HomeMy WebLinkAboutBuilding Permits Backfile14
F
014t Crummaamtalt4 of fllassac4ustna
Mepartment of 13uhlic Safety
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00
�Wla
Office Use Only
Permit No.
Occupancy 6 Fee Checked'__
(leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, S27 CM 12:
(PLEASE PRINT IN INK OR TYPE ALL FORMATION) pate
City or Town of--t 3!\ To the In o es:
The undersigned applies for a permit to ertorm t a electrical work described below.
Location (Street 8 Number) O pgJUN 24
Owner or Tenant Tel. No.L
Owner's Address I By
Is this permit in conjunction with a building permit: Yeb No ❑ (Check Appropriate Box)
Purpose of Building (70kt d fA-« Utility Authorization No.
Existing Service —f Amps -_==I- Volts Overhead ❑ Undgrnd ❑ No. of Meters
New Service Amps J Volts Overhead ❑ Undgmd ❑ No. of Meters
Number of Feeders and Ampacity (1/
Location and Nature of Proposed Electrical Work l tJc..ti" uy, ^Y j
No. of Lighting Outlets
No. of Hot TLbs
No. of Transformers Total
KVA
No. of Lighting Fixtures
Swtmming Pool Abwar, In-
❑
grnd. LJ gmd.
Generators KVA
No. of Emergency Lighting
No. of Receptacle Outlets
No. at Oil Burners
Battery Units
No. Of Switch Outlets
No. of Gas Burners
FIRE ALARMS No. of zones
No. of Detection and
No. of Ranges
No. of Air Cord. Total
tons
Initiating Devices
No. of Disposals
No. ofHeat Total Total
Pumps Tans KW
No. of Sounding Devices
No. of Be" Contained
-
No. of Dishwashers
Specs/Ares Heating KW
Datection/Sounding Devices
Local ❑ Municipal ❑Omer
No. of Dryers
Heating Devices KW
Connection
No. of No. ofr
Low Voltage
No. of Water Heaters KW
Signs Ballasts
Wiring
No. Hydro Message Tubs
No. of Motors TOW HP
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws 1 haw a current Liability In moance Policy includ-
ing Comgbtetl Operetbns Coverage or its subatanael equHalaea. VES Cf� NO ❑ 1 haw Submitted valid proof of wme to the Cnice.
YES C� NO 11 you hew checked YES, please indicate the coverage by checking the appropriate box.
INSURANCE I9 type Of
❑ OTHER ❑ (Please Specify) I9L-2,A-99
Estimatedof Valus Electrical Work S
Work to Start Inspection Date Requested: Rough C% Fi(Expirndon Date)
ne' ,t w
Signed under th/ee Penalties of Partj��j: ry 140Tu' FIRM NAME _ Cjd aimi 7 ee,4-,rIC- ZVIG. LIC. NO.
Licensee
Address Z;Y- -J-1,1C4IC1ri KV,I r'.dru
OWNER'S INSURANCE WAIVER: I ern aware Owt Lice sae do
quired by Massachusetts General Laws, and that my signature en
(Please cheek one)
NO.
.H �./ /� Bus. < Tel. No. O - I
n _ NL Tel. No. r1R-
the Insurance coverage or its substantial equivalent as re-
application waives this requirement. Owner Agent
Telephone No. PERMIT FEE S -
(Signature downer or Agent)
NotHy InspeUv tar tough anNa final Wpecrion. Permit mart be Obtained Were commencing any. and all work in compliance with G.LC. sal a al. apputa-
ble laws S ordinances Is required and understood.
xd7%
oF'YAR
�'$ 0 WIRE INSPECTOR'S DEPARTMENT
YARMOUTH TOWN HALL
SOUTH YARMOUTH, MASS. 02664
Mann •'5�
633
Fee 36 1VV
Date a!ya��/99
Name of Job �� (��{ �,111 1C ✓1/f? t Q Al
Name of Electrician��4.�
Location
TOW N OF YARMOUTH Building Department BUILDING
($U8) 398-2�PA-
z PERMIT NO B-03.1113- I PERMIT
ISSUE DATE _6/3103 _ - PROPOSED I E _
APPLICANT 'MARKSUPPENDAHL JOB WEATHER CARD
ADDRESS '00200 BLUE ROCK RD PERMIT TO Aaorations '
AT (LOCATION) 10020OBWEROCKRD 5 \ ZONING DISTRICT R-40
SUBDIVISION MAP LOT BLOC 101.1 fib BUILDING IS TO BE USE GROUP R-r
LOT SIZE 0 CONSTTYPE S-B CONTR'S
LICENSE 0
replace 2 story pillared covered front entry with one story entry as per plans dated OM2/03. CONTR'S NAM
REMARK
AREA (SO FT) EST COST ($ $7,000.00 PERMIT FEE
OWNE MARK S UPPENDAHL
ADDRESS 100200 BLUE ROCK RD BUILDING DEPT BY
INSPECTION RECORD FIELD COPY
ONE & TWO FAMILY ONLY - BUILDING PERMIT
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
Or �sss.�—/L[, Town of trill mouth Building Deparunent
1146 Route 28 • Yarmouth. MA02661-4492
TL-L (508) 398-2231 X_sl Fa.: Ltoa> 398-236;
Office Use Only
Permit No.�L_ �3�te
Permit Fee $3 >.
��{{J/��
ftposit Rec'd. $ ;e56kte�
/ .l^
Net Due $ �t
Planning Board In
Ian Type
Endorsement Date
Recording Date
plan No.
nthec
Assessors Department Information: - -
Map Lot _ Map Lot
Z
New
1.4 Pro ert Dimensions:
-P y _
Lot Area(sf) Frontage(ft),- Lot Coverage
- This Section for Office Use Only
Building P r 1t Numbe . _
Date Issued -
Signat
Certificate of Occupancy
:is. la not required
Building Official - Date
Section 1 - Site Information -I Use Group: R-4 Type: 5-B
1.1 Property Address:
�a rJ/La Qc .�
1.2 Zoning Information:
R— el U
Zoning District Proposed Use
1.3 Building Setbacks (it)
Front Yard
Side Yards
Rear Yard
Required
Provided
Required
Provided
Required Provitletl
30
30
Lv
z
1.4 Water Supply (M.GA. C. 4e. S 54)
Public Private
1..5..Flood Zone Information: - comments, - -_ -
:Zone:. BFEa --
Section 2 - Property Ownership/Authorized Agent.
2.1 Owner of Record:
m,i er / -700
Name (print) !/ Mailing Address
:122��L%2""[--- %L
Signature �— Telephone
2.2 Authorized Agent: D
Name tprint) Mailing Address �UN
Lignature Telephone
Section 3 - Construction Services
3.1 Licensed Construction Supervisor:
Not Applicable (]
2003
License Number
Address
k�WA2
11.5�
Expiration Date
Signature Telephone
3.2 Registered Home Improvement Contractor:
Company Name
Not Applicable L]
Address
Signature Telephone
License Number
Expiration Date
9 15 - 99 1 of 2 rnico
r -= 7
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 ..........
New Construction ❑ I No. of Bedrooms No. of Bathrooms
Existing Bldg. Repairs) ❑ Alterations A Addition ❑
Accessory Bldg. ❑ Type Demolition Other Specify:
Brief Description of Proposed Work:
Item NCmt(Dollam)e Check Below
nttBuilding ❑ Conservation -Commission Filing
2. Electrical (If applicable)
3. Plumbing / Gas4. Mechanical (HVAC)❑ Old Kngs Highway & Historical
5. Fire Protection Commission approval
6.Total=(t +2+3+4 + 5)(if applicable)
7 Total Square FL (new haues & add ions)
1, , as owner of the subject property
hereby authorize to act on
my behalf, in all matters relative to work authorized by this building.permit application.
Signature of Owner
re— U�' etAi � Owne /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 —�/Date
z
TOWN OF YARMOUTH
BUILDING DEPARTMENT
CONSTRUCTION SUPERVISOR FORM
PLEASE PRINT:
Job Location:
Number
Owner of Property:
Village
Construction Supervisor:
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 applicablelaws 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 2.151, 2.152 or 2.15.3 or any other section of these
rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of
license by the board.
2.16 All building permit applications shall contain the name, signature and license number of the
construction supervisor who is to supervise those persons engaged in construction, reconstruction,
alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and
regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately
cease until a successor licence 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 procedm es and the specific inspection as called for by the building official.
1
FINSURANCE COVERAGE.
ave 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
1
Chapter 152 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Owner 'U Agent
j J',gna?ure of Owner or Owner s 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: Est. Cost /
�ddress �/ of Work b �(c0 /� / (
Owner Name: kMa/ jl o%7/ -/I 'l
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.
OR.
Notwithstanding the above notice, I hereby apply for a permit as the owner of the above
property -
Date Owner Name
The Commonwealth ofMassaehusetts
Department of Industrial Accidents
af//eaa/IMSZ192M®s
600 Washington Street
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
- --- - PleasrPR119TTldfi}s3y
location:
boo ✓�I iff l�rrt!C �2r.( S Yr¢Nfs 0 �_. M14
I am a homeowner performing all work myself.
I am a sole proprietor and have no one working in any capacity
❑ [am an employer pros iding workers compensation for my employees working on this job.
1 am a sole proprietor zeneral contractor or homeowner (circle one) and have hired the contractors listed below who have
the following workers compensation polices:
Failure to secure coverage as required under Section 23A of MGL ISI tan lead to the imposition of criminal penalties of a Bee up to
one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a Bee of Sf00.00 a day against me. 1 c
copy of this statement maybe forwarded to tht office of Investigstioa of the DtA for coverage verification.
t do.hereby certify under she pains and penalties of perjury that the information provided above is true and coned
Print name
official use artily do not wrist in This area to be completed by city or town official
city or town: YARMOUTfl
C3 check if immediate response is required
permiNiremeN nBuilding Department
❑Licensing Board
21 OSelectmen's Office
(503) 398t2231 eat Wealth Department
contact person: phone e:_ ,_ n0ther
that a
Information and Instructions
Massachusetts General Lags chapter I52 section 25 requires all emplovers to provide workers' compensation for their
entplus ees. As quoted from the 'lacy", an employee is defined as every person in the service of another under any
contract of hire, express or implied. oral or written.
An emp6�rer is defined as an indis 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
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 employ er
%IGL chapter 152 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 commomvealth 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 has e
been presented to the contracting authority
Please till in the workers compensation affidavit completely, by checking the box that applies to your situation and
supplying company names. address and phone numbers as all affidavits may be submitted to the Department of
Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The
affidavit should be returned to the city or town that the application for the permit or license is being requested,
not the Department of Industrial -accidents. Should you have any questions regarding the' law' or if you are required
to obtain a workers' compensation policy. please call the Department at the number listed below.
City or Towns
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of
the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please
be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to
the Department by mail or FAX unless other arrangements have been made.
The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address, telephone and fax number -
The Commonwealth Of Massachusetts
Department of Industrial Accidents
MCI of I�gsllsall®®s
600 Washington Street
Boston, Ma. 02111
fax #: (617) 727-7749
phone N: (617) 7274900 eat. 406, 409 or 375
• of'�' R
PLEASE PRINT:
DATE:
JOB LOCATION:
TOWN OF YARMOUTH
BUILDING DEPARTMENT
1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 260
HOMEOWNER LICENSE EXEMPTION
S
NAME STREET ADDRESS SECTION OF TOWN
"HOMEOWNER" 5A-P-t -09-3 V-176c( 7-/S� 9
NAME HOME PHONE WORKPHONE
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 I
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, Hiles 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 d divner's Agent Owner Agent ❑
h:homeownrlic mp
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 �� u0 41G 1 5- y1f
Work Address
is to be disposed of at the following location: rAO',501
N
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
Signature of rlicant
Permit No.
z9 0
Da e
0
r
PROPOSED GOV o
ENITZY
FILE COPY
TOWN OF YARMOUTH
REVIEWED FOR BUILDING AND ZONING CODE COMPLI-
ANCE. ERRORS OR OMMISSIONS DO NOT RELIEVE THE
APPLICANT FROM THE RESPONSIBILITY OF'AS BUILT'
COMPLIANCE. /_'
DATE: . � y]aZa-
BUILDING OFFICIAL
E%5,nNG PROP
zM asn
FOYER �"
LIVING RM
,(Coe v�n�, PORTICO
12127
-- -
5�-Cl
TOWN OF YARMOUTH
Building Department
Town Hall
Yarmouth, MA 02664
(508) 398-2231 ext.261
BUILDING PERMIT
APPLICATION RECEIPT
Temp Permit No.:
Applicant Name:
Location:
Owner's Name:
Owner's Addres
T-03-523
Mark Uppendahl
00200 BLUE ROCK RD
MARK S UPPENDAHL
00200 BLUE ROCK RD
South Yarmou MA 02664
Owner's Telephone: (508) 394-1764
(OFFICE USE ONLY
Recorded By:
Ic
Permit Fee:
$0.00
Deposit Rec:
$25.00
Payment Type:
Check ChkNo.. 4521
Net Owed:
($25.00)
Application Date:
5/27/03
Issue Date:
Expiration Date
Comments:
/0 G
replace 2 story pillared covered front entry with
one story entry
This is NOT a building permit. Application subject to plan review. Contact Building Department for permit status. Official
Building Permit will be issued upon plan review completion, approval, and complete payment of Net Owed on Permit Fee.
