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Home My WebLink AboutBLD-19-744 e/Xail/ V/7/i, 0=44 TOWN OF YARMOUTH Building Department 0t.1261 o'? (508)398-2231 ex t1261 BUILDING 021 .eas�sti' a' PERMIT NO 'BLD-19-000744 PERMIT ivL �lc:n=50 ISSUE DATE :0 810 7/2 0 1 8 JOB WEATHER CARD APPLICANT VOGEL MARY ANN PERMIT TO l New IAT(LOCATION) (30 RIVER ST, SOUTH YARMOUTH,MA 02664 ( ZONING DISTRICT I I Bldg.Type: (Residential SUBDIVISION MAP BLOCK LOT 050.160 BUILDING IS TO BE: CONST TYPE V B USE GROUP (R-3 ( REMARKS Fence-erect a section of 8 foot stockade fence-MGL Chapter 49, Section 21 CONTRACTOR (978-302-6593) LICENSE AREA(SO Fl) 436,427,640. EST COST($) (8200.00 ( PE IT FEE($) cello OWNER (VOGELMARY ANN BUI M ING s'' ADDRESS , 140 ASH ST (MARLBORO MA 01752 �' ��al AO, O PHONE THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLE :e •g, •LK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE APPROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM MINIMUM INSPECTIONS REQUIRED FOR ALL APPROVED PLANS MUST BE RETAINED ON WHERE APPLICABLE SEPARATE CONSTRUCTION WORK 1)FOUNDATIONS OR JOB AND THIS CARD KEPT POSTED UNTIL PERMITS ARE REQUIRED FOR FOOTINGS.2)PRIOR TO COVERING STRUCTURAL FINAL INSPECTION HAS BEEN MADE.WHERE ELECTRICAL PLUMBING/GAS MEMBERS(READY FOR LATH OR FINISH COVERING) A CERTIFICATE OF OCCUPANCY IS AND MECHANICAL 3)FINAL INSPECTION BEFORE OCCUPANCY 4) REQUIRED,SUCH BUILDING SHALL NOT BE INSTALLATIONS. REFER TO DETAILED INSPECTION SCHEDULE OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTIONS APPROVALS OTHER: I WORK SHALL NOT PROCEED PERMIT WILL BECOME NULL AND VOID IF INPSECTIONS INDICATED ON THIS CARD UNTIL THE INSPECTOR HAS CONSTRUCTION WORK IS NOT STARTED WITHIN SIX CAN BE ARRANGED FOR BY TELEPHONE APPROVED THE VARIOUS MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED OR WRITTEN NOTIFICATION. STAGES OF CONSTRUCTION ARn\/F Of••Y`cit RECEIVED s'ice use only k4--)o ►�.e f.— H at StiC I : � AUG 07 2010 Amount {' -0�^ . I .Permit expires 180 days from S BUILDING DEPARTMENT • issue date f By: EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth,MA 02664 (508) 398-2231 Ext. 1261/`` CONSTRUCTION ADDRESS: MeV."S , .•S r4reliet/'/ /VA a 2 CS Y ASSESSOR'S INFORMATION: !!!!! Map: jp Parcel: 4D 4 ,v e&Co.NC st OWNER: 1.r,, 6n U, le - o% St ti loaf/ df o 2 - 8-302-0573 N � PRESENT ADD' SS • TEL # CONTRACTOR: &me,./lt Face 377144%s Q+lig i Yews MA so.9-398- ?fl2 NAME / MAILING ADDRESS TEL# residential 0 Commercial Est.Cost of Construction S 8204 Home Improvement Contractor Lic.# Construction Supervisor Lic.# Workman's Compensation Insurance: (check one) 1 0 I am the homeowner 0 I amt the sole/M/proprietor }s�I have Worker's Compensation Insurance 94 Insurance Company Name: ACorQ e7FGYt , Worker's Comp.Policy# &/EG AQ 01 WORK TO BE PERFORMED Tent _ Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares ( }Remove existing*(max.2 layers) Insulation Old Kings Highway/Historic Dist. ( )Replacing like for like tfencin e QC s eica � //\\ 4,5 .came be .4f'�� /W.?'11 / / *The debris will be disposed of at: y✓ 4 Zi, '� an S 'lGC ea l 4.5 MtAbs Lo tion of Facility / _Je / 0, c 1 I declare under penalties of perju • the statements herein contained are true and ct to the best of my knowledge and belief. I understand that any false answer(s) will be just cause for deni: .nofmy licen//t; . ecu-.nun•- e✓.L Ch.268,Section 1. o /}r ililly Applicant's Si: ature: " ' — -- / Date: spy(•�//2a1/�� Owners Si: ature(or att chment�� I� _a Date: O j7/� o//do Approved By: /�� Date: r• -i '/ O Building 0' ml • •-'gnee) EMAIL ADDRESS: Zoning District: Historical District: 0 Yes 0 No Flood Plain Zone: 0 Yes 0 No Water Resource Protection District: Within 100 ft.of Wetlands: 0 Yes 0 No 0 Yes 0 No . The Commonwealth ofMassachrrsetts p iii'c'—'i Department oflnduserial4ccldents • ; _:iii_ __.:1:=- 1 Congress Scree;Salle 100 • • `_�i— Boston,Mel 02114-2017 wlvw.massgov/dia • Workers'Compensation Insurance Affidavit:Builders/Contractors/Electridaas/Plambers. tO BE FILED VITTRTBE PERMITTING AUTHORITY. Aoolieaat Informadon Hesse Print Legibly Name ier odtnaividuan:- ':7-s'n(�-�� P(1r.r t' ( �]/d T►� r Address: 3.7l Lek j .4 1:).4--1-k. City/State/Zip: MO OCa(oC0 4 Phone#: 533-3q & q q i 2 . An you n employer?Check tbe appropriate bet Type of project(required): 1. 1 am.employer with ii employees(til endAorpes4tiae).+ 7. 0 New construction 2.01 ant a sole propteeororpmmaship and have no anployees scabs fa me b 8. Remodelin any capacity.