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HomeMy WebLinkAboutBLD-23-005001 �1 y/, e/z3 ONE & TWO FAMILY ONLY— BUILDING PERMIT Town of Yarmouth Building Department :- " y 1146 Route 28,South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 Massachusetts State Building Code,780 CMA. e , Building Permit Application To Construct, Repair, Renovate Or Demolish w'• a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: /{i ,3_Zvi Date Applie : 3/10/2024 11 r''` 5,c c; '/ .1-k.,- 3 Building Official(Print Name) ignature Date SECTION 1:SITE INFORMATION RECEIVED 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 11 Johnson Lane,West Yarmouth, MA,02673 058.115 1.1 a Is this an accepted street?yes x no Map Number Parcel Nur fiber MAR 10 2023 1.3 ZoningInformation: IN 1.4 Property Dimensions: ' BUILDING DEPARTMENT By' ________ Zoning District Proposed Use Lot Area(sq ft) Frontage(toT 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? Check if yes❑ Municipal 0 On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Kathy Downing West Yarmouth, MA,02673 Name(Print) City,State,ZIP __.--- 11 Johnson Lane 5082404096 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK(check all that apply) v New Construction 0 Existing Building® I Owner-Occupied ❑ I Repairs(s) 0 Alteration(s) Si I Addition ' 1 !'rJ . Demolition CI Accessory Bldg. ❑ Number of Units 1 Other ❑ Specify: > o I ct Brief Description of Proposed Work2: O I a Take out existing 1/2 bath and 2 closets convert to one laundry room in same footprint. LU .--I p 0 Q w m -,iks SECTION 4:ESTIMATED CONSTRUCTION COSTS. Estimated Costs: �" Item (Labor and Materials) Official Use Only 1.Building $ 1. Building Permit Fee:$ 15'Q Indicate how fee is determined: 2.Electrical $ IN Standard City/Town Application Fee 0 Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $' 3 S 4.Mechanical (HVAC) $ List: U1 m 5.Mechanical (Fire e .$ 1 Suppression) Total All Fees:$ 0;°�1 Check No. Check Amount: Cash u�nt: ✓ \ 6.Total Project Cost: $ 24,000 0 Paid in Full VI Outstanding Balance Dt,e: /l I3 1 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-115191 8/5/2024 Name of CSL Holder License Number Expiration Date Mark Rocha Jr List CSL Type(see below) lJ No.and Street Type ( Description 25 Blackthorn Path U Unrestricted(Buildings up to 35,000 cu.ft.) City/Town,State,ZIP R Restricted 1&2 Family Dwelling Forestdale,MA 02644 M Mason} RC Roofing Covering WS Window and Siding 774-327-0459 SF Solid Fuel Burning Appliances mrocha@efwinslow.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) Elisha F Winslow IV 132379 1/17/2025 HIC Company Name or HIC Registrant Name HIC Registration Number Expiration Date 8 Reardon Circle mrocha@efwinslow.com No.and Street South Yarmouth,MA,02664 508-394-7778 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 0 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 EF Wnslow Plumbing&Heating to act on my behalf,in all matters relative to work authorized by this building permit application. Kathy Downing 3/10/2024 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 Agent's Name(Electronic Signature) 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 _y „`l Department of Industrial Accidents SWIM 1 Congress Street, Suite 100 Boston,MA 02114-2017 • —„ao, 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): Mark Rocha Jr Address: 25 Blackthorn Path City/State/Zip:Forestdale, MA, 02644 Phone#: 774-327-0459 Are you an employer?Check the appropriate box: Type of project(required): 1.al I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. O Remodeling any capacity.[No workers'comp.insurance required.] 3. I am a homeowner doingall work myself. t 9. ❑Demolition ❑ y [No workers'comp.insurance required.] 1.El property.I am a homeowner and will be hiring contractors to conduct all work on myI will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance.t 13.0Roof repairs 6.