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HomeMy WebLinkAboutBLDR-23-11034 ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department -_. 1146 Route 28, South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 ilk) Massachusetts State Building Code, 780 CMR Building Permit Application To Construct, Repair, Renovate Or Demolish ...'' a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number:j (,T.g- Z 3 - //ON Date Appli . EcEIVPD Building Official(Print Name) Signature R SECTION 1:SITE INFORMATION 4 MAY 2 • 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 2023 ,5ti MnrS-' SLj c D 0, 1.1a Is this an accepted street?yes no Map Number Parcel Numb r sy DEPARTMENT 1.3 Zoning Information: 1.4 Property Dimensions: c761.4e - qd y4-7 5-2 Zoning District Proposed Use Lot Arta(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required 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 Zone: Outside Flood Zone? . Check if yes❑ Municipal ❑ On site disposal system SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: (Jt a r►I M C©i Lody �i4 r wl 0,j i iyl Al Name(Print) I City,State,ZIP lq MOe4N5/Oe D/'tv1 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction!t_cr/Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other ❑ Specify: BriDescription of Proposed Work2: I�)t la c ie,o CP''G) / ,-p 41 i'1 e g-7-.P.e�0,oi SECTION 4:ESTIMATED CONSTRUCTION COSTS. Item Estimated Costs: (Labor and Materials) Official Use Only 1.Building $ 1. Building Permit Fee:SI'3a Indicate how fee is determined: 2.Electrical $ Standard City/Town Application Fee 0 Total Project Costa(Item 6)x multiplier . x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 35-,0 C,K#I$ $ 5.Mechanical (Fire • Suppression) $ Total All Fees:$ - 6.Total Project Cost: $ ���Q a, Check No. Check Amount: Cash t: , / > 0 Paid in Full ill Outstanding Balance e: I, L. • in • (// (4;3 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction 1Supervisor License(CSL) 0 f��7$ 326„no t0 �`'& ��c121 ps%IL License Number Exp ati Date Name of CSL Holder Q 1 L�� ` List CSL Type(see below) No.and Street r� T e Description j Unrestricted(Buildings up to 35,000 cu.ft.) � r A 1Y)1Y(/B /Q lJ ee`7< Restricted I&2 Family Dwelling City/Town,State,ZIP 1 IvI Masonry v RC Roofing Covering • WS Window and Siding //` ,/ SF Solid Fuel Burning Appliances d(�Q ' r�s lee jIlidee e C2$44Y,d I Insulation Telephone Email address Cagy, D Demolition 5.2 Registered Home Improvement Contractor(HIC) Vi i // i�otoe9 4j31 .00 a c/v, k c)(--(t,) 0-1 o-e12J HIC Registration Number Expiration Date HIC CompanyXame or HIC Registrant Name Is/ 1-3 No.and Stir Email address 074DcJ-7z) m t2 m061' A0,4 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 e 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 00 t ,Ale ,e/e, t/0°(2,/ to act on my behalf,in all matters relative to work authorized by this building permit application. rmtP Owner's Name le onic i ature 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. .CPm,.) Lz7 C eft- Print Owner's or Authorized Agent's Name(Electronic Signature) / /�DDate 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.eov/oca Information on the Construction Supervisor License can be found at www.mass.2ov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) IG102 d(ff (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" 1� hatuko2 r7, J7 �'� • The Commonwealth of Massachusetts Department oflndustrialAccidents 1 Congress Street, Suite 100 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): Depkitko /-4 Address: City/State/Zip: git ®L47hPhone #: 5e - Q c Are you an employer?Check the appropriate box: Type of roject(required): LEI I am a employer with employees(full and/or part-time).