HomeMy WebLinkAboutBuilding Permits7TN
FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
D (fir —NATIONAL FLOOD INSURANCE PROGRAM �Plres July 31, 2002
DEC ELEVATION CERTIFICATE
Im Rant: Read the Instructions on pages 1 - 7.
. .............................................. .
SECTION A - PROPERTY OWNER INFORMATION For Insur...arw..s Compa..ny ...
Use:.. r.
BUILDING O Policy
George Levesque
BUILDING STREET ADDRESS (Including Apt, Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Compaq NAIC Numlxr
2 Television Lane ... ..
CITY STATE ZIP CODE
West Yarmouth MA 02673
PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
Assessors Map 14 Parcel 90
BUILDING USE (e.g., Residential, Non-residential, Addition, Accessory, etc. Use Comments section if necessary.)
Residential
LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: GPS (Type):_
( ##.W or ##.#####' ❑ NAD 1927 ❑ NAD 1983 ❑ USGS Quad Map ❑ Other:
SECTION B -FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP COMMUNITY NAME 8 COMMUNITY NUMBER 82. COUNTY NAME B3. STATE
Yarmouth - 2SM15 1 Barnstable I MA
B4. MAP AND PANEL
BS. SUFFIX
B6. FIRM INDEX
B7. FIRM PANEL
B8. FLOOD
B9. BASE FLOOD ELEVATION(S)
NUMBER
DATE
EFFECTIVE/REVISED DATE
I
ZONES)
I
(Zone AO, use depth of flooding)
1
0005
D
7-2-92
7-2-92
Al2
10.0
B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9.
❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other (Describe):
Bit. Indicate the elevation datum used for the BFE in 89: ® NGVD 1929 ❑ NAVD 1988 [--]Other (Describe):
B12. is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)?❑ Yes ® No
Designation Date
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* ® Finished Construction
•A new Elevation Certificate will be required when construction of the building is complete.
C2. Building Diagram Number 8 (Select the building diagram most similar to the building for which this certificate is being completed - see
pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.)
C3. Elevations — Zones AI-A30, AE, AH, A (with BFE), VE, VI-V30, V (with BFE), AR, AR/A, AR/AE, AR/A1-A30, AR/AH, AR/AO
Complete Items C3a-i below according to the building diagram specified in Item C2. State the datum used. If the datum is different from
the datum used for the BFE in Section B, convert the datum to that used for the BFE. Show field measurements and datum conversion
calculation. Use the space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion
Datum NGVD1929 Conversion/Comments
Elevation reference mark used RM24 Does the elevation reference mark used appear on the FIRM?
❑ a) Top of bottom floor (including basement or enclosure) B. 6 ft.(m) o
❑ b) Top of next higher floor 11 . 6 ft.(m) N
❑ c) Bottom of lowest horizontal structural member (V zones only)_ _ft.(m) 8
❑ d) Attached garage (top of slab) 10. Oft.(m) E g
❑ e) Lowest elevation of machinery and/or equipment
servicing the building
12 . 4ft.(m)
E 4
❑ Q Lowest adjacent grade (LAG)
6. 5ft.(m)
o
❑ g) Highest adjacent grade (HAG)
❑ h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade 4
❑ i) Total area of all permanent openings (flood vents) in C3h •'
sq. in. (sq. cm)
® Yes ❑ No
(Z-
SECTION D -SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information.
I certify that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data available.
I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
CERTIFIER'S NAME Steven W. Rumba LICENSE NUMBER 35791
TITLERegistered Land Surveyor COMPANY NAME Weller 8 Associates
ADDRESS CITY STATE ZIP CODE
FEMA Form 81-31, AUG 99 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS
IMPORTANT: In these spaces, copy the corresponding Information from Section A. 1 For Insurance Company Use..':'
BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO., Pocky Number
2 Television Ln.
CITY STATE ZIP CODE ' ' U t;',Company NAIC Number
West Yarmouth MA i 02673
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner.
COMMENTS " Total area of flood openings is 1728 sq. in.
❑ Check here if attachments
SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE)
For Zone AO and Zone A (without BFE), complete Items E1 through E4. If the 0evetion Certificate is Intended for use as supporting
information for a LOMA or LOMR-F, Section C must be completed.
El. Building Diagram Number _(Select the building diagram most similar to the building for which this certificate is being completed — see
pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.)
E2. The top of the bottom floor (including basement or enclosure) of the building is _ fL(m) _in.(cm) ❑ above or ❑ below (check one)
the highest adjacent grade.
E3. For Building Diagrams 6-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is
_ tL(m) _in.(cm) above the highest adjacent grade.
E4. For Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's
floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must certify this information in Section G.
SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION
The property owner or owner's authorized representative who completes Sections A, B. and E for Zone A (without a FEMA-issued or
community -issued BFE) or Zone AO must sign here.
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
ADDRESS CITY STATE ZIP CODE
SIGNATURE DATE TELEPHONE
COMMENTS'
❑ Check here if attachments
SECTION G - COMMUNITY INFORMATION (OPTIONAL)
The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete
Sections A, B; C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below.
G1. ❑ The Information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor,
engineer, or architect who is authorized by state or local law to certify elevation information. (Indicate the source and date of the
elevation data in the Comments area below.)
G2. ❑ A community official completed Section E for a building located in Zone A (without a FEMA-issued or community -issued BFE) or
Zone AO.
G3. ❑ The following Information (Items G4-G9) Is provided for community floodplain management purposes.
G4. PERMIT NUMBER I G5. DATE PERMIT ISSUED I ISSUEDE CERTIFICATE OF COMPLIANCE/OCCUPANCY
G7.'This permit has been issued for. ❑ New Construction ❑ Substantial Improvement
G8. Elevation of as -built lowest floor (including basement) of the building is: _ _ft.(m) Datum:
G9. BFE or (in Zone AO) depth of flooding at the building site Is: _ _ ft.(m) Datum:
LOCAL OFFICIAL'S NAME TITLE
COMMUNITY NAME TELEPHONE
SIGNATURE DATE
COMMENTS
❑ Check here if attachments
FEMA Form 81-31, AUG 99 REPLACES ALL PREVIOUS EDITIONS
�-OO-6F,I�yDCOPY 3�a/
BUILDIN
PERMS
DATE, Mmcch 16. 2000 19
APPLICANT &liErVeSCIM ADDRESS 2 lb3ayisica3 I
PERMIT TO STORY
(TYPE OF IMPROVEMENT) NO.
(PROPOSED USE)
PERMIT NO.L B-00-08
NUMBER OF
DWELLING UNITS_
2 FLSclvAsim Lma W. %4a� JS 0•fG+11'� ZONING R-25
AT (LOCATION) Csy� OE11iJLL4a •'+R W7J DISTRICT
BETWEEN ) • �' AND
A (CROSS•STREET) (CROSS STREET)
A
m LOT
SUBDIVISION 14/90 - LOT 52 BLOCK MW SIZE
0
O BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
m
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
i
m (TYPE)
0
REMARKS: REMMM ff If* tn Tnym
AREA OR
VOLUME
ESTIMATED COST $ 2080 .00 FEE
_PERMIT $ 50�00
(CUBIC/SQUARE FEET)
OWNER iio=w & �j�m�ig o,,,8���1.,,
ADDRESS - 2 (Ail �, W, +oS.0 mith, NA 02673 BUILDING DE
INSPECTION RECORD
DATE NOTE PROGRESS CORRECTIONS AND REMARKS INSPECTOR
ONE & TWO FAMILY ONLY - BUILDING PERMIT Igagq2 D q 1f 3(p
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMI Y DWELLING
Town of Yarmouth Building Department
1146 Route 28 • Yarmouth, NIA 02664-4492 /lY
Tel: (508) 398-2231 x261 - Fax: (508) 398-23f 5
h.li►'>z�nuular�
Office Use Only
Permit No. A— D� Date n
Permit Fee $ .� , — � j
_
DepositRec'd. $ 101Dat - 6O
Net Due $ GK• 3111
ya
Planning Board Information
Plan Type
Endorsement Date
Recording Date
Plan No.
Other
Assessors Department Information:
Map Lot Map Lot
Old New
1.4 Property Dimensions:
Lot Area (si) Frontage (ft) Lot Coverage
This Section for Office Use Only
Building Permit Number:
Date Issued:
Signature: 2,
B ilding Off Mall Date
Certificate of Occupancy
is is not V required
Section 1 - Site Inforiflation
I Use Group: R-4 Type: 5-
1.1 Property Address:
kOI/m,
1.2 Zoning Information:
Zoning District Proposed Use
—02-TILN�51OY)
1.3 Building Setbacks (ft)
Front Yard
Side Yards
Rear Yard
Required
Provided
Required
Provided
Required
Provided
o
2D,0
A 0-6
1 ep
;-o
1.4 Water Supply (M.G.L. c. 40. S 54)
Public Private
1.5 Flood Zone Information: Comments:
Zone: Z BFE: / O
Section 2 - Property Ownership/Authorized Agent
2.1 Owner of Recor
Na a (print) Mailing Address
C�
Signature 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
9 - 15 - 99 1 of 2 OVER
Section 4 - Workers' Compensation 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.
Signed Affidavit Attached Yes .......... No ..........
Section 5 - Description of Proposed Work (check all applicable)
New Construction I No. of Bedrooms No. of Bathrooms
Existing Bldg. ❑ Repair(s) ❑ IAlterations ❑ IAddition ❑
Accessory Bldg. ❑ Type
Demolition
Other Specify:
Brief Description of Propo d Work:
Costs
Estimated Cost (Dollars) to be Check Below
completed by permit applicant
❑ Conservation -Commission Filing
(if applicable)
❑ Old Kings Highway & Historical
Commission approval
(if applicable)
To be Completed When
for Building Permit
Section 6 - Estimated Construction
Item
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 & additions)
Section 7a - Owner Authorization -
Owner's Agent or Contractor Applies
as owner of the subject property
hereby authorize to act on
my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
Section 7b - Owner/Authorized Agent Declaration
i, , 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
Signature of Owner/Agent Date
9-15-99 2 of 2
TOWN OF YARMOUTH `
0
BUILDING DEPARTMENT 132q(y
BUILDING PERMIT APPLICATION SIGNOFF
Applicant: .. Building Permit No.:
at
Address: Tel. No.: �(q1A -Z0 Date Filed:
Bldg. Site Location: 2 1425A A31 W. LA-4LMap No.: - P) Lot No.: S Z
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 COAMRSSION: 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.
7he folloudng Departments must sign off, in the respective order, prior to building inspector issuing the required
building permit:
REVIEWED BY:
1. WATER DEPARTMENT:
DATE: .2 -1 '7- o '' N/A:
2. ENGINEERING DEPARTMENT: DATE: N/A:
3. CONSERVATION:
DATE: N/A:
4. HEALTH DEPARTMENT: 7�c[�
DATE: 0-1—OD N/A:
INDUSTRIAL AND/OR COMMERCIAL PERMITS
5. WIRING INSPECTOR:
DATE: / t� N/A:
6. PLUASBING INSPECTOR:
DATE: 8— l '�b°D N/A
7. FIRE DEPARTMENT: —'
DATE: 3 '' /l7y N/A:
PLEASE NOTE
All stumps andlor brush must be disposed of at an approved site.
COO►AIAIENTS: l�V,+'j:fo¢ 4kg1 byh-TrR X-er✓ica ix To b Cv"T'i CgAPv/�r? cvmb
D171�tO bnol P.i f'or w41yq v„tTKrt I'uLL.el ITV w/4TYR Q{pr' AT n ywntat F,venJ<
8/99 Applicant Signature Date
9
SERVICE NO.
