Loading...
HomeMy WebLinkAboutBLD-22-003615 ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department r of r 1146 Route 28, South Yarmouth,MA 02664-4492 /,:' � 508-398-2231 ext. 1261 Fax 508-398-0836 f 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: Lb 22....--M3(o/J Date Applied: fy Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbcss - Q. '6Y1‘11Ac.� / RECEIVE D 1.1 a Is this an accepted street?yes ✓ no Map Number Parcel Numb., 1.3 Zoning Information: 1.4 Property Dimensions: SEP 2 2 2022 Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)„,----...- BUILDING PARTM�NT �� D 1.5 Building Setbacks(ft) BY:_---------- Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided G\L 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 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2. Owner'of Record: _ Unk. vm , ON.... Ja , 0, Name(Print) City, >tt0(.3 Ciy Zio . t7-966 -Yhe 0IC,'imsres n c me . ke" No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) 0 Addition El— Demolition 0 Accessory Bldg. 0 Number of Units Other ecify: j?a in')fit\ Brief Description of Propos 1 Work2: a(1i(W'j s ! ,F, ..... ,(�.DL t OO _ a ofIL.14234 ( .kdo,s.,..1 c---- — Nt.x..) tc,v N..1.1*Cc co:\ SECTION 4:ESTIMATED CONSTRUCTION COSTS. Item Estimated Costs: Official Use Only (Labor and Mt6ials) 1. Building $ (1 1. Building Permit Fee:$ 9 3 Indicate how fee is determined: a 0 Standard City/Town Application Fee 2.Electrical $ �DJ 3 0 Total Project Cost Item 6)x,milltip lerr x 3.Plumbing $ 2. 0 er Fees: $ -.*aa70 4.Mechanical (HVAC) $ j / a t) List:l )1)��;lM - ' O f\��r6 i u ys 1`j U 5.Mechanical (Fire 5 �vx' /►tiers, \co3 a 4-too Suppression) $ Total All Fees:$ Check No. Check Amount: Cash Amount: 6.Total Project Cost: S 6 t I) 0 Paid in Full ❑Outstanding Balance Due: - • SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) O n c C A.L�C License umber 02 .0�^ Expiratio Date Name of CS Holder List CSL Type(see below) No.and Street Type Description � en Unrestricted(Buildings up to 35,000 Cu. ft.) �t. f`'�Qc),--1-i, ' r'Ju ' � R Restricted 1&2 Family Dwelling City/ own,State,ZIPIvi Masonry RC Roofing Covering _ _ 3e&kVVW0 5(AC `� WS Window and Siding n ��•i^�\� ` N` �`` SF Solid Fuel Burning Appliances -.. •-,�3�" 214' lam'' l f',/�'�:� 1 . I Insulation Telephone T— i address D Demolition 5.2 Re istered Home Improvement Contractor(HIC) �,y U J�� HIC ReegistraTion Number Expir ion Date HIC Co pany Naine or HIC Registran Name No. and Street I 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 peiurit. Signed Affidavit Attached? Yes No ❑ 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 Se Q 0 c't_ 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: OWNER1 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. 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" 1 '� The Commonwealth of Massachusetts , Department oflndustrialAccidents 1-41P71711 Con;ressStreet, Suite 100 < Boston, MA 02114-2017 \tii,` �.''� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): r Q 0-U4. Address: 7(7 ,l"A41) Cit /State/Zi WyVb1 m 6 ' Y Phone : . _ ....— Are you an employer?Check the a4ppropriate box: Type of project(required): I. am a employer with employees(full and/or part-time).* 7. Ei New construction 2. I am a sole proprietor or partnership and have no employees working for me in 8. emodeling any capacity.[No workers'comp. insurance required.] 9. ❑ Demolition 3.E I am a homeowner doing all work myself. [No workers'comp. insurance required.]t 10 tnTaddition 4._I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑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 i 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: Q. ( c142.6 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. I do hereby cert i, under the pains and penalties of perjury that the information provided above is true and correct. Signature: .4, 141 Date: 49 . . - ,,� , Phone/: di, IS S--D - ..,1_--2 " 1 C(S 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 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1261 q n n�TncH EysE/� a HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE: JOB