HomeMy WebLinkAboutBLD-19-3444 . r
• -.de.YgR BUILDING PERMIT APPLICATION
2 S APPUCATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE,OCCUPANCY OF,
• C _y OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING.
s^ c _ Town of Yarmouth Building Department
`�, ^� 1146 Route 28 • Yarmouth, NIA 026644492
Tel: 508-398-2231 ext. 1261 Fax 508-398-0836 _
'/� Office Use Only Planning Board Information Assessors Department Information:
Pe crl2. V9- 0b3v,ove_ Plan Type Map W •
Permit Fee $ it Sti Endorsement Date /7 / 3
Recording Date New
Deposit Recd. $ 356.14013_ plan No. 1.4 Property Dimensions:
Net Due $ ISA Other Lot Area(V) Frontage(ft) Lot Coverage
This Section for Ortice Use Only .
Building Permit Number. / Data Issued
Signature: -G _i oke/7 / , Certificate of Occupancy
Building Official Date is Is not . I •
Section 1 - Site Information ft E C,_tr v .- •
1.1 Property Address: 1.2 Zoning Information: 2018
/O 5$/are �/: DEC 17
S. ?cit./ex-to-4,e/L1 /U/4 d0E6V Zoning District 11Proil vResuegriIUSEfME T
l
1.3 Building Setbacks(ft) ' BY ----- ---- —
Front Yard Side Yards
Required Provided Required Provided _.urs71"' lrlICI7�
1A Water Supply(MAA-c.40.S 54) 1.5 Rood Zone Information: .n DEC 0 R 2018
Public Private Zone: BFE: /r
Section 2- Property Ownership/Authorized Agent Bu DI ' D-PARTMENTT
2.1 Owner of Record:
.list;, S.n4 }e\d %6S •5% otcDr�. 5. d(Mou u : OA.
VName •nt) J Mailing Address:
r •
Sob $44- 8g3.9 So; Sai-A-9g3a vskol d 0ne4ma t • corn
Sig atur Telephone Telephone Email Address:
22.2 uthorized Agent:
LOticsil -24 eeitscLuoiro,/ 1 /3-9 no,--2.-7.- S S. tvi.,.
Name(pd. Mailing Address:
Sr5 7oV02y Kf PLrj,cr j
Signatur- Telephone Fax Email Address: • Ric
v
Section 3 -Construction Services I Gear
3.1�/Li Licensed Constm55tion Supee InnNot Applicable 3
j rneC7201. -2AlZr . eele_C eff-av
/�� CeVAtin. S &88#e 6,26,5, License r
Address
- —� j,(j
'P4009 A ( is.snicj X ( Expiration Date
�
Signature Telephone Email Addre$9 ..X* . /7.
a.
.
•
3.2 Registered Home Improvement Contractor. `
coma H NNotAppl'cabie ❑ •
r •
4`
c �/re 2-04,57a-u 4r��;4.5aG ,
../ Registration Number �� .
s / / �
Q y oJJ, Expiration Date
Si o� �ature Telephone - /2 l57 !//o
Section 4•Workers'Compensation Insurance Affidavit(M.G.L a 152 S 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 5- Professional Design and Construction Services•for Buildings and Structures Subject
to Construction Control Pursuant to 780 CMR 116(containing more than 35,000 c.f.of enclosed space)
Section 5.1 Registered Architect
Not Applicable U
Hams(Registrant): Registration Number
Address
Expiration Date
Signature Telephone
Section 5.2 Registered Professional Engineer(s)
Hams Area of Responsibility
Address _ Registration Number
Signature Telephone Expiration Date
Hamel Il'. ; i.))I - Area of Responsibility
Address , Registration Number
' Signature - Telephone Expiration Date
Hanle • Area of Responsibility
•
Address Registration Number
Signature
Telephone Expiration Date
Hams Area rd Responsibility
Address Registration Number
Signature Telephone Expiration Date
Section 5.3 General Contractor
%j Zee-c-7 17e_ i e' A Co Not Applicable 1:1Company Name // ✓r7/_ I/Zr Ae"C-Pkczwa/'` /
v V
\'
Person Responsible for Constructlon/�p o1J / et.jet, (' //i D26^6/
Signature Telephone
• , Section 6- Description of Proposed Work(check all applicable)
New Construction ❑ (tor multiple family only) No.of Bedrooms (for multiple family only) No.of Bathrooms
Existing Bldg. ❑ Repair(s) ❑ Alterations ❑ Addition ❑
Accessory Bldg. ❑ Type Demolition Other Specify:
Brief Description of Proposed Work: eX/
�Cp2 S /mac /2 -' '
o -eete- T a i t 6Q Cfr
OO �y rr• X ire '
Section 7- Use Group and Construction Type
Building Use Group(Check as appficapable) Construction Type
• A ASSEMBLY ❑ A-1 ❑ A-2 ❑ A-3 ❑ IA
A-4 13 A.5 ❑ 1 B 0
B BUSINESS ❑ 2A l]
E EDUCATIONAL ❑ 29 10
F FACTORY ❑ F-I ❑ . F-2 0 2c ❑
H HIGH HAZARD ❑ 3A ❑
I INSTITUTIONAL ❑ I-1 O 1-2 ❑ 1-3 ❑ 38 CI
M MERCHANTILE ❑ 4 CI
R RESIDENTIAL ❑ R-1 0 R-2 ❑ R-3 ❑ SA CI
5 STORAGE ❑ S-1 0 5-2 0 58
U UTILITY l3 SPECIFY: •
M MIXED USE ❑
SPECIFY:
S SPECIAL USE 0 SPECIFY:
Complete this section if existing building undergoingrenovations,additions and/or change in use.
