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HomeMy WebLinkAboutBld-20-004233—t 1/1V\ 9 , ti� ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department of 1146 Route 28, South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 Massachusetts State Building Code, 780 CMR Building Permit Application To Construct, Repair, Renovate Or Demolish • ' VE a One-or Two-Family Dwelling EI1 I _ This Section For Official Use Only , Building Permit Number:-A(/"61 4/233 Date Applie • � Bu l thCS � , oz, " 01\O 'By I L NT Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers .?4y 70/A€7- Y/ Oviii/ livto) /4 f o 7/ 73 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: /9t(, 2Sff,ir Zoning District Proposed Use Lot Area(sq ft) 0,got, 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 Private❑ — Municipal 0 On site disposal system Check if yeslg SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Glr/£ fr R-Apn t7 s 4 yi 4 14ys,0 iavri f »oy - o uIy Name(Print) City,State,ZIP Aeypi�-sS ?al. .i— 11,07 yi3-23?—,oy7/ Mw.rsn.AAO/,► 4 &pPit-awi No.and Street Telephone Eufail Address SECTION 3:.DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building( Owner-Occupied 4 Repairs(s) fkr Alteration(s)it Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: it2,IIrDy.9-��Kl p.0.C/$Tisfh7-injA ZOO,i Ofi'�, Z¢,t3'. 4 0.?, 4,r9 1f4 E lb.�rr/ 07a., 0A-Ak,.., 4 oa /,v .dern�, 1L2.Q. 4 _, ..__-- - ,.,w,. iv !,/L — `✓d A. fir V E D 3{77.- 40 SECTION 4:ESTIMATED CONSTRUCTION COSTS 14 .__ s Item Estimated Costs: ' - "' Official Use Only JJ (Labor and Materials) Y L_ 3�H,D�C 1)CrAq —ME 1 NT 1.Building $ 0 le1. Building Permit Fee $ 1 S6 Indicate hovi3pe is determined: 0 Standard City/Town Application Fee 2.Electrical $ `Do q"' ty . . ,n PP � 0 Total Project Costa(Item 6)x multiplier x 3:Plumbing $ Do V006— 2. Other Fees: $ j 4.Mechanical (HVAC) $ List 5.Mechanical (Fire Suppression) $ ,/4 Total All Fees $ - . Check No. Check Amount: Cash Amount 6.Total Project Cost: $ 0 fG ----I17p Paid in Full 0 Outstanding Balance Due: 1 VS SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number Expiration 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 l&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 Registered Home Improvement Contractor(HIC) HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name No.and Street Email address City/Town, State,LIP 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: 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 a plication is true and accurate to the best of my knowledge and understanding. IYr,„„,r, , 4. of r/mod Print Owner's uthonzed Agent's Name(Electronic ignature) / 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.gov/oca Information 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.) .C34D SO 1nT (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) „2i386 StiTcrEl hoot_,yr1) Habitable room count 7' Number of fireplaces .2. gASenle Number of bedrooms o- Number of bathrooms a*. Number of half/baths / Type of heating system 6 4-f-fp gle 414 Number of decks/porches o2. Type of cooling system 6,/ - Cc�,✓ Enclosed Open ✓ 3. "Total Project Square Footage"may be substituted for"Total Project Cost" r � The Commonwealth of Massachusetts Department of Industrial Accidents ' _ii11_ 1 Congress Street, Suite 100 ='••F_/75 Boston, MA 02114-2017 'v, 5�•" 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/IndividuaI): 4Gr/4.0j I, 117. 4j,..4, Address: a? yyp 0,/N,• 1Y1 y • City/State/Zip: jov n y4ain/>� '4Z4- 0-w y Phone#: y/ii---Z32 o y7/ Are you an employer?Check the appropriate box: Type of project(required): i.❑I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. © Remodeling any capacity.[No workers'comp.insurance required.] 3. 1 am a homeowner doingall work myself. t 9. X Demolition y [No workers'comp. insurance required.] m a homeowner and will be hiring contractors to conduct all work on my p roPry•e I will 10 El Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.X Electrical repairs or additions proprietors with no employees. 12.IX 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•❑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#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 verification. I do hereby certify under th pains n penalties of perjury that the information provided above is true and correct. Signature: Date:°/<�1,d10 Phone#: 4.1/,'. 