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HomeMy WebLinkAboutBLD-19-2108 R _ I ; t 6IO1 T T NdfI -vid,° CI.3AI33321 �. A -7� sir>/; � �f5 �y V- . % •% • L I X( "-TrIi . t 1 oily;• ,.�i wdedon . oa_A xns r 4,.�► < I J� C..1 tit-7710A (N. I 1 , . . .. i . 1 . . _.., , . . hr "VaQSX�c }- 4 " - 42.63t-636-FoL A 4 ,n -a-, 141 r_ 1 £m J' io/ 0/1 C©fis- 12100 00 /lido(.k.v' - ONE & TWO FAMILY ONLY-BUILDING PERMIT Town of Yarmouth Building Department of r 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 R E C IVF D This Section For Official Use Only C. Building Permit Number: &f -(90j) 01/0c- ,Date Applie • OCT 04 2013 �tl� SQAr� .. � .. ,� .. i10,-3o-4 BUILDING DEPART°ENT Building Official(Print Name) Signature .. "Y -Thtr----- SECTION 1:SITE INFORMATION lerapesty„A,d/dress:,� 1.2 Assessors p&Parcel Nunbbbersrsy / 1.1a Is tEis an accepted street?yes no_ Map Number Parcel 17umb�err 1.3 Zoning Information: 1.4 Property Dimensions: m Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) m 1.5 Building Setbacks(ft) rn -rt Front Yard Side Yards Rear Yard 0 =1 - Required Provided Required Provided Required Provided m 0 T1 ye' N 1.6 Water Supply: (M.G.L c.40,I54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: r CO Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal CI Onsystem On site disposal ❑ C Check if yes❑ Z SECTION 2: PROPERTY �O'WNNERSI IIPPt - -p N 12.1 Qwner R7t72'. /+ _ Iibi j 14/ --1-t m '( n t) (/J/, `�`z'p�dj City,State,ZIP O `n . 71 / 701 z rn No.and Street Teleph a `. Email Address p SECTION 3:.DESCRIPTION OF PROPOSED WORK2(cheek all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition 0 Accessory Bldg. 0 Number of Units l Other g Specify: B f `e et? • .. . , . le: /1,v / ,7y .4.-cd/ f1d � N ^ —14•,-3- --i? ( re „4„,-,./) 14.2018 E TION 4:ESTIMATED CONSTRUCTION COSTS BUILDIN PA 6ENfs[ . atedCosts: I4m y Official-Use Only-- ----� ab.r and Materials) y 1.Building $ 1-Building Permit Fee $ CO Indicate how fee is determined: 2.Electrical $ II Standard CttylTown Application k'ee ' < • ❑Total Project Cost'(Item 6)x multiplier x • 3.Plumbing $ 2. Other Fees: $ 36- 4.Mechanical (HVAC) $ 5.Mechanical (Fire ” $ Suppression) Total All Fees $ Check No. • Check Amount: Cash Amount: 6.Total Project Cost: $ 9 ,,,di 0 paid in Full it Outstanding Balance Due:3 SECTION 5:.CONSTRUCTION SERVICES 5.1 IConstrucUon Supervisor License(CSL) �.q� J � � �-- / / , [cense Number Ex iration Date ame of CSL Holder n� r-c /p /Y 1,./' z.-2-- List CSL Type(see below) ii, No,and Street �7� Type , • Description 19 xr.'_„/� / ' oAe . U Unrestricted(Buildings up to 35,000 cu.ft.) N fly vH'N/ �"f�7_ L� R Restricted lk2Family Dwelling Cit' own,State,ZIP 1 M Masonry RC Roofing Covering WS Window and Siding Jy�_�/� y cg3 4:1,71,— SF Solid Fuel Burning Appliances c`)" �W " V '�7/ !s 4tF 6 �� Insulation Telephone Email address D DemolitionQ �/5.2 egiisstteejedddHome Improvement Contractor(HIC) ,//y L ' /A ali 4/ " ' ' v sc HIC Registration Number Exp' on Date MC Company Name or HIC Registrant Name �r � _ No.and Street / /�� ��1� Email address /'_ sf City/Town, State,ZIP Telephone C /�� 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 Issuanc of the building permit. Signed Affidavit Attached? Yes No 0 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 tA/ A4cc eA/2/2— to act on my behal>y in all matters relative to work authorized by this building permit application. J&e> Owner's Name(Electronic Si e) Date • • SECTION 7b: OWNER'.OR AUTHORIZED AGENT DECLARATION By entering my . e below,I hereby attest under the pains and penalties of perjury that all of the information contained in this is., ication i • e and accurate to the best of my knowledge and understanding.. 