HomeMy WebLinkAboutBLD-23-000160 ONE & TWO FAMILY ONLY- BUILDING PERMIT
Town of Yarmouth Building Department
1146 Route 28,South Yarmouth,MA 02664-4492 rF
508-398-2231 ext• 1261 Fax 508-398-0836 FS
Massachusetts State Building Code,780 CMR
Building Permit Application To Construct,Repair, Renovate Or Demolish !'J
a One-or Two-Family Dwelling
This Sectio For Official Use Only
Building Permit Number: Date Applied:
Building Official(Print Name) Signature R"F C F I V E D
SECTION 1:SITE INFORMATION
1.1 Pro erty Address: 1.2 Assessors Map&Parcel Numbers
137 Run Pond Rd JUL OR 2022
1.1 a Is this an accepted street?yes_ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions: 811 t MENT
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'
2.1 Owner'of Record: BROOKLINE, MA 02445
Casa Madrid, LLC
Name(Print) City,State,ZIP
320 WASHINGTON ST STE. 3FF 617-751-5119 jacob.simmons@cityrealtyboston.com
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction 0 Existing Building❑ I Owner-Occupied ❑ Repairs(s) 0 Alteration(s) ❑ I Addition 0
Demolition Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work':
Raze Existing building.
Foundation and framing of existing structure are compromised and property is structurally unsound.
SECTION 4:ESTIMATED CONSTRUCTION COSTS.
Item Estimated Costs: Official Use Only
(Labor and Materials)
I.Building $ 25000 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
0 Total Project Cost3(t- 6)x multiplier x
.� r 3.Plumbing
$ 2. Other Fees: $ ���: �f"w
0,�-
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 ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) CS-107462 7/31/23
Josh Fetterman License Number Expiration Date
Name of CSL Holder
49 Osborne Path List CSL Type(see below) U
No.and Street Type Description
Newton Center, MA 02459 U ( Unrestricted(Buildings up to 35,000 cu.ft.)
City/Town,State,ZIP R Restricted 1&&2 Family Dwelling
1v1 Masonry
RC Roofing Covering
•
WS Window and Siding
617-470 2111 SF Solid Fuel Burning Appliances
josh.fetterman@cityrealtyboston.com I Insulation
Telephone Email address D I Demolition
5.2 Registered Home Improvement Contractor(HIC)
Josh Fetterman 175587 05/23/23
I-11C Company Name or HIC Registrant Name HIC Registration Number Expiration Date
49 Osborne Path josh.fetterman@cityrealtyboston.com
No.and Street
Newton Center,MA 02459 617-470-2111 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 W 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 Josh Fetterman
to act on my
behalf,in all
matters relative to work authorized by this building permit application.
1 Ai ? 3- .- .4'9'Lir-
6/17/22
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.
c 44 9 - 6/17/22
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
I. An Owner who obtains a building pen-nit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Progr•am),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.aov/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
•
_mil_ Department of Industrial Accidents
y`;M,t` 1 Congress Street,Suite 100
,,._! ° Boston,MA 02114-2017
"4 www.tnass.gov/dia
-orkers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY,
A licant Information
Please Print eoibiName(Business/Organization/Individual): CRM Property Management/Josh Fetterman
Address: 320 WASHINGTON ST STE.3FF
City/State/Zip:BROOKLINE,MA 02445 phone#: 617-751-5119
Are you an employer?Check the appropriate box:
lVIl am a employer with20 employees(full and/or part-time).* Type of project(required):
7.
2.0 I am a sole proprietor or partnership and have no employees working for me in ❑New construction
any capacity.[No workers'comp.insurance required.] 8. Remodeling
3. 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 10❑ Building addition
ensure that all contractors either have workers'compensation insurance or are sole proprietors with no employees. 11.(]Electrical repairs or additions
5.❑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 such.
tContractors 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.
