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HomeMy WebLinkAboutBLD-22-007420 ONE & TWO FAMILY ONLY-BUILDING PERMIT Town of Yarmouth Building Department or ktc 1146 Route 28, South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-08364. al ', Massachusetts State Building Code,780 CMR Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling w `': IVED This Section For Official Use Only r " ' - Building Permit Number:,14hi _D b �—U Date Applied: 'ry, 22 Building Official(Print Name) a� i BUILDING DEPARTMENT Signature B .___ _i____-- SECTION 1;SITE INFORMATION 1.l�roperty Address: ` 1.2 Assessors Map&Parcel Numbers / G4 IV p+ ,'ccter so.. {.,Q Su,c+L. P...t, '3 e I 1 1.1 a Is this an accepted street?yes `------no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: (0 05 Aesi Ntl.,i ' Re S,(JNT1. / )010 /1, - 61 .L//1- 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:pp y:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public Et/ Private❑ Zone: — Outside Flood Zone? Check if yesD Municipal© On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: /t'1a+4 (kJ;k 0,7,cc<; Sc + IA/ww-fL. AAA. Oa C6 Name(Print) City,State,ZIP /5C-40. 'Via<cr3u,.. Roq„( Sb9-3S1-9a.li ✓tnw, .,s4: No.and Street �Gt, j 4 0�.Cr.', Telephone Email Address SECTION 3:DFSCRIPTTION OF PROPOSED WORK'(check all that apply) New Construction 0 Existing Building Cyr Owner-Occupied IS----"Repairs(s) Et----Alteration(s) El Addition p Demolition ❑ Accessory Bldg. ❑ Number of Units Other El Specify: Brief Description of Proposed Work2:,z?•e vu 1'v-, f ‘1' •IL(LI; 5 P pip„. S Wtttiatv.a>c. w lel ,A.d-vs.-, .5190 Sei,, 3. SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: (Labor and Materials) Official Use Only I.Building $ , U a I. Building Permit Fee:$ U Indicate how fee is determined: 2.Electrical $ sv v CI'Standard City/Town Application Fee i . Total Project Cost(item 6)x multiplier x 3.Plumbing $ � S o U 2. Other Fees: $ I/ I C Dt, —" 4.Mechanical (HVAC) $ 0 List: 5.Mechanical (Fire • Suppression) $ 0 Total All Fees:$ 6.Total Project Cost: $ G�lb� Check No. Check Amount: Cash t �0OC.0 0 0 Paid in Full al Outstanding Balance e: \ `� SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) � t1 CSFA-sr /O/a3�o?va3 an!e y V`_2``� License Number y Name of CSL Holder ---- Exgppiration Dare c i ✓ lt�G� 1 .Quc� List CSL Type(see below} `� No,and Street Type AAA Description �f�^"'n i'\ A `/+ C)oZ-6° U Unrestricted uildin s u to 35,000 cu.ft. City/Town,State,ZIP Restricted 1&2 Farnil Dweilin M Masonry • RC Roofing Covering WS Window and Sidin �p - L.3- 2,1 l� b L o c JPe- 4,,6 SF Sol lotion Burning Appliances �I�^�,�,co, I Insulation Tele hone Email address 5.2 Registered Home Improvement Contractor(HIC) D Demolition HIC Registr ation Number ber Ex pirD n Uon a eeHIC Company Name or HIC Name?,,,51 ..„c��,, R9 Cvc�Pt,,f , , ��N .and Street Email/yyc...,;5 (AAA 0.16o ( 50w-?-33.31-19- Cifyttown,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 t) :; O iVe%I t 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 contained in this application is true and accurate to the best of my knowledge and understanding. 