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HomeMy WebLinkAboutBLD-23-000149 fug/ft/02, RECEIVED —aim & TWO FAMILY ONLY- BUILDING PERMIT 1 JUL ()8 2022 j Town of Yarmouth Building Department ;'oF r 1146 Route 28,South Yarmouth,MA 02664-4492 ; L___. _ 508-398-2231 ext. 1261 Fax 508-398-0836 ' BUILDING DEPARTMENT Massachusetts State Building Code,780 CMRe By _ — - Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: 13(j-23—( I L 9 Date Applied: Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Pro erty Address: 1.2 Assessors Map&Parcel Numbersrs 7r c 11v--0 Lc' Ll' Q 1 1.1 a Is this an accepted street?yes N. - no Map Number Parcel Number 1.3 Zoninz Information: 1.4 Property Dimensions: r Zoning District Propo se Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required I Provided Required Provided ��Reequired Provided c 1 c �`l �� t�1< � lY < « i' fRr1-lc, 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public Private 0 Zone: Outside Flood done? !vlunicipal❑ On site disposal system 'Ix Check if yes /` SECTION 2: PROPERTY OWNERSHIP' ?`4'*C.\ Cn ee)ef-DIoI :Y: KI t,1r-F-4 NCtrrrirt-khMA c&(G7<3 Name(P int) City,State,ZIP _7a I C r Ltn L ,tcerFlAto, r j . ‘c cto &.cc i ct n No.and Street Telephone Li Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 I Existing Building 1 Owner-Occupied ❑ I Repairs(s) 0 Alteration(s} I Addition Demolition ❑ 1 Accessory Bldg. ❑ Number of Units Other 0 Specify: Brief Description of Proposed Work2: cte>L CV itA'l rs-c-`T r Vnc-CMCIM - SECTION 4:ESTIMATED CONSTRUCTION COSTS. Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building Sc. 1. Building Permit Fee:S I co Indicate how fee is determined: � `/. ❑Standard City/Town Application Fee 2.Electrical $ c)l ❑Total Project Costa{Item 6)x multiplier x (4j 3.Plumbing $ 2. Other Fees: $ 35- C .k$ -(p 3 l 5 C' 9)\' 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire • Suppression) $ Total All Fees:$ ' 0 Check No. Check Amount: Cash oRI nt:i .A, 6.Total Project Cost: $ I,/� y^� 0 Paid in Full 0 Outstanding Balance ue: '� \c SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) �1f _�� 3/� )`A O �)__ License ~�e Number Expiration /�Date Name of CSL Holder ir. C) 'tCA1 c- Ci List CSL Type(see below) No.and Street Type Description r\)`Ltc�r1 i ' t� /� C .7;I _ U I Unrestricted(Buildings up to 35,000 Cu.ft.) 1 t t l " 1/ l t`?� �l R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC I Roofing Covering _ • WS Window and Siding aD6.2f 1 kLc: Q._, , ` SF Solid Fuel Burning Appliances r). se 2�� 1�� 1: C1n I Insulation Telephone Email ddress D I Demolition . 5.2 Registered Home jImmprovement Contractor(HIC) 1 aiA7`[_ , 81 I�lrq9) t (�`l �►' �� ��� � 1-, 1 I` x t - HIC Registrattion`Number Expiration Date RIC Caompany N C C Registrant Name 1� /� �,^,� ©(andS�tre�et C ems, CATIOC,0-< `nl�l �� 1I u1 .�P MA0-9: 11 r32�) Email address� 1��yt c,CITY) City own,State,ZIP Telephone 1`i 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 Issua ce 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 BUILDINGI PERMIT I,as weer o4f the subject property,hereby authorize EciL- 1 ' j 1 �_ n-c c ei j to act on beha :. all matters relative to work authorized by this building permit application. ` — "1 �. h/mob"Irgc 'tint Owne' k :lectronic 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 contained in this application t`s and accurate tote my knowledge and understanding. l'9C Pr' er's or Authorized 6nt's Name(Electrons ' eivrcT 1 Date I. 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.eov/oca Information on the Construction Supervisor License can be found at www.mass.aov/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 508-398-22311 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 `l 71 \\lr r n Work Address Is to be disposed of oat the following location: \lar h, X.'tflicia Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. /(93 aC is Date T D Permit No. Corianonvvealth of Massachusetts Division of Professional Lit ensure, Bt>ar; Budding Regulations and Standards Coflstruttii t`Sti ervisor CS-070177 Fxp r„ns:0513012C23 EDWARD E SHED 20 DOTEN RD PLYIViOUTH MA 02360 y , Commissioner Office of Consumer Affairs and Business Regulation 1000 Washington Street-Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Corporation Registration: 124769 SHEA CUSTOM CARPENTRY,INC. Expiration: 08/19/2023 20 DOTEN RD. PLYMOUTH,MA 02360 Update Address and Return Card. Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid,for idual use only TYPE:Corporation before the expiration date.if found return to: Registration gxoirtti4n Office of.Consumer Affairs and Business Regulation 124769 08/19/2023 1000 Wasingtun Street -Suite 710 SHEA CUSTOM CARPENTRY,INC. Boston 2118 EDWARD E.SHEA 20 DOTEN RD. 1;4,7...97" ja/ " PLYMOUTH.MA 02360 Undersecretary Not valid without signature The Commonwealth of Massachusetts A_' ..,_. t Department of Industrial Accidents atw I� " , 1 R Congress Street, Suite 100 ' Boston,MA 02114-2017 ., www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information PIease Print Legibly Name (Business/Organization/Individual):�c n(i(fey -\a , t Address: iry 1 /Cii Stafie/Zi �' i7:PLII I , '�n, ,( ' l}one#: r±rf `c_ ' (x'}0 Are you an employer?Check the appropriate box: Q,� Type of project(required): 1. am a employer with _employees(full and/or part-time).