HomeMy WebLinkAboutBLD-23-005228 t
r i
ONE & TWO FAMILY ONLY- BUILDING PERMIT
Town of Yarmouth Building Department
1146 Route 28, South Yarmouth,MA 02664-4492
)--..\
508-398-2231 ext. 1261 Fax 508-398-0836ilit
Massachusetts State Building Code, 780 CMR
o.m,0 {i
Building Permit Applicatio?h ,construct, Repair, Renovate Or Demolish --:::__ iii':..'�
a One- o-Family Dwelling
3LDR 23*I(
This Section For Official Use Only
Building Permit Number: 6(� 3—Dv g Date Applied: RECEIVE D
MAR 212028
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION BUILDING DEPART VIENT
i1.1 Pro er Address: By:
p �' 1.2 Assessors Map&Parcel Numbe
1.1 a Is this an acdepted 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 Yar1 RECEIVED
Required Provided Required Provided Required P.ovided
J U N 05 2023
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal*te, _.______
Zone: Outside Flood Zone? BUILDING D,-P -TMENT
Public Private
Check if yes❑ Municipal 0 On site disposysystem r_
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
vAtkna, 1, yvrra4t_ k.rt A NA 'NA . °z&13
Name(Print) City,State,ZIP
1 Cl6 -7c Cay .1!k ) b V 151 2 V/ Tory\dims 2 0tire,kite
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check.all that apply)
New Construction I / Existing Building Owner-Occupied V Repairs(s) 21 Alteration(s) 0 Addition 0
Demolition GY Accessory Bldg. 0 Number of Units 1 Other ❑ Specify:
Brief Description of Pro osed Work'': iNJLV" Fai 'f'4 l?k&I 1i .01, J
fs 1"i•b (t~ luit �,n 1Y QP�.I�t, m ''j) -g2t S2''W Iv►�k0c),I 6' ( / , u-i �zi)
a rv, rt 5' -5 S' V. h titer Sh;}�r I�S I J()� -S 1N1
u, f �•v1,ss 2.5 6
SECTION 4: ESTIMATED CONSTRUCTION COSTS ba 0 1 St_
Item Estimated Costs: Use Official U Onlyr
(Labor and Materials) e) lea-bl n /O
1. Building $ 1. Building Permit Fee:$ 5-4 Indicate how fee is determined:
1 Standard City/Town
2.Electrical $ Application Fee �� �
0 Total Project Cost3(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $ CDIn
4.Mechanical (HVAC) $ List: 3 5,t
5.Mechanical (Fire
Suppression) $ Total All Fees:$
wiv
Check No. Check Amount: Cash t: L\ VIA
6.Total Project Cost: $ ❑paid in FulltA Outstanding Balance D 7,
CO
el if s k't IP 6 r Obile.._ tiL verizon . ne i-
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
City/Town,State,ZIP R Restricted 1&2 Family Dwelling
M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone
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 0 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: 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 this application is true and accurate to the best of my knowledge and understanding.
Vrh a. L f ra��� 3 'Print Owner's or Authorized gent'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.eov/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.) g '
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
i ir Department of Industrial Accidents
1 Congress Street, Suite 100
Boston, MA 02114-2017
..i www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information
Please Print Legibly
ame (Business/Organization/Individual): P p a a L �ifl� I'1I
Address: 1 ?e p
L.
City/State/Zip: \j t�'j-- y 4 Phone #: a
Are you an employer?Check the appropriate box:
Type of project(required):
1._ I am a employer with employees(full and/or part-time).*
E
2. I am a sole proprietor or partnership and have no employees working for me in 7. New constdelinrUCtiOn
any capacity.[No workers'comp. insurance required.] 8. [ Remodeling
3. m a homeowner doing all work myself. [No workers'comp. insurance required.]t my property. I will
9. [ Demolition
4. I am [
a homeowner and will be hiring contractors to conduct all work on10 Building addition
ensure that all contractors either have workers'compensation insurance or are sole
11. Electrical repairs or additions
proprietors with no employees.