Date Printed: 5129/03
I TOWN OF YARMOUTH
I REVIEWED FOR BUILDING AND ZONING CODE COMPLI-
ANCE. ERRORS OR OMMISSIONS DO NOT RELIEVE THE
J..� APPLICANT FROM THE RESPONSIBILITY OF 'AS BUILT"
eoze �Nusxs COMPLIANCE.
DATE: 6 'L
BUILDING OFFICIAL
- - - - - - -l-1
a
1. 1__.I _. i
Ad00 S.INVOIldd`d
I
EMNEgill
�M �r�
FOYER LIVING RM
— exls 7S s-t/,
I
TOWN OF YARMOUTH
_REVIEWED FOR BUILDING AND ZONING CODE COMPLI-
COe 9NLLGD(5 ANCE. ERRORS OR OMMISSIONS DO NOT RELIEVE THE
APPLICANT FROM THE RESPONSIBILITY OF 'AS BUILT'
COMPLIANCE. J
DATE. J
BUILDING OFFICIAL
wi
43t3/�O'.J Q3.vns
GOOSJd
, r
0
NMI
Exy NG
FOYER
EMSTING
LIVING RM
:23 V.j�AND +3.5
3.2 +3.9 _ �
9.8
�20 00 k /
i J n
COAST-- t9
;` � DECK
I+s
R
2 STORY
(IST
EXIST. DWELLIN
ZAGE
Lil , /3 1
PROP. PORTICO-" PA L 164
0.69 AC
0 X
`L60 O
1st STORY SCREENED
PORCH W/DECK OVER
Val
1
e�
al,+ 'cp �.
O. 6'-
j� PARCEL 165
PATRICIA J. CEDERIC GRENIER TR
t
ROCK
BRICK
PATIO
(REMOVE)
PROP. SUNROOM
OF #2 (
A 34r\
5L, '\
NOTES:
1. ELEVATION FROM RM 9 (NGVD)
2. FLOODZONE A5 EL 6 & C (HOUSE IS IN C)
(FIRM 250015-0002 D, REV. 7/2/92)
3. ASSESSORS MAP 101 PARCEL 164
4, ZONING: R-40 (FRONT: 30', SIDE, 20')
5. ROOF RUN—OFF TO BE DIRECTED TO DRYWELLS
KEY:
C
GUY WIRE
`Q3
UTIL POLE
TREE
D^
UGHT POST
+11.2
SPOT ELEV.
PARCEL 163
BLUE ROCK HEIGHTS
ASSOC.
DRIVE PARKING
Woo/
O DCHIPS
TRANSECT
+s, PA
�CE Qc 1f
+44 r
TRANSECI
aA
+1T
i
/ ,rtia
----LOT 23
i QQo uA
AREA
242
off. 508-382-4541 e4Ue C pA�MFA;
fax 508-382-9880 RpOt 7.
k E
down cape engi.neering, inc. "DID
(it CIVIL ENGINEERS BENCHMARK
V LAND SURVEYORS CATCH BASIN
939 main st. Yarmouth, ma 02875 IELEV 10.8'
EXIST
GARAGI
IXIST. ST
12' TREE
(%3.P
ARNE H.
S
� ft
TRANSECT
H �
DECK
2 STORY
EXIST, OWELUNG
let STORY SCREENED
PORCH W/OECK OVER
PORTICO a
PARCEL 164 '
e 0.69 AC
k
PARCEL 165
PATRICIA J. CEDERIC CRENIER TR
I9, 2.001
DATE
e'9S
FL0002CNE EL. 6
(TOP COASTAL BANK)
�E e-41:1
SJNROOM
LOCATION MAP NTS
SITE PLAN
OF #200 BLUE ROCK ROAD
IN THE TOWN OF:
(SOUTH) YARMO UTH
PREPARED FOR: MARK UPPENDAHL
30 0 30 60 90
SCALE: 1" a 30' DATE DECEMBER 19, 2001
TOWN OFYARMOUTH BuildingDepartment
BUILDING
�r r
(508) 398-22431 ext.2 1
PERMIT B-03-854
PERMIT
ISSUE DATE 4/li/03 PROPOSED U
- - - -
JOB WEATHER CARD
APPLICANT 'Markuppend N
ADDRESS '00200 BLUE ROCK RD
PERMIT TO Addition
AT (LOCATION) 00200 BLUE ROCK RD ZONING DISTRIC R-40
SUBDIVISION MAP LOT BLOC 10/.164 BUILDING IS TO BE
USE GROUP R3
LOT SIZE
CONSTTYPE 5-B
CONTR'S
ENSE 0
addition: sunroom/familyroom as per plans dated 04102103.
REMARK
\REA (SO FT) EST COST ($ $30,000.00 PERMIT FEE
OWNE MARKS UPPENDAHL BUILDING DEPT BY
ADDRESS (K)200 BLUE ROCK RD
South Yarmouth 02664
INSPECTION RECORD
LIC
CONTR'S NAM
FIELD COPY
Date
Note Progress - Corrections and Remarks
Inspector
_Z3,a3
—� o
g //-0 3
O
$-2 o-z
/D a
d!C
w
OFVAfj'r
,� 40
/ e ter., .ATTACHEwH
ONE & TWO FAMILY ONLY - BUILDING PERMIT
APPLICATION TO CONSTRUCT, REPA;-, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
Town of Yarmouth Buil&ng Department '6el' ✓/�N�Oo%u ✓2�
1146 Route 28 • Yarmouth, MA 02664-4492 FAX F 1363r
Tel: (508) 398-2231 x261 • Fax: (508) 398-0836
Office Use Only �� 4�n
Permit No.� Dater � 3
Permit Fee $/SO,' 41/�6
Deposit Rec'd. $ %v DatePlan
u�
Net Due $ �� rj i
Planning Board Information
Plan Type
EntlorsementDate
RecordingDate
No.
Other
Assessors Department Information:
Ma Lot ap tof
d a' )-3 (J / to
Old New
1.4 Property Dimensions:
O 0 G, Al
of Area (sQ Frontage (ft) Lot Coverage
This Section for Office Use Only
Buildina Permit Number
Date Issued:
Signature: - 0
Certificate of Occupancy
is is not required.
Building Official -• to
Section 1 - Si Information I Use Group: R-4 Type: 5-B
1.1 Property Address:
,400 /�/W �� ll "
1.2 Zoning Information:
/Z yp (la-$
Zoning District Proposed Use
S yz s mn rn,Y-1t �� /3L 02-1, 6 Lf
1.3 Building Setbacks (ft)
Front Yard
Side Yards
Rear Yard
Required
Provided
Required
Provided
Required
Provided
dr
aOr y
o1O�
1.4 Water Supply (M.G.L. c. 40. S 54)
Public ✓ Private
1.5 Flootl Zone Information:, Comments:
Zone:. BFE::.
Section 2 - Property Ownership/Authorized Agent
2.1 Owner of RecoM:
Name (print) Mailing Address
Si—)��.,.,/
gnature ° Telephone
2.2 Authorized Agent:
Name (print) Mailing Address
Signature Telephone
Section 3 -Construction Services
I-
3.1 Licensed Construction Supervisor.,I
Not Applicable ❑
LUVO I
MAR 9
Ull
License Number
Address t_I
Expiration Date
Signature Telephone
3.2 Registered Home Improvement Contractor
Company Name OWNERS PULLING THEIR OWN PERMITS OR
WITH UNREGISTERED CONTRACTORS FOR
^ME RAFROV MENT • OR& -DO N
Address ACCESS TO THE ARBITRATION PROGRAM
GUARANTY FUND UNDER MGL e. 142A.
Signature Telephone
U N5plicable ❑
APPU-
LiiWiEe Number
OR
Expiration Date
1 of 2
OVER
Workers Compensation Insurance affidavit must be.crmpleted and submitted with this application. Failure
to provide this affidavit will result in the denial ul the issuance of the building permit. I '
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. ❑ I Repair(s) ❑ Alterations ❑ Addition
Accessory Bldg. ❑ Type
Demolition
Other Specify:
Brief Description of Proposed Work:
N —hi wih
- to-bE
lea for
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
Q
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.
Print name
of Owner/Agent
3 f z0/o3
I Date
9-15-99 2 of 2
° TOWN OF YARMOUTH
��qq}}__1G
BUILDING DEPARTMENT
CONSTRUCTION SUPERVISOR FORM
PLEASE PRINT:
Job Location:
Number
Owner of Property -
Construction Supervisor:
Address:
Licensed Designee:
(if other than Supervisor)
Name
Name
2.15 Responsibility of each license holder -
Street
Village
License No.
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 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 constntction
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
Chapter 152 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
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 me 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. AA
Type of Work:Ylrl h� �✓ " �� �"` Est. Cost 'C"o DO O
Address of Work
Date of Permit Application: 3)2-D %03
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 PERMITS CR DEALING
WITH UNREGISTERED CONTRACTORS FOR APPLI.
CABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR
GUARANTY FUND UNDER MGL a i47A.
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.
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
Olflce 01/sveSt/Ostls/s
600 Washington Street
Boston, Mass. 01111
Workers' Compensation Insurance Affidavit
--- - PleasePRINTTldifat --
R1 am a homeowner performing all work myself.
MI am a sole proprietor and hace no one aorkin_ in any capacity
0 1 am an employer pros iding workers' compensation for my employees working on thisjob.
m — —
address,
shone X•
cllJ
insurincc
oli X
0 I am a sole proprietor, generaIcon tractor or homeowner (circle one) and have hired the contractors listed below who hace
the follouine %corkers compensation polices:
m nv na
i phone X•
insurnnize c X
compirry name*
Failure to secure coverage a required under MCnon 3SA of MCL 152 eao lead to the imposition of erimisw paWDa ofa Doe ap ro apuu.w aamar
one yea"' imprisonment a well as civil penattln in the form of a STOP WORK ORDER and a Bet of SIOO.Oo a day against me. I aadentaad that s
copy of this smlement may be forwarded to the office or investigations or the DIA for coverage verification.
t do hereby certify
under ihepains and penalties of perjury that At information provided above Is true and coned
Y�,Signature
�
Print name
OfBflil use OnI\' d0 or MCII< 10 this area t0 be completed by CItY Or tOMO OBI<lal
city or to-n: YARMOUTQ
check if immediate response is required
contact person:
_permiNicenst r1fluilding Department
Licensing Board
261. OSelectmen's once
011ealtb Department
phoneXt_ (508) 398-2231 eat. mother
m aei
1.
Information and Instructions 1,
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 empinrer 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 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 hay ing 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 employ er
MGL chapter I:'_ section also states that even state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for anv
applicant who has not produced acceptable evidence of compliance with the insurance coverage required.
