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HomeMy WebLinkAboutBuilding Permits4/1/2015 SlipGen- Portal Hone Town of Yarmouth Template [Building Dept] Slipsheet Identifier [sg23428] Document Category Building Permits Map -Block Number 125.121 Street Number 0017 Street Name POINT OF ROCKS RD Department Building Parcel ID 15951 Backfile Batch Scan No Document? Additional Naming Info Index Operator Operator, Yarmscan Date - Time 2015-04-01 - 08:21 httpJAaserflche121S11pGerV 1/1 V if., THE COMMONWEALTH OF MASSACHUSETTS ----sf,, Fee.. TOWN OF YARMOUTH No. ............... OCCUPANCY PERMIT "No building nor structure shall be erected, and no land, building or -structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor.first having been obtained from the Building Inspector. No building shall be occup e u til a cee i to of occupancy has been , issued by the Building Inspector."rrff Issued tola��!'i�f!/Fr!� .r ..... ess 2ft-... ..�G .. ....... ... Wiring Inspector.........A .......... Jnsp lion Date.. ............. Plumbing Inspecto .._. d. .... U✓ Inspection Date....7lf /p Fire Department...`1r. ..............................Inspection Date.... cz?!. Building Inspecto . ... ..... . e... ..... .................Inspection Date.... c�' ....�. Z......... S"0F" ALT�........ ...... .Inspection Date.. ... ....1............ THIS PERMIT WILL NOT BE LID, AND E BUILDING SHALL NOT BE OCCUPI D U IL SIGNED BY THE BUILDING INSPECTO UPO TISF CT R COMPLIANCE WITH T WN REQUIREMENTS. Q Date:.. R.//................... Building Inspector..................................'........... x ONE & TWO FAMILY ONLY — BUILDING PERMIT APPLICATION TO CONSTRUCT; REPA4tr, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING Town of Yarmouth Building Department 1146 Route 28 • South Yarmouth, MA 02664-4492 508-398-2231 ext.1261 Fax 508-398-0836 O,,tnu Use Only .t� Plammnq Bard l*n=hon Assessors Depa t e1 IMcmmf= Permit NOat / Phn Type Map cur Perm? Fee a x semen A ✓✓0 Deposit Reed $ �L " �vDat ✓✓�� n4g ew 1.1 tiepertp Dimdr�ions N Net Due .� Other Lot Area (st) Fratttage (it) Lot Coverage /1f Sft5wft on* iJit n BiJi((t�T I. ell„ �1W�Yet�;1. f.I ID -aft ls:ftted�_... S' ••• __(Lyr�1��a;<_...}-",.: •}:s.''•✓ i-::.::c`, hr'.. Z. bin- :•i'� rlcire���'• . Sectmit.-t • Sim Irtftictrtatiart I Use Gmu . R-4 T : 5- -1 Pr"Ij, Address 12 Z ing lnla=W= —J 7 �Q, A. I . Zoning District Proposed Use 10 &dIding setbacks (R) D Front Yard Side Yards R Provided Required Provided S Prowd 0 1 1.4 lwerhr Stgpy (aLO,f.r e; Ier 23,41 1•5 F$md Zone Wwrwa= • EN Public Private zb,r * 9FE SectionZ• 0wnersNptAuftdud ev• Zt Omer of Record, _R,ir Nn/ 7 o..vTn� Tzo �p Name (prin �7f � AWng AOdress• , - • -'� � � � Src�natwe Aq w;L ?Sy?i Telephone ail Addles§: 2-2 AOU"Amad A9entt 3310)( O Mailing Address lip Signature Telephone Fez 5ecdon a - Senricea &A Ueensed Construction SupwAson 'Not applicable ❑ Po i, oiC l�j o 2e y License Nrmber C S _ 2G Address �,, — CO FF 7 Espiration Date 03 0 -V// r Z$'o }�C r tZSH• Telephone Email Address: 3.2 Re0aftred Home Impmvement Contractor: ; t f Cam"" Name Not Appleable FR.,,1T' C524 f 7- C'o role C>I 7 eiMiN Cap Address Email Address: License Number +aturo -TO rE.R ro Telephone Erpvation Date il I or OVER SecttoR.#LMrkw4Cbm W%WW lnsUraM*AMCaVMVW%UI6.QL IVWWdMft or Workers Compensation Insurance atfdavit must be completed and submitted with this application. Failure!. to provide this affidavit will result in the denial 91 the Issuance of the building permit. Signed Affidavit Attached Yes.......... No .......... section &- l3w9cdomt of ROPOW14 Wbrk (check elf appl;M,-i New Construction ❑ I N(L of Bedrooms No. of BaUt m= ExlSdM Btd4. (] Repair(s) ❑ AReatlons jUr AdditionAccessory ek01 fg. ❑ 7ype_770tion Other SPeC1hl. Sdef 09=dpdon of Proposed Work O U C. /C/ v Al 04 section S. Estimated CdnCosts Item Estimated Cost (Dollars) to be Check Below completed by peril applicant 1. 9 0 0 ❑ Conservatkm-Commlsabn Filing 2. M < 0 0 (f applicable) 3. / l3ae — ❑ Old Kkno HIOM 4. Mechanical HVAC) approvd S. Fire Protectioncommission � (� �) e.Tatel.(t +2+3+4+5) O O 7. ratet 3q we FL (now h=M i o s -m• OwnuauftrtzadW-TabGCompateawn.rr Owner's Agent or Contractor A Iles for SuDding PetmW i, _ f� ► C rim F3 t S /r o , as owner of tha subject property hereby authorize �^ T-�-� o � to ad on behaM, in all matters relative to work authorized by this building permit application. my S�gnaaxe d owner - . o Section 7b - OvmedAuUt dzed A ent Cledaration i, as Owner/Authortzed 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. P Z-7' <32 V Pr"name Y Slonalws of owner/Agent Oils .� 9.15.99 2 of 2 ror Uttice Use Only x, Permit No. Date TOWN OF YARMOUTH ' AFMAVTT Home Improvement Contractor Law Supplement to Permit Application' MQL C. 142A requires tint the 'ree sWaction, 21taldcn, renovation, rT2ki modaninda% coavasien, Ion M=mt, manual, dernoUtioa or eonst notion of as aMtioa to any pro-aostmg owner-oavpied bufl&g aatuting at leig one but not more char four dwelft units or swadures which art adjacent to such residmceor building' be done by mfLt -ed cmftdms, with catvn mccpticnv, along with other regaireaeats: 1 Type of Work: Aa i> t Ti D ^e Est Cost Sfp r2 Address of Work 7 rbi Xsrza Owner Name•. R. 4 . Date of Permit Application 3 0 -7Z, r_ / y I hereby certify that: Registration is not requited for the following reason(s): Work exchrded by law Job under sl,000 Building not owner occupied Owner pulling own permit Other (specify) Notice is hereby given that: a"7i rk)T4 - 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. .30 - F 4- Cow Fey Date Contractor Name Registration No. OR: Notwithstarding the above notice, I hereby apply .for a permit as the owner of the above property. Date Owner Name PLEASE PRIM} Job Location: _ TOWN OF YARMOUTH BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM Number Owner of Property: Construction Supervisor. Address: / 7 POrM $ .or TL Street Name �►71=rso Village /o.; GY7 0 ZFo yc S� nse No. Phone No. Licensed Designee•. (If other than Supervisor) Name • License No. 2.15 Responsibility of each license holder. 2:15.1 The license holder shall be fully and completely responsible for all work for which he is supervising, He shall be responsible For seeing that all work is done pursuant to the state building code and the drawings as approved by the building of$cial. 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 shalIwillfuuyviolate subsections 2.15.1, 2.15.2 or 2.15.3 or anyother 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- 1 have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch 152 Yes 43"' No ra If you have checked = please Ir the type coverage by checking the appropriate box. A liability insurance polity Other type of Indemnity ❑ Bond ChaptEer1 52 of thINSURANCE Mass. General Laws, and that that my signature on this permitapplicatiothe n waives ibis requirementr'ance coverage � Check one: Signature of Owner or owners Agent owner I] Agent C) Signature: Building Official Approval: The Commonwealth of Massachusetts Department oflndun al Accidents Of ere oflnvestigadons 600 Washington Street Boston, MA 02111 www.massgov/d1a Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le2ibiy Address:_ Pa o x .67 t /!;114:7 /t74 Qz� 9�— Clty/StateMp: Phone #: Areyouas employer? Check the appropriate box: 1. 2,1 am a employer with _5 4• ❑ I am a general contractor and I employees (f U and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- ship and have no employees working for me in any capacity. (No workers' comp. insurance required;] 3. ❑ I am a homeowner doing all work myscli [No workers' comp. insurance required.] t 3e. ❑ I am a homeowner acting as a general contractor (refer to #4) listed on the attached sheet These sub -contractors have employees and have workers' comp, inennmce.t 5. 0 We are a corporation and its officers have exercised their right of exemption per MGL c. 152. § 1(4)� and we have no employees. [No workers' comv. insmanee reanired l 62� Z� 4R To yC FF" Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. �Zdo tion 9. g addition 10.0 Electrical repairs or additions I I.0 Phmrbing repairs or additions 12.❑ Roof repairs 13.0 Other •Any applicant that ndieekt boa #1 m2u also fill out the section below showing theaaatket eompeantiO3�olicy information. t Homeowners who submit this affidavit radiating they ace doing all work and then hire outside eoanaeton must submit a new affidavit indicating such. tContaeton that check this box mnst attached an additional shed showing die name of the n and state whether or not those mtH have cmployeet. If the sub -contractors have employees, they must provide thew wodaa' comp. policy u®ber. I aae an employer that is providing workers' compensation insuance for my employees. Below is the pokey and fob site informadom Insurance Company Policy # or Self -ins. Lic. #: k✓C . R 3 I R ,3 73 A 2 00 i Expiration Date: 0 e1-254r Job Site Address: J 7 Pe„t.rQtr Roves my City/Statemp/-A Z=atC7 - ^ Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a fine up to S 1,500.00 and/or one-year imprisonment; as well as civil penalties in the form of a STOP WORK'ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cer* under the pains and penaltin of palWy that the brformadon provided above is true and correct O,B4cia1 use oniy. Do not write in this area, to be completed by city or town offWal City or Town: Permit/iicense # Inuing Authority (circle one): L Board of Health 2. Building Department 3. Cityfrown Clerk 4. Electrical Inspector S. Plumbing Inspector 6.Other Contact person: Phone #: Information and Instructions Minuhusetu Qeaeral Lawn chapter 152 mquirm all cmploy&x to provide warms' compensation foi their empWiccs. pursuant: to thin statute, an empleym is defined as N_cv=Y person in the service of another under any contend of hire, express or iaVH4 oral Or written" An caepleyer is defied as "m individvsl, MUM* Win, corporation at otha k11 entity. or any two or tore of the forepiq engaged in a joint and Inahrdiag the kpI reptamtatiives of a docessed =PbM a the ixeivex of trite of m bayidOal, ps�asl*. associatim oe otba -I*entity. earployiag emP Howeverthis of a dwelling !nose having not more thaw three spartmmlt and who resides 6at3a6 or the occupant Of the dwellIng house of soother who empbys persons to do mr^+-s=*Yw cow cc � work on such dwelling loose or on the grounds of building spparteasat the:ebo shill not beaux of sack en&ymcot be deemed to be as employee MGL chapter LA 12SC(6) also states that; "trvsry slats K !test'kend g agew sksii w'damdi tbtr assaaes et renewal s(a 11cam or permit to operate a bedmom or to cosmiWa et befidlap In the mm mmmu ltk tat "I applicant wits has net producedaaeptable e►ldesee at eemptlaaas with the Ists<aaea avarap regslra�." AddWooalty. MGL chapter lA S25C(7) statx "Neitht the commonwealth mt nap cf its Pa"= subdivisions shall calm into nay coatraa fa the perkcnwn of pnbiie wok until acceptable evidence ofcomoplisocs with the iassamce of this have bens Faceted to the contracting =6019Y- APP� , Please fill alit the worlam ' Affidavit COMOCtSIA by the boxes that apply to your situation =4 if nea::asyI supply orb-cue�;) aama(s)6 addans(a) and phecs ar®bcr(s) along with thee CCitifieite(s) of iasum=*. I.inaftd Lwj ty Campania (LEC) of [ invited Lability Partnerships (LIP) with oo employe" other d m the membm a Pactmerso an not required to carry wort= compensation Inuiaace. If an LLC a UP don have eaiployev. a Policy is required. Be advised that this afBdsvk map be submimd to the Department of 1DdUstsi31 Aecidms for cOnfinnstim of iausact covaagm Alm be east to sip and dabs the zMavlt The affidavit should be szt,>med to the city or town that the application fbc the pasmi; err Heenan is being regoasaed. mt the Dgmbocot of Dial Acddm& Should you hart any questions regstdiog the lag at if you an rsgoired to obtain a wackaa' compe udm policys pieaaa can the Dgmtarre at the samba lisaed below. Self -insured companiaa shoaid cafe: the$ .rtr-e.mmra liesaaa mbar our the apQ<o I , , - fine. City w Tows onklah Pleam be an that the afEdavit is eomplebs and ported legibly, Mm Department has provided a specs ere the button of the of Sdevit fat yes to fill out in the event the Oilers of Iavestiptioas has to contact you repading the applioat Plan be an to Mn, the pendMiaase mailer which will be used as a reference aombet: to addition m applicant thm Mad snbm�li t =W& pcecear e aPPHC.dom is my givm Yes need -only sobtat an aflidavit Indicating cement pulleyWZMWM(if°0«y) ad =ier "M Silt A&hcse the applicant shouts write Nall lam'dooa In---(erty of town}N A COPY of the affidavit that has been officially stamped or mabd by the city at town may be povidod to the applicant tie pmddmt g vslid affidavit is oa file far thin pamitt a licemea A new affidavit:neat be fiGa out each yeas: Where a borne owner at titian is obtaining a Bream a paoat not related to say batInat a commercial veahse (i.& a dog limas or permit to bum leaves etc.) said person is NOT tcgiiire'to compkb this sfiidsviL The Ogles of Iavestfgstiaas would IaDi to thank yore is advance foe your cooperation and should you have sal quesdoes, please do not hesitate to Of us a MM 0 the Depacmocat's addrm tekphom sad fits number: 'rile Commonwealth of Massachusetts ' Depa tnumt of Ww Wal Act:idents Ofa of hVestfptle" 600 Washington sued Boston. MA 021 It Tel. M 617-721-4900 ext 406 or 1-977-MASSAFE Fax M 617-727-7749 Revised 1 t-22-06 wv.mass,gov/din TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext.1261 HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE: JOB LOCATION: NAME STREET ADDRESS SECTION OF TOWN "HOMEOWNER" NAME HOMEPHONE WORK PHONE PRESENT MAILING ADDRESS CITY OR TOWN STATE ZIP CODE The current exemption for `Homeowner' was extended to include owner— occupied dwellings of one or two units and to allow such homeowners to engage an individual for hire who does not possess a license, provided that such homeowner shall act as supervisor. (State Building Code Section 110 R5.1.3.1) 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 strictures. 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 110 R5.1.3.1) 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 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 142 of the Mass. General Laws and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent Check one: Owner Agent h:homeowndlieexemp t TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, NIA 02664 508-398-2231 ext. 1261 Fax 508-399-0836 Pursuant to M.G.L Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, 1 hereby certify that the debris resulting from the proposed work/demolition to be conducted at_ 0 7 n;pp 'n-p- jZ-, elc Work Address Is to be disposed of at the Following location: Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Signature of A plication Permit No. 3,9 OE, 4,Ae Date PRATT CONSTRUCTION CO BUILDING & REMODELING CONTRACTORS PATRICK COFFEY c 508.280.4688 cm7ey7@rnsn.corn a 508,420.9333 1531aveh Lane/am 731 f 508d20.9733 ' • Marston Mils MA 02648 0Mossachusettsa'- Department of Public Safety 0oard'df Building' Regulations and Standards Construction Supenisor License: CS402647 ;= PATRICKJCOFF$Y 153 Lovells Lane PO box 731�,�ii Afarstons Mills 1% m.02 .. g5z,lJ e %, s�"in %S Expiration Commissioner 03/03/2015 _�_ • - Cat, �pd�to�utlea�� o�C� G��ac�icr�eG�. Office of Consumer Affairs and Business Regulation 10 Parr Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 163855 1 E Type: Corporation �• ; Expiration: 7/31/2015 Tr# 244381 PRATT CONSTRUCTION COMPAf� PATRICK COFFEY P:O. BOX 731 .0 r MARSTONS MILLS, MA 02648 -Update Address and return card.11fark reason for change. SCA1 0 20M-05111 - ❑ Address Renewal Employment LostCard V/ie �omrnanuxalGi n�C���aafuaiuul/3 Office of Consumer Affairs & Business Regulation OMEIMPROVEMENTCONTRACTOR egistratlon: 163855 Type: . ExplraUon..7/31/2016 Corporation I.- r PRATT CONSTRUCTION COMPANY LLC. 11 I i• (_ 1 ,� PATRICK COFFEY 153 LOVELLS LN UNIT D MARSTONS MILLS, MA 02648 lfaderoecretary License or registration valid for Individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, hfA 02116 0 No alid without lure 7/31/2014 Proof of Coverages Search Date Last Updated: 7/31/2014 Workers' Compensation Proof of Coverage - Employer Details Search Name: PRATT CONSTRUCTION Employer: PRATT CONSTRUCTION COMPANY LLC Address: 153 LOVELLS LANE UNIT D Cky/iown: MARSTONS MILLS, MA02648 Back To Results Page 1 of 1 K © 0 Policy Number Insurer Policy Term LIBERTY MUTUAL FIRE INS CO WC231 S373220014 150 LIBERTY WAY PO BOX 9090 06/15/2014 06/15/2015 DOVER, NH 03821 LIBERTY MUTUAL FIRE INS CO WC231S373220013 150 LIBERTYWAYPO BOX9090 06/15/2013 06/15/2014 DOVER, NH 03821 LIBERTY MUTUAL FIRE INS CO WC231S373220012 150 LIBERTYWAY PO BOX9090 06/15/2012 06/15/2013 DOVER, NH 03821 Back To Results « ©Q II Limitations of Search Results II Proof of Coverage Application allows the public to search workers' compensation rance coverage Information for policies in the Voluntary Market and Assigned Rlsi . Do not assume that an employer is operating without coverage N your search its do not return policy information. An employer may stilt have a valid workers' pensatlon policy under a different business name or may have an alternate iod of coverage which includes licensing as as self Insurer or membership in a self rance group. Use the following links to view listings of Self -Insured Employers and Insurance Groups (Excel) in Massachusetts. N'dh limited exceptions, every employer in the Commonwealth with one or more amployee(s) is required by law to have a valid workers' compensation Insurance 3olicy at all times. If you are unable to find an employer or suspect an employer is Nrongfully operating without workers' compensation insurance, please subrnit a Workers' Compensation Investigation Referral Form or contact the Office of investigations at 617-727-4900 x214 or toll free at 1-877-MASSAFE (627-7233). Navigation Links POC Disclaimer New POC Search Report Workplace Fraud ' Debarm Me". ' List Education Links Who Needs WC Insurance? Employer's Guide to WC Employer's FAQs About WC Injured Workers Guide to WC Injured Workers FAQs About WC Related Links Mperience Rating History Connecticut POC Search New Hampshire Workers Comp New York POC Search Classification Request Form httpJ/64.73.26.43/Detalls.espx 1/1 ALii2 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 23 - South Yarmouth, MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 Offke Use Drily -3 Planning Board Information Assessors Department Information: 2PJrMi'l ate $ ��Endo Date i, ee'd. $ $'O — Date 7 tt Recording Date ing D New an No 14 Property Dimensions: $ Otnet Fron Lot Area (sf) tage (h) Lol Coverage — Thm Secdort for on= use Only f� Buildin Pe umber.I Date Issued: Stgrlahrrw r %� . CertlRCate of oa,,pnncy , e�+d�w om�.►;- DNe°.. a t. not n,q„r„e:.'. Secdon 1- Sfte Infotmnt)txI Use Gmu : R-4 T : 5•B 1.1 Prep" sa t ? Panay Aack) 1.2 Zoning Information: C 2 DI/ OfL /Yi Zoning District Proposed Use 1.3 MWIdIn5 Settlinche (n) Front Yard Side Yards Rear Yard R red 3d Provided 3�. Required Zo Provided •, R irrM Provided Z 20 .2^ I A Welter Supply (SULL c. 40. ! '541 1.5 Flood zarr lnrom>eltla,e C Public Private Zones gFE Secdon 2 - e Ownershl Authorized Agent bI MOlnee ��►�- Na prl )MailiSignature Tebsa rwthOrbted a I�1 �.Name( gd nt Maili SigA°� relepnone —111 Sectlon 3 - Constnrction Services �.1 Ue ensbw en Sepeerlsan • i - D���dLiwNPII �i�.� NotAPplitaDle� n�i�✓%ISf�aprlsZo �9 I ". L !