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HomeMy WebLinkAboutBld-20-001376 ,._ e4/44S (/3 ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department 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 E I V E. 0 I This Section For Official U Only BuildingPermit Number 9 Date A ' �—RE)�/c3 .�(a" d4O151 Building Official(Print Name) Signature - r�.' SECTION 1:SITE INFORMATION 1.1 Propergi Address: 1.2 Assessors rc:Parcel Numbers iyCv,kiluv+ct `gyp 1.1 a 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.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSIDPI SOv er'of Recor, e ��yy� B w oD-� 1 a 6o �2,� 7 3 Name(Print) `' City,State,ZIP No.and Street Telephone Email Address SECTION 3 DESCRIPTION OF PROPOSED WORK(check ail that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg.0 Number of Units Other ❑ Specify: B ref Dp,scriptiop of Proposed Work2: N('e',p t walk 44r+ . plassi 14, SECTION:et'ESTIMATED CONSTRUCTION COSTS. -, 1 L U t 9 Item Estimated Costs: Of eialUse Only • • (Labor and Materials) 1.Building $ CO ,� 1 Building Permit Fee:$ J ST) Indicate haw fee is`deterrnlneif' 2.Electrical $ ❑Standard City/T(*Application Fee: ❑.Total Project Costa. tem.6)x multiplier x 3.Plumbing $ 2. Other Fees: $ List: 4.Mechanical (HVAC) $ _ .. . 5.Mechanical (Fire Suppression) $ Total All Fees: Check No; Check Amount: Cash Amount: - z itTiN 6.Total Project Cost: $ ((j r (7 ' O Paid in Full ❑Outstanding Balance Due: II \°) OkY SECTION 5: CONSTRUCTION SERVICES 5.�1A Construction Supervisor License(CSL) cc -/05 1 ' j 1 0 t x c s- License Number Expnation'Date Name of CSL Holder P4 r-f-`c f _ J List CSL Type(see below) No.and Street Irl ,"v Type Description TS A54 �` CD) Unrestricted(Buildings up to 35,000 cu.ft.) City/Town,State,ZIP l + PWl lib ZS R Restricted 18c2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding aVt l SF Solid Fuel Burning Appliances /(3-17// ba(ieAcr@ � WCt� I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) ,q G S--4)- -/E-.- HI vompany Nape or HIC Registrant Name n C` HIC Registration Number Expiration Date N h-and Street L�/9- ; C(`tpd �'' rr G,yw�ettSf• 5 - iCli p_° }7 _S 3 3 _ p 9// Email address City/Town,State,ZIP ) l o Telephone 0 SECTION 6:WORKERS'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 Issuanncce of the building permit. Signed Affidavit Attached? Yes Ed No 0 . 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 rti \9 Co .yam n C to act on my behalf,in all matters relative to work authorized by this building permit application. Aka „ g- - �9 Print Owner's Name(Electronic Signature) Date SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION By ent my name below,I hereby attest under the pains and penalties of perjury that all of the information c 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 7 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.gov/oca Information on the Construction Supervisor License can be found at www.mass.eov/dps 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" . „„:,,i': ,',„-•',1'44,-:„•.„, ,;,,x,;, ,11474.4,F,14cfgr' ',„,c,;:,,,,4,',„,''-..,::::„:".,,•,,, ,, - , , , ,'7'''',,,,,','71',A1P711,?,,,,,V4.17V,2,1711,'',," '.1, .,;*, ,i,•;"!,:', .',„;,',,,'-',..,,-,,, "„::::,,,`;,' • • -'„ '7 '',',11.6';`140;01;i4.,,'';',,,,,i, /111' ' ',-:,.,4,,,,,,,,,,,,,,y,:.•,,,,„,,,;•:,,,,,,; . , The Commonwealth ofilassachicutis , ,•-,,:r,,,,,„:,,,:.',:1;,,w,g4f,q 4444.4e0;44„„.„..1„,, ,,,, , *I' Department of IndastrktlAccidents , . ., ,,,..•,,,,,,,,,,44,ii,,, ,Aviiie.**iw4n1.4,4,-0.,.4. , r,:wyy,;(4., I COngren Streati Stitte 100 .5,V51$4f„ „ ,•:,44.,:,::•,:.•EF', • ' - ' . .' 