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bld-20-004319 w -9//(4t.iJ/ - oont/ /20 ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department "ot r __ 1146 Route 28, South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 1t' Massachusetts State Building Code, 780 CMR Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number/3ZZ"a© CD v3d1 Date Applied: 11 M Sa.ACS a-0- 1,o Building Official(Print Name) S' a re Date SECTION 1: SITE INFORMATION 1.1 Property Address: / a-1(1) 0/ 1.2 Assessors Map Parcel Numbers 1.1a Is this an accepted street?yes Y. no Map Number Parcel Number 1.3 Zoning Information: 1.4 P o er - mensions: • 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 Watepiy: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' /� 2.1 Owner'of Record:Vivo( elk@f Val nkat_A/ DtMName(Print) `(f City,State,ZIP( Y ✓�(, DY g / )17—$y 617 944 i'q othi,et, gog yaive, eatNo.and Street Telephone Email Addre SECTION 3:DESCRIPTIf}Pd OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building fd'/Owner-Occupied ❑ i Repairs(s) 0 Alteration(s) Addition 0 Demolition ❑ Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work': S QC'Q_, th'ea feu) al 134'4 p. r TT r. r� 1 SECTION 4: ESTIMATED CONSTRUCTION COSTS I'E re 0 7 2..# 6065' 1 I i Estimated Costs: 1 i it Item Official Use Qd (Labor and Materials) �. 1. Building _ 1. Building $ ( Q Permit Fee:$ I Sd _In 0 ®Standard City/Town Application Fee '�� '" ?.Electrical $ ��� a ❑Total Project Cost'(Item 6 x multipli$r 3.Plumbing $/0 © O 2. Other Fees: $ 7 GEt 1 ZVI; 1 List: .._ /' 4.Mechanical (HVAC) $ 13i' 7 5.Mechanical (Fire $ ± 1_,,�_____�!P-4:ilf Y Suppression) Total All Fees:$ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ 60060 0 Paid in Full 19 Outstanding Balance Due: 1l� r r SECTION 5: CONSTRUCTION SERVICES 5.f Constr ction Supervi r ense(CSL) -OM' 2 Z20 License Number Expir ion Date Name of CSL Holder /J� s pli S.jj p rr List CSL Type(see below)',14, (C' No.and Stre �J/��� 'J 'r`—'-n- T n Description W l�" Jf(jrn f L f1 i 0413 Unrestricted(Buildings up to 35,000 Cu. ft.) w Restricted l&2 Family Dwelling City/Town, to ZIP// Ivi Masonry `Jv 3 16/� RC Roofing Covering ���� /� I unre �j WS Window and Siding C IYIW �(�i�� �/ feKtrfild . dot SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 RAst d fait_ rove tractor(HIC) /� /JQ i1 f4y/ HIC Re istr�atioon Nn/ er Exp. atioon ate 7rpnt Name if i�(46,�f j/J�Q � C l Gtl� N . S r (J� ` 6--- /r "LVv�t rL �(Email dress /T , St IP i,,,JTelephone SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c.152.§ 25C(6)) Workers Compensation Insurance affidavit must be corn and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuanc e building permit. Signed Affidavit Attached? Yes No 0 SECTION 7a: OWNER AUTHORIZATION TO B MPLETED WHEN OWNER'S AGENT OR CONTRACT R APPLE 0 BUII:DING PERMIT I,as Owner of the subject property,hereby authorize to actgn my beh , in all matters relative to work authorized by this building permit ap ication. 0 , d, Print Owner's N e(Electronic Signature) Date • SECTION 7b: OWNER1 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 ' his application is true and accurate to the best of my knowledge and understanding. -..., / RO7 6 Print er'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.aov/oca Information on the Construction Supervisor License can be found at www.mass.cov/dps 2. When substantial work is �qd,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/atti decks or porch) Gross living area(sq.ft.) 5-,,, Habitable room count Number of fireplaces / Number of bedrooms Number of bathrooms Number of half/baths 0f 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' — ....