HomeMy WebLinkAboutBLD-23-001723 ,., P ) off1ii 7
ONE & TWO FAMILY ONLY- BUILDING PERMIT
Town of Yarmouth Building Department
1146 Route 28, South Yarmouth,MA 02664-4492 ,:
IN)
508-398-2231 ext. 1261 Fax 508-398-0836
Massachusetts State Building Code, 780 CMR
Building Permit Application To Construct, Repair, Renovate Or Demolish :::: i;::.•'
a One-or Two-Family Dwelling
F. s�: CEIVED �
This Section For Official Use Only
SEP 2 9 2022
Building Permit Number: �j( ?3-Ud 1- /(��.3 Date Applied:
1‘-,-, a` --
l N
G r)PPARTMENT
Building Official(Print Name) Signature By: Date__ __
SECTION 1:SITE INFORMATION
•
li roORtt C QddrC�s�� /� ) 1.2 Assessors Map&Parcel Numbers
U U
1.1 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:
Public❑ Private❑ Zone: — Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
�/ i
,y°� 21 Qw4lor'ecor�,4e0 18 J�d6I art tu'C r//� A-€4—O Z,� 6
`M� Name(Print) /� city,State,ZIP oC? �" e
S`) i'-QSD-10 31 gOg` �s�,cs 4 ceti ts�R'?'
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 1 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. Cl Number of Units Other Cl Spfy:
Bri f Description of Proposed Work2: ie A C ( 4 O` I0 fo//' :e. o`'rl
f 1 w.4 s ' o L0 et ti' .. () w-19 A, S( � C/ l-�J %
SECTION 4: ESTIMATED CONSTRUCTION COSTS.
Item Estimated Costs: Official Use Only
(Labor and Materials) ���
1. Building $ t , 1. Building Permit Fee:$ �l Indicate how fee is determined: ;,))
10 Standard City/Town Application Fee
2.Electrical $ ❑Total Project Cost3(Item 6)x multiplier x (,
3.Plumbing $ 2. Other Fees: $ tD D. 1,(''
4.Mechanical (HVAC) $ List: t 1 313
'
$5.Mechanical (Fire /
/ Suppression) Total All Fees:$
�j�� c,i, Check No. Check Amount: Cash Amo t:
6.Total Project Cost: $ !/"— / 0 Paid in Full E0 Outstanding Balance Due: I c ICI y 2-2-
0 i ISM rbr'' yth4D_ erepk
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
City/Town,State,ZIP R Restricted I&2 Family Dwelling
Ivi Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
No.and Street 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 0 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
to act on my behalf, in all matters relative to work authorized by this building permit application.
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 understandi .
i J i C Sc ( 'LJ 1L-6;
Print Owner's or Authorized Agent's Name(Electronic Signature)
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.Eov/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
1 "Total Project Square Footage"may be substituted for"Total Project Cost"
The Commonwealth of Massachusetts
*-- Department of lndccstrialAccidettts
1 Congress Street, Suite 100
�
4r, Boston, MA 02114-2017
,M_ •` www.mass.gov/dig
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): t' ( 6 1 p4 (4 4'L)
/ Address: /S en a K &zociip e U
City/State/Zip: �, ,f(&,, ,,ice-,te e o�� 0 - Z, 5D—
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
any capacity.[No workers'comp. insurance required.] 8. ❑ Remodeling
/ 3. �I am a homeowner doing all work myself. [No workers'comp. insurance required.]t 9• ❑ Demolition
v 4.❑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 11.❑ Electrical repairs or additions
proprietors with no employees.
12.❑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•❑Roof repairs
6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑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. 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.m: Expiration Date:
Job Site Address: City/State/Zip:
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 certi0 er the pains and penalties of perjury that the information provided above is true and rrect.
/Sisnature:
J i� Date: d� 2 � Z 2-
Phone T: "�v
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#:
o�YAK E TOWN OF YARMOUTH
t)( - - BUILDING DEPARTMENT
1146 Route ?28, South Yarmouth, MA 02664 508-398-2231 ext. 1261
�MATTACMECSfj�aP '�
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
DA rh: '7(2 7 2
JOB LOCATION: / Cr7 j .cC7 r" 4
NA1 STREET ADDRESS ECTION OF TOWN
"HOMEOWNER" 10(C 96 Z - S 3�'
NAME HOME PHONE WORK PHONE
PRESENT5d ADDRESS
vx�r �'Zfu�ti�j 1 6i
6 e
�� d
C OR TOWN "STA'11, 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 buildinu 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 t t he / she understands the Town of Yarmouth Building Department
minimum inspection procedures and re. ements and that he / she will comply with said procedures and
requirements.
HOMEOWNER"S SIGNATURE
APPROVAL OF BUILDING OFFICIAL
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
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:homeownrlicexemp
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 l � d`'�C'� %� ` ,/t� J�.() (///� ,tbv,7 '(
Work Address
Is to be disposed of at the following location: 2 /L' ' //L/ iQ '
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
00,72z
Signatur . � ppli•:nt Date
Permit No.
