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HomeMy WebLinkAboutBLD-23-005717 ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department ;: '....y 1146 Route 28,South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 1 , .., Massachusetts State Building Code,78D CMR \i1 Building Permit Application To Construct, Repair, Renovate Or Demolish .. ......,t:!,.:-./ Q \O a One-or Two-FamilyDwelling \\ This Section For Official Use Only Building Permit Number: a,.�}.Z3'VS)1 [ Date Applied: Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION • 1.1 Properq Ades : 1.2 Assessors Map&Parcel Numbers t/.�i' " � . _4 7Z 1 ^-----'1.1 a Is this an accepted street?yes ' no Map Number Parcel Number t itt� u 1.3 Zoning Information: 1.4 Property Dimensions: t 1 _— Zoning District Proposed Use Lot Area (sq ft) Frontage(ft) z 1.5 Building Setbacks(ft) `U "� �r Front Yard Side Yards Rear Yard Required I Provided Required Provided Required Provided C 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? Check if yeses MunicipalOn site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: G< :/.4Or/ ` .94/ ,may' C ( ‘4� fr �z;' , /en a. 7:'Name(Print) ! City,State,7 P / 1�:. ,- - /et,� 54 O/4 . , - ') No.and Street � ''� � �" ♦ +.�:, /12 4J/ Telephone Email Ass -- SECTION 3:DESCRIPTION OF PROPCISED WORIC2(rhePk,all.that apply) New Construction 0 Existing Building fed ( Owner-Occupied 0 1 Repairs(s) 0 1 Alteration(s) 1 f Addition Cl Demolition Or I Accessory Bldg. Cl I Number of Units 1 Other 0 Specify: p fY: Brief Description of Proposed Work2: ) vt,� 7 6:e=A« _. 4.4-r"4/44 A A✓Z:-4, ,/I t//iY ' Is'6t'r� (7,-----7—r—"` �.r 9fri /Z-577,,_'O_j7% c Cv'I,G.7- (7A1 /r/O.tJ,"7„ A.,/i � or'?XIiGpi -- SECTION 4:ESTIMATED CONSTRUCTION COSTS. i/a'1gTG,-il>rJs Item Estimated Costs: 42et.,/r�<3z (Labor and Materials) Official Use Only 1.Building $ O O 01. Building Permit Fee:$L}c` Indicate how fee is determined: 2.Electrical $ ' Standard City/Town Application Fee ; S.Plumbing $ r65r, 0 Total Project Costa(Item 6)x multiplier x �- N/A 2. Other Fees: $ X �ty ' , 4_Mechanical (HVAC) $ 3 List: 3 fir" 4 Q O r?� `\ V \; 5.Mechanical (Fire W Suppression) $ i1,1(/ Total All Fees:$ ' �\ 6.Total Project Cost: $ r gh;: ro. ChecAmoutm \� aid in Full VII Outstanding Balance Du • 3 Cc . g55'z.15_e1 L/jI LQ a,,), 00 P SECTION 5: CONSTRUCTION SERVICES 5.1 Co traction Supervisor License(CSL) ��`J/�z /%,/�— of o� 4 n C', g_3 Name of CSL Holder License Number Expiration Date 2� e �2/,- r L��, List CSL Type(see below} No.and Sheet Type ,/� Description %�> ��i /'V /��-j U Unrestricted(Buildings up to 35,000 cu fit l City/Town,State,ZIP Restricted 1&2 Famil DweIlin lvt Maso RC Roofing Coverin WS Window and Sidin ,�.1ti / SF Solid Fuel Burning Appliances /ice/� 77'' �F�1>.F'% `` `rc"a�yL o I Insulation Teleshone Email address 4:.VI . 5.2 R$gistered Home Improvement Cori r�IC) DeQmalition n Zgi C Company Name or Registrant Name HIC Registration Number E pirati n Date C",- • r '�� No.and tree • - � j ����� City/Town,State,ZIP 1� Email address Tele.hone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(NLG.L. c.152. 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 2f No El 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 dais building permit application. 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 perjury that all of the information contained inlf4s application's true and acc ate to the best of my knowledge and understanding. Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: l. AnOwner who obtains a building e registeredg permit to do his/her own work,or an owner who hires an unregistered contractor (not in the Home Improvement Contractor CHIC)Pro program or guaranty fund under M.G.L. C. 142A. �),will not have access to the arbitration www mass ov/oca information on the Construction Supervisor importantinformationabe fon und he at wwwmriIC ms„ovld found can be at 2. When substantial work is planned,provide the information below: Total floor area(sq.fit.) Gross living area(sq.ft.) (including garage,finished basement/attics,decks or porch) Number of fireplaces Habitable room count Number of bedrooms Number of bathrooms 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" The Commonwealth of Massachusetts ' - 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 Name (Business/Organization/Individual): M Please Print Leoibt Address: ✓�, .o „ / City/State/Zip:,..4' , z;,, X/17/C-�3 Phone Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with employees(full and/or part-time),* 7. 