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Home My WebLink AboutBLD-22-004958 - pm e/2Q zz__ R E C E I VIEsID ' TWO FAMILY ONLY- BUILDING PERMIT MA $ Town of Yarmouth Building Department QF 1146 Route 28,South Yarmouth,MA 02664-4492 . 22 508-398-2231 ext. 1261 Fax 508-398-0836 ti Massachusetts State Building Code,780 CMR BUILQI A ! g,PermitApplication To Construct, Repair, Renovate Or Demolish By - — -- a One-ar Two-Family Dwelling This Section For Official Use Only Building Permit Number: 13(-b--2.2-01 �g 1 Date Applied: /l ignatur -7-3 ,11.1. -c- ..;22_ fft Da e wilding O �t tPrintName) SECTION 1:SITE INFORMATION • 1Propety,d rs / V 1.2 As essors Map&Parcel Numbers .1� rtIITA a . G.r moil rs 1.1a Is this an accepted street?yes \l no Map Number Parcel Number 1.3nZoning Information: 1.4 Property Dimensions: i. 1 .1 - 0 Zoning District Proposed Use Lot Area(lq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required I Provided R eq 1.6 Water Su 1PpY 1 (M.(M.G.',c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Municipal 0 On site disposal system Public Private 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.X . weer` Recrr Q 1 (k,,1 -.- Qa6??o_, , _ ( Ja City, tale,ZIP 1 (`lame( r:nt) qua• )_a oi)cctiz A P. o ► x7 1 No.and Street elephone Email Address V i i . ("Qr." SECTION 3:DESCRIPTION OF PROPOSED WORK"(check all that apply) tl New Construction 0 I Existing Building 0 1 Owner-Occupied ❑ i Repairs(s) 0 1 Alteration(ss Addition 0 Demolition ❑ I Accessory Bldg. 0 I Number of Un-s a Other 0 Specify: z d (` Y-n i Brief Descripti of Proposed�Nork : `e1l for) _f R ._, PAS, Lt�_V ► e P_Al . SECTION 4:ESTIMATED CONSTRUCTION COSTS. . Estimated Costs: Official Use Only Item (Labor and Materials) $ l a� Indicate how fee is determined: I.Building 1• Building Permit Fee:$lip 1 0 Standard City/Town Application Fee _ 2.Electrical $ ❑Total Project Costa(Items x multiplier x 3.Plumbing $ 2. Other Fees: $ , CA,A_j( . 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Total All Fees:$ tc � 1 Suppression) \Vv Check No. Check Amount Cash Amount: 6.Total Project Cost: $ I oZ- 0 Paid in Full l-4 Outstanding Balance Due: 4) SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) (Cn� '(1G R••� TQ License Number Ex ratio Date Name of 'L Holder I Pc �x ��q List CSL Type(see below) U No.and Street Type Description R 0).c)(01 �� {� U Unrestricted(Buildings up to 35,000 cu.ft.)�l ln��J R Restricted 1&2 Family Dwelling City wn,State,ZIP ) lvi Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I am It.00-0 I Insulation elep one Email address D Demolition 5.2 Registered Home22 Improvement Contractor(HIC) 3a5U a P-p- €1( IJ H l.C,l' ' i HIC Registration Number Expirat on Date Io ants- e ' tr t Name Ni". CI n n' r�� D2r J,( S/ �3 tyLi(i, mail address CityfTbwn,State,ZI N Gv l.o Telephone "6 SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(NI.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 X No 17 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 R (1-C.i a "vl to act my behalf,in all matters relative to work authorized by th building permit application. cu t__t 0 go a__ 119e-r- Sec). ---- 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 coned in this application i true and accurate the best of my knowledge and understanding. .;( 0 Q 2 g/c3-D-- Print Owner's or Authorized Agent's Name(Electronic Signature) 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 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 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 BUILDING DEPARTMENT 6 ' °� 1146 Route 28,South Yarmouth,MA 02664 508-398-2231 ext. 1261 HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE: JOB LOCATION: J c1 " 0 WI Cl OM� k NAME STREET ADDRESS SE ON OF TOWN "HOMEOWNER" NANAME � HOME PH�!]VE � W�} li PHONEA O 3 PRESENT MAILINTG ADDRESS � 1 (� I 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 