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HomeMy WebLinkAboutBLD-23-003814 Ps( ,/. )L. -5 R E C E I VTIB cti TWO FAMILY ONLY- BUILDING PERMIT - -- - Town of Yarmouth Building Department 1146 Route 28, South Yarmouth,MA 02664-4492 J AN 142023 508-398-2231 ext. 1261 Fax 508-398-0836 1.-,., Massachusetts State Building Code,780 CMR - BUILDING DEPARfj ' g'permitApplication To Construct, Repair, Renovate Or Demolish _- By ____ — a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: $Lf)r --Cb 1 I Date Applied: 11 r-v Se1)cS 1��%' \'\iV 43 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Addr ss: 1.2 Assessors Ma Parcel Numbers I LaSf O ct Ct c(e ILi t. 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: co, j _ 0O G i—e5 F-e_g ^�ilJ Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) / ) O P PO 5Gct cke e 6.I( , ul4zr o1-- 63O rl.4 Front Yard Side Yards Rear Yard Required ( Provided Required _ Provided Required Provided 1.6'Water pply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zo ? Public Private❑ Check if yesf7 Municipal 0 On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1 O ner'of Record: ��✓1 aot YCA-VL't 0 v Po r O 75" Name Print) City,State,ZIP I L) 1--W oock ✓I 1161 r No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 f Repairs(s) 0 Alteration(s) [Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other ❑ Specify: Brief Description of Proposed Work2: �1MM 0 �•� .� 15 4, .-1► tt k mo .o J r SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 100 iCr91. Building Permit Fee:$ I c0 Indicate how fee is determined: 2.Electrical $ ��D ®Standard City/Town Application Fee 0 Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ $000 2. Other Fees: $ (/)'Qlj Q' 'Q 7.\`l 4.Mechanical (HVAC) $ 70() List: 5.Mechanical (Fire \ti)>KS 1)0\ $ - - ' Suppression) 0 Total All Fees:$ Q 1 i.% Check No. Check Amount: Cash Amq nt:1 V"` L ,INI 6.Total Project Cost: $ t 1 3f cCO 0 Paid in Full ®Outstanding Balance Due: 0 Y • 1 t SECTION 5: CONSTRUCTION SERVICES 5.1 nst_ruction Supervisor License(CSL) Q 55 o7 ( 3 I Z f 5 /7 3 `� Gr ..N-b Cn �- 1 License Number Expiration Date Name of CSL Holder CS O(�5 o t List CSL Type(see below) No.and Street Type Description Ij N v p---v lc 1 PA ( Unrestricted(Buildings up to 35,000 cu.ft) _ R Restricted 1ik2 Family Dwelling City/Town,State,ZIP M Masonry 0 'e e S , 04- 4— RC f Roofing Covering WS Window and Siding .4(�^ p iVt rk.djv4( rd v y SF Solid Fuel Burning Appliances -73 7—t -z'7 6 1�d y MA rs Insulation Telephone Email address _4O.L D Demolition 5.2 Regist r Home Im ovement ontractor(HIC) It" 5'Z( 10 A 2 `2 Doc y 6u, 4 ci e_rs HIC Registration Number ExpirationDa te Company Name orC Registrant N kZOO PG—\ vK t't�, Nit No.and Street--- l �0 0�� 02OD Email address City/Town, State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(i1'I.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 Issua a 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 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 understanding. Print Owner'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.aov/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" §TOWN OF YARMOUTH 1146 Route 28, South Yarmouth, MA 02664 508-398-223** 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 l (A--)eS ki3ce .S V, Work Address Is to be disposed of oat the following location: 'F" Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. 6 Ad' Sig a e of Application Date Permit No. Commonwealth of Massachusetts ® Division of P Board of Building Regulations and Standards Construction Supervtsor Expires:0312912021 CS-08507' PETER V KIMBAL_L MES DOCK RO YARMOUTH PORT MAAD D 675 C)t,_ /91--- - Commissioner i i 1 The Commonwealth of Massachusetts =_?, ffM1/(l Department of Industrial Accidents lli r Ile l 1 Congress Street,Suite 100 A17/-* Boston,MA 02114-2017 www.mass.gov/dia \'Corkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant InformationPlease Print Legibly Name(Business/Organization/Individual): ill _ 1)04'c--:e ±, Address: 2 C?(') e � 0 Phone#: �o S' �110 . 3 2 c City/State/Zip: t-c..I vK 0�� � � Are you as employer?Check the appropriate box: Type of project(required): 1.�I am a employer with 3c) employees(full and/or part-time).* 7. ❑ construction 2.01 am a sole proprietor or partnership and have no employees working for me in 8. emodeling any capacity.[No workers'comp.insurance required] 3.01 am a homeowner doing all work myself.[No workers'comp.insurance required.]' 9. El Demolition 10❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.El Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.iasurance.t 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. °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: A-5 s CC /W2-Cf ,c-4 c cl c.4. +l C'y e r5 1 l t Policy#or Self-ins.Lic.