HomeMy WebLinkAboutbld-23-003411 (iNtil12
ONE & TWO FAMILY ONLY- BUILDING PERMIT
Town of Yarmouth Building Department /
1146 Route 28, South Yarmouth,MA 02664-44921.1
508 398 2231 ext. 1261 Fax 508-398-0836
Massachusetts State Building Code,780 CN
Building Permit Application To Construct, Repair, Renovate Or Demolish ; .•.:..•`
a One-or Two-Family Dwelling
- This Section For Official Use Only
Building Permit Number: 6 0.23-clocil f Date Applied:
---ri r-• eA c �= / `f-dI V E D
Building Official(Print Name) S atu e
firC 1 zazz
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Asse�s ors Map&Parcel Numbers BUILDING DEPARTMENT
(03 01 6-14 13 A-nl K r,ti - )(, ,c.__ _Y_ _ _
——�
l.la Is this an accepted street.9 yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions: ,
'R Ltv 1'1 t t.r-S I SC\
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 0 Zone: Outside Flood Zone?
— Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1Owner'of Reco d:
AmMoN0 Coy 5,1r)frovV4 y A, 0 ,(Ilts
Name(Print) City,State,ZIP
(13 glfr- t3AMl- gi) 30k 73-7- /8 3c
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 4 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other Cl Specify:
Brief Description of Proposed Work2: REp(.hCC.-EY4Yrivits ICC>k 4,„Y FltmR or, Crn-efrs'
DEC,. ,e 5 NO •k,1\ Be b",1i- to cot l- t - Lo trw AiW.C, p?esctc1P1iwe-
Q-125.4errl-►0,1 v.,cox) 1;eCk.. Co►n5tit3c.i-,O Oro%v) e
SECTION 4: ESTIMATED CONSTRUCTION COSTS -
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 7 ppc3 1. Building Permit Fee:$a.5.10 _Indicate how fee is determined:
IS Standard City/Town Application Fee
2.Electrical $ 0 Total Project Cost3(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $ 5.
4.Mechanical (HVAC) $ List: 4 1 IL)7)
5.Mechanical (Fire 7 s Xa' ��. � OeY.-1
Suppression) $ Total All Fees:$
Check No. Check Amount: Cashrt: 1 C 5 -T--
6.Total Project Cost: $ L' , ❑Paid in Full �Outstanding Balance Dc
I
\23
l
f• 4
r SECTION 5: CONSTRUCTION SERVICES e
5.1 Construction Supervisor License(CSL) CS it V 7 CJg ( 3pr y
K i mo v.),$) 1ETAANPtPc 5 License Number Expiration Date
Name of CSL Holder
.543 C S'tr-74 c E ;i)uc List CSL Type(see below) V
No.and Street Type Description
kii, yipliOM C-H ` VA w eaC4-7,$ U Unrestricted(Buildings up to 35,000 cu.ft.)
City/Town,State,ZIP R Restricted 1&2 Family Dwelling
M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
S°Y Si ti d412, gmEow AfestZ C;C-wko; ,CQt'►'1 I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improveme t Contractor(HIC) )
RAY ►JPK 5 S�iE h,C 1 /o'L / 5/23
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
q/03 GA ncry-ft) fc X1'
No,and Street M K0.t�P coward's 172 CTMGi�,Lr.,y,
tiAlAYJWS i O2..Q ) Spf O ti (:L
Email address
OM
City/Town, State,ZIP Telephone
SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(1VI.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 "7 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 IrApIJA �pu,11RP�
to act on my behalf, in all matters relative to work authorized by this building permit application.
iw 2t� _ 12- IS•21-
Print O‘ er's Name(Electron c 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 b of my vledge and understanding.
Print Owner's or Authorized Agent's Name(Electronic Signa 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.aov/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.) (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
=me 1 Congress Street, Suite 100
\S
:E_ Boston, MA 02114-2017
els s�•'� 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): ►NSI PC 1TOCOCQ0I?,,"- f
Address: (l03 L ll NceL,u ,g D c')(ry
City/State/Zip: )4 Y,pr uv•S i imut J
c.)44 a I Phone #: 5 1 y o(i 12,
Are you an employer?Check the appropriate box:
Type of project(required):
I. 1 am a employer with 2 employees(full and/or part-time).*
7. ❑New construction
2. I 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.Q Electrical repairs or additions
proprietors with no employees.
12.Q Plumbing repairs or additions
5.[I 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.❑We are a corporation and its officers have exercised their right of exemption per MGL C.
