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HomeMy WebLinkAboutBLDR-23-12957- r 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 i � .�' ■ Massachusetts State Building Code, 780 CMR V.:::;.:. Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling a.. lqiis r Official Use Only Building Permit Number: i3L,1)P—Z —1 ` Date ed: RECEIVED Building Official(Print Name) Signature OCT b3e 2023 SECTION 1:SITE INFORMATION 1.1 Pro arty d ess• NG DEP RT AM ENT C ty AAr v 5, / 1.2 Assesso s Map&Parcel Nu teensy:BUILur_ 3 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Proper Djmensions: / Zoning District Proposed Use Lot Are+ (sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided s r n 1.6W0rSu 1 M.Ga s J 3/. 0 _ QoZ 11,2- a rJ PP y: ( 4 ) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: Outside Flood Zone? Public Ilia' Private 0 Check if yes❑ Municipal 0 On site disposal system SECTION 2: PROPERTY OWNERSHIP' 2.1--A'Wner'of Record: 4 °` � Gi"I /oP Q w,U1./ A/v.. fi,, . c'o3c • Name(Print) City,State,ZIP ' ' e r.s a /,.c . 617- 7/9-veOt If Gal/Yofrc COZ ek No.and Street Telephone Email Address 0,Nth / ,Cc'rt- SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction le Existing Building 0 Owner-Occupied W Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition l' Accessory Bldg. 0 Number of Units / Other 0 Specify: Brief Description of Proposed j iork2: !,c P-e /�Ox eviiiti f 7a,t its i t eV //d e it/ ,i / - lis a eh /' 'rI 1,a_--s SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: (Labor and Materials) Official Use Only 1. Building $ Imo Boa .-1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ 't 0 Standard City/Town Application Fee —'� j 6'3 cr• 0 Total Project Costa(Item 6)x multiplier x 3.Plumbing $�C`S f Esaa. - 2. Other Fees: $ 4. Mechanical (HVAC) $ Ers ode) -- List: Ur 0 66 044 I 1(02 . 5.Mechanical (Fire Suppression) $ f Total All Fees:$ - Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ csec5 0 Paid in Full 0 Outstanding Balance Due:kv5I, ti '' SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisgr License(CSL) C4 vie. 4v,,.. 1. /.)),J4J DO / gm� r` a�3 • License Number E irati Date Name of CSL Hader d 3 w61.6-I y P ftG;Of 14.X() List CSL Type(see below) l) No.and Street J�` Type Description 6 q t � ` U Unrestricted(Buildings up to 35,000 Cu. 8.) �es� /4 F A ou li �b City/Town,State,ZIP r1�l�7 R Restricted l&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding 17 o� �T7` 3��i c SF Solid Fuel Burning Appliances Telephone 1 J �V/� �eyt�t�c��' l h, I Insulation mail address D Demolition 5.2 Registered Home Improvement Contractor(HIC) ! e��� ��1 p9 j�c , / g i4 ..51' *ads HIC Company Na ar€or I Registrant Name HIC Registration Number xpi ation Date t No. and Street e.,, 13.i, .n 6 �0 > /o f 1 / Email address , c 6 City/Town, St , IP Telephone SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(1VI.