HomeMy WebLinkAboutBLD-22-006823 ,
RECEIVED
EC 0 9 ZiniE & WO FAMILY ONLY- BUILDING PERMIT
Town of Yarmouth Building Department of r
BLit -LNG DEPARTtvtENT 1146 Route 28,South Yarmouth,MA 02664-4492
le )
__ _._--- 508-398-2231 ext. 1261 Fax 508-398-0836
BY Massachusetts State Building Code,780 CMR -e
Building Permit Application To Construct, Repair, Renovate Or Demolish
a One-or Two-Family Dwelling
yThhiss Section For Official Use Only
Building Permit Number: BLD,aa-twWdl.3 Date Applied: j
1
Building Official(Print Name) • Signature Date
SECTION 1:SITE INFORMATION .
1.1 Property Addres : 1.2 Assessors Map&Parcel Numbers
R� 0nti. e, Olq. 1g 113ai
1.1 a Is this an accepted street?yes no Map Number Parcel Number
1.3 Z ning Info mation: 1.4 Property Dimensions:
tii'SidDc4tV, 0 mt.,
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
1.6 Wat r 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' '1 l f.
2.1 Owner' f Record: s, Y�mWl`1 ►1? 1 iL� Uc U 5
Name(Print City,State,ZIP
1712cqrgvnd AU)ent)e, yti-N cotf
No.and Street Telephone Email Address
SECTION 3:DESCRIPTI• N OF PROPOSED ORK2(check all that apply)
New Construction 0 Existing Building/Owner-Occupied Repairs(s) 0 Alteration(s) 0 Addition
Demolition 0 I Accessory Bldg.0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: '{ifClrlt Old aoltr.i I-.r 1 Ile C1 r` om, 1-3C-I)corm
a tnol la ti,.. J`,uti rbO rY1
ts4 -aa-00L,efa3
SECTION 4:ESTIMATED CONSTRUCTION COSTS,
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ S3, 1 Po — 1. Building Permit Fee:S_ Indicate how fee is determined:
0 Standard City/Town Application Fee
2.Electrical $ 0000 0 Total Project Cost3(Item 6)x multiplier x 1 W
{
3.Plumbing $ gOOO 2. Other Fees: $ �.l el- CJ
4.Mechanical (HVAC) $ List: i
5.Mechanical (Fire $ .- -
Suppression) Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ c q) j QO— ❑Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES v/
5.1/CLonstrufction Supervisor� L License(CSL) cG n r�� 5/Z '7T
(- Aar/ s k)Ji, /Ce)rvi �' License(Nuumbbeer Expiration Date
Name of CSL Holder G c /� List CSL Type(see below)
Npo,and Street Type Description
Ji•C7C/l�)is /uj/l jy21 0/ e U c Unrestricted(Buildings up to 35,000 cu. ft.)
/pfi� ) l�TT v Restricted t&2 Family Dwelling -
City own,State,ZIP M Masonry
RC I Roofing Covering
,,j� WS Window and Siding
�1 neil1C ,i,oh";tab b v, I�%/- SF Solid Fuel Burning Appliances
77 I'7�7 aN all/•Ld1K I Insulation
Telephone Email address D Demolition _
5.2 Registered Home Impr vement Contractor(HIC) X3 / /�,�
6//,r�fCsm h gilt Y Oil d�,; —
d�� HIC Registration Number Expiration Date
HIC Company Name HIC Re is ant Name
71iOvnt- saph e.5 none k tvil i frAn1160►o�% m
NQ and Street ! , i ^ UL 63 j Email address 'u
41
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 Issuan of the building permit.
Signed Affidavit Attached? Yes 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 this application is true and accurate to the best of my knowledge and understanding.
7, /.2 .?—
Print Owner's or Authorized Agent's Name(Electronic ignature) Date
NOTES: _
l. 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 nor 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. 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"
,... _... .pe t�� ✓ ;,.-. =li,h=. „�.is ,.-., t .. )
.. ,t >' t 'CI•: •I :I j.{k(i I, '11 7' eii
f .
c"� '. � ,�; j':)`��,, t�;i�VI tt (�I ... i �ii_/ E ;�:.; •�I i'.'.. 5 VI'E€��A _.. ..�.
a9
• ' _ '' The Commonwealth of Massachusetts
�,=_ 1 Department oflndustrial.Accidents
• 1111 1 Congress Street, Suite 100
-4S71f, Boston,MA 02114-2017
� www.mass.gov/dig
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information 2 Please)Print Legibly
Name (Business/Organization/Individual): jA)kI�`Urnlo avI 10/I(tl�- '�.g,mo�Ii' 1�.�
Address: Po. ,gdx asp{ v
City/State/Zip: e S(inlw'A, 111 Od53l Phone#: 1-7y-7a-1-• 73c- ----a
Are you employer?Check the appropriate box: Type of project(required):
I. am a employer with cZ5 employees(full and/or part-time).* 7. 0 New construction
2.0 i am a sole proprietor or partnership and have no employees working for me in 8. ❑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. ❑Ds molition
I am a homeowner and will be contractors to conduct all work on my10 uilding addition
4.
