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HomeMy WebLinkAboutBuilding PermitsAT (LOCATION) TOWN OF YARMOUTH Building Department BUILDING (508) 398-2231 ext.261 PERMIT NO b-03-552 _ ISSUE DATE ; _ _ 12/10/02_ _ PROPOSED USE ---------------------- APPLICANT ALEXANDER MITROKOSTAS TRS ----------------------------- ----------------------------- ADDRESS '101 Crowell Road ISA RNES LN it )\ ZONING DISTRICT SUBDIVISION MAP LOT BLOCK 1023.321 1 BUILDING IS TO BE LOT SIZE I I CONST TYPE 5-B PERMIT J WEATHER CARD PERMIT TO New Construction ' R-25 new construction: 2 baths, 3 bedrooms, 1 diningroom, 1 bar garage, 1 kitchen, 1 laundry room as REMARKS per plans dated 12/03102. USE GROUP R-4 CONTR'S 001608 LICENSE CONTR'S NAME McShane, John AREA (SO FT) EST COST ($ $180,000.00 PERMIT FEE ($) $671.00 OWNER ALEXANDER MITROKOSTAS TRS ADDRESS 1101 Crowell Road BUILDING DEPT BY Certificate Issue Date � o V 3 CERiTtFCA� of OCCUPANCY � Depa ental Approval for Certificate of Occupancy and Compliance Inspector Date Permit Number Approved By Remarks P-wk !SING 6 /8-63 ,�- d3-SSZ G - PLUMBING/GAS j ELECTRICAL vG OTHER l %Q� ',YC�� )sJ? bx OTHER - 4, ©Z --.0 To be filled in by each division indicated hereon upon comDletion of its final insaection. i i TOWN OF YARMOUTH Building Department BUILDING (508) 398-2231 ext.261 PERMIT NO 03-552 _ ' ISSUE DATE 1 - - - - 2 PROPOSED USEPERMIT ---------- --- -------------------- ---------- APPLICANT WLEXANDER MITROKOSTAS TRS JOB WEATHER CARD ----------------------------- ----------------------------------------- ADDRESS ' 101 Crowell Road PERMIT TO ; New Construction ' FAT(LOCATION) 100021BARNESLN ZONING DISTRICT R-25 SUBDIVISION MAP LOT BLOCK 023.321 BUILDING IS TO BE USE GROUP R-4 LOT SIZE CONST TYPE 5-13 CONTR'S 001608 new construction: 2 baths, 3 bedrooms, 1 diningroom, 1 bar garage, 1 kitchen, 1 laundry room as REMARKS per plans dated 12103/02. AREA (SQ FT) EST COST ($ $180,000.00 PERMIT FEE ($) $671.00 OWNER ALEXANDER MITROKOSTAS TRS ADDRESS 1101 Crowell Road BUILDING DEPT BY INSPECTION RECORD LICENSE CONTR'S NAME McShane, John FIELD COPY Date Note Progress - Corrections and Remarks Inspector 5-2 - PC- ONE & TWO FAMILY ONLY - BUILDING PERMIT p� APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLINGAt ` 01 n y Towof Yarmouth Building Department J$^TTACHE �V 1146 Route 28 • Yarmouth, MA 02664-4492 Use Group: R-4 Type: 5-B 1.1 Property Address: 1.2 Zoning Information: Zoning District Proposed Use i'JeS ?' VAK 't27* 1.3 Building Setbacks (ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 3®' 90 ' 5' ly ` 30 7'' 1.4 water Supply (km.C- L. c. 400. S 54) ublic Private 2.1 Owner of Record: n MdONTAW VI IIA63C /©/ Cl,' gff 7/AP114,1(JTA Nam ) 5Py rQc� /`7 i ' %ZoK�STir� Mailing Address S,8 - %%/- 0 67 2- Signature 0Telephone 2.2 Authorized Agent: M r-S k��t C -S T. Co. ;r�, L OSrter')'t Nam2�� — Mailing Address Sign a Telephone �[l I I'n C I I 1, � i 3.1 Licensed Construction Supervisor: Signature / mmam Company Name Address Signature 9- 15-99 - r'.Zs7-r.P UI /, Telephone 0.215 U� Not Applicable ❑ NOV 0 2002 License Number Fu Expiration Date //9, Not Applicable IS.( License Number Expiration Date Telephone 1 of 2 OVER . 0 w ' t Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes ...?5.... No .......... New Construction ® No. of Bedrooms No. of Bathrooms : Existing. Bldg. ❑ Repair(s) ❑ Alterations ❑ Addition ❑ Accessory Bldg. ❑ Type Demolition Other Specify: Brief Description of Proposed Work: 33E 2 r&-rk F:7�,1I GA17 a✓rsz CAU A7-r& CA Item Estimated Cost (Dollars) to be completed by permit applicant Check Below ❑ Conservation -Commission Filing (if applicable) ❑ Old Kings Highway & Historical Commission approval (if applicable) 1. Building $ 000 2. Electrical Z ?