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HomeMy WebLinkAboutBLDR-24-266- 4i , i ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department of r- 1146 Route 28, South Yarmouth,MA 02664-4492 ,: 508-398-2231 ext. 1261 Fax 508-398-0836 Massachusetts State Building Code, 780 CMR A e • Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling R..ECE ' V D I This Section For Official Use Only Building Permit Number: '` p_.—2,9 /4 Date Applied: MAY 23 20A BUILDING DEPARTMENT Building Official(Pri ame) ignature By: nrrm — SEC ON 1:SITE INFORMATION • 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 14 St•4ANNoi Coocr 25' sic' 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 o 5ing Information: 1.4 Property Dimensions: -4330 Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required J Provided Required Provided Required Provided 30 I S Zo 1.6 Water Supply: (IvI.G.L c.40,§54) Flood Zone Information: 1.8 Sewage Disposal System: Public X Private 0 e: _ Outside Flood Zone? Municipal 0 On site disposal system Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: DE,NNis d La Zogrws LvoLOIA) wIA. ofos6 Name(Print) City,State,ZIP R AY-}-s is.€le.c_ n'C •. No.and Street �0 S31-635`S �ftike�.l1 1�9e 8S SS;,�7LG•eow� CC • Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building Ijd' Owner-Occupied al 1 Repairs(s) X Alteration(s) 0 Addition 0 Demolition 0 I Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: ,s L kJ reaGN „guiN6 14 i g i1 riiiT 41 ZP4/QA14a t t r0 s_014/0nr&PSJ• Ma tea/ r1644 SIGelAta 0 Sp: t eoUt co X — , tr12X-) 4- et SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: JUL 1 1 2024 1 (Labor and Materials) Official Use Only iii 9_ .._ ,, . 1. Building $ 3 gt93c,,66 1. Building Permit Fee:$ Indicate how f e^ '' 1'A MEN 1— By. 2.Electrical $ I t Aso i v I, ' 0 Standard City/Town Application Fee 3.Plumbing ❑Total Project Cost (Item 6)x multiplier x $ 31000 ' " 2. Other Fees: $ — 4. Mechanical (HVAC) $ 7,Z5U, c List: 5.Mechanical (Fire Suppression) $ Total All Fees:$ - - 6. Total Project Cost: $`�3/03 a► Check No. Check Amount: Cash Amount: �o 0 Paid in Full 0 Outstanding Balance Due: /".gip /Ods.rb ✓ SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License (CSL) p 1., L i 4N eL..L. Q. License Number Expi ti n Date i Name of CSL Holder e�� VAy List CSL Type (see below) 7No. and Street QvA�S! Type Description e Descri Lion U Unrestricted (Buildings up to 35,000 cu. ft.) eei4M�O L Lr !�A a2 6Z2 R Restricted 1&2 Family Dwelling City/Town, tate, ZIP M Masonry RC Roofing Covering L In r ,, I I ( r' ) WS Window and Siding ' SF Solid Fuel Burning Appliances QQ 045' 'p6S6 LihdPiELL. (NT fferinfili 4,•C'1 I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor (HIC) AAvin L D m e L L. HIC Registration on Number Expiration HIC Company Name or HIC Registrant Name g p anon Date Z C Ne QU4 i 4)D. 4j e 1 d Ix- No. and Street • Email address c—&4fl�V/U.,f inB . -o Z6;3Z So8 .3448SS� City/Town, State, ZIP Telephone , SECTION 6: WORKERS' COMPENSATION LNSURANCE AFFIDAVIT (IVI.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 ' No U SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner of the subject property, here. - .uthorize t)AtIIQ T L 1J,1a5,LC. Te. to act on my behalf; in all . - - s re . - • ' ork authorized by this building permit application. :N a NtS . k it S I 2 1 Zo2�a, Print Owner's Name (Ele • to Si .anatur:a D to • SECTION 7b: • I. i. ' I • R 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. -...,.