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HomeMy WebLinkAboutBLDC-23-76 t1 ,I �.�T.: P V D N�y A BUILDING PERMIT APPLICATION ' 'I APPLICATION TO CONSTRU CT REPAIR, RENOVATE, CHANGE THE USE, OCCUPANCY OF, F3UILUItvG [; •ryCOR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING. tir � Il Totvru of}arrnouth Building Department 1146 Rottte .'ii • Yarmouth, MA 02664—( {92 Tel: 508-398-2231 ext. 1261 Fax 508-398-0836 Office Use Only_, Planning Board Information Assessors Department Information: Permit No ,��C-''��- ----._ Date Plan Type Map Lot Permit Fee $ l/� Endorsement Date__________ Deposit Rec'd. C ` L Recording Date $ (�b Date New Plan Na. 1.4 Property Dimensions: Net Due $ Other Lot Area Frontage(ft) Lot Coverage Buildrn• Permit Number. 7 This Section for Office Use On 111111.1. Date Issued: Signature: I) r, a , , Certificate of Occupancy. Building Official Date is Is not Section 1 - Site Information required 1.1 Property Address: 4i'�l(J.j> (( DQw 1.2 Zoning Information 22 • Zoning District Proposed Use Front Yard Required Side Yards Provided Required Rear Yard Provided Required Provided IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIMIIIIIIIIIII 1.4 Water Supply fµ.I1.L o.40.S 54) 1.5 Flood Zone information; Public Private Comments Zone: BFE Section 2 - Property Ownership/Authorized Agent 2.1 Owner of Record: N *, )• �/ I Mailing Address: Si. ature i r h J * M Telephone l Telephone s t I VIE©Address:la co�� 2,ii Authorized Agent: / Email Uzi( 3 . Name print c 11/ 6.11 Jl tiro.i"ld Mailing Address: Ci -3 i etder Signature 1., II- w?7`67:3� Telephone 3r�Cb i Section 3 - Construction Services Fax Email Address_ i . Licensed Con truction Supervisor: ` , L Not Applicable ❑ 2.i 1 , LA ' : 71 C�- ®�2654 Addy ( License Number Signature I g _37 67 b 1. ►,,,F '1 I?J Telephoneorii: Expiration Date mail Address: Imo' /3errUl 1l330 camrci -1 , n n4 r SECT)QN 10b OWNER/AUTHORIZED AGENT DECLARATION I ' ' ( e/Lin I, ' OS 2-4, (,) k , as Owner/Authorized Agent hereby declare that the statements and nformation on the forgoing application are true and acurate, to the best of my knowledge and belief. S d7 under the pains and penalties of perjury. f i ,-.., Print Name ,' q /f/V?' / ' Signature of Owner/Agent a ", Date Section 11 - ESTIMATED CONSTRUCTION COSTS Item • Estimated Cost(Dollars)to be completed by permit applicant 1.Building a Electrical 3.Plumbing/Gas 4.Mechanical(14VAC) 5.Fire Protection 6.Total=(1+2+3+4+5) 7.Total Square Ft(lornew smcnnes 6 additions) Check Below ❑ Conservation-Commission Fling (if applicable) ❑ Old Kings Highway&Historical Commission approval (if applicable) r Section 6 - Description of Proposed Work(check all applicable) New Construction ❑ (for multiple family only) No.of Bedrooms (for multiple family only) No.of Bathrooms Existing Bldg. ❑ Repair(s) tri Alterations ❑ Addition ❑ Accessory Bldg. ❑ Type Demolition Other Specify: Brief Description of Proposed Work: • ,�11 ` , Section 7- Use Group and Construction Type Building Use Group (Check as applicapable) Construction Type A ASSEMBLY ❑ A l ❑ A-2 ❑ A-3 ❑ 1A ❑ A-4 ❑ A-5 ❑ 1 B ❑ B BUSINESS Ei E EDUCATIONAL ❑ ❑ F FACTORY 2 ❑ ❑ F-1 ❑ F-2 ❑ 2C ❑ H HIGH HAZARD ❑ I INSTITUTIONAL ❑ 11 3A ❑ ❑ 1-2 ❑ I.3 ❑ 3B ❑ M MERCHANTILE ❑ R RESIDENTIAL 4 0 S STORAGE ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ U UTILITY 0 S 1 ❑ S-2 ❑ 5H ❑ M MIXED USE SPECIFY: S SPECIAL USE ❑ SPECIFY: SPECIFY: Complete this.section if existing building undergoing renovations,additions and/or change In use. Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34 Proposed Hazard Index 780 CMR 34 Section 8 Building Height and Area • Building Area Existing(if applicable) Number of floors or stories Proposed include basement levels Floor Area per Floor(st) Total Area All Floors (sf) Total Height (ft) Section 9 - STRUCTURAL PEER REVIEW (780CMR 110 11) Independent Structural Engineering Structural Peer Review Required Yes No SECTION 10a OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNER'S A NT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, ))//e- V-' ' ,, -4:9 , ,... as Owner of the subject property, her y authori - `L,1� J ` (--R '�.,, my a alf, in a4 matters relative to work authorize b this buildingto act on Y permit application. ( ' & --- Sighatu a of 0 ner G �--- lDate • 3.2 Registered Home Improvement Contractor:I Company Ham. Not„pp 11V� k1 ` 'S -Rie' Ad S Registratio Number .� ( : - � 23? 6934 z `� ?` I nature Telephone Expiration ate Section 4- Workers'Compensation Insurance Affidavit(M.G.L c. 152 S 25C(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the deni I of the issuance of the building permit. Signed Affidavit Attached Yes .. . No Section 5- Professional Design and Construction Services-for Buildings and Structures Subject to Construction Control Pursuant to 780 CMR 116(containing more than 35,000 c.f. of enclosed space) Section 5.1 Registered Architect: Not Applicable U Name (Registrant): Registration Number Address Signature Expiration Date Telephone Section 5.2 Registered Professional Engineer(s) Nam. U t f I V r✓ t'tl l.t S I 11;��Q L A ,�e�sp ` ibrlity U l A t, D 'f Jt 1K C� Addres . i �yn5 ` J'�r, J1 03.1 �) '�-j I ,-� Registration Number Signature Telephone ' ( (/(� Expiration Data Hama Area of Responsibility Address Registration Number Signature Telephone P Expiration Date Hams • Area of Responsibility Address Registration Number Signature Telephone P Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone P Expiration Date Section 5.3 General Contractor� 41 1�to MM aril Rif L. Not Applicable ❑ gArnpany Name Pe son Res onsible for Constru o Add /, Ste) 2.37 6?3 C ignature Telephone §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 22- M U) -' & 44 DPA V(y'" Work Address Is to be disposed of oat the following location: 5 t 3 'p MUS! WA . Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. • isoz/z3 Signature f App cation Date Permit No. • -\ The Commonwealth of t Massachusetts Department of Industrial Accidents 1 Congress Street ..� �- y Suite 100 _ Boston, MA 02114-2017 �+S'y, www.mass.gov/diet Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. A licant Information Name (Business/Organization/Individual); G i Please Print Legibl Address: tab CI5S f , City/State/Zip: i pv. ME. ' 0117b Phone #: 6-VB ..996- -8 $a Z Are you an employer?Check the appropriate box: 1.1V1 am a employer with _employees(full and/or part-time).* Type of project(required): 7. 