HomeMy WebLinkAboutBLDR-25-580 application/plans ONE & TWO FAMILY ONLY- BUILDING PERMIT
. Town of Yarmouth Building Department pg' "Ir.4.Iq
Z -orDEC 8 2025 1146 Route 28, South Yarmouth,MA 02664-4492 � •ef#,'
508-398-2231 ext. 1261 Fax 508-398-0836 t� Q
!�` � Massachusetts State Building Code,780 CMR O ma y
`., wilding Permit Application To Construct, Repair, Renovate Or Demolish '�
��RPpRATE��b
a One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: 'J I J)R 5- c Sfi) Date Applied:
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
104 Pawkannawkut Dr.South Yarmouth 02664
1.la Is this an accepted street?yesx no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Residential Residential 8,712.00
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
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:
Zone: Outside Flood Zone?
Public I Private Cl Check if yes❑ Municipal❑ On site disposal system O
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
1 Look Solutions Hyannis,MA,02601
Name(Print) City,State,ZIP
76 Vandermint Lane 774-521-7885 sandsconstruction@comcast.net
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction 0 Existing Building El Owner-Occupied 0 Repairs(s) ® Alteration(s) a Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other U Specify:lnterior Renovation/Remodel
Brief Description of Proposed Work':Add Shower to 1/2 bathroom on second floor,remove chimney/tireplace,construct 17 dormer(Second Floor Bedroom),
Kitchen Remodel,(2)Bathroom Remodels,&create open concept on the first floor(See stamped structural plan provided).
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $35,000.00 I. Building Permit Fee: $ t Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical $2500.00 ❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $7500.00 2. Other Fees: $
4.Mechanical (HVAC) $7500.00 List:
5.Mechanical (Fire
Suppression) $ •00 Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $52,500.00 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
CS-096833 11/10/2026
Sasmuel F Naoom License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)unrestricted
76 Vandennint Lane
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
Hyannis,MA,02601 Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
774521-7885 sandsconstructionlncomcastnet I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
147624
Samuel F.Naoom 1-TIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
76 Vandermint Lane sandsmnstniction@comcast.net
No.and Street Email address
Hyannis,MA,02601 774-521-7885
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 Samuel Naoom
to act on my behalf,in all matters relative to work authorized by this building permit application.l?/Electronic tore pp
Print Owner's Name( g�Si ) e 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"
The Commonwealth of Massachusetts
Department of Industrial Accidents
slie
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):Samuel Naoom
Address:76 Vandermint Lane
City/State/Zip:Hyannis, MA, 02601 Phone #:774-521-7885
Are you an employer? Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ 1 am a general contractor and 1
employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.EI 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
working for me in any capacity. employees and have workers'
[No workers' comp. insurance comp. insurance.t 9. ❑ Building addition
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 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL
y 12.❑ Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13.1=I 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: N/A
Policy#or Self-ins. Lic. #:N/A Expiration Date: 1 1/1 0/2026
Job Site Address: 104 Pawkannawkut Drive City/State/Zip:S. Yarmouth, MA 02664
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 of perjury that the information provided above is true and correct
Signature: � Date:
Phone#: ? ! 5��� - 7.5)cp,S
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 2❑Building Department 31:City/Town Clerk 4.0 Electrical Inspector 51:Plumbing
Inspector 6.0Other
Contact Person:_ Phone#:
erg Yam. TOWN OF YARMOUTH
Office of the Building Commissioner
a,,.:114.! , 1146 Route 28, South Yarmouth, MA 02664
y,,OR�'
i�.j.00..t O�,... 508-398-2231 ext. 1260 Fax 508-398-0836
- -fir
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 104 Pawkannawkut Dr.South Yarmouth, MA 02664
Work Address
Is to be disposed of at the following location: Town Transfer Station
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, §150A.
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Signature of Applicant Date
Permit No.
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Cone Icing Structural Engineer
123 tart.Centralia Massachusetts 02632
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ADDENDUM
FLi Tc.K $N4 r jsfi Ft„UYhI.i io MICHELE CUDILO, P.E.
Consulting Structural Engineer
123 Co.tn,wood Lone. Centerville, Massachusetts 02632
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123 Cottonwood Lane. Centerville. Massachusetts 02632 .
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Property Location 104 PAW KANNAW KUT DR • Map ID 25/41/// Bldg Name State Use 1010 •
Vision ID 2565 Account# 2565 Bldg k 1 Sec# 1 of 1 Card# 1 of 1 Print Date 9/12/2025
CONRTRUCTID UCTIONDETAlLiCONTINUEOT — -
Element Cd Description Element Cd Description
Style: 04 Cape Cod
Model 01 Residential •
Grade: 04 Average+10
Stories: 1.75 1 1/2 Stories I
Occupancy 1 CONDO DATA 15 PTO WOK
Exterior Wail 1 14 Wood Shingle Parcel Id -ICI 'Owne 0.0
MR
Exterior Wall 2 19 Brick Veneer , IS $
Roof Structure: 03 Gable/Hip Adjust Type Code Description Factor 12 12 14
Roof Cover 03 Asph/F Gls/Cmp Condo Fir i 40
Interior Wall 1 05 Drywall/Sheet Condo Unit lik
Interior Wall 2 COST/MARKET VALUATION ;24 FGR 12
Interior Fir 1 09 Pine/Soft Wood CTH
Interior Fir 2 Building Value New 541,494 1 FEP
Heat Fuel 03 Gas
12
Heat Type: 04 Forced Air-Duc Year Built 1970 21 MS 24
AC Type: 01 None Effective Year Built 1996 Y1 RAS
Total Bedrooms 04 4 Bedrooms 15
Total Bthrms: 1 Depreciation Code A ------
Total H Baths 1 Remodel Rating
Half
Total XtraHalf Fixlrs Year Remodeled
Total Rooms: Depreciation% 28
Functional Obsol 0 ii
�7th StNe;. 112 _Average . Ext.Comment 0 t 12 — 14 --
Kitchen Style: 02 Average 2
N Trend Factor 1
Condition
Condition
Percent Good 72
RCNLD 389,900
Dep%Ovr
Dep Ow Comment
Misc Imp Ovr
Misc Imp Ovr Comment a I". -, 1i.
Cost to Cure Ovr
Cost to Cure Ovr Comment r�
OB-OUTBUI DING& YARD/TEMS(L)/�F-BUILDING EXTRA FEATURES(B) t ,•' ,. s ;` " R�e 7
Code Description UB Units Unit Price Yr Bit Cond.Cd %Gd ,Grade Grade Adj. • Appr.Value , a' ! 1 ' :„ y �' •.`air, t1
FPL2 1.5 STORY C B 1 4000.00 1990 72 0.00 2,900 '_ 4 ,r . -
EOS Encl Outs Shw B 1 0.00 1990 72 0.00 0 t : j.s .�
SHD1 SHED FRAME L 96 12.00 1970 75 0.00 900 , +^. Y, j
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BUILDING SUB-AREA SUMMARY SECTIONiiit ° � �
Code Description Living Area Floor Area Eff Area Unit Cost Undeprec Value
BAS First Floor 1,012 1,012 1,012 255.19 258,251 -
CTH Cathedral Clng 0 252 0 0.00 0 -...
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FEP Porch,Enclosed,Finished 0 252 176 178.23 44,913 <-_,„
FGR Garage 0 360 144 102.08 36,747 `
PTO Patio 0 144 7 12.41 1,786
TQS Three Quarter Story 759 1.012 759 191.39 193,688 . ,
WDK Deck.Wood 0 112 11 25.06 2,807 '
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Ttl Gross Liv/Lease Area 1,771 3.144 2,109 538,192
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VI Commonwealth 'DI Massachusetts
Division of Occupational Licensure ,7 ,,,,,,,.r,,,,,,�„//1 ,,�.�
Board of Building Regulations and Standards • Office of Consumer Affairs' ou§ilig‘ f( •tj' tion
rT f• = HOME IMPROVEMENT CONTRACTOR
C M . '' TYPE: Individual
~' s Registration Expiration
CS-096833 E5Icoires: 11/10/2024 147624 07/24/2023
SAMUEL F NAOOM SAM NAOOM
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76 VANDERMINT LN _r
HYANNIS MA",02601
r 'I SAMUEL F. NAOOM
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Of,/‘',IN:/ I HYANNIS, MA .02601
Undersecretary t
Commissioner cc..44. K. SY&'4-;L ,
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