Loading...
HomeMy WebLinkAboutBLDR-23-12844 ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department y -- 1146 Route 28,South Yarmouth,MA 02664-4492ill !tit—. 508-398-2231 ext. 1261 Fax 508 398 0836 ,'''' . Massachusetts State Building Code,780 CMR Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling REC _.rD /� This Section or Official Use Only f ' ' _ Building Permit Number: LJL� Date Appli • JUL 2 7 20 23 7 Building Official(Print Name) • i attire a e D E P R T M E IV T SECTION 1:SITE INFORMATION — 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 43 QA. u0A. t��YVI�.. /z / ge 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: /• SG4C 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 n 0 0 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? Municipal❑ On site disposal system Cl Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: / Cr.�g�..4 SGh tin (�/Rria,n,_ 1QI c*i Ilar '1�cc . 02-G 75— Name(Print)I City,State,ZIP e Li a,A- con. (500 clt,s4 -or sc.ti,r,►cu a ctM�,,1 •C No.and Street Telephone Email Addre SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 I Existing Building 0 Owner-Occupied 0 Repairs(s) iiV Alteration(s) 0 I Addition ❑ Demolition © Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: (Z.�,p ,r t o4..A C i k` u,AA,,•,r �rdv`cc A.as ,A.�,,V \ti u.. . v.to v,4� �� - c is SECTION 4:ESTIMATED CONSTRUCTION COSTS. Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 8 c-CX.)..'- 1. Building Permit Fee:S 1 TO Indicate how fee is determined: 2.Electrical $ 1 It Standard City/Town Application Fee 0 Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: S �l 4.Mechanical (HVAC) $ List: 3 S taU , )( 5.Mechanical (Fire . . - Suppression) $ Total All Fees:$ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ 0 Paid in Full !Outstanding Balance Due: ii 6' SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) �A INt�,rc 1v (5- ill S�t'S Z3 2.o t Name of CS4,Holder License Number Expi tion ate ClA ah fik•—• List CSL Type(see below) U No.and Street Type 1 Description '`S �"^'r�` -�"h �,�, o ,�a-1 [ U 1 Unrestricted(Buildings up to 35,000 Cu.ft.) City/Town,State,ZIP Restricted 1cPc2 Family Dwelling M 1 Masonry RC 1 Roofing Covering WS Window and Siding /� 774.1(Z quo C � � SF Solidu Fuel Burning Appliances C('��AAA;`1+�u� i Insulation Telephone Vial]addr ss D 1 Demolition 5.2 Registered Home Improvement Contractor(HIC) "A rc>,.N t,, 2ocp Sdq liney HIC ompan Name or HIC Registrant Name HIC Registration Number Expiratio Date • 59 u hew—. 1..A... No.and Street -y�,1 �r/�, C,� W wt.."V� .A�lw. , OZ(o13 t I"I�LIZ1�Q+v r Email address J �r,� 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 Issues of the building permit. Signed Affidavit Attached? Yes No D • 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 CIA to act on my behalf,in all matters relative to work authorized by this building e p rmit application. ri a v.____ keno 7 2 /Z3 Print Owner's Name(Electronic Signature) I ate • 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. in� /kCiGU/�L/ 7 23 Print Owner's Authorized Agent's Name(Electronic Signature) �/ NOTES: 1. An Owner who obtains a building pe rmit rmit 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 IIIC Program can be found at www.mass.gov/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.) Gross living area(sq.ft.) {including garage,finished basement/attics,decks or porch) Number of fireplaces Habitable room count Number of bathrooms Number of bedrooms Type of heating system Number of half/baths Type of cooling system Number of decks/porches Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" 0 0,m.0 air pet/L -)1 L,rk ��r The Commonwealth of Massachusetts y ' Department of.Industrial.Accidents ",,_ 1 Congress Street,Suite 100 `f'— Boston,MA 02114-2017 .. www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. A Iicant Information Name (Business/Organization/Individual): C Please Print Le4ibt Address: c'.i v u'.Q L r wuA.J City/State/Zip: oLbt�Piione#: 71' 2-1?—Are you an employer?Check the appropriate box: �2 l•y!am a employer with Type of project(required): employees(full and/or part-time).* 2• a sole proprietor or partnership and have no employees working for me in 7. New Jelin construction any capacity.[No workers'comp.insurance required.] 8. Remodeling 3.01 am a homeowner doing all work myself.[No workers'comp,insurance required.]r 9. ❑Demolition 10 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will [1]ensure that all contractors either have workers'compensation insurance or are sole Building addition proprietors with no employees. l l.[]Electrical repairs or additions 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.i 13.0 Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per,MIGL c. 152,§1(4),and we have no employees.(No workers'comp.insurance required.] I4.5215therilZ°,� `�S *Any applicant that checks box T 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. I ant an employer that is providing workers'compensation insurance for my employees. Below is the olio information. policy and job site Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: Attach a copy of the workers' compensation policy declaration page(showing thetpolicy 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$1 500.0 ) 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 insura coverage verification. nce I do hereby certify rcn er the pains and penalties of perjury that their formation provided above is true and correct. Signature: Phone#: Date: Z Z Official use only. Do not write in this area,to be completed by city or town official. City or Town: i Permit/License# Issuing Author ty(circle one): I.Board of Health 2.Building Department 3.City/Tow n Clerk 4.Electrical Inspector 5. PlumbingIns 1.Other pector Contact Person: Phone#: §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 a 6 tlhwvVeur\" Work Address Is to be disposed of oat the following location: J.Xv&cn/ . AN,) Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. Si a of Application $ 7Jz > D Permit No. _ r ass.gov • o ` gggvN HIC Registration Complaints Registration # 206589 Registrant Cody Mercurio Name Cody Mercurio Address 54 Monroe lane City, State Zip West Yarmouth. MA 02673 Expiration Date 09/27/2024 Complaints Details No complaints found for this registrant. You can also view arbitration and Guaranty Fund history_. Back To Search .c. Commonwealth of Massachilsetts Irt, Division of Occupational Licens Board of Build.. g. ‘„in Re ns and St:nredards Cons ,9ul tio Avt'r lion'rtiko."isor tp CS-117543 .. , .54 MOAI t 10/23/2026 CODY A MEliCD , s'er 11 apires- ** IV YARMOUt Au. -- Iv ,,c ?.t. 'A ''16'1' •••‘ 1 4,.--, '•Yir to_ 3 ;IS3 . Commissioner ic' W611(1.c4L. • 1 . • • . . • I• • ._ '• '• • • • , . • • •-d C 1 k7e i> f El a Si. / J l V • s S