HomeMy WebLinkAbout214 Pleasant St Demo request Building Dept CorrespondenceTOWN OF YARMOUTH
y BUILDING DEPARTMENT
MATM M 3 j' 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 261
a�
March 9, 2010 s
R. Thomas Coleman ="
Deborah Coleman a
10 Hidden Brick Road
Hopkinton, MA 01748
Re: 214 Pleasant Street
Dear Mr. & Mrs. Coleman:
I am in receipt of your building permit application received on March 8, 201, on which you propose
to:
Demolish the existing single family house located at 214 Pleasant Street South Yarmouth.
Having reviewed said application and associated documents I have determined that a building permit
cannot be issued at this time for the following reasons:
The house is more than seventy-five (75) years old and is subject to review by the Yarmouth
Historic Commission pursuant to the provisions of Town of Yarmouth Code Section 92—Historic
Properties. Should the Commission find that the house has historical significance, a six (60) day
delay is required "to locate a purchaser to preserve, rehabilitate or restore the subject building and
that such efforts has been unsuccessful." Re: Section 92-3(G)(2)
Therefore, I shall make the required referral and record this letter with the Town Cleric.
Any questions you may have regarding this matter may be directed to this department and / or the
Historical Commission secretary, Colleen McLaughlin.
Ve ly,
es D. Brandolini, C.B.O.
wilding Commissioner
cc: Yarmouth Historical Commission
Sarah Porter
C E I r E
MAR 1 9 2010
ISSION
TOWN OF YARMOUTH
f Building Department
Town Hall
Yarmouth, MA 02664
(508) 398-2231 ext.261
BUILDING PERMIT
TRANSMITTAL
Temp Permit No.:
T-10-344
Applicant Name:
R. Thomas & Deborah Coleman
Applicant Phone:
$75.00
Building Location:
0214 PLEASANT ST
Owner's Name:
R. Thomas & Deborah Coleman
Owner's Addres
10 Hidden Brick Road
Application Date:
Hopkinton MA 01748
IL -
Owner's Telephone:
(508) 269-7496
REVIEWED BY:
Comments: Map/Lot: 051.105
Idemolish single family house
1. WATER DEPARTMENT:
(OFFICE USE ONLY
Recorded By:
Ic
Permit Fee:
$75.00
Deposit Rec:
$75.00
Payment Type:
Check ChkNo.: 2924
Net Owed:
$0.00
Application Date:
3/8/2010
Issue Date:
6. FIRE DEPARTMENT:
Expiration Date
N/A:
Comments: Map/Lot: 051.105
Idemolish single family house
1. WATER DEPARTMENT:
DATE:
N/A:
2. ENGINEERING DEPARTMENT:
DATE:
N/A:
3. CONSERVATION:
DATE:
N/A:
4. HEALTH DEPARTMENT:
DATE:
N/A:
5. BUILDING DEPARTMENT:
DATE:
N/A:
6. FIRE DEPARTMENT:
DATE:
N/A:
PLEASE NOTE
COMMENTS:
RECEIPT OF COPY:
SIGNATURE OF APPLICANT:
LL• II14
Date Printed: 3/9/2010
N/
ONE & TWO FAMILY ONLY - BUILDING PERMIT
C APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
0 y 't'uwn 11"ildiflK I)cpat'In[c:u1
MATT "r ! 1.16 Route Y8 - Yacincluth. NIA 111661-•1'192
F~"" •��
It -1: (51114) ;s9HI-2231 x161 - Fax: (308) :398-0836
Only Planmr[q BUM Information Assessors Department information:
Permit No. Date Pw T�
Permit Fee S EFdW
Date
Deposit Rev'd. $ Date �dkV te r 4 Pro n►ew
ppb Dimension:NetDue OLoi Area (st} Frarrtage (ft) Lat t:nverags
Tw Stictton for Ottfoe Uaeoraw
Suikft Permit Number: Date Iseuett
Signature: COn Heats of Occupancy
&"V Oftw Data It Is nd required
Secdorrt - Site Inf=Mdon I Use Group: R-4 Y : 5-8
1.1 PesMerlr Addresm 12 Zoning In(ormation:
aviK
.Sto. yfrr�wr�,t�t.�
r
Zoning District Proposed Use
1.3 duNdtng Setbacks It't)
Front Yard Side Yards Rear Yard
R iced Provided Required Pravided Required Provided
1.4 Water SWVIW (tw.aL. c. 40. s s4 f f 1.5 Flood Zona IrAwnsfk)m coffww ls:
Public Private ( ZOrNK t
Section 2 - Proporty Ownership/Authorized A
S, l d Ree l I n/ l d ro e rev_
L2 AmUnwised Ate*
Name (print)
Signature
Sectbn 3 - Construction S
&1 Llemosed comer stlen
Address
Signature
telephone
Mailing A43dresr
Telephone
R CCS
Melling Address
Fa _x
Pial Applicable
j MARS 1� i License Number
rquyf ] S.piral'nn Oats
13.2 Reglatered Horne Improvement Contractor
convmmw "am,,.._ . -- r
Address
Signature rf4ephane
I of 2
e,�Jr'Tr
Not Applicable j
License Number
Expiration pate w
-- ----- OYFR
.
