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Home My WebLink AboutBLD-23-000307 • ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department ;:,•oF 1146 Route 28, South Yarmouth, MA 02664-4492 ,: 508-398-2231 ext. 1261 Fax 508-398-0836 ili 4y Massachusetts State Building Code,780 CMR =_ e Building Permit Application To Construct, Repair, Renovate Or Demolish -- a One-or Two-Family Dwelling This Section For Official Use 0 y RECEIVED Building Permit Number: BU)-.23-Cbc c)L Date Applie SRArs _ dad\ Jdt 18 2022 BuildingOfficial(PrintName) gnature B U Ma NG DIiPARTMENT Y._. SECTION 1:SITE INFORMATION = 1.1 Property Address:` a 8 1.2 Assessors Map&Parcel Numbers 3 5-. , /�� 8ci(0 20 J OD' 1.1 a Is this an accepted street?yes no Map Number Parcel Number ^^ 1.3 Zoning Information: 1.4 Property Dimensions: 1,�J ) 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: Zone: _ Outside Flood Zone? Public I Private 0 Check if yes Municipal❑ On site disposal system 6i1 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: . .,a A&javh 40 S- 0�i'vecnG S• yCuivx ov--�. ►' ) V - Qa6Co�! Name(Print) City,State, IP 8°1 (Zo at oZ8 ,so g 3 C 9.is-5.1 b 1 a h co,...-lao7 cowl cas.} ..-...-f- No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 1 Existing Buildings Owner-Occupied pg Repairs(s) 0 Alteration(s) 0 Addition g Demolition ❑ Accessory Bldg. ❑ Number of Units Other 0 Specify: Brief Description of Proposed Work2: Co i, d-e.&+ w i G .FFZovv 1a..e ctkoow. # 1 ..v\• c, at- Pi. Ip a.-4., 1 S'x 1 c• . et_ -' Jr.ti. c.-4,,-1 I S-keu rz. o wi Anse `-f { Pp o ' iv.. . - 3 v cr— edo-iv-TX) SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: RECEIVED Item Official Use 0 aly—— ------_� (Labor and Materials) 1. Building $ oo,p 1. Building Permit Fee:$O_Indicates'ow e 121 Standard City/Town Application Fee C 2.Electrical $ 0,7, 5bo 3 0 Total Project Cost (Item 6)x multipLeraUicplty : ,1,-N 3.Plumbing $ 02 , 5 0 2. Other Fees: $ 3sC-C1,5i By _ ---=- 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire c r� 35O x�. k NUL) I Z�I Suppression) $ Total All Fees:$ °c, Check No. Check Amount: Cash t:_ S . 7- 6.Total Project Cost: $ is, 0OO • 0 Paid in Full ®Outstanding Balance ue:-) C ad72_ - SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) loci Y /6 4if .4L-3 � (e\.-C/.L Licen e Number Ex iration Date e of CSL Holder J G S ��a_1 - k List CSL Type(see below) No.and Street y Type Description Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling City/Town,Sta V ZIP M Masonry RC Roofing Covering WS Window and Siding �� c SF Solid Fuel Burning Appliances /Ce 6(aci��A I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement� Contractor(HIC) 153 s is 2 7 q� e (-` HIC Registration Number Expiration Date HIC Company N or HI,C Recistrant NAne 4k. ^/ t•,C.A1c &M 6UC-f0}7Ab L A (azA Nod Street Email'dress 5 3795i)- Ci /Ton, 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 ❑ 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 to act o behalf, in all matters relative to work authorized by this building permit application. 7 , Print 0 L er'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 application is true and accurate to the best of my knowledge and understanding. t�erv0.rllo S.+ O{;vest row 7/a.2 Print Owner's or Authorized Agent's Name(Electronic Signature) ate 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.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 . _= L Department of Industrial Accidents 1 �= 1 Congress Street, Suite 100 _� Boston, MA 02114-2017 �e.; �y—5�•' www.mass.gov/dia \Yorkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information r) Please Print Legibly Name (Business/Organization/Individual): -y r_ gC.C%(�'�-L __ Address: go City/State/Zip: S qk�twrDAAA Phone #: S a 3 7 9S 92- Are you an employer?Check the appropriate box: Type of project(required): 1 ,l 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 any capacity.[No workers'comp. insurance required.] g• emodeling 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 m YProP �1' e I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.(1 Electrical repairs or additions proprietors with no employees. 12.n Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp. insurance.t 13.0 Roof repairs 6.0 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 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: P- u Policy#or Self-ins.Lic.#: •C --Se', •(ese. per' Q 6-y/ j �(; Expiration Date: � a 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 ins and penalties of erjury that the information provided above is true and correct. Signature: Date: 7 ,/ 9- 3- 1 Phone#: \ y 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 Division of Professional Licensure Board of Building R ulations and Standards Cons 14iipervisor ii CS-104107 spires:08/25/2023 CARLOS H - - - 20 CAPTAIN • SOUTH YAR U 0 Commissioner c1) Cync/ia • • r M ass.gov 11" t n �.'