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HomeMy WebLinkAboutBLD-23-002422 y pu / I wwZ 2 ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department ,. 1146 Route 28, South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 _ Massachusetts State Building Code, 780 CMR Building Permit Application To Construct, Repair, Renovate Or Demolish ..\ _._..,_ ' a One-or Two-Family Dwelling I V E D This Section For Official Use Only I -NOV Building Permit Number: !3L 23--Ob 42 L Date Applied n 1 21th / . .5 i / 1�, IS- tb B UILDINrN tW D PflR MENT „ Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Properi. ctr- 1.2 Assessors Map&Parcel Numbers 1.1a Is this an accepted street?yes3( no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public Private 0 Zone: — Outside Flood Zone? Check if yes❑ Municipal 0 On site disposal system SECTION 2: PROPERTY OWNERSH]P1 2.1 Ownerlacgrd: /_ �/ 11 `�N P`Irr-t,� /,' 1 / 4 1 .6f 6 7_3Name(Print) 7��� � City,Sta ZIP k iv 1 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 ( Existing Building 0 Owner-Occupied 0 1 Repairs(s) 0 Alteration(s) Addition Demolition k,4 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: ea,o...04 E K/ic_itto [Wee" X/S ft-ir Pe G k ee L�t1 ec K w' /4us E.cl S?� h r,�r .�c.It u v,„ C, , c:I 3e� X c)o rt clad w/ r•I-riN - SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: (Labor and Materials) Official Use Only 1. Building $ 1. Building Permit Fee:$SC) Indicate how fee is determined: 2.Electrical $ ®Standard City/Town Application Fee 0 Total Project Cost3(Item, V,,�16)x multiplier x 3.Plumbing $ 2. Other Fees: $ to 0.0 hLf' 5-14 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire e< \� Suppression) $ Total All Fees:$ �\ Check No. Check Amount: Cash t:D6.Total Project Cost: $ J G , �/pt ❑Paid in Full Fr Outstanding Balance D : LkL 1 � ti Ili - 7. SEC'i'ION 5:%CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) C S-69 6'04 fl-l1(-z,-z zd (5-2tic& License Number Expiration Date Name of CSL Holder 6 ;-k , .>, List CSL Type(see below) 0 No.and Street"""��V ' "/yZ 1/✓ J Type Description 1 *LVOV A �/ aZ [ .- U Unrestricted(Buildings up to 35,000 Cu.ft.) City/To State,ZIP V EJ R Restricted l&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding Solid Fuel Burning Appliances 1-044 4R.✓ / "d►jeflied SIF Insulation Telephone Email ad ress D Demolition 5.2 Registered Home Improvement Contractor IC) Le()15 I>w�/ /�/l g e 4 ie 47 L is-C /�.�12� � y-�Y z3 HIC Company N.i e or�3IC Registrant Name-41 HIC Registration Number Expiration Date No,and Stree 'tip 1 2eaisbc.ty 44.i aeese fig+-ter/,(a. 0 22" 136Z Email address 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 of the building permit. Signed Affidavit Attached? Yes No 0 SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTrOR� APPLIES FOR BUILDING PERMITI,as Owner of the subject property,hereby authorize L V V �l to act on my behalf, in all matters relative to work aut ' ed by this building permit application. Print Owner's Name(Electronic Signature) Date SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this appl' .tion is true and acc . - o the best of my knowledge and understanding. A - Z$—zv Print Owner'. or Au , -ed Agent's Name(Electronic Signature) Date NOTES: 1. 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 RIC Program can be found at www.mass.zov/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.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" _ The Commonwealth of Massachusetts Department of Industrial Accidents i =u�l_ , I Congress Street, Suite 100 ` Boston, MA 02114-2017 .. ''`> www.mass.g o v/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): leis f%"1,t,` /1 ldCtle/Wad�tv Address: .. / City/State/Zip: lilt >h1If141,1& Phone #: 4 g Z2, (3 b ? Are you an employer?Check the appropriate box: AnI am a employer with Type of project(required): employees(full and/or part-time).* am a sole proprietor or partnership and have no employees working for me in 7. E New construction y capacity.[No workers'comp. insurance required.] 