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Home My WebLink AboutBuilding PermitsoF'Y'9R,� 0 —y •MATT �l Permit # 1 Fee S 7i Permit expires 6 months from I Issue date. EXPRESS BUILDING PERIM APPLICATION TOWN OF YARMOUTH CONSTRUCTION ADDRESS: ASSESSOR'S INFORMATION: eTilroeD Yarmouth Building Department _ 1146 Route 28 South Yarmouth, MA 02664 ! r (508) 398-2231 Ext. 1261 Map: Parcel: M1 BY. CEIVED FU2)'3 A2012 NT CONTRACTOR.��LN� . NAME S IV" MAMINO AD� Y oCuM X-f e r # Dp7Hzj M AI ideZ3� ( 'atial D Commercial ❑ Est. Cost of Construction S IQpO O Home Improvement Contractor Lic. # � 7 7g �/) Pr-0 sl , Construction Supervisor Lis # 7 9O 76 Workman's Compensation Insurance: (check one) ❑ lam the homeowner " the sole proprietor ❑ I have Worker's Compensation Insurance Insurance Company Name: Worker's Comp. Policy# WORK TO BE PERFORMED APPROVED ❑ Teat (Fire Retardant Catificate attached) ❑ Wood Stove Stied 0 Siding: # of square 0 Replacement windows # 3�2012 0 Replacement doors: # ❑ Re -root #of Squares ❑insulation_ YARMOUTH ()Stripping old shingles* debris will be disposed of at � � n I declare under penalties will be just cause for da applicant's tigoa= I Owners Signature (or r () going over layers of existing roof Old Kings Highwa 'strict Lr7ce for Like) 'lwrn o e statements herein contained are true and correct to the best of my knowledge and belief. I understand that any false answers) of my license and for prosecution under M.G.I. Ch. 268, Section 1. Approved By: Date: Building Official (or designee) Zoning District: V Historical District Yes 0 No Flood Plain Zone Yes 0 No Water Resource Pro n District Within 100 R of Wetlands: 0 Yes 01`N Fl�=— ❑ • No 3/01 The Commonwealth ofAlassachusetis Department of Industrial Accidents Office of Investigations 600 ff ashington Street Boston, MA 02111 a, www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Address: 06 HrXV-A t r44LV- kq Q City/State/Zip: QW eLj l A VM 000�3gi Phone #: 27 L/ --Z6 Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).' 2. ❑ 1 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 have hired the sub -contractors listed on the attached sheet. These sub -contractors have cmpl ces and have workers' 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 required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions I LE] Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other •Any applicant that checks box #1 rrstst alto fill out the section below showing their workers' compmtation policy infomntion. t Homeowners who subrnit this affidavit indicating they an doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the subtontnctors and state whether or not those entities have employees. If the subcontractors have employers, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation Lnsuranee for my employees. Below Is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. Expiration Date: Job Site Address: City/State/Zip: 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 $I,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 $250.00Aday against the violator. Be advised that a copy of this statement may be forwarded to the Office of 1 do hereby; f1q y under the pains and penalties of perjury that the information provided above is true and correct. one #: / f? 7 Lf / L Official use only. Do not City or Town: 9 area, or town ofciaL Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. 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. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an 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." MGL chapter 152, §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 your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit 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. Self -insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials 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. In addition, an applicant that must submit multiple permit/license 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 (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.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like 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 11-22-06 wwmmass.gov/dia date of filing, unless stayed for a longer period by agreement of the parties or court order. 