HomeMy WebLinkAboutBLD-19-1951 •
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- 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
Massachusetts State Building Code, 780 CMR
Building Permit Application To Construct,Repair, Renovate Or Demolish
a One-or Two-Family Dwelling
This Section For Oficial Use Only -
MaudmgPermBNumber r -/.gam) /95/ Date - d R ' _^w�
IM 5e IA - Lrea. 112-/3---dig- • .SFP 27 2018_
Building Official(Print Name) Signattns /�.] Dete_
.' SECITON I: 81 E. 'INFORMATION s, C 4. )0 o`w
1.1 Property Address: 1.2 Assessors Map &Parcel Numbers
13 t (}-�„�,t- Lestvm-- RJ. f o et '/ 6. /
•
1.1a.Is this an accepted street?yes/Y' no Map Number Parcel Naber
1,3,Zoning Informaiio 1.4 Property Dimensions:
ll- 4o �Y�vfiFL.( CN, oso • nil
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Regoired Provided Required Provided ILguk 4 Provided
I 0 2 ' '-1j s ' cf k. 6
1.6 Water Supply: (tvLGL c.40,i 54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public," Private❑ Zone: _ Outride Flood Zone? Mimi ' al❑ On sitedisposal
system xi
Check ifye):4
SECTION2: PROPERTY OWNFI2SHrp' •
2_i Owner'of Record:
• n4 <
t•� 1 +Gr;sIu, 1ce.Ur S, 7evYttiutt, 1140-, vaatf
Name(Print) city,State,ZiP
7 t3 s<I- 6reatt-toesttem R.l S 39tr-Gni 6 gfizk !`i3.O( &.t4st-', Mt t-
No.and Street Telephone Fina,ZMdress
SECTION 3:bESCRTPTIOjj OF P.1101;9443 WORK'(check all that apply) .
New Construction 0 Existing Emit-ling❑ Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition JE7 Accessory Bldg. 0 Number ofUnits Other 8/ Specify. Tlw 4---s c
p
Brief Description of Proposed Worlc:_i °1i'fib,- F t.fiStwve./ C d- PCa••s}r„efr
W &ere. -e1.N.S. . G .!t ,y4,4- it, c _ cL l 7 e b a .4.' .. . r.
1\ L a. o v
tl
• . •• . : SECTION4;.ESTflvIA. . CONST'RUls1�iO. COS'TS.. : _..i14,i:- l u LUIo
:..
Item Estimated Casts: y. +_.--. . u„ tr J .;:. -r i
(Labor and.Materials) • ..-ll7se � paF'1rts,a c. .
I.Bm1dmg S 'L, et7v .;. Bui1dmg2eairiifFeea $' 0 .•:'3ndicate oR ee:maetetn ed:
2.Electrical $ 2S�d ,Stazidaxd,Criyfiri—30c?#°a ee'•._ %.thf4;:•3z--•-:,Y,::i-:..
r {iTotalProjeofb;541t . as pliii:_.':4_- :-•P14.- ;x
3.Plumbing $ a cal) ▪- _
4.Mechanical (HVAC) S 3 O p o 7.:4 -• • i .c ,J.;. .:; - Z:m.1:
,•.
5.Mechanical (Fire :._./:1;•:A:;� x.i, --.2c-r� r'-__.i:ts.k; --i:•;".:;.••:.:,-_ ..
Suppression) s •T i6N.A.1it e9:: - — - :•i: ▪ -- •" ,
6.Total Project Cost` S 3 // y ltd c3rec3t.2lc;>= :. QiEc�CAmu Cash
$Pa;dmF ' *'mgBa1aneeDpe: . -
SECTION 5: CONSTRIICTION SED. ICES
5-1 Construction Supervisor License(CSL) D� .
License Number Expiration
Name of CSL HolderList CSL Type(see below) ,
Type DescriptionNo.and Street U Unrestricted :nil. . ••to 35 000 cu.R
R Restriccedl&2P." Dwellin:
•
City/Town,State,ZIP M
RC Roofm:Caverin:
WS Wmdow and Sidin:
immmSF .,,.• ..
I Insulation
Tel ..an
Email address - D Demolition
Si Registered Home Improvement Contractor CHIC)
EIICRegs m Number Expiration Date
BIC Company Name or BIC Registrant Name .
Emil addressNo.and Street
C /Town,State,ZIP Tel ..one
SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT%GL—152.g 25C(6)) .
Workers Compensation Insoranceaffidavit must be campleadand snhmdtedwiththisapplication. Fail-re to provide
this affidavit will result in the denial of the Issuance of the bmf rt:.L permit
Silted Affidavit At ached? Yes ❑ Na ❑
SECTION 7a:OWI ERAUTPLORTLATION TO SE COMPLETED WEN '
OWNER'S AGENT ORCONTRACTOR AYPT,TF'S FOR BTII.DINGPERNIIT _ .
L as Owner of the subj eceproperty,hereby amhorm° a lication
to act on my behalf,in all matters relative to work aadhorizedby this blinding permit app
• Date
• Pant Owner'sNance(Electronic Siwe)
SECTION 7b: OWNER'.OR ADTHORIZED AGENT DECLARATION •
By entering my name below,I hereby attest under the pains andpenaties of perjury that all of the information
contained in this application is true and accurate to the best of my knowledge a ndtmderstandmg•
Dot 0let( !4 1Ut/ Date
Print Owner's or Aj>morized Agent's Name(Electronic signanue) • • ,
IkOTES:' contractor
1. An Owner who obtains a bnild'r peffirtto do his/her own ot6,or anow owner hnot hireso muse se zte con
(not registered in the Home Improvement Contractor(HI ) oProgram),moa oa e accesse ccePo the ar°�be found at
program ss guaranty
ov/oca n forma der MG3.. onstm dela Sr�isoLicense can be found atwww s
• ' wwwmass.2otdocaInformatioaoathe ConsbuctionS�IF .