/`iG� NQ Ly'1,Zv)(juT% P1� License Numbef ,r�//1 1���'"�' '�•`�7160 Addy > p. __�3Lry-�j.gs0 Expiration to gnature tebpt•ane -Fle0stered 3.2 Home Ins en'" Contractor CO""� K '�'""', Lni ve k f 1 �A4- lu Not aparcaae 9 LKen a Number ZiaSligAd Expiration Gam Lq Lure f�ie(Nrone OVER At Lr:T sectlott. s Htersi Co bit tli9Urgtit�Afftift3vK GlL de t 2tt6 Alt . Workers Compensatlon Insurance aMtdavit moat be completed and submitted with this application. Failure to provide this a"vit will result In the dental of the Issuance of the building permit. Signed Affidavit Attached Yes .......... No .......... Section x- D ' of Prcposqd Wbr1t dtedt ett appRabil)l Now Canty won (3 1 Ne. d Sedroorns Us" B►do. ❑ 1 Rapar(t) p I Aftwtlors W Addmon Accessory Bldg. 0 Type Demoli Other Specify. Brief Oescd don of Proposed Work Ad aApuiv 47A4 Rreeu!:n�*aA"110444 eOlatk POaf qA4 /0-Cit section e • Estimated Cdnabtactlon Costs Item Estimated Cost (Dollars) to be Check Below completed by pemmll applicant 1. sum"O(I d don -Commission F V 2 8ectrkal 3 / Gas- (it applicable) 4. Mechanical HVAC) - 2 00 old KhP Highway d Historical S. Fire Protection Commission approval A. Total . (1 4.2 + 3 + 4 + s) (if appkable) 1. row square FL (rse b w a s&AM.t 50 Te- or Contractor Aovlles for . as owner of the subject property hereby authorize [AK19 to act on my behalf. In ant matters relative to work authorized by this building permit application. St dOrww Y oaa 2 . as Owner/Authorfzed Agent hersby declare that the statements and information on the foregaing application are true and accurate. to the best of my knowledge and belief. Stgned under the pains and penalties of perjury. Rf e h le-vr 4 4 ` PrW Parrs Stryusr. d Cww1Agre fat. 9. 15. 99 2 of 2 V 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 contractor, with certain exceptions, along with other requirements. Type of Work: AcQdd lob %Ql er"4luv Est. Cost17-zlS" co Address of Work /7 ✓ elry }' e-( t tk- vkarl"V41 Arr Owner Name: %� I C �, a .o� Cj •w�IGN Date of Permit Application: Z 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: / l'' "� tactPknc 6)C/1 eL Lra Date - Contractor Name Registration o. N Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: S ZG/J �icti�f /V, iSlJlyo� Date Owner Name V r =:fit= Compensation The Commonwealth ojMassachusetts Department ojlndustrial Accidents Dice of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia insurance davit: Builders/Contractors/Electricians/Plumbers Name (Business/Organintion/individmi): ,F/ill v City/State/Zip: 1�/�-- %1�� Phone # A. you :an emptQyer7 Cho& the appropriate box: 1 am a employer wiL.::7,_ 4. 0 I am a general contractor and i employees (tall and/or part-time).* 2. ❑ I am a sole proprietor or partner. ship and have no employees working for me in any capacity. [No workers' comp. insurance i 3. ❑ I am as homeowner doing all work myself. [No workers' comp. insurance required] t 3a. ❑ I am a homeowner acting as a general contractor (refer to #4) have hired the sub -contractors listed on the attached sheet These sub -contractors have employees and have workers' comp. insurance.t 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp, insurance regttired Type of project (required): 6. ❑ New construction 7. 0 Remodeling 8. ❑ Demolition 9. 0 Building addition 10.0 Electrical repairs or additions 11.0 Plumbing repairs or additions 12.0 Roof repairs 13.0 Other •My applicaat tort checks box N I mart also fill out the I section below working then hire en'rnmpensatiod�OUCY infomtatlon. l Homeowners who submit thin affidavit indicting they ate doing all work and torn hire outride crontrsctors must submit a new affidavit indicating such. tContractors that check this ho: mart attached as additional sheet showing the Irate of the rub contractors and sate whether or not those rntitier have employees. if the subcontractors have employees, they must provide their workcers' comp. policy munber. I am an employer that !r providing workers' compensation ixtwanee for my employees Brlow !s the po!!cy and fob site Information. insurance Company Name..49:�LzG _ — --- — --- Policy # or Self -ins. Lic. #: Expiration Date: _�� Job Site Address: City/StatelZip: Attach a copy of the workers' comp Illation policy declaration page (showing the M11 numb and ezpintlon date). Failure to secure coverage us required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fuse up to S1,500.00 and/or one-year imprisonment, as well as civil penalties in the forth of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby renijy der the pa an enal ajperfury that the Information provided above Is true and corrnt Phone #: ,3yyS S' Q f'frlal use only. Do not write in this area, to be completed by city or towrr Offlein, City or Town:' Permit/License # Issuing Authority (circle one): 1. Board of health 2. Building Department 3. City/I'own Clerk 4. Electrical inspector S. Plumbing inspector 6.Other Contact Person: Phone #• TOWN OF YARMOUTH BUILDING MPARTDIF.NT 1146 Route 28, South Yarmouth,'MA 02664 508-398-2231 ext. 1261 Fax 508-398.0836 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter I, Section 111.5, R I hereby certify thatthe nthedebris resulting from the proposed work/demolition to he conducted at 7- /' t7 /,m k O{ � Wv Work Address j Is to be disposed of at the following location: _ 1110 Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. e',a cft-�,6-" Signature of Application Permit No. I 8 261.E Date r V 03/17/2013 13:0? 5087527172 FA(Z 02109 rf .��rr•�•r r� r� • • et r•r ITAI l&Gf%l orb a A•0%r- AcoRhr 6+CK 1 irfi.P)A i r. ur uK011ol i i lIIrJulv+l.vII6- `- BATE IMItAIXTYYTI I D2119/2013 PRDDA:£R Blackstone insurartx P.D. Box 3144 THIS CERTIFICATE I$ ISSUM AS A MATTER OF INFORSIATION ' ONLY AND COKFV0 NO MOMS UPON Ttr CMF`CATE HOLDER THIS CERTIFICATE DOES NOT AMM. EXTEND OR ALTER THE COVERACBAFFORDED BY TIE POLICIES CGT 7Vl. Worcester, flJ101613 rNSIn"3?9 ArrOMNO COVERAGE NAIL • nouX= wSUFxRA A-ELC. Unit] Enterprises INsuRn a 59 FresbDard tam Yarmouth, fAA 02875 IR-ImeR t mauReR o INsuIlR E. THS POLICIES 00 INSURAVCl L16T1t0 016C W HAVE WEN tSSUM TO TtIE MURED NANIMABOVE FOR TMR POUCY PERIOD 1-10ICATSO. NOrMrH37ANOND ANY P.EOUIREMENr, TERM OR CONDITION OF ANY CONTRACT OR OTHiR DCCVWNT WITH RESPECT TO%MtCN THE! CERTPICATE MAY EE ISSUED OR MAY PERTAIN. THE IN SURMCE AFFORDED BY THE POLK:ES oESCR•SFD %M6LCHi91ALS NO FO.Y`.L9. AOOREOATl LFAR1 SM" MAY HAVE SeV4 REDUCEO Dr PAID GI Wr% L•N w T"t OP MURAM MMY NUWM LoaK On111ML ILRY xAl►rtRCx CeaylAl uAes rrr dG:wswoe o0= OWL AOOREOATE LK.IT APPLIES P@t PCIUCr rl PR02DT rl LOG w"Orl=j"T/rx s R I s leDEXP(A "pW**1 ! PlR.OHAL A 967V IN. LAW s ' GFNML AZCAtECAT[ a PRODUCTS • COLPOP Aa3 ! 1 AUTOMOLLI LKIKUTY C' W. AN0 ALLONYEDAUTU3 loHtoul a AUTO! HRm AIITIM NPVLWR[O AUKS I 111 camsNEC Sprlu UW ! rev Parr") _ s !DOILY !L'IAY IPn aeaen[, ft � t OARA4l LNSUT .+n gVrp • AL" :M&Y. CA ACCIMW S �1lR THAN FAACC m oNLT: A46 s a) REILA LIANUTY OCCUR '.' 04 WIDE EIDIXTIBLE "Tew"Ort a I GCN OCCIlwmte I AGGREGAT! S i r j A WORIfM( SQ=lAVWT "pNC CAAAMIY 1OPRrARTNER�"pcuTN! CFWMEPAENVXR ERCUAEO/ QP:aAL PR�VIu ! OWOW WCC5307"7012012 Enrzctz I 811=13 IUNITS M eLCACW&,=C N+ ft D,�AT., lA Dr.D^.i a ,CO.000 El VISM51•P000YLMC S SDO.CCD OTfIER David Linn/'I It Gowra4 Ey Ml wadws =rVer475M policy. BIRMIR ANYOF MAW" D111CRIS62 POI.**$ In eAW 0 W*R! TNf QMATDR Town of Dennis +6 635 Routs 134 DATzrmrVF.rmmL o2uRnvvLLtmxrrxRTowm — DArs"wr x South lkrrit. MA 02060 RDTRCE» TRECERTVFJItt FIOL�ERN/ARD TO TNC t>:n, MT PAlLLTt! T000aosuLL watlas NoOAwATCRoRLLMM TaANrPruu•CNTNarm"ARs"C Mop R"MapITArrom /.GT10tQlD PpRC4NTATW AW RD � (PDT/D!] J 8 A{.yR� W IV'GIKA i I V A Tiii FROM :.L FAX NO. : 50e3621294 Jul. 15 2013 03:54PM Pi d/lid/1013 12:26 5087527172 PALE 04/04 A CERTIFICATE OF LIABILITY INSURANCE ,srfIMO„104- a7/10/2013 rA0olKen Blackstone Insurance THIS CERTIFICATE IS I3SUED AS A MATTER OF INFORUATION ONLY AND CONFERS NO RCHTH UPON M CCRTIFICATE P.O. BOX 3144 NOLDER.THIS CERMICATE DOGS NOT AT1fM FX MD OR Worctattr, MA 01013 ALTIR THE COVERAGE AFFORDED BY THE ►OLIaES BrLOV/. INSURERS AFPORDINO COVGRAOE NAIC s IutURaO Unnell Entarprless qA 0.E.I.C. ersuarRe 59 Freeboard Lane valaetr Yarmouth, MA 02675 P+e►ERa C�V►RAf1/A THE POLICIES OF ;NSURA16CE UCTED BELOW HAVE BEEN ISSUED TO THE INS'J220 NAKED ABOVE FAR THE POUC7 PETIDC MOICATED. NOTYvrTMSTANCiNG ANY RSpUItCLLENT, TERM OR CONOITpN OF ANY CONTRACTOR OTNER OOCUMEN. ralM RtyPGCT TO W4CH TR5 MRTIF1CATC MAY BC ISSUED OR MAY PERTAW. TI (Z INBURANCG AFFOROLF0 BY THE POLICIES D"Cmt= MEteIN IS SUBJECT TO ALL THE TERNS. E7CCLUSIONB AND CONCITIONR Co SUCK POLIC2E. AOG14WATE LWITB SNOWN MAY I+Av E "EN REDUCED BY pArD CW MS. n TYPE Of NAURANCK PMXvw M UY1Ta OaNTRAL UAN"J" COIW-"IAL CEtERAL LUIe'L" CLAW NAB! 0 OCCL71 "clucCURpe"Ce a j LFO Qf :Ary s. Pwfo�1 ! •�� PCRSLNAL a ADv NA*r I CIE "AL AOCRFCATf; E -- A=PMATE LI W APPLIE! PER- facer f JPRC=T rl LOC FROOUCTi. COIAriCP Asa S AMWIDDLE UAWJ" iEo.Latw: �IvcLELIMIr I ALL CIMM AVMI "N-"AutoA i BODILY ►IJJRY (re ptna+l a HIRED AUrov NCN•ow"M AMR i Epp A MII (�tr�AAMR�OC = Q^tAO!LIAIIITY AUTC ONLY- FJL ACODDIT I ANYAUTO pTMrR -EAACC I A AUrb CNLY.LT' AGO CtOtaTAMOMQLLA LAOIUTY OCCUR CLAIM$NAD1 _ EACH OCCURFE14CE I AGCREGA a a DMCTULE a 11 A �p,��111"rNro" RIIfLQ'1[Rt'LJAq'.ITY R71, Auv suyrME�7ORnARrNeer uecvTre 00761Ki�Rlvl+M6J�•ME4 O(CWOED" WCCBD07447012012 811!2012 $1112013 -FTPI E 1L EACH ACCICwr I 10C,000 E. D7GM-in 'It" S T00.000 P6GLALP6m, S1 EMer E.L. 0I3EAde • MLXY LkA I 500.000 OTYKR r David LinneU la rgverod by nt w"ara ConpaTfsBor. pdiCy CSXTrcICAT7 NHLDP Ride Bishop Point or Rock Rend Yarm"DcrL MA 02675 awOULe ANY 00 rW2 ALCM DAWA l W MXMU K OAravLLW TRPOAa n1a rx""T" MTETM"gVW.THEMWNc MSMWLLEWAAVeRYO1aAL 1e LAYS Nw"Of NCT1Ce TO TIECBLTT7CAlE MOLDlR wens YO TMR tlR a0T �AAJJIK ip N a0 MALL mmose NO 003LIOA11011 OR L"Ilk"T Of Aw flue UPON "a mutai"Asn"' S om CORFORAnoN ja Office a n luSine� ega auon� w HOMEIMPROVEMENTCONTRACTOR Registration:-420659 TYFo; a Expiration: 7aO000 DBA UN LL ENTERPRISES DAVID UNNELLJR `t i 59 FREE BOARD LANE' YARMOUTHPORT, MA 02675;' Uoderseerenry Uceuse or registration valid for fudividul use only before the expiration date. If found return to: • Office or Consumer Affairs and Business Regulation 10 Park Plaza -Suite 5170 Boston, MA 02116 �W_,alid without sign cure �� sNl �auoi,.puwu, ) E 10ZA 1,19 :uoilejid x3 p— s ' ^. SL9ZO VW 'JLUOdH1f1OW2 vA N-1 OUVOe3383 69 ar n3NNn r oma LOSIL So :asuaall s6uinama Anwe oml pue -au0 asua61'1 josinsaing uoil3nilsuo0 .paepuulS pw: %uoip:jn1 ill '..uiplmH Jo psroH (� CWp:� iiiynd Ju tu�wi.irdia - tilwcnyirs.rl� �• o* TOWN OF YARMOUTH Building Department _ Town Hall Yarmouth, MA 02664 (508) 398-2231 ext.1261 BUILDING PERMIT TRANSMITTAL Temp Permit No.: T-14-016 Applicant Name: David Linnell Jr. Applicant Phone: 5083621294 Building Location: 0017 POINT OF ROCKS RD Owner's Name: BISHOP, RICHARD A Owner's Addres 0017 POINT OF ROCKS RD Yarmouth Port MA 02675 Owner's Telephone: (617) 407-9503 REVIEWED BY: 1. WATER DEPARTMENT: 2. ENGINEERING DEPARTMENT: 3. CONSERVATION: 4. HEALTH DEPARTMENT: 5. BUILDING DEPARTMENT: 6. FIRE DEPARTMENT: (OFFICE USE ONLY Recorded By: IC Permit Fee: $0.00 Deposit Rec: $50.00 Payment Type: Check ChkNo.: 1151 Net Owed: ($50.00) Application Date: 7/11/2013 Issue Date: Expiration Date PLEASE NOTE Comments: Map/Lot: 125.121 construct garage and breezeway, dormer, replace roof and de'c�k{,, OTICE An as built plan must be submitted to this department prior to foundation inspection or any further construction. DATE: DATE: DATE: DATE: DATE: DATE: N/A: N/A: N/A: N/A: N/A: N/A: RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: Date Printed: 7/16/2013 YARMOUTH OLD KING'S HIGHWAY REGIONAL HISTORIC DISTRICT COMMITTEE 1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664 Phone (508) 398-2231 Ext. 1292 •- Fax (508) 398-0836 Colleen McLaughlin, Office Administrator (cmclaughlin@yarmouth.ma.us) CERTIFICATE OF APPROPRIATENESS APPLICATION Application is hereby made for the issuance of a Certificate of Appropriateness (C/A) under Section 6 of Chapter 460, Acts of 1973 as amended, for proposed work as described below and on plans, drawings, photographs, and other supplemental information accompanying this application. PLEASE SUBMIT 6 COPIES OF SPEC SHEET(S), ELEVATIONS, PHOTOS, & SUPPLEMENTAL INFORMATION. Check All Categories That Aopiy: / , V 1) Exterior Building Construction: New Building I Addition li Alterations Reroof Indicate type of Building: Commercial Residential Garage _Shed _Other: 2) Exterior Painting: Siding Shutters ' Doors Tri APPROVED 3) Signs/Billboards: New Sign Change to t Existing Sign ��-T 19 1! 4) Miscellaneous Structures: ✓ Fence." ence Wall' - Flagpole Poolnthpr- Type or print legibly-, = -- i j YARMOUTH OLD KING'S HIGH " Address of proposed work 17 N'5_ O T-YKOckS ROa I'0'(t Map/Lot # 69411 Oct 67- N Owner(s):.. !:91Ck4YCq A. Ish f Phone#:617-`g27-9503 . Mailing addresses: 0 P01` ri 6-. 90kk a4eQ).. - VayL DUR Pdrt "'AYearbuilt MO Email: 1�r�1$►1pQ1$ ,itlu/ Preferred notification method: US Mail Email .,Agent/contrador��W��1��GYt��i��-��A fi11 &Ige) AT A Phone#: S/A 08-%70'� Mailing Address. ►► U(eu)_TN Ve 68 CeNIC&S-WJ orli it zz 0vniA 6 13 ,MA Email: _MAC r'Zl '( R IkL_a SIq/J I • COrv%_ Preferred notification method: US Mail Email Description of Proposed Work- �cvc, 4r+r4 b�ee� cNyy gc{G�•QJ Dcrw►eYl aN Sav}l. Facl�� roaF . 2epl�cst ' rz2- yt4r old rioo wiK, scvr.c. color rooF>>,9 rvtiy-�ci►s J Signed (Owner or agent): Date: > Owner/contractodagent is aware that a permit is required from the Building Department (Check other departments, also.) > If application is approved, approval is subject to a 10 day appeal period required by the Act > This certificate is good for one year from approval date or upon date of expiration of Buliding Permit, whichever date shall be later. > Al new construction will be subject to inspection by OKH. OKH-approved plans MUST be available on -site for framing 8 final inspections. For Committee use oniv Received y O .H: Date: / /r— Cash/C eck4 Rcvd by: Date signed: V Approved Approved with _amendments Reason fnr rlPnlal- Signed: Denied /�2_/9/oat, t YARMOUTH OLD KING'S HIGHWAY REGIONAL HISTORIC DISTRICT COMMITTEE 1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664 Phone (508) 398-2231 Ext. 1292 -•— Fax (508) 398-0836 Colleen McLaughlin, Office Administrator (cmclaughlin@yarmouth.ma.us) STATEMENT OF UNDERSTANDING As property owner/contractor/agent for construction at 17 & n+ nt a' oaR C�- Map/Lot 1 A— , C/A # !a- a 10 Q_approved on ,2, In accordance with the Guidelines to the Act,"Sec. El., only minor changes may be approved by the Committee without the filing of a new application and the holding of a new hearing. Minor changes or alterations would include such matters as altering a single window or door or a minor change of color which could be made without a detrimental impact to the overall appearance of the project. All alterations by amendment or otherwise will require the local Committee's approval." Before or after work has begun on a project approved by the Old King's Highway Committee, a request for a minor change must be submitted to the Committee in writing. Approval shall be obtained before incorporating the change into the project. For more than one revision to previously approved plans, a new Certificate of Appropriateness must be filed and approval voted by the Committee before incorporating the changes into the project. Failure to do so will result in the Building Department issuing a stop -work order or delaying issuance of an Occupancy Permit or final inspection approval. Filing a Certificate of Appropriateness for revised plans after work on the changes has been undertaken will also result in having to pay a doubled filing fee of $50.00. I have read and understand the above statements. Date: _� b -� j � - ) � Signed: �., (Owner/ nt ctor/agent) Date: ID- In Signed: Ze A�r�� (Chairman", OI ing's Highway Committee) HAOKHC72010 APPLICATION FORMS\STATEMENT OF UNDERSTANDING.doc Updated 9/10/10 Ia_410�L • SPECIFICATION SHEET - GENERAL Project Address: /7 Aji4 'F Acks 'U- YAW- Year Built: /790 ----------------------------------------------------------n --- ----------------------------- j FOUNDATION: Material: CON«CT� 1 Exposure Not to exceed 18 DRIVEWAY MATERIAL r Xtrt ll jj C-rVA-54ONZ. WALKWAY MATERIAL: 1414 CHIMNEY: Material/Color. 0LA GUTTERS: Material/Color. 14101h �0 wrlj ROOF: Material: #45f Pitch (7/12 min) L Z Height to Ridge: Color: SIDING: Material/Style: Front: S %l tj &L Sides/Rear: �i)>J.t IsZ COLOR CHIPS Color: Front: erdaru- Sides/Rear: 1,,eAA CfdfA— TRIM: All windows & doors to be trimmed with: 1x 4 1x5 (Circle one.) Material: PIW9 Color: l'✓ll/ . DOORS: City: Y Material: mod Color: raAA?k Style/Size (if not listed/shown on elevations): STORM DOORS: Qty: Material: Color: GARAGE DOORS: City: Mat'I: fy00!{ Style: xW 4Color: WINDOWS: City: Brand: /Q/VG1�lS�N Color: 6✓Ji Mat'I: Grilles (Required): Pattern Type• 6(AP1r� • Snap -in, Between Glass, True Divided Light, Permanently Applied Interior/Exterior STORM WINDOWS: Qty:. Material: Color: SHUTTERS: Mat'I: Style: Paneled Lowered Color: 13hek SKYLIGHTS: City: 141 Fixed Vented Size Color: DECK: Size: A1/p Decking Mat'I: Color: Railing Mat'I: Style: Color: WALLS/FENCES (Max 6' height): Height: Color. Style: Mat'I: (Show running footage & location on plot plan.) UTILITY METERS/HVAC UNITS: Location: rc r Screening: LIGHTS: Qty: Style:.... Location(s): Additional information: Sc? 2 1 20;? 6CT 16 YARN,OUTH _ YARA� ..._ 2 - General /'Z- 4/OA 4, i April 29, 2013 Mr. Mark Grylls Building Commissioner Town of Yarmouth 1146 Route 28 South Yarmouth, MA 02664 Dear Mr.Grylls: OFI&E copy Rick Bishop 17 Point of Rocks Rd. Yarmouth Port, MA 02675 Thank you very much for your time this morning. As discussed, I constructed the screen porch on my home in 1998. 1 have attached a Town of Yarmouth Assessment, showing a record of this structure from 1-2002. (please see note: JB 01-02 and sketch) on attached report. Said structure may never be expanded. Best Regards, e1 Rick Bishop ;LU 3 0 2013 ):%3 D'Za7 Property Location: 17, POINT OF ROCKS RD AIAP ID: 125/ 121/ / / Vision ID: 15951 Oiher ID: 113/ N178/ / / Bldg tl: 1 Card 1 of 1 Print Date: 03/27/2003 08:29 CURRENT OIVNER = UTILITIES STRTIROAD A LOCATION " `" =' - CURRENT ASSESSAIENT (SHOP RICHARD A 7 POINT OF ROCKS RD ARDtOUI'11PORT, NIA 02675 Description Cade Appraised Value Assessed Value 815 YARMOUTH, AIA ES LAND ESIDNTL 1010 1010 67,500 122,700 67,500 122,700 SUPPLEMENTAL DATA ' ccount# 1615600 Subdivision 360 'ci ct IS ID: VISION Total 190,200 190 200 'RECORD OF OIVNERSHIP " r 'B%VOLIPAGE SALE DATE qLu yr SALE PRICE I : G : - PREVIOUS ASSESSAfENTS HISTOR (SHOP RICHARD A 0 Yr. Code Assessed Value Yr. Code Assessed Value Yr. Code Assessed Value 2002 2002 1010 1010 67,500 122,700 001 001 1010 1010 67,500 122,700 2000 000 1010 1010 55,300 96,100 Total: 190,200 TolaL 190,200 Total: 151,400 EXEMPTIONS ' .. OTHER ASSESSAIENTS .' '. " '. This signature acknowledges a visit by a Data Collector or Assessor Year e/Descrt tion Amount Cade Descri tion Number Amount Comm.Int. APPRAISED VALUE SUMMARY Appraised Bldg. Value (Card) Appraised XF (B) Value (Bldg) Appraise OB (L Value g (Bldg) Appraised Land Value Bld Special Land Value Total Appraised Card Value Total Appraised Parcel Value Valuation Method: 120,200 2,500 67 00 ,5 190,200 190,200 Cost/Dlarket Valuation Total: ,,_. .., . NOTES - -. / et Total Appralsed Parcel Value 190,200 BUILDING PE"11T RECORD ' _ _ P7SITICHANGE HISTORY: Permit ID Issue Date 7VPe Description Amount Insp.Date %Comp. Date Comp. Comments Date !D Cd. I Purpose/Result 99825 1/17/1990 85,000 100 NEW DWELL 7/18/1996 6/I1/ 996 DIG DH 50 Ol VERFY PHONE feamr+lVlsi[ LAND LINE VALUATIONSECTION Bq 1 Use Code I Description Zone D Frowned Depth Units I Unit Price I. Factor S.l. C Factor Nbad Ad'. Notes- AAYS eclal Pricing Ad'. Unit Price Land Value 1 • 1010 SINGLEFANI 12,632.00 SF 3.16 135 5 1.25 0050 1.00 534 67,500 JValuI67,500 Total Card Land Uninj 12,632.001 SFI Parcel Total Land Arta: 12,632 SFI Total Land Property Location: 17 POINT OF ROCKS RD AfAP ID: 125/ 121/ / / Vision ID:15951 Other ID: 113/ N178/ / / Bldg #: 1 Card 1 of 1 Print Date: 03/27/2003 08 ,. , -CONSTRUCTION CONSTRUCTION DETAIL, .. _-....; . , — - -SKETCH Element Cd. I Ch. Description Commercial Data Elements _J-7 , rade 4 verage+10 FrameType aths/Plumbing tones 2 Stories cupancy 1 iling/1Wall ooms Trtns terior Wall I l Clapboard /a Common Wall 2 4 Wood Shingle Nall Height loof J able/Illp oof Cover 3 sph/F Gls/Cmp CONDOIMOBILE HOME DATA-.