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HomeMy WebLinkAboutBLD-23-005558 po ci‘/145 y 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 This Section Fo Official Use Only Building Permit Number: O79M��,� SK 1% I'Date Applied: Al f`yr\ '`Rr Si_ attire Building Official(Print Name) �:ili r r SECTION 1:SITE INFORMATION Ohm Li Property Address: 1.2 Assessors Map&Parcel Numiri APR 2023 1 S Parcel u , Map Number - _ � W NT 1.3 Is this I accepted street?yes no 1.4 Property Dimensions: 1.3 Zoning Information: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Rear Yard RequiredIIMIMIIIIMMIIIIIIIIINIIMIIMIIII Side Yards Provided Front Yard Provided Required Provided Required 1.6 Water Supply: (M.G•1-c.40,Q 54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: Outside Flood Zone?Public 8 Private 0 Municipal❑ On site disposal system 0 Check if yell$ SECTION 2: PROPERTY OWNERSIEW 2,1 Owner'of Record: ` P wl( s City, e,ZI Name(Print) •- t`` ` - lA o 4Telephone Email Address � No.and Street " cheek all that apply) SECTION 3:DESCRIPTION OF PROPOSED WORK-( AtteaAlteration(s) 0 Addition New Construction❑ Existing Building 0 Owner-Occupied ❑ Repairs(s) ❑ fil p Number of Units____ Other 0 Specify: Demolition 0 Accessary Bldg. V,( :� in �� Brief Description of Proposed Work2: G a '�r ,r i , SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: Official Use Only r 1 V E (Labor and Materials) Indicate how fee is iirr d" 1. Building Permit Fee:$_�____ - _ 1)Standard City/Town Application Fee i A� 1 d23 1.Building t3(Item 6)x multiplier — +a.. C, 0 Total Project Cost3 � _ 1NG Gr. 2 Other Fees: 5--------- �� 3,Plumbing List: i ■ Total All Fees:$_------- _____cash • ...tint:, Su..ression (Fire Check Amount: Su..cession Check No. Check 6.Total Project Cost: $�es Q� 0 Paid in Full VII Outstanding Balance D e: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS_.LI 6646 Lc, 1a9 ica o5 wa LA C,I ? IA a-.., License Number Expiration Date Name of CSL Holder List CSL Type(see below) U _I_cv s C(1W\p 5—r Ac)-1 .�; Type Description No.and Street Unrestricted(Buildings up to 35,000 cu.ft.) , ) -z,, N.-,q .k..1 M•A , ,,nr t7 l 3 R Restricted l&2 Family Dwelling City/Toff,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances tip 6c,511c1 (J.L.LactNt.--k l,G`t‘„,.., I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) raca1t1.5 t b 5 ( J .a r �•-�_.- 44 14 HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name C3c-k Cap„P s-t A SS - - - - .. ._ i-►•% 1041 (,_ No.� and Street Email address ( C')lal\n.\ At f' \r ).. 01(`(3 , tty wn,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 X 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 L a Lac S, C.4 a to act on my behalf,in all matters relative to work authorized by this building permit application.1itPrwner's Name(Electronic Signature) Date k____,.., G 417C/1. ;*,/c,4/.2 5 • 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. f - P�� ‘.. .. o //a.S�a�03 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 (not registered in the Home Improvement Contractor(HIC)Program),will nos 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.gov/oca Information on the Construction Supervisor License can be found at www.mass.eov/dgs 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" Commonwealth of Massachusetts kWDivision of Occupational Licensure 0.4 Board of Building Re ulations and Standards Cons idAtKrvisor • CS-116646 r 4 spires: 12/29/2025 i. WALACI P M, ICHA ' 193 CAMP S'F. �A� C APT J5 `� a � .7• WEST YARMOUTH M a �� -- Commissioner aeQa K. E .". KrwimeAr.,,,,O4/,,/.:!