HomeMy WebLinkAboutBLDR-24-257 ONE & TWO FAMILY ONLY- BUILDING PERMIT
Town of Yarmouth Building Department
E 1146 Route 28, South Yarmouth,MA 02664-4492
�+ V 508-398-2231 ext. 1261 Fax 508-398-0836 '- t . ':
Massachusetts State Building Code, 780 CMR =, a
MAY 17 in Permit Application To Construct, Repair, Renovate Or Demolish ..:; ;i'''.•'`
a One-or Two-Family Dwelling
BUILDING DEPARTMENT
By: This Section For Official Use Only
Building Permit Number: 2, Date Applied:
:/(1(‘
Buildingialint Si tore Date
SECTION 1• ITE ORMATION
1.1 Property Address rj h+ 1.2 Assessors Map&Parcel Numbers
V 1.1 a Is this an a cepted streetjes no Map Number Parcel Number
1 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❑ Private 0 Zone: Outside Flood Zane?
— Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 wner'of Record:
v4 sl6eorq t S. ycuMoJ1) A* &Ott/
Name(Pint) City,State,ZIP
v13C// "2 wii9/ a 779-3(,vt 40Kflay h s7-o/yG a.)4•.Q(I•C0/-'(
- o.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction 0 Existing Building X. Owner-Occupied 181 Repairs(s) 0 Alteration(s) E' Addition 0
Demolition 0 iI Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Descr� iogf Pro ,se (�': -/ p 12414 � /� 0`�S �� , G , ei �
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 1. Building Permit Fee:S Indicate how fee is determined:
1 Electrical $
I ❑ Standard City/Town Application Fee
0 Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $ C)1 g.''^
4. Mechanical (HVAC) $ List: Y/
5.Mechanical (Fire
Suppression) $ Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ z 1 �(�Y— ❑Paid in Full 0 Outstanding Balance Due:
#SBS C I YAM
1
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License (CSL), L4569--- ,
4'/ O84 License Number Expiration Date
Name of CSL Holder
3 ����,� t� CAA U�� �� List CSL Type (see below)
f
No. and Street Type I Description
Qi
Gkl3�
i �, U Unrestricted (Buildings up to 35,000 cu. ft.)
Cja:1 Restricted 1 Pc.2 Family Dwelling_
City/Town, State, ZIP ► M 1 Masonry
RC i Roofing Covering
WS Window and Siding
SF Solid Fuel Burning_ Appliances
6a-d737‘, 002, k -A:t /aci4foje ;$...4, I Insulation
Telephone Email address ai D Demolition
5.2 Registered Home Improvement Contractor (HIC)
Crictair) 1.9(4-L-- PM i'Vq() 4ii' /67bh4.5' t9-6-Imp
H.IC Registration Number ---4-Explratr n Dare
HIC Como y Name or HIC Reg_ist t lame.
3 atip c Registrant
Ajoi,i)VI/Cliti1104-/cos-14 • (
No. an `reet 1)11/41SUAi 1' Oit) �5 �--��37 ..�%,.� Email address
City/Town, State, ZIP Telephone
SECTION 6: WORKERS' COMPENSATION LNSURANCE 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 . 0
1
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 61064 . O.If
t 1
to act on my behalf; in all matters relative to work authorized by this building permit application.
filairl
WA 5li. faqL
,61 2
Print Owner's Name (Electronic Signature) ate
SECTION 7b: OWNER1 OR AUTHORIZED AGENT DECLARATION
By entering my name below, I hereby attest under the pains and penalties of per jury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
CA he) PciIL 6iniby
Print Owner's or Authorized Agent's Name (Electronic Signature) Date
NOTES:
1 . An Owner who obtains a building peimit 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 I.G.L. c. 142A. Other important information on the HIC Prop-am can be found at
www.mass.goi/oca Information on the Construction Supervisor License can be found at wwww.mass.Qovidps
2
When substantial work is planned, provide the information below:
Total floor area (sq. ft.) (including garage, finished basementiattics, decks or porch)
Gross living area (sq. ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths I
Type of heating system Number of decks/ porches
Type of cooling system Enclosed Open
I
[ _-) . ' Total Project Square Footage" may be substituted for ` Total Project Cost"
4 .nwiLce_±, 1 I ch -e /rA 5
_ -- 1 he Commonwealth of Massachusetts
_'��, —. Department of Industrial Accidents
— �� 1 Congress Street, Suite 100
•
f_NM/
Boston, MA 02114-2017
• www.mass.go v/dia
NM 6
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): Cl( ) , � L
Address: -3 Mq//46 We /l viw4' 3//
City/State/Zip: V1/144.41 l O01311 b Phone r: 3-1 - 137-Lo g2 9
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. ❑New construction
2.'am a sole proprietor or partnership and have no employees working for me in 8. 02 Remodeling
•
any capacity.[No workers'comp. insurance required.]
3.0 I am a homeowner doing all work myself. [No workers'comp. insurance required.]
9. ❑ Demolition
10 Building addition
4.E1 I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.❑ Electrical repairs or additions
proprietors with no employees.
12.0 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.t 13. Roof repairs
6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.1]Other
152,§1(4),and we have no employees. [No workers'comp.insurance required.]
*Any applicant that checks box R1 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: itk47 f J 4, g911161 .�
Policy#or Self-ins.Lic.r: IIX / 6 60D hl v 'q - d s (7 L Expiration Date: 7l2(2
Job Site Address: 73 ant,' W114146 City/State/Zip: -5• 4G/ 6.7-6(c 7
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. under th pains and penalties of perjury that the information provided above is true and correct.