2-0 I am a sole proprietor or partnership and have no employees working for me in ❑New construction 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 'I.Q I am a homeowner and will be hiring contractors to conduct all work on my property. I will l ❑ Building ensure that all contractors either have workers'compensation insurance or are sole addition proprietors with no employees, l 1.Q Electrical repairs or additions 5. I am a general contractor and I have hired the subcontractors listed on the attached sheet, 12.Q Plumbing repairs or additions `' These sub-contractors have employees and have workers'comp. insurance.' 13•El Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per,MMGL c, ❑ 152,§1(4),and we have no employees. (No workers'comp.insurance required.] 1 Outer *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 'ob site information. cy and e Insurance Company Name: Policy or Self-ins.Lie. ; Expiration Date: Job Site Address: City/State/Zip: 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. do hereby certify under die pains and penalties of 'ury that the information provided above is true and correct. Sienature; Y, J Date: - Phone ©fficial zrse only. Do not write ire this area, to be completed by city or town offzcial. City or Town: Permit/Licenser Issuing Authority(circle one): I.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: Commonwealth of Massachusetts 1111, Division of Professional Licensure Board of Building R ulations and Standards Const t isor CS-114224 ! 9ires:08/06/2023 WILLIANS G 1 E PAS tiw, 55 CLUB VALLEY •; ^ EAST FALMOUT • ` O Commissioner HOME IMPROVEMENT CONTRACTOR TYPE:Individual Registration Expiration 197222 11/12/2023 WILUANS GENTIL DE PAULA . D/B/A CUTTING EDGE KITCHENS&DESIGN. WILLIANS G.DE PAULA 7 55 CLUB VALLEY.DR a 1a f4iv, • EAST FALMOUTH,MA 02536 Undersecreta • • • §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 50 1, 444.-- /p/ le("):,r�� � /�/.�Q Work Address Is to be disposed of oat the following location: Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. ignature of A rc cation� ppi a ion - Date Permit No. ACORCP CERTIFICATE IFF14lATG OF LIABILITY p� p/�NC DATE(MM/DDfYYYY) �✓' f i INSURANCE /31/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 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 BRZ Insurance NAME: Izadora Ferraz PHONE 107 Concord St (A/c.No.Ext): (508)603-6777 FAX E-MAIL (A/c,No): (508)603-6776 ADDRESS: coi@brzinsurance.com Framingham INSURER(S)AFFORDING COVERAGE NAIL# MA 01702 INSURERA: Utica First Ins Co 15326 INSURED INSURER B: Amguard Ins Co 42390 Real Evolution Construction Inc. 67 SETTLERS LN INSURERC: INSURER D: INSURER E: HYANNIS MA 02601 COVERAGES INSURER F: CERTIFICATE NUMBER: REVISION NUMBER: THIS 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! ADDL SUBR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF POLICY EXP 1 X COMMERCIAL GENERAL LIABILITY (MM/DD/YYYY) (MM/DD/YYYYL LIMITS EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ 100,000 A MED EXP(Any one person) $ 5,000 Y ART3000342920 04/19/2022 04/19/2023 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY I E LOC GENERAL AGGREGATE $ 2,000,000 OTHER: PRODUCTS-COMP/OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) OWNED SCHEDULED BODILY INJURY(Per person) $ AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE (Per accident) $ UMBRELLA LIAB $ OCCUR EXCESS LIAB 1CLAIMS-MADE EACH OCCURRENCE $ AGGREGATE $ DED I RETENTION$ WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y_!N X STATUTE OTH- ER B OFFICER/MEMBER EXCLUDED? N N/A REWC332043E.LEACHACCIDENT $ 1,000,000 (Mandatory in NH) -- 04/19/2022 04/19/2023 f yes,describe under , E.L.DISEASE-EA EMPLOYEE$ 1,000,000 IDESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Real Evolution Construction Inc is listed as Additional Insured's under the General Liability coverage as required. CERTIFICATE HOLDER CANCELLATION SHOULD ELLED BEFOE THE EXPIRATION HDATE VTHER OF, NOTICE POLICIESBED WILBL E CBE CDELIVERED RIN Real Evolution Construction Inc ACCORDANCE WITH THE POLICY PROVISIONS. 