❑ hiring property. I will
ensure that all contractors either have workers'compensation insurance or are sole I l.❑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.[ 1 Roof repairs
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.
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. c✓`t/7 li1 Q
Insurance Company Name: g f/H . ",IA Q acre____
Policy g or Self-ins.Lic.4: 10 t Z-sap— y ?J-.O 13- Expiration Date 9 y/��k�-Q
Sob Site Address: "/ (2cyrcirC4 n 1/l.,( - City/State/Zip: J1 d Lit1A mru' '- ol.46y ,
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 under the pains and penalties f perjury that the information provided above is true and correct.
Signature: Z
1 Date: AV2-%
Phone ti: -7 �l.�/1`r-701 -- /3 E-r
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#:
§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 / 9 Po` (hdh G� (1u-'-
Work Address
Is to be disposed of oat the following location: Uc LJ p
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Ch. 111, §150A.
Signature of Application Date
Permit No.
--
MAP NO. •
LOT
OWNERS NAME: 4,1
SEWAGE PERMIT NO. : NEW: REPAIR:
DATE ISSUED: DATE INSTALLED: - -/..f4-
INSTALLERS NA :
4,1,J.:2., •
INSTALLATION OF:
WATER "TABLE: FINAL INSPECTION BY:
DRAWING OF INSTALLATION ON REVERSE SIDE:
TOP
et.;•• 1,1—"`
1 —
stk,
\\\ N\ • ,
\\\\ .1--
\\ 7:2/
,
•
•
e» NO.
LOT NO. :` 4 ADDRESS: !-1 17.ky, t4N 4tx=
OWNERS NAME: N
SEWAGE PERMIT NO.: 1„)-• NEW: REPAIR: ✓
DATE ISSUED: 1 l d µDATE INSTALLED: 4 -y-/'-
INSTALLERS NAME:. u=7 z*t_ct G.x-[
Scc. -r•E4t—'",a - 2.4 f n P 4�.4.
INSTALLATIONI OF: µ � c,sr�1PSFtd,t. �l WATER TABLE:6 FI AL INSPECTION BY: Ay
DRAWING OF INSTALLATION ON REVERSE SIDE:
TOP 4077
/1ivr ►L
s f 4405 1st'
111 0b9'
14
11,1111.1.11111.414
�/�r. (�/riiiif/rlrtlr/ii�/ r�.
Office of Consumer Affairs and Business Regulation
1000 Washingtor Street- Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
WHITCOMB BUILDING 8 REMODELING,LLC Type
ttnn LLC
P.O.BOX 254 Registration_ 194325
EAST SANDWICH, Expiration_ 01/24/2021
CH,MA 02537
"an `�`u`�sr' Update Address and Return Card. - -
Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR R
TYPE:LLC Registration valid for individual use only
$eaistration before the expiration date. If found return to:
194325 Expiration Office of Consumer Affairs and Business Regulation
WHITCOMB 8 01/24/2023 1000 Washington Street•Suite 710
UILDING$REMODELING,LLC Boston,MA 02118
CHARLES WHITCOMB _
76 AUNT SOPHIES ROAD ���� 7 �i�j ��� �s�
BRWSTER,MA 02631 Not valid without signature
Undersecretary
a �i�tr-` -� g � �'�"• �,t � ma" �, j�u a 4.:�.. Vie.
�� spa '�
a � 4
Commonwealth of Massachusetts 1,.
- Division o.f Occupational Licensure
Board of Building Re ulations and Standards
T j
�° ' 1 I ; 2
rvisor
Cons , ion
�, uH I ` B R 42:7.::::777:„:„: 5;t ires: 0412B12024
ch �1R�.ES A, �`
88 GREENWQOD A , -,
HYANNIS 260.1 t 0 .: .
4� ^
d .0
t Ji&'
,,,, ale-
Commissioner .4,-7 (..1_,AJ,k,
.
M I
C.A.Vincent Inc.
'. ?� aXIEa aw
I rw ,
— LEGEND ;' �� _ � 'A2 :Roll[Rmm 1st
rwr—...o.w.wornay i .1-.6 a,.,e.a ,o —\ t' T 1• ---rfl
a•.1 •rt�Pvn w:a I� a o0 9....I '`.. r fl s., Imo,'n
Ia. L..Pm IS umor aie ,4,...,
Y E 9 E1 _
�I ,S.Rl j a o Km....Kiss sN1o6 '1
4 7
ED ay..ay...... : .
r .
