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Home My WebLink AboutBLD-23-003292 , I. - • ,. .01.1.- et BUILDING PERMIT APPLICATION • '1,' -- , AF'PUCATION TO CONSTRUCT,REPAIR,RENOVATE, CHANGE THE USEI‘;Obal4ACY OF, 1,11111 ' • , t,,,, , ''' OR DEMOUSH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY PWELUNG. . Town of'Yarmouth Building Department •cb.s.„,. ;05,,,,60 1146 Route 28 • Yarmouth, MA 02664-4492 .'Tel: 508-398-22.31 ext. 1261 Fax 508-398-0836 CIC,. /07 Office Use Only Planning Board Information Assessors Department Inforrnatioir Permit Ngtb'cil3-41b6gti Plan Type • map Lot 01(A Permit Fee $ 15(,! Endorsement Date / Recording Date New • 0.* Deposit Rec'd. $ , 0/Date --- Plan No. 1.4 Property Dimensions: Net Due aft VAL 102 I i e r ' f?.( Lot Area(s1) Frontage(ft) L----otCoVelc—ps This Section for Office Use Only Building Permit Number: , I Date Issued: ,.. .--- 1 , -,, Certificate of Occupancy. Signature: , ... ----,--- ,--- f -/0~01,,'w Building Official , Data is Is not— _required Section 1 - Site Information I 1.1 Property Address: 1.2 Zoning Information: r• )/19) 0-2C:6111- Zoning District -----____ • Proposed Use 1.3 Building Setbacks(ft) ' Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.4 Water Supply MULL-a.40.S S4) 1.5 Rood Zone Informatiorc Comrnenbc Public Private Zone: ______ BFE • . Section 2- Property Ownership/Authorized Agent I 2.1 Owner of Seco,* 4 - • • ' i °,' ,LS b:- . Vie- , 1 i ci 9, 1247 .2-H°,.CC: CriI ila titiAL/9+ Name • ) ..., Mailing Address: y , •'N.,1 CO '''ci ' - ,t ; .` "-(7)c?-- ;761Z-I , si - Telephone Telephone Email Address: 7 2.2 Authorized Agent I fif ,?_. -,- rea7cif ,"4- .,.7-:: 7,e•Xi'i Ilictlitl 1 7341-- . 1 / Menlo(print) 1,...:j........___ Mailing j.Wrdes: .. • 1 ,,,7 Signatu ....,,,-- Telephone e Fax 44'. 10 tV,ilifit WI Li nvi Email Address: 1 Section 3-Construction Services I 3.1 Licensed Construction Supervisor: . Not Applicable la , i la„S if ez7 4 Z .._- 0 it 10 7- -.V. -1 Xeci.__, Si.,7 r. mi, ii, iii LiCense Number-7 ('-'., Ce*C1-1-Ta f )1 i••'L e — ° ett.t ,4) yi .. <')1 2- ,c, --. Cr c06 31.--cif-92—"- Expiration Dte Telephone Email Address: mature • del . 1 q 6C-C.;1'(Di 7 n-r-)1 .rp 11.,.1.. ,-,;i /,,, • z ' • ' . Section 6- Description of Proposed Work(check all applicable) New Construction ❑ f (tor multiple family only) No.of Bedrooms I (for multiple family only) No.of Bathrooms Existing Bldg. ❑ I Repair(s) ❑ I Alterations ❑ I Addition ❑ I Accessory Bldg. ❑ Type iDooll I Other Specify: Brief Description of Proposed Work: • 1-6 bi Ocl CC.. ckr cni-ei VI. (-7 f Ci-vt C) 7 z ritYPI''' . 4 C7 i/LizvtAti fiii()"-- I-07 I' (4 '' - ('/ Section 7- Use Group and Construction Type 1 Building Use Group(Check as applcapable) Construction Type A ASSEMBLY ❑ .A-1 ❑ A-2 ❑ A 3 ❑ IA B BUSINESS �. A-4 ❑ A-5 ❑ 1B ❑ 2A ❑ E EDUCATIONAL. ❑ ❑ 2B F FACTORY ❑ F-1 ❑ • F-2 ❑ 2C ❑ H HIGH HAZARD ❑ ❑ 3A I INSTITUTIONAL ❑ 1-1 0 1-2 ❑ 1-3 ❑ 3B M MERCHANTILE ❑ ❑ 4 ❑ R RESIDENTIAL ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S ST STORAGE ❑ S-1 ElS-2 ❑ r8 ❑ ❑ SPECIFY: • M MIXED USE ❑ SPECIFY: S SPECIAL USE ❑ SPECIFY: I Complete this.section if existing building undergoing.renovations;additions and/or change In use.I Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34 Proposed Hazard Index 780 CMR 34 Section 8 Building Height and Area I • Bulking Area Existing(if applicable) • Proposed Number of floors or stories include basement levels Floor Area per Row tan , Total Area All Floors(sf) Total Height(ft) • Section 9 - STRUCTURAL PEER REVIEW(780CMR 11011)1 Independent Structural Engineering Structural Peer Review Required Yes-........ No SECTION 10a OWNER AUTHORIZATION-TO BE COMPLETED WHEN 1 OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT, , as Owner of the subject property, 1 hereby authorize , ,tW-d -..,y 1 -k-,, ( Y �' (': �`•�=t. -°L r-•�'--- to act on my behalf, in all matte relative to work authorized by this building permit application. Signs r t ( /7 if,,9, ..)- Date SECTION 1 Ob OWNER/AUTHORIZED AGENT DECLARATION t9e. I as Owner/Authorized Agent hereby declare that the statements and information on the forgoing application are true and acurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. • PrintNarni)P1 62—tetitid_ • /2/c/ 2-L— Signature of O, nt ! Date Section 11 - ESTIMATED CONSTRUCTION COSTS item ' Estimated Cost(Dollars)to be completed by permit applicant 1.Building /C-) CC ° 2.Electrical 3.Plumbing I Gas 4.Mechanical(HVAC) • 5.Fire Protection 6.Total=(1+2t3+4+5) 7 /i9,ea, 6 '(.) .w moms e s 7.Total Square Ft.iiern i&aalo Check Below ❑ Conservation-Commission Filing (if applicable) ❑ Old Kings Highway&Historical • Commission approval (if applicable) , r. ' 3.2 Registered Home Improvement Contractor. Company Name ' Not Apprscable O _ • Address / Registration dry � . ;;c;�' .�.. rt:~G; '1�}✓,v- �,eIP _'`-y' �/i' L a wG 1 motion Date �+ ` wF� j T Signature Tel .c. t/7/. ,_}.l$j Section 4-Workers'Compensation Insurance Affidavit(M.G.L c.152 S 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 1/ No Section 5- Professional Design and Construction Services-for Buildings and Structures Subject to Construction Control Pursuant to 780 CMR 116(containing more than 35,000 c.f. of enclosed space) Section 5.1 Registered Architect: Not Applicable 0 Name(Registrant): . Registration Number Address Expiration Date Signature Telephone _Section 5.2 Registered Professional Engineer(s)I Name Area of Rty Address Registration Number • Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number • Signature Telephone Expiration Dare Hams • Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address • Registration Number Signature Telephone Expiration Date Section 5.3 General Contractor Not Applicable 0 Company Name Person Responsible for Construction Address Signature Telephone • • The Commonwealth of Massachusetts t �=*iri i= l Department of Industrial Accidents • t _yinI= 5 1 Congress Street, Suite 100 Boston, MA 02114-2017 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): ) �e -Ov l re.W Address: !161 4u,t.P: City/State/Zip: Vl Phone#: (si() 1" tea) Are you an employer?Chec a appropriate box: Type of project(required): I. I am a employer with employees(full and/or part-time).* 7. ID New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in any capacity.[No workers'comp. insurance required.] 8 remodeling 3.0 I am a homeowner doing all work myself[No workers'comp.insurance required.]+ 9. Demolition 4.0 I am a homeowner and will be hiring contractors to conduct all work on myproperty. 10 Building addition ensure that all contractors either have workers'compensation insurance or are sol I will P 11.0 Electrical 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? 13.0 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 I1 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:,- a L ' tuiltiAj/-- Policy#or Self-ins.Lic.