HomeMy WebLinkAboutBLD-23-004260 ,U z/ey/t
' ONE & TWO FAMILY ONLY- BUILDING PERMIT
Town of Yarmouth Building Department '- ...
— 1146 Route 28, South Yarmouth,MA 02664-4492
RECEIVED C E I V E D 508-398-2231 ext. 1261 Fax 508-398-08364+ 4Nril,
Massachusetts State Building Code, 780 CMR
rilcding Permit Application To Construct, Repair, Renovate Or Demolish
FEB 011013 K***--Ji_;
a One-or Two-Family Dwelling
BUILDING DEPARTMCNT
By. _ -_- This Section For Official Use Only
Building Permit Number: fj ..1)- j-v 2(po Date Applied:
11'C^ SQA+(-s )t._ t.-3-1.3
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property A dress: 1.2 Assessors Map&Parcel Numbers
V 14 brtN t 1,A /
1.la 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 I Provided Required I} Provided
1.6 W
ater 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?
Check if yes❑ Municipal❑ On site disposal system 0
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner' f Record: bet (�
" ��V la. Yew v-up .4 !tit A (coca Vec.i n iik N e(Print)
City,State,ZIP 1
a Ofc,1.;I L 4o3-'�' o wica(
No.and Street V t f t� O/'►
Telephone Email Addre r� �1
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) `-LJ'' 1
New Construction 0 I Existing Building a Owner-Occupied 0 Repairs(s) 0 I Alteration(s) Ie I Addition ❑
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work': top` ;,Ntc.Dr .i dal.t ; A. t. 01.Q^;\(Li
1:34sc ".,n4- Fe r to-l-wc. is 6..04 .
SECTION 4:ESTIMATED CONSTRUCTION COSTS.
Item Estimated Costs:
(Labor and Materials) Official Use Only •
1. Building $ 3 60.06 1. Building Permit Fee:$ ‘S 0 Indicate how fee is determined:
2.Electrical $ •Standard City/Town Application Fee
❑Total Project Cost3(Item 6)x multiplier . x
3.Plumbing $ 2. Other Fees: $ C
4.Mechanical (HVAC) $ List: � �
5.Mechanical (Fire 4)kk' 1
Suppression) $ Total All Fees:$ 1
6.Total Project Cost: $ Check No. Check Amount: Cash Amount: i( (�'
0 Paid in Full Outstanding Balance Due: ‘00 S V\
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
{/j/J CS— In S�f3 1043/1(a
‘// ,'``ta,VIef 0 License Number Expiration Date
Name of CSJL Holder
List CSL Type(see below) (J
S /Vun✓a4... Leh
.
No.and Street Type Description
//,, �y� U Unrestricted(Buildings up to 35,000 Cu.ft.)
%GiV64< ✓In ✓�/(C•k.. v Z G 7 Restricted I&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
(Z�Z �Z�U // SF Solid Fuel Burning Appliances
•
77,
"/ 4,ul (u�4rn.{ry c� co y/„ctr•/•0► I Insulation
Telephone Email address ✓ D Demolition
5.2 Registered Home Improvement Contractor(HIC)
eu( iescvPr. v 2 (0 Sg4
HIC Com any Name or HIC Registrant Name
HIC Registration Number Expirati n Date
�� V'&uv rova_. L .. l.c tvtncur0Wnbr Crk- CO i
No.and Street �.( fUQAt �w.•�
Ul•40.yv,.v{� WAa... 0 2L"1 3 174 Liz.uU c) Email a8dr ss
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 Issuanc 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 Catli yINttr C.Ga. p
a to act on my behalf,in all matters relative to work authorized l y this building permit application.
o.vc, Go-tAvo.1 0) —/p —a3
P t Owners 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 perjtuy that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
/4�// ft4.J-cv✓/5 2 0/Z ;
Print Ownkr'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.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
? = Department of Industrial Accidents
°'z; 1 Congress Street, Suite 100
- �f=mr ` Boston, MA 02114-201740
„�" www.mass.gov/dia
Yorkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): Cu _�` , M,Q,rL• q J
I I� r k�`t(
Address: Sq Akui\f u'Q L-Y\, •
City/State/Zip: fJ . ( (4,✓t „A..cA f4 . U7.(o73Phone #: -11 LA Z I-L, 4 L ()
Are you an employer?Check the appropriate box:
Type of project(required): I
I.❑1 m 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 f r me in
any capacity.[No workers'comp.insurance required.] 8• El] Remodeling •
3.❑I am a homeowner doing all work myself.[No workers'comp. insuranc required.]t 9. ❑ Demolition
4.0 I am a homeowner and will be hiring contractors to conduct all work on myroe I will 10 Building addition
ensure that all contractors either have workers'compensation insurance or are sole
11.Q Electrical repairs or additions
proprietors with no employees.
