HomeMy WebLinkAboutBLD-93-717 k . a 9/,6/93
k � 'o TOWN OF YARMOUTHlira') ei/ao/gi
jolte° .0 *530; Application for a Permit to Build No. 7/7
ik—
UPON FINAL APPROVAL q c/AMAP 5 / LOT a 35/
FEE MUST ACCOMPANY THIS APPLICATION. DATE Vic- 19 93
The undersigned hereby applies for a permit to build 11413
according to the following specifications /
1. Name of property owner /I/4 r'1 L/h C4//5h 1 qkl ef.i5ei 7
Address -7 Celia A- Do,F'c 4'a(, C, Vcz ' rovF-L
2.Name of Architect(if any) Tel.
a Name of builder.eo6Q/{- Sz eatlin r Address /2? /ft rJo4 A94. C/4/ Ann
4. License No. 0063 iff 3 Tel. 73z -/9 d
5. Name of Mason Address
6. License No. _ Tel. /
7. Construction address 7 Co ?d Po �e r ,f�, C Ye, Mo vi--4
FloodDistrict
8. Date of subdivision Approval plain zone l'_ Zone i-S/0
9. Private dwelling El/ Estimated Cost --tar a DO N WRITE IN THIS SPACE
q- c43 �P` 1o.00 3Ag Type of room No.
10. Multi family 0 300Q
11. Commercial 0 Kitchen
12. Other 0 • Rig SF Dining Rm.
,Zs Living Rm.
13. No. of stories / 4 - 0' Bed Rm.
14. Foundation — Full 0 Half 0 Crawl VSlab 0 Bath
3S•a-z� 7�t,Fr
15. Materials — Wood N1 Ceme�ntt V Other 0 bt--- Deck aSG Sn /
16. Type of heat — Oil 0 Gas ud' Electric 0 Other 0 f el ,jam ),t p Closed porch
17. Garage — 1 112 ❑ b BAL Family Rm.
Sun room/2fp. /
18. Swimming pool - Size Garage
19. Storage shed — Size Shed
20. Stove —Wood 0 Coal 0 Alterations
21. Size of lot: No. of feet front /0 ✓'/ _ No. of feet rear e/ '7 No. of feet deep / 2_C)
22. Size of building. No. of feet front 1 Z 1 No. of feet side I 2-1 No.of feet rear ra I
23. Distance from nearest building: Front Ft. side Ft. side Rear
24. Distance back from line or street '?i C i From rear lot line 3 1 Side line 17 '
25. H.I.C.R. Na X30 °1`
LOT RELEASED get,9 6 3 . /Signature 2-'tL1-- SA- ;
PLANNING BOARD ;. . Address i 7 3 it404h'o r{01/1
Date3/93 9,, C.kc- ' A445
Q/4/3 retu
BUILDING PERMIT APPLICATION SIGN OFF
/
APPLICANT: az1O ki\-- S( 1: 14;_ I BUILDING PERMIT II:
ADDRESS( )7 /"(91 Y1 RC�/I. . ® TELE. NO. : y3? P/30 DATE FILED•
:
BLDG. SITE LOCATION: 7 Og I &YQ(°' £o'/, MAPA: seJ LOU: 8 39/
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
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.
