HomeMy WebLinkAboutBLD-22-006912 ,.
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ONE & TWO FAMILY ONLY- BUILDING PERMIT
Town of Yarmouth Building Department
1146 Route 28, South Yarmouth,MA 02664-4492 i1- 1oF
508-398-2231 ext. 1261 Fax 508-398-0836 . `
Massachusetts State Building Code, 780 CMR -:a .
Building Permit Application To Construct, Repair, Renovate Or Demolish
a One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: pLD- -Crryy��''' !^� '-
�"1i Date App �: V ' V E
Building Official(Print Name) r �� 7 2099
s ature Date LL
SECTION 1:SITE INFORMATION BUILDING DEP TR MENT
1.1 Prop Address: 1.2 Assessors Map&Parcel Numbers
,./ 3 9 r er.si- /2d. W `I�I,14o�k. --- __
1.1 a Is this an accepted street?yes 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)
i 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 IV Private❑ Zone: Outside Flood Zo ?
Check if yes Municipal ❑ On site disposal system 0
1 SECTION 2: PROPERTY OWNERSHIP'
2.I�ri of Record;
cy ('(Jr,4 Wtsf unwcc► c- 7
ame(Print) (� �N./,�� �/�
City,State,ZIP 1� Qd�
-3CeS It roc, - /2o..r l 1239'K. 33 (,c ev Ili. (kit .7ad No.and Street J / �j
Telephone
Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied ❑ Repairs(s) 0 I Alteration(s) 0 Addition 0
Demolition ❑ Accessory Bldg. ❑ Number of Units
Brief Description of Proposed Work2: Other El Specify:___________
/ I` !r/L
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
(Labor and Materials) c Official Use Only
1. Building $ b!yam 1. Building Permit Fee:$ -: V
Indicate how fee is determined:2.Electrical $ ! �O >�Standard City/Town Application Fee
3.Plumbing $ ❑Total Project Cost tem 6)x multiplier . /
2. Other Fees: $ G 151J x e
��V
4.Mechanical (HVAC) $ f✓��
ZOC> List: `cl
5.Mechanical (Fire n i
Su..ression) $ Total All Fees:$ ,
ty 6.Total Project Cost: $ /7 Check No. Check Amount: Cash Amount:
❑Paid in Full *Outstanding Balance Due: r f
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
Name of CSL Holder License Number Expirationa ee
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 Sidin•
SF Solid Fuel Burning Appliances
Telephone I Insulation
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.
i 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.
�`�7*v li(1rf G>L 0' ?G 2
Print Owner's Authorized ent's Name(Electronic Sib azure) - Z
Date
NOTES:
permit to do
1. An Owner who obtains a building 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 RIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/d s
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.-)--Number of fireplaces Habitable room count
Number of bathrooms Number of bedrooms
Number of half/baths
Type of heating system
Type of cooling system Number of decks/porches
Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
-\
' ,►. The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress n..-.►:= c Street, Suite 100
= j Boston, MA 02114-2017
:.4,�_ - www.mass.aov/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 Le ib!
✓/ ' / rrsli,
Address: (3� f sp-- 09.0•40.a
City/State/Zip: I- \c.,404.0 ' A-/14/4"
IIMIIIMININIMINIIIMAIMMIIMIN
Phone #: k3 .�/g.' '76 3j?
Are you an employer?Check the appropriate box: �Jrp..ri,
1.Q 1 am a employer with employees(full and/or part-time).* Type of project(required):
Ej I am a sole proprietor or partnership and have no employees working for me in 7. New construction
•
a capacity,iNo workers'comp. insurance required.] 8. [� Remodeling
3. 1ui am a homeowner doing all work myself [No workers'comp. insurance required.]red.]r
9. ❑ Demolition
4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 10 Building addition
proprietors with no employees. 11.[] 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.t
13.0 Roof repairs
6.0 We are a corporation and its officers have exercised their right of exemption per MGL c.
152,§1(4),and we have no employees. [No workers'comp. insurance required.] 14. Other
*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
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. o such.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy anri job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#:
Expiration Date;
Job Site Address:
City/SAttach a copy of the workers' compensation policy declaration page(showing the policynumber
Failure to secure coverage as required under MGL c. 152, and expiration date).
and/or one-year imprisonment, as well as civil penalties in the form of STOP WOIRK ORDER on Iand a fine oe by a fine fu poto$250.00
day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
p $250.00 a
coverage verification.
tA1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
nature: >�..� 4 -•aL 1
��V�iV//// G 2-2
Phone#: Aiww
Date:
Official use only. Do not write in this area, to be completed by city or town official.
