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BLDR-23-11031 • ONE & TWO FAMILY ONLY-BUILDING PERMIT Town of Yarmouth Building Department f''of r 1146 Route 28,South Yarmouth,MA 02664-4492 It4 AI 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 Dwelling This Section For Official Use Only R E C E I V E Building Permit Number: 3tDg'Z3- '10 3/ Date Applied.:— i 1-r, 5e1\(5 J�..>-� G-it -)- MAY 19 2923 Building Official(Print Name) • "gneture BUILDING DFFV\RTMENT SECTION 1:SITE INFORMATION By _____ 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 32 Shaker House Road Yarmouth Port, MA 02675 115 165 1.1 a Is this an accepted street?yes x no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Residential- Single Family 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: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public RI Private CI _Zone: Outside Flood Zone? Municipal 0 On site disposal system fiCI Check if yesl$] SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Henry Evans Yarmouth Port, MA 02675 - Name(Print) City,State,ZIP 32 Shaker House Road 774-268-1205 henryevans362©yahoo.com No.and Street Telephone FinaiI Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building El I Owner-Occupied El ` Repairs(s) 0 Alteration(s) El Addition 0 i Demolition LI Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work2: Basement Finishing-Add 2 sections of wall, close ceiling, no bedroom SECTION 4:ESTIMATED CONSTRUCTION COSTS. Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 20,000 1. Building Permit Fee:$ 150 Indicate how fee is determined: r intandard City/Town Application Fee ?.Electrical $ 4,000 - 0 Total Project Cost2a(It 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ .77 v 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ . Suppression) Total All Fees:$ • Check No. Check Amount: Cash Amount. 6.Total Project Cost: $ 24,000 1 0 Paid in Full Si Outstanding Balance Due: i)'5 j SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-095039 7/30/2024 Jan Kvietok License Number Expiration Date Name of CSL Holder 32 Lockwood Drive List CSL Type(see below) U No.and Street Type Description South Dennis, MA 02660 U j Unrestricted(Buildings up to 35,000 cu.ft.) City/Town,State,ZIP R Restricted lctc2 Family Dwelling lv1 Masonry RC I Roofing Covering •-- WS Window and Siding SF Solid Fuel Burning Appliances 774-317-0593 office@tatraco.com _ I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) Tatra Building Company Inc. 176970 10/17/2023 HIC Company Name or HIC Registrant Name HIC Registration Number Expiration Date 1268 Route 28 office@tatraco.com No.and Street South Yarmouth, MA 02664 508-619-6073 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 t] 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 Tatra Building Company Inc to act on my behalf,in all matters relative to work authorized by this building permit application. Henry Evans 5/1/2023 Print Owner's Name(Electronic Signature) Date • 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. Jan Kvietok 5/1/2023 Print Owner's or Authorized Agent's Name(Electronic Signature) Date 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/oca Information on the Construction Supervisor License can be found at www.mass.rov/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" §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. 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 32 Shaker House Road Yarmouth Port, MA 02675 Work Address Yarmouth DPW-606 Forest Rd, South Yarmouth MA 02664 Is to be disposed of oat the following location Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. 