5.0I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 12.0Plumbing repairs or additions
These sub-contractors have employees and have workers'comp. insurance.t 1 3.[Roof repairs
6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[Other
1 152,§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:
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 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 ce
rtify under the pains and penalties of perjury that the information provided above is true and correct.
/Sinature: tQ . Date: �'17.2 1to....3
Phone#: 77(4— tZ 9i a j
Official use only. Do not write in this area, to be completed by city or town official.
City or Town: Permit/License r
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#:
4 TOWN OFYARMOUTH
1 MATTAG[ BUILDING DEPARTMENT
+E 'o 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1261
HOMEOWNER LICENSE EXEMPTION
PLEASE PRII','T:
DATE:
JOB LOCATION: \ b( S L J(* W-ViM
NAME STREET ADDRESSECTIOl4OF TOWN
::HOMEOWNER" &A, 4,4Th kit Coca, t16--1— 3)'
NAME HOME PHONE WORK PHONE
PRESENT MAILING ADDRESS / (d Uriy
e5� ar v 44 6 2 C/.3
CITY OROWN 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 foi iii acceptable to the building official, that he/she shall be responsible for all
such work perfoiuied 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 / she will comply with said procedures and
requirements.
HOMEOWNER"S SIGNATURE 4/,64bet,
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
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 1/
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 1 L) L 4ti W L `i ?into �, 6
V�
Work Address
Is to be disposed of at the following location: e Z�(� �J CA
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
Qm.47/0:1°4-eA/E. -3li (
Signature of Applicant Date
Permit No.
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is defined as"an individual,partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally, MGL chapter 152, §25C(7) states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and. if
necessary, supply sub-contractor(s)name(s), address(es) and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy, please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition; an applicant
that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current
policy information (if necessary) and under"Job Site Address"the applicant should write "all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston, MA 02114-2017
Tel. 4 617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax # 617-727-7749
Revised 02-23-15 www.mass.gov/dia
156 Berry
Sears, Tim <tSears@VOrnl0Uth.rD8.Us>
Fri 5/19/2U2} 9:27AM
To:e|isatobin@gnnaiicorn <e|isatubin@gnnaiiconn>
D l attachments(391K8)
work in flood zone packet.PDF;
' | have reviewed the updated information that was submitted and there are some items needed.
' Attached is a packet to review, we need the cost vvorksheetfilled 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
Timothy Sears CBO
Deputy Building Commissioner
Town ofYarmouth
5O8'398'ZZ3l Ext. 1259
noai|to:tsears@yarmouth.nna.us
3/27/23,3:30 PM Mail-Sears,Tim-Outlook
156 Berry Ave
Sears, Tim <tsears@yarmouth.ma.us>
Mon 3/27/2023 3:30 PM
To:tonywms2@verizon.net <tonywms2@verizon.net>
1 attachments(391 KB)
work in flood zone packet.PDF;
I have reviewed your application and there are some items needed.
