BLDR-23-12782 permit i E c rO F &TWO FAMILY ONLY-BUILDING PERMIT
� �_ Town of Yarmouth Building Department of r44411
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1146 Route 28,South Yarmouth,MA 02664-4492
JUN 27 2023 508-398-2231 ext. 1261 Fax 508-398-0836
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Massachusetts State Building Code,780 CMR
E:UiLDI;d ct`- rn N!ding Permit Application To Construct, Repair, Renovate Or�Demolish
F }-.____, _ a One-or Two-Family Dwelling
This Section For Official Use 0
Building Permit Number: �.�( IV_7 / ate Applied-
1-;rn f. . A ) 1' .3
Building Official(Print Name) Si attire Date
SECTION 1:SITE INFORMATION
1.1 Property Addre s: 1.2 Assessors Map&Parcel Numbers
1.1a 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 CI Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY O WNEI2SFHP'
2.1 Owner'of Recd: /. �/ /p!� y� /9 r
4 o.tr 4( erC.1,,,./ 4-2.4i L 4 c4 a"•` /o`n9 e. // , 4 I 0 Z 4 -
ame(Print) City,State,ZIP
?3 ,,/5;4 leg Z.37-43.53 wideCCw2&. cz 4-7
No.and Street Telephone Email Address
SECTION 3:DESCR[PTION OF PROPOSED WQRK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 I Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition ❑ Accessory Bldg.0 Number of Units Other 0 Specify:
Brief Description of Proposed WorkZ: �: r
SECTION 4:ESTIMATED CONSTRUCTION COSTS.
Item Estimated Costs: Official- e Only
(Labor and Materials) .
1.Building $ 1. Building Permit Fee:$ 6 Indicate how fee is determined:
2.Electrical $ StStandard City/Town Application Fee
0 Total Project Cost3(Item 6)x multiplier x_
3.Plumbing $ 2. Other Fees: $ .c &I .. j
.
4.Mechanical (HVAC) $ List: t
•
5.Mechanical (Fire $ '
Suppression) Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ 0 Paid in Full 10 Outstanding Balance Due:\C\0
•
The Commonwealth of Massach usetts
Department of Industrial Accidents
=_=i�►1s 1 Congress Street,Suite 100
Boston,MA 02114-2017
Yr� s; 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): z;2's
Address: \
City/State/Zip: d fr ,,-N.<a Phone#: c()' )(.I ( (
Are you an employer?Check the appropriate box:
Type of project(required):
I. am a employer with v employees(full and/or part-time).* 7. ❑ w construction
2❑I am a sole proprietor or partnership and have no employees working for me in 8. ��modeling
any capacity.[No workers'comp.insurance required.]
3. I am a homeowner doingall work myself. t 9. ❑Demolition
❑ y [No workers'comp.insurance required.]
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 MD 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.
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. I4.El 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.Homeowners who submit this affidavit indicating they are doing ail 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.
.1 ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: k
Policy#or Self-ins.Lic.#: �C'C$ ' 3 a1)) + " Expiration Date:I(3t 14
Job Site Address:l�J City/State/Zip: LN r-71-4
c\
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 DR for insurance
coverage verification.
I do hereby certify r - ains and elites of perjury that the information provided a ove i true and correct
,Signature: '
Date:
Phone#:
Official use only. .Do not write in this area,to be completed by city or town official.
City or Town: PermitfLicense#
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#:
0Y.Y44 TOWN OF YARMOUTH
. _O BUILDING DEPARTMENT
rd" 1146 Route 28, South Yarmouth,MA 02664 508-398-2231 ext. 1261
�K.atp 6
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
DATE:
JOB LOCATION: c.749If5437— rX /�, 00odo?
