HomeMy WebLinkAboutBLD-23-000614 RECEIVED
AUG 04 2022
ONE &TWO FAMILY ONLY-BUILDING PERMIT
BUILD!N.3DEPARTMENT Town of Yarmouth Building Department ,-of .Y.
By:
---------- 1146 Route 28,South Yarmouth,MA 02664-4492
508-398-2231 ext. 1261 Fax 508-398-0836filni
Massachusetts State Building Code,780 CMR `'
Building Permit Application To Construct,Repair,Renovate Or Demolish
a One-or Two-Family Dwelling ""
This Section or Official Use Only
Building Permit Number: f 31 j7Y= 'j—•Ot(x jI I Date Applied:
/I T� .A(
Building Official (cam
S (Print Name) Signa re Data
SECTION 1:Si.rE INFORMATION
1.1 Property Adtlryss: Itv1.2 Assessors Map&Parcel Numbers
1.1a Is this an accepted street?yes ✓ no Map Number Parcel Num rR E C E ITV E 0
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft AUG-1 9 $022
1.5 Building Setbacks(ft)
Front Yard Side Yards R Y 'd T M E N T
Required I Provided Required Provided Required Provided
1.6 Water Supply: M.G.L c.pp y ( 40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private 0 Zone: _ Outside Flood Zone?
Check if yes❑ • Municipal 0 On site disposal system El
SECTION 2: PROPERTY OWNERSHIP'
;O 2.4 wner'of Recor
^y a/ss�! ff e!'-'' 6.--). y4_4,d'17( 4 4 O24h
Name(Prig City,State,ZIP
23 D bid M 47..4/ 07.E 2.0 76,0 Aid ,► /
No.and Street
d •e�s `7�9 t� Gp�
Telephone iv Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK (check all that apply)
New Constriction 0 ! Existing Building El Owner-Occupied 0 [Repairs(s) 0 I Alteration(s) ❑ I Addition 0
Demolition E3 I Accessory Bldg.0 Number of Units i Other 0
Specify:
Brief D cription of Proposed Work2:
,/� s- er--i) -e
�sty' sv.t/k2 r r.�r.-:.._.n
SECTION 4:ESTIMATED CONSTRUCTION COSTS.
Item Estimated Costs:
(Labor and Materials) Official Use Only
1.Building $ 1. Building Permit Fee:S
Indicate how fee is determined:
2.Electrical $ di Standard City/Town Application Fee
3.Plumbing $ 0 Total Project Costa(Ickm 62 multiplier x
2. Other Fees: $ L.( ,1.� 1
4.Mechanical (HVAC) $ List �T /
5.Mechanical (Fire
/ SlPFression) $ Total All Fees:$ • '
Check No. Check Amount: Cash , otmt:
5 TV,.
6.Total Project Cost: $ c 0 0
0 Paid in Full II Outstanding Balance D -: _
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
Name of CSL Holder License Number Expiratt non Date
List CSL Type(see below)
No,and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
City/Town,State,ZIP - R Restricted 1&2 Family Dwelling
M Masonry
•
RC _Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
Telephone I _Insulation
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'COIYIPENSATION INSURANCE AFFIDAVIT(&I.G.L.c.152.§25C())
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 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:OWNERI OR AOTI IORIZED 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 ?e .�
Agent's Name(Electronic Sipature) Date
NOTES:
I. An Owner who obtains a building ding 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.sov/oca Information on the Construction Supervisor License can be found at ww_ vmass zov/dns
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.t}.
Number of fireplaces Habitable room count
Number of bathrooms Number of bedrooms
Type of heating system Number of half/baths
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
Iti!..--4 = l Department of Industrial Accidents
if s"'�!� 1 Congress Street,Suite 100
- •�g
,� Boston,MA 02I14-20I7
�: www.mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information
PIease Print Legrbl
Name(Business/Organization/Individual): OW dies
7
Address: 7i; v D ld M �% .C7—
6 9--
City/State/Zip: A✓Mv a jrr 1�'1Iq' hoe 1 7 — � �D
Are you an employer?Check the appropriate ro riate box:
1. t am a employer with Type of project(required):
❑ employees(full and/or part-time).*
?❑I am a sole proprietor or partnership and have no em to7. ❑New construction
any capaciP Y working for me in S. ❑Remodeling
ty.[No workers'comp.insurance squired.]
3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition
4.t74 I am a homeowner and will be hiring contractors to conduct all work on my property. ;will10❑Building addition
ensure that all contractors either have workers'compensation insurance or are sole
proprietors with no employees. I i-❑Electrical repairs or additions
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,§t(A),and we have no employees.[No workers'comp.insurance required.]
*Any applicant that checks box gl must also fill out the section below showing their workers'compensation policy information.
