Loading...
HomeMy WebLinkAboutBLD-23-003695 • N ZOIc' ONE & TWO FAMILY ONLY- BUILDING PERMIT - Town of Yarmouth Building Department RE C E I V E D 1146 Route 28, South Yarmouth,MA 02664-4492 it 508-398-2231 ext. 1261 Fax 508-398-0836 4 ...'.. : Massachusetts State Building Code, 780 CMR ,, si JaN 061021 � ��•� uil ino Permit Application To Construct, Repair, Renovate Or Demolish .` a One-or Two-Family Dwelling BUILDI VG DEPARTMENT By' _ - This Section For Official Use Only Building Permit Number: P)-73— 3(sCig Date Applied: 1 )r . /Qp►cS 1-1. -d3 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers sV eark d Rd s. VGr ems- iz 5" 1.1 a Is this an accepted street?yes r✓ no Map Number Parcel Number 1.3 Zoning Information• 1.4 Property Dimensions: 2- ZS .+des;c3er+ a 1 Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flop Zone Information: 1.8 Sewage Disposal System: Zone:l Outside Flood Zone? Public I/ Private 0 Check if yes❑ Municipal 0 On site disposal system Ili'' SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: .� 11 (lading, L 1` 1, '.. CiocA tuts . ozoq 0 Name(Print) City,State,ZIP 3Li bbiA it8 . 3708.8no•7114 I +nc>dM a1 ey'span . Ak--A-. No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) 1 New Construction 0 Existing Building i Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition El Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: lQp triode,j Ki4c ..a r c—a --A ‘34 -c ccwAS SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only • (Labor and Materials) 1.Building $ . 6-. e0 1. Building Permit Fee:$ is O Indicate how fee is determined: 2.Electrical $ El Standard City/Town Application Fee 0 Total Project Costa(Item 6)x multiplier . x 3.Plumbing $ 2. Other Fees: $ "J.c CO (4't L i 4.Mechanical (HVAC) $ List: ` , p 5.Mechanical (Fire Suppression) $ Total All Fees:$ W Check No. Check Amount: Cash Am D__ 6.Total Project Cost: $ 7s, coo 0 Paid in Full ®Outstanding Balance Due fit/4) zc,,. r SECTION 5: CONSTRUCTION SERVICES 5.,1 Construction Supervisor License(CSL) GS-OT7& 3 S if Zo2u C r r ' -ti cZr1 'eS License Number Expiration Date Name of CSL Holder List CSL Type(see below) 50.3 A/ (fie r70,,S RC) No.and Stre et 1 T e Description � -}may+- ' '14 02.0 7,S / 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 Solid Fuel Burning Appliances�7'4 -836 5544 ce'4�`� ;�• SIF Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) Chr('6}1�cc►-� '���,eS iR7Go8Z i-O5• Zozc� HIC Com any N e or HIC Registrant N e HIC Registration Number Expiration Date c.1 ( . (penr►iS GehaleStBC�arhotir. ca"". No.an Street Email address armo ncovr- Y►9ik ca-7S 7741 936-55rW City own, State,ZIP Telephone C eft Ct TES( ,c- 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 07 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 C h Y j 54i a►(> dale S to act on my behalf, in all matters relative to work authorized by this building permit application. Oa() CAt k tks 1-- 6-2oz3 Print Owner's Name(Electronic Signature) Date • SECTION 7b: OWNER1 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.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" • The Commonwealth of Massachusetts • ._,=ram Department oflndustrialAccidents 1 Congress Street, Suite 100 �!! Boston, MA 02114-2017 um". www.mass.aov/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): C1')r 6A- 4`�,� CS Address: 603 N. Inr)iS Q�. """, Ce City/State/Zip: 'arr►io Cv 075 p � m� Phone #: - 836 -SSyy Are you an employer?Check the appropriate box: Type of project(required): 1.❑I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.ream a sole proprietor or partnership and have no employees working for me in any capacity.[No workers'comp. insurance required.] 8. [ Remodeling 3.El am a homeowner doing all work myself.[No workers'comp. insurance required.]t 9 2/Demolition 4.❑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 proprietors with no employees. 11.0 Electrical repairs or additions 5.0[am a general contractor and I have hired the sub-contractors listed on the attached sheet. 12.0Plumbing repairs or additions 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•❑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 ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: c%Awlj re, ,hS urc\Y e_ CAb. Policy#or Self-ins.Lic.