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HomeMy WebLinkAboutUntitled // C9 b /2 7/ lr ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department oF r'''7'\.1. 1146 Route 28, South Yarmouth, MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 '-4. -.' Massachusetts State Building Code, 780 CMR Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only J Building Permit Number: j U)-23- Ob ?4 Date Appliedi71 Building Official(Print Name) ign tore Date SECTION 1:SITE INFORMATION i1.1 Property ddr ss: 1.2 Assessors Map&Parcel Numbers 3 I O k- W .�o1(meut--h • R E C E I V E '--- 1.1 a Is this an accepted street?yes X no Map Number Parcel Number D 1.3 Zoning Information: 1.4 Property Dimensions: DEC 1 2 2022 J Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) BUILDING DEpq M RT 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 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private 0 Zone: Outside Flood Zone? — Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'o Record: 'KA-N;e ON c e ‘S W esv Viet(rnc. 4. AAA o?1-t-1.3 iName(Print) City,State,ZIP (,p3 —CF r4 i .d 5of 29,)3161C ?arc 1Shocn<Zia_eGirc .Ca No.and Street 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 ❑ Specify: VBrief Description of Proposed Work2: si 1 N,S� �iz.,,4 05 C veN beecc ocv , V-uw-k ir\C CCAr'� eK c deck Y.\-c he c\. SECTION 4: ESTIMATED CONSTRUCTION COSTS. Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 571 Q y/� 1. Building Permit Fee:$ I SO Indicate how fee is determined: O Ill Standard City/Town Application Fee 2.Electrical $ 75 0D ® 0 Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ � Q. 2. Other Fees: $ ``�� n Mechanical (HVAC) $ v'7 List: 3 5.UU c 4i 3 / / 4. w D 5.Mechanical (Fire $ d I i Suppression) *Of v Total All Fees:$ Check No. Check Amount: Cash t: , 6.Total Project Cost: $ 66/y/ vv 0 Paid in Full 153 Outstanding Balance D : - 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 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: 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. 12\3�/2Z Print Owner's or Authorized Agent's ame(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.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" The Common wealth of Massachusetts y , �_ Department of Industrial Accidents ::1Q]= 1 Congress Street, Suite 100 �= Boston, MA 02114-2017 ;� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly VName (Business/Organization/Individual): V..JAA,Q ?p‘ f rS Addresslf3 City/State/Zip:k .(t-cotwA-h MA QZU 13 Phone #: 5o 2.°2 ,� Z j Are you an employer?Check the appropriate box: Type of project(required): LEI 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 ca aci 8. ❑ Remodeling an • y p ty.INo 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 5.0 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.[ 13.0 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 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. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. a /Signature: Date: \2 I Z Z- v Phone#: 3D� )C4 \Qac Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License f 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#: 4 , TOWN OF YARMOUTH o _° BUILDING DEPARTMENT cc' MATTACNCSff ? 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1261 HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE: JOB LOCATION: Lea TAf-1- Rd 144 4 Lias mo NAME _ STREET ADDRESS SECTION OF TOWN "HOMEOWNER" Ketk e Pokr 1 Is 50g 2q Z 3Le ZS 5(') 5C P3 12Li Z NAME HOME PHONE WORK PHONE PRESENT MAILING ADDRE S TR-c-4 d mP 0Zf13 • C OR TOWN STA'I'L; 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 pein,it. (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. I 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 SIGNATU 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 yes, 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 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 debrisb resulting from the proposed work/demolition to be conducted at 193 i 4 11PS� L mpv� 'MA OD(.Q13 Work Address Is to be disposed of at the following location: Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Signature of Applicant Date Permit No. Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as "...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership, association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall • enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and,if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 02-23-15 www.mass.gov/dia TOWN OF YARMOUTH HEALTH DEPARTMENT PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To he completed by Applicant: Building Site Location: LC 6 T i Qd 1„)vS\- coc J- - \\L-\,/t °D U 13 Proposed Improvement: k k5\ Ca(C,cA(' w1 �, ►'Jf'A Y OC- VA 'Uv 1 d'jv \ \1 tiA ee, Y v 1n en Applicant: 1L ! i -e \),N k ` Tel. No.:�C Cl 7, -2)Lc 2 1� Address:1 f ) T 11( '\ \L.d \Ate 41\4 ,v\o . \ k\ \MN aC U % ')Date Filed: /2//?-7a z- **Ifyou would like e-mail notification of sign off please provide e-mail address: r(k.t f S 0"-N C 7 ; C11'(1' l •Cr\°1 J Owner Name: Kv1-1 i e ?Cky Owner Address:(,!%I ( It\- V_a Owner Tel. No.:566 ?CIL =- J �e 3 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, and septic system location; 2.) Floor plan Iabeling ALL rooms within building (all existing and proposed) — Note: Floor plans not required for decks, sheds, windows, roofing; (3.) If necessary, Title 5 application signed by licensed installer with fee. REVIEWED BY: t4 DATE: 1f) PLEASE NOTE COMMENTS/CONDITIONS: ,UU S J t Q vv. CEC 12 ZOZZ #, #9 163 259 O #5 °-9 #11 41 Bedroom #4 F2*ireplace Living Room #7 / I / S airs #39 to 163 g b sement #16 138 / I \ 11. I 18 #35 108 Et Full Bath Kitchen Dining I • V N #3 #18 301 135 _X ►J-n f PI 6 3 7 r F #1 163 #9 259 #30 #26 120 136 Garage Door Np NI' \ \ I 41 Bed#1 Bed#2 al#7;� Living Room RR _ #7_ 34 -4t +29 �N s` —43 e I i Lc:Mt #32 "ng #25 Garage ;3 82— � 136 !Av #13 ) L 16 t g: u Kitchen ,as Bed#3 m p Dining „a pN "'m Full Bath °° /a i i N. �� #3 #14 #18 #21 #23 163 138 135 109 136 DEC 1 2 2022 l_ 4L ic _#27 #24 111 139 116 ^n \ / !V It v ,9e fki 8 co ng 80 46 Z9 WIQr 9Z# ZZ# I : a / CO #19 #10 #31 / 82 36 99 / I \ "o �@ 99 in 8 Z1 0) 1 C m :C_ teR _it O u E #17 _#15 14 28 8 \ l 7 aaR CC C .> -.1 C Len 12 a— U ae— Y #4 #8 _ 32 39 , 1� 83 '° - / I 1�'\ #36 84 1 4 .m t..24) 171/2 m ac u tO _) 8 m N R� C..-1CO I- LL C.-4 CNJ N 1...0 ILL 49 (_y LC# Z# t` N. Parr Building&Remodeling LLC 19 Wayside Drive West Harwich, MA 02671 US (774)810-0148 parrdesignbuild@gmail.com Estimate ADDRESS ESTIMATE# 1183 Paul Richie DATE 05/25/2021 63 Taft Road West Yarmouth, Ma 02673 DATE ACTIVITY DESCRIPTION QTY RATE AMOUNT Permitting Submit plans and necessary 1 600.00 600.00 documentation to town for permit application Dust Mitigation/Floor Material and instillation of dust 1 200.00 200.00 Protection protection at kitchen Demolition Demo existing garage space per 1 1,800.00 1,800.00 proposed plans Foundation 1 0.00 0.00 Framing Frame proposed garage 1 12,500.00 12,500.00 conversion to full bath and bedroom per code Windows Furnish and install three Marvin 1 3,200.00 3,200.00 double-hung windows (specs to match existing) Exterior Door Furnish and install 3068 1 1,500.00 1,500.00 fiberglass door and hardware at gable Steps Frame and install 2x8 pressure 1 600.00 600.00 treated step with 5/4 x 6 pressure treated decking at gable entry Siding -Install clapboard siding at front 1 