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Home My WebLink AboutBLDR-26-354 application R E C E I V E S & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department di-YAK JUL 10 2026 1146 Route 28,South Yarmouth,MA 02664-4492 Z p` 508-398-2231 ext. 1261 Fax 508-398-0836 C ( Massachusetts State Building Code,780 CMR 0j.-3BUILDING DEPARTt _ \ �+. .�By _ uilimg Permit Application To Construct, Repair, Renovate O Demolish '�"CORpaR„�EO, a One-or Two-Family Ave/ling -,--- This Section For Official Use Only Building Permit Number: 4--DR Ofo-35-L1_ Date Applied: Building Official(Print Name) Signature Date SECTION l:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 4t -c lEwr�. - - tzz ____ 1.la Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: t Zoning District Proposed Use Lot Area(sq ft) Frontage(II) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided W` '4Z' 20 4Zmy36 1.6 Water Supply:(M.G.1.c.40,154) 1.7 Flood Zone tutor tion: 1.8 Sewage Disposal System: Public 4t Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system M. Cheek if yea. SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Name(Print) City,State,ZIP ey " No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building% Owner-Occupied a Repairs(s) 0 Alteration(s),B1. Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work': V4 rTAA. InctaiNkke. C:l.fxrer5 --- - i' SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) I. Building $ 4 Too I. Building Permit Fee:$ Indicate how fee is determined: — 0 Standard City/Town Application Fee 2. Electrical $ f d O - 0 Total Project Cost'(Item 6)x multiplier _ x 3.Plumbing $ t;�j� 0 2. Other Fees: $______ 4.Mechanical (HVAC) $ List: t 5. Mechanical (Fire $ Total All Fees:$ Suppression) Check No. Check Amount: Cash Amount: __ 6.Total Project Cost: $ laiS))OOO 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number Expiration Date Name of CSL Holder List CSI.Type(set below) -- No.and Street Type Description 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(111( ) Expiration Date HIC Company Name or HIC Regi HIC Registration Number strant 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 fil- 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. 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 contained in this application is true and accurate to the best of my knowledge and understanding. --ritot-z10 Print Owner's or Authorized Agent's Name(:lect i . i ture) 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(111C)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„govtoca Information on the Construction Supervisor License can be found at ,,‘,-.,.‘,‘.111 ,, alvAIN 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 3. "Total Project Square Footage"may be substituted for"Total Project Cost" Open _._ ._ r TOWN OF YARMOUTH 4 Ya.. Office of the Building Commissioner a s' .�0 11.46 Route 28, South Yarmouth, MA (l2( 6 off- `� 508-398-2231 ext. 1260 Fax 508-398-0836 HOMEOWNER LICENSE EXEMPTION DATE: JOB LOCATION: _, Isekyt,g KmAk Ack. eoweecenteNhAme. v i N,1 M L �� ST�� A[�j�REi�SZ� SECTION OF TOWN HOMEOWNER 2- NAME !IMF PHONE WORK PHONE PRESENT MAILING ADDRESS � e" 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 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations (.' Lafayette City Center 2Avenue de Lafayette,Boston,MA 02111-1750 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information ��.�, Please Print Legibly va Name(BusinessiOrgantion/Individual): �ttttQ'%4 v KLUbl _ Address: tittSEIMMREAS> � u$ City/State/Zip: ►tIll i(4-02/ TS Phone#: �!� 2A0 'r2 Are you an employer?Check the appropriate box: Type of project(required): 1.0 1 am a ernP1oYer with 4.0 l am a gfneral contractor and employees(full and/or part-time).' have hired the sub-contractors 6. 0 New construction 2.❑1 am a sole proprietor or partner- listed on the attached sheet. 