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Home My WebLink AboutBuilding Permitsr TOWN OF YARMOUTH Building Department BUILDING ...... _ _ , (508) 398-2231 ext.1261 PERMIT NO B-72-57T . PERMIT ISSUE DATE ;.. ....... P OSt uSE APPLICANT 011verKelly JOB WEATHER CARD PERMIT TO Repair ; AT (LOCATION) ZONING DISTRICT R-25 Bldg. Type: Residential 10007TIDE W SUBDIVISION MAP LOT BLOCK 1025.25 BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R-2 LOT SIZE [ CONTRACTOR strip and reroof, 25 squares, paper and vent to code LICENSE 99187 REMARKS Kelly, Oliver 8 Rhine Rd AREA (SO FT) EST COST ($ $7,800.00 PERMIT FEE ($) $35.00 Yarmouth Port MA 02675 5087754498 OWNER IMEADE, GEORGE V TRS BUILDING DEPT BY ADDRESS 10007 TIDE LN South Yarmouth MA 02664 PHONE INSPECTION RECORD FIELD COPY Date A N�!EProgress - Corrections and Remarks Inspector "OCT2 ED 11 /Xy'ODE y. urrtce use unty 1'lrmit # ��-/c�amy- ►► s tFeef Permit expires 6 months from issue date. EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: ASSESSOR'S INFORMATION: OWNER: %toe J NAME PRESENT ADDRESS TEI- # CONTRACTOR: V #K-4 0'tom -I - U' ILN 1--I,Q c NAME MAIIING ADDRESS TEI-# So 8 i7 5 y ti -/ O Residential Commercial Est. Cost of Conswction f 7gCL --7:> Home Improvement Contractor Lic. # 2 CK/ 5 Construction Supervisor Lic. # qR ((7�7 Workman s Compensation Insurance: (check one) I am the homeowner I am the sole proprietor � oprietor I have Worker's Compensation Insurance . Insurance Company Name:+&�P/ A,(,j P/o-c Worker's Comp. Policy#_ jOC23!S 33 8 8' O'y Q Z-4--3 WORK TO BE PERFORMED Tent(lire Retardant Certilicateattachod) Nation Wood Stove Shed Siding: # of Squares Replacement windows: # / ' Replacement doors: # Re -roof: # of Squares U Stripping old shingles* () going ove:_)aycrs of existing roof Old Kings Ilighwaylilistoric District L/c �` Routing/Siding (like for Ike) 'The debris will be disposed of at: �`� -.-I r-, /�1 �" Iauatioo of facility E declare tmda penaltks of perjury that the statements herein contained are true and currmt to the best of my knowledge and belief. l understand that any false answer(s) will be just cause for deniydL� ryvoc4,tion o(my license and for prusav)�y".G.I- Cb. 268, Section 1. Applicant's Signature: Owners Signature (or auachuwrot ' 1 ti Approved By: llwkhagOfheial (or desngam) Date: ( C) • 25 • zV 1 Date: �A&� Zoning Disuiict•. Historical District: Yes Nit Flood Plain Zone: �s No Water Resource Protection District: \ Within 100 of Wetlands: Yes W Y No 3101 The Commonwealth ofMassaehuseNs Department oflndustridAccidents Office oflnvestigations 600 Washington stred Boston, MA 02111 "�' www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contmetors/Elft-Wdins/Flumbera Name Ar 2. 3.❑ ra 9 an employer? Check the appropriate bom ❑ I am a employer with Z.4. ❑ I am a geoetal contractor and I employees (full and/or part-time).• have hired the sub -contractors I am a sole proprietor or puma. listed on the attached shecL strip and have On employees These sub-contractan have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.i requited) 5. 0 We me a corporation and its I am a homeowner doing all work officers have exercised their myself [No workers' comp. right of exemption per MGL insurance required] t c. 152.41(4). and we have no employees. [No workers' comp. insurance recuired.t 'My spp&wu"checb box al nwd ahw ilo out au sacdae belar+�a IheQ o i • FOdicr project (required): ew construction modeling molition Building addition ctrical repair or additions mbing repairs or sdditionnt f repairs er r liomoowaers who subuit Mix satdavit "caring rosy Am doing all Wwk mad ehm him out we I tt� subtoi i oerrt AACL lContmsetas that check this boa mutt attachad o additional sheet shoamra the trans otthe subraohac M sod Ma whether a aw thannh&vs ertptoyeea. If the su&c &acorn hara mVlOyeca, they nw Pmvlde their womkea• canP peNeY number. ,am an awpteysr rust is provldGea worhtrs' coampsasm9oe lnsrrrwtcs for soy MP/oyssx, JekW Is thepotlry and fob site Injoratatlote. . Insurance Corrpany Policy aY otxelf--ins. Lie. Expiration Date _ I Z' Z�i O[ lob Site Address: <t�`fl e (--j �J City/St,►•�Zsp. (O Ll Attach a copy of the workers' competaation policy declaration pap (showin the Policy number and expiration date). Failure to secure Coverage ge as required under Beetles 25A of MGL c. 152 can lead to the imposition of criminal penalties of • fine up to S 1.500.00 and/or one-year lmprisoomenL as well as civil penalties in the form of a STOP WORK ORDER and o fine Of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the OILce of investigations of the DIA for insurance enve.,o....:a .. I do hereby ee%t under the pales use only. Do not wilts /e area. that !hs laformadee provided above 6 tnaM• to Lowe o,Q?elai City or Town: Permit/License M fulling Authority (circle one): 1. Board of Health 2. Building Department 3. City(rown Clerk 4. Electrical ins pector 3. Plumbing Inspector Contact Person: Phone ll: Q5l Wowwtowwealtlil a1G�1�,4acl urlelfi Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration - Registration: 128957 Type: Individual Expiration: 6/14/2013 TO 213157 Oliver Kelly Oliver Kelly ' 8 Rhine Rd Yarmouthport, MA 02675 Update Address and return card. Mark reason for change. Address Renewal ❑ Employment Lost Card sCA 1 0 20M-0511 I — - --- --- —V/re iGarirnrarueen�l� rf'011awrc�uJe!!1 Office of Consumer Affairs & Busidess Regulation ME IMPROVEMENT CONTRACTOR egistration: 128957 Type: Oration: - 6/14/2013 . Individual Oliver Kelly Oliver Kelly 8 Rhine Rd. Yarmouthport, MA 02675 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,111A 02116 ' Not valid without signature '` Jl:u.aehuxlt.- Department of Public S:dct%. Board of Buildin- Regulations and Standard Construction Supervisor Specially License License: CS SL 99167 Restricted to: RF,WS -OLIVER KELLY 8 RHINE ROAD YARMOUTHPORT, MA 02675 Est Expiration: 9/28=13 • .i (numi..i ,nrr Tr#: 5155 , / CERTIFICATE OF LIABILITY INSURANCE PATapuwDmrYY) :ATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS DOES NOT AFFIRMATIVELY OR NEGATIVELY ADDEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES I CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED WE OR PRODUCER, AND THE CERTIFICATE HOLDER. If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to :ondlUons of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the or In lieu of such andomement s . ING & ONEIL INS AGCY INC :)X 1990 INIS, MA 02601 CONTACT EAWL ADDRESS' INSURER 3 AFFORDING COVERAGE NAIC e INSURERA' LIBERTY °R KELLY CELLY ROOFING NE ROAD IOUTH PORT MA D2675 INSURERS: INSURER CI INSURER D: INSURER 1: INSURER F - -- ••�•••��• rvcoouO HtVI51UN NUMBER! I IrT Irwa Int ruuL;ItS Ut• INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD TWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS 1Y BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, D CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I OF INSURANCE POLI MBER MPMOIIJ YEFF POLIO EXF LOWS EACH OCCURRENCE S AL GENERAL LIABILITY ❑ AEMI Ea ocamana i MEDEXP An on! S I -MADE OCCUR PERSONAL& ADV INJURY S GENERAL AGGREGATE f TE LIMIT APPLIES PER: . PR4 LOC PRODUCTS-COMP/OP AGO S f •B0.JTY Ee'Widem IN U S BODILY INJURY(Pw parson) f 8 AUTOS SCHEDULED NON-OwNEO AUTOS BODILY INJURY (Por accidanp i ParOicade14 S S S '� OCCUR CWMS-NADE EACH OCCURRENCE S AGGREGATE S RETENTIONS S f f RNSATION LIABIL3TY YIN EJCLUDE07�CU a NIA JWC2 - -715.338804020 - .—_ __'_�.---- 12/26l2070 __ -- 12/2812011 _ __—'-- WCSTATw 1 ER E.L. EACH ACCIDENT f 10000( E.L. DISEASE -EA EMPLOYEE S ' b EL DISEASE • POLICY LIMIT I S 500000 OPERATIONS below ►TIONSILOCATIONS/VEHICLES IAaaaAACORDI&I.AddldmWRaoMrl Sebodula,Ua opaajsmquW ) Ilion Insurance: Part One of the policy applies only to the Workers' Compensation Laws of the State of MA OMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR OLIVER KELLY CANCELLATIONLDER :LDON SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ROAD ACCORDANCE WITH THE POLICY PROVISIONS. 02601 AU7HORLMO REPRESENTATNB Jeff Eldridge I `r VG 01988-201D ACORD CORPORATION. All rights reserved. 15) The ACORD name and logo are registered marks of ACORD =13rr COUP, 132555S Aorta fl,andlor S/I4/I011 13N3,04 PH lags 1 of 1 ,le And lupereedaa ALL yr"il ly Laauad oartlfleataa. ONE & TWO FAMILY ONLY — BUILDING PERMIT APPLICATION TO CONSTRUCT. REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAh1ILY DWELLING Town of Yarmouth Building Department 1146 Route 28 • South Yarmouth, MA 02664-4492 508-398-2231 ext.1261 Fax 508-398-0836 1.1 Property Adi•••r 1.2 Zoning Information: �-14Xe*s�plevlf MY. K Zoning District 1.2 sulldlxN setheeks (ft) Front Yard Sida Yards Proposed Use Roar Vnrri Required Provided Required Provided Regi , P idetl 1.4 WMw &W4 [UA LL. a. 4& ! 841 1.5 Flood Zone Irronnetlom Corriffierd -. J U L 2 2 2 011 Public Private zom WE r JDEPT. Section 2- ONmeraN AuthorizedA Z1 rot Mae ri _ dY N (p t) / Mailing Address gnatura Telephone 2 2 Whala•d Agents n t) Mailing Address S`d� G off' -repa tun Telephone C Fax Section 3 - Conshixton Services I &I fAvin•ed Censbtsatlest superNsat O vir-ic 6 G —7 3 (M Gi� 3.2 Registered Home Improvement Contractor I '% - -� Mann Plot Applicable Q � ens• fJurnbar 7OZ&O 3 an Daj�• S//i3 Not Applicable l-.1 License Number f0 Expiration Date j N Za- 1of2 1 OVER 9ectforl. j tirersl C6 flitdeidtftt f tiJUrssti� A out: of r tsgs �l o Worker compensation insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will resuR In the denial of the issuance of the building permit. Signed Affidavit Attached Yes ... Pe.... No .......... Section S- ljiliWoMog IpMpaso Wbrk dt&*eD�l► New Consbuctlon I Na d Bedrooms No. of Bathrooms blsdn9lift O RePalr(s) or I Alterations O 1 Addition O Accessory Bldg. O Type Demolition Other. Specify: Brief Description of Proposed Work Me 7,41gcvAjL)-VlLu.