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Home My WebLink AboutB-10-069 # 97 Building PermitsSECTIONS: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor (CSL) CS &eJ1 gZ 7�31� ra MAM&W 1001411,L License Number Expiration Date Name of CSL- Holder i� 4a4t l &AIVEZ lM-4 List CSL Type (see below) V ly�UG�� T Description Unrestricted to 35,000 Cu. Ft.) R Restricted 18c2 Family Dwelling Signature Sdg M Masonry Only RC Residential Roofing Covering WS Residential Window and Siding Telephone SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition 5.2 Registered Home Improvement Contractor (HIC) ) 2S9gL Registration Number 44101910 HIC Company Name or HIC Registrant Name /t!0 v�tuRi�J Gir¢r,GL /y �J MA D 6W Expiration Date Signature Telephone SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152.1 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 ........... ❑ 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. Signature of Owner Date SECTION 71b: OWNER' OR AUTHORIZED AGENT DECLARATION I , as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and behalf. Print Name Signature of Owner or Authorized Agent Date (Signed under the pains and penalties of ) NOTES: I. 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 U have access to the arbitration program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program and Construction Supervisor Licensing (CSL) can be found in 780 CMR Regulations 110.116 and I IO.RS. respectively. 2. When substantial work is planned, provide the information below: Total floors 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" TOWN OF YARMOUTH 0 BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT. Job Location: I Z 1 CAMP t Wrr q7 ciA11 &w , Number Street Village Owner of Property: Construction Supervisor: �1'% d�ll{iLL GS G�f?SL �Og S�S9 �89J Name License No. Phone No. Address: /60 5-(,JA-iA1 e-1a- a MNSKO , �ys� D2G47 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 he 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 tinder 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 liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes a No ❑ If you have checked yam, please indicate the type coverage by checking the appropriate box. A liability insurance policy If Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 152 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: 94 Signature of Owner or Owner's Agent Owner ❑ Agent ❑ Signature: GJ Building Official Approval: 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: Est. Cost Address of Work 121 V �%• 1J�✓i T 9% Owner Name: /t/ • #, G• A . Date of Permit Application: 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: Date Contractor Name Registration No. OR: Notwithstanding the above notice. I hereby apply for a permit as the owner of the above property: Date Owner Name The Commonwealth of Massachusetts Department of Industrial Accidents kq�jl Of,�iee of Investigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (BusinessOrganization/Individual): 114#WA74) _(00 fa_ Address: A) City;'State/Zip: / 4 /0A 6Wlilq Phone #:.lV SoB' "? TVV Are you an employer? Check the appropriate box: 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 2.V 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 required.] comp. insurance. 5. ❑ We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per NiGL insurance required.] t 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 t LE] Plumbing repairs or additions 12. ❑ Roof repairs 13. ❑ Other *Any applicant that checks box # 1 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. tConowtors 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' cony. 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 e. 152 can lead to the imposition of criminal penalties of a tine up to Q 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 $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above ist true and correct. Smnatti-re: _ 4tit%� Date: &j/Tis//OI _ Phone «: fOg" 5-39' 4971 use only. Donor write in fibs area, to be completed by city or town official City or Town: Permit/License # Issuing authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: TOWN OF YARMOUTH 1146 ROU- TE 28 SOUTH YARMOUTH MASSACHUSETTS 02664- 451 Telephone (508) 398-2231, Ext. 261 — Fax (508) 398-2365 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT BUILDING ELECTRICAL GAS PLUMBING SIGNS Pursuant to M.G.L. Chapter 40, Section 54 and 780 CNIR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at :�-r yNif` y-7 Work Address is to be disposed of at the following location: ,dam Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. 