Additionalh neither the commonsealth 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 has e
been presented to the contracting authority
Applicants
Please fill in the workers compensation affidavit completely, by checking the box that applies to your situation and
supply ing company names. address and phone numbers as all affidavits may be submitted to the Department of
Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The
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 ssorkers' 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
Oltteo of lov1SHIStl9®S
600 Washington Street
Boston, Ma. 02111
fax #: (617) 727-7749
phone 9: (617) 7274900 ext. 406, 409 or 375
0
PLEASE PRINT:
DATE: c3130!63
JOB LOCATION:
TOWN OF YARMOUTH
BUILDING DEPARTMENT
1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 260
HOMEOWNER LICENSE EXEMPTION
f ?Ek: 4
STREET)
SECTION OF TOWN
"HOMEOWNER" S4 tw t
NAME HOME PHONE WORK PHONE
PRESENT MAILING ADDRESS Sl
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 Hermit. (Section 108.3.5.1)
The undersigned 'homeowner' assumes responsibility for compliance with the State Building Code and other
applicable codes, by-laws, Hiles 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 I7�L (
ADPRMAi. 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.
Signature of Owner or Owner's Agent
h:homwo ll =P
Check one:
Owner ❑ Agent ❑
TOWN OF YARMOUTH
1146ROUTE28 SOUTHYARMOUTH MASSACHUSETTS02664-4451
Telephone (508) 398-2231, ExL 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 -�'06 / /4,®7GYn p � {ITfF ��lO�
Work Address
is to be disposed of at the following location: y�
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
Signatur Applicant
Permit No.
5L7oo
Date
u TOWN OF YARMOUTH
a
Building Department
_ s Town Hall
Yarmouth, MA 02664
(508) 398-2231 ext.261
BBUILDING PERMIT
APPLICATION RECEIPT
Temp Permit No.:
T-03-400
Applicant Name:
Mark Uppendahl
Location:
00200 BLUE ROCK RD
Owner's Name:
MARK S UPPENDAHL
Owner's Addres
00200 BLUE ROCK RD
South Yarmou MA 02664
Owner's Telephone: (508) 394-1764
(OFFICE USE ONLY
Recorded By:
Ic
Permit Fee:
$0.00
Deposit Rec:
$25.00
Payment Type:
Check ChkNo.. 4472
Net Owed:
($25.00)
Application Date:
3/20/03
Issue Date:
Expiration Date
Comments:
/ 0 / Z L1
addition: sunroom/tamilyroom
2011I1410 APPROVED
This is NOT a building permit. Application subject to plan review. Contact Building Department for permit status. Official
Building Permit will be issued upon plan review completion, approval, and complete payment of Net Owed on Permit Fee.
OWNERS PULLING THEIR OWN PERMITS OR DEALING
WITH UNREGISTERED CONTRACTORS FOR APPLI-
CABLE HOME IMPROVEMENT WCRK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR
GUARANTY FUND UNDER MGL c. 142A.
Date Printed: 3/29/03
TOWN OF YARMOUTH BUILDING DEPARTMENT
PLAN REVIEW & BUILDING PERMIT APPLICATION REVIEW NOTES
ADDRESS: �8 '3L fi C /�Q c /� rPD.r` Y
Map / Lot: /o ///G y
Date of Initial Review. V17-/6 3 Other. Appm al Date:
Inspector. "I-/i✓L y/
NOTES: /) as m % fL /� f%D D /✓///�/ lv ✓%%c /moo c y (%/D FrL
s<r�a
t�"4Pa .5'�/�P,�/r2s ���arr�kro-Foz �y1<B.L�.�ra�re
3 lU rtGf. /�T �X/5r/KG F/j- 1nusrHfrv11- /Y%/N.
�f ° C[G.�rtrrxc� Ar Fi2� l3ox
t �,� /GQ ✓r OFL l��R Sr//I-E.T FG R- G'W -,3SS W/.�Do..+s
V 62 dMC Acc¢ss Nor S/h WY
7) 7110..104. A-4 Tro F. . EX' s r..re QC Nc« Nt+Fri..� S'ys r¢m
Zoning Dmial (if applicable):
&@ding Code Denial (if applicable)
Rev. 11-01
0 of aR `100 TOWN OF YARMOUTH
D � BUILDING DEPARTMENT
�,; BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF
TRANSMITTAL SHEET
Building Site Location: yh7d /Mtja f, ap No: Lot No:
Proposed Improvement:
i
Address: ld=dlflj&, - Te1No.: A/i 71 !4 Date Filed: i ZO b
The Building Department will be responsible for assisting the applicant by dispatching your plans and or application to the following
applicable departments.
WATER DEPARTMENT
Determines Compliance of Water Availability and or existing location.
ENGINEERING DEPARTMENT:
Determines Compliance for Parking and Drainage.
CONSERVATION COMMISSION:
Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of
Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc
HEALTH DEPARTMENT:
Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities.
FIRE DEPARTMENT:
Determines Compliance to State and Town Requirements for Personal
Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc.
REVIEWED BY:
1. WATER DEPARTMENT:
DATE:
N/A
2. ENGINEERING DEPARTMENT:
DATE:
N/A
3. CONSERVATION:
DATE:
N/A:
4. HEALTH DEPARTMENT:
DATE:
N/A:
INDUSTRIAL
AND/OR COMMERCIAL.
PERMITS
S. WIRING INSPECTOR:
DATE:
N/A:
6. PLUMBING INSPECTOR:
DATE:
N/A:
7. FIRE DEPARTMENT: DATE:
PLEASE NOTE
COMMENTS:
RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE:
Whioc copy- Building DcpL- Pint copy - Weser DepL - Yeaow Copy -Heatm OWL - Pink Copy- Engincaing Dwt - GoIdeuuma- Fie DeiXCamcraoon
Building Site Location:
Proposed Improvement:
TOWN OF YARMOUTH
BUILDING DEPARTMENT
BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF
TRANSMITTAL SHEET
No: /U Lot No:
S C
Address: . — ;, d- Tel.No.: :�/ci /'I/, 4 Date Filed: -3T 6
The Building Department will be responsible for assisting the applicant by dispatching your plans and or application to the following
applicable departments.
RESIDENTIAL AND/OR COMMERCIAL BUILDING
WATER DEPARTMENT: Dctennines Compliance of Water Availability and or existing location.
ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage.
CONSERVATION COMMISSION: Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of
Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities.
FIRE DEPARTMENT: Determines Compliance to State and Town Requirements for Personal
Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc.
------------------------------------------------------------------------------------------------------------------------------
REVIEWED BY: /�
1. WATER DEPARTMENT: eyu-'M DATE:3-21_03 N/A
2. ENGINEERING DEPARTMENT DATE: N/A:
3. CONSERVATION:, DATE:
4. HEALTH DEPARTMENT: DATE: N/A
INDUSTRIAL AND/OR COMMERCIAL PERMITS
5. WIRING
6. PLUMBING INSPECTOR:
7. FIRE DEPARTMENT: DATE: N/A
PLEASE NOTE
COMMENTS:
RECEIPT OF COPY: SIGNATURE OF APPLICANT:
White apy-BuMmg DcpL- Pmk copy -Wale DepL - Ydlow Copy -HaM DVL - Pmk OD" -Envoemng Dept - Goldwwd- Fue Dqx Conavatian
Building Site
Proposed Improvement:
qo�) TOWN OF YARMOUTH
BUILDING DEPARTMENT
BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF
TRANSMITTAL SHEET
No: ZO Lot No: /T
The Building Department will be responsible for assisting the applicant by dispatching your plans and or application to the following
applicable departments.
RESIDENTIAL AND/OR COMMERCIAL BUILDING
WATER DEPARTMENT:
Determines Compliance of Water Availability and or existing location.
ENGINEERING DEPARTMENT:
Detetmines 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.
REVIEWED BY:
1. WATER DEPARTMENT:
DATE: N/A
2. ENGINEERING DEPARTMENT:
DATE: N/A:
3. CONSERVATION:
// DATE: N/A
4.
5. WIRING INSPECTOR: DATE: N/A:
6. PLUMBING INSPECTOR:
7. FIRE DEPARTMENT: DATE: N/A:
PLEASE NOTE
COMMENTS:
RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE:
While copy -Building DTL- Pmkw" -Water Dap. - YdlowCopy. Health DcpL - Pink Copy-En&ewing Dept. - Go1dcnwd-Fue DepUCmvvetion
TOWN OF YARMOUTH
BUILDING DEPARTMENT
BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF
TRANSMITTAL SHEET
Building Site Location: t� /-I'!e a /C pz % S`Y 1v1ap No: /� I of No:
Proposed Improvement:
Address: e. Tel.No.: gc/v %/ 4 Date Filed: 3 7G o`
The Building Department will be responsible for assisting the applicant by dispatching your plans and or application to the following
applicable departments.
RESIDENTIAL AND/OR COMMERCIAL BUILDING
WATER DEPARTMENT:
Determines Compliance of Water Availability and or existing location.
ENGINEERING DEPARTMENT:
Determinea 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:
Detemunes 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.
REVIEWED BY:
2. ENGINEERING DEPAI
3. CONSERVATION:
4. HEALTH DEPARTMENT: DATE: WA:
INDUSTRIAL AND/OR COMMERCIAL PERMTFS
S. WRNGINSPECTOR: DATE: N/A:
6. PLUMBING INSPECTOR
7. FIRE DEPARTMENT: DATE: N/A
PLEASE NOTE
COMMENTS:
RECEIPT OF COPY: SIGNATURE OF APPLICANT:
DATE:
Whit ww-Buddmg Dept- Pmkcwy -Water Dept - YdbwCupy.HaMDept - Pink Copy-FnVwwiog Dept-�(IddmaQ-Fke DeptK'amr:v��oe—�,,
Property Loeauion: 200 BLUE ROCK RD 3/APID: 101/ 164/ / /
na.a, rn• 9n/Y(123111 Bldg 8: 1 Card I of 1 Print Date: 04/04/2003 Of
Ulan lU: Is6Ji
CURREATOWVER
'PPENDADL, MARK S
TPENDADL, JOANNI
00 BLUE ROCK RD
TOPO.
....._. ._.
CT/CITIES
"_.
STRT./R0.4D
LOCATID.V
CURRENT.ASSESSJlE.VT
Descn non
Code
Apprinsed 6'ohae
Assessed 4alve
8159
]:4R1/017777.
2ESLAND
SIDNTL
1011
1013
211,900
196.600
211,900
196,600
5 YARSIOUi'li, NIA 02664
S1'PPLEJfE:VL4L
DATA
�j
-Slo /Q
8 jam•
ccaunt9 1392400
abdivision 241
hato
har.dd
VISIC
recitta
LS ID:
Total
408,500
408500
RECORD OF'Oli:\`E'RSfIIP
PPENDAIIL, STARK S
RX-IULPAGE SOLE DA7E /u di SALE PRICE '.0 PRE 170L'SASSF.NA IENIA H11!s]
0 }-r. Code Asressed l'alue 1'r. Code Assessedlalne Yr. Code Assessed.
2003 1U1J 211,900 002 1013 211,9 1001 1013
2003 1013 196,600 002 1013 196,600 W01 1013
Total. 408 SOU i'nml 4U8.SU0 Tam(:
E.V"f-M1fP7'IONS OTHER ASSESSM1IE.VITS This signature aeknon•Iedges a visit by a Data Collector or.As!
fear T aDeveri Ilan Amarmr Code Desri non Number Amount Cmnrn. Ins.
APPR47SEU 19LL'E SO3f3LARY
Appraised Bldg. Value (Cad)
Appraised XF (B) Value (Bldg)
Appraised OB (L) Value (Bldg)
T"of Appraised land Value (Bldg)
NOTES Special Land Value
4 SALE 394-3200
10 R\15INCL 11N FH\[
Total Appraised Card Value
Total Appraised Parcel Value
Valuation Method: Cast/Nlarket 4
0241
et Total Appraised Parcel Value
Yerrni(ID Issue Date T a
375 NI/1999 RS
BUILDING PEft1flT RECORD L7SIT/CILII/
Descri Ilan Amount lns .Uare %Coin Ua(e Com . Cammenn Dote ID Co. d. Pur po ace e flea
eeidenH.1 30,000 2/102000 1W 1/1/1000 DDIIION 2/102000 GNI 01 lem."1l'init
7/26/1995 RD 10 IeaeWLtr5nt L
Np
1
L'se Code
1U13
Descn non
'FR WATER
Zone
D -ionm
a
Ue (h
L'm(s
3g056.40
LA,VULL\'E
SF
I:AL(,'ATIO.V
UrtnYrise
1.SS
SECTION
f F'a¢tor
1.65
.
5.7.
C. F'actar
2.70
bad.
dbad.
Ad'.