= ntc for Wall 1 5 rywall/Sheet lement Code Description Factor nterior Floor 21 2 lardwood Zomplex 2 14 arpet loorAdj nil Location eating Fuel leating Type 3 5 as lot Water lumber of Units %C Type H one lumber of Levels �o Ownership edrooms 2 Bedrooms COSTIMARKET VALUATION- - athrooms ZZ 112 Bathrms adj. Base Rate 60.00 otal Rooms iu Adj. Factor 1.00387 Bath Type 2 Modern inde (Q) Index 1.13 Kitchen Style 2 Modern dj. Base Rate 68.06 ldg. Value New 133,534 ear Built 1990 M. Year Built 1990 rml Physcl Dep 10 uncnl Obslnc on Obslnc pecl. Cond: Code pecl Cond % 0 0 MIXED USE 1010 SINGLE FA111 100 verall % Cond. 90 )eprec. Bldg Value 120,200 OB-OUTBUILDING&YARDITEAIS(L)/XF-BUILDINGEXTRAFEATURES(B) Code I Description UB I Units I Unit Price I Yr. I pp Rt I %Cnd I Apr. Value FPL3 M STORY CHIM 1 B 1 11 2,800.00 1990 1 11 100 1 2,500 BUILDING SUB -AREA SUMAIARYSECTION - Code Description Vvfne Area Gross Area E . Area Unit Cost Unde rec. Value BAS Irst Floor 864 864 864 68.06 58,804 FGR &rage 0 336 134 27.14 9,120 FUS pper Story, Finished 744 744 744 68.06 50,637 PTO atio 0 250 13 3.54 985 UAT ttic, Unfinished 0 336 34 6.89 2,314 UBI,I asement, Unfinished 0 864 173 13.63 11,774 I, TOWN 'OFYARNLOUTH ra .• 1146 Route 28,.South Yarmouth, MA 02664 1.508-398-2231 eA.'12461 Fax 508-398-083 Office of the.Building '`Commissioner FILE COPY April 23, 2013 Mr. Richard Bishop 17 Point of Rocks Rd. Yarmouthport, MA. 02675 RE: 17 Point of Rocks Rd. foundation as -built plan for building permit # B-13-1162 Dear Mr. Bishop, Some questions have come to light after further review of the as -built submitted for the above mentioned address. The as -built plan provided by BSC Group dated April 5, 2013 and stamped /signed by Craig Field, shows a dashed line indicating removal of the lot lines of the adjoining lots 177 and 179. The plan provided for construction on lot 178 is showing the setbacks from the northwesterly lot line of lot 177 (158.0') and the southeasterly lot line of lot 179 (115.9'). In showing these lot lines for setback purposes you have presumably merged the three lots creating one. There is however no record of the new lot configuration recorded with the registry of deeds. In order to do this you will be required to present a perimeter plan (ANR) to the Town of Yarmouth Planning Board showing that the lot lines have been expunged. Once approved by the planning board the new plan will need to be recorded at the registry of deeds and two copies of said plans should be submitted to this department to update our records. Another question is in reference to the porch located at 15.2' from the property line. The original plans for construction of the home in 1990 do not show the porch. Relief had been given via petition 42737-2, May 17, 1990 from the Board of Appeals granting relief from the setback requirements allowing the placement of the foundation to remain 18.8 from the rear property line. In that plan the porch is not shown. In a plan filed with the Conservation Commission in 2005 to construct an addition, the porch appears. I have not been able to locate the permit to allow the construction of the porch in my files. If you have any records to the contrary, including the relief required from the Board of Appeals to construct the porch at 15.2' from the property line, please provide this information at your earliest convenience. Please contact me within 14 days of receipt of this letter. ry Truly, Mark is Building Commissioner C; Kathy Williams, Sandi Clark, Doug Wrock, Craig Field, file 2 Cn N W 0 c' cep C9 aLLD O Z rr 3 a M ,4 tA M CominonweaA ol/��//amacl eih 2a1?ar&ea1 of moecire Serric" BOARD OF FIRE PREVENTION REGULATIONS Official Use Only PerrnitNo. 0)3" ((ZO fancy end Fee Checked [Rev- ene blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK A11 work to be performed in accordance with the Massaehvsetts Electrical Code PaC). 27 CMR 12.00 (PL&fSEPRINTWINK OR nPEAU MFORMATIOA9 Date: City or Town of: _Vhgy) ►av, H To the Inspecto of Wes: y this application the undersigned gives notice of his or her intention to perform the electrical work described below. tlo; (Street & Number) / -;- �� rvT o G V.Lee (LD l�diflwty�f t'I P021 or Tenant 's Address this permit in conjunction with a building permit? of Building Service 160 Amps / volts vice lDy Amps / Volts Number of Feeders and Ampaeity / Telephone No. 6 r -:�-.c{o7 - 95c$ No�U, (Check ApTVt Biz) e UtaityAuthorization No. `"'111 'D'l ` Overhead ❑ UndgrdJ No. of Meters l Overhead ❑ • . Undgrd No. of Meters t Location and Nature of Proposed Electrical Work: /(�jy c' cX r S7 r NCr lVl c r c V- I$M o i' lb ' 2 T WIP J�C/2VrLcg- IlAi t L- /Vta`t✓ 57'tzuc7-btCe: /.j 'Rvt LT rlM,v,lehrm ofdw foOarine table asar be wahrd by the lnwwtor ofVurs_ No. of Recessed Luminaires No. ofCe ASusp. (Paddle) FansNo. of Transformers Total KVA No. of Lumbaalm Outlets No. of Hot Tabs Generators KVA No. of Luminaires Swimming Poolrity ❑ nr- d, ❑ Batt Unicy g No. of Receptacle Outlets No. of OR Burners FIREALARMS No. of Zones No. of Swttefies No. of Gas Burners o. ot LletectJOU a nd Initl2fing Devices No. of Ranges . No. of Air Cond. To' No. of Alerting Devices NaofRra3teD'espmers eallo. Totals-. Numbercos of Self -Contained DeteetiodAh Devices No bf � washers S ace/Ara Heating KW P g Lon' ❑ Municipal Connection ❑Other of Dryers HeatingApplianees KW SecuNo. No. of nor Equivalent o. of Water KW Heaters o. o Slens o. o Ballasts Data Wiring: No. of Devices or Eaulvalent Hydromassage Bathtubs No. of Motors Total HP TelecommunicatioNo. No. of Devices or rna Teat OTHER- Attach adddtonat ddafl OFdesfrr4 or as rrgvtrra aY me rnrpecrar of Wars Estimated Value of Woric 0DD ' oo (When required by municipal policy.) Work to Starr 41 lo't / Inspections to be requested in accordance with NEC Rule 10, and upon completion. INSURANCE C01 GE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance inclMing "completed operation" coverage or its substantial equivalent. The undersigned certifies that such is in force, and has e:dubited proof ofsame to the permit issuing office. CHECK ONE: INSURANCE AND ❑ OnM [I (Specify.') I certify, under the pairs andpeiraftfm ofperfurq, that the Informadon on this a pt}radon Is true and complete. FIRM NAME: rim/ ����t C- , LICNO.: Licensee: 43.;V--id/V vyLv PZA' Signatu LTC NO- ItJS�;Z -6 pjapplicably ender aaenrpt" to tltr licenre rrmrrber line) Bus. Tel. N� 1 -tl L - -V �i t Address: o �'< T -- Alt. Tel. No.: •Per MO.L m 147, s. S7-61, security work requires bepartinent of Public Safety " S" License: Liu No. OWNER'S INSURANCE WAIVER I an aware that the Licensee does not /rave the liability insurance coverage normally required by law. By my signahue below, I hereby waive this requiremem I am the (check one ❑ owner ❑ owner's a ent. Owner/Agent PERMIT FEE: S Signature Telephone No NSTAR: Wiring Permit System (WPS) - Permit Page 1 of 2 C;;iments I Work Order Request I Search I JW I NSTAR Wiring Permit System (WPS) - Permit Work Order Information I Service Information I Contact Information I Permit Information • Work Order Inrormatlon Utility Auth/WO #: 01936719 Date: 04/12/2013 Company Rep: SEAN HAYES Report By: YPO 17 POINT -OF -ROCKS RD BISHOP RICHARD Status: ACTIVE Service:INCRS Type: RES Nature of Work: EXISTING 100 AMP UG TO TRANSF.. ELECT IS MOVING CUST UG SERV DUE TO Work Order Information I Service Information I Contact Information I Permit Information • oervrce rmormauon There is no Service Information. Work Order Information I Service Information I Contact Information I Permit Information vvuw %u. wnnaa.v.. Type: ELECTRICIAN Last Name: MORRIS Company: SELF Pager: Phone: Fax: Blue Book Reorder: 5082925717 W License: 0000014550 First Name: BURTON Address: 68 CENTER ST HYANNIS MA 02601- Email: Cell Phone: 5082925717 Best Hours: ANY TIME Work Order Information I Service Information I Contact Information I Permit Information • rermrt inrormauon Permit#: E13- Meters: 1 Reseal Y Date: 05/31/2013 1128 (Y/N): Inspector: W10060 Description: (Comment I Work Order Reaves t ISearchlligl Copyright 2013 NSTAR, 800 Boylston Street, Boston MA USA. All rights reserved. Reproduction In whole or in part of any graphics, Images, text or other content at this web site must be granted by NSTAR, Boston, MA, USA. Unauthorized modification of any information stored at this site may result in criminal prosecution. https://www.nstar.com/secure/apps/wps/wpspermit.asp?Work_Order Nbr=01936719 5/31/2013 O OF K TOWN OF YARMOUTH Building Department BUILDING' a ....... _ , PERMIT NO �-B-13-1162. (508) 398-2231 ext.1261 PROPOSED USE PERMIT ISSUE DATE ; 3/61201-3 ; • , - APPLICANT Rlchard Bishop ........ JOB WEATHER CARD PERMITTO NIsc.Roundationcnh AT (LOCATION) 10017POINTOF ROCKS RD ZONING DISTRIC R•40 Bldg. Type: Residential SUBDMSION MAP LOT BLOCK [125.121 BUILDING IS TO BE: CONST TYPE USE GROUP u LOT SIZE CONTRACTOR REMARKS construct foundation only- as per plans submitted 03104/13. LICENSE np AREA (SO FT) EST COST ($ $5,000.00 PERMIT FE 114.00 OWNER JBISHOP. RICHARD A BUILDING DEPT BY ADDRESS 10017 POINT OF ROCKS R Yarmouth Port I MA 102675 1 PHONE 16174079503 INSPECTION RECORD FIELD COPY Date Note Progress - Corrections and Remarks Inspector Foundation Im ation Avvr0TCd .� .�: L �ot.,aR r C Ori1J O [M UNE & TWU 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 a South Yarmouth, MA 02664-4492 508-398-2231 ext.1261 Fax 508-398-0836 Orate Use O/nl 3 Planning Board information Assessors Department information: Permit No. 3' tO Dat Plan Type MV ter Permit Fee E % Endonemen Date � ontmq Dan New Deposit Rec'd. $ �O Datt 3 rdi 1.4 Property Dimensions: Nel Due other Lot Area (st) Frontage (tt) Lot Ccvww This fteden for Offba U:• .. BUM1 4 Pe �.•' ' ' -� ^Y`�j, SRy,�:. .•4 . Y.. ' :•I .. _��1-/I�•',A�•' 1 CdrNficaht off. 1. •. .4w n ft (!fl0)' regr�"'• . . Oft1elaik..•�•• Da�1.,. S6506 t•1- Sits Infdrlttat M I Use Group: R-4 Type: 5•B 1.1 PrePWty Add ran f 7 )Oolr;r or RdigKS Rd. 1.2 Zoning Information: Zoning District Proposed Use \ rL otrl OYi7 iY1J0 1.3 QWtdIng tetbackot (R) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 30 Z0 ZO 1A Wb*W SUPPIF 11LQJ— a 40.3 541 Pudic Private 1.5 F7ood Zar IMonrulfon. Zpp gFE: oauUueas- rrOpefTy vwnersnt AtrtnorizedA 2.1 Omer o1 Ree«efir a�D fl. Q�ti7D /7 Pdir! el�/loc d r N e(pri MairingAddress Slgnaturo 6 / V07, /SO Telephone = AatRorhted Agents Name (print) Telephone Mailing Address Fax Section a - Construction SGTICO-a 3.1 R leeoae,l Conetr+attlen StgeMoeet Not Applicable MAR 0 4 2 13 License Number Address BUILDING By DEPT Expiration Date S4�� Telephone 3.2 FagWemd Home Improvernmt Contractor. ComPeny t4arffe Nor Applicable ❑ Address SlgnaNre Telephone License Number Expiration Date Iof2 OVER 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 S- DQ*Xf of Pfo Wbrk (check elf applieat") New constriaon I No. of Udmoms Na of BMW ms Existtn9Oft ❑ Repalr(s) ❑ I Altar;Wm ❑ I Addition ❑ Accessory Bldg. ❑ TYPO Demolition Other Brief Description of Proposed Work: Section f! - Est OaW consmrcoon wsrs Item Estimated Coat (Dollars) to be completed by penmjt appi" 3 Plumbing / Gas 4. Medunkat (HVAC) S. Fire protection a.Totala(t +2+3+4+5) 7. Total Square Ft. irw tvaao @31 Q* of for Specify: Check Below (a Consenratlon•Commiasfon Filing 6rnj4A (H appikabie) Old Kings Highway d Historical Commission approval (if appffcabIs) e� I, , as owner of the subject property hereby authadze to act on my behalf, in as matters relative to work authorized by this building permit application. Slgim"M of Owner ante I l Secton 7b - OwnedAuftrtzed A ont Dedamdcn 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. stgnalun of 3 y j3 oat@ 9. 15. 99 2 of 2 For Office Use Only Permit No. Date TOWN OF YARMOUTH AFFIDAVIT Home Improvement Contractor Law Supplement to Permit AppQeation MOL a 142A requires that the 're=1stnxYim, alteration, rwovstioo, repzir, mod=iatia% conversion, improvement, removal, demolition or construction of an addition to any pre-existing e own r�oavpled building contaniag at least one tut not more than four dwelling units or strumsra which am adjacent to such reside= or building' be done by registered conft tors, with cartaia exeepdens, along with other retpameam Type of Work: (VAt nc4g, f�,j dJie,-� Est. Cost 46 a tN Address of Work !7 /00 In 0/— Name: Date of Permit I hereby certify that: Registration is not required for the following reason(s): Work exchuled by law Job under Sl,000 Building not owner occupied . Owner pulling own permit tether (specify) Notice is hereby given that. - OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IWROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner. Date Contractor Name Registration No. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above prolerty. z 25 13 tch a� �' l3isl► �D�te Owner Name y .• TOWN OF YARMOUTH O y BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PL A.SE PRIM:• Job Location: Number Street Village Owner of Property: Construction Supervisor. Name License No. Phone No. Address: Licensed Designee: (If other than Supervisor) Name License No. 2.13 Responsibility of each license holder. 115.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building and structures only pursuant to the state building code and all other applicable laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Any licensee who shall willfullyviolate subsections 2.15.1, 2.15.2 or 2.15.3 or anyo Cher 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 longersupervising 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 r] No If you have checked = please Indicate the type coverage by checking the appropriate box. A liability insurance policy ❑ Olher type of Indemnity ❑ Bond OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 152 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signaturs of owner or ownees Agent Uvner Age Signature: Building Official Approval: the t,ommonwealth of Massachusetts Department of IndusNal Accidents Office of Investigations 600 Washington Street Boston, MA 02111 wwrv.mass:gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Plicant InformaHnn Name (Business om nintimiIndividtul)• Ate FO&Mf 3z 6evv Are you an employer? 21 the appropriate box: 1. ❑ I am a employer with 4. 0 I am a general contractor and I employees (full and/orpart-time).• 2. ❑ I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required;] 3. ❑ I am a homeowner doing all work myself [No workers' comp. insurance required.] t 3a. I am a homeowner acting as a eneral contractor (refer to #4) Phone #- S-vg_ Q58- ZI67 have hired the subcontractor, listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.: 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required ] Type of project (required): 6. O'New construction 7. ❑ Remodeling 8. Demolition 9. 0 Building addition 10.0 Electrical repairs or additions l 1.0 Plumbing repairs or additions 12.0 Roof repairs I3.0 Other *Any applicant that checks box #1 must also ill out the section below showing their workers• compmsatiod b I t Homeowners who submit this affidavit indicating they are doing all work and then hire outside eon 4 information. tContraeton that cheek this box must attached an additional sheet showingOrs ma+t mrbmit a new affidavit indicating such. emplayeei [f the the name of the sub -contractors and state whether or not those entities have subeontraeturs haw cmplcyea, they must provide their workers' comp policy =tuber. I arty an employer that Ls providing workers' compensation insurance for my employees. Below Is the po/ky and job site information. Insurance Company Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/Statemp: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment; as well as civil penalties in the form of a STOP WORK ORDER and a fine Ofup to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby c under the pains and pe ald" ojperjuq that the Information providel above Is erne and correct 1-11 na►.• ZZa`�i� - Sim S IM OQlclal use only. Do not write in this area, to Be Completed by city or town ojjklaL City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbinrr In.n...+,,. 6.Other Contact Person: Phone* Information and Instructions M,sa,c�em Ocnaal Laws chapter 152 requires am emploYdsa to Pco"ide couriers, compematioa for th.a cmploma• .. ' m is defined as -.»every person in for service of another under any contract of bite, Purrutat to this statute, exy yea express or implied, oral or written" An emptqer to defined as "an individual, ParMerab* 22a0abo4 corporadm or other k1d entity, or nay two cc more for foregoing mppd in a joint eaterprie% tad iscbrdW the kgal repssseowi m of a deceased employes; a the receive or trusts of taiadfvidaal. Partnership, asap a odw legal entity, cmpbyiag employees- However the owner ola dwelling boast having not more than tbree apertmeate and wbo resides ther.ia, cc the oaupaat of the who employs Persons to do meiattao aat, coastrucdoa or repair worst on such dwelling bou dwelling hotsar of another ar of on the limes or b+�i apparteaant thereto sham trot because of each employment be deemod to lot aneaspbyes" NIGI- chaptae 132,123C(6) do stOw that "every adsb K {real IlaaslK sgacy shall withbw tit lsaaasee rr remwal of a ikeese W permit to operate a budoese or to coastreet bWdbW In the m mwweslth far W appoelat whe here not preiaai acceptable evldsan of e0113PI121M with the lawraaas eavu regsskW Additionally. MOL chapter 132, 423CM states "Neither "a commnnweahh ant any of its Political subdivisions sham eater into eery coatrsd fat the palbcmaan of pabme work =W aaeptabk "eta of complitace with the bwe"cr n quiremeota of this cbapea have been Presented to the coctracting authocity'- APp21claft Pleaes fill out the worfar ' coa>paaaatba d�ri< compi�bs by chug the boxes that apply to your simatim sad, if Of necasa<7, supply uab Conaac {a) aame(s), addr aa(a) and phoor �ba(s) along with employees thm dficssothec than the ianaaau. Limited Liability ComPaajes (LLC) a Limited Liability Pumaships (LLB randm a or Perhum axenot required to carry woriesa' COuMnsados wmaacs. If sa LLC a LLP doeshave cmployeee, a Policy is required. Be advised ties dde a®darit may be submitted to the Department of Dial Accidents floe con&madoa of insurance coresap. Ales be mn to sip and date dw amdavfL Thy affidavit sbarld be retmned loft city or town tbet the applicadoe fix the permit or license is being requested, net the Depertma9t of Industrial Accidents. Sboeid yet leave eery gO6stions,g the law err if you are required to obtain a worinsa' cc --a n polhr, pkase ell the Department aai for emabet listed below. SeMWvjmd compeaiw should eater their .err_• - - llew . a the eovsopdatt lion city at Town onwak Please be surs that the afildavit is complete and printed legibly. The Department has provided i aPea At the boom of for affidavit far you to fin out in the .veal the Office of Iavestipdow has to contact you reprdiag the spPH=IL Pleaar be suns to fill is the panA%Xme mumbat which will be used as a reference number; In addition, as applicant that moat submt multiple pasaytivaer aPPlicuiooa is say Area yew, need oaFy submit are affidavit fadioadog enaeat Policy inhansdoa (if necessary) and umber "Job Site Addrw" the applicant should write "all locations is (City or town).