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Home My WebLink AboutBLDR-25-564 E ! V ! D DEC/ O1 15 ONE & TWO FAMILY ONLY- BUILDING PERMIT hUS . 1 Town of Yarmouth Building Department 4 YAK ''T 1146 Route 28, South Yarmouth,MA 02664-4492 O, 508-398-2231 ext. 1261 Fax 508-398-0836 6 'iti Massachusetts State Building Code,780 CMR � ' `�` ATy Building Permit Application To Construct,)Repair, Renovate Or Demolish t 'ti """` ` ",,4 a One-or Two-Fami y Dwelling ��R� "`EO�b This Section Foi Official Use Only Building Permit Number: i3 _ 23 5(Oy Date Applied: Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel.Numbers - B \v‘a.vo.,Kev+.ore_\ 1 ,,,... 6 2,5 l.la Is this an accepted street?yes ..I no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: --40 20%A( 5 1 % •'Z1 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 4- 2J S 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public Zone: _ Outside Flood Zone? Private❑ Check if yes❑ Municipal ❑ On site disposal system l SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: c-cpr�•t Q O•). w =o ‘Al A►�• -�1 02.\S S Name(Print) City,State,ZIP \\ s\r.\tea, SV r 4/e- 15 4a i.con/ No.and Street Telephone Email A ss SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building EV Owner-Occupied 0 Repairs(s) NI Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work'-: 1 ,,� �c>j..'- w*A\%-tCv.�' e �V«arc, v-�� v_14. rs,:\v1.„1/4 ..„.."‘ vt \ LD X-25-1AA9 ECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item (Labor and Materials) ��. Use Only 1.Building $ \•ZV., 1. Bui ding Permit Fee:$ U Indicate how fee is determined: 2.Electrical $ 0 Stan and City/Town Application Fee 0 Tota Project Cost3(Item 6)x multiplier x 3.Plumbing $ Z 1C, 2. Oth r Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total 1 Fees:$ l Check o. Check Amount: Cash Amount: 2L 6.Total Project Cost: $ �\a;., 0 Paid n Full 0 Outstanding Balance Due: C,a& L SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) \ License Number Expiration 1)at: Name of CSL Holder List CSL Type(see below) No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu. ft.) R Restricted I&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 l4/ 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 to act on my behalf,in all matters relative to work authorized by this building permit application. Gea e vv\ems Q sec \ 2: -5Print Owner's (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. '0.2\ems S \2—`2- Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: I. 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. I42A.Other important information on the HIC Program can be found at www.mass.gox!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: S Q-Q- 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 9I Office of Investigations ?:� Lafayette City Center �' 2Avenue de Lafayette, Boston, MA 02111-1750 'Mr www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): G-ego'-fie-. 4\ANsN--'4 S Address: S$ 1.4\,,,,,V\e,gA,40 TvV.\ d City/State/Zip: 5c,-,\\-\ \(vi,c v,;.V\ Phone #: ? 4S - 2$2- dc t S 7-- Are you an employer? Check the appropriate box: Type of project(required): 1.❑ 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' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.. required.] 5. ❑ We are a corporation and its 10.N Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 11.112 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ 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 arc 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: \Nt 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 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: C' _s-----(2 �3 Date: \. 1 1 1 \ 5-2- Phone#: d..S — 9—T`2.-- \ 0 S`2— 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): 1❑Board of Health 20 Building Department 30City/Town Clerk 4.0 Electrical Inspector 5EIF'lumbin; Inspector 6.0Other Contact Person: Phone#: TOWN OF YARMOUTH rg YAK, Office of the Building Commissioner 4i48`1 1146 Route 28, South Yarmouth, MA 02664 O 4-:141 a 4', 508-398-2231 ext. 1260 Fax 508-398-0836 0gPOAATE0 / HOMEOWNER LICENSE EXEMPTION DATE: JOB LOCATION: % `'��+—`� �-' �t c�� V'' NAME STREET ADDRESS SECTION OF TOWN HOMEOWNER NAME HOME PHONE WORK PHONE PRESENT MAILING ADDRESS V\ 3 `VV•-e'1.. `Ns- '�►\•e,4(ko.-4--4 p z A S,- 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 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 og.Y44,es, TOWN OF YARMOUTH "3: a Office of the Building Commissioner y.r 1146 Route 28, South Yarmouth, MA"OPXTO 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. 36ib Work Address Is to bedisposed of at the following location: I C] Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111,§150A. 5 sec 2v�5 Signature of Applicant Date Permit No. �.. .ear ,4..\ VS' 45---/cck` e C:,fiq ‘t.-; • 2. -. Namoi TOWN OF YARMOUTH Building Department BUILDING p y� (508)398-2231 ext. 1261 0 PERMIT a . ,- � PERMIT NO BEDX-25-14d9 OB WEATHER CARD "� ISSUE DATE October 29,2025 ,4 yzi �0Ro.g.tfs� APPLICANT Peter LaRoche PERMIT TO 38 INDIAN MEMORIAL DR,SOUTH YARMOUTH MA AT(LOCATION) 02664 ZONING DISTRICT Bldg.Type Residential SUBDIVISION MAP BLOCK LOT 069.215 BUILDING IS TO BE: CONST TYPE USE GROUP REMARKS REMOVE INTERIOR WET BUILDING MATERIALS FROM THE TWO BEDROOMS,THE BATHROOM AND THE LIVING ROOM. CONTRACTOR INFO AREA(SQ FT) ESTIMATED COST$4,999 PERMIT FEE$$90.00 PETER A LAROCHE OWNER POULAKOS GEORGE I LICENSE# CS-073097 PHONE# BUILDING DEPT.BY ADDRESS 11 ASHLAND ST 508-737-6862 MEDFORD MA 02155 Mark Grylis THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF,EITHER TEMPORARILY OR PERMANENTLY.ENCROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS,THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. PER SECTION R110 INSPECTIONS ARE REQUIRED APPROVED PLANS MUST BE RETAINED ON JOB WHERE APPLICABLE SEPARATE FOR ALL CONSTRUCTION WORK AND THIS CARD KEPT POSTED UNTIL FINAL PERMITS ARE REQUIRED FOR INSPECTION HAS BEEN MADE.WHERE A ELECTRICAL,PLUMBING/GAS,FIRE REFER TO DETAILED INSPECTION SCHEDULE FOR CERTIFICATE OF OCCUPANCY IS REQUIRED, PROTECTION,AND REQUIRED INSPECTIONS SUCH BUILDING SHALL NOT BE OCCUPIED MECHANICAL/SHEET METAL UNTIL FINAL INSPECTION HAS BEEN MADE. INSTALLATIONS. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS Building Final Inspector Date " \\— c WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD THE INSPECTIOR HAS APPROVED WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE CAN BE ARRANGED FOR BY TELEPHONE THE VARIOUS STAGES OF PERMIT IS ISSUED AS NOTED ABOVE. 508-398-2231 ext.1261,1260 CONSTRUCTION. Main Level A:REPLACE WALL INSULATION-R15 B:REPLACE SHEETROCK WALL C:REPLACE ALL SHEETROCK WALLS AND CEILING D:REPLACE SHEFTROC'.K CEILING SICO:SMOKE AND CARBON MONOXIDE DETECTOR. r— — — = — -"it — I A 32.,,, Dining Room 1.) Back Bedroom , 8'6" ?del \:.V(.) lit,.... Bathioo v 1 �' ' L,7.7' .l wa Tii3 Kitchen I€ im It h Living Room = ,�,9„ MA, it 1 I - Ir4„ CC) Front Bedroom POULAKOS 1 24.4,. I 38 INDIAN MEMORIAL DR i SOUTH YARMOUTH /1 14,' PERMIT NO:BLDX-25-1449 REMOVAL OF BUILDING MATERIAL M M I Main Level 20250559_POUL-2 11/12/2025 Page: 1