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HomeMy WebLinkAboutBLD-23-00499 ____, _____ _ _____------------__ , ,.,,_,,_,,,. ,.,,J.,,_/,,-- , fa A-ctez. ___ A-0A-- .. i , qicy_klmorv1/4- 1- I,_ 1 i al 5� t 1 • , . . ‘.:-,) ,. _ . . • • . , ,._._. ---,ff.: _-.'-: A1-40-‘ ---e,A1Avast•K- Z----- ................._—_—____ it / ________0 .),,,:ttilis,,Nor i 0 M C '--w---L713------Hc:cd c' Lc).) AWL- ep ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department 1146 Route 28, South Yarmouth,MA 02664-4492 Wilk; 508-398-2231 ext. 1261 Fax 508-398-0836 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 Building Permit Number: BUL3- V Date Applied: I,in zAt-5 Li-q-k3 Building Official(Print Name) grature Date SECTION 1:SITE INFORMATION 1.1 Property A dress;' j 1.2 Assessors Map&Parcel Numbers__ r ttIM k W nldfi t� 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Z nin Information: 1.4 P perty Dimensions: rep t -vim .66 AC OS 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 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Public Private 0 Check if yes6Y Municipal 0 On site disposal system 4l - SECTION 2: PROPERTY OWNERSHIP' 2.1 wne 'ofRecUvLAJ ( iPJ C *'s4a ^ SCLcf , -t-4 O(C 3 Name(Print) City,State,ZIP igl Alt 1Si(dk4- ,5h' -f L1I3'`19,3 "I 11 -i i iiroLL4 U Eyt1lL '(Cl/ No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction❑ Existing Building It-'"Owner-Occupied il-" Repairs(s) 0 Alteration(s) ' Addition 0 Demolition Cl Accessory Bldg.. 0 l Number of Units i Other 0 Specify: Brief Description of Proposed Work2: 11(t.Lid.. r • . 0 b giitnv (U‘ -}-{.,L 16 k SECTION 4: ESTIMATED CONSTRUCTION COSTS. Item Estimated Costs: Official Use Only (Labor and Materials) • 1. Building $ lC l G'eL 1. Building Permit Fee:S KO Indicate how fee is determined: 2.Electrical $ Ili Standard City/Town Application Fee �� Cl Total Project Cost3(Item 6 x multiplier x 3.Plumbing $ ( (� 2. Other Fees: $ 3S0 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ • Suppression) Total All Fees:$ C�ze �� Cash Amount: 6.Total Project Cost: $ ge• 6 � ` Pa' .� _ ■ st• ding Balance Due: I MAR 10 2023 MNGDEPT i T By' ---- _r ti • ; f SECTION 5: CONSTRUCTION SERVICES 5.1 }- �?Construction Supervisor License(CSL) C S--o'� C,0 iVIV M 013 c�.„r�e tJ esl Yll License Number Expiration Date Name of CSL Holder F ed P ( o., List CSL Type(see below) No.and Street Type Description SPr'of‘ f M OklOS U Unrestricted(Buildings up to 35,000 cu.ft.) City/Town,State,Z R Restricted 1&2 Family Dwelling M Ivlasonry RC Roofing Covering WS Window and Siding 315�7� �t �� c SF SolInsuldation Fuetion Bumin;Appliances �( J �/ �""' Q' c-O'"` Insulation Telephone Email address D I Demolition 5.2 Registered Home Improvement Contractor(HIC) MC Company Name or HIC Registrant Name HIC Registration Number Expiration Date No.and StreetiY‘°+ p r9-V A /A�lo CU ITV "� Emai dress City/Town, State,ZIP Telephone &1 '✓ p 1-S?, 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 ❑ 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 e ing my name bel ,I hereby attest under the pains and penalties of perjury that all of the information co sine in this appli do is and accurate to the best of my knowledge and understanding. tilt) (ati , l7/ Pr' er'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 CHIC)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 jr 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" . . . . . , • • . • ' . _ - . . . . . _ , . . , . . . . - „ . . . .• •- . . , . . . . , , s.t• . \ _ . , . _ • _ . • — _ . . • . . . ,.• . . , . . "% The Common wealth of Massachusetts L Department of Industrial Accidents 1 Congress Street, Suite 100 i{r,, �l Boston, MA 02114-2017 `�ar„� •''•y www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information P se Print egibl 1..4,(. .., „ -f (t � Y N32Tie (Business/Organization/Individual): 5(t V s G(F f y� 4lJLkr G , `F+'1 '- _- ..,.ate.. /� /� r /J -- Address: • ;:__._-. s 0M , �©` 1" afl� V �J 7 IAu ni 1� City/StateZip: ��1 �,1 G1-s / _� Phone #: 4g " ( ' �(i 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. ❑Rem construction Q?. I am a sole proprietor or partnership and have no employees working for me in ,L•.,J�/ an capacity. [No workers'comp. insurance required.] 8. Remodeling 3. am a homeowner doing all work myself.(No workers'comp. insurance required.]t 9. C Demolition 4.1: myProPertY•I am a homeowner and will be hiring contractors to conduct all work on I will 10 Q Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.Q 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 Q Plumbing repairs or additions These sub-contractors have employees and have workers'comp. insurance.t 13.E Roof repairs 6.11 We are a corporation and its officers have exercised their right of exemption per,MGL c. 14.Q Other 152,§I(4),and we have no employees. (No workers'comp. insurance required.] *Any applicant that checks box Ail 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: 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 verifi .n. I do hereby Bert' under the pa'is an!pen, - of perjury that the information provided above is true and correct. 