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HomeMy WebLinkAboutBld-20-003224 O1,Y Office Use Only y! Permit# 0 l Amount r _ LO ,tr n es Permit expires 180 days from issue date EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: 1 e Nt3�c ��' yaRmutt:T t-- N©(ZT MN C"�G-- ASSESSOR'S INFORMATION: Map: Parcel: OWNER: e+2125: 6210 "3. e4:P,-o 2 k4- ctto RCA-5T YP c•t-C V 1)042T C.o'c2) .=.4QA NAME PRESENT ADDRESS TEL. # CONTRACTOR: WPM k c- CPtPy 0 • 3t2— 0 t4) cs�f i i aC?�.c Nam'£ M Cc) NAME MAILING ADDRESS TEL.#(5cr8) 14.4.2Q'-b.28 12/Residential 0 Commercial Est.Cost of Construction$ c)o Home Improvement Contractor Lic.# Construction Supervisor Lic.# Workman's Compensation Insurance: (check one) f2X I am the homeowner 0 I am the sole proprietor 0 I have Worker's Compensation Insurance Insurance Company Name: e, a 1...hl'Qi.y4�PWKrc- . Worker's Comp.Policy# \NC— 193 B3 cteact WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate attached?) -4 Wood Stove t�Aacrz c ,koNt-a Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares ( )Remove existing* (max.2 layers) Insulation Old Kings Highway/Historic Dist. ( )Replacing like for like Pool fencing *The debris will be disposed of at: ebrf —� Location of Facility I declare under penalties of perjury that the statements herein contained are true and correct to the best of my knowledge and belief. I understand that any false answer(s) will be just cause for denial or revocation of my license and for prosecution under M.G.L.Ch.268,Section 1. Applicant's Signatur �� �)►' Date: Dy pub V . .ZG q Owners Signa re(or att, hmen t�. Date: all-{ 0Nrr1'> o�q Approved By: Date: Building Official(o' 4.1 ee) EMAIL ADDRESS: Zoning District: Historical District: 0 Yes ❑ No Flood Plain Zone: 0 Yes 0 No Water Resource Protection District: Within 100 ft.of Wetlands: 0 Yes 0 No 0 Yes 0 No The Commonwealth of Massachusetts i �"_W'll�►= Department oflndustrialAccidents tv milt 1 Congress Street, Suite 100 _a = ~ Boston, MA 02114-2017 •M�;,�• 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): M1C L G6�{aglc_3Z Address: (-4- G44us- �� 4AA6:t tin v.-r-4.1 6Zr M Pt 0 4 City/State/Zip: ' Phone #: (S©$) 3(Q.2— 31-1:Q:i Are you an employer?Check the appropriate box: Type of project(required): LEI I am a employer with 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 8. E Remodeling any capacity.[No workers'comp.insurance required.] 3. I am a homeowner doing all work myself. 9. ❑ Demolition ❑ y [No workers'comp.insurance required.]' _ I0 Building addition 4. I am 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.❑ Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp. insurance.1 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. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: t_Jk .C( 4-, ....r_. 