HomeMy WebLinkAboutBLDR-24-657 ONE & TWO FAMILY ONLY- BUILDING PERMIT __ -
Town of Yarmouth Building Department (8-----411(4-'-,F Y``� ,
1146 Route 28, South Yarmouth,MA 02664-4492
508-398-2231 ext. 1261 Fax 508-398-0836
Massachusetts State Building Code, 780 CMR 'Ou y
Building Permit Application To Construct, Repair, Renovate Or Demolish \N4,CATTA E s;b •
---�RPO R AT=�-'/
a One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: i LD - L4- Cp,59 Date Applied:
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
189 Center Street,Yarmouthport
1.1a Is this an accepted street?yesX no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Fro tag f(ft) -"-'-
1.5 Building Setbacks(ft) I DEC 3 0 2024
Front Yard Side Yards y Rear Yard
Required Provided Required Provided Required Provided P✓,F N T j
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public li Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system MI
Check if yes®
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Kelly Mcguill Yarmouth Port, Ma 02675
Name(Print) City,State,ZIP
189 Center Street 617 852 1516 kelly@kellymcguillhome.com
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction 0 Existing Building■ Owner-Occupied ® Repairs(s) M Alteration(s) E Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
.ef•es'ription of Proposed WDrk2:KEN'"'"'se,a','g''—6 s9 1'..''s ''"'"''''''"ob roo.ed'd"-od - .tia.a-Caro-"e`ak''
—1 - 6-41 91 1 - VEREINEEMIMEMINEWARM IY S 2 Li 1-h 1701,
MI M MrSI e TT 'J GO L
/
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $70,000 1. Building Permit Fee:$ Indicate how fee is determined:
❑Standard City/Town Application Fee
2.Electrical $20,000 Cl Total Project Costa(Item 6)x multiplier x
3.Plumbing $20,000 2. Other Fees: $
4. Mechanical (HVAC) $ List: 3 5:0o W 3oi
5.Mechanical (Fire $ Total All Fees: $
Suppression)
10 000 Check No. Check Amount: Cash Amount:
6. Total Project Cost: Si
0 Paid in Full 0 Outstanding Balance Due:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Lafayette City Center
2 Avenue 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):Kelly Mogul!! Home LLC
Address:1 89 Center street
City/State/Zip:Yarmouth Port, ma 02675 Phone #:617 852 1516
Are you an employer?Check the appropriate box: Type of project(required):
1.'I am a employer with 1 4. ❑ I am a general contractor and I 6. El New construction
employees (full and/or part-time).* have hired the sub-contractors
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. ❑Demolition
workingfor me in any capacity. employees and have workers'
P 9. D Building addition
o workers' comp. insurance comp. insurance.:
required.] 5. ❑ 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.❑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 13.0 Other
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:the Hartford
Policy#or Self-ins. Lic. #:76 WEG AB7EP J Expiration Date:06/20/2025
Job Site Address: 189 Center Street City/State/Zip:Yarmouth Port, MA 02675
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 unde the pains andpe a ' s of perjury that the information providedabove jis true and�7 correct.
Signature: r Date: v / r v D
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):
11:1Board of Health 20 Building Department 31:City/Town Clerk 4.0 Electrical Inspector 5Elumbing
Inspector 6.0Other
Contact Person: Phone#:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu. lt.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
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(HIC)
198277 0325/26
Kelly Mcguill Home LLC
HIC Registration Number Expiration Date
HIC Company Name or HIC Registiaut Name
4 River drive kelly@kellymcguillhome.com
No.and Street Email address
South Yarmouth,ma 02664 6178521516
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 .... B 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 authorizeKeny Mcguili
to act on my behalf,in all matters relative to work authorized by this building permit application.
12/20/2025
Print Owner's Name(Electronic Signature) gate
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
containedp this a plication is true accurate to the best of my knowledge and understanding.
)() .-471
Print Owner's or A rized Agent's e(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
Information on the Construction Supervisor License can be found at
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.)310 sq ft (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.)310 sq ft Habitable mom count
Number of fireplaces° Number of bedrooms
Number of bathrooms 0 Number of half/baths
Type of heating system gas Number of decks/porches
Type of cooling systemac Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
°g Yam TOWN OF YARMOUTH
f;' 1 � �' Office of the Building Commissioner
1146 Route 28, South Yarmouth, 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 resultin from the pr posed work/demolition{- t be
I
conducted at. C& hfrt- ��
Work Address M A . e 2 6
��/ -►� r ®�fil�
Is to be disposed of at the following location. "I
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, §150A.
�Signature Applicant Date
Permit No.