_ 0c? 3. Plumbing / Gas z7, 5- U 4. Mechanical (HVAC) — 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) 7. Total Square Ft. (new houses & adcri ions) : 1, SOyI2, /l1/ /�o��S i �f-S , as owner of the subject property hereby authorize �'�'��►�S-rR UCH / OYj to act on My b/ehalf, in all rs relative to work authorized by this building permit application. � K //_ / _ 0 Signature of ner Date , :fix '��: M :�; �,�:: •c� � : • ►, ��( /"6� �1f�11J , as Gwo*WAuthorized Agent 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. t'"J Print name �� QZ Signature of ner/Agent Date 9- 15-99 2 of 2 For Office Use Only Permit No. Date TOWN OF YARMOUTH AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c. 142A requires that the `reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition or construction of an addition to any pre-existing owner -occupied building containing at least one but not more than four dwelling units or structures which are adjacent to such residence or building' be done by registered contractors, with certain exceptions, along with other requirements. Type of Work: Est. Cost v Utz v Address of Work oZ 1 &,, r in LVl . Owner Name: M�� �i �U 1 L c" L1 w,1-F-aj lac cyt Z—, s Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under $1,000 Building not owner occupied Owner pulling own permit Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: 11 Slaz Date M /'T —S 6w,s7. Contractor Name 0016 0B Registration No. Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name —1 ki W iN y r i i-k n lvl v v iL i1 BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRI.VT. Job Location: 21 Barnes Lane West Yarmouth Number Street Village Owner of Property: Mountain Village Limited Partners D ,ti v•.S%7ANe-, Construction Super%-isor://OS//)AA))- 00..l1C - L' S "1 6 d 1- Sad XeZE-SSdO Name License No. Phone No. Address: d ax ywo d,s Ye z v;0% ,1441-994 0w6 s,5' Licensed Designee: (If other than Supervisor) Name 2.15 Responsibility of each license holder: License No. 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The iicense Mder s'ali be respoiiSibic i0 supervise the construction. reconstruction, alteration.repair, removal or demolition involving the structural elements of building and structures only pursuant to the state building code and all other applicable laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in irriting of the discovery of any violations which are covered by the building permit. 2.15.4 Anv licensee who shall willfullyviolate subsections 2.15.1, 2.15.2 or 2.15.3 or anyother 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 supen•ise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons. the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes Z No :i If you have checked y s, please indicate the type coverage by checking the appropriate box. A liability insurance policy !�J Other type of indemnity :1 Bond OWNER'S INSURANCE WAIVER: I am aware that the licensee does riot 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 Owner or Owner's Agent Owner �3 Agent Signature: Building Official Approval: BUILDING DEPARTMENT BUILDING PERMIT APPLICATION SIGN OFF Applicant: Mountain Village Limited Partners Building Permit No.: Address: 101 Crowell Road, West Yarmouth, MA Tel. No.: Date Filed: Bldg. Site Location: 21 Barnes Lane, W. YarmouthMap No.: 023 Lot No.: 321: MA 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 Districts (C) Flood Zones. The Building Department will be responsible for assisting the applicant through the following departments: RESIDENTIAL AND/OR COMMERCIAL BUILDING WATER DEPARTMENT: Determines Compliance of Water Availability. (applicant to obtain) 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, Marshland, Etc. HEALTH DEPARTMENT: 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. ---------------------------------------- The following Departments must sign off, in the respective order, prior to building inspector issuing the required building permit: REVIEWED BY: 1. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT: DATE: N/A: INDUSTRIAL AND/OR COMMERCIAL PERMITS 5. WIRING INSPECTOR: DATE: N/A: 6. PLUMBING INSPECTOR: DATE: N/A: 7. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE All stumps and/or brush must be disposed of at an approved site. COMMENTS: 8/99 Applicant Signature Date M The Commonwealth of ,Massachusetts Department of IndustrialAccidents Offles0/11WO S&ONs 600 Washington Street Boston. Mass. 02111 Workers' Compensation Insurance Affidavit Applicant r+ information: nims: -TQhQ "c�)F ioc5tion ZI b A�AJE-5 &A.