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Home My WebLink AboutBLD-23-000509 REC-JJVED 5 cU,5 ti O E ► TWO FAMILY ONLY- BUILDING PERMIT UG 0 1352 Town of Yarmouth Building Department of y 1146 Route 28,South Yarmouth,MA 02664-4492 �" - 608-398-2231 ext. 1261 Fax 508-398-0836 TMENT� - BUILD Massachusetts State Building Code,780 CMR By Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: PZ23-Cb(3SC' Date Applied: r- rs p �-�it_ ,'), Building Official(Print Name) • Signature Date SECTION 1:SITE INFORMATION • 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 213 Old Main Street South Yarmouth MA 02664 1.1 a Is this an accepted street?yes X 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,i 54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Public lei Private CI Checkif yesla Municipal ElOn site dispo ,ctem MI SECTION 2: PROPERTY OWNERSHIP' 1 R E .. w D 2.1 Owner'of Record: .lnnairi and Judith Silllivan South Yarmouth MA 02664 AUG 1 0 2622 Name(Print) City,State,ZIP 213 Old Main Street 508-394-7141 sullymcneil213@gmei No.and Street Telephone Email Address a�r�9 `;'�' NT eP By--_ SECTION 3:DESCRIPTION OF PROPOSED WORK=(check all that apply) New Construction 0 Existing Building❑ Owner-Occupied C1( 1 Repairs(s) 0 Alteration(s) EX(I Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2:Update existing bathroom; renovate existing bedroom and family room into main bedroom suite SECTION 4:ESTIMATED CONSTRUCTION COSTS. Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 1. Building Permit Fee:$ .1 CO Indicate how fee is determined: 3.Electrical $ 0 Standard City/Town Application Fee ❑Total Project Cost3 I m 6 x ulti 'er x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire - Suppression) $ Total All Fees:$ Check No. Check Amount Cash ount: 6.Total Project Cost: $ $39,000 0 Paid in Full D Outstanding Balance Du : !I 0 S\lel 22Z SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) cs-101604 Rand McDonald License Number Expiration Date Name of CSL Holder PO BOX 75 List CSL Type(see below) No.and Stre Type Description Eastham MA 02651 U Unrestricted(Buildi to 35,000 cu.ft.) State,ZIP R Restricted 1 Hy Dwelling fllfiTown, 1vI Maso RC ofsng Covering WS Window and Siding F Solid Fuel Burning Appliances 774-994-05 4 notisconstruction©gmail.com 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 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTO AP LI.,..3 FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize ' I to act on my behalf,in all matters relative to work authorized b this building permit application. 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 root 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.mass.aov/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 Massachusettsf t .. / Department of Industrial Accidents g _;= _ 1 Congress Street,Suite 100 vtl {;, Boston,MA 02114-2017 r--t om,[ 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): Donald Sullivan Address: 213 Old Main Street South Yarmouth MA 02664 City/State/Zip: Phone#:508-394-7141 Are you an employer?Check the appropriate box: Type of project(required): l.❑1 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. ®Remodeling • any capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 10 0 Building addition 4.g 1 am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 1 ❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 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. 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:_ 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 cert' aJ the pain and pe ties of perjury that the information provided above is true and correct XSignature: / r v....„." --- Dal J/Oi/2 2 Phone#. Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License r 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#: o� oS TOWN OF YARMOUTH o _ BUILDING DEPARTMENT �` �s .��4' 1146 Route 28, South Yarmouth,MA 02664 S08-398-2231 ext. 1261 , HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE: JOB LOCATION: 213 Old Main Street South Yarmouth MA 02664 "HOMEOWNER" Nog a d and Judi. STREET ET ADDRESS SECTION OF TOWN HOMEOWNER 508-394-7141 NAME HOME PHONE WORK PHONE PRESENT MAILING ADDRESS 213 Old Main Street South Yarmouth MA 02664 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 / she will comply with said procedures and requirements. HOMEOWNER"S SIGNATURE ��1 APPROVAL OF BUILDING OFFICIAL INSURANCE 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:homeownrlicexenp §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 213 Old Main Street South Yarmouth MA 02664 Work Address Is to be disposed of oat the following location: (U' n�r()V rS` �{/' ltld Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. Signatur -4-4( N/ Og/(41,2,2_ f Application Date Permit No. Sears, Tim From: Sears,Tim Sent: ' 'Friday,August S' 2O221Oi)6AK4 To: 'suUyrncnei1213@gnnaiioom' Cc: Slack, Christine Subject: 213 Old Main St Donald, I have reviewed your application for renovations and you are going to need Health Department sign off. Thank you Timothy Sears C8(] Deputy Building Commissioner Town ofYarmouth 5O8-398-2231 Ext. 1259 noai|to:tseam(a)yarnoouth.moa.us z x TOWN OF YARMOUTH ffi 1H8 EALTH DEPARTMENT PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant; AUG Building Site Location:213 Old Main Street HEALTH DEPT. Proposed Improvement Chan in bedroom and famil room to Master Suite on the first floor. Tel.No.:508-394-7141 Applicant:Donald&Judith Sullivan Date Filed:08/12/22 Address:213 Old Main Street, South Yarmouth **If you would like e-mail notification of sign off,please provide e-mail address:sullymcneil213@gmail.com Owner Name:Donald&Judith Sullivan Owner Address:213 Old Main Street,South Yarmouth Owner Tel.No.:508-394-7141 ................................................................. RESIDENTIAL AND/OR COMMERCIAL BUILDING RTMENT: Determines Compliance to State and Town Regulations;i.e.,Requirements HEALTH DEPA 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) roofing; Note: Floor plans not required for decks,sheds, llicensed installer (3.) 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