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HomeMy WebLinkAboutBLDPS-22-007257 ' R E C E I VOTE, TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department .`ort r JUN 15 2022 1146 Route 28,South Yarmouth,MA 02664-4492 , 508-398-2231 ext. 1261 Fax 508-398-0836 'f. Bui�oiNG [7A Massachusetts State Building Code,780 CMR aY i�lz lermitApplication To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: .5-22,-(b7oSr7 Date Applied: Ar \e. ; '',' .NCS 1'#" Building Official(Print Name) • gnature Date SECTION 1:SITE INFORMATION Li Property Addres : 1.2 Assessors Map&Parcel Numbers 1.1 a Is this an accepted street?yes ✓ no Map Number Parcel Number 1.3 Zoning Information: 1.4 Prooperrtty Dimensions: R- 15 Ioc \- '��rca, oak 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 4 30' 1i3O ‘ 5 ` 1\' -ao' i 7a ' 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❑ On site disposal system I/ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: SOAR SOmmons W a y kCeADAN r Mkt o a(13 Name(Print) City,State,ZIP C,'noc e\ ©',,IN. �s jsitnmonsadkei 0,,(et,miel-ion. No.and Street Telephone Email Address co N, SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction Il Existing Building❑ Owner-Occupied 0 I Repairs(s) 0/ Alteration(s) ❑ Addition 0 f>7I Demolition 0 Accessory Bldg. 0 Number of Units Other Specify:So-4w,ttw^41 Qo o\ Brief Description of Proposed Work2:70 ;t,s}&t' A flu' y.'s-1' zo n:Ee cw i,A m:Aa y,,,0,‘ no, AC-cm (Abrt rv4 r,vVa ►va cooker osrvA Jan ` t-ec1rtii (6,14,1"li 19 ►► cijAi1t sea SECTION 4:ESTIMATED CONSTRUCTION COSTS. Item Estimated Costs: pffici Use Only (Labor and Materials) . 1.Building $ C 1 r 5 U rj 1. Building Permit Fee:$ .j Indicate how fee is determined: 2.Electrical $ El Standard City/Town Application Fee 5, 0 00 0 Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 0 2. Other Fees: $_ C. K*11116 4.Mechanical (HVAC) $ 5 ,0 OD List: \ IV 5.Mechanical (Fire $ . ... . . Suppression) 0 Total All Fees:$_ Vi Check No. Check Amount Cash Amount: �l 6.Total Project Cost: $ (o 1 ) 50 0 0 Paid in Full 0 Outstanding Balance Due: 10/\\4\11. SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number Expiration Date Name of CSL Holder List CSL Type(see below) No.and Street Type Description U Unrestricted Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP lvl Masonry RC _Roofing Covering • WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) l oroe(k A \3e(\k CS a O'4O rota ► l r o/aoa3 HIC Company Name or HIC Registrant Name HIC Registration Number Expiration Date G. 'tr t' Sktvt ( tvc O . i5,(orr No,and Street Email address ?Ater:u1k AAA o\ fib.► ctl$-66 -- ` 1611) 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 Iss 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 C V SVO M O Wk\'‘4`\ Q p c,SS to act on my behalf,in all matters relative to work authorized by this building permit application. Jc t'Z S'.mmthnS to/tL\ a() 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 accurate to the best of my knowledge and understanding. Rth cc A i3 nk / ILA ) 10 a,a 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.aov/oca Information on the Construction Supervisor License can be found at www.mass.eov/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" The Commonwealth of Massachusetts =. l Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers. TO BE FILED WITH THE PE12MITTING AUTHORITY. Armllcant Information Please Print Legibly Name (Business/Organization/Individual): C USA-0 m Q a\ r( 0 O lj Address: ( r *1\ C City/State/Zip: ? I\l€C%C.0 i AAA oyta Phone#: C1 7'6 ` ('(0 3 — g q V Are an employer?Check the appropriate bog: Type of project(required): 1. i am a employer with AO 4. employees(full and/or part-time).* 7. ❑New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself.(No workers'comp.insurance required.]t 9. Demolition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 1 Q Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.0 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 I..❑ . •of repairs " 6.0 We are a corporation and its officers have exercised their right of exemption per,biGL c. I 4.lU Other t\ ' f Q O p 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 Eiomeowners 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. f am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: C onk,c\en1c Wes -er - 1n�. Co . Policy#or Self-ins.Lic.