require that he I she will comply with said procedures and requirements. HOMEOWNER"S SIGNATURE APPROVAL OF BUILDING OFFICIAL INSURANCE COVERAGE: I have a current liabili ranee policy or its substantial equivalent, which meets the requirements of MGL Ch.142. Yes No If you have checked ves, ease 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. heck on : Signature of Owner or Owner's Agent Owner Agent h:homeownrlicexemp §TOWN N 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 Pl R 4illY1 1 Work Address 'n location: Vanyrouil XiLposaJIs to be disposed of oat the follows g Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. 3 -2 ac , ignature App 'cation Date Permit No. Fallon,Rosa From: New Look services <newlookservices@gmail.com> Sent: Tuesday,March 8,2022 10:07.AM To: Fallon,Rosa Subject: 32 Alton Rd. Attention!: This email originates outside of the organization. Do not open attachments or click links unless you are sure this email is from a known sender and you know the content is safe. Call the sender to verify if unsure. Otherwise delete this email. Sent from m V .:.4.momwr11A of MAD,R NAM,. O.chnrt+.r 1,+fNMi1wr )1il'U-,1044kgjpr... r337. 8 Upon 07,03,2021 RO 10014 paao sox lrlw M7Ni fI&U Etpt COMM1664004 ./4i —ev,wrrevezevi////, r r�/viri�trrr/iri3 /✓.' Office of Consumer Affairs and Business Regulation 1000,��sWashington Street-Suite710 OYll1Qr itiassac 1u14ttltti Q21`Ili Home Improvement Coltzattor Registration Typo. Imeliwittual R t,ldgm 'WM ROGER E Mr 1 EApir4COM: 020/1702 J ti%A NrAAI CONSTRUCTION Q.6t}x t}41 PrivothrS..PM 0200 upArw AEON**Awl"tabor'Cwt. 1 • . jt, 2 � The Commonwealth of Massachusettss, IDepartment oflrtdustrialAccidents V�� lip I Congress Street, Suite 100 kl 2 r Boston,MA 02114-2017 ,r +•'. www.mass.govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH TUE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): Vcrri Cf-xaki ftInn Address: pc x /743 City/State/Zip: Fiti a n()is Phone : ��) Li tpoAre you an employer?Check the appropriate box: Type of project(required): l.❑1 am a employer with employees(full and/or part-time).* 7. !f New construction am a sole proprietor or partnership and have no employees working for me in $.Remodeling any capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t9 Q DemOlitlon 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 0 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑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 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. ;LI ❑Other 152,§I(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box�1 must also ill 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. 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.Lie.ii: 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. I do hereby certify under the pains and penalties of perjury that the information provided ab ye is rue and correct. 'J _,- / ,....._ --- 3 Signature: i•' Date: Phone#: ) `I ' q,q. "I r 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): I.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone 4: SO'4 iy TOWN OF YARMOUTH 4 HEALTH DEPARTMENT ..,., ... ..i.,:.1 ,.... — . .../. — PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET I IX I;.0101lese•••• , To be completed by Applicant 5 Building Site Location: 1 9 e-Z7C,"7 ki0 cVl Proposed Improvement: (741/6 i19C1 7-0 :_5? C-1/1 I Applicant: ;12 05&"1 gX61117 Tel. No.:-.5-Ce- 9-9‘.477 Address: Date Filed: **lfyou would like e-mail notification of sign off please provide e-mail address: Owner Name: Ci)i)ilt)Z0 6-0,9Z. 8e7i 7 1 Owner Address: (--),, ,t.?ft-y.01 ar e /0/ Owner Tel. No. 7457-76:2-. 9 RESIDENTIAL AND/OR COMMERCIAL BUILDING I I 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: 5 0 Q ,..4,414, DATE: . PLEASE NOTE COMMENTS/CONDITIONS: I i I 4.12 ........ • Z....,, <. 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