* 7. PIPIew construction 2. I am a sole proprietor or partnership and have no employees working for me in any capacity.[No workers'comp. insurance required.] 8. Remodeling 3. I am a homeowner doing all work myself. [No workers'comp. insurance required.]t 9 C Demolition 4.11 ProPnY I am a homeowner and will be hiring contractors to conduct all work on mye I will 10 ] Building addition ensure that all contractors either have workers'compensation insurance or are sole 11. Electrical repairs or additions proprietors with no employees. 12.C Plumbing repairs or additions 5.0I 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 13. Roof repairs 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. 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.#: Expiration Date: Job Site Address: Ci IState/Zip Attach a copy of the workers' pensation 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 ORDEI aiid 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 under the pains and penalties of perjury that the information provided above is true and correct. Signature: a��8G� ? �� Date: /, / 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#: 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. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111/5 I hereby certify that the debris resulting from the proposed work/demolition to be conducted at _ ry1 Re_< t,h6.7 .0 eti.Le Work Address Is to be disposed of at the following location: 9Acvric201- u (_,_r 8oci (-/ Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. 44/4/1(ilial Signature of Applicant Date Permit No. c•I ".. Alt -"C' ,-;', *-' —-,-- :"",- :I.,- ....(0,_ • 03 0). -0 c 0 c 0 - c... ,_ •,,,:-.. . S SI(-4A 0/, z et s \I ul ra- "--... -i-,\--3 in o 0 1_ X ul tIAgi 0 .X.'•' ...-_,..: .--- 44-- .7".'• 0 zer ",-:::i"."'k, ' .'-,'',-... `"z4: 4 0 - cn (4 0 g iii- i-.....--- -,,„ ,"'.."..'",.•-4-.. ':...7 c: j , ,. 4- .01.it- Z i- ' - - - 2 03 -,•5. CC - Is.06 ii.r-0 8 ..,...... . r LU ce .. - " cc 101 X ps 2 iii z 111 ,c, 1.-= U/0.. cto LU 0Ts' *I •:c 0 cs) ill tx tsa (.) -3 Z 5 - t.0 -_-. 0 u'LL,0 u) .... 3 E 0.. • c' ii x 111 a 0 kJ 0 ID u.1 E '2 co ul, 0 T.co Y 2r1° rj L.) -, 03 , -....- - xZ 0111.0 c13 tti 18 ,iw,-.•,„..,..„.:. (....) X- I--= z )..• 0 a 0a ct .-(NI - Lj ,,..... *2:=0,,,,,Cgd ,,,,;A:..,",,.,,,ic•___,- -,--; "•''; ''; T WN OF Y • - MOUTH ,... 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451':,7.- Telephone(508) 398-2231 Ext. 1292-Fax(508)398-0836 01.0 KING'S HIGHWAY HISTORIC DISTRICT COMMITTEE APPLICATION FOR OLo_KINGS HIctivl,,,,,, CERTIFICATE OF EXEMPTION Application is hereby made for the issuance of a Certificate of Exemption under Sections 6 and 7 of Chapter 470 of Acts of 1973, as amended, for the proposed work as described below and on plans, drawings, or photographs accompanying this application. Type or print legibly: Address of proposed work. 8q yvvA a 50 Sit)e. 0441.,,e Mapilot# 1.50/6. i Owner(s): '..