#: a! 8(AI ec L9,•1 1 Cj Expiration Date: '• f• ZD Z 3 Job Site Address: s'y fatrJi' iocd Rd. City/State/Zip: S. Vow r7. .41-N OZC�Ioy 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 render the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: /"Co"Z(32-3 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#: - ` TOWN OF YARMOUTH (6-f. UBUILDING DEPARTMENT ;ZI 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1261 HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DA 1'h: JOB LOCATION: NAME STREET ADDRESS SECTION OF TOWN "HOMEOWNER" NAME HOME PHONE WORK PHONE PRESENT MAILING ADDRESS 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 requirements and 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 4 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 resultingl fromfr the proposed work/demolition to be conducted at _ '/ arkwcoc rICJ s• Vox+ ,L+j> Work Address Is to be disposed of at the following location: Duv,npS r. pYl S 1-1-e__ Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. -6 -- 0023 Signature of Applicant Date Permit No. 1/10/23,2:39 PM Mail-Sears,Tim-Outlook 54 Parkwood Rd Sears, Tim <tsears@yarmouth.ma.us> Tue 1/10/2023 2:39 PM To: cehayes68@gmail.com <cehayes68@gmail.corn> Christian, have reviewed your application for renovations, and you need to submit 2 copies of floor plans showing the layout/work area. 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 CBO Deputy Building Commissioner Town of Yarmouth 508-398-2231 Ext. 1259 mailto:tsears@yarmouth.ma.us https://outlook.office.com/mail/sentitems/id/AAQkADE3MDQ5NWZmLTkOYzItNDIwNi1 iMDQxLWNkMGQyNmE4NzE5NAAQAAnta%2Bamw5NCvxYY... 1/1 ®� Commonwealth of Massachusetts • Division of Occupational Licensure Board of Building Regulations and Standards • Constktitt��o�n tS ,visor , y CS-077833 . fires: 05/11/2024 CHRISTIAN HAYES , f F 5 IIII 503N DENNIS ROAD ', YARMOUTH RT MA 02675_ ;r l9 i r6 o 4/!-0/J,V3i1>> COMMiSSiOlier VI 1. V..Y//lJ....�. • THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation ..--.a. HOME IMPROVEMF t CONTRACTOR TYPEiindividual ExRk.LQt1 187682 +.d 01/05/2024 CHRISTIAN HAYES f1, , , CHRISTIAN HAYES 503 N.DENNIS RD. 1 YARMOUTH PORT,MA 02675 �' �` ` Undersecrgtary • i . HAYESCH010 ASANZO .4CCPRo CERTIFICATE OF LIABILITY INSURANCE °A'�11/21/2112022 22 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). PRODUCER License#1780862 CONTACT nee.certificates@hubinternational.com HUB International New England PHONE FAX 265 Orleans Road wc,No,Exty ( )945-0446 yuc,No):(508)945-9136 North Chatham,MA 02650 Miss: INSURER(S)AFFORDING COVERAGE NAIC S INSURER A:Twin City Fire Insurance Company 29459 INSURED INSURER B: Christian Hayes INSURER C: 503 North Dennis Road INSURER D: Yarmouthport,MA 02675 e 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 CONDITION 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. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MNYDDIYYYY) (MMlDDIYYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH(rr1IRRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Fa occurrence) $ MED EXP(An/one person) 3 PERSONAL&ADV INJURY $ GEM_AGGREGATE UE'APPUES PER: GENERAL AGGREGATE $ POUCY LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY WGLE UMIT(Ea accident) ANY AUTO BODILY INJURY(Per person) $ AWNED SCHEDULED BODILY INJURY(Per accident, $ AUTOS ONLY _ ►A�UpTNOpSyyN q;pp� — AUTOS ONLY AUTOS ONLY (Per TM� $ $ UMBRA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED REIIINT)ON$ $ A WORKERS COMPENSATION I PER 1QTH AND EMPLOYERS'LIABILITY STATUTE I LfJ ANY PROPRIETOR/PARTNER/EXECUTIVE YIN 08WECL61T70 9/1/2022 9/1/2023 EL EACH ACCIDENT $ 100,000 (MandatoryOFFICER/M in ER EXCLUDED? N NIA EL rx�ASF ,000 (Mandatory in NH) 100 If yes,describe under EA EMPLOYEE$ DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(AOORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Evidence of Insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD .r.-. r C> ::Y 2, _ :.]l r.. • . vim. 11.<:V`G321 • • • 10.4,041 w. ._. - .. _..._ t _ • • 5 Pcxv 0 0 • or-) RECEIVED [ JAN 11 2023 BUFLDIN613EPARTMENT c ?nacocsy aS2 CA) S'A-osn v p ta) 1-37-771 7:7 Dzo REVIEWED FOR EL'i D! 0 AND ANCE. ERRORS OR OMISSION i40-1 APPLICANT FROM THE RESPONSIBILITY OF • BUILT 1111100 o Z. COMPLIANCE. 00Y OWII,t411.40 Pf114 Door f Li 0c3 ML° ks" 0\I e i c l• • j I 0 y „ _____ V i!Cou eV 4 L 'NN -76,p „ , , :5). ,) 0 _...i_________H.a_ , 6 0 q . „ , , r-- 1 . I 6-'cc ,, ‘. „ 0 -?. ! .A. . 70, , ,i. s , O , , ,.,,,.., 2 i 0 w , MI --1'.. (v 7 V 1 1 1 1 514 .. • Bok\--)roonr-) I RECEIVED [ JAN 11 2023 i BUILDING DEPARTMENT — ---------7 By CP r)C5 cl OC)r A-SW SA-lan d Itlf P t ' T , . , , , • , .,,... , , , , , , ......„‹,_____ - Dr REVIEWED FOR BUILDING AND OIII,'IC3 C', •'..;'7 H ANCE. ERRORS OR OMMISSIONS DO NOT R LL.LVE i I,.ffij I APPLICANT FROM THE RESPONSIBILITY OF"AS BUILT111100 0,-}4.r o COMPLIANCE. . ii_411_,WIr.45 Off IQ1& 1 1 IDoo sr EL( 1. . -------- ., ' 1 i r J.