HomeMy WebLinkAboutBLD-23-000708 , put cilwIzz-
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 ;;�.':
Massachusetts State Building Code, 780 CMR
Building Permit Application To Construct, Repair, Renovate Or Demolish ,„... ,Y
a One-or Two-Family Dwelling ' gi E C E I V E D
This Sectio,„4,5or Official Use Only
Building Permit Number:71.0'a3 a a'70 Date Applied: AUG 08 2022
' 'M �- ( j �� i s n j')1J'1 BUILDING DEPARTMENT
Building Official(Print Name) Signature Dat.,
SECTION 1:SITE INFORMATION
1.1
1 Pro/pCeVlerty ldrlt.Si-` tar WI
` pink 1.2 Assessors Map&Parcel Numbers
1.1a Is this an accepted street?yes no h 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 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? Private❑ Zone: — Outside Flood Zone?Check if yes, )Municipal 0 On site disposal system 0
SECTION 2: PROPERTY OWNERSHIP'
2. Own r'of Reeor
g len oV0.. o�t��Ql- -O avmocl, 1 �r A a26-i
Name(Print) Cit,tate,ZIP J IqC
b9 cen 4ew S/t -Ot Z3- (a0 / C� �+ar-
3� 7-� co case' ne, I-
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) —/
New Construction. Existing Building 0 Owner-Occupied Repairs(s) ❑ Alteration(s) 0 Additions
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2:
Bu I (d nehi J cie 1oc e . 3a v. e. 4 V 11
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ / fib 01. Building Permit Fee:S loci Indicate how fee is determined:
! Standard City/Town Application Fee
2.Electrical $
a, `ry`� `� 0 Total Project Costa(Item 6)x multiplier x
3.Plumbing $ Zai p ey 0 2. Other Fees: $
4.Mechanical (HVAC) $ /C fj fj 0 List: /02-0.0 1 �I_ 9 i t
o.Mechanical (Fire $
/
Suppression) Total All Fees:$ .
00 Check No. Check Amount: Cash unt:
6.Total Project Cost: $
/51 0 Paid in Full VI Outstanding Balance D e: /g t, f•77
g2�1Z2
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 Iv1 Masonry y
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)
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
No. and Street Email address
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 Issuance of the building permit.
Signed Affidavit Attached? Yes 0 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.
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.
S -e pQ4 �-c io CCLL, 4x)tn.a f J Is jZoZ z_
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
Department of Industrial Acciderzts
1 Congress Street, Suite 100
i
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 _ PIease Print Legibly
c1
Name (Busines/s_/Organization/Individual). .-J k hPr) Q'1 kVa, c4 v b a n c e-
Address: I F'J 9 Cet t r CStr-QJ't
City/State/Zip: G V h mil- 0 2 ?i `�_ 7
� hone #: � 5 m b� ' '�.
Are you an employer?Check the appropriate box:
Type of project(required):
1._I am a employer with employees(full and/or part-time).*
7. Ili New construction
2.0 I am a sole proprietor or partnership and have no employees working for me in
any acity.[No workers'comp. insurance required] 8. Remodeling
3. am a homeowner doing all work myself. [No workers'comp. insurance required.]t 9. ❑ Demolition
I/ 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 E 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.E Plumbing repairs or additions
5.❑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.[ 13• Roof repairs
6.❑We are a corporation and its officers have exercised their right of exemption per IVIGL c. 14.El 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.
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: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00
and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a
day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
V Si>�nature: / &- -LC� L
Date:
Phone#: S y I"-1 Z3 -W / q
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#:
01 TOWN OF YARMOUTH
BUILDING DEPARTMENT
cc' " E ° 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1261
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
DATE:
JOB LOCATION: I 4q Cevn`Ve V`S - a r r o U �O v
NAME , TREAT ADDRESS SECTION OF TOWN
"HOMEOWNER" S e+n VG. (..--4 Y b 0 C"- -- -7 2 3 6® I I-/
NAME HOME PHONE WORK PHONE
P ENT MAILIN SS f (" Cep v t'
CITY OR TOWN STATE ZIP CODE
The current exemption for `Homeowner' was extended to include owner-occupied dwellings of one or two units
and to allow such homeowners to engage an individual for hire who does not possess a license,provided that such
homeowner shall act as supervisor. (State Building Code Section 110 R5.1.3.1)
Definition of Homeowner:
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is or is intended to
be, a one or two family attached or detached structure assessory to such use and/or farm structures. A person who
constructs more than one home in a two-year period shall not be considered a homeowner;such"homeowner"shall
submit to the building official, on a form acceptable to the building official,that he/she shall be responsible for all
such work performed under the building permit. (Section 110 R5.1.3.1)
The undersigned `homeowner' assumes responsibility for compliance with the State Building Code and other
applicable codes,by-laws, rules and regulations.
