HomeMy WebLinkAboutbld-20-004501 ONE & TWO FAMILY ONLY- BUILDING PERMIT
Town of Yarmouth Building Department .....-4------);
1146 Route 28, South Yarmouth, MA 02664-4492
508-398-2231 ext. 1261 Fax 508-398-0836 t• .�' ■
Massachusetts State Building Code, 780 CMtr
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Building Permit Application To Construct, Repair, Renovate Or Demolish
a One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: /50 d'0 "t) 9SO/ate Applied.
ir <hCS ,fir 4`I`1- 44)
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Pro erty Address: 1.2 Assessors Map&Parcel Numbers
Gov e /4e/ o/c yd
1.1 a Is this an accepted street?yes /i-- no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (Iv1.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone:fl_ 4"Outside Flood Zone?
Public IP' Private❑ Check if yes❑ Municipal 0 On site disposal system i9-�SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record: v
CM/e 4 47 /'1)q/ M /Foot G✓e�5% 00/T/�io�tr7-- 1 2 0.2(Y
Name(Print) /� City, State,ZIP
7 Cave /341 < OV 79a 97;' --__---- -_a
No.and Street Telephone Email Acdr E � V E D
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that appl} R �a.
New Construction❑ Existing Building 0 Owner-Occupied 0 1 Repairs(s) 0 Alteration(s 154' [$iori b :) ;) '
Demolition 0 I Accessory Bldg. 0 Number of Units Other 0 Specify:
J
Brief Des/lecription of Proposed Work': y �' _t'i v ut=HAf�TMENT
P P . X Ten, A_/C57% i'1 iD e Gf� �..J� 1
—�� �K ✓�—/ / z/fit t✓/ � e& T � p r
SECTION 4:ESTIMATED CONSTRUCTION COSTS d #7...fo �_m 4
Item Estimated Costs: Official UseOnly !1,1 t
(Labor and Materials) L .
1.Building $ / p di 1. Building Permit Fee: $ )r _Indicate t o:Y �&lal d i�4i-iE r 4- P
2.Electrical $ 4 Standard City/Town Application Fee — m-- ,-----
r ❑Total Project Cost3Itern 6)x multiplier x
3.Plumbing $ .�. 2. Other Fees: $ ,.. ,��
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire •
Suppression) $ Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ / 0 e 10 Paid in Full QSi,Outstanding Balance Due: 4'0
SECTION 5: CONSTRUCTION SERVICES
6.1 Construction Supervisor License(CSL)
C S d 9 jO /1/V/2
d b e/'/ Gt.-,/Q4 e/\ License Number Expirat' n Dat
Name of CSL Holder
List CSL Type(see below) 61
CWarnae 2 /`-
No.and Street Type Description
7 d 4 Pe
ri /1 Q67 R Unrestricted(Buildings up el 35,000 cu. ft.)
!� R Restricted 18c2 Family Dwelling
ity/Town,State,ZIP Ivl Masonry
RC Roofing Covering
• WS Window and Siding
6-o 2� ` �'� g� SF Solid Fuel Burning Appliances
V �d�q,< er �C QtL,C4' ' Insulation
Telephone Email address D Demolition
5.2 Re istered Home Improvement Contractor(HIC) �2 / /
1d>b L a�
v A i�'e HIC Registration Number E irati n Date
HIC Company Name or HIC Registrant Name
Gr'drn ea-rI,L V.r. -reez/ 4 A,ee-- 5— gJdL. Ca '
No. at Street Email address
CiL Town, State,ZIP 0.24-05- 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 0 No lam"
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PPERMITI,as Owner of the subject property,hereby authorize AO b e ri 1e Ii 1Aker'
to/act on my behalf, in all matters relative to work authorized by this building permit application.
