HomeMy WebLinkAboutBLD-23-001876 'Of 'I ialz_
..• , ,
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• . pF'.'AR BUILDING PERMIT APPLICATION
• ..cEO APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE, OCCUPANCY OF,
• E�„�_+r ._�. OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING.
-_. . __ - Town of Yarmouth Building Department
M4 , CS
�C I U,.'.-..,••* 11-ffi Route 28 • Trrnouth, MA 0266-1—(49`2
L
_; il Tel: 508-398-2231 ext. 1261 Fax 508-398-0836
BIJILDIN ., DEPARTME - Use Only Planning Board Information Assessors Department Information:
dy __ ; k 3-C144ate Plan Type Map Lot
s g ts�p Endorsement Date /� /, d
Permit Fee $2
Recording Date New
Deposit ReC'd. $ (AD Date Plan No. f•�Py Dimensions: �U
Net Due G S/ > 7,,
�� $ ' k' J Other Lot Arta(sf) Frontage(tt) Lot Coverage
0.. I b NLThis Section for Office Use Only
Building Permit Number: Date Issued:
Signature: _____ //-II-4 - . Certificate of Occupancy
Building Official Dater is Is not required
Section 1 - Site Information I
1.1 Property Address:,, 1.2 Zon' g Information:
Li7wei,i.
pmt f
7 mckiv6:e •
-4a,74,_444
'C -04 0 )-6-gi Zoning District Proposed Use
1.3 Building Setbacks(ft) .
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required PProvided
g0 9z 6/ - -s
1.4 Water Supply(14.Q.L.c.40.S 54) 1.5 Flood Zone Information: Commentx
Public Private Zone: BFE
Section 2 - Property Ownership/Authorized Agent 1
n 7o j zu 7(�5 e/Y,,7 ./.. / Sf"
Na (print) Mailing Address:
`— — 24_ _/ .5./ sbii .x./3-/ c 1114-#01v rt,ft IN,tofu
Si ature Telephone Telephone /
Email Address:
2.2 Authorized Agent
Name(print) Mailing Address:
Signature Telephone Fax Email Address:ess:
Section 3 - Construction Services
3.1 Licensed Construction Su rvis n Not Applicable
r ✓ �c
An l 9- gejet4i6i �3'4/ License Number_ ,�'Addt� ff �` ' 7 T!�' V�6
`?1/3/ l I ��'440444e y C i vo. Expiration Date
Signahre Telephone Email Address: M //) /-le)- 7
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3.2 Registered Home Improvement Contractor. '
Company Name Not Applicable 0 -
Registration Number
Address
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 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
Not Applicable ❑
Name (Registrant):
Registration Number
Address
Expiration Date
Signature Telephone
Section 5.2 Registered Professional Engineer(s)
Name / _n I Area of Responsibility
�sG.�- l'�4. ,.�,w�ST�ru�s�-,�n ®�� � • /� /y/ape/�
Address/ `i lt e ✓J 0 V+13 �— / ��3 Regis La gp Vivo
Signature J �lj�/j)/_ (J)...35 6 Telephone Expiration Date
Hams 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
Qk1 7 nelrhy,reyNot Applicable ❑
Company Hams
Person Res onsi for C �Wction
Address ,,S.''
�./"( /
0 r'i�/cS/
Signa Telephone
• , Section 6 - Description of Proposed Work (check all applicable)
• ' New Construction ❑ (for multiple family only) No.of Bedrooms (for multiple family only) No.of Bathrooms
. Existing Bldg. ❑ Repair(s) 0 Alterations . AddWig
Accessory Bldg. ❑ Type Demolition Other Specify:
1
Brief Description of Proposed Work:
#PP/ Y 9(e/(1 /-tiviei_ sJed Aiiii.okte 5;1AAri- 74 i
74;4-fi,m,[(44/Le .-to 3 sizief 6,if &0\i' Ascg,(4._ --7--sw
Section 7- Use Group and Construction Typel
Building Use Group (Check as applicapable) Construction Type
A ASSEMBLY ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑
A-4 ❑ A-5 ❑ 1 B ❑
B BUSINESS ❑ 2A Et
E EDUCATIONAL ❑ 2B ❑
F FACTORY ❑ F-1 ❑ F-2 ❑ 2C ❑
H HIGH HAZARD ❑ 3A ❑
I INSTITUTIONAL ❑ I-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑
M MERCHANTILE ❑ 4 ❑
R RESIDENTIAL ❑ R-1 ❑ R-2 0 R-3 ❑ 5A ❑
S STORAGE I5�� S-1 S-2 ❑ s8 ❑
U UTILITY T❑
SPECIFY:
M MIXED USE ❑ SPECIFY:
S SPECIAL USE ❑ 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 CMR 34
Section 8 Building Height and Area
Building Area Existing (if applicable) Proposed
Number of floors or stories w
include basement levels 1,
Floor Area per Floor(sf) 3J`,0 3 5
Total Area All Floors (sf)
Total Height (ft) 1 ,:_4(.)"eel
Section 9 - STRUCTURAL PEER REVIEW (730CMR 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
I, if( , as Owner of the subject property,
hereb orize to act on
my ehaif, in all matters relative tor_worikAuthorized by this building permit application.
