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HomeMy WebLinkAboutbld-23-004143 M ://JP-5 R E C E l S"`I 9& TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department or r tv JAN 24 2023 1146 Route 28, South Yarmouth,MA 02664-4492 � 508-398-2231 ext. 1261 Fax 508-398-0836 _ BUILDING DEPARTMENT Massachusetts State Building Code,780 CMR By. __ _-_Rtiilding oermitApplication To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling - Thish Section For Official Use Only Building Permit Number: ,�L1)-'Z3--U/4 y'5 Date Applied: / r, egAc , — -g- . Building Official(Print Name) Si ature Date SECTION 1:SITE INFORMATION 1.1 roperty A ess•i444. 1.2 Assessors Map&Parcel Numbers 1.1a Is this an accepted street?yes / no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: gg7/9Z 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 I Private❑ Zone: Outside Flood 7,6ne? Check if yes4�' Municipal 0 On site disposal system SECTION 2: PROPERTY OWNERSILPg 2.1 SI li RtiT ii✓4 yk%�ltl'c(1rl / 4— t 7� Name(Print) / City,State,ZIP 3) wejf red No.and Street Telephone Rmail Address SECTIONS:DESCRIPTION OF PROPOSED'WQRK2(check all that apply) New Construction 0 Existing Building Owner-Occupied Repairs(s) 0 Alteration(s) 0 Addition ❑ Demolition 0 Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Des on of Propo Wor1c2: RP/ k CU lay r >c N✓i ' °[6. SECTION 4:-ESTIMATED CONSTRUCH O COSTS Item Estimated Costs: • Official Use Only (Labor and aterials) 1.Building $ b✓/ 000 1. Building Permit Fee:$ It t? Indicate how fee is determined: 2.Electrical $ 5 0 1 9 Standard City/Town Application Fee / ❑Total Project Cost( m 6)x multiplier . . x 3.Plumbing $ - 2. Other Fees: $ ; .3 t 4.Mechanical (HVAC) $ ,, List:. . ,9, . ' 5.Mechanical (Fire $ \��i Suppression) Total All Fees:$ ,) C . 7�Qn6 Check No. Check Amount: Cash punt: J 6.Total Project Cost: $ g ` \1\a3 CI Paid in Full a Outstanding Balance e: a 1 SECTION 5: CONSTRUCTION SERVICES 5.1 Constructionepee `i oorjLicense(CSL) c /6) ) 5 Jizmio � License Number Expiration Date Name of CSL Hold C) Rtc R or List CSL Type(see below) No.and Street " WWVV`��� Type Description yoviiiiti$, of q U Unrestricted(Buildings up to 35,000 cu.ft.) City/Town,State,ZIP R Restricted I&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding 77(L l/�Q 7�I 3jaik4deta,?6,,,,/ SF Solid Fuel Burning Appliances ���� jj �G1` / / alr� I Insulation Telephone Email address D Demolition 5.2 Registered!Ho 4 Im rov went Contractor(HIC) /Ly/ d�%/ I0.5/3 1-Q � `+� i HIC Re 'stration Number H1 o an Name egistrant Name Expiration Date c � �' 7J,461twei0�,.1e � / ,,No.an Str t Email addres . 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 I e of the building permit. Signed Affidavit Attached? Yes No 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR B DING PERMIT ,,� / 7 I,as Owner of the subject property,hereby authorize gQ,f,1" /'6/ °�Q to act on my behalf,in all matters relative to work authorized by this building permit application. 504N Cale- ih 3Ai Print Owner's Name(Electronic Signature) 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' true and accurate to the best of my knowledge and understanding. as i4'/ VOU/9?) 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.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/batbs 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" j Loh i -fie, i-e d, O(o g-ci c� n(1- . Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards ConstrilfeithiAbpervisor CS-112255 Expires:06/12/2023 JASON PATRICK WHITEHEAD 20 BUCKWOOD DR SOUTH YARMOUTH MA 02664 , Commissioner (-) 4 Office of Consumer Affairs and Business Regulation 1000 Washington Street-Suite 710 Boston, Massachusetts 02118 • Home Improvement Contractor Reoistratton Type: Individual Registration: 191891 JASON WHITEHEAD Expiration: 04/1512023 D/B/A J'S CONSTRUCTION 20 BUCKWOOD DF1 SOUTH YARMOUTH,YARMOUTH,MA 02664 Update Address and Return Card. ace 1 020M-W17 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:individual before the expiration date. If found return to: Mistretta! Expiratioil Office ol Consumer Affairs and Business Regulation 191891 04/15/2023 1000 Washington Street -Suite 710 JASON WHITEHEAD Boston,MA 02118 D;R/A CONSTRUCTION JASON WHITEHEAD • 20 BUCKWOOD DR -- SOUTH YARMOUTH,MA o2s64 Undersecretary, Not valid without signature • ......