The URL can be used to link to this page

Home My WebLink AboutBld-23-001483 . pa J® 1/2 J ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department 1146 Route 28, South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 •+Rr' Massachusetts State Building Code,780 CMR ;'.; f E I V E D Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling SEP 19 2022 This Section For Official Use Only Building Permit Number: 13I0 23-CUgp Date Applied: , BUILDING DEPARTMENT ,,v Building Official(Print Name) - i re Date 6, SECTION 1:SITE INFORMATION 1.1 Property Addr s: 1.2 Assessors Map&Parcel Numbers Zall C. HA t =r 5 ► 7 0 //Z. / 1.1 a Is this an accepted street?yes u no Map Number Parcel Number 1.3 Zoning Information: 1.4 Properry,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 zib 33 - 4v 60 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: — Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yesO SECTION 2: PROPERTY OWNERSHIP` 2.1 Owna 'of Record:n�C)u,ce to tZ1 :it-a A 12/1401/T 14, AAA oz 46/i Name(Print) City,State,ZIP 2—CA C IAApe.l.-s 5 r S -3- 7gl- 740- No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction❑ 1 Existing Building 0 I Owner-Occupied 0 i Repairs(s) 0 Alteration(s)V I Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: G /_!/r �y 1 5-I l,JC' t 13.�T 1.4 'rc LAV/V4lZ`/ iAA/��tSTlx 6 I-A6,Afog y-r6 `/? iyA--c1 SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ Z6 ITO G 1. Building Permit Fee:$ 1(Z) _Indicate how fee is determined: Ix Standard City/Town Application Fee 2.Electrical $ 3 �(, s / ID Total Project Cost (Item�6)x multiplier x 3.Plumbing $ �r 4 O U 2. Other Fees: $ 3 c..W 4.Mechanical (HVAC) $ ! 400 List: E. I LAD'i C 5.Mechanical (Fire Suppression) $ Total All Fees:$ Check No. Check Amount: Cash oust: c ' 6.Total Project Cost: $ 3 Q ,600 Cl Paid in Full ®Outstanding Balance e: I I SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) J /5-- 2-5 av Y �JC� S License Number Exp ration ate e o C NamSL Holder List CSL Type(see below) v C32 C 12AA4? kt ( txf No.and Stree Type Description L-i4 0.41 mj`rt'� 07 6 RU Unrestricted P Buildings up to 35,000 Cu.ft.) City/Town,State,ZIP ( Restricted I�c2 Family Dwelling M lvlasonry 5 JY 9 /ZG S- . RC Roofing Covering WS Window and Siding � SF Solid Fuel Burning Appliances 'F —j . /154 alu4S i •/q / ( I Insulation Telephone Email address D Demolition 5.2 Registered Home mprovement Contractor(HIC) C� ,�./ t t q HIC Company Nafne or HIC Registrant Name HIC Registration Number piratton Data No.and Street SpAr y Wo W4 `5 CAS( .X�= b-3 q� (Z o 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 0 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 won authorized by this building permit application. John Grieco 09/13/22 ___ Print Owner's Name(Elec nic 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. zap Le_./a gs 9/0-Az Print Owner's or A thorized Agent's Name(Electronic Signature) ...... Dat 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.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 I-It UUMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Individual TROY WALLS Registration: 105179 87 CRANBERRY LANE Expiration: 07/15/2024 SOUTH YARMOUTH, MA 02664 Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE: Individual Office of Consumer Affairs and Business Regulation Registration Expiration 1000 Washing Street -Suite 710 105179 07/15/2024 Bostprf,"MA 0211 ROY WALLS ROY A.WALLS 7 CRANBERRY LANE ,1/.,!l, ) ,/=) OUTH YARMOUTH,MA 02664 I lndPrsacrPtary Not valid without signature Commonwealth of Massachusetts Art Board of Professional Licensure Board of Building Regulations and Standards Co nstru tibilAtS'tnrvisor CS-044847 Expires:07/05/2023 si TROY A WALLS ,_ : 87 CRANBERRY LANE„ SOUTH YARMOUTH MA 02664 * 1.01 Commissioner dwick fi'. YEim Aim Mutual Ins Co WCC-500-5009587-2023 AT' The Commonwealth of Massachusetts �, = Department of Industrial Accidents 1—� —'�= 1 Congress Street, Suite 100 r i4 Boston, MA 02114-2017 s;�w•'' www.mass.go v/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Lecibly Name (Business/Organization/individual): TZc-,y j,its Address: e 7 C RAN i? '2y t— J • City/State/Zip:S' AR/WA/ /14 /U4 u Z46 9- Phone #: (SE 3 4' G( l Zo s--- 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 ca aci 8. remodeling an • y p ty.[No workers'comp. insurance required.] 3.❑I am a homeowner doing all work myself. [No workers'comp. insurance required.]t 9. ❑ Demolition 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.❑ 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. 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.Q Other 152,§I(4),and we have no employees. [No workers'comp.insurance required.] *Any applicant that checks box m1 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. tContractors 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 an:an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:_A (,fly Av-1V-Ac L Policy#or Self-ins.Lic.#: `iVCG- 3-790— S cog 3 1 , ZC)Z 2—Expiration Date: `i Z.7 Job Site Address: .7 q - [-LA(2_1-s S City/State/Zip: ''S YA024At j-1--t-4 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$I,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 rtify and r the and penalties of perjury that the information provided ab e is rue and correct. Sitrnat e: Date: c (p z Z Phone ': 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 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 2 C( (LA-Apt-5- S I` Work Address Is to be disposed of oat the following location: `1A RAit,u);L._ T , S e GS 4-L Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. Signa ref Appl' on Date Permit No. ,\/ .:D FOR BUILDING AND ZOi'.11NG CODE C�Jiti1PLI_ ��"`--- X S T j 4/G_ ANCr_. ERRORS OR OMMISSIONS DO NOT RELIEVE TH APPLICANT FROM THE RESPONSIBILITY OF"AS BUILT" COMPLIAA+NCE. DATE: 'I 7' r BUILD G OFFICIAL 4'-113/4'. / 7 MIGHT BE ABLE TO MOVE TOILET [`� C BACK INTO THIS SPACE.IN WHICH CASE r A LARGER SINK COULD BE ON THE OPPOSITE WALL E IIII L.L CI i I 1st FLR SCALE: 1/2" = 1'-0" '(')) r- ( - C> 0 0 ( _ 6.3 9 Cr) 70 - 1-0 - 70 Cr) rn 2 rn- < cn rn