I- -
i
NAME%.!/� :'DDti tyti vi ,fv K., • �'
• / X rlS7REET Ca
3 c7
r
,VILLAGE /� ��� , i Wit. j
METER NO.
i
oo2a sa97
C
✓T � t
4 �Tb
BUILDING
TOWN OF Y A R M O U T H ELEGMICAL
GAS
1146ROUTE28 SOUTHYARAIOUTH NIASSACHUSETTS02664-4451
Telephone (508) 398-2231, Ext. 261 — Fax (508) 398.2365 PLUMBING
SIGNS
BUILDING DEPARTMENT
DEMOLITION DEBRIS DISPOSAL AFFIDAVIT
Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5,
I hereby certify that the debris resulting from the proposed work/demolition to be
conducted at a2 %� vl� iM 4a-4�
Work Address
is to be disposed of at the following location: LJA.AvW dhdh
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
It
L-RXW�2tvvm
nature of Applicant
Permit No.
Z Cr b0
Date
pe' AR,b
TOWN OF YARMOUTH
BUILDING DEPARTMENT
PLEASE PRINT:
Job Location: _
CONSTRUCTION SUPERVISOR FORM
Owner of Property:
Construction Supervisor:
Address:
Licensed Designee:
(If other than Supervisor)
2.15 Responsibility of each license holder:
Street,
License No.
Ilage
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 licenseewho 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 ❑ 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 INSURAN E WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter%�52 of the M s. G�e�ral Laws, and that my signature on this permit application waives this requirement.
l /r, . r,fAA `/ /; /1, Check one:
Agent
Owner ❑ Agent ❑
Signature: Building Official Approval:
The Commonwealth of Massachusetts
Department of Industrial accidents
Ocoee of/orestlpstliss
600 Washington Street
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
I'# a homeownl/r performing all work myself.
Q,I am a sole proprietor and ha%e no one t.orkine in any capacity
I am an employer pros iding workers' compensation for my employees working on this job.
insurance co, policy a
I am a sole proprietor. general contractor. or homeowner (circle one) and have hired the contractors listed below who has e
the following workers' compensation polices:
company name:
address:
ems: phone a:
insuraIce co. policy H
Failure to sccure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of flat up to SI WQAO and/or
one years' Imprisonment as well as civil penalties in the form ofa STOP WORK ORDER and a flue of SI00.00 a day against me. 1 understand that a
copy of this statement may be forwarded to the Ogee of Investigations of the DIA for coverage verification.
t do hereby terrify under the pains and penalties of perjury that the information provided above is true and correct
Signature Date
Print name Phone 0
official use only do not %rite in this area to be completed by city or town official
city or town: YARMOUTIJ
❑ check if Immediate response is required
contact person:
permit/license 0 MBuilding Department
❑Llctusing Board
261 ❑Seleclmta's Office
❑Health Department
phone o; _ (508) 398-2231 eat. Mother
(, .,sed s.as rtn)
Information and Instructions
Massachusetts General laws chapter 152 section 25 requires all employers to provide workers' compensation for their
entplo%ees. As quoted from the "law", an employee is defined as every person in the service of another under any
contract of hire, express or implied, oral or written.
An etnphover is defined as an individual. partnership, association, corporation or other legal entity, or any two or more of
the foregoing engaged in ajoint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual . partnership, association or other legal entity, employing employees. However the
oatier of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another %%ho employs persons to do maintenance , construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer.
%lG1_ chapter 152 section =; also states that every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required.
Additionall%. neither the commom%ealth nor any of its political subdivisions shall enter into any contract for the
performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter ha%e
been presented to the contracting_ authority.
Applicants
Please fill in the workers' compensation affidavit completely. by checking the box that applies to your situation and
suppl%in`_ company names. address and phone numbers as all affidavits may be submitted to the Department of
Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The
affidavit should be returned to the city or town that the application for the permit or license is being requested.
not the Department of Industrial accidents. Should you have any questions regarding the "law" or if you are required
to obtain a workers' compensation policy. please call the Department at the number listed below.
City or Towns
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of
the affidavit for you to fill out in the event the Office of investigations has to contact you regarding the applicant. Please
be sure to fill in the permit/license number which will be used as a reference number. The all5davits 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 Industriall Accidents
liriflce of IMSUNNUIos
600 Washington Street
Boston Ma. 02111
fax H: (617) 727-7749
phone #: (617) 7274900 ext. 406, 409 or 375
Suggested Affidavit for Home Improvement Contractor Permit Application
For Office use only NAME OF CITY/TOWN
Permit No.
Dole
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
MGLc- 14ZA requires that the "reconstruction. alteration, renovation, repair, modernization, conversion, inprovement, removal, demolition,
or construction of an addition to any vreccisiin¢ owner -occupied building containing at least one but not more than four dwelling units .... or
to structures which are adjacent to such residence or building" be done by registered contractors, with certain exceptions, along with other
requirements.
Type of Workx Alrgflkt, Est. Cost /
Address of Work ), :& 11 V a 1112 haw
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 NOTHAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL
c. 142A.
Signed under penalties of perjury:
I hereby apply for a permit as the agent of the owner:
Date
OR:
Contractor Name
Registration No.
Notwithstanding the abo notice, I hereby apply for a permit as the owner of the above property:
D Ric 011er Name
BUILDING
TOWN OF Y A R M O U T H ' ELECIRICAL
GAS
114GROUTE28 SOUTH YARNIOUTH AIASSACHUSETTS026644451 PLUMBING
Telephone (508) 398-2231, Ext. 261 — Fax (508) 398-2365
SIGNS
uILD-iNG nt ►'ARTTIENT
TOTAL DEMOLITION SIGN -OFF FORM
State Building Code (780CMR) Chapter 1, Section 112. 1 -Service Connections
"Before a building or structure is demolished or removed, the owner or agent shall notify all
utilities having service connections within the structure, such as water, electric, gas sewer and
other connections. A permit to demolish or remove a building or structure shall not be issued
until a release is obtained from the utilities, stating that their respective service connections and
appurtenant equipment, such as meter and regulators, have been removed or sealed and plugged
in a safe manner."
"All debris shall be disposed of in accordance with 780CMR 111.5.
Building or Structure Location: OZ T.Q (/ VIS 1 l�2 �--
Owner's Name
Commonwealth Electric:
Colonial Gas: d�
Water Dept.:
Board of Health:
Date: -
By: ,
Title: OLa
Date: -,)c �q o
By:
Title:
Date:
By:
Title:
Date:
By:
Title:
Fire Dept.: Date:
By:
Title:
1"1
Pnnted on Recycled Paper
Bostongas
� k.`
essexga$Q,ILbi0nialOgas
Eastern Enterprises
re: 2 Television Lane
West Yarmouth, MA
To Whom It May Concern,
201 Rivermoor Street '
West Roxbury, Massachusetts 02132
Tel: 617-723-5512
February 29, 2000
This letter is to confirm that there are no underground natural gas facilities to the above
referenced property. This was confirmed by our representative on February 18, 2000.
I can be reached directly at 508-760-7503 should there be any further questions.
Sincerely,,
Sally S clair
Distribution Department
A
Appeal #3577
DOC:794.,759 03-16-2000 9:17
OISTR3LE LRND COURT REGISTRY
THE COMMONWEALTH OF MASSACHUSETTS
TOWN OF YARMOUTH
BOARD OF APPEALS
Date: March 15, 2000
Certificate of Granting of a Special Permit
(General Laws Chapter 40A, Section 11)
The Board of Appeals of the Town of Yarmouth Massachusetts hereby certifies that a Special
Permit had been granted
To: George & Monique Levesque
Address: 17 Silas Deane Road
City or Town: Ledyard, CT 06339
affecting the rights of the owner with respect to land or buildings at: 2 Television Lane, West. "
Yarmouth, MA. Assessor's Map: 14 Parcel: 10IW152, !Zoning District: R25
And the said Board ofAppeals fwther certifies that the decision attached hereto is a true and
correct copy of its decision granting said Special Permit, and that copies of said decision, and of all
plans referred to in the decision, have been filed with the Planning Board and the Town Clerk.
The Board ofAppeals also calls to the attention ofthe owner or applicant that General Laws,
Chapter 40A, Section 11 (last paragraph) and .Section 13, provides that no Special Permit, or any
extension, modification or renewal thereof shall take effect until a copy of the decision bearing the
certification of the Town Clerk that thirty (20) days have elapsed after the decision has been filed in
the office of the Town Cleric and no appeal has been filed or that, if such appeal has been filed, that,,
it has been dismissed or denied, is recorded in the registry of deeds for the county and district in ,
which the land is located and indexed in the grantor index under the name of the owner of record or
is recorded and noted on the owner's certificate of title. The fee for such recording or registering
shall be paid by the owner or applicant.
axle
David Reid, Chairman
CERTIFICSP.WPD
•i -
FILED WITH TOWN CLERK:
TOWN OF YARMOUTH
BOARD OF APPEALS
DECISION
r7# ,-
February 24, 2000
PETITION NO: #3577
HEARING DATE: December 23,1999 & February 10, 2000
PETITIONER: George & Monique Levesque
PROPERTY: 2 Television Lane, West Yarmouth
Map: 14, Parcel: 90 (10/W152) Zoning District: R25
MEMBERS PRESENT -AND VOTING: David Reid, Chairman, James Robertson, John
Richards, Richard St: George, Diane Moudouris, Douglas Campbell, alternate.
It appearing that notice of said hearing has been given by sending notice thereof to the. petitioner
and all those owners of property deemed by the Board to be affected thereby, and to the public by
posting notice of the hearing and published in The Register, the hearing was opened and held on
the date stated above.
The petitioner owns the locus, which is improved with a single family home. The existing lot is
located in an R25 zone. The petitioner proposes to purchase an adjoining parcel (Lot 11 on the
proposed plan) and join it with the locus to increase the size of the lot to 17,596.8 sq. ft. No relief
is needed for.this expansion of the lot. However, the petitioner then proposes to raze,and replace
the home and therefore requires a Special Permit pursuant to § 104.3.2 (5).
As shown on the petitioner's plot plan, dated October 28, 1999, the proposed house would be
somewhat more centrally located on the lot than is the existing home. It would conform to all
current set -back requirements, and would be more conforming than the existing home. It would
remain a single family home, albeit a substantially larger home.
After opening and commencing the hearing on December 23, 1999, it was brought to the
attention of the Board that the lot combination had not yet been authorized as the Planning Board
had declined to endorse the ANR plan. As the petitioner intended to proceed with a subdivision
plan, proposing the same lot configuration, the hearing was continued to February 10, 2000, at
7:00 PK for further hearing following the Planning Boards review.
On February 10, 2000, the Board reconvened and was advised that the Planning Board had, on
February 9, 2000, voted to approve the plan.
No opposition to the proposal was presented to the Board. The petitioner did file with the board
a Supplemental Sketch Plan of the adjoining Boch Broadcasting Site (dated 2/2/00)
-1-
demonstrating that the Lot 11 fell entirely outside of the "fall zone" from its existing radio tower.
The Board makes no further determination as to the use of the Boch Broadcasting site.
The Board finds that the requirements of §104.3.2 (5) have been met, and the proposed new
structure may be built in conformance with the intent and purpose of this bylaw. A motion was
made by Mr. Robertson, seconded by Mr. St. George, to Grant the Special Permit, as requested,
on the express condition that the existing Lot 52 (LCP 11781B) and the abutting Lot 11 be
combined as one lot, for zoning purposes and the above referenced subdivision plan be duly
recorded and a time stamped copy (showing proof of recording) be filed with our office. Unless
such proof of recording is filed with the Board of Appeals office by March 3, 2000, the Special
Permit shall automatically lapse, without further action. After further discussion, the Board voted
unanimously in favor of the motion.