0 Signature of Applicant Permit No. "101 Date ROSSETTI ASSOCIATES, INC. CONSMUMON MANAGEMENT CONSUTTMM 23 Evemtt Stred Franklin, MA 02038 Tek9ho6e: 508-528-507I Fa$ 5.WS28-1834 Email: To: Town of Yarmouth Building Inspector Date: June 31, 2009 Re: Villages at Camp Street Mill Pond Village Yarmouth, Massachusetts Dear Sir/Madam, A few months ago, Rossetti Associates, Inc. was engageoas the Owner's Representative to assist the Massachusetts Housing Finance Agency [A]'wvith construction consulting and administrative services in connection with— completing outstanding issues that included capping the existing concrete foundations located on lot #s 96 97 and 98 at the Mill Pond Village residential project in Yarmouth, Massachusetts. It's my understanding that Mr. Alan Perrault of Horizon Partners, LLC [Horizon] was the former facilitator for MHFA, and that Horizon provided you with written correspondence on February 10, 2009 authorizing you to issue the requisite permits to Matthew Dunhill [dba Matthew Dunhill, Builders], 16 Swain Circle, Mashpee, MA 02649 to complete the work that remains. I am writing this letter to advise you of my involvement -with MHFA and this project and to authorize you to issue the requisite permits to Mr. ll for capping the single- family dwellings on lot #s 96 97 and 98. An as-bui#-fr unoation] plan for each lot was obtained from Holmes & McGrath, Inc., Civil Engineer,.-, ik-1-axid Surveyors of Falmouth, MA, and those documents should have been given to you by Mr. Dunhill for record purposes. Sincerely, Richard W. Rossetti President Mr. Richard J. Herlihy Development Officer Massachusetts Housing Finance Agency One Beacon Street, 29's Floor Boston, MA 02108 TOWN OF YARMOUTH Building Department Town Hall Yarmouth, MA 02664 (508) 398-2231 ext.261 BUILDING PERMIT Temp Permit No.: Applicant Name: Applicant Phone: Building Location: Owner's Name: Owner's Addres Owner's Telephone REVIEWED BY: TRANSMITTAL T-10-021 Matthew Dunhill 5085399891 0121 CAMP ST Unit 97 M.H.F.A. 1 Beacon Street Boston MA (617) 854-1000 (OFFICE USE ONLY Recorded By: Ic Permit Fee: $35.00 Deposit Rec: $0.00 Payment Type: Check ChkNo.: 0 Net Owed: $35.00 Application Date: 7/7/2009 Issue Date: Expiration Date toomments: Map/LOt: U4421.1 permit transfer - refer to B-07-887 new construction: 2 baths, 3 bedrooms, 1 greatroom, 1 kitchen as per plans dated 11/17/06. 1. WATER DEPARTMENT: DATE: N/A: 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: 7/10/2009 The Commonwealth of Massachusetts Board of Building Regulations and Standards Massachusetts State Building Code, 780 CMR, 70 edition Building Permit Application To Construct. Repair, Renovate Or Demolish a One- or Two -Family Dwelling This Section For Official Use Only Building Permit Number. Date Applied: Signature: 7 4/ yZ 1 S Building Comrnissioner spector of Buildings �� SECTION 1: SITE INFORMATION 1.1 Property A dress: IZJ��t� 5T OnJ/T 17 1.2 Assessors Map & Parcel Num ers 44V % Map Number Parcel Number I . I a Is this an accepted street? yes no 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: 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. 40.154) Public-S' Private ❑ 1.7 Flood Zone Information: Zone: _ Outside Flood Zone? Check if es❑ 1.9 Sewage Disposal System: Municipal ❑ On site disposal system �— SECTION 2: PROPERTY OWNERSHIPt 2.1 Owner' of Record: Name (Print) Adds for Service: 1&/Z ` s-C - /00 Signature Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK' (check all that apply) New Construction ❑ Existing Building ❑ OwnerAkeupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units I Other ❑ Specify: Brief Description of Proposed Work 2: :19A SQL, or A i"IT SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: (Labor and Materials) Official Use Only 1. Building S I. Building Permit Fee: S ndicate how fee is determined: ❑ Standard City/Town App ication Fee ❑ Total Project Costa ( Item 6) x multiplier x 2. Other Fees: S� List: 2. Electrical S 3. Plumbing S 4. Mechanical (HVAC) S 5. Mechanical ( Fire Su ression) S Total All Fees: S Check No. Check Amount: Cash —�'" dh ❑ Paid in Full ❑ O n@t0*ngF h. Total Prnject Cost: S ju Its DLirt,1Ni,U P7 By