HomeMy WebLinkAboutBld-20-000228 5 ,1 E. tiO t & TWO FAMILY ONLY- BUILDING PERMIT
• Town of Yarmouth Building Department op
R. e____-- "-- 1146 Route 28,South Yarmouth,MA 02664-4492 e titi
19 508-398-2231 ext. 1261 Fax 508-398-0836
lV -V \
20 N Massachusetts State Building Code,780 CMR
7tOtkfti :Permit Application To Construct• Repair, Renovate Or Demolish
g°\l?' - a One-or Two-Family Dwelling
av
This Section F Official Use Only
Building Permit Number:.L j) -a Q UQ0,2 Date Applied:
Building Official(Print Name) Signature Date
SECTION 1:SLUE INFORMATION. .
. 1.1 P party Addy s et 1.2 Assessors &Parcel Numbers
1.1 a Is this an accepted. street?yes l�, no Map Number Parcel Number
I
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40,154) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes0
- SECTION 2: PROPERTf OWVNERSB]P1
2.1 Owner'of Record:
l ‘\)S\ r N Q1�cv 3. A vi \j-i'\ INR
Name(Print) City,State,ZIP
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSE D WORK2(check all that apply)
New Construction❑ Existing Building Owner-Occupied 0 Repairs(s) Alterations) Addition 0
Demolition 0 Accessory Bldg.O Number of Units Other ❑ Specify:
Brief escription of Proposed Work': 1M pi 3 15. `n 'C1'R► QT (�5+2.P1\9J\►'
• x\it\ T i
SECTION:4s ESTIMATED CONSTRUCTION COSTS. :'
Item Estimated Costs: Offcialtie Only,• - '
(Labor and Materials) -:'. . . ..
1.Building $ Li 000.coo
� :.1..:Building Permit Fee;S. n .. _Indicate how fee is determined:
2.Electrical $ "�+ ❑'Standard City!I'own.Application Fee: ...
❑.Totalproject Cost3(Item:6)x multiplier... x
3.Plumbing $ 2: OtherFees: $ /Sd '
4.Mechanical (HVAC) $ List
5.Mechanical (Fire
Suppression) $ Total All Fees:$. . __ : _. .
Check No:.' Check Amoui t: Cash Amount: -
6.Total Project Cost: $ (4000. () El Paid jam 0 Outstanding Balance Due:
' SECTION 5:.CONSTRUCTION SERVICES
5.1 Construction /ape isor License(CSL) /' 5 O g) ' 5/ D Vo i / .q, g
�)-I(Ai ) c l l/l Licensew Number 1 oG (� Expiration(3( Date(QCU J
Name of CSL Hol
< 1 14n Do)1) i 11 L List CSL Type(see below) (I
No.
andJJ Street Type . Description
r ► l YA
11 R, 0-2 '3 06 U Unrestricted(Buildings up to 35,000 cu.ft.)
City/Town,State, 'v'1 ll R Restricted lea Family Dwelling
M Masonry
RC Roofing Covering
WS Window and Siding
1 SF Solid Fuel Burning Appliances
(50g). ( ICI e)-Ayr7Y1 ►''t�Gl�)I'V(crh I Insulation
Telephone Email address D Demolition
5.2 Registered Hom" ro ement Contractor(HIC)
Y
g 4605 6.2/isl , e
l .6 int ( HIC Registration Number Expiration Date ,
tompg=blame or Kr 16 -)y)f Registrant In 6 Q, l)S)1s,1-er-,lat,s
u2. tvM
d Street
H h /�Jn IR i 0.A
�A 6 �J5 Jl/16)13 Email address .
C j
City/Town, ,ZIP Telephone
• SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6))
Workers Compensation Insurance affidavit.must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuance of the building permit
Signed Affidavit Attached? Yes A' No 0
. SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIESFOR BUILDING PERMIT .
I,as Owner of the sub'ect property,hereby authorize 3 I 'A h C6- e 1 r i
to act on I,y be.. , all matters relative to work authorized by this building permit application.
is' Ifit/_26!63
P Owner's N:1,a(Electronic Signature) Date
SECTION 7b:OWNER'OR AUY`IIORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained'tilts
�'1application S true accurate to the best of my knowledge and understanding.
