HomeMy WebLinkAboutBLD-19-4135 — - — - Offi Use Only
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Permit expires 180 days from
issue date :
EXPRESS BUILDING PERMIT APPLICATION ,
• TOWN OF YARMOUTH
Yarmouth Building Department
1146 Route 28
South Yarmouth, MA 02664
(508)398-2231 Ext. 1261
•
CONSTRUCTION ADDRESS: r 4f -• ra r L •
ASSESSOR'S INFORMATION: •
Map: $ Parcel: 6
OWNER: Be0i7,,1t t 5ic &
t , r Top1 (4- o t9fl G /7 7ar 0 7 /
NAME PRESENT ADDRESS / TEL. #
CONTRACTOR: Pg.417—^ CON$-7-2t./cri o.v / a.✓Gu s- IYII,cr so g—..2.. o f Ger
NAME MAILING ADDRESS TEL #
Nil idential 0 Commercial Est.Cost of Construction$ 3 o, 0 Cc
Home Improvement Contractor Lic.# )63 ,,e-,5 S Construction Supervisor Lic.# GS / 9-R 4 9-7
Workman's Compensation Insurance: (check one) /
0 I am the homeowner 0 I am the sole proprietor Q-1 have Worker's Compensation Insurance
Insurance Company Name: AGS)1/-4 • Worker's Comp.Policy#jfG/) SZfCJs/' ""I Z
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WORK TO BE PERFORMED ve/--I a a(-pc
Tent _ Duration (Fire Retardant Certificate attached?) Wood Stove
Siding: #of Squares Replacement windows:# Replacement doors: #
Roofing: #of Squares ( )Remove existing* (max.2 layers) Insulation
Old Kings Highway/Historic Dist. ( )Replacing like for like Pool fencing
*The debris will be disposed of at: A/ , tar ' Z. v • Y ILL
cation of Facility
I declare under penalties of perjury that the statements herein contained are true and correct to the best of my knowledge and belief. I understand that any false answers)
will be just cause for denial or revocation of my license and for�fprosecution under M.G.L Ch.268,Section 1.
Applicant's Signature: ��(( j` .O Date: /s..7-A ti J 9
Owners Signa a(or attacTir�ent) /�/ Date:
....11��UU /• /I-/2
Approved By: 'C �.,�/ Date:
Building Offici.�> e EMAIL ADDRESS:
Zoning Diss ct: E C E I V E
Historical District: 0 Yes :B.".-No Flood Plain Zone: 0 Yes C✓
Water Resource Protection District: Within 100 ft.of Wetlands:
1 2019
0 Yes Pf No ❑ Yes e No _. ___
DUI ING DEPARTME T
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Construettbri Supervisor •
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A9a6tT •'-..." £ry pirA's.:1i$fA303DAE
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PATRICK J COFFEY ';y ' r i -
153L01l.EL1_51ANE _.� t "� < : v . 11111111/// ���
,13.0 BOX 7.311":">, .t ` .t • oe j ,` CONSTRUCTION CO. •••
.MARSTONs•MIL i�IA 0264 p' BUILDING&REMODELING CONTRACTORS
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PATRICK COFFEY ,
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• c 508280.4688 coffey7@msn.com
o 508.420.9333 153 Lovers Lcne/Box 731
1508.420.9733 Mastons Mils MA 02648 -
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Office of Consumer Affairs and,Business Regulation
1000-Washington Street-Suite 710
Boston, 'Nlassachusetts 02118
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Home Improvement Contractor Registration
-;-..•L.4
'` *Type: Corporation
PRATT CONSTRUCTION COMPANY LLC 4 n k _ .r i r' Registration: 163855 •
,R,O.IBOX731 _ -_,..-7-7,1, �_ ;,;
Expiration: 08/22/2020 •
MARSTONS MILLS,MA 02648
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as roisnialialpfgetaardumegnOffice of Consumer affairs'&Business Regulation
HOME.IMPROVEMENTCCONTRACTOR .Registration valid for Individual use only
7YPEs c0ruors8on .beforeithe.e>tpiration:tlate.':If found Tetumto:
Aeaistrattort 'ExoiratioR
• oneid.Bus
iness•RegUiation4 :mo0Wahi on Street-Suit7t0r 1
IATTICONSTRUOTION�CDMPANY„LLC •Boston,'MA 0211s •
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TRICK COFFE•'ln `”Y f;° .
