HomeMy WebLinkAboutBLD-19-001257 ONE &TWO FAMILY ONLY-BUILDING PERMIT /�U /i/� /kms
Town of Yarmouth Building Department oi -i
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,uct,Repair, Renovate Or Demolish
a One-or Two-Family Dwelling
This Section For Official Use Only ('
Building Permit NuuibercftD—/`- tr0 a6 . Date Applied: • • -=arO: -f 1
. NOV 2018 1
Building Official(PrintName) ^"a , � n0i ii.grigUN
. . SECTION 1:SlIE INFORMATION. . . I By .--.:-..r...--a- _ ._-_-_ -
1.11Proa ia-oibAddress• 1� segs rs„141ap&ParcelNux ersgaft
1.1a Ls this an cepted street?yes ., no Map Num er Parcel Number
13 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
15 Building Setbacks(ft)
Front Yard - Side Yards Rear Yard
Required I Provided Required Provided Required Provided
122 e/..6 20 -
1.6 Wa er Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Publi Private❑ Zone: _ Outside F1eod;one? Mit icipel❑ On site disposal system '[e
Check if yes
SECTION 21 PROPERTY OWNERSBIP` .. '
lN1 Ong'of Record;
UC ame 2kakCa MAI 1dinv t4(hb, MA 02.61S- .
ry.li- Ou) A-Nk ,vind •
*ripsinicim . „ I .i 4 • _ .;.e' • on'i
No.and Street Telephone Frnail Address
SECTION 3:.DESCRIPTION OF!ROPOSEI)`V-QRK2(check all that apply) -
New Construction❑ I Existing Building❑ Owner-Occupied ❑ 1Repairs(s) ❑ Aitera:.., .- 1 ad,•:on ❑
Demolition ❑ Accessory Bide. Y. Number of Units Odle ;et u. 1 `
Brief Description of ProposedWorl?: k all,I �i�,� `1,�
i 1 /
VP_ a _lea'7�k uS7 61 tryAR
. 1 P
SECTION 4 ESTIMATED CONSTRUC I1ON .p:r" .
Item Est mated Costs: I3fncia13T5e Onl '
(Labor and Materials) - y. , , .
1.Buildino $ -(J iv"' :I.Building PeimitFee:aO. Indicatehow feeisdetermined:
2.Electrical g t "' eStand rd CityfTown 4 phcanon Pet :
❑.TotalProlectcosi'(It 6)xmultiplier... : :
3.Plumbing $ �f 2. Other:Fees: S �
4.Mechanical (HVAC) I $ d( � . ' i
S.Mechanical (Fire Y� k_,,, .r. :._ '.:L, ..
Suppression) $ tk total All Fees:$ . .• . . `
u ,�7� CheckNo:• . Check Anoutic Cash:Amount '
6.Total Project Cost $ Lin pPaid inFull . ` kOt ding Balance Due: Sia
_„ . - SECTION 5:.CONSTRUCTION SERVICES .
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
City/Town,State,Z1P R Restricted 1 ea Family Dwelling
M Masonry
•
RC Roofing Covering -
WS Window and Siding •
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition.
5.2 Registered Home Improvement Contractor(HIC)
•BIC Company Name or BM Registrant Name Hie Registration Number Expiration Date
No.and Street
Email address
City/Town,State,ZIP Telephone
SECTION 6:WORKERS' COMPENSATION 1NNUEANCE AFFIDAVIT(IYI.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 COMPLE i D WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT ..
I,as Owner of the subject property,hereby atmhorize
to act on my behalf,in all matters relative to work authorized by this bolding permit application
•
Paint Owner's Name(Electronic Simaaatre) Date
- • SECTION 7b: OWNER':OR Au imORIZEI)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 application is true and accurate to the best of my knowledge and understanding.
