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HomeMy WebLinkAboutBuilding PermitsPERMIT 791 12/5/97 12/5/97 LOT Z14 Yarmouth Housing Authority 534 Winslow Gray Road South Yarmouth, MA 02673 Addition SHEET 51 /2-/0-9P 2� $55,000.00 ���� ���-� o�� � BUILDING PERMIT APPLICATION APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE, OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING. Town of 11trnumth Building Department 1146 Route ` 8 • 1:►rnu►ufh. %I:t 0266.1-1-192 Tel: 508-398-2231 exL 1261 Fax 508-398-0836 Offke Use On Planning Board InfoTAss#ssorst Information:Permit NO. (' ate I an TypeMAP LaPermit Fea S � ndo'"men, DaUDeposit Rec'd. $Date Recording DateNew Plan No. ons:Net Due $ otherFron�tt) lot Coverage Signature: .3—//— // 11 Certificate of Occupancy Building 011idal Dab I. = 4 not Section 1 - Sfte Informactllond r�k•d 1.1 �3 �� Adds / "'�r`�1 1.2 Zoning Infonnaflon: Zoning District Proposed Use 1.3 Building setbacks tnl Front Yard Stde Ya.As Rec fired Ia a . I Rear Yard t.•e Mlatee byn+r (fiLtLL1.s Flood z«t.lydonnanon: Comments: Public Private: SIFE Section 2 - Pro Ownershi Authorized A ent Z.1 Owner of R•eond► ianni c4tu I SL.1?�va�.4. e�CJIi']r� _ Mailing Address: , a signature Telephone — Telephone 2.2 Authorized Annnf• (Prlrtt) / L2 • Y"��uv° Telephone StLicensed - Construction Services Construhlion Supervision Mailing Address: C1 'license Number es a� yo �C Expiration Date 3.2 Re istered Home Improvement Contractor. Not Applicable ❑ Company Nerve Registration Number Address Expiration Date Signature Telephone Section 4 - Workers' Corn nation Insurance Affidavit (M.G.L C. 1521 25C (13) Workers Compensationaffidavit w I result affidavit den al s he t be corn f the building permit. and submitted Ith his application. Failure to provide this Signed Affidavit Attached Yes . .. ... No .......... and Section 5 - Professional Design and Construction Services -for Buildings c.f. of enclo� space) Pursuant to 780 CMR 116 (containing more tha135,000 ;action 5.1 Registered rohltect Not Appxr able ❑ Nerve (pegl rontp Registration Number Address Expiration Date Professional Address Nerve Address memo Address Person Signature Area Registration Number Explratk)n Date Area d Reapai \ \ Registration Nu Telephone Expiration Data Urea of Responsibility Registration Number Exoxatbn Date \ Area of R@sponsxnnr \ Registration Number Telephone \ Expiralion Oat@ Telephone Not Applicable ❑ 2 of 4 f r. action 8 - "escrl on of Proposed work (check aN applicable) New Constnid rt ❑ (for mumple runty only) No. of Bedroame (for multlpN ram y onyl No. of Bathraorrls Existing Bldg. Repalr(s) ❑ Alteratlo m Addition ❑ Accessory Bldg. ❑ Type Demolition Other Specify: Brief Description of Proposed Work 3G L X 9/-/ y n Section 7. Use Group and Canstnxtbn Suk%V Use Group (Check me applcapabN)LO Construction Type A A33048LY Q MI O A-2 Q A4 A.S s MwAss O S EDUCATIONAL F FACTUM. Q ►.1 F-2H HIGH HAZARD O INSTMMONAL Q 1.1 1-2 R RESIDENTIAL OR.1 R,2 54 Q 8 STOMM O 3-t " O U UTEm p sF�nl: M mm um Q SFwwr s specM uea M .. w w —g w wwwWM WW rr rrvl iEffuL auumons arlaror Chenge in USe. Exktllrrg Use Gnm* Prqwb UM Gm4m EXW" Harard kW= M CMR 94 Proposed Hurd bidet lee CMR 34 Section 8 Bll*km Heiottt and Ana Nunbw of kora 01 sw" ---- krct+dra Eaunwe NaY $ Floor Am per ibw (mQ oYb Total Ana AN Floors (st) Total Heklfd (M 90,,,4- ;. . 9 - STRUCTURAL. PEER REVIEW-(MWMR 11011) wt Skuclod &Vro "SkucUd Peer Review Reglked YN .......... NO IN t0a OWNER AUTHORIZATION. Tn as FF-ua ETEn U ucu as owner of the subject propertyc hereby authorize to act on my behalf. In al t relative to wo authorized by this building permit application. aloe c1 own« -_�.�7 ll oats 3 of 4 OVER I, as. ww/Author(zed Agent hereby declare that the statements and Information on the forgoing application are true and acurate, to the beat of my knowledge and belief. Signed under the pains and penalties of perfury. Pr" tame Sec& n 11 • EgT114GSTED WRO I MMP I'%J" vw I IN itwe Es* nWMd Cod 1�s) b De co 9Mfad by P� appleenl ri- 1 0 1 2. PkwnbkV r GM 4. OWAQ e.TOW all •2#3+4*5) 7.Tbrd 94ur� R dwWwWASA4OW Check Below 0conevvedonconnbeigra Finny (N appNCable) Connie -am rr Wprovr (N epplkable) �1-7ln oafs 4of4 The Commonwealth ofMassaehusetts Department of Industrial Accidents Office oflnvesdgadons 600 Washington Street Boston, MA 02111 -%4=va' www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant information Please Print Legibly Name (3¢siness/fko2ni7A6nn/1n,1hA h,.n• /Ld... _ .. // 1 • %/ , Ci /State/Zi /��J�ZG pt',t_ig'Al &'11 ne #: ��D� Are you an empl er? Check the appropriate bos: 1. a e loyer with 4• ❑ I am a eneral contractor and I Type of project (required): m oy (full and/or part-time).* have the snb-contractors 6• ❑ New construction 2. I a so pro ' or or partner- listed o the a ed sheet. 7. Remodeling h' and h no em oyees rking me in any capaciryv These retractors have employe and have worlters' g• Demolition [Now rke 'comp. insurance comp. ' cat 9. ❑ Building addition req ' ] a co ration and its 10.0 Electrical repairs or additions 3.❑ 1 a homeo er doing all workrs have xercised their i'on 11.0 Plumbing repairs or additions m self. [No wo era' comp. ///"' insurance t f exemp per MGL 152, 12.0 Roof repairs re ] 3a. ❑ 1 am a homeowner g as a c. § I (4), v have no employees. [No orkers' 13.0 Other general contractor (refer to #4) comp, insurance reauireddl 1 •Any applicant that checks box # 1 must also fill out the section below showing their workers' compensatiod bolicy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. fConttactors that chock this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the subcontractors have employees, they must provide their workers' comp. policy number. am an employer that is providing workers' compensation Insurance for ray employees Blow is else poBey and Job site information. 111101201011 Insurance Company Name: Policy # or Self -ins. Lic. M Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DiA for insurance coverage verification. I do hereby certify under the pales and penalties of perjury that the information provided above Is true and correct i 00cial use only. Do not write in this area, to be completed by city or town of)7claL City or Town: Permit/License # issuing Authority (circle one): L Board of Health 2. Building Department 3. City/town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person:_ Phone #: Information and Instructions . ral Laws chapter 152 tequiM all aaployha to peon wodurs' comnson peatifor their empbyeee. Puaruaat to this statttas, as ODelw Massachusetts t7 o uto is defined as "...eves► Perron in the service of another under any conned of hide, express or implied, oral or written." An nWlgw is defined as "an individual, partncrsitia +W9cWiM corporation or other legal entity, or my two or more of the toretoing engaged in a joint enterpriss. AM IM is the legal� ores dealeed rntpbyaer, err the receiver of trustee or n individual, partnership` Wsociadw of odor legal enft avloft en4loy eee. However the owner of a dweWng"having not moo than three sputnentt and who resides toenia. WIND otxupant of the dwelling bones of amtor who empbya persons to do maintenance. construction or repair work on such dwelling boom or on the aouode or building thertb shall not because of such eaVbyment be deemed to be an anployer." MOL chapW 1529 J23C(6) elan states that "every stab err beat ifeeming ageaey shad withhold toe to m" w renewal sf a Hewn er permit to operates budasas of te CON" t bUddhp lM (ha esaamoaTftdtk fey aq spplleast wYs has net prodoead aaeptable tvWkwee of Compass" with the lnsnsaam mnrap requkW Additlooallp, MOL chapter 1529 #23C(7) states "Neither toe eoasmonweaith nor any of it political sobdividonsth the shad cola into my contract for. the perlbrmanee of public work until acceptable evidence of compliance � requirements of this cbspeer have bees presented to the contracting authority." Pleas till out the workers' coapenu dw affidavit cempletsly, by checldrK the boxes that apply to your situation and, it ONnny, solsply sub4oneacta(s) oame(s)' address(es) and phos noarber(s) abag with their cerdticate(s) of the insvalaes. Limited Liability Companla (LLCi or Limited Liability Pa WasWps (LLP) with no esuployees othr than rne�a r P� are noe tt� to carry workers' compensation (reuaaace. It m LLC a LLP does haw be sulmnitted to the Dell of hasstrial errrpbyeea, a Polley is eegoired. Beadvised that stit y b slpind dab the amdarit. I3s affidavit should Aaidasta fir caa&rmdon othwaanee emrcraie• be «Arced to the city or tows that the applicadoa fbr the perwit at license is befog requested, cast the Deparbent of IndustrW Accidents. Sbaald you haw any graeedoos rsgudbmg the lawn or if you are regofmd to obtain a wa ims compensation po ft pleass calf the Department at toe rumba listed below Self -in ru ed wmpmies should enter their �• ."...JWW ns 60 aenoeriate lies. IMMMINNENMNENN City or ?ewer Otselah Please be sore that the affidavit is complete and printed legibly. The Depuftnent has provided i span at the bottom of the affidavit far you to till oat in the event the Ofte of Invesdpdow has to contact you regarding the spplicu& Please be we to fill is the permdNieense rumba which win be used as a reference rim r: In addido% an applicant drat met mbm k multiple permWUc nsa applications in any given year. aged only submit as s11ldavit indicating current policy hdbrmadm (if neceaary) and under "lob Site Address" the applicant should write "all locations is (city or ens be town)." A copy of the en affidavit that has beotfleWlp sPang ed a necked by the cityor tows y provided loth* applicant a proof that a valid affidavit is on the ex &wen permit oe licensee. A new affidavit meet be filled out each year. Where a borne owon a titian is obtaining a Ifcenss erg permit not related to my burins err cons acial venture (i.e. a dog licetes or PM - to bran leaves eve.) said person Is NOT regrrired te complete this affidavit The Of"" of Invesdpdow would like to thank you in advance foe your coopendon and should you have any quesdons, please do not hesitate to giiw us a call. Ihg Department's address, telephone and fa: number: 'rho Commonwealth of Massachusetts Department of Industtid Accidents Otllee of lnvtestipdons 600 Washington Sbvd Boston, MA 02111 Tel. N 617-7274900 ext 406 or 1.877-hIASSAFE Fax A 617-727-7749 Revised I1-22416 wmman.gov/dis TOWN OF YARMOUTH BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT. job Location: ---�E3 Number6IStreeV Owner of Property: Construction Supervisor, Ze��v,4,tJ e S Name License No. Address: Licensed Designee: (If other than Supervisor) Name 2.15 Responsibility of each license holder: Village License No. 77�0,9 Phone No. 