HomeMy WebLinkAboutBLD-21-006527 (2) &L -Z/ W 27
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ONE & TWO FAMILY ONLY- BUILDING PERMIT
Town of Yarmouth Building Department
1146 Route 28, South Yarmouth,MA 02664-4492 4Nri
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: pj(()—ZI OD 1rsa7 Date Applied:
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address:' a I? Cr 1.2 Assessors Map&Parcel Numbers
1.7
1.1a 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?
_ Municipal 0 On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record: /�
Mh i4A -f LF4se.I &VT—WA YAE. i l"cr 2i 02-67s
/Name(Print City tate,ZIP
✓ t 9 �r�e S'r OR $i vie kale' er c? q/
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'- (check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other 0 Specify:
Brief Description of Proposed Work':
lion Athvots 7Zc'V dven_ 92-01/r
SECTION 4:ESTIMATED CONSTRUCTION COSTS.
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ 0 Standard City/Town Application Fee
0 Total Project Cost;(Item 6)x multiplier . x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ 0 Paid in Full 0 Outstanding Balance Due:
}
' 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(Buildings up to 35,000 cu.ft.)
R Restricted I&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D 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 ❑
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 pa'. .. d penalties of perjury that all of the information
contained in this ap_plilication is true ccurate t• the c- .f my knowledge and understanding.
Print Owner's or Authorized Agent' e(Elec•.nic 'r ature) 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.eov/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"
The Commonwealth of Massachusetts
r !�
IMIElar h Department of Industrial Accidents
1 Congress Street, Suite 100
�, Boston, MA 02114-2017
www.mass.a o v/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): #4I4A0-2— l ,4
� TE-I
Address: 173 C , Cr- `���
City/State/Zip: ;,, itJ Poa,,— 0 21-7 5- Phone #: &71 ZS 0/68'
Are you an employer? heck the appropriate box:
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
___,m�any capacity.[No workers'comp. insurance required.] 8. ❑ Remodeling
3. Lam a homeowner doing all work myself. [No workers'comp. insurance required.]t 9. ❑ Demolition
4.{:I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 El Building addition
ensure that all contractors either have workers'compensation insurance or are sole
11.❑ Electrical repairs or additions
proprietors with no employees.
5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 12.❑Plumbing repairs or additions
These sub-contractors have employees and have workers'comp. insurance.: 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#1 must also fill out the section below showing their workers'compensation policy information.
I.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 r or Self-ins.Lic.4: 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 st tement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verificati n.
I do hereby i un r the ins id et lties of perjury that the information provided above is true and correct.
Signature: Date: 9JS2-z...
Phone#: 7 ' oi&
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#:
TOWN OF YARMOUTH
6 BUILDING DEPARTMENT
a=E °' 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1261
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
DA lb: /')S--2-7-
JOB LOCATION: 179 Cotir L 4j euT74
NEE STREET ADDRESS SEC ON OF TOWN
"HOMF'OWNER" MLCl4A e- 4-u2 LA Lor; s 4 (,7 5 iS tYktF
NAME HOME PHONE WORK PHONE
PRESENT MAILING ADDRESS Skiv(r
CITY OR TOWN STA'1'h 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 supervisor. (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 th he / she unde nds the Town of Yarmouth Building Department
minimum inspection procedures and re irernents and 1 he / she will comply with said procedures and
requirements.
HOMEOWNER"S SIGNATURE
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 yes, 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:homeownrlicexemp
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 CO i tYL. S I 1/,M- JT 19C2F 07-4,-7'-
Work Address
Is to be disposed of at the following location: /167-6-K/ALS 4 DI/E'Y
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
Z2-
Si nature of Applicant Date
Permit No.
" •1r•i,�,, TOWN OF YARMOUTH Building Department BUILDING
Nip O (508) 398-2231 ext.1261
PERMIT NO nBLD-21-006527 PERMIT
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fed' „' .`2Y �, a�p.mma�a�a�m�a.m �a.m= JOB WEATHER CARD
" ; i ISSUE DATE A06/10/2021 a ..... ..........