9/9.2-�,e tint Owner's .r Authorized Ag 's Name(Electronic Signature) Date • NOTES: 1. An Owner who obtains 'ding permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the H. le Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fun, under M.G.L. c. 142A.Other important information on the HEC Program can be found at www.mass.Qov/oca Information on the Construction Supervisor License can be found at www.mass.eov/dos 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" t �_� 1 The Commonwealth of Massachusetts r _=, � / Department oflndustrialAccidents • - t WARN, 1 Congress Street,Suite 100 t-4:1- Boston, MA 02114-2017 *itt�< www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information / / Please Print Legibly Name (Business/organization/Individual): `/0 ,91( ��eep:'L1/ Address: 7 ae, S'K 4 '.7 City/State/Zip:pl/)/4C. ,tif B2& �� Phone#: �` 6-0—.d- 2) Are you a mployer?Che the appropriate box: Type of project(required): I. am a employer with 0mployees(full and/or part-time).* 7. ❑New construction 2.0 l am a sole proprietor or partnership and have no employees working for me in 8. ❑Remo.-ling • any capacity.[No workers'comp.insurance required.] 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. El I olition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 r 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.❑Plumbing repairs or additions 5.❑I 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.insurance.t 13.❑Roof repays 6.❑We are a corporation and its officers have exercised their right of exemption per MGL e. 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 sub-contractors 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 and job site information /) ./,Ojfa- �,' - Insurance Company Name: , y C c 3 l?i" / y Policy#or Self-ins.Lic.#: /_,FQ 'MO Expiration Date: 7/l -•7)a Job Site Address: r / /Aot—V-- City/State/Zip: AC Attach a copy of the workers' compensation policy declaration page(showing the policy numbet 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 c l fy nder the pains and penalties of perjury that the information provided above is/truuee an correct. Signatur 1 ' Date: 215G`T i Phone#: ertur- - —‘6— e'--1 ' 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#: ogYRS TOWN OF YARMOUTH BUILDING DEPARTMENT C :e' si $ 1146 Route 28, South Yarmouth,MA 02664 508-398-2231 ext. 1261 HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE: • JOB LOCATION: NAME STREET ADDRESS SECTION OF TOWN "HOMEOWNER" NAME HOME PHONE WORK PHONE PRESENT MAILING ADDRESS CITY OR TOWN STATE ZIP CODE The current exemption for 'Homeowner' was extended to include owner—occupied dwellings of one or two units and to allow such homeowners to engage an individual for hire who does not possess a license,provided that such homeowner shall act as supervisor. (State Building Code Section 110 R5.1.3.1) Definition of Homeowner: Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is or is intended to be, a one or two family attached or detached structure assessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner,such"homeowner"shall submit to the building official,on a form acceptable to the building official,that he/she shall be responsible for all such work performed under the building permit. (Section 110 R5.1.3.1) The undersigned `homeowner' assumes responsibility 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. HOMEOWNER"S SIGNATURE APPROVAL OF BUILDING OFFICIAL 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 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: Signature of Owner or Owner's Agent Owner Agent h:homeownrlicexemp f.. • . • Information and Instructions • • ` Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their 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, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(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 • Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned 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 a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the 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 permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/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 (city 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 be filled 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 02-23-15 www.mass.gov/dia ' • °t•."Liti TOWN OF YARMOUTH :4g c BUILDING DEPARTMENT "?_t ti' 1146 Route 28,South Yarmouth,MA 02664 • 7; .L_ yrs 508-398-2231 ext. 1261 Fax 508-398-0836 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 40,Section 54 and 780 CMR, Chapter 1, Section 1115, I hereby certify that the debris resulting from the proposed work/demolidon to be conducted at L : - Work Address Is to be disposed of at the following location: 4 r /eel_ �l7' Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. ditiesaassis. a1 attire of App I cation Date Permit No. A`O n CERTIFICATE OF LIABILITY INSURANCE DATE(MINDD/YYYY) 09m/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(les)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 cunt,' NAME: United Insurance Agency,Inc. PHONE pm: 508-759-6595 I FAX (NCC,Ne), 508-759-3822 199 Main Street XA� P.O.Box 1013 ADDRESS: Buzzards Bay,MA 02532 INSURER(S)AFFORDING COVERAGE NAICC INSURER A: Atlantic Casualty INSURED INSURER B: Travelers Indemnity Ins Co John Mackenzie INSURER C: 248 Camp Street INSURERD: L1 West Yarmouth,MA 02679 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 PERyIIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICFTTHIS 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 )NSD WVD POLICY NUMBER POLICYEFF POLICY pPOLIC YEFF IPOLIC EXP LIMITS X COMMERCIAL GENERAL LABILITY EACH OCCURRENCE S 1,000,000 DCLAIMS-MADEn OCCUR PREM SES(Ea occurre $ 100,000 MED EXP(Any one person) $ 5,000 A L907000257 09/23/18 09/23/19 PERSONAL a ADV INJURY $ 1,000,000 GEN.AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 RPOLICY ECT 0 LOC PRODUCTS-COMP/OP AGO $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ - ANYAUTO (Es widest) _ BODILY INJURY(Per person) $ OWNED —SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Par accident) >< HIRED NON-OWNED PROPERTY DAMAGE - AUTOS ONLY _ AUTOS ONLY (Per accident) _ _ S UMBRELLA LAB H OCCUR EACH OCCURRENCE _ $ EXCESS LIAB CLAIMS-MADE AGGREGATE _ $ DED I I RETENTIONS S WORKERS COMPENSATION AND EMPLOYERS'LIABILITYXI S ATUTE I ER B OFFICER/MEMBERREXC UDEDfl7�C 'WE N/A 6HUB0G3228918 09126/18 09/26119 E.L.EACH ACCIDENT S 100,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 Kdesalbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If mon spate Is remind) Carpentry John Mackenzie Is not Included on the workers'compensation policy CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN John Mackenzie ACCORDANCE WITH THE POLICY PROVISIONS. 248 Camp St Apt 1.1 West Yarmouth,Ma 02679 AUTHORIZED REPRESENTATIVE Ms Dexter I ®1988.2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD • • -'b--:� ....,. ..„.b,.Chiey uBusinessZ (u�al Omcs of Consumer Affairs Ion I °'HOME IMPROVEMENT CONTRACTOR p�,,TYPE.' dMdual 18310/219 . JOHN MACKENZ e1.r ' { • • JOHN MgCKENZIE a� , ` 248 CAMP ST L1 a s U W.YARMOUTH,MA 02873•-a' U u • Undersecretary ' { fr;,.�\ } r • . i ..- 1 fM • • i Massachusetts Department of Public Safety _ 11/ Board of Building Regulations and Standards SSS111 License:CS-085363 ._ _ : •a Construction/Supervisor °Aar..r/ JOHN A MACKENZIEY ' y rt.