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HomeMy WebLinkAboutBLD-23-001391 V R E C e v:•. e i FAMILY ONLY- BUILDING PERMIT T i wn of Yarmouth Building Department of"""� -._ SEP 15 202211'6 'oute 28, South Yarmouth,MA 02664-4492 `_:. 50:-398-2231 ext. 1261 Fax 508-398-0836 BUILDING DEPARTMEMlas.achtusetts State Building Code, 780 CMR = \� aY _____Buz e,.'s._ s= ,placation To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Bt j)—a3fio/39f Date Applied: - ei Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION • 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers t o C c&s l< ctt, \- i' 1 k-(q , 2__(, 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: 2-4o "SF R fZocvo + fZo 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 zs 38' /5 25 zs 28 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIPI 2.1 Owner'of Record• 1�1 ou /'e 1� S e lei 1110 Oh, ,,r til a c 2 6' ?3 Name(Print) ity,State,ZIP IC 6n,3 I,q 1 -}- tw� Isdw%isA1 ,' I.00w► No.and Street Telephone Email Ad�jdress SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) t$ Addition 0 Demolition 0 Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Workz: „ �N y � \5 +n s cr a v.,, P u rt `,✓., b R E C E I {' y >° i.rit) d sw..fopw. wZ 96S ---k repIc.cv SEP 2 8 2022 i SECTION 4: ESTIMATED CONSTRUCTION COSTS BUILDINe DEPARTMLN1 Estimated Costs: Item (Labor and Materials) Official Use Only 1. Building c(!'O 1. Permit Fee: $ if))$ Building `'fib Indicate how fee is determined: 2.Electrical $ Cl Standard City/Town Application Fee SOO 0 Total Project Costa(Item 6)x multiplier x 3.Plumbing $ — 0 0 2. Other Fees: $ ') CXLAk3 5), 4.Mechanical (HVAC) $ /0 0p List: 5.Mechanical (Fire Suppression) $ Total All Fees:$ Check No. Check Amount: Cash ount:. 6.Total Project Cost: $ 2asco 0 Paid•in Full ti Outstanding Balance D e: II S VI v SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) Lck4(0 3ct ? , 2 16 ,i A t ✓ License Number Expiration Date Name of CSL Holder List CSL Type(see below) Cl /00 VA oN ei s a _t.. IZA No.and Street Type Description 1' n U Unrestricted(Buildings up to 35,000 Cu. ft.) �.4\v/ N lla. O Z'�? 5 R Restricted 1&2 Family Dwelling C(ty/Z own,State,ZIP M Mason ry RC Roofing Covering WS Window and Siding } SF Solid Fuel Burning Appliances �v C��5 ?" O 720 KQa}j v��('0.�tr' G Co vAct1;ive 1 I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) )) S 3 l ei t it Owe HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name Sc e No.ancleAt 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. c 1;sCCtVs/Sc �� if,(412,02z 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 aappppliiccation is true and accurate to the best of my knowledge and understanding. -TA //5./2.02 7_- 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.gov/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 half/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" • • The Commonwealth of Massachusetts fir !,�r Department of Industrial Accidents 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): )CE?; vk r- . t y^ Address: Ioo Am.",�5 City/State/Zip:Idifolou.‘k� , Wick ato "5" Phone #: 6 c: 3 >5'c1 p fl C Are you an employer?Check the appropriate box: Type of project(required): I.❑I am a employer with employees(full and/or part-time).* 7. ❑New construction 2./a I am a sole proprietor or partnership and have no employees working for me in 8. ®`Remodeling any capacity.[No workers'comp. insurance required.] 3.❑ I am a homeowner doing all work myself. [No workers'comp. insurance required.]t 9. ❑ Demolition 4.❑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 11.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑ 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.: 1 •[1]Roof repairs •6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 1 ❑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. 