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MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITY I Yarmouth MA DATE A n127 2015 PERMIT# 13� IS-Of7SJ��
JOBSITE ADDRESS 1267 Buck Island Road OWNERS'NAMEJ Ms. Pamela Cassidy
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OWNER ADDRESS I Same TELI FAX
OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL 0
NEW. ❑ RENOVATION: ❑ REPLACEMENT: PLANS SUBMITTED: YES ❑ NO[]
FIXTURES 1 FLOOR-
BSM 1
2
3
4
5
6
7,
8
1 9
1 10
11
12
13
14
BATHTUB
!
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GAS/OIUSAND SYSTEM
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM
f
DEDICATED WATER RECYCLE SYSTEM
t
DISHWASHER
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR I AREA DRAIN
INTERCEPTOR INTERIOR
KITCHEN SINK
LAVATORY
ROOF DRAIN
SHOWER STALL
SERVICE / MOP SINK
TOILET
URINAL
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WASHING MACHINE CONNECTIO
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MIN
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1
H
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bUILU10i 4 lwlv' INSURANCE COVERAGE:
I in' olicy or its substantial equivalent which meets the requirements of MGL Ch.142. YES Q NO ❑
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IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
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LIABILITY INSURANCE POLICY El OTHER TYPE OF INDEMNITY ❑ BOND ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
CHECK ONE ONLY: OWNER ❑ AGENT ❑
SIGNATURE OF OWNER OR AGENT I
1 hereby certify that all of the details and Information I have submitted or entered regarding this application are true and accurate to the best of my knowledge
and that all plumbing work and Installations performed under the permit Issued for this application will be In compliance with all Pertinent of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME I William Heath I LICENSE # 12021 I SIGNATURE
MPO JP El CORPORATION O# 3487C PARTNERSHIP❑# 3321C LLC❑#�
COMPANY NAME I Murphys JADDRESSF34 Whites Path I
CITY South Yarmouth STATE Ma ZIP 02664 TEt L 508-760-1660
FAX 508 7601670 CELL EMAIL I hetrault@callmurphys.com I
PERMIT 450
LOT N8
Kieth, Judy
267 Buck Island Road
West Yarmouth, MA 02673
Basement--fam. rm. & bath
SHEET 41
6%29/98
6/29/98
$8,000.00
WIRE INSPECTOR'S DEPARTMENT
YARMOUTH TOWN HALL
SOUTH YARMOUTH. MASS. 02664
639
Fee
Date / / — 9
Name of Job
i
Name of Electrician L---`utq� A-Ao�
Location IN K ( T-e-IH i
Id o T lv i /zbq I Lo /vLFr,"
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TO WN OF YARMOIUTH
Application for a Permit to Build No.
I
'qX
UPON FINAL APPROVAL &6-t2q-I&AP LOT 414
FEE MUST ACCOMPANY THIS APPLICATION. DATE G 19 1�'8
The undersigned hereby applies for a permit to build
according to the following specifications Y ��
1. Name of property ownerT3
Address a(o 7 23 v S 4 Q 4 RY, ivy
2. Name of Architect (if any)
3. Name of builder
4. License No. D OD 94 Tel. 4/7 7 ` Ia ;7�
5. Name of Mason Address
6. License NO. Tel.
7. Construction address
IT
8. Date of subdivision Approval pla
9. Private dwelling Estimated Cost
10. Multifamily ❑ #Q
11. Commercial ❑�4/
12.Other ❑%�
13. No. of stories0/
14. Foundation — Full VQ Half ❑ Crawl ❑ Slab ❑
15. Materials — Wood P"'Cement eOther ❑
16. Type of heat Oil ❑ Gas ❑ Electric ❑ Other ❑
17. Garage —1 ❑ 2 111001�
18. Swimming pool - Size A62
19. Storage shed — Size M-
20. Stove — Wood ❑ Coal ❑
21. Size of lot: No. of feet front
22. Size of building. No. of feet front
23. Distance from nearest building: Front
24. Distance back from line or street _
25. H.I.C.R. No. I ly 8 8[Z
LOT RELEASED BY
10W.1ill II,IIkil[e]Z9 • ' s
)d I District n VD
n zone r Zone !�
DO NOT WRITE IN THIS SPACE
t �a Type of room
Kitchen
a.iAWr
a.� �. Dining Rm.
_ %3 7�5� Living Rm.
Bed Rm.
Bath
AT9Deck
Closed porch
Familv Rm.
No. of feet rear
I
_ No. of feet side
Ft. side
From rear lot line,
Signature
Addre
No.
I Sun room I I
Shed
Alterations
_ No. of feet deep
No. of feet rear _
Ft. side Rear
/VI a
D4:�
Side line
Date
'� . - .
1��
._
..
'.'
+ �
1
790 / g.-7k-
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Town of Yarmouth No. - 394,
PLUMBING PERMIT
Office of the Plumbing
This is to Certify that _
has permission to
in buildmd on
in accordance with an application on file in this office, and subject to the provisions of the
Ordinances relatinq to the State Plumbing Code in the Town of Yarmouth.
Fee $ 5' 1
Plumbing Inspector
UNITED STATES POSTAL SERV �� 0� _ _First Clas- s �1ai
rY1 V �
USPSge & Fees�a�d
1 :C a) — — permit No..-G 11
• Sender: Please print your name, address, and ZIP+4 in this box •
Town of y maAh
B'tl9dlvD t �\
SoulhYamaulh, MA 02664 \
■ Complete ftbms 1, 2, end 3. Also complete
item 4 if Restricted Delivery is I'I desired. ■ Print your narde and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front If space permits.
1. Article Addressed to:
'iMr. William Cushlanis
198 .Main Street
'Yarmouthport, MA 02675
A. Sol n
X / ❑Agent
❑ Addressee
B. ecelved by (Pilo ed Name) C. Date of Delivery
z—
D. Is delivery address different from Rem 1? ❑Yes
If YES, enter delivery address below: ❑ No
3. a Type
Certified Mail ❑ Express Marl
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ yes
2' ArticleNumber
hm service ab- 7001 1140 0002 9388 8387
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PS Form 3811, August 2001 Domestic Return Receipt 1025e5-0144-25os
3 . � 3.1-5: 1
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Y b44
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-- BUILDING PERMIT APPLICATION SIGN OFF
APPLICANT: ( ex Vl r� -� i BUILDING PERMIT O:
� b
ADDRESS: �J �% y� �S/�O v r TELE. NO.: -3 :�2,�?0�77DATE
p Cx 3!5
FILED: 6 S g
BLDG. SITE LOCATION: Ur MAPO:� LOT#:
THE FOLLOWING INFORMATION OUTLINES THE PROCEDURAL STEPS REQUIRED TO OBTAIN A PERMIT TO BUILD,
ALTER, OR ADD TO A STRUCTURE WITHIN THE TOWN OF YARMOUTH. THE BUILDING DEPARTMENT WILL DETER-
MINE COMPLIANCE TO THE FOLLOWING (A) ZONING REQUIREMENTS (B) HISTORICAL DISTRICTS (C) FLOOD
PLAINS ZONING. THE BUILDING DEPARTMENT WILL BE RESPONSIBLE FOR ASSISTING THE APPLICANT THOUGH
THE FOLLOWING DEPARTMENTS:
RESIDENTIAL AND/OR COMMERCIAL BUILDING
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WATER DEPARTMENT: DETERMINES COMPLIANCE OF WATER AVAILABILITY.
ENGINEERING DEPARTMENT: DETERMINES COMPLIANCE FOR PARKING AND DRAINAGE.'
CONSERVATION COMMISSION: DETERMINES COMPLIANCE .TO WETLANDS ACTS, I.E.: IF LOT(S) BORDER ANY
TYPE OF WETLANDS, STREAMS, PONDS, RIVERS, OCEANS, BOGS, BAYS, MARSH
LAND, ETC.
HEALTH DEPARTMENT: DETERMINES COMPLIANCE TO STATE AND TOWN REGULATIONS, I.E.: REQUIRE-
MENTS FOR SEPTAGE DISPOSAL AND OTHER PUBLIC HEALTH ACTIVITIES.
FIRE DEPARTMENT: DETERMINES COMPLIANCE TO STATE AND TOWN REQUIREMENTS FOR PERSONAL
SAFETY, PROPERTY PROTECTION, I.E.', SMOKE DETECTORS, SPRINKLER SYSTEMS,
ETC. I
THE FOLLOWING DEPARTMENTS MUST SIGN OFF, IN THE RESPECTIVE ORDER, PRIOR TO BUILDING INSPECTOR
ISSUING THE REQUIRED BUILDING PERMIT:
REVIEWED BY:
1. WATER DEPARTMENT � �(I,t�,QQ•o DATE: I ` S'9 CY N/A:
2. ENGINEERING DEPARTMENT: DATE:I N/A:
3. CONSERVATION: DATE:! N/A:
4. HEALTH DEPARTMENT DATE: I I a -Y N/A:
INDUS AND OR COMMERCIAL PERMITS .
5. WIRING INSPECTOR: DATE:l N/A:
6. PLUMBING INSPECTOR: DATE:I N/A:
7. FIRE DEPARTMENT: DATE:I N/A:
PLEASE NOTE
ALL STUMPS AND/OR BRUSH MUST BE DISPOSED OF AT AN APPROVED SITE. A SIGNED RECEIPT FROM THE
DISPOSAL SITE MUST BE SUBMITTED TO THE BUILDING DEPARTMENT PRIOR TO ISSUANCE OF THE BUILDING
PERMIT. 1
COMMENTS:
I •
BLM/s9
BUILDING DEPARTMENT
CONSTRUCTION SUPERVISOR FORM
PLEASE'PRINT: JOB LOCATION: ]' `/
C1 V M t7 0
NUMBER-u� e 1 ST ET VILLAGE
OWNER OF PROPERTY:_' ^ C
CONSTRUCTION SUPERVISOR: J )ei v iG� yCrT�►4 cIpJL 1 �7 Z
NAME LICENSE NO. PHONE N(
ADDRESS:
LICENSED DESIGNEE:
(IF OTHER,THAN SUPERVISOR) NAME LICENSE NO.
2.15 RESPONSIBILITY OF EACH LICENSE HOLDER:
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 ALLIWORK 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 ITHE 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 SUB—
CONTRACTOR'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. .I
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, RECON-
STRUCTION, ALTERATION, REPAIR, REMOVAL OF DEMOLITION AS REGULATED BY SECTION 109.1.1'OF THE
CODE AND THESE RULES AND REGLLATIONS. 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 DEPART?DrNT.
I HAVE READ AND UNDERSTAND MY RESPONSIBILITIES UNDER THE RULES AND REGULATIONS FOR LICENSING CON-
STRUCTION SUPERVISORS IN ACCORDANCE ;.'ITH SECTION 109.1.1 OF THE STATE BUILDING CODE. I UNDERSTA'N,
THE CONSTRUCTION INSPECTION PROCEDURES AND THE SPECIFIC INSPECTION AS CALLED FOR BY THE BUILDING
OFFICIAL.
INSURANCE COV AGE:
I have a CtIrMfitfidbility insurance pclicy or is substantial equivalent which meet the requirements of MGL Ch.152
Yes V No ❑
If you have checked ves, please indicate the type coverage by checking the ap,rcpriate bc)L
A liability insurance pc:icy ❑ O:her type of ademnity ❑ I8ond ❑
OWNER'S INSURANCE WAIVER: I am aware that the ucensee doei not have the Insurance coverge requires ty
Chapter3.g2 of the Mass: General Laws, ano that my signature on Ms permit ac;'lica:icn waives this iequirenieri
Check one:
Signature at Gb ner or OMrnr s !gent Ownero Agent ❑
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CUREs`t , gkK JY r, //,, / • $GELDING OFFICIAL APPROVAL:
locati0n�/�
rift. . A Q `h jD.2 pnhone a
❑ I m a homeowner performing all work myself.
I am a sole proprietor and have no one working in any capacity
O lam an employer proN iding workers' compensation for my employees working on this job.
company name
address -
city.: phonett
insur tnce co policy k
I
am a sole proprietor. eneral contracto or homeowner (circle port and have hired the contractors listed below who.hace
the follow in_ worker' c ipensation polices:
company
address:
city
phone R•
insurance co
polio I • 0
Failure to secure coverage as required under Section 25A of MGL 152 can Ind to the imposition of criminal penalties of a AMC nP to SI M.00 and/or
one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and aline of SHI0.00 a day against me. 1 understand that a
copy of this statement may be forwarded to the OfBer of investigations of the DIA for coverage verification.
I do -hereby certify under th pains nd pe a![ies o ry that the information provided above Is [rue and co�ryred
Signatureate �c� «� /y
7 of
Print name V t U T h 6 a - L Phone I / �� / Za
official use only
do not w rite in this area to be completed by city or town official ' I -
city or town: YARMOUTQ
❑ check if immediate response is required
contact person:
perImitAiicense N nBuilding Depsrtmeat
❑Licenslog Board
261 ❑Selectmen's Otfite
❑Health Department
phone M: _ (508) 398-2231 eat. pother
Ir�med 3,95 P1A1
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
employees. As quoted from the "law", an employee is defined as every person in the service of another under any
contract of hire, express or implied, oral or;written..
An emrphtrer 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
da el ling house of another who employs peisons 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.
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NIGL chapter 152 section 25 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 hats not produced acceptable evidence of compliance with the insurance coverage required.
Additionally, 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 ha%e
been presented to the contracting authority!
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Applicants
Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and
supplying company names, address and phone numbers as all affidavits 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.
City or Towns
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 permittlicense number'which will be used as a reference number. The aff davits may be returned to
the Department by•mail or FAX unless other arrangements have been made.
The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions,
please do not hesitate to give us a call.
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The Department's address, telephone and fax number.
The Commonwealth Of Massachusetts
Department of Industrial Accidents
MCC of Ilmsdil dels
600 Washington Street
Boston, Ma. 02111
fax #: (617) 727-7749
phones#: (617) 7274900 ext. 4069 409 or375
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Suggested Affidavit for Home Improvement Contractor Permit Application
For Office use Only
Permit No
Date
NAME OF CTTY/TOWN
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
MGLe.142Arequires that the 'reconstruction. alteration. renovation, repair, modernization, conversion, improvement, removal, demolition,
or construction of an addition to am vretcistine owneroccuried build ine containint at least one but not more than four dwelline units .... or
to structures which are adjacent to such residence or building' be done by registered contractors, with certain cxmptions, along with other
requirements
Type of Work- h S JA q S e kit is h -1� Est. Cost o, as
Address of Work a 12-7 mil) u C L 11S L 9 #+
Owner Name: J-U [./ ,x r / i- -1, h
Date of Permit Application:/ 01 4
I hereby certify that:
Registration is not required for the following reason(s):
_Work excluded by law
Job under S1,000
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:
sa �ctv►dl 9�,L"��
Date Contractor Name Registration No.
Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property:
Date Owner Name
MECcheck COMPLIANCE REPORT
1995 Model Energy Code
MECcheck Software Version 2.0
CITY: Chatham
STATE: Massachusetts
HDD: 6020
CONSTRUCTION TYPE: Single Family
DATE: 6-15-1998
DATE OF PLANS:
TITLE:
COMPLIANCE: PASSES
Required UA = 62
Your Home = 62
Permit #
Checked by/Date
Area or Insult Sheath Glazing/Door
Perimeter R-Value R-Value U-Value UA
-------------------------------------------------------------------------------
GLAZING: Windows or Doors 24 0.350 8
DOORS 36 0.350 13
BSMT: 8.0' ht/6.0' bg/8.0' insul. 752 13.0 41
-------------------------------------------------------------------------------
COMPLIANCE STATEMENT: The proposed building designlrepresented in these
documents is consistent with the building plans, specifications, and other
calculations submitted with the permit application. The proposed building
has been designed to meet the requ rem is of the 1995 CABO Model Energy Code.