''
.d ,f� ,e c1ti /
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
• NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
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.IL) . Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of halffbaths
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"
& TWO FAMILY ONLY-BUILDING PERMIT
C �. Town of Yarmouth Building Department or
i- s.. ` 1146 Route 28,South Yarmouth,MA 02664-4492 '
1g 508-398-2231 ext. 1261 Fax 508-398-0836
112
Massachusetts State Building Code,780 CMR
• -- ul-s isdi :Permit Application To Construct, Repair, Renovate Or Demolish
r�e0\ a One-or Two-Family Dwelling
;ti.
0Y
This Section F Official Use Only
Building Permit Number:liLh -a )-000,74. ,Date Applied:
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION. •
1.1 Pp_ertyCddr 1.2 Assessor &Parcel Numb /
1.1 a Is this an accepted, street?yes )4 no Map Number oo Parcel Numbe
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private❑ Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION Z: PROPERTY OWNERS ' •
2.1 Owner'of Record:
1��u5� r Q 3. APfavk v r'\ MR
Name(Print) City,State,ZIP
40 C )
No.and Struel Telephone Email Address
SECTION 3:.DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building Owner-Occupied 0 Repairs(s)'14 Alteration(s)'35( Addition 0
Demolition 0 Accessory Bldg.0 Number of Units Other 0 Specify:
Brief cription of Proposed Work2: v1 S ocr H g 5 Qftev" efV;N•
P �, S• ' C*4
SECTION:4:ESTIMATED CONSTRUCTI.ON COSTS.
Item Estimated Costs: Official Vie Only
(Labor and Materials) _
1.Building $ L(000.K)40 :•1.Balding Pemut Fee:$:. '-- .. Indicate how fee:is determined:
2.Electrical $ 0-Standard Cityfl own Application Fee: '..
Cl TotalProjeet Cost'(Item,6)x multiplier .x
3.Plumbing $ 2. Other Fees: $ S -
List
4.Mechanical (HVAC) $ - .. .
5.Mechanical (Fire
Suppression) Total All F. $
�^ Check No. Check Amount: Cash Amount: -
6.Total Project Cost $ G1,00O Go p Paid in
Full ❑Outstanding Balance Due: •
f*, cBUILDING DEPARTMENT
-• ' 1146 Route 28,South Yarmouth,MA 02664
5/ 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 I,Section 111 S,
I hereby certify the debris resulting from the proposed work/demolition to be
conducted at 0 CA�G11 G 12 j
Work Address
Is to be disposed of at the following location:YO Oh Q2)1 4-k1")S h
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
/c5L a i)17 o S 7- l' 1,2-) /// 4-a)0
Signature of Application Date
Permit No.
RECEIVED
Jt=_Y'kk TOWN OF YARMOUTH
HEALTH DEPARTMENT JUN 0 62019
HEALTH DEPT.
�` PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:Building Site Location: q 7--
b Co/t_ RA,
Pro••sed Improvement: h bOO 'S f
Vie- .
Lcx r tti ''ll 'Y J'
-
Applicant: k1ki1O C3Ott Tel. No.:Sti,S
Address: ° (00 Date Filed: ,\F3.��{
**If you would like e-mail/ notification of sign off,please provide e-mail address:
Owner Name: G,OI15 l,nor I ��
Owner Address: 40 " T ‘O 'oil (I ' 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: DATE: c/AA/C:V/
PLEASE NOTE
COMMENTS/CONDITIONS •
/ovSe c,� i i/ H,4 v'e 3 ( v ova Ft vSsr r(O0 r
NO tied ioa-- cc{
e. w 4/1,5c (.2c1 ct.e )c c se Of c-: Rr�� • �5 Rocs
Pe- .a'( ,e vo`ti`
. t
Client#:38860 2EXCELBU
ACORD.. CERTIFICATE OF LIABILITY INSURANCE DATE(MWDD/YYVY)
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on
this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
NAME:
The Hilb Group of N.E.dba PHONE 508 775-1620 -FAx 5087781218 _
(A/C,No,Ext): (A/C.Noj_
Dowling&O'Neil Insurance Agy E-MAIL --
ADDRESS:
P.O.Box 1990
Hyannis,MA 02601 INSURER(S)AFFORDING COVERAGE NAIC A
---------
INSURER A:NGM Insurance Company 14788
INSURED INSURER a:Associated Employers Insurance Company I11104
Excel Building Systems Company,Inc
I INSURER C:
PO Box 436
Forestdale,MA 02644 NsuRER
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 DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
WAR _-... __ -. _- _ 'ADDLSUBRj — __-.._— _.. _--POLICYEFF POLICY EXP
LTR TYPE OF INSURANCE i� R tyyD-� POLICY NUMBER (MWDWYYYY) (MWDD/YYYY) LIMITS
