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Home My WebLink AboutBLDR-24-6 RECEIVED JAN 0- 202 NE L. TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department .'o 'r a t_.__.._ 1146 Route 28,South Yarmouth,MA 02664 4492 • BUHLDI'VG DEPARTMENT 508-398-2231 ext. 1261 Fax 508-398-0836 By 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 ' Building Permit Number: e ).-2`1—(v Date pplie i/' 7 7 2y Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers /63 4 41/01 C1tQ;M 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) Front Yard Side Yards Rear Yard Required l 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 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system CI Check if yes0 SECTION 2: PROPERTY OWNERSHIP' 2e.1 Owne ' f Record: tvuz, P(a4 CTa/2/i' %J ice' irv, h?o N4— Oval,75 Name(Print) City,State,ZIP 103 G7i.�,gnfy 1160I 2 J /Yu,/-/u-i tb/zV&i „,,.,;jt. tU 1' No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction❑ I Existing Building,'l Owner-Occupied ❑ I Repairs(s) 0 Alteration(s) ❑ I Addition 0 Demolition ❑ I Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work: Te.,,-r,z, ;f 4,,,,..) L.;f} r4, l' a. �j rrvPzl AL./ �_S l,�Burl 4'I O ;f lr pi, (mil71( d . 2 �(1 �}a. a>1'S' In s lied _ SECTION 4:ESTIMATED CONSTRUCTION COSTS. Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee 0 Total Project Costa Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ CI a"7 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire . Suppression) $ Total All Fees:$ ' - - 6.Total Project Cost: $ %' - Check No. Check Amount: Cash Amount: 1 ' 0Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 6669 ?thi'L License Number Expiration Date Name of CSL Holder u/� l <--3:i List CSL Type(see below) No.and Street Type I Description l'Y4 40675 II t Unrestricted(Buildings up to 35,000 cu.ft.) City/Town,State,ZIP - R Restricted l&2 Family Dwelling 141 Maso • RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances .50 '737 c1(L4 i,?, �`f dset4,.i ,/ i Insulation Telephone Email address /eel D j Demolition 5.2 Registered Home Improvement Contractor(HIC) �[m �2 / 1�19 /i��t 11Y r�S /�� /(y CeIG5/2e4 y HIC Company Name or HIC Registrant Name HIC Registration Number Expiration Date 1� 5 L / (),Ai 3/l No.and�_yStreet / AL K�r 'i S l� Yl Lim all- C`V4 (U,�13(4 3''73 7—l-et:*, 'i 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 ❑ • 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 F /2.5Z. to act on my behalf,in all matters relative to work authorized by this building permit application. 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 applicati is and accurate to the best of my knowledge and understanding. 71 &G 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.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" §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 /63 6/t ii,Ciey Ya� 3)Pert 1 q-. 6-460 13 Work Address Is to be disposed of oat the following location: Rd'6a2/;4 V6Pas a/ Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. Signature of Application Date Permit No. lr ss Nauset Kitchens, LLC 157 Brick Hill Rd. Orleans, MA 02653 NausetKitchens.com Bruce&Diane Holznagel 103 Almighty Heights YarmouthPort,Ma. 02675 Master Bathroom Remodel: Project to be permitted by The Town of Yarmouth Building Department. Homeowner will supply all materials for bathroom other than what is stated in my proposal. Shower doors provided by Nauset Kitchens .Pocket doors and any miscellaneous materials such trim,baseboard,sheetrock provided by Nauset Kitchens. I will provide square footages of materials and design guidance on materials and fixtures,but will be purchased by owners. Plumbing rough and final included. Electrical rough and final included. Entry way to be framed over to closet as discussed to accommodate a walk in shower and linen closet. Painting walls ceiling and trim included. Install vanity downstairs bathroom provided by homeowner. A$5,000.00 Retainer holds your place in my queue.The remainder of initial deposit is paid upon start of project. a' 7ll /�3 Payment Plan Total Price $30,875.00 Initial Deposit 10,437.50 2nd Installment $8,000.00 (Upon rough plumbing and electrical 3rd Upon Tiling $5,437.50 Balance Due upon $2,000.00 completion Terms & Conditions The above prices, specifications and conditions are satisfactory and are hereby accepted by both parties. Nauset Kitchens is authorized to do the work as specified. Payment will made as outlined above. t/273 ClaZ Your Name Date Client's Name Date Thanks