HomeMy WebLinkAboutBLDR-24-281- RECEIVED 6'I.ClI YI'_ 011�ke4i1S
y 2 8 2O24 �l &TWO FAMILY ONLY-BUILDINGYERMIT
\ MATown of Yarmouth Building Department oF. r
1146 Route 28,South Yarmouth,MA 02664-4492
BUILDING DEPARTMENT
ay 508-398-2231 ext.1261 Fax 508-398-0836l
: Massachusetts State Building Code,780 CMR ,/
Building Permit Application To Construct,Repair,Renovate Or Demolish r`.J
a One-or Two-Family Dwelling
�tM This Section For Official Use Only
Building Permit
NNNummbe`r (Y(/�.tX,r -.e/0 Date Applied:
Gffi �N y �l 7 7 Building Merl )
SECTION .STTI INFORMATION .
1.1 P rty Address: 1.2 Assessors Map&Parcel Numbers t
i 1 1.1a Is thisil-anl
accepted street?yes no Map Numb Parcel Number
13 Zoning Information: L4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(It)
1.5 Building Setbacks(ft)
Front Yard Sider Yards Rear Yard 0/7
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40,154) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 1) Private❑ Zone:— Outside�F Zone? Municipal❑Oo site disposal system ❑
CheckSECTION 2: PROPERTY OWNERSHIP'
f Accord:
S � a SeA,Les ku.'`r6, -57\`'4,I.'',.0Llk, Mtq-
Nanx(Print) City,State,ZIP
fa -tY A--1.b:o-J S-v —zees be -3 /U AAA 4- .
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORKS(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied❑ I Repairs(s) 0 Alteration(s)❑ Addition O
Demolition ❑ Accessory Bldg.❑ Number of Units_ ..Other 0 Specify:
Brief Description of Proposed Work2: �m.Mo.--c_. e.,t 5....
"-s i n tr 5V S{+.t n C`As",_
-I- Gt�(` (.4 t 62. .4 z. - A- 2,a (1«_I�.S'
0 r.r..r�-,-e- -4- ll,r�Ac-e_ "7 aut.tdos.s -r TrL(✓"`
SECTION 4:ESTIMATED CONSTRUCTION COSTS.
Item Estimated Cow" Official Use Only
(Labor and Materials)
1.Building S(G 0 1.Building Permit Fee:S Indicate how fee is determined
❑Standard City/Town Application Fee
2.Electrical $ ❑Total Project Costa(Item 9 x mu tiplier x
3.Plumbing S 2.Other Fees:$-_L�,�
4.Mechanical(HVAC) $ List:
5.Mechanical(Fire 3
Suppression) Total All Fees$
6.Total Project Cost $ Check No. Check Amount Cash Amount
1 ❑Paid in Fri! ❑Outstanding Balance Due:
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SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor
License(CSL)
5 License Number Expiration Date
Name of CSL Holder
tit)
, , i /n'"`�S� ��r List CSL Type(see below)
No.and Street `VV (9T Type Description
/ 1' Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry/ RC I Roofing Covering
�,i l ' WS Window and Siding
�b� �6 047 T- , r; (� SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) a bS -
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
74 No.and Street Email address
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 0 No ❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
O R'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the s ct property,hereby authorize
to ac my behalf, ' all .'-rs relative to work authorized by this building permit application.
P wner's e 1 onic Signature ( 2- —tte
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.
Print Owner's or Authorized Agent'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►of 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.e.ov/dps
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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 halflbaths
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
508-398-223!1 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 /")--( (1 4 i h t o.ti l \—4,L
Work Add
ress
Is to be disposed of oat the following location: C`
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Ch. lll, §l
-4-5r 12- Y /„,20;?-r
Si of Application Date
Permit No.
Commonwealth of Massachusetts
Division of Occupational Licensure
I Board of Building Reggulations and Standards
f'Z '
ConstionI T -visor
CS-095981 s'gr1111111 qPires: 10/25/2024 •
WILLIAM F Ntra -r
15 LEXINGTON , II
fro ,.
