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HomeMy WebLinkAboutBLD-23-003202 pt iz 2-0, ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department 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: ,130..),3 4b32b�, J Date Applied: C E I V E o I) , -9hs .�' " 1e 14-J nc . .__ .�,y_ _ Building Official(Print Name) Signature Da�EC 0 d 2022 SECTION 1:SITE INFORMATION Li Property ddress: BUILDING DEPARTMENT c 7 s�� / / ?_, 1.2 Assessorrss Map&Parcel Numbers/ °y _ 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards I Rear Yard Required I Provided Required Provided Required Provided _ — 1.6 Water Supply:(IvM.G.L c.40,§54) 1.7 Flood Zone Information.' 1.8 Sewage Disposal System: Public L' . Private❑ Zone: __� Outside Flood Zone? Check if yeses Municipal❑ On site disposal system -L, SECTION 2: PROPERTY OWNERSHIP' 2.1 erl of R d: /-1/4-v1 Lo I)t XIV— /444/1-44 , Mil-- Name(Print) ' City,State,ZIP �7/ €ke-4 - '' =72/l'r? it/ 0137444.4a e.614 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction 0 Existing Building 0 I Owner-Occupied 0 I Repairs(s) 0 Alteration(s)A, I Addition 0 Demolition 0 Accessory Bldg. 0 I Number of Units / Other 0 Specify: Brief Description of Pr osed Work2: /A/j'&�A- f , ye. � fP7ce ev-r4 cfr/s id ‘4-r coy?" r, 5 . 44e0— SECTION 4:ESTIMATED CONSTRUCTION COSTS. Item Estimated Costs: (Labor and Materials) Official Use Only I.Building $ 15 v v 1. Building Permit Fee:S I S0 _Indicate how fee is determined: 2.Electrical $ Pg Standard City/Town Application Fee aGdU 0 Total Project Cost3(Item 6)x multiplier . x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: j5.00 C 020 5.Mechanical (Fire • Suppression) $ Total All Fees:$ A 6.Total Project Cost: $ Check No. Check Amount: Cash IA 0 Paid in Full 41 Outstanding Balance e: l i 1L (!i 1IWIT- SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) Name of CSL Holder J `--- License Number Expiration Date r2 9 9 I%4•/�`J�, y„? List CSL Type(see below) [) No.and Str t /�rrr/// Type 1 Description Ci CS l 7"'! /�( ` e2d� U Unrestricted(Buildings up to 35,000 Cu.ft.)ty/Town,State,ZIP R I Restricted lea Family Dwelling M Masonry ..• RC 1 Roofing Covering WS Window and Siding l>? t/ Yt ��-�y SF Solid Fuel Burning Appliances Telephone 1 ' $r`,/XJnecei''�• I Insulation Email address D 1 Demolition 5.2 Registered Home Improvement Contractor CHIC) FUC an N e r HI 1st t Name HIC Registration Number Expiration Date No. d eel jJ �l/q— "2 6 7 �7 �" r '�/ � f.�lf�f'I. 5 �•ri- i / ,� Email address City/Town, State,ZIP ✓ .Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT O.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 A 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. 4-0--, Aillettl-{ y-Iafetl�a f,in a matters relative to work authorized by this building permit application. Print ues s Name(Electronic Signature) /e+ D p -?? 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: I. An Owner who obtains a building pe rmit rmit 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.sov/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) Number of fireplaces Habitable room count Number of bathrooms Number of bedrooms Type of heating system Number of half/baths Type of cooling system Number of decks/porches Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" The Commonwealth of Massachusetts Department oflndustrialAccidents rem I Congress Street, Suite 100 ilijir r` Boston,MA 02114-2017 Y.�' www mass aov/dia we b Workers' Compensation Insurance Affidavit:Builders/Contractors/El earl cians/Plumbers. TO BE FILED WITH TIlE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): 1147 , ,/40n Address: 02q Cj 4j A r1 , P" -= City/State/Zip: 3 X�V4 /j'1 . 