Builder/Designer d/ Date ��
v
MECcheck INSPECTION CHECKLIST
1995 Model Energy Code
MECcheck Software Version 2.0
DATE: 6-15-1998
Bldg.
Dept.
Use
WINDOWS AND GLASS DOORS:
1. U-value: 0.35
For windows without labeled U-values, describe features:
# Panes Frame Type Thermal Break? [ J Yes [ ] No
Comments/Location I
DOORS:
1. U-value: 0.35
Comments/Location.
BASEMENT WALLS: i
1. 8.0' ht/6.0' bg/8.0' insul., R-13 l
Comments/Location
AIR LEAKAGE:
Joints, penetrations, and all other such openings in the building
envelope that are sources of air leakage must be sealed. Recessed
lights must be type IC rated and installed with no penetrations
or installed inside an appropriate air -tight assembly with a 0.5"
clearance from combustible materials and 3"'clearance from insulation.
VAPOR RETARDER:
Required on the warm -in -winter side of all non -vented framed
ceilings, walls, and floors.
MATERIALS IDENTIFICATION:
Materials and equipment must be identified so that compliance can
be determined. Manufacturer manuals for all installed heating
and cooling equipment and service water heating equipment must be
provided. Insulation R-values and glazing U-values must be clearly
marked on the building plans or specifications.
DUCT INSULATION:
Ducts in unconditioned spaces must be insulated to R-5.
Ducts outside the building must be insulated to R-8.0.
DUCT CONSTRUCTION:
All ducts must be sealed with mastic and fibrous backing tape.
Pressure -sensitive tape may be used for fibrous ducts. The HVAC
system must provide a means for balancing air and water systems.
TEMPERATURE CONTROLS:
Thermostats are required for each separate HVAC system. A manual
or automatic means to partially restrict orlshut off the heating
and/or cooling input to each zone or floor shall be provided.
MISC REQUIREMENTS:
Refer to the MECcheck Manual for requirements relating to swimming
pools, HVAC piping conveying fluids above 120 F or chilled fluids
below 55 F, and circulating hot water systems.
----NOTES TO FIELD (Building Department Use Only)-------------------------
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APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00
(OFFICE USE ONLY)
MIN UTH By
Fee: $
SE 2 0 2000JPERMIT NO.
(PLEASE PRINT IN INK W AI / INFORAIAJON) I Date:
To the Inspector of Wires: By this application the un Trsigned gives notice of his or her intention to perform the electrical work
described below.
r—
Location (Street & Numb/er) r% R /U/l
Owner or Tenanty 0 ay `1-_ sY/y�ht /l / f�%y%� Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? /�/tt/Yes No,
Purpose of Building aln ;&eq %O/L. Na3rUtility
Existing Service CAmps /�� Volts OverheadO
New Service .L5 /limps / Volts Overhead
Number of Feeders and Ampacity.
Location and Nature of Proposed electrical
(Check Appropriate Box)
Authorization No.
Undgrd No of Meters
Undgrd ❑ No. of Meters
tX_ rt•/:t ,%
No. of Recessed Fixtures
No. of i - a l I
No. of I
Transformer
Tota
0 Ann WWP
li
No. of Li6tine Outlets
No. of Hot Tubs I
Generators
KVA
No. of Lighting Fixtures i
/
A ve In-
SwimmingPool md. � rnd. I
No. of Emergency
BatteryUnits
firing r —
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners
nd
No. o Detection Initiating Devices
No. of Ranges
Tota
No. of Air Cond. Tonsl
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
Totals:
Num r
—
Tons
—
KW
7
No. of Self Contained
Detection/Alerting Devices
No. of Dishwashers
g S ace/Area Heating KW I
P
Local ❑ Muntnpal Other
Connection
No. of Dryers
Heating Appliances nV I
ecuucy s[ems:
No. AA`evices or Equipvalent
No. of Water
Heaters KW
No. of No. of
Signs Ballasts I
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP I
Telecommunications Wiring:
No. of Devices or E uivalent
I ' Attacb additional detail if destred, or at required by the Inspector of Wires.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability
insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies at such a ge is in f rce and has exhibited proof
aof same to the permit issuing office. T� O g
;J CHECK ONE: INSURANCE BOND[3 OTHERQ (Specify:)�j &,r c Fwy r20yl/
t" I (Expiratio(Djar
Estimated Value of Electrical Work: oao,ac+ (When required by municipal polity.) ( f (46tF
Work to Start:�.� In pections to be requested in accordance with MEC Rule 10, and upon completeo� I JOB
__ZI certify, under the pains and penald f perjury, that the information on this application is true and complete.
FIRM NAME: A I J t) S4 &:*o . LIG NO. _ _ _
Licensee:
(If applicable, enter "exempt" in the license number line.)
LIC. NO. �—
Bus. Tel. No.: W _W2 C .2.4
Alt. Tel. No.:
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature
below, I hereby waive this requirement. I and the (check one) owner owner's agent. ❑
Owner/Agent
Signature _
(Rev. o4/oo)
Telephone No.
,96ey(
i
Wk
- The Commonwealth of Massachusetts
Department of Public Safcty
BOARD OF FIRE PREVENTION REGULATIONS S27 CMR 1Z:O0
O:(lce t'a< Only
r.ratt so. 1/(6/3
Occupancy i Fee Checked
llea.e !lank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed In accordance with the Mawchusetu Electrical Code. 527 CMR 12:00
(PLEASE PRINT IN INK OR TrPE ALL MORHATION) Date
City or Tows of/rRIL>!bGi,Io,the Insp r of
The undersigned applies for a permit to perform the electrical work describe ow.
Location (Street a Number) Z6? � JUL 9 - 1998
Owner or Tenant T / T
Owner's Address Z 6 7 -aILG� T-sC,+�/Y%� I y�i A&,
=114 Is this permit in conjunction with a building permit: Yes U No ❑ (Check Appropriate Box)
7 �/ Purpose of Building wee Utility Authorization NO.
�y
Existing Service ?� Amps //0 / 220 Volts Overhead Q .Undgrd, No. of Meters__
New Service. — Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work LCSyt79E� I GQi ge-L,
No. of Lighting Outlets O
8h
No. of Hot Tubs �"�
No. of Transformers Total
KVA
No. of Lighting Fixtures
�f
Swimming Fool Above In-
8 Above
❑ grnd. � ❑
Generators KVA
No. of Receptacle Outlets Z Z
No. of Oil Burners
No. of Emergency LightingBattery Units
No. of Switch Outlets Z
No. of Gas Burners —
FIRE ALARMS No. of Zones
No. of Detection and
Initiating Devices
No. of Sounding Devices
No. of Self Contained
Detection/Sounding Devices
Local ❑ CCoonnectionnicial ❑Other
No. of Ranges
No. of Air Cord. Total
tons
No. of Disposals
No. of Heats Total Total
Tons KW
No. of Dishwashers
Space/Area Heating KW
No. of Dryers
Heating Devices KW
No. of Water Heaters Cf--^
Not of o. o
Si s Ballasts
Low Voltage
Wring
No. Hydro Massage Tubs
No. of Motors Total HP
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial
equivalent. YES(K NO I have submitted valid proof of same to this office. YES, NO ❑
If you have checked YES, please indicate the type of coverage by checking the appropriate box.
INSURANCE P' BOND ❑ OTHER ❑ (Please Specify)
(Expiration ate
Estimated Value of Electrical Work S 2�.^�
Work to Start 7"�'/ 5r' Inspection Date Requested: Rough CZP�L( 4!to� Final
Signed under AAthe //penalties of perjury:
FIRM NAME C"L&--C Lr LIC. NO.9-Z7,03G
Licensee /¢ S -4 . 25�7� Signalt/ure LIC. NO.
Address ZY� �/�fll/.w i�t ris�/Y/��! LJ*lcL Bus. Tel. No.
Alt. Tel. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub-
stantial equivalent as required by Massachusetts General wsZa ,and that my signature on this permit
application waives this requirement. Owner Agent (Please check one)
Telephone No. PERMIT FEE S
Signature of Rorer or Agent
A
P
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
— — (Print or Type) I /
OP//
U?,e1
TOWN OF YARMOU�TH,,+MA 0266644 `Date��19_� Permit #
Building Location d// (n '.7U�! ���a�wner's Name �fo-7 Th
/ia�n�r1 Type of Occupancy
New ❑ Renovation t Replacement ❑ Plans Submitted. Yes❑ No ❑
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SUB—BSMT.
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BASEMENT
`
1 ST FLOOR
2NOFLOOR
'
3ROFLOOR
1
I
4TH FLOOR
STH FLOOR
eTH FLOOR
j
7THFLOOR
STH FLOOR
Installing Company Name_ kb oll ArcA a s / 1Check one: Certificate
Address k< ;C'fL3 t„_c, ❑ (Corporation
0-ePartnership
Business TelephoneYf ��7 �'j ❑ iFirm/Co. /
Name of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE: • '
I have a cuq a Ilablllty Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes No ❑
If you have checked yes. please Indicate the type coverage by checking the appropriate box.
A liability Insurance polic�4 Other type of Indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by
Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
iCheck one:
Owner[] Agent ❑
Signature of Omer or Owners Agent
hereby certify that all of the details and Infcrmation I have submitted (or entered) in above appli I tion are true and accurate to the best of my
knowledge and that all plumbing work and Installations performed under the permit issued for this application will be in compliance with all
pertine t p ovisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws.
ByT�!:� e of License: 7Q L �
Title Gasfitter gna
Plumber a of Licensed iu oer or Gas titer
Master Ucense Number I a `r
Ctyy/Town r N Journeyman 1
FINAL INSPECTION
SKETCHES
FEE
BELOW FOR OFFICE USE ONLY
NO. 40S
APPLICATION FOR PERMIT TO DO OASFITTING
Z /&,ek
NAME A TYPE OF BUILDING
LOCATION OF BUILDING
UG � Lli 7�
PLUMBER OR OASF TTER
Uy
LIC. NO. �O
PERMIT GRANTED
DATE
GASINSPECTOR
PROGRESS INSPECTION
FIELD COPY
• • • _t RUILDING
�-bl -036 10yY
PERMIT
'- - -----------_ __ July 12 F . 2000 BO1-030
—DATE— PERMIT NO.
APPLICANT ADDRESS 19R Mnin St. YP---'=-------
,t, • .�, • .(NO.) (STREET) (CONTR'S LICENSE) iti new ad -
Deck deno -pnT� NUMBER OF
PERMIT TO 4_r'STORY DWELLING UNITS
(TYPE OF IMPROVEMENT] NO. (PROPOSFO IIAF]
AT(LOCATION) 267 Buck Island Rd ZONINc-DISTRIr
(NO.) (STREET)
v BETWEEN f • AND
m ICROSS STREET) (CROSS STREETI `
m N
m SUBDIVISION Map 47 Lot 76 LOT_ BLOCK Map 41 LOT SIZE
• 72
U
Om BUILDING IS TO BE FT. WIDE BY - FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
O
t TO TYPE USE GROUP C BASEMENT WALLS OR FOUNDATION
Z ^
REMARKS:
Uemu UL ex.La
concrete blot
AREA OR
VOLUME
(CUBIC/
OWNER
Judy Keith
ADDRESS
267 Buck Isla
construction of new 2
with crawl space
ESTIMATED COST $ 35.000
(TYPE)
addition with
ti
PERMIT
FEE $280.00
F
BUILDING DEPT. -
BY
INSPECTION RECORD
NOTE PROGRESS - CORRECTIONS AND REI;ARKS
F 70
I
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N ._�.
TOWN Ur' YARMOUTH
o� c BUILDING DEPARTMENT
» � 508-398-2231 ext. 260
5��,...u•3�.� 1146 Route 28, South Yarmouth, AIA 02664 �
BUILDING PERMT FIELD INSPECTION CORRECTION NOTICE
December 9, 2002
Mr. William Cushlanis
198 Main Street
Yarmouth Port MA 02675. ;
Inspection Date: December 4, 2002
Location: 267 Buck Island Rd.
Permit No: B-01-030
u
Issued to: William Cushlams, Yarmouth Port Building & Remodeling
During my inspection of December 4, 2002 at the address referencled above, the following violations
of the State Building Code 780CMR were noted:
EAST SIDE STAIRS
—Stair stringers are not supported on a concrete pad at the base. I They rest solely on grade.
RE: Chapter 1, Section 117-Workmanship, Chapter 36, Table 3603.1.3-Minimum Live Load, Table
3603.1.3, Note: 2
—Guardrail is less than 36 inches in height. RE: Chapter 36, Section 3603.14.2.1
—The platform is not bolted to the house frame and is less than 48"x42". RE: Chapter 36, Section
3 603.12. 1 -Landings and Table 3603.1.3
- CRAii'LSPA CE
—The crawl space access is a `cellar window that can only be opened from the inside. Therefore
access is not available from the exterior, which is the only way to access the crawl space. RE:
Chapter 36, Section 3604.9.2, Crawl Space Access "
SOUTHSIDE (waterside) STAIRS, DECK& RAMP
—Variable stair risers 7 VS " at the top to T' at the bottom. RE* Chapter 36, Section 3603.13.2-
Stairways Treads & Risers
—Stair treads and/or stringers pitch downward. RE: Chapter 1, Section 117- Workmanship
7 t:.;.... ..
Page 2— Field Correction Notice December 9, 2002 contd.
—A stringer does not support the centers of the treads and the existing stringers are bearing on an
unsupported 1 '/4 "platform edge. RE: Chapter 36, Table 3603.1.3; Note: 2 and Chapter 1, Section
117-Workmanship
—Treads are not fastened properly and are loose. RE: Chapter 1, Section 117- Workmanship and
Chapter 36, Table 3603.1.3.
—Hand rail is lose and the stair stringers are not fastened at the bottom (upper level stairs) RE:
Section 117-Workmanship and Table 3603.1.3, Note: 2
—Joist hangers were not installed on the re -framed upper level deck area. RE: Chapter 36, Section
3605.2.4-Bearing
—A 4x6 post is not mechanically fastened to the deck above. RE: Chapter 36, Section 3605.2.8-
Fastening
RAMP (south side)
--The ramp appears to exceed the maximum allowable pitch of 1/8 (12.5%). RE: Chapter 36, Section
3603.15.1
—No guardrail or handrails wereinstalled. RE: Chapter 36, Section 3603.15.2
Therefore, you are hereby advised to correct the aforementioned violations and contact this office for
a re -inspection when the corrections have been completed. Approval by an inspector from this
department is required. All corrections must be made on or beforeDecember 31, 2002.
Finally, failure by a contractor who holds a construction supervisor's license to make said corrections
by the date noted may result in the suspension or revocation ofthat license pursuant to 780CMR R5,
Section R5.2.9.
Verytruly,
James D. BrandolK C.B.O.
