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HomeMy WebLinkAbout214 Pleasant Street Building PermitTOWN OF YARMOUTH Building Department Town Hall Yarmouth, MA 02664 (508) 398-2231 ext.261 BUILDING PERMIT TRANSMITTAL Temp Permit No.: T-10-344 Applicant Name: R. Thomas & Deborah Coleman Applicant Phone: Building Location. 0214 PLEASANT ST Owner's Name: R. Thomas & Deborah Coleman Owner's Addres 10 Hidden Brick Road Hopkinton MA 01748 i Owner's Telephone: (508) 269-7496 REVIEWED BY: (OFFICE USE ONLY Recorded By: lc Permit Fee: $75,00 Deposit Rec: $75.00 Payment Type: Check ChkNo.: 2924 Net Owed: $0.00 Application Date: 3/8/2010 Issue Date: Expiration Date Comments: Map/Lot: 051.105 Idemolish single family house 1. WATER DEPARTMENT: DATE: NIA: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: NIA: 4. HEALTH DEPARTMENT: DATE: N/A: 5. BUILDING DEPARTMENT: DATE: N/A: 6. FIRE DEPARTMENT: DATE: NIA: PLEASE NOTE COMMENTS: RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: Date Printed: 3/9/2010 A ot'Ya.R, ONE & TWO FAMILY ONLY - BUILDING PERMIT APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING T } I'erwti ()I'Yarrtfnttlh Iitiddirig IN-Paltnu'ut T, Ca 1 116 Route 28 • Y.lrmrattth, MA 02!Aik-1492 t'vi: (508) :Solo-2231 x261 - Fax: (508) 39&08:% Only Permit No. tz Date Permit Fee S 7'p Deposit RecA $ Date, Net Due S �— Signature: Planning Hoard Information Plan Type Endorsement Date Recording pate Ian No. Ortier w 0ffkw OVA. ASseslars 0epartrrrent Information: - Lam 0 n4r New t 4 Property Uimeesianc Lot Area (st) Ffon" (tt) LO! COverape CertlfICWO Of Oocuparx.Y Is Is not required Seetiorel - Site Information Use Group: R-4 Type: 5-8 1.1 Propor%Addresw -- 12 Zoning Information 1Q, Scl' d! zoning District Proposed Use 1-3 eWldleN so"N"fee (ft} Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided I A Watch SWPO MULL e- 40. s 54111.5 FbW Zone InkamtIom commwft Putwic Private I ZorWK gFE-- Section 2 - Pro OWnershi Authorized A / I2. of Ree %f3 re: �3`( 1Ci N 1 /% t , Marling ASdress "' w "°"" Telephone 2.2 Authekt=d Ageo 2? 1 g C'�"1_�STD%%�f -- Name (pent) Ma+fingAddress 3�= S Signature relephana Fax r&I ction 3 - ConstructionSeryLicensed Construction � --� _ _ — 1 Won , . Plot Applicable ir1 n +' �jq �? o 3 J License Mi nber Address �Q ] L y f Expiration Oat* Signature re+aphone F3 2 Rejisterod Fiume Improvarnent Contractor ' aoenpaeetf Nae.M ._. — Not Applicable j Address License Number Eypiration bale .� -- Signature r0ephone t of 2 — CJVf fi 0 ft 9ectioh 4- Workere Odm`" nsaOw Ir nitnixAff viE l f. a it S i Workers Compensation Insurance affidavit must be completed and submitted with this application. Milwe to provide this affidavit will result In the denial of the Issuance of the building permit. , Signed Aff1davit Attached Yes .......... No ' Section S.- ot, Vllbrlt (~at anftd * New Construction ®I No. of Bedrooms Na of Ballrooms Existing Bldg. ❑ Repo o D I Alterations ❑ Addition ❑ Accessory esssory Bldg. ❑ Type Demolition Other Specify: Section IS 11'neded Constructim Oosts Item Estimated Cost (Dopers) to be completed by permit applicant 1. Sulkling 2. Electrical 3. Plumbing ! Gas 4. Mechan" (HVAC) 3. Fire Protectleort 9. Total = (t + 2 + 3 + 4 + S) 7. Total Square Ft. (rww houus a adg" I Check Below i ❑ Conservation -Commission Filing (N applicable) ❑ Old Kings Highway 3 Historical ConvnWNon approval (if applicable) Section 716 - OW M AUftrIntlon= 7b be Cw vk ted Owner's A2!M or Contractor Applies for I3,Ikllrts Permit - _ - 1,, 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. signattxr of Owns► Section 7b - OwnsdAuthorized Aaerd Declarsom I, / o IRAMWAS R --' .' 3 L&!LCf + &0!