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Home My WebLink AboutBLD-22-006332 ug11 ' RE E VED - - • TWO FAMILY ONLY- BUILDING PERMIT Z�2 Town of Yarmouth Building Department of r M�Y 1146 Route 28,South Yarmouth,MA 02664-4492 • 508-398-2231 ext. 1261 Fax 508-398-0836 ale BUILDING DEPARTMENT Massachusetts State Building Code,780 CMR By ermit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling ,c This Section For Official Use Only W Building Permit Number: 6 -2.1-O dos 33 Z Date Applied: 1-;`M1/4 S S= r) -.1)- Building Official(Print Name) Si ature Date SECTION 1:SITE INFORMATION • L1 Property Address:- 1.2 Assessors Map&Parcel Numbers // Cou /P6WooD »,S . yp 1.1 a 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 I 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? Municipal El On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: --1y hizipCe---:c?e-,, , o/0 Name(Print) City,State,ZIP A 9 y iz,), , 2 - �s3- S j ) a7L -q,7e/ 2si s. copy; No.and Street er Telephone Emtil Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 1 Existing Building❑ Owner-Occupied 0 1 Repairs(s) ❑ Alteration(s) 0 Addition 0 Demolition ❑ Accessory Bldg. ❑ Number of Units Other 0 Specify: Brief Description of ProposedWork2: re ten ddt?-j rt S)"p d pi re pi i • SECTION 4:ESTIMATED CONSTRUCTION COSTS. Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 1. Building Permit Fee:$ .1St -Indicate how fee is determined: 2.Electrical $ 6 Standard City/Town Application Fee 0 Total Project Costa(I etxt 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ L� 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ • Suppression) Total All Fees:$ _ 6.Total Project Cost: $ 73 5., 0 d Check N.o. Check Amount: Cash ^ 0 Paid in Full '®Outstanding Balance D I iJ ,11I � �. SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) oU 53 9130A ' j -L7e/Z 1' 19-a a6/U ` License NumberExpiration Date Name of CSL Holder List CSL Type(see below) 4 0 'Le)09A'o JJ No.and Street ` Type Description AginOC/7 PGI27/ m Unrestricted(Buildings up to 35,000 cu.ft.) City/To n,State,ZIP 77 R Restricted LBc2 Family Dwelling lvl Masonry • 0 75 RC I Roofing Covering WS Window and Siding ®�6 gi1. SF Solid Fuel Burning Appliances _r / e,e SQ 06/hr. I Insulation Telephone mail address cti4YDN1'S. D Demolition 5.2 Registered Home Improvement Contractor(HIC) C191fl l v fl L7 t�v�2�2E�v /�3 5-6 7 / /.9/21,. MC Company Name or HIC Registrant Name HIC Registration Number Expiration Date • v5.9114) DD 09( CU570fS LLCM // No.and Street a �e _Sandeklbc C-v i5 Gge7gr I c7a i�� Email address yy� City/Town,State,ZIP Jkiiin,j , D2.GGd Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(1'I.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 to act on my behalf,in all matters relative toe work authorized by this building permit application. 44, 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 petjuty 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.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 hal '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" w Sand Dollar Customs LLC ' a 259 Great Western Rd. Unit B South Dennis MA 02660 4'1 508-694-5618 %r Sanddollarcustoms.com General Contractor and Owner Agreement Authorization To Proceed I hereby authorize Sand Dollar Customs LLC to proceed with construction at // Co /d; � uu cc d Dr ')/c,t r c)d/ r t in accordance with signed estimate # /b 2- 7 0 , dated 3 I / 14 6z2 Homeowner agrees to make payments to Sand Dollar Customs LLC in accordance with the payment schedule listed on the signed and agreed upon estimate. r----frityg rc az Homeowner Date Sand Dollar Customs Representative Date The Commonwealth of Massachusetts f jp) Department of Industrial Accidents in— Office of Investigations 7. ��1_�' Lafayette City Center , Mare 1/ 2Avenue de Lafayette, Boston,MA 02111-1750 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):Sand Dollar Customs LLC Address:259 Great Western Road, Unit B City/State/Zip:South Dennis, MA 02660 Phone#:508-694-5618 Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with 9 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction listed on the attached sheet. 7. 0 Remodeling 2.El I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. ❑Demolition workingfor me in anycapacity. employees and have workers' p h 9. ❑Building addition [No workers' comp.insurance comp. insurance.: required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other 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:Associated Employers Insurance Company Policy#or Self-ins. Lic. #:WCC-500-5019721-2021A Expiration Date: 12/04/2022 Job Site Address: 11 Collingwood Dr City/State/Zip:YarmouthPort, MA 02 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: u24.A b . Li_24.4 A-.2-kt 92. Date: 4/29/2022 Phone#: 508-694-5618 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License # Issuing Authority(check one): 10Board of Health 20 Building Department 3❑City/Town Clerk 4.0 Electrical Inspector 5Elumbing Inspector 6.