Building Commissioner
cc: Ms. Judith Keith
267 Buck Island Rd.
CERTIFIED MAIL
H.fidd r
.Y TOWN OF Y ARMOUTH FILE COPY
BUILDING DEPARTMENT
O _ -�H
.�.. �r. 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 260
BUILDING PERMT FIELD INSPECTION CORRECTION NOTICE
December 9, 2002
Mr. William Cusblanis
198 Main Street
Yarmouth Port MA 02675
Inspection Date: December 4, 2002
Location: 267 Buck Island Rd.
Permit No: B-01-030
i
Issued to: William Cushlanis, Yarmouth Port Building & Remodeling
During my inspection of December 4, 2002 at the address referenced above, the following violations
of the State Building Code 780CMR were noted:
EAST SIDE STAIRS
-Stair stringers are not supported on a concrete pad at the base. They rest solely on grade.
RE: Chapter 1, Section 117 Workmanship, Chapter 36, Table 3603.1.3-Muumum Live Load, Table
3603.1.3, Note: 2
—Guardrail is less than 36 inches in height. RE: Chapter 36, Section 3603.14.2.1
—The platform is not bolted to the house frame and is less than 48" x42". RE: Chapter 36, Section
3603.12. 1 -Landings and Table 3603.1.3
CRAiFE SPACE
—The crawl space access is a cellar window that can only be opened from the inside. Therefore
access is not available from the exterior, which is the only way to access the crawl space. RE:
Chapter 36, Section 3604.9.2, Crawl Space Access I
SOUTH SIDE (water side) STAIRS, DECK ff RAMP
—Variable stair risers Z 1" at the top to T' at the bottom. RE: Chapter 36, Section 3603.13.2-
Stairways Treads & Risers .
--Stair treads and/or stringers pitch downward. RE: Chapter 1, Section 117- Workmanship
Page 2— Field Correction Notice December 9, 2002 contd.
—A stringer does not support the centers of the treads and the existing stringers are bearing on an
unsupported 1 1/4 " platform edge. RE: Chapter 36, Table 3603.1.3, Note: 2 and Chapter 1, Section
117-Workmanship
—Treads are not fastened properly and are loose. RE: Chapter 1, Section 117- Workmanship and
Chapter 36, Table 3603.1.3.
—Hand rail is lose and the stair stringers are not fastened at the bottom (upper level stairs) RE:
Section 117-Workmanship and Table 3603.1.3, Note: 2
—Joist hangers were not installed on the re -framed upper level deck area. RE: Chapter 36, Section
3605.2.4-Bearing
—A 4x6 post is not mechanically fastened to the deck above. RE: Chapter 36, Section 3605.2.8-
Fastening
RAMP (south side)
—The ramp appears to exceed the maximum allowable pitch of 1/8 (12.5%). RE: Chapter36, Section
3603.15.1
No guardrail or handrails were installed. RE: Chapter 36, Section 3603.15.2
Therefore, you are hereby advised to correct the aforementioned violations and contact this office for
a re -inspection when the corrections have been completed. Approval by an inspector from this
department is required. All corrections must be made on or before December 31, 2002.
Finally, failure by a contractor who holds a construction supervisor's license to make said corrections
by the date noted may result in the suspension or revocation of that license pursuant to 780CMR R5,
Section R5.2.9.
Very tru X�Q�
�`%
James D. Brandolini, C.B.O.
Building Commissioner
cc: Ms. Judith Keith
267 Buck Island Rd.
CERTIFIED MAIL
f
_
-. �,
,�
�
..
..
oi•YaR,y TOWN OF.YARMOUTH
BUILDING DEPARTMENT
�.r . 1146 Route 28, -South Yarmouth, AiA 02664 508-398-2231 cxt. 260
December 9, 2002
Mr. William Cushlanis
Issued to: William Cushlanis, Yarmouth Port Building & Remodeling
During my inspection of December 4i 2002 at the address referenced above, the following violations
of the State Building Code 780CIM R were noted.
EAST SIDE STAIRS
-Stair stringers are not supported on a concrete pad at the base. They rest solely on grade.
RE: Chapter 1, Section 117-Workmanship, Chapter 36, Table 3603.1.3-Minimum Live Load, Table
3603.1.3, Note: 2
—Guardrail is less than 36 inches in height. RE: Chapter 36, Section 3603.14.2.1
—The platform is not bolted to the house frame and is less than 48"x4T'. RE: Chapter 36, Section
3603.12.1-Landings and Table 3603.1.3
CRAWL SPACE
—The crawl space access is a cellar, window that can only be opened from the inside. Therefore
access is not availlable from the exterior, which is the only way to access the crawl space. RE:
Chapter 36, Section 3604.9.2. Crawl Space Access
SOUTIT RVE Eater side) STAIRS, DECK & RAMP
-Variable stair risers 7'' " atthe top to T''at the bottom' RE Chapter 36, Section 3603.13.2-
Stairways Treads &' Risers l
—Stair treads and/or stringers pitch downward. RE: Chapter 1, Section 117- Workmanship
Page 2— Field Correction Notice December 9, 2002 contd.
—A stringer does not support:the centers of the treads and the existing stringers are bearing on an
unsupported 1 '/4 " platform edge. ' RE: Chapter 36, Table 3603.1.3, Note: 2 and Chapter 1, Section
117-Workmanship
—Treads are not fastened properly and are Ioose. RE: Chapter 1, Section 117- Workmanship and
Chapter 36, Table 360313
—Hand rail is lose and, the stair''strngers are not fastened at the' bottom (upper level stairs) RE:
Section 117-Workmanship aad.Tab1e:36031:3 Note: 2
—Joist hangers were not installed on.the re -framed upper level deck area. RE: Chapter 36, Section
3605.2.4-Bearing
—A U6 post is not mechanically fastened t_ o the deck above. RE: Chapter 36; Section 3605.2.8-
Fastening
RAMP (south side)
—The ramp appears to exceed the maximum allowable pitch of 1/8 (12.5%). RE: Chapter36, Section
3603.15.1
—No guardrail or handrails were installed. RE: Chapter 36, Section 3603.15.2
Therefore, you are hereby advised to correct the aforementioned violations and contact this office for
a re -inspection when the, correation's have been completed. Approval by an inspector from this
department is required. All corrections must be made on or before December 31, 2002.
Finally, failure by a contiactor who holds a construction supervisor's license to make said corrections
by the date noted may result in the suspension or revocation of that license pursuant to 780CMR R5,
Section R5.2.9.
Very truly,
James D. Brandolini, C.B.O.
Building Commissioner
cc: Ms. Judith Keith
267 Buck Island Rd.:::<';<'s.;
.
CERTIFIED MAIL
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Town
of Yarmouth+ No. -
4 0 5
0 y
GAS
PERMIT
�
Office of the Gas
This is to Certify that .
has permission to -
in accordance with an applicationion file in this office, and sub,
Ordinances relating to the Gas Code in the Town of Yarmouth.
Fee $
19/ b "
to the provisions of the
Gas Inspector
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
` (Print or Type)
TOWN OF YARMOUTH, MA 0266664 Date 1g � Permit # /
Building Location LC / &IC�Lt�C�lwai Owner's Name --&n"
Type of Occupancy An e—
New ❑ Renovation Replacement D �Iarfs Submitted: Yes ❑ No D
IFIXTURES �5-0 , �g
i n
Installing Company Name !macn ✓ C �,�n a�_.� Check one: Certificate
Address r,S,94-t- ❑.Corporation
❑ Partnership
Business Telephone e T " ❑ Firmxo.
Name of Licensed Plumber %0 (, 777/ o/
INSURANCE COVERAGE:
1 have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes No ❑
If you have 6hecked Yes, please indicate the type coverage by checking the appropriate box
A liability insurance policy I Other type of Indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
I Check one:
Owner ❑ Agent ❑
hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my
knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plumbing Code and ChAer 143 of the General Lays o
Type of License: Master Journeyman ❑
Pt R ovm AI /
APPROVED 0 IC US ONLY) Ucense Number 109
BELOW FOR OFFICE USE ONLY
FINAL INSPECTIONS ,. SKETCHES PROGRESS INSPECTIONS
FEE
A�
_ wY
J APPLICATION FOR PERMIT TO DO PLUMBING
NAME A TYPE OF BUILDING
A l 7 4i
LOCATION OF BUILDING
PLUMBER ��
PERMIT GRANTED jS
- DATE
PLUMBING INSPECTOR
S �
t
3-
a• k ry
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UNE & 1'wu FAMMY ONLY —',BUILDING PERMIT
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
Town of Yarmouth Building Department
1146 Route 28 • South Yarmouth, MA 02664-4492 2
508-398-2231 ext.1261 Fax 508-398-0836
FFR
Office Use Only
Permit No. 6' 13-1151 Date �3
Permit Fee $ c�tr
Deposit ft'd. $ X.� oaten
Net Due $ 2�f'
Planning Board Information
Plan Type -
Endarsemern Due
q Due
Ha
other
Aumon Department Info on:
Map B LWILDING DEPAo�
Ln
NewIan
1.4 Property Dlme�siars:
Lot Area (sf) Frontage (fr) Lot Coverage
Tr a Sscdm for onx ilea
BuikOhil Permit Number::,: ` :, ;'.: ':: _ =
0afig ls6tie _ ... • .. .
•
S�fXin}I /�pn's .w. C41e''F r` ..+. .it ^" •1�/.
{JQI Y�Raft0cobdumv.� •�•�.'•••.••
� �_1• `—,—y,• •s.•
f rCq{sers
_ ..•`-r Y �.. s, D�.i7• ems' .•
Section 1- SM Intbrtneft U Grou : R 4 T : 5-B
1.1 Prepertr Addrsase
12 Zoning Inforrnaflon:
u r
Zoning District Proposed Use
1.3 ttattding Setbacks (n)
Front Yard
Side Yards I
Rear Yard
Required
Provided
Required
Provided
Required
Provided
(nLO.L. o 4& S S4)
13 FTood Zons Womfatl�
ft
r+A4Umpty
Privatez
BFE
- Ownershi AuthorizedI�Or
Mairag Address
,LZ Artlfsetssd Agent:
Name (grin).
Telephone
Section 3 - Constnxtten SarvirAs
Mailing Address
Fax
Z7
7w
rot Appecable
fir/ 13ri
Uc nse Number
Expiration Date
&2 ROgWered Home Improverrimt Contractor•
Narxxs
Na app'=Yb a p58`�
Address Licensef4, b —
jeo Expiration Data
Lure Telephone
1 of 2 I — -- -- OVER
k
Sectiort.4.tWoticersf Com • . (�rtltuLreiiceAffid�vi[ Cir:dkit� �i(� �
Workers Compensation Insurance affidavit must be completed and submitted with this application. Facture .
to provide this affidavit wig result In the denial of the Issuance of the building permit.
Signed Affidavit Attach Yes ......... No ..........
section s: Desch of ROPP544 Wbrk (chart er appltbam)
New Construdloe ❑ lNocIMMOM Nm of Battuoacns
Existing Bfd¢ ❑ Re;Ws) Any ❑ Adalnan ❑
Accessory Bidg. ❑ Type Demolition Other specify:
Brief Description of Pro Work73
1
s
)j' e 2 /V Cv�/
sedkn ft - Estimateo k:onsaucaon k.aars
Item Estimated Cost (Dallm) to be
ccffVktsd by permit applicant
t. But
2. Elocbical
3, PhurbkV / Gas
4. Medur ical (HVAC)
S. Fire Pmtsdfon
e.Tctal.(l+2+3+4+5)
7. Total Square FL VAW Haw a amea io -
SecWrl 77! • Owner AtttttbctzsttM- Tat be CompWW Wtlerr
nwn9es Acenll of Contractor Applies for Bulldltt Permit
Check Below
❑ Ccnservadcn•Commisalon Filing
(if applicable)
❑ Old Kings Highway & Hislorial
Conimtaston approval
(if applicable)
h �DDn ['nsk Ott , as owner of the subject property
hereby authodze T' A/A+R-D&A - to act on
my rlatlo rs relative to work authorized by this building permit application.
- — --- oats
Section 7b - Owner/AUUfonzea Agenk ueaarawn
as Owner/Author(zedAgent
hereby dedare that the statements and Information on the foregoing application are true and accurate,
to the best of my knowledge and belief.
Signed under the pains and penalties of perjury.
R4f J llliJkz t�
Print rams
stgnakue w/Agent oats
9 • IJ• 99 2 d 2
°•-0 Woce Use Only
Permit No.
' Date
TOWN OF YARMOUTH
--------AFFIDAVIT-- ---------�--
Home Improvement Contractor Law
Supplement to Permit Applleitlon
MOL c 142A rcquirrs that the 'recarutrudion, alteration, reaovatian, repair, modania ort, conversion,
improvememto remov4 demolition or construction of m addition ;to airy prexistmg owner-ooarpied
buil mg corntainiag at least c ne but not mere thm four dwelling units or structure which are adjacent to
such nlidwee or budding' be done by reeit=l =*zdorsp with'cmtaio "�� exrxptions, along with adrer
/
Type of Wort: tr w l— Es L Cost ZS�Vtj
1 I
Address of Work _ 2.6%
Owner Name:
Date of Permit Application: (Z --e6-1;?
I hereby certify that:
Registration is not required for the following reasan(s):
Work exchtded by law
Job trader S1,000
Building not owner occupied
Owner pulling own permit
Ocher (specify)
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT' OR DEALING WITH
UNREGISTERED CONTRACTORS FOR I APPLICABLE HOME
IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION
PROGRAM OR GUARANTY FUND UNDER MGL c. 142A.
Signed under penalties of pc4ury:
I hereby apply for a permit as the agent of the owner:
Date Contrador Name
OR
Registration No.
Notwithstanding the above notice, I hereby apply for a permit i the owner of the above
property.
Date Owner Name
TOWN OF YAR1Vi0UTH
BUILDING DEPARTMENT
CONSTRUCTION SUP
PLEASE PRINT. _ _ _
job
Number
Owner of Property.
ERVIISOR FORM
Ilage
Construction Supervisor. 114 `T XAQ OA, (0 91a IF
Name License No.
/ Phone No.
Address:
Licensed Designee:
(If other than Supervisor) Name License No.
2.15 Responsibility of each license holder.
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 drawin
as approved by the building official. gs
2.15.2 The license holder shall be responsible to supervise the construction, reconstructiona repair, removal or demolition involving the structural elements of bon,
uilding and structures only, , alteration,
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 offrcial in writing of the discovery of any
violations which are covered by the building permit.
2.15.4 Any licensee who shall willfullyviolate 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 log.1.1 of the code and these rules and
regulations. In the event that such licensee is no longersupervisingsaid 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 constructionode. I understand the construction
supervisors in accordance with section 109.1.1 of the state building c
inspection procedures and the specific inspection as called for by the building official.
INSURANCE COVERAGE
1 have a current liability insurance policy or its substantial equivalent which meet the requirement of MGL Ch.152
Yes No
If you have checked = please indicate the type coverage by checking the appropriate box
A liability insurance policy AB-,, Other type of indemnity I Bond
OWNER'S SURANCE WAIVER: I am aware that the licensee dces not have the insurance coverage required by
Chapter the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Stgna re of wner or Ownees Agent Caner ❑ Aqe
Signature: Building Official Approval:
M
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations 1
1 Congress Street, Suite 100
Boston, MA 02114-2017
Print Form
�'' www.mass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information I Please Print Legibly
Name (Business organizatiorv7ndividual): Mi. Nardone Carpentry LLC
Address:299 White's Path
i
Are you an employer? Check the appropriate box:
1.0 I am a employer with 6 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the subcontractors
2. ❑ 1 am a sole proprietor or partner-
ship and have no employees
working for me in any capacity.
