HomeMy WebLinkAboutBLD-23-003201 ..: .
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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 Vo eBuilding Permit Application To Construct, Repair, Renovate Or Demolisha One-or Two-Family Dwelling R CEIVED
hThis Section For Official Use Onl ro0022 ]
EC
Building Permit Number: ,)-23—'bb3 I Date Applie • _
' � RP(S %�—�6-d). BUILDING DEPARTMENT
JItt _ e
Building Official(Print Name) Signature care
SECTION 1:SITE INFORMATION
1.1 Property Address:2\ 5`,\\,vc;y, �a 1.2 Assessors Map&Parcel Numbers
✓1.1 a Is this an accepted street?yes A no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
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 ID _ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
cl a to•\AO 9e8,Jz c-, Glesr Vary,0,-, M MA 026T 3
yName(Print) City,State,ZIP
✓ 21 Sv\\wC'%VI `4c3, CSeir)360-szHo rvvi,,,do;\o-ey&)i,1alv..,,,\ .co-,
No.and Street Telephone Erilail Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 AIteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: l wool). k;'e o N1A.1ce A, el�.l roo r,., ate,A
bA&Ay-o o vv-k otvok- A S liet ii lour to W►Y f_x:S t-i iet
1 Lets c 1*-,c v' 4- _
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 1. Building Permit Fee:$ I SD Indicate how fee is determined:
2.Electrical $ 2100.0 S Standard City/Town Application Fee
0 Total Project Costa(Item 6 x multiplier x
3.Plumbing $ ti , 00 0 3 s t
2. Other Fees: $ Cl/ ��
4.Mechanical (HVAC) $ List: n
5.Mechanical (Fire i/
63
Suppression) $ Total All Fees:$
Check No. Check Amount: Cash Amount r 1Y11
„
6.Total Project Cost: $ if. Oa) ,J 0 Paid in Full le Outstanding Balance D : 1 iS
I 0\?a-
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.)
City/Town,State,ZIP R Restricted 1&2 Family Dwelling
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 Company Name or HIC Registrant Name HIC Registration Number Expiration Date
No.and Street
Email address
City/Town, State,ZIP 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 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: 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 best of my knowledge and understanding.
o \Ao ,QcSovzrn \Z/ S/ZZ
Print Owner's or Authorized Agent's Name(Electronic Signature)) 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.eov/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
j I =,=0= 1, Department oflndustrialAccidents
l=
'"_ m= 1 Congress Street, Suite 100
k.
7
0_ , Boston, MA 02114-2017
www.mass.gov/dia
\Yorkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information
Please Print Legibly
/Name (Business/Organization/Individual): Q,,,ph o..`A.0 V c so V e
✓Address: 2t Sokkiv -. ,Z9
✓City/State/Zip: WesA Yo,,,Q,,,n., a Z6 7 5 *hone #: (56 s) 360
Are you an employer?Check the appropriate box:
Type of project(required):
1.0 I am a employer with employees(full and/or part-time).*
7. 0 New construction
2.0 I am a sole proprietor or partnership and have no employees working for me in
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
4.0 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
proprietors with no employees. 11.0 Electrical repairs or additions
5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 12 Plumbing repairs or additions
These sub-contractors have employees and have workers'comp.insurance.t 13•n Roof repairs
6.❑We are a corporation and its officers have exercised their right of exemption per NIGL 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.
1Contractors 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 edtployees. 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 herebyunde the pains and penalties of perjury that the information provided above is true and correct.
/Si2natureL:
Phone#: �O 0 6e C Date: � ..5-�zz
Official use only. Do not write in this area, to be completed by city or town official.
City or Town: Permit/License f
• 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#:
:o TOWN OF YARMOUTH
C1
0,.
BUILDING DEPARTMENT
1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1261
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
DATE:
/'JOB LOCATION: Li /U/ Iv kCI Ct!. Y1!r
n NAME,✓ STREET ADDRESS SECTION OF TOWN"HOMEOWNER" K J n/(l� 04 S°v?4 50? 3-6 6-ego
NAME HOME PHONE WORK PHONE
✓ PRESENT MAILING ADDRESS e/ Sti 4 ! 14 Pni 6/1 to )1-- ,Tf
CITY OR TOWN STATE ZIP 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 shall 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 co
des,odes, 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 , 41,(7)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 ves, 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 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 21 eok. w. 'yo.r rho Alex
Work Address
Is to be disposed of at the following location:"/ci (Vvv t.2 . Viks4U5
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
947 /77
1Z / 5 /zz.
Signature of Applicant Date
Permit No.
TOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: 2 ! S V L L t U/3 R LAI ly?D✓
ll l �.
Proposed Improvement: /- / 17 C (/ G/5 ,S6 �r!/7 ]t: I/� V ( ( cA- /
to ti�lr�- tup f S I NK
tJ!�' A i�C A"
Applicant: �' /vh [ ,►J�J.)(,i?/ Tel. No.:SOB 3-CO '2`1)
Address: j Su L L i MN) 4 i (/Lt( Yi)r mot P-% Date Filed: /2/5/2Z
**If you would like e-mail notification of sign off please provide e-mail address:
�
Owner Name: O n/5 14) DK: , L)
Owner Address: / s V L I., 1 1i5 h) e Owner Tel. No.: SD 6- 3 -6' 0 d'Z�f J
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 0 5 2022,-X- (2.) Floor plan labeling ALL rooms within building
(all existing and proposed) —
HEALTH DEPT. Note:Mans not required for decks, sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
REVIEWED BY: DATE: /c) 'GJ — -2
PLEASE NOTE
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12/14/22, 11:34 AM Mail-Sears,Tim-Outlook
21 Sullivan Rd
Sears, Tim <tsears@yarmouth.ma.us>
Wed 12/14/2022 11:34 AM
To: ronaldojoey@hotmail.com <ronaldojoey@hotmail.com>
Ronaldo,
I have reviewed your application and there are some items needed.
