HomeMy WebLinkAboutBld-20-003872 /e
ONE & TWO FAMILY ONLY- BUILDING PERMIT
`of Town of Yarmouth Building Department r --__
1146 Route 28, South Yarmouth,MA 02664-4492
508-398-2231 ext. 1261 Fax 508-398-0836 hl' ■
4 i
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 Numberol 01) 82 Pate Applied:
r;r-
Buildiifg Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
/ 1.1 ypeiMre : tom? 1.2 Assessors, I7&Parcel Numb 191
1.1 a Is this an accepted s eet?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:
Public 0 Private❑ Zone: — Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1ew eri of Reco : / _
eLi 1
/ rint) _ c Ci State,ZIPc-4,4 I. co,
icatiV-4L-------Leter / . 444tvgA
,,,,t_egy,,,,,,,
No. and Street e ephone Erna Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) ❑ Alteration(s) 0 Addition 0
Demolition ❑ Accessory Bldg. 0 Number of Units Other ❑ Specify:
Brief Description of Proposed Work2: 4 -, .- „ =_r_o ` if
�Z ��► 1 ./ Ir-e 0. .��.V+i 1Tf `�
b y c. r 19 a' ie - Vo/ -. e /' e't '/�`C. ��iylas
(),b N &i /C{�''C 4:ESTIMATED CONSTRUCTION`COSSTTS. ' ,i.' ` 2 2
},! t.1 C) �0
Item Estimated Costs: Official Use On _ _ \
(Labor and Materials) YB � ikl t�i E S. I
1.Building $ 1. Building Permit Fee:$ '5d Indic e�lYow' iS r'm ne -- - ��vvv/
iil Standard City/Town Application Fee
2.Electrical $ s
0 Total Project Cost Ite)x multiplier . x
3.Plumbing $ 2. Other Fees: $ 67.
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire (iiii
Suppression) $ i , Total All Fees:$
i
Check No. Check Amount: Cash Amount 6.Total Project Cost: `g of ,w,04 0 Paid in Full '1 Outstanding Balance Due: 1.)
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 61
icense Nu 2 er Expi do Date
Name of CSL Holder
List CSL Type(see below)
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted I&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Register o e Improvement Contractor(HIC) i3RetO ZcZ I
r/HIC Registration(at Number Expiration Date
I.', ompany Name or (. Re!is ant Nam:
1//.i,A A. Jfe. !' d
Email address
City/Town, S at-,ZIP elephone
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 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.eov/oca Information on the Construction Supervisor License can be found at www.mass.aov/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
I Al.i I, Department oflndustrialAccidents
1 Congress Street, Suite 100
Boston, MA 02114-2017
,' www~ 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 (Rusin r'ga ' at' Individual): 15
.11 Address: (J I s (‘
City/State/Zip: /6C4_4(j) �/! _ Phone #: S(� ' �7 qAre y an employer?Chec appropriate box:
ype of project (required):
I. I am a employer with I employees(full and/or part-time).* 7. w construction
2.E I am a sole proprietor or partnership and have no employees working forme in 8. Remodeling
any capacity. [No workers'comp. insurance required.]
3.0 I am a homeowner doing all work myself. [No workers'comp. insurance required.]t 9. E Demolition
4.E 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.Q 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.t
6.0 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 worke s'corn e anon insz nce for my employees. Below is the policy and job site
•
information. / ^
Insurance Company Name: Q (^r/ .L�Ls - e
Policy#or Self-ins.Lic.#: la
Expiration Date:
Job Site Address: �/f // City/State/Zip:
� l���C`'�
Attach a copy of the workers' compensatiid 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.
1 do hereby ce y under the ' s and penalties of perjury that the information provided ab ye is t ue and correct.
1 Sienature: t//`44✓L Date: / (9.- 6
,J Phone#: e ,3 4 1
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#:
• � TOWN OF YARMOUTH
BUILDING DEPARTMENT
1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1261
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
DATE:
JOB LOCATION:
NAME STREET ADDRESS SECTION OF TOWN
"HOMEOWNER"
NAME HOME PHONE WORK PHONE
PRESENT MA ING ADDRESS
CITY 1R TOWN STA'l'E ZIP CODE
The current exemption `Homeowner' was extended to include owner—occupied dwellings of one or two units
and to allow such homeow -rs to engage an individual for hire who does not possess a license,provided that such
homeowner shall act as supe isor. (State Building Code Section 110 R5.1.3.1)
Definition of Homeowner:
Person(s)who owns a parcel of land . which he/she resides or intends to reside,on which there is or is intended to
be, a one or two family attached or det. hed structure assessory to such use and/or farm structures. A person who
constructs more than one home in a two- -ar period shall not be considered a homeowner; such"homeowner"shall
submit to the building official, on a form ac.eptable to the building official,that he/she shall be responsible for all
such work perfoiuied under the building pe 't. (Section 110 R5.1.3.1)
The undersigned `homeowner' assumes respons •ility for compliance with the State Building Code and other
applicable codes, by-laws, rules and regulations.
The undersigned 'homeowner' certifies that he / she u,derstands the Town of Yarmouth Building Department
minimum inspection procedures and requirements and hat he / she will comply with said procedures and
requirements.