`le
i
Print •er's or • i ooze Azent's Name(acetonic Sinatra) • Date
• NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an>mreo stered contractor
(not redstered in the Home Improvement Contractor(BIC)Promam),will not have access to the arbitration
program or guaranty find tinder M.G.L.c. 142A.Other important information on the BIC Program can be found at
www.mass.zov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dns
2. When substantial work is planned,provide the information below:
Total floor area(sq.R) (including garage,finished basement/atacs,decks or porch) •
Gross living area(sq.ft) Habitable room cotmt
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"
- s. -•'Y•'•••• ••• ..J .•uau suaa. tlfcctnentS
`- —tiny_ 1 Congress Street,Suite 100 - •
•
tag a, Boston, MA 02114-2017
'-*Cr" www.Massoov/ilia
Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMrITING AUTHORITY.
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): I'3
1(j W V!v11_\ kir t l�I
�
Address: 11' 61.6 Atc
City/State/Zip: #: , -`f i- ; 1)
Are you an employer?Ckec a approp 'ate box: ` -
Type of project(required):
l.❑lam a employer with employees(full and/or part-time).*
7. IS1-14 w construction
•
10 I am a sole proprietor or partnership and have no employees working for me in
any caparity.[No workers'comp.insurance required.] 8. ❑Remodeling
341 am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition
4.9 I am a homeowner and will he hiring contractors to conduct all work an my property. 1 will 10 9 Building addition
ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions
proprietors with no employees.
s. [am a general con
12.D Plumbing repairs or additions
❑ tactor and I have hired the sub-contractors listed on the attached sheet
These sub-contactors have employees aid have workers'comp.insurance.t 13.El Roof repairs
6.9 We are a corporation and its officers have exercised their right of exemption per MGL a 14.9 Other
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
*Any applicant that checla box k 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 cortt-actars must submit a new affidavit indicating such.
tCantracmrs that check this box must attached an additional sheet showing the name at the sub-contractors and state whether or oat 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
Insurance Company Name:
Policy m or Self-ins.LiceM: 'lap .WAY) •4- (on(oqibLl
Expiration Date: ,; • ICI
II—
Job Site Address: V l ir) 1f"11(I( S City/State/Zip: 1 . AU LIAttach a copy of the workers' compensa ' n policy declaration page(showing the policy n.,. er an exp' tion 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.
Ido hereby certify under the pains andpenalizes of perjury that the information provided above is true and correct
—4- —.as.
Signature: rip M Date: %r s- lis
Phone T: -/ 7% - -1_ 2 it
Official use only. Do not write in this area, to be completed by city or town officiaL
•
City or Town: Permit/License 2
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 1.Electrical Inspector 5.Plumbing Inspector
6:.Other
Contact Person: Phone
y • $ 1=� 1 V •Y l\ Vl' 1 L11V J.1\ Y1V 1
o �,: . � BUILDING DEPARTMENT
s3 m_4' 1146 Route 28,South Yarmouth,MA 02664 S08-398-2231 ext. 1261
•
• HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
•
DATE: •((
JOB LOCATION: 141(, 140 00441y.(NA108 ' V��►1S i j1�
NAIND STREET ADDRESS SECI1ON OF TOWN
"HOMEOWNER" g1(tgI tiaa Rs4V-• 51YJ SDfs•2.A4- ZVZ)
NAME HOME PHONE WORK PHONE
PRESENT MAILING ADDRESS
&ID b(ftY t6 J D2Web
CITY OR TOWN STATE DP 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:
Persons)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 buildina.permit. (Section 110 R5.1.3.1)
The undersigned `homeowner' assumes responsibility for compliance with the Stare 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 Ot±ICIAL
INSURANCE COVERAGE:
I have a current 'ability insurance policy or its substantial equivalent, which meets the requirements of MGL
Ch.142. IC No
If you have checked ves, 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 sig nature on this permit applicator'waives this requirement.
