HomeMy WebLinkAboutBLD-22-002906 ?aie� WVC�I\ A icir Vvc'�t roJ 52;nj l�cnc D
of•yi,4 BUILDING PERMIT APPLICATION i (,iV 17 2321
• •c�E �'2r APPUCATiON TO CONSTRUCT REPAIR, RENOVATE , CHANGE tHE1 USE,OCCUPANCY OF,
o _ •, • C OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO F 4iI DIF'ARTrv1ENT
E' l� Town of Yarn1outh Building Department my —
w.�rric�u s ---
T'---'••" 114li Route 28 • Yarmouth, MA 0966.4—E492
Tel: 508-398-2231 ext. 1261 Fax 508-398-0836
Office Use Onlyloe Planning Board Information Assessors Department Information:
Permit No. th )L Da Plan Type_ Map for
Permit Fee $ Endorsemen"Date /
�� Recording Date New
Deposit Rec'd. $ Date 1.4 Property Dimensions:
Plan Na.
Net Due $ Other
Lot Area(st) Frontage(tt) Lot Coverage
This Section for Office Use Only
1/Building Peimit Number. I Date issued:
Signature: Certificate of Occupancy
Building Official Date is Is not required
Section 1 - Site Information I
1.1 Property Address:
cr). P\ti Z� 1.2 Zoning Information:t
Zoning District Proposed Use
1.3 Building Setbacks(ft)
Front Yard Side Yards I Rear Yard •
Required I Provided Required I Provided Required Provided
1.4 Water Supply(PA-Q.`e,40.S Si) 1.5 Rood Zone Information: Comments -
Public Private Zone: _ BFE
S
Section 2 - Property Ownership/Authorized Agent
2.1 Owner of Record:
Bellew Tile _ 280 RT28 Yarmouth, Ma
Name(print) Mailing Address:
Signature Telephone Telephone /
Email Address:
2.2 Authorized Agent:
k
eC
'rti l LY Ye`-'1/�I r?� _
/ N> (pri tI Mailing Address:
Za ?J1VU1/ t7) itSignature Telephone Fax
Email Address (1
Section 3 - Construction Services
3.1 Licensed Construction Supervisor. Not Applicable I]
Bradley Yochum
54 Beach Plum Chloe Harwich, Ma 02645 License Number
Address CS-111519
r3��G y&cAum- (774) 316 5269 ApexExcavatingLLC@outlook.com Expiration Date
signature Telephone Email Address: 06/18/2023
3.2 Registered Home Improvement Contractor,
Company Name Not Applicable ❑
Address Registration Number
Expiration Date
Signature Telephone
Section 4- Workers' Compensation Insurance Affidavit(M.G.L c. 152 S 25C(6)
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure
to provide this affidavit will result in the denial cf the issuance of the building permit.
Signed Affidavit Attached Yes No
Section 5- Professional Design and Construction Services-for Buildings and Structures Subject
to Construction Control Pursuant to 780 CMR 116(containing more than 35,000 c.f. of enclosed space)
Section 5.1 Registered Architect:
Not Applicable ❑
Name (Registrant):
Registration Number
Address .
Expiration Date
Signature Telephone
Section 5.2 Registered Professional Engineer(s51
Coastal Engineering -Kevin Donovan (Structural Engineer)
Name Area of Responsibility
260 RT-6A Orleans, Ma 02653
Address Registration Number
;508) 255-6511
Signature Telephone l Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Hams Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Section 5.3 General Contractor
Apex Excavatin_g LLC Not Applicable ❑
Company Hamo
Bradley Yochum
Person Responsible for Construction
P.O. Box 1196 Harwich, Ma 02645
Address
54-a 2g G 9CAI M, (774) 316-5269
Signature O Telephone
' - ; , Section 6 - Description of Proposed Work(check all applicable)
New Construction ❑ I (tor multiple family only) No.of Bedrooms (for multiple family only) No.of Bathrooms
Existing Bldg. V I Repair(s) V I Alterations ❑ Addition ❑ 1
Accessory Bldg. ❑ Type Demolition Other S eci fy�
1 Demo of CMU Foundation
P
Brief Description of Proposed Work:
The lifting of the 75'X 54' left side of building to demo the deteriorating CMU foundation and replace
with a poured in place foundation. Interior of building to be infilled with a concrete slab poured with an
elevation to match the rest of the existing building '
Section 7- Use Group and Construction Type I
Building Use Group(Check as applicapable) Construction Type
A ASSEMBLY ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A O
A-4 ❑ A-5 0 lB
B BUSINESS ❑ 2A ❑ ,
E EDUCATIONAL ❑ 29 ❑
F FACTORY
❑ F•t ❑ F-2 ❑ 2C
H HIGH HAZARD 0
3A (]
I INSTITUTIONAL 0 I-1 ❑ 1-2 D 1.3 0 3B
M MERCHANTILE ict4 ❑
R RESIDENTIAL ❑ R-1 0 R-2 0 R-3 ❑ SA
cilf
S STORAGE DS-t
CID S 2 D — se Q
U UTILITY
SPECIFY:
M MIXED USE
SPECIFY:
S SPECIAL USE D
SPECIFY: .