ILOVELLS I.NUNalDt .' V .
RSTONS'MILLS,IMA"212648 Unliersecretary INottvalldwNlthoutsignature
UUT
. The Commonwealth of Massachusetts
to��2_=a= . is
e e; ] [t Department ofIndustrial Accidents r
• =aril—. �. • ._ 1 Congress Street,Suite 100 ti`s"
-e IN n Boston,MA 02114-2017
*. z,,s+ • www mass.gov/dia
Workers'Compensation Insurance Affidavit:Balldens/Cohtractors/Electricians/Plambers.
TO BE FILED WITT!THE PERMITTING AUTHORITY.
Applicant Information .
• • Please Print Legibly
Name (Business/Organization/Individual): 7/-A 77— Cn, I t _ J C25742 A!
Address: /513 / O ti et_t f / awe_. •
City/State/Zip:J7naz,sntA4 n,t_i_.S a2-cr`f hone#:'.5-41.5—' Z Y'o y4'gig—
Are yona employer?Check the appropriate box: o5project
Type roject(required):
I. i am a employer with 5 employees(full and/or part-time), 7. aNew construction
2.❑I am a sole proprietor or partnership and have no employees working for me in 'g, modelin
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any capacity.{No workers."comp.insurance required.] g
3.0 I am a homeowner doing all work myself-(No workers'comp.insurance required.]t 9. Demolition
4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 0 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 area corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other
152,11(4),and we have no employees.[No workers'comp.insurance required.]
*Any applicant that checks box#I 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. 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: /ICA 'r 4
Policy#or Self-ins.Lic.#: ✓C.m S;S t x/ —12 Expiration Date: 4,45/tea/9 •
Job Site Address: a S J•-7 r rigs* Po i.v r— rt b City/State Zip: Q..,T.y Q u 7 3
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$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
Ido hereby certify under the pains and penalties of perjury that the information provided above Is true and correct.
Si• ature: 401P U ea/
Date: ,7 n >ee_-J41---
Phone#: SQ0' ,3C rJt4er— '
Official use only. Do not write in this area,to be completed by city or town official ,
City or Town: Permit/License#
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
• a Berkley Company
. ad I a INSURANCE
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY
WC 00 00 01 B 01 15
issuing Company:Acadia Insurance Company -
290 Donald J. Lynch Blvd
Marlborough, MA 01752
t
_ WORKERS COMPENSATION AND EMPLOYERS
LIABILITY INSURANCE POLICY
RENEWAL
INFORMATION PAGE NCCI Carrier Code No.: 33391
Policy No.: WCA 5258951 - 12
Previous Policy No.: 5258951-11
1. Name Insured and Address Agency Name and Address 07131
Pratt Construction Company, Inc. (508) 676-1971
PO Box 731 HUB International New England, LLC
Marstons Mills, MA 02648 P.O. Box 3220
Fall River, MA 02721
Other workplaces not shown above:
Refer to Name and Location Schedule -
i FEIN:270354389 Risk ID No.: Bureau File No.: 301701
Entity of Insured: Corporation
POLICY PERIOD I
2. The Policy Period is from 06/15/2018 to 06/15/2019 12:01 AM Standard Time at the insured's mailing address.
ICOVERAGE I
3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of
the states listed here: MA
B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The
limits of our liability under Part two are:
Bodily Injury by Accident$ 500,000 each accident
Bodily Injury by Disease $ 500,000 policy limit
Bodily Injury by Disease $ 500,000 each employee
C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here:
.All states except ND, OH, WA,WY and states designated in item 3.A. of the information page.
