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HomeMy WebLinkAboutBuilding Permitsl�cco��mmontveaAol Mamacwatf! .1JeParfinanE o�.�are Jarvlcad BOARD OF FIRE PREVENTION REGULATIONS Official Use Only F[Rev�. No. ncy and Fea Checked 7] eavablank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be perfonned in ac cordanco with the Massachusetts Electrical Coda W,C), 5 j CMR 12.00 ,WEPR/NTININKOR ALLINFORMAMA9 Date: City or Town of: Y�P-M D UTH To the Inspector of Wires: this application the undersign gives notice of his orher intention to Perform the electrical work described below. anon (Street &Number) a5 � /�(� A-/JO, orTenant s Address Telephone No. Omit in conJnnctiQn with a buildto �rmltp yes ® No ofBurlding �� ❑ (CheckApproprlateBox) Utility Authorizatlan No. Service I * Amps ZI / Zlf UVolts Overhead] Undgrd 1­1 No orxr t New Service Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: of Recessed Luminaires of Luminaire Outlets of Luminaires of Receptacle Outlets of Switches of Ranges of Waste Disposers of Dishwashers of Dryers KW Ifydromnssage Bathtubs e erg Overhead 11 Of CeiL-Srsp. (Paddle) Fans of Hot Tabs mmIngPool ove ❑ n. grnd. gr of Oil Burners of Gas Burners ofAir Cmd. ,,,o a ce/Area Beating KW itingAppllances XW 0 OK o Signs Ballasts of Motors Total 11P Undgrd ❑ No, of Meters nQ TIF2 le m be waived b the Ins ector o G, oKota VAansformersnerators KVA. o mergencyg gtte Units 1E ALARMS No. of Zones of Alerting Devices ❑munici al Cormc%an ❑ fie' Estimated Value of a cal Work: �, /17 "`"runuaauronat oetatt (destred, or as required by the Inspector ofWtres. Work to Stan I ='�� (When required by municipal policy.) I Inspections to be reqaested in accordance with WC 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 coverage is in force, and has exhibited proof of same to the permit issuing ofiloe. CHECK ONE: INSURANCE ® BOND [I OTHER ❑ (Specify:) I cerft underthepalns ondpenaldes ofperjury, that the Information on this 1/ ati FIRM NAME: % d! 11,1/I ( I f 1 f7 i ( �,{ j� J (� aPP c on it true and con pieta Licensee: A IJb}2 Eb1J LIC. NO.: Ih 31 �R Z sJ NO.• 3 (Ifapp/teab/e, enter exem Y'tn the lfcensamrmbe 11.11a) Signature LIC. �12 Address: Bus. TeL No..,D >9L-3qS_0I *Per M,O.L. o.147, s. 57-61, secmitywork quires Department Lf publio Safety "S"License. AlLLicLNo. : 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/Agent ❑ owner's agent Signature Telephone No. p�F $ W > .•., N a . uJ _ WJcv1,z O V kilO W D to m Coinow, r weaR of M,4.4ae"ffi [ocupancy Official Use On Cc'X� C� ermit No. 3 — I Only 2,parlmenf o/-7iry Services ' and Fee Checked BOARD OF FIRE PREWVENTION REGULATIONS v. 1/D7] _ peaveblank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be perfona.-d in accordance with the Massachusetts Electrical Code (ME 527 12.DO (PLE4SE PRINT ININK ORTYPE ALL INFORA 77ON9 Date: 5'/Z9 13 City or Tow% of. YARMOUTH To the Inspector of Wires: By this application the pndersigned gives nonce of his or her intention to perform the -electrical work described below. Location (Street &Number) ZS t �I.aC f In YACr'16UI& PC) (+ Owner'orTenant /`1anEk \-An Telephone No.SO$ rs wner's Address this permit in conjunction with a building permit? Yes l? ❑ (Chick Appropriate Box) Purpose of Banding 0���.^�� Utility Authorization No. P-rxistiag Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Vew Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Dumber of Feeders and Ampacity and Nature of Proposed Work: No. of Recessed Luminaires wrnazrszon or me ouawdz? No. of CeiL-Susp. (Paddle) Fans table may be watved by the Irsoector of Wirer. o, of Total Transformers KVA No. of Lumiaafre Outie� No, of Hot Tubs G aerators ",VA No, of Luminaires Snzmming Pool A ove ❑ a- ❑ o, o mergency g ring (Battery erred erred UIlItS 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 No. of Air Cond. Toes No. of Alerting Devices No. of Waste Disposers eat Pump umber ores o, of elf ontarne Totals: Detection/Alertin- Devices No. of Dishwashers Space/Area Heating KW Local ❑ !! uniupal El Other Connection No, of Dryers Heating Appliances MV ecunty Systems: - No -of ater No. of Devices or Equivalent Heaters °• 01 No. o KW Datallo. Sims Ballasts of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP elecommunicanons inng: No. of Devices or uivalent OTHER: •�.. Estimated Value of Electrical Wor1r Q towe Lrc4 or ar required by the inspector of Wires. O p (When required by municipal policy.) Work to Start: 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 tout ge 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 ofperjury, that the information on this application is true and complete. FIRM NAME: C LIC NO.:vA License: ���4 �Thr Signature LIC. NO. Z 3, Addrr. Bus. Tel. No. G licdble, enter "exempt "tn the Genre number tine.) • C71� 6�j Q 13 l AddresAlt. Tel. No.: J 'Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lie. No. - OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage n— Owner/Agent S required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner El owner's agent Signature Telephone No. PERMIT FEE: $ 25 Wharf Lane Yarmouth Port, MA 02675 Hand Delivered SEP 2 3 2013 September23, 2013" �� ^'� ut''^ tTr`., Nr Mr. Ken Elliott Electrical Inspector Town of Yarmouth 1146 Route 28 South Yarmouth, MA 02664 RE: 25 Wharf Lane, Yarmouth Port Dear Mr. Elliot, Please accept this letter as confirmation that Davenport Companies hired Harwichport Heating and Cooling to complete the project at my residence that was not completed by another contractor. Should you have any questions please do not hesitate to contact me at 508-375-0054 or my son, Patrick Foran at 774-836-0182. Sincerely, P Foran M. Grylls P. Foran Sev.26. 2013 7:33AM a e� TOWN OF XARMOUTH BUILDING DBPARTMENT 1146 Route 29, South Yarmouth MA 02664 508-398-2231 eA261 FAX 508-398.0836 Permit Number Date Issued Expiration Date . Request for Electrical Inspection Date of Requested Inspection 5 Wr ��Ne� Type Of Inspection Requested: drench_ Service -Other, Electrician Rough No.0352 P. 1 ash NSnalLA— 9 -IN S rez.-r Failure to Complete this Norm properly, may result in delayed inspection. It is the responsibilityof the electrician to arrange for inspection. We do not contact the homeowner. Hand Delivered September 23, 2013 Mr. Ken Elliott Electrical Inspector Town of Yarmouth 1146 Route 28 South Yarmouth, MA 02664 RE: 25 Wharf Lane, Yarmouth Port Dear Mr. Elliot, 25 Wharf Lane Yarmouth Port, MA 02675 SFP 2 3 2013 BUILDING DLPA R F rIr.ILNT Ay ---- Please accept this letter as confirmation that Davenport Companies hired Harwichport Heating and Cooling to complete the project at my residence that was not completed by another contractor. Should you have any questions please do not hesitate to contact me at 508-375-0054 or my son, Patrick Foran at774-836-0182. Sincerely, P Foran M. Grylls P. Foran RM 0 AArr �N OW w m Q, Z v z o J_ LLI --) m 1� yoffici�l Usa Only� rr Permit No. �? _� Occupancy and Fee Checked [Rev.1/071 eaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code C), 521 CMR 12.00 EASEPRIN JYLVKORT�PEAILINFORMATT011� Date: Z.I 1.5 City or Town of: �' till d UTH To the I act of Wires. this application the undersigned gives notice of his or her intention to perform the electrical work described below. ration (Street & Number) 25 IAu-{i1-{Q .t:7 IA -MC, l ccon manwsa& al�clmalsa�Jckeff! ..UaParfmanf a�.}Ira Jarvical BOARD OF FIRE PREVENTION REGULATIONS or Tenant s Address Telephone No. permit In con janctiVo�n �with a building permit? Yes ❑ Non (Check Appropriate Box) se of Building_ PSCA NU,; Utility Authorization No. igServiceR U Amps I2 1 Volts Overhead® Undgrd❑ No. of Meters Amps / Volts Number of Feeders and Amps city Location and Nature of Proposed i Work: Overhead ❑ Undgrd ❑ No. of Meters No. of Recessed Luminaires m .euon o me ouowin No. of Cell.-Susp. (Paddle) Fans table be waived b the I actor of Wires. o• OF o a Transformers KVA No. of LuminaIre Outlets No. of IIot Tubs Generators KVA No. of Luminaires Swimming Pool e ❑ ' ❑ tte Unrigency g ng rnd d. B No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No—.oTDetection an Initlatln Devices No. of Ranges No. ofAir Cond. Tons No. of Alerting Devices No. of Waste Disposers eat ump Totals: nm er ors . o e - onta ne Deote on/Alertin Devices No. of Dishwashers Space/Area Heating KW Local ❑ Cun c pa �� onnection ❑ No. of Dryers Heating Appliances KW ecnrity Systems: o. of Water No. of Devices or E ivalent o• o o. of IIeaters' DatNo. Si s Ballasts o Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP a ecommumcations irm' Mg• No. of Devices or Equivalent OTHER: Estimated Value o Electrical Work: 6"0 v u�'r�4 or as regwrea by me inspector of wires (When required by municipal policy.) Work to Start Inspections to be requested in accordance with IvMC Rule 10, and upon completion. INSURANCE C VE : Unless waived by the owner, no penult for the performance of electrical work may issue unless the licensee pmvi es proof of liability insurance including "completed operation" coverage or its substantial equivalent The undersigned certI es that such coverage Is in force, and has exhibited proof of same to the permit issuing offioo. C IECKONE: INSURANCE N BOND ❑ OTHER ❑ (Specify:) I certtry, under the pains and penaltles ofperJury, that the information on this appllcatlon is true and conTlete. FIRM NAME: iWWI XY j o i7"t '[A U�,iN6, lily ii LIC NO.: 0 3'10 A Licensee: le enter "M "i the U Signature LIC. NO. - applicable 1 (Ijapplicable, enter "erem t" fn the ltcemenumbe li e) us. TeL No.• �] 6 Address: Alt Tel. No.: ^0 *Per M O.L. c.147. s 57-61, security work quires neparhnent Publlo Safety "S" License: Lie. No. `J OWNER'S INSURANCE WAIVER I am aware that the Licensee does not have the liability insurance coverage normally Owner/Agent by taw. By my signature below, I hereby waive this requirement, I am the (check one ❑ owner El owner's ent Agent Signature Telephone No. PERMT FEE. $ `jQ— vAA P TYPE OR PRINT CLEARLY MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY I if 7-11 1 MA DATE PERMIT # &,3 --7b7 JOBSITE ADDRESS — L ,WC OWNER'SNAME rrA.� OWNERADDRESS TEL FAX OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL t4 NEW. ❑ RENOVATION:0 REPLACEMENT: ❑ PLANS SUBMITTED: YES ❑ NO[] I FIXTURES 1 FLOOR—+ BSM 1 2 3 4 5 6 7 a 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/01USAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR 1 AREA DRAIN INTERCEPTOR INTERIOR KITCHEN SINK LAVATORY ROOF DRAIN SHOWERS SERVICE I MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER MEN - INSURANCE COVERAGE: I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES ❑ NO ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW 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: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under the permit Issued for this application will be In compliance with all ertlnent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. � �c6tMl s,�.cr..Y. w� PLUMBER'S NAME I Andrew Levesque I LICENSE # PL15162 T SIGN ( RE MP❑ •JPQ CORPORATIONO#PARTNERSHIP❑#OLLC❑#0 COMPANY'NAME1 Harwich Port Heating & Cooling, In JADDRESS 461 Lower County Road ig CITY Harwich Port STATE Ma ZIP 102646 TEL t FAX 508-032 6075 CELL EMAIL I julie@h6WchportheaUngandcooling.com 0 ROUGH PLUMBING INSPECTION NOTES 0171-pZ,67 S% /3 BELOW FOR OFFICE, USE, ONLY Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT # PLAN REVIEW NOTES FINAL TNSPEMON NOTF,S AL G TYPE OR PRINT CLEARLY MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY DMA DATE ,> � PERMIT # kl " 001/ JOBSITE ADDRESS OWNER'S NAME OWNERADDRESS TEC OCCUPANCYTYPE COMMERCIAL© EDUCATIONAL] NEW:© RENOVATION:Dr REPLACEMENT:© FLOORS-+ I BSM I 1 1 z 1 9 a c FA RESIDENTIAL® PLANS SUBMITTED: YES© NO© 10 1 11 1 12 1 13 14 I have a current liabilityinsurance policy or its substantial equlvaientwhlch meets the requirements of MGL. Ch.142 YES 21NO [J I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 5g OTHER TYPE INDEMNITY © BOND E] 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 El -•-•, -•-- �.