- A copy of the anSdsvit that has bee officially stamped or manned by the city or town may be provided to the appmaat as proof that a valid affid"k is an We fix Um parasite at licensee. A new afiidarit must be fined out each year. Where a homy owner at citizen is obtaining a liceme or pesnat not related to say business or coamasial venture (Le. a dog 8camr or perrmt to barn leaves ate.) said;, i o - is NOT required to completer this aM&YiL The Other of lnresdptiostt would M@ to thsA you in adrsau far Your cooperation and should you have any quesdoM Please do not hesitas to give us a all. Ctrs Department's address, telepbone and fax numbs: The Commonwealth of Massachusetts Department of Industrial Accidents Mike of In uflPtloas 600 Washington Street Boston, MA 02111 Tel. # 617-7274900 ext 406 or 1-977-MASSAFE Fax # 617-727-7749 Revised 1 t-22a16 www,man,gpv/dia c ., Cs •'r'ska, PLEASE PRINT: DATE: JOB LOCATION: is / TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, NIA 02664 508-398-2231 ext. 1261 HOMEOWNER LICENSE EXEMPTION NAME ; \&OMEOWNER" A/cAoiq0 A. / 0 NAME I PRESENT MAILING ADDRESS /7 Pe/A 7 Poi.,-- a�- 24cka ADDRESS SEC 617. yo7 . QSo.7 TOWN PHONE WORK PHONE CITY OR TOWN STATE ZIP CODE The current exemption for'Homeownee 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 108.35.1) 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 "homeownee' 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 108.35.1) 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. x HOMEOWNER"S SIGNATURE a 4;Z&A A \APPROVAL OF BUILDING OFFICIAL INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent, which meets. the requirements of 1lGL Ch.142. 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 142 of the Mass. General Laws and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent h • hn..wf V rn.li�►.....w 11 TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 23, South Yarmouth, MA 02664 508-398-2231 ext. 1261 Fax 508-398-0836 BUILDING DEPARTb1ENT Pursuant to M.G.L Chapter 40, Section 54 and 780 CMR, Chapter 1, Section It 1.5, 1 hereby certify that the debris resulting from the proposed work/demolition to be conducted at -'(` / Z/0017-b o4 /L,a�j� �I rzMdv14 All- Mn Work Address / Is to be disposed of at the following location: ' -' Ti2/_vim. Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. 421A Sature of Application Permit No. 2 14 Date YARMOUTH OLD KING'S HIGHWAY REGIONAL HISTORIC DISTRICT COMMITTEE 1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664 Phone (508) 398-2231 Ext. 1292 -- Fax (508) 398-0836 Colleen McLaughlin, Office Administrator (cmclaughlin@yarmouth.ma.us) CERTIFICATE OF APPROPRIATENESS APPLICATION Application is hereby made for the issuance of a Certificate of Appropriateness (C/A) under Section 6 of Chapter 460, Acts of 1973 as amended, for proposed work as described below and on plans, drawings, photographs, and other supplemental information accompanying this application. PLEASE SUBMIT 6 COPIES OF SPEC SHEET(S), ELEVATIONS, PHOTOS, & SUPPLEMENTAL INFORMATION. Check All Categories That Apply: / , y 1) Exterior Building Construction: New Building V AdditionAlterations V Reroof Indicate type of Building: Commercial Residential Garage _Shed _Other: 2) Exterior Painting: Skiing Shutters"-� �i Doors TriMW 3) Signs/Biilboards: New Sign Changeto Existing Sign l ....,, � 4) Miscellaneous Structures: ✓Fence Wall Flagpole l�P00Type or print legibly Address of proposed work 1 �OIrTIf- -O T KO��(S R64 f 0�1 • Map/Lot # �i P Dp $Z N Owner(s): � 1 ck GY 4. LA. • /� I s i1y"o�p � n `' � Phone #:617 - qV - 9sa3 Mailing address: 0 POWTI" � 1 Of-- ROCw aoR - VGnYY)" PCyt "'AYear built: M6 Email: r JI Shpp Is- (2 cono:IrA4. Y& /► Preferred notification method: US Mail ^Ys�'Em/aiill - ,Agent/contrai:tor. iMGYLi - A hn A4a- {'i! AT A Phone #: ��13 -?y -//A Mailing Address: 6 % 1}Q,SfAJINW' taoye 68 (?Wc& -fj omit zz- W Vci 6%s , MA Email: _ 1M AGY'IZ5r( is 4kLAPSlcfN I • UYv^ - Preferred notification method: US Mail ✓ Email Description of Proposed Work: �cvq 4�� b�eezx wc4 qdd quo Darmtlrs dt4 .5`64 Fscl*v roaf- - r2kPJ'rM- 22- yerr did >-oo r CV.k sue. cclo✓ roaFlvj m4ttls f Signed (Owner or agent): 5ZA—Date: 2Z % / Z— > Owner/contractorlagent is aware that a permit is required from the Building Department (Check other departments, also.) > If apprication is approved, approval is subject to a 10-day appeal period required by the Act > This certificate is good for one year from approval date or upon date of expiration of Building Permit, whichever date shall be later. > All new construction will be subject to inspection by OKH. OKH-approved plans MUST be available on -site for framing & final Inspections. For Committee use only: Received y OI .H: Date: / /. — Cash/C eck Rcvd by: Date signed: —ILApproved Approved with _amendments Reason 4^" '4^-W Signed: Denied TOWN OF YARMOUTH Building Department • Town Hall i Yarmouth, MA 02664 (508) 398-2231 ext.1261 BUILDING PERMIT TRANSMITTAL Temp Permit No.: T-13-312 Applicant Name: Richard Bishop Applicant Phone: Building Location: 0017 POINT OF ROCKS RD Owner's Name: BISHOP, RICHARD A Owner's Addres 0017 POINT OF ROCKS RD Yarmouth Port MA 02675 Owner's Telephone: (617) 407-9503 (OFFICE USE ONLY Recorded By,. IC Permit Fee: $0.00 Deposit Rec: $60.00 Payment Type: Check ChkNo.: 1096 Net Owed: ($60.00) Application Date: 3/4/2013 Issue Date: Expiration Date Comments: 125.121 construct onl Al - NOTICE An as built plan mu-,t be submitted to this r:, ;_;rtmen prior to foundati- 11tion or any further CUn�,Lru,,.wil. REVIEWED BY: 1. WATER DEPARTMENT: DATE: 2. ENGINEERING DEPARTMENT: DATE: 3. CONSERVATION: DATE: 4. HEALTH DEPARTMENT: DATE: 5. BUILDING DEPARTMENT: DATE: 6. FIRE DEPARTMENT: DATE: COMMENTS: RECEIPT OF COPY: PLEASE NOTE SIGNATURE OF APPLICANT: N/A: N/A: N/A: N/A: N/A: N/A: DATE: Date Printed: 3/4/2013 o� TOWN OF YARMOUTH HEALTH DEPARTMENT �\'•%�? PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Building Site Location: I % I'O {hT a Proposed Improvement: MAP 1251 equO)i (2l t Address: 17 V D "Ifyou would like e-mail notification ofsign off, please provide e-mail address: Owner R • Ris A Tel. No.: 617.W7.?5-6- Date Filed: - 2 Owner Address: 5 AW\A j Owner Tel. No.: 6/ ` ! 0• 9P3 RESIDENTIAL AND/OR COMMERCIAL BUILDING HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. Please submit three (3) copies of plans, to include: (1.) Site Plan showing existing buildings, water line location, and septic system location; (2.) Floor plan labeling ALL rooms within building (all existing and proposed) — Note: Floor plans not required for decks, sheds, windows, roofing; (3.) If necessary, Title 5 application signed by licensed installer with fee. REVIEWED BY: PLEASE NOTE COMMENTS/CONDITIONS: DATE: �L —C)" �� (3 Town of Yarmouth Conservation Commission Building Permit Sign -off Application Building Site Location: Map # 2 Lott(s) # I 2— Property Owner: I—.,�.44 Applicant: Applicant Address: OF Telephone: 1 b�'�S� 1 Date Filed Z Z15 IS Plans: TO BE FILLED OUT BY CONSERVATION ADMINISTRATOR: Does the Proposed Project Require a Permit? •�4co ua; %d Ch-du J Rem 4-o S F �-3 - l 4o q Comments from Consen ation,,Commission- Approved Approved Conditionally Rejected M� -lid &4dtA p-f Cvn 1440n-r Connsernation Commission Sign -off Signature: �znl 1� 14, lo•` Date: Z-s 12/13 �J TOWN OF YARMOUTH WATER DEPARTMENT 99 Buck Island Road West Yarmouth, MA 02673 Telephone: (508) 771-7921 • Fax: (508) 771-7998 BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TR SMITTAL SHEET �L v, d T Bldg. Site Location 1-2 PO I hV Of ifo 1t-oi % Map #: 2 <� Lot #: Proposed Improvement: 624 fe, Applicant: t C V_ 6is k Address 1:2 P614 01' koc 16 1111. #: Q 7 " 9 67-56rblte Filed: rhov4 pa ✓+ RESIDENTIAL AND / OR COMMERCIAL BUILDING Water Department: Engineering Department: Conservation Commission Health Department: Fire Department: Signature of applicant COMMENTS: 'Aio/y 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, Ocean, Bogs, Bays, Marshland, Etc... Determines Compliance to State and Town Regulations, Le., Requirements for Septage Disposal and other Public Health Activities Determines Compliance to State and Town Requirements for Personal, Safety, fxqerty Protection;, i.e. Smoke Detectors, Sprinkler Systems, Etc... PLEASE NOTE: 2- /2 jot T,< rv. NASA- rEAL.AgV IH[JI ALATJ VVI,I ILJ�/1,7 `l,'�t,U1R,:QJl.1lCV • c- ti )of of Insurance for A & E Forms Inc ACCO a CERTIFICATE OF LIABILITY INSURANCE DA`I(MV/MYTY" 22"013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: little CetnflCa[e holder is an ADDITIONAL INSURED, the poliey(les) must be endorsed. II SUBROGATION IS WAIVED, subject to the terms and conditions of Me policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the cartlfltate holder In Iles of such andorsemem s . "1OiC`" NAME: __ Select Dept CXt 66807__ avem Insurance Group LLC - Main PHONE— VVestCentralStreet aE•y5OM51.7700 Ac.Nm508•_ MAIL Natick MA01760 ADDREssselectvvorkCeasterninsurance.com _.._-.. INSURERS) AFFORDING COVERAGE .NAICP INSURER American Fire & Casualty Co ^ `D 31438 INSURER B:Exceisiorinsurance Company _ _.._11045_ A S E Forms. Inc. INSUREilcj 3'2General HolwayRoad WSUnrnDl_—_._ So Yarmouth MA 02664 #— INSURER E I INSURER►: C09CRArl:q PCCTICIP ATC All luOCo.. eo•.•.•r..ea ennclnel Aluueeo. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED 10 THE. INSURED NAMED ABOVE FOR THE POLICY PERIOD . INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFOROFD BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN_ MAY HAVE BEEN REDUCED BY PAID CLAIMS R'�__ - tAOOL SUER{_ _ "� T►[OF INSU—RAMC[--- I 11 POLICY NUMBER WD"Yrn i MPwD"v%P vYl UNITS GENERAL LABILITY )iKA1353e18e9B 4142012 4/4ro13 EACH OCCURRENCE 11,000,000 X COMMERCIAL GENERAL LIABILITY I I DAMAGE TO RENTED PREMISES TEA xa�oR) f 100,000 1 .. _-ICLAMSMADE IX OCCUR I MF.O ExPIMFenIPManI_jf10,OD0—__._._ PF RSONAL L ADV INJURY I51.000,000 - _ � I GENERALAOGREGATE I12000OOO `PROdTS GM AGGREGATE LIMIT APPLIES PER I K • CdAPIOP AGO 1 E$,000,000—__,--__ 1 POLICY ►RO LOC I S I AUTOMOBILE LIABILITY I 801353818898 414r2012 414 .'p13 IEilmamlj •� $1,000,000 ` ANY AUTO BODILY NA RY IPw P~) �f ALL GAINED jL AUTOS SCHEDULED AUTOS �- BODILY NARY (Pw lanAM)I f -- X ..{I NON-OEO I X .� • PROPERTY DAMAGE HHREDAUTOE AUTOS i AUTOS ;IPw lcaOwA) H - I I ,f UMBRELLA UA9 IOCCUR FACH OCCURRENCE f Exc[ss UAB _ �CLAMS•MADE 1 I I AGGREGATE f YARRERSCOMWENSATION VIC878e23e 4/4r-'012 "1'013 X ' MSTATU• OT)4 AND EMfLOYERV LIABILITY VIM .. __:TORYLIMLTSI_.., ER- ANYPROPRIETORIPARTNEIVEXECUTNE rL CACHACCIOCNT f500.000 I OFFICER/MEMIBER EXCLUDEDT N❑iN7A' I - -- I (NAWKworyin NH) I E L. DISFASF • CA CMPLOYFE 1500.000 Ern. Mler4r Pn4w - DES RIPTI OF OPERATIONS MNer I FL OISEASF•POIICY LMIT;f500000 I I i DE/CRIPPON OF OPERATIONS ) LOCATIONS T VEHICLES (Anal ACORO 101, A"llwal RwrHN A SRA•WI•, I11np•!pa a nour•AJ Concrete Construction. Richard Bishop 17 Point of Rock Road Yarmouthport MA 02675 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I. I I M 1988.2010 ACORD ACORD 25 (2010005) The ACORD name and logo are registered marks of ACORD TION- Ill rinhts reserved STUDY I MUSIC ROOM EXISTING TO REMAIN CL.P w e D EXISTING.,- PORCH EXISTING TO REMAIN am LIVING ROOM EXISTING TO REMAIN FEB 2 5 2013 . ---------- HEALTH DEPI 0 PROJECT LIMIT GARAGE EXISTING TO REMAIN I Q` NEW DN ENTRY �� BREELEWAY Y V I S� O REMAIN 8e SF I /Q TO REMAIN _ I .` \ I NEW GARAGE KITCHEN EXlsrwcTO REMAIN - — ff I', I I • ARLW I I i EXISTING lit j• I u STUDY I MUSIC ROOM EXISTING O REMAIN PORCH EXISTING TO REMAIN LIVING J ROOM EXISTING O REMAIN F,- -- - - jEP1. PROJECT LIMIT GARAGE ' EXISTING TO REMAIN I I 91, I p - NEW 4zi I ENTRY IEXISTING_ NEW Y �J I ` TO REMAIN 88 SF ' I J NEW GARAGE KITCHEN O REMAIN _- _.- - - _ lYY/ 40 /13 a r Ui �+ I a V M From: Mary -Ann Agresti anagres0®thedesigni.com>B Subject: Fwd: Design for Concrete steel composite deck for garage floor Date: February 14, 2013 9:53:45 AM EST To: Rick Bishop crb1shopl5Gcomcast.net> Is this something you asked Mark for! MA Mary -Am Agrees AIA THE CESIGN INITIATIVE INC as Carter stet Hyannis MA 02001 50e 7901 say vvww thedmia Begin forwarded message: From: mark mckenzie anarkmOrnekenolneers com> Subject Design for Concrete steel composite deck for garage floor Date: February 14, 2013 9:17:50 AM EST To: Mary -Ann Agresti <Cn39restiOttedeslonl com> HI Mary Ann Here Is the section for the design requirements for the steel concrete composite deck for the elevated garage flow for the proposed garage project at your house on point of rocks Mark [see attached file: concrete steel deck section .pdtj _ JobNp J'a 61. I. irgms %.d ' iv•r�eFUMCN •...� JobNr/ tSvcYe btn a,...s Awtneet �IA.k"i a-i-IJL .1C.ak-srnuaatu F�oLr /`i'�Lr , . ._ ww.rrd.yFr.r• t , DrAh$ •.7114 11ENGINEERING t CONSIRTAhtiS ri�-Ginc3%'sm r xr,re..i •e�a..,+p-.••:.-t:.: `. '• ...-�ne��t._ 'ersa5r.><rti wl h'Kr.y.+,:.:+1,;,�,;'_ • 'I" •• LJ:12M96 nieWElelt3 ••• ` 1Ltitipetti: 'Low roert 2"4T,hba.—'-4 _ !_..^�... :2$IARC?4Yl0JC . G1tw t.Ji•411 iN1.4 1�iu„�1 , I I {—i • ! � � r : CoAfrta� P 'G^-ttctti Slc.,d :. -•� -L..,..._ ..f._�..,.: '-. IyttXsa3Btwr:• w�zxas:lwira�vb.,w/.paPaels•tvr• '.. , .I. � f.;:altlf3'•.�f�ie*A,ets�.� - i . !..—'. _•II---i `- • i � {�LLOMUf151WS bFSTq�'_R'7cs'k3-�J�:. • ' a . . From: Mary -Ann Agresti <megresti@thedesigni.conuB Subject: Fwd: Design for Concrete steel composite deck for garage floor Date: February 14, 2013 9:53:45 AM EST To: RlokBishop<rbishopISCoomcast.net> Is this something you asked Mark for? MA Mary -Mil Agresti ALA THE DESION INITIATIVE INC as carter Street Hyannis MA 02601 $oe 7901a8a Begin forwarded message From: mark mckenzie<msrkmMmck nal4�nn rsmnh Subject Design for Concrete steel composite deck for garage floor Date: February 14, 2013 9:17:50 AM EST To: Mary -Ann Agresti <magrnstinthedesignl corm HI Mary Ann Here Is the section for the design requirements for the steel concrete composite deck for the elevated garage floor for the proposed garage project at your house on point of rocks Mark [see attached file: concrete steel deck section .pcfJ Jobfkx10-561 dra•r:4oF 12791IAG l.J ' r...� JObN moi�<�`�r tw•�,ii ar�-n J'C .K.ar�-s in�?iu �� X • •. ��i ENM CINMG' ` 1. �//4r13 NSUITANTS K �'onc,ri,�-3fcc/ Cnriilraf rF �isr .imb K i • , 1 ... .... .,..�. .s*,,5,arkA &ro.•dww+•t-✓ ...-. ,.. ..�.. ;�w'. •.I• fir. • •yJ Krift �''t�r•'I�i•rrAbG,__,..'_ WL& t t)1.4 V W 1-TktAV_ sl Jc; _ � •. .., _�...,..'_ _'. 11r�:09twr7 • Wli'LX3S: F+�thFyww�.rxPneh•Yr' �. w. f•-i ' , 1 t r •-,�.�.'. �• � i, y,y /yam!► .. n _ TOWN OF YAR(MOU'ru BUILDING DEPAR'rmEN'r 1146 Rnute 28. Sotith y.irnututh. MA 02664' 403-398 98-0836 NOV 27 2012 f�,� BUILDING DEFT . tt' Permit'Number Date Issued Expiration Date $50.00 t"PERMIT Pursuant to G.L. c. 82A §I.and-520 CMR 7.00 et seq.(as amended) THIS PERMIT MUST BE FULLY COMPLETED PRIOR TO CONSIDERATION Name of .%pplicant .0 l-1AS'e /Z CA 4 Jfr Phone Cell Street Address d 3 o AMOV OIJ Roll l /6 lr.:, r- d ��- /v/O City/town �Jena�J on-r IA r ZIP 6a6 3 °I Name of Excavator (if different from applicant) Phone Cell aic�nRd ,T. 0P-.2-/NH/Z 6 Street Address 3ya Cl9sTG_W000, cl2C�� ,��r- a37-So3 city/rown MA IZIPdgo//v/s o Name of ownerls) of propertyr ��j Phone Ceti StreetAddress / 7 j( Cfi„ -rOL7f vv City/rown �/ t J / NIA 'LIP , 0,; 73' Other Contact I Permit Fee Received No Yes 1 Veuription, location and purpose of proposed trench: Please describe the exact location of the proposed trench and its purpose (include a description of what is (or 6 intended) to be laid In prnposed trench (ea; pipes/cable lines etc..) Please use reverse side if additional space Is needed. i Insurance cerlificale Mt S / 7 ,3pj o `5 - 0 1 Name and Contact Informalinn of IInsurer. 5 ells 21�f/ �%JJU/Z%�l? C .5�0r-W- 7917 .. Pul F.s iratlon Dale: D - O - dol Dr,t s.re i,"ame "Went Person I as ueunea oy scu a aua:.vctn. 1 of l 'If...-* Nwi;p huw% ii"ns Lkitm N uemm Grades 171E - Expir2tionDates 0 a aYVLW BY SIGNING THIS FORM, THR APPLICANT, OWNER• AND EXCAVATOR. ALL ACKNOWLEDGR hND CERTIFY TEAT THEY ARE FAMILIAR WrM OR, BEFORE COMMENCEMENT OF THE WOM WILL BECO14E FAMILIAR WTTII. ALL LAWS AND REGULATIONS APPLICABLE TO WORK PROPOSED. INCLUDING OSHA REGULATIONS. G.I., a 82A. 520 CMR 7.00. et seq., AND ANY APPLICABLE MUNICIPAL ORDINANCES, Blf•LAWS AND REGULATIONS AND THEY COVENANT AND ACRES THAT ALL WORK DONE UNDER THE PERMII: ISSUED FOR SUCH WORK WILL COMPLY THEREWII I IN ALL RESPECTS. AND WITH THE CONDITIONS SET FORTE BELOW. THE UNDERSIGNED OWNER AUTHORIZES THE APPLICANT TO APPLY FOR THE PERMInr AND THE EXCAVATOR TO UNDERTAKE SUCH WORK ON I= PROPERTY OF TM OWNER, AND ALiq. FOR THE ov DURATION OF CONSTRUCTION. AUTHORIZES PERSONS DULY APPOINTED BY THE MUNICITALITY TO ENTER UPON THE PROPERTY TO MONITOR AND INSPECT THB WORK FOR CONFORMITII WITII THE CONDITIONS ATTACHED HERETO AND THE LAWS AND REGULATIONS COVERING SUCH WORK. THE UNDERSIGNED APPLICANT. OWNER AND EXCAVATOR ACRES JOINTLY AND SEVERALLY •Dlh REIMBURSE THE MUNICIPALITY FOR ANY AND ALL COSTS AND EXPENSES INCURRED BY TEE MUNICIPALITY IN CONNECTION WITH THIS PERMIT AND TIE WORK CONDUCTED THEREUNDEr4 INCLUDING BUT NOT LIMITED TO ENFORCING THE REQUIREMENTS OF STATE LAW AND CONDII'rIONS OF TMS PERMIT, INSPECTIONS MADE TO ASSURE COMPLIANCE TiiEREWfM AND MEASURES TAKI N BY THE MUNICIPALITY TO PROTECT THE PUBLIC WHERE THE APPLICANT OWNER OR EXCAVATOR HAT? FAILED TO COMPLY TiINRSWITII INCLUDING POLICE DETAILS AND OTHER REMEDIAL MEASURES DEEMM) NECESSARY BY TI$ MUNICIPALITY. THE UNDERSIGNED APPLICANT. OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY 11) DEFEND, INDP.MNIFY, AND BOLD HARMLES3'THE MUNICIPALITY AND ALL OF ITS AGENT'S AND EMPLOITES FROM ANY AND ALL LIABiLTIY. CAUSES OR ACTION, COSTS, AND EXPENSES RESULTING FROM OR MOISING OUT OF ANY INJURY, DEATH, LOSS, OR DAMAGE TO ANY PERSON OR PROPERTY DURING 'THE WORK CONDUCTED UNDER THIS PERMIT'. APPLICANT SIGNATURE DATE EXCAVATORSIGNATURE (IF D7EI 01, OWNER'S -SIGNATURE (IF DIFFERENT) DATE: 2 of 2 Co,nnwnw.a(! 0 %%%aeeK" Official Use Only Permit No. l7n [' — % 30O Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS Rev, l/07] leavebiant APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC). 527 CM It 12.00 (PLEASE PRINT IN INK OR TYPE14LL INFORM TIOA9 Date:— L (� 2" q l (( City or Town oL• 12-itt Cj(.A - To the Inspector of Wires. B this application the undersigned gives notice of his or her intention to porm the electrical work described below. �znl�:, L cation (Street h Number) 17 Paml iIG UC S 1 o O rner or Tenant jZ (Ck "gr S(4 el Q Telephone No. �01 rner'sAddress 9Is I his permit In conjunction with a building permit? Yes No ❑ (Cheek Appropriate Box) �P ose of Building Utility Authorization No. 4 E sting Service Amps/0Z4 / ?t¢ Yolts Overhead ❑ Undgrd Ej�-- No. of Meters �e Serviba Amps / Volts Overhead ❑ Und d gr ❑ No. of Meters Number of Feeders and Ampacity tp 1. e & 6- D P Location and Nature of Proposed Electrical Work: W No. of Recessed Luminaires No. of Cell -Susp. (Paddle) Fens Tr o of ransformers KVA No. of Luminalre Outlets No. of Hot Tubs Generators KVA No. of Luminaires Z Swimming Pool ve ❑ o-mergency rnd. d. g Batt Units No. of Receptacle Outlets (J No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners. lie. at DetInItlaou ln and ykes No. of Rangy No. of Air Cond. Total ns , No. of Alerting Devices No. of Waste Disposes ea ump 10120:1 imberiTFOR IKW No. Of e on n Detectlon/Alerdne Devices 1 1 No. of Dishwashers Spsct/Area Heating KW Local ❑ tin c Connectiopn ❑Other No. of Dryen Heating Appliances XW Security 77stems: No. of Dsvlees or E ulvalent o. o Water KW Heaters o. o o. o slzns Ballasts Dais Wirings No. of Devices or E ulvalent No. Hydromassage Bathtubs No. of Motors Total HP felecommunications Ivirtor. No. of Devices or Equivalent OTHER: j r-� .rrraca awtrtonm astatl ydeatre4 or ae required by the inspector of tYins. Estimated Value of E ctrica Work: / 5—D O (When required by municipal policy.) Work to Start V2& / Inspections to be requested in accordance with h1EC Rule 10. and upon completion. 