(Now wars'camp.insurance required) ❑ g 3.01 am is ieowner&tug en work myself No auks&coma instamcx nxpdd.]t re9. ❑Demolition 4.01 ma a homeodwiil be hiring contact= conduct all work or my prepay. I win 10 Q Building addition wner w ensure that all Gas 4 es saber have workers'commendtm Sum=or we sok 11.❑Electrical repairs or additions prttprktss with no employees. 12.0 Plumbing repairs or additions 101wagenera caritas e andhaw listed antbesited asset 13.0 Roof repairs '1hnembaxmactoestm 'camp,insurance • 6.0 We ere aeaparatbeand bofcenhare mth eedtheir right ofexemption per Iona.c. 14.0 Other rLIC 132.!I M wd we We no employees.1No waters'asap.bne.nos regodnd] 'Any epplioeotthm checks km#1 must also nn=the melon below showing ehdrwodnse'oompensmion policy tufhnm ins. t homeowners who abaft this Binds*Indicating they are doing el work and then hire outside 000haomnmost submit a new amdavk indicting ma t ontrectom bet catek this box must amebae ea Batted sheet showing the mme raids subeemeametsadmaewhetheranmtheseentitleshaw =playa= If the subcoutremas have employees,they must pork's emir wettn'camp.policy nnnber. I am an employer thmtisprovklIngworkers'conceesadon insurmrcejormy employees. Below Is the policy andJob site b(fonnaflon. Insurance Company Name: 4ialer 'a Policy 1 or Self-ins.Lie.#: c/ 1J e.5 6 fr * C/civ Expiration Date: i3 'sat 9 • Job Site Address&) -KI(t-L?/ ! 7•4drD us' City yip; HI3 . Attach a copy of the workers'compensation policy declaration page(showingthe policy number and expiration date). • Failure to secure coverage as required under MGL o.152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,is well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. ___ I do hereby under the pains wed penalties ofpe jury that the b�ormadon providedaboveiii Owe and comet $ienttture: Co frtIL1t Date: (J-4-ezei 8 phone if: Official use only. Do not write in thisarea,to be completed by dry or town ofjdaI City or Town: Permit/license# Issuing Authority(circle nae): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Perna; Phone tit ACQ L/ DATE(MWDO/YYYY) _, CERTIFICATE OF LIABILITY INSURANCE 08/07/2018 'THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed.If SUBROGATIONIS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME: HARTFORD FIRE INSURANCE CO PHONE (877)287-1316 FAX (888)443-6112 (A/C,No,Eat): (A/C,No): 76250768 E-MAIL 55 FARMINGTON AVENUE ADDRESS: HARTFORD CT06105 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Hartford Ins Co of the Midwest 37478 INSURED INSURER B BENNETT FENCE AND ARBOR COMPANY, INSURER C: INC INSURER D: 377 WHITES PATH INSURER E: SOUTH YARMOUTH MA 02664-1214 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. WSW TYPE OF INSURANCE ADOL SUER POLICY NUMBER FOLICY EFF POLICY EXP LTR INSR WVD 1MMR?O/WYY) 61Mmrurren LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS-MADE ❑OCCUR DAMAGE TO RENTED PRFMISFS(Fa occunencel MED EXP(Any one person) PERSONAL a ADV INJURY GEM.AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE POLICY ❑JECOT❑LOC PRODUCTS-COMP/OP AGO OTHER' AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ire srwdnnn ANY AUTO BODILY INJURY(Per person) • — ALL OWNED SCHEDULED BODILY INJURYPer ecddent AUTOS q TOS ( ) HIRED AUTOS NON-0WNED PROPERTY DAMAGE _ AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAO CLAIMS-MADE AGGREGATE DED RETENTIONS WORKERS COMPENSATION X PER 01H- AND EMPLOYERS'LIABILITY STATUTE ER YM E L.EACH ACCIDENT $100,000 A ANY PROPRIETOR/PARTNER/EXECUTIVE E N/A _ 76WEGRQ7016 06/30/2018 06/30/2019 EL.DISEASE-EAEMPLOYEE $100,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E L.DISEASE•POLICY LIMIT $500,000 If yes,desulbe under DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Those usual to the Insured's Operations. CERTIFICATE HOLDER CANCELLATION DAN VOGEL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 30 RIVER ST EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. SOUTH YARMOUTH MA 02664-6018 AUTHORIZED REPRESENTATIVE eldeOrefianaotL�aa, ®1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD r kale Are g�cc*G S� VII Q Sj zz.‘ BEAN + s� sET,/ >. If + 4%. 11101 v47 IXISTING BEAN OWEWNG + SEi + „4". /+/ EOG IN, tii SKETCH PLAN DRIVE 5 < a' LOCATED AT Iy. #30 RIVER STREET SOUTH YARMOUTH, MA frr PREPARED FOR 4) •r0. DAN VOGEL N DATE: AUGUST 6, 2018 �r's off 508-362-4541 0 downeape.comax 0 Eowneape.com O lint cape engineeri4,inc. civil engineers Scala:t'-20' land surveyors ,—.: 939 Main Street ( Rte 6A) DCE #18-183 0 10 20 30 40 50 FEET YARMOU7HPORT MA 02675