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HomeMy WebLinkAboutBLDR-23-11046 ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department RECEIVED 1146 Route 28, South Yarmouth,MA 02664-4492 `,I 508-398-2231 ext. 1261 Fax 508-398-0836 Massachusetts State Building Code,780 CMR = e„,te MAY 31 101,azti1 ing Permit Application To Construct, Repair, Renovate Or Demolish _j a One-or Two-Family Dwelling BUILDING DEPARTMENT -- This For Official Use Only !. Building Permit Number: f)n Z1— 117 4 (o Date Applied: Building Official(Print Name) attire Date SECTION 1:SITE INFORMATION • 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 693 Otetri lest. 033.3Lig! . c 3o 5S 1.1 a Is this an ace led 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 ( 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: PubIicPc Private Zone: (( Outside Flood Zone? Municipal 0 On site disposal system Check if yes0- SECTION 2: PROPERTY O WNERSFIIP' 2.1 Owner'of Record: "T AO y„t k,,,,-, S. 'f acr^-N (OM- Name(Print) l City,State,ZIP ( 3 oVtdn` N..4 . 6(7—??8 - roil 01p ►A4 (Pt 0yaGtoo. row No.and Street Telephone t Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK(check all that apply) New Construction 0 f Existing Building g Owner-Occupied 1 Repairs(s) 0 Alteration(s)AEU Addition Demolition © 1 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work': '6 f<ty(A dti'i'z, Lail 1 10a"(Gr-1,0,4.1 L %ieAA. 1 6-euktit r o'i— ' ft SECTION 4:ESTIMATED CONSTRUCTION COSTS. id' \ 11 tO Estimated Costs: Item (Labor and Materials) Official Use Only I.Building $ r 1. Building Permit Fee:S Indicate how fee is le ttitt ��'µ,- �--- rj / -- �-Standard City/Town Application Fee 1...--' 2.Electrical $ j Op fl 0 Total Project Cost (Item 6)x multiplier x 3.Plumbing $ ?ie00 `' 2. Other Fees: $ 4.Mechanical (HVAC) $ Cf 5-bob List: 5.Mechanical (Fire $ 4)/04, Total All Fees:$ . Suppression) _ Check No. Check Amount: Cash Amount:_ 6.Total Project Cost: $ Q7 j 0 Paid in Full Outstanding Balance Due: I( ,, SECTION 5: CONSTRUCTION SERVICES 5.1Cons�trurcction Supervisor License(CSL) , Cs,-08 iOH D _ � Rt 71Th c Wd cool License Number Exp lion Date Name of CSL Holder P. O X 3 y List CSL Type(see below) U No.and Street Type Description yGt t'vhQA Par tM�9 0007� U Unrestricted(Buildings up to 35,000 Cu.ft.) City/Town,State,ZIP R Restricted 1�4c2 Family Dwelling M Masonry RC ( Roofing Covering WS Window and Siding _ SF Solid Fuel Burning Appliances 174-35-T-03 sa Pa- ac. 9S ?ft@ k(aloe. co,n1 I Insulation Telephone Email address D Demolition . 5.2 Registered Home Improvement Contractor(HIC) Pa�ri L.{[,_(acobs (4,513,80 E(t/tq?oat( HIC Registration Number piratton Date RTC Company Name or HIC Registrant Name P.o. t3ox 3L(Y ett awys 78 0 yak oo. co►t.A No.and StreetEmail address 'la rwt0U V)or-'-i (MA oat"7 c 771-35-7- ,6Ca 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 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 to work authorized by this 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 in ' app• ati 's true and accurate to the best of my knowledge and understanding. 4fnzk.74 cobs `f zo23 Print Owner's or Au orized Agent's Name(Electronic Signature) ate 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 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 Comnzonwealth of Massachusetts Department of Industrial Accidents I 1 Congress Street,Suite 100 .1 Boston,MA 02114-2017 • www.mass.gov/dia r YWorkers' Compensation Insurance Affidavit: Builders/Contractors/ElectriciansfPlumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): Po* - c Address: P.0. (3 oK 3 t N City/State/Zip: Yiut-ttwt t(n 1'orr IAA 14 on.. ,7S" Phone#: -3S"3. S S� Are you an employer?Check the appropriate box: Type of project(required): i.E I am a employer with employees(full and/or part-time).' 7. 0 New construction 20 am a sole proprietor or partnership and have no employees working for me in • any capacity.[No workers'comp. insurance required.] $• 'Remodeling 3.0 I am a homeowner doing all work myself.