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Home My WebLink Aboutbld-23-005938 RECE VFD ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department E• �r 1146 Route 28,South Yarmouth,MA 02664-4492 2023 �f) 508-398-2231 ext. 1261 Fax 508-398-0836 ti Massachusetts State Building Code,780 CMR _r4/ G DEPARTMENT Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling NI)R —4•3- 1vco`'‘ This Section For Official Use Only Building Permit Number: I )_0011Cr ' Date Applied: r- <1 M 5 6-64-,0 Building Official(Print Name) Si ture Date SECTION 1:SITE INFORMATION 1.1 Property Add ess: 1.2 Assessors Map&Parcel Numbers yi4 Mon�cw,a Dr►Vt 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: 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 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Name(Print) City,State,ZIP C( (404u,,211,0 ')rriia- 5Orb-56tr L4c.( SaCAG5 Viv l -G., No.and Street ., Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'-(check all that apply) New Construction 0 Existing Building❑ Owner-Occupied 0 I Repairs(s) jit, Alteration(s) 0 ( Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: f� _Ullrt Q��: E.-1 �.lins I?'o- t mL cO Ca1Q. 'Co�qu Q.,-, +�1i1t`% 0.. 7�(ll\\ Alm' r00w. �J T ,\ 6R, a r;in,,l. a i2.mzAN, U. e cfl SECTION 4:ESTIMATED CONSTRUCTION COSTS. • Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 2,0Y) 1. Building Permit Fee:$cuu _Indicate how fee is determined: 2.Electrical $ ' Standard City/Town Application Fee 0 Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ t 4 O C) 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire • Suppression) Totai All Fees:$ Check No. Check Amount: Cash 'un 6.Total Project Cost: $ S 20, 0 Paid in Full til Outstanding Balance aue: may, ' n\V SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) Irl) i C.S - j(),5 r6 2. r�J]Jr� ^, License Number Expiration ate Name of CSL Holder List CSL Type(see below) No.and Street ✓ Type Description I) r1 �� Q r)/CO U Unrestricted(Buildings up to 35,000 Cu.ft.) City/Town,State,ZIP Cd R Restricted 1&2 Family Dwelling Ni Masonry RC Roofing Covering WS Window and Siding �j� SF Solid Fuel Burning Appliances -t-Tt(7,6 6- ‘ ICI tot /i 1'3,,10 i,�„.,i- I Insulation J Telephone EmaiI address I D Demolition 5.2 Registered Home Improvement Contractor(HIC) r�.)u)�c� [�/`l � i�7 Cx)( ; HIC Compan Name or UiCpRegistrant Name HIC Registration Number// Expiry n Date No.and Street �/� 0 �j L� DfillV) /"�'r b 9 1te? 6-42<'4t Email ad8r s �f I TCJ City/Town,State,ZIP Telephone I.n q brQ.A 1 i D 61 .4D SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c.152.§ 25C(6)) /V) 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 ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of theAubject property,hereby authorize fJ(-a 0`,!) pi r, to act on my b " f,in all matters relative to work authorized by this building permit application. Print Owne Sture) • SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARA IOl 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 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 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.gov/oca Information on the Construction Supervisor License can be found at www.rnass.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" 5/2/23,9:54 AM Mail-Sears,Tim-Outlook 44 Montague Sears, Tim <tsears@yarmouth.ma.us> Tue 5/2/2023 9:53 AM To: braulio brito <ingbrauliobrito@gmail.com> Braulio, I h e reviewed your application and you are going to need Health Department sign off. hank you Timothy Sears CB0 Deputy Building Commissioner Town of Yarmouth 508-398-2231 Ext. 1259 mailto:tsearsjyarmouth.ma.us https://outlook.office.com/mail/sentitems/id/AAQkADE3MDQ5NWZmLTkOYzItNDIwNi1 iMDQxLWNkMGQyNmE4NzE5NAAQAOFzB4ThzPIHgZsh9lg1... 1/1 c-\ The Commonwealth of Massachusetts • a _ ,=it, Department oflndustrialAccidents g = ir1= 1 Congress Street, Suite 100 =. f_ Boston, MA • 02114-2017 �r`��„�F 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): rbrOa ,j l31't (-o Address: lQ `S0,, ad City/State/Zip: )ghht1 Mk 0Z(e' 9 Phone#: '1 Y- 26 e- O2Q(,6 Are you an employer?Check the appropriate box: Type of project(required): I.Q 1 am a employer with employees(full and/or part-time).* 7. [1]New construction 20 I am a sole proprietor or partnership and have no employees working for me in c aci 8. ID Remodeling an • y ap ty.[Ivo workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Q Building addition ensure that all contractors either have workers'compensation insurance or are sole 1 1.Q ElectricaI repairs or additions proprietors with no employees. 5_0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 12.❑Plumbing repairs or additions These sub-contractors have employees and have workers'comp.insurance.1 13.0 Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.0 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. 