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Home My WebLink AboutBLDR-23-11062 p /4 0/Zil7J — E. ( POST FACTO ' ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department etc v • 1 146 Route 28, South Yarmouth,MA 02664-4492 till' 508-398-2231 ext. 1261 Fax 508-398-0836 Massachusetts State Building Code,780 CMR Building Permit Application Jo Construct, Repair, Renovate Or Demolish • , ' ..r... - a One-or Two-Family Dwelling This Section For Official Use Only ' LA el-te- ..1.3'.4, i"?C- Z-3 Building Permit Number: 6 LQR- - -II 0/Q2_, Date Applied: /---.:. 1 Ir-N (1' °\C 5 E I V F D ---- Building Official(Print Name) ature ire ih1 ate SECTION 1:SITE INFORMATION I 4 JUR 05 2023 1.1 Property Addressi, 1.2 Assessors Map&Parcel Numbers BUILDING DEPARTMENT L.1 B y .1a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: i C.) 1 0 . Zoning District Proposed Use Lot Area(sq ft) Front::e(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: Zone: .4 Outside Flood Zpne? Public El7 Private 0 Municipal E3 On site disposal system V Check if yesa" SECTION 2: PROPERTY OWNERSMPI 2.1_9wnerI of Record: , i ...Joey 42,444.cci.,‘ C) Wiv iirekoA4 t4a-ivq0LAR;t of)in) 02 6.7C— Name(Print) City,State,ZIP CO 41.I c.),*,S t. W:2-3 Y(- 277 b id 0‘.c5 i d)a.\-7 ceco Atccvot No.and and Street Telephone Email Address ... SECTION 3:DESCRIPTION OF PROPOSED WOW (check all that apply) New Construction 0 Existing Building 0( Owner-Occupied Ualtr"Repairs(s) 0 1 Alteration(s) Er/ Addition 0 Demolition 0 Accessory Bldg.0 Number of Units Other 0 Sped*: Brief Description of Proposed Work2: Ai, /A. Bf::L‘-k - SECTION 4:ESTBIATED CONSTRUCTION COSTS Estimated Costs: tem (Labor and Materials) Official Use Only _I 1.Building $ itS-00 I. Building Permit Fee:Sik00 Indicate how fee is determined: %a Standard City/Town Application Fee 2.Electrical $ "S.00 CI Total Project Cost 3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: S 4.Mechanical (HVAC) $ List: 3 C.'66 e,j(4- 3d-ie 5.Mechanical (Fire ('f.) Suppression) $ Total All Fees:S ' • Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ _s-bo 0 0 Paid in Full Ili Outstanding Balance Due: 3(r--- 0- , 611-1 1 i'l q SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS- I I Oce cel7c/P02 C—S" WS-C.) 1 License Number Expiration Date Name of CSL Holder List CSL Type(see below) 0 oi.tile"-ki No,and Street Type Description Uvv(avi Ti Unrestricted(Buildings up to 35,000 cu. R Restricted I ik2 Family Dwelling City/Town,State,ZIP M Masonry Llai wtocoft. .(Y/19- D2-(:;-7C- RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances bD2- 3&6-4z7 bcockslag-, 6---'comead:4,1i Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) - - _ 1 S ci-cl 7- -..)(,)-kcuktcz.AA i)t/kv/A41 D 1,6(441 tte-41,4-i. Inc Registration Number Expire'Oil Date HIC Company Name or HIC_, Registrant Name (-) NanStreet brOo'KS4rOg-.7(-601-41(Act i'‘424— o, d Email address k-laA vktc)LA)tti PO(1'; oz6tc%132„-3g0-4.a.-77 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 penny. Signed Affidavit Attached? Yes ..... Cl 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 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 coma this application is d accurate to the best of ray knowledge and understanding. k.V.7/23 /Print 0 er's or Authorized Agent's Name(Electronic Signature) Date NOTES: I. 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 ggl 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 wvvw.mass,gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/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" The Commonwealth of Massachusetts )11 eY Department of Industrial Accidents Et 1 Congress Street, Suite 100 N, Boston,MA 02114-2017 www.mass aciv/ditz •b •-4,401P" \Yorkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY, Applicant Information Please Print Leblv Name (Business/Organization/Individual):. cu. Lt\....Si ( Address:_ (-')0 CA vU Ovi (52C—f-S City/State/Zip: (-46-tAvvio t, art Mil Phone#: 662_- 3 Are you an employer?Cheek the appropriate box: Type of project(required): IC I am a employer with employees(full and/or part-time).