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O®ce Use Only Permit IF ee $ aj Permit expires 6 m from +13SUe date. ►UILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Ext. 261 CONSTRUCTION ADDRESS: ASSESSOR'S INFORMATION: OWNER: CONTRACTOR: N ✓l" *e'sidential ❑ Commercial Est Cost of Construction S yS�(' Home Improvement Contractor Lic. # 1 (AQ/. L Construction Supervisor Lic. # CJ Si`Tt � Workman's Compensation Insurance: (check one) ❑ I am the homeowner ❑ I am the sole proprietor ❑ I have Worker's Compensation Insurance Insurance Company Name: Jt V 2 t/,@ ke ✓ S Worker's Comp. Policy# 7 Vg d 4:2" O WORK TO BE PERFORMED ❑ Tent (Fire Retardant Certificate attached) Duration Wood Stove Shed ❑ Siding: # of Squares � � ❑ Replacement doors: Ll'Re-roof: # of Squares - ( ing old shingles* ❑ Replacement windows: # ( ) going over layers of existing roof *The debris will be disposed of at: Location of Facility I declare under penalties of perjury that the statements herein contained are true and correct to the best of my knowledge and belief. I understand that any false answer(s) will be just cause for denial or revocation o ce_nse and for prosecution under M.G.L Ch. 268, Section 1. Applicant's Signature- Date: Owners Signature (or attachment) Date: Approved By: Date: Building Official (or designee) ' V ° 2aCt /M Zoning District: A ae- Historical District: ❑ Yes "No Flood Plain Zone: ' J&Yes ❑ No Water Resource Protection District Within 100 ft of Wetlands: ❑ Yes ya; No Yes ❑ No 3/01 The Commonwealth of Massachusetts Department oflndustrialAccidents Office of Investigations 600 Washington Street Boston, MA 02111 e www.massgov/d1a Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name Phone #: Are you an employer? Check the appropriate box- 1. ❑ I am a employer with 4• am a general contractor and I emplovees (full and/or hart -time)." have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.= 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, §1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions ME] Plumbing repairs or additions 12.❑ Roof repairs ME] Other *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. tContractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the subcontractors 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. n Insurance Company Policy # or Self -ins. Lic. #: 7 ?3i)ig 7 V *4,47^a R Expiration Date: 411, / Job Site Attach a copy of the workers' compensation City/State/Zip: V- 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 imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby ce fifpirr(dery( mkains and penalties of perjury that the information provided above is true and correct. use onty. Uo not write in this area, City or Town: or town ofJlclaL 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 Information and Instructions 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,' . . 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 licensing 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 (UP) with no employees other than the members or partners, are not required to cant' 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 bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial'Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 11-22-06 wtvw.mass.gov/dia CH.11,ARLES COREY rr. R ?0 �.r�'s 1 0o -err TOTAL INVESTMENT $-475 M, Payable immediately upon completion. POSSIBLE EXTRA CARPENTRY: Any Rotted or Otherwise Deteriorated Trim Boards, Plywood Sheathing, Missing Metal Flashing, Side Walling or Any Other Carpentry Needing Replacement will be done and charged for as an Extra: Materials Plus Labor at the Rate of $ 75.00 per Hour. - PAYMENT SCHEDULE: A Deposit of One Half is due at the Signing of this Roof Proposal and the Final Payment for the Balance is Due Immediately Upon Completion. WORK SCHEDULE: All Roof Work is Normally Scheduled for Completion Within 30 Days of Acceptance and Receipt of Deposit providing the Materials are Available. Please Make Checks Payable to: CHARLES COREY CHARLES COREY Warranties the Shingles and Labor for 10 years. CERTAINTEED Warranties the shingles and labor 100% for the First 10 Years and the Shingles for LIFETIME if the shingles becomes defective. CERTAINTEED Warrants the Shingles up to a 110 MPH WIND WARRANTY ( CATEGORY 2 HURRICANE) . CERTAINTEED Warrants the Shingles to be Algae Resistant for a Full 10 Years. This proposal may be withdrawn by us if not accepted within thirty days. CHARLES COREY carries Workm s o ensation and Public Liability Insurance on the above work DATE OF ACCEPTANCE: 1'-a T ACCEPTED BY: SUBMITTED BY: HOMEOWNER ACORC � CERTIFICATE OF LIABILITY INSURANCE 2008 =0�41'"'�°"""' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF NFORMATION SCHLEGEL INSURANCE ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 34 MAIN ST HOLDER. THIS CERTIFICATE DOES NOT AMEN ALTER THE COVERAGE AFFORDED BY THE EXTEND OR POLICIES BELOW. WEST. YARMOUTH, HA 02673 INSURERS AFFORDING COVERAGE NAIC0 momm Paul Buckmiller ' rtLwRERw NORTHLAND INSURANCE MSURER B: TRAVELERS INSURANCE DHA HIICIOND:LI:.ER ROOFING SSURERc SgUREA D: ' . Hyannis, MA 02601 NSURERE: COVERAGES THE POLICIES'CF INSURANCE LISTED BELOW HAVE BEEN ISSUED. TO THE INSURED NAMED ABCA/E FOR THE POLICY PERIOD INDIC/ATTD. NOTWITHSTANDING ANY REWREMENT. 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 - POUCIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTA OWD TYPE OF POLICY NLBIBEt DATE EFFECTIVE EMRAIM DATE UNITS A: GENERALLIAEUrY X ESL/AERf]AL NA9ffRAt LIABILITY CLALASAAADE 91 OCCUR CP46859504 . 05/15/07 05/15/08 EACH OCCURRENCE 5•1,000,000 DAMAGE 10 PREAVSES(EA aewwRe) 356,000 .. LED EXP(My In, Pm ) sEXCLUDED PN]K°, &ADveaenY $1,000,000 GENERALAGGAEGATE s2,000,000 GOO AGGREGATE LAVTAPPLIES PER: POLICY NIECT LOC PRODUCTS -COWIOP AGG s2,000,000 AUTUNDBI UAEUTY ANYAUTO ALL OWNED AUTOS SCHEDULEDAUTOS IEREDNROS NOROM�DAilT05 " (( SNGLE LAVE s . BODILY MAIRY (Pwpa ) s BODILY dem (Pw wsJeRYI s PROPERTY DAMAGE (P'RAI s G1IRAOE UAEUTY ANY AUTO ' AUTOCWY-EAACCIDENT s OTHER THEA ADC AN AUTO ONLY;. AGG s s E(CESSAMENR9LA UABRlTY OCCUR ❑ CLAIMSMADE DEDUCTIBLE REft3am s EACH OCCURRENCE s AGGREGATE S s s $ B VAS COWBATAMOL AND EMPLOYERS' LIABILITY ANY PROPRIET0RIPMibteUE7fEQJTNE OFFIC3UNIAmEREXCLUDED? ffpe eras- OWN YES SPECIAL PROVISIONS bekw 7PJUB-7430A7-07 7PJUB-7430A7-08 04/11/07 04//11/08 04/11/08 04/11/09 X I I ER ELEACHACCIDENr s100,000 ELL DISEASE -EAEMPLOYEE 31D0,000 EL DISEASE -POLICY LIMIT s 500,000 OINEt DESCRIPTION OF OPERATIOO/LWATONS/ VEHICLES I EXCLUSKM ADDED By 681 =3Wff 1 ww" PRWmoo THE WORIKERS CQWENSATICN POLICY DOES NOT PROVIDE COVERAGE FOR PAUL BUCKINILLER. CERTIFICATE HOLDER CANCELLATION COREY SCOREY 1694 FAIiOUTH RD #115 CENTERVIISE, MA 02632 FAX: 508-775-0155 *'GULD ARY 09 TLE RED POLLCIFS B6 CANCELLED BEFORE TIE FCWMTOR DATE THEREOF. tAILI ENDEAVOR TO MAIL 21 DAYS V/tlTTEM NOBCE TO n1E CD[BRGT! HOLDER TO THE LEFT, BUT FAILURE TO OD E0 WALL BIPWE RO ODII/CaTO/ dl UAMyfl�W ANY JUNO UPON THE UWREA, ITS AGENTS OR .. ' i. • t.. 5 S • t • �II���:,p�s ��.��,;S�.w.�. ��.��r��r..���.��.��r.��.,�p,..±....n�....,r.:��r�:-e:r;^:.r;:«,. .. i•, t. .. ... .-.. BRP WW 03'' Amendment to Waterways Mense'or,Pe�nit :.t.::�..:.... General Waterways Application Municipal Zoning Certificate Pl asetypeor Donald J. .Gauch & Theodore Rogers print cleary ai . Name d+Dd4:11+r Information' o provided on 422A & 426 Highbank Rd. this forth. Proicdarreaastas :South Yarmouth C;ry/►or.: . Bass River WaW ay - To provide noncommercial boating access to navigable____ Desuwrw+xay�� orcunplbw, waters. y • . . F,. �. _..... _ ...... ' �r ;:i � ti,::;:,i.: ':r"'Y�ia�is�5''� .t'�r" '�.•�` tu"iiti:i:%'`.�a 7.•6ii(:`l�a!n:. •;•.,. _ . : �....:.c'.:.. �.. . To be completed by municipal clerk or appropriate municipal official.• '1 hereby certify that the project described above and more fully detailed In the applicant's waterways license application and plans Is not in violation of I zoning ordinances and bylaws' ' Pdn; Nanr drlrfupar Oneu� • sryruru, ,rcrwrararar/ 0 TWO • �l" a►• b `t � � . Due see Instructions on page 1 lefore sompieliag sections A-D of this form �+ r.Y'.aq I,. lcip-}Fl�3;w. ! ���x •�� ttti��� a '�S• i ) j' f�r n'i kc^ �7 i •.. r� � 'rf �'r•,7 ..etc � ' •: ��(QBairDlJt S81lIC$.� �� �A -�'�''�..•� t�•.�Tllrismlmll":rr,'1" BRP WW 01 `Waterways license or Permit y , " . • .' BRP WW 03 4mendment to Waterways Ucense or Permit General Waterways Application -Project Information . 1. Which permit category are you applying tor? ' 7. ProjecfrActivity description: X)GRPWW01 = BRPWW03 . Construction and maintenance of -a pile supported pie;, 2• Applicant - ramp and float system. Donald J. GauCW Theodore Rogers •� r16m1 �_ C/o 8 Kalamat Farms Circuit aWAVAMM Shrewsbury MA• 01545 6. Description otexisting andlorproposeduse(s): wor $1xt ZOM -To provide noncommercial 508-398-4781 rev" POV (WA) b tin access to oa g 3. Aulhorizedagent (Iany): navigable waters. Robert M. Perry AWV 50 Leland Rd. Brewster MA 02631 ClOror. sn;e 1tCoa 508-896-4861 ram, 4. Property Information (all information must be provided): Donald J_-Gauch & Theodore Rogers Cwwwn pmikrovkOMMranp MAP #92 PARCEL # 7 & 8 ruksessatcAfayWPrrxkimDto 422A & 426 Highbank Rd. 10260eWmW04 South Yarmouth Barnstable CANTO" Count' 5. Name of the water body: Bass.River 6. The water body at the project she Is: (check 1 or more of both a 3 b) L X:R Tidal • • = naid Tideiands = Great Pond WverrStream = Uncertain tr.Xa Natural MwMadlr 0 Uncertain 9. Is this project XX water -dependent? = non water -dependent? 10. What is the approximate total cost of any proposed work Including materials 6 labor)? $ 25,000.00 11. List the name and complete mailing address of each abutter (attach additional sheets, If necessary): Gail A. Gauch 8 Kalamat Farms C3 Shrewsbury MA 01545 Nancy K. Tripp 8 )Pattee Rd. Harvard MA 01451 12. 01 have attached project plans in accordance with the .inswctions contained In..,% )RAppendl i A (for PermOpplications) Appendix 8 (for License applications) Appendices A•fl begin on page 5 of this Application Package. • •''� • Pa1?d2of fl • 'Yt., f wili • Msuechusetti Oepedment ofEndroomental Protectlon '20703 8 Bureau of Resource Protection = Waterways Program rransmrttau • I •BRP WW 01 • Waterways License or Permit BRP WW 03 Amendment to Waterways License or Permit general Waterways Application , Please type or print Cluny ae Inforrution • provided on this form. Certification At applicants, property owners and authorized agents must sign this page. M future application correspondence may be signed by the authorized agent alone. 9 hereby make application for a permit or license to authorize the activities I have described herein. Upon my signature, I agree to allow the duty authorized representatives of the Massachusetts Department of Environmental Protection and the Massachusetts Coastal Zone Management Program to enter upon the premises of the project site at reasonable times for the purpose of inspection... 9 hereby certify that the Information submitted in this application is true and accurate to the best of my knowledge' Waterways Dredging Addendum 1. Provide a description of the dredging project. 2. What is the purpose of the dredging? 3. What is the volume (cubic yards) of material to be dredged? 4. What method will be used to dredge? Apalkwn 8,19ralm SE6RGENTFd✓1.tir ldrrfc�fF.c Date Plope/e' Owne'1 tr pnuwe (ilOiBettnr ynn e�plinnp S. Describe the disposal method that will be used and give the disposal location (Include a separate disposal site location mar AGENT AUTHORIZATION r To Whom it -May Concern, As owner of 422A Highbank Rd.. South Yarmouth, MA, I hereby designate Robert M. Perry, P.E. as my agent for purposes of preparing, filing and receiving documents on my behalf in connection with the design and permitting of the proposed pier ramp and float system for the site. 0 "W k -U / Zoo Owner Signature Date Print Name i AGENT AUTHORIZATION To Whom it May Concern, As owner of 426A Highbank Rd. South Yarmouth, MA, I hereby designate Robert M. Perry, P.E. as my agent for purposes of preparing, filing and receiving documents on my behalf in connection with the design and permitting of the proposed pier ramp and float system for the site. jrNfL// . r 1 Owner Signature Print Name „�.. • .,err. . MtSSdt hBSdtft DdF�rl%d/r!t 0/EOIIrdQfdOQtdJ prdtdCtldA EP Fla Number • Bureau of Resource Protection - Wetiandi WPA Form 5 n Order of Conditions lorDfPpseony Massachusetts Wetlands Protection Act M.G.L. c.131, §40 ' Applicant Information Frdm: YARMOUTH effmaum cis MWW For. SE 83-1499 RoiatFJrNrnear T9;'Donald J. Gauch :,Theodore Rogers- AoDkOAWe 8 Kalamat Farms Circuit cShrewsbury, MA 01545 MAC 01545 sme ZIP coa The project site Is located at South Yarmouth VT” 8 & 7 Auaaars4tafti P&WAarl and the property is recorded at the Registry of Deeds for. The Notice of Indent for this project was filed on: January 7, 2000 Do The public hearing was closed on:. January 20, 2000 Do Title and Date of final Plans and other Documents: Hydrograghic plan of land in So. Yarmouth showing proposed : pier,ramp & pile anchored float., 1-20-2000 - Robert M. Perry,P.l Barnstable Lot 7-1086: Lot 8-7913 a Tot 7- 317 Lot 8-271 10 Findings Findings pursuant to the Massachusetts Wetlands Protection Act Following the review of the above -referenced Notice of Intent and based on the Information provided in this application and presented at the public hearing, this commission finds that the area in which work Is proposed is significant to the following Interests of the Wetlands Protection Act (check all that apply): = Public Water Supply Private Water Supply Groundwater Supply XFood Control X Land Containing Shellfish Fisheries X,I Storm Damage Prevention XPrevgntion of Pollution Protection of Wildlife Habitat Furthermore, this Commission hereby finds that the project, as proposed, is: (check one of the following boxes) Approved subject to: the following conditions which are necessary, in accordance With the performance standards set forth in the wetlands regulations, to protect those Interests checked above. This Commission orders that all the work shall be performed in accordance with the Notice of Intent referenced above, the following General Conditions, and any other special conditions attached to this order. To the extent that the following conditions modify or differ from the plans, specifications, or other proposals submitted with the Notice of Intent, these conditions shag control. - Rev.10M8 Page 1 of 5 DEP Mmuchrisett BOPartment o/Eavlto menbiProtecf/oo BMW OfResoume Protection —Wetlands WPA Form 5 - Order of Conditions Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Findings (cont.) Denied becairse: the proposed work cannot be conditioned to meet the performance standards set forth in the wetlands regulations to protect those interests checked above. Therefore, work on this project may not go forward unless and until a new Notice of Intent is submitted which provides measures which are adequate to protect these interests, and a final t: Order of Conditions is Issued. E the information submitted by the applicant is not sufficient to describe the site, the work, or the effect of the work on the Interests Identified in the Wetlands Protection AcL Therefore, work on this project may not go forward unless and until a revised Notice of Intent is submitted which provides sufficient information and Includes measures which are adequate to protect the Acre Interests, and a final Order of Conditions Is Issued. A description of the specific information which is lacking and why it Is necessary Is attached to this Order as per 310 CMR 10.05(b)(c). General Conditions 1. Falure to comply with all conditions stated herein, and with all related statutes and other regulatory measures, shall be deemed cause to revoke or modify this Order. 2. The Order does not grant any property rights or any exclusive privileges; it does not authorize any injury to private property or Invasion of private rights. 3. This Order does not relieve the permatee or any other person of the necessity of complying with all other applicable federal, state, or local statutes, ordinances, bylaws, or regulations. 4. The work authorized hereunder shall be completed within three years from the date of this Order unless either of the following apply. (a) the work Is a maintenance dredging project as provided for in the Act; or (b) the time for completion has been extended to a specified date more than three years, but less than five Years. from the date of Issuance. If this Order is Intended to be valid for more than three years, the extention date and the special circumstances warranting the extended time period are set forth as a special condition in this Order. 5. This Order may be extended by the Issuing authority for one or more periods of up to three years each upon aPPlication to the Issuing authority at least 30 days prior to the expiration date of the Order. 