LOCATION: NAME STREET ADDRESS SECTION OF TOWN "HOMFOWNER" NAIVLE HOME PHONE WORK PHONE PRESENT MAILING ADDRESS CITY OR TOWN STA I ' ZIP CODE The current exemption for `Homeowner' was extended to include owner— •ccupied dwellings of one or two units and to allow such homeowners to engage an individual for hire who does of possess a license,provided that such homeowner shall act as supervisor. (State Building Code Section 110 • .1.3.1) Definition of Homeowner: Person(s)who owns a parcel of land on which he/she resides or inten&s to reside,on which there is or is intended to be, a one or two family attached or detached structure assessory to suf h use and/or farm structures. A person who constructs more than one home in a two-year period shall not be con ;dered a homeowner;such"homeowner"shall submit to the building official, on a foil,"acceptable to the building official,that he/she shall be responsible for all such work performed under the building permit. (Section 110 R5., .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 underst. ds 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 yes, please indicate the type coverag, by checking the appropriate box. A liability insurance policy Other type of ins-mnity 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 si• .t. eon this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent h:homeownrlicexemp TOWN OF YARMOUTH fir; BUILDING DEPARTMENT O - ` "'''=+y 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 9 Cin.l lj i C Work Address Is to be disposed of at the following location: c�' Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. S -,-2(172 Sig re of p ication Date Permit No. Sears, Tim From: Sears,Tim Sent: Monday,January 3, 2022 2:29 PM To: 'georgeaverycarpentry@gmail.com' Cc: Grant, Kelly Subject: 9 Millard Attachments: work in flood zone packet.PDF; 9th Edition flood FAQ.PDF George, I have reviewed your application for the addition/remodel, and there are some items needed; 1. Conservation sign off 2. Site plan stamped by land surveyor 3. Rescheck 2 copies of structural drawings with 110mph checklist or stamped plans 5. . ropertiib. cated in, a floo• .,ke. I ha. e attaced a acket ft�o o rev . W e c:•� •leted worksh -oltracto owl .effida U, s gne nd nbt .The fitiW aThdavii4Lbe n e ef4e final inspection. �{ Please submit these items for review CAY 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.I. 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@yarmouth.ma.us 1 or.Y TOWN OF YARMOUTH a'-; :t`~ °i BUILDING I)EPARTMENT �h\ 1146 Route 28,South Yarmouth,MA 02664 Telephone 508-398-2231 ext 1261 Fax 508-398-0836 Owner's Affidavit:Substantial Improvement or Repair of Substantial Damage Property Address: I rt I L L4/ J el) J o• y./4/l M J vt%f/ Mil Parcel ID Number: 03 7 . Z? • Owner's Name: 0 0^1 A L r, 9` fCA Til C E'1 rni -`!`'1 O k R 1,(G rd Owner's Address/Phone: 3 140 L L a i.J R i U f kV /d b. C K f C/,Jlro.to PO 4 6 t 7 ` b 6 tf /u C f' Contractor: "�-o R 6 f fa✓F/ Y oryL. (3 Contractor's license Number: / .'2 I 4>0 Date of contractor's Estimate: 0 6/3 0/2421 I hereby attest that the description included in the permit application for work on the existing building all improvements, rehabilitation, remodeling, repairs, additions, and other forms of Improvement I further attest that I requested the above-identified contractor to prepare a cost estimate for all of the work,including the contractor's overhead and profit.I acknowledge that If,during the course of construction,I decided to add more work or to modify the work described,that the Town of Yarmouth will re-evaluate its comparison of the cost of work to the market value of the building to determine if the work is substantial improvement. Such re- evaluation may require revision of the permit and may subject the property to additional requirements. I also understand that I am subject to enforcement action and/or fines if inspection of the property reveals that I have or authorized repairs or improvements that were not included in the description of work,and the cost estimate for that work that were basis for issuance of a permit. 