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Home My WebLink AboutBuilding Permit BackfilePERMIT 762 LOT B159 Kennedy, Mrs. Virginia 34 Highland Street West Yarmouth, MA 02673 Re -roof over 1 layer SHEET 16 11/21/97 11/21/97 y_ � 17�r� $1,800.00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00 TOWN (PLEASE PRINT IN INK OR TYP To the Inspector of Wires: By this work described below. A Location (Street & Ny Owner or Tenant Owner's Addre (OFFICE USE ONLY) (Rev. 9105) (�A B7 I N UT Fee: $ 6 JUN 1 ' Z007 PERMIT NO. (, G7— /M % - LINEORMATION - Date: ication the undersigned gives notice of his or her intention to perform the electrical M Is this permit in conjunction --with a building permit? CTYes QNo Purpose of Building Zeg&r't c5-u /-) /goo M Utility Existing Service�D Amps /J�40 / o2VC Volts Overhead JdNew Service Amps / Volts Overhead No. (Check Appropriate Box) Authorization No. Undgrd 17 No. of Meters Undgrd 0 No. of Meters Number of Feeders and Ampacity ,�r—Location and Nature of Proposed electrical Work: �J Com letio of thefollowing table may bewaived b the Inspector oWires No. of Recessed Luminaires No of eil.-Sus . Pad 1 Fans No. o To Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Above n- Swimmin Pool rnd. ❑ md. ❑ No. of Emergency Lighting BatteryUnits No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones o. of Switches No. of Gas Burners o. o Detection an InitiatingDevices No. of Ranges al No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers Heat mp Totals: um er — te ons — — — No. of Self -Contained Detection/AlertingDevices No, of Dishwashers Space/Area Heating KW Municipal Other Local ❑ Connection No. of Dryers Heating Appliances KW Security Systems:+ No. of Devices or Equivalent No. of Water Heaters KW No. of No. of Signs Ballasts Data Wirino: No. of Devices or Equivalent No. Hydro massa a Bathtubs g No. of Motors Total HP Telecommunications Wiring: No. of Devices or E uivalent C Attach additional detail if desired, or as required by the Inspector of [fires. SURANCE COVERAGE: Unless waived b e owner, no permit for the performance of electrical work may be issued unless the licensee provides proof of liability insurance including "com ted operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same t e permit issuing office. ^p G CHECK ONE: INSURANCE BOND C] OTHER[] (Specify:)/ V� o (Expiration Date 9 Estimated Valu of Electrical Work: z oz (When required by municipal policy.) Work to Start: —f —D Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the gainA and penalties ofEeerjury, that the informati9d on�this apoic4on is true and complete. 4 FIRM NA -�� Licensee: (If applici in ,12 e 2 Signature _LIC. NO. lc7 Y-77 LIC. NO. us. Tel. NO. %yl�-6oP�T Alt. Tel. No.:: . *Security System Contractor License required for this work; if applicable, enter the license number here: 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 A >r ,7crettllYEo•, s: r ; --- OF P- v a r ~ _ TOWN RMOUT MeM E JUL 1 2 2007 DE � Building AT. Location New ❑ Plans Submitted Renovation Yes ❑ No APPLICATION FOR PERMIT TO DO QUITTING Fee: PERMIT Replacement ❑ (OFFICE USE ONLY) Date / Owner's Name aw 0 n Type of Occupanc/—Vzz N Y W V) M y yL 7 6 7 y fn U z 0 O _.1 W V Z cc Z Cc Q: Q Z O O= O W m w W F Q W = W Z O f' uJ d O> W Q W W P O LU U O l4 Z Q W J Q 2~ fW" Y W Om Z LL O Z W J O y= `� tiff I 2 0 2 LL D � O V ¢ > O d H 0 c0 Cal J SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR (PRINT OR TYPE) Installing Coml Address Business Telephone elf — �v7' Check One: ❑ Corp. ❑ Partnership — Irm/Company Name of Licensed Plumber or Gasfitter INSURANCE COVERAGE: Check e I have a current liability insurance policy its substantial equivalent. Yes No If you have checked yes, please indicat he type of coverage by checking the appropriate box. A liability insurance policy Other type of indemnity ❑ J Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check One: Owner ❑ Agent ❑ Signature of Owner or Owner's Agent 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. l/ SignW6re of Licensed "Id mber or Gasfitter License Number TYPE LICE E: Plumber ❑Gasfitter Master ❑Journeyman NOTES IJOB NO. Y04-16 1. LOCUS IS A.M. 28, PARCEL 117. Bearse.dw 2. ELEVATIONS SHOWN ARE NGVD29 BASED UPON T.O.Y. MON. 3. ^ 3. LOCUS IS IN FLOOD ZONES Al2(EL.10), B &C ON FIRM DATED JULY 2. 1992. v /1 4. OFFSETS SHOWN ARE TO THE CORNERBOARDS ON EXISTING BUILDINGS. OR TO FOUNDATION ON NEW CONSTRUCTION. 3 82'43'45" E N IF L 82 14'u EN GLI SH _ w APPROX. LOCATION FROM 0 m/ ASBUILT INFORMATION =WIDE= — w 10" R.C. PIPE L 24 RAIN= _- N N —o/ — 24.2' Q N ASEM v� CVENT 24.1' — _1 21.3' I I .. EXIST. NEW 0 :: GARAGE ENCL. o PORCH 303S.F ICI Ldv / ZO N I 00 10 In / z - ExisTING 7 N HO U I ° 4 La SE 25.4' 3 SHED / TOP/CENTER NO. 34 STONE BOUND U m =13.10 NGVD29 1623 S.F. 20.0 w (3 w N v �P� N :. N :. Z Lj p Q N 24.4' 20.1, Exist w �Q . _ �/ Co ............ t elli s 29.4 Q PARCEL B s) N 109090±S.F. o 0 0 ° o`` °� N W M N /F 0 o � a M N I N N/ CAPE COD HOSPITAL o Ji / ��) / , 80.45• N 81 55 W I CERTIFY THAT THE LOCATIONS SHOWN ON THIS PLAN WERE MEASURED IN THE FIELD ON 7/27/04 N /F ASBUILT PLAN AND s/1,/o7. FITZGERALD FOR ZNDFd-gssq^ LEONARD E. BEa. 'A SgJ��gv� RIAV ? PARCEL B. 34 HIGHLAND STREET, WARMOUTH. MA e _L ; s y AUGUST 16. 2004 SCALE. 1 =20'! J SU �Q;' I RONALD J. CADILLAC. PLS. It% P.C. V,: 0, I�/Q� PROFESSIONAL LAND SURVEYOR & REGISTERED SANITARIAN ` P.O. BOX 258 REV. 6/15/07--BOARDS REMOVED ON DECK WEST YARMOUTH. MA 02673 REV. 9/20/06--ASBUILT, REV. 6/11/07--ASBUILT (508) 775-9700 REV. 10 04--ADDITION• SEPTIC, k DRAIN PIPE ©2007 BY R.J. CADILLAC (- Icsla>,K BOUND =6 WIDE= 24.2' 24.4' 24.1' NOTES JOB . Y04-1 1. LOCUS IS A.M. 28, PARCEL 117. Bearse.dw 2. ELEVATIONS SHOWN ARE NGVD29 BASED UPON T.O.Y. MON. 3. 3. LOCUS IS IN FLOOD ZONES Al2(EL10), B &C ON FIRM DATED JULY 2, 1992. 4. OFFSETS SHOWN ARE TO THE CORNERBOARDS ON EXISTING BUILDINGS. 82TO 43'45. FOUNDATION ON NEW CONSNUCF N. �I L Z ,yq0E�? E ENGLISH 7`v- rCr 82.14'U w APPROX. LOCATION FROM o coASBUILT INFORMATION -^ _ NI i� °t PIPE BRAIN_ I ` EXIST. 10 ;: Ii2 GARAGE 1z :. 10:` 1 EXISTING Io ' HOUSE a : NO. 34 1623 S.F. PARCEL B N 10,090±S.F. O N M M 80.45' I CERTIFY THAT THE LOCATIONS SHOWN ON THIS PLAN WERE MEASURED IN THE FIELD ON 7/27/04 AND 6/11/07. REV. 6/11 /07--ASBUILT REV. 9/20/06--ASBUILT REV. 10/7/04--ADDITION, SEPTIC, & DRAIN PIP NEW I I ENCL. I I PORCH I I 303 S.F I S I I � I Lo S N 125.4 w I w OI z� 3 I NIw 41 N Z / 1Q O LU . 10 R.C. 0 U 0_ tM N N m a N /F APE COD HOSPITAL N/F ASBUILT PLAN FITZGERALD I FOR LEONARD E. BEARSE AFRv EL B, 34 HIGHLAND STREET, W. YARMOUTH. MA AUGUST 16, 2004 SCALE. 1'=20' RONALD J. CADILLAC. PLS. RS. P.C. SIONAL LAND SURVEYOR & REGISTERED SANITARIAN P.O. BOX 258 WEST YARMOUTH. MA 02673 Iron) 775-9700 BY R.J. CADILLAC I 0 ONE & TWO FAMILY ONLY - BUILDING PERMIT APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING O \ ' — y Town of Yarmouth Building Department „,;r."«, 2 1146 Route 28 • Yarmouth, MA 02664-4492 Tel: (508) 398-2231 x261 • Fax: (508) 398-0836 Office Use Only Planning Board Information Assessors Department Information: ��1I S ,I riaP Type map Lot Permit No.