6. Any fill used in connection with this project shall be clean fill. Any fill shall contain no trash, refuse, rubbish, or Town of Yarmouth Wetland By -Law Chapter 143 debris, Including but not limited to lumber, bricks, plaster, wire, lath, paper, cardboard, pipe, tires. ashes, refrigerators, motor vehicles, or parts of any of the foregoing. 1. This Order does not become final until all administrative appeal periods from this Order have elapsed, or if such an appeal has been taken, until all proceedings before the Department have been completed. No work shall be undertaken until the Order has become final and then has been recorded In the Registry of Deeds or the Land Court for the district in which the land is located, within the chain of title of the affected property. In the case of recorded land, the Final Order shall also be noted in the Registry's Grantor Index under the name of the owner of the land upon which the proposed work is to be done. In the case of registered land, the Final Order shall also be noted on the Land Court Certificate of Title of the owner of the land upon which the proposed work is done. The recording Information shall be submitted to this Conservation Commission on the form at the end of this Order, which form must be stamped by the Registry of Deeds, prior to the commencement of the work 9. A sign shall be displayed at the site not less than two square feet or more than three square feet in size bearing the words, 'Massachusetts.Department of Environmental Protection' [or. VA DEP'j'File Number SE 83-1499 fteaFill Wnber 10.Where the Department of Environmental Protection Is requested to issue a Superseding Order, the Conservation Commission shall be a party to all agency proceedings and hearings before the DepartmenL 11.Upon completion of the work described herein, the applicant shall submit's loquest for Certificate of Compliance (WPA Form SA) to the Conservation Commission. 12.The work shall conform to the following attached plans and special conditions: Final Approved Plans (attach additional plan references as needed): Hydrograghic Plan of Land fits 1--20-00 Mert M. Perry, P.E. Con Com by on file om Rev.10/98 Page 2 of 5 .r Massac6rurtts Depar6cent o/ fnrlroameafal ProbcBon Town of Yarmouth Bureau of Resource Protection — Wetlands Wetland By -Law I WPA Form 5 - Order of Conditions Chapter143 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 U Findings (cont.) 13. Any changes to the plans identified in Condition # 12 above shall require the applicant to inquire of the Conservation Commission in writing whether the change Is significant enough to require the (ding of a new Notice of Intent. r 4. The Agent or members of the Conservation Commission and Department of Environmental Protection shall have the right to enter and Inspect the area subject to this Order at reasonable hours to evaluate compliance with the condi- tions stated in this Order, and may require the submittal of any data deemed necessary by the Conservation Commis- sion or Department for that evaluation. 15. This Order of Conditions shag apply to any successor in Interest or successor in control of the property subject to this Order and to any contractor or other person perform- ing work conditioned by this Order. 16. Prior to the start of work, and If the project involves work adjacent to a Bordering Vegetated Wetland, the boundary of the wetland in the vicinity of the proposed work area shall be marked by wooden stakes or flagging. Once in place, the wetland boundary markers shall serve as the limit of work (unless another limit of work line has been noted in the plans of record) and be maintained until a Certificate of Compliance has been issued by the Conservation Commis- sion. 17. All sedimentation barriers shall be maintained in good repair until all disturbed areas have been fully stabilized with vegetation or other means. At no time shall sediments be deposited in a wetland or water body. During construc- lion, the applicant or his/her designee shall inspect the erosion controls on a daily basis and shall remove accumulated sediments as needed. The applicant shall Immediately control any erosion problems that occur at the site and shall also Immediately notify the Conservation Commission, which reserves the right to require additional erosion and/or damage prevention controls it may deem necessary. Special Conditions (Use additional paper if necessary) SEE ATTACHED SHEET Findings as to municipal law, bylaw, or ordinance Furthermore, the CNISM tancminzwon hereby finds (check one that applies): that the proposed work cannot be conditioned to meet the standards set forth in a municipal law, ordinance, or bylaw, specifically hhmeridAhw01munic0kw, DAK orwkwro Therefore, work on this project may not go forward unless and until a revised Notice of Intent is submitted which provides measures which are adequate to meet these standards, and a final Order of Conditions Is issued. 7 that the following additional conditions are necessary to comply with a municipal law, bylaw, or ordinance, specifi- cally Name rMubdon 41mimiciPd kK bypw• aardinm>Ve. The Commission orders that all the work shall be performed in accordance with the said additional conditions and with the Notice of Intent referenced above. To the extent that the following conditions modify or differ from the plans, specifications, or other proposals submitted with the Notice of Intent, the conditions shall control. Additional conditions relating to municipal law, bylaw, or ordinance: - Rev. i W98 4 SPECIAL CONDITIONS DONALD L GAUCH THEODORE ROGERS SE 83-1499 1. The applicant shall be respgnsible for having a copy of these "Orders of Conditions" on the job site at all times. Failure to do so may result in a revocation of the "Orders", or a fine, or both. 2. The Conservation Commission, its agents or assigns, shall have the express right of entry upon the job site at all reasonable times for the purposes of establishing "compliance' with the conditions stated herein. 3. Upon completion of the project, a "Certificate of Compliance' shall be requested in writing. This "Order of Conditions" shall be considered incomplete until the "Certificate of Compliance" is issued and recorded at the Registry f Deeds. 4. All shellfish in the vicinity of the proposed pilings shall be removed at the applicants expense under the direct supervision of Yarmouth's Natural Resource Department. This removal must take place prior to the construction of the dock. 5. There shall be no dredging in connection with this project. 6. The pilings shall be hammer driven. 7. No other piers shall be constructed on lots 7 or 8 in the future. Routine maintenance and/or reconstruction of the proposed pier may be allowed pursuant to a new Notice of Intent. 8. The applicant shall provide the Conservation Commission a recorded deed easement indicating common use of the proposed pier by present and future owners of lot 7 and lot 8. Such easement shall run with the property title perpetually and shall be provided to the Conservation Commission prior to construction of the pier. 2 MnsachrrsetlsDeparboebtotEadronmecta/Pivtactlon Bureau of Resource Protection -Wetlands WPA Form 5 in Order of Conditions Massachusetts Wetlands Protection Act M,G.L. c.131, §40 t Findings (cont.) This Order is valid for three years, unless otherwise speed .as a special condition pursuant to General Conditions 14. from the date of Issuance. January 25, 2000 oro This Order must be signed by a majority of the conservation r commission. The Order must be mailed by certified mail (retum receipt requested) or hand delivered to the applicant. A copy aiso must be mailed or hand delivered at the same time to the appropriate regional office of the Department of Environmental Protection. Town of Yarmouth Wetland By.Law Chapter 143 On this O -� dayot ram 200 _ • . rer 0 before me personally appeared I'f rS,Sl�I to me known to be the person described in and who e)eaded the foregoing Instrument and acimowledged that hehhe executed the same as his/her tree act and deed. iwmyRpG'c � t Si- arnQ �— +bmm,;urc��;,a This Order Is Issued to the applicant as follows: 7 by hand delivery on Din by Certified mail, return receipt requested, on January 25. 2000 Appeals • The applicant, the owner, any person aggrieved by this Order, any owner of land abutting the land subject to this Order, or any ten residents of the city or town in which such land is located, are hereby notified of their right to request the appropriate Department of Environmental Protection Regional Office to Issue a Superseding Order of Conditions. The request must be made by certified mail or hand delivery to the DepaRrp4 with the aPPMriate filing fee and a completed Appendix E: Request for Departmental Action Fee Transmittal Form, as provided in 310 CMR 10.03(n within ten business days from the date of Issuance of this Order. A copy of the request shag at the same time be sent by certified mail or hand delivery to the conservation commission and to the applicant, It he/she Is not the appellant. The request shall state clearly and concisely the objections to the Order which is being appealed and how the Order does not contribute to the protection of the Interests identified in the Massachusetts Wetlands Protection Act (M.G.L e.131, §40 and is inconsistent with the wetlands regulations (310 CMR 10.00). To the extent that the Order is based on a municipal bylaw, and not on the Massachusetts Wetlands Protection Act or regulations, the Department of Environmental protection has no appellate jurisdiction. Rev. INS Page 4 of 5 ' Massac6usetis Department of Enr/roacierrfal Protection Town of Yarmouth Bureau of Resource Protection — Wetlands Wetland By -Law I. WPA Form 5 - Order *of Conditions Chapter 143 Massachusetts Wetlands Protection Act M.G.L. c.131, §40 U Recording Information This Order of Conditions must be recorded In the Registry of Deeds or the land Court for the district In which the land is located, within the chain of title of the affected property. In the case of recorded land, the final Order shall also be noted in the Registry's Grantor Index under the name of the owner of the land subject to the Order. In the rase of registered land, this Order shall also be noted on the Land Court Certificate of Tittle of the owner of the land subject to the Order of Conditions. The recording Information shall be submitted to the " YARMOUTH W wwon coeWwon on the form below, which must be stamped by the Registry of Deeds. Detach on dotted Kne and submit to the Conservation Commission. ----------------------- — ---------- To: YARMOUTH Please be advised that the Order of Conditions for the project at 422A&.426 Highbank Rd., So.Yarmouth ftWL=ucn wrimmater SE 83-1499 has been recorded at the Registry of Deeds of Barnstable county and has been noted in the chain of fitle of the affected property In east • Po� In accotdarlce wpdhe Order of Conditions issued on .Do If recorded land, the instrument number which Identifies this transaction is kawnelAfter If registered land, the document number which Identifies this transaction is DoaimtnrNunDer SiDNhoolkWiw4 : _ Rev.10/98 Page 5 of 5 "Rbk ZC G L 8 (:RAU,CH rp0 M�\ t ►sn eau �ZZ 1. ICF-"Fy-MAT TNIS PLAN WAS PREPARED INA=RDANO WITH THE M)LtS AND REGVLATIONS CP THE REGISTERS OF DEEDS EFFECTIVE. V1116 AND AS REVISED TIAMOUG14 SAN.1988• 2. UE .. C1IAP4J SL.C.81-X,G.L. I HEREBY CEI2T;:Y'1 4AT Tkt PQOPERT( LINES SHOWN ON lUlS PLAN AIZE We LINE5 DIVIDING EXISTING OWNEQSI.41PS ANDIWE LINES OFlUF- STIMM-rS AND WAYS- tFCWN AM WOSE 0FI-U5UC OR PRIVATE STREST5 oR WAYS ALREADY E'SMBLISHE.D,ANDZI-IAT NO NEW ONES 17M olvislw of pc15RNG OWNER- SHIP OR FOR NEW WAYS ARE SHOWN: DATE: {ZL'C IST E QED LAND SV IZVEYO R pi�.Izct=•L..-1 'RocZE:Rs 113 0. ¢LTM U' —k to FICu'T� )TTeR) 1L.aPP a 4zv .........�. -DER 1 14L'X3�Ip��pNiF' 1 r21S'x� WT 1 � \ kzJgx W _6 P �{ $ A sea_ PLANS ACCOMPANYING PETITION 6P 'DONAL'D GAUCH AND' THeOD02E 'POGERS TO CONSTRUCT ANO MAINTAINA -PIE- Z, RAMP AND 'FLOATS IN 10 BASS -ZjVE-JZ SOUTH YARMOc)TH, MASS. I I' zc '$Ass 'RI ve7Z g0 s flgo IS V IELSV&l p120 O� �F FLMT to EO PILLS 5UPPpRTGD PIER S�TtM W/gltCt IpR 1?o AY LONE-OLCIC L`LEVe PILINGS S 7 -s nlrzu- , cLca+ly: aaTT_ G 4, it it'11 it it It ,1 if PILE '1 II U 11 U it i Pru. (� 12 iuru.q (6p' D of F pT� 0 1?D� 'I�ENDOF c xr. - o qo 60 goo ,2p ,qo IGO �R OF EL IE 3O _� _�aizAcur�, ve�[7CIrt iex.dRAI7-� 2•x6car 2r6Ce1.P It8 cis- ALL �W¢DWOR@@ �iF'� S�-L �L STEL'L po LiB HOZ' DIP GGLVGNIZED IOC�� NCI _TYPICAL PIER DETAIL -PJO SCAL@— GAUCf-� 'QOGE�2S RAMP AND -FLOATS IM SOL)TH YAC2n,Ip 1/ MAss. BADE 0=0 ENGINEERING IN.. .50 �Q Wis gyp +eOAD er20-lz s ao ti ' � i;,:.LC �\. <.:t:.l. ;'� it r•. . Commonwealth of Massachilsetis officiat use only " Department-ofFli6Servlees' pecmicxo E,-01-5Jr� BOARD OF FIRE PREVENTION REGULATIONS Oecupancyand Fee Checked Rkev. 11/99] eave black APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (NEC), 527 CMR 12-00 (PLEASE PRINTININKORTYPE ALL INFORMAvom. Date: • 12/18/00 City or Town of: YARMOUTH To, the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 426A HIG MANK STREET Owner or Tenant amTS14 Telephone No. .Owner's Address 426A HTGHBANK ROAD S YARMOUTH MA 02664 Lc this permit in conjunction with a building permit? Yes ® No El (Check Appropriate lion) �.: 1?urpose of.Building RESIDENCE Utility Authorization No. ."'Existing Sevice Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters : _ . ,: New'§ervice _ -Amps / Volts Overhead ❑ Undgrd El No. of Meters �. ROUGH AND FINISH OF BASEMENT BLDG, PERMIT #B-01-420 No. of Recessed Futures .., ...� v..v..0 No. of CeiL'Susp. (Paddle) Fans la &Cc Vucmfwry vvrnel Ol'a Wires. o Tota Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA Net of LiAbove ghting Fixtures Ia- Swimming Pool d. ❑ grmd. ❑ No. or BattII�anry Lighting No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. a gr Devices No of Ranges No of Air Cond. Tons No. of Alerting Devices No. of Waste Disposes Totals, ° oas o, of Self- Con tained )etection/Aterflur Devices Local..❑- ❑Other ' -yCoonnnesxion No. of Dishwashers Space[Area Heating KW No. of Dryers 0.•�.� KW of Water 7 Heating Appliances ICW o I o Signs '�it 8y - ar eat ata'— =N or ent No H ydromiassage Bathtubs : No. of Motors Total: No of or eat OTHER: ........,..«..., cacti yaes,req arcsatial INSURANCE COVERAGE: Unless waived by the owner, no permit rntarrce of elmay issue unless the licensee provides proof of liability insurance including"completed operation"coverageori equivalent The undersigned certif es that such coverage is in force, and has exhibited proof of same to the permit issuing office. (HECK ONE' INSURANCE ® BOND ❑ OTHER ❑ (Specify:) GENERAL ACCIDENT INSURANCE 7/31/01 Estimated Value of Electrical Work (Etipuance Date) (When required by municipal policy.) Worlcto Stan: Inspections to be requested in accordance with h EC Rule 10. and upon completion I certify, under the pains and penalties of perjury, that the infornrarlojon this application is true and complete. FIRM NAME: BREWER ELECTRIC & UTIT,ITIES INC LIC. NO.: A9897 Licensee: MIKE MCSHEFFREY Signatur ,a LIC. NO.: A9897 (!'applicable, ewer "exempr in the license number line.).• Bus Tel. NO.' S $-7 — 40 Address: 110 OLD TOWNHOUSE ROAD, S YARMOUTH, MA 2664 Alt Tel. No.�11 OWNER'S INSURANCE WAIVER: lam aware thatthe Licensee does not have a liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement I am the (check one) ❑ owner ❑ owner's agent Owner/Agent Signature Telephone No. PERMIT FEE. S FIELD COry 04 BUILDI G"DI- dab J TON OF YARMOU H / PERMIT DATE PERMIT NO. December 15m 2000 B-01-420- Kelley Philbrook ADDRESS 38 %bights Lane Glast. Ct. APPLICANT , (NO.) (STREET) (CONTR'S LICENSE) PERMIT TO -;ter-T1?jTIQNr�(—) STORY (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) NUMBER OF DWELLING UNITS ZONING AT (LOCATION) 42 1 u.L§hbank--R - DISTRICT. R-40 (NO.) ( RE T BETWEEN STREET) SUBDIVISION 921!7- LOT — BUILDING IS TO BE FT. WIDE BY FT. LONG BY TO TYPE 5—B AND STREET) LOT- .. �76 BLOHasa—.8]L SIZE' FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION USE GROUP R-4 BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: Finish interjnT- nf nxintinq hnno-meat- ina}all g iii-al ntmi=a-30 L slider. Increase window sizes in existing area wells. AREA OR VOLUME OWNER - ADDRESS (CUBIC/SQUARE FEET) Walsh ESTIMATED COST 24000.00 FEEMIT 231.00 BUILDING DEPT. BY % 5Llr_f INSPECTION RECORD GATE NOTE PROGRESS - CORREJCT,IONS AND REMARKS INSPECTOR -o z Ael - �L c� O_H MATTAC nCES «C.h.I bfl Gy- ONE & TWO FAMILY ONLY - BUILDING PERMIT APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING Town of Yarmouth Building Department 1146 Route 28 • Yarmouth, MA 02664-4492 Tel: (508) 398-2231 x261 • Fax: (508) 398-2365 Office Use Only Permit No.