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HomeMy WebLinkAboutBLD-23-004590:. 4 pa2/WJ ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department :.-'Oi v- _ 1146 Route 28, South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 41...k I Massachusetts State Building Code, 780 CMR w,P Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling - This Section For Official Use Only Building Permit Number: e(j)'2?yO« &' d Date Applied: Building Official(Print Name) Signature Date SECTION 1:SITE INFORiMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numb rsR E " / 19SN. Maiv► S-l-rce'�' �' EIVED 1.1 a Is this an accepted street?yes f no Map Number Parcel u er 1.3 Zoning Information: 1.4 Property Dimensions: FEBD 155 2023 Zoning District Proposed Use Lot Area(sq ft) Fronta eIfDING DEPgRTM NT 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 0 Private 0 Zone: Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Rdbc,r+ Lowe. S, '/ai i.- a 4 (5). ° y jName(Print) City,State,ZIP i 16" A". on.‘;►, .S4-. (oa° 3.cs 59 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK (check all that apply) New Construction 0 Existing Building❑ Owner-Occupied 0 Repairs(s) ❑ Alteration(s) 0 Addition ❑ Demolition ❑ Accessory Bldg. 0 Number of Units Other ❑ Specify: i Brief Description of Proposed Work': �, ,�c, ensit (.,.1?Sa 4, es1.�c.rs i�-, a s e.-.i�'thAIGL ofChr to'i 0,„ g1tS4- -c►od - (.,.1? ►-. L.1).L ft3- $' cU�ler,.1.SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item Official Use Only (Labor and Materials) 1.Building $ q1 Uv v 1. Building Permit Fee:$ IS® _Indicate how feels detetaJuiugd. IQ Standard City/Town Application Fee P- E I V E D 2.Electrical $ ❑Total Project Costa(Item 6 x multiplier "x 3.Plumbing $ 2. Other Fees: $---e ` ., y FEB 2 8 2023 n 4-Mechanical (HVAC) $ List: L ) 1 I s, _. 5.Mechanical (Fire e I UILDIN 'DEP RTMENT Suppression) $ Total All Fees:$ Qv Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ 9 1 cte cs 0 Paid in Full al Outstanding Balance Due: 11 () SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) g;ckcA. T Cd y1 c , License Number Expiration Date Name of CSL Holder J Qq List CSL Type(see below) s c - ci. A-uc. No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) PCX ►"'1! 0 2s.5-1 R Restricted l&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances Sog $/O i/O77 Zclagisipecdciccreceltey do Insulation Telephone mail address D Demolition 5.2 Registered Home Improvement Contractor(HIIC) C �- (ru► �c -c}� COv1 0_f313� �� Cork r-tP�^ "� HIC Registration Number xpi ation Date HIC Company Name or HIC Registrant Name No.and Street `rt `�(' e f ae.G 5 , tk1� Q�.SS^ci1 Sa R Vic 407, Email 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 ❑ No lir 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 on my behalf, in all matters relative to work authorized by this building permit application. tZ Print Owner'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. Print Owner's or Authorized Agen' Name(Electronic ignature) 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.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" itggCLQCG'Gd(4f-penir°1 fa4/d_ darn. '� The Commonwealth of Massachusetts 1� irl, Department oflndustrialAccidents VI 1 CongressStreet, Suite 100 Boston, MA02114-2017 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): Rk.64.. T coowl3 one Cea C,f -y &1Ia _i_hG' Address: S 5,(0H4 'toe City/State/Zip: 1�'ac_ se- - Ihh.A., d2_s-s-17 Phone #: S'c%7 &L16 00-7 7 Are you an employer?Check the appropriate box: Type of project(required): LEI I am a employer with employees(full and/or part-time).* 7. 0 New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. 'emodeling • any capacity.[No workers'comp. insurance required.] 3.E I am a homeowner doing all work myself. [No workers'comp. insurance required.]t 9. Ell Demolition 4.0 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 1 Lb Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. Thes ub-contractors have employees and have workers'comp.insurance.: 13.0 Roof repairs 6. e area corporation and its officers have exercised their right of exemption per MGL c. 14.❑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. r 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 under the pains and penalties of perjury that the information provided above is true and correct. Signature Date: /T Z Phone#: Sd? $Li I-/O 77 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#: '' � _ TOWN OF YARMOUTH ,r; o . _° BUILDING DEPARTMENT ��� px=.= _�: �� 1146 Route 28, South Yarmouth,MA 02664 508-398-2231 ext. 1261 HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE: JOB LOCATION: NAME STREET ADDRESS SECTION OF TOWN "HOMEOWNER" NAME HOME PHONE WORK PHONE PRESENT MAILS TG ADDRESS C 1 OR TOWN STAVE ZIP CODE The current exemp '.on for `Homeowner' was extended to include owner—occupied dwellings of one or two units and to allow such ho -owners to engage an individual for hire who does not possess a license,provided that such homeowner shall act as pervisor. (State Building Code Section 110 R5.1.3.1) Definition of Homeowner: Person(s)who owns a parcel of la-d on which he/she resides or intends to reside,on which there is or is intended to be, a one or two family attached or •: ached structure assessory to such use and/or farm structures. A person who constructs more than one home in a two ear period shall not be considered a homeowner;such"homeowner"shall submit to the building official, on a form ..ceptable to the building official,that he/she shall be responsible for all such