1.00
Notes-Ad'S' ecial Ymmn
00-10% DR.NGE ES\IN1'
Ad'. Unil Ynce
7.05
Land I4
Twnl
Card Ld
onVn
00,056.00
SF
Parcel Toml
LandAren:
30,056
SF
Total land { ubae
Prop ton: 200 BLUE ROCK RD MAP ID: 101/164/ / /
FLIa ID: 13654 Other ID: 90/ X023/ / / Bldg #: 1 Card 1 of 1 Print Date: 04/04/2003 08
CO.YSTRUCTIO.Y DETAIL
SKETCII
Element
Cd.
ICh. I
Description
Cammerefal Dma
Elementr
FUS
'tyle/Type
3
blordal
Element
Cd. Ch.
Desenpocm
test & AC
fodal
1
esldentiul
BAS
ado
5
verxge+20
game Type
WDK UBM
athc Plmnbing
FSP
tones
Stories
28
Paray
10
eilin
12 3
oomm.
12
lV
xterior Wall
4
Vood Shingle
Co.,..
WCommon Wall
_
--
2
19
tick Vcncer
Wall Height
oofSW lure
13
bldllip
13 14 4
oofCover
3
ph/FGIs/C p
6 14
CO.\'DO/.IfOBILE UO.IIF. D4TA
4
rior Wall2
5
ry mwSheet
WDK
dement
'ode
escnpnon
'actor
3 FUS
omplex
tenor Floor 1
2
lardx'ood
S BAS
2
Floor Adj
FBM 2
nit Location
4
eating Fuel
eating Type
13
IS
lot Water
'umber of Units
'umber
12 14 14
C Type
1
one
of levels
OP
%Ownership
3edrooms
13
Bedroom
COST/.1f.4RAET
{:9LC!4TIOA
tivooms
.5
12 Bathrm
7 17
nadj. Base Rate
60.00
mal Rooms
0
0 Roomr
¢e Adj. Factor
0.90201
3rade(Q)Index
1.27
FGR
[hTYPe
2
lodern
4 2
"[then Style
2
lodern
j. Base Rote
66.73
Idg, Value New
269,490
44
ear Built
1962
&. Year Built
1972
nnl Ph"d Dep
28
unrnl Obsbw
on Obslnc
pool. Cond. Coda
3pc.ICond%
0
0
MIXED
USE
100
1013
erall%Cond,
72
[FR%VATER
fkyec. Bldg Val.
194,(MI0
OB-OUTBUILDLVG & Si1RD ITEMS I.) IX'F-BULDIT'G EXTR4 FEATURES B
Code
I Deem non
LB
Units I
Umt) nee
yr. UDR(
I 69Cnd
A r. 1'ahre
FPL3
2 STORYCIUM
B
1
2,800.00
1972
1
100
2,000
FPO
EXTRA FPL OPEN
B
1
800.00
1972
1
100
600
BULDLYGSLB-AREA
SEILIL4RYSF.CTIO.Y
CodeFIVwd
Descri non
Limrt Areo
Grom.4rea
E . Area
Unit Cost
Unde rec. Vlue
RAS
r
1,568
1.568
1,568
68.73
107,769
F13M,
Finished
0
364
164
30.97
11,272
FGR
0
576
230
27.44
15,808
FOPen,
Finished
0
96
19
13.60
1,306
FSParch,reen,
Finished
0
228
57
17.18
3,918
F11S
ory, FWshed
1,568
1,568
1.568
68.73
107,769
UBM,
Unfinlsbed
0
1,204
241
13.76
16,564
WDKd
0
744
74
6.84
5,086
{�''�IYD 667A Main Street
HOME * Route
Dennis, MA 02638
Telephone: (508) 385.1331
REALTY
Fox: (508) 385-3637
ak
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b
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ENGINEERING FIELD REPORTMORKSHEET Project No: P03-OZ
" Sheet No: f_ of
GENERAL DESCRIPTION Designer - Don I. Meyer 394-5296
_—=__= Owner - Mark Uppendahl
Narrative: Add 1 Story Family Room to 1-1/2 Story Wood Frame _�-
Location: 200 Blue Rock Road, South Yarmouth, MA
Construction: 2"x 4" o.c. Platform Frame w/ Stick -built Rog
------------- Full Height Concrete Foundation , uY�r�t 1
SPECIAL CONSIDERATIONS 1-(�
Use Group(s): R-4 (Residential) 1 Family
Construction Type: 5B (unprotected) - note separation below
------------------
Misc or Comments: o Plan and Layout Reviews
----------------- o Design Requirements and Support Needs
Beams, Columns, Details 6 Notes
o Certify
DESIGN CONSIDERATIONS
Soil Data: - Site Plan or Boring Log available: NO
---------- Preparer of plan or log:
Direct Observation: YES; P98-17
from CC Atlas - Qsm; Glacial Till, Sand s Silts
Description:
USCS = SP ( ) SBC Class = _-8-_
Specifics: Br(allow) = 2,500 lb/sq ft
w/ lo% width increase
Fire Data: Standard 1/2" GWB through -out
Loads SBC Location #/sq ft Dur Note
------------- -------- --------- -------- --------------------
Basement 50 1.0 Concrete
1st Floor 40 1.0
2nd Floor 30 1.0
Attic 0 1.0 non -Expand
Balconys/Stairs 100 1.0
Partitions: 2x4/6 10 1.0 Wall Parts.
Snow - m <= 7/12 for all 25 1.15 Zone - I
Wind - Ref Pres = 21 Zone - 3
worst +/- = -.7 -15 1.33 EXP - B/C
Loadings I 1st Floor 2nd Floor Attic Roof
------------- -------- --------- -------- --------------------
LIVE LOAD 1 40 30 0 25
DEAD LOADS 1 13 13 4 8
1 2"x 10" Joists, 1/2" GWB, 2"x 10" Rafters
DESIGN TOTAL 1 55 45 5 35
w/ round I w/ 5% on DL
NET UPLIFT = not checked; Provide Simpson Products
P82-FRW-7
ENGINEERING FIELD REPO RT/WORKSHEET Project No: P03-08
Sheet No: L ot 7—
GENERAL DESCRIPTION Designer - Don I. Meyer 394-5296
Owner - Mark Uppendahl
Narrative: Add 1 Story Family Room to 1-1/2 Story Wood Frame
Location: 200 Blue Rock Road, South Yarmouth, MA
DESIGN LAYOUTS
Floor Beam; 3.5"x 9.5" TJ-W ParalLam w/ E = 2.Ox 10(6) PSI
Wul = 281/2 x (30+15) + 8x 12 + 25
Wul = 755 lb/If 1 span = 11' 0" ea max.
Mmax = 11,420 ft-lb
Fbreq = 2,602 PSI Fbavail = 2,900 PSI
DELmax = .47" (@ 85%) DELact,= .49" for 3.5x9.5
OK for use -- no reductions required
Gable Beam; 3.5"x 14" TJ-W
ParalLam w/ E = 2.Ox 10(6) PSI
Wul=Sx 12+25
Wul = 125 lb/If
1 span
= 20' 0" ea max.
Ellmpyz-&.
Pt = 4,150 lb @ 10'0"
Mmax =
26,175 ft-lb
O-CI-N
Fbreq = 2,747 PSI
Fbavail
= 2,900 PSI
DELmax = 1.00"
DELact
= .94" for 3.5xl4
0
OK for use
-- no reductions
required
c
House column; 3.5"x 3.5" PSL w/ E = 1.8x 10(6) PSI
Pmax @ Post = 4,150 lbs Leff = 7' 6" w/o blocki
Fc(perp)req = 339 PSI F'c(perp)avail = 593 PS
OK for use (no reductions)
Wall columns; 3.5"x 3.5" PSL w/ E = 1.8x 10(6) PSI
Pmax @ Post = 3,325 lbs Leff = 7' 6" w/o blocki
Fc(perp)req = 271 PSI F'c(perp)avail = 593 PS
OK for use (no reductions)
Set bottom of posts tight to wall plates. Solid block to the
foundation sill plates or main girt beam w/ 3.5" PSL
stub columns installed snugly
Attach ParalLam beams to PSL posts w/ Simpson LCE4 post caps.
Nail outer existing band joist to 3.5xl4 ParalLam w/
2 rows of 12d/16d nails @ 16" o/c staggered T&B
13.2,�13 irc-J L�llo� I� ( Ll
bkV4C1-= AT, QK
(u] 8S7. r�<RM`
c Nd )4sbVc7WJ ��tR�
10.8 ? 30.1
VrJ.�'Aoo_1`)-1 < w
,sv
14
� "`
- k
N
.t* s3
P82-FRW-7
t ,�a
P$ILBROOR ENGINEERING
107 BEACH STREET Project: DPPENDAHL Addition
DENNIS, MA 02638 Project No: P03-08
1-508-385-8682 Date: 12 March 2003
DESIGN LAYOUTS
#1 Floor Beam; 3.5"z 9.5" TJ-W ParalLam flush framed to existing
#2 Posts; 3.5"x 3.5" TJ-W 1.8e PSL column. Attach to ParalLam
beams w/ Simpson LCE4 post caps
#3 Existing 2"x 10" floor joists. Flush frame to Parallam using
Simpson LUS28 hangers. This is a cut and snug fit assembly
#4 Beam Hanger; Simpson THD410 face mount hanger
#5 Gable Beam; 3.5"x 14" TJ-W ParalLam held tight to existing
gable wall and up flush w/ existing ceiling
#6 Band Joist -Gable Beam Nailing; 2 rows of 12d/16d nails @ 16" c/o
c/o staggered, binding the band joist segments along the bottom
of the 3.5"x 14" ParalLam. This supports the gable end wall
#7 Double 2"x 10" box w/ 1/2" CDR flitch to create header beam
#8 Box Header Hanger; Simpson LUS48 face mount hanger
PHILBROOR ENGINEERING
107 BEACH STREET
DENNIS, MA 02638
1-508-385-8682
Project: UPPENDARL Addition
Project.No: P03-08
Date: 14 March.2003
DESIGN LAYOUTS
xxxxxz= xxexxxxxx —x_--- . x-
#4 Beam Hanger; Simpson EW1410 top flange hanger. Weld top flanges
to beam top flange. Weld bottom of bucket to beam bottom flange
#5 Gable Beam; W10x17 w/ 2"z 10" ripped -to -fit side ledgers. Gun
or bolt thru w/ 1127.dia. bolts stagger spaced 26" o/c
#6 Band Joist -Gable Beam Nailing; 2 rows of 12d/16d nails @ 16" o/c
c/o staggered, binding the band joist segments to the inside
of the packed W10xl7 beam. This supports the gable end wall
4J ���0. Flush Floor Beam
T3aPam(IAQ ameeml Number. 1ao21at07 3112" x 9 112" 2.0E ParallarnO PSL
llset212�401118s7 THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN
Pape 1 �ro Veisoc t.a12
CONTROLS FOR THE APPLICATION AND LOADS LISTED
alp Pi
I tr t
Product Diagram Is Conceptual.
WADS:
Analysis is for a Header (Flush Beam) Member. TnbVM Load Width: 14'
Primary Load Group - Residential- Sleeping Areas (psf): 30.0 Live at 100 %duration. 15.0 Dead
Vertical Loads:
Type Class Live Dead Location Application Comment
UniformW Floor(1.00) 0.0 100.0 0To11• Adds To
SUPPORTS:
Input Bearing Vertical Reactions Ply Depth Nailing Detafl
Width Length (Ibs) Depth
LIvelDeaMPIINTotet
1 Wood column 3Ji0• 3.50e 2284117421014028 WA WA WA LI: Bloddrg
2 Tmberstmrd LSL 3.W Hanger 2336117821014118 1 9.50e WA H1: Face Mourn
Beam Hanger
See TJ SPECIFIER'S / BUILDERS GUIDE for detal(s): L1: Blod ftfil: Face Mount Hanger
1 Ply 1 1W 1.3E
TmberStrandO LSL
None
HANGERS: Simpson Strona-Tie(D Connectors
Support Model Slope Skew Reverse Top Flange Top Flange SupportWood
Flanges Offset Slope Species
2 Fece Mount Hanger HHUS410 0112 0 No WA WA WA
-Nalmg far Support 2 Face: 30-10d , Top WA Member. 10-10d
ESIGN CONTROLS:
Maximum Design Control
Control
Location
Smear Ps) 3902 3116 6428
Passed (52%)
RL ad Span 1 under Fluor loading
MorreN (Ft -Lis) 10284 102B4 13057
Passed MJ%)
MID Span 1 under Floor loading
Live Load Defl (in) 0254 0.264
Passed (U499)
MID Span 1 under Floor loafing
Total Load Dell (m) 0.447 0.527
Passed (L r2B3)
MID Span 1 under Floor loading
-Deflection Criteria: STANDARD(LLU480,TL:L240).
