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HomeMy WebLinkAboutBLD-23-000210 .• PlI g13)Z a-lecd -waft' rt-at ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department RECEIVED 1146 Route 28, South Yarmouth,MA 02664-4492 508-398-2231 _ _ „-.- -ext. 1261 Fax 508 398 0836 ✓ JUL 13 20 Massachusetts State Building Code, 780 CM - j R ril 'ng Permit Application To Construct, Repair, Renovate Or Demolish \...: _-.-- a One-or Two-Family Dwelling Q `' BUILDING DEPARTMENT By' This Section For Official Use Only Building Permit Number: 2j 3— L 1►n Date Applied: — �I ,IN, SSM S -- Q.X.-4 Building Official(Print Name) Sign ture Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 60 DonOrwoe Dr. , 1a tyrtr Bch 133 33, 1 1.1 a Is this an accepted 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: Public Gd Private 0 Zone: _ Outside Flood one? Check if yes Municipal 0 On site disposal system GI SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: --1-, * Ntckc,\n,c col\ax,c \10x-c n.4,, �r, x-, cm,,, Oka75 Name Print City,State,ZIP e ` e ` �CT` m ,No.and Street Telpone ail Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building l' Owner-Occupied li Repairs(s) 0 l AIteration(s) 1I Addition ❑ Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work': rev\clot Ps.i -w' f\PC(- WI rein mr r\mks i- 'Q�R'r -faaA-try' f /1 y '— 31 a' r.S plct,�L foYel/1 SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: (Labor and Materials) Official Use Only 1. Building $ I1 000 1. Building Permit Fee:$'Li Indicate how fee is determined: 2.Electrical $ 0 IN Standard City/Town Application Fee 3.Plumbing 0 Total Project Cost3(Item 6)x multiplier x $ 0 2. Other Fees: $ (90, 4.Mechanical (HVAC) $ List: r�U CLC 3 y s 5. Mechanical (Fire0)*IV O Suppression) $ 0 Total All Fees:$ 6. Total Project Cost: $ (� �y� Check No. Check Amount: Cash oimt: i WO 0 Paid in Full IN Outstanding Balance Du : 0'. 12 A7V 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 I&2 Family Dwelling City/Town,State,ZIP M Masonry y 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 Email address City/Town, State,ZIP Telephone SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c.1.52.§ 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 CIA 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 —3-or x. ' \c\a_ to act on my behalf, in all matters relative to work authorized by this building permit application. '(iah Ca\lahan 1I8/c 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 peijury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. -\Mr\I CoAcA-Nor 11g/aa 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.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.) la` x 1'4c (lea,- ous (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) �, Habitable room count Number of fireplaces 05 3 Number of bedrooms Number of bathrooms ``' .4?"dt• 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" c 1."? r Department of Indhe Common wealth of Massachusetts AzistrialAccidents 1 Congress Street, Suite 100 �\ Boston, MA 02114-2017 ,w s'S 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):\\W� \c�- o.r-- Address: 6 �c,� �. 7 City/State/Zip: yps-mai, r,c-'c, rct q -15 Phone #: _(0,4k-t05 Are you an employer?Check the appropriate box: Type of project(required): LEI I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.E I am a sole proprietor or partnership and have no employees working for me in capacity. 8. [ Remodeling any p ty.(No workers'comp. insurance required.] — 3. I am a homeowner doing all work myself. [No workers'comp. insurance required.]t 9. ❑ Demolition 4.2I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 ❑ Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑ Electrical repairs or additions proprietors with no employees. 5.❑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.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 1 4•❑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: Arbe.\\Ct thsu ame- • Policy g or Self-ins.Lic. #: cmg1 cog Oft,? Expiration Date: (0/05/ ?3 Job Site Address: (p 100,,,p-v 'or, City/State/Zip:N.c-ma\. -\ ��1 mp, O(-15 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. Sienature1 CJ�/// ./ �a1/,�c�,..,) Date: -7Ig/0�01 Phone#: ,5( (.041_ u)(00 j 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#: • M � Q, TOWN OF YARMOUTH o( BUILDING DEPARTMENT ;.4„` E' < 1146 Route 28, South Yarmouth, MA 02664 508-398-22 31 ext. 1261 HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE: 1 j JOB LOCATION:'TAN C&\\Uhnrr, /.o 'U,, j n 'Dr. Narmoc��4fl NAME STREET ADDRESS SECTION OF TOWN "HOMEOWNER" �l icy Cailcxhon Sag- (.0(11—l062Q5 NAME HOME PHONE WORK PHONE PRESENT MAILING ADDRESS S0rne CITY OR TOWN STA I.h 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 