� �..... a.lu inlunnauun i nave suommted or entered regarding this application are true and accurate to the best of m kknowledge and that all plumbing work and installations performed under the permit issued for this epplication will be in complla a with ell Pertl nt provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. v PLUMB ER-GASFITTER NAME Andrew Leves ue LICENSE # PL15166�2 NATU MP,O MGF® JPD JGFQ LPGI© CORPORATION[]# 3184 PARTNERSHIP© LLCQ# COMPANY NAMEf Hanvlch Port Heating and Cooling Inc ADDRESS 1461 Lower County Road CITY Hann Ch Port STATE® 77 02646 . TEL 508-432-395 r� Ic FAX 508 432-60751 CEL EMAIy n LRH L_ U; ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY Yes No THIS APPLICATIONSERVES ASTHE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES FINAL INSPECTION NOTES v.- qJ ONE & TWO FAMILY ONLY — BUILDING PERMIT 3Y O APPLICATION TO CONSTRUCT', REPAIR. RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWEL11NO or y Town of Yarmouth Building Department 1146 Route 28 • South Yarmouth, MA 02664-4492 508-398-2231 ext.1261 Fax 508-398-0836 oma use orgy Lcq1 Planning Board Ink adm Attestors MparmNre infarmauw Permit No L DA"w ra Permit Fee S 3S t:roorsement oxe - Deposit Reed. $ yJ C Date j(4n Da" 1A Property Dimeaft et,. Nef Oue $ J ome► roe an 00 frawa• lM Int cov.aee l5.alon fbr can U" Oft Btjgdkv Peenft NumberI Elm Itteu ;' • • "y'•••••� (irMtlifCat���{'.tl�alte� r` oel�•. N Ynof• ngtiet SscOon 1 • StM fnf M1111fon I US@ C3r0ujz. R-4 7vw.5 B 1.1 FMP*b AYwaa t.2 Zargrp tntarmafton: ! n R _ yo QeS,d���.4 Zoning District Proposed Use �� M ace s 1.3 RuNdbili a (11) Front Yard Side Yards Rear Yard R Prtrvided d; Provided R fired Provided 1.4 waftr ft"ft tit. e. 40. a a1) 1.3 F10W Zbne bft oft CarrenwRee Pima ale Tdm BF[? .geCl1Q1 Z • QWllefef II Alr@1n112ed 2.1 nw of Il6eero p oa675 �»1 I � � s MaiergAddr.t. TelepRone Aqw t 1MFNT Neme(prtrH) pUil pt n.� MaimgAaerese Sauk" reteptrone Fax Sectbn 3 • CCnStrIJCtlpR SBNfCea &I %Lkenzed us" NoolAppkabie MA c>i N ..�"S /A 060 qko �' •9 Expir • Dalq sz� TMepnone ad Horne I ant Contractor: e�tr tN.sa. Not Apple" Q Q11QN t.reente Number ✓ 50Y. 3 9 it 7ai3 Evition to /laol4 v 1 w c / OVER -�T"".'*ii3'�.'`1i"�'C�T„':T"�°'� , f'7"�t"�':�►�,�";"T��t:�>�ii��l WorkM Compensation Inumance allldavlt nest be coo Voted and aubrnNW with this appr adon. Falltm to provide this of klavlt will result In the denial of ft Isamme of the bull ft penTOL Signed AMdavit Attached a .......... No .»....... seedon ll• ae wbrlt efteefe at New Cantrur o= ❑ INLdbanrn Na al tkthraome l �dslkep ft ❑ IROW#E3 lAftftmlg JAMm(31 Accessory Mg. ❑ ripe Danditlan cow Spear 8ealbn Q- Eatlin ted CatabucdM CWW Item Ealkn.t.d Coat (OoMan) to be eampww by pwmn appaeanl 1. zEWCMcd a a / Gas s. M*dWdeal(HVAQ s. Fire PfoOICrrar rLTbtat■(1 *2+3•e•3) I. row 8*We FL pW h0 a.sataaf D I Cheek Below i Cl Cm@wvsdmCmmbdm FMV ix ❑ otd Ick,oa Htgewsy a FRalorteal Callml approval (fappeeable) 1, —' d` tq i-o ct 0�% . as owner of the aeb jest pips, hereby authorize`• ��w, ��ln __Qcv+► Q'.Icy' ' to act on ry b matters relative to work auftflzQ by this buiwg permit appkatiort. �e / 3 A013 Section 7D - awrmWAut Wznd A sit Dedaratlort as OwnsdAutha tied Agent hereby declare that the statemaets and irfofmation on the loregeing application an true and accurate. to the bed of my knowledge and brief. SIWOdd under the pains and penaltlN�of peerjury. � --Qvr I 4C%jt—DV+ of 2d2 R1 TOWN OF YARMOUTH a BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRIM} job Location: as �Gri� �aht YU�tft^✓a1� /�� Numbers Street Owner of Property: Construction Supervisor. License Address: o10 f 2oA M ' .SA14 I Xewn-eulr AAA =40 Licensed Designee: (If other than Supervisor) nnmc 2.15 Responsibility of each license holder. License No. y Alm Phone No. 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building and structures only pursuant to the state building code and all other applicable laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Any licensee who shall willfullyviolate subsections 2.15.1, 2.15.2 or 2.15.3 or any other section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. i understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVE AGE: I have a current lity insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes No If you have checked ygu, please Indic a the type coverage by checking the appropriate box. A liability insurance policy Other type of indemnity ❑ Bond OWNER'S INSURANCE WAIVER: 1 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 ojMassaehnseM Department ofIndustrial Accidents Office ojlnvestigadons 600 Washington Stred Boston, MA 02111 www.mass:gov/dla Workers' Compensation Insurance Affidavit: Bullders/Contractors/ElectrfclansMlumbers )RUCantlnformaHnn Name(Bn,ioesa/pr�niutiodrndividoal): M-f1 (At L ii Phone an employer? Cheek tie appropriate box: I I am a employer with 4. ❑ I am a general contractor and I employees (thll 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.[31 am a homeowner doing all work myself. [No worker' comp. insurance required.] t 3a.131 am a homeowner acting as a general contractor (refer to #4) have hired the snb mvgctors listed on the attached sheet These sub-contrttcoo:g have employees and have worker' comp, insurance.t 5• ❑ We am a corporation and its Officers; have exercised their right of exemption per MGL C. 152. § 1(4). and we have no emPloi'm• [No worker' comp. insurance I rIFORemodeling ct (required): ns action tion 9. ❑ Building addition 10.13Electrical repairs or additions 11.❑ Plumbing repair or additions 12.0 Roof repairs 13.❑ Other ;Any VPUC" that checb box KI and am rm out dw section below showing � wottaa' L [ Hottteow th who ck t fhb atltdavit ht Cuing theY am doing tit work and dhea bite amid f oaeY �dm tConaaetoie tbu ebxk this boat must aaacbed as additioeat sheet showing the Rams hi tha tow submit a never affidavit indicating atteh. euPloresa. Ilthe tnb-eanuaeeon have employees, tit y must pm„W their w'orlcen. comp. Polk? Bomber, wbedwor rat thom eoMla have ! an an ewployrr that h provldlnd workers' eompercradon irttarnnce or lnjoraradom I My envoyetm Below h the po/ley and fob site Insurance Company Policy 0 or Self -ins. Lic. 0: 1 / ff �; S Expiration Date: 3 0/ .Zd l y Job site Address: )r—(,e,;,«r� Attach a copy a the worker' compensation policy declaration page (showing the policy number and expiration date). fi75 ne up to 1,50e.0an as required tmder Section 25A of MGL c.152 can lead to the imposition of criminal penalties fins up to S I.500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and of fine of tip to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigadom of the DIA for insurarme coverage verification. ! do hereby andNnaffa jper/rry that the brjoraration profiled abort h irate and eonret J/- 36 7.Old QQl W rye o►rlj. Do not wrfbr in L% area, as be evmpided by c4 or tones of)?dd City or Town: PermlttUcense N Issufn= Authority (circle one): 1. Board of Health 2. Building Department 3. Cityrrown Clerk 4. Electrical Inspector S. Plumbing Inspector 6.Other Contact Person: Moe* TOWN OF YARMOUTH c BUILDING DEPARTMENT c y 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext.1261 Fax 508-398-0836 l+rn• c�3 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_o7-T-Li arl &nt y4/.+•04V Work Address Is to be disposed of at the following locatio O - C Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. 5�x� /3 A013 Signature of Application Date Permit No. For Office Use Only Permit No. Date TOWN OF YARMOUTH ' AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c 142A requires that the 'reco L*uctia% altmldcno renov2dca, repair, modemiation, conversion, imprmemeit, removal, demolition or wnstr�m of an addition to my p v cdstmg ownawoccupied building cmuining at least me but not mac than four dwelling unit or stiactua which are adjacent to such reaidence or buflc ' be done by registered cmtractora, with certtin exceptiau, along with other requimentL 1 Type of Work: +eeA-a K ESL Cost SAS O® Address of Work er 0)4(75 Owner Name: a4.j Date of Pezmit Application: 3 O I hereby certify that: Registration is not required for the followvrg 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 o f perjury: I hereby apply for a permit as the agent of the owner: �,� ► 3 moist �,�� M M� �r�►•�;� l•�. lo6o,�y Date Contractor N=6 Registration No. OR: Notwithstanding the dbove notice, I hereby apply .for a permit as the owner of the above property. Date Owner Name Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 106024 Type: Trust i_7.+`-'`` Expiration: 7/21/2014 Tr# 226884 DAVENPORT BUILDING COMPANYTRUST Dewitt Davenport = _ 20 North Main Street 'y ' South Yarmouth, MA 02664 11 ti.. Update Address and return card. Mark reason for change. -- []Address Renewal Employment Lost Card SCA 1 A 20M-05111 Office of consumer Affairs & Business Regulation ME IMPROVEMENT CONTRACTOR egistration: ..166024 Type: xpiration: �,,7121)2Q14� Trust 1� DAVENPORT BUILDING cOMPAM'rfRUST Dewitt Davenport 20 North Main Street - South Yarmouth, MA 02664 . Undersecretary License or registration valid for individul use only before the expiration date. If found return to: office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, MA 02116 Notvali wi outsignature +% \lassachusctts - Dcp: itmcnt (if' Plllllic Safct" Boar(i or Buildim_ Rcsulations and Statnlards Construction Supervisor License License: CS 12060 Ya�k DEWITT P DAVENPORT ,4L .P.` 1 20 N MAIN ST S YARMOUTH, MA 02664 Expiration: 11/2412013 Tr': 7314 OP ID: KD • • .�� DATE (MMIDDKYYY) A�oRo° CERTIFICATE OF LIABILITY INSURANCE 04/01/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: It the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . 1-1-11 PRODUCER Phone: 610.279-8550 The Addis Group, Inc. Fax: 610.279.8543 2500 Renaissance Blvd. Ste 100 King of Prussia, PA 1940G-2772 Jeffrey A. Grebe INSURED Davenport Building Co. c/o Davenport Realty Trust Stephen Aschettino 20 North Main St South Yarmouth„ MA 02664 NAME• PHONE FAX No: E-MAIL ADDRE PRODUCER . DAVEN-1 INSURERS AFFORDING COVERAGE NAI INSURER A: American Zurich insurance CO. 40142 INSURER 9:Zurich American Insurance Co. 16535 INSURER C: INSURER D: •1eCO OVERAGES crm I irwh I C r1.,,.. -- BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Q OCCUR - PREMI Ea of nce f MED EXP (Any oneperson) S PERSONAL f ADV INJURY f GENERAL AGGREGATE S PRODUCTS - COMPIOP AGG f AGGREGATE LIMIT APPLIES PER: PRO, LOC GENTrAUTO S 03/01/2013 03/0112014 COMBINED SINGLE LIMIT f (Ea acddenl) BBAP8196256 LIABILITY UTOS AUTOS NON -OWNED ALTOS BODILY INJURY(Per portion)f BODILY INJURY (Per accident) S PROPERTY DAMAGE(Per acddenqS S X S UMBRELLA LIAR OCCUR EXCESS LIAB CLAIMS -MADE AGGREGATE f f DEDUCTIBLE f WORKERS GUMrcmwuvn 1 AND EMPLOYERY LIABILITY C8196035 0310112013 0310112014 E.L EACH ACCIDENT s A ANY PR PRIETRIPARNERRIELUDED? EC�E Y� NIA E.L. DISEASE -EA EMPLOYEE $ 1 (Mandatory In NH 1 ( ry ) E.L. DISEASE • POLICY OMIT f I ea,desWDN und OF'O DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If mom space Is required) Town of Yarmouth 1146 Route 26 South Yarmouth, MA 02664 ACORD 25 (2009109) TOWNOFY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 01988.2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD E:E_ICi:.IVE0 JUN 14 2013 13UILDING DE-1 ARILIENT fly - Hand Delivered June 14, 2013 Mr. Mark A. Grylls Building Commissioner Town of Yarmouth 1146 Route 28 South Yarmouth, MA 02664 RE : 25 Wharf Lane Permit Number B-13-1116 Dear Mr. Grylls, 25 Wharf Lane Yarmouth Port, MA 02675 Please be advised that effective June 12, 2013 M1 Nardone Carpentry, LLC was terminated from working on my home at 25 Wharf Lane in Yarmouth Port. I have engaged the services of Davenport Building Company to complete the job. Please accept this letter as formal notification of a change in the General Contractor for the work being done at my property effective immediately. Please transfer the existing permit to the Davenport Building Company Immediately. Should you have any questions please contact my Attorney, Michael Angelinl at 508-791-3511. Your immediate attention to this matter is greatly appreciated. P. Foran Cc: P. Foran M. Angelini, Esq. C. Davenport ONE & TWO FAMILY ONLY — BUILDING PERMIT APPLICATION TO CONSTRUCT, REPAIR. RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING o y Town of Yarmouth Building Department ,e�o,�, •� 1146 Route 28 • South Yarmouth, MA 02664-4492 508-398-2231 ext.1261 Fax 508-398-0836 y�owe use or q Plat+ning goad Irdonnalen Assessors Deparftard Information: Permit No. �` Date Plan Type "w tat Permit Fee S� "" °ite /?/ / _` evading Dan Yew Deposit Rec'd. S Date 1�1 Net Due otiror ea (sf)6 rmma�e tm Im co�rao. TAk 58cdon toe OEbs use Offt Bylkkq PerrDitNumbeft. Dkft Iatuack : .'2 �:'�- CefWtcadloitObctfp ...: ..rt 0111e1dra • . pelf:.. If _ � � feQt�'... . sex wn s - aaaf IrIMM f MY I Use a : R-4 T : 5-B 1.1 Prrrperly A/titas 1.2 Zoning hdarrradw: as tv { Zoning Di ict Proposed U e 1.0 Building Sotbacr. InI Front Yard Side Yards Rear Yard ReMired �rovided R� �i;ed Provided ,w R fired Provided 3 -26-41t LFrw/viw 1-4(2V esioob ILLQL. e. 410. i s Private Zp BF@ Section 2 - PmpwW Ownersm Auttt &ed 2.1 of Iraeeedr Ire Name Wring Address 3U 7-7t —99Z7 Tebpftone ZZ Aa herbwd A�wrh gnAadup Address _!, S�r1e 7elepf m Fex 3eCtion 3 - ConsMxtfon Services ` 1 &, DWI /U�7m, FE fJatAppfoapy a v La AAA � � -- ,peons. Nurnbar Etpiration Date srona TNepnone M2 R9413110rod Home 1 ent Contractor: / h p°f Ifarnr! W NO ApO cable Q efepfKxw Expiration Date 1oft OVER IWorkett Compensation Ina lmm'e affidavit moat be completed and a kmNW with this application. Fallon to provide this affidavlt wil result In the dental of the Issuance of the building pemrit I Signed Affidavit Attached Yes ..K.... No .......... I Now Carotrtrdloe O . IVn of Bedrooms Ma d ttathr &m +o Ilid¢ Rp*(s) O ArteallM Admdat U Accessory Bldg. (3 Type Demolition other specify: Odef Qescript M of Pmposod Work ' ll, /WO/ A4r ki-�,c� gem" a- t:stimated Cdndnrdfon Coate Item Esdmated Cast Potts) to be Cheek Below ear+pNled by pemnR apppeare 1.sufty0 Cl Conseev—.4-11-Com ftelon F ft Z ENcef d (If appueable) 3. / Gas 4. Medwical WAq ?GrVm I t hw.y A Mkxleal S. Fire PeolecM Ca ft"W m approve! & Tbad . (t ♦ 2 ♦ 3 ♦ 4 + 5 (it aPPkable) 7. rotd !Square tti Inwnaeos w0 ls OwneftAdo0or anksclorAppiles for Bu Pom* 1. , as owner of the subject property hereby authorize Ad ZT— AfAzZbM cr- to act on r f" all In a� relod" to wont authorized by this buking permit appicattn. °r Oats 8sctlon7tl-Ow wdAuftdzedAgtrttOodmi—fti •� ` 0��"� 1. . as Ownw/Authortzed Agent hereby declare that the statements and lrrformak n on the foregoing appticatlon are tree and accurate. to the bed of my krawledgo and boost. Signed under the pains and penalties of perituy. !M - Prim Pare 417nakwe of age 9.11.99 2 012 TOWN OF YARMOUTH BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT: job Location: o2� Number Owner of Property: d111&e,1 Lti Construction Supervisor. !M . J /Ur; tLyo%--c Name License Address: Village Licensed Designee: (If other than Supervisor) Name License No. 5! & --,D/ c Phone No. 2.15 Responsibility of each license holder: 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building and structures only pursuant to the state building code and all other applicable laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Any licensee who shall willfullyviolate subsections 2.15.1, 2.15.2 or 2.15.3 or anyother section of these riles 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 constriction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes 0— No It you have checked M. please indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of indemnity ❑ Bond El OWNER'S WoSfUth C WAIVER: I am aware that the ►icensee does not have the insurance coverage required by Chapter15a s. General Laws, and that my signature on this permit application waives this requirement. Ch k one: Signature of a or owner's Agent Owner Agent FJ Signature: Building Official Approval: For Office Use Only Permit No. Date TOWN OF YARMOUTH AFFIDAVIT Rome Improvement Contractor Law Supplement to Permit Application MGL c. 142A requires that the 'reconstruction, alteration, renovation, repair, modemiration, conversion, improvernent, 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: &0w Est. Cost — Address of Work Owner Name: Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000 Building not owner occupied Owner pulling own permit Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner. - /q. J rvPV?dvu Date Co or Name Registration No. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 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 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at �5 Gi`7n y Work AddressO 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. IAAC� —�O Sin ture of Application Date Permit No. _ CJf?P W01,9"7t"w*a&1 0 Office of Consumer Affairs and Bu mess Regulation - 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration C'ed_'.W�.i• --- - — Reqistration: 135887 J Type: Ltd Liability Corpor • i......_..._ ,, .._�.__':.1> Expiration: 5/16/2014 Tr# 222824 M J NARDONE CARPENTRY LLC. MICHAEL NARDONE 299 WHITES PATH SOUTH YARMOUTH, MA 02664 Update Address and return card. I4fark reason for change. = Address Renewal ❑ Employment Lost Card aA1assachusetts - Department of Public Safet' Board of Building Regulations and Standards Constructlor Supervisor License License: CS 81139 ' 1 MICHAELJ NARDONE 299 WHITES PATF�;, S YARMOUTH, MA 02664 Cummissioner Office of Consumer Affairs & Busi ess Regulation ME IMPROVEMENT CONTRACTOR MV9lstration: ,M887 Type: plratlon:-5146/2t114 =. Ltd Liability Corpor JDO�E CARPITRY LfC Expiration: 9/162013 Tr#:•1706 License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, MA 02116 MICHAEL NARDONET 299 WHITES SOUTH YARMOUTH, MA r02664' �— Uudersecretary 9AOvalid without signature The Commonwealth of Massachusetts Department oflndustrialAccidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Print Form Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lezibly Name (Business/Organization/Individual): MJ. Nardone Carpentry LLC Address:299 White's Path Are you an employer? Check the appropriate box: 1.❑ I am a employer with 6 4. ❑ I am a general contractor and I emolovees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t listed on the attached sheet. These sub -contractors have 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.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions I I.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other 'Any applicant that checks box # 1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating 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 sub -contractors have employees, they must provide their workers' comp. policy number. lam an employer that it providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: AmGUARD Insurance Company Policy # or Self -ins. Lic. #:MJWC348502 Expiration Date:04/25/2013 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 S1,500.00 and/or one-year imprisonment, as well as civil penalties in the fort 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 ury/Iq#)rJre�%iains and penalties ojperJury that the Information provided above is true and correct Official use only. Do not write in this area, to be completed by city or town official, 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 #: NOTICE TO EMPLOYEES NOTICE TO EMPLOYEES The Commonwealth of Massachusetts DEPARTMENT • OF INDUSTRIAL ACCIDENTS 600 Washington Street, Boston, Massachusetts 02111 617-727-4900 As required by Massachusetts General Law, Chapter 152, Sections 21, 22 & 30, this will give you notice that I (we) have provided for payment to our injured employees under the above mentioned chapter by insuring with: AmGUARD Insurance Company NAME; OF INSURANCE COMPANY P.O. Box A-H 16 South River Street Wilkes-Barre, PA 18703-0020 ADDRESS OF INSURANCE COMPANY MIWC348502 04/25/2012 04/25/2013 POLICY NUMBER EFFECTIVE DATES DOWLING & O'NEIL INS AGY 973 Iyannough Road P.O. Box 1990 508-775-1620 Hyannis, MA_02601 NAINIE OF INSUILAUNCE AGENT ADDRESS PHONE MI Nardone Carpentry LLC 299 White's Path South Yarmouth MA 02664 EMPLOYER ADDRESS EMPLOYER'S WORKERS COMPENSATION OFFICER (IF ANY) MEDICAL TREATMENT 05/02/2012 DATE The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee'may select his or her own physician. The reasonable cost of the ser- vices provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NAME OF HOSPITAL. ADDRESS TO ]BE POSTED BY EMPLOYER TOWN OF YARMOUTH - Building Department _ Town Hall ft. Yarmouth, MA 02664 (508) 398.2231 ext.1281 BUILDING PERMIT TRANSMITTAL Temp Permit No.: T-13-295 Applicant Name: M. J. Nardone Applicant Phone: 5087719927 Building Location: 0025 WHARF LN Owner's Name: John Foran Owner's Addres 0025 WHARF LN Yarmouth Port MA 02675 Owner's Telephone: (508) 771-9927 REVIEWED BY: (OFFICE USE ONLY Recorded By: Ic Permit Fee: $0.00 Deposit Rec: $25.00 Payment Type: Check ChkNo.: 5021 Net Owed: ($25.00) Application Date: 2/19/2013 Issue Date: Expiration Date Comments: Map/Lot: 121.35 addition to expand master closet/bath, replace windows on rear porch, expand rear deck, Interior renovations 1. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT: DATE: N/A: 5. BUILDING DEPARTMENT: DATE: N/A: 6. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE COMMENTS: RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: Date Printed: 2/19/2013 TOWN OF YARMOUTH WATER DEPARTMENT 99 Buck Island Road West Yarmouth, MA 02673 Telephone: (508) 771-7921 • Fax: (508) 771-7998 BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET Bldg. Site Location '&0/0 Lif Map #: Al Lot #: 3 Proposed Improvement: A.I f2t /ZPli-a iA 4'et lit lwevoj Applicant: i Addresso-Cj'��'(�) ,�% V Tel. #: V cs -)?t 9' ? Date Filed: Z `(1-6 RESIDENTIAL AND / OR COMMERCIAL BUILDING Water Department: Determines Compliance of Water Availability and or Existing Location Engineering Department: Determines Compliance for Parking and Drainage Conservation Commission: Determines Compliance to Wetlands Acts; i.e. If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Ocean, Bogs, Bays, Marshland, Etc... Health Department: Determines Compliance to 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, n Safety, Property Protection;, i.e. Smoke Detectors, Sprinkler Systems, Etc... 31 na ure of applicant Date PLEASE NOTE: COMMENTS: To be completed by Applicant: Building Site Location: Proposed Improvement: TOWN OF YARMOUTH HEALTH DEPARTMENT PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET Lev A-o1 �i V110E, 6'1 ie Applicant: 1114' 3-� �X_ A4144111 t Tel. No.: �/j' Address: ��U �,N� Date Filed: aZ- **Ifyou would like e-mail notification ofsign off, please provide e-mail address: Owner Owner 6&11-r/ wiz LI/ Owner Tel. No.: RESIDENTIAL AND/OR COMMERCIAL BUILDING HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. Please submit three (3) copies of plans, to include: (1.) Site Plan showing existing buildings, water line location, and septic system location; (2.) Floor plan labeling ALL rooms within building (all existing and proposed) — Note: Floor plans not required for decks, sheds, ivindojvs, roofing; (3.) If necessary, Title 5 application signed by licensed installer with fee. REVIEWED BY: PLEASE NOTE COMMENTS/CONDITIONS: DATE: a 03NOIS-V 03dMN1S SS3lNn'S3SOdund NOubnuSN00 NO ONUIM183d 80d I I mcn.w !L MM 7LH CMMI.I 7CJW1 L t. OF YAli� F.zRo Town of Yarmouth �ol=�V Conservation Commission A`"""-� Building Permit Sign -off Application Building Site Location: Map # /1 l Lot(s) # 95 Property Owner: Applicant: �rc-•n�P Applicant Address: Telephone: 50� - Tf i — qyl � Date Filed —:?-20- I -a Proposed Project Plans: Flo I` Inn t) 25 My lone TO BE FILLED OUT BY CONSERVATION ADMINISTRATOR: Does the Proposed Project Require a Permit? QG mme om Consen ation Commission: t Approved Conditionally Approved Dnsenation Commission Sign-ojfSignature:� .ate. 11 J t Lc.0dti,..l Rejected .f W w " m z.. o'_4 YARMOUTH OLD KING'S HIGHWAY REGIONAL HISTORIC ~ a DISTRICT COMMITTEE N 1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664 p W Phone (508) 398-2231 Ext. 1292 — Fax (508) 398-0836 , � Colleen McLaughlin, Offlce Administrator (cmclaughlin@yarmouth.ma.l 9m1 CERTIFICATE OF APPROPRIATENESS APPLICATION Application is hereby made for the issuance of a Certificate of Appropriateness (C/A) under Section 6 of Chapter 460, Acts of 1973 as amended, for proposed work as described below and on plans, drawings, photographs, and other supplemental information accompanying this application. PLEASE SUBMIT 6 COPIES- OF SPEC SHEET(S), ELEVATIONS, PHOTOS, & SUPPLEMENTAL INFORMATION. Check All Categories That Apply: ' / 1) Exterior Building Construction: New Building v Addition Alterations Reroof Indicate type of Building: Commercial Residential Garage _Shed _Other. 2) Exterior Painting: Siding t� Shutters Doors t✓ Trim Other. 3) SignsBillboards: New Sign Change to Existing Sign 4) Miscellaneous Structures: t/ Fence Wall Flagpole ✓ Pool Other. Type or print legibly Address of proposed work: ?_S UJt P4Jfir LANV— _ _ _ Map/Lot Owner(s): -Tuvrm & -m#& yp\:L,N Phone #507 515 cys 4 Mailing address: '?Q eAK Gfikt YFi ^CJIIS t��T, MWilk0161� Year built: rA`PkA Email: -SP jEl7V Ah) L C Otis ( 'C. NBC I Preferred notification method: US Mail QG�Email Agent/contractor. My 7nipigynN't' C•i4m—N'tf'�f Phone #: 50511� 1 II Mailing Address: ZQA uJ\t�S Q ii'� Email: 1kMr) 1t~_CJrj Ni Preferred notification. method: US Description of Proposed Work: CC"!. S9z lk'Ct NCB© Signed (Owner or agent): — Date: _ W NOV 2 0 2012 'S > Owner/contractor/agent is awkthafa permit is required from the Building Department. (Check other departments, also.) I > If application is approved, app led to a 10-day appeal period required by the Act > This certificate is good for one year from approval date or upon date of expiration of Building Permit, whichever date shall be later. >. Al new construction will be subject to Inspection by OKH. OKH-approved plans MUST be available on -site for framing S final inspections. For Committee use only Received by OKHj `Approved Date: Y CastJChec #: Rcvd by. Signed: Date signed: 9 z y Approved with L amendments .' Denied '• ,� d n , �! CGt� la-AIID. MODIFICATIONS TO CERTIFICATE OFAPPROPRIATENESS Date: 1 i�/9 Les2— i CIA Number: 1 Z - A i ! Z— Address: 2- 5 ��`�=� L 1. 2. kj v 1 agree to the Owner/Agent Signature APPROVED NOV 210 2012 ' YARMOUTH OLD KINGS HIGH:°� sc IN U �oWc V Lr1 conditions and changes to the Certificate of Appropriateness: OKH Signature {.� '•J' 1 *1-All ol, TOWN OF YARMOUTH 1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664 Telephone (508) 398-2231 Ezt.1292 Fax (508) 398-0836 Colleen McLaughlin, Office Administrator (cmclaughlin!aftarmouth.ma.us) OLD KING'S HIGHWAY REGIONAL HISTORIC DISTRICT COMMITTEE FINAL MINUTES — NOVEMBER 19, 2012 The Old IGng's Highway Committee met on Monday, November 19, 2012, in the Hearing Room at Yarmouth Town Hall, 1146 Route 28, South Yarmouth. Members present: Chairman Richard Gegenwarth, Suzanne Courcier and James Liedell and Alternates Judith Recknagel and Stanley Kacynski. Also Present: Colleen McLaughlin, Office Administrator. A quorum present, Mr. Gegenwarth opened the meeting with a brief explanation of how the meeting is run and an explanation of the 10-day appeal period. He then stated for the record that the OKH Committee has been working with the Building Department and has revised some procedures. All applicants must pick up their paperwork at the OKH office and use the stamped OKH-approved plans for all town departments. In addition, the Building Department and OKH are working together to ensure compliance with the OKH-approved plans. To that end, OKH now inspects at framing and occupancy permit times and reports to the Building Department whether or not the approved construction has taken place or if changes requiring additional OKH review have been generated. The regular meeting convened at 7:15 P.M. 12-A111 Karin Bruckhauser (owner), John Mackenzie (agent); Installation of new front entry door at 384 Weir Road Owner and agent present. The applicant explained that she was requesting a front entry door with an oval glass insert and aluminum storm door. Ms. Courcier mentioned that the storm door was not listed on the application. Ms. Recknagel asked If the door glass was clear, Ms. Bruckhauser replied that some of it was clear, but some was translucent. Mr. Mackenzie explained that Ms. Bruckhauser was asking for this door, which was similar to other doors in the area. Chairman Gegenwarth stated that it is the charge of the OKH Committee to decide the appropriateness of exterior changes to a particular house and setting. In this case, the door is not appropriate for this style house although it might be for a different style (eg, Victorian). As far as the house next door, they had never applied for their door (which has an oval glass insert). Their situation is being reviewed as a possible violation. Mr. Gegenwarth mentioned that the neighbor's door was barely visibly due to the topography of the lot and the tree planted in front of the door. Ms. Bruckhauser's front entry is easily seen from the street. Mr. Liedell then moved to approve the application as presented; no one seconded the motion. Ms. Recknagel asked if there could be more discussion; Mr. Gegenwarth said that there could be more discussion at this point. The members continued to discuss the appropriateness of the door with the applicant and among themselves. Ms. Bruckhauser stated that the co-owner of the property is deaf, and a door with glass would help because she would be able to see people approach the door even if she could not hear them knock. Ms. Courser asked if people would really be that visible if part of the door was translucent. Ms. Bruckhauser said that the insert allowed some visiblity and also allowed for shadows to be seen as people approached. Ms. Courcier then remarked that other doors shown on the manufacturer's page submitted as part of the application packet would have some glass but be more appropriate to the style of the house. Ms. Bruckhauser stated that she had already purchased the door that she was requesting. Ms. Courcier and Mr. Gegenwarth remarked that the purchase precluded arriving at a compromise regarding the style. Ms. Courtier then moved to deny the application; Mr. Kaczynski seconded. DENIED: 4-04 (Mr. Liedell voted against the motion.) 'tZATrZ-John & Pamela Foran (owners), ERT Architects (agent); multiple alterations including reroofing, construction of wooden deck on rear, change of shutter color, replacement windows, & installation of pool fencing at25 Wharf Lane. Mike Nardone of MJ Nardone was present to represent ERT Architects; Chris Dietrich was present to represent the pool company. Mr. Nardone stated that this is a young house, but the owner wants to make changes now that will last `for all time.' The Committee members responded that no changes will last forever, but they understood the owners' intent. The house colors will change to white siding with black shutters & roof. New cariage-style doors will be installed on the garage and will be painted black. The owner was requesting a black chain -link fence to enclose the property. Ms. Courder remarked that chain - link is not appropriate for that setting and neighborhood. After some discussion, the members agreed that a. black aluminum fence with vertical posts would be acceptable. Retaining wall around pool will be natural rock. Ms. Courcler moved to approve the application as modified by the fence change; Mr. Liedell seconded. APPROVED AS MODIFIED: 5-0-0 12-A713 Mahmood Rana (owner), Fazal Rana (agent); construction of 12' x 20' accessory building at 111 Sister's Circle. Agent & owner present. Mr. Rana explained that he has a large yard and would like the building to house garden equipment. Front will be clapboard to match house; sides & rear will be shingled. Doors will be wooden. All colors and materials to match existing house. Mr. Gegenwarth explained that the shed should have a 7/12 pitch; as shown it was probably only 5 pitch. He asked Mr. Rana to change the pitch to 7/12, which would necessitate the roof being changed to 11 or 11.5 feet In height. Ms. Courser then moved to approve with the modified roof pitch and the clarification that all siding would match the existing house; Mr. Liedell seconded. APPROVED: 5-0-0 Continued Hearina: 12-A101 Geoffrey Wyler, TrsBass River Trust (owner), Ed Perdigao (agent); 2d floor addition over house & garage; 2 decks at 35 Aunt Dorah's Lane. This application had been continued to allow the applicant time to obtain elevations that accurately depicted the changes planned to the structure. The members reviewed the new elevations. Ms. Couroier then moved to approve as presented; Mr. Liedell seconded. APPROVED: 5-0-0 12-El26111 North Dennis Road 9 replacement windows APPROVED MINUTES: None 7� 7-11b�1� I_�-�-�►L•7Ty NEW BUSINESS/CORRESPONDENCE: 1) The Court found in favor of 7 Hills Foundation for the 5-bedroom home that they plan to construct at 19 Centerboard Lane. 2) Jim Wilson, OKH Commission Counsel, has requested that OKH committees have a 'Missed Meeting Form' to be used when a member or aftemate has missed a meeting and needs to be brought up to speed to sit on a follow- up hearing on the same matter/application. A copy revised to meet Yarmouth's needs is included in this packet. 