24. Arbitration. Claims, disputes and other matters in question arising out of or relating to the Contract that are not resolved by mediation, except matters relating to any lawsuit or other proceeding to which the Owner is a party, shall be decided by arbitration in keeping with the Alternative Dispute Resolution Notice below. The demand for arbitration shall be filed in writing with the other party and shall be made within a reasonable time after the dispute has arisen. The award rendered by the arbitrator or arbitrators shall be final, and judgment may be entered upon it in accordance with applicable law in any court having jurisdiction thereof. The agreement herein among the parties to the Agreement and any other written agreement to arbitrate referred to herein shall be specifically enforceable under applicable law in any court having jurisdiction thereof. 25. Alternative Dispute Resolution Notice: THE CONTRACTOR AND THE OWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT THAT THE CONTRACTOR HAS A DISPUTE CONCERNING THIS CONTRACT, THE CONTRACTOR MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUTIVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND THE CONSUMER SHALL BE REQUIRED TO SUBMIT TO SUCH ARBITRATION AS PROVIDED IN M.G.L. CIL 142A. MR WILLI"GMTUND FLYNN HIGH PERFORMANCE, LLC NOTICE: THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE SETTLEMENT INITIATED BY THE CONTRACTOR. THE OWNER MAY INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS SECTION IS NOT SEPARATELY SIGNED' BY THE PARTIES. 26. Miscellaneous Provisions. This Contract represents the complete and integrated agreement AUG .2 3 2012 BUILDINGDCE'AF2TP.1�NT 1 / Lo.r 2,& ),0-r 2�h cL- ......... i 1 Foundation Location proved �,►�- �� _ z-- CERTI FI ED ' :R. SOT PL gN:. ::Lt�_4t�1.�. k_..t.�',N IDCATION��IP..Ksr¢£�.��t�:. • • . ��s�1�Zz�'iLiY��+^ZI�L'QIL�� 'iT.`}tl5t��+ '/ems • / DATa�t�l-� i , �:3Q...DATE,., -:/� PLAN RIEFE YCE .......... ................ LRtivp ln%y�(�Ft4 T 15'Cc:P7f- . . - 1 - . ,T W- 1771MJ. f .-971 C.0r' dZVAW l968 BAP.ncsT5y24•t�,GoN3,cTr{.yg „oF u� S !f!y�Nl�f rt t'3 .G":'P.Cr•.31 . �� I CERTIFY THAT THE �c3/N.ii1��✓t,✓,P.IY.!�' .... .... .... .. ...... •SI1OWN ON THIS PLAN IS lACCAyATED.ON THE GROUND y AS SHOW N. y • • • • • • • • • • • • ` • • .' rTl Q . . �aTEP`p� DATE 8/�Z,1. �Z 1 N a surd PETITIONER: , Page I of 1 Cipro, Linda From: Nicky48@comcast.net Sent: Friday, August 24, 2012 1:19 PM To: Cipro, Linda Cc: tomfiynncapecod®yahoo.com Subject: home repair permission Dear Sir or Madam: My name is William T. Gartland and I am the owner of the property at 79 PhgaaaaLCove Circle in Yarmouth. Please consider this my formal request/permission to allow Mr. Thomas Flynn and Flynn High Performance be issued whatever permit or permits the town requires to allow Mr. Thomas Flynn and Flynn High Performance to make the necessary repairs to the property. Thank you for your attention in this matter. I am available to answer whatever questions may arise. William T. Gartland 17 Slade Street Belmont, Ma. 02478 617-484-2395 r 7 i ,,) i t �1J AUG 2 4 2012� 8/24/2012 R CTTEIVED V ." AUG 0 3 2012 BUILDING DEPARTMENT EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 q (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: � I �')'Q�%�� C, C�. C[ rC ASSESSOR'S INFORMATION: OWNER: INAXVM , PRESENT ADDRESS TEL # CONTPiACTOR: Use Only Permi W4-1j— /) Amounc�" Permit expires 180 days from -2-0 1376 NAME 1 U MAUING ADDRESS TEL # Residential ✓ Commercial Est. Cost of Construction $ 0!�IW;* Home Improvement Contractor Lic. # / / %9 �� Construction Supervisor Lic. # Workriialt's Compensation Insurance: (check one) 0ooA I am the homeowner I am the sole oprietor , Insurance Company Name: I have Worker's Compensation Insurance Worker's Comp. Policy# WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate attached?) Siding; # of Squares Replacement windows: # Roofltig: # of Squares ( ) Remove existing' (max. 2 layers) Old Kings Highway/Historic Dist. ( replacing 'ke for like ^S;ci.nyPit. only 'The debris will be disposed out: - S 4:K In xA.C6 n r `G �ln f Location of Facility I declare tinder penalties will be just cause for der ApplicSat's Signature: Owners Signature (or Approved By: Wood Stove Replacement doors: # Insulation �e statements herein contained are true and correct to the best of my knowledge and belief. I understand that any false answer(s) a of my license and for prosecution under M.G.L. Ch. 268, Section 1. Date: U (6I Building Official (or designee) Date: Zoning District: Historical District: Yes vl Flood Plain Zone: No Witter Resource Protection 'strict: Within 100 fL f Wetlands: Yes s No APPROVED AUG 03 2012 Cm YARMOUTH OLD KING'S HIGHWAY 77re Commonwealth of Massachusetts Department oflndustrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass gov/dia Yorkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organizadon/Individual): 94�,( "1-6( Phone Are you an employer? Check the appropriate box: I. 111 am a employer with 4. I am a general contractor and I rloyees (full and/or part-time).