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 No 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize Kp/6U,p./ Bug(e1-P5 i JC to act on ray behalf, in all matters relative to work authorized by this buildingll permit application. Fruit Own Name(Electronic Signature) //e/Date SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. cc_ �A) A) a / . /C isD x Print Owner's or Auth ized Agent's Name(Electronic Sig ature) 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.eov/oca Information on the Construction Supervisor License can be found at www.mass.eov/dps 2. When substantial work is planned,pprovide the information below: Total floor area(sq. ft.) , 3 7 8 (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) 8 . (o Habitable room count Number of fireplaces Number of bathrooms Number of bedrooms 4 Type of heating system ...3Number of half/baths Number of decks/porches Type of cooling system Enclosed Open 3 3. "Total Project Square Footage"may be substituted for"Total Project Cost" • The Commonwealth of Massachusetts 111111Mr, Department of Industrial Accidents ', H�'iy 1 Congress Street, Suite 100 �� .ram f• Boston, MA 02114-2017 :._,.,> www.mass.gov/dia Workers Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information (� Please Print Legibly p Name (Business/Organization/Individual): As ty C)% 1 /) Address: L6 Wl��s%" �� No lJ Rip City/State/Zip:le, )'A Pi 1c t ji/ 1t4 a;$73Phone #: 0 sr,- 36 'j// Are you an employer?Check the appropriate box: Type of project(required): I. I am a employer with employees(full and/or part-time).* �q 2.❑I am a sole proprietor or partnership and have no employees working for me in 7. `" W CO ling tIon any capacity.[No workers'comp. insurance required.] 8. El Remodeling • 3.E I am a homeowner doing all work myself. [No workers'comp. insurance required.]t 9. Demolition 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole proprietors with no employees. 11.0 Electrical repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 12.❑Plumbing repairs or additions These sub-contractors have employees and have workers'comp. insurances 13. Roof repairs 6.�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#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: pp fer, f A4 Policy#or Self-ins.Lic.#: 1 43 ' 'j1'' 3 3 '7'1i -, Expiration Date: er/./6-J/ Cg'3 Job Site Address: / ? ' /5 ` (,--v- ST City/State/Zip: $ 1t,A 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 information provided above is true and correct. Signature: u Phone T: f Date: di 0 6 g 3 Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License 41 Issuing Authority(circle one): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: TOWN OF YARMOUTH 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1261 Fax 508-398-0836 Office of the Building Commissioner BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G. L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111/5 I hereby certify that the debris resulting from the proposed work/demolition to be conducted at l Work Address Is to be disposed of at the following location: ri4U3.7- e Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Si nature of Applicant Date Permit No. b m 'S ;g § - m. ' ..a g Z 6 f. „_„---.§. , ,-- L _ ___, J 1-o; mgf- I t a 4 WO.593., J 4 m. 55 u4 ppie 221*Cli I !;1: Ili 2 i . 4 ti !,:q, , - , ,,o _ ' s� e F . 1_ Rcn a \,11 e.c i o ce 3zA era Ai 1 v. SS tvi v. J 09 _(0 w m s cT§ N r = � agx5 cof a A o3>mr oo 33 gNg= a ' 0 to D :!! li A; '-°5 1 1V1 ..--,1 l'*=-, $. g ?I J a 2 m r a^ a —� m m �: m N 1..P 'IIi'e'I A WC Guide to Wood COMStilieti011 iI2 71.igh Tflind Areas: 70 mph s zd Zone u3 chime tts e u3 for `Co iance((760 CP/^_"R 5333_.2.'