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HomeMy WebLinkAboutBLD-23-003937 I R E c E I AllNE li TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department JAN 19 2023 l 146 Route 28, South Yarmouth, MA 02664-4492 508-398-22t31 ext. 1261 Fax 508-398-0836 • L Massachusetts State Buildin Code, 780 CMR BUILDING 0EP RTMENT g B iildinPermitApplication To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only . Building Permit Number: 6W- 23-U0337 Date Applied: ►r^ Se4\C S = 0 0- 3 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Pro ty Address: 1.2 Assessors Map&Parcel Numbers R ® ' MapNumber Parcel Number l.la Is this an accepted street?yes no JAN 3 J 2023 1.3 Zoning Information: 1.4 Property Dimensions: ___ BUILDING DEPARTMENT Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) BY --- 1.5 Building Setbacks(ft) C 4-1L 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❑ Private 0 Zone: Outside Flood Zone? — Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Rec r_SA ,,,( L e1 6N ( /rYtnvll.Pori- 1 ss, d 2 67 S Name(Printf) ity,State,ZIP + No.and Street �B,�Tele hh�o _/t Email Ad..rresss SECTION 3: DESCRIPTION OF PROPOSED ORK-(checl�an that apply New `7 f � a'i COS New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition ❑ Accessory Bldg. 0 Number of Units Other 0 Specify: / f Brief Descriptionof Proposed Work2: "' k 5 I, 0-,F7.e4e4 .-11 Ai Ape:$/4-t i S.4 77 �� j,v5// �.� t7L c4.49 .�?- o s7Q(4_( f nnwV�- ,47! cLos / 4er� avle v-7�' / ,Gv c bPd/4)oivt �p h 6I--1 ,l.e-w C�7're 7�- Ll0 r\o�n - 14;14,1 SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only • (Labor and Materials) 1. Building $2/ ap 1. Building Permit Fee:$ 1(V Indicate how fee is determined: 'd1'Standard City/Town Application Fee 2.Electrical $ (y /� 0 Total Project 3 Cost (Item 6)x multiplier. . x 3.Plumbing $ / 2. Other Fees: $r - • 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees:$ / 5 f , Check No. Check Amount: Cash A>aiount: 6.Total Project Cost: $ jZi 0 Paid in Full a Outstanding Balance DUe: 1' �� \ 3 b SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) C S.— /oSSo6 �s-1o5506 fa 3t—a3 License Number Expiration Date Name of CSL Ho er Barre4 ` List CSL Type(see below) U No.and Street Type Description 3 U Unrestricted Buildings up to 35,000 cu.ft.) City/Town,State,ZIP R Restricted l&2 Family Dwelling I�(,J� MaIvl Masonry .�a6 73 RC I Roofing Covering WS Window and Siding �8 2�`I_QQby �, ����PN�L�I SF Solid Fuel Burning Appliances `G 7 `'g,'r.-*- I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) C,re�� ye, rpen�� /S6 0 8`: ?/...2 7/zozy HIC Comm-Name or HIC t me HIC Registration Number Expiration Date mit is lekgistrrt�Na C/seafi reca into e rofer j cnrc c4 N,��ogq and Ste ,�/ �,J & -c+ y�l/YrmO/t 4 A4 0473 50$-2Q/ 976f/ 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 b completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issu a 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 ]a L di re&a� to act on my behalf,in all matters relative to ork u •z by this b ' Mg permit application. T Print Owner's Name(E ectronic Signature `,�2©2 `� 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 ap 'cation is tru d curate to the best of my knowledge and understanding. ir'sor 'Authorized Ag is Name Electronic Signature) Date 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.gov/oca Information on the Construction Supervisor License can be found at www.mass.2ov/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" §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 �►u ®c g4/ Work Address Is to be disposed of oat the following location: /rigioa/ 4/41 Ato Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. Signatur of Application Date Permit No. • .