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building and structures only pursuant to the state building code and all other applicable laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Any licensee who shall willfully violate subsections 2.15.1, 2.15.2 or 2.15.3 or anyother section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction,. alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities tinder the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the constniction 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 YeAchNoIfyou haked y@g, please indicate the type coverage by checking the appropriate box. A liability Insurance policy ❑ Other type of indemnity "Al Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Cha ter 152 of the Mass. G neral Laws, and that my signature on this permit application waives this requirement. Check one: Si a re of nor or Owners Agent Owner Agent Signature: Building Official Approval: -r TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, NIA 02664 508-398-2231 ext.1261 Fax 508-398-0836 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 1 l 1.5, 1 hereby certify that the debris resulting from the proposed work/demolition to be conducted at S3V &tczz,olnr,b 97-.,, r Work Address Is to be disposed of at the following location: Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Snat re of Application Permit No. Date 40 1l machusetti -. DcPartmcnt of Public Safety, I' Board of Building Regulations and $tandards Conatrutt]on Supervisor License Lkense:. CS 97310 Restricted to:.- 00 _ , - +s b ,JOSEPH SULLIVAN 51 ANTLERS 12D YARMouTH, MA i72684 —a �j� • Expiration: 519=11 Temp Permit No.: Applicant Name: Applicant Phone: Building Location: TOWN OF YARMOUTH Building Department Town Hall Yarmouth, MA 02664 (508)398-2231 ext.1261 BUILDING PERMIT TRANSMITTAL T-11-346 Joseph Sullivan 5083982920 0534 WINSLOW GRAY RD Owner's Name: YARMOUTH HOUSING AUTHORITY Owner's Addres 0534 WINSLOW GRAY RD West Yarmouth MA 02673 Owner's Telephone: (508) 398-2920 REVIEWED BY: 1. WATER DEPARTMENT: 2. ENGINEERING DEPARTMENT: 3. CONSERVATION: 4. HEALTH DEPARTMENT: 5. BUILDING DEPARTMENT: 6. FIRE DEPARTMENT: COMMENTS: RECEIPT OF COPY: (OFFICE USE ONLY Recorded By. IC Permit Fee: $0.00 Deposit Rec: $400.00 Payment Type: Check ChkNo.: 5829/5830 Net Owed: ($400.00) Application Date: 3/9/2011 Issue Date: Expiration Date PLEASE NOTE SIGNATURE OF APPLICANT: Comments: Map/Lot: 059.44 install walls to create storage area and two office areas DATE: N/A: DATE: WA: DATE: N/A: DATE: N/A: DATE: N/A: DATE: N/A: DATE: Date Printed: 3/9/2011 ... i ,. . -I •.ram♦., .. .." _:, . , .• ...--; h 1 _ ... ,.�� 1•� � �'-. ,t 2 ' 1.� �T( "Il r "1.•r � t.'. - .' � �'...•i. .i.-r, a. fj -Y. f. . :.1 ' r fy.. .e•. '�._ •-. .. ... :t"; -.. � - 1 a. - ♦,. _�> 'i ,r... aaJ f.:..1 '.t' ., • Jy Mr "aa a. r,J. e.: •va .1 „'. ,,. _ . ,.. .' �l '{/ R G ♦ - .,•' •- • .J iJ• .T. rGJN�f1�/`� _,t ♦ r s T �.. rt...•}.i, ,. -, .. i.. f ' 1: ... r k: } i'•. hV .. u, ,. '1.. of •r• .1 R _!. ...i,l. �.. ♦. "r. 1 I •'f Via. e:, •, /a• IrN^'p 'i '••'vim Pr ♦ -i ".�,:; n rq - r '♦ .(,. r. _ _ � -- 11'G 1 i� ar •1 ,�.1,"" ^L / i el , i-{• t J. - ^. ;�,. 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T e .1 f b b '"' < 1': ' � . ) , a ♦. i 'J •' i.`', i _.y ,f a v 1 J' i e ' LR'.." .J ' J \V1 + G ,�, J.i�r-Y .I, 'Jo 1 a„ 3� R , '�tR. r. ... 1 (�fJ�\/) •�� '�"' • '" ♦ 1 r • ♦ ,,,:1• 4 r ,,, I• Y i`b lr�' ' {t =! \• t • , 11 • f Jt \ "n 4.•.• ! 11�,a .-.r ! +r y' _ ", 7 'i.-1. � - '.. aa�j ' .. 1 \1 / rZ' n T i i . '. 1 =' J,.a• i J .!� • "{ C •f `! .'., ., _�„ a yC , / ♦'• �, J j'ir�'�/yl�. - ' 3' r G• r� ., J �.: ' y /\V to Ie It iG r 1 �� ., Fr G 1 c F O• �If - J ..n 1 ' I�' 1� IF �• Cr VVV J' ti '/ ) REVIEWED FOR BUILDING AND ZONING CODE CONiPLI- az; r `, ANC€. ERRORS OR OMMISSIONS DO NOT RELIEVE THE .,1-,. ,.,.,I` ,' •„ APPLICANT FROM THE RESPONSIBILITY OF 'AS BUILT" COMPLIANCE. COPY.' ;DATE:,' BUIL IIHG OFFICIAL h. Ei ��/[/y�,J/VJyV�� �(�fQ1_/�yf/•p�_ � _ A�1/{ „ /.1./a��I f•; i`R�\� n - v., p - I.� � •��U 11 ,, Qf��j /.�,ll •�• _ YARMOUTH HOUSING AUTHORITY rO�+�voF ANC 534 Winslow Gray Road /yqR , . LONG POND PLAZA TO �2411 SOUTH YARMOUTH, MA 02664�MtHiST o Edward Blackman Telephone 508-398-2920 Chairperson FAX 508-398-1930 TRS 800-439-2370 Edward A. Roderick Executive Director March 7, 2011 Town of Yarmouth 1146 Route 28 South Yarmouth, MA 02664 Attn: Mr. Erik Tolley Chair, Board of Selectmen Dear Mr. Tolley, The Yarmouth Housing Authority respectfully requests that the Board of Selectmen waive the fee for plumbing permits, $140.00 per 4 buildings for a total of $560.00. The Board of Commissioners and I appreciate all the support that the Board of selectmen and the Town has given us. Thank you for your time and consideration. Sincerely, GG . 04e44.z %" dward A. Roderick Executive Director MA095 An Equal Opportunity Housing Agency N 1 �UCMION FOR PERMIT TO DO PLUMBING City/Town: MA. Date: Permitfl ii Building L atlniu� 440 Owners Name Type of occupancy: Commercial ❑ Educational ❑ New: ❑ Alteration: n Renovation: iS1C Reolac CWTI IDCC Industrial ❑ Institutional ❑ Residential4 lent: El Plans Submitted: Yes n No n DEDICATED Z SYSTEMS —O C7\ c Z v� V N r c mot' z Y U ( Z a W Z F Ir z _Z 3 Q vl Z cc W Z�Z N C FmW- o mX a z W z z u a 3 �i- ?� O 0 3 = O 30 N °• Q= cc I—' cccc �' Wi O I W ux t 1— u > j p w Z Q►- z 3 3 d Y In :3 3 o a 3 - SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR 3 FLOOR ,em FLOOR S FLOOR 6 FLOOR 7 FLOOR 8 FLOOR Check One Only Certificate # Installing Company Name (Corporation 17 40cp C.• Addres�� �� city�oyr State pg�/ ❑Partnership �p BusinessTel:vo�7�%�� Fax: ❑Firm/Company Name of Licensed Plumber: I have a current liability insurance policy or Its substantial equivalent which meets the requirements of MGL. Ch. 142 Ye s> No ❑ If you have checked Yes• please indicate the type of coverage by checking the appropriate box below. 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement• Check One Only SIa re of Res or Owner's Aaent Owner ❑ Agent - Im - -- ---. ---- --- -- --- ---••- -••- ••••�• •••......... ua.v ..v..... . Iv. euw. wi ruvarumu u,ls appucauon are We and accurate to the best of my owiedge and that all plumbing work and Installations performed under the permit Issued for this application will be In compliance with all PPert nent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Type of License: Title I u ❑ Plumber Signature of Licensed Plumber Citylrown lG ❑ Master G APPROVED (OFFICE USE ONLYI []Journeyman License Number.�n t USETTS U)QIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: � L MA. Date: / / Permit# — Sr11 Building Lcatln4'� nw v. . 4` Owners Name � I PType of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑, Residentialx New: ❑ Alteration: ❑ Renovation: Replacement: Plans Submitted: Yes ❑ No S I FIYTIIRFC • 1 i, • ®----------------------------- .. ' ------MMM"M-----------------M • • WMMWMWMMMMWMMMMMMMMW mmmmmmmm • • ' • --------.M------------------- • ----------------------------- ----------------------------- oo,,mmm-------------------------- • ----------------------------- One Only installing Company Name 'Y4, ,2 / LZ....�i /� �Li..aa.��ta_ '' Partnership Business /. 3./ Name of Licensed Plumber: INSURANCE COVERAGE: i have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL. Ch.142 Yes+ No q If you have checked YM please Indicate the type of coverage by checking the appropriate box below. 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only ciAnI r•e.,rMdY .n,. e� A Owner ❑ Agent - - - le --- --. ---- --- -• -•---.-..- moo_ u..v..urwv... up.• •uYaY\WY tw, •nwiwr regarumg mw appucauon are true and accurate to the best of my owledge and that all plumbing work and Installations performed under the permit Issued for this application will be In compliance with all ^nent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General taws. By�tftSW Type of License: Tide kj Q� El Plumber Signature of Licensed Plumber CitylrownPPROVE!/�f2t►tb r. `I ❑Master ,�r1 t 1 AD (OFFICE USE ONI Yt ❑Joumeyman License Number 4 :zs7T1,5' a 74-11-ao MASSACHUSETTS 11NI1ORM APPLICATION FOR PERMIT TO DO PLUMBING City/Tow. MA. Date: / Permit# _C� �- 5 [ 6 Building Locatlon&�4;0 nuu Owners Na PType of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential)@ i New: ❑ Alteration: ❑ Renovation: Replacement: Plans Submitted: Yes No ❑ I� CIYTI IACC c� DEDICATED N <I W SYSTEMS O Y) F' ZW z u v+ z cc_z 3 = i! N ' H Z a a c is sgc ccCC o 5 G a z owe a� o Z Z ij s x -' O Q N o Q. N O ~ U Y O g i O O CL O 2 Z Q Q Q W o O Y+ Q m o= 5 s h 3 3 3 a SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR 3 RDFLOOR 4 FLOOR S FLOOR 6 FLOOR 7 FLOO 8 FLOOR Check One Only Certificate # Installing Company Name -� ,,/l Addres�%%f� City/Tow State: P Corporation ❑ Partnership Business Tel: --7*7�%3Q,5 Fax: ❑Firm/Company Name of Licensed Plumber: INSURANCE COVERAGE: I have a current liabilityinsurance policy or Its substantial equivalent which meets the requirements of MGL. Ch.142 Yes+ No ❑ If you have checked Yes. please Indicate the type of coverage by checking the appropriate box below. A liability Insurance polio 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent cir�hfrnnFff m/—n,. A �/ ��' �y �•�• �•• �• �•� ��.