Associated Employers Insurance Company
Insurance Company Name:
Policy=or Self-ins.Lic. :WCC-500-5018409-2022A
Expiration Date:3/20/23
Job Site Address: 137 Run Pond Rd
Attach a copy of the workers'compensation policy declaration page(showingtthetpolicy number and exp ration 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 penalties of perjury that the inforrnatfon provided above is true and correct.
Signature: di f[tte_ ilia y
Date: 6/17/22
Phone T: 617-470-2111
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 i*:
o� TOWN OF YARMOUTH
o :-, ' - i BUILDING DEPARTMENT
ti` MAgAC�C[S''P 1146 Route 28, South Yarmouth,MA 02664 508-398-2231 ext. 1261
YG e
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
DATE:
JOB LOCATION:
NAME STREET ADDRESS SECTION OF TOWN
"HOMEOWNER"
NAME HOME PHONE WORK PHONE
PRESENT MAILING ADDRESS
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.I.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 performed 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 OFrlCIAL
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 yes,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 one:
Signature of Owner or Owner's Agent Owner Agent
h:hcrr= -_ :exemp
§TOWN OF YARMOUTH
1146 Route 28, South Yarmouth, MA 02664
508-398-223!1 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 137 Run Pond Rd
Work Address
Is to be disposed of oat the following location: 337 Whites Path,South Yarmouth,MA 02664
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Ch. 111, §150A.
6/17/22
gnature of Application Date
Permit No.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
A-- Lafayette City Center
ep,= 2 Avenue de Lafayette, Boston,MA 02111-1750
*'' www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):Josh Fetterman
Address:320 Washington St#3FF
City/State/Zip:Brookline, Ma 02445 Phone#:617-470-2111
Are you an employer?Check the appropriate box:
Type of project(required):
1.0 I am a employer with 20 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. New construction
listed on the attached sheet. 7. ❑Remodeling
2.El I am a sole proprietor or partner-
ship and have no employees These sub-contractors have 8. 0 Demolition
working for me in any capacity. employees and have workers'
[No workers' comp. insurance comp. insurance.# 9• ❑Building addition
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doingall work officers have exercised their
11.❑ Plumbing repairs or additions
myself [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13.0 Other
comp. insurance required.]
*Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information.
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:Associated Employers Insurance Company
Policy#or Self-ins. Lic. #:WCC-500-5018409-2022A Expiration Date:3/20/23
Job Site Address: 137 Run Pond Rd City/State/Zip:Yarmouth, MA 02664
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify un ins and penalties of perjury that the information provided above is true and correct.
Signature. Date: 6/30/22
Phone#: 6174702111
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(check one):
IDBoard of Health 20 Building Department 31:City/Town Clerk 4.0 Electrical Inspector 50Plumbing
Inspector 6.❑Other
Contact Person: Phone#:
Josh Fetterman — CRM Property Corp
320 Washington St C: 617 470 2111
Brookline, MA 02445 E: josh@cityrealtyboston.com
Date:4/27/22
Owner:
Casa Madrid, LLC
Property Address: 137 Run Pond Rd South Yarmouth, Ma 0255470 Southampton St Boston MA 02118
Article 1. General Conditions
It is understood and agreed that the contractor, shall perform the requirements of these specification in a proper and
professional manner, consistent with industry accepted methods and standards, and in a timely and cost-effective
manner.
1. The Contractor shall furnish all labor, materials and equipment to perform the contractual duties in
accordance with the requirements here specified.
2. The Contractor shall be responsible for any damages to the property to include but not limited to wall,
building elements and personal property caused by his/her workforce and or negligence while
performing the requirements.
3. The Contractor shall carry General Liability Insurance of least$1,000,000.00
4. The Contractor shall submit a Certificate of Insurance at the time of commence work.
5. The Contractor agrees to indemnify, defend and hold harmless the owner from any and all claims and
lawsuit arising from the contractor's performance, of lack thereof, of the work included in this contract.