`VYour address is listed as Holliston. You do not qualify as a homeowner under the building code
and will need a licensed contractor to apply for the permit
Section 110.R5 Definitions. Homeowner. Person(s) who owns a parcel of land on with he or she resides
or intends to reside, on which there is, or is intended to be, a one-or-two family dwelling, attached or
detached structures accessory 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
2. 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. 7 cCryiACet '"
la/Framing plans showing compliance with the 9th Edition of the Massachusetts State Building Code
. Insulation shown on plans to comply with 2021 IECC or Rescheck
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 for a 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 5/9- To 7'F6
508-398-2231 Ext. 1259
mailto:tsearsCWyarmouth.ma.us
https://outlook.office.com/mail/sentitems/id/AAQkADE3MDQ5NWZmLTkOYzItNDIwNi1 iMDQxLWNkMGQyNmE4NzE5NAAQAEKFVuuiYS1 Pjk1 W5v5ts... 1/2
• /,a pgop / &xtorior Fully Insured
: �,. HIC license
• Gi0/,�%7 etrial %� glikel G #133156
• Pat 1 / ea/be/thy www.proudpainters.com
` (� Car,beitterS Phone: 1 (508) 362 - 0100
Ser vinf Cabe Cod srace/999
Name Anna Ferrante Phone (508)498-0271
Address 156 Berry Ave Phone 2
Town West Yarmouth Email Elisatobin796@gmail.com
State MA Email 2
Zip Code 02673
Description Of Work Itemised List Amours
Painting / Carpentry . Deck remove $1,500.00
1 . Tear down roof deck place in dumpster on site. $1,500.00 . Dining remove $5,000.00
2 . Tear down dining room walls to the foundation. Place in onsite dumpster$5,000.00 . Frame dining $10,000.00
3 . Frame the dining room back to the same original size and dimensions.$10,000.00 New roof $18,000.00
4. New Asphalt shingles on home and garage. Certainteed AR shingles(Customer Color)$18,000.00
5 . Rubber roof the Dining room Portion of home. $5,000.00 Rubber roof $4,800.00
6 . White Cedar shingle siding of home new dining room plus the right side of home and also front- . Cedar siding $13,500.00
7 . -of home$12,000.00 . Deck $14,500.00
8 . Build deck on top of rubber roof same as prior size and shape using Mahogany wood with custom- . Electrician $5,000.00
9 . -mounting system (my invention you have ok)so no water runs below decking. $15,000.00
10 . Electrician will place 7 outlets in room with 4 ceiling lights and a center chandelier. Also a light Spray foam $3,500.00
11 . -on top roof deck along with an exterior outlet.$5,000.00
12 . Spray foam insulation in dining room area. $3,500.00
13 . Total $75,800.00
14. Payment Terms
15 .
161 4070 When We Start. 30320.00
17. 0% - $0.00
18 .
19. 60% When We Finish. $45,480.00
?0.
?1 Total $75,800.00
Labor Firs Rate Amoun
?3 . $0.00
t4.
$0.00
$0.00
U.S. DEPARTMENT OF HOMELAND SECURITY OMB No.1660-0008
Federal Emergency Management Agency Expiration Date:November 30,2022
National Flood Insurance Program
ELEVATION CERTIFICATE
Important: Follow the instructions on pages 1-9.
Copy all pages of this Elevation Certificate and all attachments for(1)community official,(2)insurance agent/company,and(3)building owner.
SECTION A—PROPERTY INFORMATION FOR INSURANCE COMPANY USE
Al. Building Owner's Name Policy Number:
ANNA L.FERRANTE
A2. Building Street Address(including Apt., Unit,Suite,andi'or Bldg. No.)or P.O. Route and Company NAIC Number.
Box No.
156 BERRY AVE
City State ZIP Code
WEST YARMOUTH Massachusetts 02673
A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
ASSESSORS MAP ID 221261
A4. Building Use(e.g., Residential, Non-Residential,Addition,Accessory, etc.) RESIDENTIAL
A5. Latitude/Longitude: Lat.41°38'34.17546"N Long.70°14'47.48719"W Horizontal Datum: ❑ NAD 1927 ❑x NAD 1983
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
A7. Building Diagram Number 2A
A8. For a building with a crawlspace or enclosure(s):
a) Square footage of crawlspace or enclosure(s) 1201,00 sq ft
b) Number of permanent flood openings in the crawlspam or enclosure(s)within 1.0 foot above adjacent grade 0
c) Total net area of flood openings in A8.b sq in
d) Engineered flood openings? ❑Yes No
A9. For a building with an attached garage:
a) Square footage of attached garage sq ft
b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade
c) Total net area of flood openings in A9.b sq in
d) Engineered flood openings? ❑Yes ❑ No
SECTION B—FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP Community Name&Community Number B2.County Name B3. State
TOWN OF YARMOUTH 250015 BARNSTABLE Massachusetts
B4. Map/Panel B5. Suffix B6. FIRM Index B7.FIRM Panel B8.Flood B9.Base Flood Elevation(s)
Number Date Effective/ Zone(s) (Zone AO,use Base Flood Depth)
Revised Date
25001C0588 J 07-16-2014 07-07-2021 AE 11
B10, Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9:
❑FlS Profile ❑x FIRM ❑ Community Determined ❑ Other/Source:
B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 0 NAVD 1988 ❑ Other/Source:
B12. is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes ❑x No
Designation Date: D CBRS OPA
FEMA Form 086-0-33(12/19) Replaces all previous editior(S. MAY 1 1 2023 Form Page 1 of 6
Gxi ul DING DEPARTMENT I
OMB No. 1660-0008
ELEVATION CERTIFICATE Expiration Date:November 30,2022
IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE
Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Policy Number:
156 BERRY AVE
City State ZIP Code Company NAIC Number
WEST YARMOUTH Massachusetts 02673
SECTION C—BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* Q Finished Construction
"A new Elevation Certificate will be required when construction of the building is complete.
