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HomeMy WebLinkAboutBld-19-007166 " :• " ; *• 01:•"sryRG BUILDING PERMIT APPLICATION • • 'tr APPLICATION TO CONSTRUCT,REPAIR,FIENOVATE,CHANGE THE USE,OCCUPANCY OF, • ��..�++ OR DEMOUSH ANY BUILDING OTHER THAN A ONE'OR TWO FAMILY DWELLING. 0 .`1 ,_• Town of Yarmouth Building Department 0 1146 Route 23 • Yarmouth, MA 92664- 492 Tel: 508-3984231 ext. 1261 Fax 508498-0836 Office Use Only 1 O �_�l ,/4 , P Ind Information Assessors Department Informed= Permit O "!) Dom. _ Plan Type i P fir - Permit Fee �--- Endor Dab 1 1 / A late New Deposit Rec'd. $ Date Pan NEL l.4Property Dimension Net Due $ _ Other Lot Ana(sf) Frontage(ft) Lot Coverage Tttia for aka ony Building Permit Number: I Date Issued • Signature• ,.c». d. .-, Cep of Dame • is 1r Ls Section 1 -Site Information , 1.1 Property Addrinun7 1.2 Zoning infortnatiwo 4c1Q er723 1 • ' BUILDING PA 7 Zoning Di . sy: E 1.3 lisdidireg Setbacks(ft) Front Yard Side Yards Rear Yard. ' : Required Provided . Requited Provided Required Provided : 4.4 Water Supply MULL,e.40.S.54) 1.5 Rood Z is kdonnetwo Corning Public Private Zflrter; BFE Section 2- Property OwnershipiAuthorfzed Ac t • 2.1 Owner M Records NO,Yay iol3�r'�-. r: .,: Aft ,,,a%1�, -T% 1-told 629/S ' 2 YY 1birl Si-. rr,a c6l71 ir Or elf Telephone Telephone Email Address: I , 22Authorized Agent id ! 1 — e -i- B. c(0. 'co. Box c t l; Mitring Address- T Telephone Fax Email Address: l . Section 3-Construcdon Services 04o v r p cakbex-Irbovr.Corrru. 3.1 IJeensed Construction Sup rvison NotAPPlicat� 0 I tit 1 . Ne - 2*cv fat e. Cs Q r RO, k +t1(►C ' IAA- (904� Wurrtber en to , t'erephone ; J Email Address: . , I � dI uaI E a) 1 .0 l'i , i 1 tctii. i 2 z I 1- • P .• 4 I 1 i , % ,, . 1 i Ai 6 '0464 "Imo • k, I 6 r� L. T Y .i 4 .•- ' - N •• f $ ' 46". I ..• .4 • It, ,.;,It C gs /^� ,,, 1 i : . jIiiiii! 77 ii 4 IN 4 e • . Section 6- Description of Proposed Work(check all applicable)I • ' New Construction ❑ (tor multiple family only) No.�t3edro0rns (for muitipk hunk orgy) No.of Bathrooms Existing Bldg. 0 Repair(s) Q Alterations *Addition Q Accessory Bldg. ❑ Type Demolition 1Fià , Other A. Specify: Brief Description of Proposed Work: • 0- ' "- ' ` o r3wIcLel e g/mAiin yr Plan- Section 7- Use Group and Construction Type Building Use Group(Check asaapp ) Cron Type • A ASSEMBLY ❑ A-1 0 Al, 0 A-3 0 IA A-a Q A-S_D 1B Q B BUSINESS ❑ 2A 0 E EDUCATIONAL ❑ 28 Q F FACTORY ❑ F-1 0 . F-2 Q Q 2C ' H HIGH HAZARD ❑ • 3A Q I INSTITUTIONAL laI-1 0I-2 1-3Q 38 Cl M M19iCHANTILE ❑ s Q R RESIDEMAL 0 14-1 Q R-2 Q R-3 ❑ sA S STORAGE (3' s-1 0 S-2 0 g3 Q M MIX USE ❑ SPECIrt S SPECIAL USE 0 IComplete this-section if existing building undeittioing.renovation%addlions and/or change in use.I Existing Use Group Use Existing Hazard Index 780 CMR 34 • Proposed.Hazard Index 780 OMR 34 Section 8 Building Height and Area I • Bulking Area Existng(iif applicable) • Proposed Number d boom or storks include basement • Roar Area per Floor(sr) Total Area All Floors(sf) Total Height(it) 47 Section 9 STRUCTURAL PEER REVIEW(71CMR 110 11) Independent Structural Engineering Structural Peer Revialty Required Yes No SECTION 10a OWNER AUTHORIZATION-T )BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLES FOR BUILDING PERMIT_ I, 11i ar __ h( ,as Owner of the subject property. hereby authorize r/I C •I A, 1: 2 to act on my beh - - . _ - ati to work authorized by this building permit application. � . 