HomeMy WebLinkAboutBLDR-25-73- ONE & TWO FAMILY ONLY- BUILDING PERMIT -
Town of Yarmouth Building Department ate .t i
1146 Route 28,South Yarmouth,MA 02664-4492 I
-WO\
508-398-2231 ext. 1261 Fax 508-398-0836 : + ;
Massachusetts State Building Code,780 CMR y�
Building Permit Application To Construct, Repair, Renovate Or Demolish ~ "'` ,A /
CORPORATES . .
a One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: O c.0 h tS-'13 Date Applied:
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Pro erty Address: 1.2 Assessors Map&Parcel Numbers
3 moY-rt.t'i c oLr- ,yenvieV wt
1.1 a Is this an accepted street?yes ✓ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions: .n, E c " 1 1 E
D
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft) MAR 04 2025
Front Yard Side Yards 5 Rear Yard
Required Provided Required Provided Requited Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system 0
Check ifyes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Recor
Name(Print) Cit,State,ZIP -
33 V► eseletttn33)rtt~-e I 77y 023/-6Acj4, t`1 ea.a,.ay191fr1fa/.
No.and Street Telephone V /' Email Ad ress itti t
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
1
New Construction 0 Existing Building lit Owner-Occupied 0 Repairs(s) 0 Alteration(s) ig I Addition ❑
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: ,r r Wn.p1,4 e y r.-,,A.- Vag id,7.1 3szaltwl 94.0 bl,„.15
Crlriv :O C .Vty\ , lore "T., bail 41.1, 4rs..",iv� , 54r`YLr," eNce S,Aled wiy/. Gre/cr
5A,S/Y 1-•c plu.l.-c .wYry gra,- a wI Ur O �1 J/4 •4, avre.
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ .7 L ig4,0 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ 0 Standard City/Town Application Fee
0 Total Project Cost3(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List: 4O.Ii Us')
5.Mechanical (Fire $
Suppression) Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $7 7211 4,e0 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
C•S -io97115— y/gpeo
e� 4 License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) 1)
73 vnc% 5X4.4ley%os t�
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
-IOTA l>r'i nt,S z Mk, Oa fr/)) R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
50oPIN Iet>ytl : 61+.0,.l.t irk Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
�. Sloo79 io a
)OSItt r `r" 712►brat) HIC Registration Number xpiration Date
HIC Company Name or HIC Registrant Name
-73 lint if SYANIKy'$ ttvn..r ja5lax.-(1Albeeu@a w+a11 .c
No.and Street Email address
501,YA l7 Pp/tSdIriet tb ‘cePti Gayai
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 Er- No ❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
N41
r- _
I,as Owner of the subject property,hereby authorize _5056 711
to act on my behalf,in all matters relative to work authorized by this building permit application.
\eaIr) CLC im 07 -ad--Zs
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.
- as-as
mt Owner's or A orized 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"
:JO "lAIifi 71A>he(w yin ) . Cd/rt__
�;og Y.� ,\ TOWN OF YARMOUTH
z %\\ Office of the Building Commissioner
a;
_....:.'.. 1146 Route 28, Yarmouth,� � South MA 02664
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) wy,., c•V r ,
Work Address
Is to bedisposed of at the following location: i %v�,)., d y9
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, §150A.
/ 9-3--
gnature of pplicant Date
Permit No.
THE COMMONWEALTH OF MASSACHUSETTS
1 Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR
TYPE:Individual
pagistration Expiration
1 r 29 .« 106/10/2026
JOSHUA F THIBEAU " i ._ _4) -
m
JOSHUA THIBEAU d m_ _ �.;' cy c�/
73 UNCLE STANLEYS WAY --I' ,/ u
• SOUTH DENNIS,MA 02660 4`'�:Y
04 Y
•--t`_ , -- Undersecretary
4�•. ....._ ..,,,..,r.. ... m�.._..lw.s.++",ra±m,w..—,,'..r,iw,Al+M2!'_Ka ,. ...
.
4ommonwealth of Massachusetts
Division of Occupational Licensuce f
Board of Building Regulations and Standards
ConS3 p rvisor
11 .• CS-109745 , :* spires: 04/08/2026
JOSHUA THi$ , u
73 UNCLE STAN - a
SOUTH DEMO
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Commissioner Z .1.4s.._-
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