- LA— ( ,-, I- ) Phone#: 6451s 34,4, 4 7<4J( All applications must be submitted by owner or accompanied by letter from owner approving submittal of application. Mailing address: ‘ 1-1 M 01(2.6 4 ioe-- 0 Iti OZ.— Year built: eie)4 Email, bK 1 i f-6 0,41 e)>C "c.L.1.,14 512 Kie'r Preferred notification method: Phone P----- Email Agent/Contractor: )eol,/n 1-4, “p(Zit ,,,i K.L 0 ez...., Phone#: 60V,-34-Z -4-4-4 Cie- MallIng Address: ;,14>E11--e-e,..) ci--- A r ert e,4.•-r-ri Pe>r-r cv 4 • Email: Did-wwizz.5-4 eild . Preferred notification method: Phone i----Imail PescrIption of Proposed Work(Additional panes may be attached f necessarvt / e.(Z.. ret764- 6:7es f/44 t"' 6 siie0 te.),, 7 1-1 4, (2_ f2,-0.4-! ) -i--:-e 10.5,t e,A/ 12„,. Rtece,14- PI a7C—P-/;‘)6 I-foci a..--..- 1.1.,.4,..4_ e-.<,42-r;4_24; '7o ier 7.0'-i•c --i /44.k."5 ... ,:,,' 7 ,-1 fro et, (.(<7 o /r ,4,4- e_)21--eve (...) g, givoc_c, 4.4)j A..)Do cdi i I 3' /4-064-,i A-, 4 5 7 .1...e co,i k.?ocioccL, W et ci-e7. A Zi2 rre)re -rr i iel ( ')e--` "3 L.,'.4Z.'d -'-‘4 ‘\ :---'1 —7/ CT 0-i, 2 e..41 -7(1,. el,-r 1,t.-e r-- Signed Vvil_i_Laid'or a!, nty (--- ,7 _,- --" \ Date: La ze.e/a-77, > owner/contractor/agent is aware that a permit may( i m the Building Department.(Check other departments,also.)recto k. This certificate Is good for one year from approval date or upon date of expiration of Building Permit,whichever date shall be later For Committee use only: Date: „iip 0 R.3 Approved Approved with changes / ,. i Amount 5 12_,.........fai Reason for denial: CasiC .......', / _ 2 k. hK St Cte.:547 Rcvd by k../0 )( e--.._.... - . ; ‘,•1'''',, .;4?, ';;;;• '',')1 ,,. 1'1,-1, iAt•-ttii101,); • ' Date Signedf.: ,'") '1.) , .1).4., Ngned: Gil P ' „, ,Z---(...," , :.0,4Lot.dAmi,i.4-.1p4•if'5-7 1.. VS 20 1 7 YARMOUTH WATER DIVISION 99 BUCK ISLAND ROAD WEST YARMOUTH, MA 02673 T ,�tL 5 a, `' N ` N PH.: 508.771.7921 FAX: 508-771-7998 BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET Bldg. Site Location 8/1 ing4 / 5-/De £'roz Map #: Lot #: Proposed Improvement: e- S h/-eD Applicant: Q,2-6 67;4 ca�Gr Address Tel. #: _OA sWk ( 14 Date Filed: 67-1-P-3 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 Acts; i.e. If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Ocean, Bogs, Bays, Marshland, Etc... Health Department: Determines Compliance to State and Town Regulations, i.e., Requirements for Septage Disposal and other Public Health Activities Fire Department: Determines Compliance to State and Town Requirements for Personal, Safety, Property Protection;, i.e. Smoke Detectors, Sprinkler Systems, Etc... 5/2/2 Signature of applicant Date PLEASE NOTE: COMMENTS: 444- (w Revie d by: Water Division Date TOWN OF YARMOUTH a HEALTH DEPARTMENT 1-4 • PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Building Site Location: clAytA /,6 -1 0 q i Proposed Improvement: e Applicant: , / r. l =" ' Tel. No.: 50 Address: S 4 f. Date Filed: "If you would like e-mail notification of sign off,please provide e-mail address: Owner Name: i / j 6, / Owner Address: w j..! /20 c'3 ' 1-c Pr f Owner Tel. No.: 5-76 3 3 ,4-/ 414 5-- 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: RECEIVED (1.) Site Plan showing existing buildings, water line location, and septic system location; MAY 0 3 2023 (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: ��►•� a`, Q � DATE: 