HomeMy WebLinkAboutBLD-23-002539 plans R E C E 1 V ,p: TWO FAMILY ONLY- BUILDING PERMIT
Town of Yarmouth Building Department - "'v
40V O 3 2022 1146 Route 28, South Yarmouth,MA 02664-4492
508-398-2231 ext. 1261 Fax 508-398-0836
�._. � Massachusetts State Building Code,780 CMR
BUILDING DEPABuiidin� 'ermitApplication To Construct, Repair, Renovate Or Demolish „r...•
By: a One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: 1 'Z32_ 22 31 Date Applied:
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property A dress: 1.2 Assessors Ma &Parcel Numbers
U R� v). yARMN t)+ p
1.1 a Is this an accepted street?yes V 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 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 0 Private El
Outside Flood Zone?
Check if yes❑ Municipal 0 On site disposal system 0
SECTION 2: PROPERTY OWNERSHIPI
2.1 wnert of Recor
NCO 5 NI U , Immo ofk ►� 026 3
Name(Print) City,State,ZIP 1
3o G o k Rap& (50i)43-7,3 gao n7Q 90144E$ IA P991 e �jMA rdCo
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition ❑ Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief D scription of Propos_eda ork2: M'� y �j �f
)N17f6 > , fV1/4
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ 0 Standard City/Town Application Fee
0 Total Project Cost3(Item 6)x multiplier . x
3.Plumbing $ 2. Other Fees: $ Cl/CISJ - Cif
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire
Suppression) $ Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total Proje Cost, $a Q �� 0 Paid in Full 0 Outstanding Balance Due:
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 Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
City/Town,State,ZIP R Restricted 1&2 Family Dwelling
Ivl Masonry
•
RC 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 Registration Number Expiration Date HIC Company Name or HIC Registrant Name
No. and Street
Email address
City/Town, State,ZIP Telephone
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 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: OWNER1 OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
1/ contained in this applic0004—e—S
tion is true and accurate to the best of my knowledge and understanding.
3R0116 MAI A.
Print Owner's or Authorized Agent's Name(Electronic Signature) lac,Date
�Z�
e
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.2ov/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"
\
t The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston, MA 02114-2017
...5•` 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/Organization/Individual): Q, ,_&) j RDA Y={€ M
/ Address: 3'0 4 r\1-t- (,�� r"
City/State/Zip: u). VMAA0(1- . NJ/1-492 V Phone #:(/SoF / - 3 Z4 '
Are you an employer?Check the appropriate box:
Type of project(required):
I.❑I am a employer with employees(full and/or part-time).*
7. E New construction
2.0 I am a sole proprietor or partnership and have no employees working for me in
any capacity.[No workers'comp. insurance required.] 8. Remodeling •
3.X]I am a homeowner doing all work myself. [No workers'comp. insurance required.]t g C Demolition
4._I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 ElBuilding addition
ensure that all contractors either have workers'compensation insurance or are sole
11.E Electrical repairs or additions
proprietors with no employees. 7
5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 12'i I Plumbing repairs or additions
These sub-contractors have employees and have workers'comp. insurance.t 13• Roof repairs
6.❑We are a corporation and its officers have exercised their right of exemption per NfGL c. 14.C Other
152,§1(4),and we have no employees. [No workers'comp. insurance required.]
*Any applicant that checks box:1 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#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.
I do hereby certify under the pains and penalties of perjury that the information provided above isTZO2
ue and correct.
,/Signature: Ø4'WQ . ' V V I� Date:
l lgO Z
V
Phone#:1 50(jj 7-3 - 3Z4
Official use only. Do not write in this area, to be completed by city or town official.
City or Town: Permit/License#
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#:
Sears, Tim
From: Sears, Tim
Sent: Friday, November 18, 2022 8:25 AM
To: brunopontesmaia1991@gmail.com
Subject: 30 Grant Rd
Bruno,
I have reviewed your application and there are some items needed.
