HomeMy WebLinkAboutBld-20-002951 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 S ction For Official Use Only
Building Permit Number: ' / Date Applied:
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property M Address: 1.2 Assessors p&Parcel NumbeLl
/3 / t76 �r - s /
1.1 a Is this an accepted street?yes X no Map Number Parcel Numb r
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❑ Zone: Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record: _ 0 L Y4(11)
Name(PrinPo Sat„zIP �1J . e! 11✓'(C 0cP°1 'W -Ncl
City,\No.and Street 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) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of P posed Work2:
/-JJlM1 � p 1 iZ th B� —/? �7�� I �-� - ,
SECTION 4: ESTIMATED CONSTRUCTION COSTS i
Item Estimated Costs: Official Use Only ;i
(Labor and Materials)
1.Building $ 1. Building Permit Fee:$ Indicate low fee is determined
2.Electrical $ 0 Standard City/Town Application Fee
0 Total Project Costa(Item 6)x multiplier . . x
3.Plumbing $ 2. Other Fees: $ SUo
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire
Suppression) Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total Project Cost: 0 Paid in Full 0 Outstanding Balance Due:
/�S oo�/
' SECTION 5: CONSTRUCTION SERVIC S
5.1 Constructio Supervisor License(CSL) / / 3 31 V P /DL
( (1 L License Number Expiration ate
Name of CSr i�er
rV"iw/� List CSL Type(see below)
and Street T e Description
l�.c 1 U J Unrestricted(Buildings up to 35,000 cu.ft.)_,.. )c
w
`� Restricted 1&..2 Family Dwelling
City/Town,State,ZIP M Masonry
C Roofing Covering
Window and Siding
1 - . --615L // C.t rj�/ 0 jt"P • 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,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.
Print Owner's Name(Electronic Signature) Date
• SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby att-st under -e pains and penalties of perjury that all of the information
contained in this application is true and .1 - e to the best of my knowledge and understanding.
,e►C L /ocpv // LJl/1
f*NPrint Owner's or Authorized Agent's N e(Ele..onic Signature) Date
NOTES:
1. An Owner who obtains a build.,Q p- . it 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.eov/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
• ;. ,$'�yT www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information �p� ,�/ Please Print Legibly
(ôOçryName (Business/Organization/Individual): LATA/D ft/,4I!I� L• -
Address: P,D, +)N ii: , you-, 1)-AL /Ov '
City/State/Zip: Phone #: 5L r— 37 J L61- L
Are you an employer?Check the appropriate box:
i Type of project(required):
I. I am a employer with employees(full and/or part-time).* 7. ❑New construction
_Ili a sole proprietor or partnership and have no employees working for me in 8. E Remodeling
•
any capacity. [No workers'comp.insurance required.]
3._ I am a homeowner doing all work myself. [No workers'comp. insurance required.]r 9. ❑ Demolition
4.❑I am a homeowner and will be hiring contractors to conduct all work on property.mY
I will 10 [ 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
5.11I 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.El Roof repairs
6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑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 verifica .
I do hereby certi , ttnd• the pains and penalties of perjury that the information provided a ove itruue and correct.
v.Signature: Date: ii17 '>`'
)
Phone#: /.--7`� 3 53 - -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#:
.p1''YAR�-E TOWN OF YARMOUTH
o u BUILDING DEPARTMENT
•
MATT�C/`i y,E4'o1 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1261
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
DA'1E:
JOB LOCATION: (& I
I-1 Pk5A 9At-06-k
5%
NAMFf.A . STREET ADDRESS SECTION OF TOWN
"HOMEOWNER"
`1
NAME'"`IOME PHONE WORK PHONE
PRESENT MAILING ADDRESS
CITY OR TOWN STATE ZIP 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 an.-quirements and that he / she will comply with said procedures and
requirements.
HOMEOWNER"S SIGNATURE
APPROVAL OF BUILDING OFFICIIIIP
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 ves, 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
bT Y TOWN OF YARMOUTH
O� :yg BUILDING DEPARTMENT
. �, �$ 1146 P I
Route 2g, South Yarmouth, A 02664
�..•�/=� 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 debris1)14,tcA
resulting from the propossed, ,work/demolition to be
conducted at� ( 3 (r ( � i)LJI
\ Work Addr
ess
IPV
Is to be disposed of at the following ocaaon I c/ /n�C D
"''
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
(//0
11 re of Application
Date
Permit No.
VDivision of Professional Licensure
Board of Building Regulations and Standards
Cons i r'i t p yvisor
7
CS-113394 �� Nyires: l2/02/2022
• ERICK W COQPa vW,; ,T4. 7
131 PLEAS ST • 1, I
S YARMOU AAr ,• • --,
1
Commissioner a.t�c�/ ‘_- __.