ft
Section 4 • Wbrkerer COmi7itt"i ' Irt9iZ;; WiR A&L &, 10 *10,9 tori
Workers Compensation Insurance affidavit must be completed and submitted with this appik:atlon. Pailere
to provide this affidavit will result In the denial of the Issuance of the building permit.
Signed Affidavit Attached Yes .......... No
Sectbn 57 gmn4m of PMPMd Wb* tchedr far wftw ly
New Conshucdon No. of Bedrooms Na of Utwooms
Existing Bldg. ❑ Repair(s) ❑ Alterations ❑ Addmm ❑
L.
Accessory Bldg. ❑ Type Demolition YOL=S J Other Specify:
Brief DesctRtlon of Proposed Work
e c
Section d - Esdmated Constntctlon Co is
Item Estimated Cost (Dollars) to be
completed by perrnN applicant
t. SulkI
2. Electrical
3. Plurnbi / Gas
4. Mechanical (HVAC)
5. Fla Protection
9.Totalw(1+2+3+4+5)
7. Total Square Ft. Irew haaas i mal
I Check Below I
❑ Conservation -Commission Piling
(if applicable)
❑ Ofd Kings Highway a Historical
Commission approval
(N applicable)
Section 779. OWrow Auftrhadoa- T6 be CwMkftd When
Owner's Agent or ConMwWApplles fa Bufklift Pam*
I, ,,, as owner of the subject property
hereby authorize to act on
my behalf, In all matters relative to work authorized by this building permit application.
Sign"" of Owner
Section 7b - OwnedAulhorized Aflent Declaradw
Oats
1. .111META3 Z L&0 -W COKJ , as Owner/Authorized Agent
/ hereby declare that tha statements and information on the foregoing application are true and accurate.
Y to the best of my knowledge and belief.
Signed under the pains and penalties of perjury.
Owns./Agent
9. 15-99 2 of 2
MID
oats
PLEASE PRIM;•
TOWN OF YARMOUTH
BUILDING DEPARTMENT
CONSTRUCTION SUPERVISOR FORM
fob Location: _(l
Number
Owner of Property:
Construction Supervisor:
COle(y%0'V\
Name
License No.
Mage
Address: 1 E G�1 r✓i' 1 Gf(� i�u �T L� (h 1 �=r �i �� (] i 7
Licensed Designee:
([rather than Supervisor} Name
2.15 Responsibility of each license holder:
License No.
2.13.1 The license holder shall be fully and completely responsible for all work for which he is supervising.
He shall be responsible for seeing that all work is done pursuan t to the state building code and the drawings
as approved by the building official.
2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration,
repair, removal or demolition involving the structural elements of building and structures only pursuant to
the state building code and all other applicable laws of the commonwealth, even though he, the license
holder, is not the permit holder but only a subcontractor or contractor to the permit holder.
2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any
violations which are covered by the building permit.
2.15.4 Any Iicenseewho shall willfully violate subsections 2.15.1, 2.15.2 or 2.15.3 or any other section of these
rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of
license by the board.
