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HomeMy WebLinkAboutBLD-19-001456 • ONE &TWO FAMILY ONLY-BUILDING PERMIT Town of Yarmouth Building Department 1146 Route 28, South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 f� Massachusetts State Building Code,780 CMR �..� Building Permit Application To Construct,Repair,Renovate Or Demolish .,-- 'art p a One-or Two-Family Dwelling thr -" .. This SectionForOfficia1U -Only oer�^ _&io p BmTdingPermit Numbej` KLtfr19`6VV.H$jo ,Date •,.>,: _. — ' • • -�-�. C,J,Y,/•1BUILDING DEPAR MENT BnudingOfclel(PrintN� Si �. jl.��8 av'' ... i SECTION 1p SITE INFORMATION.:: .: . -. , 1.}PJ'o sib j• 1.2 Assessors Map&Parcel Numbers 1.1 a Is this an acceptedstreet ?yes X no^_ Map Number �� Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: R t C E I V E D Zoning District Proposed Use Lot Area(sq ft) Frontage( ) 1.5 Building Setbacks(ft) aNL,Eks Front Yard Side Yards R IIIMILDINGDEPARiMENT Required Provided Required Provided Required ' Pmv -, 1.6 Water Supply:(M.G.L c.40,454) LI Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private 13Zone. ` Outside Flood Zone? Municipal❑ On site disposal system ❑ ' Check if yes❑ _. .: . . SECTION2. PROPERTYQ'SYNERSHIPI . ':::.:, rf. ;.. . ... :. ,.,: '. .. ,. 2.1 OwnerIArd: . 4NA/ F r..v y r_inat A A1/Q Name(Print) City,State,ZIP No.and Street Telephone Email Address : SECTION 3.rfESCRfPTIoN6OP PROPOSEt?WQRX2(cheek all'that apply).:•,- ;,.,:•: .:_ New Construction❑ Existing Building Cl Owner-Occupied ❑ Repairs(s)X Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.0 Number of Units_ Other ❑ Specify: c Brief Description of Proposed Workj: : e • i so (.5i- I, SL,,ck&c �„r n n/L /7pg rA c ,v v Je' / AI'. ',a;/bills 1w/. jo/( A/ jo> 1`, s Rvn/ •erdiv �e-et/ vlvy1 41//M k V c,1iC . Neu) isW erks&.5 , Ne7 .T. ;,,- ._ri, ,- ,,;.$ECTION4fESTIM.#TEDcONsdi;.T},O�.'19$COSTS. ;i::v '+' +> `; - Item Estimated Costs: ",c ..._Ig. » y:; otkxt4 - 4 `. .. T ,.r aS. (Labor and Materials) a ,.,, r c a �:-y( 1.Building ga/79ae do '+'1.�ButldmgPerantFers`•�O^:Indicateh*wfeeisdetermthed: 2.Electrical / , ° '• ,,, . S Stsii'Qard.CityllowR Apphcatic2l1Te9 •a', :.rf=,n t:f ': 1 '= ❑.`fotaiPld pct sty tem ^c>;”. '.:y J Co .� 'b7.amnitiplieL;rr;<,,•:; ,,g.;�,;�'�;;,�.W:.;,. . 3.Plumbing $ .$ ..:... 'i (..,--•;,. -=. .. : Z���Ot1lEX'.FEe$ y:���._�. -; ilii..: � } .. x;...s.::.. 4.Mechanical (HVAC) $ 'a:., ,+; ; , ^.,. 5.Mechanical (Fire 4'.:'f_4-p ay�L�f:ti jt`.x1e'. M . �5 iri.1..:. �`v "., ..._r..i . ! d{k- X44;. `;,. Suppression) $ Total All Fe$9:$ "-17:7',7;1;?:t" ';':I ..9-, ,,: 1.1:.),;:c - 6.Total Project Cost: $ Check-06;wCheck- .1: ;_CashAmounh: _. •" e`r',4/a8', [i lPaidlnl?ant:::_,,;.":bt>'i dihjnalafuoDue'1Ste° - _ • SECTIONS:.CONSTRUCTION SERVICES .. • 5.1 Construction Supervisor License(CSL) [795, 0 g 1 6cor. c 51 Vh(I.S1°t/ License Number n Date Name of ea,Holder /n-6 Se AN /,P /� List CSL Type(see below) U No./and Street , / (O� Type , ....:... Description cST4t///i/& / . 1l U Unrestricted(Buildings up to 35,000 cu.R) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry • RC Rooting Covering WS Window and Siding q�y • SF Solid Fuel Burning Appliances /%P- 4/07Q-72/b I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(RIC) ussP 5." Number '- `�' L 0 tr. HIC Com HIC Registration Number spir�*on Dau y a �y be 1 n t —8 bene or RIC tName ftN , ltn_9_4 cla3-6+ tkST jg/tillsn No.and tree[ Email address sCrir 1/1/<' 'A, D/S'Gy 97?Vozoa-7&M City/Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§25C(6)) 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 No SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN • OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize CCOrtert S 3) e fre to act on my behalf,in all matters relative to work authorized Wthis building permit appliation. • 9A-7/, Print Owner's Name(Electronic Signature) Date • SECTION 7b:OWNER.OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this applic tion is true and accurate to the best of my knowledge and understanding. ..r 9/6//P t s or Authorized Agent's I...a(Electronic Signature) Dau • NOTESe . ,. 