11.). Date: au ski Phone#: CG0-2 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#: igv: � _.) O}Of Y , TOWN OF YARMOUTH R. " P s ` , _,, 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451 Telephone (508)398-2231 Ext. 1292—Fax(508) 398-0836 J_ 7 i OLD KING'S HIGHWAY HISTORIC DISTRICT COMMITTEE; ,r�, iL `, 0 , Ci,'i , APPLICATION FOR TOE' C, ,`n\K SOUTH it :' CERTIFICATE OF EXEMPTION CUT MA Application is hereby made for the issuance of a Certificate of Exemption under Sections 6 and 7 of Chapter 470 of Acts of 1973, as amended, for the proposed work as described below and on plans, drawings, or photographs accompanying this application. Type or print legibly: Address of proposed work: 17 Church Street,Yarmouth Port,MA 02675 Map/Lot# Owner(s): Abraham S. Grader and Michal H.Grader Phone#: 508-3623427 All applications must be submitted by owner or accompanied by letter from owner approving submittal of application. 17 Church Street,Yarmouth Port,MA 02675 1836 Mailing address: Year built: Email: michalhgrader@gmail.com Preferred notification method: Phone x Email Agent/Contractor: Nathan C.Caputo Phone#: 508-4720388 Mailing Address: 382 Old Craigville Road,Centerville,MA 02632 Email: allcapechimneysweep@gmail.com Preferred notification method: Phone x Email Description of Proposed Work(Additional pages may be attached if necessary): The plan for the new chimney includes installing a new 8"stainless steel pipe. Internally,it will follow the existing path through the back wall with up-to-code spacing.However,once outside the stainless steel pipe will go straight up and around the roof overhang and not through the brick chimney. Signed(Owner or agent): V .; c 1_ 43$ Date: Li• ?\mil > Owner/contractor/agent is aware that a permit may be required from the Building Department.(Check other departments,also.) ➢ This certificate is good for one year from approval date or upon date of expiration of Building Permit,whichever date shall be later. For Committee use only: / Date: ,/' �, / 9 v Approved Approved with changes -- Denied Amount ca7 AJ a Reason for denial: • B Cas CK . )aro i 'V'i, 0tv r j())4 Rcvd by: 4 V i V 4 ' A y co Date Signed: /!/ 1-.cl// Signed: a ( ` / APPLICATION#: 19- CA? V5.2017 17 Church Street, Yarmouth Port, MA 02675 Permit Application for New Chimney for Existing Wood Stove We are in the process of updating a wood stove to code. The next two pictures show the location of our home and an aerial view. po t Side ,a c,11c,Q Ancient Cemetery 9 We Creek -a rC d i)1 Ue , 9 117 Church Street Older SE Edward Gorey House 9 i.ajrjot cur Hurrzu t,0 -- a- Just Picked Q S' I : Q Sel ft ti Pep Cruel Scolls Snail a, c_nyinc Rtpair Woodside Cer;eiroryr,9 (ARVIOUTIC STATION Camp VJ lqatc Kirk!, r Dent.'" .^, !, ,. , . ; : .. ,. /, „ ,.. , ,.• RECEIVE:D I rf tj / j 1 1 ' Al\ JiOu I H TOW )LU KING S I-IIGHWAY i 2,/ i..,- , ,- , SOUTH yikr ,,s ''' MA I. Here is the stove. It vents through the back wall. -4.440 CY'J 444. r*rt rt.) RECEIV0 /110 ( KING'S HIGHWAY /77, SOUTH 11,1A 194,f10 .., . .„ , . .....-- The stainless steel pipe connects t° .,...t h,,, e brick ch im ,,,....,..n... „-4e- Y stack.; .. _ 4 , .. ' . . . ..„, .,., . ,... , • ,,.. • *. -.. - ,fr . ..• ... . ,.. fif - .A.pt., • , .. . . . ..