(No workers'comp.insurance required.)t 9. ❑Demolition 4.0I am a homeowner and will be hiring contractors to conduct all work on my property. I will 1 b ❑ Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.0 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.t 13• Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per iMGL c. 14.Q Other 152,§I(4),and we have no employees.[No workers'comp.insurance required.] 'Any applicant that checks box RI 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:tame 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: 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 policy number and expiration date). Failure to secure coverage as required under N/IGL 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 u r th air and penalties of perjury that the information provided above is true and correct. Signature: ` Date: L/ z0/ZOZ3 Phone#: 77q(-3 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#: §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 (P 3 (6 C Wor ddress 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. -001-3 Signature of pplication D to Permit No. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE 1n6ividuai Registration Expiration 165888 05/14/2024 PATRICK JACOBS DB/A P.JACOBS CUSTOM CARPENTRY AND REMODELING PATRICK JACOBS 7 28 WHITTER DR. iY °s • DENNIS,MA 02638 Undersecretary Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Re ulations and Standards Const�onrS visor CS-081040 . E tcpires:04/04/2024 PATRICK H JACOBS 28 WHITT1ERIbR1VE DENNIS MA b 638 .. ,,, mar Commissioner ` _d2_ A. l two Of xq TOWN OF YARMOUTH Jatg. HEALTH DEPARTMENT cr.,:'" s� ;Ali. Y y't.z.ty �'ow '' PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: `� Building Site Location: r�0 3 of n /� a S. `km. ov le Buil g �r Proposed Improvement: f, S(n Ail Z, se a ce_ w`t beCitAro 0 yvk 1 f-r t v''A ( Gnok `cram.. Applicant: P0A-6 Zit_-3-at.c-0 ,os Tel. No.: 7114'353-108s -- Address: P O. 6 0 K 3 t'-( Yarwt.o4 1 t MA- Oexo?S.- Date Filed: `./7.o l zo2-3 **If you would like e-mail notification of sign off,please provide e-mail address: Owner Name: Saws M.0 yr Owner Address: (D 3 a c.rt°G� , S. n“.,e7 Ci. Owner Tel. No.: (o17- 908 - Snq I U 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, ii ,;:sn/ and septic system location; (2.) Floor plan labeling ALL rooms within building APR 2 0 2023 (all existing and proposed) - HEALTH KEPT Note:Floor plans not required for decks,sheds,windows,roofing; (3.) If necessary, Title 5 application signed by licensed installer with fee. REVIEWED BY: ,,,,,,.9 .1L- DATE: E. " /;' -3 PLEASE NOTE COMMENTS/CONDITIONS: Substantial Improvement Worksheet for Floodplain Construction (for reconstruction, rehabilitation,addition,or other improvements, and repair of damage from any cause) Property Owner: 3QG� Address: fo3 E(4 - c&q..(4. $`,o v-En Yu rw4 Permit No.: 0 Location: Description of improvements: �}tiSh -La in ;Ar,p,k t /.,i.,,,.. �a, fwt• eiE a NLY i ppru�l or d • sse v IBEFOI im vement, If y or . }. t .- . 'rCost • �/�{7 ('�y1� e F p Tat de C7r BEf 3a stipples"- r-3 i c mpro emer r 10 x Meet ti < If ratio is 50 percent or greater(Substantial Improvement),entire structure including the existing building must be elevated to the base flood elevation(BFE)and all other aspects brought into compliance. Important Notes: 1. Review cost estimates to ensure that all appropriate costs are included or excluded. . 2. If a residential pre-FIRM building is determined to be substantially improved,it must be elevated to or above the BFE. If a non-residential pre-FIRM building is substantially improved,it must be elevated or dry floodproofed to the BFE. 3. Proposals to repair damage from any cause must be analyzed using the formula shown above. 4. Any proposed improvements or repairs to a post-FIRM building must be evaluated to ensure that the improvements or repairs comply with floodplain management regulations and to ensure that the improvements or repairs do not alter any aspect of the building that would make it non-compliant. 