Loading...
HomeMy WebLinkAboutBLDR-24-314 '< EcEIV . JUN 07 2024 4NE&TWO FAMILY ONLY-BUILDING PERMIT Town of Yarmouth Building Department 'y. BUILDING DEPART MEN i 1146 Route 28,South Yarmouth,MA 02664-4492 By. 508-398-2231 ext.1261 Fax 508-398-0836 �<r! Massachusetts State Building Code,780 CMR Building Permit Application To Construct,Repair,Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Peerrmiit,Number: / �d4-6I`{ Date Applied: //////�j�� — /`y Building' Official iri[Name) _ S' atur `�/L ! ��2�' Date SECTION 1:S TE INFORMATION 1.1 PrAperV Addryss• x/ /Y� I.2 Assessors Map&Parcel Numbers j ee C—IckGtfc/4 t ICSt' c,d[e1J t (yam/ a71i 1.1 a Is this an accepted street?yes no_ Map Number Parcel Number 1.3 oning Information: 1.4 Property Dimensions: —Y4) 41o71 4/a70 Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required I Provided Required Provided Required Provided Jor go' o?o' — 1.6 Water Supply:(M.G.L c.40,154) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public, Private❑ Zone:_ Outside Flood Z ne? Municipal❑ On site disposal system V Check if yes SECTION 2: PROPERTY OWNERSHIP' 2.1iOwner1 Record• /•e rnn7'ft /,(IGGvire- Y/ /11, ¢ Name(Print) // � //// City, ZI J Clc/YZJCY/]Tti ,." O` 1v7 3 L137Cr�des-,f4/4 SF-)22-9.5(.1 ,6,z0,r? �117.Cossi No.and Street Telephone flail Address SECTION 3:DESCRIPTION OF PROPOSED WORK°(check all that apply) New Construction❑ Existing Building lid/ Owner-Occupied ❑ I Repairs(s) 0 Alteration(s) as l Addition ❑ Demolition ❑ Accessory Bldg.0 Number of Units Other ❑ Specify: Brief Descriptioyf Proposed Work': a 6y� p���p t- a C1/10 ZP.,rt: lie. ;pGrP ,t fx ' iit,./Fes.?S7 � (4,111 24 eve_ CV 'n ECTION 4:ESTIMATED CONSTRUCTION COSTS. Item stimated Costs: Official Use Only (Labor and Materials) 1.Building $ I.Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑Standard City/TownApplicationFee ❑Total Project Cost3 I e 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ e< yS s k /' 06 4.Mechanical (HVAC) $ List: v " 5.Mechanical(Fire Suppression) $ Total All Fees:$ Check No. Check Amount Cash Amount 6.Total Project Cost: S Alto/000 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5,1 Construction Supervisor License (CSL) License Number Expiration Date Name of CSL Holder List CSL Type (see below) --4 No, and Street Type Description U Unrestricted (Buildings up to 35,000 cu. ft.) City/Town, State, ZIP R Restricted l&2 Family Dwelling 1ti1 ivlasoru-y RC Roofing Covering• WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor CHIC) FIIC Company Name or HIC Registrant Name HIC Registration Number Expiration Date No. and Street Email address City/Town, State, ZIP Telephone SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT (N. I.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 . 3 • SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR A.PPLI ;S FOR BUILDING PERMIT I, as Owner of the subject property, hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Print Owner's Name (Electronic Signature) Date • SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLAMATION 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 Iaiowledge and understanding. &it-4 D(.1:04,2 Print Owner's or Authorized Agent's Name (Electronic Signature) Date NOTES: I . 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 I_mprovement Contractor (HIC) Program), will not have access to the arbitration program or guaranty fiend under M,G.L. c. 142A. Other important information on the RIC Program can be found at www,mass..qov/oca Information on the Construction Supervisor License can be found at www.rnass.¢ov/dos 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 _ 0 Number of bedrooms Number of bathrooms / Number of half/baths C) Type of heating system Number of decks/ porches 0 Type of cooling system Enclosed Open 3. "Total Project Square Footage" may be substituted for "Total Project Cost ' _ The Commonwealth of Massachusetts ��— Department ofi-ndustrialAccidents 1 Congress Street,Suite 100 5 Boston,MA 02114-2017 www.mass.gov/dia \l orkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information , n Please Print Legibly Name(Business/Organization/Individual): Xi-we-4 /s`Z.