HomeMy WebLinkAboutBLD-22-006968 Y
T
RECEIVE,
�`----- E & TWO FAMILY ONLY- BUILDING PERMIT
MAY 31 2022 Town of Yarmouth Building Department
1146 Route 28, South Yarmouth,MA 02664-4492 \
508-398-2231 ext. 1261 Fax 508-398-0836 �
i.
BUILDING DEPARTMENT Massachusetts State Building Code, 780 CMR
Permit Application To Construct, Repair, Renovate Or Demolish _ " _
a One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: lab-2 2-L f. (p g- I Date Applied-
I
'My.�r. .(01(-s Cr to-14.
Building Official(Print Name) Sigma re
Date
SECTION 1:SITE INFORMATION
1.1 roper ty (Address: 1.2 Assessors Map&Parcel Numbers
111.1a
-A "L
1.1 a Is this an accepted street?yes V 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 0 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: �® / l
Name(Print) "��_ ` ��� � C' e� nc�7Z-(p-Fi f
;:e
one Email ddress COtY C L',Cozi
S I'
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) Yl.LA'—
New Construction 0 Existing Building❑ Owner-Occupied ❑ Repairs(s) 0 I Alteration(s) 0 I Addition 0
Demolition ❑ Accessory Bldg. 0 Number of Units I Other 0 Specify:
Brief Description of Proposed Work2:
s-`A'iek1 9 a cry ( ✓-� 1,eA ,�C t ,S ..r
e. Tr..AAA ^'(1/ J 0,v %Ai , feN'ritik -4-0 ° 4- '911 re
SECTION 4: ESTIMATED CONSTRUCTION COSTS. `/—
Estimated Costs: 1 1(76U-C. � Joy 3 (1-')(
Item Official Use Only )
(Labor and Materials) (lvt•
1. BuildingBuilding Indicate how fee is determined:
$ 1. Permit Fee:$ _
2.Electrical $ C�'Standard City/Town Application Fee
3.Plumbing / 2 5 O° ❑Total Project Costa(It m 6)x multiplier x
$ 0-;' 2. Other Fees: $ �, � - S
4.Mechanical (HVAC) $ 0__ List: 4'il'5
.
5.Mechanical (Fire /J
/ Suppression) $ Total All Fees:$
•
6.Total Project Cost: $ Check No. Check Amount: Cash ount: �e�
c ❑Paid in Full ill Outstanding Balance ue: tk
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
Name of CSL Holder License Number Expirationa ee
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
Telephone I Insulation
Email address D I 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 I'i TSURANCE AFFIDAVIT(IVI.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 thi7,...
s a plication is true and accurate to the best of my knowledge and understanding.
.'
Print Owner's or uthorrzegen Elec( •nrc Sig-nature) .._,
Da e 2.
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.nov/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.F----------Number of fireplaces Habitable room count
Number of bathrooms Number of bedrooms
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
I le Department oflndustrialAcciderzts
y 1 Congress Street, Suite 100
Boston, MA 02114-2017
•.° www.mass.gov/dia
\anWorkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
A licant Information
Name {Business/Organization/Individual); , 1 / Please Print Le ibl
y
,/ Address:
l
City/State/Zip: '
- ' et ' Phone #:
y ? -____ - '___& --
../
Are you an employer?Check the appropriate ppro riate box:
t. I am a employer with employeesType of project(required):
(full and/or part-time).*
2.]I am a sole proprietor or partnership and have no employees working for me in 7. New CO ling tlOn
a y capacity.[No workers'comp. insurance required.] 8. Remodeling
3. am a homeowner doing all work myself. [No workers'comp. insurance required.]t
9. ❑ Demolition
4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will
10 0 Building addition
ensure that all contractors either have workers'compensation insurance or are sole
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. 1 2'❑Plumbing repairs or additions
These sub-contractors have employees and have workers'comp. insurance.t
1 3.0 Roof repairs
6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other
152,§1(4),and we have no employees. [No workers'comp. insurance required.]