TIRE 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: GJ' -i{-y N/A:
ND STRIAE 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. A SIGNED RECEIPT FROM THE
DISPOSAL SITE MUST BE SUBMITTED TO THE BUILDING DEPARTMENT PRIOR TO ISSUANCE OF THE BUILDING •
PER`fIT. yy�/ ,,// // '/
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THIS STATED Uo (or U) VALUES OF ANY ONE ASSEMBLY, SUCH AS ROOFING/CEILING, WALL OR FLOOR,
MAY BE INCREASED AND THE Uo(or U) VALUE FOR OTHER COMPONENTS DECREASED,PROVIDED THAT
- THE OVERALL HEAT GAIN OR LOSS FOR THE ENTIRE BUILDING ENVELOPE DOES NOT EXCEED THE
TOTAL RESULTING FROM CONFORMANCE TO THE STATED Uo (or U) VALUES. •
•
•
ENVELOPE ALLOWABLE U0 (PER TABLE 3109.1
Lw 0.089+(A,- 0.65'1+(A,.r,0.401+(A00 0.0331+(A f 0.05)+(A., . 0.081 = Allowable
aU.yr 9aS9 tot? 19.92 "2,
06 x 0.0s')+(Sa_6 x 0.65•)+(Zx 0.40)+(3ya x 0.os3)+(22,x 0.05)+fix 0.03) = /L3 7
• i
Q1.17 Allowable Per Table 3109.1
'ELECTRIC RESISTANCE HEAT U-VALUE WALLS = 0.05 U-VALUE WINDOWS = 0.40
ENVELOPE ACTUAL U0 (USING ACTUAL VALUES OF DESIGN OF ENVELOPES)
akwUw)+(A-Uo)+(koU + A RLI. 4 (AO,U FL+LAowvUowa = ACTUAL
2►,4v 1,510 1,q7 -)457 (,,6v
(3e4 x.c? )+0x.31 + Il.i x:(a + 2 Q x.o3a + /Ly xthys)+(,ZC_x_z_ = $ S,a
•
h 3' ACTUAL
•
COMPARE VALUES •
THE VALUES FOR ENVELOPE ACTUAL MUST BE LESS THAN OR EQUAL TO THE VALUE OF
ENVELOPE ALLOWABLE TO PASS
•
4 -_-
SI ASS 1I FAIL
•
G:1.RBRS1CHk3..03= 4 of 5
CEILING ASSEMBLY
WE: 'ice ceiling PCIUAL TOTAL R=31 ,06
ad rickfr or Thla TOP SURFACE U= WINDOWS:
7.—R=0.61 1UJIR ID MEAL 30.0
9" FIBERGLASS 0,033 •
INSULATION
R=30
c\ n111/1111ZMn M I
dg \=SHEETROCK DOORS:
R= 0.45
1 all
I PP2 0 —BOTTOM SURFACE
R= 0.61
1/2"PLYWOOD INSIDE SURFACE WALL ASSEMBLY
R= •O.62 J R. 0.68 PCILF�L TOTAL R= 13 0 1p
REAR ELEVATIONn
G. G.W.A. noS/{,
WOOD I }" SHEETROCK U=
SHINGLES ' R= 0.45 FEGUITED MAL. 1 12.5
R= 0.87 I. 0.08 WINDOWS:
' 2-- ZO 47c
OUTSIDE 1/3}" FIBERGLASS FEJJIRD'R717�. l= 20.0
rtt INSULATION Sli et dMe� lrr..clo+,y
SURFACE ECECIRIC HEAP L1 0.05 t
R= 0.17 R=L1 _ 2 r �`�1Z
. I
, If
SI:R.FACE RESISTANCE
' C" R= 0.61 FLOOR ASSEMBLY
J •.=FINISH FLOOR !CUM TOTAL R=2130 DOORS:
R= 0.91 U=
TWO BEADS I/ F�II�MEAL f� 20,0
CAULKING l� i_" PLYWOOD 1. 0,05
I/ i, RIGHT SIDE ELEVATI
UNDER PLATE \ ,-; , SUBFLOOR
R= 0.62 /
G .S�
C.W.A. 7�
SURFOUTSIDACE c i -, V JL"' r✓✓64;Lc't/tit%
R= 0.17I /r WINDOWS: G
//-6}" FIBERGLISS )- 20 el Lona,
1 • INSULATION FOUNDATION _tit/ 1
CONCRETE ' , R= 19 WALL ASSEMBLY
FOUNDATION1 SURFACE RESISTANCE (may be used instead I DOORS: . r t
ALL of floor insulation) f`fltC-s\7129
= 1.32 = 8" • R= 0.6I PCHM T0TAL R= T
LEFT SIDE ELEVA O'.
1.48 = 10" II=
it PK== R 25 G.W.A. 74. 51 /
- '{SIDE SURFACE U ?.08
1 7—Y= 0.68
SIDE
. '/8" SE TROCK I 2-Zo y F � h
Ai
/
' " 1= 0.32
. �•� �'" STYROFOAM 4,
7.1 DOORS:
y . I
t t < i . . . r _ t . A , . ..