•
YARMOUTH q R 1
47(�{r.iv(1.1:3
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs and Business Re
1000 Washington Street - Suite 710gulation
Boston, Massachusetts 02118
Home Improvement Contractor Registration
TypWILLIAM FRANCIS PLANINSHEK Registration:
Individual
Registration: 208829
15 LEXINGTON LANE Expiration: 06/04/2025
YARMOUTHPORT, MA 02675
Update Address and Return Card.
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs & Business Regulation Registration valid for individual use onl before th
HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: Y e
TYPE: Individual Office of Consumer Affairs and Business Regulation
Registration Expiration 1000 Washington Street - Suite 710
208829 06/04/2025 Boston, MA 02118
WILLIAM FRANCIS PLANINSHEK
/ /
•
WILLIAM F. PLANINSHEK /'
15 LEXINGTON LANE r
YARMOUTHPORT, MA 02675 �� 'C �'�a� k
Undersecretary Not va d without signature
•
•
'� The Commonwealth of Massachusetts
=yl= Department oflndustrialAccidents
=Eol= I Congress Street,Suite 100
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 .f- Please Print Legibly
Name(Business/Orgenizetiion/Individual): CInC>j'CL L (l4✓.-rP,S-e."-S LLC
Address: 1 S bQ -fru 5- 'U 1-424'4-<
City/State/Zip: \/ +.po"-j- (✓(a4- Phone#: cG 02 C /C(7t
Are yoe an oyer?Cheek the appropriate box: Type of (re
quired):
project(req ram:
I. I am a employer with .5 employees(full and/or part-time)." 7. ❑New construction
2.0 t am a sole proprietor or partnership and have no employees working for me in 8. [.}-)remodeling •
any capacity.[No workers'comp.insurance required.]
3. 1 am a homeowner doing all work settrequired.]r 9. ❑Demolition
❑ g my [No workers'comp.insurance
4.❑I urnn6 property.a homeowner and will be hiring contractors to conduct all work on ro I will 10 Building addition
ensure that all contractors either have workers'compensation insurance or we sole 11.0 Electrical repairs or additions
proprietors with no employees.
12.❑Roof ring 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., 13.0 repairs
6.0 We are a corporation and its officers base exercised their right of exemption per MGL a 14.❑Other
152,§I(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
*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 subcontractors have employees,they most provide their workers'comp.policy number.
I ant an employer that is providing workers'compensation insurance jor my employees. Below is the policy and job site
irtjormation.
Insurance Company Name: Alt C 0e 1 s'
Policy#or Self-ins.Lic.h: &F(v 3- I/c$t.(/00-b-1-'S Expiration Date: 2-- C-
lob Site Address: City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c.152,§25A is a criminal violation punishable by a fine up to 51,500.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify J tut' / '!7 t e information provided above is true and correct.
Si s attire: A_ A/ Date: 1+2-- ( e- `P
Phone#: G e
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License m -
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone 1$:
Property Location 12 ALBION ST Map ID 28/ 83/ / / Bldg Name State Use 1040
Vision ID 3504 Account # 3504 Bldg # 1 Sec # 1 of 1 Card # 1 of 1 Print Date 5/28/2024
CURRENT OWNER TOPO j UTILITIES ' STDT/ROAD I LOCATION I CURRENT ASSESSMENT_
WEST YARMOUTH SERIES THREE L 1 Level 2 11 Paved 12 Suburban Description Code Assessed Asseed
249,700 815
6 Septic
c RESIDNTL 1040 249,700
4 Gas RES LAND 1040 179,100 179,100
PO BOX 342 SUPPLEMENTAL DATA YARMOUTH, MA
Alt Prcl ID 23/ P316/ / / VOTE
HYANNIS MA 02601 MISC 100 VOTE DATE
SEWER P PRIVATE
CONTRACT # VISION
PLAN # 107-D
ZIP CODE 2673:
GIS ID M_302357823004 Assoc Pid# Total 428,800 428,800
RECORD OF OWNERSHIP BK-VOLJPAGE SALE DATE Q/U V/I I SALE PRICE VC PREVIOUS ASSESSMENTS (HISTORY)
WEST YARMOUTH SERIES THREE 28924 0008 06-08-2015 U I 100 1 F Year Code Assessed Year Code I Assessed V Year Code Assessed
JOHNSON NANCY L 13416 0274 12-08-2000 U I 1 1F 2024 1040 249,700 2023 1040 249,200 2022 1040 221,500
JOHNSON NANCY L TR 12729 0314 12-17-1999 U I 99 1 F 1040 179,100 1040 162,700 1040 155,300
JOHNSON NANCY L 0 I 0
1
Total 428,800 Total — 411,900 Total 376,800,
EXEMPTIONS OTHER ASSESSMENTS This signature acknowledges a visit by a Data Collector or Assessor
Year Code Description Amount Code Description ' Number Amount Comm Int
APPRAISED VALUE SUMMARY .