� UI En orsement Date Permit Fee $ Recording Date New Deposit Rec'd. $ �� Dat Jan No. 1.4 Property Dimensions: Net Due $,62 er Lot Area (sf) Frontage (tt) Lot Coverage This Section for Office Use Only - Building PerTiq, mb r: Date Issued:- O — Uzi Signature: Certificate of Occupancy is is not required Building Official Date Section 1 - Site Information I Use Group: R-4 Type: 5-B 1.1 Property Address: 1'ft .ee, l ter%� s J 1.2 Zoning Information: Zoning District Proposed Use )1/ � 5 / ynh "cow 7-14 /Y 1.3 Building Setbacks (ft) - Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided © O , 1.4 Water Supply (M.G.L. c. 40. S 54) Public Private 1.5 Flood Zone Information: Comments: I Zone: BFE: Cartinn 9 - Prnnarty (lwnprchin/Authnri7arl Anpnt 2.1 wner of Recor:V ti clYl _ n �. JJ e. _ h S� O S e s IYA Name (print) Mailing Address R— S' ure Telepho a Fax E-mail Z 2. Authorized gent: T ,, �� c S��ivpAl )Zn ki. 1 1 evoc o�� DO h Arco Name ) aftg-, ,ddres Signature Telepho ax I I I•� ; E-inadJ Section 3-Construction Services I \ v t `vw.n A N � APR 2 0 2007 L11 3.1 Licensed Construction Su pe isor: gI ILDIf:G 0o N l(,. N License=Nomb 00 5 r, - o Address Expiration D to ©p Tele hon Fox E- ail l o5 g6y /1/0Z Soft-173- 7 3.2 - Registered Hom6 Improvement Contractor C pany Name Z Re istration Number Address r Expirat' n Oatfi Q% Siona fi/�361ephone Fax J E-mLhil 0/9J3 Section 4 - Workers' Compensation Insurance Affidavit (M.G.L. c. 15z 25C (6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes ... No .......... - Section 5 - Description of Proposed Work (check all applicable) New Construction ❑ No. of Bedrooms No. of Bathrooms Existing Bldg. ❑ Repair(s) Alterations ❑ Addition �U Accessory Bldg. ❑ Type Demolition Other Specify: Brief Description of Proposed Work: J� / x / i/ 5 L c:,O O A/ jt5f't, /7 a v c _G Jl /eew11b r A- Don, ju 134 o0 Yew wlpcvol. j `61" 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 O C500 2. Electrical 3. Plumbing / Gas 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) 0?00 7. Total Square Ft. (new houses & additions) °„j (,foj / Section 7a - Owner Authorization - Owner's Agent or Contractor Applies To be Completed When for Building Permit I, fv h H e-- , as owner of the subject property hereby authorize u2 t p_ sic e— k/ V N CS/ to act on my behalf ' all matters relative to work authorized by this building permit application. F % 3 -_�;) &-� Signature of Owner lDate Section 7b - Owner/Authorized Agent Declaration I, d ALCM 1'vN�-,a- k • AE W A---' 5Y asQwmr/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. A It h e t c e ?5 e ,�y e Print name Signature of Owner/Agent ��— Date 14, 9-15-99 2 of 2 Sig TOWN OF YARMOUTH BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT: Job Location: Number Owner of Property: Construction Address: hg O- Licensed Designee: (If other than Supervisor) �ILs JA a; JJ Sf. W. 1/Jl'� k o a 7 Street Village -3�8- Name License No. Name 2.15 Responsibility of each license holder: License No. ;y-lira Phone 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 Anylicenseewho shall willfully violate subsections 2.15.1, 2.15.2 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 yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy ar Other type of indemnity ❑ Bond ❑ OWNER'S IN R CE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter a Mass. General L ws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent (� nature: Building Official Approval: I 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: Xa Est. Cost 1ecd Address of Work R q ,/ t�- /40b 9) ✓ nj" NO o I Owner Name: ,1 PD & Date of Permit Application: 45li-1— 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 of perjury: I hereby apply for a permit as the agent of the owner: 3 09 �7 �AtoAeAzc<e l,! �/y Date Contractor Name —T Registration No. Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Wnrkers' Comnensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Address:BO �7 v �� ti A �'4� �. O U-71111 HA 011,73Phone 505, City/State/Zip: A Areyyou an employer? Check the appropriate box: Type of project (required): 1. 0 t am a employer with q 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* have hired the sub -contractors listed on the attached sheet. 7. ff Remodeling 2. ❑ I am a sole proprietor or partner- ship and have no employees These sub -contractors have g, ❑ Demolition working for me in any capacity. and have workers' employees9. insurance.; Building addition [No workers' comp. insurance comp. 5. ❑ We are a corporation and its 10. lectrical repairs or additions required.] 3. ❑ I am a homeowner doing all work officers have exercised their I I.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, § 1(4), and we have no 13.❑ Other employees. [No workers' comp. insurance required.] 1 1 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 anew affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: W C O/ / 1 e3 V y Expiration Date: Job Site Address: 3 y �/ i i��C A 6c3/ .Q� City/State/Zip: {U . �t�/' NO u l Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the 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 I do hereby certifyhe pains and )ne Official use only. City or Town: _ area, to that the information provided. above is true and correct. Z� narP• Z3/7 fir'/d % or town officiaG 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 11 Contact Person: Phone #: 11 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is deemed 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 (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self -insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to 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 www.mass.gov/dia 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 resultin from the proposed work/demolition to be conducted at 3 ATy 1 a S I tAJ .-)I� KO u1 y Work Address is to be disposed of at the following location: ��5e��/� �i1 AS� eo,:4- # j`1,8- 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. asa Date of TOWN OF YARMOUTH r 4q Building Department { s Town Hall e� Yarmouth, MA 02664 a (508) 398-2231 ext.261 BBUILDING PERMIT TRANSMITTAL Temp Permit No.: T-07-454 Applicant Name: Lawrence Kenney Applicant Phone: 5083641112 Building Location: 0034 HIGHLAND ST Owner's Name: BEARSE, LEONARD E Owner's Addres 209 Main Street Amesbury MA 01913 ' Owner's Telephone: (978) 388-3912 REVIEWED BY: 1. WATER DEPARTMENT: 2. ENGINEERING DEPARTMENT: 3. CONSERVATION: 4. HEALTH DEPARTMENT: 5. BUILDING DEPARTMENT: 6. FIRE DEPARTMENT: (OFFICE USE ONLY Recorded By. Ic Permit Fee: $0.00 Deposit Rec: $25.00 Payment Type: Check ChkNo.: 1279 Net Owed: ($25.00) Application Date: 4/20/2007 Issue Date: Expiration Date PLEASE NOTE COMMENTS- ` /09 1� RECEIPT OF COPY: SIGNATURE OF APPLICANT: Comments: 028.117 construct 20 x 14 sunroom on existing deck, construct 5 x 12 deck with a connecting 18 x 9 deck, install new slider inp9droom ✓ b_ DATE: DATE: DATE: DATE: DATE: DATE: An as built plan must be submitted to this department prior to foundation inspection or any furthetv/rAonstruction, N/A: N/A: N/A: N/A: N/A: DATE: Date Printed: 4/26/2007 TOWN OF Y A R M O U T H CONSERVATION 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664 COMMISSION Tel(508) 398-2231 — Fax (508) 398-0836 Town of Yarmouth Conservation Commission Building Perm)t Sign -off Application Cons. Comm. Received Date: 3lig c;) /O Property Owner: Construction Address: vim' Assessors Map and Parcel: MAP of 25T' JPAARCEL //,% General Contractor:2,a w,4ek eaC. Company Name and Address: Z.0 O /V- �a�i A it/ �Qev- Company Telephone: , %20 2C — �(, 14 Project Description: s'aIJ kee W( ©N Contractor Plan Submitted: Title Date Revision Date Conservation Commission Filing Required: YESA NO If Yes, Type of Filing: Notice of Intent Request For Determination Of Applicability Conservation Commission Sign -off Signature: Date: T Printed on Recycled Paper 0F'Y`�R,� MATTACn CS[� C To be completed by Applicant: Building Site TOWN OF YARMOUTH HEALTH DEPARTMENT PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET -.d Improvement: s U /j AJO Applicant: Address: / OU /?o9Af nr e� **Ifyou would likee-mailnotification ofsign off, please providee-mail address: Owner Name:/%j, G O AAA ,p r:,-- '%vee-e p h s 0 Map No. -& Lot No.: 1 1 7 ecri�— C) o ,Z)oA CC tl'mS . . No.:-3 G Zl — /// 2 Date Filed: O % Owner Address: c�7 C' M-xt ;A.) S� Owner Tel. No.:,97; 02- ......... ............... ._.......... A..,�- s 8 -, .._......... A_ ...... ... .. _9..._r.._._ 3._.... _..... .................................. ............ ------------ ----------------- --------------.-..__.... RESIDENTIAL AND/OR COMMERCIAL BUILDING HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. Please submit four (4) copies of plans, to include: (L) Site Plan showing existing buildings, water line location, and septic system location; (2.) Floor plan labeling ALL rooms within building (all existing and proposed) — Note. Floor plans not required for decks, sheds, windows, roofing; (3.) If necessary, Title 5 application signed by licensed installer with fee. REVIEWED BY: PLEASE NOTE r n MX4- F NT c /rnMn rT r rnv c- TOWN OF YARMOUTH WATER DEPARTMENT 99 Buck Island Road West Yarmouth, MA 02673 Telephone: (508) 771-7921 • Fax: (508) 771-7998 BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET Bldg. Site Location: S d A 61��e R �,vy 6S / - Map #: Lot #: Proposed Improvement: SU Applicant: Address: j6v Tel. #: �d�' Date Fled: �� G G RESIDENTIAL AND / OR COMMERCIAL BUILDING Water Department: Determines Compliance of Water Availability and or Existing Location. Engineering Department: Determines Compliance for Parking and Drainage Conservation Commission Determines Compliance to Wetlands Acts; i.e. If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Ocean, Bogs, Bays, Marshland, Etc... Health Department Determines Compliance to Stat 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... REVIEWED BY WATER DIVISION: signature date PLEASE NOTE: COMMENTS: e SERVICE NO. NAME STREET 3 VILLAGE �es%•�- M�{7 6/3L 41L 1 METER NO. V �I 0 Ro a� ult a� Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. to rarm / Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Town of Yarmouth Wetland By -Law, Chapter 143 A. General Information From: Yarmouth Conservation Comm To: Applicant Leonard Bearse 34 Highland Street Mailing Address Property Owner (f different from applicant): Mailing Address West Yarmouth MA 02673 Cityrrown State Zip Code City/rown State Zip Code 1. Title and Date (or Revised Date if applicable) of Final Plans and Other Documents: To construct a sunroom and wooden deck ap 34 Highland St., W.Yarmouth 3-9-07 Title Date Title Title 2. Date Request Filed: B. Determination Date Date Pursuant to the authority of M.G.L. c.131, § 40, the Conservation Commission considered your Request for Determination of Applicability, with its supporting documentation, and made the following Determination. Project Description (f applicable): To construct a sunroom and wooden deck Project Location: 34 Highland Street Street Address 28 Assessors Map(Plat Number West Yarmouth Citylrown 117 Parcel/Lot Number wpafo 2.doc • rev. &1105 Page 1 of 5 L I Massachusetts Department of Environmental Protection Bureau of Resource Protection -Wetlands WPA Form 2 —Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Town of Yarmouth Wetland B1 B. Determination (cont.) 143 The following Determination(s) is/are applicable to the proposed site and/or project relative to the Wetlands Protection Act and regulations: Positive Determination Note: No work within the jurisdiction of the Wetlands Protection Act may proceed until a final Order of Conditions (issued following submittal of a Notice of Intent or Abbreviated Notice of Intent) or Order of Resource Area Delineation (issued following submittal of Simplified Review ANRAD) has been received from the issuing authority (i.e., Conservation Commission or the Department of Environmental Protection). ❑ 1. The area described on the referenced plan(s) is an area subject to protection under the Act. Removing, filling, dredging, or altering of the area requires the filing of a Notice of Intent. ❑ 2a. The boundary delineations of the following resource areas described on the referenced plan(s) are confirmed as accurate. Therefore, the resource area boundaries confirmed in this Determination are binding as to all decisions rendered pursuant to the Wetlands Protection Act and its regulations regarding such boundaries for as long as this Determination is valid. ❑ 2b. The boundaries of resource areas listed below are not confirmed by this Determination, regardless of whether such boundaries are contained on the plans attached to this Determination or to the Request for Determination. ❑ 3. The work described on referenced plan(s) and document(s) is within an area subject to protection under the Act and will remove, fill, dredge, or alterthat area. Therefore, said work requires the filing of a Notice of Intent. ❑ 4. The work described on referenced plan(s) and document(s) is within the Buffer Zone and will alter an Area subject to protection under the Act. Therefore, said work requires the filing of a Notice of Intent orANRAD Simplified Review Cif work is limited to the Buffer Zone). ❑ 5. The area and/or work described on referenced plan(s) and document(s) is subject to review and approval by: Yarmouth Name of Municipality Pursuant to the following municipal wetland ordinance or bylaw: Yarmouth Wetland By -Law Chapter 143 Name Ordinance or Bylaw citation wpafomadw • rev. 311105 Page 2 of S Massachusetts Department of Environmental Protection LBureau of Resource Protection -Wetlands i WPA Form 2 —Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Town of Yarmouth Wetland By -Law, Chapter 143 B. Determination (cont.) ❑ 6. The following area and/or work, if any, is subject to a municipal ordinance or bylaw but not subject to the Massachusetts Wetlands Protection Act: ❑ 7. If a Notice of Intent is filed for the work in the Riverfront Area described on referenced plan(s) and document(s), which includes all or part of the work described in the Request, the applicant must consider the following alternatives. (Refer to the wetland regulations at 10.58(4)c. for more information about the scope of alternatives requirements): ❑ Alternatives limited to the lot on which the project is located. ❑ Altematives limited to the lot on which the project is located, the subdivided lots, and any adjacent lots formerly or presently owned by the same owner. ❑ Alternatives limited to the original parcel on which the project is located, the subdivided parcels, any adjacent parcels, and any other land which can reasonably be obtained within the municipality. ❑ Alternatives extend to any sites which can reasonably be obtained within the appropriate region of the state. Negative Determination Note: No further action under the Wetlands Protection Act is required by the applicant. However, if the Department is requested to issue a Superseding Determination of Applicability, work may not proceed on this project unless the Department fails to act on such request within 35 days of the date the request is post -marked for certified mail or hand delivered to the Department. Work