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HomeMy WebLinkAboutBld-23-000929 8/17/22,5:18 AM Resized_Resized_20220815_135756(1)003.jpeg f x a 7 `` SECTION 5: CONSTRUCTION SERVICES :z: 5.1 Construction Supervisor License(CSL) 1)a r /� (''.S-olo1b.7 Name of CSL 1se-,der lcial�•Ki t}1 r License Number Expiration ace ' 6 .'46 List CSL Type(see below)I,.h�'r'=' --1 e1 ap �t lnJ( Type Description SN (} '�I do 91�Q- e' 7/ UR Unrestricted(Buildin_gs up to 35000 cu.;` + �/ !" ` Restricted Idc2 Family Dwelling CItY/Town,state,ZIP M Masonry i RC i Roofing Covering WS ( Window and Siding t Df p ( � I J' l , SF j Solid Fuel Burring Appliances t atQ+C1 3 4 C-r7ur?t4s�-1{ 2 ver(Zbrl_ I j Insulation Telephone Email address c h - D LDemolition 5.2 Registered Home[ptnproveruent t�tractor(HIC) E � � \ �O� �3a-d )'eA ( kt{S- 3 �,l c�e3rs t.I_L', CtP_ 4Y111 (£ (1C,2 Ht Registration Number Ee(piraticn Da:e\RIC ..orn y Name o C Regtst e F C/r ur.ta..1 �-.r In i t N td stet t7 0 h i _ Email adds-ss (l City/Town,State,Z Telephone SECTION 6: WORKERS' COMPENSATION fiISURANCE AFFIDAVIT(NI.G.L c.IS_.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide i this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes ciV No....... ...Cl SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN 4 OWNER'S AGENT OR CONTRACTOR PL OR 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 a,plica‘tioa t Print Owner's Name(Electronic Signature) Date - SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION By entering ray 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. ejill-riteA b(L. I,U,K1 e-1 I e , __.e Date Print Owner's or Authorized Agent's Name(Electronic Signature) 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 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.sot'/oca Information on the Construction Supervisor License can be found at vnvw.mess.eovidot When substantial work is planned, provide the information below: Total floor area(sq. ft.) (including garage, finished basement/attics,decks or porch) ,. Habitable room count �� Gross living area(sq. ft.) Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches 1 - - Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" ONE & TWO FAMILY ONLY- BUILDING PERMIT RECEIVED Town of Yarmouth Building Department --- 1146 Route 28, South Yarmouth,MA 02664-4492 Ldj 508-398-2231 ext. 1261 Fax 508-398-0836Massachusetts State Building Code,780 CMRitg Permit Application To Construct, Repair, Renovate Or Demolish BUILDIG DEPARTMENT a One-or Two-Family Dwelling ... ,,. BY (�� t� This Section For Official Use Only Building Permit Number: Bu)-d3- ? Date Applied: Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 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❑ Zone: _ Outside Flood Zone? Check if yes❑ Municipal 0 On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'ofRecprd:, • L•Ls u, -i- Win)te.,D)Xo n Ail Name(Print) ��� �C� City,State,ZIPQ f O. 10 rr �-�- 502-40_ /6(4 N-____ j,wi __,nY_C1r.�l� No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 I Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition Accessory Bldg. Number of U its Other . Specify: Brief Descri ' n of Proposed Wo y- A l� � f SEC ION 4:�ESTIMA � NI STRUCTI 4 ONCOSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical. $ ❑Standard City/Town Application Fee ❑Total Project Cost3(Item 6)x multipke x 3.Plumbing $ 2. Other Fees: $ 64).00 C e 3 3 I 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire Suppression) $ Total All Fees:$ • �T Check No. Check Amount: Cash Amount: • 6.Total Project Cost: $ /.2. 