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HomeMy WebLinkAboutBLD-22-006669 r 1 pL 11) 131Z2: ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department """y 1146 Route 28, South Yarmouth,MA 02664-4492 r 508-398-2231 ext. 1261 Fax 508-398-0836 41i ,. ,, t' 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 R E C E I V E D Building Permit Number: i3 LC- 22-(x0( 45q Date Applied- I/w. At .j' q-- 11- 1,). MAY 18 2022 Building Official(Print Name) Signature SECTION 1:SITE INFORMATION ev: o ° r • 1.1 Property Address: j /t�go 1.2 Assessors Map&Parcel Numbers 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning� Information: 1.4 Property Dimensions: / A + J 1 s g 5 a ® 8 Zoning District Proposed Use Lot Aiea(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 30 1..,0 O co_ 6 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: PublicaZone: _ Outside Flo d Zone? � Private 0 Check if yell Municipal 0 On site disposal system SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: ratty u006cs )6nwAL �t ,I`Y)pss Name(Print) City,State,ZIP 3� K�� w miG� �i o� Ack.1 -4 _® 1 . \,AaC\ CE Ct. \I . row., No.and Street Telephone mail Address' SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction Existing Building 0 Owner-Occupie Repairs(s) 0 Alteration(s) 0 Additionit Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work'`:irill00 ( ) �e..c,,p..,✓ poire \ �i_�t%QP` ON. ,1.1sTnil- . Ili;yse., SECTION 4: ESTIMATED CONSTRUCTION COSTS. Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building S30,0 O 0 1. Building Permit Fee:$ l c ) Indicate how fee is determined: q Standard City/Town Application Fee 2.Electrical $ ,SZ,0 e)0 0 Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 4 (A 2. Other Fees: $ (Jv C,W Z W p� 4.Mechanical (HVAC) $ tt p4 List: V ,x_, ,'4 cr 5.Mechanical (Fire Suppression) $ N 44 Total All Fees:$ Check No. Check Amount: Cash ount: L 6.Total Project Cost: $ CIPaid in Full Oil Outstanding Balance ue: 1 q0 c\a i`aa- — I SECTION 5: CONSTRUC'TION SERVICES 5.1 Construction Supervisor License(CSL) " • W ti .n J Cv License Number Expiration Date Name of CSL Holder List CSL Type(see below) No.and Street Type Description £$;'l_D ry iv i S m S 4'7 U Unrestricted(Buildings up to 35,000 Cu. ft.) z T R Restricted 1&2 Family Dwelling_ City/Town,State,ZIP _ Masonry FRoofing Covering D Window and Siding In SF Solid Fuel Burning Appliances "5 G j-C&O_(L 44 ` 1 412r)At* �3 (��c�,1 % I Insulation Telephone Email adalr s V [; INN, D Demolition 5.2 ,Registered Home Improvement Contractor(HIC) 6 ✓i�O Y' n s i 1:`t 5 3 Aoa`i HIC Registration Number Exirat' n Date HIC Company Name or HIC Rt gistrant Name --77 -S' CV')Nn.v.t�o P:R+� Qer1N <62' ST€cm•DAA , co hN, No. and Street V ' WE-Sr-vim, is f fl rtt 1c1SS e c �i'7�O sog ze0 i1 0 all!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 Issuance of the building permit. Signed Affidavit Attached? Yes 0 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 /;70 M n, fvel to act on my behalf, in all matters relative to work authorized by this building pit application. G a,l A Od 2 e . Mj 0, Print Owner's Name(Elec i onic Signature) Dale ` SECTION 7b: OWNER1 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. ✓ h Print Owner's or Authorizegent'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.zov/oca Information on the Construction Supervisor License can be found at www.mass.aov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq. ft.) /16 0 (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 E JQ,C- Number of decks/porches Type of cooling system jc i l t iv1 r Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" • The Commonwealth of Massachusetts Department of IndustrialAcciden is 1 Congress Street, Suite 100 Boston, MA 02114-2017 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): Address:` 0' 11O\ City/State/Zip:U• .Niv►s b 40 Phone #: SO8 0_80 ,/I 0 a Are you an employer?Check the appropriate box: Type of project(required): I.E l'am a employer with employees(full and/or part-time).* 7. ❑New construction `ifijkl am a sole proprietor or partnership and have no employees working for me in any capacity.[No workers'comp. insurance required.] 8. n Remodeling • 3.0 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 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.E Electrical repairs or additions proprietors with no employees. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. • 12.❑P1umbIrig repairs or additions These sub-contractors have employees and have workers'comp. insurance.[ 13. Roof repairs 6. We are a corporation and its officers have exercised their right of exemption per MGL c. 14.n Other 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. tContractors 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: Policy or Self-ins. Lic.