3) Yarmouth committees have been asked to remind members not to trespass on applicants'/owners' property. Members should either contact the owner in advance or identify themselves at the door before touring a property. There have been some complaints. 4) The proposed 2013 meeting schedule is attached. VIOLATIONS: 12 Musket Lane — Dorothy Henion, a neighbor but not direct abutter, called today to register her complaint regarding a chain -link fence that has been installed at this address. No application for this fence was submitted. The Violations Officer should document with photos, and a violation letter will then be sent to the owner. Update 8/13112: Violations officer has documented fence with photos. Letter to be sent to owner. Building has notified me that the RV was parked too near the road. To make necessary setbacks, RV must be moved back 15 feet or so, which will make removal or resiting of much of the fence necessary. Update 11119112: C/A application has been received and scheduled to be heard at 11/26/12 meeting. 314 North Dennis Road — Trees, which were part of conditions of shed's approval, have been removed from around shed. New landscaping plan needed. Gates and fences also need to be applied for an approved after the fad. Update 7/2/12: Notification has just been sent to owners by Building Department. Update 8/13: No info has been received regarding this issue. Update 11119/12: Violation notice will be sent out again this week. 4 IECC2009 RESIDENTIAL ENERGY EFFICIENT DETAILS CLIMATE ZONE 5A (USE EITHER PRESCRIPTIVE VALUES OR RESCHECK CALCULATION) TABLE 402.1.1 MINIMUM PRESCRIPTIVE INSULATION & FENESTRATION REQUIREMENTS FENESTRATION U—FACTOR SKYLIGHT U—FACTOR CEILING R—VALUE WOOD FRAMED WALL R—VALUE FLOOR R—VALUE BASEMENT WALL R—VALUE BASEMENT SLAB R—VALUE CRAWL SPACE WALL R—VALUE 0.35 0.60 38 20 30 10/13 10 (2 FT. DEEP) 10/13 NOTES: 1. R—VALUES ARE MINIMUMS & U—FACTORS ARE MAXIMUMS. 2. 10/13 MEANS R=10 CONTINUOUS INSULATED SHEATHING ON THE INTERIOR OR EXTERIOR OF THE HOME OR R-13 CAVITY INSULATION AT THE INTERIOR OF THE BASEMENT WALL. 3. REFER TO IECC 2009 CHAPTER 4 FOR ALL INSULATION & ENERGY REQUIREMENTS 4. EXISTING EXTERIOR WALLS TO BE INSULATED PER 101.4.3 o O Dr � Z ZD C c) � �O iv ;7 O O = C 1 _ = N O N m v IECC2009 RESIDENTIAL ENERGY EFFICIENT DETAILS CLIMATE ZONE 5A (USE EITHER PRESCRIPTIVE VALUES OR RESCHECK CALCULATION) TABLE 402.1.1 MINIMUM PRESCRIPTIVE INSULATION & FENESTRATION REQUIREMENTS FENESTRATION U—FACTOR SKYLIGHT U—FACTOR I CEILING R—VALUE I WOOD FRAMED WALL R—VALUE FLOOR R—VALUE I BASEMENT WALL R—VALUE BASEMENT SLAB R—VALUE CRAWL SPACE WALL R—VALUE 0.35 0.60 38 20 30 10/13 10 (2 FT. DEEP) 10/13 NOTES: 1. R—VALUES ARE MINIMUMS & U—FACTORS ARE MAXIMUMS. 2. 10/13 MEANS R=10 CONTINUOUS INSULATED SHEATHING ON THE INTERIOR OR EXTERIOR OFF THE HOME OR R-13 CAVITY INSULATION AT THE INTERIOR OF THE BASEMENT WALL 3. REFER TO IECC 2009 CHAPTER 4 FOR ALL INSULATION do ENERGY REQUIREMENTS 4. EXISTING EXTERIOR WALLS TO BE INSULATED PER 101.4.3 O �- v 7 ;; x{ ZD o C NOzi O �; _-i =L!jr 1 ISO �i F 0 R T E e MEMBER REPORT Level, Floor. Drop Beam 2 plece(s)13/4" x 14" 1.9E Mlcrollam0 LVL Overall Length: ll' T i 0 All Dimensions Are Horizontal; Drawing Is Conceptual 0 0 Design Results Actual 0 Location Allowed Result LDF toad: combination (Pattern) Member Reaction (Ibs) 932 0 3 1/2- 3938 Passed 24%) — 1.0 D + 1.0 L (All Spans Shear Ibs) 735 01' 51/2' 9310 Passed (8%) 1.00 1.0 D + 1.0 L (All Spans Moment R-lbs) 2564 0 S 9 1/2' 24258 Passed I1%) 1.00 1.0 D + 1.0 L (All Spans Live Load Deft. In 0.030 0 S 9 1/2" 0.367 Passed L/999+ 1.0 D + 1.0 L (All Spans Total Load Deft. In 0.D43 0 S 9 1/2" 0.550 Passed L/999+ — 1.0 D + 1.0 L (All Spans • Deflection criteria: LL (1/360) and TL (L/240). • Bracing (Lu): AN compression edges (top and bottom) must be braced at 11' o/c unless detailed otirerwise. Proper attachment and positioning of lateral bracing Is required to achieve member stability. Supports During Length Loads to Supports 0bs) Accessories Total Available Requlrad Dead Floor Total 1- Hanger on 14" SPF beam 3.50" Hanger' 1.50' 283 695 978 See note' 2 - Hanger on 14" SPF beam 3.50- Hanger' 1.50- 283 695 978 Sex note' • At ranger supports, me Total Bearing CImMS101119 equal to the wrdm or the material that IS supporting me harger • ' See Connector grid below for additional Information and/or requirements. PASSED System : Floor Member Type: Drop Beam Building Use: Residential Building Code : IBC Design Methodology : Aso Connector. Simpson Strom -Tle connector support Model seat Length Top Mans Face Mans Member Malls Accessories 24-SDS self -drilling 15-SDS self -drilling 1- Face Mount Hanger MGU3.63 (111"9.2S) 4.50" N/A wood screw 0.242 dla. wood screw 0.242 dla. v 24-SDS self -drilling 15-5DS self -drilling 2 • Face Mount Hanger MCU3.63 (11I.9.25) 4.50' N/A wood screw 0.242 dia. wood screw 0.242 dla. s Loads Location Tributary WWII Dead (0.90) Floor five (1.00) Comments 1 - Uniform(PSn 0 to IS' T 3' 12.0 40.0 Resldmtlai - Lining Areas Weyerhaeuser Notes Weyerhaeuser warrants that the sizing of he products will be In accordance with Weyerhaeuser product design criteria and published design values. Weyerhaeuser o presssly disclaims any other warranties related to the software. Refer to tlnRnt Weyerhaeuser literature for Instanatbn details. (www.woodbywy.eom) Accessories (Rim Board, Blocidng Panels and Squash Bloeda) are not designed by this software. Use of this software Is not Intended to circumvent the need fora design professional as determined by" authority haNrg Jurisdiction. The designer of record, bunderor framerIs responsible ro assure that this calculation Is compatible with the Overall project Products manufactured at Weyerhaeuser fadlities are third -party certified to sustainable forestry standards. The product application, Input design bads, dimensions and support Information have been provided by Forte Software Operator (APPROVED NOV 20 2012 Forte Software Operator Job Notes ERIK TOLLEV ERTARCHMECTS, INC (508) 362-8883 ER IKO ERTAR CHrrECTS. COM (!y) SUSTAINABIE FORESTRY HMTNE 2/12/2013 11:04:34 AM Forte v3.5, Design Engine: V5.5.3.2 Page 1 of 1 ..ro%%*N OF 1'AR,.%1OU*1'111fj9d BUILDING DEPARTMENT /%,�,?r�) 1146 Rteote 28. tinurh Varinouth. 5tA 12664 411Y-398-2231 rat. 261 Earl 5118-393-0336 GI/X/d tn* QNrdnlq rG Permit Number — 23Z Date Issued Expiration Date TRENCH PERMIT Pursuant to G.L. c. 82A §I and 520 CMR 7.00 et seq.(as amended) THIS PERMIT MUST BE FULLY COMPLETED PRIOR TO CONSIDP.RATTON ...... —^rr•��•� Town of Yarmouth Water Dept. SireetAddren 99 Buck Island Road Ulyfrown West Yarmouth I MA LIP 02673 Nome or Escerator lirdifferent from mpp8cantl Sere" Addre" Town of Yarmouth Water Dept 99 Buck Island Road l'ityR'own MA ZIP West Yarmouth 03673 Naar of Ownerls) of Property Street Address 7i 508-771-7921 508-771-7921 cen vescnprton, location and purpose of probated trench: , Men describe the exact location orthe proposed trench mad its purpose linclude a description be told In Proposed trench (eFp pipedcoble Ban etc-) Pleeue use reterse . is what to for is Intended) to ( side lr addie(orol apses is needed. i Town of Yarmouth - self insured Ymtne end conurt Infnrmmtlon of Insurer. _.. ......._ Pam Barnes - 508-398-2231 ext.: 270 Prdicy F:1 Ira M Dafe• UIK Safe .Name of t'umpetentPerwa t_ 0as as aerined by S:A C\iR 1.02I- I of 2 TOWN OF YARNtOUTH k[ILDING DEPARTMENT 1146 Route 28. South l'artnouth. NIA 02664 508-398-2231 ext. 261 Fax 508-398-0836 Permit Number R`1 I - 027 Date Issued Expiration Date TRENCH PERMIT Pursuant to G.L. c. 82A §1 and 520 CMR 7.00 et seq.(as amended) THIS PERMIT MUST BE FULLY COMPLETED PRIOR To CONSIDERATION Name of Applicant WMWVJ14�0a.,PIACPhone Cell Street Address '�543XU A4Vif0 ' C{3 99 City/Town MA �xp D61 Name of Excavator (if different from applicant) Phone Cep Street Address City/Town MA I ZIP Name of Owner(s) or Property Phone Cell Street Address P i NCST7 City/rown MA ZIP Sf UZtO Other Contact Permit Fee Received No Yes Description, location and purpose of proposed trench: Please describe the exact location of the proposed trench and its purpose (include a description of what Is (or is Intended) to be laid in proposed trench (eg; pipestcable lines etc-) Please use reverse side if additional space Is needed. 5 t✓ -5y sTeq r JAN 19 2011 �y t�hif,es -47 - Insurance Certificate tf: Name and Contact Information of Insurer. %Uy-"rN�C4- v'1j&I � NSu,i NG� Polley Ex iration Date: Dig Safe N: Name of Competent Person (as defined by $20 CMR 7.02): 1 of 2 8 Hf, os-gof7 Massachusetts H0wing L aZ c vu)ed j q/) S l l a' bll�; O 3-1 0?0 BY SIGNING THIS FORM, THE APPLICANT, OWNER, AND EXCAVATOR ALL ACKNOWLEDGE AND CERTIFY THAT THEY ARE FAMILIAR WITH, OR, BEFORE COMMENCEMENT OF THE WORK, WELL BECOME FAMILIAR WITH, ALL LAWS AND REGULATIONS APPLICABLE TO WORK PROPOSED, INCLUDING OSHA REGULATIONS, G.L. a 82A, 520 CMR 7.00 et seq., AND ANY APPLICABLE MUNICIPAL ORDINANCES, BY-LAWS AND REGULATIONS AND THEY COVENANT AND AGREE THAT ALL WORK DONE UNDER THE PERMIT ISSUED FOR SUCH WORK WILL COMPLY THEREWITH IN ALL RESPECTS AND WITH THE CONDITIONS SET FORTH BELOW. THE UNDERSIGNED OWNER AUTHORIZES THE APPLICANT TO APPLY FOR THE PERMIT AND THE EXCAVATOR TO UNDERTAKE SUCH WORK ON THE PROPERTY OF THE OWNER, AND ALSO, FOR THE DURATION OF CONSTRUCTION, AUTHORIZES PERSONS DULY APPOINTED BY THE MUNICIPALITY TO ENTER UPON THE PROPERTY TO MONITOR AND INSPECT THE WORK FOR CONFORMITY WITH THE CONDITIONS ATTACHED HERETO AND THE LAWS AND REGULATIONS GOVERING SUCH WORK. THE UNDERSIGNED APPLICANT, OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO REIMBURSE THE MUNICIPALITY FOR ANY AND ALL COSTS AND EXPENSES INCURRED BY THE MUNICIPALITY IN CONNECTION WITH THIS PERMIT AND THE WORK CONDUCTED THEREUNDER, INCLUDING BUT NOT LIMITED TO ENFORCING THE REQWREMEN73 OF STATE LAW AND CONDITIONS OF THIS PERMIT, INSPECTIONS MADE TO ASSURE COMPLIANCE THEREWITH, AND MEASURES TAKEN BY THE MUNICIPALITY TO PROTECT THE PUBLIC WHERE THE APPLICANT OWNER OR EXCAVATOR HAS FAILED TO COMPLY THEREWITH INCLUDING POLICE DETAILS AND OTHER REMEDIAL MEASURES DEEMED NECESSARY BY THE MUNICIPALITY. THE UNDERSIGNED APPLICANT, OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO DEFEND, INDEMNIFY, AND HOLD HARMLESS THE MUNICIPALITY AND ALL OF ITS AGENTS AND EMPLOYEES FROM ANY AND ALL LIABILITY, CAUSES OR ACTION, COSTS, AND EXPENSES RESULTING FROM OR ARISING OUT OF ANY INJURY, DEATH, LOSS, OR DAMAGE TO ANY PERSON OR PROPERTY DURING THE WORK CONDUCTED UNDER THIS PERMIT. APPLICANT SIGNATURE DATE lliqlll EXC A OR FIGNATURE (IF RENT) \� DATE OWNER'S SIGNATURE (IF DIFFERENT) 2 of 2 rue..a�e. 47447 gowurn ACORD- CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDONYYY) 04/30/2010 PRODUCER Dowling & O'Neil Insurance Agency 9 y 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. 