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HomeMy WebLinkAboutBLDR-24-398 ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department 1146 Route 28, South Yarmouth, MA 02664-4492 ,eNp 508-398-2231 ext. 1261 Fax 508-398-0836 � Massachusetts State Building Code, 780 CMR � - H Building Permit Application To Construct, Repair, Renovate Or Demolish -4CM EE E �4 ORPORATEO N a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: A -c 4-. 3 Date Applied: Building 0 'dal Si e ate SECTION :SITE ORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 15 West Woods 1.1 a Is this an accepted street?yes x no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: RECE1VFD Zoning District Proposed Use Lot Area(sq ft) 1.5 Building Setbacks(ft) JUL 2 2 2024 Front Yard Side Yards Rear Yard Required Provided Required Provided Required3 U I L DI N G D pii3ikiddijo E N T y 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 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Stephen Levey&Jean DiFrancis Yarmouth Port.MA Name(Print) City,State,ZIP 15 West Woods 281-222-1014 stephen.leveya@gmail.com No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction 0 Existing Building U Owner-Occupied U Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work':Renovation of part of basement to create a family room. Add a half bathroom also. SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $27000 1. Building Permit Fee:$ Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $2800 ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $9000 2. Other Fees: $ 4.Mechanical (HVAC) $1800 List: 5.Mechanical (Fire Suppression) $1 000 Total All Fees:$ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $4 1 600 ❑Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) Jose Fiuza License Number Expiration Date Name of CSL Holder List CSL Type(see below) 50 Highland Drive No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) Centerville,MA 02632 R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 508-367-1461 capecodhousecalls@gmall.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 095013 03/24/2025 Jose Fiuza HIC Registration Number Expiratio ate"' HIC Company Name or MC Registrant Name Of 50 Highland Drive capecodhousecaNs@gmail.com Jasa No.and Street Email address Centerville,MA 02632 508-367-1461 City/Town,State,ZIP Telephone Q CIO( L Gl 30 P,j4"• e/n m ' 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 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 Jose Fiuza to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's ame(Electronic Si lure) 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 cgntaineedd in this application is true and accurate to the best of my knowledge and understanding. Print Owner' o�rized Age 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.) 1675 (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count 7 Number of fireplaces 1 Number of bedrooms 2 Number of bathrooms 3 Number of half/baths D Type of heating system gas Number of decks/porches 1 Type of cooling system central ACn Enclosed Open Xxx 3. "Total Project Square Footage"may be substituted for"Total Project Cost" 575 AMMO, CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDA'YYY) `�- 07/1 5/24 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),AUTHORIZED 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 CONTNAME:ACT PAUL SCHLEGEL WORLD INSURANCE ASSOCIATES LLC (A/CC.NNo.EMI: 508-771-8381 I(A c,so): 508-771-0663 34 Main Street ADDRESS: schlegelinsurance@verizon.net West Yarmouth,MA 02673 INSURER(S)AFFORDING COVERAGE NAIC N INSURER A: NGM INSURANCE INSURED INSURER B: TRAVELERS JOSE LUIZ P FIUZA,PRESIDENT INSURER C. CAPE COD HOUSE CALLS INC INSURER D 50 HIGHLAND DRIVE CENTERVILLE,MA 02632 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. 1LTRR TYPE OF INSURANCE NSD bWVD POLICY NUMBER UHR POLICY EFF POLICY EXP LIMITS ADM (MOLIC YEFF (POLIC YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ 500,000 MED EXP(Any one person) $ 10,000 A MPT8701R 04/24/24 04/24/25 PERSONALBADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 POLICY❑JE r LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON NED PROPERTY DAMAGE $ -AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAR _OCCUR EACH OCCURRENCE -EXCESS LIAR CLAIMS-MADE AGGREGATE DED I I RETENTION$ $ WORKERS COMPENSATION I STATUTE I I CEP- AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $ 100,000 B OFFICER/MEMBER EXCLUDED? ©N/A 7PJUB4N36888124 05/21/24 05/21/25 _ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE$ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more apace is required) CORPORATE OFFICERS HAVE elected not to be covered under his current workers compensation policy INSURANCE COVERAGE IS LIMITED TO THE TERMS,CONDITIONS,EXCLUSIONS,OTHER LIMITATIONS AND