❑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.] *My 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. $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 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Arrow Mutual Liability Insurance Policy#or Self-ins.Lic.#: 2019A Expiration Date: 1/1/2024 Job Site Address:11 Johnson Lane City/State/Zip:W.Yarmouth MA 02673 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 unde h ains a enal 'es of per' ty that the information provided above is true and correct. f Signature: Date: f ��// �j3 Phone#: 774-327-0459 I 111 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#: A�CIO O® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 3/10/2023 THIS 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(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms 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 endorsement(s). PRODUCER CONTACT RogersGray, Inc-Kingston Branch NE 434 Route 134 (A/c No.Exf:800-553-1801 I FAX No):877-816-2156 South Dennis MA 02660-1601 E-MAIL ADDREss: mail@rogersgray.com INSURER(S)AFFORDING COVERAGE NAIC# _ INSURER A:Arbella Protection 41360 INSURED EFWINSL-01 INSURER B:Arrow Mutual Liability Insuran 13374 E. F.Winslow Plumbing&Heating, Inc. 8 Reardon Circle INSURER C: South Yarmouth MA 02664 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1962839109 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 POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF POLICY EXP (MMIDD/YYYY) (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY Y 8500069272 12/1/2022 12/1/2023 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $100,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY X JE X LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY Y 102007840205 12/1/2022 12/1/2023 Ea accideDISINGLE LIMIT $1,000,000 ANY AUTO BODILY INJURY(Per person) $ OWNED X SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ $ A X UMBRELLA LIAB X OCCUR 4620088355 12/1/2022 12/1/2023 EACH OCCURRENCE $2,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $2,000,000 DED X RETENTION$1fl,nnn $ B WORKERS COMPENSATION 2019A 1/1/2023 1/1/2024 X AND EMPLOYERS'LIABILITY Y/N STATUTE OTH- ER ANYPROPRIETOR/PARTNER/EXECUTIVE N E.L.EACH ACCIDENT $500,000 OFFICER/MEMBEREXCLUDED7 N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Plumbing&Heating Contractor. Central Vacuum is a division of E F Winslow Plumbing&Heating Inc. When Required by Written Contract the Following Applies: General Liability-Additional Insured Ongoing(30AP2195 04 21)and Completed Operation(30AP2195 04 21) Primary and Non-Contributory Basis(30AP2195 04 21),Waiver of Subrogation(30AP2195 04 21) Automobile-Additional Insured,Primary and Non-Contributory Basis,Waiver of Subrogation(26AP1034 11/19) Workers Compensation-Waiver of Subrogation(Endorsement#4) Excess/Umbrella-Additional insured follows form over underlying General Liability and Automobile Liability No Residential Exclusions CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. TOWN OF YARMOUTH 1146 ROUTE 28 SOUTH YARMOUTH MA 02664 AUT ED REPRESENTATIVE 7ellif4w- A --.._.._.__ ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ' 111111111111111 Commonwealth of Klassachuv _tts II. Division of Professional Licensure Board of Building Regulations and Standards vt i , . . C 0 nst 41lk „r041.140 "Stif)Arviso .. ., . . . CS-115191 ...;..0 ...4„,,,, * ;"..Qgpires: 08/05/2024 MARK A ROCHA 25 BLACKTHORN 1: .A. ,...,,, FORESTOALE-)11A—* 02644 -," ‘,..,*'. \ , /i-,,. , iiv 1 " l'iltk (),SoVill‘ . ., COMMissioner cii- i 0,- K. YEkr auk.- if arr. f Silt( ww 4 0. , �w '� z7wwlllr• �lYI�...g11 4,1 ` • 7 Y tr.c` r' 1A N 1. q .