\ The Commonwealth of Massachusetts — �=f,I, Department of Industrial Accidents =�11= 1 Congress Street, Suite 100 , ‘4,— �„ Boston, MA 02114-2017 www.mass.gov/dia IMP Workers' Compensation Insurance Affidavit: ilders/Contractors/Electricians/Plumbers. TO BE FIL i ITH T YI AUTHORITY. Applicant Information JWITTLNG \ Please Print Legibly Name (Business/Organization/Individual): i I Address:61 0 �U �1� (/d�� City/State/Zip: //900/1146s-6 Phone ;'�:Are you an employer?Check thpriate box: Type of project red): L❑I a: employer with employees(full and/or part-time).* 7. ❑ N- construction 2. am a sole proprietor or partnership and have no employees working for me in capacity. 8. emodeling . any p ty.[No workers'comp. insurance required.] 3. I am a homeowner doing9. ❑ Demolition ❑ all work myself. [No workers'comp. insurance required.]t 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 ❑ Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑ Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑[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.[ 13.❑Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§I(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 al!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. Insurance Company Name: Policy g or Self-ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: 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, a well as civil penalties in the for of A STOP WORK ORDER and a fine of up to $250.00 a day against the violator. A c of this statement may rwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify zzi n per ties of perjury that the information provided ov is true and correct. if Signature: I VLD Phone# J��0 / 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#: §TOWN OF YARMOUTH 1146 Route 28, South Yarmouth, MA 02664 508-398-223'1 ext. 1261 Fax 508-398-0836 Office of the Building Commissioner BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Ch. 40, §54 and 780 CMR - Section 105.3.1. #4. I hereby certify that the debris resulting from the proposed work/demolition to be conducted at / &&J POI 1 ITT 4 Work dress Is to be dis osed of oat the following location: MO �iOnS AS P 140 Said disposal site s 1 be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. / OZMO Signature of Application ate Permit No. TOWN OF YARMOUTH roc HEALTH DEPARTMENT PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To he completed by Applicant: k) )2i (� � OBuilding Site Location: I Pro osed Improvement: 11 6 Applicant: Address: Cbj) /0,5Rytycniiiti+ O9.&6 Date Filed: l /4 OZQ **If you would like e-mail notify Lion of sign off please provide e-mail address: Owner Name: Owner Address: t/ 6-rOtOttit A/9- Owner Tel. No.:(Q f 7 §(P �!/ 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: / 0 /49k006) PLEASE NOTE COMMENTS/CONDITIONS: r N. Specification Sheet - 42 - o 5ER 150 . s�us Ai E., Heat Recovery Ventilator Product #: 99209 Fans Two (2)factory-balanced fans with backward curved blades. Motors come Ar with permanently lubricated, sealed ball-bearings to guarantee long life and maintenance-free operation. Energy Recovery Core AHRI certified core made from water vapor transport durable polymer membrane that is highly permeable to humidity.The ERV core is freeze tolerant and water washable. Core dimensions are 9"x 9"(229 x 229 mm)with a 15" (381 mm) depth. Defrost A preset defrost sequence is activated at an outdoor air temperature of 14°F (-10°C)and lower. During the defrost sequence,the supply blower Fantech's, SER 150 is an Energy Recovery Ventilator designed for higher shuts down&the exhaust blower switches into high speed to maximize static pressure applications.The unit brings a continuous supply of fresh the effectiveness of the defrost strategy.The unit then returns to normal air into a home while exhausting an equal amount of contaminated air. operation, and continues cycle. The energy recovery core at the center of the unit transfers heat and moisture from incoming air to the outgoing air that was cooled and dried Serviceability by the building's air conditioner. Core, filters, fans and drain pan can be easily accessed through latched door. Core conveniently slides out on our new easy glide core guides. 