-7-14 Woo e,v sr^ i 4 �X. T acre v-�f sft tin e - Esdlt ated Cdnsuuctfon Coats Item Estimated Coat (Dollars) to be Check Below completed by pares applicant 12 ConserwtkwrCommkolon Filing T. 8ui 2 Eleebkal b (N applicable) 3. pkwnbing / aae 4. Mechanical O HVA Old Kings Hlyltway 8 Historical Commtapproval S. Fire ProtecdM O eplic w) (H e.Total■(1 +2+3+4+5) dL>✓ 7. row square Ft. Ow name a adralaai s � • owner rf:a - To be Completed Owner's AdigiOr Contractor ties for &IldbM Pi i.,as owner of the subject property , hereby a horize to act on my aB, kall manare a authorized by this building permit application. 'Efd Ore+ ale Section 75 - OwrtedAuthorized A srtt Dedaretfon as Owner/Authodz Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and beget. Signed under the pains and penalties of perjury. PrkMnert+a SI d Qr� 11&k Oate ki 9. 13. 99 2012 ^R TOWN OF YARMOUTH BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRIM. _ / job Location: 72O9e Zy Number /+ Street Village Owner of Property: G-�2o/ ,17&&:2002=- Construction Supervisor: rim Name Address: Licensed Designee: (If other than Supervisor) Name 2.15 Responsibility of each license holder: U No. License No. Phone No. 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building and structures only pursuant to the state building code and all other applicable laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Any licensee who shall willfullyviolate subsections 2.15.1, 2.15.2 or 2.15.3 or any other section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the 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 2r— No ❑ If you have checked yu, 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 th ss. G n ral ws, and that my signature on this permit application waives this requirement. Check one: Q;f nnh,r wnar oars A°ant _ Owner ❑ Agent Signature: �,,!�� Building Official Approval: r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Invesdgadons 600 Washington Street Boston, MA 02111 lqqew www.massgov/dla Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print L blv Name(Husinesstorganintiontindividual): c:lty/Stawzip: �ii� ��dL/ /f1Y4f'-Phone M Sc Arl y n employer? Check the appropriate box: 1. ETI am a employer with 4. ❑ I am a general contractor and 1 employees (full and/or part-time).* have hired the sub -contractors 2. ❑ 1 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 3a. ❑ I am a homeowner acting as a general contractor (refer to #4) listed on the attached sheet These sub -Contractors have employees and have workers' comp. insurance t 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 reauired.1 Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions l 1.❑ Plumbing repairs or additions 12.0 Roof repairs 13.❑ Other *Any appli�t that checks box #1 mist also till out the section below showing their workers' wmpaaatiod �olieY iafasmatioa t Homeowners who submit this affidavit indicating they are doing all work and then hire outside coamseton roust submit a new sftidavil indicating audL . tContncton that check this box must ansched an additional shed showing the osme of the m&cmtraeton and state whether or not throe entities have employes. if the rob -contractors have cmpbyea, they must provide their worked coop. policy number. I arm an employer that is providing workers' compensadon insurance for airy employees Below Is the policy and Job site Information. Insurance Company Name- �y Policy # or Self -ins. Lic. #:y.3Z/PyQ--iq y 0 Expiration Date: // , r Job Site Address: `% //y f /f City/swdzip.,r Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonmen4 as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hsnby eerO twad Fs�rins�a� kla of perturY that the information provided above is errs and corrft% Phone #: Of f7clal use only. Do not writs in this area, to be completed by city or town ofJlelaL City or Town: Permlt/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6.Other Contact Person: Phone #: Information and Instructions Mmachuno Qemad Laws chapter 152 t� A empbydn te pro" worl=s' aompemadon for their eagtorM Ptasuad to this shaft as mple w is dewed n "„.avay pesos ha for savice of awtba flare airy contend of hire. express or implied, oral or writitm." As sat Wqw is defined n "as indi� Pumas* sasach+tIOA corpostios or other lepi eathye or my two oOr MW r tb of tba t6reyaio� enppd ha aloid mtsrpdae, and b"' flea Jewof a dseeased esivio , receive a hos0ee of s bsdMdosl. putoasbiA usoeiadm ar other lepl eatitn empbyiog aaplofm Hownu the awma of a dwellhr� home bavbr= mot morn fleas three and who tetida t� or the awl; of the llb* botw of aaotbat who =Vbys pum a to do maWmsnM comhtscdos a repair wads on sock dweltEoe base. dwe or on the � or >>� apporknont tbert- shall flat became of smcb employmmt be deemed to be eat acpk+yer." Mtn. chaplet 1.% f 23C(6) ale sores that "may state ter heal ll mdmg apstey shM wfd&U &a bass" or reeawol J e llm se aw parralt te apaata s boalaaw ter tr eesstrset baildbW Is flea aamaaawnlfh tlrr W apptle A wM bar ant predw" am P , 011 erldases of eeaapitlasas wuh the bmwann esreralp rogok ." Addidoofily. MOL cbaplQ I32. �2XM steles "Nehhet the commoawealth nor any of its poHdW wbdivWow still enter ids nay eodrset tbt tba pa*emtames of pabtlo wort undl aeeeptabls srideaea of eompeaaa with tb taanramcr regrdremmis of this chaplet haw beA praaa0td to flea can 1 -1 authority." Plsaas ® out the wain compettaedw affidavit complaaalys by ebecldy the boxaa that apply to your siaudw nod It fir, sWp1y anb.00atsaetor(s) nama(a). addreaa(a) sad pbors umber(s) aktq wits their eatifiale(i) of insmswL IJmiled Ltabillty Cowpmb (LLC) or Limited UdAft Pamaeships (LLP) wft w smpbyaa other the. the members or partom as not ee geisd to carry workers' compeaudw htnasaes. If as LLC or aw LLP don h ampioyea; a policy is regatee M Bon advised that this a8lid" may be sobmitted to the Depab=M of h d=kW Acddenle rx eaafirmador of in- . - covaap. Ara be we to dp and date tY atlidavlL � ou be'F Aaad to tb eity or sown that tbs appUcsdoa for tba pemk or � » ��bdue � obtain wu hum Inchw trW Accide� ShooM you ears nay gowdoaa spndbr�the bu ccmpea u dam pollay, pksss all the Department at the oomber Weed below. Sdt tenoned eampdee sbould enla their sel�Jmatanaoa liesaao asaoba on the apteopeiaan lima. CIly ter Taws oflldda Preen be ass that the affidavit is com>plea- and printed legibly. That Department hn provided: spa at that hallos of the affidavit Aar you to IW oat fa tha event tea Of a of faraMptioms has to coated you regse " the applieamL Paean be mate ao 1111 to tea pamidlieams anmbar which wW bs used as a mfbrean ommber. In odditim as apr " - ��m(if nwm y untdrs "Moab SSIIN Addraveo the applfeaot sb=M wri/a "all locatlow (CHY of tmm)." A copy ofthen &Mdarit that has bees officially stamped or macI 1 by tbs city or tows may bat peoridsd Im the appliamt r proof the a valid affidavit Is an Me ibr Attlee ptmfb of Hccmm A mew alfidadt mut be Mad out each year. Where a home owner at cWms Is obte nb* a lieemn at pamit and rebated ao my buthteaa at commercW vemtmro (Le. a dog licence or permit to burs leavesde.) said versos b NOT regoh ed ao comgkte this affidavit. Tjw Of "of Imvadpdow would lib to thank you be odvaaee As yes cooperation and should you haw any gmdooa, please do not hesitate to She as a cA Ilse oepwm Ws addrm telephone and I!a number: The Commonwealth of Munchusetta Department of hWusbid AceWnts ofAca of Invttatlpdeu 600 Washingtoo Sbteet Boston, MA 02111 Tel. M 617-7274900 ext 406 or 1-877-MASSAFE Fax M 617-727-7749 Revised 11.22416 www.rr=.gov/d1a For Office Use Only Permit No. Date TOWN OF YARMOUTH AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MOL a 142A requires that the 'reconstruction, altaadon, remavation, «pairo modaniadon, conversio% improvement, removal, demolition or construction of as addition to any p m-alsdug owncr ooa pied building containing at leant me but not mom than four dwelling units or strvcdre which ere adjacart to such reaidd= or buil&S' be done by re&aed contractors, with certain exceptions` along with other requirameam , Type of Work: Address of Wo 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 SI9000 Building not owner occupied Owner pulling own permit Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner. Date Contractor Name Registration No. FIRZ Notwithstanding the above notic I by apply for a permit as the owner of the above prop Date er Name TOWN OF YARNIOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, NIA 02664 508-398-2231 ext.1261 Fax 508-398-0836 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/de olition to be conducted at ZI;Q if 4-1 �/�: Work Address Is to be disposed of at the following location: X« Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Z� 'Oe- O-,Z Sign re of Applica ion Permit No. �/ Date MaNsachusctts - Department of Public safct� Board of Building Rc_ulation. and Si Construction Supervisor License License: CS 69M DAVID S HODSDON II PO BOX 221 ' • , � YARMOUTHPORT, MA 02675 - Expiration: 5/112013 r'..nnn i..ionrr Tr.:. 159M IF ..._ ' Otfite o uaumer sin smess eau a sec _— HOME IMPROVEMENT CONTRACTOR Type. Q ( Registration 105172 Expiration 71152012 DBA Af[ANTICCAPE iBuiLDEftS r. . t r David Hodsdon II , 11 20 Nimble Hill Dr Yarmouth Port, MA 02675:% Uedersecretarp . 