2. When substantial work is planned,provide the infonnaiion'o elow:
(mcludi .gsaragge,frnisbedbasementlattics,decks otporch)
Totalfloor area(sq.$) Habitable room court Gross living area ces ft)�— Number of bedrooms
Number ofbathraces' " Number ofhedrooms
Number of bathrooms �'�- _ Neer of decks)porches
'Type of hooting system Enclosed —Open
Type of cooling system
. .. T
ly> • aw-of The Commonwealth of Massachusetts
= ' Department oflrcdustriai,4ccidents •
-6. Mgt= 1 Congress Street, Suite I00
•
==k�= Boston,MA 02114-2017
�'�� <��' WWw.lrfaSS.eoV�dia
•
Workers' Compensation Insurance Affidavit Builders/Contractors/Eledtricians/Plumbers.
TO BE FILED WITH TEE PERMITTING AUTHORITY.
Applicant Information
Please Print Letiibly •
Name (BnsinesslOrganization/Individual): it.
Address: I'3 ('-te J1' efre.cat U-Zes v
City/State/Zip: o,.-w�1 L• fl9 0604 Phone#: �l_-�_0 __G
Are you an employer? Cheek the appropriate box:
I am a employer wit Type of project(required):
I.
❑ �oS employees(full and/or parttime).'
—❑I am a sale 7. XNew construction
proprietor and have no employees working for me in 8. Remodeling
any capacity. [No worles'comp.insurance reguirzd.] {❑�
3�I am a homeownerdomg all work myself(No workers'comp. insurance requred.)t 9. ,I�Demolition
4.0 I am a hameovmer and will be hiring contractors to conduct all work on my property. I will 10 ❑ Building addition
ensure that all contactors either have workers'compensation ice or re sole 11.❑ EIeettical repairs or additions
proprietors with no employees.
I am ageneral co 12.❑Plumbing repairs or additions
5.
❑ contractor and I have hired the subcom actors listed on the attached sheet
These sub-contractors have employees and have workers'comp.insurance* 13.❑Raaf repairs
sub-contractors
6.0 We are a corporation and its officers have exercised their right of exemption per Mal a 14.❑Other
• 152.§I(4),and we have no employees. [No workers'comp.insurance required.]
"'Airy applicant that checks box Tl must also fill out the section below showing their workers'compensation policy imformarian.
t Romecwmers who submit this affidavit indicating they are doing all work and then hire outside contractors muse submit a new afidavit radii: such.
*Contactors that rhrrrr this box must atmebed an additional sheet showing the name of the sub-contactors and state whether or not those entities have
employees. If the subcontractors have employees,they must provide their workers'comp,policy number.
that
zrtforat:tiz employer u Prat idmagworkers'carrcperrsaiorz vtsura^re for my employees. Below is the policy and job site •
•
Insurance Company Name:
Policy#or Self-its. Lic.#
Expiration Date:
lob Site Address:
CityAttach a copy of the workers' compensation showia
page( e the policy declaration age /S policy��p
number and expiration date).
Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation pnniehgble 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 provideq4/4)
dfabove is true and correct
)0SiEnatlire: �//lam 4/4 f
Date: .f ( d'
Phone#:
Official use only. Do mai write in this area, to be completed by city or town official
City or Town.:
P ermitlLicense#
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#:
• Information and Instructions ' - ' '.,
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for theft employees. •
Pursuant to this statute, an employee is defined as"...every person in the service of another under any contact of hire,
express or implied, oral or written."
An employer 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
dwelling house of another who employs persons 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."
MGL chapter 152, §250(6)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 has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152, §250(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contact for the performance of public work until acceptable evidence of compliance with the insurance
requirement of this chapter have been presented to the contracting authority."
Applicant
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and,if
necessary, supply sub-contractors)name(s), address(es) and phone number(s)along withtheir cerdficate(s)of
insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a.policy is required Be advised that this affidavit may be submitted to the Department of Industrial
Accident for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should
be retuned 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 aworkers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter then
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that tine 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 permitllicense number which will be used as a reference number. In addition,an applicant
that must submit multiple p ermit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (may or
town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must befilled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit
•
The Department's address,telephone and fax number.
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston, MA 02114-2017
Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax# 617-727-7749
Revised 02-23-1.5 wwwrnays.gov/iia
J, . GE di.e. . TOWN OF YAR1 OUTn
$-> BUIUDING DEPARTMENT
`e ; ,s 1146 Route 23,South Yarmouth,MA 02664 508-398-2231 est. 1261
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
0 DATE:
JOB LOCATION: (3 �i a.�' kea� ) � Ywnt"-• I'L Aif eta ti
�NAME 5T�T ADDRESS SEU1'lON OF TOWN
"HOMEOWNER" ` f vliel kedler scr-3 )--crig
NAME HOME PHONE WORK PHONE
PRESENT MAILING ADDRESS 5c..."-e 4 s `
CITY OR TOWN STATE ZIP CODE
The current exemption for'Homeowner' was extended to include owner—occapied dwelinss of one or two units
and to allow such homeowners to engage an individual for hire who does not possess a license,provided th at snrh
homeowner shall act as supervisor. (State Building Code Section 110 R5.13.1)
Definition of Homeowner.