N S ADDRESS ECTION OF TOWN
"HOMEOWNER" /0/�J A' Q &Yyt) �Zr—2V37-08
NAME HOME PHONE WOR. 'HONE
PRESENT MAIL tNG ADDRESS
CITY OR TOWN STA ' ZIP CODE
The current exemption for 'Homeowner' was extended to include ow - —occupied dwellings of one or two units
and to allow such homeowners to engage an individual for hire who 'oes not possess a license,provided that such
homeowner shall act as supervisor. (State Building Code Sectio• 110 R5.1.3.1)
Definition of Homeowner:
Person(s)who owns a parcel of land on which he/she resi• s or intends to reside,on which there is or is intended to
be,a one or two family attached or detached structure as -ssory to such use and/or farm structures. A person who
constructs more than one home in a two-year period s' . not be considered a homeowner;such"homeowner"shall •
submit to the building official,on a form acceptable • the building official,that he/she shall be responsible for all
such work performed under the building permit. :ection 110 R5.1.3.1)
The undersigned `homeowner' assumes res••risibility for compliance with the State Building Code and other
applicable codes,by-laws, rules and regula 'ons.
The undersigned `homeowner' certifi- that he/ she understands the Town of Yarmouth Building Department
minimum inspection procedures an• requirements and that he / she will comply with said procedures and
requirements.
HOMEOWNER"S SIGNA ,G'`lt.
APPROVAL OF BUILDINt OFFICIAL
INSURANCE COVE• a E:
I have a current liabil' insurance policy or its substantial equivalent, which meets the requirements of MGL
Ch.142. Yes No
If you have check- ves,please indicate the type coverage by checking the appropriate box.
A liabilityinsur. ce policy Other type of indemnity Bond
OWNER'S I URANCE 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
§TOWN OF YARMOUTH
1146 Route 28, South Yarmouth, MA 02664
508-398-223 east.-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 Z 5 4C-A6v -4-1
Work Address
Is to be disposed of oat the followinglocation: 'o'--""''
P
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Ch. 111, §150A.
(4..o)V \Z1
Signature of Application Date
Permit No.
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CS-075281 r * Iires:03/12/2025
TODD J CANNAR ,
10 ECHO RDr ;
WEST YARMO T
Commissioner etfak biEm(01.
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer A &Business Regulation
HOME IMPROVE t, p ONTRACTOR
TODD CANTARA
D/B/A CANTARA HOME e m' •1 r
TODD CANTARA
10 ECHO RD.
W.YARMOUTH,MA 02613 Undersecretary
t
' • i y Re4nu a 'i Took CLERK
TOWN OF YARMOUTH
F+, 1146 ROUTE 28,SOUTH YARMOUTH, MA 02664-4451
RECEivEn .
Telephone(508)398-2231 Ext. 1292-Fax(508)398-0836
•LD KING'S HIGHWAY HISTORIC DISTRICT COMMITTEE
JUN 2 3 2023
I AHtJIVU i r APPLICATION FOR
OLD KING'S HIGHWAY CERTIFICATE OF EXEMPTION
Application is hereby made for the issuance of a Certificate of Exemption under Sections 6 and 7 of Chapter 470 of
Acts of 1973, as amended, for the proposed work as described below and on plans,drawings,or photographs
accompanying this application.
Tvoe or print lealbiv: /�A//
Address of proposed work: 2'?Frest 4 Map/Lot# /f(2/3/7..jL
Owner(s): M�f I�a/'s/ „ Phone#: C-017 1,'7 025:
All applications must be submitted by owner or accompanied by letter from owner approving submittal of application.
Mailing address: Z3 /reJ/tt 6' Year built:
Email: %p h?(d CC kre.G a 44 Preferred notification method: "D' Phone Email
Aaent/Contractor: Phone#:
Mailing Address:
Email: Preferred notification method: Phone Email
pescrlDtion of Pr000sed Work(Additional ogres may be attached If necessary):
rep/vfc kifc4,4 �oo` s' r/ia,- PSS%O
P 44e dr /4 iI odls7�s
f' /ti>`�h r
%adL! Sr'9n7.44 70•ee
Signed(Owner or agent): � � 4141.L L;� ' s ..i" te: 6/6/Z�
�
> Owner/contractor/agent is aware that a permit may be required from the Building Department.(Check other departments,also.)
> This certificate Is good for one year from approval date or upon date of expiration of Building Permit,whichever date shall be later.
