Loading...
HomeMy WebLinkAboutBLD-23-000504 t ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth BuildingDepartment - of r' 1146 Route 28, South Yarmouth,MA 02664-4492i il' 508-398-2231 ext. 1261 Fax 508-398-0836 Massachusetts State Building Code, 780 CMR Building Permit Application To Construct, Repair, Renovate Or Demolish �� a One-or Two-FamilyDwelling "'/ This Section For Official Use Only Building Permit Number: OLD--).,3 5 Date APP lied: �� JUL 2 9 2022 I1 Sehcs 'ila- Building Official(Print Name) Signature tI_DING DEPARTMENT SECTION 1: SITE INFORiMATION 17.1.1 Pr erty, ddress: 1.2 Assessors Map&Parcel Numbers 1.1 a Is this an accepted street?yes X 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: Public❑ Private 0 Zone: Outside Flood Zone? Check if yes❑ Municipal 0 On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: !-.`ems N w-b o,apAe., 4r„-o olet- Pal- ,Mp. 0 -67S- ✓ Name(Print) Ci State,ZIP 9_41 P fs4.JF C.0,..4. Ctr-c-ti -237-17in AevN 1 zit(€.cc,..„ No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction❑ Existing Building 0 Owner-Occupied 0 Repairs(s) ❑ Alteration(s) 0 Addition ❑ Demolition 0 Accessory Bldg. ❑ Number of Units Other 0 Specify: Brief Description of Proposed Work2: -4 N ;cd— L P Oct F,L fr:.c«,„%., / Laie l to_a-_„`. Masi-r-a z SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: (Labor and Materials) Official Use Only 1. Building $ '73-. I. Building Permit Fee:$kO d Indicate how fee is determined: 2.Electrical $ Standard City/Town Application Fee ❑Total Project Costa Ite.i .)x multiplier x 3.Plumbing $ /,� 2. Other Fees: $ 35' e 4.Mechanical (HVAC) $ List: &tart) 5.Mechanical (Fire Suppression) $ Total All Fees:$ ✓ Check No. Check Amount: Cash ount: )� 6.Total Project Cost: $ p S , a '� : `64 ❑Paid in Full Outstanding Balance D f - SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) ` t ( +�s� 5e A .�4V'�.sLY'" License Number Namet.of CSL Molder Expiration Date 512 L,`_— ( L J List CSL Type(see below) No.and Street Type Description F. l J/ ;1-(fi' / I U Unrestricted(Buildings up to 35,000 cu. ft.) City/To ,State,ZIP R Restricted 1 Qu.2 Family Dwelling M Masonry RC Roofing Covering / WS Window and Siding SF Solid Fuel Burning Appliances Telephone �' I Insulation Em ' ress D Demolition 5.2 Registered Home Improve Contractor(HIC) t3 1l 5w clvy /J ,tt 45_y_— "L HI Registration Number Expiration Date HIC Company Name C Registrant Name No. t G p� /V le��fGVn tiail �Z�l lGp . �rnt"e,w S4v— MA• O '77K-35j_ ('3IY address . Town, State,ZIP Telephone n 6 Al®r69 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 1 this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes 0 No 0 SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN — OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT j I s Owner of the subject pre.- ereby authorize g ' _ .,,.,,yam A..; ,Ju- ! to act on my behalf . matters relative to wor. -. Iorized bythis permitN Cam_ building application. J Ae.,- •✓�. 19 Pr' Owner's Name(Electr. 'c Signature) �� Date SECTION 7b: OWNER1 OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. 