2.Q I am a sole proprietor or partnership and have no employees working forme in ❑New construction any capacity.[No workers'comp.insurance required.] 8. Q Remodeling 3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. 0 Demolition 4.0 1 am a homeowner and will be hiring contractors to conduct all work on my property. I will l a ❑ ensure that all contractors either have workers'compensation insurance or are soleBuilding addition proprietors with no employees. 1 I.Q 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.: 13.0 Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per rMMGL c. ® �S 152,§1(4),and we have no employees.[No workers'comp. insurance required.] 14 Other *Any applicant that checks box Ail must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing ail 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. o I am an employer that is providing workers'compensation insurance for my employees. Below is the information, �. policy and job site Insurance Company Name: V 1CA inoTtf*(, IMS. co/YIP/WY Policy A.'or Self-ins.Lie.-4: �'ssCt Expiration Date: Z l ..- 26Z Job Site Address: tott1D— 1 D up- Attach a copy of the workers' compensation policy declaration page(showing thetpo icy number and eYagmm. irati n 0 3/ e . Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine upto$I 500. ) and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of u p 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 certi a der the p rs a d enalties of perjury that the information provided above is true and correct. Signature: Phone#: 6 6 Date: le, fZ 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 6. Other O Department 3.City/Town Clerk 4. ElectricaI Inspector 5. Plumbing Inspector Contact Person: Phone#: inghouse,PC P.O.Box 182 o'✓e Mashpee,MA 02649 :10 Phone: 508-221-2980 structural design Email: jensen©inghouse.net ingenuity Web: www.inghouse.net Nov. 9th , 2023 Project#: ING23045 GFM Excavating Attn: Mr. Todd Prada 15 Diamonds Path P.O. Box 1439 S. Dennis, MA 02660 RE: Review of New/Existing Foundations for Building Entry Canopy 22 Mid Tech Drive, Yarmouth, MA Dear Mr. Prada: INGHOUSE has reviewed the existing foundation conditions, as well as the newly constructed foundation supports for the two entry canopy supporting posts at the project location. We have determined that the constructed foundations are structurally adequate. Please do not hesitate to contact us with any further questions. Very truly yours, ��r`j H OF M's 4 LABSJENSEN INGHOUSE u STRUCTURAL No.50602 ti Lars Jensen, P.E., S.E. ,c /ST ° Q' 4 /// /2o23 NEW P.T.6x6 POST AT EXISTING OUTERMOST COLUMN LOCATION,TYP. ATTACH POST TO EXISTING(2)-2x8 SPF BEAM WI(4)-6..LONG SIMPSON "SDWS22-DB"TOE SCREWS FROM UNDERSIDE(ONE SCREW EACH FACE 3" EDGE DISTANCE ON POST),TYP. ATTACH POST TO FOOTING W/SIMPSON"ABU66"POST BASE WI(12)-16d H.D.G. COMMON WIRE NAILS(0.162"DIA x 3 1/2"LONG),TYP. ATTACH POST " BASE TO FOOTING W/5/8"DIA. H.D.G.ANCHOR ROD VIA DRILLAND EPDXY W/MIN.8"EMBEDMENT DEPTH,TYP. .- 4= , == ..,44;44•00=4 _ _ , 4 „..... ----- 1 *.' 1,24.. "--- 4 - i NEW MIN. 10"DIA. CONCRETE NEW SLAB ON z-_---- III SONOTUBE Wi 24" ....,.....--. DIA. BELL FOOTING; ma GRADE SYSTEM , . (BY OTHERS) Cmi'"' .....2....____ P. PROVIDE(1)- 27 .....m. ........