HomeMy WebLinkAboutBLD-23-005379 ' p14yl2f1
ONE & TWO FAMILY ONLY- BUILDING PERMIT
Town of Yarmouth Building Department of
1146 Route 28, South Yarmouth,MA 02664-4492
508-398-2231 ext. 1261 Fax 508 398 0836
Massachusetts State Building Code, 780 CMR i /
Building Permit Application To Construct, Repair, Renovate Or Demolish ..
a One-or Two-Family Dwelling
IRECEIVP. D
is ection For Official Use Only
Building Permit Number: IND-Z3- UVD3riet Date Appl'
�'�`^ F,r� ��" -Io-a�3 MAR 29 2023
Building Official(Print Name) " Signature BUILpINGI9AARr
^PENT
SECTION 1:SITE INFORMATION By. _
i 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
Qpttr— 2r
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,I54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private El _Zone: Outside Flood Zone?
Check if yes❑ Municipal 0 On site disposal system 0
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record: �,/
S e d f9%<Pk,44s S It / ar',sc.o�l rh 4- n 2 6 VS.
✓ Name(Print) Q City,State,ZIP y/
q RiV ( D✓, Sog 360 3 T G'• �Gu /�
6.07 c ..+./s l`'/QK//
o.
No.and Street Telephone p Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 1 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition ❑ Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work'-:
ifR4peace k.`/r3ea co.e.«ens Xle2e + & - PootS j Q
SQ.ii€ ,J (TY-ErCOM COS eoxPw CIP,'l 4fa
—r' s gyp. See' GcA r C-eelef p0.,'�t-• 8,142644eft- - wirie6
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials) R E C E I V E D
1. Building $ 1. Building Permit Fee:$1.00 Indicate how fee .s
2.Electrical $ 6 Standard City/Town Application Fee
0 Total Project Cost3(Item 6)x multiplier x APR 2 2023
3.Plumbing $ _ 2. Other Fees: $ Of
4.Mechanical (HVAC) $ List: 3 S' p 1i D0 ) LDING DcPARtMENT
5.Mechanical (Fire
Suppression) $ Total All Fees:$ -
1 Check No. Check Amount: Cash oust:, j I I I�'
6.Total Project Cost: $ -5 O o 0 . u D ❑Paid in Full q Outstanding Balance ue:\(lc �``
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu. ft.)
City/Town,State,ZIP R Restricted lc4c2 Family Dwelling
Al Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone
Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Company Name or HIC Registrant Name HIC Registration Number Expiration Date
No.and Street
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 0 No ❑
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.
Print Owner's Name(Electronic Signature)
Date
• 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 accurat o the best of my knowledge and understanding.
SQ 4
Print Owner's or Authorized Agent's Name(Electr ig 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.sov/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"
The Commonwealth of Massachusetts
I = g Department of Industrial Accidents
_ee�1= 1 Congress Street, Suite 100
='J_f-= Boston, MA 02114-2017
■I=' y�y www,mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information
Please Print Legibly
Name (Business/Organization/Individual
Address: ✓ Q,V,Q r Dr,`V
City/State/Zip: So XQrm oa7'4,/9i7 6?ayhone #: -C*8 3 C 0 3'6
Are you an employer?Check the appropriate box:
Type of project(required):
I.❑I am a employer with employees(full and/or part-time).*
7
2.0 I am a sole proprietor or partnership and have no employees working for me in 8. Q RNemw Jelin construction
an capacity.[No workers'comp. insurance required.] 8• Remodeling
3. 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 Building addition
ensure that all contractors either have workers'compensation insurance or are sole
proprietors with no employees. 11. Electrical repairs or additions
5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. I2.❑Plumbing repairs or additions
These sub-contractors have employees and have workers'comp. insurance.t 1 Roof repairs
6.0 We are a 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 41 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.
1Contractors 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.#:
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 tl ains and penalties of perjury that the information provided above is true and correct.
Sienature: Date: /Van e-ifc �„20 22_3
Phone#: Sr
o 8— 3 C O —3 6o
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):
I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone#:
`N TOWN OF YARMOUTH ✓
*. ' Ift: %,,,,
BUILDING DEPARTMENT
�,,� ,,r..,,„:;4- 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1261
s ��.
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
DA1'E: 04e ra .29)2 1,23
JOB LOCATION: . P.'v el-- fir $ Kar,g?of, 1;//
FE ST'EET ADDRESS SECTION OF TOWN
"HOMFOWNER" _Se Jort 1ke..4- Sob 3 6o 3 6 0
NAME HOME PHONE WORK PHONE
PRESENT MAIL tNG ADDRESS g Q;✓e.r 'Z?r r So41e ?let rstira,
nib 02Ge5i
CITY OR TOWN STATE 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 intends to reside,on which there is or is intended to
be, a one or two family attached or detached structure assessory to such use and/or farm structures. A person who
constructs more than one home in a two-year period shall not be considered a homeowner; such"homeowner"shall
submit to the building official, on a form acceptable to the building official,that he/she shall be responsible for all
such work performed under the building permit. (Section 110 R5.1.3.1)
The undersigned 'homeowner' assumes responsibility for compliance with the State Building Code and other
applicable codes, by-laws, rules and regulations.
The undersigned 'homeowner' certifies that he / she understands the Town of Yarmouth Building Department
minimum inspection procedures and requirements and that he I she will comply with said procedures and
requirements.
HOMEOWNER"S SIGNATUREek je,
S
APPROVAL OF BUILDING OFFICIAL
NSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent, which meets 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
1
I
1
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 / f,. y e ,e- ',r ,',/e .e
Work Address
Is to be disposed of at the following location: (CA vQ
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
a th? 7/0 23
Signature of Applicant Date
Permit No.
Seda Aklunts
9 River Drive, South Yarmouth, MA 02664
Phone: 508-360-3607, 774-327-0337
To whom it may concern:
My name is Seda Aklunts and I am the owner of 9 River Drive, South Yarmouth,
MA 02664. I would like to notify you that my property at 9 River Drive, South
Yarmouth has been and still is my primary residence. Last year the property was
rented for 3-4 weeks as I was away for a few weeks and we asked a real estate
agency to rent that out while I was gone but it does not change the fact that the
property is my primary residence. Last week when we paid the property tax in
person we checked with the collector's office and we were told that the property
is in fact listed as primary residence. If for some reason the property is not listed
as primary in the system and if there are any discrepancies it needs to be
corrected in the system immediately so I can get the work done as a
homeowner and not pay higher property taxes.
In addition to this I would like to notify you that I am not planing to rent out the
property this year.
1
i
Kind Regards,
Seda Aklunts
Thursday, April 6, 2023
3/31/23,3:23 PM Mail-Sears,Tim-Outlook
9 River Dr
Sears, Tim <tsears@yarmouth.ma.us>
Fri 3/31/2023 3:19 PM
To:T_gichunts@yahoo.com <T_gichunts@yahoo.com>
Seda,
I have reviewed your application and there are some items needed.
;1. This property is listed as a rental property, a licensed contractor is required to be on the
\ application.
\'2. Floor plan needs to have the total square footage shown as well as the area of work calculation
Pleased 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
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Basement .
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