* 2. �t ' a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required:] 3. ❑ 1 am a homeowner doing all work myself. [No workers' comp. insurance required.] t 3a. ❑ I am a homeowner acting as a general contractor (refer to #4) Ce,- Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11.0 Plumbing repairs or additions 12.0 Roof repairs 13.[,f„ ,01�er / •Any applicant that checks box # I t>mst also fill out the section below showing their workers, compensation polity information t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp, policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. have hued the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' C , tnc�tranCe 2 5. a area 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 recuired.1 Expiration Date: Job Site Address: City/State/Zip: 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. 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 y against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations o e DIA for insurance coverage verification. I do hereby "Ytnder the pains and penalties of perjury that the information provided above is true and correct Qfflcial use only. Do not write in this area, to be completed by city or town ofrciaL City or Town: PermItUcense # Issuing Authority (circle one): L Board of Health 2. Building Department 3.*City(rown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone #: r' Information and Instructions ' Massachusetts Oenerd Laws chapter 152 requires all emPIOY2ts to provide workers' compensation for their employes• . an ea+plgw is defined at "...every pen= in the service of another under any contract of tit Pursuant to this statute, re, 1 express or implied, oral or written:" " corporation or other legal entity, or any two oc mote An sarP&JW is defined as an individual, Patt�P. � rya of a deceased empluM, or the of the foretoutg engaged in a joint erdripsise+ and inchtding receiver err trustee of an individual, putaalh4tt associates at other legal entity, employing �PIoyem Howeverthe house not more than three a and who resides therein, or the occupant of the owns of a dwelling , m ro do maintoulwot coustrtict� or � work on such dwelling bouse of another who employs peso to be an empbyer." or el the tOUN O or building appurtenant themro shall not bmuse of such employment be deemed or MGL chapter 152, ¢25C(6) also states that "eery state or Ioal Iice�ias agency shall withhold rice Issnsace . at bnstneae or to eo=b—uet buddlap Is the eommoasvealtk foe any retxwsl et ■ Ueessse otr peritilt tooperatevidtae of eompliaaewith the laaraaeerrge n4uh" t prdxdaeeeptabW e apptkxawe bano statee "Neidw the comamnwealth nor any of its political subd b ioes shall AdditloaaRY, MGL chapter 152,125C(7i of public wow until b evidence o[complisaco with the insurance eats into UM contract fat the to the contracting authority." r of this chapter have been presented pppUesnb , . • at$dsvit completely, by checldng the boxy that apply to YOM lituation and, if . Please till out the wvrbea compensatiaa esand mupba(a) :>�8 with their certi&aids) of tie =nm roPPhe sub-cality Conn) naiie(d� � ) it Partaershipa (LLP) with m employees otter than the is,nasaca Limited Liability Companies carry or Littsited peusiti ft=,=. if to LLC at LLP does have t� err P� am required d ro cast wahis & be submitted to the Department of industrial em,iloyeea, a policy is wed, Be13advised that this affidavit may p for confirmation of ft=M oe coverage. Aye be sate to sip and date the sIDdavlt. The sffidavtt should be ciA,ed to the city or rows that the aPPEieatioe foe the permit as lieease is being tegaestA not the DePartment rePg the law err if y tithe a 40mou sae required to obtain a workers' Iodust id Accidents. Sbonid you at the number listed below. Sa-inataed companies should eater their corn Policy. Please call the Department _to :Y........ member on the •++'ropri+* lice. City