1 ❑Other
152,§1(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: thf4TPOIZO e14SUfte,-ty /•vsUf 4AI(C_ a ,y
Policy#or Self-ins.Lic.#: 0 )EC C..E 1OO5 Expiration Date:/
8 k 1 '49-A3
Job Site Address: 4 ? 4,644 eaNK 2 City/State/Zip: S.Y '"t°0r#Ar1/62Cif
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 cert' under th ns d penalties of perjury that the information provided above is true and correct.
Sisnature: Date: ^( Sh '2—
Phone#: ,Q71 $►y O6 12
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#:
4; TOWN Of' YARMOUTH
BUILDING DEPARTMENT
. ,;?E 4", 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1"- 1
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
DATE:
JOB LOCATION:
E STREET ADDRESS SECTIP OF TOWN
"HOMEOWNER"
NANI. HOME PHONE WO K PHONE
PRESENT MAILING ADDRES
CITY OR TOWN STA r ZIP CODE
The current exemption for `Homeowner' :s extended to include owner occupied dwellings of one or two units
and to allow such homeowners to engage an i .ividual for hire who do-s not possess a license,provided that such
homeowner shall act as supervisor. (State Buil.. g Code Section 1 3 R5.1.3.1)
Definition of Homeowner:
Person(s)who owns a parcel of land on which he/she re 'des or• tends to reside,on which there is or is intended to
be, a one or two family attached or detached structure asse' o ; to such use and/or farm structures. A person who
constructs more than one home in a two-year period shall no •e considered a homeowner;such"homeowner"shall
submit to the building official, on a form acceptable to the ' il• g official,that he/she shall be responsible for all
such work performed under the building permit. (Sectio' 110 R 1.3.1)
The undersigned `homeowner' assumes responsibi • y for complian,e with the State Biding Code and other
applicable codes, by-laws, rules and regulations.
The undersigned 'homeowner' certifies that - / she understands the Tow of Yarmouth Building Department
minimum inspection procedures and requ' ments and that he / she will :omply with said procedures and
requirements.
HOMEOWNER"S SIGNATURE
APPROVAL OF BUILDING O} CIAL
INSURANCE COVERAGE:
I have a current liability i .urance policy or its substantial equivalent, which meets the requi ments of MGL
Ch.142. Yes l o
If you have checked v: , please indicate the type coverage by checking the appropriate box.
A liability insuranc: .olicy Other type of indemnity Bond
OWNER'S IN RANCE 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
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. 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 �-t f c,,,1k R 1j
Work Address
Is to be disposed of at the following location: ry o 1 fT2aNs-ER S�q�
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
Signature of Applicant Date
Permit No.
12/22/22,3:58 PM Mail-Sears,Tim-Outlook
63 Highbank
Sears, Tim <tsears@yarmouth.ma.us>
Thu 12/22/2022 3:54 PM
To: rayedwards172@gmail.com <Rayedwards172@gmail.com>
N
Ray,
I have reviewed your application for the deck and you need to submit t copies of drawings of the
proposed deck showing all framing/footing details.
Thank you
This email is considered a written denial of your permit application per Section 105.3.1 of the
Massachusetts State Building Code. Section 105.3.2 states in part that "an application fora permit for
any proposed work shall be deemed to have been abandoned 180 days after the date of filing, unless
such application has been pursued in good faith"
You may appeal this denial to the Building Code Appeals Board in accordance with M.G.L. c. 143 §100,
within 45 days of this notice.
Timothy Sears CB0
Deputy Building Commissioner
Town of Yarmouth
508-398-2231 Ext. 1259
mailto:tsears@yarmouth.ma.us
https://outlook.office.com/mail/sentitems/id/AAQkADE3MDQ5NWZmLTkOYzItNDIwNi1 iMDQxLWNkMGQyNmE4NzE5NAAQAEOxQnAiN4tGIRaR95w... 1/1
•
0•Y,q iOWN OF 1ARv Ot 111
4Q WATER DEPARTMENT
k, A `Vim, 99 Buck blao,i R,,,a l
�¢eresr,�y \\R=St Virmouth. .lA _' -1
Irlrahone: 10.1; 771-7921 • {, % ,,i?i; 71 t 9
)rl
BUILDING PERMIT APPLICATION FOR
WATER DEPARTMENT SIGN OFF
TRANSMITTAL FORM
BUILDING SITE LOCATION: c^, ` H IC—Ft )' > rt ff't t„ ylt o ` t
PROPOSED WORK: fi,e /A(' O 2,.A C C". C)t (:;I-..
APPLICANT: ` `"i eta, t:.. 4,, (,,,, v�.to`
_ >
ADDRESS E'C-: ( r T,--i ) t c: v' _, ,f k1r .0 1,6 ,.% -\1
t LPIIONE: Cci, Si(( o(i.r
RESIDENTIAL AND .OR CO\tME.RCI.AL BUILDING •
Water Department Determines Compliance of Water-Availahilit)and or existing location
Ingineerinu Department: Delerniines Compliance for Parking and I)ntitlauc
comic,ation commission: I)etertnine ('omplianec to Welland,; :\et: i e. IIIot(s)border any type of
1+etlands.stretuns,ponds,risers.ocean. hogs.boys, marshland. ETC'...
