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Building Permits Backfile
The Commonwealth of Massachusetts ty r�r:lc So. Department oJPublic Safety (kcurancy 6 Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 1290 [3190 (leave ktank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All ,cork to be performed In accordance with the Massachusetu Electrical Code. 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date a City or Town of Ye,r rv, o ')+ YN To Insp of The undersigned applies for a permit to perform the electrical work rib, be w. Location (Street & Number) 8 % //�7 C Yes /-tvP owner or Tenant 80, rb ct ra /� P'r .t ek r, c k Owner's Address byl.y �-1 II "Y 1 Is this permit in conjunction with a building permit: Yes no ❑ (Check Appropriate Box) Purpose of Building S e 40 Utility Authorization NO. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters_ Hew Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity //11 nn q I� Location (and Natu\r�e of Proposed El^ectrical Work , r rva !� eDc net ✓a r>e put r �enct' Fa,t,Qe e' Flo%r hO.7SR / 6 dvr)ev recef bc.)� 71 u /eP.V-Sw,)ck Ovkrfl e/ecinc)1,e'f No. of Lighting Outlets No. of Hot Tubs No. of Transformers TKVAl No. of Lighting Fixtures Fes- I „ K Swimming Pool Above In- grnd. ❑ grnd. ❑ Generators KVA No. of Receptacle Outlets (p No. of Oil Burners 140. Bat tef EUniCsncy Lighting No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Initiating Devices No. of Sounding Devices No. of Self Contained Detection/Sounding Devices Municipal Local ❑ Connection❑Other No. of Ranges Total INC. of Air Cond. tons No. of Disposals No. of p.ts T,ortns Total No. of Dishwashers Space/Area Heating , KW O7 rj No. of Dryers Heating Devices KW No. of Water Heaters KW No, of o. o Signs Ballasts Low Voltage Wirin No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current L1 ilit Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES[4NO LJ I have submitted valid proof of same to this office.- YES ❑ NO ❑ If you havee checked YES, please indicate the type of coverage by checking the appropriate box. t,r q INSURANCE U BOND [IOTHER ❑ (Please Specify) /;" /Ae n /, . A, iv 0' Wer kfLo C ' / / 3 p/ Expauto Da Estimated Value of Electrical Work $ / DO D- Work to Start Inspection Date Requested: Rough (jrL ea // Final Gzir// dLA Signed under the penalties of perjury: FIRM NAME k' /ec '}r,<...i Serv,ce3 .rrec LIC. NO. /0c43 3 Licensee Yovvt 11 Signatur '4 ?1 '-a=?— LIC. N0. Ee?'-/8te i Address r Tel. No. _52& $.23 Oz79 iY v� + 27So 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. Signature of Owner or Agent PERMIT FEE S Me WIRE INSPECTOR'S DEPARTMENT YARMOUTH TOWN HALL SOUTH YARMOUTH, MASS. 02666 Fee Date � `7 Name of Job`��� Name of Electrician !`I Location J•�' vJ'r`"`I��'`t� �l BUILDING PERMIT Sept. 25, 2000 �w1t�� DATE ee�� PERMIT NO. APPLICANT RUfreA M. Belan= ADDRESS 20 Mites Path S_ Y- (NO.) (STREET) PERMIT TO ADIDMIM (—) STORY (TYPE OF IMPROVEMENT) NO. (PROPOSED FIELD COPY 9-01-,;1 0 91a61o6 /0j - cK• /01� B-01—Z40 NUMBER OF DWELLING UNITS (CONTR'S LICENSE) 89 ACres Am. K. Y. ZONING AT (LOCATION) DISTRICT H-25 INC.) (STREET) a BETWEEN AND q ICROSS STREET) ICROSS STREET) m SUBDIVISION 24/2 fry LOT BLOCK.�'c¢113 SIZE U O BUILDING IS TO BE FT WIDE BY —FT LONG BY FT IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION m E TO TYPE }tl USE GROUP 11114 BASEMENT WALLS OR FOUNDATION ¢ (TYPE) O LL REMARKS: AM II50*- A TtIfMlh nwi4f{M vF l.m I `4ye Gi AREA VOLU ER ESTIMATED COST $ 14,900.00 FEE PERMIT (CUBIC/SQUARE FEET) OWNER Bad=a A. + irkpat lck ADDRESS 89 Acres Ave. W. Y. BYILDING DEP INSPECTION RECORD OF Y'9R,� ONE & TWO FAMILY ONLY - BUILDING PERMIT ( • �_ C APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING ` Town of Yarmouth Building Department F .:��a, Z 1146 Route 28 - Yarmouth, MA 02664-4492 �+p"1. Tel: (508) 398-2231 x261 - Fax: (508) 398-2365 RIfice Use Only Permit No. l. L-7t/ Date k'5 Permit Fee $lam,— Deposit Rec'd. $ aJr'Date Net Due $�a 5 , ' Planning Board Information Plan Type Endorsement Date Recording Date Plan No. Other Assessors Department Information: Map Lot p Lot 3 r - 2- Old New 1.4 Property Dimensions: Lot Area (sf) Frontage (R) Lot Coverage This Section for Office Use Only Building Permit umb Date Issued: Signature: Building Official Date Certificate of Occupancy is is noty required Section 1 - Site Information I Use Group: R-4 Type: 5-B 1.1 Property Address: 8'9 Ac-'-'-s Ave- 1.2 Zoning Information: X ,x (- Zoning District Proposed Use 1.3 Building Setbacks (ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 0' r '20i upply (M.G.L. e. 40. S 54) Private 1zi7� 1.5 Flood Zone Information: Comments: �,�1 r Zone: A / a- BFE: Section 2 - Property Ownership/Authorized Agent 2.1 Owner of Record: Q IC l(/ -7(pri t Mailing Address 24 ll .'