may then proceed at the owner's risk only upon notice to the Department and to the Conservation Commission. Requirements for requests for Superseding Determinations are listed at the end of this document. ❑ 1. The area described in the Request is not an area subject to protection under the Actor the Buffer Zone. ❑ 2. The work described in the Request is within an area subject to protection under the Act, but will not remove, fill, dredge, or alter that area. Therefore, said work does not require the filing of a Notice of Intent. ® 3. The work described in the Request is within the Buffer Zone, as defined in the regulations, but will not alter an Area subject to protection under the AcL Therefore, said work does not require the filing of a Notice of Intent, subject to the following conditions (f any). ❑ 4. The work described in the Request is not within an Area subject to protection under the Act (including the Buffer Zone). Therefore, said work does not require the filing of a Notice of Intent, unless and until said work alters an Area subject to protection under the Act. wpafo=24oc • rev. W1105 Page 3 of 5 Massachusetts Department of Environmental Protection LBureau of Resource Protection - Wetlands I WPA Form 2 —Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Town of Yarmouth Wetland By -Law, Chapter 143 B. Determination (cont.) ❑ 5. The area described in the Request is subject to protection under the Act. Since the work described therein meets the requirements for the following exemption, as specified in the Act and the regulations, no Notice of Intent is required: Exempt Activity (site applicable statuatory/regulatory ❑ 6. The area and/or work described in the Request is not subject to review and approval by: of Municipality Pursuant to a municipal wetlands ordinance or bylaw. Yarmouth Wetland By -Law Chapter 143 Name Ordinance or Bylaw Citation C. Authorization This Determination is issued to the applicant and delivered as follows: ❑ by hand delivery on Date ® by certified mail, return receipt requested on 6-20-07 Date This Determination is valid for three years from the date of issuance (except Determinations for Vegetation Management Plans which are valid for the duration of the Plan). This Determination does not relieve the applicant from complying with all other applicable federal, state, or local statutes, ordinances, bylaws, or regulations. This Determination must be signed by a majority of the Conservation Commission. A copy must be sent to the appropriate DEP Regional Office (see Attachment) and the property owner (if different from the applicant). 4-20-07 Date wparom,z.doc • rev. 311/05 Page 4 of 5 L I Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 2 —Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Town of Yarmouth Wetland B, D. 143 The applicant, owner, any person aggrieved by this Determination, any owner of land abutting the land upon which the proposed work is to be done, 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 (see Attachment) to issue a Superseding Determination of Applicability. The request must be made by certified mail or hand delivery to the Department, with the appropriate filing fee and Fee Transmittal Form (see Request for Departmental Action Fee Transmittal Form) as provided in 310 CMR 10.03(7) within ten business days from the date of issuance of this Determination. A copy of the request shall at the same time be sent by certified mail or hand delivery to the Conservation Commission and to the applicant if he/she is not the appellant. The request shall state clearly and concisely the objections to the Determination which is being appealed. To the extent that the Determination is based on a municipal ordinance or bylaw and not on the Massachusetts Wetlands Protection Act or regulations, the Department of Environmental Protection has no appellate jurisdiction. wWomadoc• rev. 3YV05 Pages or 5 BOUND 24.4' NOTES IJOB NO. Y04-16 1. LOCUS IS A.M. 28, PARCEL 117. Bearse.dw 2. ELEVATIONS SHOWN ARE NGVD29 BASED UPON T.O.Y. MON. 3. 3. LOCUS IS IN FLOOD ZONES Al2(EL10). B &C ON FIRM DATED JULY 2, 1992. 4. OFFSETS SHOWN ARE TO THE CORNERBOARDS ON EXISTING BUILDINGS. OR TO FOUNDATION ON NEW CONSTRUCTION. r82-4 E N F , EN LISHN-24.3i-=�qc_A, 24.1' z EXIST. �_•` �O: GARAGE w:. o:: I EXISTING HOUSE L N0. 34 PARCEL B iv 10,090±S.F. � N M 1 CERTIFY THAT THE LOCATIONS SHOWN ON THIS PLAN WERE MEASURED IN THE FIELD ON 7/27/04. REV. 9/20/06--ASBU ILT REV. 10/7/04--ADDITION, SEPTIC, & DRAIN PIPE �j �f /l 0 N v / N Do Q LO o / N /F A� CAPE COD HOSPITAL / G3CC�f�M1[D MAR 2 9 2007 N/F ASBUILT PLAN HEALTH DEPT. FITZGERALD FOR LEONARD E. BEARSE PARCEL B, 34 HIGHLAND STREET, W. YARMOUTH, MA AUGUST 16, 2004 SCALE 1w=20' So 1-1 9� f ---7 �I¢ Trellis < i" •' c- r'- C J I < C is U �f RONALD J. CADILLAC, PL% RS PROFESSIONAL LAND SURVEYOR & REGISTERED SANITARIAN P.O. BOX 258 WEST YARMO7Ujj��{j�j�`?� 6� C�j 1 TO fU BY R.J. CADILLAC � � ' "pVl ri A�41 DCrIll AT0*4t �A ` S i • Q-ci 3 o 7 YAR.::OUTH WATER DEPT DATE NOTES I JOB NO. Y04-16 1. LOCUS IS A.M. 28, PARCEL 117. Bearse.dw 1 2. ELEVATIONS SHOWN ARE NGVD29 BASED UPON T.O.Y. MON. 3. 3. LOCUS IS IN FLOOD ZONES Al2(a-10), B &C ON FIRM DATED JULY 2, 1992. 4. OFFSETS SHOWN ARE TO THE CORNERBOARDS ON EXISTNING BUILDINGS, OR TO FOUNDATION ON NEW CONSTRUCTIO. S 82*43.45- E N F 82.14'0 EN LISH _ LaAPPROX. LOCATION FROM _ O m ASBUILT INFORMATION z ` =WIDE= N 10" R.C. PIPE N RAIN_ 24.3' N - N :z--EASEM � ENT — 24.1' EXISTI gLK FOUND,' cJ g' • ..... 35.T Icy:: / z EXIST, XIST' I v 3 r ^ I = GA V I RAGE DEC' f� z EXISTING t 19,3' ? / I a HOUSE .7 �` °�6' ::••::..::, TOP/CENTER L NO ,34 ::.. J 5 4 'SHED o STONE BOUND -13.10 NGVD29 �a .- Iv �� N 24.4' ---7 w ¢ �, N Trellis I c< :::...::::....:::...::::...:' j29.4 o Q a a —�' N o N 0i ro, I CERTIFY THAT THE LOCATIONS SHOWN ON THIS PLAN WERE MEASURED IN THE FIELD ON 7/27/04. .T �,�NCF04s , .',I p 7p �ND sum ( REV. 9/20/06--ASBUILT REV. 10/7/04--ADDITION, SEPTIC, & DRAIN PIPE 'ARCEL B �0 109090±S.F. o - " Q0 00 to•v/ o� N/F M z U n �O N I o / CAPE COD HOSPITAL �I N/ G3000;0NIGD U MAR 2 9 2007 N /F ASBUILT PLA HEALTH DEPT. FITZGERALD FOR LEONARD E. BEARSE PARCEL B, 34 HIGHLAND STREET, W. YARMOUTH, MA AUGUST 16, 2004 SCALE 1 "=20' RONALD J. CADILLAC, PLS, RS PROFESSIONAL LAND SURVEYOR & REGISTERED SANITARIAN P.O. BOX 258 WEST YARMOUIH (1M �QZ'� CD}1fDR',1 TO Rll BY R.J. CADILLAC I �y &,jAun nerm AT%n"4 jQQ i WATER DEPT DATE BOISE- Double 1-3/4" x 11-7/8" VERSA -LAM® 2.0 3100 SP Roof Beam\R1301 BC CALC® 9.3 Design Report - US 1 span I No cantilevers 10112 slope Monday, April 30, 2007 09:40 Build 057 File Name: L Kenney_Bearse.BCC Job Name: Mr. & Mrs. Leonard Bearse Description: RIDGE Address: 34 Highland Street Specifier. City, State, Zip: West Yarmouth, MA Designer: Joe Madera Customer: Larry Kenney Company: Shepley Wood Products Code reports: ESR-1040 Misc: BO, 3-1/2" DL 1241 Ibs SL 2306 Ibs B1, 3-1/2" DL 1241 Ibs SL 2306 Ibs Total Horizontal Product Length = 15-00-00 Load Summary Live Dead Snow Wind Roof Live Tag Description Load Type Ref. Start End 100% 90% 115% 133% 125% Trib. 1 Standard Load Unf. Area (psf) Left 00-00-00 15-00-00 15 30 10-03-00 Controls Summary value % Allowable Duration Load Case Span Location Disclosure Pos. Moment 12501 ft-Ibs 51.1 % 115% 3 1 - Internal Completeness and accuracy of input must End Shear 2941 Ibs 32.4% 115% 3 1 -Left be verified by anyone who would rely on Total Load Defl. L/358 (0.487") 50.2% 3 1 output as evidence