[No workers' comp. insurance
required]
3. ❑ 1 am a homeowner doing all work
myself. [No workers' comp.
insurance required.] t
listed on the attached sheet.
These sub -contractors have
employees and have workers'
comp. insurance.:
S. ❑ We are a corporation and its
officers have exercised their
right of exemption per MGL
c.152, §1(4), and we have no
employees. [No workers'
comp. insurance required]
Type of project (required):
6. ❑ New construction
7.-c[3,Rchiodeling
8. Demolition
9. ❑ Building addition
10.0 Electrical repairs or additions
I I.❑ 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.
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 subcontractors have employees, they must provide their workers' comp. policy number.
lam an employer that isproviding workers' compensation insurance for my employees. Below is thepolicy and job site
infonmatfon.
Insurance Company Name:AmGUARD Insurance Company
Policy # or Self -ins. Lic. #:MJWC348502 / EI pira . Date: 0, /25/2013
Job Site Address: t�� t57 G f Ci y/State2/
ip: `?/. &f. M11-42 67
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
and
that the
above is true and correct
Official use only. Do not write in this 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 #:
ti 0 •YaR'3'
,a e
TOWN OF YARMOUTH
BUILDING DEPARTMENT
1146 Route 28, South Yarmouth, NIA 02664
508-398-2231 ext.1261 Fax 508-398-0836
BUILDING DEP.
Pursuant to M.G.L Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 1 l 1.5
1 hereby certify that the debris resulting from the proposed work/de mol1 on to be
conducted at d 67 ,/"/ ,
Work Address
Is to be disposed of at the following location:
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 1 11, Section 150A.
Si a re Lof Application
Permit No.
� Date
, ,.
0
NOTICE
TO
EMPLOYEES
NOTICE
TO
EMPLOYEES
The Commonwealth of Massachusetts
DEPARTMENT • OF INDUSTRIAL ACCIDENTS
600 Washington Street, Boston, Massachusetts 02111
617-727-4900 1
As required by Massachusetts General Law, Chapter 152, Sections 21, 22 & 30, this will give you notice
that I (we) have provided for payment to our injured employees under the above mentioned chapter by
insuring with:
AmGUARD Insurance Company
NAbIE OF INSURANCE COMPANY
P.O. Box A-H 16 South River Street
Wilkes-Barre, PA 18703-0020
ADDRESS OF INSURANCE COMPANY
MJWC348502 I 04/25/2012 04/25/2013
POLICY NUMBER EFFECTIVE DATES
DOWLING & O'NEIL INS AGY
973Iyannough Road P.O. Box 1990 508-775-1620
Hyannis. MA 0 601
NAME OF LYSURAiNCE AGENT ADDRESS PHONE
MI Nardone Carpentry LLC
299 White's Path
South Yarmouth. MA 02664
EMPLOYER
ADDRESS
EMPLOYER'S WORKERS COMPENSATION OFFICER (IF ANT
MEDICAL TREATMENT
05/02/2012
DATE
The•above named insurer is required In cases of personal injuries arising out of and in the course of
employment to furnish adequate and reasonable hospital and medical services in accordance with the
provisions of the Workers Compensation Act. A copy of the First Report of Injury must be given to the
injured employee. The employee may select his or her own physician. The reasonable cost of the ser-
vices provided by the treating physician will be paid by the insurer, if the treatment is necessary and
reasonably connected to the work related injury. In cases requiring hospital attention, employees are
hereby notified that the insurer has arranged for such attention at the
I
NAME OF HOSPITAL. ADDRESS
TO BE POSTED BY EMPLLOYER
m
�dt W WA
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 135887
Type: Ltd Liability Corpor
= --
- Expiration: 5/16/2014 Tr# 222824
M J NARDONE CARPENTRY LLC.
MICHAEL NARDONE
299 WHITES PATH
SOUTH YARMOUTH, MA 02664
SCAt G 2OM-osMt..
0
I
-- > Update Address and return card. N12rk reason for changes
Address Renewal Employment Lost Card
Ptassachusetts - Department of Public Safeti
Board of Building Regulations and Standards
Construction Supervisor License',
License: CS 81139-..�..�, .�
h..� t
iVIICHAEI'J,N.ARDONE
299 WHITESPA7 y t �M`
S YARMOL!TH, MA02664
ai.
Expiration: 9/16/2013 1
C'umn'�aiune� Tr#:.1706
�iie rpammosuoeal0i o�9�t'aaaacviuiellt
Office of ConsnmerAffairs & Business Regulation
-- MEIMPROVEMENTCONTRACTOR
egistration: ;435887 Type:
piration: �M r2014_; Ltd Llabllity Corpor
M J a NE CARPE#�TRY L C =c
MICHAEL NARDONE""=ems= 7,:<'
299 WHITES PATH
:,ram.<_�-,, �
SOUTH YARMOUTH, MkG2 Uudersecretary
License or registration valid for individul use only
before the expiration date. If found return to:
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, NIA 02116
I
IV
valid without signature
V
ASSESSOR'S DWORMATION.-
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t'rimit expi�ls 6 apotLe Sny
6m date.
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o ccumacw PAL cost orCaustrocdiaa syp 1411 Ot7
tinplrrvemrat caatractorl ie A " 7 crostroction I I ie r sa „srr FJ`7 •
Workmen's compesuation 7nsaaoca Ghat me) I T
0 I am the homeowner0 1 am d o sole p apridor 0 I Lave Worker's Compensation Lisoranoe
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will be just wale for denier a ee�eoc�atiam eeryey Sccaee and far peourntioe maw XO.L Ch 26k Secboa 1.
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❑ Yes 'd No
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Flood Plain Zane: ❑ Yes J�No
I
Within otWetlsod� 0 No
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PEG Ina. A4CY• Pages 035
!; Dale/ 6/13/2006 Times 8140 AM To/ a 9,1,5084281547
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IIIIHIIIIIII
Client#.47298 - -- -
ACOM CERTIFICATE OF LIABILITY INSURANCE
os;306°f '
PRODUCER
Rogers &Gray Ins. Agency, Inc
434 Route 134
P. 0. Box 1601
South Dennis, MA 02660-1601
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER.THIS CERTIFICATE DOES NOTAMEND, EXTEND OR
ALTERTHE COVERAGE AFFORDED BYTHE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
NAIC 0
INSURED
Capizzi Home Improvement, Inc.
Capizd Enterprises, Inc.
1645 Newtown Road
Cotuit, MA 02635
INSURERA. National Grange Mutual Ins. Co.
INSURER B: GUARD Insurance Group
INSURERa
HSURER D'. I
INSUPERI_
WVCKAVCA ; -
LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTHE POLICY PERIOD INDICATED —NOTWITHSTANDING
I THE POLICIES OF INSURANCE
OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
I ANY REOUIREMENT.TERM
i MAY PERTAN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH
-
j POLICES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. . I
TYPE OF INSURANCE
POLICY NUMBER
A CY FFE
A H
LIMBS
p
GENERALLIABBlfY
MP010TOT
06108106
0610810T
EACH OCCURRENCE
$1000000
DAM1fAGiFSE30TED
rTO
$500000
i
X GeaRALLIABiutYCLAIMS
EXP (Any CM Peron
$10 000
MADE 0 OCCURLIED
PERSONAL a AOV INJURY
f 1 000 000
GENERAL AGGREGATE
s2.000000
GEMLAOGREC,ATELMnAPPUESP6t
PRODUCTS•CCMPIOPAGO
f2000O00
Policyn 171 LDC
A
AUTOMOBILE LIABILITY
M1010TOT
06108)06
06MBIDT'
CouEINEDSINGLE LIMIT
$500,000
(Ea eciEent)
ANY AUTO
ALL ONHED AUTOS
BODILY INJURY
f
rwpe )
X SafrDIXED AUTOS
'
X HIRED AUTOS
BOILY�p
s
X NON-OWIED AUTOS
-
X I Drive Other Car
f
PRPRC�mDAMAGE
GARAGE LIABILITY
AUTO ONLY -EA ACCIDENT
f
OTHER THAN EA ACC
=
ANYAUTO
f
AUTO ONLY: AGO
A
j EXCEssAaIBREuwLIABartY
CU010707
06108106
06108107
+CE
$5 000 000
AGGREGATE
ss OOO OOO
X oRcm F cwMs MADE
f
i
I
DEbUCTIBLE
1
s
i X RETENTION $10000
'
B
frcRIaeRSCOMPENSAnONAND
CAWC702365.
12125105
1225106
x WCSTATIY orH
E.L EACH ACCIDENT
$500000
. I .
EMPLOYERS UABILRY
E.L. DISEASE- EA EMPLOYEE
$500000
ANY PROPEUETORIPART ERIE ECUTIVE
I
OF OFEtCER1413ABER EXCLUDED?
ELpISFASE•PDLIOYLattT
f500000
'
SPECIALP�ROVISION1SDelwv -
1
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSENICNTI SPECIAL PROVISIONS
� I
I ;
V CKI IrR,A IC RVLVCR ^•^----^-
SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 07MTIDN
DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAL —JUL DAYSWRITTEN
NOTICE TDIHE CERTFCA7F HOLDER NAMED 197HE LEFT, BUT FASURE TD DO SOSHALL
. .. IMPOSE NO OBUGATION OR LIABILITY OF ANY IUND UPON THE INSURER, ITS AGENTS OR
REPRESEHTATNES.
AUTHORIZED REPRESENTATIVE
ar`non tnRPnPATIAN I9RA
( FR,VRV Li LEVY HYYI 1 07 L *M1.ZG0 1
Q/r[ f' r� 1„ 1'l ,Vf�lrlip,bl
Boston, MA 0Z)71
•;;: t �';V., �nini>_n,.nss:;; of/din
'��'arltcrs' Coz�ll�ca�saiaun )>usuranccAffidavii_ I3uild4rs1Go7�itariol�ll;Icc�iricia»slPIuxnl.�crs
r> Iic•ant 3nformalion I 7'Ii-ASe Prim I,efrilrIy
amc:<3insincxsfUrgarricatia,�ndiviaualy_ Capizzi Nome Improvement Inc.
1-6i lm R , m md
We= Wult, MA 02635
Tel 42&951811800 262 5050 -
IY/Slate/Zip:
P)ione t.
.S<n, an eamployer? Cbecl;ibru.2ppropriatcbox:
I am a ea�,loYa with
4. I am a general eontodorand i'.
CnVloyces (fiiil and/orpaii-time).'
• have birrA •d,c sub-contnciois
I = a sol�proprictorot partner-
lis[ed bn ft attached sbccL 4.
sbip•and have no employees
Tbcse sub-contcacionh2vo
Workig for me in any c2p2o4ty.
[No wozkct' coziip_•msnrance
*workers' comp. ins mm
$- 0 We arc a corporation and its -
Tr,quired-]
O icus leave eaeacised beir
I azn a h0meovancrdoknv gvodc
ri0AofcxemptionperMGL
mysCM [Noivorkeis' comp-
c.152, §IOX2md-we ha,ono
TTCurznce ztgmirCd.I t .�
eamployees_ [No wows'
fe
oc�mceau�o boa!1mtuixlsofillomfli¢sealionbetowshotoing woks'i a4i
snhmntinsaffidnortinMcmtay.S)e7=3r6gzMt
O&=Ldtbcalicreb=sideCM3tMdc doa abai rbxY$5s1=nee sl ai(a ea za aff ixional sli xi shone ing the game ofIIusub-mfractar
n eranloyea Ylzat is proridi,za s,oJirers' camponsation f*urtrancevrmy
iatioiz r r
ncx Co �7 ul ard' 1�� CO l7�rut
Or. self-im-11C,
Type of project. (regnfred): .
b.• ❑ N'ew consinlo6on
7. i] Ramodelbg
8. �] Demolition
9. EnBm7ding addiiiflm .
I0.❑ El6tldcal repairs or additioi�,
pTnmT'rm g rqpaim oI addThonS
12.j3 Roofrepairs .
33-� Otizcr
Pphoy�om,nr;ow
r�:si.siima[e�tv.r�daviimcTc�gsoch � j
ad Sieaa,oicea' ems_ noliav mfCx=F ;=-' _
�lv ss alieRoiicy andjob 3zie
lalas/d& •
.Ada I
�.
a copy of the s1 ozkers' co,a�pe,o ion policy deciataiion pane (s# ing the polio* xxumber and expizatxota dale)_
io secmzc coverage as rcquued Odra• Section 25A ofMGL a 1$2 emlead to lhe imposition of cxbnmal pmalties of a ,.
to S1,500.00 and/or one-year inap=ommmt, as vlreu as civdpeml esin &re formof a STOP WORK ORDERand a fmc
o $230_fl0 a clay as 3=�cV'OlafDr ge advised that a copy of ibis sift may be forwadrdto 114e OfG= of
gallons of tine D71: for M=nnce coverage veridoatinn•. •.
reby wsdet ,pains arulper �fp irtjtJzsrl tfze irzfornrmYon p,»vided t,�ove zs,hue mrri correct ; F. • _
e. _ ... L _...... �%/•e/1�.. nay--� /� �� C� �� o
%S19
czrri use 04t. -Do not lslr&e in this area, fo be com 7etedL
or talon affiaiaL
or'Tovm:
g A >atho ' , �'frnaiilf kose ..
rits (circle one):
cardofReatth
_ 2-$nddiagDepartment 3_Cits1ToAQ'thyezk riectxicallIXospedor Plnnnbinginpedor
-
iact Per -Son:
khane �-
•.e
Board of Building Regulations and Standards
One Ashburton Place - Room 1301
Boston. Massachusetts 02108
Home Improvement -Contractor Registration
Registration: 100740
=' Type: Private Corporation
.. Expiration: 6/23/2008
CAPIZZI HOME IMPROVEMENT,.INC
Thomas Capizzi, jr.
1645 Newton Rd.
Cotuit, MA 02635
Update Address and return card. Mark reason for change.
DPS-CA1 Co SOWK -SPC8688 Address [] Renewal Q Employment Lost Card
07M IvewwIHNIlIJQ6((/y 01'1& auac/urae4
k Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
r ' Registration: 100740
Expiration; ` 6/23/2008
.Type: Private Corporation
CAPIZZI HOME IMPROVEMENT, INC.
Thomas Capizzl, jr,. • �,
1645 Newton Rd.,,,,`
Cotuit, MA 02635 Deputy Administrator
TI-IoMAS X
1645 NEWT(
CPTUIT. W
License or registration valid for individul use only
before the expiration date. if found return to:
Board of Building Regulations and Standards
One Ashburton Place Rut 1301
Boston, Ala. 02108 .
Not valid without signature
130ARD OF Bill -DING � cueekk
Lic'ense: CONSTRUCTION S
Numb eS 057032 -�
h.
3
Page 7 of 7
CAPIZZI HOME IMPROVEMENT INC.
• SPECIFICATIONS AND ESTIMATES
STATE OF MASSACHUSETTS
I
LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT
,
OWN THE PROPERTY LOCATED AT 94 5 Q'C`
IN �` Yam✓ MASSACHUSETTS.
I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO APPLY FOR
A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING
CODE.