5/1/2023 ignature of Application Date Permit No. ONE or TWO FAMILY— BULDING PERMIT APPLICATION REGULATORY APPROVALS NOTICE Address of Proposed Work: 32 Shaker House Road Yarmouth Port, MA 02675 Scope of Proposed Work: Basement Finishing -Add 2 sections of wall, close ceiling, no bedrooms Date: 5/1/2023 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. Recei Ackno gemen • 5/1/2023 Ap rcan s Signat e Date f. Rev. Jan. 2019 • The Commonwealth of Massachusetts 'Al. L Department of.Industria/Accidents I! 1 Congress Street, Suite 1 D,11D Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. A licant Information Please Print Leoib[ Name (Business/0rganization/Individual): Tatra Building Company Inc Address: 1268 Route 28 City/State/Zip: South Yarmouth, MA 02664 Phone 508-619-6073 Are you an employer?Check the appropriate box: 1.01 am a employer with 8 employees(full and/or part-time).* Type©f project required): 0 New 1Q I am a sole proprietor or partnership and have no employees working for me in 7. Rem Jelin construction any capacity.[No workers'comp.insurance required.] 8. ©Remodeling 9. El Demolition 3.E1 I am a homeowner doing all work myself.(No workers'comp,insurance required.]t 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. 1 will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole proprietors with no employees. 11.ED 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.insurances 13. Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box m 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:_Federated Mutual Insurance Company Policy=or Self-ins.Lic.#: 1803555 Expiration Date: 3/15/2024 Job Site Address: 32 Shaker House Road Attach a copy of the workers' compensation policy declaration page(showing help l m policy number a deopira on dal). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to 51,500.00 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 hereb certify raider tit ins and penalties of perjuty that the information provided above is true and correct Sienat e: Phone#: 774- 17-0593 Date: 5/1/2023 Official use only. Do not write in this area,to be completed by city or town official. City or Town: g Permit/License Issuin 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#: DATE(MM/DD/YYYY) 4.....--- CERTIFICATE OF LIABILITY INSURANCE 01/30/2023 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 FEDERATED MUTUAL INSURANCE COMPANY NAME: CLIENT CONTACT CENTER HOME OFFICE: P.O.BOX 328 PHONE (A/c,No,Ext):888-333-4949 FAX A XC,No):507-446-4664 OWATONNA,MN 55060 E-MAIL ADDRESS:CLIENTCONTACTCENTER@FEDINS.COM INSURERS AFFORDING COVERAGE NAIC# INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 188-583-9 INSURER B: TATRA BUILDING COMPANY INC. 1268 ROUTE 28 INSURER C: SOUTH YARMOUTH, MA 02664-4459 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:0 REVISION NUMBER:0 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 TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP I TR JNSR WVD POLICY NUMBER (MM/DD/YYYYI (MM/DD/YYYYI LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 I CLAIMS-MADE X I OCCUR DAMAGE TO RENTED PREMISES (Ea ocairrence) $100,000 MED EXP(Any one person) EXCLUDED A N N 6120016 03/15/2023 03/15/2024 PERSONAL&ADV INJURY $1,000,000 GEN L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY I UEC I LOC PRODUCTS&COMP/OP ACC $2,000,000 OTHER: AUTOMOBILE LIABILITY ,Ea aBINE DSINGLE LIMIT $1,000,000 X ANY AUTO BODILY INJURY(Per Person) A OWNED AUTOS ONLY_AUTEQSDULED N N 6120015 03/15/2023 03/15/2024 BODILY INJURY(Per Accident) PROER HIRED AUTOS OWNLY NON-OWNED AUTOS ONLY (Per AcoTYnDDAMAGE t UMBRELLA LIAB _OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N X PER STATUTE OTHER ANY PROPRIETOR/PARTNER/EXECUTIVE A OFFICER/MEMBER EXCLUDED? NIA N 1803555 E.L EACH ACCIDENT $500,000 (Mandatory in NH) 03/15/2023 03/15/2024 If yes,describe older E.L DISEASE EA EMPLOYEE $500,000 DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) THIS COPY IS NOT TO BE REPRODUCED FOR ISSUANCE OF CERTIFICATES. CERTIFICATE HOLDER A CERTIFICATE HAS BEEN FILED WITH EACH OF YOUR CANCELLATION I CERTIFICATE HOLDERS. 