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Home My WebLink AboutBuilding PermitsAPPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00 28 (PLEASE PRINT 1N INK OR APE ALL--IINFORb1A To the Inspector of Wires: By hi!�EpplicationAe`un work described below. (OFFICE USE ONLY) Fee: PERMIT gives notice of his or her intention to perform the Location (Street & Number) �L6q 600Ah �AV_ 5oAk AQrv1oU Owner or Tenant :16V H 1= 11 tizr%., Telephone No. `I729 -'/5y Owner's Address t Aso EiNtea✓ME— %Dq• I +tl ii oto> of - Is this permit in conjunction with a building permit? 0 Yes Mo (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead[] Undgrd ❑ No. of Meters New Service Amps / Volts Overhead❑ Undgrd D No. of Meters Number of Feeders and Ampacity t Location and Nature of Proposed electrical Work: ter Qt Na FnV 0S KLZ GaNd-FOR may RecessedNo. of addl No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of LightingFixtures Above n- Swimmin Pool md. ❑ m-d. 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 o. ot Detection an Initiating Devices No. of Ranges No. of Air Cond. Tons No. of Alerting Devices o. of Waste Disposers Heat m� Totals: um er — Tons ns — — No. of Self -Contained Detection/Alertin Devices No. of Dishwashers Space/Area Heating KW Municipal Other Local Connection No. of Dryers rY Heating Appliances KW g PP Security Systems: 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 g No. of Motors Total HP Telecommunications Wiring No. of Devices or uivalent Attach additional detail if desired, or as required by the Inspector of lVires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in cc, and has exhibited proof of same to a permit issuing office. WCH CK ONE: INSURANCE BONDQ OTHER (Specify:) V e ' (Expiration Date) Estimated Value of Iect 'cal Work: (When required by municipal policy.) o Work to Start: 2aD O (, Inspections to be requested in accordance with MEC Rule 10, and upon completion. �v, I certify, under the pans and penalties of perjury, that the information on this application is true and complete. �FIRMNAME: Z 57(E-•a.1C. irate LIC.NO. /1633b R C" Licensee: '-)Co-I t MriA-W% Signature LIC. NO. 3b 0Q6 E (If applica � enter i the, license n�u�nber line.) Bus. Tel. No.: - - - O Address• t7r l�b h�RuJt 6k d�R af>�5/S' Alt. Tel. No.: - 53 - a Q OWNER'S INSURANCE WAIVER: I am aware that the Licensee doet not have the liability insurance coverage normally required by law. By my signature IX I hereby waive this requirement. I am the (check one) owner owner's agent wner/Agent Signature Telephone No. [Rev. 04/00] OF r TOWN OF YARMOUTH Building Department B O I L DI N G c: _0 (508) 398-2231 ext.261 - '- PERMIT NO : _FB-05-1243 PERMIT Wn•. ISSUE DATE ; _ 4/29/2005 _ ; PROPOSED USE APPLICANT 'Richardbenoii ...... . P - - - JOB WEATHER CARD ................... PERMIT TO 'Misclinground pool; AT (LOCATION) 100204SOUTH ST ZONING DISTRIC RS-4 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 1034.304 BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R 4 LOT SIZE CONTRACTOR Install inground pool as per plans dated 03124105. REMARKS AREA (SO FT) EST COST ($ $30,000.00 PERMIT FEE ($) $65.00 OWNER John Reilly Jr. BUILDING DEPT BY ADDRESS 226 Andover Street Lowell MA 01850 INSPECTION RECORD LICENSE 056174 Benoit, Richard 54 Cushing Hill Road Norwell MA 02061 5089620007 FIELD COPY Date 4 Note Progress - Corrections and Remarks Inspector -o? - D 5- M oF'YgR,� ONE & TWO FAMILY ONLY - BUILDING, PERMIT . 32 C APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELL 0 y Town of Yarmouth Building Department 1146 Route 28 - Yarmouth, MA 02664-4492 �+...• �a Tel: (508) 398-2231 x261 •Fax: (308) 398-0836 Office Use my Pinning Board Information Assessors Department Information: Permit No. t pe map La /Im ZErsement Date A13`l /3o5fPermit Fee $ngDate New Deposit Rec'd. $ O° v Date ,� Plan No 1.4 Property Dimensions: Net Due $ OtherD ri 15 0 r LotArea (sf) Frontage (it) Lot Coverage This Section for Office Use Only Building Perjn u er. I.Date Issued: Signature. Building Official to Certificate of Occupancy Is is not required Section 1 - Site Information I Use Group: R-4 Type: 5-B 1.1 Property Addressr •j0 ¢ $�Jt(iH' ST/ZLGT 1.2 Zoning Information: Zoning District sy1 Ml µ�wGc Proposed Use �. jo?'14i 1.3 Building Setbacks (ft) Front Yard Side Yards Rear Yard Required Provided Required Providqd Required Provided i- 2!• /a r s� �� 1 A Water Supply (M.O.L. c. 40. S 54) Publicr/ Private 1.5 Flood Zone Information: Comments: Zone:41 1(3 BFE:1LI—e:1L Section 2 - Property 2.1 Owner of Record. o 4 r V« 'Lb r-1ilnoU£tZ S - Name ( I , I-' • „ - Mailing Address s A horised Agent. •-'Wt4 srw¢c Exuwrrc t1xA-5 dusi?INd- �I(r// Pvjlb .� ,�,�(�— i Name n 040v Mailing Address ignat re Telephone Fax Section 3 - Construction Services I ., ,pUS 3.1 Licensed Construction Supervisor. Not A p p I i L, License Number Orin Nyes.� �I 4ii V�- 02ta(.� Addres �— OS-4 /7 KO61Ov 6H - O d Expiration Date I's"119nafurd Telephone 163 _ G _ ' 3.2 Registered Home Improvement Contractor. Company Name Not Applicable ❑ Sownf- S#OCL' 44rr` �d!S L'rfc/MSvo�� ►1fl- Addre license Number rf lk'9 Expiration Date \ ignatur Telephone •7 — 1 of 2 OVER becuort4-YvuFrltlfl VVnvnaauV„n,auana.vnn,vvna�.v.v.�..... ....pq 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 .......... ription of Proposed Work (check all applicable) No. of Bedrooms No. of Bathrooms Repalr(s) ❑ Alterations ❑ Addition ❑ WBIdg. . ❑ Type Demolition Other Specify: Brief Description of Proposed Work: t Costs Estimated Cost (Dollars) to be Check Below Section 6 - Estimated Constnlldt On Item completed by permit applicant ❑ Conservation -Commission Filing (if applicable) 1. Building 2. Electrical 3. Plumbing / Gas ❑ Old Kings Highway & Historical Commission approval (if applicable) 3 G D To be Completed When 4. Mechanical (HVAC) 5. Fire Protection B. Total = 0 + 2 + 3 + 4 + 5) 7. Total Square Ft. (new houses & 0WRIOro) Section 7a - Owner Authorization - Owner's Agent or Contractor Applies for BuildingPermit . 1, Tc�r.1�j, (oj(�1 , as owner of the subject property hereby authorize zumm'Be' Upr to act on my be in all matte ve to work authorized by this building permit application. .S - 1 4- ' o si of Owner Date lion 7b - Owner/Authorized Agent Declaration I_� �� 1 , as Owt er/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 Mum v a� Date S natu f Agen I k 9.15.99 2of 2 i V WIN y r 1 t1 lk 1V1 V U 1 ri BUILDING DEPARTMENT PLEASE PRINT: Job Location: CONSTRUCTION SUPERVISOR FORM Number Owner of Property: Construction Supervisor: ISb►'c'� l Name SOunk. : L ON -A t kr l Address: Licensed Designee: (If other than Supervisor) Name 2.15 Responsibility of each license holder: T Village ge-w- 4000 x 400 License No. Phone No. SYGusH.N,L �,ii�zv�� License No. 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building and structures only pursuant to the state building code and all other applicable laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Any licensee who shall willfullyviolate subsections 2.15.1, 2.15.2 or 2.15.3 or any other section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes orlo� No ❑ If you have checked yo, please indicate the type coverage by checking the appropriate box. A liability insurance policy @r� 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. s� Check one: igna e o O nor or Owner's Agent Owner I] Agent Signature: Building Official Approval: For Office Use Only Permit No. Date TOWN OF YARMOUTH AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c. 142A requires that the 'reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition or construction of an addition to any pre-existing owner -occupied building containing at least one but not more than four dwelling units or structures which are adjacent to such residence or building' be done by registered contractors, with certain exceptions, along with other requirements. Type of Work: R1 i ut itt 1 K1Cr Est. Cost 3©. nc� Address of Work Owner Name: 70 LA &k 0 Date of Permit Application: ' I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under $1,000 Building not owner occupied Owner pulling own permit Other (specify) Notice is hereby given that: 14 . OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as tt 9cp of the owner: D e Contractor Name Registration No. •M Notwithstanding the above notice, I hereby apply for a permit as the owner of the above Property Date Owner Name 0 The Commonwealth of Massachuseas Department of Industrial Accidents OlAcool/�jstlois 600 Washington Street Boston, Mass. 01111 Workers' Compensation Insurance Affidavit Applicant Information: Pfez!12]!H Pf`TediWar name, location- cits phone N I am a homeowner performing all work myself. 0 I am a sole proprietor _rd ha%c no one ssorking in any capacity S`am an emplo%csr pros iding workers' compensation for my employees working on this job. Unumnv_names �;Jyrf% �l�02E [ova• G �A7�5 address: � %Lf4G�'�SS CRY.: �kG wLS. F,zlZi� �i% phone N: eA�9 insurance co. /? 2�l �,h — LA 1-- C SD L 1rkg • nolicy It U 0 "/g-- 0 1 am a sole proprietor. general contractor, or homeowner (ckcle one) and have hired the contractors listed below who hale the following worker' compensation polices: Failure to secure coverage as required under Section 23A of MGL 132 us lead to the imposid" of trimiW pesaides of ■ floe op to 31,MAG and/or one years' Imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a One of SIMM a day against me. I nadentaod that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. t da hereby cenifyyw fer tht paint and ptnaftitt o/perjury that the information provided above It true and correct Print ;K, 7&knlT, Official use only do not w rite in this area to be completed by city or Iowa official city or town: YARMOOT11 o check irimmediste response is required contact person: 3-/y Or� ;.Rod 641 8o80 permitAlcense N n8uildiog Department E31ltensiog Board 261 ❑Selectmen's Office (508) 398-2231 ext. OHealtb Department pAoac N: _ nOther tat,reed 3.04 /)1k) Information and Instructions ; Massacllusctts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees- As quoted from the "law", an employee is defined as every person in the service of another under am• contract of hire. express or implied, oral or written. An emphuver is defined as an indi% idual. partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the recei%er or trustee of an individual . partnership, association or other legal entity, employing emplo%ces. Ho%%ever the o%%ner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the d%%ellina house of another who employs persons to do maintenance , construction or repair work on such dwelling house or on the --rounds or building appurtenant thereto shall not because of such employment be deemed to be an emplo%er. NIGI_ chapter 1 section 24 also states that even• state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionall%. neither the commom%ealth nor any of its political subdivisions shall enter into any contract for the performance of public %%ork until acceptable evidence of compliance with the insurance requirements of this chapter ha%e been presented to the contracting authorit%. Applicants Please till in the workers' compensation affidavit completely, by checking the box that applies to your situation and stuppl%ing company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the aMdaviL The affida% it 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 %%orkers' compensation policy, please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a calla The Department's address, telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents MCI dImstleaden 600 Washington Street Boston, Ma. 02111 fa: H: (617) 727-7749 phone 0: (617) 7274900 ext. 406, 409 or 375 DATE (MMiDONYW) 'AC-OBpw CERTIFICATE OF LIABILITY INSURANCE I 04/09/2004 04/09/2004 PRODUCER (603)432-3666 FAX (603)432-6076 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Lakeside Insurance Agency, Inc. ONLY ANL-ONFERS NO RIGHTS UPON THE CERTIFICATE One Wall Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Windham, NH 03087 INSURERS AFFORDING COVERAGE NAIC # INSURED South Shore Gunite Pool & Spa, Inc INSURERA: Castle Insurance Company 7 Progress Avenue INSURERB. Safety Insurance 394S4 Chelmsford, MA 01824-3606 INSURERC: Scottsdale INSURERD: American Intl. Group ! INSURER E: C(1VFRAnrq THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDIN ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AIJD CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR kDD'L TYPE OF INSURANCE POLICYNUMBER POLICYEFFECTIVE POLICY EXPIRATION LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE FXJ OCCUR HGL0005807 04/01/2004 04/01/2005 EACH OCCURRENCE S 11000,000 DAMAGE TORENTED S 509000 MED EXP (Any one parson) S 5 r 000 PERSONAL & ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN.L AGGREGATE LIMIT APPLIES PER: POLICY EXI !EC LOC PRODUCTS • COMPIOP AGG S 11000,000 B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-0WNEDAUTOS 3138583-LARGE 2432681-LITE 04/01/2004 04/01/2004 04/01/2005 04/01/2005 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per parson) S X X BODILY INJURY (Per accident) S X PROPERTYDAMAGE accident) S rl(Par GARAGE LIABILITY ANY AUTO AUTO ONLY • EA ACCIDENT S OTHER THAN EAACC AUTO ONLY: AGG $ S C EXCESSIUMBRELLALIABILITY X OCCUR CLAIMS MADE RXDEDUCTIBLE RETENTION S 10,000 UMS0013356 04/01/2004 04/01/2005 EACHOCCURRENCE S 1,000 000 AGGREGATE S 1,000,000 S S S D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED7 II yes, describe under SPECIAL PROVISIONS below WC969-SS-94 04/01/2004 04/01/2005 X I WC STATU• OTM E.L. EACH ACCIDENT $ 110001000 E.L. DISEASE • EA EMPLOYEE S 10000,000 E.L. DISEASE• POLICY LIMIT S 1 DOO ODD OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROM IONS overing Installation of Swimming Pools and related operations of the insured during the policy period. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE JOHN F. REILLY EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 204 SOUTH STREET 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BASS RIVER BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY SOUTH YARMOUTH a MA OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE / Edwin Duvall HUSLO !('jrJ+.'. ACORD 25 (2001/08) GACORD CORPORATION 198E 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 Loq -v�fT� ST �' yj4e iT-f Work Address is to be disposed of at the following location: Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. ZI/ 0 gnature of Applicant Permit No. Date r C72- Board of Building Regulations and Standards i License or registration valid for iudlvidul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. if found return to: Board of Building Regulations and Standards Registration: 105485 One Ashburton Place Rm 1301 Expiration:-7/1712006 Boston, Ala, 02108 Type: Supplement Card SOUTH SHORE GUNITE POOL & S AkWKRD BENOIT'- 7 Progress Ave., Chelmsford, MA01824 Administrator No ralidwi outsig ere 1 r�. ins Taa»,.lnanu�a[�/6 a�✓IiasiadiuJeLld . 1 BOARD OF BUILDING REGULATIONS L p� `'a LICense: CQNSTRUCTION SUPERVISOR . Number:-lis., 056174 F Blrthdate-' 0311611 945 Frffires; 9,3/1W,0U1 Tr. no: g523A RestriFted• 00 1 RICHARD E BENOIT`, 54 CUSHING HILL RD 061 -J NQRWELL, MA Commissioner t AC-0-RI) CERTIFICATE OF LIABILITY INSUPANCE ____ 04/0�,'2001 UIIf.I R (6f)31g32-3 fi66 FAX (603)432-5076 THIS CERT'FIGATE IS ISSUED AS A MATTER OF INFORMATION Lakeside Insurance Agency, Inc. I ONLY ANC ;ONFERS NG RIGHTS UPON THE CERTIFICATE One Wall Street HOLDER. -I � IS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THt COVERAGE AFFORDED BY THE POLICIES BELOW. Windham, NH 03097 INSURERS AFFORDING COVERAGE NAIC # INSURED South Shore Gunite Pool & Spa, Inc INSURER A. Castle Insurance Company 7 Progress Avenue INSURERB. Safety Insurance 39454 Chelmsford, MA 01824-3606 INSURERC. Scottsdale INSURERD: American Intl. Group INSURER E: rnv=o Af]CG I 7HE POLICIES Of- INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTYJIT.,'-. i:.r;n •. .a.Y RLUU;REMENT. TERM OR CONDITION OF ANY CONTRACT Oil OTHER DOCUMENT WITH RESPECT 10 WHICH THIS CLRTIFICATE MAC UE eSba— ' MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS _ F 5�..• POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSN L knol TYPE OF INSURANCE POLICYNUMBER POLICYEFFECTIVE POLICY EXPIRATION LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE O OCCUR HGL0005807 04/01/2004 04/01/200S EACH OCCURRENCE S 1, 000, 00. ENTED DAMAGE TO RIF S SO,00( MED EXP (Any one person) S 5,00( PERSONAL & ADV INJURY S 1,000,00( GENERAL AGGREGATE $ 2,000,00( GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PECT LOC PRODUCTS - COMMOP AGG S 1,000,001 B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON OWNED AUTOS 3138583-LARGE 2432681-LITE 04/01/2004 04/01/2004 04/01/200S 04/01/2005 CO!JBINED SINGLE LIMIT (Ea acodenl) S 1, 000 , 00, BODILY INJURY (Per Person) S X X BODILY INJURY (Per ACWenl) $ X PROPERTY DAMAGE (Per ecadenl) S GARAGE LIABILITY ANY AUTO M AUTO ONLY - EA ACCIDENT S OTHER THAN EA ABC AUTO ONLY. AGG S S C EXCESSIUMBRELLA LIABILITY X OCCUR CLAIMS MADE DEDUCTIBLE X RETENTION S 10, 00C UMS0013356 04/01/2604 04/01/200S EACHOCCURRENCE S 1,000,00, AGGREGATE $ 1,000,00( S S S D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR.'PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N yes. desu be w 4er SPECIAL PROVISIONS below WC969-SS-94 04/01/2004 04/01/200S X we STATU- OR1- E.L. EACH ACCIDENT $ 1 , 000 , 00, E.L. DISEASE - EA EMPLOYEE S 1,000,00, E L. DISEASE - POLICY LIMIT S 1,000,00, OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS overing Installation of Swimming Pools and related operations of the insured during the policy period. JOHN F. REILLY 204 SOUTH STREET BASS RIVER SOUTH YARMOUTH, MA ACORD 25 0001 081 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT I BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE / Edwin Duvall/HUSLO `ACOINOCORPORA. ON 1 OF k •. TOWN OF YARMOUTH Building Department _ ..... _ ... , (508) 398-2231 ext.261 PERMIT NO : FB-05-1246 ISSUE DATE ;- 4/29/2005 _ ; PROPOSED USE BUILDING PERMIT 'anWarb ------------ APPLICANT ,Brian Warburton JOB WEATHER CARD PERMIT TO %looessory Structure; AT (LOCATION) ZONING DISTRI RS-4 Bldg. Type: Residential 100204SOUTH ST SUBDIVISION MAP LOT BLOCK 1034.304 BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R-4 LOT SIZE O CONTRACTOR 10 x 10 shed - subject to zoning bylaw setbacks REMARKS AREA (SO FT) EST COST ($ $5,900.00 PERMIT FEE ($) $20.00 OWNER lJohn Reilly Jr BUILDING DEPT BY ADDRESS 23 BAss River Pwky South Yarmouth I MA 102664 LICENSE 062056 Warburton, Brian 235 Great Western Road South Dennis MA 02660 5083981900 s�!` INSPECTION RECORD FIELD COPY Date _ Note PWgress - CorrectionNand Remarks Inspector t•og Yak SHEDS LESS THAN 150 SO. FT. SHALL r '�+ BE PLACED A MINIMUM OF 30 FEET o y FROM THE FRONT LOT LINE AND A MINIMUM OF 6 FEET FROM SIDES AND REAR LOT LINES. P C0NS7RUC`n0N ADDRFSS: ASS =R'S 114FORManoN: NAME CONTRACTOR: S40- 5 F ��,,pp NAME )dRaideolial BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yafmouth, MA 02664 (508) 398-2231 Ext. 261 PRESENT Hama Improvement Contractor 1.1c. N Caostruction swavrsar Ina / W Compensation h>staanoe: (Check MC) I am the homooww ❑ I am the sole proprietor ❑ I have Worker's Compensation hmaranoe bmanoe Company Name: Worker's Comp. Poficyl 011ie Uw 0* F Fee S permit wins 6 mouths Gorr j issue dabs. I 97R 5/&-3yt(/ iz M 02&bo Dry-W1Sin� 3gpT /?00 WORK TO BE PERFORMED 11 Teat (Fire Retardant Catlsate attached) Duratioa Wood Store shed 0 Siding: Y ofSgm= 0 Rcoaccenct windows: M 0 Replacement door.: r Co k S�1-✓d' / o' 1c ! D' S><f�.� 0 Re -roof x of Sgwre, () Stripping old W"ese () going over layers of existing roof *Us debris will be disposed of at: Location of Facility I declare under penalties of perjury that the statements herein contained am true and correct to tho bob of my laoowledge and belief. I understand that any Use answer(s) will be just cause for denial or revocation of my license anal for prosecution under M.G.L. C IL 269, SeWoo 1. Applic"'s Sigoature: Owners Signo (or anal) Dde: Approved B . Date: building Official (a designee) Zming Dishict:v historical District ❑ Yes � Flood Plain Z=c. )� Yes ❑ No Water Resoutst Protepon Distnc Within 100 R of Wdlmds: ❑ Yes ATo Yes ❑ No 3)01 • SHEDS LESS THAN 150 SO. FT. $HALL BE PLACED A MINIMUM OF 30 FEET " FROM THE FRONT LOT LINE AND A PLOT PLAN MINIMUM OF 6 FEET FROM SIDES AND REAR LOT LINES. FOR LOT # Indicate location Of garage or accessory building Additiom with dashed lines --------- ______ Kell sa dispol (cesspool) ��.T� i I(16t................ft. raw) I butbor's ame of # . this is a arner lot, rite in name street. SIDE YARD REAR YARD .....Z400 ft. I SIDE YARD I* (lot.. l3 y . ....... ft. frontage) (NAME OF STREET) I Supplied t,(,Y ✓�� Abt Nat Lot If cca wr nar a ott ,o str w V G C U i LL ( Ot Nell Plans Submitted Renovation ❑ Yes No APPLICATION FOR PERMIT TO DO GASFITTING Replacement ❑ (OFFICE USE ONLY) k4519 Date N Owner's l0'►t e illy a Type of Occupancy R a i �co Y W N tp o N U Z CC ¢ N Uj 3! N W W W O U m C o Q O N W Q OQC M p 0 p F- Z U my U) N M a rN Lu H. W = W W O Q Lu 4. O � W U Q W M p J1 O W Z J ZQQ Q W S W N D: O W U. �W�-- V J rA W czr Z a m m Q cc W > ¢ W 3 R Q g 0 0 W O W F=- x 0 a s U. n o c� 0 cc > a o. t- o SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR RD FLOOR F1 k 10(& (PRI OR TYPE Installing Company Name Sand lwLk 6-4S Address MA Business Telephone So 5- 3 0— i 8 l � Name of Licensed Plumber or Gasfitter Rm beot Check One: ❑ Corp. ❑ Partnership — X Firm/Company INSURANCE COVERAGE: Check One I have a current liability insurance policy or its substantial equivalent. Yes X No ❑ If you have checked yes, please indicate the type of coverage by checking the appropriate box. A liability insurance policy / . Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check One: Owner ❑ Agent ❑ Signature of Owner or 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. Signature of Licensed Plumber or Gasfitter e)�_q , 1 License Number TYPE LICENSE: Plumber ❑ Gasfitter ❑ Master journeyman 111 "k APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00 (PLEASE PRINT IN IA To the Inspector of Wir work described below. (OFFICE USE ONLY) By A C � Fee: $ 60"'07 l PERMIT NO. r� .05- FZ q- Date: R- /y-0s� gives notice of his or her intention to perform the electrical Location (Street & Number)Sn J 3 Owner or Tenant fia ti ti E t L 14 `T'tt Telephone No. So Owner's Is this permit in conjunction with a building permit? 0 Yes ❑ No (Check Appropriate Box) Purpose of Building Pool Utility Authorization No. Existing Service Amps / Volts Overhead[] Undgrd Q No. of Meters New Service Amps / Volts OverheadO Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed electrical Work: �6_ A 'b StgF` mnv o d Fixtures NQ. of No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Above n- SwimmingPool md. rnd. ❑ No. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. o tecuon an Initiating Devices No. of Ranges No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers cat mp Totals: um er — — ons — — — No. of Self -Contained Detection/Alerting Devices No. of Dishwashers No. Space/Area Heating KW Municipal Local ❑ Connection Other No. of D Dryers rY Heating Appliances KW g PP Security Systems: No. of Devices or Equipvalcnt No. of Water Heaters KW No. of No. of Signs Ballasts Data Winng: No. of Devices or Equivalent No. Hing: dromassa a Bathtubs y g No. of Motors Total HP Telecommunications Wir No. of Devices or uivalent Attach aaamonat aetait tJ aestrea, or as requirea ny ute inspector of wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND OTHER (Specify:) (Expiration Date) Estimated Value of lectri al Work:�da (When required by municipal policy.) Work to Start: / s O Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under th� pai s and penalties of perjury, that the informationyp this ap ication is true and complete. FIRM NAME: yt-', t_ L C LIC. NO. t Licensee: e—O Signature LIC. NO. (If applicable en r "e mpt" in he 1' ense & ber line.) Bus. Tel. No.: / Address Alt. Tel. No.: to OWNER'S INSURANCE A1VER: I am aware t the Licensee does not hake the liability insurance coverage normally equired by 1 w. my signature below, I hereby waive this rc ' en I am the (c one) owner owner's agent. g Own e e No. J-0Y Sign ure Telephon [Rev. 01/00] APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00 OF y (OFFICE U E ONLY) ° g Wu TOWN OF YARMOUTH Bye" a Fee: $ Z PERMIT NO.it (PLEASE PRINT IN INK OR TYPEALL INFORMATION) Date: MAY 0 2 2 To the Inspector of Wires: By this application the undersigned gives notice of his or her int lion to perform the elect cal work described below. Location (Street & Number 6 u Owner or Tenant Telephone No. Owner's Address Is this permit in conjunction with a building permitPrU Yes CINo (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No. of Meters Number of Feeders and Location and Nature of Proposed electrical Work: JA 1740-- htg Vs-t 2�A�) 9" r 1� L lec at r0 A A 1 ..iTL . r% r of Recessedr o ddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures At)ove n- swimming Pool md. md. Q No. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Bumers FIRE ALARMS No. of Zones No. of Switches No. of Gas Bumers 1To_._orl3Ftc`cuon an Initiating Devices No. of Ranges Total No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers Heat nip Totals: um er — — ons — — — No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Municipal Q Othe[ Local Connection No. of Dryers Heating Appliances KW SecuritNo. y of DSysetems: vices or Equipvalent No. of Water Heaters KW No. of No. of Signs Ballasts Data Wiring: No. of Devices or uivalent No. H dromassa a Bathtubs y g No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent Attach additional detail if desired, or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued 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. p� CHECK ONE: INSURANCE BONDQ OTHER (Specify:) / / C -.3'0 r (Expirauon Date) Estimated Value f EleWork: 6 Q (When required by municipal policy.) Work to Start: 2!;;penbalties — Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under a of perjury, that the information on this application is true and complete FIRM NAM v LIC. NO./7�¢Y Licensee: Signature LIC. NO. (If applicable, enter "exempts",inn�the license num er line.) Bus. Tel. No.: �7 Address:l26 �/,Q «-Tlr 0Iq?yC- Wt% %A 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 am the (check one) owner iJ owner's agent. Owner/Agent Signature Telephone No. [Rev. 04/00] . Commonwealth of Massachusetts """"' "" V'"' L Permit No. E Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS Rev. 11/99) Use blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be paf=wd is smwda.m with the Marsa4uxns Elatriot Code (MELD. Sz cl+ I2.00 (PLEASE PRINT IN INK OR77PEAU- INFORUA Date: S City or Town of: /�/lir7 t 'Z= _ To the Inspector JWires. By this application the tindersignV gives notice of his a her intention to perform the electrical work describ be ow.$15 let 345D, Location Street&Number) l Sae S� I 2005 D Owner or Tenant Telephone No. fn Owner's Address Is this permit In conjunction with a building permit? Yes No ❑ ' • (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing ServiceAmps I Volts overhead p :: Uadgrd ❑ No. of Meters New Service Amps . I Vohs Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampac)ty " Location and Nature of Proposed Electrical Work: Tb''L, No. of Recessed Futures No. of CeiL•Susp. (Paddle) Fags . 0. of otal Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators • KVA No. of Lighting Fixtures ove w(mming Poo d. ❑ d. • o mergency g ng Bette Units No. of Receptacle Oatictk. No. of Oil Burners FIRE ALARMS No. of Zones o. oDetection an No. of Switches No. of Gas Burners _ No. Devices No. of Ranges No, of Air Cond. ' Tuns No. of Alerting Devices No. of Waste Disposers Heat mP , u er Tons Totals o. o oats n Detection/Alertin Devices No. of Dishwashers Space/Area Hnting,lCVif Local Cl Local ❑Other No. of Dryer's ti Hean liaacesy Heating APp ecurity ystem No. of Devices or Equivalent o. of Water Heaters KW o. o o. Signs Ballasts Data Wiring• No. of Devices or uival<nt Telecommunications Wiring: No. Hydromassage Bathtubs No. of Motors Total HP No. of Devices or EqUiV21ent OTHER: _I.._1�Jl:.I...�I.i..nirrrA..I..ser.r.eewirrdbrrAelwmtctoro/F'ira. INSURANCE COVERAGE: Unless waived by the owns. no permit for the performaof electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" cb'nce vcrage or its substantial equivalenL The undersigned certifies that such coverage is in force, and her exhibited proof of same to the permit issuing Office - CHECK ONE: INSURANCE.El-fOND ❑ On ER ❑ (Specify:) (Exp uonDate) Estimated Value of Electrical WorkC (When required by municipal policy.) Work to Start: Inspections to be requested in aaordaiux with MEC Rule 10, and upon completion. I cerfijy, under the ins and penalties ojpe jury, that the inrjormnation o ap ication is true and eomple �� F1RAi NAME: t Licensee: Signature LIC. NO.: (t/aPPfica6le. o}ro "e;empt"rn a lint t Bus. TtL No.`C� Address: (0 ` 4- 0 Alt. Tel. ND•: 0\1tNER'S IIVSURAN ' WAIVER: 1 am a\\•ar that the license does not have a liability insurance cowpge normally required by law. By my signatpre below, I hereby waive this requi nt. � 1 am the (check one ❑ owner ❑ owner's agent. Owner/Agent Tcic shone No. PE fIIT FEE: S Signature • 'IZl'c•ril,f N i Commonwealth of Massachusetts Official Use only Permit No. Department of Fire Services r6 - 6-7 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS Rcv. 11/991 kart: blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachuseus Electrical Code (MEC) 527 CMR 12). (PLEASE PRINT IN INK OR TYPEALL INFORMATION) Date: oL :1 10� Cityor Town of: ! f e 2mev�►-1 To the Inspector of JVires: By this application the undersigns gives notice o his or her intention io perform the electrical work described below. Location (Street & Number) 264 Sou-" S-ra e T 7 Owner or Tenant nV eii Pont 13 u 1 aaft, , Telephone No. Owner's Address 1 o N O t1 TH Ma N =et rt.e�;s Is this permit in conjunction with a building permit? Yes [E' No ❑ (Check Appropriate Box) Purpose of Building ri 6 w Igo r e Utility Authorization No. 1 t! 1. —I A CJ15� Existing Service Amps / Volts Overhead ❑ Undgrd El No. of Meters New Service JA(�D Amps 120 / Volts Overhead ❑ Undgrd u No. of Meters Number of Feeders and Ampacity 4 - 4/0 2 - Vc:, Location and Nature of Proposed Electrical Work: , r . of rhn fnllrn mo inhle nrav he waived by the lnvnector of Wires. No. of Recessed Fixtures bpi No. of Ceil.-Sus Paddle Fans Z R( ) ota o. Transformers Transformers KVA No. of Lighting Outlets aaa No. of Hot Tubs ( Generators KVA No. of Lighting Fixtures A0 ve n- Swimming Pool rnd. El la ❑ o. o mergency ng Battery Units No. of Receptacle Outlets JOQ No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches I I $' No. of Gas Burners J o. o Detection an Inifiating Devices No. of Ranges I No. of Air Cond. „1 Tons 1 i No. of Alerting Devices No. of Waste Disposers P O Glt Pump Totals: umber ons o. o ontain ed Detection/AlertingDevices No. or Dishwashers Space/Area heating KW Local ❑ llumidl?-on El Other No. of Dryers ( Heatlng Appliance KW yConnecti NSee a ofntevices or Equivalent o. o a ter KW Heaters o 0 al o Signs Ballasts Data Wiring No. of Devices or Equivalent No. ll dromassa a Bathtubs y l; No. of Motors Total IIP Te eco . of Devatlons Wtnmg: No of Devices or E uivaient OTHER: INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of , dctrical work may i!suel unless the licensee provides proof of liability insurance including "completed operation" coverag its substantial equivalent1 The undersigned certifies that such cove is in farce, and has exhibited proof of same to the it issuing office. CHECK ONE: INSURANCE Q' BOND El OTHER El (Sped ��' FEB 0 3 2005 / 0 (Expiration DT ) Estimated Value of Electrical Work: 'a}O,OGO.Of� (When requiredbymunicipal cy. sui�..�:+GC�PT. n., Work to Start: Inspections to be requested in accordance with NEC kuie710, and upon completion. I caWy, under thepains and penalties ojpedury, that the information on this application is true and complete FIRM NAME: S-'r6 P t e40 iW &4SV" Etcg: t Lv - LIC. NO.:ArL*, zs, Licensee: S ,6PW6,,, Signature LIC. NO.: i2S-7L� (ljapplicable,ent€r,"aem t"inthellaensenumber line.) Bus. TeLNo.: r7-114 Address: t'•O � 123 SouTH�G►aNts M0 AIt.TeLNa: OWNER'S INSURANCE WAIVER I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM O.M.B. No.3067-0077 Expires December 31, 2005 ELEVATION CERTIFICATE Important Read the instructions on pages 1.7. SECTION A • PROPERTY OWNER INFORMATION Far Ysmiarhm-Cort4arhy lJse :: ° . ' BUILDING OWNER'S NAME t?bGcyNumber r'?: .; John F. Reilly, 'r. BUILDING STREET ADDRESS OndudkV Apt, tlnit, Suite, andlor Bldg. No.) OR P.O. ROUTE AND BOX NO. Company NAIC Number 204 South Street. Bass River CITY STATE ZI South Yartnarth MA PROPERPTION (Lot and I Numbers, Pane' Number, Legalal °es°ip°a'' etc) S E P 2 6 2005 Map 34 La W4 - BUILDING USE (e.g., Residential. Norwesidential. Addition, Accessory, etc. Use a Comuments area, t necessary.) Residential pw LATTTUDEILONGTTUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: LJGPi�Fy I ( #IF-##-##JW or ##A###) ❑ NAD 1927 ❑ NAD 1983 ❑ USGS Quad Map ❑ Other: SECTION B • FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Bt. WIP COMMUNITY NAAE & C014AAM NUMBER BZ COUNTY NME I B3 Yahmoulh-A,=15 Sarralahle massaduxb B1. MAPAND PANEL W. MM PANEL Sa akE FLOOD ELEVATIONS) Nl1AM BS.Sl1FFK B&FIRMNDDCMTE EfFECTIV EVISEDMTE B& FLOOD ZOW4S) RaieAO,usedeghdloodr9) 000G D 50977 70992 All 110 B10. Indicate the sauce of the Base Flood Elevation (mil data or base Food depth an fin B9. ❑ FIS Profile " ® FIRM ❑ Cammunily Determined ❑ Other (Describe): — B11. Indicate the elevation datum used for the BFE In M. ® NGVD 1929 ❑ NAVD 1988 ❑ Other ('Desanbe):— B121s the building located in a Coastal Barrie Rensces System (CBRS) area or Otherwise Rdeded Area (OPA)? []Yes ®No DesignationDate_ SECTION C • BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Bunking devatierns are based on: ❑ Construction Drawings' ❑ Bunking Undo Construction• ® Fnis W Castructim •A new Elevation Certificate a be neWred when construction of the bnldrg is compete. C2 6uldi g Diagam Number 8 (Select the buldi g dagam most similar b the bunking for which Cris mrtificate is baM completed -see pages 6 and 7.1 no dagram accurately represents the bukkU povidc a sketch or photograph) C3. Elea s-Zones AIA30, AE, AK A (with BFE), VE, V1430, V (with BFE), AR ARIA, ARIAE, ARIAt-A'i0, ARIAH, ARIAO Wrplde hers C3.ai below according fo Cue buking dagran spedfied'n Item C2 State the dahm used. t the dabrn is Wererd tan to daturn used for the BFE h Section B, convert the daturn to that used for the BFE Shaw field measurements and datum oamve ston calculation. Use the space podded or the Comments area d Section D or Section G, as appropriate, io document the datum conversion. Daum NGVD Cahversi iCarrmds Elevation rdere ce mark used RM 26 Does the elevation reference mak used appear on the FIRM'? ® Yes ❑ No o a)Tapdboft=door(tdudugbasemodaaidosure) 9. 6tt(m) o b) Top of nerd higher 5= 13. 4 fL(m) o c) Bottom d bvnesl hortzmtal stnrchral member (V zones only) _. —IL(m) o d) Atadwd garage (top dslab) 12 S R(m) o e) LaAest devatierm of machinery adlor eW ent servicing the building (Describe In a Comments area) 13.4 fL(m) o f) Worst a4ace nt ftishg grade (LAG) -8.0 4m) o g) Highestadlacent (kd)4 Wade PG) -12 Oft (m) o h) No. of permanent openings (food vets) within 1 IL above 4acent grade 13 o ) Total area of all p rmara t opwi gs (flood vents) in C3h 1 8�72 s4 R (s4 an) 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 infor nation in Sections A, B, and C on this ceitificate represents my best efforts to interpret the data available. I understand that anv false statement maybe punishable by fine or imprisonment under 18 U.S. Code, Section 1001. TITLE Civi Ergineer COMPANY NAME Baer Nye Engineering & Suveyirg OF 30210 ADDRESS CITY STATE ZIPCODE 812 Man Street Osterville MA 02655 / �� S/LZ/cS (508)428-9131,«L13 FEMA Form 81.41. January 2003 See reverse side for continuation. Replaces all previous editions IMPORTANT: In these spaces, copy the corresponding information from Section A Far ihsufarioeCmpairy tls� BULDINGSTREETADDRFMPIdr9Apt, Uill,&knVarBI4No.)ORPOLROUiEANDBOX NO. F�ofgNurbPr 204 South Street Bass River << CITY STATE ZIP CODE OarparyPWlCtJurba y ;C SaAhYarr oulh MA 02664 SECTION D -SURVEYOR ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy boa, sides of this Elevation Certificate for (1) comrrnnty dkial, (2) insurance may, a d A building owner. _•.,[�T'W, ,i� ❑ Check here if attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A WTHOUi BFE) Far Zorre AO and Zane A (mftL t BFE), coaVW Items Et bur* E4. Ito Elevation Cerlikate is intended for use as supporting irdounabon fora LOMA or LOMRf, Section C mist be completed. El. Building Diagram Nkunber_(Select the building dagram most similar b to buildrg for which fis certificate is being ampleted -see pages 6 and 7. t no diagram accurately represents the nuking, povide a sketch or photograph) E2. The by d the bW= f oor(rdudng basernea orendoskm) d the burldvg is _tL(m) _h(cm) ❑ above a ❑ bdow (check one) the highest adac nt grade. Pse natural grade, I available). E3. For Building Qagrarm 68 with openings (see page 7). the nod higher four or elevated four (elevation b) d the buildrg is _ i(m) _in(an) above the highest a4amt grade. Carplete hers C3h and C31 on front of form E4. The by d the plabrn d nnadhinay ar d or egrprne nt servicing the bunking is _t(m) _ m(an) ❑ above or ❑ below (dock are) the West atiacera gmcle. 0w natural grade, d available). ES. For Zone AO arty. t no food depth nrrnber is aralade, is the top d the botorn Poor elevated in accordance with the mraru* js foodpW maha er nohl ordinance? ❑ Yes ❑ No ❑ lJnluam The local oKioal mist certify this rfamation in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The poperty owners owner's authorized representative who completes Sec5os A, B, C (horns C3h and pi army), and E forZo neA (without a FBAA- rred or oamxrity- issuedBFE)orZcmAOnrstslgnhem BestaM&&inSectorsAAQandEarearrWleftbestdmylmowladga PROPERTY OWNERS OR OWNERS AUTHORIZED REPRESENTATIVES NAME Stephen A Wilson, P.E. - Bader Nye En4neerrg & Surveyig ADDRESS CITY STATE ZIPCODE ❑ Check here dattadments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local dfidal who Is authaized by lacy or ordnance b adr ninister the cmTmriHs foodplain marhager naht olinance can amptete Sections A, B, C (a 4 and G of fis Elevation CertificaPe. Canplele the appiable lern(s) and sign belay. G1. ❑ The information in Section C was tam Iran otherdoamentatim that has been signed and ernbossed by a licensed surveyor, engineer, or acilecwho is aufraized by state or local law b m* elevation kbrnatiorn. (Indcale the source and date of the devabo n data in the Comr ab area below.) GZ ❑ A arrm * dfcal completed Section E for a b.MM located in Zane A (without a FEMAmissued orcorrrnultyissued BFE) or Zoe AO. G3 ❑ The blowing ikmkiim (Items G40) is provided for m n u4 foalplain management purPosm G4.PERMITNUMER I G5. DATE PFRMTi4SUED I GG DATE CERTIFICATE0FC0AFlIANCFiOCC FANCYISS" G7. This permit has been issued tor: ❑ New CastnW ❑ Siitistantial npkover nest G&Elevation dasbultlowest floor (ndudrgbasernent)oftobuildrgis. _._ rn) Datim_ Gg. BFE or(nZone AO) depth dflooding atthe buldngsite is: _._fl(m) Dahm_ LOCAL OFFICIAL'S NAME TTTIE COMMUNITY NAME TELEPHONE SIGNATURE KV-000MIJUE ❑ Check here I afactnents FEMA Form 81-31, January 2003 Replaces all previous editions OF P TOWN OF YARMOUTH Building Department Town Hall `." Yarmouth, MA 02664 (508) 398-2231 ext.261 BUILDING PERMIT TRANSMITTAL Temp Permit No.: T-05-472 Applicant Name: Richard Benoit Applicant Phone: Building Location: Owner's Name: Owner's Addres 5089620007 00204 SOUTH ST John Reilly Jr. 226 Andover Street Lowell MA 01850 Owner's Telephone: (508) 760-3220 REVIEWED BY: 1. WATER DEPARTMENT: 2. ENGINEERING DEPARTMENT: 4. HEALTH DEPARTMENT: 5. BUILDING DEPARTMENT: 6. FIRE DEPARTMENT: COMMENTS: RECEIPT OF COPY: (OFFICE USE ONLY Recorded By: Ic Permit Fee: $65.00 Deposit Rec: $65.00 Payment Type: Check ChkNo.: 1906 Net Owed: $0.00 Application Date: 3/14/2005 Issue Date: Expiration Date PLEASE NOTE SIGNATURE OF APPLICANT: Comments: Map/Lot: 034.304- install inground pool DATE: N/A: DATE: N/A: DATE: O-S`N/A: DATE: N/A: DATE: N/A: DATE: N/A: DATE: Date Printed: 3/17/2005 of .� TOWN OF YARMOUTH Building Department Town Hall Yarmouth, MA 02664 (508) 398.2231 ext261 BUILDING PERMIT TRANSMITTAL Temp Permit No.: T-05-472 Applicant Name: Richard Benoit Applicant Phone: 5089620007 Building Location: 00204 SOUTH ST Owner's Name: John Reilly Jr. Owner's Addres 226 Andover Street Lowell MA 01850 Owner's Telephone: (508) 760-3220 REVIEWED BY: 1. WATER DEPARTMENT: (OFFICE USE ONLY Recorded By: Ic Permit Fee: $65.00 Deposit Rec: $65.00 Payment Type: Check ChkNo.: 1906 Net Owed: $0.00 Application Date: 3/14/2005 Issue Date: Expiration Date Comments: install inground pool DATE: �[20 MAR 1 9 2005 N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT: DATE: 5. BUILDING DEPARTMENT: V 6C Z DATE: N/A: 6. FIRE DEPARTMENT: COMMENTS: RECEIPT OF COPY: PLEASE NOTE SIGNATURE OF APPLICANT: DATE: N/A: DATE: 034.304 Date Printed: 3/17/2005 Ifl TOWN OF YARMOUTH Building Department Town Hall Yarmouth, MA 02664 (508) 398-2231 ext261 BUILDING PERMIT TRANSMITTAL Temp Permit No.: T-05-472 Applicant Name: Richard Benoit Applicant Phone: 5089620007 Building Location: 00204 SOUTH ST Owner's Name: John Reilly Jr. Owner's Addres 226 Andover Street Lowell MA 01850 Owner's Telephone: (508) 760-3220 (OFFICE USE ONLY Recorded By: Ic Permit Fee: $65.00 Deposit Roo: $65.00 Payment Type: Check ChkNo.: 1906 Net Owed: $0.00 Application Date: 3/14/2005 Issue Date: Expiration Date Comments: Map/Lot: 034.304 install inground pool ZONING APPROVED7,V -2�,�� REVIEWED BY: 1. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: ✓3. CONSERVATION: DATE: N/A: ��iEALTH DEPARTMENT: DATE: N/A: V 55.. BUILDING DEPARTMENT: DATE: N/A: 6. FIRE DEPARTMENT: DATE: N/A: COMMENTS: RECEIPT OF COPY: PLEASE NOTE SIGNATURE OF APPLICANT: DATE: Date Printed: 3/17/2005 01/10/2005 10:18 5083856383 PKM CONTRACTORS INC PAGE 02 I I.7 hi Z P.K.M. ao� so��, st ��,., ;W-� : ,-1 CONTRACTORS, INC. 313 Hokum Rock Road • P.O. Box 775 • East Dennis, MA 0264 Phone (508) 385-5993 - Fax (508) 385-638 RS 53 V ,_. ----------� S777 v 01 1'�v�lcu 1 ' s/ W" b j Qua % a 37to.6 J'/A P)Asf`c. W, Scbi 400 1-0Ny,",L.ap 4�p. 1 J //1 Au vs.lrt . 1116 Temp Permit No.: Applicant Name: Applicant Phone: Building Location Owner's Name: Owner's Addres TOWN OF YARMOUTH Building Department Town Hall Yarmouth, MA 02664 (508) 398-2231 ext.261 BUILDING PERMIT TRANSMITTAL T-05-472 Richard Benoit 5089620007 00204 SOUTH ST John Reilly Jr. 226 Andover Street (OFFICE USE ONLY Recorded By: Ic Permit Fee: $65.00 Deposit Rec: $65.00 Payment Type: Check ChkNo.: 1906 Net Owed: $0.00 Application Date: 3/14/2005 Issue Date: Expiration Date Comments: Map/Lot: 034.304 install inground pool Lowell MA 01850 Owner's Telephone: (508) 760-3220 ' REVIEWED BY: S 1. WATER DEPARTMENT: ' DATE: a N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT: DATE: N/A: 5. BUILDING DEPARTMENT: DATE: N/A: 6. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE COMMENTS: RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: Date Printed: 3/17/2005 SERVING CAPE COD SINCE 1956 COMMERCIAL AND RESIDENTIAL CONSTRUCTION 20 NORTH MAIN STREET • SOUTH YARMOUTH • MA 02664 PHONE 508-398-2293 • FAX 508-394-p765' July 6, 2005 JUL � 2005 MEMORANDUM To: Town Of Yarmouth Building Department Mr. James Brandolini From: David Sauro (0 Re: 204 South Street, South Yarmouth As a follow-up to our telephone conversation on June 29, 2005; the Davenport Building Company has installed a French drain alongside the lot line of Mr. Henry Gill. The drain is approximately fifty feet long, one foot wide, and two feet deep. In has a four -inch drainpipe, which connects into a 600-gallon drywell. Mr. Gill has seen this French drain and has stated to our workers that he approved of it. If you have any questions feel free to contact me at 508-398-2293. MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) Mass. Date Ag aC//X>J� City, Town Permit # '� Ob Building Owne 's o VAT: Locationa04 50Ut7i Sr- Name_4y�pioviz /2.vay Y1GrCrd Type of Occupancy:G'(�GLLI/U� New LLI Renovation ❑ Replacement ❑ submitted Yes ❑ No ❑ (Print or Type) ,. J Company t• F- �11NSLOW �l 414019[r+ Check One: Certificate Installing Com an Name p 9 Corp. OA-2-846113 Address S 1ZE A4ZDonJ C()`C.(Z []Partnership Sp- Y"- M 0 UT* )i- 62.6 6 Ll ❑ Firm/Company Business Telephon $0039 4-7 7'78 Name of Licensed Plumber or Gasfitter F- F- WINSLow --1jr— r 1 hcreby certify that all of the details and Information I have submitted (or entered) In above application ara true and accurate to tho'kest of my knowladp and that all plumblat work and Installations performed under termil Issued for this appllation will be In rompllana with eminent pcovWons of the ►LsarAusetts Stab Gas lode and mapler 142 of the General Laws. By TYPE LICENSE: Plumber Title Gasfitter Signature of Licensed City/Town: 9 Master Plumber or Gasfitter APPROVED (OFFICE USE ONLY) Journeyman License�Number FINAL INSPECTION BELOW FOR OFFICE USE ONLY SKETCHES PROGRESS INSPECTION FEE NO. APPLICATION FOR PERMIT TO DO GASFITTING NAME i TYPE OF BUILDING �.►7��!yP � �GG�uy LOCATION OF BUILDING ��! l=r K ST 50C.c� PLUMBER OR GASFITTER Llo. NO. M PrsTE rt b c . 1939 PERMIT GRANTED DATE GAS INSPECTOR 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 AUGE�,, 0 3//__2005 Eiui�cAaPT. , -p (OFFICE USE ONLY) ByG . Fee: $501 0 n V4 oa 1-79 b q PERMIT NO. C% - o6 - 0119 A (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location I Owner or Owner's Is this permit in conjunct' t with a building ermit? Yes QNo (Check Appropriate Box) Purpose of Building > O U S •, Utility Authorization No. Existing Service Amps / Volts Overhead[] Undgrd ❑ No. of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No. of Meters o Recessed 'x u f I No. of Total Transformers KVA No. of Li0ting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Above n- SwimmingPool rnd. ❑ md. ❑ o. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Bumers o. ot Detection an Initiating Devices No. of Ranges No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: um r — — ons — — — No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Municipal Other Local ❑ Connection No. of Dryers Heating Appliances KW iysems: SecuNro.ty of SDetc ces or Equilivalent No. of Water Heaters KW No. of No. of Signs Ballasts Data Witing: No. of Devices or uivalent No. Hing: dromassa a Bathtubs y ]; No, of Motors Total HP Telecommunications Wir No. of Devices or uivalent Go Attach additional detail if desired, or as required by the Inspector of Wires. 000 INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued 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 tot rmit issuing office. CHECK ONE: INSURANCE gr BOND ❑ OTHER[] (Specify:) (Expiration Date) Estimated Value of 1 ct 'cal W,�Fk: ��a (When required by municipal policy.) I� Work to Start: 6 S Inspections to be requested in accordance with MEC Rule 10, and upon completion. ��1 certify, under the Ins and pe hies of pequry, that the information on this application is true and complete } FIRM NAME• LIC. NO. APJ E ,.Licensee: Signature LIC. NO. (If applicabl ,enter "exem t" in the license number line.) Bus. Tel. No.: Address: _ M /, i �-( W • Y Awm 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 am the (check one) owner owner's agent. Q Owner/Agent Signature Telephone No. [Rev. 04/00] Foundation Certification in Yarmouth MA Prepared For: John F. Reilly, Jr. Assessor's Map: 34 Lot: 304 Baxter, Nye & Holmgren, Inc. Community Panel Number 250015 0006 0 (Rev. July 2, 1992) Registered Professional F.I.R.M. Map Zones: A13 (EL 13.0'), A11 (EL 11.0) Engineers and Land Surveyors Plan Reference: Land Court Plan 9190 E 812 Main St. Osterville, MA 02655 Certificate of Title: 174,022 Phone — (508) 428-9131 Fox — (508)-428-3750 Owner. John F. Reilly, Jr. Job Number. 2004-084 Scale : 1 = 40' Date : 01-14-2005 D.E.P. FILE No. SE 83-1697 *SEVEN MONUMENTS OF RECORD (SHOWN ON L.C. PLAN 9190 G, PLAN BOOK 169 PAGE 27, PLAN BOOK 123 PAGE 103, & PLAN BOOK 91 PAGE 129 SHEETS 2 & 3 OF 3 ) WERE LOCATED BY SURVEY THAT ARE NOT SHOWN ON THIS PLAN. THEY WERE FOUND TO BE IN A SATISFACTORY MATHEMATICAL RELATIONSHIP AND WERE USED TO DETERMINE THE LOCATION THE XISTIN FOUNDATION AN SITEFEA R OWN N THI P N `A"° COURT PLAN 9190BASS (TIDAL) RIVER �e 11- E COPY E EBB 1 190'f MH i TOP OF STONE REVETMENT Z � G SILT EXISTING SILT FFJ��E�••—..—..—..�'..E?�STiNtop FENCE EXI\ F, 4X LQC�NG N AnON a. F, % 91 14,05 \ 27.7 LOT 6 0 32 �' N/F HENRY C. GILL L.C. PLAN 9190 G 0 N/F CHARLES WHITE MANAGEMENT, INC TBM: CB DH FND (HELD) LOT 2 EL. - 8.26' „ L.C. PLAN 9190 E PARCEL AREA TO OBSERVED HIGH WATER o^, 46,905t SQ. FT. 1.08f ACRES a ci N 07'53'55' W 0 175.95' O P- w N 05'36'50' w CL I 134.20' E� W 41 LOT 5 L.C. PLAN 9190 G I -� N/F CHARLES WHITE MANAGEMENT, INC ; 'C-4 I N c� CL 0 az �,g zy � � N �— AS uJ L.C. PLAN 9190 E 4+ y N/F LAURENCE P. & SALLY P. BENEDICT I ` ( 1 SON,0 in I CERTIFY THAT TO THE BEST OF MY KNOWLEDGE THE EXISTING FOUNDATION SHOWN HEREON IS IN COMPLIANCE WITH THE APPLICABLE YARMOUTH ZONING DISTRICT SIDELINE AND SETBACK REQUIREMENTS, IS LOCATED IN RELATION TO THE MONUMENTS SHOWN AND IS LOCATED WITHIN A SPECIAL FLOOD HAZARD AREA. �� ' ,IOHN ,F THIS PLAN IS NOT TO BE RECORDED NOR IS IT TO BE USED TO ESTABLISH PROPERTY LINES. EL M 74 l — 14 - 05' Cu1Ea 41 REGI ED PR�ESSIONAL LAND SURVEYOR - BAXM, M & HOLMGREN, INC. DATE of r TOWN OF YARMOUTH Building Department g lJ I L D I N G - - - - - _ - (508) 398-2231 ext.261 11 PERMIT NO FB-05-1089 •• ISSUE DATE ;- 3/25/2005 PROPOSED USE ' P E R M If .: . _ _ _ _ _ _ _ APPLICANT David Sauro .Sau ............ -------------------- JOB WEATHER CARD PERMIT TO Accessory Structure AT (LOCATION) 100204SOUTH ST ZONING DISTRIC RS-4 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 034.304 BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R 4 LOT SIZE construct 15 x 9'10' pool house with bathroom as per plans dated 03117/05. REMARKS AREA (SO FT) EST COST ($ $30,000.00 PERMIT FEE ($) OWNER lJohn Reilly Jr BUILDING DEPT BY ADDRESS POB 1865 Lowell 7771 MA 101853 CONTRACTOR LICENSE 072866 Sauro, David 20 North Main Street South Yarmouth MA 02664 5083982293 INSPECTION RECORD FIELD COPY Date Note Progress - Corrections and Remarks Insoector r of'YAR,� ONE & TWO FAMILY ONLY - BUILDING PERMIT APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING p y Town of Yarmouth Building Department J „..,,,C„. r 1146 Route 28 - Yarmouth, MA 02664r4492 Tel: (508) 398-2231 x261 • Fax: (508) 398-0836 Office Us my Planning Board Information Assessors Department Information: fit! Permit No. S- I h�6fr-.e rpe my Lot /- �En orsement Date ��. Permit Fee $,5V -Recording Date New Deposit Rec'd. $ bo / Dat bn No 1.4 Property Dimensions: Net Due $ Other Lot Area (sf) Frontage (ft) Lot Coverage This Section for Office Use Only Building Permit Number. Date Issued: 7 - d Signature: Building OK Date Certificate of Occupan 11 Is Is not required Section 1 - Site Information ff Use Group: R-4 Type: 5-B 1.1 Property Address: 1.2 Zoning Information: �Od � 00P5- Lid / /& N Zoning District Proposed Use �V c5'a� <S� 1.3 Building Setbacks (it) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 30 S /Op /O /! 02 G 1.4 Water Supply (1r60.t- c. 40. S 54) Public Private 1.5 Flood Zone formation: Comments: Zone. BFE: Section 2 - Property Ownership/Authodzed Agent 2.1 Owner of Record: /c=)O Sox �?b &f . -ee /'GL VTom_ _--- - -__241 1,L vi,Vs3 Na rint) 4'r) Mailing Address lureV 1' + R 0 ! 2uuJ Telephone 2.2 Authorized Agent: I 1 L �= ignatu a Telephone Mailing Address Fax Section 3 - Construction Services 3. icensed Construction Supervisor. A tr� A v er3 Not Applicable ❑ License Number �S O 7b1 &'� ry A ess - ll P , 3 Expiration Date Signature Telephone 3.2 Registered Home Im rovement Contractor: Company Name Not Applicable ❑ Number AddressLicense Signature Telephone Expiration Date Iof2 OVER Cartinn A. Wnrkarc' Cmmnansation 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 No. of Bedrooms No. of Bathrooms —� Existing Bldg. ❑ Repalr(s) ❑ Alterations ❑ I Addition ❑ Accessory Bldg. E(Type Demolition Other Specify: ooe //-d Cl-%e Brief Description of Proposed Work: ooG �s Ile Lv i yG, o P !3A" ��i �o.a '09LS O•c 2 za7- n--- ,QvC--5.eTre- 4%-7eo Section 6 - Estimated Construction Costs Item Estimated Cost (Dollars) to be Check Below completed by permit applicant 1. Building O d0 O Conservation -Commission Filing 2. Electrical / oOG (if applicable) 3. Plumbing / Gas (o G v O 4. Mechanical (HVAC) cQ" 00 O ❑ Old Kings Highway & Historical 5. Fire Protection /i D C✓ 0 N/9 Commission approval 6. Total = (1 + 2 + 3 + 4 + 5) C-5,01 O OJ O (if applicable) 7. Total Square Ft. (new houses & additions) t Section 7a - Owner Authorization - To be Completed When Owner's Agent or Contractor Applies for Building Permit 1, �,— . /Fe' i u �/ , as owner of the subject property hereby authorize �iM G� ��`� to act on my behalf, in afters relative to work authorized by this building permit application. Svw6re of Owner Date Section 7b - Owner/Authorized Agent Declaration 1, / he M 4S as Own uthorized 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. 7'�0 •�-t-� G2e �.. Print name Owner ent Date r nature eof 9-15-99 2 of 2 TOWN OF YARMOUTH BUILDING DEPARTMENT U41:--.tz4 CONSTRUCTION SUPERVISOR FORM PLEASE PRINT. job Location: 090 ��'� �S7'c' �4SS .Qi Le—.? Number reet Village Owner of Property: sa Construction Supervisor: AVI �v'QG &5 o2?& 6 39Sr - ne Name License No. Phone No. Address: 020 O�t 7�'� 4/-c, S7C. -S'0 ' Yam. / w7 b u „? 6 6. V Licensed Designee: (If other than Supervisor) Name 2.15 Responsibility of each license holder: License No. 2.15.1 The license holder shall be fully and completely responsible for all work for which lie is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building and structures only pursuant to the state building code and all other applicable laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Any licensee who shall willfullyviolate subsections 2.15.1, 2.15.2 or 2.15.3 or any other section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes No ❑ If you have checked yam, please indi t the type coverage by checking the appropriate box. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by T 152 of th Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: gnature of otiner or Owner's Agent Owner ❑ Agent Building Official Approval: The Commonwealth ojMassaehuseas Department of Industrial Accidents OIDce a/lirest/ostleis 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Applicant inf rmatione PltatcPRIlV'1`ie�4bin L name*�l/�/�. �Pi`�y/ 17i�• S7" . cSG - Z!ijelyl ely% /19b� cit.,Ahone # O 1 am a homeowner performing all work myself. I am a sole proprietor _nd have no one norking in any capacity 01Tam an employckpro%iding workers' compensation for my employees working on this job. V 4-41 0 a " f &a 11 C-e/; address: .4o_ /(JS/- city: -50 • phone #',6-0 8nsurance co,! � e policy is Ale P/ OC9 516F (C7 _ I am a sole proprietor. _eneraI contractor. or homeowner (circle one) and have hired the contractors listed below who ha%e the following workers' compensation polices: Failure to secure coverage as required under Section 25A of MGL 152 can lead to tfe impaaidoe of erimlW penalties of a flat ■p to 314MAO mad/or one years' Imprisonment as welt as civil penalties in the form of a STOP WORK ORDER and a flat of S100.00 a day against me. 1 understand tbat a copy of this statement may be forwarded to the Office of Investigations of the DU for coverage veriflcadoe. t do hereby c ijy under the pains an its of perjury that the information provided above is out and eorrtct Signatur ate Print name s`� i/` S-s v'E' 0 Phonc1--1C10"-32`It-cP`-'-q2 official use only do not %rite in this area to be completed by city or town oflleial city or town: YARHOUTQ (] check if Immediate response is required permitAicense 0 nBuiidiog Department plJcensiog board 261 Oselectmen's OMce pNealtb Department contact person: phone #: _ % — 398--22 J ext. nOther Ue.ned 3.0{ PJAl Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any contract of hire. express or implied. oral or written. An employer is defined as an indis idual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise. and including the legal representatives of a deceased employer, or the receiver or trustee of an individual , partnership, association or other legal entity, employing employees. However the o%%ner of a d«elling house having not more than three apartments and who resides therein. or the occupant of the d%%ellina 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 emplo%er. MG1. chapter 1: _ 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 vidence of compliance with the insurance coverage required. applicant who has not produced acceptable e Additionall%. neither the commom%ealtli nor any of its political subdivisions shall enter into any contract for the performance of public %%ork until acceptable evidence of compliance with the insurance requirements of this chapter ha%e been presented to the contracting authorit%. Applicants Please till in the workers' compensation affidavit completely. by checking the box that applies to your situation and suppling 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 affida% it 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 %%orkers' compensation police. please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address, telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Mice el lmstleadels 600 Washington Street Boston, Ma. 02111 fax fl: (617) 727-7749 phone #: (617) 7274900 ext. 406, 409 or 375 BUILDING TOWN OF Y A R M O U T H ELECTRICAL GAS 1146ROUTE28 SOUTHYARMOUTH MASSACHUSETFS02664-4451 PLUMBING Telephone (508) 398.2231, Ext. 261 — Fax (508) 398.2365 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��`� Work Address is to be disposed of at the following location:i�0��, Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Signature of Applicant Date Permit No. OF TOWN OF YARMOUTH d� Building Department -� Town Hall ." Yarmouth, MA 02664 (508) 398-2231 ext.261 BUILDING PERMIT TRANSMITTAL Temp Permit No.: T-05-453 Applicant Name: David Sauro Applicant Phone: 5083982293 Building Location: 00204 SOUTH ST Owner's Name: John Reilly Jr Owner's Addres POB 1865 Lowell MA 01853 Owner's Telephone: (978) 453-4161 ' REVIEWED BY: 1. WATER DEPARTMENT: 2. ENGINEERING DEPARTMENT: 3. CONSERVATION: 4/F-IEALTH DEPARTMENT: 5. BUILDING DEPARTMENT: 6. FIRE DEPARTMENT: COMMENTS: (OFFICE USE ONLY Recorded By: IC Permit Fee: $0.00 Deposit Rec: $50.00 Payment Type: Check ChkNo.: 3510 Net Owed: ($50.00) Application Date: 3/8/2005 Issue Date: Expiration Date PLEASE NOTE RECEIPT OF COPY: SIGNATURE OF Comments: Map/Lot: 034.304 construct 15 x 910* pool house with bathroom ZONING APPROVED DATE: DATE: DATE: DATE: DATE: DATE: N/A: N/A: N/A: N/A: N/A: N/A: Date Printed: 3/9/2005 Of 1,TOWN OF YARMOUTH Building Department Town Hall " Yarmouth. MA 02664 (508) 398-2231 ext.261 LHEALTH BUILDING PERMITRANSMITTAL Temp Permit No.: T-05-453 Applicant Name: David Sauro Applicant Phone: 5083982293 Building Location: 00204 SOUTH ST Owner's Name: John Reilly Jr Owner's Addres POB 1865 Lowell MA 01853 Owner's Telephone: (978) 453-4161 REVIEWED BY: 1. WATER DEPARTMENT: 2. ENGINEERING DEPARTMENT: 3. CONSERVATION: 4. HEALTH DEPARTMENT: 5. BUILDING DEPARTMENT: 6. FIRE DEPARTMENT: COMMENTS: RECEIPT OF COPY: (OFFICE USE ONLY Recorded By: IC Permit Fee: $0.00 ,Ipsit Rec: $50.00 Pent Type: Check ChkNo.: 3510 wed: ($50.00) Llation Date: 3/8/2005 Issue Date: Expiration Date comments: Map/Lot: UJ4.JU4 construct 15 x 910" pool house with bathroom DATE: N/A: DATE: N/A: DATE: N/A: DATE: a N/A: DATE: N/A: DATE: N/A: PLEASE NOTE c,�j l ` jj5-c SIGNATURE OF DATE: Date Printed: 3/9/2005 OF�� TOWN OF YARMOUTH Building Department s = Town Hall Yarmouth, MA 02664 (508) 398-2231 ext.261 BUILDING PERMIT TRANSMITTAL Temp Permit No.: T-05-453 Applicant Name: David Sauro Applicant Phone: 5083982293 Building Location: 00204 SOUTH ST Owner's Name: John Reilly Jr Owner's Addres POB 1865 Lowell MA 01853 ' Owner's Telephone: (978) 453-4161 (OFFICE USE ONLY Recorded By. Ic Permit Fee: $0.00 Deposit Rec: $50.00 Payment Type: Check ChkNo.: 3510 Net Owed: ($50.00) Application Date: 3/8/2005 Issue Date: Expiration Date Comments: Map/Lot: 034.304 construct 15 x 9'10' pool house with bathroom REVIEWED BY: 1. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: CONSERVATION-..,,,�1�� GIL DATE: '� ^ f0 �� "N/A: 4. HEALTH DEPARTMENT: DATE: N/A: 5. BUILDING DEPARTMENT: DATE: N/A: 6. FIRE DEPARTMENT: DATE: N/A: COMMENTS: RECEIPT OF COPY: PLEASE NOTE SIGNATURE OF APPLICANT: DATE: Date Printed: 3/9/2005 Temp Permit No.: Applicant Name: Applicant Phone: Building Location: Owner's Name: Owner's Addres TOWN OF YARMOUTH Building Department Town Hall Yarmouth, MA 02664 (508) 398-2231 94261 BUILDING PERMIT hIll JAZIF-VIIkiCAI T-05-453 David Sauro 5083982293 00204 SOUTH ST John Reilly Jr POB 1865 Lowell MA 01853 Owner's Telephone: (978) 453-4161 REVIEWED BY: �154 1. WATER DEPARTMENT: ?� 2. ENGINEERING DEPARTMENT: 3. CONSERVATION: 4. HEALTH DEPARTMENT: 5. BUILDING DEPARTMENT: 6. FIRE DEPARTMENT: COMMENTS: RECEIPT OF COPY: (OFFICE USE ONLY Recorded By. Ic Permit Fee: $0.00 Deposit Rec: $50.00 Payment Type: Check ChkNo.: 3510 Net Owed: ($50.00) Application Date: 3/8/2005 Issue Date: Expiration Date PLEASE NOTE SIGNATURE OF APPLICANT: Comments: Map/Lot: 034.304 construct 15 x 910" pool house with bathroom DATE: 3 / pr N/A: DATE: N/A: DATE: N/A: DATE: N/A: DATE: N/A: DATE: N/A: DATE: Date Printed: 3/9/2005 MICHELE C, TUDOR, P.E. Consulting Structural Engineers 123 Cottonwood Lane • Cenlerdle, Mo=xhusetts 02632-1979 (508) 771-7601 • Fax (508) 771-7163 rtckjdor(q cunca; x0 January 26, 2005 Town of Yarmouth Building Dept. 1146 Route 28 So. Yarmouth, MA 02664 Attention: Mr. James Brandolini Building Commissioner RE: Reilly Residence As -Built Stillwater Flood Foundation 204 South St., Yarmouth, AAA Dear Mr. Brandolini, Please be advised that the above captioned project has been renewed for as -built construction by this office. This office has noted that a potion of the footing at the southeast comer, approximately 6' in plan length in either direction, has from 1" to 1-1/2" footing extending from the face of the foundation wall. This was constructed due to the lapping of the upright 2x12 forms While this is generally not permissible by Massachusetts State Building Code, 6d Edition, Section 3604.3, in this case the total footing width is more than allowing 2" either side of the foundation wall, and the wall is only eccentrically positioned for a small percentage of the total plan linear footage. Upon review of the circumstances, this office finds the footing construction adequate, as amended in the field. I trust that the above addresses your needs at the present time. Should you have any question on any of the above, please do not hesitate to can. r4 r Mic cle C. Tudor, P.E. /2005-09 cc: D. Sauro iH OF Me, �MICHELE C. TUDOR No.34774 STRUCTURAL a• r TOWN OF YARMOUTH Building Department BUILDING + (508) 398-2231 ext.261 � PERMIT NO �- F6-05-867- � � PERMIT M ISSUE DATE ;--1/7/2005. - ; PROPOSED US APPLICANT _Tom Grew _...... _ . _ _ JOB WEATHER CARD PERMIT TO : New Construction : AT (LOCATION) 100204SOUTH ST ZONING DISTRI RS-4 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK LOT SIZE BUILDING IS TO BE: CONST TYPEI 5-B 1 USE raze & replace : 1 sitting area, 8 baths, 7 bedrooms, 2 bunkrooms, 1 diningroom, 1 fireplace, 1 REMARKS three bay garage, 1 kitchen, 1 momingroom, 1 laundryroom, 1 livingroom, 4 open porches,1 playroom, 1 three season room as per plans dated 12/29/04. AREA (SO FT) EST COST ($ $1,053,378.00 PERMIT FEE ($) $4,002.00 OWNER lJohn Reilly Jr ILDING DEPT BY ADDRESS POB 1865 ,A Lowell MA 01853 A CONTRACTOR UCENSE 072866 Sauro, David 20 North Main Street South Yarmouth MA 02664 5083982293 Certificate Issue Date= ,�Gsrl,�• �� a cow /N ERTIFICATE ofOCCUPANCY Departmental Approval for Certificate of Occupancy and Compliance Inspector Date Permit Number Approved By Remarks BUILDING PLUMBING/GAS g �✓ffs�, p + E �2�('1S` On/ OtW6a ELECTRICAL ENGINEERING OTHER , 9a� Qom. 1 Wj�_ 4 1 -, To be filled In by each di sI Ind t d reon u completion of its final Inspection. Page 1 of 1 Spallina, Jane From: Kelleher, Robert Sent: Tuesday, July 19, 2005 4:19 PM To: Spallina, Jane Subject: RE: Thanks, PS: 204 South st did not pass, smoke detector missing bottom of stairs, living room end. ----Original Message -- From: Spallina, Jane Sent: Tuesday, July 19, 2005 3:12 PM To: Kelleher, Robert Subject: So that you don't think your crazy, your email was attached to alien's copy that you just signed. dumb, dumb, dumb, you did email me. thanks sorry to get you over here... 7/20/2005 5- 5" S 7 V,61 TOWN OF YARMOUTH Building Department BUILDING (508) 398-2231 ext.261 PERMIT NO FB-Q5-867- 'pERMIT ...------. . ISSUE DATE ; - .1/7/2005.. ; PROPOSED USE ; APPLICANT .Tom Grew.. _ _ _ _ _ _ _ JOB WEATHER CARD .. P, . PERMIT TO ; New Construction- ; AT (LOCATION) 100204SOUTH ST ZONING DISTRIC RS-4 Bldg. Type: Reskiential SUBDIVISION MAP LOT BLOCK LOT SIZE BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R-4 raze & replace: 1 sitting area, 8 baths, 7 bedrooms, 2 bunkrooms, 1 diningroom, 1 fireplace, 1 REMARKS three bay garage, 1 kitchen, 1 momingroom, 1 laundryroom, 1 livingroom, 4 open porches, 1 playroom, 1 three season room as per plans dated 12/29/04. AREA (SO FT) EST COST ($ $1,053,378.00 PERMIT FEE ($) OWNER lJohn Reilly Jr BUILDING DEPT BY ADDRESS POB 1865 Lowell MA 01853 INSPECTION RECORD CONTRACTOR LICENSE 072866 Sauro, David 20 North Main Street South Yarmouth MA 02664 5083982293 FIELD COPY Date tS Note Progress - Corrections and Remarks Inspector - 3 - O � so-�-c_ w /rn :Lti4 OZ 4f ✓'� -��-0- r LZ -2 '6z Gu O - o Y Sit' D / - -/ 2 _6 S oZ� (iI/ A Flood Elevation Certificate is required prior to issuance of the Certificato of Occupancy. n jpp \ kxn Pww4an 4 MICHELE •C. TUDOR. P:E. Consulting Structural Engineers 123 Cottonwoar Lane • Centerville, Massachusetts 02632.1979 (508) 771.7601 • Fax (508) 771.7163 January 26, 2005 Town of Yarmouth Building Dept. 1146 Route 28 So. Yarmouth. MA 02664 Attention: Mr. lames Brandolini Building Commissioner RE: Reilly Residence As -Built Stillwater Flood Foundation 204 South St., Yarmouth, AtA Dear Mr. Brandolini. Please be adsised that the above captioned project has been reviewed for as -built construction by this office. This office has noted that a potion of the footing at the southeast comer, approximately C in plan length in either direction, has from 1" to 1-1/2- footing exlerding from the face of the foundation wall. This was constructed due to the lapping of the upright 2x12 forms. While this is generally not permissible by Massachusetts State Building Code, 6'b Edition. Section 3604.3, in this case dic total footing width is more than allowing 2" either side of the foundation wall. and the wall is only eccentrically positioned for a small percentage of the total plan linear footage. Upon review of the circumstances, this office finds the footing construction adequate, as amended in the field. I trust that the above addresses your needs at the present time. Should you have any question on any of the above, please do not hesitate to call. 'ccrely Tudor, P.E. 4,Mi'C0i1C1,C9C- 20- cc: D. Sauro b, 'W C. TUD0A No.:0774 STRUCTURAL ONE & TWO FAMILY ONLY - BUILDING PERMIT ►4 C APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING O y Town of Yarmguth7Building Department '..r.<M. f 1146 Route 28• • Yarmouth, MA 02664-4492 "".��31 Tel: (508) 398-2231 x261 Fax: (508) 398-0836 LL 'ICI fnJ17/.r n n /�i offidQuoly Planning Board Information Assessors Department Information: Permit No. ' en TYDe Map Lot 0 5 ndorsement Date Permit Fee $140 . Recording Date New . Deposit Rec'd. $ tz t n No. 1.4 Property Dimensions: Net Due $ t Lot Area (sf) Frontage (ft) Lot Coverage This Section for Office Use Only-" :. Bbildinq Permit Number: .. :: Date Issued,. Sign L Z fl C Ceflc a itiof Occupancy is `' is not ' required'* ,. Building Official Section 11 .-Site Information I Use Group: R-4 Type: 5-B 1.1 Property Address: 1.2 Zoning InnfformaPtionC: L�J� Ste,\ 4S,V Zoning District Proposed Use 020 y SO/l S�,ee>°T 1.3 Building Setbacks (ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.4 Water Supply (M.G.L c. 40. S 54) Public Private 1 5 Flood Zon I jprmat, �' Comments:— Zone: BFE Section 2 Property Ownership/Authorized Agent 2.1 Owner of Record: �0 /P6s' Uwe cL /9 0/ Na (print) - Mailing Address 79 - 4/53 ature Telephone 2.2 Authorized Agent: 2!a_111G �e�u. •Uo r rig ti S. q��a Na Mailing Address Signature Telephone i Fax I!' I \ �A Section 3 = Construction Services 3 1rnsed Construction Supervisor: A v%� SA u•f' G Not Applicable ❑ t4s a 70 00 l(la v- ;-S, -ve'V / - S \ /�f �Md U� y r License Number �t 0-5LI& doo-T Addre s pirationDat Signature Telephone ? 3.2 Registered Home Improvement Contractor. Compa y Name uu IJAII_ ti 4 Applicable ❑ Li ense Number Address By Signature Telephone Expiration Date S3 1 of 2 OVER Sectio(i14f�Wo`kers"tjom ensation`Instlrari:ce�ftiiiavit �t.no"�'►,;2�S�G.�fi � ' 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 .......... SecfloriC7escnptlon oi3roposed';Work'lieckaTG pticble New Construction No. of Bedrooms S-1 No. of Bathrooms a y9 EAstingBldg. ❑ Repair(s) ❑ Alterations ❑ •Addition ❑ Accessory Bldg. ❑ Type Demolition . Other Specify: C 1-5i7ti /Yv�it Bri Description of Proposed Work: /� / 0.c-` Inc/.$TiN '/O /�✓LW 557 i/�L-CC/1 mot,c 74S . ,q •mod s l r:• Ur 8 Sectroti ta`�,timated Constu Win_js: Item Estimated Cost (Dollars) to be Check Below completed by permit applicant 1. Building , BOO IConservation-Commission Filing 2. Electrical 7 OOe (if applicable) 3. Plumbing / Gas G O , OG 0 4. Mechanical (HVAC) '7 (JQ G ❑ Old Kings Highway &Historical 5. Fire Protection 7 5 p Commission approval 6.Total=(1+2+3+4+5) `-f(�� pp�j N/ (if applicable) 7. Total Square Ft. (new houses & ad6Gons) 4:7�;P _ 00e7 S, 11 , as owner of the subject property hereby authorize to act on my behalf, in(RI) atters relative to work authorized by this building.permit application. S ature of Owner Date as Owner/A or(zed A e 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. �G.-�w9 Print name Signature of Owne< gent Date TOWN OF YARMOUTH 0 3 c BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT: Job Location: ad Number r ect Village Owner of Property: Construction Supervisor: ►hAf f—, e/LL IAL./Z SeoroeC e4S Name License No. Phone No. Address: 261 1()14 Q��i /yf 9/.t. Sze. SO- Z offtlOe-00 i �l4 Licensed Designee: (If other than Supervisor) Name 2.15 Responsibility of each license holder: License No. 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building and structures only pursuant to the state building code and all other applicable laws of the commonwealth, even though lie, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Any licensee who shall willfullyviolate subsections 2.15.1, 2.15.2 or 2.15.3 or any other section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building, permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities tinder 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 a No ❑ If you have checked=, please indicgte the type coverage by checking the appropriate box. A liability Insurance policy t✓�J( 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. GenAral Laws, and that my signature on this permit application waives this requirement. Check one: Signature of @jyner Owner's . ent Owner ❑ Agent 42' Building Official Approval: The Commonwealth of Massachusetts Department of Industrial accidents ONCO of 1AYesllpstleis 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Applicant Information: PleascPRfiV7`kdibFv name: TOhA, cih _�6',t�ih Y�}.Q�'iGU�Gj /�f% Y/x phoneM L1C2 • y/�/ O 1 am a homeowner performing all work myself. 0 1 am a sole proprietor and ha%c no one working in any capacity 0'1 am an emplo%eerrr p)ro%idine workers' compensation for my employees working on this job. rmmnanv name- ��'tl i/.� ItrQQ'/�/ LJ &%e1 % A a address: City: SG �nS /�'`}/��7C/(J//i'�'lJ phone a: `_-570 — �9�•�a93 insurance co. �4t �/CY�(�'9S C_�'eG Vim policy H CfJC'c�ftl 9(oO d S�G,� C3 I am a sole proprietor. general contractor. or homeowner (circle one) and have hired the contractors listed below who ha%e the following worker' ;ompensation polices: company name: address* may: phone a• int�ra nee rn policy H Failure to secure coverage as required under Section 25A of MGL 152 an lad to the imposition of trislaal penalties of a One up to S1.1OOAo and/or one years' imprisonment as well as civil penalties to the form of a STOP WORK ORDER and a Oat of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Me of Investigations of the DIA for coverage verification. / do her4c',:der the pains a nalties ajprrjury that the information provided above 1s tract and coned SignaturPrint na4 S-s c.ee honer onficial use only do not %rite in this area to be completed by city or town official city or town: YARMOUTII p check if immediate response is required contact person: permit/liccase 0 nBuildiag Department pLicensiog Board 261 13Stlectmeo's Oftice pHealib Department phone at _ (508) 398-2231 eat. nOther 0a ncd 3.95 PIAt Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under am contract of hire. express or implied. oral or written. An emp/nt'er is defined as an individual. partnership, association. corporation or other legal entity, or any two or more of the forecoine engaued in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual , partnership. association or other legal entity, employing employees. However the o" ner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the d%%ellins! 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. %IGL chapter 15. 