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HomeMy WebLinkAboutBLD-23-002683 ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department of 'r 1146 Route 28, South Yarmouth,MA 02664-4492 ` 508-398-2231 ext. 1261 Fax 508-398-0836 i .-4 1 1 Massachusetts State Building Code,780 CMR '` Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling '` This Section For Official Use Only Building Permit Number: _i U)-i3-Db 2-4D( Date Applied: RECEIVED I ►r^ SO /01,-J 6--,A)- NOV 0 9 2012 Building Official(Print Name) Signature Date - SECTION 1:SITE INFORiMATION BUILDING DEPARTMENT 3y. 1.1 Droperty ddps: / Y r� (pc .2 Assessors Map&Parcel Numbers 1.1 a Is this an accepted street?yes V/ no Map Number Parcel Number 1.3 Zoning Information: ,v/g 1.4 Property Dimensions: 4./0 Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) via Front Yard Side Yards Rear Yard Required I 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 0 Private 0 Zone: Outside Flood Zone? — Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 canerf Re'ocdarv1S Saari�F'l"Lioo(71 Name(Print) City,State,ZIP JO /CCbc1►.e./ Al -733-2&56' In06. V anusC f/n6C./6iI-_ No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) , New Construction 0 I Existing Building 0 Owner-Occupied 0 1 Repairs(s) 0 Alteration(s) 13" Addition 0 Demolition ❑ Accessory Bldg. 0 Number of Units Other ❑ Specify: j� Brief Description of Pr sed Work2: (Oh yen' %%si ?Oar 4 &rc2/� 710 r-nos has/A O74ee / -�ivt/Sk d"//2f/r bce S'eme-v' SECTION 4:ESTIMATED CONSTRUCTION COSTS. • Estimated Costs: Item (Labor and Materials) Official Only 1.Building $ 1. Building Permit Fee:$VC Indicate how fee is determined: 2.Electrical $ MIStandard City/Town Application Fee ❑Total Project Cost3(Ite x multiplier x 3.Plumbing $ 2. Other Fees: $ .3 Ou `` 4.Mechanical (HVAC) $ List: (1�L4► 36371 030 5.Mechanical (Fire $ n Suppression) Total All Fees:$ I'�v Check No. Check Amount: Cash ount: »> 6.Total Project Cost: $ /S °CO ❑Paid in Full )1113 Outstanding Balance ue: t :' Ia2112L ' SECTION 5: CONSTRUCTION SERVICES 5.1�ConstructioonGSupervisor License(CSL) es 1 2DC (0 f0.7/2 Z 29 eye "L "veupz e-� License Number O Expiration Date Name of Ca Holder / e 7 W)t,c7 [2_/ List CSL Type(see below) lam( No.and Street /� Type Description ...i.e.4-div)at /12/0 60266 U Unrestricted(Buildings up to 35,000 cu.ft.) City/Town,State,ZIP 1 R Restricted 1&2 Family Dwelling IA Masonry RC Roofing Covering•p / / _` - WS Window and Siding 7 7��� 5 `,7 jiypc reo,'1i7a,ne iAs/ Oveovet -I Solid Fuel Burning Appliances 7 �S •r" / C!.ulstsulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor CHIC) t' , Y7 9/3/z3 le a Hl C any Name or l C egistrant Name HIC Registration Number Expiration Date By le 4 et r 7 )o/ mhiorne/m�rover,,,ed,G .- N ,and Str et=et,,a /Y//,. 0a563 yfoi.e.a.:35s9 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 Issua of 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 ifek 16 4G' -4/ to act on my behalf,in all matters relative to work authorized bbis building permit application. 2inC/4 jarvls ,y/t/1Z 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 ' this application is true and accurate to the best of my knowledge and understanding. in fie, Xe4ede-1/ _ 11/1/ZZ Print wner's or A thorized 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 HIC Program can be found at www.mass.00v/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" ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department .• .o .....r. 1146 Route 28, South Yarmouth,MA 02664-4492j�, 508-398-2231 ext. 1261 Fax 508-398-0836 .