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 coven to force, and has exhibited proof of same to the permit issuing once. CHECKONE: INSURANCE OND ❑ OTHER ❑ (Specify:) cerdfy, under the pains and penaides ojper/ury, that the Information on this application is true and compeeea F tNAb1E: LLIC.a7/-3 �Wl `\ J Licenser. r� 1( l.L_ Signature IC. NO.: �iAl�3 H ` (If opplkroble, ento "uenrpr !n h�ltcnve n` her Iln) Bw. Tel. No.' 7 7 eO r .,x c�` Address: 8� /1F • �4-10e <l 1 _4 AIL Tel. Nob •Per M.O.L. e. 147, s. 57.61. security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally 54�4required by law. By my signature below, I hereby waive this requirement. lam the (checrPE011T ne owner owner's a ent. Owner/Agent signaturs Telephone No. FEE. S o� r� TOWN OF YARMOUTH Building Department BUILDING + PERMIT NO (508) 398-2231 ext.1261 PROPOSED PERMIT ISSUE DATE 1/11/2011 _ ; USE ; _ . _ APPLICANT ,Richard Bishop .............................. . . . . . ., JOB WEATHER CARD PERMITTO Addition AT (LOCATION) 10017POINTOF ROCKS RD ZONING DISTRIC R- Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 1125.121 BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R-3 LOT SIZE �� construct addition for office as per plans dated 01/10111. REMARKS 1% AREA (SO FT) EST COST ($ $30,000.00 PERMIT FEE ($) OWNER JBISHOP, RICHARD A BUILDING DEPT BY ADDRESS 10017 POINT OF ROCKS RD Yarmouth Port I MA 102675 INSPECTION RECORD CONTRACTOR LICENSE 0 PHONE 15083625025 FIELD COPY Date Note Progress - Corrections and Remarks Inspector .o=•�-+%a,� VNE & •rwu FAMLY ONLY — BUILDI p APPLICA77ON TO CONSTRUCT. REPAIR, RENOVATE OR DEMOUSN A ONE y Town of Yarmouth Building Department l l46 Route 28 • South Yarmouth, MA 02664-44! 508-398-2231 ext.1261 Fax 508-398-01 DEC 13 2010 Y •/1 Lc: 1\U CE �Q0"ke Lisa 0* Pb Mnq Board Irdormaeoe kneam Dmrtmert Irdormaeon: PermtNo. \T 6l0 Oate 11 IMan Ty" Mw cor Permit Fee S Errdor"meat Dan ���AO R ec�adetq Oa1e New Deposit Rec'd. $ 0 f Ptfn No. 1.4 Property Dlmendont Net Oue $ �� V Per Lot Ara (sf) F,,,,ia, lM tm cwrave t T?* 80cdM 1w ODba uaa chve MUM PI gam Issue* ei�i00li*LM:� OtllF•• CtiitllkxEliotOt�etltianc• k Yrd' rsyui�A�.:: • Section i- Sits 1"ftmet v Use I Ft 4 W. 5 B 1.1 pe"p"etr Adi"ea Imo- PO � rr d¢ �OG(LS �b�l-ice 1.2 zw*v I Barr. —I�—'—C--�/ Z6rnn9 District Proposed Use 1.3 ou"bm S4tbw G (n) Front Yard Side Yards hear Yard Required Provided aired Provided Required Provided 2 ii r 2b Zd � � r 1.4 W~ Supply Pith. a 4a S S 1 Put>flt: Private I 1.e Fbod Zion» Manraor¢ Con"wneuc Zo w 8FE Section 2 - PMpaly OwnwiNl Authorized i1 0-- mw of Recoodi tl P G e (Pdnt Mairag Addess Signstwe Tebphone TS &MOSa!s"a A"ft Name w t" Mai ngAddress Srgnetun .rebW'one n 7 P i �S �i� Fax Secdon 3 - Carntivctton Soft --ea-- " MLk-ensedC.".1ee"us"Sapiu.;els"AN 112011 � I NotAppkable Ueen" Number Address Expiration Date �� Telephone 32RegkWW Hom ( CtMtraetor: Ce epw fr mane Nat Applicable Address �� 1'ekphpte L¢ense Number Expiration Date O12 OVEN sectlo • Cc AffldtvK �l:dl t � Workers Compensation Insurance attldaWt must be composted and submitted with this apptk adw. Failure to provide this aMdaWt will result In the dental of tha Issuance of the bullring permit. Signed AMdavit Attached Yes... .... No........ seCdM M- 0 a! PMPOSO 1Nblt docit sI Now CWOUCties 0 I me of Ba imm ft of Boron E*" M* o 1 ROWS) a I MWOM v Amseeoryr Bldg. ❑ type Qemoetlon Oths► Specify: Brief Oescrlption of Prvposad 1Mbrlc 9ecOn Q- Esdtnatsd Censbuctiort Cbsd Item Estlmaled Cat (Oossre) to be Check Below canplald by permR sppUant 1. ZD o nfl FAV 4. m P- Or (Napplicable) 3. RwribkV / Gas -- 4. hied,** (HVAC) old KkW 1 low A WhlorIeW s. F1,e Proletlan --- C&m*@Ion amoval e. ToM w (1 + 1 i 3 ♦ 4 ♦ S) p (N appimble) 7. toll squme FL Om f� a tllaal •5�. 1. . as owner of the subjed property hereby authorize to ad on my b*W, in all matters relative to work authorized by thla buking permit apptleadom I %7ftradCWW o es I Section 7b - OwnsdAuthortted A ent Oeedddaradm as OwmdAaVxWk"sM hereby d are at a sta snllnd i"n rma the foregoing application an true and accosts. to the bed of my knowledge and bsf1M. Signed under the pains and penalties of perKuyr. ark,tm ma �11./ 4- beg - 2 01 o sr9naun a O~Aq" Caft 9- fd•99 .j 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 adjacmt to such residence or building' be done by registered contractors, with certain exceptions, along with other requirements. Type of Work: i i iCost`1� — Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S 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. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: /� . / ► ". , .9 / ....�17.4 ii ytZ �o=•YqR'� TOWN OF YARMOUTH y BUILDING DEPARTMENT �'�;• • 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext.1261 HOMEOWNER LICENSE EXEMPTION PLEASE PRINT. DATE: JOB LOCATION: I - -Pb lwr' P,a;yo A2r(iQ 3Lim r— NAME STREET ADDRESS SECTION OF TOWN "HOMEOWNER" ' C4h4-W J3151-bfP t1a R 3bZ (o!:?- 4a-4- 40 ;3 NAME HOME PHONE WORK PHONE PRESENT MAILING ADDRESS _ Imo• 'Pb 4 t- mF =a e S p dL> OR TOWN STATE ZIP CODE The current exemption for 'Homeowner' was extended to include owner— occupied dwellings of one or two units and to allow such homeowners to engage an individual for hire who does not possess a license, provided that such homeowner shall act as supervisor. (State Building Code Section 108.35.1) 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 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. ;j] 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 142 of the Mass. General Laws and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent htomwwrafloexemp a II L\ v&* aA1%1t1VV L11 0 BUILDING DEPARTMENT o y 1146 Route 28, South Yarmouth; MA 02664 508-398-2231 ext. 1261 Fax 508-398-0836 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at 1-4' -ftI LT Or` ptwc- $6A-r> 11 &y {tit. ttL P0, - Work Address Is to be disposed of at the following location: V&Lt4A -t-1- l itr-ILL, Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. EAW1 8 P Signature of Application D to Permit No. yARMOUTH ^T 27 F:' .12, 12 YARMOUTH OLD KING'S HIGHWAY REGIONAL HISTORIC DISTRICT - COMMITTEE- 1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664 Phone (508) 398-2231 Ext. 1292 -- Fax (508) 398-0836 Colleen McLaughlin, Office Administrator (cmclaugh fin @ yarm outh.ma.us) CERTIFICATE OF APPROPRIATENESS APPLICATION AChapter 470, 1973 Acts & Resolves of Massachusetts of pplication is hereby made in quadruplicate for the Issuance of a Certificate of Appropriateness (C/A) under Section 6 of drawings, photographs, and other supplemental informationaccompanying73 for Proposed this applicat on bed below and on plans, CCThat Av 1A ) Exterior Building Construction: _New Building _✓Addition _Alteration Indicate type of building: ZI-FO se _Garage _Shed _Commercial _Other: 2) Exterior Painting/Reroof: _Siding —Shutters _Doors _Roof _Other. 3) Signs/Billboards: _New Sign _Existing Sign Change: _Color _Style _Size _Location 4) Structure: _Fence _Wall _Flagpole _Pool _Other. �e or Print Legibly• Address of proposed work: 1 �E a Iwr or= 00_ __ Map/Lot # 12 2 Owner(s):__ f3i5f#yp - Phone #: 5DS 3bZ �6 Mailing Address: (�- pofl�rr � �fGS �� V * Email: �� r 1 it ( Mt- Preferred notification method: US Mail Email Agent/contractor. _-f1,� Dr_si �.i���;r� �, Ie �_ . A t• Phone #: BPS 0 f e(iS Mailing Address: >ZL O * Email: Preferred notification method: US Mall Description of Pr ngg2 Work• 33 o sF aoWhrx r Signed Ownedccntractor/agent is aware that a permit is required from if application is approved, approval Is subject to a today appe This cerffflcate Is good for one year iron approval date or upon All new constriction will be subject to inspectlon by OKH. OKI Received by OKH: Date: Cash/Check#: Rcvd by. Date Signed: 4VC/Q Approved ' Reason for denial: Date nI _t 2Email whichever date shag be later. n-sita for framing 3 final insor IVED SEP 1-7 2010 _ Approved with Amendments _ Denied /,�)- /OA J TOWN OF YARMOUTH N , 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664 p_ �" f TTA [ F_r1Jf f7� Telephone (508) 398-2231 OLD KING'S HIGHWAY REGIONAL HISTORIC DISTRICT COMMITTEE STATEMENT OF UNDERSTANDING As property owner/contractor/agent for construction at C/A#_ 1 (0- A /I B approved on rI I In accordance with the Guidelines to the Act, "Sec. E.I. :)0 Only minor changes may be approved by the Committee -'-C- without the filing of a new application and a new 3 j�I- hearing. Minor changes or alterations would include _ x-� c or minor rchange lof colors single whch could be made without �� a detrimental impact to the overall appearance of the project. All alterations' by amendment or otherwise will require the local Committee's approval." Before or after work has begun on a project approved by the Old King s Highway Committee, a request for a minor change must be submitted to the committee in writing. Approval shall be obtained before incorporating the change into the project. For more than one revision to previously approved plans, a new Certificate of Appropriateness must be filed and approval voted by the committee before incorporating the changes into the project. Failure to do so will result in the Building Department issuing a stop work order or delaying issuance of an Occupancy Permit or final inspection approval. Filing a Certificate of Appropriateness for revised plans after work on the changes has been started or completed will also result in having to pay a filing fee of $50.00. I have read and understand the above statements. Signed:_ Cha r., OKHC:6/96 s Signed: Owner con ctor agent PPROVED OCT 262010 YARMOUTH _p.KINGS HIGHWX •nmw on Rrtye4e P.pw Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. - v_-v 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 Town of Yarmouth Wetland By -Law, Chapter 143 A. General Information From: Yarmouth Conservation Commission To: Applicant Richard Bishop Name 17 Point of Rocks Road Mailing Address Yarmouth Port MA 02675 Cityrrown State Zip Code Property Owner (if different from applicant): Name Mailing Address Cityrrown State Zip Code 1. Title and Date (or Revised Date if applicable) of Final Plans and Other Documents: Sketch Plan by Richard Bishop Title Date Date Title Date 2. Date Request Filed: September 18, 2010 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): Single Family Dwelling Addition Project Location: 17 Point of Rocks Road Street Address 125 Assessors Map/Plat Number Yarmouth Port Cltyrrown 121 Parcel/Lot Number wpaformidoc - Determination of Applicability - rev. 1016104 Page 1 of 6 11 LlMassachusetts 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 Town of Yarmouth Wetland By -Law, Chapter 143 B. Determination (cont.) The following Determination(s) is/are applicable to the proposed site and/or project relative to the Wetlands Protection Act and regulations: Positive Determination Note: No work within the jurisdiction of the Wetlands Protection Act may proceed until a final Order of Conditions (issued following submittal of a Notice of Intent or Abbreviated Notice of Intent) or Order of Resource Area Delineation (issued following submittal of Simplified Review ANRAD) 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 noi confirmed by this Determination, regardless of whether such boundaries are contained on the plans attached to this Determination or to the Request for Determination. ❑ 3. The work described on referenced plan(s) and document(s) is within an area subject to protection under the Act and will remove, fill, dredge, or alter that area. Therefore, said work requires the filing of a Notice of Intent. ❑ 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 Act. Therefore, said work requires the filing of a Notice of Intent or ANRAD Simplified Review (if work is limited to the Buffer Zone). ❑ 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 Ordinance or Bylaw Citation wpefom,2.doc • oetem,inetlon or Applicability. rev. 10/6M4 Page 2 of 5 J LlMassachusetts 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 Town of Yarmouth Wetland By -Law, Chapter 143 B. Determination (cont.) ❑ 6. The following area and/or work, if any, is subject to a municipal ordinance or bylaw but not 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 alternatives. (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 at the owner's risk only upon notice to the Department and to the Conservation Commission. Requirements for requests for Superseding Determinations are listed at the end of this document. ❑ 1. The area described In the Request is not an area subject to protection under the Act or the Buffer Zone. ❑ 2. The work described in the Request Is within an area subject to protection under the Act, but will not remove, fill, dredge, or alter that area. Therefore, said work does not require the filing of a Notice of Intent. ® 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). ❑ 4. The work described in the Request Is not within an Area subject to protection under the Act (including the Buffer Zone). Therefore, said work does not require the filing of a Notice of Intent, unless and until said work alters an Area subject to protection under the Act. wpaform2.aoc • Dete manor of ApPnrawufy • rev. 1 ore104 Page 3 of 5 • 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 Town of Yarmouth Wetland By -Law, Chapter 143 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/or work described in the Request is not subject to review and approval by: of Municipality Pursuant to a municipal wetlands ordinance or bylaw. Ordinance or Bylaw Citation C. Authorization This Determination Is Issued to the applicant and delivered as follows: ❑ by hand delivery on K by certified mail, return receipt requested on -n t-L&f 27, Zo 1 D Date Da e This Determination is valid for three years from the date of issuance (except Determinations for Vegetation Management Plans which are valid for the duration of the Plan). This Determination does not relieve the applicant from complying with all other applicable federal, state, or local statutes, ordinances, bylaws, or regulations. This Determination must be signed by a majority of the Conservation Commission. A copy must be sent to the appropriate DEP Regional Office (see http://www.mass.gov/dep/about/recilon.findvour.htm) and the property owner (if different from the applicant). Signatures: 77. 7"K�4r-r �A v� October 21, 2010 Date wpaformUoc • Oeterrnlnatlon of Applicability • rev. 10/6104 Page 4 of 5 r LAMassachusetts 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 Town of Yarmouth Wetland By -Law, Chapter 143 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 http://www.mass.gov/dep/abouttregion.findvour.htm) 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 Request for Departmental Action Fee Transmittal Form) as provided In 310 CMR 10.03(7) within ten business days from the date of issuance of this Determination. A copy of the request shall at the same time be sent by certified mail or hand delivery to the Conservation Commission and to the applicant if he/she is not the appellant. The request shall state clearly and concisely the objections to the Determination which is being 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. wpeform2.doc • Determination of Applicability. rev. 10/601 Page 5 of 5 Temp Permit No.: TOWN OF YARMOUTH Building Department Town Hall Yarmouth, MA 026" (508) 398-2231 exL1261 BUILDING PERMIT TRANSMITTAL T-11-249 Applicant Name: Richard Bishop Applicant Phone: Building Location: 0017 POINT OF ROCKS RD Owner's Name: BISHOP, RICHARD A Owner's Addres 0017 POINT OF ROCKS RD Owner's Telephone: REVIEWED BY: Yarmouth Port MA 02675 (508)362-5025 (OFFICE USE ONLY Recorded By: Ic Permit Fee: $0.00 Deposit Rec: $25.00 Payment Type: Check ChkNo.: 871 Net Owed: ($25.00) Application Date: 12/13/2010 Issue Date: Expiration Date Comments: Map/Lot: 125.121 construct addition 1. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3.CONSERVATION: �,fL�� DATE •.Z�_ N/A: 4. HEALTH DEPARTMENT: DATE: N/A: 5. BUILDING DEPARTMENT: DATE: N/A: 6. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE COMMENTS: L M iz /i N6 RECEIPT OF COPY. SIGNATURE OF APPLICANT: DATE: 1i a Date Printed: 12/20/2010 otr_Y'A% .� Nk ^r TOWN OF YARMOUTH HEALTH DEPARTMENT PERMIT APPLICATION SIGN OFF To be completed by Applicant: Building Site Proposed pdin7c oK / c v4p IQ, JgIJ% DEC 13 2010 Tel. No.: 4'/ 7- y094.02 Address: 17 p0,"7f0 /2ort U, /2cE%, ��u� AA ✓r Date Filed: Dec 1Z ZOJ 0 '•Ifyou would like e-mail notification ofsign of; please provide e-mail address: Owner Name: S10/YLI;, Owner Address: Owner Tel. No.: RESIDENTIAL AND/OR COMMERCIAL BUILDING HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. Please submit three (3) copies of plans, to include: (1.) Site Plan showing existing buildings, water line location, and septic system location; (2.) Floor plan labeling ALL rooms within building (all existing and proposed) — Note: Floor plans not required for decks, sheds, windows, roofing; (3.) If necessary, Title 5 application signed by licensed installer with fee. REVIEWED BY: 1 PLEASE NOTE COMMENTS/CONDITIONS: DATE: I,- 14Lo . y. TOWN OF YARMOUTH ;moo WATER DEPARTMENT C 99 Buck Island Road West Yarmouth, MA 02673 Telephone: (508) 771-7921 Fax: (508) 771-7998 BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET Bldg. Site Location t _% 9a )h f o r �C ks /2j- Map #: Lot #: Proposed Improvement: ,��''/f�� aV J, U'�f-I[Q. c% 1Y-c Applicant: 1 C Address l7 0In f c f locks *el. #: 7•YP -95-03 Date Fled: /4' o S; ( RESIDENTIAL AND / OR COMMERCIAL BUILDING Water Department: Determines Compliance of Water Availability and or Existing Location Engineering Department: Determines Compliance for Parking and Drainage Conservation Commission: Determines Compliance to Wetlands Acts; i.e. If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Ocean, Bogs, Bays, Marshland, Etc... Health Department: Determines Compliance to State and Town Regulations, i.e., Requirements for Septage Disposal and other Public Health Activities Fire Department: Determines Compliance to State and Town Requirements for Personal, Safety, Property Protection;, i.e. Smoke Detectors, Sprinkler Systems, Etc... Signature of a PLEASE NOTE: COMMENTS: to l f (�Or x� � L TOWN OF YARMOUTH BOARD OF APPEALS ti DECISION FILED WITH TOWN CLERK: MAY 11 IM HEARING DATE: May 17, 1990 PETITION NO: 2737-2 77 HAY 18 P 2 :29 u PETITIONER: down cape engineering, inc. for Richard Bishop 11,.'i 'tA.RM'JUTil 1LIWk LLLRK & TREASUREIt Property located at 17 Point of Rocks Road, Yarmouth, MA and shown on Assessor's Map #113 as parcel N178. It appearing that notice of said hearing has been given by sending notice thereof to the petitioner and all those owners of property deemed by the Board to be affected thereby and that public notice of such hearing having been given by publication in The Yarmouth Sun on May 2, 1990, and May 9, 1990 the hearing was opened and held.on the date first above written. " Present were David B. Oman, Zoning Administrator; Forrest White, Building Inspector; John Demers, engineer; Arnie Ojala, president down cape engineering; Mr. & Mrs. Paul Robinson, abutters. This is request to allow a foundation within the 2qrear line requirement of the Yarmouth Zoning Bylaw. A certified plot plan, by down cape engineering, inc., for Richard Bishop, dated and revised 3/23/90 found the error in calculations after the foundation was in place. The existing foundation was placed 18.8tfeet from the rear line. The Zoning Administrator finds the criteria for variance is met and that to grant would not derogate from the intent .or purpose of the by-law. Therefore, the petitioners request3 for a 1.5 foot variance from the required rear line setback is granted. No permit issued until 20 days from the date of filing the decision with Town Clerk. a David B. Oman Zoning Administrator TOWN OF YARMOUTH %"� BOARD OF APPEALS OWNERS: Name: Richard Bishop Appeals# 'VIZ1�.g, Address: 858.11ainStreet Hearing Date: Dennis; MA 02638 Paid: 7�TBd PETITIONER: Name: Down Cam Fngin - .ring. Inc. Address: 939 MAin Street, Rte 6A Yarmouthport, MA 02675 ��/ Telephone # 362-4541 c1 Building Inspector This application is. for' the .property and/or structure located at: 17 Point of Rocks Road Assessor's Map# 113 Parcel# N178 I/We, hereby request the action checked below: 1. Appeal from decision of the Building Inspector to grant permit and petition your Board for a public hearing on this action. 