1 Owner's Signature: / 0 A-- / ft/ /t d(14.11/?Cj Date: 1 Zb2 Notarized: h 4 trn4.fl y aS� - nr f. y ,*_y which wen be the persioil,irh .`.ai r DAVID J.�.J-' -- -� ' Dull. dueled to .- 1'4 ' ribi q :'^f', tf. . Notes Public 1.0 `"...,„,-, . ,meets ,,,. � v Carnmissiotl ElcQirts -3. October 17, 202S } � TOWN OF YARMOUTH /d1-. � ,?rye ,o`' BUILDING DEPARTMENT 4`e",n^TT=A�„_=Sz' 1146 Route 28, South `Yarmouth, MA 02664 Telephone 508-398-2231 ext. 1261 Fax 508-398-0836 Contractor's Affidavit: Substantial Improvement or Repair of Substantial Damage Property Address: 0111 Ci Parcel ID Number: Owner's Name: C c7 Yl -t- 4=1 - y D Mc. 1— Contractor: (fr.o v (q-'C A Q_A- Contractor's License Number: Z ko Date of Contractor's Estimate: I hereby attest that I have personally inspected the building located at the above-referenced address by the nature and extent of the work requested by the owner, including all improvements, rehabilitation, remodeling, repairs, additions, and any other form of improvement. At the request of the owner, I have prepared a cost estimate for all of the improvement work requested by the owner and the cost estimate includes, at a minimum, the cost elements identified by the Town of Yarmouth that are appropriate for the nature of the work. If the work is repair of damage, I have prepared a cost estimate to repair the building to its pre-damage condition. I acknowledge that if, during the course of construction, the owner requests more work or modification of the work described in the application,that a revised cost estimate must be provided to the Town of Yarmouth, which will re-evaluate its comparison of the cost of work to the market value of the building to determine if the work is substantial improvement. Such re- evaluation may require revision of the permit and may require revision of the permit and may subject the property to additional requirements. I also understand that I am subject to enforcement action and/or fines if inspection of the property reveals that I have made or authorized repairs or improvements that if inspection of the property reveals that I have made or authorized repairs or improvements that were not included in the description of work and the cost estimate for that work that were basis for issuance of a permit. Contractor's Signature Date: 7— Notarized: AMY FORBES Ie Notary Public jmM NWEALTH OF MASSACHUSETTS ,' 4 tviy Commission Expires ti - November 15, 2024 TOWN OF.Y.ARMOUTH 1146 Route 28 ) 'l .ar m i ;uth, MA 02664 508-348-223 ex Pax 508-3 8-0836 Office of the Bui issioner FINAL COST AFFIDVIT FOR WORK IN FEMA FLOOD ZONE To the Building Commissioner, In accordance with 780 CMR Section 109 of the Massachusetts State Building Code, the total estimated cost of construction, including all related costs* of the building at 01 , l cS I - and constructed,reconstructed, altered,repaired, or extended under building permit no. amounts to $ O I, � t�-v-€S y' ,being referred to as the owner/agent identified below,do solemnly swear that th atements ma a herein are strictly true, correct and made in good faith *Related construction costs include all work done with or concurrently with the work contemplated by the building permit including construction, reconstruction, repairs, demolition, HVAC work, etc. Furnishings and portable equipment are not part of the total construction costs. Al 1 Si ature of own 4gent n‘ittilki- 13-- A Notary P`ujlic Signature My Commission E*pires AMY FORBES e Notary Public Notary Seal: ( COMMONWEALTH OF MASSAChI My Commission Exc;r f.,, November 15, 2024 E.I< 3 345 P°si 108 Z44-097 , f, L19--02- 2022 ar 11 : 18a. --, �, .rr TOWN OF YARMOUTH - BOARD OF APPEALS t ;. DECISION RUE C PY AT I FILED WITH TOWN CLERK: August 9, 2022 4) PETITION NO: 4962 CM0.4C/C C/TOWN, HEARING DATE: July 14, 2022 AUG 3 0 2022 PETITIONER: Don and Kathy Morrison .PROPERTY: 9 Millard Rd, South Yarmouth, MA Map 34, Parcel 29 Zoning District: R-25 Title: Book 27063, Page 609 MEMBERS PRESENT AND VOTING: Chairman Steven DeYoung, Sean Igoe, Jay Fraprie, John Mantoni. Notice of the hearing was given by sending notice thereof to the Petitioner and