The undersigned 'homeowner' certifies that he / she understands the Town of Yarmouth Building Department
minimum inspection procedures and requirements and that he / she will comply with said procedures and
requirements.
HOMEOWNER"S SIGNATURE
APPROVAL OF BUILDING OFFICIAL
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL
Ch.142. Yes No
If you have checked ves, please indicate the type coverage by checking the appropriate box.
A liability insurance policy Other type of indemnity Bond
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter 142 of the Mass. General Laws and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner Agent
h:homeownrlicexemp
o� YaR TOWN OF YARMOUTH
o BUILDING DEPARTMENT
H - + : - 1146 Route 28, South Yarmouth,MA 02664
508-398-2231 ext. 1261 Fax 508-398-0836
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 69 Ce k v ILe
Work Address
Is to be disposed of at the following location: oc„v`S ✓' S ti. (
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
_ 7 - 20z Z�
Signature of Application Date
Permit No.
Sears, Tim
From: Sears, Tim
Sent: Friday, August 26, 2022 9:58 AM
To: 'capecarb@comcast.iet'
Subject: 169 Center St
Stephen,
I have reviewed your application for new construction and there are some items needed.
N11. HERS Certificate i' *;y( 2 ,
-2. The floor opening for the stairs requires full height studs per section 2.3.1.7 of the 2015 WCFM
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.
l imothy Sears CB°
Deputy Building Commissioner
i'own of Yarmouth
508-398-2231 Ext. 1259
mailto:tsears@yarmouth.ma.us
1
Sears, Tim
From: Sears, Tim
Sent: Thursday, August 18, 2022 12:08 PM
To: 'capecarb@comcast.net'
Cc: Fallon, Rosa
Subject: 169 Center St
Stephen,
I am reviewing your application for the garage and it appears that a dwelling unit is being created on the second floor.
This would require relief from the Zoning Board of Appeals as well as a second means of egress.
Please call Rosa Fallon at ext. 1260 and schedule an appointment to meet with the Building Commissioner and myself at
your earliest convenience.
Thank you
Timothy Sears CBO
Deputy Building Commissioner
Town of Yarmouth
508-398-2231 Fxt. .1259
mailto:tsears@yarmouth.ma.us
1
TOWN OF YAR'1Ot '
} WATER DEPARTMENT
99 Buck Island Road
Y .cm% West Yarmouth, MA 02673
Telephone: (508) 771-7921 • Fax: (508) 771-7998
BUILDING PERMIT APPLICATION FOR
WATER DEPARTMENT SIGN OFF
TRANSMITTAL FORM
BUILDING SITE LOCATION: 169 Center Street Yarmouth Port, MA 02675
PROPOSED WORK: New detached garage/bam
APPLICANT: Stephen and Eva Carbonaro
ADDRESS: 169 Center Street Yarmouth Port, MA 02675
TE LPHON E: 347-723-6001
RESIQlTIAL 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 lot(s)border any type of
wetlands,streams,ponds,rivers,ocean, bogs,boys,marshland, ETC...
