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Home My WebLink AboutBLD-23-002403 RECEIVED --F------ —ONE & TWO FAMILY ONLY- BUILDING PERMIT OCT 5 2022 Town of Yarmouth Building Department of"'r •.. 1146 Route 28,South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 �``"r�� BUILDING DEPARTMENT Massachusetts State Building Code,780 CMR BY -- -----Bvr ding Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: .3(.)-23- Z•4 O3 Date Applied: Building Official(Print Name) • Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers l '-1 Plei,wA4 5teeel- 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 0 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: A./Latti Cil vci evoi)k 5c J 11 `Ic.rinv.. , MA b (t-1 Name(Print) City,State,ZIP (Xi Piettle,„4" SM4.f -11t -cA1 S f)cat Anc.viii C vMt4:s t F' No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied ❑ I Repairs(s) (Vj Alteration(s) 0 Addition 0 Demolition ❑ Accessory Bldg.0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: Ki{s.I\e" a r ' Iwo,,, r t 44140 a1 IV't,...' Cubs;•d-s t Pv./n -614. Pp lik.,c.c*, SECTION 4:ESTIMATED CONSTRUCTION COSTS. Estimated Costs: Item (Labor and Materials) Official Use Only 1.Building $ YO vim'-vo 1. Building Permit Fee:S +cO Indicate how fee is determined: 2.Electrical $ 5 ,,,� 61 Standard City/Town Application Fee 0 Total Project Cost3(I)en: 6)x multiplier x 3.Plumbing $ f o4m %� 2. Other Fees: $ C -1043 3 5 • D L) 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees:$ Check No. Check Amount: Cash unt 6.Total Project Cost: SSvc ovv•0 J p Paid in Full 07 Outstanding Balance Du : ) 4ti SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS— uricylrl, q��l �3 L Gcluot, License Number Expiration Date Name of CSL Holder Roj List CSL Type(see below) 1-) No.and Street Type Description I)Iiiliv, % pia 0)3(JC' U Unrestricted(Buildings up to 35,000 cu.ft.) City/Town,State,ZIP R Restricted l&2 Family Dwelling M Masonry RC I Roofing Covering WS Window and Siding S`)1-3(oc�'I�`I J s emu,.t"��y'eme4, ts. SF Solid Fuel Burning Appliances iC4.hl1VN Corn I Insulation Telephone ErhaiI address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 13 I i) 1 m 54-2trh t L. HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name No.and Street S;�n�lwi01, PA 0)56'& `I(5,�-34t� - 13YU Email addr s City/Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(14.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 12K 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 5t•,,w..'41%7 PN pti•--1 c s U.it to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owher s Name(Electronic Sign re) 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 th applica• n is true and accurate to the best of my knowledge and understanding. I t'1.)y 1.•a 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.nov/oca Information on the Construction Supervisor License can be found at www.mass.nov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) )5) 5i, ►- (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 oflndustrialAcciderzts g =1r1= 1 Congress Street,Suite 100 _, ?`=,' Boston,MA 02114-2017 `�^..xr,Fs� www.mass.gov/dia \Yorkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): 5'i ;,,i„r4t Pruec i-t,Es Li.C. Address: .7 S.-15 (2,.„..k 130 sk ) 44 212 City/State/Zip: crc�•t(c.I< MA. 0)4ti`1 Phone#: 7- Ni -Y01-Oi.'1 Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with employees(full and/or part-time).* 7. ❑New construction 2 m a sole proprietor or partnership and have no employees working for me in capacity. 8. [ -&t,odeling . any ap ty.[No workers'comp,insurance required.] 3. I am a homeowner doingall work myself. 9. ❑Demolition ❑ y [No workers'comp.insurance required.]t 4.0 1 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.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.13 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.! 1 i•❑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.(No workers'comp.insurance required.] *Any applicant that checks box 01 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#1 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. 1 do hereby certif under tthh pains and penalties of perjury that the information provided above is true and correct. Signature:ck�,..t2 11 Date: CU'J y/1 Phone#: "11"-1-3 61 -)t c-1 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#: Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Consj u ttlAiSpprvisor CS-088962 . c�plres:09/27/2023 STEPHEN L OAITARIUS > i 145 VALLEY OAD PLYMOUTH M9 02360 ' 1 '' Commissioner d1,i e A. Cmc3.ra., /I' /'/////I/'////•F'/1��/f. JT�//.i i/I/' //i/'f�' . Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:Individual Registration Expiration 190072 12/17/2022 STEPHEN L CATARIUS STEPHEN L.CATARIUS ,' 10SHAWMERD e r' 'zGl�i SANDWICH.MA 02563 Undersecretary '' v. .s.r.... Construction Supervisor Unrestricted -Buildings of any use group which contain less than 35,000 cubic feet(991 cubic meters)of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license Call(617)727-3200 or visit www.mass.gov/dpl Registration valid for individual use only before the expiration date. If fc and return to: Office of Consumer Affairs and Business Regulation 1000 Washington Street -Suite.710 Boston,MA 02118 vali without signature Main Level ..THE I - 14'. r "'"""' ^^M THE RESPONSIBILITY OF"AS BUILT" — . 13' 4" DATE: (I `lG -4, BU DI O IAL f;i s ` °, Kithen � ��t R�t�x C r ' ` t I,... I - i _ cat jj'' ' i 6t MI, _- ,,2' 21' 1 od Floor (l) ,, cn /`Y' Dining Room •, t tt h'Ill" 'x�, `antry .-3t 1 1 tt_1 "A : e ;. _ t � 8t ,2t ltt1---3t9tt t i \• 2t c - Ent , CIast Entry S1oTld N -. 1- ) 1-,4_,/ !.dry Room I `� L 12' 4'----1 1 6" Vi I 1 13' 8" 1 4' 1 tt—I t. Main Level 554_21-22 TBC EST 10/6/2022 Page: 14