City or Town:
Issuing Authority(circle one): Permit/License f
1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector p or 5. Plumbing Inspector
6. Other
Contact Person:
Phone#:
o�.YA4E TOWN OF YARMOUTH
IF" BUILDING DEPARTMENT
M'"a An[ErsE•4'0
1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1261
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
DA'1E:
JOB LOCATIO • rf //, w• ma X y � �L73
� E S ET�P �SECTION OF TOWN
"HOMEOWNER"
N HQ P ONE WORK PHONE
PRESENT MAILING ADDRESS 40. X.4.rebictitit.
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 perfouued 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
APPROVAL OF BUILDING O C
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
Signature of Owner or Owner's Agent Ownerone: Agent
h:homeownrlicexemp
f ,
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 , d i/ e/. L'. Yr u l- 6 73✓
Work Address
Is to be disposed of at the following location: �v
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
(5—. 24 Z
Sign re of Applicant
Date
Permit No.
Sears, Tim
From: Sears, Tim
Sent: Tuesday, June 7, 2022 9:34 AM
To: 'Wright.Jeff27@gmail.com'
Subject: 368 Forest Rd
Jeffery,
I have reviewed your application for the garage conversion and there are some items needed.
.1. Health Department sign off(under review)
LX/Rescheck
It appears the ceiling is going to be cathedral, if so the specs on ridge beam and support for beam need to be
submitted
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.
I ir-,otE y
Deputy 8.eiidin£.r
sown 't Y.lr Seth.
e 3'"s.cs 7. 2 . #
.
mailto tsears@yarmouth.rria. s
1
;����;Y tiy. TOWN OF YARMOUTH
s c HEALTH DEPARTMENT
• '''-=`' PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
Building,Site Location: (65 ,Dfi -\`- A _
Proposed Improvement: C.t,IA,lx I-4- ac,.tt.;r-c +0 k k.,t'+- Yr..°OA Ly.a;1 k 6t
acic4 ` C.. 'r 4 c.^c ( r / •,- - �`.cr-4-- -- ` t cv S,c c( t t. c-41 Applicant: Tel. No.: �' gk. 76.?3
Address: te$ 1 c-`�- t cc c C u- y-ktnt, tc_J ,, 14(A G)6c?3 Date Filed: 5-127/2..?—
r _
**If you Quid like e-mail notification of sign off,please provide e-mail address: UC:1 t- la-)3 M-ci l • Wit.
Owner Name: tl- W 01
Owner Address`dt3t ''1" `-¢ 4 r-` „. Owner Tel. No.: (c 3Cj• Se.7033
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:
U4_ 1:Vi=DD (1.) Site Plan showing existing buildings, water line location,
and septic system location;
MAY 2 t 2022 (2.) Floor plan labeling ALL rooms within building
HEALTH DEPT. (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.
ir
REVIEWED BY: DATE: _ = .. ,
COMMENTS/CONDITIONS: PLEASE NOTE
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0 i0 0 e(-0,210-irvtcfr) forkv-dvvl(n ,c3^*-311-"Ictri
Bk 34574 Pg326 #68019
10-15-2021 @ 01 : 42p
NOT NOT
AN AN
OFFICIAL OFFICIAL
COPY COPY
NOT NOT
AN AN
OFFICIAL OFFICIAL
COPY COPY
QUITCLAIM DEED
LEWIS BAY REALTY INVESTMENTS, INC., a Massachusetts corporation with the
primary address of P.O.Box 427,Hyannis Port,Massachusetts 02647,
for consideration of FOUR HUNDRED EIGHTY-FIVE THOUSAND and NO/100
($485,000.00)DOLLARS,
grants to JEFFREY C. WRIGHT, Individually, of 112 Baxter Road, West Yarmouth,
Massachusetts 02673,
with Quitclaim Covenants,
A certain parcel of land with the buildings thereon situated in Yarmouth(South),
Barnstable County, Massachusetts and described as follows:
Being Lot 475 as shown on a plan entitled: "Subdivision Plan of a portion of'Captains
Village' South Yarmouth,Mass.,May 25, 1971,Scale 1"= 100',Thomas E.Kelley
Surveyor, South Yarmouth,Mass.",which said plan is duly filed in the Barnstable County
Registry of Deeds in Plan Book 249,Page 113.