#: W PA 5 H 73 17 1 — 10 Expiration Date: t7 a Iv I Job Site Address: . Oland Po\fl\ DC Ci /State/Zi , ty p� Wes-4 l Glt'(1rI oA t ,N1� 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 ains and penalties of perjury that the information provided above is true and correct. • Signature: Date: (e_/ 1 /'a D a• Phone#: 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#: 1 m C E T wTo 0 K 0 o 15 N e to O C m O Ds 0 m CO tN m m i _C Q Q to.-0 a o C C Nco Q m ct oo 'Sm� •O a a E 1 "r ++ ., asco 76c� O. CO Z 41.'4 C ay. gE C ?: •` O Q g N Cn Rh w L _ N QI III ro g; to CO l 'ate p� > y C < s > *egg O 1 Ems i 33 J � t, s 0'o O-Q z d 9 e1 tt tt c U m g c �► sip 1 w s ; ,t. t ,t. t. tttlt„. y xt04 e .t tt!}llimm I o c r . H a•jSK), 0) ,,,.,,, II, tll HI < .s. :,ll 1 4 (. 1 m C 0 Lna QL w 111 m.o. ,9.,J• O Q E +c9 3 0a` rn re 1 , OOm c ' 3 c.c_ *dr i 0 C. r N y° m ac.c c Al, t �' 1 p = l �0 4 o>m U Q fr �Q N 2- ~ A UE.°o �xU N � a } ~ tu —I i �p �= O wii s11a s8 o � m m i a: tr I Df, 'a. sO El i 't Ua- N O i (4u w -.I 'la-. +f4 wilt lilt r 9 I— .�' Q w m Ore `' c . 11- co OZw av g �. 71 E. J Q =Z I U o = Ucoon w 0 0 �ciQ O co E , >Zw cn w Z J U _ cnn<c m • THE COMMONWEALTH OF MASSACHUSETTS ' Office of Consumer Aff Business Regulation 1000 Washing -Suite 710 Home Im ro• .etration v � � .arims warm.ems/r aiBr .Type: Supplement Card CUSTOM QUALITY POOLS INC. = � >oon: 01000847/75/2024 6INNIS OR. 1, BILLERICA,MA 01821 'III ib update Address and Haan CNN. THE COMMONWEALTH OF MASSACHUSETTS• val id for Individual use only before the Ocoee of Consumer aBMWtes0 Re Reg HOME exaltation data.Iffound return b: • Mee of Consumer Affairs and Bestrmes Regulation 1008 Wuhlagto r Street-Suns 710 Boston,MA 02110 CUSTOM QUALITY STEVE REALE 6INNIS OR. 's... BILLERICA,MA 01821 Ur1dBtnoonot y Not valid without signature OB n of Professional r fg sf 8Maas LicOsuUre Board nt Molding Regulations and Standards Conarilt AS1r8sor CS-040192 ., < Aires:01/10/2023 ROBERT A FONT .11PO BOX 103Y - BILLER/CA s ¢v ' RO Commissioner;/i•r� �'� Sears, Tim From: Sears, Tim Sent: Tuesday, June 21, 2022 9:58 AM To: 'steve@customqualitypools.com' Cc: Water Department; Hudson, Heidi Subject: 2 Channel Point Dr Attachments: swimming pool checklist.PDF Steve, I have reviewed your application for the pool and there are some items needed. �1. Health Department sign off(under review) 3/ Conservation sign off N . Water Department sign off Second copy of pool plan ‘,5! Completed checklist(attached) Please submit these items for review This email is considered a written denial of your permit application per Section 105.3.1 of the Massachusetts State Building Code. Section 105.3.2 states in part that "an application for a permit for any proposed work shall be deemed to have been abandoned 180 days after the date of filing, unless such application has been pursued in good faith" You may appeal this denial to the Building Code Appeals Board in accordance with M.G.L. c. 143 §100,within 45 days of this notice. Timothy Sears CBQ Deputy Building Commissioner Town of Yarmouth 503-39 -2231 Ext. 1259 mailto:tsears@yarmouth.ma.us 1 TOWN OF YARMOUTH t4y i HEALTH DEPARTMENT o '� *f to CN'�4' PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Building Site Location: a c\1U n tl e 1 Qo't c f, Wes* Ucm o u}k / Proposed Improvement:fro ‘r c 11 \V,.% r1:K. S W M(`t+t ny off/ 1 i- cl,n ft S TM mrco'W c rAt,cnc l;r S0.C.e cover c&r`& 04J inAecfr21 '4 ' It6 4, if myf1 rlk7 Applicant: Cu Sc 0 M Ovca1;1-� Q OCAS Tel. No.: c\1(S ' 6 (a ?.1 `i D Address: (o Y\r1`S tic ) ,i\\e.c C ci MA 0 \$ a\ Date Filed: (,/ 13/a a **If you would like e-mail notification of sign off,please provide e-mail address: jeNn‘coracusiLomqvaidypookg •C.o r n Owner Name: J UKe S.‘men,0l1 S Owner Address: el OM/MI6 '‘eik Or ,Flo lacpnnA MA 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, Re m .ms and septic system location; JUN 15 202? (2.) Floor plan labeling ALL rooms within building (all existing and proposed) — HEALTH DEPT. Note:Floor plans not required for decks, sheds, windows, roofing; (3.) If necessary, Title 5 application signed by licensed installer with fee. REVIEWED BY: n,v-17,4 Cam..