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HomeMy WebLinkAboutBLD-23-000447 unit A I . RP. C'E_ I t0'1�_ BUILDING PERMIT APPLICATION • • �t APPLICATION TO CONSTRUCT REPAIR, RENOVATE, CHANGE THE USE,OCCUPANCY OF, J U L 2 7 .,1',C fai OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLI NG. Mt, � Town of Yarmouth Building Department N_ t i iti Route 28 • Yarmouth, MA i)2 �� ( BUILDING DEPA' /W:d6 4-449_ �Y. Tel: 508-398-2231 ext. 1261 Fax 508-398-0836 .f3U -i - Ig.,, , ,tficeOfficeUse Only Planning Board Information Assessors Department information: ~ Permit No.71A1"AlDate Plan Type • Map Lot • i.\, Permit Fee $'1-\0 Endorsement Date / i Deposit Ran:I $ Date Recording Date New � Plan No. 1.4 Property Dimensions CA Net Due $ 1 Ob Other Lot Area(at) Frontage(It) Cot Ca verape 1IB1d1 Permit Number: This Section for Office Use only d: Date issue Signature: • 5 �, Certificate of Occupancy- Building O al Date is Is flat required • Section 1 -Site Information I 1.1 Property Addreast 1.2 Zoning Information: ._J225 Whites Path, South Yarmouth, MA 02664 • Zoning District Proposed Use 1.3 Building Setback(ft) ' Front Yard Side Yards Required Provided Rear Yard Required Provided Required Provided 1.4 Water Supply(MA.Q.L c.40.S 54) 1.5 FloodZone information: Rubric comments . Private Zone: BFE: . Section 2• Property Ownership/Authorized Agent 1 2.1 Owner of Record: 1 Greg Bilezkian I 231 Willow St Yarmouthport MA 02675 Name(print) See attached authorization form with signature I Mailing Address: signature I gbilezikian@4-corners.com Telephone _ Telephone • Email Address:2.2 Authorized Agent:I Patrick Finn , 115 Research Rd East Falmouth MA 02536 Name(prints _ 339-832-1555 Mailing Address: Signature Telephone Fax pfinn@dellbrookjks.com j Section 3- Construction Services L"'�" ; ' 3.1 Licensed Construction Supervisor. _ Greg Inman Not Applicable PO Box 561 North Falmouth MA 02556 Li en flu•_ Address CS-111705 I508-889-7269 I ginman@dellbrookjks.com Sign Lure Expiration Date . Telephone Email Address: 12/29/2022 • 3.2 Registered Home Improvement Contractor. Company Ham. Not Applicable X • Address Registration Number Expiration Date Signature Telephone Section 4-Workers'Compensation Insurance Affidavit(M,G.L a 152 S 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 issuance of the building permit. Signed Affidavit Attached Yes ...n.. No Section 5- Professional Design and Construction Services-for Buildings and Structures Subject to Construction Control Pursuant to 780 CMR 116(containing more than 35,000 c.f. of enclosed space) Section 5.1 Registered Architect Kurt E. Raber Not Applicable ❑ Harm"M arshal1mM 1203 Willow St, Suite A (Yarmouthport, MA 02675 Reliallettoallmber Address 10563 See attached initial construction control Affidavit 508-362-8382 Expiration Date I gna ure Telephone 8-31-2022 Section 5.2 Registered Professional Engineer(s) Hama Area at Responsibility Address Registration Number Signature Telephone Expiration Date Name Area at Rest Address Registration Number Signature Telephone Expiration Date Hama Area of Responsibility Address Registration Number Signature Telephone Expiration Date Hama Area of Responsibility Address Registration Number • Signature Telephone Expiration Date Section 5.3 General Contractor Dellbrook JKS Not Applicable 0 Company Hama f Greg Inman r arson rtespoxns le for Construction 15 Research Rd East Falmouth MA 02536 -AddressL-�" r 508-540-6226 Signature Telephone Section 6- Description of Proposed Work(check all applicable) 'ti New Construction CD (for multiple family only} No.of Bedrooms (for multiple family only) No.of Bathrooms .,,, Existing Bldg. ® Repair(s) Q Alterations ® Addition Q Accessory Bldg. 0 Type Demolition Other Specify: Fence ' Brief Description of Proposed Work: • Build new sound attenuation fence along property line approximately 730 feet in length varying from 13 to 16 feet tall. Section 7- Use Group and Construction Type j Building Use Group(Check as appfcapable) Construction Type • A ASSEMBLY 0 .A4 ❑ A-2 0 A-3 p 1A ❑ B BUSINESS ElA-4 ❑ A-5 ❑ 1B Ca E EDUCATIONAL Q zA ❑ F FACTORY 28 Y o F-1 ❑ F-2 ❑ 2C H HIGH HAZARD o lidl 1 rNSTFTUTIONAL 1-1 3A CI ❑ r z M MERCHANTILE ❑ ❑ I'3 ID3B ❑ R RESIDENTIAL 4 0 R-1 ❑ R-2 0 R-3 ❑ SA ❑ S STORAGEIN S-1 U UTILITY , t,C ,] a AA MIXED USE - SPECIFY: S SPECIAL USE 0 SPECIFY SPECIFY I Complete this.section if existing building undergoing,renovations,additions and/or change hi use. Existing Use Group: —i S1, S2, L____.