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HomeMy WebLinkAboutBld-20-004541 v- -, ,___(2,—/A-4a: "----/,--1/ .0 ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department ....... 1146 Route 28, South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 • __r' `"'1t 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: 3L7,-og0 0 ysy Date Applied: ] r1• SQACs �/- . ,"a.1-kit Building Official(Print Name) Signa,tu Date SECTION 1: SITE INFORMATION 1.1&o.p,rtyAiddryss:, 1.2 Assessors'YI p&Parcel Numbers 1.1 a Is this an accepted street?yes no Map Number Parcel Numbe$ 1 . , I ' Cl 1.3 Zoning Information: 1.4 Property Dimensions: i t Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) f a 1.5 Building Setbacks(ft) 7 s' D C. L;r-F;A P-r4•L;:, Front Yard Side Yards Rear Y'ard r m-,Z -- 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: Public` Private❑ Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 \ Check if yes❑ SECTION 2: PROPERTY OWNERSIDPI 2.1 pwnerl of Recgrd: ya 6evf �' Ae r". rp 5 v /42'4') ' rota - Name(Print // City,State,ZIAl/, (en/ 4i7 40A, 4/Tr-f tit t JF IeM,ee / j 464 No.and Stre t Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied ❑ Repairs(s) 0 Alteration(s) . Addition 0 Demolition ❑ Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Desc iption of Proposed Work2: wye wt1// jt ik.•(.r,,) ,ke 4 rN 7t" Zi if,,,/el�.�'✓. ., 4(A. Ali c ry hi --IC E I V E 1 4 SECTION 4:ESTIMATED CONSTRUCTION COSTS i -, ' { i 1 Estimated Costs: i i Item Official Use OnlyL. ...:... W�• �,--i'MF NT (Labor and Materials) , ,tOiNG G 1. Building Permit Fee:$ 7 5 Indicate how,_ 1.Building $°�(, , t/?) . fa 2.Electrical $ aStandard City/Town Application Fee ` 0 Total Project Costa tern 6lx 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: $ I Orb J ❑Paid in Full IS)Outstanding Balance Due: 40 SECTION 5: CONSTRUCTION SERVICES 5.1 onstruction Supervisor License(CSL) et ///-(/f A,2(rt.?i)je es-- "3 9/3 "a License Numberumber D Expiration D to Name of CSL Holder 4/G Y l!7A;��C Dil v`j List CSL Type(see below) 11 No.and Street A. Description (F r ilL (/1 // �1 d , I //�/j� U 7� # Unrestricted(Buildings up to 35,000 cu. ft.) Restricted 1&2 Family Dwelling Ci /Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding ,/ / SF Solid Fuel Burning Appliances S,k3c7-a7d (old ( dt /4rlus40/0i/' I Insulation Telephone Email address D Demolition iiiRegistered Home provemenntJContractor(HIC) J���� /d �/-c Q/��f (I" HIC Registration Number Expiration Date d S ant • or HIC istr t jQame C� �' S p /"�i /i�7°J� 1 GY (of ofa, 'tc a�/r(VS/4fl �in (and Street //I _Y y `6 3� Email address '�frl/�t-f�d' v/'G" Ud City/Town, State,Li? 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 Issuanc the building permit. Signed Affidavit Attached? Yes No ❑ 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 coats.' d in this a plication is true and accurate to st of my knowledge and understanding. 1/41-?S. Print Owner's or Aut • e Agent' ame(Electronic Signature) / Date NOTES: 1. An Owner who o a • • ., rmit 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.2ov/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 Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 ,�,.• www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information / 1/ Please Print Legibly Name (Business/Organizaation/Individual): S e& ((A/ 111.5,4.I*S 2 4 Address:d3 Adi ' T 'S Thi/tl City/State/Zip:sQ . '/c Oro- ( '/!c( Phone #: 35f Jo i-,5- 7er Are you an employer?Check the appropriate box: f Type of project (required): l.. i am a employer with ( employees(full and/or part-time).* 7. E New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in . anycapacity. 8. emodeling p ty.[No workers'comp. insurance required.] 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 myroe I will 10 Building addition property.rtY ensure that all contractors either have workers'compensation insurance or are sole 11.E Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.0 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.t 13.0 Roof repairs 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 41 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: -TA/ Policy#or Self-ins.Lic.