D. This policy includes these endorsements and schedules: See "Schedule Of Endorsements"
WC 00 00 01 B 01 15 Includes copyrighted material of The National Council on Compensation Page 1 of 4
Insurance,with their permission.
• TOWN OF YARMOUTH
g '! c o �� � BUILDING DEPARTMENT*..a..s Ear,` 1146 Route 28,South Yarmouth,MA 02664 308-398-2231 ext.161
BUILDING DEPARTMENT
TOTAL DEMOLITION SIGN-OFF FORM
State Building Code(780 CMR)Chapter 33,Section 3303.6-Service Connections
"Before a building or structure is demolished or removed, the owner or agent shall notify all
utilities having service connections within the structure, such as water, electric, gas sewer and
other connections. A permit to demolish or remove a building or structure shall not be issued
until a release is obtained from the utilities, stating that their respective service connections and
appurtenant equipment, such as meter and regulators,have been removed or sealed and plugged
in a safe manner."
"All debris shall be disposed of in accordance with 780CMR 111.5."
Building or Structure Location: Map: f Lot: 4
Owner's Name: AupGyTAddress: raptFtel) Phone: 6 ! 7 26S `°7!
Contractor's Name: caret, Address: pnancei 7f Phone: co r7, 4f-a 7G0-t
Eversource: Date:
By:
Title:
National Grid: Date: tr
/� e-ow-.v`+_�cr-c� 73q t•)}2t3�
By: 1,: &-rive tit 3_AadveaCo- 'emit Misr.3
Title: /
Water Dept.: Date: /A'
/ , i
By:4,"
Title: S'.f'r—
Board of Health: Date: • 0---3-/—/g
By: �nf�et+ � �y/
Title: i_eS/Sf, fk /" ""
Condition:
Fire Dept.: Date: /2 ' a 7. 18
By: jG t
Title: C Pr MO CY
Historic Commission: Date:
�A
By:
Title:
Conservation: Date: lZ/2//Mg"
By: .
Comcast: Date: h/A
3/15
,. .. r .• • .... ♦. n,Q m..s..a. .. .. ... ......- ... +•[ •w..v.. ... •. r.'� ..� 1MFiYT r
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of •y TOWN OF YARMOUTH
e-.. �'o • WATER DEPARTMENT
• i' �l�..^ 99 Buck Island Road
West Yarmouth, MA 02673
Telephone: (508) 771-7921 • Fax: (508) 771-7998
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• BUILDINGERMIT APPLICATION
DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET
Bldg. Site Location 6 fp-7, g i a-r tom,,,,
Proposed Improvemeent: `c ��• j. . C'a" S F ;
Applicant: 1
Address _13.49_)e_ ?,_)� ��Tel. #:<'Q r� Date Fled:
y ret
RESIDENTIAL AND / OR COMMERCIAL BUILDING
Water Department: Determines Compliance of Water Availability and or Existing Location
Engineering Department: Determines Compliance for Parking and Drainage
Conseniation Commission Determines Compliance to Wetlands Acts; i.e. If Lot(s) Border any Type or
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 .