1 V TOWN OF YARMOUTH Ulo Building Department Town Hail Yarmouth, MA 02664 (508) 398-2231 941281 BUILDING PERMIT TRANSMITTAL Temp Permit No.: T-12-009 Applicant Name: David Hodsdon Applicant Phone: 5083620483 Building Location: 0007 TIDE LN Owner's Name: MEADE, GEORGE V TRS Owners Addres 0007 TIDE LN South Yarmouth MA 02664 Owner's Telephone: (508) 394-3550 (OFFICE USE ONLY Recorded By. Ic Permit Fee: $0.00 Deposit Rec: $25.00 Payment Type: Check ChkNo.: 0 Net Owed: ($25.00) Application Date: 7/1/2011 Issue Date: Expiration Date Comments: Map/Lot: 025.25 remove existing metal stairway and construct new wood stairway ZONING APPROVED 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: 5. BUILDING DEPARTMENT: DATE: N/A: 6. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: Date Printed: 7/12/2011 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 �-v Bldg. Site Location �/i /,je�ti. Syy��,cr�i2� Map #: Lot #: r Proposed Improvement: Applicant: //T1,-;-,3 ll7rQ') J �C--e V I1LI?AAE AddressP. oe�l. #: Date Filed: % 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, Safety, Property Protection;, i.e. Smoke Detectors, Sprinkler Systems, Etc... PLEASE NOTE: COMMENTS: °t TOWN OF YARMOUTH ° HEALTH DEPARTMENT o,z PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Building Site .p Applicant: G,JIL/jr L_! =-YL�iyu Tel.No.: Filed: •*Ifyou would like e-mail notification ofsign of please provide e-mail address: Owner Name: l lWm5w- Owner Address: '7 7_rkae,1N , Owner Tel. No.: 3,9/35325 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, windows, roofing; (3.) If necessary, Title 5 application signed by licensed installer with fee. REVIEWED BY: PLEASE NOTE COMMENTS/CONDITIONS: 0Town of Yarmouth Conservation Commission Building Permit Sign -off Application Property Owner: Meade, George V TRS Applicant: David Hodsdon Construction Address: 7 Tide Lane, South Yarmouth Project Description: Remove existing metal stairways and construct new wood stairways Approved Plans: NA — not submitted with plan Conservation Commission Filing Required: No, see below. This application is conditionally approved Comments from Conservation Commission: THIS PERMIT IS CONDITONALLY APPROVED The applicant shall dispose of all debris related to the removal of the metal stairs and installation of the wooden stairs off site, in a legal upland location. Conservation Commission Sign -off Signature: ZPAT N. Date: 7_13_lk N p O OC) 0 C—DRrUl cL V� I Co/wnsonwea[tAs 7 ///auac/ra" official, Use Only Permit No. Q (-1 Z9 3 k9 BOARD OF FIRE PREVENTION REGULATIONS R `c Iro7 y and Fee Checked -`�— leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachu c is Electrical Code (ME , 527 AIR 12.00 PLEASE PRINT IN INK OR TYP ALL INFORMA7101g Date: City or Town of: To the Imp or o Wires: y this application the undersigned 'ves notice orhillor her intention to perform the electrical work described below. (Street A Number) or Tenant s Address ,11 this permit In conjunction with a building permit? Yes ❑ Purpose of Building �i(-1 L & " S Utility Authorlaation No. Overhead ❑ Overhead ❑ Existing Service Amps / Volts New Servke Amps I Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Undgrd ❑ Undgrd ❑ Telephone No. 77q No U (Check Appropriate Boa) No. of Meters No. of Meters ramnleAnn n/ldv G.11nw.lws lnhli w..... tr .w.i..w.r A. A. /w.nwr I.v ,rM .. No. of Recessed Luminaires No. of CeLL�usp. (Paddle) Fans No. o of all Transformers KVA No. of Luminaln Outlets No. of Hot Tubs Generators KVA No. of Luminaires re n- Swimming Pool end. ❑ rnd. o 0. o msrgeney g Batt Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. of Initiating Dwkes No. of Ranges No. of Air Cond. Tones. N0. of Alerting Devices No. of Waste Disposers p ea ump Totals: um er I ons a o ontained Detection/Alordne Devices I I No. of Dishwashers Space/Ares Heating KW Loaf ❑ COnnitdna p 0a ❑ Other No. of Dryers Heating Appliances KW Security 8xs ms: N0. of &Sikes or Equivalent o. of Water KW Heaters o. 0 140.09 Silas Ballasts Data Wiring: N0. of Dedces or E ulvslent N0. Hydromassage Bathtubs N0. of Motors Total HP a ecomma oa nr�•.• N0. of Devices or E uivsknt OTHER: !i .t tlacil additional detail ifdau" or at required by the Inspector of Wires. Estimated ValueOfEle trical Work: t'o 0 (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with b1EC Rule 10. and upon completion. INSURANCE OV 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 office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) 1 ee►tifp, unddr the and psnaId of perjury, that the Information on this app/kalfon is true and complete. FIRM NAME: 3 LIC. NO.:/4� 3sa Licenser. So V-4e SignatureLIC. NO.: FS1 Ig S (Ifopplieab/e, enter "exempt"ln the license number line.) Bus. TeL N0.• 71 ( UV Address: AIL TeL N0.: ?AS 7AW •Pet M.O.L. c. 147. s. 57.61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: 1 am aware that the Licence does not have the liability jnsurance coverage normally required by law. By my signature below. I hereby waive this requirement. I am the (check one) Qowner Qowner's aFtent. Owner/Agent Signature Telephone No. PEXWT FEE: S 1 k6 TOWN OF YARMOUTH BUILDING DEPARTMENT Permit Number 1 - 3� 1146 Route 8 Southa'arniau 0266J 508-398-2 1 ext.1261lFpz 5081 �i 0836 Date Issued - c%— u FEB 0 U1 Expiration Date ele8 2011 �030 $50.00 r 1 -- PT TRENCH PERMIT Pursuant to G.L. c. 82A II and 520 CMR 7.00 et seq.(as amended) THIS PERMIT Nlt1Sr BE FULLY COMPLETED PRIOR TO CONSIDERATION NawofAppikaat L nrl �{' �pY76�'�nci'rorr Mae cou b vo$--nr-3s�3 504.p-p336 Street Addrto () Cky/rown MA Z1P �%,�L �l 1.F L o2 6 6l Sired Adds. chyfrowo Now of Ownt0s) of Property Pbar Celt &Aftof. `I'71t-Slo- 0616 Sheet Addrem -7 � o cr c. pig: ArTra4L oae'73 usar 191080 tomtlaa and purpwe of proposed trenrlu Pkase describe tha enact Ideation of ON proposed french sad its purpaat (laehrds a dexriptlou of what L (or Is intended) a be laid to proposed fceucb (es: plpea/cable uan eta.) Pkae use re.er:.dds irs"dea l rpace is rneeded. i insursnco cenifkats or 6e6O -;,554 6 1.226 `tsar(/sad Contact Inron"1100 of emarer. Dig sariI:�0)) (070 ,Vawo(ComW#fW Perwa las defined by 520 (:11R c- c ✓1 Cn1<1 E311t I of 2 MaNN&Ummu na:aw Lk"ms 46= 081229 ZA.4A lRx DMc 5/9$/9011 BY SIGNING THIS FORM. THE APPLICANT. OWNER, AND EXCAVATOR ALL ACKNOWLEDGE AND CERTQ+L( WITH,THAT THEY AU FAMLIARWITH,OR. BEFORE Coba#=CE3UW OF THE WORK. WILL BECOME FAMILIAR WrM ALL LAWS AND REGULATIONS APPLICABLE TO WORE PROPOSED, INCLUDING OSHA REGULATIONS. GL L S2A. 520 ME, 7AP d se+. AND ANY APPLICABLE MUNWMAL ULORDINANCES. BY-LAWS AND REGATIONS AND THEY COVENANT AND AGREE THAT ALL WORK DONE UNDER THE PERMIT LSSUED FOR SUCH WORK WILL COMPLY THEREWITH IN ALL RESPECTS AND WITH THE CONDITIONS SST FO11TH BELOW. THE UNDERSIGNED OWNER AUTHORUM THE APPLICANT TO APPLY yoR THE PERMIT AND TILE EXCDURATION TOUNDERTAKENSUCTIO SUCH WORE ON TER PROPERTY OF THE OWNER, AND ALSO, FOR THE DURATION OF CONSTRUCTION, AViHOREM PERSONS DULY APPOLNTED BY THE MUMCIPALTTY TO ENTER UPON THE PROPERTY TO MONITOR AND INSMC? THE WORK FOR CONFORMny WITH THR CONDITIONS ATTACHED HIRSTO AND THE LAWS AND REGULATIONS COVERING SUCH WORIL THE UNDERSIGNED APPLICANT, OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO RMMBURSE THE MUNICIPALITY FOR ANY AND ALL COSTS AND EXPENSES IIYMM BY THE MUMCQAUrV IN CONNECTION WITH THIS PERMITAND THE WORK CONDUCTED THEREIMM INCLUDING BUT NOT MUTED TO ENFORCING THE REQUIREMENTS OF STATE LAW AND CONDITIONS OF THIS PERJMr. INSPECTIONS MADE TO ASSURE COMPLIANCE THEREWITH. AND MEASURES TARN BY THE MUMCIPALTTY TO PROTECT THE PUBLIC WHERE THE APPLICANT OWNER OR EXCAVATOR HAS FAMED TO COMPLY THEREWITH MUMING POLICE DETAILS AND OTHER REMEDIAL MEASURES DEEMED NECESSARY BY THE MUNICIPALITY. THE UNDERSIGNED APPLICANT, OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO DgFEND, DMGMUNIFY, AND HOLD HARMLESS THE MUNICIPALITY AND ALL OF ITS AGENTS AND EMPLOYEn FROM ANY AND ALL LIABILITY, CAUSES OR ACTION. COSTS. AND MUSK= RESULTING FROM OR ARISING OUT OF ANY INJURY, DEATH, LOBS. OR DAMAGE TO ANY PERSON OR PROPERTY DURING THR WORK CONDUCTED UNDER THIS PSRM?T. APPLICANT SIGNATURE DATE e�1 EXCAVA SIGNATURENIFDISFERFINT► DATE OWNER'S SIGNATURE 1E DIFFERENT) DATE: 2 of 2 .. FIELD COPY r• BILDING PERMIT �D, - cK• 13?S U DATE Jiwk%_19m 2OW I PERMIT NO. B-00-992 APPLICANT r S Cyril Meade s%. S. Y. (NO.) (STREET) (CONTR'S LICENSE) S� NUMBER OF PERMIT TO I—) STORY DWELLING UNITS (TYPE OF IMPROVEMENT) NO. IPROPOSED USE) [7Pl Y_ ZONING AT (LOCATION) S. DISTRICT R-25 .� (NO.) (STREET) a BETWEEN AND 01 (CROSS STREET) )CROSS STREET) m IL m SUBDIVISION 25T LcjQ 825 LOT SIZE U O BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION m O Z TO TYPE r USE GROUP I" BASEMENT WALLS OR FOUNDATION (X (TYPE) REMARKS: woodlen �}�..�.�� sbad S '2. 14 —. AREA OR - - . VOLUME ESTB.IATED COST $ _ (CUBIC/SQUARE FEET) - OWNER ADDRESS 21M.0 FEEMIT 20.00 BUILDING DEPT. (i�/✓�� BY, - J _.....�. y.' INSPECTION RECORD DATE NOTE PROGRESS - CORRECTIONS AND REMARKS INSPECTOR h ONE & TWO FAMILY ONLY - BUILDING PERMIT APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING Town of Yarmouth Building Department .4e 1146 Route 28 • Yarmouth, MA 02664-4492 Tel: (508) 398-2231 x261 • Fax: (508) 398-2365 111 ,QOffic�ee Use Only Permit Nof' J"��Dat4 Permit Fee $ aO, Deposit Rec'd. $�Q�'%Date Net Due ' $ /O , f Planning Board Information Plan Type Endorsement Date Recording Date Plan No. Other Assessors Department Information: map r M � Old New 1.4 Property Dimensions: - - Lot Area (sf) , 33 Frontage (ft) Lot coverage This Section for Office Use Only Building Permit Number: Date Issued: - 4' Signature: ool Buildin Official Date Certificate of Occupancy Is is not �� required eq Section 1 - Site Information I Use Group: R-4 Type: 5-B 1.1 property Address: n/ �� Z ,y 1.2 Zoning Information: IC';- S'*� Zoning District Proposed Use SO I�:R 1.3 Building Setbacks fit) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided b �s., a-o . 