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Home My WebLink AboutBld-20-001826 f ..,1".‘t.t,t, • /19/1// ) ONE & TWO FAMILY ONLY-BUILDING PERMIT Town of Yarmouth Building Department 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 Only Building Permit Number:23.C.D'2•6 Vip 4 •Date Applie • • Or' SIZA rS J... - . \O=7 l5 Building Official(PrintName) ign Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 1.1 a Is this an accepted street?yes it no Map Number Parcel Number J 1.3 Zoning Information: 1.4 Property Dimensions: •' Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) fi O ' Front Yard Side Yards Rear Yard c ,z., Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§S4) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public CI Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system ❑ Check if yes❑ - SECTION 2: PROPERTY OWNERSIBTP1 " 2.1 Owner'of R�cord: ' rNi. Name(Print) ( �'jC�ityy State,ZIP U % No.and Street Telephone Email Address SECTION.3:. DESCRIPTION OF PROPOSE)WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition ❑ Demolition 0 Accessory Bldg.0 Number of Units Other ❑ Specify: , Brief Description of Proposed Work2: kx..v e.-t-e., �,i rr v, c t�,...�-h-s r,RS SECTION:4:ESTIMATED CONSTRUCTION"COSTS. . - . Item Estimated Costs: - s -. (Labor and Materials) . ' Oficial'Use Only 1.Building $ CA b :1. Building Peiinit'Fee:$:1.O.. ti Indicate how fee is determined 2.Electrical $ B b- ❑.Standard CityfTQ Applicationa ee: ` : " .:" ','• �() ❑.Total Project Cost?•,,(It 6).x multiplier - x 3.Plumbing $ 2. Other Fees: $ 3�' 4.Mechanical (HVAC) $ List " 5.Mechanical (Fire Suppression) $ Total All Fees: 6.Total Project Cost $ b l3& CheckNO.. Check Amount Cash Amount: - l i. C1•P4/d prFun: • 0 Outstanding Balance Due: 11 C UL1 1 . iH . fey 411547) . `•. - SECTION 5:.CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CV)c p er i Lv `p� o,iA— y License Number Expiration Date Name of CSL Holder List CSL Type(see below) 'Zl No,aptreet T Description _ f ar Unrestricted(Buildings up to 35,000 Cu.ft.) �'+� �"'��` d�p�3 Restricted 1&2 Family Dwelling CireTown,State,ZIP i M Masonry RC Roofing Covering WS Window and Siding )1% �� t�1 SF Solid Fuel Burning Appliances J a.,p� & �A I Insulation Telephone Email address ((JJ D Demolition 5.2 Registered Home Movement Contractor(HIC) `,sp,Z,\ i f NJ' �11 6 HIC Registration Number '"Expiraon Date HI omp Name or HI gistrant Name No.and Street l'1 Email address City/Town,State,ZIP 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 0 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 1 D d'� C( u 0.4 C'"' to act ono ki behalf ' al matters relative to work authorized by this building permit application. gill') 1 11 Print Owner's Nam (Electronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering a below,I hereby attest under the pains and penalties of perjury that all of the information contain is true z ate to the best of my knowledge and understanding. 'A VIA A • 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.gov/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 1!, — '/ Department oflndustrialAccidents "" 1 Congress Street,Suite 100 �^ = El Boston,MA 02114-2017 r 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)7, Can' Address: City/State/Zip: V1 ram Phone#:St VS(01—406. 1\S� Are you an employer?Check the appropriate box: Type of project(required): I)tam a employer with tel/ employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. 'emodeling any capacity.[No workers'comp.insurance required.] 3.0I am a homeowner doingall work 9. ❑Demolition myself.(No workers'comp.insurance required.] 4.CI am a homeowner and will be hiring contractors to conduct all work on mY property. I will10 El Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑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 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.El Other 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.Lie.#: WC�, Sb 56 k1t t 1 @ Expiration Date: (1, I""lq Job Site Address: p � t;� �,y ,e,,s,� City/StateJZip::► ct'1rvYt , l 1kA Attach a copy of the workers' com ensa n policydeclaration page(sho wing( wing 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 c er the pains and penalties of perjury that the information provided boy is true and correct. S' nature. 2 Date: 1 Phone#: g cad 2 "-Ct s1 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 5.Other Contact Person: Phone#: TOWN OF YARMO UTH • :,,,y c BUILDING D EPARTMENT ' • o• .""-i , 1146 Route 28,South Yarmouth,MA 02664 s'?' 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 1113, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at (AVM Work Address Is to be disposed of at the following location: Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapt j 1 I I, Section 150A. 1 /1? Signature of A pg licatio `S n Date Permit No. 77 . Commonwealth of Massachusetts lif Division of Professional Licensure Board of Building Regulations and Standards Constrl $rvisor CS-075281 : '' '4t Wires:03/12/2021 ' r 4: TODD J CANTARA 10 ECHO RD WEST YAM/10 AAA 'I' ` Commissioner F-------._ ieceommoouaea a� adaadaletGtfice of Consumer Maim& RegulationHOME IMPROVEMENT CONTRACTOR TYPE,;Individual Btlai>�,. 100t1V:Niii, 04100I2020 TODD CANT w - ' ON3 DB!A CANT , ,« y: i TODD CANTARA' ' 10 ECHO RD. W.YARMOUTH,MA o , .. UndefBeCre y a Registration valid for individual use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation. One Ashburton Plana Suite 1301 Boston,MA 02108 1,. Cl."--(; , . Not yaiid'without signature 195" B18LHDS 39" - 18" ,' ---30"- - 21" 39" 24" 24" W3012 --- 111;,, — 322„ — —51<" BD21-4D 72' — — — —552„-- -- --672„-_ SB39 ,, B3OBHDS —39" — 18"— —3 21" 3 " 12„1� 30 8 9 • mIV '1 W1830L W2130R �jl W2430R WA2430R - ��,-_-'. II �h . �_ RANGE1:30 c 12RRH �� W 1 0 45 tAA-16c1k 1 R3:P 0 .A N N 11 W W - ( O O TOWNYi',!7,Ti:GUTH REVIEWED FCC DI II_CINC ANC:0y,I,,;CODE COMPLI- ANCE. ERRORS uk '....,SSIONS DO NOT RELIEVE THE APPLICANT FROM THE RESPONSIBILI j Y OF"AS BUILT" COMPLIANCE. DATE:1_( - - 41 BUiLDING`6F CIAL N a. _. :' 9„ 4„ REF.30 I I -1 4 r—{5a �44P:' _ s W2436B 1236R W2436B x tr.,"3�M w r^7. :'..t b., r, .ti Y?, r„ ,c�H" :i r,ip:;: °'5C::"^rk L24J12OH 24"--- --3 '— - 79z„ 16z„ ——96" _. - All dimensions_size designations This is an original design and must Designed: 9/5/2019 given are subject to verification on not be released or copied unless Printed: 9/6/2019 job site and adjustment to fit job 2020 applicable fee has been paid or job conditions. order placed. Mike Grella-Merillat Cabinets.kit All Drawing#: 1 No Scale.