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HomeMy WebLinkAboutBLDR-23-13081 a .ft ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department (::oi("'"'F''''r\Nt 1146 Route 28, South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 :(:,,,.,Itwit) 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: f,_23--130.(( Date Applied: .4-117-W7Building Official(Print Name) ignature �/n Date SECTIO 1:SITE INFORMATION 1.1 r Address: 1.2 Assessors Map&Parcel Number R E C lV E D f2 firowni 4 7 A4i4 -- 1.1 a Is this an accepted street?yes / no Map Number Parcel Nu be 1.3 Zoning Information: 1.4 Property Dimensions: DEC 2 1 1U23 j 1 Zoning District Proposed Use Lot Area(sq ft) Frontage( )t3LTILDING DEPARTMENT By. 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,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: ____ Outside Flood Zone? Check if yes❑ Municipal 0 On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Rec rd: n �^ [� T� - s - �3yrK S 1. Ywiettc0T'-1 of D zegy Name(Pant City,St td e,ZIP '/i. r�0"f/5' sI ,617‘7_Yf,q No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building Fd' Owner-Occupied Er' Repairs(s) 0 Alteration(s) lY Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Descriptivv ion of Proposed Work wti '`: Ao-e 6!{i'e f,�—t �k_ h t,oc crlg F'cowe. Am 4 .21(q' a A 0, Ii'tI"`�fts , .... 1 le ..k C WO-c SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: (Labor and Materials) Official Use Only 1. Building $ !,01)U. 00 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ 4 g, vo,D6 ❑Standard City/Town Application Fee 3.Plumbing $ g v 0, v 0 Total Project Cost3(Item 6)x multiplier x d 2. Other Fees: $ 4.MechanicaI (HVAC) $ List: .3 �1� 'a 5.Mechanical (Fire Suppression) $ Total All Fees:$ 6.Total Project Cost: $ '� Check No. Check Amount: Cash Amount: QOD 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) L.,,lout( CS' a �'S7 rikY ts' License Number Expiration Date Name of CSL Holder C4 Co(tto, okx. List CSL Type(see below) r et �/I Type Description No.and St eitC id 0 NIA b r j 7 o U Unrestricted(Buildings up to 35,000 Cu.ft.) City/Town,State,ZIP R Restricted I&2 Family Dwelling Iv1 Masonry • RC Roofing Covering WS Window and Siding �]�/_ �� /�� SF Solid Fuel Burning Appliances Telephone / I j Insulation Email address D ' Demolition 5.2 Riejg istered Home mpr vement Contractor(HIC) C0w0( Mk-4 C‘a4SY ((H&c HICgmtyany,Narne orJ C RegisErapt Na� HIC Registration Number Expiration Date t. 14h64 YeM45, G6 t''l No. •tre tip/ ,i„ _ #137Q 70( ../10 ( 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 V 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) Date SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjtuy that all of the information contained in lic o •P d accurate to the best of my knowledge and understanding. 21-23 Print Owner's or Aut orized Agent's Name(Electronic Signature) /�^g to 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.eov/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.) fm-r, 9 (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.j----Number of fireplaces Habitable room count Number of bathrooms Number of bedrooms Type of heating system----_____________ Number of half/baths Type of cooling systemNumber of decks/porches Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" s•--)e ve_. 16 rn ba// pa i>lin y i PAS • ,, The Commonwealth of Massachusetts L Department ofIndustrialAccidents I Congress Street, Suite 100 47 Boston, MA 02114-2017 ..5 www.mass.gov/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 . K 4... tj'4c__4' fr,„ 4C`4. Address: l4 ea f vc,.- 'e"'.r-e.-- City/State/Zip: geC k etn0 ill 0370 Phone #: 7 i/ [.[ 3 -7 5 Are you an employer?Check the appropriate box: I. I am a employer with Type of project(required): employees(full and/or part-time).* _2. I am a sole proprietor or partnership and have no employees working for me in Zemo 8. 7. C New C eIjncUCtlOn any capacity.[No workers'comp. insurance required.] liti ng 3.0 I am a homeowner doing all work myself. [No workers'comp. insurance required.]t 9• C 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 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 12.0 Plumbing repairs or additions These sub-contractors have employees and have workers'comp. insurance.t I3• Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 1 4•Li Other 152,§1(4),and we have no employees. [No workers'comp. insurance required.] *Any applicant that checks box 441 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 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: 7-4 A4/7 -7 76 It/t, G- AZgl‹, ( Policy#or Self-ins.Lic.#: Expiration Date: -`/l- j_aL3 —i-il-2d 1'( Job Site Address: Y t Stocogeie ite..e 4149sji4.