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HomeMy WebLinkAboutBLDR-24-61 CSL ONE&TWO FAMILY ONLY-BUILDING PERMIT Town of Yarmouth Building Department 1146 Route 28,South Yarmouth,MA 02664-4492 •>4. • 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 Building Permit Number:6L ls Q-rt'-to I Date A plied: Building cial(Print➢1 e) • gnatUre Date SECTIO 1:SI INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 8 Canary Lane,West Yarmouth,MA 02673 49 243 1.1 a Is this an accepted street?yes X no Map Number Parcel Nu EC I I " r, D 13 Zoning Information: 1.4 Property Dimensions: ---------- Y R-25 Single-Family Dwelling 13,177 85 A Zoning District Proposed Use Lot Area(sq it) Frontage() FEB 0 2 2024 1.5 Building Setbacks(ft) (Nonconforming residential-lot approval pre-1996) }+ _ ,Q_ L DI NU UL PA h TM ENT Front Yard Side Yards Rear Required Provided Required Provided Required Provided 42'± 7'±N,10'±S 77'± 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public B Private❑ Zone: AE Outside Flood Zone? Municipal 0 On site disposal system mi Check if yes0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Daniel and Tina Jacques Montgomery,MA 01050 Name(Print) City,State,ZIP 132 Carrington Road (413)875-2137 danjacques@inexus.net No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK°(check all that apply) New Construction Cl Existing Building❑ Owner-Occupied® I Repairs(s) B Alteration(s)B Addition 0 Demolition (& Accessory Bldg.0 Number of Units_ Other 0 Specify: Brief Description of Proposed Work:1.Repair/Correct wall/joist/rafter connections at front wall 2.Re-work living area ceiling(frame new cathedral ceiling and re-space ceiling joists) 3.Replace(6)windows and(2)doors,reframe as required SECTION 4:ESTIMATED CONSTRUCTION COSTS. Item Estimated Costs: Official Use Only (Labor and Materials) I.Building $12,000.00 1.Building Permit Fee:S ' Indicate how fee is determined: 2.Electrical $ 0 Standard City/Town Application Fee Cl Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2.Other Fees:$ 4.Mechanical(HVAC) $ List: 5.Mechanical(Fire $ • Suppression) Total All Fees:$ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $12,000.00 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-104656 6/23/2024 Daniel Jacques License Number Expiration Date Name of CSL Holder List CSL Type(see below) U 132 Carrington Road No.and Street Type Description Montgomery, MA 01050 U Unrestricted(Buildings up to 35,000 cu.ft.) City/Town,State,ZIP R Restricted t&2 Family Dwelling lvl Iviasonry RC f Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances (413)875-2137 danjacques©jnexus.net I Insulation Telephone Email address D_ Demolition 5.2 Registered Home Improvement Contractor(HIC) N/A HIC Company Name or HIC Registrant Name HIC Registration Number Expiration Date 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 N/A(work to he self-performed) 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 contained in this application is true and accurate to the best of my knowledge and understanding. Daniel Jacques 1 February 2024 Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: j 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.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: N/A(no change in layout/footprint) 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" f Licensee Details Demographic Information Full Name: DANIEL JACQUES Owner Name: License Address Information ity: Montgomery tate: MA ipcode: 01050 ount : United States License Information License No: CS-104656 License Type: Construction Supervisor Profession: Building Licenses Date of Last Renewal: 8/15/2022 Issue Date: 9/13/2010 Expiration Date: 6/23/2024 License Status: Active Today's Date: 2/2/2024 econdary License Type: Doing Business As: tatus Change Reason: License Renewal Prerequisite Information No Prere uisite Information No Available Documents =+'� • The Commonwealth of Massachusetts la_ _ = t Department oflndustrialAccidents _ ll]=l I Congress Street,Suite 100 Ci` Boston,MA 02 11 4-2 01 7 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): Daniel Jacques Address: 132 Carrington Road 8 Canary Lane City/State/Zip: West Yarmouth,MA 02673 Phone#: (413)875-2137 Are you an employer?Check the appropriate box: Type of project(required): I.❑1 am a employer with employees(full and/or part-time).* 7. 0 New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in c aci 8. ®Remodeling an y ap ry.[t•Io workers'comp.insurance required.] 3.