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HomeMy WebLinkAboutBLD-23-000705 '') it er . - .-oF•YaR BUILDING PERMIT APPLICATION .*' -3- APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE, OCCUPANCY OF, C OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING. y TT4 CnCC �. t:s Town of Yarmouth Building Department nL ,„. *3o, 1 146 Route 28 • Yarmouth. MA 02664-1492 Tel: 508-398-2231 ext. 1261 Fax 508-398-0836 ���� Office / (,v Usel Onlyt Planning Board Information Assessors Department Information: PerT11 ND'.7-Z 3`v LJaT6, Plan Type Map Lot Permit Fee $ A 0.06 I Endorsement Date / Recording Date New Deposit Rec'd. $ Date 8i%L� plan No. 1•4 Property Dimensions: Net Due $ I /0 0O 313E Other Lot Area(sf) Frontage(ft) Lot Coverage C 44 O5(4' This Section for Office Use Only Building Permit Number. Date Issued: tc Signature: '— / . Certificate of O 'paocy Building Official Date' is is notR E E Section 1 - Site Information I 1.1 Propert/y Address: 1.2 Zoning Information:.s/-4-44,7/ 4. , [ Alit BUILDING DEPA' NT Zoning District By sJ bge 1.3 Building Setbacks(ft) . /4 ell Front Yard Side Yards);.... Rear Yard Required Provided Required Provided Required I Provided 1.4 Water Supply(M.Q.L-c.40.S 54) 1.5 Flood Zone Information: Comments --ii� Private Zone: BFE Section 2 - Property Ownership/Authorized Agent 2.1 Owner of Record: Name(print) Mailing Address: Signature Telephone Telephone Email Address: 1 2.2 Authorized Agent: g• 57 �i#1f& C — ,,2< - /a, Z5' , y/. Name tI Mailing Address: , _ /)7// ) /v,TA/4U •Car Si_ ature Telephone Fax Email Address: Section 3 - Construction Services • 3.1 Llcens Co struction Supervisor. Not Applicable jel4 W!t'I t t) ////,�9,,#�1�� - License Number Addr tfv[/� ��/‘ -7)1 ei 427 /mil-4eilliti4PAr.14t. Expiration Date Signettu Telephone Email dress: 1, v •... . , I • • N;C., • 3.2 Registered Home,A Improvement Contractor) ' vt Company Hams / .�f'�w,- � � Not Applicable Li Vt Addre Registration Number 'dtf - �;�/ c z 7 �Y1 Expiation Date Sign to 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 of 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:I Not Applicable ❑ Name(Registrant): Registration Number Address Expiration Date Signature Telephone Section 5.2 Registered Professional Engineer(;) Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Hama Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility • Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address • Registration Number Signature Telephone Expiration Date Section 5.3 General Contractor l4! J/?N�4�r"t Not Applicable ❑ Company me/` •/ �/�' / A/ '2d Person Res on ibll#for Co st tion Address -c / ‘Cd..-( VV Signature Telephone SECTION 7 0b OWNER/AUTHORIZED AGENT DECLARATION i, ``''J / f.�ti 7�•!~ fit , as Owner/Authorized Agent . hereby declarettlif at 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. �l • Print Name Signature of Ownn:nt Date Section 11 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be completed by permit applicant 1.Building y� /"-x l!' 2.Electril Q/� Q v U 3.Plumbing/Gas I 4.Mechanical(HVAC) .r---. 5.Fire Protection 6.Total=(1+2+3+4+5) ,9-3C70 7.Total Square FL porneR amclures&addibxel I 1 2S Check Below 0 Conservation-Commission Filing (if applicable) ❑ Old Kings Highway&Historical Commission approval (if applicable) Section 6 - Description of Proposed Work(check all applicable) New Construction ❑ (tor multiple family only) No.o: Bedrooms (for multiple family only) No.of Bathrooms Existing Bldg. ❑ Repair(s) ❑ Alterations ❑_ Addition ❑ Accessory Bldg. 0 Type 'Demolition Other Specify: P fY: Brief Description of Proposed Work: 4•- r //S '71-e //Z Section 7- Use Group and Construction Type Building Use Group (Check as applicapable) Construction Type A ASSEMBLY ❑ A_I ❑ A-2 ❑ A-3 ❑ to ❑ A-4 ❑ A-5 ❑ 19 i] B BUSINESS ❑ 2A ❑ E EDUCATIONAL , - — 2B ❑ F FACTORY ❑ F-1 ❑ F-2 ❑ 2C ❑ H HIGH HAZARD ❑ r 3A ❑ I INSTITUTIONAL ❑ I-t ❑ 1-2 ❑ 1-3 ❑ 39 El M MERCHANTILE ❑ 4 ❑ R RESIDENTIAL ❑ R-1 ❑ R-2 0 R-3 ( SA ❑ S STORAGE ❑ 5-t ❑ S-2 0 59 U UTILITY ❑ SPECIFY: M MIXED USE ❑ SPECIFY: S SPECIAL USE I ❑ SPECIFY- (Complete this section if existing building undergoing renovations;additions and/or change iri use. Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34 Proposed Hazard Index 780 CMR 34 Section 8 Building Height and Area I • Building Area Existing(if applicable) Proposed Number of floors or stories include basement levels Floor Area per Floor(st) Total Area All Floors (sf) Total Height (ft) Section 9 - STRUCTURAL PEER REVIEW (7B0CMR 110 11) Independent Structural Engineering Structural Peer Review Required Yes No SECTION 10a OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPJES FOR BUILDING PERMIT l =' Z 7" 1/(- 4 /'L , as Owner of the subject property, hereby authorize 4 / ,/ C'�U iJe--- to act on my behalf, in aiLa9atte relative t work authorized by this building permit application. / Oats Signature of Owner--' THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only be HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: _LYPE;LLC— Office of Consumer Affairs and Business, Registration: Expiration 1000 Washington Street -Suite 710 13,5887 - ,08!14/2024 Boston, MA 02118 A J NARDONE CARPENTRY LLC AICHAEL J. NARDONE �/// / '.99 WHITES PATH y A - '�(GG� s� �/(�1 /Als/ :OUTH YARMOUTH, MA`02664 ;--'-- yi, Undersecretary (of valid without signature Commonwealth of Massachusetts Division of Professional Licensure if Board of Building Regulations and Standards Constrt6tTnal ppyvisor /i CS-081139 Ec„pires:09/16/2023 MICHAEL J NARDONE f. 299 WHITES PATH SOUTH YARMOUTH MA 02664 - I4 ..lam Commissioner clai fi. i7UmciL 1 \ The Commonwealth of Massachusetts • �l , Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 ,,,.6Y• •r _ www.tnass.gov/dia \Y orkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print LeibIy Name (Business/Organization/Individual): '"1 Address: o2g9 j1i/1-Gg -WI-A ,1 City/State/Zip: S hiyr Ali y /fib- ©EGG',./ Phone #• Are you an employer? Check the appropriate box: Type of project (required): am a employer with / employees(full and/or part-time).* 7. New construction 2.— I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers'comp. insurance required.) 8. Remodeling 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑ DemolItion 4.0 I am a homeowner and will be hiring contractors to conduct all work on my roe I will 10 [] Building addition ensure that all contractors either have workers'compensation insurance or are sole proprietors with no em p 1 oyees 1 l•❑ Electrical repairs or additions , 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 12. Plumbing repairs or additions These sub-contractors have employees and have workers'comp. insurance. 13•El Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.0 Other 152,§1(9),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: 47,47 /the7%v4— Policy#or Self-ins.Lic.#: 36UC V O '723 W7 -, 4 Expiration Date: 3- Iz'.23 Job Site Address: a4 City/State/Zip: Akvmovi 641 e/2,; 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. 1 do hereby certify under,the/ p '' s and penalties of perjury that the information provided above is true and correct. V( f Signature: / 1/L�%�— Date: 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): I.Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: I / §TOWN OF YARMOUTH 1146 Route 28, South Yarmouth, MA 02664 508-398-22311 exte-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 cf,` (. /41- /¢d. Work Address Is to be disposed of oat the following location: )4 /1/,‘ A Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. gn tore of Application Date Permit No. Sears, Tim From: Sears, Tim Sent: Thursday, August 18, 2022 11:06 AM moo: 'mike@mjnardone.com' object: 296 Station Ave like, r have reviewed your application and we are going to need better plans with the area enlarged and dimensions.You will also need the Fire Department to sign off. Regards, f*(4_� Timothy Sears CBO Deputy Building Commissioner Town of Yarmouth 508-398-2231 Ext. 1259 mailto:tsears@varmouth.ma.us 1 MGL AND FIRE TOWN OF YARMOUTH lat'L iP REVIEWED FOR CODE COMPLIANCE. \\ ERRORS OR OMMISSIONS DO NOT RELIEVE Oil) THE APPLICANT FROM THE RESPONSIBILITY OF'AS BUILT'COMPLIANCE. \ oars- l DATE: g' 26.22 INSPECTOR YARMOUTH FIRE PREVENTION Commercial Construction Building Transmittal Project Name: DY High school room Address: 210 Station Ave. Contact Name: Brandon Faucher Phone: 774-994-7679 Description of planned project: I Y N NA Subject Regulation 1 X Access for Fire Apparatus 527 CMR 1; 18.2.4.1 X Building Numbers MGL C 148;sec 59 X *Flammable gas/liquid storage 527 CMR 1;42.2.2.1 X Fire Lanes 527 CMR 1;22.3 X *Service Stations 527 CMR 1 ;16.2.3,16.2.3.1,30.3.2 X *Hazardous Materials Storage 527 CMR 1;60.1 X *Kitchen Exhaust Systems* 780 CMR,527 1;50.1 X Extinguishers 527 CMR 1; 13.6,MGL C 148;sec 28 X Fire Alarm Systems/CO detection* 780 CMR,MGL C 148;,527 CMR 1; 13.7 X *LPG Storage Chapter 148;sec 9,10,28&527 CMR 1;69.1 X Use and Occupancy(FH Building Class) 780 CMR;302.1 X Sprinkler Systems* 780 CMR&Chapter 148 sec 26 A-I X Storage inside/outside Buildings 527 CMR 1; 10.19.4,4.4.3.1.1,19.1.2,34.1.1 X *Upholstery 527 CMR 1;20.6.2.5 X *Trash Containers 527 CMR 1; 19.1.1, 1.12 X Any Hazard to the Public MGL Chapter 148;sec 28 X *Curtains,Draperies,Blinds 527 CMR 1; 12.6.2 X Safeguarding Construction NFPA 241,527 CMR 1 Ch 16, 16.3.1,2; 16.3.4.1 X Hot Works Permit,where required 527 CMR 41.1.5.3 * YFD permit required-depending on occupancy and submittal Compliance with the following: 527 CMR 1 Chapter 16 "Safeguarding Construction, Alteration, and Demolition Operations." 780 CMR Chapter 33 *Permit is required for temporary shutdown, alterations or proposed removal of fire protection systems. Yarmouth Fire Department supports the application, subject to applicable submissions, permits and inspections. Plan Reviewed By: Lieutenant Matthew Bearse Date: August 26, 2022 Copy for Applicant Copy to Building Department Copy to Fire Prevention Entered in Firehouse Final Inspection gR