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HomeMy WebLinkAboutBLD-23-000814 ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department ort r" 1146 Route 28, South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 Massachusetts State Building Code,780 CMR e Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling RECEIVED This Section For Official Use Only Building Permit Number: e(,0— -3'Wii) `Y Date Applied: 4 6 1 2 2022 Tim F� �� BUILDING nFP4RTMENT Building Official(Print Name) gnature ay:_ Date — SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 32 Davis Rd South Yarmouth MA 02664 59 162 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: R Residential 11.761 Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) _1.5 Building Setbacks(ft) no change to setbacks Front Yard Side Yards Rear Yard Required I Provided Required Provided Required Provided . 7 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public l i Private 0 Zone: — Outside Flood Zone? Municipal❑ On site disposal system @' Check if yesGX SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Alvin Wolfgram Essex, CT 06426 Name(Print) City,State,ZIP PO Box 863 860-304-6558 alvin.a.wolfgram(a�gmail.com No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 I Existing Building Ul Owner-Occupied lB` I Repairs(s) 0 Alteration(s) 0 I Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify; Brief Description of Proposed Work2: Remove and replace drywall-and insulation in kitchen, replace kitchen floor. SECTION 4:ESTIMATED CONSTRUCTION COSTS. • Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 1. Building Permit Fee:$I50 Indicate how fee is determined: 11 Standard City/Town Application Fee 2.Electrical $ a 0 Total Project Cost (Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 3 5,60 UL-- 8 3,65 • 5.Mechanical (Fire $ . . . Suppression) Total All Fees:$ Check No. Check Amount: Cash Amouny 6.Total Project Cost: $ 2500.00 0 Paid in Full lil Outstanding Balance Due:‘k'S SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS 091653 09/30/22 Walter R. Warren Jr. License Number Expiration Date Name of CSL Holder 259 Great Western Rd. Unit B List CSL Type(see below) No.and Street Type Description South Dennis MA 02660 U Unrestricted(Buildings up to 35,000 cu.>3.) R Restricted l&2 Family Dwelling City/Town,State,ZIP Masonry RC I Roofing Covering • WS Window and Siding SF Solid Fuel Burning Appliances 508-694-5618 office@sanddollarcustoms.corn I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 193567 10/29/22 Sand Dollar Customs LLC HIC Registration Number Expiration Date HIC Company Name or HIC xx,e ' trap m ae 259 Great Western Rd.-Unit B office@sanddollarcustoms.com No.and Street South Dennis MA 02660 508-694-5618 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 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 Sand Dollar Customs LLC to act on my behalf,in all matters relative to work authorized by this building permit application. Alvin Wolfgram (see attached authorization) 08/11/22 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 per jury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. Walter R. Warren Jr. 08/11/22 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.sov/oca Information on the Construction Supervisor License can be found at www.mass.nov/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.) 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" §TOWN OF YARMOUTH 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1261 Fax 508-398-0836 Office of the I y uilding Coin;_i issio=,er BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Ch. 40, §54 and 780 CMR- Section 105.3.1. #4. I hereby certify that the debris resulting from the proposed work/demolition to be conducted at 32 Davis Rd South Yarmouth MA 02664 Work Address Is to be disposed of oat the following location: Town of Yarmouth Disposal Area Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. 09ale2A. �Gi/�/1.2J1icA., 8'11/22 Signature of Application Date Permit No. Key:'") w (e- 4�f� C..UrU ie,it :IULLjf.1 Office of Consumer Affairs and Business Regulation 1000 Washington Street-Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type; Corporation Registration; 193567 SAND DOLLAR CUSTOMS LLC Expiration: 10/29/2022 259 GREAT WESTERN RD.UNIT S SOUTH DENNIS,MA 02660 Update Ad*iaa and Return Card. wok i O 2001105.17 ornseotConsumer Aaare d Business Re9ui4lon HOME IMPROVEMENT CONTRACTOR Registration wallet for Individual use only TYPE:Crxoarelion before the expiration date. if found return to: ggyE6taahOfl Ex1>fralioo Office of Consumer Affairs and Business Regulation 193567 1012912022 1000 Washington Street-Suite 710 SAND DOLLAR CUSTOMS LLC Barton.MA 02110 WALTER R..WARREN 259 GREAT WESTERN RD.UNIT B (F� h SOUTH DENNIS.,MA MOW Undersecxetary Not valid without signature Commonwealth at Massachusetts II Division of Professional Licensure Board of Building Regulations and Standards Constt tit visor t CS-091653 spires:09/3012022 WALTER R WARREN JR le as ALEXANDER DR YARMOUTH PORT MA 02675 Commissioner daeat t. "t n ,s DO40, e Sand Dollar Customs LLC 259 Great Western Rd. Unit B South Dennis MA 02660 508-694-5618 &STO % Sanddollarcustoms.com General Contractor and Owner Agreement Authorization To Proceed I hereby authorize Sand Dollar Customs LLC to proceed with construction at 32 Davis Road So. Yarmouth MA. 02664 in accordance with 1079(w/attachment) 02 08 2022 signed estimate# , dated / / Homeowner agrees to make payments to Sand Dollar Customs LLC in accordance with the payment schedule listed op the signed and agreed upon estimate. (1/-41 03.04.2022 Homeowner Date Sand Dollar Customs Representative Date ACo CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 12/14/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Tina Reeves NAME: Dowling&O'Neil Insurance Agency PHONE (800)640-1620 FAX IA/C,No.Extl: (A/C,No): 973 lyannough Road E-MAIL ADDRESS: treeves@doins.com INSURER(S)AFFORDING COVERAGE NAIC# Hyannis MA 02601 INSURER A: NGM Insurance Company 14788 INSURED INSURER B: Associated Employers Ins Co 11104 Sand Dollar Customs,LLC INSURER C: 259 Great Western Rd. INSURER D Unit B INSURER E: South Dennis MA 02660 INSURER F: COVERAGES CERTIFICATE NUMBER: CL21121493449 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED 500,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 10,000 A MPP9284Q 12/15/2021 12/15/2022 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 -I POLICY JECTPRO X LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ A OWNED *s/ SCHEDULED M1P9336Q 12/15/2021 12/15/2022 BODILYINJURY(Peraccident) $ AUTOS ONLY '' AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY /� AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION �/ STATUTE EMPLOYERS'LIABILITY /� STATUTE ER Y N B ANY PROPRIETOR/PARTNER/EXECUTIVE Y N/A WCC50050197212021A 12/04/2021 12/04/2022 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $If 500,000 DESCRIPTIONE descrN under E.L.DISEASE-POLICY LIMIT $ OF OPERATIONS below 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements.Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended thecoverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Sand Dollar Customs ACCORDANCE WITH THE POLICY PROVISIONS. 259 Great Western Road,Unit B AUTHORIZED REPRESENTATIVE South Dennis MA 02660 ©1988-2015 ACORD CORPORATION. All rights reserved. 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