973 lyannough Rd., PO Box 1990 Hyannis, MA 02601 INSURERS AFFORDING COVERAGE NAIC 0 INSURED INSURER A. Travelers Insurance Company PKM Contractors, Inc. INSURER B: Associated Employers Insurance P.O. Box 775 East Dennis, MA 02641 INSURER C: INSURER D: INSURER E COVERAGES 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE 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. ILNTV>RK MAN TYPE OF INSURANCE POLICY NUMBER POLICYDATEIMEFFECTIVE-POLICY M/DD1YY) DATE MEXPIRATIONMIDOnrn LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE O OCCUR 1680571 D2662TIA10 05/04110 05104/11 EACH OCCURRENCE s1 OOO 000 DAMAGE TO RENTED f300OOO MED EXP (An"pe ) f$ 000 PERSONAL B ADV INJURY $1000000 GENERAL AGGREGATE s2,000,000 GENL AGGREGATE LIMIT APPLIES PER: POLICY PRO- F_1JECT M LOC PRODUCTS -COMP/OPAGG s2000000 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-0WNEDAUTOS BA1796AT0910SEL 05/04/10 05/04/11 COMBINED SINGLE LIMIT (Es scaddwt) $1,000,OOO BODILY INJURY (par P°rf0") f X X BODILY INJURY (Par sodden!) $ X PROPERTY DAMAGE (Per saldenq $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT f OTHER THAN FA ACC AUTO ONLY: AGO s f EXCESSIUMBRELLA LIABILITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION S EACH OCCURRENCE s AGGREGATE f f f f B WORKERS COMPENSATION AND EMPLOYER!' LIABILITY ANY PROPRIETORIPARTNERIEXECVTIVE OFFICERIMEMBER EXCLUDED? fine deacfteunder SPECIAL PROVISIONS bebw WCC$008068012010 NO 03/27110 03/27/11 STATL TW TWO RCLIMIT ER ELEACH ACCIDENT fSOO OOO E.L DISEASE -EA EMPLOYEE SSOO 000 EL. DISEASE -POLICY LIMIT 1 $500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Insurance coverage is limited to the terms, conditions, exclusions, other limitations and endorsements. Nothing contained In the certificate of Insurance shall be deemed to have altered, waived, or extended the coverage provided by the policy provisions. Town of Yarmouth Water Department 99 Buck Island Road West Yarmouth, MA 02673 ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION EREOF, THE ISSUING INSURER WALL ENDEAVOR TO MAIL I_ DAYS WRITTEN HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO BO SHALL NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHORIZED C, ACORD 25 (2001/08) 1 of 2 #S68692/M68615 LS1 0 ACORD CORPORATION 1933 Commonwealth of Massachusetts O(Ticial Use Only Department of F/re Services Permit No. —D Z BOARD OF FIRE PREVENTION REGULATIONS ReeOccupancy 11�99 and Fee Checked I leave blank .' APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK ...... _-_ . -A(( work to be performed th itEordance with the Mee9ehusells Eleanal Code (MEC). 527 Cm 12 Otl (PLEASE PR1Nr&1NK OR 77PEALL INFORMAT/OM) CityDate:. or Town of: y� (n � �h To the Inspector of Wires: By this application the undersigned —gives notice oihls or henr I/ntention to perform the electrical work described bet Location (Street dt Number) A. I,r)11 /)i / \TA A o 4 Owner or Tenant Owner's Address Telephone Is this permit in eonJunction with it building permit? Yes ❑ No (Check Approprlate Purpose or Building_ /y10i1 �62yl Utility Authorization No. Exlstin Servlee AIf g Flips / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed ElecMcal Work: LI X A AM Cl PV G G 0 M 0.1 %- �ia5 No. of Recessed Fixtures A one I rtrorr o the rollowin table may be waived by the Int cror o worrt No. of Ceil•Susp. (Paddle) Fans o. o Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting flstum Swimming Pool ove ❑ n• • ❑ o. o mcrgcncy g rag - rnd. cod. Barte Units No. of Riceptic)e Outlets ' '' "' No. of 011 Burnes FIRE.ALARMS No. of Zones No. of Switchrs ; ; �+', No of C1s Bursters No. OF etect on an Initlatln Device No. of Rangy No. of Air Cond.' total Tuns I No. of Alerting Devices No. of Waste Disposers at mp Totab: Number oneed o. e oats n Deteco tion/Aiersln Devices No. of Dishwasbets Space/Area If eating KW Local ❑ uarc Pa ❑ Other Connection No. or Dryers Heating Appliances KW ecu ty stems: No. of Devices o. o Water or E uivalent Heaters KW o. o o. o Data Wiring: SI ns Ballasts No. or Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP a Icc0mmun Fcal nos rag: No. of Devices or Eoutvalent OTIIER: A INSURANCE COVERAGE: Unless waived b lheownet,no "0Caddinoro/Aral (/arroro(orarrerurdby he1,uprrroro/wun Y 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: NSURANCE q BOND ❑ OTHER ❑ (Specify:) Estimated Value of Electrical Work: ( When required by municipal policy.) xplratlon ate) Work to Stan: Inspections to be requested in accordnn with RERule 10, and upon completion. / cerdA, under the pains and penattles of perjury, that the /njormatto ifMIS atlon Is true and complete .f'P' FIRM NAME: gQOS fir c• _ LIC. NO.: Al1(08 Licensee: Sof1r� 1 Ca r•O S Slgnaturt LI!.IN O.: E' $O — (Ijapplicable , enter "tie -in rhe�cenre wrlDer line./ Address: y la ._ Bus. Tel o,' S I $ OWNER'S in WAIVER: I am aware that the nsce does not have the liability Insurance coverage normally t9 required by law, By my signature below, I hereby will thi requirement. 1 ram the (check one ❑owner Owner/Agent ❑ owner's a ant. Signature Telephone No. PERMIT FEE: S. a a 0 a M T-02-192 TOTAN of YA1U1O=, e BUILDING PERMIT FI L COPY �s ylgl z, 410a) DATE__ Apr1l 17, 2002 PERMIT NO. B-02-856 APPLICANT T.3r.1pa MCGrathl Pinp Rirbnr Sh d ADDRESS 344 Yarmouth Road. Hyannis CS 073865 (NO.I (STREET) (CONTR'S LICENSE) PERMITTO tihpd ` 1-) STORY (TYPE OF IMPROTEMENTI NO. ,PROPOSED USE1 NUMBER OF DWELLING UNITS AT(LOCATION)25 W ,hrn lrf Tae YP 02675 ZONING DISTRICT R40 (NO.) (STREET) BETWEEN AND (CROSS STREET) 1 (CROSS STREET) SUBDIVISION LOT BLOCK SIZE U O M BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION 1 O fTO TYPE USE GROUP $(j BASEMENT WALLS OR FOUNDATION J (TYPE) i O < REMARKS: 10 Y 12 Rg d — 1111141171110 c fh'erk r _stir afp_n 4 are,_ 4i4 fopt, frnm rhe Oidpp- nix fppt fro the rear, thirty feet from the front property lines. AREA OR VOLUME, PERMIT �Y ESTIMATED COST $ 1700,00 FEE $ 20.00 Tom (CUBIC/SQUARE FEET) _OWNER Joan &Asache ADDRESS 25 I&nrf Lane, YP 02675 BUILDING DEPT. BY INSPECTION RECORD DATE NOTE PROGRESS - CORRECTIONS AND REMARKS INSPECTOR -07 �eyLl'op , k 11-145 TOWN OF YARMOUTH Building Department BUILDING (508) 398-2231 ext.261 PERMIT NO --6-02-856 • ' I 4/18 PERMIT• tin ISSUE DATE 4/18/02 • - ; PROPOSED USE ; APPLICANT ,THOMASEBACHE ; JOB WEATHER CARD ADDRESS 00025 WHARF LN PERMIT TO ;Accessory Structure; --•-•--•--------•---------- ......••. -- AT (LOCATION) 100025WHARF LN ZONING DISTRIC R-40 SUBDIVISION MAP LOT BLOCK 1121.35 1 BUILDING IS TO BE LOT SIZE I CONST TYPE 5-B REMARKS 10 x 12 shed AREA (SQ FT) EST COST ($ $1,700.00 PERMIT FEE OWNER THOMAS E BACHE ADDRESS 100025 WHARF LN BUILDING DEPT BY USE GROUP R-4 CONTR'S 073865 LICENSE 0 CONTR'S NAME McGrath, James THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE APPROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLUC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: 1) FOUNDATIONS OR FOOTINGS. 2) PRIOR TO COVERING STRUCTURAL MEMBERS (READY FOR LATH OR FINISH COVERING) 3) FINAL INSPECTION BEFORE OCCUPANCY 4) REFER TO DETAILED INSPECTION ef%uennrC APPROVED PLANS MUST BE RETAINED ON WHERE APPLICABLE JOB AND THIS CARD KEPT POSTED UNTIL SEPARATE PERMITS ARE FINAL INSPECTION HAS BEEN MADE. REQUIRED FOR ELECTRICAL I WHERE A CERTIFICATE OF OCCUPANCY IS PLEUIMBING AND MECHANICAL REQUITED, SUCH BUILDING SHALL NOT BE INSTALLATIONS. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTIONS APPROVALS 2 2 ` � 2 3 OTHER: 1 2 3 4 5 WORK SHALL NOT PROCEED PERMIT WILL BECOME NULL AND VOID IF INSPECTORS INDICATED ON THIS CARD UNTIL THE INSPECTOR HAS CONSTRUCTION WORK IS NOT STARTED WITHIN SIX CAN BE ARRANGED FOR BY TELEPHONE APPROVED THE VARIOUS MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED OR WRITTEN NOTIFICATION. STAGES OF CONSTRUCTION e o *Y/41 ONE & TWO FAMILY ONLY - BUILDING PERMIT APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING } p y /q�-Pfitvi or Yarmouth Btiii(ling Departnicnt N :. N:* ,,.�ja' I 1146 Route 28 • Yarmouth, 114A 02664-4492 Tel: (508) 398-2231 x261 " Fax: (508) 398-2365 Office use Only Planning Board Information Assessors Department Information: Permlt No. i%f' ate j. Permit Fee''. $1y{`{ 60 r+" / Deposit Rec'd. $ Date t Plan'Type Endorsement Date Rrding Date PlanecoNo: Map . '. tot Mao Lor�•. ' 3 Old New 1 4. Property Dimensions: Net Due• Other Lot Areas —Frontage LotCovera e t ge ( n ). 9 This Section for Office Use Only Buildin P rmit umber Date Issued: _.. Signatur Z Certificate of Occupanc is is nrot 'e e9 wird O B irding fficial - at Section 1°- Site Information I Use Group: R-4 Type: 5-B 1.1 Property Address: 1.2 Zoning Information: '5— w r Lq R 46 or ryl �f h Zoning District Proposed Use '_ 1.3 Building Setbacks (ft�-1 _ Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 3 � 7�! � �• � �a� .spa 1 A W r Supply (M.C.L e. 40. S 541 Public Private 1.5 flood Zone information: Comments Zone:' J BFE: Section 2 - Property Ownership/Authorized Agent 2.1 er of cord: r - To rn 6och -o Wh LG7.� -A Nam (print) MailingAddress MO ens DS 3Signatu d lephone 2. uthonzAgen • % t � GL n3rbcr,.Jhed rp rnz aM ' rd Na (print) Ma' pcs 9dka±b UVATUD Sl ature Telephone r\, Section 3 = Construction Services O 3.11fcens C stru n5 erviso7 Q �Q Not Applicable Q« 1 r l al d License Number D7 A s Expiration Date /L•1— o a slgKature Telephone 3.2 Registered Home Improvement Contractor. Co -parry Name Co " Not Applicable ❑ . Add s !!��//�� // `1 % _ 77/'HIV / Sig ature ' TelephoneL L cons " Expirationp�te or �- D1 J— Section 4 - Workers' Com ensation Insurance Affidavit (M.G.L c 152 S 25C (6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. L F Signed Affidavit Attached Yes ..... No .......... Section 5 - Description of Proposed Work (check all applicable) New Construction No. of Bedrooms No. of Bathrooms n.... ;.f.% C7 I Ait.r tinnc n 1 Additinn f-1 Accessory Bldg. &f Type ' K I Demolition Other Specify: Brief Description roposed Wor CqM Section 6 Estimated Construction Costs Item Estimated Cost (Dollars) to be completed by permit applicant 1. Building t 2. Electrical 3. Plumbing /Gas 4. Mechanical (HVAC) 5. Fire Protection 6.Tolal=(1+2+3+4+5) 7. Total Square Ft. (new haws 6 additi0m) Section 7a - Owner Authorization - Owner's Agent or Contractor A lit hereby authorize ��° '. "'� �N— my behalf, in all matters relative to work authorized by this buildinc L. Signature of Owner Section 7b - Owner/Authorized Agent Declaration I i be Completed When for Building Permit Check Below ❑ Conservation -Commission Fling (if applicable) ❑ Old Kings Highway $ Historical Commission approval (if applicable) as owner of the subject property to act on ermit application. ' , 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 re of owner/ gent 9-15v99 2 of 2 Date 3i �c i V w n u r x A O y BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRIM job Location: Owner of Property. Thwl A s >r JdA NN e_. Construction Supervisor: t J 'I I I I Name r No. j Address: -5 Lkfla I-JJ-�yA010uA 11021' HA - Licensed Designee: (If other than Supervisor) Name 2.15 Responsibility of each license holder. License No. li No. 