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Home My WebLink AboutBuilding Permits Backfile TOWN OF YARMOUTH Building Department (508) 398.2231 ext.261 PERMIT NO :: :~.:O7;~# : : ....H..... ~ ISSUE DATE :. .1.1a~9QG. ; OP SED USE : r. - - - - - - - - - - - - - - - - - - -. - -. -.-0 APPUCANT ,John Fa/acel BUILDING PERMIT J, \. JOB WEATHER CARD AT (LOCATION) 100011CAPT DORE RD SUBDIVISION MAP LOT BLOCK 1067.175 LOT SIZE 1 I PERMIT TO :... ~t~a~c:n~ . . . I ZONING DISTRICT~ Bldg. Type: IResidential BUILDING IS TO BE: CONST TYPE I5-B I. USE GROUP ~ CONTRACTOR LICENSE I 069152 I Fa/acel, John POB 1224 five replacement windows REMARKS EST COST ($1$900.00 I ~02664 ~ I PERMIT FEE ($) 1$35.00 BUILDING DEPT BY Hyannis 5087752815 MA 02601 AREA (Sa FT) OWNER IANGELO T ANRICO ADDRESS 100011 CAPT DORE RD South Yarmouth PHONE 15083941699 INSPECTION RECORD FIELD COPY Date ~ .~ Note Progress - Corrections and Remark Inspector /5<./~/a; 77 ..// i1:. ff -(All .- ". .. . - t/4 ~'l' ./ , / .. . . :. . . . . "" .' }i' . CONSTRUCTION ADDRESS: EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth BuildJng Department 1146 Route 28 South Yarmouth, MA 02664 (508~98-2231 Ext. 261 II {J4ff .uDtZC JLS J. Y/1-VtA. . . ASSESSOR'S INFORMATION: I Map: ? 1 I Pan:el: 17S" I AN 6&2 0 AN It.-! (1() 1 I aUT ..LJ,,u- IJJ NAME PRESENT ADDRESS TEL II CONTRACTOR: 1-!12.(!(!/r0l1YJ Fctfa;p}- /Y/f7vOtu;I-( ~ 7~S -28/.s.- 11 '~--=_I N~c,,^e t...... f1('e:7v~-"""1 ~'f:!::ff cr ee,/t- t'~.t k. TEL.II 9 ~IUQIUAI 0 Commercial Est. Cost of Construction $ _ ,f--() Home Improvement ConlractDr Lie.. " I tj J> 7 7 () Cmstruc:tion Supervisor lie. , tJ 6 7'/.s d- OWNER: 391-- 1011 W~'s CompcnsaIioo Insunmoc: (cbccltooc) t{\ 1 am the homeowner 0 1 am 1bc sole I" "I" l..tor 0 1 hlne WOI'I='s Qadpellsalioo IDsunIDcc lnsuraooeCompanyNam.e: INS. ,1(fElJ9 111 e. (!. WorkCl"sComp.PoIiCY#~7';;' tJ(P I&- WORK TO BE PERFORMED o Teat (Fino RcIIrdml CertifiCItO--.o Danlioa o R.eplaCCIIICIII doors: 1# Wood Slooe A'RcplIccmcat wiDlIows: II Sbed S- o Sicfias: "ofSquues o b-lOOf "or~ ( ) Slrippiq old shillatcs. '1'be debris will be disposccI of It: () aolag ClVa"_1aycn ofexiolillllOOf Localioa ofFacilily Approftd By: _ill COIIlaiaed are_ aad correct to 1be best afmy taowledgeaad belie! IlUIIIcnIDd dIat aay &be uswa(s) - ...____MOL"'........... :W ~ o.to: /I 7. Of, ..c0 o.to: I? 0.11:: Applicms's S~: BuilcIiDs Official (... desipee) Zooing District: Historical District: 0 Yes ~ No Water ~~ p,oteaion Dislricl: ~ DNo ~NO Flood Plain Zone: D Yes WIthin 100 It. ofWcdands: D Yes No 3/01 ) Office of Ilfvestigrrtions 600 Washington Street Boston., .MA 02111 www.mass.g01lldia -Workers' Compensation Insurance Affidavit: BuBders/Contradors/ElectriclaDSIP~bers An ilicant Information I Please 'Print Le~iblv ~I ~ .C. . .. .' N me ~11Si::.esslOrgWntiCIll!IldividuaI): Address: c? r / y I/7V J/,{G 1-(' a City/State!Zip: . /AI /hJ N I s /Ill . Phone #: ~.. onpl07u'1. Checl< th.",p...prlate ber. Type ofproject'(reqaired): . I 3: l employer with 4. 0 I am a gc:lcral ccnttae:tor and I 6. 0 New ccnmuction loyees (fall and/or pan-time). * have mod ~e Sttb-coIrtractors 7. 