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ONE & TWO FAMILY ONLY- BUILDING PERMIT' ___.___- ____ -
Town of Yarmouth Building Department -'per YA K
1146 Route 28, South Yarmouth,MA 02664-4492 1� .4p
508-398-2231 ext. 1261 Fax 508-398-0836 t ;rk 1
Massachusetts State BuildingCode, 780 CMR �.
Building Permit Application To Construct, Repair, Renovate Or Demolish `,_ti,,,, E 5`b,,q,
OAATE�
a One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: bi DR-'lo 1p-3-7 3 Date Applied:
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
147 White Rock Road,Yarmouthport,MA 02675 114 94,lot 3 PB 197 PG 91
l.la Is this an accepted street?yes XX no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
RES. 12,000 120 ft.
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
35 ft. 9 in. 40.7 ft, 20.9 ft. 37.5 ft.
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 X Private❑ Check if yes❑ Municipal❑ On site disposal system NIX
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Leonard and Patricia Curran Yarmouthport, MA 02675
Name(Print) City,State,ZIP t eC('cxJ I'L @ rn ail.corn
147 White Rock Road 774-994-0771 lec4@gmail.com
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction 0 Existing Building Owner-Occupied EY Repairs(s) ® Alteration(s) lxl Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work':existing sun room,propose to move exterior door to opposite side,replace windows and rotted trim
replace cedar shingles on exterior,move exterior stairs to new door on opposite side,replace interior wood paneling with
sheetrock,tape&joint compound.
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
jLabor and Materials)
1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ 0 Standard City/Town Application Fee
0 Total Project Cost3(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees:$
Check No. Check Amount: Cash Amount:
—
6.Total Project Cost: $ I l 1 boy0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
N/A- homeowner pulling permit License Number Expiration Date
Name of CSL Holder
- Z. 4On
List CSL Type(see below)
No.aneM
etwee
•PYY � . Type Description
7 �AI/� �o /�/e� U Unrestricted(Buildings up to 35,000 cu.ft.)
City/Town,State,ZIP I t R Restricted I&2 Family Dwelling
wnL 41./4*.do / Masonry
A vr41'/ � V
C�R Roofing Covering
VWindow and Siding
..i/ SF Solid Fuel Burning Appliances
77i ' 19'/ a 77/ I Insulation
Tel Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
N/A-homeowner pulling permit 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 0 No
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 N/A
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.
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.t=.ov/oca Information on the Construction Supervisor License can be found at www.mass.g_ov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq. ft.) 1414 (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) 1414 Habitable room count 6
Number of fireplaces 1 Number of bedrooms 2
Number of bathrooms 2 Number of half/baths 0
Type of heating system gas hot water 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"
The Commonwealth of Massachusetts
Department of Industrial Accidents
i
• Office of Investigations
_ Lafayette City Center
A 4 2 Avenue de Lafayette, Boston,MA 02111-1750
www.mass.gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/PIumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): Leonard and Patricia Curran
Address:147 White Rock Road
City/State/Zip:Yarmouthport, MA 02675 Phone #: 774-994-0771
Are you an employer? Check the appropriate box:
Type of project(required):
1. I am a employer with 4. E I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. E New construction
2.E I am a sole proprietor or partner- listed on the attached sheet. 7. E Remodeling
ship and have no employees These sub-contractors have 8. E Demolition
workingfor me in anycapacity. employees and have workers'
p Y 9. ❑Building addition
[No workers' comp. insurance comp. insurance.*
required.] 5. E We are a corporation and its 10.E 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 12.0 Roof repairs
insurance required.] i c. 152, §1(4), and we have no porch refurbishment
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. [f 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:
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: Date: `,/ •. f'.'''�
Phone#: `7 1 99 z z, 77/
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):
l0Board of Health 2❑Building Department 31:City/Town Clerk 4.:Electrical Inspector 5E'lumbing
Inspector 6.0Other
Contact Person: Phone#:
TOWN OF YARMOUTH
,� YAOffice of the Building Commissioner
-rod 1146 Route 28, South Yarmouth, MA 02664
#fNS 508-398-2231 ext. 1260 Fax 508-398-0836
HOMEOWNER LICENSE EXEMPTION
DATE:
JOB LOCATION: Curran 147 White Rock Road, Yarmouthport, MA 02675
NAME STREET ADDRESS SECTION OF TOWN
HOMEOWNER same 774-994-0771
NAME HOME PHONE WORK PHONE
PRESENT MAILING ADDRESS same
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/or farm 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 /'
F TOWN OF YARMOUTH
'� ` ':w ' Office of the Building Commissioner
1146 Route 28, South Yarmouth, MA 02664
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. 147 White Rock Road, Yarmouthport, MA 02675
Work Address
Is to be disposed of at the following location: Town of Yarmouth, 606 Forest Rd.,W Yarmouth
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, §150A.
-4, Z .s • 7/02 # �—C
Signature of Applicant Date
Permit No.
I
\\ ,I
N ..� Scope of Work- Porch sunrnom refurhishmPnt
A. remove existing entry/stairs and hot water
.
. �y baseboard on opposite wall in same location
`\ i2,
�.. B. add new entry/stairs on opposite wall in
-A • same location. y
12.00Loi SF± \N C4--.
°� ,2 `� C. replace existing casement windows with
�° °�o• `\ �p new similar 3 panel, casement window unit,
i\ —57 and white cedar shingle siding on 3 exterior
sides.
/
/ D. replace interior wood paneling with
,/ /7 ;,\ sheetrock, tape &joint compound.
' /a / .. 0
' EXISTING //Q 4 / 2P0.�/ N .
bk NG 1
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PLOT PLAN
SCALE : 1" = 20' DATE : FEBRUARY 23, 2007
, , 484
7PREPARE�D)FOR:�T off 508-362-4541 SHOWNN THIS PLAN IS LOCATED ONT THE THE ��'P`�N OF,t Y'°- JOHN WALSH fax SOB-362-9680 GROUND AS SHOWN HEREON. 42 TIMOTHY SG
down cape engineering, Inc. - FL PREPARED EXCLUSIVELY FOR THE PURPOSE OF OBTAINING A BUILDING PERMfi,NOT FOR ANY OTHER USE
— COVEti.
CIVIL ENGINEERS u No.38036 y LOCATION : 147 WHITE ROCK ROAD YARMOUTH PORT,MA
LAND SURVEYORS 2j � � d•
DCE #07-018 su
939 main rt.parmouWport,10 02675 -->— REFERENCE : ASSESSOR'S MAP 114 PARCEL 94
DA R . LAND SURVefOR LOT 3 PB 197 PG 91
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FLOOR PLAN
GROSS INTERNAL AREA
FLOOR PLAN 1,368 sq.ft.
EXCLUDED AREAS BALCONY 10 sq.ft.
TOTAL : 1,368 sq.ft
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