The URL can be used to link to this page

Home My WebLink AboutBld-20-001561 ONE & TWO FAMILY ONLY-BUILDING PERMIT Town of Yarmouth Building Department .oi. • r' - 1146 Route 28, South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 14• '�� ''ll 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:so-D vW,Th / Date Applied: !M SeA Building Official(Print Name) Signa re Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 1e �tl rtice. LAN, Y -Pa - 1.1 a Is this`an accepted street?yes no Map Number Parcel Numbe vt.�C F 3 J r 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) ck" 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 ecord: Carol v Da.ntS `1.0, >�OX ?O►-1 De_44 c Poc4- Name(Print) City,State,ZIP S5-360-71‘I No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building.. Owner-Occupied 0 Repairs(s)(113— Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work2: f CIC ci ia,....1 It Si d.L�at( Sl�t.�c"(�rtk,IL O a w L a�aINK 0lk afro► # I bkrifigit9, tom:r,kero...-.ce.i-Repasz. LJ SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: a Item Official Use Only (Labor and Materials) 1.Building $ w 1 Building Permit Fee:$ t4 Indicate how fee is determined: GI Standard City/Town Application Fee 2.Electrical $ ❑ Project Cost' Item.66).,l x multiplier. . x 3.Plumbing $ 2; OtherTotal Fees: $=-= U 4.Mechanical (HVAC) $ List 5.Mechanical (Fire Suppression) Total All Fees:$ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ 3'O O ❑Paid in Full ®Outstanding Balance Due: t i c Y SECTION 5: CONSTRUCTION SERVICES 5.1 Construction'' Supervisor License(CSL) o�(D�D l N PQ z�TacobS License Number Expi,atior Date Name of CSL Holder P vy Q OX �� List CSL Type(see below) U No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) 1 i0 < dV4'� 0No S R Restricted l&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 7711.3cl-66Q_ p«tiot.w,S?S tfo ydL(t.co .cc I Insulation Telephone Email addr ss D Demolition 5.2 Registered Home Improvement Contractor(HIC) t/ igt6 P� -, TO.�>os HIC Registration Number xpir ion Date HIC Company Name or HIC Registrant Name e and 60X 74N �tNo. `Ia Street Y-Ow+ .wry creo r" 77N,3 S3-6 8 Email ad ss 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 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: 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 accitr to to the b r,.f my knowledge and understanding. Po t&L/- 6s — 91r7JJoi 9 Print Owner's or Authorized Agent's Name(Electronic ignature) to 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.gov/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" ;►u The Commonwealth of Massachusetts A 1 Department oflndustrialAccidents =n1Nl= 1 Congress Street, Suite 100 -'V <' Boston, MA 02114-2017 ;,.•‘'47 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): Po.:(- (,(( racobS Address: Q.0, So)C 3H ii City/State/Zip: Yet rimagtPorf,.yvt o f7r Phone#: .77Y 7.-3--4 5 S-a- Are you an employer?Check the appropriate box: Type of project(required): l.❑I am a employer with employees(full and/or part-time).* 7. New construction 2.6Z am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp. insurance required.] 3. I am a homeowner doingall work myself. t 9. Demolition ❑ y [No workers'comp.insurance required.] 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. 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. 12.0 Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have em to ees and have workers' p13. Roof repairs P Y comp.insurance.t 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'on. I do hereby cer u derma-pains and penalties of perjury that the information provided above is true and correct. Signature: Date: 7// /e-0,1 Phone#: `f- 317-G 0CD_ 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#: d� Y�o TOWN OF YAR11'IO1 TH :yg BUILDING DEPARTMENT • Y -••fit = 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 I, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at I CVal rt Le_ Ln . Work Address Is to be disposed of at the following location: .S 4 i. x co Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 1 I I, Section 150A. , AAP:A-- '7/ aw 1 Signatu - of Application D e Permit No. Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards ConstruCtiOn'Supervisor CS-081040 Expires: 04/04/2020 PATRICK H JACOBS * 28 WHITTIER DRIVE , DENNIS MA 02638 5*• Commissioner Ci ..,. — He fommoju'eea/!IG of"Ita-uarkweit6 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR f TYPE:'Individual Registration Expiration 165888 05/14/2020 PATRICK JACOBS D/B/A P.JACOBS CUSTOM CARPENTRY AND REMODELING PATRICK JACOBS 28 WHITTER DR. DENNIS,MA 02638 Undersecretary Carolyn E. Banks P.O. Box 204 Dennisport,MA 02639 9/13/19 Town of Yarmouth Building Dept. To Whom It May Concern: I have secured the services of P.Jacobs Custom Carpentry and Remodeling to repair the back of the garage located at 18 Myrtle Lane,Yarmouthport,MA 02675. Please let me know if you have any questions or concerns. Thank you. Sincerely, Carolyn Banks 508-360-7161 P.Jacobs Custom Carpentry& Remodeling P.O.Box 344 Yarmouth Port.MA 02675 Date 9/1 312 0 1 9 Estimate# 457 Caroline Banks 18 Myrtle Ln. Yarmouth Port,MA 02675 Due Date 9113/2019 Take down temp wall on hack of garage,install new sill-wall 4,620.00 4,620.00 studs-sheathing,insulate wall, sheetrock-mud-tape-sand-paint inside wall,install house wrap,install"A"grade white cedar shingle 5"+1-to the weather,replace 1 side of corner board and ear board, reinstall TV dish.All debris to be removed from the site. Permitting if necessary will be billed at permit amount and time to get permit. DES f`')° �? 0� s � � 1 C 45 t � — er:v.} Gt �io_cc 1 ssi i •e SL'! :tt'ec• `• S A- Ce At% • co.-•t a-6.-4-0 r ►5 1�,cL tis�c f 11 s ! 0.l I t te L 6 Yt?c t i`S co.no. by P_ •Jcc cba� .J Subtotal $4,620.00 OCr ,Se-CA; `^ram ea;'11*-r- Sales Tax(6.25%) $o.00 `J Total $4,620.00 P.Jacobs Custom Carpentry&Remodeling -12 9/ 3/k a=ai - Phone# 508-694-6406 patjacobs78@yahoo.com pjacobscarpentry.com TOWN O YAarv7OUTH REVIEWED F02 BI IILCING ANC ZONIN:i CODE COMPLI- ANCE. ERRORS OR C....°'SSIONS DO NOT RELIEVE THE APPLICANT FROM THE RESPONSIBILITY OF"AS BUILT" �1, 1�y rt c' L-^,A'� COMPLIANCE. ++)) �yfrII^ L DATE: 9'd 6-15 BUILDING O C L a - t.'i 6» iN i —_ — n v ( a :-- I =6:i; ..., .n F-W C.: lu `4 r,. 7 S .Ii ,St,AI {j J c ?1 L I� 4 .. J r, y V\1et c ^ck- yi I, ^4 WWW 3 al-� � i ' -! t 4,,...? h3-0,- w4\` L '°,, G -,S Vic' C•' ,C" �0.' �c� Z v