- 248 CAMP ST.L-1 . ,, ,, " T 1 WEST YARMOUTH MA 02673 - '"�0,.., `' "-- ) 9 t - //JCG�_Gi� �-- Expiration: ... /Commissioner 01/03/2019 r • a • pp )# • 4 . EIEMINED pcw},y TOWN OF YARMOUTH OCT 0 5 2018 i c HEALTH DEPARTMENT "� HEALTH DEPT. PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Building Site Location: 07. / J/ 7 IC_6 J1��/ SV Proposed Improvement: ) ori / 1i-tt hG/v (4g/,*/ / � 4d 4. I - �G� row ° Applicant: 1 /' /�t' (/�i'KJ Te-l��t'eNo�.: Address: O 4/ A( 57 / , Vttt l ' Filed: . -A-/ "/fyou would like e-mail notification of sign o/f,please provide e-mail address: Owner Name: A/ 4' C5/�.0Gtny / Owner Address: fAAr AS ,tbd✓ -- 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. REVIEWED BY:A &Ole a DATE: 7•61— S k? PLEASE NOTE COM'/AeNC!1/1-10.2 4nice-rwy /tel- 74? 4rhegg4 . • ,.of.y; .. • TOWN OF YARMOUTHi 4c • WATER DEPARTMENT �r y 99 Buck Island Road 41 • WestYarmouth, MA02673 Telephone: (508) 771-7921 • Fax: (508) 771-7998 • • • BUILDING PERMIT APPLICATION . DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET Bldg. Site Location 60) /6crn E C6 pi✓ ;#: r. t Lot #: a S Proposed Improvement: ( 3 t 2 a_ /.5,c-') Applicant: p', - _ . • Address _ c 41$ :Y _R#:4,_ __ Date Filed: by _,r__/.E.-' • • Al:. U 9� ,SOFf 3�o fSU 5 ��t n kaatii>:1 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... Or igna'Jre of applicant Date 1! • PLEASE NOTE: COMMENTS: • • • U f .-L� / G�/S// / Reviewed by: Water Division .. Date NNN a o�•Y`tR Ili .. oTown of Yarmouth `. .. Conservation Commission ce,`"",'"` " " Building Permit Sign-off Application TO BE FILLED OUT BY APPLICANT: Building Site Location: j f.C.:]%— (//''t,c - 5/vv Map# Jam' q {jJ Lot(s)## 23 5 Property Owner: XII 011)-011)-€1,----e624j Applicant: Io"' yitz- Kmit)-/ Applicant Address: 07-11 allfi ,$)-7.- 2 Yr �2 Telephone:31` 1;4' --Jr"' Date Filed /Did ' ' Proposed Project De/3e / e/3ze/ / ,, 7" / Plans: Ppr-,Q4 PID 1 , 3P-I/12 TO BE FILLED OUT BY CONSERVATION ADMINISTRATOR: Do You Have A Valid Permit From The Conservation Commission For The Proposed Project? *\O Comments from Conservation Co.- sszon: Approved 'onditionally Approved Rejected All work related debris shall be taken offsite or disposed in a legal upland location At the end of each day,the area shall be clean and no debris shall be in the Resource Area Refer to: SE83- or DOA permit Conservation Commission Sign-off Signature:IMejL M& ., /'' 'i Date: 101)0)17 • .. Sews, Tim /0/51 cerlityteefir, ' `""' t From: Sears,Tim Sent: Monday, October 15, 2018 9:52 AM To: 'dijon55@hotmail.com' Subject: 21 Turtle Cove John, I have reviewed your application for 21 Turtle Cove Rd, and the addition of a bedroom requires updating smoke/co detectors. Please submit a floor plan with the smoke/co detectors marked to code. Thank you Timothy Sears CBO Building Inspector Town of Yarmouth 503-398-2231 Ext. 1259 mailto:tsears@yarmouth.ma.us • • 1 REScheck Software Version 4.6.2 Compliance Certificate Project Bedroom Addition 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: • 21 Turtle Cove Rd. John Mackenzie S.Yarmouth, MA 02664 248 Camp St. Unit L-1 W.Yarmouth,MA 02673 r.011lp d11 }�d 5_. 5 1/Mildicata 1 3r .n{�!''_x.. ..,j'so-x c L;3sl la:c' f Compliance: 0.0%Better Than Code Maximum UA: 39 Your UA: 39 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 ,.