/i/L:s-i2fA ,e//i [ Office of Consumer Affairs&Business Regulation , HOME IMPROVEMENT CONTRACTOR TYPE:Individual i Reai ation i •204015 02/2Exo 0 1 WALACI PEREIRA*4ACHADO , t 1 WALACI MACHADO-', �.� I 193 CAMP ST APT J 5 WEST YARMOUTH,MA 02673 Undersecretary 4) } Registration valid for individual use only before the expiration date. If found return to: • Office of Consumer Affairs and Business Reguiatign 1000 Washington Street -Suite 710 Boston,MA 02118 Not valid without signature : __ The Commonwealth of Massachusetts .�,1 / Department of Industrial Accidents wino: 1 Congress Street, Suite 100 t=#7 Boston, MA 02114-2017 .r f4 www.mass.gov/dirt Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): 'L (_ RPe�T p. 13c Address: — r City/State/Zip: 14lay.h-,- .).. 0a..6(4i Phone#: S.o'36c) ,5i t c Are you an employer?Chet the appropriate box: Type of project(required): I.®I am a employer with '. employees(full and/or part-time).* 7. ❑New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in $, ❑ Remodeling any capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 10 El Building addition 4.0I 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 are sole 11.❑ Electrical repairs or additions 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. I ❑Roof repairs These sub-contractors have employees and have workers'comp. insurance.t 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.0 Other 152,§I(4),and we have no employees.(No workers'comp.insurance required.] *Any applicant that checks box Rl 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:, T S c J eR% , '('11 SO)R-em.c_.e AC-P ti C.1 L ( C_ Policy#or Self-ins.Lic.#: v} C.-Ac-K114;539 S8 1-1;o D,0 k Expiration Date: o 6/33/tagcg`)N Job Site Address: yl( R-buJ e S R] City/State/Zip:.s, AR\,,,,\t,U-04, Ann )st. Attach a copy of the workers' compensation policy declaration page(showing the policy numid4r 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 wider the pains and penalties of perjury that the information provided above is true and correct. Signature: (,JOQQ,� rr,on-.9. \n-,,q.?9....-ir Date: c.) 4AS/tk t OA Phone#: .50&...6c plc) 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#: • Client#: DATE ACORD TM CERTIFICATE OF LIABILITY INSURANCE 12/19/2022 'HIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHT UPON THE CERTIFICATE HOLDER.THIS ;ERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES IELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED tEPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IAPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the erms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the :ertificate holder in lieu of such endorsement(s). 'RODUCER CONTACT Raphael Oliveira Mex4F• PHONE (508)771-4600 )ISCOVERY INSURANCE AGENCY LLC (NC.No,Ext): EMAIL raphaetdiscovery@gmaLcom i68 Main ST,#A HYANNIS,MA 02601 Phone:(508)771-4600 ADDRESS: taphaeldiscovery@gmail.com INSURER(S)AFFORDING COVERAGE NAIC NSURED INSURER A:ATLANTIC CASUALTY 2LJ CARPENTRY INC INSURER B: r6 WEST MAIN STREET#108 INSURER C: iYANNIS,MA 02601 INSURER D:AIM MUTUAL INS CO INSURER E: INSURER F: AVERAGES CERTIFICATE NUMBER:000015 REVISION NUMBER: 'HIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED NAMED ABOVE FOR THE POLICY PERIOD VDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO VHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT 'O TALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. JSRL ADDLI SUER POUCYfEFF POLICY EXP LIMITS TR TYPE OF INSURANCE NSR WVD POLICY NUMBER (MMM/DDIYYYY) (MWfDDIYYVY) A EACH OCCURRENCE $ 1,000,000.00 GENERAL LIABILITY DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES(Ea acurrence) $ 100,000.00 MED EXP(Any one person) $ 5,000.00 CLAIMS-MADE ( I OCCUR L261004216-2 8/11/2022 8/11/2023 PERSONAL&ADV INJURY $ 1,000,000.00 D GENERAL AGGREGATE $ 2,000,000.00 PRODUCTS-COMROP AGG $ 2,000,000.00 GGEN'Ll AGGREGATE LIMIT ]APPLIES PER'. f POLICY { I PROJECT[]LOC COMBINED SINGLE LIMIT B AUTOMOBILE LIABILITY (Ea accident) BODILY INJURY(Per person) ANY AUTO -ALL OWNED SCHEDULED BODILY INJURY(Per assistant) AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per acrMN EACH OCCURRENCE C' UMBRELLA MB OCCUR -- AGGREGATE EXCESS LIAR CLAIMS-MADE DED 1 1 RETENTION S D WORKERS COMPENSATION Y,N . 1WCISTATUTORY I 10TTH AND EMPLOYERS'LIABILITY ER ANY PROPRETORPARTNER,EXECUTIVE E.L.EACH ACCIDENT OFFICER:MEMBER EXCLUDED? N AWC40070395842022A 6/3/2022 6/3/2023 $ 1,000,000.00 (Mandatory in NH) -- E.L.DISEASE-EA EMPLOYEE $ 1,000,000.00 11 yes.descrbe under E.L.DISEASE-POLICY LIMIT $ 1,000,000.00 DESCRIPTION OF OPERATIONS below ESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Sfchedu(e,if more space is required) ;ERTIFICATE 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. RAPHAEL OLIVEIRA 1/1 O 1988-2010 ACORD CORPORATION.All rights reserve §TOWN OF YARMOUTH 1146 Route 28, South Yarmouth, MA 02664 508-398-22311 ext. 1261 Fix 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 L{ (.J e N Work Address Is to be disposed of oat the following location: `. �R1Mo 0 k S a,-- U Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. r \fr-47Q,ACP 11 to.S 3 Signature of Application Date Permit No. wala_ci Oet-CV- O Kc-(-mat l '�w o VVATER DEPARTMENT RECE1VE. D APR 07 2023 Bt'II.i)I\(; PFR\IIT APPLICATION FOR \\ 1TF:R 1)F:P:\RT\IENT SIGN OFF BUILDING DEPARTMENT TRANS s11 I""I:11. FORA BY--- — Bill DI\G Sill LOCATION:I ION: • - `: ADDRESS: 1 ,, ,, r • is II_PEIO\E Rt-SIDN\fI I AND FOR C'O\1\11:R('I-\I. lit ILDING \V'mcr Departinent I)cl:rnune. of.\\ate:- ;mil LAIvtnit' to:auoll I-ii�InCCrn ti I)Cpartmcn'- D:1:Snilr.o, ( Minh liI cc for I'arkiil_<Intl I (01),c:A anon C omntl,Nlon. I)c1,'Tmme-,(. p.'1:I ; c:Io\t.eland, =At-t, I - It in't.I border an\ tV"pe i+: \t eil�fI d'S. >IIt<f 111�, ponds. IlAei . ocean. I)oe,.. FFC -. I lcAItI1 Department: Detcrnime ( itmpliance to State and I<tvv 1 C. requirement, for Septage I)isp(isal and tither Public I Icalth Activ ite; Eire I)epartntent: Determines('ompliance to State and I(m n Rcctuireinents for Personal Salet4. Property Protection,. i-e. Smoke I)(tectors. Sprinkler SI1/4.stents.elc 11'PI.I(. N 1 SIGNATURE I)\TF OFFICE: USE: COAI\lFN I S ON PFRMI I ,APPROV":1I,OR DINT U • y- 7 2a'2. RF\ II:\vF:D 1 ' \\...I ER 1)IVISION(SIGN.1TURF:) DATE . • NAME STREET 4g-r /IL VILLAGE SERVICE NO. /6 _ AA/ l7/ 1,;?/fr5/tt-r) #"1/1/22-- /G151/-1,217/ METER NC / ,. •1 1 7 _ -• $ • .\ C. = t. 4/13/23, 1:41 PM Mail-Sears,Tim-Outlook 44 Howes Rd Sears, Tim <tsears@yarmouth.ma.us> Thu 4/13/2023 1:36 PM To:walacimachado@hotmail.com <walacimachado@hotmail.com> Walaci, I have reviewed your application and there are some items needed. 