�.�i ■ - Massachusetts State Building Code,780 CMR Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: ( U)-23-Qb2 Date Applied: RECEIVED Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION BUILDING DEPAR'rMENT By: 1.1 ropertyEddre;s: n/ gari e 1,2 Assessors Map&Parcel Numbers 1.1 a Is this an accepted street?yes V no Map Number Parcel Number 1.3 Zoning Information: ,(V/1- 1.4 Property Dimensions: /110 Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) ,(///? Front Yard Side Yards Rear Yard Required I 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 0 Private 0 Zone: — Outside Flood Zone? Municipal❑ On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 9wner'of Rec oc.inc/ - Jccirvi.5 A2‘..0mei..-61 Leo Name(Print) City,State,ZIP fG /00kad Al , -733-2866 ho/a_vlarviS ma:/C No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction 0 I Existing Building 0 Owner-Occupied 0 I Repairs(s) El Alteration(s) &"Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Pr,oppsed Work': (Oh veri r:%V•/ 725-eLiccr r4,Crc 2/'-, 7/0 ,/Yids / SECTION 4: ESTIMATED CONSTRUCTION COSTS. • Item Estimated Costs: Official Use Only (Labor and Materials) y I.Building $ I. Building Permit Fee:$1UO Indicate how fee is determined: 2.Electrical $ Si Standard City/Town Application Fee 0 Total Project Cost3(Ite.. . x multiplier x 3.Plumbing $ 2. Other Fees: $ 33. IJ 4.Mechanical (HVAC) $ List: (1141 g Q ZfVf 5.Mechanical (Fire $ Suppression) Total All Fees:$ /�� Check No. Check Amount: Cash oust:6. 6.Total Project Cost: $ El Paid in Full Outstanding Balance ue: 1 j `"", The Commonwealth of Massachusetts i " � . Department of Industrial.Accidents rititg----- 1 Congress Street, Suite 100 �`�®' Boston, MA 02114-2017 • NE www.mass.go v/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information QQ /`� [ / Please Print Legibly Name (Business/Organization/Individual): '(eft �/ Address: &2r P-ci/ City/State/Zip: Sclu,c(-1 /a4, i -1- /}'I /0256�JPhone #: ' ` /'2 - 5�s9 Are yo an employer?Check the appropriate box: - Type of project(required): t. i am a employer with employees(full and/or part-time).* 7. ❑New construction 2.0 1 am a sole proprietor or partnership and have no employees working for me in ca act8. ❑ Remodeling an • y p ty.[No workers'comp.irsurance required.] 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 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.t 13.E Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per,MGL c. 14.t]Other 152,§I(4),and we have no employees. [No workers'comp.insurance required.] *Any applicant that checks box All 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: E Policy 4 or Self-ins.Lic.#: '"Le 6 14)60i�J 6'g202 2 4 Expiration Date: 341/2 3 Job Site Address: 70 0/-4962 � /�/ City/State/Zip: /3"14C24 1 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 a der the pains an enalties of perjury that the information provided above t ue and correct. Sisnatur Date: .. '/"is2 Z Phone#: 2Ur 3 cf 9 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. 