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HomeMy WebLinkAboutBLD-23-000447 • f R P C E i '-.1�. BUILDING PERMIT APPLICATION • ,rMIN APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE, OCCUPANCY OF, JULN �i,�; i , OR DEMOLISHT ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING. MAT'T4 �1 own of•Yarmouth Building Depart men (� -_-_ __.. - t ._. 11-Ffi Route :'t MA • c �� BUILDING DEPA i�,.,1 ; • Yarmouth, ()?fibs-t+,)_ By Tel: 508-398-2231 eat. 1261 Fax 508-398-0836 • $u - � 23 Mice Use Only Planning Board Information Assessors Department information: _ Permit No. "{�I Date Plan Type_ Map Lot /,, Permit Fee $ ,I-.\,D Endorsement Date / '2 \„�,� Recording Date New �V Deposit Rec'd. _'� 0 1 Plan No..--;"Date 1.4 Property Dimensions: �\\ � _ Net Due $ \ 1(-' Other Lot Area(sf) Frontage(It) Lot Coverage Building Permit NumberThis Staction for Office Use Only ' Date Issued: Signature: 1 - l� - Certificate of Occupancy Building Official Date is Is not required Section 1 - Site Information i 1.1 Property Address: 1.2 Zoning information: —225 Whites Path, South Yarmouth, MA 02664 Zoning District Proposed Use 1.3 Building Setbacks (ft) ' Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.4 water Supply(M.Q.1..., c,40.S 54) 1.5 Rood Zone information: Comments Public Private Zone: _ SPE: ' Section 2 - Property Ownership/Authorized Agent 2.1 Owner of Record: _ Greg Bilezkian 231 Willow St Yarmouthport MA 02675 Name (print) — See attached authorization form with signature Mailing Address: gbilezikian@4-corners.com i6Fiature Telephone Telephone I Email Address: 2.2 Authorized Agent:1 Patrick Finn 15 Research Rd East Falmouth MA 02536 Name (print) Mailing Address: 339-832-1555 Signalure Telephone Fax Jpfinn@dellbrookjks.com 1 r.fllu,...,._. s5: Section 3 - Construction Services 3.1 Licensed Construction Supervisor. Not Applicable I] _ Greg Inman PO Box 561 North Falmouth MA 02556 Licen : 1t.- CS-111705 Address ".`'` y 508 889 7269 ginman@dellbrookjks.com Expiration Date Signature �� Telephone Email Address: L2/29/2022 3.2 Registered Home Improvement Contractor , Company Hama Not Applicable X Address Registration Number Expiration Date 1 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 ... Y .. No Section 5- Professional Design and Construction Services-for Buildings and Structures Subject to Construction Control Pursuant to 780 CMR 11&(containing more than 35,000 c.f. of enclosed space) Section 5.1 Registered Architect: Kurt E. Reber Not Applicable 0 Nam. (Raolatranth 203 Willow St, Suite A I Yarmouthport, MA 026: 5 R ictrAtinn Ntimber Address _ 10563 I See attached initial construction control Affidavit 508-362-8382 Expiration Date Signature Telephone 8-31-2022 Section 5.2 Registered Professional Engineer(sIl Hame Area of Responsibility Address Registration Number Signature Telephone Expiration Date Hama Area of Ras; - Address Registration Number Signature Telephone Expiration Date Hams Area of Responsibility Address Registration Number Signature Telephone Expiration Date Hams Area of Responsibility Address Registration Number Signature Telephone Expiration Date Section 5.3 General Contractor Dellbrook JKS Not Applicable ❑ Company Hama Greg Inman erson riesponstble for Construction _115 Research Rd East Falmouth MA 02536 AddressL� 508-540-6226 Signature Telephone ` 2 , Section 6 - Description of Proposed Work(check all applicable) New Construction ($t (tor multiple family only) No.of Bedrooms (for multiple family only) No.of Bathrooms ' Existing Bldg. ® Repair(s) ❑ Alterations ® Addition D Accessory Bldg. ❑ Type Demolition Other Specify: Fence Brief Description of Proposed Work: Build new sound attenuation fence along property line