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HomeMy WebLinkAboutBld-20-1369 gin 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 �: 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 Onl Building Permit Number:AP— iO —Oa 15� .Date Applied: 1 1c5 Building Official(Print Name) Signatiue', Date SECTION 1:SITE INFORMATION. . 1.1 Property Address: 1.2 Assessors M yarcel Numbers 121 (DC eavi ON R. .Yan r tt) 4 c bt 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(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 dd/rS Private❑ Zone: _ Outside Flood Zon;3 Municipal❑ On site disposal system I9.'. Check if yes SECTION 2: PROPERTY OWNERSHIPI - 2 weer'of Recor ` ' )c n i %e cie r► a s S-� , YOw-&-k-L, , wr v-1 Name(Print) City,State,ZIP 12 vice 4 V, PkV4 Co 17. 92 . 3']' 7 ` ico-► s sct yige . <4- )-1. No.and Street Telephone Email Address F•• _ -I Neu. it /�/ SECTION 3:;DESCRIPTION OF PROPOSED WORKZ(check.ail'that apply) �_, New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s),C Alteration(s) 0 AdditionliF ``,i',l Demolition ❑ Accessory Bldg.0 Number of Units Other 0 Specify: Brief Description of Proposed Work: `.. V%�JJ o f vt q S C71��� e terS_ I . SECTION:4i ESTIMATED CONSTRUCTION COSTS. ##f V Estimated Costs: d i . • Item •(Labor and Materials) Official Use OIy _._ 1.Building $ g p 0 O :1.:Building Permit Fee;$t�) indicate howl fee its): d ; mned�� 01 U $ ❑Standard City/Town Application Fee; �C:C 2.Electrical J L. ❑TotalProjeat Cos?(Item 6).x multiplier ctir- 3.Plumbing $ 2, OtherFees: $"3 S ; 4.Mechanical (HVAC) $ ... 5.Mechanical (Fire :. Suppression) $ Total All Fees:$ O a CheckN6,, Check Amount: Cash Amount: 6.Total Project Cost: $ S fl' 0 Paid m Full ❑Outstanding BstlPuce Due: 11 — SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisors License(CSL) C 5- O �3({ O f 3/lo?O.Z O oe r T W •`fie v%n 1 S 3I License Number Expiration Date Name of CSL Holder ja c3*i Q Si- List CSL Type(see below) • No.and Street S T e Description crew , ,. Unrestricted(Buildings up to 35,000 cu.ft.) City/To R Restricted 1&2 Family Dwelling M Masonry jd •3 2(a •Pk R. RC Roofing Covering WS Window and Siding l SF Solid Fuel Burning Appliances P"-'1 'n` ;y Jar' �`"' 04TWIC Ci 14 IB+ I Insulation Telephone Email address D Demolition 5.2 Registered Home Im rovement Contractor(HIC) t ;..12- O lae`zo Z to k-a C►w1l►S HIC C rp Naame s C Registrant Name HIC Registration Number Expiration Date 5 1l v1r%d P ST Q.W a eon t S 1r-@ Cil Ca. vi e� No1Z- ye i-` Q e Q 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 )i No 0 • SECTION 7a:OWNER AUTHORIZATION TO BE COMPLE I'ED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT .. ` I,as Owner of the subject property,hereby authorize �0 be 4- r1 rt► S 0 r". to act on my behalf,in all matters relative to work authorized by this building permit application.r�c.. )�e�eb-man loe1 1l'?-ol 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. e, Det.4 S.F.-A 1 2-01 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 Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia • Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Name(Business/organizational/individual): ROBERT W DENNIS JR d/b/a/HOME STRUCTURAL SPECIALISTS Address: P 0 BOX 534 City: EAST BRIDGEWATER State: MA Zip: 02333 Phone ss: 506-326-2464 Are you an employer?Check the appropriate box: Type of project(required): Ell. I am an employer with 2-3 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 any ❑8. Remodeling capacity.[No workers'comp.insurance required.] El9. Demolition ❑3. I am a homeowner doing all work myself.[No workers'comp.insurance required]t ❑10. Building addition ❑4. I am a homeowner and will be hiring contractors to conduct all work on my property. Ell. Electrical repairs or additions I will ensure that all contractors either have workers'compensation insurance or are sole proprietors with no employees. ❑12. Plumbing repairs or additions ElS. I am a general contractor and I have hired the sub-contractors listed on the attached E13. Roof Repairs sheet. 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. E114. Other c.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. tHomeowners 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 attach an additional sheet showing the name of the sub-contractors and state whether or not those entitles 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: LIBERTY MUTUAL INS. CO Policy#or Self-ins.Lic.