1 7 N 7/2—s>/ate 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.eov/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.) Gross living (including garage,finished basement/attics,decks or porch) b area(sq.ft.) Habitable room count Number of fireplaces Number of bathrooms Number of bedrooms Number of half/baths Type of heating system Type of cooling system Number of decks/porches Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" i - ,�� The Commonwealth of Massachusetts '7� Department of Industrial Accidents 1 Congress Street, Suite 100 ctultirrBoston, MA 02114-2017 :'" . WWw.m ass gov/dia I Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. A !leant Information Name (Business/Organization/Individual): Please Print Leoibl Address: / C �/ c S q ✓ 11-�e___ City/State/Zip: Phone. g' - �--- �• � r• HA- C72c 7 5— #: Are you an employer?Check the appropriate box: I 1.� : a employer with Type of project(required): employees(full and/or part-time).* • 2.AjI am a sole proprietor or partnership and have no employees working for me in 7. ReW Jelin construction a, capacity.[No workers'comp. insurance required.] 8. Remodeling 9. CI Demolition 3.0 am a homeowner doing all work myself [No workers'comp. insurance required.]t 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 1 0 Building addition 11.] Electrical repairs or additions proprietors with no employees. 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 12. Plumbing repairs or additions These sub-contractors have employees and have workers'comp. insurance.t 13.El Roof repairs 6.n We are a corporation and its officers have exercised their right of exemption per MGL c. 152,§1(4),and we have no employees. [No workers'comp. insurance required.] 1 4' Other *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 1Contractors 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'com such. p.policy number. • I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and ' ' information. Job site Insurance Company Name: Policy or Self-ins.Lic.#: Expiration Date: Job Site Address: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under r1\�GL c. 152, §25A is a criminal vioIation 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 the pains and penalties of perjury that the information provided above is true and correct. Signature: \--Ot_ •, _./.". . Date: S_• Phone#; 97 U Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License 4,1 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#: .0i,.-7. -- ,,„, �- TOWN OF YARMOUTH ,,. .. Ty. 0% o(. - ; BUILDING DEPARTMENT ���;4 x°� 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1261 HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE: JOB LOCATION: P— at,..„.„,9co.„_ c.,.r 4/`M9 c Pit- 6 — NAME STREET ADD SS SECTION OF TOWN "HOMEOWNER" jZ../Ad AP-So#1/4/Af... 312c1—�37-44?Y5 NAMR HOME PHONE WORK PHONE PRESENT MAILING ADDRESS q /)(, 5 ,,�4 C�,� L y cn r�— /" AAA. 0 -6? C .CITY OR TOWN 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 form acceptable to the building official,that he/she shall be responsible for all" such work performed 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. 1ng Dement The undersigned 'homeowner' certifies that he / she understands the Town of Yarmouth Buildi minimum inspection procedures and requ' ements and that he / she will comply with said procedures and requirements. HOMEOWNER"S SIGNATURE 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. Signature of Owner or Owner's Agent Check one: 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 Q. i� aSc_�t C.4,,.., t0 Work Address Is to be disposed of at the following location: Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Signature of Applicant Date Permit No. k 0 C iii \tOMI \ CC 5 c c 0S+ ° ( @ one ! - 022 13 ƒ E ;6cE �c /k do. = $ ■ CD ® k§j co� %� ® k-k o � � } c ND 3 • 2 / _ o k3ka � k e , n 0 , ,< 2 3 2 . 