HomeMy WebLinkAboutBLD-23-003205 1
RE C E I V TWO FAMILY ONLY- BUILDING PERMIT
Town of Yarmouth Building Department
b _
Q EC 0 8 2�22- 1146 Route 28, South Yarmouth,MA 02664-4492
•
508-398-2231 ext. 1261 Fax 508-398-0836
� '-
__— ----- Massachusetts State Building Code 780 CMR
BUILDING DEPARc�ing t.i;i
ernzitApplication To Construct, Repair, Renovate Or Demolish �.7
a One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: �22-D5a(2- Date Applied:
Building Official(Print Name) ignature Date
SECTION 1:SITE INFORMATION
•
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
4/Y v Yc°e s 7`
1.1 a Is this an accepted street?yes t/ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions: RECEIVE 0 1
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) i
1.5 Building Setbacks(ft) BEC 20 2022
Front Yard Side Yards Rear Yard Si
Required Provided Required Provided Required ByProvd -f
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 0 On site disposal system 1
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
( .19-i 6 S. f!- r fro. deed" 41 11( I/f 4-1-0/e3,
t/qame(Print) City,State,ZIP
lIcE7so 3i SY/(i L v/3A0I87f7 C4,,,,sicx� / --/# a C f4v
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building❑ Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. ❑ Number of Units Other 0 Specify:
Brief Description of Proposed Work2:
S
%./
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 1. Building Permit Fee: $ 150 Indicate how fee is determined:
2.Electrical $ ti Standard City/Town Application Fee
❑Total Project Cost3st ((Iteem 6 x multiplier x
3.Plumbing $ 2. Other Fees: $ CA/CIS 3s m
4.Mechanical (HVAC) $ List:
•
5.Mechanical (Fire $
Suppression) Total All Fees:$
O 0 Check No. Check Amount: Cash un
Z 6.Total Project Cost: $ /5-4 0 0 0 Paid in Full ' Outstanding Balance e: 11 s 5
;:i .
I.
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
t1om�
�s- O7Coaao a3 - 17 - ada-3
Se h r. V o,h t License Number Expiration Date
Name of CSL Holder
3 q M o n orno y Q di' List CSL Type(see below)
No.and Street Type Description
S' /a�rn o J .h a 02664
U Unrestricted(Buildings up to 35,000 Cu.ft.)
City/Town,state,ZIP R Restricted I&2 Family Dwelling
M Masonry
RC Roofing Covering
Kane t 5 yQho� v� WS Window and Siding
SF Solid Fuel Burning Appliances
3.d -(o%S -$65 4, I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
7aVNA Koz,v1t ►iaoI'd s1,�al a4
HIC Company Name or HIC Registrant tame
HIC Registration Number Expiration Date
3s Irnoinomoy Rd SK0onte45 v'�oha0-coves•
No.and reet Email address
yorn,0 Lit 6. mq 026.o4 sva -6FrS-s'6S'6
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 Q( No 0
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 is ap lication is true and accurate to the best of my knowledge and understanding.
Print Own or t orized 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.eov/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.) (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"
'''...00.....,,Nit.
' r
SECTION 5: CONSTRUCTION SERVICES
5.1 Constructiono Supervisor License(CSL)
et4,4( G S- ( P License Number Expiration Date
Name of CSL Holder
C e 5 I L Type(see below)
No.and Stree Type Description
S i 14,i14to U Unrestricted(Buildings up to 35,000 Cu.ft.)
own,State,ZIP Restricted ldc2 Family Dwelling
M Masonry
RC Roofing Covering
• WS Window and Siding
VJ„ 7 (4fr Ire' /` C 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 . 0
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 pei jury that all of the information
container. s this ap.licati`'issttrue and accurate to the best of my knowledge and understanding.
A/- 'i 442. L
Prtn%Owner'. I Aut ori. d Agent's Name(Electronic Signature) ate
NOTES:
1. An I wner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not egistered 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.$ov/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.) (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"
Fallon, Rosa
From: Noreen Little <nhlittle@comcast.net>
Sent: Friday, December 16, 2022 2:47 PM
To: Fallon, Rosa
Subject: building permit
Attention!:This email originates outside of the organization. Do not open attachments or click links unless you are
sure this email is from a known sender and you know the content is safe. Call the sender to verify if unsure.
Otherwise delete this email.
Good afternoon,
I am writing to give permission for our builder,Jack Kane, to take over the building permit for our
home at 44 Joyce St., South Yarmouth, Ma. If there are any questions you can contact me at this
email or at 413-204-8757.
Thank you,
Craig Little
i
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR
TYPE:individual
Re�st_ration E_ x ip ration
172080 05/20t2024
JOHN KANE
JOHN E.KANE � l.i
39 Y RD Undersecretary
SOUTHUTH YAR YARMOUTH,MA 02664
Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
Construction S ipper` lSOr
CS-076220 Expires:03/17/2023
JOHN E KANE
39 MONOMOY ROAD
SO YARMOUTH MA 02664 =`'
Commissioner cla a I'. FATH:220.-
12/14/22,4:12 PM Mail-Sears,Tim-Outlook
44 Joyce St
Sears, Tim <tsears@yarmouth.ma.us>
Wed 12/14/2022 4:11 PM
To:craigstevenlittle@gmail.com <craigstevenlittle@gmail.com>
Craig,
I have reviewed your application for a building permit and this property is being used as a rental, you
will need to have a licensed contractor on the application.