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:---&"c9 u.3 Policy#or Self-ins.Lic.4: Expiration Date: J f I'Z t, 2 3 Job Site Address: (O 60.5 T 'b7' City/State/Zip: '.J_ri 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 DIA for insurance coverage verification. I do hereby certify under*pains and penalties of perjury that the information provided above is true and correct. Signature: Date: ej IU!Zd2 Z Phone#: (o4) -754 0 '7Z 2 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#: /81 TOWN OF YARMOUTH BUILDING DEPARTMENT r MTiACnEsEi 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 ORK PHONE PRESENT MAIL[i' G ADD SS CITY OR TO STATE ZIP CODE The current exemption for 'Horn-owner' was extended to inclu•- owner—occupied dwellings of one or two units and to allow such homeowners to ,ngage an individual for hi who does not possess a license,provided that such homeowner shall act as supervisor. (State Building Code .-ction 110 R5.1.3.1) Definition of Homeowner: Person(s)who owns a parcel of land on w' •ch he/s resides or intends to reside,on which there is or is intended to be, a one or two family attached or detache. .truct,re assessory to such use and/or farm structures. A person who constructs more than one home in a two-year p: '.d shall not be considered a homeowner; such"homeowner"shall submit to the building official, on a foam acce. ..le to the building official,that he/she shall be responsible for all such work perfoiuued under the building sec 't. ection 110 R5.1.3.1) The undersigned `homeowner' assume responsibi .ty for compliance with the State Building Code and other applicable codes, by-laws, rules and re:ulations. The undersigned 'homeowner' ce fies that he / she u derstands the Town of Yarmouth Building Department minimum inspection procedures .nd requirements and that he I she will comply with said procedures and requirements. HOMEOWNER"S SIGNA ' APPROVAL OF BUILDINV OFFICIAL INSURANCE COVERAGt: 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:homeownrlicexemp • TOWN OF YARMOUTH 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 /( ' (C`,5 I,`G I-) 4 '~ Work Address Is to be disposed of at the following location: \4 r lvt oL , `t`ir 1 Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. i --------:f--:"I G4LC72 Signature of Applicant Date Permit No. i Commonwealth of Massachusetts ' Division of Occupational Licensure Board of Building Re ulations and Standards Constt on 5 visor I Tic CS-094639 btpi res:07/01/2024 KEVIN J FAI � ' 100 HOMER K ROAD YARMOUTHIRT MA 02676 i 0 Commissioncr v; >r;. ;; ; .TOE FO».»o. eaf//% aaersi Office of Consumer Affairs&Business'Regulation • HOME IMPROVEMENT CONTRACTOR TYPE:.Individual Reaistration Expiration 1531 11/05/2022 KEVIN FAIR , (3, i4...;-'• ......p i ___ ' KEVIN J.FAIR y 100 HOMERSDOCK RD ,f' r.+!*✓"-tdra.4 " YARMOUTHPORT,MA 02675 Undersecretary • • • • • T. Fallon, Rosa From: Everett Wilson <ejwilsonyport@gmail.com> Sent: Thursday, September 15, 2022 12:13 PM To: Fallon, Rosa Subject: Building authorization 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. Dear Ms Fallon, Please accept this correspondence as confirmation of our desire to have Kevin Fair Construction perform the work on our home at 10 Gaslight Drive in Yarmouth Port. Should you need any additional information from us, please do not hesitate to reach out to us or Kevin. Our contact info: Home number 508-375-0400 Mobile number 914-714-5598 Yours sincerely, Everett and Melissa Wilson 1 r I • E -` F Y T f: , r- ,.t 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451 w.;, Telephone(508)398-2231 Ext. 1292-Fax(508) 398-0836 I OLD KINGS 1-',qH /kOLD KING'S HIGHWAY HISTORIC DISTRICT COMMITTEE APPLICATION FOR CERTIFICATE OF EXEMPTION ,,��jj Application is hereby made for the issuance of a Certificate of Exemption under Sections 6 and 7 of Ch pt= , `'1 kV Acts of 1973, as amended, for the proposed work as described below and on plans, drawings, or o ..grapTls.,�% 1/ accompanying this application. Type or print lertibly: —7 e SFp 15?0 Address of proposed work: f© G. \ I)It 'jr L er�fCO�NG= �� Map/toot# 1:3 -p � q RT Owner(s) . A Vct IScmit ._ Phone#.et 1. �i5.i, r:.,it L� \- ivt All applications must be submitted by owner or accompanied by letter from owner approving submittal of application. Mailing address' - on. Year built l( "7(c.. Email l4/,I ( vk kik.67. c,tom. 1 ,ce.,K Preferred notification method Phone y Email Agent/contractor: 'f 1"' ,/ / Phone#:A0 3 p59 07Z[)__ Mailing Address _IOC o wa*r o k _ \1. muL4..