HomeMy WebLinkAboutBLD-23-003949 C :E o.V D l—f -4
- - oF• ay. BUILDING PERMIT APPLICATION
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE, OCCUPANCY OF,
�JAN 19 :. OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING.
BUILDING DEP v• '\I • Town of Yarmouth Building Department _
By — 11-16 Route _8 • Yarmouth, MA O9(i6-1-(•49`_' 1u 3 .. Fs-. 1
Tel: 508-398-2231 ext. 1261 Fax 508-398-0846-
Office Use On ry F C E i V E D
G Planning Board Information Assessors Department Intorratior rtp-- -------• -�—"
Permit No.r3(J)'1 -W3q Plan Type_
pate Map tpp 6 2023
Permit Fee $ ��SO
Endorsement Date
Recording Date E
Deposit Rec'd. $ Date plan No. 1.4 Property Dimensions: By ----_ -
Net Due $ IcO Other Lot Area(sf) Frontage(tt) Lot Coverage
C ZC( -- This Section for Office Use Onty
Building Permit Number. Date Issued:
Signature: _ _ � -, Certificate of Occupancy
Buildtng'(5 ciai �' Data is Is not required
Section 1 - Site Information 1
1.1 Property Address: 1.2 Zoning Information:
r
�/
1 R✓y1 t_Pr ` i '1? A Zoning District Proposed Use
1.3 Building Setbacks (tt)
Front Yard Side Yards Rear Yard
Required 1 Provided Required I Provided Required Provided
1.4 Water Supply(M.Q.L c.40.S 54) 1.5 Zone Information: Comments
Public Private Zone: _ BFE
Section 2 - Property Ownership/Authorized Agent
2.1 Owner of Record:
CA (-GO o f 1..-LAl) (+c� ;t, i35rt `� 1 i. fI 116.) G I,, "Itivkil4AGAAil
N ne(print) Mailing Address:
9-1 -1.---1--1.. 711-''' - o Z.7' r;'I'-NY s .,t& 36.L-'-J3 L 7--
Signature Telephone Telephone
Email Address:
2.2 Authorized Agent:,
Name(print) Mailing Address:
Signature Telephone Fax Email Address:
Section 3 - Construction Services
3.1 Licensed Construction Supervisor. Not Applicable
:itev2-,6 ,,..J ( e ciM..Ic.fl6AI 4- Crt'N-e,vr3-L C-Jp 1/✓.
License Number
I/ GTE,Y ; - om/ WA/ — Viti i it4 14 -444i cIN 44/1 0 LE 4 S' 1 LX0 L c
Address 7
7
1 kt/v„,,,,,j_, i\i, ikwytkv, 51 e, '23.2_t lc , r,,,,,,,,4,441,-;v6, Expiratir
ati
Signature Telephone Email Addresses� 3 ZZ
•L'# . (-1 4)
tv U t IZG r-ee.-n. e 6u IZ .G r-0
' ; , Section 6 - Description of Proposed Work (check all applicable)
• _ New Construction ❑ I (for multiple family only) No.of Bedrooms (for multiple family only) No.of Bathrooms
Existing Bldg. ❑ l Repair(s) ❑ Alterations ar Addition ❑ I
Accessory Bldg. 0 Type Demolition Other Specify:
I i
Brief Description of Proposed Work:
(.2G:4, ti,_T Cf rCI 5 4 c! , / / XC 15' ' / 0r /3M67vtz,Air 0 F-
J ' 1t'4i o LCO > d() t `�f i"i t 1; 7,-,-1 C. AV'6 4=5 •
Section 7- Use Group and Construction Type }
Building Use Group(Check as applicapable) Construction Type
y
A ASSEMBLY ❑ A-1 ❑ A-2 D A-3 ❑ to 0
A-4 ❑ A-5 ❑ 1 B ❑
B BUSINESS I ❑ 2A ❑
E EDUCATIONAL I 28 ❑
F FACTORY I ❑ F-1 ❑ F-2 ❑ 2C
H HIGH HAZARD I ❑ 3A
I INSTITUTIONAL I ❑ I-1 ❑ 1-2 0 1.3 ❑ 3B ❑
M MERCHANTILE 1 ❑ ❑
R RESIDENTIAL I ❑ R-1 ❑ R-2 ❑ R-3 ❑ LA ❑
S STORAGE I ❑ s-1 D S-2 El 59 11
U UTILITY ❑
SPECIFY:
M MIXED USE
SPECIFY:
S SPECIAL USE I ❑
SPECIFY: .
(Complete this section if existing building undergoing renovations, additions and/or change in use.I
Existing Use Group: Proposed Use Group:
Existing Hazard Index 780 CMR 34 Proposed Hazard Index 780 CMR 34
Section 8 Building Height and Area
Building Area Existing (if applicable) Proposed
Number of floors or stories
include basement levels 2-
Floor Area per Floor(sf) J f S r /at sit-; . 7
Total Area All Floors (sf) I 2461V
I Total Height (ft) '
Section 9 - STRUCTURAL PEER REVIEW (78OCMR 110 11)
Independent Structural Engineering Structural Peer Review Required Yes No
SECTION 1 Oa OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
.r'
I, Ali t< e /2 i 1- e-% , 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.