__ Proposed Use Group:.Si, S2, Bil Existing Hazard Index 78D CMR 34 3❑ Proposed Hazard Index 780 cMR 34 El Section 8 Building Height and Area 1 ' Building Area Existing(if applicable) Number of floors or stories Proposed include basement levels E E1 Floor Area per Floor(sf) 109,760 109 0 Total Area All Floors (sf) _ 109,760 1109,760 Total Height(ft) - 41 141 Section 9 -STRUCTURAL PEER REVIEW(780CMR 110 11) I Independent Structural Engineering Structural Peer Review Required Yes Na. No I SECTION 10a OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT . I Greg Bilezkian i , as Owner of the subject property, hereby authorize !Patrick Finn j my behalf, in all matters relative to work authorized b this buildin to act on y g permit application. See attached authorization form with signature See attached Signature of Owner Oats SECTION 10b OWNER/AUTHORIZED AGENT DECLARATION • Patrick Finn ` , as Owner/Authorized Agent hereby declare that the statements and information on the forgoing application are true and acurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. • 1� P4•ha Print Nam t1/06ei 3/320z . Signature of Owner/Agent Date Section 11 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be completed by permit applicant 1.Building 500,000.00 a Electrical 3.Plumbing/Gas 4.Mechanical(HVACK 4 5.Fire Protection e.Totat.e(1+2+3+4+5) 500,000.00 ' 7.Total Square Ft turn.w saw s acickore) Check Below ❑ Conservation-Commission Filing (if applicable) ❑ Old Kings Highway&Historical Commission approval (if applicable) Property Owner Must Complete and Sign This Section If Using A Builder I>662fc <-d�D�J'W�n. as Owner of the r subjectproperty hereby auth ize l r r/ck /t'A/ O //loek V `to act on my behalf, in all matters relative to work authorized by this building permit application for: 225 Whites Path, South Yarmouth, MA 02664 (Address of Job) aieT,,,,,„, Sign •e of Owner Signature of Applicant 6 V, ea./rick C Fi Ntl Prwt Name Print Name Date Q:FORMS;OWNERPERMISSIONPOOLS Rev:08/16/17 _ The Commonwealth of Massachusetts ► "� l Department of Industrial Accidents =_:ii�n►.= I Congress Street,Suite 100 t� MO Boston,MA 02114-2017 . www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual):Dellbrook JK Scanlan Address: 15 Research Road City/State/Zip: East Falmouth, MA 02536 Phone#:508-540-6226 Are you an employer?Check the appropriate box: Type of project(required): f.❑I am a employer with 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 $. ❑Remodeling any capacity.(No workers'comp.insurance required.] 3.[:1 i am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. El Demolition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. 1 will I0❑Building addition ensure that all contractors either have workers'compensation insurance or arc sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0 i am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.El Roof repairs These sub-contractors have employees and have workers'comp.insurance: 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 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 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. Tithe 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:Federal Insurance Company Policy#or Self-ins.Lic.#:005-4309740-03 Expiration Date:7/1/22 Job Site Address:225 White's Path City/State/Zip:Yarmouth, MA 02664 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as equired under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprison nt 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. co of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify u d r the ains nrpena tips of perjury that the information provided above is true and correct. Signature: Dab: 5 65-#aka Phone#:508-540- 26 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#: CamrnonWealth of Massachusetts �° Division of PRfeulat ons and Standards Board of Building hr tsor Consttpia pps 121291202z gjcpires CS-i 11705 :� �f',� ri GREGORY Y1 INM y PO BOX 661 1 'u 0265.pi : NORTH FALMQISfli MAC flf Commissioner ply YE" HATE(MMIDDIYYYY) A�coR® CERTIFICATE OF LIABILITY INSURANCE 3/22/2022 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 