-©L'+✓ Date` Permit Fee $ a$1. _>Date Deposit Rec'd. $ gip. - Net Due $ p� Planning Board Information Plan Type Endorsement Date Recording Date Plan No. Other Assessors Department Information: Map Lot Map Lot S� % Old New 1.4 Property Dimensions: a Lot rea (sf) 7 Frontage (ft) Lot Coverage This Section for Office Use Only Building Permit Number: Date Issued: Signature: Certificate of Occupancy is is not required Building Official Date Section 1 - Site Information Use Group: R-4 Type: 5-B 1.1 Property Address: f\a(JA 1.2 Zoning Information: Zoning District Proposed Use S ncznc� Ni 1.3 Building Setbacks (ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.4 Water Supply (M.G.L. c. 40. S 54) Public ✓ Private 1.5 Flood Zone Information: Comments: Zone: L BFE: Section 2 - Property Ownership/Authorized Agent 2.1 Owner of RecQl rd: /� f/`eil jiw �� a e rint) Mailing Address 5 Sign ur Telephone 2. A thor d Agent: �- Name (print) Mailing Address Al ,., - 1-1":7 a SignatureCj Telephone u ., Section 3 - Construction Services 3.1 Licensed Construction Supervisor: LbU pp Y.le By tense Number Expiration Date Jr -({ v3 Address Signature Telephone 3.2 Registered Home Improvement Contractor: Company Name \0-1 \'�r(�r\ s'(. �1',wP!' cl_cat� �tL�G, +�ttl�'C. `�f.a�fu\5, 11. c��(,'�a Not Applicable ❑ Address 1\I Signahire 171t- Telephone License Number kr Expiration Date (p 125 jO',I 9 9 - 15 - 99 1 of 2 OVER Section 4 - Workers' Compensation Insurance Affidavit (M.G.L. c. 152 S 25C (6) A - 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 .......... Section 5 - Description of Proposed Work (check all applicable) New Construction ❑ I No. of Bedrooms No. of Bathrooms Existing Bldg. ❑ Repair(s) ❑ Alterations El I Addition ❑ AccessoryBldg. ❑ Type Demolition Other Specify: Brief Description of Proposed Work: t O of V. �yl�Jc �e c[''� {� C Y//��` rG� W%Nn 0 3.5= — Ji ;"X IL!=//Z=3S,-ToTit L3/, Costs Section 6'- Estimated Construction Item Estimated Cost (Dollars) to be completed by permit applicant Check Below ❑ Conservation -Commission Filing (if applicable) ❑ Old Kings Highway & Historical Commission approval (if applicable) 1. Building as \So 2. Electrical fl 3. Plumbing / Gas -- 4. Mechanical (HVAC) yew 5. Fire Protection 2.D0 6.Total =(1 +2+3+4+5) 7.Total Square Ft. (new houses &additions) '����L�C1J Section 7a - Owner Authorization - Owner's Agent or Contractor Applies To be Completed When for Building Permit 1, j taC4uLWG L►� SK as owner of the subject property hereby authorize �����+ ���1���. 4--c ^���"C• to act on my behalf, in all matters relative to work authorized by this building permit application. Siglure o wner Date Section 7b - Owner/Authorized`Agent Declaration l ��f�i r•( lie as Owner/Authorized Agen 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. Print name Signatu of C? ler/Agent Date 0 . . 9-15-99 2 of 2 TOWN OF YARMOUTH 1146ROUTE28 SOUTHYARMOUTH MASSACHUSETTS026644451 Telephone (508) 398-2231, Ext. 261 — Fax (508) 398-2365 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT BUILDING ELECTRICAL GAS PLUMBING SIGNS 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 \^t,.G, ���t,�s.[�A%» c? `,�gp . 4n , ��Rczn00V k-1 lr• Work Address is to be disposed of at the following location: Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. `Signature of Applicant Permit No. Date • The Commonwealth of Massachusetts Department of Industrial Accidents ONCeof12yest/ystlsms 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Applicant. information: Pleas�PRINTTe�9iaTa nnmc: Tf1cw`Ltuie G> Pkt s\\ location? t-11f.. Yt\t.41:�flnlv�.t�, rJ I am a homeowner performing all work myself. I am a sole proprietor and ha%e no one working in any capacity 1 am an employer pro% iding workers' compensation for my employees working on this job. company name:4`;lZt'3t7t��4tt Ch`e� ♦. address: W:b`f 1�ERQA 5�,. city, I�Ett1A1\a. , Cl. phone #: .;Ll '1,85 Dint,? insuranceco GVtA-ZtV= —Z fQ-r Pfts. C-Cs. policy!! UNC. (?s �1`( CD I am a sole proprietor _eneral contracto or homeowner (circle one) and have hired the contractors listed below w ho have the follow ing workers comp nsat polices: company name; city: phone #: insurance co policy # Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine rap to SI M.00 aadtor one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 3I00.00 a day against me. I aadetstsad that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and coned \\_ I -�-4 } Ott Print name 1 Fit—f-N `PNOa zmy� Phone# official use only do not write in this area to be completed by city or town official city or town; YARHOUTQ 0 check if immediate response is required contact person: permitAicense # nBuilding Department OLicensiog Board 261 ❑Selectmen's Ofllce Health Department phone #: _ (508) 39842231 ext. r,Other (,e ,sed 3•95 PJA) ;kV. Information and Instructions MaSSachUsettS General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their entplo%ees. As quoted from the "law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An enrphr rer is defined as an indix idual. 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 o%%ner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the d%%ellinQ house of another who employs persons to do maintenance , construction or repair work on such dwelling house or un the sruunds or building appurtenant thereto shall not because of such emplo%ment be deemed to be an emplo%er. %IGL chapter 152 section -5 also states that every state or local licensing 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. Additionall\, neither the commom\ealth nor any of its political subdivisions shall enter into any contract for the performance of public "ork until acceptable evidence of compliance with the insurance requirements of this chapter ha\ e been presented to the contracting authorit}. Applicants Please till in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affida\ it 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 "orkers' compensation policy, please call the Department at the number listed below. City or Towns 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. The aff davits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. Tile Department's address, telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents MCC of IRVesullltleat 600 Washington Street Boston, Ma. 02111 fax N: (617) 727-7749 phone 4: (617) 7274900 ext. 406, 409 or 375 oF' 'jk }:. TOWN OF YARMOUTH Fti BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT: Job Location: Number Street Village Owner of Property: MAt— Lm \t, r 64 Construction Supervisor: g!ZLL6`I "?iAktbQco%1_ b'15 R?£Z 661?, -Ag '; J Name License No. Phone No. Address: 3A, U` pk(,wr'S LwtiS,, (ZA. Licensed Designee: !�?Cof:' (If other than Supervisor) Name License No. 2.15 Responsibility of each license holder: 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. 2.15.2 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 other 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 licenseewho shall willfullyviolate subsections 2.15.1, 2.152 or 2.15.3 or any 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 under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes ❑ No ❑ If you have checked y.Ls, please indicate the type coverage by checking the appropriate box. A liability insurance policy El Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 152 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature o}Dwner or Owner's Agent Owner ❑ Agent al, Signature: Building Official Approval: ✓Tie �io..v.,eauaralU a`'✓./zuaella BOARD OF BUILDING REGULATIONS / License: CONSTRUCTION SUPERVISOR Number. CS 006083 Blrthdate: 01 /14/1951 Expires: 01/142002 Tr. no: 15350 Restricted To: 00 THOMAS V PHILBROOK 107 BEACH ST C t!.M.w �i✓ DENNIS, MA 02638 Administrator ✓/ee '�o�rvaroou�eall�i a�✓`.vcaciu�aella BOARD OF BUILDING REGULATIONS n f nri . License: CONSTRUCTION SUPERVISOR ' Number: CS 075828 Blrthdate:05/07/1953 Expires: 05/072003 Tr. no: 75828 .-' Restricted To: 00 KELLEY C PHILBROOK 38 WRIGHTS LANE Z2 "r, -e GLASTONBURY, CT 06033 Administrator 371. HOME IMPROVEMENT CONTRACTOR _ Registration: 101422 Expiration: 06/25/2002 Type: 084 PHILBROOK ENGR. S CDNSIRUC 6 1 philbrook AOMwiSTRATOa �17 Beach Street _ - I Dennis MA 02638 4, ;► Suggested Affidavit for Home Improvement Contractor Permit Application For Omce Use Only Permit No. Date NAME OF CITY/I'OWN AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application %IGLc. 14ZA requites that the 'reconstruction. alteration. renovation. renair. modernization. conversion. innrovement. remrrval. deM61t:nn nrconstrvcunnnfanaddition toanvoretcistin rnvner{+ccuniedt+mldin contatmnentleastonebutnotmorethnnfourdwenineunm......r to arnctures which are adixent to such rcctdence. or nwldmg" be done by registered contractors. wash cenam exceptions. along witn etnr. requirements. Type of Work: \ t's-tFtn'wl V; s^��'C1M1r ,�E1,st. Cost 2 6Q Address of Work L1 � fr+ t tc.t4 C�.d f1�1 �ci7 ; S �) AcZC1o�1�[ 41 � t 1 Q . Owner Name: C kk Date of Permit Application: 12.y 16O I herebv certify that: Registration is not required for the following reason(s): _Work excluded by law _Job under S1.000 _Building not owner -occupied _Owner pulling own permit _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 PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. Signed under penalties of perjury: vr�\rxi� I hereby apply for a permit as the agent of the owner: \\ I eliL11m Date Contractor :Fame Registration No. Nonvithstandine the above notice. I hereby apply for a permit as the owner of the above property: Talc O�%ner Name PLOT PLAN Abuttor I s Name Lot # If this is a corner lot, write in name of street. s FOR LOT # Indicate location of garage or accessory building Additions with dashed lines -------------------- Sewerage disposal (cesspool) well SIDE YARD FTs (lot................ft. rear) Q REAR YARD HOUSE SET BACK ......i .ft. SIDE YARD 0----- FT� (lot..................ft. frontage) (NAME OF STREET) Information Supplied by 04 cu v b Abuttor' s Name Lot # If this is corner It write in name of other street. MARK NORTH POINT ---------------- 91 3 7�-�-- crzD ys c 10 4 5.80) '13 i T I •� -S-;b V c p rErNr-JTYzr�s�atf i t ill T� T32 Lvt_-�I i Lx 1) n -►,, C /,.O � +s�w. lev<` ►gyp A 7')-1 u v s -� C..�U Jt�t'Y[ '1 1-J L. 3�bK,ss�/C/ . w �„� Sro✓E *. - �' 2 3 J 01 IN-T"�zi wpz�� VG, 2.11 Z'3 SUO) ou 2• 9 Top fi Borr-a-r, oneL or 013 S►,eUc \ WCIUM RL-3)ML.1cc- qZL Ia1GN�3AeJtLmnn Sr,: yarcmwvn-, Yi�l� I t13rZ�O1L T'OU-3.$ 1 N rJo�1 v� Jo T nasi 7It.C. (.1cwD S;vvc i 3,c�,rc1Aa�i \ i.C.. F) r":, 1.-75 "• q ' " 21b I .a �.vL— 1: 012,. L� i TF— rn.QuC ZLa4%nn1r,]L �LOt'L` - Fiji. � .`• , � s t f I b" °ram IZx►Tr i t b�S S►leuc�,.. \ � I �t A» E 1 I1 sJ r� tz_ W AtIt �1 t- S N1GL1�Ae�Y.)2�aon rr1 - 7-- jL . ........... G 6 -Tu -- _____ - 7 ----- ----- ----------- S"' L 'Ll - X # 4A.L,w) YIA I.- SCALti X) " - ) 'ej 2,'#3no) 0u 2.9 'Tot, I- C)M..-. 77n-,-L-, 14, .-- I I--r '! Po 3 -s-s =Ra TOWN OF YARMOUTH • F„,? BUILDING DEPARTMENT BUILDING PERMIT APPLICATION SIGN OFF Applicant: Building Permit No.: 5Qb Address: —Tel. No.: 'aft+ - kf�� Date Filed: Bldg. Site Location: Map No.: Lot No.: The following information outlines the procedural steps required to obtain a permit to build, alter, or add to a structure within the Town of Yarmouth. The Building Department will determine compliance to the following: (A) Zoning Requirements (B) Historical Districts (C) Flood Zones. The Building Department will be responsible for assisting the applicant through the following departments: RESIDENTIAL AND/OR COMMERCIAL BUILDING WATER DEPARTMENT: Determines Compliance of Water Availability. (applicant to obtain) 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, Oceans, 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. ---------------------------------------- The following Departments must sign off, in the respective order, prior to building inspector issuing the required building permit: REVIEWED BY. 1. WATER DEPARTMENT: DATE: 2. ENGINEERING DEPARTMENT: DATE: 3. CONSERVATION: DATE: 4. HEALTH DEPARTMENT: DATE: INDUSTRIAL AND/OR COMMERCIAL PERMITS 5. WIRING INSPECTOR: DATE: 6. PLUMBING INSPECTOR: DATE: 7. FIRE DEPARTMENT: DATE: PLEASE NOTE All stumps and/or brush must be disposed of at an approved site. COMMENTS: �'L� G t 6 T Or 17,5 r. T N/A: N/A: N/A: N/A: N/A: N/A: N/A: B5 Ier fioA, dh� 3 A6axis N Lv�� sja✓y . 3 # 6s4TGa ? orNff,a I-H)4rt W6-W v r-DP"; —` O l (_ t i avlo l; /t-o L� � � � i� /L � !7� wo it !=� o m B � I"I 0`i G.S•Ai�� l S3- Qdl�Y2� 8/99 Applicant Signature ��•�=�� Date OF �•9 TOWN OF YARMOUTH F ; Building Department Town Hall a' Yarmouth, MA 02664 w (508) 398-2231 ext.261 . I E -v- Building Location: 0426A HIGHBANK RD Owner's Name: Philbrook Engineering Owner's Address: 107 Beach Street Dennis MA 02638 r Owner's Telephone: (508) 385-8682 Electrician Name: Reilly, James License Number: Company Name: Reilly Electrical Contractors Company Phone: (508) 771-2040 PERMIT TO PERFORM ELECTRICAL WORK (OFFICE USE ONLY Recorded By: Ic PERMIT NO- E_ 2. 27 Permit Fee: $50.00 Payment Type: Check Check Number 23500 Issue Date: 5/8/02 Type of Work: New Comments: rough and finish wiring of addition INSPECTION RECORD Date Note Progress - Corrections and Remarks Inspector C Date Printed: 5/9/02 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. C "oZ- 9Z-7 Ulu BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked SQ [Rev. 11/991 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 4/26/02 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 426A HIGH BANK ROAD, SOUTH YARMOUTH O ner or Tenant PHILBROOK ENGINEERING Telephone No. 508-385-8682 ,Is Address 107 BEACH STREET, DENNIS, MA 02638 permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) of Building RESIDENCE Service Amps vice Amps of Feeders and Ampacity Utility Authorization No. Volts Overhead ❑ Undgrd ❑ No. of Meters Volts Overhead ❑ Undgrd ❑ No. of Meters and Nature of Proposed Electrical Work: ROUGH AND FINISH WIRING OF ADDITION r'mmnletinn nftho fnllnwinv tnhle may ho waived by the In.vnectnr nfWire Wires - No. of Recessed Fixtures No. of CellSusp. (Paddle) Fans : No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑ In- ❑ rnd, rnd. o. o mergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Number . . ..........................__._....._....._................ Tons KW No. of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail ifdesired, or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE X❑ BOND ❑ OTHER ❑ (Specify:) GENERAL ACCIDENT INS Estimated Value of Electrical Work: (When required by municipal policy.) 7/31/02 (Expiration Date) Work to Start: 5/13/02 Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: REILLY ELECTRICAL CONTRACTORS, INC LIC. NO.: 1666A Licensee: JAMES R REILLY / v V "`J Signature F v I LIC. NO.: 1666A (Ifapplicable, enter "exempt" in the license number line.) Bus. Tel. No.: 508-771-2040 Address: 110 OLD TOWNHOUSE ROAD, SOUTH YARMOUTH, MA 02664 Alt. Tel. No.: 508-394-3211 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ 50.00 Signature Telephone No. PHILBROOK ZA )ENGINEERING & 107 BEACH STREET CONSTRUCTION DENNIS,1-50MA -6-5038 8-3858682 ENGINEERING DESIGN • CONSTRUCTION INSPECTIONS • BUILDING, ALTERATIONS & RENOVATIONS 22 December 2000 I Town of Yarmouth Attn: Mr. James Brandelini Building Commissioner Yarmouth, Massachusetts 02664 Reference: WALSH Basement Conversion - 1 Family Dwelling D Permit No. B-01-420 DEC 21 2000 Dear Mr. Brandelini: The following information addresses Comments on the Building Pevt Y-s^*'W�"*^ Form dtd. 24 NOV 00 (copy attached): ✓1) The height of the main room will be 8' 4" to the suspended ceiling. The height of the dropped down portion where the upstairs deck is framed over the foundation will be 7' 411. V�t) The basement space will provide a sitting 6 family room w/ a view of the water accessed inside by the spiral stairs. There will be a hobby/storage room in the rear of the basement space. Windows were added for light and to meet ventilation/fenestration requirements. '3) There is a double height deck. The upper is directly over the lower and the lower is completely over the existing full -height concrete foundation walls. Separately we are filing w/ Conservation and if approved the Building Dept. for the repair of an existing outside stairway and the addition of a walkway in front of the slider w/ another set of stairs over the stonework to the beach below. These are separate issues and not part of the current scope of work. /4) There are provisions for a wood stove. The brickwork and flue in -let exist as does the concrete floor. Fire protection wise all the nec- essary requirements can be met. Currently the wood stove is on hold. U6 The current work includes the addition of a hot water baseboard zone run off of the existing oil fired boiler. This work is being rough - and will be visible for the framing inspection. 