HomeMy WebLinkAboutBld-20-000996 1 4/4 4.••e 49/5
ONE & TWO FAMILY ONLY- BUILDING PERMIT
Town of Yarmouth Building Department : "'of r
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
This Section For Official Use 0
Building Permit Number: 4 W(Z (p .Date Applie •
%,rh 5Ar5 �/ �G .✓ % 1•1`1(')
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
/ 1.1 Property Address: / 1.2 Assessors Map_8y Parcel Numbers,z
/ 5 1 Ch i cIccOpe C4 of Y $
1.1a 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 Private 0 Zone: — Outside Flood Zoye?
Check if yes Municipal 0 On site disposal system 0
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
kc re rl m . I iiigi-er rY1 y Yzitt.ritez4.4141 3
/ Name(Print) �j City,State,ZIP )��// // y
✓ C1i,£JL4 teee, Lr .51 F'-77C L'/> �/ 1�i�91i.�4h"r'11'1�1?� (A•✓1�ie,it
No.and Street Telephone Email Addres
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 Woik2: 1
SECTION 4:ESTIMATED CONSTRUCTION COSTS.
Estimated Costs:
Item Official Use Only
(Labor and Materials)
1.Building $ a. 1. Building Permit Fee:$) S Indicate how fee is determined:
2.Electrical $ ® IIIStandard City/Town Application Fee
❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $ 0 35
,.
4.Mechanical (HVAC) $ List
5.Mechanical (Fire
Suppression) $ () Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ 0 Paid in Full *Outstanding Balance Due: fi'0
•
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted I&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
HE Company Name or HIC Registrant Name
No.and Street
Email address
City/Town,State,LIP Telephone
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: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 the best of my knowledge and understanding.
re koOCJe
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.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"
. The Commonwealth of Massachusetts
..I
I Department of Industrial Accidents
nrr11- 1 Congress Street, Suite 100
g 't�= Boston, MA 02114-2017
..5� www.mass.gov/dia
IMPWorkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
Address: ,$Y C/i(C4 Apt tAl t../
City/State/Zip: Phone #:
Are you an employer?Check the appropriate box:
Type of project(required):
1.0 I am a employer with employees(full and/or part-time).* 7. El New construction
2.0 I am a sole proprietor or partnership and have no employees working for me in 8. Ei Remodeling
a capacity.[No workers'comp.insurance required.]
3. I am a homeowner doing an work myself. [No workers'comp.insurance required.]1. 9. ❑ Demolition
4.❑I am a homeowner and will be hiring contractors to conduct all work on mYP roPrtY•
e I will 10 Building addition
ensure that all contractors either have workers'compensation insurance or are sole 11.D Electrical repairs or additions
proprietors with no employees.
12.0 Plumbing repairs or additions
5.❑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.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.ether ;C
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.
tContractors 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 certif under the pains and penalties of perjury that the information provided above is true and correct.
Signature: 4/2,.,1/4._ n - (j �,,r,,.,,,,..-1 Date:
Phone#: j LS7 -"7 7 5 -6, i 511
Official use only. Do not write in this area, to be completed by city or town official
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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#:
of*+A41t TOWN OF YARMOUTH
u BUILDING DEPARTMENT
ce.
M aA'<< p r;40 11.46 Route 28, South Yarmouth,MA 02664 508-398-2231 ext. 1261
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
DATE: // �__
JOB LOCATION: `5 4 Olt kit.'4i2.Qf �—►")
NAME STREET ADDRESS , SECTION OF TOWN
"HOMEOWNER" 4. 6(ct' V\ (J)11Pro ) Sa/"715 014
NAME HOME PHONE I, WORK PHONE
PRESENT MAILING ADDRESS s�{ (h,�`( 1-474e, lU- T et AvId 0-24e 7 3 (/
CITY OR TOWN STATE lw CODE
The current exemption for `Homeowner' was extended to include owner—occupied dwellings of one or two units
and to allow such homeowners to engage an individual for hire who does not possess a license,provided that such
homeowner shall act as supervisor. (State Building Code Section 110 R5.1.3.1)
Definition of Homeowner:
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is or is intended to
be, a one or two family attached or detached structure assessory to such use and/or farm structures. A person who
constructs more than one home in a two-year period shall not be considered a homeowner;such"homeowner"shall
submit to the building official, on a form acceptable to the building official,that he/she shall be responsible for all
such work performed under the building permit. (Section 110 R5.1.3.1)
The undersigned `homeowner' assumes responsibility for compliance with the State Building Code and other
applicable codes, by-laws,rules and regulations.
The undersigned `homeowner' certifies that he / she understands the Town of Yarmouth Building Department
minimum inspection procedures and requirements and that he / she will comply with said procedures and
requirements.
/
HOMEOWNER"S SIGNATURE a G M , !�
APPROVAL OF BUILDING OFFICIAL
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL
Ch.142. Yes No
If you have checked Eel,please indicate the type coverage by checking the appropriate box.
