HomeMy WebLinkAboutBLD-23-000709 ‘ 1z° lam
ONE &TWO FAMILY ONLY-BUILDING PERMIT
Town of Yarmouth Building Department ort r
1146 Route 28,South Yarmouth,MA 02664-4492
508-398-2231 ext. 1261 Fax 508-398-0836 fi- ,.
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:$ -13 id v ifo! Date Applied:
Building Official(Print Name) • Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address; 1.2 Assessors Map&Parcel Numbers
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 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:
Zone: _ Outside Flood Zone?
Public Cl Private CI Check if 0 Municipal❑ On site disposal system 0
yes
SECTION 2: PROPERTY OWNERSHIP`
2.1 Owner'of Record:
Rrian Davis South Yarmouth, Ma 02673
Name(Print) City,State,ZIP
7 Fresh Brook Road 774-212-0554 Brian.Davis@powereng.com
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WQRK2(check all that apply)
New Construction 111 Existing Building jai Owner-Occupied )4 I Repairs(s) ❑ Alteration(s) Cl Addition Jai
Demolition jal Accessory Bldg.0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: Bump out master suite addition on rear of home
Extend existing garage
SECTION 4:ESTIMATED CONSTRUCTION COSTS.
•
Estimated Costs:
Item Official Use Only
(Labor and Materials)
I.Building $ 30000 I. Building Permit Fee:$ ()b Indicate how fee is determined: Q
r
2.Electrical $ 5000 'B Standard City/Town Application Fee
4000 ❑Total Project Costs(Item 6)x multiplier . x U ,\
3.Plumbing $ 2. Other Fees: $"-LenJ
4.Mechanical (HVAC) $ 1 0 0 0 List:
5.Mechanical (Fire $ ��
Suppression) 0 Total All Fees:$
Check No. Check Amount: Cash oust
\19.1
6.Total Project Cost: $ 40000 Cl Paid in Full liH Outstanding Balance D :1OlO \
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
Jared Griffin CSL# 113663 12/23/2022
License Number Expiration Date
Name of CSL Holder
18 Flicker Lane List CSL Type(see below) U
No.and Street Type Description
West Yarmouth, Ma 02673 U Unrestricted(Buildings up to 35,000 cu.ft.)
City/Town,State,ZIP R Restricted leaFamily Dwelling
M Masonry
RC ___Roofing Covering
WS Window and Siding
--..-._-...
774-212-0554 SF Solid Fuel Burning Appliances
Jared)@Griffincustombuilders.com I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor CHIC)
Jared Griffin HIC # 195621 5/16/2023
HIC Company Name or HIC Registrant Name HIC Registration Number Expiration Date
18 Flicker lane JaredJ@Griffincustombuilders.com
No.and Street
West Yarmouth, MA 02673 774-212-0554 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 IJ
. SECTION 7a:OWNER AUTHORIZATION TO BE COIYIPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize Griffin Custom Builders Inc.
to act on my behalf in all matters relative to work authorized by this building permit application.
Brian Davis k&.'_ 8/2/22
Print Owner's Name(Electronic Si Date
SECTION 7b:OWNERZ OR AOTB.ORIZED 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.
Jared Griffin 8/2/22
Print Owner's or Authorized Agent's 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.aov/oca Information on the Construction Supervisor License can be found at www.mass.eov/dos
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 Cornrnonwealth of Massachusetts
. a=`��1 1 / Department vflndustrialAccidents
`' : ,4 I Congress Street,Suite 100
' s�_ Boston,MA t121I 20I 7
'''�;,t www.mass.gov/dia
\Yorkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH alh,PERMITTING AUTHORITY.
Applicant Information
Please Print Legrbly
Name(Business/Organization/Individual): Griffin Custom Builders Inc.
Address: 18 Flicker Lane
City/State/Zip: West Yarmouth, Ma
Phone#: 774-212-0554
Are you an employer?Check the appropriate box: _-
Type of project(required):
I.1Z11 am a employer with 2 employees(full and/or part-time).*
7. 0 New construction
2.0 i am a sole proprietor or partnership and have no employees working for me in
any capacity.[No workers'comp.insurance required.] 8. Remodeling •
3.0 I 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 10 �:� Building addition
ensure that all contractors either have workers'compensation insurance or are sole
proprietors with no employees 11.(Q Electrical repairs or additions
5.0 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.' 13.0 Roof repairs
6.0 We are a corporation and its officers have exercised their right of exemption per hilGL 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.