Existing Use Group: Proposed Use Group:
Existing Hazard Index 780 CMR 34 Proposed Hazard Index 780 CMR 34
Section 8 Building Height and Area
Building Area Existing(if applicable) Proposed
Number of floors or stories
include basement levels
Floor Area per Floor(st)
Total Area All Floors (sf)
Total Height(tt) •
Section 9 -STRUCTURAL PEER REVIEW (780CMR 110 11)
Independent Structural Engineering Structural Peer Review Required Yes_ No
SECTION 10a OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
-31AsI-f'\V thio 1 d / A , as Owner of the subject property,hereby authorize i7 a s�>4zt_ /1-4, 4 v to act on
my behalf, in all matte relative to work authorized by this building permit application.
Nav , 3o , aol $
Signa re t er Date
7 ill d nt•en
•
r
•
SECTION 10b OWNER/AUTHORIZED AGENT DECLARATIONI, 4u.744.-*-42-7 /if��eScv - al/ , as Owner/Authorized Agent
hereby declare that the statements and information on the forgoing application are true and acurate, to
the best of my knowledge and belief.
Signed under the pains and/penalties of perjury.
ZIST�r�vt- t2� ,�,e5W-e-Cadre
Print Name
/7. 3a. /ci
Signature of Owner/Ag=nt Date
Section 11 - ESTIMATED CONSTRUCTION COSTS
Item • Estimated Cost(Dollars)to be
completed by permit applicant
1.Building 6.4C) 01-0-0
f-CJ
Z Electrical
3.Plumbing!Gas
4.Mechanical(HVAC)
5.Fire Protection
6.Total.(1.E+3+4+5) 4' .2 1 r -'�
' 7.Total Square Ft.linty.Haus a.a kOna) /j IS) 0 .
Check Below VV
❑ Conservation-Commission Filing
(if applicable)
❑ Old Kings Highway&Historical
Commission approval
(if applicable) •
,� • The Commonwealth of Massachusetts
,�___ Department of Industrial Accidents
+'=`t Office of Investigations
..=._— Y
600 Washington Street •
• -; Boston,MA 02111
of
www.massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information / Please Print Legibly
Name (Business/Organization/Individual): eater -745 4 c. MV4517.<24.-tr‘ateeelesQicrof
Address: l.S9 ad/C-4.-7a S/7/ fit
City/State/Zip: S YQij c�G, /yI Phone#: S2' joYgc3 9
Are you an employer?Check the appropriate box: _____r_
I am a general contactor and I Type of project(required):
4.
IS I am a employer with S 0
have hired the sub contractors 6. ❑New constriction
employees(fall and/or part-time).
2.❑ I am a sole proprietor or partner- lilted on the attached sheet 7. 0 Remodeling
ship and have no employees These sub-contractors have g, 0 Demolition
working for me in any capacity. employees and have workers'
[No workers' comp.insurance comp.insurance.t 9. ❑Building addition
required:] 5. 0 We are a corporation and its 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their . 11.0 Plumbing repairs or additions
myself[No workers' comp. right of exemption per MGL
12.0Roof repairs
insurance required.]t c. 152, §1(4),and we have nopp
3 a.❑ I am a homeowner acting as a employees.[No workers' 191 Other �Care-
general contractor(refer to#4) comp.insurance required_] r.0 ecis
•Aay applicant that checks box#1 rust also fill out the section below showing their workers'eompensatiospolicy information.