.._'-f Ei Check Compliance 1.1 SCOPE Wind Speed(3-sec.gust) 110 mph Wind Exposure Category B 1.2 APPLICABILITY Number of Stories(a roof which exceeds 8 in 12 slope shall be considered a story) stories 5 2 stories Y' Roof Pitch (Fig 2) /2 512:12 ✓ Mean Roof Height (Fig 2) t ft 5 33' roee Building Width,W (Fig 3) 2 ft 5 80' Building Length, L (Fig 3) 24 ft s 80' r,/' Building Aspect Ratio(L/W) (Fig 4) f a 5 3:1 Nominal Height of Tallest Opening2 (Fig 4) �'S <6'8" _1L/ 1.3 FRAMING CONNECTIONS General compliance with framing connections (Table 2) 10/ 2.1 FOUNDATION Foundation Walls meeting requirements of 780 CMR 5404.1 Concrete Concrete Masonry _a/b. ''3 99 2.2 ANCHORAGE TO FOUNDATION 5/8"Anchor Bolts imbedded or 518"Proprietary Mechanical Anchors as an alternative in concrete only Bolt Spacing—general (Table 4) 2.'4' in. Bolt Spacing from end/joint of plate (Fig 5) 6 in.s 6"—12" Bolt Embedment—concrete (Fig 5)...... .1 in.>_7" ✓ Bolt Embedment—masonry (Fig 5) in.>15" Li Plate Washer (Fig 5) >3"x 3"x 1/4" 3.1 FLOORS Floor framing member spans checked (per 780 CMR Chapter 55) Z X10.1sa e !'rtl®�`' „„s Maximum Floor Opening Dimension (Fig 6) 1'.ft 5 12' ✓ Full Height Wall Studs at Floor Openings less than 2'from Exterior Wall(Fig 6) 4.. Maximum Floor Joist Setbacks Supporting Loadbearing Walls or Shearwall (Fig 7) i ft s d Wile Maximum Cantilevered Floor Joists Supporting Loadbearing Walls or Shearwall (Fig 8) Oft 5 d ("lc-- Floor Bracing at Endwalls (Fig 9) ,/ Floor Sheathing Type (per 780 CMR Chapter 55) Floor Sheathing Thickness (per 780 CMR Chapter 55) S in. 67-' Floor Sheathing Fastening (Table 2).1b d nails at Gin edge/1Z in field tr./ 4.1 WALLS Wall Height Loadbearing walls (Fig 10 and Table 5) 1 ft 5 10' p, Non-Loadbearing walls (Fig 10 and Table 5) 12 ft <_20' +7.-'" Wall Stud Spacing (Fig 10 and Table 5) ifs in.5 24"o.c. —� Wall Story Offsets (Figs 7&8) ft <d 4.2 EXTERIOR WALLS3 Wood Studs Loadbearing walls (Table 5) 2x b - v ft O in. Non-Loadbearing walls (Table 5) 2x -, ft ®in. _AC-- Gable End Wall Bracing 1 Full Height Endwall Studs (Fig 10) i/ WSP Attic Floor Length (Fig 11) ft>W/3 MAP- Gypsum Ceiling Length(if WSP not used) (Fig 11) ft>0.9W and 2 x 4 Continuous Lateral Brace @ 6 ft.o.c...(Fig 11) /111 or 1 x 3 ceiling furring strips @ 16"spacing min.with 2 x 4 blocking @ 4 ft.spacing in end joist or truss bays ✓ Double Top Plate Splice Length (Fig 13 and Table 6) ir ft I/--- Splice Connection(no.of 16d common nails) (Table 6) 4_ g/ ti _WrC�`,�zi�`is€�v Wood Ce��.wg�'F3Li`oAL 11'High s>jegeA�'2as o`�¢��p5? ��id ZO.�t° ��'� RSSC°''t�'4 ,e1:2 Checklist 'or ,C m nd (J 9 CIS 1.2. 1)' _ .�tt'e_c��� s _ � Loadbearing Wall Connections Lateral(no.of 16d common nails) (Tables 7) 2 ✓ Non-Loadbearing Wall Connections Lateral(no.of 16d common nails) (Table 8) 2, ✓ Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) L.--/ Header Spans (Table 9) b ft $ in.511' Sill Plate Spans (Table 9) Vi ft—in.<_11' Full Height Studs (no.of studs) (Table 9) Z Non-Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) Header Spans (Table 9) ft 8 in.