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. lithe 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: ACE AM E R I CAN
Policy#or Self-ins.Lic.#: 6S62UB6R02586A22 Expiration Date: 8/20/2023
Job Site Address: 7 Fresh Brook Road
City/State/Zip: South Yarmouth, 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 o this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verificatio , / II
I do hereby certify Ay , al ,
`/ perjury that the information provided above is true and correct.
Si• store: ,74,A `J il7
Date: 22
Phone is ® 212-0554
Official use only. Do not write in this area,to be completed
mp 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
y $ BUILDING DEPARTMENT
R - 1146 Route 28,South Yarmouth,MA 02664 508-398-2231 ext. 1261
tip 6..
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
DATE: 8/2/22
JOB LOCATION: Brian Davis 7 Fresh Brook Rd South Yarmouth, MA
NAME STREET ADDRESS SECTION OF TOWN
"HOMEOWNER" Brian Davis 203-500-0828
NAME HOME PHONE WORK PHONE
PRESENT MAILING ADDRESS 7 Fresh Brook Road South Yarmouth, Ma 02675
CITY OR TOWN STATE ZIP CODE
The current exemption for`Homeowner' was extended to include owner—occupied dwellings of one or two units
and to allow such homeowners to engage an individual for hire who does not possess a license,provided that such
homeowner shall act as supervisor. (Stara Building Code Section 110 R5.1.3.1)
Definition of Homeowner:
Person(s)who owns a parcel of land on which he I she resides or intends to reside,on which there is or is intended to
be,a one or two family attached or detached structure assessory to such use and I or farm structures. A person who
constructs more than one home in a two-year period shall not be considered a homeowner;such"homeowner"shall
submit to the building official,on a form acceptable to the building official,that he/she shall be responsible for all
such work performed under the building permit.(Section 110 R5.1.3.1)
The undersigned `homeowner' assumes responsibility for compliance with the State Building Code and other
applicable codes,by-laws,rules and regulations.
The undersigned `homeowner' certifies that he/ she understands the Town of Yarmouth Building Department
minimum inspection procedures and r uireme and that he / she will comply with said procedures and
requirements.
HOMEOWNER"S SIGNATURE
APPROVAL OF BUILDING OFFICIAL
INSURANCE COVERAGE:
I have a c . - '_'ility insurance policy or its substantial equivalent, which meets the requirements of MGL
Ch.142. 4169 No
• - {' yes,please indicate the type coverage by checking the appropriate box.
A liability insurance po cy Other type of indemnity Bond
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter 142 of the Mass.General Laws and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner Agent
h:homeownrIicexemp
§TOWN OF Y Ai;RMOUTH
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 7 Fresh Brook Road South Yarmouth
Work Address
Is to be disposed of oat the following location: Yarmouth Landfill
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
C 111, §150A.
AL! 8/3/22
a Lure OrrApplication Date
Permit No.
Office of Consumer A &Business Regulation
HOME IMPRO �„. Mi ONTRACTOR
JARED GRIFFIN ^
D/B/A JARED J.GRI -d
s
11.
JARED J.GRIFFIN . i
18 FLICKER LANE : r�' .�.�t'�G
•
WEST YARMOUTH,MA <� Undersecretary_ Commonwealth of Massachusetts
( r Division of Professional Licensure
Board of Building Regulations and Standards
• Cons�i9MtM ii visor ..,
•
CS-113663 .' , ;a pires: 12/23/2022
JARED J GR 'FIN ', ; ,
18 FLICKER I*N , l'ct ,
WEST YARMOj,f
0
Commissioner
•
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RECEIVED
i ^Y1 w"'. 'r..\<N I ,"i t,,E F;• -(:. BUILDING F--1(16 LULL
AA
'�.( WATER + � T DEPARTMENT
BUILDING PERMIT APPLICATION FOR
WATER DEPARTMENT SK;N OFF
TR.ANSM TTTAL FORM
BC II_.DI\G SI I"E LO('.\"I ION: I Fresh Brook I' oad qouth Yarmouth: MA
PR()P()SE[) 'WORK: 1. i.ttid out master-bathroom on roar of home. ExpiaiEtr €i F. xistl ig garage
APPI.IC A\T: Jared Griffin Guth Custom Builders Inc.
