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HomeMy WebLinkAboutBLD-22-007454 5i-i-t_ }7lcLAA ..— PO 1/LIME— WG4V -r t-i od -' did S Q .,E & TWO FAMILY ONLY- BUILDING PERMIT _ RECEIVED Town of Yarmouth Building Department 41-N oF r1146 Route 28, South Yarmouth,MA 02664-4492('Iry p508-398-2231 ext. 1261 Fax 508-398-0836JUN 2 8 2022 Massachusetts State Building Code,780 CMR o.:,e Bz ildng Permit Application To Construct, Repair, Renovate Or Demolish BUILDING DEPARTMENT a One-or Two-Family Dwelling BY ...��- This Section For Official Use Only Building Permit Number: /314) ...2.1.-4074 SY Date Applied: - Building Official(Print Name) Signature r14, Pate OA~S SECTION 1:SITE INFORMATION 1.1 Property Addr_e :_�^ 1.2 Assessors Map&Parcel Numbers 31 "SP/&'(1�-u O. 4-moVZ�4- 1.1 a Is this an accepted street?yes 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 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: C.) l^(J •} OUT 110 ' Name(Print) City,State,ZIP ,I Pc2i 7 12-0 5Dg'3 .7-iz .c dooI0303eIiawtal1.com No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'-(check all that apply) New Constructioty l' " Existing Building/ Owner-Occupied,, Repairs(s) 0 Alteration(s) 0 I Addition 0 Demolition .);:1"1.Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work'-: A264 E12S g2C4-1-- OP-fid clsb'" to d14)72`/ fl_DA Ni -1- G JAJ 4"t riL HOD - SECTION 4: ESTIMATED CONSTRUCTION COSTS. Estimated Costs: Official Use Only Item (Labor and Materials) $ 1. Building Permit Fee:$ro3k Indicate how fee is determined: 1.Building II Standard City/Town Application Fee 2.Electrical $ 0 Total Project Cost'(Item 6Lx m ltier _xO 0_ 3.Plumbing $ 2. Other Fees: $ ��. °O List: i J 4.Mechanical (HVAC) $ 5.Mechanical (Fire $ Total All Fees:$ Su..ression) Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ OP � ��l b ❑Paid in Full Outstanding Balance Due: 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 I&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,ZIP Telephone SECTION 6:WORKERS' COMPENSATION DISURANCE 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 ❑ 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 application is true and acc ate to the best of my knowledge and understanding. 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.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/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 _41- Boston, MA 02114-2017 ,� �'�� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERtMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): e a,KswiA, S )t la ,r, Address: As f 1 h`VT26,1 City/State/Zip: So - \I lvvtX(AJ3 © (°None #: c-C) SO ' 2� Are you an employer?Check the appropriate box: Type of project(required): l.❑I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.0 I a a sole proprietor or partnership and have no employees working for me in 8. El Remodeling y capacity.fNo workers'comp. insurance required.] 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 11.E Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0I am a general contractor and I have hired the sub-contractors listed on the attached sheet. I3•EI Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. I4.El Other 152,§1(4),and we have no employees. [No workers'comp. insurance required.] *Any applicant that checks box R1 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 r4 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 her l y tinder the pains • zd pena '-s of perjury that the information provided abo e is true and correct. Signature: Date: 4/1 Z �1Z Phone#: Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License r 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#: N of TOWN OFYARMOUTH o . ,•, _° BUILDING DEPARTMENT �'�� q:=�E;,�,_x9, 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1261 HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE: T JOB LOCATION: 31 f �; A � S 0 - Ci rfAA J , NAME 6TREE ADDRESS SECTION OF TOWN "HOMEOWNER" ('114 heA.wt 'D V (C-1--‘, NAME HOME PHONE WORK PHONE PRESENT MAILING ADDRESS `7cu, .