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Q,A Expirntion Date: /119 a;;;;•'';'"''''''':***lii*ce,-40114O Lin,i'-- WC•C SI 5:14'kJ 12L2 1,30 „,g,p,-';-,*?-':, sH,:,,,ft-,, ,vt,/,':ii-';',,:'4:::•'r'',,'.'il„ :"•,,," .' ,'"-, -C4v . . - . •- )1t.: ,,,,,, ,.., ,,,.ci,,,,,,, i,.A.wolaH., s 4,,,,,,..f......... ___.:.t, . am'number New ' dittok,!-'::':,',i,";iig,g1Z, mr, ,' lops, , , „ , ' • ,:;''''''""044 ' cocoMpenittlen policy dealers**Page(stioninS the policy , ,,, , , , ,Lvfoilag,g4::' by it fbinutiteS101(00,41ftif4,44•4,4?„:,,as required- under Mat c. 152,$25A is a criminal violation as well as civil penalties in the fin of a STOP WORK ORDE4 and a Apoi,o•i': 4eepy:alibis getement may be forwarded to the Office of Investigations of the Mk ferinieeMett- -patittandiesaides oftmpay—thaidi bionnadoilmneided above.* "4 ' . ,... ,ior. , • ,,, ,, :,„..,,; ,,,„y,',,,,,,6'',,k,,,W.,';,.".0P.I.f.i4:5*,',' 4%,''','; ."7,,'"Al';',,,I, 4°4 ,:•:.„ 7'7 C, „ iltainfi' , \. . ,- .,,„ ‘,,,4;,,,,,',.:,r*IiiiMAV, , :'• ,C' .,'',' 4':: '-' -''- ig/ - „, , , , ' Do jot**to tide area,to be eoloideted by dty or town(Odd ,.„,„ ,„..,,,,,,,,4,,,,, ,;,;,..,:,....,;•,,:,,,,. , : . . .P Sr mitILICON#, 1,..'1, Joi7i777g,_ 40iyOtTe ow* 41 i$041*00Z01thrt'- Department 3.'cityffl,avi Crk 4.Eleter'Ical In,ipecter L P, h*_D _1L,, „, 0 ".:;;..45,, , : Other . _ ", ,,'„,„,._,;,,,,,._„: „„:„.„,,..•;,:,;..,,' , , ,_ ,,-. , :„',.:a.,„•0„,,,,,,,.v,i,,,,,,,,,. , Phone* i `Vti,,':',,/,;,:;>",4•4"7, :',. .,77?,„, , : , , , , , :;;;,„V41•*/Z,W4P:0:: ,,, rafttleAtt#0, '''''," —,- ' , „ . • - ° ' ,� TOWN OF YARRIOUTH C C B UILDING D EPARTII�IENT 1146 Route 28,South Yarmouth,MA 02664 "�- i-a' 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 ars`- 4 e 1J r cl cC/U`-"o:'rR-‘) Work Address Is to be disposed of at the following location: (at-1-141 o Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. 6 ` -7 117 iafore of Application Date Permit No. TOWN OF YARMOUTH HEALTH DEPARTMENT 0 ,.:k i „3 PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: ( I 1 Building Site Location: a a- t'lA C I Proposed Im rovement:—�—f' � c� (,v ° -t Ara_ t�-�G _c,; t W .,-er— C o o r�i e +n - Applicant: W‘t, l (ck /'►'1 J Tel. No.:5-0 S1'.)-`13-77`7-7(, Address: - `f Pctie 1 P r 9l 6-0; 64 Date Filed:k'ag (7 **If you would like e-mail notification of sign off please provide e-mail address: Owner Name: 'k€,i 10 Owner Address: C,„,,,.5 r_t_61, tfeev44,0-at Owner Tel. No.s06 3 60 O / b 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: DATE: 7/ //c7_____, PLEASE NOTE COMM TS/CONDITIO S: :C l cc M e — hu r roc_ t 2 U vA- _ I /67 I V c/lev 3 c k� Gpe sec : f c✓ �vi f 4- (--v -to Ric v Q c kt j 13-rctv-oc".4 -- 1 IC-t.S i Fiov✓ S-e COD Ccv' ok7 ��V tS.0 8-Me , c cY/ IC?Ci c1,/-•._ ft,e ve stci �� ,�� (14.cl �'/y�?— C_ye • Client#:766468 2SUNRISERE /YYYY) ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD 7/10/209 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Dowling&O'Neil The Hilb Group of N.E.dba PHONE(A/C,No,Ext):508 775-1620 FAX (A/C,No): 508 778-1218 Dowling&O'Neil Insurance Agy E-MAIL coi@doins.com P.O.Box 1990 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Hyannis, MA 02601 INSURER A:Associated Employers Insurance Company 11104 INSURED INSURER B: Sunrise Restoration Company,Inc. INSURER C: PO Box 802 INSURER D: East Sandwich,MA 02537 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRT TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DDY�) (MM/LDD�) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR PREMMISES Ea o e manta) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO- POLICY JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) $ — OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION WCC50050196992018A 11/29/2018 11/29/2019 X PERTUTE OTH- AND EMPLOYERS'LIABILITY STA ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION Town Of Yarmouth SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1146 Route 28 ACCORDANCE WITH THE POLICY PROVISIONS. South Yarmouth, MA 02664 AUTHORIZED REPRESENTATIVE .