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EXPRESS BUILDING PERMIT APPLICATION
TOWN OF YARMOUTH
Yarmouth Building Department
1146 Route 28
South Yarmouth, MA 02664
(508) 398-2231 Ext. 1261
CONSTRUCTION ADDRESS: _ Z:� U H + 1� N r
ASSESSOR'S INFORMATION:
Map: -Z 9 'Parcel: Z
Unim use umy
Pamit�`D��
Fee S.
Permtt expires 6 moaft from
Issue date.
u -,e\ Nev-"
/SrGws)
OWNER. _wI I►%0..w. t`1 �-- _ S `( lMGss
NAME PRESENT ADDRESS 7u- # C Z-7 7 /
TRA CONCTOR: s a� ivt D y q A '-9 y 96
NAME MA LINO ADDRESS TEL #+
_Residential fomtnenc—ia7lp•) r� f ,. t E:t Cost of Construction S _ (�c� � /n� 416
home Improvement Contractor [ ic. / 1 Construction Supervisor Lief v i7 [� •�
Workman's Compensation Insbrmuee: (check one
rf• 1 nun the sole propnetoo 1 have Worker's Compensation Insurance
Insurance Company Name- � . _ Worker s Comp. Policy#
WORK TO BE PERFORMED
❑ Tent (Fire RetardaekChttifip'� attached) / ❑ Wood Stove Shed
Siding: # of Squares r �% yr • C RepLacement windows: #
Replaceneat doss: #
❑Re -roof: #ofSquaes j rJIawladon
() Stripping oid shatglea• ()going over • . NO ( C7 K H Ut-
i �t e,�reriL D: SinY-{ . /
`layers orexistisS root Old King: HighwayflRstor'cDiatrict bO �&3/AS
RooftnVSkHng (Uke for like)
*The debris vein be disposed of u: #44 it
Location of Facia
I declare under of t
P�� Pm1my that the statements herein contained are true and wrtect to the bear of cry "ledge aad/beRef ' I vuckrstaod that any lulu answer(s)
will be just cause for denial or tr�f .11c a aced for prosecution under K" (X 269. Section 1.
A (. ,A
Applicant's Sianao�re Date•.
f Of
Owners Sigmtors (or atmchmerK) Data• / -
Approved By _ Dare•.
Butidmg orticiai (or design«)
PEE P P A Zu15 `
Zonin; Distrk fk t
meal District Yes No
r Resource Protection District:
Yes No
Flood Plain Zone: Yes No
Within 100 tt. of Wetlands:
Yes No
O=' �_
�/j� 3Ot
t ;
The Commonwealtl't ofMassaehusetts
Department oflndusi rid Accidents
Of ee of Invesdgadony
600 Washington street
Boston, MA 02111
►vww.massgov/dia
Iftlltnsn/ T.. t'n�w.satw�
Worker' Compensation Insurance Affidavit: Builders/Contractors/Electricisns/Plumbers
Name(Htuiaas/Oryanirat+oallndividual):
— — — - ...` runts.,
Are you as employer? Check the appropriate box:
L I am a employer with 4. 0 I am a Seneral contractor and I
employees (&U and/orpart-time).have hired the
2.,® I am a sole proprietor or partner- listed on the attached sheet
ship and have no employees These sub -eons actor haw
working for me in any capacity.
[No worker' comp. insurance
required]
3. ❑ I am a homeowner doing all work
myself [No workers' comp.
ins%nance required.] 7 t
3a.13 I am a homeowner acting as a
general contractor (refer to #4)
employees and have workers'
comp. iaitrancmt
5. ❑ we are a corporation and its
officers have exercised their
right of exemption per MCI,
c. 152. 41(Q. and we have no
employees. [No workers'
comp. insurance nwaired_1
ry
Type of project (required):
6. 0 New eomMuction
7. 0 Remodeling
8. ❑ Demolition
9. 0 Building addition
10.0 Electrical repairs or additions
If -[3 Plumbing repairs or additions
12.0 Roof repairs
13.gOther d I
*Any applicant that cheeks box it meta also ml out the aectioa below showing Oak wotksysff
�
Homeowner who submit this" a they am doing all work and then hire oumde woea� MM submit a now affidavit indicating su&
lCoonsetor that Cheek this bmt must attached a additional sheet showing dw same of dw and sofa wbobworam thong entitles have
en*oy If the anb.00ntraCmn have eWloyas, they nest puovida then, wmtW Comp• policy atmebe,.
