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HomeMy WebLinkAboutBLD-23-001180 r 4 q1/ T2 AA ONE & TWO FAMILY ONLY- BUILDING PERMIT RECEIVED Town of Yarmouth Building Department .-' ""'"�..-.- __ ._ 1146 Route 28, South Yarmouth,MA 02664-4492 : + 508-398-2231 ext. 1261 Fax 508-398-0836 SEP 1 zQ22 Massachusetts State Building Code, 780 CMR Buildi hermit Application To Construct, Repair, Renovate Or Demolish BUILDING DEPARTMENT a One-or Two-Family Dwelling By._ This Section For Official Use Only Building Permit Number: 17-1D 23-Ct)I 1 Date Applied: 1 f A'S q—.1,1, g Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Pr erty Address: 1.2 Assessors Map&Parcel Numbers 38 frar%ces 0mem P. 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 I Provided Required Provided Required Provided JI 7S"` L-)o5' -s,�� 11711 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 Check if yes SECTION 2: PROPERTY OWNERSHIP' 2.1 O ner'o Record j, Coal CIlriello �Armt:,J .MA • © Z67.5 Name(Fria) ity,State,ZIP ii 3® Fran c,�S e (��. Z o 3-2 i(7 - ZSos CGIrtem o C c.t rn a,,cem 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 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: -�q Bripf Description of Proposed Work2: ej v i �.1: t— ,tt, (� u i•i f cre b itA bottle.. aP hiN.e , ApPo x.. I"Z'Y zo' OrL Ske c9i2.t- SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only abor and Materials) 1.Building /0 000 Da 1. Building Permit Fee:$ leo Indicate how fee is determined: 2.Electrical $ Ilk Standard City/Town Application Fee 0 Total Project Cost3(Item 6)x m 1t'plier x 3.Plumbing $ 2. Other Fees: $ (10 # 3 4.Mechanical (HVAC) $ List: Ilir (� 5.Mechanical (Fire $ ./ Suppression) Total All Fees:$ 1 , Check No. Check Amount: Cash o / (, 6.Total Project Cost: $ f 0j 000,.00 0 Paid in Full I$1 Outstanding Balance D e: ' 01V V ti 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 M 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 Company Name or HIC Registrant Name HIC Registration Number Expiration Date 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 ❑ 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 Z;LAN a--r� 0C..iv c_kA., r to act o Lç1iieUa 'y ehalf, ' all matters relative to w i k aut'.'rized by this building permit application. 6 20Print Owner's Na t (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.eov/dps 2. j 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" p S ± The Commonwealth of Massachusetts N/ A 1 , = Department of Industrial Accidents ='"�= 1 Congress Street, Suite 100 ='1'f= Boston, MA 02114-2017 .- um 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): Address: • City/State/Zip: Phone #: Are you an employer?Check the appropriate box: Type of project(required): I.❑I 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 • any capacity.[No workers'comp. insurance required.] 8. ❑ Remodeling 3.0 I am a homeowner doing all work myself. [No workers'comp. insurance required.]t 9 ❑ Demolition 4. am a homeowner and will be hiring contractors to conduct all work on my property. I will Jef/ 10 ❑ Building addition ensure that all contractors either have workers'compensation insurance or are sole proprietors with no employees. 11.El Electrical repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 12.