— DATE: 17,'6 PLEASE NOTE COMMENTS/CONDITIONS: The Commonwealth of Massachusetts Department of Industrial Accidents t ;3t) 1 t Office of Investigations =011= 1 Congress Street, Suite 100 I MI I1=7 Boston,MA 02114-2017 • www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Custom Quality Pools Address: 6 Innis Drive City/State/Zip:Billerica, MA 01821 Phone #:978-663-8290 Are you an employer? Check the appropriate box: Type of project(required): 1. I am a employer with 20+ 4. ❑ I am a general contractor and I 6. New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.* required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 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 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no inground pool employees. [No workers' 13.❑■ Other comp. insurance required.] *My 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:Continental Western Ins.co. Policy#or Self-ins. Lic. #:WPA5423171-10 Expiration Date:02/01/2023 Job Site Address: 2 CHANNEL POINT DR City/State/Zip:West Yarmouth, MA 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 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 pains and penalties of perjury that the information provided above is true and correct �e/2 — Date 6/14/2022 Signature: Phone#: 9786638290 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#: in TOWN OF YARMOUTH `Ir0 WATER DEPARTMENT iv 4,t -1 99 Buck Island Road West Yarmouth, MA 02673 Telephone: (5€18) 771-7921 ' Fax: (508i 7:71-'998 BUILDING PERMIT APPLICATION FOR WATER DEPARTMENT SIGN OFF TRANSMITTAL FORM BUILDING SITE LOCATION: 2 Channel Point Drive, W. Yarmouth MA PROPOSED WORK: Install a 16x32' gunite $wimmin pooa.l. w/ 6'6"x6'6" interior spa APPLICANT: Custom Quality Pools ADDRESS: 6 Innis Drive, Billerica MA 01821 • TELPHONE: 978-663-8290 RESIDENTIAL AND/OR COMMERCIAL BUILDING Water Department: Determines Compliance of Water Availability and or existing location Engineering Department: Determines Compliance for Parking and Drainage Conservation Commission: Determines Compliance to Wetlands Act: i e If lots)border any type of wetlands,streams,ponds,rivers,ocean, bogs,boys, marshland, ETC... Ilealth Department: Determines Compliance to State and Town Regulations, i.e. requirements for Septage Disposal and other Public Health Activites Fire I)epartment: Determines Compliance to State and Town Requirements for Personal Safety,Property Protections, i.e.Smoke Detectors,Sprinkler Systems,etc ,,,,,„,--4- 4 - - 6/22/22 APPLICANT SIGNATURE DATE OFFICE USE: COMMENTS ON PERMIT APPROVAL OR DENIAI, REVIEWED BY WATER DIVISION(SIGNATURE) DATE tO w SERVICE NO. 7 S .2 NAME / STREET 2, 1 Are'to/ 4,s/ 10n,/✓G (J/ ,y, VILLAGE 440 YA".r',graJfj METER NO. /iit -eriSAPY salvia • f J P /fthcAle. G•%f • 31.06 341 \or AI vat 3a, Se#44) 16#4 8� _,„.......4i CUSTO-1 OP ID: KT d4WRO- DATE(MM/DD/YYYY) 4...,.,--- CERTIFICATE OF LIABILITY INSURANCE 01/28/2022 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 781-642-9000 CONTACT Eastern States Insurance PHONE 781-642-9000 FAX 781-647-3670 Agency,Inc. (NC.No,Ext): (NC,No): 50 Prospect Street E-MAIL Waltham,MA 02453 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Union Insurance Company 25844 INSURED INSURER B:Acadia Insurance Company 31325 ustom Quality Pools,Inc.6 Innis Drive INSURER C Continental Western Ins.Co. 10804 Billerica,MA 01821 INSURER D: 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MM/DD/YYYYI (MM/DD!YYYYI B X COMMERCIAL GEtIERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X X CPA 0328206 02/01/2022 02/01/2023 PAR M SEs(EaEocccurrence) $ 500,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 JECT OTHER: Emp Ben. $ 1,000,000 COMBINED SINGLE LIMIT 1,000,000 A AUTOMOBILE LIABILITY (Ea accident) $ ANY AUTO X X MAA 0328208 02/01/2022 02/01/2023 BODILY INJURY(Per person) $ OWNED AUTOS ONLY MEWLED SCHEDULED BODILY INJURY(Per accident) $ X HIRED X NON-OWNED PROraEdRidentpAMAGE $ AUTOS ONLY _ AUTOS ONLY $ B X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE CUA 0328210 02/01/2022 02/01/2023 AGGREGATE $ 5,000,000 DED X RETENTION$ 0 $ C WORKERS COMPENSATION X STATUTE ERH AND EMPLOYERS'LIABILITY 02/01/2022 02/01/2023 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE YN N/A WPA5423171-10 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? 