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Home My WebLink AboutBLD-23-004485 L. i. 3///3 ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department ,. `y 1146 Route 28,South Yarmouth,MA 02664-4492 IN., 508-398-2231 ext. 1261 Fax 508-398-0836r� 74* .. Massachusetts State Building Code,780 CMR. Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Sectioy.For Official Use 0 Building Permit Number: 6[,b.a bQgli I Date Applie RECEIVED 1 i i• SRArs 3 ► '�-1 g 13 2023 Building Official(Print Name) ignature �j SECTION 1:SITE INFORMATION RI111 DING nFPARTMENT 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers By 8pitERcE s1.,�v y. i11Dc)7 ( 3i 3/3 1.l a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: 33 ,tES . /7c376-5. ' .IGY ' Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) -1.5 Building Setbacks(ft) Front Yard Side Yards I Rear Yard Required Provided Required I Provided Required Provided 30' 1. 9 ' /a" jl 2C ' 30' 947, ?' — 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public Ii2" . Private❑ Zone: Outside Flood Zoe? Check if yes Municipal 0 On site disposal system Er".' SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: 2Er c/,4/-/A'] , '/,912,�1ov J"rL- /l�// Name(Print) City,State,ZIP S</,b4T o&')i O t), 7dg/-005- 7& e-ICh9M,04 coa/J4/L No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK"(check all that apply) New Construction 0 Existing Building " Owner-Occupied 0 I Repairs(s) 0 I Alteration(s) 121.- Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units I Other 0 Specify: Brief Description of Proposed Work2: RE,v)pile Ery/ S T/,0 ko,dC. ///TcArec poor. - -lee cisrRocr pe-R A-CC v''/41A)yi1lq, toc./gA) S, • SECTION 4:ESTIMATED CONSTRUCTION COSTS. • Item Estimated Costs: (Labor and Materials) Official Use Only I.Building $ /0000c) 1. Building Permit Fee:$' {O,) Indicate how fee is determined: 2.Electrical $ 1 Standard City/Town Application Fee Z�0c=:/ ❑Total Project Cost3(Item 6 x multiplier v 0 CJ0� 3.Plumbing $ D n f 2. Other Fees: $ R �(� E I V E 4.Mechanical (HVAC) $ i 5 ejco List: j ;i i3 . -- 5.Mechanical (Fire f Suppression) $ Total All Fees:$ MAR 1 20 3 Check No. Check Amount: Cash An;omr _ _,._ 6.Total Project Cost: $ /5diO2O ❑PaidinFull -J Outstanding BalanceDue,'��tiOlN[, dE ARTMENT 3 Kb q SECTION 5: GONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) /,� 32G3 G y/z2 /Zy DA� �4, S PEA kl fri AA/ License Number Expiration Date Name of CSL Holder / S f eCtK etJ4 y List CSL Type(see below) 0 No.and Street Type Description /Y/4 TGc>/ Cg / /9. aZG V5 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 727`83�i-Cf66 t0A/0�4SPele/ni9:)�,yo>r' SF InsSoluld tioelBurningAppliances Telephone cam! '�'/�� I Insulation p Email address "6.0'41 D Demolition 5.2 Registered Home Improvement Contractor(HIC) DAm A. VEAK IA�V /2 00 yo 1a/8/23 I]IC Company Name or HIC Registrant N e HIC Registration Number Expiration Date No.an Street Pt��9'c- e- i/1 �AA� s /144/av,1orm4, '`/9?�-'/G�i /1//1 72`t'83c GeSq Email address .G�� 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 o the building permit. Signed Affidavit Attached? Yes 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 p4A) 4- G f9,5g/ro.riet) 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: OWNERI OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of pet jury 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: I. 