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HomeMy WebLinkAboutBLD-23-004331-BLD-23-001386 , tEC .' IVED 1 & TWO FAMILY ONLY- BUILDING PERMIT SEP 2 2022 Town of Yarmouth Building Department .off'..."y 1146 Route 28,South Yarmouth,MA 02664-4492 B UL D,ry H='?TMENT 508-398-2231 ext. 1261 Fax 508-398-0836 � , Massachusetts State Building Code,780 CMR ;; Buz ding Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling 13 Lb-23- Utz433 This Section For Official Use Only Building Permit Number: 6 U�2 3-tb I,3 p Date Applied: 7 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 22 Nimble Hill Rd Yarmouth Port, MA 02675 144 7 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: R-40 Residential 40,075 Zoning District Proposed Use Lot Area(sq ft) Frontage(It) 1.5 Building Setbacks(ft) no change to setbacks Front Yard Side Yards Rear Yard Required Provided Required Provided Required 1 Provided 1.6 Water Supply:(IvI.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public Private O Zone: _ Outside Flood Zone? Check if yes Municipal 0 On site disposal system E( SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Peter& Karen Carnes Yarmouth Port MA 02675 Name(Print) City,State,ZIP 22 Nimble Hill Rd 508-269-4399 plcarnes@comcast.net No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied fif I Repairs(s) 0 Alteration(s) 0 Addition ❑ Demolition ❑ Accessory Bldg. 0 Number of Units Other PI Specify: Brief Description of Proposed Work2: Remove and replace existing jetted tub with 42"x 72 shower with . with glass door. Remove existing vanity top and sinks and replace with new vessel sinks and new vanity anti new vanity top Replace existintg toilet. No reconfiguration of Mace. SECTION 4:ESTIMATED CONSTRUCTION COSTS. Item Estimated Costs: Official Use Only (Labor and Materials) y 1.Building $ 1. Building Permit Fee:$ C SC ,Indicate how fee is determined: Z.Electrical $ ig Standard City/Town Application Fee 0 Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ /�jc--- C{/- 372 4.Mechanical (HVAC) 1 $ List: l� r 5.Mechanical (Fire ) Suppression) $ Total All Fees:$ . /9 Check No. Check Amount: Cash ount: -.:1- 6.Total Project Cost: $ /6v v El Paid in Full Outstanding Balance ue: `15 ONE or TWO FAMILY— BULDING PERMIT APPLICATION REGULATORY APPROVALS NOTICE Address of Proposed Work: 22 Nimble Hill Rd Yarmouth Port, MA 02675 Scope of Proposed Work: Remove and replace existing jetted tub with 42" x 72 shower with glass door. Remove existing vanity top and sinks and replace with new vessel sinks and new vanity top. Replace existing toilet. No reconfiguration of space. Date: 8/9/22 no signoffs required - interior work not visible from any public way Based on the scope of work described above,the applicant is required to obtain approval sign- offs from the following departments as checked-of below: Health Dept.—508-398-2231 ext. 1241 Conservation—508-398-2231 ext. 1288 Water Dept. —99 Buck Island Road, 508-771-7921 Old Kings HWY. Hist. Comm. —508-398-22631 ext. 1292 Engineering Dept.—508-398-2231 ext. 1250 Fire Dept.—Kevin Huck/Scott Smith, 96 Old Main Street, SY Note: Please call Fire Department for an appointment. 508-398-2212 Other Appropriate plans and/or application shall be provided to each departments checked-off above. Each of these regulatory authorities has their own requirements outside the jurisdiction of the Building Department. All applicable approvals shall be obtained prior to submitting a building permit application to the Building Dept. Thank you for your cooperation. Receipt Acknowledgement: a/La:4 z,Q , iCz 8/9/22 Applicant's Signature Date Rev.Jan. 2019 The Commonwealth of Massachusetts it=?,ice t Department of Industrial Accidents SE.Faiff 1 Congress Street, Suite 100 • 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/Organization/Individual): Sand Dollar Customs LLC Address: 259 Great Western Rd Unit B City/State/Zip: South Dennis MA 02660 Phone#: 508-694-5618 Are you an employer?Check the appropriate box: Type of project(required): 1. 1 am a employer with 9 employees(full and/or part-time).' 7. p New construction 2.EI I am a sole proprietor or partnership and have no employees working for me in 8. Ei Remodeling any capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 4.01 am a homeowner and will be hiringcontractors to conduct all work on my10 Q Building addition property. I will ensure that all contractors either have workers'compensation insurance or are sole 1 1.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.1=1 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.« 13.0 Roof repairs 6.0 We arc a corporation and its officers have exercised their right of exemption per MGL c. 14.VOther Window 8 Door Replacement 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 arc 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 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Associated Employers Insurance Co. Policy#or Self-ins.Lic.