�..� emu.. nnvunou V�. • VV / V �V MYpwY tul unw�aur ruveromv mu appucauon are we ano accurate to the best of my owledge and that all plumbing work and Installations performed under the permit Issued for this application will be In compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Type of License:. Titre ❑ Plumber Signature of Licensed Plumber D ❑ Master City/Town C APPROVE(OFFICE USE ON VI []journeyman License Number. awv- TION FOR PERMIT TO DO PLUMBING City/Town: l/1�/filLl.PT�i�/ , MA. Date: / / Permit# Building LocationW;Oo Owners Name Type of Occupancy: Commercial ❑ Educational ❑ New: ❑ Alteration: n Renovation: 12 Reolac Industrial ❑ Institutional ❑ Residentialn lent: ❑ Plans Submitted: Yes n No n MMMMMMMMMMWMMMMMMMMMMMMMMMM MMMMMMMMMMMMMMMMMMMMMMMMMMMMM mwmwoimmmmmmmmmmmmmmmmmmmmmmmmmmmmmm JAPFA�Installing CheckMMMMM Company NameAAMI Clty/Towal�;W= sta r. i Business �• Fax: Firm/Company Name of Licensed Plumber: INSURANCE COVERAGE: I have a current liabilityInsurance policy or Its substantial equivalent which meets the requirements of MGL. Ch.142 Yes+ No ❑ If you have checked Yes. please Indicate the type of coverage by checking the appropriate box below. A liability Insurance polic/b 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 Massachusetts General Laws, and that my signature an this permit application waives this requirement. Check One Only Owner Agent I�} Rir iahf a nMui—n. (l.. ego A --- 6 ❑ 0 l n eby comfy that all of the details and Information I have submitted (or entered) regarding this application are true and accurate to the best of my owledge and that all plumbing work and Installations performed under the permit issued for this application will be In compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. BY L G>.t� Type of License: Titre ❑ Plumber Signature of Licensed Plumber El Master r j APPROVE (OFFICE USE OWU—n []Journeyman License Number. �� `1 OF TOWN OF YARMOUTH Building Department BUILDING g U I LDI N G fit+ , _ _ _ _ • • . _ (508) 398-2231 ext.261 '- PERMIT NO B-09-1254• PROPOSED • PERMIT ISSUE DATE ;_ 6122/2QQQ _ ; USE _ _ _ _ _ , APPLICANT .Robe v ika JOB WEATHER CARD PERMIT TO Repair AT (LOCATION) ZONING DISTRICT R-40 Bldg. Type: Commercial 10534WINSLOW GRAY RD #35 SUBDIVISION MAP LOT BLOCK 1059.44 BUILDING IS TO BE: CONST TYPE= USE GROUP = LOT SIZE one replacement window, one replacement door, one squares siding REMARKS AREA (SO FT) EST COST ($) $4,800.00 PERMIT FEE OWNER IYARMOUTH HOUSING AUTHORITY BUILDING DEPT BY ADDRESS JO&U W INSLOW GRAY RD West Yarmouth I MA 102673 CONTRACTOR LICENSE 076563 Vareika, Robert 219 Walnut Street West Bridgewate MA 02379 5065833999 PHONE 15083982920 INSPECTION RECORD FIELD COPY Date Note Prosaress - Corrections and Remark Insoector -O BUILDING PElMlIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Ext. 261 CONSTRUCTION ADDRESS: 53 y wi N S (_ o w G R A0H 1? k> A P L* 35' ASSESSOR'S WORMATION: Map: 5 9 I Pmck y owNat YARM6011-1 H(WZiNG AVYPOP—iY!y so&-399-A92D ME NAHUMENrADDRESS TM-0 ?-be Rr VARetkA a-19 wAuuvt'sT COMB MP- WIRE'[ kA CE�vsYRUc�jbt,� IAl• BeID6L4L4 r 14 023" .508':5 3-3999 NAME MAMIN0 ADDRESS TE" e idesaw ❑ ca n nemw Est Coat of Canswctfon ST Home Improvement CwUW« Lk. t canac,raiort stitpervtaor Tea r C S • 019 5 6 3 woriaa's campe nWon @uuranoe: (cheat me) 111 rm the homoowoer 0 I am the sole propriemc VI havo worker's Compavadon ama>ooe (nmmme compnq N.me F I iLt: M B1JS I NSu RAND CO . wocka's camp. Eotiq,Y 4KA 011 Z 029 - 1S 0 Teat (Firm wood Stave Shod e : r of Sgmmm . aRepmemocmt windows if D-! ep anon Goon: r � D Re -toot r ofSqumra () Strip 4 old Abloae () gigs over *M ofesiriog roof enedebris walbe&wmed*fat At,(, SY/'T9 WASYO - 8QOClrT0?j4MA 0.230 Locsdoo of Faciay I declas under pcaattia of pajwy Noll the disconrY I i coraieed are tram and Dons'to the hat of my knowledge and bclicE I undattaad that my hlme amwa(s) wM be Just ruse far dv&W or rerocadw of my Unease sad for rvscodim under XG.L Crt.268. Sadbo 1. — — Applirmt's Si woo i Datm. 6 -2Z • o .z ZmoingD/isUict: / �'T V Historical District: ❑ Ya �1 No Flood Plain Zurc ElYa � No water Rcm=w Fmw= 'District:` within 00It of wetlands: ]�Ya id Ya, ❑No 3r01 TOWN OF YARMOUTH BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT. .lob Location: 5 31 WIVSLOIA) C-ERM Rh - Number Street Village Owner of Property: YARMOUY6l 14DJWAr'G /:NLfTNo RtYy Cott.stntction Supervisor. R013EET VAkC CA 965-4 3 So$-5 S3. 3999 Name License No. Phone No. Address:' QRJ9 LOAL-001 S T . SU1T8r-B WEST Ak1D wAnekItiA Oa3'9 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 Wr seeing that all work is clone pursuant to the state building code and the drawings .t% 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 cute and all other applicable laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Any licensee who shall willfully violate subsections 2,15.1. 2.15.2 or 2.15.3 or any other section of these rule.-. and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 rUl 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. lu 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 Tlue license holder shall he responsible for requesting all required inspections. Failure to do so may be tleented .t %iolation of the pennit conditions. 1 have read and understand my responsibilities under the rules anti regulations for licensing construction supervisors in accordance with section 1fNJ.1.1 of the state building code. 1 understand the construction inspection procedures and the specific inspection .ts called for by the building official. INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes U00or No ❑ If you have checked yo, please indicate the type coverage by checking the appropriate box. A liability insurance policy or 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: of owner or Owner's Owner D " Signature: Building Official Approval: 06/18/2009 13:57 FAX 584 9510 EASTERN ADJ. JUN-18-2009 12+45P FROM:YPOICUTH HOUSING RUT 15083981930 0002 T0:1.5085849310 P.2 YARMOUxH HOUSING AUTHORITY LONG POND PLAZA► SOUTH YARMOUTH. MA 02664 Marianne Walsh Telephone 508-398-2920 Chairperson FAX 503-398-1930 Donna I Killeen TRS 800-439-2370 Executive Director June 18, 2009 ._ Mr. Doug Dodge Eastern Adjustment Company P.O. Box 446 Brockton, MA 02303 RE: Yarmouth Housing Authority Elderly/Disabled Housing Long Pond Plaza 534 Winslow Gray Rd., Apt. 35 So. Yarmouth, MA 02664 NOTICE TO PROCEED Eastern Adjustment Company is hereby authorized to have a contractor commence work at the start of business on Friday, June 19, 2009. You are informed that Donna J. Killeen is the contact person for the );lousing Authority and Tom Hackinson is the DHCD Construction Advisor. Please acknowledge receipt of this Notice to Proceed by signing and dating the original and 3 copies; one to be retained for your files. Please forward one original back to the Housing Authority and one to the Contractor. The Housing Authority's Tax Exempt Number is: 046-367-798. Sincerely,Killee toE=aJ. Executive Director ACCEPTED BY: Eastern Adjustment Company g By: Date: 'l An Equal Housing Opportuniry Agency C72. &mmonaea" Board of Building Regulation t and Standards Construction Supervisor License License: CS, 76563 Expiration: --'12 1812009 Tr# 13006 strlctlon- .00:,' ROBERT G VAREIKA\-1-j,51 86 BEDFORD STREET LAKEVILLE. MA 02347 Commissioner TOWN OF YARMOUTH 1146Rourmll SoUi"HYARMOum MAS umsEPIS026644451 Telephone (508) 398&2231, EZL 261 — Fait (508) 398&2365 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT BUIIMING ELECrsucAI. 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 "3 N wIAJ-d ,ot? C conducted at Work Addrew is to be disposed of at the following location: ,�,LL �� Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Signa[ure u[Applicant permit No. Date The Commonwealth of Massachusetts.. ry Print Forni Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lezibly Name (Business/Organization/Individual): Varelka Construction Inc Address: 219 Walnut St. Suite - B VVCQ& u1 1uycrm&c1, lvl'% VGJ/ U Are you an employer? Check the appropriate box: 1. ❑✓ I am a employer with 30 employees (full and/or part-time). 2. ❑ I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t Ynone tf: JVV JVJ-J J.7.7 4. ❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.: 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.1 Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 1 l.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.21 Other RBPikkkS VOR checks ;Any applicant that box # I must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the subcontractors have employees, they must provide their workers' comp. policy number. I am an employer that Ls providing workers' compensation insurance for my employees. Below Is the policy and Job she information. Firemens Insurance Company Insurance Company Name: Policy # or Self -ins. Lic. #: WCA 0112029-16 Expiration Date: 6/20/2010 Job Site Address:.53N !