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HomeMy WebLinkAboutBLD-23-003109 .of•Yqie BUILDING PERMIT APPLICATION Z�Y "tr APPLICATION TO CONSTRUCT,REPAIR,'RENOVATE,CHANGE THE USE,OCCUPANCY OF, t� G OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING. _ "t Town of Yarmouth Building Department 11"Z`:•T • GO 1146 Rome 28 • Yarmouth. MA(2664-1492 Tel: 508;398-2231 ext. 1261 Fax 508-398-0836 r Office Use Only Planting Board Information Assessors Department Informed= Permit NQ. � L11"23-' h 11 3dt1 Pint Typt: Mae Lot Permit Fee y d\g3-� car,. tkw / '� , Deposit Pec'd. $ _ i�t ate Dan 1.4 Property Dimensions: xew Net DueOO Other Lot Ater(sl) Frontage(ft) Lot Coverage ��\J\� This Setxfon for Olds►Use Only Building Permit Number. Date Issued: Cettficate of Occupancy Buddng pats is Is not required Section 1-Site information 1.1 Property Address: 1.2 Zoning information: 923 Rt 6A Yarmouth Port Sunflower Market Place Zoning District Proposed Use 1.3 Ruitdbry Set becks(ft) Front Yard Side Yaras Rear Yard Required Provided Required Provided Required 7 Provided 1.4 Wafer faespy(M.O.L c.40.$54) 1.5 Rood Zone irformafa. Comment: Public Private Zona EIFE: Section 2-Property Ownership/Authorized Agent 2.1 Owner o4 Record: Chapter Two LLC,James N Basler Manager PO Box 206 Yarmouth Port MA 02675 Naine(PrinU7 , :1 Mailing Address: V. l ` ; '--- '5O8 423-9311 jbasler©comcast.net Sigs7alun, Telephone Telephone Email Address: ,' 22 Authorized Agent Tli lt-N e 2 13(\,c, 1,-(il_ / ' Nr,( ) _ J` iikA V t,.D v i-(�t I)04 ( 6-2(2 7 / S(gnature Telephone Fax Email Address: Section 3-Construction Services s.t Licensed Construction Supervised Not Applicable 1J / 1-, f)c.A-G- J tv (34._s -t,c/t / 2-4 -7---2k . x C License Number Add.. 3 --?- 2- V L t"1-1-Vy7 1. G)° , t 6'1, -7 "_ Expiration bate Signature i T Email Address: �g f eOt� ✓ l, s., Vistw o1VED Vim . RECEIVED ( DEC 212022 DEC 0 22022 B U I LeK - - B U I PA ,µ-f By l��► tviv6 • s 414 }:..{ • r' t. • i• • • rci/C. • ( 1'L 3.2 Registered Home Improvement Contractor:I •Company Mame Not Applicable IJ Registration Number Address Expiration Date Signature Telephone Section 4-Workers'Compensation Insurance Affidavit(M.G.L c.152$25C(6)1 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 OAR 116(containing more than 35.000 c.f.of enclosed space) I Section 5.1 Registered Architect Nat Arocable Maine(Registranth Registration Norritier Address Expiration Oats ISignature Telephone Section 5.2 Registered Professional Engineer(s) Name Area of Responsibil ity Address Registration Mintier Signature Telephone Egaration Date llama Area ot ReVOnStittY Address Registration Number Signature Telephone Eapiradon Date Name Area of Resporishility Address Registration Number Signature Telephone Expiration Date %WOO AMA ot Responsibility RestT*Or Numbs Address Signature Telephone Expirat Date ion Section 5.3 General Contractor Not APPlaCabla. Company Name Person Responsible for Construction Address Telephone Signature of 4 , , • " ' • Sectibn 6-Description of Proposed Work(check all aPRICabiTori ' New Construction C3 (for multiple family only) No,of Bedrooms (for multiple ramily only) No.Of Bathrooms Existing Bldg. 0 Repair(s) Alterations (.3 Addition E3 Accessory Bldg. 1:3 Type Demolition Other Specify: I Brief Description of Proposed Work: Remove non bearing interior walls as shown on attached plan Section 7-Use Group and Construction Type Building Use Group(Check as applicapable) Construction Type A ASSEMBLY Ci A-t A-2 (3 A-3 (3 IA C) A4 A-5 la is c) B BUSINESS C2 2A 3 E EDUCATIONAL C) 2s 3 F FACTORY fa F.1 (3 F-2 a ac Q H HIGH HAZARD CI 3A Cl INSTITUTIONAL 1-1 0 1-2 3 I-3 (3 39 Q M MERCHANT/LE 3 4 0 R RESIDENTIAL R-1 1 R-2 0 R-3 5A S STORAGE CI S-I C:1 se Q U UTILITY SPECIFY: Al MIXED USE (3 SPECIFY: S SPECIAL USE C1 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 780 CUR 34 Section 8 Building Height and Area Busting Area Existing(if applicable) Proposed morrow of floors or stories indkide basement*vets Floor Area Par ROor(st) Total Area Ail Floors(sf) 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 OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1 Chapter Two LLC,James N Basler Manager . ,as Owner of the subject property, hereby authorize James N Basler to act on my behalf, in aft matters relative to work authorized by this building permit application. December 1,2022 Signature of Owner Oats 3o14 OVER ) SECTION 10t..)OWNEW