HomeMy WebLinkAboutBld-20-004088 , --e---04.4%- //6*
ONE & TWO FAMILY ONLY- BUILDING PERMIT
Town of Yarmouth Building Department of r -__
1146 Route 28, South Yarmouth,MA 02664-4492
508-398-2231 ext. 1261 Fax 508-398-0836 .. �' ■
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Massachusetts State Building Code, 780 CMR
Building Permit Application To Construct, Repair, Renovate Or Demolish R ` ti J v , D ,
a One-or Two-Family Dwelling
This Section For Official Use Only AN 2 2 20' 7i' d €
,� Date Applie . 4 Building Permit Number: (,�'o�� � OQ � _
�i BUILD! DAP' • „Nca
i)r �Q.Ac•S . - 3.�-4.0 8 .,�G� ,
Building Official(Print Name) ignature Date
SECTION 1:SITE INFORMATION
1.1 Property Addr ss• 1.2 Assessors Ma &Parcel Numbers
MS Cap ��- .��urw�, ii'�,, 1'�.-f 6 I�
1.1 a Is this an accepted street?yes no Map Numbe Parcel Num I e
1.3 Zoning Information: 1.4 Property Dimensions: 6 a I
€ " It 6 t
Ji-oZoning District Proposed Use Lot Area(sq ft) Frontage(ft -
1.5 Building Setbacks(ft) Vl1iLC301��L. PARTME r
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 LEI Private❑ Zone: — Outside Flood Zone?
Check if yes❑ Municipal 0 On site disposal system 0
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Z j,\ Ceti-tc.,r&k..". 6c07 Zeiroitt,,,,,,k(4f0,-+ Av 024 9,f-
Name(Print) II,c lv7JAi n1.9 City,State,ZIP
Lb— (vw•e,k eAr 1'ZdA 12y 5. 02 9i-832f la corcu r•17 O WA Zo r•re,f
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK''(check all that apply)
New Construction 0 Existing Building lir Owner-Occupied ❑ Repairs(s) 0 Alteration(s) [$I Addition 0
Demolition lf21 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Desc 'ption of Propose Work2: e. ` 10 07 '
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials) i
1. Building $ vs-pip 1. Building Permit Fee:$ 50 Indicate how fee is determined:
IN Standard City/Town Application Fee
2.Electrical $ k 1 Yoe s
0 Total Project Cost (Item 6)x multiplier . x
3. Plumbing $ y/oee 2. Other Fees: $ 36-_,
4.Mechanical (HVAC) $ ' List:
5.Mechanical (Fire $ �.
Suppression) Total All Fees:$
Check No. Check Amount: Cash Amount::/
6.Total Project Cost: $ ?--0,S 00 0 Paid in Full ®Outstanding Balance Due: 1 I S
The Commonwealth of Massachusetts
Department oflndustrialAccidents
1 Congress Street, Suite 100
ker Boston, MA 02114-2017
;�,�•'�y 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/Individual): S(,ltk$ ��fr k Sic
Address: b TV)
City/State/Zip:\••\IN(LLs f AM 0/144 ( Phone #: SO F " 2y/ -3 79 3
Are you an employer?Check the appropriate box:
Type of project(required):
l.[i am r�a employer with d' 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.E I am a homeowner doing all work myself. [No workers'comp. insurance required.]t 9. C Demolition
4.D I am a homeowner and will be hiring contractors to conduct all work on m y p roPm'
e I will 10 Ei Building addition
ensure that all contractors either have workers'compensation insurance or are sole 11..] Electrical repairs or additions
proprietors with no employees.
12.D 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.t 13. Roof repairs
6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other
152,§1(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: / "`'v \\0„4[Allirci
Policy g or Self-ins.Lic.#: / (� q& .4 C. 0 .S uir Expiration Date: 9.//O/ 12-a
Job Site Address: t"Ir (ek k tS T City/State/Zip: Yariwo g P ./10 ?19)--
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 er tl ains and pe 1 ' p jury that the information provided ab ye is t ue and correct.
Signature: , ✓ Date: / ;7/ 0
Phone#: .5 1 C - [/- 3? 73
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#:
SECTION 5: CONSTRUCTION SERVICES —
1`Ccins\ ton\tl�e r I,iccnse(CSL) —_-- ._—
ti,.._ .;t SI :1.,11,:r
4 , t X `)' � T_ L,�
u
f IaL 'cci' . yA L '•9L ,`—[ti 1.ti,ci tie iliil:lii 197 itri,•i
41 ' Masonr.
