Loading...
HomeMy WebLinkAboutBld-20-001061 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 -v'�� Massachusetts State Building Code,780 CMR Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Us- •my Building Permit Number:/" .2j2 uU/ f I,Date Ap. •. f AUE21201!, I Building Official(Print Name) Signature L I L p.E PrA R T M E ±r SECTION 1:SITE INFORMATION 1.1 Property Address: , 1 1.2 Assessors ap&Parcel Num rs (Zs. '1 ge,e.,?� .A4 w1 1.1 a Is this an accepted street?yes !/ no Map Number Parcel Number 1.3 ZooninOnformation: 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 3o 3 0..-3 15' 5. 3 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 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: "OW ID TA -Cxr AJI^I( 5�ct1(LLo c_'� 06O79 Name(Print)���J City,State,ZIP TN[� wit .,_A / No.and Street Telephone Er ail Address SECTION 3:.DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building❑ Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other ! Specify: Sal D g.cr}L Brief Description of Proposed Work2: itoi5,. .P1.14edl ' 1 �.oa� t T nitcrQ t ewt.c SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item Official Use Only (Labor and Materials) '} i t'�1 i s' 1.Building $ /S 60 1.. Building Permit Fee:$ ) ( Indicate how fee is determined Standard City/Town_Application Fee / 2.Electrical $ (, 0 Total Project Costa Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ ` . 4.Mechanical (HVAC) $ List 5.Mechanical (Fire Suppression) Total All Fees $ Check No. Check Amount: C Amount: 6.Total Project Cost: $ /5 t ) p Paid in Full IR Outstanding Balanc ue: L,) SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 65 —0113o70 ef-zz-2001 Dow 10 Tr"Cj.I j4 V(sl( License Number Expiration Date Name of CSL Holder t tiQ List CSL Type(see below) CA. No.and Street Type Description " e 1 n c._ z,( 7 c g U Unrestricted(Buildings up to 35,000 cu.ft.) Y Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding / / SF Solid Fuel Burning Appliances 'f g/'(V 13 D4V1 O,Tip G 1, Av N(gT41i.C.A11% I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) P(‘O t i ttiV XL HIC Registration Number Expiration Date HIC Company Name or HIC Registran Name 1 1)-b5p sr Ig37K /0/y/zoz0 No.and Street Email address 5�L.L.Fe' �_1_O �� a 6•sl 8 1/434-3/g46t 3 City/Town, State,LiP Telephone DIWO.T4'I,4V//4( (1)C,4 r}i(,.owl.- 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 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: OWNER1 OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under th pains and penalties of perjury that all of the information contained in p icatio true and accurat the best of my knowledge and understanding. �,..� B Z/ P wner's or Authorized Agent's a(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.aov/oca Information on the Construction Supervisor License can be found at www.mass.2ov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) 70 s d Ear (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 - 7e Department oflndustrialAccidents s51i11= 1 Congress Street, Suite 100 --=�f= Boston, MA 02114-2017 r;5..