---� a S J-.✓e CITY OR TOWN STA 1'E 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 codes, by-laws, rules and regulations. The undersigned 'homeowner' certif s that he / she understands the Town of Yarmouth Building Department minimum inspection procedure and r uirements and that he / she will comply with said procedures and requirements. HOMEOWNER"S SIGNATU - 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 yes, 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 pi''Y'Cit TOWN OF YARMOUTH ''' r,,ioNr� C BUILDING DEPARTMENT icc `_ .$ 1146 Route 28,South Yarmouth,MA 02664 "4 „„>'6rd 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 31 ASP/Isr—T /2D SL- yA- *t t4 '/ Work Address Is to be disposed of at the following location: Y/` M/1 "77 )Ut Sa'4 disposal site shall be a licensed solid waste facility as defined by M.G.L. •ter 111, Section 150A. . 1,.....iiiiiL__ eHz.,z__ .'gnature of Application Date Permit No. — . .-- i [40 YtA04 1 ,---, 1(AvN oF yARmot,ii 1 rdV1A .,611.16.14-- 4A i 'so WATER DEPARTMENT (44„ 94 Buck Wand ktf,i \Vest Yarmouth, MA 026-i 'li,h,phonc; :7)iih; 71-79.21 • BUILDING PERMIT APPLICATION FOR WATER DEPARTMENT SIGN OFF TRANSMITTAL FORM BUILDING SITE LOCATION: / Apt/1/4.1 vr ao PROPOSED WORK:--FP11-41,10k-S fLYC-44. i lisinvO 12-4. tax)H .WarAfvet., APPLICANT: ()I./el/14414 OdOk--0 ADDRESS: 3 t AS fi f1/451.7r e..,0 0 , yik-e—tmcure4 TELpitoNE: Soc:‘ a(01 - i RESIDENTIAL AND OR COMMERCIAL BUILDING ‘Vater Department: Determines Compliance of Water Availability and or existing location Engineering Department:• Determines Compliance for Parking and I b-amace Conservation Commission: Determines Compliance to Wetlands Act. i e. If lotis)border any type of wetlands, streams. ponds. rivers,ocean, bogs.boys. marshland. ETC.. I lealth Department: Determines Compliance to State and Town Regulations. i.e. requirements for Septage Disposal and other Public Health Activites i Fir )cp riment: Determines Compliance to State and Town Requirements for Personal Safety, Properly Protections. i.e. Smoke I)electors, Sprinkler Systems.etc aik - 411111W -------------- AP Ap' 77'T 7.-NATUR I-.r DATE 0 'ICE USE: COMMENTS ON PER‘III VPROVAL OR DENIAI, rimia(0— -ro &yktS 17e ve170,v;- (P Sile-le—e/,t. ZAAA.--r-t. i 6 of, - / , ',0 if .0 OAT at, illna riair,-4't illNilltir-- '• .0.4.- .i., . . I Lk - , ' if rezie .. ir- 4...• 4 , 4. ...;Aro it , 7 REVIEWED 1 `‘, TER D VISION (SI( NATURE) 99. DATE ‘1140Oh i j 1 d°°7 .4 AlIII _t I ,,g wt%Cj ft ../.._ UItS n' r k. 4 , � \ t5 ! k i 1 1 I ' 8 o► �3 �aS,�Q�19) --e7vd5 ir gg —4-4 ssb/01 I , 4ii 66._ Cz -_3 !, i/5 01<! `' 'Z,g E/5 L, 'ON a3.1.31A1 ry-----hnv Lk/✓b7-10 0OS 3ov1r11A .1DC� f .- ,` .U/dSr /G 1.33141S Vi 92C '4-1 6( tit4?/V3 Pi V N 1 — yci :247%/ 'ON 301A213S • a7 ASPIN 0..___ 7 ASSESSOR MAP 25 f,.0 F I PARCEL 91 (u Ll I j WJ/ (]T{• IIS SWARM RD i r .1 R I t ASSESSOR MAP,LI 2O PARCEL SCREEN r - AC \�\ PORCH , I Ay UNIT ®`` z t I //�.A5�,�'jy�C� r c r..FRAME NWSE / tElt SA 1J J J,ffTERI Y,17 - - -- -13.e' OOENERATaR N 7P Or C.B./D.N. T.O.V.flip-MY 1 I LEV.9.f5' / k tf0 ,.., 1 A4D f9� .�~ ��\ 16.0' I 1 I N 4�N�J{(/[\�✓ • t.`�. - I MOIAEL t9 SOUti N70 H NHALLN '.�0... .., I ASSESSOR MAP 13 � PO % l �UWE I I PARCEL! sYSTEN 4P- 1 PAVEMENT �N„,t:• 1 f t \ dnlfwNr, I V 6� GAT 1' I ''`I CATS i 1 .t. cv; i I N/r \ +r . 1 a I KAREN C tfN0OU1ST}R \ I LRNDOUIST FANNY IRR,RUST OF 2009 25 ASPNIET RD Ntt.A, 17, i•,'. ��`\ Xtea' } ASSESSOR PARCEL 2 as Nty II C6 � J h /q�Lc/', . at '�Q � =leo !I 34 T ELEVATION \\ ^-.. ---:IA ER GATE �._,�� 02 CH BASIN ` WAGE MANHOLE ER MANHOLE \ CC" zc PHONE MANHOLE `� iT POLE ""� .ITV POLE/ LIGHT o HY POLE / LUGHT 8 TRANS. `�"�' .` Q JTY POLE /TRANSFORMER --1)„� JTY POLE `—,,,1 ^I PROJ. RHEAD ELECTRIC LINE i r4K,.„`t I* . 4:../ FIELD CTRIC HANDHOLE ".+,�, y/ 3'f( '�`' h # Jy� �t t CALC. METER 24�} liTIL „J4/Y "tba' DRAW UNE r0I1 .eTl; ' CHEC GATE FILE: ER GATE DWG. ER LINE JOB. This is a photo of the sign that will be posted on Bray Farm Road, down from 6A (not on 6A). Thank you. Alethea Cozzi • + Nf � ` y m.4oye � n 'gy p ro nXs ..