HomeMy WebLinkAboutBLDR-25-443*— .....••••.r N , _ _
ONE & TWO FAMILY ONLY- BUILDING PERMIT
�' 1 g T w 'of Yarmouth Building Department pg A44
! jEp 29 202P46 o to 28, South Yarmouth,MA 02664-4492 `.� 0,.
' 5 -3 8-2231 ext. 1261 Fax 508-398-0836 P ;a,,t e d.
BUILDING DEs-ARTI 91s�a usetts State Building Code,780 CMR # ;� YT^eHC � ,�
a One-or Two-FamilyDwellin _1 rte Or Dem ish %o \bA` "
av Ruildrn�:P.er cation To Construct, Repair, Reno
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Se
/_ a This Section For Official Use Only
Building Permit Number: \j LT)(---1" 95' tfbate Applied:
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION _____ , '
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
1C GYI �\;Pwic °LiAA 416'4 1
1.1a Is this an accepted street?yes . no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft) C'k-, Q ,^
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public L9/ Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if es❑
2.1 Owner'of Record:
1-4014w c_ Sov.z - OeitLiivcvtd.4. . NA 0a673
Name(Print) City,State,ZIP 1
No.and Street Telephone Email Address het..
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction if Existing Building 0 Owner-Occupied 0 Repairs(s) V Alteration(s) 0 Addition 0
Demolition- 0 Accessory Bldg. 0 }Number of Units Other 0 Specify:
Brief Description of Posed Work': Rt l N.�c", Cone ett Sti tleiv.C're c44ts t `- €-v't ' tw's'..1e e.- A 4 C4+�Cri. a, CIt-
AUAripC
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item (Labor and Materials) Official Use Only
1.Building $ &OW. Cr a 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees: S
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ 46 O b b D 0 Paid in Full 0 Outstanding Balance Due:
IA
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) :41\
License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
No.and Street Tvpe Descr 4ti
ly
U Unrestricted(Buildings up to 35,000 cu. ft.)
— 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)
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
No.and Street Email address
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 0 No ❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIESFOR 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
conta. ed in this appli on is true and accurate to the best of my knowledge and understanding.
Naa vin 61CL4
Print 0 r s or thorized Agent's Name(Electronic Signature) Date 1
e ,
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"
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TOWN OF YARMOUTH
,;oA Office of the Building Commissioner
z, 1146 Route 28, South Yarmouth, MA 02664
-11
° w�. ' s 508-398-2231 ext. 1260 Fax 508-398-0836
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C..°gp0'RATfo J.
"G;'�nY HOMEOWNER LICENSE EXEMPTION
DATE:
JOB LOCATION: �l C r' A , SQ UZA- 'j (IL,`\ ,0 'N..I. 4 j Q-<:1 $ - o&' .W
NAME STREET ADDRESS SECTION OF TOWN
HOMEOWNER M A n C. 5 0LA.-Z,A C('1-caRi- av "/e9-
NAME HOME PHONE WORK PHONE
PRESENT MAILING ADDRESS .7 S ( \ k toe,r Li
tA5e " elv- 61.3 u 0 16, O a C. 7 3
CITY OR TOWN STATE ZIP CODE
Definition of Homeowner:
Person(s)who owns aparcel ofland 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 find/orfarm structures. A person
who constructs more than one home in a two yearperiodshallnotbeconsidereda!zomeowner.
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 thae or she will comply with said
procedures and requirements.
HOMEOWNER"S SIGNATURE ,(1tV"..7 . .
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;,4,scc4N, TOWN OF YARMOUTH
4ifei--41;\445.-
Office of the Building Commissioner
1146 Route 28, South Yarmouth, MA 02664
°RPO
TEO b ` 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. ktlil [1 A < VO'ci
Work Address
Is to be disposed of at the followinglocation: (Y ZZt� (4314, Lti:5Z16
p �'
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, § 15 0A.
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Sign . ure / Applicant Date
Permit No.
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Mr. Souza
Irv _ - , -- .,. John F.
75 Williams Rd.
W. Yarmouth Ma. 02673
Building Materials:
1. Concrete
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2. 10" Concrete columns
3. 2" x 2" Pressure treated lumber
4. PAF 44 TZ Post anchor
5. 28JHZ HANGER
6.2-1/4 316 SS T 15
. Joist hanging Nails
8, 6" x6»
P.T. Postressure treated posts
9. 1"x8"x18 ' P V C Trim Boards
10. 10"wide led flashing
11. 1"x4" Deck Boards
12. 6" Lag Bolts and washers
13.Stainless Steele nails
14. 1/2 " Nuts and bolts
15. Glue
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Mr. John F. Souza
75 Williams Rd.
Front . W. Yarmouth Md. 02673
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Mr. John F. Souza
75 Williams Rd.
W. Yarmouth Ma. 02673
3/4" Deck Boards
2"x8" Pressure Treated
Lumber
4.71°
10" Concrete Column 4' Dee
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6" x6"
P.T. Post �!
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10 " Concrete Columns 4' Deep
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Joist 16" Spacing 2" x 8" Double Box Mr. John F. Souza
75 Williams Rd.
2"x8" Pressure treated Lumber 6"x6" Posts 36" Height W. Yarmouth Ma. 02673
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