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.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.ID 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.
1Contractors 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:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: ?,A U r r C(p LA , City/State/Zip: (JO. (-4 cur (,t v1A. GZ C.13
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 under the pains and ennities of perjury that the information provided above is true and correct.
Signature:
Date: 7/0-3
Phone#: 77 Gi Z I Z L-I Z Rio
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#:
r,1
J - TOWN OF YARMOUTH
_� -077; BUILDING DEPARTMENT
, ° 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1261
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
DATE: a - ►o- a 3
JOB LOCATION: a M Or c.' A L W. Ya r.n A
NAME STREET ADDRESS SECTION OF TOWN
"HOMEOWNER" 9oue.. Gat..u.a.s n 663- - BSbc 7 g I -Sga- 717 9
NAME HOME PHONE WORK PHONE
PRESENT MAIL[NG ADDRESS NOO tI Ave.
SaAe.w. NH 630179
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. (State Building Code Section 110 R5.1.3.1)
Definition of Homeowner:
Person(s)who owns a parcel of land on which he/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/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 and tands the Town of Yarmouth Building Department
minimum inspection procedures and r uirei nts and at he / she will comply with said procedures and
requirements.
HOMEOWNER"S SIGNATURE
APPROVAL OF BUILDING 0
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL
Ch.142. Yes No
If you have checked ves, please indicate the type coverage by checking the appropriate box.
A liability insurance policy Other type of indemnity Bond
O R'S SUR E WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapt 14 of the as . General Laws and that my signature on this permit application waives this requirement.
e:
i� ture f Owner o wner's Agent caner Agent
h: meownrlicexemp
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 aLt 0 tc.\•••
Work Address
Is to be disposed of at the following location: pwh ( (a.,‘S ç(( S}G„4 c -1
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Sectio 150A.
- /6 - a3
ignature of App ant Date
Permit No.
Commonwealth of Massachusetts
Division of Occupational Lcensure
Board of BuildingRegulations and Standards
� r
Constt: lon 5 ,rvisar
r
CS-117543 Spires: 10f21t242
CODY A MEl CUR + '
54 MONROE LANE
YJ YARMOUT11 MA 02673 -% ;
J
Commissioner r.`' a,A. '. bir
Lt
Construction Supervisor
Unrestricted - Buildings of any use group which contain
kiss than 35,000 cubic feet (991 cubic meters) of enclosed
space.
Failure to possess a current edition of the Massachusetts
State Building Code is cause for revocation of this license.
For information about this license
Call (617) 727-3200 or visit www.mass.govldpl
2/9/23,9:07 AM Mail-Sears,Tim-Outlook
24 Orchid
Sears, Tim'<tsears@yarmouth.ma.us>
Thu 2/9/2023 9:06 AM
To:davegauvain@gmail.com <davegauvain@gmail.com>
Dave,
I have reviewed your application and your address is listed in New Hampshire. You do not qualify as a
homeowner under the building code and will need a licensed contractor to apply for the permit.
Pleaser update your application
This email is considered a written denial of your permit application per Section 105.3.1 of the
Massachusetts State Building Code. Section 105.3.2 states in part that "an application for a permit for
any proposed work shall be deemed to have been abandoned 180 days after the date of filing, unless
such application has been pursued in good faith"
You may appeal this denial to the Building Code Appeals Board in accordance with M.G.L. c. 143 §100,
within 45 days of this notice.
Timothy Sears CBO
Deputy Building Commissioner
Town of Yarmouth
508-398-2231 Ext. 1259
mailto:tsearsjyarmouth.ma.us
https://outlook.office.com/mail/sentitems/id/AAQkADE3MDQ5NWZmLTkOYzItNDIwNi 1 iMDQxLWNkMGQyNmE4NzE5NAAQAKujnK8dXn9HgtecZfRN... 1/1
r Jt.Y •�, TOWN OF YARMOUTH
4 o HEALTH DEPARTMENT tt
S' . ,,ti:::4
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
v Building Site Location: d a ( c \-. 1 w\Oc,,
C
i J
Proposed Improvement: \ OS , �� o CC G ' 1 '' ^ ') � + � r �^ C ``�c--1
Applicant: \ )c�.vc cc. vc� Tel. No.: /6 ? 'S�.7 " €.1 6:-
VIAddress: L' G + cJ I-, w Ya o c 1\ Date Filed: 3
"If you would like e-mail notification of sign off please provide e-mail address: I tpve 170.h V0. r\ R q ,. .1 , c 6"•-•
Owner Name: -90-v( Ga.c.,../0,;^
Owner Address: ct y or C\\J L , , `✓, . Ia t v\A p t 1•\'` Owner Tel. No.: 6 O " ( g ra�
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,
=C,a NIC DD and septic system location;
FEB 01 2023 (2.) Floor plan labeling ALL rooms within building
(all existing and proposed) —
HEALTH DEPT. Note: Floor plans not required for decks, sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
ith fee.
