HomeMy WebLinkAboutBLD-23-005893 -Q.-)\ii c-)v .-,?(C' ) - ---... , C.
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 IS
Massachusetts State Building Code,780 CMR \ e
Building Permit Application To Construct,Repair, Renovate Or Demolish
L
'i
a One-or Two-Family Dwelling
This Section For Official Use Only
lding Permit Number: -Z3 �X� Date Applied:
tu .4....cr -..--. 7uilding Official(Print Name) SignatureDateSECTION 1:SITE INFORMATION
1 Pro erty Address: 1.2 Assessors Map&Parcel Numbers
137 pRun Pond Rd
L........,...j
•
1 a Is this an accepted street?yes no 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 I 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 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Casa Madrid, LLC Allston, MA 02134
Name(Print) City,State,ZIP
500 Lincoln St Ste 2 617-751-5119 jacob.simmons@cityrealtyboston.com
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction'I Existing Building❑ I Owner-Occupied 0 I Repairs(s) 0 Alteration(s) 0 I Addition 0
D...-1:t:,,,, W Accessory Bldg.0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2:
Raze Existing building.
Foundation and framing of existing structure are compromised and property is structurally unsound.
SECTION 4:ESTIMATED CONSTRUCTION COSTS.
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 300,000 1. Building Permit Fee:$ Indicate how fee is determined:
2. 50,000 0 Standard City/Town Application Fee
Electrical $ 1
0 Total Project Costa{Iem 6)x multiplier x
3.Plumbing $ 50,000 2. Other Fees: $
4.Mechanical (HVAC) $ 50,000 List:
5.Mechanical (Fire •
Suppression) $ Total All Fees:$ ' . •
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ 450,000 ❑Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) CS-107462 7/31/23
Josh Fetterman License Number Expiration Date
Name of CSL Holder
49 Osborne Path List CSL Type(see below) U
No.and Street Type Description
Newton Center, MA 02459 U ' Unrestricted(Buildings up to 35,000 cu.ft.)_
City/Town,State,ZIP R Restricted l&2 Family Dwelling
lvi Masonry
•
RC Roofing Covering
WS Window and Siding
617 470 2111 SF Solid Fuel Burning Appliances
josh.fetterman@cityrealtyboston.com I Insulation
Telephone Email address D ' Demolition
5.2 Registered Home Improvement Contractor(HIC)
Josh Fetterman 175587 05/23/23
I-EC Company Name or HIC Registrant Name HIC Registration Number Expiration Date
49 Osborne Path josh.fetterman@cityrealtyboston.com
No.and Street
Newton Center,MA 02459 617-470-2111 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 '1 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 Josh Fetterman
to act on my behalf,in all matters relative to work authorized by this building permit application.
s' w
04/20/2023
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.
�20-Gi ,7i2 V-
04/20/2023
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.cov/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.) 7,071
(including garage,finished basement/attics,decks or
Gross living area(sq. 6,299 porch)
ft.) Habitable room count 11
Number of fireplaces 3 Number of bedrooms 7
Number of bathrooms 6 Number of half/baths 2
Type of heating system forced hot air Number of decks/porches 1
Type of cooling system central air Enclosed 1 Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
The Commonwealth of Massachusetts
Department of Industrial Accidents
s=1E1I
1 Congress Street,Suite 100
Boston,MA 02114-2017
r'■��•'� 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): CRM Property Management/Josh Fetterman
Address: 320 WASHINGTON ST STE.3FF
City/State/Zip:BROOKLINE,MA 02445 Phone#: 617-751-5119
Are you an employer?Check the appropriate box:
Type of project(required):
I. 1 am a employer with20 employees(full and/or part-time).*
2.Q I am a sole proprietor or partnership and have no employees working for me in 8 7. ❑Rem odeling w construction
any capacity.(No workers'comp.insurance required.] • Rem •
3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. Demolition
4.01 am a homeowner and will be hiring contractors to conduct all work on my property. I will 1 a❑Building addition
ensure that all contractors either have workers'compensation insurance or are sole
11. Electrical repairs or additions
proprietors with no employees.
5.❑[am a general contractor and I have hired the sub-contractors listed on the attached sheet. 12.El Plumbing repairs or additions
These sub-contractors have employees and have workers'comp.insurance.t 13.0 Roof repairs
6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other
152,§I(4),and we have no employees.[No workers'comp,insurance required.]