5. Alterations to and repairs of designated historic structures may be granted a variance or be exempt under the substantial improverrient definition)provided the work will not preclude continued designation as a"historic structure." 6. Any costs associated with directly correcting health,sanitary,and safety code violations may be excluded from the cost of improvement. The violation must have been officially cited prior to submission of the permit application. Determination completed by: G c,aJ Date: c7/0 at2 . n �ay,� TOWN OF YARMOUTH }: _ ,o`� BUILDING DEPARTMENT (- `.A. y�MATTAC' •,�-_.,[[ .11.46 Route 28, South Yarmouth, MA 02664 ` .;_` -; Telephone 508-398-2231 ext. 1261 Fax 508-338-0836 Contractor's Affidavit: Substantial improvement or Repair of Substantial Damage Property Address: (O 3 E(d.n . ram. S . `/C t ovf Parcel ID Number: 3 oct (J Owner's Name: 3 cic._ vikor-,,,, Contractor: \Pov Z(e—Tci 0 b S. Contractor's License Number: CS— o$ l O'4 0 Date of Contractor's Estimate: 2ZO I Z:0o? I hereby attest that I have personally inspected the building located at the above-referenced address by the nature and extent of the work requested by the owner, including all improvements, rehabilitation, remodeling, repairs, additions, and any other form of improvement. At the request of the owner, I have prepared a cost estimate for all of the improvement work requested by the owner and the cost estimate includes, at a minimum, the cost elements identified by the Town of Yarmouth that are appropriate for the nature of the work. If the work is repair of damage, I have prepared a cost estimate to repair the building to its pre-damage condition. I acknowledge that if, during the course of construction, the owner requests more work or modification of the work described in the application,that a revised cost estimate must be provided to the Towi of Yarmouth, which 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 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 made or authorized repairs or improvements that if inspection of the property reveals that I have made or authorized repairs or improvements that were not included in the description of work and the cost estimate for that work that were s' for '"sua of a permit. Contractor's Signature - — Date: 9� / 3 Notarized: Vraii 1 VANESSA J KUM�' &�.. = Notary 6 tsuiri; }1ASUA a €�•�, ;: Gorntionwaattho`n w:iitrf, -4;-:w P9i C.aninis.?ion Exptie5 htem.t5.2n225 TOWN OF _MOUTH 1146Route 28 t a*oath MA. 02664 508-398-223t ex 4 � �ii08-398-083f Office of the iiil .t : issio er 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 total estimated cost of construction, including all related costs* of the building at (o 3 -(cQ,ct.'. and constructed,reconstructed, altered, repaired, or extended under buildin•permit no. amounts to $ 137, 800 I, PaA--NZ(C.--Tcc.,0 kc ,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, HVA work, etc. Furnishings and portable equipment are not part of the total construction costs. i Signature of er/agent aDCU IS raC)1_ Notary Public Sign e My Coftimission xpires Notary Seal: �4,tgf�� 9Av2SvA...i KJ S_I - My atinfTit2i0flepkes Aug.15,2025 � Y_ F R ��-.* TOWN OFYARIQUTH ° fti BUILDING DEPARTMENT Irr Ic . ,,, __ .�..•,� SEiYti,�1 1146 Route 28, South Yarmouth, '1� A 02664 �' J Telephone 508-398-2231 ext. 1261 Fax 508-398-0836 Owner's Affidavit: Substantial Improvement or Repair of Substantial Damage Property Address: (o 3 Odd ei Sov1 )'etr---frt aL Parcel ID Number: .305-3 Owner's Name: Jack_ M.pr k- (,,a,..,/, Owner's Address/Phone: (,3 (c›Lr i e)( �:C, S S. `�Cc, cs Contractor: ?&+- c.doc U Contractor's License Number: (4 CS - Ob/C -10 Date of contractor's Estimate: q/po /��2 ?� 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 work that were basis for issuanc a permit., b �;i tart'Public r '/4 - Commonwealth of Massachusetts ��r "'' My Commission Expires SEP 25.2026 Owner's Signature. V ( ` —�' Date: City/County of l` ,ec'z V, c Y(7--e s ZZ� Commonwealth of Massachusetts Subscribed and sworn o before me l this Notarized: _ day of z ,2,,e 2; by4 �)/7= 1_1"6 . -�ei4 mil,-y'� � Nota Public My c crmmission expires 9 i 2 �-2-Gt Z-Ga