— ..)d S Signature Telephone 2.2 Authorized Agent: A�r2E� X ,v�� sL a�wH.r�sPard YAMH NX Name (print) Mailin Ad !J/ Signs ure Telephone u II Section 3 - Construction Services Ili �� Uid=1 5 2000 li 3.1 Licensed Construction Supervisor: I-Bu GF/1E, c1 rt/ C2 Not Appli able ❑ .1k Wk.'7Cs, M771 S. Y49HWI-11, /-1,4 02( License Number `S 00'N Address ; l � ��- 970 �` Expiration Date 12/3012001 Signature Telephone 3.2 Registered Home Improvement Contractor: Company Name BcsT FiT A11AlDOk) 9-y002 CO. zNC Not Applicable ❑ Address /A 35X� �^7oy r7-g" Is/N 1TL�-s /�%�� Signature Telephone License Number lei'] 60 Expiration Date ///?4490 9-15-99- � ' — / 1of2 OVER Section 4 - Workers' Compensation Insurance Affidavit (M.G.L. c. 152 S 25C Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure.. to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes ... No .......... Section 5 - Description of Proposed Work (check all applicable) - New Construction ❑ 1 No. of Bedrooms NfA No. of Bathrooms N A Existing Bldg. ❑ Repair(s) ❑ Alterations ❑ Addition o- 1 7W2E9 5E9SOI J ENC(-OSv(Z6 Accessory Bldg. ❑ Type Demolition Other Specify: Brief Description of Proposed Work: ScASo C_L0S'vr2 45 c)Ct /JG pC7C/__ OF 4i vsC SIzE o C- E 2' x 12 r Section 6 - Estimated Construction Costs Item Estimated Cost (Dollars) to be completed by permit applicant 1 Building / y 60, DD 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) section 7a - Owner Authorization - To Pe Completed When wnetts AcAt or ContractodADolies for MildincrPermit Check Below ❑ Conservation -Commission Filing (if applicable) ❑ Old Kings Highway & Historical Commission approval (if applicable) , as owner of the subject property hereby authorize 15ESETZEMIWAAUcuWV CO , _c.-, //MEMQ 7s�965 t' act on mMhalint all matters rill > work,authori � d by this building per it application. of Owner ' ' J I \ A Date Section 7b - Owner/Authorized Agkht Declaration I, ALil� H. ZeLA#, m6 7lL , 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 — — Signatu of Owner/Agent Date _. 9-15-99 2 of 2 r i TOWN OF YARMOUTH o ' B[;ILDI\G DEPARTMENT BUILDING PERMIT APPLICATION SIGN OFF Applicant: BRIM RA 1Gt21t PgT2tC tL Building Permit No.: Address: R9 AC24Fi AVt- W.W tartl Tel. No.. 7%; 7a0: Date Filed: Bldg Site Location: Map No.: a tf Lot No.: l 53 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 followin- (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 COMIIIISSION: 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: REVI VED BY. 0 0— 13 "D WATER DEPARTMENT: �, DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT: DATE: 100 N/A: INDUSTRIAL AND f OR COMMERCIAL PERMITS 5. WIRING INSPECTOR: DATE: N/A: 6. PLUMBING INSPECTOR: DATE: N/A: i. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE All stumps and/or brush must be disposed of at an approved site. COMJIENTS: NIAL�C.JaZ&4 D,CD < 8; 99 _Applicant Signature Date Department of Industrial.4ccidenis . OMeeel/erest/psa�iis % 600 Washington Street Boston. Mass. 02111 Workers' Compensation Insurance Affidavit Applicant information- PieasePRIlPPTedt� name BET Err AVZ&1bOk) Y-bflyp2 t'O. � rxl c -4.dGe motion• AS- WIL72S 6,472V SeY/412/1Dv7-11 f 1-14 021>e'y etc% phnnea 39d"-97oti 0 1 am a homeowner performing all work myself. I am a sole proprietor =-d hate no one %%orkint: in any capacity g I am an employer pro% iding workers compensation for my employees working on this job. companyname: 2C�� =717-WZA1bOW < oo(a CO, X-WC . 6122- 1U14 FIE-S 10ATH s. Y/1/LYW72VfHA o �y 511,.. nhnne #: t393 — 47o5i insurance co GUARa� --rAtS1-1WMAJ d G2DvP policy # 9S1UC9g32 %x E�rI am a sole proprieto . stnerat contracto or homeowner (circle one, and have hired the contractors listed below %t ho ha% the follo%%in_ %%orkers ;onipensarion polices: ro M ►4001L _/ address- a215 k/ff/7�S' 4�" Z-W city* s 1,4t2H e-177i 1-1/4 phone#• 39S-q%011 ipsurnnceco G114IZ4 �k/-�U2/gIVLL� O(%policy# 1�C2c/L9�3�1.� company name, Failure to secure coverage st required under Secdoa ZSA of MGL 152 eat tests totae impositions of erindisai pesaines of a Bee up to S1,5WAo and/or one years' Imprisonment as well as civil penalties in the form of a STOP WORK ORDER cud a Bee off100.00 a day agaimt me. 1 aadentand that s copy of this statement maybe forwarded to the OM" of Investigations of the OtA for towel ytri0arlet l do hereby certify under the paint and penaidei of etyury that the information provided above L true and tarred Signature /Dne -/� Qy Print name /f�6F2� X J3E�ANSffL f'hoae0 3S&-^970V ofrcial use only do not write in this area to be completed by eityorlo" aBfdal city or town: YARMOUT1; (3 cheek if immediate response is required contact person: permiWnau 0 MBuilding Departmeut C31Lleensing Board 261 (3Seleetmen's OBlee h phone #: QHtiltDepartment _ i508) 398-2231 eat. nOther bents 3.0. PIA) . r Massachusetts General Laws chapter 152 section 25 requires all ern plovers to provide workers' compensationfor their etttploy ees. as quoted from the "law an employee is defined as every person in the service of another under am contract of hire. express or implied. oral or written. ; - An entphnrer is defined as an india idual. partnership, association. corporation or other legal entity, or any nvo or more c the fore:_oin_ engaged in a Joint enterprise. and including the legal representatives of adeceased employer, or the recei%er or trustee of an indi% idual . partnership. association or other legal entity, employing employees. However the ow ner of a d«ellin= house ha% in_ not more than three apartments and who resides therein, or the occupant of the dw ellinc house of another who employs persons to do maintenance , construction or repair work on such dwelling house or on the _rounds or building appurtenant thereto shall not because of such employment be deemed to be an employ er %IG I. chapter I : =section =_ also states that