or Town Ot2fel2m bt The Departmout has provided a space :Z the botfnaa Please be sate riot the affidavit is complete and printed le. Y• has ro coatid Yon regulting the aPPllcsat of the affidavit for Yves to gill out is the event rise OtBca of lmatitations Please t>Q sure ro till is the per=WHccnw cumber which will be used as a reference number. In sddttioe, err appbcmt mud submit that multiple pertmtJtkease applicadoas in any Lives Year, tied only submit am atHdavit indicating cuaent Poles h fmmzdm (ifneceuzry) and under "Job Site Address" the applicant should write "all locations in (city or rov„ n)," A copy of the affidavit that has been otBcially started cc muted by the city cc town may be provided to the applicant ae proof that a valid affidavit is on file fur future pwmits as licenses. A stew affidavit toast be filled out each or p y r, Where a !tome owner or citiibt zen s osiaing a license ermit rot related to any burinesa or commercial Ye venture dof lkensa or P� to burn 0 etc_ said pemn is NOT required to complete this affidavit The Office of investigations would tile to thank you u in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. the Deputt wWl address, telephone and fax mtmber. Tile Commonwealth of Massachusetts Department of Industrial Accidents Offlet of Investlptlons 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax A 617-727-7749 Revised 11-224)6 www.mass.gov/dia D Massachusetts - Department of Public Safeth R E C E V E Board of Building Regulations and Standards Construction Supervisor License pU63 2012 License: CS 98040 (---- U +: DEPARTMENT -r gUILD1NG THOMAS FLYNN °Y' — 146 HOKUM ROCK RD DENNIS, MA 02638 —d�f� Expiration: 10/5r2013 ('ummis.iuner Tr»: 7956 Officeof CoV; u iner9ffa rrsaebniineARegu mown _ HOME IMPROVEMENT CONTRACTOR Registration .147951 Type: t' e Expiration f1=013 Private Corporatioi c_. FL HIGH PERFORWNCE LLC. THOMAS FLYNN 146 HOKUM ROCK DENNIS, M.4 02638 Undersecretary RECEIVED AUG 0 3 2012 BUILDING DEPARTMENT ©y' Owner Statement r-� 4 . I�1i,G C 1 �< < I �An r' "ereby state that I am the owner of ��"� c�� and hereby authorize Flynn High Performance, LLC as Contractor Lic # j 8040 & HIC # 147951 to apply for the permit to perform siding repairs � De i7-4-1 e-1% Sign Date 101 OF Ir TOWN OF YARMOUTH Building Department BUILDING + (508) 398.2231 ext.1261 PERMIT NO 8-13-176 _ .; PERMIT r ISSUE DATE ; _ _ 0/2012_ _ ; PROPOSED USE APPLICANT �FLYNN,THOMAS - - JOB WEATHER CARD PERMIT TO Repair/Siding AT (LOCATION) 10079PHEASANYCOVE CIR ZONING DISTRIC R-40 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK L149.48 BUILDING IS TO BE: LOT SIZE REMARKS Siding ifTrim AREA (SO FT) EST COST ($ OWNER IGARTLAND, WILLIAM ADDRESS 10079 PHEASANT COVE CIR YARMOUTHPORT I MA 102675 CONSTTYPE1 5B I USEGROUPI R3 J PERMIT FEE ($) BUILDING DEPT BY PHONE CONTRACTOR LICENSE CS 98040 Flynn, Thomas 146 Hokum Rock Road Dennis MA 02638 ASSESSORS COPY r TOWN OF YARMOUTH Building Department BUILDING (508) 398-2231 ext.1281 PERMIT NO B-12-580 - PERMIT ISSUE DATE ;.10120/Y011. ; PROPOS SE APPLICANT FLYNN HIGH PERFORMANC r JOB WEATHER CARD . PERMIT TO Alteratlons AT (LOCATION) 1007&HEASANT COVE CIR ZONING DISTRICTR-40 Bldg. Type: Resldentlal SUBDIVISION MAP LOT BLOCK 149. 1 BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R-3 LOT SIZE REMARKS SIDING - REPAIR TRIWALTERATIONS AREA (SO FT) EST COST ($ $2500.00 PERMIT FEE ($) OWNER IWILLIAM GARTLAND BUILDING DEPT BY ADDRESS 10079 PHEASANT COVE CIR YARMOUTH PORT I MA 102675 INSPECTION RECORD 00.00 PHONE CONTRACTOR LICENSE CS980401 HOMAS FLYNN 146 HOKUM ROCK RD DENNIS MA 02638 7742689370 FIELD COPY Date Noe Progress - Corrections and Remarks Inspector Z � , utske use uruy ' /. , eemilte -`T31 ' SEP 2 9 2011 (y(/ FcaS Pennit expires 6 mombs lrom 1 (WGC:?T issue date. EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARbIOUTH Yarmouth Building Deportment 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS:.? PhLa /ati F l,. v e (2f / e-t<. ASSESSOR'S INFORMATION: MaP: /(/a I Parcel: U01 I OWNER: W t I I CONTRACTOR: 1 H wK 1(-t NAME W III ADDg �l 1114 / jZa.s? 12,c tz IV r�nitr s ' (�r►'►'I Git Cc , j! t L NIAWO ADDRESS win 00z,36 Residential 1/ Commercial - Cost of Construction [loan Improvement Contractor Lie. Construction Supervisor Lic. Workmen's Compensation Insurance: (check one) _ _----------------- ------ — T - - — I am the homeowner -- I am she sole proprietor^ I have Worker's Compensation Insurance Insurance Company Name: t� Worker's Comp. PolicyN WORK TO BE PERFORMED ❑ Tent (Fire Retardant Catifkmo attached) ❑ Wood Stove Shed- 0 Siding: N of Squares [�epla r- ce wldlows: it-i! — 0 Replacement doors: N 10l04 a 17lrro., oil f.,Gs i a� ORe-roof: NofSyuacesp.f}e fa µAy�/�/'a/�j`�'j� SI !