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HomeMy WebLinkAboutBLDR-24-195- RECEIVECICE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department APR 10 2024 1146 Route 28, South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 Massachusetts State Building Code, 780 CMR By BUILDING DEPART n;Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling ((��,,�� /� This Section For Official Use Only Building Permit Number: r!tbi ._L4-10�� Date Applied: Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property A/sys. &Id 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 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❑ p' /' I SECTION 2: PROPERTY OWNERSHIP' 2.DEN «of e/i E J1`14 CQl/1ivo MH Oaoa1 Name(Print) City,State,ZIP 55 evel in Waco (fn13)83g1 3cis'r dihckeo Q rr•c#tec lgj ,or3, No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied ❑ Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition ❑ Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work'': /2xXQ (A.)0 n e )/kott,-6' pe rrn i SECTION 4: ESTIMATED CONSTRUCTION COSTS. Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 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 $ 2. Other Fees: $ 690 C.t „- /^ 4.Mechanical (HVAC) $ List: �� 5.Mechanical (Fire $ Suppression) Total All Fees:$ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $3 (/p 71 p Paid in Full 0 Outstanding Balance Due: S' 1' 010S 1") . I �_a The Commonwealth of Massachusetts •y10= L Department of Industrial Accidents rme _14_ ' =;'��`= 1 Congress Strait. Suite 100 'g1_.= Boston, MA 02114-2017 SV•,,• 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): .,5D"/ , J 1O_' -Q (771- Address: ,38 G046 C 5 1 City/State/Zip:44J1O/✓ Qua/ Phone #: 7 '/ g�j S5 9 i Are yo n employer?Check the appropriate box: Type of project(required): I. 1 am a employer with l employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in ca aci 8. Remodeling an • y p ty.[No workers'comp. insurance required.] 3.0 I am a homeowner doing all work myself. [No workers'comp. insurance required.]r 9. CI 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 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.: I. .❑Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other A9 /r 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. *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: Al /'1?I/TV/-L Policy#or Self-ins.Lic.4:(4/GC.6-00,5041.164e- A 43 A Expiration Date: �/L97a_j Job Site Address:a 64 , b 1, )t /964) I/Vt/bi®l/ri."( 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$250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: �i ��—... t 7' Date: 9-/p/ -IP—2 C./ Phone#: ?$`— Ace,--55 17 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#: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction)Supervisor License (CSL) �,,/ 43-406;743 / " L.G� A I it License Number Ex irate n Date Name of CSL Holder List CSL Type (see below) 3$ /_t____„ j L o g y r No. and Street Type Description 1 U Unrestricted (Buildings up to 35,000 cu. ft.) n ro/J MA. 402..6a/ R Restricted I&2 Family Dwelling City/Town, State, ZIP �_ ICI Masonry RC I Roofing Covering • WS ( Window and Siding 0-tows-stySF Solid Fuel Burning Appliances / ^484:04 Insulation Telephone address ` - p Email D Demolition 5.2 Registered Home Improvement Contractor (HIC) e ,0l $1©n v71 1/3/ôo HIC Registration Number pirati Date COom �1ame o L�e i .tgl.t Name... o. and Street / � Email address // G��'��� c ^ ,44' ,1aa/ /6/- Kg-cirAi City/Town, State, ZIP Telephone 1 SECTION 6: WORKERS' COMPENSATION E SURANCE AFFIDAVIT (M.G.L. c. 152. § 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide 1 this affidavit will result in the denial of the Issuance of the building permit. i Signed Affidavit Attached? Yes 0 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 / V SO"N /OgiVe Lk to act on my behalf, in all matters relative to work authorized by this building permit application.