*Any applicant that checks box Ail 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 nzy employees. Below is the policy and job site
information.
Insurance Company Name:
Policy g or Self-ins.Lic. g:
Expiration Date:
Job Site Address:
Attach a copy of the workers' compensation policy declaration page(showing thetate/Zip:policy number and e
Failure to secure coverage as required under MGL c. 152 xpiration date).
punishable by a fine up to$1,
and/or one-year imprisonment, as well as civil penalties in the form of STOP WO violat1RK on ORDER and a fine of up to$250.00
day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insura0.00 nce a
coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature:
Phone T: Date: `I' v-
Official use only. Do not write in this area, to be completed by city or town official.
City or Town:
Issuing Authority(circle one): Permit/License
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Ins ecto
6. Other
P r 5. Plumbing Inspector
•
Contact Person:
Phone#:
TOWN OF YARMOUTH
BUILDING DEPARTMENT
ti'' MATiACME[SE 7, 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1261
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
DATE:
JOB LOCATION: C'
NAME
STREET ADDRESSSECTION bF TOINT
"HOMFOWNER" r
HOME PHONE WORK PHONE
PRESENT MAIL1 TG ADDRESS ', it, 37 ) _
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 perfoiLiled 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
APPROVAL OF BUILDING O1-'r1CIAL
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 yes, 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
Signature of Owner or Owner's Agent Ownerone: 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 1 t
Work Address
Is to be disposed of at the following location: , - v /e;
`" ► � �
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
Signature of Applicant y
PP Date C/
Permit No.
Doc: 1, 459,812 05-24-2022 3 : 38
Ctf#: 230048
NOT NOT
AN AN
OFFICIAL OFFICIAL
COPY COPY
NOT NOT
AN AN
OFFICIAL OFFICIAL
COPY COPY
QUITCLAIM DEED
I,JUDITH L. PAQUIN, being unmarried, of 1 Avery Lane, South Yarmouth, MA
02664, for consideration paid of FIVE HUNDRED NINE THOUSAND FIVE HUNDRED
DOLLARS AND NO/100 ($509,500.00) grant to CHARLES CONSTANTINE, TRUSTEE
of the CONSTANTINE TRUST, u/d/t dated March 18, 2015, see Trustee's Certificate
recorded herewith,of 1 Avery Lane,South Yarmouth, MA 02664
WITH QUITCLAIM COVENANTS,
g That certain parcel of land situated in Yarmouth(South), in the County of Barnstable
and said Commonwealth of Massachusetts, bounded and described as follows:
o Lot 78.
Plan 31209-D (sheet 1)
E
There is appurtenant to said land a right of way over the streets and ways on the plans
in this case number in common with others entitled thereto.
r+ cpi
Said land is subject to reservations and restrictions set forth in Document No. 173,885.
-8 Grantors hereby releases any and all homestead rights to the within premises, whether
created by declaration or operation of law,and further states under the pains and
penalties of perjury that there are no other individuals entitled to homestead rights to
the property being conveyed herein.
For Grantor's title see deed recorded in the Barnstable Land Court Registry at
Document No.689643(Certificate of Title No. 143815).See also Death Certificate of John
A. Paquin at Document No. 1024126,Affidavit of No Estate Tax Due for John A. Paquin
at Document No. 1024128 and Affidavit of No Divorce for John A. Paquin at Document
No. 1024127.
Property Address: 1 Avery Lane,South Yarmouth,MA 02664
MASSACHUSETTS STATE EXCISE TAX
BARNSTABLE LAND COURT REGISTRY BARNSTABLE COUNTY EXCISE TAX
BARNSTABLE LAND COURT REGISTRY
Date: 05-24-2022 @ 03:38pm
Ctl#: 817 Date: 05-24-2022 @ 03:38pm
Fee: $1,742.49 Cons: $509,500.00 Ct1#: 817
Fee: $1,559.07 Cons: $509,500.00
Doc: 1,459,812 05-24-2022 3 : 38 Page 2 of 2
NOT NOT
AN AN
OFFICIAL OFFICIAL
COPY COPY
NOT NOT
AN AN
OFFICIAL OFFICIAL
COPY COPY
WITNESS my hand and seal this lb day of ‘10_1.' 2022.