> Xr l am a home6wner performing all work myself. I am a sole proprietor _-d hose no one working in am capacin 1 am an emplo%er p ros iding workers' compensation for my employees working on this job. comnanNname % e SAANe, DA) iuGfza� C�`o ANC address: / ' Q ' 1�30 X ya9 city: A L>e Ile A A 0 44,515- phone fi• Sa Fl ' Slw .C>-l�e.sa�ai7�a/aod 1 am a sole proprietor. general contractor. or homeowner (circle one) and have hired the contractors fisted below %sho hale the follost in_ �%orker_.:ompensation polices: company name: address: ci phone k insurance co oolicv I "ACU,suuauuaaa a.ccara .. Failure to secure coverage as required under Secnon 25A of MGL 152 can lead to the imposition of criminal penalties of a tine op to 51�00.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a tine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the OMee of Investigations of the DIA for coverage verification. l do herebY ccertif►• under the pains and penalties of perjury that the information provided above is true and eorreM Signature`✓ /`� Date Print name >U0 &2 Phone r official use only do not -A rite in this area to be completed by city or town o eta city or town: YARMOUT11 _ permitAicense 0 rlBuilding Department [3Licen3tog Board check if immediate response is required 261 ❑$electmen's Office eat Health Department (508) 398Z2231 contact person: phone 0: _ __ _ r'tOther TOWN OF YARMOUTH 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664-4451 Telephone (508) 398-2231, Ext. 261 — Fax (508) 398-2365 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT BUILDING ELECTRICAL GAS PLUMBING SIGNS Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at 21 '8AEMES �-� • T �%ti4ctTf Work Addr is to be disposed of at the following location: AT(-AM71 G /Vdp�r-A Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Signature of Applicant Permit No. Date j TOWN OF YARMOUTH • Building Department Town Hall Yarmouth, MA 02664 (508) 398-2231 ext.261 BUILDING PERMIT APPLICATION RECEIPT Temp Permit No.: Applicant Name: T-03-234 John McShane Location: 00021 BARNES LN Owner's Name: ALEXANDER MITROKOSTAS TRS Owner's Addres 101 Crowell Road West Yarmout MA 02673 Owner's Telephone: (508) 771-0672 (OFFICE USE ONLY Recorded By: IC Permit Fee: $0.00 Deposit Rec: $50.00 Payment Type: Check ChkNo.: 15226 Net Owed: ($50.00) Application Date: 11/6/02 Issue Date: Expiration Date Comments: new construction: ZONING i-kv This is NOT a building permit. Application subject to plan review. Contact Building Department for permit status. Official Building Permit will be issued upon plan review completion, approval, and complete payment of Net Owed on Permit Fee. n Date Printed: 11 17/02 PROPERTY ADDRESS: '#ALCULATION FOR PERMIT COST x �Fc�c 36 X /2, sx /J( / 7 i" �f y 30V X /y 7Q`y, — / P-ty_"_ 1-'Al' k_�. TYPE OF ROOM, ETC ALTERATIONS BATH BED ROOM 3 CERTIFICATE OF OCCUPANCY COMPUTER ROOM DECK OPEN DECK WITH ROOF DEMOLITION DEN DINING ROOM FAMILY ROOM FIREPLACE FOUNDATION ONLY GARAGE NO. OF BAYS / / GREAT ROOM KITCHEN LAUNDRY ROOM LAUNDRY ROOM LIVING ROOM MUD ROOM OFFICE PORCH CLOSED PORCH OPEN REROOFING SHED STORAGE AREA SUN ROOM HEATED SUN ROOM UNHEATED SWIMMING POOL ABOVE GRO SWIMMING POOL INGROUND WINDOW REPLACEMENT 1 .0 •Y,q,R .^TT�"��CS[,/ Building Site Location: Proposed Improvement: 3 TOWN OF YARMOUTH BUILDING DEPARTMENT BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET C No: Q 3 Lot No:. 3,1-) 77 i 06 -7o-21 Address: ��d /�d x �� / Tel.No.: qe7 Date Filed: / a The Building Department will be responsible for assisting the appiilaant by dispatching your plans and or application to the following applicable departments. RESIDENTIAL AND/OR COMMERCIAL BUILDING WATER DEPARTMENT: Determines Compliance of Water Availability and or existing location. 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, Marshland, Etc HEALTH DEPARTMENT: 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. REVIEWED BY: 1. WATER DEPARTMENT: 2. ENGINEERING DEPARTMENT: 3. CONSERVATION: DATE: N/A: DATE: N/A: DATE: N/A: 4. HEALTH DEPARTMENT: DATE: N/A: INDUSTRIAL AND/OR COMMERCIAL PERMITS S. WIRING INSPECTOR: DATE: N/A: 6. PLUMBING INSPECTOR: DATE: N/A: 7. FIRE DEPARTMENT: COMMENTS: RECEIPT OF COPY: DATE: N/A: PLEASE NOTE SIGNATURE OF APPLICANT: DATE: White copy - Building Dept. - Pink copy - Water Dept. - Yellow Copy - Haft Dept. - Pink Copy - Engineering Dept. - Goldenrod - Fire DeptAConservation f41- Building Site Location: Proposed Improvement: Applicant; a3y TOWN OF YARMOUTH BUILDING DEPARTMENT BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET Map No: Q 3 Lot No: -2xq- j Address:ress: �d %3d ya % Tel.No.:go? 5Oa Date Filed: / The Building Department will be responsible for assisting the applicant by dispatching your plans and or application to the following applicable departments. RESIDENTIAL AND/OR COMMERCIAL BUILDING WATER DEPARTMENT: Determines Compliance of Water Availability and or existing location. 