HomeMy WebLinkAboutBuilding PermitsP
i of Massachusetts
of Fire Services
FIRE PREVENTION REGULATIONS
Official Use Only
Permit No. F — 6( —0�/ g //
Occupancy and Fee Checked
[Rev. l 1/991 (leave blank)
PLI WorkION FOR PERMIT TO PERFORM ELECTRICAL WORK
� to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00
IN INK OR TYPE ALL INFORMATION)
City or Town of YARMOUTH
By this application the undersigned gives notice of his or her intention to
Location (Street & Number)
38 KELLEY ROAD, SOUTH Y
Owner orTenant RON DROULLETT
Date: 3/16/04
P the Inspector of Wires:
xforrit the electrical wok described below.
L447St;TN tf M E )
Telephone No.
Owner's Address SAME AS ABOVE
Is this permit in conjunction with a building permit? Yes No (Check Appropriat
Purpose of Building RESIDENTIAL Utility Authorization N
Existing Service Amps Volts Overhead Undgrd
New Service Amps Volts Overhead Undgrd
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work ROUGH AND FINISH OF GARAGE
SECONDARY TRIPLEX
Conneetion of the followine table may be waived by the Inroector of IVires.
4
Attach additional detail if desired, or as required by the Inspector of iVires.
yr INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee
provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that
such coverage is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE X BOND ❑ OTHER ❑ (Specify:) GENERAL ACCIDENT INS. 7/31/04
(Expiration Date)
11Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start 4/13/04 Inspections to be requested in accordance with MEC Rule 10, and upon completion.
AI certify, under the pains and penalties of perjury, that the information on this application is true and complete.
Pik IN
No. of hlc&4
No. of Recessed Fixtures
No. of Ceil: Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures
Above
Swimming Pool rnd. ❑ In- roil. ❑
o. o mergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners
-
No. of Detection and
InitiatingDevices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
No. or Waste Disposers
[feat Pump
Number
Tons
KW
No. of Self -Contained
_ _
Totals:
Detection/Alertin Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑ Municipal ❑Other
Connection
No. of Dryers
Heating Appliances KW
Security Systems:
No. of Devices or Equivalent
No. of Water KW
No. of No. of
Data Wiring:
Heaters
Si ns Ballasts
No. of Devices or Equivalent
No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring:
No. of Devices or E uivalent
OTHER:
`.' FIRM NAME:
REILLY ELECTRICAL CONTRACTORS, INC / RELCO
LIC. NO.:
V Licensee: JAMES J. REILLY Signature LIC. NO.: A 1¢fzfifi
p (Ifopplieable, enter "exempt" in the license number line.) Bus. Tel. No.: 508-771-2040
(j Address: 110 OLD TOWNHOUSE RD, SOUTH YARMOUTH, MA 02664 Alt. Tel. No.: 508-394-3211
y 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 a ent.FAX-508-760-1425
Owner/Agent PERM/T FEE: 50.00
ignature Telephone No.
I.X1 a GePY
TOWN O.F YARMOUTH
ENGINEMNO
1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSEM 02664 DEPARTMENT
TC1(508) 398-2231 — Fax (5087' 98-2365
STREETNUMBER CHANGES
PROPERTY LOCATION St_TK LAwE 4 XULLEV ROM>
TO: ,D1SrMtS0T10nt
ASSESSORS MAP_
PARCEL-47
DATE: I Z I ! 3! o4.
The street number for your building/dwelling was:
38 KELLEY PoAD•
This number has been changed and shall now be:
.45 Sark LANE
This number must be posted on the front of the building, preferably
at the front door, so that it may be visible from the road.
If you have any questions or problems with this newly assigned number,
please feel free to call the Engineering Department at 398-2231 as
soon as possible.
Routing:
1. Engineering Department
2. Assessors
3. Tax Collector
4. Town Clerk/Treasurer
5. Building Dept.
6. Health Dept.
7. Water Dept.
�. IZI13104.
940
-poN E 11) SoTH
CoV6ZAGES
1Z1131o4
NOTE: Please return this form to Engineering Department
x.c.: Owner ENG.D1v. D@bK
REG/pr- 1/93
Prk"d do PrcydDd P.P.,
3.
TOWN OF YARMOUTH
ENGINEERING
1146 ROUTE 28 SOUTH YARMou ni MASSACHUSETTS 02664 DEPARTMENT
TC1(508) 398-2231 — Fax (508) 398-2365
STREET NUMBER CHANGES
PROPERTY LOCATION SE7K LANE * XELLE1. ROAD
TO: �1 STft 1$UTla(� ASSESSORS MAP
PARCEL_
DATE: 121 131 04-
The street number for your building/dwelling was:
38 KELLEY PoAD.
This number has been changed and shall now be:
45 Srzri-t LAME
This number must be posted on the front of the building, preferably
at the front door, so that it may be visible from the road.
If you have any questions or problems with this newly assigned number,
please feel free to call the Engineering Department at 398-2231 as
soon as possible.
Routing:
1. Engineering Department
2. Assessors
3. Tax Collector
4. Town Clerk/Treasurer
5. Building Dept.
6. Health Dept.
. �,1�. ?211310¢
7. Water Dept.
NOTE: Please return this -form to Engineering Department
x. c.: Owner@ ENG. DjV. -DESK
REG/pr- 1/93
Prw.a on Recycled Piper
3.
OP ► TOWN OF YARMOUTH Building Department
(508) 398-2231 ext.261 BUILDING
......--
PERMIT NO FB-05-089. ........ _ PERMIT
�Ty ISSUE DATE ; _ 7116/2004 _ ; PROPOSED USE
APPLICANT ,Ronald orollett " " " " " " " " " " " P _ JOB WEATHER CARD
.....................
PERMITTO Addition
AT (LOCATION) 100038KELLEY RD ZONING DISTRICTE.40 Bldg. Type: Residential
SUBDIVISION MAP LOT BLOCK 1061.49 BUILDING IS TO BE: CONST TYPE ti-B USE GROUP R-4
LOT SIZE
CONTRACTOR
construct 18 x 12 deck as per plans dated
REMARKS
AREA (SO FT) EST COST ($ $3,000.00 PERMIT FEE ($)
OWNER IRONALD W DROLLETT SR BUILDING DEPT BY
ADDRESS 123 Churchill Road
Plympton MA 102367
INSPECTION RECORD
LICENSE 0
FIELD COPY
Date I Note Progress - Corrections and Remarks I Inspector
11
This Section for Office Use Only
Buildinq Per it urner
Date Issued:
Signature:
Certificate
is
of Occupancy
is not required
Building Officia Date
Section 1 - Site Information
I Use Group: R-4 Type: 5-B
1.1 Property Address:
1.2 Zoning Information:
Zoning District Proposed Use
1.3 Building Setbacks (it)
Front Yard
Side Yards
Rear Yard
Required
Provided
Required
Provided
Required
Provided
3o
O
zo
70
1.4 Water Supply (M.G.L. c. 40. S 54)
Public ✓ Private
1.5 Flood Zone Information:
Zone: BFE:
Comments:
Section 2 - Property Ownership/Authorized Agent
2. Owner of Record.
Name (print)
Signature
1 1
/
Mailing Address e Of
Telephone
Authorized Agent:
1 c
Name (print)
Signa Telephone
/ `%% G
Mailing Address
S2
Fax
Section 3 - Construction Services Ia9
3.1 Licensed Construction Supervisor:
1 J �s \�1�;
Not Applicable
t
Lien � I�i r,J I,'
Vrol
Address
x n ae
ILn:PIG p PT.
Signature Telephone
BY—���—
3.2 Registered Home Improvement Contractor:
Company Name
Not Applicable
License Number
Address
Signature
Telephone
Expiration Date
Z3G %
.36 7
1 of 2 OVER
Section 4 - Workers' Compensation Insurance Affidavit (M.G.L c. 152 S 25C (6)
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure
to provide this affidavit will result In the denial of the issuance of the building permit.
Signed Affidavit Attached Yes .......... No ..........
Section 5 - Description of Proposed Work (check all appgcable)
New Construction ❑ I No. of Bedrooms No. of Bathrooms
Existing Bldg. ❑ Repair(s) ❑ I Alterations ❑ AdditF ❑
Accessory Bldg. ❑ Type
Demolition
Other Specify:
Brief Description of Proposed Work:
Costs
Section 6 - Estimated Construction
Item
Estimated Cost (Dollars) to be
completed by permit applicant
Check Below
❑ Conservation -Commission Filing
(if applicable)
❑ Old Kings Highway & Historical
Commission approval
(if applicable)
1. Building
e^trC
2. Electrical
O
3. Plumbing / Gas
es
4. Mechanical (HVAC)
0
5. Fire Protection
CT
6. Total = (1 + 2 + 3 + 4 + 5)
3
7. Total Square Ft. (new houses & additions)
Section 7a - Owner Authorization -
Owner's Agent or Contractor Applies
To be Completed When
for Building Permit
as owner of the subject property
hereby authorize to act on .
my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
Section 7b - Owner/Authorized Agent Declaration
as Owner/Authorized Agent
hereby declare that the statements and information on the foregoing application are true and accurate,
to the best of my knowledge and belief.
Signed under the pains and penalties of perjury.
Print name
Signature o wner/ gent Date
/. 1
9-15-99
2of 2
°`YAk TOWN OF YARMOUTH
r "+o
r»...�.�s BUILDING DEPARTMENT
CONSTRUCTION SUPERVISOR FORM
PLEASE PRINT:
Job Location: 3g ri �
Nu r Street Village T
Owner of Property:
Construction Supervisor: wNal'
Name
Address:
Licensed Designee:
(If other than Supervisor)
Name
2.15 Responsibility of each license holder: _
-58 3G�
Phone No.
License No.
2.15.1 The license ]colder 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, 2.152 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 sicall 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=, please indicate the type coverage by checking the appropriate box.
A liability Insurance policy ❑ Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter 152 of the ass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner r Owner's Agent N, Owner Uff" 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: c\t Est. Cost 3 , crcr)
Address of Work
Owner Name:
Date of Permit Application: •:
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
Job under $1,000
Building not owner occupied
✓ Owner pulling own permit
Other (specify)
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH
UNREGISTERED CONTRACTORS FOR APPLICABLE HOME
IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION
PROGRAM OR GUARANTY FUND UNDER MGL c. 142A.
Signed under penalties of perjury:
I hereby apply for a permit as the agent of the owner:
Date Contractor Name
•'
Registration No.
Notwithstanding the above notice, I hereby apply for a permit as the owner of the above
property:
ate 0 ame
4._
..
The Commonwealth of Massachusetts
Department of Industrial accidents
excecll"astlpu/ois
600 Washington Street
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
g 1 am a homeowner performing all work myself.
0 I am a sole proprietor and have no one ssorking in any capacity
0 1 am an employer pro%iding workers' compensation for my employees working on thisjob.
company names
address:
city: phone #-
insurance co. policy #
0 I am a sole proprietor. general contractor. or homeowner (circle one) and have hired the contractors listed below ssho have
the follossin_ ssorkers compensation polices:
company names
address,
City: phone #-
Incn��nrn �� ,policy #
Failure to secure coverage as required under Section 25A of MGL 152 can lend to the imposition of criminal penalties of a Bae op to SIANA0 and/or
one years' Imprisonment as well as civil penalties in the form of s STOP WORK ORDER and a Bat of S100.00 a day against me. I understand that a
copy of this statement may be forwarded to the Oirice of Investigations of the DU for coverage verification.
I do ertijy under the �randpenaltici of perjury thal the information provided above is true and correct
Signature ate S h
Print name hone 34 7 Z—
official use only do not w rite in this area to be completed by city or Iowa official
city or town: YARMOUTIJ
❑ check if immediate response is required
contact person:
permit/liccase # nBuildiog Department
❑Llctusiog Board
261 ❑Selectmen's OBiee
❑Health Department
phone#t_ (508) 398-2231 eat. riOthcr
0ncd 7.05 PJA1
PLEASE PRINT:
DATE:
JOB LOCATION:
TOWN OF YARMOUTH
BUILDING DEPARTMENT
1146 Routc 28, South Yarmouth, NIA 02664 508-398-2231 ext. 260
HOMEOWNER LICENSE EXEMPTION
38 K.�Lk�
ti%a
.NAME STRhET ADDRESS SECTION OF TOWN
"HOMEOWNER";'i� Ry t 1.i— 1 b l — SEA •- 3 9l t S,;-N UM..., C
NAME HOME PHONE WORK PHONE
PRESENT MAILING A, Z'3
CITY OR TOWN STATE ZIP CODE
The current exemption for `Homeowner' was extended to include owner — occupied dwelling of one or two units
and to allow such homeowners to engage an individual for hire who does not possess a license, provided that such
homeowner shall act as supervisor. (State Building Code Section 108.3.5.1)
Definition of Homeowner:
Person(s) who owns a parcel of land on which he / she resides or intends to reside, on which there is or is intended
to be, a one or two Family attached or detached structure assessory to such use and / or farm structures. A person
who constructs more than one home in a two-year period shall not be considered a homeowner; such "homeowner"
shall submit to the building official, on a form acceptable to the building official, that he / she shall be responsible for
all such work performed under the building Nrmit. (Section 108.3.5.1)
The undersigned `homeowner' assumes responsibility for compliance with the State Building Code and other
applicable codes, by-laws, rules and regulations.
The undersigned `homeowner' certifies that he / she understands the Town of Yarmouth Building Department
minimum inspection procedures and requirements and that he / she will comply with said procedures and
requirements.
HOMEOWNER"S SIGNATURE
APPROVAL OF BUILDING OFFICIAL
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL Ch.142.
Yes ❑ No ❑
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required
by Chapter 42 of the Mass. General Laws and that my signature on this permit application waives this requirement.
Check one:
Owner or Owner Agent Owner (Agent ❑
h:homcownrlicexemp
BUILDING
TOWN OF Y A R M O U T H ELECTRICAL
GAS
1146ROUTE28 SOUTHYARMOUTH MASSACHUSETTS02664-4451
Telephone (508) 398-2231, Ext. 261 — Fax (508) 398.2365 PLUMBING
SIGNS
BUILDING DEPARTMENT
DEMOLITION DEBRIS DISPOSAL AFFIDAVIT
Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5,
I hereby certify that the debris resulting from the proposed work/demolition to be
conducted at 36 a 1a o A �_ 7v w" u T�
Work Address
is to be disposed of at the following location: 73 ChJy elt k j T4r7y"r=, v �qc,&
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
Signature of Appli Date
Permit No.
Building Site Location:
l9�
a, TOWN OF YARMOUTH
O BUILDING DEPARTMENT
BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF
TRANSMITTAL SHEET
3A Map No: ��_Lot No: eli
Proposed Improvement: w&,af't / X /a a-l��
Address:
The Building Department will be responsible for assisting the applicant
applicable departments.
1� QyS_Date Filed• .S o
dispatching your plans and or application to the following
ENTIAL AND/OR COMMERCIAL B
WATER DEPARTMENT:
Determines Compliance of Water Availability and or existing location.
ENGINEERING DEPARTMENT:
Determines Compliance for Parking and Drainage.
CONSERVATION COMMISSION:
Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of
Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc
HEALTH DEPARTMENT:
Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities.
FIRE DEPARTMENT:
Determines Compliance to State and Town Requirements for Personal
Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc.
REVIEWED BY:
V 1. WATER DEPARTMENT: DATE: N/A:,
2. ENGINEERING DEPARTMENT: DATE: N/A:
&/l CONSERVATION: DATE: N/A:
V4• IIEALTHDEPARTMENT DATE: N/A:
INDUSTRIAL AND/OR COMMERCIAL PERMITS
S. WIRING INSPECTOR DATE: N/A:
6. PLUMBING INSPECTOR DATE: N/A:
7. FIRE DEPARTMENT: DATE: N/A:
COMMENTS:
RECEIPT OF COPY:
PLEASE NOTE
SIGNATURE OF APPLICANT: DATE:
white copy - Budding Dept, - Pink copy -WataDept. - Yellow Copy -Health Dept - PiACM-Engineering Dclk - Goldenrod -FutD%tCooavcvatim
• N/F
Q 3
)-
3
THE STRUCTURE IS LOCATED IN ZONE "B"
JOSEPH J. ZONA
a
>- o ^
3
0 ^
AS SHOWN ON FIRM COMMUNITY PANEL
250015 0004 C EFFECTIVE DATE: 6/17/86
ASSESSORS MAP 61
o cq
tw
o ,_
N/F
PARCEL 50
W o N
Y
�-
N j
;o in
o cv
KEVIN W. OBRIEN
_
SE TH
o z
CL 2
ASSESSORSPARCEL 1�20 AP 70
LANE,
/
C'
(34 ►'RlVAC V L'
(NOT CONSTRUCTAY)
8 0
64•41'
-
Z
•, RTH
ED)
lRn n„•
Enq
NEW FOUNDATION
TOF=17.6' (HIGHES
N /F
RONALD W. DROLET SR.
ASSESSORS MAP 61
PARCEL 49
SC� TALIL
T — x
P
V` EXISTI
HOUS
`ftft� / /
o EXISTING
SHED Q I
O I3
:HI o :H
n
83.5' I
o�>
a
n W
0
o
a
W
FLOOD ZONE B 0 Q Q,
FLOOD Z NO E q Z I o-,
o J
BASS pRIVER
(TI
MEAN HIGH WATER
FLO(
C_-
r - 1 uy.
Z�0--V
=EEn
nQ
o La Q.
cn
Q
5 2V
23 CHURCHHILL RD
PLYMPTON
MASSACHUSETTS
02367
I HEREBY CERTIFY TO THE BEST OF THE BSC GROUP, INC
MY PROFESSIONAL KNOWLEDGE. ►vF 657 MAIN STREET WEST YARMOUTH MA.
INFORMATION AND BELIEF THAT THE ✓ �OFA�.��, 4
LOT CORNERS. DIMENSIONS AND �
DETERMINED�
BY INSTRUMENTSURVEYSURVEY ? CRAIGA. Ir CERTIFIED Sow' 1 'so
AND AS SHOWN ON THIS PLAN ARE FIELD PLOT PLAN
CORRECT. No.38039 E #38 DATE 9/19/03
KELLEY ROAD BSC# 4-8008.01
CRAI A. FIELD. PLS DATE , LAND t YARMOUTH
FOR THE BSC GROUP. INC. �vvy q MASSACHUSETTS r SHEET 1 OF 1
• _ TOWN OF YARMOUTH
Building Department
Town Hall
" Yarmouth, MA 02664
(508) 398-2231 exL261
BUILDING PERMIT
APPLICATION RECEIPT
Temp Permit No.: T-04-610
Applicant Name: Ronald Drollett.
Location: 00038 KELLEY RD
Owner's Name: RONALD W DROLLETT SR
Owner's Addres 23 Churchill Road
Plympton - MA 02367
Owner's Telephone: (781)585-8452
(OFFICE USE ONLY
Recorded By:
Ic
Permit Fee:
$0.00
Deposit Rec:
$25.00
Payment Type:
Cash ChkNo.: 0
Net Owed:
($25.00)
Application Date: 5/25/2004
Issue Date:
Expiration Date
Comments:
construct 18 x 12 deck
ZONING APPROVED
L z9,07
This is NOT a building permit. Application subject to plan review. Contact Building Department for permit status. Official
Building Permit will be issued upon plan review completion, approval, and complete payment of Net Owed on Permit Fee.
Printed: 6/16/2004
Building Site Location:
�\V
TOWN OF YARMOUTH
BUILDING DEPARTMENT
BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF
TRANSMITTAL SHEET
3��GI�L Sy Map No: Lot No: 46
Proposed Improvement: / t X % of
Address:
The Building Department will be responsible for assisting the applic
applicable departments.
WATER DEPARTMENT:
ENGINEERING DEPARTMENT:
CONSERVATION COMMISSION:
HEALTH DEPARTMENT:
FIRE DEPARTMENT:
Date Filed: 5
dispatching your plans and or application to the following
RESIDENTIAL AND/OR COMMERCIAL BUILDING
Determines Compliance of Water Availability and or existing location.
Determines Compliance for Parking and Drainage.
Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of
Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc
Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities.
Determines Compliance to State and Town Requirements for Personal
Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc.
PREVIEWED BY:
V1. WATER DEPARTMENT: DATE: N/A:
2. ENGINEERING DEPARTMENT:
P"S. CONSERVATION:
V4. HEALTH DEPAR
N/A:
S. WIRING INSPECTOR: DATE: N/A:
6. 'PLUMBING INSPECTOR: DATE: N/A:
7. FIRE DEPARTMENT: DATE: N/A:
COMMENTS:
RECEIPT OF COPY:
611W&114ORIUMITZ\9-2116 ik"
DATE:
Qf-g ((5�fF0dCD
White copy - Building DcpL - Pick copy - Water Dept - Yellow COPY - Haft DVL - Pink COPY - Engkcicriag Dept - Goldwod - Fiio I)cVJCooeQvrtim
7 2004
00•Yga,� TOWN OF YARMOUTH
oBUILDING
DEPARTMENT
BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF
TRANSMITTAL SHEET
Building Site Location:
as: Map No: __6V_Lot No: 411
Proposed Improvement: �1Jr31�Q1�i' / 6 ,i
Ads; a
70'/
The Building Department will be responsible for assisting the appitcanndispatching your plans and or application to the following
applicable departments.
RESIDENTIAL AND/OR COMMERCIAL BUILDING
WATER DEPARTMENT: Determines Compliance of Water Availability and or existing location.
ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage.
CONSERVATION COMMISSION: Determines Compliance to Wetlands Acts; i.e., If Lots) Border any Type of
Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities.
FIRE DEPARTMENT: Determines Compliance to State and Town Requirements for Personal
Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Eta
REVIEWED BY:
WATER DEPARTMENT: DATE: N/A:
2. ENGINEERING DEPARTMENT: DATE'. N/A
3. _ CONSERVATION: � T DATE /%.O N/A
HEALTH DEPARTMENT: DATE:
3. WIRING INSPECTOR DATE: N/A:
6. PLUMBING INSPECTOR DATE: N/A
7. FIRE DEPARTMENT: DATE: N/A:
[KIM)0',1aV
RECEIPT OF COPY: SIGNATURE OF APPLICANT.
DATE:
Whft Copy - BuMing DepL - PWk Copy - W&W Dept. - Yd1ow Copy - Hohh Dept - Pmk Cow • Eagmawing 13 Fat D o0
r •Ss. fi• W � .1 •. `n..Y4 � '
• .. Y.^'1 �.. .. ♦ Y. �r ♦ r.. .. .. � /Iv.r .r a �-1<♦. ♦•r'r •'�1.�!'1.♦..'.T V..ft )�1'.1
1 V •
1 1• 1
0�
o�
Building Site Location:
TOWN OF YARMOUTH
BUILDING DEPARTMENT
BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF
TRANSMITTAL SHEET
5-
v1
Proposed Improvement: %✓�' � j.1�:1 /.; a � k .i �,� dJ, ^ �
Address: d
No:—LI_Lot No:
G,2%, % Of
The Building Department will be responsible for assisting the applicant by dispatching your plans and or application to the following
applicable departments.
RESIDENTIAL AND/OR COMMERCIAL BUILDING
WATER DEPARTMENT: Determines Compliance of Water Availability and or existing location.
ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage.
CONSERVATION COMMISSION: Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of
Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities.
FIRE DEPARTMENT: Determines Compliance to State and Town Requirements for Personal
Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Eta
-------------------------------------------------------------------
--------------------------------------------------------------------------------
�REVIEWED„BY:
V
1. WATER DEPARTMENT:
DAM4QN/A:
2. ENGINEERING DEPARTMENT:
DATE:
N/A:
6. CONSERVATION:
DATE:
N/A
V 4 HEALTH DEPARTMENT:
DATE:
N/A:
INDUSTRIAL AND/OR
COMMERCIAL PERMITS
3. WIRING INSPECTOR
DATE:
N/A:
6. 'PLUMBING INSPECTOR
DATE:
N/A:
7. FIRE DEPARTMENT.
DATE:
N/A:
COMMENTS:
RECEIPT OF COPY:
PLEASE NOTE
SIGNATURE OF APPLICANT:
DATE:
White copy - Bmldmg Dept - Pick copy - Water Dcpt - Ydlow Copy - Health Dept - Pick Copy-Eogioewn Dept - GoWcowd - Fire DcpuConwvnb=
N/F
3 3 THE STRUCTURE IS
LOCATED IN ZONE "B"
JOSEPH J. ZONA
0Q
a >- AS SHOWN ON FIRM COMMUNITY PANEL
> o a- ^ 250015 0004 C EFFECTIVE DATE: 6/17/86
ASSESSORS MAP 61
00
,o �n �� N/F
PARCEL 50
Y b N iv, to
o N KEVIN W. OBRIEN
c T� _
ASSESSORSPARCEL 1^20 AP 70
^' c'
(34 PRI Vq -C V
(NOT CONCwAY)
' �
64.410
gTH
SU
TED
,
NEW FOUNDATION
`
TOF=17.6' (HIGHEST M
EXISTING
I
co
SHED >-
IQ
3
- Q � N/F �
Q ") RONALD W. DROLET SR.
�
O :R
I
2� o aN ASSESSORS
MAP 61
z
N
PARCEL 49
83.5• I
Z W a
to
W
W
0 , Q
n n
C)• -� 9 EXI S
S G
I A
�
o
J�
FLOOD ZONE
N N o
^ o
�4
B
FLOOD Z NO E A
a
a
1
7
\
Z C� 0
BANK
r
- OF COASTAL
o wa
BASSoRIVER
MEAN HIGH WATER
PREPARED FOR:
- RONALD DROLET
f 44 'r 23 CHUONHHILL RD
EBB MASSACHUSETTS
02367
I HEREBY CERTIFY TO THE BEST OF THE BSC GROUP, INC
MY PROFESSIONAL KNOWLEDGE. J� F 657 MAIN STREET WEST YARMOUTH MA.
INFORMATION AND BELIEF THAT THE ✓ OF
LOT CORNERS, DIMENSIONS AND
SETBACKS
DETERMINED eY INSTTRRUMENI STRUCTURE
•� cRAIGA. �•i CERTIFIED sCALE t'-so•
AND AS SHOWM ON THIS PLAN ARE r FIELD tA PL
AN LAN CORRECT. No.38039 DATE 9/19/03
fir- •..� 9�4�03 � �� KELLEY ROAD esct 4—soos.ol
CRAI A. FIELD, PLS DATE �►�`'���� YARMOUTH
FOR THE BSC GROUP, INC MASSACHUSETTS SHEET 1 OF 1
0 M4AAA:. J0 g qjamA Qua-/ 2r, A IL
VOFI) TOWN OF YARMOUTH Building Department BUILDING__.__, (508) 398-2231 ext.261
PERMIT NO B-03-1148PERMIT
ISSUE DATE 6/10/03 . _ ; PROPOSED USE
APPLICANT RONALD W DROLLETTSR JOB WEATHER CARD
ADDRESS '23 Churchill Road PERMIT TO Addition
AT (LOCATION) q5 ZONING DISTRICT R-40
SUBDIVISION MAP LOT BLOC 061.49 BUILDING IS TO BE OUP R-4
LOT SIZE CONSTTYPE 5-B C IT 'S
E E 0
addition: two car garage with storage above & master bedroom addition as per plans dated CO R'S NAM
REMARK 04/03103. Third garage bay subject to Attorney General bylaw approval.
AREA (SO FT) EST COST ($ $35,700.00 PERMIT FEE
OWNE RONALD W DROLLETT SR
ADDRESS 123 Churchill Road BUILDING DEPT BY
INSPECTION RECORD
FIELD COPY
Note Progress - C�orrectlons and Remarks
r �
•
� i ,
/
, w
r01
I 17C4' 9-0y
,8
ONE & TWO FAMILY ONLY - BUILDING PERMIT
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
Town of Yarmouth Building Department
1146 Route 28 - Yarmouth, MA 02664-4492
Tel: (508) 398-2231 x261 - Fax: (508) 398-2365
bHice Use Onl
Planning Board Information Assessors Department Informabon
PermitN3'03'1I �at �0
Plan Type Map' Rol Map f L
Endorsement Date' I "A
Permit Fee'^
"
Old lVew
lecordmg Date 1 4 Propertyi Dimensions
Deposit Reii'd a Data •�6�
$ 5'.
Plan Ho r
Net Due $`s V
:'
Other
;
"Lot Area (sf) Frontage (ft) : Lot Coverage ,.9
r This Section for Office Use Only,;
BUildin `Per ;Nu b .i " ' :: `'
iDate Issued.
` .-
Certificate of,Occupat a'
Signature
BuildingOtticial Date !
`
Is Is,not 'required ,
Sectlon 1 `Site'Informatio'6
Use Group: R-4 Type: 5-B
1.1 Property Address.
1.2 Zoning Information:
BudRcoM
Sr,ut6. /.� Q v no �"T�, 122in SS.
Zoning District Proposed Use
1.3 Building Setbacks (ft)
Front Yard
Side Yards
Rear Yard
Required
Provided
Required
Provided
Required
Provided
-30
Zo
70 = S
20
ioo
1.4 Water Supply (IN.O.L. c. 40. S 54)
11 5 Flood Zone Ipfor radon Comrpents
ublic Private
;^
..' Zone- l" BFE.
SectionPro erty:Ownership/AuthorizedA ent
2.1 Owner of Records
.1
' nV.Ab,`V� b
N e (print) Mailing Address
E31 S 8 S— -,3
Signature Telephone
2.2 Authorized Agents
Name (print) Mailing Address
'`
�.o`yvm r
Signature Telephone Ci
Section 3 -.Construction Services:
5_
3.1 Licensed Construction Supervisor.
Not Applicable 011,
License Number
Address
}Expiration Data
_
Signature Telephone
3.ZRe istered.Honie rnprovementiContractci:
JI
Company Name 2003
tApplicable
ense Number
Address
By
Expiration Date
Signature Telephone
Zae,7
A-
7-1.99 1 of 2 OVER
0`
a
Section 4 :.Workers' Com ensation Insurance Affidavit (M.'G.L c. 152 S 25C ( ))
y
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failua
to provide this affidavit will result in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes .......... No ..........
Section' 5'- Descri ion Lof Proposed Worki (check all,appiicable)
New Construction Existing Bldg. ❑ Repair(s) ❑ Alterations ❑ Addition
Accessory Bldg. ❑ Type Demolition Other Specify:
Brief Description of Proposed Work:
V C 2
Section 6 =`Estimated Constructlon Costs.
Item Estimated Cost (Dollars) to be Check Below
completed by permit applicant
1. Building 30. poo Conservation -Commission Filing
2. Electrical 34000 (if applicable)
3. Plumbing / Gas o O ❑ Old neat
aapp
4. Mechanical (HVAC) o o Commission oival
5. Fire Protection 2.o cs (if applicable)
6.Total=(1+2+3+4+5) �5
Section Tar- OwnerAuthorization = To be'Completed:When:
Owner'sAgeritor;Contractorkp' Iiesfoi;Buildin Permit ;-
I, , as owner of the subject property
hereby authorize to act on
my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
Section 7b'4'Owner/Autthor�ized Agent Declaration'
I,�(-9�i �^ as Owner/Authorized Agent
hereby declare that the statements and information on the foregoing application are true and accurate,
to the best of my knowledge and belief.
Signed under the pains and penalties of perjury.1
Print name
Signature o wnedAgent Date
7-1-99 2 of 2
-For Office Use Only
Permit No.
Date
TOWN OF YARMOUTH
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
MGL c. 142A requires that the 'reconstruction, alteration, renovation, repair, modernization, conversion,
improvement, removal,. demolition or construction of an addition to any pro -existing owner -occupied
building containing at least one but not more than four dwelling units or structures which are adjacent to
such residence or building' be done by registered contractors, with certain exceptions, along with other
requirements. I '
Type of Work: A �; C, tl Est. Cost -? 0 00 U
J
Address of Work
Owner Name:
Date of Permit Application: 3 2e. a
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded bylaw
Job under $1,000
uilding not owner occupied
Owner pulling own permit
Other (specify)
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR D19ALING WITH
UNREGISTERED CONTRACTORS FOR APPLICABLE HOME
IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION
PROGRAM OR GUARANTY FUND UNDER MGL c. 142A.
Signed under penalties of perjury:
I hereby apply for a permit as the agent of the owner.
Date
OR:
Contractor Name
Registration No.
Notwithstanding the above notice, I hereby apply for a permit as the owner of the above
property:
Tl..4..
The Commonwealth_ofMassachusetts
Department of Industrial Accidents
MCO0""atfpstlsss
600 Washington Street
Boston, Mass. 01111
'XY Workers' Compensation Insurance Affidavit
Applicantfnformaiion: PfeaicPR[N7`Tbds'IsT�
n
am a sole proprietor --d have no one workinc in any capacity
O 1 am an employerpro% iding workers' compensation for my employees working on this job.
insurance co. policy p
I am a sole proprietor. general contractor, or homeowner (circle one) and have hired the contractors listed below who have
the following workers' compensation polices:
Failure to secure coverage as required under Section 25A ofMt;L 152 can lead to the imposition ofertmlW penaitiea ota line op to 31400.00 aadlor
one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a tine of SI00.00 a day against ma I understand that a
copy or this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
t do •he - under the pain nd penalties of perjury that the information provided above is true and correct
Signature \ Date �3 �2 G 0 3
Print name A 1 hone 9 tr
official use only do not write in this area to be completed by city or town aMclal
city or town: YARMODTIi
❑ check if immediate response is required
permiNieease p nBuitdiag Department
❑Licensing Board
261 ❑Selectmen's Office
5nb% 3 0 -22 1 ❑Health Department
contact person: 9 phonep;_ ._ 3 exL. riOther
c
} y H
Cl
PLEASE PRINT-
DATE:
JOB LOCATION:
TOWN OF YARMO TH
BUILDING DEPART+IWENT
1146 Route 28, South Yarmouth, MA 02664 503-398-2231 ext. 260
HOMEOWNER LICENSE EXEMPTION
D"W• ffflll
CITY OR TOWN b.1 emu- %1vLM'
The current exemption for `Homeowner' was extended to include owner —occupied dwellings of one or two units
and to allow such homeowners to engage an individual for hire who does not possess a license, provided that such
homeowner shall act as supervisor. (State Building Code Section 108.3.5.1)
Definition ofHomeowner-
Persons) who owns aparcel of land on which he / she resides or intends to reside, on which there is or is intended to
be, a one or two family attached or detached structure assessory to such use and / or farm structures. A person who
constructs more than one home in a two-year period shall not be considered a homeowner, such `homeowner" shall
submit to the building official, on a form acceptable to the building official, that he / she shall be responsible for all
such work performed under the building permit. (Section 108.3.5.1)
The undersigned `homeowner' assumes responsibility for compliance with the State Building Code and other
applicable codes, by-laws, rules and -regulations -
The undersigned `homeowner' certifies that he / she understands the Town of Yarmouth Building Department
minimum inspection procedures and requirements and that he / she will comply with said procedures and
requirements.
HOMEOWNERS SIGNATURE • .
APPROVAL OF BUILDING OFFICIAL
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent, which meets the requirements ofMGL Ch-142.
Yes 0 No 0
Ifyou have checked}_es, please indicate the type coverage by checking the appropriate box.
A liability insurance policy 0 Other type of indemnity D Bond D
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter 142 of t e Mass. General Laws and that my signature on this permit application waives this requirement.
�— Check one:.
P ' Aaemt Owner (N Agent 0
0 TOWN OF YARMOUTH
G ,'� 1146ROUTE23 SOUTH MUOUTH MASSACHUSEITS02664-4451'
� MATTACH9ic�s� Telephone (508) 398-2231, Ext. 261 . Fax (508) 398-2365
aen.
BUILDING DEPARTMENT
DEMOLITION DEBRIS DISPOSAL AFFIDAVIT
BUnnMG
EUGUCAL
GAS
PiUWc
SIGNS
Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 1II.5,
I hereby certify that the debris resulting from the proposed work/demolition to be
conducted at 36.����-a-
WarkAddrem ,
is to be disposed of at the following location: r
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter Ili, Section 150A.
Signature ofApplicant
Permit No.
ate
w TOWN OF YARMOUTH
Building Department (OFFICE USE ONLY
Town Hall Recorded By. Ic
" Yarmoum, nnn o2ssa Permit Fee: $0.00
(508) 398.2231 exL261
Deposit Rec: $25.00
113
BUILDING PERMIT Payment Type: Cash ChkNo.: 0
Net Owed: ($25.00)
APPLICATION RECEIPT Application Date: 3/25/03
Issue Date:
Temp Permit No.: T-03-416 Expiration Date
Applicant Name: Ronald Drollett Sr.
Location: 00038 KELLEY RD
Owner's Name: RONALD W DROLLETT SR
Owner's Addres 23 Churchill Road
Plympton _ MA 02367
Owner's Telephone: (781) 585-3472
Comments:
addition: two car garage with storage & master
bedroom
ZONING AIM R0VED
616,
This is NOT a building permit. Application subject to plan review. Contact Building Department for permit status. Official
Building Permit will be issued upon plan review completion, approval, and complete payment of Net Owed on Permit Fee.
Date Printed: 3/29/03
.-,. +.-.. _ �+r �wy....¢..;rJ.�. -,is�`)+wy.k� S��•. ,r,.... �•.�,�.i,..•r..w:r.:.:Jf`�ifbCS.�`A1VAivf.iti:nl w.rt V7Ww+A•Mwy.�. ��.fw1i�^1a�ti t.�w ..
o� YAR TOWN OF YARMOUTH
BUILDING DEPARTMENT
O H
A" BUILDING PERMIT' APPLICATION DEPARTMENTAL SIGN OFF
TRANSMITTAL SHEET
Building Site Location:
Proposed Improvement:
Address:
The Building Department will be responsible for assisting the
applicable departments.
R
No: 6 / Lot No: -
by Dispatching your plans mJ W or to the following
RESIDENTIAL AND/Oi; AMERCIAL BUILDING
WATER DEPARTMENT: Determines Compliance of rater Availability and or existing location.
ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage.
CONSERVATION COMMISSION: Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of
Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public. Health Activities.
FIRE DEPARTMENT: Determines Compliance to State and Town Requirements for Personal
Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc.
.....................................................................................................................................................
REVIEWED BY:
I.
WATER DEPARTMENT:
DATE:
N/A:
2.
ENGINEERING DEPARTMENT:
DATE:
N/A:
3.
CONSERVATION:
DATE:
VA:
4.
HEALTH DEPARTMENT:
�/
OVATE—.
M
IND
R CO3 MERC L P
3.
WIRING INSPECTOR:
DATE:
N/A:
6.
PLUMBING INSPECTOR:
DATE:
N/A:
7. FIRE DEPARTMENT:
COMMENTS: I2
$rc KI
RECEIPT OF COPY:
SIGNATURE OF
PLEASE NOTE r
Ccc/-I-q 2 CZGl/`CJ�;
t N to
A vtlam° R . ewe -t-c w Sz OP.. t7j dFFt*!�
:ANT: DATE: F"t ..n
White cwy - BuDdmg Dept - Piak copy - Wata Dept. - Yellow COPY' Hahh DqL - Pick Copy - Fngkcmg Dpt• - Goldwad - Fire DcpL Convwation % I I
VE�
,3,7
FILE COPY
SD
SD SD
SD
l I I IS ,�Sl
-C 7-
�dr lt�/-Cy
f
t�y.Y
Di,J
rLoo.,P\
6 pj/ / S s
if/ v/,Z--/�
J�bL e-c /T
3y ,vc-ZZAE:y 16
1774
3a-T-a M
L/11/�c1 lfoom ,
nITol 60MP,rA4TII
Sp o
EfiTN
Roo n1
SD
ru�E
(,JoQ1(�b0/►1
FIRE DEPT.
f3 �DR�^1
SD
SD SD
yRct�
doom F1cDRoaq
�° I I I IS -�5I
r
6111j%�5 ,fj.vEe�
-v
s J
d U
3r
_b�OG,E71—
3 E� _6y /b
S.
a
3
� }sr
SD S ol►rtfjUIT774AJ
u
�v
/ sr �Loo)�
djj ss /Ft vE',
)9066c—IF
5 y�o�rN 1271.
L4p�,
aai�o �
LIVIAJgl'oOM ,
K r rc N COM&AMT11
Ct-oser
wms
SAD
WoPKSmm
BRTN
Raorl
1�5y5
0F.YAR`i
0 G
O` y
� '� •. ., 1, .i. � .. ., r'. ... Ip_yt .. •. ., r. ii. � .'.� 'a. 2.:%C (;;i.�.r ../\. i.�a .M.�tir.(w'�:i ... ..
TOWN OF YARMOUTH
BUILDING DEPARTMENT
BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF
TRANSMITTAL SHEET
Building Site Location: 3R Y6_ z !:
Proposed Improvement:
Address;
The Buil(
applicable departments.
No: 61 LotNo:.
74-Tel.No.:�Y� � 5 Date Filed
�is:
3 d patching your plans ator or application to the following
RESIDENTIAL AND/OR COMMERCIAL BUILDING
WATER DEPARTMENT: Determines Compliance of Water Availability and or existing location.
ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage.
CONSERVATION COMMISSION: Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of
Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities.
FIRE DEPARTMENT: Determines Compliance to State and Town Requirements for Personal
Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc.
REVIEWED BY:
1. WATER DEPARTMENT: I / Ytl �Q, DATE:.3 L-03 N/A:
2. ENGINEERING DEPARTMENT: DATE: N/A:
3. CONSERVATION: DATE: N/A:
4. HEALTH DEPARTMENT: DATE: N/A:
INDUSTRIAL AND/OR COMMERCIAL PERMITS
S. WIRING INSPECTOR: DATE: N/A:
6. PLUMBING INSPECTOR: DATE: N/A:
7. FIRE DEPARTMENT: DATE: N/A:
RECEIPT OF COPY:
-A, -
SIGNATURE OF APPLICANT: �^ DATE:
Whaespy-Bwld igDcpL - Pickw"- Wow Dept - YdbwCopy -Haft Dept - PiokCopy-E & Dcpt - Goldenrod - Fie DcptCbn9mvi n
Building S
Proposed)
AppL it -
Address:
The Built
applicable departments.
TOWN OF YARMOUTH
BUILDING DEPARTMENT
BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF
TRANSMITTAL SHEET
ZV—TelNo.: 4 6Y 15 Date Filed: �G
-7 3 `V7.�
patching your plans and or application to the following
RESIDENTIAL AND/OR COMMERCIAL BUILDING
WATER DEPARTMENT: Determines Compliance of Water Availability and or existing location.
ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage.
CONSERVATION COMMISSION: Determines Compliance to Wetlands Acts; i.e., If Lots) Border any Type of
Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities.
FIRE DEPARTMENT: Determines Compliance to State and Town Requirements for Personal
Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc.
.....................................................................................................................................................
REVIEWED BY:
1. WATER DEPARTMENT: DATE: N/A
2. ENGINEERING DEPAR'.
j 3- - 99N9&T[ON:
4. HEALTH DEPARTMENT DATE: N/A. -
INDUSTRIAL AND/OR COMMERCIAL PERMITS
S. WIRING INSPECTOR: DATE: N/A:
6. PLUMBING INSPECTOR: DATE: N/A
7. FIRE DEPARTMENT. DATE: N/A:
COMMENTS:
RECEIPT OF COPY:
SIGNATURE OF APPLICANT: DATE:
Whikcopy-BaJdmgDcpL - Pmkcopy-WaWDep[ - YdlowCoff-HafthDcpt - PlnkCopy-f;agiocaiogDcpt -j GodWorod. ireDgLCansavation.
TOWN OF YARMOUTH BUILDING DEPARTMENT
. PLAN REVIEW & BUILDING PERMIT APPLICATION REVIEW NOTES
ADDRESS:
Map /Lot: /T zo
Date ofInitial Review- 141-3 'Other Approval Date:
Inspector. 162�
NOTES:
1�17
10�.5
Ll
leo,
Zoning Denial (if applicable):
— — — Section 10432, pars.
nonconforming)
The proper �—iwnlires a Special
--Other
Building Code Denial (if applicable)
L
or Alteration //(/
'Iro�the Zoning Board of Appeal
Rev. 11-01
Building Site Location:
Proposed Improvement:
TOWN OF YARMOUTH
BUILDING DEPARTMENT
BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF
TRANSMITTAL SHEET
S',
The Building Department will be responsible for assisting the
applicable departments.
S
No: 61 Lot No: —�—
f 2ZTel.No.: W 47 5 Date Filed: 73
-7 3 117'2_�
fiispatching your plans and or application to the following
WATER DEPARTMENT:
Determines Compliance of Water Availability and or existing location.
ENGINEERING DEPARTMENT:
Determines Compliance for Parking and Drainage.
CONSERVATION COMMISSION:
Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of
Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc
HEALTH DEPARTMENT:
Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities.
FIRE DEPARTMENT:
Determines Compliance to State and Town Requirements for Personal
Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc.
....................
REVIEWED BY:
I.
WATER DEPARTMENT:
DATE:
N/A:
2.
ENGINEERING DEPARTMENT:
DATE:
N/A:
3.
CONSERVATION:
DATE:
N/A
4.
HEALTH DEPARTMENT
DATE:
N/A:
INDUSTRIAL AND/OR COMMERCIAL PERMITS
S. WIRING INSPECTOR: DATE: N/A:
6. PLUMBING INSPECTOR: DATE: N/A:
7. FIRE DEPARTMENT: DATE: N/A
PLEASE NOTE
COMMENTS:
RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE:
white copy - Budding DcpL - Pick copy - Wow Dept - Ydlow Copy • Heft DepL - Pink Copy -EngineerinB DcPL - Goldenrod - Fire DcpuCmsavrtioo
v
Important:
When filling out
forms on the
computer, use
only the tab
key to move
your cursor -
do not use the
return key.
6Q
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 2 — Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
A. General Information
From:
YARMOUTH
Conservation Commission
To: Applicant
Ron & Barbara Drollett
Name
23 Churchill Road
Mailing Address -
Plinn on MA 02367
Cityrrown State Zip Code
1. Title and Date of Final Plans sand Other Documents:
Property Owner (if different from applicant):
Name
Mailing Address
Cityrrown State Zip Code
Site plan for Ron & Barbara Drollett 1/24103
Tale Final Date (or Revised Date If applicable)
2. Date Request Filed:
i-q&n-i
B. Determination
Pursuant to the authority of M.G.L. c.131, § 40, the Conservation Commission considered your Request
for Determination of Applicability, with its supporting documentation, and made the following Determination.
Project Description (if applicable):
Construct an addition & garage to existing single family dwelling.
Project Location:
38 Kelley Road South Yarmouth
Street Address Cityrrown
61 49
Assessors Map(Plat Number Parcel/Lot Number
WPA Fam 2 Page t d 5
R" 1170)
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 2 Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Determination (cont.)
The following Determination(s) istare applicable to the proposed site and/or project relative to the
Wetlands Protection Act and regulations:
Positive Determination
Note: No work within the jurisdiction of the Wetlands Protection Act may proceed until a final Omer of
Conditions (issued following submittal of a Notice of Intent or Abbreviated Notice of Intent) has been
received from the issuing _authority (i.e., Conservation Commission or the Department of
Environmental Protection).
❑ 1, The area described on the referenced plan(s) is an area subject to protection under the Act.
Removing, filling; dredging, or altering of the area requires the filing of a Notice of Intent.
❑ 2a. The boundary delineations of the following resource areas described on the referenced
plan(s) are confirmed as accurate. Therefore, the resource area boundaries confirmed in this
Determination are binding as to all decisions rendered pursuant to the Wetlands Protection Act
and its regulations regarding such boundaries for as long as this Determination is valid.
❑ 2b. The boundaries of resource areas listed below are blot confirmed by this Determination,
regardless of whether such boundaries are contained on the plans attached to this Determination
or to the Request for Determination.
s
fan(sY'anddocrimen,(S)-_' within an areasubtect lo. `
protection under -the Ad:and will remove, fill, :dredge or alterthat area.Therefore said worts _
requires the filing ofa Notice oflntent
❑ 4. The work described on referenced plan(s) and document(s) is within the Buffer Zone and will
alter an Area subject to protection under the.AcLTherefore, said work requires the filing of a
Notice of Intent.
.l
❑ 5. The area and/or work described on referenced plan(s) and document(s) is subject to review
and approval by:
Name of Municipality
Pursuant to the following municipal wetland ordinance or bylaw:
Name
or Bylaw
WPA Porte 2
Rw JPKn
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 2 — Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 13,1, §40
B. Determination (cont.)
❑ 6. The following area and/or work, if any, is subject to a municipal ordinance or bylaw but no
subject to the Massachusetts Wetlands Protection Act:
❑ 7. If a Notice of Intent is filed for the work In the Riverfront Area described on referenced plan(s)
and document(s), which includes all or part of the work described in the Request, the applicant
must consider the following altematives. (Refer to the wetland regulations at 10.58(4)c. for more
information about the scope of alternatives requirements):
❑ Alternatives limited to the lot on which the project is located.
❑ Alternatives limited to the lot on which the project is located, the subdivided lots, and any
adjacent lots formerly or presently owned by the same owner.
❑ Alternatives limited to the original parcel on which the project is located, the subdivided
parcels, any adjacent parcels, and any other land which can reasonably be obtained within
the municipality.
❑ Alternatives extend to any sites which can reasonably be obtained within the appropriate
region of the state.
Negative Determination
Note: No further action under the Wetlands Protection Act is required by the applicant However, if the
Department is.requested to issue a Superseding Determination of Applicability, work may not proceed
on this project unless the Department fails to act on such request within 35 days of the date the
request is post -marked for certified mail.or hand delivered to the. Department. Work may then proceed
atihe owner,'s ruk'only upon.notice to the Department and. to the Conservation Commission.
f2equrrements for requests for3upersedrng Determrnatwns are listed at the end ?of this document..
' ❑ 71 The area described in the Request is not an area;subjeeito protection under. the Act or the
Buffe Zone
t
F -. ai Yi.%l1Y hJ �� �r< a F .• >""' 4A .r •-h wa++5:k+ i ,. M L �h 9 +. ..... 1 d 1`f
ih 1 Aj
t ❑ 2{The.workdesciibed rgthe itequest is within an area subject to protection under the A.:
ct, but will
not reiriove; fill, dredge,.or alter that, area.. Therefore, said, work does not require the filing of a
Notice of Intent:
® 3. The work described in the Request is within the Buffer Zone, as defined in the regulations, but
will not alter an Area subject to protection under the Act Therefore, said work does not require
the filing of a Notice of Intent, subject to the following conditions (if any). t
yi
❑ 4. The work described in the Request is not within an Area subject to protection under the Act
(including the Buffer Zone). Therefore, said work does not require the filing of a Notice of Inter
unless and until said work alters an Area subject to protection under the Act.
WPA Fam i
Rw MW
Massachusetts. Department of Environmental Protection
Bureau of Resource -Protection -Wetlands
WPA.Form 2- Determination of Applicability
4 JfAas"sachusetts Wetlands Protection Act M.G.L. c. 131, §40
�+ B. Determination (cont.)
❑ 5. The area.described in the Request is subject to protection under the Act. Since the work
described therein meets the requirements for the following exemption, as specified In the Act and
the regulations, no Notice of Intent is required:
Exempt Activity (site applicable statuatory/regulatory provisions)
❑ 6. The area and/orwork.described in the Request Is not subject to review. and. approval by:
Name of Municipality
Pursuant to a municipal wetlands ordinance or bylaw.
Name Ordinance or Bylaw Citation
C. Authorization
This Determination is issued to the applicant and delivered as follows:
❑ by hand delivery on
® by certified mail, return receipt requested on
2-10-03
I
Date Date
This Determination is valid for three years from the date of issuance (except Determinations for ,
.Vegetation_ Management Plates which are valid for th,a duration of the Plan) This Determination does not
-`.relieve the apphcant irom'complying with aA otherapplicable federal, state,or local statutes ordinances,
bylaws, or regulations L
I ThisDeteimrniGon in be signedby,a majonty of t#ie Conservation Comrrussron A copy nwst.be sent t
,n
to the: appropriate DEP Regional Office (see ppendiic A) andahe piopetty owner(if different from the
.applicant): D g atures
�r
27
•'��
_2-06-03
Date
WPA Form Z
Rev COM
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 2 — Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
D. Appeals
The applicant, owner, any person aggrieved by this Determination, any owner of land abutting the
land upon which the proposed work Is to be done, or any ten residents of the city or town in which
such land is located, are hereby notified of their right to request the appropriate Department of
Environmental Protection Regional Office (see Appendix A) to issue a Superseding Determination of
Applicability. The request must be made by certified mail or hand delivery to the Department, with the
appropriate filing fee and Fee Transmittal Form (see Appendix E: Request for Departmental Action
Fee Transmittal Form) as provided in 310 CMR 10.03(7) within ten business days from the date of
Issuance of this Determination. A copy of the request shall at the same time be sent by certified mail
or hand delivery to the Conservation Commission and to the applicant if he/she is not the appeAant
r The, request shall state dearly and concisely the objections, to_ the Determination which is being
r ' appealed. To the extent that the Determination is based on a "municipal ordinance or bylaw and not''
on the Massachusetts Wetlands Protection Act or regulations, the Department of Environmental
Protection has no appellate jurisdiction.
i
- r
r
tt
b 1 .Y �4 � 5
1 1
♦
I .r 3�
3 4
4
,IT
m m
if
f
,
WPA Fp 2
R" COM
t1' TAYLOR DESIGN ASSOC., INC.