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 insuranceeoverage required. Additionall%. neither the commom%ealth nor any of its political subdivisions shall enter into any contract for the performance of public %%ork 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 suppling 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 %%orkers' 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 affdavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents fftice of lavestUitleos 600 Washington Street Boston. Ma. 02111 fax #: (617) 727-7749 phone th (617) 7274900 exL 406, 409 or 375 TOWN OF YARMOUTH 1146ROUTE28 SOUTHYARNIOUTH NIASSACHUSETTS02664-4451 Telephone (508) 398-2231, EXL 261 — Fax (508) 398-2365 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT BUILDING ELECTRICAL GAS PLUMBING SIGNS Pursuant to M.G.L. Chapter 40, Section 54 and'780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at dd / �&')0/-// SOS Z4�,`1C Work Address is to be disposed of at the following location: Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. i/ z� (/ Signature of Applicant Date Permit No. PROPERTY ADDRESS: %ALCULATION FOR PERMIT COST TYPE OF ROOM ETC - BATH BED ROOM 6, COMPUTER ROOM /2L6• 3/b.S� DECK OPEN DECK WITH ROOF zS,DEMOLITION 3�S 2• DEN _ DINING ROOM FAMILY ROOM �opZ. FIREPLACE FOUNDATION ONLY GARAGE NO. OF BAYS 3 GREAT ROOM KITCHEN ► 5 2 LAUNDR OOM LIVING ROOM q f ' o MUD ROOM 3 6S 1 OFFICE PORCH CLOSED PORCH OPEN IW66 ' STORAGE AREA SUN ROOM HEATED SUN ROOM UNHEATED SWIMMING POOL ABOVE GRi SWIMMING POOL INGROUND / TOWN OF YARMOUTH Building Department Town Hall Yarmouth, MA 02664 (508) 398-2231 GXL261 BUILDING PERMIT TRANSMITTAL Temp Permit No.: T-05-273 Applicant Name: Tom Grew ,t Applicant Phone: / 5083982293 Building Location: 00204 SOUTH ST Owner's Name: John Reilly Jr Owner's Addres POB 1865 Lowell MA 01853 Owner's Telephone: (978) 453-4161 (OFFICE USE ONLY Recorded By. Ic Permit Fee: $0.00 Deposit Rec: $50.00 Payment Type: Check ChkNo.: 3145 Net Owed: ($50.00) Application Date: 11 /12/2004 Issue Date: Expiration Date Comments: Map/Lot: 034.304 raze & replace - new construction: ZONING APPROVED ly REVIEWED BY: /. WATER DEPARTMENT: DATE: WA: ✓2. ENGINEERING DEPARTMENT: DATE: WA: /3. CONSERVATION: DATE: WA: 9�HEALTH DEPARTMENT: DATE: WA: 5. BUILDING DEPARTMENT: DATE: WA: 6. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE or to Issuance RECEIPT OF COPY: SIGNATURE OF APPLICANT: Date Printed: 11/17/2004 TOWN OF YARMOUTH s Building Department Town Hall Yarmouth, MA 02664 (508) 398.2231 ext.261 BUILDING PERMIT TRANSMITTAL Temp Permit No.: T-05-273 Applicant Name: Tom Grew Applicant Phone: 5083982293 Building Location: 00204 SOUTH ST Owner's Name: John Reilly Jr Owner's Addres POB 1865 Lowell MA 01853 Owner's Telephone: (978) 453-4161 (OFFICE USE ONLY Recorded By: Ic Permit Fee: $0.00 Deposit Rec: $50.00 Payment Type: Check ChkNo.: 3145 Net Owed: ($50.00) Application Date: 11/12/2004 Issue Date: Expiration Date Comments: Map/Lot: 034.304 raze & replace - new construction: 12IE @ IE0W(9D NOV 2'2 2004 HEALTH D REVIEWED BY: 1. WATER DEPARTMENT: DATE: N/A: 9—ENGINEERING DEPARTMENT: DATE: N/A: ... W%JNSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT: DATE: WA: 5. BUILDING DEPARTMENT: DATE: N/A: 6. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE COMMENTS: RECEIPT OF COPY: SIGNATURE OF APPLICANT: ATE: /7� Date Printed: 11/17/2004 r ►r OF Y TOWN OF YARMOUTH Building Department Town Hall m Yarmouth, MA 02664 (508) 398-2231 ext261 BUILDING PERMIT TRANSMITTAL Temp Permit No.: T-05-273 Applicant Name: Tom Grew (OFFICE USE ONLY Recorded By: Ic Permit Fee: Deposit Sac: Payment Type: Net Owed: $0.00 $50.00 Check ChkNo.: 3145 ($50.00) Application Date: 11 /12/2004 Issue Date: Expiration Date Comments: Map/Lot: 034.304 Applicant Phone: 5083982293 raze & replace - new construction: Building Location: 00204 SOUTH ST Owner's Name: John Reilly Jr Owner's Addres POB 1865 Lowell MA 01853 Owner's Telephone: (978) 453-4161 REVIEWED BY: 1. WATER DEPARTMENT: DATE: %% -L A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: 4. HEALTH DEPARTMENT: 5. BUILDING DEPARTMENT: 6. FIRE DEPARTMENT: PLEASE NOTE COMMENTS: DATE: N/A: DATE: N/A: DATE: N/A: DATE: WA: /`2ia2 70 Vfn&aL,I7'io^//1 / rl- `i4 f Z.,db "ZZ / 41472e>A) fo 2 A " �L17- -YL GW P'1 RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: / 7 QS— Date Printed: 11/17/2004 TOWN OF YARMOUTH 1146ROUTE28 SOUTHYARMOUTH MASSACHUSETrS026644451 Telephone (508) 398-2231, Ext. 261 — Fas (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 do y SG Work Address is to be disposed of at the following location: Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Signature of Applicant Permit No. !02 / GSA Date TOWN OF YARMO U TH 1146ROUTE28 SOUTH YA.RMOUTH MAS.SACHUSEM026644451 Telephone (508) 368-2231. Ext. 261 — Fax (508) 398-2365 BUiLbING DEPARTMENT DEMOLITION DEBRI'S DISPOSAL AFFIDAVIT BUILDIN( E _FCC GAS PLUMBIN( SIGNS Pursuant to M.G.L Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resultingfromtChe� proposed work/demolition to be conducted at � `� Sov- \ Work Address is to be disposed of at the following location: oA' Sav if ►\ hlS . Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. IJ12L,1611 (j ignature of Applicant Da Permit No. 0; TOWN OF YARMOUTH Building Department Town Hall Yarmouth, MA 02664 (508) 398-2231 ext.261 BUILDING PERMIT TRANSMITTAL Temp Permit No.: T-05-273 Applicant Name: Applicant Phone: Building Location: Owner's Name: Owner's Addres Tom Grew 5083982293 00204 SOUTH ST John Reilly Jr POB 1865 Lowell MA 01853 Owner's Telephone: (978) 453-4161 REVIEWED BY: 1. WATER DEPARTMENT: 3. CONSERVATION: 4. HEALTH DEPARTMENT: 5. BUILDING DEPARTMENT: 6. FIRE DEPARTMENT: r (OFFICE USE ONLY Recorded By: IC Permit Fee: $0.00 Deposit Rec: $50.00 Payment Type: Check ChkNo.: 3145 Net Owed: ($50.00) Application Date: 11/12/2004 Issue Date: Expiration Date PLEASE NOTE Comments: Map/Lot: 034.304 raze & replace - new construction: DATE: WA: DATE: I 4w. �— DATE: WA: DATE: N/A: DATE: N/A: DATE: N/A: RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: Date Printed: 11/17/2004 / a TOWN OF YARMOUTH Building Department Town Hall �' Yarmouth, MA 02664 (508) 398-2231 exL261 BUILDING PERMIT 1 TRANSMITTAL Temp Permit No.: T-05-273 Applicant Name: Applicant Phone: Building Location: Owner's Name: Tom Grew 5083982293 00204 SOUTH ST John Reilly Jr Owner's Addres POB 1865 Lowell MA 01853 Owner's Telephone: (978) 453-4161 REVIEWED BY: 1. WATER DEPARTMENT: (OFFICE USE ONLY Recorded By: Ic Permit Fee: $0.00 Deposit Rec: $50.00 Payment Type: Check ChkNo.: 3145 Net Owed: ($50.00) Application Date: 11/12/2004 Issue Date: Expiration Date Comments: Map/Lot: 034.304 raze & replace - new construction: DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: CONSERVATION: DATE: /— J' J-O WA: e�g4. HEALTH DEPARTMENT: DATE: WA: 5. BUILDING DEPARTMENT: DATE: WA: 6. FIRE DEPARTMENT: COMMENTS: RECEIPT OF COPY: PLEASE NOTE SIGNATURE OF APPLICANT: DATE: WA: DATE: is Date Printed: 11/17/2004 1 TOWN OF YARMOUTH BIDING DEPARTMENT PLAN REV W & DUHM1riG PERhfl T APPLICATION REYIFF'W NOTES. ,j ADDRESS: Map / I,ot: ! , Date of hkW Roview 1.6 ��: • : Other:. �, App�c�val Date: NOTES: - _ Zmiug Denial (if Socdm 1043.2, paa. Cam, zxbmvim a Albmadou (pm-cxisdov . mm requ= a Spemal peat frcm1heZmmgBowd ofAppeals. Otliez' . 8 Cock Deael (dappFxable) - —'b GENERAL MANAGER CONSTRUCTION MANAGER DAVID SAURO THONUS GREW Davenport Building Company SERVING CAPE COD SINCE 1956 COMMERCIAL AND RESIDENTIAL CONSTRUCTION 20 NORTH MAIN STREET • SOUTH YARMOUTH • MA 02664 PHONE 508-398-2293 • FAX 508-394-6765 December 30, 2004 Town of Yarmouth Yarmouth Building Department Mr. Ken Bates Re: 204 South Street As per your recent request enclosed you will rind the following: 1. Letter from Architect, Michael J. Keane, that he will be responsible for all manufactured lumber and steel beams. 2. Letter from Architect, Michael J. Keane, addressing the architect stamp for the flood plain by a Massachusetts architect. 3. Tom Grew dropped off set of plans to the fire department. 4. We would like to make the pool house part of this application but not the pool. The pool installer will pull his own permit. What do we need to do for permitting the pool house. h,.eg d,• &N, ft f,Q_;r� If any additional information is needed please let me know. Thank -you! David Sauro 0EE DEC 3 0 2004 BUILDING DEPT. Dec-29-2004 14:47 F rom- T-298 P.001/001 F-385 TOWN OF YARMOUTH BUILDING DEPARTMENT PLAN REVIEW & BUILDING PERMIT APPLICATION REVIEW NOTES ADDRESS: Map / Lot: Date of Initial Review: /Z - 2 9 - D / Other: Approval Date: Inspector. AL7� 6Q0 7Y — (6 16Sr Zoning Denial (if applicable): Section 104.31, pars Change, Extension or Alteration (pre-caistin& nonconforming) The proposed rrqw= a Special Permit from the Zamng Board of Appeals. Banding Code Denial (if applicable) vy� 7 xev.11-01 Dec 30 04 10:42a Michael J. Keane 1 603 292 1402 p.3 Michael J. Keane A A C H I T E C T S ruc architecture preservation planning design 101 kenl place nowmarkel, new hampshire 03667 tel 603/292.1400 fax 603/292.1402 mail G mikarchilecls.com December 30, 2004 Mr. Jim Brandolini Building Commissioner Town of Yarmouth Town Hall 1146 ROUTE 28 SOUTH YARMOUTH MA 02664-4463 Re: Reilly Residence 204 South Street Flood Certification Mr. Brandolini: This letter is to confirm that the foundation at the above referenced property has been designed to equalize the hydostatic pressure resulting from a flood event in the Al flood zone. The foundation has been designed with "Smart Vent, Insulated Vents" which are FEMA approved to provide adequate equalization of the foundation according the National Flood Insurance Program (NFIP) when provided at a ratio of 1 vent per 200 S.F. of enclosed space. (Certification is included on Dwg. C-1). The enclosed area of the basement is 4,380 S.F., requiring 21.9 vents to satisfy the accepted ratio. 22 vents are provided. The sills of the vents are planed les than 12" from the grade with crawlspace elevation at or above grade on one side and vents are provided on more than one wall face as required by Diagram 8 of the NFIP Elevation Certificate. Please let me know if I can provide any additional information. Sincerely Michael J. Keane, A.I.A Registered Architect - MA. 7384 a/ V cHAEL JOHN :EANE .r ti: Dec 30 04 10:41a Michael J. Keane 1 603 202 1402 p.2 Michael J. Keane A R C H I T E C T S I'LLC architecture preservation planning design 101 kent place newmarket. now hampshirei 03857 let 603/292-1400 fax 603/292-1402 mail kAmikarchitects.com December 30, 2004 Mr. Jim Brandolini Building Commissioner Town of Yarmouth Town Hall 1146 ROUTE 28 SOUTH YARMOUTH MA 02664-4463 Re: Reilly Residence 204 South Street Framing members Mr. Brandolini: This letter is to confirm that the engineered wood products and structural steel members for the above referenced property have been designed by me. I will be reviewing the installation and connections in accordance with the manufacturer's specifications throughout the construction phase. Please let me know if I can provide any additional information. Sindrely I W.. Michael J. Keane, A.I.A JOHN Registered Architect - MA. 7384 ((Kx, "ATw+`L Nrl Permit Number REScheck Compliance Certificate Checked By/Date Massachusetts Energy Code REScheckSoftware Version 3.6 Release 1 Data filename: C:\Program Files\Check\REScheck\#4584.rck PROJECT TITLE: New Custom Home CITY: South Yarmouth STATE: Massachusetts HDD: 6137 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) WINDOW / WALL RATIO: 0.25 DATE: 11/11/04 DATE OF PLANS: 10-28-2004 PROJECT DESCRIPTION: The Reilly Residence 204 South Street South Yarmouth, Ma. 02664 F�N l;DESIGNER/CONTRACTORDavenport Building Company 1 Z ��; 4 20 North Main Street South Yarmouth, Ma. 02664PROJECT NOTES: MaCheck by Cape Cod Insulation Inc. # 4584 COMPLIANCE: Passes Maximum UA =1323 Your Home UA = 1248 5.7% Better Than Code (UA) Gross Glazing Area or Cavity Cont. or Door Perimeter R-Value R-Value U-FactoI JUA Ceiling 1: Flat Ceiling or Scissor Truss 3998 30.0 0.0 140 Ceiling 2: Cathedral Ceiling (no attic) 832 30.0 0.0 28 Wall 1: Wood Frame, 16" o.c. 7138 21.0 0.0 300 Window 1: Wood Frame:Double Pane with Low-E 1324 0.340 450 Window 2: Wood Frame:Double Pane with Low-E 210 0.310 65 Door 1: Glass 260 0330 86 Door 2: Solid 40 0.280 11 Door 3: Solid 20 0240 5 • Door4: Solid 20 0.380 8 Floor 1: All -Wood JoistPfruss:Over Unconditioned Space 3888 30.0 0.0 128 Floor 2: All -Wood JoisttTruss:Over Unconditioned Space 833 30.0 0.0 27 Furnace 1: Forced Hot Air, 82.7 AFUE COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the Massachusetts Energy Code requirements in RES checkVersion 3.6 Release 1 (formerly MECche4 and to comply with the mandatory requirements listed in the RES checkInspection Checklist. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the de§gn load as specified in Sec ' 780CMR 1310 and J4.4. uiB lder esigne Date / /� Gy REScheck Inspection Checklist Massachusetts Energy Code REScheckSoftware Version 3.6 Release 1 DATE: 11/11/04 PROJECT TITLE: New Custom Home Bldg. Dept. Use Ceilings: [ l 1. Ceiling 1: Flat Ceiling or Scissor Thus, R-30.0 cavity insulation Comments: [ ] 2. Ceiling 2: Cathedral Ceiling (no attic), R-30.0 cavity insulation Comments: Above -Grade Walls: [ l 1. Wall 1: Wood Frame, 16" o.c., R-21.0 cavity insulation Comments: Windows: [ ] 1. Window 1: Wood Frame:Double Pane with Low-E, U-factor. 0.340 For windows without labeled U-factors, describe features: # Panes_ Frame Type Thermal Break? [ ] Yes [ ] No Comments: [ ] 2. Window 2: Wood Frame:Double Pane with Low-E, U-factor. 0.310 For windows without labeled U-factors, describe features: # Panes_ Frame Type Thermal Break? [ ] Yes [ ] No Comments: Doors: [ ] 1. Door 1: Glass, U-factor. 0330 Comments: [ ] 2. Door 2: Solid, U-factor. 0280 Comments: [ ] 3. Door 3: Solid, U-factor. 0240 Comments: [ ] 4. Door 4: Solid, U-factor. 0.380 Comments: Floors: [ ] 1. Floor 1: All -Wood Joist/fruss:Ovcr Unconditioned Space, R-30.0 cavity insulation Comments: [ ] 2. Floor 2: All -Wood Joist/fruss:Over Unconditioned Space, R-30.0 cavity insulation Comments: Heating and Cooling Equipment: [ ] 1. Furnace 1: Forced Hot Air, 82.7 AFUE or higher Make and Model Number . I Air Leakage: [ ] I Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. [ ] I When installed in the building envelope, recessed lighting fixtures shall meet one of the following requirements: 1. Type IC rated, manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated, in accordance with Standard ASTM E 283, with no more than 2.0 cfin (0.944 Ls) air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/ft2 pressure difference and shall be labeled. I Vapor Retarder: [ ] I Required on the warm -in -winter side of all non -vented framed ceilings, walls, and floors. I Materials Identification: [ ] I Materials and equipment must be identified so that compliance can be determined ( ] I Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided [ ] I Insulation R-values, glazing U-factors, and heating equipment efficiency must be clearly marked on the building plans or specifications. I Duct Insulation: [ ] I Ducts shall be insulated per Table J4A.7.1. I Duct Construction: [ ] I All accessible joints, seams, and connections of supply and return ductwork located outside conditioned space, including stud bays or joist cavitiestspaces used to transport air, shall be sealed using mastic and fibrous backing tape installed according to the manufacturer's installation instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted. [ ] I The HVAC system must provide a means for balancing air and water systems. I Temperature Controls: [ ] I Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided I Heating and Cooling Equipment Sizing: [ ] I Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. I Circulating Hot Water Systems: [ ] I Insulate circulating hot water pipes to the levels in Table 1. I Swimming Pools: [ ] I All heated swimming pools must have an on/offbeater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. I Heating and Cooling Piping Insulation: [ ] I HVAC piping conveying fluids above 120 °F or chilled fluids below 55 T must be insulated to the levels in Table 2. • Table 1: Afinlmurrr Insulation Thickness for Circulating Hot Water Pipes Insulation Thickness in Inches by Pine Sizes Heated Water Non-Circulatine Runouts Circulatina Mains and Runouts Temperature ( F) Up to 1" Up to 1.25" 1.5" to 2.0" Over 2" 170-180 0.5 1.0 1.5 2.0 140-160 0.5 0.5 1.0 1.5 100-130 0.5 0.5 0.5 1.0 Table 2: Minimum Insulation Thickness jar HVAC Pipes. Fluid Temp. Insulation Thickness in Inches by Pip Se izes Piping System Types Range F1 2" Runouts 1" and Less 1.25" to 2" 2.5" to 4" Heating Systems Low PressureNemperature Low Temperature Steam Condensate (for feed water) Cooling Systems Chilled Water, Refrigerant, and Brine 201-250 1.0 1.5 1.5 2.0 120-200 0.5 1.0 1.0 1.5 Any 1.0 1.0 1.5 2.0 40-55 0.5 0.5 0.75 1.0 Below 40 1.0 1.0 1.5 1.5 NOTES TO FIELD (Building Department Use Only) oT. TOWN OF YARMOUTH o} �y BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, NIA 02664 508-398-2231 ext. 261 BUILDING DEPARTMENT TOTAL DEMOLITION SIGN -OFF FORM State Building Code (780 CMR) Chapter 1, Section 112.1-Service Connections "Before a building or structure is demolished or removed, the owner or agent shall testify 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 teeter and regulators, have been removed or sealed and plugged in a safe manner." "All debris shall be disposed of in accordance with 780CM 111.5." JOLT 51413)rh Building or Structure Location: YA m%,VVk Map: Lot: Owner's NameAsk Rc��1 I Addres B°ui rnp, o,�y3 Phone: $08-7L03 Za O Contractor's Name: CN - �f1'2r<i�1a Address: Uf 0"N" c"d _ Phone. jaf -3�8-a (1 C MA oa�3�► NStar. �Keyspaa% ve _4�:7/3� I ly Water Dept.: + N Board of Health:-w ' Fire Dept.: Ac+ %-,r\ 1AjS%t'r Historic Commission: Date: BY: Title: Ownw ilk& % 6.1c (14ze 4f-1..ti' 1ul 4ty. v4,.„1i, WI.C41-4'r , P. + do••�n +oi,)' , ( l: c1-01 7tf+- 44I - 393S Af":V-244 Dater.1?16q ca W �SUa 7 l0,0,{ i 5o 2 �+v�+ ��`�(��o..,.� BY: `-1'►U►, (D et`c.t�tt� L�Q (:F.t.rc Title: Date: y 71d y By: 10 16JA lot Title: Sti y� Date: f/Ibi Dry) - By: Title: Condition: Date: `j I15I°`1 (Pt� Title: 5P - Date: By: Title: Verizon Date: By: Lv Title: R".s-2,o+ TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 261 v ` BUILDING DEPARTMENT NOS 9 l u��i� TOTAL DEMOLITION SIGN -OFF FORM State BCode (780 CMR) Chapter 1, Section 112.1-Service Connections "Before a buWiii�i 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: Map: Lot: Owner's Nan f>e. k ICe, \y Address:goq 5cAj_\ St Phone: tf v J -760 — 3aao Contractor's Name: 690 `10 rcf & Address: 36 0`1 kC k' b Phone: SOS -3q r - f� Mz�. pu�r.ts ��-�- NStar. Date: Br. Title: Keyspan: Date: By: Title: Water Dept.: Date: By: Title: Board of Health: Date: By. X,7zff Title: /�f1is%UL� G Condition: 174,Ile, Fire Dept.: Date: By: Title: Historic Commission: Date: By: Title: Verizon Date: By: Title: / 10/.24/2004 21:07 9789373987 10/25h2001 XON 07:13 FAX NSTAR One NSTAR Way. Wenowd. WaNaNYlUem 020004M GA S October 25, 2004 Dear John J Reilly, Jr, This letter will serve as confirmation that the daxxric service at 204 South St So Yarmouth, Ma was removed. Based on this information, them is no dectric power to this building and you may proceed with the demolition. If you have any questions, please contact me at (898) 633.3797. Sincerely yours, Customer Smrix Clair KaWeen HcWng 10 SEP-16-2004 THU 12:43 PM KEYSPAN ENERGY DELIVERY FAX NO. 17818904898 P. 01/01 KOYSPal Energy Delivery 127 Whiffs P.!h 5001 Yum.uut •. Massuaniset;s o2Grr1 September 16, 2004 l ax it 508-394-1017 RE: 20.1 South Street, South Yarmouth, MA To Whom It May Concern, This lcuer is to confirm that there are no underground natural gas facilities to the above referenced property. This was confirmed by our representative on September 15, 2004. I cm be reached directly at 508-760-7502 should there be any further questions. Sincerely, >E7luf�..e tl,c ohannc Ouellette Field Co6rdinator, Cape Division GENERAL MANAGER CONSTRUCTION MANAGER DAVID SAURO THOMAS GREW Davenport Building Company SERVING CAPE COD SINCE 1956 COMMERCIAL AND RESIDENTIAL CONSTRUCTION 20 NORTH MAIN STREET • SOUTH YARMOUTH • MA 02664 PHONE 508-398-2293 • FAX 508-394-6765 December 1, 2004 Yarmouth Building Department Mr. Jim Brandolini Re: 204 South Street el er your recent request enclosed you will find the following: 1, of coverage shown on "Building Department Note" on site plan from Baxter & ye (6 copies enclosed). /2. Debris afterdavit. The following information you requested should be submitted the beginning of next week: / �/ 1. Plans stamped by an architect for structure and with flood information including detail of hydrostatic vents. 02Pool house does not exceed 150 s.f., dimensions will be given to show that. ✓ll 3/3. Height from the grade to ridge will be shown. 4. Demo sign off sheet should now be completed by NStar as they have disconnected power at the site. If any additional information is needed please let me know. David Sauro ,Dp C c L DEC 0 1 2004 �T. �Y— • GENERAL MANAGER CONSTRUCTION MANAGER DAVIDSAURO THOMAS GREW Davenport Building Company SERVING CAPE COD SINCE 1956 COMMERCIAL AND RESIDENTIAL CONSTRUCTION 20 NORTH MAIN STREET • SOUTH YARMOUTH • MA 02664 PHONE 508-398-2293 9 FAX 508-394-6765 December 21, 2004 Town of Yarmouth Yarmouth Building Department Mr. Jim Brandolini Re: 204 South Street As per your recent request enclosed you will find the following: 1. Baxter & Nye Site Plan revised to show the lot coverage to the upland and that no vegetated wetlands are on the parcel. 2. Pool house Plans revised so that it does not exceed 150 s.f., dimensions given (Sheet A-20). If any additional information is needed please let me know. Thank -you: David Sauro GENERAL MANAGER CONSTRUCTION MANAGER DAVID SAURO 1110MAS GREW Davenport Building Company SERVING CAPE COD SINCE 1956 COMMERCIAL AND RESIDENTIAL CONSTRUCTION 20 NORTH MAIN STREET • SOUTH YARMOUTH • MA 02664 PHONE 508-398-2293 • FAX 508-394-6765 December 16, 2004 Town of Yarmouth Yarmouth Building Department Mr. Jim Brandolini Re: 204 South Street As per your recent request enclosed you will rind the following: 1. Plans stamped by an architect for structure (all sheets stamped) and with flood / information including detail of hydrostatic vents (C-1 & A-1). 2. Pool house (10 z 15) does not exceed 150 s.f., dimensions given (Sheet A-20). 3. Height from the grade to ridge shown (35 feet on Sheet A-5). As we had discussed, due to the size of the home and for time saving reasons, we definitely would like to be able to have inspections done in phases and understand that additional inspection fees would be required. If any additional information is needed please let me know. Thank -you! LGI.�.vfr�' David Sauro HENRY C. GILL • .� P. 0. Box 981 • 206 SOUTH STREET • SOUTit YARMOUTH, MA 02664 cS A a a, a-0tr`1 A R ? A •1ti'Z J* Q 2 4-,co o Lj k I Q V r 1, K Ct �+-rS P rGTfi 2 ramrM ►--a(i7;k rw t1 a 2 cflj7o-:!a(j4, soc.•z- sr, ,►��-�� a5� z o-rBoy J2ori•�,,7�iLy owr-c2� !37 G..�2vcY►� '"ToZvirvs 5-0 `3-v�f-6{ Io?r t.l-,y � *$ N U-e S ua tiv I% S ,q A tr.s-+c ro Y o v T• Q MsA A 4-•a c• r A-TTL t' 1 I e V o c- �• v v �� Tµ "'r •2 4- 1L0v it ,4-7-� � -(- i SEP 2 3 2ooa D TOWN OF YARMOUTH APPLICATION FOR PERMIT TO DO GASFITTING (OFFICE USE ONLY) By n Fee: $ r�' - O 3 ' PERMIT NO. Date &-,Z3.O?- Building Owner's AT: Location �?0`/ Name_ Type of Occupancy `sIAIC& > • New Renovation ❑ Replacement ❑ Plans Submitted Yes ❑ No ❑ N N Y W Cn N Z 2 R N M W J 0)W cc 0 U m t M N W W xO a N N a W Q w x Q 2 0 0 > Q W W J 2 Q m Q S W a W F" W H W Z 2 FQQ- Z j W Q W 2 O> 0 m LL FZ .-1 W W ~ Q x > 0: W Z 3 Q O O W¢ o O x 0 0 x U. M 0 ¢> o. t- O SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR (PRINT OR TYPE) Check ne: Installing Company Name �l� z/ le- Corp. _ Address - 3.SS 2y- / 3y ❑ Partnership s0 . 3>0 nri(S ) M/9 • O 2 W 6 O ❑ Firm/Compi Business Telephone SX17 - 3 Name of Licensed Plumber or Gasfitter e INSURANCE COVERAGE: Check One have a current liability insurance policy or its substantial equivalent. Yes IfNo If you have checked yes, please Indicate type of coverage by checking the appropriate box. A liability insurance policy Other type of indemnity ❑ t l` b7 ,yam oa AUG 2 8 2002 11 C-'- 03�-/2'a 6. By 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 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. Signature of Licensed Plumber or Gasfitter iag�9 License Number E LICENSE:. ❑Plumber Gasfitter C ga' ster ❑Journeyman TOWN OF YARMOUTH r ?' ;N a g� Building Department }.3'= Town Hall Yarmouth. MA 02664 }Z.3_ (508) 398-2231 ext261 Building Location: Owner's Name: Owner's Address: Owner's Telephone: Gasfitter Name: License Number: Company Name: Company Phone: PERMIT TO DO GASFITTING WORK Recorded By. PERMIT NO. Permit Fee: Payment Type: Check Number: Issue Date: Type of Work: Comments: INSPECTION RECORD (OFFICE USE ONLY Date f Note Progress - Corrections and Remarks Inspector �F TASK O /702 Tom, iLs. avn/ Date Printed: 5/16/02 1/152015 SlipGen- Portal Hone Town of Yarmouth Template [Building Dept] ■ Slipsheet Identifier [sg16719] Document Category Building Permits Map -Block Number 034.304 Street Number 0204 Street Name SOUTH ST Department Building Parcel ID 3169 Backfile Batch Scan No Document? Additional Naming Info Index Operator Operator, Yarmscan Date - Time 2015-01-15 - 15:21 htipJAaserfiche121S1ipGW 1/1