<< I ;arr r' i yi 5.;v Gra4 Atrwra : hR VIO I1C Cal, - attar :uA,l1A-value meeul ,Nr• ul tau Ceiling 1: Flat Ceiling or Scissor Truss - 220 38.0 0.0 0.030 7 Wall 1:Wood Frame, 16"o.c. 344 21.0 0.0 '0.057 18 Window 1:Vinyl/Fiberglass Frame:Double Pane with Low-E 23 0.300 7 Floor 1:All-Wood Joist/Truss:Over Unconditioned Space 220 30.0 0.0 0.033 7 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 4.6.2 and to comply with the mandatory requirements listed in the REScheck Inspection Checklist. Name-Title Signature Date Project Title: Bedroom Addition Report date: 10/10/18 Data filename: Untitled.rck Page 1 of 9 REScheck Software VersionChecklist 4.6.2 cm, is( Energy Code: 2015 IECC Requirements: 0.0% 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 'r: Value Complies? Comments/Assumptions 103.1, Construction drawings and ., '.❑Complies 103.2 'documentation demonstrate ❑Does Not [PR1]' energy code compliance for the ya ;building envelope.Thermal tg, d.❑Not Observable 'envelope represented on —Not Applicable 'construction documents. I. 103.1, Construction drawings and 1, ❑Complies 103.2, 'documentation demonstrate I : ❑Does Not 403.7 energy code compliance for (' ; �i [PR3]' lighting and mechanical systems. ]S r❑Not Observable 52• • 'Systems serving multiple ❑Not Applicable ;dwelling units must demonstrate 'compliance with the IECC 'Commercial Provisions. I 302.1, ':.Heating and cooling equipment is Heating: Heating: m w '.❑Complies 403.7 sized per ACCA Manual S based Btu/hr - Btu/hr ❑Does Not [PR2]' on loads calculated per ACCA Cooling: Cooling: db Manual J or other methods Btu/hr Btu/hr ❑Not Observable 'approved by the code official. !❑Not Applicable Additional Comments/Assumptions: 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: Bedroom Addition Report date: 10/10/18 Data filename: Untitled.rck Page 2 of 9 • . ,' , . .;.Section ;. # Foundation Inspection Complies? - Comments/Assumptions & Req.ID 303.2.1 9;A protective covering is installed to ❑Complies [FO11)2 : protect exposed exterior insulation ❑Does Not and extends a minimum of 6 in. below ❑Not Observable grade. ❑Not Applicable 403.9 . Snow-and ice-melting system controls'.❑Complies [FO12)2 ; installed. ODoes Not 4)J___ , . ; ❑Not Observable ❑Not Applicable Additional Comments/Assumptions: • 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: Bedroom Addition Report date: 10/10/18 Data filename: Untitled.rck Page 3 of 9 • Section PlansVerified Field Verified , # Framing/Rough-ln Inspection .Value - Value Complies? Comments/Assumptions & Req.ID , ;.. 402.1.1, Glazing U-factor(area-weighted U-_ U- i❑Complies ;See the Envelope Assemblies 402.3.1, average). ❑Does Not table for values. 402.3.3, 402.3.6, ❑Not Observable 1 402.5 i❑Not Applicable ! [FR21' , .5 I 303.1.3 U-factors of fenestration products',: ❑Complies [FR4]1 'are determined in accordance }❑Does Not ;with the NFRC test procedure or F i e` 43. ,taken from the default table. ❑Not Observable - ❑Not Applicable 402.4.1.1 'Air barrier and thermal barrier }.❑Complies [FR231' installed per manufacturer's ❑Does Not ;instructions. 1 H S ❑Not Observable ':❑NotApplicable 402.4.3 !Fenestration that is not site built ]` i❑Complies (FR20]1 is' listed and labeled as meeting i.. ODoes Not 64 AAMA/WDMA/CSA 101/1.5.2/A440 L or has infiltration rates per NFRC ❑Not Observable 400 that do not exceed code ' .`❑Not Applicable limits. _ �: . 402.4.5 ,IC-rated recessed lighting fixtures, f.❑Complies [FR16]2 sealed at housing/interior finish ,ODoes Not and labeled to indicate s2.0 cfm •. `❑Not Observable leakage at 75 Pa. 14: ' :❑Not Applicable 403.2.1 :Supply and return ducts in attics f • i:.