®I am a homeowner doing all work myself[No workers'comp.insurance required.]t 9. ❑Demolition p req re ] 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property.I will 10 El Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0 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.i 13•❑Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,11(4),and we have no employees.[No workers'comp.insurance required.] °Any applicant that checks box Cl 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. 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: Policy 4 or Self-ins.Lic.4: 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 certhe pa rs rt p nalties of perjury that the information provided above is true and correct Signature: A„ Date: 4 January 2024 Phase g: (413)875-2137 Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License C 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 h: o� V TOWN OF YARMOUTH BUILDING DEPARTMENT MATM1Tr"SOA[a� , 1146 Route 28, South Yarmouth,MA. 02664 508-398-2231 ext. 1261 4 HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE: JOB LOCATION: Daniel Jacques 8 Canary Lane West Yarmouth NAME STREET ADDRESS SECTION OF TOWN "HOMEOWNER" Daniel Jacques (413) 875-2137 NAME HOME PHONE WORK PHONE PRESENT MAILING ADDRESS 132 Carrington Road Montgomery MA 01050 CITY OR TOWN STATE 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.I.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 work performed under the building permit. (Section 110 R5.1.3.1) 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 equirements and that he / she will comply with said procedures and requirements. /\ ,/} HOMEOWNER"S SIGNATURE!. Z-��; APPROVAL OF BUILDING Orr1CIAL (�� INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL Ch.142. YVeX No If you have checked ves, please indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of indemnity Bond O 'S INSURANC WAIVER: I am aware that the licensee does not have the insurance coverage required by Cu ter 1.2 of the.a . eneral Laws and that my signature on this permit application waives this requirement. l .,,,..,(7,,--) ._ Check one: Signature of Owner or Owner's Agent Owner Age 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. 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 8 Canary Lane, West Yarmouth, MA Work Address Is to be disposed of oat the following location: Yarmouth Transfer Station Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. 1 February 2024 Signature of Application Date Permit No. TOWN19, ' 'all' i* .*. ;!, ITTI I '4'' * :.. ray 1146 Route 2 -,s /: . , ' ..itt..'er: t tAtit h MA 02664 ' a � # . 3 . 3 . _ - . . . t. Office missioner ate". ..� • ,, (. Massachusetts Existing Building Code Checklist Based on 2015 IEBC w/Massachusetts Amendments To be submitted with Building Permit Application Address: 8 Canary Lane West Yarmouth MA (Street number, name) (City/Town) Unit Suite (location within building) Risk Category: (Check one), i— Risk Category I, 1 1 Risk Category H. 0 RC 111, I l RC IV. Work proposed: 1 . Repair/Correct wall/joist/rafter connections where front wall has pulled away 2. Re-work living area ceiling (frame new cathedral ceiling and re-space ceiling joists) 3. Replace (6) windows and (2) doors, reframe as required Construction Control, building at 35,000 c.f.. or greater ❑ Yes El No If Yes then "Investigation & Evaluation Report" is required (780 CMR 34, 104.2.2.I.) Compliance Method: [Only one method to be used] (Check all boxes that apply) Prescriptive Work area Performance (Chapter 4) (Chapters 5 — 13) (Chapter 14) ❑x Repairs 0 Repairs: Chapter 5 ❑ Repairs n Alteration 0 Alteration: (check only one box) n Alteration ❑ Addition fT Level 1 : Chapter 7 Addition ❑ Change of Occupancy I I Level 2: Chapter 7 & 8 I I Change of Occupancy fal Level 3: Chapter 7, 8 & 9 ❑ Change of Occupancy: Chapter 10 ❑ Additions: Chapter 11 O Historic Buildings: Chapter 12 ❑ Relocated or Moved. Buildings: Chapter 13 Note: Chapter 15 applies to all compliance methods. Applicant's Na e: (pr t) a ie dcques illskAAA. Date: I February 2024 ONE or TWO FAMILY—BULDING PERMIT APPLICATION REGULATORY APPROVALS NOTICE Address of Proposed Work: 8 Canary Lane,West Yarmouth,MA 02673 Scope of Proposed Work: 1.Repair/Correct wall/joist/rafter connections at front wall 2.Re-work living area ceiling(frame new cathedral ceiling and re-space ceiling joists) 3.Replace(6)windows and(2)doors,reframe as required Date: 1 February 2024 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. Receipt Acknowledgement: Applicant's Signature Date Rev.Jan.2019