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HomeMy WebLinkAboutBLD-22-007483 R E • -ETV E D & TWO FAMILY ONLY-BUILDING PERMIT [ JU 2 y 2022 Town ofYarmouth Building Department 1146 Route 28, South Yannouth,MA 02664-4492 _ 508-398-2231 ext. 1261 Fax 508-398-0836 BUILDI G DEPARTMENT Massachusetts State Building Code, 780 CMR _ / dy` gPermitApplication To Construct,Repair, Renovate a"Demolish a One- or Two-Family Dwelling This Section For Official Use Only Building Permit Number: 1))(D.—L2 09 i ? Date �Applied: 6/ 022 I r' e S / 10'44. Building Official(Print Name) Si ure DEk SECTION 1: SITE INFORi'lATION _ , 11 Property Address: 12 Assessors Map &Parcel Numbers 18 Australian Ave Yarmouth,Port MA '136 7 1.1 a Is this an accepted street?yes no Map Number Parcel Number 13 Zoning Information: 1.4 Property Dimensions: R-40 Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks (ft) Front Yard Side Yards Rear Yard Required Provided Required I Provided Required 1 Provided I 1.6 Water Supply: (M.GL c 40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public V Private Zone: _ Outside Flood Zone? p po y M Check if yes y,/ Municipal On site disposal system SECTION 2 PROPERTY OWNERSHIP' 2.1 Owner'ofRecord: Lisa Xiarhos Yarmouth Port MA 02675 Name(Print) City, Slade,ZIP 18 Australian Ave 774-212-2037 lxiarhos@comcast.net No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK' (check all that apply) New Construction 0 Existing Building D Owner-Occupied VA Repairs(s) 0 I Alteration(s) KA Addition 0 Demolition ❑ Accessory Bldg. ❑ Number of Units I Other 0 Specify: Brief Description ofProposed Work': Remove existing kitchen and reintall new tile floor,subfloor,cabinets,counter tops and backsplash.Remove 3'x8'existing wall and install new sheet rock,blend in pine ceiling boards as needed.Paint new kitchen/dining area Remove and replace existing casement window. SECTION 4 ESTIMATED CONSTRUCTION COSTS. . Item Estimated Costs: OfficialUse Only (Labor and Materials) 1. Building $6720 1. Building Permit Fee: $ i'O Indicate how fee is determined: Standard City/Town,Application Fee 2.Electrical $1000 OTotal Project Cost' (Item 6)x multiplier x 3. Plumbing $ 2. Oilier Fees: $ 4. Mechanical (HV AC) $ List: 1/5. Mechanical (Fire . . • . ' \I) Sunnression) $ Total All Fees: $ Check No.___ Check Amount: Cash ount:_ _ 6. Total Project Cost: $ 7720 D Paid in Full Outstanding Balance D e:• \ Gj • SECTIONS: CONSTRUCTION SERVICES '5.1 Construction Supervisor License (CSL) 091653 09/30/2022 Walter R. Warren Jr. License Number Expiration Date Name of CC Holder List(4,Type(see below) Unrestricted 259 Great Western Rd Unit B No.and Street TT Description South Dennis MA 02660 ` J U B din uPb 35,000 cu. ft)_ Restricted 1&2 Family Dwelling: City/Town, State, ZAP M Masonry RC Roofing Covering WS Window and Sidine SF Solid Fuel Burning Appliances 508-694-5618 rob@sanddollarcustoms.com I Insulation Telephone Email address D Demolition 5,2 Registered Home Improvement Contractor(RIC) 193567 10/29/2022 Sand Dollar Customs LLC HIC Registration Number Expiration Date HTC Company Name or HIC Recant Name 259 Great Western Rd Unit B rob@sanddollarcustoms.com No.and Street 508-694-5618 Email address South Dennis, MA 02660 City/Town, State, GIP Telephone SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M,G.L. e. 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 ofthe Issuance of the building permit. Signed Affidavit Attached? Yes I/ ND I7 SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as O1.vner ofthe subject property,hereby authorize see attached authorization to act on my behalf, in all matters relative to work authorized by this building permit application. Lisa Xiarhos 06/23/2022 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 ofpeljUly that all of the information contained in this application is true and accurate to the best ofrny lmowledge and understanding. ' 1�2 4 , a4 J d 06/23/2022 Print Owner's ar Authorized Agent's Name(El c Signature) Date NOTES: I. An Owner who obtains a building permit to do his/her ovm work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(RIC)Program), will not have access to the arbitration program cr 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 Constntction Supervisor License can be found at www.mass.eov/dQs 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. IL) Habitable room count Number of fireplaces Number of bedrooms Number ofbathrooms Number ofhalflbaths Type of heating system Number of decks/porches Type o f cooling system Enclosed Open 13. "Total Project Square Footage" may be substituted for"Total Project Cost" tJ' o,:w2€iwe 2'CZ e/k/ff eMckz Cl f'?t ` 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_ 10129;'2022 259 GREAT WESTERN RD.UNIT B SOUTH DENNIS,MA 02660 Update Address and Return Card, SCA 1 0 2067A8'77 � n S!riixiirwxrv�t'//ey/.AtV....nNlfiw/1/4 OM*et Ceneumer Adlesre#Bini teee Regulation HOME IMPROVEMENT CONTRACTOR Registration valid to IndMdual use only TYPE:C aoaraton before the expiration data. If tannin return to: Itapiainion Expiration Office of Consumer Affairs and Business Regulation 193667 102B2022 1000 Washington Street-Suite 710 SAND DOLLAR CUSTOMS LLC Boston,MA 02110 WAL1'ER R.WARREN ��� 250 GREAT WESTERN RD.UNIT B F"�nee", +k Not valid without signature SOUTH DENNIS,MA 02Gfi4! Undersecretary Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Constri tIbIt i rvi1sor CS-091653 -ritAsires:09/30/2022 WALTER R WARREN JR 1 40 ALEXANDER DR YARMOUTH PORT MA 02675 C Commissioner r'ti#t• i. GCwtt�+A. H _- W I u\ IFLIPPA W r' Ni- N q 0 3., (ppNPiEI ���333 © i � ROAD fiVN ROB a.. ,DAD Poro v r' N� M ppuUNs Z CCU O J ZO CV N Ne:_ a � Mr 11 ' E \ ,./. ,l,/ 3 \ c> �n �` /�� 1N0y , P pNC\k \r �p �/ c ° t� =OVA °ORN6 0-..1�'\E 1 is . `3p' i. "cp OD g ` 3 NE VV . ... D. xb O wn ,' COle -, Ply ] \ �.