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HomeMy WebLinkAboutBLDR-26-429 application R E C E I V EOz ii+ & TWO FAMILY ONLY- BUILDING PERMIT ..__.__ —— - - — Town of Yarmouth Building Department /mpg-.Y.�.�, j 4 2026 1146 Route 28, South Yarmouth,MA 02664-4492 %� 4 p. AUG508-398-2231 ext. 1261 Fax 508 398 0836 ;e 1 - . .,.-41 ` Massachusetts State Building Code,780 CMR t� - i BU U...)1 N.;, C E ' t 1Ki g Permit Application To Construct, Repair, Renovate Or Demolish tic 4 f By L Y C 1 _ RpO R ATE____ 016- y;,_ '' Date Applied: Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 200 $uck T>:Jaud 124.,4131, w.Yarwtok'i . l.la Is this an accepted street?yes V no °a"3 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: 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 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public I/ Private CI Municipal Outside Flood Zone? Municipal ❑ On site disposal system I/ Check if yes SECTION 2: PROPERTY OWNERSHIP' 2/ Owner'°Record: I3 G -V ` Aut. r• bs(n IA). yarraot,.`t--i nifi aat73 Name(Print) City,State,ZIP 300 &&ckis)ar•ei cci., (.6;4- 13F .3-08- 69-75718 el dab bum No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction 0 Existing Building Owner-Occupied Erl Repairs(s) 0 Alteration(s) 117/1 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units / Other 0 Specify: Brief Description of Proposed Work': t3 as a n,e..►t -k a.W.•(! roo nn SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 8 -, 0. , 1. Building Permit Fee: $ Indicate how fee is determined: 0 Standard City/Town Application Fee 2. Electrical $ 9 SD, ' ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ — List: 5.Mechanical (Fire $ Total All Fees: $ Suppression) Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ /VI /SI). 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 CSL Type(see 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(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 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 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 enteri y name below,I hereby attest under the pains and penalties of perjury that all of the information contai d in is application ' true and accurate to the best of my knowledge and understanding. z toz� Print Owner's or Authorized Agent's Name(Electronic Signature) D 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.) (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 a L Office of Investigations m 7.. = �i1_ �y Lafayette City Center m l 2 Avenue de Lafayette, Boston,MA 02111-1750 ,s'` www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information // Please Print Legibly Name (Business/Organization/Individual): PA4 V • —0O1y a 1J Address: 3 00 .Lc.k 5 4.1d. Tact City/State/Zip: i 3 . ,, o�-/`j W1.-6Z�73 Phone#: 5 3- ZL9- 7,5L8 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. El 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 workingfor me in anycapacity. employees and have workers' P Y 9. ❑Building addition [No workers' comp. insurance comp. insurance.* e uired. 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions q ] officers have exercised their 11. Plumbingrepairs or additions 3. I am a homeowner doing all work ❑ P myself. [No workers' comp. right of exemption per MGL 12.❑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 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: 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 c rti under the p 'ns�aanAd penalties of perjury that the information provided above is true and correct Signature: cS '"4.5'`�� Date: z 26 7 Phone#: SZS.G-- 7 --2_SW3 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 5Elumbing Inspector 6.0Other Contact Person: Phone#: Information and Instructions ` Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and,if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Lafayette City Center, 2 Avenue de Lafayette Boston, MA 02111-1750 Tel. (617) 727-4900 or 1-877-MASSAFE Fax (617) 727-7749 Revised 7-2019 www.mass.gov/dia TOWN OF YARMOUTH '; Office of the Building Commissioner •V/ . ,No) D- 1146 Route 28, South Yarmouth, MA 02664 ,t4 _=�4'4 508-398-2231 ext. 1260 Fax 508-398-0836 \nzgPOq A ' HOMEOWNER LICENSE EXEMPTION DATE: JOB LOCATION: 300 Fi44k I /4,0d Qr b E$l AME STREET ADDRESS SECTION OF TOWN HOMEOWNER NAME � ( �0k) Jam' Zlo4- 75/8 S ivu.. ._ NAME HOME PHONE WORK PHONE PRESENT MAILING ADDRESS 5 A tit E 4 5 A-4 6,, Q CITY OR TOWN STATE ZIP CODE Definition of Homeowner: Person(s)who owns aparcel of land 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 Of C S-) 20'..5ar—f---) o Y TOWN OF YARMOUTH Fo lt Office of the Building Commissioner 1146 Route 28, South Yarmouth, MA 02664 ztotL. 