Pecson(s)who owns a parcel of land on which he/she resides or intends to reside,on whichthereis oris intended to
be, a one or two family attarhed or detached structure assessoryto such use and I or farm.structures. A person who
constructs more than one home in a two-year period cha11 notbe considered a homeowner,such`homeowner"shall
submit to the building official, on a form acceptable to the building official,that he/she chart be responsible for all
such work performed under the building permit (Section 110 85.1.3.1)
The undersigned 'homeowner' assnmPs responsrl±ility for compliance with the State Building Code and other
applicable codes, by-laws,rules and regulations.
The undersigned 'homeowner' certifies that he / she understands the Town of Yarmouth Building Department
minimum inspection procedures and requirements and'that he / she will comply with said procedures and
requirements. Vi
HOMEOWNER'S SIGNATURE OU
APPROVAL OF BUDDING Ol+r'ICIAL
INSURANCE COVERAGE:
I have a. current liability 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 policy .Other type of indemnity Bond.
OWNER'S INSURANCE WAIVER I am aw are that the licensee does not have the insurance coverage requiredby
Chapter 142 of the Mass. General Laws and that my signature on this permit application waives this requirement
Cherie one:
Si amore of Owner or Owner's Agent •...e Agent
micrueowurnoexecum
-24:::5.
:. t r
r�. '� E'Y 4 TOWN OF YARMOUTH
{'
�',! •, o BITELDINGDEF.ARIAENr
0 'i VS_- 1146 Route 28,South Yarmouth,MA 02664
• r 508-398-2231 ext.1261 Fax 508-398-0836
•
BUILDING DEPARTMENT
DEMOLITION DEBRIS DISPOSAL AFFIDAVIT
Pursuant to MG.L. Chapter 40, Section 54 and 780 Ova, Chapter 1, Section 111.5,
I hereby certify that the debris resulting from the proposed work/demolition to be
conducted at 12 Lie,s Q' 6reest' Lei.i Cgn Pc.? c. t!'wwcaerL
Work Address
Is to be disposed of at the following location: VtiM M0 tond 6l' I t
Said disposal site shall be a.licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
g il614//V
Signature of Application Date
Permit No.
' `i r S:p15%C TOWN OF YARMOUTH
F � �,v 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451
Telephone(508)398-2231 Ext.1292-Fax(508)398-0836
OLD KING'S HIGHWAY HISTORIC DISTRICT COMMITTEE
APPLICATION FOR
CERTIFICATE OF DEMOLITION OR REMOVAL
Application is hereby made for the issuance of a permit for the Demolition or Removal of a building or structure or
part thereof, under Section 6 of Chapter 470, Acts of 1973, as amended, for the proposed work described below
` and on plans, drawings,or photographs accompanying this application. PLEASE SUBMIT SIX (6) COPIES OF
APPLICATION FORM AND ACCOMPANYING INFORMATION(INCLUDING PHOTOS).
Type or print legibly: Please note:All applications must be submitted by owner or accompanied by letter from owner approving
submittal of application,
Address of proposed work: 1,"R is),-a-a- (.r r-c,.a.a- Wes•kre, Map/Lot# l o gr /94, /
Owner(s): .n r-',. 1 Kr=,s-4-r ..' ' Kr lEt— Phone#: 0&'73'7 cc'&,
Mailing address: C.. m•C Year built
Email: Yr._ ctP_
rSt Spon t co e r nn
mrr-r� k
r ne Preferred notification method: US Mail Email
Agent/contractor: S f'l.F Phone#:
Mailing Address: R A.A,t%i
Email: $A-n G Preferred notification method: US Mail Email
Description of Proposed Work(Additional panes may be attached If necessary): / - 3
Osaje-
�.I i
Signed(Owner or agent): 6,100 / Date C /
> Photos (6 sets)showing all sides of building MUST accompany application. >If building is to be moved,give new) "tidn. 1 _
> If relocation Is granted,Certificate of Appropriateness application Is required if new location Is within the Yarmo&h District.` /1
> Owner/contractor/agent is aware that a permit is required from the Building Department.(Check other deparbnehfs)So.). /
> ,If application Is approved,approval is subject to a 10-day appeal period required by the Act. 'NT- , i i
> This certificate is good for one year from approval date or upon date of expiration of Building Permit,whichever date shall be Ill
„ f L
For Committee use only: _Approved _Approved with_modifications ` r dent
Oat 'I/IQ,Ved --7 Reason for denial: (/ r/. f I'
Amount 50' 'r
Signed: /
-
•cvd by:
Date Signed: '
APPLICATION#: 19- 1)00-2 '
. \ 1_____ .._ .__ ___.
• TES F0119
..\ asT
ST GREi
A �y '6i
' �sf"..YID
#13 \ ! .
20.09 \ ,..,N
•
\ LOT 1
44,050 t SF.
\ P,11.0
co
11 1- ACRES
th.0\i \
v
I • .0
I
It- 45.4' e
a / LINO ; N
0 6. " f;NG'Q '
2
40.1'
o Teim
PROPOSED
m PUMP POOL
\,z„ HOUSE
. GAREENHOUSE • d
L.,
N
\ SAS LOCATED
%/' o BY 'OTHERS'
•
20 0° 191.00'
9�00'
TO THE BEST OF MY INFORMATION, "PROPOSED" PLOT PLAN
KNOWLEDGE, AND BELIEF THE YARMOUTH, MASS.