15�0 --- 0 Paid in Full ❑Outstanding Balance Due: Sears, Tim From: Sears, Tim Sent: Wednesday, August 24, 2022 9:49 AM To: 'cbanksbuilders@verizon.net Subject: 481 Buck Island Rd Charles, I have reviewed your application for the deck addition and this complex was created by relief from the Zoning Board of Appeals.The expansion will require a special permit for expansion of a non-conforming property. You will also need the approval of the condo association for the Zoning Board hearing. Please call with any questions This email is considered a written denial of your permit application per Section 105.3.1 of the Massachusetts State Building Code. Section 105.3.2 states in part that "an application for a permit for any proposed work shall be deemed to have been abandoned 180 days after the date of filing, unless such application has been pursued in good faith" You may appeal this denial to the Building Code Appeals Board in accordance with M.G.L. c. 143 §100, within 45 days of this notice. Timothy Sears CBO Deputy Building Commissioner Town of Yarmouth 508-398-2231 Ext. 1259 mailto:tsears@yarmouth.ma.us ;C k Ce Cx ,i S 11 2 5 1 8/17/22,5:17 AM Resized_Rec ed_20220816 063314001.jpeg • -i, i ;5��.. 4 . '.,5 ��' , fie 1 e , 4 gi•y st If aa w h .q ., ft, P e) ,.),),co. 4-. • ' . '0 a (f1 ......4 . . Na-. . ,, e t ,,,.. ., .. ._.. ... . t C4i ,f JJ , Ipt?1,1 ....,_ , , . _ _ .. . ,k,, . , . . . .. • . _ , . . . _ ,.., . . _ . ......„.._. .70 . „.„ .,.. , , , - ,. .. . 5 cat 0+III(5 . _ . to (3,Viht- -1 s ♦ \ • • • s ¢ � .'�� �xvyf ' �e V yA aft-. Nam., .�.. ;.M 4 r f .Q� k n er 2 r�aa. 1 yr kaM i. 4 4 y y 1 Y . $l' _ -,. 'Y. �F.yy 'jk1 „ Vi M �1- • t.t • EY _ _ a • - a.. x r' 4 ,'•- t xt ' fit. .* r • °`44 -;�, ?F' 1 ".• f y s 1 �{ M s • t � 1 - i3- SPr f. t 0-.•iJ�. { -*y , r s ,.+raw y , -', • ,itt •,.,- 5 g f ^ v. y,*-', .R :� y .x !! ma) 2 ,1a1' . . �t s rZ , - -- - - x, • '. 2W aj` All The Commonwealth of Massachusettsr *i Department of Industrial Accidetzts _ir 1 Congress Street, Suite 100 Boston, MA 02114-2017 .; 4•''�yf 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): j r- �� � � y� u l rl ers l -c, Address: �- � e hc.. e(j J � y City/State/Zip: Ai �� Phone 4: 60 46 e'-. 4).�9 Are you an employer?Check the appropriate box: C} Type of project(required): I.❑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 any capacity.[No workers'comp. insurance required.] 8. [1] Remodeling 3.[I]I am a homeowner doing all work myself. (No workers'comp. insurance required.]t 9 El Demolition 4.❑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 proprietors with no employees. 11•❑ Electrical repairs or additions 5.X1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 12.7 Plumbing repairs or additions These sub-contractors have employees and have workers'comp. insurance.t 13•❑Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14 Other t.k 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. 