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HomeMy WebLinkAboutBLDR-23-12950 ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department N 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 DwellingRECEIVED This Section For Official Use Only Building Permit Number: L .—z 3-I 7 CI SO Date Applied: ` iv° �Acc-� IG- O GFAP�3 4T 10202T 11M T Building Official(Print Name) - Signa e ar -. .� » SECTION 1:SITE INFORMATION 1.1 Property Addr s: ( 1.2 Assessors Map&Parcel Numbers at ear O. C 'farm 1.1 a Is this an accepted street?yes K. 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) 12-,?'c Front Yard Side Yards Rear Yard Required I 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 Private❑ Zone: _ Check if y Outside Flo 4 Zone? Municipal 0 On site disposal system SECTION 2: PROPERTY O' NERSHIP' 2.1 Owner'ofaccord: { 6-c“--.4ioc ' ?— v�i cet S. totr''t,Ot t VL.t fA4 l4 oo Name(Mint) City,State,ZIP al ec,r-ktnlod la. eatMAawcbSag6 clouctc0An No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction 0 Existing Building.( Owner-Occupied1 Repairs(s) Cl Alteration(s)* Addition 0 Demolition ❑ Accessory Bldg. 0 Number of Units Other ❑ Specify: Brief Description of Proposed Work2: Q1e�no dbt(� k1 8�1� 64vt,cw BA a`� - (mr� A2,1 k rooN•• -i c Pr c 4 A.ifi2 ax-e a SECTION 4: ESTIMATED CONSTRUCTION COSTS, • Item Estimated Costs: Official Use Only (Labor and Materials) I.Building $ 90()6 .- 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ S El Standard City/Town Application Fee 0 Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ /a000% 2. Other Fees: $ List: 4 ,)/) � .c. (I4'7 4.Mechanical (HVAC) $ pt//� L �•U �-� 5.Mechanical (Fire $ - Suppression) vt1 Gq Total All Fees:$ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ O�f Q 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) • a- 0810KO 't ?-Oa-'( Pam;At_ \u.c¢os License Number Expiration Date Name of CSL Holder List CSL Type(see below) No.and Street Type Description ��,t ( i� 6a 7 U Unrestricted(Buildings up to 35,000 cu.ft.)) Ct R Restricted l(t2 Family Dwelling City/Town,State,ZIP lvi Masonry RC Roofing Covering • WS Window and Siding 77�'3S3-6BSa Insulation SF Solid Fuel Burning Appliances nalilo-•�S 78 ( vot,�o• Cow I Telephone E' EmaiI address D ! Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Company Name or HIC Registrant Name HIC Registration Number xpir tion Date (',0. (30 3'{K p#cE j a,ca 1P$ f @ VAGt • coy�.� No.and eet i Email addreis #trv^0iXt?et- ►'vu o 7 5 '77Y-3 57-Co o'S4 City/Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e.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 ❑ 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) a/Dake -1_ 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. 0 Print Owner's or Authorized Agent's Name(Electronic Signature) / ate 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/ocg 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 oflndustrialAccidents 1 Congress Street, Suite 100 3 Boston,MA 02 2017 www,mass.gov/dia iot-kers' Compensation Insurance Affidavit:Builders/Contractors/EIectricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): Pocirci L -T f_o(bc Address: Po. IS ox 3 W-( City/State/Zip: Yctrru.001A VorT r IM 14 Oa4P 75" Phone#: 77K-3S"3- SG2 Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with employees(full and/or part-time).* 2 am a sole proprietor or partnership and have no employees working for me in 7. 0Rey`construction any capacity.[No workers'comp. insurance required.] 8. ( �� Re[rtodeling 3.0 I am a homeowner doing all work myself.(No workers'comp.insurance required.]% 9. i__t Demolition 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I wil{ I0 ❑ Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.E 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 Plumbing repairs or additions These sub-contractors have employees and have workers'comp.i tsurance.t 13.Q Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per,MGL c. 14.0 Other 152,§1(4),and we have no employees.(No workers'comp.insurance required.] 