#: WCC-500-5019721-2021A Expiration Date: 12/15/2022 Job Site Address: 22 Nimble Hill Rd City/State/Zip: Yarmouth Port MA 02675 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�/certtlify under the pains and penalties of perjury that the information provided above is true and correct. Signature: £ / , ei..2a Lb¢Ji. Date: 8/9/22 Phone#: 508-694-5618 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#: D O/ Sand Dollar Customs LLC 259 Great Western Rd. Unit B South Dennis MA 02660 508-694-5618 '-')� � Sanddollarcustoms.com 1 General Contractor and Owner Agreement Authorization To Proceed I hereby authorize Sand Dollar Customs LLC to roceed with construction at 2_ 2. /t//mad c ///c, c • j, .hov77-0 /Nin accordance with Z,a ZZ signed estimate # / 2 -7 / , dated S / / Homeowner agrees to make payments to Sand Dollar Customs LLC in accordance with the payment schedule listed on the signed and agreed upon estimate. /S1 /2,0 2 Z_ Homeowner Date Sand Dollar Customs Representative Date I SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-091653 9/30/22 Walter R. Warren Jr. License Number Name of CSL Holder Expiration Date 259 Great Western Rd. Unit B List CSL Type(see below) No,and Street Type ( Description South Dennis MA 02660 U I Unrestricted(Buildings up to 35,000 cu.ft.) City/Town,State,ZIP R Restricted I&2 Family Dwelling Ivl Masonry • RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D J Demolition 5.2 Registered Home Improvement Contractor(HIC) Sand Dollar Customs LLC 193567 10/29/22 FTC Company Name or HIC Registrant Name HIC Registration Number Expiration Date 259 Great Western Rd Unit B No.and Street office0,sanddollarcustoms.com South Dennis MA 02660 508-694-561€3 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 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 see attached authorization to act on my behalf,in all matters relative to work authorized by this building permit application. Peter& Karen Games 8/9/22 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 application is true and accurate to the best of my knowledge and understanding. Walter R. Warren Jr. I Sand Dollar Customs LLC 319122 Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1 I. An Owner who obtains a building permit to do his/her own work,or an owner who hires au 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.ttov/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" Sand Dollar Customs LLC } 259 Great Western Rd. Unit B South Dennis MA 02660 + 508-694-5618 ‘1STOW Sanddollarcustoms.com General Contractor and wner Agreement Authorization To Proceed I hereby authorize Sand Dollar Customs LLC to,3 roceed with construction at 2 2 /li""L c: , C C ) ,�o v�74 17 Pill' in accordance with Zo Z2 signed estimate # / 2 -1 , dated E / / 31 Homeowner agrees to make payments to Sand Dollar Customs LLC in accordance with the payment schedule listed on the signed and agreed upon estimate. o22_ Homeowner Date Sand Dollar Customs Representative Date 1 3 §TOWN OF YARMOUTH 1146 Route 28, South Yarmouth, MA 02664 508-398-22311 ext.-1261 Fox 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 22 nlimble Hill Rd Yarmouth Port, MA 02675 Work Address Is to be disposed of oat the following location: Town of Yarmouth Disposal Area Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. 8/9/22 Signature of Application 7 Date Permit No. • • • Kel,/,/ I,,,riVY(.6/1 /04.7eit:fficA:e/1.3,01:4) Office of Consumer Affairs and Business Regulation 1000 Washington Street-Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type Corpora4ort 11 Repistration' 103567 SAND DOLLAR CUSTOMS LLC Expiration. 10;292622 2S4 GREAT WESTERN RD UNIT R SOUTH DENNIS,MA 02660 Update Address and Return Card. A • orriceGf Cotututnet;All 81,04.0 fti,voiattoo HOME iMPROVEMENT CONTRACTOR R60463666 valid tor indtvIdual use only TVP C6-t-‘6,A4/3n before rho expiration date. If found totum to; attwatram 606.64.1.66 Offmt of Consumer Affaito and Elnanness Ream16666 193667 '0,29 24;22 1000 Washington Stro et-Sudo 710 NANO LX)t...t,At1 5A.tb705IS Lt.0 Roston,MA 02110 MiALILM N.WARM 1 259 GRUAt WI:STERN RO UNIT B r scum mums,fAA 07660 uncersecrowy Not valid without signature Commonwealth or massachusetts 119-11 Division of Professionat Ltconsure Board of Building Regulations and Standards pprvtso:- ' CS.091653 •4" Epre :09;30i2022 WALTER RWARRENJR 7 •— •,0.4,:4 40 ALEXANDER DR YARMOUTH PORT MA 0°)675 awr dr) / COM missioner /-101-40 VC4111,V=2„, • 1 A D CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) 12/14/2021 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(s). PRODUCER CONTACT — NAME: Tina Reeves Dowling&O'Neil Insurance Agency PHONE (800)640-1620 FAX (A/C,No,Esti: (A/C,No): 973 lyannough Road E-MAIL treeves doins.