&/ , as Owner/Aulhorized Agent / hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Owner/Agent MID Oat* 4• f 9- 49 2 of 2 e a PLEASE PRINT: job Location: TOWN OF YARMOUTH BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM Number Owner of Property: Construction Supervisor: Na ea h Name r Phone. No. Address: i 'J i' l GIU 4� v- t h f" .y /t- O i - � g Licensed Designee: (if other than Supervisor) Name 2.15 Responsibility of each license holder: License No. License No. 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.13.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building and structures only pursuant to the state building code and all ether applicable laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Any licensee who shall willfully violate subsections 2.15.1, 2.15.2 or 2.15.3 orany other section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities tinder the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 (if the state building code. I understand the construction inspection procedures and the .specific inspection its called for by the building offlcial. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. t52 Yes fa No Fa It you have checked M please indicate the type coverage by checking the appropriate box. A liability insurance policy ❑ Other type of indemnity ❑ Band fJ OWNER'S INSURANCE WAIVER: I am aware that the licensee dgMfi_aQLhM the insurance coverage required by Chapter 152 of the Mass. General laws, and that my signature on this permit aphicatlan waives this requirement. Check one: Sgnatwe of owner or owners Ag" CWKQ A(.pM �J Signature: Building Official Approval: The Commonwealth of Massachusetts x Department of Industrial Accidents Offlce of In vestigations lkvi 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance .affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeiblv Name (Business/Organizadonrindividual): ��►'L( t yy} �p V?'� y� Address: c°Yll �i City/State/Zip: 44R 011q� Phone #: ��� `� Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. V I am a general contractor and I employees (full and/or part-time).• have hired the sub -contractors 2. ❑ i am a sole proprietor or partner- listed on the attached sheet ship and have no employees These sub -contractors have working for me in any capacity, emploYem and have workers' [No workers' comp. insurance comp, insurance) required.) 5. 0 We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.l t c. 152. §1(4), and we have no employees. [No workers' come• insurance reauired.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 11.0 Plumbing repairs or additions 12.[] Roof repairs 13.0 Other 'Any applicant that checks box *1 moat also fsa out the section below showing their worker' compewtion policy inforaatim. t Homeowners who submit this affidavit indicating that' aka doing aft worst and then hire outside contaacton must submit anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractor and state whether or not Rase entities have ernployc". If the subcontrutors have employees, they must provide their worker' camp. policy number. I are an employer that is providing workers' compensation Insurance far my employees MOW Is the policy and fob site informatlom 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 Section 25A of MGL c. 152 can lead to the Unposition of criminal penalties of a fine up to S 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 ❑p to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do herebZ erti& under the pains and penalties of perjury that the Information provided above L; true and correct: St nature: i Dal Z� use only. vo not write in this area, City or Town: Issuing Authority (circle one): I. Board of Health 2. Building Department 6. Other Contact Person: or town offlclaL Permit/Llcense # 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector Phone 4: Information and Instructions • , It ns4� Massachusetts General Laws chapter 152 requires all employdrs 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, e rest