�,/...,� 'a Ceirs ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S239284/M239283 CDR 'Ae Wommoww•eAgid ofalladoaciteae 1 Office of Consumer Affairs and Business Regulation One Ashburton Place- Suite 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Type: Corporation SUNRISE RESTORATION COMPANY INC. Registration: 90352 Expirati P.O.BOX 802 � 01/18/2020 SANDWICH,MA 02537 Update Address and Return Card. SCA 1 0 20�,M--05/17 / OMlee of Consumer Mars&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Caroore6on before the expiration date. If found return to: Basialudise Esaindian Office of Consumer Affairs and Business Regulation 190952 01/18/2020 10 Park Plaza-Suite 5170 SUNRISE RESTORATION COMPANY INC. Boston,MA 02116 W ILLIAM FEDER 480 ROUTE SA - Ot valid without signature SANDWICH,MA 02537 Undersecretary Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Construction Supervisor CS-105323 E#tpires:03/14/2020 MLLIAM M FEDER • 24 PARRISH WAY WEST BARNSTABLE MA gaga• 1 Commissioner vL Construction Supervisor Unrestricted-Buildings of any use group which contain less than 36,000 cubic feet(991 cubic meters)of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license Cali(617)727-3200 or visk www.mass.govldpl Sunrise Restoration Company 480 Rte 6A,PO Bo.802,East Sandwich,MA 02537 Home Improvement Contractor#: 160037 AUTHORIZATION TO PERFORM SERVICES AND c:4\a4 DIRECTION TO PAY (1t'l i herein referred to as"Customer,"authorizes Sunrise Restoration Company,herein referred to as"Sunrise,"to perform demo of damaged drywall and insulation, treating for mold and rebuild on Customer's property at: ,:,.t4Y'` Tel: ,()0 9to / mter�uthorizes1:47 Insurance Company,herein"insurance Company, to directly add solely pay Sunrise. If rm." er any'reason the cbeck(s)from the insurance company should come to or be made payable to .Customer,Customer then agrees to pay Sunrise immediately upon receipt of said ebeck(s). If Ike loss is not covered by insurance,Customer agrees to the pay the total amount to Sunrise open receipt of the Invoice for work performed. P � 1�n a t _ eel_ x% ) �c „/ epees to pay to Sunrise Customer's insu nee claim Deductible,the amount of which is amain£firmer"s insurance policy. �` ,, + josarmine Company: f.�g; r `(-t�itn►5 `t� C / L" tE►-fir.r- ate,I C C 5 S�ksa��a/5 h. that Sunrise is working for the Customer and not the Insurance Company or its rr�tunlcs: • w � completely t the terms within. j -,......27 t*>17 1 Cie 1..:'''''' '''''''''';', ' I 4R f ✓5 9 Z k $ • si�'. Date i�-�g , k k F : L' r1L 4 x �wg M 2s � A.'& RECEW D ;,, to t,,, 4- o .'a_._ 6-7 3 SEP 042019 dekr-‘4-1°jN11-`11,k), HEALTH DEPT. • R ce_Sc ime`ti I 15'6" I 5'4" I 13'6" 7 15' v, 5'__'- 13' Zo Laundry Room 11 X 6-12) "t e4r— °` El o .109 in r--4 3' 11"--+ .;:i \(22c. *()It - 4-e . -i.( 41'1 3,7„ �. :n J '" t id 34 5 H 4,44,4*-1, - Li• 14'S"— L.. - Co - Stairs f::: ro- dp) i • :1 a Eni3 g.,,tr),, [ - = II Rot witkitlik 1: " 18'4" r.. I•---5'6„ 9' 10" _ - 19' I TOWN OF YA RMOUTH REVIEWED FOR BUILDING AND ZONING CODE COMPLI- F 0 L E COPY ANCE. ERRORS OR C,. ,11SS;ONS DO NOT RELIEVE THE APPLICANT FROM THE RESPONSIBILI1 Y OF"AS BUILT" COMPLIANCE. , DATE Y ')3 -11 BUILDING`5-F CIAL