❑Complies (FR12]1 :insulated >=R-8 where duct is ❑Does Not 44 >=3 inches in diameter and >= S' ❑Not Observable R-6 where < 3 inches.Supply and ii: return ducts in other portions of }❑Not Applicable the building insulated >= R-6 for i diameter>= 3 inches and R-4.2 for< 3 inches in diameter. [` 403.3.3.5 Building cavities are not used as +-: ❑Complies [FR15]3 :ducts or plenums. M1❑Does Not ❑Not Observable ❑Not Applicable 403.4 HVAC piping conveyingfluids R-_ R-_ :❑Complies [FR1712 r above 105 QF or chilled fluids ODoes Not below 55 QF are insulated to aR- ❑Not Observable 3. i - ❑Not Applicable 403.4.1 Protection of insulation on HVAC ": "❑DComespNlieost[FR2411 piping. 2.❑ Observablet . : �. ❑Not Applicable 403.5.3 t;Hot water pipes are insulated to R-_ R-_ ,❑Complies [FR18]2 -!'aR-3. ODoes Not • ❑Not Observable ❑Not Applicable 403.6 Automatic or gravity dampers area; ., y.❑Complies EF R1912 installed on all outdoor air ODoes Not +;intakes and exhausts. ` ❑Not Observable " ❑Not Applicable Additional Comments/Assumptions: 1 High Impact(Tier 1) -.2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: Bedroom Addition Report date: 10/10/18 Data filename: Untitled.rck Page 4 of 9 • •, . t - 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: Bedroom Addition Report date: 10/10/18 Data filename: Untitled.rck Page 5 of 9 • Section Plans Verified Field Verified • - fF Insulation Inspection '.Value "'Value Complies? Comments/Assumptions & Req.ID • 303.1 'All: installed insulation is labeled_ ❑Complies 11N1312 or the installed R-values ! ❑Does No[. provided. ...' '`❑Not Observable ONot Applicable 402.1.1, Floor insulation R-value. ' R- R- ❑Complies See the Envelope Assemblies 402.2.6 ❑ Wood 0 Wood ❑Does Not table for values. [IN111 0 Steel ❑ Steel(41 ❑Not Observable ONot Applicable 303.2, Floor insulation installed per1❑Complies 402.2.7 manufacturer's instructions and '❑Does Not (IN211 ' in substantial contact with the underside of the subfloor,or floor ONot Observable framing cavity insulation is in (- ONot Applicable contact with the top side of sheathing, or continuous , insulation is installed on the f: :underside of floor framing and P:: ;extends from the bottom to the r. �$ :top of all perimeter floor framing 'a members. I I" 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/of the F❑ Wood 0 Wood !❑Does Not table for values. 402.2.6 wall insulation on the wall ❑ Mass ❑ Mass ONot Observable (lN3]1 exterior,the exterior insulation ,t1 requirement applies(FR10). i 0 Steel 0 Steel ONot Applicable 303.2 Wall insulation is installed per i' :i❑Complies [IN411 manufacturer's instructions. f� ❑Does Not ONot Observable e '' ❑Not Applicable Additional Comments/Assumptions: • • . 1 High Impact(Tier 1) 2 !Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: Bedroom Addition Report date: 10/10/18 Data filename: Untitled.rck Page 6 of 9 Section: Pians Verified Field Verified • ` fF -. Final Inspection Provisions - Value Value Complies? Comments/Assumptions & Req.ID `. 402.1.1, Ceiling insulation R-value. R- R. ❑Complies 'See the Envelope Assemblies 402.2.1, 0 Wood i 0 Wood ❑Does Not table for values. 402.2.2, -0 Steel I 0 Steel ❑Not Observable 402.2.6 [Hi]1 DNot Applicable • 303.1.1.1, Ceiling insulation installed per 1' ' ' ❑Complies 303.2 manufacturers instructions. �( ODoes Not [FI2]1 Blown insulation marked every a.. 300 ft'. ,; ' ['Not Observable ❑Not Applicable j 402.2.3 Vented attics with air permeable -. i:❑Complies [F12212 "insulation include baffle adjacent 9,- ❑Does Not ; to soffit and eave vents that extends over insulation. ` is❑Not Observable :' 1.❑Not Applicable 402.2.4 Attic access hatch and door R-_ R- ❑Complies [F1311 insulation aR-value of the ODoes Not 'adjacent assembly. ❑Not Observable ❑Not Applicable 402.4.1.2 Blower door test @ 50 Pa.<=5 •! ACH 50 = ACH 50= OComplies [F11711 'ach in Climate Zones 1-2,and ODoes Not <=3 ach in Climate Zones 3-8. ❑Not Observable ❑Not Applicable 403.2.3 Duct tightness test result of<=4 cfm/100 cfm/100 ❑Complies [FI4]1 dm/100 ft2 across the system or ftp ['Does Not <=3 cfm/100 ft2 without air !