TOTES:
P /-yL
E'"_L.'^L..TL': IN;T:.:.:ID STC.': 6�, of -2- SK '1 H7 '? t/ � S
S� t
x:.".:13 WALL AREA= 3;24 SI •!9/�/� /3.O ¶ 4P -kite,/
Wr. ...w �.m..= '? ' j, .it.t' t 3.USLt� '7r C/ S; ' Y
::(::.-. •\.t',= I -7 .1_, 1t (/
•
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4rn37d
Bottom of foundation elevation
(+) 3.68 above water table
of December 5, 1968. Top of
foundation wall (+) 3,2' above CERTIFIED PLOT PLAN
center of road.
LOCATION South Yarmouth, ,T4ag; .
,�*✓iK pr M�Ss� ;.SCALE V'=20 T DATE Nov. .1,19.72
�� rHOM• I PLAN REFERENCELOt. ,x391, as. shown•
•
•
Kcu in, r] ari. BQOiC .;':'249 .Sage. x!111 . .
• �'c "C.aptains .Village". . .12_/17/.70. . • ••
i -C'/STE0. P / n r ,
Ho�Ko t.. .delley. -. Surveyor
Yarmouth .Flanning •I3o-ard• 7,1A 2283-4
•
• I CERTIFY THAT THE Foundation SHOWN
Dennis port b' ON THIS PLAN IS LOCATED ON THE GROUND /
Route urniture Co, AS SHOWN HEREON AND THAT IT CONFORMS TO I
7128 THE ZfNING Le.gS OF THE OWN OF
Dennisoort, Mass. Y1/1/72 EN /yUCTED. il
11/1/72 r /
PETITIONER : • DATE �ve-C .
G. LAND SURVEYOR
Suggested Affidavit for Home Improvement Contractor Permit Application •
For Office Use Only NAME OF CITY/TOWN
Permit Na
Date
AFFIDAVIT
Home Improvement Contractor Law
• Supplement to Permit Application
MGL e.142A requires that the"reconstruction.alteration.renovation.renair,modernization.conversion,inprovement,removal.demolition.
orconstruction of an addition to any pre-existing owner-occuoied building_mntaining at least one but not more than four dwelling units....or
to structures which are adjacent to such residence or building"be done by registered contractors,wtth certain exceptions,alongwith other
requirements. /
The of Work: Add/ 1(0 L Est. Cost 49/ J�
Address of Work 7 Cary , A J,G /EQ,/
Owner Name: ./t10t,ri(yr, Ce /I4bt ?'
Date of Permit Application: /19 3
I hereby certify that:
Registration is not required for the following reason(s):
_Work excluded by law
_Job under 51,000
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:
%s 9 3 %ff COLe // 1/210
Date Contractor Name Registration No.
OR: •
Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property:
Date Owner Name
l .
t =. - COMMONWEALTH OF MASSACHUSETTS
�.- e.
=� DEPARTMENT OF INDUSTRIAL ACCIDENTS .
t. !' 600 WASHINGTON STREET
James J Camooei, BOSTON, MASSACHUSETTS 02111 •
•
rrornrtssioner WORKERS'1COMPENSATION INSURANCE AFFIDAVIT • .
1, ?C.�?-e-✓ Can 7 �, ?-r Irl (
(licensee/permittee)
• with a principal place of business/residence at:
/ 73 m 4 t 4 ct,, -tiar,z, Guess .
(City/State/Zip)
do hereby certify, under the pains and penalties of perjury, that:
[] I am an employer providing the following workers' compensation coverage for my employees working on this
job.
Insurance Company Policy Number
[ I am a sole proprietor and have no one working for me.
•
[ ] I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below
who have the following workers' compensation insurance policies: -• • • • --- _ . .
Name of Contractor . Insurance Company/Policy Number.. .
. Name of Contractor Insurance Company/Policy Number • - -
•
Name of Contractor • Insurance Company/Policy Number t
O I am a homeowner performing all the work myself.
NOTE...Please be aware that while homeowners who employ persons to do maintenance,construction or repair work on a
dweiiine of not more than three unto in which the homeowner also resides or on the grounds appurtenant thereto are not generally
considered to be employers under the Workers' Compensation Act(CL C. 152.sect. 1(5)), application by a homeowner for a license
or permit may evidence the legal status of an employer under the Workers' Compensation Act.