1 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 ant 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.k: Expiration Date: Job Site Address: iy Moilta ✓e_ tJ 0•r(V1 City/State/Zip: 70.trti9u4// � • Attach a copy of the workers' compenIation 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$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: /!LGc./ Date: oq Z$/23 Phone_ T: 11-U- Z6a- 'vZ06 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 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 Gf Pogta c* h (Az Woik Address Is to be disposed of oat the following location: YCttwl Out,L ao A 0— Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. O f25/23 Signature of Application Date Permit No. / Coninonweatth of Massachusetts Division of Occupational Licensure Board of Building R cations and Standards THE COMMONWEALTH OF NIASSACHUSEZTS SBusinessneuUlatien Cans 0t1:�isor mice of Coxr..umet Alta. eP No�ael e P �► n cTOB s Aires:05/23/2024 CS-110548 _ * p1 02H02026 BRAUL10 BRATO ? Alt ' ,to -• MM ULio gwro 19 SAGA ROAD ",/ obso4BSRfrowe+ACES '- SOUTH DENNIS r .: IA b I BRAM°BRITo ip , l25 UNCLE STAHLEY WAY t �!•f'GN✓ _ ?,� ,3SaJTHDENN1s.MA 02000 d+ undersecretary 01.1V Commissioner d.it t;• tAnt Q- .°' .YR,_. TOWN OF YARMOUTH a� y HEALTH DEPARTMENT ''_ PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Building Site Location: L f LI If On.• Lit e, \ a- --1- /v-'L(VJ'Dt7 4 `'(4 Proposed Improvement: _bRX NY') LA `�T Ai(% T, ill ,1)1 . ( 10 CO A C' 1d e i'` —v�L�, Y I Applicant: �,4 a/,p �/b Tel. No.: f ) /2,2 Address: 6 ),,, Date Filed: **If you would like e-mail notification of sign off please provide e-mail address: Owner Name: f/l-IGrAifl c L (,c Owner Address: '..(2. _ A %X_____ 5,41Owner Tel. No.: 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, RECEIVED and septic system location; (2.) Floor plan labeling ALL rooms within building .iUN 0 8 2023 (all existing and proposed)— HEALTH DEP Note:Floor plans not required for decks,sheds, windows, roofing; (3.) If necessary, Title 5 application signed by licensed installer with fee. REVIEWED BYE:-�"�',a,-,,....) L__ - ,Oa - 1 3 c). PLEASE NOTE DATE: COMMENTS/CONDITIONS: 44 r/ 6-)41- __ wuc,-- tiu, F- y/9420146 RECEIVED JUN 0 8 2023 �f��i dZ HEALTH DEPT. r ,d Com =:. & 11 h , LCT \ vivimco V ,_, _.,‘,, c_ :. 1 \irii6/_14,) ' .4 • K\ ftiPA l az Is..'s g 4 t -� RECEIVED -� HEALTH DEPT. F- } , I .a � . f l' • i • § . I ! f -� ti �. s 1' 4 ° ? ..._ _ . n. a:o -»�..�. ,f=--, ,e.s� ._e_.� , m r, z r ..... It, „, , 1 t. ,.......... ,,,:.,_...,,,, 0,„,„ ..... „.... c„. 0 ..:. . II ._, , , , . ,f,42,17 ._- fts -•!, - 0 7. , ft* } • cr 4 I -16 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 ':,f77 ___ Massachusetts State Building Code,780 CMR '� Par�TMt tvr Building Permit Application To Construct, Repair, Renovate Or Demolish ‘,..1....._... , -'" " ---_ a One-or Two-FamilyDwelling ` "� 8 This Section For Official Use Only Building Permit Number: 1 "— .Ei Date Applied: Building Official(Print Name) • Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers u MonLrs.:u DrLue- 1.1 a Is this an accepter?.street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: 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,I54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Z 10 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP 2.1 Ow err of Record: Q m &Li n✓ Co I/m �:1)P LLC �19,1( kP,r111 'S. °Z C Name(Print) City,State,ZIP k Q m EN ( (Okt( 10A 40 prrrLia -SO`b-56(n-t94:1 CSs 'CINo.and Street `, Telephone Email Ad ress SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) R. Alteration(s) 0 Addition 0 Demolition ❑ Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: P V\ Z. k"0 C O IQ. �{J AL(' it 0.. Y-tp 1A, UI (- roov, SECTION 4:ESTIMATED CONSTRUCTION COSTS. Item Estimated Costs: Official Use Onl (Labor and Materials) Y 1.Building $ zoo() 1. Building Permit Fee:$ Indicate how fee is determined: El City/Town Application Fee 2.Electrical $ /50, 0 Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ / 4-O J 2. Other Fees: $ 4.Mechanical (HVAC) $ List:_ 5.Mechanical (Fire Suppression) $ Total All Fees:$ . Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ ,5 tor) 0 Paid in Full 0 Outstanding Balance Due: LYE iv 0(/‘4,c9 ut Drivt q vnouti'v AA (k 0 ce‘011,► S I 42►Skt 914 S L l ectr:t ' ci 0��r , (BOOM Et ERThit-it Or a:' i i....1 0sM R00m s 2 x 12 :; ,� « ,», ,=, __ 19 11 ' .77. .. \` !.' 1 m RE" 4 ED FOR BUILDING AND ZGi'6J6 Cu: • *1 7 IA ANCE. ERRORS OR OMMISSIONS DO NOT f _�. ,H `' SrtORaG\ APPLICANT FROM THE RESPONSIBILITY OF"AS BUILT' k COMPLIANCE. `°' (��iJ �" DATE:6-h.-4,; ,, 0t _ it 5 w + < yttP,„ r,r,••,:,, Y If '.� O P �`»� 4 23 1