28 Barnstable Road
HYANNIS, MA 02601
PHONE & fax:(508) 790.4686
JOB pRot.c�6�T� .� �o•¢TstJiOG
SHEET h0. I Of
CALCULATED BY T l -- 1
CHECKED BY N �
-` TAYLOR DESIGN ASSOC., INC. z o<.— -•'"
GHEET NO.---�----'
28 Bamstable Road — — — _ DATE
HYANNIS, MA 02601 ���A"TEoar
PHONE & tax:(508) 790-4686 ZZHECKEO BY
DArE
WOW M I A.* y.w X61 rv+14
• INC- S,IEET NO. C�
' Road
•---_ OAte:��_
7AYL0 8 Barnstab a (,kICULATFD RY��—��
MA 02601
-- DA1E
j; HYANNIS,
PHONE & fa(508) 790 4686
x:
i !;GALE �—
C.
V ✓J �O
1
j:
,
- 3a 49 Cz, (-J
3. k1`/
lZ K q.17� Si�
i
_ _3 i•�
fzrr$o
tom'
I ,
T--r C-7
' •
_
h�
I
�rC71,LC.�'
V Go4 G'Psr7
F1(.{Y12rA I Caµ. Skit MTI pna: 4
Manual of 4
STEEL
CONSTRUCTION
Allowable Stress Design
NINTII IiDIT10N
American Institute of Steel Construction, Inc.
II East Wacker Drive, Suite 3100
Chicago, Illinois 60601
I
I
I
2-120
Fy = 50 ksi BEAMS W 12
W Shapes
Allowable uniform loads in kips T
for beams laterally supported 1
For beams laterally unsupported, see page 2-146
-Designation_
_ W 12
W 12 1
W 12
Wt./ft
50
45
40
35
30
26
22
19
16
14-
Deflection
Flange Width
8'/s
8
8
6Yz
61/2
61/2
4
4
4
4
In.
L,
7.20
7.20
7.20
5.90
5.80
5.80
3.60
3.60
2.90
2.50
L
14.1
12.8
111
9.10
7.80
6.70
4.60
3.80
3.60
3.60
3
106
95
.03
94
82
4
128
114
D5
112
94
5
75
66
.07
6
150
128
112
93
78
63
55
.10
143
121
105
7
180
162
80
67
54
47
.14
8
141
125
106
92
70
59
47
41
.18
178
160
127
9
158
142
111
94
82
62
52
42
36
.23
10
142
128
114
100
85
73
56
47
38
33
28
11
129
116
104
91
77
67
51
43
34
30
.34
12
119
107
95
84
71
61
47
39
31
27
.41
13
109
98
88
77
65
57
43
36
29
25
.48
14
102
91
82
72
61
52
40
33
27
23
.56
15
95
85
76
67
57
49
37
31
25
22
.64
16
89
80
71
63
53
46
35
29
24
20
.73
17
84
75
67
59
50
43
33
28
22
19
.82
18
79
71
63
56
47
41
31
26
21
18
.92
4119
75
67
60
53
45
39
29
25
20
17
1.03
Y
o
u!
20
71
64
57
50
42
37
28
23
19
16
1.14
in
c
22
65
58
52
46
39
33
25
21
17
15
1.38
�.
a
24
59
53
%@
42
35
31
23
20
16
14
1.64
N
26
55
49
44
39
33
28
21
18
14
13
1.92
28
51
46
36
30
26
20
17
13
12
2.23
30
47
43
38
33
28
24
19
16
13
11
2.56
Properties and Reaction Values
& in ° 64.7 58.1 51.9 45.6 38.6 33.4 25.4 21.3 17.1 14.9
V kips 90 81 70 75 64 56 64 57 53 48 For .
R, kips 42.0 34.5 30.4 24.8 20.1 16.6 18.8 15.8 13.6 11.3 explanation
Ri kips/in. 12.2 11.1 9.73 9.90 8.58 7.59 8.58 7.76 7.26 6.60 of deflection,
R, kips 43.3 35.3 27.6 28.5 21.1 16.3 20.8 16.2 12.8 10.2 see page 2-W
R, kips/in. 4.68 3.91 3.01 3.00 2.33 1.89 2.42 2.20 2.42 2.15
R kips 60 49 38 39 29 23 29 24 21 18
Load above heavy line Is limited by maximum allowable web shear.
AMYAICAN IN571M6 OF S rcn. CONSTROC710N
W11
k: I
Designati
Wt./it
.A Rance Wi
Y•.
.e�-...: .�1YlNbe �rte.. a .._�.. _ .1�.�.=N- (._. ♦ ..5 i'33n,t:�-. Ftr r.-�row,.�vW
TTWIDE FLANGE (W) AND MISCELLANEOUS SHAPES (M)
A
(Continued)
I•-B-�I
Stocked in Lengths up to 60'. See Page 1 of this Section.
A
B
C
Weight.
Lbs.
AISI
Depth
Flange
Web
Designation
In
Width
Thickness
Per
20-Ft.
40-Ft.
60-Ft.
Inches
Inches
Inches
Fool
Length
Length
Length
M12 x 11.8
12.00
3.065
.177
11.8
236
472
708
W 12 x 14
11.91
3.970
.200
14.0
280
560
840
W 12 x 16
11.99
3.990
.220
16.0
320
640
960
W 12 x 19
12.16
4.005
.235
19.0
380
760
1140
W 12 x 22
12.31
4.030
.260
22.0
440
880
1320
W12x26
12.22
6.490
.230
26.0
520
1040
1560
W 12 x 30
12.34
6.520
.260
.30.0
600
1200
1800
W 12 x 35
12.50
6.560
.300
35.0
700
1400
2100
W 12 x 40
11.94
8.005
.295
40.0
800
1600
2400
W 12 x 45
12.06
8.045
.335
45.0
900
1800
2700
W 12 x 50
12.19
8.080
.370
50.0
1000
2000
3000
W12x 53
12.06
9.995
.345
53.0
1060
2120
3180
W 12 x 58
12.19
10.010
.360
58.0
1160
2320
3480
W 12 x 65
12.12
12.000
.390
65.0
1300
2600
3900
W 12 x 72
12.25
12.040
.430
72.0
1440
2880
4320
W 12 x 79
12.38
12.080
.470
79.0
1580
3160
4740
W 12 x 87
12.53
12.125
.515
87.0
1740
3480
5220
W 12 x 96
12.71
12.160
.550
96.0
1920
3840
5760
W12x106
12.89
12.220
.610
106.0
2120
4240
6360
W 12 x 120
13.12
12.320
.710
120.0
2400
4800
7200
W 12 x 136
13.41
12.400
.790
136.0
2720
5440
8160
W 14 x 22
13.72
5.000
.230
22.0
440
880
1320
W 14 x 26
13.91
5.025
.255
26.0
520
1040
1560
W 14 x 30
13.84
6.730
.270
30.0
600
1200
1800
W 14 x 34
13.98
6.745
.285
34.0
680
1360
2040
W 14 x 38
14.10
6.770
.310
38.0
760
1520
2280
W 14 x 43
13.66
7.995
.305
43.0
860
1720
, 2580
W 14 x 48
13.79
8.030
.340
48.0
960
1920
2880
W14x 53
13.92
8.060
.370
53.0
1060
2120
3180
W 14 x 61
13.89
9.995
.375
61.0
1220
2440
3660
W14 x 68
14.04
10.035
.415
68.0
1360
2720
4080
W14x74
14.17
10.070
.450
74.0
1480
2960
4440
W 14 x 82
14.31
10.130
.510
82.0
1640
3280
4920
W 14 x 90
14.02
14.520
.440
90.0
1800
3600
5400
W 14 x 99
14.16
14.565
.485
99.0
1980
3960
5940
W14 x 109
14.32
14.605
.525
109.0
2180
4360,•
6540
W14 x 120
14.48
14.670
.590
120.0
2400
4800
7200
W14x 132
14.66
14.725
.645
132.0
2640
5280
7920
W 14 x 159
14.98
15.565
.745
159.0
3180
6360
9540
W 16 x 26
15.69
5.500
.250
26.0
520
1040
1560 .
W 16 x 31
15.88
5.525
.275
31.0
620
1240
1860
W 16 x 36
15.86
6.985
.295
36.0
720
1440
2160
W16x40
16.01
6.995
.305
40.0
800
1600
2400
W 16 x 45
16.13
7.035
.345
45.0
900
1800
2700
W16x 50
16.26
7.070
.380
50.0
1000
2000
3000
tfiFmo
t
«C WIDE FLANGE (W) AND MISCELLANEOUS g
A (Continued)
1 l�B- l Stocked in Lengths up to 60' I$ee Page 1 of lhi•
B C •f Weight, LI
A Web
AISI Depth n"ge er 20-Ft. 4n
Width Thlcknw w
Designation Inch" inches Inche+ Foot Length Le
W 16 x 57 16.43 7.120 .430 57.0 1140 2
16.33 10.235 .395 67.0 1340 2
W16x67 W 16 x 7T 16.52 10.295 ..455
7.0 1540
780
365 .525 89.0 1
W16 10585100.0 2000
W 16x100 16.97 10.425
W 18 x 35 17.70 6.000 -300 35.0 700
W1BX40 17.90 6.015 -315 46 0 800
W 18 x 46 . 18.06 6.060 .360
920
W 10 x 50 17.99 7.495 .355 50.0 1000
.0 1100
W 10 x 55 18.11 7.530 '390
W 18 x 60 18.24 7.555 450 415 6o.o 1200
655.0 1300
W 10 x 65 18.35 7.590
W 18 x 71 18.47 7.635 .495 71.0 1420
W 18 x T6 18.21 11.035 .425 76.0 1520
WlBx86 18.39 11.090 .480 86.0 1720
18.511.145 5.0 10
W18x97 2120
W1Bxl06 18.73 11.200 90 .
W 18 x 119 18.97 11.265 .655 119.0 2380
W21x44 20.66 6.500 350 44.0 880
,405 57.0 1140
W 21 x 57 21.06 6.555 62.0 1240
W21x62 20.99 8.240 •4W 68.0 1360
W 21 x 68 21.13 8.270 .430
W21x73 21.24 8.295 .455 73.0 1460
W 21 x 83 21.43 8.355 515 83.0 1660101.0 2020
W21 x 101 21.36 12.290 •500
W24 x 55 23.57 7.005 .395 t 55.0 1800
W24x68 23.73 8.965 -415 68.0 1360
W24x76 23.92 8.990 .440 ". 76.0 1520
`
W24 x 84 24470 .10 9.020 84.0 168094 0 1680
W24x94 24.31 9.065 .515 104.0 2080
W24 x 104 24.06 12.750 0
.550 .0
W24x117 24.26 12.800 5506o5 ` 111717.0 2234340
W24 x131 24.48 12.855 650: 146.0 2920
W24 x 146 24.74 12.900
W24 x 162 25.00 12.955 .705 162.0 3240
W27 x 94 26.92 9.990 490 94.0 1880
W27 x 102 27.09 10.015 :515 102.0 204('
W27 x 114 27.29 10.070 .570 114 0 292'
W27 x 146 27.38 13.965 605
W 27 x 161 27.59 14.020 .660 161.0 322+
W30 x 108 29.83 10.475 .545 10B.0 216'
W30x116 30.01 10.495 .565 116-0 2332'
W30 x 124 30.17 10.515 .585 124.0
24
W30 x 132 30.31 10.545 .615 132.0 26
•
MAScheck COMPLIANCE REPORT
I
I
Massachusetts Energy Code
I
Permit #
MAScheck Software Version 2.01 Release 2
I
I Checked by/Date
I
I
CITY: Yarmouth
I
i
STATE: Massachusetts
HDD: 6137
CONSTRUCTION TYPE: 1 or 2 Family, Detached
HEATING SYSTEM TYPE: Other (Non -Electric Resistance)
DATE: 1-27-2003
DATE OF PLANS: 01/27/03
PROJECT INFORMATION:
Mr. & Mrs. Drollett
38 Kelley Road
S. Yarmouth 02675
COMPANY INFORMATION:
Northside Design Assoc.
141 Main Street
Yarmouth Port, MA. 02675
COMPLIANCE: PASSES
Required UA = 289
Your Home = 162
Area or Cavity
Cont.
Glazing/Door
Perimeter R-Value
R-Value
U-Value
UA
-------------------------------------------------------------------------------
CEILINGS 800 30.0
32.0
14
WALLS: Wood Frame, 16' O.C. 1726 15.0
14.0
78
GLAZING: Windows or Doors 131
0.320
42
GLAZING: Windows or Doors 20
0.320
6
DOORS 20
0.086
2
FLOORS: Over Unconditioned Space 675 32.0
0.3
20
----------------------------------------------------
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 requirements of the Massachusetts
Energy
Code.
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 design load as specified in
Sections 780CMR 1310 and J4.4.
Builder/Designer Date
Massachusetts Energy Code
MAScheck Software Version 2.01 Release 2
DATE: 1-27-2003
Bldg.
Dept.
Use
CEILINGS:
1. R-30 + R-32
Comments/Location
WALLS:
1. Wood Frame, 16' O.C., R-15 + R-14
Comments/Location
WINDOWS AND GLASS DOORS:
1. U-value: 0.32
For windows without labeled U-values, describe features:
# Panes Frame Type Thermal Break? [ ] Yes [ ] No
Comments/Location
2. U-value: 0.32
For windows without labeled U-values, describe features:
# Panes Frame Type Thermal Break? ( ] Yes [ ] No
Comments/Location
DOORS:
1. U-value: 0.086
Comments/Location
FLOORS:
1. Over Unconditioned Space, R-32
Comments/Location
AIR LEAKAGE:
Joints, penetrations, and all other such openings in the building
envelope that are sources of air leakage must be sealed. 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 cfm (0.944 L/s) 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.
VAPOR RETARDER:
[ ] Required on the warm -in -winter side of all non -vented framed
ceilings, walls, and floors.
MATERIALS IDENTIFICATION:
Materials and equipment must be identified so that compliance can
I• be determined. Manufacturer manuals for all installed heating
I and cooling equipment and service water heating equipment must be
I provided. Insulation R-values and glazing U-values must be clearly
I marked on the building plans or specifications.
I
DUCT INSULATION:
[ ] I Ducts shall be insulated per Table J4.4.7.1.
I
DUCT CONSTRUCTION:
[ ] I All accessible joints, seams, and connections of supply and return
I ductwork located outside conditioned space, including stud bays or
I joist cavities/spaces used to transport air, shall be sealed
I using mastic and fibrous backing tape installed according to the
I manufacturer's installation instructions. Mesh tape may be
I omitted where gaps are less than 1/8 inch. Duct tape is not
I permitted. The HVAC system must provide a means for balancing
I air and water systems.
I
TEMPERATURE CONTROLS:
[ ] I Thermostats are required for each separate HVAC system. A manual
I or automatic means to partially restrict or shut off the heating
I and/or cooling input to each zone or floor shall be provided.
I
HVAC EQUIPMENT SIZING:
[ ] I Rated output capacity of the heating/cooling system is
I not greater than 125% of the design load as specified
I in Sections 780CMR 1310 and J4.4.
I SWIMMING POOLS:
[ ] I All heated swimming pools must have an on/off heater switch and
I require a cover unless over 20% of the heating energy is from
I non-depletable sources. Pool pumps require a time clock.
HVAC PIPING INSULATION:
HVAC piping conveying fluids above 120 F or chilled fluids
below 55 F must be insulated to the following levels (in.):
HEATING SYSTEMS:
Low pressure/temp
Low temperature
Steam condensate
COOLING SYSTEMS:
Chilled water or
refrigerant
PIPE
SIZES
(in.)
TEMP (F)
2" RUNOUTS
0-1'
1.25-25
2.5-4"
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
CIRCULATING HOT WATER SYSTEMS:
Insulate circulating hot water pipes to the following levels (in.):
PIPE SIZES (in.)
NON -CIRCULATING I CIRCULATING MAINS & RUNOUTS
HEATED WATER TEMP (F): RUNOUTS 0-1" I 0-1.25' 1.5-2.0" 2.0+"
170-180 0.5 I 1.0 1.5 2.0
0 t 1,
140-160 0.5 0.5 1.0 1.5
100-130 0.5 0.5 0.5 1.0
----NOTES TO FIELD (Building Department Use Only)-------------------------
v
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Waterways Regulation Program W033409
Transmittal No.
Chapter 91 Waterways License Application - 310 CMR 9.00
Simplified, Water -Dependent, Nonwater-Dependent, Amendment
G. Municipal Zoning Certificate
Ronald Drollett
Name of Applicant
38 Kelley Road Bass River South Yarmouth
Project street address Waterway Cityfrown
Description of use.or change in use:
Construction of fixed pier with ramp and floats accessory to a single family residence.
To be completed by municipal clerk or appropriate municipal official:
'1 hereby certify that the project described above and more fully detailed in the applicants waterways
license application and plans is not in violation of local zoning ordinances and bylaws'
T am,rs
Prioted Name of
of Municipal
31 offi '
Tidal Tttt�
/C;) Cr d
Date
/V1 b
Cityfrown
COPY
CH91App.doc • Rev. 10102 Page 6 of 17
M.L.W. DATUM
PLAN
�> JOhrN C, SCALE: 1" = 40'
LOCUS MAP
CLE1: Y
LOT, AR,
I 58,000i S
11.3t AO
EXIST.
DA'ELL.
161
�115
1A ,
'82 Zc Sp Y4 28 � TI %A B
�4Y rl
O�'fl, �A �s4f�OClf 3»2
0. co � IIR' dE EHW
ON EXISTING
GRANITE WALL
x (EL. S.3') -kN of
/%\, q,
+ 9. 5
O
FT.
+-0.08 0� A��.
5 CIVIL
O No.3o792
��FSSIONAE f�
:W
:�
+ —1.27
tQ
y: W +-1.58
L2.93
i--0.01 112 0' 10'X 2.5' RAMP
ACCES
STAIRS +-1.87 +-4 31 (2)"
• N(8'X 12') i
6.0' c FLOATS
+0.04 ni A
0. >9
+-2.31
ko� �o o �ase,�4 A e�oAT ,•44U,yo
y RlJZS. +-5.87
/ >OR? �' BENCH MA
1--,�1 �� �' �rn cape engineering, hc.
BRASS DISK —3.47
)ATE: REG. LAND SURVEYOR MARKED "MAKI 1618S" C V L ENGINEERS
0. 0 ELEV. = 4.79 (MLW) LAND SURVEYORS
PLAN ACCOMPANYING PETITION OF 939 noh st ynrrauth na 02615
RONALD DROLLETT
AT #38 KELLY ROAD
TO CONSTRUCT AND MAINTAIN
A TIMBER PIER, RAMP. FLOATS d!:
BLOCK FALL IN AND OVER THE
WATERS OF BASS RIVER
YARMOUTH, MA.
SCALE. 1" = 40' OCTOBER 28, 200E
#01-221 SHEET 1 OF 2
EXISTING GRANITE BLOCK SEA WALL 10'x 2.6' RAMP
(TO BE RELOCATED) PIER
x4" POSTS DECK EL 6.0'1
IMLW. EL 0.0'
EXIST.
ILTER INTERLOCKING BLOCKS, BASE AT EL —1.0' GRADE
ABRIC
USE EXISTING GRANITE BLOCKS AS CAP lots PILINGS,
12' O.C. (TYP)
PIER PROFILE A— A (2) 12'x 8' FLOATS
1" = 20' Hok V
art ING-W-4541
TOP NEW ftx 309-3U-"M
GRANITE CAP HALL IV BE �
Ar ZLSV.
PROVIDE T. GRADE 5.50f wn tape eng/neerkV, Inc.
2px$'x4' / 0 ENGINEERS
L01YG 3' — 3.6'f ��N URVEYORS
INTERLOCKING ACE 02675
CONCRETE OJALA r
BLACKS. gA'dC CIVIL H
BASE AT $ No.30792
MIN.O. .ES A���FSfCISTEP�G���`�
S�ONAL
BLOCKS EL -1.0'
HIGH. PROP. `
GRANITE FILTER �(� g OZ
BLOCKS TO FABRIC _� �---- ---- ---- ---
C PUSED AS PROFILE OF PROP. WALL DATE: REc. LAND SURVEYOR
1" = 4' H d: V
/ CSK HEAD 2X6 DECK 3
1" SPACING
2-2X8 BENTS
2X6 DECKING ,
1" SPACING
2X6 BRACE
ELEVATION SECTION
PIER CONSTRUCTION DETAIL
RONALD DROLLETT 1" = 3' H & V
AT #38 KELLY ROAD
YARMOUTH, MA.
#01-221 SHEET 2 OF 2
2X6 STRINGER
518"0 H.D. GALV.
THRU BOLT
2X6 BRACES
10" PILING
12, O.C.
11
~ FIELD COPY
i
BUILDING
PERMIT
DATE 11/17/1999 19 PERMIT NO. B-00-342
APPLICANT DONALD C. TAYLOR ADDRESS 30 ROM Us YARPORT 000051
(NO.) (STREET) (CONTR'S LICENSE)
PERMIT TO W1IIdOV5/RF?iODII. NUMBEOF
(—) STORY DWELLRING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
AT (LOCATION) s
38 Ki JM ROADS SOUTH YARMOOTH MISS. 02664 ZONING
DISTRICT R-40
(NO.) (STREET)
BETWEEN AND
q (CROSS STREET) (CROSS STREET)
m
m OT
SUBDIVISION 61/49 LOT t-10 BLOCIF�" 53 SIZ
0
O BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
- m
O
= TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
f
0 (TYPE)
° REMARKS: REPLACE 1 STTNG NiNII[R 9 WITH NEW (15) VMM.ACE Si KGI.RS AND REPATRq AS XMTM
I
AREA OR PER
VOLUME ESTIMATED COST $ 8 500.00� FEEMIT $ 7 0
(CUBIC/SQUARE FEET)
OWNER RON D80LEM
ADDRESS 23 QWRailU ROADS PLMRTONS MA BY
BUILDING DEPT
i
DATE
INSPECTION RECORD
NOTE PROGRESS CORRECTIONS AND REMARKS
INSPECTOR
M'JP it l
ONE & TWO FAMILY ONLY - BUILDING PERMIT c-, yF
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
Town of Yarmouth Building Departinent
1146 Route 28 • Yarmouth,111A 02664-4492
Tel: (508) 398-2231 x261 - Fax: (508) 398-2365
Office Use Only Q
Permit No.&1i� 7-Date ��U
Permit Fee $ %�� J "
Deposit Rec'd. $/0,- Date 'fir
Net Due $ 6 Q, uo
Planning Board Information
Plan Type
Endorsement Date
Recording Date
Plan No.
Other
Assessors Department Information:
M Cot Map Lot
S
o/d New
1.4 Property Dimensions:
Lot -Area (so Frontage(It) Lot Coverage
This Section for Office Use Only
Building Permit Number:
Date Issued:
--
Signature:� 07 4�1iSA-5
Certificate of Occupancy
is is not _required
—Id�Ji+
Buildin fficial ab to
Section 1 - Site Information
I Use Group: R-4 Type: 5-B
1.1 Property Address:
3s 6L
1.2 Zoning Information:
2-
Zoning District Proposed Use
1.3 Building Setbacks (It)
Front Yard
Side Yards
Rear Yard
Required
Provided
Required
Provided
Required
Provided
/00-F
/004
/0
1.4 Water Supply (M.G.L. c. 40. S 54)
Public Private
1.5 Flood Zone Information: Comments:
Zone: - BFE:
Section 2 - Property Ownership/Authorized Agent
2.1 Owner of Record:
%DV Z=j
Name (print) M IingAddress
Pi. y n�-o •a r Z.96
Signature Telephone
2.2.A@Luthorlzed Agent_ ? 3 2- -V s
dVOWAM C. a
Na (print) Mailing Address
36 2 - �� y3 ft2�/oti,�d
Signature Telephone
A
nl
Section 3 - Construction Services
3.1 Licensed Construction Sisor:
tot
Applicable ❑
By o� .
4wo4,7-aA0,e7Xt-04G75
License Number _
Address
- / 23
Expiration Date _
Si a e ephone
3.2 Registered Home Improvement Contractor:
Compan Name
-041Ad-P 074—
Not Applicable ❑
License Nurnper�/
Address Jy L /1�%rN S // 11, O,C'7
,/ y� 36 7, 4v/ Z 3
Signature �ti one
Expiirralii n Date/
D ( 00
9- 15-99 r / 1 of2 ' I OVER
Section 4,- Workers' Compensation Insurance Affidavit (M.G.L c: 152 S 25C (6)
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure
to provide this affidavit will result in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes ......... No ..........
Section 5 - Description of Proposed Work (check all applicable)
New Construction I No. of Bedrooms No. of Bathrooms
Existing Bldg. ❑ Repair(s) Er I Alterations I Addition ❑
Accessory Bldg. ❑ Type
Demolition
Other Specify:
Brief Description of Proposed Work:
;60066 gr,571 A & Jd1,w0ws c•/'Tsl IVC-W r/5> /i/o
IQCHo✓t i c�l,9tt I/aE ,�J,9cc W cea.9,G Sh'/N64L4S o.t/ tU! utG
S—Ieq C. IU/f 1E tj410 HAeC foa,as 45 A16e0&h ,44ba /S ezr7%AZE
II'm �5vnC o r 4Zc,ft4-77OW—C o 71741
E1(T�.1/T/o•r/ ooT/Q/•✓T X/STi.✓G GOG.
Costs
55-2)0, 01
Section 6 - Estimated Construction
Item
Estimated Cost (Dollars) to be
completed by permit applicant
Check Below
❑ Conservation -Commission Filing
(if applicable)
❑ Old Kings Highway & Historical
Commission approval
(if applicable)
1. Building
95o8, oa
2. Electrical
N/it
3. Plumbing / Gas
Al A-
4. Mechanical (HVAC)
5. Fire Protection
N ,4-
6. Total = (1 + 2+ 3+ 4+ 5)
g 11,o o i o o
7. Total Square Ft. (new houses & additions)
Section 7a - Owner Authorization -
Owner's Agent or Contractor Applies
To be Completed When
for Building Permit
I, oa ec tAr"'f , as owner of the subject property
hereby authorize aAI A LD L to act on
my behalf in all matters rq4afilye to work authorized by this building permit application.
SignJt4e 94 Owner Date
Section 7b - Owner/Authorized Agent Declaration
as Owner/Authorized Agent
hereby declare that the statements and information on the foregoing application are true and accurate,
to the best of my knowledge and belief.
Signed under the pains and penalties of perjury.
Print name
Signature of Owner/Agent Date
9 - 15. 99 2 of 2
SUBMITTAL REQUIREMENTS/CHECK LIST FOR BUILDING PERMITS
New Structures
Application signed by the owner and owner's authorized representative/construction supervisor. Application shallinclude:
:onstruction Supervisor's License, Workers Comp. Affidavit/Certificates, Home Improvement Affidavit.
.Four certified site plans, stamped by a Mass. Registered Professional Land Surveyor, showing all boundaries, proposed
_tbacks, existing & proposed grades/contours, proposed location of structure(s), parking, curb cuts, drainage, impervious
over calculations (when applicable), flood zone and Title V design and any other zoning related details deemed necessary.
. Three sets of complete construction plans, including a complete structural cross section, floor plans, use of rooms,
'imensions, window & door schedule, HVAC details- electrical, plumbing &: mechanical plans are also required for
ammercial & multi -family (3 units or more) structures.
. Flood zone applicability -Compliance with Section 3107 of the State Building Code —Elevation or flood proofing
ertifi'cates (whichever is applicable), shall be submitted prior to the issuance of a certificate of oeeupanry.
Plans shall be reviewed by.the following departments: Health, Engineering, Fire & Conservation (when applicable). The
uilding Department will forward.
Old Kings Highway & Historical Commission (when applicable).
Mass. DPW approval for State Highway curb cut and access ways.
Construction control affidavits for all projects to be constructed or altered under the provisions of Section 116 of,the State
uilding Code. Buildings containing 35,000 cubic feet or more. One & two family structures are exempt, except, certified
:signs may be required for unusual structural circumstances. Section 3107 of the Building Code requires certified plans for
..w and substantially improved structures in flood zones.
Additions
Same as above, except the blank generic "Plot Plan" available from the Building Dept., may be used for one & two family
ructures, when setbacks are not marginal.
Flood zone applicability When the value of improvements equals or exceeds 50% of the structure's value (substantial
iprovements).
Alterations
Same as above, except existing & proposed conditions shall also be shown on the plans.
D WORK IS TO COMMENCE UNTIL THE BUILDING PERMIT HAS BEEN ISSUED. Filing a building permit
iplication does not imply approval and should not be construed as permission to begin work
ily 1, 1999 (a)
BUILDING
TOWN OF Y A R M O U T H ELECTRICAL
GAS
1146ROUTE28 SOUTHYARDIOUTH MASSACHUSETTS026644451
Telephone (508) 398-2231, Ext. 261 — Fax (508) 398-2365 PLUMBING
SIGNS
BUILDING DEPARTMENT
DEMOLITION DEBRIS DISPOSAL AFFIDAVIT
Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5,
I hereby certify that the debris result' g from the proposed work/demolition to be
conducted at
Wort 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.
ItIvd dI I
Date
Permit No.
TOWN OF YARMOUTH
0 BUILDING DEPARTMENT
nBUILDING PEERRMIT APPLICATION SIGN OFF
1
Applicant:
Building Permit No.:
Address: �3 Z /i�.ti� S f' „e�OL� t� el. No.: 7,62,- Z'3 Date Filed: �9 �� �`'a/
Bldg. Site Location: 3�ES. Map No.krr s`s Lot No.: W 1v
The following information outlines the procedural steps required to obtain a permit to build, alter, or add
to a structure within the Town of Yarmouth. The Building Department will determine compliance to the
following: (A) Zoning Requirements (B) Historical Districts (C) Flood Zones. The Building Department
will be responsible for assisting the applicant through the following departments:
RESIDENTIAL AND/OR COMMERCIAL BUILDING
WATER DEPARTDIENT: Determines Compliance of Water Availability. (applicant to obtain)
ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage.
CONSERVATION CONMUSSION: Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type
of Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc.
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements
for Septage Disposal and other Public Health Activities.
FIRE DEPARTMENT: Determines Compliance to State and Town Requirements for Personal
Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc.
----------------------------------------
The following Departments must sign off, in the respective order, prior to building inspector issuing the required
building permit:
REVIEWED BY:
1. WATER DEPARTMENT: �"� DATE: 4 N/A:
2. ENGINEERING DEPARTMENT: DATE: N/A:
3. CONSERVATION: DATE: N/A:
4. HEALTH DEPARTMENT: DATE: N/A:
INDUSTRIAL AND/OR COMMERCIAL PERMITS
5. WIRING INSPECTOR:
6. PLUMBING INSPECTOR:
7. FIRE DEPARTMENT: —
PLEASE NOTE
All stumps and/or brush must be disposed of at an approved site.
COMMENTS:
DATE:
N/A:
DATE:
N/A:
DATE:
N/A:
8/99 Applicant Signature Date
0
PLEASE PRIAT.-
job Location: _
TOWN OF YARMOUTH
BUILDING DEPARTMENT
CONSTRUCTION
� SUPERVISOR FORM
if, 'J/Cat/ / ' e-.71 111-4,ZAov7'�
Owner of Property:
Construction Supervisor:
Address:
Name
Licensed Designee:
(If other than Supervisor) Name
Street
C.L £ r
2.15 Responsibility of each license holder:
No.
Village
License No.
Phone 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 willfully violate subsections 2.15.1, 2.15.2 or 2.15.3 or any other section of these
rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of
license by the board.
2.16 All building permit applications shall contain the name, signature and license number of the
construction supervisor who is to supervise those persons engaged in construction, reconstruction,
alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and
regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately
cease until a successor license holder is substituted on the records of the building department.
2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may
be deemed a violation of the permit conditions.
I have read and understand my responsibilities under the rules and regulations for licensing construction
supervisors in accordance with section 109.1.1 of the state building code. I understand the construction
inspection procedures and the specific inspection as called for by the building official.
INSURANCE COVERAGE:
have a curve lability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152
Yes e No ❑
If you have checked yu, please indicate the type coverage by checking the appropriate box.
A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑
OWNgR' INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Cha er 52 of the Mass Gener Laws, and that my signature on this permit application waives this requirement.
i_/ /r / Check one:
of Owder or
Owner ❑ Agent Cr0000"
Signature: Building Official Approval:
The Commonwealth of Massachusetts
Department of Industrial accidents
Of esOfl"OStf MINI
600 Washington Street
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
Applicant information: PleasePRiPTP7t•dr'bhr
Inentinn• r f—irL1-:v A/
O 1 am a homeowner performing all work myself.
O 1 am a sole proprietor and hase no one %yorkine in any capacity
1 am an employer pros iding workers' compensation for my employees working on this job.
emmnanv name r /-5.t1*L,0
- — /1%r/ &/ S -f' r
6 Z. y-,
r
insurance eo.
I am a sole proprietor, general contractor. or homeowner (circle one) and have hired the contractors listed below who hase
the follouin_ ssorkers' compensation polices:
company name•
uty: phone N•
Failure to secure coverage as required undtr Secaoo 25A of MGL 152 can lad to the imposition of erimi_al penalties of a Doe up to 51AMA0 ■ndlor
one years' Imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a floe of SI00.00 a day against me. I aaderstaad that a
copy of this statement may be forwarded to the Once of Investigations of the DIA for coverage verifiatioa.
I do hereby eertif - un)fer the pal" and
Print name
FA
the information provided above Is true and correct
official use only do not w rite in this area to be completed by city or town official
city or town: YARMOOTIJ
p check if Immediate response is required
Contact person:
permit/license N nBuilding Department
pl.lcensing Board
261 Oseleetmen's Office
phone N; _ (508) 398-2231 eat. pNealtb DepartmentnOther
In•ned 3,95 %At
Information and Instructions
Massachusetts General Laws chapter I52 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 errrplorer is defined as an individual. partnership. association. corporation or other legal entity, or any two or more of
the foreeoine 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 dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another aho 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.
MGI_ chapter I section 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 am of its political subdivisions shall enter into am contract for the
performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter ha%e
been presented to the contracting authority.
Applicants
Please till in the workers' compensation affidavit completely, by checking the box that applies to your situation and
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 workers' compensation policy. please call the Department at the number listed below.
City or Towns
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of
the affidavit for you to fill out in the event the Office of investigations has to contact you regarding the applicant. Please
be sure to fill in the permit/license number which will be used as a reference number. The 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
Imce of laves"I ttleos
600 Washington Street
Boston, Ma. 02111
fax #: (617) 727-7749
phone #: (617) 7274900 ext. 406, 409 or 375
. Suggested Affidavit for Home Improvement Contractor Permit Application
For omce Use only /NAME OF/;I7Y/TOWN
Perrnit 1o.
Date
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
NGLc.132Arcquires that the "reconstruction. alteration renovation rMir modernizat ion. conversion. innmvemem. removal. demolition.
nrccnstructinn of an sdditinn to any rretctstine nwner-Occuvted huddin r con tamme at least one huI nnt more than four dwellmr units .... or
to structures which are adjacent to such residence or hutldinr' be done by rcetstered contractors. with certain exceptions, along with other
requuemcnu. n ,
Type ofWork•i5rfifr+6tf,/ NCe ✓ U),-V4P�%-5 Est. Cost 8'SUU
Address of
/,
Owner Name: %1pr✓
Date of Permit Application:
I hereby certify that:
Registration is not required for the following rcason(s):
_Work excluded by law
_Job under SI.000
_Building not owncr-occupied
_Owner pulling own permit
_Other (specify)
Notice is herebv given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL
c. 1d2A.
Signcd under penalties of perjury:
I hereby apply for a permit as the agent of the owner:
od l%lwr �o
.tl9ld (j
Date Contractor Name Rceistration No.
MR
Notwithstanding the above notice. I hereby apply for a permit as the owner of the above property:
Da1e Owner Name
INSPECTION SCHEDULE
NEW CONSTRUCTION, ADDITIONS , & ALTERATIONS
The receipt of a building permit is not the end of the permit process, but rather the beginning. The
building permit holder is responsible for arranging the required inspections before proceeding with
additional work. Failure to do so may result in having to exposure concealed work through the partial or
complete removal of some building elements, causing you delay and unnecessary expense.
It is imperative that you arrange for the following inspections by either calling 508-398-2231, extension
261, or make a personal request at our office, at least 48 hours in advance:
FOUNDATION
• Before concrete floor is poured
• Before backflll
• Before first deck is constructed
• Auer dampproof ng
• After perimeter drain has been installed
• After certified "as built" site plans have been submitted
• After certified flood zone elevations have been submitted (when applicable)
Note. When proposed plans specify re -enforcement rod installation or
other unique design criteria, you are required to call for an inspection prior
to pouring the concrete. In some cases, a separate inspection may be
required fora strata/soil or footing inspection.
FRAME
• After rough electrical, plumbing & gas approvals have been made
• Before insulation
• After being made tight to the weather
FIREPLACE/CHIMNEY
• When smoke chamber is complete
• when chimney is complete (maybe inspected with frame)
• Final
INSULATION
• After building envelope is completely insulated
FINAL
• After all other inspections have been approved
• After electrical, plumbing, gas, & fire inspections have been approved
• After all applicable Historical applications have been completed
• After an applicable flood elevation certificate has been submitted
G
k i
TOWN OF YbRMOUTH
,
APPLICATION FOR PERMIT TO DO GASFITTING
(OFFICE USE ONLY)
By —
Fee: $ `>
PERMIT NO. -too -ro X
Building Owner's
AT: Location �3� jyELL�% Name ,� D/1A7'T—
s
Type of Occupancy I VET1&)2
New ❑ Renovation Replacement ❑
Plans Submitted Yes ❑ No ❑
y
N
W
Cn
CKgUe
En
ccVo:
cc
O
¢o
cc
W
OF
t�
m
H
N
(7
_J
O
Cn
W
=O
'
W~
Cn
a
¢
m
W
H
a
W
W
Z
r-
N
n¢>
O
W
W
Q
F>-
Z
Z~
'J
D:
1_
N
m
O
W
O
N=
_
'0
0=
3
0
a
g
0
a.~
o
U.
U¢>
SUB-BSMT.
BASEMENT
I
1ST FLOOR
2ND FLOOR
3RD FLOOR
(PRINT OR TYPE)
Installing Company Name
Check One:
Corp. 104/- ,-?Cf416
❑ Partnership
ti . ❑ Firm/Company
Business Telephone _ -�-2� � 9
Name of Licensed Plumber or Gasfitter C. r All t)S 1070
TZ
INSURANCE COVERAGE: Check One
1 have a current liability Insurance policy or its substantial equivalent. Yes No El
you have checked yes, please Indicate the type of coverage by checking the appr late box.
A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: 1 am aware that the licensee does not have the insurance coverage required by Chapter 142 of
the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check One:
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
1 hereby certify that all of the details and Information I have submitted
(or entered) In above application are true and accurate to the best of
my knowledge and that all plumbing work and Installations performed
under Permit Issued for this application will be In compliance with all
pertinent provisions of the Massachusetts State Plumbing Code and
Chapter 142 of the General Laws.
Signature of Licensed
Plumber or Gasfitter
License Number
TYPE LICENSE:
13 Plumber ❑ Gasfitter Master ❑ Joumeyman
„• %k."
` APPLICATION FOR PERMIT TO DO PLUMBING
TOWN OF YARMOUTH (OFFICE USE ONLY)
By
_ Fee:
PERMIT NO.
Date 19
Building Owner's
A . Location—.�g z i �• Name 9VL1==
Type of Occupancy
New ❑ Renovation Replacement ❑
Plans Submitted Yes ❑ No ❑
c �ty�a83
o
le
z
..
U)
Y
V)
J
cn
Q
V
cc
M
fA
Q
z
7
O
y
2
�V tU
W
O
O
W
Q
N
Q
W
?
G
Q
u)
Z
cc
O
0.
OJ
U.
W=
Q
S
3
X
O
Z
=
3
Y
G.
Q
H
Q
Y
W
LL
Y
W
a
N
0
=
g
a
0
Q
Q
Q
iZ
Wa
Ir
Q
O
'M'
F=-
G
3
x
H
u,
a
o
M
o
a
3
0M
o
SUB-BSMT.
VASEMENT
1ST FLOOR
2ND FLOOR
3RD FLOOR
L�
(PRINT OR TYPE) L� ' Chhft
eck One:
Installing Company Name �, �' Jf// /Z Z� . �Corp. �Address � rr�/y G;l/2 • ❑ Partnership
,LflF/�T�1L/�J7 n_/�j ❑ Firm/Commpany
Business Telephone 3g / �! Name of Licensed Plumber d5- /-•
INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent. Check One: Yes}�1 No ❑
If you have checked YES, please indicate the type of coverage by checking the appropriate box.
1,
A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance voerage required by Chapter 142 of
the Mass. General Laws, and that my signature on this permit application waives this requirement.
Signature olOwneror Owner's Agent
I hereby certify that all of the details and Information 1 have submitted
(or entered) In above application are true and accurate to the best of
my knowledge and that all plumbing work and Installations performed
under Permit Issued for this application will be In compliance with all
pertinent provisions of the Massachusetts State Plumbing Code and
Chapter 142 of the General Laws.
Check on Owner ❑ Agent ❑
Signature of Licensed
Plumber
17939
License Number
Type: Master Journeyman 0
IC
By
TOWN OF YARMOUTH
APPLICATION FOR PERMIT TO DO GASFITTING
• •.
u A
d 1✓trt�_
Building Owner's
AT: Location 3 Y' /`fe/�ti �� Name 4hc /D ���
New ❑
Plans Submitted
Renovation ❑
Yes ❑ No ❑
Replacement ❑
Type of OccupancyT
Qp
co
W
(n
u)
V
Z
2cc
N
NOV 1 ZOG
l
m
z
¢
¢
ur
¢
a}
O
5
Z
rn
z
=
o
W
m
Cn
W
W
¢O
O
d
¢
W
Q
rn
FW-
W
=
W
Q
cc
Or
.Z
-Q
W
W
Jj
Z
i-
U
Z
W
(n
W
O
O>
U.
C
H
f.
U
W
_
J
►U)
W
_
W
j
H
Q
Q
m
W
Cr
W
Q
ac
W>
x
o
M
a
x
u.
Z
Q
3
Dial
g
O
0
O
M>
O
F-
SUB-BSMT.
BASEMENT
1ST FLOOR
2ND FLOOR
3RD FLOOR
(PRINT OR TYPE)
Installing Company Nam6 4 f/Ji 46 S d�2 A/
Address
Check One:
❑ Corp.
❑ Partnership —
Firm/Company
Business Telephone -+�� �- b 5�%// & 5'
Name of Licensed Plumber or Gasfitter-
INSURANCE COVERAGE: Check 0 e
I have a current liability insurance policy or its substantial equivalent. Yes Check
❑
If you have checked yes, please indicate a 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
1 hereby certify that all of the details and Information I have submitted
(or entered) In above application are true and accurate to the best of
my knowledge and that all plumbing work and Installations performed
under Permit Issued for this application will be In compliance with all
pertinent provisions of the Massachusetts State Plumbing Code and
Chapter 142 of the General Laws.
Signature of Licensed
Plumber or Gasfitter
//alv /
License Number
TYPE LICENSE:
0 Plumber ElGasfitter 0 Master ❑ Journeyman
APPLICATION FO PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed i ccordance with the Massachusetts Electrical Code, (MEC), 527 CNIA,12.00
(OFFICE USE ONLY)
�i TOWN OF YARMOUTH By 3n 1
WTT�CnEtS[ _ Fee: $
_
PERMIT NO. F_ �a y% F
(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. i
Location (Street &
Owner or Tenant D� p nit v Telephone N
Owner's Address
Is this permit in conjunction with a building permit? Q YeS ONci (Check Appropriate Box)
Purpose of Building 1 0a } Utility Authorization No.
'Existing Service Amps / Volts OverheadO Undgrd
New Service "' Amps^ / Volts Overhead❑ Undgrd
Number of Feeders and Ampacity
Location and Nature of Proposed electrical Work: agAw'd-a 01,PI-14-i
No. of Meters
No. of Meters
Completion of the follntrin q table may he trained by the Inspector of W res
No. of Total
RecessedNo. of s
No. o s s
Transformers KVA
No. of Lightin V Outlets
No. of Hot Tubs
Generators KVA
Above n-
❑
No. of Emergency Lighting
No. of Lighting Fixtures .
Swimming Pool rnd. rod.
Banery Units
No. of Receptacle Outlets . >
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners
W-o-Ti Detection an
Initiating Devices
-t•
es
No. of Rang' • t '.,! �', : '
No. of Air Cond. Tons)
No. of Alerting Devices
�..
eat ump
um er
ons
No. of Self -Contained
No. of Wastc'Disposers _
Tuta s:
— —
— —
— —
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Municipal
Local Other
❑ Connection
No. of Dryers '
y
Heatin • A liances KW
b PP
Security Syystems:
u't of Dcviccs or E ui valent
No. of Water :
No. of _ No. of
Data Wiring: w
Heaters KW
.
Signs Ballasts
No. of Devices or Equivalent
No. H dromassa a Bathtubs
y g
'Nd;yf Nlotors Total HP
Telecommunications Wiring:
No. of Device or Equivalent
—
Attach additional detail if desired, or as required by the Dispector of Mires.
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.
CHECKONE: INSURANCE,O BOND[] OTHER (Specify:
(Expiration Date)
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with NIEC Rule 10, and upon completion.
1 certify, under the pains and penalties of perjury, that the information on this application is true and complete.
FIRM NANIE: LIC. NO. Ali) i) d !4 0
Licensee:1-1�Signature ` LIC. NO. fir" (Ft^li
(If applicab enter "exempt' t the license number line.) Bus. Tel. No.:
Address- 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, l hereby waive this requirement. I am the (check one) owner owner's agent.
Owner/Agent
Signature Telephone No.
[Rev. (9/001 , -
Commonwealth of Massachusetts
Department of Fire Services
OF FIRE PREVENTION REGULATIONS
Official Use ,Ostnlly -1
Permit No. C ry7 /79y'
Occupancy and Fee Checked
[Rev. 11/99] (leave blank)
TION FOR PERMIT TO PERFORM ELECTRICAL WORK
eNk to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00
J"y
S lDate: 3/16/04
ITo the Inspector of Wires:
this ap ion the undersigned gives notice of his or her intention to perform the electrical work described below.
Local Street &Number) 38 KELLEY ROAD, SOUTII YARIIOUTII
or Tenant RONDROULLETT
Telephone No. 508-3944795
Owner's Address SAME AS ABOVE
Is this permit in conjunction with a building permit? Yes No (Check Appropriate Box)
Purpose of Building
RESIDENTIAL Utility Authorization No.
Existing Service 100 Amps 120/240 Volts
New Service 200 Amps
Number of Feeders and Ampacity
120/240 Volts
Location and Nature of Proposed Electrical Work
SECONDARY TRIPLEX
Overhead Undgrd X No. of Meters
Overhead Undgrd X No. of Meters
REPLACE EXISTING SVC W/NEW 200A UG, REPLACE Oil
rmmnletinn nfthe fnllnwinv tahle may he waived by the Insnertor of Wirer.
No. of Recessed Fixtures
No. of ceil: Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures
Above In-
Swimming Pool rnd. ❑ rnd. ❑.
omergencyLighting
oBatte Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS No. of Zones
No. of Switches
No. of Gas Burners
No. of Detection and
Initiating Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
No. of Waste Disposers
Beat Pump
Totals:Detection/Alerting
Number
Tuns
KW
No. of Self -Contained
Devices
No. of Dishwashers
Space/Area heating KW
Local ❑ Municipal ❑ Other
Connection
No. of Dryers
Heating Appliances Key
Security Systems:
No. of Devices or Equivalent
No. of Water KW
Heaters
No. of No. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Ilydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
OTHER:
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 issue u cs S5e licensee
provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersign rtifies that
such coverage is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE X BOND ❑ OTHER ❑ (Specify:) GENERAL ACCIDENT INS. 7/31/04
(Expiration Date)
Estimated Value of Electrical Work:
(When required by municipal policy.)
Work to Start 3/16/04 Inspections to be requested in accordance with MEC Rule 10, and upon completion.
I certify, under lhe pains and penalties of perjury, that the Information on this application Is true and complete.
FIRM NAME: REILLY ELECTRICAL CONTRACTORS, INC / RELCO
LIC. NO.:
Licensee: JAMES J. REILLY Signature LIC. NO.: A 16666
(Ifopplicable, enter "exempt "in the license number line.) Bus. Tel. No.: 508-771-2040
Address: 110 OLD TOWNHOUSE RD, SOUTH YARMOUTH, MA 02664 AIL Tel. No.: 508-394-3211
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 aeent.FAX-508-760-1425
Owner/Agent PEItA!!T FEE: 15.00
Signature Telephone No.
—� n �, ►,
III P�PY
31-� 3
U
2 �' 20N/
Q 3 3 THE STRUCTURE IS
)- AS SHOWN ON FIRM
LOCATED IN ZONE 'B"
COMMUNITY PANEL
JOSEPH J.
L,—WRS
n R
NA / o to w C p - 250015 0004 C EFFECTIVE DATE: 6/17/86
>-
61 wo C)
RCEL 50
Y ^ cvv Cv Q o cUi KEVIN W OBRIEN
N�
SE
ASSESSORS MAP 70
_ o z a 2 PARCEL 120
nn'
n'
�. /
z
c
P V L
(NOT C RIVgTE WAY
ONSIRUCTED )
1 5
64.41'
NORTH
NEW FOUNDATION o
EXISTING
TOF=17.6' (HIGHEST) of
SHED I Q
3
C n
Q Lo -H
N/F
RONALD W. DROLET SR.
p ')
I
2 Cif W cv
ASSESSORS MAP 61
° i
oQ c`v
PARCEL 49
83.5' I
co
z La
w
w?
ol> o
3
n w
EXISTING o
I rn o
M
a,
HOUSE
ZONE B
Y r\
I '" o a co
co
Z
FLOOD 'ONE q
7
ZiV
BANK
'
OF WALL=TOP OF COASTAL
O Wa
TOP
MEAN HIGH WATER
Q
BASSoRIVER
FLOOD
r �
EBB
PREPARED FOR:
RONALD DROLET
23 CHURCHHILL RD
PLYMPTON
MASSACHUSETTS
02367
I HEREBY CERTIFY TO THE BEST OF
THE BSC GROUP, INC
MY PROFESSIONAL KNOWLEDGE, ,�AA
INFORMATION AND BELIEF THAT THE OF (�
LOT CORNERS, DIMENSIONS AND •
•��
657 MAIN STREET WEST YARMOUTH MA.
SCALE: 1 -50
SETBACKS TO THE STRUCTURE AS •
CRAIG A.
CERTIFIED
DETERMINED BY INSTRUMENT SURVEY
AND AS SHOWN ON THIS PLAN ARE $ FIELD '^
PLOT PLAN
DATE 9 19/03
/
CORRECT. No.38039
#38
.'��•
�: 9�9/6�
KELLEY ROAD
BSC# 4-8008.01
�►� ,
CRAIG FIELD, PLS DATE
FOR THE BSC GROUP, INC
YARMOUTH
MASSACHUSETTS
SHEET 1 OF 1
N/F
JOSEPH J. ZONA
ASSESSORS MAP 61
PARCEL 50
—
'(34 R1V TANS
(NOT CON -WED
�to
CL
z�CCW
U
2w4
W N
Q
3
0
THE STRUCTURE IS LOC
e >- : AS SHOWN ON FIRM C l I
o La b ^ o� 3 0 ^ 250015 0004 C EFFEC f3ATEi '6% 6
N s�
r; o N �' •""� N/F SEP G d 03
Y N o cv KEVIN W. OBRIEN
0 2 ASSESSORS MAP 70 ,
. a Z PARCEL 120 By
64.41.
..
NEW FOUNDATIft
ON o '
TOF=17.6' (HIGHEST) 0 EXISTING I I
SHED >
13
RONALD W. DROLET SR. O :� o
ASSESSORS MAP 61
N
z
PARCEL 49 83.50 I
0 EXISTING
�L
o HOUSE
r
2
W
a
N.
Lo r N
FLOOD ZONE B I ^ o a
FLOOD I o
Z NO E A 7 \ cn -►
BASSpRIVER
(TI
1 HEREBY CERTIFY TO THE BEST OF
MY PROFESSIONAL KNOWLEDGE. AAAA�
INFORMATION AND BELIEF THAT THE �TMOF
LOT CORNERS, DIMENSIONS AND
SETBACKS TO THE STRUCTURE AS
DETERMINED BY INSTRUMENT SURVEY �� CRAIG A. k
AND AS SHOWN ON THIS PLAN ARE c4 FIELD
CORRECT. No.38039
CRAIGA. FIELD, PLS DATE —
FOR FOR THE BSC GROUP. INC
MEAN HIGH WATER
FLOOD
r
PREPARED FOR:
RONALD DROLET
23 CHURCHHILL RD
PLYMPTON
MASSACHUSETTS
02367
THE BSC GROUP. INC
657 MAIN STREET WEST YARMOUTH MA.
CERTIFIED
PLOT PLAN
#38
KELLEY ROAD
YARMOUTH
MASSACHUSETTS
SCALE: 1'-50'
DATE 9/19/03
BSC/ 4-8008.01
SHEET i OF 1
2/11/2015 SlipGen - Pa U Hone
Town of Yarmouth
9iTemplate [Building Dept]
■
Slipsheet Identifier [sg19655]
Document Category Building Permits
Map -Block Number 061.49
Street Number
0045
Street Name
SETH LN
Department
Building
Parcel ID
8954
Backfile Batch Scan
No
Document?
Additional Naming Info
Index Operator
Operator, Yarmscan
Date - Time
2015-02-11 - 11:43
httpJAaser&he12/S1ipGen/ 1/1