-Bnedng(Lu): Al compression edges (top and bottom) must be braced at 7 8e ok Wass detailed otherwise. Proper aCachmerl aid position ft or lateral
bracing is required to achieve member stability.
PROJECT INFORMATION:
OPERATOR INFORM.
UPPENDAHL
T. Vamum Philbrook
Project No: P034DS
Phlhrodc Engineering
200 Blue Road Road
107 Beach Street
South Yarmouth, MA
Dennis, MA M638-1825
Phone 508305-88W
Fax 508:i85a682
TVwnPhfl@AoLcan
Copyright a 2002 by sew Joist, a reyenhsauser Business
PstallsY and yLber trs ane regfstsx" trsdoosrks of hvs Joist.
Siqum Strovg-Sled Cmnsrtoxs is a registered txedeesxk of Sis¢scn Soong -tie Coupeny, Inc.
Fkmh Hone Bin
TJam.(rw ace so,isi M mzn, m; 31/2" x 9112" 2.0E Parallam® PSL
u_z 12�113,tIS ss
r.Be2 EnWi V dorc1.512 THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN
CONTROLS FOR THE APPLICATION AND LOADS LISTED
ADDITIONAL NOTES:
-IMPORTANTI The aralysm Presented a abut from software developed by T=Joist (TJ). TJ wanianls the stung of is prodiits by this softvmm wifi be
accomplmhed in aaordence with TJ poduct design aterm and code accepted design vale The specft product application. OPL't design loads, and
staffed dimensions have been provided by the scift a user. This output has not been reviewed by a TJ Assocets.
-Not all pmdrets are readily avatabM. Check with yaw supplier a TJ tectrtcal mpresentafive for pnodud avabbifiry.
-THIS ANALYSIS FOR TRUS JOIST PRODUCTS ONLYI PRODUCT SUBSTITUTION VOIDS THIS ANALYSIS.
-Almvable Stress Design mtlhodology was used for Buddng Code BOCA analyang the TJ Dmbbubm pro wt fisted ahwe.
UPPENDAHL
Pr*d Na P0308
200 Blue Road Road
Seth Yannoth, MA
Copyright i PJUB by tros Joist, a Weyerhaeuser Businea
parallax a TinherStranCi are teglsterea trrleaarka of Sw Joist.
S=m Sttoag-Tiem Connectors is a regiaterea tredmark of SLym Strrng-Sia fapavy, lac.
F.1
ENERGY CONSERVATION APPLICATION FORM FOR
LOW-RISE RESIDENTIAL NEW CONSTRUCTION and ADDITIONS
780 CMR Appendix J (effective 3/1/98)
Applicant Name: ' Aarg
(J Q!1 / Site Address: ,)C0BhLeea)P_d
V
Applicant Add
r o 1116 6 keez City/Town: S yOr' a,p39 0-�(aloy
pti /Jm /h9 O>kby Use Group:
QQ /l' Date of Application:
APPIicPant Ph SO R—,3 9 (— l 7(,Applicant Signature: Z l
Complianc ath (check one): !"
I] Prescriptive Package (Limited to 1- or 2-family wood frame buildings heated with rossll fuels only)
Package (A through KK from Table 15.2.1b): _ Heating Degree Days (HDD„) from Table 15.2.1a:
(For items d. through i., fill in all values that apply from Table 15.2.lb:)
a. Gross Wall Area sq.ft f. Wall R-value R-
b. Glazing Area' sq.ft. g. Floor R-value R-
c. Glazing%(looxb+a) °/a h. Basement wall R-
d. Glazing U-value U- i. Slab Perimeter R-
e. Ceiling R-value R- j. Heating AFUE
❑ Component Performance: "Manual Trade -Off' (Limited to wood or metal framed buildings only)
Climate Zone (from Figure J6.2.2) ❑ Zone 12 [:] Zone 13 Q Zone 14
Attach Trade-OffWorksheet from Appendix 1, (and NYACTrade-Off Worksheet, if applicable]
HAScheck Software
Attach Compliance Report and Inspection Checklist printouts.
i] Systems Analysis OR O Renewable Energy Sources
Attach Mass Registered Architect or Engineer Analysis
ALTERNATIVE FOR ADDITIONS ONLY:
a. Gross Wall + Ceiling Area 5$0 q.R. b. Glazing Area' /i sq.ft. c. Glazing %(100 x b+a) .3,2_%
ADDITION with Glazing % (c.) up to 40% may use 780 CMR Table J 1.1.2.3.1 below -
MINIMUM R•Valua
Fenestration
Cellia
Wall
Floor
Basement Wall
Slab Perimeter, Depth
0.39
RJ7
R•13
R•19
R-10
I R-10,4It
"SUNROOM" addition (greater than 40% glazing -to -wall and ceiling gross area)
Attach "Consumer Information Form" from 780 CMR Appendix B.
Official's Name: Official's Signature: _
Application Approved Denied 0 Date of Approval/Denial:
Reason(s) for Denial: (provide additional details as needed on back side)
'Gluing Area may be either Rough Opening or Unit dimensions. aaas Wins
'.t
TOWN OF YARMOUTH BOARD OF APPEALSY[�,F��t-,^;QU i_
H
DECISION r01Af 1,:RK
FILED WITH TOWN CLERK: January 23, 2002
y,I pi 23 Pit 3: 56
RECcivEU
PETITION NO: #3729
HEARING DATE: January 10, 2002
PETITIONER: Mark S. Uppendahl
PROPERTY: 200 Blue Rock Road, South Yarmouth
Map: 101 Parcel:164, (90/X23) Zoning District: R40
MEMBERS PRESENT AND VOTING: David Reid, Chairman, John Richards, Joseph
Sarnosky, Diane Moudouris, Richard St. George.
It appearing that notice of said hearing has been given by sending notice thereof to the petitioner
and all those owners of property deemed by the Board to be affected thereby, and to the public by
posting notice of the hearing and published in The Register, the hearing was opened and held on
the date stated above.
The property in question is a .69 acre residential lot, in an R40 zone, currently improved with a
single family home. The homeowner proposes to extend the existing attached garage, in order to
create a work shop/storage area for their personal use.
The petitioner represents that the existing home and garage were constructed in (approximately)
1962, as shown on the plans filed with the Board. They wish to have a workshop area within the
existing garage, and propose to extend it out, adding 16' x 22.5'. It would remain a two (2) car
garage, for their household use. The existing structure extends to within 14.1' of the side
(northerly) lot line. The proposed addition will come within 9.3' of the same side line. The
petitioner represents that he can not maintain the existing set back because of the angle of the
existing house and garage, and their plan to continue to use a portion of the existing garage for
the vehicles. The adjoining parcel is an unbuildable lot, owned by the neighborhood association.
It provides a point of access for the neighbors to the river.
While there is ample room for the addition to be constructed, without encroaching further on the
lot line, the Board does agree that the unusual angled position of the existing structure makes it
impractical, at least, to do so. Further, since the adjoining property is an unbuildable common lot,
the need to maintain the full set backs is less significant. In any event, the Board finds that the
proposed construction would not be substantially more detrimental to the neighborhood.
Therefore, a motion was made by Mr. St. George, seconded by Mrs. Moudouris, to grant the
Special Permit for the addition as proposed. Mr. St. George, Mrs. Moudouris, Mr. Reid, and
Mr. Richards voted in favor. Mr. Samosky voted against the motion. The Special Permit is
therefore Granted.
-1-
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 MGL c40A section 17 and must be filed within 20
days after Sling of this notice/decision with the Town Clerk. Unless otherwise provided herein,
the Special Permit shall lapse if a substantial use thereof has not begun within 24 months. (See
bylaw § 103.2.5, MGL c40A §9) Unless otherwise provided herein, a Variance shall lapse if the
rights authorized herein are not excised within 12 months. (See MGL c40A § 10)
David S. Reid, Clerk
-2-
OWNER MARK S UPPENDAHL
ADDRESS 100200 BLUE ROCK RD
BUILDING DEPr BY
INSPECTION RECORD FIELnCOPY
DIJAN
T a T r D Office Use Only
u LC // O
Pauut# . —6 3— U
2 1 2003 y��Fees— /�l� �D Permit erpees 6 momf sfrom
-issue date.
Y
EXPRESS BUILDING PERMIT APPLICATION
TOWN OF YARMOUTH
Yarmouth Building Department
1146 Route.28
South Yarmouth, MA 02664
(508) 398-2231 Ext_ 261
f-ocl )CY S rrnaufLi, i�R
ASSESSOR'S INFORMATION:
Parcel: �G
CONTRACTOR:
NAME MAMING ADDRESS TEL.#
ZF.csidential
❑ Commercial Eat Cost of Construction E 0 boo t rt Q l C
0
Home Improvement Contractor 1= # Construction Supervisor Lic. #
Workma is Compensation Insurance: (check one)
Xl am the homeowner O I am the sole proprietor ❑ I have Worker's Compensation Lcsurm¢e
Insurance Company Name: Worker's Comp. Policyll
WORK TO BE PERFORMED
❑ Tent (Fire Retardant Certifimmsamchedl
Una ton
❑Siding: #ofSqums, 2:
❑ Replacement window.. # 1L ❑ Replacemen doors: #
❑Re -roof #of Squares ad
tx'Strippingold'sshiilmles* (}going over layers ofadstinguroof
'The debris will be disposed ofat -.M pet_
Location of Facility
I declare under penalties Ofpegmy that the statements herein contained=true and currect mthe best afmy knowledge and belief I mudersdnd that any false answer(s)
will bejust cause for denial or revocation of my license and for prosecution under M.G.L. Cb. 268, Section 1.
Applicant's Signature:
Owners Signature (m
Date ,IAz� 3
Approved By' Date:
Budding Official (or designee)
Zoning District: FEU &f�
Historical District kYes J�,_No flood Plain Zone: C Yes ❑ No
Water Resource Protection District: WitMn,���100 R of Wetlands:
`-Yes G No }a_es C No
VOI
RILE GGPY
C.;t;�i t. 2003
BY
r
320 I
K _
TOP COASTAL 6 o" ROCK
o.
DECKppea ui „�l %.,/WALL
0
2 STORY
GARAGE EXIST. DWFLLING
�o
LOT 23PARmoo. a
EL 164
0.69 CACRESt L60 s
4 �1
dlU� R���4?• �s.