#: A()C - t/oo-703 7,59 r Ze Zv/1 Expiration Date: ) L' Job Site Address: f(k 3O C� 4i t l t City/State/Zip:YU'tA-Lo v` k A H-oze)S 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 certi nder the pains and penalties of perjury that the information provided above is true and correct i a e: Date: Phone#: <O -S'`f a - Z5 ' 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#: • HICRegistration (SCA) HIC Registration Card Oct 25, 2022 at 10:05:09 AM Michael Duffany Dear Registrant, Attached please find your new HIC registration card, you must sign the card using ink. Sincerely, Home Improvement Contractor Registration Program tHE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Wasrtngton Street-Sure 713 Boston,Massachusetts 02118 Hone Improvement Contractor Reg strat on f YV� wtHtit3'.- i4e .taeon 1t-=et r.L'•..t'Asti i L+/J Li tiC Ap11:Jtin i h=.12 2221 200 VAL1.1:7_f ^'t�•4IJi: -AUTO-.'-.I.L4 Update Address and Return Card. Tt'Q COMMONWEALTH OF MASSACHUSETTS Ottice tN Convener ALrmes&8tcstess Regulation Registration raid tor ndivaluai use only before the HOME RUP/tOVEUENT CONTRACTOR expiration date If found return to: TYPE:Lltr.y.,t_r, Office of Consumer Attain and Business Re°tlabcn Rsgistraban Eaoifation tv3t Wast.ngeon Street-Stire I/J .:,, /'`_:l Be start.VA 021/tf tt Gt_f%+.F. [•,:_[CRS nIC r14Cr ACL:• _,,ff,uir f.sLll?,;TII Ole-__1_ Cl x>r•_-arY Not valid with° sign ear 1st • \t . DuFFANYBflIDERS k1C1 1N1 January 11, 2023 TO Yarmouth Buitding f opartm nt I authortte,Peter Kimball.,t M ()tiffany 8uildcr.to apply fo' permit%as requlrei and tom0I'ete work at 1 West WWocd%Allnet, Yarmouth Purl 7,., Thank you Anr rnarit Gawsi MDUFFAN-01 JDRISCOLL ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) �.� 12/23/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). ICONTACT PRODUCER NAME: Almeida&Carlson Insurance Agency,Inc PHONN,Ext FAX PO Box 664 (NC, Y 508( )540-6161 (A/C,No):(508)457-7660 Falmouth,MA 02641 E-MAILDSS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Quaker Special Risk INSURED INSURER B:AIM Mutual Insurance Company M Duffany Builders Inc INSURERC: 200 Palmer Ave INSURER D: Falmouth,MA 02640 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CDNDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I SN R ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER �MM/DD/YYYY1 (MM/DD/YYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR HCG1000168-03 1/20/2022 1/20/2023 DAMAGE TO RENTED 50,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 6,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JECT LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER: BROAD FORM ADDL $ AUTOMOBILECOMBINED SINGLE LIMIT LIABILITY (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY _ AUTOS BODILY INJURY(Per accident) $ NON-OWNED (Per PROPERTYDAMAGEAUTOS ONLY TSS ONLY i ct $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B 'WORKERS COMPENSATION PER OTH- I STATUTE I I ER ' AND EMPLOYERS'LIABILITY Y 1 N ANY PROPRIETOR/PARTNER/EXECUTIVE AWC40070376982023A 111/2023 1/1/2024 E.L EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) EL DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks.Schedule,maybe attached if more CERTIFICATE HOLDER IS AN ADDITIONAL INSRED space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE M Duffany Builders Inc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 200 Palmer Avenue Falmouth,MA 02640 AUTHORIZED REPRESENTATIVE ZcP-7 284:2,4C.L. ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 1431" 27" ` 36" 1 36" t 36" I ° 861" .. 91"f- 42" t 27"— t15" —39" 10 ' + 14i"-•-24"•'.24"—+1+-23 e"—. ! ° } ► -- ° N j I SW2733VL 2W W 3633 23633 2W3633r.N),, M BCSOS51VL 3DB27 KB15 BCSOS48 ?4IBIFi487 2UBIF2487 n MI.in 1 mlW co h. 4._ /3- :2 1 ;4] O 0 310j _C 1 Iv -.10 co co in co x N—• i_ _f_ IV -1-- _ - A ' N W N W 'Im i.„ _ N CD —'*OSI NI co "N n NI. co M �j O it — b t • -' _ _ Annmarie Gavin 1 Westwood i Yermouthport,MA cn ir : O : 2RW3615 2B27RT 2827RT Fieldstone-Roseburg Maple- -Full Ov t/ s: 2W2733 2W2733 Color TBD CH:90 DH:87 V .1— 36" , 27" I 27" -I alr 201" `1- 82i" j ` 36" i�I 27" 27" -afi . , hGT10.34" ANCE, ERROR .I APPLICANT FROM I HL tst:ii-Ui, ,IL(" r COMPLIANCE. {� r--, if• F / —11 I DATE: i-1$-13 L' ,`(Y 11 111" 71 e" -I 52i" 9UILUI OFFICIAL 135+" Cindy Woyton ,f� �, This original design is the property of Designed: 10/6/2022 • White Wood Kitchens $ (Jo White Wood Kitchens. Design is subject Printed: 10/6/2022 508-212-1720 ,3 d to change pending field measurements, cindy@whitewoodkitchen.com clients selections and changes in layout. Sandwich * Kingston 'Peli - Gavin post meetingl All Drawing#: 1 No Scale.