even" state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a.business or to construct buildings in the commonwealth for any :applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally. neither the commom%eahli nor am of its political subdivisions shall enter into am contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter ha% heen presented to the contracting authority .applicants Please till in the workers" compensation affidavit completely, by checking the box that applies to your situation and supply ing company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affida% it should be returned to the city or town that the application for the permit or license is being requested. not the Department of Industrial Accidents. Should you have any questions regarding the "law" or if you are required to obtain a workers' compensation policy. please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The afadavits 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 foryou cooperation ind 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 ance etImstltetlen 600 Washington Street Boston, Ma. 02111 fax #: (617) 727-7749 phone #: (617) 7274900 ext- 406, 409 or 375 06/14/20210 14:45 5088329555 NORTHEAST INSLPANCE PAID 01/01 AC-QB-D_ CERTIRCATE5V UASILITY. N5URLP,N E�gR L : DA G(MMDOM-, x BBL 06/14/00 FRODl10ER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Northeast Insurance Agency,Inc HOLDER.TH!S CERTIFICATE DOES NOT AMENO, EXTEND OR 567 Southbridge St. ALTER THE COVERAGE AFFORDED BYTHE POLICIES BELOW. Auburn MA 01501 COMPANIES AFFORDING COVERAGE Scott linger (A144) COMPANY P.* _ _ F A Guard Insurance Croup INSURED COMPANY B Merchants and Business Menlo Alfred Belanger COMPANY Beat fit Window & Door CID 28 White's path i COMPANY p S Yarmouth K& 02664 G.RgGE3...... ....... ..... THIS 18 TO CERTIFYTHATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN IS'PUECTO THE INSIAPFD NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTW9TYETANOINO ANY REQUIREMENT. TERN OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE IAAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES OBSCRISED HEREIN If SUDJECT TO ALL THE TER`JS. IO(CW BICNf AND CCFARIONS OF BUCH POLICIES. LIMITS SHOWN MAY NAVE BEEN REDUCED BY PAID CLAIMS. DO, TYPE OF INSURANCE POLICYNUMBER POLICY EFFECT%r CATS (MM/DOm•1 IPOLICYEKPIPAWNLTR DATE!MM/OONV) LIMITS GENERAL LIABILITY CENEJiN- AGGREGATE 7 E X COMKERCWLGENEPoLLLLiBILIN 0020346993 I 06/03/00 06/03/01 PROOVCT9 •COMP/OPAGG 310000010000000 CWN9 MADE ❑X OCCUR PERSONAL B AOV INJURY IS EACH OCCURRENCE i300300 CWNER94 CONTRACTORS MOT FIFE DAMAGE (Arty ena F.ro) f tieD E%P IenY PnA pArBPn) a6000 AUTOMOBLELIABILITY IC7MBINED ANYAUTO I SINGLE LIMIT S ALL OWNED AUTOS SCASOULEDAUTOS BODILY INJURY ,Pr paRon) 13 HIRED AUTO) I BODILYINJURY 3 40N-0WNEO ALfrvJ6' IN 11=d ) PROPERTY DAMAGE a GARAGE LIABILITY AVID OWY-EAACCIOE.VT 3 ANYAUTO OTHER THAN AUTO ONLY: :.. • EACH ACCIDENT f I A33REGATE J EXCESS LIABILITY EACH OCCURRENCE 1 UMBRELLAFORM AGGRECATE 3 OTHER THAN UMBRELLA FORM 3 V/ORKER8 COMPENSATION AND ' 1SJAi U.BI EN. ......,...... .... ..... ....... EN OYCRZI LIABILITY BILE+cr acD¢>ENT f 100000 A TNEPROPRETDw wa FHE Pn RbIILTORI NE BBaTC030611 10/23/99 SO 23 OD / / EL DISEASE PDUCY OMIT s500000 OFFICERS ARE: EXCL 601SU5'e F+I EMROYEE a100000 OTHER RE RIPTION Of OPERATI@640UTIONSNEIICLE 'SPECJAL ITEMS CFRTIF4CATE:HQLWR ..... ........ ... - ...., .. -.CANCEL . TI .. „.... - .. . TOWNOFY JHOUL YOF ABOVE DESCRIBEO POLICIES BE CANCELLED BETORETHE EXPI ON CA ERECF, THE I6SUIN3 COMPANY WILL ENDEAVOR TOMAIL Town Of Yarmouth Building Dept 10 CAY R ENNOTICEMTHE CE-1171CATEHOLOER NAMED TOTIELEFT, 1146 Rt 28 BUT ILU TO IL SUCH NOTICE SHALL IMPOSE NO OBUGA710M OR LIABLITV S Yarmouth MA 02694 C A NO ON THE COMPANY. ITS AGENTS OR REPRESENTATNEB. AU,ACED ulger (A144) ?�i#tp?` si? .. .......... ... .... - hGORD:CQftPCrtgTJON:)U88.. 1146ROL'TE28 SOL'THYARAIOL'TH AL-_SSACHtS=02664-4-461 Telephone (608) 398-2231.Ext. 26I — Fax f308) 398-2363 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT C,:1S PLUMBING SIGNS Pursuant to M.G.L. Chapter 40. Section 54 and 780 C\IR. Chapter 1. Section 11 1.5. 1 he: ebt certifv that the debris resulting from the proposed work demolition to be cn:ducted at P9 A(flzd--S 19V6 W yA(24VVVT/!' N.9 D26?3 Work Address is ttt br disposed of at the following location: LUMP,SZIC-%Z- a9'WH'TES PAT" SHAM-MiT}l Said disposal site shall be a licensed solid waste facility• as defined bi \1 G.L. Chapter 111. Section 150A. I/ Signauirc• of Applicant Permit No. 6-�y-nd Date :of_; TOWN OF YARMOUTH =y BUILDING DEPARTMENT .. - 1 146 Route 28. South Yarmouth. NIA 02664 508-398-2231 ext. 2611 HOMEOWNER LICENSE EXEMPTION PLEASE PRINT DA rE. JOB LOCATION. g,11zagA kIr`ILpRTRICt_ Y9hgezo Ay6 /t/,1X)yf1oU-1-ht NAME STREET ADDRESS SECTION OF TOWN -HOMEOWNER" -775--%d05- NAME HOME PHONE WORK PHONE PRESENT MAILING ADDRESS n A,C12t55 AV6 W oYARI700_14, 11f1 021. 