HomeMy WebLinkAboutBLD-23-002514 c 0�•YRR �„/� (^ f Office Use Only
��.• �r0 ��/ ? / JPermit# e0a585
y y C
N ' 'Amount 1i9•OO
MATTA M CU
��'�������� Permit expires 180 days from
issue date
-02
EXPRESS BUILDING PERMIT APPLICAT�i-? 3 -bOv26/2/
TOWN OF YARMOUTH RECEIVED
Yarmouth Building Department
1146 Route 28 NOV 0 7 2022
South Yarmouth, MA 02664
(508) 398-2231 Ext. 1261 BUILDING DEPARTMENT
By:
CONSTRUCTION ADDRESS: ,2,2 g ?,h S+ �� 0,.,U N-f I �D r t /- 'A b.2( '7`J
ASSESSOR'S INFORMATION:
Map: Parcel:l
OWNER: N;(.Vl�(�. V Ir tAYM�yt 2a D 2t y� �t / t\tri--roLA 1 ! 1>r--L (56v) . -'2'7'19
NAME PRESENT ADDRESS TEL. #
CONTRACTOR:Adtv,Inc ea I"i re 1�l�n c L`O._SV -(� VY T v f ei r...� (-NOV-1 I -Ow
NAME 11 MAILING ADDRESS / TE
X,Residential ❑Commercial Est. Cost of Construction$ j� ��UD
Home Improvement Contractor Lic.# Construction Supervisor Lic.#
Workman's Compensation Insurance: (check one)
❑ I am the homeowner ❑ I am the sole proprietor ❑ I have Worker's Compensation Insurance
Insurance Company Name: Worker's Comp.Policy#
WORK TO BE PERFORMED
Tent Duration (Fire Retardant Certificate attached?) Wood Stove X
Siding: #of Squares Replacement windows: # Replacement doors: #
Roofing: #of Squares ( )Remove existing* (max. 2 layers) Insulation
✓" Old Kings Highway/Historic Dist. ( )Replacing like for like Pool fencing
Gi pp—r)vA( L. //i 7/Z Z
*The debris will be disposed of at:
Location of Facility
I declare under penalties of perjury that the statements herein contained are true and correct to the best of my knowledge and belief. I understand that any false answer(s)
will be just cause for denial or revocation of my license and for prosecution under M.G.L.Ch.268,Section 1.
Applicant's Signature: Date: 0/7/,)
Owners Signature(or attachment) `� �� �j Date: ///7/cl
Approved By: tj Date:
Building Official(or d gnee IAIL ADDRESS:
Zoning District:
Historical District: Yes J, No Flood Plain Zone: 0 Yes No
Water Resource Protection District: Within 100 ft.of Wetlands:
❑ Yes '( No 0 Yes No
f 4 .
'� • The Commonwealth of Massachusetts
_, — 1• Department oflndustrialAccidents
_�rMr"�II- 1 Congress Street, Suite 100
e=_rt= Boston, MA 02114-2017
f www.mass.gov/dia
OM
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
I
Name (Business/Organization/Individual): 41,c t,, C r j& t—
Address: .2) - P;,,.., S-
City/State/Zip: -i-( /iA / 7SPhone #: (j X' ,j(Q)-77y €
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
2.0 I am a sole proprietor or partnership and have no employees working for me in 8. ❑ Remodeling
any capacity.[No workers'comp.insurance required.)
3. I am a homeowner doing all work myself. 9. ❑ Demolition
❑ y [No workers'comp.insurance required.]
4.l I am a homeowner and will be hiring contractors to conduct all work on mYP property.e 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.
12.0 Plumbing repairs or additions
5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑ROOF repairs
These sub-contractors have employees and have workers'comp.insurance.$
6.❑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#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 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 the pains and penalties of perjury that the information provided above is true and correct.
Signature•;� /�.„.../� Date: //,/7//2
Phone#: (6 Db") a•7 —,17,5
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#:
k • ti.