(.Q�dC�ioG:C Res qql WLL.� /✓�L�aLJ �ncuLuloo r�ay��r� wG(�� ()Stripping old shLtgla• () going over layers of existing roof ❑ Old Kings 1-11911way4fistodc District -y- ` r RooflnStSkling (I.1ke for 11ke) Th •e debris will be disposed of at: LC 6/ &1 /1 <r G `/Ct, M AI4� Location or racluty I ill be J undo penalties of thu the taternents herein contained are true and corral [Oft bat of my knowledge and belief. [understand Uut any false answer(s) will be Just cause for denW �r raulonmy Ikense and for prwecuUoo under MQI_ Ch. 268, Section 1. Applicant's Sign== Dare /1 2. _ OwnersSfgsrtars( Approved By: Dec Building ORlciai (or designee) Zoning District , `t Historical District' Yef No Flood Plain Zoos Yes No Water Resource ProtatrDistrict: Within 100 fL of Wetlands: Yes c+o Yes No V01 The Commonwealth of Massachusetts Department of Industirial Accidents Office ofInvestigadons 600 Washington Street Boston, DNA 02111 Wain" .Mom tirgo Vt•sCant Ieformallon v/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electric1saWTlumbers Name (Buuincss/a mimaodlndividu,l):-FI_vI 0 ti R t lL rtrvi & r_/G "" &WA' Phone #• Are you as employer? Cheek the appropriate bo:: I. ❑ t am a employer with 4. 1 am a general contractor and I ,,, y�PloY� (M and/or part-time).* have hired the sub -contractors 2. 1 am a sole proprietor or partner listed on the attached sheet ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance mp• insurancmt required:] 3. ❑ 1 am a homeowner doing all work S. We are a corporation and its officers have exercised their . myself. [No workers' comp. right of axempdon per MOL 3a. ❑insurance required] t I am a homeowner acting as c. 152, 41(4), and we have no a general cmmu-tor (refer to tt4) employees. [No workers' co . insurance ] MaV ee GC r'S m<<1 �ZG3a Type of project (required): 6. ❑ New construction 7. 0 Remodeling 8. ❑ Demolition 9. 0 Building addition 10.[] Electrical repairs or additions 11.0 Plumbing repairs or additions 12.❑ Roof repairs 13.b161cr 11V idilr •./ /�jA/�c — 1__ appUcant that cheeks box el snot also till out the section below showing their woredk' eongensstiod i�k7 Ldbtmatioa. — -- I - Hommwoen wbo submit ibis snidavit indiatins they as doing all work cod they Airs outride tContraetors that cheek this boa nut attached m additional shoat COGMW a must submit a new atltdavit indicating such. �ploYee+. It the subcans aaan have employes, they most provide titdrth* wo ittses f mp subloo nombrs and sum whahar a no those aerials haw comp. policy Dumber. I an an employer that is proyidind workm' compensadon Larurance jor oqr atrploye" Below b iha po/ley and Job surf injormadom Insurance Company Name: Policy it or Self -ins. LID. #: Expiration Dab: Job Site Address: City/StateMip: Attach a COPY of the workers' compensation policy declarados page (showing the policy number and expiration date). Failure to secure coverage u required under Section 25A of MOL a 152 can lead to the imposition tine up to S 1,500.00 and/or one-year imprisonment. as penalties of a of up to 5230.00 a day against the violator. Be advisewell ascivil Perseids is We form of TOP WOC RK ORDER and a fined that a copy of this statement may be forwarded to the Office of MUMMENUME Investigations of the Djk for ins�rance coverage verification I di hanrby cenl/�r (dcr, and penoleia ojPsrlra, tlFar the in oraradow10000010000 Sigas`/ I Prortdd abere u trim and cot'nct ZL // Phone ll )?6, e-2z o � �a SOME 70ffld491/ uro only. Do not write in Ift arts, is be, complied 6y city or town oJJkiaLMINE City or Town: Permit/License 0 Issuing Authority (circle one): 1. Berard of Health 2. Building Department 3. City/Tows Cork 4. Electrical Inspector S. Plumbing Inspector Other Contact Person: Phone N: Information and Instructions IN "IoYd" to Po" W"k"S' C0�o 6" chr their eapb �,� t3cSte:al Laws chapost152 saed as @ .ary pr --CrMs is the aeevin oranothSs trader am t ova rhiM re p s,uant to &W Stott M as r'" ► YW express or WVIIcd, oral or writtee aamocia w% comorados at adw ko eadty. at M two at m e* As ea/re}a► detiasd s• "ss isdiridasl. tin kW Ora Ascwmad ampbm at the ar