--
ki: —
R. ,r
——
�11\ t f 1. 5 -_
t _TIA4t in -t tl0t'
or —__—E:rat: tea e:a r D ' D i t.f,..,
• 5.2 Registered I-ionic Improvement Contractor(}IIC)
1EC C, r \ �1r III d t.ai ?':r t.• ._. tC R .t. ..r .,, iai r
V i � (j 1 / r
. rctkiy
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SECTION 6 WORKERS'COMI'I Ns. Ilt)N INSURANCE AFFIDAVIT(\LG.L.c. 152.§ 25t t(i)j
'It itr er-.42,qr.pc.r..,;atta lt:: li lc ittla;'rit niu t b.':Cell,pt..ted and slihmitieri vdth this aptli t tiro .•it Ittr tt lilt` tip
this i,.ti lv,t',kill result It ni tile denial c t the Issuance .,t the hu idin?..permit
SECTION ia: OWNER AUTHORIZATION TO BE COMPLETED WHEN
N
OW`iER S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I as l+vca, dis t i),c t I:e e hereby a t,.:ze S Cca-'t
to c:or.in, eh:i! ni d.l_l,ttc._S.t-elative to Won,—,au hori?c `. tins hulhILlc rt.,tt.t d:p t-it'`[i.
WIIIr4M
tkry Zoe
1) .,
t —
SEC l ioN 1) OW NERI OR AUTHORIZED AGENT DECLARATION
Dt. enierurL my tiaire heIiv, . I i,crehy attics:under the pains and
penalties f pe it — that ail of t e int.. in:V.1Q
CO.,t:illed !II is L. ':r rl`!caiint: :`;trtle and accurate:C tile hcj'°lint, knowledge and imderstatida;
�._
Crate
I A:: ') c li , ;i ..„tau: _bu.ld.n psi :to i s hi. 1hii, cm:: wort`_.. ,;;1:: ,
.' r � o Eli:cr.an inir _r 'e ,t i�t,
in.): i.: red it:u-e Il • L ,
t._
' � is ,tr ia:'_ rtO'IU:.ct +FIir iI nsail ti I,tctLi)e c „ x ;. 1 ,
'rill f t fima under\Il•.L:. c 1 (1 1 s information IBC .l t�_, tint ,_.ir i.inn on tile I ar r Cu:an
a I_
. . •l.. 'Tl'' .zC' 0 ,lt ? (;O:l on t!':t LJ.1::(.!L'tiL[I Supervisor License Ly'.r,be round ii. :-:v' "13� il_ t`G . .-.
'Allen 1.
t. rian?ed,pr:;'..dt the infortr.a6ttn.ekes `__
T Ot n. '' area
itorar !sq. Et (tricluding garage fine:-,ii basemen:.iiuk, S:e:.:; •:nrc-t
it
Gross its-, i area i,sq. fl.) _ Lahtt_bde room L, �i_
NLimber of fireplaces scec
Number of p dr • m
um'cr of ba ;-cou.
__ Number+it h 1 —
`
Tvne of h tin:system Number of decks I"i.. f'c.
-
L l ot.. . . ,, 5,IL.:.J Footage. tTl be.r4t�.�.....:i .. :i. IC `•I+'..i;Project Cost'
t'_
y o TOWN OF YARMOUTH
'yg c BUILDING DEPARTMENT
• •
0, -ft-0 69 114-6 Route 28, South Yarmouth,MA 02664
s- 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 I, Section 111.5,
I hereby certify that the debris resulting from the proposed work/demolition to be
conducted at LIS- (& .A4 \\�. Ybk,,ry��4'l "94, /4
Work Address
Is to be disposed of at the following location: )OpJ( t`S
91 fi gA ar f a, yr 3
/741
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
014°)0
Signature of Application Date
Permit No.
f r..
THE HARTFORD
BUSINESS SERVICE CENTER
THE � 3600 WISEMAN BLVD
HARTFORD SAN ANTONIO TX 78251 April 19, 2019
Scott Reid DBA S R Plumbing
PO BOX 222
HARWCH PORT MA 02646-0222
Account Information:
Contact Us
Policy Holder Details : Scott Reid DBA S R Plumbing Business Service Center
Business Hours: Monday-Friday
(7AM-7PM Central Standard Time)
Phone: (877)287-1316
Fax: (888)443-6112
Email:aaencv.serviceseIthehartford.com
Website: https:l/business.thehartford.com
Enclosed please find a Summary Of Insurance for the above referenced Policyholder. Please contact us if you have any
questions or concerns.