I tc•alth Department: I)ctertuines('omptiance to State and Town Rcaulations,i.e.
requirements for Septace I)isposai and other Public I lealth Acticites
Fire I)cpariment: Ik•termincs Compliance to State and Town Requirements for Personal
Safety. Property Protections. i.e. Smoke I)etectors.Sprinkler Svstenis,etc
am"
. J
' r c✓'d, 'fir' y ....a _... / j 1 - ' .,
APPI.IC NT SIGNATURE DATE.
OFFICE USE: COMMENTS ON PERMIT APPROVAL OR DENIALla'. , / c YMt.e t? „taxi t t (1 e w/
to .- 'c. ( (4 c -e r v
REVIEWED BY WATER DIVISION(SIGNATURE) DATE
0
r•J�•,Y� ,� TOWN OF YARMOUTH
°; HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
Building Site Location: (S - i 5 A/III(
f7Cc
Proposed Improvement: r = ''i + `� I 1 X I S t ; ✓v G (% C.- E
rar
Applicant: vvt ✓v>> D L,JA-R pS Tel. No.:SCk Sl(l o(,
'of\S 2
Address: 2-0 �nICE CIE Date Filed: I-2 -/ci `a
**If you would like e-mail notification of sign off,please provide e-mail address: gick9 QCJW p:l 7 1) Cr'fllc1, i ,
Owner Name: 1Z `1 a o'✓v n (-
Owner Address: 3 ) 1 G N cf AN\< { > 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;
DEC 1 92022 (2.) Floor plan labeling ALL rooms within building
(all existing and proposed) —
HEALTH DEPT. Note: Floor plans not required for decks, sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
REVIEWED BY: i/ DATE: / ()`,- 1 7/21-
PLEASE NOTE
COMMENTS/CONDITIONS
a S 4 —
No i$e 1 o r ‘P ✓a<
GENERAL NOTES:
1 S 12°30'55"W
7< 145.00' tv- Map Id:70/59
Flood Zone: X
Zoning District: R 40
! Lot 2 Wind Exposure Category: B
(...3
co
0 17,435 Sq.Ft. Owner Of Record: Raymond Roy
CO
63 Highbank Rd
South Yarmouth,Ma
Y Lot Coverage:
IW/D 35.4' z Lot Area 17,435 Sq. Ft.
u) Existing
40.9' A Existing Structures:
{ o Garage {,co i.n .Ip. House,Deck,Garage 2,008 Sq. Ft. 11.5%
wco w __
m Brick i `�y 0
_ Existing Patio �� :
Dwelling �� DAVID ti
Paved RLE6,
O • #63 Drive cn 4 ''` K� y
O'4GISTER�Y
t.
' \ '' L LAND SV
� I
A=06°40'48" R=801.70' L=93.47' N 09°33'52"E 59.18' PLOT PLAN OF LAND
HIGHBANK ROAD LOCATED IN
YARMOUTH ,MASS.
�
G; , PREPARED FOR
ncr 1 y 9(322 RAYMOND ROY
DATE: DEC. 16, 2022
,l r -, _ __- - - __ - _ _____ DAvlD-SANICKI--F-ALMOUTH MA
GENERAL NOTES :
S 12°30'55"W
'1 145.00' A Map Id: 70/59
Flood Zone: X
Zoning District: R 40
w Lot 2 Wind Exposure Category: B
co
co 17,435 Sq.Ft. Owner Of Record: Raymond Roy
63 Highbank Rd
South Yarmouth,Ma
Lot Coverage :
cn W/D Existing35.4' Z Lot Area 17,435 Sq. Ft.
0 40'9 — .A Existing Structures:
„ .A = Garage0, �N House,Deck,Garage 2,008 Sq. Ft. 11.5%
- o _- cp
- w
ni Brick g
_ Existing patio
Dwelling , �pvi4 Or 4
Paved 40
+ 90
O • #63 Drive 4 DAVID ti�
cri
o CHARLES
1J\ /
�/ S'NICK,
0G/S�0
rn /
424691. LAND 9N'
N
0=06°40'48" R=801.70' L=93.47' N 09°33 52 E 59.18'
PLOT PLAN OF LAND
H I G H BAN K ROAD LOCATED IN
YARMOUTH ,MASS.
PREPARED FOR
RAYMOND ROY
DATE: DEC. 16, 2022
DAVID SANICKI FALMOUTH,MA
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