HOMEOWNER"S SIGNATURE
APPROVAL OF BUILDING OFFICIAL
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent, hich meets the requirements of MGL
Ch.142. Yes No
If you have checked yes, 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
°� Yfi�o TOWN OF YARMOUTH
-yg BUILDING DEPARTMENT
• 1-, —t -.' 1 Ld6 Route 28, South Yarmouth,PvLA 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 e debris resulting from the proposed work/demolition to be
conducted at /L71
i' l ki'f
Z4(___La/14L--
Work Add
Is to be disposed of at the following location: it--
11)944
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
//617n
Sign tare o Ap 'cation
Date
Permit No.
1 ,200.00 $ due when the project is
50% complete.
1 ,200.00 $ balance due when the
above specified terms of the project is
fully complete, not including any
additional supplemental work .
Acceptance of contract
Ed Mulligan
Roger Byam / Byam Construction
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kv Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations
Const\ustt6ri Itl pc
and Standards
rvisor
CS-075376 4 E,pires: 07/03/2021
ROGER E BY,AM 4,44 i.
PO BOX 1793!
HYANNIS MA'.#2601;'''-,„ ,,,,,,- .
Commissioner / feJ,---
•
5N..Y k,r TOWN OF YARMOUTH
• *: ,• c HEALTH DEPARTMENT
,I,,4c„`'. PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant: /
Building Site Location: 4 Iteil /lt41e __ill W
Proposed Improvement: Ala �-�/, J J
)(cot,li
Applicant: is // c/ �J .ice Tel. No.: in V-/`1q1
Address: Mia4,0 ) [ 4 P7 . ,. .. r �yn�' Date Filed: z—lei
**If you would like e-mail notification of sign off pl ase provide e-mail address:
Owner Name:
- taOwner Address: 4 Owner Tel. No.
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: DATE: id' /
c7' i l ( _
PLEASE NOTE
COMMENTS/CONDITIONS:
o� Yq�,
f #. Town of Yarmouth
tom.: if___:,5,
,.I,��,ttoConservation Commission
vMA-T.4CC '.T • • • • •
\ Building Permit Sign-off Application
TO BE FILLED OUT BY APPLICANT:
Building Site Location7 : (/ &//1444j1
f 1410K
Map # Lot(s) # Z...- I
Property O►4'ner: 64 f CA-n-_-
Applicant: 114
4/
Applicant Address: - g• ri4\3
Telephone:CDate Filed � If
Proposed Project Description:
Plans: IIM \,\\OL2 Piin l II-6 5
TO BE FILLED OUT BY CONSERVATION ADMINISTRATOR:
Does the Proposed Project Require a Permit? Iv0
Comments from Conservation Commis • .
Approved Co itionally Approved Rejected
All work related debris shall be taken offsite or disposed in a legal upland location
At the end of each day, the area shall be clean and no debris shall be in the Resource Area
Refer to: SE83- or DOA permit
\ 1IIf
Conservation Commission Sign-off Signature: 1.."6:1401/"' ��),
Date: a I t 9
YARMOUTH WATER DIVISION
99 BUCK ISLAND ROAD
WEST YARMOUTH, MA 02673
PH.: 508.771.7921
FAX: 508-771-7998
BUILDING PERMIT APPLICATION
DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET
Bldg. Site Location / - '�,LAde ,d4dAir, Map #: Lot #: C % l
Proposed Improv-ment: /" &, /
Applicant: 7i
LAddress f /L1:1 / Tel. - :�. / i
Date Filed: /Z (36
` RESIDENTIAL AND / OR COMMERCIAL BUILDING
Water Department: Determines Compliance of Water Availability and or Existing Location
Engineering Department: Determines Compliance for Parking and Drainage
Conservation Commission: Determines Compliance to Wetlands Acts; i.e. If Lot(s) Border any Type of
Wetlands, Streams, Ponds, Rivers, Ocean, Bogs, Bays, Marshland, Etc...
Health Department: Determines Compliance to State and Town Regulations, i.e., Requirements
for Septage Disposal and other Public Health Activities
Fire Department: Determines Compliance to State and Town Requirements for Personal,
Safety, Property Protection;, i.e. Smoke Detectors, Sprinkler Systems, Etc ..
Signature of applicant Date
PLEASE NOTE:
COMMENTS:
Rev wed by: Water Division f
Date
USIC* PROTECTING INFRASTRUCTURE
Ticket Status Notification
To: SAME
Email: MULLIGANE@AOL.COM
Below lists utilities that were statused by USIC. Please note there may be other Utilities which include private facilities that
may be present in the work area and are NOT the responsibility of USIC to locate or mark.
You are receiving this notification because your contact information is listed on the above ticket from the One Call System.
If you have any questions regarding this notification, please contact USIC at 1-800-762-0592.
Ticket Address
20200101634 14 KENNEDY LN,YARMOUTH,MA
Utility Locate Date/Time Status Detail
VERIZON MA 01/6/20 07:35 AM Not Marked Excavation Site Clear
VERIZON MA 01/6/20 07:35 AM Not Marked Excavation Site Clear
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Sears, Tim
From: Sears,Tim
Sent: Wednesday,January 15, 2020 9:22 AM
To: 'rogerbyam@gmail.com'
Subject: 14 Kennedy Ln
Roger,
I have reviewed your application for 14 Kennedy Ln,and we are going to need a plot plan showing the setbacks to the
new deck.The Zoning Bylaw allows for steps below 30"to encroach into the front setback, but that only applies to the
minimum landing required by code.
Thank you
Timothy Sears CBO
Building Inspector
Town of Yarmouth
508-398-2231 Ext. 1259
mailto:tsears@yarmouth.ma.us
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