the oars biadbrldel. pa uwuuR assoefadom a other kW eStdtr. emPisyfom Q°�l° ' K t t� o e It at &-Uh boom harbi ad was mas thane and � � � o°� ft bm" owlet Ora dweilhem . wbe ealploys pm m b do maw dndlta{ bone or a -d- tbe:eb rh.Y not became orSacl ea &y.M be &wwd to be a "mpbyr * or os the ponds or boddiai WPutk and titnL chaplet 15% 12=6) sire th" that "avK7 state w bal lie"satsm agteteY a me * M MO W Isauaste as' to epstrsle s berssas ar t• ase[truet bsW6t� is tie a� � s4 resrwsl er s Ikssas cc pardt eriisssa d amp wit! ter Ismtteaaste eurtanme rM~ applltse+ttafshos pedtromAaaeeW nor orita snbdlvldosmSbn!! Addldoealtr. b" cbgw 132. j2%M Status "Nti&w the tutmoswesid say PoUdeal enter tab may Cat ft ft p of p+btle woait uold atxsptabls eridsnce orb wtt>r the tosaascu Rqa. -- b or ebb cbmpw bare ban pecaaolad b the cOd medog atbO*'' Appacas Ithe bootee that apply b yaw nit=" a� it P1 so m1 oat the wortoaes' Coo,pesrattas a�"'s moab"e(a) alum Wilk their eatitics*s) or nee"aes76 a:;tp1Y as `oowWmWm) moo"' sd&em() P y *� as othst thaw thin inowsw& Lboited Usbift CaaPede (�7 w t hOWd LJabiitey PaUUUAV�IM M'M O N (� ad required b �f *0 isemanoe. Ira I1.0 of E.l.ti doe bawe at hubsirid efr9kne t aroOmbere of �b� � advisedthat b 1M a The e113datk ahoum be d mb r Oafthe aPp.. .. - P� or lioesas it being Ss4eaa� ant tbs&#"pace--- or was r� Aaidear. 4amM yos have say q=W s � the law ae iryos ao ngdead b obads a Sheld eamttetheir uld es ss' ee®m po11eY. Plume Cad theDMWUO.. b the nmtbat Uded bebw. Ssl�tnmu d campeeles Ctlr • Tmws Omebb Pieces b" taco that the .tddavit b eoolpt"ts ad pry bWW. The D"�'nt he p�&d a spat at the bottom b eu oat is the "wet the Ott3n or tavadgebna tee to oontaet you repa+diam der sppHcaA or the at>ldnit yea mmbw whkh will be and a a refas Itat c is ddidOq app m 8ad pleame be eau b till Is the pamWUetaate i. am tl nsd uh► a0 nee att3darit Wlesd am cuawd that mart Submit maldpte PCity Polk► °' (iraseaaa•b d e b a bo rot Site Admasr lot mr br der cky or tows �Ps"'id'd loft u taws}" A COPY Or the be a vdnit that has bra le IN & ab W at Ue"sns A new at2rdartt moat be M W out cart ■ &#coott'hat. raW atl3datft b a rile bt lhaes p"rmilm yeeG�wbaA a home owlet at ctlts is obtaining a UOme Or pwmit mt tehttad b aaY bttatoaw or comimaSeW vents+ (La a Ix b boa rectaeaa>olw dds .mdevit do{ ikenea pencil The Oft$ or ts"StIvilow wO"M Itb ee thank you is adwan A* yes cooprados and Should you haw may gONSOMWO Plane de ad b"I" r mew us a caLL rtn Dwleatm es wWkm% t"lepbue ad tha otosbses TAt CQn=Ottw*Wt5 at Mttss.c RMtts Depatoseat of industrid Aot:itieats OtIIa at tanttsdpdow 6w washlops Shtd Bostom MA 02111 Ted. # 617-72749W w d406 of I-M-NtASSAFS Fax 0 617-W-7749 FUvbtd 11.22476 wvlr<1l.nutagov/dIs i M Owner Statement & Work Authorization Form J74 % /!hereby state that 1 am the owner of 9tI ^fir 6)Le CV,,,nd hereby authorize Flynn High Per%rmance, LLC as Contractor Uc # 98040 & HIC # 147951 to .apply for -the permit -' �„ •L Datel 12f 9 j Board of Building Rejulado ■hd Staadardt �r y, CofittrbC"0n 8t*rw r uce tx I.ICa3w.' C3i, 98040' RiE b 1 f ! d HOKUM) IiOCIt` Ej i -t-G- '-jte { ii,f4 , OENNis, IIf1102838 } ` - Commissioner j o ooousamer s at Ome anon , License'or registration valid for individul use only -= HOME IMPROVEMENT CONTRACTOR ) before the expiration date. If found return to: Registration: �147951 Type: I1I Office of Consumer Affairs and Business Regulation Expirationt J23Z2013 Private Corporatioi1 10 Park Plaza - Suite�S170 Boston, MA 02116/ FL HIGH PEF�F R GEC ^ _THOMAS FLYNN "5 // / 148 HOKUM ROCKS _ g DENNIS, MA MA 02838 Undersecretary valKwithout signature I I w w Vfx CV YARMOUTH OLD KING'S HIGHWAY REGIONAL HISTORIC CM0 DISTRICT COMMITTEE i-- 1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664 r N Telephone (508) 398-2231 Ext.1292 Fax (508) 398-0836 a Colleen McLaughlin, Office Administrator Q Ln (cmclaughlin@yarmouth.ma.us) CERTIFICATE OF EXEMPTION Application is hereby made for the issuance of a Certificate of Exemption under Sections 6 and 7 of Chapter 740, Acts of 1973, as amended, for the proposed work as described below and on plans, drawings, or photographs accompanying this application. PLEASE SUBMIT TWO (Q COPIES OF APPLICATION FORM & ACCOMPANYING INFORMATION (INCLUDING PHOTOS). Tvoe or print Ieaibly: �1 Address of proposed work: i�^�1,, _ 9 T h�$/t f L & V e Map/Lot # Owners: tultham 11-16t IfX Phone#: 77�I' Mailing address: Year built: / 9 Email: Preferred notification method: Phone Email Aoent/contractor. r=1 u K v% 14r k MCr 11 all u' ue— Phone #: 71 2 ,-V L�?3 ! 