I 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:
Policy#or Self-ins.Lic.#:
Expiration Date:
Job Site Address:
City/State/Zip:
Attach a copy of the workers' comp
ensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under ivIGL 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 certi .iiiiiiiiir•.- - ,at and penalties o j ry f per u that the information provided above is true and correct Si•na
Aill�/ Phone T: r Date: "' 'Z-0 7- z---
Official use only. Do not write in this area,to be completed by city or town offrciaL
City or Town:
Permit/License 4
Issuing Authority(circle one):
I.Board of Health 2.Building
6.Other o Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
Contact Person:
Phone ft:
TOWN OF YARMOUTH
so-
0 ��-,; BUILDING DEPARTMENT
n ^ , t1 1146 Route 28,South Yarmouth,MA 02664 S08-398-2231 ext. 1261
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
DA'i'h;: 3 `7'2--
JOB LOCATION: 23 /ii A( s% ,
/ NAME STREET ADDRESS SECTION OF TOWN
"HOMEOWNER" � X),`�' R2(r am ' — csi. �/r�i2.lZt z2r
NAME HOME PHONE WORK PHONE
PRESENT MAILING ADDRESS --5,954-2e b/-7 3 — v toy
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 R5.1.3.1)
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 SIGNA
APPROVAL,OF BUILDING O1-1-1CIAL
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.
Signature of Owner or Owner's Agent Check one:
g Owner Agent
h:homeown licexemp
§TOWN OF YARMOUTH
1146 Route 28, South Yarmouth, MA 02664
508-398-22311 ext.4261 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 230 D4J riJ/
Work Address
P following Yf1v21z'xi% aIs to be dis osed of a#the location: /4 �`'�'`� �-
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Ch. 111, §150A.
-' j
ign. i + -A'poication Date
Permit No.
Sears, Tim
From: Sears, Tim
Sent: Monday, August 15, 2022 3:56 PM
To: 'htpowers2@icloud.com'
Cc: Water Department
Subject: 230 Old Main
Harry,
I have reviewed your application for the deck and there are some items needed.
1. Water Department sign off
' .„,...„12. Footings are required to be 12" min. and 4ft below grade.
r.
3. Details of ledger connection to house need to be shown on the plan MkSmn )1,5 lAcil,‘
Please submit these items for review
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.
Timothy Sears CBO
Deputy Building Commissioner
Town of Yarmouth
508-398-223.1 Ext. 12.59
mailto:tsears@yarmouth.ma.us
1
::, �, TOWN OF YARMOUTH
tt
r HEALTH DEPARTMENT
Y
, '', (.- PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant.
Building Site Location:
2 3' a L.?7 rvi',n,/
Proposed Improvement: t 'C"� f k)-17-oe-r2) _r-/jF C=e Z iy? z__
0C-0/6 cam/,/_o<V c) T�1lO i--_p--
Applicant: ,-47470I`'y /90 k f�/G _C Tel. No.:6/7 ..3 —76 61 J.-
Address:-s Date Filed ` > 2�...
**Ifyou would like e-mail notification of sign off,please provide e-mail address:
Owner Name: 41 /c'l/�'�- V f 1 'i&l''_.s's,q Pic..i/r x7..r
Owner Address: —fie 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: 3 2- .>".• j
COMMENTS/CONDITI SS: PLEASE NOTE
1.20 1/1,- r(a<-e 5 P'v1 `( , c c vE.,✓"
• "00 2-- e'.2 /0; 1-r 04. ce714
r At N. OF\Ak
/871.7s4N
WATER DEPARTMENT
99 Buck Island Road
AA' si '"•
arm .iiih NIA 0267
771.7921 . Fax, f.-)fm, 771.7998
BUILDING PERMIT APPLICATION FOR
WATER DEPARTMENT SIGN OFF
TRANSMITTAL FORM
BUILDING SITE LOCATION: O 2-49 17-1,17111-1
PR()POSED WORK: getresz- iee-A...42.0E- 1 6X fre9i1:41
)49.
APPLICANT: 1
ADDRESS: *rtr4-
.__„
TELPHONE: 32"0 706 >if
RESIDENTIAL AND OR COMMERCIAL BUILDING
Water Department: Determines Compliance of Water Availability and or existing location
Engineering Department: Determines Compliance for Parking and Drainatw
Conservation Commission: Determines Compliance to Wetlands Act: i.e. If Ions)border any type of
wetlands, streams. ponds,rivers, ocean, bogs. boys, marshland. ETC...
I leak!' Department: Determines Compliance to State and Town Regulations, i.e.
requirements for Septaue Disposal and other Public Health Act i vites
Fire Department: I Mermines Compliance to State and Town Requirements for Personal
Safety. Property Protections. i.e. Smoke Detectors, Sprinkler Systems,etc
- -A PPI,I CA, SIG T
1).1,TE
OFFICE t. F,: CONINIENTS ON PERMIT APPROVAL 012 DENIAL
REVIEWED B WATER DIVISION(SIGNATURE)
DATE
‘10
....
WORK MUST CONFORM ro ALL
WN 8 t NS & REGULATiO S
Lfroir—
, lt'MUTH WATER DEPT 71,7 121)4r---
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