REVIEWED BY: DATE: ::;_ ,t.
LEASE NOTE
COMMENTS/CONDITIONS:
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MINCIDIARIc SOIL TEST
TOP OF cWNDATCN 20 Fi.MINIMUM FROM CELLAR OR CRAW.SPACE
100_00 10 FT.MINIMUM 10"f.MINIMUM PROM SLAB DATE TESTOF SOIL TEST AJt 1 2Q�1_2��EL'cV. C N R TE -CLEAN SAND
$Op. DONE BV �ENGINf.(84jG(ASSUMED) [[ WiNESSED BY_A__YOH.HONE-____
CSv1O.'RS INSPECTION PORT
4'SCHEOVLF.4O PER P'PE LOAM AND SEED OBSERVATION HOLE 1 EL[v..__9190
E� MIN.BITCH Vs' FT ", 11\T' 2'LAYER OF
_- -----'-T ` 1' `\ WASHED S10NE °ERCOLAGCN FAZE_5,_l_-MIN,/INCH AT__19___INDIES
ROTH 4'CAST'RCN PIPE 6._ 97,80 MAX OR OL.ER FABRIC VENL I OEP TH HFRIZ TEx TURF
' � $ NOT RCQUwCD COLOR MOTT OTHER 93.90
(OR EQUAL)MINIMUM \ r 8 0 7' AD LOAMY SANG 10ttE3/1 _ N0 ROOTS
OUTLETS PITCH 1/4"PER FT. FL W' \
LE VE/ER5 f-�E I7 19' B LOAMY SAND IOMB/B ROOTS
9132
- FLUW lWE • ' --a� I)9 IJ2' C MEDILV SANG 7.5Y7/1 - - -
�-flEv-_4j 84._ 10' -- 1�, a � ■ •
' NO WATER ENCOUNTERED AT_IN: FLEv.- 849 04.90
/ MIN ---
LEY _0'vA•I4_ �, VEI. Pr 6i�g{yy�L,��.iivr/`1p�A%1�mimi1. y�-
ELEv -_46r09_i. GA9 ELEV.._}7_4Jj_ e'SUUP ELEV.-_44.W >IHiR_Nv�iC19N ••lr ELEV. a].17_
BAFRE DISTRIBUTION DESIGN CALCULATIONS
ELEV.-
LIQUID gqJATLET' -----_ V 4 HIf.N CAPACCIITI INFILTRATORS MTH NU49ER OF BEDROOMS
LEE BOA -41.DO--� / SiCNE IN AN
(TO BE PLACED ON FIRM BASE) GARBAGE DISPOSAL UNIT
4 14 IN^N t0 RE WATER TESTED 3 6.27 TOTAL ESTIMATED FLOW
3 T 9_=N IF MORE THAN ONE OU REI Tt•%JB'%10' TRENCH FCRusT10N (110 d1LIER./pAY% E RN) _�7C_GAL./DAY
[E 1500 GALLON D
B 1'EEi 1a IN ^ y (i0 BE PLACED ON FIRM BASE) /' SOIL ABSORPTION WELL_NA_
•
REI/IREO$EE WC TANK CAPACITT = GAL.SEPTIC TANK ]/4'i0 1 1/2'CLEAN N i ZONE____ ACTUAL SIZE OF SEPTIC TANK OAL
DW91.E WASHED STONE SYSTEM (SAS) , INOCK_,.__ SOIL CLASSIFICATION _j_
FREE OF FINES a SILT ADJUST
DESIGN PERCOLATION RATE S 4- MIN./)N.
f EFFLUENT LOADING RATE 3 /DAY/S,F.