„ , . - , ,...... s . .,. ....... , ,,.. . . .... ..„ .., . , .. • , . .. .,..,,, ---- .. . . ., ,,,,4**IreP, - ,'.4i.v://,',-4:4!,5-' ''''''''4 • . ,,,. .,..',-; '',, -,,-2,-;"",,--:". ,,..,„--;*;:"v•-•A''"1,—.:.:± - ' ' '' '':'',,,,,'7,,, J,'i.:',•-4„,, 'e:" ',,,,,,,,,,,: : ''''. . :;,,4k • ,,,.. F D ()V -, Et. ' A g \ ' ,x,,,i,RECEIVED AY "-- HW - 's , . ;N'`-- ) L if ,--.1 V 0 -,,' ri'l 1 1!) ,.., Nbry ' - ,e.' rptc lq souTH-wo (31_:-.--H, mil T°y,,,,,!---,';viciu This Plot Map shows the proposed chimney location. r N/F ,A -.,.f. .4 .P,ot - BERGQUIST n 0 N 83'27'00" E' z 92.47 i i C r-------r------------------------1\-- ',44----T------ . _' -7.) \ rn .....,FF \--I , z z .. 0 0 . - T '. ....4 Location 1 - 6 t I• o� of the � i 0 �, I ,�► �, proposed ' in r" ,:i } 1 chimney s 0 W 1 s $1.31.1 NA PHINNEY 4- sari p i� / , .; ;I Fa TCU�tk�,i ,-u i< L0 KING HIGHWAY ---I i e��..l�1 1 i r IV��-t Here is an aerial view of the chimney location. -- ... A i `• , .1.11#F, -,,,..N4 -.. .". ; � ... 0 #• ; ,' tp 7 ChLur7 h St et e 4 i r x @ :oti: ' ,,,,,,, ... . . v. . , _.., „ . ... .. , :„...: 4.. s . • . .,„ .. .., ,,,. ,.. ,___ _ ___ 1 I t, 70 nz:,,tt 1 t,+ F t 1 No �f % i, ! 1 sqA,k[VI UJ I H OLD KINC--;'S HIGHWAY H, MA itD -"--•• . . ., . • . . ., The Plan for the N . involves installing a New Chimney . with up-to- path through the wall . The plan for the new chimney it will follow up outside willnew 8" stainless'steel pipe. 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': ii MOON: ' '1:r,': 1..-ft,'-:-,:-:',:0:';: r':'::7.-VitS,•.11-4-1.7'''-'7''441?„i':r .it,? **in° tiliii0-07$0;14;w4 iI. ,,,..,y ,.:A, iaSfitaRiaA7re':•=:: 1:- :,,,,::!'-..:('''''..iin• I::!'41';;•!i -.:i._ ?"•':,,t-:.•: -.; ij.., •11-irl','::T--•.:7'..::'::.:T:•,: :::•'.,:: . :'' . ifvrt;:'•1-s-!§: . ••=,•-_,:•., ::i!....:•.•::. • ,.•. , ,',-.- i.,...:,, ;F4.'z+-•;kiy.itr!f; ::: •:, ... •. 1.. gi...,,,,,T1:,,:,:t,, . _...,„• :,,,...... „ _It Fireplace Inetallatim rrhei!tee f ois9'somt , ,,,,,,, 4,,v,.,.:.;„:. :,-:;...-A.70.1411:,:if';':.-;:...- °--0, .y&cum _ .. . ,.. . •.,.--,....,,,...f.,-, ,,,,,, ,. . _.., :' , Anew Mew -......' - --" 9PD1 • k ,'' t, .". n..Z.;... NOV ti / (f:' '-1 'Ai i L .,. . 1IG''I-IIGHWAY..iLL)Ki ,- . _______......CLF:czys--- . _... SOUT1-1 , , NIA 1)09 )91/ ,,,.. plan is • for the is too small The only difference between the diagram aboveat the connection to the roof overhang, because theovaenrhdaonugr chimney to go through it. The sketch contractor) shows the proposed plan. tit f * - 1 • ; 0,0 - W 4:‘ „.„ bLDKINGSHIGI-IWA._ 770 SO1J1-/-1 Pv1A F-1&-- , . Thisis an illustration of the new chimney design. ., ... .... ,A;-...7-, .., -., , - , ----, • ,, 1 ..... . , . .. • . '• , •,.3 ' • ,' .4 , .... .... ., r• _...,....At. ..-... is.\, ' •:.• , - k -.. ' • . ...... __ . viotie -,--------7.- . ' ... .. ., r_- - 1 A,.",.' A" • ?j ' a -..-, • , '•-: . I4'' . 4 S : AnoR(IVFC)1 . . .„ I i RCEIVI7D 1 1 I', '). Th,' CLERK kovv- OL D RN(ii s'._ !--lif_DiiVVA • SOU1 i--; 17,,„-..,.,j1,TH, IVA