For Committee use only:Date: ,
�12 3/93 ✓Approved Approved with >P R O 1/ pried
11
Amount 2trry tV//��
Reason for denial J U N 2 6 2023
Cash/CKf. fife YARN!(1tjTF;
Rcvd by: 1. 1.7< . 9LO KlNULIIQHWAt
n Date Signed: lea 93 Signed: 5ee zylizotAM (?41 .+ APPLICATION#: 2w
V52017
Sherman, Lisa
From: Richard Ventrone <rav9463@gmail.com>
Sent: Monday,June 26, 2023 4:39 PM
To: Sherman, Lisa
Cc: Richard A.Ventrone Jr. 23-
Subject: Re:23-E056 23 Forest Gate
Attention!:This email originates outside of the organization. Do not open attachments or click links unless you are
sure this email is from a known sender and you know the content is safe.Call the sender to verify if unsure.
Otherwise delete this email.
Lisa,
,441APPIICONt s`appficatfon.Mgr*`you.
Rick
On Jun 23, 2023,at 9:38 AM, Sherman, Lisa<LSherman@yarmouth.ma.us>wrote:
Hi Rick,
Residents would like to replace a door with a slider and expand the landing in the
back of 23 Forest Gate.
Please let me know if you need any additional information.
Thanks Rick, APPROVED
Lisa JUN 2 6 2023
YARMOU i'H
OLD KING'S HIGHW Y
Lisa Sherman
Town of Yarmouth
Administrator,Old King's Highway Historic District and Yarmouth Historical Commission
508-398-2231,ext. 1292
IshermanPyarmouth.ma.us
<23-E056 23 Forest Gate.pdf>
1
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$ ¢, TOWN OF YARMOUTH
1146 ROUTE 28,SOUTH YARMOUTH,MASSACHUSETTS 02664-4451
Telephone(508)398-2231 Ext.1292 Fax(508)398-0836
OLD KING'S HIGHWAY HISTORIC DISTRICT COMMITTEE
WAIVER OF 45-DAY DETERMINATION
The applicant/applicant's agent understands and agrees that due to the current declared National
and State public health emergencies the determination of our Application for a Certificate of
Appropriateness/Demolition/Exemption may not be made within 45 days of the filing of such
application.
The applicant agrees to extend the time frame within which a determination is to be made as
required by the Old King's Highway Regional Historic District Act.
SECTION 9-Meetings,Hearings, Time for Making Determinations
"As soon as convenient after such public hearing; but in any event within forty-five (45) days
after the filing of application, or within such further time as the applicant shall allow in writing,
the Committee shall make a determination on the application."
Applicant understands that the review of this application will be scheduled as soon as the
situation allows.
Applicant/Agent Name(please print): OMof (aim e�/dfcv�
Applicant/Agent signature: .71 Date: 4/0 3
RECEIVED
.IUD P, ; I APPROVED
Hhiv�uir; ) jUN 2 6 2023
n�n►nNG:g HIGHWAY_'
'AHMOUTh
1 OLD KtNG'S HIGHWAY
•
Application#: 692-'vg,
3/2020
KINGS WAY CONDOMINIUMS
Request for review by the Architectural Modification Committee
ALL OWNERS MUST BE LISTED AND SIGN REQUEST
First Name: 10A'i 94. �/ IL.
Last Name: a4/0.40 /1/ At," 63
2023
Address: 3 [ t ,2
AHfviGu t r,
OLD KING' HI HWAY
Unit:
Email: G'A.Fac G C✓i1 v 1 i
Best contact phone: £0 `c'3 }� "1'/ 1JAQ 6.2S? -..737-49c
Disairf of Work:
//761(41 .100 vfte<.Sz 'R: Attie- Ste' ee),74►'
X _Situ
NOTE: Please attach plan drawings and/or photographs and specifications from your contractor. All forms must
be completed and all required Information Included with each request before they can be reviewed. Please send
completed form and requested information to the Property anagement Office.
Homeowner signature: _ii.'.� 751' Aggc/X4fter S 02. VS
Property Management suture: % Date: sfZZ -$
AMC Committee Approvals: Date:
Board Chair Approval: Date:
NOT APPROVED: Date:
JUN 2 6 2023
'ARMOU T H
OLD KING''5 HIGHWAY
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