22%"
Radiant
Maximum Heat 45,00o BTU/hr
Log size 16 5"
Max.Area Heated 1300 ft2 0
Firebox Dimensions. . . . 17'A"W x 9" D
Firebox volume/capacity 1.04 ft3
Outside air supply Available
Gross Weight 3o9 Lbs , •
Mobile home approved Yes
Basic Clearance m%+
1g jH aas r,:tr.au
(using single wall pipe top vent)
Stove to side wall 16"
Stove to rear wall 6%z"
Stove to corner 81/2"
40"
MORSO DESIGN GLASS
HEARTH PAD-
CODE:62g79600
22 ,0
For all clearance options download installation manual from www.morsona.com
7
•
•
•
t,_1-71 .. *:„ TOWN OF YARMOUTH
ivli- :412 ) 1146 ROUTE 28,SOUTH YARMOUTH, MA 02664-4451
ilitg.....37 Telephone(508)398-2231 Ext. 1292-Fax(508)398-0836
...
7 ;.',11fi`
OLD KING'S HIGHWAY HISTORIC DISTRICT COMMITTEE
i OLD KING'S HIGI-J'A5f,1::', :
APPLICATION FOR
CERTIFICATE OF EXEMPTION
Application is hereby made for the issuance of a Certificate of Exemption under Sections 6 and 7 of Chapter 470 of
Acts of 1973, as amended, for the proposed work as described below and on plans,drawings,or photographs
accompanying this application.
Type 9r print legibly:
Address of proposed work:c2t2 ‘ Pi A e Si Map/Lot# I 05 /0
Owner(ay A);C en c,,I c CY 1--sA./----,c,1,-,,,,,,k Phone#: 02 (.0-7 - 27, ?
All applications must be submitted by owner or accompanied by letter from owner approving submittal of application.
Mailing address: ) ) V P;r,p._ SI 1/21 r-r-i,n LA+1,-, Pnrt, A-1/1,, Year built: I CI Va
Email V'I ,.),,,,-k„...r.,,,, ?-0 e__ 47,0i (i 3 1A-1 Preferred notification method. Phone Y Email
Aaent/Contractor: Phone#:
Mailing Address:
Email Preferred notification method: Phone Email
°ascription of Proposed Work(Additional Pages may be attached it necessary):
0 J Stts)'VC— 1
xi 4 ,,,..., r V' 0$ ty•ti"v4.y.-
----",
Signed(Owner or agent). 7,-,-"` ;(2..eiev. ...----e Date: / - /7- ,)
.). Owner/contractor/agent is aware that a permit may be required from the Building Department.(Check other departments,also.)
This certificate is good for one year from approval date or upon date of expiration of Building Permit,whichever dale shall be later.
i
for Committee use only:Date: PP 712) _....L.Approved Approved with changes! , ;*:'41' iii: ji'.`.:, ;: itri. i
'w li I
Amount 20.it) Reason for denial:
I 1
CashICK#i g 5-ft)
,
,
Rcvd by
Date Signed: tql712. Signed: 5Q-e aifecivo ..ovv)?1 1
APPLICATION
V5 201 7
Sherman, Lisa
From: RICHARD GEGENWARTH <r.gegenwarth@comcast.net>
Sent: Monday,October 17, 2022 5:32 PM
To: Sherman, Lisa
Subject: Re:22-E148 228 Pine Street
Attention!:This email originates outside of the organization. Do not open attachments or click links unless you are
sure this email is from a known sender and you know the content is safe. Call the sender to verify if unsure.
Otherwise delete this email.
I would hope that the proper precautions will be adhered to not burn down the building. A coat of
black stove pipe paint would further camouflage the pipe.
approve.
Richard
On 10/17/2022 10:33 AM Sherman,Lisa<Isherman@yarmouth.ma.us>wrote:
Hi Richard,
Resident is adding a wood stove to the garage, and the exhaust pipe will extend
slightly above the roofline in the back of 228 Pine Street. The exhaust pipe will
not be visible from the street.
Please let me know if you need any additional information.
Thanks Richard,
OCTI 7 2022
Lisa
YARMOUH
OLD KNGS HGH WAY
Lisa Sherman
Town of Yarmouth
.29:61tir
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