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ONE & TWO FAMILY ONLY- BUILDING PERMIT
Town of Yarmouth Building Department "'......"r
1146 Route 28, South Yarmouth,MA 02664-4492
508-398-2231 ext. 1261 Fax 508-398-0836 ii)
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 P i y J
Building Permit Number ID oC Date App ' d:
) )reN SRArs _ \\=5—Ick
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors ap&Parcel Nu
3q 1 rb /We. jo D n�
1.1 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:
—/ Zone: _ Outside Flood Zone?
Public C2 Private❑ Check if yes❑ Municipal ElOn site disposal system 12/
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
-7 .K VielomoviA , rn A-
Name(Print) City,State,ZIP
34 C rrosc- Aug
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction 0 Existing Building IV Owner-Occupied 0 Repairs(s) 0 Alteration(s) 27 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: "Ti"-A i Cok,r- 0fitd ra.ral(r ,,)io
al.?
i n.s c.t�e,{'Lal. . � e.0010✓C- q R ,e GµsQ [n 5471- 1 Z ' y E
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SECTION 4:ESTIMATED CONSTRUCTION COSTS. 1 a i 1`.T 2 1 2019 i
Item Estimated Costs: Official Use Only
(Labor and Materials) IPART70tE�T
1.Building $ jQ 1. Building Permit Fee:$1 S). Indicate how fi datPrrp
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1 Lil Standard City/Town Application Fee
2.Electrical $ -
�' U1 co 0 Total Project Cost3(Item 6,)�x multiplier . x`.
3.Plumbing $ 2. Other Fees: $ 2,0rV
4.Mechanical < r ; ) 01
(HVAC) $ /, �bo List: � ' � � � �.� :;
'
5.Mechanical (Fire
Suppression) $ Total All Fees:$ ', .. 4
Q Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ 'U)3�0 0 Paid in Full 't Outstanding Balance Due: \\5
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i SECTION 5: CONSTRUCTION S`I I j$ '
5.1 Construction Supervisor` License(CSL) rf' /
Cui ( 1,wt t `�t�f s l i
License Number Expiration l ate
Name f CSL Holder
List CSL Type(see below) U
�J'
No. StreetkcaIq e D� Type Description
U. 1/145 i /�Y114 614(ao R Unrestricted I (Buildings up tol 35,000 Cu.ft.)
R Restricted 1�r.2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
D '/ SF Solid Fuel Burning Appliances
7?,T-L�'1-334 tracn.rilp hell(.0444-pn es Ince I Insulation
Telephone Email ad eslma4/•Ga✓n D Demolition
5. egistered H e Improvemen Contractor(HIC) I �3 7�
�� HIC Registration Number Ex iratio Date .
HIC Company Name or HI Registrant Name
No.and Street K t. I. Email address
q
City/Town, State,LE' Telephone
SECTION 6:WORKERS' COMPENSATION INSURANCE Al ilDAVIT(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 Issuannce of the building permit.
Signed Affidavit Attached? Yes Gd' 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 CD�t-tYau,P ff'7`6Lh e1
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.
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.2ovIota Tnformation 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"
Y -� TOWN OF YARMOUTH
• Sly Art. c B UII�D ING DEPARTMENT
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x 114-6 Route 28, South Yarmouth, NIA. 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 1113,
I hereby certify that the debris resulting from the proposed work/demolition to be
conducted at re4s-./
Jed
Work Address
Is to be disposed of at the following location: y4e,,,... f
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
S' attire of Application
Date
Permit No.
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Office of Consumer Affairs and Business Regulation
1000 Washington Street-Suite 710
Boston, Madllachusetts 02118
Home Improvemerit.Contractor Registration
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s .M Type: Corporation
R.A. CAMPBELL ENTERPRISES INC. ;; Registration: tt33732
10 ATLANTIC AVEtixia Expiration: 07/1et2O21
SOUTH YARMOUTH.MA 02664
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SCA t a :moray
usru Update Add ati and Return Card.
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HOME IMPgariiewr
CoroarrCONTRACTOR Registration valid for individual use only
Basidteggg before the expiration dal. V found return to:
lialtalhai Offoi of Consumer Affair.and Business RegWallon
R.A. CAMP " 1d .ry,OMB/2021 1000 WashingtonSidleStreet •Se 710
BEi1 �,KK 'W. INC. Boston.PIA 0211ti
RYAN CAMPSEt L
10 ATLANTIC AVE a f .
SOUTH YARMOUTH,MA 02004
Undersecretary NOt valid without signature
� Commenweaith or ` '. r
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Board wino, of Professional Licenstm'
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9 Regulations and Standards
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,oME IMPROVEMENTS ESTIMATE
100622
A_MPBELL
� ,t?EppR Ec ��'1C Date
9/24/2019
10 Atlantic Ave. S Yarmouth. MA. 02664
774-212-3321
Blake,Tim Project
Frost Road
West Yarmouth REMODEL
Description Amount
DEMO: 28,370.00
{Remove all of the sheetrock and garage door
Create a larger opening to the kitchen and basement
FRAME:
Frame in the old garage door opening to receive two new windows
Frame a floor system to match the kitchen floor height
1 Frame walls to separate the new room from garage side door entry
ELECTRIC:
l Run new electric in the new room with recessed lights,plugs/switches
Run new electric in the entry area and hallway
HVAC:
Run new floor vents and returns to heat the new room
INSULATION:
To code
DRYWALL:
(Install new drywall with a smooth finish
Taped,mud, sanded,primed
TRIM&WINDOWS:
I Cased openings,no interior doors
Total
Accepted by: Date:
Page 1
. ii4oME IMPROVEMEN s ESTIMATE
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100622
CAMPBELL
E TERRRi ES Date
9/24/2019
10 Atlantic Ave. S Yarmouth. MA. 02664
774-212-3321
Blake,Tim Project
Frost Road
West Yarmouth REMODEL
Description Amount
Install new trim around new windows
I PAINT:
{Walls and ceilings
TILE:
I Floors in entry and laundry
Allowance included for materials, 70sf @$5/sf
I NOT INCLUDED;
Carpet-by owner
Construct new 10x12 shed in the back yard i 7,000.00
{
Total $35,370.00
Accepted by: , , Page 2 Date:
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M 101
Jt-Yk'� TOWN OF YARMOUTH _
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5;' • HEALTH DEPARTMENT OCT 1 8 201
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,�'\`, " , '. =41_TH DEPT
• ' �- PERMIT APPLICATION SIGN OFF TRANSMITTAL
To he completed by Applicant:Building Site Location: 34 ;((054- AvQ-.
Proposed Improvement: ` Gar e_
0 u §Y0olwl ie-eh-arc{GI
�U 36" wed ip�nzn? � e_er1,►i ,rx in.v
L r rmALe rt - alG �e41 7 -473 i'avAdry awl
Applicant: Ce wt farm,/i Tel. No.: q 74 2-LI-31t I
Address: I L. j�jaA4 lQ ay- Date Filed: 1O/1b/if,
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"If you would like e-mail notification of sign off please provide e-mail address:
Owner Name: 1 W '-g le
Owner Address: .S' r Y ' lv_ Owner Tel. No.: 2 7 `e-a-f,-3YICe
RESIDENTIAL AND/OR COMMERCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities.
Please submit three (3) copies of plans, to include:
(1.) Site Plan showing existing buildings, water line location,
and septic system location;
(2.) Floor plan labeling ALL rooms within building
(all existing and proposed) —
Note:Floor plans not required for decks,sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
REVIEWED BY: a5rr— DATE: /07dIth?
PLEASE NOTE
COMMENTS/CONDI IONS:
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