37--G r12/ 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#: - 61"• A�q TOWN OF YARMOUTH u - 4 BUILDING DEPARTMENT „gip=t p E% o 11.46 Route 28, South Yarmouth,MA 02664 508-398-2231 ext. 1261 sz, HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DA'1h: JOB LOCATION: 'Y'- //AvrGyi9 y f;r7i-, ¢ viii1 AI# 0-24Y NAME STREET ADDRESS SECTION OF TOWN "HOMEOWNER" Wt4'Im 47, `Yyn0r.r ,T,¢. yi3-237-oy7/ NAME / HOME PHONE WORK PHONE PRESENT MAILING ADDRESS .7 c,irs-./favNr�i $ovn3� y/1•r�o vr� A,w- D- 6G7 CITY OR TOWN / STATE 7W CODE The current exemption for `Homeowner' was extended to include owner—occupied dwellings of one or two units and to allow such homeowners to engage an individual for hire who does not possess a license,provided that such homeowner shall act as supervisor. (State Building Code Section 110 R5.1.3.1) Definition of Homeowner: Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is or is intended to be, a one or two family attached or detached structure assessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner;such"homeowner"shall submit to the building official, on a form acceptable to the building official,that he/she shs11 be responsible for all such work performed under the building permit. (Section 110 R5.1.3.1) The undersigned `homeowner' assumes responsibility for compliance with the State Building Code and other applicable codes,by-laws, rules and regulations. The undersigned `homeowner' certifies that he / she understands the Town of Yarmouth Building Department minimum inspection procedures and requirements and that he / she will comply with said procedures and requirements. HOMEOWNER"S SIGNATURE 2 • APPROVAL OF BUILDING OFFICIAL INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL Ch.142. Yes No If you have checked es, 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 e ass. General Laws and that my signature on this permit application waives this requirement. Check one: Signature of wner Owner's Agent (Owner) Agent h:homeownrlicexemp '� Y o TOWN OF YAR1YIO UTH :y c BUILDING DEPARTMENT • Y,\ -•..l S 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 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at .2 Gyt'/l S Time,-`I//y Si✓ttj/�j 47#4,1--D.4GY Work Address Is to be disposed of at the following location: littonow, 19Ati.- Said disposal site shall be a licensed solid waste facility as defined by 1 .G.L. Chapter 111, Section 150A. /if/ )- e 1 4/2 OLP Signatu AppticatIoII Date Permit No. • ON-..:1k TOWN OF YARMOUTH �; = 'fir ,itt.t1 2 g 2020 V c HEALTH DEPARTMENT k HEALTH DEPT !, ,.,,t• PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To he completed by Applicant: Building Site Location: v? Cyr CC�14r,r l ?y :-ovo'y/sighlev 494 0,2‘4Y Proposed Improvement: gem,Weil-MA.6' eV- A(" n/cy,RDo,,,Of c-1 5949,e eoo, Awn /y411.17, f LDAh�l"0-veyJo,i/ ZPF h'L WeE kv 3g► h2 44E0- } ire ioi U,Po 01g an AND ihvr, iii4 JYx12✓e /4 L 7 dig c`-,,ile -c.e(- fr sue,. Applicant: k0111 "' A I ,.iv Tel. No.:943-„??7—ei 7/ Address: ,,? LyFie 7e1 IVflV &DvF1'A .R./flo' l 1)74-4p/GY Date Filed: o?7c--11o?4.a) **If you would like e-mail notification of sign off please provide e-mail address: 49U.. J'iZ..1, , c LDi¢1L,e1M7 Owner Name: // a>ram A, AilimAiw 72, Owner Address: oityag.Fgs PoMJr Zv 1 sOU zi/i itmaw/l h2)94 d y Owner Tel. No.: 9/3-..?37-b97/ 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. i REVIEWED BY: ?1--\11j/.. DATE: I I\c/I AC k)' PLEASE NOTE COMMENTS/CONDITIONS: . EXISTING BASEMENT FLOOR PLAN - 2 Cypress Point Way, South Yarmouth MA 02664 Septic Pipe Basement Casement Sliding Windows Flow Existing Unfinished Basement Area - 45' x12' = 540sgft Gas Furnace Water • Supply Existing Water Heater Sauna Room Electrical 6' x6' = 36sgft Panel Doorway to Doorway to unfinished bathroo ► 11. basement 0"/ area Existing Half Bathroom otair Doen 6wx 6o = 36 sq ft Existing Family Room (-ASP hallwa - Existing Office 19' x14' = 266sgft Existing 15' x12' = 180sgft • Hallway & as""wide x 7"-riser Laundry Area 6' x5' = 30sgft Doorway to Doorway to Sliding door hallway ® (+1 hallway to backyard Doorway to Double Hung Window 2x Double Hung Window backyard REVIEWED FCT 1.!"'.i:l"!, ANC "Vift CO:'¶PLI- ANCE. ERR^i,.. ;;Sr;'S nO NOi -:rLIEVE THE 7kOc1 THc P.LSPOt�SIBILli Y OF"AS BUILT" �'� COMPLIANCE, Sketch not to scale DATE: ci,— Prepared By William A.Wyman,Jr.,Owner&Applicant 27 January 2020 BUILDING L,IAL RENOVATED BASEMENT FLOOR PLAN - Cypress Point Way, South Yarmouth MA 02664 n Septic Pipe Basement Casement Sliding Windows � , Flow Xi 100- 1111 Unfinished • Unfinished Basement Area New Office Basement Area - II' x13' = 143sgft 9' x18' = 162sgft 9' x11' = 99sgft Gas Furnace 0 �i Water � Supply i 111 Water Heater Full Bathroom & Electrical 10 Panel Laundry Area INommommimOb Cased Openin between ► Family Room and Office 8' x 12' = 72 sq ft Doorway to Family Room Open hallwa 0 Office 19' x14' = 266sgft Stair 15' x12' = 180sgft 01% �� Case II . el% I\ 45"wide x 7 . 4i riser 40 Doorway to 6' 5' = 30 sqft Doorway to Sliding door x hallway hallway to backyard 41.....m•i.110. Doorway to Double Hung Window 2x Double Hung Window backyard JAN 2 9 2020 Sketch not to scale r Prepared By William A.Wyman,Jr.,Owner&Applicant HEALTH DEPT. 27 January 2020