1.4 Water Supply (M.O.L. c. 40. S 54) ubIic Private 1.5 Flood Zone Information: Comments: Zone: LL '— BFE: -12�— Section 2 - Property Ownership/Authorized Agent 2.1 Owner of Record, nn C'�v�G� 4 (, APOL b,!F 7 7iP!57-r LM To Ka 114 Name ( Mail dyes 54��9 ipr7�s Sa ignature Telephone 2.2 Authorized Agent: Name (print) Mailing Address Signature Telephone Section 3 - Construction Services 3.1 Licensed Construction Supervisor: Not Applicable ❑ License Number Address _ Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor: Company Name Not Applicable ❑ License Number Address Signature Telephone Expiration Date Section 4 - Workers' Compensation Insurance Affidavit (M.G.L 6.152 S 25C Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. I Sigr,2d Affidavit Attached Yes .......... No .......... Section 5 - Description of Proposed Work (check all applicable) New Construction .ZK I No. of Bedrooms No. of Bathrooms Existing Bldg. ❑ I Repair(s) ❑ Alterations ❑ I Addition ❑ AccessoryBldg. ❑ Type Demolition Other Specify: Brief Description of Proposed Work: s v c 7- diooD� ti ,x Section 6 Estimated Construction Costs Item Estimated Cost (Dollars) to be completed by permit applicant 1. Building 2. Electrical 3. Plumbing / Gas 4. Mechanical (HVAC) 5. Fire Protection 6.Total=(1 +2+3+4+5) . 7. Total Square Ft. (new houses 3 additions) Section 7a - Owner Authorization - To be Completed When Owner's Agent or Contractor Applies for Building Permit 1, Des- Check Below J�onservation-Commisslon Filing (if applicable) ❑ Old Kings Highway & Historical Commission approval (if applicable) , as owner of the subject property hereby authorize my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Section 7b Owner/Authorized Agent Declaration Date to act on I, cZP. e-3 oe 6c- l L,L � , 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 9- 15-99 2 of 2 -TOWN OF YARMOUTH BUILDING DEPARTMENT BUILDING PERMIT APPLICATION SIGN OFF Applicant: tj�0'P6c !�%c Building Permit No.:' s sso Address: 7 %/ �� L Tel. : )s V� ate Filed: 6 S� Bldg. Site Location: S�/�C Map No.: Lot No.. 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 CONBUSSION: 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. ---------------------------------------- 77te following Departments must sign off, in the respective order, prior to building inspector issuing the required building permit: REVIEWED BY: 1. WATER DEPARTMENT: DATE: N/A: �2,,/. ENGINEERING DEPARTMENT: DATE: N/A: LS. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTDIENT: DATE: N/A: INDUSTRIAL AND/OR COMMERCIAL PERMITS 5. WIRING INSPECTOR: DATE: N/A: 6. PLUNIBING 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. COMDtENTS: 8/99 Applicant Signature Date TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route'_3. South Yarmouth. NIA 02664 503-393-2231 ext. 260 PLEASE PRINT: 445ATE: �j2lOQ GTB LOCATION: 6&nk, 6'F C+ t F NAME 4HOMEOWNER" NAME RESENT MAILING ADDRESS HOMEOWNER LICENSE EXEMPTION 7 ADDRESS SECTION OF TOWN PHONE WORK PHONE L CITY OR OWN STATE ZIP CODE The current exemption for `Homeowner' was extended to include owner — occupied dwellings of one or two unit and to allow such homeowners to engage an individual for hire who does not possess a license, provided that suc} homeowner shall act as supervisor. (State Building Code Section 109.1.1) Definition of Homeowner: Person(s) who owns a parcel of land on which he / she resides or intends to reside, on which there is or is intender to be. a one or two family attached or detached structure assessory to such use and / or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner; such "homeowner shall submit to the building official, on a form acceptable to the building official, that he / she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned `homeowner' assumes responsibility for compliance with the State Building Code and other applicable codes, by-laws, rules and regulations. The undersigned `homeowner' certifies that he / she understands the Town of Yarmouth Building Department minimum inspection procedures and requirements and that he / she will comply with said procedures and requirements. OMEOWNER'S SIGNATURE PROVAL OF BUILDING OFFICIAL INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL Ch.142. Yes C No If you have checked ves, please indicate the type coverage by checking the appropriate box. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws and that my signature on this permit application waives this requirement. ✓ Check one: Signat ofOwne or Owner's Agent Owner >� Agent ❑ h:homeo,.%nrlicexemp r \ MITTACnLp (,' A._ . ,...- 1146ROL'TE28 SOL7HIAMIOL71-1 NUSSACHtS=502664-i451 PLL'�fBl�c. Telephone 15081 398-0231. Ext. 261 — Fax i508) 398-^_365 SIGNS BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to I.G.L. Chapter 40. Section 54 and 780 CMR. Chapter 1. Section 111.5. 1 ltereby cerufy at the debris resultin? from the proposed work 'demolition to be ortducied atl 7 T/�� Work Address i• to br disposed of at the follotrina location: U p Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111. Section I50A. S W nature of Applicant Permit No. atm• For Office Use Only Permit No. Date TOWN OF YARMOUTH AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application NIGL c. 142A requires that the `reconstruction. alteration. renovation. repair. modernization. conversion. improvement, removal, dentolidon 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. ype of Work: eQ NS rjec1c'7iDo1 S7-0015& Sol st• Cost 2>0(90 dddress of Work % / 1 j% L ,4,) -Own r Name: � z�CJ P-61 C �%' O zGDate of Permit Application: O6m I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000 uilding not owner occupied Owner pulling own permit Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. Notwithstanding the above notice, I hereby apply for a permit as the owner of the above ZI-2-72 6 Dat aO%nc�P=�e 130. Department of Industrial.4ccidenis exceffaffesgosvess 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance AMdavit A tvz; ;5�aei2'/o U7W A [!' I am a homeowner performing all work myself. 77 1 am a sole proprietor =.1 have no one working in any capacity 6CO mhaneo 394-3SSa � j lam an emplo%er pro%idin¢ workers' compensation for my employees working on this job. address: citv- i urnnc tl C I am a sole proprietor. general contractor. or homeowner (circle one) and have hired the contractors listed below %%ho ha% the folio%%in_ %%orkers' :ompensation polices: comoanv name - address: ctn^ nhone++ incurnnce co. policy M camnanv name - address, city. phone N. rauure to secure coverage as required under Secttoo 25A of MGL 152 can lead to the imposition ofcrimiaal penalties ofa Oae op to f1.SD0W0.00 and/or one yean' imprisonment as well as civil penalties is the form ofa STOP WORK ORDER and a tine ofSIMM a day against I Sl ad that a Copy of this statement may be forwarded to the OMcc of Investigations of the DU for coverage veriQndan. l da herehp cert sunder the pains and penalties ojpery'ury that the infornmdow provided above is ouir and gorse name (f? e0 ('�! 64rO r �Sok7 39y 3 sso wTicial use only do not %rite in this area to be completed by city or town aMcial city or town: Yt?oDTA _ permiWtense 11 nBuilding Dtpsrtment Q check if immediate response is required pUcensing Board261 C3Stleetmen's OIBct contact person: phone M: _ (508) 398-2231 ext. QHealth Department n0ther \las�achtlsetts General La%%s chapter 152 section 25 requires all employers to provide workers' compensation for their empio%ees. As quoted from the "lac+", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. .-fin entp6,t•er is defined as an indic idual. partnership, association, corporation or other legal entity, or anv two or more the fore.'eina en_umued in a joint enterprise, and including the regal representatives ofa deceased employer, or the receic er or trustee of an iodic idual . partnership. association or other legal entity, employing employees. However the o%%ner of a dccellin(= house hag in= not more than three apartments and who resides therein. or the occupant of the dcc ellin^ house of another who employs persons to do maintenance , construction or repair work on such dwelling hous or on the _rounds or building appurtenant thereto shall not because of such employment be deemed to be an emplo%er. %IGI.:Itapter 1: _ ;ectirn _: also states that every state or local licensing agency shall withhold the issuance or renc%%al of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant is hn has not produced acceptable evidence of compliance with the insurance coverage required. Additionallc . neither the cominoncc ealth nor any of its political subdivisions shall enter into any contract for the performance of public %cork until acceptable evidence of compliance with the insurance requirements of this chapter hag been presented to the contractin_ authority. .applicants Please till in the workers' compensation affidavit completely. by checking the box that applies to your situation and suppi% ink= company names, address and phone numbers as all affidavits may be submitted to the Department of Industrial accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The aftidac it sltotild be returned to the city or town that the application for the permit or license is being requested. not the Department of industrial accidents. Should you have any questions regarding the "law" or if you are required to obtain a %corkers' compensation policy. please call the Department at the number listed below. City or I -owns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address, telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents iiflCe of IB stfii>tden 600 Washington Street Boston, Ma. 02111 - fax N: (617) 727-7749 phone #: (617) 7274900 ext. 406, 409 or 375 �"' PLOT PLAN I Abutter's 6' 7 Name Lot # If this is a corner lot, write in name of street. FOR LOT # Indicate location of garage or accesso building Additions with dashed lines ------- ------------ Sewerage disposal (cesspool) Well ot..... .o.b .....ft. rear) Ex 1 TT11.1(>-I rR�(O E sr�Eb �SHP- I 85 x ,q !FX 14 I REAR YARD / ........ 