-.. ...........,,,, ......."" . sta,-. Z.'' 01 y 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 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.Qov/oca Information on the Construction Supervisor License can be found at www.mass.govidns 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 i Number of bathrooms Number of half/baths Type of heating system Number of decks/ porches Type of cooling system Enclosed Open a 3. "Total Project Square Footage" may be substituted for "Total Project Cost" ` I he Commonwealth of Massachusetts _':4 y 1 Department of Industrial Accidents ' Irgril 1 Congress Street, Suite 100 ���if Boston, MA 02114-2017 ,,, www.mass.gov/dia Wot-kers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information PIease Print Legibly Name (Business/Organization/Individual): 114V/0 L'vnjdtt. Jz L,,111 ,11c. 6/4rexpe /b Address: Z CH QVAQ l// T It✓A y City/State/Zip: 6 742yi LL 6 44 , �h32 Phone #: f'404- 3404 • 8855 Are you an employer? Check the appropriate boy: Type of project (required): I I am a employer with / employees (full and/or part-time).* 7. (l New construction ?. I am a sole proprietor or partnership and have no employees working for me in 8 Remodeling any capacity. [No workers' comp. insurance required.] 3.7I am a homeowner doing all work myself. [No workers' comp. insurance required.] 9 Demolition — 4.7 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. 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. 1 ❑ Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per NIGL c. 14. 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. 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: SUZILSTONA 1►�,/Sa(1,4414 Policy # or Self-ins. Lic. #: j'CCop _ - Expiration Date: Job Site Address: Pi SM4i4I ' efiNi i Ci /State/Z' Attach a copyof the rY 1p'��'� '/`7f��0����"v� 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 insura nce coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signatu Date: 600i. .2,--c„2,4- Phone #: tre:IP P-— ‘5'"'"7' -- 88 -'- 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 pector Contact Person: Phone #: , TOWN OF YARMOUTH o ,_L . �� BUILDING DEPARTMENT arcs`»as%° 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1261 HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE: J03 LOCAI:10 \r: NAME STREET ADDRESS SECTION OF TOWN "HOMEOWNER" NAME HOVF PHONE WORK PHONE PRESENT MAILING ADDRESS CITY OR ' OWN STATE ZIP CI DE The current exemption for ' . e eowner' was extended to include owner — occu .ied dw: ings of one or two units and to allow such homeowners to -ngage an individual for hire who does not possess icense, provided that such homeowner shall act as supervisor. tate Building Code Section 110 R5. 1 .3.1) Definition of Homeowner: Person(s) who owns a parcel of land on whi he / she resides or intends to re 'de, on which there is or is intended to be, a one or two family attached or detached s cture assessory to such us- and / or farm structures. A person who constructs more than one home in a two-year pe '.d shall not be conside •d a homeowner; such "homeowner" shall submit to the building official, on a form acceptab to the building o 'cial, that he / she shall be responsible for all such work perfoiuied under the building permit. (S: tion 110 R5. _). 1) The undersigned 'homeowner' assumes responsibility or co • pliance with the State Building Code and other applicable codes, by-laws, rules and regulations. The undersigned 'homeowner' certifies that he / she u►ders ands the Town of Yarmouth Building Department minimum inspection procedures and requirements d that Ze / she will comply with said procedures and requirements. HOMEOWNER"S SIGNATURE APPROVAL OF BUTT DL?JG OFFICIAL INSURANCE COVERAGE: I have a current liability insurance .olicy or its substantial equivalent, which meets the requirements of IvIGL Ch. 142. Yes No If you have checked yes, pleas- ndicate the type coverage by checking the app epriate box. A liability insurance policy Other type of indemnity Be d OWNER'S INSURAN WAIVER: I am aware that the licensee does not have the surance coverage required by Chapter 142 of the M .s. General Laws and that my signature on this permit applica:'on waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent h:horneownriicexemp • 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 /1/ J A,i4J,jn &Zurt Work Address Is to be disposed of at the following location: sf S erc.0r Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111,Section 150A. Signature of Applicant Date Permit No. Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Re ulations and Standards Constructio i( a r,��'� "u ,�1 & 2 Fa ;iv CSFA-071507 Y ires 08/11/2025 DAVID J LINILL, JR 2 CHEQUACa1ET WAY -y CENTERVILLf MA 02632 .�► it 1` r e, Commissioner r �.w.tt fvis From: HIC-NoReply@massmail.state.ma.us d? Subject: HIC Registration Card Date: February 7,2024 at 6:25 PM To: LINNELLENT@gmail.com LINNELLENT@GMAIL.COM Dear Registrant, Attached please find your new HIC registration card,you must sign the card using ink. Sincerely, Home Improvement Contractor Registration Program THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street Sdite 710 Boston.Massachusetts 02118 Home Improvement Contractor Registration air c DAM LPINELi Rapaeaxr '12.5 ,CMEOuACKNI WAY LApxsacr c2:'M'222E CENTERYIttr MA 026:YJ Lye..Aildnma and Corn "•••E CONVOMNEALTM OF VASSACHO5E 75 OIM•W CunauPM•AIIMn eu•LMf•Rau lotiun • �++1 v nt I •n• MOVE MIPROYENt CCNTRAC TOP TIT( na. - rr. vgw.ue n R•yFMa.e Aa Vn6inale 5,••I1 Sulle'•5, C2"9:CJi. M. .. MA aJ.r• Not toad eithout signature wM. WORKSHEET Roberts 7 Railroad Ave. ELECTRIC CO., I N C. Wilbraham, MA 01095 •----_, 413-596-2868 est. 1987 CUSTOMER: PROJECT: DATE: BY: PAGE: 14 S oANktoto cow2J lita°r-rk-E°01" i . t ' , rn i fr..IWO. 1st S4,1411K 24 I 4 iinim. S0041 Pk c O ?Av. k ,*1) I ) I 0 „I . . . 1 A00et IV 7 ........... S j R ! IBil.,.7 i LM22282 i L_L._ BUtLB1NG LID 1=NART E By -�- f Wm. WORKSHEET Roberts 7 Railroad Ave. ELECTRIC CO., I N C. Wilbraham, MA 01095 '---,—, 413-596-2868 est. 1987 CUSTOMER: PRO II:( I`. DA I I:: BY: PAGE: r 1-4. CANNoN Ccoor i 0 18 ti Ib3o. 1-.)... IV - 30I24 UT f 12'7 v►J3�3 is . . , I )1SW AS . C5414 115.P� j8s, isase sass REF.33 -: 1 Zl.�� � .30 i2 30' 1Tivf-73);pi 1314 g3C::4491- _ti.._____— , ____ ' 7_ 1 = 0 t V &musk ir 114 I �UIL ING DEPART r TOWN OF YARMOUTH (k.,:wc;\ BUILDING DEPARTMENT Z. 1146 Route 28,South Yarmouth,MA 02664 ems :' „° Telephone 508-398-2231 ext.1261 Fax 508-398-0836 Contractor's Affidavit: Substantial Improvement or Repair of Substantial Damage Property Address: 14 S 1-IAN I.IQ1J Coon SO 5&A YA(Z.IT10uTH rv1A Parcel ID Number: 31c Owner's Name: 60141415 t 1 g� nOBC'P'c Contractor: (\Nil) T L1r.wrwy -Te_ I I.r,..►eu_ [=uT Persr55 Contractor's License Number: C3FA- 07/COl Date of Contractor's Estimate:'53 vS 4,ASV I hereby attest that I have personally inspected the building located at the above-referenced address by the nature and extent of the work requested by the owner,including all improvements,rehabilitation, remodeling,repairs,additions,and any other form of improvement. At the request of the owner,I have prepared a cost estimate for all of the improvement work requested by the owner and the cost estimate includes,at a minimum,the cost elements identified by the Town of Yarmouth that are appropriate for the nature of the work. If the work is repair of damage,I have prepared a cost estimate to repair the building to its pre-damage condition. I acknowledge that if,during the course of construction,the owner requests more work or modification of the work described in the application,that a revised cost estimate must be provided to the Town of Yarmouth,which will re-evaluate its comparison of the cost of work to the market value of