Signatur t�Owner Date
I
r .
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SECTION 10b OWNER/AUTHORIZED AGENT DECLARATION
, 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.
rint game
/ Jy/r
Si a re of Owner/Agent Date
ection 11 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be
completed by permit applicant
1.Building
qo1 0 0
2 Electrical 171 U
3.Plumbing/Gas 0
4.Mechanical(F-WAC) d
5.Fire Protection D
6.Total=(1 +2+3+4+5)
7.Total Square Ft.(tornewsmc3„as&atl1bxe) 9L( ()6
Check Below
❑ Conservation-Commission Filing
(if applicable)
❑ Old Kings Highway&Historical •
Commission approval
(if applicable)
TheCommonwealth o
� of Massachusetts
Department of Industrial Accidents
.` y 1 Congress Street, Suite 100
Boston, MA 02114-2017
..5„• www.mass.aov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information
Please Print Leeibty
Name (Business/Organization/Individual). `)o, /V /_ a'V 47
Address: /ô ) /01/4&L :ed
City/State/Zip: � ; �i ,�1, Phone #: ‘�- 2—/sr(
Are you an employer? Check the appropriate box:
Type of project (required):
1.[ I am a employer with employees(full and/or part-t me).* —
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. I am a homeowner doing all work myself. [No workers'comp.insurance required.]t 9. ❑ Demolition
4.[I am a homeowner and will be hiring contractors to conduct all work on myproperty. I will 10 [ Building addition
ensure that all contractors either have workers'compensation insurance or are sol p 11.[ Electrical repairs or additions
proprietors with no employees.
5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet 12.7 Plumbing repairs or additions
These sub-contractors have employees and have workers'comp. insurance.t 13 [Roof repairs
6.0 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.
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. 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, §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.
I do hereby certi wilier the pains and penalties of perjury that the information provided above is true and correct.
Signature: 7 Date: !/I ��J /� ' Z
Phone#: Ci-6 ?- ic�/
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#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is defined as"an individual,partnership,association, corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner ofa dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6) also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and,if
necessary, supply sub-contractor(s)name(s), address(es) and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy, please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the.applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current
policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston, MA 02114-2017
•
Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax# 617-727-7749
Revised 02-23-15 www.mass.gov/dia
§TOWN'OF YARMOUTH
1146 Route 28,,South Yarmouth, MA 02664
508-398-224 next. .1261 Fax 508-398-0836
Office of the Building Commissioner
• 1
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 % 4,4k;c: AO'
Work Address
Q,6 lac 5r '
Is to be disposed of oat the following location: --C6-1101 9/Ovilt v//
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Ch. 114 §150A.
a
7 7)e/2—-71
Si ature of Application Date
Permit No.
Sears, Tim
From: Sears, Tim
Sent: Tuesday, October 18, 2022 12:48 PM
To: 'Ted Mahoney'
Cc: Slack, Christine; Bearse, Matt; Huck, Kevin
Subject: 49 Whites Path
Ted,
I have reviewed your application and there are some items needed.
ti/1. Health Department sign off
Fire Department sign off
37 —Plamshowing-f4oarslrains_required-by✓2 ��51Umbing &-gas-code) ---
I spoke with Kathy Williams about design review, and it will not be required.
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
1
oy..y4iii TOWN OF YARMOUTH
440„
HEALTH DEPARTMENT
t PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant: Cam
Building Site Location: ( I� Y AV ticmt � ' ''Zr /14
Prqppsed Im ro e ent: r el C 5,�i?1 7,�yi , /1 4 , ,
Applicant: --y i5orpf- - .
t .ertfC�' }''7 7,/" Tel. ''Z'� ��
e No..
Address: OW2.
2e� /i f/7Z
f �1�1� '3' / Date Filed: ld
**Jf vou would like e-mail notification of sign off'.'please provide e-mail address: t- i 4tm'""v/ e f ►C Y U.ceri '
Owner Name: l 7 1' 14 i 7 1°Sk9
Owner Address: /2 t:262•r vt _cci r Owner Tel. No. dF' -5 V5,37
.&zie:-e-1-1/-01-.i At- e,--3,-9"
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:
EL1UVLL (1.) Site Plan showing existing buildings, water line location,
OCT 1 a 2022 and septic system location;
(2.) Floor plan labeling ALL rooms within building
HEALTH DEPT. (all existing and proposed) —
Note: Floor plans not required for decks, sheds, windows,roofing;
(3.) If necessary, Title 5 application signed by licensed installer
fee.