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building and structures only pursuant to . the state building code and all other applicable laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Any licensee who shall willfullyviolate subsections 2.15.1, 2.15.2 or 2.15.3 or any other section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by'the building official. INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the -requirements of MGL Ch.152 Yes ❑-01, No ❑ If you have checked y-es, 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: I Signature of Ow.uqr or owner's ,1 Signature: Owner ❑ Agent 0/ Official Approval: • For Office Use Only Permit No. Date TOWN OF YARMOUTH AFFIDAVIT, Home Improvement Contractor Law Supplement to Permit Application MGL c. 142A requires that the reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition or construction of an addition to any pro -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 WorkQ Address of Work Owner Name: Date of Permit Application: I hereby certify that: d- Registration is not required for the following reason(s): Work excluded by law of under $1,000 Building not owner occupied Owner pulling own permit Other (specify) Notice is hereby given that: Cost 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 ofpedury: I hereby apply for a t as the agent of the owner: a Date onttactorVRegistration No. OR. Notwithstanding the above notice, I hereby apply for a permit as the owner of the above Property: Dat6 er Name r The Commonwealth ojMassaehasetts Department of Industrial Accidents MMOO/ MOVItgtltdEfts 600 Washington Street Boston. Masx 02111 Workers' Compensation Insurance Affidavit ARplitSatInformation• _ PfenfnPKI1 s'IrT+t 0 ak,) r✓� L [ I m a homeowner performing all Urork myself. 0 1 am a sole proprictor:rd ha%e no one working in any capacity 0 lam an employer prroo %,iidding workers* compensation for my employees working on this job. rornpaepnome Irl(l'�1 atf I P�)t �-BeQm �8 1�larbor star. cv )W7 Varrrana f^I-h rcL. E oa IDOI 6QQ 7 70661 0 lam a sole proprietor. general contractor, or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation polices: napless: t itv phone N•'- IIl! rLL�are eo. 12off" N Failare to secure coverage as required ader Settler, 2SA of MGL IS2 m kod to tie hEpowdoa of trislsul peaaltles of a eK 4 as SIA00" aad/or one years' Imprisonment as well as dvtl peahtn in tie form ara STOP WORK ONVM soda fin OSlti0.0i a day agafaff rite. i nderst•ad flat a copy of tells shtement may be fwwarded to Me OMcr of larestlgadoas ertle DIA for ternage veruksdea. 1 do hereby 5 rW4jyrder the paint aAd*"*ies)Vkary that the )njoneadon prorided abore is one and comet Prim name/' T, "LsECD CCA phone R �71 5pi( V omcial use OUIV do not write in this area to be completed by city or town off of l city or town: YAIMDUTI; _ pasitmeeam a neuildiag Department ❑Lleeedec hoard ❑ check irimmediate response is required 261 ❑selectmen's Office (50$) 39&-2231❑HtYithDtpartmeat n COMM pcon: phone Nt _ � nether C TOWN OF YARMOUTH 1146ROUTE28 SOUTHYARMOUTH MASSACHUSETTS02664-4451 Telephone (508) 398-2231, Ext. 261. — Fax (508) 398-2365 BUILDING DEPARTMENT , DEMOLITION DEBRIS DISPOSAL AFFIDAVIT BUILDING ELEGIMICAL GAS PLUMBING SIGNS Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at 36 W b gr-J a 4-olru _ �. P p r�- Work Address a _ / is to be disposed of at the following location: a59 Q(jp W dIVIL (d- lb(-0 6'? Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. A ,9 ,60 i t re of App scant Date Permit No. TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 260, PLEASE PRINT. DATE: JOB LOCATION: "HOMEOWNER" NAME PRESENT MAILING ADDRESS 4- HOMEOWNER LICENSE EXEMPTION STREET WORK CITY OR TOWN STATE "LIP CUUH The current exemption for 'Homeowner' was extended to include owner — occupied dwellings of one or two units and to allow such homeowners to engage an individual for hire who does not possess a license, provided that such homeowner shall act as supervisor. (State Building Code Section 108.3.5.1) Definition of Homeowner: Person(s) who owns a parcel of land on which he / she resides or intends to reside, on which there is or is intended to be, a one or two family attached or detached structure assessory to such use and / or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner; such "homeowner" shall submit to the budding official, on a form acceptable to the building official, that he / she shall be responsible for all such work performed under the building permit. (Section 108.3.5.1) The undersigned 'homeowner' assumes responsibility for compliance with the State Building Code and other applicable codes, by-laws, rules and regulations. The undersigned 'homeowner' certifies that he / she understands the Town of Yarmouth Budding Department minimum inspection procedures and requirements and that he / she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL INSURANCE COVERAGE: I have a Curren bilrty insurance policy or its substantial equivalent, which meets the requirements of MGL CIL 142. Yes No ❑ If you have checked yes, please icate the type coverage by checking the appropriate box. A liability insurance policy V Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER I am aware that the licensee does not have the insurance coverage required zzag Laws and that my signature on this permit application waives this requirement. eck one: gnature o caner or s Agent Owner ❑ Agent ❑ h:homeownrlicexemp 7 \J •• i.• V 1 1 i�i\lti V V s ai BUILDING DEPARTMENT BUILDING PERMIT APPLICATION SIGN OFF Applicant: j c_ a, In' �d`�1 �a Building Permit No.: w Address: h�Q 0'-t 1. NDate Filed: Bldg. Site Location: Map No.: /a / Lot No.: .3S The following information outlines the procedural steps required to obtain a permit to build, alter, or add to a structure within the Town of Yarmouth. The Building Department will determine compliance to the following: (A) Zoning Requirements (B) Historical Districts (C) Flood Zones. The Building Department will be responsible for assisting the applicant through the following departments: RESIDENTIAL AND/OR COMMERCIAL BUILDING WATER DEPARTMENT: Determines Compliance of Water Availability. (applicant to obtain) ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage. CONSERVATION COMMISSION: Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc. HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements for Septage Disposal and other Public Health Activities. FIRE DEPARTMENT: Determines Compliance to State and Town Requirements for Personal Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Eta ---------------------------------------- 7he following Departments must sign off, in the respective order, prior to building inspector issuing the r equired building permit: REVIEWED BY: 1. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT: DATE: N/A: INDUSTRIAL AND/OR COMMERCIAL PERMITS 5. WIRING INSPECTOR: DATE: N/A: 6. PLUMBING INSPECTOR DATE: N/A: 7. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE All stumps and/or brush must be disposed of at an approved site. COMMENTS: Applicant Signature )uttorIs ►me )t # this is a rner lot, :i.te in name street. PLOT PLAN FOR LOT # 35 Indicate location of garage or accessory building Additions with dashed lines -------------------- Sewerage disposal (cesspool)' Well 0 I' I(lot................ft. rear) x m I v WO REAR YARD SIDE YARD HOUSE SET BACK .........ft. (lot..................ft. frontage) (NAME OF STREET) Information Supplied by SIDE. YARD FT u Abuttor' Name Lot # If this corner write name of 701 . T-r; N Street. : : ,r ►., TOWN OF YARMOUTH Building Department Town Hall Yarmouth, MA 02664 (508) 398-2231 ext.261 BBUILDING PERMIT APPLICATION RECEIPT Temp Permit No.: T-02-192 Applicant Name: James McGrath/ Pine Harbor Shed Co Location: 00025 WHARF LN Owner's Name: THOMAS E BACHE Owner's Addres 00025 WHARF LN Yarmouthport 0 MA 02675 Owner's Telephone: (508) 385-3797 (OFFICE USE ONLY Recorded By. Ic Permit Fee: $20.00 Deposit Rec: $20.00 Payment Type: Check ChkNo.: 565 Net Owed: $0.00 Application Date: 4/9/02 Issue Date: Expiration Date Comments: 10 x 12 shed This Is NOT a building permit. Application subject to plan review. Contact Building Department for permit status. Official Building Permit will be Issued upon plan review completion, approval, and complete payment of Net Owed on Permit Fee. Date Printed: 4/10/02 A-AZ7 7;4 TOWN CLERK Old IGng's Highway Regional Historic District Committee in in the Town of Yarmouth fora CERTIFICATE OF APPROPRIATENESS APR -U AN D o7 AWlication is hereby made in triplicate, for the issuance of a Certificate of Appro�tm ' of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work d on Plans, drawings or photographs accompanying this application for. CHECK CATEGORIES THAT APPLY: 1. MderiorBuildmgConstruction: f;:'RewBuilding 13Addition O Alteration IodimLe type ofbudlding 0 House E3 age CI Commercial p Other 2. Exterior Painting: p 3. Signs or Billboards: [3 New Sign p E,dsting Sign 13 Repainting cdsstiing sign 4. Sttuchac [3 Fence Q Wall [3 Flagpole Other 0 4 1t"7- TYPE OR MIM LEMLY DATE , -CL2 ADDRESS OF PROPOSED WORK ,Q ^ a ✓ Qn/ ASSESSORS MAP NO. /,_i / OWNER HI9 S c) N rc__ �Q c -✓ 1-� ASSESSORS LOT No.��"tir HOME ADDRESS _30M_Q__ TELEPHONE NO�,,S` O,F• 347• 3 % P r% AGENT OIL NO,- 771-5007 • USE ATTACHED SHEET IN PACKET FOR ABUTTING OWNERS APPROVED 1?" DETAILED DESCRIPTION OF PROPOSED WORK Give all y� r is be used In cue of signs,give locations of edstin sign and locations sig to lien �f ._ ' 3 8i 8 8� ) � (Attach �Iditlopal sheet, if J,� necessaryX ConNroc Io X la Pc�Sf ge�rr� �hQci. �/ '�h W1 i le Cedar -�-d rYla FCh Vj60 S 2CFRoNr Received by OKHC Date - 5 Check /� Bra This certificate is 4V 4V /l ca , D aL_ APPROVED p IMPORTANT: ItCertificate is akm4d, iappro--al is subject to the 10 day appeal period provided in the Act DISAPPROVED O Please return to: Yarmouth OKHC District Committee Yarmouth Town Hall,1146 Route 28, S. Yarmouth, MA 02664 SPECIFICATION SHEET (YARMOUTH OKHQ A`Ad-ec" 'Please ill out the form in its necessary. INDICATE LANDSCAPING, PLANS FOR MICA entirety providm*;0;41r& where EXTERIOR.LIGHTINGSITE FOUNDATION (18" MAx EXPOSED): CONCRETE/OTHER Sol► eI conc.re k $loci WALKWAY: STEPS (INDICATE BRICK/CEMENT/OTHER): SIDING TYPE & MATERIAL: COLOR ugh,,,P, cerjor nafvYa � CHIMNEY (INDICATE BRICK/STUCCO/WOO ACED) COLOR: ROOF MATE PITCH ((7/12 COLOR-1 a5ph a ;S%ZLnWMAX. EXP.