Please update your application
This email is considered a written denial of your permit application per Section 105.3.1 of the
Massachusetts State Building Code. Section 105.3.2 states in part that "an application for a permit for
any proposed work shall be deemed to have been abandoned 180 days after the date of filing, unless
such application has been pursued in good faith"
You may appeal this denial to the Building Code Appeals Board in accordance with M.G.L. c. 143 §100,
within 45 days of this notice.
Timothy Sears CB0
Deputy Building Commissioner
Town of Yarmouth
508-398-2231 Ext. 1259
mailtoasears@yarmouth.ma.us h`ea,I n
https://outlook.office.com/mail/sentitems/id/AAQkADE3MDQ5NWZmLTkOYzItNDIwNi1 iMDQxLWNkMGQyNmE4NzE5NAAQAGpm9WDpUVdBmY%2... 1/1
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_ � The Commonwealth of Massachusetts
4� l Department of Industrial Accidents
I —�' s
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r 1 Congress Street, Suite 100,Is Boston, MA 02114-2017
we s'• 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 h n K�q ►'\ (
Address: 3 'I 010%1 o Choy e d‘
•
CitCity/State/Zip: o t 4b N
Y P: S. yA rrn ou4 ti ('Ac Phone #: 50 8'- 6 s''"-310 S'G,
Are you an employer?Check the appropriate box:
Type of project(required): j
I.❑I am a employer with employees(full and/or part-time).*
7. ❑New construction
2.041 I am a sole proprietor or partnership and have no employees working for me in
ca aci 8. Remodeling an •
y p ty.(No workers'comp. insurance required.]
3.❑I 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 my property. I will 10 El Building addition
ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions
proprietors with no employees.
12.0 Plumbing repairs or additions
5.❑[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.
14.0 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 al!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: 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.
I do hereby certify and r the pal and penalties of perjury that the information provided above is true and correct.
Signature: 4/ 14,..........- Date: la /b -a a-
Phone#: soe-(a $ -566-6
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#:
*- The Commonwealth of Massachusetts
I _t.,= Department of Industrial Accidents
=' _ 1 Congress Street, Suite 100
=;I_`_ y Boston, MA 02114-2017
;,Sr•,,,. 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): (t 14, C, S L t 1.'� '-C
t/ Address: 3 / 3 ((/A-- 1 G Vi
City/State/Zip: Pt°c/( hie' /lJ/11"0/9e. Phone #: Y/3 2 v 1 8 7S
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.❑I am a sole proprietor or partnership and have no employees working for me in
8. Remodeling
an pzcity.[No workers'comp. insurance required.]
3. am a homeowner doing all work myself. [No workers'comp. insurance required.]t 9. El Demolition
4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 ❑ Building addition
ensure that all contractors either have workers'compensation insurance or are sole
11.0 Electrical repairs or additions
proprietors with no employees.
5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 12.n Plumbing repairs or additions
These sub-contractors have employees and have workers'comp. insurance./ 1 .❑Roof repairs
6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other
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 such.Contractors that check
thisboxindicating
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.polic number.
II
Y
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.
I do hereby certify it er the ains d penalties of perjury that the information provided above is tr a and correct.
✓Signature: Date: / 5 L.
Phone#: 3) T ,7 7 f7
Official us• on . 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#:
I
A TOWN OF YARMOUTH
r
."• _til BUILDING DEPARTMENT
�.^,,,'. - '°d 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1261
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
DATE:JOB LOCATION: C? ,---
1/ ( (t P 5 t- £ it*rip,d ("1
NAME STREET ADDRESS SECTION OF TOWN L/
"HOMEOWNER" Co 4 S. L. e rfk c-----
NAME HOME PHONE „ WORK NONE/
PRESENT MAILING ADDRESS 3( ) 5'/ v L"1 fee We, 1 11 S t/14- O/oh ( --
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 assessory 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, rules and regulations.
The undersigned 'homeowner' certifies that he / she understands the Town of Yarmouth Building Department
minimum inspection procedures and require nts and that he / she will comply with said procedures and
requirements.
HOMEOWNER"S SIGNATURE c.
APPROVAL OF BUILDING OFFIC
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
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 7 (( JC yre
Work Address
-i2
Is to be disposed of at the following location: / f / //o Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
/ / z2
jgna re of Applicant Date
Permit No.
TOWN OF YARMOUTH
� � HEALTH DEPARTMENT
'�• ` PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
Building Site Location: J () C r
Proposed Improvement: j;j r.) ( I f qv-- le f It 1 S j/,-1 i(
cW1 • ---- ' IDD \.iN \�-c, Y�--r\+
Applicant: ( L,- f ( t S. C r f C ( c Tel. No.: ) o`( e 7r )
Address: ?7 S PC,1,4 % �'i /-{'P��� / //s /i 0(u3 d Date Filed: /), Z Z,
"If you would like e-mail notification of sign off,please provide e-mail address: ( Sk--el /, /r%' c r Ii ./•/c ,
Owner Name: (I- 4-i (/ 5, (
Owner Address: 7 - . S r/e. Ii'i L 4-A Owner Tel. No.:( S'/J))0 Y 75 i
RESIDENTIAL AND/OR COMMERCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements
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;
DEC 0 8 2022 (2.) Floor plan labeling ALL rooms within building
(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.
REVIEWED BY: (7)-s /1/ DATE: I - ( Svi
PLEASE NOTE
COMMENTS/CONDITIONS:
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