-> 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/Individual): T.4 v/D lfttQ 4 AV/ Address: /y I /�0S p Sr City/State/Zip:$t,c,f/A7 j L.D Cl� 0I,67Q Phone#: 4"f 3 C j3/ ( 3 Are you an employer?Check the appropriate box: Type of project(required): 1.Q I a employer with employees(full and/or part-time).* 7. XC New construction 2. I am a sole proprietor or partnership and have no employees working for me in 8. El Remodeling any capacity.[No workers'comp.insurance required.] 3.❑I am a homeowner doing all work myself. [No workers'comp.insurance required.]t 9. ❑Demolition 10 0 Building addition 4.[III am a homeowner and will be hiring contractors to conduct all work on my property. I will 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. Roof repairs ,cC-I . GO B 1 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other X 7 152,§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. 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 verification. I do hereby certify ut , to pains • d penalties of. . ,ry that the information provided above is true and correct Si•nature: //i/ "T `�-®"""� Date: B 1l— Phone#: g!3 S'-i/ y6/3 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#: d� Y -S TOWN OF YARMOUTH �� :Vg c B UIILD ING DEPARTMENT o, -.24p =�/, 11d-6 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 I, Section 111 S, I hereby certify that the debris resulting from the pro sed woric/demolition to be conducted at /� Ra'.12. -R7 �c r"1 -1 )f(Uwl Work Address Is to be disposed of at the following location: y/'4 tv )tk 7R14t)f - o'-'( Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. B-21- Z017 Signature of Application Date Permit No, • o 'ram` , . ,v: Town of Yarmouth o'...- ,.,--: .1 Conservation Commission "':: " %' Building Permit Sign-off Application TO BE FILLED OUT BY APPLICANT: Building Site Location: 1 Z(=> 1 R X ?b It t--154-b & y1- Map # 3L-1 Lot(s) # Z F ' Property Owner: —DAV 1i) -t- Ly i T -C.-LLA.V i 4,( Applicant: -PAV t. 1 , -Li! V I Applicant Address: (yc( T lL0 S'€.Ci 5 c- SO f(g.Lh C•V o &7 Telephone: L I 13 53\ i--k L vs Date Filed ej '�t - �(� Proposed Project Des ption: ' ( i L) S`'`'^1,. l e'c. Plans: TO BE FILLED OUT BY CONSERVATION ADMINISTRATOR: Does the Proposed Project Require a Permit? I p,D Comments from Conservation Com." ssion: Approved Co'i itionally 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- 2I 05 or DOA permit Conservation Commission Sign-off Signature: ' , 4 g41116) Date: vo ille 5,' ,Jt:Y ,� TOWN OF YARMOUTHN HEALTH DEPARTMENT , ,.., PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Building Site Location: (2C DR.ere -4)�11,+.-k" 744 5. /A-9-4A-us1/4)-4--, e c � L Proposed Improvement: 7 X (l) j7 E-GkL 4_ lgAJC S t Dom. Applicant: NU t 0 I-A G L l 4J.4AL ( Tel. No.: y1353141 fo l 3 Address: l y q i -,D Sf e-c-k- ST- 5 l -.0 Gca(7a Date Filed: e.2 -2- **/fyou would like e-mail notification ofsign off please provide e-mail address: Owner Name: AV tip 'A-C-Ll Av(A.