Check one:
Sionatnn of Owner or Owner's Agent Owner Agent
I hoseownricecemp
• inxutlullaLion anti instriCLIOIIS
r' 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,§25C(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 is 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 contacting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checldn_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 Accident. 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 bantam
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 ramped 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 td any business or commercial venture
(i.e.a dog license or permit to burn 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, M.A02114-2017
Tel. r 617-727-4900 ext. 7406 or 1-877-MMASSAFE
Fax t 617-727-7749
Revised 02-23-15 www.mass.govidia
c�C BUILDING DEPARTMENT
1146 Route 28,South Yarmouth,MA 02664
^' cs, • s, 508-398-2231 ext. 1261 Fax 508-398-0836
•
•
BUILDING DEPARTMENT
DEMOLITION DEBRIS DISPOSAL AFFIDAVIT
Pursuant to MEL Chapter 40, Section 54 and 780 CMR, Chapter. 1, Section 1115,
I hereby certify that the debris resulting from the proposed work/demolition to be
1111 ` 1
conducted at 1-O Ihl. a Nit 4_A 11
Work ; ddress IP
Is to be disposed of at the following location: Oil 'IC en ^"`} I MA
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
Signature of Application Date
Permit No.
Sears, Tim
From: Sears,Tim
Sent Thursday,August 30, 2018 3:51 PM
To: 'nmitchlandscape@comcast.net'
Subject: 77 Old Hyannis Rd
Nick,
I have reviewed you're your application for the barn/garage at 77 Old Hyannis Rd,and the Town of Yarmouth Zoning
Bylaws require a special permit from the Board of Appeals for storage of more than 3 vehicles.
If you have any questions please call.
Thank you
Timothy Sears CBO
Building Inspector
Town of Yarmouth
508-398-2231 Ext. 1259
mailto:tsears@varmouth.ma.us
1
•
RECEIVED
LAW OFFICES OF
PAUL R. TARDIF, ESQ., P.C. NOV 08 2018
490 MAIN STREET BUILDING DEPARTMENT
9Y:
-
YARMOUTH PORT,MA 02675
(508)362-7799 (508)362-7199 fax
Paul B. Tardif,Esq. Melissa G.Macleod,Esq.
ptarclif@tardiflaw.com www.tardiflaw.com mdissa(o)tardiflaw.com
REFER TO FILE NO.
November 7,2018
Sandra Clark
Yarmouth Zoning Board of Appeals
1146 Route 28
South Yarmouth,MA 02664
RE: Zoning Appeal—77 Old Hyannis Road, Yarmouth Port
Nicholas G. Mitchell III and Heather S. Mitchell -Petition#4761
Dear Ms. Clark:
Enclosed please find a copy of the Board of Appeals Decision, which was recorded, for
the above referenced matter on November 6,2018 in the Barnstable County Registry of Deeds in
Book 31648, Page 217. Please note that a copy of the recorded Decision has been forwarded to
. the Building Department for their records. I thank you for your assistance in this matter.
V- y I ly Yours,
i '
aul R. ' ardif
cc: Nicholas and Heather Mitchell
•
Mark Grylls,Building Department
Bic 31648 P9217 :55422
11-06-2018 a 03 : 220
r� jl} O TOWN OF YARMOUTH
• C BOARD OF APPEALS
i
0 ' _ ^; DECISION
•
_ . :
FILED WITH TOWN CLERK: October 15,2018
PETITION NO: 4761
HEARING DATE: September 13,2018
PETITIONER: Nicholas G.Mitchell IH and Heather S.Mitchell
PROPERTY: 77 Old Hyannis Road,Yarmouth Port,MA
Map & lot:#0094.1.2; Zoning District: R-40
Book& Page: 28086/238
MEMBERS PRESENT AND VOTING: Chairman Sean Igoe,Richard Martin,Richard Neitz,
Thomas Nickinello and Tom Baron
Notice of the hearing has been given by sending notice thereof to the Petitioner and all those owners
of property as required by law, and to the public by posting notice of the hearing and publishing in
The Register,the hearing opened and held on the date stated above.