7 3 CITY OR TOWN STATE ZIP CODE The current exemption for 'Homeowner' was extended to include owner — occupied dwellings of one or two unit: 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 109.1.1) Detinition 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 intender. to be. a one or two family attached or detached structure assessory to such use and / or farm structures. A persor 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 109.1.1) 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 requAements and that he / she will comply with said procedures and requirements. HOMEOWNER" S SIGMA 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 it No If you have checked ves, please indicate the type coverage by checking the appropriate box. A liability insurance policy✓ Other type of indemnity 0 Bond 0 o%NER'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 0 Agent Z_�— '::homeou nnicexemp 310 CHR 10.99 ram 1 Co®ommalth of xassaahusetts DEP 14e No, 1 I (ro be povk%d by DM .. a !4, 7.' 'J�as��C Request for a Determination of Applicability Massachusetts Wetlands ProbwHon Act, G.L m 131, § 0 and the Town of Yarmouth Wetland Bylaw. 1. I, the undersigned, hereby request that the TOWN OF YARMOUTH conservation commission make a determination as to whether the area, described below, or work to be performed on said area, also described below, is subject to the jurisdiction of the wetlands Protection Act, G.L. C. 131, $40. 2. The area is described as follows. (use maps or plane, if necessary, to provide a description and the location of the area subject to this request.) Location: street Lot Number: !::�g -,L.- , 3. The work in said area is described below. (use additional paper, if necessary, to describe the proposed work.) 01`6� 0 lo 1_1 Effective 11/10/89 4. The owner(s) of the area, if not the person making ttpis j e , has been given written notification of this request on (date) The name(s) and address(es) of the owner(s)s AVA �.dr.. 2 have filed co plate copy of this request with the appropriate regional of c t sachusetts Department of Environmental Protection (date) DEP Northeast Regional office 10 Commerce Way Woburn, MA 01801 DEP Southeast Regional office 20 Riverside Drive Route 105 Lakeville, NA 02347 DEP Central Regional office DEP western Regional Office 75 Grove Street State House West, 4th Floor Worcester, MA G1605 436 Dwight street Springfield, MA 01103 1 understand that notification of this request will be placed in a local newspaper at my expense in accordance with Section 10.5(3)(b) I of the regulations by the conservation commission and that Z will be billed accordingly. 1-2 �� ava v v 1 L1 BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLE4SE PRINT: Job Location: tyl AC46S W. Number Street Village Owner of Property: BA23A99 �CiR r�/iT21GlL Construction Supervisor: Ky'-ricC Name Licensed Designee: (If other than Supervisor) Name 2.15 Responsibility of each license holder: License No. Phone No. 2.15.1 The license holder shall be fulls' and completely responsible for all work for which he is supervisin;. 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 anv 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.t 52 Yes — No ❑ If you have checked y-U, please indicate the type coverage by checking the appropriate box. A liability insurance policy a Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: 1 am aware that the licensee does not have the insurance coverage required by Chapter t 5 of the Mass. eneral Laws, and that my signature on this permit application waives this requirement. �� ,ZZ Check one: Signature of Owner or Ownees Agent Owner ID Agent r 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: �cAN�jA) gyp, e/j Est. Cost / 00. aD Address of Work 9? AQZi S A49 W.VARH0vTN.F nA 01402 Owner Name: 1?428mm 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: /s7G�j G -IV-00 Affize6b M REIAF,�E t 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 FOR LOT # a Abuttor's Name Lot # If this is a corner lot, write in name of street. Indicate location of garage or accessory building Additions with dashed lines -------------------- Sewerage disposal (cesspool) Well I I I(lot................ft. rear) I i Wr-rH 3 gGiXOnl REAR YARD j'02Cki CNCCpSc2 .............ft' w C4 S b SIDE YARD Ia---- -n. � SET BACK SIDE YARD 0-----FTo �i (lot.... 70 ..........ft. frontage) �9��JL �7FFI �l�DVI IT (NAME OF STREET) / Information / Supplied by MARK NORTH POINT Abu" Nam Lot 9 If t con wri nam othE stre DREAMSPA%. RATIO I:NCLOSUR8S A.& Ve n� 19..v Ab.9 MINOR c? T� HOUSEWALL F' FIR" 0 G R A Mv, n,4q W O J a _O J � o 01 FA 1 K O G 1 1 2 3/4' 2 3/4" . n b 3J b� RtDCE BEAM 3 1/2 X 9 1/2 X 16C O] b3 rosr ASSEMBLY 2 3/4" 2 3/4" I J 1 89 15/16" GLASS � l u —ill "" 113 7/8" 89 SIDE 2> 143 3/4" ENCLOSURE NUMBER: 3067. DEALER: BEST TR WDw. CUSTOMER: XIRKPATRtCK KN F O O T P R I N T DREAMSPAc PATIO ENCLOSURss ROOF LAYOUT A.0 Y.r Z . W. J"d Lill) lel:wAl 1 k u P R O G R A M 84 3/4 64 3/4' PANEL LENGTH PANEL LENGTH ENCLOSURE NUMBER: 3G87 1Z DEALER; BEST fa CUSTOMER: KIRKPATRICK I — 9.255 K: 88 HD HE 62.945 56.750 31.887 F�----- 55.750 f 143.750 SIDE 2 (OEI) rq u 00 9.285 m 20.000 WGING (EIGHT <<i26cPAT(2ACk SIDE - I &0 Xb o" Sc�uwG TyP, IR"WALL Tjt' CA - 'I � I Ij-`I le-4xy ?