(�/ire Address: 307 Cot-4%5'6T/att't Ja/0,2673 City/State/Zip: (.(Jett Varef )ft4 ,f/1/}- Phoned: „Dr-776—Are., Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with employees(Mt and/or part-time).* 7. 0 New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in any capacity.[No workers'comp.insurance required.] 8. DRemodeling • 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]r 9. ❑Demolition 4.2I 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. 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet 12.0 Plumbing repairs or additions These sub-contractors have employees and have workers'comp.insurance.t 13.0 Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.0 Other 152,§I(4),and we have no employees.[No workers'comp.insurance required.] .Any applicant that checks box: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. tCantractors 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 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 4 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. I do hereby certify en er the pains td penalti f perjury that the information provided above is true and correct. Signature: e� 4 e Date: Phone#: �yoT�77/v-9SZ7 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License 4 • Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: • TOWN OF YARMOUTH °}° BUILDING DEPARTMENT 1146 Route 28, South Yarmouth,MA 02664 S08-398-2231 ext. 1261 HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE: / JOB LOCATION: /5 t yr�i •� /�Ic(Jir1L° , aid C t .h e fd 4/A �4i"A-n* , N ,/ STREET ADDRESS SECTION OF TOWN "HOMEOWNER" 1Ce. kt e /*Clue*. S oF=?76-jszr NAME A HOME PHO ,/ WORK PHONE PRESENT MAILNG ADDRESS a2 7� f�1 '1es f )6/iflati, �j� D.Q 73 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.I.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 performed 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. HOMEOWNER"S SIGNATURE d ` APPROVAL OF BUILDING 01~1-1CIAL 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 ves, please indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of indemnity Bond OWNER'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 YA O TH 1. 146 `!, oute 28, South Yarmouth, MA 02664 508-39 -22 1 ext. 4261 Fax 508-398-0836 ffice of the tuilding Commissioner BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Ch. 40, §54 and 780 C1 - Section 105.3 . 1 . #4. I hereby certify that the debris resulting from the proposed work/demolition to be conducted at _ c r _T- Work Address Is to be disposed of oat the following location: 7,744 ( .4. Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, ,§ 150A. I ; -z-zzy,e,v 6/6?/20.2 Signature of A plicafion Date Permit No. Ii 1 C� — 3 , ,,. iiil— - F ': _ ---.. —. - � ....74 7-- _, , ,=_. ....,,__---1 a a a = .... .... .... ... 2 0 FRONT ELEVATION .... fir.. 3 f i tIIII: i,I! RIGHT ELEVATION a •` — proposed:rir C RESIDENCE a �be CENTE o O NT LJ � ® 32 GONESET PATH WEST YARMOUT-1, MA DIESn � �.,�,«:, "' F p i i it TT —— Milli ---—1 ii 1 I= — 5 5 Nil nE - ' aa 1 � as a'i'6• 1 REAR ELEVATION I!i�ibl „ LAI1II_______ Mi.!.Wriq .� ME X5 ,.10 ' e[ece LEFT ELEVATION �1�� RESIDENCE proposed: ' R F MCGUIRE ©SLATEON T r\ MaER, ® (�r 32 CO I4ESETPATI-I �"'"" La� WEST YARMOUTI-I, MA Dt LJC�jS fNJ a,,,,,.m, ,,E, o • DI _ _y ®/ ,,.. _ ,__ti n 1 E► . p . a ..�M GARMAGE PLAN P _ __ _�,. '�` a — L `�" • 1_ / \ OFIIR ST: OOP PLAN L... proposed: a E .ter .NUMB., MCGUIRE RESIDENCE :� C�CNI�RPO[I�I�f ® � WEST YARMOUTNT MA DEs[am W°°°°' • • Ae. 4.,u w nn • Y s C 4 C GARAGE ABC, 0 ➢ sir e, 4 4 ' 4 , °GARAGE FOUNDATION y - 1 proposed: " c�ENN O NT SEE.NUMBER MGGUIRE RESIDENCE o 0 ® r WEST YARMOUTNT MA 0Es��x v; ;••+ ��