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HomeMy WebLinkAboutBLD-23-000847 p4 )0121)22- O► & TWO FAMILY ONLY- BUILDING PERMIT R E • E I V E\si_ ETown of Yarmouth Building Department 1146 Route 28, South Yarmouth,MA 02664-4492 1 2Q�2 Code, 780 CMR NT508-398-2231 ext. 1261 Fax 508-398-0836 .,r % \, .� AU Massachusetts State Building �'n _ __ Bzrr ding Permit Application To Construct, Repair, Renovate Or Demolish _ LUtLDI G RTME a One-or Two-Family Dwelling y: — ' This Section For Official Use Only Building Permit Number: 4).-23-t 1 Date Applied: O nn i Building Official(Print Name) O J � - Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers - . 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 q 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? Check if yes❑ Municipal 0 On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: fJr1e r ►i R j O f� o Metz,!) t figf f .. i Nam (Print) City,State,ZIP ' ..9 Pi cJf s—T 5o3-7/3 706 5 ,„ ;1„r�/ No.and Street (� G�,I�q�Q9C eGIM / Telephone Email Address `\ SECTION 3:DESCRIPT�N OF PROPOSED WORK (check all that apply) \ 0.,New Construction❑ Existing Building l Owner-Occupied ❑ Repairs(s) 0� Alterat ion(s)tton(s) V Addition ❑Demolition ❑ Accessory Bldg. ❑ Number of UnitsJ(/ Br•ef D scription of Proposed Work': Other 0 Specify: SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: (Labor and Materials) Official Use Only I. Building $ "3a®a 1. Building Permit Fee:$7 _Indicate how fee is determined: 0 Standard City/Town Application Fee 2.Electrical $ 3.Plumbing 0 Total Project Costa(Item 6)x multiplier x $ 2. Other Fees: $r 6 b 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire Suppression) $ Total All Fees:$ 6.Total Project Cost: $ Check No. Check Amount: Cash ount: 3 WO 0 Paid in Full DJ Outstanding Balance ue: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) Name of CSL Holder License Number Expiration eateat 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 /vI Masonry • RC Roofing Coverin ® Window and Sidin• ® Solid Fuel Burning Appliances Telephone Email address © Insulation 5.2 Registered Home Improvement Contractor(HIC) D Demolition 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) ��J �. Date SECTION 7b: OWNER1 OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of peijury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. Print Owners 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 wtivw.mass.sov/oca Information on the Construction Supervisor License can be found at www.mass 2. When substantial work is planned,provide the information below: — ov/dns Total floor area(sq. ft.) (including garage, finished basement/attics, decks or porch) Gross livina area(sq.ft.F---Number of fireplaces Habitable room count Number of bedrooms Number of bathrooms Type of heating system Number of half/baths Type of cooling system Number of decks/porches Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost' -\ _ The Commonwealth of Massachusetts I �`�ls_IDepartment of IndustrialAccidents -L�= 1 Street, �1/4":71 : j_ Congress Suite 100 ► Boston, MA 02114-2017 m' www.mass.Qov/dig Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. A • licant Information Name (Business/Organization/Individual): Please Print LeEibl Address: �� MIC S'f City/State/Zip: �,,e�i'h ��—[ , Phone #:�G�_ 7/� -7U6j Are you an employer?Check the appropriate box: LC I am a employer with employees(full and/or part-time).* Type of project(required): 11 2.0 I am a sole proprietor or partnership and have no employees working for me in 7. New Jelin UCtlOn any pacity.[No workers'comp. insurance required.] 8. E Remodeling 3. 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 or are sole ensure that all contractors either have workers'compensation insurance10 Building addition proprietors with no employees. I l. Electrical repairs or additions 5.111I 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.: 13.❑Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 152,§1(4),and we have no employees. [No workers'comp. insurance required.] 14'C Other *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 wheeror 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 'ob site information. l Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: CityAttach a copy of the workers' compensation policy declaration page(showing the/State/Zip: Failure to secure coverage as required under MGL c. 152, policy number and expiration date). a criminal and/or one-year imprisonment, as well as civil penalties in the form of STOP WOIRK ORDER and a fine ofon punishable by a fine up poo1 500.00 day against the violator. A copy of this statement may be forwarded to the Office of Investigationsp to$250.00 a coverage verification. of the DIA for insurance I d hereby certify under t • .gins an s- zalties of se ury that the information provided above is true and correct. Signature: Phone#: Date: Official