STRUCTURES SHOWN ON THIS PLAN LOT 1,PL BK. 576/18
HAS BEEN LOCATED ON THE GROUND DATE 2/17/11 SCALE 1' = 40'
AS INDICATED. • JOB 6996-00 CLIENT KELLER
217/11 SWEETSER ENGINEERING
203 SETUCKET ROAD
DATE PROFESSIONAL LAND SURVEYOR �0,BOX 713 SOUTH DENNIS, MA 0266 3-6901
C: 1 SR 1 PROJ 1 6996-00 1 Nva 1 6996-PPP-PCOL.Nwa 0 2071 SWVEETSER ENG.
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• °tA,mky TOWN OF YARMOUTH
• { °e. HEALTH DEPARTMENT
N. _ 1-
.
^•'` PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: I{3 S't &e�`f 1 Shtn'- 2 S. '��a-
Proposed Improv ment: 2c s.'toLC 8-1,06145thtncje l Add Lvov- �rcrc.1e wkL
wk.**...r we .-e t rc ,e.-4- L-e.31 -2 o/e 't fia 2 by re4.tW�
14--‘,„1 ( acf...�p, eacu.4(Le r- TTJrz's _ 'TZ, •F� I 3 Ria t 4kec 6,-.4flef-e
Applicant: psyl ie-( 4- T'vi3Lt t iCe,Uety Tel. No.: 533-29Y'CY 6
Address: 12 1,...e.54- - Gve - -- cJ c. Yom+-tffr t Date Filed:� Gj if 8
**Jfyou would like e-mail notification of sign
off please provide e-mail address: S-t-1 G k Ig 7.0(il.. COtatCcaJ÷. \','e t
/1rOwOwner Name: I- h 1 e( + 1--vir'Slot- keit-eft--
Owner
ner Address: S-4•-c c-f 4l ,.1c Owner Tel.No.:
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: '
(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.
GIS\1
REVIEWED BY: *
DATE: 7/1-C178
PLEASE NOTE
COMMENTS/CONDITIONS: f jo
3 n /
u$2 Rt IM 0.1 in geCv'OcAM. c
• -moo TOWN OF YARMOUTH
L4 1146 ROUTE 28,SOUTH YARMOUTH, MA 02664-4451 \REC ELV E R
£ � -- Telephone(508)398-2231 Ext. 1292-Fax(508)398-0836
OLD KING'S HIGHWAY HISTORIC DISTRICT COMMI EE SEP 11 ZU17 ,
YARMOUTH
APPLICATION FOR OLD KING'S HIGHWAY
CERTIFICATE OF APPROPRIATENESS
Application is hereby made for issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts of 1973 as
amended,for proposed work as described below&on plans,drawings,photographs, &other supplemental info accompanying this
application. PLEASE SUBMIT 6 COPIES OF SPEC SHEET(S),ELEVATIONS,PHOTOS,&SUPPLEMENTAL INFORMATION.
Check All Categories That Apply: Indicate type of Building: Commercial Residential
1) Exterior Building Construction: New Building /Addition /Alterations _Reroof_Garage
Shed Solar Panels Other.
2) Exterior Painting: _Siding _Shutters _Doors Trim _Other.
3) Signs/Billboards: _New Sign _Change to Existing Sign
4) Miscellaneous Structures: Fence Wall Flagpole _Pool _Other:
Please type or print legibly:
efiV
Address of proposedpropwork: \' �G�t LAslc•A" QA. Map/Lot# r 1$ /0 5/76,
Owner(s): Van A ¶-C�a�n V •tar Phone#:
All applications must be submitted by owner or accompanied by letter from owner approving submittal of application.
Mailing address: SO'cn.t Year built: icri8-
Email: Daeta\e psirop\rn CO roe. tc cC. y`a \ Preferred notification method: Phone `"/ Email
Agent/contractor. Se P Phone#: ;OS-V5-1 00(a2
Mailing Address: Safa.E
Email: `'?tn% Preferred notification method: Phone ✓ Email
Description of Proposed Work:
1�si.Mo\s'c t ot_ ¢x�s'c`1 o at,o.ay 4 `2acor`yac<maCmpet cc- ,paw can a-ac,.e \k3
coAres. - rc�W&Lw cv 0-,\ o Pco''GoM\ (o orPw 'ka \ 'Leone,+rJc-t- a.•14.e. ed
jarat e -Yo et.c.l,d-C p_,,.. i :4-%ona-1 (o 1 t... w'cbl-h, a..Shea-dorrnorern rat'-r °'-'`d
z do� t„,0 0,5e_ dorev' erj
Signed(Owner or agent): /�k id/ Date: 9•\2-•vi
> Owner/contractor/agent is aware that a permit Is required from the Building Department.(Check other departments,also.)
> If application is approved,approval Is subject to a 10-day appeal period required by the Act.
D This certificate is good for one year from approval date or upon date of expiration of Building Permit,whichever date shall be later.
> All new construction will be subjecttoinspection by OKH.OKH-approved plans MUST be available on-site for framing&final Inspections.
For Committee use only: /Approved _Approved with—ReecelpgeD _Denied
Rad Date: 9-t/17 Reason for Denial; V G
Amount 'YD OCT I 1 Z01]
CK . 3, APPROVED
Rad by Signed: �- f TOWN CLERK
Cas
45 Days: /00'a6-it, ��!/ y .��a - A- OUTH, A OCT lv curt
el 1e I YARMOUTH
ir en Ay
Date Signed: Jd/6112 017l'
...c-
Ar - • • -
1/2016 1 APPLICATION#: ]9-AD 7 2
��Q
.,:avy TOWN OF YARMOUTH /�/ 3
•
. WATER DEPARTMENT
3itia 9 y 99 Buck Island Road
••c� � :roc West Yarmouth, MA 02673 .
