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HomeMy WebLinkAboutBLD-23-002066 • ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department : """"� --_ 1146 Route 28, South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836F 1 '' Massachusetts State Building Code,780 CMR Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: B l>, -(=Nolo Date Applied: Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION FRECLIVE ') dd 1.1 Proper ress: 1.2 Assessors Map&Parcel Numbers 1.1 a Is this an accepted street?yes l/ no Map Number Parcel Number OCT 18 2022 1.3 Zoning Information: 1.4 Property Dimensions: L— BUILDING DEPARTM1 ,,T By 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 0 Zone: Outside Flood Zone? _ Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP'2 Owner'of or`: e{‘JVNG�2 5, ya ryt40�A k I���j g ✓ Name(Print) City,State,ZIP `10`I Siectaloi 4 cog-774-3c46 Ott/+- qua. v/�i ee ✓CviLAy.no." No.and Street Telephone , Emaif Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction e Existing Building 0 Owner-Occupied 0 Repairs(s) .0 Alteration(s)' Addition .0 Demolition 21 Accessory Bldg. 0 Number of Units 1 Other ❑ Speci • Brief Description of Proposed Work2: Jqe v5 e /ir$ 741,h5 Q V i / SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 1. Building Permit Fee:$ )C Indicate how fee is determined: -ll.Standard City/Town Application Fee 2.Electrical $ ❑Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ .cO.a�n 4.Mechanical (H Gt[' VAC) $ List: -94 5.Mechanical (Fire $ Suppression) Total All Fees:$ ©� Check No. Check Amount: C otmt_� 1 6.Total Project Cost: $ �r 4� 0 Paid in Full tROutstanding Bean e Due: 5 ` `11ti1 r SECTION 5: CONSTRUCTION SERVICES 15.1 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 Ivi Masonry RC Roofing Covering • WS I 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 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: 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. ‘)e_Ae-v-- ei)a,v pl-i ji442.e. /W/81/2Z- 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.aov/oca Information on the Construction Supervisor License can be found at www.mass.aov/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 il = jf, Department of Industrial A cc/dents l,_ 1 Congress Street, Suite 100 —.4:—��__ Boston, MA 02114-2017 ;�,�•'�( www.mass.go v/dia «Yorkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTINNG AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): �e ty"- 1 )i e / Address: � tjd y 9 S4q' • , b6k '" City/State/Zip: S. ypi j•iyv 'J1g� � °1471*Phone : Svk 774 3 s-7)6 Are you an employer?Check the appropriate box: Type of project(required): LEI I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.0 I am a sole proprietor or partnership and have no employees working aci comp. for me in 8. remodeling cap acity.ty.[No workers' insurance required.] 3. I am a homeowner doing all work myself [No workers'comp. insurance required.]trflY 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 11.0 Electrical repairs or additions proprietors with no employees. 12.17 Plumbing repairs or additions 5.0 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.[ I •❑Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.El Other r 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. [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: t)kytAith/14 �dc,i IAA-f ow° Zoyyy0 Policy#or Self-ins.Lic.#: Expiration Date: /6)74e..../.42z.„ Job Site Address: 409 S A'V\Qy-, iive City/State/Zip:c 4y04/I L 4) Mei, OZ6e, y 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 hereby certify under th ains and enalties of perjury that the information provided above is true and correct. -Signature: p,,ftc, /�4.5 fJ Date: / /1(/LZ Phone#: .