The Petitioner seeks a Special Permit pursuant to Zoning Bylaw §202.5 of the Bylaw. The Property
is located in the R-40 Zoning District and is improved with a two story single family structure
having 4 bedrooms and 3.5 baths, and constructed in approximately 2003. The lot consists of
40,023 square feet, and has 140 feet of frontage on Old Hyannis Road. The house was originally
constructed with an attached 2 car garage. In 2015, a third garage bay was added to the end of
the second bay, creating garage space for or storage of more than three (3) vehicles. The
structures on the property all comply with the setbacks and other bulk requirements.
The proposal is to construct a 42 foot by 30 foot detached barn on the property, which will
contain one garage door, and which will be capable of storage of an additional vehicle on the
property. The structure itself is allowed by right as it will comply with all setbacks. The
building coverage for the property will increase to 13.3%. No living space is planned for this
new barn,but will be for storage only.
The Board was satisfied and agreed that the lot was of sufficient size so that the barn would be
hardly visible from the road, and the addition of more interior storage space would be a benefit to
the alternative of storing items in the elements, and where abutters can see them. The Board was
in unanimous agreement that the additional garage space would not be substantially more
detrimental to the neighborhood, zoning district, or Town, than the existing non-conforming
structure.
y
Accordingly, a Motion was made by Mr. Martin, seconded by Mr. Neitz, to grant the Special
Permit, as requested,with the condition that no habitable space may be made of the second floor
of the new barn. The members voted unanimously in favor of the Motion.
No permit shall issue until 20 days from the filing of this decision with the Town Clerk. Appeals
from this decision shall be made pursuant to MGL c40A section 17 and must be filed within 20
days after filing of this notice/decision with the Town Clerk. Unless otherwise provided herein,
the Special Permit shall lapse if a substantial use thereof has not begun within 24 months. (See
bylaw§103.2.5,MGL c40A§9)
•• goe,Chairman
J
.
o,- COMMONWEALTH OF MASSACHUSETTS
... -.7
;_ G TOWN OF YARMOUTH
$ )1C BOARD OF APPEALS
IlL
5 [[
• 4�',.cNE%"
O®f
Appeal#4761 Date: November 5,2018
Certificate of Granting of a Special Permit
(General Laws Chapter 40A, section 11)
The Board of Appeals of the Town of Yarmouth Massachusetts hereby certifies that a Special
Permit has been granted to:
Nicholas G.Mitchell HI and Heather S.Mitchell
77 Old Hyannis Road
YarmouthPort,MA 02675
Affecting the rights of the owner with respect to land or buildings at: 77 Old Hyannis Road,
YarmouthPort, MA Zoning District: R-40; Map & Lot#: 0094.1.2; Book/Page: 28086/238 and
the said Board of Appeals further certifies that the decision attached hereto is a true and correct
copy of its decision granting said Special Permit, and copies of said decision, and of all plans
referred to in the decision,have been filed.
The Board of Appeals also calls to the attention of the owner or applicant that General Laws,
Chapter 40A, Section 11 (last paragraph)and Section 13,provides that no Special Permit, or any
extension,modification or renewal thereof, shall take effect until a copy of the decision bearing
the certification of the Town Clerk that twenty(20)days have elapsed after the decision has been
filed in the office of the Town Clerk and no appeal has been filed or that,if such appeal has been
filed,that it has been dismissed or denied,is recorded in the Registry of Deeds for the county and
district in which the land is located and indexed in the grantor index under the name of the owner
of record or is recorded and noted on the owner's certificate of title. The fee for such recording
or registerin s all be paid by the owner or applicant.
i
i �
S-•. Igoe,Ch.,. ii an
•
'suF I. TOWN OF YARMOUTH
•• : .. ,�i •.2 Town
tE� • 1146 ROUTE 28, SOUTH YARMOUTH,MASSACHUSETTS 02664-4451 Clerk
Telephone(508)398-2231 Ext. 1285,Fax(508)398-0836
CERTIFICATION OF TOWN CLERK
I, Philip B. Gaudet, III, Town Clerk, Town of Yarmouth, do hereby certify that 20 days have
elapsed since the filing with me of the above Board of Appeals Decision #4761 that no notice of
appeal of said decision has been filed with me, or, if such appeal has been filed it has been
dismissed or denied. All appeals have been exhausted.