6 Mailing Address= y'L Pa 147u m r4 c-Q4-I Ht { KA& d Z (.- Email: Preferred notification method: hone Email (Zed (u 1 U1 t K &O-W Signed (Owner or agent): 0 A �Jst,J Trig vt� u/I, L t +17e f C G.A, J Q f1r= pasej S �3�2 't-oe �f�i -+4 . JJ w t't1l4Ljf fe >N4Fk4 Date: 6 �/ ➢ Photos (2 sets) showing all sides of building MUST accompany application. I ➢ Owner/contractor/agent is aware that a permit may be required from the Building Department. (Check other departments, also.) ➢ This certificate is good for one year from approval date or upon date of expiration of Building Permit, whichever date shall be later. For Committee use only: Receive OK Date: Cash/ ec #: Rcvd by If Date signed: '" Approved Reason for denial: ECEIVED SEP 2 8 2011 YARMOUTH _Approved with changes Denied APR OVER SEP 2 7 2011 YARMOUTH DLD KIND'S HIGHVVA //- 50 9� 33H ZZ:OIWCBZd3STTi 718313 NMOI Hl(lOWM Q- O i LU 1 v Iw u U uw ix LiJ 0 s i Q w r o N =_� � - 0 _ U � c/ c\i �.. a } Y a Cw a o Mee use umy 4j�` PermitFee S Pemrltexpi issue date. EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth BuIlcUng Department r02 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Fact. 1261 CONSTRUCTION ADDRESS;} �V� ASSESSOR'S INFORMATION: Map: Parcel: OWNER: Po-e,1IC1�'1_ S NAME PRESENT ADDRESS TEL M CONTRACTOR: ry 1.1 �.,+-� V\ 1^ 11 Pe Clu I- mQ rl M , I je e-7 &'" L OADDRESS TE Z6 J /C TEL ff Residential Commercial p ti+1st. Cost of construction S �— Hlome Improvement Contractor Lic, II Construction Supervisor Lie. Workman's Compensation Insurance: ' 1 am the homeowner C, —Insurance __Company Name: LLJ!!� I have-WorkeCS Compensation Insurance - -- - Worker's Comp. PolicyS WORK TO BE PERFORMED Teat (Fire Retardant Certi/fi�cate attached), / Vj j"Q `Y'�'"� ❑ Wood Stove Shed r— ❑ Replacement doors: N V ` C Replacement windows: k ❑ Re -roof M of Squares 1.14Pping old shingles' 'The debris will be disposed of at: g + j' declare under penalties of pedur the state will be just cause or denial or atioa of my Applicant's Signanue Owners Signature (or ❑ Iasulatloo () going over layers of alsting roof e-o C) r Location of Facicty Old Kings HighwaY/Mtoric District Roofmg/Sidinf (Like for Like) c4•-tS�' � 4�.1�'an . herein contained arc true and correct to the best of my knowledge and belief. I understand that any false answers) 'and for Prosecution under M.O.L Ch. 268, Section I. Data �� Date' Approved By Building Official km designee) Dom: Zoning Distrii Historical District: No Water Resource Protecti District Yes Flood Plain Zone: Yes >�o Within 10U. of Wetlands: (� Y11.1 No 3101 The Commonwealth of Massachusetts Department of lndusMal Accidents r� Offlce oflnvestlgatlons 600 Washington Street Boston, MA 02111 Workers' Compensation Insurance Affidavit: govldla udders/Contractors/Electriclans/Plumbers ,1 Ilcant Information Name Business/ Please Prim Le b ( Orguumtioniladividual): mQ� e-L Address: / y� h(� IL v M !2o City/State&ip: �e�-� yi l n4 * a Z� Phone #: 7 r/—ZG as employer? Cheek the appropriate boy a employer with 4. 01 am a general contractor and I Type of proJeet (required): ployees (full and/or part-time).• have hired the sub -contractors 6. ❑ New construction a sole proprietor or partner. listed on the attached sheet. and have no employees LC� These subcontractors have 7. Remodeling king for me in any capacity. workers comp. insurance E01 employees and have workers' a. ❑ Demolition comp. inSIMUCe.t 9. ❑Building addition ire&] a homeowner doing all work 5• We are a corporation and its 10. Electrical repairs officers have exercised their or additions elL [No workers' comp. right ofexemption per MGL 11.0 Plumbing repairs or additions ance required] t c. 152, ¢1(4), and we have no 12.0 repairs �- cmploI� [No L�Other SCG(CN Any aWkang dw cheeks icon at nag a4o BU out tAe required ] /'�tLt r/ t Homeowners who submit dds am&vit indwgin 'eCdw below shoring their aqa• w,Md PaUcy inform don, am doins an wark and then him tConowton that elrek dds box must att.ehed as addidanat chat rhowin dr ouotida eontractoo oast submit a new attidavit i diatin arh. ."10yees-,1ithe subcontractors have employees, tlw7 must prongs their = num of the � and sow wbedw a not groan enttdcs luw sorters eonq. PoUey number. - — -- - -- -I gas an employer that Lr provldIng workers' COMP