� .iN tNE2wooD WINDOWS (GRILLES RE INDICATE SIZE IF NOT LISPED ON ELEVX ��Lo Trv� U� al 4 DO yl " � RS (INDICATE SIZES AND STYLE IF NOT J�ISI'F,p�ON LEVATIONS): C aoft K / 6014, on. TRIM: (AL M C701bg tID�YED1 WITH ix$ / 1 COLOR: D� GAQQ A05 lu SIZE & STYLE: STORM WINDOWS & DOORS: (INDICATE SIZES IF. NOT LISTED ON ELVATIONS) SKYLIGHTS: TYPE/SIZE: DECK: SIZE & MATERIAL: FENCING (MAX. HEIGHT 61): STYLE: (SHOW LAYOUT & RUNNING FOOTAGE ON SITE PLAN) COLOR: COLOR: COLOR: COLOR: COLOR: COLOR: COLOR: APPROVED RETAINING WALL: (P.T. ORFIELDSTONE-CONCRETE INAPFROPRIATE)!OUTN COI.11"ITTEE (SHOW LAYOUT & RUNNING FOOTAGE ON SITE PLAN) OMRD �JI v SIGNS: (indicate size, style, colors) SIGN POST: (indicate size, style, color) ADDITIONAL INFORMATION REV. 12/01 COLOR: COLOR: g-aos� YARMOUTH TOWN CLERK logo ��� ) aa 11€ r-� v, �♦ t..i u"S_'."',€f rut ,r � 4'�('k.4)�;` � �fM -, ""6'7'.4rY' r _^'rt•-'1t�[w� L e %S"�.Y.k;��iy'A: viy;H,.l r'I ' h:• .i .YuJtl r,"� �� ty hhti5lli/� 4 i�ar Y'i+y'kM'j n, .�ehi�bh'OA�dT'.Falnv '.p rt ✓ .rA �. Piwtr ' (. iFl P boa27�S %o lrn R i�cuSE APPROVED YARA'OUTH CO'0-IMITTEE MIRD r 0 i . I . IC9 - 1f - ON -lK Pcol lo.(Ia Even PC�v) A I ol Le4vj 1, 1-0 u v VC LA av,/-6 Yja I,,/,qt, Acd rrtrri L4.&PLOAk-tl, I J11, ceclo -37 o r 5kL,n -."- L 9�ZS -ALOT 1. • AGE 0� 1�,,66.34 R,-525.00 133.66YARMOUTH TOWN CLER CD ►F LOT D 4 m n I Areo 35, 0.82 Acres± RECEIVE 0 c CONCRETE FOUNDATION TF-34.05' D tD rn 31.8� 1 • LOT 6 9;0 115.009 LOT 6 NOTE: TOP OF FOUNDATION IS 5.35' ABOVE THE HIGH POINT IN WHARF LANE CERTIFIED PL 0 T PLAN LOCATION : WHARF LANE YARMOUTHPORT, MA SCALE : 1" 40' DATE : DECEMBER 19, 1997 REFERENCE LOT 7 LCP 23512-C I HEREBY CERTIFY THAT THE STRUCTURE SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON. .rt soe—aa8,2s:-9845 8o `� * soe APPROVED YAR,NOUTN C01.41y1JTEE OKHRD 1.1/ �u HIGH POINT EL -28.7' JOB # 94-370 1 PREPARED FOR: THOMAS AANH K OW A CHE own cape eb&eerigg inc. DaZ2 Akwct CIVIL ENGINEERS l►N S LAND SURVEYORS DATE REG. LAND SURVEYOR 939 main eL yw much, mo 02675 SPECIFICATION SHEET (YARMOUTH OKHC) a `Aroosq ' Please fll out the form in its entirety providingq*W 'where necessary. INDICATE LANDSG4mm, EXTERIOR.LIGHTI vG do N SITE PLANSFORNEwHOUSES CLERK PROPERTY FOUNDATION (18" MAX EXPOSED): CONCRETE/OTHER ) � 3o►► el concre.�e.. Bloc. lrlo,t. t x�oo W WALKWAY: STEPS (INDICATE BRICK/CEMENT/OTHER): SIDING TYPE & MATERIAL: U)ftt'l-P,_ eAC) tr 31L'n2LO S CHIMNEY (INDICATE BRICK/STUCCO/WOO ACED) COLOR !Jq o bep 0.as 0010Ka WIN1160 COLOR: ROOF MATERI PITCH (7/12 C LOR: , El5Ah a� t Shin Cj - MAX Exp.� UkATHEawoo7) WINDOWS (GRILLES RE fIRE$�INDICATE SIZ IF NOT LISTED ON ELEVA' DO RS (INDICATE SIZES AND STYLE IF NOT ki�TF,p ON ELEVATIONS): C �ORL��,a I +&14 TRIM: (AL ]]D�VVS ORS D WITH 1X�/ lX� COLO O� MATERIAL O TRIM1N OD�►VINYL, ALUMINUM) ` LgMSW Mahaclpti+y SHUTS EELS_ (MD/VINYL) (PANELED/LOUVERED) COLOR: GUTTERS [(/RS (W�OOQQOOD/ALUMINIJM): COLOR: GAY2AGE D0. SIZE & STYLE: COLOR: STORM WINDOWS & DOORS: COLOR: (INDICATE SIZES IF NOT LISTED ON ELVATIONS) SKYLIGHTS: TYPE/SIZE: APPROVED COLOR: YARMOUTH cool, I EE DECK:ZE SI& MATERIAL: OKHRD COLOR: FENCING (MAX. HEIGHT 61): STYLE: 1'V COLOR: (SHOW LAYOUT & RUNNING FOOTAGE ON SITE PLAN) "I RETAINING WALL: (P.T. OR FIELDSTONE -CONCRETE INAPPROPRIATE) (SHOW LAYOUT & RUNNING FOOTAGE ON SITE PLAN) SIGNS: (indicate size, style, colors) COLOR: SIGN POST: (indicate size, style, color) COLOR: ADDITIONAL INFORMATION: REV. 12/01 V) I as ghat L isyr Rcol 3ha'nyl.s �a o ' o v c � r f i o rdL av, d- ("/ /" tOocc) rr,m li 1� �11 i i 5. 0 YARMOUTH a''koll F,eofut- �21AOLCA- s �X -MATCH 46USC, APPROVED YARMOUTH COIdI"ITTE OKHRD 0 LOT 6 DBE pF ,-66.34 R,-525.00 9=10 NOTE: TOP OF FOUNDATION IS 5.35' ABOVE THE HIGH POINT IN F-�Area'� 33.66YARMOUTH TOWN CLER 35.��4 Afl in .82 Acres* RECEIVE CONCRETE FOUNDATION o TF-34.05'� l4'-0 115.00' LOT 6 CER TIFIED PL 0 T PLAN 73.1,* 3.38' LOCATION : WHARF LANE YARMOUTHPORT, MA SCALE : 1" 40' DATE : DECEMBER 19. 1997 REFERENCE LOT 7 LCP 23512—C I HEREBY CERTIFY THAT THE STRUCTURE SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON. off, =-3u-9581 tax SOE 364-90l0 APPROVED YARN"oUTN CollplI TEE OKHRD 0 ®1HIGH � POINT EL a28.7' JOB If 94-370 PREPARED FOR: THOMAS _ BACHE ARNE N. OJlkLA Own Cape eb&eeriog; Inc. �, CIVIL ENGINEERS ----- LAND SURVEYORS DATE REG. LAND SURVEYOR 939 main st. Iommouth. ma 02675 o R 3� �JC Of C- Building Building Site Location: D a - TOWN OF YARMOUTH BUILDING DEPARTMENT BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTIAL SHEET No: 10, / Lot No: 2S The Building Department will be responsible for assisting the applicant by dispatching your plans and or application to the following applicable departments. RESIDENTIAL AND/OR COMMERCIAL BUILDING WATER DEPARTMENT: Determines Compliance of Water Availability and or existing location. ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage. CONSERVATION COMMISSION: Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. FIRE DEPARTMENT: Determines Compliance to State and Town Requirements for Personal Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc. REVIEWED BY: 1. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPAR •NT: DATE: N,,/A: 3. CONSERVATION: ____PATE: T,• 4. HEALTH DEPARTMENT: DATE: N/A. - INDUSTRIAL AND/OR COMMERCIAL PERMITS S. WIRING INSPECTOR: DATE: N/A: 6. PLUMBING INSPECTOR: 7. FIRE DEPARTMENT: DATE: N/A: RECEIPT OF COPY: PLEASE NOTE SIGNATURE OF APPLICANT: DATE: White copy— Budding DepL - Yellow Copy— Health Dept -Pink Copy— Engineering Dept - Goldenrod -Fire Dept/Consemtion IW MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING -- (Print or Type) TOWN OF YARMOUTH, MA 02664 Date d 19 cly Permit #L Building Location 2.5- ` L✓ "^/ Lti Owner's Name 'fo--I Type of Occupancy�fs C-1- FD" MAY By r3s New I;k Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ No ❑ N N N N Y U C W_ N 6 N a N rL N O 0 to S F V LU J N W 0 61 G S C 4 1998 _ K m C y o a C N W < S w F� N C m � R N W C W N yNj = U _W - C 0 C LJ 4 C C W H C W H S yt C '- J FW' ^ N C) U. W J �. W C t W '= W > O C N < W S C 7 W = 7 ` 3 R N < V O < J _> O U O O C .. W Y C O O O 6 N W H S F O SUB—BSMT. BASEMENT 1ST FLOOR 4 2NOFLOOR 3SO FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7THFLOOR 6TH FLOOR Installing Company Address � f�5— 1SIC-NW (0of ;-aa lJ�y/1r1V�1A?-,r)1 360 Business Telephone a-)-A-I - 7goi) Name of Licensed Plumber or Gas Fitter Check one: Certificate ❑ Corporation ❑ Partnership M Firm/Co. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes N No ❑ If you have checked Yes. please indicate the type coverage by checking the appropriate box. A liability insurance policy Ig Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or owner's Agent Owner❑ Agent ❑ that all of the details and information I have submitted (or entered) in above applie a true and accurate to the best of my that all plumbing work and Installations performed under the permit Issued f lion will be in compliance with all ions of the Mas ch etts State Gas Code and Chapter 142 of the G ne T e of Ucense: Plumber -'Signature o Licensedlumber of Gas titer Gastitter t� / aster License Number / l Journeyman BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE '- 3 's 1 N0. sL� APPLICATION FOR PERMIT TO DO GASFITTING NAME It TYPE OF BUILDING LOCATION OF BUILDING c,. iu - I' .L cl PLUMBER OR GASFITTER LIC. NO. 1� 7 f S PERMIT GRANTED DATES 19 o� YAR Town of Yarmouth No. 261 0 GAS PERMIT (� H • MATTACHE 9 r // Office of the Gas Inspecto , outh Yarmouth This is to Certify that has permission to lg L_ in building on 2S LAI IL;AV<,F j b�IJ (� X 1: in accordance with an application`on file in this office, and subject to the provisions of the Ordinances relating to he Gas Code in the Town of Yarmouth. Fee $ 3S — Gas Inspector MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) c TOWN OF YARMOUTH, MA 02664 Date _ 19 1 v Permit # l q Building Location L'-' HC'—% 1 r'1 Owner's Name +0 ^ tihc- S C V Type of Occupancy, A/ New (, Renovation ❑ Replacement ❑ Plans Submitted: Yes ❑ No ❑ FIXTURES Z Y Z •• > o 0 Z Q W aW Y J y y 7 O C ¢ J y y y 2 Q ~ W (n C a O Q d C X nQA o 7 cc d y¢ Q W m O j= C C C U. be Z.W W k !d W V } F. O S b O y F" O Z O oo y 2 W F" Q O V 2 Q J J Q C¢ ¢ 3 O Q F Y J o y O O J Br F y U. O n Q C a! O SUB—BSMT. BASEMENT 7ST FLOOR 3 3 1 1. I 2ND FLOOR I I 9RD FLOOR 4TH FLOOR STH FLOOR 6THFLOOR 7TH FLOOR STH FLOOR InsW ling Company Name Business Name of Licensed Plumber 4JC%h ryJ Check one: ❑ Corporation ❑ Partnership Lf hrm/Co. Certificate INSURANCE COVERAGE: I have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes 8 No ❑ If you have checked Les, please Indicate the type coverage by checking the appropriate box. A liability insurance policy L$ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ certify that all'of the details and information I have submitted (or entered) in above application are true and accurate to the best of my ;e and that all plumbing work and installations performed and�t�qa permit issued for this application will be in compliance with all :Dtovisions of the Massachusetts State Plumbing Codaent[-Cjaater 142y4he General Laws. Type of License: Master ❑ Journeyman [8 , License Number �l 7 /5� R BELOW FOR OFFICE USE ONLY FINAL INSPECTIONS SKETCHES D� FEE NO.� APPLICATION FOR PERMIT TO DO PLUMBING NAME & TYPE OF BUILDING / LOCATION OF BUILDING PLUMBER 1:5_ PERMIT GRANTED _ G4AR 4199& DATE 18 PLUMBING INSPECTOR PROGRESS INSPECTIONS Town of Yarmouth No. 14 4 PLUMBING PERMIT ffice of the Plumbing Ins p or, South Yarmouth 3 _1 This is to Certify that has permission to _19 for k I s ^ in building on 145' `ZW( 1'140> �- F�15I in accordance with an application on file in(this office, and subject to the provisions of the Ordinances relating to the State Plumbing Code in the Town of -Yarmouth Fee Plumbing Inspector THE COMMONWEALTH OF MASSACHUS TTS C% Fee a-? .... TOWN OF YARMOUTH No... ...... . OCCUPANCY PERMIT F 79a "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been Issued by the Building Inspector." �y� Lot; Issued td�° ... ..... Addressa&...,/4.0 � Wiring Inspector .. Q... .........Inspection Dated ..� 9P ..... . Plumbing Inspecto ............Inspection Date `?.' ��-.`�. P ...... Fire Department.. / . �. ..... ...........Inspection Date (Y�/.q�Q� ......... Building Inspector . ..... ..�...�..� Inspection Date....p Board of Health .. ���..... c.......Inspection Date . A-PF:- ...... THIS PERMIT W L NOT B VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED "BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. r " I Date:... s/���.... Building Inspector%%J ��.................... . PERMIT 792 found. 12/22/97 LOT N7 FOU,4 d Bache, Thomas & Joan rra yk 25 Wharf Lane /u 5A Yarmouthport, MA 02675 Single family dwelling 12/5/97 12/23/97 a ! 3_} $305,000. SHEET 108 1 O.P. 119/1997 �a�l � � � _ ���-`FYI � �9� � � � 9 � g� ��� 12nano14 SIIpGen- Portal Home Document Category Map -Block Number Street Number Street Name Department Parcel ID Backfile Batch Scan Document? Additional Naming Info Index Operator Date - Time Town of Yarmouth Template [Building Dept] Slipsheet Identifier [sg12178] Building Permits 121.35 0025 WHARF LN Building 15232 W Operator, Yarmscan 2014-12-18 - 08:57 httpJAaserftche12/SlipGW 1/1