Telephone: (508) 771-7921 • Fax: (508) 771-7998
• • BUILDING PERMIT APPLICATION
DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET
Bldg. Site Location I11A-nd 6-4 k' 70.11 at p 1 . _ .
Proposed Improvement: Imo {Gnirat IL Afcij6'- (3�t LvC ,
Applicant: vi i cA / c/ie .
Address(3 0.411- Gr—St- 0-611c-44- Tel. #: Jit''3? - 66°2 Date Filed: gASi / er
s, Yw ,f
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...
Y /c
cG �
1A-CH S /asli6
Sign ure of applicant • Date
PLEASE NOTE:
COMMENTS:
•
_card
sD �
• /(
Reviewedision .. Date
a
N ROAD
WESTER
GREAT 111'76 s
#1
3 WES11
to .
N
20'09 \ LOT 1
44,050 ± S.F.
m '°,o 1.0 1 f ACRES
\\ mac.
. Z•
v
rn'A
- 1 y
a4OLLIN , 5' N
20.6 'C BgRN '>,.1, tzz
NExist,AG DECK
�� 40,1'
o
\ m PROP. - 6'
ADDI770N APPROX.
rn PUMP POOL
\Z HOUSE
coo GREENHOUSE • I .
0
o c w o
0\ 0 • 't A ��
31
\; j61
, LA
N_
\ S.A.S. LOCATED
_ i - o BY OTHERS' �tN 42415,40
G3 MMED 0 1v oOBtft.
SEP 2 6 2018 2� 0 , WILLIAM(4:fiCIN
1NILCOX m
No.31341 a
HEALTH DEPT: �o� � G ��,� >o .
,STS
u\N A.. 14 4414
TO THE BEST OF MY INFORMATION, "PROPOSED" PLOT TUN
KNOWLEDGE, AND BELIEF THE YARMOUTH, MASS. •
STRUCTURES SHOWN ON THIS PLAN LOT 1,PL. BK. 576/18
HAS BEEN LOCATED ON THE GROUND DATE 2/17/11 SCALE 1" = 40'
AS INDICATED. JOB 6996-00 CLIENT KELLER
1/17/11 ,�
2/17/11 11 SWEETSER ENGINEERING
203 SETUCKET ROAD
DATE PROFESSIONAL LAND SURVEYORPO BOX 713 SOUTH DENNIS, MA 02660
OFF. 508-385-6900 FAX. 508-385-6991
C: I S8 I PROJ 1 6996-00 I dwg 16996-PPP-POOL.dwg 0 2011 SWEETSER ENG.
\-3,
VIVST
0
. „QST 0•111 \
1 A ''1'6
mss..
S
#13 n. EP 1 7 20)7
20p9 ..- \ \ LOT 1 N OLD
Kn�SNG,11
44,050 f S.F.
1Dco
1.011 ± ACRES
m co
1 ' v
ea Z Z
D
41 ,.,1'1 P ' `�
1 a /DOLLING ,A 45• N D
eA�N Ex'S�NG / DCT 10 2017
20.6
D 6, ,
\ G DECK/ , YARMOUAH
pr'r` / 41 I •LD ING'S HIGHWAY
-873,1
m PUMP PROPOSED
z HOUSE POOL
\ GREENHOUSE ii .
to
91
, N
0\O Ca' 0co
o -1 ai
\ S.A.S. LOCATED
vo BY 'OTHERS' • r
CW2i 20 DD "- '9, DD' •
•
TO THE BEST OF MY INFORMATION, "PROPOSED" PLOT PLAN
KNOWLEDGE, AND BELIEF THE YARMOUTH, MASS.
STRUCTURES SHOWN ON THIS PLAN LOT 1,PL. BK. 576/18
HAS BEEN LOCATED ON THE GROUND DATE 2/17/11 SCALE 1" = 40'
AS INDICATED. JOB 6996-00 CLIENT KELLER
2/17/11 SWEETSER ENGINEERING
203 SETUCKET ROAD
DATE PROFESSIONAL LAND SURVEYORPO BOX 713 SOUTH DENNIS, MA 020
0FF. 508-385-6900 FAX. 50666-385-6991
C: I SR I PROD 16996-00 I rhea 16996-PPP-POOr^f}-flSFJTSER ENG.
OCT 11 2017
TOWN CLERK
SOUTH YARMOUTH, MA4717 7
11/
0 REScheck Software Version 4.6.5
Compliance Certificate
Project New Garage with Master Over
Energy Code: 2015 IECC
Location: South Yarmouth, Massachusetts
Construction Type: Single-family
Project Type: Addition
Climate Zone: 5 (6137 HDD)
Permit Date:
Permit Number.
Construction Site: Owner/Agent: Designer/Contractor:
13 West Great Western Road Daniel A.&Kristen M.Keller Erik Tolley
South Yarmouth,MA 02664 13 West Great Western Road ERT Architects
South Yarmouth,MA 02664 299 Whites Path
South Yarmouth,MA 02664
508-362-8883
I
omp Inc-,-asses s n•- I • ra•e-0'
Compliance: 3.3%Better Than Code Maximum UA: 121 Your UA: 117
The%Better or Worse than Code Index reflects how close to compliance the house is based on code trade-off rules.
It DOES NOT provide an estimate of energy use or cost relative to a minimum-code home.