5 - PLEASE NOTE COMMENTS/CONDITIONS: ONE or TWO FAMILY— BULDING PERMIT APPLICATION REGULATORY APPROVALS NOTICE Address of Proposed Work: 1M v5`-' S c'YJ QKi v� Scope of Proposed Work: T.4,5 .0Z S ilk,c] -- tZ )1- icS - e&ioc sit,/ Date: 03/23 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 0 d Kings HWY. Hist. Comm. —508-398-22631 ext. 1292 Engineering Dept. —508-398-2231 ext. 1250 Fire Dept. — Kevin Huck/Matt Bearse, 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 Acknowledgement: Applicant's Signature Date Rev. March 2022 5 °' 01&'Y 111!, P¢ R 2° °P A, • 0 0 MAP 150 PCL. 5.1 rn 100.00' MAP 150 PCL. 7.1 19'f G #3.NG � a X LOT 49 40,437± S.F. n (0.93t AC.) 326.03, MAP 142 PCL. 2C MAP 142 PCL. 1C MORTGAGE INSPECTION PLAN THIS PLAN IS INTENDED FOR BANK MORTGAGE PURPOSES ONLY. THIS IS NOT AN INSTRUMENT LOCUS : 34 MARSH SIDE DRIVE SURVEY AND IS NOT TO BE USED FOR FENCING, YARMOUTHPORT, MA CONSTRUCTION, DEED DESCRIPTIONS, RECORDING, BUILDING OFFSETS OR PROPERTY LINE DEFINITION. REF : LAND COURT CASE #31551-E PLAN PREPARED FOR JP MORGAN CHASE BANK, N.A. SCALE : 1"=60' DATE : 4/22/2021 OWNER OF RECORD: MARSH SIDE DRIVE REALTY TRUST THE DWELLING AS SHOWN COMPLIED WITH THE YARMOUTH _ +4/22-/at ZONING BYLAW BUILDING SETBACK REQUIREMENTS WHEN CONSTRUCTED. DATE EG. D SURV OR OR EXEMPT FROM VIOLATION UNDER M,G.L. TITLE VII, CHAPTER 40A, 4.. SECTEXEMP.T FROM VIOLATION UNDER M.G.L. TITLE VII, CHAPTER 40A, SECTION 7. ARE NO VII iiklag5 OR ENCROACHMENTS OTHER THAN JOHN Z. DEMAREST JR., P.L.S. 1 o'F' / • lF• SO li Sv\ goo ©o OP" p,- O 0 v; a, - MAP 150 rn PCL. 5.1 H- 100.0p, MAP 150v'"- PCL. 7.1 N pg N j gt� 434 i41G if Q 1- LOT 49 ?'�. ji .. 44,437E S.F. (0.93± AC.) c { t1 326.03' MAP 142 PCL. 2C MAP 142 PCL. 1 C \ MORTGAGE INSPECTION PLAN THIS PLAN IS INTENDED FOR BANK MORTGAGE PURPOSES ONLY. THIS IS NOT AN INSTRUMENT LOCUS : 34 MARSH SIDE DRIVE SURVEY AND IS NOT TO BE USED FOR FENCING, YARMOUTHPORT, MA CONSTRUCTION, DEED DESCRIPTIONS, RECORDING, BUILDING OFFSETS OR PROPERTY LINE DEFINITION. REF : LAND COURT CASE #31551-E PLAN PREPARED FOR : �` ` JP MORGAN CHASE BANK, N.A. , ,-` . ,-- SCALE : 1"=60' DATE : 4/22/2021 I .)C , „ 7 R ' ,; OWNER OF RECORD: MARSH SIDE DRIVE REALTY TRUST r'/, THE DWELLING AS SHOWN COMPLIED WITH THE YARMdUTH ___ ��z.z./a ,r��, -1 ZONING BYLAW BUILDING SETBACK REQUIREMENTS WI-EN CONSTRUCTED. DATE •EG..D SURV OR OR EXEMPT FROM VIOLATION UNDER M.G.L. TITLE VII, CHAPTER 40A, SECTION 7. I THERE ARE NO VISIBLE EASEMENTS OR ENCROACHMENTS OTHER THAN JOHN Z. DEMAREST JR., P.L.S. 1 UNDERGROUND SITE UTILITIES OR AS NOTED ON THE PLAN. PROFESSIONAL LAND SURVEYOR I i 4' / .,/ lt 40. , \ .................. ' 4" "4 ,...,,..... 4 Ra.74.1 pp 441 ., // .15.• . . i• ..C./\ .. , ... .,, .... 1 1 1 \t .‘ X V i In. ezeme‘ ,Temovrnat it ii A 1 't 1 ‘ tame.ex stone wool At k Re-gritile liftole tatti-4 Islam /barn end seed i. A ,......-.—...,,,,.. wdbit...a. 1, _...... • ----- I law ......„,,,, .— A. ••. •,.. Itillill11111111e•I '''Illikl ' I 1 E 1 .e..1040- \ \ i..e,.....,, \\ \ Emnp.,...s. Detetritmemto ..,,,„...... Ir Pr..111• = 1, 1::\2184, , ) ths4.41 \ '101 ...Z1.4.1 \ \ vtii#,PAIIIII , ,1 tl \_ _ 1 \ 6.11,1tenetty . woo 1 1 / I: , 1 i . 41P6711 ...t..ati (:. 4 .., 1 ,., , 1 7 ft el i 1 ... ."`'" 0 i ';;;;-1z: i , I 4 4 0 / 471 i i i 1 2 ', i 44 k - , ;/I ' l / -15:19marivpa i ' I „..m.tir, •-..