AUTHORIZED AGENT DECLARft rtoN 1 James as Owner/Authonzed Agent hereb92I` rare 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. James Basler Pant Marne ti ' -- Dec 1,2022 Signature of Owner/Agent __. Data Section II-ESTIMATED CONSTRUCTION COSTS Item EstMttated Cost(Ooeats)to be competed by t applicant Tr 9utacting:> 2 Electrical 3 Plum r Gas 4.Mechanical(HVAC) S Fire Pmaec¢on tiTopN.S1.2o3+4+S> 17.Taal SQuitre Ft.tb nrt+aazaaa i addadwt Check Below J Conservation-Commission Filing (if applicable) Old Kings Highway&Hietoaal Commission approval (if applicable) • ;� yxt� s • a hy ; u k f n x • �' �?s"��w'`�3'fi� � � arr. ✓ `rwa � � y` ", • Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Re I lations and Standards Consort Sisor CS-012929 spires:03/08/2024 � •w � �'� �. JAMES N BALER : i PO BOX 366 i 7 ' �i YARMOUTH*pm' :. , ,. • Commissioner eiciirt K. t"'l°`' - The Commonwealth of Massachusetts 4, � „.t Department of Industrial Accidents _=,....6- i: Office of Investigations __;;�; 600 Washington Street _'= Boston,MA02111 w�ww.mass.gov/din Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): James N Basler Address: 42 Vesper Lane Box 366 City/State/Zip: Yarmouth Port, MA 02675 phone#: 508 423 9311 Are you an employer?Cheek the appropriate box: Type of project(required): I am a employer 4• 0 I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction listed on the attached sheet 7. Rf Remodeling ✓i am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp.insurance.t 9. 0 Building addition required:] 5. Q We are a corporation and its 10.0 EIectrical repairs or additions 3.❑ I am a homeowner doingall work officers have exercised their . 11.0 Plumbing repairs or additions myself.[No workers' comp. right of exemption per MGL 12.0 Roof'repairs insurance required.]t c. 152,§1(4), and we have no _ 3a.❑ I am a homeowner acting as a employees.[No workers' Other general contractor(refer to#4) insurance ce required.] 'Any applicant that checks box#1 must also fill out the section below showing[her works'compensatio4oiicy 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. :Contractorsthat check this box must attached an ndir[itional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contactors 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: 923 Rt 6A unit U 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 Section 25A of MGI.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 DIAL for insurance coverage verification. I doh evy certi and 1 pains and penalties of perjury that the information provided above is true and correct d Signs December 1,2022 Date: Phone : 508 423-9311 f 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#: :erg Y � TOWN OF YARMOUTH % BUILDING DEPARTMENT o ' "1- 1146 Route 28,South Yarmouth,MA 02664 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 923 Rt 6A unit U Work Address Is to be disposed of at the following location: Nauset Disposal Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. \j\k, - '" December 1,2022 Signture of Application Date Permit No. Remove non bearing walls —........... /; 11, i 0 <, • le) CI 1 / \ \ . • • hvac • • i 1 M U a :-.. / _........4.. ,....... RR 'Iry,.., �7� • At • 0t,1P11- Unit U A. - r,:THE C(:).,li' 1wC, .. . ;BUILT" n i BL):_-..,s \ii Caiuy1_ Sunflower Market Place 923 Rt 6A • Yarmouth Port Massachusetts Building 7 • Unit U October 26, 1999 scale 1/8" = 1' drawn by: jnb Remove non bearing walls-------- r i CI / / l' -"'Imi.ains-', \jr,ciA ! \ \\. ct ilcta .', / . . t, 1 l r• J hvac r __Lir_______„'-*7-- /V1/4-A-4.f.‘„,, 'N'- ... . .. 1 ... .. .. Unit U Unit V • Sunflower Market Place 923 Rt 6A • Yarmouth Port Massachusetts Building 7 • Unit U October 26, 1999 scale 1/8" = 1' drawn by: jnb famed I I \ playground unit H Building 3 -- un J Building 4 Building 2 unit K ""its Sunflower Market Mace unit l i \ 1 °nit` _ 32,086 square feet unitF I I I l ^ I unit M I i J unit N unit F 2nd Floor i` unit Q ^ 2nd Floor i unit 0 i I _ 1--- [i untE HC' its i 01.111.** unit R i i —- unit D - i unit L ea i vt ;v � He Flexible Fitness Unit U unit AA Site Plan unit 5 2nd.Floor ' SUNFLOWER MARKET PLACE I /fig§§ �M1 j( unItC 923 RT. 6A YARMOUTH FORT, MA 02675 unit Y unit A `•, , unit W 6 X unit 00 ' Map 143 Building 1 unit V unit U 2nd Floor unit Z r Lot111 Building 7 Building 5 ' un t r Building 6 Sca 1e:1"=50' ) U is /1 drawn by,jnb 8/27/92 revised 12/4/18 Sunflower Market Place 32,086 square feet ROUTE 6 A