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Hyannis MA 02601 NGM Insurance Company INSURERA: P y 14788 INSURED INSURER B: Associated Employers Ins Co 11104 Sand Dollar Customs,LLC INSURER C: 259 Great Western Rd. INSURER D: Unit B INSURER E South Dennis MA 02660 INSURER F: COVERAGES CERTIFICATE NUMBER: CL21121493449 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 IP 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 ADUCSUISH POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MMIDD/YYYY) LIMITS X'COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED 500,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 10,000, A MPP9284Q 12/15/2021 12/15/2022 PERSONAL BADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY n PRO X LOC 2,000,000 JECT PRODUCTS-COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED M1 P9336Q AUTOS ONLY X AUTOS 12/15/2021 12115/2022 BODILY INJURY(Per accident) $ X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY /� AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY YIN X STATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE N/A WCC50050197212021A 12/04/2021 12/0412022 E.L.EACHACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? ` (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLIGY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 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 thecoverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION 4 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE . THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Sand Dollar Customs ACCORDANCE WITH THE POLICY PROVISIONS. 259 Great Western Road,Unit B AUTHORIZED REPRESENTATIVE South Dennis MA 02660 • .,r"'� * I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Property Location: 22 NIMBLE HILL.DR r - n -- tsion : 13 Account#17313 Bldg#: 1 of 1 Sec#: 1 of 1 Card 1 of 1 Print Date:09/01/2017 15:42 CONSTRUCTION DETAIL CONSTRUCTION DETAIL(CONTINUED) ( Element Cd. `Ch.I Description Element Cd. Ch. Description tyle 03 jColonial II1e odel ( 12 1 fi rade 01 esidential 06 lExcellent tones 2 Stories BAS 1414 WDK Occupancy 1 MIXED USE 14 Exterior Wall 1 14 ood Shingle Code Description Percentage 11 Exterior Wall 2 11 I lapboard 1010 SINGLE FAM MDL-01 100 12 20 Roof Structure 03 able/Hip 1 16 24 Roof Cover 03 ph/F Gls/Cmp tenor Wall 1 05 . rywall/Sheet terior Wall 2 COST/MARKET VALUATION FUS Interior Fir 1 12 ardwood Adj.Base Rate: 24.20 BAS 34,311 20 UBM 20 FUS EAF nterior Fir 2 14 Carpet BAS 2624 FGR 24 eat Fuel 03 as et Other Adj: Q640.00 FBM eat Type 05 of Water eplace Cost 444,951 AC Type 03 entral YB995 — 16 Total Bedrooms 04 Bedrooms , ep Code G 24 Total Bthrms 2 emodel Rating 34 Total Half Baths 1 ear Remodeled ' otal Xtra Fixtrs ep% 110 otal Rooms • unctional Obsinc ath Style 02 verage External Obsinc 'tchen Style 02 odern ost Trend Factor ondttion E Complete Zerall%Cond 90 prefis Val 400,500 s ' Ovr Comment isc Imp Ovr 0 Mise Imp Ovr Comment Cost to Cure Ovr 0 Cost to Cure Ow Comment OB-OUTBUILDING&YARD ITEMS(L)/XF-BUILDING EXTRA FEATURES(B) , Code Description Suh I Sul)Descript S/B i Units Unit Price Yr Gde Dp Rt Cnd %Cnd Apr Value111 SHD1 SITED FRAME' L 96 8.00 2003 0 75 00 FPL3 2 STORY CHIT B 1 2,800.00 2005 1 100 t2,500 gg i BUILDING SUBAREA SUMMARY SECTION f e' ,. �: Nat; Code ( Description Living Area( Gross Area ( E1.Area Unit Cost nde,rec. Value ' - AS First Floor 1,372 1,372 1,372 124.20 170,396 t EAF Attic,Expansion,Finished 202 576 202 43.55 25,087 BM Basement,Finished 0 884 398 55.92 49,430 FGR Garage 0 576 230 49.59 28,565 US Upper Story,Finished 1,204 1,204 1,204 124.20 149,531 VBM Basement,Unfinished 0 320 64 24.84 7,949 WDK Deck,Wood 0 274 27 12.24 3,353 TtL Gross Liv/Lease Area: 2,778 5,206� 3,497 444,951 �� Office of Consumer Affairs and Business Regulation 1000 Washington Street -Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Typo: Corporation SAND DOLLAR CUSTOMS LLC Rcristratinn: 193567 259 GREAT WESTERN RD UNITB Expiration: 10;2911022 SOUTH DENNIS,MA 07660 Update Address and Return Card. Office.of Con.u-naf Ar1Mr,A Brsinuus Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:Cor>:ar oon before the expiration date. If found return to: Rep etre don gasiutan Office of Consumor Affairs and Business Rogulition 193587 10/292022 1000 Washington Strout -Suite 710 SAND UULLAR CUSTOMS LLC Boston,MA 02110 WAL I ER R.WARREN 259 GREAT WESTERN RD.UNIT B lai....r•r ,:rllo'h SOUTH DENNIS.MA 07660 Untl« Not valid without signature socroary Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards nst �Co rvisor • 'i CS-091653 >' pires:09/3012022 WALTER R WARREN JR 11P r, 40 ALEXANDER DR YARMOUTH PORT MA 02675 `` ()/tiff 1.1 . Commissioner ct Wer a. :.� fi 13 ' O O 1 0 .v Replace jetted tub with 42"x 72"tiled shower,glass door. .... Existing „o O l O 1 10' • Replace jetted tub with 42"x 72"tiled shower,glass door. 1 Y�- J3 Proposed rF IHE ( BUILT" BUILDING OFFICIAL