GIVE MY PERMISSION TO I LESSEE
TO APPLY FOR A BUILDING P
STATE BUILDING CODE.
SIGNATURE OF OWNER:
OWNER'S ADDRESS:
OWNER'S TELEPHONE:
LESSEE'S SIGNATURE:
LESSEE'S ADDRESS:
LESSEE'S TELEPHONE:
APLLICANT'S SIGNATURE:
APPLICANT'S ADDRESS:
APPLICANT'S TELEPHONE:
RESPONSIBLE OFFICER:
508428-9518
RESPONSIBLE OFFICER ADDRESS:
RESPONSIBLE OFFICER TELEPHONE:
Cotuit, MA 02635
OF 11 Vqj�61TOWN OF YARM9 zBuilding Department
l
BUILDING
(508) 398-2231 ext261
PERMIT NO 8-06-233 - ... "I.. " _ . PERMIT
ISSUE DATE : _ 8/22/2005 _ : PROPOSED USE :
--""""""""""'" "" ""' APPLICANT Bert Mosher . JOB WEATHER CARD
PERMITTO Repair
AT (LOCATION) 00267E CCK ISLAND RD ZONING DISTRICTK2fl Bldg. Type: Residential
SUBDIVISION MAP LOT BLOCK 1047.76 BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R-4
LOT SIZE
strip and reroof, 15A44r4, paper and vent to code
REMARKS
AREA (SO FT) EST COST ($ $4,300.00 PERMIT FEE ($) $25.
OWNER SYLVIA KEITH BUILDING DEPT BY
ADDRESS 100267 BUCK ISLAND RD
West Yarmouth I MA 102673
CONTRACTOR
LICENSE 145504
osher, Bert
Box 1131
South Dennis MA 02660
50836"655
M
INSPECTION RECORD FIELD COPY
Date Note Progress - Corrections and Remarks Inspector
B'Read dd a commend Bit cad aicm*wdm s
tim.IIaetoatCmlefQmp ur. / f t-16"!ro! -m R.pervisarUr. /
ware.OamQe..�im m.:�oa (Cheek m.)
01sa>b.Lomeowna i m.sobp�aprieeor0Ihavewar6�esc wmmfimimQaooe
km ACM MNr �l�nrt �c�n�n warbesclosa
o T" Q%sum"creiso.aardwo
Dmrod= Nana seas siea
0 saw / arswa O sapiamane ww"W /
O s¢e�atdoors /
°N'�' () so4 a*< � araeifias soar
•sr.d.w.�w arat �'�S �a �
m room"
wis MJ}d o sr dis OrMOO" dNW soma aid Ihrmar 1[O.L Ct 26%sedim 1.
/ippie�ti s(/erra �i uT' I wAY� .. AA Q.c V122'ln
owraslpran(oraelaa•rt) � Ke lDft
wP1ro"d
MWdisGf5M (or dryn) Dec
ZoninDi*kt: r�
iii$WW Diesiet U Yes d No Flood Piero Zmc 0 Y. *ljo
Wakr Resou m hdogda boriot Wi N 00 R d Wedmdc
a Yes lb I \m 0 No
t
"I
0
JLLL
y
f0
E
N
LU
2
LL
ruuy it��...-- i
Free Estimates
t
— custom MOW, ... n
MA02660
P.O. go lM • south Dennis,
o�•Y� TOWN OF YARMOUTH
BUILDING DEPARTMENT
O 1
"A 3' ra 1146 Route 28, South Yarmouth, AAA 02664 508-398-2231 ext. 260
BUILDING PERNITT FIELD INSPECTION CORRECTION NOTICE
Date: 4-9-03
Location: 267 Buck Island Rd.
Permit No: B-01-030
Issued to: William Cushlanis, Yarmouth Port Building &Remodeling
198 Main St.
Yarmouth Port, Ma.
-02675
During my inspection of 4/8/03 at the address noted above, the
Building Code were noted:
violations of the State
East Side Stairs
Stairs are not supported on a concrete pad at the base. They rest solely on grade.
Re: Chapter 1, Section 117- workmanship, Chapter 36, Table 3603.1.3-Mmimum Live Load, Table
3603.1.3, Note 2.
Guardrail is less than 36" in height. Re: Chapter 36, Section 3603.14.2.1
The Platform is not bolted to the house Same and is less than 48" x 42". Re: Chapter 36, Section
3503.12.1- Landings and Table 3603.1.3
South Side (water side) Stairs, deck & Ramp
Variable stair risers 7 %" at the top to 7" at the bottom Re: Chapter 36, Section 3603.13.2-
Stairways Treads and Risers
Stair Treads and/ or stringers pitch downward. Re: Chapter 1, S I •on 117 Workmanship
A stringer does not support the centers of the treads and the edsting stringers are bearing on an
unsupported 11/2" platform edge. Re: Chapter 3603.1.3,Note 2 and Chapter 1, Section 117-
workmanship
Treads are not fastened properly and are loose. Re: Chapter 1, Section 117- Workmanship and
Chapter 36, Table 3603.1.3
Hand rail is loose and the stair stringers are not fastened at the bottom (upper level stairs) Re: Section
117- Workmanship and Table 3603.1.3, Note, 2 1
A 4x6 post is not mechanically fastened to the deck above. Re: Chapter 36, Section 3605.2.8-
fastening ' I
Page 2-Field Correction Notice April 9, 2003 Continued
The ramp appears to exceed the maximum allowable pitch of 1/8 (12.5%). Re: Chapter 36, Section
3603.15.1
No guardrail or handrails were installed. Re: Chapter36, Section 3603.15.2
Therefore you are herby advised to correct the aforementioned violations and contact this office for a
reinspection when all the corrections have been completed. Approval by this department is required.
This is your second notice and these corrections were to be made by December 31, 2002, they have
not been fixed as of April 9,2003. You are being given until April 3O'h 2003 to have a final inspection
on this property or this matter will be turned over to the proper authorities for legal action.
Failure to get the final inspection within these time limits will also result in this being referred to the
Building Board of Regulations and Standards in Boston for their 'review of your license pursuant to
780 CMR R5, Section R5.5.2.9
Very truly,
Kenneth Bates
Building Inspector
0;
12
TOWN OF YARMOUTH
BUILDING. DEPARTMENT
I 1 -0--
1146 Route 28, South Yarmouth, MA 02664 508-398-2231 cit. 260
BUILDING PERMIT FIELD INSPECTION CORRECTION NOTICE
December 9, 2002
William Cushlanis
198 Main Street
Yarmouth Port MA 02675 0(—Os
Inspection Date: December 4, 2002
Location: 267 Buck Island R&
Permit No: B-01-030
Issued to: William Cushlanis, Yarmouth Port. Building & Remodeling
During my inspection of December 4, 2002 at the address referenced above, the following violations
of the State Building Code 780CUR were noted:
EAST SIDE STAIRS
—Stair stringers are not supported on a concrete pad at the base. They rest solely on grade. 'i%'
RE: Chapter 1, Section 11 7-Worlananship, Chapter 36, Table 3603! 1.3-Nfiaimum Live Load, Table
3603.1.3, Note: 2
—Guardrail is less than 36 inches in height. RE: Chapter 36, section 3603.14.2.10d i it i, 4op
—The platform is not bolted to the house frame and is less than 49"x427. RE: Chapter 36, Section
3603.12.1-Landings and Table 3603.1 .3
CRAWL SPACE
—The crawl space access is a cellarwindow that can only be opened from the inside. Therefore
access is not available from the. exterior, which is the only way,t6 access the crawl space. RE:
Chapter 36, Section 3604.9.2, Crawl Space Access Lk JP&,- odtPJ52
/6
SOUTHSLDE (waterside) STAIRS, DECK& RAMP
—Variable stair risers 7 !6 " at the . top to,7" at the bottom. RE: Chapter 36, Section 3603.13.2-
Stairways Treads& Risers Ra-v_ 98 rno�elc4f
-Stair treads and/or stringers pitch downward. RE&-:74rhapter 1, Section 117- Workmanship
��- o-�-s�,�
%/�
- I ��
Page 2— Field Correction Notice December 9, 2002 contd. .
—A stringer does not support the centers of the treads and the existing stringers are bearing on an
unsupported 1 1/4" platform edge. RE: Chapter 36, Table 3603.13, Note: 2 and Chapter 1, Section
117-Workmanship 1
—Treads are not fastened properly and are loose. RE: Chapter 1I Section 1'17- Workmanship and
Chapter 36, Table 3603.1.3.
-Hand rail is lose and the stair stringers are not fastened at the bottom .(upper level stairs) RE:
Section 117-Workmanship and Table 3603.1.3, Note: 2
—Joist hangers were not installed on the re -framed upper level deck area. RE: Chapter 36, Section
3605.2.4-Bearing % 1 4'
—A 4x6 post is not mechanically fastened to the deck above. RE: Chapter 36, Section 3605.2.8-
Fastening
RAMP (south side)
appears to exceed the maximum allowable pitch of 1/8 (12.5%). Cha er36, Section
3603.15.1
— o guardrail or handrails were installed. RE: Chapter 36, Sectil n 3603.15.2
Therefore, you are hereby advised to correct the aforementioned violations and contact this office for
a re -inspection when the corrections have been completed. Approval by an inspector from this
department is required. All corrections must be made on or before December 31, 2002.
Finally, failure by a contractor who holds a construction supervisor's license to make said corrections
by the date noted may result in the suspension or revocation of that license pursuant to 780CMR R5,
Section R5.2.9.
Very truly,
James D. Brandolini, C.B.O.
Building Commissioner
cc: Ms. Judith Keith
267 Buck Island Rd.
CERTIFIED MAIL
Hlield'mspmr
?o� Y � TOWN OFXARMOUTH — C - 03
BUILDING DEPARTMENT
01� � 1146 Routee-28 ' South Yarmouth .NIA 02664 508-398-2231 ext. 260
BUILDING PERMIT FIELD INSPECTION CORRECTION NOTICE
December 9, 2002
Mr. William Cushlams `..
198 Main Street
Yarmouth Port MA 02675
Inspection Date: December 4; 2002
Location: 267 Buck Island.Rd
Permit No: B-01-030
Issued to: William Cushlams, Yarmouth Port Building & Remodeling
During my inspection of December 4, 2002 at the address referenced above, the following violations
of the State Building Code 780CMR were noted:
EAST SIDE STAIRS
—Stair stringers are not supported onaconcrete pad at the base. They rest solely on grade.
RE: Chapter 1, Section 117 Workmanship, Chapter36, Table 3603.1.3-Mmin=Live Load, Table
3603.1.3, Note: 2
—Gruardrail is less than36 inches in height, RE: Chapter 36, Section 3603.14.2.1
—The platform is not bolted to the house fiame and is less than 48"x4T'. RE: Chapter 36, Section
3603.12.1-Landings and Table 3603.13
-CRAWL SPACE
The crawl space access is a cellar window that can only be opened from the inside. Therefore
access is not available from the exterior,. which is the only way to access the crawl space. RE:
Chapter 36, Section 3604 92, Crawl Space Access
SOUTH'SIDE,�water. side) STAIRS, DECK & RAMP
—Variable stair usersst'the top�to 7" at the bottom RE: Chapter 36, Section 3603.132-
Stairways Treads &Risers ` '' • ' I -
Stair treads and/or _stringers pitch downward. RE: Chapter 1, Section 117- Workmanship
—A stringer does not .support.the centers of the treads and the existing stringers are bearing on an
unsupported 1 '/4 "platform edge. RE: Chapter 36, Table 3603.13, Note: 2 and Chapter 1, Section
117Workmanship
—Treads are not fastened properly and,are Ioose. RE: Chapter 1, Section 117- Workmanship and
Chapter 36, Table 3603 13. ; :-
Hand rail is lose and the stair stnngers are not fastened at the bottom (upper level stairs) RE:
Section 117-Workmanship, and Tab1e:3603.1.3, Note: 2
—Joist hangers were not installed on the re -framed upper level deck area. RE: Chapter 36, Section
3605.2.4-Bearing
—A 4x6 post is not mechanically fastened to the deck above I RE: Chapter 36, Section 36052.8-
Fastening y
RAIN {south side)
—The ramp appears to exceed the ma 'unum allowable pitch of 1/8 (12.5%). RE: Chapter36, Section
3603.15.1
No guardrail or handrails were Installed. RE: Chapter 36, Section 3603.152
Therefore, you are hereby advised to correct the aforementioned violations and contact this office for
a re -inspection wheel the corrections have been completed i Approval by an inspector from this
department is regwred All corrections mist be made on or before December 31, 2002.
i l
Finally, failure by a contiactor.whio holds a. construction supervisor's license to make said corrections
by the date noted mayiesultRi the sri'spensiog dr revocation of that license pursuant to 780CMR R5.
Section R5.2.9
Very may,
James D. Brandolini, C.B O
Building Commissioner
cc: Ms. Judith Keith
267 Buck Island Rd
CERTIFIED MAIL
HT,eikupwrr
AG
71,
i'.,
og YqR ONE & TWO FAMILY ONLY - BUILDING PERMIT
�r r G APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH AONE OR TWO FAMILY DWELLING
O
Town of Yannotlth Building Department
1146 Route 28 • Yarmouth, MA 02664-4492
Tel: (508) 398-2231 x261 • f'ax: (508) 398-2365
Of sce'Use Only ' Planing Board Information Assessors Department intorrnation:
6 ;a-00: P for . r. M ccr
t'ermR No. 3- I oop pate 8 �7 / �6
Permit Fee , �Y�'t^ ,ad How
.. ' t � ,. � •`' ��`e � ' n A 1.4 Property l)Irttenaltms p ; y � � � • ;
r��,c,,yos<ft Reb d tSIl�� I •
' `lase '?'e � • i:4+ �'ts /Qj� �, �,_..1;• .>.....� . t^... }il.----+—��
4Net17oe``f ,,. �-70:'. �" r •..aa(8f), Isiomta9e(h) Lo+tbveraga
Building Permit Numt o2 ° 0
•narl¢1ts.
r '
Slgilatute:' ;ram r '' �F jrequked:
y o� Section 1 -Site !r' >>'
1.1 Property AdO�y sop. o 1%*
Proposed Use
.3 Building
Yard
D,
1.4 r SupPhr tA•o.1- c. 40. S 54) i.5 ROOM
Public Private Zone:
Section 2-- Property Ownership/Authorized A
2.1 owner of Record:
N me
gnat
2.2 Authorised Bent:
i� is 6
N p t)
' 3 G2-eo
Signature Telephone
Rear Yard
Required Provided
comments: • `
Idnx,� T-s I.;...rc Raul
Mailing Address
Telephone I
Address
Section 3 - Construction Services
3.1 Licensed Construction Supervisor I Not Applicable ❑
L) Gn,sl,la►.; •
_ I License Number
ed
.t r s �— qea- P•r'r I fr 9 oL
ffrs
362 oQGQ Expiration Date
Signature Telephone
3.2 Registered Home Im rovemerd Contractor.
ComponyNane 2 I Not Applicable ❑
gs�
P t License Nsber,
Add
• 3�2-00 6a Expiration Date^_-^
Signature Telephone 1 f0� ��dC.Vat
M a OVER
C
9-15-99
0
rwnwcra�a /�
ONE & TWO FAMILY ONLY - BUILDING PERMIT
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH AONE OR TWO FAMILY DWELLING
Town of Yarmouth Building Department
1146 Route 28 - Yarmouth, MA 02664-4492
Tel: (508) 398-2231 x261 - Fax: (508) 398-2365
i
Oflfee Usa poly +
Planning Boar! Information
,
Assessors Department Information: -
Plan Type �
� `c`r • ' • 6.