1. finished ceiling height shown on plan
2. natural ventilation calculation per section R303 or spec on air exchanger
Please submit these items for review
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 for a 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 CBO
Deputy Building Commissioner
Town of Yarmouth
508-398-2231. Ext. 1259
mailto:tsearsPyarmouth.ma.us
https://outlook.office.com/mail/sentitems/id/AAQkADE3MDQ5NWZmLTkOYzItNDIwNi1 iMDQxLWNkMGQyNmE4NzE5NAAQALxXSg0D6HNHg%2BH... 1/1
Und erAire 4TM- Crawl Space - . u i afors
- pecifications 3. 4 How to determine the
V1 V1D V2D number of UnderAireTM
Model
Performance 110 CFM
110 CFM 220 CFM Ventilators neede :
Motor 115/1/60 115/1/60 2 @ 115/1/60 Calculate the cubic area of the crawl space by
0.30 amps 0.30 amps 0.60 amps multiplying the length x width x height.Divide
Dehumidistat dehun ldist t o Dab OFF/ON R or 0-80°0 or
this number by 15 to determine the minimum
O
dehum�distat available 20-80°o RH 2O-80 o RH CFM necessary to fully ventilate the space in 15
seaarately minutes. Example: 20' wide x 40' long x 3' high
Thermostat Opens at 40°F Opens at 40 F Opens at 40 F crawl space = 2,400 cubic ft. 2400 cubic ft. _ 15
minutes = 160 CFM of ventilation.Choose two V1
Dimensions 14 3/8" x 6 718" x 2" 18" x 9" x 2"
18" x 9"x 2" or V1D ventilators or one V2D ventilator.
Trim Dimensions 9 3 8" x 5 313"
9314" x6" 14" x6'
xchange
RT" Ventil . " • 1 ,aFans
4��,�� � Dimensions
Optional Accessories
�\ Add the SCP plug-in speed control
Om •
s t"
1 . Model X2D for variable performance or use
any plug-in timer to cycle as
! r desired. Model
`i SCP
3;11, 3Iif If using the XchangeR w ,
t in an enclosed utility - .
'r� �j 13.141Q room with chimney `_
z 05' �� (, vented heating
< L. �s� �'" ��.� equipment, use the
,'-i „- - �. �� optional DT2-6 6"
� 'z, 6.;R 't- duct take-off and G-6
/ �`'= oRrlex •
, t i ,�` .°UCT _ diffusers to pull ex
r rj<-14. 004 1- haust air from an
adjacent room. Model .+w� .
Model X2R DT2-6
Specifications
For Dehumidification ■SWR Switch-It Wireless 120v Outlet The X2D includes a Dehumidistat ■ G-6 6" White Plastic Exhaust/ Intake Grille
�BD-6 6" Spring Return Back Draft Damper
Model X2D & X2R control to automatically cycle based
1 Fan 2 Fans on user set RH (Relative Humidity) (for use with X2R)
level. The model X2R requires the
Voltage 120 120 DH2P plug-in Dehumidistat for Model X2D Includes Automatic
Watts 20 40 automatic RH based operation.
Amps 0.3 0.6 For Timer Based Dehumidistat Control
CFM 90 180 Air Exchange Turn either fan on or off and automati-
.33 Air Change/Hour (ACH1 recommended ,..iiiir__ catty operate your basement fan by ad-
Basement FT2 XchangeR Run justing the dehumidistat control to the
Time/Hour �S level needed. Rotate the dial fully clock-
(8 foot ceiling) wise for constant operation. For X2R
1 Fan(90 2 Fans(180 CFM) models, order optional DH2P Control.
'-' 500 15 min 7.5 min
750 22 min 11 min
1000 30 min 15 min
1250 37 min 18.5 min
Available From: Ali , LIERNLUND PRODUCTS, INC,
T 1601 Ninth Street White Bear Lake, MN 55110-6794 [■illeVE ]
1.41..UND Reversible Basement
;(( ( W
CrawlSpace &
,,, p ...., ..„,
RopvG
Ventilation Fans
Fan-powered ventilation improves indoor air quality
reduces moisture to help eliminate odors, reduces
radon and protects both home and occupants.
1•— s -_�
VIIIII
Ilimhzio•-- -. t 4,, t: t
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X� ~) Simple` NO-..,_ ate vr;. '•"9"'
Electrical 1,.. w.,
Ji
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UOEItAIuIr TNI
XcHAHc
Crawl Space Ventilators Reversible Basement
Ventilation Fans
■ Excess moisture can cause mold, Many basements are stale, musty or
mildew and wood rot. UnderAire smelly because of: ENERGY
fans increase air circulation to fight
condensation. ■ Seasonal water issues,
sump pits & floor drains. SA.F RS
• Constant operation helps vent radon, ■ Off-gassing of molds that thrive wher
treated wood off-gassing and odors humidity is in excess of 60% RH.
that might otherwise migrate into .. • General lack of air exchange or
living areas. ^ ventilation.
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