6) rrent construction is 2"x 12" @ 16" c/o spanning 1410". Obviously there is ample floor capacity. The cut-out for the spiral stairway creates a 510"x 510" square against one wall. The openings for the the stairway only need doubled 2"x 120. Originally and in the plan provided the Town the floor system was thought to be 2"x 101's. 46 this is not the case the header and trimmers will be doubled 2"x 12". Note that the spiral staircase is a center bearing pole supported structure. tl�t will rely on the opening for lateral stability. I- ran a quick check of solid SPF lumber to show this for you. Respectfully submitted, T. VARNUM PHILBROOK, P.E. Mass. C.S.L. No. 006083 as: 2 Inclosures Y 2 of .YgR�e, TOWN -OF Y A R M O U T H 0 .SF?y BUILDING DEPARTMENT BUILDING PERMIT APPLICATION SIGN OFF Applicant: S RLAM.snIS LlNs-SM Building Permit No.: Sog Address: y� l�tw� t3AS 1�0 Tel. Date Filed: Bldg. Site Location: SAME Map No.: 9\ Lot No.: - *5 k The following information outlines the procedural steps required to obtain a permit to build, alter, or add to a structure within the Town of Yarmouth. The Building Department will determine compliance to the following: (A) Zoning Requirements (B) Historical Districts (C) Flood Zones. The Building Department will be responsible for assisting the applicant through the following departments: RESIDENTIAL AND/OR COMMERCIAL BUILDING WATER DEPARTMENT: Determines Compliance of Water Availability. (applicant to obtain) 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, Oceans, 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. The following Departments must sign off, in the respective order, prior to building inspector issuing the required building permit: REVIEWED BY: 1. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT: DATE: N/A: INDUSTRIAL AND/OR COMMERCIAL PERMITS 5. WIRING INSPECTOR: _ DATE: N/A: 6: PLUMBING INSPECTOR: DATE: N/A; 7. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE All stumps and/or brush must be disposed of at an approved site. COMMENTS: _3LZG D %fs r OOz .i3s n `T D1::� 3� 40W� X 6.Afe-�C I-I6- fl, rLm t� ac�r,rr� 8/99 Applicant Signature :..+ .:t _6_- Date \4.2yV�ts Double 2"x 12" SPF trimmer members •TJ-BeamTM v5M Serial N mber.7001OB349 2 PCs of 1.5" x 11.25" 1.4E SOLID SAWN SPRUCE -PINE -FIR #2 BEAMUSA 1111 22-Dec00 10:13:11 AM Page 1 or 1 Build Code: 146 THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN CONTROLS FOR THE APPLICATION AND LOADS LISTED n :n ,4' Product Diagram is Conceptual. LOADS: Analysis for Beam Member Supporting FLOOR - RES. Application. Tributary Load Width: 1' 4" Loads(psf): 40 Live at 100% duration; 15 Dead; 0 Partition; and: TYPE CLASS LIVE DEAD LOCATION APPLICATION COMMENT Point(lbs.) Floor(1.00) 425 160 8' 6" Adds to SUPPORTS: INPUT BEARING REACTIONS(lbs.) WIDTH LENGTH LNE/DEAD/TOT. PLY DEPTH DETAIL OTHER 1 2x6 Plate 5.50" 5.5" 538 / 250 / 788 1 11.2" Blocking 2 2x6 Plate 5.50" 5.5" 634 / 286 / 919 1 11.2" Blocking DESIGN CONTROLS: MAXIMUM DESIGN CONTROL CONTROL LOCATION Shear(lb) 893 808 1575 Passed(51%) Rt end Span 1 under Floor loading Moment(ft-lb) 3542 3542 4614 Passed(77%) MID Span 1 under Floor loading Live Defl.(in) 0.144 0.444 Passed(L/999+) MID Span 1 under Floor loading Total Defl.(in) 0.208 0.667 Passed(L/770) MID Span 1 under Floor loading - Deflection Criteria: STANDARD(LL: U360, TL•L/240). - Bracing(Lu): Ali compression edges (top and bottom) must be braced at 11' o/c unless detailed otherwise. Proper attachment and positioning of lateral bracing is required to achieve member stability. - The allowable shear stress (Fv) has not been increased due to the potential of splits, checks and shakes. See NDS for applicability of increase. -Analysis assumes continuous member. Lap joints, splices and finger joints significantly reduce member performance and have not been considered. ADDITIONAL NOTES: - IMPORTANTI The analysis presented is output from software developed by Trus Joist(TJ). The specific product application, input design bads, and stated dimensions have been provided by the software user. This output has not been reviewed by a TJ Associate. - Solid sawn lumber analysis is in accordance with 1991 NDS methodology and is solely presented for comparison purposes. Program limitations and assumptions about this analysis are available through the software's On-line Help. Trus Joist does not warrant the analysis nor the performance of solid sawn lumber materials. - Allowable Stress Design methodology was used for Code BOCA analyzing the solid sawn lumber material fisted above. Provide trimmers (& 60" header) for spiral staircase opening )JECT INFORMATION OPERATOR INFORMATION: WALSH Build -out Philbrook Engineering & Construction Project No. P00-35 Vam Philbrook 107 Beach Street Dennis, MA 02638 1-508-385-8682 Copyright 0 2000 by Trus Joist, a Weyerhaeuser Business. TJ-Pro"' and TJBearn ' are trademarks of Trus Joist. �/2G Ile,,5/�aHC %II/ United States Census 2000 How America Knows What America Needs www.census.gov i TOWN OF YARMOUTH 1146ROUTE28 SOUTHYARMOUTH MASSACHUSETTS02664-4451 Telephone (508) 398-2231, Ext. 261 — Fax (508) 398-2365 BUILDING DEPARTMENT w t May 24, 2000 r Kinlin Grover 4 Wianno Ave Osterville MA 0265S To Whom it may concern: BUILDING ELECTRICAL GAS PLUMBING SIGNS 1. On 426 Highbank Rd in South Yarmouth you have a Real Estate sign that is not located on the property that is for sale, as required by section 303.3.1.3 of the Town of Yarmouth Sign code. I have called before and asked that this sign be removed, and it was. It now is back at that address so I am sending you this WRITTEN WARNING as is called for by the sign code and this will be followed by a daily citation and $50 fine. If you wish to avoid this please ask your agents to not display this sign other than on the lot that is for sale. Sincerely, Richard B. Graham Local and Signs Inspector .•a__� bra Printed on Recycled Paper o ,4,-C a P 3dg are J' 9�.f MAY-31-2000 11:33 j{IN LIN �����C (IRMT R 1 4&RpatRcrate 15099454343 P.01 856 Main Street, Chatham; Mai 92633 • (608) 945 Fax (508) 845 e1z ,_. 856 Main Street 6 Chatham, tilKV633- . Phone: 508-9454856 Fax: 508-945-1872 1j . Fro RY Feightner To: � `� i m:1-a Data: f fit Phone 8. 1 Pages: s CC:._ Re: ❑ Urgent 0 For Review' L�IPlesso Comment ;` ❑ Pleese.RePh/ •Comments: - Sincerely, LARRY FEIGKTNER?17 Cell phone 237-1331 • _ r7 1- ® NILS MAY-31-2000 11:33.2... _. _ 15089454343 P.02 Y • _ -- ..y. `(` •. may` ` J uYr � 7 ��..`[ �F�{` JJ 1-1 S-• 1 sect e G 1 a 15 I, THEODORE S. ROGERS a]k/ayTHEODORE SENN ROGERS, of P.O. Box 472, South Yarmouth, MassachusettA 02664 for consideration of '$415,000.00 grant to Donald J. Gauch 2nd Gail A. Gauclt, slaw of a Kalamat Farm Circle,:. Sh-ewsbury, , MA. 01545, husbimd`'.and wife as tenants by the entirety c with QUITCLA-Nq COVENANTS, the land situated' in Yarmouth (South), Barnstable County; Massachusetts, more..particularly bounded and described,:as'follows: a y Beginnin aC a concrete bound ac the SOUTiTWESTERLY corner of land g- x } now or formerly of Arnold T. Melbye et,;ux�,.,ehence.running pNORTHEASTERLY by land of said Melbye 100;96-feet to land of s s Laurence Rogers; thence turning and•running SOUTHEASTERLY by said ,00i� land of Laurence Rogers 328.20 feet to Bass River; thence turning and running SOUTHWESTERaY-,�by.Bass River about 106.00 feet to IN o other'land,.of Dwight Rogere;,,thenoe turning .and. running v U3 NORTHWESTERLY by other land of Dwight Rogers,,about 314.36 feet to the point or place -'of beginning. N :"' •; The above described premises are shoWn.on a plan entitled "Plan 'w of Land•in South Yarmouth, Massachusetts as surveyed for Dwight i0 Rogers"=made by Crowell•& Taylor Corp.; Yarmouthport, Massachusetts, dated May 1972, recorded with Barnstable County a Registry of.Deeds in Plan Book 2HO,.Page L16. W The above deacribed-premises are conveyed subject to and with the benefit,-of7the right -described in=a deed•from Dwight Rogers to mma S.,= and'•others dated June,4;-1973=and recorded in Book ;r(� 1998, Page`282: For title,`. -Bee deeds reco fled at the _Barnstabl4--county Registry of Deeds Book Book .11970,.•_Page lo7j, Bookc.1998, Page_282 and Book 7913I'�Pige WITNESS•:ay hard and,aeal.'this (I zday_of�November, 1999. J, .T eo ore S. Roge _ I 1 •Gf 1 : •• 1 ti V. Yam- 111 w K. O r �.11 rnAlk �' e3 a- o-7.30.'' R'� X &. W ,, m a x ? CP Y, ' Please type or print clearly &I Inlomation provided on this form a BRP WW 03' mendment to WaterwaysLlcemse orermit:�=.{::.W:.:.. General Waterways Application Municipal Zoning Ceilificate Donald J. Gauch & Theodore Rogers 422A & 426 Highbank Rd. ,South Yarmouth Bass River To provide noncommercial boating access to navigable 0 Vwx waters. To be completed by municipal clerk or appropriate municipal official, I hereby certify that the project described above and more fully detailed In the applicant's waterways license application and plans Is not In violation of IoS4 zoning ordinances and bylaws' A /Ake-rdie e, 4 tk Ditt tree (ntINtUOAe OA pegelielon - Completing seCUonsA-0 of this form BRP ww 01 ` Waterways License or Permit ' ;�a is .� } � 1 ;-.;.-,.•,>•., sti'::rr if:. BRP WW 034mendment to Waterways License or Permit ' General Waterways .Application -Project Information . db 1. Which perMt category are you applying tor? 7. Pro)ecUAct vtly description: al6RPWW01 = BRPWW03 , Construction and maintenance of•a pile supported pie;,. 2. Applicant: ramp and float system. V6nald J. Gau_c_W Theodore Rogers ._ C/o 8 Kalamat Farms Circuit 14,'SVA* Shrewsbury MA•.01545 WOO sat Iptod 508-398-4781 Tr " IVA) & Authorized agent (d any): Robert M. Perry 8. Description of existing andror proposed use(s): • To provide noncommercial boating access,to navigable waters. awe • 50 Leland Rd. A!?w 9• Is this project Brewster MA 02631 XX water -dependent? =non water -dependent? Gtfle . sat zo CO* - 508-896-4861 i. Property Information (all information must be provided): Donald J_-Gauch & Theodore Rogers VoWUaM94* 1offlarr v MAP #92 PARCEL # 7 & 8 - rukeeuakAraOWPrurNumeers 422A & 426 Highbank Rd. lwago lmefsape) South Yarmouth Barnstable c4nown cow S. Name of the water body: Bass.River 6. The water body at the project site Is: (check 1 or mors of both a & b) L x:R Tidal .' = rdled Tidelands M Great Pond = RhrerrStream = Uncertain b.)RNatural =Man -Made 01 Uncertain- 10. What is the approximate total cost of any proposed work (including materials 6 labor)? $ 25,000.00 11. Ust the name and complete mailing address or each abutter (attach additional sheets, fl necessary): Gail A. Gauch 8 Kalamat Farms Ci Shrewsbury MA 01545 Nancy K. Tripp 8 Pattee Rd - Harvard MA 01451 12.1 have attached project plans in accordance with the .instructions contained In...% RAppendbi A (for Pemu(applicatlons) Appendix B (for Ucenss applications) Appendices A-B begin on page 8 of Ws Application Package. Rev, 2JOT ' i Palo 2of 6 n Ailluschusetts Deplidment ofEndirorimental Protection L 070.3 8 Bureau orResouree Protection=Watermys Program NOHOW l J BRP WIN01. • Waterways License or Permit. BRP WW 03 Amendment to Waterways License or Permit General Waterways Application Please tugs or print clrurfp an information provided on this form. Certification 11A applicants, property owners and authorized agents must sign this pigs. An future application correspondence may be signed by the authorized agent alone. . I hereby make application for a permit or license to authorize the activities I have described herein. Upon my signature, I agree to allow the duly authorized representatives . of the Massachusetts Department of Environmental Protection and the Massachusetts Coastal Zone Management Program to enter upon the premises of the project site at reasonable times for the purpose of inspection.. . 9 hereby certify that the information submitted In this application Is true and accurate to the best of my knowledge' Waterways Dredging Addendum 1. Provide a description of the dredging project. 2. What is the purpose of the dredging? 3. What is the Volume (cubic yards) of materw to be dredged? 4. What method will be used to dredge? , MpikenrYetpnrnn 'SEERGFiYTFd✓1H1 R7TjrGYF.� Dare ploper y OMI SOWIre Ol dinena /un appii<'eerl S. Describe the disposal method that will be used and give the disposal location (include a separate disposal site location mar AGENT AUTHORIZATION To Whom it'May Concern, As owner of 422A Highbank Rd. South Yarmouth, MA, I hereby designate Robert M. Perry, P.E. as my agent for purposes of preparing, filing and receiving documents on my behalf in connection with the design and permitting of the proposed pier ramp and float system for the site. / Zooms Owner Signature Date Print Name AGENT AUTHORIZATION r To Whom it May Concern, As owner of 426A Highbank Rd. South Yarmouth, MA, I hereby designate Robert M. Perry, P.E. as my agent for purposes of preparing, filing and receiving documents on my behalf in connection with the design and permitting of the proposed pier ramp and float system for the site. �A'&64at " Owner Signature Print Name M 6 .,.y,. /` ,. ,. .• r .. -- ;"'1'�s l";t...�. .r. r ....-. '.._ .- - ..,.__tom.•_, .; -... _ . ..... .._._.�.. MtSSschtfSdKt Department 01 iEaHnpamtmh/Prott►etlM EP File Number Bureau of Resource Protection-: Wetlands WPA Form 5 = Order of Conditions lorDEPuseony Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 ` Applicant Information Frdm YARMOUTH caruer4101 commaw For. SE 83-1499 PmiaaFikNanaer T4; Donald J. Gauch .,Theodore Rogers- kpWAfir r 8 Kalamat Farms Circuit hVpAirg.. N?krewsAomw bury, MA 01545 ttVow 01545 san rowan The project site Is located at South Yarmouth VTO 8 & 7 Aattstara►* t/ Pa "a/ and the property is recorded at the Registry of Deeds for. The Notice of Intent for this project was Ned on: January 7, 2000 our - The public hearing was closed on:. January 20, 2000 On Title and Date of final Plans and Other Documents: Hydrograghic plan of land in So. Yarmouth showing proposed : pier,ramp & pile anchored float: 1-20-2000 - Robert M. Perry,P.f Barnstable Lot 7-1086; Lot 8-7913 CW* Tot 7- Aw Lot 8-271 emirantoff"b ok" Findings Findings pursuant to the Massachusetts Wetlands Protection Act Following the review of the above -referenced Notice of Intent and based on the Information provided in this application and presented at the public hearing, this commission finds that the area in which work is proposed is significant to the following Interests of the Wetlands Protection Act (check all that apply): = Public Water Supply Private Water Supply Groundwater Supply Vlood control X Land Containing Shellfish X Fisheries X Storm Damage Prevention XPrevgtttion of Pollution = Protection of Wildlife Habitat Furthermore, this Commission hereby finds that the project, as proposed, Is: (check one of the following boxes) Approved subject to:• the following conditions which are necessary, In accordance with the performance standards set forth in the wetlands regulations, to protect those Interests checked above. This Commission orders that all the work shall be performed in accordance with the Notice of intent referenced above, the following General Conditions, and any other special conditions attached to this Order. To the extent that the following conditions modify or differ from the plans, specifications, or other proposals submitted with the Notice of Indent, these conditions shag control. Rev. Intl Page 1 of 5 1 Msmchdiv tsDeparfineotofEnrfronmeatalProtectloo Town of Yarmouth Bureau of Resource Protection — Wetlands Wetland By -Law I WPA Form 5 - Order of Conditions Chapter143 Massachusetts Wetlands Protection Act M.G.L. c.131, §40 U Findings (cont.) Denied because: 0 the proposed work cannot be conditioned to meet the performance standards set forth In the wetlands regulations to protect those Interests checked above. Therefore, work on this project may not go forward unless and until a new Notice of Intent is submitted which provides measures which are adequate to protect these Interests, and a final Order of Conditions Is Issued. E3 the Information submitted by the applicant is not sufficlent to describe the site, the work, or the effect of the work on the Interests Identified in the Wetlands Protection Act. Therefore, work on this project may not go forward unless and until a revised Notice of Intent is submitted which provides sufficient Information and Includes measures which are adequate to protect the Acts Interests, and a final Order of Conditions is Issued. A description of the specific information which Is tacking and why It Is necessary is attached to this Order as per 310 CMR 1O.O5(b)(c). General Conditions 1. Failure to comply with all conditions stated herein, and with all related statutes and other regulatory measures, shall be deemed cause to revoke or modify this Order. 2. The Order does not grant any property rights or any exclusive privileges; It does not authorize any injury to private property or invasion of private rights. 3. This Order does not relieve the permittee or any other person of the necessity of complying with all other applicable federal, state, or local statutes, ordinances, bylaws, or regulations. 4. The work authorized hereunder shall be completed within three years from the date of this Order unless either of the following apply: (a) the work is a maintenance dredging project as provided for in the Act or (b) the time for completion has been extended to a specified date more than three years, but less than five Years. from the date of issuance. If this Order is intended to be valid for more than three years• the extention date and the special circumstances warranting the extended time period are set forth as a special condition in this Order. S. This Order may be extended by the Issuing authority for one or more periods of up to three years each upon application to the Issuing authority at least 30 days prior to the expiration date of the Order. 