HomeMy WebLinkAboutBLDR-23-12768 iv i l/ ern 60 / pJJr7j
ONE & TWO FAMILY ONLY- BUILDING PERMIT
Town of Yarmouth Building Department • ""-p .
1146 Route 28, South Yarmouth,MA 02664-4492
508-398-2231 ext. 1261 Fax 508-398-0836 �•. .
i.
Massachusetts State Building Code, 780 CMR
`"-"li
Building Permit Application To Construct, Repair, Renovate Or Demolish
a One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: ,3L A 23- /z7Fj i' I Date Applied:
BuildingOfficial IRECEvEDI
(Print Name) Signature ----Date
SECTION 1:SITE INFORMATION JUN 21 2013
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
17/ we6i- ok a ��r Pad- __
l.la Is this an accepted streets RIM ntNG DEPARTMENT
p yes no Map Number Parcel Neer
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, Private❑ Zone: Outside Flood Zane?
Check if yes❑ MunicipalElOn site disposal system 0 \U
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record•
o ,:o 4 s Ptee Xt'r . Pam- 414 d267s
Name(Print) City, State,ZIP /
el"7 ti we64- Yarnlo RA, 5cg-no 1` fv.,c-ori e_pa, ,cow,
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 l Addition k
Demolition ❑ Accessory Bldg. ❑ Number of Units Other 0 Specify:
Brief Description of Proposed Work': /r'u6+k✓' L 4 joA„, ,.�'-r,,� 4 t 1�' 4 4
w-A-Aaw'S
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
(Labor and Materials) Official Use Only
1. Building $ /0 3 j d 0_0,co 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ 0 Standard City/Town Application Fee
6t 606,Qo 0 Total Project Cost3(Item 6)x multiplier x
3.Plumbing, $
// � 30/07:rD ,rro 2. Other Fees: $
4.Mechanical (HVAC) $ 1 .,e,cro.m List: IP 0 r 0 0 e ctk- 8�S'
5.Mechanical (Fire V
Suppression) $ Total All Fees:$
6.Total Project Cost: $ Check No. Check Amount: Cash Amount:
50 k ❑Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
Name of CSL Holder License Number Expiration Date
List CSL Type(see below)
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
City/Town,State,ZIP R
Masonry 4 Restricted I&2 Family Dwelling
nI
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
Telephone I Insulation
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 ❑ No ❑
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 to work authorized by this building permit application.
Print Owner's Name(Electronic Signature)
Date
SECTION 7b: OWNER1 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 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.2ov/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.) ! °. 6 az, (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) 6 2 �
Number of fireplaces d y Habitable room count
Number of bathrooms Number of bedrooms
Type of heating system G /w Number of half/baths Number of deckks/s/po po
rches Type of cooling system OV
Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
The Commonwealth of Massachusetts
Department oflndustrialAccidents
1 Congress Street, Suite 100
Boston, MA 02114-2017
iLtur,:f
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): .)61.440.4N_ Part5 uw
Address: 14)614 l
City/State/Zip: Yeermo k PO4-, MA 6205 Phone #: - "2.80-gam f 6
Are you an employer?Check the appropriate box:
1. I am a employer with employeesType of project(required):
(full and/or
2.0 I am a sole proprietor or partnership and have no employees working for me in 7. New constdelinrUCtlOn
any capacity. (No workers'comp. insurance required.) 8. Remodeling
3.0 I am a homeowner doing all work myself [No workers'comp. insurance required.]t 9 Demolition
4.RI 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
1 1.❑ 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.El Roof repairs
6.❑We are a corporation and its officers have exercised their rieht of exemption per MGL c. 14. Other
152,§I(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 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. lithe 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 pol cy 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 c tify u, der El pains nd penalties of perjury that the information provided above is true and correct.
Signature: /
Phone T: 6-08 _ 0 -�/6
Date: E7 ZO Z.O2,3
Official use only. Do not write in this area, to be completed by city or town official.
City or Town:
Permit/License 4-
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#:
F YAR�, TOWN OF YARMOUTH
: am o,
(k. rrnn ti
BUILDING DEPARTMENT
acccsr y'�
�� 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1261
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
DA 1E:
JOB LOCATION: H7j Luny.- 14,m.,,,14, AL Xnituvik M
NAM STREET ADDRESS SECTION OF TOWN
::HOMEOWNER" Ua.064O . t/7444w 5'0g- .53"0- 4aatI`
NAME HOME PHONE WORK PHONE
PRESENT M�I\��D� R7if U,� � � �,
CITY OR TOWN 444 o-zG 7j
A
The current exemption for `Homeowner' was extended to include owner 1 occupied ZIP elODElings 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 assessor_y 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 perfotuned 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 an irements an a le / she will comply with said procedures and
requirements.
HOMEOWNER"S SIGNATU
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
Cha ter 142 o e ss. General Laws and that my signature on this permit application waives this requirement.
Che ne:
Signature of Owner or Owner's Agent COwner Agent
h:homeownrlicexemp
TOWN OF YARN1OL TH
1146 Route 28, South Yarmouth, MA 02664
508-398-2231 ext. 1261 Fax 508-398-0836
Office of the Building Commissioner
BUILDING DEPARTMENT
DEMOLITION DEBRIS DISPOSAL AFFIDAVIT
Pursuant to M.G. L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111/5
I hereby certify that the debris resulting from the proposed work/demolition to be
conducted at 771 ttlic4i- kL4 RL
Work Address
Is to be disposed of at the following location: 4 t&.'t44c- Aatt,
‘0 6 — Rapt 1. m-%AL-.
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
‘- 26- a62,3
Signature of Applicant
Date
Permit No.
YARMOUTH TOWN CLERK
fh, ---*0'4-
23FPH289:58 REC
. . ,
TOWN OF YARMOUTH
-',.. . .._ e *,,, 1146 ROUTE 28, SOUTH YARMOUTH,MA 02664-4451 V." 114‘:-: Telephone(508)398-2231 Ext. 1292-Fax(508)398-0836
'
OI_D KIN 'S HIGHWAY HISTORIC DISTRICT COMMITTEE
--, ,
1 APPLICATION FOR
CERTIFICATE OF APPROPRIATENESS
Application is hereby made for issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts of 1973 as
amended,for proposed work as described below&on plans,drawings,photographs,&other supplemental info accompanying this
application. PLEASE SUBMIT 4 copies OF SPEC SHEET(S)1 ELEVATIONS PHOTOS,&SUPPLEMENTAL INFORMATION,
Check All Categories That APIA : Indicate type of Building: II Commercial Li Residential
1)Exterior Building Construction: I INew Building R Addition LI.Iterations II Reroof Ei Garage
LiShed Li Solar Panels I Other:
2)Exterior Painting: Siding Shutters [1 Doors Trim 0.0ther:
3)Signs/Billboards: ri Newrkipn Change to xi ting Sign
4)Miscellaneous Structures: Fence Wall Flagpole Pool Liother:
Please type or print legibly: 04430
' ' e Y.ur at . PX,
Address of proposed work: 9 7if W 5+-s . 4A/L Map/Lot# i-Zil 11,,d .30 Lai" 111 A
Owner(s): avv,„:‘,.,„,„ 4. 73e-nit'vcr-r- P41.is"es CA.+-; Phone#:6 - 7AT:0
All applications must be submitted by owner or accompanied by letter from owner approving submittal of application.
Mailing address: ci 71 kA-,e 4 )/4,-"‘" 4& I:1<A. Year built:
Email: haCe-'t VPet.el 444; ( (3)14,4:I. ,owl. Preferred notification method Phone El Email
Agent/contractor:
Phone#.
Mailing Address:
Email: 1 a... i)A 4-7,14a 4.41 i.... evom.:1.i 4;14,1/4 Preferred notification method: PI Phone El „Email
Description of Proposed Mc i
i I.'s, N i r i ._
/Via 5,k,,,,. 6 elt„,av", 44.I,At 1).-00,1".. 6'1"-Z 1 k-A-1—
- A 0 4..,e- (....j I 4
/ ,Signed(Owner or agent): -`` ,, -' Date: i-/ ei • 2 3
'..- Owner/contractor/agent is aware that a permit is required from the Building Department.(Check other departments.also.)
..-... If application is approved,approval is subject to a 10-day appeal period required by the Act,
.• This certificate is good for one year from approval date or upon date of expiration of Building Permit,whichever date shall be later.
- All new construction will be subject to inspection by OKH.OKH-approved plans MUST be available on-site for framing&final inspections,
For Committee use only:. '-"Approved Approved with Modifications Denied
, .
Rcvd Date- .;2/4112 Reason for Denial:
Amount Y0,10
Cash/CK#: 1
Signed: Al'ar, - f Signed: -
Revd by:
lefAMIIrd5'.. — Allir...
45 bays;
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Date Signed:
1 4 IC*
APPLICATION#:
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Telephonc'(:+08)398-221I Ext. 1292 Fati ( 0 )208 0836
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elGenerated by REScheck-Web Software
Compliance Certificate
Project Parseau Residence
Energy Code: 2018 IECC
Location: Yarmouth Port, Massachusetts
Construction Type: Single-family
Project Type: Addition
Climate Zone: 5 (6137 HDD)
Permit Date:
Permit Number:
Construction Site: Owner/Agent: Designer/Contractor:
974 West Yarmouth Rd Damian Parseau
Yarmouth Port,MA 02675 974 West Yarmouth Rd
Yarmouth Port,MA 02675
Compliance: Passes using UA trade-off
Compliance: 0.9%Better Than Code Maximum UA: 113 Your UA: 112
The%Better or Worse Than Code Index reflects how dose to compliance the house is based on code trade-off rules.
It DOES NOT provide an estimate of energy use or cost relative to a minimum-code home.
Slab-on-grade tradeoffs are no longer considered in the UA or performance compliance path in REScheck. Each slab-on-grade
assembly in the specified climate zone must meet the minimum energy code insulation R-value and depth requirements,
Envelope Assemblies
Gross Area
Assembly or Cavity Cont. Prop. Req. Prop, Req.
Perimeter R-Value R-Value U-Factor U-Factor UA UA
Ceiling 1: Cathedral Ceiling 768 38.0 0.0 0.027 0.026 21 20
Wall 1:Wood Frame, 16"o.c.
800 21.0 0.0 0.057 0.060 40 42
Door 1:Glass Door(over 50%glazing) 40 0.300 0.300 12 12
Window 1:Wood Frame 60 0.300 0.300 18 18
Floor 1:All-Wood joist/Truss 624 30.0 0.0 0.033 0.033 21 21
Compliance Statement: The proposed building design described here is con ' tent with the ilding plans,specifications,and other
calculations submitted with the permit application.The proposed building been design to meet the 2018 IECC requirements in
REScheck Version: REScheck-Web and to comply with the mandatory re ' emefyts list the REScheck Inspection Checklist.
Timothy Trott-Summit Insulation Co. ''.-/9— 2.3
Name-Title Sig ature Date
Project Title: Parseau Residence
Data filename: o Report date: 06/1 f 99
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