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Home My WebLink AboutBLDR-23-12897 if ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department of r 1146 Route 28, South Yarmouth,MA 02664-4492 '• 508-398-2231 ext. 1261 Fax 508-398-0836 Massachusetts State Building Code, 780 CMR \.._,:o a Building Permit Application To Construct, Repair, Renovate Or Demolish ................ . a One-or Two-Family Dwelling This Section For Official Use Only t.:..1�► Building Permit Number: 8 L b 23.—l 7 1 Date Applied: 7 1-[r-N CPAr 5 ------;----,.. -,-- Building Official(Print Name) Signature Date . SECTION 1: SITE INFORiMATION 1. 1on Ijrfldres V" 1.2 Assessors Map&P 1 rR EneeEIVED 1.1 a Is this an accepted street?yes no Map Number P luUU�n lr 2024 1.3 Zoning Information: 1.4 Property Dimensitr s: " 1 BUI-llLDtNG j �rARTh4ENT Zoning District Proposed Use Lot Area(sq ft) B : l a (I --1.5 Building Setbacks(ft) r` Front Yard Side Yards 9* 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: PP P1 Public El Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 y� Check if yes❑ Z • SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: K,1a yk 7 . e.x (( ?toe Inc A- o Ytr Name( r t) City,State,ZIP ?S ,..1.1 k al 4- ?' LJdd LI ZtA-114 Ef3i $' e d No.and Street Telephone mail Ad ess SECTION 3:DESCRIPTION OF PROPOSED WORK'-(check all that apply) New Construction 0 Existing Building V Owner-Occupied 0 Repairs(s) 0 Alteration(s)eg Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units / Other 0 Specify: Brief Desc iption of Proposed Work': - ( E Q SEP SECTION 4: ESTIMATED CONSTRUCTION COSTS 1.. 202 3 Estimated Costs: EPi4RTMENT Item Official Use Only B L (Labor and Materials) Bv: 1.Building $ 1. Building Permit Fee: $ I 5-0 Indicate how tee is t grained: 5kex RI Standard City/Town Application Fee 2.Electrical $ V, Project Costa(Item 6)x multiplier x ❑Total P 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: A M ®Qssh 5.Mechanical (Fire $ l I Total All Fees:$ Suppression) Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ ih 4 f 0 Paid in Full lEI Outstanding Balance Due: I/O 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.) R Restricted 1 Pu.2 Family Dwelling City/Town,State,ZIP 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 Registration Number Expiration Date HIC Company Name or HIC Registrant Name No.and Street I 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 F 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 I, as Owner of the subject property,hereby authorize V' (,j,44 1,,,,, P 4,6 cei to act on my behalf, in all matters relative to work authorized by this building permit application. I Print Owner's Name(Electronic Signature) Date SECTION 7b: OWNER1 OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. `/ Vaal te•-e ) 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.cov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) , Zs)0 (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Alf, ld Habitable room count .g Number of fireplaces 3 Number of bedrooms .3 Number of bathrooms Number of half/baths D Type of heating system 4 C Number of decks/porches Type of cooling system '4 Enclosed ` Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" .._\ The Commonwealth of Massachusetts I 1, Department of Industrial Accidents 1 Congress Street, Suite 100 " 11 Boston, MA 02114-2017 j www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): 4 ...1,9 SA. Le -1.,._ Address: 3 Ste, 4=t, ;-A t76"1-,1' City/State/Zip: )t 5 p e, ift Phone #: 2„2J -2. ( ;S' / Are you an employer?Check the appropriate box: Type of project(required): LC I am a employer with employees(full and/or part-time).* 7. C New construction 2.E I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp. insurance required.] 3. all work myself. [No workers'comp. insurance required.]t I am a homeowner doing 9. D Demolition 4. I am a homeowner and will be hiring contractors to conduct all work on my property. 1 willpi 10 [] Building addition ensure that all contractors either have workers'compensation insurance or are sole 11. Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.E 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.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.n Other 152,§1(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 certify under the pains and penalties of perjury that the information provided above is true and correct. iSienature: k ,�r_+�—J _ Date: �� Phone#: ( � 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 Phone#: Contact Person: » o R� _ fC( TOWN OF YARMOUTH BUILDING DEPARTMENT g a„=o�;=��; 1146 Route 28, South► Para oath, 1t IA 02664 508-398-2231 ext. 1261 HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DALE: JOB LOCATION: I z La Ike Rd 14785- 'Otee k 1-5/44 iti NAME STREET ADDRESS SECTION OFrTO'HOMFOWNER" 1, C`I& 7 t3�..�,. 'Z? -1/ Qj) I c !`� 4 L NAME HOi PHONE WORK PHO PRESENT MAILING ADDRESS ' q4 cit. (0.9 Kt %rtee, hi, 40 ..,-‘ 1-7)r •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 foLin acceptable to the building official,that he/she shall be responsible for all such work perfoiwwed 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 jtequirements. i 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 r Ch.142. Yes No If you have checked ves, please indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of indemnity Bond OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent h:homeownrlicexemp TOWN OF YARMOUTH 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1261 Fax 508-398-0836 Office of the Building Commissioner BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G. L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111/5 I hereby certify that the debris resulting from the proposed work/demolition to be conducted at 11 1,4 ke 1 Lae� LIJ - eke, 1. - Work Address Is to be disposed of at the following location: Cnwe4`t- 11,1 "T Yak44tlt . Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. ��a cCirL 1?)" / Signature of Applicant Date Permit No. Alan Wenk-12 Lake Rd West, West Yarmouth 8/14/23, 8:08 PM Alan Wenk -12 Lake Rd West, West Yarmouth Kitchen Install new cabinets Install new counter top Install under cabinet lighting Install microwave Install window Install wood floor Replace kitchen window with casement window Remove wood paneled wall with sheet rock Relocate gas stove Install recessed ceiling lighting Install three 2 gang outlets Replace ceiling tiles with sheet rock Living room/Dining room Replace picture window and adjacent 2 double hung windows Replace ceiling tiles with sheet rock ge.:9.(4- C 4 <74 Install wood floor Install four 2 gang outlets Replace fireplace wood paneled wall with sheet rock Replace ceiling with sheet rock Page 1 of 3 Alan Wenk-12 Lake Rd West, West Yarmouth 8/14/23,8:08 PN Install tile entry way Install entry storm door Middle room Install wood floor Install recessed lighting p 4 xle•-\ 12rg--, S7 Install three 2 gang outlets Remove wood paneling in closet/ replace with sheetrock Install new entry door Back bedroom Install three 2 gang outlets Install wood floor Replace ceiling tiles with sheet rock Install new closet door Replace entry door Master bedroom Install wood floor Remove popcorn ceiling texture Install three 2 gang outlets Replace two double hung windows Replace entry door Page 2 of 3 Alan Wenk-12 Lake Rd West, West Yarmouth 8/14/23, 8:08 PN Wash room Remove wall cabinet Install water proof plank flooring Replace one double hung window Replace entry door Three season porch Replace jalousie windows with three gliding windows Replace interior walls with ship lap boards Install entry storm door Exterior Replace cedar shingles with new cedar shingles Install new gutters/downspouts Pape 3 of 3 t• 1ft LLL($vg) lit Q S(ls+au!go) !°saI0%M �. 8 E Z ml ��a�oad uat�� i Q N mua/� :auaeN qor1014,1111 lip Q €.,.1 84" X • 21" 11" 21" 33"11" • 3„ 21„ 1 11„ 1 ! 1 , N F W2130iF3. 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