6. Any fill used in connection with this project shall be clean fill. Any fig shall contain no trash, refuse, rubbish, or debris, Including but not limited to lumber, bricks, piaster, wire, lath, paper, cardboard, pipe, tires, ashes, refrigerators, motor vehicles, or parts of any of the foregoing. 7. This Order does not become final until all administrative appeal periods from this Order have elapsed, or If such an appeal has been taken, until all proceedings before the Department have been completed. 8. No work shall be undertaken until the Order has become final and then has been recorded In the Registry of Deeds or the Land Court for the district in which the land is located, within the chain of title of the affected property. In the case of recorded land, the Final Order shall also be noted in the Registry's Grantor Index under the name of the owner of the land upon which the proposed work Is to be done. In the case of registered land, the Final Order shall also be noted on the Land Court Certificate of Title of the owner of the land upon which the proposed work is done. The recording Information shalt be submitted to this Conservation Commission on the form at the end of this Order, which form must be stamped by the Registry of Deeds, prior to the commencement of the work 9. A sign shall be displayed at the site not less than two square feet or more than three square feet in size bearing the words, 'Massachusetts.Departmenf of Environmental Protection' [or. OMA DEP']'File Number SE 83-1499 ftedFdoMa ba 1O.Where the Department of Environmental Protection Is requested to issue a Superseding Order, the Conservation Commission shall be a parry to all agency proceedings and hearings before the Departmerit. 11.Upon completion of the work described herein, the applicant shall submira inquest for Certificate of Compliance (WPA Form 8A) to the Conservation Commission. 12.The work shall conform to the following attached plans and special conditions: Final Approved Plans (attach additional plan references as needed): Hydrograghic Plan of Land Me 1-20-00 robert M. Perryr P.E. s'peduMsrvnyedey Con Corn Rev.10MB ehfile with Page 2 of 5 11 DEP Massacbasetls Depaflbrfent of Entrlrowaabl ProbcNon Bureau of Resource Protection — Wetlands WPA Form 5 w Order of Conditions Massachusetts Wetlands Protection Act M.G.L. c.131, §40 U Findings (cont.) 13. Any changes to the plans Identified in Condition 112 above shall require the applicant to Inquire of the Conservation Commission in writing whether the change Is significant enough to require the fling of a new Notice of Intent. r 14. The Agent or members of the Conservation Commission and Department of Environmental Protection shall have the right to enter and Inspect the area subject to this Order at reasonable hours to evaluate compliance with the condi- tions stated in this Order; and may require the submittal of any data deemed necessary by the Conservation Commis- sion or Department for that evaluation. 15. This Order of Conditions shall apply to any successor in Interest or successor in control of the property subject to this Order and to any contractor or other person perform- Ing work conditioned by this Order. 16. Prior to the start of work, and if the project Involves work adjacent to a Bordering Vegetated Welland, the boundary of the wetland in the vicinity of the proposed work area shall be marked by wooden stakes or flagging. Once in place, the wetland boundary markers shall serve as the limit of work (unless another limit of work line has been noted In the plans of record) and be maintained until a Certificate of Compliance has been issued by the Conservation Commis- sion. 17. All sedimentation barriers shall be maintained in good repair until all disturbed areas have been fully stabilized with vegetation or other means. At no time shag sediments be deposited In a wetland or water body. During construc- tion, the applicant or hislher designee shall Inspect the erosion controls on a daily basis and shall remove accumulated sediments as needed. The applicant shall immediately control any erosion problems that occur at the site and shall also Immediately notify the Conservation Commission, which reserves the right to require additional erosion and/or damage prevention controls it may deem necessary. Special Conditions (Use additional paper if necessary) SEE ATTACHED SHEET Town of Yarmouth Wetland By-lAw Chapter 143 Findings as to municipal law, bylaw, or ordinance Furthermore, the caruavx hcammWW hereby finds (check one that applies): that the proposed work cannot be conditioned to meet the standards set forth In a municipal law, ordinance, or bylaw, specifically horror cWonOrdwg7kipdkKOw. orwdum Therefore, work on this project may not go forward unless and until a revised Notice of Intent Is submitted which provides measures which are adequate to meet these standards, and a final Order of Conditions Is Issued. that the following additional conditions are necessary to comply with a municipal law, bylaw, or ordinance, specifi- cally AUMRdPUMOfOw UPSIAW.WN.ordrdiwpr. The Commission orders that all the work shall be performed In accordance with the said additional conditions and with the Notice of Intent referenced above. To the Went that the following conditions modify or differ from the plans, specifications, or other proposals submitted with the Notice of Intent, the conditions shall control. Additional conditions relating to municipal law, bylaw, or ordinance: Pry inga SPECIAL CONDITIONS DONALD L GAUCH THEODORE ROGERS SE 83-1499 1. The applicant shall be responsible for having a copy of these "Orders of Conditions" on the job site at all tunes. Failure to do so may result in a revocation of the "Orders", or a fine, or both. 2. The Conservation Commission, its agents or assigns, shall have the express right of entry upon the job site at all reasonable times for the purposes of establishing "compliance' with the conditions stated herein. 3. Upon completion of the project, a "Certificate of Compliance' shall be requested in writing. This "Order of Conditions" shall be considered incomplete until the "Certificate of Compliance" is issued and recorded at the Registry f Deeds. 4. All shellfish in the vicinity of the proposed pilings shall be removed at the applicants expense under the direct supervision of Yarmouth's Natural Resource Department. This removal must take place prior to the construction of the dock. 5. There shall be no dredging in connection with this project. 6. The pilings shall be hammer driven. No other piers shall be constructed on lots 7 or 8 in the future. Routine maintenance and/or reconstruction of the proposed pier may be allowed pursuant to a new Notice of Intent. 8. The applicant shall provide the Conservation Commission a recorded deed easement indicating common use of the proposed pier by present and future owners of lot 7 and lot 8. Such easement shall run with the property title perpetually and shall be provided to the Conservation Commission prior to construction of the pier. DEP Marssatc6uuttsOeparlmento/EnrironmeatslAroEecdou Bureau olResource Protection -Wetlands Town of Yarmouth Wetla WPA Form 5 - Order of Conditions 11,pl r By_)t,Aw Chapter 143 Massachusetts Wetlands Protectlon Act M.G.L: C. 131, §40 Findings (coot.) This Order is valid for three years, unless otherwise specified .as a special condition pursuant to General Conditions 14. from the date of Issuance. January 25, 2000 om This Order must be signed by a majority of the conservation commission. The Order must be mailed by certified mail (return receipt requested) or hand delivered to the applicant. A copy also must be mailed or hand delivered at the same time to the appropriate regional office of the Department of Environmental Protection. Appeals The applicant, the owner, any person aggrieved by this Order, ony owner of land abutting the land subject to this Order, or any ten residents of the city or town in which such land is located, are hereby notified of their right to request the appropriate Department of Environmental Protection Regional Office to Issue a Superseding Order of Conditions. The request must be made by certified mail or hand delivery to the Departrtent, with the appropriate filing fee and a completed Appendix E: Request for Departmental Action Fee Transmittal Form, as provided in 310 CMR 10.03(r) within ten business days from the date of Issuance of this Order. A copy of the request stall at the same time be sent by certified mail or hand delivery to the conservation commission and to the applicant, It he/she Is not the appellant. On this Z 0 4 day.ot 2,00 b • Yer before the personally appeared � t� �Dwt►.f ISSf�t �, to me known to be the person described in and who executed the foregoing instrument and acimowledged that he/she executed the same as hisrtler free act and deed. rbdryt3�efic +trme+Aavavt� This Order is Issued to the applicant as follows: O by hand delivery on oue U by certified matt, return receipt requested, on January 25. 2000 The request 92U state clearly and concisely the objections to the Order which is being appealed and how the Order does not contribute to the protection of the interests identified in the Massachusetts Wetlands Protection Act (M.G.L. C.131. §40 and Is inconsistent with the wetlands reputations (310 CMR 10.00). To the extent that the Order is based on a municipal bylaw, and not on the Massachusetts Wetlands Protection Act or regulations, the Department of Environmental Protection has no Wilflate jurisdiction. Rev. large Page 4 of 5 Massachuseii .Department of fnrlronarental Protection Town of Yarmouth Bureau of Resource Protection — Wetlands Wetland By -Law WPA Form 5 = Order •of Conditions Chapter 143 Massachusetts Wetlands Protection Act M.G.L. C. 13ie §40 U Recording Information This Order of Conditions must be recorded in the Registry of Deeds or the land Court for the district in which the land is located, within the chain of title of the affected property. In the case of recorded land, the Rnal Order shall also be noted in the Registry's Grantor Index under the name of the owner of the land subject to the Order. In thelase of registered land, this Order shall also be noted on the land Court Certificate of Title of the owner of the land subject to the Order of Conditions. The recording Information shall be submitted to the YARMOUTH Caaervariancommiss'on on the form below, which must be stamped by the Registry of Deeds. Detach on dotted line and submit to the Conservation Commission. -----------------------°gt---------- To: YARMOUTH Cavervarlon camniWW Please be advised that the Order of Conditions for the project 422A&.426 Highbank Rd., So.Yarmouth imOaLwluon DipnmAumbw SE 83-1499 has been recorded at the Registry of Deeds of Barnstable count' and has been noted in the chain of title of the affected property In eoox _ Pape In accoldarll withlhe Order of Conditions Issued on ' Dare If recorded land, the Instrument number which Identifies this transaction is k4ft enrA4mba If registered land, the document number which Identifies this transaction is Doar ONunber slyVA eOfApplicant Rev. WSW Page 5 of 5 I 'F.b,, LZC G L 8 c�Auc+-i 1� fl-u .o�Zz P RI'va:R s mmm3 $ A -Fl PLANS ACCOMPANYING PETITION 6P 'DONAL-D GAUCH ANc- T+ieODOQC— 'ROG ERS TO CONSTQUCTAND MGIMT,NNA PI E'1Z, RAMP AND FLOATS IN 1. ICEi2TIFYIWATTHIS PLAN WAS PREPAREDWA 01MANC W171I TWe RULLS AND REGUL XnCNS CF'1Hb RWISTMIS OF DEEDS EFFECTIVE. V1176 AND AS REVISED 714MOUG14 JAN.19456. 2. REF. C4AP41 SEC,Bi-X,GL. I HERESY CLRTIFyTEIAT THt:. PROPERTY UNES SHOWN ON'1111SPLAN AM TL1E LINES DIVIDING EXISTING OWNERSHIPS AND-FWE LINES OF IU6 STRt•CTS AND V1/AYg sgl- p N AM 11305e OF PUS UC OR PRNA.T@ STREETS oR WAYS ALRL+AMY E �15t-{gp/ANDT1-LAT NO KEW UNES TbQ DIVLSION OF DCr-MNG OWNER- C-1-11P OR FOR NEW WAYS ARM -SHOWN. RbStSTEQED LAXPSUMVEYOR 1ZoG�E:Rs NT BAss ur v EQ SOUTH YARMOUTH, MASS. 'BAZS Rl VB'R DGCIC 5710 3 F. FL O&T '5 s M W/AUCHOR PJLJNcgS A LOOPAWW rVOLI t;, 4•J 1' THRtJ- ?. SSTMPs �., i; y ii 'I ii ii j 11 ,II1 PILE iDtPTWN I 1112 Mfl•!.q led I?O� •�LLTJD OF r Yn o m 'IO 60 100 120 140 I40 A -P-R'S OF Ersrzcurn 330 L IE � _J{4 fa4�PAIL(lL�) 1 1 IMF. _. s• ALL H8 STE r-Jor olf� G4LW TYPICAL PIER OETAI L 'ram SCALM- k P= X -GAUCH � �pGE�s �F2 r RAMP AND FLOAT'S rr� Bass -QIVE-2 Sot�Tl-1 1/,q-q��Ir MAss. �AP>: oD ENGINEE2ING INc. 5o L>=LAJ.Jc 'T2oAp =IEeT 2�R Iz :W5!' m N"SS. W� FIELD COPY . BUILDING TOMN of YAM:01zi1 PERMIT s Feb ar if 002 _ DATE PERMIT NO. —02-669 APPLICAq{ L AD RE * n 06033 rg075£323 INO,) (STREET) (CONTR'S LICENSE) NUMBER OF addition PERMITTO O TORY - DWELLING UNITS (TYPE OF IMPROVEMENT) NO. ROPOSED USE) 426A lii hbank Road SY 026 ZONING AT (LOCATION) gi f - DISTRICT R 40 (NO.) (STREET) v I BETWEEN • AND rn . rn (CROSS STREET) (CROSS STREET) m 92/7 LOT SUBDIVISION LOT BLOCK SIZE U m BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION O ` 5B USE GROUP R4 BASEMENT WALLS OR FOUNDATION ,.. (TYPE) O LL REMARKS: ad 1n-1 of4'hd flnnr h doom, hathrumn, stairwell with mat-plem d d - -k nn per plans dated 1/30/02.=, AREA OR VOLUME ESTIMATED COST $ 58,200.00 FEE PERMIT $ 221.00 (CUBIC/SQUARE FEET) ---. OWNER tiartha Henderson ADDRESS 4 Skylar Road, Southborough, YIA 01772 �f�� V INSPECTION RECORD DAM PROGRESS - CORRECTIONS AND REMARKS INSPECTOR NOTE ( ,3 p L- ' zh A �-�- pF'YA�� S' C I MATTACMCCS ONE & TWO FAMILY ONLY - BUILDING PERMIT APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING Town of Yarmouth Building Department 1146 Route 28 - Yarmouth, MA 02664-4492 Tel: (508) 398-2231 x261 • Fax: (508) 398-2365 Office Use /Only GG Permit No/uete1' Q Permit Fee $ / 1Iiecording �sit Rec'd. $ oa��ate I Net Due $ Planning Board Information Plan Type Endorsement Date Date Plan No. Other Assessors Department Information: Map Lot 01d New 1.4 Property Dimensions: Lot Area (sq Frontage(ft) Lot Coverage This Section for Office Use Only Building Permit Number: Date Issued: �1 Signature: �= �' % a Certificate of Occupan is is not required Bung Official Date ' Section 1 - Site Information I Use Group: R-4 Type: 5-B 1.1 Property Address: latc.aog a :or�p 1.2 Zoning Information: 2-4A Zoning District Proposed Use 1.3 Building Setbacks (ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided ao� ad 1.4 Water Supply (M.G.L. c. 40. S 54) Public Private 1.5 Flood Zone Infofrt�ation: ^ Comments: ��� � - Zone: BFE: Section 2 - Property Ownership/Authorized Agent 2.1 Owner of Record: /�1APer7tn- M FEEnIA�fzSi1/1� \ ° aame (print) Mailing Address Signature Telephone 2.2 Authorized Agent: C. ��\TICS?OD'� Name (print) Mailing Address Signature Telephone h'? Section 3 - Construction Services 3.1 Licensed Construction Supervisor: I y' J I J . 7 lfDlr{ Not Applicable ❑ Y License Number $ Address c . Expiration Date 5 p� Sig tur Telephone 3.2 Registered Home Improvement Contractor: Company Name tia.LmocK [\uc�. tCo� s-. I V Not Applicable ❑ Address ^� g (1'7 �qCN S2.. Vrty� Shia 'bA5 i-loges. Signature Telephone License Number Expiration Date p 9- 15-99 1 of 2 OVER Section 4 - Workers' Compensation Insurance c. 152 S 25C 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 ...?C.... No .......... Section 5 • Description of Proposed Work (check all applicable) New Construction ❑ I No. of Bedrooms No. of Bathrooms Existing Bldg. 0 1 Repair(s) ❑ I Alterations ❑ I Addition Accessory Bldg. ❑ Type Demolition Other Specify: Brief Description of Proposed Work: Section 6 - Estimated Construction Costs Item Estimated Cost (Dollars) to be completed by permit applicant 1. Building 2. Electrical 3 3. Plumbing / Gas 11 sp 4. Mechanical (HVAC) 3 5. Fire Protection 6.Total=(1+2+3+4+5) 5f3^cC� 7. Total Square Ft. (new houses & additions) 53a Section 7a - Owner Authorization - To be Completed When Owner's Agent or ContractorADDIIeS for Buildinq Permit Check Below ® Conservation -Commission Filing (if applicable) ❑ Old Kings Highway & Historical Commission approval (if applicable) I, S�)A270NA "KrQ0C-:2C,0t0 , as owner of the subject property hereby authorize )� vL_e`( �m-K.,�aC)ng- to act on / my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date Section 7b - Owner/Authorized AgentDeclaration as Owner/4:u horized g 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. Print name Q\&, _ 1 W a:1lo\ Signature o Owne1 ram Date 9- 15-99 2 of 2 . S,Z f VgR^r�• TOWN OF YARMOUTH BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT. Job Location: t-kaa-� ��w413Acv`+fin' �(�Rt1�l it1 NumberStreet Village M Owner of Property: ` Apn%A �Ufomcc2���`t Construction Supervisor: E `� �1NLt5abG+t O jsFaa Name License No. Phone No. Address: S.?-> L QCOrzk Licensed Designee: (If other than Supervisor) Name 2.15 Responsibility of each license holder: 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. 2.15.2 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 other 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 willfullyviolate subsections 2.15.1, 2.15.2 or 2.15.3 or anyother 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 under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes ❑ No ❑ If you have checked ryes, please indicate the type coverage by checking the appropriate box. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 152 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Si`gn`at urge o—Owner or owner'- A=nt Owner ❑ Agent (� Signature: \_(� Building Official Approval: For Office Use Only Permit No. Date TOWN OF YARMOUTH AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c. 142A requires that the 'reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition or construction of an addition to any pre-existing owner -occupied building containing at least one but not more than four dwelling units or structures which are adjacent to such residence or building' be done by registered contractors, with certain exceptions, along with other requirements. Type of Work: ' a o Stog i 4oz) \7-0,c to Est. Cost Address of Work LAa A ����, �c cn�� �oSn. Owner Name: Mq2-C%,\q `�ctiio S? l� �l 12q f 41 Date of Permit Application: k\ aq(ok I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under $1,000 Building not owner occupied Owner pulling own permit 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 PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. Signed under penalties ofpedury: I hereby apply for a permit as the agent of the owner: wlq(6\ 1���. acc�a � �Cc�—s:. tCA42a Date Contractor Name Registration No. Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name �, The Commonwealth ofMassaehusetts Department of Industrial Accidents exceellolvSMS&ONS 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Applicant information: name: �(C-L%Ey �t ic+,sX�si Location: ti�� (o �1\c 4t�zta2 si cits nhon # .5C8 3t55 S81t O 1 am a homeowner performing all work myself. I am a sole proprietor and hase no one workine in any capacity I am an employer pro%iding workers' compensation for my employees working on this job. company name\1\\c�'2t�n\i �tL�C�IR�CC�\tLY (�(un `-OM1ycT� ACT\011� address: L3C. 654 qlH 3q insur-ince co. policy f! eny"5 taco enaas d FJ I am a sole proprietor. general contractor. or homeowner (circle one) and have hired the contractors listed below who have the following worker:' compensation polices: comoanv name: address: city: nhon k• insurance co. policy q company name: Failure to secure coverage as required under Section 25A of MGL 152 can lad to the imposition of criminal penalties of a One op to S1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a One of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. t do hereby certify under the pains and penalties ojperjury that the information provided above is true and coned Print namePhoneM SOB 3i 2S P>&r67_ oMcial use only do not w rite in this area to be completed by city or town official city or town: YARMOUTII ❑ check if immediate response is required contact person: permit/license 0 riBuilding Department Cl Licensing Board 261 ❑Selectmen's Office phoneM;❑Health Department (508} 398-2231 eat. n0ther 0a,sed 3i95 PJAI Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all emplovers to provide workers' compensation for their employ ees. As quoted from the "la%v", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An etnp/nt•er is defined as an indiN idual, partnership, association, corporation or other legal entity, or any two or more of tite 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. `IGI_ chapter 152 section =5 also states that every state or local licensing 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. Additionalh, 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 ha%e been presented to the contracting_ authority. Applicants Please till in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names. address and phone numbers as all affidavits 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. City or Towns 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. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents office of Invesdistleos 600 Washington Street Boston, Ma. 02111 fax #: (617) 727-7749 phone if: (617) 7274900 ext. 406, 409 or 375 jv TOWN OF YARMOUTH 1146ROUTE28 SOUTHYARMOUTH MASSACHUSETTS02664-4451 Telephone (508) 398-2231, Ext. 261 — Fax (508) 398-2365 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT BUILDING ELECTRICAL GAS PLUMBING SIGNS 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 �lQl, Work Address is to be disposed of at the following location: CA I= `ZES>6LQCC-9 . 2ti`sAbt t q. Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Signature of Applicant Permit No. Date t 1 ` BOARD OF BUILDING REGULATIONS R License: CONSTRUCTION SUPERVISOR Number. CS 075828 s " Birthdate: O5M7/1953 Expires: OW07/2003 Tr. no: 75828 Restricted To: 00 KELLEY C PHILBROOK 38 WRIG14TS LANE GLASTONBURY, CT 06033 Administrator �/ee �xmon«ea`bi a�./�aaac%ueQ2 BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number. CS 006083 i Birthd8te:01/14/1951 Q ExPiros: 01/1412002 Tr, no: 15350 it } ResWeted To: 00 THOMAS V PHILBROOK 107 BEACH ST (,,.. ► Div! DENNIS, MA 02638 Administrator HOME IMPROVEMENT CONTRACTOR Registration: 101422 Expiration: 06 /2572002 Type: OBA PHILBROOK ENGR. E CONSTRUC �hilbrook ADMINISTRATOR 7 Beach Street i Dennis MA 02638 " ISSUED BY THE STOCK INSURANCE COMPANY HEREIN CALLED THE COMPANY COMPANYGRAN,rrE7--S1TATE -INSURANCE AGENT NUMBER WAr"Jaellis POLICY NUMBER WIC 854-44-39 r I PENNSYLVANIA T 1/ADAl11M DLII1 DDnnl/ c U[1 IV null nnnnv SEND CORRESPONDENCE TO: AMERICAN INTERNATIONAL CO. P.O. BOX 409 PARSIPPANY, N] 07054-0409 PHONE: 1-800-645.2259 013-66-0301-02 107 BEACH STREET • ' • ..__.. '01M Member Companies of DENNIS, MA 02638-0000 American International Group EXECUTIVE OFFICES: 70 PINE STREET, NEW YORK, N.Y. 10270 SEE NAME AND ADDRESS SCHEDULE - WC990610 I.D# MA I : aa' ..- M K.LOVELETTE INS AGCY INC _ WORKERS COMPENSATION AND EMPLOYERS 396 MAIN STREET LIABILITY POLICY INFORMATION PAGE WEST YARMOUTH, MA 02673-0000 INSURED IS PREVIOUS POLICY NUMBER PARTNERSHIP RENEWAL 001254700 OTHER WORKPLACES NOT SHOWN ABOVE:SEE NAME AND ADDRESS SCHEDULE - WC990610 ITEM 2 POLICY PERIOD 12:01 A.M. standard time at the Insured's mailing address I FROM 03/01 /01 TO 03/01 /02 ITEM 3 A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to the work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 100', 000 each accident Bodily Injury by Disease $ 500.000 policy limit Bodily Injury by Disease $ 100,000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: SEE ENDORSEMENT - WC200306A ITEM 4 The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Estimated Total Rate Per Estimated Classifications Code Number Remuneration Annual ❑ 3 Year $100 OF Re- muneration Premium 0 Annual ❑ 3 Year SEE EXTENSION OF INFORMATION PAGE - WC7754 TAXES/ASSESSMENTS/SURCHARGES $105 EXPENSE CONSTANT (EXCEPT WHERE APPLICABLE BY STATE) $ 2 1 4 MA MINIMUM PNGMIUM ) 17UU MA TOTAL ESTIMATED PREMIUM 52,639 If indicated below, Interim adjustments of premium shall be made: Semi -Annually Quarterly Monthly DEPOSIT PREMIUM ' ENDORSEMENTS (FORM NUMBER) SEE ATTACHED FORM SCHEDULE - WC990612 03/12/01 ASSIGNED RISK m Issue Date 39967 Issuing Office Authorized Representative WC 00 00 01 INSURED'S COPY HAMLYN CONSULTING A- 690 Thousand Oaks Drive, Brewster, MA 02631 - Phone & Fax: (508) 394-5803 September 26, 2001 0 Yarmouth Conservation Commission Town Hall 1146 Route 28 South Yarmouth, MA 02664 RE: John Henderson, 426A Highbank Road, (South) Yarmouth, MA Wetlands File No. SE 83-1566 Enclosed please find the receipt for the recording of the Order of Conditions relative to the above referenced matter and recorded at the Barnstable County Registry of Deeds. Yours truly, Melissa Freedman, Hamlyn Consulting enc cc: John Henderson T. Vamuth Philb;ook 9 0 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. - I ICI Massachusetts Department of Environmental Protection DEP File Number: Bureau of Resource Protection -Wetlands SE 83-1566 WPA Form 5 - Order of Conditions Provided by DEP Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 A. General Information From: YARMOUTH Conservation Commission This issuance if for (check one): ® Order of Conditions ❑ Amended Order of Conditions To: Applicant: Property Owner (if different from applicant): John Henderson Martha Henderson, Jacqueline Walsh & Name G.Carrivale Four Skylar Road Mailing Address Southborough MA 01772 City/town State Zip Code 1. Project Location: ,. .. 426A Highbank Road Street Address 92 Four Skylar Road Mailing Address Southborough MA 01772 Cityrrown State Zip Code South Yarmouth Cttyrrown 7 Assessors Map/Plat Number ParceV4ot Number 2. Property recorded at the Registry of Deeds for. Barnstable vk i 13074 221 County - Book Page Certificate (if registered land) 3. Dates: 8-21-01 9-06-01 9-18-01 Date Notice of Intent Filed Date Public Hearing Closed Date of Issuance 4. Final Approved Plans and Other Documents (attach additional plan references as needed): Site Plan 416A Highbank Road,'South Yarmouth, MA 8-01-01 Title Date 5. Final Plans and Documents Signed and Stamped by: Arne H. Ojala_, P E , P 1' S. Name 6. Total Fee: $220.00 (from Appendix B: Wetland Fee Transmittal Form) WPA Fonn 5 Page 1 of 7 R. rmmn Massachusetts Department of Envir nmental Protection DEP File Number: Bureau of Resource Protection -Wetlands SE 83-1566 WPA Form 5 — Order of Conditions Provided by DEP Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Findings Findings pursuant to the Massachusetts Wetlands Protection Act: Following the review of the above -referenced Notice of Intent and based on the information provided in this application and presented at the public hearing, this Commission finds that the areas in which work is proposed is significant to the following interests of the Wetlands Protection Act. Check all that apply: ❑ Public Water Supply ❑ Private Water Supply ❑ Groundwater Supply ❑ Land Containing Shellfish ❑ Fisheries iq Storm Damage Prevention ❑ Prevention of Pollution ❑ Protection of Wildlife Habitat X Flood Control Furthermore, this Commission hereby finds the project, as proposed, is: (check one of the following boxes) Approved subject to: ® the following conditions which are necessary, in accordance with the performance standards set forth in the wetlands regulations, to protect those interests checked above. This Commission orders that all work shall be performed in accordance with the Notice of Intent referenced above, the following General Conditions, and any other special conditions attached to this Order. To the extent that the following conditions modify or differ from the plans, specifications, or other proposals submitted with the Notice of Intent, these conditions shall control. Denied because: 1, ❑ the proposed work cannot be conditioned to meet the performance standards set forth in the wetland regulations to protect those interests checked above. Therefore, work on this project may not go forward unless and until a new Notice of Intent is submitted which provides measures which are adequate to protect these interests, and a final Order of Conditions is issued. ❑ the information submitted by the applicant is not sufficient to describe the site, the work, or the effect of the work on the interests identified in the Wetlands Protection Act. Therefore, work on this project may not go forward unless and until a revised Notice of Intent is submitted which provides sufficient information and includes measures which are adequate to protect the Act's interests, and a final Order of Conditions is issued. A description of the specific information which is lacking and why it is necessary is attached to this Order as per 310 CMR 10.05(6)(c). General Conditions (only applicable to approved projects)..; 1. Failure to comply with alf conditions stated herein, and with all related statutes and other regulatory measures, shall be deemed cause to revoke or modify this Order. 2. The Order does not grant any property rights or any exclusive privileges; it does not authorize any injury to private property or invasion of private rights. 3. This Order does not relieve the permittee or any other person of the necessity of complying with all other applicable federal, state, or local statutes, ordinances, bylaws, or regulations. WPA Form 5 Page 2 of 7 R. mRn DEP File Number: Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands SE 83-156Provd by o P WPA Form 5 - Order of Conditions Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Be Findings (cont.) 4. The work authorized hereunder shall be completed within three years from the date of this Order unless either of the following apply: a. the work is a maintenance dredging project as provided for in the Act; or b. the time for completion has been extended to a specified date more than three years, but less than five years, from the date of issuance. If this Order is intended to be valid for more than three years, the extension date and the special circumstances warranting the extended time period are set forth as a special condition in this Order. 5. This Order may be extended by the issuing authority for one or more periods of up to three years each upon application to the issuing authority at least 30 days prior to the expiration date of the Order. 6. Any fill used in connection with this project shall be clean fill. Any fill shall contain no trash, refuse, rubbish, or debris, including but not limited to lumber, bricks, plaster, wire, lath, paper, cardboard, pipe, tires, ashes, refrigerators, motor vehicles, or parts of any of the foregoing. 7. This Oyler is not final until all administrative appeal periods from this Order have elapsed, or if such an appeal has been taken, until all proceedings before the Department have been completed. 8. No work shall be undertaken until the Order has become final and then has been recorded in the Registry of Deeds or the Land Court for the district in which the land is located, within the chain of title of the affected property. In the case of recorded land, the Final Order shall also be noted in the Registry's Grantor Index under the name of the owner of the land upon which the proposed work is to be done. In the case of the registered land, the Final Order shall also be noted on the Land Court Certificate of Title of the owner of the land upon which the proposed work is done. The recording information shall be submitted to this Conservation Commission on the form at the end of this Order, which form must be stamped by the Registry of Deeds, prior to the commencement of work. , 9. A sign shall be displayed at the site not less then two square feet or more than three square feet in ` size bearing the words, "Massachusetts Department of Environmental Protection" [or, "MA DEP"] 'File Number SE 83-155u 10 Conservation commission shall be a party to all agency proceed ngs .and hearings before the DEP. 11. upon completion of the work described herein, the applicant shall submit a Request for Certificate of Compliance (WPA Form 8A) to the Conservation Corrrission. 12. The work shall conform to the plans and special conditions referenced in this order. 13. Any change to the plans identified in Condition #12 above shall require the applicant to inquire of the Conservation Commission in writing whether the change is significant enough to require the filing of a new Notice of Intent. 14. The Agent or members of the Conservation Commission and the Department of Environmental Protection shall have the right to enter and inspect the area subject to this Order at reasonable hours to evaluate compliance with the conditions stated in this Order, and may require the submittal of any data deemed necessary by the Conservation Commission or Department for that evaluation. Page 3 of 7 WPA Form 5 Re man Massachusetts Department of Environmental Protection DEP File Number: UVBureau of Resource Protection -Wetlands SE 63-1566 WPA Form 5 - Order of Conditions Provided by DEP Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Findings (cont.) 15. This Order of Conditions shall apply to any successor in interest or successor in control of the property subject to this Order and to any contractor or other person performing work conditioned by this Order. 16. Prior to the start of work, and if the project involves work adjacent to a Bordering Vegetated Wetland, the boundary of the wetland in the vicinity of the proposed work area shall be marked by wooden stakes or flagging. Once in place, the wetland boundary markers shall be maintained until a Certificate of Compliance has been issued by the Conservation Commission. 