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HomeMy WebLinkAboutbld-23-004706 ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department ort r 1146 Route 28,South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 { Massachusetts State Building Code,780 CMR .e +' Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling RECEIVED This Section For Official Use only Building ermit Number: 6E0 Z3-(.„ b Date Ap.,;s-.: 2 3 B23 Building Official(Print Name) • ignature ey: Date , SECTION 1:SITE INFORMATION • 1.1 Pro erty ress; 1. Assessors Map&Parcel Numbers '� 'a. /ivdd aut. • yoimtth 1.1 a Is this an accepted street?yes no/ M&. Map Number Parcel Number 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 I 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 0 Zone: Outside Flood Zone? — Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP` ' / // 2.1 Tonn Record: it _ arrn(� p6K-i-� M (A . {0 7S Name(Print) Cty,State,ZIP 3 rJ2 '/mod au.. 339- , 33- eia nQ h .Perml-1-.140 /vny hr. No.and Street Telephone Email Address SECTION 3:DESCRIPT .ON OF PROPOSED WORK2(check all that apply) CU/)') New Construction 0 f Existing Building Owner-Occupied 0 [ Repairs(s) 0 Alteration(s) TyleAddition ❑ Demolition 0 1 Accessory Bldg. 0 Number of Units Other 0 Specify; Brief Description of Proposed Work2: ), AIVLD (S-}- 1= 16yN. - cip\„404./v , 49 est._ 1,,a-Hr\r--;py., ,J.)ii\chA WI *eprkflirva u)( 11)4 -'v\sp..a.-0_ oyt LA---u _ -t.ur-SS-+-,ti, ('��U C:e n&&k 0 V v SECTION 4:ESTIMATED CONSTRUCTION COSTS. Item Estimated Costs: Official Use Only (Lab4r7 and Materials) 1.BuiIding $ 9 1. Building Permit Fee:$ k`SCE :Indicate how fee is determined: r !i Standard City/Town Application Fee 2.Electrical $ a 0 Total Project Cost Item 6)x multiplier x 3.Plumbing $ DO (J 2. Other Fees: $ I �/ � I�,", 4.Mechanical (HVAC) $ List: e 1y5(I& • 5.Mechanical (Fire $ __� • . - Suppression) Total All Fees:$ Check No. Check Amount: Cash Amo 6.Total Project Cost: $ "7'7) El Paid in Full -Rd Outstanding Balance Due: —:{ 1 SECTION 5: CONSTRUCTION SERVICES 5.1` Constructionrur Supervisor License(CSL) c� -/l s-s�O jd- 9_0 JIola 346/6 License Number /Expiration Date Name of CSL Holder 360 1 1 q/q „ J-J-& jj,, ,),` List CSL Type(see below)No.and Street� � , U Type Description /) i ,rko r /t • b J -7 p,6 U Unrestricted(Buildings up to 35,000 Cu.h.) �( ,(CJ /''r l.� ( L! R Restricted l&c2 Family Dwelling Ci /Town,State,ZIP I NI Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 339-,333-b//7 !)L /)1 I)J at'mr/-J 0 1 Insulation Telephone Email kddress /0 O hp. (') Demolition 5.2 tstered Home Im/rrov(�ement//Contractor(HIC)'-' I J g�s/6 1/ �(� a 3 �� ��"' /!v HIC/Registration Number Expiration Date HIC Com any l or Regi t am No. Street ne�Q'' "_POD�i/��1 �Q !l}(�� n C m g 339- 33-6/T8 >✓hnau address .1 City/Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6)) Workers Compensation Insurance affidavit must b completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issua a of the building permit. — Signed Affidavit Attached? Yes 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 to act on my behalf,in all matters relative to work authorized by this building permit application. e, 4ec - Cl-ei'Vii-( Print Owner's Name(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 true and acc to the •:. of_my knowledge understanding. IVALS L\)(.4 [(7) DI n() 3 l firt-O ifter's or Authorized Agent's Name(E .. rc 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" §TOWN OF YAIUMOUTH 1146 Route 28, South Yarmouth, MA 02664 508-398-22311 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 <A. I C c. b d Q k 9- Work Address Is to be disposed of oat the following