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HomeMy WebLinkAboutBLD-22-006105 i. ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department '`s :t 1.-In.,. .,. 1146 Route 28, South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 Massachusetts State Building Code,780 CMR %":b ,' Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Bu�'2, ;( Date Applied: " E D 17i 1-, N - APR 212022 Building Official(Print Name) ignature Date . ___ SECTION 1:SITE INFORMATION i BUILDING UE�'/�RTMENT 1.1 Property Address: -= !o 1440D5 1 , g-. 1.2 Assessors Map&Parcel Numbers 35.00 1.1a Is this an accepted street?yes x no Map Number Parcel Number e! Q 0 1.3 Zoning Information: �� . Property-Dimensions: / Z ('� Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards I R -_ D Required Provided Required Provided Required Ze, Li 7 2-c 3.c7 �) - 1.6 Water Supply: _ { pp y: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disp al y I 0 20�, Public Private❑ Zone: — Outside Flood Zone? Check if yes Municipal a On si e TE G7ATE NT SECTION 2: PROPERTY OWNERSHIP' By ______ 2.1 Owner'of R_ecord;'w A -""""-- 14-412.40 Name(Print) ty,State,ZIP t/ /0 t t Snzi Psi . L!13 - P,Lf- &33S foraK,vtle ric •c esi No.and Street Telephone Email Addrits SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction el Existing Building❑ Owner-Occupied W I Repairs(s) 0 I Alteration(s) El I Addition „lir Demolition ❑ I Accessory Bldg. 0 Number of Units I Other ❑ Specify: Brief Description of Proposed Work2M Ret401f.Q .f-ee Q(Att 2 WI WO S N �IJ cdA)S A/t-f v Stint(t S r? auto W(100ar c) SECTION 4: ESTIMATED CONSTRUCTION COSTS. "k, Item • Estimated Costs: /' OV (Labor and Materials) Use Only ON I.Building $Sit 01,0 1. Building Permit Fee:$ Indicate how fee is determined: 2.ElectricaI $ ®Standard City/Town Application Fee • . 0 Total Project Costa(Item 6 x multiplier x ��' 3.Plumbing $ 2. Other Fees: $ % C, ' 4.Mechanical (HVAC) $ 12' List: 5.Mechanical (Fire v Suppression) $ ® Total All Fees:$ /p Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ ❑Paid in Fula tJ Outstanding Balance Due: YIVI\22 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) G(/t WA 4444 �/tL/4. c D14q 7ZZ Z 26 z Name of CSL Holder `uuT License Number Expiratio Date /(05 AL'Jitc List CSL Type(see below) jNo,and Street A © Type I Description '/ �Z re� 144 �i 5 ?/ Cu) 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 9e-Se?,95e1 W n,6 !L�A�` iC�t SF Solid Fuel Burning Appliances Telephone r � I Insulation Email address D I Demolition 5,2 Registered Home Improvement Contractor(HIC) I t,tc¢wt g���SC c� i 3 7/� ( lo�q�z HIC Company Name or HIC e •strant Name HIC Registration Number Expiration Date I No and s�-eet tt g w()o gg Street 1�/� 023211 Email address City/Town,State,ZIP Telephone SECTION 6:WORKERS' COMPENSATION INSURANCE AFFI DAVIT(iYI.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 Cl • 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 Ith LL( f 0)}11¢ ( 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 ap lication is true and accurate to the best of my knowledge and understanding. AA Print Owner's or Authorized Agent's Name(Electronic Signature) 21 27i 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 nor 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.aov/d s 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) Gross living area(sq. ) 5 q (including garage,finished basement/attics,decks or porch) Habitable room count (n Number of fireplaces / Number of bathrooms Z Number of bedrooms Type of heating system a t, Number of half/baths p Number of decks/porches / Enclosed Open (/ 3. "Total Project Square Footage"may be substituted for"Total Project Cost" • -\ Mn The Commonwealth of Massachusetts �',tj�l..._ 1, Department oflndustrialAccidents S1 Congress Street, Su y* ite 100 • Boston, MA 02114-2017 :.rt 'V~f www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. A licant Information Name (Business/Organization/Individual) ( � - Please Print Leoibl 't A � i . rj Address: 1 G,5 fop(L 4 City/State/Zip: VI/ l- i e232' Phone #: 99? ",SOQ " 95r l Are you an employer?Check the appropriate box: Type of project(required): 1.0 l am a employer with employees(full and/or part-time).