2{ k§e ■ 13 l 2 \ 2 w d iii\k�� o @ m _c E . . . . . / xc \ - c ^ < . 2�o�< � cTi02 � 2e22 § 1 c w El l . �$/§ k | 3 E ��o0m CO $ y d � � U) a »2. » . » k 0 0 0 0 �\ ƒ 0 0 r I ` § < 90 \ .0 < \�o 0 (.5 k 0 2 `8w ca - At) O 3 Q irc. \\ \ c § \ \§i-or � �2o \\\ >£/ / \< \\ /\7 \\§��-ca 0 o o I ic§ z :« ® < 3nc 0w 0 ^ {55 � �/( \ $\\ g (*(5 u) a2 0 j uou \Gi } N. I \ 0 � . « a >, V _ § ~ 0 y. CI) to _ � CD \ . . .20 Ul /2 e0c‘"i.•,' AlEa„t is() \ \ th-01 ®4 _ 0 . » . 2 �y_ . ... . a o ±0 r : . «< � a� . :> '. \/ # : \ g > $ §=/ � 2z2 « ' 0C » � a»� E0' z $�: } )/' „I. «kb k ««o ■©w @ a 7 722 ) \�\ >in§ E / Li.: . . /0 3 . 0 ° , J,N,,,(.12_„, 4 c7 -k)(,-)5 C 6 221a--z p(--r.cv. ,A)U L C__,65,-t._ C C r c-t* y),,..,, eo,,,.__„4, °,6,t, ___ . . k.ctS see __T_ Jii _p_a_i_pte _c_Pcw,k_ ___________.[ C„-Cz2 C q . pir i 1c-.. z\c____071-1A---e. _kl-'- --------------- 4 . __________ _ __ ___________ .../. 1- _____________ ____________________________ _ _____ , 1 _ ____________ _____ Bk 35203 P51 -$31941 06-22-2022 a 03 a 55 ra ac Doc: 17461s814 06-22-2022 3:44 Ct f z:230302 N 0 T F3ARNrn LAND AND COURT REGISTRY A N AJIASSACHUSETTS STATE EXCISE TAX 'BARNSTABLE LAND COURT REGISTRY Antes A6122-2022 a 03:44pm OFF I C I A :G OFF I C O P Y tut: 4r Dort.: €461E14 C 0 FQe' $3,249,00 Cons: $950,000.00 QUITCLAIM DEED N 0 T N O T 1, LINDA CONTI Trusfeie of the Whitney Realty Trust .I/l/T dated July 28, 2015, (See Declaration of TRisttreForcieSin;hhihtstable CosntY RcgiitrFof'DtA.in Book 29196, Page 342 and being Documet4M l,.l,2Y8,624)of 29 Pheasant Cgeti�'cleYYarmouth Port,MA 02675 for consideration of NINE HUNDRED FIFTY THOUSAND AND NO/I00 ($950,000.00) DOLLARS PAID) grant to grant to LEON DAVID NARBONNE, JR. and TIFFANY JAZELLE NARBONNE husband and wife, tenants by the entirety of 964 West Yarmouth Road, Yarmouth Port, MA 02675 WITH QUITCLAIM COVENANTS, the land together with the buildings thereon located in Yarmouth (Port), Barnstable County, Commonwealth of Massachusetts,described as follows: Parcel 1: Being shown as Lot 271;containing 19,11E square feet, more or less,as shown on a plan of land entitled"Subdivision Plan ofLand in Yarmouth,Mass.,for Jordan Pierce Corp."dated April 1971, by Barnstable Survey Consultants, Inc„ filed with Barnstable County Registry of Deeds in Plan Book 248 Page 93. Said premises arc conveyed subject to and with the benefit of all other rights, restrictions, easements and reservations of record so far as the same arc in force and applicable. Property Address:29 Pheasant Cove Circle, Yarmouth Port,MA Parcel II: BARNSTABLE COUNTY EXCISE TAX BARNSTABLE LAND COURT REGISTRY Date: 06-22-2022 a 03:44am LOT 3 eta: 741 Doi 14618€4 Fee: $2,907.00 Cons: $950,000.00 LAND COURT PLAN 36I75-B(Sheet 1) Said premises arc conveyed subject to and with the benefit of all other rights, restrictions, easements and reservations of record so far as the same are in force and applicable. Property Address: 13 Loch Rannoch Way,Yarmouth Port,MA David C.Nunheimer,Esq.