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HomeMy WebLinkAboutBLDR-26-297 application ti ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department SI" 4 1146 Route 28, South Yarmouth,MA 02664-4492 c Q 508-398-2231 ext. 1261 Fax 508-398-0836 r, 4 Massachusetts State Building Code, 780 CMR xce , Building Permit Application To Construct, Repair, Renovate Or Demolish 'a�a, rat. b54 a One-or Two-Family Dwelling RPcrtsss a This Section For Official Use Only Building Permit Number: D ./ - Date Applied: Building Official(Print Name) Signature Date SECTION 1: SITE'INFO1 � 1 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 32 CAMELOT RD YARMOUTH PORT MA 02675 133/13/// 118/X036/// 1.1 a Is this an accepted street?yes x no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: SINGLE FAMILY 14,810 90.5 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 30 30 20 20 20 20 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 N Private 0 Check if yesB Municipal 0 On site disposal system SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: SCANNELL MICHAEL J TR SCANNELL SUSAN TR WEST ROXBURY MA 02132 Name(Print) City,State,ZIP 60 ROBIN ST 603-759-0720 MJSCANN@GMAIL.COM No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) ❑ Alteration(s) 8 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work':Basement game room conversion Project also includes constructionof a full bathroom and new heating and cooling systems with all labor and materials provided in accordance with current building codes. SECTION 4; ESTIMATED CONSTRUCTION COSTS Estimated Costs: t: Item OfficialUse Only (Labor and Materials) 1.Building $57,600.00 1.'Building Permit Fee:$ Indicate bow fee is determined: 0 Standard City/Town Application Fee 2.Electrical $12,000.00 ©Total Project Cost'(Item 6)x multiplier x 3.Plumbing $15,000.00 *"2, Otber•Fees; $ 4.Mechanical (HVAC) $22QQQ,QQ List 5.Mechanical (Fire $ Suppression) 1 rital All Fees: $ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $106,600.00 C Paid in Full 0 Outstanding Balance Due: r SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-094639 KEVIN J FAIR License Number Expiration Date Name of CSL Holder List CSL Type(see below) 100 HOMERS DOCK RD No.and Street U Unrestricted(Buildings up to 35,000 cu.ft.) YARMOUTH PORT,MA 02675 Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 603-759-0720 kevinfair@comcast net I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 153196 11/05/2026 KEVIN J FAIR HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 100 HOMERS DOCK RD kevinfair@comcast.net No.and Street Email address YARMOUTH PORT,MA 02675 603-759-0720 City/Town, State,71P Telephone SECTION 6: 1VORKERS' COMPENSATION INSURANCE AFFIDAVIT(1I.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 KEVIN J FAIR to act on my behalf,in all matters relative to work authorized by this building permit application. Aklcae G� &se U. 6 I t 2_(..92.,L Print Owner's Name(Electronic Signature) Date ,.,s ... m $10A N „,. GENT DECLARATION^ 4 I N'. t 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. KA :J Co( 12049 Print Owner's or Authorized Agent's Name(Electronic Signature) Date 4,fJ 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.) 1,633 (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) 1,633 Habitable room count 7 Number of fireplaces1 Number of bedrooms 3 Number of bathrooms 2 Number of half/baths o Type of heating system GAS Number of decks/porches 1 Type of cooling system CENTRAL Enclosed 1 Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost"1.100 .i fie l.untrnurtWeuttn of ii'iu.sucnusetts Department of Industrial Accidents ° Office of Investigations Lafayette City Center 2 Avenue de Lafayette, Boston,MA 02111-1750 www.mass.govldia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly' Name (Business/Organization/Individual):KEVIN J FAIR Address:100 HOMERS DOCK ROAD City/State/Zip:YARMOUTH PORT, MA 02675 Phone#:603-759-0720 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 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 anycapacity. employees and have workers' 9. 0 Building addition [No workers' comp. insurance comp. insurance,: required.] 5. 0 We are a corporation and its 10,® 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 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] *My 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. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees.they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance_for my employees. Below is the policy and job site information. Insurance Company Name: t A.cA,',A S •MA,QAt, c v D Policy#or Self-ins. Lie. #: Expiration Date: / 12 �3 7 l nZb?C Job Site Address: . Z Cca, e`0 7 City/State/Zip: a ,M Ai ,O✓$ Mee 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 certi under pains and penalties of perjury that the information provided above is true and correct. Si nature: .. - . Date: E t t L �= Phone#: 4 3 7 Sct O 7 2-0 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 20 Building Department 30City/Town Clerk 4.0 Electrical Inspector 5Ek'lumbing Inspector 6.❑Other Contact Person: Phone#: oY` TOWN OF YARMOUTH MOUTH z -': of the Build Buildion Commissioner °' Ra1146 Route 28, South Yarmouth, MA 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.32 Camelot Rd, Yarmouth Port, MA 02675 Work Address Is to be disposed of at the following location: Town of Yarmouth Disposal Area Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, §150A. ?�--- Zoz6 Signature of Applicant Date Permit No. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Aff &Business Regulation HOME IMPROVE ' . ONTRACTOR TiSra �4•11.%_ i.n CEVIN FAIR t t. CEVIN J. FAIR ` 4 ? ek- x"sA 100 HOMERSDOCK RD t (ARMOUTHPORT,MA 0174‘ ;*" Undersecretary Commonwealth of Massachusetts fi Construction Supervisor Division of Occupational Licensure h, � p Unrestricted-Buildings of any use group which contain less than Board of Building Regulations and Standards 35,000 cubic feet(991 cubic meters)of enclosed space. ftf' Cons tc '1 o ' rvisor CS-094639 07101/2028 KEVIN J FAIL 100 HOMER9'DO YARMOUTH0 JRl • C7fJ,ti'dl� Failure to possess a current edition of the Massachusetts State / weeBuilding Code is cause for revocation of this license. Commissioner —`� 2 r sr� Contact OPSI:(617)727-3200 or visit www.mass.gov/dpl/opsi 32 Camelot Rd Yarmouth Port MA 02675 Basement Existing Bulk Head Proposed Mech Room Proposed [\Bath of SIM New Partition Walls ¢Q 4Va Plea Storage area to remain unfinished a¢' E sting Stair C e - Proposed Mechanical Room land ng New Proposed Bathroom E Exterior walls to receive insulation • 1111111111111111111111111111111101111111111111111 32 Camelot Rd, Yarmouth Port, MA 02675 Basement Existing Bulk Head Existing Unfinished Basement E Isting Stair Ca Land►ng