'Any applicant that checks box rl must also;'nil out the section below showing their workers'compensation policy information, t Homeowner 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. Jam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site in jornration. insurance Company Name: Policy or Self-ins.Lic.h: Expiration Date: Job Site Address: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under IvIGL 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 u r th air and penalties of perjury that the information provided above is true and correct Sitmature: Phone 77 - -6 Date. /Q 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): I.Board of Health 2. Building Department 3. City/Town Cleric 4.Electrical Inspector 3. Plumbing Inspector 6. Other Contact Person: Phone#: §TOWN OF YARMOUTH 1146 Route 28, South Yarmouth, MA 02664 508-398-22301 ext.4261 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 1 pa4,0,5„ k eck • Work Address Is to be disposed of oat the following location: OM 4- Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. �% 9- 3 Signature f Application D e Permit No. 4 Gary Wood From: Pamela Wood <pamelawood29@icloud.com> Sent: Saturday,September 23,2023 5:35 PM To: Gary Wood Subject: September 23, 2023 September 23, 2023 Gary&Pamela Wood 21 Parkwood Rd. South Yarmouth, MA.01821 To:Town of Yarmouth 1 This note gives authorization for Patrick Jacobs Construction to enter 21 Parkwood Rd.for remodeling and construction as agreed on signed contract. Gary Wood ., A..)191-112 Pamela Wood Sent from my iPad 1 • Substantial Improvement Worksheet for Floodplain Construction (for reconstruction,rehabilitation,addition,or other improvements, and repair of damage from any cause) Property Owner: Pa0.4.1_,(A (1,5614 Address: , ( ` eark OD6l . sne,. j r.M 0 vvtW 0,loln'{ Permit No.: Location: Description of improvements: t,i-{-c.,L ,h raito isv\1 (oa-t( o'-.. Crrt. .Cc cJ ef4er , 4-N;fiA NO atft'Z.. Present M ket value of s re ONLY(market aapprtIsal or.adjusted. assessed value BEFORE improvement,orrf d , before the damage mot cncluclxac farad valve: $ as7000 • Coif 4O o cs*it.. • ai f the r t� �" see items �ricl�lt�cfe $ /0 7L Q V- *IrJcir�de 1 nteerlaborarul rlotaated supper' F; • -f at 0 lr cif iletpr 1400ia t r cst ltepaa c/ 10... Market Value r 1 7 If ratio is 50 percent or greater(Substantial Improvement),entire structure including the existing building must be elevated to the base flood elevation (BFE)and all other aspects brought into compliance. Important Notes: 1. Review cost estimates to ensure that all appropriate costs are included or excluded. 2. If a residential pre-FIRM building is determined to be substantially improved, it must be elevated to or above the BFE. If a non-residential pre-FIRM building is substantially improved,it must be elevated or dry floodproofed to the BFE. 3. Proposals to repair damage from any cause must be analyzed using the formula shown above. 4. Any proposed improvements or repairs to a post-FIRM building must be evaluated to ensure that the improvements or repairs comply with floodplain management regulations and to ensure that the improvements or repairs do not alter any aspect of the building that would make it non-compliant. 5. Alterations to and repairs of designated historic structures may be granted a variance or be exempt under the substantial improvement definition)provided the work will not preclude continued designation as a"historic structure." 6. Any costs associated with directly correcting health,sanitary,and safety code violations may be excluded from the cost of improvement. The violation must have been officially cited prior to submission of the permit application. Determination completed by: ?ct$ 1 Z L.I .-c.p(c$' Date: /Q/r /��j vVY4t TOWN OF YARMoU'rti I 3 ,,, ,-.'S� BUILDING DEPARTMENT' o " - ~t- - _ 1146 Route 21h South Yarmouth„MA 02661 telephone -3W-2231 eit. 1261 Fat SI-39$-03136 Owner's Affidavit: Substantial Improvement or Repair of Substantial Damage Property Address: 0 W rid . S. L1oa-,44 ;, (\. Parcel 10 Number. 95 Js l 3 Owner's Narno: i%ek.CI a Prx0.