#MSL0W (kkl RD Ae'r 3S City/State/zip:YARH0()34 1A 0a46d Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certoyunder the pains and penalties of perjury that the Information provided above Is true and correct Phone #: 508-583-3999 OfJiclal use only. Do not write In this area, to be completed by city or town ofJlciaL City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone #: ACORD CERTIFICATE OF LIABILITY INSURANCE vRDDUCER (978)392-4567 FAX (978) 392-9696 E. ]. Wells Insurance Agency, Inc. Regency Park 238 Littleton Road 06/19/2009' 06/18/2009 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Westford, MA 01886 INSURERS AFFORDING COVERAGE NAIC 2 INSURED Vareika Construction Co., Inc. 219 Walnut Street Suite B W. Bridgewater, MA 02379 INsuRERR Union Insurance (Acadia Croup) INSURERS. Acadia Insurance INSURERc: Firemens Insurance Company INSURER a. INSURER E THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AD TYPE OF INSURANCE POLICY µUMBER POLICY EFFECTIVE QATEfummnim 06/20/2009 POLICY EXPIMTWN DATE 06/20/2010 LIMITS GENERAL LIABILITY CPA 0092564-16 EACH occuRRENcE s 11000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED f 20OO CLAIMS MADE FX OCCUR MEO EKP (Any me pm ) S 5.00C A ff: PERSONAL S ADV INJURY s 1,000,001c GENERAL AGGREGATE S 2,000,00( GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS• COMROP AGG f 2 QQQ QQ POLICY rZX JEC LOC AUTOMOBILE Lmum MAA 0092568-16 06/20/2009 06/20/2010 ANY AUTO COMBINED SINGLE LIMIT (Es beaderO f 1.000.0001 ALL OWNED AUTOS A SCHEDULEDAUTOS (1 DILINJURY f X X HREDAUTOS NON-0WNEDAUTOS BODILY INJURY f X PROPERTY DAMAGE f (Po 8"WW U OARAGE LMBIM AUTO ONLY. EA ACCIDENT f ANV AUTO 7 OTHER THAN EAACC S AUTO ONLY: AGG S UA&UTY EACH OCCURRENCE f 5 OQQQQOCCUR CLMMSMADE CIJA0121032-IS 06/20/2009 06/20/2010 AGGREGATE S 5,000,00C B NESSAIMBRELLA s DEDUCTIBLE $ RETENTION S S WORKERS COMPENSATION AND WCA 0112029-16 06/20/2009 06/25/2010 X I WOSTATU• I JOTK EMPLOYERS'LIABIITYCRY C ANY PROPWETOR(PARTNERIEXECVTNE E.L. EACH ACCIDENT f 5000O OFFICEHMEMBER EXCLUDED) Syyaake dwhbeInner EL. DISEASE • EA EMPLOYE i S00 00 SPECIALPROVISIONSOelm E.L.DISEASE•POLICY UMR S S00 0D I-Ptoted Materials CPA0092564-16 06/20/2009 06/20/2010 $200,000 any one job site A $200,000 temp off premises $200,000 property in transit ADOEO BYENDORSEMENT/iPECW.PROVISIONS DESCRIPTION OFOPERATIONS 1LOCATIONS I VEHICLES/eds 61009 Renovations to Special Needs Housing Ho' Except 10 days for non-payment of premium Yarmouth Housing Authority Donna Killeen, Executive Director Long Pond Plaza So. Yarmouth, MA 02664 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. PaulAUTHORIZED fey/ENTATIVE I(w..4-P k Paul Coffey/TMV �j' " .'— . T`.'.'W'1 CACORD CORPORATION 1988 G 3'LI W ( NSA ow GMJ j21) P1i'l' S YARHOEM 140"14G NU-V A* ( N VAiZti RA cEa -ST INc. al 9 U uS' s� tom. BRi��u���t1r�1 oa3�� �E�IRs Fon r�t3To 'l�AhAG� K�� •�••�- T w)Al POW Rt'KW e; l b©oiZ F57PLACC- bA MAGEb FkAhrN G " ce4e Sflti�''6�b6�k TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 261 Fax 508-398-0836 MEMORANDUM To: file From: Andrew Amault Date: May 31, 2009 Subject: Emergency call for 534 Winslow Gray Road At 11:55 AM, May 31, 2009, I responded to a request from Yarmouth Fire Department to evaluate the condition of an apartment at Yarmouth Housing Authority, 534 Winslow Gray Road. A vehicle driven by a tenant jumped the curb and staved in the front fagade of her apartment. The passenger side mirror of the vehicle hit the post supporting the 2°s floor deck, but did not cause it any damage. The framing around her front door and window was pushed in about one foot, but there did not appear to be a structural damage to the building. The wiring and the electrical outlet in the wall didn't appear to be damaged. YFD Captain Mike Caruso shut off the breaker for the outlet, and closed off the area with yellow tape. I directed the maintenance man for the Housing Authority to have the tenant vacate the premises until temporary repairs could be made to separate the damaged area (in the front of the living room) from the rest of the apartment. The apartment is at ground level, the rear door is functioning, and the bedroom includes an emergency escape window, so I said that the tenant could move back into the apartment after these repairs were complete. MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or 11Type) c' XaPiNQ�i Mass. Date/ b0 : 9'_U6 Permit # F O 7 Building Location T Gtl)mSf" Owner's Name Type of Occupancy ��8 . New ❑ Renovation ❑ Replacement &,"' Plans Submitted: Yes ❑ No ❑ FIXTURES N N N O Y < N NNe ..! N < U Fd•` N O O C C 11 Z d O - W C F- W C C N 1- C G � - d - � N - d 6. 3• : F- X V Z C C N W p d N - C S C W d O > '� N C _O W X d 1- �' F O h N _O N F- Y O O N -- W r... O U - >+ Y J C N O C J 3 Q O SUB-BSMT. BASEMENT 1ST FLOOR O'I ' "NDFLOOA 3A0 FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8THFLOOR Installing Company Name A & B Canco Check one: Certificate Address 350 Main Street g] Corporation 2305 West Yarmouth, MA 02673 ❑ Partnership Business Telephone 508-775-2800 ❑ Firm/Co. Name of Licensed Plumber Doug Langtry INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ,� No ❑ If you have checked Les, please indicate the type coverage by checking the appropriate box. A liability insurance policy 7E 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: Slrn.vfl llP of Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered finabove application are true and accurate to the best of my knowledge and that all plumbing work and installations p ormed under the p it issued for this application will be in compliance with all Pertinent provisions of the Massachusetts State Plumbing Co and Chapter f the General Laws. By T tle Signature tuber City/Town Type of License: Master] Journeyman ❑ APPROVED (OFFIC U ONLY) License Number 11305 4LN hD � � 1( MaslacAa� Mcial Use Only Q �' Permit No.� �! U ((opartnunt ire s rvicre B0��-E VTION REGULATIONS (Rev. 1/0 jy and(les eeebC eked Q APPLIC TION_`FOR_P_E MIT TO PERFORM ELECTRICAL WORK All wor to be pe?ormedin accor once with the Massachusetts Electrical Code (ME;), 527 MR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date: 9/ /a/6 `% City or Town of: Y%?'4t'l p t.,7-df To the Inspec' for of Wires: By this application the undersi edgives n ice f is or her intention to perform the electrical work described below. Location(Street&NumberP? � ..5-3y I-t/=VVSL0w C-7e!, -f Owner or Tenant LtX ^'7 OyTN NO !/ e, T mil/ Gr Telephone No. Owner's Address w�r`�S LOsu lyJi Is this permit in conjunction with a building permit? Yes ❑ No ® (Check Appropriate Box) Purpose of Building /f d t/s'.:2t6 Utility Authorization No. Existing Service,200 Amps �2•O / 011y4avolts Overhead ®10� Undgrd ❑ No. of hfeters / New Service —'Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work:eJs7 // /�tti`-;I- �9- COS rL0 c. Lai r%r� Completion ofthe followine table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Cell.-Susp. (Paddle) Fans r o Total Transformers KVA No. of Luminaire Outlets No. of [lot Tubs Generators KVA No. of Luminaires over' n- Swimming Pool rnd. ❑ rind. ❑ o. o mergeacy Lighting BatteryUnits No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners t and o. o aunt on vi Initiating Devices No. of Ranges Total No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers Hear lamp um er ons Detection/Alerting ction/Ale tin of Self-Contained Devices -- No. of Dishwashers Space/Area Heating KW Local ❑ Municipalti❑ Other Connection No. of Dryers Pleating Appliances K�V Security of Devices or Equivalent o. o Water K,V Heaters o. o o. o Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP a ecommunrcations ring No. of Devices or Equivalent OTHER: tQ 0. O� Attach additional detail iitdesired or as required by the Inspector of iVires. Estimated Value of lect 'cal Work: %(When required by municipal policy.) Work to Start: q 10 V '7 Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such c,_ovejr� is in force, and has exhibited proof of same to the permit issuing office. p CHECK ONE: INSURANCE �" BOND ❑ OTHER ❑ (Specify:) I certt, under the aims and penalties of perjury, that the information on this application is true and complete. �. FIRbI NAME: ,PI E Y;f /I Ee ;o f 5' Z t C LIC. NO,: 3� 413 Licensee: % d 17 * S , J7/ 077 Ae- Signature -ram — LIC. NO.: 3L, y3 / E (If applicable, enter "exempt ' in the license number��lir �ee.) � Bus. Tel. No, - - c,3 Address: � 3� �fl�lY1 / LC ' %�-iJ N �Z 77�ti AIL Tel. No.: -i �- 'Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's a ent. Owner/Agent PERIifIT FEE. S Signature Telephone No. R E-o�ntr�ot e of Maaac4woi>`J OtTcialUse�y�� [� Permit No. 7 eParttrrw /` ..rim servicod 77nnnn7 Occupancy and Fee Checked lug 09 R t 11 NTION REGULATIONS (Rev. 1/07j leaveblank APPLIQATfON-FOR-PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (ME , 5 CMR 12.00 (PLEASE PRINT IN INK OR TYPEALL INFORMATION) Date: 1491a City or Town of: �"f.M Oy 7-1t To the Inspeclor of IVires: By this application the and i tied gives noti a is or her intention to perform the electrical work described below. Location (Street & Numbook f5 ,j?t/ U/.. VS LCk"J G7 Owner or Tenant UT/f OUtyitJ 11-VT/1.. Telephone No. Owner's Address /L f? Is this permit in conjunction with a building permit? Yes LJ No Lvw%j (Check Appropriate Box) Purpose of Building E f PF,0LY jf 0 Utility Authorization No. Existing ServiceX2 0 Amps / Zf/OVolts Overhead 0� Undgrd ❑ No. of Meters 1_ New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity — Location aqd Nature of Proposed Electrical Work: V COMpletion ofthe followine table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ce6.-Susp. (Paddle) Fans r o Total Transformers KVA No. of Luminalre Outlets No. of Hot Tubs Generators KVA No. of Luminaires Above n- Swimming Pool rnd. rnd. ❑ o. o Emergency Lighting BatteryUnits No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. o Detectin] an InitiatingDevices No. of Ranges al No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers Heat talp um er ons Detection/Alerting No. of Self-Contained Devices ..—.- _ No. of Dishwashers Space/Area Heating KW Local ❑ Municipal❑Other Connection No. of Dryers Beating Appliances Key Security ystems:" No. of Devices or Equivalent o. o Water KW Heaters o. o o. o Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Ilydromassage Bathtubs No. of Motors Total HP ons wiring: a No o f Devices No. of Devices or E uivalent OTHER: Attach additional detail ijdesireef or as required by the Inspector of Wires. Estimated Value of lee 'cal Work: 1 S0Oi OQ (When required by municipal policy.) 