�6 —7 7�- 3�226 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): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: H [� O1''Y`q�E TOWN OF YARMOUTH ,/ p .1 BUILDING DEPARTMENT 0( . _do ,z_��=E% '.d 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1261 HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE: JOB LOCATION: YO 15' eat17 ., / S.yq1'10702,44 NAME �_ STREET ADDRESS SECTION OF TOWN "HOMEOWNER" r42-''f'ry DI u ,vlca .5a - 77G-34706 NAME HOME PHONE WORK PHO PRESENT MAILWG ADDRESS `it'll S i'q- e.. #vt s. 4,, yz,li', G)‘t y CITY OR TOWN STA'1'h 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' 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 APPROVAL OF BUILDING OFFICIAL INSURANCE COVERAGE: I have a current liabi y insurance policy or its substantial equivalent, which meets the requirements of MGL Ch.142. Yes ti 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 /'t ter 142 of Mass. Gen 1 Laws and that my signature on this permit application waives this requirement. 4' ` heck one: Signature of Owner Owner's Agentwner 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 % / 5 ') c 2 %' ? Work Address Is to be disposed of at the following location: *WI/V/1/W /) Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. —"Ae Signature of Applicant Date Permit No. Fy, TOWN OF YARMOUTH } ., x• o WATER DEPARTMENT i'4 99 Buck Island Road• 4 ,c NE ti �� West Yarmouth, MA 02673 �' Telephone: (508) 771-7921 • Fax: (508) 771-7998 BUILDING PERMIT APPLICATION FOR WATER DEPARTMENT SIGN OFF TRANSMITTAL FORM BUILDING SITE LOCATION: 7U y 5*1 ' 7 'Ie _ PROPOSED WORK: 2-401 ce,__ *çc)v\ Vi0rc,0 .1_ 'sec- k APPLICANT: n�/ 1t/ILAP ADDRESS: 0 { sioAt,__AL ___ ____ __.._ _ _ TELPHONE: 08 - 776 - S ST 2 peter; 4# iiiee C) !Q v 1 Zvkiilet RESIDENTIAL AND/OR COMMERCIAL BUILDING Water Department: Determines Compliance of Water Availability and or existing location Engineering Department: Determines Compliance for Parking and Drainage Conservation Commission: Determines Compliance to Wetlands Act; i.e. 1f lot(s)border any type of wetlands,streams,ponds, rivers,ocean, bogs, boys, marshland, ETC... Health Department: Determines Compliance to State and Town Regulations, i.e. requirements for Septage Disposal and other Public Health Activites Fire Department: Determines Compliance to State and Town Requirements for Personal Safety, Property Protections. i.e. Smoke Detectors. Sprinkler Systems,etc A _ ,,,// 1/2 APPLICANT SIGNAT[f E DATE OFFICE��OMB S ON PERMIT APPROVAL OR DENIAL t REVIE 8Y W TER DIVISION (SIGNATURE) DATE fI ;ot-Y mks TOWN OF YARMOUTH : HEALTH DEPARTMENT PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To he completed by Applicants Building Site Location: COLA 31ck 0h IVC- Proposed Improvement: P �`4 .e {'yU / clec k v Applicant: ?ee '\. May ee Tel. No.: 5 '- 7 7 '3So Address: ( \tgitt_o." l vvP Date Filed: /0—/ **If you would like e-mail notification of sign off please provide e-mail address: Owner Name: Owner Address: Owner 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: �/ / 0 — PLEASE NOTE COMMENTS/CONDITIONS: 4.0or -2— '' 1r Dr,° 6087-7-(310) NAME f0- r , Peter Dauphlnee 4' -6-21-R6 STREET...