„. ... 14.- i ki10 . . 406 E 1 ... fa of aP aiiiiisirl ,111 a E .. . . .. . , . . y ,_ r ter. . ,.. w ,yam. J • :.":'"v "" ," w, .1 ita •YaR ! Town of Yarmouth Conservation Office � •. $ kgrant yarmouth.ma.us Conservation Commission Building Permit Sign-off Application TO BE FILLED OUT BY BUILDING PERMIT APPLICANT: Building Site Location: , V`—c �- - T o Map # 3 Lot(s) # ( Property Owner: C r(>d'llA A j aer(c '`'-- Date filed: — 2-2 *Applicant: C---1)rCt C L"c CJv ( G" Applicant Address: f p) r v_ `� �V rn V (-)4 Email:,C1-0D kc l,1 L (A 0 C`t 1 ' W Telephone: Please note:by submitting this application,the applicant grants permission to the Conservation Office to enter the location to conduct a site visit(if needed). Proposed Project Description: I� AC\ \or, Sci iv \ OCrr( A Cv (\ rki CV. Site Plan Title/Date: C ; -L 1, ( (c.-, ;r -7 IO 122 TO BE FILLED OUT BY CONSERVATION ADMINISTRATOR: Does the proposed project require a permit? y{ ) Refer to: SE83- or QA permit Comments from Conservation Commission. I --ro ev d ) Conditionally Approved Rejected Conservation Commission Sign-off Signature: ( -r Date: S're *TO APPLICANT: All work-related debris shall be taken offsite or disposed in a legal upland location. At the end of each day, the area shall be clean and no debris shall be in the Resource Area. If work is permitted under an Order of Conditions, please arrange a pre-construction site visit with the Conservation Administrator. At the time of site visit, the MassDEP File Number sign must be installed, along with the erosion control/work-limit line. A copy of the Order of Conditions must remain on-site during construction. Please refer to the Order of Conditions for further details. TOWN OF;411.G HEALTH DEPARTMENT ''�•` PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To he completed by Applicant: Building Site Location: I AS PI ` � -- Rd- S ia, rL'thJtk DZIP Proposed Improvement: - v1i1,i2--Y Gk. SC fe-k- 4 ( LA ( ktti►i I v Applicant: 62) Y UIC,.wt „JD©1 G i` Tel. No.: �0 Address: J'S.( 7v iQ t 12 - Date Filed: 7 1 1t E !, **If you would like e-mail notification of sign off please provide e-mail address: Q D 1][a Vl )3 e k D o 1 I • Ca wm __9 Owner Name: {r ice,. i G ►i\-& 0601 c -Owner Address: 31 Vet (vvluAwner 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; (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. REVIEWED BY: / DATE: 7-0), PLEASE NOTE COMMENTS/CONDITIONS: 1 y• > � oN 30N3d / O� £ 01 X/ I 0_('� O„ v . ► 4 �� � I I A9 \ a SVJ 31V0yo\ \ \ \ • • /iIll ' • I o \ • \ I / vMwa \ \ 1N3w3/IVd Co \ ,£"ll X SnONIWn118 / \� • c•1L/ / I w3is,�s / 011d3s • 11Nn H�a0d �� A. 03SOd0ad • . 4% * ) '1;4 4 I 0'91 ` 0'LG 8961 MVN Ai/ / ,9l'6 A313 I ,L'Zl = A313 �'O1 'H'0/'8'0 d0 d01 71Yd3N3O .9'£l = /1313 d 13S HaVWHON38 I a31 SVJ 3W / l£# 3Sl1OH 3WVad 000 11.3 , ./.4- Aa01S Z — couo3sodoad ', l6 I �'3h10 #;``.7 d / HOdOd '.a. • N33a0S /. I03SOdoad •LZ / .2 2! >1030 CD Nv 1OH l(JOd 8V-1S 0N00d0 _ - Z6130aVd 31.3 ION00 'o 3/108V /..9 U sZ dVW aOSS3SSV n SdW(ld 0a 13NIdSV L£ 100d 0l0ddlnl V NO V V NHOI' C N030 ,L'9 r rl 03S0dOad / 1 • dkX / w A ..,, .,,„ 100d 0NV S03HS `sxo30 `3SnOH 3H1 40 Sears, Tim From: Sears, Tim Sent: Wednesday, July 13, 2022 1:03 PM To: 'gdoolan73@hotmail.com' Cc: Slack, Christine; Water Department; Hudson, Heidi Subject: 31 Aspinet Rd Attachments: work in flood zone packet.PDF; 9th Edition flood FAQ.PDF Graham, I have reviewed your application for the addition and there are some items needed. Health Department sign off Water Department sign off ✓ onservation sign off ertified plot plan showing setbacks to proposed construction This property is in a flood zone. Attached is a packet to review, the cost worksheet and owner affidavit need to be submitted. 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:tsears@yarmouth.ma.us 1 Substantial Improvement WVorksheet for Floodplain Construction (for reconstruction, rehabilitation, addition, or other improvements, and repair of damage from any cause) Property Owner: L 1 ak141�`v _ f� Address: :3( 1Plh.