❑Plumbing repairs or additions These sub-contractors have employees and have workers'comp. insurance.: 13.El Roof repairs 6111 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. tContractors 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: 38 Fra t' CeJ ele,„1 - City/State/Zip: Yct in 4. Q Z b J Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). P 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 certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: t/ Phone#: 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#: AR : TOWN OF YARMOUTH o . _'!'- BUILDING DEPARTMENT ��'�„ T,��;,,_xt' 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1261 HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DA1E: A/ I / Zz-- JOB LOCATION: ('"a•�C: (;c 110 -38 \''e..r,ce..ti i-1et.zn fZ.) l c' ,i0 4-tAp ;.s-- NAME STREET ADDRESS SECTION OF TOWN "HOMEOWNER" �a Ay C;f,e II() 7-L5 2l 7 2 05- t ( , I . I NAME HOME PHONE WORK PHONE PRESENT MAILING ADDRESS 3) --c(, L.-L.5 (A.4 Le,a�n re.,) CITY OR TOWN STATE 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 assessor 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 building 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, riles and regulations. The undersigned 'homeowner' certifies that he / sh , nderstands the Town of Yarmouth Building Department minimum inspection procedures and re, ireme s d 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 RE-C—EIV TOWN OF YARMOUTH 1146 ROUTE 28,SOUTH YARMOUTH, MA 02664-4451 SEP 01 702 Telephone(508)398-2231 Ext. 1292-Fax(508)398-0836 YARMOU-i ri OL f KING'S HIGHWAY HISTORIC DISTRICT COMMITTEE OLD KING'S HIGHWAY APPLICATION FOR CERTIFICATE OF EXEMPTION Application is hereby made for the issuance of a Certificate of Exemption under Sections 6 and 7 of Chapter 470 of Acts of 1973, as amended, for the proposed work as described below and on plans, drawings, or photographs accompanying this application. Type or print legibly: Q Address of proposed work: 38 ► A t✓ S N e,kh ,`�. Map/Lot# Owner(s) Cirit,ile a e4 A t-f1 D L Phone# 2 O ....-2 )17 --2 0 All applications mus be submitted by owam er or,accpani by letter from owner approving submittal of application. Mailing address. r�'S l'J G4t0�.G&S ` 'eien t}J, " �5� init Year built: 16183 Email.CC if 1 e ll b 0 C,p_a i:A p.�,.[$ MG�eferred notification method. l✓ Phone __Email OD /J} v T .—. •COY►' ( r 1 Aaent/Contractor: ' ei -e t(� u 1_G y\er Phone#: SV S Z Litz: - I. 1 g 2- Mailing Address 5Q.0 . O Y.... 3 O 2_ P Email: K t f G h A,e,r(p Lot .41S�'"CONK C . ne,./± /7----,ErnaH Preferred notification method. Phone _ Description of Proposed Work(Additional pastes may be attached if necessary): + V I t�2�S.S it 0 A/tiR JST fir' C= G�` ' `S t) beALK� v' ;F,r of tiov-ee,. Poi-scan. Approx., '- i CP-41-A Al w � trs I 2- !.- �, iS' 1h• lea- JT cites * r 4 Signed(Owner or agent)' • Date. 7-z..9-Z- 2 T. Ownertcontractortagent is aware that a permit may be required from the Building Department.(Check other departments.also.) T. This certificate is good for one year from approval date or upon date of expiration of Building Permit,whichever date shall be later. For Committee use only: l / Date. 'I'7- I/ Approved Approved with change Denied Amount 2)=cC Reason for denial *� Cash1CK#. " l Q�" ! SEP 0 7 2022 Rcvd by. Lrr r - ARNt{jll P i i LDI{ - 4 Date Signed Qt 71/2- Signed. � ` 412 '4` t I �}� �..),.,3APPLICATION#:____2?T. _ VS 2a 11 I4 , ' WAT E R DEPARTMENT .w y,�k ."