HomeMy WebLinkAboutBLD-23-000953 _ ONE & TWO FAMILY ONLY- BUILDING PERMIT
RECEIVED Town of Yarmouth Building Department
1146 Route 28, South Yarmouth,MA 02664-4492 ,stkelhin ---,,
a 508-398-2231 ext. 1261 Fax 508-398-0836 is
1 AUG 2 2 2022 Massachusetts State Building Code, 780 CMR "I
Bui i Permit Application To Construct, Repair, Renovate Or Demolish
BUILDING DEPARTMENT a One-or Two-Family Dwelling
By:
p \\ This Section For Official Use Only
• J
Building Permit Number: L.A 23`&x Date Applied:
1.--r-N SOk(5 --: ..--,..ci.,
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
,/ c�C'/ N
/I.1 Property /d�&/L /�
0., 1.2 Assessors Map&Parcel Numbers
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 I 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 El _Zone: Outside Flood Zone?
Check if yes❑ Municipal 0 On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record: /��/
£( ' Ats�iC 0.//
Name(Print) City,State,ZIP
r lealri 4t, /1.00 l/f/‘ hL v "disks" 2C04 44144 i 441 1 401.6,
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction a Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition a
Demolition 0 Accessory Bldg. 0 Number of Units Other ❑ Specify:
Brief Description of Proposed Work2: Q__ + / _ At O f) tit
I./ 4 2,,,.-„,„, /-z,z th chz_zz Wee-lz,, _Lenz.,„" \._1)./
SECTION 4: ESTIMATED CONSTRUCTION COSTS
\4'
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 1. Building Permit Fee:$ ISO _Indicate how fee is determined: v
2.Electrical $ ❑Standard City/Town Application I'ee
❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $ 3c cr I Lt.al
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire
Suppression) $ Total All Fees:$
/6.Total Project Cost: $ f Check No. Check Amount: Cash Amount: vq,'
�/ ! � 0 Paid in Full 0 Outstanding Balance Due: I V
SECTION 5: CONSTRUCTION SERVICES
5.1 Co r tion Supervi or License(CSL) /�7 �I j,� //1/2� D
/�/��` ',` 'Li c! i(�fA LiiiccensjeCN/umber(/b Expiratio ate /70��
Name of CSL Holder
/04 /J_, t/ List CSL Type(see below)
No.and S eet Type Description
f //4kGt t //. d Unrestricted(Buildings up to 35,000 Cu.ft.)
rir t Restricted I Q&2 Family Dwelling
/ City/Town,State,ZIP C'ICl Masonry
✓ RC Roofing Covering
WS Window and Siding
9f�'}}fj /J/���YJy ` SF Solid Fuel Burning Appliances
`I L /% '</ K S./,./yQ�., I Insulation
Telephone Email address `L D Demolition
5.2 Registered Home I/mprovent Contractor(HIC) l ?���r
�G !r!¢/LC Jl�fi,t, HIC Registration Numberwa,..„..„
HIC ompany Name or HIC Registrant Name
No. an trreeet 4,,,410,a044_,Afq L`d`'L,
/ / , -.2-r'r29,EEmail address
t/ City/Town, State,ZIP elephoTne "b
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 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
to act on my behalf, in all matters relative to work authorized by this building permit application.
4...e 7*--WO ril t‘er ,2 2_
4-7 Print wner's ame(Electronic Signature) Da
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 this application is true and accurate to the best of my knowledge and understanding.
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.aov/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.) (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"
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The Commonwealth of Massachusetts
Department oflndustrialAccidents _
��'� � i 1 Congress Street, Suite 100
Pi
fir,, Boston, MA 02114-2017
`�,;,=�•'�y www.mass.gov/dia
\Yorkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): IC g/
Address: gP2 �4/ ,-t #1:
City/State/Zip: /17frAtli,/1 f Phone #: rot pies---- 2 — '
Are you an employer?Check the appropriate box: G.J
p Type of project(required):
I.❑I a. mployer with employees(full and/or part-time).*
7. 7 New construction
2 am a sole proprietor or partnership and have no employees working for me in
any capacity.[No workers'comp. insurance required.] 8. Remodeling
3.❑I am a homeowner doing all work myself. [No workers'comp. insurance required.]t 9. ❑ Demolition
'4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 El 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
5.0 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 13.0 Roof repairs
6.❑We are a corporation and its officers have exercised their right of exemption per iNIGL c. 14.El Other
152,§1(4),and we have no employees. [No workers'comp. insurance required.]