1. Rooms labeled on plan
2. Finished ceiling height shown on plan
3. Ventilation calculation per Section R303 or specs on air exchanger
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 C80
Deputy Building Commissioner
town of Yarmouth
50 -3 -2231 Lxts 1259
mailto:tsears@yarmouth.ma.us
1
.,,y R TOWN OF YARMOUTH
BUILDING DEPARTMENT
L" MTTC( sE $Q 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1261
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
DATE:
JOB LOCATION: 3o . -p - (`) itt-lvmosb4-
NAME STREET ADDRESS SECTION OF TOWN
-HOMEOWNER" QjIW tJ Q P. t4P4A (So? 3 2 41
NAME HOME PRONE WORK PHONE
PRESENT MAILING ADDRESS 30 Rid
v�.). .k R -
&u �f �, 0 26��
TTY OR TOWN STALE 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 0 to k7 et t,44/19
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:homeownrlicexemp
TOWN OF YARMOUTH ✓'
1146 Route 28, South Yarmouth, MA 02664
508-398-2231 ext. 1261 Fax 508-398-0836
Office of the Building Commissioner
BUILDING DEPARTMENT
DEMOLITION DEBRIS DISPOSAL AFFIDAVIT
Pursuant to M.G. L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111/5
I hereby certify that the debris resulting from the proposed work/demolition to be
conducted at 30 G( (N1t Rt U3. OO44
Work Address
Is to be disposed of at the following location:I(J Oc Y0N1444)1414 OIS( 0 - ,-L
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
P, ` 0/30/ 2022
Signature of Applicant Date
Permit No.
0t YAk TOWN OF YARMOUTH 1 - � HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location:
Proposed Improvement:
-j ±:cI C
Applicant: Tel. No. 5- S' z. 1 ra')
Address: . a ; ,}L /AR Date Filed: F'
**Ifyou would like e-mail notification of sign off,please provide e-mail address:
Owner Name:
Owner Address: Owner Tel. No.: 3C61
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: (12
'VDATE: /y 3 _ Z.
PLEASE NOTE
COMMENTS/CONDITIONS:.
I-
1 14'7:1
C\.,
(A.
,i)
,-,..
0 ....1.
q cc 1 0
i 4)
,.-..;..-
.'-'zr....."
47.6
r5 t
i .2-
0
-Zi 0.1
.5L.
L...7
--i i r f 1---
--
..4.._". i ....
r 1.•.0' .....-.4.44 1
2,..
-3 ....4 i
i
,
L'Illii i\D‘r) 8
§ 2.-
-
..-
8 1
2
....... 40....c
1 i
.3 1ce' 0
0•••••••.4
i
-i
r 1
AV) -JA4)
(...)..._.... .,„
,......) i ....-
Nt,
iT.---- ,,.... ,,,,4: I
-I. -
I
s-4
, i 1
004- 0
B (,litil,
. .,,
"2. .
,....4rt
.....
1
XQc) I 1 3,T
R E C E i VCEsTIP TWO FAMILY ONLY- BUILDING PERMIT
Town of Yarmouth Building Department .
NOV 3 Z�22 l 146 Route 28, South Yarmouth,MA 02664-4492 •
•
: ~ --.�
508 398 2231 ext. 1261 Fax 508-398-0836
-- -fy- Massachusetts State Building Code, 780 CMR ;'
g !u l,D' DEPA�ui(L ing rnzit Application To Construct, Repair, Renovate Or Demolish • o�#
By. a One-or Two-FamilyDwelling
This Section For Official Use Only
Building Permit Number:-2,?— 253c1 Date Applied:
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORtMATION
1.1 Property A dress: 1.2 Assessors Map&Parcel Numbers
GA•NrWt Qc 0• YANA°0+4
1.1 a Is this an accepted street?yes 1/ 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 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 0 Private 0 Zone: Outside Flood Zone?
Check if yes❑ Municipal 0 On site disposal system 0
SECTION 2: PROPERTY OWNERSHIP'
2.1 91,wilerl of Recor
Q0 NO €s J441O U1/4)E4 kfr ft MO L7 k A AA 0 Zb �
Name(Print) City,State,ZIP )
3o Gawk Ro,boD (501)43-1-3zGj t ga�14oc�or s IA '�991 e �jMArko
No.and Street - Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition ❑ Accessory Bldg. 0 Number of Units Other
Other 0 Specify:
Brief Dgscription of Proposed Work2: �1�D 4...- IV Roo M 1 pl.. i M ..AA{) e�'i.i (c' .A.
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 1. Building Permit Fee:$ . Indicate how fee is determined:
2.Electrical $ ❑ Standard City/Town Application Fee
❑Total Project Cost3(Item 6)x multiplier . x
3.Plumbing $ 2. Other Fees: $___Clit 3 C)
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total Proje Cost:J $a o < 0 Paid in Full 0 Outstanding Balance Due:
• 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 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
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(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 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: 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.
3 vNo 6A11-e-s /1/41AkAlk
��f I 2022
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.Rov/oca Information on the Construction Supervisor License can be found at www.mass.eov/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"
\ The Commonwealth of Massachusetts
� „�, Department of Industrial Accidents
�� 1 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 Please Print Legibly
Name (Business/Organization/Individual): ,1)r) eoN lam~' Mom,.