*Any applicant that checks box m i 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.
tCantractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
f am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Associated Employers Insurance Company
Insurance Company Name:
Policy#or Self-ins.Lic.#:WCC-500-5018409-2023A 03/20/2024
Expiration Date:
137 Run Pond Rd
Job Site Address: Yarmouth,MA 02664
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 certify under the pains and penalties of perjury that the infornzatiorz provided above is true and correct.
Signature: 4 f a2�.1'240--
Date: 04/20/2023
Phone#: 617-470-2111
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
508-398-22311 ext.-1261 Fox 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 137 Run Pond Rd
Work Address
Is to be disposed of oat the following location: 337 Whites Path,South Yarmouth,MA 02664
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Ch. 111, §150A.
ig �� 6/17/22
nature of Application Date
Permit No.
• Information and Instructions
Massachusetts General Laws chapter l52 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association.corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152,§25C(6)also states that"every state or local Iicensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston, MA 02114-2017
Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax#617-727-7749
Revised 02-23-15 www.mass.gov/dia
,—! o-, TOWN OF YARMOUTH
;
o 1 . 1146 ROU 1 E 28 SOUTH YARMOUTH MASSACHUSETTS 02664-4451
., ; Telephone(50$) 398-2231,Ext. 1250—Fax(SQ$)760-4830
Engineering and Surveying Division Building Permit Review
Residential and/or Commercial Buildings
Name of Applicant: Jacob Simmons
Telephone or Email Address: Jacob.simmons@cityrealtyboston.com
Proposed Building Location: 137 Run Pond Rd
Date Submitted: 3/6/23
Requirements for review:
Please submit one(1)copy of plans,to include:
1. For Residential: Site Plan showing proposed and/or existing buildings,
proposed contours with bench mark, water service location, and septic system
location.
For Commercial: Site Plan showing details required by the Zoning By-law and
revisions required by Site Plan review, if any.
Note: Site plans must be signed and stamped by a Licensed Professional Land
Surveyor and Engineer or Sanitarian.
2. House or Building- Floor Plan(s) and Elevation Plan(s)
3. One(1)copy of application.
Amanda r=d=t cen,9
'oson.o�varmem orw,
Reviewed By: Lima oar 02303 16161029-M'°S Date: 3/16/2023
PLEASE NOTE
Comments/Conditions: Applicant noted existing driveway to be reduced to width 01
proposed garage. Road opening permit will be required for reduction of drivew%
restoration. Northern portion of driveway within high groundwater area. Suggesh
the drywell to the north. Retain stormwater on site during & post construction.
isa
Printed on Recycled Paper
ONE or TWO FAMILY— BULDING PERMIT
APPLICATION REGULATORY APPROVALS NOTICE
Address of Proposed Work:137 Run Pond Rd
Scope of Proposed Work: Construct new building per plans
Date: 04/20/2023
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
Old Kings HWY. Hist. Comm. —508-398-22631 ext. 1292
Engineering Dept.—508-398-2231 ext. 1250
Fire Dept.—Kevin Huck/Scott Smith, 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.
Rec
9.
04/20/2023- t Acknowledgement:41- ��'
Ap icant's Signature
Date
Rev.Jan. 2019
5/8/23, 11:38 AM Mail-Sears.Tim-Outlook
ti
137 Run Pond Rd
Sears, Tim <tsears@yarmouth.ma.us>
Mon 5/8/2023 11:36 AM
To:jacob.simmons@cityrealtyboston.corn <Jacob.simmons@cityrealtyboston.corn>
Jacob,
I have reviewed your application for new construction and there are some items needed.
�1. Conservation Transmittal form
2. HERS Certificate
�3. 2nd copy of plans
4. FEMA Elevation Certificate based on construction drawings
�5. Drawing S-1 shows a basement which is not allowed in a flood zone per section R322
Please update your plans and 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 CB()
Deputy Building Commissioner
Town of Yarmouth
508-398-2231 Ext. 1259
mailto:tsears@yarmouth.ma.us
https://outlook.office.com/mail/sentitems/id/AAQkADE3MDQ5NWZmLTkOYzItNDIwNi1 iMDQxLWNkMGQyNmE4NzE5NAAQADT2L6akIDdPnBBYgPk... 1/1
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Massachusetts Department of Environmental Protection
,i BureauWp of Resource m 2 _ rm
source Protectionpete -Wetlandsinatio
A Fo of ApplicabilityMassachusetts Wetlands Protection Act M.G.L, c. 131, §40
--- Town of Yarmouth Wetland By-Law, Chapter 143
B. Determination (cont.) .„
....