No permit shall issue until 20 days from the filing of this decision with the Town Clerk. Appeals
from this decision shall be made pursuant to MGL c40A § 17 and must be filed within 20 days
after the filing of this notice/decision with the Town Clerk.
David S. Reid, Clerk
-2-
TOWN OF YARMOUTH
TOWN CLERK
CERTIFICATION OF TOWN CLERK
I, George F. Barabe, Town Clerk, Town of Yarmouth, do hereby certify that 20 days have
elapsed since the filing with me of the above Board of Appeals decision #3577 and that no notice
of appeal of said decision has been filed with me, or, if such appeal has been filed it has been.
dismissed or denied.
Ge;org;g,f. Barabe
Towu;Clerk '
Clerkcertification.wpd
BARNSTABLE COUNTY
REGISTRY OF DEEDS
AT//RUE COPY, ATTEST
JOHN F. MEADE, REGISTER
BARNSTABLE REGISTRY OF DEEDS
RADIp LANE
CERTIFIED PLOT PLAN
FOR
2 TELEVISION LANE WEST YARMOUTH, MA.
PREPARED FOR
GEORGE LEVESQUE
SCAIE: 1" = 40' DATE: MAY 11,2000
WELLER & ASSOCIATES
1645 FALMOUTH RD. + SUITE 4C CENTERVILLE, MA 02632
(508) 775-0735
N
NOTE: TOP OF FOUNDATION IS AT ELEV.
10.0 - 41 ABOVE THE HIGH POINT OF
THE FRONTING ROAD.
I CERTIFY THAT THE FOUNDATION SHOWN
ON THIS PLAN IS LOCATED ON THE
GROUND AS SHOWN HEREON.
'<<-oJ
RADIO LANE
CERTIFIED PLOT PLAN
FOR
2 TELEVISION LANE WEST YARMOUTH, MA.
PREPARED FOR
GEORGE LEVESQUE
SCALE: 1" = 401 DATE: MAY 11,2000
WELLER & ASSOCIATES
1645 FALMOUTH RD. - SUITE 4C CENTERVILLE, MA 02632
(508) 775-0735
W/
NOTE: TOP OF FOUNDATION IS AT ELEV.
10.0 - 4' ABOVE THE HIGH POINT OF
THE FRONTING ROAD.
I CERTIFY THAT THE FOUNDATION SHOWN
ON THIS PLAN. IS LOCATED ON THE
GROUND AS SHOWN HEREON.
.J
1
APPLICANT
DATE
CDIF►C11ZE/I�SU D _�
LL l
BUILDING PERMIT`
CERTIFICATE OF OCCUPANCY
2W9 PERMIT NO.
1. (NO.) ISTREETI (:Song" (CONTR'S LICENSE)
RCRMIT TO Nw Houm (_�) STORY NUMBEROF
NG UNITS
(TYPE OF IMPROVEMENT) NO:� (PROPOSED USE)
AT (LOCATION) 2 +�s&m
Lms V.%mmatheM
ZIT1f1O1' D
(NO.)
(STREET)
BETWEEN
- AND
A
m
(CROSS STREET) - (CROSS
STREET) -
m SUBDIVISION 1,4190
EtLOT
LOT. 2 BLOCK _HNZlQSIZE
00
BUILDING IS TO BE -
FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL
CONFORM IN CONSTRUCTION
m
CI
Z TO TYPE -
USE GROUP BASEMENT WALLS OR FOUNDATION
Z
�
_
(TYPE)
0
I` REMARKS: lCltc+[SS'S�i_
DiniM T] m.-I t,+wiM tafzb_��_VAIA nommi.3_li1!>��f.�i�%t_
sixth aoom-1. I AREA OR
VOLUME p'3(j 8'.STI �pS.71 �'.I71
^�(CUBIC/SQUARE S��.�aaFEET) ♦ )LI,E'LL','I;11 SjLy'1,I•+lll yri`,Y~(I,(13y1,1I�R11
OWNER �SSa�7 �i �S�' `anigm +Asvwv_{A�v v,�rrl oN-r�vrn vrn
ADDRESS --- 2 ao�J� 15w' • W. H MR 02673
Piam&-2� Pk=m= 8u.—ldr
TO BOREMISES %
SEE REVERSE SI ONS RT IFICATE
DEPARTMENTAL APPROVAL FOR CERTIFICATE "
oT OCCUPANCY and COMPLIANCE .
To be filled in by each division indicated hereon
upon completion of its final inspection.
BUILDINGS Permit No./ )— 00 5/2
Approved by Date L
Remarks
PLUMBING . Permit No. '
Approved b Datea !J - am
Remarks
ELECTRICAL ermit No.
r��
Approved byDate 12-
Remarks
OTHER' VVC� Permit No.
Approved by Date
,,-Remarks
OTHER''_ik7f ?it •/,,PermitNo. i(—�Z
Approved by 61 &�V— Date
Remarks
FIELD COPY
BUILDING
PERMIT
��rr,,..��,,..��ii �1Py� gyp/' •
DATE ••Ea�'W 16. 2M9 PERMIT NO.y D�7
APPLICANT i 1 Chamal Point FAN31t9 p• 0.kt8=s727 w• Yanoouth. iA 02673
(NO.) (STREET) C:SoogM (CONTR'S LICENSE)
NUMBER OF
PERMIT TO Mm Home (_) STORY DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE) I.
AT (LOCATION) 2Tolairlalm Lms W, Yazmjxthm NA DST
(N0.) (STREET)
BETWEEN AND
(CROSS STREET) (CROSS STREET)
ldion al w,11n
LOT
BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE
USE GROUP BASEMENT.WALLS OR FOUNDATION
sittug '=n
AREA OR VOLUME ESTIMATED COST $ PERMIT �7
(CUBIC/SO DARE PEST) EE �
OWNER ��Y��`���� p,..,�,.� \ /
ADDRESS 2 ihleyii'Aam Laoo, W. a�amaxt a• Hi 02673 BUILDING DEPT.
rzo
INSPECTION RECORD
DATE
NOTE PROGRESS - CORRECTIONS AND REMARKS
INSPECTOR
pro
pf YqR�
a
H HArTACw{[,
y� N.�w.M.Ai1�1
ONE & TWO FAMILY ONLY - BUILDING PERMIT
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
Town of Yarmouth Building Department
1146 Route 28 • Yarmouth, NIA 02664-4492
TO: (508) 398-2231 x261 - Fax: (508) 398-2365
Office Use Only
Permit Nctr-DD:� Date 3-/4bb
Permit Fee $ f 7/, 75
Deposit Rec'd. $6a Dat
Net Due $ 73-�
Planning Board Information
Plan Type
Endorsement Date
Recording Date
Plan No.
Other
Assessors Department Information:
Map for Map cot
Old
1.4 Property Dimensions: New
L g
Lot Area (so Frontage (ft) Lot Coverage
This Section for Office Use Only
Building Permit Number:
I Date Issued:
Signature:
Buiftling Official tate
Certificate of Occupancy
I isy is not required
Section 1 - Site Information
I Use Group: R-4 Type: 5-B
1.1 Property Address:
-0 levi s IbA UrLe-
1.2 Zoning Information:
Zoning District Proposed Use
1 L). vx
rrYlhuh
raxa
1.3 Building Setbacks (it)
Front Yard
Side Yards
Rear Yard
Required
Provided
Required
Provided
Required
Provided
0
3D .Rq
'is /.<
I CP
1 A Water Supply (M.G.L. c. 40. S 54)
Public r/ Private
1.5 Flood Zone Information: - Comments:
Zone: _,ALL BFE:
Section 2 - Property Ownership/Authorized Agent
2.1 Owner of Record: ,
brae t. lkmipua- uvslpim 1-7 .WAA , AVY Ra ,ltd
Na pri Mailing Address
Signature UTelephone
2.2 Authorized Agennt:
1/ I
N e (print) Mailing Address
ignature Telephone
Section 3 - Construction Services
3.1Licensed Construction Supervisor:
p
Not Applicable ❑
-?O 20 Y �)'
/Licle�nse Number
CAS Q —g
ress
^�'�
Expiration Dat
2
igna ure Telephone
3.2 Registered Home Improvement Contractor:
Coo�m��p��a//n��y jjNa/jm�e1,
��"' wt In r e�o'� � ��
Not Applicable ❑
License Number
Addr ss (2
1� S-Z�131v
nature Telephone
Expirati Date
LO 0
9- 15-99
1of2
OVER
Section 4 - Workers' Compensation 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 denia f the Issuance of the building permit.
Signed Affidavit Attached Yes .. ...... No ..........
Section 5 - Descri ' n of Proposed Work (check all applicable)
New Construction I No. of Bedrooms — 3 1 No. of Bathrooms
Existing Bldg. ❑ Repair(s) ❑ Alterations ❑ I Addition ❑
Accessory Bldg. ❑ Type
Demolition
Other Specify:
Brief Description of Proposed Work:
ZVQAY-Vtt+
Costs
Section 6 - Estimated Construction
Item
Estimated Cost (Dollars) to be
completed by permit applicant
Check Below
pQ Conservation -Commission Filing
(if applicable)
❑ Old Kings Highway & Historical
Commission approval
(if applicable)
1. Building
ALIS
2. Electrical
02 DIP
3. Plumbing / Gas
—
4. Mechanical (HVAC)
5. Fire Protection
S. DOD—
6. Total = (1 + 2 + 3 + 4 + 5)
30 D COO.
7. Total Square Ft. (new houses & additions)
�3 i Did
Section 7a - Owner Authorization -
Owner'4 Agent or Contractor Applies
To be Completed When
for Building Permit
I, , as owner of the subject property
hereby authorize _R1 DW l4 s - ��� to act on
my behalf, in all matters relative to work authorized by this building permit application.
LqAl a M, lm�
Sign-amfa of Own Date
Section 7b - Owner/Authorized Agent Declaration
C 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
Iftmatw4of Owner/Agent
�� Date
J
9. 15.99 2 of 2
A
r°`-AkA+ TOWN OF YARMOUTH 133Rf
3 °
° S BUILDING DEPARTMENT 40
BUILDING PERMIT APPLICATION SIGN OFF
Applicant: IhDyL" g • 8-VOL1S Building Permit No.:
Address: IPQ &V y 7)7 1,01 1,ar0b)L&L Tel. No.: i7_'wVP Date Filed: d /
Bldg. Site Location: a T.P h Vt-� 1 lT'1 kn ' Map No.: ID Lot No.: S Z
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 COAIlIIISSION: Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type
of Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc.
HEALTH DEPARTAIE1Vr: Determines Compliance to State and Town Regulations; i.e., Requirements
for Septage Disposal and other Public Health Activities.
FIRE DEPARTMENT: Determines Compliance to State and Town Requirements for Personal
Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc.
----------------------------------------
The following Departments must sign off, in the respective order, prior to building inspector issuing the required
building permit:
171_4 0! 1 t
1. WATER DEPARTMENT: 2 �'�►+7r— DATE: N/A.
2. ENGINEERING DEPARTMENT: 59Q BEbow DATE:.2ZZ oc N/A:
3. CONSERVATION: DATE: N/A:
4. HEALTH DEPARTNIENT• 4' 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. /
CONBIENTS: jyra'1" 1.vwT<A Qp.2T N.e<Gl filk i°Lwn Xhog. jft 1'rot'o� ftlr
Vt efF-e2 AA Vte_.1 To /o.e U k V f3,i ov KrTe►t bg a. ioL n., r.,,Vrtlerj. s
w.,o/-ry,226eWORK i_r Z2" 1I0n !3v L.A. f l 194p 1 eir Aprrov�Traelf .
