HomeMy WebLinkAboutBLD-20-1113 p t
ONE & TWO FAMILY ONLY- BUILDING PERMIT
Town of Yarmouth Building Department "o '''r
1146 Route 28, South Yarmouth,MA 02664-4492
508-398-2231 ext. 1261 Fax 508-398-0836 �'
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Massachusetts State Building Code, 780 CMR
Building Permit Application To Construct, Repair, Renovate Or Demolish
a One-or Two-Family Dwelling
44hhis Section For Official Use Only
Building Permit Number:Pal0 ""« Date Applied:
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
Property Address:, 1.2 Assessors Map&Parcel Numbers
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1.l 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 0 Private 0 Zone: Outside Flood Zone?
_ Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1_owner'of Record: /5 /4 � �j, _G
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Name(Print) City,State,ZIP
fA-rA v,.✓n r�.�- /� ^3�-l-V(4/ r�r, •��eve/zcZe,
No.and Street Telephone Email Address
SECTION 3:.DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction❑ 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 Work2:
73/4),_4 _ o
SECTION 4 ESTIMATED CONSTRUCTION COSTS.
Estimated Costs:
Item Official Use Only
(Labor and Materials)
1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined:
0 Standard City/Town Application Fee
2.Electrical $
0 Total Project Cost3(Item 6)x multiplier x_
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $
List
5.Mechanical (Fire $ Total All Fees:$
Suppression)
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ �i OTT 0 Paid in Full 0 Outstanding Balance Due:
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SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) C
License Number 7 Expiratio ate
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
HIC 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 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.
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.
/ ,4 c/� �.�.n g/3 9
en Print Owner's or Authorized A Name(Electronic Signature) ate
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.2ov/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
?:41.41kirm....
Department oflndustrialAccidents
1 Congress Street, Suite 100
�1f Boston,MA 02114-2017
"•�'•� • www.mass.gov/dia
I.
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
Address:
City/State/Zip:tY P• Phone #:
Are you an employer?Check the appropriate box:
Type of project(required):
1.0 lam a employer with 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 8. El Remodeling .
any capacity.[No workers'comp.insurance required.]
3.0 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 my roe I will 10 111 Building addition
ensure that all contractors either have workers'compensation insurance or are sole 11.0 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.* 13.0 Roof repairs
6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14. 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.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.
1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
tS��ignature: Date:
l'tone#:
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#:
oA��E TOWN OF YAI2MOUTH
o . u BUILDING DEPARTMENT
_
v. M. .r. c 4-4 1146 Route 28, South Yarmouth,MA 02664 508-398-2231 ext. 1261
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
DATE:
JOB LOCATION: / 7.4-/ G✓/./ C,/, ,� S Y� 7
N� � " STREET ADDRESS SECTION OF TOWN
"HOMEOWNER" 4/14- /1� o "r7e--e �oY-3 4 I- 9' 6
NAME HOME PHONE WORK PHONE
RESENT MAILING DRESS 6' g oX' 5'/4
/emu , oZ G 4
CITY OR TOWN STA'l'E liP 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 / e will comply with said procedures and
requirements.
HOMEOWNER"S SIGNA
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 yes,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.
Check one:
Signature of Owner or Owner's Agent Owner Agent
h:homeownrlicexemp
y y o TOWN OF YARIV1OUTH
:yg c B TJII,DING DEPARTMENT
• ti, t = `2' 1146 Route 28, South Yarmouth,MA 02664
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..5,
I hereby certify that the debris resulting from the proposed work/demolition to be
conducted at)c / 647. c,/// /'L
Work Address
Is to be disposed of at the following location: . � 'Q
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
1/3° /Signature of Application Date
Permit No.
QI.T'CLAIM DEE 'I
We, Nicholas J. Vetrano and Angela Vetrano, as Husband and Wife of Mamaroneck,
Westchester County, New York
For consideration paid and in full consideration of Two Hundred Ten Thousand 00/100
Dollars ($210,000.00) GRANT TO
Mark S. Denommee and Jennifer A. Denommee, as Husband and Wife,Tenants by
gthe Entirety, now of P.O. Box 916, South Yarmouth,Massachusetts 02664,
With QUITCLAIM COVENANTS
'o.
The land situated in Yarmouth (South), Barnstable County, Massachusetts being shown
c as Lot 25 on a plan of Land entitled "Oyster Cove on Bass River; subdivider and owner,
Oyster Cove Investment Trust, P.O. Box 1288, Dennisport, Massachusetts 02639, dated
January 12, 1987 drawn by Lydell-Byster Mechanical Services, Inc., 95 Whiting Street,
Hingham, Massachusetts 02043;" and being duly recorded at Barnstable County
Registry of Deeds in Plan Book 435, Pages 85, 86, and 87.
No portion of the fee in Cove View Drive or Fair Wind Circle is hereby conveyed. The
43 above-described premises are conveyed together with a right of way over Cove View
Drive and Fair Wind Circle as shown on said Plan, to be used in common with others
now or hereafter legally entitled thereto. Reserving to the Grantor the right to grant to
a all others, including those not owning property in this subdivision, the right of way
4, over, in, under, and along all of the ways or any part thereof as shown on said Plan, to
be used for all purposes for which ways are commonly used in the Town of Yarmouth.
Reserving to the Grantor the right to install and maintain all public utilities, in, over,
under, along, and upon the private ways as shown on said Plan, reserving also to the
Grantor the right to grant easements to public service corporations for the installations
and maintenance of such public easements to public service corporations for the
installation and maintenance of utilities underground in strips of land 10' in width
abutting said private ways on said Plan.
Said premises are further conveyed subject to and with the benefit of all other rights,
restrictions, reservations, and easements of record insofar as the same are now in force
and effect.
Under the pains and penalties of perjury, the signatories to this document hereby state
pursuant to M.G.L. ch. 188 §13 that no other person or entity is entitled to claim the
benefit of an existing homestead in the premises and hereby release any and all
homestead rights to said property.
For our title see Deed from Jeffrey F.Komenda,Trustee of the Oyster Cove Investment
Trust dated October 26, 1988 and recorded with the Barnstable County Registry of
Deeds in Book 6499,Page 170.
Signature Page to Follow
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Witness our hands and seals this 'day of f)(1`G 2019.
Nicholild / _ a,,.e....a x_ p--;,t,
trano Angela Vetrano
State of Peck.) up f 1
County:(UQ }fjz(uk
Y 1
On this Or dayof afj, 2019 before me ersonall a eared
� p Y PPNicholas J. Vetrano and Angela Vetra> ogved to me through satisfactory
evidence of identification,which was a
CC _ , to be the persons
whose names are signed on se .receding or attached document, and acknowledged to
me that . - .; ed it •luntarily a for its stated purpose.
AOPF
41111440 fw .
SHANTELL S SMALLS
•
Seal: Notary Public, State of New York
ubllC: No. 01SM6249686
G Qualified in Nassa�Co( ntx
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My Commission Expires: A ` \ Cemmission Expires 1 (