#: F!( << 7d .�!6 /'17 /old/ Expiration Date:/c) / Job Site Address: (;F 7 (2/2 1 Itic.✓-1 I F) City/State/Zip:, ` -"a/ r4 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 cer fy under the ins and a ties of perjury that the information provided above is rue and correct. Signature: Date: 049 Phone#: Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/Licenser • 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#: nrt — TOWN OF YARMOUTH lei, o BUILDING DEPARTMENT • Y `�`� = $ 1146 Route 28, South Yarmouth,NIA. 02664 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 111.5, I hereby certify`that thedebris resulting from the proposed work/demolition to be 6 conducted at 7 ( G r a 5e (.lip/114-14 4' Work Address Is to be disposed of at the following location: 10zA"N C/a /44144 — Said disposal site shall be a licensed solid waste facility as defined by M.G.L. apter 111, Section 150A. Signature P. Appliie lion Date Permit No. Client# 765382 2SANDDOI • AdORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 12/04/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer any rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME: The Hilb Group of N.E.dba PHONE 508 775-1620 FAX 5087781218 Dowling&O'Neil Insurance Agy E-MAILo,Ext): (A/C,No): ADDRESS: P.O.Box 1990 INSURER(S)AFFORDING COVERAGE NAIC3 Hyannis, MA 02601 INSURER A:A.I.M.Mutual Insurance Company 33758 INSURED INSURER B: Sand Dollar Customs, LLC 23 Whites Path, Unit G,Suite 1 INSURERC: South Yarmouth, MA 02664 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER POLICY EFF POLICY EXP (MMIDD/Y1'W) (MM/DDlYYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACHpESAAMM OCCURRENCEEE70 PREM $ CLAIMS-MADE OCCUR {Ea oca rF nce) $ MED EXP(Any one person) $ PERSONAL&ADV INJJRY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO- POLICY ..ECT LOC PRODUCTS-COMP/OP AGG $ OTHER' $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Es accident) $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY -_ AUTOS ONLY (Per accident) UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION WCC50050197212019 12/04/2019 12/04/2020 X STATI ITF FOTH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y 1N E.L.EACH ACCIDENT s500,000 OFFICER/MEMBER EXCLUDED? Y N IA (Mandatory In NH) E L.DISEASE-EA EMPLOYEE $500,000 Eyes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT s500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions.The workers compensation policy does not provide coverage for individuals,partners,or members unless otherwise stated. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S248633/M248632 TB1 aBoiseCascade - Triple 1-3/4" x 14" VERSA-LAM® 2.0 3100 SP PASSED FB01 (Floor Beam) BC CALL®Member Report Dry I 1 span I No cant. November 13,2019 13:58:03 Build 7295 Job name: Lemiere File name: Bobola-Lemiere Address: 67 Captain Wright Description: City, State,Zip: Yarmouth, MA Specifier: Customer: Bobola Designer: Kevin Lonkart Code reports: ESR-1040 Company: Mid Cape Home Centers 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 111 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 01 1 1, 1 1 1 1 1 1 1 1 1 1 1 1 1 Jk / B1 18-00-00 B2 Total Horizontal Product Length=18-07-00 Reaction Summary (Down / Uplift) (Ibs) Bearing Live Dead Snow Wind Roof Live B1, 3-1/2" 3624/0 1406/0 B2, 3-1/2" 3624/0 1406/0 Load Summary Live Dead Snow Wind Roof Tributary Live Tag Description Load Type Ref. Start End Loc. 100% 90% 115% 160% 125% 0 Self-Weight Unf. Lin. (lb/ft) L 00-00-00 18-07-00 Top 21 00-00-00 1 Ceiling Unf.Area(Ib/ft2) L 00-00-00 18-07-00 Top 30 10 13-00-00 Controls Summary Value %Allowable Duration Case Location Pos. Moment 22228 ft-lbs 51.0% 100% 1 09-03-08 End Shear 4240 lbs 30.4% 100% 1 01-05-08 Total Load Deflection L/397(0.547") 60.4% n\a 1 09-03-08 Live Load Deflection L/551 (0.394") 65.3% n\a 2 09-03-08 Max Defl. 0.547" 54.7% n\a 1 09-03-08 Span/Depth 15.5 %Allow %Allow Bearing Supports Dim.