or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, ar 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 houaa laving not mare 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 appurkqu at 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 licensing agency shall withhold the Issuance or renewal of it license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produe" acceptable evidence of complimm wits this Insnrsace coverage required." Additionally, MGL chapter 152, 125C(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 corrapliaace with this insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checidmg the boxes that apply to your situation and, if necessary, supply sub -contractors) name(:), 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. Ain be sate is sip and date the affidavit. The affidavit should be redrned to the city or town that the application for the permit or Dense is being requested, not the Department of Industrial Accidents. Should you have any questions regardiing 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 hm City or Town 01`11clals 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. Pleats be sure to fill in the permittlicense 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 wader "Job Site Address" the applicant should write "ail 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 mat 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 Office of investigations would like to duu* you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call 'The DeparWWW's address, telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office of InveApdons 600 Washington Street Boston, NIA 02111 Tel. # 617-7274900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised I t-12-06 www.mass. govIdle For Office Use Only Permit No. Date — TOWN OF YARMOUTH AFFIDAVIT HOMO IaIDproVemest Coatrieter Law Supplement to Permit Appal ation -MOL c. 142A nqurea that d w 'recwgrucd0% alta v an. repave ah, repair. modm' imp'a�ark remove!, danalitian or mutuc im of sr additlaa to °`d1i'�'ezeGaht. caov�iW buildbg containing at leW ane but not mare thah tau dwell g ownv-aocupied such reakkm or building, be dons by reglswW &I wits ar wucture;a whk:b are to requirm,a m ""di outdo exapkM alarm widh other Type of Work: dcm 0 Est. C Address of work ZI 4 f j �G�,s�C n f` �S�} . ,� r Ivt d J tk Oww Name: '—rd J-A t- L-o lewd Date of Permit Application: 3 Y -01 b I hereby certify that: Registration is not required for the following reason(s): Work excluded bylaw Job under SI,000 Building not owner occupied - .�.. Owner pulling own pma Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS To THE ARBITRATION PROGILkM OR GUARANTY FUND UNDER MGL c. 1424L Signed under penalties of perjury; I hereby apply Fora permit as the ;agent of the owner; Date Contractor Nov Registration No. OR: Notwithstanding the above notice; I hereby apply property: for s Permit is the owner of the above L 20 16 � ��jv VZ(4 T o rA CO Date ,- ncr ►Vamc l/ TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, ILA 02664 508-398-2231 etL 260 PLEASE PRINT: DATE: IOB LOCATION: Oo g e ma 0 iYAME . "HOMEOWNER" �0 [ -Wl6 t` f NAME MAILING ADDRESS j HOMEOWNER LICENSE EXEMPTION 2 Iq P 1eas�rt f f -<O. y y v,,M 6 �. rtl STREET ADDRESS SECTION OF TOWN Ef ME PHONE d dyyl fir/ �6 Pi WORK PHONE CITY OR TOWN STATE ZIP CODE Tic curerd exemption far `HOmeownrer' was extended to include of ore or two units and to allow such homeowners to engage an to gvkhW for him wha deed rat possess a iicerne, 1 IbUslich I. (State Building Code Section 108.3.5.I) Person(s) who owro a parcel of land on which he / she resides or intends to rcsi&, on which there i� or is intendad to be. a one or two family attached or detached structure asaeasory to such use and / or Csrm des. A person who corvtnwb none than one home in a two-year period sing not