HomeMy WebLinkAboutBLD-19-003708 ONE & TWO FAMILY ONLY- BUILDING PERMIT
Town of Yarmouth Building Department o' 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
REThis Section For Official Use linty r C ! VL/
Building Permit Number:$Lb -/q 150(37fl Date Ap'
EtEC 12018
)i Se/11.5 .,/ _ 4,/ 11.-M•- IV . .. _
Building Offrcial(Print Name) - - Signature .,, .SUIL SIIiiiC ' r;i NIL NT
SECTION 1:SITE INFORMATION
1 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
3- W-r-r, lz fin- 039. NS
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
31) t 37' -1,— ,27 .v/n-
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public IT Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system m
Check if yes❑
/ SECTION 2i PROPERTY OWNERSHIP',
2.1 Owner'of Record:
ml/'Eue1.. ,e. 44»Lri4 w&Pr gine u7/74- /14 C267 '
Name(Print) City,State,ZIP
a co//AJ--6-p i,-- S0O790 3239 •rodekSilva@,9,,nlonConmid/edLC
No.end Street . Telephone Email Address
' SECTION 3:.DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) 0 Alteration(s) El Addition 0
Demolition 0 Accessory Bldg.❑ Number of Units_ Other 0 Specify:,C p/R ti 70 re7/ S 4-11
Brief Description of Proposed Work': '"7 At ct. Gor en 7' f;-e-n 74 S¢ep s✓i i"! a
-PP-40-77-1,7 0/00 of M 4-744-rn c wit?' 3 SSS.
• SECTION 4:ESTIMATED CONSTRUCTION COSTS. H E:G 1% • "_L" -"' 1
Item Estimated Costs: Official Ilse Only ,
(Labor and Materials) : - , 119 I ,19
1.Building $ 2o I Building Permit Feer$)C ,Indicate he f is&rmined. .j
2.Electrical $ M Standard Crty/fgwnAppircationFce _PUILohGiara: .r1/411-;i }
❑Total Project Cost'(Item,6)xmultiplier... evx--
3.Plumbing $
2: Other Fees: $ ..3.5:_>`'.
4.Mechanical (HVAC) $
5.Mechanical (Fire
Suppression) $ Total All Fees $
p� CheckI4d Check Amount: Cash Amoun
0 0 0 Paid in Full. , .. ' El Outstanding Balance Due: �tO
6.Total Project Cost: $
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.) •
City/Town,State,ZIP R Restricted I&2 Family Dwelling
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 AI ILUAVIT(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 ❑
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:OWNER3 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.
�lil rrsz k . 11isi1,k/g /i//y/a
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.eov/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"
•
_ The Commonwealth of Massachusetts
t =—lilli=a=
l Department of Industrial Accidents
( -'s:llll= 1 Congress Street,Suite 100
=':. 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/Organizatior/lndividual): Ai/C-0et Q 1)4s/LVfJ-
Address: 5ra C4217-71-6-te ,1j2 •
City/State/Zip: we-ger -hi—nit 9 Ph ne#: SM 790-3239
Are you an employer?Check the appropriate box:
Type of project(required):
1.01 am a employer with employees(full and/or part-time).* 7. 0 New construction
2,01 am a sole proprietor or partnership and have no employees working for me in $- 0 Remodeling '
any capacity.[No workers'comp,insurance required.]
3.211 am a homeowner doing all work myself.[No workers'comp.insurance required.]r 9. ❑Demolition
4.01 am my ProPert3•a homeowner and will be hiring contractors to conduct all work on 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.
12.0 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) 13.0 Roof repairs
6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. - 14.0 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, lithe 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.
Ido hereby certify under the ains and penalties of perjury that the information provided above is true and correct.