010 Work to Start: 7 I 0 �% Inspections to be requested in accordance with MEC Rule 10, and upon completion. 1 INSURANCE C V RAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such cover ge is in force, and has exhibited proof of same to the permit issuing office. dCHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) �l certify, under the pains and penalties ojperjury, that the information on this application is true and completes FIRM NAME: /) /?% 5 / i'-►5 L C LIC. NO.: 36 79/ E Licensee: l - S, D1�),e?n O- Signature ��� r LIC.NO.: 391 E (Ifopplicable, enter "ex�en t" in the license nu er line.)) Bus. Tel. No.. O t!— tv6 3 Address: J— 3A17'111-4 � Al • -rCS%7 ��• OAS'% Alt. Tel. No.- t — • 9ri 17 *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. —� OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one ❑ owner ❑ owner's a ent. Owner/Agent PERAIIT FEE. $ Signature Telephone No. N16N- a APPL (PLEASE PRINT IN INK OR City or Town of: By this application the undersig Location (Street & Owner or Tenant Owner's Address �i m wnw.a& of Mamactucsa(fd �^O�fcial Use Only E /� �.��.' Permit No.E0 �-21� af Occupancy and Fee Checked E ENTION REGULATIONS Rev. 1/07j leaveblank i PERMIT TO PERFORM ELECTRICAL WORK 1�in a cordance with the Massachusetts Electrical Code Q4EQ, 27 Ch1R 12.00 ALL INFORMATIO,NI Date: q O O /7 odzand u %n To the !n peed r of Wires: es notice of his or her intention to perform the electrical work described below. Ic-e t: own 7 6'3 y sir vs wcw tit x-r=- v POU-rh lfovj Telephone No. Is this permit in conjunction with a building permit? Yes ❑ No R] (Check Appropriate Box) Purpose of Building r-/DFRL Y //6us- tW4 Utility Authorization No. Existing Service AOO Amps %.IO / Oa/0 Volts Overhead [9' Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of dieters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: -TW jj?;/j P6tU er P- C.O/r t -�Q r n eW b o s• l'° f Completion ofthe followine table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Cell.-Susp. (Paddle) Fans o. o ota Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Above n- Swimming Pool rnd. ❑ rnd. ❑ o. o Ent rgency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARdIS No. of Zones No. of Switches No. of Gas Burners nd o. o elect on Initiating Devices No. of Ranges Tal No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers earn lamp um er ons Detection/Alerting No. of Self-Contained No. of Dishwashers Space/Area Heating KW Local ❑ Alunlclpal❑� Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent o. of Water KW Heaters o. o o. o Signs Ballasts Data Wiring: No. of Devices or E uivalent No. Hydromassage Bathtubs No. of dlotors Total HP elecommunicat ons r ng' No. of Devices or E uivalent OTHER: Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value of lect 'cal Work: %J��d r O!% (When required by municipal policy.) Work to Start: 9 14 6 7 Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVE GE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such cove age is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRAINAME: /1py/e II-q1try /j//IPZJ,-FS LLG LIC.NO..36931 F Licensee: % O­b S. Signature -- LIC. NOr= (!f applicable. enter "exempt" in the license nu^m �er fine.) Bus. Tel. No.• Ol- 3 y� (. Address: m3 r-Sfi'v171/L1- 0— rN• Sc=7-- r. 0�857 Alt. Tel. No.: *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's a ent. Owner/Agent PER1iIIT FEE: $ Signature Telephone No. ` E [� e nute� o� ///aslachulsff! �Offiicii�al Use Onl "� Permit No. 1 I .11a(�ar op7ire service! S E P 1 0 70�7 Occupancy and Fee Checked B ARD i2 ENTION REGULATIONS Rev.1/071 leave blank RUII ING DEPT. APPLI 1AT1 RMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code yf,4 27 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 9 le/7 City or Town of: ..n-, e) 0- To the Inspector of Wires: By this application the undersigned gives tpe tM r h t _ perform the elegtUC.;J w91k�q�gribe¢_beJp}yF-,, Location (Street & Number) - Owner or Tenant Owner's Address S-j � to J OUTelephone No. Is this permit In conjunction with a building permit? Yes ❑ No Er (Check Appropriate Box) Purpose of Building, f -D15AI y H0 V 5X-v-J , Utility Authorization No. Existing Servlce4�ZOO Amps lZeMP40 Volts Overhead [9'00� Undgrd ❑ No. of Meters New Service `Amps / Volts Overhead ❑ Undgrd ❑ No. or Meters Number of Feeders and Ampacity -� Location and Nature of Proposed Electrical Work: v Comoletlon ofthe following table may be waived by the Iaspector of Wires. No. of Recessed Luminaires No. of Cell. -Sus p• (Paddle) Fans r o ota Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Above n- Swimming Pool rnd. ❑ rnd. ElBatte o. o mergcncy rg ing Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARNIS No. of Zones No. of Switches No. of Gas Burners nd o. o elect on Initiating Devices No. of Ranges Total No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers P eat Pump Totals: Number ons o. oSelf-Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal[I Other Connection No. of Dryers Heating Appliances KW Securityys vices No. of Devices or Equivalent o. of Water KW Heaters o. o o. o Signs Ballasts Data Wiring; No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP a ecommumcanons ring: No. of Devices or Equivalent OTHER: Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value of lec rical Work: f �� ir7�/ (When required by municipal policy.) Work to Start: 9 I4 e"7 Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE E3'0' BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: M6 S L LC LIC. NO.:3c Licensee: O1 5- !i/ 0hnee Signature LIC.NO.:3C39 /� (Ifapplicable enter "exempt" in the license number line.) Bus. Tel. No.: y0 1/' 6C Address: Y35" Slt"llmI 1- 1, e.Zi N. se-X.T. Rr Alt. Tel. No.: 2V 1oy917 *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. — OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's a ent. Owner/Agent PERMIT FEE: S SignaturetoreTelephone No. R (' I rr V& ah4 of MamacL.uj Official Use Only Permit No.,O 8 �� 7 S E P ] 0 Z�jP nt of �irr s'.rtnic.a Occupancy and Fee Checked-�= BOA Fifes EVENTION REGULATIONS [Rev.1/07] leave blank APPL-`IGATION-RO.R-PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code C), 5 7 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: q/ 1 D d /7 City or Town of: lul v I H To the Inspector of Wires: By this application the undersi ed ves notic f his r her intention to perform the electrical work described below. Location (Street & NumberpONz _ 6311 Ci jz� Owner or Tenant Owner's Address 6v,-V,v5 to cv Is this permit In conjunction with a building permit? Yes Lf Purpose of Building Z;71D-er4V //Ot/zr� Telephone No. No & (Check Appropriate Box) Utility Authorization No. --� Existing Service.200 Amps JW / ; tVO Volts Overhead Undgrd ❑ No. of Meters New Service _CAmps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work:—=WJ.'7M t'/ z)W-e4- • I;#- G z3,17xaLs -56fZ .t,e�j bo i A'e Completion ofthe followine table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of CeB.-Susp. (Paddle) Fans No. n ota Transformers KVA No. of Luminaire Outlets No. of [lot Tubs Generators KVA No. of Luminaires Above n- Swimming Pool rnd. ❑ rnd. ❑ o. ol EmergEn—cy Llgfttlng Battery Units No, of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. --of Detection an Initiating Devices No. of Ranges Total No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers eaT ita sp um er ons Detection/Alertln No. of Self-Contained ---- No. of Dishwashers Space/Area Heating KW Local ❑ Municipal❑Other Cyonnection No. of Dryers Heating Appliances KW eCNo of Devices or Equivalent o. of Water KW Heaters o. o o. o Signs Ballasts Data Wiring: No. of Devices or E uivalent No. Ilydromassage Bathtubs No. of Motors Total IIP Telecommunications ring: No. of Devices or Equivalent OTfIER: Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value of Elec rical Work: %S�dt%i OC% (When required by municipal policy.) Work to Start: .9 /0 D J�% Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COV RAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. ^CHECK ONE: INSURANCE LT BOND ❑ OTHER ❑ (Specify:) certify, under the pains and penahies ofperjury, that the information on this application is true and complete. /� I�%� /ELF �¢//I7C/�r J t L G LIC. NO.: 3[3 4 / E FIRM NAME: &E ",�Licensee.,_/_'0�> S . Z)101Ir1e Signature LIC. NO.: 3�/ E �- (Ifopplicable, enter "e empt" in the license number line.) Bus. Tel. No.