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HomeMy WebLinkAboutBLD-23-000815 . fa Ve2122, ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department :.• 'y 1146 Route 28, South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 Massachusetts State Building Code,780 CMR '�` Building Permit Application To Construct, Repair, Renovate Or Demolish _ ....., a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: D(,).13-OW K I,S Date App ' . RECEIVED Building Official(Print Name) Signature SECTION 1:SITE INFORMATION _ _ BUILuiNG DEPART MENT 1.1 Property Address: 1.2 Assessors Map&Parcel Number- By: _ n Kt&Ciir Wt‘elr104..1 9 . 1)t-1 - _ j 53 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 Rear Yard Required l 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 Private 0 Zone: _ Outside Flood Zone? Check if yes Municipal 0 On site disposal system SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Fri. 4- 1,1eictc e -5©0.)ruck, yc (mcv c--ict, 1-)t 01.cc;i_S Name(Print) City,State,ZIP 3-1 Viti- i i\ `MiC?ACA.ltt Qd 114*c 4''d53 ; .1;41=IG+r49 1 fro v Y1 taol5(3 Coi`hcal l- CC.M No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction 0 I Existing Building 0 I Owner-Occupied Ili 1 Repairs(s) 0 Alteration(s)'l I Addition 0 Demolition ❑ Accessory Bldg. 0 Number of Units Other ❑ Specify; Brief Description of Proposed Work2: c`i r(ltsr bc,,s t`cvQ k, , Gc A, tI Z S00,-Mr-c i,N'N SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: ' (Labor and Materials) Official Use Only I.Building $ 3,a co 1. Building Permit Fee:S ISO Indicate how fee is determined: 2.Electrical $ — IS Standard City/Town Application Fee riCEl Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ ,c`,co 2. Other Fees: S 4.Mechanical (HVAC) $ \„0 CO List: 3 s-,aI CIJ# 12-,4 i)\)1J 5.Mechanical (Fire Suppression) $ Total All Fees:$ - \ 6.Total Project Cost: $ Check No. Check Amount: Cash • /.a}�n5, 0 Paid in Full V Outstanding Balance D 1�t L 1 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number Expiration Date Name of CSL Holder List CSL Type(see below) No.and Street Type 1 Description U I Unrestricted(Buildings up to 35,000 cu.ft.) City/Town,State,ZIP R I Restricted 1&2 Family Dwelling NI Masonry • RC f Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D ' Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Company Name or HIC Registrant Name HIC Registration Number Expiration Date No.and Street Email address City/Town,State,ZIP Telephone SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(MYI.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 PERAIIIT 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 contained in this application is true and accurate to the best of my knowledge and understanding. uCiNit_5 3O'..)c (\At, Print Owner'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 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.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps <t , 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 5 Number of fireplaces p Number of bedrooms ,2) Number of bathrooms a Number of half/baths Type of heating system co (2, r Ok c .r Number of decks/porches i Type of cooling system ( c r\-\-cchtrm( Enclosed Open P `X 3. "Total Project Square Footage"may be substituted for"Total Project Cost" �---= • The Com monwealth of Massachusetts _�►ar Department ofIndustrialAccidents 1 Congress Street, Suite 100 li Boston, MA 02114-2017 ft.,' , www.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/Organiaatio ndividual Address: 1--1KGANAC>.Cks(1 V-A\C . City/State/Zip:\ICe CA(1UNt�� k„,tit o'r),CAS Phone #:-1`6 .-CXg- -11'a•% c,r 114 •O1c14, a5C9 Are you an employer?Check the appropriate box: Type of project (required): I.E I am a employer with employees(full and/or part-time).* ?.Q I am a sole proprietor or partnership and have no employees working for me in 7. ❑New construction 8• dRemodeling any capacity.[No workers'comp.insurance required.] 3.❑I am a homeowner doing all work myself. [No workers'comp. insurance required.]t 9. El Demolition 4.K/I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 ❑ Building addition ensure that all contractors either have workers'compensation insurance or are sole 11•❑Electrical repairs or additions proprietors with no employees. 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 12'❑Plumbing repairs or additions These sub-contractors have employees and have workers'comp. insurance.t 13.❑Roof repairs 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.] *Any applicant that checks box Ri 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. 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. 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 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. 