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 debris7 resulting from the proposed work/demolition to be conducted at. 300 r74e/t' 17544,d Work Address /I Is to be disposed ofat the following location: 1/lAnss�z S4/JbYJ Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111,§150A. c2sL. D3,5.0 Signature of Applicant Date Permit No. Doc: 1 , 538 , 870 02-13— 026 12 : 48 3(----Ctf#:C1-13F • MASSACHUSETTS STATE EXCISE TAX N 0 EIARNSTABLE LAND COURT REGIST ( 0 T A NDate: 02-13-2026 12 12:48pm A N (3 Pages) Ct1#: 272r PLEASE RETURN T� F F I CFee: 1,�50.3o Consc)$4WS00/.d2 I A L Jim C. Hoye,Esq. COPY COPY BARNSTABLE COUNTY EXCISE TAX Hove&Duane,P.C. 21 McGrath Hiughway,Suite SUS BARNSTABLE LAND COURT REGISTRY Quincy,MA 02169 N 0 T N 0 T Date: 02-13-2026 0 12:48pm A N A N Ct1#: 272 Fee: $1,422.90 Cons: $465,000.00 en OFFICIAL OFFICIAL COPY QUITCLAIM DPti P Y We,Karen Tracey, being married, of East Greenbush,New York, and Kristen Cleveland, being unmarried,of Melrose, Massachusetts,as tenants in common, for consideration paid of Four Hundred Sixty Five Thousand($465,000) Dollars, grant to Paul G.Dobson and Diane F. Dobson,husband and wife, as tenants by the entirety, now of 300 Buck Island Road, Unit 13F, w Yarmouth,Barnstable County, Massachusetts, M WITH QUITCLAIM COVENANTS -0 That certain condominium situated in Yarmouth in the County of Barnstable and Commonwealth of Massachusetts, created by Master Deed dated February 15, 1972 duly filed with the Land Registration Office for the Barnstable County Registry of Deeds on March 15, 1972 as Document - No. 157445 as amended in accordance with the Provisions of G.L.c. 183A of Massachusetts described as follows: UNIT NO. 13F as described in the aforesaid Master Condominium Certificate of Title and Master Deed and indicated on Condominium Plan No. 32462 D4 together with and undivided fractional interest in the common areas as set forth in the Master Condominium Certificate and d Master Deed and as they may be or have been lawfully amended under Chapter 183A. cSubject to and with the benefits of all rights, reservations,restrictions and easements of record, insofar as the same arc in force and applicable. Upon recording of this deed, the Grantors, and their spouses, hereby waive any and all rights of Homestead in the property herein conveyed and warrant under the pains and penalties of perjury that there are no other persons entitled to any Homestead rights in the property pursuant to M.G..L. c. 188, and the Grantors never occupied said home as a primary residence. Meaning and intending to convey the same premises referenced in a deed dated April 18, 2003, registered at the Barnstable County Registry of Deeds, as Certificate of Title Number C1-13F. See also Order of Court dated January 23,2026,Registered as Document 1537975, Certificate of Title Number C1-13F. 1 0.10 N4,4 Doc: 1 ,538 , 870 02-13-2026 12 : 48 Page 2 of 3 NOT NOT AN AN OFFICIAL OFFICIAL WITNESS our hindis di d)fieals this 11 day of fribitaty,2026. NOT N O� OFFICIALAN // Atjv. COPY ; en rags O P STATE OF NEW YORK ,ss February�2026 (name of county) On this 11 day of February,2026,before me,the undersigned notary public,personally appeared Karen Tracey,who proved to me through satisfactory evidence of identification, which was a New York Driver's License, to be the person who signed the foregoing Quitclaim Deed in my presence and acknowledged to me that she signed it voluntarily for the stated purpose, as her free act and deed. Ni( -lhZiehVgee-/-A Public: r My Commission Expires: /ilal.th 9024z. ANTDNP TE L.MUR ai-IY filotary%1ST,State of New York Reg.Np•{i7(�TU5i3567t3 Qal,de.o rn t.=n---: County tisian tVitas MAR 04.20, 426 Doc: 1,538 , 870 02-13-2026 12 : 48 Page 3 of 3 NOT NOT AN AN P OFFICIAL OFFICIAL WITNESS our ands and seals this i 3/(day of el�ruazy2026. N O T ,N O T AN OFFICIAL C` ` )F COPY Kristen Cle ie?an2 1 COMMONWEALTH OF MASSACHUSETTS Middlesex, ss February l,2026 On this 1 1ii day of February, 2026, before me, the undersigned notary public, personally appeared Kristen Cleveland, who proved to me through satisfactory evidence of identification, which was a Massachusetts Driver's License,to be the person who signed the foregoing Quitclaim Deed in my presence and acknowledged to me that she signed it voluntarily for the stated purpose,as her free act and deed. tAICHAEL A. STANKAVISH ///,' A.)/ w�(7-OP Notary Public I;`' COMMONWEALTH OF on Ex HUSETfS Notary Public: Michael A. Stankavish +, My Commission Expires `,d' June 03,2027 My Commission Expires: June 3,2027 7 JOHN F. I,MADE, ASSISTANT RECORDER BARNSTABLE REGISTRY LAND COURT DISTRICT RECEIVED & RECORDED ELECTRONICALLY • , 300 Buck Island Road, Unit 13F, West Yarmouth PRIMARY BEDROOM ® .......„ 17' X 15' Pr er.4uxhic4 S,'QCe. C 0. LIVING ROOM I 17' X 19' r- .,,,, CLOSET BATH- ' X a D3 /71. OPENTO o I BELOW Zr a �,u,.. HALL _______ 19' X8' 7 BATH 8' X 5' BASEMENT I= � 17' X 33' ~ • P .1"."7 CLO !� ' =—.—t• , KITCHEN j 1 14' X 15' BEDROOM �� BATH 15' X 10' '. 5' X 5' Hi CLO I ®,® I % FOYER 0 0 I LIM= J 7' X 14' ! UPPER LEVEL �_i f , -•‹ MAIN LEVEL LOWER LEVEL f,,r t fockr it< RPO 111 410.-- ot , ,...„. «. y, a m : a:< »C<S a%L ; «a | 4 . ! i : . a ! \ i 41 ( ° < \ Z .y } ` ° « ƒ : - „.1 2 . / «® «._d ± ! } © \ . \ } . < 4 \:/ t < < : - . 1i : ! > =tea.$ \ \ 2 4 < . \ § © . r , . { } . < w ) : : ! . > ., , § § } \ } 2.2 . 2 : } y : .. .. . > . . i _ _ .. . } . / \ a | a . . . . ! /.. \ .2j