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HomeMy WebLinkAboutBLD-23-002271 ONE &TWO FAMILY ONLY-BUILDING PERMIT Town of Yarmouth Building Department r 1146 Route 28,South Yarmouth,MA 02664-4492 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: ('J L D—2 3 -0,2, / I Date Applied: IIr• c2Acs \\-\'ate Building Official(Print Name) ignature Date SECTION 1:SITE INFORMATION R E QE 1 V E 9 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers �Q22 74 White Cedar Point,West Yarmouth 9 6 \-- OCT 2 6 Li a Is this an accepted street?yes V no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: BU LDING DEPARTMENT R87 " 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? Municipal❑ On site disposal system Igi Public 0 PrivateCheck if yesl7 SECTION 2: PROPERTY OWNERSHIP! 2.1 Owner'of Record:Phipps Cape Cod LLC Tallahassee,FL 32312 Name(Print) City,State,ZIP 4300 North Meridian Road 850-264-6318 keeganlindsey81@yahoo.com No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WOBIC (check,all that apply) New Construction❑ I Existing Building Cl Owner-Occupied 0 I Repairs(s) 0 Alteration(s) El I Addition 0 Demolition 15/I Accessory Bldg.0 Number of Units 1 Other 0 Specify: Brief Description of Proposed Work2: Demo existing garage and foundation 19 -0 Lr p/di[AA SECTION 4:ESTIMATED CONSTRUCTION COSTS. . Estimated Costs: Official Use Only Item (Labor and Materials) $ 10,000 1. Building Permit Fee:$qD,Q1)Indicate how fee is determined: I.Building ❑Standard City/Town Application Fee 2.Electrical $ 3,000 Cl Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List e 2-c • 5.Mechanical (Fire $ Total All Fees:$ Suppression) Check No. Check Amount Cash Amount:, 6.Total Project Cost: $ 13,000 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES� � 5.1 C nstrnctlon Supervisor License(CSL) —e�---I�/ l D'i g` 0 3 /nn A K '0&O SI AA/ License Number Expiration Date f 'Name of CSL Holder c.3ly 7 /�1Am( ,TrR r List CSL Type(see below) vV No.and Set Type Description f k/vt o V T 1 /4//,L &25 q T.! Uttrestr(txed( ulldints up to 35.000 cu.tt) R Restricted lde2 Family Dwelling City/Town,State,ZIP f M Masonry RC Roofing Covering . WS Window and Siding . r/7 a�s I .� 4 1nnr fiIlaivcji SF Solid Fitel%� i Burning Appliances Telephone Email ress C'M'j D_ , Demolition 5.2 Registered Home Improvement Contractor�IC) / 7 3 /0./7,2 3 4 0/V 0 -GL 0 Ut/ 1 E 37 6A/ /�U/� HIC/R�stration Number Expiration Date . HIC Company or HIC,.�,e�'tarrant Name ' C b7 Aei4/VT / e4 -Vv"'_�..... dABU /iM DES 6 77 ".c5 70y l address ty own,State,VP Teiephon 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 issuanc of the building permit _ Signed Affidavit Attached? Yes 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_6% 441\`'')-21k r� to my be in all rs r lative to work authorized by this butEding pehait ap lic 'ou. ~ �� 10/12/2022 "D ' Print r' Name(i !chronic Signature) Date • SECTION lb:OWNERt OR AUTHORIZED AGENT DECLARATION By entering my nu a below,I hereby attest under the pains and penalties of perjury that all of the information co ' ed in this 'cation is true and accurate to the best of my knowledge and understanding. Print 's Au ized Agent's Name(Electronic Signature) e NOTES: ` I. 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 wider M.G.L.c.142A.Other important information on the HIC Program can be found at www.tttass.gov/oca information on the Construction Supervisor License can be found at eww.mass.gov/dp 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 halflbatbs 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" ACORCP CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 09/29/2022 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 CONTACT Charlie Downey Downey Insurance Agency,Inc. PHONE EA: (508)485-0130 FAX No): (508)485-6463 190 East Main St. ADDRESS: chartie@downeyinsurance.com INSURERS)AFFORDING COVERAGE NAIC# Marlborough MA 01752 INSURER A: EVANSTON INSURANCE COMPANY INSURED INSURERS: COMMERCE INS CO 34754 Longfellow