01 to ; /ICA RSK Print Owner s or Authorized Agent's N e(Electronic Signature) `�r�O 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 fiend 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 os 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.11.5"---- Number of fireplaces Habitable room count Number of bathrooms Number of bedrooms Type of heating system----__________ Number of half/baths Type of cooling systemNumber of decks/porches Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" ice• Office of Consumer Affairs&Business Regulation reir Commonwealth of Massachusetts Division of Professional Licensure HOME IMPROVEMENT CONTRACTOR TYPE:Individual Board of Building Regulations and Standards Regis,tration Pxp___ ration Constructio i'�9y.1 &2 Family 168722 05114/2023 ri DANIEL O'NEILL CSFA-105994 CrB/A CAN L.0 NFILL CARPENTRY s c�pires 10/23/2023 • DANIEL O'NEILL 351 MEGAN ROAD U/�iII L n NEILL HYANNIS MA 02601 J = 351 Mi^AN RD HYANN!S,MA 026U1 `- cf Undersecretary f)/SS,I_Ik-/`‘ Commissioner caka Construction Supervisor 1&2 Family Registration valid for individual use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 1000 Washincton Street -Suite 710 Boston,MA 02113 Not va{id without signature Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license Call(617)727-3200 or visit www.mass.gov/dp1 • se —*— The Commonwealth of Massachusetts Department of Industrial Accidents :� _�; �-=y. 1 Congress Street,Suite 1©0 Boston, MA 02114 2i?17 .4,,,,,,,5,- www.mass.govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. A licant Info mation Name(Business/Organization/individual): L . Please Print Leoibl Address: City/State/Zip: 40 ,..,`% a Co Phone : 50 g- -333 -- --1 9 Are you an employer?Cheek the appropriate box: Type of project(required): 1.0 I am a employer with _employees(M1 and/or part-time).* tj 2. 1 a sole proprietor or partnership and have no employees working for me in 7. u New construction any capacity.[No workers'camp.insurance required.) 8. [j Remodeling 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 I ❑ ensure that all contractors either have workers'compensation insurance or are sole Building addition proprietors with no employees. 11.Q 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.1 13.El Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per lvIGL c. El Other 152,§1(4),and we have no employees.(No workers'comp.insurance required.) I4. *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 1Contractors that check this box must attached an additional sheetg showing the name of the all work and then hire sib-contractorsde rand u state whether or st submit a new no dthose'entities have G� employees. Uthe subcontractors have employees,they must provide their workers'comp policy number. .l am an employer that is providing workers'compensation insurance for my employees Below is the policy and l r information. Job site Insurance Company Name 0 t e E,.,, h S CtiC. 1�/' Q.7✓, Policy#or Self-ins.Lic.#:I.tls S oy 0 t 2 0 l o l'¢ Expiration©ate;7 - /1 -o?Oa), Job Site Address: LS Cct $.i k.e Rd Attach a copy of the workers'compensation policy declaration page(showing the policyr number expiration p '`� Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine upto$1 ate) and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of upto$250.0 day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the ,5ra ce coverage verification. 0 a g DIA for insurance .1 do hereby certi 1cder the pains and penalties o perjury that the information provided above is true and correct i of nature. c� Date: —Q. — Ph Ile e n: — —9-3 _ •Z 1 P- Official use only. Do not write in this area,to be completed by city or town official. City or Town: Issuing Authori Permit/License m ty(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: AC - DANILON-01 DEATON `...-- CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 6/22/2021 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 RogersGray,,Inc. PHOE: 434 Rte134 PHONE (Alc,No,Ext):(800)553-1801 FAX No):(877)816-2156 South Dennis,MA 02660 DDRESS:mail@rogersgray.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Associated Employers Insurance Company 11104 INSURED INSURER B: Daniel L.O'Neill DBA Daniel L.O'Neill Carpentry INSURER C: 351 Megan Road INSURER D Hyannis,MA 02601 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. INSR ADDL SUBR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF POLICY EXP (MMlDD/YYYY) (MM/Dp/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO OWNED SCHEDULED BODILY INJURY(Per person) $ AUTOS ONLY AUTOS BODILY INJURY(Per accident)_ $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ 1 $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I RETENTION$ A WORKERS COMPENSATION $ PER OT AND EMPLOYERS'LIABILITY STATUTE EERH ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N WCC50050162012021A 7/12/2021 7/12/2022 1,000,000 OFFICER/MEMBERrt EXCLUDED? N N/A E.L.EACH ACCIDENT $ If yes,describe under E.L.DISEASE-EA EMPLOYEE $ 1,000,000 DESCRIPTION OF OPERATIONS below _ E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Whitla Brothers Builders THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 419 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Medfield,MA 02052 AUTHORIZED REPRESENTATIVE Cir-C:117.42 Zda"A"-------______ ACORD 25(2016/03) The ACORD name and logo are registered marks s of ACORD1988-2015 CORPORATION. All rights reserved. ACORD §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 CcP--a,L„ ItQ,Z C&erSo� Work Address Is to be disposed of oat the following location: Orl S +q eXco Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. Signature of Application Date Permit No. 6/ 3/22,11:16 AM ParcelSketch.ashx(1100x767) ak,a. '(J D4i- KI4 Ci Qv ) ¶erUc/'c.-4-1`c) WDK 15 12 EAF BAS EAU BAS UBM BAS coo �ly/ 22 22 26 3e� 30 14 16 WcAker https://gis.vgsi.com/yarmouthma/ParcelSketch.ashx?pid=11151&bid=11606 1/1 TOWN OF YARMOUTH o - c HEALTH DEPARTMENT 4c PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Building Site Location: .c C� ,� 11/4)1'6k,v&a.. Proposed Improvement: A II (Re,-„ )c,.�iv�, . 5 de fl4c.a 4 CQ . • Applicant: pct.r e 0 u.e,\ k Tel. No.: Address: 3S ) �(/� e \oc.� \ w+n•3 .MA ` Date Filed: G-. **if you would like e-mail notification of sign off,please provide e-mail address: I)L CCJ 2 krf-r�f®GG n., (.Ca� / o� Owner Name: ./`/ c,,.} ;\r,C-,70N,S I,�r Owner Address: /5 G c���.G,,� �, (,�� PC1 /4/.. 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: /67),-)/C PLEASE NOTE COMMENTS/CONDITIONS: 6123/22, 11:16 AM ParcelSketch.ashx(1100x767) GD.ep i- /5 Cot p K1 Cc-) P✓-) ehVvc { 15 12 EAF BAS EAU BAS UBM BAS I $t- 22 22 26 �Lt5�'G� �Vavr� 30 14 16 LkicAitc %f ocwfio''S - https://gis.vgsi.com/yarmouthma/ParcelSketch.ashx?pid=11151&bid=11606 1/1 6/23/22, 11:16 AM ParcelSketch.ashx(1100x767) 15 12 EAF BAS EAU BAS UBM BAS l`/ Cvv v \ 22 22 26 na- cts t L4 voce". 30 14 16 — https://gis.vgsi.com/yarmouthma/ParcelSketch.ashx?pid=11151&bid=11606 1/1 • 1 III II I J I I1 11 II I ' , Il d iII I�]I I�Milii� I I�� i liI 1l I III III�I I I I i Ilfoi il i I i I „ el II II 4 t< o tip. @ ` i W A k \ tt \.. Pi 9 Q . yy } . , ,. ,, li �` � k + ' c 20 II Ig K ,'�M k M 1 J"til si z°+k c 1 t $ n � ivy M9 4 41 t! p \ a ,, M t1n u e .1 ' sr a€ r am. o 1.,_- ' -1-. , (. ,� i,. L ;.ry, .,'1 , M 1. 6. • ems"` •. - ) 61.! k c L., a c Cis u x C i' era w U� Cie C) 1 4 hf'�v.00 .- , �, I 1 6 P,9s f2 X . 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