I Y( gg ! T
G /
J r�7w '1 t
•
wJ
1 Soto"
. ,,, ) i . K.',a' s
: moi n0 e
BARNSTABLE REGISTRY OF DEEDS
Jahn F. Meade, Register
Insured Copy Page 1
FEDERATED FEDERATED
s aqu INSURANCE55060
COMPANY
121 EPSquare, MN
INSURANCE7' (507)455-5200
WORKERS COMPENSATION AND EMPLOYER'S LIABILITY INSURANCE POLICY
INFORMATION PAGE
MUTUAL COMPANY PARTICIPATING NONASSESSABLE POLICY NEW
Phone:800-533-0472 NCCI Carrier Code: 16446 Policy No. 6069104
Prior Policy No.
Producer/Agent: BRIAN J ANDERSEN Account No. 160-448-7
ITEM 1. NAMED INSURED AND ADDRESS:
MITCHELL LANDSCAPING LLC Entity Type Limited Liability Co.
'NICHOLAS MITCHELL DBA FEIN 82-4664294
PO BOX 2120
SOUTH DENNIS MA 02660
See Extension of Information Page "Named Insured"
Other workplaces not shown above:See Extension of Information Page "Other Workplaces of the Insured"
ITEM 2.POLICY PERIOD: The policy period is from 04-07-2018 to 04-07-2019 12:01 A.M. Standard time, at the
insured's mailing address.
ITEM 3.COVERAGE:
A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers Compensation law
of the states listed here: MA
B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in Item 3.A.
The limits of our liability under Pad Two are:Bodily Injury by Accident $500,000 each accident
Bodily Injury by Disease $500,000 policy limit
Bodily Injury by Disease $500,000 each employee
C. OTHER STATES INSURANCE: Part Three of the policy applies to states, if any, listed here: All states
except states designated in Item 3.A. and ND OH WA WY
D. ENDORSEMENTS: This policy includes these endorsements and schedules: See Extension of Information
Page "List of Endorsements"
ITEM 4. PREMIUM: The premium for this policy will be determined by our Manual of Rules, Classifications, Rates, and
Rating Plans. All information required below is subject to verification and change by audit to be made
ANNUALLY.
Prem.Basis Rate Estimated
Loc. Name Code Est.Total Per$100 Annual
No. No. No. Classification of Operations Ann.Remun. Remun. Premium
See Extension of Information Page "Schedule of Operations"
Minimum Premium Total Estimated Annual Premium $13,830
$372 Total State Surcharges $620
Total Estimated Cost $14,450
Deposit Amount $14,450
c
his policy consists of: (1)this Information Page; and (2)the Workers Compensation and Employers Liability Insurance
Policy(the WC-F-5).
WC 00 00 01 A (04-92)
WC-F-1 A (03-17) Issue Date: 04-12-2018
Insured Copy
FEDERATED FEDERATED MUTUAL INSURANCE COMPANY
INSURANCE'" 121 East Park Square, Owatonna, MN 55060
(507)455-5200
DECLARATIONS
COMMERCIAL GENERAL LIABILITY COVERAGE PART
LIMITS OF INSURANCE Umit
GENERAL AGGREGATE LIMIT(Other than Products-Completed Operations) $2,000,000
PRODUCTS-COMPLETED OPERATIONS AGGREGATE LIMIT 52,000 ,000
PERSONAL & ADVERTISING INJURY LIMIT S1 ,000,000
EACH OCCURRENCE LIMIT S1 ,000 ,000
DAMAGE TO PREMISES RENTED TO YOU LIMIT Any one premises S100,000
MEDICAL EXPENSE LIMIT Any one person EXCLUDED
Refer to General Liability Schedule CG-F-8 for Locations and Classifications.