* 2 i am a sole proprietor or partnership and have no employees working for me in s7 ❑New construction !�any capacity.(No workers'comp. insurance required.] 8.1sykemodeling 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will )Q El Building ensure that all contractors either have workers'compensation insurance or are sole a addition proprietors with no employees. 11.Q Electrical repairs or additions 5.Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 1 Plumbing repairs or additions These sub-contractors have employees and have workers'comp. insurance.t 13.0 Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per�MGL c. 14.0 Other I52,$1(4),and we have no employees. [No workers'comp.insurance required.] *Any applicant that checks box m I 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. nn ,J Insurance Company Name: rA ,'# / I tt f C)Pc'zicY#° Self-ins.Lic. V —11'N 2, 1 P—2- Expiration Date: 5-- ! Za. Job Site Address: 0 puh n72r �, // Attach a copy of the workers' compensation policy declaration page(showing tthetpo icy number dZ��T Failure to secure coverage as required under VIGL c. 152, and expiration date), and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of upviolation punishable by a fine up o$250.00 day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA forto insurance a coverage verification. e I do hereby ce ti y� er the pains d p.nal,•e,f perju that the information provided above i true and correct.Slonature: A A.��_� ,L Phone#: O ') 4, i Date: `T 2 Z Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License r Issuing a Authority(circle one): 1.Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector Contact Person: Phone#: ONE or TWO FAMILY-- BULDING PERMIT APPLICATION REGULATORY APPROVALS NOTICE Address of Proposed Work: /0 04I b S/- A-mot Scope of Proposed Work: RQoyfkc kg,de c( 7 wiktiv s tl( j 12,C,pco t/r2utis quo5�ec�S /6 '5 Sfr�S— f'e/27/44 SGc ¢G�-- r Date: Based on the scope of work described above, the applicant is required to obtain approval sign- offs from the following departments as checked-of below: Health Dept. —508-398-2231 ext. 1241 Conservation —508-398-2231 ext. 1288 Water Dept. —99 Buck Island Road, 508-771-7921 Old Kings HWY, Hist. Comm. —508-398-22631 ext. 1292 Engineering Dept. —508-398-2231 ext. 1250 Fire Dept. — Kevin Huck/Scott Smith, 96 Old Main Street, SY Note: Please call Fire Department for an appointment. 508-398-2212 Other Appropriate plans and/or application shall be provided to each departments checked-off above. Each of these regulatory authorities has their own requirements outside the jurisdiction of the Building Department. All applicable approvals shall be obtained prior to submitting a building permit application to the Building Dept. Thank you for your cooperation. Receip kn ledgemen Applicant's Signature / ZZ (4) Atil4 �j i+LA5C tfT ,vraf -7>2 Da e Rev.Jan. 2019 01. TOWN OF YARMOUTH 4-. c) o BUILDING DEPARTMENT? 2 4���j3��4 1146 Route 28, South Yarmouth,MA. 02664 508-398-2231 ext. 1261 ss) HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE: JOB LOCATION: NAME STREET ADDRESS SECTION OF TOWN "HOMEOWNER" NAME HOME PHONE WORK PHONE PRESENT MAILING ADDRESS 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 shaU 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 1 - /she res. es or intends to reside,on which there is or is intended to be, a one or two family attached or det. hed s'4 cture as essory to such use and/or farm structures. A person who constructs more than one home in a t . yea; seriod sh not be con '11 ered a homeowner;such"homeowner"shall submit to the building official,on a f4� a 'eptable t the building • icial,that he/she shall be responsible for all such work •erformed under the bu' .a 'iermit. (S Lion 110 ' '. .). ) The undersigned `homeowner' . su f��respons' ility for •mpl'ance 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 APPROVAL OF BUILDING OPrICIAL 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:homeownrlicexemp §TOWN OF YARMOUTH 1146 Route 28, South Yarmouth, MA 02664 508-398-22* 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 I V t.M(j $71Z£'%- a) - Work Address Is to be disposed of oat the following location: Dv fi a 5116 PAdr Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. ` Signature of Application Da e Permit No. Commonwealth of Massachusetts _ Division of Occupational Licensure Board of Building Re ulations and Standards • Const ortr$ Isor st tP CS-049722 x spires:02/28/2024 WILLIAM F.