approximately 730 feet in length varying from 13 to 16 feet tall. Section 7- Use Group and Construction Type Building Use Group (Check as applicapable) Construction Type 'A ASSEMBLY 0 A-1 0 A-2 0 A-3 ❑ 1A 0 A-4 ❑ A-S ❑ lB El B BUSINESS 2,4 a E EDUCATIONAL L❑J 2B y F FACTORY ❑ F-1 ❑ F-2 ❑ 2C 17 H HIGH HAZARD ❑ 3A ❑ I 1NSTRUT1oNAL ❑ 1.1 a 1.2 Q 1.3 a 3B I] M MERCHANTILE ❑ 4 0 R RESIDENTIAL ❑ R-1 ❑ R-2 ❑ R-3 ❑ SA a S STORAGE Y s-i Y s-2 Y se ❑ U UTILITY '❑" •----- SPECIFY* _ M MIXED USE ❑ SPECIFY: _ S SPECIAL USE ❑ SPECIFY: _ Complete this section if existing building undertioing renovations, additions and/or change )ri use. Existing Use Group: _1 S1, S2, Proposed Use Group: .Si, S2, B Existing Hazard Index 780 CMR 34 l ff 3 Proposed Hazard Index 780 CMR 34 13 I Section 8 Building Height and Area 1 • Building Area Existing (if applicable) ' Proposed Number of floors or stories — 1 include basement levels 1 — Floor Area per Floor(sf) 109,760 109,760 Total Area All Floors (sf) 109,760 .109,760 Total Height(ft) 7 41 — 141 Section 9 - STRUCTURAL PEER REVIEW (780CMR 110 11) Independent Structural Engineering Structural Peer Review Required Yes No No SECTION 10a OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Greg Bilezkian as Owner of the subject property, hereby authorize I Patrick Finn to act on my behalf, in all matters relative to work authorized by this building permit application. I.S2:attached authorization form with signature] See attached Signature of Owner Date • SECTION 1 Ob OWNER/AUTHORIZED AGENT DECLARATION Patrick Finn , 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. PaIr7L 6%1/1 • . Print Nam . ØØoz& Signature of Owner/Agent ate Section 11 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be completed by permit applicant 1.Building 500,000.00 2.Electrical 3.Plumbing/Gas 4.Mechanical(HVAC) 5.Fire Protection 6.Totala(1 +2+3+4+5) 500,000.00 7.Total Square FL{Icrn..,:tncs,sn t ate) Check Below ❑ Conservation-Commission Filing (if applicable) ❑ Old Kings Highway&Historical Commission approval (if applicable) Property Owner Must Complete and Sign This Section If Using A Builder it -1,66215chth/i as Owner of the subject propertyhereby autho•ize I Q7/.iCk r/A/ttl Del/dook 77<rto act on my behalf, in all matters relative to work authorized by this building permit application for: 225 Whites Path, South Yarmouth, MA 02664 (Address of Job) 744/(11-:," Sign t •e of Owner Signature of Applicant 6 1 eark C F,'N>,l Pr t ame Print Name Z1201 iJ2Z Date Q:FORMS:OWNERPERMISSIONP00LS Rev:08/16/17 The Commonwealth of Massachusetts ...a= 1, Department of Industrial Accidents :5 �.,:�]0 1 Congress Street, Suite 100 !T f — Boston, MA 02114-2017 M A— tv><v>v.mass.gov/dia IMP Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/individual): Dellbrook JK Scanlan Address: 15 Research Road City/State/Zip: East Falmouth, MA 02536 Phone#:508-540-6226 Arc you an employer?Check the appropriate box: Type of project(required): l,®I am a employer with employees(full and/or part-time)." 7. ❑New construction 20 I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.E3 I am a homeowner doing ail work myself.[No workers'comp.insurance required.]f 10 1=1 Building addition 4.0 1 am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or arc sole 11.0 Electrical repairs or additions proprietors with no employees, 12.0 Plumbing repairs or additions 5.17 I am a general contractor and I have hired the subcontractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.:nsurance: 14.0 Other 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c, 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:Federal Insurance Company _ Policy#or Self-ins. Lie.