The URL can be used to link to this page

Home My WebLink AboutBLD-23-005432 E C E V E & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department "y 1 MA �- �Q23 1146 Route 28, South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax iii,: LDEPARTMENT Massachusetts State Building Code,780 CMRy - _—__Bull atr g Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This SectionFor Official Use Only Building Permit Number: 43 LO�-d 3-C1)S l3 Date Applied: Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers iy7 ,e3r4.e.fiLy /-77; ! Ed 3y /06 1.1 a Is this an accepted street?yes L/ no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: At X/-� ..z, A/. /On 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.40,4 54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private[� Zone:`l Outside Flood Zone? Municipal El On site disposal system.g Check ifyes❑ S'CTION 2: PROPERTY OWNERSHIP' 2 ytiLl v ame(Print) City,State,ZiP / 17 ./?rcr.27" ?o '( 77 37 -1 7( No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK`(check all that apply) New Construction C# I Existing Building% Owner-Occupied l I Repairs(s) L�y Alteration(s) 0 I Addition C3 Demolition 0 I Accessory Bldg. 0 Number of Units / Other /❑'Specify:—� Brief Description of Proposed Work: % S/ �, e i i- rfl 7"rs-,7 .-ie // /2c.3 /4- -7,4 - SECTION 4: ESTIMATED CONSTRUCTION COSTS. • Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 6 0 j I. Building Permit Fee:S Indicate how fee is determined: 2.Electrical ✓ 0 Standard City/Town Application Fee ✓ Project 0 Total Project Costa p /�( }x multiplier x 3.Plumbing $ Sai7 ji 2. Other Fees: $ l I .C. ti 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees:$ Check No. Check Amount: Cash Amount: 6.Total Project Cost: S 70 O& 7 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) C5" --if0S?5i -z'y Br vi (7L,U/n O._I2 License Number Expiry en Date Name of CSL Holder 57 6-rove, _<7. List CSL Type(see below) (A.. No.and Street Type Description /E/C3 �- � ��c��'� �� U Unrestricted(Buildings up to 35,000 cu.ft.) Cit iITown,State,ZIP f/ R Restricted 1t4c2 Family Dwelling M Masonry RC Roofing Covering • WS Window and Siding SF Solid Fuel Burning Appliances .c 77// /7 666,14' /IN e)� r1—` ' I Insulation Telephone Email address D Demolition 5.2 Registereder Home Improvement Contractor(HIC) 431 y'Ce_,...5 6".�,l.?l�.e.. i".J��at o Expi .r�'�a BIC Company/' 'Verne or HIC Registrant Name HIC Registration umber tion Date 7 11.-e'>tie, s; Ga..tJ 0,,,,z tf:`L?f,�� s No.and Street �t /�� "c :� "cie : 4., /lizi2c.ze^E7 .,(e � 40 56,1 1,7// 7 Email ddress 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 )f; No E3 SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACT AP LIE FOR B RA/11T I,as Owner of the subject property,hereby authoriz & Ki .../- to act on my behalf, ' all matters relative to work authorized by this building permit application. (7://, ,r,/e--s /,i --2t- 44, �� Prim Owner's Name(Electronic Signature) Date • SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION By entering my name be w,I hereby attest under the pains and penalties of perjury that all of the information contained in this appl. tion is true and accurate to the best of my knowledge and understanding. Print 0 er's orized 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.sov/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" 4/5/23,7:31AM Mail-Sears,Tim-Outlook 147 Breezy Point Sears, Tim <tsears@yarmouth.ma.us> Wed 4/5/2023 7:31 AM To:Guimar101@gmail.com <Guimar101 @gmail.com> 1 attachments(391 KB) work in flood zone packet.PDF; Bryan, I have reviewed your application and there are some items needed. 1. This property is in a flood zone. Attached is a packet to review, we need the cost worksheet filled out along with the contractor and owners affidavits notarized and returned. The final affidavit will be required at the time of final inspection 2. Floor plan of work area 3. Copy of CSL & HIC 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 CB0 Deputy Building Commissioner Town of Yarmouth 508-398-2231 Ext. 1259 mailto:tsears@yarmouth.ma.us https://outlook.office.com/mail/sentitems/id/AAQkADE3MDQ5NWZmLTkOYzItNDIwNi1 iMDQxLWNkMGQyNmE4NzE5NAAQAOOkymmsTL9EvaoiL5Lq... 1/1 The Commonwealth of Massachusetts M r Department of IndustrialAccidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 ter,,, www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information PIease Print Legibly Name (Business/Organization/Individual): �/J3/f)/(;c_x) 6j-�,t,/L>'t4«/, Address: 5 7 &-/tx/r, /�-0, 6-04," 4 , c776' . City/State/Zip: Phone#: (Z' 77/ /6Y- Are you an employer?Check the appropriate box: Type of project(required): I.0 i am a employer with employees(full and/or part-time).* 7. Q New construction 2.�,I am a sole proprietor or partnership and have no employees working for me in any capacity.[No workers'comp.insurance required.] 8•jil Remodeling 3.ElI 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 t 0 ❑ Building addition ensure that all contractors either have workers'compensation insurance or are sol l 1.❑ Electrical repairs or additions proprietors with no employees, 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet, 12.0 Roofr Plumbing repairs or additions These sub-contractors have employees and have workers'comp. insurance.t 13.0 oaf repairs 6.0 We are a corporation and its officers have exercised their right of exemption per NIGL c. 14.0 Other 152,§I(4),and we have no employees.(No workers'comp.insurance required.] *Any applicant that checks box R I 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 ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: // C6)( .vs4;e I•c s«. /'; :7 ,-- ( "C-eri--f Zre.4. ., 4 i 1/ Policy}or Self ins.Lie.#: //OO, ?6 6 _ 6 ( Expiration Date: .�/ �' ' / Job Site Address: //7 131z.C.zy' R,. /V City/State/Zip; Attach a copy of the workers' compensation policy declaration page(showing e policy number and pir�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 tinder t1 pains at penalties of perjury that the information provided above is true and correct. Signature: Date: , . Phone T: 2G.. /f/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.ElectricaI Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: 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 Work Address Is to be disposed of at the following location: Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Signature of Applicant Date Permit No.