^' '( seer ) EY-s`3l' o-1t, ",, ii2(. II BUI1.UING PERMIT APPLICATION FOR WATER DEPARTMENT SIGN OFF TR:1`ti ;titITTAL FORM BUILDING SITE LOCATION: #y k: « 0: <_.. • " Ut ,�,.._., -{:, ,<- .r'-° C.CCra ra PROPOSED WORK: _ +0jc;, APPLICANT: ti) c s f,_:) ` RESIDENTIAL AND `OR COMMERCIAL BUILDING Water Department: Determines Compliance of Water Availability and or existing location C 1 Fi in<ering Department: Determines Compliance for Parking sand Dr rini ie CC C'onsenation Commission: Determines Compliance to Wetlands .Act: i.e. It Ions)border any type of r t,,elands_streams, ponds.ris cis,ocean. hogs.hoe,. marshland. ETC... Iiealth I)ep artment: Uctermincs Compliance to State and Town Regulations. i.e. � re( mans for Septage Disposal and other PublicLTe:rlt}t.�cttc itcs ._ Eire I)epartmei . / ermines t'ompliance to State and"Sown Requirements for Personal .'stew, Property Protections. i.e.Smoke Detectors, Sprinkler Systenis.ele / t,j / _. ` ' API . C". SIGNATURE.. D '. I I' .. ;5 OFFICI: t SE: CO\IIII'�I`+ O'\ PI 101 I I 1PPR( \' \I. OR DEN! tit ,12 l'i , 'y ‘ , RI-'\ Lk: 1I) B\ 1TI R DIVISION (SI(,t I TRE) DNI} tilt („ 44' a)/ C z_oi ) ,-"' q o.S4Ac0 . CI ' / /Z°'/o. 1 • kJ / � l Q N L..© 7— / ? '4' 03, ass s. �' 1 , `;fir REGULAT/0?,,S 4 f At nor . 5 .. Ct qt di 4 ct Gor1c. � � fvurtc� ' ' 11- fi i G c 1 .,, AN.. ti57.51;1J-r a i`i ``9,1 \ C*0. '7700/ T " •C:34 icor 0=4,44 f:P -Top op fo uIJD. - 3,1'i . .GCcgT/O.V• 'Y,q,etr70077-i r5 .1 • RBoV6 HIGH Flo/Arr. /Al !N SE/IJG Gor /9 •—g-- Fl.. BBC. 347 } PG. 25 - , c t.�✓LiE,E_ : TH©fvI A$ G ..l.41 ow'44u 4Z % 6.S CO.+,f�w0t4e.4.+/ xtr _ 4}'ti-4.Rives odd: . 7'NR .7t',4"..! tare /431er7OV-Trf K .v / 0,7 . � I V44.0.4.• coArarArticraiD. ► , •1• '41 i Ems``...►,O (N.)• ila i�f-l: I (A. .uR 1 '.. 0 IA/ e IA./ G.'G.•a•ie hvG.' ' 0\ ---,--A,'Nl 0 tUT H l MR S S. i . • 3l /9�Z W 17fJTE _.. � • ) SERVICE NO. V 1895-8 NAME Mark A Fortner •=7"..r At• •-?4-21-92 STREET VILLAGE 1 .7;Y (z.Z. - 9r 4? , METER NO. L'?t4',.)•-'7-, 9 *44-- , I r (L, q C., • .-• • .7,1;4 ...„ ' '+_.. �., i i i i 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 J + PC't n C.Cj 2"jC. ir'1 var'Yl „ Work Address Is to be disposed of at the following location: Ct fl S 5-cu-i-fo n Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Signs a of Applica Date Permit No. 5 , � 1 • I r•' :ii; Ecov ,,..... TOWN OF YARMOUTH „....„ .ix 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451 0 Telephone(508)398-2231 Ext. 1292-Fax(508)398-0836 1 ni,,, . ommou,rr OL KING'S HIGHWAY HISTORIC DISTRICT COMMITTEE m... ) ow KING'S HtGHWAY APPLICATION FOR CERTIFICATE OF EXEMPTION Application is hereby made for the issuance of a Certificate of Exemption under Sections 6 and 7 of Chapter 470 of Acts of 1973, as amended, for the proposed work as described below and on plans, drawings, or photographs accompanying this application. Type or print legibly: Address of proposed work 38 FR twcEs Heiek. Rd. MapiLot# /Z.S- Owner(s) C lc itlivanALArma_ Phone#. 2 C. .,..2 iq All applications applications must be submitted by orier or accompanie by letter from owner approving submittal of application. Mailing address A/5 Frew4es 144evk(1-4. , Year built I 1133 Email C Cif Ielit2 0 cpa-coyetoimaseferred notification method V Phone ,L,, Email (2 _.... 