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HomeMy WebLinkAboutBld-20-002014 ,..-e,,c. ' is/Fr5 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 Only Building--Permit Number: BLD-.6'7 0 c D A Date Applied Setif 5 c. Ia.-I).- iq Building Official(Print Name) Signature . Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map &Parcel Numbers 1.1 a Is this ah accepted street?yes 1 . no Map Number Parcel Nui'hber 1.3 Zoning Information: 1.4 Property Dimensions: v I ' Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) h-- 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 FIood Zone Information: 1.8 Sewage Disposal System: Public 0 Private❑ Zone: _ Outside Flood Zone? Check if yes❑ Municipal 0 On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP1 2.1 Owner'of Rec rd: i . .- -' M L.(44 a� f� r` /l ti 5- )d ivci fe l- //J e l I / A. - Q 13-4 y Name( rmt) City,State,LW cl PI;c1\ Apt )1) P Yri q.1, �` No. and Street e ephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORKZ.(check all that apply) . New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) IlY Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work': �%, j, s'fI ,4 x's7' ' Roc � � 09hn7e_ ECEIVE '1 i. 2 f 2 9 li .. _ SECTION 4:..ESTIMATED C:ONS.TRUGTIQN COSTS. . . Item - ; ''''.' Estimated Costs: .- .:- -:. _ • -.OfficialUse "OWL -• - (Labor and Materials) - . : t_n 1,. ;, �._.. 1. Building $ - 1. Building Permit:Fee:-$/ O_. Indicate how-fee:is:determmed: 2. Electrical $ -:(Standard._City/T.own Application Fee:-.-H. z:._'==:- 3. Plumbing $ O.TotalProject'Cost3-:(Item:6)�x.multiplies_._ X:'- <:.<< -2. Other Fees: $ -. = .... .. , . SAC) $ 4. Mechanical = _ 5. Mechanical (Fire . - ' r. : --:.- -_ -. _. .. ._ ._ _. Suppression) Total All:Fees , ....r._:_ .-.. .__.._.._ .. ,,:*. .� .: -. . .-. .__ -- - • 6. Total Project Cost $ Check No.-> ` Cliec&z.Amount Cash Amount, 1 UO b E O Paid m Pull Outstanding B al ail ce.Due:: li r .' SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License( L) c 3 00 J 5-'' / �Q /�H j, h C /)N �l License Number piratio Date Name of CSL Holier List CSL Type(see below) Gam, w . yirn No. and Street Type Description t4/ h j' v. 1I'T �13 Q; i^ U Unrestricted(Buildings up to 35,000 cu.ft.) /r (O R Restricted 1&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) /g,/A s Qg 12p/l� e Y /al//c9t ks I M HIC Registration Number Exp. ation Date C Company Name or HIC Registrant Name e l' 5 ( 7 No. and Stre j��4. 45 9 0 .-e_, Email address City/Town, State, Al P Telephone Afi9ji r GO 14 • SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152. g 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 ."CC‘' . X..2 P y J �r y‘. to act on my behalf,in all matters relative o work authorized by this building permit application. N� Jprr 1lp c Icgo J6 4 //of Print 0 er'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 and curate to the best of my knowledge and understanding. o� lv p A V I. A�/�/�= Jo)1 ��l O 17 Print Owner's or Authorized Agent's Name(Electrons ignature) 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 Tnformation on the Construction Supervisor License can be found at www.mass.aovldps 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 ofhalf'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 r� _ Department of Industrial Accidents 1 Congress Street, Suite 100 =IV= Boston, MA 02114-2017 �■Syy, 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): A-1;A?P,r_/ 8£4I tZ Address:lip 3 W5.1' 7 r,/-,o o—r }Hl W - City/State/Zip: W )/A/ itiSt, 0,74.73 Phone #: -_ 3C ll_ 3// Are you an employer? Check the appropriate box: Type of project(required): l.r- I am a employer with 4 employees(full and/or part-time).* 7. ❑ New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers'comp. insurance required.] 