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, Marshland, Etc HEALTH DEPARTMENT: 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. -4i--------------------------------------------------------- ------------------------------------------------------------------ ------------------------ REVIEWED BY: 1. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: 4. I SALT 4 DEPARTMENT: DATE: /%/,;�vZN/A: �� 6L — INDUSTRIAL AND/OR COMMERCIAL PERMITS S. WIIMG INSPECTOR: DATE: N/A: 6. PLUMBING INSPECTOR: DATE: 9. FIRE DEPARTMENT: DATE: N/A: COMMENTS: RECEIPT OF COPY: PLEASE NOTE SIGNATURE OF APPLICANT: DATE: White copy - Building Dept. - Pink copy - Water Dept. - Yellow Copy - Health Dept. - Pink Copy - Engineering Dept - Goldenrod - Fire Dept/Conxrvatnn Building Site Location: Proposed improvement: '.•�,; - `fir T �.;:,,� y, any TOWN OF YARMOUTH BUILDING DEPARTMENT BUILDING PERMff-APPLIC C t DEPARTMENTAL SIGN OFF .� TRANSMITTAL SHEET / f' Map No: Lot No: Ile '7 7 / 66 7o2� - Address: i / 1l Tel.No.: qv? 5 Date Filed: / Ae fr The Building Department will be responsible for assisting the applicant 155y1spatching your plans and or application to the following applicable departments. WATER DEPARTMENT: ENGINEERING DEPARTMENT: NSERVATION COMMISSION: I�EALTH DEPARTMENT: n FIRE DEPARTMENT: ----------------- REVIEWED BY: Determines Compliance of Water Availability and or existing location. Determines Compliance for Parking and Drainage. Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc Determines. Compliance to State and Town Regulations; i.e., Requiremeas For Septage Disposal and other Public Health Activities. Determines Compliance to State and Town Requirements for Personal Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc. ------------------------------------------------------------------------------------------------------------------------ 1. WATER DEPARTMENT: � DATE: - P d =- N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N1A 4..: HEALTH DEPARTMENT: DATE: N/A INDUSTRIAL AND/OR 5. WIRING INSPECTOR: COMMERCIAL PF LDtM DATE: N/A: 6. PLUMBING INSPECTOR: DATE: N/A: 7: FIRE DEPARTMENT: DATE: N/A COMMENTS: RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: Wuix aopy - Bw1ft Dept - Pint copy - WAW Depk - Ydlow Copy -Haft Dept. - Pink Copy - Engineering Dept - Goldauod - Fire Depf/r�i TOWN OF YARMOUTH WATER DEPARTMENT 99 Buck Island Road West Yarmouth, MA 02673 Telephone: (508) 771-7921 • Fax: (508) 771-7998 Date of Issue : Nov 8, 2002 Letter of Water Availability 1. Single Family Dwelling X 2. Duplex Family Dwelling 3. Condominium Dwelling 4. Commercial / Industrial S. Other (Specify) Reference; Massachusetts General Laws Chapter 40, Section 54 To : Town of Yarmouth Building Inspector Please be advised that the Town of Yarmouth Public water supply is available to service lot/parcel(s) 321 Street 21 BARNES LANE as shown on Assessors sheet/map # 23 Issuance of this Letter of Availability is subject to the following provisions/restrictions. (1) The property owner agrees to comply with all Federal, State, and Local Laws, Rules and Regulations as they pertain to the use of the Public water Supply. (2) The Yarmouth Water Department shall have exclusive rights as to the size, number, type and location of all water service lines, fire service lines or appurtenant items connected to the water distribution system. (3) The Yarmouth Water Department reserves the right to require, at the property owners expense, the installation of water mains and appurtenant items to meet water demand requisites within any structure relevant to this Letter of Availability. (4) This Letter of Availability will expire 180 days from the date of issue. I have read and understand the provisions/restrictions of this Letter of Water Availability. Reference ALEXANDER MITROKOSTAS C/O JOHN MCSHANE PO BOX 429 OSTERVILLE, MA 02655 Owner (Sign) Yarmouth Water Department Building Site Location: Proposed Improvement: Applicant; 3 TOWN OF YARMOUTH BUILDING DEPARTMENT BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET Map No: o2 3 Lot No: - 7 � Address: �� RdTel.No.: �f o2 $ � SOd Date Filed: / A/e ��6 The Building Department will be responsible for assisting the apg scant y dispatching your plans and or application to the following applicable departments. RESIDENTIAL AND/OR COMMERCIAL BUILDING WATER DEPARTMENT: Determines Compliance of Water Availability and or existing location. 