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.1ov/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.) /St Z. S. r, (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) /j//2 V.,t', Habitable room count Number of fireplaces 1 Number of bedrooms 3 Number of bathrooms 2 Number of half/baths / / Type of heating system c/{ S Number of decks/porches Al lff Type of cooling system EC.EG. Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" Mail-Dan Speakman-Outlook I SECTION 5: CONS1 ItUCTIQN SI'SIIVICiIS r- 37 Construction Supervisor License(CSL) 4 ?GZZ2'�lA\ = 't* y`�} License Number ptration Date me of CSL Bolder ,' ,,41 0. 4.,,,, Litt CSL Type(sea below) { No.anti Steel. Type Description r ¢ U Unrestricted(Buildings up to 35,000 cu.it.) �1"c _ R Restricted 1&2 Family Dwelling i G1�Toum,State,ZIP M Masonry • RC Roofing Covering " WS Window and Siding SF Solid Fuel Burning Appliances K I _ •ter �`.P' a�w,�t ram<` '�.'�+!�n/-'ktltrr/ i } Insulation # Tel xle Small address D Demolition i5.2 Registered Hume Improvement Contractor(RIC) / / EIIC Con party Name to MC Registtsutt Name HIC Registration Number Expiration Date No.and Soto 9t3n4�,DPcr i> nrsOo'�i�Jq�(,Gory 61 t t,,,Jici-ii , 2y''€26, 85 r' Email address Ci /Town,State,ZAP Telephone SECTION 6:WOm COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.15T.§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 AiTidevit Attached? Yes Gl.'"r No CI . SECTION 7a:OWNER AUT'E[ORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTB ACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize ,L),44 /I S Poq , , to act on my behalf,in '..:.. .relative work authorized by this building permit application. ,& at 11 f. / eC,am i i hiiii&I' nic S•.,,:. .) Date • SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest ender the pains and penalties of perjury that all of the information contained in this application is true and accurate to th5 best of my Imowiedge and understanding. Print Owner's or Audtotized Agent's Name(Electronic Sig,tautre) Date I. An Osvaer wha obtains a boil ' NOTES; drug permit to do h 1/hher ovm work,or an owner who hires an unregistered contractor (not regi t red in the Home Improvement Contractor(HIC)Program),will rwt have access to the arbitration ` program or guaranty fund under M.G.L.c. 142A. Other kips ant information on the HIC Program rk. wivw.maas.gov/pca Information on the Construed an S�v r License can be found at yvww can ofatuid at 2. When substantial work is planned,provide the information beio�Total Soor era(sq,ft) Gross living area(sq. )} (including garage,fnishad basement/attics,decks or porch) Number of fireplaces Habitable room count ;�4; 'ibex ofbe;hrooms Number of ltedrooms z. Type of heating system Number ofdecks pa Type of cooling system Number of decks/porches Enclosed Open 3. "Total Project Square Footage"may be substituted Tate}Project Cast" � — ti • fi, his . .. .. •are. .. : Sent from my !Phone ttps://outlook.live.com/mail/O/inbox/id/AIDMkADAwATEOYjYwLWMxMQAyLW E4 VDctMDACLTAwCgBGAAADSpiOdiNumUG l a8MmmMARx,,,,,A,,,.,1 7 N .3 m I o8.40 W J us tp.c /0,6 //0X 5✓`/"- I . PROPOSED Ai 1t a %� T9 (NG wL�� C N PORCH- m O nA. - O Q on EXISTING g 3 t.9' FOUNpgTtON LLJ ez W 0 37.9 i 4p 9 o Q CO 0 0 •ct: / Lo U co co Ill N. LOT 2 �-- 17874.6 S.F. / .............................,,,,,,,,.....j BUILDING LOCATION PLAN FOR ��N°F"'ASS 8 PIERCE ST., WEST YARMOUTH, MA �`� r q°ti o� �cn n PREPARED FOR ST vENRUMBA W. a ANT* 10 E. IZADETN U No. 35? IAM PA n o, r�o o� I - 30' I 0-2 I -2020 -o- '9€Gi re9-` TMW C!. ass/ONA LAN° CPP- I ,, WELLED * ASSOCIATES P.O. BOX 4 17 CENTERVILLE, MA i2 ,..1..- Z 0 TEL: (508) 328-4692 EMAIL: trtsweiler@mail.com REGISTERED LAND SURVEYORS S ENVIRONMENTAL CONSULTAN Traverse PC „,, N °� I08.40' ,t- m _ !--). 