HomeMy WebLinkAboutBld-20-002365 a- ,ft•t.e.e to Azfli
ONE & TWO FAMILY ONLY- BUILDING PERMIT
Town of Yarmouth Building Department ;• "of '�
1146 Route 28, South Yarmouth,MA 02664-4492
508-398-2231 ext. 1261 Fax 508-398-0836 ;i'
Massachusetts State Building Code,780 CMR
Building Permit Application To Construct, Repair, Renovate Or Demolish /
a One-or Two-Family Dwelling �. : y___- j
This Section For Official Use Only ' .- Y"(T
Building Permit Numb - 30 'OP of Anp,S1 Date Applied: f i O C T , :f j
,DzAo�dvii-ey v/ 4 , B LDINv u DA , r
Building Official(PriOName) Signature s. '
SECTION 1:SITE INFORMATION
1.1 Propsty Address: 1.2 Assessors Map&Parcel Numbers
I us 7 L. --
1.1 a Is this an accepted street?yes no Map Number Parcel Number
1
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 ID _Zone: Outside Flood Zone? Municipal 0 On site disposal system ❑
Check if yesO
SECTION 2: PROPERTY OWNERSHIP'
2.1 wner'of$�ord:
10 ar) rereio, g k-,,,,,a -fi l t- / AA el
Name(Print) City,State,ZIP
No.and Street J 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) ❑ Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: .-___,_ ---- _.
Brief Description of Proposed Work2: (? r 14 4-r- :�. r ' r" ,
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
Official Use Only ---"-
(Labor and Materials)
1.Building $ 1. Building Permit Fee:$ / ndicate how fee is determined:
2.Electrical $ 0 Standard City/Town Application Fee
0 Total Project Costa jtem )x multiplier . x
3.Plumbing $ 2. Other Fees: $ J d
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire
Suppression) $ Total All Fees:$
� Check No. Check Amount: Cash Amount:
./6.Total Project Cost: $ /�D Ott ❑Paid in Full 0 Outstanding Balance Due: /
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
�)�1(GioIn \ /07Yu7 r
\ License Number E pirati n Date
Name of CSL Holder
( 7 q C Ci'y List CSL Type(see below) LA
No.and Street i \ ( � Type Description
4,404�.,,,^ l� �/� /r� U Unrestricted(Buildings up to 35,000 Cu. ft.)
J ,'"S l ii r iv`4 tD41(,L �C R Restricted I&2 Family Dwelling
City/Town,State,ZIP M Masonry
✓ RC Roofing Covering
WS Window and Siding
I SF Solid Fuel Burning Appliances
c(70 -3(, -(r` 3) d!1�A-►� to /��Q ! I Insulation
Telephone Email address J D Demolition
5.2 Registered Home Improvement Contractor(HIC)
44
„„14-04l 501V)--Zi �/Dt HtCRefration Number xpir ion Date
HIC Co�mpanName or HI �stranamen
No.and Str et v� Email address
�/ s nil IS / aa��c¢
tty/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
to act on my behalf, in all matters relative to work authorized by this building permit application.
� ran ?CrQr(-1 ,Dprit9
✓ Print Owner's Name(Electronic Signature) r Date
• SECTION 7b: OWNER1 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.
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/:ot 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.2ov/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
•
szr �
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 Please Print Legibly
Name (Business/Organization/Individual): f V 3-13 (9A.S \-k-k-r-
Address: C,2' b- I�—►� .
Cit /State/Zi
Y P: .0)1,1. j AA-1k K M Phone #: g8 2 3 ,d 61 3
Are you an employer?Check the appropriate box:
Type of project(required):
I. I am a employer with employees(full and/or part-time).*
7. Q New construction
2C2cam a sole proprietor or partnership and have no employees working for me in
ca aci 8. Q Remodeling
any
p ty. [No workers'comp.insurance required.]
3.Q I am a homeowner doing all work myself. [No workers'comp. insurance required.]t 9. Demolition
4.Q
I am a homeowner and will be hiring contractors to conduct all work on myproperty. I will 10 Q Building addition
ensure that all contractors either have workers'compensation insurance or are sole 11.Q 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.
These sub-contractors have employees and have workers'comp. insurance.t 13.El Roof repairs
6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.0 Other
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.
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$250.00 a
day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify z er ai nd penalties of perjury that the information provided above is true and correct.
Si nature: �. Date: /0 d7
Phone#: 5q-Id a -6/ jo)
Official use only. Do not write in this area, to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone#:
TOWN OF YARMOUTH
o y BUILDING DEPARTMENT
• T ` 1146 Route 28, South Yarmouth,MA 02664
tea..•► 5 508-398-2231 ext. 1261 Fax 508-398-0836
• BUILDING DEPARTMENT
DEMOLITION DEBRIS DISPOSAL AFFIDAVIT
Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.3,
I hereby certify that the debris resulting from the proposed work/demolition to be
conducted at a 5' ('av--s bef7- /4
Work Address
Is to be disposed of at the following location: a.!-i-t.c,- -Ir4A5 Ftr
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 11 I, Sect' 150A.
/92 0?
Si a of Application Date
Permit No.
CY2e Vammonweald o/CitadJaelwella J- n
Office of Consumer Affairs it Business Reguleon EV ?
HOME IMPROVEMENT CONTRACTOR
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TYPE:Individual
• I anintrithiii, Expiration or''"
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179410 ' 07/27/2020 . a
NATHAN BAILEY a
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NATHAN BAILEY 5 JONES RD 6/2-c-c.(2.1.--
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MARSTONS MILLS,MA 02648
Undersecretary
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NIB Construction
5 Jones RD. Marston Mils,Ma 02648
508-360-6132,njbtede gmail oom
CUBIT: PROPOSAL
Joar.Perera Quotation QT1156
1$Sbawbery in. Date 08/OB/2019
Yarmouthport, MA
. as Ref.
arst Ref.
Terms
Description
Qtll Unit Price Amount
Davnstairs walk in shower project
-Remove eking tub)aid shower Se(save shower head)
-install new shower floor pan and drain
-Prep orals for de with omele board- .
-Frame ai wall niche and bends
-Apply isle floor and walls
-instal shelving in doses/paht $6,000.00
-Allowance for the —
Half Bath Project
-Remove shelving in proposed half bath area
- Remove eidstkig sink
ti -Build wall sting pantry,drywall,mud and paint both sides
-Install toilet,run new drain pipe
Instal vanity and necessary plumbing •
- Install vaiiy kit and aeiing light/fan
-Frame and instal new 28"solid wood 6 panel door/paint
-Pabst walls,ceiling and window
-Install new flooring(hoary vinyl plank)recommended $10,000.00
-Allowance for vary,toilet,vanity light,flooring :: $2,000.00
Remarks ,, ` T $18,800.00
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