1Contractors 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 ion. _ _ I do I 'reby cell „ } ZRIl . ies of, ' � �+. t the information provided above is true and correct. !.to �I=_„i &„iiiktrAmat - Date:J Phone#: - 4—I i �_3 . _` 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#: 1 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 )'g eat 0,, )76u-rat Work Address Is to be disposed of at the following location: 7Ci--r ;(`_1) Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. APOPOAIJ, ///(,-/ tokAA-forde,/ii ature of Applicant Date Permit No. i--.4,1 BANIUKI OP ID: KF JAWR0 DATE(MM/DD/YYYY) �--- CERTIFICATE OF LIABILITY INSURANCE 07/05/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 508-398-6060 CONTACT Bryden&Sullivan Insurance Bryden&Sullivan Ins Agency PHONE rY 508-398-6060 FAX 508-394-2267 of Dennis Inc. Sac,No,Est): (Illc,No): 485 Route 134, PO Box 1497 E-MAIL So.Dennis, MA 02660 ADDRESS Bryden&Sullivan Insurance INSURERS)AFFORDING COVERAGE NAIC U INSURER A:Associated Employers Insurance INSURED INSURER B:NGM Insurance Company 14788 Theodore C. Baniukiewicz QUALITY CRAFTMANSHIP INSURERC: 4 Nathan Henry Rd West Harwich,MA 02671 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDSIG ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXPO LTR INS° INV° IMM/DD/YYYYI IMM/DD/YYYYI B COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE J OCCUR MPP2225C 05/25/2022 05/25/2023 DAMAGE TO RENTED 500,000 PREMISES(Ea occurrence) $ X Business Owners MED EXP(Any one person) $ 10,000 — PERSONAL 8 ADV INJURY $ 1,000,000 GENT_AGGREGATE LIMIT APPLES PER GENERAL AGGREGATE $ 2,000,000 POLICY JET LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER $ AUTOMOBILEC LIABILITY a cccident)INED NGLE LIMITE a $ ANY AUTO BODLY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODLYO INJURY(Per accident) $ NON-Q (Pr�ERTY accident)AMAGE $ OD ONLY AUTOS ONLY (P UMBRELLA UAB OCCUR . EACH OCCURRENCE $ EXCESSUIB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION X STATUTE OTH- ER AND EMPLOYERS'LIABILITY - Y/N WCC-500-5018201 2021 A 12/21/2021 12121/2022 100,000 ANYIPROPRIETORP RT DED/E CUTIVE N N/A E.L EACH ACCIDENT $ (Mandatory in NH) EL DISEASE-EA EMPLOYEE $ 100,000 If yes.describe under 500,000 DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION TOWN-02 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. TOWN OF YARMOUTH 1146 ROUTE 28 S.YARMOUTH,MA 02664 AUTHORIZED REPRESENTATIVE Bryden&Sullivan Insurance ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD lation fOffice iConsumerAffa' &BusinessOR HOME IMPROVEMENT CONTRACT TYPE:LLG� irafion Ae4tsttaizbr — 192Mie.71—_ 0912312022 T_ C BANKS gllILD _; , t. CHARLEs BANia1E�Al Ez= =�' �r Nj��� °�Z 4 i3ATHAI3 HENRY RD== ," zoo'^ WEST HAAWlCH,MA;b2s7'i Undersecretary Cornmonwealth of Massachusetts is'' �'. Division of Occupational Licensure Board of Building Re ulations and Standards Cons iflnr rvISOr ,i tF CS-067057 _ �, ,s, spires:12120t2423 � :n g.. .ram x CHARLES P pARIIUKiEECZ�.IR s r - 4 NATHAN HENRY FtD x: • `�'�. WEST HARIRtIfiH MA 1 26 4 i : • - r14.-f) LE'ci l 0 Commissioner do fi_ ti'vino.. u • TOWN OF YARMOUTH f c HEALTH DEPARTMENT '�• `` PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To he completed by Applicant: Building Site Location: L/ i fQ/-jry 7(a,, 4 Ylt i j n n) L; tLFiIt5B Proposed Improvement: /< la( ;;ap Applicant: '., 1 I C.7 (CZA-4>KS ted C5 Tel. No.: J' 06 i .t L-�v. �.1'1I1�1�1 G� Address: 1-.1 // t"h r 1-4-t- t'" c4. ) , 40-k- 0.) �-() Date Filed: ✓1/ **If you would like e-mail notification of sign off please provide e-mail address: Owner Name: F --!_7S(t -- t I LEA) I,dr Owner Address: Jig/ t,lo_k : t Owner Tel. No.6 --3(QO-?I td , 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; AUli 1 8 2022 (2.) Floor plan labeling ALL rooms within building (all existing and proposed) — HEALTH DEPT. 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: �` ' PLEASE NOTE COMMENTS/CONDITIONS: 1 1 i . (-> ..... T7>...- °,0 %---, .---. 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