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Home My WebLink AboutBLD-23-004237 4. 7 . 0 peo ONE & TWO FAMILY ONLY- BUILDING PERMIT RECEIVE PAN 3 1 2923Tawn of Yarmouth Building Department ;,,: - — - -- 1146 Route 28, South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836a •. PAN 312 23 Massachuset ttV ts State Building Code, 780 CMR BuilWng Permit Application To Construct, Repair, Renovate Or Demolish -. ., IBUILDING DEPARTMENT a One-or Two-Family Dwelling 1 This Section For Official Use Only Building Permit Number: 13Lb-23-( 2 7 Date Applied: Building Official(Print Name) igna re Date SECTION 1:SITE INFORMATION 1.1 Pr. . ty..4ddress: •�C% `�' "'� Y am` 1.2 Assessors Map&Parcel Numbe s 00 1.1 a Is this an accepted street?yes k no Map Number Parcel mber 1. Z i Information: , 1.4 Pr er.Dimons: AI Z ning istrict Pro sed Use Lot1Area s✓q ft) Frontag (ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required4 rovided Required Provided Required Provided )10 r IV, 0,-Z CdO l'e- 1 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private [ Zone: Outside Floone? // Check if yes 'Municipal 0 On site disposal system q t, SECTION �2: PROPERTY OWNERSHIP' 2.1Gl GYP/ae(l dio a woke47jTf/ ,fr .. _____ Name rint) City,State,ZIP 17 No.and treet ��?� � �' Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK.'(check all that apply) New Construction Existing Building Owner-Occupied Repairs(s) 0 Alteration(s) Addition Demolition l❑ Accessory Bldg. ❑ Number of Units Other 0 Specify: Brief escription of Proposed W rk2: SECTION 4: ESTIMATED CONSTRUCTION COSTS. Item Estimated Costs: (Labor and Materials) Official Use Only 1.Building $ j` p 1. Building Permit Fee:$3S-6 Indicate how fee is determined: 2.Electrical $ WOO O ' Standard City/Town Application Fee mot/ 0 Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ .O C at. I I 4.Mechanical (HVAC) $ IWO List. Za Z-� 5.Mechanical (Fire Suppression) $ -.....' Total All Fees: - - 0 Check No. Check Amount: Cash ount:6.Total Project Cost: $ ,5 , 0 Paid in Full IV Outstanding Balance ue: V\° . SECTION 5: CONSTRUCTION SERVICES 5.1 Co tructio•�Supervisor Lic nse(CSL) /Ofp20C/0 7 /2. 12,72 Licen e Num er Expiration Date Name or��L Hof� �:] r�' �17i-6(A(^ WI List CSL Type(see below) V No.and Street 'T Description i g w Unrestricted(Buildings up to 35,000 cu. ft.) City/Town,Stat Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering • WS Window and Siding t SF Solid Fuel Burning Appliances ( �711 Or 'C ,1 I Insulation T ephone mail address l D Demolition 5.2 Registleree Home Improve(,"rm,�eenn'tACon actor(HIC) �k "fi/ ` -T% f 1 �1 c HIC C,ompan Nam^e 61 ir istrant Nam HQCY�elifr i�n Number Expiration ate d ('�� No,and Street 11?J•- Ig i "`�h �f s; 4/ . Email a s VV1 � (r dv 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 ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 6' I,as Owner of the subject property,hereby authoriz ii to act on my behalf, in all ma rs relative to work a orize by this bu ding p rmit application. 4b& Mvian �fd ONDei f - • t'23 Print Owner's Name(Electroni 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 conta. y his application ' d accurate to the best of my knowledge and understanding. Print Owne ' or Authorized Asent ame(Electronic Signature I r i4 ) 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.aov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial worI s 4ini o.,r vi the information below: Total floor area(sq.ft.) /�f% I (including garage,finished baseme t/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms 1 Number of half/baths Type of heating system Number of decks/porches Type of cooling system P Qi+• Enclosed ✓' Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" irzirerizrpnrr/i (>7. Office of Consumer Affairs&Business Regulation HOME.1MPROVEMENT CONTRACTOR • TYPE:Corporation Da^gistr^tion Expiration 139811 08/24/2023 MOUDOURIS CONSTRUCTION INC GEORGE M.MOUDOURIS -2 12 ATHENS WAY W.YARMOUTH,MA 02673 Undersecretary CommonweaKh of Massachusetts Division of Professional Licensure Regulations Board of Building and Standards , rvisor ConsltF.f�� /i aspires:0711212023* CS-066290 1 x 3 GEORGE M . 12 ATHENS � ,A k , WEST YAR ;Inc_ rr r� Commission iii..��+++er a .0 TOWN OFYAINOUTH 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext, 1261 Fax 508-398-0836 Office of the Building Commissioner 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 resultin from the proposed V�ork/demolition to be , i c 1 i . conducted at—'* 144 '1�,rV�t pillgrn Work Address I Is to be disposed of at the following location: 2YvtAtA 4t ,ot"t411 'i✓1' v Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. ' ________sA5y2_2 __ gnature of Applicant Date Permit No. 01: o. TOWN OF YARMOUTH s t HEALTH DEPARTMENT `' `,is PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To he completed by Applicant: Building Site Location: ' :r .( ' F-,%t- J,tis, r - o � k) Y (ifl L h r� Proposed Improvement: C.„)(C.„)(= hc-d, '0 i }1 r r;--. J�'{7) cLI ILn`u , j , ` ) --/ ` ,12 r ra t lam} , 1,,e - C' �'.CO 9 )it }1 Tel. No.: ?7,o 'I Applicant: �,� d , t��l(i�.� �r i / . ^ Date Filed: (�' (� Address: \4,1 v I r 1 V 7`l 1 3 I ou would like e-mail notification o o , provide e-mail address: C. ;: **fysignI�pleaseKTV`�i -'�" i �� Owner Name: 1 P c,,tihmer) Owner Address: 1 i =(�) ( ve , �,,rl �i' " F'.4 ` � , . Owner Tel. No.:1, 1(72, '44 , I< j 1 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: ,2,, ,,---'1DATE: d\ *---S PLEASE NOTE COMMENTS/CONDITIONS: _ I • 4 Massachusetts Department of Environmental Protection Bureau of Resource Protection -Wetlands OJ ( WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Town of Yarmouth Wetland By-Law, Chapter 143 A. General Information Important: When filling out From: forms on the Yarmouth computer,use Conservation Commission only the tab key to move To: Applicant Property Owner(if different from applicant): your cursor- do not use the Amedee Prouvost return key. Name Name 4717 Essex Ave 44171 Mailing Address Mailing Address Chevy Chase MD 20815 City/Town State Zip Code City/Town State Zip Code noAr e ` 1. Title and Date(or Revised Date if applicable)of Final Plans and Other Documents: Proposed Change to the Zone of Improvement and a"Bay"Addition 11/08/2022 Title Date Title Date Title Date 2. Date Request Filed: 01/04/2023 B. Determination Pursuant to the authority of M.G.L. c. 131, §40,the Conservation Commission considered your Request for Determination of Applicability,with its supporting documentation,and made the following Determination. Project Description (if applicable): Proposed addition to a single-family dwelling locaated over exisiting deck, and dormer installation in the buffer zone to a coatal bank Project Location: 875 Great Island Road West Yarmouth Street Address City/Town 3 6 Parcel/Lot Number Assessors Map/Plat Number Page 1 of 5 wpaform2.doc•Determination of Applicability•rev 5/18/2020 4 Massachusetts Department of Environmental Protection Bureau of Resource Protection -Wetlands WPA Form 2 - Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Town of Yarmouth Wetland By-Law, Chapter 143 B. Determination (cont.) ❑ 6. The following area and/or work, if any, is subject to a municipal ordinance or bylaw but not subject to the Massachusetts Wetlands Protection Act: ❑ 7. If a Notice of Intent is filed for the work in the Riverfront Area described on referenced plan(s) and document(s),which includes all or part of the work described in the Request, the applicant must consider the following alternatives. (Refer to the wetland regulations at 10.58(4)c. for more information about the scope of alternatives requirements): ❑ Alternatives limited to the lot on which the project is located. ❑ Alternatives limited to the lot on which the project is located, the subdivided lots, and any adjacent lots formerly or presently owned by the same owner. ❑ Alternatives limited to the original parcel on which the project is located, the subdivided parcels, any adjacent parcels, and any other land which can reasonably be obtained within the municipality. ❑ Alternatives extend to any sites which can reasonably be obtained within the appropriate region of the state. Negative Determination Note: No further action under the Wetlands Protection Act is required by the applicant. However, if the Department is requested to issue a Superseding Determination of Applicability, work may not proceed on this project unless the Department fails to act on such request within 35 days of the date the request is post-marked for certified mail or hand delivered to the Department. Work may then proceed at the owners risk only upon notice to the Department and to the Conservation Commission. Requirements for requests for Superseding Determinations are listed at the end of this document. ❑ 1. The area described in the Request is not an area subject to protection under the Act or the Buffer Zone. • 2.The work described in the Request is within an area subject to protection under the Act, but will not remove, fill, dredge, or alter that area. Therefore, said work does not require the filing of a Notice of Intent. ❑ 3.The work described in the Request is within the Buffer Zone, as defined in the regulations, but will not alter an Area subject to protection under the Act.Therefore, said work does not require the filing of a Notice of Intent, subject to the following conditions(if any). ❑ 4.The work described in the Request is not within an Area subject to protection under the Act (including the Buffer Zone). Therefore, said work does not require the filing of a Notice of Intent, unless and until said work alters an Area subject to protection under the Act. Page 3 of 5 wpaform2.doc•Determination of Applicability•rev.5/18/2020 - 4 Massachusetts Department of Environmental Protection -- Bureau of Resource Protection - Wetlands i\ WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Town of Yarmouth Wetland By-Law, Chapter 143 C. Authorization (cont.) Signatures: fd iADrpes Signat Printed Name{�,� � 7( Ge(YlS\2i✓1 Sign0 Printed Name Z:\c.1 ( is1 ap Signat`= LL''' Printed Name ' M El le �..au,ccvtc..¢.. Sign rE P inted Name t MX(k. Kii*,, ,cn Signature ..-- / Printed Name d T T 1 s-' z-' ' _ i�1QV1 ta'S OUt-t41 Signattfri ? Printed Name Signature Printed Name Signature Printed Name D. Appeals The applicant, owner,any person aggrieved by this Determination, any owner of land abutting the land upon which the proposed work is to be done, or any ten residents of the city or town in which such land is located,are hereby notified of their right to request the appropriate Department of Environmental Protection Regional Office(see https://www.mass.Qov/service-details/massdep-regional-offices-by- community)to issue a Superseding Determination of Applicability. The request must be made by certified mail or hand delivery to the Department,with the appropriate filing fee and Fee Transmittal Form(see Request for Departmental Action Fee Transmittal Form)as provided in 310 CMR 10.03(7)within ten business days from the date of issuance of this Determination. A copy of the request shall at the same time be sent by certifies mail or hand delivery to the Conservation Commission and to the applicant if he/she is not the appellant. The request shall state clearly and concisely the objections to the Determination which is being appealed.To the extent that the Determination is based on a municipal ordinance or bylaw and not on the Massachusetts Wetlands Protection Act or regulations, the Department of Environmental Protection has no appellate jurisdiction. wpaform2 doc•Determination of Applicability•rev 5/18/2020 Page 5 of 5 4 Massachusetts Department of Environmental Protection L Bureau of Resource Protection - Wetlands WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Town of Yarmouth Wetland By-Law, Chapter 143 B. Determination (cont.) 0 5.The area described in the Request is subject to protection under the Act. Since the work described therein meets the requirements for the following exemption, as specified in the Act and the regulations, no Notice of Intent is required: Exempt Activity(site applicable statuatory/regulatory provisions) -❑ _6.The area and/or work described inthe Request is not subject to review and approval by: Name of Municipality Pursuant to a municipal wetlands ordinance or bylaw. Name Ordinance or Bylaw Citation C. Authorization This Determination is issued to the applicant and delivered as follows: ❑ by hand delivery on ® by certified mail, return receipt requested on I )10/Zoz3 Date Date This Determination is valid for three years from the date of issuance(except Determinations for Vegetation Management Plans which are valid for the duration of the Plan). This Determination does not relieve the applicant from complying with all other applicable federal, state, or local statutes, ordinances, bylaws, or regulations. This Determination must be signed by a majority of the Conservation Commission. A copy must be sent to the appropriate DEP Regional Office(see httpsa/www.mass.gov/service-details/massdep-regional-offices- by-community)and the property owner(if different from the applicant). Page 4 of 5 wpaformdoc•Determination of Applicabdity•rev 5/18/2020 2 4 Massachusetts Department of Environmental Protection �Y Bureau of Resource Protection -Wetlands WPA Form 2 - Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Town of Yarmouth Wetland By-Law, Chapter 143 B. Determination (cont.) The following Determination(s)is/are applicable to the proposed site and/or project relative to the Wetlands Protection Act and regulations: Positive Determination Note: No work within the jurisdiction of the Wetlands Protection Act may proceed until a final Order of Conditions(issued following submittal of a Notice of Intent or Abbreviated Notice of Intent)or Order of Resource Area Delineation(issued following submittal of Simplified Review ANRAD)has been received from the issuing authority(i.e., Conservation Commission or the Department of Environmental Protection). Q 1. The area described on the referenced plan(s)is an area subject to protection under the Act. Removing,filling,dredging, or altering of the area requires the filing of a Notice of Intent. ❑ 2a. The boundary delineations of the following resource areas described on the referenced plan(s)are confirmed as accurate.Therefore, the resource area boundaries confirmed in this Determination are binding as to all decisions rendered pursuant to the Wetlands Protection Act and its regulations regarding such boundaries for as long as this Determination is valid. ❑ 2b. The boundaries of resource areas listed below are not confirmed by this Determination, regardless of whether such boundaries are contained on the plans attached to this Determination or to the Request for Determination. ❑ 3.The work described on referenced plan(s)and document(s) is within an area subject to protection under the Act and will remove, fill, dredge, or alter that area. Therefore, said work requires the filing of a Notice of Intent. ❑ 4.The work described on referenced plan(s)and document(s) is within the Buffer Zone and will alter an Area subject to protection under the Act. Therefore, said work requires the filing of a Notice of Intent or ANRAD Simplified Review(if work is limited to the Buffer Zone). ❑ 5. The area and/or work described on referenced plan(s)and document(s)is subject to review and approval by: Name of Municipality Pursuant to the following municipal wetland ordinance or bylaw: Name Ordinance or Bylaw Citation wpaform2 doc•Determination of Applicability•rev.5/18/2020 Page 2 of 5