Bld-20-001560 7 - 9/a,C /i
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 �:►�f�E- ' ')
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 Use Only
Building Permit Number: $0..)`070 .�®e/,% ate Applied: - 7 2019
111r^ StACS `jam, -4.6-1S , 7.1.
Signature
Building Official(Print Name)
SECTION 1:Si ri:INFORMATION
1.1 Property Address: 1.2 Assessors p&Parcel Numbers
�/ 6pr.n9 er 1 rl W I/a7i11 M
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(it)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard (°
Required Provided Required Provided Required Provided
3 1. i o?i- y I/ O
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private❑ Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSIUP'.
2.1 Owner'of Record:
�a ") 3e/t-e cJJ t yroou- AI U�6 '3
Name(Print) City,State, 1P
y/ 6 pri i q ey /_ 7V- 72z - V//3
No.and Street Telephone Email Address
SECTION 3 DESCRIPTION OF PROPOSED WORK(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg.0 Number of Units Other 0 Specify:
Brief Description of Proposed Work':
r"slev rl eel Jim?'o c-u ecie,LL
SECTION 4:-ESTIMATED CONSTRUCTION COSTS. -
Estimated Costs:
Item • Official Use Only .
(Labor and Materials)
1.Building $ -7, e U ,b c) 1 Building Permit Feed$:I SC) Indicate how fee is determine&
2.Electrical $ *Standard City/Town Application Pee;
•
CI Total Project Cost3(Item6)x multiplier. . x •
3.Plumbing $ 2. Other Fees: $ 3S
: :
4.Mechanical (HVAC) $ List - •
5.Mechanical (Fire $
Suppression) Total All Fees:$
6.Total Project Cost: $ UU Uo CheckNO. Check Amount Cash_Amount:
❑Paid in Full .'Outstanding Balance Due: I tS
`•, r r SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 1
I Ll6 6701/y � /
j �7 t4'71( .1/)t /( License Number Expiration Date
Name of CSL Holder T
5 L y�CA /�reet Type . Description
List CSL Type(see below) (4
No.and St
/.��' � �J.7( S ( 17) Unrestricted(Buildings up to 35,000 cu.ft.)
_ R 1 Restricted I&2 Family Dwelling
Ciry/Town,State,ZIP M Masonry '
RC j Roofing Covering
WS ' Window and Siding
L SF Solid Fuel Burning Appliances
5421 61,2 f�9 T/"/�ad?i(P/tj//TQ b. 1 Insulation
Telephone Email address edill D Demolition
5.2 Registered Home,IImprovv;e/ment Contractor(HIC) / ��l 9 i g a/
F ' ! �"v — 1 HIC Registration Number 7Expiration Date
IIIC Company Name or HIC Registrant Name
No.and trees rL ��
L At.r�/(,h M/ �6/� 2I/36�9sv Email address
City/Town, State,ZIP Telephone L
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 Ere"-
No ❑
i SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
/
! I,as Owner of the sub' ct property,hereby authorize X/t n__
FA
f P. t o, y ben• ,in 11 matters relative to work authorized by this building permit application.
------A 9/ - #'
r wner's Name(Electronic Signature) ate
LSECTION 7b: OWNER'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
hehe best of my knowledge and understanding.
f-r 61-4 ie 14 ka_/e el„____ I i V/9
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.gov/oca information on the Construction Supervisor License can be found at www.mass.P.ovidps
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 i
Type of cooling system Enclosed_ _ _ Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
The Commonwealth of Massachusetts
►A=�_ , _ Department oflndustrialAccidents
1- 1 Congress Street,Suite 100
�'� _<' Boston, MA 02114-2017
.51t" �s.•�''� www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information PIease Print Legibly
Name (Business/Organization/IndividuaI): f-raij/C /dale
Address: 5 Litiqej, U1
City/State/Zip: 11�i'Gt eA /yf 4 U� VC Phone#: 5" —y3(�-'02.-9S 7 •
Are you an employer?Check the appropriate box: Type of project(required):
I.Q I afra employer with employees(full and/or part-time).* 7. 0 New construction
2 errarn 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. [No workers'comp. insurance required.]t
9. [1]Demolition
10 (l Building addition
4.❑I 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.❑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 13. Roof repairs
These sub-contractors have employees and have workers'comp.insurance.:
6.0 We are a corporation and its officers have exercised their right of exemption per MGL c.
14. ther &j d/)
152,§1(4),and we have no employees.(No workers'comp.insurance required.] r- f fLLI7l
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
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.
1 do hereby certify der the pain nd penalties of perjury that the information provided a ove i true and correct.
Signature: Date: / / /
Phone#: 3 ) V30 2,937
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#:
i °� z TOWN OF YAR.MOUTH
Q 4:yg yBUILDING DEPARTMENT
IENT
_� 1146 Route 28, South Yarmouth,Pv1A 02664��.-•• 5-�' 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_5,
I hereby certify'that the debris resulting from the proposed work/demolition to be
conducted at J/ or,%I ,ey L1 Wj/ai-in uJh
rk Address
Is to be disposed of at the following location: 1 199 d 4,-
Said disposal site shall be a licensed solid waste facility as defined by M.G.Q.
Chapter 111, Section 150A.
- 1,e---, fA j/
Signature of Application Date
Permit No.
® t.O w U U ma nuxua nnInweaII I aaa'..
JDivision of Professional Licensure •
Board of Building Regulations and Standards
Constr{i r4!S rvisor
CS-070914 ,spires:06/06/2021
FRANK A VI ALE
5 LYNCH LANE. f
HARWICH MA1026 . r ..
�/..1' tipi:ll„S Commissioner G.�,.c �----
t .