an air employer that is proridlna workers'rompersadon bssaraiseefor my tmp/oym Belotr it dFe
lnformwdo s PO&7 and job rile
Insurance Company Name:
Policy g or Self -Ins. Lic. #. Expiration Date -
Job Site Address: City/Sutemp:
Attach a Copy of the workers' Compensation policy declaration page (showing the policy number and expirstlos date).
Failure to secure coverage a regWred under Section 25A of MOL c. 152 can lead to the imposition of aimimi penalties of a
fuse ltP to Si,500.00 and/or one-year imprisomr)ent, as well as civil peaslda is the Coma of a STOP WORK ORDER and a fine
of UP to 5250.00 a day against the violator. Be advised that a copy of this statement >� be forwarded [o the Office of Investigations of the DIA for insurance coverage verifiatmn
h"'rAY cam' , /�/ / / A ofpedwy fl oat the btforaaetdon pr+ovWd above Is t>rate and eorrnt
081kla1 we only. Do not write In L% em% to be compk*d by city or tower o07daL
City or Town: Permitildcense 0
Issuing Authority (circle one):
1. Board of Health 2. BuMnf Department 3 Cityrr en is
6. Other own er 4. Electrical Inspector S. Plumbing Inspector
Contact Pesos: Phan #:
1"f Massachusetts - Department.of Public Safety
" Board of Building Regulations and Standards
Conctructiun Superi kor
License: CS-080546
WILIAA111 J KACZO
39 CHESTNUT St j c
SEEKONK NIA 0277f
Expiration
dt Commissioner 0612612015.
Office of Consumer Affairs & Business Regulation - Mass.Gov
Page 1 of 1
The Official Website of the Office of Consumer Affairs & Business Regulation (OCABR)
Consumer Affairs and Business Regulation
Home Consumer Rights and Resources Home Improvement Contracting
HIC Registration Complaints
=#179752
Name
WILLIAM KACZOWKA
Address
39 CHESTNUT ST
City, State Zip
SEEKONK, MA 02771
Expiration Date
09/08/2016
Complaints Details
No comp:alals iOuad fo this royis'U—zM .
("Vo fro M P t.a-% rn rx
You can also view arbitration and Guaranty Fund history.
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® 2012 Commonwealth of Massachusetts.
Mass.GovO Is a registered service mark of the Commonwealth of Massachusetts.
e� ) F
d
Nov �
Home Improvement Contractor
Registration Home Page
httpJ/services.oca.state.ma.us/hic/licdetails.aspx?tKtSearchLN=81687 2/20/2015
. • Vision Government Solutions
Pagel of 3
151 BAYVIEW ST
Location
151 BAYVIEW ST Assessment $310,100
Mblu
28/ 29/ / / PID 1289
Acct#
1289 Building Count 2
Owner
KACZOWKA WILLIAM 3
Current Value
Assessment
Valuation Year
Improvements
Land
Total
2015
$187,700
$122,400
$310,100
Owner of Record
Owner KACZOWKA WILLIAM 3
Sale Price $400,000
Cc -Owner KACZOWKA NOREEN A
Book & Pape 16774/ 248
Address 39 CHESTNUT ST
Sale Date 04/18/2003
SEEKONK, MA 02771
Ownership History
Ownership History
Owner Sale Price Book & Page Sale Date
MCMAHON THERESA3 $99 16694/196 04/03/2003
MCMAHON WILLIAM) $0
Building Information
Building 1 : Section 1
Year Built:
1930
Living Area:
1248
Replacement Cost:
$167,581
Building Percent
68
Good:
Replacement Cost
Less Deoreelation:
5114.000
Building Attributes
Field
Description