$4 ;Wi 165 ALDRICFj:RD., .I a t ' BRIDGEWAII`62 NIA xop_ ' Commissioner ci'a a i . `tV n . f--- _ _ ¢¢ Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE,:Individual ReaistratAo Expiration 10/09/2022 WILLIAM F.BA ,s i 614 vk ;w s WILLIAM F.BALASC ` ) 1,/ 165 ALDRICH RD. .f � ^`��'� °lL BRIDGEWATER,MA '2i4 Undersecretary .. . . r Sears, Tim Fnonn Sears, Tim Sent: Thursday, June 16' 2022 12:42 PM To: VViUiano 8a|aschi Subject: 10 Midstream Or William, on provided and the plans submitted are not stamped by a Registered Design ofeion Profe al. Apchiteots and Engineersane required to wet�ompthe plans with their seal, the plans you submitted have n� �ve,manop. Please update and submit for review Tirnnthy Sears C'8O Deputy Building Commissioner I own of Yarmouth 508'398-I231 Ext. 1I59 !noi|to:tsears(cDya/mouth.moa.us 1 Sears, Tim From: Sears, Tim Sent: Tuesday, May 3, 2022 11:53 AM To: 'wfb99@comcast.net' Cc: Water Department Subject: 10 Midstream Dr William, \I have reviewed your application for the addition and there are some items needed. 11. Water Department sign off - \f\5 \'4"~- i Certified plot plan stamped by land surveyor showing proposed addition with setbacks 2 complete sets of plans with elevation drawings showing framing details that comply with section R301.2.1.1 including a 110mph checklist The use of sonotubes for footings will require plans stamped by a Registered Design Professional (section R403.1 of MA Amendments) 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 C Deputy Building Commissioner Town of Yarmouth 5O -3 -2.23 i. Ext. 1259 mailto:tsearsft varmouth.ma.us 1 TOWN OF YARMOUTH HEALTH DEPARTMENT • PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To he completed by Applicant: Building Site Location: 10 lit ' 5 /111V Cia12. Proposed Improvement: l C 4 3 5- -se-Ai . Fs ate Applicant: /, '/ Li�9�1�C. / t5)F- 9. 9rj�( W 1 �`// f�"��it� Tel. No.: Address: fOJ LDS// t / v 2 324 Date Filed: Y-),C **If you would like e-mail notification of sign off please provide e-mail address: WP6 y f e Ce)1/Gi 6407146# Owner Name: k > L W d( k Owner Address: tO //lkl, SMiAim., 1)-,/ Owner Tel. No.: y13' 8ZA . 1335 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. 7i3Tj Please submit three (3) copies of plans, to include: (1.) Site Plan showing existing buildings, water line location, APR 2 6 2022 and septic system location; HEALTH DEPT. (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: 27-'°)`� —�` PLEASE NOTE COMMENTS/CONDITIONS: _0 0 ' t �h;': - /2'l• . �%: _=20 ' " i•. -:2s:s :� " . -.0 a : - . ice'' -• - • •.: : - �� :- .- - ,' ' •.. -.f • • �^ r. • - ..: .. • _ 'i=• . . . :.•. •- s► -' ^ - - - .•1. .• � • �_ • I P a 4 �".. :.s'n • •• • c•- - - : _ r, �•;. • _ _.. •. •ice _ { ' _ 0 t!- n 'wry ' •' • '-. -- .. • .. _ - .. 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BOX 4 17 CENTERVILLE, MA 1 1 - Z L TEL: (508) 328-4692 EMAIL: trisweller@gmail.com REGISTERED LAND SURVEYORS $ ENVIRONMENTAL CONSULTANT" Traverse PC ' Ta i 3 jj i � 4 47_ _,-,-»,-«...,.-,.«. »»w, .>,. ,.w� ,. ,-- e•.s-..., k�s+ > • ' gg .w < kk j11, r i -3 y 8 E 1 d tit F7 ., ,r°= =.#' '�T,'..' .a �_ - ....:. ��_....., V ys �-..,�-",a�} t � tom• ,- N. ��:- i �,t e 1 F �, r t,.,^--..._..,..'S. w ?' •-.,*`:- b-ea }: .';F',.-1 '::-f iw.as* :.°'.. ,$,ip e>°;,3x#sa<°�vY _ _' az...e'^"_' eat„' 3 , r t t � z� - a • , t +W� f j i�� e. i✓ -"mot 3 �y:�w,i. ''Z"`<ra*r--:•.aa�,� i �,` rt � p. i. .�,�'• .z . #-� r A _.t . � :� - _, i ,q 6.:S - ♦,. _ ,. i .} ,. #,T" :� :=' •' Y z_'` .s--..• �as" ,i,:'+ Y_..,3.�,.t...�.,-..#.:�, <.,.., F .� , m.s...,.:a, ..:.e., , ¢...._.,w.. : , .,,,r�.,,�«, .... ,. ,_ .. ... , #.�. . , � �. � .' � ":�, : "` tit.'w^k "1 -. i•.. >_. - vTk i' _ �� f Y"' ... .v..ri+r'. %;.T-., :w" =a 's,. €'..e• ii T -•#�:. . 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