ENDORSEMENTS APPLICABLE
"'See Schedule Attached"'
This Coverage Part consists of: (1) this Coverage Part Declarations Page; (2) the Schedule of Forms and
Endorsements if attached hereto; (3) all forms and endorsements listed on this Coverage Part Declarations Page
or, ii attached here,the Schedule of Forms and Endorsements; and (4) any other schedules attached hereto.
Includes copyrighted material of Insurance Services office. Inc., with its permission.
CG-F-1 (01-17) Policy Number. 6069103 Effective Date:04-07-2018
•
ortkit- TOWN OF YARMOUTH
}� � � , WATER DEPARTMENT
c1 y 99 Buck Island Road
z4. West Yarmouth, MA 02673
Telephone: (508) 771-7921 Fax: (508) 771-7998
BUILDING PERMIT APPLICATION
DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET
Bldg. Site Location 77 p (c'( IrkinAif 94 Map #: Lot #:
•
Proposed Improvement: iVzV ec,fiV
Applicant: (Mt__ Qtti}ztee.-f
Address $.-mac— Tel. #: Sur R2,-—S71 f Date Filed: 41112-0er
•
RESIDENTIAL AND / OR COMMERCIAL BUILDING
Water Department: Determines Compliance of Water Availability and or Existing Location
Engineering Department: Determines Compliance for Parking and Drainage
Conservation Commission: Determines Compliance to Wetlands Acts; i.e. If Lot(s) Border any Type of
Wetlands, Streams, Ponds, Rivers, Ocean, Bogs, Bays, Marshland, Etc...
Health Department: Determines Compliance to State and Town Regulations, i.e., Requirements
for Septage Disposal and other Public Health Activities
Fire Department: Determines Compliance to State and Town Requirements for Personal,
Safety, Property Protection;, i.e. Smoke Detectors, Sprinkler Systems, Etc...
Signature of applicant Date
PLEASE NOTE:
COMMENTS:
cad 1 ; ad /,
Reviewe• by: Water 1 4 •n D-to
a
ofgk, TOWN OF YARMOUTH
2:Fi? rQ
or.;y -�c HEALTH DEPARTMENT
cttt-t�$ PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: 77 Oak Rd Yc.Mz,flf„C
Proposed Improvement: w Or..00 30t.x !—
Applicant:
Applicant: NcL[ ittOrkta Tel.No.: r --'777—S7n'
Address: rc.-.G Date Filed:T 9
"Ifyou would like e-mail notification of sign off please provide e-mail address:
Owner Name: /IJI & t{
Owner Address: cc,.."-C_ Owner Tel.No.: 54-wt-C._
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: AAA7'
DATE: /& 8
PLEASE NOTE
COMMENTS/CONDITIONS:
rk—i\C ?
cSti
t
.k .. .3> _3_ _ .
i ,
1211Lrifeu:di
II
C 0 lli4
g iii
%�' i..recroo; , j\1fl own^ R 1 L C S
�1 / pq Y�
CAM
ASSESSORS 1W 94 PARCEL 1.2
1 .51
-I �1 �- i LOCUS C Ina MIA Hdl ZONE S
?IVT21 �t
�� / - naMw nPAr¢ 001102maOWMER OF RECORDtrOL 5L%ELL a.IEAADER S.ALIwrLLYMnWniYMr.MA.01515why REFERENCES i a : ` - RMN Keg Sm P.PAGE AM 74 H` ZONHO SUMMARY
C' 1 I zuo m,acR w Smwcr
ill,‘
1ST ' I n�iL LOT g¢ w.0a0 v.