3z.ft. v 1 i I eSDE YARD _ FT. I'\ HOUSE Q I SET BACK ... 3.S.ft.� I� I (lot ....... E."Z�.s...... ft. frontage) ,SIDE YARD .5— FTij Abuttor I s Name Lot # if this is corner lo- write in name of a other bstreet. (NAME OF STREET) Information Supplied by 'Y MARK NORTH POINT For Office Use Only Permit No. Date TOWN OF YARMOUTH AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application '�tGL c. 142A requires that the 'reconstruction. alteration, renovation, repair, modernization. conversion. improvement, removal, demolition or construction of an addition to anv 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 Address of Work Est. Cost 20GY Owner Name: Date of Permit Application: 6 2— lid I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under $1,000 utlding not owner occupied V Owner pulling own permit Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DE.AL.ING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. Notwithstanding the above notice, I hereby apply for a permit as the owner of the above :77le Date O%vnfr Nam fw \! .. 41•Y.r •: i ♦ ` • ... l-♦•� •- w ... iM {.[.:.. -.. �[I. ,. w'.. .♦. ry♦lw.tr•tl•�l.Y.w .. •4-0 e APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, FPR-I I TOWN OF YARMOUTH IMPORTANT WNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws, and that my signature on this permit ap- plication waives this requirement Owner Agent (Sqw. a o.w w Aanq Tel. No To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location 0 Owner or Owner's A Is this permit in conjuncti; n Vth ap; A ,I Building Use _ Service Amps permit? (OFFICE USE ONLY) By / Fee: $ PERMIT NO. Date /1—/5' 19—?�L— Yes _� No No. of Meters Existing New Increased from to Nature of the Proposed Electrical Work /,JJ d 1J l he— R ¢ LC_,&-_-o& f/�. ¢ ¢ l�/ r�� Qa2 t�A� �� e• 7"L�� - PROPOSED FIXTURES IN DETAIL (See attached schedule, if necess ) Location of Room light t ens Sw. Plugs Fix[. Location of Room Light Outlets Sw. Plugs Ffrt. No. of Sw. Out I [feat -Type No. of Outlets Lt. Oil No. of Rec. Gas No. of Motors H.P. Electric -KW Connected Load No. of Signs Trans. Hot Water -Motors and Size Air Cond. Steam Motors and Size Range Name plate rate I Hot Air Motors and Size Water Heater Name plate rate Misc. Clothes Dryer Name plate rate Total Load Size of Main Entrance Sw. Size of S.E. Conductors INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws. - - I have a curve Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES NO O I have submitted valid proof of same to this office. Yes H No/O If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE /BOND O OTHER (Please specify) - (Expiration Due) Esdi atedvalueof ic Workf ? r%�s�� r Work to Start A /J (/] , Inspection Date Requested Rough Final Signed under the penalties of perjury:/ ,/ FIRMNAME:—Ait9/l 8k,1sE - ny e6Z1 ( r LIGNo. 94 4 2 Licensee 1r1R1e ff• ekR �/ 6 p LIC.No. (dilres Ai9t Roo ;71 I{ldRrL','- r �Y/P /�l�,t�"r�l / Dus.Tel.No. •�''73z�/ /��_ Alt. TeL No. Supplemental information on forms furnished by the inspector of wires, shall be mailed or delivered by the applicant within five (5) working days from the dated of said application, if required by the inspector of wires. I t PERMIT 342 5/17/99 5/17/99 LOT K-1 Meade, George ®R 7 Tide Lane South Yarmouth, MA 02664 Shed 8' x 14' $2,000.00 amw a SHEET 20 d.4"e -P� j4rjLC4"� �7O TOWN OF YARMOUTH Application for a Permit to Build No. 3 Z UPON FINAL APPROVAL 'M, 5111I99 FEE MUST ACCOMPANY THIS APPLICATION. MAP 'Z LOT r / The undersigned hereby applies for a permit to build according to the following specifications 1. Name of property owner Address 7 -rl jam Gatti DATE 19 %/9 1�7. g� 2. Name of Architect (if any) 3. Name of builder Address 4. License No. Tel. 5. Name of Mason Address YC icense No. onstruction address 8. Date of subdivision Approval Tel. 9. Private dwelling 9 Estimated Cost 10. Multifamily ❑ i-00 11. Commercial ❑ 12.Other ❑ 13. No. of stories 0 14. Foundation — Full ❑ Half ❑ Crawl ❑ Slab ❑ 15. Materials — Wood ❑ Cement ❑ Other ❑ 16. Type of heat — Oil ❑ Gas ❑ Electric ❑ Other ❑ 17. Garage —1 ❑ 2 ❑ 18. Swimming pool - Size 19. Storage shed — Size 0. Stove — Wood ❑ Coal ❑ to , Te1.✓-S --3s" Te1. district n Azone /T Zone DO NOT W 1TE IN THIS SPACE Type of room No. dim 4GvS�d.ep Kitchen Dining Rm. Living Rm. Bed Rm. Bath Deck Closed porch Family Rm. Sun room Shed Alterations 21. Size of lot: No. of feet front z 6 No. of feet rear TO No. of feet deep /4 22. Size of building. No. of feet front 14, No. of feet side No. of feet rear y 23. Distance from nearest building: Front Ft. side JO Ft. side Rear 24. Distance back from line or street 12 O From rear lot line Side line 6' � 25. H.I.C.R. No. LOT RELEASED BY PLANNING BOARD Date Signature Addre 6! lu-M-2-8-1999- __.-- --- BUILDING PERMIT APPLICATION SIGN OFF APPLICANT: G�GE //n/.�i�� BUILDING PERMIT #: ADDRESS: %, 7/ l,�� 1-41-le TELE. NO.: 39¢ SS✓tO DATE FILED: BLDG. SITE LOCATION: % %/ % C 4 V MAP#: -z(o LOT#: k I THE FOLLOWING INFORMATION OUTLINES THE PROCEDURAL STEPS REQUIRED TO OBTAIN A PERMIT TO BUILD, ALTER, OR ADD TO A STRUCTURE WITHIN THE TOWN OF YARMOUTH. THE BUILDING DEPARTMENT WILL DETER- MINE COMPLIANCE TO THE FOLLOWING (A) ZONING REQUIREMENTS (B) HISTORICAL DISTRICTS (C) FLOOD PLAINS ZONING. THE BUILDING DEPARTMENT WILL BE RESPONSIBLE FOR ASSISTING THE APPLICANT THOUGH THE FOLLOWING DEPARTMENTS: RESIDENTIAL AND/OR COMMERCIAL BUILDING WATER DEPARTMENT: DETERMINES COMPLIANCE OF WATER AVAILABILITY. ENGINEERING DEPARTMENT: DETERMINES COMPLIANCE FOR PARKING AND DRAINAGE. CONSERVATION COMMISSION: DETERMINES COMPLIANCE TO WETLANDS ACTS, I.E.: IF LOT(S) BORDER ANY TYPE OF WETLANDS, STREAMS, PONDS, RIVERS, OCEANS, BOGS, BAYS, MARSH LAND, ETC. HEALTH DEPARTMENT: DETERMINES COMPLIANCE TO STATE AND TOWN REGULATIONS, I.E.: REQUIRE- MENTS FOR SEPTAGE DISPOSAL AND OTHER PUBLIC HEALTH ACTIVITIES. FIRE DEPARTMENT: DETERMINES COMPLIANCE TO STATE AND TOWN REQUIREMENTS FOR PERSONAL SAFETY, PROPERTY PROTECTION, I.E., SMOKE DETECTORS, SPRINKLER SYSTEMS, ETC. THE FOLLOWING DEPARTMENTS MUST SIGN OFF, IN THE RESPECTIVE ORDER, PRIOR TO BUILDING INSPECTOR ISSUING THE REQUIRED BUILDING PERMIT: REVIEWED BY: 1. WATER DEPARTMENT DATE: N/A: 2. ENGINEERING DEP THENT: DATE: N/A: 3. CONSERVATION: 45DATE: % `� 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. A SIGNED RECEIPT FROM THE DISPOSAL SITE MUST BE SUBMITTED TO THE BUILDING DEPARTMENT PRIOR TO ISSUANCE OF THE BUILDING PERMIT. COMMENTS: BLM 89 Suggested Affidavit for Home Improvement Contractor Permit Application For omen Use only NAME OF CITY/I'OWN Permit M6 71 Al ni. AFFIDAVIT Home Improvement Contractor II.ew Supplement to Permit Application MGLe.142Atequiresthat the "reconstruction alteration or construct ion or an addition to any orcedstint ameroccuvied buildint containine at leaat one btn not more than fourdwellwellinr uniu....or to structures which are adjacent to such residence or buildint' be done by registered contractom with eenain eaceptiona, along with other tequttements. <01 Type of Work: IN-VPZ 44 rio.� of ESL Cost 20 00 Address of Work % �7- j DE L A khg— Owner Name: Date of Permit Application: 4 �6 I hereby certify that: Registration is not required for the following rcason(s): _Work excluded by law _Job under S1,000 _Building not owner- occupied vt)wner 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. Z ' Dat Contractor Name Registration No. OR: M Notwithstanding the above X ce,,l hereby a ly for a permit as the owner of the above property: Dat Ownc amc BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT:' JOB LOCATION: OWNER OF PROPERTY: &r — CONSTRUCTION SUPERVISOR: ADDRESS: 457— v p 73B�n/¢ /NS7�3cccD By L!Un Cm! LL E NO. LICENSED DESIGNEE: (IF OTHER.THAN SUPERVISOR) NAME LICENSE NO. 2.15 RESPONSIBILITY OF EACH LICENSE HOLDER: 2.15.1 THE LICENSE HOLDER SHALL. BE FULLY AND COMPLETELY RESPONSIBLE FOR ALL WORK FOR WHICH HE IS SUPERVISING. HE SHALL BE RESPONSIBLE FOR SEEING THAT ALL WORK IS DONE PURSUANT TO THE STATE BUILDING CODE AND THE DRAWINGS AS APPROVED BY THE BUILDING OFFICIAL 2.15.2 THE LICENSE HOLDER SHALL BE RESPONSIBLE TO SUPERVISE THE CONSTRUCTION, RECONSTRUCTION, ALTERATION, REPAIR, RMOVAL OR DEMOLITION INVOLVING THE STRUCTURAL ELEMENTS OF BUILDING AND STRUCTURES ONLY PURSUANT TO THE STATE BUILDING CODE AND ALL OTHER APPLICABLE LAWS OF THE . COMMONWEALTH, EVEN THOUGH HE, THE LICENSE HOLDER, IS NOT THE PERMIT HOLDER BUT ONLY A SUB— CONTRACTOR OR CONTRACTOR TO THE PERMIT HOLDER. 2.15.3 THE LICENSE HOLDER SHALL IMMEDIATELY NOTIFY THE BUILDING OFFICIAL IN WRITING OF THE DISCOVERY OF ANY VIOLATIONS WHICH ARE COVERED BY THE BUILDING PERMIT. 2.15.4 ANY LICENSEE WHO SHALL WILLFULLY VIOLATE SUBSECTIONS 2.15.1, 2.15.2 OR 2.15.3 OR ANY OTHER SECTION OF THESE RULES AND REGULATIONS AND ANY PROCEDURES, AS AMENDED, SHALL BE SUBJECT TO REVOCATION OR SUSPENSION OF LICENSE BY THE BOARD. 