C2. Elevations—Zones A1—A30,AE,AH,A(with BFE),VE,V1—V30,V(with BFE),AR,AR/A,AR/AE,AR/A1—A30,AR/AH,AR/AO.
Complete Items C2.a—h below according to the building diagram specified in Item A7. In Puerto Rico only,enter meters.
Benchmark Utilized: GPS Vertical Datum: NAVD1988
Indicate elevation datum used for the elevations in items a)through h)below.
❑ NGVD 1929 0 NAVD 1988 ❑Other/Source:
Datum used for building elevations must be the same as that used for the BFE.
Check the measurement used.
a) Top of bottom floor(including basement,crawlspace or enclosure floor) 5.4 x❑ feet [] meters
b) Top of the next higher floor 11.6 ❑x feet ❑ meters
c) Bottom of the lowest horizontal structural member(V Zones only) ❑ feet ❑meters
d) Attached garage(top of slab) ❑ feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building feet 4.5 x meters
(Describe type of equipment and location in Comments) ❑
f) Lowest adjacent(finished)grade next to building(LAG) 8.2 x❑ feet ❑ meters
g) Highest adjacent(finished)grade next to building (HAG) 8.9 x❑ feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs,including x feet meters
structural support 8.2 ❑
SECTION D—SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation information.
I certify that the information on this Certificate represents my best efforts to interpret the data available.I understand that any false
statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
Were latitude and longitude in Section A provided by a licensed land surveyor? ❑Yes ❑x No 0 Check here if attachments.
Certifier's Name License Number
GARY S. LABRIE 40039
Title LANDj�'piSH oF�RS
REGISTERED SURVEYOR 02� A 9cy n
Company Name g AR 8h!E
WARWICK&ASSOCIATES, INC.
U o,'w,. to
Addressq�,, a y
BOX 801 \ir4 0
City State ZIP Code At NANO
NORTH FALMOUTH Massachusetts 02556
Signature St* Date Telephone Ext.
G�/ SA/0i (508)563-7777
Copy all pages of this Elevation Certificate and all attachments for(1)community official,(2)insurance agent/company, and(3)building owner.