___ I ` I .I 33 yr" s i HVE O -T-`�-_- ONO4 '.. MERCHANT A`� ' (n I CO� , e it 8 Q {}�- 'agr H DENN\5 RD 44C:''''' Sp\'N O 3 3 a i o k''g X Z --,F]_.-__ 6, le a U a Ir 6p' O °pbd'sy._ _I I Z W o I U� J /: 414 I 3 MERCHANT P �- < it sti O H 6 ^�`� j Q 44 C� 3 0 Z 6 & .4A m r� I \ e z p m J'�V1yi q- OI. I 3 311 C i \/ 1 i W tit— yy NAtl[ ybl I h ti \\\ oo, n „, „ \ \ \ Npy 2 Z Z IZ % \ ` F ZZz W O -i, \.> z9zl old 1 ra LO1 - . ? m7 §TOWN OF YARMOUTH 1146 Route 28, South Yarmouth, MA 02664 508-398-22311 ext.. 1261 F x 508-398-0836 Office of the Building Commissioner 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 18 Australian Ave Yarmouth Port MA conducted at 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. 09e A, 4 0.)a4.44.4.-, 06/23/2022 Signature o f Application Date Permit No. • 1. , Sand Dollar Customs LLC Estimate 259 Great Western Rd. t Suite B Date Estimate# South Dennis MA 0245450 2 21 2022 1084 Name I Address Lisa Xtarhos $Austrahan Avenue Yanuouthport MA 02157i Project Kitchen Remodel DescA,p1ion Total Wbether you are in the cum km for Dew cousinictton,nnaddrnou a 700111 you'd hke te renovate we have the ability to work within your budget to provide the custom details to riuthe your home truly tunque We take great pnde in creaang one-of-a-kind homes our clients can be proud of Tata, ) Customer Signature i Page 4 ' The Commonwealth of Massachusetts 1 - l Department of Industrial Accidents •.�1= = 1 Congress Street,Suite 100 =fief= Boston, MA 02114-2017 4,,!, ' =i wwrv.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): Sand Dollar Customs LLC Address: 259 Great Western Rd Unit B City/State/Zip: South Dennis MA 02660 Phone#: 508-694-5618 Are you an employer?Check the appropriate box: Type of project(required): I.{ZI am a employer with 9 employees(full and/or part-time).* 7. New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. DI Demolition 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 El Building addition 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 11.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0Roof repairs These sub-contractors have employees and have workers'comp.insurance.* 14.❑Other 6.0 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.] *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. tContractors 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: Associated Employers Insurance Co. Policy#or Self-ins.Lic.#: WCC-500-5019721-2021A Expiration Date: 12/15/2022 Job Site Address: 18 Australian Ave City/State/Zip: Yarmouth Port MA 02675 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$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Oh .- A uJ , 94., Date: 06/23/2022 Phone#: 508-694-5618 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector b.Other Phone#: Contact Person: •,,t r •3t• 5 ,, .s i 5 'f. litls-cp 111' IX tt41 P 1 . 11 < f,r W iii 31 i 1AI i I ; 1 4 . Whe'ilL 'it,I.I._ !;3;,..f.„_,,s„ §,dc.,34 qei* lit gisql ' , I 6 0 < <,, R. x.• iltil.a ir.1 1 1 Ai. k lii Igtili 6:lig:It.!;tiii via ilt !:W14 P. 11!;lejIt,4-.. AttP4it$w;171itiVit114PP.11 h coRXM .7- ZW;:s. IN..14..1!••1:--1 loc-1."::,...7,7, :•.' 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Warren Jr. /Sand Dollar Customs LLC Address 259 Great Western Road Unit B South Dennis MA 0213re. #: 508-694-5618 Date Filed: 6/23/2022 RESIDENTIAL AND / OR COMMERCIAL BUILDING Water Department: Determines Compliance of Water Availability and or Existing Location Engineering Department: Determines Compliance for Parking and Drainage Conservation Commission: Determines Compliance to Wetlands Acts; i.e. If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Ocean, Bogs, Bays, Marshland, Etc... Health Department: Determines Compliance to State and Town Regulations, i.e., Requirements for Septage Disposal and other Public Health Activities Fire Department: Determines Compliance to State and Town Requirements for Personal, Safety, Property Protection;, i.e. Smoke Detectors, Sprinkler Systems, Etc... u2A-, c / 4y-, 22, 06/23/2022 Signature of applicant Date PLEASE NOTE: COMMENTS: Alp L X k1 5er li c-e involved( Reviewed by:Water Division Date Sears, TiM From: Sears, Tim Sent: Wednesday, July 13, 202 3:23PK4 To: SanddoUar[ustoms Subject: 18 Australian Ave V/1 have reviewed your application for the kitchen remodel and you will need Old King's Highway approval for the window change. 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