all those owners of property as required by law, and to the public by posting notice of the hearing and publishing in The Cape Cod Times. The hearing opened and was held on the date stated above. The petition of Don and Kathy Morrison concerning property located at 9 Millard Road, South Yarmouth, MA, such property being in a Zoning District R-25 seeks a Special Permit to increase the height of their home which currently encroaches in the rear setbacks. Appearing for the petitioner was George Avery of George Avery Carpentry who did a fine job with his presentation. Mr. Don Morrison, the homeowner was also in attendance. The existing home is a one bedroom ranch which is located in a flood zone. Accordingly, in order to obtain a proper Elevation Certificate, the house needs to be raised 12 inches. The property sits adjacent to Millard Road which has not been developed to the full taking/layout of the road. All Board Members concurred that with the few houses on this road, there is no significant likelihood that it will be developed or widened in the future. Therefore, each Board Member considered the house actually well beyond the usual setback required. The construction will also include an addition which will include an additional bedroom. Each Board Member thought that the request was reasonable and that the relief needed was modest. The lot is, in itself, unique in its shape. No one spoke in favor or in opposition to the petition. Two exhibits were received at the hearing, the first being a plan showing beyond the existing footprint and the second being a larger version of the site plan . During discussions on the merits of the petition,the Board felt that the relief could be granted without creating any undue hazard, nuisance or congestion nor would it cause any detriment to the existing or future character of the neighborhood or Town both as it is presently or as it will become in the future. A motion was made by Mr. Igoe, seconded by Mr. Mantoni to grant the request for the Special Permit without conditions. A roll call vote was made with the following results: Mr. Mantoni-Aye; Mr. Igoe-Aye; Mr. DeYoung-Aye; and Mr. Fraprie-Aye and, the Special Permit was therefore granted, without conditions. As to the petitioner's request for relief by Variance,at his request the Board considered whether or not to allow withdrawal of this request for relief, without prejudice, and a roll call vote was made with the following results; Mr. Fraprie- Aye; Mr. Igoe-Aye; Mr.Mantoni-Aye;and Mr. DeYoung-Aye. Therefore,the request for the grant of a Variance was allowed to be withdrawn, without prejudice on a unanimous vote. No permit shall issue until 20 days from the filing of this decision with the Town Clerk. Appeals from this decision shall be made pursuant to MGL c40A section 17 and must be filed within 20 days after filing of this notice/decision with the Town Clerk. Unless otherwise provided herein, the Special Permit shall lapse if a substantial use thereof has not begun within 24 months. (See bylaw §103.2.5, MGL c40A §9) Steven DeYoung, Chairman CERTIFICATION OF TOWN CLERK I, Mary A. Maslowski, Town Clerk, Town of Yarmouth, do hereby certify that 20 days have elapsed since the filing with me of the above Board of Appeals Decision #4962 that no notice of appeal of said decision has been filed with me, or, if such appeal has been filed it has been dismissed nr denied. ppeals have been exhausted. kkeytia. RUE C PY ATTEST: Mary A.Maslowski AUG 3 0 2022 cinci cnr,�; rowN CLERIC AUG 3 0 20 `2 �, f 't COMMONWEALTH OF MASSACHUSETTS -- • ' TOWN OF YARMOUTH . it BOARD OF APPEALS r , Petition #: 4962 Date: August 30, 2022 Certificate of Granting of a Special Permit (General Laws Chapter 40A, Section 11) The Board of Appeals of the Town of Yarmouth Massachusetts hereby certifies that a Special Permit has been granted to: Don and Kathy Morrison 9 Millard Rd, South Yarmouth,MA 02664 Affecting the rights of the owner with respect to land or buildings at: 9 Millard Rd, South Yarmouth, MA; Map #: 34; Parcel#: 29; Zoning District: R-25; Book/Page: 27063,609 and the said Board of Appeals further