pollcy(les)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 CONTACT NAME: Stephen Turner Alllant Insurance Services, Inc. Pam"; �t1;617-535-7200 i FAX Nel:617-535-7205 131 Oliver Street,4th Floor E-M Boston MA 02110 ADDRESS; stumer[d3alliantcern INSURER(S)AFFORDING COVERAGE NAICS , _INSURER A:Starr Indemnity&Liability Co 38318 INSURED INSURER B:Executive Risk indemnity Inc 35181 Dellbrook JK Scanlan One Adams Place INSURER C:Federal Insurance Company 20281 859 Willard Street INSURER D:American Guarantee and Llabili 26247 Quincy MA 02169 _INSURER E: _INSURER F: COVERAGES CERTIFICATE NUMBER:1285532130 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. L TYPE OF INSURANCE ADDI SUER POLICY EFF POLICY EXP LIMITS WVD POLICY NUMBER (MMIDD/YYYYI (MMIODNYYY) B X COMMERCIAL GENERAL LIABILITY Y Y 54309739-03 7/112021 7/1/2022 EACH OCCURRENCE $2,000,000 DAMAGE TO RENTED CLAIMS-MADE a OCCUR PREMISES IEa occurrence) $300,000 X XCU MED EXP(Any one person) $10,000 X Contractual PERSONAL&ADV INJURY $2,000,000 GENT.AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000.000 POLICY P7( PROT- IFiI LOC PRODUCTS-COMP/OP AGG $4,000,000 I JEC $ OTHER: pp MBINED SINGLE LIMIT C AUTOMOBILE LIABILITY Y Y 21-5430-97-38 7/1/2021 7/1/2022 eOMccldeDl $1,000,000 X ANY AUTO BODILY INJURY(Par person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS PROPERTY SAMAGE HIRED — NON•OWNED (Par accident) $ AUTOS ONLY — AUTOS ONLY $ A UMBRELLA LIAB X OCCUR Y Y 1000584533211 7/1/2021 7/1/2022 EACH OCCURRENCE $10.000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000 DED RETENTIONS $ C WORKERS COMPENSATION Y 005.4309740.03 7/1/2021 7/1/2022 X rST TUTE EH AND EMPLOYERS'LIABIUTY Y/N ANYPROPRiETOR/PARTNER/EXECUTIVE a N/A E.L.EACH ACCIDENT $1,000,000 OFFICEAWMEMBEREXCLUDEO?(Mandatory In NH) E.L DISEASE•EA EMPLOYEE $1.000,000 11 yes.describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $1.000,000 0 O Excess Liability AEC-4222834.01 7/1/2021 7/1/2022 Each te15,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 10i,Additional Remarks Schedule,may be attached It more space Is required) 225 White's Path Units 2 and 3 LLC is included as Additional Insured as required by written contract and executed prior to a loss,but limited to the operations of the Insured under said contract,with respect to the Automobile,General Liability and Umbrella/Excess Liability policies.Automobile,General Liability and Umbrella/Excess Liability evidenced herein are primary and noncontributory to other insurance available to an additional insured,but only to the extent required by written contract with the insured and executed prior to a loss.A Waiver of Subrogation applies in favor of above mentioned additional insureds with respect to insured operations where required by written contract but limited to the operations of the Insured under said Contract and executed prior to a loss,with respect to the Automobile,General Liability,Workers Compensation and Umbrella/Excess Liability policies. 30 days'notice of cancellation or non-renewal will be provided to Certificate Holder,except 10 days'notice for cancellation for non-payment of premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 225 White's Path Units 2 and 3 LLC ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Greg Bilezkian 231 Willow Street AUTHORIZED REPRESENTATIVE Yarmouth Port MA 02675 1 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD §TOWN OF YARMOUTH 1146 Route 28, South Yarmouth, MA 02664 508-398-2231. 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 225 White's Path South Yarmouth Ma 02664 Work Address Is to be disposed of oat the following location: Cavossa-210 Mason Ellis Hwy East Falmouth MA 02536 Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. .00Z Sign of Application ate • TBD Permit No. Sears, Tim From: Sears,Tim Sent: Wednesday,August 3, 2022 9:02 AM To: 'Pat Finn' Cc: Water Department; Slack, Christine; DiRienzo, Brittany Subject: 225 Whites Path Pat, I have reviewed your application for the sound attenuation wall and there are some items needed. 1 Health Department sign off ....V2. Conservation sign off N.3. Water Department sign off 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 CBO Deputy Building Commissioner Town of Yarmouth 508-398-2231 Ext. 1259 mailto:tsears@varmouth.ma.us 1 } Initial Construction Control Document * I To be submitted with the building permit application by a 1�. v I Registered Design Professional for work per the 9th edition of the • y�. Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Selective Demolition and Removal of Building Elements Date: 03-28-2022 Property Address: 225 Whites Path,Suite 2&3,South Yarmonth, MA 02664 Project: Check(x)one or both as applicable: New construction X Existing Construction Project description: The affidavit is for the early release Demo Permit Package and is lilted to the non-structural work that can be done in advance of new scope that will be permitted in a subsequent Buidling Permit Application. Any work required to alter the buildings lateral bracing system & other structural elements will be included in the building permit package. Similarly alterations to the mechanical and electrical systems will be shown in the building permit Dachau. I Kurt E. Raber MA Registration Number: 10563 Expiration date: 08-31-2022 , am a registered design professional, and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning': X Architectural Structural Mechanical Fire Protection Electrical Other: for the above named project and that to the best of my knowledge, information,and belief such plans,computations and specifications meet the applicable provisions of the Massachusetts State Building Code,(780 CMR),and accepted engineering practices for the proposed project. I understand and agree that I(or my designee)shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this code and the design concept,shop drawings,samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official, I shall submit field/progress reports(see item 3.) together with pertinent comments, in a form acceptable to the building official. Upon completion of the work, I shall submit to the building official a `Final Construction Control Document'. REDEnter in the space to the right a"wet"or '<t05� 1 E. �Te electronic signature and seal: /3 Phone number: 508-362-8382 Email: kurt catalvstarchitects.com o No. 10563 (n M 7 BARNSTABLE. O MASS .t) Building Official Use Only 1(,. •F Ma`��'P Building Official Name: Permit No.: Date: Note 1.Indicate with an`x'project design plans,computations and specifications that you prepared or directly supervised. If`other'is chosen, provide a description. Version 06 11 2013 Initial Construction Control Document To be submitted with the building permit application by a Registered Design Professional for work per the 9th edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Sound Wall Permit Date: 07-21-2022 Property Address: 225 Whites Path, South Yarmouth, MA 02664 Project: Check(x) one or both as applicable: X New construction X Existing Construction Project description: This Initial Design Affidavit shall accompany the application for building permit for the proposaed sound wall as shown on the plans. I Kurt E. raber MA Registration Number: 10563 Expiration date: 08.31.2022 , am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning': X Architectural Structural Mechanical Fire Protection Electrical Other: for the above named project and that to the best of my knowledge, information,and belief such plans,computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I understand and agree that I(or my designee) shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17, as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official, I shall submit field/progress reports(see item 3.)together with pertinent comments, in a form acceptable to the building official. Upon completion of the work, I shall submit to the building official a `Final Construction Control Document'. Enter in the space to the right a"wet"or - 0 A electronic signature and seal: eq:S E. ' a No. 10563 r BARNSTABZ_E, ,t y MASS G� Phone number: 508-274-3378 Email: kurt(iecatalystarchitects.com <q P • Ty IF MPS Building Official Use Only Building Official Name: Permit No.: Date: Note 1.Indicate with an`x'project design plans,computations and specifications that you prepared or directly supervised.If'other'is chosen, provide a description. Version 06 11 2013 .01Y4-its, ."/ . ° 1 # Town of Yarmouth Conservation Office kgrentavarrnouth,rnwus Conservation Commission ..