I understand that a copy of this statement will be forwarded to the Department of Industrial Acddenn' Office of Insurance for coverage
verification and that failure to iecure coverage as required under Section 25A'ot MCI. ]52 can lead to the impovtion of criminal penalties
consisting of a fine of up to 51500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a
fine of S100.00 a day against me. / /
Signed this ,> day of ?0h iZ q, 19 / 3
t_iceas:_. . _.r..r._. Lite o:;Permiaor /
• BUILDING DEPARTMENT
CONSTRUCTION SUPERVISOR FORM
•
LEASE PRINT: - ' •
nQ /
OB LOCATION: 7 •t-gpi- , LAO/1C- 461 • 5, /�I 4rAiDJ
NUMBER / STREET VILLAGE
WNER OF PROPERTY: ' Agri Iyer • l land--- '
ONSTRUCTION SUPERVISOR: d t Pd .,J9 Lily 7 .600 20 9 V32. --/(/36
• / •
NAME `� / . . / LICENSE NO. PHONE NO.
(DRESS: 7 0/0V yi ga c C4J'lain . •
ICENSED DESIGNEE: .
(IF OTHER.THAN SUPERVISOR) NAMELICENSE NO.
.15 RESPONSIBILITY OF EACH LICENSE HOLDER: '
.15.1 THE LICENSE HOLDER SHALL, BE FULLY AND C0`SPLETELY RESPONSIBLE FOR ALL WORK FOR WHICH HE
S SUPERVISING. HE SHALL BE RESPONSIBLE FOR SEEING THAT ALL WORK IS DONE PURSUANT TO THE STATE
UILDING• 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, RE!OVAL OR DEMOLITION INVOLVING THE STRUCTURAL ELEMENTS OF BUILDING
AND STRUCTURES ONLY PURSUANT TO THE STATE BUILDING CODE AND ALL OTHER APPLICABLE LAWS OF THE
"0MMONWEALTH, EVEN THOUGH HE, THE LICENSE HOLDER, IS NOT THE PERMIT HOLDER BUT ONLY A SUB-
"ONTRACTOR OR CONTRACTOR TO THE PERMIT HOLDER.
2.15.3 THE LICENSE HOLDER SHALL IfilEDIATELY NOTIFY THE BUILDING OFFICIAL IN WRITING OF THE
ISCOVERY 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
THER SECTION OF THESE RULES AND REGULATIONS AND ANY PROCEDURES, AS AMENDED, SHALL BE SUBJECT
0 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, RECON-
STRUCTION, ALTERATION, REPAIR, REMOVAL OF DEMOLITION AS REGULATED BY SECTION 109.1.: OF THE
CODE AND THESE RULES AND REGULATIONS. IN THE EVENT TPAT SUCH LICENSEE IS NO LONGER SUPERVISING
SAID PERSONS, THE WORK SHALL I:_^EDIATELY CEASE UNTIL A SUCCESSOR LICENSE HOLDER IS SUBSTITUTED
N THE RECORDS OF THE BUILDING DEPA.ST:ENT.
I NAVE READ AND UNDERSTAND MY RESPONSIBILITIES UNDER THE RULES AND REGULATIONS .FOR LICENSING CC.
STRUCTION SUPER:'ISORS IN ACCORDANCE Mir. SECTION 109.1.1 OF THE STATE BUILDING CODE. I U4DERSTA.:
.HE CONSTRUCTION INSPECTION PROCEDURES AND TEE SPECIFIC INSPECTION AS CALLED FOR BY THE BUILDIN
OFFICIAL. '
INSURANCE COVESAGE: • •
I have a cu:rert ab:!ity insurance policy cr s substantial ecuivatent which meets the requirements ct MGLth.152
Yes V No ❑
If you have checked_ please irc,ca._ethe type c;•:e:age by checking the ___rco^ate tax.
A liability insurance pc:icy Cher type ct ' ,temn.ty 0 Bcnd 0
C'NNER'_ ;NSL'RANCE WAIVER: I am aware that the :.._nsee cc__. ct N'.VA ..the inranze _.,ver-",e rectarec _
Cha er 152 of the!daL-
_:. General ws. an:: that my sic _Lure cn "pe.m:: _-- cr wae•es this rec_ircr•_-_
• -Check one:
C..vneral Agert 0
S.gra: ra cc Cyo..nerrcct Ueret z a;znt
r