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HomeMy WebLinkAboutBLD-22-006741 R E C E I V & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department /� MAY 19 2022 1146 Route 28,South Yarmouth,MA 02664-4492 I lL 508-398-2231 ext. 1261 Fax 508-398-0836 1 -N BUILDING DEPARTMENT Massachusetts State Building Code,780 CMR \� G ; - 6y — Building Permit Application To Construct,Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Secjtiot`jFor Official Use Only Building Permit Number: -,�U-r od (�(p/ ( Date Applied: Building ..":57 Official �� (Print Name) Signature : Date.. SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 43Autumn Drive in So. Yarmouth 59 73 1.1a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: 0045 Residential 15,497 sqft 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 47.5' 20.5' 20.5' 1.6 Water Supply: (M.G.L c.40,I54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: PublicX Private CI Zone: _ Outside Flo • ne? Municipal 0 On site disposal system X Check if yes SECTION 2 : PROPERTY OWNERSHIP' _ 2.1 Owner'of Record: Jack Lee Name(Print) City,State,ZIP Same 508-280-8345 jack-lee@comcast.net No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory BldgX Number of Units Other ❑ Specify: Brief Description of Proposed Work2: e.:i"k"NR-, kvilS� L.i wU!- 5 grigli---------- SECTION 4s.ESTIMATED CONSTRUCT190 COSTS_ Item Estimated Costs: = (Labor and Materials) `Official Use Only 1.Building $ 140,000.00 1. Building Permit Fee $ 9 Indicate how fee:is-determined: IS Standard City/Town Application Fee 2.Electrical $ 6,500.00 ❑Total Project Cost'- tem 6 : .multi lier x 3.Plumbing $ 2. Other Fees: $ l'r 7 * ' - 4.Mechanical AC List:. / 5.Mechanical (Fire Suppression) $ Total All Fees:_$, 6.Total Project Cost: $ 146,500.00kNo. ' C'Checec`AmO1t ' °'`' i ❑Paid in Full IS Outstanding Balance D : 3 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-107347 9/9/23 Michael Ferullo License Number Expiration Date Name of CSL Holder h: List CSL Type(see below) U PO Box 549 No.and Street Type Description Yarmouth Port, MA 02675 U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding _ SF Solid Fuel Burning Appliances 508-801-3532 ferulloremodeling@comcast.net I insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) Michael Ferullo 171899 4/29/24 HIC Company Name or HIC Registrant Name HIC Registration Number Expiration Date PO Box 549 ferulloremodeling@comcast.net and Street q@comcast.net Yarmouth Port, MA 02675 508-801-3532 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 X No 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLES 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. SEE ATTACHED Print Owner's Name(Electronic Signature) Date • SECTION 7b:OWNER1 OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information ii contained in "s li • is and accurate to the best of my knowledge and understanding. 5/3/22 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.aov/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 1►iW=ME 9.i,,,vi� l Department of Industrial Accidents s1; = 1 Congress Street,Suite 100 �IOW 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):Ferullo Remodeling Inc Address:PO Box 549 City/State/Zip:Yarmouth Port,MA 02675 Phone#:508-801-3532 Are you an employer?Cheek the appropriate box: Type of project(required): 1.0 I am 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 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3. I am a homeowner doingall work t 9. ❑Demolition ❑ myself.[No workers'comp.insurance required.] 