Envelope Assemblies
Gross Area_,.Cavi Cont. iT
Perimeter l ' lue .R Value
Ceiling 1: Flat Ceiling or Scissor Truss 600 38.0 0.0 0.030 18
Floor 1:All-Wood joist/truss:Over Unconditioned Space 600 30.0 0.0 0.033 20
Wall 1:Wood Frame,16a o.c. 936 21.0 0.0 0.057 47
Window 1:Vinyl/Fiberglass Frame:Double Pane with Low-E 94 0.300 28
Door 1:Solid 20 0.180 4
Compliance Statement: The proposed building design described here is consistent with the building plans,specifications,and other
calculations submitted with the permit application.The proposed building has been designed to meet the 2015 IECC requirements In
REScheck Version 4.6.5 and to comply with the mandatory requirements listed in the REScheck Inspection Checklist.
Keith Presswood VP i<¢ Pt screed 09/26/2018
Name-Title Signature Date
Project Notes:
REScheck by Cape Cod Insulation, Inc.
18 Reardon Circle
South Yarmouth, Ma. 02664
800-696-6611
#727876
Project Title: New Garage with Master Over Report date: 09/26/18
Data filename: Untitled.rck Page 1 of 9
cidREScheck Software Version 4.6.5
Inspection Checklist
Energy Code: 2015 IECC
Requirements: 39.0%were addressed directly in the REScheck software
Text in the"Comments/Assumptions" column Is provided by the user In the REScheck Requirements screen. For each
requirement,the user certifies that a code requirement will be met and how that is documented,or that an exception
is being claimed. Where compliance is itemized in a separate table,a reference to that table is provided.
Section Plans Verified Field Verified
# Pre-Inspection/Plan Review Value Value Complies? Comments/Assumptions
& Req.ID
103.1, Construction drawings and i - - ❑Complies Requirement will be met.
103.2 documentation demonstrate o , ':❑Does Not
[PR11' energy code compliance for the y. I
0 building envelope.Thermal ONot Observable
envelope represented on ONot Applicable
construction documents. I i
103.1, Construction drawings and : ❑Complies
103.2, documentation demonstrate ❑Does Not
403.7 energy code compliance for a
(PR3J' lighting and mechanical systems. ,. ONot Observable
a Systems serving multiple ONot Applicable
dwelling units must demonstrate t
compliance with the IECC fi. t
Commercial Provisions. ,.
302.1, 1 Heating and cooling equipment is Heating: Heating: ❑Complies
403.7sized per ACCA Manuals based Btu/hrr
_ Btu/h ❑Does Not
(PR2h I on loads calculated per ACCA Cooling: Cooling:
J - (Manual J or other methods Btu/hr_ Btu/hr_ ONot Observable
Iapproved by the code official. ,ONot Applicable
:
Additional Comments/Assumptions:
1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3)
Project Title: New Garage with Master Over Report date: 09/26/18
Data filename: Untitled.rck Page 2 of 9
Section
Foundation Inspection Complies? - Comments/Assumptions
&Req.ID
303.2.1 ;A protective covering Is installed to .❑Complies Exception:Requirement is not applicable.
(FO31l2 3protect exposed exterior insulation ODoes Not
J d and extends a minimum of 6 In.below ONot Observable
grade. ❑Not Applicable
403.9 ;Snow,and Ice-melting system controls ❑Complies
(F01212 'installed. ODoes Not
'SJ r ❑Not Observable
❑Not Applicable
Additional Comments/Assumptions:
1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3)
Project Title: New Garage with Master Over Report date: 09/26/18
Data filename: Untitled.rck Page 3 of 9
Section Plans Verified Field Verified
# Framing/Rough-In Inspection Value Value Complies? Comments/Assumptions
402.1.1. Door U-factor. U- U- ❑Complies See the Envelope Assemblies
402.3.4 ODoes Not table for values.
[FR3]1
ONot Observable
O ONot Applicable
402.1.1, Glazing U-factor(area-weighted U-_ U- ❑Complies See the Envelope Assemblies
402.3.1, average). ODoes Not table for values.
402.3.3,
402.5 ONot Observable
[FR211 ONot Applicable
a
303.1.3 U-factors of fenestration products OComplies Requirement will be met.
[FRO are determined In accordance ODoes Not
a with the NFRC test procedure or ['Not Observable
taken from the default table.
1 ONot Applicable
402.4.1.1 Air barrier and thermal barrier l ❑Complies Requirement will be met.
[FR2312 Installed per manufacturers 'ODoes Not
Instructions.
a4ONot Observable
ONot Applicable
402.4.3 Fenestration that is not site built i ❑Complies Requirement will be met.
[FR2011 is listed and labeled as meeting ' ODoes Not
,9 AAMA/WDMA/CSA 101/I.S.2/A440 t " '❑Not Observable
or has infiltration rates per NFRC
400 that do not exceed code }❑Not Applicable
limits. J
402.4.5 IC-rated recessed lighting fixtures ❑Compiles Requirement will be met.
[FR1612 -sealed at housing/Interior finish p :ODoes Not
1
I and labeled to indicate s2.0 cfm y. ❑Not Observable
leakage at 75 Pa. I
j _. ONot Applicable
403.3.1 Supply and return ducts in attics 1 ❑Complies
[FR1211 Insulated>=R-8 where duct Is I ❑Does Not
O >=3 inches In diameter and>_ ( ❑Not Observable
R-6 where<3 Inches.Supply and;.