2.16. ALL BUILDING PER`fIT APPLICATIONS SHALL CONTAIN THE NAME, SIGNATURE AND LICENSE NUMBER OF THE CONSTRUCTION SUPERVISOR WHO IS TO SUPERVISE THOSE PERSONS ENGAGED IN CONSTRUCTION, RECON— STRUCT ' ION9 ALTERATION, REPAIR, REMOVAL OF DEMOLITION AS REGULATED BY SECTION 109.1.1 OF THE CODE AD THESE RULES AND REGULATIONS. IN THE EVENT THAT SUCH LICENSEE IS NO LONGER SUPERVISING SAID PERSONS, THE WORK SHALL IMMEDIATELY CEASE UNTIL A SUCCESSOR LICENSE HOLDER IS SUBSTITUTED ON THE RECORDS OF THE BUILDING DEPARTMENT. I HAVE READ AND UNDERSTAND MY RESPONSIBILITIES UNDER THE RULES AND.REGULATIONS FOR LICENSING CON- STRUCTION SUPERVISORS IN ACCORDANCE A'ITH SECTION 109.1.1 OF THE STATE BUILDING CODE. I UNDERST:L%" THE CONSTRUCTION INSPECTION PROCEDURES AND THE SPECIFIC INSPECTION AS CALLED FOR BY THE BUILDING OFFICIAL. INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGLCh.152' Yes 0 No ❑ If you have checked ves, please indicate the type c average by checking the ap:.rcpriate box. A liability Insurance pe:icy ❑ Daher type of :.idemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the ucensee does not have the Insurance coverage required =y Chapter 152 of the Mass: General Laws, ana that my signature on th:s permit =plication wanes this requirerrem- Check one: Signature or Omer or Owner s Agent Owner❑ Agent ❑ SIGNATURE: _,A!(1pi...�BUILDING OFFICIAL APPROVAL: 'C. The Commonwealth of Massachusetts Department of Industrial Accidents oxess/1"ps paffm 600 Washington Street Boston, Mass. 02111 NcepY Workers' Compensation Insurance Affidavit ,&Onlicant Information PfeaseFRilPi'Te�Gbia name* C �� B 61)• �� //�///��/ /7 phone N ❑ 1 am a homeowner pertotming all work myself. ❑ I am a sole proprietor and have no one working in any capacity ❑ lam an employer pro%iding workers' compensation for my employees working on this job. gamasny ns-n-• — - - ritv ^:- phone#! insuranceeo po�sY M ❑ 1 am a sole proprietor. general contractor, o omeowne circle one) and have hired the contractors listed below who have the followinn workers' :ompensation polices: samn2ny-- pp p� address• ram' % Z O SQ, Vwe� OVTtr Failure to secure coverage at required ender Section 25A of MGL I52 as kad to the imposition of erimiW pes"cits of s Gas sp to S1.snAll asdlor one years' Imprisonment as well as civil penalties in the form of a STOP WORK ORDER soda An of SIOOAO s day against Use. 1 nndentand that a copy of" statement maybe forwarded to the Otacc of Investigations of the DIA for coverage vM anon. t do -hereby cep der the pains t!a dilry that the infornsadac prarldcd abort is atte a d correct (Sienantm Q/ Print name a CIL. 92 official use only do not write in this area to be completed by city or town official cityoftown: YANlOOT$ _ permiWecat M ZlImildlag Department pUaaslsg Board p check if immediate response is required 261 OSe1edNc8's Oface contact person. phone t; _r. (508) 398-Ml est. C3oW O Department PLOT PLAN F Abutbor's 6l Name Lot # If this is a corner lot, write in name of street. 0 � b v FOR LOT # < 1 Indicate location of garage or accessory building Additions with dashed lines -------------------- Sewerage disposal (cesspool) Well � (lot...... 9 ......ft. rear) I I SIDE YARD ID_ FT. t1 REAR YARD ......j....ft. HOUSE SIDE YARD a--3-5 - FTo l—to- � 2�j� SET BACK `�—J/ - I (lot..................ft. frontage) (NAME OF STREET Information Supplied by �i b Abuttor I s Name Lot # if this is corner la write in name of other street. 'lRkERe RIIIE'e MARK NORTH POINT • �}•�• 4 : � yr.•..�..�wr.•wYrwr u..wlr.r J..►.r►aa' L ..}i.Y DSO/L S 'GO.V•S/,ST.'OF .F/N�' ANO NEd✓IJN, �.. •. ' ` .. � ' � s ANQ ..:W/TN : SOHc � G.?Al�EL., , _ i r' Gam: YEG/TATrON ON R%YER 8.4NiKS' CONS/ST ,: pF. yARS{�/ 'COJ20 GRASS �" '; + ALONG 'SyORE.*G/NE ANO NARS/a/ .Y.9Y, '�FURTiYER UP 7-owe BANK. ND F/N FiSN iiv -T7lE jZii'E/7 /NoG iUOE ''.%/EftRING� • f, c •' FLOVNOER ROCK BASS 'BLOh/F/SN •EE[.S, .: +„ r " G✓N/7Lr • P�.�CN fiIVOIf sEFS ; iQOB/NS ^�. It RI VIEW i' • ` _e � :, � ,,.:, • NOTE•' EX/ST/NG /�N� �XNEC TFd / 70 �C STRUpTUR�S ` .8 I c� PricPc.�.>✓ A .y 9uuu.�• d : y • o PERMIT 337 5/18/98 P 5/18/98 LOT K1 u Meade, George & Carol 7 Tide Lane South Yarmouth, MA 02664 Replace existing deck on 2nd flr. 8' x 28' $1,800.00 SHEET 70 TOWN OF YARMOUTH Application for a Permit to Build UPON FINAL APPROVAL & S-1$'9" MAP ZD FEE MUST ACCOMPANY THIS APPLICATION. DATE The undersigned hereby applies for a permit tgbuild accoNding to the following specifications ame of property owner C�L�0 2Ge- ttC l4P-IJOL, Address 7 r/ be f_N So 2. tame of Architect (if any) Name of builder 6'-:j o L�(, a ddress 4. License No. ti A Tel. 5. Name of Mason 04 Address y�icense No. ti A Tel. onstructionaddress 7 r/b6' LN 8. Date of subdivision Approval F 9. Private dwelling IL Estimated Cost 10. Multifamily ❑ 7-0 O,Ocv�- 11. Commercial ❑ eio-z- 12. Other 2VICE 13. No. of stories 0qW i No. -�f— LOT urvf 394- 3SS0 el(77i7-4b3¢ Flood Uistrict y� — plain zone Zone DO NOT WRITE IN THIS SPACE Type of room No. _ 0 47 14. Foundation — Full ❑ Half ❑ Crawl ❑ Slab ❑ 115. Materials — Wood 9 Cement ❑ Other ❑ 16. Type of heat — Oil ❑ Gas ❑ Electric ❑ Other ❑ 17. Garage —1 ❑ 2 ❑ 18. Swimming pool - Size 19. Storage shed — Size 20. Stove — Wood ❑ Coal ❑ 21. Size of lot: No. of feet front 22. Size of building. No. of feet front _ 23. Distance from nearest building: Front 24. Distance back from line or street LOT RELEASED BY PLANNING BOARD Date Signatur Add No. of feet rear Kitchen Dining Rm. S jG� Living Rm. a Bed Rm. Bath �xr Deck Closed port Family Rm. Sun room Garage Shed Alterations No. of feet side Ft. side No. of feet deep No. of feet rear _ Ft. side Rear From rear lot line Side line BUILDING PERMIT APPLICATION SIGN OFF APPLICANT: (Z0266- 4 COkOL I ff-APt: BUILDING PERMIT #: , ADDRESS: %T/D&- 14J, '_-'0. n rY0VrllTELE. N0. .(�la)-3`Iy'3MDATE FILED: BLDG. SITE LOCATION: % %I DE L MAP#: r40 LOT#: THE FOLLOWING INFORMATION OUTLINES THE PROCEDURAL STEPS REQUIRED TO OBTAIN A PERMIT TO BUILD, ALTER, OR ADD TO A STRUCTURE WITHIN THE TOWN OF YARMOUTH. THE BUILDING DEPARTMENT WILL DETER- MINE COMPLIANCE TO THE FOLLOWING (A) ZONING REQUIREMENTS (B) HISTORICAL DISTRICTS (C) FLOOD PLAINS ZONING. THE BUILDING DEPARTMENT WILL BE RESPONSIBLE FOR ASSISTING THE APPLICANT THOUGH THE FOLLOWING DEPARTMENTS: WATER DEPARTMENT: ENGINEERING DEPARTMENT: CONSERVATION COMMISSION: HEALTH DEPARTMENT: FIRE DEPARTMENT: RESIDENTIAL AND/OR COMMERCIAL BUILDING DETERMINES COMPLIANCE OF WATER AVAILABILITY. DETERMINES COMPLIANCE FOR PARKING AND DRAINAGE. DETERMINES COMPLIANCE TO WETLANDS ACTS, I.E.: IF LOT(S) BORDER ANY TYPE OF WETLANDS, STREAMS, PONDS, RIVERS, OCEANS, BOGS, BAYS, MARSH LAND, ETC. DETERMINES COMPLIANCE TO STATE AND TOWN REGULATIONS, I.E.: REQUIRE- MENTS FOR SEPTAGE DISPOSAL AND OTHER PUBLIC HEALTH ACTIVITIES. DETERMINES COMPLIANCE TO STATE AND TOWN REQUIREMENTS FOR PERSONAL SAFETY, PROPERTY PROTECTION, I.E., SMOKE DETECTORS, SPRINKLER SYSTEMS, ETC. THE FOLLOWING DEPARTMENTS MUST SIGN OFF, IN THE RESPECTIVE ORDER, PRIOR TO BUILDING INSPECTOR ISSUING THE REQUIRED BUILDING PERMIT: REVIEWED BY: 1. WATER DEPARTMENT DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: / Q 99-N/A: 4. HEALTH DEPARTMENT— I DATE: I 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. A SIGNED RECEIPT FROM THE DISPOSAL SITE MUST BE SUBMITTED TO THE BUILDING DEPARTMENT PRIOR TO ISSUANCE OF THE BUILDING PERMIT. COMMENTS: BLM 89 .. ~T I } -L, ----. LL LJ U LJ Ll LL , i :1 .-1 TV _ H60111well: ;. _ xS�xBf�Z7 I -- PLOT PLAN AbuttorIs K L Name vrm N Lot # If this is a corner lot, write in name of street. mm . FOR LOT # Indicate location of garage or accessory building Additions with dashed lines - -------------------- Sewerage disposal (cesspool) Well 0 I P(5U-rra e '!A .o -& (, I IN am9 : We ..... .........ft. rear) SIDE YARD �]-- — - FT. 0 REAR YARD HOUSE SET _.1 USIDE YARD to a_ 39 FT� I (lot ........ I.e—'. %r..... ft. frontage) \ � (NAME OF STREET) / Information / \ Supplied by MARK NORTH POINT AbuttorIs Name Lot # if this is corner la write in name of other street. �i b N TOWN OF YARMOUTH BUILDING DEPARTMENT PLEASE PRINT: DATE JOB LOCATION 7 "HOMEOWNER" A HOMEOWNER LICENSE EXEMPTION 7-/ 1)&7- L. ti STREET ADDRESS Si OF TOWN 3 Fj!-3 SSo (600 oz W RK PHOD PRESENT MAILING ADDRESS &-0 2G&- NAME WOL `'j me (-' CITY OR TOWN STATE ZIP CODE THE CURRENT EXEMPTION FOR "HOMEOWNER" WAS EXTENDED TO INCLUDE OWNER - OCCUPIED DWELLINGS OF ONE OR TWO UNITS AND TO ALLOW SUCH HOMEOWNERS TO ENGAGE AN INDIVIDUAL FOR HIRE WHO DOES NOT POSSESS A LICENSE, PROVIDED THAT SUCH HOMEOWNER SHALL ACT AS SUPERVISOR. (STATE BUILDING CODE SEC- 109.1.1) DEFINITION OF HOMEOWNER: PERSON(S) WHO OWNS A PARCEL OF LAND ON WHICH HE/SHE RESIDES OR INTENDS TO RESIDE, ON WHICH THERE IS, OR IS INTENDED TO BE, A ONE OR TWO FAMILY ATTACHE D OR DETACHED STRUCTURES ASSESSORY TO SUCH USE AND/OR FARM STRUCTURES. A PERSON WHO CONSTRUCTS MORE THAN ONE HOME IN A TWO-YEAR PERIOD SHALL NOT BE CONSIDERED A HOMEOWNER, SUCH "HOMEOWNER" SHALL SUBMIT TO THE BUILDING OFFICIAL, ON A FORM ACCEPTABLE TO THE BUILDING OFFICIAL, THAT HE/SHE SHALL BE RESPONSIBLE FOR ALL SUCH WORK PERFORMED UNDER THE BUILDING PERMIT. (SECTION 109.1.1) THE UNDERSIGNED "HOMEOWNER" ASSUMES RESPONSIBILITY FOR COMPLIANCE WITH THE STATE BUILDING CODE AND OTHER APPLICABLE CODES, BY-LAWS, RULES AND REGU- LATIONS. THE UNDERSIGNED "HOMEOWNER" CERTIFIES THAT HE/SHE UNDERSTANDS THE TOWN OF YARMOUTH BUILDING DEPARTMENT MINIMUM INSPECTION PROCEDURES AND REQUIRE- MENTS AND THAT HE/SHE WILL gOMPLY WITH SAID PROCEDURES AND REQUIREMENTS. . HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL INSURANCE COVERAGE: I have acurrent liability Insouance policy or b substantial equivalent which meets the requirements of MGL Ch. 142. If you have checked Yves. 