PetmitFee
EndariementDate
New
,1 K,r
RectirdPng Oats;
1.4 Property blmenerotts i t . ` ',
`NEI DIIBa t �u'�%D:
Omar
:LottXrage
LotArea (at), Ftontege (R) Ne
j ,
.. This Section4orOffice Use OM
Building etmitNumber: -
Date Issued: -
-of pecupaney..
Sigtlaitutse7:
; b hoof:roquked.
: Building" Official Date
.:
Section 1 Sfte Information
I Use Group. R-4 Type: 5-B
1.1 Property Address:
12 Zoning Information:
10 f k-c�l__� R
P a m
Zoning District Proposed Use
1.3 ouiiding setbacks (ft)
, Front Yard Side Yards. I
Rear Yard
Required T Provided Required
Provided I
Required Provided
O
r Spply (Y.G.Le. 40. S b4I T.5 Flood Zone Information: IComments:
1A.,
Public Private Zone:
'Section 2 - Property Ownerstiip/Authortzed Agent
2.1 Owner of Record:
•
1 I
C
Mailing Address
N me
9
gnat
Telephone i
2.2 Authorized A e11t:
Sf-
;1 co.r, s
N F t1
Mailing Address
Signature Tel;h.!C
Section 3 - Construction Services
2,1 Lfeensod Construction Supervisory
I
Not Applicable ❑
a•% LA 1j, CLr.i
D -A
I
License Number
,
&rL�.s
62 DQ `Q
Expiration Date
Telephone
Signature
3.2-Registered Home Improvement Contractor.
NotAppii able ❑
Company Name
9,1
l I
Y
AIR Part
li License N sber�
tAdds
Expiration Date
�;-,,,r Telephone
i rfl'-aOOa�
„.�._._
1012 OWR
9.15-99
Workers Compensation Insurance aidavit st be completed and submitted itted with this application. Failure
to provide this affidavit will result in the depifil of the issuance of the building permit.
Signed Affidavit Attached Yes ......... No ..........
section 6 .� Desoiiptioh'of Proposed Work,16heckallAPPO b1A)
New Construction ❑ - No. of Bedrooms No. of Bathroo
Fad tl Bld ❑ Repair(s) ❑ ARerations ❑ Addition
s ng M.
Accessory Bldg. ❑ Type
Dolitio�
s
Other Specify:
Brief Description of Proposed Work: I
10 G G Jc
I
Check Below
I
iConservation-Commission Filing
(if applicable)
❑ Old Kings Highway & Historical
Commission approval
(if applicable)
as owner of the subject property
hereby authorize �� (•'� CoS+^� < to act on
1mybeAhalnll matters re Live to work authorized by this building permit application.
er Date
, as Owner/Authorized Agent
" I
hereby declare that the statements and information on the foregoing application are true and accurate.
to the best of my knowledge and belief.
Signed under the pains and penalties of perjury.
L✓i IlfGaw
Print n
—ame
A
W /- G erg'—�p 00
Signature of Owns gent I Date
9 . f5.99 2 of 2
E)c i s liV t pu,e,�l;
�%:e w•'a�ou1 io
4.
403�
Iaa
ulipj
6)
oc TOWN OF YARMOUTH Buildi rtment BUILDING
-----"•• (508 9 2 �1 xt1261
r = PERMIT NO B-13-1.... r I PERMIT
ER IT
ISSUE DATE _31412013- - : PROPOSE SE
APPLICANT . 'N'"•e •-'"""."""'""' "" JOB WEATHER CARD
.......
PERMfrTo Repair
AT (LOCATION) 10267BUCK ISLAND RD ZONING DISTRIC R-25 Bldg. Type: Residential
SUBDIVISION MAP LOT BLOCK 1047.76 BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R-3
r LOT SIZE
- CONTRACTOR
REMARKS repairs to wall due to plow damage - replace studs, sheething, siding and window LICENSE 081139
Nardone, Michael
299 Whites Path
AREA (SO FT) - EST COST (E $2,500.00 PERMIT FEE ($) 550.00 South Yarmouth MA 02664
5087719927
OWNER Pohn Cassidy BUILDING DEPT BY
ADDRESS 10267 BUCK ISLAND RD
West Yarmouth MA 102673 PHONE 15087719927
INSPECTION RECORD FIELD COPY
Date Note Progress - Corrections and Remarks Inspector
,:A
TOWN OF YARMOUTH
BUILDING DEPARTMENT
1146 Route 28, South Yarmouth. AIA 02664
908-398-2231 $0-398-0836
RECEIVETAN)
MAR 28 Z01Z
Permit Number
Date Issued
Expiration Date.
$50.00
By: --' TKLIYl:HY1r:�ilVll"l
Pursuant to G.L. c. 82A I and 92MMR 7.00 et seq.(as amended)
THIS PERMTr MUST BE FULLY COMPLETED PRIOR TO CONSIDERATION
i
Nane of Applicant L+Hfrj f e IV71 'e 1?C1j 9A-
Phones cell
Street Adch 36 %N AuIA 64, /T d
City/Town
)Oenni.r 106ni
MA
I ZIP
W 63 q
Name of irxcsvator (if different from applicant)
Phone cell
/tiic/VC1, 6 c C U.
I
Street Address
af?/Uf - n6/;C;"
Ct,Ve 3'n 17J 1i,'i LL'%G w
MA � 6
/
Name of Ownerls) of PeopertL✓�w
Phone I cell
tAddress : � o 7 ��
Chyfrown
MA
Z1P
Other Contact I Permit Fee Received No Yes
Description, location and purpose of proposed trench:
Please describe the exact location of the proposed Ireneh and its purpose (Include is description of what b (or Is intended) to
be laid In proposed trench (es: pipes/cable lines etc-) Please use reverseside if additional space Is needed.
!lane and Contact Infoulinn of Insurer/Z. '
OGCkS
I rm-�_�r/Z/�/-�i�su'2/9��-e'
s-or-39J' )W7
Pol F_v irsdan Date: OS- - a D/ x
Dig Safe V: A0 t a-- —130 — G Co34r
,Vane of Competent Person (as elefined by S20 C'JIR 7.02):
—YY.filf -,f i i/ . P /yr-i.71
1 of2
' I
Mar 05 2012 10:57AM HP LRSERJET FAX
.. �! :. .. - .. y .-_ f.-..1 Mom. r^ r >y'- ..rYna {p'i(,06
.�•}1�.t4 S E'4N.T � it � -� w rril( iY , 4 j✓,++"%.��»•, Jt M3' f:n .:.;....r.... :. ..
P.2
Musstts iiuistiu� Lksnae S H
BY SIGNING TUO FORM, TUE APPLICANT, OWNERS AND EXCAVATORt ALL ACKNOWLEDGE AND C!?327D'Y
THAT THEY ARE FAMILIAR Wpi' OR.. SEFORE COMMENCEMENT OF THE INCLWoluUDING
. IN Z SJ PEGNIE LATl Wt
WR'U. ALL LAWS AND REGULATIONS APPLICABLE TO WORK PROPOSED. 7NCLUDIIVG OSHA ES,� LAWS LAND
G.L a BTA. ST0 CAM 7.00 et seq.. AND ANY APP12CABLB MUNICIPAL 4HDYIIANCY�.S. lS.SUYD TOR
R9GULATIONS AND rMY COVENANT A.ND•AGIUM THAT ALL WORK DONE UNDER Tti>i Pk�thHT
SUCH WORK WII.i., COMPLY THEME'WITH IN ALL RESPECTS AND I WTi THE pONDI'I IONS SET FOxTI1
bELOW.
THY: UNDERSIGNED OWNER AUTHORIZES THE •APPLICANT TO APPLY FOR.,n,[X P6iAhi1T AND TTUE
HE
10CLUVATOR TO UNDERTAKE SUCH WORK ON THE PROPERTY OF TSE OWLy THE Iv1 AND ALSO, FOR TO
DUBATLON OF CON6T� x cnON.. AUTHORIZES .pKRSONS DULY • APPOIIVTED YiTHE
LKER UPON THE PROPERTY TO MON=IL AND INSPECT THE WORE FOR CO1 FUO
CONDITIONS ATTACHED HERETO AND THE LAWS AND REGULATIONS) GOVERING SUCH WORK.
= UKD=SIGNED APPLICANT. OWNER AND EXCAVATOR AGREE J OINT'LY AND SEVERALLY TO
RM►1RV= TII XUN U PAXXrY FOR ANY AND! ALL.COSTS AND EXPENSES II+iCtJRBEDIIY TIII:
1JU1rlCWjil=*C0NNECTZOK;WITJB-TH:$ AKDTHEWAORKC01'ID:UCTAA IINDF.R
INCLIIAl�(G8[1T•'NOT Y 3 +11EX?RQ!!IG Jz tI7YRED�1 'SiO.PSi'A'I MBAlEATAi N
A1XD CONDTTI NsoF
DY T8E
THIS PER1�ft :TNSVVE 10NS'Dr�+t E TO:ASSUIfE COMPI:ZAT?CE T�iERE I'TH. AND S RES
hIUMOii'ALTrY.TO)4RA=CI' :THE PUBLIC WEVM TEEZ APPLICANTbWN M OR EXCAVATOII;HAS Fr AIDS TO
COMPLYT =mTWp;CLxIDING POLICE DETAUS AND O'iTIBg - MEASURES DEEMED
NECESSARY KII( THE MIRGCIPALITY►
T109 UNDERSIGNED APPLICANT. OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO DEVEN4
INDh W4W, AND HOLD T;ARMLFSS Tm MUNICIPALITY AND ALL OF ITS AGENTS AND EWPLOYW'' FROh!
ANY AND ALL YJA ILTTY. CAUSES OR ACTION. COSTS, AND ESPENSESS RJLSULM NG, FROM OR AR]SMG OUT
OF ANY INJURY, DEATH, LOSS. OR DAMAGE TO ANY PERSON OR PROPERTY DUMG THU WORK
CONDUCTED UNDER TIM PERMIT. +
APPUCAnNT SIGN ATURE
____ / k+�+0,r-�i) ,r DATE
EXCAVATOR SIGNATURE (IF DWFEWFUT �
l.ce�a.�.PiXtY� DATE
OWNER'S SIGREIF IF'% -RENT?
•' _" DATE: 3 .. � '/ �.
. ' C' LY( �. • /r6M7i Ifi�!'� DO not b tl�IY
I7tscu v y. • ,. •: pl+�iiq.tbn Pes • ,
f �
OF r TOWN OF YARMOUT�Building Department
(7�oxj . _ _ _ . , (508) 398-2231 ext.261
PERMIT NO
ISSUE DATE 10/4/2005 _ : PROPOSED USE
APPLICANT -SYLVIA KEITH.........................
BUILDING
PERMIT
JOB WEATHER CARD
PERMITTO PooessoryStructure;
AT (LOCATION) 100267BUCK ISLAND RD ZONING DISTRI R-25 Bldg. Type: Residential
SUBDIVISION MAP LOT BLOCK 1047.76 BUILDING IS TO BE: CONST TYPE 5 B USE GROUP R-4
LOT SIZE O
10 x 12 SHED
REMARKS
AREA (SO FT) EST COST ($ $2,500.00 PERMIT FEE ($) $25.00
OWNER ISYLVIA KEITH BUILDING DEPT BY
ADDRESS 00267 BUCK ISLAND RD
WESTYARMOUTH I MA 102673 1 --J
CONTRACTOR
LICENSE 071717
C655 Portsmouth Ave Bldg. M 2
Greenland NH 03840
16269
INSPECTION RECORD I FIELD COPY
Date Note Progress - Corrections and Remarks Inspector
j—",7 - Ol r. v k -
r
SHEDS LESS THAN 150 SO. FT. SHALL
BE PLACED A MINIMUM OF 30 FEET
FROM THE FRONT LOT LINE AND'A
MINIMUM OF 6 FEET FROM SIDES AND
REAR LOT LINES.
Ault s
I�iessit epim
EXPRESS BUMDING PERMIT APPLICATION
TOWN OF YARMOU M
Yarmouth Building Department
1146 Route 28
South Yarmouth, MA 026"
(508) 39&2M I Eat. 261
as�S>NEOPasATM. 1\1'i%7:2�VtYllt,
NAM' PRFSffi11 I InL
ooMRAClnR:_ o S P P 13�J► rOl\ i � a , i. 3� ��}� 0 t 60 3- 8�8 , i 3 0
❑ Rampstid ❑ CCMMCrcw EML Cod of Conthuce. S�.SII ,
Hemet Impe emmtcaatractorI.ic. I23 421 cme*tim3apa�itar1.ia r O 17 IT
Walaman a compmsition htto<mce. (beck me)
❑ 1 am the hameatv>rr ❑ I am the role poprietar D)1 have Wadba•s Campmstim Fasmooe
huotmaecampanyNme S fi 0� h Wa zescai p.Pt", h/ c 002 1 R
WORK m U r»O N"
0 Tit (rim Rdw&dcwdscdewachpd)
wooditwe Sited
❑ SWEMF A dSgnne O R¢oesed wbdowe R
0 Repbcemrd dose /
o R.{oac a ar3pam
U ��PPros dd rblostu• O tt0i"s vwv�1"= desiremj rod
nk &br6 wID be dhpd det
Loediaw atrw bty i
I daaten coder pmeRiee d tAethe e0ramub bereie oodaiesdm tra eed oorred to the bet dmy bno 1Wp cad bsW I mderMeed tbd any w" ewww(e)
wMbejesteaufar draWor v:7=0d�ioe mditpmwdoyae M.O.I.Ch26kSabm1.,
AppGcedti Sip,elete
Oweere S*Abm
AppondHT_
Or
Zbews District k-as I
Me cxW Dwnct ❑ Yea 8 No El d Pitia Zmc ❑ Yes ❑ i.N6
Water Rnomee Ptetectim Dnblct Within 100 R o[ WeltLendt~
❑ Yes [0k dYSCa ❑ I No
C.K .
OCT 0 4
.q5a
101
SHEDS LESS THAN 150 SQ. FT. SHALL I,
BE PLACED A MINIMUM OF 30 FEET
=� FROM THE FRONT LOT LINE AND A
PLOT PLAN MINIMUM OF 6 FEET FROM SIDES AND
REAR LOT LINES.
1 's _
ame
of #
= this is a
goer lot,
sibs in dame
street
FOR LOT
A na idicat location of garage or lac,�axy bt>Til ibg
with dashed lines--------���_--
Sewerage disposal (cesspool)
r�
I
®E YARD
REAR YARD
I
SET BACK
I
(lat..................ft. fzatt�ge)
(NAME OF STREET)
. Information
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All
Building Localiona_ _ t9l T tKk Ti IC11 /�( T�rrer's Name
\ /1 �� Q ' Cxt-a-�k TYPe of Occupxncy�\P� �Yl�
New Q Renovation Q Replacement Plans Submitted: Yeso No Q
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1ST FLOOR_
II
_
+�
'
2Np FLOOR
-•
I
I
3R0 FLOOR
4TH FLOOR
(
'
IM
STH FLOOR
I
6TH FLOOR
7TH FLOOR
I
6TH FLOOR
Installing Company Name Sosw. SE:oCLc ��<^A:1.JL `L Coo�s.1` Check one: Certilicate
Address S'] L.» ♦ �S QA� Corporation 90C
S . Alt to.�Z-H Q Partnership
Business Telephone —G1901• , O Firm/Co.
Name of Licensed Plumber or Gas Fitter-SPsMES ��L'e2 E'er ��
INSURANCE COVE GE:
I have.a current 1' ilily insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes No ❑ I
If you have checked, eyes. please indicate the type coverage by checking the appropriate box.
A liability insurance policy Other type of indemnity O Bond O
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter 142 of the Mass. General Laws• and that my signature on this permit -application waives this requirement.
Check one:
OwnerO I Agent Q
Signature of Owner or Cwner's Agent
I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my
knowledge and that all plumbing work and installations performed under the permit i;sued for this application will be in compliance with all
pertinent provisions of the Massachusetts Slate Gas Code and Chapter 142 of the General Laws. n i
BY T e of License: �
%umber 4 nature of Ucensed Plumber or as filer
Title sfiller 6gc,
sler Ucenso Number �i 13 7.2 6
City/Town Ujoumayrnan
AppFarL675FNCEU NL 1
I FIIIAL INSPECTION
I
DCLOW FOR OFFICE USE ONLY r
� 1
._".SKETCHES - PROGRESS INSPECTION
FEE
140. i
r
APPLICATION FOR PERMIT TO 00 GASFITTING
NAME d TYPE OF OUILOINO
LOCATION OF BUILDING
PLUMDER OR CASFITTER r
-. /9p .� �.
CASINSPECTOR
:• - . .. r . . 1.
TOWN OF YARMOUTH
Building Department
= Town Hall
Yarmouth, MA 02664
(508) 398-2231 ext261
,t
Building Location: 00267 BUCK ISLAND RD
Owner's Name: SYLVIA KEITH
Owner's Address: 00267 BUCK ISLAND RD
West Yarmouth MA 02673
Owner's Telephone:
Gasfitter Name:
DeForest, James
License Number:
3728
Company Name:
South Shore Htg & Cooling
Company Phone:
(508) 398-6901
PERMIT TO DO GASFITTING WORK
(OFFICE USE ONLY
Recorded By.
Ic
PERMIT NO.
G-03-712
I
Permit Fee:
$25.00
Payment Type:
Check
Check Number.
31040
Issue Date:
3/17/03
Type of Work:
Replacement
I
Comments:
heating boiler
INSPECTION RECORD
Date Note Progress - Corrections and Remarks Inspector
OKI I
c4 Ao
Date Printed: 3/19/03
'Commonwealth of Massachusetts
Official Use Only
Department of Fire Services I Permit No. ��ty
= BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
Rey. 11/99j leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC). 17 C R 12.00
(PLEASE PRINT IN INK OR TYf E l 1. JNFORMATIUN� I Date:
City or Town of- 1Men I To the Inspector W res:
By this application the undersigned Ives notice of his or her intention to perform the electrical pork described below.
Location (Street & Number)_ LJ
Owner or Tenant _
Owner's Address
is this permitlin conjunction with a building permit?
Purpose of Building
Existing Service -Amps / Volts
New Service Amps / Volts
Number of Feeders and Ampacity
Locatioti and Nature of Proposed Electrical Work:
RETROFIT
FOR -
I r
tie No. `f9
Yes ❑ No M (Check Appri 1%ratewo4 I
1[ I
Utility Authorization I
Overhead ❑ Undgrd ❑ No.eters
Overhead ❑ Undgrd ❑ No.9)q
/Metetsb
- /•,.....t.,�:......fri... ! llnw:nn inhla mn" hn wnivnd by de lnre¢etnr o%Wires.
No. of Recessed Fixtures
No. of Ceit: Susp. (Paddle) Faris '; ., „i
No. of Votal
Transformers'' r.: ;..: KVA
No: of Li' htirg Outlets`' •'i ' `' i
—
No. of Hot Tubs.. l - "`i . 'i '" "f
Generators KVA
No.' of Lighting Fixtures 1," N :'
Above In-...
Swimming Pool rnd.r;' � rnd.1:1
o.-o mergency. rgi utg —.-
Battery Units C
7.
No of Receptacle Outlets
Nti.`of OiI Burners `. ' ' ' `;' ` ''
FIRE•AL:ARMS
No. of Zones
No'. of Switches
No. of Gas Burners ' �
o• o electron and
Initiating Devices
No. of Ranges
No. of Air Cond. Tons I
No. of Alerting Devices
No. of Waste Disposers
P
eat ump
Totals:
ons
_
o. o el - ontamed
Detection/Alerting Devices
..umber_
_
__
N_ o. of Dishwashers
Space/Area HeatingKW
Local ❑ Municipal Other
Connection
No. of Dryers
Heating Appliances KNr
Security Systems:
No. of Devices or Equivalent
o. of Water KW
Heaters
o. o o• o
Signs Ballasts I
Data Wiring:
No. of Devices ocatloRr E uivalent
No. H dromnssa a Bathtubs
y g
No. of Motors Total HP
a ecommun vices or
No. of Devices or Eq uivalent
i
OTHER: I
inacn aaantonai deran Iij uesireu. or as requuru vv aoc uupuwu, Ni .u. u.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue 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 `aiid has exhibited proof of same to the permit issuing office -:',, - '
'CHECKONE'INSURANCE [9 BOND OTHER ❑'(Specify:)•'t ��i :�" �' OT/13/05
_ _ _
(Expiration Dare).
;Estima_ ted Value b�' Electrical Work: !' 1 I . • ' (When required by municipal policy.):
;W&k'to'Start: Inspections to be requested, in accordance wnh MEC Ride 10; and upon completion. — —"
/ certify, rirrder Ore pains and penult/es ojperjnry, that the injarmrrn ut 1/rit n /pticiuion is true and, complete." � - - -. - •
FIRM NAME: - M & M Electric, Inc. �
- - LIC. NO.:24108-E
Licensee: Paul Morris
LIC. NO.:A14414—MastE
(ljapplicable. enter "eTempt" in the license number line.) f/ — � N-.,Bus. Tel. No. -
Address:' 92 Rayber Road, #3, Orleans, MA 02653 Alt. Tel. No. -
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner LJ owner's agent.
Owner/Agent
Signature _
Telephone No. I PERMIT FEE. $
I
OF r TOWN OF YARMOUTH Building Department BUILDING
(508) 398-2231 ext.261
PERMIT NO B-07-682 _
=-= = = .- PERMIT
K ISSUE DATE : _ 11/21/2006_ ; PROPOSED USE
APPLICANT __ThomasCapial I JOB WEATHER CARD
PERMIT TO Alterations
AT (LOCATION) 100267BUCK ISLAND RD ZONING DISTRI R-25 Bldg. Type: Residential
SUBDIVISION MAP LOT BLOCT1047.76 BUILDING IS TO BE: CONST TYPE 5 B USE GROUP R-4
LOT SIZE
CONTRACTOR
REMARKS
one replacement bay window
LICENSELp CS057032
Cap'im, Thomas Jr.
1645 Newtown Road
AREA (SO FT)
EST COST ($ $4,100.00 PERMIT FEE ($) $35.00
Cotuit MA 02365
5084289518
OWNER
SYLVIA KEITH
BUILDING DEPT BY
ADDRESS
100267 BUCK ISLAND RD
West Yarmouth
I MA 02673 I
PHONE 15087780274
INSPECTION RECORD I
FIELD COPY
Date Note Progress - Corrections and Remarks Inspector
L-0'
r
7. FIRE DEPART11iENT. DATE:
I
PLEASE NOTE i
All stumps and/or brush must be disposed of at an approved site.
COINB ENTS: 3L�� 7 /yl k. Ti�roC�) l��irrs ii u1
V. Accas T Ae u,•-Poitryo�e
�rLo o iL S rn&s o�ms
> Oam Fa/L S'[,A p/xd-
PD W1,v. G 07'r o z- y Uk.a�2
pry IVKD RLacks am TP 0.= 7
QNs-W4140-BUILDING
1 U wiN Ur xAxZviU u 1-HBUILDING DEPART\LENT
PERMIT APPLICATION SIGN OFF
Applicant: U& llfa•. CJ5 AC6-%.i7S Building Permit No.:
Address: 0 `r Pa;a 5i— q r.wA for'' Tel. No.: 3U2-0040 Date Filed:
Bldg. Site Location: Map INo.: ti % Lot No.: -7b
The following information outlines the procedural steps required to obtain a permit to build, alter, or add
to a structure within the Town of Yarmouth. The Building,Department will determine compliance to the
following: (A) Zoning Requirements (B) Historical Districis (C) Flood Zones. The Building Department
will be responsible for assisting the applicant through the following departments:
i
RESIDENTIAL AND/OR COMMERCIAL BUILDING
WATER DEPARMNT. Determines Compliance of IVaterAvailability. (applicant to obtain)
ENGINEERING DEPART11=. Determines Compliance for Parking and Drainage.
CONSERVATION COMIIIISSION: Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type
of Wetlands, Streams, Ponds,lRivers, Oceans, Bogs, Bays, Marshland, Etc.
HEALTH DEPARTAlENT: Determines Compliance to State and Town Regulations; i.e., Requirements
for Septage Disposal and other Public Health Activities.
FIRE DEPARTMENT: Determines Compliance to State and Town Requirements for Personal
Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc.
—
7be follouring Departments must sign off, in the respective order, prior to building inspector issuing the required
building permit: I
REVIEWED BY:
I. WATER DEPARTb1F.NT: I DATE: N/A:
2. ENGINEERING DEP.n=. DATE: N/A:
3. CONSERVATION: DATE: N/A:
4. HEALTH DEPARThff.IVT DATE: 7 7—O0 N/A
I
5. WIRING INSPECTOR: DATE: N/A:
6. 1-1-U1iBING INSPECTOR: DATE: N/A:
N/A:
.1rr Fovrray-ne,v
N
r a� Us�v his
6) fbD OKE Ci 7 Smo�e� fh-r,� �roit �o E rg S, rrixs lea o.r�
4/99 Applicant Signa
Date - ,�/�—D 0
The Commonwealth oimassaehusetts
Department of Industrial Accidents
0lf eeof/aresl/pstlois
600 Washington Street
" Boston. Mass. 02111
Workers' Compensation Insurance Affidavit
Applicant1Informations PlessePRilPf'Tedt'isia
namr- 0, tliow OA att 5
� t' lucatinn- 10//��Lo"/` cb+-
O 1 am a homeowner performing all work myself.
1 am a sole proprietor and have no one working in any capacity
(9/1 am an employer pro\ iding workers' compensation for my employees working on this job.
addreslsl:lot 7 1^'Lt:�. S�— I .
city: for-+ AD"-7 nho lea: aG1—+DoGO
incurance co.LemiOIL':\Sy"eG1 C noliev M
I
❑ I am a sole prop rietor.:eneral contractor. or homeowner (circle one) and have hired the contractors listed below who have
the following \\orkers' compensation polices:
�9u7�hlil`lihL�
city phone M-
incur-ince co policy M
comp-mnv name-
address, '
i1tY' phone B•
Failure to secure coverage as required under Section 25A of MGL I52 can lead to the imposition of erimiaal penalties ore time sip to siAMM madfor
one years' Imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a flee ofS100.00 a day against me. I madentaad that a
copy of this statement may be forwarded to the OMee of Investigations or the DU for coverage vedfiadoa.
I
l do hereby cerdj q der the pat t a penaltlet of perjury that the information provided above Is true and correct
Signature su (��4—'oZD00
Print name L.19, j 110+., I4.6%i S I PhoneIt 3C2-6040
official use only do not write in this area to be completed by city or town official
city or town: YARMODTII _ permitticense M n8uilding Department
pllcensing Board
check if immediate response is required 261 Qseleetmen's Omcc
C3Health Department
contact person: phone o; _ (508) 398-2231 eat. mOther
..n nee ; a t Pik)
Information and Instructions
Massachusetts General Laws chapter 152 'section 25 requires all emplovees to provide workers' compensation for their
en►plo%ees. As quoted from the "law", an'emplayee is defined as every person in the service of another under any
contract of hire, express or implied, oral or written.
An enrplo►•er is defined as an indi% idual. 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 employgr, or the
recei%er or trustee of an individual . partnership. association or other legal entity, employing employees. However the
owner of a d%%ellin�_ house having not more than three apartments and who resides therein; or'th`e occupant of the
d%%elling house of an who employs persons to do maintenance,, construction or repair wo k on such d%kelling house
or on the mxinds Sr buildings appurtenant thereto shall not because of such emplo%ment1be deemed to be an employer.
I
%lGl. chapter 1: =section =: also states that every state or local licensing agency shall withhold the issuance or
renewval 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.
Additionalh. neither the commonwejlth nor any of its political subdn•isions shall enter into am contract for the
performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter ha%e
been presented to the contracting authorit%.
i
.applicants
Please till in the workers' compensation affidavit completely, by checking the box that applies to your situation and
supp1%ing company names. address and phone numbers as all affidavits may be submitted to the Department of
Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the aMdavit. The
at'tida% it 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.
City or Towns
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 permittlicense number which will be used as a reference number. The affidavits may be returned to
the Department by mail or FAX unless other arrangements have been made.
The.Office of investigations would like to thank you in advance for you 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
600 Washington Street
i
Boston, Ma. 02111
fax #: (617) 727-7749
phone 9: (617) 7274900 ext. 406, 409 or 375
°=='k OWN OF YARIM 0UTH
3r r
Q
r..:.....j� BUILDING DEPARTIMENT
CONSTRUCTION SUPERVISOR FORM
PLEASE PRINT: nn nn '/
job Location:�(1 a..k�s1a.J 1�nod J.,4- '[nrl+I,
Number Street Village
Owner of Property:—k.�'�'�
Constniction Superisor: UJ-- I It
Name
License No.
Address: egg Ma:ti 54-. gQXA..rYK Per•4' iMl� 02.67s
Licensed Designee:
(If other than Supervisor) Name I License No.
2.15 Responsibility of each license holder.
Phone 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 building1official in writing of the discovery of any
violations which are covered by the building permit.
2.15.4 Any licensee who shall willfullyviolate 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 1109.1.1 of the code and these niles 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 under the roles and regulations for licensing construction
superisors in accordance with section 109.1.1 of the state builditg code. I understand the construction
inspection procedures and the specific inspection as called for byi the building official.
INSURANCE COVERAGE:
have a curre lability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152
Yes No ❑
If you have checked yo, please Indi the type coverage by checking the appropriate box.
A liability insurance policy Other type of indemnity ❑ I Bond ❑
I
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:
Signature of
Agent
Owner ❑ Agent
Sigmature: iVoleA..—me � Building Offic lal Approval:
For Office Use Only
Permit No.
Date TOWN OF YARMOUTH
AFFIDAVIT 1
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. / A
Type of Work: Est. Cost 3 5� 00
11 II i
Address of Work oo.Ll (�v..�c T s Low- �� i✓-Y`�'"`+'%��
Owner Name: '3 0 A V Aoi
Date of Permit Application: 6-St' ;L&00
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.
G-"'auto Ul ec., CasLI% 3
Date , Cier�ractor N/ _
OR.
126Sy4'
Registration No.