* 7. ❑New construction 2.0 1 am a sole proprietor or partnership and have no employees working for me in any capacity.[No workers'comp.insurance required.] $• ❑Remodeling 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]f I. Demolition 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will I0 ❑ Building addition ensure that all contractors either have workers'compensation insurance or are sole proprietors with no employees. I 1•0 Electrical repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 12.0Plumbing repairs or additions These sub-contractors have employees and have workers'comp. insurance.[ 13. Roof re airs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other " 152,§I(4),and we have no employees. [No workers'comp.insurance required.] 1 *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 1 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. iTh(11 Pc) Insurance Company Name;�. c ',-;Policy#or Self-ins.Lic.k:)C, ,r, -Y P c .3 tlAExpirationDate: F,,inrN 4:9—;? Job Site Address:? �\��r v ,` Attach a copy of the workers' compensation policy declarationpage 1 City/State/Zip: � �� p (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$250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify rig a p enalties of perjuritat the it formation provided above is true and correct Signature: 'C Date: Phone T: _ C, .- Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License r Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) "' 09/02/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND. OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 00509-001 (CONTACT INAME: Branch 509-1 I(PHONE-.- ._..... Baldwin Krystyn Sherman Partners LLC dba RogersGray Inc, I(A/C.No.Ext): (800)553-1801 (508)398-0246 RogersGray Inc � .No.: 434 Route 134 qpk ss: mail@rogersgray.com South Dennis,MA 02660 INSURERMI AFFORDING COVERAGE NA)C$__ INSURER A: Associated Employers Insurance Company 11104 INSURED - - Shea Custom Carpentry Inc ,INSURERS: INSURER C: 20 Doten Road Plymouth, MA 02360 INSURFRD: !j INSURER E: ' I INSURER F _-_ COVERAGES CERTIFICATE NUMBER: 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. LTR INSR TYPE OF INSURANCEpp p C P ADDLSUBR __—_— INSR_W1/D POLICY NUMBER (MMIDDIYYYYI'tM1MlDDyYYi LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES1Ea occurrence) $ CLAIMS-MADE OCCUR MED EXP(Any one person) $ -- PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEM_AGGREGATE LIMIT APPLIES PER: — PRODUCTS-COMP/OP AGG $ POLICY VT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident $ UMBRELLA LUAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS MADE AGGREGATE $ yyp�KDEEpDg p� ERNETpEN�TIIOON$ AND EMPLOYERS'LIABILITY ._ ... _-- -,_.-- T O $ NY Rp R�E''pR q�7NEq/ ��µµ x TJ'nu s . /� OFF�GER,PMEAAI3ER�EXCLUDED?�UTIVE Y(-"I N/A WCC-500-5023002-2021A 8/28/2021 8/28/2022 E.L.EACH ACCIDENT $ (Mandatory in NH) 1,100,000.00 d d E.L.DISEASE-EA EMPLOYEE $ 100,000.00 6 sCF1r1§1�r s OF OPERATIONS below E.L.DISEASE-POLICY UMIT $ 600,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is P required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25(2010/05) The ACORD name and logo are registered marks19 ACORD ACORD CORPORATION.All rights reserved. Sears, Tim From: Sears, Tim Sent: Tuesday, July 19, 2022 12:57 PM To: office sheacustomcarpentry.com Subject: 72 Silver Leaf Ed, I have reviewed your application for the basement finish and there are some items needed. Finished ceiling height on plan 2. 4% natural ventilation calculation or specs on air exchanger 6\hPI R V Please submit these items for review f V - 0 4 V C I 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. I imothy Sears CBO Deputy Building Commissioner Town of Yarmouth 508-39 -2231 Ext. 1259 mailto:tsears@yarmouth.ma.us 1 ONI TOWN OF YARMOUTH c HEALTH DEPARTMENT PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To he completed by Applicant: Building Site Location: 1(9 cs31\\.jcv 'tc....4- ../j--P t Proposed Improvement: % ' "C `' c✓�' I"r -- ' 4(AA , Applicant: �.... T'� k I ,,' j L Tel. No.. � L Address:" '- J Cf : '� ' `"''c c A-) MA Date Filed: 7 **Ifyou would like e-mail notification of sign off,please provide e-mail address: Owner Name: x ctr-\ \cl _u� \� Owner Address:79 e, r t\..11i0'--t \- Owner Tel. No.: 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. REVIEWED BY: DATE: 7 - PLEASE NOTE COMMENTS/CONDITIONS: flIH'flil *@7` lgis k a ( \ }/ ( % [ a k -\ —i }ogg gia ■ ( 0 p ■ ck \I - ( q. SJI 2 2 2 ri '"c'N 5e.nt 7, e ` L ^ . 7 \ | - - - - \ ''I @ : . ? ® ti 2 § � , /""*.) ! ` a E & � - 7 0- 2 -\ \ ! ' » - 2 a c.~ , 7 « 2 © 2 2 3 \ , —• t � § a - Q Q r on . > m q 0 • zm Y m - q k ■ > m � � ■ 2 RI - % c 2 ` i. , \� � - �. Q 9 z. 5 \ e / A/ ? / . - »-0�4 . 1O e� | / • \ e@4 Vim ' • f: .T -0. Y«r.1r... m.... APO TN10 I .. Mw_10...1.4.14 rL 1 ayd� - I. AMP, :7H5"l f.Y ttlitR�tllit Cblt K. t , .. . i iOK lc.Tr cur0 r-- , 1 ..,.t,y•y_,W. la k'Irc.__i,.f¢ F, �'M k P.'r.i. .r.a- I rl rtYV N. 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