Design Build in INSURER C: NATIONAL LIABILITY&FIRE INSURANCE 866 Main St INSURER D: INSURER E: Osterville MA 02655 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 TYPE OF INSURANCE INSODDL WVD SUER POUCY NUMBER (M LICY EFF POLICY EXP LTR INSD /DDIYYYY1 (MM/DD/YYYYI LIMITS X COMMERCIAL GENERAL UABIUTY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 300 000 CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 A 4919321-1 09/27/2022 09/27/2023 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO-T LOC PRODUCTS-COMP/OPAGG $ 2,000,000 JEC OTHER: AUTOMOBILE LIABILITY (Es accadeernitSINGLE LIMIT $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ 20,000 OWNED SCHEDULED RWL621 08/19/2022 08/19/2023 BODILY INJURY(Per accident) $ 40,000 B AUTOS ONLY X AUTOS X HIRED X AUUT S ONLDY PROPERTY DAMAGE $ AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER ERH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N N/A V9WC380892 09/27/2022 09/27/2023 E.L.EACH ACCIDENT $ 100,000 C (MandatoryaR/MEMNH)EXCLUDED? N E.L.DISEASE-EA EMPLOYEE$ 100,000 In NH) If yes,desaibe under E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS i LOCATIONS/VEHICLES(ACORD 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 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Yarmouth 1146 Route 28 AUTHORIZED REPRESENTATIVE South Yarmouth MA 02664 c : ... —©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD •) e (il'/2//»1'///fYIK%:1' C/.. / CIJJ/ll1111JC>f/i Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02 118 Home Improvement Contractor Registration Type: Corporation Registration: 176959 LONGFELLOW DESIGN BUILD,INC. Expiration: 10/17/2023 866 MAIN STREET OSTERVILLE,MA 02655 Update Address and Return Card. SCA 1 C, 200.1-05i17 ✓/iiY i/i//ii•i if/f/,. //;ri-ire/)/i/-ii// Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Corporation before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 176959 10/17/2023 1000 Washington Street -Suite 710 LONGFELLOW DESIGN BUILD,INC. Boston,MA 02118 MARK BOGOSIAN r , 866 MAIN STREET Not valid without signature OSTERVILLE,MA 02655 Undersecretary CommonWealth of Massachusetts Division of Occupational Licensure Board of Building Regulations and Standards r Constctit4ton Supervisor CS-106114 pires: 10118/2023 MARK R SI 367 MAIN STi = FALMOUTH ip `. ~' � 1 f g: !'' x;r Commissioner :11. .:A. +_r ONE or TWO FAMILY-- BULDING PERMIT APPLICATION REGULATORY APPROVALS NOTICE 74 Wite Cedar Point,West Yarmouth,MA Address of Proposed Work: Scope of Proposed Work: Demo existing garage and foundation Date: 10/20/2022 Based on the scope of work described above,the applicant is required to obtain approval sign- offs from the following departments as checked-of below: Health Dept.—508-398-2231 ext. 1241 Conservation—508-398-2231 ext. 1288 Water Dept.—99 Buck Island Road, 508-771-7921 Old Kings HWY. Hist. Comm. —508-398-22631 ext. 1292 Engineering Dept.—508-398-2231 ext. 1250 Fire Dept.—Kevin Huck/Scott Smith, 96 Old Main Street, SY Note:Please call Fire Department for an appointment. 508-398-2212 Other Appropriate plans and/or application shall be provided to each departments checked-off above. Each of these regulatory authorities has their own requirements outside the jurisdiction of the Building Department. All applicable approvals shall be obtained prior to submitting a building permit application to the Building Dept. Thank you for your cooperation. Receipt Acknowledgement: 24// _ gora'�� 10/20/2022 Applicant's S/Signature Date Rev.Jan. 2019 The Commonwealth of Massachusetts } Department of Industrial Accidents ittl 1 Congress Street,Suite 100 =' {=_ Boston,MA 02114-2017 „=4 ' www.mass.g,ov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Annlicant Information Please Print Legibly Name(Business/Organization/Individual): Longfellow Design Build Address: 367 Main Street City/State/Zip: Falmouth,MA 02540 Phone#: 774-255-1709 Are you an employer?Check the appropriate box: Type of project(required): am a employer with 38 employees(full and/or part-time).