Sincerely,
Your Hartford Service Team
WLTR005
THE r
HARTFORD April 19, 2019
Account Policy Information:
Agency Name COMPLETE BENEFIT SOLUTIONS/PAC
Agency Code 76250837
Recipient Information
Scott Reid DBA S R Plumbing
PO BOX 222
HARWICH PORT MA 02646-0222
SUMMARY OF INSURANCE
Account
�c Policy Number Term
Policy Recap
Worker's
Compensation 02/18/2019 to
The Hartford 76 WEG AC8SDO 02/18/2020 $1,727
Fire Insurance
Company
Sum of Insurance
Commonwealth of Massachusetts
l®11
r Division of Professional Licensure
�� Board of Building Regulations and Standards
Consf��7+;ti1�r�ISiSp�rvisor
CS-113285 '` l�.ac�ires:08/10/2022
SCOTT L REID f,'Litt, n
P O BOX 222! a' ' •
jHARWICH PjT MA g,, ` .�
/ fF
10/Ss":1:10`-S` "
Commissioner 440--•"-A-----
Office of Consumer Affairs 8 Business Regulation
HOME IMPROVEMENT CONTRACTOR
T,lf Individual
Regjttioh.,, miration
7
03120/2021 •
("--- SCOTT REID'1' = j
D/B/A SR PLUM l�
SCOTT REID ' r .'-'.1- "`rF
36 CROSS ST " g4,n...ea.4
HARWICH PORT,MA'02646 Undersecretary
°.Y� TOWN OF YARMOUTH
44, 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451
REc - t • • 6 Telephone (508)398-2231 Ext. 1292-Fax (508)398-0836 FP � lV
OLD KING'S HIGHWAY HISTORIC DISTRICT COMMITT. E 2 2u20
JAN 2020 ,,,;,:,,,L; .
TOWN CLERK OLD
SOUTH YARMOUTH APPLICATION FORKING'S�,,Ur1vvAY
MA CERTIFICATE OF EXEMPTION
Application is hereby made for the issuance of a Certificate of Exemption under Sections 6 and 7 of Chapter 470 of
Acts of 1973, as amended, for the proposed work as described below and on plans, drawings, or photographs
accompanying this application.
Type or print legibly: L
Address of proposed work: 9 5 ( 0 (XO\ 7.1 \fo
u ,,AL filet Map/Lot#
Owners): b\\\ )(COS &A. Phone#: 6/ / 4'7/-3 3 2
All applications must be submii n
tte by owner oor accompanied by letter from owner approving submittal of application.
Mailing address: /,j C�r•Q,lyi `(, Y ek,r-m . Li-L \u 'I t Year built: 1411.02.
Email: ba`C,f 1 q U d V eI 2 81A- 1/LC. Preferred notification method: V Phone Email
Agent/Contractor: eCAA `F-Q,i SL Phone#: $$0 it-if-`l t'3 223
Mailing Address: V0 /k 7)- Hai wit( 1p ('l" ,i1 612 'o
1, /
Email: S� (P J 4't B I I C- Lit (71►tiG,1,61A1preferred notification method: Phone V Email
Description of Proposed Work(Additional pages may be attached if necessary): L C t& \.Lio \/&L'I �►-i V.5 o ',ht- C- 5 7l Alo ke- 1 L.t _
Wyk"' gd-4,-,...., ' i lL�t ,e- / �J` i_f ai,;�. Art ce.. We- U�v1e_ Pet-.c»ti�
l ,%\N04.
Signed (Owner or agent): 4� " / .l" '`` ,% Date: / 9 l 2tl
0
> Owner/contractor/agent is aware that a permit may be required from the Building Department.(Check other departments,also.)
> This certificate is good for one year from approval date or upon date of expiration of Building Permit,whichever date shall be later.
For Committee use only: /Ajpproved
Date: -- '07Oo�O Approved with changes Denied
Amount a(} Reason for denial: AP PROVED
Cash/CK#: A2,3'2, JAN 2 3 2020
b
Rcvd by: V i
YARMOUT HwAY
OLD KING'S HIG
Date Signed: 05/70 1 6 Signed: J
7, i.,
ieL ..o.ti76--- do-- L--Too V
APPLICATION#: -15 4---76°
V5.2017
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Anderson 400
Awning/Casement
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REC�'lv�c® 0� m
APPROVED
JAN — �P!
�'G20 JAN 2 3 2020 == N
0 SOUTH AR CLERK YARMOUTH
MOUTH MA OLD KING'S HIGHWAY