HomeMy WebLinkAboutBld-23-003879 R E C E I fFi _ TWO FAMILY ONLY- BUILDING PERMIT
Town of Yarmouth Building Department
1 1146 Route 28,South Yarmouth,MA 02664-4492
JAN 17 2023 i 508-398-2231 ext. 1261 Fax 508-398-0836 a
Massachusetts State Building Code,780 CMR
BUILDING DEPA �PrmitApphcation To Construct, Repair; Renovate Or Demolish
er:_ a One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: 6(-0-2-3-(J)1'cfq 7 Date Applied:
4
3621-1 V E D
Building Official(Print Name)eam ) Signa re
SECTION 1:SITE INFORMATION pp
11/.1 Property Address: 1.2 Assessors Map&Parcel Numbers FEB 2 1 2023
4'5 (ir'cc.i t'4 red ‘IGy r>'aGN h )
r.___-
1.1 a Is this an accepted street?yes )( no Map Number Parcel Number BUILDING DEPARTMENT
ny
1.3 Zoning Information: 1.4 Property Dimensions: "'-
Zoning District Proposed Use Lot Area(sq ft) Frontage(It)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required I 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:
Zone: Outside Flood Zone?
Public Private❑ Check if yes0 Municipal 0 On site disposal system L
SECTION 2: PROPERTY OWNERSHIP`
2.1 Owner'of Record:
j uiclk DI Pic VGrerwl-{-k MA-
I Name(Print) City,State,ZIP
&s c -cu;a- 12.cA 70/ eici 5W 1 r T4724 Y4 �.Ccrr'
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building El Owner-Occupied lid f Repairs(s) Vf Alteration(s) fir I Addition 0 I
Demolition ❑ Accessory Bldg.0 Number of Units Other ❑ Specify:
Brief Description of Proposed Work2: 6.,c>1 e)ci s-F-i,1 ervi-r-y c.- \I-5 # 1�e_mcic.( e7cisl•i»n
4,etGv•rN Mot at ned-,t L.,: -lc kr_tkkc,r-,.
SECTION 4:ESTIMATED CONSTRUCTION COSTS.
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 23, 0 7 Z 1. Building Permit Fee:S L0 Indicate how fee is determined:
&Standard City/Town Application Fee
2.Electrical $ Z/0 D(j ❑Total Project Cost3(Item 6)x multiplier x
3.Plumbing $ 5;9 2..c 2. Other Fees: S_ a 33 (00 .(1..)
4.Mechanical (HVAC) $ List:��e.clt 7 c x a, )ou
•
5.Mechanical (Fire 17, 1 0
Suppression) $ Total All Fees:$
Check No. Check Amount Cash Amount:
6.Total Project Cost: S .32j 99 2 0 Paid in Full al Outstanding Balance Due: 3 Lt0
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SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
C;SF4 /6h36(n II/ox,-/zaz.3
ce r ► .()f c-(/,ev ccr License Number Expiration Date
Name of CSL Holder
2 so 1 List CSL Type(see below) /Z
No.and Street , Type Description
/ U Unrestricted(Buildings up to 35,000 cu.ft)_
C-ns+, -cr✓1{1G. M GZ(i3 Z R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
77'l 25.3 0133 E cc ?►ufec',e )4J3 )6h, ;I.CAh I Insulation
Telephone Email address D I Demolition
5.2 Registered Home Improvement Contractor(HIC)
1905'6/ mac 'IGr►�J ,iv;C�/�vc�j--��FerJ- l�— 1�ro�issisc,1» S HIC Registration Number p�ration Date
HIC Confpany Name or HIC R gis ant Name
7-SO ran 4;clx YPaI ec54-Ccc5 ircz sScc,Is a o 1.
Na.and Street ei CCm
� �/ Email address
Ci.Y]{-Gr (Ivitic /✓(r4- 61 2. 27'/ J?J S7 & 73
City/Town,State,LIP 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 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 ��rtrr / rJ`((,CGvccr,
to act on my behalf in all matters relative to work authorized by this building permit application.
Dcv,ca i l7�c��2�. //iqz 3
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 accurate to the best of my knowledge and understanding.
✓t ;
�Zi�yrn/ I ,
C ttscen
Print Owner's of Authorized Agent's Name(Electronic Signature) Date
NOTES:
I. 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.sov/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
ft' Department of Industrial Accidents
$ 1 Congress Street, Suite 100
it I Boston, MA 02114-2017
'��, www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name (Business/Organization/individual): j¢ C�c f- Pr r 1'i ,di -e O � �
rY T-ern-r ,I li-�� l
Address: ZSO Cop n I;' %,) Rd Cen4w>r•%lle AAA o? C7 7>7 _
City/State/Zip:Cen4erv:I k /4,4 QZ(0 Z Phone#: 2'7'/ 353 &, ' 3 3-
Are you an employer?Check the appropriate box:
Type of project(required):
i.ryl 1 am a employer with / employees(full and/or part-time).'
