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HomeMy WebLinkAboutBLD-23-001874 ":" , Of5L\ 4[C-J DocuSign Envelope ID:5DB6BE9C-5476-4C88-8o8E-EFECDDD7228E i q,3- QU\\\ ArV ONE & TWO FAMILY ONLY-BUILDING PERMIT 1 R E C % ! •V E ® Town of Yarmouth Building Department -of y -- 1146 Route 28,South Yarmouth,MA 02664-4492 ' �y -i 508-398 223I ext. 1261 Fax 50$-39$-08,6 • s V C I O z�22 Massachusetts State Building Code;7.80 CivEI. ilk-Mg Per Application To Constt�ucr Repair, Renovate Or Demnolish i BUILDING bEPARTMENT a One-or Two-Family Dwelling IBy' --_....r.,,a in-- -- This Section/For Official Use Only Building Permit Number: ' 2 y-1 Date Applied: auildine Official.(Print Name) Signature Date SEtvTION 1:SITE INFORMATION 1.1 Property Address , 1.2 Assessors Map&Parcel Numbers 3)-PimscatC .:)tt�'d S, (tttrtr�:x�. 143 _ 6 ' 1.la Is this an accepted street?yes / no — Map Number Parcel Number 1.3 Zonm Information: 1.4 Property Ditnen "o s: /t Zoning District Pro d Lis i Lot Ara(sq F) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards j Rear Yard Required j Provided ! Required ` Provider Required- Provided 0, J {. Q.. { . r 1.6 Water Supply: (IM O.L c 40,§5 1.7 Flood`Lone Information. l 1.8 Sewage Disposal System: Zone_ X Outside Flood Zone? Public 82 Private 0 Municipal 0 On site disposal system ® Chcekifycsfl , SECTION 2: PROPERTY OWNERSHIP' i. 2.1 Owner'of Record: Name(Print) CfQ. ,:s-0,h ( CR.m City°.State.ZIP %t te—S.fc t 5=0, 0 ocr- c 7 G78-6 5 fcC:cx14y,cAteeevnr'apt . i No.andStreet Telephone Email Address 1 SECTION 3:DESCRIPTION OF PROPOSED WORK"'(check all that apply) New Construction 0 Existing Building 41 _ Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 , Addition 0 Demolition 0 i Accessory Bldg.0 umber of Units ! Other 0 Specir: Brief Descr'otion of Proposed orl i - mega new " coot -,to tai 0 or3r v4ii e i d,•9 J . SECTION 4:ESTIMATED CONSTRUCTION COSTS itemEstimated Costs: (Labor and Materials) i Official Use Only 1.Building l S 66.00 t,tJ j 1. Building Permit Fee:$15"t) Indicate how fee is determined 0 Standard City/Town Application Fee o Electrical $ 0,00 - t4.7 i -----i 0 Total Project Cost (Item 6)x multiplier x 3.Plumbing 1 S 3 ic1.r j ' 2. Other•Fees! $ 3S Ct(�((OfJ' • 4.Mechanical (HVAC) S i t 0�„Gt1 i List: V 5.Mechanical {Fire $ Suppression) I ! Total All Fees:$ I Check No. Check Amount: Cash t:/ I 6.Total Project Cost: 1 S I(t 700. 00 p Paid in Full 0 Outstanding Balance D : 1)!, 1 — t • la1). l Y DocuSign Envelope ID:5DB68E9C-5476-4C88-808E-EFECDDD7229E f, SECTION S: CONSTRUCTION SERVICES f 5.1 Construction Supervisor License{CSL) ` L/1 .S'rOPHesL 3-. C.44LL,44/ `Li5- 36 of!&S� /�df12.1E2 2 License Number Expiration Date Name of CSL Eloider i. List CSL Type(see below). U ,7 wt4.4 SFiett 57-de&rr No,and Street Type ; Description �'5 A/, O 20. _ ( i Unrestricted(Buildings up to 35.000 cu.ft.)7 R Restricted i�71 amity t�weliing i Cftf�llOwn.Jta<w,ZIP , .. - --.1 M '•. Masonry RC J, Roofing Covering WS I Window and Siding SF j Solid Fuel Burning Appliances 7 / S Sf-14 76 CL, t.5,1.Cow%4 i I Insulation Telephone Email address E j Demolition 5,2 Registered Home Improvement Contractor (IIIC) / e Hit/37"dikielt- 1 FTC Registration Number Expiration Date EEC Company-Name or HIC Registrant t 24. M'4 1 L.D 3-7re err C _c.c ' Q"I SA Cot t No.and Street Email address • City/Town,State,ZIP Telephone 1 I SECTION 6: WORKERS'COMPENSATION EYSURM.NCE 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 o p SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWN'ER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of he subject property,hereby authorize Christopher Callan • ;,e-ettoerf4eld v if,in all matters relative to work authorized by this building permit application. 