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HomeMy WebLinkAboutBLD-23-000834 I n//0 -- 7� - --"''S 1 i & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department R t. 1146 Route 28, South Yarmouth,MA 02664-4492 U1.5 ziU 508-398-2231 ext. 1261 Fax 508-398-0836 Cif 4\1 Massachusetts State Building Code,780 CMR �yF,K t n.1 Permit Application To Construct, Repair, Renovate Or Demolish stilt I,P..3� _ a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: i l Sri• Date Applie 1 r' c<- S -:: Date Building Official(Print Name) ignature SECTION 1: SITE INFORMATION . 1.1 p rty Address: 1.2 Assessors Map&Parcel Nurrers \Ae.c•Scwt� Lc 1e _IA A J �/ 11.1 a s this an accepted street?yes ✓'^ no Map Number Parcel Number 1.3 ZoningInformation: 1.4 Property Dimensions: I Z C9t9d "5 ` Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) owif , 1.5 Building Setbacks(ft) Rear Yard Front Yard Side Yards Provided Required Provided Required Provided Required O WallifilliMINIONIMINNI an —1.- - 111 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: — Outside Flood Zone? Municipal 0 On site disposal system 0 Public CI Private 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 E1o ,:p -- --4 ii C. State,ZIP .Q Telephone Email Address No.and Street SECTION 3:DESCRIPTION OF PROPOSED WORK'"(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) X Addition 0 Demolition 0 Accessory Bldg. ❑ Number of Units Other ❑ Specify:� � Brief Description of Proposed Work2: ,r , La. - / SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: Official Use Only (Labor and Materials) Indicate how fee is determined: 1. Building Permit Fee: S t.. 1.Building $ Standard City/Town Application Fee • $ Z 0 0 Total Project Cost3( em 6)x tlltiplier x 3.Plumbing $ 2. Other Fees: $— 3 M i 6i lAci) - 4.Mechanical (HVAC) List: — 5.Mechanical (Fire $ t We Total All Fees:$ Su••cession) Check No. Check Amount: Cash •°u ount: ©p© 0 Paid in Full 1 Outstanding Balance D,e: _ \� 6 2/ .Total Project Cost: $ �� 0\\/� d SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) to -2) -7 It 11.44 Usti( Va. License Number Expiration Date Name of CSL Holder List CSL Type(see below) (Z o.and Street Type Description l� ' Unrestricted(Buildings up to 35,000 Cu.ft.) t`J 0✓ t d Restricted 1&2 Family Dwelling City own,State,ZIP Masonry (� 'Z Co`, 5- • RC Roofing Covering WS Window and Siding 4�� 5 SF Solid Fuel Burning Appliances �( 0?Z O I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 5 3 t(I S jLvL� HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name Gl S 14a); ti t t i' © 7 'C(S 1•t1 Q)' No.and Street Email address ou 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 CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize ��1 to act on my behalf, in all matters relative to work authorized by this building permit application. � r� Lc,2, Print Owner'iName(Electr nic 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 application is true and accurate to the best of my knowledge and understanding. �QJi -M - ✓ fri(cI1 2-2— Print Owner's or Authorized 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 wvvw.mass.eov/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 �► itt. /, Department of Industrial Accidents -,., __;= j'= 1 Congress Street, Suite 100 Boston, MA 02114-2017 �S,y.•�� www.mass.gov/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): �C'.,L}1 vv c / ay,5 `4 L. '-+.\ Address: t(Po k- 0 e,✓4 "D8,- - Z0 City/State/Zip: de,d'IiA t_.4 „ ( u O�-cc75 Phone #: 5O' • (oZ *) -e, Are you an employer. Check the appropriate box: Type of project (required): I.❑I am a employer with employees(full and/or part-time).* 7. ❑New construction 2. I am a sole proprietor or partnership and have no employees working for me in 768. 0 Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑ Demolition 3.0 I am a homeowner doing all work myself. [No workers'comp. insurance required.]t 10 Building addition 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 11 Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole proprietors with no employees. 12.0 Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13_❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.* 14.❑Other 6.111 We are a corporation and its officers have exercised their right of exemption per MGL c. 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 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: ,,/'U LPL,. �✓(0' v. Policy r or Self-ins.Lic.#: Expiration Date: 4"Il I L02..3 9 e • City/State/Zip: \- d✓�0 . b ?s Job Site Address: �i S }>�e c� �� �v.�ft.�� �'c. Attach a copy of the workers' compensation policy declaration page(showing the policy nu ber 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 certif under ains and penalties of perjury that the information provided a ove is true and correct. Signature: _ Date: Er I b I t 0 LL Phone#: C 0 b 1 6 2..