-2117,t_ . .1/...--/' 7r.s2..:.,i/
A
Signature of Owner Date
SECTION 10b OWNER/AUTHORIZED AGENT DECLARATION
I, I ..51 v0 e t— I> , as Owner/Authorized Agent
hereby declare that the statements and information on the forgoing application are true and acurate, to
the best of my knowledge and belief.
Signed under the pains and penalties of perjury.
�` t L ey •
Print Name
btF/d.
Signature of Owner/Agent Date
Section 11 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be
completed by permit applicant
1.Building ��\\
a Electrical 1
*/, Sly
3.Plumbing/Gas /il
4.Mechanical(FfVAC) 15 �` /G7O
5.Fire Protection I ZZCO
6.Total_(1 +2+3+4+5) ,/ XOJ
- 7_Total Square Ft Ilsruw scictnes a addibore) I 1 I
Check Below
❑ Conservation-Commission Filing
(if applicable)
❑ Old Kings Highway&Historical
Commission approval
(if applicable)
— The Commonwealth of Massachusetts
` Department of industrialAcciderzts
=zifirm I Congress Street, Suite 100
ce ••
�{•- Boston,MA 02114-2017
MENIMMEr
sys
www.rnass.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): t'• r - S - * j, It/C- o7j-
Address_ 4"if 91/6-�2. to-Y — v ' fl i`'t f
City/State/Lip: /Witt t y—O,X b *is Phone #: s `l20
Are you an employer?Check the appropriate box:
Type of project (require
19 I am a employer with I employeespart-time).*
sJ� (full and/or 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. -assurance required]t g Demolition
4.❑I am a homeowner and will be hiring contractors to conduct all work on 10 I I Building addition
ensure that all contractors either have workers'compensation insurance or are sole I will
proprietors with no employees. 1 I.� Electrical repairs or additions
6.E I am a general contractor and I have hired the sub-connectors listed on the attached sheet 17 Plumbing repair or additions
These sub-contractors have employees and have workers'comp.insurance_: 13.n Roof repairs
6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other
152,§1(4),and we have no employees.jNo workers'comp.insurance required]
*Any applicant that checks box fl must also fill out the section below showing their workers'compensation policy imuinianon.
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 then- 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.
Tnsurance Company Name: A i /3&}2,_TJ r wn/y1,- ,f�2 r
Policy#or Self-ins.Lic.#: "V(t —T f S — 2 c 3 9 / 7
Expiration Date: 3 /�
Job Site Address: ) d) l/11/j% S i )°*- /LIOt//J -F 4-I 1 •�7s
lty/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
e 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 anda 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 • nder the pains and penalties of perjury that the information provided above is true and correct
Signature: `f/ (4 1( �/
Date: //-S/1-,}—
Phone#: ,-Dgi ) ) — (95 l�5 I 7
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):
I. Board of Health 2. Building Department 3.City/Town CIerk 4.Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone m:
42.
--J �� 'man "rclrtnn-' �' 71i
'fir, / v ® �
s e O 1:41 B /►
Ill 4
p MF i .4
...,
f;, 4.....
GREENOUGH'S O a-,,
O
, 44
i POND r
i €
t,3 -, .
,,, •
,1„, .,„. 5 . ,1
— .. 40
0 .iiii,„, ,,,„
\.,..., / r
X A\ttl 1 41 I I:14201
- 0o
MV
VA.4), id 4. .1'4A ),,,,41,
, ,,,,,,,,„.
N,
„„
, -tk), Vi
I A
•Irs=s_stickii
, ..,.
DATE OF LATEST MAP REVISION:9/30/33 TAX MAP 113114115
INFORMATION SHOWN HEREON IS FOR ASSEBSINO iW 30 0 100 200 TOWN OF YARMOUTH '_ 1 s 106 SHEET
PURPOSES ONLY.NO LIABILITY FOR ERROR IS _J� r �
ASSUMED BY THE TOWN OF YARMOUTH. mF°'t "Ti - BARNSTABLE COUNTY,MASSACHUSETTS 95 105
1 94 96
g
R11 1
i74 g
Fpa
a
8
g / /i i
114
,
c.
8 I\
..