...
0 5 The area described in the Request is subject to protection under the Act.Since the work
!,..' described therein meets the requirements for the following exemption,as specified in the Act and
the regulations, no Notice of Intent is required:
Exempt Aclivity(site appliciblesteiiiiiiiiyireg Watery provisions)
).
..,
).•,'
..... 0 6. The area and/or work described in the Request is not subject to review and approval by: ,
.,.
.,, Name of Municipality ---
Pursuant to a municipal wetlands ordinance or bylaw.
Name - Ordinance or Bylaw Citation
C. Authorization
';,'',':',",;',,:,, ..,,,',•,,,,L
This Determination is issued to the applicant and delivered as follows:
0 by hand delivery on Z by certified mail, return receipt requested on
,,,,,,,...„,,
2/17/2023 ,;
1Y;tie------- Date
This Determination is valid for three years from the date of issuance(except Determinations for di
Vegetation Management Plans which are valid for the duration of the Plan).This Determination does not 4.i:
relieve the applicant from complying with all other applicable federal,state,or local statutes,ordinances, t;')iii,
:,,,y,,,,,,,,bylaws, or regulations.
,r11
This Determination must be signed by a majority of the Conservation Commission.A copy must be sent to lib
the appropriate DEP Regional Office(see https://wwvv.mass,qov/service-details/massdeo-reqiona)-offices-
by-community)and the property owner(if different from the applicant).
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1 Massachusetts Department of Environmental Protection
Bureau of Resource Protection-Wetlands
WPA Form 2 —Determination of A licabili
,,, PP § tYLlj C(� �,,
Massachusetts Wetlands Protection Act M.G.L. c. 131, 40
Town of Yarmouth Wetland By-Law, Chapter 143
A. General Information
Important: I
When filling outFrom:forms on the Yarmouth
computer,use Conservation Commission
only the tab
key to move To: Applicant Property Owner(if different from applicant):your cursor- &
do not use the Jacob Simmons
return key. Name Name ®-
320 Washington Street,Suite 3FF
V(JA° Mailing Address
Mailing Address �
Brookline __ MA 024.45
city/Town State 21p Code Cityfrown State Zip Code
1. Title and Date(or Revised Date if applicable)of Final Plans and Other Documents:
Site Plan of#137 Run Pond Road South Yarmouth,MA _ 01/11/2023
Title Date 't
Title Date
'.
- t
Title Date '�
2. Date Request Filed:
02/02/2023 '
------------
:11 :::illi'le'itio'lf,,!.
B. Determination
Pursuant to the authority of M.G.L. c 131, §40,the Conservation Commission considered your Ai,,,,,, ,��f
Request for Determination of Applicability,with its supporting documentation,and made the followingr.
Deternation.
i ,tr
Project Description (if applicable):
Proposed raze and replace of a single family dwelling partially located within land subject to coastal
storm flowage.The exisiting septic system and driveway will remain.
Project Location.
137 Run Pond Road _ South Yarmouth
Street Address City/Town
34 _ — 15
Assessors Map/Plat NumberParcel/Lot Number
wpaform2.doc•Determination o(Appl cabdity•rev.51182020
Page of 5
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4
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands
I£1111
WPAForm 2 — Determination of A' Applicability
Massachusetts Wetlands Protection Act M.G.I , c. 131, §40
Town of Yarmouth Wetland By_Law, Chapter 143
B. Determination (cont.) --_
The following Determination(s)is/are applicable to the proposed site and/or project relative to the Wetlands
Protection Act and regulations:
Positive Determination
Note.No work within the jurisdiction of the Wetlands Protection Act may proceed until a final Order of
Conditions(issued following submittal of a Notice of Intent or Abbreviated Notice of Intent)or Order of
Resource Area Delineation(issued following submittal of Simplified Review ANRAD)has been received "
from the issuing authority(i.e.,Conservation Commission or the Department of Environmental Protection)
r j 1. The area described on the referenced plan(s)is an area subject to protection under the Act
Removing,filling,dredging,or altering of the area requires the filing of a Notice of Intent.
❑ 2a,The boundary delineations of the following resource areas described on the referenced plan(s)are
confirmed as accurate.Therefore,the resource area boundaries confirmed in this Determination are ' ;
binding as to all decisions rendered pursuant to the Wetlands Protection Act and its regulations regarding
such boundaries for as long as this Determination is valid.