A )( COMMERCIAL GENERAL LIABILITY X X MP02774T 0 2/22/201 9 1 0 2/2 2/20 2c EACH OCCURRENCE S1,000,000
DpAMAGGEET RENTED
CLAIMS-MADE X OCCUR j j j Waal:Vance) $500,000
MEDEXP,Any one personl S10,000
PERSONAL&ADV INJURY S1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE $2,000,000
PRO- PRODUCTS-COMP'OP AGG S2,000,000
X
POLICY X JECT LOC
OTHER. $
A M102774T 12/09/2018 12/09/201 )
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
tEaaccigent g1,000,000
ANY AUTO j I BODILY INJURY(Per person) S
OWNED -SCHEDULED BODILY fNJJ V Pet acntlen()
AU MS ONLY X AUTOS
X.HIRED X j NON-OWNED I PROPERTY DAMAGE $
�
AUTOS ONLY I I AUTOS ONLY (Per accident)
UMBRELLA LIAB OCCUR
EACH OCCURRENCE 5
EXCESS LIAB I CLAIMS MADE I j I AGGREGATE $_.I
DED I RETENTION S II I S
B iwoRKERSCOMpENSAnON 1 WCC50050098182019A 03/05/2019.03/05/2020 X IPEATUTE AFt
qN0 EMPLOYERS'LIABILITY Y/N - - --
ANY PROPRIETOR-PARTNER EXECUTIVE E L.EACH ACCIDENT 5550 000
OFFICER/MEMBER EXCLUDED? N N/A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S500,000
it yes. under L.DISEASE-POLICY LIMIT $500,000
DESCRIPTION ON OF OPERATIONS bekrx I I � E
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101.Additional Remarks Schedule.may be attached I more space is required)
The following coverages applying in the favor of The Valle Group,Valle Redbrook,LLC,&John Parker Road,
LLC:Additional insured status on the General Liability;Waiver of Subrogation on the General Liability,as
well as other parties as required by contract.General Liability is Primary and Non-contributory for
premises,products and completed operations.
(See Attached Descriptions)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
1988-2015 ACORD CORPORATION.All rights reserved.
ACORD 25(2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD
RPJX1
#S230329/M230326
Commonwealth of Massachusetts
11/1 Division of Professional Licensure
Board of Building Regulations and Standards
str ct cn S„oervisc.
CS-081256 Expires:08/01/2019
BRIAN D PATCH
86 BLANDING AVENUE
BARRINGTON RI 02806 - r
Commissioner
`6n,vrnrrmpeal//r/T l(a;.;arf1r.;e/6
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR
TYPE:Individual
Registration Expiration
184609 - 02/15/2020
BRIAN PATCH
BRIAN D.PATCH �C�t�tv -
86 BLANDING AVENUE
BARRINGTON,RI 02806 Undersecretary
Registration valid for individual use only
before the expiration date. If found return to:
Office of Consumer Affairs and Business Regulation
10 Park Plaza-Suite 5170
Boston,MA 02116
/r4 GL(sK/
Not valid without signature
• Lepurtrnenr of.tnausrrrat Acctaents
='se1Hl= 1 Congress Street,Suite 100
Boston, MA 02114-2017
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): eCt.,., But 1. 1 N*A t!
31�'
Address: ?).9)( ( l(6'G
City/State/Zip: F S"-ba,e, f ' P', `l Phone#: SOg I 01143
Are you an employer?Check the appropriate box:
Type of project(required):
1 XI am a employer with 3 employees(full and/or part-time).* 7. ❑New construction
2.0 1 am a sole proprietor or partnership and have no employees working for me in 8. yffRemodeling
any capacity.[No workers'comp.insurance required.]
3. I am a homeowner doingall work t 9. ❑Demolition
❑ myself.[No workers'comp.insurance required.]
4.❑I am a homeowner and will be hiring contractors to conduct all work on mY property. I will 10 El Building addition
ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions
proprietors with no employees.
12.0 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 repairs
6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑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.
tContractors 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
Insurance Company NameIG I " ' fflfVk'crnC , Cp;in
Policy#or Self-ins.Lic.#:(f.eL 5C;al L O I t7 A Expiration Date:3/ 5 420,20
Job Site Address: LI 0 f4"P. ,C VC:\ City/State/Zip:c55L) h G - }l
� J`l� ljri�'
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
1 do hereby certify unde t ains and penalties of perjury that the information provided above is true and correct.
