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HomeMy WebLinkAboutBLD-23-002695 ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department ;'oF . 1146 Route 28, South Yarmouth, MA 02664-4492 ' 508-398-2231 ext. 1261 Fax 508-398-0836 " t` '' Massachusetts State Building Code,780 CMRo Building Permit Application To Construct, Repair, Renovate Or Demolish _ ._ a One-or Two-Family Dwelling R E •'`-""'S E //�yyT��his Section For Official Use Only Building Permit Number: 6 4-2.3—W Date Applied: NOV 1 2O22 r BUiLDINO :'F' .:=;f:TMENT 1 1,� ✓ �1 -by. Building Official(Print Name) Signature — f at- SECTION 1:SITE INFORMATION 1.1�PTroperty ddress:/ . 1h' 1.2 Assessors Map&Parcel Numbers I °b iS -JMI/--\ yof I�,� v m'.DD`ifi 6 Doogq 000ro 1.1 a Is this an accepted street?yes no`i\(\,Pr 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 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 0 Private 0 Check if yes❑ Municipal 0 On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Reco d: 1. Name( rmt) Ci State,ZIP VQ114- 1 ba LA)12SCIOA, P C6AIV lk--- a a ?,3 N4m 4`k GC�K, No.and Street Telephone it A d ss SECTION 3:DESCRIPT N OF PROPOSED WORK2(check all that apply) New Construction❑ ExistingBuilding l Owner-Occu Owner-Occupied 0 Repairs(s) ❑ Alteration(s) Addition ❑ P Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: Ni- (-- SECTION 4: ESTIMATED CONSTRUCTION COSTS. • Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ a 0-151) 1. Building Permit Fee:$I Sc) Indicate how fee is determined: i] Standard City/Town Application Fee 2.Electrical $ 3 ❑Total Project Cost (Item 6 x multiplier x 3.Plumbing $ ei (6 2. Other Fees: $ 5,7 Log 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ ., Suppression) Total All Fees:$ Check No. Check Amount: Cash • II• ' 6.Total Project Cost: $ 1 r S, ba ❑Paid in Full IN Outstanding Balance D - kl ���l \\`� t a • co� VOPI • n i J,rL • SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License] (CSL) �c l S a ) C 0>�..Q I ,( License umber Ex ' atio Date � Name o S der List CSL Type(see below) .and Street Type Description U I Unrestricted(Buildings up to 35,000 cu.ft.) ��'City/Townn,StateRRestricted 1&2 Family Dwelling 11011/6hat f M Masonry RC Roofing Covering WS Window and Siding k Q�, SF Solid Fuel Burning Appliances Sb4n 6�- N2bt„ Apszi,a5r I Insulation Telephone Email address Demolition 5.2 Registered Home Improvement Contractor(HIC) Y e J 1� t (� Re istration Number pira on ate crjZ any Name or C Registr N e 5 � �� Seuie.a ep� o.and Street � Ema 1 address zINV o staMh. �7CO3 r* i--�- �'�-- Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c.152.§ 25C(6)) Workers Compensation Insurance affidavit must be co pleted and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuanc f 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 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 co s • in this application lieh.and acc r to the best of my knowleda and understanding. t O, er's or Authorized Agent's Name(Electronic Signature) //// dDate 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.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/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 �� I, Department of Industrial Accidents —'� 1 Congress Street, Suite 100 Boston, MA 02114-2017 �� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): 1� ' "� LJ Address:c2 \ 't 12)4/0 - City/State/Zip:Y P: �(�0•d14-vn t_m,v,-- b0.7 Phone #: ilk — ��l —44"0- Are you employer?Check the appropriate box: Type of project (required): I. I am a employer with a J employees(full and/or part-time).* 7. ❑Ne construction 2.0 I am a sole proprietor or partnership and have no employees working for me in • any capacity.[No workers'comp. insurance required.] 8• emoliti ng 3.❑I am a homeowner doing all work myself [No workers'comp. insurance required.]r 9 E. DemlltlOn 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 C 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.❑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.t 1 Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§I(4),and we have no employees. [No workers'comp. insurance required.] *Any applicant that checks box 4-'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. J am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: 0_,,h,, Q SYV���S A11., ,,(IOW 1 kik Policy or Self-ins.Lic.i#: it r Expiration Date: Job Site Address: ) 6D C :oh 3 City/State/Zip: L f' Attach a copy of the workers compensation policy declaration page(showing the policy number and e$tklYtAvt00,4 ration 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$250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ce ' snider the pains and penalti erjury that the information provided above is true and correct. Signature: Date: // /V Phone#: 4.? (i g"di l q . i-- Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License e Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone It: §TOWN OF VARMOUTH 1146 Route 28, South Yarmouth, MA 02664 508-398-22311 ext. 1261 Fax 508-398-0836 Office of the Building Commissioner BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Ch. 40, §54 and 780 CMR- Section 105.3.1. #4. I hereby certify that the debris resulting from the proposed work/demolition to be conducted at Q b cP444/\._ Work Address 9-(913 Is to be disposed of oat the following location: ') f Vt.Cthj\'\. t Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. !bid, ' ign_ re of Applica�� Date Permit No. Commonwealth of ssae < Division of Professional Licensure Board¥Building k9umt ns and Standards cons,ƒ§$ s r cs11554\: \ 1 \ d b@G4/2\mk SFC ; P 1SF : }\ + ,jf \ s BRIDGE»TER#\ #% . � �� : � © � / iw • 01 •\ . �: • Commissioner� \� c/a8G • Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: LLC LONG ROOFING LLC Registration: 187510 8530 CORRIDOR RD,SUITE 200 Expiration: 04/20/2023 SUITE 200 SAVAGE,MD 20763 Update Address and Return Card. Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:LLC before the expiration date. If found return to: Registration Expiration Office of ConsumerAffairs and Business Regulation 187510 04/20/20,1 1000 Washington Street -Suite 710 LONG ROOFING LLC Boston,MA 02118 (7n, JOHN F.DEPAOLA SR. r L 8530 CORRIDOR RD,SUITE 200rli.� G' SUITE 200 Undersecretary Not vali out signature. SAVAGE.MD 20763 10/24/22, 11:01 AM Mail-Rene Dionne-Outlook ' Left d ra i n Plumbing left wall Before T T,_, 33" to endCu rf ent tub it 3 " to end of tile of wall J12 , 291/2 of right side wall 1_ I 60x30 1 00/1 0 S• ink Toilet ' - - - - 1 ' THE ,UILT" Left drain Plumbing left wall 11- ,,/,‘: ,\ After T -------„A T 33" to end J2„ Current tub 29 Yi2„ 3 '° to end of the of wall of right side wall ID- 1 oof como) , • Sink Toilet https://outlook.office365.com/mail/inbox/id/AAQkAGY2YzkwZjU2LTcyNDEtNGl1ZC1 hNWNmLWE1ZTVkOGNhMWY3NwAQADgKaV4JKwhMpZegygE... 1/1