Complete this section if existing building undergoing renovations,additions and/or change in use.
Existing Use Group: Proposed Use Group:
Existing Hazard Index 780 CMR 34 Proposed Hazard index 7B0 CMR 34
Section 8 Building Height and Area 1
Building Area Existing ii applicable) Proposed
Number of floors or stones
include basement levels 2 Stories
Floor Area per Floor(sf) 15,583 15,583
Total Area All Floors (sf) 15,583 15,583
Total Height(ft)
Section 9 - STRUCTURAL PEER REVIEW (780CMR 110 11)
Independent Structural Engineering Structural Peer Review Required Yes No
SECTION 10a OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNER'S AGENT ORA CONTRACTOR APPLIES FOR BUILDING PERMIT
I, 3 l rr my Be.i/cum . as Owner of the subject property,
hereby authorize T1 O L)'�1vt;\rhit4 ()Snt(J,,)rrty YUL/1Qk ) to act on
my behalf, in all matters relative to work authorizedf by this building permit application.
/Signature wrier Date
SECTION 7 Ob OWNER/AUTHORIZED AGENT DECLARATION I
1, 6 C.-0%.1 ey ` oz- L fYl as Owner/Authorized Agent
hereby declare that the statements and information on the forgoing application are true and acurate, to
the best of my knowledge and belief.
Signed under the pains and penalties of perjury.
ervitlk ri rv-
/
Print Name
4:7 • 1/4.71i:L4)
Signature of OvMer/Agdnt Date
!Section 11 - ESTIMATED CONSTRUCTION COSTS
Item • Estimated Cost(Dollars)to be
completed by permit applicant
1.Building
$302,394.10
2.Electrical
3.Plumbing/Gas
4.Mechanical(HVAC)
5.Fire Protection
6.Total---(1 +2+3+a+5) $302,394.10
7.Total square Ft.(Ianrw sauisaa&additiora)
Check Below
❑ Conservation-Commission Rung
(if applicable)
❑ Old Kings Highway& Historical
Commission approval
(if applicable)
The Commonwealth of Massachusetts
1—'.4l=r Department of IndustrialAccidents
I Congress Street, Suite 100
•:rlir
Boston, MA021I4-2017
;r 0.' www mass gov/dia
Workers' Compensation Insurance Affidavit: Builders/ContractorsfElectricians/Plumbers.
TO BE FILED WITH TNT PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
Address: 1;Qi f cl ilf', l
City/State/Zip:_14.1ri A i\(.41 I r1/L4 QA6, (f`.- Phone#: -- 7q — 6---`-)- 6 q
Are you an employer? Check the appropriate box:
Type of project (required):
1.❑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 8. ❑ Remodeling
any capacity. [No workers'comp. insurance required.)
3. I am a homeowner doingall work myself. t 9. ❑ Demolition
❑ ys [No workers'comp.insurance required.)
4.E] myProPen}'•I am a homeowner and will be hiring contractors to conduct all work on I will 10 ❑ Building addition
ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions
proprietors with no employees.
12.❑Plumbing repairs or additions
5,❑1 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 boxft 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.
*.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_Lie.#: 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 S250.00 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.
1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
`% Aim A
Signature: ';11T4f / ! `y Date: I �,� ,�r (/
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
508-398-223[1 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 280 RT28 Yarmouth, Ma
Work Address
Is to be disposed of oat the following location: Concrete to be Disposed at Robert Childs Inc for Recycling
Building Debris to be Disposed of in On-Site Demo Containers
Provided by Robert Childs Inc or Equal
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Ch. 111, §150A.