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
TYPE:Individual before the expiration date. If found return to:
EISilitriltilln Expiration Office of Consumer Affairs and Business Regulation
Imo= ., 04/28/2021 1000 Washington Street -Suite 710
FRANK VITALE: .: �.,s
Boston,MA 02118
a .
.
FRANK A.VITALS
5 LYNCH LN. _, i a.
HARWICH,MA 02645' Not valid Without signature
Undersecretary
g- 23- a) FLAT.'. REF:
-R- w`f /9-E 2 PLAu BOCK Zpa
PAGE 11 .1
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E`c' 4ICKERSO1J 4 BERGER, INC--RLS, 4, PE.
ORLEAIJS MASSAC1-1USEZTS
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WELL COVERS itcocKiiiirELLm
POLYCARBONATE COVERS FQR-OREMIER AND
• ELITE WINDOW WELLS
-1111111,111*/covers are durable and will prevent members --. -....--
of your family from accidentally falling into the window well. MIIIINIIIMIIIIIMMINIMWENDOVIT v!LLLS
The polycarbonate covers are effective at keeping your -. . .,,.
wells free from leaves and debris while still allowing natural } . rr^"• '• • r '15",
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sunlight to enter your basement a.,.�: i�� .�..I•
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Our dear polycarbonate coves are available for both the Elite and Premier window well series.They are 1 • i
constructed of 10 mu fluted polycarbonate material with IN kght protection.They wall hold up to 500 lbs of i(mac e.0 [�C/.i# �i rl'•!cilui. . rp" ' 7`"'" .' (,J
weight,but are not intended for continual foot traffic. "
I LAV,i to INt lliL. L.- IN-1N1.0 V I �Nl i;I()l ,RI �.i�I -
WELL GRATES .!' .
METAL GRATES FOR PREMIER AND ryw�'" '-.
ELITE WINDOW WELLS
These safety grates are disable and will prevent members ' -I 'k'
of your family from accidentally falling into the window �1 p.,;! r
well.They allow ventilation and natural light to enter your . w Tot.4,y S
basement.The grates are powder coated with an earth tone . / re r,.i„*-t ,
color that will blend into your tome%natural landscape. J
Our grates we available for both the Elite and Premier window well series.They are constructed of steel tubing e,. t"ri y.c " ..:.
and angle iron.They will hold u p to 500 lbs of weight,but are not intended for continual foot traffic. w 1.%am' , *..-
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WELL LADDER ' �• r: e`
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SAFETY LADDERS FOR PREMIER WINDOW WELLS .* : ! \ • can- ,9ti.
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These optional ladders are decorative and arable to help someone climbing out of ` ` rg.,,r".i . . a , •:• ..x..
any basement window.The ladders are powder coated with an earth tone color that A •
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will blend into your home's natural landscape.These optional ladders are to be used • - . .. ,.,,,4, .
with our Premier series only.
WARRANTY:RodtWell Widow Wells offers a five(5)year limited warranty. - - .... j.
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ROCIOArEill;
NAHB
wa�aoNfws.Ta
www.rodcwa
am
Offices:(801)375-7400 .
Provo,UT ..
Mist ht 0 2009 lied Wb4 t1[.AI Rights Reamed
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4.5
SPFAX Sompt,
RockWell,LLC
n...y Elite Window Well
0.0 66x44x60
NAM., ,� WET-664460 "3
PREMIER SERIES TRUE TEXTURE SAFETY
SIZES LOOKS AND FEELS LIKE REAL STONE
With ReckWeirs built-in
.v ITEM WIDTH PROJECTION HEIGHT WEIGHT step,you will have peace -
R k Fatally there is an alternative t0 UnMtfdUlve mind keg .s"
./'r` 663924 66 39 24 35 window welts.RockWell has duplicated in great
',, a'; detail the texture and color of real stone.These your faro. can es
663936 66 39 36 48 from your bit
aj window wells truly look and feel like real stone. in the evert of an
E-. 663948 66 39 48 69
armyeiKY•Escape steps Provide emergency escape
66 39 60 80 for families and fee and rescue personnel.
.` PREMIER SERIES FEATURES cRnv TAN
' .Safety step r _
.Available In Tan or Gray P r
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ELITE SERIES . - ______
SIZES
ITEM II WIDTH PROJECTION HEIGHT WEIGHT ; DURABILITY
.Undonable Strength That W81 Not Collapse From Badd11
►Baddll wail Soil r...__,_..., ..�_.
664484 66 44 84 123 : E 1
s, .IN Stable and Resistant to Water,Front and Extreme iamperdug. J 1
664496 66 44 96 144 }
•' .Rigid Composite Construction �''
6644102 66 44 102 154 '- .Runt and Rat Roof R"''�.— .
ELITE SERIES FEATURES SIMPLE INSTALLATION I r I ' ,
.MI4It4le Sups I.%WOOS Less Than Steel Window Wells �r r-----_.—_..,. ...�..
>Available ion Tan or Gray r No Pea Gravel or Rock Baddlil Required '^. �
.mounts to Foundation Wall
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400 SERIES TILT-WASH DOUBLE-HUNG WINDOWS WINDOWS•DOORS ma )pr-
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Table of Basic Unit Sizes Scale Vs"=1'-0"(1:96)
1'-9 5/8' 2'-1 5/8° ,2-5 5/8. 2'-7 5/8", „2'-9 5/8• 2'-11 5/8" 3'-1 5/8' 3'-5 5/8" 3'-9 5/8"
Unit Dimension .---4 - + 4 •
(549) i (651). 1 (752) • ' (803) 1 I (854) I 1 (905) I (956) (1057) • (1159)
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Rough Opening (562) (664) 1 (765) (816) (867) (917) (968) (1070) (1172)
Unobstructed Glass . • i 15" 1 19" • 23' • 25' • 27' i 29' • 31" 35" i • 39"
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