0 c ,,,ox/4 0_X 5/(7/1 1-1.77 in to ,...6 10- I '� Q r`3FTflit1oN4 wqKc IL. PROPOSED +�‘. N PORCH Nz m 1.., EXISTING z cV 31.9, FOUNDATION 37.9' WCZ 4p 9 EL N (f) O Q vl 0 0 11.1 CO CZ oo LOT2 17874.E 5.F. / ' / 58 09 BUILDING LOCATION NfLAN • FOR z�' ��°FMASs9cti✓ ry 8 PIERCE ST., WEST YARMOUTh, MA ° GN PREPARED FOR z STE W. m ', A T. I • _” 8 RUMBA �, _ E IZABETh IA NO.3s7• PA 'o 'QcG, Tf.0' liinIIIIIIIIIIIIIIIIIM o °� .:` �v,orF I _ 30 I 0-2 I -2020 MOM ir t S%NA.LAISO • WELLER ASSOCIATES P.O.— BOX ,�y- L 4 17 CENTERVILLE, MA TEL: (508) 328-4692 EMAIL: trisweller@gmail,com REGISTERED LAND SURVEYORS $ ENVIRONMENTAL CONSULTAN ;' ravcr5e PC §TOWN OF YARMOUTH 1146 Route 28, South Yarmouth, MA 02664 508-398-223[1 ext. I261 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 8 LP/C 2 C G T. M 0 u Tv Work Address Is to be disposed of oat the following location: S f 3 EX C o Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. . z / i2 /z3 Signature of Application Date Permit No. Commonwealth of Massachusetts Division of Occupational Licensure' Board of Building Re ulations and Standards Cons rvisar v tP • CS-037636 * spires:04/22/2024 DAN A SPEA�M•-.t 1j 1 _ 15 SPEAK WAY '3` ,*Il ; HARWICH Mt p 4) otJVa_z'3° Commissioner n ;; �»; • • • /Z- Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:Individual Registration Exoi_ ratio �120040 10/08/2023 DAN A SPEAKMAN DAN A.SPEAKMAN 15 SPEAK WAY NO HARWICH,MA 02645 Undersecretary Print Form The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations j 'j'1 1 Congress Street, Suite 100 =�::= ' Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/El ctriciPleas Print Leiibly Builders/Contractors/Electricians/Plumbers Applicant Information � G Name(Business/Organization/lndividual):D Ynl R• SPEW l 1"1 Cc�.l S�'3�v Ti Address: IS s5p E 4M ' City/State/Zip: Alto'CAJGC1 ( Phone #: ? 8.?�' Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4• Q"Lam a general contractor and I 6 IDNew construction employees(full and/or part-time).* have hired the sub-contractors listed on the attached sheet. Remodelin❑ g 2.❑ I am a sole proprietor or partner- These sub-contractors have 8. Demolition ship and have no employees employees and have workers' working for me in any capacity. 9. auilding addition comp. insurance [No workers' comp. insurance 10.0 Electrical repairs or additions required.] 5. [] We are a corporation and its 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no 13.❑ Other 00 / R f employees. [No workers' comp. insurance required.] *Any applicant that checks box Ill 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: A. 'S.SO rot,°yams /A?t Co Policy#or Self-ins.Lic.#0CC-600 —$OO 9 '45�O/ Expiration Date: i� ,O le023._.,. Job Site Address:, 8 P/ERc E 5 : _ City/State/Zip:. Ga. YARMOOT71 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do herebyLti471fj ren r th•e pains d pe ties of perjury that the information provided above is true and correct. Signature:-g Si C Dater e r ie /Z.3 � Phone#: 77er 483G ' C 85 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): I. Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Associated Employers Insurance Company 54 Third Avenue, Burlington, Massachusetts 01803-0970 (800) 876-2765 NCCI NO 40959 POLICY NO. WCC-500-5009565-2021A PRIOR NO. WCC-500-5009565-2020A1 ITEM 1. The Insured: Dan Speakman DBA: Dan A Seakman Construction Mailing address: 15 Speak Way FEIN:**-"*4938 Harwich,MA 02645-0000 Legal Entity Type: Individual Other workplaces not shown above: See Location 2. The policy period is from 11/10/2021 to 11/10/2022 12:01 a.m.standard time at the insured's mailing address. 