-P.O.Box 1489,West Chatham,MA 02669-508-945-1000 Bk 35203 Pg52 #31941 N O T N O T Grantor hereby releases anyanJ all homestead rights created githff automatically by operation of law or by a writtoz c cli ratiorithat iArggordcd,and bergbyFwalrr tsrangt rgpresents that there are not any other persons egtitdptolany rights of I-IomesteadCurderpMiG.L. c. 188 in the premises conveyed by this deed. N O T N 0 T I, Linda Conti, Ttus4ecf the above referenced Trust,lrAy certify that: OFFICIAL OFFICIAL 1. Said Trull iiin'ul1force and effect and thcrthremPanjendment thereto which have not been recorded in the Barnstable County Registry of Deeds; 2. All the beneficiaries of said trust who arc natural persons are of full age; 3. All the beneficiaries of said trust who are natural persons are competent;and 4. All the beneficiaries of said trusts have consented to the transfer of the property to Leon David Narbonne,Jr.and Tiffany Jazclle Narbonne,for consideration of Nine Hundred Fifty Thousand and NO/100($950,000.00)Dollars Paid. 5. Pursuant to the terms of said Trust, the Trustee has the full right, power and authority to convey said property For Grantor's Title,see Deed recorded in the Barnstable County Registry of Deeds in Book 29147, Page 1,and Certificate of Title No. 20;543 respectively. aa`(%fsa- David C.Nunheimer,Esq.—P.O.Box 1489,West Chatham,MA 02669—508-945-1000 Bk 35203 Pg53 #31941 NOT NOT AN AN OFFICIAL OFFICIAL WITNESS my hand and gear'eider the pains and penaldiescofjpetury this c i day of 2022. NOT NOT AN OFFICIAL LINDX T isieea L f COPY COPY COMMONWEALTH OF MASSACHUSETTS Barnstable,ss. L /MS On this o1 day of 2022,before me,the undersigned Notary Public,personally appeared L CONTI,Trustee as aforesaid,proved to me through satisfactory evidence of identification,w ch was name is signed on the preceding or attached document personal m knowledge, to be the person whose that she signed it voluntarily for its stated y presence and acknowledged to me e that the contents of the document are truthful and accurate to the best of her knowleo swore or dge and beled to liief.. (SEAL) NOTARY PUBLIC My Commission Expires: sgoe .ie ifieruggd s9Jidx3 uolss!wwo0 tSilaSA-myssvW j0 H11Y3MNOM100 Iolfgnd �IJ61oN ONIN 'a NVVIS David C.Nanheimer,Esq.—P.O.Box 1489,West Chatham,MA 02669—508-945-1000 Bk 35203 Pg54 #31941 N O T N 0 T I,Mary Whitney,hereby rilekie any and all homestead rightsPcrehted automatically by operation of law and by a*it*nkledlaiCtidn thatfis recorded ill B?,ok 1Q294,Rags 223 deed. COPY COPY WITNESS hand and Aea1under the pains and penalti sAocperjury this o2.I S day of 4 "I C M.L OFFICIAL COPY COPY Mary Whitney( COMMONWEALTH OF MASSACHUSETTS Barnstable,ss. %. On this ?\ day of--' 2022,before me,the undersigned Notary Public,persona ap eared Mary Whitney,proved to me through satisfactory evidence of identificati w ch was ,-k `A, 3.-. I t ,to be the person whose name is signed on the preceding or attached document in my Presence and acknowledged to me that she signed it voluntarily for its stated purpose and who swore or affirmed to me that the contents of the document are truthful and accurate to the best of her knowledge and belief. -(.1..1 0'2- rzz:< . (SEAL) NOTARY PUBLIC My Commission Expires: S4 SUSAN D. KING i IJCOMMONWATaHr yO F PMbSAC HUSETTs \ / My Commission Expires February 21, 2025 • 8ARNSTABIE REGISTRY OF DEEDS John F. Meade, Register David C.Nanbeimer,Esq.-P.O.Box 1489,West Chatham,MA 02669 508-945-1000 t 1, ,•AISLE COUNTY I, -'G STRY OF DEEDS ~ '' RUE COPY ATTEST