17. All sedimentation barriers shall be maintained in good repair until all disturbed areas have been fully stabilized with vegetation or other means. At no time shall sediments be deposited in a wetland or water body. During construction, the applicant or his/her designee shall inspect the erosion controls on a daily basis and shall remove accumulated sediments as needed. The applicant shall immediately control any erosion problems that occur at the site and shall also immediately notify the Conservation Commission, which reserves the right to require additional erosion and/or damage prevention controls it may deem necessary. Sedimentation barriers shall serve as the limit of work unless another limit of work line has been approved by this Order. Special Conditions (use additional paper, if necessary): SEE ATTACHED SHEET �1 Findings as to municipal bylaw or ordinance Furthermore, the\.YARMOUTH hereby finds (check one that applies): Conservation commission ❑ that the, proposed work cannot be conditioned to meet the standards set forth in a municipal ordinance or bylaw specifically: Namur Municipal Ordinance or Bylaw Therefore, work on this project may not go forward unless and until a revised Notice of Intent is submitted which provides measures which are adequate to meet these standards, and a final Order of Conditions is issued. ® that the following additional conditions are necessary to comply with a municipal ordinance or bylaw, specifically: Town of Yarmouth Wetland By -Law Chapter 143 Name Municipal Ordinance or Bylaw The Commission orders that all work shall be performed in accordance with the said additional conditions and with the Notice of Intent referenced above. To the extent that the following conditions modify or differ from the plans, specifications, or other proposals submitted with the Notice of Intent, WPA Fortn5 the conditions shall control. 017 a.,, mmn WPA FORM 5-ORDER OF CONDITIONS SPECIAL CONDITIONS -PAGE 4A OF 7 SE 83-1566-JOHN HENDERSON 1. The applicant shall be responsible for having a copy of these "Orders of Conditions" on the job site at all times. Failure to do so may result in a revocation of the "Orders", a fine or both. , 2. The Conservation Commission, its agents or assigns, shall have the express right of entry upon the job site at all reasonable times for the purposes of establishing "compliance" with the conditions stated herein. 3. Upon completion of the project, a "Certificate of Compliance" shall be requested in writing. This "Order of Conditions" shall be considered incomplete until the "Certificate of Compliance" is issued and recorded at the Registry of Deeds. 4. Gutters and downspouts directed into drywells shall be installed to provide for roof runoff. 5. All cut off ends and debris shall be cleaned up at the end of each day and not be allowed to enter the waterway. 6. A haybale dike shall be staked in place as shown on the plan, prior to any work on the project. The Conservation Administrator may allow the substitution of a siltation fence in an appropriate case. 7. This dike shall,constitute a "work limit line". No work of any kind shall be permitted on the wetland side; f this line. - 1 • 8. The deck shall not be closed in without a future filing with the Conservation Commission. • .C.\ Massachusetts Department of Environmental Protection DE ...Fli a Number: AI Bureau of Resource Protection - Wetlands WPA Form 5 - Order of Conditions ProvidedbyD p� Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. findings (cont.) Additional conditions relating to municipal ordinance or bylaw: This Order is valid for three years, unless otherwise specified as a special condition pursuant to General Conditions #4, from the date of issuance. This Order must be signed by a majority of the Conservation Commission. The Order must be mailed by certified mail (return receipt requested) or hand delivered to the applicant. A copy also must be mailed or hand delivered at the same time to the appropriate Department of Environmental Protection Regional Office (see Appendix A) and the p%pear owner (if different from applicant). 1 1 'ate lin Of ;Lac 1 Day. ( Month amend Year t I. before me personally appeared �r �Tle �I-W4tsSa-� to me known to be the person described in and who executed the foregoing instrument and acknowledged that he/she executed the same as h' /her free act and deed. Notary Public o My commission Expires This Order is issued to the applicant as follows: ❑ by hand delivery on © by certified mail, r'tum receipt requested, on 9-18-01 Date Date ti WPA Fom 5 P. nrtn Page 5 of 7 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 5 - Order of Conditions Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 D. Recording Information (cont.) DEP File Number: SE 83-1566 Provided by DEP Detach on dotted line, have stamped by the Registry of Deeds and submit to the Conservation Commission. • -------------------------------------------------------------------------------------------------------------------------- To: YARMOUTH Conservation Commission Please be advised that the Order of Conditions for the Project at: 426A Highbank Road South Yarmouth SE 83-1566 Project Location DEP File Number Has been recorded at the Registry of Deeds of: for. BARNSTABLE County Book Page Martha M. Henderson Jacqueline Walsh and Guiseppe Camivale Property Owner and has been noted in the chain of title of the affected property in: Book. , Page Bk 14264 • Pg208 #t•70555 i 09-25-2001 @ 12:56p In accordance with1he Order of Conditions issued on: Date If recorded land, the instrument number identifying this transaction is: Instrument Number If registered land, the document number identifying this transaction is: Document Number ant 7 WPA Forth 5 Page 7 of 7 R. roan ` S Book: 14264 Page: 208 Inst#: 70559 Ctl#: 1091 Rec:9-25-2081 @ 12::i6:3Op YARN 426A HI6HPANK ROAD ------------ -------- —------ DOC DESCRIPTION TRANS ANT ------------------------ ---------- 1 YARMOUTH TOWN -OF ORDER 10.00 rec fee- 12.80 Surcharge CPA $2O.00 20.00 Total fees: 32.00 0 3 Property Location: 426A HIGIIBANK RD 1 ision ID: 12793 MAP ID: 92/ 7/ l l Other ID: 81/ F001/ / / Blde #: 1 Card 1 of 1 Print not,- 17/07/20(Il 11-76 CURRENT OWNER TOPO. UTILITIES ISTRTIROAD I LOCATION CURRENT ASSESSMENT ENDERSON, MARTIiA DI SKYLAR DR UELINE & CARNIVALE, GUISEPPERES OUTHBOROUGH, MA 01772 Additional Owners: Description Code Appraised Value Assessed Value $IS YARMOUTH, MA LAND ESIDNTL 1013 1013 403,200 129,800 403,200 129,800 SUPPLEMENTAL DATA Account# 1311400 Subdivision 241 Photo Ward Precinct GISID: - VISION Tot,! 533,000 533,000 RECORD OF OWNERSHIP BK-VOL/PAGE SALE DATE /u v/i SALE PRICE VC, PREVIOUS ASSESSMENTS HISTORY ENDERSON, MARTHA M OGERS, THEODORE S OGERS LAURENCE T 13074/ 221 11970/ 109 06/15/2000 01/06/1999 Q U I I 750,000 99 00 1F 0 Yr. Code Assessed Value Yr. Code Assessed Value Yr. Code Assessed Value 2001 2001 1013 1013 403,200 2000 126,800 2000 1013 1013 191,000 99,200 Total. 530,000 Total: 290,200 Total: 306,800 EXEMPTIONS OTHER ASSESSMENTS This signature acknowledges a visit by a Data Collector or Assessor Year TypelDescription Amount Code Description Number Amount Comm.Int. APPRAISED VALUE SUMMARY Appraised Bldg. Value (Card) Appraised XF (B) Value (Bldg) Appraised OB (L) Value (Bldg) Appraised Land Value (Bldg) Special Land Value Total Appraised Card Value Total Appraised Parcel Value Valuation Method: 125,800 4,000 0 403,200 533,000 533,000 Cost/Market Valuation Total: NOTES HUGE FPL W/20VENS 0241 et Total Appraised Parcel Value 533,000 BUILDING PERMIT RECORD VISIT/CHANGE HISTORY Permit ID O1-420 805 Issue Date 12/15/00 10/28/96 Type RS RS Desch - -Lion Residential Residential Amount 24,000 10,000 Insp. Date 5/22/01 3/3/97 % comp. 100 100 Date Comp. 1/1/01 FINISH l/l/97 2 Comments BASEMENT FPL,WIN Date 5/22/01 9/20/95 ID KF RD Cd. 00 00 Purpose/Result easur+Listed easur+Listed LAND LINE I'AL UATION SECTION B# 1 I Use Code I 1013 Description SFR WATER Zone D Frontn a I Depth Units 33,105.60 SF Unit Price 1.46 I. Factor 1.93 S.I. I 7 C. Factor 3.60 Nbad. 0076 Ad'. 1.20 Notes- Ad/Special Pricing 0OX90%ACCESS Ad'. Unit Price 12.18 Land Value 403,200 Total Card Land Unitsl 33,106.001 SF Parcel Total Land Area: 33,106 SF Total Land Valu 403,200 Property Location: 426A HIGHBANK RD MAP ID: 92/ 7/ l / / ision ID: 12793 Other ID: 81/ F001/ / / #: 1 Card 1 of 1 Print Date: 12/07/2001 11 verage +20 Stories Exterior Wall 1 11 lapboard 46 Common Wall 2 Nall Height Roof Structure 03 able/Hip Roof Cover 03 sphtF Gls/Cmp CONDO/MOBILE HOME DATA Interior Wall 1 2 Interior Floor 1 2 04 06 Plywood Panel Inlaid Slut Gds lement Code Oescription Factor omplex loorAdj Unit Location eating Fuel eating Type C Type 2 5 1 Oil Hot Water None umber of Units umber of Levels % Ownership edrooms 2 2 Bedrooms COST/MARKET VALUATION athrooms 1 3 Bathrooms nadj. Base Rate Size Adj. Factor 60.00 0.97384 otal Rooms S 6 Rooms Bath Type D2 iodern Grade (Q)Index 1.17 Kitchen Style 02 iodern dj. Base Rate Bldg. Value New Year Built 6836 157,296 1976 ff. Year Built 1980 rml Physcl Dep uncnl on Obslncslnc pecl. Cond. Code Specl Cord % verall % Cord. 20 0 0 80 MIXED USE 1013 SFR WATER 100 eprec. Bldg Value 125,800 OB-OUTBUILDING & YARD ITEMS(L) /XF-BUILDING EXTRA FEATURES(B) Code Description UB Units Unit Price Yr. Dp Rt %Cnd Apr. Value FPL3 2 STORY CHIM B 1 2,800.00 1980 1 100 2,200 FPLI FIREPLACE I ST B 1 2,200.00 1980 1 100 1,800 EOS Fact Outs Shwr B 1 0.00 2000 1 100 0 BUILDING SUB -AREA SUAIMARYSECTION Code Description Livin Area Gross Arn05, Unit Cost Unde rec. Value BAS First Floor 1,495 1, 6836 102,198 FBM Basement, Finished 0 30.85 6,016 FOP Porch, Open, Finished 0 13.67 1,436 FUS Upper Story, Finished 495 6836 33,838 PTO Patio 0 3.45 1,299 UBM Basement, Unfinished 0 13.66 11,758 WDK Deck. Wood 0 7.16 752 QUOTE Store 2681 NORWOOD 1415 BSTN PROVIDENCE HWY NORWOOD, MA 02062 Phone: (781) 762-9270 ` Salesperson: MWREW � Reviewer: MWJWB Dr Phone TZIDES KIMON (617) 327.2327 rNameHome 48 BEECH ST Work PhoneCompany Name OSLINDALE Job Description ADDITITON MATERIALS MA zip 02131 County SUFFOLK Page 1 of 2 NO. 781 08 ----------------------- --, QUOTE 12001.1130 16:57 IPrices Valid Thru: 1210112001 L---------------------- m�9tuosequantities of ranoocstmerMERCHANDISE AND SERVICE SUMMARYMae HOMEDEPOT DELIVERY #1 REF#V17 STOCK MERCHANDISE TO BE DELIVERED: I I I I I I I I I I I I I I I - I I ./ R01 438-135 1.00 EA LOWE/FULL SCRN 2/4X3/2 4 9/16 PRIME /LOW E GLASS THERMAL PANE. RO 30-1/4X41-1/4 Y $112.00 $112.00 v R02 388-615 6.00 EA 4/OX4/0 2400 WHT LOWE W/1/2 SCRN /R.O. 48-1/2"X48-1/2" THERMAL j GLASS WITH LOW E Y $112.00 $672.00 J R03 826-488 1.00 EA 36 LH IRIS BRASS 22X36 IS BM /R.O. 38-1/4"X82" STEEL INSULATED DOOR Y $249.00 $249.00 R04 254-176 1.00 EAl 5500 6/OX6/8 LOWE CLR OPR PNL W/SCRN/160.00 + 140.00 + 65.00 = 365.00 Y $160.00 $160.00 J R05 254-472 1.00 EA 5500 6/OX6/8 LOWE CLR STAT PNL / Y $140.00 $140.00 R06 230-713 1.00 EA 5500 KDDR 6FT WHT FRM HARDWARE / Y $65.00 $65.00 R07 343-943 40.00 EA R-19 151N KRAFT ROLLS 48.96 SOFT / //y Su joa7 Y $16.98 $679.20 J R08 267-954 2.00 EA VENT GABLE MOUNT PRO -ONE 1280 CFM / Y $35.87 $71.74 J R09 293-870 3.00 EA AC ALARM CONTROL SMOKE ALARM / Y $10.97 $32.91 R10 439-614 32.00 EA 1 23/32 4X8 CDX RATED SHTG DFR /3/4 / Y $16.92 $541.44 386-081 22.00 EA 7/16 4X8 WAFERBOARD/OSB /EXT WALLS Y $6.20 $136.40 JR11 R12 166-081 34.00 EA 19/32 4X8 CDX RATED SHTG SYP/5/8 /EXT ROOF PLY Y $13.93 $473.62 R13 841-262 3.00 EA 3 1/2 X 7FT6LOLLY COLUMN / Y $19.98 $59.94 R14 554-591 EA 4-LOLLY COLUMN CAP/BASE / Y $4.4626 76 .3 rc--5 vy """ CONTINUED ON NEXT PAGE Page 1 of 2 NO. 78108 3 QUOTE - Continued Last Name: KAL.AITZIDES Page 2 of 2 NO. 78108 HOME DEPOT DELIVERY #1 IContinuedl REFNVI7 STOCK MERCHANDISE TO BE DELIVERED: REF SKU C3TY t1M £fESCRIPI IOIf .:.. FAX PRICE EACH EXTENSION R15 258-350 35.00 EA 1/21N 4X8 DRYWALL / Y $4.79 $167.'65 R16 201-625 60.00 EA 2X10X14 K.D. NO. 2 SPRUCE / Y $11.50 $690.00 MERCHANDISE TOTAL: $4,277.66 ............... ...................... ...................................................... .................................................................................... wx% V177 515-663 1 1.00 1 EAJ Curbside Delivery Service Y $50.00 DELIVERY SERVICE SUBTOTAL: $50.00 ............................................................................... ........................................................................... HOM1 iTEPiITINIifb)L1StER;Nt051~T0 :.....................:................:.:.................................. KALAITZIDES, KIMON ADDRESS:148 BEECH ST CITY: ROSLINDALE STATE: MA ZIP: 02131 COUNTY: SOFOLK SALES TAX RATE: 5.00 PHONE: (6171327-2327 $4,327.66 ES' OF ' 1 $4.327.66 SALES TAX $216.38 TOTAL $4,544.04 BALANCE DUE $4,544.04 Page 2 of 2 No. 78108 MAScheck COMPLIANCE REPORT I Massachusetts Energy Code I Permit # MAScheck Software Version 2.01 I I 1 Checked by/Date I CITY: Yarmouth STATE: Massachusetts HDD: 6137 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 12-18-2001 COMPLIANCE: PASSES Required UA - 127 Your Home = 122 Area or Cavity Cont. Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 596 38.0 0.0 18 WALLS: Wood Frame, 16" O.C. 741 15.0 0.0 57 GLAZING: Windows or Doors 128 0.300 38 GLAZING: Skylights 19 0.480 9 HVAC EQUIPMENT: Furnace, 80.0 AFUE ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. Builder/Designer Date �" � 22 '.ram 'LOD'L Philbrook Eng. & Const. 107 Beach Street Dennis, MA 02638 v 3 vZ7 • MASchegk INSPECTION CHECKLIST Massachusetts Energy Code MASchec$ Software Version 2.01 DATE: 12-18-2001 Bldg.I Dept.I Use I CEILINGS: [ ] ) 1. R-38 i Comments/Location I WALLS: [ J ) 1. Wood Frame, 16" O.C., R-15 Comments/Location I 1 WINDOWS AND GLASS DOORS: [ ] I 1. U-value: 0.3 I For windows without labeled U-values, describe features: I # Panes Frame Type Thermal Break? [ 1 Yes [ ] No Comments/Location l SKYLIGHTS: [ ] I 1. U-value: 0.48 I For skylights without labeled U-values, describe features: I # Panes Frame Type Thermal Break? [ ] Yes [ J No I Comments/Location I I HVAC EQUIPMENT: ( ] 1 1. Furnace, 80.0 AFUE or higher I Make and Model Number I I AIR LEAKAGE: [ ] I Joints, penetrations, and all other such openings in the building I envelope that are sources of air leakage must be sealed. When I installed in the building envelope, recessed lighting fixtures I shall meet one of the following requirements: I 1. Type IC rated, manufactured with no penetrations between the I inside of the recessed fixture and ceiling cavity and sealed or I gasketed to prevent air leakage into the unconditioned space. I 2. Type IC rated, in accordance with Standard ASTM E 283, with no I more than 2.0 cfm (0.999 L/s) air movement from the the I conditioned space to the ceiling cavity. The lighting fixture I shall have been tested at 75 PA or 1.57 lbs/ft2 pressure I difference and shall be labeled. I VAPOR RETARDER: [ ] I Required on the warm -in -winter side of all non -vented framed I ceilings, walls, and floors. I I MATERIALS IDENTIFICATION: [ ] I Materials and equipment must be identified so that compliance can I be determined. Manufacturer manuals for all installed heating I and cooling equipment and service water heating equipment must be I provided. Insulation R-values, glazing U-values, and heating equipment efficiency must be clearly marked on the building plans 1 or specifications. I DUCT INSULATION: [ ] I Ducts shall be insulated per Table J4,4.7.1. I I DUCT CONSTRUCTION: [ l I All accessible joints, seams, and connections of supply and return 1 ductwork located outside conditioned space, including stud bays or I joist cavities/spaces used to transport air, shall be sealed 1 using mastic and fibrous backing tape installed according to the 1 manufacturer's installation instructions. Mesh tape may be I omitted where gaps are less than 1/8 inch. Duct tape is not 1 permitted. The HVAC system must provide a means for balancing J air and water systems. i TEMPERATURE CONTROLS: [ ] I Thermostats are required for each separate HVAC system. A manual 1 or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. I I HVAC EQUIPMENT SIZING: [ ] J Rated output capacity of the heating/cooling system is I not greater than 125% of the design load as specified 1 in Sections 780CMR 1310 and J4.4. I [ ] I SWIMMING POOLS: I All heated swimming pools must have an on/off heater switch and ( require a cover unless over 20% of the heating energy is from 1 non-depletable sources. Pool pumps require a time clock. I [ ] I HVAC PIPING INSULATION: I HVAC piping conveying fluids above 120 F or chilled fluids 1 below 55 F must be insulated to the following levels (in.): I PIPE SIZES (in.) I HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4" 1 Low pressure/temp. 201-250 1,0 1.5 1.5 2.0 1 Low temperature 120-200 0.5 1.0 1.0 1.5 1 Steam condensate any 1.0 1.0 1.5 2.0 1 COOLING SYSTEMS: Chilled water or 40-55 0.5 0.5 0.75 1.0 1 refrigerant below 40 1.0 1.0 1.5 1.5 I [ ] I CIRCULATING HOT WATER SYSTEMS: I Insulate circulating hot water pipes to the following levels (in.): I PIPE SIZES (in.) NON -CIRCULATING I CIRCULATING MAINS 6 RUNOUTS 1 HEATED WATER TEMP (F): RUNOUTS 0-l" 1 0-1.25" 1.5-2.0" 2.0+" 1 170-180 0.5 1 1.0 1.5 2.0 1 140-160 0.5 I 0.5 1.0 1.5 100-130 0.5 I 0.5 0.5 1.0 I ----NOTES TO FIELD (Building Department Use Only) V�CQ F Cu n �6m-Ca t3EAN1 W \TH �\�� wt�t�cZ t�tuo sc� 3A2�.\tQ SP\.WG 'a\JcR 'C�p 2KR\ EX'C, t.JAL` - �aEx�C, SHEq'f�1\NC, W�Z� �1ovSE A? 5/fix ZgflwS �Dc.E 3Y'LI � 3E SET 12;P( VMNYoLIE COUIR Es So�NT C3E'fWE�N SEAM AtiJ StOEt-��\.t SGA�Eo W\ �N r'I�Z�NE Ao\kEswE c()UvAAkL%G Cv.