--111 V I/ i 1 ' 0141.7.13t1•91-1';', . 1 1 -- elfliii...- itirkt• I i i ', f MIFIVAiliPeilliug' i '"r r ii1%-,..Nii,ki.iii,„:4 2 ....., . Yeeleconeeterommo il ihr"firr-!ilt.."11. Nitellil:`"IttiO450411.9. — ---- ,...Inriallir imiliT 11610..1 1-114 al Fill!:il*M.ii.i ---- ilip.mtegimirri,MgainilL 'f,: , NI ...,..-0. ii'.."- ' "11=Nnalf ', '-;•, WORK MUST CONFORM TO ALL .,i,.. ....... 1.2.1., . , i . ,AB -.....A.A., a.,-,'. / - A • ;:;. -,—' T 'N BYL4ZGULATFAS , rill Akalr: .7 ' . ) - 5 i', 12- Ntrabltspost at...WO isin 1.11117 ,,,12 4 AL. ” 911allifiTaarniEritirt!':Z 4 .. .........--.- -..,.. YAM lit VrE.1; iEPT. DATE 3 \ \ FigVii 1 lefosa 1 IllittiV, 1 \ vi4;t:r114.47.1 1...- ..3... \ ....,-. M."4,. OP.C11.1. 't r-torif-vo' ,t4,0,-....-,..-.- ti ....., . ... ttillotti.i.amionall etati177.480 \ ‘ 1----,--.1 Fireplace Concept Scale:t"= ''''m'MRb-aieoes'teet sat'o/nlo-fad lw'dedarao-inypllsl ain gttoihao tl Po nVgC„. ...,.. !Grading Key: Hardscape Plan I am,.!Fel Zeracc +1107. I % The Gilooly Residence ProWS.1 SPVI C... •II.2V 0. ......7 xi ve 34 Marsh Side Drive Yarrnouthport By:Philip L.Cheney 508-394-2373 Seale:2/8"-=t-o"9/29/2022 Rev.3/29/23 01;x44, TOWN OF YARMOUTH .... \-0 t / .. L D.3 O KING'S HIGHWAY HISTORIC DISTRICT COMMITTEE 1146 ROUTE 28. SOUTH YARMOUTH. MA SSACIlusETTs 02664-4451 Telephone(508)398-2231 Fxt 1292 Fax (508)398-0836 STATEMENT OF UNDERSTANDING CHANGES TO AN OLD KING'S HIGHWAY APPROVED PLAN As property owner/contractor/agent for construction at 34 Si Siszt-t, Ott. , Map/Lot 1511 fe,' . 1 C/A# ? -11\1:67 Approval Date•(--- f- .....1 "1 4.-1---) ;,'.' ti,,,,- I certify that I understand the following requirements regarding any changes that may be required for this project: In accordance with paragraph 2(a) of section 1.03(General Procedures) of the OKH 972 CMR Rules and Regulations: Only minor changes may be approved by the Committee without the filing of a new application and a new hearing. Minor changes include alterations that can be done without a detrimental impact on the overall appearance of the project such as altering a single window or door change or a minor change of colors. All minor changes by amendment will require the local Committee's or its designee's approval. All changes to previously OKH approved plans require notification to and approval from the local OKH Committee. Change requests must be submitted to the Committee in writing on the appropriate request form, which may be obtained from the OKH office. All change approvals must be obtained before incorporating the change into the project. If the change has been implemented prior to receipt of OKH approval, a Minor Change approval or Certificate of Appropriateness application for the revised plans is still required and will result in a doubled filing fee for the appropriate category of work. Failure to comply with the above statements will result in the Building Department issuing a stop-work order or delaying issuance of an Occupancy Permit or final inspection approval. I have read and understand the above statements. ' / 5-7--,--,„, /2 7, Date: , /--- /- Signed: ,,,,,,2/ / /- v'.' / (Owner/Contractor/Agent) n t , :,,, , , , , ( , , Signed. \J" i- A ,,, k , _, (Chairman, Old King's Highway Committee) H 10KH COMMITTEPAppacation Forfrs1Statement of Understanding 2015 does Updated 12 2015