of suitability for Live Load Defl. L/551 (0.317") 43.6% 3 1 particular application. Output here based Max Defl. 0.487" 0.48 48.7% 3 1 on building code -accepted design properties and analysis methods. Span / Depth P p n 1 Installation of BOISE engineered wood products must be in accordance with % Allow % Allow current Installation Guide and applicable Bearing Supports Dim. (L x W) Value Support Member Material building codes. To obtain Installation Guide BO Post 3-1/2" x 3-1/2" 3547 Ibs 39.9% 38.6% Spruce-Pine-Fir S P (8 ask questions, please call (800)232-0788 before installation. B1 Post 3-1/2" x 3-1/2" 3547 Ibs 39.9% 38.6% Spruce -Pine -Fir Cautions Column at Bearing BO analyzed for bearing only, column analysis has not been performed. Column at Bearing B1 analyzed for bearing only, column analysis has not been performed. Notes Design meets Code minimum (L/180) Total load deflection criteria. Design meets Code minimum (L/240) Live load deflection criteria. Design meets arbitrary (1") Maximum load deflection criteria. Member Slope = 0, consider drainage. Connection Diagram a minimum = 2" c = 7-7/8" b minimum = 3" d = 12" Member has no side loads. Connectors are: 16d Common Nails BC CALC®, BC FRAMER®, AJSw, ALLJOISTO, BC RIM BOARDw, BCIV , BOISE GLULAM-, SIMPLE FRAMING SYSTEM®, VERSA -LAM®, VERSA -RIM PLUS®, VERSA -RIM®, VERSA -STRAND®, VERSA -STUD® are trademarks of Boise Wood Products, L.L.C. oEGEoVE� APR 3 0 2007 BUILDING DEPT. By Page 1 of 1 TOWN OF ,YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 261 Fax 508-398-0836 Inspection and License Report BUILDING ELECTRICAL PLUMBING GAS ZONING SIGN CODE Address ( C Business Name Date of Inspection '• !' c Contact /.c Phone j During the annual inspection of your premises, performed in accordance with the provisions of Section 106 of 780 CMR (Massachusetts State Building Code), the Board of Selectmen and/or the Board of Health rules, the following violation (s) were observed: EE2ress ❑ Emergency egress signage Location ❑ Emergency egress lighting Location ❑ Egress door hardware • " ❑ Maintenance of exits ❑ Guards/Handtails Mechanical F El Combustion Combustion Air = E ❑ vents ❑ Storage in boiler rooms ❑ Automatic door closures E. on boiler room doors Location Location Location Location Location Location Location Smoke Detectors Location Other f (_ ' LL}ckao,, t 14/� �•� C .�;'f -L t � �f . C. / 'taw- L c. � c �' L �/ F Deck/Stairway Certification �1 �' • l ` r € l `` ' (� C H l j� 0 780 CMR Section 103 MAINTENANCE provides that the owner, as defined in 780 CMR Chapter 2, shall be responsible for proper maintenance. In order to abate the above violation(s) you must: El corrections immediately and�c'ontact thus office for a follow-up inspection. Zecorrections w,idun c f 1 c- w S Af r^ Says -and conta 's�office for a follow-up inspection. � ��c � � • ' v / Local Official Inspector _ f,,_ _ !l/lam - + � / Received By: /' �' > - � _ �-;� � Titre Rev. 3/04 Original -Premises Yellow -Building Department Pink -Licensing Authority APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00 OF Y49� (OFFICE USE ONLY) 73 TOWN' 0 - MOUTH By MAM HEESE IVi OCT 1 0 2006 �00 I Fee: 2 W6171. �(% T 1 Jj7� PERMIT NO. � � 3� t 1 11_` /:GD.��V I m i . ... (PLEASE PRINT IN INK ak=TPPP:%Iz1MEORMATION) Date: 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) -?q lhowvv Pwner or Tenant t° ar),2 d l) l0ea ! s,-e_. VTelepboneNo. Is this permit in conjunction with a building permit? Yes []No (Check Appropriate /Box / 15") / y Purpose of Building A&2-//7 0/y UtilityA orization No. ` �r7 ! 3 / O d&40';7 �l Existing Serviced Amps 1020 / 421 Volts Overhead[ Undgrd C3 o. of Meters New Service Zi—eV Amps 1W 4"00 Volts Overhead Undgrd No. of Meters �umber of Feeders and Ampacity :q and Nature of Proposed electrical) Work: Wge- /,-,00IncN -t lL e LOC��e- �Uerka,{ ;il V/CO -7n V4 /.lit n J &4-16( . may No. of Recessed Fixtures No. of Ceil.-Sus . Paddle Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of LightingFixtures Above In- 71 SwimmingPool rnd. Emd. No. of Emergency Lighting Battery Units o. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. o etecnon an Initiating Devices No. of Ranges Total No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Num er — — Tons — — KW — — No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Municipal Other Local Connection No. of Dryers ry Heating Appliances KW g pp Secutity Systems: No. of Devices or E uipvalent No. of Water Heaters KW No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring No. of Devices or Equivalent Attach aad[tionat aetau J aeszrea, or as requzrect oy the inspector of nyzres. INSURANCE COVERAGE: Unless /w�aivedthe owner, no permit for the performance of electrical work may be issued unless the licensee provides proof ppf liability insurance includingperation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, bnd has exhibited proof of samit issuing office.�nCHECK ONE: INSURANCEON1) OTHER (Specify:) 0/l�� /f -eC0/% L'O �. (Expiration Date) Estimated Value 9f Ele trical ork: ((%%!/ (When required by municipal policy.) Work to Start: (i 'Q Inspections to be requested in accordance with MEC Rule 10, and upon completion. CI certify, under FIRM NAME_ 4J Licensee: information on this application is true and complete. �� LIC. NO. A/3 Signature OWNER'S INSURANCE WAIVER: I am aware that the Licensee doe/n below, I hereby waive this requirement. I am the (check one) owner Owner/Agent LIC. NO. `u0 Bus. Tel. No.: 4 i%/. 1 Alt. Tel. No.: have the liability insurance coverage normally required by law. By my signature owner's agent. Signature [Rev. 04/001 Telephone No. WPS - Permit Page 1 of 1 ,NSTAR WPS - Permit Work Order Information Utility Auth/WO #: 01544397 Date: 09/22/2006 Company DAVID LENTINI Rep: Report By: HPK 34 HIGHLAND ST BEARSE LEONARD E Status: ACTIVE Service: RELOC Type: RES Nature of Work: UPGRADING & RELOCATING ---- RELOCATING OH TO UNDERGROUND, USING SAME POLE #12/05...... UPGRADING 150A TO 200A..... ADDING 200SFT (SUNROOM).... LIGHTS/PLUGS ONLY..... RESEAL AFTER INSPECTION Service Information: There is no Service Information. Permit Information Permit #: E07-368 Meters: 1 Reseal (Y/N): Y Date: 10/11/2006 Inspector: W10060 Description: t Search List Detail Contacts NSTAR Home WPS Logon WPS Help Comments. WO Request _WPS News �� W Copyright 2003 NSTAR, 800 Boylston Street, Boston MA USA. All rights reserved. Reproduction in whole or in part of any graphics, images, text or other content at this web site must be granted by NSTAR, Boston, MA, USA. Unauthorized modification of any information stored at this site may result in criminal prosecution. http://www.nstaronline.com/apps/wps/wpspermit.cfm?Page=Permit&Unique= { ts_'2006-... 10/11 /2006 MOTES JOB NO. 1. LOCUS IS A.M. 28, PARCEL 117. Bearse.d 2. ELEVATIONS SHOWN ARE NGVD29 BASED UPON T.O.Y. MON. 3. 3. LOCUS IS IN FLOOD ZONES Al2(EL10), B &C ON FIRM DATED JULY 2, 199 4. OFFSETS SHOWN ARE TO THE CORNERBOARDS ON EXISTING BUILDINGS, OR TO FOUNDATION ON NEW CONSTRUCTION. S 823'N F45" •UE EN LISH4 _-6 WIDE- _'i 24.3' c 24.1' BOUND 24.4' \ N� 3 13. OHO 0 o Z r4- 0 o to o b m N N w RAIN- �C-C�4 N2_�=EA� BEN T :::.:...:::.............. 35. 7- 1 1 .9 EXIST. EXIST. I v �. GARAGE DECK I I 4 Ico I a EXISTING HOUSE NO. 34 PARCEL B N 10,090±S.F. 0) N M M I CERTIFY THAT THE LOCATIONS SHOWN ON THIS PLAN WERE MEASURED IN THE FIELD ON 7/27/04. m IZ106 REV. 9/20/06--ASBUILT REV. 10/7/04--ADDITION, SEPTIC, & DRAIN PIPE APPROX. LOCATION FROM ASBUILT NFORMATION / 10" IPE 4$�C 0 2• .. 