#:005-4309740-03 Expiration Date:7/1/22 Job Site Address:225 White's Path City/State/Zip:Yarmouth, MA 02664 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as equired under MGL c. 152, .525A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprison' nt as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator. co of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certifj'a d'r the ems na-peual s of perjury that the information provided above is true and correct. Signature: Date: -' --as Phone#:508-540- 26 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#: Commonwealth of Massachusetts pi%ision of Professional and Standards LicenSUre ��,r Board o`Building �ConstrUgt4h t i ,§W.ilp rvisor i tL�jcptres 1212912022 CS-i 11705 45. �.Ve, ` /. ; GREGORY W,.1NMAN !� ��' PO BOX 561 MA56` NORTM FAL ThM9U t • -,♦C h Commissioner ea/12z g, A ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) `...----- 3/22/2022 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 pollcy(les) 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: Stephen Turner Alllant Insurance Services, Inc. PHONE 617-535 7200 FAX c,No:617 535 7205 131 Oliver Street,4th Floor (Arc.No.Extl: E•MA1L Boston MA 02110 ADDRESs: sturner@alliant,com INSURER(S)AFFORDING COVERAGE HATCH INSURER A:Starr Indemnity&Liability Co 38318 INSURED INSURER B:Executive Risk Indemnity Inc 35181 Dellbrook JK Scanlan One Adams Place INSURER C:Federal Insurance Company 20281 859 Willard Street INSURER D:American Guarantee and Llabili 26247 Quincy MA 02169 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER:1285532130 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 ADDL SUER POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD Ywc POLICY NUMBER (MMIDD/YYYY) (MMIDD/YYYY) B X COMMERCIAL GENERAL LIABILITY Y Y 54309739-03 7/1/2021 7/1/2022 EACH OCCURRENCE $2,000,000 DAMAGE TO RENTED l CLAIMS-MADE ( X l OCCUR PREMISES(Ea occurrence) g 300,000 X xCu MED EXP(Any one person) $10,000 X Contractual 1 PERSONAL aACV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 POLICY 1 X 1 JEOT LOC PRODUCTS-COMP/OPAGG $4,000,000 $ OTHER: C AUTOMOBILE LIABILITY Y Y 21-5430-97-38 7/1/2021 7/1/2022 (Ea CBI ED1SINGLE LIMIT $1,o00,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS PROPERTY DAMAGE HIRED NON-OWNED (Per accident) $ AUTOS ONLY AUTOS ONLY $ A UMBRELLA LIAB X OCCUR Y Y 1000584533211 7/1/2021 7/1/2022 EACH OCCURRENCE $10,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000 DED RETENTIONS $ - C WORKERS COMPENSATION Y 005-4309740-03 7/1/2021 7/1/2022 X STATUTE ERRH- AND EMPLOYERS'LIABILITY Y I N ANYPROPRIETOPJPARTNER/EXECUTIVE N 1 N/A E.L.EACH ACCIDENT 51,000,000 OFFICER/MEMBEREXCLUDED?(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 II yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT $1,000,000 0 Excess Liability AEC-4222834-01 7/1/2021 7/1/2022 Each Occurrence 15,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached It more space Is required) 225 White's Path Units 2 and 3 LLC is included as Additional Insured as required by written contract and executed prior to a loss,but limited to the operations of the Insured under said contract,with respect to the Automobile,General Liability and Umbrella/Excess Liability policies.Automobile,General Liability and Umbrella/Excess Liability evidenced herein are primary and noncontributory to other insurance available to an additional insured,but only to the extent required by written contract with the insured and executed prior to a loss.A Waiver of Subrogation applies in favor of above mentioned additional insureds with respect to insured operations where required by written contract but limited to the operations of the Insured under said Contract and executed prior to a loss,with respect to the Automobile,General Liability,Workers Compensation and Umbrella/Excess Liability policies. 