- -XIST�NG a�S� 1<akPPT2k c.V Sib -3 600 SLIDIQ& i r,. J J 3 r-Y' T► N G "OUS6 Thermal Industries, INC. 301 Btushton Avenue Pittsburgh, PA 15221-2168 (412) 244-64W FAX (412) 244-6496 August 13, 1993 To ifhcIb It May RS1jlag10 ROOF roan/Load Teat wing eo"ments were utilised during the load tests S UV 1 .019 AL / 7/16 008 / 1.3t EPS ! .024 AL E 1 3• R 46" X L£NGTS, 2.3 LBS.1 SQ. FT. 1 NORAD 336, 396 OR 612 1 EXPANDED POLYSTYRENE 1.34 DENSITY SKIN I .019" & .024" TEICX, ALLOY 3003 S 14 1 ORIENTED STRAND BOARD 7/16" TBICX EXTRU8171 4091 - T 6 ALLOY TEMUfALLY RAOXEN S N17LLION .050% HALL EAVTNG 3" NEB & 3" FLANGE NEIGSINc 0.6s34/FT. 8 !lions ate placed on the aid& of the test panels and are attached to the panel y Ii." with 314" steel screws on the top only. Th alysis ielbased upon the experimental load testing results as performed by our employed during our tests. The test procedures conform to the method described by ricab 80c sty for Testing and Materials, Section E-72, "conducting Strength Tests of for Euildihg coostruotion". Please refer to that report for details of the teat nt and me�hhod used in our testing. progressively conducted in accordance with these procedures to the load Ads sustained for one hour and then released, ultimate load was not 0 the panels war* not tasted to failure. ww MAXIMUm allowable superimposed live load Pounds per square foot with a motor of safety - 2.5. w 67.9 pof 49.9 psf 27.6 pat EDWARD J. BROWN CIVIL NO 37647 OF VINYL, FRAMED BUILDING PRODUCTS EXPOSED 1.300 �--�{.t0O � 1.300 r .130 I I 11 .342 093 U 1.245 (9) .01 P. 4 O30 Xp� SY�M-- 2.348 .6l0 tt (4) i t.245 .412 y0 010 OP. .t60O 1�- X Cr 3.000 EXPOSED T .680 .54O .280 .030 c=) ro50 Ca) .220 i .165 f.— R.070 .i00 f)0) MARKED I�ADI R.O35 /��A/�REA OF POCWw .147 dL COIINEII! KM42 wu3s memo VNS►E INED WAIL. TMICKNUI .07D Auaym �Em E063—T5 FANG l0 .N:NMETEII 1000UNMI1Ef)'YfT,.N.E. 21.983 Excel Extrusions Inc. WAAMIN, OHOO 444.3 A U En 4 22 DOWA1.INDUS7RIES F "M 5566 .LAM S 3100 Fb 2.OE ALLOWABLE STRESSES (PSI) FOR BEAMS Al E!N NaMO[ TENSION COMRNF%M0N CrOaaNraicnMRN SH V 0 A (X Itr) Ft I r.lauaF¢oaaaar 1 IWN I Fv ;3100 Ofc 31 2.0 2300 3180 1020 290 • Velrr 12.1awk iFor other depth adjust values by (12/depth)". For depths less than 5.5", use the value for 5 5". CLAM S $ 100 Fb 2.0E SEC110N PROPERTIES M/11fe,1RM�) [iVT �( MAXIMUM MOM[NT'INlRiIA WEIO(Lbsl q n 1 1.1% 114% ,a1a1,3% a•1% 1.174 21% 31i'. t•1i'. �tY1. 8•ii'. 1.1% t-0N�i Y1V. 4188 8377 12585 2452 4905 7358 55 111 188 3.83 7.28 10.89 v. 5636 13272 19908 3129 825 9388 115 230 346 4.63 9.26 13.89 8978 113997 20936 3214 6428 9642 125 260 375 4.76 9.51 14.27 It 98114 19209 28814 3806 7612 11418 207 415 622 5.63 11.27 16.90 t' 1t)037 21275 31912 4017 8035 12053 244 488 732 5.95 11.90 17.84 f4 14517 29034 43551i 4736 9473 14210 400 800 1200 7.01 14.02 21.03 t 1fb6821 37384 56046 5413 10626 16240 597 1194 1722 8.01 16.02 24.03 U 233371 46874 70011 6090 112180 118270 650 1701 2551 9.01 18.02 27.04 M Factors: poloWells Ilreasew listed A we for bending (Fb), tension (Ft), compression parallel to grain (Fc), shear (Fv), also maximum moment and m shear values are for normal load duration. 71,ese may be increased where allowed by code for shorter bad durations. F wet For nag bolts Instant perpendicular to the wide face of the beam, use National Design Specification (1991) Spruce • Pine • Fir Vila e r teral foods. F nails inoWW in the edge or narrow face of the beam paraiiei to the glue lines, use the code allowable Witted slues for lutnb¢r having a maximum specific gravity of 0.47. YET. U00 Fb 2.OE BEARING CHARTS 1__."'"'." rs ;�t7;tl�f�tAwf�ra�gi�r.,�w�lsfa�r,�lslatl's11t�.�trt�9��+1atrlitrr c::t:, a �■tar�a����trE� � � r�r�l�tr� 1 _^-:r 1^_ '..J©)•�1�ELr1•��1��1lQtE;�(iI'��i�i:t•iL��fl!7��i 1::u. w�7:...1�iF3[1f�F'.3�1�)•fil��f�(�Lr.'.�i[}A'sit":�xir��1�11�' r • • � Lli<ii�i1;C 1 -'•�^ ir! ']SC11•ILCf•i�1��9.'�1��'D1��ir�P'���t�V.! 1. U= ��mr111111r� o��frQ>•fam�f��ttft�•1a�w� a"n .mr. +' L'�A;I3:Oi ii7s�IFi'Ir f7:1r�iZ!F1M��F}I7tSf4�1•-:5>• 7112911111111- P."7:'il•[rit'"MtI1i>�si�¢>)Mt��t�ti81•t�t�S',w�l�ti!1• 11112L'• 1l_7.t. CS �etf[7i?a��k!}7iir�I•L.l�������11E''II31 a::,,..1.^, gi.."u•^.'1, , 41G�I•i7tiil!ts!•f��llielCH�iL•1•�IfLP.7•[IMsst1'>A�i� r^t^:1•i-fP..�it5TGi)!1<F - �j7ii . Y>•�SFi: ���iiYli!♦I7L-F',-f�Ck71<LF7•T)• How t WJFxnittl C 1, De the number o pllea required for the Qang fan beam end calculate the maximum reaction. 2. th appropriate tab for 1.2 or 3 plies. 3. a after length■maximumreaction 'list meet$orexceeds yourmkubttedvalue. 4. M I u the support h rnrraly adequate to carry the reaction. a o p : 2 fin 2VV Gang• m LVL with a reaction of 9200lb. Selrtfa : t a 3" bearing;length with a maximum reaction of 10710 lbs. 9 0 4 u 4 AII,OWABLE ROOF LOADS (P� 125% NON -SNOW 114x7N 1Pty1%111% 1Ply 1%16% 1Myw1x11Ye 1Ph114x11rA iPIy1Y4x14 ?� 22a 462 722 j 63s 4" ON 722 508I600 ISO 329 S 3 342 $17 Us 370 731 124 247 S 257 $14 418 2" 557 893 05 191 2}7 iN 396 322 214 429 534 T6 150 75�.7 1" 311 253 160 337 42C 60 120 1 7 126 240 203 135 270 3M 40 95 152 101 203 185 110 290 272 40 80 1 5 03 lay 130 90 101 221 34 67. 1 4 70 139 113 75 151 161 29 56 3 61 117 95 94 127 111 60 100 81 64 109 11, 43 aS 80 46 93 "1 37 14 60 40 90 10( �44 22 64 52 35 70 Bi • 442 25 56 46 30 61 7 61 4: am maxlmu a unlforr6 load tables: t the correct to 1k for the beam Application eed. is the require beam span in the lets column. t a beam depth from the tables that satisfies H the an e1 toad ms on the beam. k the leeea ring uirctnenn as shown on page S. e; Aoof live lo450 PLF, LJ240 deflection IImIL A load 675 MY, 1.1180 deflection limit. pan IV • 0e, 115% snow lad r: Try 2 plies 14" x Inv. which can carry: oed 2 x 264 . US;, 450 PLF ✓ OK laid 21t 353 • T06> 675 PLF ✓ OK 76 302 332 291 09 761 152 To Is 55I 341 8271 T4 19o1 2 1= 435I 190I 160I 102l 1 Notea: 1. All beam Vans shown are clear spans and do not Include bearings. 