(, ( Owner Address: I ` ct {' R= Q Si- 54 f- l gU L-Owner Tel. No.: Lf(3 s-3 f cg L? 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: Ey021 / , PLEASE NOTE COMMENTS/CONDITIONS: ---3---\ A ,--___N j 1\_,__________ ezy Pont Roa 7 1 (40' Wide — Public) d O Pa vem en t S 75.00' . z..) / /.•• os ¢ � � .. fa cb • / 7,77 W S zi 0 0 O to MAP 34 PARCEL 237.1 —� x' W W TOWN OF YARMOUTH r OB 13263 PG 164 PROPOSED s•3' � �� � � � R X 24'` PROPOSED GARAGE ��J /DECK i iy.�• �/ EX/S11NG Existing DWELLING Existing 1ST FL EL. 10.8' 1 h DECK ,Fc TC :5 1?et �, �v ��s�dq RIJij 2�19 0,.3.1" 1 :� C' X '`-PROPOSED ADDITION i x X�� ' IN AREA OF EXISTING DECKS HEALTH DEFT. IN EXPANSION AN it/ oORK SEC D FLOOR SUN o� N. 4-�_� LIMIT — NLINE ALLOW PATH T EDGE OF 'ASS TO 1 I - - O - - - TO 4' WIDTH 3 BVW 3 _ •�'NO / 11-A ,;� '�. BVW 2l ��6ERING `� ,;ti, l, -----ier—** / sts, all, . / / .;i_. '� / Q / LOT B :AI, ;,g / ii,753± SF L: A ezy Point Rom 7 (40' Wide — Public) _ d 04 Pavement s ---;.115.---. - 75.00' 4---- -----Ig ••---\St.,..Q_ 1 oco 0 W ZJJ 0 0 0 nK M S MAP 34 PARCEL 237.1 - > 3W TOWN OF YARMOUTH t7(w i �, �5.3' � � Iec DB 13263 PG 164 PROPOSED \ TPROPOSED GARAGE 4' DECK' ' e, J i EXlS17NG / Existing pWELLING Dwelling 1ST FL EL. 10.8' h DECK �- ' -.3' ,'Ii �50 OFF B . ._. .�...�...� ..i''� ,,��.�c •� 24 C. X PROPOSED ADDITION \ \-_______i_____,---,----- ---_______ — T X . IN AREA OF \N'.1 EXISTING DECKS ONSISTS OF FIRS ORK �� o � EXPANSION AN �`'- 4_ SEC o FLOOR su LIMIT ALLOW PATH T — — ALINE OF 'ASS TO VEGETATE EDGE— O TO 4' WIDTH 3 BVW 3 i'ND / 1U, B 1 /p �... W er 91w N„ � ,,i_, mo, at,, / a.: t- / / .,i�, / Q 1 LOT B ,,If, .,li, _LA Q / 11,753t SF t ...-5\ A ))((/),......6, /I Ilt ezy Point Rom 7 (40' Wide — Public dgA 04 Pavement C,L,5, 75.00' -5.... — I �•• 1 /�.../11 T h cd • 7,, 44.. 0 0 0 M 3 MAP 34 PARCEL 2371 -- x' W "> TOWN OF YARMOUTH �W 4, OB 13263 PG 164 PROPOSED S•3' >� }- 1 / 1 2' X 24' PROPOSED GARAGE /DECK ice'..' / EXISTING > Existing DµELLING Dwelling 1ST FL EL. 10.8' 1 • / . ._ DECK r {^ �/ 5.3 -�50" OFF B .— CK • �� 24 REbed �J� p ropos q AUG 212019 c� .),1,_ l I C "\-> PROPOSED ADDITION 1� x X�� IN AREA OF EXISTING DECKS ONSISTS OF FIRS HEALTH DEPT. 1141L:ep o �, EXPANSIONAN (ORK �`'- SEC D FLOOR SU 4- LIMIT — NLINE ALLOW PATH T r \ EDGE OF 'ASS' RE-VEGETATE — — — — — — �-- TO4' WIDTH 3 vi3 1 ;� •� = 80�pERINO a�: A,, ili, Ail. :,I'' I / a,�. ;� �" l , /A. TB :Ig, / I LO �, I 11,753t SF 1 I ::;� alb. I I : . tGv ,,,, -\ �D1►,*t ���1, k a' ., I -- _. ,, , _ . „ , . tvsz.\31 bcA---• ! r 'ct )2 11 Ptt .- ? C X1$T \I. 0-ou-$f. 2-4' TOWN OF YAN, UTH '' z Revie =D For.RIVI'NS A.G'_''V-,:i CCnF COVPLI- 605 ANCE. ERROk.,vk, iSSI NS DO NOT RELIEVE THE t-� APhLICAt�T FBOIv1THr RFSP'bNSiBILI-t Y OF"AS BUILT" ' ���' 1` COMPLIANCE. DATE:3- 31 / BUILDIN4 OF•ICIAL i' P i ,R trE (zI`.W?„,pflvtD I Dower.- win r•-- . � ,- 14 )•) AtTtU►,1 4. v t2x,?., . . Lrr, V,,t_tS s© . y,A-�►�d0, /�'4 - le` x ��.� - bA-v '1) T AcL,pviMI z•{ i ".7 ! `/ r , -17PtJio , T�6.LIAvil•tt