2.16 All building permit applications shall contain the name, signature and license number of the
construction supervisor who is to supervise those persons engaged in construction, reconstruction,
alteration, repair, removal of demolition as regulated by section W9. 1.1 of the code and these rules and
regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately
cease until a successor license holder is substituted on the records of the building department.
2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may
be deemed a violation of the permit conditions.
1 have read and understand my responsibilities under the rules and regulations for licensing construction
supervisors in accordance with section 109.1.1 of the state building code. I understand the construction
inspection procedures and the specific inspection as called for by the building official.
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. t52
Yes U No FJ
If you have checked 4" please indicate the type coverage by checking the appropriate box.
A liability insurance policy ❑ Other type of indemnity ❑ gond (J
OWNER'S INSURANCE WAIVER: I am aware that the licensee dQea I1QLftM the insurance coverage required by
Chapter 152 of the Masa, General Laws, and that my signature on this permit application waives this requirement.
Check one:
of Owner or Owner's Agoot
Signature:
Building OfFcial Approval:
The Commonwealth of Massachusetts
x
Deparfinent of Industrial Accidents
O, j ee of Invesdgations
kvi 600 Washington Street
Boston, MA 01111
www.mass,gov/dta
Workers' Compensation Insurance affidavit: Builders!Contractors/Electriciansmiumbers
Applicant Information Please Print Levibiv
Narne (Business/Organizatiowindividual): E? ���( �p iy1 yk
Address:__ i 0 f
CityiState/Zip: 4 Q l lq� Phone #: -0g 71 — 7 yi q
Are you an employer? Check the appropriate box:
1. ❑ I am a employer with
4. I am a general contractor and I
employees (full and/or part-time).*
have hired the sub -contractors
2. ❑ I am a sole proprietor or paler_
listed on the attached sheet
ship and have no employees
These sub -contractors have
working for me in any capacity,
employees and have workers'
[No workers' comp. insurance
comp. insutrance.t
required.]
5. ❑ We are a corporation and its
3, ❑ I am a homeowner doing all work
officers have exercised their
myself. [No workers' comp.
right of exemption per MGL
insurance required.] t
c. 152, § 1(4), and we have no
employees. [No workers'
comp. insurance reauired.l
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
8. 21 Demolition
9. [] Building addition
10.❑ Electrical repairs or additions
11.❑ Plumbing repairs or additions
12. ❑ Roof repairs
13.❑ Other
'Any applicant that checks box #1 must also tin out the section below showing their workers' compensation policy infornnNm.
t HOnreowner who submit this affidavit indicating they are doing all work and then hire outside contractor neat subnrit a new affidavit indicating such.
:Contractors that check this box must attached an additional shat showing the name of the sub-contn ton and state whether or not those entitles have
employees. if the sub-contrctor have "loyea, they must provide their worker' co policy comp, po cY number.
I arra an employer that is providing workers' compensadan Insurance for my employee& Below Is the policy and fob she
information,
Insurance Company N
Policy # or Self -ins. Lic,
Expiration Date:
Jolt 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 Section 25A of MGL e. 152 can lead to the imposition of criminal penalties of a
Fne up to 51,500.00 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
Investi ations of the DIA for insurance coverage verification.
I do herebXrtify under the pains i d penahles of perfury that the informaden provided above Is true and correct
'N'Si nature: -K4
Phone #: �-U G1 — I `IK
use only. Do not
City or Town:
area, to
or town of iclat
Permit/License #
Issuing ,authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector
6. Other
-;/z/Mry
Contact Person:
Phone #:
Information and Instructions
Massachusetts General Laws chapter 152 requires all empioyeirs 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 contract 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 tewtee 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 that* or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or an the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6) also stats 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
appikant who has not produced acceptable evidence of compliance with the Insurance coverage required."
Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth not any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please tilt out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub -contractors) name(s), addresses) and phone numbers) along with their certificate(s) of
insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the
membars 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. Alae be sure to sign and date the affidavit. The affidavit should
be returned to the city or toren that the application for the parmit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy, please call the Department at the number listed below. Self-insured conpaaies should enter their
self-insurance license number on the zpgrwriaft lam
City or Town Offtclals
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant
Please be we to fill in the permittlicense number which will be used as a reference number. In addition, an applicant
that must submit multiple pernri"cemw applications in any given year, need only submit one affidavit indicating current
policy informaation (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or
town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit.