- Life In 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#: o1"'Y'�R,t, TOWN OF YARMOUTH ,z C - BUILDING DEPARTMENT O . H 1146 Route 28, South Yarmouth,MA 02664 ":�;,,,,,::Y,q? 508-398-2231 ext. 1261 Fax 508-398-0836 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at 33 )hecs ,,t C C. sc `N Work Address Is to be disposed of at the following location: t d eNtite A i., Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. /1 b z,c., Signature of Application Date Permit No. i / .. FLOOD ZONE C / 2500015 WO1 El NUMBER _��^,��-... 07-02-1992 FILE (` r� • Foundation Location Appr d Ite15 64 ill, NQV 2 0 2009 �,,.et,.3s5.t7o cw,LCc. C!PT . By PCL. 40.1 +,, POT- 35 '� y 4. + `r / . iiii PC€r 38 • `` . , e LOT 45► � '` ?,t�� 14.703 SF.* Ns.. A-20.38' e' . R'-505 G0 54' `I .:: de Ns. ....s it/ mot•.• \Cr R 4:41,5;' . '. d' "at e 'to - le 'S > 1 HEREw CERTIFY Tt AI THE BUILDING SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON. 'CERTIFIED PLOT PLAN J.C. EL1J5 DESIGN — SUBJECT: ,__ 36 PHEASANT COVE CIRCLE ptr...: rr. 7.-, 4 YARMOUTH, MA ' .,,, ,,,,,, 7 PREPARED FOR: U_ 9 •',,, DON PREISILY INN(UMW - i, P.O. BOX 599 ,A�, c MASHPEE, MA 02649 . P.O. BOX 2152 •.,14t tk�+tiV ,_. ASSESSOR'S SCALE: 1'-30' BREWSTER, MA C2631 s MAP 149 PARCEL 36 t508 -222B tiOVEitBER 19, 2009 Ema1 jod dasignOV Z1ZOA nat DATE: H. REG©, P.L.S. REtt): SHEET 1 OF 1 . Sears, Tim From: Sears, Tim Sent: Monday, August 22, 2022 3:48 PM To: 'Kevin Fair' Subject: 36 Pheasant Cove Kevin, I have reviewed your application and you are going to need a Registered Design Professional review and stamp the plan regarding the cantilevered deck. Thank you l imothy Sears CBO Deputy Building Commissioner Town of Yarmouth 508-398-2231 Ext. 1259 mailto:tsearsC>varmouth.ma.us • TOWN OF YARMOUTH HEALTH DEPARTMENT • PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To he completed by Applicant: Building Site Location: 7. •(L` cf,-1 `� C. 6 Proposed Improvement: ► c, . ck 5 t cL (c4 � ct vc,t c1 Applicant: tt tt Tel. No.: ( c:?>2 e7Zo Address: it Date Filed: 7 **If you would like e-mail notification of sign off please provide e-mail address: I •‘Rct ,'i'®(cv,gCd 5 1 • t/1E Cam---^ Owner Name: Ci t/ v/ o t' 0 >c:5 Owner Address: -4 C Owner Tel. No.:( q$L 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: (l.) Site Plan showing existing buildings, water line location, and septic system location; (2.) Floor plan labeling ALL rooms within building (all existing and proposed) — Note: Floor plans not required for decks, sheds, windows, roofing; (3.) If necessary, Title 5 application signed by licensed installer with fee. REVIEWED BY: t l'i ' DATE: / - d1`e —dam PLEASE NOTE COMMENTS/CO DITIONSS:, n �;_,. HUc-3c 1�% jC'C ✓Nc� W� �� �e ✓ V c ti c _ I 'bGw vt ' 3 (1) y / e ,ro . . I .., .. . ,, • 0 1"Yilitu. • TOWN OF YARMOUTH 0,... - '114: I. .5%1 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSEITS 02664-4451 ..,be....pusini•- r; s •••v. '\"•••1 **im•ssts• c_1,2.!,..- Telephone(508) 398-2231,Ext. 1250—Fax(508)760-4830 .,,..• Engineering and Surveying Division Building Permit Review Residential and /or Commercial Buildings Name of Applicant: le€,J.: r- (-V co....„1..4,4 . Telephone or Email Address: 40 75C1022,D, Proposed Building Location: 1 . —1- C .ec, ( e 12. ......, _ Date Submitted: Requirements for review: Please submit one(I)copy of plans, to include: I. For Residential: Site Plan showing proposed and/or existing buildings, proposed contours with bench mark,water service location,and septic system location. For Commercial: Site Plan showing details required by the Zoning By-law and revisions required by Site Plan review, if any. Note: Site plans must be signed and stamped by a Licensed Professional Land Surveyor and Engineer or Sanitarian. 2. House or Building - Floor Plan(s) and Elevation Plan(s) 3. One(1)copy of application. Amanda °„,,,'Iz?,=-7::,'-,,- Reviewed By: Lima Dale 202208121033.3 04170 Date: 8/12/2022 PLEASE NOTE Comments/Conditions: Discharge gutters to drywells tag, Printed on Recycled Pow - - TOwN OF N'ARm( ?' T' li . , ,ci WATER DEPARTMENT ,,,,,, .c irnooth MA 026- —1-7921 • fax, l'Ant, 7"1-7'196 BUILDING PERMIT APPLICATION FOR WATER DEPARTMENT SIGN OFF TRANSMITTAL FORM t C f BUILNGDI SITE LOCATION: 34 ' k e ets 4ti C..'"t 'Ve I e PROPOSED WORK: 4 XII clio.,AL ?,.:1." 5..-._At APPLICANT: ,:„.1, ''"'t4,,,,,,-- (4)- , Cu.,s r-•%$.71 - tN-e...-1 ADDRESS: J__. 0. \----Vt,%. es,'5 N...1- ,..,(... (4-. r,i 1( TELPI.IONE: 7 5.ci (..,'TLC) RESIDENTIAL AND 'OR COMMERCIAL BUILDING Water Department: Determine Compliance of Water Availability and or existing location Fnginwring Department: Determines Compliance for Parking,and 1)rinnage Conservation Commission: Determines Compliance to Wetlands Act: i c If lous)border any type of k\QtlatIdS,siretims, ponds,rivers. OCCall, hogs. boys, marshland. ETC— I lealth Department: 1)k:1c:twines Compliance to State and tn Regulations, i.e. requirements for Septage Disposal and other Public I ieulth Activites Fire I kpartment: Determines Compliance to State and loss n Requirements Ibr Personal Safety, Property Protections. i.e. Smoke Detectors, Sprinkler Systems etc 11......\--.1-...... 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