* 7. 0 New construction 2.Erra-m a sole proprietor or partnership and have no employees working for me in 8. E- modeling any capacity.[No workers comp.insurance required.] 9, 1.]Demolition 3.0 I am a homeowner doing all work myself(No workers'comp.insurance required.]t 10 E Building addition 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. 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. 13.0 Roof repairs These sub-contractors have employees and have workers'comp. insurance.t 14.0 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. Other 152,§1(4),and we have no employees,(No workers'Corp.insurance required.] Any applicant that checks box 1,1 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, lain an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:_ Policy 4 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 andJor 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 certi under the pains and penalties of perjury that the information provtded above Is true and correct. Signature: , 64/leekeL Date: k.) Z3 _Phone 4: '47d - 3 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): I.Board of Health 2,Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6,Other Contact Person: Phone#: TOWN OF YARMOUTH tr• BUILDING DEPARTMENT 1146 Route 28,South Yarmouth, MA 02664 508-398-2231 ext. 1261 HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE: JOB LOCATION: 3?CV aVe.j>/L..5-/- 147/ri,-70 kik poi-/1 ---N STREET ADDRESS SECTION OF TOWN "HOMEOWNER" ,jefildAl\y/Lirt A),../ ~ 8(32-3cf)—CD77 NAME HOME PHONE WORK PIAIN4 PRESENT MAILING ADDRESS 2CZ ail IV) 5-/ %?frndalf-ll e6)47( friA 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.I.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 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 1 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 BUILDINGSFFICIAL 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:homeowndicexerap §TOWN OF YARMOUTH 1146 Route 28, South Yarmouth, MA 02664 508-398-223). ext.-1261 Fax 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 conducted at OO (Ativ(cYlas qaltviloultk 90(ei-, oft Work Address Is to be disposed of oat the following location: 44wtadiA I aumiTA SefaihdA Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. . 9 :nature of Date Permit No. THE COMMONWEALTH OF MASSACHUSETTS • ,> Office of Consumer Affa Business Regulation 1000 Washing -Suite 710 Bosto, , ;,: 4 118 Home Im ro; =- d. -e.istration Type: individual JONATHAN WILLIAMS , et f-lion: 185797 D!B!A J D WILLIAMS DESIGN E. .lion: 08/11/2024 200 UNION ST. `k' YARMOUTHPORT,MA 02675 " r�� Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Aff.;.-c,&Business Regulation Registration valid for individual use only before the HOME IMPROVE I„ tcONTRACTOR expiration date. If found return to: IT Office of Consumer Affairs end Business Regulation :1a a ii`.r 1000 Washington Street -Suite 710 wM "'g r N� : Boston,MA 02118 JONATHAN WILUAM : c r D/B/A J D WILLIAMS I JONATHAN D.WILLIA f' l 200 UNION ST. ' * a 1"` / '/d YARMOUTHPORT MA ' `` `'� ��" Undersecretary /r� i.._�"" �' Not valid without signature y Commonwealth of Massachusetts +® Division of Occupational Licensure Board of Building Re ulations and Standards Canst�onrS oervisor CS-110501 Epires: 06/20/2024 JONATHAN VfILLIAMS `- • 200 UNION STREET .� YARMOUTH PART MA 02675 r I vr)L11 {13 b V \ J \A( 1 L 1-i f\ 1 S 3b)( oo Urvi o n Pay- i D .1- i1 k,nts ti • — UJ rc s Ra v►1e dk ids vtlojrca, V ,o( 9a t'clef- n }} I ftvt v � � — OwEte_f"5 CYv St. c .,. 4 ' it; __ H a i C6 -0 ,. ri \A( I L L 11R(Y1 S aUt) U,nron St; o' Pa h-Q Ehae. n-C �s h — W r�PQS TYa v►�dL •i01S vlla-rc , Vapor r ff¢r L�P FI oacvraq inS{r ec t _J — 'lhst Lec.. 4 if d cit •