Style
Ranch
Model
Residential
Grade:
Average
Stories:
1 Story
Occupancy
Exterior Wall 1
Aluminum Sidng
Building Photo
(http:ffimages.vgsi.coMphotos/YamwuthMAPhotos//\00\00
\60/93.3pg)
Building Layout
http://gis.vgsi.com/yarmouthma/Parcel.aspx?Pid=1289 2/23/2015
. Vision Government Solutions
Page 2 of 3
Exterior Wall 2
Roof Structure:
Gable/Hip
Roof Cover
Asph/F GIs/Cmp
Interior Wall 1
Plastered
Interior Wall 2
Interior Fir 1
Hardwood
Interior Fir 2
Carpet
Heat Fuel
Gas
Heat Type:
Steam
AC Type:
None
Total Bedrooms:
3 Bedrooms
Total Bthrms:
1
Total Half Baths:
0
Total Xtra Fixtrs:
Total Rooms:
Bath Style:
KRchen Style:
Building 2: Section 1
Year Built:
Living Area:
Replacement Cost:
Building Percent
Good:
Replacement Cost
Less Depreciation:
1930
1200
$106,171
68
$72,200
Building Attributes: Bldg 2 of 2
Field
Description
Style
Duplex
Model
Residential
Grade:
Below Average
Stories:
I Story
Occupancy
Exterior Walt 1
Wood on Sheath
Exterior Wall 2
Roof Structure:
Gable/Hip
Roof Cover
Asph/F GIs/Cmp
Interior Wall 1
Plywood Panel
Interior Wall 2
Interior Fir 1
Pine/Soft Wood
Interior Fir 2
Heat Fuel
Gas
Heat Type:
Hot Water
AC Type:
None
Total Bedrooms:
4 Bedrooms
Building Sub -Areas Legend
Code Description
Gross
Area
Living
Area
BAS First Floor
1248
1248
FEP Porch, Enclosed, Finished
351
0
UBM Basement, Unfinished
1248
0
f
2847
1248
Building Photo
(http://Images.vgsl.com/photos/YarmouthMAPhotos//\00\01
\05/38.Ipg)
Building Layout
http://gis.vgsi.com/yarmouthma/Parccl.aspx?Pid=1289
2/23/2015
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Mamchusem Electrical Code, (MEC), 527 CMR 12.00
(OFFICE USE ONLY
�JI' Rn 0 By —
Fee: $S�
A7�R"1 5 2004 �J
PERMIT NO. / S�
BUILDING DEPT, _
(PLEASE PRINT IN INK Oft"'"T E AU ' IFOR L4VON) Date: /" 40 V
To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical
work described below.
Location (Street & Number) I 5 ( L-_l Lf)
Owner or
Is this permit in conjunction with a building permit? Q Yes MNo (Check Appropriate Box)
Purpose of Building / v Utility Authorization No.
Existing Service ¢ Amps 20 Volts Overhead Undgrd Q No. of Meters
New Service Amps /ZO / A 4D Volts OverheadO Undgrd Q No. of Meters
Number of Feeders and
Location and Nature of Proposed electrical
Camnletian of the fallax•inP table may be x aived by the Insnector of Bires
No. of Total
of Recessed Fixtures
o of it - addl Fans
Transformers -KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators KVA
Above n-
Q
No. o Emergency Lighting
No. of Lighting Fixtures
Swimming Pool gmd. gmd.
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches -
No. of Gas Burners
o. of Detection an
Initiatin Devices
No. of Ranges '1
No. of Air Cond. Tons
No. of Alerting Devices
No. of Waste Disposers G
Heat mp
Totals:
um r
— —
-loss-
—
— —
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Spg ace/Area Heating KW
Local Q Municipal Connection Q Other
No. of Dryers
rY
Heating Appliances KW
g PP
Secutity Syystems:
No. of Devices or ui valent
No. of Water
No. of No. of
Data Wining
Heaters KW
Si Ballasts.