The 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 us a call.
The Department's address, telephone and fax number.
The Commonwealth of Massachusetts
Department of Industrial Accidents
MCC of Investigations
600 Washington Street
Boston, NIA 02111
Tel. 1# 617-7274900 ext 406 or 1-877-MASSAFE
Fax # 617-727-7749
Revised 11-22-06
rvwtiv.mass.gov/dim
For Office Use Only
Permit No.
°ate TOWN OF YARMOUTH
AFFIDAVIT
Hose Impsvrement Coatrader Law
Soppkmrnt to permit Applidtioa
OL c. 1+2A nMujw that runt 'recamsdvctian, alteration,
�prorement, removal, d®dittos or �4�' rQatr. modamintion, oattveryian,
cons& Ww of a adM= to any Precd3ting awns -occupied
buildin j containing at least ant but not mot than lour dwdlin* units or streteirant whkh are adjecew to
welt residata or baildirg' be dant by rued odors,
rcquvwentt, wide oatain exoeptiarM alas with aha
Type of Work: LM0 Est:C
�
1
Address of Work Zj ek5e n I ` �' �S� . �. i -t t.d j
Owner Name: ---�v i'm t- Ct
Date of Permit Application: 31 Y "1 b
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded bylaw
Job wader S1,000
Building not owner occupied
.�. Owner pulling own permit
Other (specify)
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WrM
UNREGISTERED CONTRACTORS FOR APPLICABLE HOME
IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION
PROGR %M OR GUARANTY FUND UNDER MGL c. 142A.
Signed under penalties of perjury:
I hereby apply fora permit as the agent of the owner:
Date Contractor ►%lam
Registration �Yo.
OR:
Notwithstanding the above notke. I hereby apply for a permit as the owner of the above
property -
1, 2VI6 � �h � 0rA Co WV
(h+- nor Name
4/
TOWN OF YARMOUTH
BUILDING DEPARTMENT
1116 Route 28, South Yarmouth, NLA 02664 508-398-2231 ext 160
PLEASE PRINT:
DATE: 2 L4 i o
JOB LOCATION: Oo I e ma,0
PiANE .
"HOMEOWNER" �0 kjr i I^ �
NAME
SENT MAILING ADDRESS 16
-- SDC 607 h -Yl MA O i 7
HOMEOWNER LICENSE EJ B4MON
S,a 1/4 vw a c, a,
STREET ADDRESS SECTION OF TOWN
ic1Y yl,y_1��
Co-"(, HeW PHONE
WORK PHONE
x �f Plw��
' CITY OR TOWN STATE ZIP CODE
The cu nvnt exemption fbrHommwgg' was extended to include QHM — of one or two units
and to allow such homeowners to engage an individual for hire who does not possess a kerne,ymyided that sant,
. (State Building Code Section 108.3.3.1)
Definition of Homaownw..
Pe:mn(s) who owns a parcel of land on which he / she resides or h tends to reside, on which there is or is intended
to be, a one or two &n* attached or detached mucture assessory suse to ch uand / or farm structures. A person
who congructs more thea one home in a two-year period shall not be considered a homeowner; such"homeowner
shall submit to the bw1ding oi$cial, on a farm acceptable to the batt ofBcisl, that he / she shall be
all such work .pj&rmed ,the buildg. (Section 108.3.3.1)
The undr"s Pod `homeowner' assumes responsibility for compliances with the Stats Building Coda and other
applicable codes. by-laws, rues and regulations
The undersigr>rd 'homeowner' certi&s that he / she ,understands the Town of Yarmouth Building Department
mi dmurn kupection procedures and mqubvments and that he / sbe will comply with
requirements. Mid procedures and
;HOMEOWNER"S SIGNATURE ( ,f
APPROVAL OF BUILDING OFFICIAL
INSUILILNCE COVER.LGE:
ha�ar a current liability inwranct: policy or its substatrtid equnraknt. which rt'Xvts the rrquat'rr�nts of MGL Ch 142.