I� 1
\ .a._
jj
�ImmOC l' i
Z 71 Cn
D f73b
N3 ,_I
4
W. o ' - R=
.9 o a 0
€g o
113
I 1u1 IT O ❑ 6l n
11jiilc Ii1Ei O
I
•ili'lili•
O ;
CV II o
1 CA* O ,,11110 A 8 t 1 gli C..) St_ ,_• x. '\\Lt O I
t f j $ J/taSy �\DD
83:iii g it , cp
. 4 c,!)
it
tslito„Yilivii. .Mill S.� FAirpirlInCL:41&&11V4
i il/ _mn _ � . 41111t. ri _
sacnuserts
CommonWeattc e°S.1 Licensure
r and
pivision°f P Regulations d:tandafd4t,..5, _
ill
Board o1 gurtd'n9 • St1 .'
onstf : cibt� E'FtTes'p311 112g�2
CS G HARD A. WON
SOU".1D 4 �.
dlejir6s
Go miss onef .
r tl4Tuter•Arr orr;
�1,. i:,/n)ilnrrrnrrr�f�n��
Oft,ce of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR
TYPE:Corporation
Reaistrati°n Exai_ _Latwn
190712 02/20/2022
E.T.S.&L.,INC.
DB/A EG MANAGEMENT SERVICES
RICHARD A.HAMLIN a.//I
4 EVERGREEN WAY UNIT#4 Undersecretary ary
HARW ICH,MA 02645
� TOWN OF YARMOUTH
c HEALTH DEPARTMENT
•
�• `` PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
Building Site Location: Z2 PI 14; S • (Lee
Proposed Improvement: A PP _ w,4 2 l S (.2 K. y ) To Got c.t
(?Ac.r r 5- , ,T. elcx // ' 2K / Rvctm
of 6 S7n wiv4C ( s
Applicant: 1..10AJl{ CAt 1J Tel. No.: VE---s-or—) 0 3/
Address: pc ee)i ,'P ,4 Date Filed:
**/fyou would like e-mail notification of sign off please provide e-mail address:
Owner Name: 3five 7sLAwfr ((i1NCrL SSA Fi
Owner Address: fa 2 f7 Wi I1A^/ s t y MjJ►1 Owner Tel. No.:5d-362.-�9 322_
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,
�IAN 2023 and septic system location;
(2.) Floor plan labeling ALL rooms within building
HEALTH DEPT. (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.
c
REVIEWED BY: i6 /tr--I-\---r DATE: I I <✓ ?1 3
PLEASE NOTE
COMMENTS/CONDITIONS:
(-7-- --
MaushopLodge - Basement Room Layout
._.
Existing New Rear Side
Proposed Room Existing Storage Room
11' x 14'
.\
3---==
I
24'
Relocate Existing Door
Replace Existing Door Proposed 2' x 12' Scout storage shelving
L. i
30' Rr''' CO iPLI 8
AL_ , IFVF THE
A . _. :,S BUILT'
COMPLIANCE.
DATE: )•'�'a,-3
BUILDING OFFICIAL
I
EXTERIOR WALL 2x WALL STUDS SEE PLAN
SHEATHING, SEE PLAN 5/8"x18"ANCHOR BOLTS
__i '>,..____________— P.T. SILL PLATE ON 2x BOTOTM PLATE
*': cfl
10)
i CONC. SLAB ON GRADE SEE PLAN
_ _ x —x--x—x— 01 T/FLR
•
0"
\ _.
1 l i I-1I-1I I —
—II- I II-TI VIAP0RBARRI0R, SEEARCH
I ITIIIIE
RIGID INSULATION, SEE ARCH
• CONT.#5 BAR
CONC. WALL
0 - #5 BAR CONT.AT 12"o.c.
q ..— r "f� #5 DOWELS AT 18"o.c.
#5 TOP AND BOTTOM OF WALL
ALT ENDS
—4 - CONC. FTG
T/FTG
3'-6" ' di?
0
:MINN.....1- ,,,,,.....-- (3) CONT.#5 BARS
•
\ \
•
/ 8" 8"lf / 8"
2'-0" ,(N��MASSY '
/ / 1 4 THOMAS CyG
E.
LAMB .1.1 ..
'.. o STRUCTURAL ;4 :;
NO.49045 ,
j a-off , ��
bk;%/STEP 6�a� .,
•
ei-e,,"''' °-1)ZZ,
SECT
ION
O 3/4"= 1'-0"
VP148 Constitution Drive BOY SCOUTS OF AMERICA
Bedford, NH 03110 227 PINE ST.
Phone#: (603)472-4488 YARMOUTH, MA
Fax#:(603)472-9747
PREPARED FOR
Engineers www.tfmoran.corn
Copyright 2010®Thanes F.Maan Inc.(TFI.)
40 Cunsfitulicn Prize,Bedford,NM 03110
AI rights reserved.Tr, S KS-1
aed orandmalerrep may not
copied,duplicated,replicated or otherwise reproduced n any
see,o.ro, scue
don,whatsoever horizwnhr of the prior wdtfen permission of TFM,
3/4"= 1'-0" 3191
These plans and maleals are not effective unless elg led by 9.QQ ��`duly authorized officer o1 TFM. onrs; J,_,�
07/29/22 �«.e. TEL MJB