00
r
x• • NE I "7W.WMEW •
8/99 Applicant Signature Date
FROM AR •J PORTER ARCHITECT PHONE N0. : 508 362 6469 Dec. 02 1999 03:56PM P1
IG'=;L/j l ir.,o
"77 I • 0.:)
780 CMR: STATE BOARD OF BUILDING REOULATIONS AND STANDARDS
IVE
MASSACHUSETTS STATE BUILDINO CODE
Manual Trade -Off Worktbeet
Pem1 a
Builder Name Date— m'ro-lb-zl
Builder Address` ? a1 / i Yl Yl I lQ (J�110? i Checked By •`
Site Addm_s� TES Y 141Ot3-A•��yYLY alp Zone%12 ❑13 ❑14 i pole I
Submitted By Phone 1
PROPOSED
CyJIMm_ Skylights, and Floor Over Outside Air
. � _. _.. I1uNlulon A�jAra
b.maden R.Value mvalue
create • iz, 30 . Q3 9 I OA2�
able 16.1.24
F]w Over 06Pw4e Air
rrat•Ie 141.1.121
REQUIRED
Required
U•Valus
UA Table 16.2.2hI x Am UA
Qr,�,2 ,v�fo 1a:�1 � 33 •(o
I
Tout Ana
�• R'}�_
..rJ
Walt%_ Windows. and Doors
Inwlallotr
A IhA
Required
' Drxr7 tion
R•Value U•Y$W
Am .
UA
U•Vdue Are VA
W blle16.2.2b.e.dl.'
y�x
W lneows
--•
��
•fHrRCorTsb1elI.$.3s1
Doom
W e of Teble 11.1.3a
, 3
no ^-•
'7.2
stwit{ Claw Doors
(MC orTable 11A.1a
rtr
FICoct and Foundations
Total Area
q`
Insulation IewlulatR• aAmor
r h U.9— rl.U.4. .wrw.. .11♦
Flow Over Umeondkioaed (fable
spw 1622.1
q
4047
K
19'74
CIS
surnent Wan able 16.2.111
Utnated slab
able 16.2.1
In.
n
Hewed slap
able 10.20
In.
A
' M
Ile
Thal Prmrwed ur aowl ►i law Total
than K ageal to rorel (I►AQr1hQ )tryebrd VA Proposed UA
,
Isutormt of ComplIumm The propored hulMing desipl represented In
three doevacests k tomalrar uaA1A1 bvddOrtolaa. sO tWalrlom,
Required
V•yalwt x Area - UA
%05 IQ7(� qR
�-----M Total
6��a
op( Krquired VA
L---•--+AdJwrrd
Rrjulrrd UA
i
�_ _'\ �� iI/ O�7YLiit492UIP,CLGf� Q�ii��GQ,Q6�1166 I 1
and of Building Regulations and Standards I
One Ashburton Place - Room 1301
Boston, Massachusetts 02108
Home Improvement Contractor Registration j
I j
I
Registration: 118304 Expiration: 2/26/01
-r-----------------------------------
Type: Private Corporation��--««�
I NPROV�T OOITRIICTOR
UVET
stration:304
CHANNEL PONT REALTY INC j ratim: 2/26/01
THOMAS POWER I: Private Corporatia
PO BOX 277/ OFF SOUTH SEA AVE
W. YARMOUTH MA 02673 j CRAM KIT RMT1 3C '
I TFAS K0 1
L�ceM. o &i�I 211/ OFF SOOTR SFA
ADMIWSTRAJOR p, yj,R,yQ,7'Tg MA 02673
DEPARTMENT OF PUBLIC SAFETY
= ONE ASHBURTON PLACE, RM 1301
BOSTON:�MA 02108-1618
CONSTRUCTION SUPERVISOR LICENSE .',
Number: Expires: Birthdate�_._
CS 009486 02/23/2000 �02l23[194t3_ `
Restricted To: 00
THOMAS B POWERS ` At, 1PO BOX 727
c
W YARMOUTH, MA 02673 c--=
Keep top for receipt and change
of address notification.
166622
166822
2
of ' Aker
o y ,
TOWN OF YARMOUTH
BUILDING DEPARTMENT
CONSTRUCTION SUPERVISOR FORM
PLEASE PRINT: Job Location: a T _ tlwl� 1,
Number
Owner of Property: -1�60. )
Construction Supervisor: III
Name
Address:
Licensed Designee:
(If other than Supervisor)
Name
2.15 Responsibility of each license holder:
Street
License No.
Village
License No.
cy
Phone
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 Anylicenseewho shall willfully violate subsections 2.15.1, 2.15.2 or 2.15.3 or any other section of these
rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of
license by the board.
2.16 All building permit applications shall contain the name, signature and license number of the
construction supervisor who is to supervise those persons engaged in construction, reconstruction,
alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and
regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately
cease until a successor license holder is substituted on the records of the building department.
2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may
be deemed a violation of the permit conditions.
I have read and understand my responsibilities under the rules and regulations for licensing construction
supervisors in accordance with section 109.1.1 of the state building code. I understand the construction
inspection procedures and the specific inspection as called for by the building official.
INSURANCE COVERAGE:
have a current liabi nsurance policy or its substantial equivalent which meets the requirements of MGL Ch.152
Yes No ❑
If you have checked M, please indicate he type coverage by checking the appropriate box.
A liability insurance policy Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter 152 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner ❑ Agent
Signature: Building Official Approval:
t._
The Commonwealth of Massachusetts
Department of Industrial Accidents
ANce olloresaffiffiss
600 Washington Street
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
Applicant information: P1easePR11V Cj0d ft
1 am a homeowner performing all work myself.
0 1 am a sole proprietor and hate no one working in any capacity
U am an employer pro%iding workers' compensation for my employees working on this job.
address: 'PD Rol 7-)7 V
1 am a sole proprietor. general contractor. or homeowner (circle one) and have hired the contractors listed below who ha%e
the follo%%in_ %%orkers' compensation polices:
cDry: phone No
Failure to secure coverage as required under Section 2SA of MGL 152 an lad to the imposition of criminal penaities oraunt op to s1.500.00aadfor
one years' Imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a floe of S100.00 a day against me. I understand that a
copy of this statement maybe forwarded to the Orrice of Investigations of the DIA for coverage veriticatloa.
I do he b- under the pains a es of per)u hat the information provided above is tine and coned
Signarurruykz ate a/� -
Print name t r 'Urn�`� �1�" Phone N
olricial use only do not write in this area to be completed by city or Iowa orllcial
city or town: YARMODTQ _ permit/license # nBuilding Department
❑licensing Board
❑ check if Immediate response is required 261 ❑Selectmen's Office
❑Health Department
contact person: phone#:_ (508) 398-2231 eat. r,Other
tinned 3,95 PJAI
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
employees. As quoted from the an employee is defined as every person in the service of another under any
contract of hire, express or implied, oral or written.
An entph,rer is defined as an individual. partnership, association. corporation or other legal entity, or any two or more of
the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual , partnership. association or other legal entity, employing employees. Ho%%ever the
o" ner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance , construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer.
%IGI_ chapter I section also states that even• state or local licensing agency shall withhold the issuance or
renewal of n license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required.
Additionally, neither the commom%ealth nor any of its political subdivisions shall enter into any contract for the
performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter ha%e
been presented to the contracting authority.
Applicants
Please till in the workers' compensation affidavit completely, by checking the box that applies to your situation and
supplying company names, address and phone numbers as all affidavits may be submitted to the Department of
Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The
affidavit should be returned to the city or town that the application for the permit or license is being requested.
not the Department of Industrial accidents. Should you have any questions regarding the "law" or if you are required
to obtain a workers' compensation policy, please call the Department at the number listed below.
City or Towns
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of
the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please
be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be retuned to
the Department by mail or FAX unless other arrangements have been made.
The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address, telephone and fax number.
The Commonwealth Of Massachusetts
Department of Industrial Accidents
MCI of Ims"11"Ins
600 Washington Street
Boston, Ma. 02111
fax #I: (617) 727-7749
phone #: (617) 7274900 exL 406, 409 or 375
Sugcestcd Affidavit for Home Improvement Contractor Permit Application
Foromce Use Oniy NAME OF CITY/TOWN
Permit No,
Date
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
NGLc.142Areoutresthat the'reconstructionalteration. renovation. repair. modernization. conversion. tr.rrrnrmcnt. removal. Cemoiition.
nreanstrucuon of an addition to anv orecosnn rnvner{ ccurned huddtn contamme it least one tut net more tnnn fnurowrihr.c'Jails ... .,r
to wucierm wnich ire adincent to such residence or nuildmC be done by registered contractors. wttn certain accpuons, along win ether
requirements.
Type of
Address
Owner
Date of Permit Application:
I hereby certify that:
Rceistration is not required for the following rcason(s):
_Work excluded by law
_Job under SI.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 IMPROVEMENTWORK DO NOTHAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL
c, 142A.
Sicncd under penalties of perjury:
I hereby apple for a permit as the agent of the owner:
Date Contractor Name Reeistration No.
OR:
Notwithstanding the above notice, 1 hereby apply for a permit as the owner of the above property:
�atc Owner Name
TOWN OF YARMOUTH
1146ROUTE28 SOUTH YARMOUTH MASSACHUSETTS02664-4451
Telephone (508) 398-2231, Ext. 261 — Fax (508) 398-2365
BUILDING DEPARTMENT
DEMOLITION DEBRIS DISPOSAL AFFIDAVIT
BUILDING
ELECTRICAL
GAS
PLUMBING
SIGNS
Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5,
I hereby certify that the debris resulting from the proposed work/demolition to be
conducted at Q 7t&vfS1 cM W14—
`J Work Address
is to be disposed of at the following location: Q J KS� 11111110
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
d izpa)
Sig a e of Applicant Date
Permit No.
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CERTIFIED PLOT PLAN
FOR
2 TELEVISION LANE WEST YARHOUTH, BA -
PREPARE) FOR
GEORGE t 110NI9UE LEVESQUE
DATE: OCTOBER 2A, 1411 SCALE: 1" a 20'
YELLER L ASSOCIATES
MS FALROUTH 13. - SUITE IC
P.O. BOX 417 CENTERVILLE, RA 02L32
(SOA) 775-073S
1
It• 9''+5
ZIZ2/00
q—for- J
51C:►�1ED
1 .� --�
�oAr
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C-L)--iIs'*SPI
E�RE�0 RDED
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OFFICE USE ONLY
CALCULATION FOR PERMIT COST TYPE OF ROOM ETC NO
5-q
�9 X�
1117
&,5-X lq= 1-3(,`
(j S X 36 = l{ �(-
334
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35"ov
FAA oy
op
75
6�2 asxasaG; ��; s� •�
7-Siy'96
OPS
/
KITCHEN
DINING ROOM
I
LIVING ROOM
l
GREAT ROOM
COMPUTER ROOM
5S vv
OFFICE
FAMILY ROOM
BED ROOM
3
BATH
-3
STORAGE AREA
MUD ROOM
DECK WITH ROOF
lax 9 DECK OPEN
/
PORCH OPEN
PORCH CLOSED
SUN ROOM HEATED
SUN ROOM UNHEATED
LAUNDRY ROOM
,:75` a s- GARAGE
DEMOLITION
SHED
SWIMMING POOL INGROUND
SWIMMING POOL ABOVE GROUN
FIREPLACE
LAUNDRY ROOM
ADDITION
ALTERATIONS
REROOFING
WINDOW REPLACEMENT
FOUNDATION
n J A2
DOC:794.759 03-16-2000 9:17
OHSTA3LE LAND COURT REGISTRY
THE COMMONWEALTH OF MASSACHUSETTS
TOWN OF YARMOUTH
BOARD OF APPEALS
1
p Appeal ##3577 Date: March 15, 2000
J Certificate of Granting of a Special Permit
(General Laws Chapter 40A, Section 11)
The Board of Appeals of the Town of Yarmouth Massachusetts hereby certifies that a Special
Permit had been granted
To: George & Monique Levesque
y. Address: 17 Silas Deane Road
h
City or Town: Ledyard. CT 06339
1
affecting the rights of the owner with respect to land or buildings at: 2 Television Lane, West
r, Yarmouth, MA. Assessor's Map: 14 Parcel: 101W152, Zoning District: R25
And the said Board of Appeals further certifies that the decision attached hereto is a true and
correct copy of its decision granting said Special Permit, and that copies of said decision, and of all
` plans referred to in the decision, have been filed with the Planning Board and the Town Clerk.