Health Department: Determines Compliance to State and Town Regulations, i.e.
requirements for Septage Disposal and other Public Health Activites
Fire Department: Determines Compliance to State and Town Requirements for Personal
Safety, Property Protections,i.e.Smoke Detectors,Sprinkler Systems,etc
c J J CAA, `March 3, 2022
APPLICANT SIGNATURE DATE
OFFICE USE: COMMENTS ON PERMIT APPROVAL OR DENIAL
REVIEWED BY WATER DIVISION(SIGNATURE) i)k t (:
dt`= k,, TOWN OF YARMOUTH
= 6 HEALTH DEPARTMENT
' �• � PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant:
pr?f�Y- f,>r q rjou �1 I �✓ /�f� 0Z6 '7
Building Site Location: l�h� �. 1 ) vrY
p � 5-j-u 10►� — rLc( c3 c� ova � v <<�
Proposed Improvement:
pe.w se v.) c��
e✓ G-t
c'c Sr,fie'✓r cit-- 6eC(Jo
Applicant: -i LUG C(A V bona I" L. Tel No.: 3�'f 7-72 3-600 I
(Gc k
Address: VG� -9 se v7 le tom' /01&Z(, j }(Y1 i Z02Z Date Filed: —
b
*"/f you would like e-mail notification of sign off please provide e-mail address: C eCCCc � �, ��Ct1�- l")`e.
Owner Name: .� '�' ' `A Oct AO viu- v C7
Owner Address: I 6( CE''r' "� - u- Owner Tel. No.-hq 7-
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
(all existing and proposed) —
Note: Floor plans not required for decks, sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
i
REVIEWED BY: t -- � DATE: 637S '
PLEASE NOTE
COMMENTS/CONDITIONS: ipC ig ttv --_w 1- 6u5-e t )ir vvo ('
1 . ✓oc ^
�.---- eJ ro .
.i < c( StiBC DC,�gw
I ` 1 c' ( (t /.fir[ is'-
TOWN OF YARMOUTH
OF61111 - if 1146 ROUTE 28,SOUTH YARMOUTH, MA 02664-4451
- ,,-,,,,,0,—; V ,..: :,- Telephone(508)398-2231 Ext. 1292-Fax(508)398-0836
'', clii-Di2KING'S HIGHWAY HISTORIC DISTRICT COMMITTEE E1VED
APPLICATION FOR
l„)KING'S ht6I-IWAY ' 1
CERTIFICATE OF APPROPRIATENESS i / MAR 0 1 2022
1 i
_ d
Application is hereby made for issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts set 1.973ANTMENT
amended,for proposed work as described below&on plans,drawings,photographs,&other supplemental info accompanying.this_
application. PLEASE SUBMIT 4 copies OF SPEC SHEET(Si,ELEVATIONS,PHOTOS,&SUPPLEMENTAL INFORMATION.
Check All Categories That Apply: ./„. Indicate type of Building: Commercial V Residential
V" ,---
1)Exterior Building panstruction: New Building _Addition Alterations Reroof V'Garage
VI
Shed Solar Panels Other:
,,, /
2) Exterior Painting: ir Siding Shutters ,,,,/
Doors I--lcim Other
3)Signs/Billboards: New Sign Change to Existing Sign
4)Miscellaneous Structures: Fence Wall Flagpole Pool Other:
Please type or print legibly: n "..)
S
Address of proposed work:. /6 7 c....eolei-- heee-7-
u '
Map/Lot# i"3,2-
Ovvner(s): irl
S-i-ep en e, k.v/04., ear to chrlar 0 Phone#: 3 Li7- 72. 3 -60 I
All applications must be submitted by owner or accompanied by letter from owner approving submittal of application,
Mailing address: ‘:ycf Ceniter S If 4‘>14.,ir yylourtirt?ork LIA 02615-Year built:
Email: co.?ccartoe 00 meets+, Preferred notification method:, Phone Email
Agent/contractor: h orirte,oco teve_v- Phone#: 341 7- 72-
Mailing Address: II,9 Ce ni-e v ,--.C.(, ( , ,A,„0„...tiiti 2C43,,--t- ty\A 02_6-7 4D—
Email: C.--04? 0-0-v- C-Olv'teckS t ,rk-12+
t9 Preferred notification method: Phone 1.---" Email
Description of Proposed Work: ' '' - DV F;;;0
ct..ce& 64*-rThCA' C'' bc'r et
/ FEB 2 8 21-1K '
/7 /z „
-1 -42--
1,---\---->,-,-----.,...