30 days'notice of cancellation or non-renewal will be provided to Certificate Holder,except 10 days'notice for cancellation for non-payment of premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 225 White's Path Units 2 and 3 LLC ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Greg Bilezkian 231 Willow Street AUTHORIZED REPRESENTATIVE Yarmouth Port MA 02675 1 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD §TOWN OF YARMOUTH 1146 Route 28, South Yarmouth, MA 02664 508-398-22311 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/dernolition to be conducted at 225 White's Path South Yarmouth Ma 02664 Work Address Is to be disposed of oat the following location: Cavossa - 210 Mason Ellis Hwy East Falmouth MA 02536 Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. -l� _04/&Z Sign re of Application ate TBD Permit No. Sears, Tim From: Sears, Tim Sent: Wednesday, August 3, 2022 9:02 AM To: 'Pat Finn' Cc: Water Department; Slack, Christine; DiRienzo, Brittany Subject: 225 Whites Path Pat, I have reviewed your application for the sound attenuation wall and there are some items needed. . Health Department sign off .J2. Conservation sign off 3. Water Department sign off 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 Initial Construction Control Document 1 I f To be submitted with the building permit application by a Registered Design Professional f^ for work per the 9t1' edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Selective Demolition and Removal of Building Elements Date: 03-28-2022 Property Address: 225 Whites Path,Suite 2&3, South Yarmonth, MA 02664 Project: Check(x) one or both as applicable: New construction X Existing Construction Project description: The affidavit is for the early release Demo Permit Package and is lifted to the non-structural work that can be done in advance of new scope that will be permitted in a subsequent Buidling Permit Application. Any work required to alter the buildings lateral bracing system & other structural elements will be included in the building permit package. Similarly alterations to the mechanical and electrical systems will be shown in the building permit pachage. I Kurt E. Raber MA Registration Number: 10563 Expiration date: 08-31-2022 , am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning': X Architectural Structural Mechanical Fire Protection Electrical 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 conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance 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 ��\S�Es or`; /7 electronic signature and seal: _ 4 Phone number: 508-362-8382 Email: kurtca catalvstarchitects.com 1 2, No 10563 M ry a G.F. Building Official Use Only c4:1 F µPSSP Building Official Name: Permit No.: Date: Note 1.Indicate with an'x'project design plans,computations and specifications that you prepared or directly supervised. If`other'is chosen, provide a description. Version 06 11 2013 Initial Construction Control Document To be submitted with the building permit application by a q4( 4,3 Registered Design Professional for work per the 9th edition of the \41.1SJ•v'V Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Sound Wall Permit Date: 07-21-2022 Property Address: 225 Whites Path,South Yarmouth, MA 02664 Project: Check(x) one or both as applicable: X New construction X Existing Construction Project description: This Initial Design Affidavit shall accompany the application for building permit for the proposaed sound wall as shown on the plans. I Kurt E. raber MA Registration Number: 10563 Expiration date: 