7. ❑New construction
Q I am a sole proprietor or partnership and have no employees working for me in
any capacity.[No workers'comp.insurance required.] 8. �Remadeling •
3.0 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 m y property. I will 10 ❑ Building addition
ensure that all contractors either have workers'compensation insurance or are sole I I.Q Electrical repairs or additions
proprietors with no employees.
12.0 Plumbing repairs or additions
5.a 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 13.0 Roof repairs
6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.0 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 infonnation.
t Elomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors 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: Pro/;v c-it-c,- :2-71_42 j rent-to Sri i(G'/ %true 1c I.-S
Policy g or Self-ins.Lie.#: ,!-JLI/3 yy_, 7 P?2 27 Expiration Date: //lb,/�3
Job Site Address: G S ('; ci - City/State/Zip: yiri h .MA
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.
1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature: Date: / /.SIZ 3
/,
Phone#: (/ 7)i/ .353 4,4/3;
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License 4
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town CIerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
A,c ORL� CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDDIYYYY)
811,—..r 12/1 2/22
ITHIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERIS).AUTHORIZED
REPRESENTATIVE OR PRODUCER.AND THE CERTIFICATE HOLDER. j
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER CON TACT NAME: JOE DEOLIVEIRA
Deoliveira Insurance Services IA/CNNo,Ext): 508-477-3023 (A/C,No): 508-638-6463
800 Falmouth Rd. E-MAIL
UNIT101-A ADDRESS: joe@dinsinc.com
Mashpee,MA 02649 INSURER(S)AFFORDING COVERAGE NAIC#
INSURER A: MSA
INSURED INSURER B: Travelers
EAST COAST PROFESSIONAL BUILDING& INSURER C: Travelers/Assigned Risk
REMODELING INC INSURER D:
250 CAPN LIAJAHS RD
CENTERVILLE, MA 02632 INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS
LTR INSD WVD (MM/DD/YYYY) (MM/DD/YYYY)
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 1,000,000
DAMAGE IRENTED CLAIMS-MADE X OCCUR PREM SESOtEa occurrence) $ 500,000
MED EXP(Any one person) S 10,000
A MPT3201 F 08/25/22 08/25/23 PERSONAL&ADV INJURY $ 1,000,000
GENII AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000
POLICY JE� LOC PRODUCTS-COMP/OP AGG $ 2,000,000
OTHER- $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
(Ea accident)
ANY AUTO BODILY INJURY(Per person) 5
OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE 5
_ AUTOS ONLY _ AUTOS ONLY (Per accident)
S
UMBRELLA LIAB OCCUR EACH OCCURRENCE S
EXCESS LIAB CLAIMS-MADE AGGREGATE 5
- DED RETENTIONS 5
WORKERS COMPENSATION X PTA OTH-
AND EMPLOYERS'LIABILITY STATUTE ER
C ANY OFFICER/MEMBOEREXCLUDED PROPRIETOR/PARTNER/EXECUTIVE NIA 6HUB4437P22322 11/07/22 11/07/23 E.L.EACH ACCIDENT S 100,000
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 100,000
If yes describe under
DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT 5 500,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
CARPENTRY 3 STORIES OR LESS
JEREMY NICKERSON HAS ELECTED TO BE COVERED UNDER THIS WORKERS COMPENSATION POLICY
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
TOWN OF YARMOUTH
1146 ROUTE 28
SOUTH YARMOUTH, MA 02664 AUTHORIZED REPRESENT TIVE
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0 1988-2015 ACORD CORPORATION. All rights reserved.
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§TOWN OF YARMOUTH
1146 Route 28, South Yarmouth, MA 02664
508-398-223r1 ext.-1261 Fax 508-398-0836
Office of the Building Commissioner
BUILDING DEPARTMENT
DEMOLITION DEBRIS DISPOSAL AFFIDAVIT
Pursuant to M.G.L. Ch. 40, §54 and 780 CMR- Section 105.3.1. #4.
I hereby certify that the debris resulting from the proposed work/demolition to be
conducted at 63- C r c";F Po( yrr nIc144- -)
Work Address
Is to be disposed of oat the following location: lci-r►-,c t 11 fir? 0407
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Ch. 111, §150A.
///qz3
e of Application Date
Permit No.
1/24/23,3:45 PM Mail-Sears,Tim-Outlook
•
65 Circuit Rd
Sears, Tim <tsears@yarmouth.ma.us>
Tue 1/24/2023 3:44 PM
To: 'eastcoastprofessionals@gmail.com' <eastcoastprofessionals@gmail.com>
Jeremy,
I have reviewed your application and there are some items needed.
