HomeMy WebLinkAboutBLD-23-004958 fa .g/is-/23
RECEIVS1 4 TWO FAMILY ONLY- BUILDING PERMIT
Town of Yarmouth Building Department 'oF R 08 2023 1146 Route 28, South Yarmouth,MA 02664-4492
__ _ 508-398-2231 ext. 1261 Fax 508-398-0836
BUILD NG DEPARTMENT Massachusetts State Building Code,780 CMR
ay - — Bui7Xr=,6 Permit Application To Construct, Repair, Renovate Or Demolish
a One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: - 3-D(Aci . 1 Date Applied: ;
'1,\ )e,'N,-S r .3-N.- .-3
BuildingOfficial(Print Name) ignature Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
21 \A cah4,i4 LC/v►e _ ?c _ 55
1.1 a Is this an accepted street?yes no Map Number Parcel Number
1. oning Information: 1.4 Pr perty Dimensions:
lK-25 Ze .,„Su,I ct,-Dd3 -2-
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
34 l31 l la 5 t
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record: We.� �� i� b2Cfl-13
5hel�p G-G . 2d� � �crw��
Name(Print) City,State,ZIP
Z`. \IGc-.4k-i0.,, (.,00k.g__ (g(oo Z l Z- 172Z
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
( .
New Construction CIExisting Building Owner-Occupiedi Repairs(s) ❑ Alteration(s) Addition 0
, 1
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
-
Brief Description of Proonosed Work2:
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ Z.6t000 5.! 1. Building Permit Fee:S‘SC Indicate how fee is determined_:it: 4 V E
2.Electrical $ z+Cv0 o� 'l Standard City/Town Application Fee I f -40
-W--
0 Total Project Cost3(Item 6)x multiplier x
3.Plumbing $ 1 .tt 2. •Other Fees: $ -�� R r 5 LU43
3 ( 35
4.Mechanical (HVAC) $ 1l List: )53i
i!.. rJv L)PART NT
•
5.Mechanical (Fire $ *(�
Suppression) Total All Fees:$ -._._�Check No. •
Check Amount: Cash Amo ✓
6.Total Project Cost: $ Z'l t-'(�"�' ❑Paid in Full l�Outstanding Balance Due: `\� P')
-
. f t ti -71 t.: t; 1. -'''•' ''' --...,
":17-7 11 9 11 0,',I,- ''.; ': 5. -\147,..!:".',0 fit ft.11 , "ill' !;4' -t.Vr) - - -- • - •-. ? • !-..:.. 1 ,
r;,;::;.- '-44'''''''‘''''- 1 a.'",t :',-IV'0 fv,t,t?!-.. ,a':::::,, , ,•'•,;,:.,; " eV:,i.::; :-,,.' 't: ';,. ,::
i .
'I:it/- *44!)\\ I '':"':::•4--:''- 7..'.5: „: -' '''''It".. ' - ''''•• ' ..7.I , , '; -'•':a:" r r , tSOS (1 RAM :
'••iai '5 '' '
I/ 5, ,71 -• 7:-•77;ar , ,,. .: ". ' : :7- ••,•:,••••4.,..- ;;;;•••.;•_/ ;/:.t,/r, / • -. 1'
,Z" ‘,..-4••aPifr_...el %
2 ••,,k,,, -,-;;4;•••••• ::./
\',...;•X;"-,',"/Atfsi".••' • '..---' ..' '''.f:, ''''. '•.••' C : ':•.• .-':. :'', : '' ."- : .:,';',-'.•)•'. .,:::,',", .:,1,""••S:c.',.:',,,'‘-'i.4::;'ill;''',.'. -'-':' ' •1 '•- ' '
''....-St"....k.,...--•....
. . .. .. ,
. ..-.A...... ....-. -w.. ...,.. .....
-1"."C• .::.; -..;•?ts,V.::'' :'''.'''', ,..':-':•' '.1;:'.''.
,-.--. -.............. ;.,.... ...,.. .
::. -5'1';:i',.4.- •1!••:•1"-i"a: .5'r:75,t';':'-1:CI.
i I
71:0iTi :' ''/.; 7.'f:.! ..'',",•I:, : .54 i.'''.-1:";,-f5 :
.. . ....._... . ..... .. . ..-„ —.. -_ ...
,.;7}: .:.- ''?' ' ; :. ;i:i '• 1. ,•:.;.i .i (4 1...!..
- ,
"::.,--(-,•1!.:.•••',.71•!;;.`i /... . /: . Lo-•.'/,:/r/.'.., /•.,.'. "7fa', -:-. iiiT,I. ,,;•., !/!:-.gt.willi •(••*`••-; •i ( : .." . - '.• .E.,i, 1
; ....___. ....._ _ . ..._„.._ ... . _ „ ..... . . _ . _
4. :'
- ,4-
,.1:7,,r ;.71_,(.:4t.,7.; '..; if,"•,'-`t1.. e ,,
_.