„&4" /�L� ,, r -- , y.'i , A" - VILLAGE Hi-fi;{ y�Ey�G'ti SERVICE NO. G u s' 7 - 7 METER NO. 97 • \ / Property Location: 404 STATION AVE MAP ID:88/221/// Bldg Name: Stale Use:1010 Vision ID:12026 Account#12026 Bldg#: 1 of 1 Sec#: 1 of 1 Card 1 of 1 Print Date:03/07/2017 10:04 CONSTRUCTION DETAIL CONSTRUCTION DETAIL(CONTINUED) Element Cd. Ch. Description Element Cd. Ch. Description tylc DI Ranch i ode! 01 Residential adc 03 Average FOR 20 3$ • ►torics I 1 Story BM • cupancy 1 MIXED USE xtcrior Wall I 14 Wood Shingle Code Description Percentage .xtcrior Wall 2 1010 SINGLE FAM MDL-01 100 i oof Structure 03 Gable/Hip 2 r'oof Cover 03 Asph/F Gis/Cmp 125 2'05 t nterior Wall I 05 Drywall/Sheet interior Wall 2 COST/MARKET VALUATION nterior Fir I 14 Carpet Adj.Base Rate: 19.69 nterior Fir 2 12 Hardwood 155,597 10 eat Fuel 03 Gas I et Other Adj: .00 OP 0 I'eplace Cost 155,597 cat Type 05 Hot Water . 20 28 10 YB 970 C Type 01 None otal Bedrooms 03 3 Bedrooms u •Code otal Bthrms 1 { ( r{{ { pp 3 t 1 emodemRating aritOR � MUST CONFORM t O+ iL_I,. otal Half Baths 0 ear Remodeled oral Xtra Fixtrs lei,% 0 '' !� IS & REGULATIONS otal Rooms unctions!Obslnc _ �J_ ryi•ath Style 02 Average 1•xternal Obsinc /40 / V1 itchcn Style 02 Modern ost Trend Factor 47"-;':::111:1-_ J/` _ ,,, a IT onditionA D 1 4: Yu Complete • erali%Cond 0 •pprais Val 08,900 -1iep%Ovr Dep Ovr Comment - Misc Imp Ovr "- isc Imp Ovr Comment '''. '� goil° - -- ost to Cure Ovr ,�;_. : ..I..T . ' oat to Cure Ovr Comment OB-OUTBUILDING& YARD ITEMS(L)/XF-BUILDING EXTRA FEATURES(B) ! k' T. Cade Description Soh Sub Descript U81Units Unit Price Yr Gde Dp Rt Cod %Cndl Apr Value .HDI SHED FRAME L 120 8.00 1995 1 50 300 Alli illbelliallifigr. t BUILDING SUB-AREA SUMMARY SECTION Code Description [Living Area 1 Gross Area I Eff Area Unit Cost Unde•rec. Value !:AS First Floor 910 910 910 119.69 108,918 GR Garage 0 500 200 47.88 23,938 OP Porch,Open,Finished 0 40 8 23.94 958 BM Basement,Unfinished 0 910 182 23.94 21,784 TM Gross Liv/Lease Area:! 9101 2,3601 1,300l 155,597 �1. . ._ sue'.• _.. :. 4 tea" r r ti ��,..,,,,...:,..aver-,A„ A..- �7 r u'k 'X. , a J tb- 'N2Y„4c , f.' F— - TOWN Of YARMOUI Fi 4.A. 4-174b \41) WATER DEPARTMENT k isiamii Road ?,,''--..21—".41 \AVst Yamouth, MA 0267i lidephom,: ‘51Hh -71-7921 , i<r.;: (.7(18 77i-79,w BUILDING PERMIT APPLICATION FOR WATER DEPARTMENT SIGN OFF TRANSMITTAL FORM BUILDING SITE LOCATION: .,() t PROPOSED WORK: f,.....-e„oaf e_ kv,,),,,-1\---- 9,rc.,,t,•,0, 7 / D APPLICANT t,e.,,../ t-21,-' C),Cttj cIVI me42 • ADDRESS: q 0 S -.\1 01.1 ' (--i --kr ' A/L. .... ....... _ TELPIIONE: ,f) 6, L -- 7 76 3 .s.---0 ., e/er-,-. di u pi4/.,k7 e*e. #vev`i zoko's el RESIDENTIAL AND/OR COMMERCIAL BUILDING Water Department: Determines Compliance of Water Availability and or existing location Engineering Depanment: Determines Compliance inr Parking and Drainage Conservation Commission: Determines Compliance to Wetlands Act: i.e. If lot(s)border any type of wetlands,streams,ponds,rivers,ocean,hogs,boys, marshland, I.;IC... health Department: Determines Compliance to State and Town Regulations, i e requirements for Septage Disposal and other Public Ilealth Activiies Fire Department: Determines Compliance to State and Town Requirements for Personal Safely. Property Protections, i.e.Smoke Detectors, Sprinkler Systems.ete f,e4--- //c/1/ ki:/4;2 .,-.2 APPLICANT siGNAT ' E DATE OFFICE USE: COMMENTS ON PERMIT APPROVAL OR DENIAL 744/ --) ,--1 f i - ‘,1.,... /2'' i 7 '''-- f ' '-- REVIEW Icil'WATER DIVISION(SIGNATURE) DATE Ott t#11 T k .4 r . ____ ir t *-* it" (\ fr-ok1T Door' .-- 1 t y( -7'.. S f • ---rs f-----"Cp 0, JK •—. , c-t1 al ;mi, t CI J v1 _ --t- -- - --7.Y.-44e -r-5' Z. ..t, r C7 — — ID ` p U ,� a . = A CA.= ( Qi 0 k\i, cri E-5 )„,.'I, , W I r . 1 r- 0 - . 0. m — -pF , .� — — — — j at Cti. -It-----0------ --*----* — s - - C. N - — — - - � - . E d�X(r X ys -.SM 43 ;"i C. _,-- Ck , t --(3 (1\) .. ..._.... _ _ __... r, oti__ ____v_ __A_7'- • f3-g- fi1/40------ --