+t (^ i coo Owner's Address/Pt+one: l f^v-C.l„ar R . • -e Contractor it r;c`L d at c ,4 Contractors License Number: /'S " CLj iLl 0 Date of contractor's Estimate: i'C 31 3 I hereby attest that the description included in the permit application for work on the exstrng building all improvements, rehabilitation, remodeling, repair,, additions, and other forms of Improvement. l frther attest that 1 requested the above-identified contractor to prepare a cost estimate for all of the work, irndudina the contractor's overhead and profit.. I acknowledge that if, during the course of construction, I decided to add more work or to modify the work described, that the Torn of Yarmouth will re-evaluate its comparison of the cost of work to the market value of the budding to determine if the work is substantial improvement. Such re- evajuaticn may require revision of the perm l and may subject the property to additional requirements I also understand that I am subject to enforcement action and/or fines if Inspection of the property revea'3 that I have or authorized repo rs or improvements that were not included in the description of work, and the cost estimate for that work that were basis for rssuance of a permit. owe 64-7-7-tc-6.-L., 2.--i) - Owner's Signature:✓ ```,._„gH egtis%, Date: /%/ 0--3 7 N: Notarized: 3 �Q i vy 1 W i �1123 so:-.;i4iiiiuN1,1 TOWN Of:YARMOUTH 1146 oute 284'S armouth, MA 02664 508-3 8-223 e 126 Fax, 08-398- 836 Office of the Buildingo issioner FINAL COST AFFIDVIT FOR WORK IN FEMA FLOOD ZONE • To the Building Commissioner, In accordance with 780 CMR Section 109 of the Massachusetts State Building Code, total estimated cost of construction, including all related costs* of the building at r�-� Pa.-U � '(Z� . and constructed,reconstructed, altered,repaired, or extended under building permit no. amounts to $ (O 7,000 I, P0r ?k_TC..6OS ,being referred to as the owner/agent identified below,do solemnly swear that the statements made herein are strictly true, correct and made in good faith *Related construction costs include all work done with or concurrently with the work contemplated by the building permit including construction, reconstruction, repairs, demolition, HVAC work, etc. Furnishings and portable equipment are not part of the total construction costs. Signature f owner/agent .L.10 ,� /O © No ry Public Signature My Co ission, Expires Notary Seal: COMMONw OF S HUSETTS �, MICHELLE M LEBLANC COUNr�rof Lcr� �+� L v ` Notary P u b f i c On this(O daypf Ocji l ,2Q before me,the undersigned 1 COMMONWEALTHOFMASSACHUSEriS notarypublic, f'i^`Y�fT 1 c.r'1V'� personaNyappeared, '"7/ My Commission Ex gyres p' proved to rr]gthrough sans actory evidence of identification, May 10,2030 which were lti'Jt+' I,(-4 X to be the person whose name is signed on the ing or attached document,and acknowledged to me at he)(she)signed it voluntarily for its stated rpose. ,/� N tary 's rgnature My Commission Expires/'U''( -''7.- • s`"4' A``-, TOWN OF YARMOUTH o . ° BUILDING DEPARTMENT A..`•�MA"A 'f_C,/,,w .11.46 Route 28, South Yarmouth, MA 02664 ,\�,,TA.rr �i.<4' `' r ''' Telephone 508-398-2231 ext. 1261 Fax 508-398-0836 Contractor's Affidavit: Substantial Improvement or Repair of Substantial Damage Property Address: 3 \ Paw- rA. s. an.co t/o G4 Parcel ID Number: 9 3 ( 3 Owner's Name: �zn i' Pao-c-e-(..e�. lJeacl Contractor: PO ' “(...5 Contractor's License Number: Cc — 0 6 i O 1-L.C Date of Contractor's Estimate: CD .> ?SO a-_7 I hereby attest that I have personally inspected the building located at the above-referenced address by the nature and extent of the work requested by the owner, including all improvements, rehabilitation, remodeling, repairs, additions, and any other form of improvement. At the request of the owner, I have prepared a cost estimate for all of the improvement work requested by the owner and the cost estimate includes, at a minimum, the cost elements identified by the Town of Yarmouth that are appropriate for the nature of the work. If the work is repair of damage, I have prepared a cost estimate to repair the building to its pre-damage condition. I acknowledge that if, during the course of construction, the owner requests more work or modification of the work described in the application, that a revised cost estimate must be provided to the Town of Yarmouth, which will re-evaluate its comparison of the cost of work to the market value of the building to determine if the work is substantial improvement. Such re- evaluation may require revision of the permit and may require revision of the permit and may subject the property to additional requirements. I also understand that I am subject to enforcement action and/or fines if inspection of the property reveals that I have made or authorized repairs or improvements that if inspection of the property reveals that I have made or authorized repairs or improvements that were not included in the description of work and the cost estimate for that work that were-- asis f r iss ce of a permit. COMMONWE H OF MA ACHUSETTS Contractor's Signature , _ COUNTY OF .ISC r iN V• �-t- On this(U dayo€U_f 'f 204before me,the undersigned / notary public, 14-I'; a< '�,,r personally appeared, Date: 70 1 O , (} proved to me though satisfactory evidence of identification, which were I X. >.