Signature of appl can- Date
PLEASE NOTE;
COMMENTS: •
•
/t/g//s- •
Rev(dwer Divis
Y Date
TOWN OF YARMOUTH
HEALTH DEPARTMENT
• 0
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: Co St-HZ-W:5 Patty r SZD
Proposed Improvement: I1 7 cC -/ fte Q L.4 CV- S f.D
net../ % Dit-L. cj 5 f a
Sde c r_e.r-'a intS
Applicant: Tel. No.;Sow A ga 41 agar-
Address: Pa e cK 73 ( t r2.- *A d pr. Date Filed: // .pc c /r
•"/f you would like e-mail notification of sign off please provide e-mail address:
Owner Name: c Ark, A/ /3 fitLa f f T CR% 4-41n I,
Owner Address: j� �Bea GQsr-3 Owner Tel. No.: et 7 7 iS 7o f
/_..3.0.4. x.-f- .MA q.......0... . -, 3./5
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: Aaaire DATE: '>- / uI'
PLEASE NOTE
COMMENTS/CON'ITION :
/ ' i" di - -_A. Cray/ Atit 'e&' st L ; J
4e-6- 6 .07>66--7-Adif /W /. a 3 z*'Ti €aaf�
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\`�o Town
N� $ ConservationofYarmouth Commission
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Building Permit Sign-off Application
TO BE FILLED OUT BY APPLICANT:
Building Site Location: ct f 1'i ins 95 p4/N� /52-17
Map # C Lot(s) # .4 /
Property Owner: 17 y r n,% A 1--(341.1 ed 7
Applicant: J7n�4.t4/ , Corr-
Applicant
x
Applicant Address: B c -7) / /4-7 t-1 /o7 Gizir
Telephone: SBC 2 t tvt SrDate Filed Al }Pe e_/r
Proposed Project Description:
r z -- it -- ,nsf tA c-- Sent,
Plans: 1 61It a la - 10 61 'I t ibte Ai. t Dw As.
h VAS •owt ' ;. 4b '9 wig CC E� iv-rynj fA1 11 il/i ir:
TO BE ILLED OUT BY CONSERVATION ADMINISTRATOR:
Do You Have A Valid Permit From The Conservation Commission For The Proposed
Project? Ye S
Comments from Conservati I 'ommission:
Approved onditionally Approved Rejected
All work related debris shall be taken offsite or disposed in a legal upland location
At the end of each day,the area shall be clean and no debris shall be in the Resource Area
Refer to: SE83- 2/7O or DOA permit
Conservation Commission Sign-off Signature: 1
Date: 2 l z)/20/8.
Yarmouth Conservation Commission
Pre-Construction Meeting
DEP File Number SE83-2170
Applicant 6 Smiths Point LLC
Address 6 Smiths Point Road
Company
Contact Info:
f- -
✓ Co-( fcy fry-- 7..._jr; fad---
Signature of Acknowledgement: My signature acknowledges that I read and understand the Order of Conditions,
including the special conditions per the Yarmouth Conservation Commission. A copy of the Order of Conditons will
remain onsite.
1 v y
E, Order of Conditions Recorded? •
ir.
File Number Sign Up?
27 Erosion Control: Your sediment and erosion control has been properly installed in the appropriate location(s)
Y•u MAY MAY NOT begin work.
/z/Zi//t
Other Comments:
g//1 SOck I?, is addocf fo 4s-c ' Of S/f4ticQ .
MGL AND FIRE
•
e TOWN OF YARMOUTH
re iti
REVIEWED FOR CODE COMPLIANCE.
04m.1) ERRORS OR OMMISSIONS DO NOT RELIEVE
THE APPLICANT FROM THE RESPONSIBILITY
otyt. / OF"AS BUILT" COMPLIANCE.
DATE: /S
c , p,. • K
INSPECTOR
YARMOUTH FIRE PREVENTION
Commercial Construction Building Transmittal
Project Name: 6 Smiths Point LLC Address: 6 Smiths Point Rd.