7. RI Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity employees and have workers' 9. Building addition [No workers'comp.insurance comp.insurance.: required.] 5.0 We are a corporation and its 10.tid Electrical repairs or additions 3.K 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.] c.152,§1(4),and we have no employees.[No workers' 13.0 Other comp.insurance required.] 'Any applicant that checks box k I must also fill out the section below showing their workers'compensation policy information. 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 employee,if the sub-contractors have employees,they must provide their workers'comp policy number. l am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. s I do hereby certify under the pains and penalties of perjury that the inJitrniation provided above is true and correct. Signature: Dote:�j /� Phone#: S80 � �`'2 Official use only. Do not write in this area,to he completed by clay or town official. City or Town: Permit/License# Issuing Authority(check one): lDBoard of Health 2E1 Building Department 3E1City/TownClerk 4.0Electrical Inspector 5EPlumbing Inspector 6.[jOther Contact Person: Phone#: A TOWN OF YARMOUTH Office of the Building Commissioner , �l 1146 Route 28, South Yarmouth, MA 02664 �ruuttse � 508-398-2231 ext. 1260 Fax 508-398-0836 DEMOLITION DEBRIS DISPOSAL APPLICATION Pursuant to M.G.L. c.40 §54 and 780 CMR Section 105.3.1 #4. I hereby certify that the debris resulting from the proposed work/demolition to be conducted at. A" (jsj Work Address Is to be disposed ofat the following location: tet.ACLITTI Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, §150A. _ • 7 (10 (740 • Signature of Applicant Date Permit No. .1 ty.4 401 Z.aZ42 t Mtetl NweteAtZd Kt114 46 ell tivagJ< t Y,b,-QttpuTA'Pow tAA 02E S 502) 2140 A-Z 86 'Btx.K+leAD e 59 1... CLI�SB'( PuaMBtt ASS R I (47 NQ nz ] 11C V C0tu cala, et' l I" 1= 46HeD 4 I 1 riet$CJN tc AQ eki-ta4c0. M - _ ZtnvliPe..-5.0 f off 6'5" - - - sin oCLS 1 J Ai �- 14 6`t i cow gjCISZINEc Bo�l2 - � _ LOCa�itxl ntt 13p_attpe er�tiy.tN,0 Acre- s vPaar s,..3Q Es ftc�`3`0 tact Ws/L SAS Nt' '^ T pE. t4eRN- czecessen tAtarnit4LA tNsuL/ €- exce-gins V' U.S Rt°.) Az., 1 Syr. .. t. . d: r 4.• I • N. •w 1 .. ♦ 4 • . • • b--. r • Item # bci531496 Panasonic WhisperComfort 40 CFM 0.8 Sone Ceilinc Mounted Spot Energy Recovery Ventilator with Balanced Ventilation Model:FV-04VE1 from the WhisperComfort Collection * * * * (9) 4 RIB l $436.49 PRO PRICE Finish: White - 26 In Stock Delivered to 02675 by Tuesday, September 26th - Shipping to 02675 -� Add to Cart Save to Project I__ Compare Return & Shipping Details Customers Also Viewed • r air do Soler and Palau TR300 Soler and Palau TR90 Soler and Palau TR130 $1795.77 $1033.56 $1202.40 Details Features: • Characterized by two ducting components,stale air gets exhausted out of one duct, while the other replenishes the fresh air supply from outside. • Balanced pressure system provides fresh air to replace exhausted musty air. • Two Sirocco fans driven by a capacitator motor power this Energy Recovery Ventilator. • Both barometric damper and electric damper prevent backdrafting in Exhaust Air Duct and Outdoor Air Duct. • Capillary Core recovers energy from humidity, and transfers heat and moisture into incoming cold air in a heating climate,and is capable of working conversely in a cooling climate by reducing the amount of humidity in the incoming air. Technologies: • Spot Energy Recovery Ventilator: Ideal for the single rooms like the home office, den,or family room,this spot Energy Recovery Ventilator provides a continuous rate of air exchange. Balanced pressure ventilation allows fresh air to be supplied through one duct,while stale air is promptly exhausted through the other, restoring healthy air to your living environment. • Patent-Pending Capillary Core:WhisperComfortTM Fans efficiently transfer heat and moisture to the incoming air supply to regulate humidity levels and temperature