<_12' ✓ Sill Plate Spans (Table 9) _ft_in.512" 50 Full Height Studs(no.of studs) (Table 9) Z _I.e/ Exterior Wall Sheathing to Resist Uplift and Shear Simultaneously4 Minimum Building Dimension,W 10 Nominal Height of Tallest Opening2 G id< 6'8" Sheathing Type (note 4) Edge Nail Spacing (Table 10 or note 4 if less) _WAD.! .s Field Nail Spacing (Table 10) -it:in. ,/ Shear Connection(no.of 16d common nails)(Table 10) �Or Percent Full-Height Sheathing (Table 10) $7% �r" 5%Additional Sheathing for Wall with Opening>6'8"(Design Concepts) r Maximum Building Dimension,L Nominal Height of Tallest Opening2 , �<6'8" i✓� Sheathing Type (note 4) 71 b e, Edge Nail Spacing (Table 11 or note 4 if less) 6 in. Field Nail Spacing (Table 11) d2 in. ✓ Shear Connection(no.of 16d common nails)(Table 11ier Percent Full-Height Sheathing (Table 11) % ✓ 5%Additional Sheathing for Wall with Opening>6'8"(Design Concepts) _L. Wall Cladding ✓ Rated for Wind Speed? 5.1 ROOFS Roof framing member spans checked? (For Rafters use AWC Span Tool,see BBRS Website) Roof Overhang (Figure 19) _ft<_smaller of 2'or U3 ✓ Truss or Rafter Connections at Loadbearing Walls Proprietary Connectors Uplift (Table 12) U=le,pif i✓ Lateral (Table 12) 74 p Shear (Table 12) S= pif Ridge Strap Connections,if collar ties not used per page 21... (Table 13) T=t 10 plf �/ Gable Rake Outlooker (Figure 20) ft 5 smaller of 2'or U2 Truss or Rafter Connections at Non-Loadbearing Walls Proprietary Connectors Uplift (Table 14) U= lb. Lateral(no.of 16d common nails)..(Table 14) L= lb. Roof Sheathing Type (per 780 CMR Chapters 58 and 59) " Roof Sheathing Thickness in.a 7/16"WSP / Roof Sheathing Fastening (Table 2) _ ✓ Notes: — 1. This checklist shall be met in its entirety,excluding the specific exception noted in 2,to comply with the requirements of 780 CMR 5301.2.1.1 Item 1. If the checklist is met in its entirety then the following metal straps and hold downs are not required per the WFCM 110 mph Guide: a. Steel Straps per Figure 5 b. 20 Gage Straps per Figure 11 c. Uplift Straps per Figure 14 d. All Straps per Figure 17 e. Corner Stud Hold Downs per Figure 18a and Figure 18b 2. Exception: Opening heights of up to 8 ft.shall be permitted when 5%is added to the percent full-height sheathing requirements shown in Tables 10 and 11. 3. The bottom sill plate in exterior walls shall be a minimum 2 in.nominal thickness pressure treated#2-grade. AWC Guide to Wood Construction in High Wind Areas. 11Areas:110 mph Wind Zone Massachusetts Checklist for Compliance(780 ci m 5301.2.1.1)1 4. a. From Tables 10 and 11 and location of wall sheathing and Building Aspect Ratio,determine Percent Full-Height Sheathing and Nail Spacing requirements b. Wood Structural Panels shall be minimum thickness of 7/16"and be installed as follows: i. Panels shall be installed with strength axis parallel to studs. ii. All horizontal joints shall occur over and be nailed to framing. iii. On single story construction,panels shall be attached to bottom plates and top member of the double top plate. iv. On two story construction,upper panels shall be attached to the top member of the upper double top plate and to band joist at bottom of panel. Upper attachment of lower panel shall be made to band joist and lower attachment made to lowest plate at first floor framing. v. Horizontal nail spacing at double top plates, band joists,and girders shall be a double