be conakdered a homeowner, such "homeowner" shall submit to the bu&ft ofciak on a farm acceptable to the building ojacisl, that he / she shall be (Section 108.3.5.1) The uderrs4ned `homeownar, amm= responsnbility for compliance with the State Building Code and other applicable codes, by-laws, riles and regulations The undersigned homeowner' certifies that he / she understands the Town of Yarmouth Building Dept minimum inspection procedures and requirements and that he / she will comply with said proce&M and requirements. HOMEOWNER"S SIGNATURE ,%UL .1PPROVAL OF BUILDING OFFICIAL INSUPLILNCE COVEILIGE: ! ha,,c a cumrt Gmbility insuruxe poUcy ,)r its substantial equivalent, which rrkets the. requkrrnrrts of MGL Ch 142. YuS -- vo If you haNc checked }cam' • pkua<• ir-licate the type cor`erage by checking the appropriate box. A liability iruurarxe policy � Other t%pe of indcnmity, , i pond OWNER'S IMURANCE WAIVER.: I am aware that the iiccnsce 11W VLb nthe ' u� by Chapter [42 of the l4iass. General Laws and that s' knLrance coverage required *ware on this permit application %aives this requiem nit. ---- -- __ Chktik Sivr aviry -)f ii�, ncr or 011%ncr,-,i Agent 0%%n r 1,;cnt TOWN OF YARMOUTH 1146 ROUTE 28 SOUTH YrlRltitOLTH 14ASSACHUSE o26644431 Telephone (508) 398-2231, Ext. 261 — Fa: (308) 398.2366 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT BUIMENC, EUC_MC1%L GAS PLUMBING SIGNS Pursuant to M.G.L. Chapter 40, Section 54 and 780 Cti1R, Chapter 1, Section 111.5, 1 hereby certify that the debris resulting from the proposed work/demolition to be conducted at Work Addrm is to be disposed of at the following location: 1IHN4EL.5 c� �/D�Jli4l� �icG /P.o_ Q � LC'A/ZtS Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Signature -if Applicant Permit No. Date Rv CERTIFICATE OF LIABILITY INSURANCE OP ID GM - DATE(MWOONYYY) CLOVADI 03/04/10 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Paul Peters Insurance Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 680 Falmouth Rd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Mashpee MA 02649- Phoue: 508-477-0021 INSURERS AFFORDING COVERAGE NAIC # INSURED d� �-rlD 0� INSURER A- Nautilus Insurance INSURER B: Adam C. Clough INSURER C: 10 Peep Toad Road Centerville MA 02632 INSURER D: INSURER E: COVERAGES i ne rULwitb Ur IrvSUnarvct Llb I Eu UFLUW 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER POILICY DATE MD EFFECTIVE Wl DATE MWD N N LIMITS GENERAL LJABtLTrY EACH OCCURRENCE $ 500000 A )[ CO MMERCIALGENERALLIABiLITY CLAIMS MADE 1_x_1 OCCUR TO BE ISSUED 03/04/10 03/04/11 PREMISES Eaoocurence MED EXP (Any one person) $ 50000 $ 5 000 $ 500000 PERSONAL&ADV INJURY $ 1000000 GENERAL AGGREGATE GEN'L AGGREGATE LIMIT APPLIES PER: X I POLICY I I PRO- Ll LOC JECT $ 500000 PRODUCTS - COMP/OP AGG AUTOMOBILE LWBILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) $ HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) $ $ PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO F1 OTHER THAN EA ACC S $ AUTO ONLY: AGG EXCESS / UMBRELLA LIABILITY 71 OCCUR CLAIMS MADE EACH OCCURRENCE AGGREGATE $ $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y N ANY PROPRIETORIPARTNERIEXECUTIVEM OFFICER(MEMBER EXCLUDED? TOAY LIMITS ER E.L. EACH ACCIDENT $ (Mandatory In NH) N yes, describe under E.L. DISEASE • EA EMPLOYE $ $ SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPERATIOI yA M009 DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Town Of Yarmouth IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 1146 Rte 28 REPRESENTATIVES. S . Yarmouth MA 02 664 AUTHORIZED REPRESENTATIVE Gary Bruno ACORD 25 (2009101) O 1988-2 ORD C ATION. All rights reserved, The ACORD name and logo are registered marks of ACORD °o�'YgR TOWN OF YARMOUTH. • �1° BUILDING DEPARTMENT O' -398-2231 ext. 261 !