1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: 41,Zeiy44.2.,. ' Date: ' 'a a Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License T 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 � ' �'AMf�IJTI�[ gyp; - BUILDING DEPARTMENT MATTAC,tE[s[f x,� 1146 Route 28 South Yarmouth, MA 02664 508-398-2231 ext. 1261 HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE: JOB LOCATION: oc cr .c —1 1c�V11GIn i-Akcccut 34. NcipmcMv\A9x NAME STREET ADDRESS SECTION OF TOWN "HOMEOWNER"Eft 4V1/42.1CAMr "S.,,,rneti 71-14 r►Gu'X)&La&A lii•-1OCD•"1-1a NAlvIE HOME PHONE WORK PHONE PRESENT MAILING ADDRESS 1 Viino :r\ VAtCWc4► Q.r1. _ CITY OR TOWN STA'a, 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 R5.1.3.1) 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/ 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 lif.P.Grcuu V,,gt-t4A-Ltk"--- APPROVAL OF BUILDING OFFICIAL 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 yes, 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:homeownriicexemp §TOWN OF YARMOUTH 1146 Route 28, South Yarmouth, MA 02664 508-398-22Y1 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 Th,k\AGA( .� VA C VOLSiX (LA , y�►t�Y1 , pGt 0 G\cam-is Work Address Is to be disposed of oat the following location: -Tpc�0 oc 'c OiUW\ Dj90SG 1 at c oc Fore ,V\O u Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. 9 - U: is Signature of Application Date Permit No. TOWN OF YARMOUTH HEALTH DEPARTMENT PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To he completed by Applicant: Building Site Location: 1.-4 \C)C\CL\ 12ct. \ICA-IAc.x..)V,n tpck , t_Avi Gg - 5- Proposed Improvement: \oots e'c'Ae y , 0.6 Z , ra v-' I o cry Applicant: H 't ra oC Tel. No.:`.s1 • -90 - Address:; -'v1C'ai .A,IC;.\i ) ..1 , co(y row \- \i ,tl, Date Filed: i 'a a • aa. **If you would like e-mail notification of sign off,please provide e-mail address:%�.\VY\Gq 5 C�(V1C5��1 . CO(Y) Owner Name: tvLikeAKILA .) ..)`Of '_k; Owner Address:'1 lKfi nctr 0 C.A.12A NoLANyz.ftOwner Tel. No.:-1S1• ` GCs,• 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; Jul 2 1 202? (2.) Floor plan labeling ALL rooms within building I (all proposed)HEALTH ®APT, existing and P P osed ) Note: Floor plans not required for decks, sheds, windows, roofing; • ((3.) If necessary, Title 5 application signed by licensed installer with fee. 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C 9 1 , rill I , ... )(' ''''\ 7/21/22,2:46 PM WhisperCeiling®DCTM Precision Spot Ventilation Fan,50-80-110 CFM I FV-0511VQ1 WhisperCeiling® DC, SmartFlow 50-80- 110 CFM FV-0511VQ1 FIND A DEALER ;01- ,i WhsperCiIin •ENTI lrION' N T https://na.panasonic.com/us/home-and-building-solutions/ventilation-indoor-air-quality/ventilation-fans/whisperceilingr-dc-smartflow-50-80-110-cfm? ai... 1/7 7/21/22,2:46 PM WhisperCeiling®DCTA4 Precision Spot Ventilation Fan,50-80-110 CFM I FV-0511VQ1 Advanced Features Single Speed Air Volume (CFM) 110, 111, 80, 83, 50, 53 Blower Wheel Type Sirocco California Title 24 Compliant Yes Current (Amps) 0.18, 0.26, 0.11, 0.18, 0.07, 0.13 Duct Diameter 4" or 6" Energy Efficiency (CFM/Watt) 10.6, 6.9, 13.6, 7.7, 12.5, 7.4 ENERGY STAR® Certified Yes Grille Size (in sq.) 13" Gross Weight (lbs) 11.0 MAX. Current (Amps) 0.27 Mfg in ISO 9001 Certified Facility Yes Motor Type (AC/DC) DC Mounting Opening (in sq.) 10-1/2" RESOURCES + Performance and efficiency perfected with precision spot ventilation fan/LED combo WhisperCeiling DC comes from a line of time-tested and customer approved quiet, yet powerful and energy efficient ventilation fans. This precision spot ventilation solution improves IAQ by effectively removing moist, polluted air from your bathroom, laundry room, sun room, basement or garage. https://na.panasonic.com/us/home-and-building-solutions/ventilation-indoor-air-quality/ventilation-fans/whisperceilingr-dc-smartflow-50-80-110-cfm? ai... 3/7 7/21/22,2:46 PM WhisperCeiling®DCTM Precision Spot Ventilation Fan,50-80-110 CFM 1 FV-0511VQ1 Panasonic ventilation fans are ENERGY STAR certified, where guidelines exist. They've been engineered to comply with the ENERGY STAR® 4.0 requirement for increased efficiency (CFM/Watt), ensuring low cost, energy efficient operation. 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F-- ---'--- cv • ...., 1 j pi 73, ) Go(6.9)F tt..•471 zr LP Cs I r-tn ir- .1 , v _ - 1 (ra 0 a (f) GO -,, • 9) ..0 --- C/3 c _ I r. ...- --0 1 1 SF Dr) --3 ---1 :, 0 in 3 9) Cf) cr c , V I m . •IP„ fr c1 —. 9-1 1-C 'r\ 1 I CA di, ("? Li•CP0. rN ...,93.., 2 el C, ....:C'tlIC ' 1.• ..... P V. .1:14.,..... ri v•-la. 4 ' 7 .1' -1• 9 3 Gs Fal 4.) (143 0 4 - 4.1 _ . ..0 i 0 i I , i )54 14) ) c r 4- 00...... er 17-... ... , 1 ,,. SO 1 I- J. )x \. c ..17c 4- 1— et- e ie ci __._ _ c+..— ,/ 0_ ,..4, , ,-(v r-r-^ 7/21/22,2:46 PM WhisperCeiling®DCTM' Precision Spot Ventilation Fan,50-80-110 CFM I FV-0511VQ1 S IAI t/NKUVINt:t - Select - v PHONE NUMBER* 1234567890 CATEGORY OF INTEREST* - Select - v PLEASE PROVIDE ADDITIONAL INFORMATION ABOUT YOUR INQUIRY HERE.* By submitting this form, you confirm you've read and agree to our Privacy Policy and Terms of Service. 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