8. Ej 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 property. I will 1 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.� Electrical repairs or additions proprietors with no employees. 5.0 1 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.: 1 Roof repairs 6.111 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§I(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 infonnatior. I.Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 1Contractors 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 itzformation. 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 certify under the pains and penalties_of perjury that the information provided above is true and correct. &m__4fs;:: ::)""'"--"------ .. ature: Date: Ip Z D -Z-Z 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 508-398-2231 ext. 1261 Fax 508-398-0836 Office of the Building Commissioner 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 `� / A--ve Work Address Is to be disposed of at the following location: J t."- frt 6 7 pc1(21441/u11/1 Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. J z6 - L Signat Applicant Date Permit No. .: . Li Li {mar IL- (.0 SECTION 5: CONSTRUCTION SERVICES 5.C stuei on Supervisor License(CSL) "��T • _._._...__...:..............................._ License Number Expiration Da Marne of GSL Holder "'�"`.""'-"—•'----• � Date ' `- List CSL Type(see b^_low i No.and Street Type ( Description i U i Unrestricted(Buildings up to 35,00cu ft.) City/Town,State,ZIP " — R Restricted i k2 Family Dwclline Masonry L. RC Roofing Covering 1 WS Window end Siding SF Solid Fuel Burning Appliances i r _ Insulation Tele hone Email address D ' Demolition _ j 5.2 Registered Home Improvement Contractor(HIC} j HIC Company Name or HiC Registrant Name HIC Registration Number Expiration Date No.and Street " Email address f City/Town,State,ZIP Telephone I 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 I this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes 0 No 0 „,• SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN i OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUIL ING PERMIT j ctc•''_,,.'S fi ll l � I,as Owner of the subject property,hereby authorize ,,., � S I �� `� fix S't c..., • to act on my behalf,in all tn tters relative to work authorized by this building permit a lication. ON Pe ,�Z cie-pt S _ ! 012,q) c)'r}' Print wner's Name(Electronic Signature) Date '.''`.1 . SECTION 7b:OWNER1 OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information 1 contained in this application is true and accurate to the best of my knowledge and understanding. I f 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 3. (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty find under M.G.L.c. 142A.Other important information on the HIC Program can be found at ,,vww,,vw,mass,so�Coca Information on the Construction Supervisor License can be found at www.mass.gov/dos 7 Whe substantial sntaantial work is planned,provide the information ludmelgarage,finished basement/attics,decks or porch) Total floor area(sq.ft.) ( g Habitable room count Gross living area(sq. •) Number of bedrooms Number of fireplaces Number of balfibaths Number of bathrooms-----_____ afnrootns Number of decks/porches Type of heating system Enclosed Open s stem Type of coolie, Y a �: rare Footage"maybe substituted for"Total Project Cost" i 3• Total Project Square i ; `— 0. OXIee of Consumer Afbes A Business Regulation HOME IMPROt4EMENT COMPACTOR Regrstratwn vend for(ndvidu0l use only 'TYPE:LI C 60401* a expiration date It found return to: Rc0 s58d00 E71DIr*tlOU Dtea Qt Cnneumer AHalrs end Business Regulation 115726.. 04,+24,2023 Bost Weshintiton SHeet-Suite 710 LEWIS BAY MANAGEMENT LLC. Boston MA u2t10 EDQ'HERITAGEARDSTAFFDRORD,. ^4 " 6a 2e.'.tt W,YARMOUTH,MA axJ Undersecretary f VBiUt 'Pg� r it Conunoon RaBl ml Massacnas0R0 ,� brviswo of Professwnai LILORSWP Board of Buedvg RegotOtions and Standards Ionst Jdn uPoraiGar 7„ Cs°4"En Y© XPlres:1111Ar20 2?