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Home My WebLink AboutBLDR-24-221- + S too, 6V ti ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department eii—v 1146 Route 28, South Yarmouth,MA 02664-4492 iVi. RECEIVED 508-398-2231 ext. 1261 Fax 508-398-0836 Massachusetts State Building Code, 780 CMR e v--- 1 APR 2 in Petrnzit Application To Construct, Repair, Renovate Or Demolish uL a One-or Two-Family Dwelling / I I BUILDING DI^PAR I MENT n This Section For Official Use Only By: Building PermtfNum-ber: 6 b —40 Date Applied: Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Progrty Odd�sns: �� 1.2 Assessors Map&Parcel Numbers 11.1a 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 CICheck if yes❑ SECTION 2: PROPERTY OWNERSHIP' 24-0wilierlof Recor i-e- ci A p l5� ..q.-4r.C.(t I `C o ►(z Name(Print) City,State,ZIP S 'c ri4 -3 . In -6(5—q4.)-q( 3 e. )st (17/6)�r�,7.Com No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 1 Repairs(s) 0 Alteration(s) 0 I Addition 0 Demolition 0 I Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work-: 6\Yd cl-ttin 0 4- x 8 I:C ✓ Le-1-4- (3)-- F- l-e_ 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: 0 Standard City/Town Application Fee 2.Electrical $ 3 0 Total Project Cos�(�et��x Cti�Sih x 3.Plumbing $ 2. Other Fees: $ , C�/T 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Total All Fees:$ Suppression) Check No. Check Amount: Cash Amount: tf 6.Total Project Cost: $ 3 100(� •� I ❑Paid in Full CI Balance Due: d y • 1i ICJ .. ., ASKS a S Acid 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 j Restricted i L2 Family Dwelling City/Town, State, ZIP tit I Masonry RC Roofing Covering WS i Window and Siding SF Solid Fuel Burning Appliances T Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor (TJIC) RIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name No. and Street Email address Ci,•.'Towri, State, ZIP Telephone SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152. § 25C(6)) j Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide I this affidavit will result in the denial of the Issuance of the building peiiiiit. Signed Affidavit it Attached? Yes ❑ No . ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WFIEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner of the subject property, hereby authorize to act on Icy behalf, in all matters relative to work authorized by this building pei snit 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 infoi;iia}ion contained in this application is true and accurate to the best of my knowledge and understanding. 6/k5 Print Owner's or Authorized Agent's Name (Electronic Signature) Date NOTES: 1 . An Owner who obtains a building pei n it 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 infoi ination on the HIC Program can be found at www.mass. gov.loca Infoiuiation on the Construction Supervisor License can be found at www.mass.aov/dps When substantial work is planned, provide the information below: jTotal floor area (sq. ft.) (including garage, :finished basementlattics, decks or porch) I 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 1 . Total Project Square Footage" may be substituted for '`Total Project Cost' The Commonwealth of Massachusetts _ ....-a— A ,u_ Department of Industrial Accidents ! lel= 1 Congress Street, Suite 100 _ j Boston, MA 02114-2017 �;,„•`; www.mass' v/dia o v/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): Cal-V- C�. Si--\_ 7 Address: S C.Doti cr kr\ .C.,,x,1,1. Mq CO&3 City/State/Zip: Phone #: •S98 - Q t (a- d63 Are you an employer?Check the appropriate bog: Type of project(required): I.❑1 am a employer with employees(full and/or part-time).' 7. Li New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. El Remodeling • a y capacity.[No workers'comp. insurance required.] 3. I am a homeowner doing all work myself. [No workers'comp. insurance required.]t 9. 0 Demolition 4.❑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.EiPlumbine repairs or additions 5.111I 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 13•❑Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Ell Other 152,§1(4),and we have no employees. [No workers'comp. insurance required.] `Any applicant that checks box R I 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: Policy r 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 cert(iy.und r the pains q_t d pet; [ties of perjury that the information provided above is true and correct. Slenature: \)C� — l f / Date: � lasja4 If Phone#: 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): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other I Contact Person: Phone#: Y : TOWN OF YARMOUTH r )9:1L3 BUILDING DEPARTMENT _ •M � ;C oN�SE% 1146 Route 28, South Yarmouth, MA 02664 S08-398-2231 ext. 1261 HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE: re JOB LOCATION: p GU NAME STREET ADDRESS SECTION OF TOWN "HOMEOWNER" 566 ' 9 - 3 NAME HOMF, PHONE WORK PHONE PRESENT MAILING ADDRESS Cxv7SCrig_ 0'k 10063 , 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 perfonued 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 . HOMEOWrER"S SIGNAI RE (it...1i- 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 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 7 f2U. Work Address Is to be disposed of at the following location: If-4✓!g rc/ ( � Oin Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. 4//02c lag Signature of Applicant Date Permit No. 5t10W I NCB A PROPOSED DECK LOT 1119 RAINI5OW SOAP YARMOUf11, MASSAGt1USETTS remove siding at ledger • 69.06/ exterior sheathing prior to installation existing stud wall threshold carefully flashed and LOT I I ( caulked to prevent water intrusion ledger and joist flush on top N 9,�jQp .FT �$, existing 2x band joist I continuous flashing > or 1"minimum O.ZjtAG. ►�� extending past joist EWP rim joist hanger \ 2'min.` I 1l ; deck joist 1-S1-5/Ermin.f MII1II, �:,. / 5'max.` 1/2"diameter lag �I7.7 2'min.T j ~ 2x floor joist, l screws or EXISTING wood I joist, • .. through-bolts with or MPCWT • washers DWELLINS joist hanger i wallexisting 2x ledger board;must be greater than or equal to the depth of the deck joist and no greater than the LL I' ' )'? 1457 depth of the house band or dm joist CS-- U�82 PROPOSED to EXI5TIN6 S x8 joist hanger with inside flanges to DE PIER LA - jili Ir.s. guard I' decking blocking IIII�I ledger board IIIIIIII �� fasteners existir- o IIIIIIIII I use ql I11H / 4 i=•r construction 4 Iq�lll `�� , guard post--. / ��'� ��'attachment 1Oil . ` —top of beam or U`j� ' ledger board joist ledger and joist U,�A,\ attachment to hanger must be at same -xisting house ; elevation_, rim joist— ' � /I — `�`! � joists beam // pos postt-t. •eam connection joist-to-beam footing / (flush,tg 9) h •-arin - connection •400,00 12)34 diameter single 3'or 4' / through-bolts nominal or double wNh w••h•r• 2'nominal beam Win/_ 27 Pre eat$t" beam must .P101111_ ss • p bear July on II 'TDo,{,1 yt r, notched 6x6 Tr Q bob min.- -- -- existing wall -�- ---- , " Joist Irum joist ' .ZdX/0ol ilii a e mechanical fastener or ' foist anger hurricane clip I ledger board VA / iJo.kt,ed , --- post (y 1(tp, 1 beam Jo A. 46___t'1 6n '^7`t.----.-'lyr/aCO ' a ..,f iii, ,,.. ,,,, . 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