Signed(Owner or agent): ,„„„,--"V Date: we.?„„deittifr
)> Owner/contractor/agent is aware that a permit is required from the Building Department(Check other departments,also.)
YP. If application is approved,approval is subject tea 10-day epeesl period required by the Act.
• This certificate is good for one year from approval date or upon date of expiration of Building Permit,whichever date shall be later
)' All new construction will be subject to inspection by OKH.OKKapproved plans MUST be available on-site for framing&final inspections.
For Committee use only: L/Approved Approved with Modifications ____Denied
Rcvd Date: 1/A/2.2- Reason for Denial:
Amount '')N 57,P 0
Cash/Ck#: II 5
Signed:
Rcvd by: (-•' “-).
7)-(904:17
45 Days: --'
Date Signed: 2-/2 irij/ c)2 'I
APPLICATION#: '
YARMOUTH OLD KING'S HIGHWAY HISTORIC DISTRICT COMMITTEE
APPLICANT'S RESPONSIBILITIES & APPLICATION CHECKLIST
, RSPONS1BlLtflES...
'
1. All applications shall be filed on Commission-approved forms available at Town Hall and on the Town of
Yarmouth website (www varmouth.ma.us). An incomplete application can be the basis for rejection or denial
of a filing. If you have any questions concerning your application, please check with the Office Administrator
for clarification.
, .
2. Number of copies: '-
It-4. 1Vrt
t
Art ificate of Appropriateness Application (Front page)®1 copy '
t eneral and/or sign spec sheet
_4 copies .1 t
—
ptioutters' List (Map&Lot numbers only)
1 copy ,
,
1 ,I\
, ,pevations(Minimum acceptable scale: 1/4"= 1') 4 copies „,...OLU KtN23,HICC,\77 :':Ld
' ,lot/Landscaping Plans 4 copies
V Color Photos(Front of house&location of proposed work) 4 copies
3. General&Sign Specification Sheets:
Materials to be used (including detailed descriptions of size, style, and composition)must be specified. Color
chips for any color other than white are required. The only pre-approved color is white: all other colors must
be approved by the OKH Committee. The only exception is the use of colors that match those already on the
structure and that were previously approved by the OKH Committee. Color photos(see#2 above)are
required; "to match existing"should be noted on specification sheet. If a material is to be left"natural"
(unpainted), please include that information on the spec sheet. Manufacturer's information/brochures for
windows, doors, garage doors, etc. should be attached. Please note grid pattern and type(snap-in, between
glass, permanently applied, etc.)for windows. Skylights should have a flat, not curved or"bubble", profile.
4. Abutters' Lists:
Map and Lot numbers for properties directly abutting and directly across the street from the work location are
required. Instructions for obtaining the abutters Map and Lot numbers can be found on the Old King's Highway
Department page on the Town website: www.yarniouth.ma.us.
CHECKLIST FOR REQUIRED APPLICATION INFORMATION:
I AP'
1. New Building Construction (e.g.,residencelcommercial,shed,freestanding garage,etc.)
a. Certificate of Appropriateness, Specification Sheet, and Abutters Lists
' 4 ,-,1/
b. Elevations/drawings of all 4 sides to scale (Minimum scale accepted is 1/4" = 1')
PLUS: 'For new houses or commercial buildings:
Topographical plot plan including new building(s), landscaping, retaining walls, exterior lighting,
and utility/HVAC hookups.
For sheds and other auxiliary buildings:
Plot plan &color photos showing location of new building in relation to existing building(s).
Color photos of front of house and location of proposed building.
2. Additions/Alterations(e.g.,sunroom, attached garage,dormers,vinyl siding,new chimney.stairs.
porches/decks, windows/skylights,doors.window boxes,solar panels,lamp posts. etc.
a. Certificate of Appropriateness, Specification Sheet, Abutters' List
- b. Color photos showing front of building PLUS affected sides.
c. Brochure or manufacturer specification sheet showing type of window, skylight, door, solar panel,
lamp post, etc.
d. Elevations to scale required for changes to building's"footprint"; not necessary for windows,
doors, and the like UNLESS the location or size of items on facade is chanclino. (Minimum
acceptable scale is 1/4"=1')
e. Plot plan showing location of new work relative to existing building(s). (Only required for work
affecting"footprint"of building; e.g., deck addition.)
f. For solar panels: An aerial drawing to show the area and layout design.