row of 8d staggered at 3 inches on center per figures below:Vertical and Horizontal Nailing for Panel Attachment �-bWN THE EDGE RI•SBON F�'tVox. Fl5£8dNAq$ • AT$b.c • u 11 II II Ia It II 11 .t it IS Y 6, Id it IIVI II 1i M IIII II It Li II II 1 t .a M II ■Fr. - 11 tl m i1 .t 11 tT it : 7171 1X ie r4p, .; .4 Q' 11 Si n r I ii2 U a tt g tZ • .1 It l7 LI Ea- '. tI 11 ti � � 11 tl if ii ii g . u w` to u 1t " ./ 1 I t t o t t 11 I j it u U . Y 2P1U ul' L It f•�•t x1 DQUHL.Ei er�r�li. _i EDGE '1� NAIL SPACING i i t_ PANEL _•�'.i L See Detail on Next Page Vertical and Horizontal Nailing for Panel Attachment Joe Gilmore From: Whelan, Ellen T. <Ellen.Whelan@nationalgrid.com> Sent: Thursday, March 10,2022 2:22 PM To: 'Joe Gilmore' Subject: No Gas Letter- 179, 181 and 183 River St, South Yarmouth Hi Joe, Below please find the letter to give to the town for your demo permit. Thank you. nationalgrid March 10,2022 Joseph Gilmore 4 Dorset Ln. Walpole, MA 02032 TO WHOM IT MAY CONCERN: RE 179,181 and 183 River Rd, South Yarmouth, MA This email is to confirm that there is no live gas at these properties. I can be reached directly at 508-760-7439 should there be any further questions. Sincerely, ///1ii>r Ellen Whelan Customer Connections, NE National Grid 127 Whites Path S. Yarmouth, MA 02664 (T) 508-760-7439 This e-mail,and any attachments are strictly confidential and intended for the addressee(s)only. The content may also contain legal.professional or other privileged information. If you are not the intended recipient,please notify the sender immediately and then delete the e-mail and any attachments. You should not disclose,copy or take any action in reliance on this transmission. _A CORD CERTIFICATE OF LIABILITY INSURANCE DATE(MDD/YYYI) IMU 03/06/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE 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 NAME: Alan Burstein Peter M.Bakker Agency,Inc. PHONE (860)378-2700 FAX 302 West Main St (A/C.No,Ext): 1(A/C,No): ADDRESS: alan.burstein@optisure.com Avon INSURER(S)AFFORDING COVERAGE NAIL ft CT 06001 INSURER A: American Zurich Insurance Comp 40142 INSURED INSURER B: Main Street America Assurance Company Kenney Builders Inc. INSURER C: 603 W YARMOUTH RD INSURER D: INSURER E: WEST YARMOUTH MA 02673-1459 INSURER F COVERAGES CERTIFICATE NUMBER: CL233624254 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 SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD X COMMERCIAL GENERAL LIABILITY n ) (MMIDD/YYYY) LIMITS EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR DAMAGE TO RENTED 500,000 PREMISES(Ea occurrence) $ B MED EXP(Any one person) $ 10,000 MPJ7842M 04/06/2022 04/06/2023 1,000,000 PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO- GENERAL AGGREGATE $ 2,000,000 JECT LOC PRODUCTS-COMP/OP AGG $ 2° (:),C)00 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $$ANY AUTO (Ea accident) OWNED SCHEDULED BODILY INJURY(Per person) $ - AUTOS ONLY AUTOS HIRED NON-OWNED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ d UMBRELLA LIAR OCCUR $ EXCESS LIAB CLAIMS-MADE OCCURRENCEEACH $ DED l (RETENTION$ AGGREGATE $$ WORKERS COMPENSATIONI AND EMPLOYERS'LIABILITY PER OTH- ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N XI STATUTE I ER AOFFICER/MEMBER EXCLUDED? II N/A