I, . �
JU f L. PAQUIN
COMMONWEALTH OF MASSACHUSETTS
County ofjs }Q11Q
On this O ion day of !4044 2022, before me, the undersigned notary public,
personally appeared,JUDITH L. PAQUIN
❑ personaIy known to me,or
wved to me through satisfactory evidence of identification, which was
driver's license
0 (other:)
to be the person(s) whose name(s) are signed on the preceding or attached document,
and who swore or affirmed to me that the contents of the document are truthful and
accurate to the best of her knowledge and belief, and acknowledged the foregoing to be
her free act and deed for its stated purpose.
1 el
Nota aryfr4L
Public
pon �� r�i My Commission Expires jd I z0�$,
[SEAL] ''. F ss'on
(Ty OF MAS
JOHN F. MEADE, ASSISTANT RECORDER
BARNSTABLE REGISTRY LAND COURT DISTRICT
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Sears, Tim
From: Sears, Tim
Sent: Thursday, June 9, 2022 1:10 PM
To: 'charlesconstantine@comcast.net'
Subject: 1 Avery Ln
Charles,
I have reviewed your application for finishing part of the basement and there are some items to address.
1. Finished ceiling height needs to be on the plan
2. The layout approved by the Health Department with a 4' opening and no door leading to the family room leaves
no way to insulate to meet the building code unless you finish all the exterior basement walls.
Please update your plan and submit 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.
1
TOWN OF YARMOUTH
r; c HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant
Building Site Location:_ ( \/ tf VN L (, -..-- ' � fxA' “' ti;if
-_---
Proposed Improvement:
w\?;,c,A-N,Ne-oone-x
Applicant: ��( 4--e . -.Tel. No.. � {; ,7( -7 .:17
Address: --J /J -",,:* " Date Filed: ��/' ,- '1 C' i
**/f you would like e-mail notification of sign off please provide e-mail address:
Owner Name:
Owner Address: • / / 1 �'S-t-IA Tt N _ Owner Tel. No.:
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,
and septic system location;
(2.) Floor plan 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.
REVIEWED BY: ?itDATE: \, 1—
X)'
PLEASE NOTE
COMMENTS/CONDITIONS /
� l`) f v t ct t ' e d✓`oit A
p (�C0c)h
u Se v4e,4: j c �' j-e4 V e c_Afed ✓Jz�-
-- /`� both/- i4 c C c. e 0 c— a_ eilP g c,c vL
.Y44,� TOWN OF YARMOUTH
;. 4 r, HEALTH DEPARTMENT
'''���`` PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: ( A- V fill\ ,, ti , 'y a,y' V A,
Proposed Improvement: l ek-N( , ._,, ki? i t Li I ti d
\ .- ,r-Qo^'1 �k..,, u
Applicant: /44 441-4,4 1.04„ 1 1*--e. Tel. No.: 6 ( -1' -`7C 7 ci7
Address: I V r_ L Date Filed: 5,,/07/` 0
**lfyou would like e-mail notification of sign off,please provide e-mail address:
Owner Name: c>4.... A(;(-4,i e?.e -,4-41:"---41-ifk4 <
Owner Address: / A., 44f), 4 i Owner Tel. No.: 6 07.-7‘7
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, •
EilaI 'E and septic system location;
(2.) Floor plan labeling ALL rooms within building
MAY 1 2022 (all existing and proposed) -
Note: Floor plans not required for decks, sheds, windows, roofing;
HEALTH DEPT. (3.) If necessary, Title 5 application signed by licensed installer
with fee.
f
.�� / -- DATE: c I- ,�.
REVIEWED BY:
®fit
PLEASE NOTE
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ouce -TO
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