2. These talks arc for simple spans Wth a support at each end) or for continuous (multiple span) beams if spans are equal 3. PLF values are for a single ply of 14te Gluit aun LYL Double the values for two plies. e Triple the values for three plies. *4. For 141" x 16" beams end deeper, two plies (minimum) are required. S. More then three plies may requirespeclal design. Contact your 1R engineered products diatributor. ALLOWABLE ROOF LOADS (PLF) 115% SNOW MI1AxM Pt l*AzrA 1PIy114x91S 1PIy1Y4x1114 1P1y1'Yill 1111Me14 tPty114x18 ? 184x18 lire Lrle Teal LIr4 WI Taal Uld WI 74M+ W4 tool I LY4 to" Lead Oeflwuse Leae DeMeaaa Lead DaueaM LOW OMMOM Lua We Orgoodea Wd L M VIU 4e LAW VIM U240V7MNM V240 VMOV111 L/241 U INtRM UMa VIM UHI L?M LJiM U2a1 LMI urea [483 322 554 7743 6fi8 743 643 J00 635 M4 506 760 665 953 810 953 010 953 a19 1023 877 1=3 677 1023 577 1282 1009 12821292 108010" 1658 1311 1656 311 1568 1311 1Us 1SS6 888 558 16882284S0M340 1S58 1S6 220 612 342 '687 6611 210 "a 718 816 71a 768 724 760 947 047 647 1132 132 1132 1334 334 1334 124 247 366 257 490 415 278 517 540 462 640 883 544 OM 938 US 936 ON 996 996 1187 157 1187 93 101 291 199 390 322 214 429 534 358 578 615 412 615 151 880 751 089 ON 880 1036 038 1030 73 150 233 150 311 253 189 331 420 2810 $19 494 329 569 001 661 = 003 603 934 934 934 60 120 167 125 249 203 133 270 336 224 448 396 284 499 Us 432 623 722 64.9 732 849 849 848 46 96 /52 101 203 185 110 220 273 182 303 322 214 429 S27 351 573 073 524 873 778 747 770 40 40 8o e3iis? 138 90 lei 225 150 300 2a4 1T7 3S3 434 2a8 531 e23 432 823 718 111 710 90 34 87 �25 04 70 139 113 75 111 185 125 250 221 147 295 Us 241 470 540 300 S79 897 513 067 42 29 66 00 00 �175 117 95 64 127 158 105 211 160 124 248 306 203 407 415 303 $41 523 432 623 - OD too 81 54 104 135 90 170 16s 105 211 259 1 346 397 258 422 651 367 584 • 44 43 85 69 46 93 115 77 164 136 90 181 222 140 290 332 221 442 472 315 549 • 135 37 74 6o 40 8o Ton Be 130 117 78 168 122 120 9e6 967 191 30 406 272 300 • 145 32 64 52 33 TO 87 5a 110 102 a6 138 107 111 223 249 155 339 355 237 404 �2 26 Be 40 30 61 T 51 101 00 59 111 148 6T 155 211 145 "1 311 207 414 • OUT4S 89 79 52 105 129 00 172 192 120 250 273 182 305 • 59 31 79 09 40 93 114 76 152 170 113 W 181 323 h 53 36 70 82 41 02 101 07 135 161 101 201 .242 QiS US 287 • i i 47 31 63 50 37 74 90 120 135 90 100 192 in 256 4 33 as 01 S4 iom 121 81 1 1 172 115 2 7 %6 % COUNTERfLASH HANGING 'HEIGHT REMOVABLE CHAN ROOFIPANEL I II � TOPWALL "F" SECTION �I TEK SCRtw 3 1/2" x 9 1/2" GANG -LAM II II POST "U" POST "H" The Commonwealth of Massachusetts Department of Industrial Accidents O/Acee//aMMstIS&Ois 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Applicant information: P►easrJ iJZCCJ 2 tr C] I am a sole proprietor and halve no one working in any capacity I am an employer pro%iding workers' compensation for my employees working on this job. address: insurance co policy # 0 1 am a sole proprietor general contractor or homeowner (circle one) and have hired the contractors listed below who ha%e the folio%%in_ «orkers compensation polices: company name: city, phone #: insurance co pommy # company name• Failure to secure coverage as required under Section 25A of MGL 152 an lead to the imposition of crimiaal penalties of a One up to S1,500.00 and/or one years' Imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of $100.00 a day against me. I understand that a copy of this statement may be forwarded to the Once of Investigations of the DIA for coverage verification. t do hereby c ijy der thepains apd penalties ojperjury that the information provided above is true and coffeeet Signature /`'""/ ate I Print name K one official use only do not write in this area to be completed by city or town official city or town: YARMOOT$ O check if immediate response is required contact person: permittlicense # t-IBuilding Department Licensing Board 261 ❑Selectmen's Office (508) -ion 2231 pHeaith Department t phone #; _ _ es 130ther Umsed 3,91 PIA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all emp lovers to provide workers' compensation for their enployees. As quoted from the "lass", an employee is defined as every person in the service of another under any contract of hire. express or implied, oral or written. An enip/r�rer is defined as an individual. partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in ajoint 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 _rounds or building appurtenant thereto shall not because of such employment be deemed to be an employer %lGL chapter 1 section '> also states that even state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Add itionalh, neither the commomsealth 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 hax e been presented to the contracting authority Applicants Please till in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidaN it should be returned to the city or town that the application for the permit or license is being requested. not the Department of Industrial -accidents. Should you have any questions regarding the "law" or if you are required to obtain a "orkers' compensation policy, please call the Department at the number listed below City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The