44,
THE
HARTFORD December 30, 2024
Account Policy Information:
Agency Name PAYCHEX INSURANCE AGENCY INC
Agency Code 76210762
Recipient Information
Kelly McGuill Home LLC
930 MAIN ST
WALPOLE MA 02081-2948
SUMMARY OF INSURANCE
Account Policy Number Policy Premium
Policy Recap Term
Worker's
Compensation 06/20/2024 to
Hartford Fire 76 WEG AB7EPJ 06/20/2025 $4,584
Insurance
Company
h
Sum of Insurance
Summary of Insurance (Continued)
Worker's Compensation Summary of Insurance
with
Hartford Fire Insurance Company
A member company of The Hartford
06/20/2024 - 06/20/2025
Policy Detail: Worker's Compensation
Policy States: MA
Location 1 Premises Address:
930 MAIN ST
WALPOLE MA 02081
Worker's Compensation Coverages:
Employer's Liability Limits Limit
Disease - Policy Limit $500,000
Bodily Injury—Accident $100,000
Disease - Each Employee $100,000
Class/Payroll Class Description Class Code Payroll
Detail
Location 1 - MA INTERIOR 9521 $156,440
DECORATORS- HOUSE
FURNISHINGS
INSTALLATION
This Summary and its attachments provides a high level overview of policy coverages and does not include all conditions,
limitations or exclusions. Please refer to the actual policy forms for detailed coverages, limits and deductibles.
Sum of Insurance
TOWN OF YARMOUTH
`� bi YAK, Office of the Building Commissioner
,R�f, c 1146 Route 28, South Yarmouth, MA 02664
508-398-2231 ext. 1260 Fax 508-398-0836
�yCONPONASEOI
HOMEOWNER LICENSE EXEMPTION
DATE:
JOB LOCATION: � " I \ C6 1 Lcn+el-
M
Er DRESS SE TIOr DF TOWN 1- `A
HOMEOWNER l
NAME HOME PHONE WORK PHONE
PRESENTMAILINGAD RESS I / I V�/ ��
CITY OR TO STATE ZIP CODE
Definition of Homeowner:
Person(s)who owns a parcel of land on 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 procedures and requirements and that he or she will comply with said
procedures and requirements.
HOMEOWNER"S SIGNATURE th
u.
• O
V
•
. In 3 =
3
4 1.301 5
ACRES
32 ACRES 2.290 ACRES _r
in
0
tD
Z
w
S 28°14'30"W o
.' M
.. 72.00 u)
O O °
O w
O cn
o 0)
Pf.aps6a
05 ' z �orna4
. * .
0
O •
in
O tt
;. N 3
• 189 Z
:O 70.00
•
0' w
226.19
o �r 7 4a619-___)::5 .
to • " 2� �o"w s-�RE.E� •
_'
z 160.00
-- 515°3 �7 0 ;n
rn c-•I 0
000 l
y ARM,O�a kkRp 0 I 1`' ` '
• 1 \
;'..
D IN YARMOUTHPORT , MASSACHUSETTS '
FOR
)VILLE AND HELEN C. CHALKE
r rommi - miiiir , 9 0 f 8 3
I
..._i,
I
1-1
. ;..
--. .
),..,
FAMILY ROOM
....
gg x 156"x 2210"
41 I
.............. _
4/141
_ II in
IIIII MO
, 1 11111111111111111111111
LU sir x 5. HALL
1" )BATHDECK
:- -;
SCREENED PORCH -10'3"x 16'11" r"--",\ 127"x 10'11"
1, 6"x 910" 268"x 278"
III IV Z - IMMU.1
IKITCHEN \,. 1" Af4 -..\\ r")
I143"x 217"
I411111 I
./ / A s
.
.
- i JD DINING ROOM , ,___, th OFFICE xi.
"- 16'1"x 17'0" ,y,-.1
0 N
All _ C
HALL
6'4"X 17'0"
f 717`
I
• Ill ----4 )-•-.---4 k MI UVING ROOM
15.0.x 14'1"
SITTING
2R091OP 4_ YER
\\'''•••••••.-. PORCH..r .r.
ARMINIII -,11-7.--4116, IIIIII OR On .1
•
-
1
OOR 1
h,Flotl '',.a,f ‘;;Jr1 r, liehdrtriril VS'irlf:',' i the?too,of Ow pr,)o.rty,hodolo,,of 4 ,,,,t.,, , ?o,ot p donro.:o . ,.of- -,jam al-,, - , , , ,- FlOPlan
, , „„, ,,,,
Bk 36669 Pg60 #45055
11-12-2024 @ 11 : 58a
NOT NOT
AN AN
OFFICIAL OFFICIAL
COPY COPY
NOT NOT
AN FIDUCIARY DEEDA N
OFFICIAL OFFICIAL
Cape Cod Five Cents§a$ nis hank,Personal Repres ntae the Estate of Jean S.
