Loading...
HomeMy WebLinkAboutBLD-23-000928 -: // 8/ >',' L 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 Massachusetts State Building Code,780 CMR Building Permit Application To Construct, Repair, Renovate Or Demolish "• ;:. a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: g Li).`L3-wag? Date Applied: Building Official(Print Name) Si a re Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Asse sors Map&Parcel Nut er 3 a M is 11� q pot, i /c 1.l 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 I 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 0 Zone: Outside Flood Zone? — Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Own�/'.�Record: £ 0c •)j Name Print) C. ,State,ZIP `1� vaC .CSC _.)-7;2•,5'i • 9 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 I Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition ❑ Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: SECTION 4:ESTIMATED CONSTRUCTION COSTS • Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 1. Building Permit Fee:STSO Indicate how fee is determined: 2.Electrical $ 16 Standard City/Town Application Fee 0 Total Project Cost3 Item 6)6)�x multiplieripp x 3.Plumbing $ 2. Other Fees: $___ �• V c.t 2I` 4.Mechanical (HVAC) $ List: ZSJ 5.Mechanical (Fire Suppression) Total All Fees:$ / Check No. Check Amount: Cash Amount: 6.Total Project Cost: $_at 3 y -1 0 Paid in Full Outstanding Balance Due: Ji� SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) ef • ©6�6�y �� •/ CL'tiiC License Number Expiration Date Name of CSL Holder oy k_ List CSL Type(see below) a. No.and Street Type Description C,' i(J��� OCy U Unrestricted(Buildings up etol 35,000 Cu.ft.) t�iy�/Ta�v/wn,S te,ZIP ' R Restricted I dc2 Family Dwelling ivl Masonry RC Roofing Covering / WS Window and Siding 6ya . r?r,?_?an. c e 4l Ce` it E SF Solid Fuel Burning Appliances ii.17/cfelet. Insulation Telephone Email address _ lo.�. D Demolition 5.2 Registered Home Improvement Contractor(HIC) JJ t JC1t./I .z�� 3 G '�/ ��t HIC Registration Number Expira'on Date HIC Company Name or HICRegistrant Name .Zf p jd7C £.r. J11 Na.and Street 4.AP_ y, 7�3 Email address s AAA-, ,- oz6y7 City/Town,ttate,ZIP Telephone SECTION 6:WOR KERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C 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. ,Ler-e r- c .L. Print Owner's Name(Electronic 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 app' ati a and accurate to the best of my knowledge and understanding. geh 4Z Print is or Au zed Agent's Name(Electronic Signature) ate 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.aov/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 It=-1 /. Department of Industrial Accidents = e 1 Congress Street, Suite 100 it_; 1:1 Boston,MA 02114-2017 _� 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/Organiration/Individual):JS Clark Builders Inc. Address:25 Oyster Way City/State/Zip:Mashpee, MA 02649 Phone #:508-477-9003 Are you an employer?Check the appropriate box: Type of project(required): 1.❑I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ✓❑Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3 pI am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 ❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6. We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other �+-1 152,§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. 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. 1 am an employer that is providing workers'compensation insurance for nzy employees. Below is the policy and job site information. Insurance Company Name:Farm Family Policy#or Self-ins.Lic.#:2001 W6337 Expiration Date: /?le./ ao i 2- Job Site Address: J 1[u--4"-jltvC44- ""C. City/State/Zip: i4 a.,g--1A - c,- ?6 Ag Attach a copy of the workers'compensation policy declaration page(showing the policy nuthber 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 forwanled to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify an pains and penalties of perjury that the information provided above is true and correct. / Signature: 41 Date: te//1/4 Phone#:'';477-:�'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#: §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. 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 3 LAAA04,6 J,'j.ic Work Address Is to be disposed of oat the following location: /6/Z0 1 4;1- /10/211 Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. f4 "•"A� ion a 27_, • te ignature + pplicat Permit No. •• •• @den gsl , REMODEL BATHS, KITCHENS & MORE July 9, 2022 Town Of Yarmouth Subject: Letter Providing Authorization to Obtain Building Permit To The Building Department: April Garbitt 3 Hummock Lane Yarmouth Port MA 02675 This letter is to authorize John Clark of JS Clark Builders/@designREMODEL to apply for a building permit for work to be performed at 3 Hummock Lane . I am the owner of the property and have retained Mr.Clark's company to perform the aforementioned renovations. If further clarification of this matter is required, please do not hesitate to contact me via telephone at 508.517.4583 . Kind Regards, April Garbitt Address: 25 Oyster Way, Mashpee MA 02649 I Phone:508.477.9003 I Website:AtDesignRemodel.com C l ,9e earn/2-wim tea�i o� e14- Office of Consumer Affairs and Business Regulation fr 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 )1 - " Home Improvement Contractor Registration Z //P Type: Corporation Registration: 145474 Expi JS CLARK BUILDERS, INC. 25 OYSTER WAY ration: 01/31/2021 MASHPEE,MA 02649 ' Update Address and Return Card. SCA 1 Ca 20M-05117 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Corporation before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 145474 01/31/2021 1000 Washington Street-Suite 710 JS CLARK BUILDERS,INC. Boston,MA 021 8 JOHN S.CLARK 612..0 -- er4/. 25 OYSTER WAY , MASHPEE,MA 02649 Undersecretary Not valid without signature Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards ConstruCtiC tipervisor CS-065629 excpires: 10/14/2022 ;F JOHN S.CLARK 25 OYSTER WAY MASHPEE MA 02649 . _P 0 ,0 4ilS'._.a— , S Chrome File Edit View History Bookmarks Profiles Tab Window Help dy ='a (B1 e Qft .. �] 't _ Q � Q Wed Jun 1 5r38 AM r •• 115 Upcoming.Todoint x ut Budget I Job 1 I JobTread X e Building and Inspection I hour X Submit Building Ported-View X CJ New Tab x Office of Consumer Affairs&r: x + C 4 ii https:/fservices.oca.state.ma.us/hic/Iicenseelist.aspe iJ 'd C * 0 01 Apo, BM LI Sb El Web Ot Weather t'.:.1 Now, Towns E VEN &J ;''j Watch f BT k WP B.corn - GP .. BTsncamp JobTread tE ToDnlsl LC An ` en Other Bookmarks Htta rs a n a Ho ��a �� �� ���r �� , n Home Improvement Contractor Registration Lookup To search by registration number,enter the registration number in the textbox below and click the'Search'button. Please note pressing the Enter key will clear fields. Search by Registration Number;145474 ; I Search You must click the"Search Registrant"button to search by name or location. Please note pressing the Enter key will clear fields. Search by Registrant Company name � , 1 Search Registrant Search by Registrant Last name Search by Registrant First name [_- City/Town L_..—_.