Signature: I Date: J/t). I q
Phone#: MY go] (ly 3
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
5.Other
Contact Person: Phone#:
•
•, SECTION 5:.CONSTRUCTION SERVICES
5.1 Construction Snpe '\o r^License(CSL) (1(3 (\ (' +� \Qt
�dl s � License Number ", Expiration Date
Name of CSL Holder 1
eo (3q0 List CSL Type(see below) V
No.and Street Type . Description
P0 5 Q, NW- GZ I i U Unrestricted(Buildings up to 35,000 cu.ft.)_
Ci�y/Town,State,ZIP �7` R Restricted I&2 Family Dwelling
M Masonry
RC Roofing Covering
WS Window and Siding
�> s_ nO`�t� SF Solid Fuel Burning Appliances
W` \ ` I Insulation
Telephone Email address D Demolition
5.2 Registeredte Home Improvement Contractor(HIC) ;�a0%\l 5, a
`
` `�� s k v N HIC Registration Number Expiration Date
HIC U.ail.as ameorHIC . •i.:..47 me
I , •
No.M , - -- J `\J A A F.mail address
City/Town,State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes X 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 r ►a1) Si I
� NW
to act on m behalf all matters relative to work authorized by this building permit application.
04
P ' Owner's saolq a(Electronic Signature) Date
• SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is i�;,' accurate to the best of my knowledge and understanding.
a.,,
(5-,63,q,
Print Owner's or Authorized • . ame(Electronic Signature) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
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"
c BUILDING DEPARTMENT
, 1146 Route 28,South Yarmouth,MA 02664
�'-•••o S;� 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 I, Section 111.5,
I hereby certify that the debris resulting from the proposed work/demolition to be
conducted at 410
CiVrPfyl b y T,�
Work Address
Is to be disposed of at the following location: \/0\c( )J \ —17rCAS{U'
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 1 11, Section 150A.
Signa 4 Application Date
Permit No.
x: .
.y
RECEIVED
•ov-Yak TOWN OF YARMOUTH
{� �� JUN 062019
cf HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
HEALTH DEPT.
To be completed by Applicant:
Building Site Location: 10 -' /-!` & CaN a_
Pro sed Improvement: • h '--5S P�
Q, i
P LOCPc6'Ea7 ` �\
Applicant: Rt�C1��1'0 C \1 04-t e q10 - Oe.
`""�"h Tel. No.: .9:a
iir0
Address: P.000 Date Filed: ,N(o.\
**If you would like e-mail notification of sign off please provide e-mail address:
Owner Name: k)WLv)O1 (Ie -I .
Owner Address: 40 "PT NO (1o0 (SO , Owner Tel. No.:
il
614j/13 RESIDENTIAL AND/OR COMMERCIAL BUILDING
HEALTH D P NT: Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities.hvihes.
Q, \c::k
Please submit the 3 i SN
( ) eofplans,
(1.) Site Plan showing re co existing buildingsto , waterinclude:(0/ and septicline location,
lw system location;
(2.) Floor plan labeling ALL rooms within building
��L 1 (all existing and proposed) -
Gir—
---V Note:Floor plans not required for decks,sheds, windows, roofing•,
`y�` 10°
(3.) If necessary, Title 5 application signed bylicensed installer
0
C�Sc eat' with fee.
REVIEWED BY: 8-\ 7/7----
DATE: �oI/°//
PLEASE NOTE /, '
COMMENTS/CONDITIONS;
NIov5e cLii ii Hove 3 ( cI OCt Ft "c7 F1'o&r -
NO 6ed.'0a t k Rc---S-c
��
Nie. w ys ao.ci cpe k,yc t vt Raf-e - t f(r2c� . In kocwk
Pc_ �7
C_9-y r►-t .
/eel Building Systems Company,Inc.
an Sebastian Drive Site 9
Sandwich,MA 02563 US
ebsystems@live.com
ADDRESS
Louisinor Pierre
40 Captain Bacon Road
South Yarmouth,MA 02664 4�
�-;;: c RT.T..rir.Wc_`,.'u-sv'':,r T4`_`_•%-7 `..12-x;'�. ..u+ X.�s_ .r'ak'- `J.°�f""'9..Y x r'ra, �i•„ e' ,5r„
s" e Sel' .tI—„`* ,' Ys'.c+�,ii"'Sr i ffi". yOz4F �" s .,3�..'s
xa's
't.�.:'>o�rt� q;05/05/2019 Services 100.00
Item#1,Phase
#1
Apply for
permit.