for your interest in Nauset Kitchens! Adam Pearl 508.737.6629 • • Commonwealth of Massachusetts ® Division of Occupational Licensure Board of Building Regulations and Standards Constructio ce3r N`v �rvf1 &2 Family CSFA-106368 * �tpires:04/07/2024 ADAM PEAR 157 BRICK HILL R 1' Mat ORLEANS Mt 0265 # Commissioner icAr—Cieft 71.. T7cm/1(a... THE COMMONWEALTH OF MASSACHUSETTS • Office of Consumer A Andr a Business motion HOME I + ONTRACTOR / Z ADAM PEARL g' D/BtA NAUSET KITCHEN £ a 4 • ADAM PEARLY 157 BRICK HILL RD ▪ "< /` ORLEANS,MA 02653 ▪ Undersecretary • • • • • ` •:-J- p [ i \ ;, Ada v tot- - j �j -ram 'X' ','K V r AAA t Z..., 0 / I )\ Div ONE or TWO FAMILY— BULDING PERMIT APPLICATION REGULATORY APPROVALS NOTICE Address of Proposed Work: irt)pj/ Scope of Proposed Work: b(/� ' {/;AJ( /v A .0 wl/'M YIP.ti✓, 60/45 / UCI1Hi - Date: ll2/27 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. Receij Acknowl g ent: /2/2_3 Applicant's Signature Date Rev.Jan. 2019 • • The Commonwealth of Massachusetts ..,11 . I Department of Industrial Accidents Ajoilloy%In1,_. 1 Congress Street, Suite 100 Boston, MA 02114-2017 " „ www.mass aov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): 4644) ta, Og7 tv iv Address: 3 /q4(`/4C/J Wa 4)41 'f City/State/Zip: Pkt poems 17 /1 O0I3(17) Phone#: �D�- 7. 7 C�C�z Are you an employer?Cheek the appropriate box: Type of project(required): 1.0 I am a employer with employees(full and/or part-time).* 7. ❑New construction -•7iI am a sole proprietor or partnership and have no employees working for me in any capacity.[No workers'comp.insurance required.] li• Remodeling • 3.0 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•0 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.Q We are a corporation and its officers have exercised their right of exemption per 141GL c. I4.a Other I52,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box Rl 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. 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. Insurance Company Name: Ake�7KU ee. c iw a 7 Policy#or Self-ins.Lic.4: /J),c'7'42 Li)D 11 .—OS (' • �- Expiration Date: 7�ZrZOL17/ Job Site Address: /O3 C{lvt/ghI`' /e�i� City/State/Zip: i)ett, Pdlt / . Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). te). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00 andlor 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. 1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: (2r/ ,,, 4-1 Date: l/zl/L.3 Phone#: d; /37-'iZ7 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#: °E'Y �i TOWN OF YARMOUTH ;�- moo, o . 4 -cl BUILDING DEPARTMENT % %x°d 1146 Route ? �� 28, South Yarmouth,MA. 02664 508-398-2231 ext. 1261 PLEASE PRINT: HOMEOWNER LICENSE EXEMPTION DATE: JOB LOCATION: 3&) 4 Petyk.tFd z,iq c1 tej OI i�r,4r �, NAME STREET ADDRESS SECTIO► SF TOWN "HOMEOWNER" NAME HOME PHONE W S 'K.PHONE PRESENT MAILING ADDRESS CITY OR TOWN ST< ' ZIP CODE The current exemption for `Homer' was extended to include ow r—occu I ied dwellings of one or two units and to allow such homeowners to engage an individual for hire who e oes not possess a license,provided that such homeowner shall act as supervisor. (State Building Code Section 10 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 asses.ory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall ,of be considered a homeowner;such"homeowner"shall submit to the building official, on a form acceptable to e building official,that he/she shall be responsible for all such work performed under the building permit. (Sec' on 110 R5.1.3.1) The undersigned `homeowner' assumes respons'.ility for compliance with the State Building Code and other applicable codes, by-laws, rules and regulations The undersigned 'homeowner' certifies that e / she understands the Town of Yarmouth Building Department minimum inspection procedures and req rements and that he / she will comply with said procedures and requirements. HOMEOWNER"S SIGNATURE APPROVAL OF BUILDING OFFI'IAL INSURANCE COVERAGE: I have a current liability insure., ce policy or its substantial equivalent, which meets the requirements of MGL Ch.142. Yes No If you have checked ves, pie,se indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of indemnity Bond OWNER'S INSURAN WAIVER: I am aware that the licensee does not have the insurance coverage required.by Chapter 142 of the M s. General Laws and that my signature on this permit application waives this requirement. Chk Signature of Owner or Owner's Agent Owner one: Agent h:homeownrlicexemp