•
. . t Homeowners who submit this affidavit imlirnting they are doing all work and then hire outside contractors most 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. !f the sub-mntracton 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 / /
Insurance Company Name: //ter 4 r`7.-al
Policy#or Self-ins.Lic.#: Gt�C- /// /9 Expiration Date: . it 3g. /7
lob Site Address: /07. S. $hn—e /-r City/State/zip: ,�, f ez-nt ezi/i/e/4_
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby cern)' under the pain cires o perjury that the infoneation provided above is true and correct
Si®attire: Date: /41.3o. /0°Phone#: sry fa y D537
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#:
Information and Instructions
Massachusetts General Laws chapter 152 requaes•all employsnss to provide workers'compensation for thea esployies.
Ptursuant to this statute,an escpleyee is defined as"...every pawn in the service of another under any coutnct of hire,
express or implied,oral or written."
An employer is defined a"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 at trustee of en individual,partnership,association or other legal entity,employing employ. Howes the
owner of a dwelling hoer having not more than three apartments and who resides therein,at the occupant of the
dwelling hoose of another who employs persons to do insirtplumrp,construction or repair work on such dwelling house
or on the grotmds or balding appurtennnt thereto shall not because of such employment be deemed to be an employer"
MGI.chspta 152, §25C(6)also stains that"nary state or local doorsg agency shall withhold the laas:nee w
renewal of a license or permit to operate a business or to construct bandiap It the commonwealth foe lay
apas evidence of comp/lance with the instffaaes uncap remated."
Arl dkaat who has not ter 152,2,1d acceptable of its political subdivisions shall
• Art�tir:.m.fty,MGL chapter §25C('n sista"Neither the commonwealth or any with the i*�^+++�'e
enter into any contact for the performance of public work tmtil acceptable evidence of compliance
requirements of this chapter have bent presented to the contacting authority."
Applicants
Please fill out S workers'compensation affidavit completely,by checking the boxes that apply to your Mansion n end,if
necessary,supply sub-contractor(s)name(s),address(es)and phone nmaba(s)along with thea certificate(s)of
Sumas Limited Viability Compania(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members ar partners are not required to carry workers'compensation insurance If an LW at 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 Suns coverage. Also be sure to sip and date the affidavit. The affidavit should
be retrained to the city or town that the applicatiaa for the permit or limes@ is being requested.not the Department of
Irdnatrial Accident. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the D part nen at the number listed below. Self-torted campers tea should eater their
self-urea Some number on the appropriate lig
City or Town Offidak •
Please be sure that the affidavit is complete and primed legibly. The Department has provided i space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations ha to contact you regarding the applicant.
Please be sure to fill in the permitilicense number which will be used a a referees a amber. in addition.an applicant
that must submit rmltiple patUticense application in any given year,need only submit we affidavit indicating current
policy idiomation(if necessary)and under"lob Silo Address"the applicant should write"all locations in (city or
town)."A copy of aha affidavit that has been officially stumped cc marked by the city or town may be provided to the
applicant u proof that a valid affidavit is on file for future permit or licenses A new affidavit rant be filled out each
year.Where a home owner or citizen is obtaining a license at permit not related to any business or commercial venture
(i.e.a dog license or permit to barn leaves etc.)said person is NOT required to complete this affidavit
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give to a ill.
the Department's address,telephone and fax cumber
The Commonwealth of Massachusetts
Department of Industrial Accidents
Otilce of Inratigations
• 600 Washington Street
Boston, MA 02111
Tel. !)617-7274900 ext406 or 1-877-MASSAF.E.
Fax it 617-727-7749 •
Revised 1 I-22 06 • www.maiss.gov/dia
;Fr --et, TOWN OF YARMOUTH
• ok•- e o, BUILDING DEPARTMENT
. € y 1146 Route 28,South Yarmouth,MA 02664
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 111.5,
I hereby certify that the debris resulting from the proposed work/demolition to be
conducted at ��.7Z• S$ -,-e
Work Address
Is to be disposed of at the following location: A/L*�STet 014 �/ e
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
a-
// 30. /d
Signa re of Application Date
Permit No.
1R
CO _ ..
