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Commonwealth of Massachusetts a[s9M#Vim
Title 5 Official Inspection Form 11 �eApq
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
LUTW&§PrT .
3 Carrie Lane South Yarmouth M - 51 P -152
Property Address
Charles & Virginia Wilkins clo Russell Wilkins
Owner's Name
3 Came Lane, South Yarmouth MA 02664 April 18, 2012
City/Town State Zip Code Date of Inspection
-11 t e f c
Inspection results must be a C,ra
way. Please see completene �'►
a r
A. General Informati f7 ,71 /11 // ji!�44qllt
1. Inspector.
Troy Williams •)
Name of Inspector AP�
Troy Williams Septic Insp
Company Name
19 Hummel Drive
Company Address 'w IMP
South Dennis • •44A
_ 02660
City/Town now Zip Code
(508) 385 -1300
Telephone Number .2d+—
not be altered in any
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5 (310 CMR 15.000). The system:
® Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
April 18, 2012
Inspector's Signatulle Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
""This report only describes conditions at the time of Inspection and under the conditions of use
at that time. This inspection does not address how the system will perform in the future under
the same or different conditions of use.
t5ins - 11/1 o Title 5 Official hspeclion Form: Subs rfam Sewage Disposal System - Pape 1 of 17
• • •
;� Commonwealth of MassachusetCs
Title 5 Official Inspection Form
Subsurfa�Sewage Dlsposal8ystem Form-Not for Voluntary Assessrt�ants
3 Cartie Lane South Yarmouth M-51 P-152
PmPertynda�aa
Char�s 8 Yrginia Wilkins cJo Russell Wilkins
�� owner8 Narna
��76016 3 Carrie Lane, South Yartnouth MA 02664 April 18, 2012
requiretl tor every
�,. cnyrtown smce zro coae oaoe a i�non
C. Checklist
Chedc ff U�e following have been done. You must indicate"yes•or"no•as to each of the following:
Yes No
� ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ � Were any of the system components pumped out in the previous two weeks?
� ❑ Has the system received nortnal flwirs in the previous two week period?
� � Have large wlumes of water been introduced to the system rocently or as part of
this inspection?
� � Were as buik plans of the system obtained and ex�amined?(If they were not
aveilaWe nole�WA)
� ❑ Was tfie feCility or dwelling inspec[ed for signs of sew�e back up4
� ❑ Was the site inspected for signs of break out?
� ❑ Were all system components,exduding Me SAS, Wcated on site?
� ❑ Were lhe septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the bafrles or tees, material of consWctlon,
dimensions,depth of liquid,depth of sludge and depth of scum?
Was the facility owner(and occupants if diHerent from ovmer)provided with
� � infortnation on the proper mairKenance of subsurfa�sewage disposal systems?
The size and locatlon M the Soil Absorptlon System(SAS)on the site has
been detertnined based on:
� ❑ Fxisting information. For example, a plan at the Board of Heafth.
� � Determined in the fi�d(ff any of the failure criteria related to Part C is at issue
approximation of distance is unaxeptable)[310 CMR 15.302(5)]
D. System Information
ResMeMial Flow Condidons:
Number of badrooms(design): 3 Number of bedrooms(actual): 4
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x i of bedrooms): 330 gpd
tSiro•t7n0 � � . . ... . . . � . � Ttlfs501Rd�lYaps�OanFam9�arhm8sY�p�ppos�SyWm•Paps8af17 -. . �
, HU14ll1NG PL•'1trlLT hYPL1CA'1'lON S1GN UkF f
� APPLICANT: �p�o,....'f C.�.>i��'�.��j BUZLUING PERMIT $: / �/ 3 �
ADDRESS; 3 G�-Cz-(v�f. 6-�.- S .Y. TELE. N0.: �L'��E''" l DATE FILED't �'! �^`
HLDG. SITE LOCATION: 3 t�rr2t 1.�, 5. �/• MAP#. �j� LOT�: � i%
` THE FdLLOWZNG INFORMATION OU2LINES THE PROCEBURA2. STEPS REQtiIRED Td OBTAIN A PERMIT TO St
' ` ALTER, OR ADD TO A $TRUCTURE WITHIN THE TOWN �F YARMOUTH. TFIE BUILDING DEPA&TMENT WILL DF
MINE GOMFLIAt3CE TO THE FOLLOWING (A) ZONING REQUIREMENTS (B) HISTORICAL DISTRZCTS (C) FLC
PLAINS ZONZNG. TI3E BllII,DING DEPARTMENT 4}ILL BE RE5F4NSZBLE FQR AS5ISTING TAE APPLICA23T TF
THE FOLLOWING DEPARTMENTS: '
RESIBENTZAL ANDJ6R COMMERCIAL BIIILDZi1G
' WATER DEPI+RTMENT: DETERHINES COMPLIA2ICE OF WATER. AVAILhDTLITY. •
ENGINEERING DEPARTMENT; DETERti22�ES COMPi,Xt1NCE EdB. PARRIHG IiNND DRAINAGE.
` CONSERVATION COMMISSION: DETERHINES COMPLXANCE TO WGTLANDS ACTS. I.E.: IF LOT(S) BORDE&
. ' TYPE OF WETLANDSs STREAMS, PONDS, RZVEItS� OCEANS� BOG$a BAYS� t
LAND: ETC,
HP'.ALTg DEPART(�II:NT: DETERMINE5 COI�LIANCS TO STATE ANll TOWN REGUI.ATZONS, I.E.: REQL
MENTS EOR SEP'TAGE I?ISPOSAL ANt? 4TBER PUBLZC BEALTB ACTIYZTZE5.
EIRE DEPARTM�IT: , DETER2TINES COMPLIANCE TO STATE AN'D TOWN REQUIRFF2�NTS FOR PERSOP
. . SAFLTY� PR4PERTY PItOTECTF02S, I.E., SMOKE DETECTOAS, 5PRINRI.ER :
ETC.
TBE F{JLLOWING DEPARTHF.NTS MUST SIGYI QFF', IH T�E RESPECTIVE ORDER, PRZQB TO BUZLi?ING ZtiSFF
ISSUING TNE REQUI&ED BUILD7NG PERI�IIT: ,
RB,VIEHID BY: ,,/,� ��� �� .
j �; l, WATER DEPARTMENT !'� �Y] .�,�...xx.�. DATE. �a�.' �E `g� N/A:
� Z. ENGINEERING AEPARTMEE?IT: DATE: N/A:
3. COtiSERYATION: � DATE: NiA:
4. HEALTH DE�ARTMENT DATE: �,- ��-'�'8. N/A:
INDUSTRIAL (OR C4t4lERCI1�L PERMITS
5. WIRING INSPEGTQR: I}ATE; N/A=
6: PLt1MBING INSPEGTOR: DATE: N/A:
7, FIRE DEFARTMENT: DATE: NI41:
PLEASE NOTE
Ai.L STUMPS AKD/4R BRUSfl MUST�BE DISPOSED QF AT At� AYPRQtiED SZTE. A &IGNEU REGEZPT FROM TE
DISPOSAL SITE MUST BE SUSHITTED TO THE BUILDING DBPARTMENT PRIOR TO ISSUANCE 07e THE B[fILI
PEEi33ZT. y � �d-�- '
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vonHone, Amy
From: Bob Churchill <bob@BobChurchill.com>
Sent: Thursday, June 26, 2014 11:29 AM
To: Amy Von Hone(vhmarinesolutions@comcast.net); Amy Von Hone
(vhmarinesolutions@comcast.net); vonHone, Amy
Subject: re: 3 Carrie Ln
Importance: High
Hi Amy:
Just a follow up and question, this property was originally a three bedroom dwelling with all three bedrooms on
the first floor. I believe built in 1985.
In 1998,the owner added a breezeway and gazage with a bedroom above the garage.
, It was stipulated in the permit application that the main house would be "downsized"to two bedrooms by
eliminating a common wall between two bedrooms. What was actually done was to add a doorway between the
two rooms so now there aze two doorways in this room, in addition, the closed door has been removed.
The house is being marketed as a three bedroom. And is assessed that way as well.
I'm just checking with you as my buyer-client does not want any surprises going forward ie: would she have to
upgrade the septic to a 4BR.
Thoughts?
Bob
Bob Churchill
Representing Real Estate Buyers Exclusively
Broker-Owner Realtor�ABR,ABRM,GRI
2007 President,Cape Cod and Islands Association of Realtors�
Massachusetts Licensed Real Estate Broker
+��***ssa>r�x�x»+�*�++r**+r��*+�»�:<*�.:+*x+�awrt���
Buyer Brokers of Cape Cod�
Churchill Associates,Inc.
923 Rte.6A
Yarmouthport,MA 02675
800-292-2540 508-362-6855
Cellulaz: 508-776-8686
+«»....+»+++++�..+..+..+«.+:.+...
EXPERIENCE*ADVOCACY*DILIGENCE
Bobna BobChurchill com
www.BobChurchill.com
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�""TY"`""=�� ppplicatian for a Perrnit to Build �o. / � �'
��s«*
UPON'FlNALAPPFiOVAL �� �-(���Y MAP ��' Lt�i' � �
FEE MUST AGGdMPANY THIS RPPLIGATlON. DA7E i9 �S�
The unders3gned hereby applies for a parmit to bvifd � ��Gf
accord+ng to the#aElowing specifica#ions ��cfl�c��
l
1. Alame of property owner '� � j Tel. �-�c? �
Address
2.Name of Archiiect{if any} Te1. ;��
I 3. Name c�3 buiider� ' dress�? LV^ A, l(t°�,.i�,lrr �r.. +�t';�t$
'i 4. �icense �to.�2� 1 �� Tel. .�t�{- L:S 3 2.
'', 5. Nsme of Mason �lcidress
' 6. License Na. Tei.
7,Construction ac�dress _ .� t'�r`.c. �r'F� .,�.�,�t.--, .�ri���r�+., �s,�.�
6. Dafe a#subdivision Approval _ pla�n znne t', �is#�nct i� �d'�"
c. i'rivate dwelCing� Estimated Cost "'�i"� � � t�{?N��1=ilTE EN�YP �osoom� ' Na. .
i4.Multi famiiy � � ,�Q � � � '�= t�.�a �e � la�rar,7
�� t�: ;;i�� �'��'�� - � i�'
11. Commereial 0 �"�-'p C-�aw.�,,.�, �.r,� t---^��wg IGtchen s
12.Other ❑��� ��., P�h ��`''u ��ck .5'�� � r`f. Dining Fim.
� ���._-,r ' Living Rm.
13:N0. of stor��s �x- ! `jS, ,5�� Beti Rr�. �"`°""'�
t�.Foundation--� Fuii ❑ Hali ❑ Craw! � Slab #� ��--j �c> Bath
�5. Materials —Wood C`i Gemeni ❑ {?#iaer ❑ / ��R �S+ � €}eck ��x�'�
l �� ' Clvsed tGh
16. Type of heat— QiI � Gas ❑ Eiectric €�f C7thsr � , P�
17.Garage — 1 ❑ 2 D ��'S,S� � Farnily Rm.
�-- fG ` u�,�,�, ' .raom
18. Swrimming poal - Size j �'�..�L� � Garage n
19. Storage shed —Size Shed
20: Stove —Wood � Coa! ❑ Alterations
21. Size of lot: No. of feet front No. of ieet�ar 1Vo.af feet deep
22.Size of bui}ding. No. of`feet front No. o#feeE side No.o#fee#rear
23. Distance from nearest building: Front Ft. side Ft.side Rear
24. Distance backfrom line o�stree# �rom rear Iot iine Sitle 6ine
2S: H:l.G.Fi, No: f�'? �,�
LOT RELEASED SY Signature
Pl�NNING SOAR€} Address �-. 1�C5Cr-�w.�r �:
DdtB Jo �.a.,nt li i"k� c32f��rr�
f f8"���J" �'Y.�'
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ABDRESS: 3 G�s� t...,,. S.Y. TELE. N0. : �'r t7:;� i DI�'CE PILED: �'(£'�"7tu'
s��c. sz�r� �,c�cAr�or�: � �r�G ��.., S. `I- csnr�c �� �.o��: � �
Tl?E F{SLLUWING INFORMATION f3i7TI.ZNES 2HE PROCEBURhL STEP� REtjU3RED TO 6BTA3I7 A PERMI'� TQ BUIL4,
ALT�It> QR Al1D TO A STRUGTLIRE WITHIN THE TfYWJS OE 'tARPitStITH. T1iE SUILDiNG DEPARTMENT WILI, BETER—
MINE COMPLIANCE TO THE F'OLLt3W3NG {A) ZONING R$QUZR��?TS {B} xIST0ltx�hL ASSTRSG�S {G} FL60I7
PLAINS Zflt�ING. TA8 BUiLDING AEFAR'ZMENT WILb 8E RESP{}NSiBLE �C}A AS�ZS'TZNG S17E APPLIGANT ZHOU6kt
THE FOLZ,OWING DEPARTMENTS: ,
x�sz����Az� �rrtnit�R c4r�t�xczAt, ��a�.n��ac
crn��a n�r�s�•r: ��r�z�s ctu�,�tc� or c�ax�a Au��azzz�. �
ENGTNEk�LNG ➢EP@R2t�i'�': DExFR24.T:NES COMPLIAIdG� Ftiii Pe1RKT�G ADtTI DAAZN6GE.
GCENSERVATION GGHM13SZtfiN't S}�'r��x�RES G�MPLI�sNCE TO 'Wl::[Z.ANbS Af:TS> Z.E.: IF LqT{S) IIORllI�t ANX
TY£E OF i7£TLANl3Sa 53'RF:FaMS� PONDSs Ri4Flt.�sa flCFAZdS. B(3G5� BAYS+ "H9R`a`H
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BEAI.TH UEFA&�ciT: UETERM'INES Gt12�LI�id£� ZC! STATE AND T�Wti RE�iUI�bTi4NS, I.E.: REt7UIBE—
23ENTS F4R SSP�G� DI51'f1S9L A�7D QTRF.'$ I'iTBbZC H�Tt1L'Lfl A�TIVITI�S.
FII:E TIEPisE1'EIIi�1`C: _ DETL�R.MM�IIES CQPf�+L7.t1NGE Ttl 52ATE ANY7 TflYiiri KE(}U2RF�iENTS FS3R PE8:50STAZ
SA�GTs, PR�P�TtTY PRL3T�CTZt}N; I.E., SHOKE llE'TECT02LS, SPFt1NRL':�It SYSTFZ�
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REYI'EW'�.1 SY: \
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ii 7, EIf2E DEL'AHTn'�SENT: DAl'E:- N/&.1
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ALL S�UHYS AAIllIQR BRIISfl MOST�SE BZSP{7SI:D' OF A'F dk7 APPItAVED SITE. A BZ�N�Z! RECETPT Eitttti TSE
17Z5POSAL SITE tIUST SS SUB�iTT7:k."I7 T4 `C0E' BtTIi.T3IN� DEPAR'i'�iF:N`� PRZ4It R4 255AAN�$ pE TBE St1SLD32TG
PER�IT.
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. Suggest�d AfSdacit for klome Fmprovemeac Cantractor Permii Applicatian
• ParOIIkc ux t�y NY12vlE£7��I'I1`!I"4WN
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Suppiament Ep P�nit Appiicatiria
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tn axnrciures whteh are adiacrnz jo au�h rssidenccar buiidine"�doba by ztgisW�ed wnuacioY�.wath trrtaus cfecptiont,slang uith svitia'
zequiremefise. -.
Type of Waric �r.:��{'.r.-�,�,y,r F,s�.c�c�'/c�Y,� _
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Addz'�s of Wozk r^- � 1.t�9ti,:G
Owner Name: �a��� t �� ! :r�`
L7ase of Pezmit App3Fcation: :�����, .
I hez�tiy aertity that:
RegBstrazion is not reqvired for€he Iallrnving reasQn(s):
iYrirk exctudsx! by 3avr
~Jotr undcr 31,b00
�Bui3ding not oumer-tsc�u�ried
�Chvraer p�rliing owin peszsiit
�a:tser {sp�cit}'}
Noisce is hereby given thaac
O"WN�RS PtJLF.IFuG THE3R�twN PERMi?" QR DEr;LING WTTii UNREGISTERED
CC1M'RAGTQRS FUFL AF'PLfCABLE HQI�lE TMPRU VVE.�tEN`C WX.�RK Ut�NflT HAYE
ACGFSS TC7 THE ARBITRA71bN PRQGt�'AM OFt GUAliANTY FUN[7 lJNL7Eit MGL
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Sig�ed upder penaitics of per3uty:
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t hereby a 3 fox a rmit as tAe a ent nf the ow
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T)ate Registration 2do.
OIt:
Notwithstanding the atiove notice, 1 hercby appEy fpr a petmit as ti�e owoct csF the abav�pro�erty.
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Property Location:3 CARRIE LN MAP ID:50/152/// Bldg Name: Sta[e Use:1010
Vision ID:6256 Account#0665900 Bidg#: 1 of 1 Sec#: 1 ot 1 Card I of 1 Print Date:O]/18/2014 ll il0
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ILKINS,CHARLES O TRS 1 evel ublic Water 1 Paved Suburban �Descrip(ion � Code ���Appruised Vu[ue Assessed Yah�e �
ILKINS,VIRGINIA F eP��� ES LAND ]010 151,800 151,800 8!5
045 SHOOT FLYING HILL RD SIDNTL ]010 189,SW � 189,500
YARMOUTH,MA
ENTERVILLE,MA 02632 #tFp�i ��,Jj,,�j .' �
ddiHonalOwners: ��[herlD: � ��36/L008/// VOTE N ��
ISC 190 VOTE DATE01/19I2011
HANGES PRIVATE R(CARRIE LN-SY VISION
ETTERMENT
LAN NUMBEI405-A1
IP CODE 2664
lSID: 6286 ASSOCP/D# Tnta( 341,300 341,300
: ..��,na,.:d1� "Ul,l DP,"�:N�Y�'RS���1`�'!' . , .:� :r8 •.T✓f1/.jh'.�4�GE'. i�: � T � wSAL��'F,.R.ICB ,C `. .:+ : �.; �...i R&Vl ASSE1�� .'�'HZST /t �.- .'. ���=° ��
LKINS,CHARLES O TRS 7489/124 04/OS/1991 I Yc Code As,ressed Value Yr. Code As.sessed Vu/ue Yr. Code Assessed Va/ue
ILKINS CHARL69 O TRS I 0 013 1010 16Q100 012 1010 162,500 011 ]O10 172,600
013 10�0 185,600 012 ]O10 197,200 Otl ]O10 203,400
TntaL• 345 700 Tntal: 359 700 TutaG 376 000
' ...., . ...�: . �+. �<:� � ;p jpN' '�'. � ' '::.. .. ''.:'�. . ;'.':':': ', "fy�'.HER A5 �SM�'N�'S . ". .� .'�. This signature acknow[edges a visrt by a Data Co[/ectar ur Assessor
� Year T e Deseri lion Amaun! Code Descri (ion Numb¢r Amoun[� Comm.hU.�
� '� .��/.���-�i.,' $�1��..;.'k'
Appraised Bldg.Value(Card) 187,700
� �: � :,; �,;. ����.r .l�I�rH:$'�'k,�,�OLYl� :.�: ,., . . .. "'?. ... . ..::: .. . . '':il Appraised XF(B)Value(Bldg) 1,800
': . ;;, ..�,,: . .
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NBFlD/SUB NBFID Name Sireet Index Name Tracin Batch �Appl'aised OB(L)Value(Bldg) � 0
0070/A
� Appraised La�d Value(Bldg) 151,800
:;' .. .+...�' ..i; ..� ,... :i: ....�.�: .," .:. :ll'(17'Eifi.� .= i: . ..', .:t::Special Land Value 0
RMS
N-LAW APT ABOVE GAR To[al Appraised Parcel Value 341,300
APE STYLE RANCH Valua[ion Me[hod: C
ATURAL&GRAY � �
�$Q Adjustment 0
et To[al Appraised Parcel Value . 341,300
i,� .. �...., ': . �.::? °'.: gl'/I �'�RMITR C'UR� . . :: . ` , °.; `�J31�`�'� x�NGEH1�'' /�Y
Permi!ID Issue Dare T e e,scri lion Amaunt Ins .Da(e %Com . Dole Com . omrnettts Dale� T e /S /D Cd. Pur o.ve/Resu[f
130 03/04/1998 AD ddiNon 40,000 OS/27/1999 ]00 01/01/1999 AR,DECK,BROVER 5/14/2004 JB 00 easur+l,isted
5/27/1999 GM 00 easur+Liated
� 4/24/1996 PW 00 easur+Liated
i's .. ...t�' .,3.::.�.... ` :,,i: � :i , ; :': +4�.�(�TI� :S�*CZ',�{J7Y' .
,... � ... .. ,. . , . ;'� . . . '!:: :.:. :,'. ,,..�i .. ...� 'f .. . . r;;.��.°iI
B Use Use Uni! L Acre C ST. S ecialPricin SAdj
# Code Descriplion Z�ne D Front De th Onils PrYce Fae(or .q, p�y� Faeror /dx Ad'. Noles-Ad' S ee U.ce S ec Ca(c Fuet d'. Uni(Prlce Land�o1ue
1 10t0 INGLEFAM MDL-01 13,068 SF 6.12 1.0000 '7 1.0000 1.00 070 1.90 1�.00 11.62 151,800
Total Card Land Onifs: 030 AC Parcel Tolal Land Area: .3 AC Total Land Value: 151,800
Property Location: 3 CARRIE LN MAP/D:50/152/l l B/dg Name: State Use:]O10
Vision ID:6286 Account#0665900 Bldg#: 1 of 1 Sec#: 1 af 1 Card 1 oj 1 Print Date:01/18/2014 ll:10
Tx roa� �. >: v�v ' c�r ' arE c �, , ,,,, . . ;.;
,.:. , ,. .
Elemem Cd. CA. Devcription Elemen! Cd. Ch. Ducription -
Style 1 Ranch
odel 1 Residential 1z
rade 3 verage �.
tories 1 1 Story . WpK 12 PT� 1
ccupancy :.. '!� b: ��' 10 12
xterior Wa0 1 14 ood Shingle Code �Descri fiott � Percenlu�e 24 12 � 48
xterior Wa112 1/ lapboard 1010 INGLE FAM MDGOl 100 . .
oofStrucn�re 3 able/Hip FEP
oofCover 3 sph/FGIs/Cmp 12 � �
nterior Wall 1 5 rywalUShee[ FUS 12
� Interior Wa112 '�: faS ,� ,�"�`.. 1}�U�J.'�'/(j{�" 4 FGR 2 FOP 6 U M 2
In[crior Flr I 12 Hardwood Adj.Base Rate: 1.80
tcrior Flr 2 29,684
cat Fuel 2 �� ct Othcr Adj: 000.00 �
cat Typc 5 Hot Water R}pg ce Cost 985 a4 24 1$
C Typc 1 one 30
otal Bedmoms 3 Bedrooms Dep Code
otal Bthrms emodel Rating
otal Ha1fBa[hs car Rcmoddcd
otal Xtra Pixtrs ep% 0
o[al Rooms unctional Obslnc
ath Style 2 verage External Obslnc
'Ichen Style 2 odern Cosl Trend Factor
Condition
%Complele
Ove�al!%Cond U
pprais Val 87,700
ep°/a Ovr
Dep Ovr Comment
Misc Imp Ovr
Misc Imp Ovr Commenf
Cost to Curo Ovr
Coat to Cure Ovr Commant
; ... . a��z a� E�t� '�v�.€�a�n�r;�nr,�rtz���ma ;l�nr,v��rr�� aTerx,�s��j . . :
� Code Desc�i rion Sub SubDescri�t /B Unifs UnitPrice Yr Gde D Rt C�ad "/oCnd A rVulue
PLl IREPLACE 1 1 ,200.00 1992 1 100 1,800
No Photo On Record
" !:�;>EL7�/71N':S��$." `�U +1��4t�T'S,6CT�ON ,�' ' ,:'
_�.... ' ... !.,.:
Code Descrr (ion Livin Area Gross Arw E .Area Uni(Cost Onde rea �a[ue �
AS irstFloor 1,308 1,308 1�309 91.80 12Q074
EP orch,Enclosed,Finished 0 144 101 64.39 9,272
FGR arage 0 576 230 36.66 21,ll4
FOP orch,Open,Finished 0 48 10 19.13 918
US pper Story,Finished 576 576 576 91.80 52,877
O atio 0 IG4 7 4.46 643
BM asemen[,UnMished 0 1,308 262 18.39 24,052
DK eck,Wood 0 RO R 9.18 734
Ttl. Grnss Liv/Lea.ve Area: 1.884 4,184 2.502 234,684
;,s� F'�'A� . f�� �I,�(�.j�Z' �r-
� , �, ��r.��'[ T{�V�N OF �ARMC)LTTH
o =�,-:����, -� 1 '''"""777 ///
� MATTACM£E$ � '� �
���A�a,E�.��� App cation for a Permit to Build No.
UPON FINALAPPFiOVAL d� �-i�-�g- MAP _��' �OT ' � �
FEE MUST ACGQMPANY THIS APPLICATIQN. DATE 19 `�S'
The undersigned hereby applies for a permit to build � �94
according to the following specifications �,c/l�f,�
1. Nameofpropertyowner �jd� �h�, � f5.,�� �l Tei. �f'F�C-hRol
Address '��r-�:� � �i�� S�t.�.:
2.Name of Architect{if any) _ Tel. ��
3. Narneofbuilder C�i[�u. �}�Ui.0 AddressGl I�P.t.v �,,:�c.n �So '.�'n'�tS
4. �icense No.�2,`�2�—i,."�,�—_,_ Tel. .��- c7g�2
5. Name of Mason Address_
8. �Icense No. Tel. _
7. Canstruction address ��` C~c<.-rr3e ��..�,�i� �����-G-h �
8. Date af subdivisian A ravai Flood �., Z istrict � Z�
pp piain zane
9. Private dweNing,�1 EsTimated Gost �� DO NC1T WRITE IN THIS SPACE
1d. MuEti family O �=� �-'�� �� ��'�����'o Type of room No.
��� �{�a.�� n - .� ��,- .�
11. Cammerciai � �D �+�'-., �+ot� �'+ry Kitchen
�Sp."`� '�r,,,�-: � ",��� c4�.k S�Y� �g ri. Dining Rm.
12. Oiher O as„
� Living Rm.
13: No. of stories �2- „5`� Bed Rm. °�
14. Faundation — �ull ❑ Half ❑ Crawl ❑ Slab ❑ 1 �'S
� ��R �S, �D Bath
15. Materials — Wood ❑ Cement ❑ C7ther ❑ �s-, � Deck ��v��'
� �� Closed orch
18, Type ot heat — Oil ❑ Gas ❑ Electric ❑ Other p
17. Garage — 1 ❑ 2 ❑ � ���"''�� Family F?m.
r� �--,-� -roam
18. Swimming pool - Size j 9�,S�L� Garage p�
19. Storage shed — Size Shed
20. Stove — Waod 0 Coa! ❑ Aiterations
21. Size of lat: No. of feet front No. of feet rear No. of feet deep
22. Size of building. No, of feet front No. of feet side No. af feet rear
23. Distanc�from nearest building: Front Ft, side Ft. side Rear
24. Distance back from line or street From rear lat line Side line
25. H.I.C.R. No. !C�'1 �,��
LOT RELEASED BY Signature
PLANNING BOARD Address Cc.a 1f�.n-�.-t �-=
Date � '�?��,., r �, ►`Y� �2..���,a _
� 1.�'/�.,r' ���
�:
`ua� •- � `�-o��..-'f C.+-� l�lli�n,�j BUILDING PERMIT �l: J y f � �
�a,�� —
�;�q;; .3 C�2� � 1...,�.. 5 .y. TELE. N0. : �`�/��- U�� � DATE PILED": ��( �'-SY+
;ITE L4CATION: � �-S�L �r. �_ y. MAP1f: j� LOTf�: � �
OI,LOWING INFqRriATION 4UTLINES THE PROGEDURAL STEPS 12EQUZRED TO 4BTAZN A PERMZT TQ BUZLD,
y 0R ADD TO A STRUCTURE WITflIN THE TOWN OF YARMOUTH, THE BUILDING DEPARTMENT WILL AETER-
SCpMPLIANCE TO THE FOLLOWING {A} ZONING REQUIREMENTS (B} HI5TORICAL DISTRICTS (C} FLOOD
ZNS ZONING. THE BllZLDING DEPARTMENT WILL BE RESPONSIBLE FOR ASSISTING THE APFLICANT THOUGH
$E FOLLOWING DEPARTMENTS: �
RESIDENTZAL ANDJOR COMMERCIAL BUILDZNG
==WATER DEPARTMF:NT: DETERMINES COMPLIANCE OF WATER AVAILABILITY,
IIdGZNEERING DEPARTMENT: DETERMZNES COMPLIA23CE FOT{ FARRING AND DRAZNAGE.
CONSERVATION COMMISSION: DETERMINES COMPLIANCE TO WE7'LANDS ACTS, I.E. : IF LOT(S) BQRDER ANY
7RFE OF WE3'ZANDS, STR.EAMS, pOt3US, RZ4ERS, f?CEANS, BdGS, BAYS, HARSH
T,AND, ETC.
HF.LiI.TH DEpARTMENT: DETERMINES COMYLIANC� TO STATE AND TOWN REGULATIONS, I.E. : REQIIIRE-
MLNTS F4R 3EPTAGE DISP4$AL AND 4THER PUBLZG HEAT,TH ACTIYZTISS.
FIRE DEPARTMENT: _ DETER.`fINHS COMPLIANCE TU STATE ANU TpWN REQUIREMENTS EOR PERSONAZ
SAFETY, PROPERTY PR�JTECTZON: I.E. , SMOKE DETECTdRS, SPI2IATKLER SXSTEtL'
ETG.
_ _ _.._ ------------------------------------------�_�w.
TBE Fdl.LOWZNG DEPARTMENTS MIiST SZGN OFF, ZN THE RESPECTIVE ORI}ER, PRIOR 20 I3UZLDIPIG ZNSFEGTQR
ISSUING TEIE REQUIRED BUILDING PER'�SZT:
RE9IEFT�11 BY: �,,"�
i. WATER DliPARTMENT � �,Y vt,�QQ�, DATE: i�. ' (�' "gg N/A:
2. ENGINEERI2IG DEPARTt�SE:NT:� ,_ DATC: NIA:
3. C4NSERVATION: �DATE: NjA:
4. HEALTH DE�ARTMENT ,���� — ^DATE: �,- �.b-q�$, N/A:
INDI?STItIAL /4R COtQfEBCIAI. PERMYTS
5. WIRING FNSPEGTQR: DATE: N/A;
6. PLiJMBING INSPECTOR: DATE: N/A:
7. FIRE DEPARTMENT: DATE: NjA:
PLEASE NOTH
ALI. STUMPS ANDJQR BRUSH MOST BE DISPOSED OF AT AN APPRQVED 5ITB. A SZGNED RECEIPT FROM THE
DISPOSAL SITE MUST BE SiJBHITTED TO THE BUILDING DEPARTMkNT PRIOR TO ISSUANCE OF THE SUILDING
PER`iIT. /�, � �,.-�— /�
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