❑Not Observable handler @ 25 Pa. For rough-in tests,verification may need to ❑Not Applicable occur during Framing Inspection. 403.3.2 Ducts are pressure tested tom/100 cfm/100 ❑Complies [F127]1 determine air leakage with ! j ft2 ODoes Not • either: Rough-in test:Total leakage measured with a ❑No[Observable pressure differential of 0.1 inch ❑Not Applicable w.g.across the system including the manufacturer's 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 [F124]1 by manufacturer at<=2%of `❑Does Not design air flow. �, r;❑Not Observable ="`1❑Not Applicable 403.1.1 is Programmable thermostats [ ;:❑Complies [FI9]2 ;installed for control of primary a; "❑Does Not ;heating and cooling systems and ;, ' ' initially set by manufacturer to ❑Not Observable $codespecifications. ! DNot, Applicable 403 1.2 ' Heat pump thermostat installed [I. [ ❑Complies [FI10]1 ;!on heat pumps. �; )❑Does Not ,� � ;:❑Not Observable ;; i ',❑Not Applicable 403.5.1 ",Circulating service hot water . ['Complies [F1ll]2 'systems have automatic or "❑Does Not 'accessible manual controls. • {❑Not Observable - ;❑NotApplicable • 1 High Impact(Tier 1) 2 . Medium Impact(Tier 2) -3=Low Impact(Tier 3) Project Title: Bedroom Addition Report date: 10/10/18 Data filename: Untitled.rck Page 7 of 9 Section - Plans Verified Field Verified io # Final Inspection Provisions Complies?, Comments/Assumptions • &Req.ID Value Value. 403.6.1 All mechanical ventilation system ❑Complies [112512 ,fans not part of tested and listed s.. ; : `•❑Does Not HVAC equipment meet efficacy g, .and airflow limits. ❑Not Observable f: '!.❑Not Applicable 403.2 'Hot water boilers supplying heat ❑Complies [1126)2 through one-or two-pipe heating {.: ❑Does Not systems have outdoor setback . control to lower boiler water ' �:❑Not Observable .temperature based on outdoor ❑Not Applicable temperature. 403.5.1.1 _Heated water circulation systems �'� ❑Complies [FI28]2 have a circulation pump.The 1�- ❑Does Not system return pipe is a dedicated return pipe ora cold water supply; :❑Not Observable pipe.Gravity and thermos- ,syphon circulation systems are hermos-;syphoncirculationsystemsare . not present.Controls for (; M circulating hot water system pumps start the pump with signal i=. ,;for hot water demand within the [" 'occupancy.Controls automatically turn off the pump :" ] " when water is in circulation loop is at set-point temperature and !; no demand for hot water exists. j.! 403.5.1.2 Electric heat trace systems ❑Complies [112912 'comply with IEEE 515.1 or UL . ❑Does Not 515.Controls automatically y.. ±❑Not Observable <adjust the energy input to the ) _ ,❑Not A licable heat tracing to maintain the desired water temperature in the 403.5.2 : Water distribution systems that ?: ❑Complies [113012 't,have recirculation pumps that ; ';❑Does Not pump water from a heated water :- ,.❑Not Observable supply pipe back to the heated f. ` ❑Not A licable 'water source through a cold water supply pipe have a ;demand recirculation water ',,system.Pumps have controls Ethat manage operation of the pump and limit the temperature .of the water entering the cold water piping to 104°F. 403.5.4 !Drain water heat recovery units ❑Complies [F13112 ;tested in accordance with CSAd❑Does Not B55.1.Potable water-side ,4pressure loss of drain water heat t. . ;.`❑Not Observable ,recovery units.c 3 psi for ;." '! s❑Not Applicable individual units connected to one [. ; or two showers. Potable water- %side pressure loss of drain water k, ;heat recovery units.c 2 psi for individual units connected to _, I three or more showers. 