peiiilit. (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 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:homeownrficexemp 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 (D DaLzp- c1'. pc. '1ac" cxs r irk, cc c j Work Address Is to be disposed of at the following location: yp, a, —V g. etc;,,., Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. —1/8/ate. 1111, gnature of Applicant Date Permit No. Sears, Tim From: Sears, Tim Sent: Wednesday,July 20, 2022 8:17 AM To: 'tiffanyhoyt24@gmail.com' Cc: Sherman, Lisa; Water Department Subject: 6 Dauphine Dr Tiffany, I have r;viewed your application and there are some items needed. ,fig Health Department sign off(under review) Water Department sign off N 3. Old King's Highway approval 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 C80 Deputy Building Commissioner Town of Yarmouth 508-398-2231. Ext. 1259 mailto:tsears@varmouth.ma.us t-.Y'+k TOWN OF YARMOUTH :`tIA c F} HEALTH DEPARTMENT ',,co PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To he completed by Applicant: Building Site Location: \') . Proposed Improvement: 0) \ -- i L•i` ,, t'-, , ) ,� wt;1 i pe4, 3c x '- .5 Applicant: Tel. No.: 1 , ,_, , Address: _.. ',r . , _ =\ Date Filed: 2— I _Z **lf you would like e-mail notification of sign off please provide e-mail address: Owner Name: .- Owner Address: Owner Tel. No.: ":>5- LC-A) l-rcr>0= 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. i( dam- ,' `� -),� -Z REVIEWED BY: DATE: I/ 7 PLEASE NOTE COMMENTS/CONDITIONS: _ H/N \ 1)li)I V E'+.-,.\ l4 s2,'Ory Vy AF�\�o �� Ah�py •1 T'6.46 \`_� 11, \ 1 ,— ? / r 0 * / / O • w(A co // // 0 / / // 00)j > / / 73 o / / l+ tTl g// / T� / V) -- - __, / .c w v X 1 / / Ti w z z ` 26 0, 0 f •a > o i - D D v� N gxX1 °\1144% k' v. Z .›. ?g• /NT 0 r?s 486 N 1`f*l R PROP / E ``— ,FRry t/ y /// r . �F / /; / coaacvo /S -33, �\ // c0 Z n 11 N / t+ c,i^ � 1 / `' _ rWW / 7 n c (,,w� O c s "rr0 N 7' / •`► co n c* / // �. NZn (-1) // / (/)? 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C---- (_( 1)-c)si---;---( b... .- I ��,�, it.}SL\OF °, `utt.,Ttt 14 4** (.4-!?,i) \I WATER DEPARTMENT O— ,-{y -) 99 Buck IA:rid R,I .r � f ruse " 'v€:,t 'latrr'touti3 MA 0267 t f='lr, 'auto" 7i)ii "71-792I * I aN: C,M 77 1--998 BUILDING PERMIT APPLICATION FOR WATER DEPARTMENT SIGN OFF TRANSMITTAL FORM RC'IIT)ING SITE LOCATION: '., ' VCR, ..,__ C,,c ,,� - , K`s`t ),31;;;I PROPOSED WORK: cf')'\ee.c ci \-,x ?c` , _.....Lxj4 ' . =;s \ a - 0,A,: ` _ z~-, - n,: APPLICANT: -ty--. � tfi`ttir> ADDRESS: tp DQ,,,, \-)\v- t RESIDENTIAL AND 'OR COMMER('I.AI. BUILDING ‘Vater t)epat ment: Determines Compliance of Water :AN.ailahility and or existing location Engineering Department: Determines Compliance for Parking amnd Drainage Cernserti.rtion Commission: I-)etermine+Compliance to Wetlands Act: i.e. It Iot(s)border any type of S4 etlands.streams.ponds,rivers,ocean. hogs, boys. marshland. ETC... IIealth.)cpartnient: I)ctcrminc_s Compliance to State and Toy,n Regulations.i.c. requirements for Septage Disposal and other Public I Iealth Activites Fire I)epartment: Determines Compliance to State and Town Requirements for Personal Safety. Property Protections. i.e. Smoke Detectors, Sprinkler Systems,etc tP , 'ANT SIGNATURE DATE E OFFICE USE: COMMENTS ON PERMIT 1PPROVAl.OR DENIAL 4-12- -,— -141-;"1/41-144.-2.--- 7i 2 REVIEW r BV WATER DIVISION(SIGNATURE) DATE • of Y TOWN OF VAn^\1 )l J t d /2- ' WATER DEPARTMENT �� 99 BuckIsland Road u_ a,c West Yarmouth, ,\IA ti?f,?; tt lx',�ium; 51it 1-7921 • tat CI)f t-' i n BUILDING PERMIT APPLICATION FOR WATER DEPARTMENT SIGN OFF TRANSMITTAL FORM BUILDING SITE LOCATION: xi }CN . claw crec ( PROPOSED WORK: r ` t:e axe°:3Rr _r ? K .uA� vw+..) vim, ece.1 _ :.__C,� APPLICANT: ru~►.t; CoAciirmttm ADDRESS: _lv c,savh\ TELPIIONE: (�f (:-.1stc..5 RESIDENTIAL AND OR COMMERCIAL BUILDING Water Department: Determines Compliance of\V'ater:Availahilit and or existing location Ingineering Department: Determines Compliance for Parking and I)r tinm _ Conservation Commission: Determines Compliance to Wetlands :1ct; i.e. If Ions)border any type of u edam's.streams. ponds.rivers, ocean, hogs. boys, marshland. ETC... I IL Rh Department: I)etcnnines Compliance to State and 'I'm%n Regulations, i.e. requirements for Septage Disposal and other Public I Iealth Activites Fire Department: Determines t'ompliance to State and Town Requirements for Personal Safety. Property Protections. i.e. Smoke Detectors,Sprinkler Systerns,etc P NT SIGNATURE DATE OFFICE USE: COMIMF:N'I'S ON PERMIT APPROVAL OR I)I•:NIAI. 2— REVIEW D BY WATER DIVISION(SIGNATURE) DATE: 4136 Jane E. Harrison NAME E80-4 7/17/31 STREET,,O. 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