1)621 ►tIII Signature of Owner e ,$E +ON4 la:OMER/A tZEO AGENT DEC' tAAT#ONas OwratriJkatheitated'Asert x ; • 41,1)4(4 Dat4 1,kinrc.‘ • he reby'declare that the statements and intamlation o f the forgoing application are true and. t . the trty kn ►%Hedge and belief. Signed.order the pains and penalties of peljutY Ott) 19 Aqr Date Section 11 -ESTIMATED CONSTRUCTION COSTS • Esi runted Cost(Doers)to too ttPtetsd by psomit 1.euad ,g a See:trtaa a.Ru cc, • 4.lAsdvinical(HV 5.fire Pratabn 7 1bw Squmni Pt.siti w s a.0lass) `�i(/ti✓ Check Below oConservation-Gommisidorr Ring (U- > D (Id tan &Ilstorical cam,approval • • • • • • t he commonwealth of Massachusetts r _ l Department of Industrial Accidents r 1= 1 Congress Street, Suite 100 Boston,MA 02114-2017 ,.�•'•y` • www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Indivi dual): etec- _00( CC) c. Address: 214 C—�' O,-c ec r City/State/Zip: tC ' C'��f 3Phone#: CrOCY L132-oS O Are you an employer?Check the appropriate box: Type of project(required): l.�am a employer with `CI Omployees(full and/or part-time).* 7. ❑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.] 3.0 I am a homeowner doing all work myself. t 9. [Kemolition y [No workers'comp.insurance required.] 4.❑I am a homeowner and will be hiring contractors to conduct all work on myproperty. I will 10 Li Building addition ensure that all contractors either have workers'compensation insurance or are sol p 11.❑Electrical repairs or additions proprietors with no employees. 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet 12.❑Plumbing repairs or additions These sub-contractors have employees and have workers'comp.insurance? 13.El Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other 152,§I(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. 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:CO c) c Y Policy#or Self-ins.Lic.#: pA 631( `1-IS Expiration Date: '\ li r7is) Job Site Address: 4Z Ty City/State/Zip:t.,0 {crn rsr) oz(g-7 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 civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy oft ' atement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify u e the ns a penalties of perjury that the information provided above is true and correct. Signature: Date: e))."1 t Phone#: �O� L-t3Z 3 Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: RECEIVED TOWN OF YARMOUTH ° HEALTH DEPARTMENT JUN 1 72019 o HEALTH DEPT. PERMIT APPLICATION SIGN OFF TRANSMITTAL • To be completed by Applicant: Building Site Location: vqe2e---eyT-c28 (Air- V� �� S r‘c,"��eL. Proposed Improvement: —Di Ebel o/Re osler5J1C,I G 112 ( ern? h I� S sae-C�l"I��o2 Applicant: C 7? ,0 �}(� . Tel. No.:3 U g -7 30G-0330 t / II Address:? CR��r .. 7b. 1-41-&"W i19, Date Filed:/•...OAJ ,9 **ifyou would like e-mail notification of sign off please provide e-mail address: Owner Name: 17' �DL.i�VA rs$ Owner Address: WI Jni/, J . i. Y471440,-117/ /144_ Owner Tel. No. a- Z80 •CC 7 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: 9r12 DATE: 6 /7 f PLEASE NOTE COMMENTS/CONDITIONS: /I C row k -12 e("cud Ci h X1�4� S 1 v4 I v 5 'f25: H • • • :.o •X TOWN OF YARMOUTH ° BUILDING DEPARTMENT co 1146 Route 28, South Yarmouth,MA 02664 508-398-2231 ext.261 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: L oa tQfZZ Map: Lot: Owner's Name: Address: Phone: Contractor's Name: Address: Phone: Eversource: By: t-A 1 �.