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the BIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.row/dns 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" • The Commonwealth of Massachusetts to :area '/ Department ofIndustrial Accidents e —_ I— 5 1 Congress Street,Suite 100 iFli_ 'lic. ar Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Eleetricians/Plumbers. TO BE FILED WITH TUE PERMITFI?cG AUTHORITY. Applicant Information Please Print Leeibly Name (Business/Organization/Individual): (tc)49i- S• Shb, rG(/ Address: /7-8 Sow -Wr r/ City/State/Zip: 6A4-1111/4/6 /%P 11 '/ Phone#: 97w—Yaa -7314 Are yon ao employer?Check the appropriate box: Type of project(required): 12 I am a employer with 2 employees(thu and/or part-time). 7. 0 New construction 2.0 I am a sole proprietor or partnership and have no employees waling for me in 8. ®Remodeling any capacity.[No workers'comp.instance required.] 3.01 am a homeowner doing all work myself[No workers'comp.insurance required]t 9. ❑Demolition 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I wall 10 0 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees 12.0 Plumbing repairs or additions 5.01 am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.Stance.: 13. Roof repairs insura 6.0 We area corporation and its officers have exercised their right of exemption per MGL c. 14.0 Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] '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 subcontractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy andJob site information. Insurance Company Name: Policy#or Self-ins.Liffe.#:(o / Expiration Date: 7 Job Site Address: po Lida HO/ City/S tate/Zip:_/4€1YJDVA /VIQ. Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Si¢nature: //h 2a{�/1 Date: 2/47/P Phone �( 97r— 4', a-7s'/4 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#: o'''r',R,r TOWN OF YARMOUTH ,;,K,G e .-J e G BUILDING DEPARTMENT 0 Y+I 1146 Route 28,South Yarmouth,MA 02664 • E. '�� 508-398-2231 ext. 1261 Fax 508-398-0836 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to MO.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 & LA& Rd Work Address go. 8a 67/ Is to be disposed of at the following location: W. y'5'ernaiSh /4. Oasis Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 1S0A. / //0? Signature of App ' tion Date Permit No. ACORD CERTIFICATE OF LIABILITY INSURANCE DATE IMMIDDIYYYY) `a./. 09/05/18 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(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS 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 NAME t.L CHERYL MAGGS,CSR PRIME INSURANCE AGENCY,INC. muu No.Est: 978-537-8222 FAX,No): 9784404695 739 CENTRAL STREET ADDRESS: PRIMEINS3@COMCAST.NET LEOMINSTER,MA 01453 INSURER(S)AFFORDING COVERAGE NAIC R INSURER A: LIBERTY MUTUAL INSURANCE CO. INSURED INSURER B: GEORGE SHOSEY INSURER C: DBA SHOSEY HOME IMPROVEMENT INSURER D: 17 BEAN ROAD STERLING,MA 01564 INSURER E: 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. NOTLMTHSTANDING 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. )LTR TYPE OF INSURANCE INSP WYD POLICY NUMBER POLICY EFF POLICY EXP (MOLICIYE (POLIC YEXP) LIMITS X( COMMERCIAL GENERAL LIABIUTY EACH OCCURRENCE S 1,000,000 R P CLAIMS-MADE El OCCUR EMI MAE TO RENcDET EN1 ED occurrence) S 60,000 — MED EXP(Ary we person) S 5,000 A _ BKS 57 86 89 28 07/01/18 07/01/19 PERSONALE ADV INJURY S 1,000,000 GGEEMLAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 1 POLICY❑JEo- ID LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S - (Ea accMeM) _ ANY AUTO BODILY INJURY(Per peraon) S 100,000 