I
CERTIFICATE OF LIABILITY INSURANCE f DATE(IA WDDANYY)
09007/18 .
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. IS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE FOLIC!
•
BELOW..THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHO D
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. I
• IMPORTANT: H the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provlelons or be a orsed.
If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A on
this certificate does not confer rights to the certificate holder In lieu of such endorsement(s).
PRODUCER N4ME I JIM HINDMAN
3Sfchlegel t lapel Ins Brokers,Inc. Nag 508-77143381J(Okx
An.** 808.77 -0883
West Yarmouth,MA 02573 Main _ iilitttk
ADOREsa: sehIegellnallrenCeegme6.Gom I
INSURERS)AFFORDING COVERAGE I RAC 0
INSURER A1 NOM INSURANCE i •
INSURED - muses e: LM INSURANCE COMPANY
KREATIVE BARNS INC INSURER C: I
169 OLD MAIN STREET
INSURER D: I
SOUTH YARMOUTH,MA 02884 •
INSURER E:
INSURER F:
COVERAGES • CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
. INDICATED. NOTWITHSTANDING ANY REQUIREMENT;TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENTWITH RESPECT TO YWIICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCEAFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TOALt THE TERMS;
EXCLUSIONS AND CONDMONS OF SUCH POUCIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR in TYPl OF INSURANCE 4ODL Bow FUMY EM POUCH EXP
/NSD YND POUCY NUMBER (MMNOM/YY) IMWDOIYYYY) UNITS
X COMMERCIAL GENERAL LIABILITY. EACH OCCURRENCE? f 1,000,000
•
CLAIMSMADE ❑X OCCUR DAMAGE ID HEN ItU
•
PREMISES(Ea oognllrca) f 600,000 •
• MED EXP(My one pNeIann). f 10,000
A - MPP6963J 08/28/18 08/28119 PERSONAL BADV MUURY f 1,000,000
GENT.AGGREGATE LNTTAPPLIES PER GENERAL AGGREGATE 5 2.000,000
peuevERERei CI LOC •
PRODUCTS•COMP/WAGO f 2,000,000
OTHER:
S
AUTOMOBILE UADI TTY • COMBINED SINGLE UNIT $
—ANYAUTO• (Ea acYEwq
BODILY INJURY(Par person) f .
OWNED — SCHEDULED
- BODILY INJURY(P
AUTOS ONLY _ AUTOS Ma:Y I Se f
HIRED NUTOSOl D - PROPERTY DAMAGE I $
AUTOS ONLY AUTOS ONLY (Per acaJe,Xl
I f
UMBRELLA LIAe
OCCUR
_, — EACH OCCURRENCE t
EXCESS LIAB CLANS-MADE - AGGREGATE f
DED I I RETENTIONS I i
WOUNERSCOMPENSATION
AND EMPLOYERS LIABILITY - XI 3T TUT! I TER •
ANY PROPRETORNARTNERIEXECUTNEY/N WC-1186197 08130118 08/30119
(Mandatory
OFFICER/MEMBER EXCLUDED? N NE.L EACH ACCIDENT $- 100.000
B (Mandatory In NH) . E.L DISEASE-EA EMPLOYEE f ' 100,000
NDESCyw dptTb order '
RIPTION OF OPERATIONS below - EL DISEASE-POLICY LSAT f ' ' 500,000
DESCRIPTION OF OPERATRINS/LOCATIONS/VENLE
CS(ACO IN.AdFIIIIN l Raba SOHN*may beaSeM M way Wow Is rewind). -
CORPORATE OFFIERS HAVE ELECTED TO BE COVERED UNDER THEIR CURRENT WORKERS COMPENSATION POUCY
•
CERTIFICATE HOLDER CANCELLATION I 7
SHOULD ANY OF THE ABOVE DESCRIBED POLICIE BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BEiDELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
• . AUTHORIZED R TME ,
IPi( .
1• 8-". . ORD CORPORATION. All rights reserved.
ACORD 26(2016/03) The ACORD name and logo are registered marks of ACORD
i
°`pr ti, TOWN OF YARMOUTH
°� HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant: cc�� / (p
Building Site Location: /0 °`- _S. 5-Le die 57
Proposed Improvement: re-p C4 C2 P.k/S742-5 de-cies CCS 7 X 7a
flip few on s j _ cJly?cv -r 4,wecA
oF+ t.c-e .
