HomeMy WebLinkAboutBLD-23-005070 r
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ONE & TWO FAMILY ONLY- BUILDING PERMIT
Town of Yarmouth Building Department of .
1146 Route 28, South Yarmouth,MA 02664-4492 See 508-398-2231 ext. 1261 Fax 508-398-0836
Massachusetts State Building Code, 780 CMR e
Building Permit Application To Construct, Repair, Renovate Or Demolish ..-;: 0":"+
a One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: U(D-2 _(3'),) Date Applied: ,Z
Building Official(Print Name) ature Dare
SECTION 1:SITE INFORMATION RECEIVED
/ 1.1��P er Address: k t. d f_ 1.2 Assessors Map&Parcel Number! 1
V tO U I 4 2023
1.1 a Is this an acceioted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions: BUILDING DEPART—MENT
By' __
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:
Public❑ Private 0 Zone: — Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
1p\ 2j..vayc
Owngt-'_ofRe�coordd �.( �/
1 `! ( rint)i ' - � &v S PI (I l�l V e r'VI�1 0 tf lilt 1 a2 G 6
City,State,ZIP
.'and Street
t I/(�{4 al r 9O C C 3 ce y✓l�_ I�,v ey.,1,,,,, 6. ,
Y 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. ❑ Number of Units Other ❑ Specify:
Brief ,
Des ription of P oposed Work2:
ej e x Proposed
A io vt o •4' . . rot
SECTION 4: ESTIMATED CONSTRUCTION COSTS.
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 1. Building Permit Fee:S.) -Indicate how fee is determined:'l
2.Electrical $ �Standard City/Town Application Fee �(,
V+
El Total Project Costa(Item 6)x multiplier . x V
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List: tQ,ou tetzA
5.Mechanical (Fire
Suppression) $ Total All Fees:$
/ Check No. Check Amount: Cash unt: a�'�
✓ 6.Total Project Cost: $ 3 00 P. 0 g 0 Paid in Full 'lig Outstanding Balance D : i \�
r
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.)
R Restricted I&.2 Family Dwelling
City/Town,State,ZIP 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 Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
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 ❑
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.
d.3(4(4 3
Print Owner' 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(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 Commonwealth of Massachusetts
.
Department off Industrial Accidents
_
7�1
=0� 1 Congress Street, Suite 100
':1•_ Boston, MA 02114-2017
www.mass aov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
/ Address: 2-c 6 0 V ( 'u Yr
y t74
City/State/Zip: 0 Li ((it Yg r-y, p ft, Phone #: 54 6 6 3 .eO(
Are you an employer?Check the appropriate box:
Type of project(required):
I.❑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
any capacity.[No workers'comp. insurance required.] 8. Remodeling❑ •
3. am a homeowner doing all work myself. [No workers'comp. insurance required.]t 9. ❑ Demolition
4.❑ ProPnY
I am a homeowner and will be hiring contractors to conduct all work on mye 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.❑Plumbing repairs or additions
5.❑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.t 13•❑Roof repairs
6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑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.
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 i er the pains and penalties of perjury that the information provided above is true and correct.
Signature: 03 jk(23
Date: M
Phone#: G-oe 66 ; WO6
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. 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
Work Address
Is to be disposed of at the following location: (.7tA.
I
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
(14 .03( (( I o2
Signature of Applicant Date
Permit No.
RECEIVED
MAR 17 2023
B IL N
DING DEPARTMENT
By CP
100.04
tf
TANK a
—% v
O rn o
Z o I EX.
m ,` DWELLING
= 30.06' , "I E .
��� EC
r PROP.
8.5'x11.5'
0 DECK EXTENSION
4'x3.5'
STAIRS
MBLU 118-8
26 STONEY HILL DR.
YARMOUTH, MA
•7, , 70.00
FROMSEPSYSTEM PLOTTED
INFORMATION PROVIDED M A TTH E WS LANE
BY OWNER, BUILDER TO CONFIRM PR
V�
CERTIFIED PLOT PLAN
MBLU 118-8
I CERTIFY THAT THE IMPROVEMENTS SHOWN of M 26 STONEY HILL DR.
A
HAVE BEEN LOCATED BY A FIELD SURVEY. *cP�t� ASSgc4- YARMOUTH,DRWN: RBS
.i ROBB s DATE: 3-15-2023 JOB S080
o SYKES SCALE: 1"=30' DWG. CPP
No. 35418 N EASTBOUND
PA
�o,,'Q'c F,�4�� LAND SURVEYING, INC.