afldavits 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 MCC tl lall SU12ll8as 600 Washington Street Boston, Ma. 02111 fax #: (617) 727-7749 phone #: (617) 7274900 ext. 406, 409 or 375 TOWN OF YARMOUTI BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE-1 cl rc1 51 JOB LOCATION R c( IW "HOMEOWNER" PRESENT MAILING ADDRESS p 9 dtA_Qo (& a 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 SEC- 109.1.1) 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 ATTACHE D OR DETACHED STRUCTURES 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 109.1.1) THE UNDERSIGNED "HOMEOWNER" ASSUMES RESPONSIBILITY FOR COMPLIANCE WITH THE STATE BUILDING CODE AND OTHER APPLICABLE CODES, BY-LAWS, RULES AND REGU- LATIONS. THE UNDERSIGNED "HOMEOWNER" CERTIFIES THAT HE/SHE UNDERSTANDS THE TOWN OF YARMOUTH BUILDING DEPARTMENT MINIMUM INSPEECCTION PROCEDURES AND REQUIRE- MENTS AND THAT HE/SHE WW L Y 1't � X�P OCED S 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 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 Ma s. Gene Laws, and that my signature on this permit application waives this requirement. —� (i� eck one: Owner Agent ❑ Signature of Omer br'Okner s Aktnt Suggested Affidavit for Home Improvement Contractor Permit Application For Onlce Use only NAME OF CITY/TOWN Pertnil No. MGL a 142A requites that or mnstraction of an additi to structures which are adi requirements. AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application mntmctors, with certain Type of Work: Est. Cost Address Owner Date of a uuu �Fp is ,,uu. I hereby certify that: 0 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 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 owner - Date OR: Contractor Name Registration No. Notwithstanding th a no 1 hereby apply fora permit as the owner of the above property: L. Date Owner t t Jac ,,S Av�NCIr• reWAI uiAy 1 5 t 70. 0 t v, U � O � W .., ti• u �ee7ww1 a c :a} JJ N O 0" ` r' •Ib �(Q r . r a - S1 Jt 0�' sKsr�H .�csr^r � a�nBk2p KluKP,4 arc B g9 AGES /tom W. y A2� r y�n scAtE/^�30'pero8F2r994 acoN W.YARmOPM; mA. PERMIT 38 1/20/99 1/20/99 LOT J42 , Kirkpatrick, Barbara A. 89 Acres Ave. West Yarmouth, MA 02673 Shed 10' x 14' $3,000.00 SHEET 13 4 W7--, W C) tv, TOWN OF YARMOUTH Application for a Permit to Build No. ',� kv UPON FINAL APPROVAL (� l "010 -99 MAP FEE MUST ACCOMPANY THIS APPLICATION. The undersigned hereby applies for a permit to build acc rding to the following specifications V"Name of property owner Address 2r Name of Architect (if any) 3. Name of builder (� t.4 ) Address 4. License No. Tel. L(W VAI /// %/9 q - 3 LOT DATE � 0/99 TeI.77!;'--,0o.S 5. Name of Mason 76. cense No. Construction address 8. Date of subdivision Approval Tel. W 9. Private dwelling ❑ Estimated Cost 10. Multifamily ❑ 3 0 o a 11. Commercial 12.Other �l•G�' �1 13. No. of stories 0 14. Foundation — Full ❑ Half ❑ Crawl ❑ Slab ❑ 15. Materials — Wood ❑ Cement ❑ Other ❑ 16. Type of heat — Oil ❑ Gas ❑ Electric ❑ Other ❑ 17. Garage — 1 ❑ 2 ❑ 18. Swimming pool - Size 19. Storage shed — Size 20. Stove — Wood ❑ Coal ❑ Tel. zone ?V6 Zone � DO NOT WRITE IN THIS SPACE I Type of room I No. aC r-7 �lJ Kitchen Dining Rm. Living Rm. Bed Rm. Bath Deck Family Rm. Sun room Garage Shed 1,,px Alterations 21. Size of lot: No. of feet front No. of feet rear No. of feet deep _ 22. Size of building. No. of feet front No. of feet side No. of feet rear 23. Distance from nearest building: Front Ft. side Ft. side 24. Distance back from line or street From rear lot line T Side 25. H.I.C.R. No. LOT RELEASED BY PLANNING BOARD Date Rear aa6 7, 310 CMR 10.99 Form 2 COPY� �,,�,(to M porMrtl by OEP) �;,YTown YARMOUTH • Commonwealth of Massachusetts Appocant BARBARA KIRKPATRICK Zy +. 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 Barbara Kirkpatrick Same (Name of person making request) (Name of property owner) Address 89 Acres Avenue, West Yarmouth, MA This determination is issued and delivered as follows: Address Same by hand delivery to person making request on (date) by certified mail, return receipt requested on November 9, 1998 (date) Pursuant to the authority of G.L. 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: Street Address 89 Acres Avenue, West Yarmouth. MA Lot Number. J42 12 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. 1Z The work described below, which includes all/part of the work described in your request, is within an Area Subject to Protection Under the Act and will remove, fill, dredge or alter that area. There- fore. said work requires the (Ting of a Notice of Intent. Effective 2.1 e I a YARMOUTH CONSERVATION COMMISSION , ; NOTICE + 3� — . _ 0 CT 2 3 Notice is hereby given for the Request of Determination of Applicability Mrs. William E. Kirkpatrick y 89 Acres Avenue West Yarmouth, MA 02673 To construct a 10 x 15 shed at 89 Acres Avenue, West Yarmouth, MA in accordance with the plans filed with the Yarmouth Conservation Commission. Hearing on the above will be held in the Yarmouth Town Hall, Route 28, South Yarmouth, MA on Thursday, November 5,1998 @ 7:30 p.m. PHIIH E. MAGNUSON, CHAIRMAN CONSERVATION COMMISSION TOWN OF YARMOUTH 3. ❑ The work described below, which Includes aNpart 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 fling of a Notice of Intent. 