08.31.2022 , am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning': X Architectural Structural Mechanical Fire Protection Electrical 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 conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance 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: •�t E ! o No. 10563 BARNSTABLE, W 0 MASS. Phone number: 508-274-3378 Email: kurt(a,catalystarchitects.com �Fq`T SSPss NOFMA Building Official Use Only Building Official Name: Permit No.: Date: Note 1.Indicate with an`x'project design plans,computations and specifications that you prepared or directly supervised.If'other'is chosen, provide a description. Version 06 11 2013 #4 Town of Yarmouth Conservation Office 0 ' -3 kgrant@yarmouth ma us Conservation Commission Building Permit Sign-off Application TO BE FILLED OUT BY BUILDING PERMIT APPLICANT: Building Site Location: -(1'2 3 A//4:,,t.,. -71-e...‹, Map # Lot(s)# Property Owner: 6er /I/,/ezi, kiwi, Date filed: /7Ait&i>12 *Applicant: kle ,,, 7.).0)isove'i Applicant Address: /5 if eSe cri-a. A ci Fit/al er,ICSA At ii— (''''Z i*36- , Email: f/t/clit't/Kc tia(1•:,` -,ddiefrok/Ale:s.,,e,0,,,,, Telephone: 65/7- ,-41.7-,,,Z 6.V/ Please Note.By submitting this application the applicant grants permission to the Conservation Office to enter the location to conduct a site visit(if needed) Proposed Project Description: ille Cabe .1e44 pi i 4/0/7 _Ths--/:a i I 4 74/em I Site Plan Title/Date: Seti/f/ ltr / Ph/7/r ,./6W-el '/"./ci 1 I TO BE FILLED OUT BY CONSERVATION ADMINISTRATOR: 1 Does the proposed project require a permit? V 0 1 i Refer to: SE83- or DOA permit 1 -----Th f Comments from Conservation Commissior4.)proved Conditionally Approved Rejected 7) i Conservation Commission Sign-off Signature: Date: 'IQ APPLICANT: All work-related debris shall be taken offsite or disposed in a legal upland location. At the end of each day, the area shall be clean and no debris shall be in the Resource Area. If work is permitted under an Order of Conditions, please arrange a pre-construction site visit with the Conservation Administrator. At the time of site visit, the MassDEP File Number sign must be installed, along with the erosion control/work-limit line. A copy of the Order of Conditions must remain on-site during construction. Please refer to the Order of Conditions for further details. TOWN OF YARMOUTH HEALTH DEPARTMENT• PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To he completed by Applicant. / l , Building Site Location: Proposed Improvement: A II W;h „LIZ Applicant: ve K//1c i, /e//5o vU Tel. No.: 6771-7979/-0MY/ Address: '/ sea r'c ,< , FaZmaw% , R,4 O25-3 d Date Filed: ct7 /6eac,Z **If you would like e-mail notification of sign off please provide e-mail address: m ilis-ova e b`GokfkS.COP'l Owner Name: gm? U//fez/k/oe Owner Address: o?3' M //UG/ syt `at/YI evil Pori /114 Owner Tel. No.: t t 026 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, and septic system location; _aIL (2.) Floor plan labeling ALL rooms within building AUG 0 2022 (all existing and proposed) — Note: Floor plans not required for decks, sheds, windows, roofing; HEALTH DEPT. ; (3.) If necessary, Title 5 application signed by licensed installer with fee. REVIEWED BY: G2 - g, 91,DATE: g—g- 20ZZ_ PLEASE NOTE C MENTS/CONDITIONS: ` ,-0 pad; � C,A4 / cti I ( p o--r �,m S h e e��4-h Derr, d e cs �-c -�he 5Os--ur'c �/75 of 4-he A TIVM 11V1 1333El, • --—f-—-I —.. Ie IIIIIT- -.- -I — O) m — — m — — D r _ r D 4 4 r r 1m I b 70 nn§mc, —I — !)m r a. P8 • II W • _.— i i1 _ 1 F a — — 4 ' — — \* h -.- a i /p�o � �y�kD x 2 k rn m ni G rs \ a,' C) Biel /1�� �,. 