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Home My WebLink AboutBLDR-24-268 S b ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department of r RECEIVED 1146 Route 28, South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 itt., Massachusetts State Building Code, 780 CMR = e MAY 2 2 20ri1 ng ernzit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling BUILDING DEPARTMENT By - ., `'1 This Section_ onti For Official Use Only Building Permit Number: B 2 h toe Date Appli : ---- 1-4Building Official(Print IQame) Signature Date SECT N 1: SITE INFORMATION 1.1 Pro erty Address:_ 1.21 Assessors Map&Parcel Numbers 45 `c MOIL `�k)L)t O2A.4A-1.91 1.1a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: 1314 Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards 1 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 Zone: _ Outside Flood Zone? C9� Private❑ Check if yes❑ Municipal 0 On site disposal system 6-"-- SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: F Lase c_Ni-4 L 1.)c,271-\ U.3 fin,. 671-1,t S A. C sb 1 Name(Print) City,State,ZIP • 'as `:mac oI_k__ 4v`C.0.)Uc TI4 gib$(iU l‘. 51- 11s-;L 0A-1 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'-(check all that apply) New Construction❑ Existing Building liK Owner-Occupied W' Repairs(s) l'Alteration(s) 0 Addition ❑ Demolition ❑ 1 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work': po v!/c/ /a'-71 P/o Y ii+-,.-r4 f/ji/t-n n C.Y ,41 G4 el e S' 1 a/ Nc to c P / S1.1 r1 L- air/y SECTION 4: ESTIMATED CONSTRUCTION COSTS I ! Estimated Costs: Item Official Use Only j (Labor and Materials) i 1. Building $ 17' 1. Building Permit Fee:$ Indicate how fee is determined: t ❑ Standard City/Town Application Fee 2.Electrical $ 0 Total Project Cost3(Item 6?x multiplier x 3.Plumbing $ 2. Other Fees: $ C v, a Cl 01 i (:0 00 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees:$ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ 1 0 Paid in Full 0 Outstanding Balance Due: JZ1 su&a3 — 07/s i7ie/ ri -ero. i'1 is/L E 3oic>i I cor �' SECTION 5: CONSTRUCTION SERVICES , , 5.1 Construction Supervisor License (CSL) 5'-- i64 / 5--70 3/7/al L` S - 0 i •� ) License Number Expiration piration Date Name of CSL Holder LA q e chce C.... N List, CSL Type (see below) q6060eci � I No. and Street Type Description 4/ Y t-rot)7 Pe9 17W 1- U I Unrestricted (Buildings up to 3 5,000 cu. ft.) R Restricted I &.2 Family Dwelling City/Town, State, ZIP CSD Masonry Hq /- i•tij C I /1 4 .d / I RC ; Roofing Covering �V S Window and Siding V-' SF Solid Fuel Burning Appliances 7 ) ;do? — , i,31 $Joc' //4 e_to i I I Insulation Telephone Email address 44-6---i—t444/ D Demolition 5.2 Registered Home Improvement Contractor (HIC) 4 4::0 ' it 0 3-5-PC- ///d /4 tiee4ce C--groonlie4q I-iIC Registration Number Expiration ate HIC Company Name or Wc Registrant Name No. ,5.--74e, i/ e r/4 c e ( I e. ,.. . 5-101/ 6 e i i ei-r6-,24-/ P cer and Street 77J21J Email address 95y i_ el n 7 AA /n r 7V,-)k).2 --0V407 City/Town, tate, ZIP iketific, P)4 p ,3." 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 I this affidavit will result in the denial of the Issuance of the building pelinit. Signed Affidavit Attached? Yes ❑ No p SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT i I, as Owner of the subject property, hereby authorize ,4-- q U r en C e G g 1--750n n eq q to act on my behalf; in all matters relative to work authorized by this building permit application. tL /fAe IAA / �� r Q p a� � s y .)< JintOers Name (Electronic Siature..9 ) 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. ill x e r s /�?/a2 r. >1Print 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 (H:C) 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 Infolination on the Construction Supervisor License can be found at www.rnass.Qovidos 2. When substantial work is planned, provide the information below: Total floor area (sq. ft.) (including garage, finished basement/attics, decks or porch) 1 Gross living area (sq. ft.) Habitable room count Number of fireplaces Number of bedrooms Number of batarooms Number of halfibaths 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" 1 he Commonwealth of Massachusetts il 90,_; - Department of Industrial Accidents e= 1 Congress Street, Suite 100 47:�_` Boston, MA 02114-2017 �;� www.mass.go v/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERttMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): pre '/1 �?e 1--' 4,-.6„,„ eAt4 L..-- Address: q i A on, / i,d z2r c.- City/State/Zip:Mr--,,,,,/Of eays- Phone #: Are you an employer?Check the appropriate box: Type of project(required): I.❑I 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 capacity. 8. Remodeling • any p ty.[No workers'comp. insurance required.] 3.0 1 am a homeowner doing all work myself [No workers'comp. insurance required.]? 9 C 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 11.0 Electrical repairs or additions proprietors with no employees. 12.0 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.t 13• Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 1 4•❑Other 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. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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#or Self-ins.Lic. r: 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$250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. L. Signature: Gp: Ls�,�'a7in-,- 1 c/a./a Date: �� Phone#: 77r- lad- a30 9 Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# • Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: Proposal a(,o �M�CV PROPOSAL NO. 2. .'( oa4,y s- SHEET NO. 3_05_ 7- 7/S" DATE PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT: ///7/u,3 NAME ADDRESS ADDR /14 �`amtot��C cr. 777$ Og7D DATE OF PLAN PHONE NO. ARCHITECT We hereby propose to furnish the materials and perform the labor necessary for the completion of � S�a:u e,71 d—a4 L vrr,�uc� � _S t . / 51 1.)." , RE CEIVED IN 17 2024 BUILDING DEPARTMENT er.._ At material is guaranteed to be as specified,and the above work to be performed in accordance with the drawings and�specifications submitted for above work and completed in a substantial workmanlike manner for the sum of Dollars($ r y r�U )with payments to be made as follows. /d f\P 3f �-Lca1�t I k,$)(_, /// My alteration or deviation from above speciarallons involving extra ads 1 will be executed only upon written order,and wig became an extra charge Respectfully over and above the estimate.All agreements caNngad upon shims, submitted acclderds,or delays beyond our COMM. Per Note—this proposal may be withdrawn by us if not accepted within days. \ J ACCEPTANCE OF PROPOSAL The above prices,specifications,and conditions are satisfactory and are hereby accepted.You are authorized to do the work as specified.Payments will be made as outlined above. ( y Signature Date \J(",\ G a� Signature \ atdsor Dana a-12 . 50g-.)37-a 7<r , - - - _ - r-, r-, (--- g q, '-1 U5. WICMOLAS FIEF) REEE 3( °r _-___ 6I d Floe 260 CHURCH STT REET T M4RWCCH,MA 02645 o?S-- $c,d/l 4/e RECEIVED ' v, ycnr ,...To✓7A JUN 172024 o?6, 7379, 72 y-54 e-Dg _7o BUILDING DEPARTMENT By PC- , ,S/i/6 L (' .SI"Ory f/o m e _ . G a �� aV/: 6rtJl( e/r o v e 6ri cg 57-4"/ 4 GM`h h e, tea vin9 owe G ?re,b P r fit. tac-fP� add h Pe w Eh'eaS ;'/ eSY's4A77 — 1 Fob kdAtr°r)F I l