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, Marshland, Etc HEALTH DEPARTMENT: 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. REVIEWED BY: 1. WATER DEPARTMENT: 111 DATE: N/A 3. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT- DATE: N/A: INDUSTRIAL AND/OR COMMERCIAL PERMITS 5. WIRING INSPECTOR: DATE: N/A: 6. PLUMBING INSPECTOR: DATE: N/A: MAP/LOT _2 3 -_ 32 I ADDRESS-_ 2 1__ BAR N Es _ LA AJ E PLAN INFORMATION PLAN TYPE -----A-. N _ R . ENDORSEMENT DATE ___ I_� �O 6 8 RECORDING DATE __ No V.__Co8---- ?_ ASSESSORS PLAN # ------------------ PLANNING BRD. # __ 4 - --------------------- PLAN. BRD. RELEASE __-- N -A -- ------------------ TOWN OF YARMOUTH BUILDING DEPARTMENT PLAN REVIEW & BUILDING PERMIT APPLICATION REVIEW NOTES ADDRESS: Map / Lot:DateDate of Initial Review: Z Other: Approval Date: Inspector: �ILYi2 NOTES:) -�M 5 /w`T FG� rl �F S �ICGAiT/GL,LTtKT�EXP,�ius�G,�.lo.�rfic.`�2 e?"- POLY 5'tf3 3) r U171-t rr (o�sr+ � Lr�v scvrt Y (�ccr�n. f/!`fvTSy�u Dle- ✓e- ��F� S'! 9e 614 aT - _ i v C-4, DAir - %I �F, �e+ D - ��e • 3l c� 3. 6 , 4, z Il D A0',17-vlz/9L '3g�,�j(•48=31.(.��%>'Ed_D - gqq, tQ,AV.,s X 3 Z. �-5/ ADD 6"Ve-0) /%%" S ?ty0 01160-F Co 5;e 1'4 Aw s 1 S Zoning Denial (if applicable): Section 104.3.2, pares Change, Extension or Alteration (pre-existing, nonconforming) The proposed - requires a Special -Permit from-thezoning Board -of Appeals: Other Building Code Denial (if applicable) Rev. 1 i GI r TOWN OF YARMOUTH Building Department Town Hall �s Yarmouth, MA 02664 (508) 398-2231 ext.261 P 0 Building Location: 00021 BARNES LN Owner's Name: McShane Construction Owner's Address: 00021 BARNES LN Owner's Telephone: Plumber Name: License Number: Company Name: Company Phone: West Yarmouth MA 02673 Silva, Robert 20536 Bob Silva Plb & Htg (508) 428-0864 PERMIT TO DO PLUMBING WORK (OFFICE USE ONLY Recorded By: Ic PERMIT NO. P-03-485 Permit Fee: $95.00 Payment Type: Check Check Number: 1773 Issue Date: 3/19/03 Type of Work: New Comments: 2 water closet, 1 kitchen sink, 2 lays, 2 bathtubs,1 wash mach conn, 1 dishwasher, 1 HWT, water piping INSPECTION RECORD Date Note Progress - Corrections and Remarks Inspector -- fu ro �S -r r/C oev'ST 7 Div �5- - Date Printed: 3/20/03 v FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE Read the -instructions on oaoes 1 - 7. O.M.B. No. 3067-0077 Expires July 31, 2002 SECTION A- PROPERTY OWNER INFORMATION For Insurance Company Use: BUILDING � ER' j NAME � � TCu�r Pdqum iNber BUILDING STREET A DDRESS (Including Apt. Unit. Suite, and/or Bldg, No,) OR P.O. ROUTE AND BOX NO. Company NAIC Number i. CITY ' , r, YA f ,F��. ^ UT* STATE Mk 7J DE D J 2k�2 PROPERTY DESCRII rrION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc_) ' IM r4P 2� , 32l NG USE (e.g., Residential, Non-residential, Addition, Accessory, etc. Use a Comments area, if necessary.) PCs l �E 1rl�klL. LATITUDE/LONGITU: iE (OPTIONAL) HORIZONTAL DATUM: SOURCE )_) GP (ype): ( W - ##'-##,##" or ##.fly) LI NAD 1927 LI NAD 1983 LI USGS Quad Map L—I Othe SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFl COMMUNITf NAME & COMMUNITY NUMBER B2. COUNTY NAME 83. STATE k I M h I0015 '5" I NS " (eE I MA B4, MAP AND PANEL FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE Read the -instructions on oaoes 1 - 7. O.M.B. No. 3067-0077 Expires July 31, 2002 SECTION A- PROPERTY OWNER INFORMATION For Insurance Company Use: BUILDING � ER' j NAME � � TCu�r Pdqum iNber BUILDING STREET A DDRESS (Including Apt. Unit. Suite, and/or Bldg, No,) OR P.O. ROUTE AND BOX NO. Company NAIC Number i. CITY ' , r, YA f ,F��. ^ UT* STATE Mk 7J DE D J 2k�2 PROPERTY DESCRII rrION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc_) ' IM r4P 2� , 32l NG USE (e.g., Residential, Non-residential, Addition, Accessory, etc. Use a Comments area, if