location:ILP � ib site shall be a licensed solid waste fail t as defined`by . .LL.. Said disposal tY Ch. 111 50A. g 7-YS Si 're of Application Date Permit No. Page 1 of 1 MA HIC#187510 Long Roofing, LLC • 300 Myles Standish Blvd Taunton MA, LONG HOME 02780 (800)470-LONG • (240)473-1400 • LongRoofing.com PRODUCTS Donna Legere (508) 776-8501 Date: 02/06/2023 34 Railroad Ave djl21860@yahoo.com Product Specialist: David Smith Yarmouth Port MA 02675 The Buyer(s) listed above hereby jointly and severally agree to purchase the goods and/or services listed herein, in accordance with the prices and terms described in this "Agreement." Description of Changes This is an addendum to the contract dated 1/15/23 adding a tempered glass window to the project.The price is to stay the same at$13,770. No other changes to the agreement. Total Purchase Price $13,770 Deposit with Order $4,590 Amount Due on Substantial Completion $9,180 Amount Financed $0 Form of Deposit Check The Estimated Date of Commencement Of The Work Is 8-10 Weeks The Estimated Completion Date Is a-10Weeks I am aware that the above dates are an ESTIMATE The Project Is Contingent Upon Obtaining N/A D L THERE ARE NO ORAL AGREEMENTS It is agreed and understood by and between the parties that this Agreement, constitutes the entire understanding between the parties, and there are no verbal understandings, changing or modifying any of the terms of this Agreement. Buyer(s) hereby acknowledge that Buyer(s) has read Agreement and has received a completed, signed and dated copy of this Agreement, including the two accompanying Notice of Cancellation forms, on the date first written above. Buyer(s) acknowledge that they were orally informed of their right to cancel this transaction, and if this transaction occurred in Virginia, that Buyers(s) has received a completed Virginia Statement of Protections. £�crmtt L.C..jCrt, David Smith Donna Legere 02/06/2023 02/06/2023 Date Date • • • gpgir rortw a.00'a=1144..060vs:ett4 cs ' Division of Professional ltcensgre, Board of Building Regulations and • s Standard ! 4 • Cons>ri,s iviso'r ' d ires 12/29/2024{ { =JAMEp..,O ELL O '{ (te a - pk� z gjyp t•� & 1y r•i „ 5' yz EAST BRID 6 ATE `MA7a' *f a�'� � 2333;� f•; (} fix ' G9trrri4005nei p� •so 'it:` W� ' Fin-t '...,..;, • • • \\\ .. �-._.__-.:"___tF�.u.•-s.__. - `:fit J2 THE COMMONWEALTH OF MASSAUHUSE I I S Office of Consumer Affairs and Business Regulation 1000 Washington:Street - Suite 710 Boston- Masachusett's=02118 Home Improve tent-Contr-actor- Registration Ili m ,i i' , il „; r i,Type: Supplement Card , __ _ Registration: 187510 LONG ROOFING LLC Li r" Expiration: 04/20/2023 D/B/A LONG HOME PRODUCTS ,,I�4' _, i'_ 8530 CORRIDOR RD, SUITE 200 � I ,I SUITE 200 i° v," y ' SAVAGE, MD 20763 l' 1 ,,,, —�' 1 a--' \ , a' Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENTCONTRACTOR expiration date. If found return to: TYPE:_Supprement:Card Office Consumer Affairs and Business Regulation Registration Expiration 1000 a hington Street -Suite 710 1875-10 -7..U;04/20/2023 Bos on, A 02118 .ONG ROOFING LLCw; J`' rd i ; )/B/A LONG HOME PRODU TS 1r 's5 Y AYrJ �..: J K ��1..,7 JY ,.n.+e,--...�,......�.�^""-^^""_ 1 f ' / TAMES COSTELLO i ., � 1 1530 CORRIDOR RD,SU,iTE-20D I�,+' ! ��/ (GL•�*xfi' /v SUITE 200 <�r 4 :4+ ' ' UndersecretaryNot valid without signature SAVAGE, MD 20763 - 9 • The Commonwealth of Massachusetts Department of Industrial Accidents 9 fp Office of Investigations t� �� Lafayette City Center d !