4.0lam a homeowner and will be hiring contractors to conduct all work on my p perty-ro f will ]0 Q Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 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.: 13.0 Roof repairs 6.0 We are a corporation and its officers have exercised their ri ht of ex tion 14.0 Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.]MGL c. •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. Insurance Company Name:Star Insurance Company Policy#or Self-ins.Lic.#:WC0870985 Expiration Date:4/15/23 Job Site Address: 43 Autumn Drive City/State/Zip: S Yarmouth MA 02664 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/u under he penalties of perjury that the information provided above is true and correct, Signature: �S Date: 5/3/22 Phone#:508-801-3532 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#: o1."44-. M TOWN OF YAROUTH 4,.,--) 0•.. ,,V, BUILDING DEPARTMENT o C y 1146 Route 28,South Yarmouth,MA 02664 .%, ..sA1. ; 508-398-2231 ext. 1261 Fax 508-398-0836 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 43 Autumn Drive in So. Yarmouth Work Address Is to be disposed of at the following location: Town of Yarmouth Transfer Station Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. , y -I ..- 5/3/22 Signature of Application Date Permit No. Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Con st ► t1'{ervisor CS-107347 4. - F spires:09/09/2023 MICHAEL FERULLO. 447 OLD CHATHAM SOUTH DENN`i MA Commissioner A. �• ' 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:lriditi idual Office of Consumer Affairs and Business Regulation EfitibliBdififi gigirglIgg 1000 Washington Street -Suite 710 171999 ' ; 14/29/2024 Boston,MA 02118 MICHAEL FERULLO MICHAEL FERULLO ;9/1' 52 SEMINOLE DR . .t' YARMOUTH PORT,MA 02875 Undersecretary Not valid without signature A ow CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 4/14/2022 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(s). PRODUCER CONTACTNAME: AHT Insurance,A Baldwin Risk Partner PHONE 800-648 4807 fFA FAX No:7g1 447_7230 458 South Ave (evC.No. ' )' Whitman MA 02382 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC C License#:CA#0658748 INSURER A:Main Street America Assurance 29939 INSURED FERUREM-01 INSURER B:NGM Insurance Company 14788 Ferullo Remodeling, Inc.PO Box 549 INSURER c:Star Insurance Company 18023 Yarmouth Port MA 02675 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:752066350 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. ADDL SUER POUCY EFF POUCY EXP ILTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) UNITS A X COMMERCIAL GENERAL LIABILITY MPP6465G 4/15/2022 4/15/2023 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(E,a occurrence) $500,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY ROT- LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ B AUTOMOBILE LIABILITY M1P6465G 4/15/2022 4/15/2023 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS PROPERTY DAMAGE Xy HIRED X NON-OWNED (Per accdent) $ AUTOS ONLY AUTOS ONLY $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ C WORKERS COMPENSATION WC0870985 4/15/2022 4/15/2023 X STATUTE ERH- AND EMPLOYERS'UABILITY Y I N ANYPROPRIETOR/PARTNER/EXECUTIVE N N/A E.L.EACH ACCIDENT $500,000 OFFICER/MEMBEREXCLUDED9(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. Ferullo Remodeling Inc PO Box 549 AUTHORIZED REPRESENTATIVE Yarmouth Port MA 02675 f Zo/n I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD THIS CERTIFICATE SUPERSEDES PREVIOUSLY ISSUED CERTIFICATE Owner Authorization Form Authorization must accompany application if the owner is not the applicant ,,-- / 7,) , I, ,,,,. II-C.