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Home My WebLink AboutBLD-19-3812 • % i/ SP • ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department co 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 T tvo-Family Dwelling l • 1RFCrt \II n This Section For Official Use Only ": j "" ^�- Building Permit Number: -1 f' ,3 Z7.3. Date A 'ed:''. I w lire NPnrS ,/..e. /4-/ •:1 rial...1 Building Official(Print blame) Signatu e _ eip - � .:' 1:?ate1 SECTION 1:SITE INFORMATION'. • . 1.1 Property Address: 1.2 Assessors Map&Parcel Numbe 7 1 SPrtie.ltnJG Qsosc2W 1.1a Is this an accepted street?yes 1/ no Map Number? Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq R) 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,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public i2/ Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system LY Check if yes❑ SECTION 2 .PROPERTYQ'WNERSHIP,. ' 2.1 Owner'of Record: . P -rrazci matoll-t= 4ricm0-n-Pt (114- Name(Print) City,State,ZIP 21 $P2 Jr4T-t3(r Btocic 9mfdtillilebail-ewmcra:,ii r No.and Street Telephone Email Address SECS'.CONS'S)ESCRIPTIONOF PROPOSED WORK;Echeek Alt that apply) .:' New Construction 0 Existing Building 0 Owner-Occupied O Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units_ Other 0 Specify: Brief Description of ProposedWork2: RCyn Ina L't� gam 51-f.4(r Fut 1.. t3/i'sr4 ) CUsmmM SMAW&t r r4(n.i -T1 1.--e r dA..a irm l4rt.0 -rth-t-t_CT r [ RECEIVED ..., SEC rION 4�EsrwigriD CONST1lt1CTIO. COSTS 11;i to 1dicit, 261 Item Estimated Costs: Of*cial i7de(jilt'`' ` . (Labor and Materials) >72 ,i a4`.� z c*Bt D niciDEPARTME.NI / 1.Building $ Sp a C.L Building PermttFee S :54' ,Indicate hoe fe 9tlderinmed — 2.Electrical $ m3stnda stai l Crty :011Apphcatioti 'e6 ? :.. ,4 • r;; • . - SECTION 5: CONSTRUCTION SERVICES . . 5.1 Construction Supervisor License(CSL) 068 G G Aricni / ONt4 l W2Ne License Number Expiratio Date Name of CSL Holder' ISS D ePar ST List CSL Type(see below) No.and Street 'ftype .. Description • 1)6-M1/41I, t'oeLT M/} O J� `U) Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling Cip'rrown,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) ,^ (2553 - ► i {tt tCNONt.1 L1/4111•4n1 HIC Registration Number Exp. on Date BIC Co1y)atz Name or RIC Registrant Name ISS �JG (Jbf �f 601/44•1031 -t'tOJ.Mft " �,`�o�.and Street Email address IJ(^NN(J Ar in4- o26301 Sob 9n92oiti City/Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AP'rlilAVIT(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 la.'" 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 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 . 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. 1A'1\1-1140Nt, tN.A 12.( 18118 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. 142k 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/dns 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 kir G1 Department oflndustrialAccidents • fel= 1 Congress Street,Suite 100 Wit= 2l° Boston,MA 02114-2017 www mass.gov/dia - Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH TUE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): OAA Address: SS ®troy: City/State/Zip:'itct-tr,t i3 Psi aiq.- 02439 Phone#: Mpg 2 3 2-°1 Li Are you an employer?Check the appropriate box: Type of project(required): I.❑I am a employer with employees(full and/or part-time).' 7. 0 New construction 2.2t1 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 myself. 9. ❑Demolition ❑ ys [No workers'comp.insurance required.]t 4.0 I 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.: 13.❑Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] 'Any applicantthat checks box 11 must also fill out the section below showing their workers'compensation policy information. t Homeowner who submit this affidavit indicating they am doing all work and then hire outside contractors must submit a new affidavit indicating such. IContractors 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 verific. on. I do hereby c under the pains and penalties of perjury that the information provided above is true and correct Signature: Date: 12-be la Phone#: -aoa ' i� 201 L( Official use only. Do not write in this area,to be completed by city or town offidaL City or Town: Permit/License# Issuing Authority(circle one): L Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Q `lk,� TOWN OF YARMOUTH • o BUDG DEPARTM'' 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 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at 21 SP Zrvmr r r,* 13Qo�lc Work Address Is to be disposed of at the following location: 5 Arlo t ace &Jfl t Privwt Said disposal site shall be a licensed solid waste facility as defined by M.G,L. Cha ter 111, Section 150A. I2f 181 /0 Signature of Application Date Permit No. • iw Won:manweatfi♦-aiC>�raar s aseats ReguIat • Ottice of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:IndMdual R elfin \ xittlo 125537: '301/14/2020 ANTHONY SEANviUS QUINN ANTHONY S.OUINN 155 DEPOT ST UnderseCretaN DENNISPORT,MA 02639- Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Con structrOn'Supervisor CS-068599 Expires: 04/06/2020 ANTHONY S QUINN 155 DEPOT STREET i- DENNIS PORT h1A .0269 Si -' �•. Commissioner CL i • Patricia A. Metcalf 21 Spinning Brook Road South Yarmouth, Massachusetts 02664 December 11,2018 1 authorize Anthony Quinn to apply and receive a building permit to renovate my bathroom at above address.The work will begin as soon as possible. Thank you, elAtea Patricia A. Metcalf • Ezst? 1& 014-56e. 'BATh 21 SPT-ti u4(s 13RwK C Wit" n \ / 1,113L06 a. wo•so 0 / \ SwkIv ► >0 :'q" WASIAtN cr mA.k+ z Z29 BA I TOWN OF YARMOUTH REVIEWED FOR BUILDING AND ZONING CODE COMPLI- ANCE. ERRORS OR C4.1ISSIONS DO NOT RELIEVE THE APPLICP.NT FROM THE RESPONSIBILITY OF'AS BUILT' COMPLIANCE. • FILE COPY DATE: ',,'1 BUILDING OF CIAL r • PaoPox-fl aWsiV2 597.4.p4I1* r t CI-osrcr 5t CjW ` O ' 1 Oav'n 5VIOtW&L 74' a 8WkICAd w1D V / t With ,- /