67 Settlers Lane aUTHDRYZEDREpfYESE'N1A1pe Hyannis,MA,02601 ACORD 25(2tI1 ) 01988 2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Owner Authorization to be completed when owner's agent or contractor applies for building permit. I, as owner of the subject property (50 Pamet Road West Yarmouth, MA 02673), hereby authorize Viratt-Y71- Ca-CYPOO To act on my behalf, in all matters relative to work authorized by this building permit application. Print Owner's name (Electronic Signature) Date ONE or TWO FAMILY— BULDING PERMIT APPLICATION REGULATORY APPROVALS NOTICE Address of Proposed Work: .5e 1--4,(4, Are/l . `Lr /e<1(2 Scope of Proposed Work: / Date: `i/CYj>77 3 Based on the scope of work described above, the applicant is required to obtain approval sign- offs from the following departments as checked-of below: Health Dept. —508-398-2231 ext. 1241 Conservation—508-398-2231 ext. 1288 Water Dept. —99 Buck Island Road, 508-771-7921 Old Kings HWY. Hist. Comm. —508-398-22631 ext. 1292 Engineering Dept.—508-398-2231 ext. 1250 Fire Dept.—Kevin Huck/Scott Smith, 96 Old Main Street, SY Note: Please call Fire Department for an appointment. 508-398-2212 Other Appropriate plans and/or application shall be provided to each departments checked-off above. Each of these regulatory authorities has their own requirements outside the jurisdiction of the Building Department. All applicable approvals shall be obtained prior to submitting a building permit application to the Building Dept. Thank you for your cooperation. Receipt wledgem t: / ` -7 Applicant's Signature d - Date Rev.Jan. 2019 i'''V'Ya TOWN OF YARMOUTH BUILDING DEPARTMENT` ;' = 1146 Route 28, South Yarmouth, MA 02664 MASTAGA asa%r r �: &-.�` Telephone 508-398-2231 ext. 1261 Fax 508-398-0836 Owner's Affidavit: Substantial Improvement or Repair of Substantial Damage Property Address: ✓!.f , /Y %�%<' d 'r ,'� lG <--'erk-' �'� Parcel ID Number: ,2 �7 Owner's Name: 4.6 4"4Oi' //,: f: 1.r.'t/y� Owner's Address/Phone: ' r : , , - ' ' 1 t'",41,-'A/'fl l" "01/lv� ,0 7 /'€' Contractor: ', .,',jig'.j , / ' .ilk t / Contractor's License Number: r'- /% _ ' ,. Date of contractor's Estimate: (' - / --.=7 - 3 I hereby attest that the description included in the permit application for work on the existing building all improvements, rehabilitation, remodeling, repairs, additions, and other forms of improvement. I further attest that I requested the above-identified contractor to prepare a cost estimate for all of the work, including the contractor's overhead and profit. I acknowledge that if, during the course of construction, I decided to add more work or to modify the work described, that the Town of Yarmouth will re-evaluate its comparison of the cost of work to the market value of the building to determine if the work is substantial improvement. Such re- evaluation may require revision of the permit and may subject the property to additional requirements. I also understand that I am subject to enforcement action and/or fines if inspection of the property reveals that i have or authorized repairs or improvements that were not included in the description of work, and the cost estimate for that wor hat were basis for issuance of a permit. Owner's Signature: I A Date: SI(.� , Notarized: -Zs, FRANTZNOTARY CHARLESPUBLIC JR = ''i Commonweakh of Massachusetts I. My Commission Expires on ,.W too December 25,2026 I - TOWN OF YARMOUTH 1146 Route 28 .So.uth Yarmouth, MA 02664 508-398-2231` ext. 1261 Fax;508-398-0836 Office of the ,Building Commissioner FINAL COST AFFIDVIT FOR WORK IN FEMA FLOOD ZONE To the Building Commissioner, In accordance with 780 CMR Section 109 of the Massachusetts State Building Code, the tot estimated cost of I construction, including all related costs* of the building at ' ` `-Ait' / ,%t ,ste/`'/ ii 44./10'�;', and constructed,x� ns cte at d,repaired, or extended under building permit no.' r amounts to $ ___. 