Y45 _ No �=
If you have the kt.A I, p(<a*: ir11katc thL' type Mcrnge by checking the appropriate: hos.
A Vabdity insurance policy 1 Othur t% pe of indemnity, J pow
OWNER'S INSURANCE W,UVER. I sm aware that the licensee {lass r�o�h g the inur a coverage requited
by C(mpta'r 132 of the Mass. Gcr>rral Laws and that my s4pmturx on thio permit application waives this rcqui:trr>Lnt.
-- __ C'hvck one:
Siunutury q)t'0%.6ncr or �tncr 1
. ,Scent
it.h�Mr��r.�•irli..l��.np
TOWN OF YARMOUTH
1 1 46ROIU-M 28 SOUi'H YARNIOLTH MA&ACHU5t j j 026644451
Telephone (549) 398-2231, Fats. 261 — Fax(508)399-2365
BUILDING DEPARTMENT
DEMOLITION DEBRIS DISPOSAL AFFIDAVIT
BUILDING
ELECTRICAL
GAS
PLUMBING
SIGti3
Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5,
1 hereby certify that the debris resulting from the proposed work/demolition to be
conducted at
Work Addrew
M
is to be disposed of at the following location: 5 /fL ,Clib , ("d
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter l 11, Section 150A.
Signature of Applicant
Permit No.
72,�.7
Date
ACORI�" CERTIFICATE QF LIABILITY INSURANCE aPID I^zjy DATE (MMfDo
'
nous,03/04
nous,THIS
PRODUCER
BEEN ISSUED TO THE INSURED NAMED
CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
PERIOD INDICATED. NOTWITHSTANDING
ANY
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Paul Peters Insurance Agency
CONTRACT OR OTHER DOCUMENT WITH
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
680 Falmouth Rd.
MAY
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Mashpee MA 02649 -
POLICIES DESCRIBED HEREIN IS SUBJECT
TO ALL THE TERMS,
Phone: 508-477-0021
POLICIES,
INSURERS AFFORDING COVERAGE NAIC #
INSURED , _`
BEEN REDUCED BY PAID CLAIMS.
INSURER A: Nautilus Insurance
LTR
INSURER B:
Adam C. Clough
POLICY NUMBER
INSURER C:
10 PeepToad Road
Centerville MA 02632
INSURER D:
_.
COVERAGES
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,
AGGREGATE LIMITS SHOWN MAY HAVE
BEEN REDUCED BY PAID CLAIMS.
LTR
NSR
TYPE OF INSURANCE
POLICY NUMBER
DATE M EFFECTIVE
DATE MMIp N LIMBS
GENERAL LLABILTTY
EACH OCCURRENCE $ 500000
A
X COMMERCIAL GENERAL LIABILITY
TO BE ISSUED
03/04/10
03/04/11 PREMISES Eaoccurence $ 50000
CLAIMS MADE FX] OCCUR
MED EXP (Any one person) $ 5000
PERSONAL BADVINJURY $ 500000
GENERAL AGGREGATE $ 1000000
GEN'LAGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG $ 500000
X i POLICY jE a LOC
AUTOMOBILE LIABILITY
SINGLE LIMIT $
ANY AUTO
Ea accident)
ALL OWNED AUTOS
BODILY INJURY $
SCHEDULED AUTOS
(Per person)
HIRED AUTOS
BODILY INJURY $
NON -OWNED AUTOS
(Per accident)
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT $
ANY AUTO
OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS UMBRELLA LIABILITY
EACH OCCURRENCE $
OCCUR F1 CLAIMS MADE
AGGREGATE $
S
DEDUCTIBLE
$
RETENTION $
$
WORKERS
COMPENSATION
AND
EMPLOYERS' LABILITY YIN
_
TORY LIMITS ER
ANY PROPRIETORIPARTNER/EXECUTIVED
OFFICERIMEMBER
EXCLUDED?