8. El Remodeling 30 I am a homeowner doing all work myself [No workers'comp. insurance required.]t 9. Demolition 4.❑ I am a homeowner and will be hiring contractors to conduct all work on myproperty. I will 10 El Building addition vt ensure that all contractors either have workers'compensation insurance or are sole 11.❑ Electrical repairs or additions proprietors with no employees. 50 I am a general contractor and I have hired the sub-contractors listed on the attached sheet 1 ❑Plumbing repairs or additions These sub-contractors have employees and have workers'comp. insurance.$ 13.❑Roof repairs 6.n We are a corporation and its officers have exercised their right of exemption per MGL c. 14.7 Other 152,§1(4),and we have no employees. [No workers'comp. insurance required.] *Any applicant that checks box 41 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: Cec/ 4 k) /h Policy It or Self-ins. Lic. #: �p �� y u e?H ;j 3 7 ki 76 Expiration Date: Votc./0 0O Job Site Address: /i p. {w Ci /State/Zi �J. /// �, Attach a copy of the workers compdnsation policy declaration page(showing the policy number expiration date). 7� 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 DI A. for insurance coverage verification. I do hereby certify u er the pains and enaltie of perjury that the information provided above is true and correct. S imature: Date: f e, /fi Phone#a 6 - 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#: • 4 f • Information and Instructions • • Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual,partnership, association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7)states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and,if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address" the applicant should write"all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 02-23-15 www.mass.gov/dia !.,7: ��4,? TOWN OF YA_RMOUTH BUILDING DEPARTMENT o . � 1146 Route 28, South Yarmouth, P r 02664 M47.;;. c 508-398-2231 ext. 1261 Fax 508-398 0836 `w'otib. o,cQ Ord �_ • 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 / (o ,5'1/ iciL/ Work ddrtss Is to be disposed of at the following location: 2/,4 o Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. / /� /Si nat re of Applicatio Date Permit No. From: Chris Kenney kenneybuilders@gmail.com Subject: licences Date: April 25,2019 at 11:10 AM 41g0 To: Larry and Fran Kenney kenbuild@comcastnet, Chris Kenney kenneybuilders@hotmail.com • 1 5 / 1/ C _ I ; t !, ..1 ./ /*I • I / / ••• t11:: na5sacnu--..t-tt; :trzictoo at RerILlat-nns ttt rxr:i-m• .*• CtiRISTOPKR T KENNEY 603W YARMOUTH RD „ ' • 'AI YARMOUTH MA 02673 ' t yz • :her •- -- . (.1/://./ierrf.e- /-:// ("4'7i-),{•///-73 ' - Office of Consumer Affairs and Business Regulation 1000 Washington Steel-Suite,710 Boston_Massachusetts 02118 iiome!morovemont Contractor Registration T.ype. Cr.,r7..oretinr: rzgist-31.; 1512..6 L<FNNi Y BUILDERS NC. Ex11ton: e3'162021 WEST YARMCLiT:-i -Ni-B YARMaUTI MA U2(17::: Update Addrees and Return C . • c. Ztke c Ccnmn =airs 3,Cosmic"-,Roduteeen ACME IMPROVEMENT CONTRACTOR Roststr-aion toad tor trutividualtsortzy YPE CuttXreem before the expiration date. troi.xxi return to: F_Le_gt§:tratio_a fgpLrqtiou Office cf or&turier Affaire end Etmnass RegulAtion 13•,256 01,1d?7.1 1COn W=hinOtOtt Shaw-Suite 71C NNCYUtif:r);RSil . Bosion,MA 02118 _ c;HRISTC1.PI- '?Ki7LINNEY gra V.T.ST YArdIaliTt:I40,10 vie.rva+s3rt. To: Page 2 of 2 2018-09-20 03:41:09 GMT+14 18668b6131b From: IncomingrAAt.O incoriui yrrinc.a • AC EP CERTIFICATE OF LIABILITY INSURANCE DATDIYYYY' 09/19/2/19/2018 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 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 rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER Name Daniel Bemblum COCHRANE& PORTER INSURANCE AGENCY IAJC Nq>EsD: (781)943-1553 FX (AAtc.No1: Amens: daniel.bernblum©D renaissanceins.com 981 WORCESTER ST INSURER(S)AFFORDING COVERAGE NAIC S WELLESLEY MA 02482 INSURERA: AMERICAN ZURICH INSURANCE COMPANY 40142 INSURED INSURER B: KENNEY BUILDERS INC INSURER C: INSURER D 603 WEST YARMOUTH ROAD INSURERE: WEST YARMOUTH MA 02673 INSURER F: COVERAGES CERTIFICATE NUMBER: 316031 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY 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. INSRLT TYPE OF INSURANCE INSO A D POLICY NUMBER (IAVDDOIYYYYY) (MMIDDIYYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S DAMAGE TO ENTED I CLAIMS-MADE n OCCUR PREMISES(Ea ococaurence) S MED EXP(Any one person) S � N/A PERSONAL 8 ACV INJURY S GENL AGGREGATE UMITAPPLIESPER: GENERAL AGGREGATE S POLICY❑JE- n LOC PRODUCTS-COMPIOP AGG S OTHER: S AUTOMOBLJE UABLJTY COMBINED SINGLE LIMIT S (Ea accident) ANY AUTO BODILY INJURY(Per person) S ALL OWNED —SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per aarJderd) S _ NON-OWNED PROPERTY DAMAGE HIRED AUTOS _ AUTOS (Peraccidernt S UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS UAB CLAIMS MADE N/A AGGREGATE S DED RETENTION S S WORKERS COMPENSATION X STATUTER� ER AND EMPLOYERS'U ABILITY A ANVP R PRicTO REXC UDEDEXECUT� n WA NIA E.L.EACH ACCIDENT S 500.000 6ZZUB8H33747618 09/25/2018 09/25/204..4 (Mandatory in NH) EL.DISEASE-EA EMPLOYEE S 500.000 �SC desathe under DER ON OF OPERATIONS belay EL.DIEASE-POLICY LIMIT S 600.000 N/A DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES(ACORD 101.AM:Morel Remarks Schedule,may be attached name space is required) workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B.no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hives,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www-mass.govliwd/workers-compensationlinvestigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Yarmouth ACCORDANCE WITH THE POLICY PROVISIONS. 1146 Route 28 AUTHORIZED REPRESENTATIVE South Yarmouth MA 02664 1. Daniel M.Cry,CPCU.Vice President-Residual Market-WCRIBMA 81988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD of=Y4A. TOWN OF YARMOUTH 5, c HEALTH DEPARTMENT RECEIVED Y,,- nT 102 ,:i4;! " PERMIT APPLICATION SIGN OFF TRANSMIT i AL S EET'�'' ' HEALTH DEPT ' To be completed by Applicant: Building Site Location: / 4, s fdp pv". 6 , ,t Propo ed Improvement: ` Al S ® ti P� 0 . ---- 3aH Cu2REU 1ZOU6 ff j t�)I C.C_ Pl1J t EH G- CAL �" N her- CC.Z1SEr) Applicant: riV hc'1 r3z) a5^ / C , Tel. No. a$,-36V 3/I Address:6 C� vo- (VAIN [�ZQ Date Filed/chi/ **If you would like e-mail notification of sign off please provide e-mail address: � � 1 / Owner Name: i. ,r►y A9 it_ R iq A JfOy /0 �0t Owner Address: 9' r /A c I A 4 ,.) -R.-- Ska• t- Owner Tel. No.: $/- ,"? 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: t-" DATE: /obj 7\"--fK PLEASE NOTE COMMENTS/CONDITIQIyS:utove- 10 t(41/4) Ftr-c,„,,‘ 3 ^� n e c v o � 1.4e-44-' t'4o e S c 1 ./4-4 ) -).0 -o ( = 413e�v1:30,,,.. c k FP.. M1: y rz t '2 9 » > < .w » \� m: . .�Ev.. . < . \ \ \ 7 „ • -� - . \ \k < « \ \ . � \ \ ~ : � � . . . .. .„ .�\ \ „.„�ƒ ^ . Ok , . .�. • 1 • \ . . > y •• \ \ 2 \% • � © © gy ,A;.......... 7 ei 62 ?.. Closet Pantry •-1- Closet Master * * Half Bathroom Bathroo Kitchen Garage Landry CA r. Master0 Living Room , I INT7 - Bedrom INs-- Den Loi . I Sunroom -1Cil41N OF YTTH REVIrlNED F07'll"I.r.'IN': AND;•.:•:!'N.II , CCI')E CI :IPLI- ANCE, ERPCI'1,;_. „ . . :i2SI'I'd PO NO RFLIEIVI:._THE AITLIC1,,I.J FROM THE 1:1a.ir101V-.IBILI 1 1 OF'AS BUILT" COMPLIANCE. DATE:/0 -/ BUILDING OFFICIAL L„;„ o i 6,Li.,„„ .•._...4 c,'..„),'•:.:1 f ____ , 2nd Floor N . Open • To Below 11 Closet Cl—- 10 Ro . to be Finished ›N, L______ -V* Full Bathroom 2 \J l „ . i , •• • A etc/1mA,, co Closet . 1 Closet ....._ i--• •ci /-- . c Closet Bedroom 2 Sitting Room .. il i Bedro e 25 -3" = --: f 1 3' 7- " I 3-9"