•
. I.;••••.7 ::;,--;' •,..•;. ' :
• i _. . .. ..„
I ..;;A:iv:3•:a•-; :."1 A',41,: . ,,. , ... r11•11.,,;o7;51. ;
; .... _...___. ..
, .
: •a•-.-4;/-i'.•-• 4v.,•,,,,,,.,.zi4.1#,::#•,,,,-, :'' ,,, , :•• `.:.:..,1'i •;• • , . ' 7. , .' ; '' '.;;/.1•'' .. ...fi•li.i?,-;' -:,AVI. ,... ;
,_
., .') rilti)z.v!f.,'k!•:(-.!,;?:, !.., '. ,-,r, ::: -},,,,O,' ! Li..
..... . —
' ;':;,1.:1-••,'•":";;:.'.:4 .i f"''..',.i, ' • i-;'' :V' ).'1';`..:
. ._ ._.—.. . . . . -----
J0.17, 1,'.•'i:1.•.11'.4.,,:i 7..:1`.
, .
.... ... ..
,;1•:...,:-..:•7i•#:::,;" ;
; . . .
etsIII.I1 film.; • . /.1.-.-r• ./-/; ,,!'• •
. . . t
. ;7::7 ill;-,f'ii.: -'-o-i ki'•:?.!:)(10:.'.-I i•--'-' .-' / . -": •';•, ":/•'.:,,I•:., ,T. ',-•,( , L-'::-.
- • - : -
t'',3 fr.-,itibbill i i:". '•'ilf::'7.','• i:- -'. ,:. - , .'Jr'. 7.-.; ,..:::,•..p,• •:" : •;;: i 7_' --. ;.: :-..;:*:.: -.,,,;..:,2 ; ':. icA.;•„,,,i7,-.. :.r).:;.;te.#3i4 ;
I ; .,:•..., -,:. ' ' -!•7:4-:' : •'. 'at 7' - 7 • ' . i ...':.:,P7i. ,.7,-: :.:5•',,.• '', :•,.1 :IC:!ia,..7;t1Z7.:4.1
';'•.',; : ''i'AC
- _ . ... _ .... .., .. . ..
, .
_ _ ..: . -. . ., •... ... _ . .
t•;i,•,`.:''...',.... .0.. 1.71'', :...T ..,:-.-: •';'; ei. •
; yfOU!..#:•:/ Ir..i,•.)i';',:;:
' ; '0,. -.,;:.,.:-'; •,;-. ,: ..„,, ;
r-, ;,',/rr.,,..,,?...t,-,,.; .,.,0 -_,I:',,,,,I.,..)
i . '.7 •‘•-•-, . • -,.••! .1 ' ,:i::!1',.: -'• I
i . . - '''':.-.• 7'..., `..1
•
-. : (,) • ::-.;; i' ' .. .- ' .., • . .-
, 1..(:ii'., l'-'., ,";.:;z1-.----- ----- • •
- - .. .... . . . ...__._. .. . . _ _ __
_ _ -:- - _ --,--
. . .
-.. ,-
?.! 7.....!....,...„7.i:,_
.; ).rr.,:' :7 7',-I ''-'1!:"T-,k 7.4.:71.7,,.17.; (,‘i74 l'.. . ,.: ,
7., " . • 7 , V)4.1%-.)•W :•',,;.;:t1T A 1:7.,( ; i'. • 5-a. ',,,: '.'":', : ':::);II .
....... .. . _ :
. .
•
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) CS- �J l� 3 ZS is -io Z C L (' � S
J co I -" E. ✓e.S s(e r License Number Expiration Date
Name of CSL Holder r
i I n e l�_/ � �t R.o�n� , J O List CSL Type(see below) .
No.and Street v �C Type Description
W t'_S YG r av ►, , A- O Z(o 3 U Unrestricted(Buildings up to 35,000 cu.ft.)
1 R Restricted l&2 Family Dwelling
City/Town,State,ZIP IvI Masonry
RC Roofing Covering
WS Window and Siding
Girt V�Ii1 l v r-poo i SF Solid Fuel Burning Appliances
�S 9)5 .02 J ZO / @ 3'I t.(0)44 I Insulation
Telephone Email address _ D Demolition
5.2 Registered Homem Improvement Contractor CHIC) 191 �- S-13-Z�
1 D V+ T'a I LA—C HIC Registration Number Expiration Date
HIC Cempany Nake or HIC Registrant Nam
1N �n,, ere Ra alytin1,1 6,4 ►nl- 2OLLte
No.and Street eq5;50 S— Lniail address
9 West- ar0,0,./nn , AAR- 02473 00?-2. ;.
Ci /Town State,ZIP Tejphone Cot',,
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(iMI.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 0
•
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETE])WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize "yam l'�� Bv+ ��to f, l_t_C.
to act on my behalf,in all matters relative to work authorized by this building permit application.