Comments(including type of equipment and location, per C2(e), if applicable)
C2 a.CRAWLSPACE HAS DUG OUT UNEVEN DIRT FLOOR. LOWEST AREA OF FLOOR IS AT ELEV.5.4 FT NAVD 1988
C2 b.TOP OF NEXT HIGHER FLOOR IS FINISHED FLOOR OF ENCLOSED PORCH ELEV. 11.6 FT NAVD 1988
C2 e. LOWEST MACHINERY IS HOT WATER HEATER LOCATED IN CRAWLSPACE ELEV. 5.4 FT NAVD 1988
FEMA Form 086-0-33(12/19) Replaces all previous editions. Form Page 2 of 6
OMB No. 1660-0008
ELEVATION CERTIFICATE Expiration Date:November 30,2022
IMPORTANT:In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE
Building Street Address(including Apt.,Unit,Suite,and/or Bldg. No.)or P.O. Route and Box No. Policy Number:
156 BERRY AVE
City State ZIP Code Company NAIC Number
WEST YARMOUTH Massachusetts 02673
SECTION E—BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)
FOR ZONE AO AND ZONE A(WITHOUT BEE)
For Zones AO and A(without BFE),complete Items El—E5. 11 the Certificate is intended to support a LOMA or LOMR-F request,
complete Sections A,Band C. For Items El—E4, use natural grade,if available.Check the measurement used. In Puerto Rico only,
enter meters.
El. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below
the highest adjacent grade(HAG)and the lowest adjacent grade(LAG).
a) Top of bottom floor(including basement,
crawlspace,or enclosure) is
❑feet ❑meters ❑above or ❑below the HAG.
b) Top of bottom floor(including basement,
crawlspace, or enclosure) is ❑feet ❑meters ❑above or ❑below the LAG.
E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9(see pages 1-2 of Instructions),
the next higher floor(elevation C2.b in
the diagrams)of the building is ❑feet ❑meters ❑above or ❑below the HAG.
E3. Attached garage(top of slab) is feet❑ ❑meters ❑above or ❑below the HAG.
E4. Top of platform of machinery and/or equipment
servicing the building is 0 feet ❑meters ❑above or ❑below the HAG.
E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's
floodplain management ordinance? ❑ Yes ❑ No I: Unknown. The local official must certify this information in Section G.
SECTION F—PROPERTY OWNER(CR OWNER'S REPRESENTATIVE)CERTIFICATION
The property owner or owner's authorized representative who completes Sections A, B,and E for Zone A(without a FEMA-issued or
community-issued BFE)or Zone AO must sign here.The statements in Sections A, B,and E are correct to the best of my knowledge.
Property Owner or Owner's Authorized Representative's Name
Address City State ZIP Code
Signature Date Telephone
Comments
❑Check here if attachments.
FEMA Form 086-0-33(12/19) Replaces all previous editions. Form Page 3 of 6
OMB No. 1660-0008
ELEVATION CERTIFICATE Expiration Date:November 30, 2022
IMPORTANT: In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE
Building Street Address(including Apt.,Unit,Suite, and/or Bldg.No.)or P.O.Route and Box No. Policy Number
156 BERRY AVE
City State ZIP Code Company NAIC Number
WEST YARMOUTH Massachusetts 02673
SECTION G—COMMUNITY INFORMATION(OPTIONAL)
The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete
Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s)and sign below.Check the measurement
used in Items G8—G10. In Puerto Rico only,enter meters.
G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor,
engineer,or architect who is authorized by law to certify elevation information.(Indicate the source and date of the elevation
data in the Comments area below.)
G2 0 A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)
or Zone AO.
G3. 0 The following information(Items G4—G10)is provided for community floodplain management purposes.
G4. Permit Number G5. Date Permit Issued G6. Date Certificate of
Compliance/Occupancy Issued
G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement
G8. Elevation of as-built lowest floor(including basement)
of the building: ❑feet ❑ meters Datum
G9. BFE or(in Zone AO)depth of flooding at the building site: ❑feet ❑ meters Datum
G10. Community's design flood elevation: ❑feet ❑ meters Datum
Local Official's Name Title
Community Name Telephone
Signature Date
Comments (including type of equipment and location,per C2(e), if applicable)
❑ Check here if attachments.
FEMA Form 086-0-33(12/19) Replaces all previous editions. Form Page 4 of 6
BUILDING PHOTOGRAPHS OMB No. 1660-0008
ELEVATION CERTIFICATE See Instructions for Item A6. Expiration Date' November 30,2022
IMPORTANT: In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE
Building Street Address(including Apt.,Unit,Suite, and/or Bldg. No.)or P.O.Route and Box No. Policy Number:
156 BERRY AVE
City State ZIP Code Company NAIC Number
WEST YARMOUTH Massachusetts 02673
If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the
instructions for Item A6. Identify all photographs with date taken; "Front View"and"Rear View";and, if required, "Right Side View"and
"Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or
vents,as indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page.