1 PR • I �' MI.Lm REMADE so'
1 I aP' FRwt sISAa.
1 I
DRIVE I 1 ,RL SCC
SETBACK N
Ja .c e�wa5 COVERAGE SMACK m (PROPOSED•m
•'' ll._ ea.-u5xq
•
s art a LOOMED.n.,MIAMI
__ ser9u+ 7 P.PoRsnw*WY orsrper
L — --- a"— SITE PLAN
or
+ s .—.q/`nm i #77 OLD HYANNIS ROAD
I _ YARMOUTHPORT, IAA
PRWRED FOR
NICK MITCHELL
_- t 1 I
Out.n IA.Saul
RAM W M Iwo Dams MQ
_LC, - w.cope toginetimix
clod) angin..As
lanSm.r_>p ¢ty-IS A 4. V^ and.A Senn(«MCV
�a n wa DML A.OMA PC Pu nl
OCA frrsrs ""
WORK MUST INFIRM TO ALL
RECEIVED TOWN BYLA if &'REGULATIQNS
AUG 2 9 2018 "
�� �
YARMOUT ATER DEPT DAT
HEALTH DEPT.
bv:►dy,ty
• /Y" 1b TOWN OF YARMOUTH
y >i 1146 ROUTE 28,SOUTH YARMOUTH,MA 02664-4451 'REC���E®
Telephone(508)398-2231 Ext. 1292-Fax(508)398-0836
OLD KING'S HIGHWAY HISTORIC DISTRICT COMMITT E AUG — 7 2018
APPLICATION FOR OLD KINGSHIGHWgy
moni
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 4 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: 1ct.CSIOM tiVre 450XV1'
2) Exterior Painting: Siding _Shutters V Doors t/ Trim Other:
3)Signs/Billboards: _New Sign _Change to Existing Sign
4)Miscellaneous Structures: _Fence Wall Flagpole Pool _Other.
Please type or print legibly: (y� `.'f,�
Address of proposed work: I 1 Olt) 1& 111`S , (2 1 Map/Lot# '`�
Owner(s): N1c,tc,v 4i Q. &WV (Ikt'i(�I , Phone#: O1' `1'
All applications must be submitted
by owner or accompanied by lett from owner approving submittal of application.plication.
Mailing address: Y•b&Fo' /IWV 1S1 1A V Year built: oo5
Email: rw (killavviSaketeC )L AL1'
Preferred notification method: Phone V Email
Agent/contractor: e'tyStkat Phone#:
Mailing Address:
Email: Preferred notification method: Phone Email
Description of Proposed Work_ 91, 'r Q qt f- _ f o-v' h ARA a is S„_h t o-
Signed(Owner or agent): Date: "A/W—
>
A/W -> 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.
> 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 subject to inspection by OKH.OKH-approved plans MUST be available on-site for framing&final inspections.