LOOM MAP
1 SOMA 1..2000.9
FLOC E
Q iSiMG___ ^l :ASSESSORS AIM 79 PMI 19
YL
eE- .oareo �'.�' a. MEOM _
MOROS.,w.Ao ^�ins�Raxi o�"�ONEa aSvw��S�' 1 I 3, LOCUS IS M.�a:.w°'u..'R`a.n Rw"a SC0
5i GATEDThem.
I
,......... ZONING SUMMARY
J �10 c _r_.. ‘7' f• zcww a9TRCT.a a[Mai
I II 13,11,E 1- ....tOT MCNrra MO'
rT SIM 02.002 sr
twEUN9 �s NN MORT SCTB.SA( 39'
l� ttF^39e ,• e: 1 NN.SIDE Wt.. t9'
_. - . -- Nx.REM.ACXGOM IN
-s p\ Lw;- it-1 D3A� SW TO' c MAX MIN N.C.OMIT Mr
,O. -:yf. . EXISTING 9119.0 COviir3rs-+zeR
acci - '�SCe`fl""• .. MO..e,9ne¢COVERAGE_1394 aN.
'i 1..
1^.wMr,T' E SEtNC:
rKN
l
iI S , a �� C� a,,
It 4 i
-
SITE PLAN I
*17 RAYMOND AVE
SOUTH YARMOUTH, MA FEAR
MM.ma ,� 11 9yjnwnd n.x..e
MA
C. A VRdCENT SULDINCi I Run,Var..
7. , a< Rz:
. '' �'—•
..„ .:
P` re ape ea aseemj,iee -1—
:A Lc 1,, .,r;,,..r,
DAM one A AWA P.E,P.LS Y4AIdOun.a.N+.... ?ATM
P-2
............_
. A i
.• ,
I CA Vincent.Inc.
: •.
i i i .•••, .i i i 1 clesion/Nein i. , i ,,•.?iTi'/•ir ,
• : .. DECK :i
•i
: .
. :
.•.
. i, 1 1•f'niiiiiiiiii..iie.iiitini. 1
• i ii.. /i i
,
1 i -'''''''"'• I
•• .,'!! i i ,
:1: ......,.• .: I '.*.....117...... i
. ..4 1
: .... ........
1-'
MTMLL.:-.Tart .
MSS ', Tref'
.7: ..'.•:.'::-:.-.7:7'.::..'i.::7_--.2-._.__' -7 ! ,r.:own i
Section i
ii
,
,Eievetiene '
at•,,,, i
,. . .
i ;;•...; ;.; ;;;. . _ • -
.... 1 WV.1.1, ,,i,'“P iei 4 i
• -
: —.
' . .
I
,, , .
. ..
, -11:,, , x , a !! • ... ..... :
:: .. .. - ":: 1 ..* .1 ' ]::::=--..........—. •:•.
, ..
•• . LiViniS AREA
ii r:-,• nit so i--
1: ..........
, . ,-..,-.2) ',- ,, 0,.. , I •=7.:1,'477'''.T'L.2:4:•,",;:-:".:1
• -1 ' . `, '. / EXISTING FIRST FLOOR
:
• . ' .
,,,,,,. , —',-;;;'' i: ....,,,,,,„„,,,,,_, F.....-..2;=:-.ii,•••.•:,,-„••i
- .-1 ----, •..191). 1 Scar iin.n i
i
,.....iii
,,,,M.. : • n.e.n '.
2,,,.„, .....• i j isienni,ininin/nen ,
' ..
—
„...., 1
1 i ,
'.. -.4L ............
.• .....,'
•
.....
.i.i*. I il!Fiiin •
In
1 . ,
---.
i.-17.-- -.. 7' ' ' 1— :•,...rea,41.
FEAR •!
1.1,ING AREA ! 17 Raytnon0 AVerflie
-V:V.,.. ,•.e. :'71',___rth_44.41.,_... .:::.:.-••.,,,e.t._,,,,% 1:, i..' '' '''''''"'...:'''''''' : SOUth Yarmouth.MA i
...li',%11■11111
PROPOSED FIRST FLOOR VslINDOVst&DOOR SCHEDULES
,Proposed let Floor
MOIMMIMI tool , Plan
,
; !..819ng MO A-2
• ----- • -•••••••••••••••••••••••••••••7 •••- - T ,.._ . ..„„"_„:"""""""._. ..L._
ffTTfTr"
-' -,- '
i !,,,;:,,,,p lib A
:i Ilt o 1 1 ri §1110r1 1'! ,t,:r•ill;:'1iiili ., ;.. .,4 lk ill_ li,en Illiikt.