-1 0 2 y Attach a copy of the workers' compensation policy declaration page(showing the policy number andte expiration 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 pa' s at ena ies f perjury that the information provided above is true and correct. Sienature: Date: / ' — 2 Phone#: Official use only. Do not write in this area, to be completed by city or town official. City or Town: Issuing Authority(circle one): Permit/License T 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing 6. Other Inspector 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 Aretilite7 ytkAn.0t,'J �. Work Address Is to be disposed of at the following location: &40-(YitK Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Signature f Applicant Date Permit No. THE ,00 HARTFORD October 23, 2023 Account Policy Information: Agency Name PAYCHEX INSURANCE AGENCY INC Agency Code 76210760 Recipient Information KIMBALL PAINTING 94 PINEHAVEN DR WHITMAN MA 02382-2347 SUMMARY OF INSURANCE Account Policy Policy Recap Policy Number Premium Worker's Term Compensation Twin City Fire 76 WEG AZ5JK1 08/11/2023 to Insurance 08/11/2024 $2,722 Company Sum of Insurance Summary of Insurance (Continued) Worker's Compensation Summary of Insurance with Twin City Fire Insurance Company A member company of The Hartford 08/11/2023-08/11/2024 Policy Detail: Worker's Compensation Policy States: MA Location 1 Premises Address: 16 Culver Dr Rockland MA 02370 Worker's Compensation Coverages: Employer's Liability Limits Limit Disease-Policy Limit $1,000,000 Bodily Injury—Accident $1,000,000 Disease- Each Employee $1,000,000 Class/Payroll Class Description Class Code Payroll Detail Location 1 -MA PAINTING OR 5474 $50,000 PAPERHANGING NOC & SHOP OPERATIONS, DRIVERS This Summary and its attachments provides a high level overview of policy coverages and does not include all conditions, limitations or exclusions. Please refer to the actual policy forms for detailed coverages, limits and deductibles. Sum of Insurance Commonwealth of Massachusetts Division of Occupational Licensure IV Board of Building Regulations and Standards ConsttAitdnrrvisor CS-088557pires: 11/14/2023 STEVEN J K IBALL '1 ° 94 PINEHAVSN DR ai WHITMAN MYk';02382 1 r, 410 3yO aJ coiiimiSSioncr n•na T'. :1i9(�tC • war �. / w._—-• `l JJrrr3Jacfi e/4 Offles of Consumer Affairs Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:LLC Rrplstrall on EXRitatlon 186454 11/15/2022 KIMBALL PAINTING 1.1.0 STEVEN KIMBALL 94 PINEHAVENDRIVE �'CG WHITMAN,MA 02382 Undersecretary - 12/17/23,8:15 AM Office of Consumer Affairs&Business Regulation-Mass.Gov Click on the registration number to view complaint history. You can also view arbitration and Guaranty Fund history. The list is current as of Sunday, December 17, 2023. Search Results RegistrantNarne f RES ONSIF3L ! REGISTRAMONADDRESS EEXPIRATIOMSTATUS iNDI '°IDU L. NUMBER " ATE KIMBALL PAINTING Kimball, Steven 186454 94 Pinehaven 11/15/2024 ;Currerxt LLC Drive Whitman, MA 02382 Site Policies Contact Us © 2018 Commonwealth of Massachusetts. Mass.Gov® is a registered service mark of the Commonwealth of Massachusetts. https://services.oca.state.ma.us/hic/licenseelist.aspx 2/2 12/17/23,8:00 AM Details Licensee Details Demographic Information Full Name: STEVEN J KIMBALL Owner Name: License Address Information ( City: Rockland State: MA Zipcode: 02382 Country: United States License Information License No: CS-088557 License Type: Construction Supervisor Profession: Building Licenses Date of Last Renewal: 12/1/2023 Issue Date: 11/14/2011 Expiration Date: 11/14/2025 License Status: Active Today's Date: 12/17/2023 Secondary License Type: Doing Business As: Kimball Painting Status Change Reason: License Renewal Prerequisite Information No Prerequisite Information No Available Documents https://mad pl.mylitense.comNerifi cati on/Details.aspx?result=f56cf3e5-9679-4865-95b6-e67bf 7e4 e2e8 1/1 H ! 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I * - 1 kli Al t� ice , 1 Q- VIEr'')t (ir if lr.P"./ 4� s d a.,. 1.. cti , 4 —# .e.. ......, - .«r .rry. �. ri C/7 :5'3i P �r. e. f i44 i r ' ' 1 I 1ILi Fallon, Rosa From: Clarke, Kristin Sent: Thursday, December 21, 2023 2:37 PM To: Fallon, Rosa Subject: FW:42 Browning Ave From:Sarah Burns<sburns07@gmail.com> Sent:Thursday, December 21, 2023 2:29 PM To:Clarke, Kristin <KClarke@yarmouth.ma.us> Cc:Jeff Burns<burnsyny@gmail.com> Subject:42 Browning Ave Attention!:This email originates outside of the organization. Do not open attachments or click links unless you are sure this email is from a known sender and you know the content is safe. Call the sender to verify if unsure: Otherwise delete this email. Hi Kristin, We both give Greg Mardirosian and Steven Kimball permission to obtain a permit for the basement remodel at our property 42 Browning Avenue. Thank you to you and the Yarmouth Building Department. Happy Holidays, Sarah and Jeff Burns i