HomeMy WebLinkAboutBLD-23-002709 pia/A 0 3 ziJat
ONE & TWO FAMILY ONLY- BUILDING PERMIT
Town of Yarmouth Building Department ;.• of ""y -._.
1146 Route 28, South Yarmouth,MA 02664-4492
r R E C E VED 508-398-2231 ext. 1261 Fax 508-398-0836
Massachusetts State Building Code, 780 CMR e
Building Permit Application To Construct, Repair, Renovate Or Demolish •::::: .;.:.• ,.
NOV 15 2022 a One-or Two-Family Dwelling
BUILDING DEPARTMENT This SectioA For Official Use Only
By. - 44141.tn �
P rr is L er: -2 2 Y RR'1 l/ Date Applied:
a SQ CS �-- 3/ il(,t
Building Official(Print Name) Signa re Date
SECTION 1:SITE INFORMATION
71.1 Prop rty Address: 1.2 Assessors Map&Parcel Numbers
(.9ftTA/itl 4PCKE R540AJ
1.1a 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 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 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record: u L t 39(4 3/ �
fN e(P t) City,State,ZIP
f L. cLe ✓a/./ .S•2a.I'aq U I eH hop .�(►'
o. Ind Street Telephone EmailAjdress I
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 1 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other ❑ Specify:
Brief Description of Proposed Work2:(V91g` /8' • / c
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials) ' .co
1. Building $ 1. Building Permit Fee:$' Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost3(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $ L00,00 CO+ I D I U
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire )kl L.A11 lk L/0 pirM
Suppression) $ Total All Fees:$
7
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ /0 pee, ❑Paid in Full ®Outstanding Balance Due:'12v Cit) t
31v
e.
•
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted I&2 Family Dwelling
City/Town,State,ZIP Iv1 Masonry
RC Roofing Covering
• WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
No.and Street 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
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
c me this application is true and accurate to the best of my knowledge and understanding.
V
R.� 54/-1-1///17A/ d-7-
rin Owner's or Authorized Agent's Name(Electronic Signature) 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.) (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
1
Department of Industrial Accidents
LW;� 1 Congress Street, Suite 100
��t,=t`- Boston, MA 02114-2017
�.MEIr' •y www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
/Name (Business/Organization/Individual): k/(-h Qfj X. *- Past Su// iv'1r
Address: /
City/State/Zip: Phone #: -39S/-.3, a5""
Are you an employer?Check the appropriate box:
Type of project(required):
LEI I am a employer with employees(full and/or pan-time).'
7. ❑New construction
2.0 I am a sole proprietor or partnership and have no employees working for me in
ca aci 8. ❑ Remodeling an y p ty.(Ivo workers'comp. insurance required.]
3.0 I am a homeowner doing all work myself. [No workers'comp. insurance required.]t 9. ❑ Demolition
4. Im a 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 11.❑ Electrical repairs or additions
proprietors with no employees.
12.❑Plumbing repairs or additions
5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet.
These sub-contractors have employees and have workers'comp. insurance.* 13.❑Roof repairs
6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other
152,§I(4),and we have no employees. [No workers'comp. insurance required.]
*Any applicant that checks box'41 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing al!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:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and 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 c• ' der the pains and pen t ties of perjury that the information provided above is true and correct.
e
7Sienat - I .� �-.a Date: —4 ��� �Z1�
Phone Y:
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 Plumbing Inspector
6. Other
Contact Person: Phone#:
o�R _ TOWN OFYARMOUTH
BUILDING DEPARTMENT17-
o ,
MwagC ;,F: od 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1261
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
DA 1E:
JOB LOCATION: I CPYR/u -J 1 /aS,,c) 1 I?
GAME STREET ADDRESS SECTION OF TOWN
"HOMEOWNER" Agv StA41.0 323-3N-31.25
NAME HOME PHONE WORK PHONE
PRESENT MAILING ADDRESS / 6977 'Ar /?i A)
CITY OR TOWN STA l'E 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 R5.1.3.1)
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 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 workperformed under the building permit. (Section 110 R5.1.3.1)
1
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 SIGNATU % �,�",� i'
APPROVAL OF BUILDING OFFICIAL
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:homeownrlicexemp
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 /ag/7722l t/ A / .S,t/ Z
Work Address
Is to be disposed of at the following location: 2,ao P
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111,Section 150A.
I.
Signature of Applicant Date
Permit No.
12/9/22, 12:59 PM Mail-Sears,Tim-Outlook
1 Capt. Nickerson
Sears, Tim <tsears@yarmouth.ma.us>
Fri 12/9/2022 12:59 PM
To: Richie <searayguyl @yahoo.com>
Richard,
I have reviewed your updated plans and there is not sufficient detail showing conformance to the
Building Code. You can review the deck construction guide at the link below, or have plans prepared by a
3rd party.
https://www.yarmouth.ma.us/DocumentCenter/View/5163/Deck-Construction-Guide
Please submit updated plans for review
Timothy Sears CB0
Deputy Building Commissioner
Town of Yarmouth
508-398-2231 Ext. 1259
mailto:tsearsPyarmouth.ma.us
https://outlook.oifice.com/mail/sentitems/id/AAQkADE3M DQ5NWZmLTkOYzItNDIwNi1 iMDQxLWNkMGQyNmE4NzE5NAAQAOt7IBTPVhNKVVhKd4%... 1/1
lo ,nin of Yarmouth
subsurface Sewage Disposal `_,y.iterrp A -Efu!i . Information
Street Address. ('Jlap: `t' _ F'arceJ -S`tlf-/—�`�S�
Owner Nam. _rc i A . iok_ Perrrlit O. r
Date Installed: t'1i `-? -- <3 . New: ✓ Repair:
___. — _ �
Installer Name: ,' .. C I .