6. Contractor may not perform any work above and beyond the scope of the specifications without prior
written notice to and approval from the owner.
7. All materials and paint to be provided by the Contractor, any debris and or paint cans, paint brushes,
nails, wood, tools, etc. shall be responsibility of the Contractor.After each workday,the contractor shall
clean up any and all debris remove it off the premises.
Article 2. Change Orders
Any alteration or deviation from the attached scope, including but not limited to any such alteration or deviation
involving additional material and or labor costs will be executed only upon a written order for same, signed by owner
and contractor, and if there is any charge for such alteration or deviation, the additional charge will be added to the
contract price of this contract.
Article 3. Payments
If payments are not made when due, contractor may suspend work on the job until such time as all payment due
have been made.A failure to make payments for a period in excess of 30 days from days from the due date of the
payment shall be deemed a material breach of this contract.
Article 4. Scope of Work
The Contractor shall furnish all of the materials and perform all of the work involved as it pertains to 46 Sheridan St
St, Jamaica Plain, MA
Article 5. Time of Completion
The work to be performed under this contract shall be commenced the day after signed contract and after permit is
secured and shall be substantially completed 365 days from start. Time is of the essence.
WORK TO INCLUDE:
Agreement for Work.
Page 1 of 2
Josh Fetterman — CRM Property Corp
320 Washington St C: 617 470 2111
Brookline, MA 02445 E: josh@cityrealtyboston.com
Exploratory Demo $1,000
Total $1,000
1. All staging, scaffolding, ladders, drop cloths, hand tools, power tools, and all equipment and tools normally
used in the industry.
This agreement made 27 April 2022 between Josh Fetterman herein called the Contractor and Casa Madrid,LLC,
called the Owner.
Signed thisWednesday,April 27, 2022th day of 27 April 2022.
Agreed to:
Casa Madrid, LLC
Josh Fetterman
MA CS License: CS-107462
-gent for Work.
Page 2 of 2
ONE or TWO FAMILY— BULDING PERMIT
APPLICATION REGULATORY APPROVALS NOTICE
Address of Proposed Work:137 Run Pond Rd
Scope of Proposed Work: Raze Existing building
Date: 6/17/22
Based on the scope of work described above,the applicant is required to obtain approval sign-
offs from the following departments as checked-of below:
Health Dept.—508-398-2231 ext. 1241
Conservation—508-398-2231 ext. 1288
Water Dept. —99 Buck Island Road, 508-771-7921
Old Kings HWY. Hist. Comm. —508-398-22631 ext. 1292
Engineering Dept.—508-398-2231 ext. 1250
Fire Dept.—Kevin Huck/Scott Smith, 96 Old Main Street, SY
Note: Please call Fire Department for an appointment. 508-398-2212
Other
Appropriate plans and/or application shall be provided to each departments checked-off above.
Each of these regulatory authorities has their own requirements outside the jurisdiction of the
Building Department. All applicable approvals shall be obtained prior to submitting a building
permit application to the Building Dept.
Thank you for your cooperation.
Receipt Acknowledgement:
6/17/22
Ap icant's Signature Date
Rev.Jan. 2019
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Sears, Tim
From: Sears, Tim
Sent: Thursday, July 28, 2022 9:09 AM
To: 'josh.fetterman@cityrealtyboston.com'
Cc: Water Department; Slack, Christine; Huck, Kevin; Bearse, Matt; DiRienzo, Brittany
Subject: 137 Run Pond Rd
Josh,
I have r iewed your application for demolition and there are some items needed.
Health Department sign off
�2. Water Department sign off
�3. Fire Department sign off
4. Conservation sign off
5. Gas & Electric disconnect letters
Please submit these items for review
This email is considered a writterf`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 fora 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 CBO
Deputy Building Commissioner
Town of Yarmouth
508-398-2231 F xt. 1259
mailto:tsears@yarmouth.ma.us
1