S elle '.J.e., 03161] 2023
Print Owner's N e(Electronic Signature) to
•
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
conta'',Id in t•' #lies on is true and accurate to the best of my lmowledge and understanding.
A , d3 lYl&3
Print Ii er's or A orized Agent's Name(Electronic Signature) ate
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.zov/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"
•
=a
'� • The Commonwealth of Massachusetts
omol ,_11, Department ofIndustrialAccidents
-"'8= 1 Congress Street, Suite 100
„44, f
7— ,
•,,=. � 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): A IA my' &Lit- p, l y„ 1- L_L L
Address: II edy
J 2 ve-r`
1�� � �-o av1 J
V
City/State/Zip: VV• Ye,rw,o..itL, ` 111/1A O'673phone#: 0y5 5OS 502_Z
Are you an employer?Check the appropriate box: -
Type of project (required):
l.❑1 am a employer with 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
y capacity.[No workers'comp.insurance required.]
3.0 1 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 myproperty. 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.t 13. Roof repairs
6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[1:]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.
$Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lie.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$I,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.
X
1'do hereby c y to t pains and penalties of perjury that the information provided above is true and correct.Signature: 1 Date: 0401 I1-023
Phone#: Si7S S_ 002-2—
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):
I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person:
L. Phone#:
§TOWN OF YARMOUTH
1146 Route 28, South Yarmouth, MA 02664
508-398-22311 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 21 Va cab ov Lain w' Yar-v,,o)i1„ VA?\ o at, 3.3
Work Address
Is to be disposed of oat the following location: of YY r'vvi tl i LAr c t-6 I
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Ch. 111, §150A
03 I Di 1 2023
Sign e of Ap lication Date
Permit No.
•
- „
k 44-t 4:
4
4. t ;4
-
; :1'1; 1
7".
I
,
•-]:
- _
•
r
v__ Commonwealth of Massachusetts •
Division of Occupational Licensure
Board of Building Regulations and Standards
Constetit4t4tr*:x9f-visor
s.,.,
C S-1 1 6 3 28 , 141.-)ires: 08/28/2025
, .....
SCOTT E SESLER
11 WEDGEMERE RD _ .
.. ..,
WEST YARMO_UTH MA 02673
t -,......-,
k ;
.-'.
Corn m iss io ner o,
i
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs and Business Regulation
1000 Washington Street- Suite 710
Boston, Massachusetts 02118
Home Improer�r ent Contractor Registration
M — 4 `Type. LL
ANYTHING BUT PAINT LLC _ I♦ " B.
Ffegistration: 191777
11 WEDGEMERE ROAD '* `=� Expiration: 08/13/2024
MOWN!�w
WEST YARMOUTH, MA 02673
`C :c1I
el 4.
Update Address and Return Card.
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:LLC Office of Consumer Affairs and Business Regulation
Registration Expiration 1000 Washington Street -Suite 710
191777 08/13/2024 Boston,MA 02118
ANYTHING BUT PAINT LLC%,
I.
w t,,
.f4.=..
SCOTT E.SESSLER
11 WEDGEMERE ROAD '`/
WEST YARMOUTH,MA 02673 Undersecretary Not valid without signature
•
s
tA p 'c� ac maRI
�� y, m v n
rD(39 N n r, m—n c
O m
"' a, G1 "\ D tat c ,
x
rt CI)
D CM �-G V) CD r.
Crq (D /3 CI) i_ n
TI
Crq CDD 0 /- O p
�
CT -•� 0 D n rri ""1
r
Fri A.
al -:mr-
Z
• x. (D
O
r ..,
,.
x IFIT
_,. -.N., .
Ms? IN.....
I CT
I
N a_mN 0 -_'q x r
X Qrq 0
in I 0
r+ 0 0
= C 0
Rn to
CD
9
U)
x
ro
r.
0
s
C
v
0 SketchUp
New Double Sliding Patio Door
Existing Garage Wall to be made
fire resistant.
11,
1------liq
8 i"
Existing Garage Existing House
Con4rete Slab Floor to remair immuili 12'
New 2x6 Wood Frame Wz
•
with 15 Lite Entry Door ai
2 ea Double Hung Windo.
10' Exterior finishes to match existing
SketchUp
New 2x6 Wood Frame Wall r `
with 15 Lite Entry Door and
2 ea Double Hung Windows
Existing Garage
1
Existing Garage Wall to be made
Existing House /fc\lb9L1
fire resistant. $,
- Concrete Slab Floor to remair
A
New Double Sliding Patio Door —
•
•
•
•
•
•
•
o 00 : fD N.
rD 5
,-4- m • N•04
rD
x n
(n 0 n,
ET o-a WI
•
T CI : (D
O Di :
O CU
O rD : O
N 1. cr
rD
E
Q.-
rD
-...114. a
,....
-.4%._„....„1“...
MIIIIIiiimmommlie
Z
m uui. II
rD
ri.x
� 0
o- o
C
-fi �_
O In
rD Qx �.O= O O0 CO rD47