\ The Commonwealth of Massachusetts = t Department of Industrial Accidents 0-0.�� 1 1 Congress Street, Suite 100 IP ='»'.I,: Boston,MA 02114-2017 .: www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/lndividual) Qr7 to � a it v e G7 el./..71 7 Address: -3 3e'F/4 1___5 POtti• City/State/Zipthe afro 6(71 ,'l(� 02673 Phone #: 5-6 0 -24 /— 99 6 Are you an employer?Check the appropriate box: Type of project(required): is fl i 3et/a employer with employees(full and/or part-time).* 2 U'-j'l`am a sole proprietor or partnership and have no employees working for me in 7. 0 Ne Jelin construction any capacity.[No workers'comp,insurance required.] 8• emodeling • 3.❑1 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 t0 ❑ Building addition ensure that ail contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 5.❑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.? 13.[]Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14•0 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. f 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: .SeLe.eh)tier infs.. Policy 4 or Self-ins.Lic.#: -5 d ‘1/57 Expiration Date:l--/—202- Job Site Address: 3-2 ,I)l.Vtio G •d City/State/Zip: ( // ,447.. -- Attach a copy of the workers' compensation polic declaration page(showing the policy number and ex iration 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 certify der the pain zd,• aloes of perjury that the information provided above is true and correct. Signature: I: ✓ r .�Lf�/ �( Date: —70/ o2 a 3 Phone#: — 2 - 9 Z 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): I.Board of Health 2. Building Department 3. City/Town CIerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: • Conununwealttt of Massachusetts Division of Occupational Licensure Board of Building Regulations and Standards Consttton Srvisor CS-105506 E'3tpires• 12131'2023 BARRY R HALL 3 BETTY'S PATH WEST YARMOU TH MA 02673 1111411 Commissioner _ • THE COMMONWEALTH OF MASSACHUSE`` Office of Consumer Affairs&8usires 1 HOME IMPROVEMENT CONTE.-<{ TYPE: Individual Registration Expiration. 186088 09/27/2024 BARRY HALL D/B/A CREATIVE CARPENTR" BARRY HALL 3 BETTY'S PATH - ;eft W. YARMOUTH, MA 02673 Undersecretary 011 Y4k TOWN OF YARMOUTH �' ter. HEALTH DEPARTMENT '�•`` PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To he completed by Applicant: Building Site Location: 3 2- L11v7CL [, Proposed I provement: 1 A " I l 11/ CLP .(I/ivCtr-.f(l'/l( C'aif1- { f-o1 :V - a lti , .o . C�oc t f i 4A., ti ` r- ioaj ) /"V V6 0A"...,",,./ Ca.e-f- ` Applicant: 16 � �' �/ Tel. No.: �48'2y�`l � / Address: 3 6 . 1 / S a�f2 Date Filed:/--/%- 20 Z _5 **If you would like e-mail notification of sign off please provide e-mail address: Owner Name: /Mh /,✓% C cip/� /l Owner Address: 32 7 /1,7r r�C1:// (.7 Owner Tel. No.: / / 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; (2.) Floor plan labeling ALL rooms within building (all existing and proposed) — 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: / / (7/0)-2 PLEASE NOTE COMMENTS/CONDITIONS: 1 --�- c..cjt CtoS-E ( _' ,____,... ,,,,-). '--I ' L., - , rt) kc. "Act I ,-, 3 ,I,eciv-cy ,_,,,, _ I bOtx_4-1 ..__ . . t,,, ___________,,_________ ,...„--5. k.,\.) _ _, P t- , i --t, 1 c-ict , ( :. 1 -4. is.... i 1 1 iiiIN \ f- Y .. , - R- ,. ! !.I.i.i 1 , - 's os ,111 Ii i '' D V\ , ...-'` 11 rt-1,- ('--- T:,, i . 1 ............., e -,- i 4 . 1 , i , 1 z___ -i-j TiL, 1 • \T, .i !: 4, i --t4 -4-1 1 0.c.-- ---Ii. 7)- 1 -t- ) -Vc): i i )4 ,. ‘ , ;,2, ---() - !r° v\ 1 - -..4- C?) g, §. _ liT:v --d - ,v 1 • --; \ --- I- , ill .„ L 1 1 tI- �- Q --3, i t_. ,,-.1 (1) \f- ,._____ 1 i v n' E- i N N 7 c Co r . 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