return ducts in other portions of 1 ONot Applicable
the building Insulated>=R-6 for
diameter>= 3 Inches and R-4.2 1 1
for<3 Inches in diameter. 1
403.3.5 Building cavities are not used as i. OComplies
[FR1513 ducts or plenums. i ODoes Not
J l'• j❑Not Observable
ONot Applicable
403.4 1 HVAC piping conveying fluids R- R- ❑Complies
[FR1712 ;above 105 2F or chilled fluids ODoes Not
8 below 559F are Insulated to aR- DNot Observable
dONot Applicable
403.4.1 Protection of Insulation on HVAC 1 ❑Complies
[FR2411 piping. 1 ODoes Not
O I ONot Observable
I ONot Applicable
403.5.3 [Hot water pipes are Insulated to R- R- ❑Complies
[FR18I2 i tR-3. ODoes Not
a .1 P❑Not Observable
❑Not Applicable
403.6 .,,Automatic or gravity dampers are„ ❑Complies Requirement will be met.
[FR1912 d installed on ail outdoor air ODoes Not
+intakes and exhausts. • '^
f ONot Observable
I ONot Applicable
1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3)
Project Title: New Garage with Master Over Report date: 09/26/18
Data filename: Untitled.rck Page 4 of 9
Additional Comments/Assumptions:
1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3)
Project Title: New Garage with Master Over Report date: 09/26/18
Data filename: Untitled.rck Page 5 of 9
Section Plans Verifled Field Verified
# - Insulation Inspection Value Value Complies? Comments/Assumptions
& Req.ID
303.1 ;All installed Insulation is labeled ( ':['Complies Requirement will be met.
[IN13)2 Iorthe Installed R-values [ ❑Does Not
J a provided. `..
❑Not Observable
i ❑NotApplicable
402.1.1, Floor insulation R-value. R- R- ❑Complies See the Envelope Assemblies
402.2.6 0 Wood 0 Wood ODoes Not table for values.
[INtl1 - 0 Steel 0 Steel ❑Not Observable
0 ❑Not Applicable
303.2, Floor Insulation Installed per k' ❑Complies Requirement will be met.
402.2.7 manufacturer's Instructions and '+ ❑Does Not
(INV In substantial underside of the subfl or,or floor,ct with the �'❑Not Observable
framing cavity insulation Is in ` - Not Applicable
contact with the top side of 1❑
sheathing,or continuous I. !
insulation is Installed on the
underside of floor framing and
extends from the bottom to the
top of all perimeter floor framing I.
members.
402.1.1, Wall insulation R-value.If this is a R- R- ,❑Complies See the Envelope Assemblies
402.2.5, mass wall with at least IA of the ❑ Wood 0 Wood ,ODoes Not table for values.
402.2.6 wall Insulation on the wall 0 Mass 0 Mass ❑Not Observable
['NW exterior,the exterior Insulation ❑ Steel ❑ Steel ❑Not Applicable
0 requirement applies(FR10).
303.2 Wall insulation Is Installed per I ❑Complies Requirement will be met.
[IMO manufacturer's Instructions. i ❑Does Not
e ONot Observable
❑Not Applicable
Additional Comments/Assumptions:
1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3)
Project Title: New Garage with Master Over Report date: 09/26/18
Data filename: Untitled.rck Page 6 of 9
Section Plans Verified Field Verified
# Final inspection Provisions value Value Complies? Comments/Assumptions
& Req.ID
402.1.1, Ceiling insulation R-value. R- R- ❑Compiles See the Envelope Assemblies
402.2.1, 0 Wood 0 Wood ODoes Not table for values.
402.2.2, 0 Steel 0 Steel ❑Not Observable
1 6
[F111 ❑Not Applicable
[1111
303.1.1.1, Ceiling insulation Installed per E ❑Complies Requirement will be met.
303.2 manufacturer's instructions. i ❑Does Not
(1121' Blown Insulation marked every "❑Not Observable
300 ft2. t
❑Not Applicable
402.2.3 Vented attics with air permeable I OComplies Requirement will be met.
[FI2212 ',insulation Include baffle adjacent I' ODoes Not
to soffit and eave vents that j
I extends over Insulation. i - ❑Not Observable
1 f ❑Not Applicable.
402.2.4 Attic access hatch and door R-_ R- ❑Complies Requirement will be met.
[1131' insulation aR-value of the ❑Does Not
adjacent assembly. ❑Not Observable
O Not Applicable
402.4.1.2 Blower door test®50 Pa. <=5 ACH 50= ACH 50. ❑Complies Requirement will be met.
[F1171' ach In Climate Zones 1-2,and ODoes Not
<-3 ach in Climate Zones 3-8. QNot Observable
❑Not Applicable
403.3.4 Duct tightness test result of<-4 cfm/100 dm/100 ❑Complies
[1141' dm/100 ft2 across the system or Itr ft— ODoes Not
<-3 cfm/100 ft2 without air
handler®25 Pa.For rough-In not Observable
tests,verification may need to ❑Not Applicable
occur during Framing Inspection. 1
403.3.3 Ducts are pressure tested to dm/100 dm/100 ❑Compiles
[11271' determine air leakage with T- ftr— ODoes Not
either:Rough-in test:TotalQNot Observable
leakage measured with a ❑Not Applicable
pressure differential of 0.1 Inch
w.g.across the system including
the manufacturers air handler
enclosure If Installed at time of
test.Postconstruction test:Total
leakage measured with a
pressure differential of 0.1 Inch
w.g.across the entire system
Including the manufacturer's air
handler enclosure.
403.3.2.1 Air handler leakage designated ', ❑Complies
[FI241' by manufacturer at< 2%of I ,❑Does Not
design air flow.