026G,/ Phone#: ..-77/ e:77'02-77 Are you an employer? Check the appropriate box: Type of project jest(required): l.ig am a employer with / employees(full and/or part-time).* 7. ❑New construction 2.1=I 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. I am a homeowner doingall work myself t 9• CI Demolition ❑ y [No workers'pomp.insurance required.] 10 ❑Building addition 40 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 II.C 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 li.❑Roof repairs These sub-contractors have employees and have workers'comp. insurance.I 6.0 We are a corporation and its officers have exercised their right of exemption per MOL e. 14•❑Other • 152,§1(.1),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. 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 ens an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: 4 /4I /Maf'4— Policy#or Self-ins.Lic.#: 44' _ AO-703 41(70C- 4 Expiration Date: 3- 1 Z_ "`"2' Job Site Address: 627, c' '�'' City/State/Zip: -1-*/ Attach a copy of the workers' compensation policy declaration page(showing the policy number aria 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 p "" s and penalties of perjury that the information provided above is true and correct. Signature: 114 111�c(%v`—' Date: /a--1`"" .— ` )/ �? ?- 7 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 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 o2 ?(' t9 , ` Work Address Is to be disposed of oat the following location: /4 / 7/?l Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. /�--ft- Si ture of Application Date Permit No. Office of ConsumerAffairs and Business Regulation 1000 Washington Street-Suite 710 Boston,Massachusetts 02118 Home Improvement Contractor Registration Type: LLC M J NARDONE CARPENTRY LLC. Regislrason: 135887 299 WHITES PATH Expiration: 08I7412022 SOUTH YARMOUTH,MA 02664 , Update Address and Return Card. office of Consumer:Nabs li Business Regulation HOME IMPROVEMENT CONTRACTOR Reglatradan valid for individual use only TYPE:LLC before the expiration date.IEfaund return to: Rauletailee Exolratian Once of ConsumerAffairs and Business Regulation 135887 0811412022 1800 Washington Street-Suite Tin JNAROONE CARPENTRY LLC. Boston,MA 02118 CHAEL J.NARDONE 9 WHITES PATH .xo'41 " )UTH YARMOUTH,MA 02664 Undersecielary Not id Without signature Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Cons 48;%iS' rvisor CS-081139 � t Y�pires:09/16/202; MICHAEL J tstAR 299 WHITES PATH : O SOUTH YARI UTH` 64 e SSFI.1�Z1 �/ ;t Commissioner c i E K. di:Y TOWN OF YARMOUTH eir '- , 9 HEALTH DEPARTMENT iv- PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To he completed by Applicant: 'Building Site Location: r>2r7 / c#,(04,c /_ Proposed Improvement: //fr,S A ,le.,- — S4,-,_/ - -4-/'�v-4,- -5'/ r ' ,• UG)dr ti/Y J-, G k x_1 ( '/dd ) rm 51 ,-4/0°. Applicant: IIIiyAA d 1 Tel. No.: C� A-s 1 > / , Date Filed: !?-5'— z� Address: `.�Cl GI 4117, > **If you would like e-mail notification of sign off,please provide e-mail address: C Owner Name: ,Awg// 617i/r1),-- Owner Address:_ ©)12 / �--�,e / / A Owner Tel. No.: _7N 9 27 RESIDENTIAL AND/OR COMMERCIAL BUILDING I LTH 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 labeling 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 w_ ith fee. (?.... /7"-- REVIEWED BY: :_/ DATE: I �' 2_2-' PL ASE NOTE COMMENTS/CONDITIONS: •N1 1"-r-) he (..)c-re.P c a.4-- ('- ,e,ci.\./a c"-A." — J.2 c-IA i ? L-i> SUS . a. , 4,k 9 A-19 C.IVC-) ' .--1. ,