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 it) a & eJ ,'.1��' / 9r/nc',tg_to° ,1 Work Address /�f (7 Is to be disposed of oat the following location: -ow:e i'Laa er Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. Signature of Application Date Permit No. Dream Home Improvement LLC. 60 Franklin Ave, Hyannis, MA, 02601 1REA.A i Home Email:john.dreamhillc@mail.com Improvement LLC. 508-332-8119 John Collinson Project Manager 774-208-3589 Alexey LebedevOwner/Contractor www.dreamhomeimprovement.com HIC#: 176777 CS#: CS-108208 Contract DATE: 9/25/22 PHONE: 508-733-2856 NAME: Mike and Linda Jarvis EMAI: lindavjarvis@gmail.com MAIL ADDRESS: 10 Lookout Rd. Yarmouthport, Ma. 02675 JOB ADDRESS: 10 Lookout Rd. Yarmouthport, Ma. 02675 Dream Home Improvement hereby proposes to perform the following services in a neat, professional like manner in accordance with the manufacturer's specifications and local building code. Home remodel: Master bathroom: Frame for new master bathroom as shown on a plan. Strip existing hardwood floor in new bathroom and install hardie backer underlayment. Install shluter electric heated floor. Rough in plumbing and electrical. Install picked out by customer drop in tub with stone top. Install vanity picked out by customer. Tile the shower. Install solid core interior doors. Paint to customer colors. Complete final plumbing and electrical. Refinish floors in entire house. Repaint whole house. Basement: Frame per plan. Install electrical plugs and ceiling lights. Install R21 insulation in walls. Install % " sheetrock with three coats of tape and mud. Install vinyl laminate floor. Install solid core interior doors. Trim to match main house. Install single zone mini split. Paint to customer colors. Finish stairs with oak treads and pine risers. Install 2x2 drop ceiling. Total cost of project $158,000.00 Payment due upon signing of contract $30,000.00 Payment due upon finish of Frame and rough electrical and plumbing $50,000 Payment upon insulation and drywall installation $50,000.00 Due upon completion of project. $28,000.00 Initials: L2 Make All Checks payable to "Dream Home Improvement LLC" Compliance with Laws: Contractor agrees that it is properly licensed and insured under Massachusetts General Laws Chapter 142A and that it will perform the services contracted for herein in compliance with applicable building codes, laws, statutes and ordinances. Parties' Understanding of This Agreement: by signing this agreement, the undersigned Parties acknowledge they have had the opportunity to ask any questions concerning its terms; have read, understand and agree that its terms are fair and reasonable; and agree to be bound by the terms in their entirety. This agreement is effective as of the date it is executed by all the undersigned. Contractor .0001) Customer Date signed (0///22- ..›mrnoorneent, aissaacnusents esinri Prating...anal i_acensunr 9.0,aact 9!Eiunit.tict ReqUilliltGell and Stoddard" • C,oe,,”su, C.5 WS2C41 eaves. i (27(2022 ALEAE V L EtIEDPV 7 WINDSOR RCI SANDWICH MA 'MU ::.onnrnissioner ta,", kz,/, _,J(v/////cy///./v./7,/ . Office of Consumer Affairs and Business Regulation 1DOD Washington Streel-Suite 71(1 Boston, Massachusett$ 02118 Home Improvement Contractor Rr-igtstratioii Ty1 ,1_, RogitdritItun FlOWE IMPR,OVPMENT LLC. Expithtion 7 WINDSOR RD SANDWICH,MA 1.12'FA3 Update Address and Return Card. • t;r•4dvr4tantawwww11**Ta4 IdEasausnwfuointrat,,, I C•ME:MP ROYEMEN I COsITRACTC•R Ragistration valid tor Indis.dva4uve only TYPE I before tht. Foliation dale Illtaiina Islam to: Office of Consenter Affairs ant Edema's Regulation '76/77 1006 ltmthingtOn Strew -suite 710 clE IMPRINEME/41 13on MA D2118 i ".1iNi*PO ,'•••,,•.