►3 ! T� �,�: 1146 Route 28, South Yarmouth, NIA 02664 508 BUILDING DEPARTMENT TOTAL DEMOLITION SIGN -OFF FORM State Building Code (780 CMR) Chapter 1, Section 112. 1 -Service Connections "Before a building or structure is demolished or removed, the owner or agent shall notify all utilities having service connections within the structure, such as water, electric, gas sewer and other connections. A permit to demolish or remove a building or structure shall not be issued until a release is obtained from the utilities, stating that their respective service connections and appurtenant equipment, such as meter and regulators, have been removed or sealed and plugged in a safe manner." "All debris shall be disposed of in accordance with 780CMR 111.5." Building or Structure Location: Map: Lot: Owner's Name: COLC: fP'1 A hJ Address:1 /I/ flcc ^-s /r rftone: Contractor's Name: Address: Phone: NStar: Date: By: tou Title: fYv& c1. -I-X - v w ti r W (al ca-N C-r- I ! u National Grid: Date: By: Title: Water Dept.: Date:i/-1_gA By: T Title: �Ssif Board of Health: Date: Title: Condition: � q Fire Dept.: Date: By. Y Title: --T �, Historic Commission: Date: By: Title: Verizon: Date:�'�' By: Title:a' comcast: Date: /V,� Q- 1p By: .� H:danosigw$f Title:. Pz 44(t Y TOWN OF YARMOUTH BUILDING DEPARTMENT or - MATri"e (! 1146 Route 28, South Yarmouth, ,i*4A 02664 508-398-2231 ext. 261 BUILDING DEPARTMENT TOTAL DEMOLITION SIGN -OFF FORM State Building Code (780 CMR) Chapter 1, Section 112. 1 -Service Connections "Before a building or structure is demolished or removed, the owner or agent shall notify all utilities having service connections within the structure, such as water, electric, gas sewer and other connections. A permit to demolish or remove a building or structure shall not be issued until a release is obtained from the utilities, stating that their respective service connections and appurtenant equipment, such as meter and regulators, have been removed or sealed and plugged in a safe manner." "All debris shall be disposed of in accordance with 780CNM I 11. 5." Building or Structure Location: S, Y4amou-'N Map: '=-5-1 Lot: "46 /DS� Owner's Name: Cai,L yn ,jh) Address4/yPhone: Contractor's Name: Address: Phone. NStar: Date: By: Title: National Grid: Date: By: Title: Water Dept.: Date: By: Title: Board of Health: Date: By: Title: Condition: Fire Dept.: Date: By: Title- 0" Hi *wk Commission: Verizon: Comcast: Date: // By: C'-?i(c j�ctc Title:c Date: By: Title: Date: By: Title: nationalgrid February 2, 2010 To: Richard Celeste Re: The Coleman Residence Re: 214 Pleasant Street, South Yarmouth, Ma This letter is to notify you that after our investigation, it has been determined there is no gas being supplied to 214 Pleasant Street, South Yarmouth, Ma 02664 If you have any questions please feel free to contact us at 781-907-2930 Sincerely, Diane L. Stevenin Customer Driven Construction diane.stevenin@us. ngrid.com 781-907-2930 781-522-1056 fax 40 Sylvan Road E-2 Waltham, Ma 02451 0: F E.W. Drew, Inc. Electrical Construction 103A Mid Tech Drive West Yarmouth, MA 02673 508-778-0723 February 02, 2010 To whom it may concern: This letter is to verify that all the electric power has been disconnected from: 214 Pleasant St South Yarmouth, MA 02664 Thank you Eric Drew 88 8 � $ $ o $ e g y'$8 8 v n ao o p a o a p Q c �j M a N V� •-• � y N N i� � .. � .fir �/1 lu +Z + �8a? .5 �o CA ts s � a a N� E° a -• 23 a o UG74 CL. yy Ob b � y in � 5 0 m 7 cam^ cG 9 Ek ooe Ln N4a a a `o a aa+a3 .. o a Z.<Z �z to tn ...,.,.... U tnLU O B�' �$ oo� ooa oc s m 4 3 1 0a0mr-* CL AAA p Z W m •� Wp a a 1.uZ z Qom' Wqu cn in -+ iO n E Q pC Ii Gr} j W N EQ„�.avwi� 4z ooaaaa a g z as " a00 zc QJJWJ x ago u O .� zoo ob ozzz� z w z g� 3 Z z m . . ii gas ONE 1-4 tq y .+ + u 9i fii � o E gig QQ U '' aO'O1 ��oo+ g�52K a rn _ Q Q G � L y b .■ .. � p 4 Q U w 42 y v N ! 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