Y:44 TOWN OF YARMOUTH
OLD KING'S HIGHWAY HISTORIC DISTRICT COMMITTEE
„ v
..., 1146 ROUTE 28. SOUTH YARMOUTH, MASSACHUSETTS 02664-4451
Telephone(508)398-2231 Ext 1292 Fax(508) 198 0836
STATEMENT OF UNDERSTANDING
CHANGES TO AN OLD KING'S HIGHWAY APPROVED PLAN
As property owner/contractor/agent for construction at 161 tov'tAser.
Map/Lot 1 40/3,2- C/A # g2-"NI?0 Approval Date:
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.
Date: '27/C-8/2--*u 2-1-- Signed:
(Owner/Contractor/Agent)
Signed: (? ,-,..
(Chairman, Old Ki s Highway Committee)
H'OKH COMMITTEEApp catoon Forms‘Staterrent 01Untiwstand ng 2015 docx
Updated 120015
GENERAL SPECIFICATION SHEET
Project Address:
FOUNDATION:Material: v ire Exposure(Not to exceed 18"):
CHIMNEY: Material/Color GUTTERS: Material/Color 11411-, (.4 frYi '
ROOF: Material: AS )ha
ft Pitch(7112 min) Height to Ridge: Color:
SIDING: Material/Style: Front ,2). 910041v'`.= Sides/Rear ",.:-.4Cti Oa .\ COLOR CHIPS
Color Front 1-•=e,,-$.'n1-:?,-,14 Sides/Rear /14- 44‘`` a-
TRIM: All windows&doors to be trimmed with: lx=4 1x5 (Circle one.)
Material kVhilitt '41 Color
DOORS: Qty: Material: Color
Style/Size(if not listed/shown on elevations):
STORM DOORS:Qty C===-) Material: Color
GARAGE DOORS:Qty.: - Marl: ttlaii 0, CI YI If Style L..4rr14. Color („,4
WINDOWS:Qtvisitle::Front: k 5 Left: E":; Right Rear Im-4 Color
Manufacturer/Series: ; Material:
Grilles(Required). Pattern(6/6,2/1,etc) Grille Tvoe:True Divided Lite:
Snap-In: Between Glass: Permanently Applied: 7:=`, Exterior jntenor
STORM WINDOWS: Qty: Material: Color
SHUTTERS: Mel: it44-11 14"6/ Styte{,Raneted .1,> Louvered Color 4A-I“
I
SKYLIGHTS: Qty: (Z./ Fixed Vented Size Color
in
DECK: Size: a „X/ L.,' Decking Matt ' Color 11,-4-1
Railing Mall: - Style: Color:
WALLS/FENCES*(Max 6'height): Height: Marl:
Style: Color:
(Show running footage&location on plot plan.) *Finished side of fence must face out from fenced in area.
UTILITY METERS/HVAC UNITS: Location I Screening:
LIGHTS:Qty: Style. - = = Color
Location(s):
LIGHT POSTS:Qty: Material: Color
Location(s):
Additional information:
2-General
APPLICATION#: .:9? ,11)="1-C1
TOWN OF YARMOUTH
OLD KING'S HIGHWAY HISTORIC DISTRICT COMMITTEE
ABUTTERS' LIST
Applicant's (Owner) Name: S e 0\e Crl .."- Ca (b°\eTha-r
Property Address/Location: f Cev", . ifYIcruAlt-i—Pcd rn Pt 0-2"61 9.
Hearing Date: ,21,231,..??...
Notices must be sent to the Applicant and abutters (including owners of land on any
public or private street or way) who's property directly abuts or is across the street from
the Applicant. Please provide the Assessor's Tax Map and Lot numbers onlv. The
OKH Office will send out notices using the addresses as they appear on the most recent
applicable tax list.