The Grantor represents and warrants to this Grantee that the conveyance of this property
does not constitute a sale or transfer of all or substantially all of Grantor's assets in
Massachusetts and is in the ordinary course of its business.
Subject to and with the benefit of all rights, rights of way, reservations, easements,
appurtenances and restrictions of record insofar as the same may be in force and
applicable.
Meaning and intending to convey the same premises as described in Deed recorded with
the Barnstable County Registry of Deeds in Book 34096,Page 330.
Property Address: 368 Forest Road, South Yarmouth,MA 02664
MASSACHUSETTS STATE EXCISE TAX BARNSTABLE COUNTY EXCISE TAX
BARNSTABLE COUNTY REGISTRY OF DEEDS
BARNSTABLE COUNTY REGISTRY OF DEEDS
Date: 10-15-2021 @ 01:42pm
Date: 10-15-2021 @ 01:42pm
Ct1#: 773 Doc#: 68019 Ct1#: 773
Fee:
$4
$1,658.70 Cons: $485,000.00 Do : 68019
Fee: $1,484.10 Cons: $485,,0000..
00
Bk 34574 Pg327 #68019
NOT NOT
AN
Signed under the piss aridcpeaalriestof perjury this F/Jb I day of Oloctpber,2021.
COPY COPY
NOT Le +i•, •. Realty Investments,Inc.
AN A N
OFFICIAL OF \.,C I ,. ' L
COPY •
r � �`v
John C. Shea t&Treasurer
•l l
COMMONWEALTH OF MASSACHUSETTS
Barnstable,ss: October L ,2021
}t1
On this ►� day of October, 2021 before me, the undersigned notary public,
personally appeared JOHN C. SHEA, proved to me through satisfactory evidence of
identification, which was a MA Driver's License to be the person whose name is signed
on the preceding or attached document and in my presence swore or affirmed to me that
the contents of this document are truthful and accurate to the best of his knowledge and
belief, and acknowledged to me that he signed it voluntarily for its stated purpose on
behalf of Lewis Bay Realty Investments,Inc..
(seal)
Note P"ii.1 tanley P.Nowak
�uttitiiu�lir�iq�i
5'�4�yp i,�! My commission expires: 6/05/2026
,,
44 �
2
Bk 34574 Pg328 #68019
le Common eaN,ec,./1/1amackt.tre#te/
0 F F fit j e; Wa on- F'f c4i mYttti. 0-21S8
way, COPY C O
William Francis Galvin
Secretary of the N O T N O T
Commonwealth
A N A N I A OF F FI C I A L O F F oat':Vct bei 12,2021
OTo Whom It May Concern :
I hereby certify that according to the records of this office,
LEWIS BAY REALTY INVESTMENTS,INC.
is a domestic corporation organized on February 01,2016 , under the General Laws of the
Commonwealth of Massachusetts. i further certify that there are no proceedings presently pend-
ing under the Massachusetts General Laws Chapter 156D section 14.21 for said corporation's
dissolution; that articles of dissolution have not been filed by said corporation;that,said cor-
poration has filed all annual reports,and paid all fees with respect to such reports,and so far as
appears of record said corporation has legal existence and is in good standing with this office.
In testimony of which,
SIG'\
.,, f� I have hereunto affixed the
/t•-f a * Great Seal of the Commonwealth
u�` I on the date first above written.
Imo' • V: 1
c: :2/kizze.,:_0/2/444."..;701,eizait4
491/ Secretary of the Commonwealth
Certificate Number: 21100251020
Verify this Certificate at:http://corp.sec.state.ma.us/CorpWeb/CertificatesNerify,aspx
Processed by: smc
JOHN F. MEADE, REGISTER
BARNSTABLE COUNTY REGISTRY OF DEEDS
RECEIVED & RECORDED ELECTRONICALLY
`
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BUILDING