The Board ofAppeals also calls to the attention ofthe owner or applicant that General Laws,
^� Chapter 40A, Section 11 (last paragraph) and Section 13, provides that no Special Permit, or any
.� extension, modification or renewal thereof shall take effect until a copy of the decision bearing the
-4— certification of the Town Clerk that thirty (20) days have elapsed after the decision has been filed in
Q the office of the Town Clerk and no appeal has been filed or that, if such appeal has been filed, that
J it has been dismissed or denied, is recorded in the registry of deeds for the county and district in
which the land is located and indexed in the grantor index under the name of the owner of record or
is recorded and noted on the owner's certificate of title. The fee for such recording or registering
shall be paid by the owner or applicant.
David Reid, Chairman
CERTIRCSP.WPD
TOWN OF YARMOUTH
BOARD OF APPEALS
DECISION
FILED WITH TOWN CLERK: February24, 2000
PETITION NO: #3577
HEARING DATE: December 23,1999 & February 10, 2000
PETITIONER: George & Monique Levesque
PROPERTY: 2 Television Lane, West Yarmouth
Map: 14, Parcel: 90 (101W152) Zoning District: R25
MEMBERS PRESENT AND VOTING: David Reid, Chairman, James Robertson, John
Richards, Richard St. George, Diane Moudouris, Douglas Campbell, alternate.
It appearing that notice of said hearing has been given by sending notice thereof to the petitioner
and all those owners of property deemed by the Board to be affected thereby, and to the public by
posting notice of the hearing and published in The Register, the hearing was opened and held on
the date stated above.
The petitioner owns the locus, which is improved with a single family home. The existing lot is
located in an R25 zone. The petitioner proposes to purchase an adjoining parcel (Lot 11 on the
proposed plan) and join it with the locus to increase the size of the lot to 17,596.8 sq. ft. No relief
is needed for this expansion of the lot. However, the petitioner then proposes to raze and replace
the home and therefore requires a Special Permit pursuant to § 104.3.2 (5).
As shown on the petitioner's plot plan, dated October 28, 1999, the proposed house would be
somewhat more centrally located on the lot than is the existing home. It would conform to all
current set -back requirements, and would be more conforming than the existing home. It would
remain a single family home, albeit a substantially larger home.
After opening and commencing the hearing on December 23, 1999, it was brought to the
attention of the Board that the lot combination had not yet been authorized as the Planning Board
had declined to endorse the ANR plan. As the petitioner intended to proceed with a subdivision
plan, proposing the same lot configuration, the hearing was continued to February 10, 2000, at
7:00 PM, for fiuther hearing following the Planning Boards review.
On February 10, 2000, the Board reconvened and was advised that the Planning Board had, on
February 9, 2000, voted to approve the plan.
No opposition to the proposal was presented to the Board. The petitioner did file with the board
a Supplemental Sketch Plan of the adjoining Boch Broadcasting Site (dated 212/00)
-1-
demonstrating that the Lot 11 fell entirely outside of the "fall zone" from its existing radio tower.
The Board makes no further determination as to the use of the Boch Broadcasting site.
The Board finds that the requirements of §104.3.2 (5) have been met, and the proposed new
structure may be built in conformance with the intent and purpose of this bylaw. A motion was
made by Mr. Robertson, seconded by Mr. St. George, to Grant the Special Permit, as requested,
on the express condition that the existing Lot 52 (LCP 11781B) and the abutting Lot 11 be
combined as one lot, for zoning purposes and the above referenced subdivision plan be duly
recorded and a time stamped copy (showing proof of recording) be filed with our office.. Unless
such proof of recording is filed with the Board of Appeals office by March 3, 2000, the Special
Permit shall automatically lapse, without further action. After further discussion, the Board voted
unanimously in favor of the motion.
No permit shall issue until 20 days from the filing of this decision with the Town Clerk. Appeals
from this decision shall be made pursuant to MGL c4OA § 17 and must be filed within 20 days
after the filing of this noticeldecision with the Town Clerk.
David S. Reid, Clerk
-2-
.%t
V
FILED WITH TOWN CLERK:
TOWN OF YARMOUTH
BOARDEC APPEALS
DECISION
U
February 24, 2000 C
PETITION NO: 0577
HEARING DATE: December 23,1999 & February 10, 2000
PETITIONER: George & Monique Levesque
PROPERTY: 2 Television Lane, West Yarmouth
Map: 14, Parcel: 90 (10/W152) Zoning District: R25
MEMBERS PRESENT AND VOTING: David Reid, Chairman, James Robertson, John
Richards, Richard St. George, Diane Moudouris, Douglas Campbell, alternate.
It appearing that notice of said hearing has been given by sending notice thereof to the petitioner
and all those owners of property deemed by the Board to be affected thereby, and to the public by
posting notice of the hearing and published in The Register, the hearing was opened and held on
the date stated above.
The petitioner owns the locus, which is improved with a single family home. The existing lot is
located in an R25 zone. The petitioner proposes to purchase an adjoining parcel (Lot 11 on the
proposed plan) and join it with the locus to increase the size of the lot to 17,596.8 sq. ft. No relief
is needed for this expansion of the lot. However, the petitioner then proposes to raze and replace
the home and therefore requires a Special Permit pursuant to § 104.3.2 (5).
As shown on the petitioner's plot plan, dated October 28, 1999, the proposed house would be
somewhat more centrally located on the lot than is the existing home. It would conform to all
current set -back requirements, and would be more conforming than the existing home. It would
remain a single family home, albeit a substantially larger home.
After opening and commencing the hearing on December 23, 1999, it was brought to the
attention of the Board that the lot combination had not yet been authorized as the Planning Board
had declined to endorse the ANR plan. As the petitioner intended to proceed with a subdivision
plan, proposing the same lot configuration, the hearing was continued to February 10, 2000, at
7:00 PM, for further hearing following the Planning Boards review.
On February 10, 2000, the Board reconvened and was advised that the Planning Board had, on
February 9, 2000, voted to approve the plan.
No opposition to the proposal was presented to the Board. The petitioner did file with the board
a Supplemental Sketch Plan of the adjoining Boch Broadcasting Site (dated 2/2/00)
-1-
demonstrating that the Lot 11 fell entirely outside of the "fall zone" from its existing radio tower.
The Board makes no further determination as to the use of the Boch Broadcasting site.
The Board finds that the requirements of §104.3.2 (5) have been met, and the proposed new
structure may be built in conformance with the intent and purpose of this bylaw. A motion was
made by Mr. Robertson, seconded by Mr. St. George, to Grant the Special Permit, as requested,
on the express condition that the existing Lot 52 (LCP 11781B) and the abutting Lot 11 be
combined as one lot, for zoning purposes and the above referenced subdivision plan be duly
recorded and a time stamped copy (showing proof of recording) be filed with our office. Unless
such proof of recording is filed with the Board of Appeals office by March 3, 2000, the Special
Permit shall automatically lapse, without further action. After further discussion, the Board voted
unanimously in favor of the motion.
No permit shall issue until 20 days from the filing of this decision with the Town Clerk. Appeals
from this decision shall be made pursuant to MGL c40A §17 and must be filed within 20 days
after the filing of this notice/decision with the Town Clerk.
David S. Reid, Clerk
-2-
.� MAP /O c yr I Z 7,br4"4r/eA1 LM"� V
m�P �y
LOT NO.: W-S-2 ADDRESS:A/oEyr y-9m,/ arnt, N1j
OWNERS NAME • axrxae $ n bNigwo 1-.vyxsqwo
SEWAGE PERMIT NO.: 95=5�6 NEW: ✓ REPAIR: ✓
M,sY .2v -•2.2
DATE ISSUED: a 9S. DATE INSTALLED:_ /99�
INSTALLERS NAME.y,ew+wn5r,/9—
/000 GST ��iNPGJl/lMBFJt �.B,
INSTALLATION OF:,<,ij� AB��'"O"�
WATER TABLE: /.35� FINAL INSPECTION BY:B.MvAAyY
DRAWING OF INSTALLATION ON REVERSE SIDE: >lrs
Kl G ftt�
r� fi
000
rYj p' -
r
•r '
' G
r
A RTC•... r�+e_.. .... _^�..1 ._._.�.�n����....... .._w — .r—.... .. .. ..... •'j. ����Ta.
SERVICE NO• '
MAME ✓wit 1 ti
STREET pZ / •i Q ✓ i • , o V • • .. .
f'
,vIRA� . ° C; Wiz, ..A
METER NO./
//-ae2a sa3 %
i
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B
loo.00
I
LOT ARE , 17596.8 s.P.
0.40 oc.
4 �
--tom i
I I
I I \
1
I
i
I
PROPOSED DWELLING—?/6•0
c Z/ z3 mxx 1 P6WI
): H
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0 1 \Z-�
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RADIO LAN BLOC?.�a6Z4rr6 (Aego=c
E
CERTIFIED PLOT PLAN
FOR
2 TELEVISION.LANE WEST YARMOUTH, MA.
PREPARED FOR
GEORGE & MONIQUE LEVESQUE
DATE: OCTOBER 28, 1444 SCALE: 1" = 20'
WELLER & ASSOCIATES
1645 FALHOUTH RD• - SUITE 4C
P.O. BOX 417 CENTERVILLE, RA 02632
(508) 775-0735
ti-9 -c►c)
• TOWN OF YARMOUTH BUILDING DEPARTMENT
PLkN -REVIEW & BUILDING PERMIT APPLICATION REVEE:W NOTE
• • Address: A 7,6 LAc rii s/ o k //N.
MaPn-0e �y/9�•C/o/wi-sz�• . .
Date of Initial Review: ther APProval Dm—�
InspledY.o
Notes: > Ji,v (c. p * f3Le L r J x R-cj';uy e0g 01►Z.£ D
lrv/L, Chime L' 5,P,--)LCr �/?%s tar FAT
' OIL_ ADavr 37,4s �l�o��••%�1z!/�ri/aN �r�F. CaDFi
55---noN 3/07,s, I
. ��,Ap its, rc� �dto � o� TaPo�ToP P�-isr�r B�rwE6N .
/p�}Frr,r�s
' H� i�TT/G /ACC ASS /yoT si./o+., if
• - 5� ��ov� �� /�di4-G l7�TA •
Zoning Denial (if aPP ): .
• _:Secdon 104.3A pate C1111ugG Fxteasion or Alteration, (pt44sama&
The propose- 1 d equm a Sp=al Permit $era
the Zowag Board of Appeals.,.: t .
:Other
• h
Building Code Decrial (iFappcable)
TOWN OF YARMOUTH
BOARD OF APPEALS
DECISION
FILED WITH TOWN CLERK:
PETITION NO: #3577
rw
February 24, 2000 �.
HEARING DATE: December 23, 1999 & February 10, 2000
PETITIONER: George & Monique Levesque
A I
PROPERTY: 2 Television Lane, West Yarmouth
Map: 14, Parcel: 90 (10/W152) Zoning District: R25
MEMBERS PRESENT AND VOTING: David Reid, Chairman, James Robertson, John
Richards, Richard St. George, Diane Moudouris, Douglas Campbell, alternate.