*4 A..., 3-15-2023 � �FrsCisTE�` J�, P.O. BOX 442
i.�J FORESTDALE, MA 02644
ROBB SYKES, P.LS. DATE r•� 508-477-4511
.0 TOWN OF YARMOUTH
• -1,4 y HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: 2 cto'y1,? 1,_:' , . i '
Proposed Improvement: 1'l d/ - et__C 0 t_ .e.clA V k ‘A
Applicant:
Tel. No.: ��(EG G P�
Address: t Ur c r elk
MA, 422kkDate Filed:
"Ifyou would like e-mail notification of sign offplease provide e-mail address: V )
Owner Name: D` 49 ,Af i M DV
1
Owner Address: e 0 01 Y
Owner Tel. No.: g(3 Of
RESIDENTIAL AND/OR COMMERCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e. R ui _For Septage Disposal and-other Public Health Activities. rements
4Please submit three (3) copies of plans, to include:
41.) Site Plan showing existing buildings, water line
and septic system location; location,
_ (Z.) Floor plan labeling ALL rooms within building
(all existing and proposed)d)—
Note:Floor plans not required for decks,sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
DA
4 REVIEWED BY: �-_. __.... ......._.._._..._ -__ _._
• L LTV
COMMENTS/CONDITIONS: PLEASE NOTE MAR 10 2Ci23 �'
HEALTH DEPT
pF y •.. TOWN OF YARMOUTH
} 16- WATER DEPARTMENT
Iatt# 99 Buck Island Road
E / West Yarmouth, MA 02673
Telephone: (508) 771-7921 • Fax: (508) 771-7998
BUILDING PERMIT APPLICATION FOR
WATER DEPARTMENT SIGN OFF
TRANSMITTAL FORM
BUILDING SITE LOCATION: J It L IA( y;4'"-Y14 GC<('C 026Ce
PROPOSED WORK: 0 1/1 o-e_ClA S Q>n
APPLICANT: a M O V
ADDRESS: QC LLv.,r? , -, 0 Oir_ 9.cv,N49Ali•
TELPHONE: Ca( (a 63 w ✓ yaGt pc? covr,
RESIDENTIAL AND/OR COMMERCIAL BUILDING
Water Department: Determines Compliance of Water Availability and or existing location
Engineering Department: Determines Compliance for Parking and Drainage
Conservation Commission: Determines Compliance to Wetlands Act; i.e. If lot(s)border any type of
wetlands, streams, ponds,rivers,ocean, bogs, boys, marshland, ETC...
Health Department: Determines Compliance to State and Town Regulations, i.e.
requirements for Septage Disposal and other Public Health Activites
Fire Department: Determines Compliance to State and Town Requirements for Personal
Safety, Property Protections, i.e. Smoke Detectors, Sprinkler Systems,etc
(t/
3(1q2
APPLICANT IGNATURE DATE
OFFICE USE: COMMENTS ON PERMIT APPROVAL OR DENIAL
A44 ‘-e,e--
9 3/r 3 2-3
REVIEWED B WAT R DIVISION(SIGNATURE) DATE
go Stoney Hill Dr., South Yarmouth, MA, 02664
+, ,.;,at'Neyi to II M-Af 0210
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A CERTIFIED AS BUILT IS REQUIRED
---- --------
BEFORE FINAL INSPECTION
yFiRmOtiTH ffigiN CLERK
TOWN OF YARMOUTH
-- ,,, 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451 '23APR I.:_e01,9:0 -RFC
- - .,:° - Telephone(508)398-2231 Ext. 1292-Fax(508)398-0836
OLD KING'S HIGHWAY HISTORIC DISTRICT COMMITTEE
APPLICATION FOR
CERTIFICATE OF APPROPRIATENESS
Application is hereby made for issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts of 1973 as
amended, for proposed work as described below&on plans, drawings, photographs,&other supplemental info accompanying this
application. PLEASE SUBMIT 4 copies OF SPEC SHEET(S),ELEVATIONS,PHOTOS,&SUPPLEMENTAL INFORMATION.
Check AU Categories That Apply: Indicate type of Building: Commercial Residential
1) Exterior Building Construction: New Building Addition _Alterations Reroof Garage
Shed Solar Panels Other:
2) Exterior Painting: Siding Shutters Doors Trim Other: a'e- (.
3) Signs/Billboards: New Sign Change to Existing Sign
4) Miscellaneous Structures: Fence Wall Flagpole Pool Other:
Please type or print legibly: 4 fkt, ,./4, A. 0_2-6
1 ‘Or, df it 11" '
Address of proposed w'rk: 0,/ lc \> (21^.--t / /1 1 - , 1-). ' Map/Lot# It
Owner(s):2,7 f:i, LC Njt, t lii,..W
1
r /1
Phone#: ---)-ti(rta1/4"....7
All ap ication must be submitted by own,r or accompanied by letter from owner approving submi I of application.
; ir, 1
Mailing address: )tii; (.0 A(/. ',:t Ut:t.i LiV:,. t4r;-:- (L ‘14-:C 11 (32(2p(-4.Year built:
,,,,,- fl
Email: 11/4 ,,,14 'vl Ot; fil q..7 t A. 0 C Cal.,.. Preferred notification method.
.(i17
Phone Email
Agent/contractor: V(1,/il 01*t C ,0,- kr" 1-i2A v 0(7
ti
Phone#:it i(12 VS7 tif It4.,)31A
D 1
Mailing Address: V ka.0\ft e t.) 16;1/., 1 I:2
C ( d '
Email: Preferred notification method: Phone Email
Description of Proposed Work:
c ec lf-- ,-,,, C 20-0
Signed(Owner or agent). 2 i
[to ) fs
Date. )I t c' <-9`.. d
.,..„,.
> Owner/contractor/agent is aware tha a permit is required from the Building Department.(Check other departments,also)
> If application is approved,approval is subject to a 10-day appeal period required by the Act.
> This certificate is good for one year from approval date or upon date of expiration of Building Permit,whichever date shall be later.
> All new construction will be subject to in pection by OKH.OKH-approved plans MUST be available on-site for framing&final inspections.
For Committee use only: Approved Approved with Modifications Denied
Rcvd Date: Reason for Denial:
Amount 2,,S,-.N , C
Cash/CK#: (6S h
Signed: °AZ -A (- / A t
Rcvd by: I,i 50 p
- , —
45 Days:
0 lour
'4 Aar
Date Signed: -
1
APPLICATION#.