0 Rcmode1:i:lg --kD I a:m l sole proprietor or pliItlle:r- :. _ .listed on the ~~chcd sheet. : s1Iip and hr;e 110 c:mployees These Stlb;;COIItrac:tCIS bzve - , & [J- Demolition ., working f'crmem my czpacity. work~' compo insmancc. 9. 0 Building addition (No WOIkI:IS' <;amp. iIlsurancc . S. 0 We llI'e a cmpo,ntion and it! 10.0 Electrical repairs or additiOIlS requIrcd.] o:flice:rs hzve eierdsed their 3.0 I am a hOIlicO'Wllcr dow.g all work . of cxcmpticn per MGL 11.0 PbImbing~airs 0+ additioJls my3c1f. (No warkCIS' compo c. 152, 91(4), and 'We me no 12.0 Roofrcpa::iIS ~Ieqcired.] t . employees. (NoWOIkcrs' . 13.0 Otller . C'mIp. i::Jstl:;mcc required.] . 9J?-: 7 7 ~ 2f?ts- *A:Iy r,:plicalrttllltchecla bax 11 must a!sa un Cl14tt'lle sec:'::icm below Ihcwilli'll:1~~' ~poTicyi:libml&licll: . '.' t R=cWllClS who sub:::i1 tm.s ESdavit i:lciicCl:1i llley an dcill; all 'fmk met Iteu ~ om:ddc c:ant=tcn mc:st rubmit & Un! If5davit :cli~ mch. . lCo::l:1clC%S ~ check lll:is be: =s: &:acl:ed lllI additiClllal !her. shoM::r 'Il:1e n=e of'll:1e ~t:'aCtcn md lllc:r WOIkm' eo:Ilp. poTiey i:lf'on:c:tiQ'n. I am an employer that is pruvlding warlun1 compUl3mon irrsw'ance far.11r'/ employees. BeIaw is t1u polkj amIjob site ::::- Ccmpany:N=: /N~. ;keN",! J' (1 _c-. .... . . 'poliq#c:Sclf-iDS.i.ic. #: 'M ~ t/-4 I %- ~Dai::: . '9 /Is,-/a"f' 10b Site Addre:lS: f YA-~7t II {!/lfT 6 ~ r4 City/Strtct'ZiP: ILl A () 2-fOGti- Attach I topy of the workers' compensa:!ion p.aficy declaration page (showing the policy number and apirlrtion date). Failmc 10 SectlI'ccovcragc as rcqmcd tmdci' Section 2SA qfMGL c. 15.2 'C3:ilead to the imposition of crlm:inal penalties of Ii -- - fine IIp to $1,500. po and/or one~y= imprlsOIlIlJ.CIrt, as well as civil. pCll311ies in the foIm 01 a -sroP"'WQRK. ORDER :md a fine ofilp to S250.00 a day agamstfheviolator. Be advised ~ a c...'1'Y oftbis statcmemmaybe forwarded. tD the Office of hrrcstigations of the DlA for insmmce covciage verification. penalties a/perjury tlurt the i1':/orlMiian J1ruvUkd abuve is trUe ani correct. Da:t:e: II 'r;f7~ 1\ Official uJe onlJ.. Do rr.qt wriU i1r. thb areA, to be cumpleted..'" crt} 01' ttnm affU:itrL City or ToWlJ.: PermftlLlc::nse # lssuing Authority (circle one): \ 1. Baud of Health 2. Building Department 3. CitytTowu Oerk 4. Elearic.al Inspector 5. Plumbing Inspe~or 6. Otb.er . 11 I I I , I CaIrt:ict Person: Phone #: I J J- O'~.:...."-..'~"..;. ...... ;; t!: ~ -'4't" ."' "'-.... -.;;r~ ..,.B I ~~ ....---- _..~_.-,..' 91r<1l!"'''~I1l",,,u-dd Q) .~,',~ BOARD OF BUIl.DING REGULATIONS ,Ucense: CONSTRUCTION SUPERVISOR Number: CS 069152 . Blrthdate: 1211111962 : Expires: 12111/2006 Tr. no: 6328.0 ,-. Restricted: 00 JOHN M FAIJ\CCI PO BOX 122411441 RT 132 HYANNIS, MA 02601 ~~i~~~ "" ~~ "'. .b....,;,:';:<.~!". Board of Building Regulations and Standards "~.,,JJ.. ..,., ~ 11::.~-Y\ HOME IMPROVEMENT CONTRACTOR ';.'l '''/f'l - ');.&J--:~ ..Rllqistration:l48no -__~~ . ,,,"-,,,,. expiration: 1 0/2512001 Type: Private Corporation 'dI jll' -fff,nm"",mc""lrl. cf ~ !faJJnditl4etB HOME IMPROVEMENT SPECIAl.IST OF CAPE COO JOHN FAIJ\CCI 25 IY ANNOUGH RD HYANNIS, MA 02601 z:z-..,...-~ Admlnistl"lltor I . . ACORD. CERTIFICATE OF LIABILITY INSURANCE CSRC'l' HOHEI-1 09/30 06 THIS CERTlFICATE IS ISSUED ~ Ii. MATnR OF INFORMATlON ONLY AND CONFERS NO RIGHTS UPON TtIE CERTlF1CATl! HOLDER. THIS CERTlFlCATE Does NOT AliENO. exTEND OR ALTER THE COVERAGE AFFORDED aY THE POLICIES BELOW. 'ROOU~ The Insw:ancCI Aqency of Cape Co~, Inc. 480 Route 61., POBox 960 Ea.~ SaD~wich ~ 02537 Phone:S08.888-2766 IN$URCO . I INSURERS A""ORClNG COVERAGE '~e~"'s..~..1:y Insuran';~.. Company " I 33618 INSIJ~~II: AIG ~;,ic:an Int:e:rnil!Uonal ~~ IN$UIltiR c; }tarl~sviJ,.le WorCl!lS~ Ins ?. Ho_ IlIIp%ovement: spe<:ialists of Capl!l Cod, Inc. POBox 1224 Hyannis 10. 02601 l~eR 0: INSlJRen e: -r- COVERAGES ~POUCIl!S OF INlIUIWtCe ~1ST!0 seLOW NAill! SP-ll I$SUEO TO THE 1N.'llJReD _OAlOlll!I'OftTNE POLIC't~OO INOIColTliD. NOlWlTNSTANOlNG .." ~eQ\JIREMEHI'" TtAN OR CONQI1lQIj 01' ANT CONTRACT Oft OTHER DOCUIOf/lT wmi R~T TO _Ie" 'TIl'$ C~RnFlCATR MAY at! ISSUED OR MAV PrnTAIN. TN~ IHSURAIICE A~eo SYTHe POUCIES DeSCftlIll!O "'ReiN IS :MSJeCTTO AU. THe TtRIoI:l, J:XCLUSIQOI$ AND COHOInGN! 0' SUCH . PQUC.E$. _GATE I.lMITl: _MAY""1Ili """ REOUCEOOYPAIO C,""I4.~ 1N . .. LTIt ___ l,J"rrs I -l 3953673 09/16/06 09/16/07 I -I UCU$AlII8euA LlA8ft.lTV I "] occ~ 0 QV.1OoIS MADf I oeouC1M8li I RemmoN s i I WOJU<ER$ co....eNSA11Ofl AND 0I1'\.OYE1lS" UA8LlTY a I ANY ~o"",~"""''''Il!JCl!CUTMi I oJI'1CeRIIII'''IliR uCLUDED" ~re6.A~~.- . OTItiR I 09/15/061 I 09/15/07 WC9964613 95000 PltOPE1\on I QESClllnlON 011 OI'EMTIONS I ~T1ONSI YEIIICLU 11W:l.U_ AOOG IV ENDOllSl:Il&lOT I SPE<:1Al. PRC",llIOIIS 1995 Chevy G10 VAN 1GCOG1SZ4SF2220S1 1986 Chevy Plat: DUMP TRUCK lGBHC34HOGS1890S1 Hcnae improveml!lnt and :eftO~linq CERTIFICATE HOLDER CANCl:t.LA TlON WOOOPAl SMOU1.D...... OFT14! AllOY. _&eo P'DI.IClIS ac ~LLeo aEFORe TH! _no DAn T14~eo'. TN! IS31mlClINSUIlER WILL e>lOIAYOR TO MAlI, 3L DAYS_TTVl I<OT1Cli TO TNl! C&RTlFlCAn ItOLDelt NAMED TO TIll! LEFT. BUT 'AILURe TO DO SO ~""L I.Pose NO O8LIGA T10N 011 LIAIIIUTY 01' ANY KINO uf'QN T14e INSUI<SI. ITS AGEH1S OR TA11WS. TOWN OF YARMOUTH Building Department ,_ _ _ _ _ _ _ _ _ _ , (508) 398-2231 ext,261 PERMIT NO : _ JH)7~~1_ _ : .. - -... -... - - - -. - - - - -. ISSUE DATE : _ .191~~OQ~ _; PROPOSED USE _ . . . . . . . . . BUILDING PERMIT .. APP~T :~i~i~ 8~~~ : : : : : : : : : : : : : : : : : : : :: JOB WEATHER CARD PERMIT TO : Alterations AT (LOCATION) 100011CAPT DORE RD SUBDIVISION MAP LOT BLOCK 1067.175 LOT SIZE I I AREA (Sa FT) OWNER IANGELO T ANRICO ADDRESS 100011 CAPT DORE RD South Yarmouth EST COST ($1$5.416.00 1 ~02664 ~ 1 ZONING DISTRICT~ Bldg. Type: IResidential BUILDING IS TO BE: CONST TYPE I 5-B I USE GROUP ~ CONTRACTOR LICENSE I 085985 IHUrley, William 43 Joyce Street South yarmouth MA 02664 5083989727 rEllTlO\le existing deck and replace with14 x 15 deck as per plans dated 09128106. REMARKS 1 PERMIT FEE ($) 1$95.00 BUILDING DEPT BY PHONE 15083941699 ,--' INSPECTION RECORD FIELD COpy Date Note Progress. Corrections and Remark Inspector IIJr 3()~t)' , .... , / . , ONE & TWO FAMILY ONLY - BUILDING PERMIT APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING Town o[Yarmouth Building Department ,. 1146 Route 28 . Yarmouth, MA 02664-4492 Tel: (508) 398-2231 x261 . Fax: (508) 398-0836 . - Planning Board Information Assessors Department Information: (; LO~ 7: 17, New 1.4 Properly Dimensions: Lot Area (sf) Frontage (It) Lot Coverage is required Section 1 - Site Information I Use Group: R-4 Type: 5-B 1.1 Property Address: 1.2 Zoning Information: 1\ CAP"'( .l)o~~ *?J:> flf{D ;::5 . YA:R M jl) u. ..... Zoning District Proposed Use 1.3 Building Setbacks Iftl Front Yard Side Yards Rear Yard . Required Provided Required Provided Required Provided "30 .eo Zo ..z, cJ .-(-4- 1.4 Water Supply IM.G.L. c. 40. S 541 1.5 Flood Zone Information: Comments: .. ... ... Public Private Zone: C BFE: . . Section 2 - Property Ownership/Authorized Agent \ l CAPT. 'l)"Re: f:-'D Mailing Address 3"i'4-- I~'<f Telephone C:SO&s: ~~ Expiration Date {., \i'12w7 Not Applicable 0 10f2 OVER '\ Sectioll4;/WofkerMCol11pellsatioll Illsurance..Affi avit..(M.G;t'ic)15,2$25C(6) ~orkers Compensation Insurance affidavit must completed and submitted with this application. Failure . . to provide this affidavit will result in the denial of t e issuance of the building permit. " . '" , . Signed Affidavit Attached Yes .......... No ...k!.... Section:52 Description .of. 8roposedWorK (c::heck al applicable) New Construction 0 No. of Bedrooms N . of Bathrooms Existing Bldg. 0 Repair(s) 0 Alterations 'S' ddition 0 Accessory Bldg. 0 Type Demoliti n Specify: SeCtion6f Estil11atedGonsfflJction ..Costs Item Estimated Cost Dollars) to be completed by p rmit applicant Check Below 1. Building 2. Electrical 3. Plumbing I Gas 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) 7. Total Square Ft. (new houses & add~ions) S~9tiqn7a7p.~n~rAuthoriz~tiqn...7Io 8~Co~8.I~t d Owner.'s.AgentorContractorAppliesJor Building er .A o Conservation-Commission Filing (if applicable) o Old Kings Highway & Historical Commission approval (if applicable) , as owner of the subject property to act on Date , as Owne~orized Ag~ hereby declare that the statements and informatio on the foregoing application are true and accurate, to the best of my knowledge and belief. I, Signed under the pains and penalties of perjury. ~~e qW~ . Date 9-15-99 2 of 2 TOWN OF YARMOUTH . . BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT: Job Location: LAPI. 'b o.ne ~l') Number Street Owner of Property: A.J.J c:.&t-o Au ~I c.....o Construction Supervisor: tV iLiA J:\ l'Y\ Wl,)l2-L2.'I Name I I S. VAr~i'k-f) l),H Village GS"8M.B~ License No. Go~) ""31'~ - Q'67 Phone No. Address: -+ 0. ~OYce Licensed Designee: (If other than Supervisor) U) ll,V\ Jl>J.~ Name $[""" . S. Y ~fl"\.o u......&..l W l> R.u::-\..f I ~3 {...-z..r" 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 buildin'g official. INSURANCE COVERAGE: I have a curren~i1ity insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes !B' No 0 If you have checked ~, please indi~ the type coverage by checking the appropriate box. A liability insurance policy o:r Other type of indemnity 0 Bond 0 OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chap 152 of the Mass. General Laws, and that my signature on this permit application waives this requirement. _. Check one: / Owner 0 Agent IZa'" Signature: Building Official Approval: , For Office Use Only Permit No. Date TOWN OF YARMOUTH AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MOL 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. ~ /" . __ _ . ~~ 0'-' Type of Work: J...;E"c..\l( ~ntJ Est. Cost v 4-tLP-- Address of Work I \ a.'P'T--ol>~ 12b. Owner Name: A.iJ Ge: Lc1 ~ r-J Rt Co Date of Permit Application: c:; II 4- I 0 " 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 ofperjury: q\,+l~ Date WUMA.yY\ -t-llJlU-L>-Y Contractor Name /33 b2~ C--..j v.; 5" 11 ~ r Registration No. I hereby apply for a permit as the agent of the owner: OR: 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/ContractorslElectricianslPlumbers Applicant Information Please Print Lee:iblv tV \ W-t t>, I'V\ .w l,) f.4LeY Jc.\.fCg ~,. O~h4-Phone#: (5"Of!) ~g'- Q72.. 7 - Name (BusinesslOrganizationlIndividual): Address: City/State/Zip: 4~ $: YAgfYtOUn-l Are you an employer? Check the appropriate box: I. 0 I am a employer With 4. 0 I am a general contractor and I employees (full andlor part-time). * have hired the sub-contractors 2. cp-1 am a sole proprietor or partner- listed on the attached sheet ~ . ship and have no employees These sub-contractors have working for me in any capacity. workers' compo insurance. [No workers' compo insurance 5. 0 We are a corporation and its required.] officers have exercised their 3. D I am a homeowner doing all work right of exemption per MGL , myself. [No workers' compo c. 152, ~ 1(4), and we have no insurance required.] t employees. [No workers' C'Jmp. insurance required.] Type of project (required): 6. 0 New construction 7. [B1'{emodeling 8. 0 Demolition 9. 0 Building addi~on 10.0 Electricalrepairs or additions 11.0 Plumbing repairs or additions 12.0 Roofrepairs. 13.0 Other . · Any appliC8llt that checks box #1 must also fill out the section below showing their workers' compensation policy infonnation: . 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 tbat check this box must attached an additional sheet showing the name of the sub-contractors and their wotkers' compo policy infonnation. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and Job site information. Insurance Company Name: Policy # or Self-ins. Lic. #: Job Site Address: City/StatelZip: Attach a copy of the workers' compensation polic aration page (showing the policy number and expiration date). Failure to secure coverage as required under on 25A ofMGL c. 152 can lead to the imposition of criminal penalties ofa fine up to $1,500.00 andlor one-year' sonment, 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 . ator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. l}nder:.the pains and pe alties of perjury that the information provided above is true and correct. Date: q 11.3 0 Phone #: Official use only. Do not write in this area, to be completed by citJ' or town official City or Town: PermltILlcense # Issuing Authority (circle one): 1. Board of Health Z. Building Department 3. Cityrrown Clerk 4. Electrical Inspector S. Plumbing Inspector 6, Other Contact Person: Phone #: Information a d Instructions Massachusetts General Laws chapter 152 requires all empl yers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as .....every erson in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, asso iation, corporation or other legal entity, or any two or more of the foregoing engaged in a jomt enterprise, and incIudin 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 ofa dwelling house having not more than three apa ents and who resides therein, or the occupant of the dwelling house of another who employs persons to do main enance, construction or repair work on such dwelling house or on the grounds or building appUrtenant thereto shall not ecause of such employment be deemed to be an employer." MGL chapter 152, ~25C(6) also states that "every state or oca1licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or t construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of ompliance with the insurance coverage required." Additionally, MGL chapter 152, ~25C(7) states "Neither th commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work til acceptable evidence of compliance with the insurance . requirements of this cbapter have been presented to the con acting authority." Applicants . Please fill out the workers' compensation affidavit complet ly, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) an phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited iabiIity Partnerships (LLP) with no employees other than the .members or partners, are not required to carry workers' co ensation insurance. Ifan LLC or LLP does have . employees, a policy is required. Be advised that this affida 't 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 p 't or license is being requested, not the Department of Industrial Accidents. Should you have any questions regard g the law or if you are required to obtain.a workers' compensation policy, please call the Department at the n er 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 leg! ly. The DePartment has provided a space at the bottom of the affidavit for you to fill out in the event the Office ofI vestigations has to contact you regarding the applicant Please be sure to fill in the permitlIicense number which wi! be used as a reference number. In addition, an applicant that nmst submit nmltiple permitlIicense applications in any 'ven year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Addre s" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially sta ed or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future p 'ts or licenses. A new affidavit nmst be filled out each year. Where a home owner or citizen is obtaining a license 0 permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person' NOT required to complete this affidavit The Office ofInvestigations would like to thank you in adva ce 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 Commonweal of Massachusetts Department of In ustrial Accidents. . Office of In estigations 600 Wash. gton Street. Boston, 02111 Tel. # 617-727-4900 ext 06 or 1-877-MASSAFE Fax # 617 727-7749 .gov/dia Revised 5-26-05 1146ROUTE28 SOUTH YARMOUTH MASSACHUSETIS02664-4451 Telephone (508) 398-2231, Exl. 261 - Fax (508) 398-2365 BUILDING DEPARTMENT BUILDING ELECTIUCAL GAS PLUMBING SIGNS TOWN OF YARMOUTH 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 I' c::A.~ \:)ORE' ~ Work Address is to be disposed of at the following location: YP.RMOCJT~I1)S?05A. .J::A.c,L'""fY Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. U)l~ ~ Signature of AppIican Date Permit No. TOWN OF YARMOUTH HEALTH DEPARTMENT w~@~OW~@) SEP 1 4 2006 SHEET HEALTH DEPT. PERMIT APPLICATION SIGN OFF TRANSMITT To be completed by Applicant: Building Site Location: l \ UQl1).,QF=:: ~ . Proposed Improvement: ~E"PL- A~ l'=" ~ Map No.: Lot No.: \. /. C'c.//....d 9J !8/a Applicant: LlJI Lt.. Po"",,- l-h"'R.L8'Y Tel. No.:lSL>BJ'O,\;r -'}7 27 - Address: 4~ JoV""p8, g Yo.:~..MtOU-r-H Date Filed: q lr~ Joc, **If you would like e-mail notification of sign off, please provide e-mail address: ~~ l h'h pf't)U' e.@Jrh\1cast::.J}eJ-: , Owner Name: ~)6ao AuR..'Co Owner Address:_ll LAP'T'.1JORE- Ro S.YARrYlDlft4-\ Owner Tel. No.:SOS -~Q4-1 (Pt\~ ----.---.--.-.--.-.-----.-.-.-..-----------------------.-..-------------------..-.--.--.-.-.-.--.---.------.. 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/or decks, sheds, windows, roofing; (3.) If necessary, Title 5 application signed by licensed installer with fee. RE~~~-:~:---.--~:-.---.--_.._--.-.---.-.-.-_..~~:~..---.-17;.81;2~.-.---.--. ~PLEASENOTE . COMMENTS/CONDITIONS: O"E tJ 80-35'2 120.00' LOT 390 O 12600 S.F. SHED - /20,00' 5 80-35'20"" LOCATION OF PItOPOSED DECK AfflOYE11 BY BRUCE WRPHY IN THE FIEUJ, 2 o 'D . I\) ~ ~ o . ::IE o 111 o o TOWN OF YARMOUTH ZONING ZONE : R-40 SETBACKS : FRONT - 30 . SIDE - 20' REAR - 20' '{ r . , . I HEREBY CERTIFY THAT THE DWELLING DEPICTED ON THIS PLAN WAS LOCATED ON THE GROUND BY SURVEY ON AUG. 9. 2006 AND EX I STS AS SHOWN AS OF THE DATE OF LOCATION. THIS PLAN IS FOR PLOT PLAN PURPOSES ONL Y AND NOT FOR RECORDING. DEED DESCRIPTIONS OR ESTABLISHING PROPERTY LINES. THIS PLAN IS VOID IF NOT STAMPED AND SIGNED IN RED. 4<\''1: / PROPOSED 14 X 15 /JECIC N 107 C") ';l:... "'\:J ~ ';l:... """" '<: t:J c ~ t'r1 (I) o 'D . I\) ~ .... o . tT'I o 111 o o CEIVED ';l:... . .-- l::Sfp 1 9 2006 10iI BUILDING DEPT. By: -' THE LOCATION OF THE ORIGINAL DWELLING SHOWN HEREON EITHER WAS IN COMPLIANCE WITH THE LOCAL APPLICABLE ZONING BYLAW IN EFFECT WHEN CONSTRUCTED (WITH RESPECT TO HORIZONAL DIMENSIONAL REQUIREMENTS ONLY) OR EXEMPT FROM VIOLATION ENFORCEMENT ACTION UNDER TITLE VII CHAPTER 40A SECTION 7, t. ,., o 20 40 PLOT PLAN IN YARMOUTH. MA, SCALE: 1"-40' AUG, 10, 2006 REVISED SEPT 5, 2006 EAGLE SURVEYING, INC 92ll Rout. CIA ~ YOnrDUlhport. 1M. 021175 (1lQlI) 382-8132 (1lQlI) 43H333 80 PROJECT NO. 06-094 ~ ai7n'~ JOB SKETCH SHEET JOB# (pOl?" CUSTOMER AN 'R \ co .i ~: ~ "_', _._...~.... <"1"'" 43 Joyce Street . (508) 398-9727 Bass River. MA 02664 f5.malt clmhimprove@comcastnet Sketch info ' -.------..-----.---------------.-.-.-.-.-.--------------------.-----------------------------------.-.-.....----------- '3/4" SJ'lD.'RT' OF Ne'AJ tEC/<: peR. RE~\Je'$T ()F" VAl'l:.l'v\ouT'>-\ . ~f::.D ep I4eAL TH C;eCt<. e: STEP . SURl"PCe 5/4)(4) I I I I E"fD I OF 1:'X.15TI~G I 'PECK ~I I I Z><8 LEClGc=.R. :5'I'>ACE'P 9/4M CiPP HOuSe e LA<$. 1!!><'>LTS \1,fTO HWSE 01,) 1""c:a.rrE'R~ I':J'" -1 I Z>r'f> JOISTS 1 <Q;"'o.C. ijANGaR.'5 'eo.+! SJPs r ,(5" & \4-' 10" SO'-lP\-rueE ~/NG .48"OP. 3 PLACE: 5 T N OJ;,. YA8MQUTH EWED oR1IDrtDiN~~iNGCO~E COMPLI- A I ,ERR RS,pR OMMISSIONS DO NOT RELIEVE THE A ICA M THE RESPONSIBILITY OF 'AS BUILT' C LI -' . '~-06Jd 2)( e S!)PPOR:8um~FFICIAL 4><4 RAll-lf.JG ~iS["~ Pft'iCEif'\, 'STAI~ l<l$z ~ 1~1 t (lOP Y f X:;l' J1Al.LOS l'eRS S\>oIlGSD ~'/'z./'O~ C. 3G,"HIGijRAu.. ef:f! 0SCl<. ~URFI!>C2 2 lor. \"Z- STAIR STRI~~ oPlJ'oC:E;~ 'l>5O< t:?A.l1... ceTAll.. -- 'Pee:. ~ """D~c. K . if.. STArR RAILS ... ~. . Zl(4 "1OP~AlI.. 2>-'2 ~JJ;-- 2><+ .. 1'1; - ~x.4- ~ . ~- ~l- 4x+ RAIl- P1:::lS;t~ \080\ 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: l~ CA.~.TbRe ~b. Map #: Lot #: Proposed Improvement: ~c:..t<. ~=:P'-A-'"": E:" r-n~ Applicant: \U\LL.\,..,Y'V"\ WvR-u:<:"""f Address: ~? ~ST. 3>/"'RfV\.O.)lttTel. #: ~-3'}8 ."l7z.7 Date Filed: q (/'~/<X:'p RESIDENTIAL AND I OR COMMERCIAL BUILDING Water Department: Engineering Department: Conservation Commission Determines Compliance of Water Availability and or Existing Location. Determines Compliance for Parking and Drainage Determines Compliance to Wetlands Acts; i.e. If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Ocean, Bogs, Bays, Marshland, Etc... Determines Compliance to Stat and town Regulations' i.e., Requirements for Septage Disposal and other Public Health Activities. Determines Compliance to State and Town Requirements for Personal Safety, Pro erty Protection; i.e. Smoke Detectors, Sprinkler Systems, Etc... Health Department Fire Department: PLEASE NOTE: COMMENTS: ~~'r Signature Of Applicant c; k~ J06 Date: TOWN OF YARMOUTH Building Department Town Hall Yarmouth. MA 02664 (508) 398-2231 ext.261 (OFFICE USE ONLY Recorded By: Ie Permit Fee: $0.00 Deposit Rec: $25.00 Payment Type: Check ChkNo.: 869 Net Owed: ($25.00) Application Date: 9/19/2006 Issue Date: Expiration Date BUILDING PERMIT TRANSMITTAL Temp Permit No.: T-07-135 Applicant Name: Applicant Phone: Building Location: Owner's Name: Owner's Addres William Hurley Comments: Map/Lot: 067.175 5083989727 00011 CAPT DORE RD remove existing deck and replace with14 x 15 deck ANGELO T ANRICO 00011 CAPT DORE RD South Yarmouth MA 02664 ZONING APPROVED fl5 J/.J-Y 67 Owner's Telephone: (508) 394-1699 REVIEWED BY: 1. WATER DEPARTMENT: 2. ENGINEERING DEPARTMENT: 3. CONSERVATION: 4. HEALTH DEPARTMENT: 5. BUILDING DEPARTMENT: 6. FIRE DEPARTMENT: COMMENTS: DATE: N/A: DATE: N/A: DATE: N/A: DATE: N/A: DATE: N/A: DATE: N/A: PLEASE NOTE d</~x, $1.>-- /j7f~ /515:,-- RECEIPT OF COPY: \ -- SIGNATURE OF APPLICANT: DATE: Date Printed: 9/26/2006