E.L. EACH ACCIDENT $
(Mandatory
M yes,
In under
describe un
E.L. DISEASE - EA EMPLOYEE $
SPECIAL
PROVISIONS below
E.L. DISEASE -POLICY LIMIT 1 $
OTHER
DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
YARM009 DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Towns Of Yarmouth
1146 Rte 28 REPRESENTATIVES.
S. Yarmouth MA 02 664 AUTHORIZED REPRESENTATIVE
Gary Bruno
ACORD 25 (2009101) 0 1988-2 ORD C ATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
Y I.'VWN Vr Y AKIVlLJU I I7
°off' qR
'° BUILDING DEPARTMENT
1146 Route 28, South Varmouth, IIIA 02664 508-398-2231 est. 261
BUILDING DEPARTMENT
TOTAL DEMOLITION SIGN -OFF FORM
State Building Code (780 CMR) Chapter 1, Section 112.1 -Service Connections
"Before a building or structure is demolished or removed, the owner or agent shall notify all utilities
having service connections within the structure, such as water, electric, gas sewer and other
connections. A permit to demolish or remove a building or structure shall not be issued until a release
is obtained from the utilities, stating that their respective service connections and appurtenant
equipment, such as meter and regulators, have been removed or sealed and plugged in a safe manner."
"Ali debris shall be disposed of in accordance with 780CMR 111.5."
Building or Structure Location: Map: Lot:
Owner's Name: C{)U /41A hJ Address: o� 1 1� 04L 45.44, rftone:
Contractor's Name: Address. Phone:
NStar: Date: d-) a--/ �-os0
By: (,)Yrxj
Title:5++�`
National Grid: Date:
By:
Title:
Water Dept.:
Date: i/�Z_9>/
By. �jT'/Z
Title: �SS��F !/
Board of Health: Date:
Title: 6A? k
Condition: �
� � ��
Fire Dept.: Date:7�c��/Cf�/
Title:
Historic Commission: Date:
By:
Title:
Verizon: Date: L6
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Title:aru'
comenst: Dare:1 Q- 11
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o� BAR l UWIN UN' YARMOUTH
a BUILDING DEPARTMENT
..4T. 1146 Route 28, South Yarmouth, NIA 0266.4 508-398-2231 ext. 261
BUILDING DEPARTMENT
TOTAL DEMOLITION SIGN -OFF FORM
State Building Code {780 CMR} Chapter 1, Section 112.1 -Service Connections
"Before a building or structure is demolished or removed, the owner or agent shall notify all utilities
having service connections within the structure, such as water, electric, gas sewer and other
connections. A permit to demolish or remove a building or structure shall not be issued until a release
is obtained from the utilities, stating that their respective service connections and appurtenant
equipment, such as meter and regulators, have been removed or sealed and plugged in a safe manner."
"All debris shall be disposed of in accordance with 780CMR 111.5."
Building or Structure Location. S, YilaH 0V -r v Map: =,5-1 Lot: ':" /4,5'
Owner's Name: Cot, Lr kn ,I k) Addressa/y p<4_A,�4nV7,!�T Phone: SDS- a� 7y9�
Contractor's Name: Address: Phone:
NStar: Date:
By:
Title:
National Grid: Date -
By:
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By:
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Condition:
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Commission:
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Comcast:
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Date:
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Title: 0//� z<,
Date:
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Date:
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Title:
nationalgrid
February 2, 2010
To: Richard Celeste
Re: The Coleman Residence
Re: 214 Pleasant Street, South Yarmouth, Ma
This letter is to notify you that after our investigation, it has been determined there is no
gas being supplied to 214 Pleasant Street, South Yarmouth, Ma 02664
If you have any questions please feel free to contact us at 781-907-2930
Sincerely,
Diane L. Stevenin
Customer Driven Construction
diane.stevenin@us.ngrid.com
781-907-2930
781-522-1056 fax
40 Sylvan Road E-2
Waltham, Me 02451
� M w
E.W. Drew, Inc.
Electrical Construction
103A Mid Tech Drive
West Yarmouth, MA 02673
508-778-0723
February 02, 2010
To whom it may concern:
This letter is to verify that all the electric power has been disconnected from:
214 Pleasant St
South Yarmouth, MA 02664
Thank you
i -
Eric Drew
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