G�ac/tam. 11/17/2021
Si na re of APp lication Date
g
Permit No.
Commonwealth of Massachusetts
IFDivision of Professional Licensure
Board of Building Regulations and Standards
C o ns�i!Dbtt�t�i5 ,rvisor
CS-111519 6rpires:06I18/2023
BRADLEY M XO
54BEACH PL)MC.
HARWICH MA 2 ••• •
Commissioner Baia fi. 1�Fimc1
Sears, Tim
From: Sears, Tim
Sent: Wednesday, November 24, 2021 3:27 PM
To: 'ApexExcavatingLLC@outlook.com'
Cc: Grant, Kelly; Grylls, Mark
Subject: 280 Route 28
Attachments: Xerox Scan_11242021151534.PDF
Bradley,
I have reviewed your application for raising a portion of the building, and there are some items needed;
1. Conservation sign off
. A determination needs to be made whether this project is a substantial repair of a foundation. Please refer to
the definition (attached) and submit a plan showing the entire foundation with the percentage that is being
worked on/repaired
Please submit these items for review
This email is considered a written denial of your permit application per Section 105.3.1 of the Massachusetts
State Building Code. Section 105.3.2 states in part that "an application for a permit for any proposed work
shall be deemed to have been abandoned 180 days after the date of filing, unless such application has been
pursued in good faith"
You may appeal this denial to the Building Code Appeals Board in accordance with M.G.L. c. 143 §100, within 45
days of this notice.
Timothy Sears CBO
Deputy Building Commissioner
Town of Yarmouth
508-398-2231 Ext. 1259
mailto:tsears@varmouth.ma.us
I.
Sears, Tim
From: Sears, Tim
Sent: Wednesday, November 24, 2021 3:27 PM
To: 'ApexExcavatingLLC@outlook.com'
Cc: Grant, Kelly; Grylls, Mark
Subject: 280 Route 28
Attachments: Xerox Scan 11242021151534.PDF
Bradley,
I have reviewed your application for raising a portion of the building, and there are some items needed;
1. Conservation sign off
\ . A determination needs to be made whether this project is a substantial repair of a foundation. Please refer to
the definition (attached) and submit a plan showing the entire foundation with the percentage that is being
worked on/repaired
Please submit these items for review
This email is considered a written denial of your permit application per Section 105.3.1 of the Massachusetts
State Building Code. Section 105.3.2 states in part that "an application for a permit for any proposed work
shall be deemed to have been abandoned 180 days after the date of filing, unless such application has been
pursued in good faith"
You may appeal this denial to the Building Code Appeals Board in accordance with M.G.L. c. 143 §100, within 45
days of this notice.
Timothy Sears CBO
Deputy Building Commissioner
Town of Yarmouth
508-398-2231 Ext. 1259
mailto:tsearsPyarmouth.ma.us
1
§TOWN OF YAR IOUTH
1146 Route 28, South Yarmouth, MA 02664
508-398-223!1 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 280 RT28 Yarmouth, Ma
Work Address
Is to be disposed of oat the following location: Concrete to be Disposed at Robert Childs Inc for Recycling
Building Debris to be Disposed of in On-Site Demo Containers
Provided by Robert Childs Inc or Equal
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Ch. 111, §150A.
G�ac/cum 11/17/2021
Si natiYrel/of Application Date
g Pp
Permit No.