25.41 6 SI/EQ� 0 Lldi 0 Ld _� O N Ld p Q v N —, J Trellis I -< z m \ V/ iNo AQ U ot` o E� o 3 �/ b /O� w o u� U Qoa o� N/F Lu Z VU7 / Q N I N /`CAPE COD HOSPITAL w J Q /U .N/F ASBUILT PLAN FITZGERALD I FOR LEONARD E. BEARSE PARCEL B. 34 HIGHLAND STREET, W. YARMOUTH, MA AUGUST 16, 2004 SCALE: 1'=20' RONALD J. CADILLAC, PL% RS PROFESSIONAL LAND SURVEYOR & REGISTERED SANITARIAN P.O. BOX 258 WEST YARMOUTH. MA 02673 BY R.J. CADIUAC (508) 775-9700 C 00 oF'Y`1R,� ONE & TWO FAMILY ONLY - BUILDING PERMIT APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMIL VVELLING Town of Yarmouth Building Department rp N „.;,„«, 2 1146 Route 28 • Yarmouth, MA 02664-4492 Tel: (508) 398-2231 x261 • Fax: (508) 398-0836 Office Use Only Planning Board Information Assessors Department Information: BOG_ h-) S te Map Lot Permit No. JJ ^!3Z la Permit Fee $� odding Date Date ' Re ding Date New Deposit ReC'd. $`v � Date No 1.4 Property Dimensions: Net Due $la,� Other Lot Area (sf) Frontage (ft) Lot Coverage This Section for Office Use Only Buildinq Permit N ber° Date Issued: � sl _90 Signature:Ll� Certificate of Occupancy is is not required Building Official Date Section 1 - Site Information I Use Group: R-4 Type: 5-131 1.1 Property Address: 3 1.2 Zoning Information: &5 Zoning District Proposed Use b p 1.3 Building Setbacks (ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided Q O 1.4 Water Supply (M.G.L. c. 40. S 54) Public Private 1.5 Flood Zone Information: Comments: I Zone: BFE: Section 2 - Property Ownership/Authorized Agent 2. Owner of Re ord: ,�eo a Haay o Na (print) Mailing Address .Q'� Signature Telephone 2 Authorized Agent: � l Q ✓ ✓ N Name Mailing Address Signature Telephone aiL�j lit P Section 3 - Construction Services 3A Licensed Construction Su Is / 1 5 d C Not Applicable ❑ al �a N A �. S License Number s-1 o 9 Addres 3 o i ti Da tephone O t Signature Tele , 3.2 Registered Home Improvement ontractor: Company Name (6b llcable ❑ Ligense Number /13 A dr 3 (o y j 1 i Sig_nature7 Telephone Expirati n Date j a to 01 /t1A- Section 4 - Workers' Compensation Insurance Affidavit (M.G.L c. 152 S 25C (6) Worket Compensation Insurance affidavit must be completed and submitted with this application. Failure' to proviey this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes ..I`� . No .......... [Section5 Description of Prnnosprf Work 1chpek all annticahiAl New Construction ❑ No. of Bedrooms No. of Bathrooms Existing Bldg. ❑ IRepalr(s) ❑ Alterations I Addition ❑ Accessory Bldg. ❑ Type Demolition Other Specify: Brief Description of Proposed Work: n / d PJ C 01 x O U N Section 6 - Estimated Construction Costs Item Estimated Cost (Dollars) to be completed by permit applicant 1. Building 2. Electrical 3. Plumbing / Gas 4. Mechanical (HVAC) 5. Fire Protection 6.Total=(1+2+3+4+5) DO CO , 7. Total Square Ft. (new houses&additions) Section 7a - Owner Authorization - To be Completed When Owner's Agent or Contractor Applies for Buildin Permit I, P hereby authorizeufr AGQ0-CQ— A- A 6Al Ne my behalf, in all matters relative to work authorized by this buil (' Tt 2o,c4 o /,( / Signature of Owner Section 7b - Owner/Authorized Aaent Declaration I W A _e IuCe _ A'.e Check Below ❑ Conservation -Commission Filing (if applicable) ❑ Old Kings Highway & Historical Commission approval (if applicable) , as owner of the subject property to act on permit application. O ;f 4 J Date as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print name Signature of Owner/Agent y d� Date 9- 15-99 2 of 2 oF'YAR,,� 2 o � 0 c TOWN OF YARMOUTH BUILDING DEPARTMENT PLEASE PRINT. Job Location: Owner of CONSTRUCTION SUPERVISOR FORM Construction Supervisor: Address: Licensed Designee: (If other than Supervisor) Name 2.15 Responsibility of each license holder: N I Village Vfiv v!�l d0,6-6 0 9 ,rab'• 3G0/ - /I/ 2 License No. Phone No. 1414P i i'-N/ A Al" 7w 1*'IA- 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 licenseewho 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 U No ❑ If you have checked y�s, please indicate the type coverage by checking the appropriate box. A liability insurance policy as 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 of Owner or Owners Agent 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: C� 4 ACC{' 1-r- Sy AJ hcc e Est. Cost Address of Work Owner Name: �` Date of Permit Application: 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 of perjury: I hereby apply for a permit as the agent of the owner: ate Contractor Name Registration No. Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name i re Commonwealth of Massachusetts Department of Industrial Accidents OfJlcea/Imstooffess 600 Washington Street CJis W . �,A h /W C) 1 4 N4 phone tJ I am a homeowner performing all work myself. I am a sole proprietor and hase no one ssorking in any capacity I am an employer pros iding workers' compensation for my employees working on this job. eN C%.e K. „ 11 �O address /t��! 9z,A�U 0P ^�e� �— city:� �IhP &o& /mil r �(1A phone # Oi• �b/ �y - P .a rt. oi.sS A w tie, / Ai 9: a //32 H F1 I am a sole proprietor. general contractor, or homeowner (circle one) and have hired the contractors listed below ssho ha%e the follow in_ ssorkers' compensation polices: company name, address• city phone #' insurance co policy # m an name: Failure to secure coverage as required under Section 25A of MGL 152 cis lead to the imposition of erimiaal ptaaltits of a (INC op to SI M-00 and/or one years' Imprisonment as well as civil penalties in the form of a STOP WORK ORDER mad a Doe of SI00.00 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. I do ;herehy certify thepains andpen ties of perry that the information provided above is true and correct.Signe j� ate H "' S Cr S Print name Atv 2 raL h N hone ii official use only do not write in this area to be completed by city or town official city or town: YARMOUT11 [] check if immediate response is required permitAicense # r'IBuilding Department []Licensing Board 261 ❑selectmen's Office 508) 398 2231 []Health Department t phone 0; _ IL ea rJOthcr contact person: Iwsned 3," P3A1 Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for th; employ 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 entpl(tver is defined as an indi-, idual, partnership, association. corporation or other legal entity, or any two or more c the foregoing engaged in a joint enterprise. and including the legal representatives of a deceased employer. or the recek, er or trustee of an individual . partnership, association or other legal entity, employing employees. However the ox%ner of a dwellin(, house ha% ine 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 urounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter I section also states that even- 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 work until acceptable evidence of compliance with the insurance requirements of this chapter ha% e been presented to the contracting authorit%. Applicants Please fill in the workers' compensation affidavit completely. by checking the box that applies to your situation and supply ing 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 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 pennit/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 Inves"139812 600 Washington Street Boston, Ma. 02111 fax #: (617) 727-7749 phone #: (617) 7274900 ext. 406, 409 or 375 4.. 