1 Signature: "` Date: ////////p
Phone#: JOd) 790-3239
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 it:
oi.YAR TOWN OF YARMOUTH
*ay 1 •
44 j ° BUILDING DEPARTMENT
% .'ri 1146 Route 28, South Yarmouth,MA. 02664 508-398-2231 ext. 1261
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
DATE:
JOB LOCATION: M 1 Girt-1- 0.-.— ci-
NAME STREET ADDRESS SECTION OF TOWN /
"HOMEOWNER" 1"l i a-A*L Col 79oc?Z.3q ✓
NAME HOME PHONE WORK PHONE
PRESENT MAILING ADDRESS -5-C2- ck'77-4 -b2 Wel? Yfic (Tfl Sf-- 02i'73
CITY OR TOWN STATE ODE
The current exemption for`Homeowner' was extended to include owner—occupie wellings of one or two units
and to allow such homeowners to engage an individual for hire who does not pos ss a license,provided that such
homeowner shall act as supervisor. (State Building Code Section 110 R5.1.3. .
Definition of Homeowner.
Person(s)who owns a parcel of land on which he/she ides or intends; reside,on which there is or is intended to
be,a one or two family attached or detached structure assesto such'use and/or farm structures. A person who
constructs more than one home in a two-year period shall not be nsidered a homeowner;such"homeowner"shall
submit to the building official,on a form acceptable to the building 'tial,that he/she shall be responsible for all
such work performed under the buildine permit. (Section 110 R5.1.3.
The undersigned `homeowner' assumes responsibility for compliance with e State Building Code and other
applicable codes,by-laws,rules and regulations.
The undersigned `homeowner' certifies th e / she understands the Town of Yarmouth Building Department
minimum inspection procedures and quirements and that he / she will comply with said procedures and
requirements. /
HOMEOWNER"S SIGNA I/
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
,. z°�'T��� TOWN OF YARMOUTH
•' 3 ` vy c BUILDING DEPARTMENT
• �� ?"_� ; 1146 Route 28,South Yarmouth,MA 02664
a 508-398-2231 ext. 1261 Fax 508-398-0836
BUILDING DEPARTMENT
DEMOLITION DEBRIS DISPOSALAFFIDAVIT
Pursuant to M.GL Chapter 40,Section 54 and 780 CMR, Chapter 1, Section 1115,
I hereby certify that the debris resulting from the proposed work/demolition to be
conducted at .S=2 ten-q et' ✓)/L
Work Address
Is to be disposed of at the following location: !Weir YA12n44u7+/ 1(4ni/Gen-- .(7 °V
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
PAA4
Signature of Application Date
1
Permit No.
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 not required to carry 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 burn 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
•
•pt y� TOWN OF YARMOUTH
eo WATER• DEPARTMENT \\A . , , .
'l'. 4r=Y...
r 44 Buck Island Road
,West Yarmouth, MA 02673
Telephone: (508) 771-7921 • Fax: (508) 771-7998
•
BUILDING7ERMIT APPLICATION
DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET '
Bldg. Site Location jot CO77116e .1)T` Map #: Lot #:
Proposed Improvement: R p/st a #-v , SVe,' "
Applicant: . ://i ve� 7- ,�C�,�i%!ice '
Address 52. e ✓Y` Tel #: Pi 7t!:3239 Date Filed: /111//J'
RESIDENTIAL AND / OR COMMERCIAL BUILDING
Water Department: Determines Compliance of Water Availability and or Existing Location
Engineering Department: Determines Compliance for Parking and Drainage
Cense-nation Commission: Determines Compliance to Wetlands Ads; i.e. If Lot(s) Border any Type of
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 Personal,
Safety, Property Protection;, i.e. Smoke Detectors, Sprinkler Systems, Etc ..
V1 `• Ei/9//1
S gnature of applicant Date
•
' PLEASE NOTE:
COMMENTS:
Reviewe •
Water 0i4ision Dae / /
Y
•
EagrodEo
• ' otriAte TOWN OF YARMOUTH
HEALTH DEPARTMENT NOV "i 41r118
Yx PERMIT APPLICATION SIGN OFF TRANSMITTAL SH I HEALTH DEPT.