14! 4 CO-WI AgentiContractor 1 u..71-ev Nrc t\y‘e,i-- Phone# SVS--2 q lc. - 1 ,2- Mailing Address , Q.() 4 ?)OX 3 0 Z.-- Email VCCSAA met"60 COPIN C.A,Sf. r\CI- Preferred notification method. Phone Email ascription of Proposed Work(Additional pages may be attached if necessary): • 1?)t.)41 IS, er,,,,,-, +re4,4,41 oiece- NM eV IST7110 Cefk covvcrele .glaA=. p ' 0 1-11 x 2.01 Pli.„ hotcK o\C Imvs.6. P of- seem. c-Avy" cvl,,,A4we ci.....s ppm. -, ,. ' ad °I, Decle, 1,. ote s4-ef) 'ft yfvtd-c- bc.ctlitri Ls' 4.4 ' . N.& igned(Owner or agent) , Date 7 z f--z.. z , owner...dor/agent is aware that a permit may be required from the Building Department.(Check other departments,also,) *p. This certificate is good for one year from approval date or upon date of expiration of Budding Permit,whichever date shall be later. or Committee use only: Date. ,.,q/0,-- lApproved Approved with changes—_ _ Denied I ........ ....._______ « , ,i.„ Amount 2:),tO Reason for denial, 4-1-110r1 ;;;;;:::77; ------ 10' ''1,=-''lir,;,ikVny- I- Cash/CK 0: lif0/1 SEP ° 7 2022 1 ---------------) Date Signed 41712)- Signed. .32, .. 11ZI 1%44 eftila 1 I APPLICATION# vs 1 ot..Y4k TOWN OF YARMOUTH r HEALTH DEPARTMENT •..4.‘ PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant:Building Site Location: U Q Era Y1 LC.S 44,1 2 Proposed Improvem�et#: ( nns+Y U (4" �. - (�1� 0 Ler e� s-�( ii �C G (t erne. I t2t)( Z o` Applicant: CcI C'. ',_t. I \ Tel. No.: '7- 27 2A - 25 (-)c) Address: 1_.)) -t j ir4 -I F ,1 jZ-0) l a-iw,'. . i. •' + 1 Date Filed: 1 /i`//UZ--- **If you would like e-mail notification of sign off,please provide e-mail address: Owner Name: ,`,`' l ,', 1 J--\ r . U 3 L. 1 "i Z G Owner Address: 'I) � , .� ��� ��-�\.:c , Owner Tel. No.: E RESIDENTIAL AND/OR COMMERCIAL BUILDING • HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Reduirements For Septage Disposal and other Public Health Activities. Please submit three (3) copies of plans, to include: (1.) Site Plan showing existing buildings, water line location, RECEIVED and septic system location; (2.) Floor plan labeling ALL rooms within building ';':2 (all existing and proposed) — HEALTH DEPT. Note: Floor plans not required for decks, sheds, windows, roofing; (3.) If necessary, Title 5 application signed by licensed installer with fee. i REVIEWED BY: ( DATE: (i -A--) :7 -/) PL ASE NOTE COMMENTS/CONDITIONS: I I , / fLe1TEo Qv goF (3-3-83) !9M4" ' ... . . .. C ° Bel Lof .. • �-- la`s--819 ` � .-_ \ A = 0,54Ac. a • I /2 • �� 0. tit , i N LOT / ? • • \t' 231 G85 s.f • N J to ; a-�Lk-, 't O E 'T 'r, p i. 1+ 5q - V 7" . a Q • ' Z Gone. • 1 )-}1 k \ 41 36 , • 1 I I I d �� 3z�+ \-.�, rS26c� , �� G �lI pg.! a 7,../ /l' D ID.LaT ocoLAt/ Top •op Fouwo.. u 3 /.d 40C.4Tfo�/• amoUTh( ,=4"AP h.ia 2 '• CW47'66: i' 4, )5 tia : le C)119° R6aV6HIGyPoinJT ;AI. a4/A/G GOT /7 -- PG. 8X. 3 7 PG. 05 01.4./ivE,E'_ THO M.9 s GCE z ,Necl a1• Gra r, -. rasexar Ti'O 6U.' - `, r .?#. VA/.OAI Tivla PL iiw. /Q Loc r D OA/ 7"x*. o .RGE l; — Q'acac.AiO 'A., -?!e•O WA/ Ntall0A1' oaA/D 776/AT /T LO ' 7-16 '1 c"OE5 CO#J.$OC4.I ,c� 4) -Lqb o OR .T.V! .row", o r �R�!`70 � { T j� ! I✓.NtA/ CGN/aT.rc/CT/'co. • 1 . 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