necessary.) PCs l �E 1rl�klL. LATITUDE/LONGITU: iE (OPTIONAL) HORIZONTAL DATUM: SOURCE )_) GP (ype): ( W - ##'-##,##" or ##.fly) LI NAD 1927 LI NAD 1983 LI USGS Quad Map L—I Othe SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFl COMMUNITf NAME & COMMUNITY NUMBER B2. COUNTY NAME 83. STATE k I M h I0015 '5" I NS " (eE I MA B4, MAP AND PANEL B5. SUFFIX 86, FIRM IFOEXB7. FIRM PANEL 88, FLOOD 59. BASE FLOOD ELEVATION(S) NUMBER I DATE EFFECTIVEIREVISED DATE ZONE(S) (Zone AO, use depth of flooding) 2hoof5 5 D 2 Z Aq ln,nf BIO. Indicate the soy rce of the Base Flood Elevation (BFE) data or base {food depth entered in 69- 1-1 FIS Profile bCI FIRM I —I Community Determined I —I Other (Describe): B11. Indicate the elevation datum used for the BFE in B9: IX1 NGVD 1929 I —I NAVO 1988 1-1 Other (Describe): B12. Is the building I:1cated in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? 1—I Yes W No Designation Dare: SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevatio is are based on: LlConstruction Drawings' L)Building Under Construction" XIFinished Construction 'A new Elevatior Certificate will be required when construction of the building is complete- C2, Building Diagran Number 2— (Select the building diagram most similar to the building for which this certificate is being completed - see pages 6 and 7. 1 f no diagram accurately represents the building, provide a sketch or photograph.) C3. Elevations — Zon as Al-A30, AE, AH, A (with BFE), VE, VI-V30, V (with BFE), AR, ARIA, ARMS, AR/AI-A30, ARIAH, AR/AO Complete Items :33.a-I below according to the building diagram specified in Item C2. State the datum used. If the datum is different from the datum used -or the BFE in Section S, convert the datum to that used for the BFE Show field measurements and datum conversion calculation_ Use the space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion. Datum AAAVCI_ Conversion/Comments Elevation referer ice mark used 'f43 M_ ;Q,. I ek Does the elevation reference mark used appear on the FIRM? l Yes I No gF a) Top of bott )m floor (including basement or enclosure) 10 . f -(m) m lid b) Top of ner., higher floor ft_(m) ❑ c) Bottom of! )west horizontal structural member (V zones only) fQm) i O d) Attached c arage (top of slab) _ ft.(m) w g PU ❑ e) Lowest ele: iatlon of machinery and/or equipment servicing tie building (Describe in a Comments eras.) _ ft.(m) X f) Lowest adjacent (finished) grade (LAG) A _ -Q ft.(m) z' Zr la g) Highest ail scent (finished) grade (HAG) Ig - � tt(m) ❑ h) No. of perr went openings (flood vents) within 1 ft. above adjacent grade _ ❑ i) Total area .if all permanent openings (flood vents) in C3.h sq. in. (sq. cr;_ o0.3 SECTION D -SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This cer6Frcation is ,o be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information_ I certify that the inA rmation in Sections A. B, and C on this cert/Boate represents my best efforts to interpret the data available. I understand that say fa/se statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. CERTIFIER'S NAME I LCENSE NUMB TITLE FEMA F m -31, .. UL 00 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS ZOIn U911TA V SaTsuoH OSTC CCs SOS XY3 CZ:bT CO/6T/90 IMPORTANT_ In the se spaces, copy the corresponding Information from Section A_ For Insurance Company BUILDIN STREET AC RESS (Idu ing Apt., Unit. Suite, and/or Bldg_ No.) OR P.O. ROUTE AND BOX NO. Policy Number CITY STATE ZJP CODE W/yA C�uni - dUPr GZ6_+3 SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner, COMM9TS I 1 Check here if attachments SECTION E - BU ILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zone AO and Zon a A (without BFE), complete Items El. through E4. If the Elevation Certificate is intended for use as supporting information for a LOM 4 or LOMR-F, Section C must be completed. E1. Building Diagram Number (Select the building diagram most similar to the building for which this certificate is being completed — see pages 6 and If no diagram accurately represents the building, provide a sketch or photograph.) E2. The top of the bot om floor (including basement or enclosure) of the building Is I-1_1 ft_(m)1-1-1in_(cm) 1-1 above or 1_,1 below (check one) the h ghost adjacent grade. (Use natural grade. If available_) E3. For Building Diagi ems 6-8 with openings (see page 7). the next higher floor or elevated Floor (elevation b) of the building is I—I-1 fL(m) I—(_—lin.