No. of Devices or Equivalent
No. H dromassa a Bathtubs
Y g
No. of Motors Total HP
Tel No capqons Wiring:
No. ic-or Equivalent
O
Attach aaattional detail tf aesirea, or as required by the inspector of Wires.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued unless the licensee provides
proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in
force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE BOND[] OTHERQ (Specify:)
(Expiration Date) '
Estimated Value of Electrical Work: �� (When required by municipal policy.) r
%� Work to Start: S ef/ fAiC-- Inspections to be requested in accordance with MEC Rule 10, and upon completion.
kZ I certify, under the pains aad penalties of perjury, that the information on this application is true and complete.
`FIRM NAME: ✓'I S /} /tih ! [ GGT✓YGA / LIC. NO. 33 6 %D
M Licensee: Cam► �.S 4�y vQ Signature LIC. NO. -M. _( 76 F
(If applicable, enter "exempt" in the license number line.) Bus. Tel. No.:.3 Z. Co -eS/'%/�%
Address: 9 Z.3i&� ,;-e✓"GliGL.% 5,cZ4 CO U.0 Alt. Tel. No.: 3 4 `t 609' 7
\OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature
low, I hereby waive this requirement. I am the (check one) owner owner's agent.
be
Owner/Agent
Signature Telephone No.
(Rev. 04100]
OFTOWN OF YARMOUTH Building Department BUILDING
. - .... , (508) 398 2 ext.2
(79N�;Plw
PERMIT NO 6-04296 .
ISSUE DATE PERMIT
:...9/5103...: PROPOSED U E
APPLICANT W�1II "a"McMahon""""""" "' JOB WEATHER CARD
•.
- PERMITTO Repair'
AT(LOCATION) 100151BAYVIEWST ZONING DISTRIC R-25 Bldg. Type: Resklential
SUBDIVISION MAP LOT BLOC 102829 BUILDING IS TO BE: CONST TYPE b-B USE GROUP R-4
LOT SIZE O
CONTRACTOR
REMARK strip and reroof, paper and vent to code ( 30 Arlington Street) LICENSE 0
AREA (SO FT) EST COST ($ $9,000.00 PERMIT FEE ($) $50.00
OWNER IWILLIAM J MCMAHON - BUILDING DEFT BY
ADDRESS 139 Chestnut Street
Seekonk MA 02771
INSPECTION RECORD
Date _ Note Proaress - Corrections and Remarks
FIELD COPY
r
I
Sege Ce (S D
�56 lu P`%A\
i
i
TOWN OF YARMOUTH
WATER DEPARTMENT
99 Buck Island Road
West Yarmouth, MA 02673
Telephone: (508) 771-7921 • Fax: (508) 771-7998
NOTICE
July 8, 2008
Service #: 3580 Service Address 151 Bayview Street
Map & Lot 028.29 Certified Mail #:
0 New structure YkExisting Structure
Dear Mr. Kaczowka:
This is to advise you the Town of Yarmouth Water Division or their authorized agents have installed a
new water service or rehabilitated an existing water service at the above service address.
Materials used during this installation are electrically nonconductive.
The Town of Yarmouth Water Division regulations prohibit the use of this water service as a
grounding device for your electrical service.
It is recommended you contact an electrical contractor to ensure your electrical service grounding is
in compliance with the Massachusetts Electrical Code, CMR, S27-12.00 Article 250.
A copy of this notice is being forwarded to the Town of Yarmouth Wiring Inspector.
Sincerely,
,�
Dan Mills, Superintendent
Cc: Wiring Inspector
72112D15 SlipGen- Portal Hone
Town of Yarmouth
`l Template [Building Dept]
■
1.
Slipsheet Identifier [sg33951]
Document Category
Building Permits
Map -Block Number
028.29
Street Number
0151
Street Name
BAYVIEW ST
Department
Building
Parcel ID
1289
Backfile Batch Scan
Document?
Additional Naming Info
Index Operator
Date - Time
No
Operator, Yarmscan
2015-07-21 - 09:41
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