� 33rAku(s E _ _ 4er i'/ 0�t o'er 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. . e•t &--74 0 ---? 1/ Pr' Owner's r 7� �' /� < o Authorized Ag„n� 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.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/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" • 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 605 i''yC.rePt Work Address Is to be disposed of at the following location: rX/----elL pl✓M'77.64/ Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Signature of Applicant Date Permit No. - — ----- South Dennis Mid-Cape Home Centers CUSTOMER COPY 1mH 465 Route 134 South Dennis,MA Mid-Cape 02660 (508)398-6071 Il II 111111111 II I11111111111 Fax:(508)-398-4559 5�NC „ 9 ORDER 2006-D26809 PAGE 1 OF 1 SOLD TO SHIP TO I ACCT NO. 1 JOB DENNIS E MCKENNA DENNIS E MCKENNA 146876 0 35 EVELYN WAY 2 Bassriver Parkway ENTRY DATE 6/17/2020 2:09:13 PM CANTON MA 02021 SOUTH YARMOUTH MA 02664 617 880 3454 DELIVER ON 06/18/2020 BRANCH 4000 CUSTOMER PO# STATION D206 OLD MAIN ST TO SOUTH ST CASHIER DEBMCG SALESPERSON ORDER ENTRY DEBMCG MODIFIED BY DEBMCG Item Description D Ordered I Sold Remain UM Price Per Amount I 54620AM 5/4X6X20'AZEK MAHOGANY VINTAGE 20 20 EA 110.4452 EA 2,208.90 COLLECTION DECKING SQUARE EDGE 110AZEK12 1X10 12'AZEK TRIMBOARD MARKED I 3 3 EA 46.4280 EA 139.28 WITH ONE VERTICAL LINE 8SON4 8"X4'ECONOTUBE 47#CONCRETE 3 3 EA 5.7031 EA 17.11 PER FT TO FILL 302018 80#CONCRETE MIX 7 7 BAG 6.4615 BAG 45.23 QUIKRETE.60 CUBIC FEET PER BAG 42 BAGS PER PALLET 21020PT 2x10x20'#1 PT GROUND CONTACT 2 2 EA 43.4300 EA 86.86 MCA TREATED SYP 407353 LUS28Z 2X8 JOIST HANGER 28 28 EA 1.5900 EA 44.52 405079 16D 5#COMMON GALV NAIL 1 1 EA 14.9900 EA 14.99 Payment Method(s) Buyer: MCKENNA, DENNIS SubTotal 2,556.89 Sales Tax 159.81 MA 6.25% Deposit 0.00 Please pay this 2,716.70 amount DELIVERY TIMES ARE ESTIMATES-ACTUAL TIMES MAY VARY. I Signature D Mid-CapeSouth Home enn Centers _®,[� 465 Route 134 CUSTOMER COPY i, - a I South Dennis,MA 02660 �r� (508)398-6071 III II II II II II III DftI I III II II IIIII I 110111101111 ----_.., SINCE 1895 . - ,< Fax: (508)-398-4559 __ INVOICE einagigaMEIBM 2007-266623 PAGE 1 OF 1 SOLD TO JOB ADDRESS ACCOUNT JOB DENNIS E MCKENNA DENNIS E MCKENNA — 146876 0 35 EVELYN WAY 35 EVELYN WAY SOLD ON 7/6/2020 3:53:18 P CANTON MA 02021 CANTON MA 02021 CUST PICKUP 617 880 3454 BRANCH 4000 ICUSTOMER PO# STATION D100 CASHIER TOMPOW SALESPERSON i ORDER ENTRY Quantity UM Item Description D T Price Per Amount 1 EA 54616AM 5/4X6X16'AZEK MAHOGANY VINTAGE Y 88.3562 EA 88.36 COLLECTION DECKING SQUARE EDGE SubTotal 88.36 Payment Method(s) Buyer: MCKENNA, DENNIS Sales Tax 5.52 MA 6.25% Charge to Acct 93.88 Deposit Please Pay This 93.88 Amount DELIVERY TIMES ARE ESTIMATES-ACTUAL TIMES MAY VARY. Signature MCKENNA, DENNIS South Dennis �� Mid-Cape Home Centers //' ®i1 \ 465 Route 134 CUSTOMER COPY i, Mid-Cape j South Dennis,MA 02660 Fax:(508)398 4559 1110101111101111111111111011111111111111011111 SINCE 1895 - INVOICE HOME CENTERS 2006-226936 PAGE 1 OF 1 SOLD TO JOB ADDRESS ACCOUNT JOB DENNIS E MCKENNA DENNIS E MCKENNA 146876 0 35 EVELYN WAY 35 EVELYN WAY SOLD ON 6/17/2020 2:33:48 PMi CANTON MA 02021 CANTON MA 02021 CUST PICKUP 617 880 3454 d BRANCH 4000 x !CUSTOMER PO# STATION D206 CASHIER DEBMCG SALESPERSON ORDER ENTRY Quantity UM Item Description D T Price Per Amount 1 BOX 401539 372431 1/2X4-1/2 GALV WEDGE RAWL Y 73.9900 BOX 73.99 POWER STUD WEDGE ANCHOR 2 CRD 424835 DW5439 SDS 