A liability insurance policy Other type of indemnity Bond
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter 142 of the Mass. General Laws and that my signature on this permit application waives this requirement.
Yri Ch one:
S'gnature of Owner or Owner's Agent Owner gent
h:homeownrlicexemp
d o TOWN OF YARIv1O UTH
:5►g c B T TII DING D EPAR I'IbIENT
• Y "7j = $y 1146 Route 28,South Yarmouth,I1 fA 02664
��••• 5-� 508-398-2231 ext. 1261 Fax 508-398-0836
BUILDING DEPARTMFNF
DEMOLITION DEBRIS DISPOSAL AFFIDAVIT
Pursuant to M.G.L. Chapter 40,Section 54 and 780 CMR, Chapter 1, Section 111.3,
•
I hereby certify that the debris resulting from the proposed work/demolition to be
conducted at 3 4 0 i t-.(r tellt
Work Address
Is to be disposed of at the following location: I (v.- itil
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
67LivAi . (14-} ' Wei- ,/
Y//1.--A
Signature of Application Date
Permit No.
Property Location: 54 CHICKADEE LN MAP ID:74/75/// Bldg Name: State//se:1010
Vision I11:9216 Account#9216 Bldg#: 1 of 1 Sec#: 1 of 1 Card 1 of 1 Print Date:09/01/2017 01:20
• CONSTRUCTION DETAIL . CONSTRUCTION DETAIL(CONTINUED)
Element Cd. Ch. Description Element Cd. Ch. Description
Style 03 Colonial
Model 01 Residential 22
Grade 03 Average
Stories 2 2 Stories
Occupancy 1 MIXED USE 12 WORK MUSTCONFORM TO ALL
Exterior Wall 1 25 Vinyl Siding Code Description Percentage WDK 18 "1� N RYLA REGULATIONS
Exterior Wall 2 14 Wood Shingle 1010 SINGLE FAM MDL-01 100 16 !
Roof Structure 07 Gambrel 41 4 r --'/9"
Roof Cover 03 Asph/F Gis/Cmp g
Interior Wall 1 05 Drywall/Sheet 12 FEP 12 6YARMOUTH WA41 KDEPT DATE
Interior Wall 2 COST/MARKET VALUATION 8 WD
Interior Fir 1 14 Carpet Adj.Base Rate: 89.31 16 128 5
Interior Fir 2 274,8% 39 13
Heat Fuel 03 Gas Net Other Adj: 10,000.00
Heat Type 05 Hot Water Replace Cost 284,8%
AYB 1972
AC Type 01 None C C
Total Bedrooms 04 4 Bedrooms Dep Code A FUS FUSS R C E I V E D
Total Bthrms 3 Remodel Rating 26 UUBBSM 2626 BAS 24 rvr.N.
Total Half Baths 0 Year Remodeled
Total Xtra Fixtrs Dep% 20 AUG 1/3 2019
Total Rooms Functional Obslnc D c,(C.
Bath Style External Obslnc D
Kitchen Style Cost Trend Factor 39 13 _ EALTF I DEPT.
Condition
%Complete
Overall%Cond 80
Apprais Val 227,900 :' 1 "� .
Dep%Ovr D r z
Dep Ovr Comment _ 4 s ' >
•
Misc Imp Ovr p "` 41 Misc Imp Ovr Comment .itki‘ R ._ '` '
Cost to Cure Ovr 0 - �. } y
Cost to Cure Ow Comment �► 1 ;,,.
OB-OUTBUILDING& YARD ITEMS(L)/XF-BUILDING EXTRA FEATURES(B) �.. —�
Code Description Sub Sub Descript LIB Units Unit Price Yr Gde Dp Rt Cnd %Cnd Apr Value -
STB1 STABLE L 192 13.00 1974 0 100 2,500 � �
FPL3 2 STORY CHIT B 1 2,800.00 1995 1 100 2,200 i
7
BUILDING SUB-AREA SUMMARYSECTION { '`
Code Description Living Area Gross Area ES:Area Unit Cost Undeprec. Value
BAS First Floor 1,352 1,352 1,352 89.31 120,747
FEP Porch,Enclosed,Finished 0 192 134 62.33 11,968 """" in
FUS Upper Story,Finished 1,352 1,352 1,352 89.31 120,747 � ,z:� "° "
UBM Basement,Unfinished 0 1,014 203 17.88 18,130 :.
