Loading...
HomeMy WebLinkAboutBLD-23-002838 ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department y 1146 Route 28,South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 Massachusetts State Building Code,780 CMR e Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: so -a 3 -Oi?,R,t3' Date App 'ed- / /G Building Official(Pfint Name) 'Signature jg s _ T�y E D SECTION :SITE INFORMATION NOV 2 2022 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 71 Driftwood Lane,Yarmouth MA 02664 ! 2'7 —7 O . _-- -_.-- -- _ 1.1 a Is this an accepted street?yes 12 no Map Number Parcel Number t3 U I L U I N G DE PA R T M E N T _ 1.3 Zoning Information: 1.4 Property Dimensions: itO 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 Private Zone: Outside Flood Zone? Municipal❑On site disposal system 2 Check if yesEr SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Sylvia,Terry Yarmouth MA 02664 Name(Print) City,State,ZIP 71 Driftwood Lane 508-776-7922 tnsylvia@cocmast.net No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction❑ Existing Building Owner-Occupied 11 I Repairs(s) ElAlteration(s) 0 ( Addition 0 Demolition 0 I Accessory Bldg. 0 Number of Units Other ✓❑Specify:Wood Stove Brief Description of Proposed Work':Installation of a new MF Fire Wood Stove into an existing masonry fireplace_ SECTION 4:ESTIMATED CONSTRUCTION COSTS • Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $7200 1. Building Permit Fee:Siadaindicate how fee is determined: ?.ElectticaI IDStandard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ l, 4.Mechanical (HVAC) $ List O A l 5.Mechanical (Fire $ Suppression) Total All Fees:$ 6.Total Project Cost: $7200 Check No. Check Amount: Cash Amount: 0 Paid in Full 0 Outstanding Balance Due: � ° � ` ' - ' � � ' ' - � � ` ` r"C\ `' ` ��8g � ``. . ` . ` `� � �� so ' ' ' - ' - __ _ ___ - SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number Expiration Date Name of CSL Holder List CSL Type(see below) No.and Street Type Description U Unrestricted(Building up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC I Roofing Covering • WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D I 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 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. Print Owner's or 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 acc&cs 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.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" I The Commonwealth of Massachusetts Department of Industrial Accidents = Office of Investigations Lafayette City Center 2 Avenue de Lafayette, Boston,MA 02111-1750 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Apnlicant Information Please Print Legibly Name(Business/Organization/Individual): Terry Sylvia Address:71 Driftwood Lane City/State/Zip:Yarmouth, MA, 02664 Phone#:508-776-7922 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition workingfor me in anycapacity. employees and have workers' p tY 9. ❑Building addition [No workers' comp.insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions officers have exercised their 11.0 Plumbing repairs or additions 3.® I am a homeowner doing all work myself. [No workers' comp. right of exemption per MGI. 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no 13.0 Other Wood Stove 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: Policy#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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that 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 the pains and penalties of perjury that the information provided above is true and correct. Signature: ,(ram Date: // ` Z / — 2 Z Phone#: 508-776-7 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License # Issuing Authority(check one): 10Board of Health 21:1 Building Department 3.0City/Town Clerk 4.0 Electrical Inspector 501'lumbing Inspector 6.DOther Contact Person: Phone#: ONE or TWO FAMILY— BULDING PERMIT APPLICATION REGULATORY APPROVALS NOTICE Address of Proposed Work: 71 Driftwood Lane, Yarmouth MA 02664 Scope of Proposed Work: Installation of a new MF Fire Nova Wood Stove into existing masonry chimney Date: Based on the scope of work described above, the applicant is required to obtain approval sign- offs from the following departments as checked-of below: Health Dept. —508-398-2231 ext. 1241 Conservation —508-398-2231 ext. 1288 Water Dept. —99 Buck Island Road, 508-771-7921 Old Kings HWY. Hist. Comm. — 508-398-22631 ext. 1292 Engineering Dept. —508-398-2231 ext. 1250 Fire Dept. — Kevin Huck/Scott Smith, 96 Old Main Street, SY Note: Please call Fire Department for an appointment. 