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HomeMy WebLinkAboutBuilding Permits BackfilePERMIT 268 5/9/96 LOT K-82 5/9/96 O'Conner, L. C. 369 Gt. Island Road West Yarmouth, MA 02673 Strip & re -roof $3,500.00 SHEET 9 PERMIT 747 10/19/98 10/19/98 LOT K82 e- - --7 O'Connor, Lawrence & Helen 369 Great Island Road r/ 117C West Yarmouth, MA 02673 Addition 2-car gar 22'x74', convert existing 2-car gar. to exercise rm. & bathrm., 2 decks. $35,000.00 SHEET 9 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',OF YARMOUTH MAR L(��j6� Zuol (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) (OFFICE USE ONLY) (Rev. 9/05) By Fee: $ `�/i PERMIT NO. F C7 — Z Z► nntP• To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. �_ 1 Location (Street &Number) 3 (9 ,, t Owner or Tenant 1"1 r S M 1 GO2-41 Telephone No. Owner's Address 7�1�� �s1r2G~✓� ���n(� R� Is this permit in conjunction with a building permit? O Yes allo (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts OverheadQ Undgrd CJ No. of Meters New Service Amps / Volts Overhead Undgrd Q No. of Meters 0 Number of Feeders and Ampacity Tom, r ^; Location and Nature of Proposed electrical Work: LZW V `/ cM ��2r 1 OSi �S) L Co m letio of thefollowing table maybe waived bthe Inspector o Wires No. of Recessed Luminaires No. of Ceil.-Sus . Paddle Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Above n- SwimmingPool md. rnd. No. of Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. of Detection an Initiating Devices No. of Ranges Total No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number — — Tons — — K — — No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Municipal Local Connection Q Other Dryers No. of D rY Heating Appliances KW g PP Security Systems:* No. of Devices or Equivalent No. of Water Heaters KW No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. H dromassa a Bathtubs Y g No. of Motors Total HP Telecommunications Wiring No. of Devices or E u ivalent Attach additional detail if desired, or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued unless the licensee provides N proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in yforce, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BONDC1 OTHER (Specify:) (Expiration Date) Estimated Value of Electrical Work: 4 107 (When required by municipal policy.) b Work to Start: . �'7 Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and enalties of perju , th t the information on this application is true and complete. FIRM NAME: G��G 2 (.c +T L��� 1G LIC. NO. Z) Licensee:4;;AcV\ CM-fy Signature i LIC. NO. (If applicable, ente "exempt" in the license number line.) Bus. Tel. No.: $-i7 I—ZZ21 his. 12 L J'ddre,s: 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 waiv this quirement. I am the (check one) owner ❑ owner's agent. Owner/Agent Signature I/ Telephone Nd.S `-' �y'Ft, LEWIS POND ~ LOCUS v a NANTUCKET SOUND / LOT 82 LOCUS MAP 19320 t S.F. , GENERAL NOTES: 1. THIS PLAN IS FOR PERMITTING PURPOSES ONLY. TLND 111EM"E -Or 'VA. A6:E 1O1 J I.RU['II,fJ NET-✓ RUl(T 0• dJB3lAIil•A:LE 2. VERTICAL DATUM IS NGVD. FOR BENCH MARKS /+Y� � TOM R A ✓ :N^ROYiO ON AND Arr£B Nsn+ea IS IwO / / SfT, SEE SITE PLAN. :N efsm:uf'D roeJ UL IA..NFRx �/ �J \`94 J. THE FLOOD ZONES SHOWN ON THIS PLAN ARE TAKEN �i� 1EXISTING / FROM THE FLOOD INSURANCE RATE MAP PANEL NO. I �� i�/'�/ -6t --z'�- +B 250015 0005 D. YAP REVISED: JULY ?. 1992 AND .' �Yq a ,'� �� ✓� .PUMP ONANiER DO NOT REPRESENT OR IMPLY A FLOOD CERTIFICATION'' './ +£ S ,'-' + • •A ,. �B 't FOR THIS STRUCTURE BY THIS OFFICE. ., _10 •j� ' I �yO I. BEFORE CONSTRUCTION CALL 'DIG -SAFE*. 1 '' y'�EK TIND �- _�� 1 -EDRNER CoNCRE7'� 1.888•DIO-SAFE AND THE LOCAL WATER DEPT. l ,Y SERF yNK E✓B. RR Koro i FOR LOCATION OF UNDERGROUND UTILITIES. t�� /.•�� ,' Fpf � Rta; i � l .Yn a .-- - .-- OfC*` \ I PROPOSED D= Of A //. RDVE e Va�tOR IL00.1 MCI ArA•.AB.i FOR J fR�CR ALA NL YLT BVILr OR J.RSYAIIr+AL,l IMPRIVEII ON N.L A'1£R O: TONCR 1 f:S IN DESI.:IUT+:O LOAIIAL SAAA'ERS. LEGEND ■ CB CONCRETE BOUND —0 WATER LINE 0 HYDRANT —a— OAS LINE — OHW— OVER HEAD WIRES 4 LIGHT POST —E— UNDERGROUND ELECTRIC LINE —T— UNDERGROUND TELEPHONE LINE — CTV— UNDERGROUND C49LEVISION LINE }.10.4 SPOT ELEVATION ,—AD--- EXISTING CONTOUR pal PROPOSED ,CONTOUR PROPOSED EN AND PORTICO t�A ceTnw F rQ„ a' F do o UP n/ST k V G '. pQ SB ..' p ,.. 10 20 AO IK OP B J / ' St�' f'•Ielf' ' SVi SWTER 51 CONSERVATION NOTES: 1. THE WORK LIMIT SHOWN SHALL BE FITTED WITH A SILT FENCE AS REOU/RED BY THE CONSERVATION COMMISSION. THE FENCED WORK LIMIT SHALL CONSIST OF A CONTINUOUS. STAKED. DUG -IN FABRIC SILT FENCE. THE FENCE SHALL REMAIN IN PLACE UNTIL THE DISTURBED GROUND IS STABILIZED COMPLETELY. PROVIDE ALTERNATE SILT FENCE SUCH AS STAKED HAYBALES IF NEEDED AS DIRECTED BY THE CONSERVATION COMMISSION. - 2. NO CONSTRUCTION RELATED ACTIVITY SHALL OCCUR ON THE WETLAND SIDE OF THE WORK LIMIT. J. ROOF DRAINS SHALL BE DIRECTED TO SUITABLY SIZED DRYWELLS FOR STORMWATER RUA'OFF CONTROL, I. INITIAL SOIL STABILIZATION ITITNIN THE WORK LIMIT. SHALL BE ACCOMPLISHED BY AFPL /CATION OF MULCH AND/OR LOAM AND SEED WEATHER PERMITTING. 5. ACCESS FOR DEMOLIIION AND CONSTRUCTION SHALL BE VIA THE STREET SIDE OF THE PROPERTY WITH LIMITED'ACC£SS AS SHOWN AROUND THE PROPOSED DWELLING SITE. 6. ALL DEBRIS SHALL LADED FROM THE SITE AS IT IS PRODUCED AND TRANSPORTED TO A SUITABLE SOLID WASTE MANDL I NO FACILITY. READ S/ TIE- P L,4 /V O F L A /V D G 369 GREAT / SL AND ROAD. MAP 14. PARCEL / WEST YARMOUTH. "A. P R EPA R ED FOR: M,4RT//V REILL Y 22 MAIN STREET, HYANN/S. MA 0200/ SCALE: % "- 20' ✓UNIT 30. 2006 REVISED: JULY 20. 2000 REVISED: AUGUST 7. 2006 EAGLE SUFRVEY I NG , I NC 923 Route 6A ° i Yarmouthport. MA. 02675 �ii ��l(jljrZ� (508) 362-8-132 _ (508) 432-5333 \t/ JOB NO: OT119 F_IELD:CFW/EEK CALC: SAH/CFW. CHECK: CFW DRN: SAH._ III h111r 11111 f•, •1 III "• n� n•, ,U1, rBl rl II�fLI I. �• EXIST. rwr. a(x.r•' REMODELED DECK SOLARIUM � I mJTC. r}157ING 5LIDING CYJrS '� \ur U TIT DL AND P1!lNA1 U t ITn IIIIN [�J�•r$ h55Y.lyNN pII(Yp EN AI rpF rN CIP 'I P1(N• lvl, 9mrIt rWG GU481! �_/ fYx_1 I�'ItrN Atx ©AIN irv'p rill I•III PIMP/r U I PEM ,1ST• _ nr ., iiisp[!'� `I EXIST. Ob DECK FIr. O _ 7 cis rvnulTrDLTnB1F1-NEW O_ I IWALK-IN n1lDresu, EXIST. "MOD. i � / E+ATti EXIr;T -�' rn MA TER ICL_5ET rwGalC,P DININGP.M, KITCHEN ° 1 CIDROONI Ic, '+-- - --- BATH i 1 E6 P' 11u �` IVAUP[D uunu;i I'+FRJn(nDm �/ I` n NEW LIFiP.ARY/ nev>rL I in,nm wen: I[ri FAMILY R.M. ;n �✓ �L�L,� ICn6 E1157. r1r11YnCC TO ^,F. PFB Tr - 1 PIMU'iED MI'J UrUIIN_=rU !'f " I I\/�1/I11j1'PEMOD. I .6.(� I :nlx ir.0 rrlllNGl (IftIU INyAjfl,w )1111 rpf!%i M; pfr \l ILAV. ,C• IM INII [YI:i1114_ - CI�.± \ '•L �• 1 -,t a:1 I I-i�riun rive �' C� /urP I 1 MVIL __-.- -- - - REMODELED „'lecvTr.r EXIST. L J MASTER nePJ+C 1Iv r SnPti/f � N L.tj Lr v,,l•9 IT 1nn n 111. w.J1..n1 nN!i 0 I IALL DEDP,OOM 1 A11C)" uI EXPANDED- n G SVG .\ ounce_ LIVING RM. P.FMOUELLD -- I O Fg11IU /AULTCD CFIhI11Gl ,1 nDON[ r STUDY .. NEW rt :.0.4C�- 1ro- _ -.-_ DECF, - - nanrp r 1 Gns _ ur ua L u .:. ;m E rwr IReS..t P -d�'- "gym SAS? tx :6D NIP AS rl New OPAYIT.-- r�LnlFp io - r.I'•I nU1u-IN --1 DECK eu11i 1N -x wnu ceLCTY -rIFW NE , N�W. .,,. �L;<•, - n 4 _ c-�lo. C I --- T m - L ��[CIp.CL2T(X --� ItM1 11(TlP.:. irT' MPMFP. A A A • -. LJ LW'/C I Ire ?A' THIS IDE NLW A POPTICO Q D A5 I As - Imw lcnln ! 1N IIM115 D I I — Irn",lux;1 I FI RST FLOOR PLAN EXIST. FIRST FLOOR. - 2300 S.F. EXIST. LOWER. FLOOR, - 1200 S.F. VISIT. GARAGE - 528 S.F. IIFW FIRST FLOOR. - 12G S.F. IIEW GARAGE - 2G1 S.F. LEGEND O EASTIIIG WALL C01-15TPUCTIO14 TO P.EMAIN [-7 NEW WALL CONSTRUCTION C7 EXISTII IG WALL C0115TRUCTION TO DE REMOVED © NEW 5MOF.E DETECTORS GENERAL NOTES: I J COIT P,ACTOP. 15 TO VEP.IFY EXISTII IG COIIDITIOIIS AI II I 0IME11510t15 III TtIE FIELD PP.IOP, TO THE 5TAPT OF %oF I, 2.) CONTPACTOP, TO P.EMOVE tY,15TI11G DOOP5, V II IDON',. WALLS, 4 P,OCrRIG A5 P.EQUIPEO FOF IIEW C0115TPIJf LI)II 3,) ALL NEW C0115TP.UCTION TO MATCH EXISTING IN MAI rH/11, DETAIL, AND FIN15H. 4) ALL WOPK SHALL COHFOP,M TO THE MA55ACHU501`1S STATE DUILDING CODE AHD ALL OTHEP. APPLICADLF LOCAL CODES ACID ORDWANCF.S. , ' 5.) ALL NEW GAS FIREPLACES TO DE INSTALLED AS PEP MANUFACTURER5 R15TALLATIOH N5TRUCTIOH5. VERIFY ALL REQUIREMENTS IN THE FIELD. i WINDOW SCHEDULE I,FE MANUFACTURER UNIT ROUGH OPENING A ANDERSEJ TW 2452 2' 6 /8' x 5'-4 7/8- DOUDL.EtIUNG---__-_—_ 8 CT CX 2 5'-3 1/4' x 2'-1 O 1/5" CIRCLE TOr Q Prot IT DOQP. C D TW 24310 - TW 21042 2 2'-G I/8'x 4'-0 7/5" 5'- 1 1 7/8" x 4'-4 715" DOUDLEtIUHG _.- DOUBLEHUtIG (MULLED) V./ TEMFEPED GLA%_ E LTC 3 G'-O 3/8' x 3'-2 3/4' CIRCLE TOP F CN 25 3'-5 1/4' x 5'-0 3/8" CASEMENT -- .— G CTOA 3 3'-0 1/2.' x 3O 1/2" QUARTER. POUND -- tl 5E r03 G' 0 1 /2" x 5- 1 1 1 5/ 1 V 5PRINGLIt1E CIRCLfTOP WINDOW I CR 25 2'-1 O 114" x 5'-0 3/8' CASEMENT __--- I IOTE:CDIM,ACTOR TO VEP,IFY ALLOUAtANICb Arlu 5lcco ur wlnvv.•a w:... ...... .. .... •,----- %1TH W111DOW MAI IUFACTURER PRIOR TO ORDEPIIIG OF W "DOWS (PEVISED:7/ 14/2000) ..,:1 i,-Il w w FLid 1 N Y^Il O /\ U coo o z-iU0 C7 `� � A W Qi CO Q^�l l4 W z rn 00 Q E� a O I�L•i E-1 0 F-�•-I W�y QL4 F-L-i E-H W m µi rll co c) SCALE DATE: G1s&3GLLYID 4/2G/200G JUL z 4 mus PP�OJ. NO. F TH P 25-92 1 2 DWG. NO.: -Al Qa MAPN I. �, • yxKENZIE '. DIVIL No. ]BOBB Ll//-\-�91 p ,II "JIINII L I; rt.P— I I L� Nfw CONT Rlp/_-rVOn rIF'% PCIYED CI IIM:ln ♦� Nfw P.pkEp CMIMIICt' N'/ ST011G FACING W w/ 5TONE FACNJ6 NY PED f.EUAP V P _ ___ ._ ___- — ._- .____ CD -_ _. co Z El W 1 l &MRUS v./Ir31�Flr NEW RED CEDAR I1r<SLLi PA'F a O LO P.00f SIt11 K.IZ5 IY1 12 � \ � N U co I u y W o D' STI..F FASCIA -- ---C BC9 \ T() Bf P.CPLAfFp AS PfUD. r{ in 1 ___. _ ___ _____ _ \ O TC _..... _. ___. ��11��^�^•.�'—r_ .. ___._ ____ _ .. / } 1 � `� 2�. TwrJr Pl ry+j I W I L� AjrFR.,,T,,.'vxi5 lyl ,IIr� {� I IIr '11 1 'I -! II(�I j i r RIFP (YIARDS r, 11 I 4I- LJI LJ,' /{ 1 1 �\„ II4W W1111f CCCnP. i W 1 '� IIII aLC Slf I hT R /•� �II � wrAlI11.PF. L U is r. nrsT noon ILI p_ILi'ptT�•R 5u9nWR n. Q I ; 1 nRv Ia CNA. -_ --- ------'-�'-- ID rfw 10 pe � iA COLUMNS LIXUMIF r�/V� rfT Wrw I I,?. U ,iiX L'/ATFRTABIE L X Ih1 Y IA 1 IIPW CARP. 5111E W � O v, FRONT ELEVATION RI,ln1 L 5 fH 1.t I!n.lu Al �fF rVNl nr Cvn.r4Nfp Ql C P.OUND LFVCL 11 r"(111..TN Xl f. hl!elnl - 1 �/ 5uerLLC#1 _ I v rvafnrtF. 1 - 1 W M W PE- a o 23' S'1 32 at (I" 7- IfX15iIIIG1 q rune DECK A G n Ab1 f ' m u•.r. I r r: I I I x E-1 U'IST 32. 12 f-1P1 i<1 RFlXnlll ' - llrrtf: fY151 R1f SOIIn I' IAUUi 4/11111If'N_IV IrV_ L(A11M115-�—'�- "' I 1V•4:fv 1 � I NEW I • • r ' �I 5TOP.ACB _ rnf�T. Cn91. 015T In51 [IF CA— N 5 BAST. �N x I BATH O EY.IST. BATH A \U NEW -- I a � \ BEDP.00M f Q F•—i EXIST. O II —i E U] MECH./ NOTE: fx15TING 5ouARe ro5T5 LDP'Y NEW E A-+ TO BC E1a 0 AND PS^LGCLU ,�1 Ann NEW lv A. fAwmr;S EXIST. I'IEw GARAGE CLOS. 41 ``I �LI E FAMILY RM. 1 nrtwX•cOlx: s Bl EXIST. « c > a+ q _ ExIST r _ GARAGE N g I I'JTf... FIRWDC 2-1 3M'. 9 1/4'LVL . 'Lu O nywFra AD5vr N nie; Etlwtjs Doors EXIST3v r uc 1 — MALL DfCF".BWf r, . � oISNTO NEW �p MUDP.00M I `n YI t1dw ' T"I E s SCALE ab.1 tout n BAP AREA uI UN APR NJ „f 5 NCN 5u rM 011 RE1P Nfw 9'O'. T0' O n.po:K 1/411_ 11 011 _ cto. DATE DIA �Illlr L,r 4/26/2006 L Ill!", I (v UNf (N (.a11!MIl9 waL ABa.4 NEW wnlu ANY C unr (X• PORTICO q5 Dff,FABN[ ,Nlrfir fl«>PA PROJ. NO. q D wrrt nm'rt A5 AS 25-92 1 2 A5 DWG. NO. 44'-4- 112'2 22'.F-x� (fX151111(.I ILYt5111u .) IfY15lING1• MAM(h MCItE L z A ( X. LEGEND pI"` L_L/�/•O/1 GROUND LEVEL FLOOR PLAN I= EX15TI11GWAU.CO115TP.UCTIOt1TOREMAIN, O NEW WALL C0115TP,UCT1011 rsrrOM1 r.L+`+� Z�� (REVISED:7/ 14/2006) C_EY15TIRIG WALL COI15TRUCTION TO BE PEMOITD � II" I , L'r I rIHG PMY' C(JnFr51•rll .3 r1Ylr I rA SI lD-rr. Il,rr.Aun "rm n11 n.rvnna.to oL ru'ru t uo.l,cU LEFT SI ,f- ELEVATION REAR ELEVATION nrvr rtxrt..rlrt r,l P.n l.rnwrr• t1 ,nr I ul^-rm from _ 111'l• 1'1'M IIf."N PIP Cl/I AOPPl1 I }IIt 11ir rl IJ r.f .r. PIMPLI .. lJ�l I ❑ •:L �I T n lerr { fPn l:l 'r Ae•r"r ' rVlrr Ili r!I L` „I� RIGHT SIDE ELEVATION_ r Irn rl t r rcamu lrr'rr rnnnc.w 11 til ruyY unnr»P Crt Nnl`LI' rr Nlxllr lr _... w h 0 a CQ o .� U co co Lo O zLo VI--1 � A �•W W W � � IV CI] z l�' 0 A Ex-1 0.1 O Fi E- 0 O � � W � � � Q W O � � co SCALE 1 /411= I 1—OII DATE : 4/2G/2000 PROJ. NO. 25-92 1 2 �F DWG. NO. _ ZI ZIE A 3 E (P,EV15ED:7/ 1 4/2000) I ^.P- tm ion.. ri Izom Al srru 11111121 FOUNDATION PLAN GENERAL NOTE5 s MATERIAL SPECIFICATIONS f0UNDATl0N';,: I AU. WOP,LMAII 5t11P 10 CC#IFOPIA TO THE Ff.MIIPEtA:IR5 OF lnr. CMDSACHU5ETT5 STATE BUILDING COD[, LATf.ST EDITIOII 2, FOP SITE LOCATIOtI AID GP.ADItIG mrOPMATl011, 5FE SITE PVdI. BY OTt1FP.5. 3. A55UtArr) NET ALLOA'NDLC 501L BFAP.RIG CAPA('tn. qq - 4CXN1 ' FOP A COMPACTED I.PD. 5AIIU/GPAVEt COMPOSITIOtI. COMPACT DA(.t.FIU. 5C)115 APOI �IID rrPIMCTF.R. 08A VIBPAI OPY COMPACTEF AUD 5AI ID/GPAVCL AIly A5 PEGUIFCU DURING r.OMPACTION TCI PP.OVIDE FIIIAL GPAUf'.. .1, COtICR.EI'E 9I171i,i M 28 DAY 5TRENGTt1. 1c 3000 n. 3W' AGGREGATE. DC516I IFD PCP. AMFP.ICAI I CONCUTE ItISTITUTE A.) 5TFEl FEIt IFOP.CIIIG BAPS: NEW BILLET STEEL. A51M A C 15. r.K DE 4;0 13.) Al ICt10R DOLT5 A5TM A 307 CALVAIII:ED. 5/3' D1A.. 12- LOI IG. N7 2' HOOK. 5PACFD AT 4O' n C.. MAY.. 1' O' FP,OM JOGS U11LC55 OTtIEP %15E tIOTFD. C.) wum) N9PF FABRIC: ASTM A 185: FU?.1115N FIA1' 5NEF.T5 PIACF IN TOP 1". W CD o ., U co CC) Ln o V) i co X ul ,eU o F P3 O x E-+ O Q z o H H oz w�C) SCALE 1 /4"= 1 I-O'I DATE 4/2G/2000 PROJ. C1. 25-E) 12 DWG. NO. Q4 (P.EVI5ED:7/ 14/2000) T Y I PLTur•.ilie Of IIFM4fl 1rtYC1 Iv �. MIT r I EXPANDED U15T. LIVING RM. ' I DINING P.M. " lI. �IbuuoljooIYI IIfIC YvY.AFIH�TO RL Mr 11 l/I!Ii111 Ifllif - EX15T. FAMILY PM.' 11.1 POOTI1N: it 1`11111n+N111� 1 I!Y15T_ROOF i GONST_ A BUILDING SECTION EXPANDED LIV. W. qS EX15T. WALL GON5T. 1 •p .IJ 11 I In H.Y 1 11't'+ 9 Illn IM [A.' 10W-V u1K. rr'NdP NEW ROOF- CON5T. --� wirp I "I If :r irll:rr v.r.r 'i+nr llfnl. 1p \ 1� r co ll I'll 'All ., , ' If r'Ilnll rlpUln+l'YI .?r 41!)1'rr) rrl'ITV:911:.• If i \\ _ _ _ F� f-� El •• M't Illy'+nlv nl • i . . .r.s I' 1 1. T_,I r� rr <r � Uj r'orn. w:nru r.rr erx r'rv,+•nr;. I•Innl Q•1 li2 \ NN co co F WT '.ZI `-1 LO `-Hca .•'r:�r r nI :u a noPliv U) '.•,-rtrr•'^"If. rS lFnr. — .. ram, A EXIST. WALL A P.EMOD. EX15T. REMOD. REMOD. P.EMOD. CON`')T. FOYEP, HALL I. AV. -- E3ATI1 50LARILIM -- I IL': LI•IM1n C4 O� 0 T Inv r rar:nn; rvnr••,:1 �rru%, Cub 'n I'nnll[l'a (\2 _ I i rI e , Ir, W PC v1 ll�.. co Z Q O � z EXIST. tl`W EXIST. r.. 'n•II . nm �.y ;r^•, .rr inn L f IALL %LV j -' LtATN -- , rn61-. I W I' Ip'/ 11r 9I 4...+1I _. r (:1.•I•'+r •, I. O E- ^ O 'A 11-1-10175 n BUILDING SECTION 5 PEMOD_POYER ail tlt11lrr A5 -- -�---- i • r r+ n'rr NEW P.00F CONST. r rl- r.V• IY r\:I r +I • I r r.+r ru I' nll I'IX: .. Prl+(.I.INr rrxM •I:nF lrn \ 151 R 1 rIl rr Rr p•In F PAtI nf"•!Il ntl'ul ' fD 91(Nlllrl'II IIY-'11" 1r r: �•nn.n nPUlnur nl ......... . s➢nrrlrnnY'-rv' 1'!I \t 1:4 nnna nrv:r w'+M r_rr rr v.. rl�rn+I' 1 v W ^� Gr.I uM r'(Ynlnl.l vlfY..f PfnM—�M1 TV IIr • .' I.+P. IN rr "I Tell, \ u;r u1:11 n'r I v'.l 10 mr nn —j.131r1.191/.r l�L'I _. I4+II"1 NEW LI6PPP.Y/ P.EMODELED NEW REMODELED NEW MA51EP MASTER MASTER FAMILY PM - DEW DEDPOOM BATH DFDP,OOM + 1 r¢'n1ttx: rr•9T ulxx 1 , - 9VDILrt+Y iUrrL(rm c -n.$Yrlr'cpnMIHG TfI P.I'I.,AIN I\'LP.IrI IN rIr.LLrl -� i}�N f, Ill...7 ) 11r 77'All WrPlul"I'l1 .1 .vlSlll tt'.I:nl lr4. rrvrMr AT WALIS(wf-ARr!-C !i• R07 ee H1A!url -v Tir-, r)i)I. t.'I' ifo IF-3tn AT µnll'111 fnvrr:r NEW NEW WALL CON5T. v EXISTING '- EXISTING.:' llll, rra 6 G GAP,AGt GAP,AGE GAP,AGE .ur ruw;r,,li 6-lrnrnur - - _9. lilr&^TT INWA111'MI (n- 13) _ J wl. ITTnsmnK: ,,Tr - uGv o•uxl: +—rronlry IN...DtloN'vm; r • ='I>In suKttl7v+ 1 I Ali, am I l �1:{y: ♦)'r f'i rr Nl(:.1_. 20 P'l nLr:Tr lt",r(`(jI I'll J1I-flJJ .._f rC'OTRLL1`+I 1U w T [fill TN FrnUr BUILDING SECTION NEW LIBRARl1 FAMILY RM. nBUILDING SECTION cy REMOD. 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Ir IAI^u51,011111P. p5r!APIIr.I.Wln T to rrr":r •• 3nr•1 157 rtcx IP, ,0',Ai 61up lr.vU ,• 21F4 Prr, - cord CAFACP 1cc - r: no t YWr-. nIu ,111.t-'IrlI nl`^XIn Ill .,ll.1, a. burl" W. 111 rol l nn'O:%` 111Wo,P p M I a/nl I rP0"V:n PINT x,'. n, F+T r. mA,TmuM 11r", n melnY. '>v!rrNln F. nln nl<[r ur:,n Prncn.r: l r' dv:rnnn5 rPr.N 5,Ur l(w P:nn:'rr,j STUUrI uax u,n+ns; encn Ellu lw.z lunlo unm. lunrn, Il" I'll f_' nr' T AIU!nll NrlllNr. !iI1Au Hr Ill Actr i` wx won rlTl-mm CrX w,3'Toll Pool, r,. Yl VII A IPSS NOIFn nl"Yrnl FrpClr!rf lh P ZnI,I. 11n1155'IAII Ill'(TMY.N.MI'.,IPJ IIn 11^� r IY,1'r nmrRr; NAH,,,, rlp, l') nrVT lSt%A! C MI4,11'I r5T11115 I4,1 /t I7- lA-.rPtU r nPAVEx50"Too THAII. A' rl lltir] r•k�:All (,rITP'i rPPNln'I�ArIII r=•Pl,*, 1.1,Tr PIIPn... r R,e?Yq CIX?r �X q rP r!nC. LFIIIKVYI) top 1FA,rflnll !i:IrnllllllG Ilnlll,lr. IP II) PILL-FI�IA1'. 114=1 IIAII),)Iv_� 'IR cr •^,Puc1.l1 rn.2 c•ov n.l llp e'e.. nAA: lr•r.., I'nl::!-. n!• r" co w 1 F .`7 In 0 �\ U c0 OJ LO O zLC) � v U) �wQ �w x 0 OCool V/ A � A v) zu) 0 co 0 A F a 0 d x F 0 C4 O W O 0) CD co SCALE : 1 /4"= 1 '-0" DATE : 412GI2000 PROJ. NO. 25-92 1 2 DWG. NO.: M L�_ (REVI5ED:7/ 14/2000) 1I G TOWN FEB ,g,IIV 3u;LUNG of 6y: Building AT. Location 36 4 6 New X Plans Submitted Yes E3/ APPLICATION FOR PERMIT TO DO GASFITTING (OFFICE USE ONLY) By `�' Fee: $ / PERMIT NO. l� —07 C� o3 Replacement ❑ Date Owner's nn Name /v/!c iti t; A2 12, 4 & Type of Occupancy �7 {?�•' �116 N 2 At V lA U Z 2 2 W 0 W cc O 0 m H ~ En " J X W Q > Z Z o 2 Lu _ 2 m W~ Q W 2 Z WLLI O to M O 2 W~ > W l ^ 12 c7 F GLLI F- 2 e A (311C1 V� C7 ~ Q Z W J J r Q Z S~ W F w r rA O m > Z lL O P Z= C) J 0 F rA W 2 e X= � J d F O� O a 2 t=L � G C7 U 2 > C SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR (PRINT OR TYPE) (� Installing Company Name co Address -11 R Q �� - 0- Li N V--1 r l Check One: ❑ Corp. ❑ Partnership — rm/Company Business Telephone 1�,1 Name of Licensed Plumber or Gasfitter INSURANCE COVERAGE: Check One I have a current liability insurance policy or its substantial equivalent. Yes Imo ❑ If you have checked yes, please indicate the a 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 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. Signature of Licensed Plumber or Gasfitter �Lf ,,Y,---) License Number TYPE LICENSE: ❑ Plumber ❑ Gasfitter ❑ Master l�Jorneyman 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 To the Inspector of Wires: By FEB 2 g 2007 (OFFICE USE ONLY) (Rev. 9/05) Bydwi 1. V-9 . Fee:$10. 1(1O. 0-- 169 G PERMIT NO. L 7PJ— 7M? Date: gives notice of his or her �) work described below. L j (� Location (Street & Number) E �% �,�aT =-5��• �� 2c! �Owner orTenant Owner's Address ALLIINVPORIIMA perform the electrical Telephone No. 503 r7 914 5 36 Is this permit in conjunction with a building permit? 