*. a 6.4 i rA THE COMMONWEALTH OF MASSACHUSETTS w Office of Consumer Affairs & Business Regulation Registration valid for in HOME IMPROV • NT#CONTRACTOR expiration date. If foun TYPE: ` lion Office of Consumer Aff: Registration Expiration 1000 Washington Street 132379 ` ' 4* .O1/17'2025 Boston, MA 02118 =.F. WINSLOW PLUMBIC 4,11 CO., INC t. Olr =LISHA F. WINSLOW i 3 REARDON CIRCLE - e t 'I ,�� SOUTH YARMOUTH, MAC Undersecretary Not valid wi .w a §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 11 Johnson Lane,West Yarmouth,MA,02673 Work Address Is to be disposed of oat the following location: Yarmouth Disposal Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. 3/10/2024 Signature of Applic n Date Permit No. t r'� J ,� l (f , E. • ■ Win W Quote Number: 30961 L t `) Work Order Id: n(? Date: 01/30/2023 j1l� Submitted By: HEATHER POND Proposal To: //AU!' Page: 1 of 2 DOWNING, KATHY* Service Location: 11 JOHNSON LANE DOWNING, KATHY* West Yarmouth MA 02673 11 JOHNSON LANE 5082404096 West Yarmouth MA 02673 5082404096 Thank you for giving E.F. Winslow the opportunity to provide you with an estimate. We look forward to working with you, and to show you our professional workmanship. Please do not hesitate to contact me if you have any questions or concerns. DIRECT LINE: 508.258.5651 or EMAIL: heather.pond@efwinslow.com Option# 1 **TAKE OUT 1/2 BATH AND TWO CLOSETS, CONVERT TO ONE LAUNDRY ROOM** **TO KEEP** * Medicine cabinet * Light fixture over medicine cabinet **CARPENTRY** *We will set protections. * Demo the interior walls of the closets and 1/2 bath to create the new interior layout for the laundry. *Close up two doors on dining room side * Repair sheetrock as needed on walls and ceiling *Widen doorway in kitchen * New 4'double bi-fold doors in kitchen *Tile floor In new laundry room *Tile 1/2 wall behind washer/dryer **TILE AND GROUT FROM SUPPLY NEW ENGLAND** *Aspire, color Ivolre, 12 X 12 field tile per quote S9138507 *Accucolor grout, color Sandstone Beige sand grout per quote S9138507 *Tile to be installed on floor, and 1/2 way up wall behind washer/dryer. *Additional niches, corner shelves, accent tile, complex layout pattern or decorative boarders may incur additional charges. **PLUMBING** *Supply the necessary pipe and fittings to add a new laundry connection on the first floor. * Install a laundry box with Mass approved air hammer arrestors. *Connect to existing waste and water lines in the basement and terminate a new vent through the roof. *Waste and vent pipe will be in PVC. *Water pipe will be in copper and PEX tubing *We will install all plumbing per code and secure all installed material in a professional manner. **Any alterations, modifications or repairs to the existing piping deemed necessary by the local plumbing inspector will be brought to the owners 8 Reardon Circle, South Yarmouth, MA 02664 • Phone 508-394-7778 • Fax 508-394-8256 www.efwinslow.com E. . Win I w Quote Number: 30961 Page: 2 of Option# 1 (Continued) • attention and completed at time and materials. **PLEASE NOTE: If making connections to the existing pipe, fixtures and appliances can not be done in a professional and legal manner due to the age and condition, we will bring the cirmcumstances to the owners attention. **ELECTRICAL** * Demo the existing electrical wiring In the old powder room. *Wire for one (1) new switch location at the new entry door. * Install one customer supplied ceiling light fixture to be centered over the washer/dryer, * Box the existing washer feed in the basement and extend it to the 1st floor. * Demo the existing three wire dryer feed and supply and install one(1) new four wire circuit from the panel to the first floor. * Supply and install dual function breakers at the panel for the washer and dryer circuit, * Includes an Electrical Permit. *Owner to have a new four wire pigtail for the dryer. **This estimate is subject to change due to any unforseen circumstances during remodeling and/or requirements by local and state building codes. **WASHER AND DRYER NOT INCLUDED** $ z-s1- K 8 Reardon Circle, South Yarmouth, MA 02664 • Phone 508-394-7778 • Fax 508-394-8256 www.efwinslow.com 1 33.,..._._._.___// 1, 1 ., i \ -N.s, , -.''; ' ---- ' '' -- . 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