(LxW) Value Support Member Material B1 Column 3-1/2"x 5-1/4" 5029 lbs n\a 36.5% Unspecified B2 Column 3-1/2"x 5-1/4" 5029 lbs n\a 36.5% Unspecified Notes Design meets Code minimum(L/240)Total load deflection criteria. Design meets Code minimum(U360)Live load deflection criteria. Design meets arbitrary(1")Maximum Total load deflection criteria. Calculations assume member is fully braced. BC CALC®analysis is based on IBC 2009. Design based on Dry Service Condition. Connection Diagram: Full Length of Member b d • F• • Page 1 of 2 Boise Cascade - Triple 1-3/4" x 14" VERSA-LAM® 2.0 3100 SP PASSED FB01 (Floor Beam) BC CALL®Member Report Dry I 1 span I No cant. November 13,2019 13:58:03 Build 7295 Job name: Lemiere File name: Bobola-Lemiere Address: 67 Captain Wright Description: City, State,Zip: Yarmouth, MA Specifier: Customer: Bobola Designer: Kevin Lonkart Code reports: ESR-1040 Company: Mid Cape Home Centers Connection Diagram: Full Length of Member a minimum=2" c= 10" b minimum=4" d = 12" e minimum= 1" All FastenMaster screws may be installed from one side of multiply Versa-Lam beams. Connectors are: FMFLOO5 Disclosure Use of the Boise Cascade Software is subject to the terms of the End User License Agreement(EULA). Completeness and accuracy of input must be reviewed and verified by a qualified engineer or other appropriate expert to assure its adequacy,prior to anyone relying on such output as evidence of suitability for a particular application.The output here is based on building code-accepted design properties and analysis methods. Installation of Boise Cascade engineered wood products must be in accordance with current Installation Guide and applicable building codes.To obtain Installation Guide or ask questions,please call(800)232-0788 before installation. BC CALC®,BC FRAMER®,AJSTM', ALLJOIST®,BC RIM BOARD' ,BCI®, BOISE GLULAMT"",BC FloorValue®, VERSA-LAM®,VERSA-RIM PLUS®, Page 2 of 2 • .9:4 Wae->2,i-Ao-r4zoeailo-/ 4- Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, M-,-=``=\husetts 02118 Home Improve .: tractor Registration Type: Corporation rdt SAND DOLLAR CUSTOMS LLC - x. Registration: 103567 1851 FALMOUTH ROAD "' '"-L' ` • � Expiration: 10/29/2020 CENTERVILLE,MA 02632 W + o h fr ..r �. "4 yPl� `�" \, ti°ocf -. .ti Update Address and Return Card. SCA 1 0 20M-05/17 ...Fee Fsin ezaeue,+etcggh°a Ja iereAle/4 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TY orooration before the expiration date. if found return to: 1;„,..,. Expiration Office of Consumer Affairs and Business Regulation _= - 10/29/2020 1000 Washington Street-Suite 710 SAND DOLLAR:4 r' 2, a Boston,MA 02118 s, s (i() W b—JJ9 WALTER R.WA i - ` \2x-cal---- 1851 FALMOUTH W we Li CENTERVILLE,MA 02632 Undersecretary Not v:'' • I out -ignature • i:. Commonwealth of Massachusetts [ rDivision of Professional Licensure Board of Building Regulations and Standards Constr t %upervisor CS•091653 Nip ires:09/30/2020 WALTER R -, 40 ALEXAN !DR ° .. TARMOUrH P MA `'` Commissioner l I T BEDROOM BEDROOM rl I - ---. NEW CLOSET en-- TBATHROOM © i MM....". BD IA BEDROOM W/E. CLOSET .\ OXON EMT 1.111.r .11 IL'',HAFT 1 I AT ••• ••II ME II ••• ( {1 0— 1:3 IL D wALL Ls A. AocAlION M BATH ---tk_ 2A6 WALIS-2.T... jpr;TALA:,e0,.c.,,,,.....nt•TO mid MST .00111011 FLOOR PLAN SCALE:1/4,1' SECTION A-A ISCALE:1i41 I T 11' r5i7N c.)F REvE.\AL--.....,- FC'.- 'IL'7,;N::ANC:,7,v. :',..TDOE COMPL- I-- ----- ANCE ERRPI ;'),i I. , !SSI:'%:\!S DO NOT r\'-'!:_LIT-JVE.1FII: APPLICLI'4I c'ROM THE RESFON6IBILI i Y OF'AS BUILT" NOTES: COM?LiAN'OE 1.SEE CODE CHECKLIST FOR SPECS,ETC, DATE: . --_( :_lN1-"ctO name ` 1 00 SAND DOLLAR CUSTOM HOMES ,......... ----BUILDING ,FICIAL CAA m on. I ro FOUNDATION PLAN SCALE:1/41' '::7::::::P;DT 772. NEW:::M 0 N 20:„.....d...g. 0*Appro....«.—..., kEt11819-00 :::,,,1 ...,..... (l4-..'„ 'il-,9 FZ,' P 0 Dyr ,,i 6 E_.L. -.4 -I'i