3,041.00 3,041.00 elevation to match existing -Install cedar shingles at previous openings and weaved in where necessary -Install exterior vapor barrier, flashings and pvc trims at windows and doors Electrical Electrical Allowance to upgrade 1 7,500.00 7,500.00 service, provide switches, receptacles , bath fan, plugs and lighting at proposed addition (specifications TBD) HVAC HVAC to be done by others 1 0.00 0.00 Parr Building&Remodeling LLC • DATE ACTIVITY DESCRIPTION QTY RATE AMOUNT Plumbing Allowance to provide rough to 1 5,200.00 5,200.00 finish plumbing at proposed bathroom Plumbing -Plumbing supply allowance 1 1,800.00 1,800.00 -Sterling Accord (72260100-0) 48"Vikrel white shower -Refinia whidespread Lay -Refinia shower trim -Universal Rite-Temp Valve kit -Cimarron CH EB 128 Rev 360 2-pc toilet -White bravia toilet seat Insulation -Closed cell foam insulate 1 4,200.00 4,200.00 foundation floor walls -Fiberglass Batt insulation at wall cavities -Fiberglass batt insulation at ceiling Sheetrock -Hang whiteboard at common 1 5,500.00 5,500.00 space and moisture resistant at bath -Tape and mud three coats -Prime walls and ceilings Attic Staircase Install attic pull down staircase 1 1,350.00 1,350.00 and provide insulated case Flooring Furnish and install Coretec 1 6,000.00 6,000.00 Grande XL Premium Granden Vista Oak 9"flooring throughout kitchen, hall, bedroom and bath Interior Doors Furnish and install 4 interior 1 1,800.00 1,800.00 solid core doors and hardware Interior Trim -Install 2.25 colonial casing at 1 1,750.00 1,750.00 doors and windows -Install 4.25 speed base baseboard throughout proposed space -Install single shelve and closet pole at bedroom closets -Install 3 shelves at bath closet Interior Finishes -Install bath vanity and hardware 1 500.00 500.00 -Install single towel bar, tp holder and towel ring -Install bath mirror Paint Paint walls and interior mill work 1 3,500.00 3,500.00 Waste Removal Provide roll-off dumpster and 1 1,200.00 1,200.00 remove waste for duration of project Supervision Meet with sub contractors, 1 1,800.00 1,800.00 project management costs TOTAL $65,541 .00 Parr Building&Remodeling LLC Shaw Woodworking, Inc 31 Jonathan Bourne Drive, Unit#6 Pocasset, Ma 02559 508-563-1242 1/2612021 Room 1 Not To Scale 06 234 3'4 30 3,4 _ 1 'al :2 4o m u CEO 11n M 4 i3 A 38 El it as El EMI CI ` 0980 ® ® 11n I�N ® 0 ©' 0 ® " is ® ® 1 1/2 K1 198 i r j Shaw Woodworking, Inc 31 Jonathan Bourne Drive, Unit #6 Pocasset, Ma 02559 508-563-1242 1/26/2021 Room 1 - Wall 1 Not To Scale 2 2 1 1/2 3/4 3/4 13114 43114 ---. . 25 x 30 >. 25— ir 111111111119=11111111 33 IT : mF ' ,.. i 87 y �• 87 11/2 ... ._: ,......„..,:.. _ _--- ./ I Knife[Rock V'' • al • li ard 34112 ir' MI Ili! , r 4-241/4 x 24 sa -36—__..----.4--22 x 8-..,,- ---30------►r-8-►'-191/4-7.< ► 11r2 Canister pullout Spice Pullout 1 c -198_- __-_ .__.____—__. _-_ ► Shaw Woodworking, Inc 31 Jonathan Bourne Drive, Unit #6 Pocasset, Ma 02559 508-563-1242 1/26/2021 Room 1 - Wall 3 Not To Scale F-11 3/4---* 3/4 ,______ __.__471.2 -. _.-.. ._ n _- - 24 r 33 33 87 7 1e 87 1 1/2 li II Lernans 34 1 n• • Blind Corner 34112 I. 1 e 471/2 s' 24 s 3/4 --11 3/4-s 84 N. 1 r Shaw Woodworking, Inc 31 Jonathan Bourne Drive, Unit#6 Pocasset, Ma 02559 508-563-1242 1/26/2021 Room 1 - Wall 6 Not To Scale 4 — 891/2 _. _...._—y 1 1/2 4--30 3/4 ,4 40 at 71 1n m 33 ? i,. , 33 ' ``F r , 87 '.A A 87 _ 87 -y--- ----"- 1 in I ,,8 71 r 87 1 L RASTYndKGprprisr41- � fir. 341/2 Nia: S _ = ---303/4 > 4--1. as !1/4 -,*---241/4—* 3/4 112 < 891n > < 234 , -fz:; i 1— (t ` � . g 3 _.-7------ =-----:------......... ..._____ : , . -,k ... •. ,. , , , v. s 7_ w S ‘ i: , s, t-t a'. ...... 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