certifies that the decision attached hereto is a true and correct copy of its decision granting said Special Permit, and copies of said decision, and of all plans referred to in the decision, have been filed. The Board of Appeals also calls to the attention of the owner or applicant that General Laws, Chapter 40A, Section 11 (last paragraph) and Section 13, provides that no Special Permit, or any extension, modification or renewal thereof, shall take effect until a copy of the decision bearing the certification of the Town Clerk that twenty (20) days have elapsed after the decision has been filed in the office of the Town Clerk and no appeal has been filed or that, if such appeal has been filed, that it has been dismissed or denied, is recorded in the Registry of Deeds for the county and district in which the land is located and indexed in the grantor index under the name of the owner of record or is recorded and noted on the owner's certificate of title. The fee for such recording or registering shall be paid by the owner or applicant. aa.... Steven DeYoung, Chairman A TRUE COPY ATTEST: . G)44,1),(,YhA4,thtae—f BARNSTABLE REGISTRY OF DEEDS a John F. Meade, Register CMMC/CMC ITOWN CLERK AUG 3 0 2022 12/28/2021 To the Town of Yarmouth, We have entered into agreement with George Avery Carpentry 26 Doane Rd Harwichport Ma to perform the renovation of our home at 9 Millard Rd South Yarmouth as well as the addition of two bedrooms and bath to the existing structure. George Avery will coordinate all construction work to be done at our home. Sincerely, L � � Donald and Kathleen Morrison 9 Millard Rd South Yarmouth 02664 617-966-4498 dkmorrsn@comcast.net 12/28/2021 To the Town of Yarmouth, We have entered into agreement with George Avery Carpentry 26 Doane Rd Harwichport Ma to perform the renovation of our home at 9 Millard Rd South Yarmouth as well as the addition of two bedrooms and bath to the existing structure. George Avery will coordinate all construction work to be done at our home. Sincerely, ckt (4, u h /kLLLS i4 r Donald and Kathleen Morrison 9 Millard Rd South Yarmouth 02664 617-966-4498 dkmorrsn@comcast.net k yu(Scan } � rC� j ,> 1`,aTER DEPARTMENT � 1 C t© y: .. C j At\ --- t f , OnA. Imo° pi BUILDING PERMIT APPLICATION FOR WATER DEPARTMENT SIGN OFF TRANS,NIITTAL FORM i BUILDING SITE LOCATION: T trip -0� APPLICANT: 6.,,,, _.„ , vc „__ ___ ADDRESS: a� 1 .4...g- . ,4:1 • i\ fiCL-• Uo -;',7- , ry7 pel TE l.f'flONE r . RESIDEN HAI. AND 'OR COMMERCIAL [WILDING i water Delrti7lenr Determines Compliance of\ti ater Axailahihty and or existing i location I)(Tat-linen!: Determines Compliance tir Parking and Drainage t�r('un enatiun Commission: I)etennine. Compliance to \Vetlands Act; t e II'lot( border any t.pe ()I'wet lands. streartis. ponds. ri k as, ocean, bogs, buys. marshland, I:I�('_. IIcaitli I)eparUnerlt. Determines ( c,rliltiarice to State and Iuttrl Regulations. i e requirements to: Sehtage I)1sposal and other Public Health Acti ices I ire Department: Determines Compliance to State and Town Requirements toi Personal Salr`t\. Prl,hert> Protections, i c Smoke Detectors. Sprinkler S�stenr.e►c gal APP , A 'IGNA 416 : DATE OFFICE. t'SE: COMINIENTS ON PERNIl1 APPROVA1, OR DENIA1. REVFf..-'E:D 81- 11 A7ER DIVISION (SIGNATURE) DATE Donald Morrison NAME 4224-28 - 7/27/77 • 7 • - . - . STREET VILLAGE SERVICE NO. -3• METER NO. 4 - — 45. 5-414,*462 err OP e o 0, F.4 :3• k•IN, / v ...--- . 9,geTwl.......YS gfILP Penti akpilc SYS T 1=441 SEC rtorA ,i,N.M165,:iiiiMMAU•"' 1 4 ir-m. 1 .1 7i; I.-i-."'".'"''-,,,,...',./'•../TOLG/1 a, ) -7,7tr., , 99,19.9., '.,..!..A 9._ . .... ,,,,,,,,,......• ... . .,,,,, , .....<..,,,,,f.=LE...,9,9,9 9,.•.9,..f.0,0 1 . tyr 1.1 .. . ,T.:.:‘:::;.;:1, 71,,,%;''."1.±%—'''.'''''''''"' --ViL"--,,7 4.,'Z.:9 r•,4,'.-44,..,-- I - AVI,rtr4V,1:4-4,.. ''''''''''''-. Pir.P44WI:=6"141. - ,,, ..--............: ' -•-•-•-• I _ TEST HOLE LOGS 69.9.4.4.9 ......... '9.9.,-9...... ' . ,, .• 14 i tl7P,V:IN 0 ,.,• ..t. 1 ii ,--*— • ,. . NOTF.% ,, \ /. iifalg.,,7,7\ 't---.. '"''' ' '''' ''''' • ;,, „,....' [ r...„..., i , 1 ... ,-.- ,.., '. P,..1•e ,',•,.- 'i , . , "\ ,,.