.o •v TOWN OF YARMOUTH Building Department BUILDING
4 (508)398-2231 ext.1261
0 ....� y PERMIT NO :BLD-18-004462 PERMIT
leiii JOB WEATHER CARD
ISSUE DATE 02/08/2018
APPLICANT ;Edward Shea PERMIT TO New
AT(LOCATION) 1131 PLEASANT ST, SOUTH YARMOUTH, MA 0266 1 ZONING DISTRICT i Bldg.Type. Residential
SUBDIVISION MAP BLOCK LOT 1051.32 i BUILDING IS TO BE ICONST TYPE V B USE GROUP `R-3
�_ ___....__. __.._.. ._,__.__� s CONTRACTOR
I REMARKS Addition/Alteration-permit transfer-refer to BLD-18-1736-Construct 8 x 30
front porch,replace all windows,siding&trim(508-525-6901) ° LICENSE °124769
Home Improvement ',
SHEA CUSTOM CARPENTRY
iEdward Shea
"' �34 Gifford Rd.
AREA(SQ FT) '872 855 280', EST COST($) 64000 00 ; PERMIT FEE($) 35 00
..___ - �----- !1+Plymouth, MA 02360 ,
It
OWNER ;COOPER ERICK W . BUILDING DEPT BY
ADDRESS 1,P 0 BOX 1048 l
A _,._ ... ____-_ .,___._�_. __
SOUTH YARMOUTH MA 102664 PHONE
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR
PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE
APPROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE
OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM
MINIMUM INSPECTIONS REQUIRED FOR ALL APPROVED PLANS MUST BE RETAINED ON WHERE APPLICABLE SEPARATE
CONSTRUCTION WORK: 1)FOUNDATIONS OR JOB AND THIS CARD KEPT POSTED UNTIL PERMITS ARE REQUIRED FOR
FOOTINGS.2)PRIOR TO COVERING STRUCTURAL FINAL INSPECTION HAS BEEN MADE.WHERE ELECTRICAL PLUMBING/GAS
MEMBERS(READY FOR LATH OR FINISH COVERING) A CERTIFICATE OF OCCUPANCY IS AND MECHANICAL
3)FINAL INSPECTION BEFORE OCCUPANCY 4) REQUIRED,SUCH BUILDING SHALL NOT BE INSTALLATIONS.
REFER TO DETAILED INSPECTION SCHEDULE OCCUPIED UNTIL FINAL INSPECTION HAS •
BEEN MADE.
POST THIS CARD SO IT IS VISIBLE FROM STREET
BUILDING INSPECTIONS APPROVALS
/a/2�� 'z/ 17 K E
/71
i i/7 4-7 -7.-
OTHER:
WORK SHALL NOT PROCEED PERMIT WILL BECOME NULL AND VOID IF INPSECTIONS INDICATED ON THIS CARD
UNTIL THE INSPECTOR HAS CONSTRUCTION WORK IS NOT STARTED WITHIN SIX CAN BE ARRANGED FOR BY TELEPHONE
APPROVED THE VARIOUS MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED OR WRITTEN NOTIFICATION.
STAGES OF CONSTRUCTION AROVF
-ot•116,4 TOWN OF YARMOUTH Building Department BUILDING
iO (508)398-2231 ext.1261
O .... �y PERMIT NO BLD-18-004239 PERMIT
`py ISSUE DATE 01/29/2018 JOB WEATHER CARD
— APPLICANT :EDWARD E SHEA PERMIT TO New
AT(LOCATION) 1131 PLEASANT ST, SOUTH YARMOUTH,MA 0266 ZONING DISTRICT i Bldg.Type: ;Residential
•
SUBDIVISION MAP BLOCK LOT '051.32 I BUILDING IS TO BE CONST TYPE IV B ! USE GROUP R-3
REMARKS Addition&Alterations-permit transfer(refer to BLD-18-003759)-per approved ` I CONTRACTOR
I plan 780 CMR MSBC,8th Edition,TOY Bylaws-Note:A CERTIFIED AS 1 LICENSE yCS-070177
BUILT IS REQUIRED BEFORE FINAL INSPECTION(508-525-6901) 'Construction Supervisor
I 's-._.