1. Health Department sign off(under review) t,2. Updated plot plan stamped by Land Surveyor showing setbacks to proposed porch 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:tsearsPyarmouth.ma.us https://outlook.office.com/mail/sentitems/id/AAQkADE3MDQ5NWZmLTkOYzItNDIwNi1 iMDQxLVVNkMGQyNmE4NzE5NAAQAEtNmOM5YvBKif2GDOh... 1/1 TOWN OF YARMOUTH HEALTH DEPARTMENT PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Building Site Location: L)L( Pc) �_c� R. 6 . vM , •k r Proposed Improvement:` k h L. , _) a €�(jj I © k � (A) Applicant: U j(?, GS � � r�' r���� ),0 Tel.No.: ,6G1?. c t Address: l 9\3 c_ vv,v, ST p 5 ( J `�(�(��,,��-r� lly,,ly Date Filed: **If you would like e-mail notification of sign off please provide e-mail address: Owner Name: 1 a.U K a r\iN V bO t S a Owner Address: (-oo es R S. ( 3 h,,,,c1V-r Owner Tel. No.:_c-)P -3 ' 83 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. RECEIVED Please submit three (3) copies of plans, to include: (1.) Site Plan showing existing buildings, water line location, APR 0 6i 2023 and septic system location; HEALTH UEPT. (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: la"..-40 Ct..c. DATE: 6-- / 3 PLEASE NOTE COMMENTS/CONDITIONS: . . ia:7 11\, a.. .. ....t. ,,. 715 > • 1 a i•l, k • 0 .4%....i > 7. lit a .:• :..f.• 1 , ..... as, \ ..*.•. 4ii 7 FENCE i Jlifaill........41rabaaa...416.....7.4440.......foa am a.7.7.,a 4.01r77.17..7.411.........4..........L 1---- 110.00 • MAP a LOT 8+ T 41; ..' ° . . , .6.61Z SRI • ..., , . a 31193/142. - .1 RESIWCW PLAN BOOK#i5, 0 ser " . , ....... PAGE/I '• -..-qr--1,--4 EMU* i oi•.: LOT5 I& SCIttfatiRE .•••. Z i 4• , , .. . - . CO/DISC la . 8-2... FOUND , , ..._. 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'''' -:.-::. ....-- s: P:P:i.:•-•-4.!.`.%ik. 11/4 e in ii, 't v it:1,1 ir b,.: N ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department ;: "`of y - 1146 Route 28, South Yarmouth,MA 02664-4492 ' 508-398-2231 ext. 1261 Fax 508-398-0836ati" Massachusetts State Building Code,780 CMR Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section Fo Official Use Only Building Permit Number: 1 -13-OD5 Date Applied: Building`Official(Print Name) Signature a 'a SECTION 1:SITE INFORMATION -- - 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers APR 0 LI 4 t4c,LA es _ Q23 1.1 a Is this an accepted street?yes no Map Number Parcel Tun her ___.�_` $tfht$f-NC BEPA-R+M=NT 1.3 Zoning Information: 1.4 Property Dimensions: By: i 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 El Private CI Municipal _ Outside Flood Zone? Municipal 0 On site disposal system ❑ Check if yestr SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: c..-AW R e.Y J Ca s.wak \t UT 14 \nn .K . Name(Print) City,%Ate,ZIP 4 2-k t-..Vo1/4.1eS ..5(323 381 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'-(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 ` Repairs(s) 0 Alteration(s) 0 Addition >il Demolition Cl Accessory Bldg. 0 Number of Units Other ❑ Specify: Brief Description of Proposed Work2: L . \n( t 4-r Y SECTION 4:ESTIMATED CONSTRUCTION COSTS. Item Estimated Costs: OffieiafUse OnIy (Labor and Materials) I V F D I.Building $ , 1. Building Permit Fee:$ I S'd Indicate how feel ti 'Pd:....,.-------'- 9��� Lb Standard City/Town Application Fee i 2.Electrical $ 0 4 Q23 �� 0 Total Project Costa(Item 6)x multiplier Ix M Ay 4 3.Plumbing $ G 2. Other Fees: $ K 1.-007 4.Mechanical (HVAC) $ C List: (QOD1 i U�� INO GE('AF TMENT —5.Mechanical (Fire $ Suppression) Total All Fees:$ r Check No. Check Amount: Cash unt: "J 6.Total Project Cost: $ ❑Paid in Full 4 Outstanding Balance D : \?'? 0