Contact Name: Patrick Coffey Phone: 508-280-4688
Y NO NA Subject Regulation
E
S
X — Access for Fire Apparatus — - -_ _ 527 CMR 1; 18.2.4.1
X Building Numbers MGL Chapter 148;sec 59 -
X *Flammable gasliquid storage 527 CMR 1;42.2.2.1
X Fire Lanes 527 CMR 1;22.3
X *Service Stations 527 CMR I ;16.2.3,16.2.3.1,30.3.2
X *Hazardous Materials Storage 527 CMR I;60.1
X *Kitchen Exhaust Systems* 780 CMR,527 1;50.1
X Extinguishers 527 CMR 1; 13.6,Chapter 148;sec 28
X Fire Alarm Systems/CO detection* 780 CMR,Chapter 148;,527 CMR I; 13.7
*LPG Storage Chapter 148;sec 9,10,28&527 CMR I;69.1
X Use and Occupancy(FH Building Class) 780 CMR;302.1
X Sprinkler Systems* 780 CMR&Chapter 148 sec 26 A-I
X Storage inside/outside Buildings 527 CMR 1; 10.19.4,4.4.3.1.1,19.1.2,34.1.1
X *Upholstery 527 CMR l;20.6.2.5
X *Trash Containers 527 CMR 1; 19.1.1, 1.12
X Any Hazard to the Public Chapter 148;sec 28
X *Curtains,Draperies, Blinds 527 CMR 1; 12.6.2
* YFD permit required-depending on occupancy and submittal
*Per 527 CMR 1 13.1.8, a permit is required from the Fire Department to shut down any
fire protection system.
Fire Alarm system to be evaluated and conform to existing Codes
Description of planned project/other requirements:
The YFD supports the applications, subject to applicable submissions,permits and
inspections.
Permit for Oil Tank Removal
Permit for Propane Tank
Plan Reviewed By: Captain/Inspector.7Cenin Stwi% Date: 12-27-2018
Copy for Applicant CI Copy to Building Department II Copy to Fire Prevention
Entered in Firehouse I--I Final Inspection
Engineering / Surveying Division
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New House (vacant lot/ never developed/new foundation)
Building Permit Review Work Sheet
Address: (p 5inn1-os PbitJT QDAi'
Assessors Map &Parcel: PM 5 , Km (v
Assessors Plan#: RA7E 4 QgCE
Plan Type: Not Pl).
Recording Date: Ncj- v a
Planning Board#: Not REA),
Endorsement Date: t)rrr peck,
Planning Board Release Date: NOT MC)
Subdivisions Only&Post-February 14,1950
1
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g�Y•gR' _,
. kir ;! o- TOWN OF YARMOUTH
c
,._I $ 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664-4451
, 4to,„.n.•Ygil Telephone(508)398-2231,Ext. 1250—Fax(508)760-4830
Engineering and Surveying Division Building Permit Review
Residential and/or Commercial Buildings
Name of Applicant: T corr. e
Telephone or Email Address:_L.�Q�2 kcal fGs-g--
Proposed Building Location: G $p-z i t S t-
Date Submitted: 9 1 �P
Requirements for review: /'
Please submit one(1) copy of plans,to include:
1. For Residential: Site Plan showing proposed and/or existing buildings,
proposed contours with bench mark, water service location, and septic system
location.
For Commercial: Site Plan showing details required by the Zoning By-law and
revisions required by Site Plan review, if any.
Note: Site plans must be signed and stamped by a Licensed Professional Land
Surveyor and Engineer or Sanitarian.
2. House or Building- Floor Plan(s) and Elevation Plan(s)
3. One(1) copy of application.
Reviewed By: lr g1trv qA, Date: 10.19Z/IC
PLEASE NOTE
Comments/Conditions: L,4 E_
• iia
Pdnled on Recycled Paper
41405 /. COpagca , PERCOLATION TEST LOG Time: V V
• Lot No. /Street: S' 11$i ' S 1'I/ll/ Date: —
Z —
' . Engineer: /!/ a/4 Health Agent:
Expansion Area:Yes:_No:_ Suitable/Subsurface Sewage:Yes:_No:_
Expansion Area Tested:Yes:_No:_ Leaching Field:_Pits:_Trenches:_
If No-Why? Unsuitable' Why?
Well:_ Town Water: Subdivision/Owners Name:
Sketch: ;c.. ' f
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Notes: ,��� Water At:�t.
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