% 9 2 Avenue de Lafayette, Boston, MA 02111-1750 ~ www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Long Roofing LLC/Long Baths LLC _ Address:300 Myles Standish Blvd City/State/Zip:Taunton MA 02780 Phone #:339-333-6118 Are you an employer? Check the appropriate box: Type of project(required): 1.0 I am a employer with 25 4. n I am a general contractor and I employees (full and/or part-time).* have hired the sub contractors 6. El New construction 2.n I am a sole proprietor or partner- listed on the attached sheet. 7. ❑$ Remodeling ship and have no employees These sub-contractors have 8. n Demolition workingfor me in anycapacity. employees and have workers' p tY 9. ❑ Building addition [No workers' comp. insurance comp. insurance.t required.] 5. n We are a corporation and its 10.111 Electrical repairs or additions 3.n I am a homeowner doing all work officers have exercised their 11. 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 no employees. [No workers' 13.n Other 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 Name: Liberty Mutual Insurance Corporation Policy#or Self-ins. Lic. #:WC5-315-626143-013 Expiration Date:1/1/24 Job Site Address: `�� £((J J City/State/Zip: Ia(fit,/�,��'W�i 7 Attach a copy of the workers' compensation policy declaration page(showing the policy nu er 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 certify under the •• 'ns and pena es • :- ' • at the information provided above . true and correct. Signature: Date: (( C 3 Phone#: 33% 33- 118 Office" use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority(check one): IDBoard of Health 20 Building Department 3UCity/Town Clerk 4.11 Electrical Inspector 5 nPlumbing Inspector 6.0Other _ Contact Person: Phone#: ___—', LONGFEN-04 DHARRIS ,4C I RL CERTIFICATE OF LIABILITY INSURANCE DATED/YYYY) �/ 1 1/3/2/3/2023 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER License#0C36861 CONTACT Danielle Harris NAME: Lanham-Alliant Ins Svc Inc PHONE I FAX 16901 Melford Blvd Ste 123 (A/C,No,Ext): (A/C,No): Bowie,MD 20715 noon ss:danielle.harris@alliant.com - INSURER(S)AFFORDING COVERAGE NAIL* INSURER A:Everest Indemnity Insurance Company 10851 INSURED INSURER B:Commerce Insurance Company 34754 Long Roofing LLC dba Long Home Products INSURER C:Burlington Insurance Company 23620 300 Myles Standish Boulvard INSURERD: Taunton,MA 02780 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. INSR LTR TYPE OF INSURANCEN°SO SUBR POLICY NUMBER POLICY EFF POLICY EXP IY LIMITS (MMIDDYI'Y) (MM/DD/YYYY), _ A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR CF4GL01198-221 12/31/2022 12/31/2023 DAEMGEETOEoNccTuEDe ncs) $ 100,000 MED EXP(Any one person) $ I PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X PE Q LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: EBL AGGREGATE $ 2,000,000 B AUTOMOBILE LIABILITY (Eaacci entSINGLE LIMIT $ 1,000,000 ANY AUTO BCDX02 12/31/2022 12/31/2023 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY X AUTOS BODILY INJURYp (Per accident) $ AUTOS ONLY NON-OWNED ONLYY (Per a dent)AMAGE $ $ C UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 X EXCESS LIAB 1 CLAIMS-MADE 6008E00525-03 12/31/2022 12/31/2023 AGGREGATE $ DED RETENTION$ Aggregate $ 5,000,000 WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 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. Town of Yarmouth AUTHORIZED REPRESENTATIVE boyeile_ iiii,e_46 , ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DATE(MM/DD/YWY) AccPRE)® CERTIFICATE OF LIABILITY INSURANCE 1/8/2023 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 rights to the certificate holder in lieu of such endorsement(s). CONT PRODUCER ALLIANT INSURANCE SERVICES INC NAMEACT 16901 MELFORD BLVD STE 123 PHONE FAX BOWIE, MD 20715 (A/C, Ex (A/C,N _ - IL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER LM Insurance Corporation 33600 INSURED INSURER B: LONG ROOFING