508-398-2212 X Other Appropriate plans and/or application shall be provided to each departments checked-off above. Each of these regulatory authorities has their own requirements outside the jurisdiction of the Building Department. All applicable approvals shall be obtained prior to submitting a building permit application to the Building Dept. Thank you for your cooperation. Receipt Acknowlecqem nt: ✓'i'L u 4/t� /l / — °� Applicant's,Pgnat e Date Rev. Jan. 2019 „ is A .. TOWN OF YARMOUTH � °° BUILDING DEPARTMENT ��" a."=s; =C 1146 Route 28, South Yarmouth,MA. 02664 508-398-2231 ext. 1261 HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE: JOB LOCATION: 71 Driftwood Lane, Yarmouth MA 02664 NAME STREET ADDRESS SECTION OF TOWN "HOMEOWNER” Terry Sylvia 508-776-7922 NAME HOME PHONE WORK PHONE PRESENT MAILING ADDRESS 71 Driftwpod Lane Yarmouth MA 02664 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,provided that such homeowner shall act as su ervisor (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 ' it'y, 'W-r '&• i1 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 vem, 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:homeownriicexemp §TOWN OF YARMOUTH 1146 Route 28, South Yarmouth, MA 02664 508-398-22311 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 workldemolition to be conducted at 71 Driftwood Lane Work Address Is to be disposed of oat the following location: No Debris Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. _7 ,4-� / 7 // — 2% - 2 Z Signatur6Hof lication Date Permit No. NOVA AND NOVA TOWER OWNER'S MANUAL L 440 , 4600 Trzt Wig 1144 Safety Notice: Please save these instructions for future reference. Please check our website for the most up to date version of this manual. Please read this entire manual before you install and use your new room heater. Failure to follow instructions may result in property damage, bodily injury, or even death. Contact local building or fire officials about restrictions and installation inspection requirements in your area. Do not install Nova in a mobile home! Manufactured by: MF Fire, Inc. 3031 Washington Blvd STE G, Baltimore, MD, USA PFS `iFFIRE c us Report Number F20-590 Floor Protection Requirements Nova must be installed on a non-combustible surface or with adequate floor protection. Floor protection must extend around the front, sides, and rear of the stove, according to listed clearance requirements below. Floor Protection Clearances hml K K Floor protection from front 16"US/18" CAN (406/457 mm) L Floor protection from side 8" (203 mm) M Floor protection from 2" (51 mm) chimney connector Floor protection must be listed to UL 1618. Floor protection must be made of a non-combustible material and at least 0.018" (0.45 mm) thick. For a Nova equipped with 6" legs and ash lip, Nova equipped with 9" legs, and for all Nova Tower configurations, only Type 1 ember protection is required. For Nova equipped with 3" legs, Type 2 thermal protection with minimum R-value of 1.35 is required. 13 I Page Nova Owner's Manual I © MF Fire 2021 Minimum Clearance Requirements Nova may be installed as a top vent with a ceiling exit in either a standard or corner configuration, or as a rear vent with a direct rear exit. The minimum clearance requirements are listed in the table below. Clearances may be reduced following methods in NFPA 211, listed wall shields, pipe shields, or other means approved by local building or fire officials. Top vent, ceiling exit B o r / f l ( ) A Single Wall Double Wall Connector Connector Pipe Pipe with Reduced _ Clearance Kit A Sidewall to unit 20" (508 mm) 20" (508 mm) B Backwall to unit 17" (432 mm) 7.5" (191 mm) C Sidewall to connector 28" (711 mm) 28" (711 mm) D Backwall to connector 22" (559 mm) 13" (330 mm) E Corner to unit 12" (305 mm) - F Corner to connector 21" (533 mm) - 11 I Page Nova Owner's Manual I © MF Fire 2021 Special Installation: Hearth Mount in Masonry Fireplace Nova may be used in conjunction with a masonry fireplace provided all installation instructions are followed. The entire fireplace must be clean, undamaged, and meet all local building codes. This installation requires a full reline. The liner must be a stainless steel chimney connector or flexible vent pipe. Follow the liner manufacturer's instructions for installation and support. • !Pill u,%:. Full \� reline Clay liner ♦ 1. tr- 36"(915 mm) t` ` 4,? Check clearance to seals on 1lJ�ll�.e •J. combustible "clean our mantle 11 r.°4 Damper • must be l• `v itiv securely fastened r � open ?>>:: - �Srr• k.„ 19 I Page Nova Owner's Manual I © MF Fire 2021