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 resulti from the proposed wor/k'/demolition to be conducted at �� lzj,, ALA, 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 of •lp,,9 TOWN OF YARMOUTH Building Department = Town Hall e Yarmouth, MA 02664 (508) 398-2231 ext.261 BBUILDING PERMIT TRANSMITTAL Temp Permit No.: T-05-562 Applicant Name: Lawrence Kenney Applicant Phone: 5083641112 Building Location: 00034 HIGHLAND ST Owner's Name: Leonard Bearse Owner's Addres 209 Main Street Amesbury MA 01913 Owner's Telephone: (OFFICE USE ONLY Recorded By: Ic Permit Fee: $0.00 Deposit Rec: $25.00 Payment Type: Check ChkNo.: 7520 Net Owed: ($25.00) Application Date: 4/28/2005 Issue Date: Expiration Date Comments: Map/Lot: 028.117 construct addition to expand existing garage, add 16 x 20 deck ZOHRIG APPROVED REVIEWED BY: ✓1. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: CONSERVATION: DATE: N/A: 4�iEALTH DEPARTMENT: DATE: N/A: 5. BUILDING DEPARTMENT: DATE: N/A: 6. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE COMMENTS: RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: Date Printed: 5/4/2005 OF r;9 TOWN OF YARMOUTH Building Department s Town Hall Yarmouth, MA 02664 o (508) 398-2231 ext.261 BBUILDING PERMIT TRANSMITTAL Temp Permit No.: T-05-562 Applicant Name: Lawrence Kenney Applicant Phone: 5083641112 Building Location: 00034 HIGHLAND ST Owner's Name: Leonard Bearse Owner's Addres 209 Main Street Amesbury MA 01913 Owner's Telephone: REVIEWED BY: (OFFICE USE ONLY Recorded By: Ic Permit Fee: $0.00 Deposit Rec: $25.00 Payment Type: Check ChkNo.: 7520 Net Owed: ($25.00) Application Date: 4/28/2005 Issue Date: Expiration Date Comments: Map/Lot: 028.117 construct addition to expand existing garage, add 16 x 20 deck 1. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION:= DATE: 4. HEALTH DEPARTMENT: DATE: N/A: 5. BUILDING DEPARTMENT: DATE: N/A: 6. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE COMMENTS: RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: Date Printed: 5/4/2005 of •,, TOWN OF YARMOUTH �g Building Department Town Hall 'P Yarmouth, MA 02664 (508) 398-2231 ext.261 BBUILDING PERMIT TRANSMITTAL Temp Permit No.: T-05-562 Applicant Name: Lawrence Kenney Applicant Phone: 5083641112 Building Location: 00034 HIGHLAND ST Owner's Name: Leonard Bearse Owner's Addres 209 Main Street Amesbury MA 01913 i Owner's Telephone: (OFFICE USE ONLY Recorded By: Ic Permit Fee: $0.00 Deposit Rec: $25.00 Payment Type: Check ChkNo.: 7520 Net Owed: ($25.00) Application Date: 4/28/2005 Issue Date: Expiration Date Comments: Map/Lot: 028.117 construct addition to expand existing garage, add 16 x 20 deck a1E@1Rad[g MAY 0 4 2005 I HEALTH DEI REVIEWED BY: 1. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT: DATE: oS N/A: 5. BUILDING DEPARTMENT: V I DATE: N/A: 6. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE COMMENTS: RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: Date Printed: 5/4/2005 TOWN OF YARMOUTH y. �9 r° ;g Building Department _,.� s Town Hall y°` Yarmouth, MA 02664 (508) 398-2231 ext.261 BBUILDING PERMIT TRANSMITTAL Temp Permit No.: T-05-562 Applicant Name: Lawrence Kenney Applicant Phone: 5083641112 Building Location: 00034 HIGHLAND ST Owner's Name: Leonard Bearse Owner's Addres 209 Main Street Amesbury MA 01913 r Owner's Telephone: 5�� 33 (OFFICE USE ONLY Recorded By: IC Permit Fee: $0.00 Deposit Rec: $25.00 Payment Type: Check ChkNo.: 7520 Net Owed: ($25.00) Application Date: 4/28/2005 Issue Date: Expiration Date Comments: Map/Lot: 028.117 construct addition to expand existing garage, add 16 x 20 deck REVIEWED BY: 1. WATER DEPARTMENT: DATE: SL1,SN% : 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT: DATE: N/A: 5. BUILDING DEPARTMENT: DATE: N/A: 6. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE COMMENTS: RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: Date Printed: 5/4/2005 NOTES JOB NO. Y04-16 1. LOCUS IS A.M. 28, PARCEL 117. Bearse.dw 2. ELEVATIONS SHOWN ARE NGVD29 BASED UPON T.O.Y. MON. 3. 3. LOCUS IS IN FLOOD ZONES Al2(EL70), B &C ON FIRM DATED JULY 2, 1992. 4. OFFSETS SHOWN ARE TO THE CORNERBOARDS ON EXISTING NOTE: BASE FLOOD BUILDINGS, OR TO FOUNDATION ON NEW CONSTRUCTION. ELEVATION OF 10' S 82'43'45+ E NdF RUNS MORE INLAND 15.6 EN LISH THAN SCALED LOC- 82.14'0 ATION OF A ZONE. 152 w z APPROX. LOCATION FROM ® < O m E_ ASBUILT INFORMATION / =6'=W1 N t. N �2/ 1011 R.C. PIPE 4 zz 4.1' �i N A lq � 1 5 3 gig N � Nr / J __ !7_ _ 4• zo GAOP. 10 I jt4o q U .......... PROP. EXIST� :. ......-.:::..... 35 � 6 , ca :: I I< GARAGE DECK I _ Lai :P I la IPP 1.OQ�� o ' ORCH / ao 0; 25.8' un z ^� eff EXISTING os . By — -- 1 a SE 5.4 TOP CENTER = s.9 o -- — — STONE BOUND -13.10 NGYD29 0 w Z O 0 Nl, N IN Q' n 24.4' / N uj ;:r:,. �Z i... Trelli�2/3.8z m .......:::ci ...:. ' oP a9.4'VlN o co 4.3 PARCEL 0/'10, s� iv 101090±S.F. W - o �+- 3 p 3.9 3 1 M 10.9 N w I c¢Ji v�oi c`" N /F M Z � M 6.3 0 5.7 iM. /Q `0 N I N/ CAPE COD HOSPITAL Lu c^ o Q I TER WOOD TAKE 80.45• ( -4.33 NGVD29 N 8155 WQ 1 3.8 .0 I CERTIFY THAT THE LOCATIONS SHOWN ON THIS N/F ASBUILT PLAN PLAN WERE MEASURED IN THE FIELD ON 7/27/04. FITZGERALD FOR OFAM LEONARD E. BEARSE L _ PARCEL B. 34 HIGHLAND STREET, W. YARMOUTH, MA S AUGUST 16, 2004: SCALE: 1`=20' v # 35 9 Fess RONALD J. CADILLAC, PLS, RS PROFESSIONAL LAND SURVEYOR & REGISTERED SANITARIAN O P.O. BOX 258 1 WEST YARMOUTH, MA 02673 REV. 10/7/04--ADDITION, SEPTIC, do DRAIN PIPE (C)2004 BY R.J. CADILLAC (508) 775-9700 I 10" CONC PIER 48" MCN LI AME W/ P.f. 4X4 1905f fYP. 2XI2 Pf LF12ar W/ J015f NANaF5 nr. NEW (4wme WALL: 2X4 5TUM5,1/ 2" C %fATNING, CEMAP 51.11ME5 J PENDING L p AMMMON NEW CONC. 1� t %AD V\ z "� ISX361N5ULA Is EXI51ING WALE fO EE REMOvEM EXI511NG WAa FOR BUILDING AND ZONING n0Q 00 ORA141001n,In nn u FROM THE RESPONSIBILI 1 ;E. KIfQfN REPLACED 18 CChiPLI- i BUILT, p A BUILDING OFFICIAL GARAGE ADDITIONIDECK ADDITIOI BEARSE RESIDENCE WEST YARMO APRIL 12, 2005 P05f fO MMAJN REMOJEM a TMOvEMAN17 TfNCN MOOR �pG�� D I APP , ,1 2005 3Y..— FLOOp FLAN 5CALE: I/ 8" - I'-O" , MASSACHUSETTES NEW FRENCH MY f0 MFLAa EXI511NGWNDOW - LOCATE PER GVUr IN FIELD EXI51ING DOG? fO X _ REMOVED - IN FILL GPENING AND 5HINCLE CONC, PIER fW EXI5fIN6 CMAa I GWAa ADDI110N m - FRE95f CONC, 5tr WEAi UF5f DECKING/RAILING 5Y51EM NEWP,SpFW. SNNLLES - MATCFI GJfiEty AND C OWNSRGLtf � NWAIM12 ooDTRIM -MAfCN EXIST G n NEWCEDAp IN6I.EENTREWALL (EXISI�NG AN NEW) OUriLINE DECKR>JL ^, ; /Vf � � � V 5CALE:1/ 8" -1'-0° .,�- NEW FAINIP WO( 3 I W6 IN5ULATE D WOOD MaV, MAfCN EXISTING WINDONlMATERIN.5 AND MOILS EXI511N6 P RCNOVVM(A� CONCP 9FOUN12MONWALL 5CALE: 1/8" - I'-O" GARAGE ADDITIONIDECK ADDITIOI BEARSE RESIDENCE WEST YARMO APRIL 12, 2005 7AR SNNCLE WALL ON , MASSACHUSETTEA �tr*, OF yf TOWN OF YARMOUTH ;A. = PERMIT NO B-06-932 _ e� ISSUE DATE ;_ 1/22/2006 _ ; PI ----------------- APPLICANT _Lawrence Kenney ------ Building Department BUILDING (508) 398-2231 ext.261 DSED PERMIT JOB WEATHER CARD --- PERMITTO Alterations AT (LOCATION) 100034HIGHLAND ST ZONING DISTRIC R-25 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 1028.117 BUILDING IS TO BE: CONST TYPE 5-B USE GROUPR-4 LOT SIZE E= ICONTRACTOR SIDING (5) SQ. REMARKS AREA (SQ FT) EST COST ($ $3,100.00 PERMIT FEE ($) 1$25.00 OWNER IVIRGINIA P KENNEDY LIFE EST IBUILDING DEPT BY ADDRESS 100034 HIGHLAND ST WESTYARMOUTH I MA 102673 LICENSE 005609 Kenney, Lawrence 100 Sullivan Road West Yarmouth MA02673 5083641112 PHONE 19783883912 INSPECTION RECORD FIELD COPY Date Note Progress - Corrections and Remark Inspector modhsfiem EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 . (508) 398-2231 Exf 261 ADDRESS: 3 ' / / / / s /� >3 N s l 1J , yi) N MBy'T�l ►��y�z�•5i�iIZICc, SMTc. V• I Map' 2 5 Parcel: // 7 OWNEIL-I egAd E l3ea�s�- ac9.illmv s% 4/te:jaw-� NAME PRESENT ADDRESS CONfRAGFOR-JAt)Fo 4/o:-e. V 1G eN.oey - 388- 37/ 9�, TEL # �dF-.3Gy-lll y lI ". -e1 ❑ commercial Est Cost of Caostruction S J / ©0• ' Home kpvwt mcw contractor Lic.1t i a ! 