¢ ' 4" i C 07/7C Z I/ 2 - s '.4 a
Print wn i Name(Electronic Signa�ure) 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
i
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"
The Common wealth of Massachusetts
A .�.74h Department of Industrial Accidents
Ent'im1= 1 Congress Street, Suite 100
Boston,1.4
MA
A 02114-2017
;;s• www.mass.gov/dig
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information _ Please Print Legibly
Name (Business/Organization/Individual): ,/161 e,• / Gez,a
Address: 7
City/State/Zip;4/3 0,(7;jvf�d // 0.2(7f Phone #: 7 d 3 4- i / ��
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. am a sole proprietor or partnership and have no employees working for me in
any capacity.[No workers'comp. insurance required.] 8. ❑ Remodeling
3.❑I am a homeowner doing all work myself. [No workers'comp. insurance required.]t 9. ❑ Demolition
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 11.7 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.
These sub-contractors have employees and have workers'comp. insurance.: 13.❑nRoof reyp�airs
6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 1�'L�t118r1i eC iC MAW('
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.
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 g 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 certifyifl under the pains,and" penalties of perjury that the information provided above is true and correct.
Signature: 6 e% ' D� � Date: 2 - 6- - A d
Phone#: 3C7-
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
1146 Route 28, South Yarmouth, MA 02664
508-398-2231 ext. 1261 Fax 508-398-0836
Office of the Building Commissioner
BUILDING DEPARTMENT
DEMOLITION DEBRIS DISPOSAL AFFIDAVIT
Pursuant to M.G.L. Ch. 40, §54 and 780 CMR - Section 105.3.1. #4.
I hereby certify that the debris resulting from the proposed work/demolition to be
conducted at C o c/e if
Work Address
Is to be disposed of oat the following location: 27,en,vofQ 1 , TA11-n`s
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Ch. 111, §150A.
��� d
•
Signature of Application Date
Permit No.
Office of Consumer Affairs & Business Regulation-Mass.Gov Page 1 of 2
•
Mass.gov
Office of n Co sum r
e
Affairs and
Business
Regulation (OCABR
HIC Registration Complaints
Registration # 182141
Registrant ROBERT B. WALKER
Name ROBERT WALKER
Address 9 CROMWELL DR.
City, State Zip YARMOUTHPORT, MA 02675
Expiration Date 02/27/2020
Complaints Details
No complaints found for this registrant.
You can also view arbitration and Guaranty Fund history.
Back To Search
Site Policies Contact Us
https://services.oca.state.ma.us/hic/licdetails.aspx?txtSearchLN=182141 2/14/2020
YARMOUTH WATER DIVISION
99 BUCK ISLAND ROAD
WEST YARMOUTH, MA 02673
PH.: 508.771.7921
FAX: 508-771-7998
BUILDING PERMIT APPLICATION
_ DEPARTMENTALt� SIGN OFF TRANSMITTAL SHEET
i /
Bldg. Site Location C u e/e / ,' Warr. Leri:1
Proposed Improvement: ,Z') e c /k---
Applicant: 46s Co"P /'/ 64�/,1 4 A" •.2 r-
c1' C✓`C/.-rj ui e •C C to r-
Address ,y /v/P9o7Orf%/i 7.4e 6: #: 3r0' g`— v� Date Filed: 2 - 7 .-- 2, o'
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 ..
X 7/0(c... --7 ,,, -
2 7 zc.
Signature of applicant
Date
PLEASE NOTE:
COMMENTS:
l-/1Reviewed by: Water Division v D /72- �
ate
• ' rot_Y yky TOWN OF YARMOUTH
• HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
Building Site Location: 7 Cave n
Proposed Improvement: V e K ,EX Ire/7 , / D '-1
Applicant: G/ GY6 e Zit' )^ Tel. No.5 3 t� .� / 5 2
Address: 7 C rc2 /7I 1/f L L >O / , A/l/1 ee to Filed: 2
**Ifyou would like e-maili notification of sign off please provide e-mail address:
Owner Name: /'//9/1/ C C``7,7 e
Owner Address: 7 Cot/' 1 % Owner Tel. No.:60 V 790 .2 91(
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: Mn/LDATE: /2-e) W
PLEASE NOTE
COI ENTSICONDITIONS:
`vuw�s a���?ID Ake Q(//C41414 rt iteaft PiA4
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a is��a "Pia
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40 4 --fie,
oo.