WDK Deck,Wood 0 372 37 8.88 3,304 -
h,�
f "
TIL Gross liv/Leace Area: 2.704 4,282 3.078 284.896 .--
•
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YARMOUTH WATER DIVISION
99 BUCK ISLAND ROAD
WEST YARMOUTH, MA 02673
PH.: 508.771.7921
FAX: 508-771-7998
BUILDING PERMIT APPLICATION
DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET
f BIdg. Site Location j(fa,�,)k w Map #: Lot #:
Proposed Improvement:
Applicant: *14)--eil Wak61/(4'
Address5f CY;i\Gpf4e4 Tel. #: sc37-77j'-k/>r ate Filed: i AL
RESIDENTIAL AND / OR COMMERCIAL BUILDING
Water Department: Determines Compliance of Water Availability and or Existing Location
Engineering Department: Determines Compliance for Parking and Drainage
Conservation Commission: Determines Compliance to Wetlands Acts; i.e. If Lot(s) Border any Type of
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 Personal,
Safety, Property Protection;, i.e. Smoke Detectors, Sprinkler Systems, Etc...
14)
Signature of applicant ih
9 PP /� 1
Si
Date /
PLEASE NOTE:
COMMENTS:
Reviewed by: Water ivision Date
TOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: ( , I 9e L„.,„,_
Proposed Improvement: $X /O (4.4q1-
po
Applicant: Pare (V rp1,(Ct p Tel. No.:
Address: 51( ( , L��— Date Filed: 11,4,.;
**If you would like e-mail notification of sign off please provide e-mail address:
Owner Name:4 U./Ak�-n�
Owner Address: S" (if (4 r CQid Owner Tel. No.: 5-0d6\i 7 25- j)y
RESIDENTIAL AND/OR COMMERCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities.
Please submit three (3) copies of plans, to include:
(1.) Site Plan showing existing buildings, water line location,
and septic system location;
(2.) Floor plan labeling ALL rooms within building
(all existing and proposed) —
Note:Floor plans not required for decks, sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
REVIEWED BY: 26." DATE: 8 I i
y1
PLEASE NOTE
COMMENTS/CONDITIONS:
o ✓S-e_ G ti ryprc v-t -- f cs7 0 - -'- v_ --
',Grade: i Average ®Buildng Photo
i Stories: 12 Stories
I
Occupancy 11
Exterior Wall 1 I Vinyl Siding
I Exterior Wall 2 I Wood Shingle y
Roof Structure: `Gambrel
1 Roof Cover E Asph/F Gls/Cmp
Interior Wall 1 i1 Drywall/Sheet
1 Interior Wall 2 '
Interior Fir 1 (Carpet i
I 1 (http://images.vgsi.com/photos2/YarmouthMAPhotos/A00\03
I Interior Fir 2 ( 4 \47/27.jpg)
1 Heat Fuel I Gas 1 Building Layout
Heat Type: (Hot Water
AC Type: 1 None
t 22
1 Total Bedrooms: 14 Bedrooms 1
2
1 Total Bthrms: 13 I 'I
i iK t£
12 FEP 1 +,
Total Half Baths: {0 ,
'Total Xtra Fixtrs: t ' � trs
Total Rooms: ` ._.
Bath Style: ( 261:p1, r °r„
Kitchen Style: _'' :'' ',`$
1__
1 Building Sub-Areas(sq ft) Leaend I
i Code Description Gross Living 7. j
j Area Area I
j BAS First Floor 1,352 I 1,3521
r
I FUS Upper Story,Finished 1,352 1 1,352
FEP i Porch,Enclosed,Finished 1921 0
t
UBM I Basement,Unfinished 1,014 I 0
i WOK I Deck,Wood 3721 0
4,282 2,704
Extra Features
Extra Features Leaend
Code Desaiption Size Value Bldg*
FPL3 2 STORY CHIM 1 UNITS $2,200 1
Land
Land Use Land Line Valuation
Use Code 1010 Size(Acres) 0.47
Description SINGLE FAM MDL-01 Frontage 0
Zone Depth 0
Neighborhood 0040 Assessed Value $101,000
C.B.
•
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189 35 .\
N8126"52.'E Z
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STABLE
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LANE
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RES. ZONE "R-40" This MORTGAGE INSPECTION F plan is For FLOOD ZONE "C"
TOWN: �'FSZ Y19ji� Bank Use Only
DEED REF: ,265 — — REGISTRY OWNER: ROBFST D & GONS3V�TS 16
DATE: 7F: J6 —BUYER: EE5 C W4'RM IT KRRgNJ MCN,EIL _
PLAN REF: .2587 77 ,_ __SC ALE:1"= 30' FT.
I HEREBY CERTIFY TO BAST r c S"A VjN L BALNk r
TSHOWN ON THIS PLAN IS LOCATED ON THE AT THEGR UND BUILDINGAS �ZHOi /44. YANKEE SURVEY
SHOWN AND THAT ITS POSITION DOES ____ CONFORM CONSULTANTS
TO THE ZONING LAW SETBACK REQUIREMENTS OF THE FR ffHE 40B (SUITE 1)
TOWN OF ___YILEMQUTH AND THAT ME.32098
No.32098 � '' INDUSTRY ROAD
IT DOES NOT LIE WITHIN THE SPECIAL FLOOD HAZARD , �" ARSTONS MILLS, MA. 02648
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