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HomeMy WebLinkAboutBld-20-002473 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 Only Building Permit Number: a, 2D--2_,q - Date Applie " r") r-‘ cRA c•\ Building Official(Print Name) Signature' . Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 102 Nottingham Drive 150 38.1 1.1a Is this an accepted street?yes X no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: R-40 no change 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: Zone: Outside Flood Zone? Public E Private 0 Municipal 0 On site disposal system g Check if yesg SECTION 2 PROPERTY OWNERSHIP' 2.1 Owneri of Record: William Hendrickson&Lorraine Wilson-Hendrickson Yarmouth Port,MA 02675 Name(Print) City,State,ZIP 102 Nottingham Drive 508-362-7994 wilson.lorraine@comcast.net No.and Street Telephone Email Address SECTION 3:AESCRIPTION OF PROPOSED WORK2(check all that apply) . . New Construction 0 Existing Building NI Owner-Occupied 0 Repairs(s) 0 Alteration(s),15- -Addition- E- C Demolition 0 Accessory Bldg.Cl Number of Units Other El Specify: Brief Description of Proposed Work2: Renovate 2 bathrooms. Master Bath tile,vanity,plumbing&light fixtures 1 UV U-2 ?nig Guest bath:tile,vanity,plumbing&light fixtures,open up tub wall to re orient tub L_ . . . SECTION ESTIMATED CONSTRUCTION COSTS. : .• . Estimated Costs: . Item • ;'' • (Labor and Materials) : :. - • Official Use Only' : 1.Building :1. Building Permit'Fee:$\SO Indicate how fee,is detertainech 2 Electrical ri.Standard City/Town.4igiCation Fee: . •Ei Total Project tauitifilier. . x 3.Plumbing 2.. Other Fees: $ 3.S V '• 4.Mechanical (HVAC) $ List 5.Mechanical (Fire Total All Peek$ Suppression) CheCkNO. Check Amount oaah Amount: 6.Total Project Cost: $48,000.00 6 Paid Full '411 Outstanding Balance Due: ftj --Wor6363 9f:31-crr) SECTION 5:.CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-097057 11/29/20 Robert McPhee License Number Expiration Date Name of CSL Holder List CSL Type(see below) unrestricted 28 Bakers Pond Road No,and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) South Dennis,MA 02660 R Restricted l&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 508-385-2704 mcphee@mcpheeassociatesinc.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 104158 7/12/19 McPhee Associates,Inc. HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 1382 Rt. 134,PO Box 797 mcphee@mcpheeassociatesinc.com No.and Street Email address East Dennis,MA 02641 508-385-2704 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 No .❑ . SECTION 7a: OWNER AUTHORIZATION TO BE COMPILE 1'E1)WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize McPhee Associates,Inc. to act on my behalf,in all matters relative to work authorized by this building permit application. (please see attached) 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. aVerm Oct le//61 y 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 planed,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" MB 170 SF,GB 90 SF The Commonwealth of Massachusetts Department of Industrial Accidents 1 congress Street,Suite 100 1 Boston, 114 02114-2017 WWW mass.govidlia Workers'Compensation Insurance Affidavit:Builders/Contractors!ElectriciansfPlumbers. TO BE FILED WITH THE PERMiTTING AUTHORITY. Applicant Information Please Print Legibly Name(BusinessOreanization.'htdividual): McPhee Associates, Inc. Address: 1382 Rte 134, PO Box 799 City/State/Zip: East Dennis, MA 02641 Phone 508-385-2704 Are you an employer?Check the appropriate box: Type of project(required): I.E I am a employer with24 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_ ®Remodeling any capacity.[No workers'comp insurance required.] 