A ONMEDSCHEDULED AUTOS ONLY X AUTOS BAO 57 86 89 28 06/27/18 08/27/19 BODILY INJURY(Per student) $ 300,000 HIRED NON.OViNED PROPERTY DAMAGE S 100,000 AUTOS ONLY _AUTOS ONLY (Per accident) _ $ UMBRELLA DAB OCCUR EACH OCCURRENCE S _ EXCESS LIAB CLAIMS-MADE AGGREGATE S DED RETENTIONS S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVE❑ NIA EL EACH ACCIDENT S OFFICERMIEMBER EXCLUDED? (Mandatory In NH) EL DISEASE-EA EMPLOYEE S DESCRIPTION OF er EL DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS baba , DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If mon space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ANN PETERSON ACCORDANCE WITH THE POLICY PROVISIONS. 66 LAKE ROAD WEST YARMOUTH,MA 02673 AUTHORIZED R ESENTATIVE 1 01988-2015 ACORD COR ORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ACORE) CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY) 09/05/2018 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 SUBROGATION IS 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: James Padovano PRIME INSURANCE AGENCY INC PHONE WNo bob (978)537.8222 u"c.Npt: ADDRESS: PrimeinsC comcast.net 739 CENTRAL ST INSURER(S)AFFORDING COVERAGE NAIC# LEOMINSTER MA 01453 INSURER A: AMERICAN ZURICH INSURANCE COMPANY 40142 INSURED INSURER B: SHOSEY GEORGE S DBA SHOSEY HOME IMPROVEMENTS INSURERC: INSURER D: 17 BEAN RD INSURER E: STERLING MA 01564 INSURERF: COVERAGES CERTIFICATE NUMBER: 310299 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. INS TYPE OF INSURANCE ADDL SUBR POUCY EFF POUCY EXP LTR INSD WYD POLICY NUMBER (MM/DD/YYYYI IMMIDDIYYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S CLAIMS-MADE (OCCUR DAMAGE TO RENTED LL PREMISES(EaPccunence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY _ $ GEN.AGGREGATE LIMIT APPLIES� PER: GENERAL AGGREGATE $ RPOLICY E TTeiII LOC PRODUCTS-COMP/OP AGG $ OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea',cadent) ANY AUTO BODILY INJURY(Per person) $ ALL AUTOS _ AUTOS LED N/A BODILY INJURY(Per acddent) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS _ AUTOS (Per accident) S UMBRELLA UAB _ OCCUR EACH OCCURRENCE S EXCESS UAB CLAIMS-MADE N/A AGGREGATE S DED RETENTION$ X $ WORKERS COMPENSATION STATUTE ETH AND EMPLOYERS'UABIUTY YIN A OOFFFIICEORIM MBERpEXCLUD D?ECU ?E I1 WA WA 6ZZUB0506N03718 05/16/2018 05/16/2019 E.L.EACH ACCIDENT $ 100,000 (Mandatoryln NH) I ' ELDISEASE-EA EMPLOYEE $ 100,000 xdescribe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If mon space I.required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees In states other than Massachusetts H the insured hires,or has hired those employees outside of Massachusetts. This certificate of Insurance shows the policy in force on the date that this certificate was Issued(unless the expiration date on the above policy precedes the issue date of this certificate of Insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/N+dMrorkerscompensationf nvestigations/. Sole proprietor has not elected coverage. CERTIFICATE HOLDER CANCELLATION ) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ANN PETERSON ACCORDANCE WITH THE POLICY PROVISIONS. 66 LAKE ROAD AUTHORIZED REPRESENTATIVE WEST YARMOUTH MA 02673 ea-0 (., Daniel M.Cr L. y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD • • • • Cys .. r4.. .��.. .......t ( e iCwnn+anr�ea�l�a�G�(/cwacA,a.e!3 SI\ Office of EConsumer A}fain 8 Business Regulation tot HO f Consu OVEMENTCONTRACTOR ,lil.;TYPE:IndWidualpecistratiorlFxoiratioR`= =124552 07/15/2019 '1 GEORGESHOSEY;- ' 7*,t; . _fir ' ., ._..,r:,- - GEORGE S.SHOSEY '' - S,,,, ' -= 17^B BEAN RD i- ' i i i STERLING,MA 01564 '�"_ Undersecretary ti r ®t Commonwealth of Massachusetts 1 Division of Professional Licensure Board of Building Regulations and Standards Constrylcttorl IS 0pervisor CS-095182 i !