes"using UAtra"de-offci.^. e u i li r; 1111*Iz ,21 hatCjsY44 Or AtiawP at,aV l ,it a 'i
Compliance: 4.1%BetterThan Coda Maximum UA: 148 Your UAE 142
The%Better or Worn!Than Code Index reflects how close to compliance the house Is based on code tradeoff rules.
tt DOES NOT provide an estimate of energy use or cost relative to a mlMmumcode home.
Envelope Assemblies
Gross Area Cavity Cont.
Assembly `' or U-Factor UA
Perimeter R-Value R-Value
Ceiling:flat Ceiling or Scissor Truss 520 49.0 0.0 0.026 14
Wall:Wood Frame,16'o.c. 1,472 21.0 0.0 0.057 78
Window:Vinyl Frame 110 0.300 33
•
Floor:All-Woodjoist/Truss 520 30.0 0.0 0.033 17
Compliance Statement The proposed building design described here is consistent with the building plans,specifications,and other
calculations submitted with the permit application.The proposed building has been designed to meet the 2015 IECC requirements in
REScheck Version:REScheck-Web and to comply with the mandatory requirements listed in the REscheck Inspection Checklist.
Name-Title Signature Date
Project Title: McNiff Report date: 11/05/18
Data filename: Page 1 of 9
•
) 2015 IECC Energy
0
Efficiency Certificate
Insulation Rating . , R-Value
Above-Grade Wall 21.00
Below-Grade Wall o.00
Floor 30.00
Ceiling/ Roof 49.00
Ductwork(unconditioned spaces):
Glass&Door Rating U-Factor SHGC
Window 0.30
Door
Heating&Cooling Equipment Efficiency
Heating System:
Cooling System:
Water Heater:
Name: Date:
Comments
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