-1k— k rz 'r._ as owner of the property located at , SO tie it ( 0 ci Tit Authorize Michael Ferullo to file an application for a building permit. Authorization Michael Ferullo. Ferullo Remodeling Inc Name of Authorized,. (/gent/Contractor 4.,/ it, '''' — ner(s)—Srgnature 5--i,'-720;2t:,2 Date k. ' N WATER DEPARTMENT .„, 1- '4'. -0.4 ,,,, , ,,,. ,,,,,,,1 kc,,,, BUILDING PERMIT APPLICATION FOR WATER DEPARTMENT SIGN OFF TRANSMITTAL FORM 81`111)1NO Sit F LOCATION 43 Autumn Dive in So„Yamtouth PRoPOsED woRK., Build new detached two car garage APP1 WAN r- Michael Ferullo, Ferullo Remodeling Inc - - N.1)DRESS: PO Box 549 Yarmouth Port, MA 02675 r F1,PflON F'. 508-801-3532 R I:SIM:NI 1A1 YN't) OR (0\1\11-R( iAi, BUILDINA 1 Vt.;vat; I)epartmentt Dem fnme-,t otnrai.anco ot Water -1,cattablitty and or emstim;ioca.,tort I•timncermg Department, Detemnnest Complianee tor Patkrne and Dramage Conso\anon( ommissamt I)tnermines t omphanee to Weflamtnt 'ket.. e If lot(sa border any t mat iY a ettand,, stream-,ponds,;tilers,oceralL hoes'. boys, marshland. LI( ilea illi Department I klerm trae rnpnanee to State and I craN n Regatta-tams. requtremerm for Septage Dhposal and lather Public I icaith Actik In:, hie Dcpartnieni Doern-nne,c ornpliance to State and town Requirements lot Perna , Sato‘ Vroperty Picitcsetions, i e Smoke Detectors, Sprinkler sysrems,ev,- / 8/9/21 APPIICANT SIGNATURE DATE oFEICE usE:cOMMENEs ON PERNII1 APPROV.kL OR DENIM. REVIEVVE I'WA ER DIVISION(SIGNATURE) DATE tO 4ink o Yq? TOWN OF YARMOUTH MAY 1 9 2022 HEALTH DEPARTMENT HEALTH DEPT. t *''*� 40. PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Building Site Location:43 Autumn Drive in So.Yarmouth Proposed Improvement:Build new detached two car garage Applicant:Michael Ferullo, Ferullo Remodeling Inc Tel.No.:508-801-3532 czr Address:PO Box 549 Yarmouth Port, MA 02675 Date Filed: 1-1" **If you would like e-mail notification of sign off,please provide e-mail address:ferulloremodeling@comcast.net Owner Name:Jack Lee Owner Address:Same 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: c?)Th'/-7):." --- DATE: PLEASE NOTE COMMENTS/CONDITIONS: CB(fnd)HELD OWNER OF RECORD Jack S. Lee &Audrey Lee Deed Book 7245, Page 238 LCP 30561-B,SHT 6, a, LEGEND PL BK 174, PG 127& PL BK150, PG 31 0 Assessors' Map 59, Parcel 73 po CB Concrete Bound FND Found •S . ,X \\\X .,pk r1 62.02r fJpD PARCEL I / $RQ ° `I . 8,575 SF± PARCEL II • • PROP* ED CRUSHED STONE \� . / Attached Shed 1,490 SF± DRIVEWAY EXTENSION \ __ , (framed to house) • CB(fnd) EXISTING CRUSHED t -�30�'x �� • HELD STONE DRIVEWAY----l<RMTo /, Fksn. / ,�\ • 20"Doug Fur � DofA-Ai, / �k'e//j„ 462 .Si S, Q Q 9„ , r ico, PARC E L I I I , _ F'�e '' k f Fnt ery/p/ �6,432 SF± 1.O o •dfren?e r/ IJ i ora� n t. . �/ teps <�STi> o n ... .way.,>., a x / • 1�J BENCHMARK J 0/ �/ ,— Top of Conc Bound < `v j Approx. �\ EI=52.5±(Assumed) �� i Location of <\ 11) Leach Pit 7 (4CEP/ilk Oo/.�. .. 9?Sy, 1_,`I ter/ TF� �\ q)9 1O/) • Location of Leaching ��``�� • Facility as Indicated by Property Owner EXISTING BUILDING COVERAGE: jtt OF Mq : QL �. S�i DWELLING: 1,742 SF± ���S JOHN b HOOP HOUSE: 240 SF± M. SHED: 101SF± LOT: 16,497 SF± -----� 'H LY ''+ ► .4.....",s\ '. os, COVERAGE: (2,083/16,497)x 100%=12.6% CERTIFIED PLOT PLAN PROPOSED BUILDING COVERAGE: SHOWING DWELLING 4'0 Stia\l { 4 AT Iry DWELLING: 1,756 SF± 43 AUTUMN DRIVE. SOUTH YARMOUTH, MA GARAGE: 784 SF± LOT: 16,497 SF± PREPARED FOR COVERAGE:(2,540/16,497)x 100%=15.4% JACK & AU D R EY LEE 0 30 60 90 SCALE 1"=30" APRIL 11, 2022 G:\AAJOBS\IEE6706\DWG\6706.PROPOSED PLOT PLAN FOR GARAGE-4-11-22.dwg Drawn by:JMO/BSH JMO-6706 J.M. O'REILLY & ASSOCIATES, INC. 1573 Main Street, P.O. Box 1773 Professional Engineering & Surveying Services Brewster, MA 02631 (508)896-6601