Notwithstanding the above notice, I hereby apply for a permit as the owner of the above
property:
Date
Owner Name
BUILDING
TOWN OF Y A R M O U T H ELECTRICAL
1146ROUTE28 SOUTHYAR1 oum MASSACHUSETTS0266411451 GAS
Telephone (508) 398-2231, EXL 261 - Fax (508) 398.2365 PLUMBING
SIGNS
BUILDING DEPARTMENT
DEMOLITION DEBRIS DISPOSAL AFFIDAVIT
Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5,
I hereby certify that the debris resulting from the proposed work/demolition to be
conducted at eLG1 ck 14'� Ro,%cL
Work Address
is to be disposed of at the following location: Rv-se dre-e- k
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
Signa ure of Applicant
Permit No.
G-q-'Zdoo
Date
ACORD_ CERTIFICATE OF LIABILITY INSURANCk[D NR DATE(MMIDD"n
SHW50 1 07/03/00
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
GOLDMAN G ASSOCIATES
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
933 FALMOUTH RD .
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
1
HYANNIS MA 02601
Phone:508-775-6010 Fax:508-790-0249
Ii NSURERS AFFORDING COVERAGE
INSURED
NSURERA: ASSURANCE COMPANY OF AMERICA
INSURER B: LEGION INSURANCE CO.
WILLIAM CUSHLANIS DBA
YARMOUTH BLDG G REMODELING
NSURERC:
NSURERD:
198 MAIN ST
YARMOUTHPORT MA 02675
INSURER I —
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR
MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I
INSR LTR
TYPE OF INSURANCE
POLICY NUMBER
DATE MMDIYY
DATE MIDONY
LIMITS
A
GENERAL UABLJTY
X COMMERCIAL GENERAL LIABILITY
CLAMS MADE FXJ OCCUR
SCP33401481
06/25/00
06/25/01
EACH OCCURRENCE
$1000000
FIRE DAMNGE(Any one fire)
S 300000
MED EXP(Any one person)
S 10000
PERSONALS ADV INJURY
$1000000
GENERAL AGGREGATE
$2000000
GENT. AGGREGATE LIMIT APPLES PEF•
POLICY JE LOC
PRODUCTS-COMPIOP AGO
$2000000
AUTOMOBILE UABIUITY
ANY AUTO
ALLOW NED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
-
-
COMBINED SINGLE LIMIT
(Ea accident)
S
BODLY INJURY
per Person)
S
BODLY INJURY
(Per accident
S
PROPERTY DAMAGE
(Per accident)
S
_
GARAGE LIABILITY
ANYAUTO
AUTO ONLY -EA ACCIDENT
S
OTHER THAN EAACC
AUTO ONLY: AGO
S
S
EXCESS LIABILITY
OCCUR CLAMS MADE
DEDUCTIBLE
RETENTION S
-
EACH OCCURRENCE
S
AGGREGATE
S
S
S
S
B
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
TBI
07/03/00
I
07/03/01
X TORY LMRS ER
EL EACH ACCIDENT
$100000
EL DISEASE -EA EMPLOYE
$100000
E.L. DISFJISE-POLICY LIMIT
S 500000
OTHER
DESCRIPTION OF OPERATIONSOLOCATIONSNENCLESIEXCWSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
CARPENTRY
CERTIFICATE HOLDER I N I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION
TowNYAR
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYSYVRRTEN
NOTICE TO THE CERTIFICATE BOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
TOWN OF YARMOUTH
BUILDING DEPT
IMPOSE NO OBLIGATION OR UABIIITY OF ANY IOND UPON THE INSURER. ITS AGENTS OR
RTE 2B
REPRESENTATIVE
/t
YARMOUTH MA 02664
DILL L. MAN
ACORD 25-5 (7I97) (/ I ®ACORD CORPORATION 1933
dwL
%r
41
_ _` ♦ c.. al 3 -a�rry '-fix-:'wT u ti. i •, � �_. t�
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f:. .. � ` • � .a.',. i eh.• • • I� y y r+t♦ 1• ti� .yr ryi:r ita-.`
. -t •• � _ ��.( •p �At'L>Q T•af W `�-`!r t� a K... a I! 4Sa .`
..... +..�.•. ' •�" -. . • .. 2 1+ 4 ,w.r f T R iM. s � J7 -.. _, • \ f ; - fu ."A ' _
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- � ` - • •] - -_ + VyY� ) ('•4 �- r ax - !i. Y; ; 1s a 1e -Y
. - }•1 ^< C"�}'.1a 1 �� _ t• R .w♦s ,1-... •"' a��� +a,! ffi ice. ' P �.x.- a a .a a.•• '•Y•
- _ .i _ -I+• ti - '4� � •-_•�� fS_. �.,-32 i�� -. � 1S + ♦iT - I • `+i~•. , Y••
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Mamdxsd&Department ofEadmumental Protectlon
Bureau of Resource Protection — Wetlands
WPA Form 2 w Determination
• t
Massachusetts Wetlands Protection Act M.G.L
Town of Yarmouth Wetland By -Law
Chapter 143 .
of Applicability
From: 3. line and Renal Revision Date of Plans and Other Documents:
YARMOUTH
Sketch of addition proposed
c wagon cmnmiww
1. Applicant
Judv Keith
AWM arPftM AWM fte&
267 Buck Island Road
Afi7LVAdL1=
West Yarmouth
GKmm
MA 02673
SUD rmcocr
2. Property Owner.
SAME AS ABOVE
Atrnx orPmpenowx. fa�arrraom,vor�p
A4i MAddmt
Sto rip CD*
Determination
Pursuant to the authority of M.aL c.131, §40, the
YARMOUTH
C MY&M cMftzan
has considered your Request for a Determination of
Applicability, with its supporting documentation, and has
made the following Determination regarding:
267 Buck Island Road
SUMAOM
West Yarmouth
Cry/Tom
T*76
47
AsuumtAloftl PmGtorI
1267 Buck Island Road.
Rov InMA
Massacbuseiis Department of Errrdronmentdi Protection , Town of Yarmouth Wetland sy-Law
Bureau of Resource Protection — Wetlands Chapter 143
WPA Form 2 - Determination of Applicability
Massachusetts Wetlands Protection ActM.G.L c. 131, §40
U Determination (cont.)
The following Determinations) is/are applicable to the :3 5. The area and/or work described on plan(s) and
proposed site and/or project relative to the Wetlands document(s) referenced above, which Includes all or part of
Protection Act and Regulations: the work described in the Request, Is subject to review and
approval by
Positive Determination
Note: No work within the jurisdiction of the Wetlands
Protection Act may proceed until a final Order of Conditions
(issued following submittal of a Notice of Intent or
Abbreviated Notice of Intent) has been received from the
issuing authority (i.e„ conservation commission or the
Department of Environmental Protection).
0 1. The area described on the plan(s) referenced above,
which includes all or part of the area described in the
Request, is an area subject to protection under the Act.
Therefore, any removing, filling, dredging, or altering of
that area requires the filing of a Notice of InteriL
_J 2 The delineations of the boundaries of the resource
areas listed directly below, described on the plan(s)
referenced above, which includes all or part of the area
described in the Request, are confirmed as accurate:
Therefore, the resource area boundaries confirmed In this
Determination are binding as to an decisions rendered
pursuant to the Wetlands Protection Act and its regulations
regarding such boundaries for as long as this Determina-
tion is valid. However, the boundaries of resource areas not
listed directly above are 04f confirmed by this Determina-
tion, regardless of whether such boundaries are contained
on the plans attached to this Deteardnation or to the
Request for Determination.
❑ 3. The work described on plan(s) and document(s)
referenced above, which includes all or part of the work
described in the Request, is within an area subject to
protection under the Act and will remove, fill, dredge, or
after that area. Therefore, said work requires the filing of a
Notice of Intent.
4. The work described on plan(s) and document(s)
referenced above, which includes all or part of the work
described in the Request, is within the Butter Zone and will
after an Area subject to protection under the Act Therefore,
said work requires the filing of a Notice of Intent
nar„e orAGavdp�4ry
i
pursuant to the following wetlands law, bylaw, or ordinance
(name and citation of law).
❑ 6. The following area and/or work, If any, is subject to
municipal bylaw but EM subject to the Massachusetts
Wetlands Protection Act
7. If a Notice of Intent is fled for the work in the Riverfront
Area described on plans and documents referenced above,
which includes all or part of the work described in the
Request, the applicant must consider the following
aftematives (Refer to the Wetlands Regulations at
10.58(4)c. for more Information about the scope of
aftemative requirements) :
❑ Aftematives Grnited to the tot on which the project is
located.
❑ ;Attematives limited to the lot on which the project is
located, the subdivided lots, and any adjacent lots formerly
or presently owned by the same owner.
C 'Attematives limited to the original parcel on which the
project is located, the subdivided parcels, any adjacent
parcels, and any other land which can reasonably be
obtained within the munidpality.
C i Alternatives extend to any sites which can reasonably
be obtained within the appropriate region of the state.
AlaS= 1040iff DJPXt d 01 EAV$DQJ 8VW PfNtE flW Town of Yarmouth Wetland By -Law
Bureau of Resource Protection —Wetlands I Chapter 143
WPA Form 2 = Determination of Applicability
Massachusetts Wetlands Protection Act M. G. L C. 13 Is §40
Determination (cont.)
Negat n Determination
Note: No further action under the Wetlands Protection Act
Is required by the applicant. However, if the Department of
Environmental Protection is requested to Issue a Supersed-
ing Determination of Applicability, work may not proceed
on this project unless the Department fails to act on such
request within 35 days of the date the request Is post-
marked for certified mail or hand delivered to the Depart-
ment. Work may On proceed at the owner's risk only
upon notice to the Department and to the conservation
commission. Regctrertents for requests for Superseding
Determinations are fisted at the end of this document.
1. The area described In the Request is not an area subject
to protection underthe Act or the Buffer Zone.
= 2 The work described in the Request is within an area
subject to protection underthe Act, but will not remove, fig,
dredge, or alter that area. Therefore, said work does not
require the filing of a Notice of Intent
X3. The work described In the Request Is within the Buffer
Zone, as defined In the regulations, but will not alter an
Area subject to protection under the Act. Therefore, said
work does not require the firing of a Notice of intern.
4. The work described In the Request Is not within an Area
subject to protection underthe Act (including the Buffer
Zone). Therefore, said work does not require the filing of a
Notice of Intent, unless and until said work alters an Area
subject to protection under the Act.
:1 5. The area described In the Request Is subject to protection
under the AcL Since the work described therein meets the
requirements for the following exemption, as specified in
the Act and regulations, no Notice of•Intent is required:
&VVAC6*
10 6. The area and/or work described In the Request is not
subject to review and approval by
IAhmvefMot ffry
pursuant to a municipal wetlands law, ordinance, or bylaw,
(name and citation of bylaw).
CONDITION:
I
WORK LIMIT LINE TO BE SET AT
10 FEET FROM CONSTRUCTION.
AuthOl%Tdt/On This Determination must be signed by a majority of the
conservation commission. A ropy must be sent to the
This Determination is issued to the applicant and delivered appropriate Department of Environmental Protection
as follows: regional office (see appendix A) and the property owner (if
different from the applicant).
XX by hand delivery on
May 23, 2000 Sig
om �
❑ by certified mail, return receipt requested on /l
no
This Deterndnadon Is valid for three years from the date of
Issuance (except Determinations for Vegetation Management
Plans which are valid for the duration of the Plan).
This Determination does not relieve the applicant from
complying with all other applicable federal, state, or local
statutes, ordinances, bylaws, or regulations.
i
May 18, 2000
!' .
Massachusetts Depadment of Eadiomaental Ptntection ToWn of Yarmouth wetland By-1.aW
Bureau of Resource Protection — Wetlands I Chapter 143
. WPA Form 2 - Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
' Appeals
The applicant, owner, any person aggrieved by this Determina-
tion, any owner of land abutting the land upon which the
proposed work Is to be done, or any ten residents of the City or
town in which such land is located, are hereby notified of their
right to request the appropriate Department of Environmental
Protection Regional Office to Issue a Superseding Determina-
tion of Applicability. The request must be made by certified
mail or hand delivery to the Department, with the appropriate
filing fee and Fee Transmittal Form (see Appendix E Request
for Departmental Action Fee Transmittal Form) as provided In
310 CMR 10.03(7) within ten business days from the date of
Issuance of this Determination. A copy of the request shall at
the same time be sent by certified mail or hand delivery to the
conservation commission and to the applicant If he/she is not
the appellant. The request shalt state clearly and concisely the
objections to the Determination which is being appealed. To the
extent that the Determination Is based on a municipal bylaw,
and not on the Massachusetts Wetlands Protection Act or
regulations, the Department of Environmental Protection has no
appellate jurisdiction.
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Brandolini, Jim
From: Johnson -Staub, Peter
Sent: Thursday, November 14, 20021:13 PM
To: Brandolini, Jim
Subject: Judy Keith
Ms. Keith described a problem she is having with a contractor - Yarmouthport Construction Co. Apparently, the
contractor did some work that does not comply with the building code - stair construction I think. She claims the
contractor has refused to come back to rectify the problem. She has spoken to Bill Stone and said he had been helpful.
She is looking for assistance In resolving the problem and possibly filing a complaint.
Q6zt3uckisland y: /�'l0e.7` cr
eSLY 73
Peter Johnson-Staub
Assistant Town Administrator"
Town of Yarmouth, MA
1146 Route 28, S. Yarmouth, MA 02664 i
V.508.398.2231 x 270
F.508.3982365
d
I
k
or k, TOWN OF YARMOUTH
* Building Department
•49 _ Town Hall
Yarmouth, MA 026rA
(508) 398-2231 ext.1261
BUILDING PERMIT
TRANSMITTAL
Temp Permit No.:
T-13-299
Applicant Name:
M. J. Nardone
Applicant Phone:
5087719927
Building Location:
0267 BUCK ISLAND RD
Owner's Name:
John Cassidy
Owner's Addres
0267 BUCK ISLAND RD
West Yarmouth MA 02673
Owner's Telephone:
(508) 771-9927
REVIEWED BY:
1. WATER DEPARTMENT:
2. ENGINEERING DEPARTMENT:
3. CONSERVATION:
4. HEALTH DEPARTMENT:
5. BUILDING DEPARTMENT:
6. FIRE DEPARTMENT:
COMMENTS:
RECEIPT OF COPY.
(OFFICE USE ONLY
Recorded By.
I
Ic
Permit Fee:
$50.00
Deposit Rec:
$50.00
Payment Type:
Check ChkNo.: 5022
Net Owed: .
$0.00
1
Application Date: 2/27/2013
Issue Date:
Expiration Date
PLEASE NOTE
SIGNATURE OF APPLICANT:
Comments: Map/Lot: 047.76
repairs to wall due to plow damage - replace
studs, sheething, siding and window
DATE:
N/A:
DATE: I
N/A:
DATE: I
N/A:
DATE: I
N/A:
DATE:
N/A. -
DATE: I
N/A:
DATE:
Date Printed: 3/1/2013
B 2015 SlipGen- Portal Hone
I
Town of Yarmouth
I
■
Template [Building Dept]
Zoe
Slipsheet Identifier [sg35427]
Document Category Building Permits I
Map -Block Number 047.76
Street Number 0267
Street Name BUCK ISLAND RD
Department Building
Parcel ID 6832
Backfile Batch Scan No I
Document?
Additional Naming Info
Index Operator Operator, Yarmscan
Date - Time 2015-08-07 - 12:16
httpJAasedche12/Sl1pGeN I 1I1