To be completed by Applicant:
Building Site Location: 52 G o T tni,a ./)ii
Pt'4t'24J, l f -
Proposed Improvement: Re /� Wer
Applicant: ve / R• Dr 6/VA' ,Tel.No.: 30P 790-3239
---
_Ca L' of e ��f 6 A'- lie aDate Filed`
Address: /is///6
""lfyouwould like e-mail notification of sign off please provide e-mail address: '774'- ,-/- gortipn cal)ii,7/ ede
Owner Name: /1ve / Fe• beCilto-
Owner Address: Co/W-9e- Jr' Owner Tel. No.: s°f' 79C-7.123y
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: t f DATE: / / la/J /8
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DWELLING Tom{ -,, ADDITION
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FLOOD ZONE C
LOT AREA 11,340 SF
EX. DWELLING AREA- 956 SF
EX. DECK AREA= 387 SF
PROP. ADDITION AREA= 336 SF
PROP. LOT COVERAGE= 14.8%
SEPTIC FROM ASBUILT
ON FILE AT THE TOWN
HEALTH DEPARTMENT
BUILDER TO CONFIRM
CERTIFIED PLOT PLAN
DASILVA RESIDENCE
I CERTIFY THAT THE IMPROVEMENTS SHOWN52 COTTAGE DRIVE
HAVE BEEN LOCATED BY A FIELD SURVEY. r41% of y4ss4Oy YARMOUTH, MA
Or
OF
N DATE: 2-18-2016 DRAWN: RBS
o SIXES SCALE: T'=30' O�WBG ppz01
No. 35418 '^ EASTBOUND
aree Zia,, 2-18-2016 •F�1 R,,o�+ it LAND SURVEYING, INC.
sTeSg� P.O. BOX 442
ROBB SYKES, P.LS. DATE FORESTDALE, MA 02644
"w' 508-477-4511
RECEIVED
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DEC o3 201$
\ HEALTH DEPT.
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DWELLING ADDITION
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TANK
STIED
FLOOD ZONE X
LOT AREA 11,340 SF
EX. DWELLING AREA- 956 SF
EX. DECK AREA= 387 SF
PROP. ADDITION AREA= 336 SF
PROP. LOT COVERAGE= 14.8%
SEPTIC FROM ASBUILT
ON FILE AT THE TOWN
HEALTH DEPARTMENT
REVISED: 11-30-18, SEPTIC SYSTEM BUILDER TO CONFIRM
CERTIFIED PLOT PLAN
DASILVA RESIDENCE
I CERTIFY THAT THE IMPROVEMENTS SHOWNOF 52 COTTAGE DRIVE
HAVE BEEN LOCATED BY A FIELD SURVEY. 4o���tiN �SsiYARMOUTH, MA
or G DATE: 2-18-2016 DRAWN: RBS
ROBB ,'^.. SCALE: 1"=30' JOB f: S201
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sins DWG. CPP
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I" No. 35418 H EASTBOUND
1e "'' "`�' 11-30-2018 �`�ISTEl�� It LAND SURVEYING, INC.
sr, „ s P.O. BOX 442
ROBB SYKES, P.LS. DATE �:: FORESTDALE, MA 02644
508-477-4511
Sent By: Yankee Survey; 1 508 420 55531 Jul•30•C, 2:29PM; Page 111
To: hAYES HAYES At: 15087750893
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REVIEWED FOR BUILDING AND ZONING CODE COMPLI-
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ANCE. ERRORS OR C; ;i sSIONS DO NOT RELIEVE THE
APPLICANT FROM THE RESPONSIBILITY OF'AS BUILT' . .
front step COMPLIANCE.
I r. ._ -- DATE: 1J,- '/� •
I. 1 BUILDING OFFICIAL f
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a a0/1/7-- DECK LAYOUT
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Label Name Quantity Length Bevels
A Fascia 2 6' 1/4" 45,45
B Fascia 2 4' 1/4" 45,45 •
C Header 2 5' 11"
D Outer Joist 2 3' 8"
E Internal Joist 4 3' 8" -
I F Stringer 7 2' 9 1/2"
Cut Angles: L=Left, R=Right, F=Front, S=Side • •
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BEAM LAYOUT LEVEL 1 .g,iMif/v
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Label Beam Length Post Count Post Spacing
A 5' 11" 2 4' 7 1/2"
B 5' 11"
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ANALISYS LEVEL 1
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A 5' 11" 2 4' 71/2" 1 ,
B 5' 11" 2 4' 7 1/2"
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ANALISYS LEVEL 1
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