� O8
pC+f
4pwo
JOB # 94-310
FOUNDATION PL 0 T PLAN
FOR THE PURPOSE OF OBTAINING A BUILDING PERMIT ONLY
LOCATION : 200 BLUE ROCK ROAD SOUTH YARMOUTH, MA
SCALE : 1" = 50' DATE : JUNE 23, 2003 PREPARED FOR:
REFERENCE ; LOT 23 LCP 28477B
ASSESSOR'S MAP 101 PARCEL 164 MARK UPPENDAHL
I HEREBY CERTIFY THAT THE STRUCTURE
SHOWN ON THIS PLAN IS LOCATED ON THE p��NOF�fIu"`�
GROUND AS SHOWN HEREON. �� ill",OTHY
an sae—sez�e+t yL L,17
tQ eoe 36z-seeo = COVC-LL -i i>
wn cape engineering, me CIVIL ENGMEERS---
LAND SURVEYORS DATE RE .` D=;�SORVEYOR
939 main sL yamouth• ma 02675
'PHILBROOK
E1-50NGINEERING & 076EACHSTREET
CONSTRUCTION DENNIS,MA 688
> 1-508-385-8-8682
\`ENGINEERING DESIGN • CONSTRUCTION INSPECTIONS • BUILDING, ALTERATIONS 8 RENOVATIONS
17 April 2003
To: Town of Yarmouth
Attn: Mr. James Brandolini
Building Commissioner
South Yarmouth, Massachusetts 02664
Reference: Slab Footing Inspection — Reference Letter Dated 7 April 2003
UPPENDAHL Residential Covered Entry
200 Blue Rock Road, South Yarmouth, MA
Dear Sir:
Previous site conditions remain unchanged. The proposed entryway will be constructed as a porte-de-
chere (flat roof with ornamental 18"-24" ballistrade). This structure remains a non -habitable covered
entryway At the owner's discretion 2 or 4 or more columns can be installed however the original design
requirements remain; a minimum of 2 are to be load bearing and 2 (at the comers if square or at the
1/3(+/-) points if an arc) are to be connected for uplift restraint. Loading remains essentially unchanged
as previously snow on a pitched roof less than 7/12 was taken to govern; 25 Ib/sq ft. Dead loads will be
slightly reduced as the roof is the ceiling in the new structure vs. a roof and ceiling in the gable assembly
>Q3.OS
Respectfully submitted,
Ii 1� qc
��ilNtAti S, moo_ T. H
VAFHUM yN�
i� PIL ANI
EC qN, H
T. VARNUM PHILBROOK, P.E. M30u90
�1
PHILBROOK
ENGINEERING &
CONSTRUCTION
:SIGN • CONSTRUCTION INSPECTIONS
To: Town of Yarmouth
Attn: Mr. James Brandolini
Building Commissioner
South Yarmouth, Massachusetts 02664
107 BEACH STREET
DENNIS, MA 02638
1-508-385-8682
BUILDING, ALTERATIONS 8 RENOVATIONS
7 April 2003
Reference: Slab Footing Inspection
UPPENDAHL Residential Covered Entry
200 Blue Rock Road, South Yarmouth, MA
Dear Sir:
i; APR 1 5 2003
ICY
I conducted an investigation of the in -situ soils and site conditions at the above address on 28 MAR
2002. The purpose of this letter is to present conditions per Para. H 5.1 of the State Building Code (6th
ed). In accordance with Para. 1804.1 of the State Building Code this letter shall serve as documentation
for the suitability of the soils and reduced depth foundation at this site to support the proposed new
covered entryway. Presently there is a large semi -circular brick veneer front step. The step is about 30
years old, sound and in reasonably good condition. In order to determine the condition and depth of the
concrete base an excavation was dug on one side and two holes were drilled with a rotary hammer -drill.
Observations:
• The base slab edge is continuous concrete and extends below grade about 16"
• The two holes drilled through solid masonry then concrete for a depth in excess of 16"
• The following soils determination was made:
USCS Type Classified - SP Medium -Coarse Sand (Non -frost susceptible)
State Building Code Material Class — 8
Soil Bearing (allow) - 3,000 lb/sq It
Commentary- The spread slab footing will support a non -habitable covered entryway; 2 faux -marble
round columns and a gable peaked roof. The structure will cover less than 100 sq ft and the surrounding
grades are favorably pitched away from the front step. As such this base will safely support the proposed
construction and provide a bearing factor of safety in excess of 2.4. Uplift attachment is more of a
concern. Some form of positive attachment anchored to the step with a capacity in excess of 600 Ibs is
required at both column bases. 3/8" dia. SS aircraft cable threaded thru embedded eye -bolts and made
captive to the framed roof plates would suffice.
-Wo3o-la
Respectfully submitted, r
zNOFnaqs
�o�T VARNUM PHILBROOK, P.E. A
6-3
PERMIT 375
LOT 164 (X23)
Uppendahl, Mark
200 Blue Rock Road
South Yarmouth, MA 02664
Screened porch, deck, 2 baths
SHEET 101 (90)
6/1/99
6/1/99-
7-,2-7f
$10,000.00
D t
TOWN OF YARMOUTH
Application for a Permit to Build o. 315
Q� D/� .gyp X .23
UPON FINAL APPROVAL Q � `� MAP 101 LOT 1 &q
FEE MUST ACCOMPANY THIS APPLICATION. DATE Ad 19��—
The undersigned hereby applies for a permit to build 7 %%
according to the following specifications pO 1. Name of property owner 44A-4Y- Il��r' N'7k f♦t i Tel. ''"
Address 2,-» Fz,,✓�E eoCy- �o
2. Name of Architect (if any) Tel.
3.Nameofbuilder AiA'w-y— C'E''`f"Ll Address i7-1 J 1AW i� 6,
4. License No. DS") I?i h Tel. !F47g{22,1
w• �rvas
5. Name of Mason Address
6. License No. Tel.
7. Construction address Zvn )Sy
Flood C District (� 6
8. Date of subdivision Approval plain zoneZone -
9. Private dwelling C' Estimated Cost p DO NC, WRITE IN THIS SPACE
10. Multifamily Eltp �rtsp`� 7o•oo Type of room No.
yes 5//�99
11. Commercial ❑ �+�'�` `�/�"" Kitchen
12.Other ❑ ',«i c� o� D rc�i S6� Dining Rm.
� ��1..' / Living Rm.
13. No. of stories 2 �� C4K 3
a�/if 7 � � ° Bed Rm. �..
14. Foundation — Full ❑ Half ❑ Crawl El Slab ElBath
15. Materials— Wood ❑ Cement ❑ Other ❑ z_- Deck
16. Type of heat — Oil ❑ Gas ❑ Electric ❑ Other ❑ P �U d cJ Closed porch
Dr 17. Garage — 1 El ❑ Family Rm.
�5 CIO Garage
Sun room
18. Swimming pool - Size Garage
19. Storage shed — Size Shed
20. Stove — Wood ❑ Coal ❑ 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 Rear
24. Distance back from line or street From rear lot line Side line
25. H.I.C.R. No. 12a37&
LOT RELEASED BY Signature
PLANNING BOARD Address �`%
Date 8
BUILDING PERMIT APPLICATION SIGN OFF
APPLICANT: JAAQK CLAYN BUILDING QPEERMIT #:
ADDRESS: 1Zt_T r)lAlJ Porno Rb TELE. NO.: 3gq-o2�2L% DATE FILED: ZI(I S(4
BLDG. SITE LOCATION: �CD fi4a dY/IJ, MAP#:—l6I LOT#: J&L4
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:
RESIDENTIAL AND/OR COMMERCIAL BUILDING
WATER DEPARTMENT: DETERMINES COMPLIANCE OF WATER AVAILABILITY.
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, MARSH
LAND, ETC.
HEALTH DEPARTMENT: DETERMINES COMPLIANCE TO STATE AND TOWN REGULATIONS, I.E.: REQUIRE-
MENTS FOR SEPTAGE DISPOSAL AND OTHER PUBLIC HEALTH ACTIVITIES.
FIRE DEPARTMENT: DETERMINES COMPLIANCE TO STATE AND TOWN REQUIRElMENTS FOR PERSONAL
SAFETY, PROPERTY PROTECTION, I.E., SMOKE DETECTORS, SPRINKLER SYSTEMS,
ETC.
THE FOLLOWING DEPARTMENTS MUST SIGN OFF, IN THE RESPECTIVE
ORDER, PRIOR TO BUILDING INSPECTOR
ISSUING THE REQUIRED BUILDING PERMIT:
REVIEWED BY:
I. WATER DEPARTMENT
DATE:
N/A:
2. ENGINEERING DEPARTMENT,
DATE:
N/A:
3. CONSERVATION•
DATE:
N/A:
4. HEALTH DEPARTMENT
DATE:
-
L�- IIw N/A:
4
INDUSTRIAL AND/
COMMERCIAL
PERMITS
5. WIRING INSPECTOR:
DATE:
N/A:
6. PLUMBING INSPECTOR:
DATE:
N/A:
7. FIRE DEPARTMENT:
DATE:
N/A:
PLEASE NOTE
ALL STUMPS AND/OR BRUSH MUST BE DISPOSED OF AT AN APPROVED SITE. A SIGNED RECEIPT FROM THE
DISPOSAL SITE MUST BE SUBMITTED TO THE BUILDING DEPARTMENT PRIOR TO ISSUANCE OF THE BUILDING
PERMIT.
COMMENTS:
LOT NO.: ADDRESS: Z(,
OWNERS NAME: (�i�V nm t�CrT)e(0, uI
- lyrfcto
SE14AGE PERMIT NO.: y(69_NEW:_REPAIR:—L
DATE ISSUED:DATE INSTALLED:
i
INSTALLERS NAME: (:4c qQ-((
INSTALLATION OF: ��pai n. S c Fs,ter(-
i
WATER TABLE: FINAL INSPECTION BY:
DRAWING OF INSTALLATION ON REVERSE SIDE:
v toW
BUILDING DEPARTMENT
CONSTRUCTION SUPERVISOR FORM
PLEASE PRINT:
JOB LOCATION: -
NUMBER STREET VILLAGE
OWNER OF PROPERTY: �PPI:rvoA41-
CONSTRUCTION SUPERVISOR: 64kz'k- AT G-YM1Il.�I b'51 F S q D2,21
NAME LLICENSE NO. PHONE N0.
ADDRESS: I" Oid-4 17Y 9)VJ Vr(YNIS MA- D2 -70
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 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 REGLZTIONS 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 NUMBER 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 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.
I HAVE READ AND UNDERSTAND MY RESPONSIBILITIES UNDER THE RULES AND REGULATIONS FOR LICENSING CON-
STRUCTION SUPERVISORS IN ACCORDANCE WITH SECTION 109.1.1 OF THE STATE BUILDING CODE. I UNDERST.'::,:
THE CONSTRUCTION INSPECTION PROCEDURES AND THE SPECIFIC INSPECTION AS CALLED FOR BY THE BUILDING
OFFICIAL.
INSVAANCE ERACE:
I have a curve liability insurance policy or i!s substantial equivalent which meets the requirements of MGL�Ch.152
Yes No ❑
If you have checked ves, pleasindicateindicate the type c average by checking the ap.rcpriate box.
A liability insurance pc:icy G Other type of .idemnity ❑ Bond ❑
OWNER'S INSURANCE AVER: I am aware that the licensee does not have the Insurance coverage. required ty
Chapter 1 20 ais. eneral Laws, ana that my signature on ta:s permit ccplication wanes this requiremect.
/ Check one:
Owner) Agent 12__�
Signature of ner or Owners Agent
SIGNATURE: BUILDING OFFICIAL APPROVAL:
PLOT PLAN
Abuttor's
Name
Lot #r
�Y
If this is a
corner lot, ;el
write in name
of street.
FOR LOT # X
Indicate location of garage or accessory building
Additions with dashed lines --------------------
Sewerage disposal (cesspool) ED
Well g
SIDE YARD
0— I!L FT_ 0
(Iot.4:Y........ ft. rear)
REAR YARD
....... ....ft.
SIDE YARD
a _ _ 2v FT*{
SET -BACK
...�.�D .ft.
(lot.....✓(4�.........ft. frontage)
i/Ia ktr— &40
(NAME OF STREET)
Abuttor' s
Name
Lot #
jr$7 /' E4—
If this is
corner lo-
write in
name of
CL
other
street.
AO�
Information �y- 6 _ m4
Supplied by �t6Vt�� —
MARK NORTH POINT
Suggested Affidavit for Home Improvement Contractor Permit Application
For omce use only NAME OF CrrY/rOWN
Perralt No.
MGLQ
Type of
AFFIDAVIT
Home Improvement Contractor Iaw
Supplement to Permit Application
be done by registered mntracton, with certain mmi lion, along with other
Cost 10. OM
Address of Work p ZoD �7WE teaLt[- tin 4 / AL- OZ66Y
(Tuner Name: /V I"le- An'9 ISA rV 120 rV 04-di=
Date of Permit Application: It
I hereby certify that:
Registration is not required for the following reason(s):
_Work excluded by law
_Job under S1,000
_Building not owner•occupicd
_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 132A.
Signed under penalties of perjury:
I hereby apply for a permit as the agent of the owner:
.4 110'�A-"� A . l'� t4 Mu f 12237
Da Contractor Name Registration No.
OR:
Notwithstanding the above notice, 1 hereby apply for a permit as the owner of the above property:
Date Owner Name
The Commonwealth of Massachusetts
Department of Industrial Accidents
x - OlOceel/srestlp�tlns
600 Washington Street
Boston, Mass. 02111
" Workers' Compensation Insurance Affidavit
Ap.plicant i,.e rmilb n pleasemllgT'Tga
cm VVOjnLAI It MA- O7-610 phone # 50'S ??-lq=
0 1 am a homeowner periorming all work myself.