1. Floor plan of bathroom
2. Framing plans for deck/stairs
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:tsearsjyarmouth.ma.us
https://outlook.office.com/mail/sentitems/id/AAQkADE3MDQ5NWZmLTkOYzltNDIwNi1 iMDQxLWNkMGQyNmE4NzE5NAAQAANSll9g4BBDrMX8cY1x... 1/1
Substantial Improvement Worksheet for Floodplain Construction
(for reconstruction, rehabilitation,addition,or other improvements, and repair of damage from any cause)
Property Owner: Pc,v; P i P;c,Z ZGi
Address: ( 5 C cA C —it 7 4
Permit No.:
Location:
Description of improvements: cNe• .4.;r‘c. .4- - 4-‘&41.4 Add / (A),ir.kg.4) yn 1A4)-2eacn')
Paitiejit et Value or mil tiviasal aej4sted
assessed or
bee # wry $ i 1' )400
•
host atf � ;
"�nrde�ao5aw � �
.�!� �;
If ratio is 50 percent or greater(Substantial Improvement),entire structure including the existing
building must be elevated to the base flood elevation(B E)and all other aspects brought into compliance.
Important Notes:
. 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
-ion-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:
Date:
1/16/23,2:15 PM Scan_65 Circuit 1-12-23.png
•p1. TOVVTIOF YARMOUTH
o� l,� BUILDING DEPARTMENT
tit -"' 4 mit 1146 Route 2$,South Yarmouth, ia102663
-\`3 . Telephone 508-398-2231 ext. 1261 Fax 508-398-0836
� P
Owner's Affidavit: Substantial Improvement or Repair of Substantial Damage
Property Address: ( -.) . /n 'l,iv /- 1 �'4.0 Lin ' / . -r
Parcel ID Number:
Owner's Name: i.r,41,'i.6 1), AAa
Owner's Address/Phone: 4;c C'/#zCIJ'% j'ti 1,,/— /y— op6 L.,
Contractor: •./eXrJ1j 1J/CK&�RSCv'<t
Contractor's License Number: e Sr-1 — /C�,, 7L,.ri.
Date of contractor's Estimate: /J(} "A 3
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.
Owner's Signature: ,70(-'
I(
Date: / //.zl cd43
JACK E CARAVELLA
Notarized: JACK E CARAVELLANotary Public
Notary PublicState of New Jersey
State of New Jersey My Commission Expires May 14,2024
My Commission Expires May 14,2024 t D#24513993
I r1 f^•,Rnc 1
,
,,,,o - = TOWN OF YARMOUTH
Ai" - \\o BUILDING DEPARTMENT
�``,.,,, ',._Lu-tzf 1146 Route 28, South Yarmouth, MA 02664
J.'; ;0 Telephone 508-398-2231 ext. -1261 Fax 508-398-0836
Contractor's Affidavit: Substantial Improvement or Repair of Substantial Damage
Property Address: 6-C C; -car F 12J \%r cI A A4,,4
Parcel ID Number: /
Owner's Name: DGv;e D;Pi ., zZc-,
Contractor: Scrcr-Ny .4) 1/6✓scr► l %� Ccc.�- PVc,-c L()/S 131,0161;-�� �cencric4.-7
Contractor's License Number: C S FA- /b,3 LC.
Date of Contractor's Estimate: //0 ,
I hereby attest that I have personally inspected the building located at the above-referenced address by the
nature and extent of the work requested by the owner, including all improvements, rehabilitation,
remodeling, repairs, additions, and any other form of improvement.
At the request of the owner, I have prepared a cost estimate for all of the improvement work requested by
the owner and the cost estimate includes, at a minimum, the cost elements identified by the Town of
Yarmouth that are appropriate for the nature of the work. If the work is repair of damage, I have prepared a
cost estimate to repair the building to its pre-damage condition. I acknowledge that if, during the course of
construction, the owner requests more work or modification of the work described in the application, that a
revised cost estimate must be provided to the Town of Yarmouth, which 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 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 made or authorized repairs or improvements that if inspection of the property reveals that I have
made 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.
Contractor's Signature ---- --
Date: ///7/23
Notarized: JENNA F.GRAZIANO
A * 4 Notary Public
I I' Commonwealth of Massachusetts
`:.V.'// My Commission Expires October 30.2026 (�II 7 x j�3
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'EM to,11;se'e,c!orrr--:;3
iOWi.� O'Y r1VUlH
1146 Route 28 So Ityarthouth, MA 02664
508-398-2231'e. ax 508-398-0836
Office of tlit, I: T. otumissioner
-
FINAL COST AFFIDVIT FOR WORK IN FEMA FLOOD ZONE
To the Building Commissioner,
In accordance with 780 CMR Section 109 of the Massachusetts State Building Code, the total estimated cost of
construction, including all related costs* of the building at (t,C C:r c.c,4- `/cr mcu+h .N1 A
and constructed,reconstructed, altered,repaired, or extended under building permit no.
amounts to S 3O 55 7 .0 Q
I, ��,� .,� Ai/c G.i/Sc ,being referred to as the owner/agent identified below,do solemnly
swear that the statements made herein are strictly true, correct and made in good faith
*Related construction costs include all work done with or concurrently with the work contemplated by the building
permit including construction, reconstruction, repairs, demolition, HVAC work, etc. Furnishings and portable
equipment are not part of the total construction costs.
ignature of owner/agent
tary Publ igna a My Commission Expires
Notary Seal:
.. JENNA F.GRAZIANO
Notary Public
i Commonwealth of Massachusetts
�" My Commission Expires October 30.2026
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142.