ENDORSEMENTS OF THE POLICY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN STEPHEN LEVEY ACCORDANCE WITH THE POLICY PROVISIONS. stephen.levey@gmail.com, AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD . TOWN OF YARMOUTH ,.t.g=, Office of the Building Commissioner ii , =� V 1146 Route 28, South Yarmouth, MA 02664to,t �� ; ,,,r 508-398-2231 ext. 1260 Fax 508-398-0836 CgPORAb HOMEOWNER LICENSE EXEMPTION DATE: JOB LOCATION: King's Way 15 West Woods Yarmouth Port, MA 02675 NAME STREET ADDRESS SECTION OF TOWN HOMEOWNER Stephen Levey 281-222-1014 NAME HOME PHONE WORK PHONE PRESENT MAILING ADDRESS 94t4/L CITY OR TOWN STATE ZIP CODE Definition of Homeowner: Person(s) who owns aparcel of landon which he or she resides or intends to reside, on which there is or is intended to be, a one or two family attached or detached structure accessory to such use and/orfarm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Any homeowner performing work for which a building permit is required shall be exempt from the licensing provisions of780 CMR 110.R5, provided that if a homeowner engages a person(s)for hire to do such work, then such homeowner shall act as supervisor. This exception shall not apply to the field erection of manufactured buildings constructed pursuant to 780 CMR 110.R3 The undersigned 'homeowner' assumes responsibility for compliance with the State Building Code and other applicable codes, by-laws, rules and regulations, and certifies that he or she understands the Town of Yarmouth Building Department minimum inspection proeedures and requirements and that he or she will comply with said procedures and requirements. ;' I_ - /,., I HOMEOWNER"S SIGNATURE----T._ , / TOWN OF YARMOUTH YA�"* z '-y ° Office of the Building Commissioner '° M2[6 4' 1146 Route 28, South Yarmouth, MA 02664 `y \[uc ) `A 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. L (A)L� I,13 U(-Q S VA-le!1/10 ` - POOT k\- o - 1 Work Address Is to be disposed of at the following location: CC Li Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, §150A. Signature of Applicant Date Permit No. The Commonwealth of Massachusetts �^ Department of Industrial Accidents �= Office of Investigations 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 Legibly Name (Business/Organization/Individual): 52-T ot a) ,,L(�I 7 06- Address: I Lk) �S I (J 100 0 S r. City/State/Zip: YI o ?O Phone#C &in : 24 ( — 0 I Are you an employer?Check the appropriate box: Type of project(required): 1.D I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction listed on the attached sheet. 7. ❑ Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.$ 9. ❑ Building addition required.] 5. El We are a corporation and its 10.0 Electrical repairs or additions 3._,.required.] am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ 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: Policy#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 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'ior insurance coverage rification. y , I do hereby certify un 'r e pai and pen of perjury that the information provided above is true and correct. Signature Date: 7/ 3/21 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): lDBoard of Health 20 Building Department 3❑City/Town Clerk 4.0 Electrical Inspector 50Plumbing Inspector 6.❑Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the penult/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to buns leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Lafayette City Center,2 Avenue de Lafayette Boston,MA 02111-1750 Tel.(617)727-4900 or 1-877-MASSAFE Revised 7-2019 Fax(617)727-7749 www.mass.gov/dia THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Corporation Registration: 195013 CAPE COD HOUSE CALLS INC Expiration: 03124/2025 50 HIGHLAND DR CENTERVILLE, MA 02632 Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs & Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE: Corporation Office of Consumer Affairs and Business Regulation Re9igtrotiQn Expiration 1000 Washington Street - Suite 710 195013 03/24f2025 Boston, MA 02118 CAPE COD HOUSE CALLS INC JOSE LUIZ P. FIUZA 50 HIGHLAND DR .Of ; s„ CENTERVILLE. MA 02632 , Undersecretary Not valid without signature contractor licensejpeg 7/19/24, 1:03 PM Contractor Licenses Q Contractor's Name * Business Name OS F106-4 GAPE (0.D 0 Os G, cALL5, -)c- License # License Expiration Date ) 95.0 ) 3 03/24/205 License Type * Type of Business POHE wipeo1er-4;07- cooTeAcroP Select your option Mailing Address City 50 i-ItG4-ILAOD DR CEISTE. L LE Stat,J, Zip Code Preferred Telephone # Email 508 - 6 ; - 1(i 6 I c ape coc: oose cas rnai .cor CAricf,i Save https://mail.google.com/mail/u/2/?ogbl Page 1 of 1 t . i ..........* ,......,„ „...*,..,. Ir, I t r". Z : . 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