- G) 17663 of Address: _ _t% :5,APV 'N J LL /L-N. Se�:*—. R.,r Q, � 5'f Alt. Tel. No.: O/— — 6 y97 'Per M.G.L. c. 147 s. 57-61 security work requires Department of Public Safety "S" License: Lic, No OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's a ent. Owner/Agent PERMIT FEE. $ Signature Telephone No. GCG ASSOCIATES, INC. PROFESSIONAL CIVIL ENGINEERS AND LAND SURVEYORS 84 Main Street Wilmington, Massachusetts 01887 Phone: (978) 657-9714 Fax: (978) 657-7915 June 6, 2007 Mr. James Brandolini Building Commissioner Town Hall 1146 Route 28 South Yarmouth, MA 02664 RE: DHCDNarmouth Housing Authority Project Long Pond Plaza Site Improvement 534 Winslow Gray Road Site Plan Review Request Dear Mr. Brandolini: On behalf of the applicant, Yarmouth Housing Authority, GCG Associates, Inc. would like to submit plans for the above mentioned project for site plan review. Enclosed please find 8 copies of the Pavement and Site Improvement Plans, 8 copies of the Site Plan Review Request, 2 copies of NOI Application, and 2 copies of Stormwater Management Plan, Drainage Design and Calculations. Should you have any questions, please do not hesitate to contact our office at (978) 657-9714. Respectfully Submitted, GCG Associates, Inc. Heather Chew Project Engineer Enclosure CC: Mr. Bradford Hall, Ms. Donna Killeen Formal ,X_ Informal_ Review SITE PLAN REVIEW COMMENT SHEET Jim Brandolini Deputy Kelleher Donna Killeen Karen Greene Mike Carter Vern Santos Joe Sullivan Terry Sylvia Project Summary The applicant proposes to expand parking at this pre-existing, non -conforming apartment complex in the R40 residential zoning district This expansion requires a site upgrade to today's parking and loading standards, as outlined in Zoning Bylaw 301.2 The number of parking spaces will increase from 40 to 56, which is closer to, but not meeting, the minimum required parking for the site. Comments Building: (1)Because the existing number of parting spaces is less that what is required for the number of dwelling units, the proposed Increase in the number of parting spaces triggers a Site Upgrade pursuant to zoning bylaw Section 301.2. (2)Those elements that will not comply with Section 301 require a special permit from the Zoning Board of Appeals. (3)AII Handicapped Spaces including van parking shall comply with 521 CMR. Community Development: Proposed upgrade will be an improvement to an important component of the Town's affordable housing stock. onservation: Not present. Design Review: Not present, but sent a memorandum with comments. Engineering: Not present. / /! ire: The proposed upgrade will greatly relieve the access difficulties the fire department has experienced. Repositioning the hydrant will enhance operational effectiveness and access during sow emergencies. Health: Not present, but stated earlier that there was no comment. lannin : Parking spaces created by the plan are to be 9' x 18', 10' x 20' spaces are required, per Zoning Bylaw section 301.4.4.,18 foot long spaces are allowed under 301.4.2, Paragraph 2, when 2.5 overhangs are available. Vegetative screening, as outlined in 301.4.5, would be required on the eastern and northern parking lot areas to limit view of the parting area by abutting residential uses. Relief from these requirements may be sought from the Board of Appeals. The applicant should submit parking calculations for the entire site to determine compliance with the 301.5 Table of Parking Demand. Provide in -lot tree calculation on the plan, per 301.4.6. Curb radii must meet the 25 foot maximum of section 301.4.2, paragraph 2. Buffer trees must meet the standard of 3.1.4.4, with one 3' caliper tree located every 20' in all buffers. Handicapped parking must be supplied, per 301.4.8; show calculations on the plan. An impervious surface calculation should be shown on the plan. Vl Water. Evergreen hedges shown on the plan should be planted dear of the existing water service. Read & Received by Applicant(s) TO: FROM: SUBJECT: DATE: TOWN OF YARMOUTH 1146 ROUTE 28 SOUTH YARMOUTH, MASSACHUSETTS 02664-24451 Telephone (508) 398-2231 ext. 292, Fax (508) 398-0836 MEMORANDUM Site Plan Review Team Dick Martin, Chairman Design Review Committee 534 Winslow Gray Road (Long Pond Plaza) June 19, 2007 Design Review Committe The Design Review Committee met with representatives of the Yarmouth Housing Authority yesterday and reviewed the parking lot plan for Long Pond Plaza at 534 Winslow Gray Road. Based on the discussion, the Committee supports the application as presented and considers the proposal an improvement over existing conditions. Please contact me should have any questions. Thank you. DM/jlc TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth,1%IA 02664 FILE COPY 508-398-2231 eat. 261 Fax 508-398-0836 May 29, 2007 GCG Associates, Inc. Ms. Heather Chew 84 Main Street Wilmington, MA 01887 Re: YHA Long Pond Plaza-534 Long Pond Drive Dear Ms. Chew: I have reviewed the proposed site plans, dated December 4, 2006, revised, April 4, 2007 for the Yarmouth Housing Authority location at Long Pond Road. My continents are as follows: • All plans shall reflect the address • Denote in table format the number of existing and proposed parking spaces based on demand (refer to zoning bylaw Table 301.5). • The proposed parking spaces triggers a site upgrade as per zoning bylaw Section 301.2— Applicability. All elements that do not comply will require a special permit form the Zoning Board of Appeals Finally, the proposed site changes triggers Site Plan Review pursuant to the provisions of Section 103.3.3. You may obtain an application for this review process on line and submit the packages to the Building Department for scheduling. Very truly, James D. Brandolini, C.B.O. Building Commissioner GCG ASSOCIATES, INC. 84 MAIN STREET WILMINGTON, MA 01887 (978) 657-9714 TO: Jim Brandolini Building Commissioner Town Hall 1146 Route 28 South Yarmouth, MA 02664 WE ARE SENDING YOU: ® Attached . LETTER OF TRANSMITTAL 5�r JOB #: 0638 DATE: May 23, 20 7 ATTENTION: RE: YHA Long Pond Plaza Site Improvement Plans ❑ Under a Separate Cover via Parcel Post ❑ Shop Drawings ❑ Prints ❑ Plans ❑ Copy of This Letter ❑ Change Order ❑ Disk ❑ Specifications COPY DATE NO. DESCRIPTION 1 95% Plan Set for Long Pond Plaza 667-1 1 Copy of Layout Plan including Impervious Area Calc's THESE ARE TRANSMITTED as checked below: ❑ For Approval ❑ For Your Use ❑ As Requested ❑ Approved as Submitted ❑ Approved as Noted ❑ Returned for Corrections ® For Review and Comment REMARKS ❑ Resubmitted ❑ Copy for Distribution ❑ Returned Corrected Enclosed please find the 95% design plan set for Long Pond Plaza along with a layout plan that includes impervious area calculations. Please contact me with any concerns. Thank you for your assistance. FROM: Heather Chew SITE PLAN REVIEW X . FORMAL INFORMAL June 19, 2007 TO: _ASSESSOR (w/o plans) _CONSERVATION _PLANNING DEPT (3) Planning Design Review (s. a W. side only) Econ. Development _HEALTH DEPT IWAMERING DEPT _FIRE DEPT WATER DEPT Town Clerk's Office (2) /w/o plans -for posting ,BUILDING DEPT FROM: James D. Brandolini Building Department SUBJECT: SITE PLAN REVIEW AGENDA TIME: 1:30 NAME OF PROJECT: Long Pond Plaza ADDRESS: 534 Winslow Gray Road MAP: 59 LOT: 44 Chair: BUILDING ! � BUILDING PERMIT FIELD COPY _ ��* 'Q DATE `ems 24, �2pOW PERMIT NO. qO�L APPLICANT Thams ttes 234 Hillpi�pREA7H• Soutladick, MA 01077 (NO.) (STREET) (CONTR'S LICENSE) NUMBER OF PERMIT TO (_) STORY DWELLING UNITS (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) AT (LOCAT,A34 HnSjJW (kW Rd* S• Y- ZONING D STRICT.R40 (NO.) (STREET) v BETWEEN AND m m )CROSS STREET) (CROSS STREET) LOT m SUBDIVISION 59 LOT BLOCK -SIZE U O BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION m 6J—B Z q-y� f TO TYPE USE GROUP • BASEMENT WALLS OR FOUNDATION 4 MALiV7 - yAvyA�aJAyj�,� •nM REMARKS: AREA OR VOLUME. ICUBIC/SQUARE FEET) OWNER ��ffi l L T*J ADDRESS -•"�'g PWd pl'a/ W. 1 ESTIMATED COST $ (TYPE) 35O PERMIT $ N/r FEE B INGDEPT. D• DATE f INSPECTION RECORD NO,TTE PROGRESS - CORRECTIONS AND REMARKS INSPECTOR ONE & TWO FAMILY ONLY - BUILDING PERMIT APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING Town of Yarmouth Building Department 1146 Route 28 • Yarmouth, NIA 02664-1492 Tel: (508) 398-2231 x261 • Fax: (508) 398-2365 ffice Use O ly Permit No. - Dat 6 Permit Fee $ (' ✓ ` Deposit Rec'd. $ to Net Due $ Planning Board Information Plan Type Endorsement Date Recording Date Plan No. Other Assessors Department Information: Map cot iva 0/d New 1.4 Property Dimensions: Lot Area (sO Frontage (ft) Lot (average ' This Section for Office Use Only'• - Building Permit Nu ber: Date Issued: Signature: I &S� Z sC� d o uilding Official Date I I Certificate of Occupa is Is not required Section 1 - Site Information I Use Grou :-A-4.2 Type: 5-B 1.1 Property Address: S3ID ("a 1.2 Zoning Information: Zoning District Proposed Use 1.3 Building Setbacks fit) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided Water Supply (M.G.L. c. 40. S 54) rPublic Private 1.5 Flood Zone Information: Comments: I Zone: BFE: Section 2 - Property Ownership/Authorized Agent 2.1 Go�wpper of Record: 0 �1Ctr i2n6 iflll_ c,�to Na�) Mailing Add ess Signature Telephone 2.2 Ault orized Agent: C - t -MailingAddress rureTelephone Section 3 - Construction Services 3.1 Licensed Construction Supervisor: (75- 03i 7 G f? n1 /a 5 A 2r16r L LGT ,& TR'£ /3 686 Not Applicable ❑ j O o7h W/ A U 10 7) License Number Addresg o Expiration Date " Si nature Telephone 3.2 Registered Home Improvement Contractor: Company Name VA 4 M Not Applicable ❑ Address Signature Telephone License Number Expiration Date 9. 15 - 99 1 of 2 OVER 4 Workers' Compensation Insurance Affidavit (M.G.L c. 152 S 25C Workers Compensation Insurance affidavit must be completed and submitted with this application. Fail6r.r _ to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes .... No .......... Section 5'- Description of Proposed Work (check all applicable) New Construction ❑ I No. of Bedrooms No. of Bathrooms Existing Bldg. ❑ I Repair(s) )a I Alterations ❑ Addition ❑ Accessory Bldg. ❑ Type Demolition Other Specify: Brief Description of Proposed Work: IZ-r Section 6 - Estimated Construction Costs Item Estimated Cost (Dollars) to be completed by permit applicant 1. Building 2. Electrical 3. Plumbing / Gas 4. Mechanical (HVAC) 5. Fire Protection 6.Total =(1 +2+3+4+5) F. Total Square Ft. (new houses & editions) Check Below ❑ Conservation -Commission Filing (if applicable) ❑ Old Kings Highway & Historical Commission approval (if applicable) Section 7a - Owner Authorization - To be Completed When Owner's Agent or Contractor Applies for Building Permit as owrier of the subject property hereby authorize— to act on my behalf 'n all matters relative to work authorized by this building permit application. SI re of Owner Date Section 7b - Owner/Authorized Agent Declaration I, �, - - �� •-•Nu�� _ , 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 Sign a of Owner/Agent Date 9-15-99 2 of 2 0°YAk TOWN OF YARMOUTH ��-`",'..