AI)I)RFSS: 18 nicker Lane r= ',Neel. Yorrt r E.nr. MA
f EI.PH()\E. 7 t 2 '.t) 5:
RESIDENTIAL IAIA AND OR COMMERCIAL BUILDING
Water I)cpattnacnt' Determine;Compliance of Water \c ailahilite and or existing location
I rt glalcent,t: I)epant ent_ Determine t.'ri tpliaricc for Parking and I)ranra°c
Conservation Commission.: Determines Compliance to 'cetlandS A:1.; r e It IOU S) horder a y type of
ce clland . streams,ponds,rivers, ocean, hogs, boys. marshland. FTC
Ilealtli Department: 1 eierrt roes Compliance to State and limn Regulations.. i.e.
requirements for Septa:e Disposal and other Public I lath Actic ices
here I)cpi jiltent: De ,rrtnmes Compliance to State and [own cn Requirements for Personal
S7 4. Pr pert Protections, i.e. Smoke Detectors, Sprinkler S}stems.etc
1P'• N 'SIGNATURE DATE
0141 E ESE: C'O11NIE NTS ON PE:RNIIi APPROVAL OR DE'\I fit.
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RE VIFWI•: )131'WATER DIVISION(SICN:t'I"URF
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CERTIFIED
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PLOT PLAN
PROPOSED
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ADDITION'S
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rfirsii BROOK ROAD
SOUTH YARMOUTH
MASSACHUSL i i S
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SERVICE NO.
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SmithCabrera, Patience
Sent Jared Griffin <jaredj@griffincustombuilders.com>
To: Thursday,August 4,2022 7:09 PM
Subject: SmithCabrera, Patience
Attachments: RE:Yarmouth Water application
AttemKivn!:This email originates outside of the or0anbatiom oo not open at�obmne��U�emaUb�ma��n�d a��u�wt�— _������|�� r�ord�� Un�u����a�
� Otherwise 6e�tethis ennaU. ^�`'"= aend�rt�ve,��ifun�u/e^
Good Evening Patience, '
Attached/smnV signed copVofw/hatyouneedfor7FneshBrook,
Let nme know of anything else you need.
Thanks so much,
.18"d Griffin
Griffin Custom guilders Inc.
From:SmnithCabrena' Patience<PSrnithCabrera@8yammouthmmaus>
Sent:Thurmday'August4'2D221:59PK4 ' '
To:Jared Griffin<jaremV@Qrif0ncustornbui/dcrscom>
�
Sm� ct:Yannmuth Water application
'
Good afternoon. Please fill out the attached application and return tunne with asite Plan. Thank you!
PatienceS,n/th-Cabrera
cusLomer�em.oe�upemis�r ^
Yarn»ou�h V%a��rDepar�nnen[
�8Buc� /s/an6Road
VVes� Yarmou|M' K4A 7
5O8-771 7�Z1
|
011 TOWN OF YARMOUTH
'771 ° HEALTH DEPARTMENT
4.'4
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
Building Site Location: —7 Ey' Ys, ôj1ii, jL4&
Proposed Improvement: 6- ikA
b &çi O (Rif Oi 1J►t,L,..
c02,46k CYI r`) rA9_,
( ( 11 � 55i
Applicant: , (lam C� ' ((AC AA Cy( tf Tel. No.;c . �j 'f3
(f (it( ,1 ,Address: 1 t` ,, toot .fL t'�t�!` �i`�I M A Date Filed: Vii;52..
**If you would like e-mail notification' of sign off,please provide e-mail address: de 6,,f foit t{ :JM V as/ ' C,,Q//4
Owner Name: E( "` l S
Owner Address: 7 figso 6cOLA g,40. Owner Tel. No.: J j`-`50)-6G-5
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,
RECEIVED and septic system location;
(2.) Floor plan labeling ALL rooms within building
ZU:L`I_ (all existing and proposed) -
Note: Floor plans not required for decks,sheds, windows, roofing;
HEALTH DEPT. (3.) If necessary, Title 5 application signed by licensed installer
with fee.
REVIEWED BY: DATE: 8/', /Z2_,
PLEASE NOTE
COMMENTS/CONDITIONS: