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HomeMy WebLinkAboutBLD-23-001318 ‘ ON!ilk TWO FAMILY ONLY-11 MANG moor T Ir aiff to meth D ,..mot ;Y R : '. € D SO 1 .�1 - TN'� Ep 0 7 2 la Ci ,1 .. �r.,aa� _ BUI , t.:cr,t+Kl MENT Bar b 'mI rP &. s % 1* 1 i......te.....i.,.. • . sig... DM : , /TN 52/115 ...-:- ..,, a-ki.---.),„).,I) & ul utiothis> ._ . - ; It totbnistiou ,: , <i . 5 1.7 u t*s. r:mot PlibS , Ithiut r VW— „Aid . Lr i 'r tee Ow Sow 231° -3412 cortYle.l.gunkto t" W I-4 Ida..sod Street ltiepteme 10 i! = - :`, ' a oommog urpiid n ,- M � D ,per a pr .. ,: • mat maim..:a.iwsrsawasrr 'RT ALt+ r� tt ► arW enM SEP 3 0 -12- i .---,I' Dltvi. .,Dr..Pkr\ III' t,I I z),4` ,..- .J - :...L.,...._, . te=m111111102messalL8.5**-ittiatill: '...,_'. \ \,\vi . cam f - • gauisti+ . + ` e''=.- t__b} i .._._.......i--�-�--- 0°1'4 M / 5. - -- .= - Tiro Wall= , _ TotoiAlasES 13=1 ' ' ' S ievi,, , mow* cotatinagsagat ., SZCnOn S CONSTRUCTION Sorrows Likens c .3 .S .v0T,?1 S• Zr- to:11 Name OCR.Mfrs litchi.Type(,ere boter.)I tr�?Sri No. �x '14 g ' . _ -R' I_. ., Ewea Wiest D Deaooiiaiaa Registered Rams Improvement Caaee MC) I *me or BIC Rummel Nile t ►.)CA '. �k1 t 4 1t )(i 4''1 -t,t'�sc n C? a r�:� Si. ,..C `' emu seam EICTION tic WORUSUP COKPENSATIONII 1NCE AFFIDAVIT(hd.G.l.c.1S2.i 2sc Wad=C tapasetioi Imam*:Wes*must be completed sod aebo nd*tit us Payee TO pcov ds this affidavit will molt its the amid of tbs lsataacs i the bad past S1pad Affidavit Arociald? Yet.......,. ,• No..... .. fl =nom 7a:OMER AIITUOSILATION TO BE compuTU)WNW a': .1 ,.°si`"l:`i! a It.a..it t: . *ala`. - r.� T( :_i)I I-.'Xi_ s 1 1.as Owerer aa€tlee aobjsii ptsapetsy,Os<sday eatiaorasea T. ,. t 3 c",.0 t Ce., f 1Crt is r,... _,,, =' TO set©n my bsii,in all msosrs relative to vat eo@aorbed by ibis besides permit appti _ � C4 j x-r.....2_(e.s 41..E G . V/ c ar)..a ) i.�-1 Prim Oeste'stases CDcaoic Das SECTION Tbc OINXEDI OR AMBORIZID marzfr DlQAstAliON By so series 4.0.. • .1 busby coast coder dm piss sad}Mies of parjosy flat s11 riche inkrtuatioc ter.: • . is roe and ac+weme m the bat am iamb*sad umistuaudies. inSo/.1.. J''' $•31•2-a2 - . Owaaa ras sr •: ... Apses Ann atietuntic S'apaewsl pre I. An Omer wbe abodes a building permit as do biN6er vet wok,or sac owner wise lines au oaegistred caaeoraaaac (pot tsgistaeed is the F3otr+e ltpeorament Camsmor PC)Ptocam),sat mg have access m the abibanioa pilgrim or gummy Fled s oder KW.a 1 2k Other*mum Imbrued=cm the ffiC Proven c a s be 1'caaead et ..:A.:.. _ an the Ccmttaeetioa Diparvisor License cal be Steed Sig Zitzmusaraz 1 'Wee sabstwatiat crock is s+d,provide abe peas o be m ° G:rc k1r{ t..) Tarot Bow area R fi r� c* > FOP (actaa gene,b Meal c decks ar port* Grua living sea(s9.8) 7 . Ebbbebie ream coeatat _ Timber of t3tepimgt ?lusher et badtccar+s /-. .. absorb= Number Type enemies woes& la_.S Number pordxs 4 o sT io it a/o I, =dm TYpe of coolies SPIRIII Endued Open f k'�' a 3. "Total Pulled Sepias Footage''may be sebed ewed for"Total Project Gad' 4;1:1 I ne uummunweuun u) mussurnus•eus Department of Industrial Accidents =' Office of Investigations _ t�►_ \=� Lafayette City Center #„_4 x,!1 2 Avenue de Lafayette, Boston,MA 02111-1750 °M� .•`' www mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly Name (Business/Organization/Individual): T.A. Nelson Construction Co., Inc. Address: 1112 Main St. Suite 12 PO Box 749 City/State/Zip:Osterville, MA 02655 Phone #:508.428.7801 Are you an employer? Check the appropriate box: Type of project(required): 1.❑■ I am a employer with 9 4. ❑ I am a general contractor and I 6 ©New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity. employees and have workers' q ❑ Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. 0 We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no 13.® Other Garage and Deck 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: A. I. M. Mutual Insurance Company Policy#or Self-ins. Lic. #:WCC-500-5026132-2021A Expiration Date: 11/29/2022 Job Site Address: 1170 Great Island Rd. City/State/Zip:West Yarmouth, MA Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for ins ,a' coverage verification. 111. I do hereby ce i '• , '4, , , ', %e r''�'* - that the information provided ove i rue and correct. -r Signatur Date: Phone °: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License # Issuing Authority(check one): 10Board of Health 20 Building Department 3EICity/Town Clerk 4.0 Electrical Inspector 50Plumbing Inspector 6.1=1Other Contact Person: Phone#: §TOWN OF YARMOUTH 1146 Route 28, South Yarmouth, MA 02664 508-398-22311 ext.-1261 Fax 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 I t7 0 (e )cin 1,6 RI I I-it ,\rY1JA Work Address Is to be disposed of oat the following location:7p too O{ o v+k. Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150 ture of Application Date Permit No. • Commomvaaith of Naiadwsolls Division of OccupalionN MammaSods Board of Building and CS-000869 ► * � TNOMMS A '7"' a POBOX7 t Of.EV ) Commissioner MNO z m i 1 14 ri >Nr �otn mZ 0 Xi07M t mpz CD I IT c I = o m ...% 1/ _ n ® 00 8 Q 6 i 30 � c C 00ID3 z f , 1 3 m 1Pi ! . y m ik riir ill r_4 r 41 t iP' fit' 1 1........ 4 I i .• i ,.., i=t _� 0 i ,. II 1I '' I. � C 1) i . - w n e '' 1I- - :. a o � N 3 0 t0 m N o P. • ACCGRct CERTIFICATE OF LIABILITY INSURANCE DATEGMU3 022 Y) 0THIS 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(es)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the tends 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 endsrsement(s). PRODUCER NCWITACT A Maureen Roderic Horgan Insurance Agency , E (508)775-5830 Nei: (508)775-6688 44 Barnstable Rd. r lin' maureenrfilhorganinsurancecOm ADORERS: PO.Box 250 INSURERIS)AFFORORNi COVERAGE NAIL• Hyannis MA 02601 Haulm A Evanston Ins.Co. INSURED =mat 8 Safety Insurance Co. TA Nelson Construction Co.Inc puma c: Al Mutual Ins.Co. PO Box 749 INSURER D: INSWIER E: O*terv(Ib MA 02655 imau t F: COVERAGES CERTIFICATE NUMBER: 21-22 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.UNITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TR TYPE OF INSURANCE WM�p POUCY NUMBER MEKITIGNYrnnaroorrirri LIMTs COMMERCIAL GENERAL LIABIUTY EACH OCCURRENCE S 1,000.000. CLAIMS-MADE OCCUR DAMAGE TO RENTED 100,000. PREMISES(Ea occurrence) S _. MEO EXP(Any one person) S Exd A Y MKLV1PBC002058 10/12/2021 10/12/2022 PERSONAL&ADMINJURY S 1.000,000. GEMLAGGREGATELIMITAPPLIESPER- GENERAL AGGREGATE S 2.000,000. X POLICY Rian LOC PRODUCTS•COMP/OPAGG S 2•000,000. OTHER: S AUTOMOBILE LUIBIUTY COMB1t D SINGLE UNIT S 1.000,000. (Ea sooaent) ANY AUTO BODILY INJURY(Per person) S B — OWNED N,i SCHEDULED Y 5922218 09/29/2021 09129/2022 soDIY INJURY(Per accident) S AUTOS ONLY /'• AUTOS X HIRED ONLY X AUTOS NON-OMMIE ONLY) PROPERTY DAMAGE AUT (Pus aoNderal S INCL S UMBRELLA LAB ('C('UR EACH OCCURRENCE S EXCESS UAB CLAIMS-MADE AGGREGATE S DED RETENTION S _ S WORKERS COMPENSATION Y PER OTH- ANO EMPLOYERS'LIABILITY X[STATUTE I I ER C ANY PROPRtETORRARTNERIE�ECUTIvE NIA VYICC-5005026132-2021A 11/2912021 11/29/2022 EL EACH ACCIDENT S 1,000,000. OFFICER/MEMBER EXCLUDED `_,J (Mendetory In NH) E L.DISEASE-FA EMPLOYEE S 1,000,000. It yes,dew*,under DESCRIPTION OF OPERATIONS below, E.L.DISEASE•POLICY UMIT S 1,ODO,OOD. DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES IACORD 101.AMMiond Resets Schedule.slay be Miadred a more space M required) RE:Certificate Holder is named an Additional Insured on a primary noncontributory basis,per contract for GL 8 Auto.Vetiver of additional insured Subrogation is in place for CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED Ni Curtis and Ann Viebranz ACCORDANCE WITH THE POLICY PROVISIONS, 1170 Great Island Rd. AUTHORIZED REPRESENTATIVE West Yarmouth MA 02673 431 __ /608(410A 1888-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD rime and logo are registered narks of ACORD Sears, Tim From: Sears,Tim Sent: Wednesday, September 21, 2022 11:50 AM To: Thomas Nelson (tanelson@tanelson.com) Subject: 1170 Great Island Rd Tom, I-have reviewed your application and there are some items needed. eparate application and framing plans for the deck proposed for the existing structure ra rage plans are not stamped by architect/engineer Site plan stamped by land surveyor 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 'Pr . o' Conservation Office o , _y Town of Yarmouth kgrant(a�yarmouth.ma.us nY, Conservation Commission .,,""� to.'w Building Permit Sign-off Application TO BE FILLED OUT BY BUILDING PERMIT APPLICANT: Building Site Location: ///1J 9M7' . —Shia Map# O G C' Lot(s)# J Property Owner: C,(orb s "-Ail lieica,1 Z Date filed: *Applicant: / A. /4/. 5A C.c„,,S4.711c„, a c . Applicant Address: ///Z /r/4 in) S 5 i 4c /2 Pd 6'x 7c y o/FlVt IBC ,106 62_4 Email: 6_ oe is6, -,(a -tail), IS,.c' , col Telephone: Please note:by submitting this application,the applicant grants permission to the Conservation Office to enter the location to conduct a site visit(if needed). Proposed Project Description: / k)0,46(/ LUU, l�( 4 q ar4 yC. , c' EXISTI/I vt-1--z (Palio �%� of ,K . (/kr )?L!J . '7• e, • L 2 Site Plan Title/Date: Aka) /ei. �`% , r%r- L .S i---t-Ai-e. ,... Pc,r-c.,.A. 4.- o(C&.n C� �f(i S e c U 1/t / Y. ) 1. ZO .� TO BE FILLED OUT BY CONSERVATION ADMINISTRATOR: J Does the proposed project require a permit? j"j 0) Refer to: SE83- or DOA permit Comments from Conservation Commission:6pproved Conditionally Approved Rejected Conservation Commission Sign-off Signature: p Ay..._ Date: CI —7 _ 2� *TO APPLICANT: All work-related debris shall be taken offsite or disposed in a legal upland location. At the end of each day, the area shall be clean and no debris shall be in the Resource Area. If work is permitted under an Order of Conditions, please arrange a pre-construction site visit with the Conservation Administrator. At the time of site visit, the MassDEP File Number sign must be installed, along with the erosion control/work-limit line. A copy of the Order of Conditions must remain on-site during construction. Please refer to the Order of Conditions for further details. ay.-Y 1747 TOWN OF YARMOUTH HEALTH DEPARTMENT PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET - To he completed by Applicant: Building Site Location: //'70 9/YC) .rS/i i. I yoffrk,-/k , a Proposed Improvement: ai Sfriic.f he 9 lire S- A-C P, cz tJ is '.)s. s,`c R.• t' .fto Applicant: 7-• 1. /Ve1. i.-N ( n Tel. Na.: '47-{ ~ Date Filed: 7_Z,Z Address: �J/Z_ �;„J S� Sc- I z �'� ��x' -14 t CSS��lV��/ , 4• G26S **If you would like e-mail notification of sign off,please provide e-mail address: 66- Ile iSC"-- (P Z1-6-ne. ISc^•C e 11 Owner Name: (o r it i S ^r JINN Vie ./4 r 2 Owner Address: 5 5 Fla c Ken 66 rrq ,2d• GLisle/, ,iv/ Owner Tel. No.:C • g 72- 3477 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) — HEALTH DEPT. Note: Floor plans not required for decks, sheds, windows, roofing; (3.) If necessary, Title 5 application signed by licensed installer ith fee. REVIEWED BY: ( / DATE: 7 ✓ LEASE NOTE COMMENTS/CONDITIONS: 14-,A WATER DEPARTMENT ? 4ti BUILDING PERMIT APPLICATION FOR WATER DEPARTMENT SIGN OFF TRANSNIITTAL FORM Ht . / /; 4. / / 'II.DINCi SITE 1,()CA'1.1()N: /// t-- PROPOSED WORK: /42,-,/ J , 4 APP! WANT: V'r't t AI)DRESS: fit! f ;tt' FLPIIONE: ( RESII)EN'TIAL AND 'OR COMMERCIAL BUILDINO Water I kpartment I),..Jernines Compliance of Wawa. 'tot ailabilil and evicting lot:anon Faigniecring 1),:tpannactu ktt ermines omphatkte for Parking and I Yiairmate Cons...to—mon Commission: Dctonunes Omplianc:c to Wetlands \et: e It 101(1)border alp:. type of wetlands, Atoms. ponds. ritt cr., ocean, bop. hi)).N, marshland. I-..I C.. I lealth Department: )eterintnes Omphance to State and Toy,.n Regulations, it requirements for Septatle Disposal and other Public I lealth Acti‘itcs Tire I Yeparimeni: I)eteriumcsC Compliance to State and I oia,n Rcquiremnts for Personal Salett,, Propell Protections. i.e. Smoke Iktectors, Sprinkler Systems.etc ./7 " APPT1CANT SIGNATURE D.tTE OFFICE ('SE: COMMENTS ON PERNIIT APPROVAL OR DFALO, /1#767 77,14,1,4,1 i„,/,.14,1 44 14 vAt2,,tin ....„..ENVED BY WATER DIVISION(SI(;NATURE) 1).1TE tit