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HomeMy WebLinkAboutBLD-23-004145 AI Jc?iJ3 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 'k •r `i 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: 6(,I)- -co.414,s I Date Applied: J � Acs i BuildingOfficial ,_. Gv —i -3--�3 (Print Name) ignature Date SECTION 1:SITE INFORMATION 1.1 Property It Address: 1.2 Assessors Map&Parcel Numbers parr0LO 1.1 a Is this an accepted stree . yes no Map Number Parcel Number RECEIVED 1.3 Zoning Information: 1.4 Property Dimensions: "'---- Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) [ JAN 252023 1.5 Building Setbacks(ft) BUILDING DEPARTMENT Front Yard Side Yards Rear Y Y -- _ 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: Publics Private 0 Zone: — Outside Flood Zone? Check if yes❑ Municipal 0 On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner`!of Record: 1^ ) Name(Print) City,State,LIp 31- NOr61041 Dravt 6 / 1-9y3-6619 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 I Existing Building 0 Owner-Occupied 0 I Repairs(s)VC Alteration(s)'ffi I Addition 0 Demolition 0 I Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of roposed Work2: Amp,ID ` £ i 11 l4o.Jl,m On+ an J K c 4 _/ n SECTION 4:ESTIMATED CONSTRUCTION COSTS. JItem Estimated Costs: (Labor and Materials) Official Use Only 1.Building $ 3 R 0 9 V 1. Building Permit Fee:$ I S p Indicate how fee is determined: 2.Electrical $ )pl Standard City/Town Application Fee r)09 0 Total Project Cost3(Item 6)x multiplier . x 3.Plumbing $ I,COO 2. Other Fees: $ 4.Mechanical (HVAC) $ List: p0_00 t! 5.Mechanical (Fire \( \ Suppression) fi $ Total All Fees:$ 6.Total Project Cost: $ Check No. Check Amount: Cash o�t: \')9 3g009 0 Paid in Full 19 Outstanding Balance D e: II 0 "--. bW ct SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) �� �ri c.W 105�(?� • Z3 2 Name of CSL Holder License Number Expiration ate SeiL List CSL Type(see below) No.and Street Type Description Ponni Mit U Unrestricted(Buildings up to 35,000 Cu.ft.) City/Town,State,ZIP R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding t 11_26t-©2n 4 i- j f SF Solid Fuel Burning Appliances Telephone i�SgrGLllr1e`!1'C . I Insulation Email address L/ D Demolition 5.2 Registered Home Improvement Contractor(HIC) �rq.UI brio ie coo HIC Company Name or HIC Registrant Name HIC Registration Number Expiration Date ti 5sga No.and Street fAUiioE ail o ar(•Cow, 1.)Q On!, I^NAt (9ZG GO /7 Zr: troaX �fJ Email add 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 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 ! ( .i/"� orito to act on my behalf, in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) a 40 3 Date • SECTION 7b: OWNER' 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: 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.eov/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.) 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 ?-3----7=7:01114,762..... Department ofIndustrialAccidents ;�,tom` 1 Congress Street, Suite 100 i ,,� Boston, MA 02114-2017 �' www.mass.go v/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. A licant Information Name (Business/Organization/Individual): J 0G Please Print Le ib[ Address: t 3 City/State/Zip: thht € Z ,r Phone g: - ic,(_ Are you an employer?Check the appropriate box: 1.0 I am a employer with employees(full and/or part-time).* Type of project(required): 7. -.�I am a sole proprietor or partnership and have no employees working for me in ❑New construction any capacity.[No workers'comp. insurance required.] 8. ❑ Remodeling 3.y�Q1 am a homeowner doing all work myself. [No workers'comp. insurance required.]t T" 9. ❑ Demolition 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 10 ❑ Building addition proprietors with no employees. 11.0 Electrical repairs or additions 5.0[am a general contractor and I have hired the sub-contractors listed on the attached sheet. 1 ❑Plumbing repairs or additions These sub-contractors have employees and have workers'comp. insurance.* 13.❑Roof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 152,§1(4),and we have no employees.