0,l � \ kiReU�Zt� 9/22/2022 � �1-?-g (Electronic `nature; `• ,Robert C. Healey, Manager, Pine Bass IIY ip,ite SECTION i b:OWNER' OR AUTHORIZED DECLARATION AGENT DECL I ' By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information £ Eont9.. its` application is true and accurate to the best of my knowledge and rnderstanding. F4a9904667634E6.., 9/23/2022 Print O her'sorAuthorizedAgent'sName(ElectronicSignature) Christopher Callan 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)Promam),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.soviocalrformation 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 __f___ Number of bedrooms Number of bathrooms Number of lialibatits [ 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" DocuSign Envelope ID:5DB68E9C-5476-4C88-808E-EFECDDQ7229E :ne commonwealth of 'Massachusetts Department of Accidents ( {= I Congress Street, Suite 1.00 • ~' �'-, Boston,MA 02114-2017 w33'W.inass.gov/dia «orkers' Compensation Insurance Affidavit: Builders!Contractorsi lectricians/Plumbers. TO BE FILED WITH.THE PERMITTI'tiG AUTHORITY. Applicant Information /�� Please Print Legibly Name(Business/Organization/Indlvid':al). C/(.s5 o?ff Address: 1 MSt-162j) 57"kE7' C;tyi'State/Zip:54A4,,j 'vti¢ ozob? Phone 7le1 ' S$—/676 Are you an employer."Check the appropriate host . i ama employer with Type of project(required): e y oy e (full and/or part-time).* - jjI I i� :\'Iew construction an sole proprietor orpartnershipand have no employees working vr die 8 in__Remodeling any-capacity FN.workers'comp.'insura-nce r ui ed,j IL]I am a homecwner going" ;wore myself f. o.ton 01-1 workers'con it insurancerey ". j 9 Demolition'+"[J I ern a honneow;terand will be-hiring contractors.to conduct a i work on my a ope^.. I will t 10 ll1lt�'i addition ensurethat all Cont either er have workers'compensation insurance'or are Sole F J `i propir io s With no ernrito ee i 1! i.�..i Eleccrie2l"re airs or additions: i zr 4aneral.co.tr _tcr oc.I I av hired th sub-contractors I2. Plumbing repairs or additions r actors listed or the attached stee,. These sub-contractors have employees and have workers'comp, insurance.: l Roof repairs 5:0 We a corporation and its officers, I Otherf= rs.7 have exercised t�> right of ocr GT c. 152,§i('i),and we have no employees.(No workers'cop;_insurance requireid.1 11 '"Any-applicant tliat che Is box4i must also fill out thesecttonbelowshowingtheirw ':tcrr..o".vners who submit this affidavit indicating orkers .-or^oensa.ipn policy information. ndi ng they are doingI" ark and then hire outside contactors must submit a ne✓affidavit indicating such. 'Contractors thatthat,check this box must ana;,l-ed an:additional sheet showing the name of.he sub-contractors and state,whether cr not those entities haveemployees. Tithe sub-contractors have employees,they must provide their-workers carp,policy umber. I am an employer that is providing workers'compensation insurance for my erplovees. Below is the policy and job site information, Insurance Company Name: Policy=or Self-ins. Lic.#: Expiration Date: Job Site Address: Ci tv'Stats:'Z ip:. Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under;i'[GL c, I52 25A.is a criminal violation punishable by a fine up to S1,500.00 an for 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 OI this statement may be forwarded to the Office of Investigations of the DR for insurance coverage verification. I do hereby tertif'under t re pains and penalties of perjury that the information proizded above is true and correct. Sii:nature: Date: 5%y 1202 2- .Pitorie 7Fs/ FSS��/ -7 4 Official use only. Do notwrite its this.area; to be completed by city or town official City or Town: Permit/License g Issuing Authority(circle one): I. Board of Health 2. Building Department 3,City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector . 6.Other Contact Person: Phone 4: DocuSign Envelope ID:5DB68E9C-5476-4C88-808E-EFECDDD7229E TOWN OF N, Al-MOUTH 146 Route 28, South Yarmouth, MA 02664 08-398-2231 ext. 1261 Fax 508-3980836 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 resulting from the proposed work/demolition to be conducted at 2-3 2- 17Le45474/T $rizeer Work Address Is to be disposed of at the following location fita.vtod774 1.--4,0 4_ Said disposal site shalt be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. il,Y/2-02-Z Signature of Applicant Date permit No. • DocuSign Envelope ID:5DB68E9C-5476-4C88-808E-EFECDDD7229E 8 r--... •".•.. 6: -:::,-.1 # -......., \...- r,A , -,--1 , tz: ,,_ji,,,,.,,,,\\ r‘i_ ........-1 . . , , ! ' .- ..-- ' . .. : . , --;.. . . ! ..'.1- .•-.,.D 0 3 I , . ): • c--, ' ......, 3 -`',1', (FN. • - — — \I\ — . \ . . c4\ __ 1---. ---!•-•-' 1 • ! . 1'. ._ . . . .. . . . ,ca • ,...,......,.. , , _____d._\ ey _. <-6 .• . ; •I CG „ rd ... . .. . • \ ' . --,... . . :-.... : -->rt \ . r.) . U.1 • .... , - L . , --.--2 c-6.. \ -...... .4- 4TOWNot: '' n OF YARMOUTH ti ,�' r'� HEALTH DEPARTMENT '.'�,o,' PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: � - SBuildin Site Location: c .- - ' t mo—i t _ ( G _43(ti \� ,- , Proposed Improvement: t t tc›D r^ c-•, 01/4 Y•. (A„to 1 t,. ( S a- IC Applicant t)-,.0. C 5 Tel. No.: 7? `t " t /? _,,,r Address: kip t Nc-, t t tj e / S, c;�.,,,t;,c--�Jt.,--�. Date Filed: t O 5.7� l **/f you would like e-mail notification of sign off please provide e-mail address..j �{C� ( S �C C' (7- \ .C-v �� `' Owner Name: -0t [Z c,,�c.0 (c(e;r r4,t> s v\^�6.._ Owner Address: 4 t0 Si tC C` 5 1- (vv f`" Owner Tel. No.: •717 7 '- ,c0S 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 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 with fee. REVIEWED BY: DATE: d ,) ( 4----.• LEASE NOTE COMMENTS/CONDITIONS: Sears, Tim From: Sears, Tim ' Sent: Friday, October 14, 2U22419PK4 To: dcent@nosn.com Subject: 232P|easant St Christopher, � I have reviewed your application and we need a second set of plans submitted. Thank you Timothy Sears CB{) Deputy Building Commissioner Town QfYarmouth 508-398-3231Ext. 1259 mnai|to:tsearoPyarnmouth.nna.us 1 r." VATER DEPARTMENT ,.; BUILDING PERMIT APPLICATION FOR WATER DEPARTMENT SIGN OFF TRANSNIITTAL FORM r •r.„„, BUILDING SITE LOCATION. +- • ( .•(-1...A, PROPOSED \VORK: 0"-"S ‘,,,f1"• , APPLICANT: v— ADDRESS: (:)) (Pj ; • —> TELPII )NE: • / ()- 1 (1, RESIDEN.ILAI AND :OR CONIMER('IALRIAIDIN(i IA wet Deportment Delerontics Compliance of\Vater and ae‘i,inw, location Entinnecrtng Department: Determine,Compliance ttir Parking and I)ramage Con,erkation('tin Determines Compliance taWetlands Act: e If lonst horde,.any type of wet kind,. .Nireanh,pond, rik, s,Oticau,hoes, bwp, inaNhiand, lealth Department !Mei-1)111)e,Compliance to State and Town Regultns, c toquorment, ha Seplage Do,poii-al and other Act i‘oe, hre Depao mem: Deteninne, omphani:e to State and Town Requiremenk In Personal . Propeo, Pro:echo:1,, c Smoke Delecior, Smokier Si. ( APPLICANT SIGNATURE l• I) IT OFI-ICE USE: (I)MNIEN'IS ON PERMIT APPROVAL OR DENIAL 1 12 I 1::"Z-0 REVIEWED I(11 WAVE DIVISION(SIGNATURE) DATE SERVICE NO. 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