I!EDWARD E SHEA ,
!EDWARD SHEA
AREA(SQ FT) 3 872, 5 280 EST COST($) 121000 00 PERMIT FEE($) 35.00 ; 'Plymouth, MA 02360
85
OWNER !COOPER ERICK W
BUILDING DEPT BY
ADDRESS P 0 BOX 1048 ,
`SOUTH YARMOUTH `MA '02664 a PHONE r
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR
PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE
APPROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE
OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM
MINIMUM INSPECTIONS REQUIRED FOR ALL APPROVED PLANS MUST BE RETAINED ON WHERE APPLICABLE SEPARATE
CONSTRUCTION WORK: 1)FOUNDATIONS OR JOB AND THIS CARD KEPT POSTED UNTIL PERMITS ARE REQUIRED FOR
FOOTINGS.2)PRIOR TO COVERING STRUCTURAL FINAL INSPECTION HAS BEEN MADE.WHERE ELECTRICAL PLUMBING/GAS
MEMBERS(READY FOR LATH OR FINISH COVERING) A CERTIFICATE OF OCCUPANCY IS AND MECHANICAL
3)FINAL INSPECTION BEFORE OCCUPANCY 4) REQUIRED,SUCH BUILDING SHALL NOT BE INSTALLATIONS.
REFER TO DETAILED INSPECTION SCHEDULE OCCUPIED UNTIL FINAL INSPECTION HAS
BEEN MADE.
POST THIS CARD SO IT IS VISIBLE FROM STREET
BUILDING INSPECTIONS APPROVALS
OTHER:
I
WORK SHALL NOT PROCEED PERMIT WILL BECOME NULL AND VOID IF INPSECTIONS INDICATED ON THIS CARD
UNTIL THE INSPECTOR HAS CONSTRUCTION WORK IS NOT STARTED WITHIN SIX CAN BE ARRANGED FOR BY TELEPHONE
APPROVED THE VARIOUS MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED OR WRITTEN NOTIFICATION.
STAGES OF CONSTRUCTION AROVF
of:•Yg44 TOWN OF YARMOUTH Building Department BUILDING
(508)398-2231 ext.1261
�`""�,-+ O PERMIT NO BLD-18-003759 PERMIT
Ice * JOB WEATHER CARD
N" � ISSUE DATE 01/11/2018
APPLICANT DAVID L DADMUN PERMIT TO Addition
AT(LOCATION) 131 PLEASANT ST, SOUTH YARMOUTH, MA 026 ZONING DISTRICT Bldg. Type: Residential
SUBDIVISION MAP BLOCK LOT 051.32 BUILDING IS TO BE: CONST TYPE V B ' USE GROUP R-3
REMARKS Addition&Alterations per approved plan 780 CMR MSBC,8th Edition,TOY CONTRACTOR
Bylaws-construct 9 x 35 addition and a 18 x 32 addition as per plans dated LICENSE CSFA-074205
01/09/18. (508-367-5851)NOTE: A CERTIFIED AS BUILT IS REQUIRED Construction Supervisor
BEFORE FINAL INSPECTION.
DAVID L DADMUN
DAVID DADMUN
West Dennis, MA 02670
AREA(SQ FT) 872,855,280. EST COST($) 121000.00 PERMIT FEE($) 640.00
OWNER COOPER ERICK W
BUILDING DEPT BY
ADDRESS P 0 BOX 1048
SOUTH YARMOUTH MA 02664 PHONE
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY
OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE
APPROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE
OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM
THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.
MINIMUM INSPECTIONS REQUIRED FOR ALL APPROVED PLANS MUST BE RETAINED ON WHERE APPLICABLE
CONSTRUCTION WORK: 1)FOUNDATIONS OR JOB AND THIS CARD KEPT POSTED UNTIL SEPARATE PERMITS ARE
FOOTINGS.2)PRIOR TO COVERING STRUCTURAL FINAL INSPECTION HAS BEEN MADE. REQUIRED FOR ELECTRICAL
MEMBERS(READY FOR LATH OR FINISH WHERE A CERTIFICATE OF OCCUPANCY IS PLUMBING/GAS AND
COVERING)3)FINAL INSPECTION BEFORE REQUIRED,SUCH BUILDING SHALL NOT BE MECHANICAL INSTALLATIONS.
OCCUPANCY 4)REFER TO DETAILED INSPECTION OCCUPIED UNTIL FINAL INSPECTION HAS
BEEN MADE.
SCHEDULE
POST THIS CARD SO IT IS VISIBLE FROM STREET
BUILDING INSPECTIONS APPROVALS
OTHER:
WORK SHALL NOT PROCEED PERMIT WILL BECOME NULL AND VOID IF INPSECTIONS INDICATED ON THIS CARD
UNTIL THE INSPECTOR HAS CONSTRUCTION WORK IS NOT STARTED WITHIN CAN BE ARRANGED FOR BY TELEPHONE
APPROVED THE VARIOUS SIX MONTHS OF DATE THE PERMIT IS ISSUED AS OR WRITTEN NOTIFICATION.
STAGES OF CONSTRUCTION NOTED ABOVE.