Applicant:ACSA4444,'Mr-561406-`117 /� Tel. No.: B 90k 33/
Address: /5? ged ,zot42, $( S T�jLGt ui4 Date Filed: /z - y /8
•'lfyou would like e-mail notification ofsignigpoff please provide e-mail address:
Owner Name: 5 r f cac&r Le e /fitsit;te /2tG�G
Owner Address: 1/7 .CJ/Lore.- 4/'. J rt44t4wnerTel. No.: 6239 379p j9>
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: / DATE: I }-/
PLEASE NOTE
COMMENTS/CONDITIONS:
i
oR
$ G 4_ Town of Yarmouth
N, '.. x Conservation Commission
4„ 0„.9. Building Permit Sign-off Application
TO BE FILLED OUT BY APPLICANT: n
Building Site Location: / A
-X S. cztere A. $ yam/ %/
Map # L/�ot(s) #��
Property Owner: </,y CO -ear 474e//t 7% //y
Applicant: %,»sc$7 nt' 1 /r- t/i�aao-/ /L -edt 4Se `/ /w'ii c5
Applicant Address: /57 ae 1/• • fiyit-. 2t-t/4 Ai,-
Telephone: "(2d 79r .0,539 Date Filed /2.I . /S
Proposed Project Description: /
te>ey:s- 7 ,e1 , Tre,,,r,„ trne,/,..„,,e_
. le/2_
Plans: Ski kin PIaN (07 S-skotAt 0t'/VP. llenfHA Oe t-Stet 144p
TO BE FILLED OUT BY CONSERVATION ADMINISTRATOR:
Do You Have A Valid Permit From The Conservation Commission For The Proposed
Project? AM"
Comments from Conserva o ommission:
Approved Conditionally 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
0 oft-el apptro✓ed
Da imAnAd teltivurda&ous, /00/7/Q re /h 2X/SbH 9
Conservation Commission Sign-off Signature: 1(9e/ a,-
Date: CZ/6 Pe
t - • fFk Yah 1 ,2t ti .\ &cM 5�+�+' '.4•• Z ,.. i'y a� '.21%,: y.1 i r .
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DEC 042018 �;;o r , . y3 1 -; .,,.y�y,i '�` ?� *�` 11,,,.. "14` >.�
'i �� „'t�� � l�14iti C �� LB41A �y 1 t T ru•
HEALTH DEPT. O ' 2/k ,,, s s}K a:iS � O •
0t -. cwi Ill ° 1
1+r�q�¢fo. _.„„.-A.,..;4cite? slPCo users. , -•,,....s... 5-H0/
711.1 ;{i $: .f�I'dff” r s.o srJnc, . UN/7S>-•'.4•t .:p 1 V
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iI � • � • � MYIr
s1.
�rt.y,� TOWN OF YARMOUTH
} .w •
i o, WATER DEPARTMENT �(5
o. r 99 Buck Island Road
,West Yarmouth, MA 02673
Telephone: (508) 771-7921 • Fax: (508) 771-7998
•
•
• BUILDING PERMIT APPLICATION
•
DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET/i a
. Site Location /c.z S 54-°ref �� u
Bldg.
g f. Map #: Lot #:
Proposed Improvement:
ly fi-P 2 S, y re ,Z ,Z/ a�eC,�S;
Applicant: M14.574-7.--04-7.-/ •
/
Address/He e.,a., SL Tel. #:545_,R15/0737 Date Filed: 3D./2
RESIDENTIAL AND / OR COMMERCIAL BUILDING .
Water Department: Determines Compliance of Water Availability and or Existing Location
Engineering Department: Determines Compliance for Parking and Drainage
Ccnsern_tion Commission Determines Compliance to Wetlands Acts; i.e. If Logs) 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 Persona!,
Safety, Property Protection;, i.e. Smoke Detectors, Sprinkler Systems, Etc ..
S nature or applicant Date
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Sears, Tim
From: Sears,Tim
Sent: Tuesday, December 11, 2018 6:42 PM
To: 'kbarnsinc@gmail.com'
Subject 107 South Shore Drive
Aleksandrov,
I have reviewed your application for 107 South Shore Drive,and there is one item to address;
We need more information on the use of Diamond Piers in a commercial application.All the information we have here
only seems to approve the use of them in a residential application.
Please have the engineer submit information for review.
Thank you
Timothy Sears CBO
Building Inspector
Town of Yarmouth
508-398-2231 Ext. 1259
ma iltoasears@varmouth.ma.us
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