* 7.Wkilew construction Q t am a sole proprietor or partnership and have no employees working for me in 8. E3 Re odeling • any capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. emolition 10 Q Building addition 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 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 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.0 We are a corporation and its officers have exercised their right of exemption per MIGL 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 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:_ Downey Insurance Agency Policy#or Self-ins.Lic.#: V9WC380892 Expiration Date: 9/27/2023 Job Site Address: 74 White Cedar Point City/State/Zip: West Yarmouth,MA 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 Signature: thr Date: 10/20/2022 Phone#: 774-255-1709 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 508-398-223t1 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 74 White Cedar Point,West Yarmouth Work Address Is to be disposed of oat the following location: CL Noonan- 436 West Street,W.Bridgewater,MA Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. 71 thrt a-a- 10/20/2022 Signature of Application Date Permit No. TOWN OF YARMOUTH Y -1 1146 ROUTE 28,SOUTH YARMOUTH,MASSACHUSETTS 02664-4451 } ,,, Telephone(508)398-2231 Ext. 1292 Fax(508)398-0836 HISTORICAL COMMITTEE MEMORANDUM TO: Mark Grylls,Building Commissioner FROM: Lisa Sherman,Office Administrator, Yarmouth Historical Commission DATE: July 20,2022 SUBJECT: 74 White Cedar Road—Demolition Request On July 20, 2022 The Yarmouth Historical Commission assembled and considered the above referenced property due to a request to demolish. The intended purpose of the total demolition is to enable construction of a new house. A Notice of Intent to Demolish A Historic Building form was filed with the Yarmouth Historical Commission on July 7, 2022 by Longfellow Design Build on behalf of Phipps Cape Cod LLC,the owner of the property. This application was considered by the Yarmouth Historical Commission at their meeting on July 20, 2022. While noting that the house is over 75 years old and is located in an historic area, the Commission agreed unanimously that the structure is not architecturally or historically significant. A demolition delay will not be imposed; accordingly,the applicant can proceed with demolition. Please let me know if you have any questions. Cc: Yarmouth Historic Commission James Bustamante,Longfellow Design Build Karen Northam,Longfellow Design Build E E 1 E Eversource Energy 111, 247 Station Dr,Westwood,Massachusetts 02090-9230 ENERGY October 3,2022 Colin S Phipps 4300 N Meridian Rd. Tallahassee, FL 32312 RE: 74 Cedar Point Rd.,W. Yarmouth, MA 02673 To Whom It May Concern: At Eversource,we're committed to delivering great service. This letter serves as confirmation that, as of September 30, 2022 the electric service to above addresses has been removed. Based on this information,there is no electric power at this address. If you have any questions,please contact me at(888)633-3797 Sincerely, ColLee v Maga vi. Colleen Magan Electric Services Support Center Eversource Energy wondershare PDFelement October 5, 2022 Phipps Cape Cod LLC Attn: Keegan and Lindsey Phipps 4300 North Meridian Road Tallahassee, FL 32312 VIA EMAIL: keeganlindsev81@vahoo.com Dear Lindsey, Please allow this letter to confirm that the Great Island Architectural Review Committee and Board has approved your plan dated September 1, 2022 to build a new construction at 74 White Cedar Road. Please note that the ARC will need to approve any changes/modifications should they occur to the siting, exterior, landscaping, etc. during construction. Thank you, and please let us know if you have any questions. Sincerely, 6116.41 . Craig Fleminn General Manager Great Island Homeowners' Association Great Island Homeowners'Association 1100 Great Island Road West Yarmouth, MA 02673