(cm) above the highest adjacent grade, Complete Items C3.h and C3.i on front of form. E4. For Zone AO only If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain manage iment ordinance? I-1 Yes 1-1 No I —I Unknown. The local official must certify this information in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner c c owner's authorized representative who completes Sections A, B. C (items C3.h and C3J only), and E for Zone A (without a FEMA-issued or community -issued BFE) or Zone AO must sign here_ The statements in Sections A, B, C, and E are correct to the best of my kno'd e, PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS 1-1 Check here If attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who i , authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B. C (or E , and G of this Elevation Certificate. Complete the applicable Item(s) and sign below. G1. 1_1 The information in Section G was taken from other documentation that has been signed and embossed by a licensed surveyor. engineer, or, irchhect who is authorized by state or local law to certify elevation information. (Indicate the source and date of the elevation dat; a in the Comments area below_) G2. 1—I A community official completed Section E for a building located In Zone A (without a FEMA-issued or community -issued SFE) or Zone AO. G3. L.1 The following information (Items G4-G9) is provided for community floodplain management purposes. G4. PERMIT NUMBER. I G5. DATE PERMIT ISSUED] i rs_ ntoTF; rc e n rnuoI 1Atircinrr� ioe G7. This permit has br yen Issued for: Ir1 New Construction 1-1 Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building is: _ _ ft.(m)Datum: G9. BFE or (in Zone h 0) depth of flooding at the building site is: _ ft.(m)Datum: LOCAL—OFF0=1 ME TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE - I I Check here if attachments FEMA Form 81-31, JL L 00 REPLACES ALL PREVIOUS EDITIONS cpQ!I Ua11TM V daTS.zog 09TC 9C8 909 XVa CZ:bT CO/6T/90 Jun 17 03 01:53p McShane Construction 508 428 8508 p.2 TOP OF FOUNDATION — EL 14.3cTs SCRAWL SPACE 100 YEAR FLOOD PLAIN — EL 10 . COMMUNITY PANEL #250015 0005 D �e MINIMUM ELEVA77ON OF CRAWL SPACE FLOOR — EL. 10.0 ESTIMATED SEASONAL HIGH GROUNDWATER — EL 5.5 NOTE: FOOTINGS FOUNDATION WALL AND CRAWL SPACE SLAB TO BE ►►`= CONSTRUCTED ACCORDING TO ARCHITECTURAL PLAN. SHARON e*� MOFARS MALONE—JOHNSON. 16 APRIL 2000 tj EDWMW L " PESCE VL `<' U No =I l FOUNDATION DATE: , 15-May-00 !PCY__..._ LMIMAM DRAWN BY' 21 BRNES LANE 1C CHECKED BY: i ELP YARMOM , MA -g--•----- . __..... APPROVED BY.' ELP , SCALE: I 1" = 100' ' MOUNTAIN VILLAGE LIMITED PARTNERS 1 Horsley &Witten, Ina Environmental Services 90 RoLib GA Sexhrrt HW Sen"Ch MA 0250 fax 833021W Date Name TOWN OF YARMOUTH WATER DEPARTMENT 99 Buck Island Road West Yarmouth, MA 02673 Telephone: (508) 771-7921 • Fax: (508) 771-7998 March 25, 2003 Mountain Village Ltd. Partnership Legal Address 101 Crowell Rd. W. Yarmouth, MA 02673 Service Address 21 Barnes In. W. Yarmouth, MA 02673 Assessor's Sheet # : 23 Certified Mail # : 7000 0600 0028 3346 6124 New Structure : x Existing Structure : NOTICE Service # : 15039 Lot(s) # : 321 This is to advise you that the Town of Yarmouth Water Department or their authorized agents have installed a new water service or rehabilitated an existing water service at the above service address. Materials used during this installation are electrically nonconductive. Town of Yarmouth Water Department regulations prohibit the use of this water service as a grounding device for your electrical service. It is recommended that you contact an electrical contractor to ensure that your electrical service grounding is in compliance with Massachusetts Electrical Code, CMR, S27-12.00 Article 250. A copy of this notice is being forwarded to the Town of Yarmouth Wiring Inspector. Dan Mills, Superintendent cc Wiring Inspector File TOWN OF YARJI MOUTH 2003 �.S 1 APPLICATION FOR PERMIT TO DO PLUMBING (OFFICE USE ONLY) By. Fee: $ PERMIT NO. Building > Owner's 42 AT: Location I?