Bk 35017 Pg308 #16981
04-01-2022 @ 08 : 18=
N O T N O T
A N A N
OFFICIAL OFFICIAL
COPY COPY
MASSACHUSETTS STATE EXCISE7, TAX
BARNSTABLE� COUNTY EXCISE TAX
BARNSTABLE COUNTY REGISTRY QF REEDS BA387STQBIW COUNTY REGISTRY OF DEEDS
Date: 04-01-2022 @ 08:184 N DateA 0N-01-2022 @ 08:18am
Ct1#: 55 O }Do :I16l.1 AL 0 F ct#I 5t I A L Doc#: 16981
Fee: $2,394.00 Cons: t700,000.00 FeCe:O$2�142.00 Cons: $700,000.00
DEED
We,William J.Milot and Jill S.Milot,husband and wife married to each other,of 8 North
Walker Street,Taunton,MA 02780
In Consideration of Seven Hundred Thousand dollars and Zero cents($700,000.00)receipt of
which is hereby acknowledged
Grant to Ramol Partners LLC,a Massachusetts Limited Liability Company with a mailing
address of 397 Eliot St,Newton,Ma 02464
With Quitclaim Covenants
The land in Yarmouth with buildings thereon on Oak Grove Road,and being Lot 44 as shown on
a Plan entitled"Parkwood,Land in Yarmouth,Mass.",dated August, 1928,by Whitman and
Howard,Civil Engineers,recorded with the Barnstable Registry of Deeds in Plan Book 57 Page
75. Said Lot contains 6,700 square feet according to said Plan.
ALSO Lot 3B as shown on plan entitled,"Plan of Land in South Yarmouth,Massachusetts for
the Town of Yarmouth,Scale 1"=40',June 11, 1982,John L.Newton—Registered Land
Surveyor,Town of Yarmouth Engineering Department"and recorded in the Barnstable Registry
of Deeds,Book 401 Page 98.
CIO
Subject to and with the benefit of restrictions of record in so far as now in force and applicable.
a
There is also hereby conveyed an easement for all purposes for which ways are commonly used
vo in the Town of Yarmouth in,over and under and upon the Access Easement running between
Pine Grove Road and Oak Grove Road as shown on a plan entitled,"Plan of Land-Oak Grove
Road,Yarmouth,Massachusetts,Scale: 1"=40',January, 1983,John L.Newton Registered Land
Surveyor,Town of Yarmouth Engineering Department"which said plan is recorded in Plan
Book 399 Page 85.
For the Grantors'title,see the deed recorded on 6/2/2006 in the Bamstable County Registry of
Deeds in Book 21063 Page 115
[THE REMAINDER OF THIS PAGE IS INTENTIONALLY LEFT BLANK]
Bk 35017 Pg309 #16981
NOT NOT
AN AN
OFFICIAL OFFICIAL
We,William J. Milot and Al1(S.$Vb'fot,do hereby voluntaril rdlbak kid relinquish all of my/our
rights,if any,as set forth in Massachusetts General Laws,Chapter 188,and state under the pains
and penalties of perjury thatIllwaiVE any and all homestead rightsQnd-further state that no other
person or entity is entitled to gri d Late of homestead in the propettyN
OFFICIAL O F ift,E I A L
Witness our hands and sews orr Lhis1Quitclaim Deed on thi a'cif March 2022.
71(1A 41,1ak
William J. Milot
Ji1911(411) 7/'4
iltsJ2te
COMMONWEALTH OF MASSACHUSETTS
County of Plymouth
On this 94 day of March 2022,before me, the undersigned notary public,personally appeared
William J.Milot and Jill S.Milot proved to me through satisfactory evidence of identification,
which were photographic identification with signature issued by a federal or state
governmental agency, ❑personal knowledge of the undersigned, ❑oath or affirmation of a
credible witness,to be the persons whose names are signed on the preceding or attached
document, and acknowledged to me that he/she signed it voluntarily for its stated purpose.
(SEAL)ifitt,ro.�►ossi;)w�''•.s7��
�t�`' ' Catherine M.L.MacGregor
"t i * Notary Public
e off, ,Jq My Commission Exp: 10/7/2022
NIA
HUt
yuw
&.0
y4Nw+06
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JOHN F. MEADE, REGISTER
BARNSTABLE COUNTY REGISTRY OF DEEDS
RECEIVED & RECORDED ELECTRONICALLY -
CONSTRUCTION PHASING KEY
I I EXISTING WALL TO REMAIN
I= Z/Z Zl REMOVE WALL
REMOVE ELEMENT
21
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1/a"=1-o APPLICANT FROM THE RESPONSIBILITY OF"AS BUILT"
NEW STRUCTURAL COLUMNS COMPLIANCE.
DATE: IU- __
BUI FICIAL
DerbyWR Builders ,t- 4^ ' pfTF
PROPOSED FIRST FLOOR (1i )4'j
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Project number 21019 WRBI ' O t
Yarmouth Development ` a y
Date 8/2/2022 E y�,�' J
Architects Drawn by AKP Al •� '�`'�P�� cq
18 Oak Grove,Yarmouth MA q!)N OF MPS N
io Derby Speer,Garden Sim*ee.sae,n MA e1970
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Project number 21019 WRBI04%144Yarmouth Develo ment
Architects 18 Oak Grove,Yarmouth MA ~ Date
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Yarmouth Development ect number R81
18 Oak Grove.Yarmouth MA RIGHT, LEFT ELEVATIONS
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Date
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