work perfoinwed under the building pe , 't. (Section 110 R5.1.3.1) The undersigned `homeowner' assumes respons'.ility for compliance with the State Building Code and other applicable codes, by-laws, rules and regulations. The undersigned 'homeowner' certifies that he / she uncerstands the Town of Yarmouth Building Department minimum inspection procedures and requirements and t .t he / she will comply with said procedures and requirements. HOMEOWNER"S SIGNATURE APPROVAL OF BUILDING OFFICIAL INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent, which -Teets the requirements of MGL Ch.142. Yes No If you have checked ves, please indicate the type coverage by checking the appropriate box. A liability insurance policy 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 TOWN OF YARMOUTH 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 resulting from the proposed work/demolition to be conducted at I g 5- /V, r- ;h &I-fce4- Work Address Is to be disposed of at the following location: -36,4 ne Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. a),,s-ja 3 Signature of Applicant Date Permit No. A ass. ov ;; ; g .%1 I k 4,1 I 1A i # t 4 HIC Registration Complaints Registration # 203132 Registrant RICHARD T. CONWAY DBA Cape Cod Carpentry Guild Name RICHARD CONWAY Address 5 second Avenue City, State Zip Pocasset, MA 02559 Expiration Date 09/14/2023 Complaints Details No complaints found for this registrant. You can also view arbitration and Guaranty Fund history. Back To Search • / 61S 60041 11700 g--/- Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Re ulations and Standards • ConsttoriiFjrvisor CS-116503 ti _ Eicpires:04/27/2025 RICHARD T ctONWI 5 SECOND ME POCASSET l 026 i= z'" Commissioner clae(2, A'. Y&nc/&. • • r ` i :'PropoSa ,, Xni IV 1 k AA PROPOSAL NO. J� ' eX-11lL A C C0114..,C'4,M,C SHEET NO. DATE t PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT: 6 7 8 113 A E ADDRESS ADDRESS — — — — — -- DATE OF PLANS PHONE NO. -- ARCHITECT — —_ J `S 'e, 6 k'-- Li 1�C\t.A.Ps C5 \ c-Lf°Je - +- t C_,,\e_v eZ\6•c3 �' ,�?ivIcAii- cit[3th fc_cv, :,4— R--ee r Sew e_ a• lx30 1_ 4-6 •e f '. ci f rt.,-AZC,4 ` i , ` e'c" b 00.e, Ce \ `ni:\ y iS4t a- 1*.'itQ rr- 1 et. ft,c,cy—,-- - ."a�*� u, a . ��c t y,3 -1-1ca-;d ` Y}C...w` G -; c )n y — vi S �,n Int '. g�rc a- c Sid-- t©r1,,AAoi7s t Ccrin9J ►i "ex3"t'\., ‘•.►a.1 l e3 n Piv-s-4- SIG rJ�' c�t�,�\4"-� � �"�- v\e Li L, .V, _ ' -�- i-,,»o- 0 4, cam,\, /� '' �.r��, IC -)-ci le. i e'kr, 1( t 11 „ -p tt'`11 cae t -� Sire- �A1:\l neae — "7 ` ° '' O 'L i r 6-tio.Co ('�, 7 S c1'4e1Vt h ex - t i-\:ek -- f `r 1(�`e t G'sP ► i t iT''a t " All material is guaranteed to be as specified,and the above work to be performed in accordance with the drawings and specifications submitted for above work and completed in a substantial workmanlike manner for the sum of nttrV .1 4 A6,,c^'S Dollars ($ of COO., )with payments to be made as follows. Any alteration or deviation from above specifications involving extra costs wit be executed only upon written order,and will become an extra charge Respectfully r, . f� � . over and above the estimate. All agreements contingent upon strikes, submitted �. accidents,or delays beyond our control. i'e-Co a' ' '7 j'- I" l u Per Note--this proposal may be withdrawn by us if not accepted within 3 days. III - _._._._.._._.__..._..._ — ACCEPTANCE OF PROPOSAL Tin above prices,specifications,and'conditions an.satisfactory and are hereby accepted. You,0e authorized to do the work as Frloc tied. L'aymenta will he made as out,:ned above. q Signature7::Ce____,1:: 1/4------ -- -- 1 RR `'J Signature '.— ..� ,e: r L-.--4.-0✓11n.r --- ----- -� atF e\ , :i-t2 g aadams'D8118 ❑ C. If a dispute arises under this Agreement, the parties agree to first try to resolve the dispute with the help of a mutually agreed-upon mediator in . Any costs and fees other than attorney fees associated with the mediation shall be shared equally by the par- ties. If it proves impossible to arrive at a mutually satisfactory solution through mediation, the par- ties agree to submit the dispute to a mutually agreed-upon arbitrator in . Judgment upon the award rendered by the arbitrator may be entered in any court having jurisdiction to do so. Costs of arbitration, including attorney fees, will be allocated by the arbitrator. 17. Notices All notices and other communications in connection with this Agreement shall be in writing and shall be considered given as follows: • when delivered personally to the recipient's address as stated on this Agreement • three days after being deposited in the United States mail, with postage prepaid to the recipient's address as stated on this Agreement, or • when sent by fax or electronic mail, such notice is effective upon receipt provided that a duplicate copy of the notice is promptly given by first class mail, or the recipient delivers a written confirmation of receipt. 18. No Partnership This Agreement does not create a partnership relationship. Neither party has authority to enter into contracts on the other's behalf. 19. Applicable Law and Jurisdiction This Agreement will be governed by the laws of the state of rttiSSnelvo eii-e and any disputes arising from it must be handled exclusively in the federal and state courts located in Signatures R/ rz Signature of Owner Date A Printed Name of Owner Title (18/� Signature f Co actor Da R T, C® 0 W in e. r Printed Name of Contractor Title Taxpayer ID Number: OM) 132i))SW17 ❑ This agreement may be signed by an electronic or digital signature. LF155 Contractor Agreement 5-15,Pg.4