„ Building Permit Sign-off Application TO BE FILLED our BY BUILDING PERMIT APPLICANT: Building Site Location: '''''-'15- /1,4„--1,-/-e-S' /9,tvelt:-.- Map# Lot(s)# ,,-- Property Owner: -6 /5/Ie.e/ k' /ay Date filed: 014(/ ,42 *Applicant: 4161/1„,"al- ken 601/4 Applicant Address: /5 ifeSearci; kci Fecithcci-64 , iliii- cv?5-36- Email: fii/e/Mctit,?02 ' €1/4>ca/,e,s,-40111 Telephone: 677- „19"/-a 6-97' Please Note:By submitting this application the applicant grants permission to the Conservation Office to enter the location to conduct a site visit Of needed). Proposed Project Description: ca ch( 1,t't oil 410/7 70 cla//4. Site Plan Title/Date: Sotmoi Weill 7)4(4 S /6,--/-ei TO BE FILLED OUT BY CONSERVATION ADMINISTRATOR: Does the proposed project require a permit? Al 0 Refer to: SE83- or DOA permit Comments from Conservation Commissio Approve. Conditionally Approved Rejected P.,"----- ?—Li —2-2- Conservation Commission Sign-off Signature: Date: *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. i • QY.Y TOWN OF YARMOUTH A.-CC HEALTH DEPARTMENT ti07. .Y1j •• PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Building Site Location: -oZ 6t/ ef- Proposed Improvement: L"- 6-‘ �% ;Jcce_ft,. �.�� Applicant: vG `1 i?U. ?I"/45-6,i'c? Tel. No.: 6j//07,!/;,/6Y / Address: / , 2C.1?it IK/, ,' / ,t O"?.53 6 Date Filed: �I% .�� **If you would like e-mail notification of sign off,please provide e-mail address: ih de/ g0U'Gl 60 chi'hr kt-cop, Owner Name: 6,, ,&//?Z/, / '/ Owner Address: cr'3 f i//U Gu' , �C?-i m ci 7ti Per/ t / 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, and septic system location; (2.) Floor plan labeling ALL rooms within building AUG 0 4 2022 (all existing and proposed) — Note:Floor plans not required for decks,sheds, windows, roofing; HEALTH DEPT. (3.) If necessary, Title 5 application signed by licensed installer with fee. 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Health Department: Determines Compliance to State and TOWII Regulations i.e. requirements for Septage Disposal and other Public Health Activites Fire Department: Determines Compliance to State and l'own Requirements for Personal Safety,Property Protections, i.e. Smoke Detectors, Sprinkler Systems etc APPLICANT GNATURE DATE OFFICE USE: COMMENTS ON PERMIT APPROVAL OR DENIAL ((Ai*V km( voile( trNtUil c kW. fa-vet-Ali 04- -ViAL. ihf ow ever. rLAJA, Lb ti 1-t)Z-2- EVIEWED BY W ER DIVISION(SIGNATURE) DATE t*,4111f I { i 1WM 111/1133 I£L s — b* O/ m m m -4 -4 D 3 a r 2l'm 30.8O*4 d D b f F., g I r f f s 1F I1 f !. 1. of 1 :' . , -� iE 3t t 1 1 --I- A.?, ! , i 3t / rf ili C {JJ I1- ft 7rt 1 W N 1j I ,' f I�i� I — I�1 g. _l ALTERATION TO EXISTING a WAREHOUSE do DISTRIBUTION CENTER r cn .0 zC _,::� � G.1 N n <o 228 WHITES PATH UNITS 2&3 LLC jl!tl - s b- D 225 WHITES PATH 1 is' . Oil `s, SOUTHYARMOUTH MA02664 w,=-..•A f 1 y - -• 1 L. 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Subject: RE:225Whites Path Attachments: Stamped &Signed FeclEx 225 WP Sound Wall Permit Plans.pdf,Acoustic Wall-Water Department Sign Off Requeatpdf Attention!:This email originates outside of the organization. Do not open attachments or click links unless you are sure this email is from a known sender and you know the content is safe. Call the sender to verify if unsure. � Otherwise delete this email. � As requested,please see attached the filled out Water Department form along with the stamped plans. In addition, Rob McCurdy and Pat Finn are longer involved on this project. I will be Dellbrook's point of contact moving forward. Thank you, David Femandes �ssis�an� pru1�ct mana�er !-DELLBROOK JKS M: 774-K8-2876 From:Water Department<yVat�r thmaus> Sent:Wednesday,August], 3O33g:19AK4 Tm:Sears,Tim< ma L!E>; Pat Finn «FFklnV@daUbroukiks.co1T1» Cc:Water Department<VVaterDept us>;Slack, Christine<[S|ack1�yprmuuth.nna.uy>; DiRienzo, Brittany <BD|Kienzm(cDyarmounh.maus> Subject: RE:235 Whites Path Good morning. Please complete the attached water signoff application and return to me along with a site plan.Thank you/ PadenceSmith'[obrera Customer Service Supervisor Yarmouth Water OepartmenL 99 Buck Island Road West Yarmouth, M4O2667 608'771-7921 From:Sears,Tim<tsears@v�rmouthma.os» Sent:Wednesday,August 3' 2O229l2AKO � Tm:'PatFinn'<PFinn@de||brm9kiks.coro* | � Cc:Water Department<yaterDepLRyarmouth.r[a.us>;Slack,Christine«[S|ack@y�[mouth.ma.us»; DiRienzo, Brittany � |