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Home My WebLink AboutBLD-23-001312 w Z. ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department :•-'OF"""y._-: 1146 Route 28, South Yarmouth,MA 02664-4492 le: 414t) 508-398-2231 ext. 1261 Fax 508-398-0836 Massachusetts State Building Code, 780 CMR o�e • Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling L This Se i n For Official Use Only ? Building Permit Number: jC LI/DDicl b Date Applied: RECEIVED e7 9--jo—,t)). Building Official(Print Name) Si re tee SECTION 1:SITE INFORMATION SE$� t1 S ZCZZ 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers BUILDING DEPARTMENT .. 0 4Cet aES Fu.R Cif-SSE /�! . 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 Yar R E is EVE D Required Provided Required Provided Required P ovided a SEP 23 2022 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposalfstm: Public 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site di s�{>r'li C�E�ARTMENT Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: G+'/GG,Avv. G GJA-g (LE 5 kt Name(Print) City,State,ZIP e.) 24___ g % $(L(DR a eG.m4./c. .Cc No.and Street y oyiy Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units . Other 0 Specify: Brief Descriptio of Proposed Work'`: I '15 a u Lk Set e.E curd li)-ec4r ?.r SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only V (Labor and Materials) 1. Building $ / D o 90_4.. Building Permit Fee: $ 1 ti W Indicate how fee is determined: Q..j 2.Electrical $ illi Standard City/Town Application Fee 0 Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 5(3 0 0 ^ yj� +0z 4.Mechanical (HVAC) $ List: c.X_ 15 5.Mechanical (Fire $ Suppression) Total All Fees:$ '1 - Q O Check No. Check Amount: Cash t: 6.Total Project Cost: $ I �� 0 Paid in Full 191 Outstanding Balance ue: i(i() 6fIv ' SECTION 5: CONSTRUCTION SERVICES �j 51 Construction' ti Supervisor License(CSL) C_ ! /r" /,�/ Ev4 44 1 �Jt 4/4 License Number Expiration Date ��L� Name of CSL Holder e,-- _ //iy�`/0 4/ /!/fir List CSL Type(see below) No.and Street �l/,r Type Description !.aT ' Y�,z,,.� t , 9111/g• 6266/ U toed(Buildings up to 35,000 cu.ft.) City/Town,State,ZIP R Restricted I&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding Z �/f 7 SF Solid Fuel Burning Appliances o ! 2D45 / i ip -CdaA0,W I Insulation Telephone Email address ed D Demolition 5.2 nered <co"..--4. over;ygn Contractor(HIC) 17S 20 r 4 I L• HIC Registration Number Expiration ate RIC or..,.anydrr pr lj,C egistrant e N}. Add Street �.t /�%�''Li=c4 P s t�''�l 4 i4 c„,, 1 }/ q /� y/j/4 g2t "� r-eh'b j Email address City Town, State, IP 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 V OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize rN t c-44-6L s!L(/ 4 to act on my behalf,in all matters relative to work authorized by this building permit application. tv/a/ 04---1/41,444.01- . Print Owner's Name(Electronic Signature) Dat€ • SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest und- h- •ains and pe - ties of perjury that all of the information conta• a in'this application is true and acc o t i,est of . owledge and understanding. .cam dill/Jc C'�i �� ,i- 7__ Print Owner's or Authorized Agent's Nam (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 riot 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.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 3. "Total Project Square Footage"may be substituted for"Total Project Cost" 4 Co Board OiviS o onwealth of C of$ �nf Professiona,sachuseffs CSFA 1 p nstrUCtion.s1de Ulefions ana S Ure ?MICHAEL CH EL S/219 �*r 2 Fa�ilYgs HY NNIS Mqq F�UE 'ry~ 'I r 06/28/ es: a26 1 2023 goner •///Off iot4onsamerktfai j&Rkisiness fiegu1ation HOME IMPROVEMENT CONTRACTOR TYPE:Individual Registration Expiration 175708 06/03/2023 MICHAEL SILVA MICHAEL D.SILVA 82 WALTON AVE. t-/ k. HYANNNIS,MA 02601 Undersecretary __ The Commonwealth of Massachusetts ► '• 1 Department of Industrial Accidents ::Iel=MINIM 1 Congress Street, Suite 100 °' 1 < Boston, MA 02114-2017 �,,.�NI. www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information r Please Print Legibly Name (Business/Organization/Individual): 4E' � •1 -.1 6 Address: r,- fri../19-17‘11.1 7/& t . City/State/Zip: /4171'Liel j/ /.1 Phone #: SD r 2 rd 270-6 Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am ployer with employees(full and/or part-time).* 7. ❑New construction ? am a sole proprietor or partnership and have no employees working for me in 8. El Remodeling • any capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself.[No workers'comp. insurance required.)t 9. ❑ Demolition 10 E Building addition 4.0 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. 12.0 Plumbing repairs or additions 5.❑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. insurance.: �J 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other��✓$ue/w .��iN�.� 152,§I(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.#: 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. 1 do hereby certify u d r the pains ; id pen, ies of perjury that the information provided above is true and correct. Signature: Date: Phone#: 5 Yr c72q'O8 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 IContact Person: Phone#: oi "NI& • • • I 1 ‘ • 1 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 C e Y fi ,. C1r1 IP Sg Wor Address Is to be disposed of at the following location: - 412 d v/c /`��' /4 S Said disposal site shall be a licens2d solid waste facility as defined by M.G.L. Chapter 111, Section 150A. (f, Signature of Applicant Date Permit No. • • • • S Ga �a4 -has his �0a' �s,, ..yft as ss CDs "o Ga `vi- G'* Ia4..0,400c, Nett �Ga��AJs• °`ram/ sa 6- \ ''',i, s G �aJ A a s yet` �a, aA�S �o y / �o S 00, a,, �9`°4 s Go��, i/ot,. �G ss 'bi '... T`O y�•ps�� ,.�'►-A 4 J/O �� ' J• 'O to tt. 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