0 0 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I /046:04 e. ,z.,„4., ACORD 25(2016/03) The ACORD name and logo are registered marks of AC RDA 2015 ACORD CORPORATION.All rights reserved. ate. Cornottonweatth Meesactomptto Divotoo of Otecopoltonot Ltepoeurp of oil-0 A d k., etttt . 1 5 • 039 rcs 07t31,1421)24 32 LAG * ► Fibs or ni si ner P Ty" ::,s: :tt'> aL�a % I �YR3T€•S'1R # IS.J f �t.`Y ".r' ikr ad it 1 tire5:?>e 2fi$s i0 r <»r aw€E,ii �� �, KM-Ma CakelfWi'V tDe; T .'# . fir € 22 16FGR 16 BAS 16 WOK 16 22 15 14 53 BAS 24 6 UBM 24 /iisaer7 YENJ/LAT/ON FAN Energy Recovery VentilatorF��04 M E 1 Specification Submittal Data /Panasonic Ventilation Fan 2 x 4„ducts , �, ,.. Description Grille: / f Energy Recovery Ventilator provides a tempered •Attractive design usingABS material. �,I �� 7�1`�) air supply,humidity control,and a balanced •Attaches directly to housing with torsion , —I \i amount of exhaust to help maintain neutral springs. pressure throughout the home.Panasonic ERV Warranty: H, �� ` shall not be installed in a bathroom.Only one . �1 ��%� unit is needed for a 1,750 sq.ft.2 bedroom •ALL Parts:For period of 3 years from the date �Q: ,,;� of the original purchase. �--, . F r home to meet the ASHRAE 62.2 ventilationp „•,s requirement. Architectural Specifications: Motor/Blower. ERV shall be of the ceiling mount type with no lass than 40 CFM on the exhaust port,30 CFM •Totally enclosed AC condenser motor rated for on the supply port,and no more than 0.8 sone continuous run. as tested in accordance with HVI 915 and 916 •Power rating shall be 120 volts and 60 Hz. standards at 0.1 static pressure in inches water �'` i �/ •Two highly efficient blower wheels running on gauge.Power consumption shall be no greater single motor for lower power consumption and than 23 watts,Apparent Sensible Effectiveness FV-04VE1 decreased noise. for heating shall be no less than 66%at 30 •Motor equipped with thermal cut-off fuse CFM net air flow under 32°F(0°C)as tested in Title-24,and WA Ventilation Code compliant. control. accordance with CSA-C439.Total Recovery Effectiveness for cooling shall be no less than ERV Core Technology: Housing: 36%at 29 CFM net air flow under 95°F(35°C). •Indoor and outdoor air passes through •Rust proof paint,galvanized steel body. The supply port damper shall close below 20'F Panasonic's capillary core technology. •Dual 4"intake and exhaust ducts. (-7°C)to prevent freezing of the core.The motor This process tempers supply air while •Built in backdraft damper on exhaust duct. shall be totally enclosed,AC condenser type transferring moisture and energy. •Filters on supplyengineered to run continuously.Power rating •Built in Frost Prevention Mode prevents the and exhaust air extend the shall be 120v/60Hz.Duct diameter shall be core from freezing.Frost Prevention Mode is free life of the ERV core. no less than 4". Fan shall be ASHRAE 62.2, of interaction and operates without intervention. •Expandable mounting bracket up to 16"on LEED,ENERGY STAR IAP,EarthCraft,California center. Performance:WhisperComfort FV-04VE1 Air Volume Setting 40(,'FM Z0 CFM 10 CFM t? 4.54 3 Static Pressure in inches w.g. 0.1 0.1 0.1 P Exhaust Air Volume(CFM) 40 20 10 0.40 FV-04VE1 (Exhaust) Supply Air Volume(CFM) 30 20 10 a FV-04VEt Noise(cones) 0.8 <0.3 N/A0'30 —(SuPr b') --•20 Feet i Power Consumption(watts) 23 21 17 —40 Feet • Speed(RPM) 1479 1292 1095 0.20 •,•'�, - 60 Feet 0 Feet Current(amps) 0.15 0.10 1 0.09 li. "���� � -8o0Feet Power Rating(V/Hz) 120/60 D.10 /% Energy Performance:WhisperComfort FV-04VE1 0.00 --- Apparent Sensible Effectiveness for Heating 66%at 30 CFM and 32°F(0°C) 0 10 20 30 40 50 60 Total Recovery Efficiency for Coolin Airfbw(CFM) g 36%at 29 CFM and 95°F(35°C) As of date 4/11 For complete Installation Instructions visit www.panasonic.com/building Model Quantity Comments Project Location: Architect: Engineer: Contractor: Submitted by: ' Date: Panasonic Home and Environment Company Division of Panasonic Corporation of North America One Panasonic Way Secaucus,NJ 07094 www.panasonic.com/building ~f ` u` E= Panasonic VF11144SS � MisaeFF6,�#4'. PENT/LAT/o,y FAN Energ/Recovery Ventilator .