9, ❑Demolition 3.0 I am a homeowner doing all work myself_(No workers'comp.insurance required_] 10❑ Building addition 4.0 tam a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 50 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs These sub-contractors have employees and have workers'comp insurance.: 6_0 We are a corporation and its oftteers have exercised their right of exemption per MG(..c. 14.❑C)tlter 132,§I(4),and we have no employees.[No workers'comp.insurance required.] `Any applicant that checks box=l must also till out the section below showing their workers'compensation policy information, }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: Selective Insurance Company of America Policy or Self-ins.Lic.r: WC908077200 _ Expiration Date: 01/01/2020 Job Site Address: 102 Nottingham Drive City/State/Zip: Yarmouth Port,MA 02675 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under WiL 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 S250.00 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 cern:6.trader!fie pains and pp nobles of perjury that the information provided above is true and correct Si nature: 1C. iij ` ilY/ "t t Date: 10/16/19 Phone : 508-385-2704 Official use only. Do not et'rite in this area,to he completed by city or tmen 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 is •ti . tvwr' Or' YAR MOUTH • o c BUILDING D EPARTIVIENT • • 11�6 Route 28, South Yarmouth,MA 02664 �-•� i 508-398-2231 ext. 1261 Fax 508-398-0836 • BUILDING DEPARThIENT 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 frotn the proposed work/demolition to be conducted at 102 Nottingham Drive Work Address Is to be disposed of at the following location-s&J Exco,200 Great Western Rd.,S.Dennis Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter III, Section 150A. tid 1/9 Sign tare of Application li, IG Date Permit No. • i'""'1 • MCPHASS.O1 _ '��- Rox CERTIFICATE OF LIABILITY INSURANCE DAT/16/2019YY) 4/16/2019 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(les)must have ADDITIONAL INSURED provisions or 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 CONTACT NAM : _ Rogers&Gray Insurance Agency,Inc. PHONE • FAX 816.2156 434 Rte 134 (NC,No,Pxt):(800)553-1801 (A/c,Ncr�877)� South Dennis,MA 02660 E.ADD' ss mail a@rogersgray.com INSURER(S)AFFORDING COVERAGE _ NAIC INSURER A;Selective Insurance Company of South Carolina 19259 INSURED INSURER a;Selective Insurance Company of the Southeast 39926 McPhee Associates Inc INSURER CI .r P.O.Box 797 INSURER p; East Dennis,MA 02641-0797 INSURER E: INSURER F: COVERAGES CERTIFICATE DUMBER: 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 ADO SUB . POU EPP POLICY EXP LTR I TXPE OF INSURANCE INsru im i POLICY NUMBER niM4/PD .yl y� I .YYta LIMITS A X COMMERCIAL GENERAL LIABILRY EACHQ I 1,000,000 �ECCUkRENCE is CLAIMS-MADE X OCCUR S2010213 1/1/2019 1/1/2020 pREAMIBES° ce) I$ 500,000 MED EXP(Arty oneperson) I$ 15,000 . PERSONAL&ADV INJURY i$ 1,000,000 GEN'L AGGREGATE pLIRM�IT.APP S�. S PER: OENF�RAL AGGREGATE S 2,000,000 _. POLICY u JEC'T LOC PRODUCTS COMP/OP AGO $ 2,000,000 OTHER: I$ B AUTOMOBILE LIABILITY COMBINEDBI SINGLE UMIT _I$ 1,000,000 ANY AUTO 9095287 1/1/2019 1/1/2020 BODILL INJURY(Per person) _$ — OWNED SC AUTOSp X ONLY X Eli/RULEDBODILY INJURY(Per accident)!$ AUTO x S ONLY " 0 ONLY (Per eecPE=1pM GE s . Is UMBRELLA LIAB _w OCCUR EACH OCCURRENCE_ I$ • EXCESS LIAB ,CLAIMS-MADE AGGREGATE_ $ DEO RETENTIONS I$ A ANORKERSDEMPLOYERRS'LLIABILIITY N X STATUTE_ EERR I ANY PROPRIETOR/PARTNER/EXECUTIVE MI_ WC 908077200 4/112019 1/1/2020 500,000 EOP EXCLUDED? N NIA A E.L.EACH ACCIDENT $ t'nae�amryFt"n" j 500,000 If yes desaibe under E.L.OVEASE-E 4 EMPLOYEE!