HomeMy WebLinkAboutBLD-23-001965 i
ONE & TWO FAMILY ONLY- BUILDING PERMIT
Town of Yarmouth Building Department
1146 Route 28,South Yarmouth,MA 02664-4492 t
------1508-398-2231 ext. 1261 Fax 508-398-0836 . f
I �' Massachusetts State Building Code,780 CMR ``
( p�� 13 n �" .,
{ 20ZZB Idi gPermitApplication To Construct, Repair, Renovate Or Demolish
i __._._ ___ 1 a One-or Two-Family Dwelling
1 BUILDIt:G DEPANIMENT
u,,
--- ---___-, This Section For Official Use Only
Building Permit Number: [)-23- g� Date Applied:
'1'11-• QIACS \c) 't$'
Building Official(Print Name) ignature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
3P t--�2 ��c—�1(�1 -----
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:
Public 0 Private 0 Zone: — Outside Flood Zone? Municipal❑ On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2LATii er'of Neoxay.(i-mA/ s.grn{n7 /1 HA D0--66
Name(Print) City,State,ZIP
33 Xg c-r/io/J C)AV 781-?I3-7I1 examitez a_gain,em
No.and Street Telephone Email Addresg
SECTION 3:DESCRIPTION OF PROPOSED WORK(check all that apply)
New Construction 0 Existing Buildings ( Owner-Occupied ❑ } Repairs(s) 0 Alteration(s) 0 I Addition 0
Demolition ❑ 1 Accessory Bldg. 0 Number of Units Other ❑ Specify:
Brief Descri tion of Proposed Work2: l re-xi gio CA hl t`7S li7 Q s 01 71/61
SECTION 4: ESTIMATED CONSTRUCTION COSTS.
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ Qa I 6 1. Building Permit Fee:$ ) ' Indicate how fee is determined:
7//�0 15 Standard City/Town Application Fee
2.Electrical $ l[
0 Total Project Cost3(Item 6)x multiplier x
3.Plumbing $ G 3 D 0 2. Other Fees: $ CU p 3 3 S •ct •
4.Mechanical (HVAC) $ //q S0 List: ���(( \\(\
5.Mechanical (Fire $ — - �J
Suppression) Total All Fees:$
Check No. Check Amount: Cash o'
6.Total Project Cost: $ (l/i Ct0 U 0 Paid in Full l Outstanding Balance Die: 4:- ' 1
\'g-
\- J
SECTION 5: CONSTRUCTION SERVICES
3.1 Construction SupervisorW License(CSL) - l l L3 6
'L-D )d`N f r I`I L(/.0/ License Number Expiration Date
Name of CSL Holder
74 J/ H 4 4�V y l ,� n . List CSL Type(see below) IA-
No.and Street �K Type Description
v Kko u7-/1 rC 7 6 v _ U Unrestricted(Buildings up to 35,000 Cu.ft.)
City/Town,State,ZIP I I l I l R Restricted l&2 Family Dwelling
M Masonry
RC Roofing Covering
l N,'I ( WS Window and Siding
(i-CIA LL SF Solid Fuel Burning Appliances
3 4y-yDtiD .t v rr2 i,(.e.,@ cl e sil sy e.Gr I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement/ Contractor(HIC) / Q 3,y
KI u_gAe ��'fA iV i f`< l'" k -Le t i i/k(L-W [HICReegistrati�on Number Expiration Date
HIC Compan Name or HIC Registrant Name
76 /Iced Al Z)R,. ailLedJ d rt d;� ciy
No. d Street
Email address
an Mitn/w 0,2673 gcaa 3q4'yam
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 .❑
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 14 R,1%N A)// ( /�'�
to act on my behalf,in all matters relative to work authorized by this building permit application.
C-41..7(Z)." C11/14-1"
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.
L6 / /6 l[fLL&A) /0 -t(-
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. I42A.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.) //J g y (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) q -7 Q 0 Habitable room count
Number of fireplaces Number of bedrooms A
Number of bathrooms a Number of half7baths
Type of heating system nti,4D �Q j DU C, 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
Office of Consumer Aff- $Business Regulation
HOME IMPROV ,i7 ONTRACTOR
Re•ist motion
KILLEN COMPANIES]Alatarr
1R1
LORAINE KILLEN
76 HEMEON DR. ^-"•""' /r
WEST YARMOUTH,MA 0", — =•'' ! `
Undersecretary
Commonwealth of Massachusetts
P Division of Occupational Licensure
Board of Building Regulations and Standards
1'II I'
Constlion Srvisor
CS-116362 r 5;cpires:03/01/2025
LORAINE KII#EN .' •:11/1
76 HEMEON'6RIVE �li
W YARMOUT M/ • ' fc',.
•
Commissioner cla i'. bo'F.vnr6,,k,
The Commonwealth of Massachusetts
Department of Industrial Accidents
'VI_- Office of Investigations
_?�1 ,�� Lafayette City Center
'' 2 Avenue de Lafayette, Boston,MA 02111-1750
'�,,,, www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): Loraine Killen
Address:76 Hemeon Dr.
City/State/Zip:West Yarmouth, MA Phone#:02673
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. 0 I am a general contractor and I 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑� Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. employees and have workers' 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.:
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.El I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.]t c. 152,§1(4),and we have no
employees. [No workers' 13.0 Other
comp. insurance required.]
*My 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.
1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: Hartford Casualty
Policy#or Self-ins. Lic. #:08WECCU3392 Expiration Date: 10-4-23
Job Site Address: 33 Reflection Way 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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that 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 pain and penalties of perjury that the information provided above is true and correct.
•
Signature:
Date: 10-11-22
Phone#: 508-394-4020
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(check one):
11:1Board of Health 2❑Building Department 3.DCity/Town Clerk 4.0 Electrical Inspector 51=klumbing
Inspector 6.0Other
Contact Person: Phone#:
§TOWN OF YARMOUTH
1146 Route 28, South Yarmouth, MA 02664
508-398-223!1 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 33 J? L- 77 O l) t ) A S, VA °� u,r
Work Address
Is to be disposed of oat the following location: i(j)4 Gt SL r ISI�JA 1—
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Ch. 111, §150A.
Signature of Application Date
Permit No.
1.
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APPLICANT FROM THE RESPONSIBILITY OF"AS BUILT'
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VANDERSEN"
WINDOWS & DOORS
CREATED DATE
SOLD BY: SOLD TO: 6/28/2022
Fairview Millwork Co., Inc.South
Yarmouth LATEST UPDATE
344 Route 107 6/28/2022
Seabrook,NH 03874
Fax: 508-929-0902
t� �( OWNER
jV °� Earl Rehrauer
Abbreviated Quote Report - Customer Pricing
QUOTE NAME__ PROJECT NAME QUOTE NUMBER CUSTOMER PO# TRADE ID
David Ri6ardi-Monahan Pr ect Unassigned Project 2535031
ORDER NOTES: DELIVERY NOTES:
Item 2.yt Operation Location Unit Price Ext. Price
100 2 Left Custom $631.64 $1,263.28
I ! ' RO Size =22 1/2"x 36 1/2" Unit Size =22"x 36"
gx I `-`., 'PSC 1' 10"X3', Unit, 400 Series Casement, Installation Flange, White Exterior Frame, White Exterior Sash/Panel, Pine w/White -
I
'Painted Interior Frame, Left, Hinge with Wash Mode, Dual Pane Low-E4 Standard Series Argon Fill Contour Finelight Grilles-
Between-the-Glass 2 Wide, 3 High, Specified Equal Light Pattern,White, w/White, 3/4"Grille Bar, Traditional Trim Stop Profile
• Stainless Glass/Grille Spacer, Traditional Folding, White,White, Full Screen, Aluminum
- n____, Wrapping:4 9/16" Interior Extension Jamb Pine/White-Painted Standard Complete Unit Extension Jambs, Factory Applied
Hardware: PSC Traditional Folding White PN:1361560
Insect Screen 1:400 Series Casement, PSC 22 x 36 Full Screen Aluminum White
Unit# U-Factor SHGC ENERGY STAR Clear Opening/Unit# Width Height Area (Sq. Ft) Comments:
Al 0.28 0.29 NO Al 12.2980 31.1480 2.66010
Pricing valid subject to any increase in Andersen costs, or expires in 30 days which SUB TOTAL: $1,263.28 ,
ever occurs first. FREIGHT: $0.00 VIA �I`'�,t
LABOR: $0.00 A eW"
DISCLAIMER: TAX: $78.96 5
_
TOTAL: $1,342.24
. f
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Quote#: 2535031 Print Date: 6/28/2022 6:18:28 PM UTC All Images Viewed from Exterior Page 1 of 2 (,--7 is I