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HomeMy WebLinkAboutBLDR-24-339- ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department pg~YAi4` 1146 Route 28, South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 f r - 1 Massachusetts State Building Code,780 CMR _ • y Building Permit Application To Construct,Repair, Renovate Or Demolish %oR `b�q .. PORAi E.C.a One-or Two-Family Dwelling j t\� ^� This Sect For Official Use Only Building Permit Number: �-t -LPL` Date Applied: 4------------- , ....e-'" g.--F91 Building Officta (Print Nam , ignat e Date SECTI 1:S E INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parce.1 33 Jacquiline Circle 29 1.1a Is this an accepted street?yes)" no Map Number i fl11im1iei 13 Zoning Information: 1.4 Property Dimensions: I JUN 2 0 2024 reas single family home 12,854 22E Zoning District Proposed Use Lot Area(sq ft) F DE PA Rif-1/1 F NT 1.5 Building Setbacks(ft) By Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 30. 30.5 15 19.5 n/a n/a 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public II Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Tasha Lingos west yarmouth Name(Print) City,State,ZIP 33 Jacquiline Circle No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction l i Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) ❑ Addition 0 Demolition ❑ Accessory Bldg. 0 Number of Units"' Other 0 Specify: Brief pescri?tjon of Propo ed Work2: At j1/7C--'ka714 % .e._,Eiz 0, 4,5 1._-64A_t„,,t_ SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $300000 1. Building Permit Fee:$ Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $Modular o Total Project Cost'(Item 6)x multiplier x 3.Plumbing $modular 2. Other Fees: $ '` ? 4.Mechanical (HVAC) $25000 List: tp() ,Q© 0,V t )2 J j 5.Mechanical (Fire $ Suppression) Total All Fees:$ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ 325,OOO 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 081040 07/31/24 Pat Jacobs License Number Expiration Date Name of CSL Holder List CSL Type(see below) 28 whittler dr No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) dennis ma.,02638 R Restricted I&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 5083756300 nnbametekbuiideccom I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 189300 06/26 william D'Antonio HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 17 JOhn Hall Cartway bill@horneteldwik1er.com No.and Street Email address Yarmouthport,MA 02675 508 37 56300 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 ® No 0 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 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 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 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 Information on the Construction Supervisor License can be found at www.mass.gov/dps 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 half/baths 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" �r ll ilome kit)9 )der; The Commonwealth of Massachusetts Department of Industrial Accidents (MI lam. Office of Investigations � ir Lafayette City Center 2Avenue de Lafayette,Boston,MA 02111-1750 ^�� www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le¢ibly Name(Business/Organization/Individual):HOmeTek Builder _ Address:17 John Hall Cartway City/State/Zip:Yarmouthport,MA 02675 Phone#:508 375 6300 Are you an employer?Check the appropriate box: Type of project(required): 1.❑■ I am a employer with 0 4. ❑I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ®New construction 2.®I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. in Demolition workingfor me in anycapacity. employees and have workers' P tY• 9. ❑Building addition [No workers'comp.insurance comp,insurance.: required.] 5.0 We are a corporation and its 10.0 Electrical repairs or additions 3.❑I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c.152,§1(4),and we have no employees.[No workers' 13.0 Other 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:AIM Mutual Policy#or Selfzins.Lic.#:3AA695650 Expiration Date:07/31/24 Job Site Address:3.3 Jacquiline Circle City/state/Zip:W Yarmouth Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c.152 can lead to the imposition of criminal penalties of 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. Be advised that 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 ofperjury that the information provided above is true and correct Signature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(check one): 10Board of Health 21:1 Building Department 3❑City/Town Clerk 4.0 Electrical Inspector 5.0Plumbing Inspector 6.0Other Contact Person: Phone#: TOWN OF YARMOUTH 0 z r Office of the Building Commissioner ° 1 1146 Route 28, South Yarmouth, MA 02664 .usura+eEse. �:, ORAT4,,• 508-398-2231 ext. 1260 Fax 508-398-0836 DEMOLITION DEBRIS DISPOSAL APPLICATION Pursuant to M.G.L. c.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.3 3 J a cq u i l i n e circle Work Address Is to be disposed of at the followinglocation: TB D p Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, §15 0A. Signature of Applicant Date Permit No. V.v) Mass.gov Oifce r r . 4.0 ' ' k S, ard 1 n r71 ouNt. LI . . HIC Registration Complaints Registration # 189300 Registrant HOME TEK BUILDERS/AFFORDABLE MODULAR HOUSES LLC Name William Dantonio Address 17 John Hall Cartway City, State Zip Yarmouthport, MA 02675 Expiration Date 06/12/2026 Commonwealth of Massachusetts Construction Supervisor Division of Occupational Licensure Unrestricted-Buildings of any use group which contain less than Board of Building Re ulations and Standards 35,000 cubic feet(991 cubic meters)of enclosed space. Const�Zio�nf lii'p rvisor ^ra' d CS-081040 33 . cpires: 04/04/2026 o PATRICK H 41ACCOB" '_. `• 28 WHITTIEIDRIVE DENNIS MA 113638 i° , �O F�X,Ldd t3 Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Commissioner / Contact OPSI:(617)727-3200 or visit www.mass.gov/dpl/opsi