401 Signature: L1L .,' �� Date: Zf Phone#: y/J ' QcJ3 ' VOr' 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 CIerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: } _ - • III br TOWN OF YARNIOUTH _ BUILDING DEPARTMENT ��,�4 ^ � s`` °� 1146 Route 28, South Yarmouth, MA 02664 S08-398-2231 ext. 1261 c. �L HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE: 4tL* W(IJOB LOCATION: �) V\ �� (S yGt � `"4 .Mn1� ikr o--ET 3 `S�;` 7Imo` ON OF TOWN "HOMEOWNER" l17 E C NAKE OME PHONE AL.Aff..K PHONE PRESENT MAILING ADDRESS "rpZ l� al G'` S - S 0 -V 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 an uirements n that he / she will comply with said procedures and requirements. HOMEOWNER"S SIGNATURE APPROVAL OF BUILDING O14/41CIAL INSURANCE COVERAGE: I have a cu - • '`!:.ility insurance policy or its substantial equivalent, which meets the requirements of MGL Ch.142. No If you have ►•- ed ves,please indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of indemnity Bond R'S S E WAIVER: I am aware that the licensee does not have the insurance coverage required by ter 1 of t ss. General Laws and that my signature on this permit application waives this requirement. _Ch clf ne: Signature of Owner or Owner's Agent C Owner Agent h:homeownrlicexernp §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. 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 Lgq (3( (6A kd , ,Secs Work Address Is to be disposed of oat the following location: lit‘ PPtikaA-' l. d6- id Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. , 50A. 67t_ 37i12-_g Signature of Application Date Permit No. .1 Vr1111IV11WCasU I VI 11110DJab11UDCUS , Division of Professional Licensure Board of Building Regulations and Standards ConsEU t'il Eilt llpprvisor I CS-076047 R 1 r tfpires:04/16/2023 MATTHEW D CAMPAGRARI r 128 FEDERAL`STREET;' SPRINGFIELOAA 01105 .% r` ! v(-)i54".1 t(-)Z1` Commissioner 'CAA f. DIF tha, THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street-Suite 710 Boston, Massachusetts;02118 Home Improvement ntractor Registration I Iw s � Type: indlvWttal MATTHEW CAMPAGNARI F{eBis$atbn. 167628 128 FEDERAL ST r--F • Fickiratlon: 10/14/2024 SPRINGFIELD,MA 01105 ._ Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for Individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPEi"Indi4idual Office of Consumer Affairs and Business Regulation Registratlart '';'Expiration 1000 Washington Street .Suite 710 167628 10/14/2024 Boston,MA 02118 MATTHEW CAMPAGNARI MATTHEW CAMPAGNARI , 128 FEDERAL ST ,r,n.g 4,4• SPRINGFIELD,MA 01105 Undersecretary Not valid without signature 3/20/23, 10:51 AM Mail-Sears,Tim-Outlook 40 Wilfin Sears, Tim <tsears@yarmouth.ma.us> Mon 3/20/2023 10:51 AM To:erincouture@yahoo.com <erincouture@yahoo.com> Erin, I have reviewed your application and there are some items needed. 1. Your address is listed as Southhampton and is a rental. You do not qualify as a homeowner under the building code and will need a licensed contractor to apply for the permit Section 110.R5 Definitions. Homeowner. Person(s) who owns a parcel of land on with he or she resides or intends to reside, on which there is, or is intended to be, a one-or-two family dwelling, attached or detached structures accessory 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. 2. This property is in a flood zone. Attached is a packet to review, we need the cost worksheet filled out along with the contractor and owners affidavits notarized and returned. The final affidavit will be required at the time of final inspection. 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 iMDQxLWNkMGQyNmE4NzE5NAAQAA11 N71v8pIMtOLwPObE... 1/1 oog' TOWN OF 3'AI�I�I®UT '� �1°' BUILDING DEPARTMENT �AnA R5_ 1146 Route 28, South Yarmouth, MA 02664 \Acta', Telephone 508-398-2231 ext. 1261 Fax 508-398-0836 Contractor's Affidavit: Substantial Improvement or Repair of Substantial Damage Property Address: 46 1 --d-- , So,d-L. ytk ccA' .. 1-kil— 0 2LC2‘k4 Parcel ID Number: 0 34, :4-5 Owner's Name: COLi+ s c4,41 "Ac— a r��.���, ,j,�..