2. Application for Special Permit under Section(s) of the Yarmouth Zoning By-law and/or for a use authorized in the "Use Regulation Schedule" Section(s) 3. Petition for Variance from the terms of the Yarmouth Zoning By-law to allow: A rear setback to be established at 18.5 feet . W Hic" Wo„ r% 6E ,o% i•j� \/^FZ1^rJcV' FfioM THE LXI�MrJG REArk Z5L-rSA K In order to grant petition, a variance of Section(s) 203 of the By-law is necessary. A list of abutters within 300 feet of the perimeter of the property, as shown on the most recent Assessor's Maps is attached. Copies of the Rules and Regulations of the Board and a general informactiioon sheet are available from the Board's Secretary. !/ D N G �a LL oM.� ( �w Lt. / � U Signature o c% / -� J f , I -,• • It G M,GrR .r Re,w.� ...v. a.q rVINT OF ROCKS Rpe,p LA'T' ITT NOTE: TOr OF POWO4T\ON IS ws. H,GrL0. TP1...N TNe HI4N P . 1N PIS.NT OC RaCKa iiel,0, ►-pT 1'Tq f RR — CERTIFIED PLOT PLAN LOCATION. LOT 178 POINT OF ROCKS RD YARMOUTH RED FOR: SCALE. 1 "-30 ' DATE. 02/28/90 REFERENCE. P8 207 PG 57 RICHARD BISHOP I HEREBY CERTIFY THAT THE STRUCTURE SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON. 1H OF NtJ� down cape engineering, inc. ,�„o JOHN McELWEE CIVIL ENGINEERS 31L3/-�P0 $ NO.33602 LAND SURVEYORS OZ 2$ RE� . ROUTE 6A YARMOUTH MA DATE R Apo m fJ MIG.IR, ..1 1 e- E.Ev• a.-1 POINT OF ROCKS itO,.,p LCT I-TS \� ? 112,So0 S t. tI %AC-) LOT 1'f7 0 > >11 1 l /10 16 U \Xic 1�9 Itt►r.c 0.00 V iy 12 p � 001/ V Fewer 1eN - -C,s 111.14 NeTL: -ro" o�Fe�NogTIeN IS Ia.. ' reP06W'.PNY SNO.•/IJ�Ta.KQN 13E�'ME HIGHER TG M( F11M PT �.tION COR �ouraD�lT1eN . 1N Pe....t OC RsCK! Reap, CERTIFIED PLOT PLAN LOCATION. LOT 178 POINT OF ROCKS SCALE. • I II -30 ' DATE. 02/28/90 REFERENCE. PB 207 PG 57 I HEREBY CERTIFY THAT THE STRUCTURE SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON. down cape engineering. inc. CIVIL ENGINEERS LAND SURVEYORS ROUTE 6A YARMOUTH MA PREPARED FOR: RD YARMOUTH RICHARD BISHOP 4 iv �� JOHN ,@saseo o MCELWEE -9/L 316j0 $ No. 33602 DATE 17R Leo TOWN OF YARMOUTH BUILDING DEPARTMENT PLAN REVIEW & BUILDING PERMIT APPLICATION REVIEW NOTES ADDRESS: 17 Map / Lot: Date of Initial Review: Other Review Dates: Inspector Review Date: Approval Date: NOTES Permit Fee Calculations 0� Correction List Description ---/-/ rz WHOSE- WMA1000M Zoning Denial (if applicable): Section 104.3.2, para. Change, Extension or Alteration (pre-existing, nonconforming) The proposed Other Building Code Denial (if applicable) hpinrv&bldgpermit requires a Special Permit from the Zoning Board of Appeals. I Rev. 3/2109 + OF ry TOWN OF YARMOUTH Building Department g U I L D I N G , ' (508) 398-2231 ext.261 PERMIT NO ......Pol .... >a ISSUE DATE PERMIT �. 5/29/2007 - ; PROPOSED USE � _ _ - _ - - - - ; APPLICANT RICHARDA BISHOP -- . . . JOB WEATHER CARD ............................. PERMIT TO �essory Structure%SP IAT (LOCATION) 10017POINTOF ROCKS RD ZONING DISTRIC R-40 Bldg. Type: Residential I SUBDIVISION MAP LOT BLOCK 1125.121 BUILDING IS TO BE: CONST TYPE 5 B USE GROUP R-4 LOT SIZE SHED 12 X 12 REMARKS AREA (SQ FT) EST COST ($ $1,000.00 PERMIT FEE ($) OWNER JBISHOP, RICHARD A BUILDING DEPT BY ADDRESS 10017 POINT OF ROCKS RD Ly YARMOUTH PORT I MA 102675 CONTRACTOR LICENSE O PHONE 15083625025 INSPECTION RECORD FIELD COPY Date , Note Progress -Corrections and Remark Inspector /////l'7 1 / /l .//.f4A-I — ///:_// //, -_TD . A_ _ n,- . . _ .0191w,41._L_ NAM L V ' R 0 .ur*- „ SHEDS LESS THAN 150 SO. F7 SHALL BE PLACED A MINIMUM OF 30 FEET FROM THE FRONT LOT LINE AND A MINIMUM OF 6 FEET FROM SIDES AND REAR LOT LINES. t EXPRESS BUILDING PERMIT API TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508) 399-2231 Ext. 261 CONSTR.UCTiON ADDRESS: 1-7 Po PtrmN N 6 I Fen f �u 1'amit o�ira 6 atmtla ttom trine datt i�v� MAY 2 °�2007 D 9 ASSESSOWSl? ORMATION: `(7. y67 -gS 03 125 �� 121 OWNER: f'i5 off' NAME PMENr ADDRESS TEL N CONMCMLO dc�u1Z�2-- NAMe MAILING ADDRESS TF.1.N Xtesidentlid ❑ CamnteYcild Fat. Coat of cooetrucdon f /0000 &a, - Home Imp mwocat Contractor Lim N Construction Supariaor Lie. N Worimso's Compmsadon Insuta = (check ow) Vam the hamcowner❑ I am the ante proprietor ❑ i have Workees Compeatadon insiaaoce w%vaoce Company NEW. Worker's Comp. Polley/ a Tent r shwa / Z 0 Siding N of Sgmes ❑ Repteoerned wiedm N 11 Replacement doom N a Ra+ooc N of aquas () Strippiet dd shlotics• () Nit ors b7crs of eaisehtt roof (Fire Reta is t Catlltede a Dwwoq- wood store 07U debrb will be diapoaed of at Location of Facility I declare vader penahka of the statements hobo are troe and eomed to the beet of my kmwledte and belief I undentsod that any Ww aaswer(s) /will Jost ease Ibr deg' a of my t aid 16r uda Md.L. Ch. 261, section 1. 2 d Itesot's Sigmttue G( Del¢ Ownen sitnatme (a attecbment) Ddx Approved Date: Building Official (or designee) Zoning Detrick off: Mstortal District: )yYald�—No Flood Plain zone ❑ Ya ;k No Water Rom= ProteqIon Distrlet: Within 1001L of W andr. ❑ Yes XNo ❑ Yea No 3101 The Commonwealth ofMassaehusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electric]ans/Plumbers 1Aualtcant Information Please Print Legibly Name (Business/Orpnization/Irifflvidual): Ch er I I S fV0 1 Address: _ 7 0) i t�, Y .� City/State/Zip:��n /mN 41 p o ✓* Phohe M 2 -SO 1 S(`� Are you an employef? Checkthe•appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full,and/or part-time).' have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet t ship and have no employees working for me in any capacity. [No workers' comp, insurance �( required'] 3. (J I am a homeowner doing all work myself [No workers' comp. insurance required.] t These sub -contractors have workers' comp. insurance, 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 1529 § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. 0 Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 11.0 Plumbing repairs or additions 12.0 Roofrepairs- 13.❑ Other *Any applicant that checks box N 1 must ahao fill out the section below showing their worken' convensation policy infometion: t Homeowners who submit this affidavit indicating they are doing all work and then him outride conhacton must submit a new affidavit indicating suck t rontracton that check this box must attached an additional sheet showing the name of the subcontrsctors and their worken' comp. policy information. I am an employer that to providing workers' compensation Insurance for my employees: Below is the polky and job sits Information. Insurance Company Name: Policy # or Self -ins. Lie. #: Expiration Date: Job Site Address: City/State2ip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL e. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby c u der the pains and n a of perjury that the informatdon provided Above Or true and correct Si®ature: Z Phone #: v , Offlcial use only. Do not write in thh area, to be completed by city or town gl)9elaL J City or Town: Permlt/Llcense # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6.Other Contact Person: Phone #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Mass person in the service of another under any contract of hire, Pursuant to this statute, an employe is defined as "...every express or implied, oral or written." or any two or An employer is defined as "an i includsuig the legal rpepresentativc�s oaf a a�e�asa��employer, or the re re the foregoing engagedemployees- However the receiver or trustee of an individual, Partnership, association or other legal entity, employing �P Y owner of a dwelling house having not more than three daP���� who construction ns�� o repair therein, or the occupant Of the on such dwelling house dwelling house of anther who employs p be deemed to be an employer." or on the grounds or building appurtenant thereto shall not because of such employment MGL chapter 1529 §25C(6) also states that "every state or local licensing agency shall withhold the Issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to you situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) 000f� than tho insurance, Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees members or partners, are not required to carry workers' comthat this affidavit may insurance. If an LLC or LLP does have employees, a policy is required. it advised ay 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 obtaida workers' compensation policy, please call the Department at the number listed below. Sclf-insured companies should enter their self-insurance license number on the appropriate lime. City or Town Officials Please be slue that the affidavit is complete and printed legibly. The Department has provided a space at the bm 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 permittlicense number which will be used as a reference number. in addition, an applicant that must submit multiple permittlicense applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in I(city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i c. a dog license or permit to burn leaves ctc.) said person is NOT required to complete this affidavit. The Office of Investigations would bike to thank you in advance for your 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 Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 5-26-05 www,mass.gov/dia y • ue am of # M PLOT PLAN FOR LOT # J Z ( Indicate location of garage ar accessory building Additions with dashed lines -------------------- W� ewerdisposal (Cesspool) GD . this is a =ner lot, rite in name street SIDE YARD s i REAR YARD ........1...oft& SIDE YARD SET HACK ..:......ft. a (lot....... 100 frontage) (NAME OF STREET) rnformatio) G Supplied by uia rungs nignway tceg1U11a1 nsasuxIC r✓saaa Mt %.vussnsucc in the Town of Yarmouth for a APPLICATION FOR CERTIFICATE OF APPROPRIATENESS Application Is hereby made in triplicate, for the Issuance of a Certificate of Appropriateness, under Section 6 of Chapter 470, Acts and Resolves of Massachusetts,1973, for proposed work as described below and on plans, drawings or photographs accompanying this application for - CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: C New Building ❑ Addition C Alteration S Indicate type of building: C House C Garage C Commercial PIbther G" Af d TtJ2' 2. Exterior Painting: C .PR � 3. Signs or Billboards: C New Sign C Existing Sign C Repainting existing sign 4. Structure: G Fence G Wall G Flagpole TYPE OR PR/NT LEGIBLY DATE Si! Zy 70 ADDRESS �O�F PROPOSED WORK 17 PM4 of ROek$ Q • VFW ASSESSORS MAP NO. - IZS OWNER 1-x lGblCrf A • 6ISh0 p ASSESSORS LOT NO. 17.1 _ HOMEADDRESS %7 POtAk of ROCKS IZO40• YOMA POCTTELEPHONENO. (4151'9,63 ucu AGENT OR CONTRACTOR ftk' . TELEPHONE NO ADDRESS ZIP CODE USE ATTACHED SHEET (PAGE #3) IN PACKET FOR ABUTTING OWNERS DETAILED DESCRIPTION OF PROPOSED WORK: G1w all pardeulars ofwork to be done Including materials to be used In case ofstgns, give locations ofexisting signs and proposed locations ofnew signs. (Attach additional sheet, if necessary). CaH� tz�et 6srdeNsl ab w1�1, mal�x" Roof= gooRQo•�6s s d„af s P ITV' Gruuy. (;e6ie.-ro R'ee.s4eumt 2 avt•+oows e.-? Door -to Fom Soto, t-4 vef.96ctt F,,.w. s&-Atf • !2 x l2 Pt�ci (Hoot' -Po rvurF�t� rwjt Nou�s� • SN6D �uttl Lag lotg:< ,0 a cros NV4 Goeae ale propwi Signed y . Date Y Y Q• ' • Owner -Contractor -Agent Is aware that s Permit is required from the Building Department. • All new construction will be subject to Inspection by OKH In to a It is required that OKH approved (with BD stamp) plans are av 1In%RJa J4a1l t6 [tom Ing and final Inspections. �I j------I Date This Certificate Is hereby TAr UUTH Check Date `! c By ✓�.6, u APPROVED IMPORTANT: If Ccrdficate is approved, approval is subject to the 10 day appeal period provided in the Act DISAPPROVED ❑ PLEASE RETURN TO: Yarmouth OKHC District Committee Yarmouth Town Hall, 1146 Route 28. S. Yarmouth, MA 02M4 ?/40&3 SPECIFICATION SHEE 1 (YAKMUU I rl Unn1,01 • Provide color chips and attach where necessary. • New House: Provide Landscape Plan. On Site Plan show exterior lighting and electric meter. Address �Z P o mT aF Ro eKS Roa Q YaLrAy-A Pert I'1 Description of proposed work: t' C0.S 'r1UGi' ed S �24 /off FOUNDATION (IS" MAX. EXPOSED): CONCRETE/OTHER DRIVEWAY: WALKWAY: STEPS (INDICATE BRICK/CEMENT/OTHER): SIDING TYPE & MATERIAL: e444a W4 mW gill p�,we.)Sro>) GCL CHIMNEY (INDICATE BRICK/STUCCO/WOODFACED) N4#M ROOF MATERIAL: PITCH (7/12 MIN.) MAX. EXP. WINDOWS (GRILLES REQUIRED)—(WOOD/OTHER) INDICATE SIZES IF NOT LISTED ON ELEVATIONS: Z j 0 DOORS (WOOD/OTHER) I (INDICATE SIZES ANDS E IF NOT LISTED ON ELEVATIONS): 3(,, )4 11 & S TRIM: (ALL WINDOWS & DOORS TRIMMED WITH IX4 / IXS) MATERIAL OF TRIM: (WOOD, VINYL, ALUMINUM) SHUTTERS (WOODNML) (PANELED/LOUVERED) GUTTERS (WOOD/ALUMINUM): GARAGE DOORS: SIZE & STYLE: STORM WINDOWS & DOORS: (INDICATE SIZES IF NOT LISTED ON ELVATIONS) SKYLIGHTS: TYPE/SIZE: W0010 M"it. "b N f /V arve. New /VVN�q. WOOD DECK: SIZE: n/eaj-t, WOOD FENCING (MAX. HEIGHT 6�: STYLE: (SHOW LAYOUT & RUNNING FOOTAGE ON SITE PLAN) RETAINING WALL: (P.T. OR FIELDSTONE —CONCRETE INAPPROPRIA (SHOW LAYOUT & RUNNING FOOTAGE ON SITE PLAN) SIGNS: (indicate size, style, colors) COLOR: Ct� COLOR: DAAJV COLOR: COLOR: COLOR: I tfo COLOR: ~T'� GnA� COLOR: COLOR: COLOR: COLOR: COLOR: COLOR: COLOR: APPROVE !4AY 2 4 2007 No Ark /V O Nl& YAI KN SIGN POST: (indicate size, style, color) / OLD ID ...�, Additional Information 4 �p,el 2 a0lPOINT of RocKS RCaO P3.30 t .,,. ' IUWN CLE Lo-t 1'T8 ' a Lo—r ►TT „ L pT lig � I I I � � gZ.3 �' J fO WtY.T.eN . Yr..i AA-k . APPROVED MAY 2 4 2007 f NOTL: •YOA O�FOW o4T.ON .S IO.S. 1 f ' F116NIL0.'T'M,," TNC Noaw FL,. YAR".10UTH I w Pef«-r ec ROCKS ae^,e, OLD KING'S HIGHWAi' JOB # 88-331 CERTIFIED PLOT PLAN PREPARED FOP: LOCATION. LOT 178 POINT OF ROCKS RD YARMOUTH SCALE. 1 11 =30 DATE. 02/28/90 REFERENCE. PB 207 PG 57 RICHARD BISHOP I HEREBY CERTIFY THAT THE STRUCTURE SHOWN ON THIS PLAN IS LOCATED ON.THE �� GROUND AS SHOWN HEREON. �( oA����d OF N/f�y JOHN down' cape engineering, inc. MCELWEE CIVIL ENGINEERS - /Z3lbjo th.336022 LAND SURVEYORS ROUTE 6A YARMOUTH MA DATE R EYOR ISTA I . n l as "CY `\\ S2 AC aimpukulum a MM IVININ OF YARMOUTH 119 : 9.1e AC COMSMATKWI C!OMMt681Oq ,y 82 m A 1 123 C AC 0.30 AC 122 027AC jr 127 MAC 134 .01 AC A 1 W I W E TAX MAP 2 51 s TOWN OF YARMOUTH BARNSTABLE COUNTY MASS:ACHUSETTS I t OZ AC b e N MILL POND APPROVI~ � , MAY 2 4 2n�"1 YARMOL'f�I OLD KINGS HIGHV✓AY J ®r®M 001 Page 1 of 1 04 w.. .., .tip , '�.!• „,�,-..i w t� �• . � _fir ' „_w `. � � ell APPR®VEV P:AY 2 4 2007 YARMOUTH DING'S HIGH' S jj http://vwvw.visionappmisal.com/photostYannouthMAPhotos//00/00/51/94 jpg 4/26/2007 l 7 lbll2t aP /mac :s 2040 6A!1oG�iv Sf1'�Q ' �C�S7' ELevS�iar� N �_(7 0 W4:r o C\2 IL a L 7lit° 43 l 7 ALII4t ot- /?4W SKIP Z�dvry EL¢�16)4 /Z I ��013 via nmg•s 1Cnlgnway imegluntt/ ntstuttc "13tssca �.usuwntcc b1Y\�1 `YJ / In the Town of Yarmouth for a APPLICATION FOR CERTIFICATE OF APPROPRIATENESS Application Is hereby made in triplicate, for the Issuance of a Certificate of Appropriateness, under Section 6 of Chapter 470, Acts and Resolves of Massachusetts,1973, for proposed work as described below and on plans, drawings or photographs accompanying this application for. CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: C New Building G Addition C Alteration �'Ar l E E �u, Indicate type of building: C House C Garage C Commercial ji�bther a J 2. Exterior Painting: C "7 APR 3 0 20p1 3. Signs or Billboards: C New Sign C Existing Sign C Repainting existing sign 4. Structure: G Fence G Will G Flagpole G Other KING I UT HWAY TYPE OR PRINT LEGIBLY n, DATE % z Il D7 ADDRESS OF PROPOSED WORK 17 Pt)14of Rork PA • Y 1' ASSESSORS MAP -NO. Zf OWNER V1�ICV%4 A • GiSho a ASSESS .OTIO. 1 'J, HOMEADDRESS 17 Porn}' of RocicS P-00' YgtrflVWL POCTTELEPH& NO�7'Y3_ ttu n AGENT OR CONTRACTOR /VONe. TELEPI�NE N0-? ;t ' ADDRESS (ZiMOD1 t - -U Z_ USE ATTACHED SHEET (PAGE #3) IN PACKET FOR ABUTTING OWNERS DETAILED DESCRIPTION OF PROPOSED WORK Gtve allparticularsofwork to be done lnclud►ngniater`talsto be rued In east of alg?m glw locations of existing signs and proposed locatlom of new signs. (Attach additional sheet, if nettssary). eoxgrzvef (�frder457A4 AVA DARxRoot= 6o�a.,�6ctrk,.1 Sle�i./f S�v� Ljyj�' CAay. (;4&L-ro Aet.C44%Lxt Z suW0ew5 -r.-? Door -to AX'1L Sotfj% tl' t'rltF6ca F, w rhvJ0s • 12 x 12 PI1c�(noos= -to tv�rFt;1� mFft Housr� • SNfD u,,tl t� lac o /r� a erns NW Co�rtuc of Proporl Signed Y /� tl Date Y Y • Owner -Contractor -Agent is aware that s Permit it required m_theBuildln D¢ epartmlIent. e All new construction will be subject to Inspection by OKH Ins c,(� fl P R O V 1 e It Is required that OKH approved (with BD stamp) plans are it fallable-on-site-for- be- taming and Anal Inspections. I I MAY 2 4 2007 Soave below for Committee use only. 1 1 Date This Certificate Is hereby. Check By APPROVED DISAPPROVED u IMPORTANT: YARMOUTH KING'S HIM If Certilicate is approved, approval is subject to the 10 day appeal period provided In the Act. PLEASE RETURN TO: Yarmouth OKHC District Committee Yarmouth Town Hall, 1146 Route 28. S. Yarmouth, MA 02664 i 714a & 13 c�a✓�A, gl5tOP 17 1001 n-t of" (2-b C-ks ,12� yqrl- rwovR on/,F) M)q 02(i djN 5 1V-e peA--� c ,Pwo (1A4p,- 4 o w4L4c,,,, (", cqelgIIc�I;��,� { v. Cis l.-. � C%. I �:, a,� q-:I"� TOWN OF YARMOUTH DEPT FILE COPY z0 BUILDING PERMITVALIDATION DATE PERMIT NO. APPLICANT Richard Bishop Bishop ADDRESS 17 Pnint of Rntrkc Rd_ Y_P n2679 (NO.) ISTREETI (CONTR'S LICENSE) PERMITTO_ Addition (_) STORY (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) NUMBER OF DWELLING U AT(LOCATION) 17 Point of Rncka Rnnd DIO TING R CT R 40 (NO.) (STREET) BETWEEN AND (CROSS STREET) (CROSS STREET) LOT SUBDIVISION-199.191 LOT N17R BLOCKm8p III SIZE 97 BUILDING IS TO BE TO FT. WIDE BY FT. LONG BY USE GROUP FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: arld 191 v 92' hinroof garage -CO- xislting—home AREA OR VOLUME ESTIMATED COST $ 10.UOO.00 FEEMIT $ SS —On ICUSIC/SQUARE FEET) OWNER Richard Bishop BUILDING DEPT. ADDRESS__17 Point of Rocks Rd_ Y_P_ n2675 By gozor (Affidavit on reverse side of application to be completed by authorized agent of owner) I hereby certify that the proposed work is authorized by the owner of record and I have been authorized by the owner to make this application as his authorized agent. SIGNATURE OF AGENT ADDRESS (NUMBER) (STREET) (CITY) APPROVED BY DATE TITLE FIELD COPY BUILDING _.. 'Town OF•,YAItt�oUTH PERMIT - \s DATE I :PERMIT NO. APPLICANT Richard Bishop ADDRESS 17 Point of Rocks Rd. Y.P. 02675 ` - (NO.) (STREET) (CONTR'S LICENSE) PERMIT TO addition NUMBER OF j \� (_) STORY DWELLING UNITS ' (TYPE OF IMPROVEMENT) NO. (PROPOSED USE), ZONING AT (LOCATION) 17 Point of Rocks Road DISTRICT R 40 (NO.) '� (STREET) a BETWEEN — AND rn (CROSS STREET) (CROSS STREET) Oi m SUBDIVISION 125/121 LOT N 178_ BLOCKMI'lp 113 SIOZE -27 �- -U- .O �.BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION n - _. O z 'It TO TYPSR - ' USE GROUP R 4 BASEMENT WALLS OR FOUNDATION It ... • - (TYPE) O --REMARKS: add 10 : 771 hipr of gaagsto-Amisting bame AREA OR " VOLUME, PERMIT ESTIMATED COST $ 10,000.00 FEE $ 55-0n (CUBIC/SQUARE-FEET) OWNER -Richard>Bishopl ADDRESS _ 17 Point of Rocks Rd, Y.P. 02675 BYILDING DEPT. ('% INSPECTION RECORD DATE I NOTE PROGRESS- CORRECTIONS AND REMARKS I INSPECTOR APPLICANT COPY Z o THIS PERMIT NOT VALID UNLESS BUILDING <a PROPERLY RECEIPTED BY CASHIER `row of Year:ovrx � PERMIT VALIDATION DATE PERMIT NO. APPLICANT Richard 131ahop _ ADDRESS' 17 Point of Rocka Pd. Y.P. 02675 (NO.) (STREETI _ (CONTR'S LICENSE) PERMIT TO addition ( - STORY NUMBER OF DWELLING UNITS (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) - 17 Point Racks Road ZONING 40 AT (LOCATION) of DISTRICT R (NO.) (STREET) v BETWEEN n - AND 01 )CROSS STREET) ICROSS STREET) m SUBDIVISION 125/121 O LOT H178 8LOCKr-lp l3 SIIZE -27 u O. BUILDING IS TO BE.FT. ' WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION m Z Y TO TY153 USE GROUP R 4 BASEMENT WALLS OR FOUNDATION (TYPE) n REMARKS:-nd&A2_x_2 2-1-_hinrnnf_� Qara Qahr,"A 4- AREA OR YOUR SPECIAL ATTENTION is called to the following: .This permit is -granted on the express condition that the said construction shall, in all respects, conform to the Ordinances of this jurisdiction 'including the Zoning Ordinance, regulating the construction and use of buildings, and may be revoked at any time upon violation of any provisions of said ordinances. Weatherproof placard given at the time penuit is issued must be displayed on premises. The department must be notified and inspection made of prior construction work as requested on weather card. All new buildings and additions and alterations to existing buildings require a minimum of three called inspections, namely, (1) Footings. drain tile systems, foundation and basement walls. when walls are at least two feet high, but before back filling the wall and before proceeding with the superstructures. - - (2)-Framing prior to lath or finishcovering but after tirestopping,-electrical, plumbing and mechanical systems- am installed. (3) Final inspection when building or structure is completed. .-On jobs involving reinforced concrete work, inspection must be made after steel is in place and before concrete is poured. The Department reserves the right to reject any work which has been concealed or completed .without first having been inspected and approved by the Department in accordance with the requirements of the various codes. Any deviation from the approved plans must be authorized by the approval of revised plans subject to the same procedure established for the examination of the original plans. An additional permit fee is also charged predicated on the extent of the variation from the original plans. - permits are not valid if construction work is not started within six months front date permit is issued. Request for Final Inspection should be made by postcard or "phone call to This &pat-lmeiil when the construction work is completed and heating apparatus has been installed. Painting or decorating is not required before the Final Building Inspection. Final Inspection and certificate of occupancy crust be obtained before occupying building. a m_ IL m U ASSESSORS COPY zG mil OF Y�4h230iS2ii BUILDING <a PERMITVALIDATION i DATE PERMIT NO. APPLICANT Richard Bishop ADDRESS 17 Point Of Rocks Pd, Y.P. 02(t7S INO.) (STREET) - ICONTR'S LICENSE) PERMIT TO addition I _) STORY (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) NUMBER OF DWELLING UNITS 17 Point of Rocks Road ZONING AT (LOCATION( DISTRICT R 40 (NO.) (STREETI BETWEEN AND (CROSS STREET) (CROSS STREET) LOT SUBDIVISION 125/121 LOT R178 BLOCKVIV 119 SIZE .27 m, BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION O tt�� Z TO TYFU USE GROUP R 4 BASEMENT WALLS OR FOUNDATION f R (TYPE) O 4I. REMARKS: nt!d 121 x 221 hi'aroef,tnr.-t&e to e+tnttnR hntw AREA OR VOLUME ESTIMATED COST $ 10, 00.00 FEE PERMIT $ S5.00 (CUBIC/SQUARE FEET) .PLANER- Richard Bishop ADDRESS 17 Point of P.ocka Rd. Y.P. 02675 BUILDING DEPT. BY .T'O" OF YMMUT8 JOB WEATHER CARD DATE PERMIT NO. APPLICANT richara ftaheP ADDRESS 17 Point of Roeks Pd. Y.P. O261S (NO.) (STREET) (CONTR'S LICENSE) PERMIT TO additionNUMBER OF (_1 STORY —DWELLING UNITS (TYPE OF IMPROVEMENTI NO. (PROPOSED USE) AT (LOCATION) 17 Paint of Pocka Road ZONING DISTRIC4n (NO.) (STREET) a BETWEEN AND pI (CROSS STREET) (CROSS STREET) m SUBDIVISION 1r5i121 LOT 5178 BLOCKt!TQ 117 LOT SIZE •27 � 1 V ..g;,. BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION O ( z: TO TY P£� USE GROUP R 4 BASEMENT WALLS OR FOUNDATION c O (TYPE) REMARKS: ndd 12' X 221 b1proof rnrarom to erk-Atilig bore "AREA OR VOLUME ESTIMATED COST IO1t±QV�G{I FEEMIT 55.00 (CUBIC/SOUARE FEET) OWNER 1'iiCh�ra Biat�ag O nt O OC • i.po 02675 BUILDING DEPT. - ,ADDRESS BY • THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART T EREOF, EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP. _s PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. r 'nP-' u APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARAT INSPECTIONS REQUIRED FO R CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND 1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE• MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QUIRED, SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MEMBERS (READY FOR LATH OR FINISH COVERING). FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE OCruPANrV. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 2 2 2 3 HEATING INSPECTING APPROVALS REFRIGERATION INSPECTION APPROVALS I I OTHER 2 2 WORK/SHALL NOT PROCEED UNTIL THE PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD INSPECTOR HAS APPROVED THE VARIOUS WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE CAN BE ARRANGED FOR BY TELEPHONE ST/ AGES OF CONSTRUCTION. PERMIT IS ISSUED AS NOTED ABOVE. OR WRITTEN NOTIFICATION. i Of YqR� ..ATTACnt r�i' ONE & TWO FAMILY ONLY - BUILDING PERMIT APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING Town of Yarmouth Building Department 1146 Route 28 - Yarmouth, NIA 02664-4492 Tel: (508) 398-2231 x261 • Fax: (508) 398-2365 Office Use Only Permit No. Date Permit Fee $ SS friRecording eposit Rec'd. $a$�ate � Net Due $ 30 , Planning Board Information Plan Type Endorsement Date Date 1.4 Plan No. other Assessors Department Information: Map Lot Map Lot Old New Property Dimensions: IL G otArea (sf) , A7 Frontage (ft) Lot Coverage This Section for Office Use Onl Building Permit Number: Date Issued: Signature: e Certificate of Occupancy I / Is is not v required Building Official Da a Section 1 - Site Information I Use Group: R-4 Type: 5-B 1.1 Property Address: 1.2 1-7 Poi n-r of- OWCkS 12oA0 'ReslAwh4 Zoning Information: 6A2A6E Zoning District Proposed Use r MA OSG 1.3 Building Setbacks (ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 6 .fit o' �o' slz.s N2d.i �o� 18.8 1.4 Water Supply (M.O.L. e. 40. S 54) Public Private 1.5 Flo d Zone Information: Comments: Zone: a BFE: Section 2 - Property Ownership/Authorized Agent 2.1 Owner of Record: t i�tCl'Wr� A. Q.sko,o 1 Polar 0E'(0C(,1 fry T N (pn ) Mailing Address 09) 3.6Z- 6 Z5- 62.1 Z575- c Signature Telephone 2.2 Authorized Agent: Name (print) Mailing Address Signature Telephone Section 3 - Construction Services 3.1 Licensed Construction Supervisor. Not Applicable ❑ r i License Number Address APR iA Expiration Date Signature Telephon 3.2 Registered Home Improvement Contractor. Company Name Not Applicable ❑ License Number Address Signature Telephone Expiration Date 9- 15-99 1 of 2 OVER Section 4 - Workers' Compensation Insurance Affidavit (M.G.L. c. 152 S 25C (6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure, to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes .......... No .......... Section 5.- Description of Proposed Work (check all applicable) New Construction ❑ 1 No. of Bedrooms No. of Bathrooms Existing Bldg. ❑ T Repair(s) ❑ Alterations I Addition Q Accessory Bldg. �] Type 6drc Demolition her Specify: F Brief Description of Proposed Work: Arob 12 i. L: O Exi6Nq 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 2. Electrical 3. Plumbing / Gas 4. Mechanical (HVAC) 5. Fire Protection 6.Total =(1+2+3+4+5) 7. Total Square Ft. (new houses & addflions) Section 7a - Owner Authorization - Owner's Agent or Contractor Applies To be Completed When for Building 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 - 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 �;"a� 32,zO Signature of Owner/Agent Date 9-15-99 2 of 2 i°`Y"`'� TOWN OF YARMOUTH }®C r�,.._.IS.�S�' IIUILDING DEPARTMENT BUILDING PERMIT APPLICATION SIGN OFF Applicant: R 1nho -4` F hoyj� n Building Permit No.: Address: 17 1201 rff Of (LoW Tel. No.: 362'502(_ Date Filed: Bldg. Site Location: Map No.: qll�Lot No.: 6 The following information outlines the procedural steps required to obtain a permit to build, alter, or add to a structure within the Town of Yarmouth. The Building Department will determine compliance to the following: (A) Zoning Requirements (B) Historical Districts (C) Flood Zones. The Building Department will be responsible for assisting the applicant through the following departments: RESIDENTIAL AND/OR COMMERCIAL BUILDING WATER DEPARTMENT: Determines Compliance of Water Availability. (applicant to obtain) ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage. CONSERVATION COMl1IISSION: 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 REVIVED BY: . WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTENT: DATE: N/A: ✓/3. CONSERVATION: DATE: N/A: LeHEALTH DEPARTMENT: DATE: G N/A: INDI 5. WIRING INSPECTOR: _ 6. PLUMBING INSPECTOR: 7. FIRE DEPARTAEM: — PLEASE NOTE All stumps and/or brush must be disposed of at an approved site. DATE: N/A: DATE: N/A. - DATE: N/A: COMMENTS: �LDG MIN wf Coef.cn sl Fe oriKc. %�e NoT EXCEED 11 F/10�it EX�sT�vG Nrccc-77�',--e,c.c)tt r.n Ct2Jcc._0- 10P10. Ct-c-t — 8/99 Applicant Signature Date 0OWN OF YARMOUTH BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT. Job Location: Number Owner of Property: Construction Supervisor: Address: Licensed Designee: (If other than Supervisor) Name Name 2.15 Responsibility of each license holder: Street License No. Village License No. Phone No. 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building and structures only pursuant to the state building code and all other applicable laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Anylicenseewho shalIwillfully violate subsections 2.15.1, 2.15.2 or2.15.3 or any other section of these niles and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes ❑ No ❑ If you have checked M, 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 Chan of the Mass. Geneja�aws, and that my signature on this permit application waives this requirement. i'" ,4 Check one: of Owner or Owners Agent Owner ❑ 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: /7"� �F+ Est. Cos��O/ 0 0 6 Address of Work / 7 A / P)-A ol" Y. -40s HL Owner Name: e-he d �f j Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): W Work excluded by law Job under $1,000 Building not owner occupied Owner pulling own permit Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name The Commonwealth of Massachusetts Department of Industrial Accidents OlAcdOfIffr sUpstliis 600. Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Applicant informaiion: PieaseYR11P1'Teds'bTtr (dlamr� /Cim' phone 0 / 1 am a homeowner performing all work myself. ✓ ❑ I am a sole proprietor and ha%e no one working in any capacity O 1 am an employer pro%idine workers' compensation for my employees working on this job. comnanv name*. auaress: city: phone N• insurance co. polity N 0 I am a sole proprietor:general contractor• or homeowner (circle one) and have hired the contractors listed below Ssho have the folio%%ing workers' compensation polices: companv name• address: city phone N: insurance en, policy N Company name: Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine op to 51,500.00 and/or one years' imprisonment as well as civil penalties to the form of a STOP WORK ORDER aad a flae of S100.00 a day against me. I eadentead that a copy of this statement may be forwarded to the Office or investigations of the DIA for coverage verification. Ida hereby certify under the paint and penalties of perjury that the information provided above Is true and correct. Signature Date Print name Phone N Official use only do not %rite In this area to be completed by city or town official city or town: YARMOUT$ O check if immediate response is required contact person: permit/license N n8uilding Department pldcensing Board .261 OSeleetmen's Oftce phone N; _ (508) 398-2231 eat. pllealth Department pother Pe.ned 7A5 P1A1 Information and Instructions Massachusetts General laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An emphgrer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the foreuoing 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 owner of a dwelling house having not more than three apartments and who resides therein. or the occupant of the dwelling house of another who employs persons to do maintenance , construction or repair work on such dwelling house or on the urounds or building appurtenant thereto shall not because of such employment be deemed to be an emplo%cr. NIG1. chapter 1:2 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. Additionalh, neither the commomvealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter ha%e been presented to the contracting authority. Applicants Please till in the workers' compensation affidavit completely. by checking the box that applies to your situation and supplying company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested. not the Department of Industrial Accidents. Should you have any questions regarding the "law" or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be 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 ItflCe of laveslllnbos 600 Washington Street Boston, Ma. 02111 fax #: (617) 727-7749 phone #: (617) 7274900 ext. 406, 409 or 375 PLEASE PRINT. DATE: JOB LOCATION: TOWN OF YARMOUTH BUILDING DEPARTMENT 146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 260 HOMEOWNER LICENSE EXEMPTION 1-7 4/K M6A 00yr MN NAME STREET ADDRESS SECTION OF TOW14 "HOMEOWNER" PUCK 611640 3 6'z. Roll TO25" g L22— t z5'o NAME HOMEPHONE WORK PHONE PRESENT MAILING ADDRESS (ZOO CITY OR TOWN STATE ZIP CODE The current exemption for `Homeowner' was extended to include owner — occupied dwellings of one or two units and to allow such homeowners to engage an individual for hire who does not possess a license, provided that such homeowner shall act as supervisor. (State Building Code 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 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 of MGL CIL 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 142 of the Mass. General Laws and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ hhomeownrliaxemp � a TOWN OF YARMOUTH 1146ROUTE28 SOUTHYARMOUTH MASSACHUSETTS02664-4451 Telephone (508) 398-2231, Ext. 261 — Fax (508) 398-2365 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT BUILDING ELECTRICAL GAS PLUMBING SIGNS Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at ���o��� 04- &VA, IZ4 Work Address is to be disposed of at the following location: /CNKlLKm Lrfrl/os 70 • V , Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Signature of Applicant Permit No. /:�/y ,:'J Date PLOT PLAN 1Zvh4o AbuttorIs Name Lot # If this is a corner lot, write in name of street. A) b R A FOR LOT # l :? 0 Indicate location of garage or accessory building Additions with dashed lines -------------------- Sewerage disposal (cesspool) We11 0 I I (lot...... ..:.......ft. rear) SIDE YARD I1�7 IZ.S FT. Y REAR YARD $ 000 V. ..... ft. I HOUSE I SET BACK I� I I I I SIDE YARD ��-• FT� (lot....L O........... ft. frontage) nvh,d AbuttorIs Name Lot # If this is corner la write in name of w other street. \ (NAME OF STREET) \ Supplied by t k ��l�e� aFG C'e.► fi�S��/o� �Yy MARK NORTH POINT 3/?3/9a .. , SUBMITTAL REQUIREMENTS / CHECK LIST FOR BUILDING PERMITS New Structures 1. Application signed by the owner and owner's authorized representative / construction supervisor. Application shall include: Construction Supervisor's License, Worker's Comp. Affidavit / Certificates, Home Improvement Affidavit (all applications except new homes). 2. Four proposed site plans, stamped by a Mass. Registered Professional Land Surveyor, showing all boundaries, proposed setbacks, existing & proposed grades / contours, proposed location of structure(s), parking, curb cuts, drainage, impervious cover calculations (when applicable), flood zone and Title V design and any other zoning related details deemed necessary. 3. Three sets of complete construction plans, including a complete structural cross section, floor plans, use of rooms, dimensions, window & door schedule, HVAC details — electrical, plumbing & mechanical plans are also required for commercial & multi -family (3 units or more) structures. 4. Flood zone applicability — Compliance with Section 3107 of the State Building Code — Elevation or flood proofing certificates (whichever is applicable), shall be submitted prior to the issuance of a certificate of occupancy. 5. Plans shall be reviewed by the following departments: Health, Engineering, Fire & Conservation (when applicable). The Building Department will forward. 6. Old Kings Highway & Historical Commission (when applicable). 7. Mass. DPW approval for State Highway curb cut and access ways. 8. Construction control affidavits for all projects to be constructed or altered under the provisions of Section 116 of the State Building Code. Buildings containing 35,000 cubic feet or more. One & two family structures are exempt; except certified designs may be required for unusual structural circumstances. Section 3107 of the Building Code requires certified plans for new and substantially improved structures in flood zones. Additions 1. Same as above, except the blank generic `Plot Plan' available from the Building Department may be used for one & two family structures when setbacks are not marginal. 2. Flood zone applicability — When the value of improvements equals or exceeds 50% of the structure value (substantial improvements). Alterations 1. Same as above, except existing & proposed conditions shall also be shown on the plans. NO WORK IS TO COMMENCE UNTIL THE BUILDING PERMIT HAS BEEN ISSUED. Filing a building permit application does not imply approval and should not be construed as permission to begin work 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 expose 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 • After certified `as built' site plans have been submitted • Before concrete floor is poured • After perimeter drain has been installed • Before backfill • Before first deck is constructed • After damp proofmg • 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 for a 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 (may be 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 1 , Ji /4 1 MISM Im portant: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. _ 1� ICI Massachusettsa eno vivo ental Protection De p 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 To: Applicant Richard A. Bisho Name 17 Point of Rocks Road Mailing Address Yarmouthport MA 02675 City/rown State Zip Code 1. Tale and Date of Final Plans and Other Documents: Property Owner (if different from applicant): Name Mailing Address Cityrrown State Zip Code Certified Plot Plan for Richard Bishop 3-20-90 Tide Final Date (or Revised Date If applicable) 2. Date Request Filed: ll-Id-jnnn 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 (f applicable): Construct attached garage to existing dwelling Project Location: 17 Point of Rocks Road Yarmouthport Street Address Cdy/rown 113 N178 Assessors Map/Plat Number Parcel/Lot Number wPA Fa 2 Pogo d5 Rw.� MRY1 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 Detennination(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 Order of Conditions (issued following submittal of a Notice of Intent or Abbreviated Notice of Intent) has been received from the issuing authority (i.e., Conservation Commission or the Department of Environmental Protection). ❑ 1. The area described on the 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 not confirmed by this Determination, regardless of whether such boundaries are contained on the plans attached to this Determination or to the Request for Determination. ❑ 3. The work described on referenced plan(s) and document(s) is within an area subject to protection under the Act and will remove, fill, dredge, or after that area. Therefore, said work requires the filing of a Notice of Intent. ❑ 4. The work described on referenced plan(s) and document(s) is within the Buffer Zone and will after an Area subject to protection under the Act. Therefore, said work requires the filing of a Notice of Intent. ❑ 5. The area and/or work described on referenced plans) and documents) is subject to review and approval by: Name of Municipality Pursuant to the following municipal wetland ordinance or bylaw. Name Ordinance or Bylaw citation WPA Fam2 Ppe2dS Rw MM Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. a 131, §40 B. Determination (cont.) ❑ B. The following area and/or work, if any, Is subject to a municipal ordinance or bylaw but not 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 plans) and document(s), which includes all or part of the work described in the Request, the applicant must consider the following alternatives. (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 at the owner's risk only upon notice to the Department and to the Conservation Commission. Requirements for requests for Superseding Determinations are listed at the end of this document. ❑ 1. The area described in the Request is not an area subject to protection under the Actor the Buffer Zone. ❑ 2. The work described in the Request is within an area subject to protection under the Act, but will not remove, fill, dredge, or alter that area. Therefore, said work does not require the filing of a Notice of Intent. ® 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 Of any). ❑ 4. The work described in the Request is not within an Area subject to protection under the Act (Including the Buffer Zone). Therefore, said work does not require the filing of a Notice of Intent, unless and until said work alters an Area subject to protection under the Act. WPA Forth 2 Papa 3 d S Rw mmn 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.) ❑ 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 Brea and/or work 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 Date ® by certified mail, return receipt requested on December 13, 2000 Data This Determination is valid for three years from the date of Issuance (except Determinations for Vegetation Management Plans which are valid for the duration of the Plan). This Determination does not relieve the applicant from complying with all other applicable federal, state, or local statutes, ordinances, bylaws, or regulations. This Determination must be signed by a majority of the Conservation Commission. A copy must be sent to the appropriate DEP Regional Office (see Appendix A) and the property owner (if different from the December 7, 2000 Date WPA Form 2 Rev. a= Ppr. 4 of 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 appellant. The request shall state clearly and concisely the objections to the Determination which is being 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. WPA ram 2 Ppe S d S Rw men 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.) ❑ 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 Acttv4 (site applicable statuatory/regulatory provisions) ❑ 6. The Brea and/or work 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 December 13, 2000 Date Date This Determination Is valid for three years from the date of issuance (except Determinations for Vegetation Management Plans which are valid for the duration of the Plan). This Determination does not relieve the applicant from complying with all other applicable federal, state, or local statutes, ordinances, bylaws, or regulations. This Determination must be signed by a majority of the Conservation Commission. A copy must be sent to the appropriate DEP Regional Office (see Appendix A) and the property owner (if different from the December 7, 2000 Date WPA Form 2 Page ld5 Rev. 07/l70 M1G+p/. .M Re Ab c..c�• 8• Po1NT OF NOT �: TOA OC F�ow04•T,oN 1S IO.j' ' H,GHCR Z,,...w �rwE HIGH Pr. �w PO.MT OC H.aCK� Q010 TO\lVi',! 4' Fzocr ^�1 �•�tcz, �,d�1 9- 26 / FowerTew ml .00 . ;ii`;rci �1.��`=REASUiICI{ IUWN'CLE . .. 0 N APPROVED YARMOUiH COMMITTEE OKHRD i - Joe f BB-3 CEPTIF_►ED'PLOT'-PLAN PREPARED FOP: LOCATION. LOT 178 POINT OF ROCKS RD YARMOUTH SCALE., 1"=30 - DATE: 02/28/90 REFERENCE: PB 207 PG 57 RICHARD BISHOP I HEREBY CERTIFY THAT THE STRUCTURE SHOWN ON THIS PLAN IS LOCATED ON.THE GROUND AS SHOWN HEREON. down- cape engineering, CIVIL ENGINEERS LAND SURVEYORS ROUTE 6A YARMOUTH MA inc. ,�,-hCp� ELWEE AJOHN a.93s02 oz z6 ., DATE R ,hllA� Y LraT ITZ TOWN Po1NT ct= F2ocJ p1r�.dM 9 26 4 D p 3.30 y LL t • . IUWH CL� Lo-r I-TS N • ••• � il N • �1 - �Z,ry� •• FOWp.�T.Ow APPROVED YARMOUTH COMMITTEE J OKHRD j.. r 100.00 --- NOTL: TOA O�FoW ohTroN IS 10.'�• W6HC0. TwE H16M PT, 1N PO.wT OC'R.CKS Re.�p, • JOB # CERTIFIED PLOT PLAN PREPARED FOR: LOCATION. LOT 178 POINT OF ROCKS RD YARMOUTH SCALE. 1`=30' DATE. 02/28/90 REFERENCE. PB 207 PG 57 RICHARD BISHOP I HEREBY CERTIFY'THAT THE STRUCTURE SHOWN ON THIS PLAN IS LOCATED ON.THE GROUND AS SHOWN HEREON. 1jK OF SAX J0 down*- cape engineering, inc. WELWEE CIVIL ENGINEERS 017-3/170 Na•33602 LAND SURVEYORS oz Ze ROUTE 6A YARMOUTH MA DATE R ,bnla� �VEYOR NV18 NO( �W, u JOl ONIlSIX3- ���00000�es�e 0 DRILL t GROUT I I #4 DOWELS • 12' Or, I I I I I I I I 42 � I I ON COMPACCTM OwRAVCLEAN COMPA=. E � L I I 7 I I F nI I "---- i i I l I ' I I� GROUT DROP TOP I I ELS 0'120. OC Or WALL 12' I I e' TNK, x 4'-0' CONC. WALL ON CON'T. t 'xto' CONC. FOUNDATION- PLAN SCALEd/4'■1'-0 2Ws / 169 GARAGE 3/s' FIRE RATED GYP. ON WALLS 4 CEILING . O Y 3EGTION THRU GARAGE ADDITION �CALEd/4'1'-0' TYPICAL ROOF CONSTRUCTION, ROOF, SHINGLES.:TO MATCH_:EXIST. /115* . FELT RAPER 11W CDX ' PLYWOOD/ 2x10 RAFTERS AT ' to O.C.- GUTTER ON FASCIA DD. TO MATCH MIST. TYPICAL EXTERIOR WAIL CONSTRUCTION, SIDING TO MATCH EXIST./'TYPAR' OR EQUAL 1,OUSEWRAPA12' CDX PLYWOOD S14EAT14ING/2x6 STUDS AT 16' O.C. S' THK. x 4'-0' CONC. WALL ON CON'T. 16'x10' CONC. FOOTING NOT TH T44 CO w PR PA AP 0 TOWN OF YARMOUTH Application for a Permit to Build No. UPON FINAL APPROVAL FEE MUST ACCOMPANY THIS APPLICATION. ®ram 6*719.p MAP / % 3 LOT 4/ 76 DATE I f 84A V 19 The undersigned hereby applies for a permit to build according to the following specifications 1. Name of property owner Address eR�C A, Ctf 6 ,o Te1.362.-saZ-r�H) 17 1261NT of bock( EIGZ-IZKS- /el 2. Name of Architect (if any) 3. Name of builder oWN,V\ Address 4. License No. Tel. I 5. Name of Mason Address 6. License No. Tel. 7. Construction address 8. Date of subdivision Approval 9. Private dwelling ❑ Estimated Cost 10. Multifamily ❑ so 0 11. Commercial ❑ /�� ��►x /d 12.Other 13. No. of stories 0 14. Foundation — Full ❑ Half ❑ Crawl ❑ Slab ❑ 15. Materials — Wood 19 Cement ❑ Other ❑ 16. Type of heat — Oil ❑ Gas ❑ Electric ❑ Other ❑ 17. Garage —1 ❑ 2 ❑ Swimming pool - Size- - - - 'Ni 19 Storage shed —Size 10 x 10 20. Stove — Wood ❑ Coal ❑ Tel, )d I District n zone C, zone R y6 DO NOT WRITE IN THIS SPACE Type of room No. Kitchen ap, o-o -. 10. Dining Rm. Living Rm. Bed Rm. Bath Deck Closed porch Family Rm. Sun room__ Garage Shed /d .X f o Alterations 21. Size of lot: No. of feet front No. of feet rear No. of feet deep _ 22. Size of building. No. of feet front No. of feet side No. of feet rear 23. Distance from nearest building: Front Ft. side Ft. side Rear 24. Distance back from line or street I 1 Q From rear lot line 4 8' Sideline 10' :!: 25. H.I.C.R. No. LOT RELEASED BY Signature PLANNING BOARD Addre Date c)r-6-Hr.,14 W . . ; /9,p TOWN OF YARMOUTH Application for a Permit to Build No. UPON FINAL APPROVAL MAP 3 LOT IV/ 70 FEE MUST ACCOMPANY THIS APPLICATION. DATE 11 M l 19 The undersigned hereby applies for a permit to build according to the following specifications 1. Name of property owner *OR, A • (3t f 6 Te1.362-SaZS-kH) lAddress 17 961NT nF ►2ocId r `/Cytr»oul 8(,2-12 5S col 2. Name of Architect (if any) — — ---- Tel.: 3. Name of builder aw+�� Address 4. License No. `J Tel. 5. Name of Mason Address 6. License No. Tel. 7. Construction address 8. Date of subdivision Approval 9. Private dwelling ❑ Estimated Cost IF 10. Multifamily ❑ SO p 11. Commercial ❑ 12.Other Elm 13. No. of stories 0 14. Foundation — Full ❑ Half ❑ Crawl ❑ Slab ❑ 15. Materials — Wood 9 Cement ❑ Other 16. Type of heat — Oil ❑ Gas ❑ Electric ❑ Other ❑ 17."Garage — 1-0-2 ❑-- _- 18. Swimming pool - Size NJ 19. Storage shed Size 10 )(10 20. Stove - Wood ❑ Coal ❑ 21. Size of lot: No. of feet front )o . I uistnct n zone G Zone R- qC) DO NOT WRITE IN THIS SPACE F-�v�-ya <a Type of room No. IFS ��s i��� No. of feet rear 22. Size of building. No. of feet front No. of feet side Kitchen Dining Rm. Living Rm. ; r Bed Rm. 1 Bath ? Deck ! Closed porch Family Rm. Sun room_-- — Shed /d y f o Alterations ' No. of feet deep _ No. of feet rear 23. Distance from nearest building: Front Ft. side Ft. side Rear 24. Distance back from line or street 1 t ®� From rear lot line 4 8, Sideline 10' 7± 25. H.I.C.R. No. LOT RELEASED BY Signature PLANNING BOARD Addre Date IJEj ,-/a-/sue . TOWN OF YARMOUTH BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE -2.-1 mom) l97S JOB LOCATION /7 AdJn-� o f' AO6L rc e NUMBER STREET "HOMEOWNER" %2)C4ayd 4. (9).r -7C2-S6'Zr 4L — /Z SS" NAME HOME PHONE WORK PHONE PRESENT MAILING ADDRESS /% )aOIAP/ O)e- 2ocA3 d fly el-2mov4 CITY-OR-T /kq QZ 675 STATE ZIP CODE THE CURRENT EXEMPTION FOR "HOMEOWNER" WAS EXTENDED TO INCLUDE OWNER - OCCUPIED DWELLINGS OF ONE OR TWO UNITS AND TO ALLOW SUCH HOMEOWNERS TO ENGAGE AN INDIVIDUAL FOR HIRE WHO DOES NOT POSSESS A LICENSE, PROVIDED THAT SUCH HOMEOWNER SHALL ACT AS SUPERVISOR. (STATE BUILDING CODE SEC- 109.1.1) DEFINITION OF HOMEOWNER: PERSON(S) WHO OWNS A PARCEL OF LAND ON WHICH HE/SHE RESIDES OR INTENDS TO RESIDE, ON WHICH THERE IS, OR IS INTENDED TO BE, A ONE OR TWO FAMILY ATTACHED OR DETACHED STRUCTURES ASSESSORY TO SUCH USE AND/OR FARM STRUCTURES. A PERSON WHO CONSTRUCTS MORE THAN ONE HOME IN A TWO-YEAR PERIOD SHALL NOT BE CONSIDERED A HOMEOWNER, SUCH "HOMEOWNER" SHALL SUBMIT TO THE BUILDING OFFICIAL, ON A FORM ACCEPTABLE TO THE BUILDING OFFICIAL, THAT HE/SHE SHALL BE RESPONSIBLE FOR ALL SUCH WORK PERFORMED UNDER THE BUILDING PERMIT. (SECTION 109.1.1) THE UNDERSIGNED "HOMEOWNER" ASSUMES RESPONSIBILITY FOR COMPLIANCE WITH THE STATE BUILDING CODE AND OTHER APPLICABLE CODES, BY-LAWS, RULES AND REGU- LATIONS. THE UNDERSIGNED "HOMEOWNER" CERTIFIES THAT HE/SHE UNDERSTANDS THE TOWN OF YARMOUTH BUILDING DEPARTMENT MINIMUM INSPECTION PROCEDURES AND REQUIRE- MENTS AND THAT HE/SHE WI OMPLY WITH SAID PROCEDURES AND REQUIREMENTS. 1 - -- HOMEOWNER'S .SIGNATURE APPROVAL OF BUILDING OFFICIAL INSURANCE COVERAGE: I have aycurrent es ❑ liability INo Once policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. 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 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner 0 Agent 0 The Commonwealth ofMassaehusetts Department of Industrial Accidents Olflceollovest/pu/i�s 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Applicant Information: PleaieYRl]VI'Tl�s'bTa \ name• /` CAO/W 1 % _r.J).-Aoa c t114 /�jA , 02 G 7 f—one 86z-12 55' (d) 10 1 am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity O lam an employer pro%iding workers' compensation for my employees working on this job. company name• a d d re%s: city.: phone 0: Policy N I am a sole proprietor. general contractor, r homeow (circle one) and have hired the contractors listed below a ho have the following workers' :ompensation polices: address, city, phone N• insurance co policy N Failure to secure coverage as required under Section 25A cf MGL 152 as lead to the imposition of erimisal penalties of It fiat np to S1,500.0o a8d/or one years' Imprisonment as well as civil penalties In the form of a STOP WORK ORDER and a fine of SI0o.00 a day against me. 1 nadentand that s copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verificsdoa. t do hereb Fit }- der the pains and penalties of perjury that the information provided above f: trste and eorred, \ Signature it/lt.A.r 7 � Date 2 m—;—i D A f3l s1t�� ` m_-sd2�- INJ� Print name KI L. f' A♦ Phone N (TSa3� 962,— I Z5T official use only do not w rite In this area to be completed by city or town official city or town: YARMODTII _ permitAieense N nBuilding Department ❑Lieensiog Board ❑ check if Immediate response is required 261 ❑Selectmen's Office ❑Healtb Department contact person: phone N; _ (508) 398-2231 est a 1`10ther Oe.ned 3,95 P1A1 Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An eerphuver is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise. and including the legal representatives of a deceased employer, or the receiver or trustee of an individual , partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance , construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. NIGL chapter I: -' section also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionall\, neither the common\\calth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter ha\ e been presented to the contracting authoriq. Applicants Please till in the workers' compensation affidavit completely. by checking the box that applies to your situation and supplying_ company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested. not the Department of Industrial Accidents. Should you have any questions regarding the "law" or if you are required to obtain a workers' compensation policy. please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be 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 MCC II IRVISH129I13 600 Washington Street Boston, Ma. 02111 fax #: (617) 727-7749 phone #: (617) 7274900 ezL 406, 409 or 375 Suggested Affidavit for Home Improvement Contractor Permit Application For Ocoee Use Only Permit No. Dale NAME OF CITYITOWN AFFIDAVIT home Improvement Contractor Law Supplement to Permit Application MGL c.14ZA requires that the "reconstruction, alteration, renovation, repair, modernization, conversion, inmovement, 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 to structures which are adjacent to such residence or huildingbe done by registered contractors, with certain exceptions, along with other requirements. ' n Type of Work: Est. Cost _ \ Address of Work 1-i Po I Wt- o iZ OC Ik j rW *ktrh 0-v4 � \ Owner Name:'R%L1n aletQ a. (91S{vr \Date of Permit Application: 'L 1 M Q&4 (5 28 I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law _Job under S1,000 _Building not owner -occupied %N,,, _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 e.142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR: Notwithstanding the ab tice, I herccbb�y apply for a permit as the owner of the above property: Date m Owner Name PLOT PLAN AbuttorIs Name -Lot_# If this is a corner lot, write in name of street. .s� a 4+ L' i FOR LOT # sy 17' a Indicate location of garage or accessory building Additions with dashed lines • -------------------- Sewerage disposal (cesspool) Well I I ioo (lot................ft. rear) Q REAR YARD fO� SIDE YARD SIDE YARD HOUSE �]----FT_ �]-----FT� 4 SET BACK I I (lot..................ft. frontage) (NAME OF STREET) Information IR) G Supplied by a b 4j IL l Abuttor' s Name Lot # If this is corner for write in name of other street. MARK NORTH POINT TOWN OF YARMOUTH BOARD OF APPEALS DECISION FILED WITH TOWN CLERK: MAY IB WO HEARING DATE: May 17, 1990 PETITION NO: 2737-2 -►1;"p I' MAY 18 P 2 29 PETITIONER: down cape engineering, inc. for Richard Bishop . IR IO+NN l.LcfiK � jitEASURE:ft Property located at 17 Point of Rocks Road, Yarmouth, MA and shown on Assessor's Map #113 as parcel N178. It_appearin_g that notice of said hearing has been given by sending notice thereof -to the -petitioner -and -all -those_ owners of property deemed by the Board to be affected thereby and that public notice of such hearing having been given by publication in The Yarmouth Sun on May 2, 1990, and May 9, 1990 the hearing was opened and held.on the date first above written. Present were David B. Oman, Zoning Administrator; Forrest White, Building Inspector; John Demers, engineer; Arnie Ojala, president down cape engineering; Mr. & Mrs. Paul Robinson, abutters. This is request to allow a foundation within the 201 rear line requirement of the Yarmouth Zoning Bylaw. A certified plot plan, by down cape engineering, inc., for Richard Bishop, dated and revised 3/23/90 found the error in calculations after the foundation was in place. The existing foundation was placed 1E.8±feet from the rear line. The Zoning Administrator finds the criteria for variance is met and that to grant would not derogate from the intent or purpose of the by-law. Therefore, the petitioners request~ for a 1.5 foot variance from the required rear line setback is granted. No permit issued until 20 days from the date of filing the decision with Town Clerk. n ]!Qi{�llo, - David B. Oman Zoning Administrator :116 M 1Ci•, rT. ,r 72oap^ ...�• g.q P01N'T OF RACKS ROAD �r'—qTI V Iy is� 16 rf Gew—. fa W cw ,T,ON -rc..lgsy / \ Fa NOTE: TOP O�FoJNoAT10N IS 16.5, TOPOGRAPH`C SwOy1. -IrA mE 4 H,GMCR TRAM TM6 F11GM F4, 1'�CE�/�VA.T,ON FQfZ L—OVN�/��10N 1N Pol"-r eC ROC,c! ROAJZ. CERTIFIED PLOT PLAN PREPARED LOCATION: LOT 178 POINT OF ROCKS RD YARMOUTH SCALE: 1 11 =30' DATE. 02/28/90 REFERENCE. PB 207 PG 57 RICHARC I HEREBY CERTIFY THAT THE STRUCTURE. SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON. down cape engineering. CIVIL ENGINEERS LAND SURVEYORS ROUTE 6A YARMOUTH MA REVISED N/y/r i n c . .am -sec, -i/L 3l °90 oz Zf3 DA TE JOB 8 FOP: BISHOP OF JOHN MCELWEE No. 33602 M IC.N�r .M ROA.G' C..CV. 8.y POINT of Rocres Ro,.�fl LOT ITT .3eTE: -Tor OW- Fow =.gT10N IS H16MG9L -7 . " TMG F116M FL-, IN pa'wr OC QOCKS Re.L'b. VIC 3 1 ' R -1 P3' L-ck-r IlC9 JOB 88-336 CERTIFIED PLOT PLAN PREPARED FOR: LOCATION. LOT 178 POINT OF ROCKS RD YARMOUTH SCALE: 1"=30' DATE. 02/28/90 REFERENCE. Pe 207 PG 57 RICHARD BISHOP I HEREBY CERTIFY THAT THE STRUCTURE. SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON. itµ OF JOHN rys down cape engineering, inc. o WELWEE C CIVIL ENGINEERS s/L3/go N3.33602 LAND SURVEYORS oz r3 ROUTE 6A YARMOUTH MA DATE Rt��EYOR 411=15 SIIpGen- PaW Home Town of Yarmouth Template [Building Dept] Slipsheet Identifier [sg23428] Document Category Building Permits Map -Block Number 125.121 Street Number 0017 Street Name POINT OF ROCKS RD Department Building Parcel ID 15951 Backfile Batch Scan No Document? Additional Naming Info Index Operator Operator, Yarmscan Date - Time 2015-04-01 - 08:21 httpJAaserfiche12/SIIpGerY 1/1