<"pires: 04/19/2020 i 3:44 GEORGE S SHOSEY ' ' J - - _ 17"8 BEAN ROAD L;.; ''; s'.:STERLING MA 01564 � - - t I,nicV.11LIt ¢,,.i. Commissioner cL S ..r3ky TOWN OF YARMOUTH HEALTH DEPARTMENT \'�,y V � PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: ?dyke_r Building Site Location: (oCo k Rd / Q�- Proposed Improvement: • 4 : mar C 4/4 • al G L SCAT* r *5t- AIV! WA CLM—Wtrt Applicant: 17ep11/7v— ,S, 5A,Se '/ Tel.No.:9N— Address: P7-8 Setae 2L S �/,v6 44 . D/s'Y' Date Filed: 9/L/1, **If you would like e-mail notification of sign off please provide e-mail address: Owner Name: # N/s/ A-& AJ Owner Address: LI, AA_k. Owner Tel.No.:?%5'-32;'gIdd RESIDENTIAL AND/OR COMMERCIAL BUILDING HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e.,Requirements For Septage Disposal and other Public Health Activities. Please submit three (3) copies of plans, to include: L(1.) Site Plan showing existing buildings, water line location, and septic system location; (2.) Floor plan labeling ALL rooms within building (all existing and proposed) — Note:Floor plans not required for decks,sheds, windows,roofing; (3.) If necessary, Title 5 application signed by licensed installer with fee. REVIEWED BY: ( DATE: OP G PLEASE NOTE COMMENTS/CONDITIONS: 1oF.irgR TOWN OF YARMOUTH (l4 b 1� e' WATER DEPARTMENT � ; 99 Buck Island Road N wnw¢ESE co West Yarmouth, MA 02673 ' � Telephone: (508) 771-7921 • Fax: (508) 771-7998 BUILDING PERMIT APPLICATION • DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET • Bldg. Site Location .� a/.ilk gd , Map #: Lot #: Proposed Improvement: &pAr_ f • , • keg- , ,,,, g a . ` A 6 Applicant: G S. cA Ci/ Address /7-5&ey/,Aave Tel. #: 77?-%2.2-7, Date Filed: jA e 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, Ocean, 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... ,/ • 9/0 Si nature applicant Date PLEASE NOTE: COMMENTS: ] di99 t�q -Pan- Nev) /2 �' 3oM6-71Z4c._5 "//r Re ewe 6y: ater Divi n Date • • • George,S. Skos.ty cV&a- SHOSEY HOME IMPROVEMENTS. : 17-B Bean Road tle �x Sterling, MA 01564 Phone/Fax(978)422-7816 ix,i- ,• 978)422-7816 , PROPoSAG ' FULLY INSURED Date: 7/25/2018 Job Site: 66 Lake Road Customer Name: Ann Peterson West Yarmouth, MA Complete Siding Job Demo old siding. • Remove old vinyl siding and old wood siding on some walls. Install pewter gray cedar shake panels. Remove old freeze board. Install new freeze board above new vinyl windows. Install tyvek water barrier paper. All assessories included with vinyl siding. Remove all debris using dumpster. • TOTAL - $13,323.00 Authorized Signature: Acceptance of Proposal The above prices specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlinedut✓ above. 7 Date of Acceptance: J//1/t�ecSignature: /47)/47) / ne7/i222 Vision Government Solutions Page 3 of 3 • Category p 4 rT -z. Legend Y !aa �. I 44 ,fes 9.a',,...-^ Z ' t ,($ tr2 3' TSS s��i1' Land Total sty... c „2, iX -ar L A'-!N; .1c 44!it,' t ''''. s,,.";' $ter yr ,."4I.3\' a #.s ,f,'" _•�.$82,600 $119,900 $202,500 .tsl«,,,S . rr..ki.:; s'4 et. t li 1 f baa$a,- 'j✓,Lf s' \.t r-- Mr; • ! �lf+c' 1, -,y �,'F ..o � $82,600 at $97,700 $180,300 ,� { -a vet !--; .0 'i4129,400 $97,700 $227,100 jO- --^�, •Ig *a.lett (c)2016 Vision Government Solutions,Inc.All rights reserved. 1 14 e rr '1 .y„ it t « � e;;, 1 ‘• K' i{ tr y III... > .� � �n l irkt, 4 4+'j., ' :' '0, e Y i if ..,:z... . , `. 12/23/2016 , http://gis.vgsi.com/YarmouthMA/Parcel.aspx?Pid=7242 9/6/2018 _., . r ThsicAl Zeofreg, ;11 op -- nctobthu )61 0/c , I< q - U15T Jnou aXg r 1a'` ° c r k A CANAL re. p1 -e. box PPa. Jol spy,kt 4+ 54-p►rzs 6 MT JZ Loc,,ci' GA/ d beARd� TON OF YAR V OU H REVIEWED F R BUILD*G AND ZONING COD COMPLI- AN;E. ERRO S OR OM-ASSIGNS DO NOT IEVE THE APPLICANT F OM THE P,ESPONSIE ILITY F' S BUILT' O COMPLIANCE — DA-E: 5-hl-l1 �� BUILDING OFFICVI. nnLE C og � >1 la S&No 1u b�. 1�v OUP T ° 0 AAA yy bdftom plies SEP 0 6 2018 HEALTH DEPT. cri O Wouse- _1 L O ji o I 0 a 0