404.1 75%of lamps in permanent .. ❑Complies [11611 fixtures or 75%of permanent }{ . ''❑Does Not fixtures have high efficacy lamps. Does Observable Does not apply to low-voltage €.; lighting. ; , i' `❑Not Applicable 404.1.1 Fuel gas lighting systems have ❑Complies [FI2313 no continuous pilot light. ;❑Does Not #g �.❑NotObservable f , , ? ❑Not Applicable 1 High Impact(Tier 1) =.2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: Bedroom Addition Report date: 10/10/18 Data filename: Untitled.rck Page 8 of 9 • • • Sects°n Plans Verified Field Verified ° • ' # Final Inspection Provisions ..Value z Value Complies? CommentslAssumptions'I 401.3 Compliance certificate posted. ` ❑Complies [FI712 '. - +: ` ,I:❑Does Not c. '' � - ❑Not Observable .;❑Not Applicable 3033 Manufacturer manuals for t' ❑Complies [F118]3 mechanical and water heating 1, ❑Does Not systems have been provided. .'❑Not Observable ❑Not Applicable Additional Comments/Assumptions: • 1 High Impact(Tier 1) '2 'Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: Bedroom Addition Report date: 10/10/18 Data filename: Untitled.rck Page 9 of 9 2015 IECC Energy jEfficiency Certificate Above-Grade Wall 21.00 Below-Grade Wall 0.00 Floor 30.00 Ceiling / Roof 38.00 Ductwork (unconditioned spaces): Window 0.30 Door 1.4 pg lir 9 Es uipme t ,, £.,;,, Eftlderwc)( [ at ` r Heating System: Cooling System: Water Heater: -tri ..z, w- , si «,, #".` .ti_ Name: Date: Comments r . � '�- - I ,, TOWN OF YARMOUTH • — 1 L / � n REVIEWED FOR BUILDING AND ZONING CODE COMPLI- .4 • DA "w r`i i' (out. E • ANCE. ERRORS OR OM611SSIONS DO NOT RELIEVE THE APPLICANT FROM THE RESPONSIBILITY OF'AS BUILT' 51 Vetryvn-o l tiff COMPLIANCE. 7nDATE:16-)6•'/L.----- • ` /h,1(( S' � .Ianke y -r __ BUin1NG FI 70 3 -9F'q 71Fea) l':...t ep -94y � ' T1=!�, o?t MICHa E-Its._ ( y ,-..,,:l ...(_ 1 \._.1__,. `._. o gTRucTURAL m '..1.__:..1._L'' \` TJ_.... No 347740 '1 1 - ' _►_ _` .�\ 1.,.. a._ i. tcc--, \ ' . i teSSIoNne\ (V /47 l'A at .- • . 3. ll I q 7,746 . .i' 1I I1 c!! ' , I.% I_..r.�__ 1---r 1 I.L .1 s ' r f� I 1 f T t ,. ( 17 . ' 1 1 I ' ' L. r . 1_ IT 11 3 Ob ,• 1 . 1 1 FILE COPY •� :- A .,�( 1 , 1 11 • 1.... 1 +<.:‘,1/4L., r :..A�U� •41 v' CERTIFIED AS BUILT IS REQUIRED I . - N' _��d- � Ci - .-,� BEFORE FINAL INSPECTION -'/- 171 - I 1 ri'v N1 X (3 I , 1-0.---( -Wt ND icfrb L/w -- is 3 I-crvc,) , •• 1 0� � �< <PTty� c 7{ _ _ -I 1 ,- : , -_... A - 2- . • _ . • • . • ; ' • \is,,1/40F MAsk, . . . ail -IL I-' le- C e u Q.- rat- . ceMICHEI-E t 3 cunt() c!..1 5 sTRUG11.01,1- 0-, 1. 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I • Ic)akP� - k,i 6---\-a.../ -1o1 -R ?:`11 9 (3 � . ... 1• ! • • . 1• (..,165e.4 CloS ...- Pi \,,'/1 tfr...r..Dr \..._.______._,c.._.. ;- \ ; 11 ors.,.., ..__,, ,,,,,_, , , ;, 1,.....ii.. gl 11 r , . . . , 2.. tx. . i _ii__ Y_1.3 t, �� —i Sun rnowt • l�X - _ 1.20 Cts C,tb r __ • — ; . - Sys , . , . 1 E y n -. _.- - _ * LT • /21 TURTLE COVE ROAD , L-11495' Iv LOT 5 O1. 18,847.7 th SF. o N i �. e I/ 216, '1, PROPOSED EMSIINC OMELLMC ® . 21 ® . 3X17 ADO/770A1 i. 254 I D., $ ...L. - , . P1&0 1 N / . y& t8 OBIN '0LLIAM m'- Yar oath Health Department o WILCOX y . 1�� APPROVED .� No. 3134 e �� �F�7 41 1 ��� • L t-11 A -r7# \se --\--- ---- Name Date , sTE cis LAN'). — •— TO THE BEST OF MY INFORMATION, "PROPOSED" PLOT PLAN KNOWLEDGE, AND BELIEF THE SOUTH YARMOUTH, MASS. STRUCTURES SHOWN ON THIS PLAN LOT 5, LC. PL 21531_A HAS BEEN LOCATED ON THE GROUND DATE 8/4/18 SCALE 1" = 30' AS INDICATED. / JOB 8060-00 CLIENT MACKENZIE 8/20/18X 7 /�- SWEETSER ENGINEERING 203 SETUCKET ROAD DATE PROFESSIONAL LAND SURVEYOR PO BOX 713 SOUTH DENNIS, MA 02660 OFF. 508-385-6900 FAX. 508-385-6991 C: 1 S8 I PROJ 18060-00 I dwg I 8060-PPP1.DWG 0 2018 SWEETSER ENGINEERING