�i ['Not Observable
S ❑Not Applicable
403.1.1 s Programmable thermostats l,. OComplies
[11912 l Installed for control of primary i -- '❑Does Not
heating and cooling systems and ❑Not Observable
initially set by manufacturer to I _
code specifications. . ❑Not Applicable
403.1.2 Heat pump thermostat Installed G - OComplies
[111012 on heat pumps. i - ODoes Not
i ,
QNot Observable
1 4.. ❑Not Applicable
403.5.1 I Circulating service hot water ❑Complies
[F11112 !systems have automatic or ! - - ODoes Not
accessible manual controls. ;. ❑Not Observable
-- - --- -- ❑Not Applicable
1 High Impact(Tier 1) n Medium Impact(Tier 2) 3 Low Impact tiler 3)
Project Title: New Garage with Master Over Report date: 09/26/18
Data filename: Untitled.rck Page 7 of 9
Section Plans Verified Field Verified
# Final inspection Provisions Value Value Compiles? Comments/Assumptions
& Req.ID
403.6.1 JAII mechanical ventilation system ❑Complies
[F12512 ;fans not part of tested and listed ❑Does Not
HVAC equipment meet efficacy '❑Not Observable
?andairflowlimits. ;, ONot Applicable
403.2 Hot water boilers supplying heat r ❑Complies
[F126]2 'through one-or two-pipe heating . ❑Does Not
systems have outdoor setback ONot Observable
icontrol to lower boiler water 1:.
:temperature based on outdoor i ❑Not Applicable
':temperature. L . i
403.5.1.1 Heated water circulation systems ; ❑Complies
[F12812 have a circulation pump.The i ❑Does Not
!system return pipe Is a dedicated i
ONot Observable
return pipe or a cold water supply i ❑Not Applicable
pipe.Gravity and thermos- i. pp
syphon circulation systems are c.
i not present.Controls for
'circulating hot water system j
+pumps start the pump with signal y' - 1
i for hot water demand within the f,
!occupancy.Controls [ - i
i automatically turn off the pump j
1 when water is In circulation loop
i Is at set-point temperature and j Al
it no demand for hot water exists.
403.5.1.2 j Electric heat trace systems ❑Complies
[FI2912 I comply with IEEE 515.1 or UL F. ❑Does Not
1515.Controls automatically A.
adjust the energy Input to the ❑Not Observable
heat tracing to maintain the I' ❑Not Applicable
desired water temperature In the L
ipiping.
403.5.2 1 Water distribution systems that f: ❑Complies
[F13012 -s have recirculation pumps that c -- ❑Does Not
1 pump water from a heated water `j AONot Observable
supply pipe back to the heated ❑Not Applicable
4 water source through a cold i PP
water supply pipe have a I ]]
Idemand recirculation water ). M
system.Pumps have controls 1.
that manage operation of the )-
pump and limit the temperature )
3 of the water entering the cold I 1
water piping to 1042F. q I _
403.5.4 I Drain water heat recovery units 1 ❑Compiles
[F13112 ;tested In accordance with CSA i ;❑Does Not
i,B55.1.Potable water-side ONot pressure loss of drain water heat i Observable
- ONot Applicable
recovery units<3 psi for (.
'individual units connected to one ;
'or two showers. Potable water-
side pressure loss of drain water ; I
heat recovery units<2 psi for
Individual units connected to F i
three or more showers. 'i - -
r
404.1 75%of lamps In permanent ' ❑Complies
(FI6]3 fixtures or 75%of permanent ❑Does Not
fixtures have high efficacy lamps.) - ` '❑Not Observable
Does not apply to low-voltage
lighting. t ONot Applicable
404.1.1 Fuel gas lighting systems have S: ❑Complies
[F123]3 no continuous pilot light. ❑Does Not
g i . . ONot Observable
ONot Applicable
1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 iLow Impact(Tier 3)
Project Title: New Garage with Master Over Report date: 09/26/18
Data filename: Untitled.rck Page 8 of 9
Section Plans Verified Field Verified o
# Final inspection Provisions Value Value Complies? Comments/Assumptions
& Req.ID
401.3 Compliance certificate posted. ; ❑Complies Requirement will be met.
[F1712 1 : ❑Does Not
ONot Observable
❑NotApplicable
303.3 Manufacturer manuals for ❑Complies
[F11813 mechanical and water heating ❑Does Not
systems have been provided. ONot Observable
1 }.
[Not Applicable
Additional Comments/Assumptions:
1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3)
Project Title: New Garage with Master Over Report date: 09/26/18
Data filename: Untitled.rck Page 9 of 9
2015 IECC Energy
Efficiency Certificate
1
Above-Grade Wall 21.00
Below-Grade Wall 0.00
Floor 30.00
Ceiling/Roof 38.00
Ductwork(unconditioned spaces):
G ass&Doo Rat ng 1'-Fac or M
Window 0.30
Door 0.18
1 .ti g : .. mg qupu
Heating System:
Cooling System:
Water Heater:
Name: Date:
Comments
Sears, Tim
From: Sears, Tim
Sent Thursday, October 4,2018 9:44 AM
To: 'stick1970@comcast.net'
Subject: 13 West Great Western Rd
Daniel,
I have reviewed your application for 13 West Great Western Rd,and we are going to need a floor plan showing the
smoke/CO/heat detectors marked to code.
Please submit for review.
Thank you
Timothy Sears CBO
Building Inspector
Town of Yarmouth
508-398-2231 Ext. 1259
mailto:tsears@varmouth.ma.us
t