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, fill, dredge, or alter that area. Therefore, said work does not require the fTng of a Notice of Intent. 3.i 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 fling of a Notice of Intent. 4. ❑ 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: r /�1.�G jifLu� This Determination must be signed by a majority of the Conservation Commission. On this cS day of personally appeared f%r e- a 9 Q9' before me to me known to be the person described in, and who executed. the foregoing instrument, and acknowledged that heishe executed the sam s his/her free act anJ deed. Notary Public My commission expires Thts Oetemwnnon otee not"ohow the applicant from cohho"t; with as other actibcable iecera4 state or f=w smmes. oromames. "wa or nMumomm Thia MNRMahpn shell be vaW for these Yeah term the oats cf mumnct. The AWbOrd.bte owner, any parson aggrieved by this Donartmnstiwt. A" owner of land atuttdng the lane upon whieh tho pfdppted work istoaaona,cr"Y%nneWftctthatrayorwwrlinwhimsuchmoisboated,anherebynotitwooftheirrignttore"outheDeptmrent of Eminmmanai Promotion to ww a SuWoeding Determination of AppicabilaY• Prointlbg the to== is MR" by cgnMed mad or nand de1n+ry tothe DeparansM. wink the appropheni tiling fag and FN Trenimbal Form as providaE In 310 CUR 10.03(7) within ten Days from 111e doe of awartoe of this Deformonsuan. A copy of the rebuttal snaa at tam $1111011 time be sent by cendittd mail or nand dakwry to the conservation commeslon onto the appkconn. 2-2A G TOWN OF YARMOUTH APPLICATION FOR PERMIT TO DO QUITTING (OFFICE USE ONLY) Fee: $ cq6 0 D PERMIT NO. (; -ol Date Building Owner's 9 AT Location Name ,(per Alr,0 11%fir nrwnu>1r � ✓ Type of Occupancy-12 we New ❑ Renovation ET, Replacement ❑ Plans Submitted Yes ❑ No ❑ to 41 Y Z M to W V) O 2 F y K /bD Z Q�Z22=M Q m ¢� a w w o N a w a �\ y¢ N O W U W 2 V) Z Q 2 O Y W W y W Z W F O LU ~ F.. 2 J F W W J Q 2 I- Y Y W m Z O Z W O (n 2 s o a_ U. D 3 0 a g ¢> o 0 c0) Q. IW- SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR (PRINT OR TYPE) Installing Company Name . ?-, 411nSIAW r/7 Address X �FyM77t('ir./c_ S2y�r)=tnuii MA /12 ii Business Telephone Sd Lr/ 3,7V 7 7 7X Name of Licensed Plumber or Gasfitter INSURANCE COVERAGE: Check One: C"Corp. D q' ,:Zkr/6/R3 ❑ Partnership ❑ Firm/Company Check One I have a current liability insurance policy or its substantial equivalent. Yes ❑ No ❑ If you have checked yes, please indicate the type of coverage by checking the appropriate box. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance 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 7939 License Number TYPE LICENSE: ❑ Plumber ❑ Gasfitter plaster ❑Journeyman G 00 TOWN OF YAMQUTH /,I as —�0o' ff APPLICATION FOR PERMIT TO DO GASFITTING USE ONLY) Fee: $ 0W. UV PERMIT NO. G -o1- -7h� Building Owner's AT: Location U Name 15arborerfriC% We -It tnyialh , Type of OccupancyDiK New ❑ Renovation Replacement ❑ Plans Submitted Yes ❑ No ❑ y W V) cc I a cd N w °0 z ¢ P¢ m W a ¢ o I¢ Z a W r w w x w F N a w w¢ N w z c� CC rn w a¢ w lam- s ¢ aW>�W¢Za�amZOZW0U)W cr ---� ¢ Wx ¢ x o a x LL D 3 0 c� - � cc> 8 CL � o SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR (PRINT OR TYPE) Installing Company Name Addresses S-YI/Dr�a at'm , /t1i➢ �2�6y Business Telephone '6SlS Y- 7778 Name of Licensed Plumber or Gasfitter INSURANCE COVERAGE: Check One: C3�Corp. b y �.28�16/93 ❑ Partnership ❑ Firm/Company Check One I have a current liability insurance policy or its substantial equivalent. Yes ❑ No ❑ If you have checked yes, please indicate the type of coverage by checking the appropriate box. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance 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. ��� OLA--- Signature of Licensed Plumber or Gasfitter '1939 License Number TYPE LICENSE: 11 Plumber 0 Gasfitter L7lvlaster ❑Journeyman G 6° CP �O, APPLICATION FOR PERMIT TO DO GASFITTING TH ByLOFFICE USE/ N LYJ DEC 1 9 2000 �f Fee: $s,2© PERMIT NO. — O (� S O 3 ��7 , -ors Building p AT: Location r7 9 &eE S �a yAP.�fe [rrN New ❑ Renovation ET� Replacement ❑ Plans Submitted Yes ❑ No ❑ .. A ... . • , .14400A.400_. Type of Occupancy__ bYEGGINr Cn YIr w N y X 0 z X cc H Cd = a J co W O T m ~ z 2= cc z a m rA H WUj W O CC Fn O W Q w a= z F y a O x> w w W N J Z a= 2 ¢ 0 Q W aw w F O = rn ¢ a w> ¢ w¢ z a¢ a m z U. z w 2 O F N w 2 3 > o a- o = O a_� 0 0 (s _j c0i cc SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR (PRINT OR TYPE) Check One: Installing Company Name F. �' 41mar✓ ALG : #T(' Ercorp. /)V- ;21y,/,/93 INSURANCE COVERAGE: Check One have a current liability insurance policy or its substantial equivalent. Yes ❑ No ❑ If you have checked yes, please indicate the type of coverage by checking the appropriate box. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check One: Owner ❑ Agentw❑ 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 'I93 J License Number TYPE LICENSE: El Plumber IC Plumber Gasfitter aster []Journeyman 0 Expand your living space... DREAMSPACE° Imagine Your Dreamspace In just days, your seldom used deck, patio or porch area can be transformed into extraordinary living space at a fraction of the cost of conventional construction. Transform your backyard into a beautiful and comfortable "dream space' by incor- porating both a Dreamspace Enclosure and DreaWDeck vinyl decking system. 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