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Home My WebLink AboutBLDR-24-168- ONE&TWO FAMILY ONLY-BUILDING PERMIT Town of Yarmouth Building Department oF....y 1146 Route 28,South Yarmouth,MA 02664-4492 I E 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: B( 612 7.4-`(oi"— Date Applied Building Official(PrintName) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers Sri hri vinq T,E (irr le 1.1 a Is this an acceptedtreet?yes no Map Number Parcel hIpmht, 1.3 Zoning Information: 1.4 Property Dimensions: Rt ( LIV D Zoning District Proposed Use Lot Area(sq ft) Frontage(it) APR 01202 1.5 Building Setbacks(ft) Front Yard Side Yards lea ING DEPART ENT Os Required Provided Required Provided Required rrovedett 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: 12- Public 0 Private❑ Zone:_ Outside Flood Zone? Municipal❑On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Own r'of Record: %ofr1 h/c( rICaa S. YCJ�r,J1�j• M4 Woe)/ Name(Print) City,State,ZIP / u 7'�fi h nr�7 CiNc1-(. .gfr-q.3 - ni %f 1LC4�-k/Ijr'QJ aia-,l Co No.and Street Telephone Email Ad SECTION 3:DESCRIPTION OF PROPOSED WORKZ(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied❑ I Repairs(s) ❑ Alteration(s) 01 Addition❑ Demolition 0 Accessory Bldg.❑ Number of Units_ Other ❑ Specify: Brief Lion of Proposed World: SECTION 4:ESTIMATED CONSTRUCTION COSTS. Estimated Costs: Item (Labor and Materials) Official Use Only 1.Building S 1.Building Permit Fee:$ Indicate how fee is determined: 2.Electrical S ❑Standard City/Town Application Fee ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing S 2. Other Fees: $ 4.Mechanical(HVAC) $ List j c.z „is 8t 5.Mechanical(Fire S Suppression) Total All Fees:$ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ Z71 72,1 l' 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) a624, Gs�A a T 8,t A ayi-41� License Number Expiration Date Name of CSL Holder 3 U��i�� w4� List CSL Type(see below) No,and Street Type Description Lie;I f' ;1 I Unrestricted(Buildings up to 35,000 cu.tt.) City/Town,State,ZIP Restricted 1&2 Family Dwelling M Masonry LIMO) 11,19., 0)-306 • RC I Roofing Covering t WS Window and Siding SF Solid Fuel Burning Appliances Or- 7 3 7'1414 daysti 4,1M4)/boy I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 6idci, 1 e4.44 pR� /la's6t /�JBI HIC Company Name or Registrant Name C Registration Number Expiration Date 3 Pbri,Lks l,,Y, 01-1-3/1 da a/t, 4i3 /o6., No and Street Email address ox3ii?) ,C-737_//Gil ity/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 0 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: OWNERZ 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 and ccurate to the best of my knowledge and understanding. _ Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: I. 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: 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" i aaSe4-)i- -1w s ( qJt- I _ '� The Commonwealth of Massachusetts . 4 ~s=,v„`ii Department oflnrizcstrialAcciderzts =mil_ 1 Congress Street, Suite 100 =T=_. 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): Cleigni ia/G i),60 4-AA f---,L 0 S Address: 3 /14,94 (,,A y Lyptif- gtt City/State/Zip: 1,1 iiA 1.)tili _/L14. Oc213/() Phone#: 6 - 73?- Coflp7 Are you an employer?Check the appropriate box: Type of project(required): Ii�am a employer with 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 c ci8. Remodeling an y apa ty.[No workers'comp. insurance required.] 3. I am a homeowner doingall work myself. required.]r 9. 0 Demolition ❑ y [No workers'comp.insurance 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 5.0[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.t 1 •❑Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. I4.❑Othec 152,§1(4),and we have no employees. [No workers'comp.insurance required.] "Any applicant that checks box Al must also fill out the section below showing their workers'compensation policy information. f 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: kW"—nS f 150/0A(L Q _J--7 A/xi LAWf Policy#or Self-ins.Lic.#: (p �I71' p 6 Expiration07 / - � Date: /d Z/202 Y Job Site Address: 'A /-GC, 5, l`�t�m 417Z. f C� �Co4 ��/� nit 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 certify to der the pair and penalties of perjury that the information provided above is true and correct. Signature: Date: `7/AY Phone#: st'k 73 9--(LO Z 5 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 508-398-22311 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 57 V/I✓in9 6a,p_ 40N/1P/ Work Address Is to be disposed of oat the following location: 11f Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. 6), why Signature of pplication Date Permit No. TOWN OF YARMOUTH $ BUILDING DEPARTMENT ncxr d 1146 Route 28, South Yarmouth,MA 02664 S08-398-2231 ext. 1261 HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE: JOB LOCATION: NAME STREET ADDRESS SECTION OF TOWN "HOMEOWNER" NAME HOME PHONE WORK PHONE PRESENT MAILING ADDRESS 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 R5.1.3.1) 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 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 requirements and that he / she will comply with said procedures and requirements. HOMEOWNER"S SIGNATURE 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 A i E, 3' SjT�Y!TAIw r Nauset Kitchens, LLC 157 Brick Hill Rd. Orleans, MA 02653 NausetKitchens.com Tom & Joyce McCafferty 57 Driving Tee Circle S. Yarmouth, Ma. 02664 Bathroom Remodel:Demo and removal included. New Coretec luxury vinyl flooring installed. New comfort height toilet included. New mirror and light fixture installed. 48" vanity with top and faucet included. Walk in shower with tile ready base and walls to be tiled to ceiling with built in niche for soaps and shampoo and blocking for future grab bars included. New shower valve and trim with handheld included. Painting walls ceiling and trim included. Home to be professionally cleaned upon job completion Total Price $27,724.00 Initial Deposit $13,862.00 2nd Installment $6,000.00 (Upon rough plumbing and electrical 3rd Upon Tiling $6,362.00 Balance Due upon $1 ,500.00 completion Terms & Condition'... The above prices, specifications and conditions are satisfactory and are hereby accepted by both parties. Nauset Kitchens is authorized to do the work as specified. Payment will made as outlin-d above. Name247:672 V 1A//4$7/ ; Date Client's Na =� Your Date Thanks for your interest in Nauset Kitchens! Adam Pearl 508.737.6629 W tcL c,ov1( 1 . 1 •4 tt i: 1 , .4 THE COMMONWEALTH OF MASSACHUSETfS Office of Consumer Affairs & Business Regulation I t l HOME IMPROVEMENT CONTRACTOR t TYPE tnaivtdual ,; Exp� iratfon I, ! • r. • 11&16,R�is-tratip►� , 06/25/2024 .i i • ADAM PEARL ✓ „ II ', '' D/BfA NAUSET KITCHENS r P} ( I t ADAM P EARL /i �. 157 BRICK HILL RD 14 t o :i QRLEANS, MA 02653 Undersecretary Commonwealth of Massachusetts ,: p - Division of Occup.- `l F i4 , Lt Board of Building Re ' • 1 6 i Constructi Pe► ` , it �' a s ' cpires: 0410712024 `' r ', is CSFA-106368 4 ADAM PEAR f f 157 BRICK HILL RD II ' J ' ORLEANS M`*,- 0265 a s Commissioner .dc , I . l' `1 I