❑Other Contact Person: Phone#: o A� TOWN OF YARMOUTH o. - BUILDING DEPARTMENT 1146 Route 28, South Yarmouth,MA 02664 508-398-2231 ext. 1261 HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE: JOB LOCATION: NAME STREET ADDRESS SECTION OF TOWN "HOMEOWNER" NAME HOME PHONE WORK PHONE PRESENT MAIL NG ADDRESS 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 I she will comply with said procedures and requirements. HOMEOWNER"S SIGNATURE APPROVAL OF BUILDING OI41-1CIAL 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:homeownrlicexernp • §TOWN OF YARMOUTH 1146 Route 28, South Yarmouth, MA 02664 508-398-223!1 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 %/ do L.C./k 6 lu001) DR) y Work Address Is to be disposed of oat the following location: %per nJ o` q�2�J7el v7/I Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. Itiazne,i, 4-9/22, Signature of Application Date Permit No. J //Z1lTfk11{!`tr'a f.rG lJ21/r.�fv' fi Office of Consumer Affairs and Business Regulation 1000 Washington Street-Suite 710 Boston,Massachusetts 02118 Home Improvement Contractor Registration Type: Corporation SAND DOLLAR CUSTOMS LLC Registration' 193567 259 GREAT WESTERN RD.UNIT B Expiration: 10129I2022 SOUTH DENNIS,MA 02660 SC 1 a tea+�s r7 Update Address and Return Card, y r v....,.....•.../Ir."ff.fit E r asrry OMMee Of Consumer AQWs i Busnps ReguIerlon HOME IMPROVEMENT CONTRACTOR Regtetralbn valid for Individual*e only TYPE:Corooreton before the expiration date. If found return to: EX0100R00 Office of Consumer Moire and Business Ra ulefion 193567 'I0/2912022 1000 Wsehington Street-Suits 710 SAND DOLLAR CUSTOMS LLC Boston,MA 02110 WALTER R.WARREN 259 GREAT WESTERN RD.UNIT wfiC. %'4¢41.4- SOUTH DENNIS,MA.02650 Und eta ry Not valid without signature Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Coriskiro, a visor CS-091653 `ltrr fires:t19f3sl2022 'WALTER R WAR 40 ALEXAN i - YARMOUTH P9RT- ' � 5 "y Commissioner , 't !. K. `�'`c`rrtiba., A,c R® CERTIFI CATE OF LIABILITY INSURANCE DATE(MM/DD12/ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS 14/2021 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 Tina Reeves Dowling&O'Neil Insurance Agency PHONE (A/C.No.Eat): (800)640-1620 I FAX 973 lyannough Road E-MAIL (A/C,No): ADDRESS: treeves@dolns.COm Hyannis INSURER(S)AFFORDING COVERAGE NAIC# MA 02601 INSURER A: NGM Insurance Company 14788 INSURED INSURER B: Associated Employers Ins Co 11104 Sand Dollar Customs,LLC INSURER C: 259 Great Western Rd. INSURER D: Unit B South Dennis INSURER E: MA 02660 INSURER F: COVERAGES CERTIFICATE NUMBER: CL21121493449 REVIITHIS 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 AUUL SUI:11( LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF POLICY EXP X COMMERCIAL GENERAL LIABILITY (MM/DD/YYYY) (MM/DD/YYYY) LIMITS EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE n OCCUR DAMAGE TO RENTED 500,000 PREMISES(Ea occurrence) $ A MED EXP(Any one person) $ 10,000 MPP9284Q 12/15/2021 12/15/2022 1 0 ,00 000 PERSONAL&ADV INJURY $ , GEN'L AGGREGATE LIMIT APPLIESPER: GENERAL AGGREGATE $ 2,000,000 H POLICY n PR0. I X)LOC JECT PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: AUTOMOBILE LIABILITY $ COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident)ANY AUTO OWNED BODILY INJURY(Per person) $ A AUTOS ONLY X SCHE ULED M1P9336Q 12/15/2021 12/15/2022 BODILY INJURY(Per accident) $ X HIRED X NON-OWNED AUTOS ONLY !� AUTOS ONLY PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB _ OCCUR $ EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE DED I I RETENTION$ $ WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY PER I J OTH- ANY PROPRIETOR/PARTNER/EXECUTIVE �Y/N STATUTE ER B OFFICER/MEMBER EXCLUDED? 1 1 N/A WCC50050197212021A 12/04/2021 12/04/2022 E.L.EACH ACCIDENT $ 500,000 (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE $ 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements.Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended thecoverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Sand Dollar Customs ACCORDANCE WITH THE POLICY PROVISIONS. 259 Great Western Road,Unit B AUTHORIZED REPRESENTATIVE South Dennis MA 02660 ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 15 ACORD CORPO•RATION. All rights reserved. Sears, Tim From: Sears, Tim Sent: Wednesday, May 11, 2022 4:08 PM To: Sanddollar Customs Subject: 11 Collingwood I have reviewed your application and you are going to need Old King's Highway approval for the window change. Thank you ,re Timothy Sears CB() *Lai a no Deputy Building Commissioner Mtui49; 14/151d/1/0 Town of Yarmouth 508-398-2231 Ext. 1259 e n a3i cpor-wzropti mailtolsears@varmouth.ma.us -iv q 4rewt 1 -6-1 tin evi K-Acci Owl A, )0 etiliit 110 111C •,.. . ..i -,. .„....1 -.., ,...._1- 1 \ N.., c.L.) c-* r" et"'N "--... . .'••' .., 14.9 Ft, V. ..,. . ,_.. ___-- ._- _ ....- / -'-"'''' .''''',.,,, .,, '1 ON i . ... , . . . . ,-`. . . r.r.."..:.- ' L'i .. . ' ,. / . ., ., „ ,, ,c,, ''t, ' . IA .,4 . 0\ . ,,,, - ' 't 4 , -... /i I, / \ . / ! ..... ............................_____ -4- rit i i / k.p....) / ... ......... 'N. N. A al x r- rn Fa c) 1/4..) - ..- ' • 7) .2.,- r-- Cr ..., .......;.j 0 t c I 111\ :c., , i , is ..... 0 .r.,•7' . - 5 c. ... .-----„......._,-- r- Ei '. ..• F' ;----, ..".•:::' '...:-.., .) n ,i *L-t... •t i"' " '•'. . c . Ill '