UB-8H337476-22 500,000 (Mandatory In NH) 09l2512022 09/25/2023 E.L.EACH ACCIDENT 5 If yes,describe under E.L.DISEASE-EA EMPLOYEE $ 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) - CERTIFICATE HOLDER CANCELLATION THE SHOULDEX ANYPIRATION OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Tom Cardone DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 21 Lakewood Rd AUTHORIZED REPRESENTATIVE South Yarmouth MA 02664 ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD I5 ACORD CORPORATION. All rights reserved. J 0 -tea Q-. r 2n tofa. c c€ co-. > C _dtza00 - ?�c i' E p=O G I. C, 3— 2 it ta.a z ry C C ,J m k. t > 4C7 _".",sr -- m0 —4 p -4gc 0 I 1 ai +' 9 W m s 4 ,._._ a C3 < =' m 0 04x 0 P � 5 a 9 €n SYa 0t4.sa. o `� ` al04 m,E ^.,'0 © -3-. c . -i ea tP 'ti1 (A q ri. �, c ! _ �. s 41, la Ct o 0 1i4 0 * co. in C. _e n tdS t?tb: ri e m m C3La0 . 0) O33 9 e 3 CS SU C Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Regqulations and Standards Constcnc,l �`�'.II r'on Sitvervisor CS-001895 t c`pires 01/13/2024 CHRISTOPHER T KENNEY 603 WEST YARMOUTH RD Z WEST YARMO}ITH MA 02673 • tel:-. �� �yu- Citzt- Commissioner dlqci x - YZm • • c.4 ��� mn d194.A le . we Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Corporation KENNEY BUILDERS INC. Registration: 181256 603 WEST YARMOUTH ROAD Expiration: 03/16/2023 WEST YARMOUTH,MA 02673 Update Address and Return Card. SCA 1 41 201d-05/17 t Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Corporation before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 181256 03/16/2023 1000 Washington Street -Suite 710 KENNEY BUILDERS INC. Boston,MA 02118 CHRISTOPHER KENNEY 603 WEST YARMOUTH ROAD ( ,04 WEST YARMOUTH,MA 02673 Not veil witho signature Undersecretary 77 � ., TOWN OF YARMOUTH WATER DEPARTMENT O- ; �y: 99 Buck Island Road 'A\ ,poet !x' West Yarmouth, MA 02673 Telephone: (508) 771-7921 • Fax: (508) 771-7998 BUILDING PERMIT APPLICATION FOR WATER DEPARTMENT SIGN OFF TRANSMITTAL FORM BUILDING SITE LOCATION: / 7q J ' V4 & / PROPOSED WORK: C �, � C4Ap4t APPLICANT: /5-/-e A p¢'/ ge51 / ADDRESS: t�j O 3 Vt1 . Y1, RI Vi31••• _ / /4. TELPHONE: /// 3 /l / 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 Act; i.e. If lot(s)border any type of wetlands, streams,ponds,rivers, ocean, bogs, boys, marshland, ETC... Health Department: Determines Compliance to State and Town Regulations, i.e. requirements for Septage Disposal and other Public Health Activites Fire Department: Determines Compliance to State and Town Requirements for Personal Safety, Property Protections, i.e. Smoke Detectors, Sprinkler Systems,etc to' c 4:7 6" /7/07 APPLICANT SIGNATURE. DATE OFFICE USE: COMMENTS ON PERMIT APPROVAL OR DENIAL REVIEWED BY WATER DIVISION(SIGNATURE) DATE TOWN OF YARMOUTH • ° BUILDING DEPARTMENT na-i�c'nEEs �'' 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 261 .