HomeMy WebLinkAboutBLD-19-3709 &i tit r% ia./z6 r
ONE & TWO FAMILY ONLY-BUILDING PERMIT
Town of Yarmouth Building Department os r
1146 Route 28, South Yarmouth,MA 02664-4492
508-398-2231 ext. 1261 Fax 508-398-08$, s
Massachusetts State Building Code,780 t•i t C F I t t t
Building Permit Application To Construct, Repair, Ren. at; Or Demolish
aOne-orTwo-Family Dwelling I DEC 2 203 I~'
This Section For Official Use a, • -; 52.Cy'IL f $A, '&
Building Permit Numbc80) '. /g 61707: .Date Applie• "!i°i ,N r I
r. SMr5 . -li.;•13-1�
Building Official(Print Name) Signature,.,,. . Date
SECTION 1:SITE INFORMATION •
1 1 Propert/yAddress: 1.2 Assessors Parcel&Parcel Numbers /
(o Diced Circle 5. /,4i+10,rnH �0�1)
1.1a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
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.O.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public Er" Private❑ J Zone: _ Outside Flood Zone? Municipal D On site disposal system t3
Check if yes0
SECTION 2: PROPERTY OWNERSHIP'
a,} Owner'of Record:
r4-e', wh L1-Ai 5 , VAI-gr hnot y ,T) 4 ort;(Y
Name(Print) City,State,ZIP
20 CDIcCEf C,rcic 61-7 -5-•13 -1067 e4/7-1
No.and Street Telephone Email Address
SECTION 3:.DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction❑ Existing Building 1122 Owner-Occupied Ell Repairs(s) D Alteration(s) IW" Addition 0
Demolition fY Accessory Bldg. 0 Number of Units_ Other 0 Specify:
Brief Description of Proposed Work2: /2 e Kr-rc 4 e.✓ Cn4/.✓d -ret • /Zemin✓e
OM 641 — 73t.a.c L4/41 rc r, o/- n-r - 4 A/ Bcrwce,,„.• X i-c4 c✓
/( vd D/,/in/1' 4oAni . ,Sfien>et. c<C /4pa:rf
SECTION'4i ESTIMATED CONSTRUCTION COSTS. _ )
Item
Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ '95100.00 1-Building Permit Fee:$ 150 'Indicate how fee is determined: -
2.Electrical $
111 Standard City/Town Applicationl;ee
Z,2 00• CD D Total Project Costa gym 6)x multiplier x
3.Plumbing $ 2,1-0b •60 2. Other Fees: $""3)
4.Mechanical (HVAC) $
5.Mechanical. (Fire _
Suppression) $ Total All Fees $ tv E tD
iW lr 'v:
/+ Cheek NO. Check Amount: fCass Amount: ---') I�
6.Total Project Cost: $ 7�, 60 .60 0 Paid inFull Outstandin Ba)ance Due:
•
SECTION 5:.CONSTRUCTION SERVICES
• c `' 5.1 Construction Supervisor License(CSL)
/7,t/ cl • .N b �a dCs License NumberDIPsit Date
zoici
/L( t (� Expiration Date
Name of CSL Holder
List CSL Type(see below) U
a 7,AM —O -J4'4fltc wA.y
No.and Street Type Description
l/�4/L1�1 riot DZ 6 U Unrestricted(Buildings up to 35,000 cu.ft)
Ciry/1'own,State,ZIP t7✓7 R Restricted 11%2 Family Dwelling
M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
SDP-3tP-2VLF Ce pc_(aclIoIim4in, Ce !tune , I Insulation
Telephone Email address c or.. D Demolition
5.2 Registered Home Improvement Contractor(HIC) /lib b I • L/r- /
(4., t Cod f 107110-1/nd" 1/07/44 r•✓ e- HIC Registration Number Expiration Date
Mc Company Namur HIC RegistrantName
G 1 1 Frei 4.,a A-tit Cei ci ,otum /e Czy yetis. .w�
No.and S eet Email addtess
5• ,x- 70✓�� nn SeP -31P- au,
City/To ,State,ZIP Telephone
SECTION 6:WORICERS'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 l9'ncNo ❑
• SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETE])WHEN
• OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING/PERMIT
•
I,as Owner of the subject property,hereby authorize (�/L/4,f /// V/g� r I
to act on my behalf,in all matters relative to work authorized by this building permit application.
rent 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 in this application is true and accurate to the best of my knowledge and understanding.
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.zov/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
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"
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4,., •ze--T-aty TOWN OF' YARMOUTH
vg c BLTILDING DEPARTMENT
tt?- '?'_t = •i? 1146 Route 28, South Yarmouth,MA 02664
` • • qs-i s=ue 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 1 l l5,
I hereby certify that the debris resulting from the proposed work/demolition to be
conducted at c2 0 a 0 tre,r 1 1. f E c /c 5. /.94,07bv7 j
Work Address
Is to be disposed of at the following location: y,4•'Lmo,i-riv /iL-„/,rf
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
Let , 2-/‘//P
Signature of Application Date
Permit No.
Massachusetts Department of Public.Safety.
v Board of Building Regulations and Standards
License: CS-067499
Construction Supervisor
BRIAN S HIBBARD
2 TAM O SHANTER WAY 3
SOUTH YARMOUTH MA 02664 d �
.
•
Commissioner
Expiration:
05/01/2019
...Vie' genenev:eivarcliVieez.uere:‘,:ea0,
Office of Consumer Affairs E Business Regulation
HOME IMPROVEMENT CONTRACTOR
TYPE:Corporation
is io xIgi
1,` 186609 xa 12/12/2020
CAPE COD PLUMBING AND HEATING INC.
•
a c+x
BRIAN HIBBARD',
21HFRUEAN AVE ;>
SOUTH YARMOUTH,MA 02664
Undersecretary'
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REVIEWED FCR BU CINv"AND ZONI"w CODE CO"dPl6
ANCE: ERRORS OR Ci;',!iSS;O V5 DO NOT RELIEF THE
APPLICANT FROM THEP.ESPONSIBILII F'A8BUILT'
COMPLIANCE.
- BUILDING O CIAL
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