05/05/2019 Services 150.00
Item#2,Phase
#1:
Remove three
existing doors.
05/05/2019 Services 1,000.00
Item#3,
Phase#1: RECEIVED
Open three
existing door 16 I019
openings width
to a 48" cased HEALTH DEPT.
openings and
install trim to
match original. ;u �15e ,�✓k•
(including
materials)
s ::i :,#$t * N s l*:....,.,z-a ! . vt:P, N nisi `,711 f w 3 .m tn.:4,,,.i f Ir: y ,h -Z a'.
7/05/2019 Services 2,000.00
Item#3,Phase
#2: RECEIVED
After final
inspection we WI 1 62019
will remove
previous HEALTH DEPT.installed 48"
cased openings
and install
three 48"
double doors9/
`;�- n (4c4..
�S' CA- t� /{
and re-install 1
trim to match e
original. C S
(includes Ce, re Cot—
doors/ C ti i'c,-S� PV 41,7'.
materials) _
05/05/2019 Services 500.00
Item#4,Phase
#2:
Paint doors and
new trim work.
(includes
materials) A
05/05/2019 Dempster 250.00
Remove all
related debris.
05/05/2019 Services 0.00
*** THERE
WILL BE AN
EXTRA
CHARGE
ABOVE
ORIGINAL
SCOPE IF
ANY EXTRA
WORK IS
NECESSARY
DUE TO
ELECTRICAL
OR
PLUMBING.
***
Pierre Project
40 Capt.Bacon Rd.
S.Yarmouth MA
a sins
a
41P11
OV:
111.01
TOWN OF YARIVIOUTH
1146 Route 28, South Yarmouth, MA 02664
508-398-2231 ext. 1261 Fax 508-398-0836
Office of the Building Commissioner
Violation Notice
Pierre Louisinor April 12, 2019
Pierre Laure Sherly
40 Capt. Bacon Rd.
South Yarmouth, MA 02664
Re: Basement apartment
Dear Mr. & Mrs. Pierre,
This Violation Notice is your official notification that the apartment located in your basement has been
constructed illegally without benefit of the required zoning relief and building permits. The construction of the
apartment is in violation of the MA State Building Code as well as the Town of Yarmouth Zoning Bylaws.
As you are aware,this office was notified of a potential gas leak or electrical fire on April 10, 2019. The
source of the odor could not be identified after an inspection by Yarmouth Fire,Yarmouth Wiring Inspector
and Yarmouth Plumbing and Gas Inspector as well as myself.
Your home is listed with the Town of Yarmouth Assessors office as a three bedroom home with an unfinished
basement.
You are required to apply for relief from the Zoning Board of Appeals. The creation of an affordable or family
related accessory apartment as defined Section 407 of the Zoning Bylaw requires relief in the form of a
Special Permit. The creation of an accessory dwelling unit for the purposes of rental will require a variance.
The construction of a dwelling unit requires that you apply for a building permit prior to the commencement
of construction.
780 CMR- MA State Building Code Section R105.1 states:
R105.1 Required. It shall be unlawful to construct, reconstruct, alter, repair remove or demolish a building
or structure; or to change the use or occupancy of a building or structure; or to install or alter any equipment
for which provision is made or the installation is regulated by 780 CMR without first filing an application
with the building official and obtaining the required permit.
The permit holder is also required to request inspections at the appropriate intervals per section R110.5.
R110.5 Inspection requests. It shall be the duty of the permit holder or their agent to notify the building
official when work is ready for inspection. It shall be the duty of the permit holder to provide access to and
means for inspections of such work that are required by 780 CMR. The building official may require the
permit holder or his or her representative or the licensed construction supervisor to attend these inspections.
You are also required to register your rental with the Town of Yarmouth Health Dept. per section 108 of the
Code of the Town of Yarmouth.
You are hereby ordered to abate or correct said violations within thirty(30)days.
Failure to do so may result in criminal/civil complaints being filed against you. You may be subject to fines
as prescribed by pertinent laws and regulations. You also have the right to appeal this decision with the
Zoning Board of Appeals as prescribed under MGL c. 40A. § 7,8, and 15.
You have fourteen days to respond to this request. Failure to respond may lead to further legal action as
allowed by MGL ch 139& 143.
cLTru7
ly,
Mark Grylls
Building Commissioner
CC:
Capt. Kevin Huck-YFD, Lt. Scott Smith—YFD
Bruce Murphy—Health Director.