3. A. Workers Compensation Insurance:Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers'Liability Insurance:Part Two of the policy applies to work in each state listed in item 3.A. The limits of liability under Part Two are: Bodily Injury by Accident $ 500,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 500,000 each employee C. Other States Insurance: Coverage Replaced by Endorsement WC 20 03 06 B D. This Policy includes these Endorsements and Schedules: SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules,Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Classifications Premium Basis Rates Code Estimated Per$f100 Estimated O No. Total Annual Annual Remuneration Remuneration Premium INTRA 000137314 INTER SEE CLASS CODE SCHEDULE Minimum Premium $550 GOV GOV STATE CLASS MA 5645 This policy,includingall endorsements,is herebycountersigned 9 by __----_-_-. _ 10/28/2021 Authorized Signature Date Service Office: HUB International New England LLC 54 Third Avenue PO Box 696 Burlington MA 01803 Wilmington, MA 01887 WC 00 00 01 A(7-11) Includes copyrighted material of the National Council on Compensation Insurance, used with its permission. 2/22/23,9:20 AM Mail-Sears,Tim-Outlook 8 Pierce Rd Sears, Tim <tsears@yarmouth.ma.us> Wed 2/22/2023 8:51 AM To: 'danaspeakman@hotmail.com' <danaspeakman@hotmail.com> Dan, I have reviewed your application and you are going to need Health Department sign off. Thank you Timothy Sears CBO Deputy Building Commissioner Town of Yarmouth 508-398-2231 Ext. 1259 mailto:tsearsjyarmouth.ma.us https://outlook.office.com/mail/sentitems/id/AAQkADE3MDQ5NWZmLTkOYzItNDIwNi1 iMDQxLWNkMGQyNmE4NzE5NAAQAJVtmnDFnGxLhIvoELgje... 1/1 TOWN OF YARMOUTH HEALTH DEPARTMENT PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Building Site Location: 8 /0/C`/ 'CE E....214osed Improvement: a /c^ R 7e,4 �'Y1�vcJ e szce_ Applicant: 7;)4A) 4. P 7ir' A) Tel. No.: 9 BAG. C,-Sa Address: /S , S10 4/e-C" G c/r9 J �- l9 i2 4) /c.c/ Date Filed: Z/2 7/23 **Ifyou would like e-mail notification of sign off,please provide e-mail address: Owner Name: Owner Address: 5"f Z ��0, 304 2'4 A d) lv 1.'1e Owner Tel. No.: 7 /- 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. 424, Please submit three (3) copies of plans, to include: ; �� (1.) Site Plan showing existing buildings, water line location, y �p and septic system location; Zs f 17y®� (2.) Floor plan labeling ALL rooms within building 'OT (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: COMMENTS/CONDITIONS: PLEASE NOTE t-toU5e w l ( � 3 3e d vc: c"S •_ �_ �-� 2 fir- r-l�v rL t I I ..11.11,1111111111. orrimmrmirrrrorm— lijul-- o o-i lanimin II J i II 1 •o _R ea 3 If Ili ; I. !II 04) ....I ammo) to [o 'i 2 M. m m.. ,,, G W 0' 1 IIg 00 ,'O i I MI II . --] 11 1 1 1111 , ,- o MI a I y I p• i II 3 0 ____—_ =, ....] rr I-1 1 1 r• T1 f;m..m,I "13 a a A Iv CI .... o r ..!.. I1 . 8 8 N C alai ciili 6 . .tI r 1111,41 o h0 8w-- MUMM MOIMM imam 3 S ; L D 3 3 i '� iim DENNIS COLWELL I f. 9 g;� VARCHITECTS $ � ; ` ]C[Nt)M)Illf1,)Uli]]0).fOA)OAOUOM.W 0]0)) -J u )00.]]i.]I]]!.)061)S))N 4:,DG�NCWIfGI 4 £ i y I I • a M r i i 1= . IiliT 1 ci a �_ i O _ 5 (I> I I I 1 g miceprs 1 8 L _ I 11 l sL I'.... 10 �111! --a•i .�Y �Y111 --- h o 111 ■... i�'�MIMI IIIN Ell E 53 _ l .-~--:,_.�� ►�- Q Gnl • o --- i — ---- A r - I ammo I me .... z omum 8ur.---4. i : -- ill L 1-111 9 1 a , s s ; e 1 r DENNIS COLWELL , 2b • � AK � fi i c � TS vp� • S 9 l i -, - 8 �, I]) .fl 1l SIf[fi,SUIT!]0)_t0)t0)OUGX,W OCOff y 3 fo4ta I.ti t[I.foFaSYaaM]YVI]Y DC.NCXIitCi.COM