SEWAGE DISPOSAL SYSTEM PROFILE USGS PROBABLE WATER TABLE LIEU .___ LEACHING AREA FF TT
NOT f0 SCALE ODSER'.EC W\TER TABLE( / )ELEV.._ (11%JNN(Q%2A00/12)
BOTTOM OF TEST HOLE ELEV-_ QQ._ LEACHING
%0.74(AREA x RATE) ,4LOIl fiAl/DAY
RESERVE LEACHING CAPAGTY JONI_GAL./DAY
•
NOTES:
•
ALL'WORKMANSHIP AND MATERIALS SHALL CONFORM TO O.E.P.
TIRE 3 ANT THE TOWN'S RULES AND REGULATIONS FOR
THE SUBSURFACE DISPOSAL OF SEWAGE.
1.ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO
WITHIN 8'OF FINISHED GRADE.
-_---_-_- 3 ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF
A• 17 ...r WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR'WITHIN
IO'�B1 10 FT.OF DRIVES OR PARKING AREAS.H-20 LOADING SHALL BE
•-'-1" USED UNDER ON WITHIN 10 FT.OP DRIVES OR PARKING AREAS.
'- 4.ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL
BE MORTARED IN PLACE.
3.NO OETEROINAnCN HAS BEEN MADE AS TO COMPLIANCE WAN
DEEDED OR ZONING RECAILATONS,OWNER//APPUCAN7 IS TO
OBTAIN SVCr1 DETERMINATION FROM APPRGPR)ATD AUMORITY.
LOT 21 8.UTIU ES SHUNT ARC APPROAMA E ONLY EXCAVATOR CONTRACTOR
l5,67.3.6 ± S.T: PRIOR TO COMMENCING MOOR NIS 11)CALL'DIG-SAFE"AT 8S[4Y;2J3 AT LEAST 72 HOURS
7.CONTRACTOR II TO VERIFY GRADES ANO ELBVATONS AS WELL AS
GTE CONDITIONS PRIOR TO COMMENCING WORK ON SITE.ANY VARIATION
IS TO BE BROUGHT TO THE ATTENTION OF THE OESICN ENGINEER
_ INMEOIATELY.
(IG1)--- IOT.BB' (i.• ,,i_- /� 9 LOT IT SHOWN ON ASSESSORS M _¢¢-„AS PARCEL_„R._,
[�) 10.(HORNS CESSPOOL IS-to
0 BE PUMPED AND REMOVED.
IT.THERE ARE OVERHEAD TITRES OVER THE LEACHING FACIUTES.
rl
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10T2B _ / / AAJ� YarmoMN Health Depa1E18eot
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4 ; 99 J F� - m • p 1 I iAT� .'IN O,d P„VC�(G 3 ate
tOF_10 r I 'J 7 Date
_. t .r41 1�.NI I-99.8 PA RU EAASRNG°KLING
+of° A. ------ L -(If-,�/cY /.{z�,z �vtJ,1q
__ (1p0)� I T CAP 'I00 ORB S APPROVED: BOARD OF HEALTH
_ MAR 26 2012
1
11)O.r
i T192I __•] I \2 II;Aij111.IFl T
99.4 - -- -- ----
\ / DATE AGENT
ri
LLON 1` \ PROPOSED SEPTIC DESIGN
3 •,SEPTIC TANK .'x FOP
I t RIKER/CLEARY
Locus
E4. Twla 8 "� `« 24 ORCHID LANE
(981/ 197.41, 97 •98.B aa.00'� 55 T - •
' 98.]S °rp`y'O WEST YARMOUTH, MASS.
A 9)0 9 870,100./ '` \ U 3FFCO(117cyr9p �a�yA p�p�EEAE'`ry.
( at / .Z 203pp.sETUggCKxET A!3p(1
LEGEND: 9Ro- X Dse 06.3 - 94 A 38526900 SON) DENNI§�itLASS. 268.0 FASTING SPOT ELEVARON 00.0 - _ Q
FASTING CONTOUR--__00____
BUC/(A$(ANO ® ICATEMAR- 21, 2012 SCALC i^ _ •20,- .�
FINAL SPOT ELEYATIDN B:rTLR 20 ORCHID LANE
FINAL CONTOUR •
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SOIL TEST LOCATION A
UTILITY POLE -0- -
TOWN WATER�W-,...�.W� I R[V No. 7110-00 CATCH BASIN .■) -- `
GAS LNE LOCATION MAP T
CLEAN OUT_&.s-- i"-
CESSPOOL C.P 0 J REV SHEET 1 OF 1
-- 1 c(S8\PRAAP100-001s»'s177/0-$4.SoHHOA p_2010'SWE{TSER ENGItaiip
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LAND REGISTRATION OFFICE
NOv. 2/ e966
JAM. /.�, /60
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