= BUILDING DEPARTMENT TOTAL DEMOLITION SIGN-OFF FORM State Building Code (780 CMR) Chapter 33, Section 3303.6-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 hi accordance with 780CMR 111.5." Building or Structure Location: Map: Lot: r Owner's Name: L�'�iYai �- Address: ki IkngcTIA Phone: "...tit `7-- 7i 9'i 1 Contractor's Name p tomy �j/l Address: GD3 dUy. jr / Phone:3 ' 1 ` 3 Eversource: Date: By: Title: Date: By: Title: r Water Dept.: t� Date: o a-- 7 7/- f By: - Title: Board of Health: Date: S v 17- a- FY I F oVl f BY: . GAR 0; r- Title: A$s'ir I)it Condition:3e t.., Se-St Esf;� 5y374-e Fire Dept.: Date: Sc z 3 1 By: Title: l,R �s -Iris"/ r,. � Id Historic Commission: Date: ' ji7P9" th,,,,,,l ook. hm'stunC A\sty) - By: L►‘s-z sh 141>el 444" �,1-0,., �z�n�z� ,�eg�S Title: OP)�h�51-.,q-d�w��✓a _ Date:1 S te '- 3 ` - / By: Comcast: Date: 3/l5 c`= r-ulES PATH 0 5 0 1 Lr-i 2 S 0 8 Cj a '1 14.111.....mili4i ca .:'- co u) — Vittx. . 2° PARKWAY 1 i I • \ 0 I 8 , 1 \ . . ,211......... I lac) _. RE_ 9........,............., ...v!:,- .0 40., \ c:\ a 2 . 03 C:3. i CD D IioAE, zzy S •EE ,- . , RWE EET „ . . , \i3 D o ' 0 ; E , . co 7.i..1 .4 . . , . EVFRS=URCE Eversource Energy , 247 Station Dr,Westwood,Massachusetts 02090-9230 ENERG March 15,2022 Joseph Gilmore 183 River St. S.Yarmouth,MA 02664 RE: 183 River St., S Yarmouth,MA 02664 To Whom It May Concern: At Eversource,we're committed to delivering great service. This letter serves as confirmation that, as of March 15,2022 the electric service to above address has been removed. Based on this information,there is no electric power at this address. If you have any questions,please contact us at 888-633-3797. Sincerely. Ms. Jurgilbwicz Eversource Electric Electric Service Support Center comcast March 24, 2022 RE: 181 River Street 183 River Street South Yarmouth, MA 02664 This letter is to inform you that there is no Comcast service running to the addresses listed above. John Mawhinney Technical Operations Supervisor Comcast Cape Cod, MA. 508-630-8824 ",, CONSERVATION OFFICE « ., „4 kgrant[yarmouth.ma.us Yarmouth Conservation Commission =W Administrative Review �C'o-0 s Applicant Information: "�U,( n'` sf n` tr"'' Name: liQ c e?lt —3 ' / kr o L .z. Mailing Address: y i.),,1- ce /\At 11" 141 17 ci e' / 1 �' . 7/ 7 Email:: J a,! H`c�/h a C'.68 0 +L�s r-7 i�i S I I . C c ti Phone: •„1�7" C? 0 C Signature: 4},,,, , v„, ,/ v ' 7 Location of Work: / 7 ? R1 %Pir— Street Name and Number Please Note:By submitting this application the applicant grants permission to the Conservation Office to enter the location to conduct a site visit(if needed). Detailed Description and Reason for Proposed Work: /l _,-- 7- . 4/7e14,s <? /`? ° —42., /i' Yc /S/1 A., i )) , I-,,.-..0- 71 9 A. DA/ri6i -' Closest Distance to Resource Area: F'`tea 2!'0t ti 0IN It Proposed Start Date: 4'3 A I Company to do Work: / Name: I r 1 A)--Cy <' 8 e , / A; C, ' Address: 0 .3 W. YiviyG G W /A-0 iv, Y . , /Y,} 'Phone: Nam& .,11( �"31J Email:l� ,[+/110'/ Bc.i1L� d5' Rol- /� //9 I t // . Cow • Administrative Approval: ti-4F10\)eC\, D 0-7,--- This approval is valid for one year. This Approval does not grant any property rights or any exclusive privileges;it does not authorize any injury to private property or invasion of property. Yarmouth Conservation Commission• 1146 Route 28,South Yarmouth,MA 02664•(508)398-2231•Ext 1288 `...,,,. --, \„.... ?,,, — a , d P N M L- o . 0 0 Fli E 0. .,.,,,,,,:_ ., CD G,. . Li :::7 3 • n121£8i ' i [:1:7 lair° 1 0 Z 8 o6081. 1 41 r.....°°...°.1.•.•.IIC: :°.il..g•'1 1..•.°..1 1..•.P.°.1 I.1.1.03C: 0 1t2 1 p 0 1 0 V 1 Li:5 1 _ O r• cn .lb'M>INt/d G3:�r.�r: `° bz oz X z i $ \C-31 0 w b r-l-? inp Hlbd SatCna