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HomeMy WebLinkAboutBLD-22-003551 • \-\- \),/,%- 1 3 ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department 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 E f V E p This Section For Official Use Only DEC 1 6 2021 Building Permit Number: S I Date Applied: BUILDING DEPARTMENT By Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 3 5- �- 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 3a ►ra.r( v as2"Oh 2 DGi 1.1 a Is this art ac epted street?yes no Map Number Parcel Number 2_3 1.3 Zoning Information: 1.4 Property Dimensions: 11� Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required I Provided Required Provided Required Provided 1.6 Water Supply: (IvI.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.A Owner'of Reco : CbFITA flEf��RGF fi('1Nli ih h� 4 026 7J Name(Print) C' ,State,ZIP 1 . Nar6,-4 1- J o of ���v� 09 3, 96 33 Ro.gf rr,> c,146? No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'-(check all that apply) New Construction 0 Existing Building❑ Owner-Occupied 0 I Repairs(s) 6r' Alteration(s) ❑ I Addition 0 Demolition ❑ Accessory Bldg. 0 Number of Units Other 0 Specify; Brief Description of Proposed Work: Ige) LfgcQ. t A S 7 I)&)L J2 F 0 vU i >�5 A () 'r l-f IZ W iU () 02e4 2 G t hi'41 oF -r t? F r c/L SECTION 4:ESTIMATED CONSTRUCTION COSTS. Item Estimated Costs: Official Use Only (Labor and Materials) I.Building $ F,&LI ' 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ 0 Standard City/Town Application Fee ❑Total Project Costa(It pm 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ G 1pZ 3 4_Mechanical (HVAC) $ List: 5.Mechanical (Fire ' Suppression) $ Total All Fees:$ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) i AAUL;;Ns f" 51z License Number Expiration Date Name of CSL Holder List CSL Type(see below) CO GOX co3 o.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) `rT I M o Lt'14 y I 001.6 Ly (5) Restricted l&2 Family Dwelling City/Town,State,ZIP 1Vl Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances %1 133 PAI/CONi P 'E &-Ma;(.P'Y I Insulation Telephone alai]address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 1,5 /of/ C Company N,r�e or HIC Registrant Name I Registration Number Expiration Date 0 b'A =�G�, AUcc-LAM A " i S cE'1� M4oL 6vl1 q.and Street Email address ftrNeup1, f4/ - 02 >O8%T 5'7 3' 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 El 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 th's building permit application. CACJ��� 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. 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.rtov/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 oflndustriaiAccidents 1 Congress Street, Suite 100 i , 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): PA a ( 0 MI t L Address: 0-0 8r,;� 3 City/State/Zip: rN/ Lki, IL14- O2&621f Phone#: / • Are yo an employer?Cheek the appropriate box: Type of project(required): I. I am a employer with employees(full and/or part-time).* 7. 0 New construction 2.E1 I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] � 3.0 I a a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition m 4. I am a homeowner and will be contractors to conduct all work on my10 [ Building addition Q hiring property. Iwill ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5.01 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.Q ROOF repairs These sub-contractors have employees and have workers'comp.insurance? 6.0 We are a corporation and its officers have exercised their right of exemption per,biGL c. 14'br her 152,§1(4),and-we have no employees.[No workers'camp.insurance required.] *Any applicant that checks box ill 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: Q G U.. 9 r1 Policy or# Self-ins.Lic.