�4-tvpa:"T IL(c( e_?y Email. ' (.1 A Preferred notification method _______Phone l .' _Email Description of Proposed Work(Additional pages may be attached if necessary): ' -vc4 WsF i5lief( A-c..e"v4,..‘ ?ot4L 40 ye,,r ►A0.,.v%C} 5(...4.h P toe+41 Signed(Owner or agent) tom• Date. f 3 .! 1 Z v .3. r 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 dale shall be tater. For Committee use only: Date. (II �'� VPpproved Approved with charges 3�, Amount_ X,6 Reason for denial: CashfCK*._-5S"..5)" S E P 1 g r,V? 1 Rcvd by: ___ -- _—w. _ Y 4hiPF1(3t�e i t j_ i T T;`KING'c' lir6-!may_ Date Signed 'h i1-2 Signed. ',. (' V ji v,c-. etrke-1 l APPLICATION f 2.2--c ic)is- 'I20 1I' , A1.,/tom U.I _ f, r' // NOI1bA313 1HOla `k�� NOI1Vh313 Ybja r to NOLLO3S ' p Z D f'-1 /'N s'�Ml o� .o.rt .t/:�. .e-dt .3 HE Y ek I_ II YO.rL B I� ill 1 I ■ ot `Y`" a-..t -�`-'-y-� .n�.wasL�xi+"�n I�UN) ` I II"" 306 to.,r a) -- -a g ro fC.71`i exam L .i' .y i z r= e a NM atefx3ro nxisnwirn .— - 5N1 OOP.,01 VW Fr' - Mm an 5 03,01.1PPPau'sfor P- _ in.r of..ONILS. _ N = �,,,,,,3,,,a / NV7d NOUVONn03 N011bA31- 1131 p xu3 .01313 U3 A tt w/c:OM k 0 woo Stomp ova N,r¢ IIIMEMD awe-exrsu 1 1 - 'gym+® \: ,a7kFi3is3i.Yircil -__.____ -__ rT - - . SJt R xo♦em m3 rMr, �-x0,,x. epxxoO asa S t• .t 111 z 10Nx 03 AMI ,,, T Aso roovvr N u-'t /' 'AXES" ks mu.wx�. Y77 rou_ _ :w,�iF:`m3Man k w rno m.x'"x+ NO3f1 MRN )d N011100V/M Nbld 15110H pt x i III" • 3 wooa N(S.t•, 1 xoum.0-t 3Mo �(0°- .m . on ( zi® }-Q-� ® .- " p asoxoM r J A.00110 .!MI m fi .108.38 ga wooajNns 1. o..t.n. wo.oM® + 1331 I j 1H01a v.. a.e L u.KsxwM(il i wpm g K 3oa,6).roe of o3.m - (i) m emu, r NgEA-i .°,� moor, ( i wY3 ww ----I () 9i an � � ie. ..,„o/„ o, i maoo y) ,� i room sz. ...:_ . A .oars 3..MM a ,174.-...vie i`t, I- 31Oi3tl I 3SrVoH ONIISIX3 TOWN OF YARMOUTH ; r HEALTH DEPARTMENT PERMIT APPLICATION SIGN OFF TRANSMITTALJHRECEIVEr) E ¢ bEP 15 2022 To be completed by Applicant: BUILDING DEPARTMENT By Building Site Location: q �+�Iy Proposed Improvement: T 1/4.1/4 �� c_v` ` C_ i 1 rod K Applicant: !C i t t i Tel. No.: /e,0'3 25 D7 LID Address: ( 0 14c (.0l0 CGL L ttd. Date Filed: 2 **If you would like e-mail notification of sign off,please provide e-mail address: Owner Name: VA- l ` j i ct at S L Owner Address: J 0 6CP 5 ( qI'rI- Owner Tel. No.: c/ I ( SO (c(( RESIDENTIAL AND/OR COMMERCIAL BUILDING HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. Please submit three (3) copies of plans, to include: (1.) Site Plan showing existing buildings, water line location, and septic system location; (2.) Floor plan labeling ALL rooms within building (all existing and proposed) — Note: Floor plans not required for decks, sheds, windows, roofing; (3.) If necessary, Title S application signed by licensed installer with fee. 1\-W. REVIEWED BY: / DATE: 7 / � • PLEASE NOTE COMMENTS/CONDITIONS: • PECEweD Os/ (,—6- o3J eY eDF . 114s o,3! Ac .sic V • E GINEERING DEPT.COPY T:)euE 16.1. G.I.5. I1t3103 { 2.or3G • IJoCATioN I ppgaximAm' I . 4i ,1 . : %%...MOO /?0.a° ) ..... './ • /3 300 Il ru 1g- _ o 4 sv. r • O w�E STo,� �i 1 1.4 23 r'+' ,Loi. 3 ' o0o Y , g►I_ ` #�O�E % IIO a -_ Wc ai � N O 1± ,� �S�o , 7 33 ' f �qj _M rCEULlS iQ l 12o.do N 0 6 Z003 Pj J t *to `4o'W/DL. GA SL/G H T 772/vE - PWivA k4e,p4I y • HEALTH DEPT II A SSe54f S ''+7ftP S�9./ 26 CERTI FI ED I PLOT PLAN NOTE: THE Pnefenry DoEs NorF.4LC u i/p/rn' R LocATION /0 GASC/GHTOz YA/t f/ g4. ff/G// f/f�Z, -R.0 fGOob Z.0tiE. (ZO,Ve h/C"JAS „ .. - #0trx/ eAr cam/plop/fry p,q -L No. Zroo/s - SCALE. -.3v DATE/ �3/ ?Z. . . )oO/. f IZEVisED �?//Ly 2,/99Z.By�"E�A- PLAN REFERENCE I w ' 1 `-`4 E" THE Lvvvs is Nor/ ✓7 AnviFE•2?ZerC/7/OM ��"Al y,¢J?�no 'N,Fo2 SCo]j'�pR�jpN zzwLc- SCANT/ -/00• ocioBeR/9681+010s1: zo t/ED g-44o ` So.Rv6ytow5LfJ JI!C./' ) /?ayn/,n • „.( K of - .\ ,SE-E It. i31I ZZ9 Pam.3/ . . . . . rkr. . . . . . . fi • °* ; .- ,� I CERTIFY THAT THE .,,i:eg.f.:Afl(. A/Y L LI' SHOWN ON THIS •Is LOCATED ON THE WOUND . . . • . . • . . • . . . . • g N !TO y AS SifOWH HEREON 19„ 3' ' l i/� fsTERO� . . • • V' suc DATE l27:3/aL PETITIONER: . . . . • • Wg,,yy/i9/r/»o I77i9SS. REGISTERED LAND SURVEYOR II