• vto; (12563 Not vetild without signature AC�® DATE(MM/DD YYYYI CERTIFICATE OF LIABILITY INSURANCE 3/11/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Eastern Insurance Group LLC PHONE FAX - 233 West Central St (A/c.No.Ext(:800-333-7234 INC.No):781-586-8244 Natick MA 01760 ADDREss: CSR24CL@easteminsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Arbella Protection Insurance Co 41360 INSURED DREAHOM-01 INSURER B:Associated Employers Insurance Company 11104 Dream Home Improvements LLC 7 Windsor Road INSURERC: Sandwich MA 02563 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1418929464 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSUBR POLICY EFF POUCY EXP LIMITS LTR TYPE OF INSURANCE INSD VVD POLICY NUMBER (MMIDD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL UABILITY 9520053178 3/8/2022 3/8/2023 EACH OCCURRENCE $1,000,000 lCLAIMS-MADE X OCCUR P PREMISES(Ea occurrence) $100,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY JET LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _AUTOS ONLY (Per accident) UMBRELLAUAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION WCC50050156792C22A 3/8/2022 3/8/2023 X STATUTE AND EMPLOYERS'UABIUTY ANYPROPRIETOR/PARTNER/EXECUTIVE Y� N/A E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED iN ACCORDANCE WITH THE POLICY PROVISIONS. Display Purposes Only AUTHORIZED REPRESENTATIVE Cs1/0212melliec ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ONE or TWO FAMILY— BULDING PERMIT APPLICATION REGULATORY APPROVALS NOTICE Address of Proposed Work: — i'D ices Zt7 a-' / jtC orivadZiocr71 Scope of Proposed Work: _d ?1VP(/ /r0l7D7') -LD /17ci6!e,r eC4 I 'n,sv-i_ S'eme,7 Date: ///i/Z 2- Based on the scope of work described above, the applicant is required to obtain approval sign- offs from the following departments as checked-of below: Health Dept. —508-398-2231 ext. 1241 Conservation —508-398-2231 ext. 1288 Water Dept. —99 Buck Island Road, 508-771-7921 Old Kings HWY. Hist. Comm. —508-398-22631 ext. 1292 Engineering Dept. —508-398-2231 ext. 1250 Fire Dept. — Kevin Huck/Scott Smith, 96 Old Main Street, SY Note: Please call Fire Department for an appointment. 508-398-2212 Other Appropriate plans and/or application shall be provided to each departments checked-off above. Each of these regulatory authorities has their own requirements outside the jurisdiction of the Building Department. All applicable approvals shall be obtained prior to submitting a building permit application to the Building Dept. Thank you for your cooperation. Receipt Ackno gement: 47C------ ii/1/2 2— Applicant's ignature Date Rev. Jan. 2019 • °Y.y, TOWN OF YAR,MOUTH { WATER DEPARTMENT C-' I 99 Buck Island Road a ,r a �` M ACHCESE $! West Yarmouth, MA 02673 Telephone: (508) 771-7921 • Fax: (508) 771-7998 BUILDING PERMIT APPLICATION FOR WATER DEPARTMENT SIGN OFF TRANS MITTAL FORM BUILDING SITE LOCATION: 10 G7e-f Pei yell 1).1 L Dr 1 PROPOSED WORK: C'd iv,14)ravczz-' % 'Cr `90-)e 7L APPLICANT: Le f/ ADDRESS: 10 L1 & / c F/YdQe-c-"g fil TELPHONE: #71X4 2498 `36-89 RESIDENTIAL AND /OR COMMERCIAL BUILDING Water Department: Determines Compliance of Water Availability and or existing location Engineering Department; Determines Compliance for Parking and Drainage Conservation Commission: Determines Compliance to Wetlands Act; i.e. If lot(s)border any type of wetlands, streams,ponds,rivers, ocean, bogs, boys, marshland, ETC... Health Department: Determines Compliance to State and Town Regulations, i.e. requirements for Septage Disposal and other Public Health Activites Fire Department: I •rmines Compliance to State and Town Requirements for Personal 'ety, Property Protections, i.e. Smoke Detectors, Sprinkler Systems,etc / ,0472 2 AcP4 T SIGNATURE DATE OFFICE USE: COMMENTS ON PERMIT APPROVAL OR DENIAL% tn e) tit^ 01\A--prtt 9/2Z- REVIEWED I3Y W TER DIVISION(SIGNATURE) / DATE F.