Ken Elliott—Wiring Inspector
Lee Hall—Plumbing& Gas Inspector
file
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Technical S3ecs ULTRA-AIRETM 70H
:._
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Features
• Compact Size
• Top or End Supply Option iiit
• Energy Star® Rated Ultra'Aire
a
• Onboard Dehumidistat
• Superior MERV-13 Filtration
• Optional Outdoor Air Ventilation s
• Unmatched 6 Year Warranty
* 12" * * 12"
4 Part Number 4033730
Capacity
12" 0 0 12" Water Removal_ _ 70 Pints/Day @ 80°F/60%RH _
Efficiency 1 5.0 Pints/kWh @ 80°F/60%RH
* 9 if' °� i Performance
Blower 150 CFM @ 0.0"WG
Front View Back View 140 CFM @ 0.2"WG
130 CFM @0.4"WG
Energy_Factor 2.4 L/kWFl _
Sized
* 28° For —Up to 1,800Square Feet
t 22" - — _ -
Operating Range 49°F-95°F Inlet Air Temperature
> °i -
34°F`- 135°F Outside Cabinet
12" °I'`� 12" Electrical
Ultra-Aire
7t1 Power _ _ 580 Watts_@_80°F/60%RH
g 55 LBS. — Supply Voltage __Ya 115 VAC - 1 Phase 60 Hz.
i ° ° ° Current Draw 5.1 Amps Mu__ -_-. _
Power Cord 9 Foot- 115 VAC-Ground
End Supply Option --_ -_-"`
Circuit Requirement _...__15 Amps _a ___...r__-
* 25"- * Functionality
* 22" * Duct Connections 8"Round Inlet-8" Round Outlet
A.A. Drain Connection 3/4"Threaded Female NPT
4 Transformer Protection JPush button reset located near the
power cord
15" T
-'t1, Control Onboard dehumidistat or use of the
-Aire 12E DEH'3000/R digital control for
741 outdoor air ventilation and humidity
control in the living space
55 LBS.
Refrigerant R410A 15 Oz.
Shipping Dimensions 15"W x 161H x 31"D-65 Lbs.
Top Supply Option
(R001 511-7511 I WWW l IITRA-AIRF COM
Recommended Instal ations Accessories
DEH 3000 Control 4028539
Dedicated Return to HVAC Supply
Create a separate return for the Ultra-Aire 70H in a central area of the building. DEH 3000R Control 4028407
Duct the supply of the Ultra-Aire 70H to the air supply of the HVAC system with
a backdraft damper. Ultra-Aire Sentry 4037220
Air Handler
Outdoor Air Intake(Optional) HVAC Return HVAC Supply MERV--13 Filter(9"x 11"x 1") 4037724
MERV-13 Filter 4-Pack 4037735
Motorized Damper' Backdraft
Indoor Air Damper MERV-13 Filter 12-Pack 4037736
Return � 3,
US apply Pump Kit 4022220
Hang Kft 4036695
Basement/Crawl Space - Dedicated Return to HVAC Supply 6"Motorized Damper 4023672
Duct the supply of the Ultra-Aire 70H to a 8"x 8"x 8"tee damper that is
20 percent open to the basement. 6"Flex Duct 25' 4026859
Duct the other side of the tee to the air supply of the existing HVAC system
with a backdraft damper. 6"Flex Insulated Duct 25' 4020128
Indoor Air Return 6"Inlet Hood 4020656
Air Handler Supply
8"Gravity Damper 4023647
44 Backdraft
8"Flex Duct 25' 4027415
Damper
Dry Air to 8"Flex Insulated Duct 25' 4020177
Outdoor Air Intake
k j Motorized uh am -7 Basement
(Optional) Damper \ Manual
Damper
Ultra-Aire Supply
Ultra-AireTM Whole House
Ventilating Dehumidifiers
Alternative Instal atlon are specifically designed for
professional HVAC installation
and deliver the ultimate in
HVAC Return to HVAC Supply indoor air quality and comfort.
Check Damper should be in place between the Return and Supply connections
of the dehumidifier.
If Check Damper is not in place,the HVAC fan must turn on when the
dehumidifier is in operation. soft •
Optional Check Damper Ukra•Aire-
HVAC Air Handler
(no HVAC fan needed)
Return , HVAC Supply DEHUMIDIFIERS
Outdoor Air Intake "�' ""`° gir12
(Optional) _ - , Backdraft 6 YEAR
'i DamperIA1106011,W1
Motorized th' A"'
Damper Ultra-Aire
Supply
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HVAC Installer: Please Leave Manual for Homeowner
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