/ �������� Name Type %J Occupancy �f Replacement ❑ _03_ Date NewK Renovation ❑ Plans Submitted Ye,< No ❑ N z Z Z W Y J fn Q V Q z M C7 cn N _z U W H w ¢_~ N X O u. Z z z a. 3 D x v cn Z M cn m x x N M~ w¢ a w cn N Y Z c a a cn z Q d a a Q CC o LL Lu cn M J Z G Fes_- >~ m O Cn N y - 3= z 0 Cn 0 . cn 0 M Z c w a P 3 O M U m 2 o 3 Y-j c c SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR (PRINT OR TYPE) ? j 'P ff jj Installing Company Name I I A f �' f Address S- sT�� S �� c x! P r / Check One: ❑ Corp. ❑ Partnership L�j r-f i S t 6" S 4'!�Ie7 ZI-R Company .�as z� 0�6 %7�ber < s Business Telephone % Name of Licensed Plumber � ' � ✓ � INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent. Check One: Yes ❑ No ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance voerage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature of Owner or Owner'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 Permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Check on Owner ❑ Agent 1 Signature of Licensed Plumber 7-ar36 License Number Type: Master ❑ Journeyman4 APPLICATION FOR PERMIT TO DO GASFITTING TOWN Building AT. Location New Y Plans Submitted glq Renovation ❑ Yes No (OFFICE USE ONLY) By Fee: $ PERMIT NO. Replacement ❑ Date s'Jt3 �— Owner's Name,Sh� �r�rs+tycfiun Type of Occupancy fps jdLnhA- CD YLu � Cn N W M 0 Z M N H = uj w cc V m 2 N cc a O m Cl) w Q O M O Z H � a W = w Z a => Q w O W N J Z Q 2 M CO) 0 Ir W 0 C w = N cc F— W> Z �_ F W z OC w w O> m Z w O F- Z W � 0 w _ Q = O OC a= l=i Z D Q G Q C7 J V = > G a H 0 SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR (PRINT OR TYPE) Check One: Installing Company Name �NeA21� ❑ Corp. Address 15� 4)1 c,%--/e ❑ Partnership i1,Ar-1kn-5 02;L,�j v-1A �2 F1 �j Firm/Company Business Telephone - b - Q Name of Licensed Plumber or Gasfitter 5_�:;jvA INSURANCE COVERAGE: Check One I have a current liability insurance policy or its substantial equivalent. Yes If No ❑ If you have checked yes, please indicate the type of coverage by checking the appropriate box. A liability insurance policy 0 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. Check One: Owner ❑ Agent ❑ Signature of Owner or Owner's Agent V / I hereby certify that all of the details and infdrmation-I lta (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 0 w 'a �, i Signature of Licensed Plumber or Gasfitter License Number TYPE LICENSE: ❑ Plumber ❑ Gasfitter 0 Master Journeyman APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00 OF yq (OFFICE USE ONLY) RE g -- -- = T I _ A UTH By_� MATTACHEESE � A>�0 ,� � ;� � /vC,7 � Fee: $ �rx I' I 3 PERMIT NO. �G3 Y (PLEASE PRINT IN INK TYPF�F�R 1 ION) Date: 2 3 To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) " / 0Of r k?eS 44"e 46 YQ/''A-1-1 0V 1'W-1 Owner or Tenant kIC .S 42 C t7 P- (--o L7_I- 14r, Telephone 0 Owner's Addres Is this permit in conjunction with a building permit? 0 Yes 0 No (Check Appropriate Box) Purpose of Building /- 0 tyl e�— Utility Authorization No. Existing Service Amps / Volts Overhead Undgrd C1 No. of Meters New Service 50 Amps 12_-C` /2 Volts Overhead Number of Feeders and Ampacity Location and Nature of Proposed electrical Work: Undgrd q No. of Meters C tlE' Completion of the following table may be waived by the Inspector of Wires No. of Recessed Fixtures No. of Ceil.-Sus . Paddle Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Above In- Swimming Pool grnd. gmd. No. of Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges Total No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers Heat Pum Totals: Number — — — Tons — — KW — — No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Municipal Local Connection Other No. of Dryers Heating Appliances KW Secutity Systems: No. of Devices or Equi valent No. of Water Heaters KW No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. H dromassa a Bathtubs y g No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent Attach additional detail if desired, or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE M BOND C1 OTHERC] (Specify:) (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start:,3 Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: G LS LIC. NO. % �� • 3 / Licensee: Signature," a14V--- LIC. NO. (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: Address; 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 Cl owner's agent. Owner/Agent Signature Telephone No [Rev. 04/00]