$ DESCRIPTION OF OPERATIONSpelow E.L.DISEASE-POLICY LIMIT I$ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) • CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE • For Information Purposes Only THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE •L ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. • The ACORD name and logo are registered marks of ACORD . . Conalionwealth of Massachusetts * Division of Professional Lieensure CarruniNlYottiltit tx?MiltsaChasetts INVisicat vt Prafefosioruf L w AcetSe eaed of BoOdin;R.9441alwas*nil Standatais ''' Board of Building Regulations and Stiindards Constroctitnititparvisor construction'Supervisor Ffpires:1W302020 r, iires:02./09/2021 '-'," I, i, = ; I. ..lf PERRY I.ERt RoseRT H sicotiES ;•••-,i I F:' :Q.-' PO BOXI111 r-, I,/ ,'• ager EnsT omen fist .'r MARSTONS 141.LSM:iss-02049 *•' s ' ..':' -',''',:',; , Commissmner z,4,-- Commissioner C2 ig.....-- . r r Commonwealth of Maar.achusefts .ri-. Commonwea Ith of Massachusetts it Division of Professional Licensors NF' Dreision of Professions!Licensor. Board of Building Regulations and Standards Board of Building Regulations and Standards ConstroOttOtlpervisor Construction'Supervisor rit -i CS-097057 , , E.x.r ire,aes:11/2-01202: CS,4344.510 4.-, .1.,,,' , ''''' ratipires;04/2012020 • ". •';vr",,, u. kit' -," ----------. - .-.; r • .. :, , h. il " ROBERT M MCPHEE •-'''' - a. .,. , z,;:,..: J°NkTHANR-filuvelf,/4 ;:r. , . "-, 49 AVVVOOD GIRDLE\.pf• ,.1, 2," , : 28 BAKERS POND ROAD,- --. 4"-.. :-BRE -* 4,14 4NSTER M3142$31:;00-' '..' 1/4. ,,,....,,-z-•,„ :, SOUTH DENNIS MA 02660 ,,,,,rs„''," !".. -,'- ', . , .,-,-' ',:•"" .'i'e'. '44.)/ss-i:10:1‘ = ----' ' 1 -.,-.- ' ,.;,-,-; ;,-• . .;., *--,'.g Com ib, tniksioner %,- Commissioner al'`' i. . 0c . 1‘.. Comrnomveann or Massacitusens kir Divisiori of Prohissinne!Lit:ensure I ConanonweitIM of Massachusetts Division of Professional Licansure Boit or Building Regulaisii• is and Standards Shard of Building Regulations and Standar& i Co ristrutithSAIStipervisor Consrutttbitqdpervisor I CS-098835 ..,-F la i aoires:08t16/2021 ,L E;rirer 07,18/2021 StraAN E 00)FTONIO 4., 1 7 • BERNARD OLINEHA14,1„!a• --, -'-'' : '' - ' PO BOX 110/ ' .1<-' ''. HAANIC 102 NORTH tvasToutifcto? =.- , *1 fek))26411 :.y :-.7 ., - 1 FORESTDALPLA4A 02 61(1 ..,:r- .,:...-=---.. /A.. '1?),SV•14k'' . ,i , .. f. , COM missiorier Commissioner AIL,..or..4,......4____ ' _._........,„. . . Commonwealth of Massachusetts • Division of Professional t.icenstire 91 Shard of building Regulations and Standards ronstrootttn4Stipervisor CS-072139 ' • . , rxp tres.112712019 WiMAN W BROOKS JR, PO BOX 0.11 '2„ ,,-.,.• ,„ --ktv.)gt,: POMOLITH MA,02,362 " , '''' ,,..., •-• :..,...,„,0:,..- . <!-e.,-, Comrhissioner .., .... ,...... . , „ . , .• . , °Mee et De tor:el/Xi Businilalsalettis aureola HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:Corooralan before the**kaftan date, It found return to: fiesdahallan Ladollaa °loci of Consumer Affairs and Boldness Regulation 104,1PA: 07/12/2020 Orla Ashburton Phice-Srate 1301 MOPPIEE ASSOOIATES aro Boston, 02106 . . .. . Roaaar H.MOP4EE .'' CCQufk--- MA 0264i Undersecretary PO BOX 79703$1 F(T 134 1302 ROUTE 134 Not valid without signahue E.DENNIS, September 19, 2019 TO: TOWN OF YARMOUTH ATTN: Building Commissioner To Whom It May Concern: This letter is to confirm that we, William Hendrickson and Lorraine Wilson-Hendrickson, owners of the property at 102 Nottingham Drive, Yarmouth Port authorize McPhee Associates, Inc. to act on our behalf as the contractor for work to be performed at the above referenced address. ifick&Z ZV16.4 William Hendrickson Lo aine Wilson-Hendrickson -;11 1 1 1; 1 _ r L 1 . ' I i 11. i • i . ' :. . .: ,. __,__ __ . i I 1 ‘1 4 . • ' r !--I----i- i 1 \ .- I I _4. z.i _._ _ __;_____„...1__ 1 -1 ' '1 i . =1 1_ 1 1 1 I -t- i • 1 L i . I i 1.• T-T- . 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