APPLICANT Jared J Griffin PERMIT TO i Addition
AT(LOCATION) 179 CENTER ST,YARMOUTH PORT, MA 02675 ZONING DISTRICT Bldg.Type: iResidential 1
SUBDIVISION MAP BLOCK LOT 140.33.1 j BUILDING IS TO BE: ICONST TYPE USE GROUP [R-3
REMARKS New Construction per approved plan 780 CMR MSBC, 9th Edition,TOY CONTRACTOR
Bylaws-Built new detached 2 car garage(774-212-0554)
I LICENSE 113663
Owner removed contractor and taking over permit.9/15/2022 9 '1Construction Supervisor
fi
GRIFFIN CUSTOM BUILDERS INC
Jared Griffin
AREA(SQ FT) 5,806,286,64� EST COST($) i54000 00 PERMIT FEE($) 1665.00 18 Flicker Lane
.. _ � s. .,.... �..�� - West Yarmouth, MA 02673
OWNER Michael Letters
BUILDING D T BY
ADDRESS Leslie Letters 179 CENTER ST j /._____ . .......___
a
YARMOUTH PORT MA 02675 1 ...,,,7� _ PHONE 16785250168 _ _
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OF
PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE
APPROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE
OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM
MINIMUM INSPECTIONS REQUIRED FOR ALL APPROVED PLANS MUST BE RETAINED ON WHERE APPLICABLE SEPARATE
CONSTRUCTION WORK: 1)FOUNDATIONS OR JOB AND THIS CARD KEPT POSTED UNTIL PERMITS ARE REQUIRED FOR
FOOTINGS.2)PRIOR TO COVERING STRUCTURAL FINAL INSPECTION HAS BEEN MADE.WHERE ELECTRICAL PLUMBING/GAS
MEMBERS(READY FOR LATH OR FINISH COVERING) A CERTIFICATE OF OCCUPANCY IS AND MECHANICAL
3)FINAL INSPECTION BEFORE OCCUPANCY 4) REQUIRED,SUCH BUILDING SHALL NOT BE INSTALLATIONS.
REFER TO DETAILED INSPECTION SCHEDULE OCCUPIED UNTIL FINAL INSPECTION HAS
BEEN MADE.
POST THIS CARD SO IT IS VISIBLE FROM STREET
BUILDING INSPECTIONS APPROVALS
Footings&Forms Footings&Forms Foundation
Inspector ,3I P Date ',fq- . Date $- /g Inspector
fJl�l Z� Inspector ,l call l �c �z�l G'1��Z/ri Date t c5'-��zy
F044/7 bet,- OK oe /.. ss-ems
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Inspector /3172m'f. Date Inspector Date 1 Inspector Date
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Insulation Insulation Insulation
Inspector ate Inspector Date 3/9/?a Inspector 8,/em Date e./H2z
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NORK SHALL NOT PROCEED PERMIT WILL BECOME NULL AND VOID IF INPSECTIONS INDICATED ON THIS CARD
UNTIL THE INSPECTOR HAS CONSTRUCTION WORK IS NOT STARTED WITHIN SIX CAN BE ARRANGED FOR BY TELEPHONE
APPROVED THE VARIOUS MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED OR WRITTEN NOTIFICATION.
STAGES OF CONSTRUCTION AR(1VF
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Town of Yarmouth September 15, 2022
Building Department
This letter serves to notify that Michael and Leslie Lettera owners of 179 Center Street,Yarmouth Port,
Massachusetts are removing Jared Griffin of Griffin Custom Builders, Inc as contractor of record on
building permit BLD-21-0065
Regards
cele,,, . ....„,„........
I,fir�`�� RECEIVED
Mic ael Lettera mi ettera@gmail.com 678 525 0168i ) a.7 _
SEP 15 2022
Leslie Lettera leteral5@gmail.com 214 641 954
BUILDING DEPARTMENT
By --