��r� fL� So • YAwt,k) 1704 Permit No.: Location: Description of improvements: 4 A ILIZ P ti,4v)&?)'(24# yA 5C r-, ev) /Zed Present Market Value of structure ONLY(market appraisal or adjusted assessed value,BEFORE improvement,or if damaged, i before the damage occurred), notincluding land value_ 0 `: 1P► - )00 I $ Cost of improvement- Actual cost of the construction*'(see items to include/exclude) ; $ h,01)tr] 'Include volunteer labor and donated supplies_ Ratio= Cost of Improvement(or Cost to Repair) X 00 i ono Market Value ' If ratio is 50 percent or greater(Substantial Improvement),entire structure including the existing building must be elevated to the base flood elevation (BFE)and all other aspects brought into compliance. FImportant Notes: 1. Review cost estimates to ensure that all appropriate costs are included or excluded. 2. If a residential pre-FIRM building is determined to be substantially improved. it must be elevated to or above the BFE- If a non-residential pre-FIRM building is substantially improved, it must be elevated or dry floodproofed to the BFE. 3. Proposals to repair damage from any cause must be analyzed using the formula shown above. 4. Any proposed improvements or repairs to a post-FIRM building must be evaluated to ensure that the improvements or repairs comply with floodplain management regulations and to ensure that the improvements or repairs do not alter any aspect of the building that would make it non-compliant. 5. Alterations to and repairs of designated historic structures may be granted a variance or be exempt under the substantial improvement definition)provided the work will not preclude continued designation as a"historic structure." 6. Any costs associated with directly correcting health, sanitary, and safety code violations may be excluded from the cost of improvement The violation must have been officially cited prior to submission of the permit application. Determination completed by: I Date: /2ZI r��._ .;. f`. y P PSI-- R�, TOWN OF Y ARMOU TH a BL TLDLNG DEPARTMENT � � ; ` 1146 Route 28, South Yarmouth. MA 0266 �� Telephone 508-398-2231 ext. 1261 Fax 508-398-0836 Owner's Affidavit: Substantial Improvement or Repair of Substantial Damage Property Address: 1 1r1 (1\47 ItIO c 0 . ,Al2m'Q kit Parcel ID Number: Owner's Name: GTk"1141 Doo Lc.- "ti Owner's Address/Phone: i /C 72d / �4 l�,v (,� �� �t '7-12 S Contractor: Contractor's License Number: Date of contractor's Estimate: I hereby attest that the description included in the permit application for work on the existing building all improvements, rehabilitation, remodeling, repairs, additions, and other forms of improvement. I further attest that I requested the above-identified contractor to prepare a cost estimate for all of the work, including the contractor's overhead and profit. I acknowledge that if, during the course of construction, I decided to add more work or to modify the work described, that the Town of Yarmouth will re-evaluate its comparison of the cost of work to the market value of the building to determine if the work is substantial improvement. Such re- evaluation may require revision of the permit and may subject the property to additional requirements. I also understand that I am subject to enforcement action and/or fines if inspection of the property reveals that I have or authorized repairs or improvements that were not included in the description of work, and the cost estimate for that work that were basis for issuance of a permit. City/County of I C (t— �On�monwea►th of M Owner's Signature: OIL assachusetts scribed and sworn to •,'•re me is Date: 1 (�.j ( 'LI b •4.'. ?L Notarized: My commission ,g 2 , �P`'�u'bhic/._ r,,4 HEATHER A.CAMPBELL C� •' Notary Public ') Commonwealth of Massachusetts My Commission Expires SEP 25..202,6 _ __. _ 04 counuist,ow taittotsx px--- - ___ cloh ok- 2npecupsq etsq amow to cot.uwouomailli oi roatascoeei4? CILMC0uA O. 1 , 1 ,....„