It appearing that notice of said hearing has been given by sending notice thereof to the petitioner
and all those owners of property deemed by the Board to be affected thereby, and to the public by
posting notice of the hearing and published in The Register, the hearing was opened and held on
the date stated above.
The petitioner owns the locus, which is improved with a single family home. The existing lot is
located in an R25 zone. The petitioner proposes to purchase an adjoining parcel (Lot 11 on the
proposed plan) and join it with the locus to increase the size of the lot to 17,596.8 sq. ft. No relief
is needed for this expansion of the lot. However, the petitioner then proposes to raze and replace
the home and therefore requires a Special Permit pursuant to § 104.3.2 (5).
As shown on the petitioner's plot plan, dated October 28, 1999, the proposed house would be
somewhat more centrally located on the lot than is the existing home. It would conform to all
current set -back requirements, and would be more conforming than the existing home. It would
remain a single family home, albeit a substantially larger home.
After opening and commencing the hearing on December 23, 1999, it was brought to the
attention of the Board that the lot combination had not yet been authorized as the Planning Board
had declined to endorse the ANR plan. As the petitioner intended to proceed with a subdivision
plan, proposing the same lot configuration, the hearing was continued to February 10, 2000, at
7:00 PM, for further hearing following the Planning Boards review.
On February 10, 2000, the Board reconvened and was advised that the Planning Board had, on
February 9, 2000, voted to approve the plan.
No opposition to the proposal was presented to the Board. The petitioner did file with the board
a Supplemental Sketch Plan of the adjoining Boch Broadcasting Site (dated 2/2/00)
-1-
! A.
demonstrating that the Lot 11 fell entirely outside of the "fall zone" from its existing radio tower.
The Board makes no further determination as to the use of the Boch Broadcasting site.
The Board finds that the requirements of §104.3.2 (5) have been met, and the proposed new
structure may be built in conformance with the intent and purpose of this bylaw. A motion was
made by Mr. Robertson, seconded by Mr. St. George, to Grant the Special Permit, as requested,
on the express condition that the existing Lot 52 (LCP 11781B) and the abutting Lot 11 be
combined as one lot, for zoning purposes and the above referenced subdivision plan be duly
recorded and a time stamped copy (showing proof of recording) be filed with our office. Unless
such proof of recording is filed with the Board of Appeals office by March 3, 2000, the Special
Permit shall automatically lapse, without further action. After further discussion, the Board voted
unanimously in favor of the motion.
No permit shall issue until 20 days from the filing of this decision with the Town Clerk. Appeals
from this decision shall be made pursuant to MGL c40A § 17 and must be filed within 20 days
after the filing of this notice/decision with the Town Clerk.
David S. Reid, Clerk
-2-
DOC:794.,759 03-16--LO_
ONSTA3LE LAND COURT REGISTRY
0
Appeal #3577
THE COMMONWEALTH OF MASSACHUSETTS
TOWN OF YARMOUTH
BOARD OF APPEALS
Date: March 15, 2000
Certificate of Granting of a Special Permit .
(General Laws Chapter 40A, Section 11)
The Board ofAppeals; ofthe Town of Yarmouth Massachusetts hereby certifies that a Special
Permit had been granted
To: George & Monique Levesque
Address: 17 Silas Deane Road
City or Town: Ledvard. CT 06339
affecting the rights of the owner with respect to land or buildings at: 2 Television Lane, West
Yarmouth, MA. Assessor's Map: 14 Parcel:10/W152, Zoning District: R25
And the said Board ofAppeals further certifies that the decision attached hereto is a true and
correct copy of its decision granting said Special Permit, and that copies of said decision, and of all
plans referred to in the decision, have been filed with the Planning Board and the Town Clerk.
The Board ofAppeals also calls to the attention ofthe owner or applicant that General Laws,
Chapter 40A, Section 11 (last paragraph) and Section 13, provides that no Special Permit, or any
extension, modification or renewal thereof shall take effect until a copy of the decision bearing the
certification ofthe Town Clerk that thirty (20) days have elapsed after the decision has been filed in
the office of the Town Clerk and no appeal has been filed or that, if such appeal has been filed, that
it has been dismissed or denied, is recorded in the registry of deeds for the county and district in
which the land is located and indexed in the grantor index under the name of the owner of record or
is recorded and noted on the owner's certificate of title. The fee for such recording or registering
shall be paid by the owner or applicant.
or
David Reid, Chairman
CERTIRCSP.WPD
TOWN OF YARMOUTH
BOARD OF APPEALS
APPLICATION FOR HEARING
Niw '99 uDU -9 A 9 zW
Appeal #: 3577 Hearing Date: 121Z3 Fee $bb ,$ O ; .; Mh -' if rAictNJ,; ,
—' 1V N CLERK - IREAS6 i
Applicant:
(Full Name- including d/b/a) p ,, //'' ..''
(Address)J (Zip) (Telephone Number)
and is the (check one) fr]'Owner ❑Tenant ❑Prospective Buyer ❑Other Interested Party
Property: This application relates to the property located at: n2 TC, 0a✓ ;n-► ,CQn�
). which is also shown on the new Assessor's Map: /174
as Par el: Ct D (old Map & Lot #) O Zoning District: A,2-T
Project: The applicant seeks permission to undertake the following construction/use/activity :(give a brief
description of the project. i.e.: "add a Why 15' deck to the front of our house" or "change the use of the existing
building on the property"):
RELIEF REQUESTED: The applicant seeks the following relief from the Board of Appeals:
1) REVERSE THE DECISION OF THE BUILDING INSPECTOR OR THE ZONING
ADMINISTRATOR dated (attach a copy of the decision appealed from). State the reason for
reversal and the ruling which you request the Board to make.
2) ✓ SPECIAL PERMIT under § / 04. 3. a- of the Yarmouth Zoning By-law and/or for a use
authorized upon Special Permit in the "Use Regulation Schedule" §202.5
3) VARIANCE from the Yarmouth Zoning By-law. Specify all sections of the by-law from which relief is
requested, and, as to each section, specify the relief sought:
Section:
Section:
Section:
Additional comments:
Relief sought:
Relief sought:
Relief sought:
FACT SHEET
This sheet must be completed and filed at the time of application.
Owner of Property (if other than applicant) ��
(Full Name)
( Address) I (Telephone Number)
.
How long has the owner had title to the above premises:
(Ave title reference if available)
Use Classification: Existing:. -kW OU, §202.5 # 41
Proposed: J it §202.5 # Q
Is the property vacant: ✓lam How long has it been vacant:
1!
& 9 ,
Lot Information (if available) Area: Subdivision/Plan Reference;
Is this property within the Aquifer Protection Overlay District: Yes No t/
Other Department(s) Reviewing Project: Indicate the other Town Departments,which are/ have/ or will review
this project, and indicate the status of their review process: LI 1-&4
Repetitive Petition: Is this a re -application: /10 If yes, do you have Planning Board Approval:
Prior Relief: If the property in question has been the subject of prior application to the Board of Appeals or Zoning
Administrator, indicate the Appeal number(s) and other available information:
ADDITIONAL INFORMATION: Please use the space below to provide any additional information which you
feel should be included in your application:
I( plicant's Sigtlat6fe/Attorney" Address
� -430 C 747 W-Y. 'Tr�•Z�l3ro
_ ;
Building Inspector's Signature
1
• i3ignature
Site Plan Review
Required Completed
❑ Yes ❑ No ❑ Yes ❑ No
100.00
LOT AREA; 17596.8 s.f.
0.40 oc.
cI PROPOSED D\
CZ/Z3 VR
s
16.00
N 17 �e
1mCo 7-5z
Lco rr7� B _
a PooH 13.5
ram_
19.j4
RADI❑ LANE
CERTIFIED PLOT PLAN
FOR
2 TELEVISION LANE WEST YARMOUTH, MA -
PREPARED FOR
GEORGE & MONIQUE LEVESQUE
DATE: OCTOBER 28, 1999 SCALE: 1" = 20"
i�
WELLER & ASSOCIATES
1645 FALMOUTH RD. - SUITE 4C
P•0. BOX 417 CENTERVILLE, MA 02632
(508) 775-0735
0
SUPPLEMENTAL SKETCH OF LAND
SHOWING
-'-- ZONE RADIUS OF EXISTING RADIO TOWER
OWNED BY BOCH BROADCASTING CORP.
LOCATED AT
RADIO LANE WEST YARMOUTH, MA
: FEBRUARY 2, 2000 SCALE: 1" = 801
✓F
RECE VIED
FEB :1999
TOWN OF YARMOUTH
BOARD,OF APPEALS
-, -.-Nc;o
WELLER & ASSOCIATES
1645 FAIMOUTH RD. - SUITE 4C
P.O. BOX 417 CENTERVILLE, MA 02 632
(508) 775-0735
11
W
?PLEMENTAL SKETCH OF LAND
mowrm
ZONE RADIUS OF EXISTING RADIO TOWER
OWNED BY BOCH BROADCASTING CORP.
LOCATED AT
RADIO LANE WEST YARMOUTH, MA
FEBRUARY 2, 2000 SCALE: 1" = 80'
IF
RECCE IED
.FEB :1999
TOWN OF YARMOUTH
BOARD,OF APPEALS
WELLER & ASSOCIATES
1645 FALMOUTH RD. - SUITE 4C
P.O. BOX 417 CENTERVILLE, MA 02632
(508) 775-0735
l
K
TOWN OF YARMOUTH
1146 ROUTE 28 SOUTH YARMOUTH
Tcicphonc 398.2231
FORM C-1
MASSACHUSETTS 02664
PLANNING BOARD .
TOWN OF YARMOUTH, MASSACHUSETTS
PLANNING
BOARD
FEB I o 1999
TOWN OF YARMOUTH
BOARD OF APPEALS
CERTIFICATE OF APPROVAL OF A DEFINITIVE PLAN
February 10, 2000
Town Clerk
Town of Yarmouth, Massachusetts
RE: Planning Board Reference No. 2787B, George Levesque
It is hereby certified by the Planning Board of the Town of Yarmouth, Massachusetts,
that at a duly called and properly posted meeting of said Planning Board, held on
February 9, 2000, it was voted by the requisite majority to approve a definitive
subdivision plan submitted by George J. Levesque of P.O Box 417, Centerville, MA
02632, entitled "PLAN OF LAND IN WEST YARMOUTH, MA PREPARED FOR
GORGE J. LEVESQUE.," dated November 3, 1999 and revised December 15, 1999,
by Steven W. Rumba, Registered Professional Land Surveyor of Weller and
Associates, 1645 Falmouth Rd., Suite 4C, P.O. Box 417, Centerville, MA 02632.
The plan concerns land in West Yarmouth located off of Radio Lane and Sea Gull
Road and shows a 4 lot subdivision. The plan and application were originally filed
with your office on December 20, 1999.
As requested by the applicant, the Planning Board waived the provisions of the
Rules and Regulations Governing the Subdivision of Land in the following manner.
1. the provisions of section 3.4.2, subsections m, n, p, q, r, s, t, and u, which deal
with definitive plan contents, were waived entirely;
2. the provisions of section 3.4.1.3, subsection b, which deals with fees for the
review of definitive plans and for construction inspection services, were waived
entirely, and;
3. the provisions of section 3.4.1.2, which deals with the definitive plan application
fee, were partially waived. The non-refundable subdivision fee was reduced from
$300 to $100.
Form C, Page 2
The Planning Board made the following condition to their approval:
1. the plan must be altered to indicate that lots 11, 12, and 13 are not to be
considered buildable lots.
NOTE TO PLANNING BOARD: Conditions should be written on the endorsed plan
which is recorded or should be set forth in a separate instrument, which could be a
copy of the approval vote, and which should be referenced on the endorsed and
recorded plan.
NOTE TO TOWN CLERK The Planning Board should be notified immediately of
any appeal to the Superior or Land Court on this subdivision approval made within
the statutory twenty (20) day appeal period. If no appeal is filed with your office the
Planning Board should be notified at the end of the twenty (20) day appeal period in
order that the plan(s) may be endorsed.
A true copy, attest:
John H. McCormack, Jr., Clerk
Yarmouth Planning Board
Duplicate copy sent to applicant
Duplicate entered into subdivision file
b
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00
TOWN OF YARMOUTH
(OFFICE USE ONLY)
Fee: $ CC
PERMIT NO.
(PLEASE PRINT IN INK OR TYPE ALL INFORAIATION) Date:
To the Inspector of Wires
described below.
Location (
Owner or
Owner's t?
By this application the undersigned gives notice of his or her intention to perform the electrical work
Is this permit in conjunction with a building permit? 0-Yes ❑ No
Purpose •of Building R25<- b�,C/GUtility
G
�tisemg _ _E— Amps < oIts Overhead ❑
New Service Amps / Volts Overhead ❑
Number of Feeders and Ampacity
Location and Nature of Proposed electrical Work:
(Check Appropriate Box)
Authorization No.
Undgrd No of Meters
Undgri
No. of Recessed Fixtures
No. of eil.-Susp,(Paddle) FansTransformers
No. of
No. of Liphting Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures
Above In-
Swimming Pool gmd. ❑ rnd. ❑
No. of Emergency lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners
No. of Detection an
Initiating Devices
No. of Ranges
Total
No. of Air Cond. Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
Totals:
Number
Tons
—
KW_
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Municipal
Local ❑ Connection ❑ Other
No. of Dryers
Heating Appliances KW
ecuuty ystcros:
No. of Devices or Equipvalent
No. of Water
Heaters KW
No. of No. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. H dromassa a Bathtubs
Y 8
No. of Motors Total HP
Telecommunications Wiring
No. of Devices or E uivalent
Attach additional detail if desired, or ar required by the Inipedor ojWres.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability
insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof
of same to the permit issuing office.
CHECK ONE: INSURANCE ❑C BOND[] OTHER[] (Specify:)
�, (Expiration Date)
Estimated Value of Electrical Work: / 75 (When required by municipal polity.)
Work to Start: . !C:� -GYM Inspections to be requested in accordance with MEC Rule 10, and upon completion.
I certify, under the pains and penalties of perjury, that the inform ion on this application is true and complete.
FIRM NAME: I "c- ),.* i , LIC. NO.
I~ Licensee: >>R✓,y /,P✓rp_ 4e � Signature � � IC. NO. t e
(If applicable, enter "exempt" in the license um� ate.) �6 3 l s. Tel. No.: S"h
Address: /// C z0A wai- n A;t-�t���t• Alt. Tel. No.:
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature
below, I hereby waive this requirement. I and the (check one) owner owner's agent.
Owner/Agent
Signature Telephone No.
(Rev.04/001
D
APPLICATION FOR PERMIT TO INSTALL AND REQUEST
�N FOR ELECTRICAL SERVICE _
Inspector of Wires 1 Wiring Permit # j: b COM/Electric #
Town of Z�rt.&e e 1.7 k Massachusetts Building Permit # Date
Customer: sn.rg
Lot # in the
Customer's billing address—
Temporary —
Job description
on (Street #)
c
of utility pole number or underground number
Change of service Starting
Service entrance voltage 1/ ' /,Pt Amperage SE2 Phase Z,0�
Wire size (cu. or 4CLe"" Conductor per phase w/
Number of meters Water heater Off peak: Yes — No —
Estimated load: Electric heat kw, lights kw, Range dryer Motors, H.P. & Phase
Ready for first inspection Ready for fine I inspection
Electrical Contractor'!� ic. # ��2 Telephone #-soy"may --3/77
Address /l/ • g.Plia 'd,{��
Additional Remarks: Ax-
Do Not Write Below This Line
ELECTRICAL WIRING INSPECTION CERTIFICATE
INSPECTOR OF WIRFS
INSPECTIONS
Temporary Service
Roughing in
Service and Meter
Off Peak Meter
Final Approval
Disapproved'
'For the following reasons
AT FEE CHARGE
CERTIFICATE OF INSPECTION DATE J✓
To the COMMONWEALTH ELECTRIC COMPANY. The installation described above has om ekd and this day been inspected and
approval granted for connection to your service. ��
Inspector of Wires
WIRING INSPECTOR TO BE NOTIFIED WHEN WORK IS READY FOR INSPECTION
Permit Good For One Year From Date Of Issue cA4&1
While — COM/Electric Green — Inspector Canary — Town Receipt Pink — Inspector's Copy Goldenrod — Electrical Contractor
to COWElectric
7
0( �(>APPLICATION FOR PERMIT TO INSTALL AND REQUEST
�r` FOR ELECTRICAL SERVICE
U . _ `-. E-DU-
Inspector of Wires Wiring Wiring Permit # COM/Electric #
^ Town of y�� R A4 =s '+� Massachusetts Building Permit # Date
r
Customer: on (Street #)
Lot # in the villa a of utility pole number or underground number
Customer's billing address a rC7 (��7
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Temporary —
Job description
Change of service Starting
Service entrance voltage / ; A Amperage Phase Z;;2!f
Wire size (cu. or al.)��? Conductor per phase
Number of meters Water heater Off peak: Yes— No
Estimatedload: Electric heat kw, lights kw, Range dryer Motors, H.P. & Phase
Ready for first inspection — Ready for finng�I''inn'sp''ection
Electrical Contractor
"c �iT, i t Telephone # sob•��/is �/�7
— ZLic. # —v
/
Addres4,
s /// /J.P� r�G� 'c?;7� ��r.� 3�6—T �T�`'f�
Additional Remarks: e_6 b � 2Z g6cF� /�d —��� T
Do Not Write Below This Line
ELECTRICAL WIRING INSPECTION CERTIFICATE
INSPECTOR OF WIRES,
INSPECTIONS ��� Q �' AT
Temporary Service r G
Roughing in
Service and Meter
Ott Peak Meter
Final Approval
Disapproved'
'For the following reasons
FEE CHARGE
CERTIFICATE OF INSPECTION DATEaa
To the COMMONWEALTH ELECTRIC COMPANY. The installation described above has been comp ted and haslthis day been inspe bed and
approval granted for connection to your service. l/ ( /hale f�
Inspector of Wires
WIRING INSPECTOR TO BE NOTIFIED WHEN WORK IS READY FOR INSPECTION
Permit Good For One Year From Date Of Issue CA 46-1
White — CON/Electric Green — Inspector Canary — Town Receipt Pink — Inspector's Copy Goldenrod — Electrical Contractor
to COM/Electric
'.'•...si.r�7+.tn a-iM'S+: y. .•k� ry,.:. �.. _... �-.+ai :F. •�." .r.7 r'ry^•:^ .:n .�._,. r..
APPLICATION FOR PERMIT TO INSTALL AND REQUEST
"I,
FOR ELECTRICAL SERVICE %�
Ins ector of Wires Wiring Permit # C-DbI COM/Electric #
Town of R O - Massachusetts Building Permit # Date
Customer: ef/—Ld /Jo / ,'* 1 �' � P" �r /n on (Street #) r
Lot # in the vili of ;OVutili ; pole number or underground number
Cust,omer's billing address .3
Temporary New installation Change of service Starting Date
Job description 1 4 //4��. o� ii.i?Z) .er.P.,6►.�L
Service entrance voltage
Wire size (cu. or at.)
Number of meters
Estimated load: Electric heat
Ready for first inspection —
Electrical Contractor
Address 10
Additional Remarks: ___4
??7 , C• Amperage 122 Phase
Conductor per phase
Water heater Off peak: Yes — No _
_—kw, lights kw, Range dryer Motors, H.P. & Phase
Ready for finaj inspection
ri_.t.� Lic. #�Telephone
Do Not Write Below This Line
ELECTRICAL WIRING INSPECTION CERTIFICATE
INSPECTOR OF WIRES,
INSPECTIONS i— 0 r O)ATJ FEE CHARGE
Temporary Service
Roughing in
Service and Meter
Off Peak Meter
Final Approval
Disapproved'
'For the following reasons
CERTIFICATE OF INSPECTION DATE
To the COMMONWEALTH ELECTRIC COMPANY. The installation described above has been compI Ind and h,�s`1his day been inspected and
approval granted for connection to your service. �!/�� ✓ezalUz.,'
Inspector of Wires
WIRING INSPECTOR TO BE NOTIFIED WHEN WORK IS READY FOR INSPECTION
Permit Good For One Year From Date Of Issue CA ae-t
White — COWElectric Green — Inspector Canary — Town Receipt Pink — Inspector's Copy Goldenrod — Electrical Contractor
to COWElectric
G
APPLICATION FOR PERMIT TO DO GASFITTING
TOWN OF YARMOUT fH� By
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PERMIT
Building (.
AT Location A ft
New L9--�- Renovation ❑ Replacement ❑
Plans Submitted Yes ❑ No ❑
(OFFICE USE
Date 10 o a
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Check One: L000
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Name of Licensed Plumber or Gasfitter
INSURANCE COVERAGE: Check One
have a current liability insurance policy or its substantial equivalent. Yes No ❑
If you have checked yes, please indicate the type of coverage by checking the appropriate box.
A liability insurance policy El-�- Other type of Indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of
the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check One:
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
1 hereby certify that all of the details and Information I have submitted
(or entered) In above application are true and accurate to the best of
my knowledge and that all plumbing work and installations performed
under Permit Issued for this application will be In compliance with all
pertinent provisions of the Massachusetts State Plumbing Code and
Chapter 142 of the General laws.
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S nature of Licensed
umber or Gasfitter
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License Number
TYPE LICENSE:
2flumber ❑Gasfitter aster ❑Joumeyman
11
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TOWN OF YARMOUTH
APPLICATION FOR PERMIT TO DO PLUMBING
(OFFICE USE ONLY)
Fee:
PERMIT NO. 'T _t) V—
Date
Building Owner's -L- vC
AT. Location o`1 • 1 • V Le, vxr, Name
Type of Occupancy_" i OCL..1`
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Plans Submitted Yes ❑ No ❑
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Address �2 LJV -
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_E/-Zc.CS3;1D-1gM I \\-,o. L, IV- �.j bl—U-IQ irm/Company
Business Telephone Qy- lao Fc/ <-Y Name of Licensed Plumber = A ti kPl` 6 bo E
INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent. Check One: Yes No ❑
If you have checked YES, please indicate the type of coverage by checking the appropriate box.
A liability insurance policy ga chOther type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance voerage required by Chapter 142 of
the Mass. General Laws, and that my signature on this permit application waives this requirement.
Signature of Owneror Owner's Agent
I hereby certify that all of the details and Information I have submitted
(or entered) in above application are true and accurate to the best of
my knowledge and that all plumbing work and Installations performed
under Permit Issued for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plumbing Code and
Chapter 142 of the General Laws.
Check on Owner ❑ Agent ❑
gnatur of Licensed
Plumber
7
License Number
Type: Master P—� Journeyman 0
cArs. BA= zrrsPEczzoN FEES
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1ST CALL BALM $20+00 ✓
2ND CALL BALL $30,0
3RD CALL BAM $40,00•
ALL OTC CALL BACKS.$40.00
DATE:
DATE QFC;
REASON FOR CALL BAM:
BUIMING PERMIT:
OCMPANCT PERMIT:
PLMLB33G PERT:
us PEI�=: i
=CTICAL PEOUT:_
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Commonwealth of Mas ache etts 01 iclal Use Only
k9z-n1
Department of Fire Services Permit No.Fv
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked _
[Rcv. 1 U99[ (leave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordaince with the btassachusc:tts ElectricaLC01,d1lc(1ME-c)Z.27C IR12.00
(PLEASEPRINTININKORTYPEAL��L�lJNIORILITION) Date:p
City or Town of: ��,! %/V D ti�� To the Inspector o Mres:
By this application the undersigned gives notice of his or her intention to perfonn the electrical work described belon•.