0 ,°
3 3 "%-...--1-1'' .,-4 ,- ttv -
', , . , , , . ii% -',0144 i i= , ,
s it 01. ..,
14
t sr_ -, ,, .. m ..r ' ,...... 'K.
... 4 .4r:74,7-„ :.,,,,i.... .....4
Photo One
Photo One Caption 156 BERRY AVE WEST YARMOUTH,MA FRONT VIEW MAY 4,2023 Clear Photo One
t
+.yj, _ ._. ...
c.�
it I
_woo— It --1
I1!.!Fih
t ..
-. 2 III air..
J r.... .x�,..
'
err
tk
Photo Two
Photo Two Caption 156 BERRY AVE WEST YARMOUTH,MA REAR VIEW MAY 4,2023 Clear Photo Two
FEMA Form 086-0-33(12/19) Replaces all previous editions. Form Page 5 of 6
BUILDING PHOTOGRAPHS OMB No. 1660-0008
ELEVATION CERTIFICATE Continuation Page Expiration Date: November 30,2022
IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE
Building Street Address(including Apt., Unit, Suite,and/or Bldg. No.)or P.O. Route and Box No. Policy Number:
156 BERRY AVE
City State ZIP Code Company NAIC Number
WEST YARMOUTH Massachusetts 02673
If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs
with: date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." When applicable,
photographs must show the foundation with representative examples of the flood openings or vents,as indicated in Section A8.
Photo Three
Photo Three
Photo Three Caption Clear Photo Three
Photo Four
Photo Four
Photo Four Caption Clear Photo Four
FEMA Form 086-0-33(12/19) Replaces all previous editions. Form Page 6 of 6
RECEIVE ®
MAY 25 2023
PARTMENT
Substantial Improvement Worksheet for Floodplain Construction -
(for reconstruction, rehabilitation,addition, or other improvements, and repair of damage from any cause)
Property Owner: u o 1 S P, ;p_12.PA NTH
Address: )S;'o 13eirzA y pc Q-oO 0-n4 oz.(o 9-3
Permit No.:
Location: 5 p„ g
Description of improvements: 9_06 FS Dt �GI�S, S t P r G , - INS!►S4.„-4,j(11.
Present Market Value of structure ONLY{market.appraisal or adjusted
assessed valuue,BEFORE:improvement,or f darriaged,
before the arnage'occurred) notincludmg'landvalue $ a 700
Cest of Improvement
Actual cost.of the ConstniCtion""'`(see items to indludetexclude) J $ 7S 4 a
'`'Include Volur>teer•faborarid donated su lies"
Ratio iCoost of Improvement(or Cost to:Repair) ii
IVlarket Value tX30'! I 2 d 1 0/
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
improvement 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:
Date:
Costs for Substantial Improvements and Repair of Substantial Damage
Included Costs
Items that must be included in the costs of improvement or costs to repair are those that are
directly associated with the building. The following list of costs that must be included is not in-
tended to be exhaustive, but characterizes the types of costs that must be included:
I Materials and labor, including the estimated ■ Structural elements and exterior finishes
value of donated or discounted materials (cont.):
and owner or volunteered labor Windows and exterior doors
I Site preparation related to the improvement
or repair (fot:uidation excavation,filling in M Roofing, gutters, and downspouts
basements) MI Hardware
! Demolition and construction debris disposal
Attached decks and porches
! Labor and other costs associated with
III Interior finish elements, including:
demolishing, moving, or altering
building components to accommodate M Floor finishes (e.g., hardwood, ce-
improvements, additions, and making ramie,vinyl,linoleum,stone, and
repairs wall-to-wall carpet over subflooring)
! Costs associated with complying with any MI Bathroom tiling and fixtures