the building to determine if the work is substantial improvement. Such re- evaluation may require revision of the permit and may require revision of the permit and may subject the property to additional requirements. I also understand that I am subject to enforcement action and/or fines if inspection of the property reveals that I have made or authorized repairs or improvements that if inspection of the property reveals that I have made or authorized repairs or improvements that were not included in the description of work and the cost estimate for that work that were basis for issuance of ermit. Contractor's Signature ���� i Date: 05'9, )o Oa-`f R E CEIVFD Notarized: 44114AlLtat 2. ) KIMBERLY KVIETOK MAY 22 2024i Notary Public _ 1,�I'h�'/'COMMONWEALTH OrMASSACHUSE IS BUILDING _ i,T\ My Commission Expires ex DEPARTMENT y March 14,2025 "—�___ �v . TOWN -OF YARMOUTH 1146 Route 28, So,uth Yarmouth, M.A.. 02664 508-398-2231 ext. 1261 Fax 508-398-0836 Office of the Building Commissioner FINAL COST AFFIDVIT FOR WORK IN FEMA FLOOD ZONE To the Building Commissioner, In accordance with 780 CMR Section 109 of the Massachusetts State Building Code, the total estimated cost of construction, including all related costs* of the building at liet SI4ANNo.I coota Soc t4 YARinckin4, and constructed, reconstructed, altered, repaired, or extended under building permit no. amounts to S S31 p 3G. 00 I, li AV L,NN r L e, , referred to as the owner/a ent identified do pbeing g below, solemnly swear that the statements made herein are strictly true, correct and made in good faith *Related construction costs include all work done with or concurrently with the work contemplated by the building permit including construction, reconstruction, repairs, demolition, HVAC work, etc. Furnishings and portable equipment are not part of the total construction costs. /, Signature of owner/agent Not ry Public Signature My Commission Expires Ai ‘"(-6-(Let04-079Z----- Notary Seal: REDF1VPD -am-le:mgillib-al"..°6"1111-.111-48b6"1161KlMBERLY KVIETOK �y �t Notary Public MAY 2 i COMMONWEALTH OF MASSACHUSETT� 2 2024 My Common March issi�a, 2o2s Expires BUILDING DEPARTMENT Arc R CERTIFICATE OF LIABILITY INSURANCE DATE(MM/OD/YYYY) 01/24/2024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZE[) REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 03019-001 ''NAMEACT Blackstone Insurance 3019-1-91 ONE Blackstone Insurance (A/CC.No.Ext): (A/ .No.: PO WorBcesterox , MA 01613 FdD Ess: workerscomp@bostonbrokerage.com INSURERS)AFFORDING COVERAGE NAIL# INSURER A: Associated Employers Insurance Company 11104 INSURED INSURER B: David Linnell Jr Linnell Enterprises INSURER C: 2 Chequaquet Way Centerville, MA 02632 INSURERD: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILSR TR TYPE OF INSURANCE POLICY NUMBER (MM/DDY) (MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ PREMISES(Ea occurrence) CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ pEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ k/LICY PRO- JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE UMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ DED RETENTION $ $ c x - Th YS �wy��R�p��Ro�sF�psR��RTn4E�(E)( A OFFICER/MEMBER/EXCLUDE/D?ECUTIVEYNN NIA WCC-500-5007447-2023A 8/1/2023 8/1/2024 E.L.EACH ACCIDENT $ 100,000.00 (Mandatory in NH) EL.DISEASE-EA EMPLOYEE $ 100,000.00 DSCRIION OF P OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attaced if more space Is required) "Proof of Coverage" David Linell Jr is covered by the workers compensation policy. CERTIFICATE HOLDER CANCELLATION David Linnell Jr dba Linnell Enterprises 2 Chequaquet Way SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Centerville,MA 02632 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD