HomeMy WebLinkAboutB-08-070a r TOWN OF YARMOUTH Building Department BUILDING 1
i s. _ _ _ _ . _ _ , (508) 398-2231 ext.261
PERMIT NO B-08-070 _
ISSUE DATE ;: 7 1=007: ; PROPOSED USE :::::::: PERMIT
` �..""".."."....""". JOB WEATHER CARD
APPLICANT Peter La e
PERMIT TO Repair
AT (LOCATION) 10029NIGHTINGALE DR ZONING DISTRIC R-40 Bldg. Type: lResidential
SUBDIVISION MAP LOT BLOCK 1088.182 BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R -
LOT SIZE I I
repairs due to water damage: kitchen & bathroom - remove & replace insulation, sheetrock,
REMARKS underlayment, kitchen & bath cabinets, repair plumbing & HVAC system as per plans dated 07/16/07
AREA (SO FT) EST COST ($ $35,000.00 PERMIT FEE ($) $75.00
OWNER 1HAYES, FLORENCE M BUILDING DEPT BY
ADDRESS 10029 NIGHTINGALE DR
South Yarmouth I MA 102664
INSPECTION RECORD
Date Note Progress - Corrections and Remarks
B O4�
CONTRACTOR
LICENSE 073097
LaRoche, Peter
217 Thornton Drive
Hyannis MA 02601
5087713110 _
PHONE 15083943672
FIELD COPY
nE. •
z:r:
�.•tt:a:::::
•I
M.M1 N M
[ka r
ONE & TWO FAMILY ONLY - BUILDING PERMff
o APPLICATION M CONSTRUCT; FOANt RENOVATE OR DEItMM ACNE OR TWO FAMILY DM aL fIq
y Town of Yarmouth Building Depuanent
1146 Route 28 - Yarmouth, KA,025644492
Tel: (508) 39&2231 x261 - Fax: ("A8) 398.0836
Ofba we Oay
PermR No. _d W Date �
F1rNn0 Bard lorortnsde�
�h'a'
area
Asoma DOPIM tit INitoa:
�1
Pw* Fee S -7 �
f�6ers�r� Date
/--
a.ode.g Do1
Now
DoosB Recd. S �: D*2
c
1
� Preprty Diols�
Net Due S S�b
to Aw (dl Fn M 4d +fa<
•.
•
•.�: J. • • � q
'T..•t ..•.'�.•�,.r.••h .-%����\'A.••
...,.: i1
•1.. i•:J'.'T..�• •�
Y' 1. �.. 'tHl! /
•J�'�CL�♦%S.Vy. •C..�'�Y .���..'���`�J�.�
i.'•^.r�5 „y.�.�•T�:; •tia�.•it.Mr;r::
���yy�.��(y�� e.p.Y.y<.w%�eG`:�'�, ;' �?.• ..��.'•1S•� y�''"'�'�P•'.tiit4 .
l' s� r.�',1 e:.
♦'
4.. ..f :..
.F7y{A:irS p.. ,., ,,tw. Jyn ..�5 ^-
t,;oq
.Yp
• `t 1�:A.
•Tt•:q: •f.''•l y.t•CS�.« ! r.
., ;�,.•i♦�„•}b•, �•.. •. w' \
w.f..: iY.^� i•'.t:7 •J���.i����
•'••'i.�\,••t
:W' a'� .'K.'•1.J.•!'1;f. �,ya
l•�.� � He `- yA�.
_
.��l,�. t�'�.' �'t1 IA• I
171JIIOMM V.
••t.�Y
�
...�l..�t • • 'PtiP L,%�f+. ~~,••
r .;}t' �: ?.. >..Iy., r� ��:', y��.' ��
'.t;Xl��o-•.f.A.....�tf/�`�..0lvi1�.�w�s;��%!y'�•
��� iJ� • ��y{.�� •-'•r
�1}
,
Irrdrlr.•
I Rbnl'"t!Ay
Secttorr? s Sha krfciiriatl6n.'
Use :IL-4 : frB
1.1 P vp=4r A/ftr<"r
1.2 Zw" ttiarnAkas
2! WOM19-04 214!%
(1c)
plstrky Ptapoaed Uea
S«Ali yAj#7A , MA o2[[�-
1.3 warn saftm*8 tn1
Frord Yard
Side Yards
Roar Yard
RogtAmd PmNded
P40AMd Pmvkbd
Provided
1.1 t#~ pfio.t. a 14 ! KI 1.5 ftw zw* Mftn" r=JJ
' :ws:
PtAib PrrY9aB
. • .: :::�st� t`J7� tt�,�JliJ�'i: i�-a�-;^�,',j'�i
•P :�, tiT 1 ..•. w'. y.J .•. P, i•C,�i�iY '^t. .U�l: M
• i:�i'•'+.a.w.+N:�'.i�'•^.�• •�•�.'i',�. pJ a'�i,L. y. .1. �'a �
v.
r, r-
0
77t-3110 -! " —7
" F r
,
/L,"
AA
1— re °` •14 m �
t M 9 M!Fca
•• •.r -rr r•• • ...r.••r..��Mw,pV V.�.t-MV•-MYV�rYni.Yl+•�MwV r ...�r-wti.�l-P.'1•�'•
Woftm Canpensation Intwrartee aftldav* must be eortpleted and submrlted with thb .
to provlda this afBdenh will result In the dental of the Issuance d the "ding perms, aPplieatl0n• t=aaure
Signed Affidavit Attached Ya3 ...
New comics ❑ Na. of dKoarra
Ea fta sac• p Raps $) ARrwsUarn p NOdltlon ❑
Ac==ry Bldg. p Type . pemollgon Oprot qty.
Brl
�Desm"m✓ At
Proposed WorS.02
.t
he" t�,ta etea cosy mows) ro be
M: np ted Dy pennR eppOco n,
17, 400 .00
2. Eleehleaf p p
3 NOW . 4.0 a o_oo
S. Fire ProteQbn 00
& TOW= (142+3+1.5) 1 79000.400
I - ch&* Below,
❑ Fft0
(a apple**)
❑ old nip y a natorW
Corm*WW epprvvd
(N apple")
hereby authorizeINC- to ad on
my behalf, to ea matters relative to work authorized by this butktirrg permit appkvt6L
C F svwkn of OOO
rraer
I. OCEltafte�. ftI - yeL•f� �dtt? ,. •..•, ;.
--�--�- . aS OwnsdAuthorized Agent
hereby declare Owl the statements and Inforrnagon on the foregoing applk ntfon are true and accurate,
to the best of my knowledge and bald.
Signed under ftpaMa and penaAtes of pprlury.
M1. � � rr��, �� .. ..- y • • r . ., 4.'^ . , . ,
PINI I s. ^ + - •••w
r _ h La7
sbnaa.. down.rlAp�nt ora
e- rQ-err
2d2
....r.rv..r...........•..,...•...n......�.............�-.. •.rn••..... �.n�..,,, ...`.,.,..... r.. .... ..... r. ..v.... -.......w..+- .......w ..-..•ww •..�-w+n.w.
TOWN OF YARMOUTH
Building Department
Town Hall
Yarmouth, MA 02664
(508) 398-2231 ext.261
BUILDING PERMIT
TRANSMITTAL
Temp Permit No.:
T-08-020
Applicant Name:
Peter Laroche
Applicant Phone:
5087713110
Building Location:
0029 NIGHTINGALE DR
Owner's Name:
HAYES. FLORENCE M
Owner's Addres
0029 NIGHTINGALE DR
Expiration Date
South Yarmouth MA 02664
Owner's Telephone:
(508) 394-3672
REVIEWED BY:
(OFFICE USE ONLY
Recorded By: Ic
Permit Fee:
$0.00
Deposit Rec:
$25.00
Payment Type:
Cash ChkNo.: 0
Net Owed:
($25.00)
Application Date:
7/10/2007
Issue Date:
N/A:
Expiration Date
DATE:
Comments: Map/Lot: 088.182
repairs due to water damage: kitchen &
bathroom - remove & replace Insulation,
sheetrock, underlayment, kitchen & bath
cabinets, repair plumbing & HVAC system
'IV 4L
1. WATER DEPARTMENT:
DATE:
WA:
2. ENGINEERING DEPARTMENT:
DATE:
N/A:
3. CONSERVATION:
DATE:
N/A:
4. HEALTH DEPARTMENT:
DATE:
N/A:
5. BUILDING DEPARTMENT:
DATE:
N/A:
6. FIRE DEPARTMENT:
DATE:
N/A:
PLEASE NOTE
COMMENTS:
RECEIPT OF COPY:
SIGNATURE OF APPLICANT:
DATE:
Date Printed: 7/13/2007
3ro`YgQ�e TOWN OF YARMOUTH
O
BUILDING DEPARTMENT
CONSTRUCTION SUPERVISOR FORM
PLEASE PRINT: ,q2
Job Location:
Number
Owner of Property:
Construction Supervisor:
Address:
Street
Name
License No.
W AMea rW .
7/- 3iio
Phone No.
Licensed Designee:
(If other than Supervisor)
Name
2.15 Responsibility of each license holder:
License No.
2.15.1 The license holder shall be fully and completely responsible for all work for which lie is supervising.
He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings
as approved by the building official.
2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration,
repair, removal or demolition involving the structural elements of building and structures only pursuant to
the state building code and all other applicable laws of the commonwealth, even though he, the license
holder, is not the permit holder but only a subcontractor or contractor to the permit holder.
2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any
violations which are covered by the building permit.
2.15.4 Any licensee who shall willfully violate subsections 2.15.1, 2.15.2 or 2.15.3 or any other section of these
rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of
license by the board.
2.16 All building permit applications shall contain the name, signature and license number of the
construction supervisor who is to supervise those persons engaged in construction, reconstruction,
alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and
regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately
cease until a successor license holder is substituted on the records of the building department.
2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may
be deemed a violation of the permit conditions.
I have read and understand my responsibilities under the rules and regulations for licensing construction
supervisors in accordance with section 109.1.1 of the state building code. I understand the construction
inspection procedures and the specific inspection as called for by the building official.
INSURANCE COVERAGE:
I have a current liabi ' insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152
Yes � No ❑
If you have checked y -u, please indicate the verage by checking the appropriate box.
A liability insurance policy Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chap 152 of P Mas�ws, and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner ❑ Agent
Signature: Building Official Approval:
Vr
Board or Building Regulations and Standards
nLl
HOME IMPROVEMENT CONTRACTOR
_ Registration: 100121
Expiration: 6/912008
Type: Supplement Card
OCEANSIDE, INC.
PETER LAROCHE
217 Thornton Dr�,--e��
Hyannis, MA 02601 Administrator
u
rt:
Board or Building Regulations and Standards
Constructlot) Supervisor License
Licenses, CS 73097
Birthdate: 11&1957
`a
Explratlon: 111314008 Tr# 7187
Resetrifoon:.00
PETER A LAROCHE =" '. ,
18 CEDRIC ROAD
CENTERVILLE, MA 02632 Commissioner
-
For Office Use Only
Permit No.
Date
TOWN OF YARMOUTH
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
MGL c. 142A requires that the 'reconstruction, alteration, renovation, repair, modernization, conversion,
improvement, removal, demolition or construction of an addition to any pre-existing owner -occupied
building containing at least one but not more than four dwelling units or structures which are adjacent to
such residence or building' be done by registered contractors, with certain exceptions, along with other
requirements.
Type of Work: WWOL adm4l: UFAIES Est. Cost J3S,000
Address of Work 1_9 N46t1t1NLA44 91126 1 S°yV *h` VA
Owner Name:
Date of Permit Application: 01h1/97
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
Job under $1,000
Building not owner occupied
Owner pulling own permit
Other (specify)
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH
UNREGISTERED CONTRACTORS FOR APPLICABLE HOME
IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION
PROGRAM OR GUARANTY FUND UNDER MGL c. 142A.
Signed under penalties of perjury:
I hereby apply for a permit as the agent of the owner:
01111107 Ocatiri) , tic 10011.1
Date Contractor Name Registration No.
Notwithstanding the above notice, I hereby apply for a permit as the owner of the above
property:
Date Owner Name
Ed
Vl
The Conuno►nwealt/n of tlfassachusetts
Department of Industrial Accidents
Office of Investigations
? 600 Washington Street
Boston, MA 02111
ivivmniass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Le ibl
Name (Business/Organization/Individual): ocrMir,016 INSo0aele,4 4e 1�4AfAl.
Address: 7-17 IUAtMll) t44VC
City/State/Zip: JAJANNI5-1 t44 oUGI Phone M(#)771.711 G
Are Y(mu an employer? Check the appropriate box:
1. I am a employer with IS 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub -contractors
2. ❑ I am a sole proprietor or partner- listed on the attached sheet.
ship and have no employees These sub -contractors have
working for me in any capacity. employees and have workers'
[No workers' comp. insurance comp. insurance.:
required.]
3. ❑ I am a homeowner doing all work
myself. [No workers' comp.
insurance required.] t
5. ❑ We are a corporation and its
officers have exercised their
right of exemption per MGL
c. 152, § 1(4), and we have no
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
8. [:]Demolition
9. [:]Building addition
10.❑ Electrical repairs or additions
11.0 Plumbing repairs or additions
12.❑ R frepairs
13.01
Other ;r,
Any applicant that checks box #I na,st also fill out the section below showing their workers' compensation policy inforrnation.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such.
:Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have
employees. If the subcontractors 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
Policy # or Self -ins. Lic. M wd% 174e -v-.93 Expiration Date:
Job Site Address: z% NI Lry'rAlf 0( City/State/Zip: Toyf JAi4'1p,1f14, MA o261+
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.
1 do hereby certify de/r/tr}Ir/�rpains a/n/d Penalties of perjury that the information provided above is true and correct.
iionafiire� Li li�� nate- i1eIi/ /A%
Phone #:,�77f-ai/O
Official use only. Do not write In this area, to be completed by city or town ofJlclal.
City or Town: Permit/License #
Issuing Authority (circle one):
1. Board of IIealth 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone #:
BUILDING
TOWN OF YARMOUTH ELECTRICAL
GAS
1146ROUTE28 SOUTH YARNIOUTH MASSACHUSETTS02664-1451
Telephone (508) 398-2231, Ext. 261 — Fax(508)398-2365 PLUMBING
SIGNS
BUILDING DEPARTMENT
DEMOLITION DEBRIS DISPOSAL AFFIDAVIT
Pursuant to M.G.L. Chapter 40, Section 54 and 780 CNIR, Chapter 1, Section 111.5,
I hereby certify that the debris resulting from the proposed work/demolition to be
conducted at 19 NlON'ALL DME - SwrN `i5 -126 N 84 ot[(�-
Work Address .
is to be disposed of at the following location:ToGN 4 Owfw( LANDFILL -
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
Signature of Applicant
Permit No.
00214
Date
°FY9R TOWN OF YARMOUTH
o HEALTH DEPARTMENT ,JUL 0 6 2007
H M.TTA M[[f
PERMIT APPLICATION SIGN OFF TRANSMITTAI, WEETTH DEPT.
To be completed by Applicant:
Building Site Location:.2 9 Al rQ od 0.1 �� Map No.: Lot No.:14,
Proposed Improvement: We-ogg,;, Me Te o"(h4AL_ YTA% eoA.N:(j, 4MEnplE _Cjr%511
&WCtf oNl`1. .ea�A/.r .�imsou Aa Ei�oi�.•
Applicant: 01�649fiQC, W. Tel. No.: a I - i lI "•
K
Address: 117 11° ar) 9ptvE OHN1 S , MA 011#1 Date Filed: *7 °5 n%
**Ifyou would litre e-mail notification ofsign of; please provide e-mail address:
Owner Name: Yto y+cF
401b
Owner Address: 29 t� liT�
4(bg �vF; s 011 `IPM��t�1
,INS otic+
,, l
Owner Tel. No.: �1/�-5 3
RESIDENTIAL AND/OR COMMERCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities.
Please submit four (4) copies of plans, to include:
(1.) Site Plan showing existing buildings, water line location,
and septic system location;
(2.)) Floor plan labeling ALL rooms within building
(all existing and proposed) —
Note. Floor plans not required for decks, sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
REVIEWED BY:
PLEASE NOTE
COMMENTS/CONDITIONS:
M
n