Signature: Date: AV/7l L
Phone#: 50k" 737 (e(e Z
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
I', 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 12 621/T1i,, (,t'ljy.yf Ua(s
Work Address
Is to be disposed of at the following location:
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
611 V7/2
Signature of Applicant Date
Permit No.
CkirrAUSEDCHE
Nauset Kitchens,LLC
157 Brick Hill Rd.
Orleans,MA 02653
NausetKitchens.com
Mary Beth St George
73 Captain Wrights Rd
S.Yarmouth,Ma.02664
Bathroom Remodel:Demo and remove existing.Comfort height toilet included.New ceiling fan with light and
recessed can in shower and over vanity included.48"vanity,top,sink and faucet provided by owner.Shower trim
and valve provided by owner.Entry door to be moved over with linen closet framed back 5"for future built in or
piece of furniture by owner.Pocket door to be installed.Ship lap on walls 48"with cap as discussed included.New
60"fiberglass tub base only included.Shower walls to be tiled with built in niche and blocking for future grab
included.Toilet paper holder,towel bars and hooks provided by owner installed by Nauset Kitchens.Painting walls
ceiling and trim included.Bathroom tile floor included.
Deposit:$6,966.00
Payment Plan
Total Price $27,864.00
Initial Deposit $6.966.00 to be paid
prior to starting job
tea Installment $6,000.00
(Upon rough plumbing and
electrical
3rd Upon Tiling $6,432.00
Balance Due upon $1,500.00
completion
Terms&Conditions
The above prices,specifications and conditions are satisfactory and are hereby accepted by both parties.Nauset
Kitchens is authorized to do the work as specified.Payment will made as outlined above.
2/0 v
Your Name Date C ent's Name Date
Adam Pearl
508.737.6629
•
2. .•
a.
,�V
., as ;v:.;: .; .:.i .:,.,. .,:, :.J::.:,.....:'F .. Y, k.. H. r?.". .6;t ."Y �.".
, n.
g� L`
A
„ ,:
•
Z''I: :!:::.i,ligi -, 4111,:i1P: N.'''':.:1;1111:iik1111"1':t'ls''''
iSt
f(
a
. >:� .e a ,ate. x .s=�> J.I. f �aS': >f .2 �:�;'�.`s..`� `5<. •
m
s
uv
tit':,. '
�+. h
;
vy..
„
x
v
2.. 2„
t, ite i ¢ x 2. 1.i,LC �i
`,
iti
,�t ;.,;' •�Wit,.,� , L :r v F
c.
n�
n:` .t
,
"" vv
v
21
air•.
2 Y. :
5` y�
,
3' is L
i�t"x'
C• vim. 01. f� �£::' ;\cx
+� R
! 3s b
`�' �.x f t.
a 'c\».max: .sF „:,,_:.a, :"
'..aIA a ,..a .. ifG>.. `d� ...vv v: .. .>.. ..v. .v kir;t . : •t<.�, h3�
n , .
LIR lab ,'�.• tzm",
r
W .X'. ".sY
.a.. twirl 4 ,"Y�.:.
sci,j A+
3
5�;
� T�
.Avv
Y,i '%' .. ::. ..`:6 is
i C.. �.
iT
w�:
, t
/ v
,;;
< t'
%
�a ,t,t>x�" �.F
t, ,
£ UB;': h , is f£:.: •:�'�yc:' '%�;: '&
a ,
v,
to,
' V 1f1xw iX , Nv
�' THE Y„kt ; ..::_
utation
� �*► �III� +ki*2: f.' � �,;i ...4�
" ' 1wiQ ° "'"fef'
dthai
:.
aiz
,,,....,:.:::1", .‘,..:,...:3—,,w..4:,..:
•
•
#' f''"tE e.. ,,, y K :Wa"`^ »•,.,F..; Y ';g;r,„
2
1 # � a €2
�' � Iii• +
{ y ''tie:> : .
a
y.,
;;+=Sti
bli:;% Y Wk.' • .. ...,..#411141160#41 . •:‘ ;;:tz:k:, •...•':ii.:' 1....:'•,:!..;:.•:!.--,:-
•
, hT!',€'It.:
„ "fix. iy Y � 02653 < ;.k:: >5 gt i1 � . "s.
,
,
:::;
::s.„ 3 •:G F. ;:�:�'�,HY�'''/�;'ntr'':;.t;°, :< ,tn'"p" '�f �9 .. '::,nxoaal?'>c:.F^:c.. �,
'.;oyfa L` :fin:.':::" ...
if>;:
.. r ,::Y.:r:r;.ffi,F<.s.SfS»-a.. .. i
«
,n
•
Commonwealth of Massachusetts Construction Su rvs$ot 2 Family
, Division of Occupational Licensurs
'�' Board of Building Re utations and Standards
l tsnstt<u£ tio�ttd�1i t x�,1 & 2Farnify'
,.
CSFAW1O6368 b N..k;.: - t ins s: 04J4712t1 6
ADAM PEAR
3 MAFUNERSIN l tM
UNIT 311 . *,, .: :`
PLYMOUTM lit f" '
IA
•
'31/
AnAi %10' yr':' 6","% ' ;
_. ` ... .:•
. ' tBflttBuC Itd QinOgS SCAode$S 9 i i crtirtu8nei ofrr ev#v:oft avvwLtt€IoP nN�.omRI tattha ai aI1fti1cvSCe.ndtsptea
S,..4....2Sp1 Contact OPSI i611i 727-32CO1# iE3ton$r fas -
20kcpi min
13 (a pion woo
( o
1
MI fi r I - I
dcac.,
-- -- ----
__ _ _-_ _ _
..
I
- __-----
____ --
i
s