1/2"(12"BIT)ROCK Y 15.9900 CRD 31.98 CARBIDE HAMMER DRILL BIT Payment Method(s) Buyer: MCKENNA,DENNIS SubTotal 105.97 Sales Tax 6.62 MA 6.25% Charge to Acct 112.59 Deposit Please Pay This 112.59 Amount DELIVERY TIMES ARE ESTIMATES-ACTUAL TIMES MAY VARY. Signature MCKENNA,DENNIS South Dennis Mid-Cape Home Centers 1E8I I I 465 Route 134 CUSTOMER COPY Mid—Cape South Dennis,MA 02660 (508)398-6071 IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII Fax: (508)-398-4559 SINCE 1895 INVOICE CIZIEMIESSIMED 2006-244747 PAGE 1 OF 1 SOLD TO SHIP TO _ ACCOUNT JOB DENNIS E MCKENNA DENNIS MCKENNA 146876 0 35 EVELYN WAY 2 BASS RIVER PARKWAY SOLD ON 6/25/2020 7:33:34 AM CANTON MA 02021 SOUTH YARMOUTH MA 02664 DELIVER ON 6/25/2020 617 880 3454 I BRANCH 4000 CUSTOMER PO# j STATION D132 ***BACK OF HOUSE WHERE DRIVEWAY CASHIER RICGRO IS***POISES PATH*** SALESPERSON ORDER ENTRY LAUFRA Quantity UM Item Description D T Price Per Amount Order: 2006-D40935 16 EA 21012PT 2x10x12'#1 PT GROUND CONTACT Y 25.3731 EA 405.97 MCA TREATED SYP Payment Method(s) Buyer: MCKENNA,DENNIS SubTotal 405.97 Sales Tax 25.37 MA 6.25% Charge to Acct 431.34 Deposit Please Pay This 431.34 Amount DELIVERY TIMES ARE ESTIMATES-ACTUAL TIMES MAY VARY. Signature MCKENNA,DENNIS . -fiv ..,41.' Ailliblor Alas 4% �� � Moresaving.saving. 0 More doing. JOIN A WINNING TEAM, NOW HIRING APPLY 9 CAREERS.HOMEDEPOT.COM 2612 00052 80664 07/04/20 07:58 AM SALE SELF CHECKOUT 707392466604 4X4CMPPSTSTO <A> CPS4 4"X4" PLASTIC STANDOFF BASE 294.41 8.82 044315430701 ZMAX 4X4 <A> ABA44Z 4"X4" 16GA ZMAX ADJ POST BASE 31311.98 35.94. SUBTOTAL 44.76 SALES TAX 2.80 XXXXXXXXXXXX4214 VISA $47.56 USD$ 47.56 AUTH CODE 07342D/2520281 TA Chip Read AID A0000000031010 CHASE VISA 26 2 1I!'I Jø1J1I1JHJ1l/1UJIS li Ii RETURN POLICY DEFINITIONS POLICY ID DAYS POLICY EXPIRES ON A 1 180 12/31/2020 Due to COVID-19, we have extended our returns policy for most items. Please see homedepot.com for details. Ve*Yr***W'XY(7t]t*W1c Ycyc :C]InOtlt Y(iC'KY is WR..IoricK**C** DID WE NAIL IT? Take a short survey for a chance TO WIN A $5,000 HOME DEPOT GIFT CARD Opine en espar of www.homedepot.com/survey User ID: H89 164229 161669 PASSWORD: 20354 161617 Entries must be completed within 14 days of purchase. Entrants must be 18 or older to enter. See complete rules on 7�1,,— pin purchase necessary. &55 /L=cic=72 /0A/ ne 1 IiI,q�� 1 /,f 6<rocc (1 1/a'v} "s `>a.x/O Pt @ /£ oc THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs & Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE; InTividual Registration Expiration 1.13100:._' 4;09/06/2025 JELSON DEMORAES, JR JELSON DEMORAES 38 GREEN LODGE STREET - 3ANTON, MA 02021 ' Undersecretary • Commonwealth of Massachusetts Division of Occupational Licensure Board of Building R ulations and Standards Constl9,,,, omr visor CS-067703 * l ,pires: 04/17/2024 NELSON DE .. • -t 104 38 GREEN L%• I CANTON MAil Commissioner , it K. b'Eir .�., • r ..... Certified Plot Plan yder, Location &Wiled 2 Bass River Parkway Ya77noutla, A/A e SURVEYING ENGINEERING prepared for HOME PLANNING & DESIGN Dennis cl" Paula McKenna 111111111111111.11111111111111111111111111 Scala. f .20' 3 Groom Hsi Rom) PO 601 4.36 Daly: ifay 20. 2013 so.imams.MASSACHUSEITS 02662 TEL 506-295-8312 Revised. 4/20/2023 www.ryder-16kut.ornt POSZes ii"rtitze, 6,10 f‘d-4 76' 117./4. cs FNO '.(EIROKEN) r_44 1:g 6-4 U.) posrovc QZ) •0.F,7 2.3wkluivc CI) 9 LOT 9 21,690 S.F..* 0.5 ai 11.e14_..once Assr s Map 34, Pct. 276 Pl. Bk, 22, Pg. 131, Lot 9 70. 19,4S;5,. •19.1V.e,:e? cerlt4/ Mad 1h.s• a'wslling shown hereon is ttIOF located as 11 exists On the ground DAVID .tir 34620 c:6'EsSle.S'44 141515 4.0 .4. IJANit Dale.. 406/1/.24 Professional.(rof S. t/esfor dab No. 11646