❑ I am a sole proprietor and have no one working in any capacity
26am an employer pros iding workers compensation for my employees working on thisjob.
address,
city,shone p• �1 l/ -
ins rnnce co �i�shv/�Lt"�S policy
I am a sole proprietor. general contractor or homeowner (circle one) and have hired the contractors listed below who ha%e
the follow ing workers compensation polices:
company n
city, hone #•
insurnnee co policy#
in n
Failure to secure coverage as required under Section 25A of MGL 152 an lead to the imposition of eriminai penalties on one op m apuu.w ana,er
one years' Imprisonment as well as civil penalties to the form of a STOP WORK ORDER and a fine of gI00.00 a day against me. 1 ondersaad that s
copy of this statement maybe fornaded to the Office of Investigations of the DIA for coverage veriReados.
I do hereby certify
Print name
that the information provided above is true and comes.
nine I•-F•�
officialuse only do not ss tint in this arcs to M completed by city or town official
city or town: YARMOUT11 permWiceose# mBuilding Department
❑Licensing Board
p check if immediate response is required 261 Oselectmen's Office
�Ilealth Department
contact person: phone#:_ (508) 398-2231 eat. r•IOther
lr .,W ley Plel
Information and Instructions
Massachusetts General Laws chapter I52 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 enrpint'er is defined as an individual. partnership, association. corporation or other legal entity, or any moor more of
the foregoing en_aged in a joint enterprise. and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual I. partnership, association or other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer
%IGI_ chapter I;'_ section 25 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 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 authoritv
Applicants
Please till in the workers' compensation affidavit completely, by checking the box that applies to your situation and
supplcing company names. address and phone numbers as all affidavits mac be submitted to the Department of
Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The
affidavit should be returned to the city or town that the application for the permit or license is being requested.
not the Department of Industrial Accidents. Should you have any questions regarding the' law" or if you are required
to obtain a workers' compensation policy, please call the Department at the number listed below
City or Towns
Please be sure that the affidavit is complete and printed legibly The Department has provided a space at the bottom of
the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please
be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to
the Department by mail or FAX unless other arrangements have been made.
The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address, telephone and fax number.
The Commonwealth Of Massachusetts
Department of Industrial Accidents
$MCC of IMSURRUI RS
600 Washington Street
Boston, Ma. 02111
fax #: (617) 727-7749
phone #: (617) 727.4900 ext. 406, 409 or 375
Massachusetts Department of Environmental Protection Town of Yarmouth Wetland By -Law
Bureau o1 Resource Protection — Wetlands Chapter 143
WPA Form 2 - Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
0 General Information
From: 3. Title and Rnal Revision Date of Plans and Other Documents:
Yarmouth Conservation
cavenzion Canntcvu, Commission
1. Applicant
Mark & Joan Uppendahl
hb=GfPWWAUtVR&),"
200 Blue Rock Rd.
MIdripAMM
South Yarmouth
cl y/rw
MA 02664
SUN ip Cade
2. Property Owner.
NO aRmomyOmwRrdravtatatvo /e U
olyIn-
Sae
t Determination
Pursuant to the authority of M.G.L c. 131, §40, the
Yarmouth Conservation Commission
canenaWO C&ffly a+
has considered your Request for a Determination of
Applicability, with its supporting documentation, and has
made the following Determination regarding:
200 Blue Rock Rd.
S"d Addrtn
South Yarmouth, MA 02664
Wy/rtte Lp Coh
new•101 164
AvnssatAr*ft Pow4ar
Rev.10/98 Page 1 of 4
oeP
Massachuseftf Department of Environmental Protection Town of Yarmouth Welland By -Law
Bureau of Resource Protection — Wetlands Chapter 143
WPA Form 2 - Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
U Determination (conL)
The following Determination(s) istare applicable to the
proposed she 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 Intend) has been received from the
issuing authority (i.e., conservation commission or the
Department of Environmental Protection).
1. The area described on the plan(s) referenced above,
which includes all or part of the area described in the
Request, is an area subject to protection under the Aft
Therefore, any removing, filling, dredging, oraftering of
that area requires the filing of a Notice of Intent.
7 2. The delineations of the boundaries of the resource
areas listed directly below, described on the plan(s)
referenced above, which includes all or part of the area
described in the Request, 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 Determina-
tion is valid. However, the boundaries of resource areas not
listed directly above are DM confirmed by this Determina-
tion, 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 plan(s) and document(s)
referenced above, which includes all or part of the work
described in the Request, 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 plan(s) and documents)
referenced above, which includes all or part of the work
described in the Request, is within the Buffer Zone and will
after an Area subject to protection under the Act Therefore,
said work requires the filing of a Notice of Intent
❑ S. The area and/or work described on plan(s) and
daCement(s) referenced above, which Includes all or part of
the work described in the Request, is subject to review and
approval by
N" aMwociW1rlr
pursuant to the following wetlands law, bylaw, or ordinance
(name and citation of law).
❑ 6. The following area and/or work, it any, is subject to
municipal bylaw but pgt subject to the Massachusetts
Wetlands Protection Act:
Z: 7 It a Notice of Intent is filed for the work in the Riverfront
Area described on plans and documents referenced above.
which includes all or part of the work described in the
Request, the applicant must consider the following
alternatives (Refer to the Wetlands Regulations at
10.58(4)c. for more Information about the scope of
alternative requirements)
❑ Ahematives 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.
C 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.
Rev.1098 Page 2 of 4
MassachesettsDepaftmerrto/Environmental Protection Town of Yarmouth Wetland By -Law
Bureau of Resource Protection — Wetlands Chapter 143
WPA Form 2 - Determination of Applicability
t Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
t Determination (conL)
Negative Determination
Note: No further action under the Wetlands Protection Act
is required by the applicant However, if the Department of
Environmental Protection is requested to Issue a Supersed-
ing 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 Depart-
ment. 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 Act or 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 after 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 after an
Area subject to protection under the Act. Therefore, said
work does not require the filing of a Notice of Intent
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 AcL
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 regulations, no Notice of Intent is required:
Earmp(AWAY
6. The area and/or work described in the Request is not
subject to review and approval by
AhmeotMonldpal),
pursuant to a municipal wetlands law, ordinance, or bylaw,
(name and citation of bylaw).
* SEE CONDITIONS ON SEPERATE
SHEET.
Authorization This Determination must be si ned b a m ' ' f th
This Determination is issued to the applicant and delivered
as follows:
:1 by hand delivery on
DO
2 by certified mail, return receipt requested on
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.
g y alorrty of
conservation commission. A copy must be sent to the
appropriate Department of Environmental Protection
regional office (see appendix A) and the property owner (it
different from the applicant).
April 1, 1999
Rev. 1098 age
Page 3 0l 4
DETERMINATION OF APPLICABMM
SPECIAL CONDITIONS
MARK UPPENDAHL
1. Roof run off shall be handled by downspouts and drywells.
2. The Conservation Administrator shall review proposed walls with contractor prior to
construction.
DEP
Massachusetts Department of Environmental Protection Town of Yarmouth Wetland By -Law
Bureau of Resource Protection — Wetlands Chapter 143
WPA Form 2 - Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
U Appeals
The applicant, owner, any person aggrieved by this Determina-
tion, 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 to issue a Superseding Determina-
tion of Applicability. The request must be made by certified
mall 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 it 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 bylaw.
and not on the Massachusetts Wetlands Protection Act or
regulations, the Department of Environmental Protection has no
appellate Jurisdiction.
Rev. 108 Page 4 of 4
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TOWN OF YARMOUTH
BOARD OF APPEALS
YARMOUTH
TOWN CLERK
T
APPLICATION FOR HEARING 20M DEC 2D PH � 51RECENEDAHearing Date: 1 Ia 02. Fee$ 6 %• A
d/b/a)
(Address) (zip) ,(Telephone Nmnber)
and is the (check one) K Owner ❑ Tenant ❑ Prospective Buyer ❑ Other Interested Party _ D
Property: This a plication relates to the property located at: — bo K�Li( �1041
S )/aem r j &1191 which is also shown on the new Assessor's Map:
as Parcel: (old Map & Lot #) i?0 X 3 Zoning District: RVA
Project: The applicant seeks permission to undertake the following construction/use/activity :(give a brief
description of the project. i.e.: "add a 10' by I S' deck to the front of our house" or "change the use of the existing
building on the property"): %b ex__n�.i n —t PXi s finny /!N a2�it�iea�
RELIEF REQUESTED: The applicant seeks the following relief from the Board of Appeals:
1)_REVERSE THE DECISION OF THE BUILDING INSPECTOR OR THE ZONING
ADMINISTRATOR dated (attach a copy of the decision appealed from). State the reason for
reversal and the ruling which you request the Board to make.
2)_SPECIAL PERMIT under § /bti 3• A ( 9L of the Yarmouth Zoning By-law and/or for a use
authorized upon Special Permit in the "Use Regulation Schedule" §202.5 41— ,- _5�!,_• •
3) VARIANCE from the Yarmouth Zoning By-law. Specify all sections of the by-law from which relief is
requested, and, as to each section, specify the relief sought:
Section:
Relief sought:
Section:
Relief sought:
Section:
Relief sought:
ADDITIONAL INFORMATION: Please use the space below to provide any additional information which
you feel should be included in your application:
FACT SHEET
Owner of Property (if other than applicant) 14 m e.
(Full Name)
(Telephone Number)
How long has the owner had title to the above premises: /3 Ve rS
(Give title reference if available)
Use Classification: Existing: J(i f bit §202.5 # .
Proposed: n�0_ §202.5 #
Is the property vacant: JU0 How long has it been vacant:
Lot Information (if available) Area: • toq dereS Subdivision/Plan Reference: /
Is this property within the Aquifer Protection Overlay District: Yes No .
Other Department(s) Reviewing Project: Indicate the other Town Departments which are/ have/ or will review
this project, and indicate the status of their review process:
Repetitive Petition: Is this a re -application: A/0 If yes, do you have Planning Board Approval:
Prior Relief. If the property in question has been the subject of prior application to the Board of Appeals or Zoning
Administrator, indicate the Appeal number(s) and other available information:
Building Commissioner Comments:
Applicant's Si e/Attorney Signature Owner's Signature
Address:
Site Plan Review
`7 - />_ 5 o/ Required Completed
ding Commissioner Signature ❑ Yes ❑ No ❑ Yes ❑ No
Application.wpd
Property Location: 200 BLUE ROCK RD
Kbion ID: 13654
MAP ID: 101/ 164/ / /
Other ID: 901 X023/ / / Bldg 8: 1 Card 1 of 1 Print Date. 12202001 15:40
AAssessed
PENDAHL, SOAN M
00 BLUE ROCK RD
YARMOUTH, MA 02664
scnpnon
code
Appraised Value
a ue
15
YARhIO8 U
UTH, A1A
ESIDNTL
1013
196,600
196,600
wun
ubdivision 241
kata
and
recinct
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VISION
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201
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196,600
0001013
142,100
0 a
oa:
o
ul
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ear
yp scn➢uon
Amount
o e
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um er
Antolini
Conin, n.
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:
194,000
2,600
0
211,900
408,500
409,500
Cost/Market Valuation
a a :
10 RMS INCL 1 IN FBM
0241
�et I otal AppraisedParcel Value
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ermu
esue We
ype
Description
Anuntill I
Imp. Date
omp.
ate omp,
ommcnts
Date
Furposelliesudl
esr eo a
7/26/95
RD
10
essur ist
leasu/LtrSnt Letter Se
IN
Xv
Use code
Description
ne
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actor
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ores- pecm Hang
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Property Location: 200 BLUE ROCK RD MAPID: 101/ 164/ / /
Vision ID: 13654 Other ID: 90/ X023/ / / Bldg #. 1 Card 1 of 1 Print Date: 12/20/2001 15
Stories
Wall 1
2
Floor 1
2
ling Type
IS
of Water
Type
A
one
rooms
13
Bedrooms
rooms
1.5
1/2 Bathrm
d Rooms
to
0Rooms
t Type
2
odern
hen Style
2
odern
FPO EXTRA FPI, OPEN
Finished
en. Finished
Ownership
nadj. Base Rate
60.00
ize Adj. Factor
0.90201
:irade
1.27
dj. Base Rate
68.73
Idg. Value New
269,490
ear Built
1962
R. Year Built
1972
and Physcl Dep
28
uncnl Obslnc
0
Bcon Obslnc
0
Sped. Cond. Code
Sped Cond %
Overall %Cond.