Location (Street & Number) r,- 7;:-TL 9 ✓I f Al,
Owner or Tenant
Owner's Address
Telephone N
Is this permit in conjunction with a building permit? Yes ❑ No JO (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead ❑ Undgrd ..ovool
Met
New Service Amps / Volts Overhead ElUndgrd - c�
Number of Feeders and Ampacity OCT 0
Location and Nature of Proposed Electrical Work:
No. of Recessed Fixtures
� ......... o.
No. of Ceil: Susp. (Paddle) Fans
,..... nw vv-c,,rru uv u,e uu eeror of hires.
N-0-50-f Total
Transformers KVA
No. of Lighting Outlets
No. of clot Tubs
Generators KVA
No. of Lighting Fixtures
Swimming Pool Agbove n-
rnd. ❑ rnd. ❑
I o. o mcrgcncy Ig tmg
Battcry Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARL\IS
No. of Zones
No. of Switches
No. of Gas Burners
No. of Detection
at ti n anTota
In cs
No. of Ranges
No. of Air Cond. Tonsl
No. of Alerting Devices
No. of Waste Disposers
1 cat umin Number ons \1
Tot;Ils: —
No. oSelf-Contained
Detection/Alcrtinp Devices
No. of Dishwashers
Space/Arca Heating Kw
Local Aluntclpal ❑Other
nn ction
No. of Dryers
Hcatin ; Appliances MV
cur
t Systc
Ices or E uivalcl
o. of Water KWo.
Heaters
o o. o
Signs Ballasts
Data \Virin�:
No. of Dcviccsbr E uivalcnt
No. Hydromassage Bathtubs
No. of ARotors Total UP
Te ccommumcations Wiring:
No. of Dcviccs or Equivalent
OTHER:
nuacn aaamonot aetatt V aestrea, oras required by the Inspector of R tres.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue uldess
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 pcnnit issuing office.
CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:)
(Expiration Date)
Estimated Value of El c 'cal Work: 33ro a p (When required by municipal policy.)
Work to Stet: er pL,,I- Inspections to be requested in accordance with h EC Rule 10, and upon completion.
I certify, under the p ins and penalties of perjury, that the information on this application is true and complete.
FIRM NAME: ADT Security Services 111 Alorsc Street, NArwood, AIA 020G2 LIC. NO.: 1533C
Licensee: John S. Bassett
(Ifopplicable, enter "exempt"lrl the licensenunrberline.)
Address:
OWNER S INSURANCE WAIVER: I ain aware that uIe Licensee does
required by law. By my signature below, I hereby waive this requirement.
Owncr/Agent
Signature Telephone No.
(. &�LIC. NO.: 1533C
Bus. Tel. No.• 201-22B-t I3l
Alt. Tcl. No.: JRt-� t_, ., - M
not have the liability instuance coverage nor►nally ON
I am the (check one) ❑ owner ❑ owner's agent.
PEZ fIT FEE: $ 0 U
EOCT 0 A 2000
By
v v
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 Ucensee 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
(OFFICE USE ONLY)
Fee: $ �� J
PERMIT NO.
lsV.mao.w>as.q Tel. No. Date y' /8 Dtso
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
Is this permit in con' ion -with a building permit?
Amps //C)A 0 Volts
!/ New
the Proposed Electrital Work
No.
t� Yes
No. of Meters
Increased from to
No
By OSED
FIXTURES IN
DETAIL
(See attached schedule, if necessa )
Location of Room
O 8 ets
Sw.
Plugs
Fist.
Location of Room
Lig
Outlets
Sw.
Plugs
Fist.
No. of Sw. Out
Ileat-T e
No. of Outlets Lt.
Oil
No. of Rec.
Gas
No. of Motors H.P.
Electric -KW Connected Load
Hot Water -Motors and Size
No. of Signs Trans.
Air Cond. =P— rcw4)
Steam Motors and SIXI
Range Name plate rate
Hot Air Motors and, S
AM
Water Heater Name plate rate
Misc. ju
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 current%dabdity Insurance Polity including Completed Operations Coverage or its substantial equivalent. YES W NO ❑ 1 have submitted valid proof of same to this
office. Yes P Noo 0 If you have checked YES, please indicate the type of coverage by checking the appropriate box.
INSURANCE -'BOND ❑ OTIIER (Pleasespecify)
(Expiration Date)
Estimated Value of Electrical Work S O C. O
Work to Stan / -/,9- &0
Inspection Daze Requested: Rough Ls.Ji11L,f// Final
LIGNo. 414-6 1 3
it
— LIC. No.
Tel. No. Tome;/ %
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.
APPLICATION FOR PERMIT TO INSTALL AND REQUEST
+• •
�r
FOR ELECTRICAL SERVICE
i Inspector Wir�,e��
Wiring Permit COWElectric
of
Town of PARA40 vTA
# #
Building Permit # _/- Date 9'
Massachusetts
Z4�r`�
�f
Customer:- s /t���
'�0�T' on(Street#)
`a
Lot # SZ in
the vil e of �Z0,ef4s4—..11tili y pole number or underground number �a S�
<
Customer's billing address
Temporary
New installation Change of service Starting D to
J
Job description �l�i.Pi.cilC
nr e !94te le-, V,C42 71
O
Service entrance voltage Amperage CEO Phase
Wire Conductor
size (cu. or al.)
per phase
e
Number of meters Water heater Off peak: Yes — No c/ C
-Y&
Estimated load: Electric heat
kw, li hts kw. Range dryer Motors, H.P. & Phase -T
'
Ready for first inspection
Ready for final inspection
Electrical Contractor
_
Lic. # *Ie, G / Telephone # 20 C'26 �617
Address
Additional Remarks:
Do Not Write Below This Line
ELECTRICAL WIRING INSPECTION CERTIFICATE
INSPECTOR OF WIRES
INSPECTIONS
Temporary Service
Roughing in
Service and Meter
Off Peak Meter
Final Approval
Disapproved'
'For the following reasons
DATE
FEE CHARGE
CERTIFICATE OF INSPECTION DATE
To the COMMONWEALTH ELECTRIC COMPANY. The installation described above has been completed and has this day been inspected and
o approval granted for connection to your service.
AInspector of Wires
WIRING INSPECTOR TO BE NOTIFIED WHEN WORK IS READY FOR INSPECTION
Permit Good For One Year From Date Of Issue CA46-1
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APPLICATION FOR PERMIT TO INSTALL AND REQUEST
FOR ELECTRICAL SERVICE
Inspector of Wir Wiring Permit # OM/Electric #
Town of , i�RNc �� Massachusetts Building Permit #-!-Ay�7Date '7" 03 " 00
Customer: �l�.cl.C>�� "' "�"- R4 on (Street #)
Lot # �� in the villane of '�' '� �'r F�'( utility pole number or underground number
Customer's billing address A -0
/i A.vn O b
Temporary New installation hange of service Starting D to - ov
Job description 1 // r IR'r A)1 O / + G u-) "-e /_ �-, 47 Z.-(.1 :P el �
Service entrance voltage 14f C), 1P6 Amperage - a6 o Phase /
Wire size (cu. or al.) lor
It"' 04'Conductor per phase /
Number of meters Water heaters Off peak: Yes — No
Estimated load: Electric heat kw, )hts kw, Range ✓ dryer •� Motors, H.P. & Phase
/. )�.¢/
Ready for first inspection Ready for final inspection
Electrical Contractor G d VF - Lic. # ��4 / Telephone # S� d5S/G a07
Address /n1e t�atJS %lt� 1 k0-t4)LT?Y1Z
Additional Remarks: 4" /a
Do Not Write Below This Line
ELECTRICAL WIRING INSPECTION CERTIFICATE
INSPECTOR OF WIRES
INSPECTIONS
Temporary Service n
Roughing in rA» .- J t
ic
Service and Meter.
Off Peak Meter
Final Approval
Disapproved'
'For the following reasons
DATE FEE CHARGE
a CERTIFICATE OF INSPECTION DATE
To the COMMONWEALTH ELECTRIC COMPANY. The installation described above has been completed and has this day been inspected and
approval granted for connection toyouui service.
1 Inspector of Wires
WIRING INSPECTOR TO BE NOTIFIED WHEN WORK IS READY FOR INSPECTION
Permit Good For One Year From Date Of Issue cnas-1
White — COM/Electric Green — Inspector Canary — Town Receipt Pink — Inspector's Copy Goldenrod — Electrical Contractor
to COM/Electric
1/52015
SlipGen- Portal Hone
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 [sg15309]
Building Permits
014.90
0002
TELEVISION LN
Building
261
No
Operator, Yarmscan
2015-01-05 - 13:47
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BOARD OF FIRE PREVENTION REGULATIONS
Official Use Only
Permit No. 2
Occupancy and Fee Checked
[Rev. 1/071 leave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (NEC), 527 CMR 12.00
(PLEASE PRINTININKORTYPE4I.T. FORMATIOI9 Date: �/ X2
City or Town of:- J1hro nJ17— To the Inspector of Wires:
�y is application the undersigned gives notice of his or her intention to perform the electrical work described below.
tion (Street & Number) 2 %1eLj;S;e7M LrL. e
CD
'1w er or Tenant �t� ✓eS9Ue Telephone No —�/, ] `P-g 22
N
w er's Address
c4 0
cq LNef4crvlce
t In conjunction with a building permit? Yes ❑ No � (Check Appropriate Box)
tr seuilding Utility Authorization No.
a. vice Amps / Volts Overhead ❑ Undgrd❑ No. of Meters
Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: TSir�1� CA SPoI f1lV S(aGAP.
Comoletion ofthe following, table mnv be waived by the Inspector of Wires.
No. of Recessed Luminaires
No. of CeiL-Susp. (Paddle) Fans
o.
KVformers KVA
Transformers
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool Above ❑ In- Elo.
md. rnd.
o itLighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners
o. o electron an
Initiating Devices
No. of Ranges
Ttal
No. of Air Cond. Tons
No. of Alerting Devices
No. of Waste Disposers
eat Pump
Totals:
um er
ons
o. o c - ontained
Detection/Alerting Devices
of Dishwashers
Space/Area Heating KW
AluniNo. ❑ Other
Local ❑ Connection
Cyyonnection
No. of Dryers
Heating Appliances KW
Security
Devices or Equivalent'-?
o. of Water
Heaters KW
o. o o• o
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. H dromassa a Bathtubs
Y g
No. of Motors Total HP
a No. or Wiring:
No. of Devices or Equivalent
OTHER:
Attach additional detail ifdesired or as required by the Inspector of Wires.
Estimated Value of Electrical Work: St�d (When required by municipal policy.)
Work to Start Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE COTE —RAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office.
CHECKONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) Self Insured
I certify, under the paints and penalties ofperjuiy, that Cite i ormadon on this application is true and complete
�FIRMNAME: ADT Security Services Inc LIC.NO.: C - 4 5
c. Licensee: Mark A. Brophy Signature LIC.NO.: C-45
(/fapplicable.enter"exempt"in the licensenwnberline.) Bus Tel.No.•781-355-5619
ddress: 410 Universit Avenue Westwood MA 0 090 Alt.TeLNo.���20
Per M.G L. c. 147, s. 57-61, security work requ'ves Department of Public Safety "S"License: Lic. No. 00953
WNER'S INSURANCE WAIVER: I am awaze that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requiremenL I am the (check one) ❑ owner ❑ owner's a ent.
Owner/Agent PERMIT FEE: $ `�7
Signature Telephone No.