#: WC2-31 S-621333-019 Expiration Date: MAY 31, 2020 Job Site Address: k Cr.X..eCtivt S . (1'0•A YV% A 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 under the pains and penalties of perjury that the information provided above is true and correct,and that clicking this checkbox and typing my name in the Id below will act as my signature. C^ �7 Name: \�.c� t-T �� Q(in'S 1' Date: call+• I Z 2tl(Cj Phone#: 508-326-2464 Email: RWDENNISJR@COMCAST.NET AR DATE(MMIDD/YYYY)CERTIFICATE OF LIABILITY INSURANCE 09ro3/2019 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). PRODUCER NAME CT Suzanne Duffney MCSWEENEY AND RICCI INS AGENCY INC (NC.No.Ext: (781)848-8600 FAX (A/C,No): E-MAIL ADDRESS: sduffney@mcaweeneyricci.com PO BOX 850984 INSURER(S)AFFORDING COVE RAGE NAICS BRAINTREE MA 02185 INSURER A: LIBERTY MUTUAL FIRE INS CO 23035 INSURED INSURER B ROBERT W DENNIS JR& DONALD A ATKINSON INSURERC: DBA HOME STRUCTURAL SPECIALISTS INSURERD: PO BOX 534 INSURER E: EAST BRIDGEWATER MA 02333 INSURER F: COVERAGES CERTIFICATE NUMBER: 443773 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY 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. INSR TYPE OF INSURANCE ADM SUBR POLICY EFF POLICY EXP OMITS LTR INSD WVD, POUCY NUMBER (MM/DD/YYYY) (MMIDD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS MADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JET LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABIUTY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X PER ERO AND EMPLOYERS'LIABILITY Y I N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 A OFFICER/MEMBEREXCLUDED? N/A N/A N/A WC231S621333019 05/31/2019 05/31/2020 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more 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 hires,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.govAwd/workers-compensation/investigations/. No partners have elected coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Donna Biederman ACCORDANCE WITH THE POLICY PROVISIONS. 121 Ocean Ave AUTHORIZED REPRESENTATIVE So Yarmouth MA 02664 DanieleI M..C Cr y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD • TOWN OF YARMOUTH c BUILDING DEPARTMENT i c 114.6 Route 28,South Yarmouth,MA 02664 °+ %\�►—� 5=� 508-398-2231 ext. 1261 Fax 508-398-0836 BI DING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 40,Section 54 and 780 CMR, Chapter I,Section 1113, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at I2\ Ct•ea..,‘ p, Work Address Is to be disposed of at the following location: ..iwnQs4'2 - ` ucc J Sp ;c9 a s— fist NT Sal,•I4:4v ✓1W Said disposal site shall be a licensed solid waste facility as defined by Nq,G L Chapter 111, Section 150A. Signature of Application 2 )i Date Permit No. Commonwealth of Massachusetts 11, Division of Professional Licensure Board of Building Regulations and Standards ConstruCtoti tSpervisor CS-018348 expires:08/31/2021 ROBERT W DENNIS ; ,; 524 BRIDGE ST PO : It. ' EAST BRIDGEWATER' 2333 s - �tPa 1()r1. i I )'` Commissioner A,/, '..�/r --- 1 .7iP 6r9zinoiu«44)(of t9o4sar/ii{s.-.40 Office of Consumer Affairs&Business Regulation f HOME IMPROVEMENT CONTRACTOR TYPE:Individual Registrtition Expiration a 11823 - 02/20/2021 ROBERT W.DENIJIS;J6 D/B/A HOME STRUCTURAL.SPECIALISTS • ROBERT W.DENNIS Jai C 524 BRIDGE ST. C EAST BRIDGEWATER,MA 02333 Undersecretary DIVISION OF I°RCFIE.SSICNAt . £:.• ENSURE PO SOX*Pt _ I`. E 1.- 1334 '#; ' Robert W. Dennis Jr. Registered Structural Engineer Don Atkinson dba/ Home Structural Specialists P.O. Box 534 East Bridgewater, MA 02333 508-326-2464 rwdennisirAcomcast.net www.homestructuralspecialists.com Proposal Structural Work 121 Ocean Ave. So Yarmouth, Ma August 16, 2019 We propose to provide engineering design, obtain building permit, and provide labor and material to perform structural work at a property located at 121 Ocean Ave. So. Yarmouth, Ma. Work generally will consist of the following: 1. Cut access holes in subfloor to gain access to crawl space. 2. Install 7 new 2 ft. x 2 ft. x 1 ft. reinforced concrete footings 3. Jack main beam as required to help level floor 4. Install 7 new block piers 5. Replace subfloor 6. Cleanup Estimated time 4-5 days Cost$8800 Deposit when sign contract$800 Deposit when work begins $3500 Payment when work complete $4000 Payment after final inspection $500 All work will be done in a professional manner to the complete satisfaction of the owner. Owner is responsible for removal of debris. We will remove debris for an additional charge of$250. When work is complete, owner agrees to contact the local building inspector for a final inspection at (508-398-2231 ext 1261). This is necessary because the inspector requires that someone is home when they come for the inspection. Please call if you have any questions. Bob Dennis 508-326-2464 Don Atkinson 781-724-4257 Please sign the contract, and return it with the deposit payable to Home Structural Specialists, P.O. Box 534, East Bridgewater, MA 02333. Upon receipt, we will proceed with obtaining a permit and schedule the work. CONTRACT Contractor Home Structural Specialists Owner /(47 i,r.r Vil "1,)jQ /S/060 MA) Sig ature Print Owner Signature Print Date -1-2>� (7 15d ph- 1 j1 m • 1 -1:ns l l `1 t•le.-,3 2'R. 5 2-F-t. x ► 4. s 1e4-s s Q.Ari.a, C�QIa•�� _ �Pac.r�� f TOWN OF YARMOUTH REVIEWED FOP fILDING AND ZONING CODE COMPLI- `' �'t Dy ANCE. ERRORS or(C.,,;,�ISSIONS DO NOT RELIEVE THE Y ti�iL < I Y APPLICANT FROM THE RESPONSIBILI1Y 0 ' S BUILT' COMPLIANCE, IA DATE: _1 "l d -19 BUILDING OFFI L • ,,\ 1C OF sq Robert W. Dennis Jr 121 cicr k.k. oaf R��� BNIS JR. cN� Registered Structural Engineer Sd. �AeVit 0; s 'UCTURAL ; : P.O. Box 534 No. 13834 1596'Gis ‘° East Bridgewater, MA `6 /ONAL E#'' 508-326-2464