#: 4(� �"��1 C � 77,2, Expiration Date: �/'f f3/2:Z Job Site Address: 3.4 r t '/ i 0 S E ), PO4 of City/State/Zip: r Mi l Li7 H i M O 7 jr 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 penalti f perjury that the information provided above is true and correct. Signature: Date: /2//2./2/ Phone#: SC 'fib- 7 rJ 7 33 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: Wednesday, January 5, 2022 10:43 AM To: 'pavcompanies@gmail.com' Cc: Slack, Christine;Water Department; Sherman, Lisa Subject: 32 Margret Joseph Rd Pavlin, I have reviewed your application for the deck addition, and there are some items needed; 1. Health Department sign off 2. Water Department sign off 3. Old King's Highway approval 4. Certified plot plan showing setbacks to proposed addition 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 CB() Deputy Budding Commissioner Town of Yarmouth 50 a-. -- 231 Ext. :12.59 rnailto:tsears@yarmouth.ma.us 1 • §TOWN 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 .3,,2 tv14 "6-R r e Y :, )S coo M ' Work Address Is to be disposed of oat the following location: \/7 r Ho LIT i 10L-c Hp Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. 1 01/2 /.2/ Signature of Application Diate Permit No. Ac CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) ��_ 11/18/21 _ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER.AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER '. CONTACT NAME: JIM HINDMAN Schlegel&Schlegel Ins Broker PHONE FAX 34 Main Street (A/c.No,E:e): 508-771-$381 (A/c,No): 508-771-0663 E-MAIL West Yarmouth,MA 02673 ADDRESS: schlegelinsurance@gmaiLcom INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: NGM INSURANCE INSURED -- -- INSURER B: NOR GUARD INSURANCE PAV CONSTRUCTION LLC INSURER C: PO BOX 983 SOUTH YARMOUTH,MA 02664 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. )NSR ADDLBUUR POLICY EFF ----POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DDIYYYY) (MMIDD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR DAMAGE f O RLN t tU PREMISES(Ea occurrence) $ 500,000 MED EXP(Any one person) $ 10,000 A I MPP93339F 02/22/21 02/22/22 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 POLICY JE T LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER _ $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ — — OWNED SCHEDULED _, AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ - $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 B OFFICER/MEMBER EXCLUDED? N N/A PAWC980772 11/13/21 11/13/22 (Mandatory In NH) EL.DISEASE-EA EMPLOYEE $ 100,000 I(yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 - DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 109.Additional Remarks Schedule,may be attached it more space Is required) CORPORATE OFFICERS HAVE EKLECTED TO BE COVERED UNDER THE WORKERS COMPENSATION POLICY INSURANCE COVERAGE IS LIMITED TO THE TERMS,CONDITIONS, EXCLUSIONS AND OTHER LIMITATIONS AND ENDORSEMENTS OF THE POLICY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN TOWN OF HARWICH ACCORDANCE WITH THE POLICY PROVISIONS. BUILDING DEPARTMENT HARWICH MA 02645 AUTHORIZED RE ENTATIVE PAVcompanies@gmail.com, 1988-2015 ACORD CORPORATION. All rights reserved. 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Yarmouth, MA 02664 US iPAV _ - pavcompanies@a gmail.com httpifwww.pavconstructionllc.com Estimate ADDRESS ESTIMATE 7954 Roberta - �Ot����� � DATE 11 f 12f2C121 32 Margaret-Joseph Rd • Yarmouth Port, MA , V ` • a am ,,,, WE HEREBY SUBMIT ESTIMATES AND SPECIFICATIONS FOR PORCH REPLACEMENT_ *Remove and dispose existing porch. *Install 2 new 12"x48"sonotubes and 2 28"big foot footings roof rated. *Frame new 2x8 pressure treaded 8'8"x 6'platform and two steps 8'8"long. install Azek slate gray azek on deck. *Install Azek premier railing on both sides of platform. *Secure basement stairs. *Install new railing to code on both sides of stairs. Price includes labor and materials. Price does not include and plot plan,engineering or landscaping if necessa; : TOTAL $8r . 00 kt#, , bee4/' Accepted By . 03 Accepted Date a,- -- j1, .�_ d ;. '%*. .. 4 ..i^fi ^' ..°5�q,S t M•r "i'5?'.xn Y'I' ':ji'. r%: I ' I ) I I 1 . i • , , . I . ., . , ..• . 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