• .! 1 t!0 1 . -.-,ft it4, 2' i--i 1i-:iirPi;11iim 1 i A a )1 ,1-....,.' •IIIIi! E E.', ' II'liII
I VI
5 i , i !lr‘ I ! . - l'Iiiiin!;:1W.;i
d
1 II Li .:'.- , . .
g,ttill, 1g •
il
,.... R____L_.............„.. ......... ...A, 1
, .........___ ...................: .
r -----,
•„if6. •
c f -
-.1B
1 !11
.1;:.
1 I 1 11;1 iiii:_, ! ;Isg 1
' '1 ' i • YP,4 1;eltil i igil.;
i 1 . t i, .iil t111i'§y 1 .11:
11.21
1 11 li IF ,1,1;i1 11:y1t4 1 )il!;:'i
. t . .
1 1 iq.1, i
/
6 I I I
, i •I
/2 i .
,
t 1 1 I
/ .,
C.
1• • . • • ,, .,..,,,
1 i :'•-•:‘,,/, ',.,'',.,,,:•' ic-,
..
,r_.::-...• c
0
-k------• =
41....„,
',..'',:•' .
P..
. P. ,,.
,.,
.
. -.
•„‘„, . .:..---:
bum paL4spli .b
oz
1
HT-. r-
\ ..]' • ' \ -,,
r.,_• 1 k)
0
, .• , i ,,, ,e, ,. 0
. , ...
ill
I , i
, ] L
, ,
‘ kriiii5i751•41Migk::"'''" : '•,•:•,,•,....i
• . .•
•
,.,..,., 1!
.-Ir.
,-.- =
1.1.11 - ..ii---11, *,
: .•
.•
• .t,„,,, „,.,1.
. ,. ce .=N :i•, ;;,' 5 i,i to 11.1,1b,,,I,,lil
; ;:,,
g , 1;g; 11 1:,
,
• .1 ill,.1 i . ,JF : if T 5 :-..ti‘% !1..•;,!,0.i.t,i1111 '.1' < 11 'I'..' -1:g. •
t•
I
'''.. 1J !I 1 i •-' S'.' K 8/,'41,....#.1-....$ :: fht• III i:! :
iv 14J
n i - I .1:4:: 5- i?, ;1 1
I i op . I ,-,e4 ,,; ,,
0111 ii4 1., 1 ,..1 I , 7,I ,i
. .
..j.Z ,71:1 2 7 , ,
....................-..............................
..______
.......
i
Ix
:11
i,;-'-1- --•,c' , 1
f.[
i
11 IIIII1 4
1, illni
t ,..
1 •
'I i. .',,,i•Tairi,00k.. . :; —..r. 1 '1
01 11 .'',.. •,, .,,i I i
:
1 .
•I '' k: i
k' , •
y, . _:1 in,-7 -.i4•• ..,•
r
11111 111 : : ' ....
1 :r, : 1 i 11,.:. , .. 4, ...
•i .a.....A. , .,, ,_____
A:.
• ,...
A A.
. ,.
. .
. .
„, ,.•
. „.
14... JL__=„:„:„:„:„:„.,
. .
4, , • .. ,
. :.
. ..
. ..
,.„ , •••„„.„.. ,, 1 ,„, -, 1 ,
. .: .•
%.D
, .•
• 1,- . 2
•
1,
I it I
, , .! •
I I! ! .
.
.
ii— •
IL
1 I .
•
• 0 p
, 1
. . •
i . . ...... .
. ..
. , •.• .:
, .• ::
. ..
, . .
: ,... . ..
, •, .••. ., . . H. - ..r1. !I ' -7.171• ,I
. ., !
! ••. .
1! .
... ,
I .•;; .
• :.
1 .:
1 ; ,
•I I
II
1 ,
:••
1 .
t T , ' I- -I-' .1- _.•
1-'AMMIIMMION r , ii ;
. •,.,. •., ,
,
'''• 1
Il
; 1
. . ,
i I ,
.'•i .•
TL
rx
, • ; .1! i .
•.•7, ..; : ,i
. .
9 •. . .. .
;
. -• ; ;I .
E I
: , . •
: , •
•• • .
•. .
; :, ,.„„.....,,...,.....,,...=..,....,,,...,..., ••. .
. i .
11,I 0I
, I T 7',Ll I I 1••i o ,
.
.•
. 1_ giligilic..=_I ,•••••••-1,--,--1-Lir I I 1.--11- .......... 1I
i I
I
I i
1 I I
I
,
I. 11
......
{ •
l*C1 # g UJ
# i f !ril
- '1
6 v .u. W
= _1
-------------
•
•
``,
jw! -zei
;
(
W Z
41, : 2 ,.
0
lu 1
: i 2
N
!
i
I pa d
1
1
1
Tom..
•
I i 1 J i
III! 1. '
I tf
C
OOZ
1a ILSc
I o
t,
61 W
ILI O
O
P
l I
''.T 1 1 yl 1 ., 1 1
fits 1. •=1
n