` �04VE I Specification Submittal Data /Panasonic Ventilation Fan v 2 x 4"ducts Description Driller: m/ `��;�a�'.�- I Energy Recovery Ventilator provides a tempered •Attractive design using ABS material. r,. air supply,humidity control,and a balanced • \�/�) Attaches directly to housing with torsion �J \mil amount of exhaust to help maintain neutral springs. / pressure throughout the home.Panasonic ERV r lj+ —;j /z �1" shall not be installed in a bathroom.Only one Warranty: unit is needed for a 1,750 sq.ft.2 bedroom •ALL Parts:For period of 3 years from the date + � '� �% home to meet the ASHRAE 62.2 ventilation of the original purchase. requirement. a° Architectural Specifications: Motor/Blower: ERV shall be of the ceiling mount type with no •Totally enclosed AC condenser motor rated for 1 than 40 CFM on the exhaust port,30 CFM �` continuous run. on the supply port,and no more than 0.8 some as tested in accordance with HVI 915 and 916 •Power rating shall be 120 volts and 60 Hz. standards at 0.1 static prrbure in inches water is"''� •Two highly efficient blower wheels running on gauge.Power consumption shall be no greater single motor for lower power consumption and than 23 watts.Apparent Sensible Effectiveness FV-04VE1 decreased noise. for heating shall be no less than 66%at 30 •Motor equipped with thermal cut-off fuse CFM net air flow under 32°F(0°C)as tested in control. accordance with CSA-C439.Total Recovery Tits 24,and WA Ventilation Code compliant, Noosing: Effectiveness for cooling shall be no less than ERV Core Technology: 36%at 29 CFM net air flow under 95°F(35°C). •Indoor and outdoor air passes through •Rust proof paint,galvanized steel body. The supply port damper shall close below 20 F Panasonic's capillary core technology. •Dual 4"intake and exhaust ducts. (-7°C)to prevent freezing of the core.The motor This process tempers supply air while •Built in backdraft damper on exhaust duct. shall be totally enclosed,AC condenser type transferring moisture and energy. •Filters on supply and exhaust air extend the engineered to run continuously.Power rating •Built in Frost Prevention Mode prevents the life of the ERV core. shall be 120v/60Hz.Duct diameter shall be core from freezing.Frost Prevention Mode is free no less than 4". Fan shall be ASHRAE 62.2, of interaction and operates without intervention. •Expandable mounting bracket up to 16"on LEED,ENERGY STAR IAP,EarthCraft,California center. Performance:WhisperComfort FV-04VE1 1 Air Volume Setting 40 CFM 20 CAW TO CM a; ASD Static Pressure in inches w.g. 0.1 3 0.1 0.1 -g Exhaust Air Volume(CFM) 40 20 10 7 0.40 — FV-0E7 hill' Supply Air Volume(CFM) 30 20 10 —(su(Exhaust)PP 4VH) u FV-04VE1 Noise(sons) 0.8 <0.3 N/A 0.30 Power Consumption(watts)n w 20 Feet 21 17 —40 Feet Speed(RPM) 1479 1292 i 1095 0.20 23 ` -'60 Feet --80 Feet Current(amps) (1,15 I 0.14 n.08 �'i� lOOFeet Power Rating(V/Hz) 120/60 �.10 .. /i Energy Performance:WhisperComfort FV-04VE1 Mpm Apparent Sensible Effectiveness for Heating 66%at 30 CFM and 32°F(0°C) 0 3 20 30 40 50 60 Total Recovery Efficiency for Cooling 36%at 29 CFM and 95°F(35°C) Airflow(CFM) As of date 4/11 For complete Installation Instructions visit www.panasonic.com/building Model Quantity Comments Project: Location: Architect: Engineer: Contractor: Submitted by: Date: Panasonic Home and Environment Company Division of Panasonic Corporation of North America One Panasonic Way Secaucus,NJ 07094 www.panasonic.com/building r—� /1 MY coos VF11144s3 +��� Panasonic .. ,, i