= EOWARO T$TAFK ,, 64HERITAGE ORNOr ; , ,p> rr' W YARMOUTN,MA.O ? Sears, Tim From: Sears, Tim Sent: Thursday, November 17, 2022 9:50 AM To: 'Ed Stafford' Subject: 44 Park Ave Attachments: work in flood zone packet.PDF Ed, I have reviewed your application and this property is in a flood zone.Attached is a packet to review, we need the cost worksheet filled out along with the contractor and owners affidavits notarized and returned. The final affidavit will be required at the time of final inspection. Please submit for review Timothy Sears CBO Deputy Building Commissioner Town of Yarmouth 508 398-2231 Ext. 1259 mailto:tsears@varmouth.ma.us \\\\ ) o(K) ')\ ')20° QX\ )Noc) t)Q Vf\t'fi)‘ 90\ } c.R( ,� TOWN OF YARMOUTH °; HEALTH DEPARTMENT PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To he completed by Applicant: Building Site Location: r V PC(K I /(:7e_ G✓` Proposed Improvement: qe.A`'I/ ( , FL It C,4 I /I'/r S 73 e c( D'; ((1 (ot1)7 R�w� A ✓t^G✓EEC. ,�/ F�� t��-� 4.T`✓dv�_ P Applicant: e- . l : t Tel. No.: G 9 LZ / Address: ( V `; / 4W ,(010 Date Filed: /c - L a — **/fyou would like e-mail notification of sign off please provide e-mail address: Owner Name: a 74 Pci Owner Address: VY et, - 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. Please submit three (3) copies of plans, to include: (1.) Site Plan showing existing buildings, water line location, �F44 and septic system location; OCT 2112022 (2.) Floor plan labeling ALL rooms within building (all existing and proposed) — HEALT H DEPT 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 I o /� j PLEASE NOTE COMMENTS/CONDITIONS: Se a t j -- i-ed voc "AS'— Gc l cry ztA.c‘ Id �� 5 / L. NS/YiCIS(c lL /(G/l 1 Owner's Affidavit: Substantial Improvement or Repair of Substantial Damage Property Address: t.tl T PAAA< ,4i f E . \, YAK$l 0014 MA-- o z G 7 3 Parcel ID Number: R E V E D / Owner's Name: LA, p �^ ` v-) l';‘ot.r `� DEC 15 2022 Owner's Address/Phone: _ - gutLplNG DEPARTMENT Contractor: -�t. Cron' BY - Contractor's-License Number: c S_0 g b c{Z 0 Date of Contractor's Estimate: ;/ „ z.z— Z_-z._ I hereby attest that the description included in the permit application for the work on the exist- ing building that is located at the property identified above is all of the work that will be done, including all improvements, rehabilitation, remodeling, repairs, additions, and any other form of improvement. I further attest that I requested the above-identified contractor to prepare a cost estimate for all of the work, including the contractor's overhead and profit. I acknowl- edge that if, during the course of construction, I decide to add more work or to modify the work described, that the [insert community] will re-evaluate its comparison of the cost of work to the market value of the building to determine if the work is substantial improvement. Such re-evaluation may require revision of the permit and may subject the property to additional re- quirements. I also understand that I am subject to enforcement action and/or fines if inspection of the prop- erty reveals that I have made or authorized repairs or improvements that were not included in the description of work and the cost estimate for that work that were the basis for issuance of a permit. Owner's Signature: .. kc Date: 11 3 o 1 -?, Notarized: The�Qmmonwealth of Massachusetts On this 55 day of NN��tP M a.eI. 20 before me,the undersigned notary public, v et personally appeared,proved to me through Ctg sts2ictory evidenc of identification,which were A Alexis Robert ��— ca.," to be the person whose name isV Notary Public signed on the preceding or attached document,and acknowledged to me that he/ he signed it volunta ly for its stated purpose. COMMONWEALTH OF MASSACHUSETTS A My Commission Expires —� 02/16/2029 i\j Alexis Rob rt, Notary Public . My Commission Expires 02/16/2029 6 of 7 SAMPLE NOTICE FOR PROPERTY OWNERS, CONTRACTORS, AND DESIGN PROFESSIONALS Contractor's Affidavit: Substantial Improvement or Repair of Substantial Damage Property Address: 1-1 7 ?c€4< L Ud, 1oad 0. 