�C»R 5WAN vz 5VD ZAP. � s � Window Schedule 426A Highbank Road, South Yarmouth Anderson Windows: C-235 2 units ; one in newbath, one in new media room C-345 1 unit in new bedroom P 4040 1 unit in stairwell Anderson Sliding Door: FWG 120684 1 unit in new bedroom Roto Skylights: RV 2127 1 unit in new bathroom RV 2938 2 units in new bedroom ' BOISE CASCADE - BC CALCTm 2001 DESIGN REPORT - US Tuesday, December 18, 200108:01 Single -11 7/8" BCI 9OXL File Name: Untitled Job Name H 2nd Story Addition Customer _ Address 426a Highbank Road 6a High an Specifier Designer - T. Vamum Philbrook, P.E. City, State, Zip - So. Yarmouth, MA Company: - Philbrook Engineering & Construction Code Reports - ICB04665, NER446 Misc. - Project No: P0035H Main 2nd Floor Joists 640 Ibs LL 240 Ibs DL General Data Version: US Imperial Member Type: - Joist Number of Spans - 1 Left Cantilever - No Right Cantilever - No Slope 0112 OC Spacing 16" Repetitive Yes Construction Type Glued Live Load 40 PSF Dead Load 15 PSF Part Load 0 PSF Duration 100 Disclosure The completeness and accuracy of the input must be verified by anyone who would rely on the output as evidence of suitability for a particular application. The output above is based upon building code -accepted design properties and analysis methods. Installation of Boise Cascade engineered wood products must be in accordance with the current Installation Guide and the applicable building codes. To obtain an Installation Guide or if you have any questions, please call (800)232-0788 before beginning product installation. Total Horizontal Length - 24-00-00 Load Summary ID Description Load Type Ref. Start End Live Dead OCS S Standard Unf.Area Load Left 00-00-00 24-00-00 40 PSF 15 PSF 16' Controls Summary Control Type Value % Allowable Duration Loadcase Span Location Moment 5280ft-lbs 61.7% @ 100% 2 1 -Internal End Reaction 880 Ibs 61.8% @ 100% 2 1 - Right Total Deflection L/331 (0.8T) 72.5% 2 1 Live Deflection U455 (0.632") 79.1 % 2 1 Max Defl. O.87" (Limit 1") 87.0% 2 1 SDan/Deoth 24.3 1 Bearing Supports Name Type BO Beam B1 Beam Dim. (L x W) Value % Allowed Case Material 2-1/2" x 3-1/2" 880lbs 11.2% 2 Versa -Lam 2-112" x 3-1/2" 880 Ibs 11.2% 2 Versa -Lam NOTES: Design meets Code minimum (1-1240) Total load deflection criteria. Design meets Code minimum (L/360) Live bad deflection criteria. Design meets arbitrary (1') Mapmum load deflection criteria. J�A 2 s Zoo2 � 640 Ibs LL 240 Ibs DL Dur. 100 Page 1 of 1 BCI® and Versa -Lam are registered trademarks of Boise Cascade Corp. PWLBRO'OK ENGR & CONST Title: Job # T. Varnum Phllbrook, P.E. Dsgnr. Date: 8:16AM, 18 DEC 01 107 Beach Street Description Dennis, MA 02638 Scope: 1-508-385-8682 raw uo3oo User: KWA60325, Ver 5.1.3, 22Jurn1999, WM32 General Timber Beam Page 1 (c) 1983 99 ENE.IILC Description P00-351-1; HENDERSON Cantilever Deck Beams - Stresses Reduced for Service Level 2 Exterior Use of Parall-am Stocks per Trus-Joist MacMillan General Information Calculations are designed to 1997 NDS and 1997 UBC Requirements Section Name Prllm: 3.5x9.5 Center Span 14.50 ft .....Lu 1.33 ft Beam Width 3.500in Left Cantilever 6.00ft .....Lu / 1.33 ft Beam Depth 9.250 in Ranti ever Lu 0.00 ft Member Type Truss Joist - MacMillan, Parallam 2.0E Bm WL Added to Loads Fb Base Allow 2,090.0 psi Load Dur. Factor 1.000 FvAllow, 175.0 psi Beam End Fb4 Pin -Pin Fc Allow 650.0 psi Wood Density 45.000per E 1,740.0ksi Full Lengh Uniform Loads Center DL 10.00 #/ft LL 25.00 #M Left Cantilever DL 55.00 #fft LL 315.00 #/ft Right Cantilever DL #/ft LL Vft j Summary E Beam Design OK Span=14.50ft, Left Cant-- 6.00ft, Beam Width = 3.500in x Depth = 9.25in, Ends are Pin -Pin Max Stress Ratio 0.789 : 1 Maximum Moment -6.8 k-ft Maximum Shear • 1.5 3.4 k Allowable 8.7 k-ft Allowable 5.7 k Max Positive Moment 0.67 k-ft at 9.011 ft Shear. @ Left 2.25 k Max Negative Moment -1.17 k-ft at 0.000 ft @ Right 0.33 k Max @ Left Support -6.84 k-ft Camber: @ Left 0.186 in Max @ Right Support 0.00 k-ft @ Center 0.034 in Max M allow 8.67 Reactions @ Right 0.000 in fb 1,645.02 psi fv 104.22 psi Left DL 0.62 k Max 3.08 k Fb 2,084.65 psi Fv 175.00 psi Right DL 0.07 k Max 0.25 k Deflections Center Span... Dead Load Total Load Left Cantilever... Dead Load Total Load Deflection 0.023 in -0.047 in Deflection -0.124 in -1.044 in ...Location 4.014 ft 8.356 ft ...LengttUDefl 1,159.5 138.0 ...Length/W 7,679.9 3,688.12 Right Cantilever... Deflection 0.000 in 0.000 in ...Length/Defl 0.0 0.0 Stress Calcs Bending Analysis Ck 23.400 Le 2.739 ft Sxx 49.911 in3 Area 32.375 in2 Cf 1.000 Rb 4.983 Cl 0.997 Max Moment Sm Read Allowable fb @ Center 1.17 k-ft 6.75 in3 2,084.65 psi @ Left Support 6.84 k-ft 39.39 in3 2,084.65 psi @ Right Support 0.00 k-ft 0.00 in3 2,090.00 psi Shear Analysis @ Left Support @ Right Support Design Shear 3.37 k 0.49 k Area Required 19.281 in2 2.794 in2 Fv. Allowable 175.00 psi 175.00 psi Bearing @ Supports Max Left Reaction 3.08 k Bearing Length Req'd 1.354 in Max Right Reaction 0.25 k Bearing Length Req'd 0.108 in Query Values M, V, & D @ Specified Locations Moment Shear Deflection @ Center Span Location = 0.00 ft -6.84 k-ft 0.80 k 0.0000 in @ Right Cant Location = 0.00 ft 0.00 k-ft 0.00 k 0.0000 in @ Left Cant Location = 0.00 ft -6.84 k-ft 0.80 k 0.0000 in TOWN OF YARMOUTH BUILDING DEPARTMENT FILE COVY 1146 Route 28, South Yarmouth, MA 02664 Telephone 508-398-2231 ext. 260 Fax 508-398-0836 January 2, 2002 Kelley C. Philbrook 38 Wrights Lane Glastonbury, Ct. 06033 RE: 426 A HIGHBANK ROAD Dear Mr. Philbrook: I am in receipt of your building permit application received November 29, 2001, on which you propose to perform the following work: "Addition/add 2"d floor bedroom, bathroom, stairwell with new deck from 2"d floor to existing home" Having reviewed said application and associated documents I have determined that a building permit cannot be issued at this time due to the following reasons: 1. Building Code, Chapter 1, Section 110.7, Construction documents. The following documents were not included with application. • Energy Print out. • Para Lam Printouts — Exterior exposure for deck. • Print out or Certification for all manufactured lumber and joists. • How will cantilevered deck be flashed to basement to prevent water infiltration? • Provide complete floor plans for smoke detector location. Additional bedroom triggers full compliance. 2. Section 3107, Flood Zone was not identified on site plan. Therefore, you are required to contact this office before proceeding with said work pursuant to 780CMR Chapter 1, Section 110 of the State Building Code. Finally, your application package will again be reviewed upon resolution of the foregoing. Very truly yours, V e��,I J14 -D. )�randohni, C. B. O. Building Commissioner JDB/is kdenialbldgcode CERTIFIED MAIL 7001 1140 0002 9388 7045 I[S ROUTE TO Li�yyL^ 1"t_ � (W i us i tMiNly let. rrFyltSfL 1KI73fFj t%%ZPJEf�1' CO Postage $ CO M Certified Fee Er Postmark Retum Receipt Fee Here f1J (Endorsement Required) 0 C3 Restricted Delivery Fee p (Endorsement Required) M Total Postage & Fees ' S r-ISent To q r_ h ba n ... ..._........ —• -- � ••..._.______ Street, Apt. No.; 0 or PO Box No. City, State, ZIP+ 4 � Certified L1211 Provides: Y A malling receipt Y A unique Identifier for your mailplece o A signature upon delivery ra A record of delivery kept by the Postal Service for two years hyWrtairrf Reminders: o CCertlfred Mall may ONLY be combined with First -Class Mail or Priority Mail. C Certified Mall Is not available for any class of Intematlonal mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables, please consider Insured or Registered Mail. to For an additional fee, a Return Receipt may be requested to provide proof of delivery. To obtain Return Receipt service, please complete and attach a Retum Receipt (PS Forth 3811) to the article and add applicable postage to cover the fee. Endorse mallpiece "Return Receipt Requested". To receive a fee waiver for a duplicate return receipt, a USPS postmark on your Certified Mali receipt is requred. ra For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent. Advise the clerk or mark the mailpiece with the endorsement `Restricted Delivery. • If a � e � On the Certified Mail receipt is desired, please present the arti- clepost office for postmarking. If a postmark on the Certified Mail receipt Is not needed, detach and affix label with postage and mail. IMPORTART: Save this recelpt and present It when making an Inquiry. jail I;JQ12W E ■ Complete items 1, 2,.and 3. Also complete A. 'gn t re item 4 if Restricted Delivery is desired. Xi, { ■ Pririt your name and address on the reverse v❑Agent so the weban'return the card to you. ` -` `-" Wee ■ Attach this card to the back of the mailpiece, B. Received bw"�Printed Nam4bew: i �� or on the front if space permits. 1. Article Addressed to: D. Is delivery address different If YES, enter delivery addref❑ No 3. SServ' e Type n 1 L ertified Mail ❑ Express Mail U❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑ C.O.D. 4. Restricted Delivery? (Extra Fee) ❑ Yes 2. Article Number (71101 1140 0002 9388 7045 Transfer from service k _ PS Form 3811, August 2001 Domestic Return Receipt 102595-01-M-250' UNITED STATES POSTAL SERVICE First -Class Mail Postage & Fees Paid USPS Permit No. G-10- 0 Sender: Please print your name, address, and ZIP+4 in this box • -ro"Glysmum t S00&, MA 0w i TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, NIA 02664 Telephone 508-398-2231 ext. 260 Fax 508-398-0836 January 2, 2002 Kelley C. Philbrook 38 Wrights Lane Glastonbury, Ct. 06033 RE: 426 A HIGHBANK ROAD Dear Mr. Philbrook: I am in receipt of your building permit application received November 29, 2001, on which you propose to perform the following work: "Addition/add 2`a floor bedroom, bathroom, stairwell with new deck from 2nd floor to existing home" Having reviewed said application and associated documents I have determined that a building permit cannot be issued at this time due to the following reasons: 1. Building Code, Chapter 1, Section 110.7, Construction documents. The following documents were not included with application. Energy Print out. / • Para Lam Printouts — Exterior exposure for deck. /• Print out or Certification for all manufactured lumber and joists. i/• How will cantilevered deck be flashed to basement to prevent water infiltration? Provide complete floor plans for smoke detector location. Additional bedroom triggers full compliance. !/ 2. Section 3107, Flood Zone was not identified on site plan Therefore, you are required to contact this office before proceeding with said work pursuant to 780CMR Chapter 1, Section 110 of the State Building Code. Finally, your application package will again be reviewed upon resolution of the foregoing. Very truly yours, � �Jam_e`s�D. Brandolini, C. B. 0. Building Commissioner JDB/is hAcnialbldgcode CERTIFIED MAIL 7001 1140 0002 9388 7045 TOWN OF YARMOUTH BUILDING DEPARTMENT PLAN REVIEW & BUILDING PERMIT APPLICATION REVIEW NOTES ADDRESS: Map /Lot: Date of Initial Review: h - er: v ai Inspector: (� NOTES: 6--r�C- 5 P ning Denial (if applicable): Section 104.32, para. Change, Extension or Alteration (pre-existing, nonconforming) The proposed requires a Special Permit from the Zoning Board of Appeals. 7,Im kBuilding Code Denial (if applicable) Rev. I1-01 � - 7 3 /6 7 Ave-f4-0 i vs+t TOWN OF YARMOUTH BUILDING DEPARTMENT PLAN REVIEW & BUILDING PERMIT APPLICATION REVIEW NOTES ADDRESS: 4 (� Map / Lot: Date of Initial Review: `d - Other: Inspector: NOTES: Zoning Denial (if applicable): Approval Date: Section 104.3.2, pars Change, Extension or Alteration (pre-existing, nonconforming) The proposed requires a Special Permit from the Zoning Board of Appeals. Other Building Code Denial (if applicable) /JRev. 1111-011�' Building Site Location: Proposed Improvement: TOWN OF YARMOUTH BUILDING DEPARTMENT BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTIAL SHEET A 1�4Ao� ' � Map No: _ Lot No:7 Applicant:. ? /1 tJ Address: Sr L l�J'J,- . f'� \.(1-tv Tel.No.: I '' t%�ate Filed: IJ The Building Department will be responsible for assisting the Tplicant by dispatching your plans and or application to the following applicable departments. _. 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, Oceans, 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. 111 *yj L*► v 31033140 1. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT: DATE: �f N/A: INDUSTRIAL AND/OR COMMERCIAL PERMITS 5. WIRING INSPECTOR: DATE: N/A: 6. PLUMBING INSPECTOR: DATE: N/A: 7. FIRE DEPARTMENT: DATE: N/A: _ PLEASE NOTE COMMENTS: RECEIPT OF COPY: SIGNATURE OF z11l 1l6L White copy — Building Dept. - Yellow Copy — Health Dept. - Pink Copy — Engineering Dept. - Goldenrod - Fire Dept/Conservation TOWN OF YARMOUTH� d� BUILDING DEPARTMENT BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTIAL SHEET Building Site Location: Proposed Improvement: Applicant: Address: The Building Department will be applicable departments. WATER DEPARTMENT: ENGINEERING DEPARTMENT: CONSERVATION COMMISSION: HEALTH DEPARTMENT: _. ---FIRE DEPARTMENT: -------------- 4 REVIEWED BY: Map No: Lot No: cr - Tel.No.: t1 Date Filed: � <-2 « 2f�G'..v2�;1O/ for assisting he Ppllcant by dlSpatching your plans and or application to the following RESIDENTIAL AND/OR COMMERCIAL BUILDING Determines Compliance of Water Availability and or existing location. Determines Compliance for Parking and Drainage. Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. Determines Compliance to State and Town Requirements for Personal Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc. J. WATER DEPARTMENT: 1` DATE: L-� N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: I_ 4. HEALTH DEPARTMENT: DATE: INDUSTRIAL AND/OR COMMERCIAL PERMITS S. WIRING INSPECTOR: 6. PLUMBING INSPECTOR: DATE: N/A: 7. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE COMMENTS: 0, RECEIPT OF COPY: SIGNATURE OF APPLICANI`:'r!'G f, I Jl , It. 'e�/ / / r DATE: White copy -Building Dept. - Green copy - Water Dept. - Yellow Copy -Health Dept. - Pink Copy - Engineering Dept. - Goldenrod -Fire Dept/Conservation TOWN OF YARMOUTH BUILDING DEPARTMENT BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTIAL SHEET Building Site Location: 11 Proposed Improvement: _'it"e'V;1, The Building Department will be responsible for assisting the applicable departments. Map No: ��Lot No: 7 by dispatching your plans and or application to the following 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, Oceans, 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. /f7� IaCS%*31`F 1. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: 3. CONSERVATION: 4. HEALTH DEPARTMENT: S. WRUNG INSPECTOR: N/A: DATE: N/A. - INDUSTRIAL AND/OR COMMERCIAL PERMITS 6. PLUMBING INSPECTOR: DATE: 7. FIRE DEPARTMENT:_/9 COMMENTS: RECEIPT OF COPY: PLEASE NOTE SIGNATURE OF APPLICANT: N/A: �&—',�ATE: Z u 07L White copy — Building Dept. - Yellow Copy — Health Dept. - Pink Copy — Engineering Dept. - Goldenrod - Fire Dept/Conservation PROPERTY ADDRESS: ALCULATION FOR PERMIT Z5�7cf��n -- 3 .S TYPE OF ROOM, ETC ALTERATIONS BATH BED ROOM CERTIFICATE OF OCCUPANCY COMPUTER ROOM DECK OPEN DECK WITH ROOF DEMOLITION DEN DINING ROOM FAMILY ROOM FIREPLACE FOUNDATION ONLY GARAGE NO. OF BAYS GREAT ROOM KITCHEN LAUNDRY ROOM LAUNDRY ROOM LIVING ROOM MUD ROOM OFFICE PORCH CLOSED PORCH OPEN REROOFING SHED STORAGE AREA SUN ROOM HEATED SUN ROOM UNHEATED SWIMMING POOL ABOVE GROUN D SWIMMING POOL INGROUND WINDOW REPLACEMENT TOWN OF YARMOUTH Building Department Town Hall Yarmouth, MA 02664 (508) 398-2231 ext.261 Building Location: Owner's Name: Owner's Address: Owner's Telephone: Plumber Name: License Number: Company Name: Company Phone: 0426A HIGHBANK RD Henderson South Yarmouth MA 02664 Glenn Boucher 12256 Cape Cod Mechanical Systems PERMIT TO DO PLUMBING WORK (OFFICE USE ONLY Recorded By: Ic PERMIT NO. P-02-571 Permit Fee: $53.00 Payment Type: Check Check Number: 5053 Issue Date: 5/8/02 Type of Work: Renovation Comments: 1 water closet, 1 lavatories, 1 shower stalls, 1 water piping, 1 bidet INSPECTION RECORD Date Note Progress - Corrections and Remarks Inspector z -S �. s it Z - Z -0577- E L2 1d.40, v ',eL 4 o� Date Printed: 5/14/02 -r J OF yq 'AT ACHE t�0" o C TOWN i F YARMOUTI+Ab i 1 �I ZOO V V 1 0 APPLICATION FOR PERMIT TO DO PLUMBING (OFFICE USE ONLY) By /J _ �y / Fee: $ ]'/ PERMIT NO. 10—l4 %— Date / 20 62-- Building / I Owner's n �vN AT: Location %6A 161�84jaw I�N Name Type of OccupancyS New ❑ Renovations' Replacement ❑ Plans Submitted Yes ❑ No ❑ z z N z ¢ ~ COJ CO U z z W W a 3 X Q z¢ m¢ y w}¢ a) Z¢ co a¢ a. a M W O M W 0 Q S fA Cn Q W y F" Q z Y G 0: 0 CC FW- V Q x d z x C. o O O a X ¢¢ Q W a LL °O Y a W J Y J ro ni o o ¢ S a F- N LL (7 7 O Q X m O SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR (PRINT OR TYPE) /J Installing Company Name rIxe, jW. Address E' r ezG �o..rrl-i i°.1�✓1 Business Telephone Check One: ❑ Corp. _ ❑ Partnership ❑ Firm/Company Name of Licensed Plumber INSURANCE COVERAGE:' I have a current liability insurance policy or its substantial equivalent. Check One: Yes ❑ No ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance voerage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature ofOwnerorOwner'sAgent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Check on Owner ❑ Agent ❑ Signature of Licensed Plumber License Number Type: Maste,Pg� Journeyman ❑