Total 0.00 Appraised Bldg. Value (Card) 249,700I
ASSESSING NEIGHBORHOOD -Appraised Xf (B) Value (Bldg) 0
Nbhd Nbhd Name B Tracing Batch 0,
0050 Appraised Ob (B) Value (Bldg)
NOTES Appraised Land Value (Bldg) 179,100
NATURAL & GREY I/A E/A Special Land Value 0
Total Appraised Parcel Value 428,800
Valuation Method C
Total Appraised Parcel Value 428,800
BUILDING PERMIT RECORD VISIT/CHANGE HISTORY
Permit Id Issue Date Type Description Amount lnsp Date % Comp Date Comp Comments Date I—id Type Is Cd Purpost/Result
99887 02-23-1989 1,000 100 REC ROOM 04-08-2020 LS 54 Field Review
08-04-2017 BH 02 CL Cyclical
01-01-2014 BH 01 1 CY CYCLICAL2014
06-26-2003 JB 00 Measur+Listed
04-04-1996 RD 01 Measur+lVisit
LAND LINE VALUATION SECTION
B Use Code Description Zone Land Type Land Units Unit Price Size Adj Site Index 1 Cond. Nbhd. Nbhd. Adj Notes Location Adjustment Adj Unit P Land Value
1 1040 TWO FAMILY 10,454 SF 13.70 1 .00000 5 1 .00 0050 1 .000 WF12 1 .0000 17.13 179,100
I
Total Card Land Units 10,454 SF Parcel Total Land Area 0.24
Total Land Value 179,100
Property Location 12 ALBION ST Map ID 28/83/// Bldg Name State Use 1040
Vision ID 3504 Account# 3504 Bldg# 1 Sec# 1 of 1 Card# 1 of 1 Print Date 5/28/2024
CONSTRUCTION DETAIL CONSTRUCTION DETAIL(CONTINUED) _
Element Cd I Description Element Cd Description WOK
Style: 10 Duplex _____________, i
Model 01 Residential WOK gt
r ! 8
Grade: 03 Average s;
Stories: 2 2 Stories
Occupancy 2 1 CONDO DATA 8 12
Exterior Wall 1 14 IWood Shingle ,Parcel Id ICJ Owne [0.0
Exterior Wall 2 25 Vinyl Siding IB JSf FUS
Roof Structure: 03 Gable/Hip Adjust Type_ Code Description Factor% FBM
Roof Cover 03 Asph/F Gls/Cmp ICondo Fir
Interior Wall 1 05 Drywall/Sheet (Condo Unit
Interior Wall 2 COST/MARKET VALUATION
Interior Fir 1 09 Pine/Soft Wood Buildin Value New 372,626
Interior Fir 2 05 Vinyl/Asphalt g
Heat Fuel 03 Gas
Heat Type: 03 Hot Air-no Duc 24Year Built 1950
AC Type: 01 None Effective Year Built
Total Bedrooms 04 4 Bedrooms Depreciation Code A
Total Bthr : 3 Remodel Rating
Half Baths Half Baths 0 Year Remodeled
Total Xtra Fixtrs Depreciation% 33
Total Rooms: Functional Obsol 0
Bath Style: 02 Average Ext.Comment 0
Kitchen Style: 02 Modern Trend Factor 1 36
Condition 3 WOK
Condition%
Percent Good 67 I 6: 12Zp t�,`C�
RCNLD 249,700 (v!
Dep%Ovr i1
Dep Ovr Comment
Misc Imp Ovr - .