#: 6 S 60 Ut3.4k2()%I -A-2-2- Expiration Date: n 3 -23 Job Site Address: 11' q j City/State/Zip:' 26" Attach a copy of the workers' compensation policy declaration page(showing the policy nu er and expiration date). Failure to secure coverage as required under MGL c. 152, §25A )q 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 ' 'is statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify der t o,cio. an, :- aloes of peijury that the information provided above is true and correct. Signature: (21 A7 Date: /Z � Z7i Phone#: ( f) / - /I1 l�7� 7/ ? ,i ~o LJ < i 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,S Guth Yarmouth, MA 02664 508-398-223(1A,e -512.661: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 I 1 q 7) 4ie ii6 tith94/'r am 7-�i Work Address Is to be disposed of oat the following location: ( (L2411A)L.t i ,>1, o.GJ f ' Said disposal site s 1 be a licensed solid waste facility as defined by M.G.L. Ch..111, §150A. Si of Application ate Permit No. NOTICE r , NOTICE TO TO EMPLOYEES .0' =-= _ EMPLOYEES 14f = SNI The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS LAFAYETTE CITY CENTER,2 AVENUE DE LAFAYETTE, BOSTON, MA02111 (617) 727-4900 — www.mass.gov/dia As required by Massachusetts General Law, Chapter 152, Sections 21, 22 &30, this will give you notice that I (we) have provided for payment to our injured employees under the above mentioned chapter by insuring with: HARTFORD UNDERWRITERS INSURANCE COMPANY NAME OF INSURANCE COMPANY P.O. BOX 4614 BUFFALO, NY 14240-4614 ADDRESS OF INSURANCE COMPANY (6S6OUB-1K20561-A-22) 03-22-22 TO 03-22-23 POLICY NUMBER EFFECTIVE DATES � J J GILMARTIN & SON AGCY 1293 POST RD dimmm WARWICK RI 02888 NAME OF INSURANCE AGENT ADDRESS PHONE # ALL SEASONS HOSPITALITY INC 1199 ROUTE 28 o= ��. SOUTH YARMOUTH o�� MA 02664 EMPLOYER ADDRESS EMPLOYER'S WORKERS COMPENSATION OFFICER (IF ANY) DATE MEDICAL TREATMENT " The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the o= provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the - injured employee. The employee may select his or her own physician. The reasonable cost of the services - provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In .cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NAME OF HOSPITAL ADDRESS 014894 w20P1G15 TO BE POSTED BY EMPLOYER k a a. a wo l 4 } ° ; ! w ,. AkIfffikk a co ra sae. ros a .. to- tiol '° wfl .. i .. • 4 if all ZZ 'AA . z .....w..,, = 0 r Y / // R .�KZy`3� .air "'''' 4. .,„ ''''";'44,„ a,,,i,,, , 40 ea VI ' '2' f °`s.. " u•H i.. r / „mod . „- alliRMAIVIFIZLIU.'.4111.'.': Ul f >. e _° s .a s I Po^ �p • wm.-,: �,a ^.�. a, _.,..° T: °� vim•.»'""° ' 12/16/22,9:35 AM Mail-Sears,Tim-Outlook 1199 Route 28 Sears, Tim <tsears@yarmouth.ma.us> Fri 12/16/2022 9:34 AM To:Carlos Figueiroa <Chfigueiroa2002@hotmail.com> Cc: Huck, Kevin <KHuck@yarmouth.ma.us>;Bearse, Matt <MBearse@yarmouth.ma.us> Carlos, I have reviewed your application for the addition of soffits in the hallways and there are some items needed. N\1. 2 copies of plans showing proposed work 2. Fire Department sign off i . l so please-shrow-a-cross--section-detailing-the-distance from any sprinkter head-s--aid-whether1bewillbe considered an obstruction per NFPA 13 Please 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 fora 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. 1.259 mailto:tsears@yarmouth.ma.us https://outlook.office.com/mail/sentitems/id/AAQkADE3MDQ5NWZmLTkOYzItNDIwNi 1 iM DQxLWNkMGQyNmE4NzE5NAAQAPzuMwu3gBRHiXmz9i%... 1/1 d )it 1M § >1 IF). 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