= .. „,...to J, VERTICAL#5 BAR IN „ L.. . .,,. o0 - SONOTUBE. 4-- - - OR: - _ . _- PRECAST WITH 2FT ,,,, - , -- SQUARE FOOTING, , - TYP. PROVIDE MIN.4'-0" , FROST DEPTH, —_, ... TYP. NEW SIMPSON SIMPSON "HSLQ37" SHEAR ANGLE AT EACH END OF (2)-2x8 EAVE BEAMS, TYP. FILL ALL HOLES W/ 1/4" x 2 1/2" SIMPSON "SOS" SCREWS, TYP. OF c"Ott A4444\ en 4 LARS Ana 4 o STRucTuRAL ... INSTALL NEW SIMPSON "H2.5A" 0 No 50602 HURRICANE CLIPS AT EACH RAFTER, TYP. BOTH EAVE 1 SIDES OF ENTRY ROOF Ns:::::.,..;.;.:-.,:.. . -... ' ' .-....•.. ... 023 , • -, . . . . . 1NGHousE pc NEW ENTRY ROOF SUPPORTS, FOUNDATIONS AND FRAMING CONNECTIONS niotholi KO kat I a/ 06 e 41W.."4"44'' 22 MID TECH DRIVE ,,,,0 ,A. ,..Swot Slaw lis°q• *6m=C;t7:ta YARMOUTH, MA Ant.: Ws 1.11 Zvir, INGHOUSE PC ING23044 06/22/2023 Page 1 ot 1 ,. . 0 1°4 . `;'' . _ 40 .74t t's ,_ ' :l _ „th.�J" Y� ?M` 'may BM"'4rM t�'` M +• '9 r ` }'`y'.AI /" }YA d*- twy a�Y K'` y �, -fir a.' �,gs v �^ ,... ,,.y ',: .� Arta", '. -.r'�°,",3, ? ` " "�..^' .*"r' �.-` 4 `` ^ *�^" _x ':1:--..''I,:,,• >1 w• ;fir � .r � r� `1r'+r".f<; j +" • -k a ,fr. i t ' � - ,.„ �Y d 4 Y YY Ya;'> ?rt ';#j ems' to • ,s A to 5;.; $ nT —.- it's"'{4:.. _ t g. 11 'v.-Ow.' , }� d J x liliftop ..""till''"IlL, —.. arm 4 • g M • Ey. m 4444 } * . ""')':' ,''6It r, 1 ;_ ,r 4 -�^. ma „ Y 'a. �a+�-n . a ' .�. Ifs+ >.* ,.�► " r . . .100:..„.. .,. .,.....,..:,.;-,.:; .,.-.--,.,,n,„---..r., it-,..,- it.,•- ,--::.,..,-.,....., -_'.- ,....,, ,At- " A v or ` .� "�' i .. 'r� l ' - �. 'yam" , tlily � .;.. s:4`;.-',;.,',.,,,04../.„ ,,,,..',' '.-7'''' . . , N NOTICE v NOTICE TO TO EMPLOYEES EMPLOYEES 7%'I4 V�v`�� S IMP The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS LAFAYETTE CITY CENTER, 2 AVENUE DE LAFAYETTE, BOSTON, MA 02111 (617) 727-4900 — www.mass.gov/dia As required by Massachusetts General Law, Chapter 152, Sections 21, 22 & 30, this will give you notice that I (we) have provided for payment to our injured employees under the above-mentioned chapter by insuring with: Utica Mutual Insurance Company • NAME OF INSURANCE COMPANY 201 Edgewater Place, Suite 295 Wakefield, MA 01880 ADDRESS OF INSURANCE COMPANY 4615597 2023-02-15 -2024-02-15 POLICY NUMBER EFFECTIVE DATES Gallant Insurance Agy Inc P 0 Box 975 Acton, MA 01720 978-263-3500 NAME OF INSURANCE AGENT ADDRESS PHONE # HIGHLAND BUILDERS, INC 80 MOSS LN BREWSTER MA, 02631 EMPLOYER ADDRESS EMPLOYER'S WORKERS' COMPENSATION OFFICER(IF ANY) DATE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the ser- vices provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NAME OF HOSPITAL ADDRESS TO BE POSTED BY EMPLOYER THE COMMONWEALTH OF MASSACH!JSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR TYPE:Corporation expiration date. If found return to: Re istration Eation ion Office of Consumer Affairs and Business Regulation 134951 02/14/2024 1000 Washington Street -Suite 710 HIGHLAND BUILDERS,INC. Boston,MA 02118 RUSSELL J.PERRY iff 80 MOSS LANE BREVVSTER,MA 02631 Ey' Notvalid without signature Division of Occupational Commonwealth of Massachusetts Li Sta e Board of Building Retnj lrations and Standards ConS lon S ivis43r 4, CS 082654 �fcplres 05/22/2024 SS J RRY Jft r 80RU MOSSELL LNG BREWSTERA 02631 'y()I.Lv,A.A .. a ,dam Corn