0 Yes []No (Check Appropriate Box) Purpose of Building ; Utility Authorization No. j �l3 L/ CExisting Service 100 Amps 0 ZZOVolts Overhead[] Undgrd OL No. of Meters 1 � New Service .7 L�O Amps I I U / ZZ=l Volts Overhead[] Undgrd [9 No. of Meters / dumber of Feeders and Ampacity Location and Nature of Proposed electrical Work: . i rt-_ L._) B oS' .Se U i C Com letion ofthefollowing table may be waived by the Inspector of Wires 4 No. of Recessed Luminaires No. of Ceil.-Sus .Paddle Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Above In SwimmingPool md. [] md. [] No. of Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. of Detection 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 — — K — — No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Municipal Local [] Connection [] Other of Dryers Heating Appliances KW SystNo. SQcurNo.tof Devices or Equivalent 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 E uivalent Attach additional detail if desired, or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued unless the licensee provides V) of of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in �y forc , and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [a BOND[] OTHER[] (Specify:) Zy (Expir on Date) ,,Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 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 ' true and complete. .M FIRM NAME: LIC. NO. Licensee: . 7n Signature LIC. NO. is 17 D (If applicable, enter "e emgt in the cense nu�per line.) Bus. Tel. No.: Address• 12- LeA4;11 S4— sr, .lwic L, 02Sb Alt. Tel. No.: S6 e/ S *Security System Contractor License required for this work; if applicable, enter th icense number here: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the ability 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. WPS - Permit Page 1 of 1 NSTAR WPS - Permit Work Order Information Utility Auth/WO #: 01574434 Date: 02/28/2007 Company DAVID LENTINI Rep: Report By YAR0697 GREAT- 16,-,�„`:;;- ;P RE-166 �. MARTIN T 24r666;'o Status: ACTIVE Service: INCRS Type: RES Nature of Work: UPGRAD 100 TO 200 AMP UG TO POLE... ADDING 1000 SQ FT ADDITION/ JACUZZI/ LITES/PLUGS.... NOT RELOCATING SERV... NEEDS SCH DISC/ REC... NO FLAT FEE QUOTED.... TO BE DETERMINED AFTER DESIGN... RESEAL AFTER INSP Service Information: There Is no Service Information. Permit Information Permit #: E07-799 Meters: 1 Reseal (WN): Y Date: 04/17/2007 Inspector: W10060 Description: Search Detail ^Contacts NSTARHomeWPS Loaon WPS Help Comments WO Reauest WPS News 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.comlappslwpslwpspermit.cfm?Page=Permit&Unique=l ts_'2007-0... 4/17/2007 .1 TOWN O�YARMOUTH F-1 CECt, �_ 3 o E FEB 12 2007 L . d2 r 6L/:D`:G C Pi ©y. APPLICATION FOR PERMIT TO DO PLUMBING (OFFICE USE ONLY) Fee: $ �/ 1— 103 1190 PERMIT NO. 0 / Date Building Owner's /qet )1 ,%,j AT. Location 3 (oq GKy.4 /-.�"-41VW Name \ % Type of Occupancy D �titE �1 1 n New 9 Renova on Replacement ❑ Plans Submitted Yesi4 No❑ I�a1 1 �V`� Z w z R 3'v07 w V) Y J m y Q U 2~ Y Q z Z O 0 y Ly z of Z y w m FQ- m W S Lu Q W to N Y 0 I LQ LL Z Q Z_ a ga x_ Z w O � w Q U) Q y K J Z G G 0 LL w S a 3 0 G z = Lu .j Q, F Q Y Q Q. w u. LL `1 Q. w Q h- a x Q 2 N IL Q p a 0 0 0 J m N O N D J Q 2 Q F- N LL Q (7 W 7 W 0 W Q Q O W Q m H 0 U -BS BAS ENT 3 [ [ FLOOR I 3 1 1 2 2ND FLOOR 3RD FLOOR �WA �o �e�w MOT �rr Prjc -Qb � z w A7 -I�B �� X-f15 v I'.' �7K// � r CI �JR�%��� Installing Company Name i . �c6 �� V t,Lb, Urn t�SA t❑ Corp. Address 3 Q -� - (r t N �� Ln. ❑ Partnership �L%%1 Vt�o�;` � I MA D? to"l3 �m/Company Business Telephone �� `} ` �!^`�%� I Name of Licensed Plumber -� ^3 � c INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent. Check One: Yes (7� 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 coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent 1 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 ❑ ire of Licensed Plumber License Number Type: Master❑ Journeyman 11� G4► � 8) - syz 3-2 z RE -INSPECTIONS l �l' RE -INSPECTION 2" RE -INSPECTION DUPLICATE WEATHER CARD DATE: ADDRESS: ISSUED TO: REASON FOR RE -INSPECTION: BUILDING DEPT.: ELLC:'1 MUAL: FIRE DEPARTMENT: GAS: OCCUPANCY PERMIT: PLUMBING PERMIT: OTHER: 3 $30.00 $40.00 $25.00 FILED WITH T PETITION NO: HEARING DA'I PETITIONER: PROPERTY: MEMBERS PR] Richards, Mr. S, Notice of the he, property as requ. Register, the heal The petitioner sE home. The prol single-family he a front -door "po then be only 24' the petitioner's 1 front door, but n DOCZ17055l232 01-31-2007 10-00 BARNSTABLE LAND COURT REGISTRY TOWN OF YARMOUTH BOARD OF APPEALS DECISION CLERK: September 279 2006 #4069 September 14, 2006 Martin T. Reilly 369 Great Island Road, West Yarmouth Map & Parcel: 14.1 Zoning District: R25 ,NT AND VOTING: David S. Reid, Chairman, Mr. Joseph Sarnosky, Mr. John Igoe and Mr. Steven DeYoung. has been given by sending notice thereof to the Petitioner and all those owners of by law, and to the public by posting notice of the hearing and publishing in The opened and held on the date stated above. :s a Special Permit per bylaw §104.3.2, in order to extend a pre-existing non -conforming ty is in the R25 zone. The lot contains an area of 19, 320 square feet, and an existing ;. The home is undergoing extensive remodeling at this time. The design plans call for m?' to extend about five (5) feet from the front wall of the structure. The portico would om the front lot line, where a 30 feet front setback is required. The portico, as shown in ns and photo -quality rendering, would be as open structure, providing a roof over the adding any interior space. The Board finds that the proposed extension would not be substantially more detrimental to the neighborhood. The portico would be an attractive architectural feature, not affecting the use of the site or structure. The lot appears to have the benefit of substantial additional space between the private road surface and the road layout, making the encroachment area less of a concern visually to the neighbors. Accordingly, a m tion was made by Mr. Richards, seconded by Mr. DeYoung, to grant the Special Permit, as requested. The members voted unanimously in favor of the motion. The Special Permit was therefore granted. No permit shall is ue until 20 days from the filing of this decision with the Town Clerk. Appeals from this decision shall be tnade pursuant to M.G.L. C40A §17 and must be filed within 20 days after the filing of this notice/decisidn with the Town Clerk Reid, 1 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00 Far aF y49;oi (OFFI E USE ONLY) = T F W UTH By •^//l/� MpTTACHEESE t42x.90 Fee. JUN U 6 2005 ��✓{{{{ ✓ fn- PERMIT NO. — S (PLEASE PRINT IN INK TION) 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) tf �G� �iEYI MA1yy Owner or Tenant �tC I/�i8 Telephone No. Owner's Address Is this permit in conjunction with a building permit? 0 Yes C3 No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts OverheadEl Undgrd r3 No. of Meters New Service Amps / Volts Overhead Undgrd C1 No. of Meters Number of Feeders and Ampacity L� t�9��C Location and Nature of Proposed electrical Work: D"'p J2,n�_a c Cmmnletinn of the following table may be waived by the Insnector of Wires 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 Lighting Fixtures Above C3 in SwimmingPool rod. rod. No. of Emergency 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 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 Local ❑ Connection Other No. of Dryers ry Heating Appliances KW g pp Security Systems: No. of Devices or ui valent No. of Water Heaters KW No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent dromassa a Bathtubs No. H y g No. of Motors Total HP Telecommunications Wiring: No. of Devices or uivalent Attacn aaamonat aetau q aesirea, or as requirea ny the inspector of wires INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies tha such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE �— BOND O OTHERCI (Specify:) l lG �v Expira n ate) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. 0'. I certify, under.1hppains a It y 2f 131213 t, tha the infi FIRM NAME 15?0 � /� E�l KA J Licensee: Signatut (If dress! 1?5 fitter "exempt" in the licetyse numl2er e� Address•���/�'���' l� :Qi� CUB i on this application is true and complete. -., /i LIC. NO. LIC. NO. Bus. Tel. No.: t. Alt. Tel. No.: I rd 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 Signature [Rev. 04/001 Telephone i °`YAR TOWN OF YARMOU 2 � ��s BUILDING DEPARTMENT RECEIVED OCT 1 3 2006 BUILDING DEPT. NOTICE TO THE BUILDING DEPARTMENT OF WITHDRAWAL OF LICENSED CONSTRUCTION SUPERVISOR FROM PROJECT 19 ��d r 17��le I CONSTRUCTION SUPERVISOR LICENSE # d0t/382 HEREBY CERTIFY THAT 1 AM NO LONGER THE CONSTRUCTION SUPERVISOR LISTED ON THE APPLICATION FOR THE PROJECT UNDER CONSTRUCTION AS AUTHORIZED BY BUILDING PERMIT # Fs'b7- 221, ISSUED TO4J6t l!-te-P ON 1 ALSO CERTIFY THAT ON I-30-a 6 ', 1 NOTIFIED THE PERMIT HOLDER; THAT THE PROJECT UNDER CONSTRUCTION MUST CEASE UNTIL A SUCCESSOR LICENSED CONSTRUCTION SUPERVISORS IS SUBMITTED ON THE RECORDS OF THE BUILDING DEPARTMENT CONSTRUCTION SITE��?tier �SC�Ido /1/�_ MAP d/'/- / PARCEL LICENSED HOLDER DATE: TOWN OF YARMOUTH BOARD OF APPEALS DECISION FILED WITH TOWN CLERK. September 27, 2006 PETITION NO: HEARING DATE: PETITIONER: PROPERTY: 94069 September 14, 2006 Martin T. Reilly 369 Great Island Road, West Yarmouth Map & Parcel: 14.1 Zoning District: R25 :.. "'. 07 MEMBERS PRESENT AND VOTING: David S. Reid, Chairman, Mr. Joseph Sarnosky, Mr. John Richards, Mr. Sean Igoe and Mr. Steven DeYoung. Notice of the hearing has been given by sending notice thereof to the Petitioner and all those owners of property as required by law, and to the public by posting notice of the hearing and publishing in The Register, the hearing opened and held on the date stated above. The petitioner seeks a Special Permit per bylaw §104.3.2, in order to extend a pre-existing non -conforming home. The property is in the R25 zone. The lot contains an area of 19, 320 square feet, and an existing single-family home. The home is undergoing extensive remodeling at this time. The design plans call for a front -door "portico" to extend about five (5) feet from the front wall of the structure. The portico would then be only 24' from the front lot line, where a 30 feet front setback is required The portico, as shown in the petitioner's plans and photo -quality rendering, would be as open structure, providing a roof over the front door, but not adding any interior space. The Board finds that the proposed extension would not be substantially mere detrimental to the neighborhood The portico would be an attractive architectural feature, not effecting the use of the site or structure. The lot appears to have the benefit of substantial additional space between the private road surface and the road layout, making the encroachment area less of a concern visually to the neighbors. Accordingly, a motion was made by Mr. Richards, seconded by Mr. DeYoung, to grant the Special Permit, as requested The members voted unanimously in favor of the motion. The Special Permit was therefore granted No permit shall issue until 20 days from the filing of this decision with the Town Clerk. Appeals from this decision shall be made pursuant to M.G.L. C40A §17 and must be filed within 20 days after the filing of this notice/decision with the Town Clerk. avid 9. Reid, Chairman OTI Board of Building Regulations and Standards Construction Supervisor License License: CS 80556 Birthdate: '4/23l1958 Expiration:" 4/23/2009 Tr# 13923 Restrictiorr..00 o Tr- BRIAN W RODOALPH 7 FIELD ISLAND POINT' SO SANDWICH, MA 02563-" Commissioner � r APPLICANT Richard P. / RELD COPY BUILDAG PERMIT D—r2plirmary-28 2001 PERMIT NO. B-01-561 Garneau Jr. ADDRESS 251 Woodside Rd. W.Barnstable I -A 02668 (NO.) (STREET) A4Q4m%f ENSE) ALTERATIONS NUMBER OF PERMIT TO ER (_) STORY DWELLING UNITS (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) y� ZONING f{ AT (LOCATION) '*T` C'reat Island Road # 369 W.Y. 02673 DISTRICT R-25 (NO.) (STREET) BETWEEN (CROSS AND (CROSS STREET) LOT SUBDIVISION 14/1 LOTK82 MapK 9 SIZE 43 BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE 5 6' USE GROUP 1 \-• BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: Florida room on existing deck roof OV r h Windnw W111 Pnrtinn of --{Grim} wood deck/extending north east section 7' 6" -- 11 AREA OR VOLUME (CUBIC/50UARE FEET) i ESTIMATED COST ) i e OWNER Lawrence O'Connor ' ADDRESS 118 Admiral Lane, Key West Fla. 33040 PERMIT $ 16*500.00 FEE $ 209-00 BUILDING DEPi BY i INSPECTION RECORD DATE NOTE PROGRESS - CORRECTIONS AND REMARKS INSPECTOR ONE & TWO FAMILY ONLY - BUILDING PERMIT APPLICATION TO CONSTRUCT, REPAIR, RENOVATEIDR DEMOLISH AONE 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. � Date WjW o Permit Fee $ — Deposit Rec'd. $35, Datela"3 Net Due $ ��tf,�.� Planning Board Information Plan Type 7— Endorsement Date Recording Date Plan No. Other Assessors Department Information: Map Lot r , _ y neap Lot $L Old New 1.4 Property Dimensions: Lot Area (sf),c13 Frontage(ft) Lot Coverage This Section for Office Use Only Building Permit Number: Date Issued: `� ? Signature: Certificate of Occupancy is is not required wilding Off i ' Date Section 1 - Site Information I Use Group: R-4 Type: 5-B 1.1 Property Address: 1.2 Zoning Information: oning District Proposed Use 1.3 Building Setbacks (ft) Front Yard Side Yards Rear Yard Required Provided Requi ed Provided Required Provided 1.4 Water Supply (M.Gi.L. c. 40. S 54) Public Private 1.5 Flo d Zone Information: Comments: Zone: -& `'BFE: at Section 2 - Property Ownership/Authorized Agent 2.1 0 ner of Record: !�/�L✓I�IF/1�C'e // '(-04//O�fi a//IiAA/ - !• �S/ /'� Nam (print) Mailing Address30yQ o�iuuv�u O Asa-. ,S'o 77,E ` 7 z '- Signature Telephone 2.2 Authorized Agent: / _ t7 lam' c�A1-2n/f 44.jZ 17oA6 P9,4 Na (pr' t) ��� �t�67 Mailing Address 96- %G% Bab I-Qnature Telephqe7 Section 3 - Construction Services 3.1 Licensed Construction Supervisor: Not Applicable ❑ rd 219 2001 C - Licenragum 7J1 Ad .7 9G ? Expiration Date !: ZYZO-2 ature Telephone 3.2 Registered Home Improvement Contractor: Company Name , 2 Not Applicable ❑ A esK -3 ignature ele License Number 1000341 Expiration Dat 9 - 15 - 99 1 of 2 OVER Section 4 - Workers' Compensation insurance Affidavit (M.G.t: C. 152 S 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 I No. of Bedrooms No. of Bathrooms Existing Bldg. ❑ Repair(s) ❑ Alterations Addition ❑ Accessory Bldg. ❑ Type Demolition Brief Description of Proposed Work: 1A /nni7 /Je i+/i �Yi�./�iw//:, Nni/h �d!-� - SOCIn w/ / ��w Section 6 - Estimated Construction Costs Item Estimated Cost (Dollars) to be completed by permit applicant 1. Building o0 2. Electrical s o0 3. Plumbing / Gas 4. Mechanical (HVAC) 5. Fire Protection 6.Total=(1 +2+3+4+5) 00 sa 7. Total Square Ft. (new houses & additions) Check Below ❑ Conservation -Commission Filing (if applicable) ❑ Old Kings Highway & Historical Commission approval (if applicable) Section 7a - Owner Authorization - To be Completed When Owner's Agent or Contractor Applies for Building Permit I, 1-4A14V Ve O e .'-�— , as owner of the subject property hereby authorize ',�ehA¢V to act on my behalf, in all matters relative to work authorized by this building permit application. -MU !!� `l Z /s/dVol. Signature of Owner Date Section 7b - Owner/Authorized I /f/r/fA2 f�- C�,i7.f/Pa7J TiZ 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. //C ".4 /c v r - Print name sl'guiature of Owner gent 9-15-99 2of2 �� Date 0oF' �R �{ Y �c TOWN OF YARMOU H �:�.,,�y BUILDING DEPARTMENT 93l� 5- BUILDING PERMIT APPLICATION SIGN OFF Applicant: �� i //,fR'D J.) 6ARIllP.AIJ a7 Building Permit No.: �ao 6� o0 Address %— Tel. No.: 779-3797 Date Filed: zek Bldg. Site Location: 6 Map No.: Lot No.: K_'z? 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: 1 5-k L I 1 t WATER DEPARTMENT: )al _ Vy - DATE: 10 N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: ja! ONSERVATION: DATE: N/A: 1� HEALTH DEPARTMENT: DATE: I i C 0a N/A: 5. WIRING INSPECTOR: 6. PLUMBING INSPECTOR: 7. FIRE DEPARTMENT: — All stumps and/or brush must be disposed PLEASE NOTE at an approved site. ucI R�.vt .0 - � -- - DATE: DATE: DATE: N/A. - N/A. N/A: L l a So/5T Ae S 7 Ou r D O' F40-orz, :To-Irr5 T ac-cTu F o o Dh 40 l'/_A-O/ncG WtIr-N-frr ��` 0J �/YfS/-f'c) Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. IL�I IL�I Massachusetts Department of Environmental Protection CHOP Bureau of Resource Protection - Wetlands WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 A. General Information From: YARMOUTH Conservation Commission To: Applicant Lawrence O'Connor Name 369 Great Island Road Mailing Address West Yarmouth MA 02673 Cityfrown State Zip Code Property Owner (if different from applicant): Name Mailing Address City/Town Zip Code Title and Date of Final Plans and Other Documents: Proposed construction for Lawrence O'Connor REV 2/2/01 Title Final Date (or Revised Date if applicable) 2. Date Request Filed: 1 /16/01 B. Determination 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 (if applicable): To enclose an existing deck. Project Location: 369 Great Island Road West Yarmouth Street Address CityfTown 14 1 Assessors Map/Plat Number Parcel/Lot Number WPA Forth 2 Page 1 of 5 RA min H 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 B. Determination (cont.) The following Determination(s) is/are applicable to the proposed site and/or project relative to the Wetlands Protection Act and regulations: Positive Determination Note: No work within the jurisdiction of the Wetlands Protection Act may proceed until a final Order of Conditions (issued following submittal of a Notice of Intent or Abbreviated Notice of Intent) 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 after that 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. ❑ 5. The area and/or work described on referenced plan(s) and document(s) is subject to review and approval by: Name of Municipality Pursuant to the following municipal wetland ordinance or bylaw: Name Ordinance or Bylaw Citation WPA Form 2 Page 2 of 5 a.,, roan 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 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. ❑ Alternatives 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 Act. Therefore, said work does not require the filing of a Notice of Intent, subject to the following conditions (if any). Roof runoff shall be handled by drywells or drip trenches. ❑ 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. WPA Forth 2 Page 3 of 5 P. mmn In •\kil; 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 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 provisions) ❑ 6. The area and/or work described in the Request is not subject to review and approval by: Name of Municipality Pursuant to a municipal wetlands ordinance or bylaw. Name Ordinance or Bylaw Citation Authorization This Determination is issued to the applicant and delivered as follows: ❑ by hand delivery on ® by certified mail, return receipt requested on 2/06/01 Date 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 Appendix A) and the property owner (if different from the applicant). Sigi 2/01/01 Date WPA Forth 2 Page 4 d 5 P' Mm 1►► kW! 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 D. Appeals 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 Appendix A) 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 Appendix E: 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. WPA Form 2 Page 5 of 5 Rev n1m 94440& _.._REAR. FlIVA7ro1-e rg.,sr,v DErK RAI Nfv,I ST-vcT�Ac 6 rx;snj DECK im "lull, �.TIOVIJD �-,Ems7T,J 6A2.106 : M F.ROOR'U'l, I V.� C,, R , --c S -��O"Tg 34-7 70 ..._ ___. .,a,:_ su 9� V'= Board of Building Regulations One Ashburton Place, m 1301 Boston, Ma 02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 04/04/1957 Number: CS 009714 Expires: 04/04/2002 Restricted To: 00 RICHARD P GARNEAU JR 251 WOODSIDE RD W BARNSTABLE, MA 02668 Tr. no: 21613 Keep top for receipt and change of address notification. / i • . • • i111 • ' I • • • • One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration RICHARD P. GARNEAU JR. G.C. & Remod Richard Gameau Jr. 251 Woodside Rd W. Barnstable, MA 02668 Registration: 100034 Type: DBA Expiration: 6/8/02 Update Address and return card. Mark reason for change Address ❑ Renewal ❑ Employment Lost Card 0oFY�� TOWN OF YARMOUTH p,,;,,•'�,,; BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT. Job Location: ILD7C CA I Z s I AA.;v v h " . Number Street illage Owner of Property: D'CCf4) Jn? • • • - • I1TJ:/.ill�7�f�JCITL/RC7/�R�1� Licensed Designee: '--s4a+2 (If other than Supervisor) Name License No. 2.15 Responsibility of each license holder: S —J%Y' 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 Any licensee who shall willfullyviolate 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 �d No ❑ If you have checked yas, please indicate the type coverage by checking the appropriate box. A liability insurance policy 0 Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Cha ter 1 2 of a Mass. 9eneral Laws, and that my signature on this permit application waives this requirement. Check one: Sig ature of Own r or Owne s Agent Owner ❑ Agent L&� 7 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: 1�)rc e jvc,Io sew Est. Cost Address of Work Owner Name: l AaJRCA1C (? O'coOR Date of Permit Application: o 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: 144, 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: 0o n 03 'Date Contractor Name Registration No. OR: �/CI ,4IeD R�5,4,Z1VeJl1)T(3- 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 ON ao/1"est/pstlsss 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit IlLwal, ( 1 n 11:, t 1 94K51lxi .,a.�r I 114 Out 1��Wffrdww#-- M L/ f O 1 am a hortfeowner performing all'work myself. 2' 1 am a sole proprietor and hase no one working in any capacity O 1 am an employer pro%iding workers' compensation for my employees working on this job. comnanv name, /FfCNrIi2t7 address: rr�� // l.�groe-�y/Scat citV: 14 !d �17 V5 l f) /� l & A4 an2e5Ge phone M• 114F— (206 insurance co policy N I am a sole proprietor. general contractor, or homeowner (circle one) and have hired the contractors listedbelow who have the followin_ worker' compensation polices: company name: address: city- phone N: insurance co policy N company name: Failure to secure coverage as required under Section 25A of MGL 152 an lad to the imposition of criminal penaltiesof a fine op to SI M.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a floe of 3100.00 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 yerifleadoa. i do hereby certify under the pains and penalties of perjury that the information provided above is true and correct% Signature �u1�r/'�r� % Date I /��( Print name _&11*7 /� P. Gft7ZA)rA✓ -: (Z_ Phone N 4LF_— � 45e ;!finial use only do not write in this area to be completed by city or town official city or town: YARMOUTIL _ permit/license N nBuilding Department pLicensing Board EJ cheek if immediate response is required 261 OSelectmen's Olfiee pHealth Department contact person: phone N; _ (508) 398-2231 ext. MOther (, s,sed 7:95 PJA1 Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their enipIo%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 erttplot•er is defined as an individual. partnership, association, corporation or other legal entity, or any two or more of the fore(min_ 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 dx%ellinc 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 emplo%er. %lGL chapter 152 section 25 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 commonwealth nor an% 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 suppl%ink* company names, address and phone numbers as all affidavits maybe 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 110ce of 19YOsuladOOs 600 Washington Street Boston, Ma. 02111 fax #: (617) 727-7749 phone #: (617) 7274900 ext. 406, 409 or 375 TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 260 PLEASE PRINT: DATE: JOB LOCATION: NAME "HOMEOWNER" NAME PRESENT MAILING ADDRESS HOMEOWNER LICENSE EXEMPTION STREET ADDRESS HOMEPHONE SECTION OF TOWN WORK PHONE CITY OR TOWN STATE ZIP CODE The current exemption for `Homeowner' was extended to include owner — occupied dwellings of one or two units and to allow such homeowners to engage an individual for hire who does not possess a license, provided that such homeowner shall act as supervisor. (State Building Code Section 108.3.5.1) Definition of Homeowner: Person(s) who owns a parcel of land on which he / she resides or intends to reside, on which there is or is intended to be, a one or two family attached or detached structure assessory to such use and / or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner; such "homeowner" shall submit to the building official, on a form acceptable to the budding official, that he / she shall be responsible for all such work performed under the building permit. (Section 108.3.5.1) The undersigned `homeowner' assumes responsibility for compliance with the State Building Code and other applicable codes, by-laws, rules and regulations. The undersigned `homeowner' certifies that he / she understands the Town of Yarmouth Budding Department minimum inspection procedures and requirements and that he / she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL Ch.142. Yes EMI No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy P� Other type of indemnity ❑ 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: iiature of Owner or Owner's ent Owner ❑ Agent h:homeowm1icexemp BUILDING TOWN OF Y A R M O U T H ELECTRICAL GAS 1146ROUTE28 SOUTHYARMOUTH MASSACHUSETTS 02664 4457 PLUMBING Telephone (508) 398-2231, Ext. 261 — Fax (508) 398-2365 SIGNS BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at 36gt 62Par-'5An1 D � a0777 Work Address is to be disposed of at the following location: '"z -relz 6C Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. i Signature of Applicant . Permit No. PLOT PLAN Abuttor's Name Lot # Tf this is a corner lot, write in name of street. FOR LOT # Indicate location of garage or accessory building Additions with dashed lines -------------------- Sewerage disposal (cesspool) Well (g I I (lot../J�C112y.... ft. rear) I SIDE YARD 00 ft ,_ FT_ �t 19 REAR YARD ....5-,� j....ft. I SIDE YARD I SET BACK I ( lot.. /. L .( : a..l ..... ft. frontage) 2A . (NAME OF STREET) Abuttor's Name Lot # If this is corner lo- write in _ name of cL other 8 street. ro (VJ vJ S Information �j�ZJ11C'fJIJ �12. Supplied by icrfA7r17 AS %rz C,;zT. f lo'1— ?1AAI MARK NORTH POINT SUBMITTAL REQUIREMENTS / CHECK LIST FOR BUILDING PERMITS New Structures 1. Application signed by the owner and owner's authorized representative / construction supervisor. Application shall include: Construction Supervisor's License, Worker's Comp. Affidavit / Certificates, Home Improvement Affidavit (all applications except new homes). 2. Four proposed site plans, stamped by a Mass. Registered Professional Land Surveyor, showing all boundaries, proposed setbacks, existing & proposed grades / contours, proposed location of structure(s), parking, curb cuts, drainage, impervious cover calculations (when applicable), flood zone and Title V design and any other zoning related details deemed necessary. 3. Three sets of complete construction plans, including a complete structural cross section, floor plans, use of rooms, dimensions, window & door schedule, HVAC details — electrical, plumbing & mechanical plans are also required for commercial & multi -family (3 units or more) structures. 4. Flood zone applicability — Compliance with Section 3107 of the State Building Code — Elevation or f lood proofing certificates (whichever is applicable), shall be submitted prior to the issuance of a certificate of occupancy. 5. Plans shall be reviewed by the following departments: Health, Engineering, Fire & Conservation (when applicable). The Building Department will forward. 6. Old Kings Highway & Historical Commission (when applicable). 7. Mass. DPW approval for State Highway curb cut and access ways. 8. Construction control affidavits for all projects to be constructed or altered under the provisions of Section 116 of the State Building Code. Buildings containing 35,000 cubic feet or more. One & two family structures are exempt; except certified designs may be required for unusual structural circumstances. Section 3107 of the Building Code requires certified plans for new and substantially improved structures in flood zones. Additions 1. Same as above, except the blank generic `Plot Plan' available from the Building Department may be used for one & two family structures when setbacks are not marginal. 2. Flood zone applicability — When the value of improvements equals or exceeds 50% of the structure value (substantial improvements). Alterations 1. Same as above, except existing & proposed conditions shall also be shown on the plans. NO WORK IS TO COMMENCE UNTIL THE BUILDING PERMIT HAS BEEN ISSUED. Filing a building permit application does not imply approval and should not be construed as permission to begin work. • LC-1- 61 I 1 � I 1 I}� m D In T9j?IL IS r 1 P 75 N � e z , EXISTYr Docr� L•o 3t�3.1 i \ \ I1 �8I6 i51.3 31 AO LOT 32- 19,4oO * a o.A, y: APPROXIMATE C456011. BF-Lmw n Q L EACHI N(K MHu1 L) a1taA. �b 7 1�S I en Fe of J r��5• LJLLJJJ .��.,J!�oxy-_8'tt,.l TR ELK 3' T owN4� , F-'�- 1 NG /{,� >ECK. ge 0. , �Thr4.,K O 67lISTINCr 7Iz-r go 7d wb, FR`�I. �. S� -n •- ` -•0 I IZf I 7•T APPROVED: BOARD OF HEALTH DATE AGENT vl\ %L..S7EC 1N �RE.TAININ4 I P�T10 CP�•vl Ny i glceic. SUV-feCE) , , II 18 G' L,L, o-ISA 1 NOr6 : PROP0IED GA,2/96 t �; - iIGD/T/o nJ �L�'/JT/ �• or LEAtN-TJZEVCN �35� m" asi OF.MIYY0 % ��. AFCIsTEFE� s°tiPr'Ea K, 9 F•%SIO cN • yJ t f,• 'f �' � L.. f7 ,�� ttth �apn'ROytpJ FROM 2/22�84 J/Te TEmFbR.PeRY PERMIT• pL9N dYC.K.Jt'JORT, MASS L S 1952-71 PROPOSED �, A RA C E eDFCIC FOR PROJECT LOCATION 3 4 9 AND P2D. WE_, 7-- M0 u7-. / Mt1---,51 CRAIC R. SHORT PROFESSIONAL ENGINEER 508- P.O. BOX 1044 398-8311 SOUTH DENNIS, MASS 02660 DATE JOB NO. REVISED SHEET / OF REVISED REFE�E\JL�' Lir-pL, 144Z L° ELEVACTIOW5 -tA.5Eb OIJ 1'1-AN SEA LEVEL_ FILE." i7--458 OF 1, TOWN OF YARMOUTH Building Department + (508) 398-2231 ext.261 BUILDING --- PERMIT ► PERMIT NO FB-07-444_ ISSUE DATE : _ 10/3/2006 _ ' PROPOSED USE . _ ... . APPLICANT .BrianRodoalph JOB WEATHER CARD PERMIT TO 'Misc./permit transfer; AT (LOCATION) 100369GREAT ISLAND RD ZONING DISTRICT R-25 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 1014.1 BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R-4 LOT SIZE I CONTRACTOR permit transfer - new windows, doors, roofing, siding, interior changes, new kitchen, new loorinorphMuical REMARKS service, bathroom renovations, new exterior decks as per plans submitted 7/26106 - Note: Pr o encroaches into front setback and is to be deleted from project. Refer to FB-07-224 AREA (SO FT) EST COST ($ $240,000.00 PERMIT FEE ($) 1$50.00 OWNER I Martin Reilly BUILDING DEPT BY ADDRESS 122 Main Street Hyannis MA 102601 INSPECTION RECORD LICENSE 080556 �Rodoalph, Brian 7 Field Island Point Sandwich MA 02563 5085423222 PHONE 5087714536 FIELD COPY Date Note Progress - Corrections and Remark Inspector e-`? -06 lJ Ae D �2 /O -a 1 a OF TOWNF YARMOUTH Building Department y :BUILDING (508) 398-2231 ext.261 ►° ,� = PERMIT NO = i=B=o�-224= PERMIT ISSUE DATE : _ 8/14/2006 _ : PROPOSED USE _ _ _ _ _ _ _ _ _ er - -- ------- JOB WEATHER CARD APPLICANT ,Walter Brennan Jr. ------------- PERMIT TO Alterations AT (LOCATION) 100369GREAT ISLAND RD ZONING DISTRIC R-25 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 014.1 LOT SIZE BUILDING IS TO BE: CONST TYPE 5-B USE GROUPC new windows, doors, roofing, siding , interior changes, new kitchen, new flooring, electrical service, REMARKS bathroom renovations, new exterior decks as per plans submitted 07/26/06 - Note: Proposed Portico encroaches Into front set back and is to be deleted from project. AREA (SQ FT) EST COST ($-<11,000.00 I PERMIT FEE ($) 1$495.00 OWNER IMartin Reilly BUILDING DEPT BY ADDRESS 22 Main Street Hyannis MA 02601 INSPECTION RECORD CONTRACTOR LICENSE 004389 Brennan, Walter Jr 267 Magnet Way Brewster MA 02631 5084007388 PHONE 16178729933 FIELD COPY Date I Note Progress - Corrections and Remark I Inspector OF r19 TOWN OF YARMOUTH Building Department BUILDING (50$) 398-2231 ext.261 PERMIT NO FB-06-1505 ' - - - - - - - - PERMIT ISSUE DATE 6/19/2006 • , PROPOSED USE APPLICANT •WalterB --rennan ------------------ , JOB WEATHER CARD PFr7MIT Tr) Demolish ' AT (LOCATION) 00369GREAT ISLAND RD ZONING DISTRICT R-25 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 014.1 BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R-4 LOT SIZE selective interior demolition -Approval In Part as Per 780 CMR Sect. 111.13 REMARKS AREA (SO FT) EST COST ($ I$75,000.00 PERMIT FEE ($) 1$50.00 OWNER I Martin Reilly BUILDING DEPT BY ADDRESS 122 Main Street Hyannis MA 02601 INSPECTION RECORD CONTRACTOR LICENSE 004389 Brennan, Water Jr 80 Mattakese Road Unit 2 West Yarmouth MA 02673 5084007388 PHONE 16178729933 FIELD COPY Date I Note Progress - Corrections and Remark I Inspector Danlel L Braman, PE 4 189 Harbor Point Road Currenaquid, MA 02637-0361 Phone (508) 362-6016 February 22, 2007 Brian Rodoalph BriCo Associates Inc. 178 Thornton Drive, Hyannis, MA 02601 Project: 4407 369 Great Island Road, West Yarmouth, MA For: BriCo Associates On this date,at your request and in your presence;I made a site visit to the above residence, which has been extensively renovated and remodeled. I made a visual, non-invasive evaluation of the structural integrity of this residence. The construction has been well performed and I believe is structurally sound. Particular condideration and attention was given to the effects of wind load on the structure as well as vertical loads being carried to the ground level. The joining of the new and old has been well performed. -wi°FdAff'• Daniel E. Bram DArJiEI E.CR C Bn''i,',{API SV AL C4r ,, ONE & TWO FAMILY ONLY - BUILDING PERMIT APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING Town of Yarmouth Building Department H „ATL•C„°; 1146 Route 28 • Yarmouth, MA 02664-4492 Tel: (508) 398-2231 x261 • Fax: (508) 398-0836 -L ce Usee�Onty tanning Board Information Assessors Department Information: Permit No. /" ate to I Map. La Permit Fee $ � Endorsement Date Recording Date New Deposit Rec'd.� Datl� No. Net Due $ v 1.4 Property Dimensions: / Other Lot Area (sf) Frontage (ft) Lot Coverage This Section for Office Use Only Building Permit Number: I Date Issued: Signature: . Building,0 Kral , ate D Certificate of Occupancy . . - is Is not required Section 1 - Site Informato I Use Group: R-4 Type: 5-B 1.1 Property Address: 3 ( �?,,J - 1.2 Zoning Information: Ras Zoning District Proposed Use %� PAT-/liy��t • dl/�.�}-y d 4 7 1.3 Building Setbacks (ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required . - Provided P. i 1} 1.4 Water Supply (M.G.L. c. 40. S 54) Public Private 1.5 Flood Zone Information: Comments: } l S EP 2 9 0 Zone BFE: By V Section 2 - Property Ownership/Authorized Agent 2.1 Owner of Record: ��J • Name (print — �tz?P5&4 - Signature Mailing Address - -,) ?z Telephone 2.2 A{ orizod Agent: Name nt ZZ- C11 Si re Telephone Mailing Address Fax Section 3 --Construction Services 3.1 Licensed Construction Supervisor. TrnLd-!S. Not Applicable ❑ 7 i e License Number �O ss� Address ^d �`f 3 ZZ Z Expiration Date Y —� 3 — 0 Signa Telephone rYa.n onop'LAff 3.2 Registered Home Improvement Contractor: Company Name , -�gntc6 A-SSoz?ca7-,e-5 Not Applicable ❑ ,,/� n Address, 7� / �,Li_ �,,a�k�� VAN —I—S \ �T Z License Number 9 Expiration Date M %V W 0 2-60-t! If --r--1—Vb Section 4 - Workers' Compensation Insurance Affidavit (M.G.L. c. 152 S 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 0— 1 No. of Bedrooms No. of Bathrooms �- S Existing Bldg. 2� I Repair(s) ❑ Alterations ar I Addition ❑ Accessory Bldg. ❑ Type Demolitio Other Specify: Brief Descri tion of Proposed Work: v u K1 L is (-c 2 Section 6 - Estimated Construction Costs 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 /?T vac? 2. Electrical 2_0 d3J 3. Plumbing / Gas 2z-'D -Jo 4. Mechanical (HVAC) yr? oz2rJ 5. Fire Protection 27oa7 6. Total = (1 + 2 + 3 + 4 + 5) p 0 7. Total Square Ft. (new houses & additions) Section 7a - Owner Authorization - Owner's Agent or Contractor Applies To be Completed When for Building Permit I, !lpt as owner of the subject property hereby authorize�`��o AL�G� to act on my behalf/in IImatter7el towork authorized by this building permit application. 9-2! 6r Signature 'Owner Date Section 7b - Owner/Authorized Agent Declaration I, , 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. 26�+ Signed under th ains and penalties of perjury. Gil. [%�y(ywta�' Print name Signs ure of Ow er/Agent Da 9.15.99 2 of 2 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street < Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers _ADVUcant Information Please Print Legibly Name (Business/organizatiorOwividual): /`Q w -- Address: % City/State/Zip: S� w� , (1/1 Phone #• 9;;-02 Are you an employer? Check the appropriate box: I. ❑ 1 am a employer with 4. 1 am a general contractor and I employees (full and/or part-time)." have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet _ ship and have no employees 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 These sub -contractors have workers' comp. insurance. 5. ❑ We arc 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. [RNew construction 7. NRernodeling 8. ❑ Demolition 9. ❑ Building addition 1 oLlElectrical repairs or additions 11.0 Plumbing repairs or additions 12.®.)toof repairs 13.❑ Other, •Any applicant that checks box # I must also fill out the section below showing their workers' compensation policy mfotmatio t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating suck =Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is thepolky and job site information. Insurance Company Policy # or Self -ins. Lic. #: ro KUd� 6 .9 _� 1 3, � Expiration Date: / o— / 20 — Vcp Job Site Address: 3 6 4 Q ,r.��— � `-`t • City/State/Zip: ''t'i ✓ u�-1--L�V� (3 a(9 73 Attach a copy of the workers' compensation policy declaration page (showing the policy numb r 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. I do hereby certify unde� th e pains f 9d penalties of perjury that the information provided above is true and correct: official use only. Do not write in this area, to be completed by city or town 0-&IaL City or Town: PermlULicense # Issuing Authority (circle one): 1. Board of health 2. Building Department 3. Cityfrown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other 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: &-" eJ n '�k-+A Est. Cost o7400%) 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: ft-b 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: lqq t7� Date Contractor Name Registration No. Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: natP owner Name s TOWN OF YARMOUTH BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT: 7 r �y Job Location: SLR Number Owner of Property: Construction Supervisor. Address: Licensed Designee: (If other than Supervisor) S '. JYppGI Name License 1` L�- in utl �[T v1 T W i Name Phone No. rev-v. License No. 3Z2Z 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 licensee who shall willfullyviolate 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: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes (�[- No ❑ If you have checked yam, please indicate the type coverage by checking the appropriate box. A liability insurance policy ia 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 Owner's Owner ❑ Agent ❑ TOWN OF YARMOUTH 1146ROUTE28 SOUTHYARMOUTH MASSACHUSET002664-4451 Telephone (508) 398-2231, ExL 261 — Fax (508) 398-2365 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT BUILDING 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 6J &"-°s'7- —i 5�a : • tj• �%R2�1u� 1, OA& Work Address is to be disposed of at the following location: `04S'tf &LCAV7e-�;S Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Signature of Applicant Date Permit No. TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 eat. 261 Fax 508-398-0836 BUILDING PERMIT APPLICATION REGULATORY APPROVALS NOTICE Address of Proposed Work: 3 13 1—e�ee�� t� - 'eST ?i'141,it Scope of Proposed Work: Date: C ' —�? —()& Based on the scope of work described above, the applicant is required to obtain approvals/sign- offs from the following departments as checked -off below: Health Dept. — Town Hall Phone No. 508-398-2231 ext. 241 Conservation Comm.— Town Hall Phone No. 508-398-2231 ext. 288 Water Dept.— 99 Buck Island Rd. phone no. 508-771-7921 Old Sings Hwy. Hist. Comm.— Town Hall phone no. 508-398-2231 ext. 292 Engineering Dept. —Town Hall phone no. 508-398-2231 ext. 250 Fire Dept.--Capt. Kelleher, 96 Old Main St. So. Yarm. Phone no. 508-398-2212 Other Appropriate plans and/or application shall be provided to each of the departments checked -off above. Each of these regulatory authorities has their own requirements outside the jurisdiction of the Building Department. All applicable approvals shall be obtained prior to submitting a building permit application to the Building Dept. Thank you for cooperation. Receipt Date —0 r, i.TTS MASSACHUSE 1 NUMBER DRIVER'S LICENSE 021485149 3 ..w DATE OF BIRTH CLASS REST HEIGHT SEX G 04-23.1958 D 5.11 M B -;-. EXPIRES 04-23-2009 '' RODOALPH " #j BRIAN Wi7 FIELD ISLAND POINTXSANDWICH, y.. MA, 02563 ' t H . ! ✓iEe T06nvnzMe[ueal�i a�.iG"�usciuwe�d'i ./' BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 080556 Birthdate: 04123/1958 Expires: 04/23/2007 • Tr. no: 11017 Restricted: 00 BRIAN W RODOALPH 7 FIELD ISLAND POINT SO SANDWICH, MA 02563 Commissioner ✓%e C�arn�na�uueultii a� , �r'�a ui�iu ella Board of Building Regulations and Standard% HOME IMPROVEMENT CONTRACTCR Registration: 144983 Expiratlor,: 11/24/2006 Type: Individual BRIAN RODOALPH BRIAN RODOALPH 7 FIELD ISLAND POINT 0ANDWICH, MA 02563 ad t`t - 1 9/26/06 3:44:26 PM 4170 ® 03/03 ACORD. CERTIFICATE OF LIABILITY INSURANCE 9/2 /2006 PRODUCER (508)540-2400 FAX (508)289-4111 Murray MacDonald Insurance Services Y 406 Jones Road Falmouth MA 02540 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURED SRI-MAR REALTY TRUST 7 FIELD ISLAND POINT SOUTH SANDWICH MA 02563 INSURERACharter Oak Fire 25615 INSURER B Travelers Insurance INsuRmc-Travelers ASSigMed Risk INSURER D: INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT MATH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS, INSR LTR A00'L MVBRD TYPE OF INSURANCE POLICY NUMBER POLICYEC ATE MW O/YY) ( PDATE(MMAD/YY)N LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY PREMISES Es oourrence S 300,000 A CLAIMS MADE ❑ OCCUR I690015OW750 5/30/2006 5/30/2007 MEDEXP (Any one arson E 5,000 PERSONAL&ADV INJURY 1 1,000,000 GENERAL AGGREGATE E 2,000,000 GENL AGGREGATE LIMIT APPLIES PER. PRODUCTS -COMP,OP AGG E 2,000,000 N1 POLICY PECOTEl LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE L IA17 (Ea accident) E BODILY INJURY (Perperson) S 100,000 B ALL OV.NED AUTOS X SCHEDULED Al1T05 AOGA672K9478IND06 5/30/2006 5/30/2007 BODILY IN.IIRY (Parecadent) S 300,000 X HIREDAUTOS X NON-ONNED AUTOS PROPERTY DAMAGE (Parecadent) E 500,000 GARAGE LIABILITY AUTO ONLY -EA ACCIDENT E OTHER THAN EAACC E ANY AUTO $ AUTO ONLY: AGG EXCESSAIMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE E S $ DEDUCTIBLE It RETENTION E C VVORKERSCOMPENSATIONAND EMPLOYERS' LIABILITY ANY PROPRETOR/PARTNER/EXECLTTIVE TORY LIMITS ER EL. EACH ACCIDENT S 100,000 E.L. DISEASE -EA EMPLOYEES 100,000 OFFICER/MEMBER EXCLUDED? 6KOB685Z8156 10/18/2005 10/18/2006 Ilyes, desmbe under SPECIAL PROVISIONS below EI. DISEASE -POLICY LIMIT E 500,000 OTHER DESCRIPTION OF OPERATIONSILOCAT10NS1VEHICLESA7KLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS Project Located at 369 Great Island Road West Yarmouth H& 02673 Tara of Yarmouth Building Inspector Route 28 South Ya=outh, MA a rnen 99 nnna mQ% INS025(aioe).oe AMS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER VVILL ENDEAVOR TO MAIL 10 DAYS wRRTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT 02673 FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY RIND UPON THE THORRED REPRESENTATIVE Harrington/SMH VMP Mortgage Solutions, Inc (800)327-0545 r ARR Page A of 09/26/2006 16:47 50856355B7 MURMACINSLRANCE U �►-� ' CORD CERTIFICATE OF LIABILITY INSURANCE PROWLER (508)540-240D FAY (S08A289-4111 THIS CERTIFICATE IS ISSUED ONLY AND CONFERS NO R MLTrrayr & MacDonald Insurance Services HOLDER OLD THE COVERATHIS GE LAFF ATE 406 JoneR Road BRI-MAR REALTY TRUST 7 FIELD ISLAND POINT Brian RodcalPh THECS OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WFIICI THE INSURANCE AFFORDED 8Y THE POLICIES DuE-SC IB vD IH HEREIN 19MS. SUBJECT TO ALL THE TERMS, PAGE 02/02 DATE (NN DVftV W G7J DO INDICATED. NOTWITHSTANDING ANY ;ATr, MAY BE ISSUED OR MAY PERTAIN. AND CONDITIONS OF SUCH POLICIES. GENERAL LUt61LITY Tv NEry I ry ISES EA N9eee AERCIAL GENERAL LIA&LrtV CLAIMS MADE ❑ OCCUR IS00015DI4750 5/30/2006 5/30/2007 tGE EXP A ONALSAIRAL AGGREGATEUCTS-COMPIOPA GEMGREGATE LIMIT APPLIES PER, CY I COMBINED SIHCLE LIMIT (EA Axldem) BILE UABILRY BDmLV INJURY RnpLEDULED AUTO OWNED AUTOS AOGA672x947SlVD06 5/30/2006 S/30/2007 IwuRr AUTOSBDwty EDAUTOS (P,r*eed.eD•OWNEDAVTOS►ROpERTV DAMAGE AUTO ONLV - FA ACCIDE THAN LIABILITYOTHER AUTO AUTO ONLY: OCCUR u CLAIMS MADE DEDUCTIBLE RETENTION $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR?ARTNERrXrCUTNE 10/18/2005 10 / 18 /2 DO6 OFFICEWMEMBER EXCLUDED? 61m1166SX8156 ayes ' yes, dowty tinder SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONSROCATIONSNEHICLESIEXCLUSIONE A5090 BY ENDORSEM%IwTM W- Proyaet Located at 369 Great Yaland (toad Waat Yarmouth HL 02672 S L,000,00 300,00 5,00 1,000,00 2,000,00 100,000 300,000 500,000 100 100 'ICAT cANU;LLLAI IV17 SHOULD ANY OF THE ABOVE DESCRIBED pouaea BI CANCELLED BEFORE THE HOIDCS BY The -Sea EXPIRATION DATE THEREOF, THE ISSUING INSURER VALL ENOCAVOR TO MAL Mirtin Rilay 10 DAYS wI11TTEN NOTICI TO THE CERTIFICATE HOLDER NAMED TO THE LEFT- BUT 22 Main Street FAILURE TO DO SO SHALL IMPOST NO OBLIGATION OR WIDLRT OP ANY KIND IKON THE Hyannis, MA 02601 INSURER ITS AGENTS OR Re►RESENTATWES. AVTHOWLED RE►051INTATNE S Harrington/SNIT " -- ID ACORD CORPORATION 1905 125 (2001108) PP9e 10(2 INS025(010R).06 AMS .�,��............._..�..._.�_. JUL. 6. 2006_ 2:21PM .ASSOCIATED INSURANCE N0. 2529-P. CERTIFICATE OF INSURANCE OF RMA ON NLYI CERT CATEIS ASA PRODUCER CONFERS pi0 RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTII NOT p11IEPID, EXTEND OR ALTER THE COVERAGE AFFORDED B! DOES Minuteman Insurance Agency POLICIES BEI Ow. 76131ancbmd Road COMPANIES AFFORDING COVERAGE Burlington, MA 01903 INSURED Genesis Consolidated Services Inc 76 Blanchard Rd, fl 2 Burlington, MA 01803 A A.I.M. Mutual Insurance CO COVERAGES THAT I'm POLICIES OF INSURANCE OR OTIM DOCUMENT Wrm RFS OF EANY CONTRACT THis 15 TO MTIFY INDICATED. NOTWMMANDING ANY OR CONDITION REQtTiREMSNT, SUBJECT DESCRIBED PERTAIXTHE DUPED ECLAIMS H SUCH �OWN MAY HAVE BEEN RR BBY BxRCLUsIONS AND CONDITIONS OF POLICIES. LIMITSY POLICY 8FF6C TE POLICY E7O"IRA LDMS CO TYPROFINSURANCE POLICY NUMBER ),TEp4MND/1'Y) DAT6(MMMDIYY) L BNERAL AGGREOATTE S NERAL LIAZV= p(IODUCLS-COMP/OP AGO. S MMERCIAL GENERAL LIABILITY PERSONAL ✓r ADV. RQURY S LAIMS MADe�ICCUR EACH OCCURRENCE S OWNRR's& CONTRACrOR'S PROT• RE DAMAGE(Any ow Era) S ' MOD. EYPE14SP (Any ON Pena) IS MBINEDSINGLE S AVIOMOBILELIABILITY LIMIT ANY AUTO BODR.Y MURY S LL QWNED AUTOS Per Pasco) LED AUTOS. BODILY INJURY S NIRBI) AUTOS we dmo NON.OWNED AUTOS S GARAGE LIABILTY' PERTY ppMAGE CH OCCURRENCE S XCEMIIABILITY AGGREGATE S MEREU,A FORM , ER THAN UMBRELLA FORM X T C STATU• X OTH- WORKER'S COMPENSATION AND EMPLOYERS' LIABILITY OI10112007 S 1015963012006 01101t2OD6 S �j A TUC PROPRIETOR/ f X I1NCL ELb LI IT _. _.__.... �. c�a n ry 1S 'TPnON OF OPERATIONS/LOCATIONEIOCL88/9'OCIAL ITEM tPRAGE IS RESTRICPI D TO EMPLOYEES LEASED TO: BRENNICK BUILDING SYSTEMS, L 369 GREAT ISLAND RD: INTERIOR WORK, 5 WEEKS. TOWN OF YARMOUTH AM- BUILDI14G DEPT. 1146 ROUTE 28 S. YARMOUTH, MA 02664 WHICH THIS THE TERMS. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TILE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 15 DAYS WRITIENNOTICE TOTHE CERTIRCATEHOE )E OB� TIOTO THE N OR an, BITE AAILUR£ TO MAIL SUCH N TEES COMPANY, � .ITS AGENTS OR LIABILITY OF ANY KIND REPRESENTATIVES. 07/06/06 15:17 FA% 781 860 9562 GENESIS CONSOLIDATED 0 001/001 TOWN Oir YAP -MOUTH AWNIZ BMDI NG DEPT- 11461ROM 28 S. YAMMOUTBP bfA CM64 ` N0. --'JUL. 6.2006 2;25PM�ASSOCIATED INSURANCE CE�t�CA� OT' INRNCE iltauum ance ASWC!' Mimrte�7an Insur 76 Bl=cherd Road Burlington. MA o1sM ' ugum Zv=is Consoudated Services Inc 76 Blanchwd Rd, fl 2 Buriingtoa. MA 01203 7NS ANDY�� OF SUCH POUFS- L1M1TS roucYxLrt� 71RS O4IIi6 LU1a1T: AvrybYl13 6v WM=ACRS PVM' OOP V[AMn= ANY AUTO ALL OWWW AUTOS LED AUTOS w AUTOS GARAO LU18%M Ss LL4wx r� MyRMLA PORM RmTwo'UMB m"FORM 7YprAND — �1�,011006 COS AMgnIN(; COVERAGE A A.Y.M• Mutual In sane Co rouzzOZ DATE LDOTTS ORAL AOOMA-M DIICSS�QppAM f P2R"ALA AM-VQE' S DI pGC(1RRENM S In DOLKE(All M Pae) f •ONFE5S"OWPI J 8W= J OM-1 QOURY S Pm* ILY L7NRY S wddar) Opwr,rnA,(Acs s Ofi0�1RR f DOREWTB f 0'{'H• x 01101006 01l0117AOT s rERADFOp&AATi ST OCA Tq g oYEES L�iA r33D TO, BR2NNICK BUILDING SYSTSN'Ys, LLG rEgAc3E IS RESTRICTED pR WOItIt, 5 W�i�' 369 GIMAT ISLAND RD.-IIRTM ;ANCEUaTt ; as CANC9M 1 T 1 gSotSLD Ali7f OF'i'{rs ABOVE . MM aQ C.QWANY �• IPMFAVOR TD IM]SAM14 DATE NT TO TM C0SL14i ATSVMDMNA� TO TAIL �, 6ZTF P SOGg Nm7C5 SHA L BOWE 740 ow.MATIM OR 1 OF ANY K" Opos Tilt; COIdPANY: TlS A N1S OR 1XPRggsNTATiM. A1TrJJO61ZT� g�g,5ffiTfAS.r� pF'YARtr ONE & TWO FAMILY ONLY - BUILDING PERMIT $ p APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING Town of Yarmouth Building Department H „«S 1146 Route 28 • Yarmouth, NU 02664-4492 Tel: (508) 398-2231 x261 • Fax: (508) 398-0836 Office Use Only Planning Board. Information Assessors Department Information: Permit No. at )LIB Plan Type Map Lot Endorsement Date Zy Permit Fee $ New Recording Date Deposit Rec'd. $' Date No 1.4 Property Dimensions: Net Due �D� )/ Othe Lot Area (sf) Frontage (ff) Lot Coverage is Section for Office Use Only Building Pe I Date Issued: Signature: Certificate of Occupancy is is not required Building Official Date Section 1 - Site Information I Use Group: R-4 Type: 5-13 1.1 Property Address: 34,9 G/2- fa -rsc,4,--� ra �� 1-> 1.2 Zoning Information: Zoning District Proposed Use 4V, i%9YrHOu "/ f9A O 0&73 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: BFE: Section 2 - Property Ownership/Authorized Agent 2.1 Owner of Reco.0 i912Ti;U �, Gl y ZZ HA,a S 7 I-/`1AA W S "A. Name (print) Mailing Address 61- 87z- 9933 Signature Telephone 2.2 Authorized Agent: ejALT,4r2 0 �/ .dic�rr.J ✓/1. 267 !�-1 k — - 2Fu�srf. H Name (print) Mailing Address .So'- faz)-73eb Sala-77.S-lo333 Signature Telephone Section 3 - Con ction Services R 3.1 Licensed Construction Supervisor. oos JUL 2 Not Applicable ❑ Z Co -7 Iy.4 61 A.J f % 64� ev y �.4J S T�2 a ZOO 3 BUILDING D�PT. icense Number �e23 0 Address SOg- DO-7 Expiration Date t� _ Z — D 8 Signature -Telephone 3.2 Registered Home Improvement Contractor: Company Name [ T f� C, - j/l F.✓�/l A% / • �G7 /yAl�,rJc i C,dA'� %3Q FWS 7 `e /yR zLi Not Applicable ❑ License Number 7-7 ,5 Address SOP - -yo o -73 86 Signature Telephone Expiration Date v 1 or Z — " r Section 4 -Workers' Compensation Insurance Affidavit (M.G.L. c.152 S 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 ..X0 ... No .......... Section 5 - Oescriotion of Proposed Work (check all aonlicahlel New Construction ❑ No. of Bedrooms_ Existing Bldg. )0 Repair(s) ❑ Alterations No. of Bathrooms Addition ❑ Accessory Bldg. ❑ Type Demolition Other Specify: Brief Description of Proposed Work: 7f IA.) tvS e A.) Tt✓I r U &NA V6 el C ��O !Tt -f-e H f-Al A,) uJ �,012jA AJkct) Zzi:e i/?i tAC SmvlC `r !� /1ot� ,2 .tJUrJ J-1UNS Fi.J Section 6 - Estimated Construction Costs Item Estimated Cost (Dollars) to be completed by permit applicant 1. Building 3 SQ Cj p O 2. Electrical eD C.2 a 3. Plumbing / Gas 250 0 O 4. Mechanical (HVAC) ZS O C20 5. Fire Protection a0p 6.Total=(1+2+3+4+5) 3 f 000 7. Total Square Ft. (new houses & additions) 3 So O Section 7a - Owner Authorization - To be Owner's Agent or Contractor ADOies for 91 Permit Check Below ❑ Conservation -Commission Filing (if applicable) ❑ Old Kings Highway & Historical Commission approval (if applicable) , as owner of the subject property hereby authorize my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Sectioon,,7b - Owner/Authorized I, ' fWzre4_1z_ t Declaration y to act on 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. 2 Print name Signature of Owner/Agent 7 Z'- Date 9- 15-99 2 of 2 ,'�}oFYgRc TOWN OF YARMOUTH 0 .:....,, s BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT: Job Location: -31�2 1<k''A T 1S4yAJ,-I XA /t/ Number Street Village Owner of Property: AA 2 'i'-' % LG x y Construction Supervisor: l�%%LTf'/� �` /✓�4'cJ,(,A�✓/2 CJD5�3�c/ �5749-Vew 73H£3 Name License No. Phone No. Address: 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 Anylicensee 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 9 No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy V 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 a ral Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner' gent 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: 4604 ✓A h D tJ Est. Cost Address of Work 36, 9 Gn e4 i =1,24 :vQ ;�"O- lw- telve,oy0 ce N� Owner Name: r Date of Permit Application: 7 2 `/- ,04- 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: �"� Oo'�38i 7 ZY D (0 6u4478X (D7,9P, J a 7 yS3 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 of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers fI z Ma Name (Business/orpnizatiou/Individual):��3/2e - t • r t Gn u i Lp i �J Lo SYS T� y-S LL L i/ .r 6/►' City/State/Zip:W. Y�I✓1/9/�t! 5�9� &4.626 73 Phone #: DS- Vao --,7380 AV1, on an employer? Check the appropriate boa: am a employer with /�z 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. 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.] Type of project (required): 6. ❑ New construction 7. zolition odeling 8. 9. addition 10&Building ectrical repairs or additions 11.❑ 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 suck =Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. �1 _ Insurance Company Name: A —L �- Policy # or Self -ins. Lic. M. %Ol SS& 3O / Z 00 t� Expiration Date: /2.-3 I - 0 (-, Job Site Address: 3(n9 GfeME =t A 0City/State/Zip: A), 021e73 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 Investigations of the DIA for insurance coverage verification. I do hereby certify under (hens and penalties of perjury that the information provided above is true and correct official use only. Do not write in this area, to be completed by city or town offciat City or Town: Permit/License #_ Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: 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 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 (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 rnust 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-NMSSAFE Revised 5-2&05 Fax # 617-727-7749 www.mass.gov/dia TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, NIA 02664 508-398-2231 ext. 260 HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE: JOB LOCATION: NAME STREET ADDRESS SECTION OF TOWN "HOMEOWNER" NAME HOMEPHONE WORK PHONE PRESENT MAILING ADDRESS CITY OR TOWN STATE ZIP CODE The current exemption for `Homeowner' was extended to include owner — occupied dwellings of one or two units and to allow such homeowners to engage an individual for hire who does not possess a license, provided that such homeowner shall act as supervisor. (State Building Code Section 108.3.5.1) Definition of Homeowner: Person(s) who owns a parcel of land on which he / she resides or intends to reside, on which there is or is intended to be, a one or two family attached or detached structure assessory to such use and / or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner; such "homeowner" shall submit to the building official, on a form acceptable to the building official, that he / she shall be responsible for all such work performed under the building permit. (Section 108.3.5.1) The undersigned `homeowner' assumes responsibility for compliance with the State Building Code and other applicable codes, by-laws, rules and regulations. The undersigned `homeowner' certifies that he / she understands the Town of Yarmouth Building Department minimum inspection procedures and requirements and that he / she will comply with said procedures and requirements. HOMEOWNER"S SIGNATURE APPROVAL OF BUILDING OFFICIAL INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL Ch.142. Yes ❑ No ❑ If you have checked yes, 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 142 of the Mass. General Laws and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ h:homeoworlicexemp BUILDING TOWN OF Y A R M O U T H ELECTRICAL GAS 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664-4451 Telephone (508) 398-2231, Ext. 261 — Fax (508) 398-2365 PLUMBING SIGNS BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conductedat Work Address is to be disposed of at the following location: AUl f-D 1,J < Z-!E — �cINPST>±/1-S Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. &AYF�j Signa ur Y4plicant Permit No. Zy-a � Date r • . �T�e ���re� n�✓1�,4�a� - Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR _ - Registration: 127453 Expiration: 11 /112006 Type: Individual WALTER C. BRENNAN, JR WALTER BRENNAN,JR 267 MAGNET WAYS BREWSTER, MA 02631 Administrator t �.. ✓'le [oorrernarurteull� n� ��laatur.�u4e� BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 004389 BIrthdate: 01/21/1951 1 Expires: 01/21/2008 Tr. no: 13089 f _ Restricted: 00 WALTER C BRENNAN 267 MAGNET WAY BREWSTER. MA 02631 Commissioner l......... ........................ .....r. �•Y TOWN OF YARMOUTH 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664 H MATTA Lo �"x Tel(508) 398-2231 — Fax (508) 398-0836 �eit•eMTLC �y Town ofYarmouth Conservation Commission Building Permit Sign -off Application Cons. Comm. Received Date: %—;-!�J Property Owner. I-11j✓t n�) 9 �-- I I V CONSERVATION COMMISSION Construction Address: 3& 9 <121�4`; S'24 .AQ 20 - Gy. Assessors Map and Parcel: MAP_/ — PARCEL / General Contractor:_ J2P,cJ.y c6r ct L� r.�G �S Y-f i f�`r'.f $D /-1i4 T�•O frF t f /��. Company Name and Address: 73 Company Telephone: S'DR - ZeO - 73 Project Description: % Z 4 761, /1IWOy.Q rrD c� — ,cJ c /� �` �� d,� /�C�4A) AJy 09„t/.-MLJ_c Contractor Plan Submitted: Title leQ (IP LIA tWZ- )rot y'Y 2Ti.cJ %Zft-a x Date- 7- y O Revision Date 7-/ Y-OW 4- Conservation Commission Filing Required: YES NOL4 if Yes, Type of Filing: Notice of Intent Request For Determination Of Applicability Conservation Commission Sign -off Signature: Date: a -7 — OJ Printed on Recycled Paper TOWN OF YARMOUTH HEALTH DEPARTMENT PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Building Site Location:,', 9Gk,4r Ss44AiJ /LO- Map No.:_Lot No.: Proposed Improvement: R,0A10L14 N O,J Applicant:/Q/QC i S-2 0� p/zItAJA--34A 1 1:10, Tel. No.:,�ij)q - Llae)-73 08 2L7 iYAlo.J4T GlJiO `� Address:fZg�fzyx Date Filed: 7- 2 V-0 **Ifyou would like e-mail notification of sign of, please provide e-mail o � Owner Name: WHIZ i 7 A) nC-t L L y Owner Address: Z 2- HA t .y -C 7- /-) ,YXA) Jt d Ar,4 0.26 d/ Owner Tel. No.: 6 / 747Z - f P3.3 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: DATE: —Xy—o C. PLEASE NOTE COMMENTS/CONDITIONS: 14cme_ To R-e_ mQ i n oou� S, 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: 30 4;4f aT jk d do 6L0 Map #: ('/ Lot #: Proposed Improvement: /�j/,1 v i2 �i rJ��,q j-za J Applicant: leydgz 1 r.e (fp- 32PtiX"�10-) y2 2L7 MfJGN5-�TGtJAy Address: 3 ,ysi f H4 Tel. #: S4n8-Vvo-7 303 Date Filed: 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 Pro ction; i.e. Smoke Detectors, Sprinkler Systems, Etc... REVIEWED BY WATER DIV SI N: /,-1-1,c4 signatur da PLEASE NOTE: COMMENTS: OF -v� TOWN OF YARMOUTH Building Department s Town Hall k-Qe" Yarmouth, MA 02664 (508) 398-2231 ext.261 BBUILDING PERMIT TRANSMITTAL Temp Permit No.: T-07-038 Applicant Name: Walter Brennan Jr. Applicant Phone: 5084007388 Building Location: 00369 GREAT ISLAND RD Owner's Name: Martin Reilly Owner's Addres 22 Main Street Hyannis MA 02601 ' Owner's Telephone: (617) 872-9933 (OFFICE USE ONLY Recorded By: Ic N Permit Fee: $0.00 Deposit Rec: $25.00 Payment Type: Check ChkNo.: 4525 Net Owed: ($25.00) Application Date: 7/26/2006 Issue Date: Expiration Date Comments: Map/Lot: 014.1 new windows, doors, roofing, siding , interior changes, new kitchen, new flooring, electrical service, bathroom renovations, new exterior deck �ONIPJG APPRrD 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: 5. BUILDING DEPARTMENT: DATE: N/A: 6. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE COMMENTS: RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: Date Printed: 7/31/2006 OFFICE MEETING NOTES .ADDRESS: � � � / %-1� �D DATE: � �p Names of Attendees:, Zoning District: Flood Zone:_— Meeting Topic: r 05/08/2006 14:20 FAX 5087713397 02/2742005 15:23 5172546784 (goad �((o' 744 7 30- ANG.ELA RAE PHILBROOS OIL CALL �2�f17 �S LA-/vb i2.7 0001 PAGE 04 FEDERAL EMERGENCY MANAGEMENT AGENCY >Yqq Ky Q B/f03087 STANDARD FLOOD HAZARD DETERMINATION xrsmaon Caw" O=bWJ", 2= 6ECTIDN I . LOAN NFORMATiON n. LENDER NAME AND ADDRESS 7- COLLATERAL l`ftAfinpAloble HWnWF& onaf ftilw yJ PROPERTY ADDRE39 Selective 2aaaraaae Company (LOW Dssa/pBar ffoy 69 array em 40 Wantagd Ave 369 G MAT SSLAT® 9a CNT 101 VVIT YABtIMM, N71 02673 Branchville. W 07290 XARTSN T.asu.7.Y a.=z Harold d Salaat 3. LENDER ID. NO. a. MM IDENTIFIER 5. AMOUNT OF FLOOD INSURANCE RECUOUD 009002006190 $ ' 9CCT1pN I A. NATIONAL FLOOD INSURA)Xr PROGRAIA psq +j COMIrIuwIY.N)R19DICTION 1. NFlP OOnart Eft Name 2. Cowt(Ne) 8. State <. NFlP Cmmwnity Number 7.AR1lmm. T*w OP I Zh"Sriset.s 1x 250015 IL NATIONAL FLOOD INSURANCE PROGRAM (KM DATA AFF%CTINC BU LDIN6IMOBILE HOME 1. NFlP Map Number or Cartanunlly paned Number 2. NRP Map Panel Effective! 3. LOMAALOMR A.Flood Zone S NO NFIP (Commmily Name. Ind the acme as'Ah Reviaad Data map 250015 0005D 07/02/92 g Yea� Data C. FEDERAL FLOOD 1 NSURANCE AVAILANLfry (Cheok all Us* qwW 1. Federal Flood Irouren a is avalkbW (c0mnxv ypwffc jmfos bi NFAPJ. Q ftegL&r program ❑ El.mgm cy prngrem of NFIP 2. ❑ Federal Flow kmaw oa is hot araw* beCauw wnnwd[y I^ not portiapWM In the NFIP. 3. ❑ Home b In a Coeelel ESOter Reumm s Anew (CBRA) or Oftrwim Rolerled Area (OPA). Fedaal Mood kmrrmm beavagabk may not CBRA/OPA DemWWm palm D. Ot"IERie1W770N IS BUILDINGlMOBILE HOME IN SPECIAL FLOOD HAZARD AREA (ZONE CONTAINING THE LETTERS "A" OR -% rr) 7 YES ® NO If yeg. Iaod Insurar4a iS rCA and by to Flmd Dlaadar ProWdlar Act of 1973. I no. SOW km"'ee Is not mq *od by the FTood Oeaat+! Rt)Oeclmt Act d I=. I. COMMENTS (Oprlonan: The delermnak n is bored on axwn" g the NFIP map. arty any Floral t3fraryarey Manegenranl Agency revrsrOre b i er10 Other Wbrtnatlat needed t0local� the btrNdlrrglrtrob% horns on the NFIP F. PREPAItMM IdFOIWT10N e.. A NAMl; ADDRESS, TELEPHONE NUMBER (Sopro►rlyq r.artaeq ;I DATE OF DETERMINATION Pine! Aeaoriean P1ood Data aevvican lOY20/05 at 12240 PX CDT 11902 Barnet Road !leggin, = 78739 ..�:.u•.�•�: FSoodCert N: Ob10C91723 1-800-447-1772 � �' P WA Form i Get a2 = Igar0e at 12,t6 PM CUr TOWN OF YARMOUTH BUILDING DEPARTMENT PLAN REVIEW & BUILDING PERMIT APPLICATION REVICW NOTES I. IVA� �,em i r � cosT c� E AWRESS: Map I Ld: ate Dof Initial Review: OrfAC-9� l� 6, kje� 3 Correction Ust No. Descri don Code Section Cv r w —(2/, (For G®Ce M Only) Demal (dam): Saxion 104.32, pna. Change. Emmsioa or Ahms im Wm-cashag, Wig) The pap X require a Special laetmit 8nm the Zaoiag Bard of Appals. Banding Code Denial (if WPlicabie) =F- Y1q TOWN OF YARMOUTH 3� c Building Department ,. x Town Hall Yarmouth, MA 02664 (508) 398-2231 ext.261 BBUILDING PERMIT TRANSMITTAL Temp Permit No.: T-07-006 Applicant Name: Walter Brennan Jr. Applicant Phone: 5084007388 Building Location: 00369 GREAT ISLAND RD Owner's Name: Martin Reilly Owner's Addres 22 Main Street Hyannis - MA 02601 Owner's Telephone: (617) 872-9933 REVIEWED BY: (OFFICE USE ONLY Recorded By: Ic Permit Fee: $0.00 Deposit Rec: $25.00 Payment Type: Cash ChkNo.: 0 Net Owed: ($25.00) Application Date: 7/6/2006 Issue Date: Expiration Date Comments: • Map/Lot: 014.1 interior alterations - new partitions and ceilings 1. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT: DATE: N/A: 5. BUILDING DEPARTMENT: DATE: N/A: 6. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE COMMENTS: RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: Date Printed: 7/13/2006 OF'Y'jR ONE & TWO FAMILY ONLY - BUILDING PERMIT o$p APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING Town of Yarmouth Building Department E" „ TT C„EES 1146 Route 28 • Yarmouth, MA 02664-4492 Tel: (508) 398-2231 x261 • Fax: (508) 398-0836 Office Use Only Planning Board Information Assessors Department Inform do . Plan Type Permit No. Date Map 10 6 20061 Endorsement Date dU Permit Fee $ j Recording Date N BUILDING DEPT. Deposit Rec'd. $'ate Ian No. 1.4 Property Dimensions: oy. Net Due $ / Other Lot Area (sf) Frontage(ft) Lot Coverage This Section for Office Use Only Building Permi m er: I Date Issued: Signature: Certificate of Occupancy is is not required Building Official Dat Section 1 - Site Information I Use Group: R-4 Type: 5-B 1.1 Property Address: 369 62-;-,ar _y/J izo. 1.2 Zoning Information: o Zoning District Proposed Use A/. ;'tq/z�pu{ /`9i4. (J' 2l073 1.3 Building Setbacks (it) 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 I ormation: Comments: Zone BFE: F %L/ Section 2 - Property Ownership/Authorized Agent 2.1 Owner of d: H�'k i-;j-:KRe L C H „�41xj t Name (print) Mailing Address 02&0/ Signature Telephone Co 17- 87 Z- 9 9 S 3 2,2 Authorized Agent: !09T6,�. Le & kl'SS O. (,.t/t ,— Z Nam (print) /� Mailing Address �. rf'ARHoce> H ' >-�-c/ Signature lephone Fax 508_ 776 —6 3-3- Section 3 - Construction S rvices 3.1 Licensed Construction Supervisor: y A14,1 T,Cl'e- 0- "-�2f-A&14A) V� Not Applicable ❑ a(p % 1-11.q COA..) -i� s .4 DzG3/ License Number 001/3f39 Address 1 'g-68-y�� _73 �g Expiration Date Signature ephone 3.2 Registered Home Inipfovement Contractor: doo�mpany Name f'/�� �/j ,Uwzv-f e �2���a� Not Applicable ❑ License Number Address Zoo 7 �jQ B it/ �! LRJ/� `1 Signature Telephone St9 - 00-?3 2 7 5 3 Expiration Date //-/, 0 1of2 vvmn Section 4 - Workers` Compensation Insurance Affidavit (M.G.I_. c. 152 S 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 Descriotion of Proposed Wnrk fcheck au nnniicahiP) New Construction ❑ I No. of Bedrooms N I Existing Bldg. Repair(s) 5d I Alterations No. of Bathrooms 1 Addition ❑ Accessory Bldg. ❑ Type Demolition Other Specify: Brief Description of Proposed Work: /e) �10 rho v v� ,v�crv./ °o S 1910 0.(--/ elOA-14 -T — !N T!?/t i o2 A140,- -/r' 61414- — Section 6 - Estimated Construction Costs Item Estimated Cost (Dollars) to be completed by permit applicant 1. Building S U O 2. Electrical 3. Plumbing / Gas 4. Mechanical (HVAC) 5. Fire Protection 6.Total=(1+2+3+4+5) 7. Total Square Ft. (new houses & additions) O Section 7a - Owner Authorization - To be Completed Wt Owner's Agent or Contractor Applies for Building Permit 1. MM r,,J Wge u Y Check Below ❑ Conservation -Commission Filing (if applicable) ❑ Old Kings Highway & Historical Commission approval (if applicable) , as owner of the subject property hereby authorize (if/�G/iC �2 >:.f/.�lrQa% to act on my behalf, in all matters relative to work authorized by this building permit application. of Owner Date Section 7b - Owner/Authorized Agent Declaration 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 —6 —o Co Date 9-15-99 2 of 2 . OF YgR^r o ° TOWN OF YARMOUTH BUILDING DEPARTMENT PLEASE PR71VT. CONSTRUCTION SUPERVISOR FORM Job Location: :Mo° r2 r —L5 'J� Number ,,/ Street Owner of Property: 11zY12 hA) 1 Construction Supervisor: A A17�4 S32WAR A) 0/'e 00V 389 5D8- yoD -7 a 8g Name License No. Phone No. Address: 7?fi% Licensed Designee: (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 licensee who 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 Z 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 Owner's Agent Owner ❑ Agent Ll 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: Est. Cost 2S�C90 D Address of Work 3Lo Cf �2 4A T =9 A kJ/0 2D '`,- CIA le40u Owner Name: "/92 /�7.V Date of Permit Application: 7- G _p (�- 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: Date Contractor Name Registration No. •A 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 If www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 23i�f�%,tJ/ G`f ,7�ui L•O�.tJj� y Ysr1�'/ys Address: t O Hlf >-� IT'45-S a ,U I T Z City/State/Zip: H;4 • Phone #: 509 - Yea -7 386 Are ou an employer? Check the appropriate box: [.WI am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* h hed th b 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. El am a homeowner doing all work myself. [No workers' comp. insurance required.] t ave u e su -contractors 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.] Type of project (required): 6. ❑ New construction 7. KRemodeling 8. ❑ Demolition 9. ❑ Building addition ME] Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box # I must also fill out the section below showing their workers' compensation policy information: t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is thepoliey and job site information. _, A Insurance Company Name: Policy # or Self -ins. Lic. #: 76 / Q0&30 / ZOO !o Expiration Date: / 2 - 3 t - O (� Job Site Address:,;V6§/r?xgT �S�,a,JD lam%.'*AAV44-L City/State/Zip:! .%-/XAhVUW 02.(0'7,3 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 Investigations of the DIA for insurance coverage verification. I do hereby certify under th4,pains and penalties of perjury that the information provided above is true and correct Ofcial use only. Do not write in this area, to be completed by city or town ofciat. City or Town: Permit/License -6 -0 �- 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 employers to provide workers' compensation for their employee 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 (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 permidlicense 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 can. 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-OS www.mass.gov/dia BUILDING TOWN OF Y A R M O U T H ELECTRICAL GAS 1146ROUTE28 SOUTHYARMOUTH MASSACHUSETTS026644451 Telephone (508) 398-2231, Ext. 261 — Fax (508) 398-2365 PLUMBING SIGNS BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at Work Address is to be disposed of at the following location: /444/ 1E0 AJ267f — &"s OS7;�t2 S Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Signature 017plicant Date Permit No. TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 261 Fax 508-398-0836 BUILDING PERMIT APPLICATION REGULATORY APPROVALS NOTICE Address of Proposed Work: 36 626X 7-7i41VI-3 /r7 . 4L.* it/©u Scope of Proposed Work: ZzQ 1`3,i 1k2X /,lJM /4f Akle AK4A) Date: (o ­0 6 Based on the scope of work described above, the applicant is required to obtain approvals/sign- offs from the following departments as checked -off below: Health Dept. — Town Hall Phone No. 508-398-2231 ext. 241 Conservation Comm.— Town Hall Phone No. 508-398-2231 ext. 288 Water Dept.— 99 Buck Island Rd. phone no. 508-771-7921 Old Kings Hwy. Hist. Comm.— Town Hall phone no. 508-398-2231 ext. 292 Engineering Dept. —Town Hall phone no. 508-398-2231 ext. 250 Fire Dept.—Capt. Kelleher. 96 Old Main St. So. Yarm. Phone no. 508-398-2212 Other Appropriate plans and/or application shall be provided to each of the departments checked -off above. Each of these regulatory authorities has their own requirements outside the jurisdiction of the Building Department. All applicable approvals shall be obtained prior to submitting a building permit application to the Building Dept. Thank you for cooperation. Receipt s Signature `7- 6 -v 6 Date Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 127453 Expiration: 11 /1/2006 Type: I idividual WALTER C. BRENNAN, JR: WALTER BRENNAN;JR_ 267 MAGNET WAY ' BREWSTER, MA02631 Administrator i¢ t�anL»ta�aurealll n� �iiazw.r�uaeCG`, BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 004389 Birthdate: 01/21/1951 Expires: 01/21/2008 Tr. no: 13089 Restricted: 00 WALTER C BRENNAN 267 MAGNET WAY BREWSTER, MA 02631 u TOWN OF YARMOUTH WELDING DEP,rI$TMZNT PLAN REVIEW R BUILDING PERMIT APPLICATION REVIEW NOTES CA�c� -FIX �Exm i r Cog r ADDRESS: Map / Ld: Date of Initial Review: OTif.E9 i Correction List N Description Code Section (For affim me only) z Dmial (ave)r Section 104.32, pm ChsoM Exwxfi7 ie w Ahmdion (pe-a� nmmmfmmbW •Iris popoaed I, a Spocw Permit from me Z= ft Board of Appals odw Bail ft Code Denial (if RV&") 05/08/2006 14:20 FAa 3087713597 ANGELA RAE PHILBROOH L1001 02/271208b 15:13 5172546784 (508) WT(n'7w 7 ONE CALL PAGE 04 FEDERAL EMERGENCY MANAGwENTAGENCY See TheAtt=W O.M:BA 3w-d4Ad STANDARD FLOOD HAZARD DETERMINATION M + lEmoss n, 2= SECTION 1. LOAN IVFORMAT1 11 �. LENDER NAME AND ADDRESS 2 COLLATERAL 0XQfwV%(0 Ie Horrrerl'a WfW PtOPwW PROPERTY ADDRESS Selective luourance Company RagaibewrovanmmYbeaftd)co 40 Nantagc A" 369 WHAT SSLA= ab CIS 101 NEST 7C8H!lOQPi;<, I(A 02673 Branchville. NJ 07890 JIARTW T.Ttg=yT.Y Harald d Sa3A-t 3. LENDER ID. NO. 4, LOAN IDENT1flER S. AMOUNT OF FLOOD MISURAhM REOURWO 009002000190 $ ' 9CCT10N I A. NATMAL FLOO13 IN8URANCEPROGRAM go:" COMMUNlwjuRWlCTXM /. NFl NConwmwvw 2. Oxmt Mal a. Stale 4. NFIP�Cemnaarity we IIx"EXITH. TOWH Oil I 8.713nir5'r L= la 15003,5 IL NATIONAL FLOOD INSURANCE PROGRAM (1111" DATA APFSCTWG BIALDINGIYOBILE HOW T. NFIP MaD Number Or C-0mmuaty Parted Numbu 2 NFIP Map Panel Wlecwd 3. I.OMAILOMR d. Flood Zone S NO NFlP (COnxnuniY Name. R nat the same as. W) Revfeed Onto I yyD 250025 0005D 07/02/92 � B bens C. FEDERAL FLOOD INSURANCE AVAILA01LrrY (Chock anew appttr) 1. E Fadoral Flood insurance i$ava"W NDMmLFLVYPpfgo*7asin t*n Q Regale► Program ❑ Emergency Pro9remdNMP 2. [j Fedenall Flood Me uterma is nnI avau* bnatroe wmnwrdty in not porddpaling In rho NFIP. 3. Q sui bUe Home is in a C®elel Sevier Reaouroes Area (CBRA) Or a ProhaiAre a ea (OPA). Federal Flood 4surance may M avallabo CORAIOPA Daelp mkn Date 0. DETEFUMMATIGN IS BUILDINGIMOBILE HOME IN SPECIAL FLOOD HAZARD AREA (ZONE CONTAINING THE LETTERS W OR " Vr) 7 YES ® NO N Yee. flood InsuMnOu is rexalred by the Flood Dlaeder Promdlen Act of 197& d no, tmod kmmwm io M mq *od by dte Ffaod Dha Pnr6ecBOn Ad 0t 1973. E. COMMENT13(oamom4: This de urmallon is based On axamirny the NFIP map. any Federal EmeyencY fiaaegon»nl Aomwy revswns b i, end any other NKomtatlon n odad to be84e Me bullft ftwblN home on Ore NFIP F. PREPAR5RS INFORMATION a.. NAME ADDRESS, TELEPHONE NUMBER (frp(ho om 49rdorJ . I DATE OP DETERMWAT70N Piret Amazican Plead Data 9eroicoa 10/20/OS at 12.48 PK CDT 11902 Baraat Road lenetia, 1'X 78758 . . ��.,...r.�. F1004Cert N: 031OC94723 1-1100.447-1772 FWA Form ata3. Oct 02 ......a.r.a an 10=4e of 72A4 PM �Sr RECEIVED By: To: Town of Yarmouth Building Inspector From: Harold Salant, One Call Insurance Agency file, Re: 369 Great Island Road, West Yarmouth, MA 02673 Dear Inspector; AUG 0 4 2006 Pet"hie attached, rr-N4A'_siWard Flood Hazard Determination ,tht hotise located at the above referenced address is NOT located in a spacial flood hazarri ar a/ilood a one. The prior flood leap hated 1986 stipulated that h was located in a flood zone. Upon clarification, in the 1992 map, the aclual home is not located in a flood zone. Attached you will note the difference in Toning according to the federal f mcrge.n' Management Agency 1or NFIP. FLMA is the governing agency for determining if a property is inn flood zone. Thank you for your consideration in this niatter and il'you have any questions, please feel free to contact me. Sincerely yours, ' a,•old Salaitt One Call Insurance Agency, Inc. 4 August 2006 12 I B TAc oNT STREET, SfteaHTON, MA 02 135 I O CONCORD ROAD, SUDBURY, MA 01 7715 MA a00.773-50$3 USA 800 72 5268 BRIGHTON MA 01 7 762 2255 FAx 61 7-254-6764 MV0 3110 b8L9P9ZL19 bl:bi 900b/t'0/80 05/08/2006 14:20 FAX 5087713597 02/27/2096 15:13 6172546784 (50a) vv 744 7 Aptyr..A AA8 rnlL nwvn ONE CALL PAGE 84 FEDERAL EMERGENCY MANAGEMENT AGENCY' seeThe aeadee a1LeNa3067�6t STANDARD FLOOD HAZARD DETERMINATI a n• zoos SECTION I . LOAN INFORMATION ,. LENDER MANE AND ADDRESS 2 COLLATERAL fFk ,?d'dW liable Itaar8Pl3l w9W Fr4VCM PRDDERTY ADDRESS (Logal bow4ftn may beR&N*CO selective Inm=all.de coopmay 40 9Pantage Aw" 369 632MT ZSZA= RD C27 101 NEAT IMMD LH, UL 02673 Branchville. NJ 07890 Ja3RTIN T.RSILLY af, Harald J SaAant 3. LENDER 10• NO. 4. L.OAN IDENTFIER S. AMOUNT OF FLOW INSURANCEREWIRED 009002000190 $ 9CCTION ■ A. NATIONAL FLOOD INWRANCE PROGRAM 90" C*MWU V WI0DICTION 1. NFlP Camw"row Name 2. Cow"") I w!. Stafe I 4. NFIP Cor mw►ty I ►NioeW T&Tjgm =, T'ONM OF I SA,yPc+n = I WA Z50015 S. MT OWU. FLOOD UMMANCE PROGRAM VMM DATA APFWTD= BUILI)INGNMMUM HOLE 1. NFIP MaD Number or QrwunkY Panel Number 2. NIRP Map Panel EflectkW 3 LOIMAILOMR 4 Fbad Zone S No NFIP (CanxrwkyName.Inot frosameas AA) ReviowOnto Map 250025 0005D 07/02/92 B YM oft C. FEDERAL BLOOD INSURANCE AVAILMUIY (Choi* all Urd appal 1. Q Fedard Flood Inwronce is avaOablo (e mm mllypsrtic>;fmfesn W-n Q Reamer Pm9rom ❑ 6ms9mu9 ft7 m of MRp 2. Federal I bid ksutww la nil avalFahle fle - , cmmmomy In not pw1;dPwbV In rho NFIP- 3- I] Rueding/Mab9a Name 6In a Caeab) f ffw Resolsaas Ama (;BRA) of Ohftw ae Pmf clad /Yea (OPA). Fodord Road freavance may not be avaaable CBRA/OPA Dosom lon Oats o. trel>�rMrtvaTwN IS SUILDINWWRILE HOME IN SPECIAL FLOOD HAZARD AREA (ZONE CONTAINING THE LETTERS "A" OR "V") 7 (] YES ® NO N yes. fbod Irts=MW is reWrad by the Flood M&wdor PfoMeta Ad of 1979. If no. lead kmmxa Is not r WkW by the Fbod Db w RdeOm Ad of 197a. E. COIAlT MM (OPdbm4o. This delermmooM b b®ed an axO mwv me NFIP moo. any Foldi Enwrgency IMarmgarrxnrt Agaaw rewisiore b )L orw any ether Wbrawaoe neoded br beats fle larYdkrg/rtwbNo home an the NFIP F. PREPARERS MM MOTION e• • . * NAMQ ADDRESS, TELEMC3NE NUMBER (6C0br&m t.andX) . I DATE OF DETEJiMWAT10N First American Flood Data Services 10/20/05 at 12:46 FX CDT 11902 Barnet Goad Austin, = 78750 - noodGart R: OS10C94723 1-800.447-1772 ,•sr+rr,nr. _ . ousfw txvm—d m, 0=0 at 12. t'M Property Location 369 GREAT ISLAND RD rrsion M 94 MAP ID. 1411/ / / Other ID: 9/ K082/ / ! #: 1 Card 1 of 1 Print Date: 07/05/2006 1 1 2 rior Wall 1 2 rior Floor I . 2 tin. Fuel Ming T}pe T}pe Roans Tape tell Style FPO OOS PATI DCK1 verage+20 Story re -Fab Rood )reed Air-Duc entral Bedrooms 1n Bdums LACE IST ►FPL OPEN Oi11' SHORE i-AVG :S-RE.S TITE B I 1 B 1 L 280 L 140 e T}pe I Plumbing rgWall isPrtns inunon Nall Heigbt I COiDO/-11OBILE HOME D.4Ta4 1 1j. Base Rate 105.00 Adj. Factor 0.92188 le (Q) Index 1.40 Base Rate 135.52 ;. Value Nov 444,777 Built 1971 Year Built 1977 1 PhNscl Dep 25 IIIObslnc 0 i Obslnc 0 1. Cond Code 1 Cond u o rail "o Cond. 7S rec. Bldg Value 333,600 F-BC'ILDLVGECTR4 FE4TC, rtPrlce D-. D Rt I Vo.Cnd 2.200.00 1977 1 100 800.00 1977 1 100 0.00 1977 1 100 2.50 2001 0 50 25.00 2001 0 75 BA.S irstFloor 1,224 L224 IJ24 135.52 FEF oreh, Enclosed, Finished 0 575 403 94.98 FGR 3,aragge 0 528 211 54.16 FOP orch, Open. Finished 0 665 133 27.10 FITS rpper Story. Finished 476 476 476 135.52 PTO ado 0 540 27 6.78 SFB 3ase, Semi -Finished 0 1,188 713 8133 RCS eck Rood 0 946 95 13.61 600 0 - - - - 2,600 Y • -' IWile 65,876 54,615 28 49g 18,024- 64 S08 r 3,659 96,626 12,874 wr .. a ., Property Location 369 GREAT ISLAND RD MAP ID: 14/ 1/ / / Vision ID: 94 Other ID. 9/ K082/ / / BLAw #: 1 Card 1 of 1 Print Dalai 07/09/2006 11406 CURRE.\'TOIi1ER TOPU UTILITIES STRTIROAD LOC.4T70.V CCRRE\'TA&VE,SSJIENT ILLY DLLRTIN T 69 GREAT ISLAND RD 1'ESTI'ARIIIOIIT'H,11L4 02673 Owners: 2 4bova Street 4 'as I aced 2 Y!burban Desm non Code 14vPrw.vedN71ue Assessed ['ahre 815 I:-1RlIOCrTH,JL�1 ollin� blic Wat� S LAND SIDNTL SIDNTL 1013 1013 1013 841900 335,900 3,000 84000 335900 3,000 � ptle SUPPLEMENTAL DATAdditlonal Account # 0002200 ubdiNision 130 photo Ward NUMBER 246D I,SID: 94 ISION Total 1,180.800 111801800 RECORD OFOli1ERSHIP R-IOLIP4GE SALE DATE Lit vAVALE PRICE :C. PREI701:SA,SSEKKIIEVIEV (HIS 1) H LY 11L4RTIN T C OCONNOR LLC C'. OCONNOR LLC CONNOR LaR REIVCE C D10177G3 D928615 C169749 11/02/2005 07/07/2003 07/07/2003 Q P I I 1 I 2,000,000 1 0 1F Fr. .'ode Assessed !•ahre Pr. Code Assessed f ah(e 1r. lCode I assessed !blue Z006 006 006 1013 1013 1013 841900 335,900 3,000 006 OOG OOG 1013 1013 1013 743.200 335900 4.200 005 005 005 1013 1013 1013 743.200 335900 4.200 TomL 1,180,8011 Toml: 1.M.300 Total: 1,083,300 EXEMPTIONS OTHER A.SSESSVENEV is signature acbitmvledges a i isit by a Data Collector or Asssseo. Fear Type Desch non Amount Code Descii non Number Amount Comm. Ant. APPRU.SED J'ALCES131.11ART 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: 333.600 2,300 3.000 841900 11180,800 1,180,800 Cost/1Alarket Valuation Total: I NOTES 160 SQ.FT,OF FLOATING DOCKS (75%) - I/A et Total Appraised Parcel Value 1,180,800 11I7LDI-\'G PER111T RECORD I TSITICIL-1 \'GE HISTORI- PermrtlD Issue Dare Tv a Desch non Amount Ins .Dare %Comp. Date Comp. Comments Date ID Ot PurposeResult 01-561 00-633 747 268 2/28/2001 3/10/2000 10/20/1998 "/1996 W; RS AD RS Residential Residential Addition Residential 16 S00 12 S00 35,000 3-"0 5/8/2002 "/2002 5/25/1999 100 100 100 100 I/l/2002 ADD 111/2002 FINISH 1/1l2000 2 1/l/1997 REROOF FLORIDA R11I O OVER GARM CAR GAR CONVER 11/18/2003 5B/2002 4/23/2001 1/26/2000 5/25/1999 11/7/1995 KF KF Imo' GM Ghl AIH 02 00 00 01 01 02 Ieasur+2Visit - Info Ca Ieasur+Listed Ieasur+Listed Ieasur+lN3sit Ieasur+111sit Ieasurf211,51t - Info Ca L-L D LIVE I ALC:1TJON VECT10:ti' x I Use Code I)CS07 non Zone D rrontagel Depth Units 1 Unit Price !.Factor S.I. C.Foctor A'hhd. Ad. I hues -Ad S ecralPricrn Ad.UmtPvice Londlalue 1 1013 'FR WATER 18,730.80 SF 6.77 2.95 9 2.25 0090 1.00 Z.10 x 90 topo 44.95 841900 Total Card Land C'nits 18 731.00 SF Parcel Total Land area: 19.731 SF Total Land T'alue!j 841.900 )ore 1 lJ��F� A i✓d,//'I Dec Ofe D �i(-��bpGlGr�D/✓ joq 4 L �b% BEa/dyA��l Tip/ i i r%/�-- �8 c%!E �r �� 9 4-tedC�nA A,'D 16A,4::2 W/ A.O /I D� /L A/% �6 oT�ie/AIT D� ��� &%re /4Z ea ie 1-r x/o .4yD,�lar/,4 ,L /�//.i�G' .,�G5 A 7 /✓' 4 /og . ,f.yo GXoe-X � 4 R6;;4 . 3 EA,*t /CAI' G�/s�✓' i /'� ��� �,�o�►JT ��/i'��ai.,/ per' �- .P6A.�. y�E �oy✓� 4ZL �,✓/��/E �� cow off" GJ �llCbAl. `.- !AID 1?7P A 6A� m ;QL1 U vq gw25 lir Jko/o �5i!5 0 I �G/lLD/cl� ?2jW L This Section for Office Use nly Building Permit Number: - Date Issued: de I f vj-. Signature: Certificate of Occupan La (snot required - Building cial Date Section 1 -Site Information I Use Group: R-4 Type: 5-B 1.1 Property Address: 36 9 6,oP—f-A-r �s z/1,0 0 1.2 Zoning Information: District Proposed Use l�jS�eP�lort°rh` / f-lA Z!o 7-3Zoning 1.3 Building Setbacks (ft) Front Yard Side Yards Rear Yard Required I Provided Required Provided Required Provided 1.4 Water Supply ( M.O.L. c. 40. S 54) Public Private 1.5 Flood Zon ration: Comments .. I Zone: BFE: Section 2 - Property Ownership/Authorized Agent 2.1 Owner of Record: �fjQ/L77,L) ^j4?f/G1 J ZZ /-/Alm S7- AA)V IS H4 62 Name (print) Mailing Address ` i — 97Z — 933 Signa ure Telephone 2.2 Authorized Agent. 4- Tf,- &. ' 3/2 c c1,r1,4 A.) �,� AT7AIT E tle 0 L!N / : Z Name (print) Mailing Address 0S- qV0- 30/,�J-7�i{2HdU H•4 OxL73 Signature Telephone ai P T=—!0 3 3 3 Section 3 - Construction Services 3.1 Licensed Construction Supervisor. G7"tie CT f,cJA 7 / JUN 0 2006 N itApplicable ❑ 2-&7 f-/Aevi-r BUILDING DEPT. Li ense Number pdy38 Address Sd _L14,0 - Expiration Date rol6nature Telephone 3.2 Registered HorWe Improvement Contractor: Company Name L 7f /- (f� <- ZAW'l' j �Z Not Applicable ❑ License Number z 3 Address Z4,7 ",4 e,A) -T c.JA y Signatur Telephone ,5-08- OD - 3 uv Expiration Date / / - / - O <-- OVER o/ 1 of 2 Section 4 - Workers' Compensation Insurance Affidavit(M.G.L. c. 152 s 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 .Y... No .......... Section 5 - Description of Proposed Work (check all applicable) New Construction ❑ I No. of Bedrooms 3-1 No. of Bathrooms. Existing Bldg. Er I Repair(s) ❑ I Alterations Pr I Addition ❑ Accessory Bldg. ❑ Type Demolition Other Specify: Brief Description of Proposed Work: t)11 te tkja LIA �-7 e� a-J — /p-ov— fcr� Siof rJL — {�rl yTEAWP T2i — r�J uJr cJAvu1S— N TAR ro% L�l v pc `t C c;4, k r- S�(t✓� vll'�°0�1 ASReiL i2tjqA IV7144e t o ,e Section 6 - Estimated Construction Costs Item Estimated Cost (Dollars) to be completed by permit applicant 1. Building .Z SZ) 0 t' 2. Electrical 30. c.) 3. Plumbing / Gas 4. Mechanical (HVAC) 2D o D / 5. Fire Protection / 6.Total=(1+2+3+4+5) 23, 047f? 7. Total Square Ft. (new houses & additions) Z p p Section 7a - Owner Authorization - To be Completed Wh Owner's Agent or Contractor Applies for Building Permit I, Check Below ❑ Conservation -Commission Filing (if applicable) Old Kings Highway & Historical Commission approval (if applicable) , as owner of the subject property hereby authorize //n &1 44,14 !rw to act on my behalf, in all matters relative to work authorized by this building permit application. Date Section 7b - Owner/Authorized Agent Declaration y 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 9-D 4- Date 9-15-99 t 1 2 of 2 32 pf 'YARrc TOWN OF YARMOUTH 0 ° ;;,,•,,; BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT. Job Location: 369 0ZG73 Number Street Village Owner of Property: Construction Supervisor: ALTe4 &-` Name ./A I License Address: Z &-7 f�AG � r` LAJ A y �2s= Gci,5 r-i 4 /�1i9 O � G3/ Licensed Designee: (If other than Supervisor) Name 2.15 Responsibility of each license holder: License No. r'rL"srA0. 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 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 0 No ❑ If you have checked Xes, please indicate the type coverage by checking the appropriate box. A liability insurance policy ,f � 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. Ge rat Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner AAent 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. /'� i "—lv IL OD Type of Work: �S.t�D t % D "� Est. Cost Address of Work 369 �o /� �,4! 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: 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 of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 NWr www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ApDlicant Information / Please Print Leeibly Lz e Name (Business/organ=tion/Individual): �2�•JN� z� �u� "� L y YS r�/�s Address: C, AJ I Z City/State/Zip: Phone #: S�00 -12OW - 73Lb A�re.,/�' on an employer? Check the appropriate box: i. 319 I am a employer with I L/ 4. ❑ I am a general contractor and I employees (full and/or part-time).' 2. ❑ I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance 5. ❑ required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t have hrrcd the sub -contractors listed on the attached sheet. t These sub -contractors have workers' comp. insurance. 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 11.❑ Plumbing repairs or additions 12. ❑ Roof repairs 13.❑ Other +Any applicant that checks box # I must also fill out the section below showing their workers' compensation policy infotnation: 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 sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees Below is the policy and job site information. _ Insurance Company Name: A Policy # or Self -ins. Lic. #: 76/ SSG, 3D / ZOO (-o Expiration Date: / Z -3 1- O to Job Site Address: 369 6 ► (-A7- --rS LAa 0 City/Statc/Zip: GU- yA•�rrou i-r/ Hi4 oz�73 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 andior 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 Offic f Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. 6-08 yao - 7 U S-e. _o 4, Ofcial use only. Do not write inYhis area, to be completed by city or town official. City or Town: Permit/Ucense # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. Cityfrown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone M 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 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 (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 Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia TOWN OF YARMOUTH 1146ROUTE28 SOUTH YARMOUTH 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 369' 4;k9-4:ZyC"t "JO `��P-Hv Ltd, HA O zG 73 Work Address n is to be disposed of at the following location: ia� / UJAs SYS' `ryS Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Date Permit No. GGC�iE0MCED TOWN OF YARMOUTH h4AY 0 9 2006 �_ �,Z�, °. HEALTH DEPARTMENT HEALTH DEPT. PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Building Site Location: 3&9 GRrAT ._L.s 1xAj6 /2/-) Map No.: Lot No.: S Proposed Improvement: _SW, o U O kAy o,e (�.JO 0A i1 D +3 Applicant: WA t— T1_-2 0.' gyZ C..a /0,Q,J J2 Tel. No.: SOS - Y00 -`7 3 S �i 80M�4TT�v}r�1� tin uv�Tz Gv.�/iQRKDui-r/ /-/A oZt,73 Address: zb-7 HA60f-A/x1 Ozk 31 Date Filed: 5 -oi n S� **Ifyou would like e-mail notification of sign off, please provide e-mail address.-. aR�,U,yi ck Bct i C4 i ,Jto Q C7,o WMsr, �C1 fT Owner Name: �'i.Q 2T1 �rri LL y Owner Address: ZZ. HA W ST Owner Tel. No.: b t 7 - 072- -g 4 3 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: (1.) 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: V DATE: 5_21010 17 PLEASE NOTE COMMENTS/CONDITPN)S: M ST n v 3 '3�� ✓vS 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: 3:F61 6o2i�A7 Map #: Lot #: Proposed Improvement: !'x 74 Npi ✓:? (Z,t/O VA --7 o A) S Applicant: OA6 !z'X D-2P.y f/J 8D M,4rrnKts,5- e0_ 2 A/ ARNou Address:z&? HAL,6f7-p)AA>- AsrTeI. #: ti�-YaZ 73&6 Date Filed: 5 37 -0 S- 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 W TE DIVISION� sionature date PLEASE NOTE: COMMENTS: Signature Of Applicant Date: p NAME STREET 369 GREAT ISLAND ROAD LOT 82 VILLAGE ;-BEST YAIU-IOUTH SERVICE NO. 2 02- Hyd. # 41411 43,p 32'Q" „ 181011 141 6/ r.- GREA.'' ISUND ROAD WEST YAM40UTH SERVICE NO.koe /39SDrQG� • NAME�W�enC� C'. D�w��o.�. ,STREET ,369 A(�-relt?'—�S'C�7ci Odd J VILLAGE (,JeS-� arrmau4"P� METER NO. .41&A•V =9 35•• 3 - 23-0o j 4-00 lip ' -t U I Gr'e.0.+ ._t_S IanC �oa9 ✓!ie �iamo,ea uaea a1,A& aacXuaeM Board of Building Regulations and Standards - ' = HOME IMPROVEMENT CONTRACTOR -�- - Registration:127453 ..Expiration: 11/1/2006 Type: Individual WALTER C. BRENNAN, JR WALTER BRENNAN, JR 267 MAGNET WAY :_ -:, �, ,mac.✓ BREWSTER, MA 02631 Administrator ✓/P BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number. CS 004389 { t _ i Birthdate:01/2111951 I Expires: 01/21/2008 Tr. m . 13089 Restricted: 00 WALTER C BRENNAN - 267 MAGNET WAY Q" BREWSTER, MA 02631 Commissioner 05/08/2006 14:20 FAX 5087713597 e2e27/2eeb i5:13 6172546784 C5oa) m(o.7w 7 "tiLl.A RAM rnA, nVVal OW CALL PAGE 84 FEDERAL EMERGENCY MANAGEMENT AGENCY SceTheAttadxd aMBhfo3007C2ts1 STANDARD FLOOD HAZARD DETERMINATION r.2W5 SECTION I • LOAN NFORMTION F40 NDER NANE AND ADDRESS 2 RAL ODLLATEfE4riMidrplAA16le) hnraPDr> of PttpeRy% PRGPERTY ADDRE39 R� mmyboomnfty ective inpuranao cmVany Wantago Ave 369 GM2&T IRLJA<D ffi TIE9T mMIMOtM, Tel. 02673 CS 101 BranCbvil].*. NJ 07890 8>;�;g: Harold d Salant 3. LENDER 10. NO. 4. LOAN IDENTFIER S. AMOUNT OF FLOOD *4SLfiW E REWIRED 009002000290 $ BCCTION a A. NATIONAL FLOOD INWRANCEPROORAM Pa') COMWJWFT 1URMD= Mi 1. NFlP CommunlW Name 2. Co molds) & Stole 4. NFlP C&Wwr ity nluo6ar =30100m. Town OP I BA=snAnr.>• 250015 6. NATIONAL FLOOD INSURANCE PROGRAM (IMM DATA 4FFUMV C 81AL00J&WOME now 1. NFlP Moo Number or Cwmwnt)f Panel Number 2. NFIP Map Panel ErmaUvef 3 LOMMLOMR 4 Rood Zone S Ne NFlP (Cwnrmtahly Name. 0 not the same am W) Revised Onto I bap 250015 0005D 07/02/92 s yesDew M FEDERAL FLOOD INSURANCE AVAMML(TY(Chu* on Ihnt OppW t. Qz Fedmal Fbod keurance ie avaftW (mrnmraldy psrtictmles i0 AI -n Q Room Pregram Emsgm cy Program ofNF1P 2. p Federa, Fbad Inenrenoe b not avalahte becatsx oamv'KY in not pm6Spadng in 0u NFlP. 3. ❑ BeHome is In a C®lel Daaw Retrdaeea Ama (CBRA) orOMemom Proffi�d Nee (OPA). Federal Hood kmaanoe may not bavagabk CO RA/OPA Des pn ftm Data 0. DETERIMMATION IS BUILDINGlM0131LE HOME IN SPECIAL FLOOD HAZARD AREA (ZONE CONTAINING THE LETTERS "A" OR "W) 7 (] YES ® NO If yes. IbW Insmancm is reolimd by of Ffoed Dleeafsr Pmlacem Ad of 1979. If Iood ihaaarm is not mq *od by the Flood ObeaeOsrRwteclw0 Ad of 1973. E. COMMERM (oven: bored on w4pn nkV the NFIP mew. *W FVft y Manegenront ABeoc7. revrsiorra bit orw any odsd to l- a-- Ole bukfthrrob% home an the NFlP TOis FO)tMATIDN r• LNAMP- TELEMONE NUMBER (ffofhorMan wax) I DATE OF DETERMINATION A>sorican P1ood Data 9esvicap 10/20/05 at 12:46 PK CDT 11902 Barnet Toad Austin, = 78750 F1004cert !: 051OC94723 1-000-447-1772 ZORN F 8 �atA orm octsz ogw" Vm&m=daft'1WA4"12A6PMCbT- TOWN OF YARMOUTH F ;¢ Building Department 4x Town Hall Yarmouth, MA 02664 (508) 398-2231 ext.261 BBUILDING PERMIT TRANSMITTAL Temp Permit No.: T-06-509 Applicant Name: Walter Brennan Applicant Phone: 5084007388 Building Location: 00369 GREAT ISLAND RD Owner's Name: Martin Reilly Owner's Addres 22 Main Street Hyannis MA 02601 Owner's Telephone: (617) 872-9933 (OFFICE USE ONLY Recorded By: Ic Permit Fee: $0.00 Deposit Rec: $25.00 Payment Type: Cash ChkNo.: 0 Net Owed: ($25.00) Application Date: 6/8/2006 Issue Date: Expiration Date Comments: Map/Lot: 014.1 selective interior demolition sib N REVIEWED BY: 1. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT: DATE: N/A: 5. BUILDING DEPARTMENT: DATE: N/A: 6. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE CO /MtIENTS: RECEIPT OF COPY: OF APPLICANT: DATE: Date Printed: 6/9/2006 APPLICANT PERMIT TO `-.FIELD COPY BultDING-Ob-633 3/i%o PERMIT March 10, 2000 B-00-03 e��==�y,,��a DATE 14 �_PEBp1 IT O. l�,awi�iu P.Galmom/ • ADD E�$S �\ �DO�.Slii�I. W • (N0.) (STREET) wjMCA OF (CONTR'S LICENSE) Alta ttms (_) STORY DWELLING UNITS (TYPE OF IMPROVEMENT/ NO. •• •1-1 ---- --- ZONING AT (LOCATION) ISL-odNA 02673DISTRICT-��..t7�` (N0. (S REET 1 BETWEEN AND m (CROSS STREET) ? (CROSS STREET) m m SUBDIVISION 0 BUILDING IS TO BE m O Z. TO TYPE f N O REMARKS: AREA OR VOLUME 14/1 LOT l�L BLOCK 7 SIZE FT. WIDE BY FT. LONG By- FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION USE GROUP BASEMENT WALLS OR1r OUNDATION // (TYPE) cff existing ovw ale Car QarcYP far lb= mapose• n9, bathrom and wet bar area. 12500.00 PERMIT ttuub� ESTIMATED COST $ FEE 133_-W (CUBIC/SQUARE FEET) OWNER Tamrmm C nTrCC33r' BUILDING DEPT. ADDRESS 17R'A(ljir-Al m2 may kbst.m- 13NO BY INSPECTION RECORD DATE NOTE PROGRESS - CORRECTIONS' AND REMARKS INSPECTOR ic_ _ �-- -�Gi r�G -L !a"��,;�d r7 cc Ps va 0, ? 7 5 - 4Y-7 Yz/ t OF YAR'tr OH MA4T s0 CMCC+,S ONE & TWO FAMILY ONLY - BUILDING. PERMIT APPLICATION TO CONSTRUCT, REPAIR, RENOVATE 6A 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 PermitNo6-bb-W Datel/P-OD Permit Fee $/q3�K it �" 1� Deposit Rec'd. $161' Date.3.36b Net Due $/33, Planning Board Information Plan Type Endorsement Date Plan Recording Date Other Assessors Department Information: Map of Mpp /Lot Old �f New 1.4 Property Dimensions: Lot Area (sf) y3 Frontage(ft) Lot Coverage This Section for Office Use Only Building Permit Number: Date Issued: Signature: Certificate of Occupanc is is not required Building Official Date Section 1 - Site Information I Use Group: R-4 Type: 5-B 1.1 Property Address: �?4G 6RCA7- 7SGRNb Ra4J) 1.2 Zoning Information: Zoning District Proposed Use �t% yZAJT) 1,0 c/ 21V 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) ublic Private 1.5 Flood Zone Information: Com 8 t I Zone: _,R BFE: Section 2 - Property Ownership/Authorized Agentlip ultin Pj ",..,., U 2.1 Owner of Record: � _A- rGa7L[._ 15 .47�'1D�'= Name (print) Mailing Address Xe cr 2u e-!J T r(, 33oY6- p Signature Telephone 2.2 Authorized Agent: .tic I -IA rr L-> r7,41ZV P 16JT s r VN (p mt) Mailing Aclress tr ignature Telephone / Section 3 - Construction Services 3.1 Lic sed Construction Supervisor: Not Applicable ❑ F) GA�NEA u .r^uArz License Number Ad Expiration Date Dllloylpoot7 i ature Telephone 6 _ 3.2 Registered Home Improvement Contractor: Company Name C0157 DO DSl D C P0 Not Applicable ❑ /zL7 6Ai7A1<Ar):12, License Number S Expiration Date JL Signature Telephone �f 0610 606 nor 8 9-15-99 1 of 2 OVER i Section 4 -,Workers' Compensation, insur nce Affidavit(M.G.L. c. 152 S 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 ❑ I No. of Bedrooms No. of Bathrooms Existing Bldg. Repair(s) ❑ Alterations Addition ❑ AccessoryBldg. ❑ Type Demolition Other ✓ Specify REC�?rATi )/0 /�oov✓1 Brief Description of Proposed Work: AA x a S 1 Al �/ A a .. D I< iZ O - i C/ - /AJG R,4771200^ AND Section 6+'='Estimated Construction Costs 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 SO O 00 2. Electrical o0 3. Plumbing / Gas p 4. Mechanical (HVAC) p oo 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) a c_D 7. Total Square Ft. (new houses & additions) V / Section 7a - Owner Authorization - Owner's Agent or Contractor Applies To be Completed When for Building Permit as ownffr of the subject property hereby authorize irNA'R D :R 65A7 VEA U M to act on my behalf, in all matters relative to workauthorized by this building permit application.w- '/ ahaCpe. CJ , �� "P_ - ja - UO Signature of Owner Date Section 7b - Owner/Authorized Agent Declaration I, 2e- A1471 P G.47N6D,44) 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. -,k111R b ?. r142NrA0 �2 Print name Signature of Owner/Agent Date 9-15-99 2 of 2 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 �� C1 91-F[-A7- 20.4C> Work Address is to be disposed of at the following location: VfmoiyoZZ 7AifI tc'Z S-15 Oil/ 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. oo� c-5oa� Dad °FYgR TOWN OF YARMOUTH 2 'rQ BUILDING DEPARTMENT BUILDING PERMIT APPLICATION SIGN OFF Applicant: 'J /C Building Permit No.: W Tel. No.: '09'6�6620 Date Filed: 364' CiZc%7- �56AA > i?cQ �c Bldg. Site Location: 11) XApk&4 601Z,IW A _ 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 folloty ng Departments must sign off, in the respective order, prior to building inspector issuing the required building permit: REVI D BY- . WATER DEPARTMENT: 2. ENGINEERING DEPAR t3�CONSERVATION: t4. HEALTH DEPARTMENT 5. WIRING INSPECTOR: 6. PLUMBING INSPECTOR: 7. FIRE DEPARTMENT: — PLEASE NOTE All stumps and/or brush must be disposed of at an approved site. COMMENTS: L,Uco& d K_ DATE: '1 eta N/A: DATE: N/A: DATE- N/A: DATE: 3 N/A: DATE: DATE: N/A: N/A: DATE: N/A: 8/99 Applicant Signature Date °fYA�i TOWN OF YARMOUTH 0�C °�„;„�„,,,s BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT. Job Location: ?U 9 617 EAT TS L AAI b Rd 4t% t/�0106 1--A i'fA Number Street Village Owner of Property: GAW /Zt UC r C6) ?Cd1Znlo? Construction Supervisor: /?J c i4'4i2 b P. t542NGAV, Uh 009 71 y 662 -o;?0G7 Name License No. Phone No. Address: r� 40C)b CS / i' zC cvi L�/}7/1%S T.4 L�� /L{ tl 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 licenseewho 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 @ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Phe152 of t eMass. neral Laws, and that my signature on this permit application waives this requirement. Check one: of Owner or Owner's Agent Owner ❑ Agent FJ Signature: Building Official Approval: The Commonwealth of Massachusetts Department of Industrial Accidents Office ellevesduffoss 600 Washington Street Boston, Mass 02111 Workers' Compensation Insurance Affidavit Applicant information: PTeasePRULUggaft rime %�iC N 4i2tom- II � A 7AN nEALA �l i2 location C� S/ W D O i? c5 f 1i e SIC% R.+W?1% � 724 i? i r phone # -17�F=17;�6 5 ❑ I am a homeowner performing all work myself. 2' 1 am a sole proprietor and ha%e no one working in any capacity I am an employer pro%iding workers' compensation for my employees working on this job. company name; may phone N• insurance co policy N I am a sole proprietor. general contractor. or homeowner (circle one) and have hired the contractors listed below who ha%e the following worker' compensation polices: company name: may phone N• insurance co policy N 3rrur��.ruz Failure to secure coverage as required under Section 25A of MGL 152 an lad to the imposition of criminal penalties of a fine op to S1,MA0 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine 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. 1 do hereby ce • nnde the pains enalti s ojperjury that the information provided above is tare and correct / Signature ate 0,210, 1�`000 Print name 7 Phone # h�r�-o90 6 / official use only do not w rite in this area to be completed by city or town official city or town: YARMOUT$ ❑ check if immediate response is required permit/license N nBuilding Department [3Licensing Board 261 OSelectmen's Office (508) ion 2231 t Health Department phone N. _ _ ea • n0ther contact person: Ire .,s d 3,95 PJA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their 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 entpleirer is defined as an indi% idual. partnership, association, corporation or other legal entity, or any moor more of the foregoine 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 d.vellin_ house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another vvho employs persons to do maintenance , construction or repair work on such dwelling house or .in the wounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGl_ chapter 152 section 2� 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 authorit%. Applicants Please till in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplyini-I 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 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 1111fliC0 0f INVOStl111nlSIS 600 Washington Street Boston, Ma. 02111 fax #: (617) 727-7749 phone #: (617) 7274900 ext. 406, 409 or 375 , Suggested Affidavit for Home Improvement Contractor Permit Application For Office Use Only Permit No. Date NAME OF CITY/TOWN AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGLc. 142Arequires that the "reconstruction. alteration renovation repair, modernization, conversion, inprovement, removal, demolition, or construction of an addition to any pre-existingowner-occupied building containing at least one but not more than four dwelling units .... or to 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 C./2Odr✓1 OL)fl? rX i < /ii7/C� �Aili��C Est. Cost .00 Address of Work Owner Name: 2Ae4)/ZL 4VCj5 V 'CQA itJn/? Date of Permit Application: I hereby 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: I hereby apply for a permit as the agent of the owner: ,2 tc gA7zp 7 �,ARAICAJ /D003�i Date Contractor Name Registration No. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name PLOT PLAN uttorIs .me t # this is a =ner lot, -ite in name street. 4 FOR LOT # b Indicate location of garage or accessory building Additions with dashed lines -------------------- Sewerage disposal (cesspool) Welt I n I I(lot..%.A............. ft. rear) I SIDE YARD -1,9-ET-0 I I i REAR YARD ....�.1....ft. I I SIDE YARD d- '-�o_FT,� I SET. BACK .. .ft. I� I ' I ( lot.. J. �. l : 3 � ...... ft. frontage) 69 61-ZE,�r 1 s GA (NAME OF STREET) AbuttorIs Name Lot # If this is corner lo- write in name of a other bstreet. M M �e Supplied b P �A� � 1 m v Supplied by 2y lV - MARK NORTH POINT 'J'w'rA'� 6 '5 a JTPe-K o0 C•euuo WEE!- C' F.R i NOIZrN .SarYI316R WALE. o ew fwln�Q 4.J.J�•� CelivarC Df'rw� 1C CC OF�f W W NFD SNEIVE{ (IM L•IL�NG+WaIES T �Ir--rl � DrPEury Uw. Ei. l I I a (ltfrrA ri 4•• �ygsE BeNRO ' IAS' "YI�'DlaErwP 6ornTH TNTERrDR V✓A!-(� EiliSTING GARAGE A:Awic �C30 ____:AST.1rt'CEliloR.wncc . F ar,.y I AW 21— P_ NEit .TMfR�og WALL 22' w A[TaATONS TO -C. STIIJG.Aanft $P4cE 26 NORIM "�(,�Nbrn�a_ 6 jDEE R..w 01 EUND WEE4 L __.. NDRiN jr&7.6R16R WA R, o ew IF; nw� � ,Cna�wrf DE'rn� rp Uf p[rEWy�wED SNEIwES�M A C41 Wn[E5 T °ICI 'Drys,n.rw. M. 1 1 1 � pt[rb ri M" (LIRE EenR 0 Als' /r�'exrr.i lSowTH SNTER10�'Z WaN-L r-AISTOA)& 6ARAE1E %,TA^19 Ex, RM 7uillL --rTA .£AS77.1tyCtFJkIOR. NAU . eL.awJ—I A32( C_ k/Eir_.pvr4g,oR UALL _- Z�. 1 ' P'N4'fln,cso � O l yffr cShTs � "1 ATERATiDNS To-rW-rlNG _f700(t SPACE 26' NeRM �N6TccL SDf6TTRoot el C�fuNO 7 SifE4 O El _. NORra-rYrEFRiOR WALL A R GeuND+v/��t5 I .� �MIi Y'• 6v.E e».xno ' IRS•'Wl�'barvwP tSO4Tli SNTERIOR WAOL E%I.STIAJG GARAGE FTAngE -C. lx.ar,.y I AW 21 WALL 22' xnn.r d f..anw fi.T --srn�p r�nPin. r�een.. • p'xY'flxisfo � S.ffr cs tits � 1`ZbORr� It ATt7AT"ONS TO E4I4TIN6 nOOii S�gGE. NeRM 2G' i LOT 61 Ii5f.33t pi LU1-8z m �yy I A 19, 400 + L 4' ApPRpx1MATE C4500�, BE�a.) 1r1 Q p I IEACHI N(� 1to MN� •`• ( AREA. 3• 1'S Ell- _ I EDGE OR �. 1 owN ,(oAS I NG �� 1 1 N J D-IV L yy 1 3a c RAOC� i/p.41 r' u1 , 01 J l�• EGYC. ° r `i r Q �f. P 1 E%l sllu(i Sf_ N. MY,%5T 1 NCr I WALK + t jhr)K O I exls7t, Docr< L.o p>p'T O < v�0 � 6IL � I1� )8 y f.. APPROVED: BOARD OF HEALTH DATE AGENT F C-K ' 4v.SSEe 1 N �� xeTAI NI NC) \vhLL 1 1>^T 10 CPAvi N4 i, �glccic suaFAcE) 1 � � t 1'8 G' L.C. IIlk_I NOr6 �ROPa J6D GA,EI96 S \., pOorTlan/ �Lr/ST/ or L�AS/1'-TRENCH �ID� ` ey c eA�G -�Yh 2ln p••`E 0f,XElYy/ST'•. tc0 tQ;% E �FSSO ;`rslJS�t E�R]K�E,,.O9':'1 ALR�i\/ i)a1oyE, FROM 2/22l84 S/TE T�mPo1ZPc1iY PERMIT PLnAi OY C.R. SyaRT, MASS L S 1902 -7Z PROPOSED (;A RA C-E ,DE0;c FOR PRO.ECT LOCATION 3 L 9 G E/-'\ 7- Jr-YZ AND P-D. WE O (JT/-/ Mr1T.i CRAIG R SHORT PROFESSIONAL ENGINEER 508- P.O. BOX 1044 398-8311 SOUTH DENNIS. MASS 02660 SCALE �• =LQ DATE /p�22�"-8 JOB NO. REVISED SHEET / OF / RE`"sm REFETZ6u«- LL.PL.144ZL' ELEVATIOIJS MA,5ED o1J h1-A1J 5EA LEVEL_ Fjua. 17--458 11 I 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 HUD: 6137 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 3-3-2000 DATE OF PLANS: 10-1-98 TITLE: New Room over Garage PROJECT INFORMATION: Lawrance 6 Hellen O'Connor 369 Great Island Road West Yarmouth Ma. 02673 COMPANY INFORMATION: Rick Garneau 251 Woodside Drive West Barnstable Ma. 02668 NOTES: MaCheck by Cape Cod Insulation INC. # 1330 COMPLIANCE: PASSES Required UA = 131 Your Home = 113 Area or Cavity Cont. Glazing/Door Perimeter R-Value R-Value U-Value UA ----------------------------------------------------------------------------- CEILINGS 584 30.0 0.0 21 WALLS: Wood Frame, 16" O.C. 506 13.0 0.0 42 GLAZING: Windows or Doors 86 0.320 28 DOORS 20 0.220 4 FLOORS: Over Unconditioned Space 572 30.0 0.0 19 HVAC EQUIPMENT: Furnace, 85.0 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 MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.01 New Room over Garage DATE: 3-3-2000 Bldg.[ Dept.[ Use I CEILINGS: 1. R-30 Comments/Location WALLS: 1. Wood Frame, 16" O.C., R-13 Comments/Location WINDOWS AND GLASS DOORS: 1. U-value: 0.32 For windows without labeled U-values, describe features: # Panes Frame Type Thermal Break? [ ] Yes ( ] No Comments/Location I DOORS: [ ] I 1. U-value: 0.22 I Comments/Location FLOORS: 1. Over Unconditioned Space, R-30 Comments/Location HVAC EQUIPMENT: 1. Furnace, 85.0 AFUE or higher Make and Model Number AIR LEAKAGE: Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. When installed in the building envelope, recessed lighting fixtures shall meet one of the following requirements: 1. Type IC rated, manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated, in accordance with Standard ASTM E 283, with no more than 2.0 cfm (0.944 L/s) air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/ft2 pressure difference and shall be labeled. VAPOR RETARDER: Required on the warm -in -winter side of all non -vented framed ceilings, walls, and floors. MATERIALS IDENTIFICATION: Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R-values, glazing U-values, and heating equipment efficiency must be clearly marked on the building plans or specifications. DUCT INSULATION: Ducts shall be insulated per Table J4.4.7.1. DUCT CONSTRUCTION: All accessible joints, seams, and connections of supply and return ductwork located outside conditioned space, including stud bays or joist cavities/spaces used to transport air, shall be sealed using mastic and fibrous backing tape installed according to the manufacturer's installation instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted. The HVAC system must provide a means for balancing air and water systems. TEMPERATURE CONTROLS: Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. SWIMMING POOLS: All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. HVAC PIPING INSULATION: HVAC piping conveying fluids above 120 F or chilled fluids below 55 F must be insulated to the following levels (in.): HEATING SYSTEMS: Low pressure/temp Low temperature Steam condensate COOLING SYSTEMS: Chilled water or refrigerant PIPE SIZES (in.) TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4" 201-250 1.0 1.5 1.5 2.0 120-200 0.5 1.0 1.0 1.5 any 1.0 1.0 1.5 2.0 40-55 0.5 0.5 0.75 1.0 below 40 1.0 1.0 1.5 1.5 [ ] ( CIRCULATING HOT WATER SYSTEMS: I Insulate circulating hot water pipes to the following levels (in.): PIPE SIZES (in.) NON -CIRCULATING I CIRCULATING MAINS a RUNOUTS HEATED WATER TEMP (F): RUNOUTS 0-1" I 0-1.25" 1.5-2.0" 2.0+" 170-180 0.5 I 1.0 1.5 2.0 140-160 0.5 I 0.5 1.0 1.5 ` I' 10D-130 0.5 I 0.5 0.5 1.0 ----NOTES TO FIELD (Building Department Use Only)------------------------- TOWN OF YARMOUTH Application for a Permit to Build No. 71/7 UPON FINAL APPROVAL �b 'l 9 `'�I� AP GI LOT FEE MUST ACCOMPANY THIS APPLICATION. DATE 19 9F' The undersigned hereby applies for a permit to build according to the following specifications !G/Zo/gy 1. Name of property owner �c8e.�rce C'/elPty `ram )tidZ Tel. 775 'f Address ?�G ei�T r< ,?-a d ) c4/. ?dR'fdp,0% 2. Name of Architect (if any) ,NIA Tel. 3. Name of builder -ke 141 L2 � �7�L�1d �i Address , Ct/DOJsrfle II T(�jl�iysT�J,�/c� 4. License No. 00 !:2 / H Tel. SSD( 7 5. Name of Mason Address 6. License No. Tel. 7. Construction address 3G C s 14,1 pXd 6v Z dO Flood District 8. Date of subdivision Approval plain zone Zone 9. Private dwelling ❑ Estimated Cost 0 �/ /OGU N�TE IN THIS SPACE Type of room No. 10. Multifamily El Po- c3�000 . ya4 76 o saaJATo v�...T l 11. Commercial ElAC,&A e- ` C&¢ , rdE445r;f.", Sa�� rr Kitchen Dinin Rm. 12.Other _ h �o g Living Rm. 13. No. of stories � 3 Cs 4- :.. Rm.ocEgn ��ti frS� rr'' 14. Foundation — Full ❑ Half Crawl ❑ b C7, As -Bath flaX 15. Materials — Wood ❑ Cement ElOther�L7 Deck a 16. Type of heat— Oil ❑ Gas ❑ Electric ❑ Other ❑ ate,- 6 -r I-Aa Closed porch 17. Garage —1 R�'2 ❑ 70 r ale Family Rm. 18. Swimming pool - Size �� 090 Sun room Garage a 19. Storage shed — Size -� Shed 20. Stove — Wood ❑ Coal ❑ Alterations 21. Size of lot: No. of feet front /91A9 No. of feet rear Jo?4. 7�' No. of feet deep _/S1• 33 22. Size of building. No. of feet front c�� No. of feet side c �i No. of feet rear o?o� 23. Distance from nearest building: Front Ft. side /I Ft. side Rear 24. Distance back from line or street 3 I From rear lot line Side line 25. H.I.C.R. No. / 0003 4 � i A 1 , LOT RELEASED BY Signature --� PLANNING BOARD Address Date ?o. a' qF 3'-S%° Cw13S Fwrf 6068 �,FlaHg06Ey-ASR o rt ic1S ALL Y Nam. Rcr'cv� --� ��Er•,, ; _ tx,sT,rJG,. EweANG (j,9 icAC is r Li GOi< Doo W. 7 4oG8 SA SL oR FWG koG�R _CAc,C-M,-,V_r ./ \ f' © C LJ / 4 /10 x li I'---- YIA rill 17) T -2-I jII i OCT Cox _Z6,01 L j4FA0,511 STIED LVL fbc k CIA rx'ST".)e 1 1.6 2 FO0 =T��LAnD kd. = IW. YAR1),,cc)T-9, 111A. ,SCAIE /,,:: J� I I - - - --- - - -..sue • ..a �•' V .. .-fw... �— _ - '„ •. — t _ •'�' LOT 451 t ,77. LUG 8z - - App'ppX1MAT-E G4Soon. Ba�ow LEAC-tit N(S 1 ":y. ExvsT111tt tDX 8�4 /AM 3 All 5 1 '�� To'.7 _ i i Ex15 'G j•� I a i Q IZh o Q �f 7.1 r K '- - T �; . - , 14vssEo i►a �, WALE ��. 1 P�'aj10C9•,��N4 •ei 1.8 310 CMR 10.99 Form 2 r, — Commonwealth ` of Massachusetts a c s tzar A. r+s. fro a a.Maa er i7e1 City To"YARMOUTH Appiaeanr Lawrence & Helen O' Conno: Determination of Applicability Massachusetts Wetlands Protection Act, G.L. c.131, §40 and the Town of Yarmouth Wetland Bylaw From Town of Yarmouth Conservation Commission Issuing Authority To Lawrence & Helen O'Connor Same (Name of person making request) (Name of property owner) Address 369 Great Island Road Address Same West Yarmouth, MA This determination is issued and delivered as follows: (3 by hand delivery to person making request on (date) W by certified mail, return receipt requested on o _+s hhA. R.. 19 9 R (date) Pursuant to the authority of G.t_ c.131, §40. the Town of Yarmouth Conservation Commission has considered your request for a Determination of Applicability and its supporting documentation. and has made the following determination (check whichever is applicable): Location:StrintAddress 369 Great Island Road. West Yarmouth. MA Lot Number. ' 1. rJ The area described below, which includes all/part of the area described in your request, is an Area Subject to Protection Under the Act. Therefore, any removing, filling, dredging or altering of that area requires the filing of a Notice of Intent. 2. C The work described below, which includes alVpart of the work described in your request, is within an Area Subject to Protection Under the Act and will remove, till, dredge or alter that area. There- fore. said work requires the filing of a Notice of intent. Effective 2.1 - - - - -.. _. _. 3. ❑ The work described below, which includes ail/part of the work described in your request, is within the Buffer Zone as defined In the regulations, and will alter an Area Subject to Protection Under the Act. Therefore, said work requires the flung of a Notice of Intent. CONDITION: A silt fence shall be installed 10 feet from the proposed foundation on the wetland side. This Determination is negative: 1. ❑ The area described in your request is not an Area Subject to Protection Under the Act. 2. ❑ The work described in your request Is within an Area Subject to Protection Under the Act, but will not remove. IIU, dredge, or alter that area. Therefore, said work does not require the firing of a Notice of Intent. 3. P1 The work described in your request is within the Buffer Zone, as defined in the regulations, but will not alter an Area Subject to Protection Under the Act. Therefore, said work does not require the firing of a Notice of Intent. 4. C The area described in your request is Subject to Protection Under the Act, but 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: Issued by OF YARM TH Conservation Commission Sign This Determination must be signed by a majority of the Conservation Commission. On this / day of personally 19 Te before me to me known to be the person described in. and who executed. the foregoing instrument, and acknowledged that hetshe executed the sir r his/her freeact and de ! .C_ Notary Public My commission expires The D@WMMPM Does not !*Mire trill apme•m tram CanpMng wAh as orw aomeabie 1*0", stets or IN* snariss. 0rde1er10ae. by laws or ngt Wou. Thu Dowmmawm shae t» vsid forme. yers tort^ tM over• o+.auertee. TM apoba M. the owner. any person sgpneved by mts tHarmmarim aril' o"'"•r of lane at UMM tie taro loon wheh tM prdDOMd work is w ho aa»: o►any un rostdonts of tM Csy ortown in wh= such land Is ktear•d. an non" ioWred of iek MM to!•quM trio DOMMOM Of ErwironmMel Protsew" to asm a Supansdirq Det.mw+erni of Appi"huny prOwl"V tM rower a mods by ow Mreo miss at hand Osier! 10 the Deperteent, with the sppropna• filing tes and Fee Traiisn" Form u provided in 310 CMA 10.03M within ton Cays trim Mrs dun of iouerro• of tfds D•nmtlnmom A Copy of the rsquea shah at vo tart.Oms be Md by C•niMd feed Or hah0 OshvM t0 the Co eervaion Comnsion and the appheam. 2.2A PLOT PLAN AbuttorIs Name Lot # If this is a corner lot, write in name of street. FOR LOT # 24 Indicate location of garage or accessory building Additions with dashed lines • -------------------- Sewerage disposal (cesspool) Well 0 SIDE YARD .I -- — — FT_ (lot................ft. rear) REAR YARD HOUSE SET BACK SIDE YARD 0-----FTO (lot..................ft. frontage) /7eAT--7S1wA/D Rc) (NAME OF STREET) Information Supplied by Abuttor' s Name Lot #�/ If this is corner lo- write in _ name of 04 other aa)i street. ro 19 MARK NORTH POINT e I On, F TOIL _3 -To Ic " ;Vat., /�fri , IT, otiq 'c i.A"A -,A ar.05,11i ui'ar U'Roi-!ar. A"U twf: tq I �S jso'�-'-n F'vwn &—,f V.- .its a ;.UA&I WIN pn 6v dit, OfV -!7 :fv trz to fzwj T_i"l 4.--. x"IT too at. tr,�y ftrel •, v I .. i rmx bw- Suggested Affidavit for Home Improvement Contractor Permit Application For Office use only NAME OF CITY/TOWN Permit No Date AFFIDAVIT Home Improvement Contractor IAw Supplement to Permit Application MGLc.14ZArequires that the"reconstruction alteration, renovation, repair, modernization, conversion, inprovement, removal, demolition, or construction of an addition to any pre-edsting owner -occupied building containing at least one but not more than four dwelling units .... or to structures which are adiacent to such residence or building" be done by registered contractors, with certain exceptions, along with other requirements. 1iP1c�D / Fx�✓2s�zc / aao' Type of Address of Owner Name: �Aw,?fA1= elP�Ci!/ / DCOAMIQI Date of Permit Application: ,% I hereby 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: Cogr O �' OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOTHAVE 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 downer: Dantractor Name Registration No. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT: JOB LOCATION: OWNER OF PROP CONSTRUCTION SUPERVISOR: _ a,2 t—) G, ?/1/l I l� oD 71 E ts NetLICENSE NO. PHONE ADDRESS: LICENSED DESIGNEE: (IF OTHER.THAN SUPERVISOR) NAME LICENSE N0. 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 LA'S OF THE COMMONWEALTH, EVEN THOUGH HE, THE LICENSE HOLDER, IS NOT THE PERMIT HOLDER BUT ONLY A SUB- CONTRACTOR OR CONTRACTOR TO THE PERMIT HOLDER. 2.15.3 THE LICENSE HOLDER SHALL IMMEDIATELY NOTIFY THE BUILDING OFFICIAL IN WRITING OF THE DISCOVERY OF ANY VIOLATIONS WHICH ARE COVERED BY THE BUILDING PERMIT. 2.15.4 ANY LICENSEE WHO SHALL WILLFULLY VIOLATE SUBSECTIONS 2.15.1, 2.15.2 OR 2.15.3 OR ANY OTHER SECTION OF THESE RULES AND REGULATIONS AND ANY PROCEDURES, AS AMENDED, SHALL 3E SUBJECT TO REVOCATION OR SUSPENSION OF LICENSE BY THE BOARD. 2.16. ALL BUILDING PERMIT APPLICATIONS SHALL CONTAIN THE NAME, SIGNATURE AND LICENSE .LUMBER OF THE CONSTRUCTION SUPERVISOR WHO IS TO SUPERVISE THOSE PERSONS ENGAGED IN CONSTRUCTION, RECON- STRUCTION, ALTERATION, REPAIR, REMOVAL OF DEMOLITION AS REGULATED BY SECTION 109.1.1 OF THE CODE AND THESE RULES AND REGUZATIONS. IN THE EVENT THAT SUCH LICENSEE IS NO LONGER SUPERVISING SAID PERSONS, THE WORK SHALL I121EDIATELY CEASE UNTIL A SUCCESSOR LICENSE HOLDER IS SUBSTITUTED ON THE RECORDS OF THE BUILDING DEPARTMENT. I HAVE READ AND UNDERSTAND MY RESPONSIBILITIES UNDER THE RULES AND REGULATIONS FOR LICENSING CON• STRUCTION SUPERVISORS IN ACCORDANCE .%ITH SECTION 109.1.1 OF THE STATE BUILDING CODE. I UNDERSTZ'"N" THE CONSTRUCTION INSPECTION PROCEDURES AND THE SPECIFIC INSPECTION AS CALLED FOR BY THE BUILDING OFFICIAL. INSURANCEERAGE: I have a curreDyfiability insurance policy or its substantial equivalent which mee!s the requirements of MGLCh.152 Yes MI No ❑ If you have checked ves, please indicate the type c average by checking the ap;rcpriate bex. A liability insurance pciicy ❑ Other type of :.idemnity ❑ 8ond ❑ OWNER'S INSURANCE WAIVER: 1 am aware that the ucensee does not have the insurance coverage• required ty Cha U-r2 of t e ass: G eral l.sws, ano that my signature on v,,:s permit :cplication waives this requirement - Check one: Owner) Agent 2/ i nature of CA.ner or ONners ent SIGNATURE: BUILDING OFFICIAL APPROVAL: The Commonwealth of Massachusetts Department of Industrial Accidents oxce elinest/pstliis 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit cin phone # I am a homeowner performing all work myself. Q' I am a sole proprietor and ha%e no one working in any capacity I am an employer pro,, iding workers' compensation for my employees working on this job. comnan}• name: cim phone #• insurance co policy # CD I am a sole proprietor. general contractor. or homeowner (circle one) and have hired the contractors listed below, who ha%e the following worker' compensation polices: company name: city- phone #• insurincc co policy. # GIi7TiTP.7,77iP.7U Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a gist ap to slsuv.uu Anatol one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a not of SI00.00 a day against me. I understand that a copy of this statement may be forwarded to the Officeof Investigations of the DIA for coverage verifiation. t do hereby certify finder ;he pains and penalties of perjury that the information provided above is true and coned v Print name-ge,1A72b ;7 4,4 Zn/PAAJ fT - Phone q ow F-- aa/ T OM021 use only do not w rite in this area to be completed by city or town otticial city or town: YARMOUM ❑ check if immediate response is required permit/license # []Building Department Cl Licensing Board 261 ❑Selectmen's OMce ❑health Department frnn% 398-2231 eat phone #; _ []Other contact person: (,e ,,cd 3,95 %A) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. 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 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 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. %IGL chapter 1 section 2i 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 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 suppling 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 tite 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 affdavits 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 Mice of lavestlltetle12 600 Washington Street Boston, Ma. 02111 fax #: (617) 727-7749 phone #: (617) 7274900 ext. 406, 409 or 375 o9b , BUILDING PERMIT APPLICATION SIGN OFF APPLICANT:,al/Al2b 7> �j%//�/�>n�/(���J J/Z BUILDING PERMIT 4�: ADDRESS:A% WODD_S(DC /7lit -W - BABA( ELE. NO.: W F. a067 DATE FILED:�� BLDG. SITE LOCATION: ,-?,- C�i7�',gT-� SGA�t/D /fll MAP#: LOT#: 641 yi11 Ivc) 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 DETER- MINE COMPLIANCE TO THE FOLLOWING (A) ZONING REQUIREMENTS (B) HISTORICAL DISTRICTS (C) FLOOD PLAINS ZONING. THE BUILDING DEPARTMENT WILL BE RESPONSIBLE FOR ASSISTING THE APPLICANT THOUGH THE FOLLOWING DEPARTMENTS: WATER DEPARTMENT: ENGINEERING DEPARTMENT: CONSERVATION COMMISSION: HEALTH DEPARTMENT: FIRE DEPARTMENT: RESIDENTIAL AND/OR COMMERCIAL BUILDING DETERMINES COMPLIANCE OF WATER AVAILABILITY. 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, MARSH LAND, ETC. DETERMINES COMPLIANCE TO STATE AND TOWN REGULATIONS, I.E.: REQUIRE- MENTS 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. THE FOLLOWING DEPARTMENTS MUST SIGN OFF, ISSUING THE REQUIRED BUILDING PERMIT: REVIEWED BY: \1. WATER DEPARTMENT 2. ENGINEERING DEPARTMEN': \3. CONSERVATION: 4. HEALTH DEPARTMENT IN THE RESPECTIVE ORDER, PRIOR TO BUILDING INSPECTOR DATE: -/ fo - �;a N/A: DATE: N/A: DATE: -tld N/A: DATE: AO— A-- —cgN/A: 5. WIRING INSPECTOR: DATE: N/A: 6. PLUMBING INSPECTOR: DATE: N/A: 7. FIRE DEPARTMENT: DATE: N/A: ALL STUMPS AND/OR BRUSH MUST BE DISPOSAL SITE MUST BE SUBMITTED PERMIT. COMMENTS: PLEASE NOTE DISPOSED OF AT AN APPROVED SITE. A SIGNED RECEIPT FROM THE TO THE BUILDING DEPARTMENT PRIOR TO ISSUANCE OF THE BUILDING BLM/89 �.y TOWN OF YARMOUTH WATER DEPARTMENT y 99 Buck Island Road West Yarmouth, MA 02673 Telephone: (508) 771-7921 • Fax: (508) 771-7998 Date : April 4, 2000 Service # : 13980 Name : LAWRENCE O'CONNOR Legal Address : 369 GREAT ISLAND ROAD : WEST YARMOUTH, MA 02673 S rvice Address : 369A GREAT ISLAND ROAD : WEST YARMOUTH, MA 02673 Assessors Sheet # : 14 Lot(s) # : 82 Certified Mail # : Z 483 195 057 New Structure : X Existing Structure NOTICE This is to advise you that the Town of Yarmouth Water Department or their authorized agents have installed a new water service or rehabilitated an existing water service at the above service address. Materials used during this installation are electrically nonconductive. Town of Yarmouth Water Department regulations prohibit the use of this water service as a grounding device for your electrical service. It is recommended that you contact an electrical contractor to ensure that your electrical service grounding is in compliance with Massachusetts Electrical Code, CMR, S27-12.00 Article 250. A copy of this notice is being forwarded to the Town of Yarmouth Wiring Inspector. �Ricltakd A row ey Superint dent cc Wiring Inspector File z� The Commonwealth of Massachusetts O:jice Use Only p = M1reic No. L —06 — t4 1 v`). Department of Public Safcty _ Occupancy b Fee Checked BOARD OF FIRE PREVENTION REGULATIONS S27 CMR 12.00 3/90 (leave blank) APPLICATION toFOR �PIERoMITrdance �TOth e PERFORM aIELEZGTRICoAL WORK All %,ork (PLEASE PRINT IN INK OR 7YPE ALL INFORMATION) Date b o /00 r— City or Town of fLU To the Inspect f Wires - The undersigned applies for a permit to perform the electrical work describedow- IA1 n Location (Street & Owner or Tenant %�C e 0 )LO�� Q �- APR j Owner's Address . Is this permit in conjunction with a building pewit: Yes u No ❑ i&3; to Box) Purpose of Building. r��' T �1TLAC E � m Utility Authorization NO. Existing Service %DO Amps / w / 2 �b Volts Overhead ❑ Undgrd No. of Meters_�_ New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and location and Nature of Proposed Electrical Work Q pAl ve`T S (a CL b®ue Gr-�R(Z� No. of Lighting Outlets g No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above ❑ In- ❑ grnd. grnd. Generators KVA No. of Receptacle Outlets 1 No, of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners \ FIRE ALARMS No. of Zones NIn of Detection and InofDevices No. of Sounding Devices No. of Self Contained Detection/Sounding Devices Local ❑ Municipal Ll Connection []Other No. of Ranges No. of Air Cond. Total tons No. of Disposals No. of peps TTons Total No. of Dishwashers S ace/Area Heating P Dryers No. of Dry Heating Devices KW No, of Water Heaters KW No, of o. o Si s Ballasts Low Voltage Wiring: No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE- Pursuant to the requirements of Massachusetts General Laws I have a current i ility Insurance Policy including Completed Operations Coverage or t ubstantial equivalent. YES VO ❑ I have submitted valid proof of same to this office. YES NO ❑ If you have chec�kko YES, please indicate the type of coverage by checking the appropriate box. INSURANCE BOND ❑ OTHER ❑ (Please Specify) Expiration Date Estimated Value of E ectrical Work S / / Work to Start OO Inspection Date Requested: Rough wT/'( /� (�l Final Signed under 7the penalties of perjury: '_ 1 FIRM NAME_ E �� LIC. NO I� \9\'S Licensee\Z0 Le 'P\L E VLkC-n Signature LIC. N0. Address2� I \kUL t- !If L Ykx� Q�W�,,y� 076 Bus. Tel. No. 694- Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub- stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE S Signature of Owner or Agent MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING OEM (Print or Type) ' TOWN OF �0,0,5 Y/��ii1D(J7� Date Permit # Building Location o-ka O%QA i _JS. Owner's Name �ev17 n o2 Type of Occupancy / ens 11z)c/Un5 G New ❑ Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ No ❑ il 0 ME IN ON 9r :.°:eeee�:e;;M Cz=MANEMEEANEMNMMA:a exee� Installing Company Name _e ARL- FZTEDEL -J SnN Address '7 1? MAIN ST OSTcRVIL• F MA !>'?_LASS7 Business Telephone 47-$- (e3tois' Name of Licensed Plumber or Gas Fitter Check one: ❑ Corporation ❑ Partnership ❑ Firm/Co. Certificate INSURANCE COVERAGE: I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ❑ No ❑ If you have checked vees_, 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 142 of the Mass. General Laws. and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner[] 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 the permit Issue for this applica 'on will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene Law �� BY T e of Ucense: 16. Title � Plumber gna ure o tensed lumber or as Fitter Gasfitter�� City/Town Master Ucense Number Journeyman AP I "* 4-Ll qA ,ieft�� Z!-? 05 8y 2040 4z 0 a MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) 1/�� / TOWN OF w��' YprRmfw-L 'ale f 0 eO Permitr# - O 4 Building Location G1Qeu Owner's Name QL Q��NNc9�'j �S a ,, Type of Occupancy ��-✓ New ❑ Renovation W Replacement ❑ Plans Submitted: Yes ❑ No ❑ FIXTURES NEW ■_�'__� a� Installing Company Name C6aL KT G,'DEL! ��CCheck one: Certificate Address 7'7R' A41,A1 sr Ly'Corporation (L) E!E7R V i L L. M A ❑ Partnership Business Telephone q-aw - G,3G,S ❑ Firm/Co. Name o! Licensed Plumber INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ❑ No ❑ If you have checked Les, 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 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ 1 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 the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plum,bi Code aRP Chapter 14 o the�neral taws. By))/ Title Signature of Licensed Plumber Type of License: Master ❑ Journeyman ❑ City/Town APPROVED (OFFICE USE ONLY) Lic'ense Number pi Z'y(Q 7 APR 12 2000 D, C V 6 N 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 OF RMOUTH' MAY 3 0 2001 D g 5 3& (OFFICE USE ONLY) LL Fee: J ov) PERMIT NO. C-o/" 7 is (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: \�3 To the Inspector of Wires: By this application the undersigned gives notice of his or her intention work described below. (p� Location (Street �- Number), n 9 rotten` c �-Sk Av.J�, li t Owner or Te Owner's MOJI MI perform the electrical ephone No. Is this permit in conjunction with a building permit? 9Kes CJNo (Check Appropriate Box) Purpose of Building- SLgsoo 2 V0 Utility Authorization No._ .Existing Services 00 Amps 1-?a / 241 Volts Overhead Undgrd New Service l O Number of Feeders Amps / Volts Overhead and A Location and Nature of Proposed electrical Work: No. of Meters i Undgrd ❑ No. of Meters Completion of the fallmrine table may be trained by the Inspector of Wires 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 Lighting Fixtures Above ln- Swimming Pool -rnd. grnd. No. of Emergency Lighting Battery Units No. of Receptacle Outlets d 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 Total No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number — — Tons — — KW — — No. of Self -Contained Detection/Alerting No. of Dishwashers Space/Area Heating KW Local 71 t[ t J No. of Dryers Heating Appliances KW Pp Security Systems: t No. of Device. quipvalent No. of Water Heaters KW No. of No. of Signs Ballasts Data Wiring: 9 1 No. of Device. quiva ent No. H dromassage Bathtubs y � No. of Motors Total HP Tel No. of Device., ns Wiring: No. of Device. tii E uivalent Attach additional detail if desired, or as required by the Inspector of Wires. 'INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued 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 Jr BOND[] OTHER (Specify:) (Expiration Date) Estimated Value of Flectrifal Work: (When required by municipal policy.) d"Work to Start: Z O f Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under he pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: LQ �C rUCO (=,yVL tC— LIC. NO. LicenseeNtA UCI-L C d Sign: (If applicable, enAr `_exempt" in the license numb( inc.) 6-a- LIC. NO.(\ \ 11 S J Bus. Tel. No.: 36'L—�6� Alt. Tel. No.: 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. 1 am the (check one) owner ❑ owner's agent. Owner/Agent Signature [Rev. 04/001 Telephone No.