• „ „AP A 4,....,1.W.0,•U..,7,5,90. tIolr I 0 0 .„.• 2)‘ ; > 0 .,. .. . I I , \ it Si .,. ,,,-..."-': I 1 1 ,una.A RD tut, I-OM/UK Al t ' ..9.919,19t'9.,,- DO &MINI'MORRISS" zs,,,f_ 4,,,,,,,,,,o,4.1 1 \ It ,-,..... ...., ,,,,,... '—- 1-, orA,'./.. ,. ...... .1741,-tj rt40/44.8 WORK MUST CONFORM TO ALL WN Y WS& REGULA 10 10 4 VA OUTH WATER-OEPT A E ��o° { Keg�iMeion Commonwealth of Massachusetts ntrt�nnn�ry,a/l/ifn, . //r34,76,^ `-' us news i Division of Professional ticensure Office of Consumer A vs HOME IMPROVEMENT CONTRACTOR { Board of Budding Regulations and Standards TYPE:Individual Reg' 1 ian Const� t rvisr r 182180 06/02/2023 GEORGE AVERY ' C ,-p32$ti9 z spires:06115121 GEORGE AVERY , s 26 DOANE ROAD GEORGE J.AVERY ( HAR1NICH pay 26 DOANE Rb ' , ,-, HARWICHPORT,MA 02646 Undersecretary '�`01Wit:lk'` Commissioner icatli2A K. tr— DATE A�® CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFER I 08/20/2021 HOLDER. CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BYCATE 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 CONTACT JudyPashko NAME: Complete Benefit Solutions PHONE (800)684-5470 FAX One Carando Drive,Suite 1 /C,No,Ext): (A/c,No): (413)538-5761 MAIL ADDRESS: Jpashko@comptetepayrollsolutions.com Springfield INSURER(S)AFFORDING COVERAGE NAIC# MA 01104 INSURERA: NorGUARD INSURED 31470 INSURER B: George Avery Carpentry LLC INSURER C: 26 Doane Road INSURER D: INSURER E Harwich MA 02646 INSURER F: COVERAGES CERTIFICATE NUMBER: CL20'12403345 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER COMMERCIAL GENERAL LIABILITY (MMlDDlYYYY) (MM/DD/YYYY) LIMITS EACH OCCURRENCE $ CLAIMS-MADE ,OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL 8 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY I PRO- GENERAL AGGREGATE $ 1 JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) OWNED BODILY INJURY(Per person) $ SCHEDULED AUTOS ONLY AUTOS HIRED BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY $ (Per accident) UMBRELLA LIAB OCCUR EXCESS LIAB EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE $ DED I (RETENTION$ WORKERS COMPENSATION v $ AND EMPLOYERS'LIABILITY Y/N /��STATUTE I I EERH A ANY PROPRIETOR/PARTNER/EXECUTIVE 100,000 OFFICERlMEMBEREXCLUDED? Y NIA GEWC194438 11/24/2020 11/24/2021 E.L EACH ACCIDENT $ (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE $ 100,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Yarmouth ACCORDANCE WITH THE POLICY PROVISIONS. 1146 Route 28 AUTHORIZED REPRESENTATIVE Yarmouth MA 02664 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD TOWN OF YARMOUTH s,' A c. HEALTH DEPARTMENT PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To he completed by Applicant: Building Site Location: 61 c 1"GO Proposed Improvement: A.60 6m-1NQ ,n1 (A- 6 ,( 4 Applicant: 0� U , Tel. No.:,4R 3-2•.- 36'5 Address: , D 's2.- st1ic"-' CIN.98 (111 Date Filed: **Ifyou would like e-mail notification of sign off please provide e-mail address: Owner Name: �J/:\ K occ�'S Owner Address: =3 I\I3 � � ) Owner Tel. No.:�' t7- - 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, - .errerwesamLJ � ;J and septic system location; (2.) Floor plan labeling ALL rooms within building OCT 2 5 Z021 (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: c57-E-57'.4--€ •% DATE: /21/74:1/21°2 I PLEASE NOTE COMMENTS/CONDITIONS: 3 b SSTs_. U.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency OMB No. 1660-0008 National Flood Insurance Program Expiration Date: November 30,2022 ELEVATION CERTIFICATE Important: Follow the instructions on pages 1-9. Copy all pages of this Elevation Certificate and all attachments for(1)community official, (2) insurance agent/company, and (3)building owner. SECTION A—PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name Policy Number: Donald J. Morrison A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Box No. Company NAIL Number 9 Millard Road City State ZIP Code South Yarmouth Massachusetts 02664 A3. Property Description (Lot and Block Numbers,Tax Parcel Number, Legal Description, etc.) Map 34 Parcel 29 A4. Building Use(e.g., Residential, Non-Residential,Addition,Accessory, etc.) Residential A5. Latitude/Longitude: Lat.41.64691 Long.