LLC DBA LONG HOME PRODUCTS INSURERC: LONG BATHS LLC INSURER D: 8530 CORRIDOR RD INSURERE: SAVAGE MD 20763 INSURER F: COVERAGES CERTIFICATE NUMBER: 72387605 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. INSR ADDLISUBR ! POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD! POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S __ f DAMAGE TO RENTED l CLAIMS-MADE r li OCCUR PREMISES occurrence) $ 1MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: _GENERAL AGGREGATE $ POLICY JECT LOC PRODUCTS-COMP/OPAGG $ OTHER: ,$ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED r ! SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB _ — OCCUR EACH OCCURRENCE $ _ L._ EXCESS LIAB _ CLAIMS-MADE ,,. AGGREGATE $ DED 1 RETENTION$ I j $ A WORKERS COMPENSATION WC5-31S-626143-013 1/1/2023 1/1/2024 STATUTE OTH- ER AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1000000 OFFICER/MEMBEREXCLUDED? Y 'N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1000000 If yes,describe under - - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1000000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional RemarksSchedule, Sc edule,may be attached if more space is required) WORKERS COMPENSATION INSURANCE COVERAGE APPLIES ONLY TO THE WORKERS COMPENSATION LAWS OF THE STATE OF MA. This certificate cancels and supersedes all previously issued certificates,only as they relate to workers compensation coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Yarmouth ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Jon Smith ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 72387605 1 1-626143 123-24 WC- 1 n0270258 11/8/2023 5:11:08 PM (PST) 1 Page 1 of 1 0 Tue 1213.2C22 4:42 PM �lo,_ Miller �jQ c.r�l�ill r@khpp.us> RE: Request for Window Manufacturer's Specification Sheet Pires 652180 To Daniel Carlson Cc Customer Service,:.Anthony Yodice I Meridian Double Hung U- glass Air CPD# factor SHGC VT Condensation Resistance Grid package Infi tratior North KHI-IM-23-00060-0000_ 0,2 0.23 0.41 65 G Barrier 0.09 cfmlft; I Meridian Slider North KHI-M-21-00060-0000_ 0.21 0.23 0.41 64 G Barrier 0.05 cfm/ft: Certified Products Directory(nfrc.org) Data can be verified at the 'ink above using the CPD number. Joyce A. Miller (\tanager Customer Relations KHPP Wit-claws and Doors 724-236-0503- Direct 724- 845-5421 Fax • ONE or TWO FAMILY— BULDING PERMIT APPLICATION REGULATORY APPROVALS NOTICE Address of Proposed Work: 3 (La (. yaripoic#, r7t- PProposed ( ��CiS 4�*(YI' o.�3 / �1, Q . r')a2(o 7 Scope of Work: S�' (JAM-- � / 4 l.� Date: Based on the scope of work described above, the applicant is required to obtain approval sign- offs from the following departments as checked-of below: Health Dept. —508-398-2231 ext. 1241 Conservation—508-398-2231 ext. 1288 Water Dept. —99 Buck Island Road, 508-771-7921 Old Kings HWY. Hist. Comm. —508-398-22631 ext. 1292 Engineering Dept.—508-398-2231 ext. 1250 Fire Dept.— Kevin Huck/Scott Smith, 96 Old Main Street, SY Note: Please call Fire Department for an appointment. 508-398-2212 Other Appropriate plans and/or application shall be provided to each departments checked-off above. Each of these regulatory authorities has their own requirements outside the jurisdiction of the Building Department. All applicable approvals shall be obtained prior to submitting a building permit application to the Building Dept. Thank you for your cooperation. Receipt Acknowle.:-men • / (?_3 Applicant's Signa ate Rev.Jan. 20 z . p tr,771, REYEKE)FOR DUILIING AND ZOIG CODE COMPLI- k<IE, ERRORS OR OMISSIONS DO NOT RELIEVE THE VACANT FROM THE RESPONSIBILITY OF"AS BUILT" COMPLIANCE. DATE: UILDIN FFIC1AL Toilet (11111) (10) LID AjiueA