REVIEWED BY: DATE: l G O''i
PL SE NOTE
COMMENTS/CONDITIONS:
•
•
Commonwealth of Massachusetts
it Division of Occupational Licensure '
Board of Building Regulations and Standards
Const iort S ' /,visor
CS-010562 s• .i cpires:01/26/2024
JOHN T MAHpNEY, Ili f
rill
100 PEARL ST
BRIDGEWATE:$MA 02324
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Commissioner &lett K. UlCmck,t.k.
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FOUNDATION AS-BUILT DCE #20-343
LOCATION : #49 WHITES PATH SOUTH YARMOUTH, MA
SCALE : 1" = 100' DATE : 11-8-2021 PREPARED FOR:
REFERENCE : MAP 97 PARCEL 20 FAIRVI /, ' ' ►�: WORK
,/ot DANIEL o,•°,
I HEREBY CERTIFY THAT THE STRUCTURE z4 A. "�'.
SHOWN ON THIS PLAN IS LOCATED ON THE o OJALA N
GROUND AS SHOWN HEREON. Nu.40980,,, /
off 508-362-4541 .G.„
'� a`r
fax 508-362-9680 ( g3Sk0 P
downcopo.com o 4N'9U'V��O/
Jowls ceps enjideering i c. I , C`C r)
Civil engineers 1 ( /r ji�,Z_i �`
land survey+vrs / `
939 Moir) Street (Rte 6A)
YARMOUTHPORT MA 02675 DATE REG. LAND SURVEYOR
Initial Construction Control Document
To be submitted with the building permit application by a
1 Registered Design Professional
for work per the 9th edition of the
um,0• Massachusetts State Building Code, 780 CMR. Section 107
Project Title: Fairview Millwork Storage Building Enclosure Date: July 26.2022
Property Address: 49 White's Path, South Yarmouth, MA
Project: Check(x)one or both as applicable: XX New construction XX Existing Construction
Project description: Partial Wall Infill for 50' by 140' Existing Pre-Engineered Steel Building.
I,Robert Desrosiers, MA Registration Number: 36770 ST Expiration date: June 30, 2024, am a registered design
professional, and I have prepared or directly supervised the preparation of all design plans. computations and
specifications concerning':
XX Architectural XX Structural Mechanical
Fire Protection Electncai 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 conforrrancc- to this code and the design concept, shop drawings, samples and other submittals by the
contractor in accerdn_ice 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
electronic signature and seal:
+ v
7 Z(o-z
Phone number: 508-946-3561 Email: robdesrosiers.asap(cvverizon.net
Building Official Use Only
•
Building Official Name: _ Permit No.: Date:
Version 06 I 1 2013
IsitCAL AND I iRE.
13/ W 'ARM UTH
e P 1EWEO FOR a,r t A0,EL JC E
ERRORS P OM"r1 S [ONS OE,,4,1 it ,t°;`
C.,A. t THEAPPLIi.AN i, OM r.i 1 3 rp,€ ;;'"
OF'AS BUIt COMP],*r,r;c
'tri 0Al l0-t .2.
YARMOUTH FIRE PREVENTION
Commercial Construction Building Transmittal
Project Name: Fairview Millworks Address: 49 Whites Path
Contact Name:Joe Santos Phone: 401-256-9056
Description of planned project: Add walls to existing T shed
1 V N NA Suhhect Reulatiun
'1 X i Access for lire Apparatus 527 C' 1R. 1: 18.2.4.1
X 1 Building Numbers MGL C 148;sec 59
X I *Flammable gas/liquidstnrage__.. 527 CMR 1;42.2.2.1
X t Fire Lanes 527 CMR 1;22.3
X , *Service Stations 527 CMR i 16 2.3.16.2.3.1,30,3.2
X 1 *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 Sy=step s/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 1
X Use and Occupancy,(FH Building Class) 780 CMR;302.1
X Sprinkler Systems* 780 CMR&Chapter 148 sec 26 A-1
X Storage inside-outside Buildings 527 CMR I; 10.19.4.4.4.3.1.1,19.1 34.1.1
X *Upholstery 527 CMR I;20.6.2.5
_ —
X ' *Trash Containers 527 CMR 1; 19.1.1, 1.12
X Any Hazard to the Public I MGL Cha er 148;sec 28
X j , *Curtains,Draperies,Blinds _._...,......._: 527 CMR I: 12.6.2
I X Safeguarding Construction ._ EPA 241,527 CMR 1 Ch 16, 16.3 12; 16.3.4.1
( X 1 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 I Chapter 16"Safeguarding Construction.
Alteration,and Demolition Operations." 780 CMR Chapter 33
'Permit is required for temporary,shutdown,alterations or proposed r t:oval of tire
protection systems.
Yarmouth Fire Department supports the application,subject to applicable submissions,
permits and inspections.
Plan Reviewed By: Lieutenant Matthew Bearse Date: October 19,2022
Copy for Applicant El Copy to Building Department I J Copy to Fire Prevention I I
Entered in Firehouse J-i Final Inspection