Note: Instructions for obtaining the abutters Map and Lot numbers can be found on the Old King's
Highway Department page on the Town website: www varmouthsna us
Map Number Lot Number
Applicant Information: /A10
Abutter Information:
ILrO
I LI° 7:4 0
LIV i
41/4)
Application #:
3
8.2018
LOCOS �1f LOCUS INFORMATION NO. DATE oESC.
'Py N CURFEW W OiNEA: STEPH EN F.*EVA N. OVERLAY 011,No t: H1'Q _
�'`Y� TITLE 800K 2Th11.PAS.390 HOT 1N A ZONE A
i. OUS CLE PLATA REFTROKE ROOK 242.PACE 30 FELLA t1A00 ....
.'tat astact. 9C.OAW'D 7jf0 4
ASS MAP: 140 PA1E7. 767
I PARCEL: 32
R- WgAOA LOT SEIE: 40.000 S.F.
ZOPLN2 OS'TtECF. R-10 FAS=LOT SF7E:. 31.112 ASP, I CERTIFY TO THE REST OF MY
V
StiE <HO SE EOC.PO CH.SHKL 1.538/31.t12w3.31CPROFESTOWN NFORMATION
AIRI aux, THAT THE U7T CORNERS.
a \'*\ REAR �' (NOI gCC7t.PORCH.SHED) AND SETBACKS TO THE
`� PROPOSED RO*DNC CO 41/43E:. 2.044/31.112.65X INSTRUMENT'STRUCTIARE AS DETERINNED BY
SCANEYAND AS SHOWN OH
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140! 31/ I I
JUAN CHIEN CHING Please use this signature to certify this list of properties
NG WAI-SA directlyabuttingand across the street from the parcel located at:
161 CENTER ST
YARMOUTH PORT, MA 02675 169 Center St.,Yarmouth Port, MA 02675
Assessors Map 140, Lot 32
140/ 30/ / / r fZti
PILIBOSIAN PHILIP STEWART TRS
PILIBOSIAN GAIL PATRICIA TRS Andy M hado, Director of Assessing
979 E GULF DR UNIT 374 February 8, 2022
SANIBEL,FL 33957-6918
140/ 32/ / I
CARBONARO STEPHEN F
CARBONARO EVA M
169 CENTER ST
YARMOUTH PORT,MA 02675
140/ 33.1/ / /
LETTERA MICHAEL J
LETTERA LESLIE C
2001 E 2ND AVE UNIT 10C F
TAMPA , FL 33605
FP 8
140/ 56/ I 1 1
STONEJONES LLC £
80 HILLSDALE ST OLD I C"5_ I ' :wx/',mn
DORCHESTER,MA 02124
140! 33.2/ 1 / \t✓19'
LETTERA MICHAEL J
LETTERA LESLIE C
2001 E 2ND AVE UNIT 10C
TAMPA , FL 33605
1�
ov-Yett, TOWN OF YARMOUTH
1146 ROUTE 28,SOUTH YARMOUTH,MASSACHUSETTS 02664-4451
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Telephone(508)398-2231 Ext.1292 Fax(508)398-0836
OLD KING'S HIGHWAY HISTORIC DISTRICT COMMITTE„
CWFJ
;',1 2 i 2022
WAIVER OF 45-DAY DETERMINATION tAtiPt,
'it
The applicant/applicant's agent understands and agrees that due to the current declared
National and State public health emergencies the determination of our Application for a
Certificate of Appropriateness/Demolition/Exemption may not be made within 45 days of the
filing of such application.
The applicant agrees to extend the time frame within which a determination is to be made as
required by the Old King's Highway Regional Historic District Act.
SECTION 9-Meetings, Hearings, Time for Making Determinations
"As soon as convenient after such public hearing: but in any event within forty-five (45) days
utter the filing of application, or within such further time as the applicant shall allow in
-writing, the Committee shall make a determination on the application.
Applicant understands that the review of this application will be scheduled as soon as the
situation allows.
Applicant/Agent Name (please print): e
6 i-e-Ph 11 avra VO 44,4, C
114
Oct fr- o a
Applicant/Agent signature: Date:_ — 20 LI--
(t_
atitVAL1-4-9-
Y. 8 ;
Application#:
312020
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