❑ 2b The boundaries of resource areas listed below are not confirmed by this Determination, "'
regardless of whether such boundaries are contained on the plans attached to this Determination or to the Request for Determination. ;Si` rik
I.
❑ 3. The work described on referenced plan(s)and document(s)is within an area subject to
protection under the Act and will remove, fill, dredge,or alter that area.Therefore, said work
requires the filing of a Notice of Intent. pa
❑ 4.The work described on referenced plan(s)and document(s)is within the Buffer Zone and will IiiT,` ''
alter an Area subject to protection under the Act. Therefore, said work requires the filing of a 5iligitii
Notice of Intent or ANRAD Simplified Review(if work is limited to the Buffer Zone).
❑ 5,The area and/or work described on referenced plan(s)and document(s)is subject to review
and approval by:
Name of Municipality — —
Pursuant to the following municipal wetland ordinance or bylaw;
r N
,�: , e;
• FName M
rs� t
.. ' 0 ; 4 of + 60a
wGafwm1 ox•Datermmatror of ApG+t Aar.rqy 5tlbrtA2c C` 6. q !l A''xkA T 5l '.
b N b y y
f
� .
p —
Massachusetts Department of Environmental Protection 4
Bureau cf Resource Protection -Wetlands
WPA8-orm 2 --Determination of Applicability
Kxaoeeuhumet(aVVeMandoProtection Act 121 �4O -� '
Town of Yarmouth M.G.L.�
By`Law, �h�pber � 3� ' "
mv. Determination (cont.)
[] G The follow
suqec mmn ~area arid/or work, ~' is s" ^wm � ordinance
Massachusetts Wetlands Protection Act
[] 7.If a Notice of Intent is filed for the work in the Riverfront Area described on referenced plan(s)
and-~~. .~~"p^which includes all m part uf the work described in�eRequoo��e
mustconsider Meho|�wngoUema�es (Refer tu the waUandmgubUonasd1O �me�
`n�rma�onabout the scope ofoUemo— `oequ/nemenh): 5»(4)c. for more
El Alternatives limited to the lot on which the p"4*o//s/nonteu
[J Amemeo"ev om/mo to the lot on°mco the vn�eot/s woamu me subdivided
� s nu
aanen�/onn�nyo,pm �
sen� own*duytxeoamem*n�,. a �»»� �m
[] amamauvoa limited x,the original parcel on which the project ia/ooaueu the subdivided
parcels. adjacent
the municipality.
' mm El Alternatives extend to any sites which can reasonably be obtained within the appropriate
region of the state.
Negative Determination
Note: Vo further action under the Wetlands Protection Act io required by the app|inant Howeve� ifthe
D=pa ^"uxu� �
u�ueonaoux/nsueaSupersedingOenninaUonofAppUcabUi wmck - notpn�xed
~..this project unless meuepa�mentfails k�a��on such equestwdh/n35days` f th
^ o ^'~z
request ispPost-marked for certified mail orhand delivered to the Department e oab*&h e
Work m�y�hen proceed
at the owner's risk only upon notice to the Department and to the Conservation Commission.Requirementsforrequestefo,Supemouing Determinations are listed at the
end of this document.
[] ' -Txe area described in the Request is not an area subject to protection under the Act or the
Buffer Zone.
, The work described in the Request is within an
not rem
o«e. 0/, dredge ora|�er�ha�a/ea Theneyoama nubect to pro
tenton unuorthe*ct but wm
Notceof/nenL ' ra' sa/dworkdoennotrequirethehUng ^fa
LJ 3, The work described in the Request is within the Buffer Zone, as defined in the regulations,*"Area nu�ec/mm
pteobonunder the Act Thero0oe ooidw kU '
�s0hn� ofallobm�uf/nben� nu�eot&othofh||nwingcund�ona(�' oy), mo»*»»»��q»im
'-----'---------'---- --
LJ4 The work described in the Request ionot within an
(including nhe Bu��/�pna) Ther�oe said work «ea subject to protection under the Act
unless and unU/�aidwo/k alters an Area
not equ/»ethe @mgofmNohoeoy|n*ant
neasu�ecthzpm�uhununderMhaAo� `
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Page 3 of 5
14
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i ,, Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands
WPA Form 2 — Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
Town of Yarmouth Wetland By-Law, Chapter 143
C. Authorization (cont.)
Signatures: ft
�j� f�r�nB�
Si na iM ��t/l�c� _�_ ,,,,pa
9 Printed Name
11 c_ _ +0
Signature .- ��"'� printed Name
Sig ure Printed Name
P t)� c.ta Au\\Aeucv'
- Signature /7,, l Printed Name
, ;( � :rt to «!4•t/u- , _ '�h0mus s►
Signatur Printed Name v ��
�'��v 'I l(JI _ad_ l4ugcq i�tS
Signature Printed Name ¢ ;� *
' 0 2 rywAa� x s,
"'arrM,
Signature Printed Name
Signature Printed Name
�4S u
D. Appeals , , o,
The applicant, owner,any person aggrieved by this Determination, any owner of land abutting the land fi ,
upon which the proposed work is to be done, or any ten residents of the city or town in which such land is` w'".
located,are hereby notified of their right to request the appropriate Department of Environmental .. ',,
Protection Regional Office(see https://www.mass.gov/service-details/massdep-regional-offices-by- i'
community)to issue a Superseding Determination of Applicability.The request must be made by certified i'
mail or hand delivery to the Department,with the appropriate filing fee and Fee Transmittal Form(sea
mot." n ; k
Request for Departmental Action Fee Transmittal Form)as provided in 310 CMR 10.03(7)within ten
sa>'r
business days from the date of issuance of this Determination.A copy of the request shall at the sam .
time be sent by certified mail or hand delivery to the Conservation Commission and to the applican
he/she is not the appellant. The request shall state clearly and concisely the objections to the ?
Determination which is being appealed. To the extent that the Determination is based on a munic's.=i ,;
�, ordir,ntnance or bylaw and not on the Massachusetts Wetlands Protection Act or regulations,the •e•
s ". of Environmental Protection has no appellate jurisdiction. : ,,, .,m, :' .-•;re..
r�
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kr /y
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f sus " 4, 1 ,„ F.s . z' z',.'.
f: 1'° 401,,i t -i rti to i".
wpararrn2 rice•De"ermmaton et aDpr,tabety rev.,,r;
YARMOUTH WATER DIVISION
99 BUCK ISLAND ROAD
WEST YARMOUTH, MA 02673
PH.: 508.771.7921
FAX: 508-771-7998
BUILDING PERMIT APPLICATION
DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET
Bldg. Site Location 137 Run Pond Rd Map #: 34 Lot #: 15
Proposed Improvement: Single Family Home 01.e,,Yy7 buiI d
Applicant: Jacob Simmons �-
Address 500 Lincoln St 2nd Floor Allston MA 02134 Tel. #: 857-264-1803 Date Filed: 3/3/23
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...
e6 Sati-nett... 3/3/23
ignature of applicant Date
\ac o . ...S t r►`t C r t.S e... re0-1+13
PLEASE NO b®(Sirk . C L rv-1
COMMENTS:
cur/C-44-r, � 20) 1,11D
P (Awy A.vt‘r?artS roLeksc , .K
2) Up Ai,- AFE J Cb K S Svc-rz ern. •r-k r
S � LL S t tG.v c- Irv- W,Q7E-ie.
5412-0“ Vw u--I2 AWL( *IA 0 15 ` P/4 S r �=a tfK 0 A--no tut 'no
t�12.15 S .A-,e A . r,�S �. m Ply- i '1 AO►�D
to 2O2.
l
Reviewed by:Water nr sion Date
...
SERVICE NO. if&''
2522
NAME Key program Imcorp ( (/./..>_. 7
......
STREET
4,744/1 6 e,.) C-/ r'irilI it-... ' ' .5 c IA IL.
VILLAGE ‘,...._)tie ,/ /I' ,-...).E',41 el a il
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METER NO. - .....1.6);_71, _441,....tr, k,....f 5/s, -
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NOTES
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i .77' OrST VW 0, 0.077000
\ .1-4677- A4..5 E-3,,,,AA ' 1 0.17,0100 31470.OE 70917:70.71.0 OM CALM
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, ; ' fie, KAG,Tosm '' !SCAT.OF 74.;100010110.00 0 O.K.FIRMS
MIKA TO 000,0.71.017 OF 0011x.i' 07 "SW O. 11 F.MAW WOO TOW.707 Ft-GM CO..1
WM MOO SYSICY TO MOM '..:'.....''''''''.'1'..................'.....V....'....../j7N S'17:411 '
O AU.KC!17.0077 TO Ot 0010170 TO LOA.001;
71%.CO Roar Pr..
it i 'FL ;mar,.ste; I
.;"'"',1.° ;Fro(11710.47Ar&7704.1009TO TOT
i ',Ole NO.10•10•11770700 0 owool
U 7 007075 MO 00100,OUTE FO OE WOOD It
MOM.00 700I OW UP130;WOK wawa
i val;SIV, R°1'13 a
5 11;
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A.