•
efThai kt( (,) 6-)-05(4 Di Jul
S t 1 ad
1 r O(\ .t�nn ov , r ,a
_ �} {y Eyre .(j. {
WATER DEPARTMENT
014- / CuK,
x r ` F
BUILDING PERMIT APPLICATION FOR
WATER DEPARTMENT SIGN OFF
TRANSMITTAL FORM
I3t..;ILD1\G SITE LOCATION 4t `,
PROPOSED WORK: T J;
APPLlc'.A NT A ,7iV EYckv / cij c'0Gtic,/ it;
AI)DREsS: p .. y ��t`t "t h 4i?. - . v
T1-t.Pl iON E (7; .516
RESIDENTIAL AXE) OR CO12\11'14'1= i. MIMING
V4atrt Demi went I)eterntntc,( omphance of Water Ata:iabilitt and Or existing location
I=n,gineernl i Department I)ctersniue,Compliance tot Parking and Drainage
("(nisei nafi? Commission I)cteninnes Compliance to Wetland, Act, Le if Inds) horde( any tlpe of
4t eilxtntt,, titrcam>, ponds. trier!,. ocean. bogs. boys. marshland. I'.1(
I Icalth Departntcm Determines( oniphance to State and I then Regulations. i e
settttitetttents lot Setttaize Disposal and other Public Health Act nes
Fire I)eparnment- Determines Compliance to State and loy,n Requirements (ol Personal
Safety Ptopenv Protection,- i c Smoke Detectors- Sprinkler S"tem,.etc
1///7 1
1PPI I( I SlekATLRF I)1TE;
)h FR F: USE:: C°O\I\I EN FS O\ 1410111 ‘PPROV-Al, OR DE\I XI.
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REVIF« D BY WATER DIVISION (SIGNATURE) DATE
SERVICE NO.
NAME
STREET 310 ki AY
VILLAGE 1,47V,)1 1 Agy Ott(tt
METER NO, l' i:41 .1411.1t-C'Vlef woo F- viA_.._
fiaiki , 41. titol1
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4s TOWN OF YARMOUTH
; A ° HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant.
Building Site Location: (:n0
Proposed Improvement: l I' =r- r 1 I ,
•
t 7 A. I a _ e
Applicant: t^p
lc (CIA —Ape/ Tel. No.: / / y)
Address: )00 ex 1'/9 6
rcAlith_,.,1• Iif Sl S Date Filed:
**Ifyou would like e-mail notification of sign off please provide e-mail address: 43 e.y' ✓ahn (1_6 k,C(jvii
Owner Name: yytm f3 eleut`
Owner Address: JQ rS 11 / �//
l�ri�Mrr,•n f� ,1►'If�' Owner Tel. No.:
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.
v D Please submit three (3) copies of plans, to include:
(1.) Site Plan showing existing buildings, water line location,
NOV 1 8 2021 and septic system location;
HEALTH DEPT. (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: ` G /0\,
PL ASE NOTE
COMMENTS/CONDITIONS:
Initial Construction Control Document
Ie To be submitted with the building permit application by a
I Registered Design Professional
per the ninth edition o
for work f the
�''•..� Massachusetts State Building Code, 780 CMR, Section 107
Project Title: Date:
Bellew Foundation November 17, 2021
Property Address:
280 RT28 West Yarmouth, MA 02673
Project: Check(x)one or both as applicable: New construction V Existing Construction
Project description: Replacement of Existing CMU Foundation with Poured Foundation and the Infilling
and Pouring of Interior Concrete Slab
I, Kevin Donovan, MA Registration#48972, Expiration date 6/30/2022, am a registered design professional, and I have
prepared or directly supervised the preparation of all design plans, computations and specifications concerning':
Architectural ✓ Structural Mechanical
Fire Protection Electrical Other:
for the above named project and that to the best of my knowledge, information, and belief such plans,
computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780
CMR), and accepted engineering practices for the proposed project. I understand and agree that I (or my
designee) shall perform the necessary professional services and be present on the construction site on a regular
and periodic basis to:
1. Review, for conformance to this code and the design concept, shop drawings, samples and other
submittals by the contractor in accordance with the requirements of the construction documents.
2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable.
3. Be present at intervals appropriate to the stage of construction to become generally familiar with the
progress and quality of the work and to determine if the work is being performed in a manner consistent
with the approved construction documents and this code.
Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107.
When required by the building official,I shall submit field/progress reports(see item 3.)together with pertinent
comments,in a form acceptable to the building official.
Upon completion of the work,I shall submit to the building official a'Final Construction Control Document'.
Enter in the space to the right a"wet" or os , ti'
electronic signature and seal: //�I
i0 t 1.
I/ C URAI to
No. 8972 ��'
Phone number: 508-255-6511 Email: kdonovan@coastalengineeringcompany.com ,S� P�° 4,;/
%NAL s."
Building Official Use Only
Building Official Name: Permit No.: Date:
Note 1.Indicate with an'x'project design plans,computations and specifications that you prepared or directly supervised.If'other'is
chosen,provide a description.
Version 01 O1 2018