HomeMy WebLinkAboutBLDR-24-90- 0`
ONE & TWO FAMILY ONLY- BUILDING PERMIT
Town of Yarmouth Building Department
1146 Route 28, South Yarmouth,MA 02664-4492
it
INI
508-398-2231 ext. 1261 Fax 508-398-0836
Massachusetts State Building Code, 780 CMR o„.., o
Building Permit Application To Construct, Repair, Renovate Or Demolish
a One-or Two-Family Dwelling
This Section For Official Use Onl I E (; E I V
Building Permit Number: )LCR-2 t C Date Ap •
�l FEB 2 0 2024
Building Offici rint Name) Signature
SE TION :SITE INFO TION E3 r N T
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
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 `n
Required Provided Required Provided Required Provided V
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 Own r'of Reco
Name(Print) City,State,ZIP
( C%.4.1A, li"
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 I Existing Building 0 Owner-Occupied 0 I Repairs(s) 0 Alteration(s)'ti Addition 0
Demolition 0 1 Accessory Bldg. 0 Number of Units Other 0 Specify:
-
Brief Description of Proposed Work2: R.ew.a..c_ .ex i 5..;- Y x Ff' dAs-tc--
'3 v s4-r-k M.,w lot k -3 d•¢,ntc, - '— d..a-- -" ,1..,,,,/"
SECTION 4: ESTIMATED CONSTRUCTION COSTS.
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 114. $OL} 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Costa(Item 6)x multiplier . x
3.Plumbing $ )vv 2. Other Fees: $
4.Mechanical (HVAC) $ List: ,3 5, OD e4,2/ q 9
5.Mechanical (Fire
Suppression) $ Total All Fees:$
Check No. Check Amount: Cash Amolti ...../.
6.Total Project Cost: $ 16 15-0() 0 Paid in Full 0 Outstanding Balance Due: D
.\44/
T
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License (CSL)
C5 — 1k 1°0-L) ix -7 /Jogs
C Atra,, FL._i 4 5 License Number Expiration Date
Name of SL Holder
N P
g . , List CSL Type (see below) L
-3 T ---e_. 54-
No. and Street Type Description
Clr' Unrestricted (Buildings up to 35,000 cu. ft.)
kieL,Fe4c_A- c&i-e-es :+- tioble VV-1- t)d- K f R Restricted I&2 FamilyDwelling
City/Town, State, ZIP M Iviasonry _
RC Roofing Covering
WS Window and Siding
141 e f`;1 P ' 5C)le---3
&"c't ` w'-‘ SF Solid Fuel Burning
rnin Appliances
L13iik -- -05446
I I Insulation
Telephone Email address D I Demolition
5.2 Registered Home Improvement Contractor (HIC) teq ---rui
0 d6c4 i Ho os,e )
HIC Registration Number t J
HIC Corn any Nam Mr HIC Registrant Nameill' pt-e,.).et -.4-ci 50 y __,.s tyke, I i C,v 0"--•
E, piratron Dare
r2:2-'46 .-"iVNt 4 .4.-
No. and Street -
vQe`.T� c;;L, Aii•ILC iivtA q4(tects 3O5 b Vmail addre
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 . 0
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 be w, I hereby attest under the pains and penalties of perjury that all of the information
contained *a this l* - tion is true and accurate to the best of my knowledge and understanding.
Print Owns or Autho Agent's Name (Electronic Signature) . - - t 3 - aM
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
w-ww.mass.crov/oca Information on the Construction Supervisor License can be found at www.mass.Qov/dps
2. When substantial work is planned, provide the infoimation 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 Nilmber of decks/ porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage" may be substituted for "Total Project Cost"
P _ \ The Commonwealth of Massachusetts
. i
'V 1'—' ►= Department of Industrial Accidents
= __ 1 Congress Street, Suite 100
C� Itar
1m...
f Boston, MA 02114-2017
:, 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): EH Pv 0/ MU 4-
Address: 3 �;,,€ Si-
City/State/Zip:wess}- e•cie`s}cb1e, fir, Phone #: Ll 1i-01.191-054-1 L
Are you an employer?Check the appropriate box:
Type of project(required):
I.❑I am a employer with employees(full and/or part-time).*
7
N
2.W am a sole proprietor or partnership and have no employees working for me in 8. El Remw deling construction
any capacity.(No workers'comp. insurance required.] 8• [] 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.❑ Electrical repairs or additions
5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 1 2'❑Plumbing repairs or additions
These sub-contractors have employees and have workers'comp. insurance.t 13.❑Roof repairs //
6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.V.'.Other k c 1 /a71'-,/�
152,§1(4),and we have no employees. [No workers'comp. insurance required.]
*Any applicant that checks box#1 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.
1Contractors 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.
1 do hereby cer fy and p in id penalties of perjury that the information provided above is true and correct.
Signature:
Date: �— I. -?AA
Phone#: H q r-?3N--0 S`I6
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#:
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 ..2J1 Cke r,,.lj ),s ,,-41"- rrw f of/A--
Work Address
Is to be disposed of at the following location: Fad_
Said disposal site shall be a licensed solid waste facility as defined by M.G.L
Chapter 111,Section 150A.
_
a r3
ignature of Applicant Date
Permit No.
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Commonwealth of Massachusetts
Division of Occupational Licensure
`�a�r✓✓ Board of Building Resuiations and Standards
Con ietfeSap rvlsor
CS-111920 yk spires: 12/27/2025
CASEYR • c-.
238 PINE STx
y
WEST BARN'
v• •
Commissioner Cr.
� �
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs&Business Regulation
HOME IMPROVE CONTRACTOR
E1Ell uN
9estl.ti Expluiion
189734 11/17/2025
SEY HODGES
/A HH PROPERTY E
E
SEY R. HODGES ' if
PINE ST zl
• 6 WEST BARNSTABLE,MA 02608
Undersecretary
Casey Hodges Estimate
HH Property Maintenance
238 Pine St
West Barnstable,MA 02668
U.S.A
Bill To' Estimate* CS Deck Job
Klute/Schoeffel Living Trust(Carol Schoeffel) Estimate Date Feb 13,2024
31 Cherub Ln
South Yarmouth,MA Expiry Date Mar 13,2024
Item Name Quantity Rate Amount
Permits($300?) 1 300 300.00
Disposal 1 500 500.00
Plumbing.(52000?) 1 2000 2000.00
Deck labor. 1 7500 7500.00
Deck Materials($4500) 1 4500 4500.00
Shower labor. 1 1200 1200.00
Shower Materials.($800?) 1 800 800.00
Subtotal 16800.00
li Total $16800.00
Notes = 'Feb, /'� ao.z4/-
Everything with a question mark is an estimate.Labor and disposal are set prices.All materials
will be pressure treated.I will pull all necessary permits.50%deposit required before work
begins.
Terms&Conditions
This estimate is valid only if signed and dated on or before the expiry date. Please recognized
that a signed estimate gives HH Property Maintenance permission to pull all permits for this
deck job.
CAL
4 C*-- / 3 z_(
Ti zoho
Invoice
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