." HIC Registration Complaints Registration 153792 Registrant C & F REMODELING INC Name CARLOS FIGUEIROA Address 20 CAPTAIN NOYES RD. City, State S. YARMOUTH, MA 02604 Zip Expiration 01/07/2023 Date Complaints Details No complaints found for this registrant. You can also view arbitration and Guaranty Fund history. Back To Search TOWN OF YARMOUTH BUILDING DEPARTMENT N ` 1 1146 Route 28, South Yarmouth,MA 02664 "tea,;,` *VG ra 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 '0Q R „Liz. Work Address Is to be disposed of at the following location: CLA wi v-1- 5-_a4 ►o.._ ,34 0- 5 yo S-- c c— Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. / /a,oZ} Signature of Application Date Permit No. DATE(MM/DD/YYYY) ACORO CERTIFICATE OF LIABILITY INSURANCE 05/07/2021 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 Debi James NAME: Leonard Insurance Agency.Inc PHONE (508)428-6921 FAX (508)420-5406 (NC,No.Extl: (A/C,No): 683 Main Street E-MAIL debi@leonardagency.com ADDRESS: Suite 8 INSURER(S)AFFORDING COVERAGE NAIC# Osterville MA 02655 INSURER A: Atain Specialty Insurance INSURED INSURER B: The Commerce Ins.Co. 34754 C&F Remodeling Inc. INSURER C: Associated Ind.Of MA-ARWC 26158 INSURER D: 20 Captain Noyes Road INSURER E South Yarmouth MA 02664 INSURER F COVERAGES CERTIFICATE NUMBER: 21-22 Master 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 HAi E BEEN REDUCED BY PAID CLAIMS. SNT R TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LTR INSD WVD (MMIDD)YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE 10 RENTED 100,000 CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 A CIP403384 04/18/2021 04/18/2022 PERSONAL aADvweuRv $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,P000 X POLICY JECT LOC PRODUCTS-COMP/OPAGG $ 2.000,000 _ OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ 250,000 g OWNED X SCHEDULED RVM277 01/18/2021 01/18/2022 BODILY INJURY(Per accident) $ 500,000 AUTOS ONLY AUTOS X HIRED NON-OWNED PROPERTY DAMAGE $ 250,000 AUTOS ONI Y X AUTOS ON;Y (Per accident) Medical payments $ 10,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB -- CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y f N 1 C ANY PROPRIETORiPARTNER/EXECUTIVE N NIA WCC-500-5018589-2021A 04/30l2021 04/30/2022 E.L.EACH ACCIDENT $ , , OFFICERMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000000 ^_DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ . 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. AUTHORIZED REPRESENTATIVE MA 02653 r 4)J,,,r. ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD � / � / | ' | � ` . � / /L-----� | � � � ` | / / ! , - � ` ` � � \ \k ` � . ' i | | / / � ! 1 t"--.- • I' i : 1 ! ,r-7 ......_.... II .•-...:6.::1.::--a 7 f,4‘-.:-.1'.-'11:-..:''f. - - i .. i- _ID . 4 11 IH-------..."--------------------------) , . i i / I 1 // i 1 / • L 1 h ,; , . _ i I ; ; 1 1: . . . \ S., kdi \ \ . . , .• ,:. 1. 1 . • • ) . . . 1 .. , . lt, 1 . . \ +.1 1.. ‘. . .. ,, .. 1 .1 1 I E II . HV..........................................„........._ , i Se liti --'. -i s /7 1 Pj2J2oom 1 R 1 4 \$ \..i Ui 1 �1 o (--z,Ir' ' ' I cl. r 9 i N ,:., 1_, p)--ck.A.1., 5 CO • -11 , 1 (ttpvin01 I ^` T d 1 d al �k,„ TOWN OF YARMOUTH 4.4t: HEALTH DEPARTMENT PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Building Site Location: . Proposed Improvement: v\V-e/J W 1 C , C- Applicant: ki(2,)j � t •c Tel. No.: ,.)3 79 92. .�. L' /W. Date Filed: 7 /c-,��Address: _ ,. c� �.."�. , > t� **If you would like e-mail notification of sign off,please provide e-mail address: Owner Name: ()Lk-A". Owner Address: 96 • ter f' vdi ..-, Owner Tel. No.: 5 . { /..=>5-2- 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; (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: DATE: 7 PLEASE NOTE COMMENTS/CONDITIONS: lh l---1 , 1 9 ii i?T. 4 A t i U I-Gr,olt 1 )' RJF7' ip . X) T i ) ct-. CA 6 * 0 \ 3 ito R) Gb 9 - 5 S-1-Q-et-4- Rae_ a g S' Sears, Tim From: Sears, Tim Sent: Friday,July 22, 2022 2:44 PM To: 'citfigueiwea Cc: Slack, Christine; Water Department Subject: 896 Route 28 GU �, (aQ2-D02_0 iv -1'1'1 j ( , L1L Carlos, J I have re iewed your application for the addition/renovations and there are some items needed. ?S12�i2'Z . Health Department sign off '2-7N-ater_De ar a=sigr -' ph-c-hecklist.nr._stamped glacns S,—Panssbawing-cod ompliant-foundatioll �6. Floor plan for ne,bathroom with fixture layout^ l and clearance dimensions shown. 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@yarmouth.ma.us 1 Re If? —4,4.is ; b` i 1 , liSeckoorvN J. i 4 \c 8 1 r, ! •••- r: \ 1 k1/4•-, 7 ----t ki) 2 E. i _.2 o 2 c >., ot1 0 , I -,4. - . o cr-2 5 —1- 6pkiinol 'I i i 1 ----- 7—. i (1C3 QC d -1--- i .4.. .c.:...5 i (I)