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 2 of the s-General taws. and that my signature on this permit application waives this requirement. Check one: Owner )� Agent El natu t Owner or Owner s Agent Z In accardance with the provisions of MGL c 40, S 54, a candition of Building Pe. —...it Number is that the debris resulting from this work shall be disposed of in a property licensed solid waste disposal facilirr as dcffned by %tC:. c 111, S 'Ihe debris will be disposed of in: TH (Location of Facility) /LLL .-AzeA Sic:at W�027j.):2�� Fcr-,,, Acpi-cznv, Date BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT: JOB LOCATION: % T /yE LA Ndp_ SD'yfl >M0UTE NUMBER STREET VILLAGE OWNER OF PROPERTY: GeO2G6 . C''4ROL mg-4 Dc= CONSTRUCTION SUPERVISOR: Ow N e NAME ADDRESS: LICENSE NO. LICENSED DESIGNEE: (IF OTHER.THAN SUPERVISOR) NAME LICENSE NO. 2.15 RESPONSIBILITY OF EACH LICENSE HOLDER: 2.15.1 THE LICENSE HOLDER SHALL. BE FULLY AND COMPLETELY RESPONSIBLE FOR ALL WORK FOR WHICH HE IS SUPERVISING. HE.SHALL BE RESPONSIBLE FOR SEEING THAT ALL WORK IS DONE PURSUANT TO THE STATE BUILDING CODE AND THE DRAWINGS AS APPROVED BY THE BUILDING OFFICIAL 2.15.2 THE LICENSE HOLDER SHALL BE RESPONSIBLE TO SUPERVISE THE CONSTRUCTION, RECONSTRUCTION, ALTERATION, REPAIR, MIOVAL OR DEMOLITION INVOLVING THE STRUCTURAL ELEMENTS OF BUILDING AND STRUCTURES ONLY PURSUANT TO THE STATE BUILDING CODE AND ALL OTHER APPLICABLE LA;S OF THE COMMONWEALTH,, EVEN THOUGH HE, THE LICENSE HOLDER, IS NOT THE PERMIT HOLDER BUT ONLY A SUB— CONTRACTOR OR CONTRACTOR TO THE PERMIT HOLDER. 2.15.3 THE LICENSE HOLDER SHALL IMMEDIATELY NOTIFY THE BUILDING OFFICIAL IN WRITING OF THE DISCOVERY OF ANY VIOLATIONS WHICH ARE COVERED BY THE BUILDING PERMIT. 2.15.4 ANY LICENSEE WHO SHALL WILLFULLY VIOLATE SUBSECTIONS 2.15.1, 2.15.2 OR 2.15.3 OR ANY OTHER SECTION OF THESE RULES AND 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 ;LUMBER OF THE CONSTRUCTION SUPERVISOR•WHO IS TO SUPERVISE THOSE PERSONS ENGAGED IN CONSTRUCTION, RECON— STRUCT ' IONj ALTERATION, REPAIR, REMOVAL OF DEMOLITION AS REGULATED BY SECTION 109.1.1 OF THE CODE AD THESE RULES AND REGULATIONS. IN THE EVENT THAT SUCH LICENSEE IS NO LONGER SUPERVISING SAID PERSONS, THE WORK SHALL L2 EDIATELY CEASE UNTIL A SUCCESSOR LICENSE HOLDER IS SUBSTITUTED ON THE RECORDS OF THE BUILDING DEPARTMENT. I HAVE READ AND UNDERSTAND MY RESPONSIBILITIES UNDER THE RULES AND REGULATIONS FOR LICENSING CON- STRUCTION SUPERVISORS IN ACCORDANCE :KITH SECTION 109.1.1 OF THE STATE BUILDING CODE. I UNDERSTA:1: THE CONSTRUCTION INSPECTION PROCEDURES AND THE SPECIFIC INSPECTION AS CALLED FOR BY THE BUILDING OFFICIAL. INSURANCE COVERAGE: I have a current liability insurance pelicy or its substantial equivalent which meets the requirements of MGL Ch.152 • Yes 0 No ❑ If you have checked ves, please indicate the t•;•pe c average by checking the ap;rcpriate box. A liability Insurance pciicy ❑ O.'her type of :.idemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the ucensee does not have the insurance coverage required ty Chapter W of the Mai General Lws, ana Mat my signature on this permit ec;lication waives this requiren:er.-- Check one: Signatura ner or divnel s Agent Owner Agent ❑ SIGNATURE:BUILDING OFFICIAL APPROVAL: Suggested Affidavit for Home Improvement Contractor Permit Application For omce use only NAME OF CITY/rOWN Penult No. r;10 Date AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGLe.142Arequiresthat the "reconstruction. a Iteration. renovation, repair, modernization conversion inDrovement removal demolition. or construction of an addition to a nvoretcisnn¢ ownerrccuoied butldine contain ineat least one but not more than four dwelline units .... or to structures which are adjacent to such residence or but ldine" be done by registered contractors with certain exceptions, along with other requirements. Type of Work: _J�ACc EXIST/Q—" DC'�CN O,U 2mA F'Ladl�_-Est. Cost a O09-2— Address of Work 7 Tf b & I- /U SO, YA12vnn u-rH, ,11r9 Owner Name: (��Oetse' 4 06PCjL ME -Abe - Date of Permit Application: I hereby certify that: Registration is not required for the following rcason(s): _Work excluded by law mob under S1,000 _Building not owner -occupied 4=Owner pulling own permit _Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: 4 Date w c ;vamc avvN The Commonwealth of Massachusetts Department of Industrial Accidents exceelleraW1,1988S 600 Washington Street Boston. Mass. 02111 y Workers' Compensation Insurance Affidavit Annlicnnt Information:PleaseP�iRPTedtititr ., come7 C-- 7T/ L f}NG� citv So, V- 4o �oUrH soggy;3? -1 %%/ %� phone d J. I am a homeowner performing all work myserf. I am a sole proprietor _nd ha%a no one working in any capacity I am an employer pro%iding workers' compensation for my employees working on this job. insurance co nolicv N 1 am a sole proprietor. general contractor. or homeowner (circle one) and have hired the contractors listed below w ho ha% the following workers' compensation polices: name!company address City, phone a• ooliev N n p,tucnaaaaoau atuetxrn Failure to secure coverage as required under Section I5A of MGL 152 ua lead to the impoatioaf c orimiaal penalties of a Ilse up .o S19 —W and, one years' Imprisonment as well as civil penalties In the form of a STOP WORK ORDER and a floc of $100.00 a day against me. I sadersuad that copy of this statement may be forwarded to the Orrice of Investigations of the DIA for Coverage verifludos. I do hereby cenify u er the pains and penalties ojpci jury that the informadon provided above is true and correct �lLlA �v1�a`c mate �/6�5� Print name 6' 614eG6-= W F—R D 6, Phone i,( �)44- ^ 3 SS6 I fficial use Orly do not write in this area to be completed by city or town official city or town: YARMODT$ _ permit/license 0 (3Buildfog Department CLiccosiag Board 0 check if immediate response is required 261 C3Selectmen's Office pHealtb Department contact person: phone N: _ (50 ) 398-2231 eat. nOther — �i V Massachusetts Department of Environmental Protection Town of Yarmouth Wetland By -La Bureau of Resource Protection — Wetlands Chapter 143 DEP Co WPA Form 2 - Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131e §40 General Information From: YARMOUTH COW10MCmmmisba 1. Applicant GEORGE MEADE &W 0f FV= Ar bVfieq" 12 Peabody Drive AW14AMU Stow C011TO n MA 01775 snu & code 2. Property Owner name d fteq ww rda'aenna tom epplano Mj&;Add1= Ciry,Aown snre zo Co& U Determination Pursuant to the authority of M G.L c.131, §40, the YARMOUTH canumoanComnuMW has considered your Request for a Determination of Applicability, with its supporting documentation, and has made the following Determination regarding: Seven Tide Lane StedMVW South Yarmouth, MA Colro" LpCoe 20 K1 AtsesM MUWwI PHebtd / I/ 3. Title and Final Revision Date of Plans and Other Documents: Rev.10/98 Page 1 of 4 W Massachtrseffs Departmental Environmental Protection Tow- of Yarmouth Wetland By -Law Bureau of Resource Protection — Wetlands Chapter 143 WPA Form 2 = Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 U Determination (cont.) The following Determination(s) is/are applicable to the proposed site and/or project relative to the Wetlands Protection Act and Regulations: Positive Determination Note: No work within the jurisdiction of the Wetlands Protection Act may proceed until a final Order of Conditions (issued following submittal of a Notice of Intent or Abbreviated Notice of Intent) has been received from the Issuing authority (i.e.. conservation commission or the Department of Environmental Protection). 1. The area described on the plan(s) referenced above, which includes all or part of the area described in the Request, Is an area subject to protection under the Act Therefore, any removing, fining, dredging, or altering of that area requires the filing of a Notice of Intent M 2. The delineations of the boundaries of the resource area listed directly below, described on the plan(s) referenced above, which Includes all or part of the area described in the Request, are confirmed as accurate: Therefore, the resource area boundaries confirmed in this Determination are binding as to all decisions rendered pursuant to the Wetlands Protection Act and its regulations regarding such boundaries for as long as this Determina- tion is valid. However, the boundaries of resource area not listed directly above are DM confirmed by this Determina- tion, regardless of whether such boundaries are contained on the plans attached to this Determination or to the Request for Determination. 3. The work described on plan(s) and document(s) referenced above, which includes all or part of the work described in the Request, is within an area subject to protection under the Act and will remove, fig, dredge, or alter that area. Therefore, said work requires the filing of a Notice of Intent C 4. The work described on plan(s) and document(s) referenced above, which includes all or part of the work described in the Request, is within the Buffer Zone and will after an Area subject to protection under the Act Therefore, said work requires the filing of a Notice of Intent :1 5. The area and/or work described on plan(s) and document(s) referenced above, which Includes all or part of the work described in the Request, is subject to review and approval by NaM oMa Cgi0' pursuant to the following wetlands law, bylaw, or ordinance (name and citation of law). rJ 6. The following area and/or work, if any, is subject to municipal bylaw but EM subject to the Massachusetts Wetlands Protection Act G 7. If a Notice of Intent Is filed for the work in the Riverfront Area described on plans and documents referenced above, which includes all or part of the work described in the Request, the applicant must consider the following alternatives (Refer to the Wetlands Regulations at I OM(4)c. for more Information about the scope of aftemative requirements) : C3 Atematives limited to the lot on which the project is located. 