[No workers'comp. insurance required.] 14.❑Other *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 *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'com such. p.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: Attach a copy of the workers' compensation policy declaration page(showing thetate 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 render the pains and penalties of perjury that the information provided above is true and correct. Signature: Phone Y: 1 xK- ZOo g—OZorr Date: ` 2T 23 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#: R. TOWN OF YARMOUTH o . -,. BUILDING DEPARTMENT „v. ^°~E�=,~'�a 1146 Route 28, 02664508-398-2231 South Yarmouth, MA 50 � ext. 1261 HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE: JOB LOCATION: NAME STREET ADDRESS SECTION OF TOWN "HOMEOWNER" NAME HOME PHONE WORK PHONE PRESENT MAILING ADDRESS CITY OR TOWN STA 1'h 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 and requirements and that he / she will comply with said procedures and requirements. HOMEOWNER"S SIGNATURE APPROVAL OF BUILDING OFFICIAL INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL Ch.142. Yes No If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of indemnity Bond OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent h:homeownrlicexemp • • 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 ! ( Spr:Lin/,9441 (� Work Address Is to be disposed of at the following location: y .ers Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. a 2 Signature of Applicant Date Permit No. GammouildinnwealoifOccuU� tional MassachuLicensetts ~ Division pan sure F Board of Bin R uions and Standards i'tfttit Of Consume,'Agaivs IL8u Regulation Cons � iIsO t E IMPROVE/RENT CONTRACTOR spires:0512312024 TYPE:lndfi'itl;�c CS 110548 Re ExpirationCS BRAUUO BRITO 137001 '14'2029 19 SAGA ROAD 8RAUL1O BRITL ' SOUTH DEW ,S MA 02660 �� Y D B A BBRITO SERA { 16f.Lv.'L 13' �pAU t�Q�}j��/�� ,�jam. B I_IO 17fi1 4 _ i-Lo f ,, S-(J.r. Y zt osSAGA RO ,.. Bk 35575 Pg161 #238 01-04-2023 @ 11 : 29a N O T N O T A N A N OFFICIAL OFFICIAL COPY COPY MASSACHUSETTS STATE EXCISE TAX BARNSTABLE COUNTY EXCISE TAX BARNSTABLE COUNTY gRfGD$T$,y OF DEEDS .apR2 ST4$L04COU2NTY@REGISTTRY OF DEEDS Date: 01-04-2023 @ .j1,1:J2��9,,7am1� li V 61 Ct1#: 174 `DOc1: 238 Ch0174 Doc#: 238 Fee: $950.13 Forg: I27e,40.A0 L 0 F FFeP: O85P.A tons: $278,000.00 COPY COPY MASSACHUSETTS FORECLOSURE DEED BY CORPORATION U.S.Bank Trust National Association,not in its individual capacity but solely as owner trustee for RCF 2 Acquisition Trust a National Association duly established under the laws of the United States of America and having its usual place of business at c/o Selene Finance,LP,3501 Olympus Boulevard,5th Floor,Suite 500, o Coppell,Texas 75019,holder of a mortgage From: Loretta R.King and James King a/k/a James J.King ITo: Mortgage Electronic Registration Systems,Inc.,as Mortgagee,as nominee for Countrywide Bank,FSB Dated: February 14,2008,and recorded with the Barnstable County Registry of Deeds,in Book 22711, Page 32,of which Mortgage the Undersigned is present holder by assignment. by the power conferred by said mortgage and every other power,for TWO HUNDRED g SEVENTY-EIGHT THOUSAND and 00/100 Dollars($278,000.00)paid,grants to: vs Rita DeCassla Andrade,Individually with a place of business and mailing address of 37 Norman Drive,Framingham,MA 01701,the premises conveyed by said mortgage to wit: va -. SEE EXHIBIT"A"ATTACHED HERETO b a� R 0 IT:, rr— Town of Barnstable '� CT ! e/_E 10 Building Department Services / ' JAN 2 610? aARNSTA�BLE, Brian Florence,CBO 3 N4.1.7 I�`� Building Commissioner BUILDING DEPARTM NT 200 Main Street, Hyannis,MA 02601 -- ----__ _ www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, Rita Andrade , as Owner of the subject property hereby authorize B ra u 1 io B r it o to act on my behalf, in all matters relative to work authorized by this building permit application for: 11 Sparrow Way South Yarmouth, MA, 02664 (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. 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