113 C=tmcbw Sgcry r I.ic. # cc, %5'&/ o % Wcdonw s Campion Insurance: (check one) e ❑ I am the hcmwwm 0 I am the sok proprietor M" I have Worlds C nopensatian Insurance c� Insurance Company Names fl e Pf/ A 15 � ) c � wails Comp. Policy! W C d //3 ,2 WORK TO Bit IFRMRMED 0 Ted (Fire Retardant Catificte Wwbed) (� nmtion wood stow o fi: ❑ Sidi # of square. V ❑ Repl awme wkdm 0 Replacement doss # 0 R"mf # of sgoara () g otd sbJng1a* * hie debris wifl be disposed oft: I dedare codes Panama of will be jut cause far dnahtotmeheeein a and far Apptiwd's ()tag arar ts9as of exiting roof uJgs7{ —Wit, v J L, A t2 3 2006 2006Li " 0?6-,6 i d oc sedto dw bet of say tmowledge and belief. I rmdastand tbt say She amwer(s) M.o.L CL. 262. section 1. Dew Approved BY Dde: BuddingC1fcid (or designee) flistaicalDistrict ❑ Yes ❑ No Water Resaux Protection District: ❑ Yes ❑ No Flood Plain 7mc ❑ Yes ❑ No Within 100 Wedandx P"Yes ❑ No M The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washinxton Street W Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name Address: FM" City/StatelZip: Phone #: Aree an employer? Check the- appropriate box: 1. LJ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).' have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- 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. t These sub -contractors 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] �i Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other -nny appncmr u cuccsa cox rF r muse also rru our me secnon oerow showmg thetr workers- compensation policy lnforrmtion: t Homeowners who submit this affidavit indicating they ate doing all work and then hire outside contractors must submit a new affidavit indicating such tContractors that check this box rnust attached an additional sheet showing the name of the sub -contractors and their workers' cotnp. policy inforrrration. I am an employer that is providing workers' compensation Insurance for my employees Below Is the polley and job site Information. n Insurance Company Name: f'S epi1/ A l S.S A oc 0- J 11 S Policy # or Self -ins. Lis M wco // 3�_ r/ 6i Expiration Date: Job Site Address:-Jq �{/T f F`� A N City(State/Zip: WVP A fecal e717" 7 C 73 Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to segue 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 m* *' tent, 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. I de hereby certi rider the pains and e f perjury that the information provided ove ls and correct: Si a LP/ ell azt<� Date: / L/ D Phone #: `J - 3 G l - // / ), Official use only. Do not write in this area, to be completed by city or town official, City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. Cftyfrown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their omplaii 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 r 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 "Neither the coplmmonwwith Ith nor the any of its political snsurance ubdivisions shall Additionally, MGL chapter 1520 §25C(7) enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s)' address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents forpolicy ieconfirmation re insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be retuned 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 applicantIi ant Please be sure to fill in the permitilicense number which will be used as a reference number. In addition, an app lt iple permit/license applications in any given year, need only submit one affidavit indicating current that must submitmuIt policy information 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. Anew 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 (ie. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit Tb- Office of Investigations would lace 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 5-26-05 www.mass.gov/dia cF r4 TOWN OF YARMOUTH Building Department BUILDING 3r e; (508) 398-2231 ext.261 PERMIT NO := B g3ia = s ---------- PERMIT Pu ISSUE DATE :1?J2/o2__; , ---------- "- 767SE APPLICANT Leonard Bearse JOB WEATHER CARD ADDRESS 00034 HIGHLAND ST PERMIT TO Accessory Structure' AT (LOCATION) 100034HIGHLANDST W ZO ISTRICT R-25 SUBDIVISION MAP LOT BLOCK 1028.117 BUILDING IS TO BE USE GROUP R-4 LOT SIZE I I CONST TYPE 5-13 CONTR'S 071717 8 x 10 shed - subject to zoning bylaws REMARKS AREA (SQ FT) EST COST ($ $1,000.00 PERMIT FEE ($) 1$20.00 OWNER Leonard Bearse ADDRESS 100034 HIGHLAND ST WY BUILDING DEPT BY UCENSE CONTR'S NAME Baroni, Joseph INSPECTION RECORD FIELD COPY Date Note Progress - Corrections and Remark Inspector 9 I e Office Use Only SHEDS LESS THAN 150 SQ. FT. SHALL PC ma 63 "Sas BE PLACED A MINIMUM OF 30 FEET FROM THE FRONT LOT LINE AND A Fee $;,;;2®c a . MINIMUM OF 6 FEET FROM SIDES AND Permit expires 6 months from REAR LOT LINES. issue date. \`off EXPRESS BUILDING PERmrr APPLICATION n_+ TOWN OF YARMOUTH -1 Yarmouth Building Department 1146 Route.28 South Yarmouth, MA 02664 /. L (508) 398-2231 Ext_2161 Cl CONSTRUCTION ADDRESS: _// A � M ,- /9 ryj s 7- , W eS 7—%Yi M o u %l7 /L A ASSESSOR'S INFORMATION: r/ OWNER: L &d N A, R. j 4yj Map: o2�f Pazcel:! sr 3yA;Qh1,0Nd sr W yn'If100171 _ CONTRACTOR S.Y, ` NAME esidential ❑ Commercial 01 3 TEE. # 4) eA/, y, 60 3 _� TELI / 36a Est Cost of Construction $ ee�f CIL -- Home Improvement Contractor Lic. # Construction Supervisor Lic. Workman's Compensation Insurance: (check one) 0 1 am the homeowner ❑ I am the sole proprietor ❑ I have Worker's Compensation Insurance Insurance Company Nam e/�G /yJ� �) i1,� Worker's Comp. Policy# li ❑ Teat (Fire RetardamCertificate attached) WORK TO BE PERFORMED Duration ❑ Siding: # of Squares `' 5 h e d 0 Replacement windows: # ❑ Replacement doors: # Re -roof # of Squares () Stripping old shingles* . 0 going over layers of existing roof *The debris will be disposed ofat Location of Facility I declare under penalties of perjury, that the statements herein contained are tine and correct to the best of my knowledge and belief I understand that any Use answer(s) will be just cause for denial or revocation of my license and for prosecution under RG1,. CIL 268, Section 1. // Applicant's Signature: --�djYLj ! � Datc /l 1j4wners Signature (or attachment) Approved Zoning District:) Historical District: ❑ Yes XNo Water Resource Protection District: D Yes -�C o Date — Flood Plain Zone: ❑ Yes /d No Within 100 & of Wetlands: ❑ Yes IX No NO SHEDS LESS THAN 150 SQ. FT. SHALL BE PLACED A MINIMUM OF 30 FEET PLOT PLAN FROM THE FRONT LOT LINE AND A MINIMUM OF 6 FEET FROM SIDES AND REAR LOT LINES. FOR LOT # - J S— Indicate location of garage or accessory building Additions with dashed lines Sewerage disposal (cesspool) Well lg (16t................ft. rear) Uttar I s (: I me t# �9Shc t_O N this is a rer lot, Lte in name street. b SIDE YARD REAR YARD C) Zep7l � TeN/C ........ 1.... ft. � ao, v I SET BACK N SIDE YARD �]--- FTO (lot..................ft. frontage) � (:1AME arSl;tcr;�1'J Information Supplied by RK "na"rrtT Abuttor's Name Lot # If this is corner 1c write in name of other street. b i,