�y BUILDING DEPARTMENT BUILDING PERMIT APPLICATION SIGN Applicant: Permit No.: OFF Address: 9 A�Vzps/ PlW - S;i �"`3'6"el. No.: 920 Date Filed: -o-D Bldg. Site Location: -5-qd 1 Map No.: 5 % Lot No.: The following information outlines the rocedural steps required to obtain a permit to build, alter, or add to a structure within the Town of Yarmouth. The Building Department will determine compliance to the following: (A) Zoning Requirements (B) Historical Districts (C) Flood Zones. The Building Department will be responsible for assisting the applicant through the following departments: RESIDENTIAL AND/OR COMMERCIAL BUILDING WATER DEPARTMENT: Determines Compliance of Water Availability. (applicant to obtain) ENGINEERING DEPARTMENT. Determines Compliance for Parking and Drainage. CONSERVATION COMDIISSION: Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc. HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements for Septage Disposal and other Public Health Activities. FIRE DEPARTMENT. Determines Compliance to State and Town Requirements for Personal Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc. ---------------------------------------- The following Departments must sign off, in the respective order, prior to building inspector issuing the required building permit: REVIEWED BY - I. 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 5. WEIUNG 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. COMMENTS: 8/99 Applicant Signature Date 3i°^k� TOWN OF YARMOUTH 0 r••....... S" BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT. job Location: S N Owner of Property. Construction Supervisor: No. s ; .. i! 1 • � 0 . 1 1 . • Licensed Designee: (If other than Supervisor) Name 2.15 Responsibility of each license holder: License No. Phone No. 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building and structures only pursuant to the state building code and all other applicable laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Any licensee who shall willfullyviolate subsections 2.15.1, 2.15.2 or 2.15.3 or any other section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the roles and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes ❑ No ❑ If you have checked M, 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: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ Signature: Building Official Approval: The Commonwealth of Massachusetts Department of Industrial Accidents Omev8114restlpftllss 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit city Y/)A r4�-L� phone M ❑ I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity (] I am an employer prop iding workers' compensation for my employees working on this job. eomnanv names address: city' phone N• insurance co. policy N 0 [am a sole proprietor. general contractor. or homeowner (circle one) and have hired the contractors listed below who have the following workers' :ompensation polices: company names address• chi y: phone H: insurance co. policy N Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fiat up to S1,5N.00 and/or one years' Imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine ofSI00.00 a day against me. 1 eaderstand that a copy of this statement may be forwardtd to the Office of Investigations of the DU for coverage verifiadoe. I do hereby certify under the pains and penalties ojperjury that the Injormadon provided above is true and eorrem Signature naic Print name Phone 0 official use only do not write in this area to be completed by city or town official city or town: YARMOUTH _ permit4icense 0 C3Building Department p1.1censisg Board p check if immediate response is required 261 ❑Selectmen's Office contact person: (508) 3982231 mot, C3Hcalth Department phone N: _ —nOther Ironed 3,95 %AI Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their enrplo%ees. As quoted from the "law", an enrployee is defined as every person in the service of another under any contract of hire, express or implied. oral or written. An entph,ver is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual . partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance , construction or repair work on such dwelling house or oil the grounds or building appurtenant thereto shall not because of such employment be deemed to be an emplo%er. NIGL chapter 1522 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 far any applicant whn has not produced acceptable evidence of compliance with the insurance coverage required. Additionall%. 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 ha% e been presented to the contracting authorit%. Applicants Please till in the workers' compensation affidavit completely, by checking the box that applies to your situation and 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 fffice If Iaoesdi ttleos 600 Washington Street Boston, Ma. 02111 fax H: (617) 727-7749 phone #: (617) 7274900 ext. 406, 409 or 375 For Office Use Only Permit No. Date TOWN OF YARMOUTH AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c. I42A 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: rz - � Est. Cost �L Address of Work Owner Name: y Date of Permit Application: 5�- -2a -fro 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: _40 03 Contractor Name Registration No. Notwithstanding the above notice, I hereby apply for a permit as the owner of the above BUILDING TOWN OF Y A R M O U T H ELECTRICAL GAS 1146ROUTE28 SOUTHYARDIOUTH NIASSACHUSETTS02664-4451 Telephone (508) 398.2231, Ext. 261 — Fax (508) 398-2365 PLUMBING SIGNS BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at !:5--33t geL :aev z /6w Work Addred is to be disposed of at the following location: �. 91. Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. i Signature of Applicant Permit No. Date BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number. CS 034768 Birthdate: 01/08/1952 Expires: 01/08/2002 Tr. no: 130M Restricted To: 00 THOMAS BARTHELETTE 234 HILLSIDE RD/P 0 BOX 1038 SOUTHWICK. MA 01077 G�l.......'�. ram✓ Administrator Commonbueaftlj of 01a9;2;ad)uq;ett2; �Barngtable Countp �&Ijeriffg Office 10epartnteut of Public &afetp Route 6A, Main Street Barnstable, MA 02630 508-375-6000 Fax 508-362-5023 Sheriff James M. Cummings Community Service Program Integrity, Professionalism, Compassion & Teamwork AGREEMENT ON TERMS OF INMATE LABOR Parties: The Barnstable County Sheriffs Office's Community Service Program and (Organization) Yarmouth Housing Authority (Address) Lone Pond Plaza, South Yarmouth, MA 02664 (Contact person and phone) Catherine Botamar (508) 398-2920 Whereas it is the policy of the Barnstable County Sheriffs Office to find opportunities for individuals in their custody to participate in community activities and programs that enhance their reintegration into the community as well as make reparations and restitution to the community, and Whereas governmental and non-profit agencies seek cost effective assistance and labor to provide services to the citizens and communities of Barnstable County, the above mentioned parties agree to the following: • All individuals participating in Community Service will be carefully screened for their appropriateness for work in the community. • All individuals will be appropriately supervised by Sheriff's Office staff according to the individuals assessed need for community supervision. • No individual in the Sheriffs Office's custody will spend the night at any work site or activity. • All individuals working for a host agency (the organization indicated above) between the hours of 11:30 am and 12:30 pm will be provided lunch by the host agency, and all individuals working for a host agency between the hours of 5:00 pm and 6:00 pm will be provided dinner by the host agency. On behalf of the Sheriffs O Assistant Deputy Superintendent On behalf of the host organization (Print name) Lois B. Steele tr Z"In C r crce9) 'T)rintnnamPl /1W1( te. C Date S = Z?- o t C/ 1�d ,V4 v i TO' ity Date 05/22/00 BARNSTABLE - BOURNE - BREWSTER - CHATHAM - DENNIS - EASTHAM - FALMOUTH - HARWICH - MASHPEE ORLEANS - PROVINCErOWN - SANDWICH - TRURO - WELLFLEET - YARMOUTH T b APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00 TOWN OF YARMOUTH (OFFICE USE ONLY) By r(rr___ Fee: $ G PERMIT NO. (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. ? tt 11ll % DEC 0 7 N0-4 Location (Street & Number`l/ cJ W I l b t7Ge� Co t \Q V r-� Owner or Tenant 7A QK oti-t to VkDu5111� A-T-IJT Telephone No. ���4 � d�� 10 Owner's Address � � M 'p Is this permit in conjunction with a building permit? ❑ Yes ,23LNo (Check Appropriate Box) Purpose of Building _Lyt 4U � XK D1$-aC Utility Authorization No. )Q/A Existing Service, I Amps ((O / a)0 Volts Overhead❑ Undgrd 9L No. of Meters l New Service "�ZK: Amps / Volts Overhead❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed electrical Work: I i4c,`f Aj C 0 _r WO (,O AJJ 4 tadL i0 —LAVA&_ CEJARPAL cQ2 UPW SOplIt' Sys-rzLd Completion of the follow in a table may be waived by the Inspector of Wires No. of d Fixtures No. o Fans No. of Total Transformers KVA No. of Lii!htin2 Out No. of Hot Tubs Generators No. of Lighting Fixtures Above In- SwimmingPool md. ❑ md. ❑ o. of Emergent ting Battery Units No. of Receptacle Outlets o. of Oil Burners FI LARMS No. of Zones No. of Switches No. o as Burners o. o etecuon an Initiating Devices No. of Ranges al No. of Air CTo on . No. of Alerting Devices No. of Waste Disposers Heat mp Totals: um — s — — — No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area He g KW Municipal ❑ Other ❑ Local Connection No. of Dryers rY Heatin liances KW g P Secutity Systems: No. of Devices or ui valent No. of Water Heaters KW No. No. of Si s Ballasts Da iring No. Devices or Equivalent No. H dromassa a Bathtubs Y 8 No. of Motors Total HP Telecommun is Wiring• No. of Device r Equivalent Attach additional detail if desired, or as required by nspector of Wires. .INSURANCE COVERAG • nless waived by the owner, no permit for the performance of electrical work may be issued unless the licensee provides proof of liability ins it including "completed operation' coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhi ed proof of same to the permit issuing office. HECK ONE: INSURANCE BOND ❑ OTHER❑ (Specify:) (Expiration Date) 4Estimated Value of Electrical Work: 1 td (When required by municipal policy.) Work to Start: I a.