-- _ -_ I State Li Zip code Click on the registration number to view complaint history.You can also view arbitration and Guaranty Fund Jiittpry. The list Is current as of Tuesday,May 31,2022. Search Results ReglstrantName RESPONSIBLE REGISTRATION ADDRESS EXPIRATION STATUS INDIVIDUAL NUMBER DATE JS CLARK BUILDERS,INC. CLARK,JOHN 145474 25 OYSTER WAY 01/31/2023 Current MASHPEE,MA 02649 Site Policies Contact Us 2018 Commonwealth of Massachusetts. Mass.Gov®is a registered service mark of the Commonwealth of Massachusetts. DATE(MM1DDlYYYY) ® AC O CERTIFICATE OF LIABILITY INSURANCE 05/27/2022 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(s1. - PRODUCER CONTACT J NAME: en Davis Mark Sylvia Insurance Agency,LLC t / ,PHONE.Ext)c (608)957-2125 _ _ I FAX (508)957-2781 404 Main Street ADORES: mark©marksylviainsurance.com INSURER(S)AFFORDING COVERAGE F NAIC/< Centerville MA 02632 INSURERA: Farm Family Casualty Insurance 000000 INSURED INSURER B: — — j JS Clark Builders, Inc. INSURER C: Oyster Way 25 0 Y INSURER D: INSURER E: Mashpee MA 02649 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. NOTWITHSTANDING 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- ;ADDLISUBRI ----- _ J LTR TYPE OF INSURANCE II POLICY EFF IMM10 Y EXP INSD WVa. POLICY NUMBER IMMIDDIYYYYI IMM/DDlYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY i EACH OCCURRENCE $ 100,0000 I •CLAIMS-MADE h OCCUR ( DAMAGE TO RENTED 1 PREMISES(Ea occurrence) $ 100,000 ____i ,_ MED EXP JAny one person) (S 5,000 A I 2001 X0243 04/29/2022 04/29/2023 PERSONAL&ADV INJURY t$ 100,0000 LGEN'L AGGREGATE LIMIT APPLIES PER: i GENERAL AGGREGATE $ 2,000,000 —1 PRO- POLICY JECT L J LOC ! I PRODUCTS-COMP/OP AGG I •$ 2,000,000 OTHER i $ AUTOMOBILE LIABILITY COMBINED SINGLF LIMIT $ ANY AUTO BODILY INJURY(Per person) '$ I. OWNED 7 SCHEDULED i._-._-- — .,AUTOS ONLY 'AUTOS I BODILY INJURY(Per accident)!$ HIRED NON-OWNED i I .PROPERTY DAMAGE $ , _AUTOS ONLY .i AUTOS ONLY I j(Per accide') $ UMBRELLA UAB l---1 OCCUR I i EACH OCCURRENCE $ EXCESS LIAR CLAIMS-f:1ADEI AGGREGATE _,_$ CEO -; i RETENTION$ j $ WORKERS COMPENSATION f I PER 'OTH- AND EMPLOYERS'LIABILITY STATUTE ' 1 ER • 'ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N EL EACH ACCIDENT $ 500,000 A !OFFICER/MEMBER EXCLUDED? CYJ NIA, 2001 W6337 : 12/2/2021 12/2/2022 I (Mandatory in NH) l E.L.DISEASE_EA EMPLOYF.E�$ 500,000 if yes,describe under -- - ---- -- --- - DESCRIPTION OF OPERATIONS be ow I E.L.DISEASE-POLICY LIMIT '$ 500,000 , DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached IT more space Is required) Builder. Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Falmouth ACCORDANCE WITH THE POLICY PROVISIONS. 59 Town Hall Square AUTHORIZED REPRESENTATIVE M?��3~_ I Falmouth MA 02540 FaX:5085484290 Email: ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD / 149 1/2' / / 110 1/2" 3'1 1/2°-1 1 t2„2"/ j2//'4 ie L \ \ i j\- - - - C \ fJ ® 7) 3 '�i(.,&04.d r.(,_ /4.4ff _ i 1.y[.w ore) y4tAiAki(64,7-" ® o n <r i I (' a 1 \ `5 I w Elevation 1 FTG:86.5" TOG:84.5" 0 CT: 1 1/4" assumed 14 Cabinet Range: #1 -#25 ii, '" Full overlay 1 1/4" i Albany doors and matching drawers Molding: Filler slab 2" r..-— \\ I A Elevation 3 ., 0 12 , 8 l 0 1 iv — _- l / 30" / � I i !_ - - 1 I I 1 1 1 RE ..-_ r ,'' - .- 7 . -COMPLI- THE1 ! �1 z) : 5. iLT" \ I WLo DATE: 0` .3- - / Lam] BUILDIN OFFICIAL SHEET: 1 DATE:la/10/2022 This design is the result of information that you,the customer,have provided to Cabinet Joint for the purpose of visualizing your ' gh �'m ' John Clarkcabinet layout before placing an order.It is the sole responsibility of the customer to verify all room dimensions,cabinet sizes,and CABINET JOINT appliance openings before placing that order.If you would prefer to consult with a designer for a more detailed and customized Finely crafted,fully custom RTA cabinetry Value Design drawing,we suggest you speak with your Cabinet Coach about our Pro Design Services. Cabinet Coach: Ph.888.211.64.82