6 Z6 73 Parcel ID Number: l Owner's Name: i/n ll / 4 70./c// Owner's Address/Phone: Lti( TA-g J , -673 Contractor: id -t,Nro K L Contractor's License Number: 6, -o z 6 iou Date of Contractor's Estimate: /(- Z. -- ZZ I hereby attest that I have personally inspected the building located at the above-referenced address and discussed the nature and extent of the work requested by the owner, including all improvements, rehabilitation, remodeling, repairs, additions, and any other form of improve- ment. At the request of the owner, I have prepared a cost estimate for all of the improvement work requested by the owner and the cost estimate includes, at a minimum, the cost elements identi- fied by the [community] that are appropriate for the nature of the work. If the work is repair of damage, I have prepared a cost estimate to repair the building to its pre-damage condition. I acknowledge that if, during the course of construction, the owner requests more work or modi- fication of the work described in the application, that a revised cost estimate must be provided to the [insert community],which will re-evaluate its comparison of the cost of work to the market value of the building to determine if the work is substantial improvement. Such re-evaluation may require revision of the permit and may subject the property to additional requirements. I also understand that I am subject to enforcement action and/or fines if inspection of the prop- erty reveals that I have made or authorized repairs or improvements that were not included in the description of work and the cost estimate for that work that were the basis for issuance of a permit. Owner's Signature ..0:5?7------------ Date: /2 _ 0 _ 2 Z Notarized: MICHELLEALDRICH Commonealt NotaryPMalic "V My Commission Ex asachusetts pires September 14,PAS SAMPLE NOTICE FOR PROPERTY OWNERS, CONTRACTORS, AND DESIGN PROFESSIONALS 7 of 7 • Substantial Improvement Worksheet for Floodplain Construction (for reconstruction, rehabilitation, addition, or other improvements, and repair of damage from any cause) Property Owner: /4C7'h Address: �Y pc, i4vei . W pruivicAirci fvu. . (ZL , 7 j Permit No.: Location: Description of improvements: &)(e,A �N/ 4 f 5 r 7✓lv� }/ `lC � Present Market Value of structure// ONLY(market appraisal or adjusted assessed value, BEFORE improvement, or if damaged, before the damage occurred), not including land value: $ -/SG COO —}— Cost of Improvement- Actual cost of the construction** (see items to include/exclude) $ a 0 3 b s� ""Include volunteer labor and donated supplies.** Ratio= Cost of Improvement(or Cost to Repair) 100 Market Value If ratio is 50 percent or greater(Substantial Improvement),entire structure including the existing building must be elevated to the base flood elevation (BFE)and all other aspects brought into compliance. Important Notes: 1. Review cost estimates to ensure that all appropriate costs are included or excluded. 2. If a residential pre-FIRM building is determined to be substantially improved, it must be elevated to or above the BFE. If a non-residential pre-FIRM building is substantially improved, it must be elevated or dry floodproofed to the BFE. 3. Proposals to repair damage from any cause must be analyzed using the formula shown above. 4. Any proposed improvements or repairs to a post-FIRM building must be evaluated to ensure that the improvements or repairs comply with floodplain management regulations and to ensure that the improvements or repairs do not alter any aspect of the building that would make it non-compliant. 5. Alterations to and repairs of designated historic structures may be granted a variance or be exempt under the substantial improvement definition)provided the work will not preclude continued designation as a"historic structure." 6. Any costs associated with directly correcting health, sanitary, and safety code violations may be excluded from the cost of improvement. The violation must have been officially cited prior to submission of the permit application. Determination completed by: d —2 Date: l Z— -- Z