LOT 62
c;. `�4) 18600 ± S. F.
v
J ��(/ i
eep `` PROPOSED
ADDITION
edr06 S %
? #7 PROPOSED
AP
4 4 ADDITION 00
PROPOSED 4. lei ht0'
ADDITION 10
14O3 ,4
SEPTIC
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h~ TANK . Oct?. ,, .V-
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�`:4 RAY •
.D-BOX ''l p T/4& b
N Z20 °'PS h
70 OF YARMOUTH ZONING sl"ye�•
' ;�,, LOCATION OF SEPTIC SYSTEM
ZONE = R-25 COMPONENTS TAKEN FROM
SETBACKS : AS-BUILT.CARD.
FRONT - 30'
RF04OR 14 .
TOWN BYLA 'rS: '' ,; THE LOCATION OF THE ORIGINAL DWELLING
de SHOWN HEREON EITHER WAS IN COMPLIANCE
- -- 0'2-17. WITH THE LOCAL APPL ICABLE ZONING BYLAW
YA R M 11 T -WATER r; IN EFFECT WHEN CONSTRUCTED t W I TH RESPECT
TO HOR'ZONAL DIMENSIONAL REQUIREMENTS ONL YI
OR EXEMPT FROM V IOLAT ION ENFORCEMENT
I HEREBY CERTIFY THAT ACT ION UNDER TITLE V I I CHAPTER 90A SECTION 7.
•
THE DWELLING DEPICTED ON THIS ' •
PLAN WAS LOCATED ON THE GROUND PLOT PLAN
BY SURVEY ON JULY 10. 2002 •
IN
AND EXISTS AS SHOWN AS OF THE
DATE OF LOCATION. YARMOUTH. MA.
SCALE: I'-40' AUG. 5. 2002
-,� THIS PLAN I S FOR PLOT PLAN
I PURPOSES ONLY AND NOT FOR REVISED OCT. s AOCT. 16. 2003
" EAGLE SURVEYING. INC
Y'7 RECORDING, DEED DESCR I PT IONS { V /-AL oss welt. OA
1 ¢ma re i ' c Yarot isrt. MA. O2S 5
OR ESTABLISHING PROPERTY LINES. /4/a.. 3 • s `-
-`-.�N. to) 4J2-O 3
5C
THIS PLAN IS VOID IF NOT _ __
STAMPED AND SIGNED 1N RED. 0 20 40 80 PROJECT NO. E129 ''
L m
•
° •YAi`r
i -r . o Town of Yarmouth
roi , , y. Conservation Commission
ATTAGM fi SE, Building Permit Sign-off Application
��JOGpe;:J
TO BE FILLED OUT BY APPLICANT: /�
Building Site Location: CEO d-� / q/r
Map # I T Lot(s) # 440
Property Owner: i?/9fi/
Applicant: /90 4 e r Chi /4'lY e,
Applicant Address: 657 C 70 4 e/ JD/^.
Telephone: 0 Date Filed:
Email: 7 0 G4474,/c- e 6 q0 i , C a/4'
Proposed Project Description:
Co vvl.J2✓ /de c!r' ?—ltS/e,
Plans: Y of Act i2.00 a .
TO BE FILLED OUT BY CONSERVATION ADMINISTRATOR:
Do You Have A Vali kermit From The Conservation Commission For The Proposed
Project?
Comments from Consery n Commission:
Approved Conditionally 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
Conservation Commission Sign-off Signature: A2:112_,--Not
Date: Z li cy//,O a O.
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,A,a ., „ ,,, ,,.,: , . - .,,, ,,•—•,,,-, GENERAL NOTES:
, 1 / /1. ./A'
7 17, 57 1
e411 r' - 1 .) ALL MEMBERS TO BE CI
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r E, c , ‘ ,,,,,, 2.) CONSTRUCT ALL DECK
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3.) ALL NALL SHEATHING t
41 ALL ROOF SI4FATI4INtry 1