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ALSO HA,f , F141-- SARiNOAR t11estt Giboi4 SERVICE NO. D Li 0 7 - !2/ /9 �-^ I O L D ( NAME 1i 1G12L es ai tc z t KiRri Coi i.revri STREET VILLAGE _.... So ti-Thyieig&I Li^ _ LI N METER NO. /())-0)Z,, /.2/7?/ J. // 3r'0 fo t CZ a9 vI —. s 9 v94 J p1` 1 2,"m.t/.) L11 VL h I ftS J", 9 SmithCabrera, Patience From: David Fernandes <dfernandes@dellbrookjks.com> Sent: Wednesday, August 3, 2022 1:34 PM To: Water Department Cc: tsears@yartmouth.ma.us;Slack, Christine; DiRienzo, Brittany Subject: RE:225 Whites Path Attachments: Stamped & Signed FedEx 225 WP Sound Wall Permit Plans.pdf;Acoustic Wall- Water Department Sign Off Request.pdf Attention!:This email originates outside of the organization. Do not open attachments or click links unless you are sure this email is from a known sender and you know the content is safe. Call the sender to verify if unsure. Otherwise delete this email. As requested,please see attached the filled out Water Department form along with the stamped plans. In addition, Rob McCurdy and Pat Finn are longer involved on this project. I will be Dellbrook's point of contact moving forward. Thank you, David Fernandes '.s star!t Proitrl: `'1s3)age7' DELLBROOK JKS NI: 774-328-2876 From:Water Department<WaterDept@yarmouth.ma.us> Sent: Wednesday,August 3, 2022 9:19 AM To:Sears,Tim<tsearsgyarmouth ma us>; Pat Finn<PFinn@dellbrookjks.com> Cc:Water Department<WaterDept@yarmouth.ma.us>; Slack, Christine<CSlack@yarmouth.ma.us>; DiRienzo, Brittany <BDiRienzo@yarmouth.ma.us> Subject: RE:225 Whites Path Good morning. Please complete the attached water signoff application and return to me along with a site plan.Thank you! Patience Smith-Cabrera Customer Service Supervisor Yarmouth Water Department 99 Buck island Road West Yarmouth, MA 02667 508-771-7921 From:Sears,Tim <tsears@varrnouth.ma.us> Sent:Wednesday,August 3, 2022 9:02 AM To: 'Pat Finn'<PFinnsiDdellbrookiks.com> Cc:Water Department<WaterDept@varmouth.ma.us>; Slack, Christine<CSlack@yarmouth.ma.us>; DiRienzo, Brittany 1 ' • z r .• of•YA,4 BUILDING PERMIT APPLICATION • fie- 'rr APPLICATION TO CONSTRUCT,REPAIR, RENOVATE, CHANGE THE USE,OCCUPANCY OF, €; �i y OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING. E4 11 - ,Z.. Town of litrrnouth Building Department %),1u,.�TT�c:53 �••"' 1146 Route _t • Yarmouth, MA 02664--1492 Tel: 508-398-2231 ext. 1261 Fax 508-398-0836 Perg,t Offiicce�Uyse Only Planning Board Information Assessors Department Information: NO v` ° Date Permit Fee $ Deposit Rec'd. $ Plan Type Map Lai Endorsement Date / Recording Date New Date Plan No 1.4 Property Dimensions: Net Due $ UV.0t) Other Lot Area(sf) Frontage(It) Lat Coverage This Section for Office Use Only Building Permit Number Date Issued: - Signature: ,i,I- ;, - Certificate of Occupancy Building Official Date" is is not required Section 1 - Site Information 1.1 Property Address: 1.2 Zoning Information: ZZ5 lAlltu- e? p - V K6?.,/1/ ter--/-4 , frb/ 0 266' Zoning District Proposed Use 1.3 Building Setbacks(ft) " Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.4 water Supply(M.O.I—a.40.S 54) 1.5 Flood Zona Information: Comments -. Public Private Zone: BFE . Section 2 - Property Ownership/Authorized Agent 1 2.1 Owner of Record: :a L.o T1'Ta.JZ Name(print) Mailing Address: Signature Telephone Telephone Email Address: 2.2 Authorized Agent: ;Al i�-,r./4 Vi c_ . „ , �-, l—��a. R C.X S-0 9 Ham print) " —._� MailingAddress: i /r v; LAIC 6. 1--S- / is gnature Telephone Fax i Email Address: 1 Section 3 -,Construction Services 3.1 Licensed Construction Supervisor: Not Applicable i,] License Number Add ��) DH skJovv1l 1."rem „;441�4 c - S C> 5 C— 71) r/..�.