*Any applicant that checks box 41 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.
1Contractors 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.
v 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 ' =orm of a STOP WORK ORDER and a fine of up to$250.00 a
day against the violator. A copy of this statement be fo rded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify tt� ,ains and pen ties erjury that the information provided ab/22
ue and corr t.
lQnature: ,x,
2,Date: �/
Phone#:
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#:
TOWN OF YARMOUTH
_ BUILDING DEPARTMENT
1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1261
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
DATE:
JOB LOCATION:
AME STREET ADDRESS SECTION OF TOWN
"HOMEOWNER"
N` LE HOME PHONE WORK PHONE
PRESENT MAILING ADD: SS
CITY OR TO STATE ZIP CODE
The current exemption for `Romeo ner' was extended to include owner—occupied dwellings of one or two units
and to allow such homeowners to enb.ge an individual for hire who does not possess a license,provided that such
homeowner shall act as supervisor. ( ,.te Building Code Section 110 R5.1.3.1)
Definition of Homeowner:
Person(s)who owns a parcel of land on whic' he/she resides or intends to reside,on which there is or is intended to
be, a one or two family attached or detached st i cture assessory to such use and/or farm structures. A person who
constructs more than one home in a two-year pe 'od shall not be considered a homeowner;such"homeowner"shall
submit to the building official, on a form acceptab e to the building official,that he/she shall be responsible for all
such work performed under the building-permit. ( -ction 110 R5.1.3.1)
The undersigned `homeowner' assumes responsibilit for compliance with the State Building Code and other
applicable codes, by-laws, rules and regulations.
The undersigned 'homeowner' certifies that he / she unde tands the Town of Yarmouth Building Department
minimum inspection procedures and requirements and tha 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, whi meets the requirements of MGL
Ch.142. Yes No
If you have checked ves, please indicate the type coverage by checking the approeriate box.
A liability insurance policy Other type of indemnity Bons
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the ins, rance 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
I �w
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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 th propos d work/demolition to be
conducted at Aô
l
Work Address
Is to be disposed of at the following location: C�e)c/ 7'
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
///:
Signature of Applicant
Date
Permit No.
Commonwealth of Massachusetts
Division of Professional Licensure
��" Board of Building Regulations and Standards
ConstructiopSD e {i40p,1 & 2 Family
CSFA-106219 6„,pires:06/28/2023 •i
MICHAEL SILVA
82 WALTON AVENUE • ',
HYANNIS MA 02601 `" •r .
1()►.ti'ti 13(ft
Commissioner daida, K. F..,d,.
• Off oyQonsm»aratrg
HOME IMPROVEM NT CONTRACTOR on
TYPE:Individual
ggistrafion Exu_ 'r`tion
175708 06/03/2023
MICHAEL SILVA
MICHAEL D.SILVA
82 WALTON AVE.
HYANNNIS,MA 02601
• Undersecretary
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•
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Michael Silva
82 Walton AV.
Hyannis Mass.02601
CSFA106219
Wayne and Kathy.Twombly Bathroom Remodel.
44 Clover Rd.
Yarmouth,mass.
Description of work. Remove old toilet vanity tub. Drywall on walls. Remove flooring. Relocate toilet
New plumbing vanity Install new drain shower. New plumbing for bathrooms will be paid for
by home owner. Install new lighting. Recessed lighting. Medicine cabinet. Electrical will be paid.
By home owner.Then install new insulation in the wall per building code. Install new tile
backerboard on walls and floors. Install new rubber pan For shower. Install new tile on walls.
And floor of shower Floor of bathroom .All labor installation of tile Supplied by Builder.Tile will
be paid for by homeowner. All plumbing fixtures will be supplied by homeowner. All tile will be
supplied by homeowner.This proposal includes painting. Installation of sheetrock, installation
of tile backer Tile backer will be supplied by builder.Sheetrock will be supplied by Builder.
Toilet will be supplied by homeowner. Michael Silva Retain building permit for the project.And
schedule all inspections to according schedule.Total cost for plumbing.$5500. Budget price.
Total cost for electrical. 2500 Proposal includes.All painting trim and walls inside bathroom.
Total cost. For builder.Will be. S12,400. Payments as follow. 1/3 to start. One third one tiles
install one.The rest when finish.
- i3
-
,...; Kathy Twonmbor
r
M e Si a ' Wayne Twombly
Bathroom Length 96"
w
Tio a ea
34 2" Vanity 30"x22" d
t
Shower 32"x60" h
Open floor 64"x38" Door 36"
6
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