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HomeMy WebLinkAboutBLD-23-005227 ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department of ---..- 1146 Route 28, South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 Massachusetts State Building Code,780 CMR o� a • Building Permit Application To Construct, Repair, Renovate Or Demolish . A;;.:..• a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: g w ii 3.1,U tj7 Date App ' RE C { ‹rA i0(IS ..... ...- — 31 2.43 Building Official(PrName) Signature MAR 2 21023 S SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Nu b ILDING DEPARTME VT j It.5-- Alk /�itn t cl! 9/ — 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 oning Informatio • 1.4 Property Dimensions: p(.�D .�/4/kl F PAP? (1)fit-- ° 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 El Private❑ —Zone: Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: 7/tv) - MoYaze.,, /JO(L0 r�+v ! r197t-eviovIA Name(Print) City,State,ZIP No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction 0 Existing Building 11 Owner-Occupied 0 I Repairs(s) 0 Alteration(s) ti Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units / Other ❑ Specify: Brief Descri Lion of Proposed Work2: .frew A6G 442.., Cod/i e tom. 4 d I a4t r-., Ag vn dry 1 /4 1" k#i€E y .-94C e /Ye.,. !Io w,r .9'I G9d t '�4 toL ( y al4.v44/,J 12e414cc ? Se.-A, fr cis cf4f sDoo.t. -- 1--a.,, 4skirLvi /7-oo7 /°rttirl- SECTION 4:ESTIMATED CONSTRUCTION COSTS. Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ .SI 06 O 1. Building Permit Fee:$a )O Indicate how fee is determined: lg Standard City/Town Application Fee 2.Electrical $ .$ 40° ; 0 Total Project Cost (Item 6)x multiplier x 3.Plumbing $ (,�. to 0 2. Other Fees: $ _ t `/ 4.Mechanical (HVAC) $ �1 J p p List: 3 5 , � U,IAr:Nk-- 5.Mechanical (Fire $ Suppression) Total All Fees:$ Check No. Check Amount: Cash t: ._ . 6.Total Project Cost: $ 6 // 70 0 0 Paid in Full Outstanding Balance D e:‘(p A,0 - !(1 G 7 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS —01:'g29 / /2te 02.7 P419(4 r U 1 GALVr License Number Expira ion Date Name of CSL Holder z cr ee/ /,fF tv1�i Da,vf List CSL Type(see below) 0 No.and Street v / Type Description _fitAliVS TA Q i F U Unrestricted(Buildings up to 35,000 cu.ft.) City/Town,State,ZIP R Restricted l&2 Family Dwelling M Masonry �n /� 0g 6 O / • RC Roofing Covering WS Window and Siding / -Oo 6481'6 29. PAWL. AL/1 A v w SF Solid Fuel Burning Appliances G [Ah� . � I Insulation Telephone Email address D Demolition 5.2 Re istered Home Improvement Contractor(HIC) /2L7/2 0942zt HIC Registration Number piration Date HIC Company Name or HIC Registrant Name 9_ gToNFf-/s-O6r 14drec/T L L a 6,-/ ,L . horn No.and Street 01641?A0L6. MR- D2601 .-or 64rr424 mail 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 1 OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize (.s q v ,4 3 r cS r\--- to act on my behalf,in all matters relative to work aut orized by this builderermit application. kV g c rC eaj CLia/a� 3 Print wne a(Electronicattrre) to c • 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. Print Owner's or Authorized Agent's Name(Electronic Signature) 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.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/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 Department of Industrial Accidents _ �r::�� 1; 1 Congress Street, Suite 100 f Boston, MA 02114-2017 imps'•'� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Peg — 64Lv/i1 Please Print Legibly Name (Business/Organization/Individual): 64010/4/4 L.L.C. ®iC 6.-j/4/ 4O TFt'2.i. Address: /7 %ho7,--4 LO,I 122 t c_e._ City/State/Zip: g8 ecn,t r ,V? - 0 a 6 0/ Phone #: .S`oP fj e 42 G Are you an employer?Check the appropriate box: Type of project(required): I.Etam a employer with 2 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.INo workers'comp. insurance required.] 3.0 I am a homeowner doing all work myself[No workers'comp. insurance required.]I 9. ❑ Demolition 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10Ell Building addition ensure that all contractors either have workers'compensation insurance or are sol 11.❑ Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.❑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.: 13.El Roof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[1]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. 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. �,J�/�'' Insurance Company Name: /r�,trTlL vs Iysvrl4yC,r CaA-1/D,q/v y Policy#or Self-ins.Lic.#: i CL— 6.--0 0 -- SO 2 6 22 2 Expiration Date: /2///022 Job Site Address: 3 4 - lu/6!/,QA/yA (qp City/State/Zip:S ?9/L/10 t/Tit/ 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$250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify z r to pains and penalties of perjury that the information provided above ' true a correct. 1 �� Sisnature: / Date: Z2 23 Phone#: ..C.) 64 P <42 . Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: TOWN OF YARMOUTH 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1261 Fax 508-398-0836 Office of the Building Commissioner BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G. L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111/5 I hereby certify that the debris resulting from the proposed work/demolition to be conducted at 264 //84,(fczit �,Q s rX(Wc)v;i, Work Address Is to be disposed of at the following location: ;P-r/ov&`i ./440f- es-- sZ jo.-7 Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. 22 20 2� Signature of Applicant Date Permit No. Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Re ulations and Standards Const }ioir$ visor CS-073839 Opires:01/12/2025 PADRAIG J QALVIN 72 STONEIIEADGE DRIVE BARNSTABLt MA 02630 t ., } {1/.1,V,LI:3' Cviu�iGSiviwr " !/ LI •ir-t ll• atm. Commonwealth of Massachusetts ';� / Divisibn of Professional Licensure Board of Auilding Regulations and Standards Cons ru %1iStSptrrvisor CS-073839 « 6cpire • .1/12/2023 • PADRAIG J GALVIN i,, 72 STONEHEDGE ' BARNSTABLE;MA /St..1_lC' Commissio nae .77e bY42ofts a4uatrii gaimare4ivgalgtion HOME IMPROVEMENT CONTRACTOR TYPE:Individual Registration Expiration 130184 01/24/2024 PADRAIG GALVIN PADRAIG J.GALVIN. i%,l2 72 STONEHEDGE OR BARNSTABLE,MA 02630 Undersecretary ...`��1 DATE(MM/DD/YYYY) A �. �►/'� CERTIFICATE OF LIABILITY INSURANCE 3/9/2023 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) roust 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 CONTACT CHARLES H CAHILL INSURANCE AGENCY fA(PHNCONEn Fxtl• (781) 837-2300 o No)(781)837-2800 PO Box 321 ADRSS:giselagcahillinsurance.corn Duxbury, MA 02331 INSURER(S) AFFORDING COVERAGE NAIC0 INSURER A: NAUTILUS INSURANCE COMPANY INSURED Galhomes, LLC INSURER B: AIM INSURANCECOMPANY 139 Thornton Drive INSURER C' _ INSURER D Hyannis, MA 02601 INS.URERE: _ __ INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMIEIER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME!)ABOVE FOR THE POLICY PERIOD INDICATED. NOTWfTHSTANDING 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. Y� 2 t�L 8UeK POLICY EFF rOLICY EXP .w�� LTF; TYPE OF INSURANCE_ IN SIR WVD POLICY NUMBER (MM/DD/YYYY) (NIM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $$1,000,000 UPJNAGE TO RENT .-) X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ 100,000 ICLAIMS-MADE 0 OCCUR MEDEXP(Any one person) $ $5,000 A NN1283827 06/15/2022 06/15/2023 PERSONAL&ADV INIJURY $$1,000,000 GENERAL AGGREGATE $$2,OOO,OOO GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $$2,000,000 D POLICY p PGrOT Cj LOC $ AUTOMOBILE LIABILITY COeBINED1 SINGLE LIMIT(Ea $ ANYAUTO BODILY INJURY(Per person) $ _ ALL OWNED SC HEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAG $ HIRED AUTOS AUTOS (Par accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ IRETENTION$ $ WORKERS COMPENSATION I TORY I IMITS I X IQFR AND EMPLOYERS'LIABILITY ^I B OFFICER/MEMBER EXCLUDED?PROPRIETOR/PARTNER/EXECUTIVE U WCC-500-5026232 E.L.EACH ACCIDENT $ 1,000,000 (Mandatory In NH) 12/11/2022 12/11/2023 E.L.DISEASE-EA EMPLOYEE $ 1,000,600 If yes,describe under E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION QF OPERATIONSbelow , • DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additonal Remarks Schedule,if more space is required) JOB LOCATION: Jim and Noreen Bordeau, 345 High Bank Road, South Yarmouth, MA 02664. , atTIFICATE HC.DER CANCELLATION TOWN OF YARMOUTH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1146 ROUTE 28 THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN YARMOUTH, MA 02664 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE f t._.1-1.-- IS 1?.. . e.G tt•.. -�'••�p ,._ __ I ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD TOWN OF YARMOIJTI WATER DEPARTMENT ( 1y. 99 Buck Island Road WAn West Yarmouth, MA 02673 � '�` �'�" `� Telephone: (508) 771-7921 • Fax: (508) 771-7998 BUILDING PERMIT APPLICATION FOR WATER DEPARTMENT SIGN OFF TRANSMITTAL FORM BUILDING SITE LOCATION: 314 141 ea, • U / J PROPOSED WORK: Kt--/--C-11.e_i---1 R-e_IcY1 od-e / APPLICANT: r"CLd r&t c cif vie) ADDRESS: TELPHONE: 50g- /01 -g-/-1 a -2. RESIDENTIAL AND/OR COMMERCIAL BUILDING Water Department: Determines Compliance of Water Availability and or existing location Engineering Department: Determines Compliance for Parking and Drainage Conservation Commission: Determines Compliance to Wetlands Act; i.e. If lot(s)border any type of wetlands,streams, ponds, rivers,ocean, bogs, boys,marshland, ETC,.. Health Department: Determines Compliance to State and Town Regulations, i.e. requirements for Septage Disposal and other Public Health Activites Fire Department: Determines Compliance to State and Town Requirements for Personal Safety, Property Protections, i.e. Smoke Detectors, Sprinkler Systems,etc 2-Z 6 2 20APPgej- e ( � eT SIG ATU DATE OFFICE USE: COMMENTS ON PERMIT APPROVAL OR DENIAL REVIEWED 'WATER DIVISION(SIGNATURE) DATE f HIP.1 ijOv / _:\ 6'4 4Cc i ! i /Fd- r CT+D I I I '1:;i zF„IFT -ter - - - �7-..4 r) i 1 1 At , 1HE bU;L" C U , 1 /5‘. #45. -i 7.1 r"--'_. ifm,.`-i-.)-, 10) ' 4,\L,,,_a N i 1)""Z-f- i 1J icts.:::: ' , I Proposed Renovation For I Existing Plan Jim & Noreen Bordeau Scale Date 345 Highbsnk Rd. S. Yarmouth 1/4=1' 0" 3/5/2023 Drawn By Builder IPadraig Galvin/Galvin Brothers 1 i l i 1yII ' foOJ It ..., , (C) CA / r jt j....._ 1 vki t 11 14{-0 I a 9 t . ci.c . 1 i [ jIi a, n .,. I 1 0 F j 00 1,�.... Proposed Renovation For } ' 'Jim & Noreen Bordeau Seale Date Proposed Plan 345 Highbsnk Rd. S.Yarmouth 1/4=1'-0" 3/5/2023 Drawn By Builder IPadraig Galvin/Galvin Brothers -r. 1- if ------ 1 : . - t - .7.76....-------------- -------"---- ,,e--(7- AM& ! I ( I ',.IL if1 f U aa � _ f 4 I Existing Left side I Proposed Renovation For I ! Iim & Noreen Bordeau Scale Date I '345 Highbsnk Rd. S. Yarmouth 1/4=1'-0" 3/5/2023 Drawn By Builder Padraig Galvin/Galvin Brothers is a /.."*-7.--...,"7"7". ''''''''''''''''''' '''----,... ,v ..--'--- . ,,,,,,,,-).„:2- .- i t 1 I t a : ,. E ' ffl I i � s I. l Ld . 1 ______,......___ , _......„....,,........__,.........._____, ------t,---_____ „,....... Proposed.i Left< side 1 Proposed Renovation For fJriir OR Noreen Bordeau Scale Date 345 Highbsnk Rd. S. Yarmouth 1/4=1'-0" 3/5/2023 Drawn By Builder Padraig Galvin/Galvin Brothers , . / 1 | � ' | _ � l | t I / . � Proposed Back I proposed Renovaton �or 1 � |�----- - ji�� �� Noreen [�Orde8U 'Scale LJ@t2 345Hi0hbsnk Rd. S. Yarmouth 1/4=1''O" 3/5/2023 Drawn By Builder 'PadratffGa|v\"/Gahon8rothers | | | i • 4 1 II 1 It I1,,,,).-' lilt f i MI I 1771 s 111 ' ! . a , Hi 1 , I -i I i 1 % 1 S I 1 i i i i i iii ( Di 3 I, j Existing Back ' Proposed Renovation For Ir__i_ Ir•_L,. f j i i it . ' j ii w i Cam!! D Lfl Li tt c..!.- .��C i e ;i..4''I t 345 Highbsnk Rd. S. Yarmouth 1/4=1'-0" 3/5/2023 Drawn By Builder Padraig Galvin/Galvin Brothers