use only. Do not write in this area, to be completed by city or town official. City or Town: Issuing Authority(circle one): Permit/License 1. BoardInspector of Health 2. Building Department 3. City/Town Clerk 4. Electrical Ins 6. Other p r 5. Plumbing Inspector Contact Person: Phone#: TOWN OF YARMOUTH tie BUILDING DEPARTMENT �6 a x^7 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1261 PLEASE PRINT: HOMEOWNER LICENSE EXEMPTION DA'1E: i JOB LOCATION: 0444 J MAO ? P"' tNAME STREET ADDRESS SECTION OF TOWN "HOMEOWNER" NAME HOME PHONE WORK HO PRESENT MAILING ADDRESS �7 ,C 4.p. -S-i a z y' "Ae4L C/L( 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,providecat 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' 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 SIGNATU -----"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 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 oz Cl /Al S f 7`? a4. ,4 Work Address Is to be disposed of at the following location: �J S"3' _ /C-� L C- cad- Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. 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No.:.c &'i7/ 3 %t16,� Address: 029 12l4`-t-- / 4eMP Uil.:4- Date Filed: ///-7/,/,,22-- **Ifyou would like e-mail notification of sign off please provide e-mail address: Owner Name: r. 1 M 112i Lrnc) Owner Address: gy /�l�L- S* )61244,(414 /?907-/ Owner Tel No.: �f� -`7/3 `% � 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. r 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. 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'., :.<.#'1,..a-.x.x.;..-,.- r . ,ter ---'5-; .< ` --i-t-W-, ---'.4.'-',-.A.4.4:74-4T-,:.-711-----."--''---'•';'• ''-"'-'-'-.-5,:' �` .s.- - '.� - - - :€ :'a* �_ � j. �r x _.1 S tea. �� .� ' � https://mail.google.com/mail/u/0/?tab=rm&ogbl#inbox?projector=1 ?Cir-13,(..,.. tU 1/1 .:r 1146 ROUTEMA TOWN OF YARMOUa 4451 Ai G ; 7 '202(' Telephone(508)398-2231 Ext. 1292—Fax(508)398-0836 rARIviQU QLD ING'S HIGHWAY HISTORIC DISTRICT COMMITTEE OLD KING' it(iHW,AY APPLICATION FOR CERTIFICATE OF APPROPRIATENESS Application is hereby made for issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts of 1973 as amended,for proposed work as described below&on plans,drawings,photographs,&other supplemental info accompanying this application, PLEASE SUBMIT 4 COMBS OF SPEC SHEET(S),ELEVATIONS PHOTOS,&SUPPLEM NTAL INFORMATION. Check All Categories That Appiv: Indicate type of Building: Commercial .1 , 1)Exterior Buildin Construction: INew Building 1'I Addition Iterations IReri, , ,;tr2gr f V E p ,Shed Solar Panels Other. �" '�` ---_ 2)Exterior Painting; I ISiding Shutters 1 1 Doors Trim I lather: SEP 13 ��21 3)Signs/Billboards: l 1 Ne ' n Change to ` ' ting Sign Bvl�Uirv� 4)Miscellaneous Structures: Fence Wall Ffa [� cry--_ EI ARr jENT gpole [ i Pool FlQther: Please type or print legibly: ot Address of proposed work: a1 �//ne 0 t�gnicMM-4' Map/Lot# 12 3 Owner(s)- 3)im A(Li tfit 6 Phone#:,5 08 7/3-70 6_6 All applications must be submitted by owner or accompanied by letter from owner approving submittal of application. Mailing address; Fla 5 � /1 0 E4� Year built: d`OOJ 41 Email: In9► Q J 1 t V ff►4t fi- QM C Preferred notification method: fE Phone I Email Agent/contractor: Phone#: Mailing Address: Email; Preferred notification method. 0 Phone12:1Description of Proposed W rk ,Email C x+ d`sv k /s-h N' c., . 'ha.t�r,� S c 5 .k ' Ii A rr�4>4 Signed(Owner or agent): -� - �A-r-- •. Date: r Owner/contractor/agent is aware that a permit is required from the Budding Department.(Check other departments.also.) If application is approved,approval is subject to a 10-day appeal period required by the Act. y This certificate is good for one year from approval date or upon date of expiration of Budding Permit,whichever date shall be later. r All new construction will be subject to inspection by OKH.OKH•approved plans MUST be available on-site for framing&final inspections, For Committee use only: Approved Approved with Modifications . - Denied Revd Date: � I 7 7-1 Reason for Denial: Amount ,GQ }# PR.o� 9`� Cash/CK M: Cr'.S f 1 r s' Signed. Rcvd by: L. ' ' 45 Days: l i Date Signed: 1 " t APPLICATION#: " ' r I , Sears, Tim From: Sears, Tim Sent: Tuesday, August 23, 2022 3:14 PM To: 'Dhimitri Lako' Cc: Water Department Subject: 29 Pine Dhimitri, I have reviewed your application for the front deck and there are some items needed. N2Y.VOld King's Highway approval . Water Dep artment sign off ,., \�'S��►��� Please submit these items for review. Timothy Sears CBO Deputy Building Commissioner Town of Yarmouth 508-398-2231 Ext. 1259 mailto:tsears@yarmouth.ma.us 1 • „ n .<;1 lee ‘":"-- . _ Le �" I . t. _ III Fil 0 L ro 0n _ 0--) 11 4. Ith c ) • .c cr y 1 O,9 E r.z CDT m fn ' G � 1 C , .'.' r, ' illak t• D .ry r 9- i.., - ,) Mr. .. ( ! -....7) T) ..r. .4 iA 03 r , , er z 0) ,. &-li 0---4 e- e.. % -\/ c • M (° 2 _ In �7 t r