%9 I r-tk i to be the person whose name is signed on the ceding or attached document,and Notarized M I C H E L L E M L E B L A tJ acknowledged to me at(he)(she)signed it voluntarily for its �;'C Notary Public stet d u ose. 11/4ii!. COMMONWEALTH OF MASSAChur,t'My Commission Expires �i May 10,2030 ary blic s Signature My Commission Expires" < ' THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:Individual Registration Expiration 165888 05/14/2024 PATRICK JACOBS D/B/A P.JACOBS CUSTOM CARPENTRY AND REMODELING 28 WHiTTER DR.S 1 a, ' DEANS,MA 02638 Undersecretary Commonwealth a"Massachusetts c Division of Occupational Licensure Board of Building Re ulatiofs and Standards Cons tantbejrvisor CS-081040 -- I pi es 04/04/2024 PATRICK H*COBS 28 WHITTIEWDI VE DENNIS MA 0 638 ' J '' 7 %�1Jr5 <t3.3 Commissioner ultra f% t ; 1 >J-u'_ • { 0 8 tc w Ii1 , `> i1 j z 8 to 8 a � Gtc 'r 'CS 8 a� f to "2 . 0 w w ► ( I , ,> I [ Ii 132" S t .-llN P V - _ ^/ n I W OC` N 11 T I 'o A SHOW.D.OFRM.EXP' • Lois \ CV / \\ i TOIL.STD BATH.LEG.COZY.F) i 14 3 „ 43„ it I 55 8 „ P-1 14" . ;. L. L li All dimensions.size designations This is an original design and must Designed:9/8/2023 given are subject to verification on not be released or copied unless Printed: 10/6/2023 job site and adjustment to fit job ^ applicable fee has been paid or job conditions. (`fl order placed. Upstairs Bathroom El 1 Drawing#: 1 No Scale. 115" • B18R. FH BATH.LEG.COZY.FX l APL wit 1 i� 5 t� 95s.4 1616 1 ,8, ,,, 53 1 „ ,�,„ ,' 4 61 1�6 All dimensions size designations This is an original design and must Designed:9/8/2023 given are subject to verification on not be released or copied unless Printed: 10/6/2023 job site and adjustment to fit job applicableapplicable fee has been paid or job conditions. order placed. Upstairs Bathroom _El 2 Drawing#: 1 No Scale. 115" A CIO Lo q V — =T6193= =T6193� , , , sue — — _ K-2839-1-95 �_ DKD2424 K-289 j 95 VF3 WHVC2421 WHVC2421 I c� TOI L.STD s 2 ft" ►- 24" -� 2 " �� 41 -1' • 12 2 II I 13 ' 7 �� 1511 16 47 8 k! 3416 1 716 oil (i it": All dimensions size designations This is an original design and must Designed:9/8/2023 given are subject to verification on not be released or copied unless Printed: 10/6/2023 job site and adjustment to fit job applicable fee has been paid or job �O2conditions. order placed. Upstairs Bathroom _El 3 Drawing#: 1 No Scale. • 132" -14 8"1- 43" 6� 551" —14:".- w x ,,:it.,2 , . ?Ti 1 —IN J X r X A1, t O CO co y m [w N r �, (Ni O'Z Y = , K F— tl- nIoD 4- N (•-• N 1411 Q •. Y 0 _ A,4- N I'',r f �ii• , Jito /' , k �� �t CO co APL • 1') I• N 71 M — _-- Y I ( - a 21 ' 87" 188" 4„ 28' 198" m 2 8" 811 4-1 1811 132" All dimensions size designations This is an original design and must Designed:9/8/2023 given are subject to verification on not be released or copied unless Printed: 10/6/2023 job site and adjustment to fit job applicable fee has been paid or job �2conditions, order placed. Upstairs Bathroom All Drawing#: 1 No Scale.4 • • 14 —132" 1 w - vr.V-ie,,,,,,,,,,n4iv---4v4gy,..v,pr,,,w.f.thz-;42,•,--r=,,,=. ,::-=, — — 1 :41+14-v,ifk_'4a,---sWit'="4;;;4241114=1*-'-`4,4?.-",--; ,,,---,.%,,,,,•; . Or ,, •"---!_r :'4,. :,." r=4v. a t=". __X-------- I-- 220 C 2 Yi : (** ••=i )) 71 to io ,t1=4, , K - CO C1,2 - ,--,-= 0 0 ,=.= ,. X in -0 1" ' Legend se (a) o„) L._ _. 4: WHVC2421 74 fd _ 8: DKD2424 I 18: APL I I- 19: B18R.FH - 1 20: APL col Nr ,.. 1.0 • 20 p==' ,•,-,I ,y Y_,, , 1 t 1 7" .4 110i" i 2-i" .. - --48" 41i" 132" All dimensions size designations This is an original design and must Designed:9/8/2023 given are subject to verification on not be released or copied unless Printed: 10/6/2023 job site and adjustment to fit job applicable fee has been paid or job conditions. 2020 order placed. Upstairs Bathroom .__ _. _ ... Legend Drawing#: 1 No Scale.