#: Expiration Date: 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 underthe pains at penalties of perjury that the information provided above is true and correct. Signature: / Date: Phone#: -5—(7 _Sp) D j L c)x 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#: o�YA TOWN OF YARMOUTH re of • _ BUILDING DEPARTMENT `� Po�< ,v 1 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1261 HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DA 1E: JOB LOCATION: NAME STREET ADDRESS SECTION OF TOWN "HOMEOWNER" NAME HOME PHONE WORK PHONE PRESENT MAILING ADDRESS CITY OR TOWN STA 11, ZIP CODE The current exemption for `Homeowner' was extended to include owner—occupied dwellings of one or two units and to allow such homeowners to engage an individual for hire who does not possess a license,provided that such homeowner shall act as supervisor. (State Building Code Section 110 R5.1.3.1) Definition of Homeowner: Person(s)who owns a parcel of land on which he/she resides or int: ds to reside,on which there is or is intended to be, a one or two family attached or detached structure assessory . such use and/or farm structures. A person who constructs more than one home in a two-year period shall not . considered a homeowner; such"homeowner"shall submit to the building official, on a foiiii acceptable to the •4ilding official,that he/she shall be responsible for all such work perfouuiied under the building permit. (Sectio► 110 R5.1.3.1) The undersigned `homeowner' assumes responsib. ty for compliance with the State Building Code and other applicable codes, by-laws, rules and regulations. The undersigned 'homeowner' certifies that -e / she understands the Town of Yarmouth Building Department minimum inspection procedures and requ. ements and that he / she will comply with said procedures and requirements. HOMEOWNER"S SIGNATURE APPROVAL OF BUILDING OFF.CIAL INSURANCE COVERAGE: I have a current liability insu ance policy or its substantial equivalent, which meets the requirements of MGL Ch.142. Yes No If you have checked ves, p -ase indicate the type coverage by checking the appropriate box. A liability insurance poli Other type of indemnity Bond OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent h:homeownrlicexemp o '.YaR- . TOWN OF YARMOUTH • BUILDING bEPARTMENT o wIt. y 1146 Route 28,South Yarmouth,MA 02664 " a �" 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 34 kn7'/JR'yw /))/LLI J£L Work Address Is to be disposed of at the following location i E x Go Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Ze 5/6/A Signat:fie of Application Date Permit No. Sears, Tim From: Sears,Tim Sent: Wednesday, May 25, 2022 4:07 PM To: 'martinfutej57@gmail.com' Cc: Water Department Subject: 37 Kathryn Michael Rd Thomas, t.I have reviewed your application for the addition and there are some items needed. Water Department sign off 2. 2 sets of plans showing compliance with the 9th Edition State Building Code 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 CB0 Deputy Building Commissioner Town of Yarmouth 508-393-:27.3t Fxt, 1..759 mailto:tsears@yarmouth.ma.us 1 �� 2YdrJtC I) �t � A'�Ir ct, km ( 5 ; ciJu tnJ t„,_si-uis, me b1'l5 •H fit - -c10 8 b. C.4 M, a 5 rE,t G t:,cc;Y.JcAd i i Commonwh M Division of ealt Professionalofassachusetts Ucensure Board of Building Re we and Standards Construct r Specialty CSSL-101165oltr �i. mows MF� , c�pires:09/27/2023 P.O.BOX 1 TEJ fp' 1 WEST DEN M1 r Commissioner �, /„ Office o HOME %l� E IMPROVEMENT CONTR Regulation CONTRACTOR Tr •Individual THOMAS M.F -- " 03/14/2023 THOMAS FUTEJI . ay7 5 WINDWARD R .., {..r W.DENNIS,MA 02 >' _- / �. Undersecretary I r .),'"". .'..‘ 0 .1 . , -((..4 ' o D$9 0 3 , . i 7%. \\\ .11_/........ .,,..._, . . � . , . 4 _ .i , . 1 ,12... 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Zataa as MIE 11111111111111111111111111101111110111111111111111111111111111111 ■aalllaaraa a al mlm aaNaaaaaaaaa _ a s 11111aMEMEMINIMONNINEMPINAIMMENROMINIMEM IMMIMINEMINIMINIMIUMEMPHIEMINIMMININ aaaara11aaaaaaMaaaaaa ENIMM NINE a s ■aaaaaaaaaaaaaaa � �aa�mm.ama�am aauaa aaaaaMaaaaaaaMaa E_ EMMI EMENNI ■■raaraaaaaaaaaaaanWIPIPISN aaaaaIaaaaN Nammommumormmommmaaarammommum IIIIIiiIiIiiIiiiiiiIII1iIIIIiI aaa MEMEMMEMEMMEMMEME ■ MEMMEMEMIMM_EMOMMEMMEMMIMEM©E , .MIN , TOWN OF YARMOUTH 1146 ROUTE 28,SOUTH YARMOUTH,MASSACHUSETTS 02 -4451 Telephone(508)398-2231 Ext.1292 Fax(508)398-0836 pr,OLD KING'S HIGHWAY HISTORIC DISTRICT CO E 0 7 2022 i WAIVER OF 45-DAY DETERMINATIO y ah,v,uk.>>t, OLDKING' HIGHWAY The applicant/applicant's agent understands and agrees that due to the current declared National and State public health emergencies the determination of our Application for a Certificate of Appropriateness/Demolition/Exemption may not be made within 45 days of the filing of such application. The applicant agrees to extend the time frame within which a determination is to be made as required by the Old King's Highway Regional Historic District Act. SECTION 9-Meetings,Hearings, Time for Making Determinations "As soon as convenient after such public hearing; but in any event within forty-five (45) days after the filing of application, or within such further time as the applicant shall allow in writing, the Committee shall make a determination on the application." Applicant understands that the review of this application will be scheduled as soon as the situation allows. 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