3.5.
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LOCUS MAP
SCAEZ r-200.0'.7
Toe. - ,,, ASSESSORS+AAP TA PAACEL+5. ,.
09,'
AKTKETE LOCUS IS 70 0.FEMA z10,30 ZONE AC(EL 11)
'. -..
,.- - - .\\\' c'z
3
MK) AND ZONE X(AREA OF MINIMAL 71000 HAZARD)
,,,,, ,, AS SHOWN ON COMMUNITY PANEL 625001C05894
Tpt,.
\t
,. 9 DATED 7/16/2011
E....,
''s V" -- l' 7.•. ZONING SUMMARY
.. , ...4
OF.....-- .
ZONING DISTINCT,R-25 DISINGT
... -!
A Eit 1 1 % A
,R)- -'
REQUIRED EXVING PROPOSED
1.'1 MIN.LOT sa 25,000 SS. 18.325 S.F. 13325 SE
.29- v•---10,',. CI-,, \ .-., . ' WOO LOT KRONTADE ISC/ 264.16E 264,66.
-1Pt04' MIN FRONT SETBACK 30' 0' 34.r
%
0 PROPOSED
7 BEDROOM ,, 1 . 39" 0 MIN.SIDE SETBACK IS I 0.74. 17.3.
:6'67,7-'f3 ' A ' - t ' ()WRUNG TOP Of 1. ' .9- . MIN.PEAR SETBACK 20' N/A N/A
-."9,,,,...,,,,,,\• * )30 E.; am, 1 . KNON a77.1
MAX BUILDING COVERAGE 250 30.7X 2 11 65
CRAWLSPACE SLAB \ : ,....4. , MAX.BUILDING HEIGHT 32 030' 26,9,s IL EL 11.2 MIN. ' I 1 :
7607E CRANAGRACE SLAB ELEVATION MAME COSMO SAS ELEVAIION
*4353 '''-'--- l, t 1
-....... -•t 3.6'
15 ',,, PAIOKNG,
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l
t CORCKli
.5 3.. LTTA, no {' Et.121 \', n,EAsomo', WORK MUST CONFORM CO A:.
TOWN BYLAWS & RFOUt AT'or''
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YAFFVr-OU 31C();(fE°7-3
Tat,eivArx,_-H WATER DEPT
,.
vo 044 '44...• SITE PLAN
ttt
, = #137 RUN POND ROAD
. ,..,
SOUTH YARMOUTH, MA
,r,z.=, i OFNOFFOFF
IF,.Moe 1
mt-PARro.MR„LT o IT IF
EXISTING CONDITIONS PROPOSED CONDITIONS JACOB SIMMONS
\( ' .0 KTN9ANT 11.2023
76 767 7,7(77,lcm ea iseerig,i*e.
DEG , cnvil engineers
.
lOng surveyOr'S
..,.........."..1..... ......
9.,',Or,Pr..?(liter 5..4...
BCE #21-457 ------
,,, OWE A C.,... 5E..01...0. YARAIG)'NOON,50 O.,71.
TOWN OF YARMOUTH
o te)c 4
HEALTH DEPARTMENT
-!r''_"rt' PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: 137 Run Pond Rd
Proposed Improvement:New construction single family home.Existing septic to remain
\;
Applicant:Jacob Simmons
Tel.No.:857-264-1803
Address:500 Lincoln St 2nd Floor Allston MA 02134
Date Filed:3/3/23
**If you would like e-mail notification of sign off,please provide e-mail address:Jacob.simmons@cityrealtyboston.com
Owner Name:Casa Madrid,LLC
Owner Address:500 Lincoln St 2nd Floor Allston MA 02134
Owner Tel.No.:857-264-1803
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:
T �`�'�O E(D (1.) Site Plan showing existing buildings,water line location,
VAR 'I 3 2023 and septic system location;
(2.) Floor plan labeling ALL rooms within building
HEALTH DEPT. (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.
REVIEWED BY: ..V,
DATE: 'L`- L/,, oZ 3
COMMENTS/CONDITIONS: PLEASE NOTE