-�/v> -.. . f J��' '�'C Expiration Date ignattire Teleph !j+ 7 Email " Address: ,O ' .12.0 : • f ' • , Section 6 - Description of Proposed Work(check all applicable)I • New Construction ❑ I (for multiple familyonly) of Bedrooms No. (for multiple family only) No.of Bathrooms Existing Bldg. (] Repair(s) ❑ Alterations I ❑ J Addition ❑ 1 Accessory Bldg, ❑ Type I Demolition jother Specify: Brief Description of Proposed Work: Section 7- Use Group and Construction Type I Building Use Group(Check as applicapable) Construction Type A ASSEMBLY ❑ A-1 ❑ A-2 ❑ A-3 ❑ to ❑ A-4 ❑ A-5 ❑ la ❑ B BUSINESS ❑ E EDUCATIONAL El2A El F FACTORY 2B ❑ ❑ F-1 ❑ F-2 ❑ 2C ❑ H HIGH HAZARD ❑ I INSTITUTIONAL ❑ 1-1 ❑ 1-23A ❑ ❑ 1-3 ❑ 38 ❑. M MERCHANTILE ❑ R RESIDENTIAL 4 ❑ S STORAGE ❑ R-1 CDR-2 ID R-3 ❑ SA ❑ ❑ s 1 ❑ S-2 ❑ se U UTILITY ORA ❑ M MIXED USE SPECIFY: S SPECIAL USE ❑ SPECIFY: SPECIFY_ Complete this.section if existing building undergoing.renovations;additions and/or change In use.I 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) Number of floors or stories Proposed include basement levels Floor Area per Floor(sf) Total Area All Floors(sf) Total Height(ft) Section 9 - STRUCTURAL PEER REVIEW (7B0CMR 110 11) I Independent Structural Engineering Structural Peer Review Required Yes 1 No SECTION 10a OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT] I, , as Owner of the subject property, hereby authorize my behalf, in all matters relative to work authorized b Y this building permit application to act on . Signature of Owner Date SECTION 1 Ob OWNEFV AUTHORIZED AGENT DECLARATION I, , 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. • Print Name Signature of Owner/Agent Date Section 11 - ESTIMATED CONSTRUCTION COSTS Item • Estimated Cost(Dollars)to be completed by permit applicant 1.Building a Electrical 3.Plumbing/Gas 4.Mechanical(HVAC) 5.Fire Protection 5.Total=(1+2+3+4+5) 7.Total Square FL pansy(gnome&addltio,ei Check Below ❑ Conservation-Commission Filing (if applicable) ❑ Old Kings Highway&Historical • Commission approval (if applicable) • 3.2 Registered Home Improvement Contractor. Company Name Not Applicable ❑ r Address Registration Number Expi anon 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 j 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 0 Name(Registrant): Registration Number Address Expiration Date Signature Telephone Section 5.2 Registered Professional Engineer(s) Name 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 Hams Area of Responsibility Address Registration Number Signature Telephone Expiration Date Section 5.3 General Contractor Not Applicable Cl Company Hams Person Responsible for Construction Address Signature Telephone Greg Bilezikian, Manager-Owner 225 White's Path Units 2 & 3 LLC do Turtle Rock LLC 231 Willow St. Yarmouthport, MA 02675 781-987-3647 20 September 2022 Mr. Mark Grylls, Building Commissioner Town of Yarmouth 1146 Rte. 28 S. Yarmouth, MA 02664 Re: Request for change of construction supervisor Renovation of 225 White's Path Units 2 & 3 Dear Mr. Grylls, I am the owner-of-record of the subject property and have been asked by Dellbrook JKS to submit this letter acknowledging and approving of the change in construction supervisors from Greg Inman of Dellbrook JKS, the selected construction manager, to Michael Schmidt, also from Dellbrook JKS. Greg Inman, submitted the building permit application several months ago and due to changes in project schedule, has now been replaced with Mr. Schmidt. Based upon Mr. Schmidt's deep background and experience with the type of work with which we will be engaged, we are in support of this personnel change. Please let me know if you require any additional information. Sincerely Your 11/1 i f Greg ,ty Bilezikian CC. 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