For Committee use only: I/Approved _Approved with_Modifications _Denied
Rcvd Date: �/7//ft' Reason for Denial:
Amount chi J
Cash
CK#: /..5-2/5 Rcvd by: 4-V
Signed: Ilk
•
-17
45 Days: S(
r
U7�J P
Date Signed: WZ 7/2-611 1' / •
03/2ola 1 APPLICATION#: 1 8 - A 0 8 6
RECEIVED
RECEIVED APPROVED AUG — 7 2018
. AUG 2 8 2018 AUG 2 7 2018 YAKMOUTH
OLD KING'S HIGHWAY
rte . Tr+fticlOUTI I
SOUTH YARMOUTH, MA OLD KING'S HIGHWAY
C g
���
„ 1 g
Whigill
�° - • ,�--" 1 LOCUS x`
LI — ,. • ----CC..\‘'c'-- I 11 /a
a,\ ^? q N8791'3YE 1 Taman /,
ads
di lihr 194.06 714
. ) I
r1% :';;;;<//'iI 0<47.7 ), I
t P I ',,,,,,,://,,,
' /' 1 EwsnNc 1163 41
"(0) LOCUS MAP
If
e' � A , j i on Z I HOT SCALE
e m I 1 ��',� %:� �. I I ^ ' 1$ 9. LO
ASSESSORS MAP 94 PARCEL 1.2
s9 . , III / O LOCUS IS WITHIN FEMA FLOOD ZONE K
-, •'-;f /4p I 4' V Q (AREA OF MINIMAL FLOOD HAZARD) AS
'8 ) �— . SHOWN ON COMMUNITY PANEL i25001C0559J
1 1 a. TING / I I F: C ry DATED 7/18/2014
SEPT ',; O4 I I C J
1 IS A '' k (C'. c° 0 OWNER OF RECORD
I 57 �/ ai " I m NICHOLAS G. MITCHELL III & HEATHER S. MITCHELL
• C 77 OLD HYANNIS ROAD
• I
,tel / ,(��GG , 1 1 • F YARMOUTHPORT. MA 02875
^'+'III
1 1/ C��AS�1 i / REFERENCES
Iir I I OT 7A I ) n O DEED BOOK 28088 PAGE 238
NOIOLAI G.NITCHDA 11 t / • I 5
NEAIHER s MRtlE11 1 1' �" :4 PLAN BOON 58S PAGE 74
1
0022085P0.238 !
1 Fre 525 Pa 74 t 84 1 C. ZONING SUMMARY
II
I I ZONING DISTRICT: R-40 DISTRICT
\ j 13TW I 4. MIN. LOT SIZE 40.000 S.F.
J\ 1 IPAVEt LBn. LOT FRONTAGE 150'
DRNE ,t MIN. FRONT SETBACK 30'
I MIN. SIDE SETBACK 2d,} p1ry ,/ . Tv� lMIN. REAR SETBACK 2d°�J�/) ,i � ,15 MAX BUKDSE COVERAGE 2576 BARN X 13.`• ildiss
` 2YWif SITE IS LOCATD WITHIN AWIFER
et'
PROTECTION OVERLAY DISTRIC •
T
sitnappir
' — WATER EA5D6MSITE PLAN
1 -- ---------
of
}---• � #77 OLD HYANNIS ROAD
Ir'� �� _ _ �_ _ v — YARMOUTHPORT, MA
r ' ^ �~ FOR
NICK PREPARED
TCHELL
i
I • DATE: MAY 14. 2018
DATE MAY 24. 2018 (MOW BARN)
p� OANIEI A�:IN M'508-362-4541
tl3 m.508-382-9880
./4010:01, CML a eooncopo0ont 0
w,,, ewe ape ti ffkwial,Tae.
•V civil engineers
Scale:IN 20' 5 Ly-18 1 >�C land surveyors
- - - 1/ 939 MoM Street (RN 6A)
DCE N 14-315 0 m 20 30 40 50 nit DATE DANIEL A. OJALA. P.E. P.LS. YARMOU7NPORT MA 02675
1 8 — AO 86
RECEIVED ' APPROVED
RECEIVE®
AUG 27 2018 AUG - 7 2018
AUG 8 2(]18 YAMIVIUU fH
TOWN YARMOUTH OLD KING'S HIGHWAY
BUJIt-iYARMCOU H, MA OLD KINO'3IItOtIWAY ites.,Vter
j -r-��-- --- _ I j).„,,, Loan
I 1 m
,� el N87U7'3YEI . . , r_ Raia g
�� 194.06' J
llk
Sili - �i -�'�- g 1 ` a .
1451 el - ---- 3 1 , IpIS;
)))t
•
`�
I a, i I ,.•,4! ..—:( a w i POOL c n'! "`Oi < LOCUS MAP
POOL . 1
l'/��i„'�/� 1 a AssEssaas MAP 94 PARCEL 1.2
11_.%