Hilliard,duly appointed in Barnstable County Probate Court Docket No. BA24P1038EA,
pursuant to the power of sale conferred by the Will of Jean S. Hilliard and every other power
hereto enabling,
for consideration of ONE MILLION FIVE HUNDRED FIFTY THOUSAND AND NO/100
($1,550,000.00) DOLLARS,paid,
grant to Kelly McGuill,Trustee of the K. Farrington-McGuill Family Trust under
Declaration of Trust dated August 12,2022 with Certificate of Trust recorded herewith,with a
mailing address of 189 Center Street, Yarmouth Port, MA 02675,
the land with the buildings thereon in Yarmouth(Yarmouth Port), Barnstable County,
Massachusetts bounded and described as follows:
NORTHEASTERLY by Lot 5 as shown on the hereinafter mentioned plan, 310.84 feet;
NORTHWESTERLY by Lot 5 as shown on said plan, 72.00 feet'
NORTHEASTERLY by Lot 5 as shown on said plan, 190.00 feet;
SOUTHEASTERLY by Center Street,a public way, 226.19 feet;
SOUTHWESTERLY by Lot 3 as shown on said plan, 539.90 feet;
NORTHWESTERLY by land now or formerly of Grandville and Helen C. Chalke, 174.36 feet.
Containing 2.29 acres and being shown as Lot 4 on a plan of land entitled"Plan of Land in
Yarmouthport, Massachusetts for Grandville and Helen C.Chalke, March 26, 1985, Scale 1"=
60', Edward E. Kelley, Reg. Land Surveyor,Cummaquid,Mass."Which plan is recorded at the
Barnstable County Registry of Deeds in Plan Book 398, Page 69.
Said lot is conveyed subject to easements,restrictions and rights of way, if any of record,to the
extent the same are now in force and applicable.
The Grantor hereby releases any and all homestead rights in the property and warrants and
represents under the pains and penalties of perjury that there are no persons entitled to any rights
of homestead under M.G.L. c. 188 in the premises conveyed by this deed.
For title see Deed recorded with the Barnstable County Registry of Deeds in Book 4645, Page
64. See also Barnstable Probate Court Docket No. BA24P1038EA, Estate of Jean S. Hilliard and
BA23P1724, Estate of Hugh C Hilliard, Jr.
MASSACHUSETTS STATE EXCISE TAX BARNSTABLE COUNTY EXCISE TAX
BARNSTABLE COUNTY REGISTRY OF DEEDS BARNSTABLE COUNTY REGISTRY OF DEEDS
Date: 11-12-2024 (^ 11:58am Date: 11-12-2024 11:58am
Ctl#: 431 Doc#: 45055 Ctl#: 431 Doc#: 45055
Fee: $5,301.00 Cons: $1,550,000.00 Fee: $4,743.00 Cons: $1,550,000.00
Bk 36669 Pg61 #45055
NOT NOT
AN AN
OFFICIAL OFFICIAL
COPY COPY
Property address: 189 Center Street. Yarmouth Port. MA 02.675.
N 0 T NOT
Signed under the pains anc'p lalties ol'perjury thisPtliAla of Q f 1 �'�'Y`'lr , Ztl2 t.
OFFICIAL 0 CI AJL
COPY COPY
Cape Cod Five Cents Saving Bank.
Personal Representative of the Estate
UI'.lean S. Hilliard
- A.: ( . /1/4„.._______
13v: i' ,'�,t '
N tine: '(. Vt.) 10_ A,_, ('/fk t..--••-
l itle: �, j--iv 'v
CoMMoNwi Al,l'11 OF MASSAC'I11JSE'I FS
County: „e.. ,Q,Q._ ss.
On this '7t 'day of A/a V. . 2024_ before me. the undersigned notary
public. personally appeared Zf„.x, 5 . personally known to me or proved to me
through satisfactory evidence of identification, which was_ r-. i.,r _,i_,_ to he
the person whose name is signed on the preceding or attached document.and acknowledged to
me that she signed it voluntarily for its stated purpose on behalf of Cape Cod Five Cents Savings
Bank.as Personal Representative of the l state of,lean S. I lilliard.
fl-V-t—t"..- -
Notary Public
My commission expires:
6942023,1 .Z MARY A. FOWLER
Notary public
ry Commonwealth of Massachusetts
i
M Commission Expires
December 13, 2024
JOHN F. MEADE, REGISTER
BARNSTABLE COUNTY REGISTRY OF DEEDS
RECEIVED & RECORDED ELECTRONICALLY
II I �('I y mziN\ i ) 141 ,Th G 1-)
hvm .05 Art . ° ! ' nfizr st
rort; MR 6-)-- (07L-7--
' er orlieteJ
'<,A447f viivk41,
ot1
\,4„ kjop725)7-