other regulation or code requirement that
is triggered by the work,including costs • Wall finishes (e.g., drywall, paint, stuc
to comply with the requirements of the co, plaster, paneling, and marble)
Americans with Disabilities Act (ADA) Built-in cabinets (e.g.,kitchen,utility,
! Costs associated with elevating a structure to entertainment, storage, and bathroom)
an elevation that is lower than the BFE
Interior doors
• Construction management and supervision
■ Contractor's overhead and profit
• Interior finish carpentry
• Sales taxes on materials • Built-in bookcases and furniture
■ Structural elements and exterior finishes, M Hardware
including:
k Insulation
Foundations (e.g., spread or continu-
ous foundation footinperimeter walls; ! utility and service equipment, including:
, P
chainwalls, pilings, columns, posts, etc.) `Z HVAC equipment
M. Monolithic or other types of concrete MI Plumbing fixtures and piping
slabs
Electrical wiring, outlets, and switches
HI Bearing walls, tie beams, trusses
Light fixtures and ceiling fans
Joists, beams, subflooring, framing,
ceilings M Security systems
Interior non bearing walls MI M Built-in appliances
Exterior finishes (e.g.,brick, stucco, sid- Central vacuum systems
ing, painting, and trim) Mi Water filtration, conditioning, and re-
circulation systems
4 of 7 SAMPLE NOTICE FOR PROPERTY OWNERS, CONTRACTORS, AND DESIGN PROFESSIONALS
Excluded Costs
Items that can be excluded are those that are not directly associated with the building. The fol-
lowing list characterizes the types of costs that may be excluded:
I Clean-up and trash removal I Outside improvements,including
landscaping, irrigation. sidewalks, driveways,
I Costs to temporarily stabilize a building so fences,yard lights, swimming pools,
that it is safe to enter to evaluate required pool enclosures, and detached accessory
repairs structures (e.g., garages, sheds. and gazebos)
I Costs to obtain or prepare plans and ■ Costs required for the minimum necessary
specifications work to correct existing violations of health,
I Land survey costs safety, and sanitary codes
I Permit fees and inspection fees ■ Plug-in appliances such as washing
■ Carpeting and recarpeting installed over machines. dryers, and stoves
finished flooring such as wood or tiling
SAMPLE NOTICE FOR PROPERTY OWNERS, CONTRACTORS, AND DESIGN PROFESSIONALS 5 of 7
s
c,0-0 -- _ TOWN OF YARMOUT.H
Mtit
. BL ILDING DEP'O lT.' �� AR'I'1�ZENT
"�, nikt.__:...e 1146 Route 28, South Yarmouth, MA 02664
4�= � Telephone 508-398-2231 ext. 1261 Fax 508-398-0836
Owner's Affidavit: Substantial Improvement or Repair of Substantial Damage
Property Address: /SC Berry Ave..) W j- XQ -m 0 w
Parcel ID Number: � "
Owner's Name: Ala 1'1Or I _ 5_rr ctire,
Owner's Address/Phone: -7 7 4 - L.I 'Z- ,- -(_ 1
Contractor: pro rte.? Po f ht2.r s
Contractor's License Number:
Date of contractor's Estimate: lift r ch 2 d . 2 Q 23
I hereby attest that the description included in the permit application for work on the existing building all
improvements, rehabilitation, remodeling, repars, 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 issuance of a permit.
Owner's Signature: apt„fteL 31,1-A4_
6C+�K t.
Date: ,'/a,S / 3
Notarized: COMM. OF MASSACHUSETTS
S � GARY JUNIOR SIMPSON
COUNTY OF BARNS7ABLE / Notary Public
Massachusetts
Subscribed and sworn to before me , , My Commission Expires
ats5.yG . ', , Massachusetts � Aug i i, 2028
L+�7" .
,_ 9r_' .a_.. Pr A Zia i, 'In