17 Alternatives limited to the lot on which the project is located, the subdivided lots, and any adjacent lots formerly or presently owned by the same owner. C Alternatives limited to the original parcel on which the project is located, the subdivided parcels, any adjacent parcels, and any other land which can reasonably be obtained within the municipality. Alternatives extend to any sites which can reasonably be obtained within the appropriate region of the state. Rev.10193 Page 2 of 4 If DEP Massachusetts Department of Environmental Protection Town of Yarmouth Wetland By -Law Bureau of Resource Protection — Wetlands Chapter 143 WPA Form 2 = Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 U Determination (cont.) Negative Determination Note: No further action under the Wetlands Protection Act Is required by the applicant. However, If the Department of Environmental Protection is requested to issue a Supersed- ing Determination of Applicability, work may not proceed on this project unless the Department fails to act on such request within 35 diys of the date the request Is post- marked for certified mail or hand delivered to the Depart- ment. Work may then proceed at the owner's risk only upon notice to the Department and to the conservation commission. Requirements for requests for Superseding Determinations are listed at the end of this document. = 1. The area described In the Request is not an area subject to protection under the Act or the Butter Zone. = 2. The work described In the Request Is within an area subject to protection under the Act, but will not remove, fill, dredge, or alter that area. Therefore, said work does not require the filing of a Notice of Intent. S 3. The work described in the Request is within the Butter Zone, as defined In the regulations, but will not after an Area subject to protection under the Act Therefore, said work does not require the filing of a Notice of Intent 4. The work described In the Request is not within an Area subject to protection under the Act (including the Buffer Zone). Therefore, said work does not require the filing of a Notice of Intent, unless and until said work afters an Area subject to protection under the Act 5. The area described in the Request is subject to protection under the Act. Since the work described therein meets the requirements for the following exemption, as specified in the Act and regulations, no Notice of Intent is required: LwWAOwty 2 6. The area and/or work described in the Request is not subject to review and approval by NmeolAlwuC04 pursuant to a municipal wetlands law, ordinance, or bylaw, (name and citation of bylaw). Authorization This Determination must be si ned b a f th This Determination is Issued to the applicant and delivered as follows: Z by hand delivery on on 2F by certified mail, return receipt requested on May 7. 1999 Do This Determination is valid for three years from the date of Issuance (except Determinations for Vegetation Management Plans which are valid for the duration of the Plan). This Detemunation does not relieve the applicant from complying with all other applicable federal, state, or local statutes, ordinances, bylaws, or regulations. g y malorny o e conservation commission. A copy must be sent to the appropriate Department of Environmental Protection regional office (see appendix A) and the property owner (if Rev, to198 DO Page 3 of 4 DEP Massachusetts Department of Environmental Protection Town of Yarmouth Wetland By -Law Bureau of Resource Protection — Wetlands Chapter 143 WPA Form 2 = Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 13lt §40 0 Appeals The applicant, owner, any person aggrieved by this Determina- tion, any owner of land abutting the land upon which the proposed work is to be done, or any ten residents of the city or town in which such land is located, are hereby notified of their right to request the appropriate Department of Environmental Protection Regional Office to issue a Superseding Determina- tion of Applicability. The request must be made by certified mail or hand delivery to the Department, with the appropriate filing fee and Fee Transmittal Form (see Appendix E: Request for Departmental Action Fee Transmittal Form) as provided in 310 CMR 10.03(7) within ten business days from the date of Issuance of this Determination. A copy of the request shall at the same time be sent by certified mail or hand delivery to the conservation commission and to the applicant if he/she is not the appellant. The request shall state clearty and concisely the objections to the Determination which is being appealed. To the extent that the Determination is based on a municipal bylaw, and not on the Massachusetts Wetlands Protection Act or regulations, the Department of Environmental Protection has no appellate jurisdiction. Rev.10/98 Page 4 of 4 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, FPR-11 TOWN OF YARMOUTH IMPORTANT NNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the Insurance coverage or its substantial equivalent as required by Massachusetts General Laws, and that my signature on this permit ap- plication waives this requirement. Owner Agent f (OFFICE USEONLY) By Fee: $ PERMIT NO. -DD -D 17 (sa.tm a o. o Ag�) Tel. No. Date To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street and Owner or Tenant_ Owner's Address_ Is this permit in co Building Use Service Amps permit? 1110V 16 1999 r Pule No. 19-y? Yes ✓ No No. of Meters Existing New Increased fromn to Nature of the Proposed Electrical Work "J. dvT51De- ij�[Cy4� -P Al LV i`[siC 6AS )roItP PROPOSED FIXTURES IN DETAIL (See attached schedule, it necess ) Location of Room 0 8 etS Sw. Plugs Fixt. Location of Room Light ig ets Ou Sw. Plugs Fixt. No. of Sw. Out Heat -Type No. of Outlets Lt. Oil o. of Rec. Gas No. of Motors H.P. Electric -KW Connected Load No. of Signs Trans. I Hot Water -Motors and Size Air Cond. Steam Motors and Size Range Name plate rate Hot Air Motors and Size Water Heater Name plate rate Misc. Clothes Dryer Name plate rate Total Load Size of Main Entrance Sw. Size of S.E. Conductors [ INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General laws. /fit I have a curre Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES WC NO ❑ I have submitted valid proof of same to this office. Yes ZZ 0 if you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE/BOND OOTHER (Please specify) O (Fspiruion Due) Estitrtated Value ofElepical VUurk S 2 70 00 p Work to Start I� � A /J Imp�utt Late Reques[ed: Rough Fuel Signed under the penalties of pperjurrr, JJ�� nn p ,/ FIRMNAME.Mfflgk f'9 115 &LY' LVr 11C.No. /3w'L .7• e1%4� L1C.No `` p '" 7 �j tsz8-Paz-99o� Address: Ps �t 8�,k /� � 9 �irlRwt � � �0. Dz� � a'J � / Bus.TeL No. 4..., rd wxnM Alt. TeL No. Supplemental information on forms furnished by the inspector of wires, shall be mailed or delivered by the applicant within five (5) working days from the dated of said application, if required by the inspector of wires. "ASSACHUSE'iTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (print or Type) !y� 0 .6- S83 9 ."G f N 0 k. /I/'�Y1DL17 Mass. Date 19914? City, Town Permit I 101A Building Owner's� ,rr�� AT: Location 7 �c% Znh� Name ('jt06L4 � //e4oe- YArfhoal�Z Type of Occupancy: j1e- Newt2 Renovation ❑ Replacement ❑ 61 Plans Submitted Yes ❑ No ❑ e��nn�nmou�onn��m �nnru�n�n�o�comonr ��o�o�nm��oo�nnom �nnnnmm�nn�nnnn (Print or Type) Installing Company Company Name_£, F. WINSLOW ?Lutt$tl &+ Check One: Certificate Address S 1ZEA4zDcn1 [tRC,� YSKIVCorp. 04-2946193 ❑Partnership • y�} 1 o uTE{- j1/► �}- OZA 6 y ❑ Firm/Company. Business Telephond&9-2394-7779 Name of Licensed Plumber or Gasfitter E. F. V IIJ5LO W ZM a I haobr ecay that all of the dddU sad tafoon&don l han WbmUted (or entered) la abon appltatba so Una sad sewtau to tbs of mf loaowtedss wad Ilat all plamblos rock wad Icutal4Uoaa pccfocmed wader hrmlt laved fat " spplkadon wM bo to 07jaoe W" a�ttaeat pcotiloat of 60 idaaathodu State C S Cods sad taaptet 142 of tW Cameral laws. t) � By, Titley'- City/Town.. APPROVED (OFFICE USE ONLY) TYPE LICENSE: Plumber Gasfitter Master Journeyman signature Of'Licensed Plumber or Gasfitter 1939 License Number FINAL -INSPECTION BELOW FOR OFFICE USE ONLY SKETCHES FEE APPLICATION FOR PERMIT TO DO GASFITTING NAME 1 TYPE OF BUILDING &0 rkeaC, LOCATION _ _•ia fa rr'-D` - PLU►IBER OR GAS ER .y=-.. F. ININ,SLO LA.; + 44 uC. NO. M 1prsl-s of LL c . # '7 9 3 9 PERMIT GRANTED OCT 8�10 DATE GASINSPECTOR PROORESSINSPECTION Town of Yarmouth No. 670 GAS PERMIT Office of the Gas This is to Certify that . has permission to , South Yarmouth 19 q fc-t y in building on in accordance with an application on file in UVs office, and subject to the provisions of the Ordinances relating to the Gas Code in the Town of Yarmouth. Fee $�� Gas Inspector 1/7J2015 SlipGen - Portal Home Town of Yarmouth Template [Building Dept] ■ Slipsheet Identifier [sg15127] Document Category Building Permits Map -Block Number 025.25 Street Number 0007 Street Name TIDE LN Department Building Parcel ID 2477 Backfile Batch Scan No Document? Additional Naming Info Index Operator Operator, Yarmscan Date - Time 2015-01-02 - 11:24 httpJAaserfiche12tSlipGerJ 1/1