1 I,_ r koc\ J mnL,being referred to as the owner/agent identified below,do solemnlyP swear that the statem is ade herein are strictly true,correct and made in good faith 1 *Related construction costs include all work done with or concurrently with the work contemplated by the building permit including construction, reconstruction, repairs, demolition, HV k, etc. Furnishings and portable equipment are not part of the total construction costs. Si atu weer/ag .t cl .k Gc___. /lam 12) 7-5 1 Notary Public Signature My Commission Expires Notary Seal: . y FRANTZ CHARLES JR ' ftia _r NOTARY PUBLIC p Commonwealth of Massachusetts . _ My Commission Expires on =,,, December 25,2026 4/19/23,9:21 AM Mail-Sears,Tim-Outlook 50 Pa met Sears, Tim <tsears@yarmouth.ma.us> Wed 4/19/2023 9:20 AM To:cuttingedgecustombuilders@gmail.com <cuttingedgecustombuilders@gmail.com> 1 attachments(391 KB) work in flood zone packet.PDF; Wiliians, I have reviewed your application and there are some items needed. V)iealth Department sign of t2. This property is in a flood zone. Attached is a packet to review, we need the cost worksheet filled out along with the contractor and owners affidavits notarized and returned. The final affidavit will be required at the time of final inspection. Please submit these items for review This email is considered a written denial of your permit application per Section 105.3.1 of the Massachusetts State Building Code. Section 105.3.2 states in part that "an application fora permit for any proposed work shall be deemed to have been abandoned 180 days after the date of filing, unless such application has been pursued in good faith" You may appeal this denial to the Building Code Appeals Board in accordance with M.G.L. c. 143 §100, within 45 days of this notice. Timothy Sears CBO Deputy Building Commissioner Town of Yarmouth 508-398-2231 Ext. 1259 mailto:tsearsjyarmouth.ma.us https://outlook.office.com/mail/sentitems/id/AAQkADE3MDQ5NWZmLTkOYzItNDIwNi1 iMDQxLWNkMGQyNmE4NzE5NAAQAA2%2BrrPfwl xLq%2FFF... 1/1 TOW1N-4IVAOMOUTH A 1146 Route 28,MO,S ,,,aterrtouth, MA 02664 508-398-223P:et 16 ar,508-398 0836 Office of the,\Buikiti '124Anmissioner t • FINAL COST AFFIDVIT FOR WORK IN FEMA FLOOD ZONE To the Building Commissioner, In accordance with 780 CMR Section 109 of the Massachusetts State Building Code, the t0t91 estimated cost of construction, including all related costs* of the building at 50 Triwe-71-7/7 /1 • Xf47,4‘74/74:4f4' - and constructed, reconstructed, altered, repaired, or extended under building permit no." amounts to $ I, di/74446- ,being referred to as the owner/agent identified below,do solemnly swear that the statements made herein are strictly true, correct and made in good faith *Related construction costs include all work done with or concurrently with the work contemplated by the building permit including construction, reconstruction, repairs, demolition, HVAC work, etc. Furnishings and portable equipment are not part of the total construction costs. .0Wg' Signat9re of owner/agent M arch 1 ?`*, 2.6 2-cf Notary Public Signature My Commission Expires Notary Seal: HEATHER LORENTSEN Ari Notary PLblic C ommonweaith of Massachusetts My Commission Expires March 8,2a4 of rYgR TOWN OF YARMOUTH , HEALTH DEPARTMENT MAY, 9?a PERMIT APPLICATION SIGN OFF TRANSMITTA H• L1 H DEP7 To be completed by Applicant: 1;79'/(<4.t f /� /��Buildin Site Location: L� G r4ei' ///A ae !e.7 /01 g Proposed Improvement: ,-�/�? %��zr ,�r'ts�' -r �!p :.---- , " ,e .N.�k7 Applicant: f�' r� �l r L . �U,;dL /U (�%4'NS�Tel. No.�J� 11�` �J�.e�e� PP z Address: t �,1,''� t� r .z• ,,'-✓� r/� / e2gMDate Filed: i94- / 2 **If you would like e-mail notification of sign off please provide e-mail address:f.1/ ,t/ Zlei .6 yi,o2 Owner Name: ,fG7 /j i97t4'-d;' Owner Address: F cc;/ 8 5f ,q,v1gic t] gi i gig Owner Tel. No( 4',('))3. -0(4' O%/30 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, APR 2 4 2023 . and septic system location; plan HEALTH DEPT. (2.) Floor labeling ALL rooms within building (all existing and proposed) — Note:Floor plans not required for decks, sheds, windows, roofing; (3.) If necessary, Title 5 application signed by licensed installer with fee. 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