17" Features (432 mm)of clearance is recommended for removal of core. • Compact design • Fans with backward curved blade Case • Electrostatic filters (washable) 24 gauge galvanized steel. Baked powder coated paint. • ERV transfers both heat and humidity Insulation • Anti-microbial material Cabinet is fully insulated with 1"(25 mm)high density expanded • Withstands freezing polystyrene. • AHRI certified • Removable screw terminal for easy connection Filters • Lighweight 46 lbs (20Kg) Two(2)washable electrostatic panel type air filters 8.5" (216mm) x 15" • Multiple speed operation (380mm)x 0.125"(3mm). Optional Controls Controls • EC0-TouchTM (#44929) — Programmable Touch Screen Wall Control External three (3) position(Low/Stand By/Medium) rocker switch that will • EDF7 (#448e3( — Electronic multi-function dehumidistat offer continuous ventilation. Fantech offers a variety of external controls. • EDF1 (#40375( — Multi-function control (see controls) • RTS5 (#44794) — 20/40/60 minute over-ride • RTS2 (u4o164( — 20 minute over-ride Installation • MDEH1 (u4o072) — Dehumidistat Unit is typically hung by using installation kit supplied with unit. Mounting bolts provided on top four(4)corners of unit.An optional wall bracket is Specifications available. • Duct size — 6" (152 mm) Warranty • Voltage/Phase — 120/1 • Power rated — 171 W Limited lifetime on aluminum core, 7 year on motors, and 5 year on • Amp — 1.4 A parts. • Average airflow — 145 cfm (68 Us) 0.4"Ps (100Pa) 42' fantech ® a systemair company s"% Dimensions$Airflow —�r• . - -MIIIMPF I ' iIii: • ` fresh air from outside _, '_ ,:` , W4i&i._ '�--kNor• =5!:_lid 1' stale air B - A .__B C� to outside A BCD SHR 150 23 3/4 604 2 1/6 55 171/4 438 161/4 414 Clearance of 17"(432 mm)in front of the unit is recommended for removal of core.All units feature three foot plug-in power cord with 3-prong plug. Airflow[Us] Ventilation Performance 2® 30 60 90500 in.wg.(Pa) 0.2(50) 0.4(1001 0.6(1501 0.8(2001 1.0(2501 O Reduced Speed 1 ©A odium Speed 375 cfm(Us) cfm(Usl cfm(Us) cfm(Us) cfm(Us) IT' ® ©H( Speed Net supply airflow 167(78) 145(68) 128(60) 106(58) 83(39) a 1 1 ® �© 250 illiii.essa (3 s supply airflow 170 OM) 148(70) 130(61) 108(51) 85(40) Mill 0 ®�� 111111 �-. 1 �- ® 125 Gross exhaust airflow 170(80) 148(70) 130(61) 108(51) 85(40) i ®1t4 ® l\- p r 25 50 75 100 125 150 175 200 Airflow[cfm] Energy performance Net effectiveness Supply temperature Net airflow Consumed Power Speed Sensible Latent Total °F °C cfm Us 00 °/n % 9io Low 35 1.7 75 35 88 62 44 55 Heating Medium 35 1.7 115 54 120 59 41 53` High 35 1.7 150 71 171 56 37 50 Low 95 35 75 35 62 40 50 Cooling Medium 95 35 115 54 120 59 37 46 High 95 35 150 71 171 56 33 42 Requirements and standards • Complies with the UL 1812 requirements regulating the construction and installation of Heat Recovery Ventilators • Complies with the CSA C22.2 no. 113 Standard applicable to ventilators • Complies with the CSA F326 requirements regulating the installation of Heat Recovery Ventilators • Energy Recovery Core is ISO 846 certified for mold and bacteria resistance and AHRI certified (certificate#8931522) • Technical data was obtained from published results of test relating to AHRI 1060 Standards Contacts Distributed by: Submitted by: Date: Quantity: Model: Proiect#: Comments: Location: Architect: Engineer: Contractor: United States 10048 Industrial Blvd.•Lenexa,KS 66215.1.800.747.1762•www.fantech.net Canada 50 Kanalflakt Way•Bouctouche,NB E4S 3M5•1.800.565.3548•www.fantech.net Fantech,reserves the right to modify,at any time and without notice,any or all of its products'features,designs, .••••°• f a n t e C h CD and specifications to maintain their technological leadership position. loot ;; • i.S... a systemair company ,I, • lo Lo ely( ecopt;e.. 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