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EXPRESS BUILDING PERMIT APPLICATION
TOWN OF YARMOUTH RECEIVED
Yarmouth Building Department ______
1146 Route 28
South Yarmouth, MA 02664 JUN 212022
(508) 398-2231 Ext. 1261 .________
BUILDING DEPARTMENT
CONSTRUCTION ADDRESS: I CA Fro-11- /-Q W`
)1- By:
ASSESSOR'S INFORMATION:
Map: Parcel:
ii AA __ '' 4—O ? -77to 077if
OWNER: fl Cu.+e@ew. � a:rtA l I(e Prt A 'f e— " W
NAME PRESENT ADDRESS TEL. #
CONTRACTOR: Joe King
NAME 36 CheckerberYLiHeDDRESS TEL.#
R 1A'��
esidential v nrtt&&n oath, MA 02673 Est.Cost of Construction$ l'13S-b `
Phone: 508-775-6448
Home Improvement Contractor Lie.`# 1 vo g g i Construction Supervisor Lic.# C.-5 51._-0 erg.la
Workman's Compensation Insurance: (check one)
2 I am the homeowner IQ.am the sole proprietor 2 I have Worker's Compensation Insurance
Insurance Company Name: Worker's Comp.Policy#
WORK TO BE PERFORMED
Tent Duration (Fire Retardant Certificate attached?) Wood Stove
Siding: #of Squares 7 Replacement windows: # ` Replacement doors: #
Roofing: #of Squares ( )Remove existing* (max.2 layers) Insulation
Old Kings Highway/Historic Dist. ( )Replacing like for like Pool fencing
,/ 5 i4 " Da v 0v5
*The debris will be disposed of at: "L L.V'n/to L_ [ r c `r
Location of Facility
I declare under penalties of perjury that the statements herein contained are true and correct to the best of my knowledge and belief. I understand that any false answer(s)
will be just cause for denial or revoc on of my license and r prosecution under M.G.L.Ch.268,Section 1.
Applicant's Signature: I ✓�J, � Date: _TV'r--n- 2_ "2-62_- 6 z-
wners Signature(or attachment) G _�nate: r J JUL-f)"r7--4/` 7--0-`7/1/
Approved By:
/
�i Date: C' --02*2.
Building Offi . or. gnee) EMAIL SS:
Zoning District: Cr-
Historical District: ❑ Yes 2 No Flood Plain Zone: 2 Yes ❑ No _ P
('/
Water Resource Protection District: Within 100 ft.of Wetlands: n I ` 0?
Yes 0 No ❑ Yes 0 No r O.?'
The Commonwealth of Massachusetts
Department oflndustrialAccidents
1 Congress Street, Suite 100
r Boston, MA 02114-2017
.. www.mass.go v/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Joe King
Name (Business/Organization/Individual): 36 Checkerberry Lane
West Yarmouth, MA 02673
Address: Phone: 508-775-6448
City/State/Zip: Phone #:
Are you an employer?Check the appropriate box: Type of project(required):
l.E I am a employer with employees(full and/or part-time).* 7. ❑New construction
2.�I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling
any capacity.[No workers'comp. insurance required.] 9. Demolition
3. I am a homeowner doing all work myself [No workers'comp. insurance required.]t
10 Building addition
4.C I am a homeowner and will be hiring contractors to conduct all work on my property. I will
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._I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof re airs
These sub-contractors have employees and have workers'comp. insurance.r,
6.❑We are a corporation and its officers have exercised their right of exemption per MGL c.
14.VgOthe l caS
152,§1(4),and we have no employees. [No workers'comp. insurance required.] CIr' ,1, Pod-re Do .$
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy informa on.
T Homeowners who submit this affidavit indicating they are doing all 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=or Self-ins. Lic. n: 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, 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.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
-- ✓n.- 2 —
Signature: 1 l Date: 4
z c)2-z_.
Phone-: 4-0 it• 7 7c C 14
Official use only. Do not write in this area, to be completed by city or town official.
City or Town: Permit/License 4
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#:
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3/07/2023
SUNRUN
Subject: Post Installation Approval Letter
Project Info: 223R-016HAND,16 Frost Ave, West Yarmouth, MA 02673, USA
Attn: To Whom It May Concern
The purpose of the review was to verify the installation is in conformance with what was specified in the
published plan set and that any potential modifications from those plans are adequate under the
existing structural calculations.
After reviewing the installation, the footings and flashings of the PV panels were installed in
conformance with the above plan set and specifications for this project. The installations comply with
the provisions listed below.
Design Criteria:
780 CMR (2015 IBC) (ASCE 7-10)
Basic Wind Speed Vult = 141 mph
Ground Snow Load = 30 psf
If you have any further questions on the above for mentioned, please do not hesitate to contact.
Current Renewables Engineering Inc.
Professional Engineer
info@currentrenewableseng.com
STAMPED 03/07/2023
Exp: 6/30/2024
CIVIL
NO. 56313
VAOSMS IA
GHAHR