/
V Address: 30 6 (gip,1,-4•- O
City/State/Zip: u). ApMoO-l„{. A44-02673 Phone #:(So ' ) q3,2 - 3 2.4 I
Are you an employer?Check the appropriate box:
Type of project(required):
I.❑I am a employer with employees(full and/or part-time).*
7. New construction
2.E I am a sole proprietor or partnership and have no employees working for me in
any capacity.[No workers'comp. insurance required.] 8. ❑ Remodeling
3.X)I am a homeowner doing all work myself. [No workers'comp. insurance required.]t 9 C Demolition
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Li Building addition
ensure that all contractors either have workers'compensation insurance or are sole 11.❑ Electrical repairs or additions
proprietors with no employees.
5.❑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. We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other
152,§1(4),and we have no employees. [No workers'comp.insurance required.]
*Any applicant that checks box#1 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 r#�-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.
I do hereby certify under the pains and penalties of perjury that the information provided above is ue and correct.
Signature: 9 IV V I Q' Date:
` 30 Z0 2 z
Phone4:1 50C ) 73,1 - 3Z49
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 4:
Sears, Tim
From: Sears, Tim
Sent: Friday, November 18, 2022 8:25 AM
To: brunopontesmaia1991@gmail.com
Subject: 30 Grant Rd
Bruno,
I have reviewed your application and there are some items needed.
1. Rooms labeled on plan
2. Finished ceiling height shown on plan
3. Ventilation calculation per Section R303 or specs on air exchanger
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.
imothy Sears CB()
Deputy Building Commissioner
sown of Yarmouth
508-398-2231. Ext. 1259
mailto:tsears@yarmouth.ma.us
1
TOWN OF YARMOUTH ✓
( BUILDING DEPARTMENT
1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1261
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
DA 1'E:
JOB LOCATION: 3o Cj Q, ..i1J (d) "4-itmoitt+
NAME STREET ADDRESS SECTION OF TOWN
"HOMF;OWNER" Q>(W t30 P� (50 4-3 3 2 4 Is
NAME HOME P ONE WORK PHONE
PRESENT MAILING ADDRESS 30 k h
w• Qr\4o Ot-P 2643
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 perfoullied 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.
HOMEOW
NER"S S SIGNATURE 0/y449
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:homeownrlicexemp
TOWN OF YARMOUTH
vr
1146 Route 28, South Yarmouth, MA 02664
508-398-2231 ext. 1261 Fax 508-398-0836
Office of the Building Commissioner
BUILDING DEPARTMENT
DEMOLITION DEBRIS DISPOSAL AFFIDAVIT
Pursuant to M.G. L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111/5
I hereby certify that the debris resulting from the proposed work/demolition to be
conducted at 1/430 (*pc Of Rt U).1&r O04+
Work Address
Is to be disposed of at the following location:tOU)J Oc Yilk(004# OISP I -6`, ,.4
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
ittiA9 Pi d
10{3o/ 2W22
Signature of Applicant
Date
Permit No.
F
1
oN. TOWN OF YARMOUTH
c titHEALTH DEPARTMENT
-,,,,t`" PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
Building Site Location:
Proposed Improvement:
Applicant: km
., t *vI , Tel. No :b -'3 r ,2', -
f
Address: 2,---, 1: t-_..5 I. a >, Date Filed: J`,' ' '
**If you would like e-mail notification of sign off please provide e-mail address:
Owner Name: ) `\/) %)�) tr t,
j Owner Address: k15,
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.
I t(i), ..4,5: -'
.-" ` IREVIEWED BY: ! 1 DATE: 11 2.. - ... , .
1
PLEASE NOTE
COMMENTS/CONDITIONS:
/ 4 S'-e nil POT f -� V Se 4- S ( e t 4 C I
/-1 (-,.<•.. --c, (: c- v-, q t ,A..' — „1,« c -
(1. ic)10;tCri (-1 C-i'A.1:4 i (ICI
i I
t4m7eJ
I rite.i
0 2.
1 ,3,.....
..1-'.
C o
,... ----i
cii ; 0
— , 4:3
I Cliii
0 ......i 3
C..)
"7 ii
,,....
.... ...-401.4
`...# 17 . *.1 i'....
...
4 -9 Sb D
),..,
c4.
1 -4-
r--
,f)
3 i I ir
o ,.....
4.01
= ' ,,,--
NNW". 2-
2
givcza 3 ----
0
0 L)_NA A- ,
0........ 1 2
(11) -417 t'C'''- -----k---
,) --1, ....---
NA
...I L_ .4.
•l.'s-
,
, g.
CC , c
IF?)
i__,
2
. -
(,)
4110.... g ..... t.1.5
h' i
Li,
....... ,
. . , . _.. . .