- (D - 0,0 Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME- tr c-t LD h( LIC. NO. F� 15 t!D Q (r1 - Licensee: `T Signature LIC. NO. E ? Oq _ A (If applicabi enter "exempt" in the license number line. / Bus. Tel. No.: Address: o X l�O c7 U� - lNh`� ��n a.1t660 Alt. Tel. No.: 0 f=0' � -, 3 3 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature °^below, I hereby waive this requirement. I am the (check one) owner ❑ owner's agent. ❑ C,etowner/Agcnt Signature Telephone [Rev. 04/00] 94 d 4 A.A Zw ht w w 44 ZL �V a . Office Use Only ehr �ntnmaltwealth nf.85Bc1eh115tS Permit No. Elcpartintnt of public bafrtp Occupancy A Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 5192 (leave blank) APPLICATION FOR PERMIT TO PERFORM EI All work to be performed in accordance with the Massachusetts Electrical (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) City or Town of - YARMOUTH The udersigned applies for a permit to perform the electrical work described t Location (Street & Number) D34 wlrv�tkw UtviT tcy, Owner or Tenant YA 4OUTH HOUSING AUTHORITY CAL WORK fnAp�ctor GGII..&O Owner's Address 534 WINSLOW GRAY ROAD, S YARMOiT H, MA 02664r 1• •508-398-2920 Is this permit In conjunction with a building permit: Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building RESIDENCE Utility Authorization No. Existing Service Amps _/ Volts Overhead ❑ Undgrnd ❑ No. of Meters New Service Amps _/ Volts Overhead ❑ Undgrnd ❑ - No. of Meters �( c►YjX ROUGH -AND FINISH WIRING OF REMODEL I No. of Lighting Outlets No. of Not Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above �' ❑ ❑ _ gmd. timid. Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners Battery Units No. of Switches No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and No. of Ranges No. of Air Cond. Total . tons Iridatlng Devices No. of Disposals No.of l Tots Pumps It,,,f No. of Sounding Devices No. of Sell Contained No. of Dishwashers SpaWArea Heating KW DeuetionIMounding Devices Local ❑ CMor cipal tl [:)Other No. of Dryers Heating Devices KW No. of No. of Low Voltage No. of Waler Heaters 1I Signs Ballasts Wiring No. Hydro Massage Tubs No. of Motors Total HP Security System OTHER: INSURANCE COVERAGE: Pursuant to the requirements obMassachusans general Laws 1 have a current Liability Insurance Policy including Completed Operations Coverage or Its substantial equivalent. YES O NO O 1 have submitted valid proof of same to the Office. YES O NO O It you have checked YES, please indicate the type of coverage by checking the appropriate bout. INSURANCE 10 BOND O OTHER O (Please Speciy) - GENERAL ACCIDENT' INSURANCE 3/12/99 (Expiration Date) CHECK APPROPRIAIE BOX: I have Worker's Compensation Insurance I have no Employees ❑ Estimaled Value of Electrical Work S Work to Sun Inspection Date Requested: Signed under the Penalties of perjury: Rough ASAP Final WILL CALL yj FIRM NAME LE ES INC uc. No. A14092 Licensee JOHN BREWER Signature A14092 uc. No. Address _u' MA 02554 Bus. Tel. No. _(508 )771-2040 All. Tel. No.�—�T— OWNER•$ INSURANCE WAIVER: 1 am aware that tM ensse noes not hew the insurance coverage of es substantial equivalent as re- qufrad by At�issa; huser! Genc.nt Laws, and Thal my signature on this permit application waives this requirement. Owner Agent N rA O� APPLICATION FOR PERMIT TO INSTALL AND REQUEST FOR ELECTRICAL SERVICE Inspector of Wires % / -/ Wiring Permit # 1/690 COM/Electric # Town of YARMOU TI Massachusetts Building Permit # Date 1.2/3/98 Customer: YA[dvI MI HUTSING AUTHORITY on (Street #) 534 WINSLOW GRAY ROAD, TANG POND PLAZA Lot # in the villaof S YAT MOJFH utility pole number or underground number Customer's billing address 53ge 4 IffNSLOW GRAY ROAD S YARMOUM, rug 02664 Temporary New installation Change of service Starting Date Job description ROTI(;H JATI71 FTNTTRH TnTTRTW, OP RFMC)T)F.T. Service entrance voltage Amperage Phase Wire size (cu. or al.) Conductor per phase Number of meters Water heater Ott peak: Yes— No Estimatedload: Electric heat kw, lights kw, Range dryer Motors, H.P. & Phase Ready for first inspection ASAP Ready for final inspection HULL ('ALTO Electrical ContractorBREWER ELT-rrRIC & UTILITIES, Its # A3.4092 Telephone # 508-394-3211 Address 110 OLD TaINHOUSE ROAD, SCUM YARMOUTH, MA 02 6 Additional Remarks: INSPECTIONS Temporary Service — Roughing in Service and Meter — Off Peak Meter Final Approval Disapproved' 'For the following reasons Do Not Write Below This Line ELECTRICAL WIRING INSPECTION CERTIFICATE INSPECTOR OF WIRES DATE FEE CHARGE CERTIFICATE OF INSPECTION DATE To the COMMONWEALTH ELECTRIC COMPANY. The installation described above has been completed and has this day been inspected and approval granted for connection to your service. Inspector of Wires WIRING INSPECTOR TO BE NOTIFIED WHEN WORK IS READY FOR INSPECTION Permit Good For One Year From Date Of Issue C 46-1 White — COM/Electric Green — Inspector Canary — Town Receipt Pink — Inspector's Copy Goldenrod — Electrical Contractor to COM/Electric 1100 Date WIRE INSPECTOR'S DEPARTMENT YARMOUTH TOWN HALL SOUTH YARMOUTH, MASS. 02664 /g--9-98 Fee 60 = Name of Job �uU� Name of Electrician Location Commonwealtlj of Alaoncljuoetto �Barngtable QCountp &Ijerft Office Department of Public :bafetp Route 6A, Main Street Barnstable, MA 02630 508-375-6000 Fax 508-362-5023 Sheriff James M. Cummings 5/23/00 Town of Yarmouth Municipal building 1146 Route 28 South Yarmouth, MA 02664 Dear Sir/Madam, Integrity, Professionalism, Compassion & Teamwork Regarding Workmen's Compensation Insurance, the Barnstable County Sheriffs Office is self- insured, however our Workmen's Compensation claims are administered by Cook and Company Insurance. The operations of the Sheriff's Office are insured through the Continental Casualty Company. The aggregate limit is one million dollars per year. If you have any questions please call me at (508) 375-6013. ours truly, Matthew J. Murphy, Esq. Staff Attorney BARNSTABLE - BOURNE - BREWSTER - CHATHAM - DENNIS - EASTHAM - FALMOUTH - HARWICH - MASHPEE ORLEANS - PROVINCETOWN - SANDWICH - TRURO - WELLFLEET - YARMOUTH TOWN OF YARMOUTH BOARD OF APPEALS DECISION FILED WITH TOWN CLERK: Novembec24, 1997 PETITION NO: #3433 HEARING DATE: November 14,1997 PETITIONER: Yarmouth Housing Authority PROPERTY: 534 Winslow Grey Road, West Yarmouth Map: 51 Parcel: Z14 Zoning District: R40 ZONING ADMINISTRATOR PRESENT AND VOTING: Leslie Campbell 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 petitioner owns and operates an existing multi -family elderly housing facility, with attendant administrative offices and community function facilities, off of Long Pond Drive and Winslow Grey Road, South Yarmouth. This is an R40 district, and the use is a lawfully pre-existing non- conforming use. The petitioner presently proposes to enlarge this so called "community building" so as to allow the relocation of the administrative functions which are presently interfering with the residents community functions area. No new residential units are proposed. Six (6) new parking spaces will be added, and an additional 11 spaces are provided for on site. The petitioner requests permission to delay construction of those eleven spaces until such time as the Building Inspector determines that they are needed, based upon actual and projected usage of the site. A Special Permit to allow this proposed expansion was granted on June 21, 1996 (#3315) and remains in effect. However, that decision also purported to grant a Variance for the project "to the extent that it is necessary". Because of the passage of more than one year, that Variance has lapsed. The petitioner therefore requests that it be reissued so that the project may now proceed. The petitioner represents that the project remains the same as originally proposed. All other approvals have been secured. The delay in the project was due to a series of events, including the illness of the Executive Director and State budget delays. The Zoning Administrator finds that the project would have qualified for a six (6) month extension of the Variances, had they asked for it prior to the expiration date. Further, the Zoning Administrator is satisfied that the conditions and circumstances present in June 1996 remain 4- unchanged at this time, and incorporates by references the findings and decision #3315. Finally, the Zoning Administrator finds that the need for a Variance is margined, and probably duplicitous, as the relief requested appears to be covered by the Special Permit already granted and in effect. No correspondence was received relative to the petition, nor did anyone appear at the hearing to oppose the request. Therefore, to the extent that any Variance is needed, in addition to the existing Special Permit (#3315), the Zoning Administrator finds that the same conditions and circumstances are present as were found to be the basis for the earlier Variance, and therefore the same Variance is granted at this time, upon the same terms, limitations and conditions as were expressed in said decision #3315. No permit shall issue until 30 days from the filing of this decision with the Town Clerk. Appeals from this decision shall be made pursuant to MGL c40A §17 and must be filed within 30 days after the filing of this notice/decision with the Town Clerk. David S. Reid; Clerk -2- 12110/2014 SlipGen- Portal Home Town of Yarmouth ' Template [Building Dept] iffi Slipsheet Identifier [sg9844] Document Category Building Permits Map -Block Number 059.44 Street Number 0534 Street Name WINSLOW GRAY RD Department Building Parcel ID 8351 Backfile Batch Scan No Document? Additional Naming Info Index Operator Operator, Yarmscan Date - Time 2014-12-10 - 11:29 httpl/Iaserfiche12/SlipGerV 1/1