Misc Imp Ovr Comment "� ' A ,M
Cost to Cure Ovr �� • 4 • �_ '
Cost to Cure Ovr Comment /f ���
t
OB-OUTBUILDING& YARD ITEMS(LJ�/XF-BUILDING EXTRA FEATURES(B) 4 ;�t ,
Code Description UB Units Unit Price Yr Blt Cond. Cd %Gd Grade Grade Adj. Appr.Value .. ,
‘4.:._,` 1
_I
BUILDING SUB-AREA SUMMARY SECTION I _ _
Code Description Living Area Floor Area Eff Area Unit Cost Undeprec Value f° _
BAS First Floor 864 864 864 169.61 146,543 � � « '�
FBM Basement, Finished 0 864 389 76.36 65,978
FUS Upper Story, Finished 864 864 864 169.61 146,543
WDK Deck,Wood 0 210 21 16.96 3,562 -
4.1....Au
Ttl Gross Liv/Lease Area 1,728 2,802 2,138 362,626
ONE or TWO FAMILY-BULDING PERMIT
APPLICATION REGULATORY APPROVALS NOTICE
Address of Proposed Work: I brk--) Luc sr Ylqrt^'`U
Scope (�
ofProposed Work: V`Q:n1O-'-e. r2o-+r1 5-- rci A-S .+ I}rcic
�C-.F t-�-c_ 9 r 5 t Y p S �rc�L �A a� 4 2 Q 4 r , �A-'L
nT�=
cck.S at-.Mc>� .- CL-ol.Ac-�
Date: 'J i.7-0�Oa�
Based on the scope of work described above,the applicant is required to obtain approval sign-
offs from the following departments as checked-of below:
Health Dept.-508-398-2231 ext.1241
Conservation-508-398-2231 ext.1288
Water Dept.-99 Buck Island Road,508-771-7921
Old Kings HWY.Hist.Comm. -508-398-22631 ext.1292
Engineering Dept.-508-398-2231 ext.1250
Fire Dept.-Kevin Huck/Scott Smith,96 Old Main Street,SY
Note:Please call Fire Department for an appointment.508-398-2212
Other
Appropriate plans and/or application shall be provided to each departments checked-off above.
Each of these regulatory authorities has their own requirements outside the jurisdiction of the
Building Department. All applicable approvals shall be obtained prior to submitting a building
permit application to the Building Dept.
Thank you for your cooperation.
Receipt Ac ow-.:-
lt: •
cu I
Applicant's S'; ature Date
Rev.Jan.2019
t
TRAVE
WORKERS PE ?I
AND
IPLO �TYPE AR INFORMATION PAGE WC000001 ( A)
RENEWAL OF c GRUB-186I60-0-
E N. TR+ z?:- 23• �'r.�y' �Is�''~`'_ .:�tv r i �e� s �r CO~LsirttA $ O w►' A-ctsk-+ T tzEt.
w
_ NCO CO CODE13439
INSURED: FROTIUCI=P_:
g".sRM0 f1Ts- - 0267 BOURAis 02532
Insulted is A 1:12FET1 rc WW T C 4
Other Mt places and identification numbers are shown in the schedule(s) attached_
_ The € cy period is from 02-25-24 to G2-25_25 12 1 AA. at the irisuredis adder_
3_ A. WORKERS C PENSATI -II U NCE: Part One of the policy applies to
the Workers
Compensation Law of the state(s) listed here.:
EitiiPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in
3_A. f of our lab under Pa
-...` �- Part .T
.._L are_
=....4
'~� Bodes Injury by Accident 500000 Each Accident
Bodily Injury by Disease: $ 500000 Policy Limit
Bodes Injury by Disease_ $ s000 o Each - to e
ee of the pap"apples to the sue, € any listedhere:
coy—ERA—OK RIMILACED BY ENGDORSTarr We 20 03 063
-
IX_ This policy includes these endorsements and schemes:
SEE LIS . .NG O S �S - OF ri PAGE
4. The premium for this policy will he determined by our Manuals of Rules, Classifications, Rates aad Ramon
g
Plate All required informationis sub:feat° vaificalion rand change be amain he made
DATE OF ISSUE: 01-30- 24 j ST ASSI(a
PRODUCE, MRRELY & wi.MOIA D 7 smrri
019232