-70.20798 Horizontal Datum: ❑ NAD 1927 Ex NAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. A7. Building Diagram Number 9 A8. For a building with a crawlspace or enclosure(s): a) Square footage of crawlspace or enclosure(s) 1400.00 sq ft b) Number of permanent flood openings in the crawlspace or enclosure(s)within 1.0 foot above adjacent grade 7 c) Total net area of flood openings in A8.b 896.00 sq in d) Engineered flood openings? ❑x Yes ❑ No A9. For a building with an attached garage: a) Square footage of attached garage N/A sq ft b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade c) Total net area of flood openings in A9.b sq in d) Engineered flood openings? ❑ Yes ❑ No SECTION B—FLOOD INSURANCE RATE MAP(FIRM) INFORMATION B1. NFIP Community Name&Community Number B2. County Name YARMOUTH 250015 B3. State BARNSTABLE Massachusetts B4. Map/Panel B5. Suffix B6. FIRM Index B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s) Number Date Effective/ Zone(s)( ) (Zone AO, use Base Flood Depth) J Revised Date 25001C0589 07-16-2014 07-16-2014 AE 11 B10. Indicate the source of the Base Flood Elevation (BFE)data or base flood depth entered in Item B9: ❑ FIS Profile FIRM ❑ Community Determined ❑ Other/Source: B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 ❑x NAVD 1988 ❑ Other/Source: B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes No Designation Date: ❑ CBRS ❑ OPA ❑ FEMA Form 086-0-33(12/19) Replaces all previous editions. Form Page 1 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2022 IMPORTANT: In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Box No. Policy Number: 9 Millard Road City State ZIP Code Company NAIC Number South Yarmouth Massachusetts 02664 SECTION C—BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: 0 Construction Drawings* 0 Building Under Construction* Finished Construction *A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations—Zones A1—A30, AE,AH,A(with BFE), VE, V1—V30, V(with BFE),AR,AR/A,AR/AE,AR/A1—A30,AR/AH,AR/AO. Complete Items C2.a—h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters. Benchmark Utilized: CARLSON BRX7 Vertical Datum: NAVD88 Indicate elevation datum used for the elevations in items a)through h)below. NGVD 1929 NAVD 1988 0 Other/Source: Datum used for building elevations must be the same as that used for the BFE. Check the measurement used. a) Top of bottom floor(including basement, crawlspace, or enclosure floor) 7.8 LJ feet ❑ meters b) Top of the next higher floor 12.3 0 feet ❑ meters c) Bottom of the lowest horizontal structural member(V Zones only) N/A 0 feet 0 meters d) Attached garage(top of slab) N/A 0 feet El meters e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) 12.3 0 feet meters f) Lowest adjacent(finished)grade next to building (LAG) 8.8 0 feet ❑ meters g) Highest adjacent(finished)grade next to building(HAG) 9.4 0 feet 0 meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 8.8 Qx feet 0 meters SECTION D—SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. I certify that the information on this Certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. Were latitude and longitude in Section A provided by a licensed land surveyor? El Yes ❑No ❑Check here if attachments. Certifier's Name License Number Terry A. Warner 38721 Title Professional Land Surveyor moo Company Name 1'EAt4Y Warner Surveying WARNER6. Address No.3872f 22 Long Road t City State ZIP Code Harwich . Massachusetts 02645 Signature Date Telephone Ext. 7Q4 .rQ. 02d2o1.4_4. 05-11-2022 (508)432-8309 Copy all pagg of this Elevation Certificate and all attachments for(1)community official, (2)insurance agent/company,and(3)building owner. Comments(including type of equipment and location, per C2(e), if applicable) Existing wood ranch with concrete block crawl space, to of crawl space to be raised to 1.3'over flood level. No machinery servicing the house to be in the crawl space. Seven (7)flood vents to be installed in the new foundation to service 1400 s.f. of interior space. FEMA Form 086-0-33(12/19) Replaces all previous editions. Form Page 2 of 6