_ . • The Commonwealth of Massachusetts eqj�. Department of Industrial Accidents _ � 1 Congress Street, Suite 100 VA1:2— Boston, MA 02114-2017 www.mass.gov/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): )t i1 /t�, J Address: c U c4C/t1 i ai . / " City/State/Zip: J2. ytti-444,il ,/14-0 ,e, ( Phone #:7( ✓1(37/75 Are you an employer?Check the appropriate box: Type of project(required): l.[I am a employer with employees(full and/or part-time).* 7. E New construction 2.01 am a sole proprietor or partnership and have no employees work ng for me in 8. Remodeling any capacity.[No workers'comp. insurance required.] �j 3.0 I am a homeowner doing all work myself[No workers'comp. insurance required.]t g DI Demolition 4.0 I am a homeowner and will be hiring contractors to conduct all work on m property.Y I will 10 [ Building addition ensure that all contractors either have workers'compensation insurance or are sole ILL 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. 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. 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. 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 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, §2.5A 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 'r s an ei Ides of perjury that the information provided above is true and correct. Signature: /0/Il', // �' Y _ Date: /l'�3/) Phone#: 77 , 7��_5_, 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#: og'Y` 4- TOWN OF YARMOUTH yh� C• BUILDING DEPARTMENT {o/ 4+''��': 1146 Route 28,South Yarmouth,MA 02664 MAT'A M t � 508-398-2231 ext. 1261 Fax 508-398-0836 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 3) lie, K0` `/e,j f*It1.Tij O'6 Work Address Is to be disposed of at the following location: )Q4itU7 ' � '.✓`/ Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. *Je4 03/0 Signature of Application Date Permit No. • Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Const t'h4416 visor _ CS-112255 y�' Expires:06/12/2023 JASON PATRICK WHITEHEAD 20 BUCKW0013 DR SOUTH YARM9UTH MA 02664 Commissioner da a 2/3/23, 1:53 PM Mail-Sears,Tim-Outlook 32 West Rd Sears, Tim <tsears@yarmouth.ma.us> Fri 2/3/2023 1:52 PM To:jwhitehead0689@gmail.com <jwhitehead0689@gmail.com> Jason, I have reviewed your application to convert the carport and you need to submit specs on the beam where the wall is being removed. Thank you Timothy Sears CBO Deputy Building Commissioner Town of Yarmouth 508-398-2231 Ext. 1259 mailto:tsears@yarmouth.ma.us https://outlook.office.com/mail/sentitems/id/AAQkADE3MDQ5NWZmLTkOYzItNDIwNi1 iMDQxLWNkMGQyNmE4NzE5NAAQACVku%2FRiKaBCsFfksJf... 1/1 oF.YgR TOWN OF YARMOUTH it..: ,. '�=�y HEALTH DEPARTMENT EIVED . , ED � PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET JAN 2 6 2023 To be completed by Applicant: _I._ D // ,UIDING DEPARTMENT Building Site Location: 32 U/ 4� WJpf i� �,� D Proposed Improvement: cif -1 t n t ✓D c t c#crJ✓�`� Applicant: cia5ail 4/7 ?% / Tel. No.: 77Y 4P/*7/73 Address: QO ateiCtati w k ,,1 �t�/il�'%j� 0- Date Filed: //))/23 j **If you would like e-mail notification of sign off please provide e-mail address: V l� f/412/!/66 l&-c9/29e1j I. Owner Name: ..1.4,1 61 ' Owner Address: 301 ttiti 114 1;2f -li 0267; Owner Tel. No.: Sa—C Hg4012 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; �qN 2 ?� (2.) Floor plan labeling ALL rooms within building T yFq� 23 (all existing and proposed) — �FpT 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: / a-SA 3 PLEASE NOTE COMMENTS/CONDITIONS: § +R, ; $jR - 1 3 4 • , , 1S �l mot' • • } 1 �.. " i, :, } 5. ,,�;•;ter unt`t° ' .t • `i • t#C • , °t« 1 q/ tVt '_(_ f f x xT L.,_,,_-__..:=,-,..„--t-Jf5ftri) Fhor .t/t.� N 2 4 2023 „LTH DEPT.' 1 it . . . _ . pel,„0,4 .. W. _ -..�. � . __ w .. __ III Kt4eN .. 4....„ Coy . _ . . . . . . . . _ . . . aG' - Q . . 1 . , . . . _ _ 1 . . . ,. .. 3 ; Fiv ;3 s � vj .. t i . -- .� ----- - ~-- s,004.01011.01.,01__ . . _- CN /&Ve7 & (( A) ((ef Stde ) . , _ I # • . . . _ 1. JAN 2 4 2023 ! HEALTHDEFT. iti i r i \ _. . 1 1`J Cr'-'- ti _r. • . JAN Z 4 2023 _ _ - --- HEALTH DEPT. - x D Imommi I r,) i . . x ' iL) V3 , - ; ©:' c � _..1. .- ._..Y . 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