72
Deprec. Bldg Value 1194,000
19721 11 100
BAS
WDK UBM
FSP 28
6 14
WDK 3
8 FUS
BBAS
FBM
4
FGR
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type)
TOWN OF YARMOUTH, MA 02664 Date D Z Z 1g1L �tPeermit # V,3 b
Building Location20C) R�WE (0oc � {�,� Owner's NameC-r-k0196 UpID
Type Of Occupancy. �e5 r e,,,, ,
New ❑
Renovation IK� Replacement ❑ Plans Submitted: Yes M- No ❑
FIXTURES
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SUB—OSMT.
BASEMENT
1ST FLOOR
2ND FLOOR
aRD FLOOR
4TH FLOOR
STH FLOOR
6TEFLOOR
7TOOR
6TH FLOOR
Installing Company Name Sherman Plumbing Services Corp.
Address 24-U Uommonwealtn Ave.
Business Telephone
Name of Licensed Plumber
Check one: Certificate
❑ Corporation
❑ Partnership
❑ Finn/Co.
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 Aoent Owner ❑ Agent ❑
"'J ' -, d, ono imormauon r nave submitted for entered) in above application are true and accurate to the best of my
and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all
pvisions of the Massachusetts State Plumb'n Code and Chapter 1 eneral Laws.
4117 ,i��ti�
Signature of Licensed Plumber
City/Town Type of License: Master ®. Journeyman ❑
APPROVED OFFICE USE ONLY) License Number a ^2—C7,5—
i
BELOW FOR OFFICE USE ONLY
R
SKETCHES _ PROGRESS INSPECTIONS
FINAL INSPECTIONS LL
FEE`-J
N0.
APPLICATION FOR PERMIT TO DO PLUMBING
5�-- Fy
NAME & TYPE OF BUILDING 1
�%•r� UD�e.,.cic-1n1
LOCATION OF BUILDING 11
2.00 I v e, {%oc. i2d
PLUMBER
SeCv;r .s C,ocL�.
PERMIT GRANTED
DATE 19
Jnm LO lb99
PLUMBING INSPECTOR
. @office
Town of Yarmouth No. 338
PLUMBING PERMIT
of the Plumbing Ipspector, South Yq/r;nou/th 0A1 19 9
This is to Certify that
has permission to
for
in building on
in accordance with an application on file in this office, and subject to the provisions of the
Ordinances relating to the State Plumbing Code in the Town of Yarmouth.
Fee $ _S5. - F/ X
Plumbing Inspector
NOTES:
1. ELEVATION FROM RM 9 (NGVD)
2. FLOOOZONE A5 EL 6 & C (HOUSE IS IN C)
(FIRM 250015-0002 D. REV. 7/2/92)
3. ASSESSORS MAP 101 PARCEL 164
4. ZONING: R-40 (FRONT: 30', SIDE, 20')
5. ROOF RUN-OFF TO BE DIRECTED TO DRYWELLS
KEY.
C
GUY WIRE
UTIL POLE
i J
TREE
LIGHT POST
+11.2
SPOT ELEV.
PARCEL 163
BLUE ROCK HEIGHTS
ASSOC.
+;"
DRIVE/PARKING
WOOOCHIPS
TRANSECT
4
P
' -CY' aT
Q'
s TRANSECT
TRANSECT
.
Jr�T
1al STORY SCREENED
00PORCH
W/DECK OVER
z)+iu
TOP COASTAL B'-
u - ins
I DECK
PROP
ADDITI
/LOT 23
sl�u
aH. 506-362-I541
fax 506-362-9680
down cape engineering, inc.
CIVIL ENGINEERS
LAND SURVEYORS
939 main St. Yarmouth, ma 02675
EXIST. ST
o°2 12" TREE
�34
pep=,,,7s{
Rpga �„ ff„
CATCH BASIN
ELEV 10.8'
EXIST 2 STORY
GARAGE EXIST. DWELLING
N
/ 13'
\ PROP. PORTICO J .y
PARCEL 164
P,r. iD�+ 0.69 AC
\ kl'
ARNE H.
ARNE
H.
OJALA
PATRICIA J.ARCEL CEDE165
RIC GRENIER TR
19, a.00
PLS DATE
PROP. SUNROOM
FLOODZCNE EL 6
(TOP COASTAL BANK)
SITE PLAN
LOCATION YAP NTS
OF #200 BLUE ROCK ROAD
IN THE //TOWN OF:
PREPARED
SOUTH) VARMO UTH
MARK UPPENDAHL
30 0 30 60
90
SCALE: 1' v 30' DATE: DECEMBER 19. 2001
NOTES.
1 ELEVATION FROM RM GVD )
FLOOZOUE �C3—EC 6 & C_M EIS IN C_�
i(FIRM_250015-0002 D,,,,REV..,�7/2/9.222)
3. ASSESSORS MAP 101 PARCEL 164
4 ZONING. R-40 (FRONT: 30', SIDE, 20')
5. ROOF RUN—OFF TO BE DIRECTED TO DRYWELLS
KEY:
C GUY WIRE
rCl. UTIL POLE
{ TREE
LIGHT POST
+11.2 SPOT ELEV.
PARCEL 163
BLUE ROCK HEIGHTS
ASSOC.
LOT 23
Q FL\
(APPROX.
az 1� /3 vga @e
Off. 508-362-4541 ocFp 4,�s�,� I.
fa. 505-362-9580 e(�e glg•,NF =lua
do
wn cape engineering, inc. Rp�k NT 2 E
CIVIL ENGINEERS LAND SURVEYORS
BENCHMARK
939 main St. yarmouth, ma 02675 CATCH BASIN
ELEV 10.8'
94-310
TRANSECT
+x'•e z•
, fpOE
• •.OF x)
N ,s
TRANSE}CT
+In,
u
r1li,Ys
,I�a •' EXIST
+,z.• I, GARAGE
+10.1
p*,xs
+, a
EXIST. ST
12" TREE
(D.,
EXIST. DWELL.
TRANSECT
3v 2.4
34 -+•z
10
i m
X ss
m
n
� COASTAL BPNK,_ rq•_'_
L
DECK
2 STOEXIST D
PARCEL 164
{ Js 0.69 AC
BULKHEAD DETAIL
1"=15,
1st STORY SCREENED
PORCH W/DECK OVER
O EXIST. ROCK
WALL
EXIST
BRICK
LOCATION MAP NTS
a 'o
PROP 6.3'x 5.3'
BULKHEAD
(SEE DETAIL ABOVE)
PROP SUNROOM
PARCEL 165
PATRICIA J. CEDERIC GRENIER TR
ARNE H. OJALA, PE, PLS
S "
FLOOOZONE EL. 6
(TOP COASTAL BANK)
SITE PLAN
OF ##200 BLUE ROCK ROAD
IN THE TOWN OF-
PREPA(o O UTH) YARMO UTH
MARK UPPENDAHL
30 0 30 60 90
- )s3 SCALE: DATE: = 1" 30' E: DECEMBER 19, 2001
DATE REV. 1/14/03 (BH)
NOTES.
1 ELEVATION FROM RM 9 (NGVD)
2. FLOODZONE A5 EL 6 & C (HOUSE IS IN C)
(FIRM 250015-0002 D, REV 7/2/92)
3. ASSESSORS MAP 101 PARCEL 164
4 ZONING. R-40 (FRONT. 30'. SIDE, 20')
5. ROOF RUN-OFF TO BE DIRECTED TO DRYWELLS
KEY:
C
GUY WIRE
eO�
UTIL POLE
{/
TREE
C*
LIGHT POST
+11.2
SPOT ELEV.
off. 508-362-4541
faz SOB-362-91189880
down cape engineering, inc.
ACIVIL ENGINEERS
VLAND SURVEYORS
939 main St. yarmouth, ma 02675
PARCEL 163
BLUE ROCK HEIGHTS
ASSOC.
DRIVE/PARKING
WOODCHIPS
T 93
Ot+lll(t�
9(Ve 12',1feNT� ,,
ROCk 5
ROq�
CATCH BASIN
ELEV 10.8'
TRANSECT
4ia
fOCe
z. _.
.,4c
nT
IL
`y
TRANSECT
23
+9i p1
SY+3
n
Y3T
n
7.7
+inl a
00
•3+IM
fI
Gi 3
}Icy c .
.........
-_. -_.__.
/ N
FUA
EXIST
'mac
I GARAGE
+U., ,
qv.:. 9 X-
o;
EXIST. SEPTIC
102 LEACHING AREA
(APPROX. AREA)
+Ia
+138/
EXIST. ST
12" TREE
(,DP,411.3
EXIST DWELL.
TRANSECT
DECK
2 STORY
WE
EXIST DLUNG
PARCEL 164
( Ja 0.69 AC
BULKHEAD DETAIL
1"=15'
1st STORY SCREENED
PORCH W/DECK OVER
PARCEL 165
EXIST. ROCK
PROP SUNROOM
LOCAnOH MAP NTS
FLOODZONE EL.'6
(TOP COASTAL BANK)
0 2003 ( �
B.S. 5.3'
AD
:TAIL
SITE PLAN
OF #200 BLUE ROCK ROAD
PATRICIA J. CEDERIC GRENIER TR IN THE TOWN OF:
PREPARED
(SOUTH) YARMO UTH
MARK UPPENDAHL
30 0 30 60 90
/ SCALE. 1" = 30• DATE DECEMBER 19, 2001
DATE REV. 1/14/03 (BH)
NOTES.
1 ELEVATION FROM RM 9
(NGVD)
2. FLOODZONE A5 EL 6 Sc
C (HOUSE IS IN C)
(FIRM 250015-0002 D.
REV 7/2/92)
3. ASSESSORS MAP 101 PARCEL
164
4 ZONING. R-40 (FRONT.
30', SIDE, 20')
5. ROOF RUN—OFF TO BE
DIRECTED TO DRYWELLS
KEY:
C GUY WIRE
TRANSECT
`Tv UTIL POLE
2.4
+�
{ TREE
PARCEL 163
Z'9;- xT
Ca LIGHT POST
BLUE ROCK HEIGHTS
`�'.o
+11.2 SPOT ELEV.
ASSOC.
+9.
TRANSECT
.3 2
'#02
nYar-_.
n
zT
•
9
'+1a4
c
;L
CID"
G13 _.__._
_
r7
tii5 DRIVE/PARKING '
ce
14B
WOODCHIPS
1 �
I .FNA
W ,MSi I
Exlsr
1
M.e 1�
GARAGE
+Ix4
%
A•2:Y- t*135
��
.X(}T'
i411.3
LOT 23 40 •'
0
-EXIST. SEPTIC
EXIST. S7
440A LEACHING AREA
p / (APPROX. AREA)
Off. 508-362-4541
fax 508-362-9880
down cape engineering, inc.
CIVIL ENGINEERS
LAND SURVEYORS
939 main St. yarmouth, ma 02675
94-310
I j4 12" TREE
734 Z 0t�a (J.3
f p {
e4Cle A�f',(jt:NTu3
Rpq� �4w ff+1
EXIST. DWELL.
TRANSECT
DECK
2 STORY
EXIST DWELLING
PARCEL 164
{ J.s 0.69 AC
BULKHEAD DETAIL
1"=15,
1st STORY SCREENED
PORCH W/DECK OVER
EXIST. ROCK
O. PROP 6.3'x 5.3'
BULKHEAD
(SEE DETAIL ABOVE)
PROP SUNROOM
LOCAnON MAP NTS
/ &1V
FLOODZONE EL. 6 'r
(TOP COASTAL BANK)
bl-
� M0!R 0 2003
SITE PLAN
OF #200 BLUE ROCK ROAD
IN THE TOWN OF:
(SOUTH) YARMO UTH
PREPARED FOR: MARK UPPENDAHL
30 0 30 60 90 1!
No... Qx 1
BENCHMARK .p.
CATCH BASIN I" - 30' DECEMBER 19. 2001
ELEV 10.8' �( A SCALE. DATE:
ARNE H. OUA A, PE, PLS DATE REV. 1/14/03 (BH)
ARNE
PARCEL 165
PATRICIA J. CEDERIC GRENIER TR