� jc Y 6 Title: L7 C National Grid: Date: N By: / Title: Water Dept: Date: By: Title: KA-T Board of Health: Date: � / 13 �.� L Ac k' By: 4"i .. t4c� LA 4 (L e Titl r l 7lt � ��;, T- Condition: c �' Fire Dent.: Date: &/ //9 BY: �� 477 fr fa �iS 7 Title: �/ i ` Historic Commission: Date: By: / Title: Conservation: Date: NA k By:. / Comcast: Date: 3/15 mstrair sow Brivissisaaw REILLYELECTR/CAL CONTRACTORS,INC. 110 Old Townhouse Rd.-So. Yarmouth,MA 02664 508-771-2040•888-GO-RELCO•FAX 508-760-1425 July 9,.2018 Mr.Joe Marrama Cape Cod Family Resort 518 Rte.28 West Yarmouth,MA 02673 Re: Cape Travelers Motel Bldgs.Demolition 492 Rte.28 West Yarmouth,MA Dear Joe, All power, telephone and CATV services to the existing four rear housing bldgs., Rms. 5 thru 30 and pool house at the rear of the property have been disconnected in their entirety. From an electrical and communications systems standpoint it is safe for the demolition and removal of the subject structures. Please consider additional utilities such as water, sewer and gas as well as contacting Dig-safe prior to demolition and excavation. Should you have ay questions and/or concerns,please do not hesitate in contacting me at any time. Yours Truly, Sit 14444,14 Scott A.Ventura Director of Operations Ltr.Cape Travelers Demo Electrical Contracting•Design •Service&Maintenance GoogleM ,i,,,,,I1/44.1)16 ,. . , ..,......„ :..A.,.. .,, . , ,. 4:4;:: „: .., ..,:.*:itIt'': J i g c •, H 7 t. i6.,), d.onled, '�`JC+. ,.. ,., � 'an , , - y 4.. ' ..i".,fil'' r.."..".':.•, .t..--t.00;. e.,, ........ . . k tt t t� t ,: a _ H. '�.. �` ''.:',F;i;.1*'',1 i'i!';°'.:',' f t ' �y.,= 'Alf': ;�. ..,� ,„` � t ._. -.ta,, 5 .. � .. w- I�j� '�" � liitl itat,ie"/;itr-r•,�,('r � • �..... * 3 t Cape t:,�e E M t i i i '� is ( (t t(r,{, x;a l y}. 'mac -� - ; - # � k i .'E PA ._p -�,, �� � ° if* g �"�- iro'3,� i �:�,.aF j�s { �t� � � .,F. •' gR� rd � jj d y;>, t W s� b>„ ''''''Li �: x� " j Mtiyfl()Yvp( az moo'.+. � >...;': .,1., . ", r' t+s"1 F)(' `Glnf sF t"_ a. �,�w. x tom. , y �, j w ',, at s �� j �' � ;�;Hoiid�y V,acatEor � � �-,st .f•_`=``"'_„'� ,� : ,F�� ,+� . -I � �� �' Go(rdnn(�niu'ns � . . it � $ „r° �i� ` tr d • j ° a a W. —:.•__e...{ w:�• Emit..' F,.,rn /kt.., m .ram Imagery©2018 Google,Map data©2018 Google 50 ft .m,,,.. ,,-„a,;,, ..w,:ry > o TOWN OF YARMOUTH e O BUILDING DEPARTMENT i 1146 Route 28,South Yarmouth,MA 02664 st ;...: 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 S, i hereby certify that the debris resulting from the proposed work/demolition to be conducted at 41 grA91.Y (19Work Aess y ocd ae ba `0 MoLAW is to be disposed of at the following location: _ COfl(L€ d2ie - 4-0 Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, S�;tirm454A. Signature"licati+ice Date Permit No. t , ComrnonWealth of Massachusetts , * Division of pReeulations and Standards e Board of Building 9 Nisor Const` �. Alt /i • ,pires:0610312021 CS-092761 ABIGAIL O ROSE Y 1 s. P.O.BOX 1530 ? HARWICH M02645 -N �' '�O15sTAA Commissioner '"