Installer Phone 5?Y 7.71- °,3
Installation of (list all components, both newly installed and existing to rernain in use): •
--- --- - ---
Leach Capacity C ifTe-- 45 1
p y (gpd) S 6'E'--- G -c,urd Water Depth (incf e ;j _4-- Health Inspection by _�
i t -
As-built Diagram
• (Print Clearly in Black/Blue Ink and Use Straight Edge)
. i.4• c 3c. CI V Q C' Ij )
L'
3
`- RECEIVED
\ - - - t i ,
{
B C D
__—
.
11/23/22,4:02 PM Mail-Sears,Tim-Outlook
1 Capt.Nickerson
Sears,Tim <tsears@yarmouth.ma.us>
Wed 11/23/2022 4:02 PM
To:searayguyl @yahoo.com<searayguyl @yahoo.com>
Cc:Water Department<WaterDept@yarmouth.ma.us>
Richard,
I have� reviewed your application and there are some items needed.
i Water Department sign off
Framing/footing details to show compliance to the 9th Edition Building Code
Please submit these items for review
This email is considered a written 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 for a 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 Ext.1259
ma ilto:tsears@ya rmouth.ma.us
https://outlook.office.com/maiVsentitems/id/AAQkADE3MDQSNWZmLTkOYzItNDIwNi1 iMDQxLW NkMGQyNmE4NzESNAAQAKGImzeg55ROWXV9l15... 1/1
Certified Plot Plan
Rver Location
Captain Nickerson Road
&WILCOX Yarmouth, "1144
prepared for
Richard Sullivan
SURVEYING •ENGINEERING
HOME PLANNING & DESIGN
Scale: 1" = 30'
Date: Nay 23, 2022
3 GIDDIAH HILL ROAD P.O.BOX 439
SO.ORLEANS,MASSACHUSL I IS 02662
TEL:508.255.8312 FAX:508.240.2306 Reference.
Assr's. Nap 78, Pcl. 113
KICKERS
ON ROAD Fl. Bk. >51, Pg. 75, Lot 46
CAPTAIN ,50„ E T_34 - -
IV 7g 57 , — — • � tS�
65 43 e
Nsue,
!PI;
LOT 46
F I 15,316 S.F.±
1 0.35 AC.± ��,
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- 21.0' C p� i
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H 1 t'• r? `� APPROX. Q
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O �- OF EXISTING N �Ik
A SEPTIC SYSTEM u
DECK , PER D.O.H. Ike
EXISTING
UNDER
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CONSTRUCTION SHED_ �_i i_y,i_ /
Ill
r l- '-l-' 104•00
`\ y S 79057 50 W AIinimumZONE 0 Building Setbacks
Front — 30'
Side/Rear — 20 '
COVERAGE CALCULATIONS
I certify that the dwelling shown hereon is L'xistivt1 4 ,672 S.F._t• (10. 1%)
located as it exists on the ground and that as so �y-0+QFAm
located it complies with the minimum property qcs,
line setback requirements of the Town of Yarmouth. ., DAVID Gth
.g- A. a
18 LYTTLE cin
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#34620
( Lc' gEDate.• ''' eOFo �
Professional Lan uue or H • -to ,
s u R\I • Job No. 12998
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REILCEIVED
EC o
[o2n]-
BUILDING DEPARTMENT
By----
Here is your link to be used with the product in this envelope; you will also receive
an email with the same link on December 5th . Dated December 5th, 2022, to
December 18th, 2022
Please NOTE that this information is for
RN : 19682
PC: 265
Link to Questionnaire :
https ://pgsu rvey.decipherinc.com/su rvey/selfserve/580/0w120522
For your convenience we are providing the calendar below. Please use it to mark the days you have filled in your
online survey. You don't have to return this. It's just to help you remember the days you filled the survey.
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
5 6 7 8 9 10 11
12 13 14 15 16 17 18
Ct dv"t
WATER DEPARTMENT
BUILDING PERMIT APPLICATION FOR
WATER DEPARTMENT SIGN OFF
TRANSMITTAL FORM
BUILDING SITE LOCATION: L_.._ ,,,w77 ,, _ _ /�: t > ? f
PROPOSED l'ORi ,4 C=E72��� �-- 1'#<.:
APPLICANT:/.. ',',, ' _� ', 1✓fz �ltt`
ADDRESS: `
TE.I.PII()NE ? ` %' ..
RESIDI'.NTIAI. AND 'OR COMMER('I.AI.. WILDING
Water I)cp.u'ment: fhtcrantnes Compliance of Wafer A attahifity and or existing location
Hntnneermg Department. Determines Compliance tier Parking,and Drainage
Cimsertat on Comanission I)eteimules('omphance to Wetlands Act. i e. Iflints)border any type of
ttetlands.streams,ponds. tigers.ocean.hues. boys. marshland, I.I(` _
!leap!'Department: Determines Compliance to State and I own Regulations, i e.
requirements For Septau e Disposal and other Public f lealth .' ctit lies
Fire Department: Determine;(_'omptiancc to State and town Requirements hit Perszmat
Safety. Property Protections. i.e. Smoke Detectors. Sprinkler Systcnts.etc
/
A .IC1N1'SIG`tiA"if RE"- DATE
OF-IICE USE: COMMENTS ON PERMIT APPROVAL.OR DENIAL,
//CAL
RE;t EWE BY WATER DIVISION(SIGNATURE) DATE