500,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B Equipment Floater CPA0328206 02/01/2022 02/01/2023 Sched 270,000 Leas/Rent 25,000 DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) HERC RENTALS INC.IS INCLUDED AS ADDITIONAL INSURED IN REGARD TO GENERAL LIABILITY AND AUTO LIABILITY WHEN REQUIRED BY WRITTEN CONTRACT.HERC RENTALS INC.IS INCLUDED AS THE LOSS PAYEE IN REGARDS TO LEASE/RENTED EQUIPMENT CERTIFICATE HOLDER CANCELLATION HERBONI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZEDHO/ REPRESENTATIVE�� I ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD • TOWN OF YARMOUTH 0 , y BUILDING DEPARTMENT ' '' 1146 Route 28,South Yarmouth,MA 02664 508-398-2231 ext. 1261 Fax 508-398-0836 Office of the Building Commissioner SWIMMING POOL& SPA PERMIT APPLICATION CHECK LIST -Compete application -Pool/Spa designation x Private, Semi Public, Public -Pool Type x In Ground Above Ground Inflatable-24 inches&deeper -Proposed Location x Outdoor Interior -Barrier Description or Approved Cover Specifications—NOTE: Spas &Hot Tub Safety Covers and Pool Powered Safety Covers shall comply with ASTM F 1346 Standards(American Society for Testing&Materials—International Standards Worldwide). Hydramatic by Aquamatic Cover Systems- UL tested ► and certified to exceed ASTM F1346-91 standards . If erecting a fence,please describe and depict on Certified Site Plan with Pool Location: N/A Please note who will be responsible for fence installation. Pool Installer Property Owner -Above Ground Pool Ladder/Stairs Description(shall comply with International Swimming Pool and Spa Code as amended, Section702) Type A ,Type B , Type C ,Type D ,Type E ,Type F -Heater x Yes No If Yes, a Gas permit is required. -All Pools and Spas require a Wiring Permit -Exterior Door Alarm(s)please note location(s) N/A All Pools and Spas shall comply with the applicable provisions of 780CMR, State Building Code/International Swimming Pool and Spa Code, as amended. In addition, Outdoor Semi Public and Public Swimming Pool Barriers shall comply with MGL Chapter 140, Section 206. NOTE: 1. AS THE PERMIT HOLDER YOU ARE REQUIRED TO CALL FOR ALL REQUIRED INSPECTIONS,INCLUDING THE FINAL INSPECTION. 2. Semi Public and Public Pools are subject to annual inspections. Fonn June,2019,ISPSC 2015 �'` !O Conservation Office o? *3 Town of Yarmouth o rmouth.ma.us " ',itzConservation Commission Ott c�'�Se�t,�tr Building Permit Sign-off Application °rn�tiss;�� °n TO BE FILLED OUT BY BUILDING PERMIT APPL A NT�N:• -A 4022 Building Site Location: (POOL) 2 Channel Point Drive, W. Y C P E0 Map# 14 Lot(s)# 9 Property Owner: Jake Simmons Date filed: *Applicant: Custom Quality Pools Applicant Address: 6 Innis Drive, Billerica MA 01821 Email: j ennifer@customqualitypools.com Telephone: 978-663-8290 Please Note:By submitting this application the applicant grants permission to the Conservation Office to enter the location to conduct a site visit(if needed). Proposed Project Description: Install a 16x32 ' gunite swimming pool with an ASTM approved automatic safety cover and an integral 6 ' 6"x6 ' 6" gunite spa. • Site Plan Title/Date: Proposed Garage and Pool Locations - 8/25/21 TO BE FILLED OUT BY CONSERVATION ADMINISTRATOR: Does the proposed project require a permit? V,e-- v Refer to: SE83- -3O 2 or DOA permit ---'— ( Comments from Conservation Commission: Approved Conditionally Approved Rejected Conservation Commission Sign-off Signature: Date: i a 31 *TO APPLICANT: All work-related debris shall be taken offsite or disposed in a legal upland location. At the end of each day, the area shall be clean and no debris shall be in the Resource Area. If work is permitted under an Order of Conditions, please arrange a pre-construction site visit with the Conservation Administrator. At the time of site visit, the MassDEP File Number sign must be installed, along with the erosion control/work-limit line. A copy of the Order of Conditions must remain on-site during construction. Please refer to the Order of Conditions for further details.