� Contractor: Contractor's License Number: c7 0 7 �O Date of Contractor's Estimate: 3- 22-- - I hereby attest that I have personally inspected the building located at the above-referenced address by the nature and extent of the work requested by the owner, including all improvements, rehabilitation, remodeling, repairs, additions, and any other form of improvement. At the request of the owner, I have prepared a co5.t estimate for all of the improvement work requested by the owner and the cost estimate includes, at a minimum,the cost elements identified by the Town of Yarmouth that are appropriate for the nature of the work. if the work is repair of damage, I have prepared a cost estimate to repair the building to its pre-dam43ge condition. I acknowledge that if, during the course of construction, the owner requests more work or modification of the work described in the application,that a revised cost estimate must be provided to the Town of Yarmouth, which will re-evaluate its comparison of the cost of work to the market value of the building to determine if the work is substantial improvement. Such re- evaluation may require revision of the permit and may require revision of the permit and may subject the property to additional requirements. I also understand that I am subject to enforcement action and/or fines if inspection of the property reveals that I have made or authorized repairs or improvements that if inspection of the property reveals that I have made or authorized repairs or improvements that, re not included in the description of work and the cost estimate for that work that e sis for issua ce of permit. Contractor's Signature Date: 3_22 . 23 Notarized: SL MARY M SCIMEMI Notary Public 4 //a/y '7)/ rAo-y/9 Commonwealth of Massachusetts V� My Commission Expires ( October 26, 2029 s • 7:°^ TOWN OF YARMOUTH fr( BUILDING DEPARTMENT tfl,, ,, w An.r= 1146 Route 28, South Yarmouth, MA 02664 N. Telephone 508-398-2231 ext. 1261 Fax 508-398-0836 Owner's Affidavit: Substantial Improvement or Repair of Substantial Damage Property Address: ItO 1t lCd. SOJA----YCVAA,0-41 Ws1 32-4-to if Parcel ID Number: V 3-t . 9-9 Owner's Name: 00(1-}1,1,, .K.Gr1}.- (i; 111L11 , Owner's Address/Phone: t*L k�..,12c.0 a,.--\-� ' h jv4 p P,,� cA 3 t {?.. 3• qi }y-' Contractor: LCt± `0 OA U 4 (l it I r Contractor's License Number: es - 0 L)`("~ Date of contractor's Estimate: ' // 3 k I hereby attest that the description included in the permit application for work on the existing building all improvements, rehabilitation, remodeling, repairs, additions, and other forms of improvement. I further attest that I requested the above-identified contractor to prepare a cost estimate for all of the work, including the contractor's overhead and profit. I acknowledge that if, during the course of construction, I decided to add more work or to modify the work described, that the Town of Yarmouth will re-evaluate its comparison of the cost of work to the market value of the building to determine if the work is substantial improvement. Such re- evaluation may require revision of the permit and may subject the property to additional requirements. I also understand that I am subject to enforcement action and/or fines if inspection of the property reveals that I have or authorized repairs or improvements that were not included in the description of work, and the cost estimate for that work that were basis for issuance of a permit. Owner's Signature: - c �, • sio J:e.PRY2�g-fog Date: 3j &2,, - Q ovN; Notarized: • �o `�=I��� o`` T %, �� gRYPv \>,5 •o„','1gSOAC IEU5, �,,, Commonwealth of Massachusetts Hampshire County On this 23rd day of March, 2023,the undersigned notary public, Erin Couture personally appeared, proved to me through satisfactory evidence of identification,which was personal knowledge,to be the person who me is signed on the preceding or attached document in my presence. Notary Public:Julie E. Duffe My Commission Expires: 01/29/2027 Commonwealth of Massachusetts Hampshire County On this 23`d day of March, 2023, the undersigned notary public, Erin Couture personally appeared, proved to me through satisfactory evidence of identification,which was personal knowledge,to be the person whose name is signed on the preceding or attached document in my presence. TOWN OF YARll'IOUTH 1146 Route 28, Sou�t1 Yarn-Louth, MA 02664 508-398-2231 ext. 1261 Fax 508-398-0836 Office of the`Buitdixt Commissioner C FINAL COST AFFIDVIT FOR WORK IN FEMA FLOOD ZONE To the Building Commissioner, In accordance with 780 CMR Section 109 of the Massachusetts State Buildinz Code, the total estimated cost of construction, including all related costs* of the building at ItQ �`\ ,.. Qom., -`6r1,Kv w4,.j __ and constructed,reconstructed, altered,repaired, or extended under building permit no. amounts to $ cb l I, ,r`, 00..1,-) -- ,being referred to as the owner/agent identified below,do solemnly swear that the statements made herein are strictly true, correct and made in good faith *Related construction costs include all work done with or concurrently with the work contemplated by the building pennit including construction, reconstruction, repairs, demolition, HVAC work, etc. Furnishings and portable equipment are not part of the total construction costs. - , y Signature of owner/agent 1, ; \.v .\\\. - x; >r .---4 Notary Public i la ure My Commission Expires Notary Seal: E. p .••.1ssloN .• AN tici) )f i g ♦ *_ V (32� TgRY Pv?' '• O i,.sggCHUs c,,,,,