ewsedow &sx — - --- - — - Informadoa. p 'a"nlor �y earployep: Below it the p- axd/ob slfi Insurance Company Name: Policy # or Self -ins. LIc. #: Expiration Date: Job Site Address: Attach a copy of the Workers' compeCity/Statemp: nsation Polley declaration page (showing the poQey number grad expiration date). Failure to secure coverage as required under Section 25A of MGL c.132 an lead to the fine up to 51,500.00 and/or one ;yimposition of criminal penalties of ear imprisonment, as weU as civil Penalties in the form ofa 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 �r investigations of the DIA for imurance coveraee vrriF'ir,r;.... I do hereby eerdA use and pseadrta ojper/uq that the MUMUM lnfa nrarlonProvkled above is due and correct area or town o.0kiaL -7/Co City or Town: Issuing Authority Author) (circle one). Permit/Ucense # 1. Board of Health 2. Building Department 3. CI1Y1TOwu Clerk 4. Electrical Inspector S. Plumbing Inspector 6.Other Contact Person: V Phone #: Information and Instructions compensation for their employees. Massachusetts General Laws cbapter 152 requires all employ'" to Prov ide workers' d sa "every person in the service of a.4 nother under any contract of hire, pursuant to this statute, an es ploy«is define express or implied. oral or written" ... or two or more an individual, p iron or other legal entity. to or the " umership, association, corpora • An earplera defined a and tachtding the legal representatives of a decried emp Yen+ ed in a joint ent Mds , employing eaployees, However the of the foregoing engaged association or other legal entity. mP ym ur the occupant of the receiver a trustee of an individual. pumen and wbo resides therein. owner of a dwelling House having not mote than three apartments work on such dwelling house dwelling house of another who employs person to do maintenance. construction of en be deemed to be an employer. or on the grou nds or building appurtenant thereto shall not becawe of such employment 23 6 also stave that "every:tate or local licensing agency shall withhold the Issuance or MGL chapter 152, 4 C() mrealth for any ce of compliance with the Insaranee coverage required-" renewal Of a license or permit to operate a business or to construct buildings In the t0 applicant who has not produced acceptableslaw "Nether the commonwealth nor any of its political subdivisions shall Additionally. MGL chapter 152, g25C(' public work until acceptable evidence of compliance with the insurance enter into any contract for. the performance of pub authority" ..MArements of this chapter have been presented to the contracting EMMUM • -- ApPUesnb affidavit completely. by checking the boxes that apply to your situation sad. if Please fill out the workers' conrrpensation s nsnse(s). address(es) and phone number(s) ci0� with their certifi�ate(s oot� than the necessary, supply sub-co'msct°r() or Limited Liability Partnerships (LLP) with no employees insurance. Limited Liability Companres (LLC) tion insurance. If an LLC or LLP does have members or Partners. are not required to carry workers compensation Department of Industrial Cal a policy is required. Be advised that this affidavit maybe submitted t e the coverage. Afro be sure to sign sad date the affidavit. The affidavit should Accidents for confirmation of insurancet rn Ucense is being requested, not the DeparbDcnt of application for the permi be returned to the city or town that the regarding the law or if you as required to obtain a workers Industrial Accidents. Should you have any questions reg a should eater their compensation policy, pleaseMMOOKUNMOMMM ..her onthe t}anit>a at the number lured below. Self -insured companies to line. City or Town Metals provided i specs at the bottom Please be sure that the affidavit is complete and printed legibly. •Ibe DePartment has ins' ou regarding the applicant. of the affidavit for you to fill out in the event the Office of Investigations has to contact Y In addition. an a applicant Please be sure to fill in the pernut/ltcense aumbet which will be used as a reference number. le tllicenss applications in any given Year. need only submit ooe affidavit indicating current that rraat submit multiple p under "Job Silo Address" the applicant should write "all location is (city or PC information (if necessary) of ed by the city or town may be provided to the town)." A COPY of the affidavit that has been officially stamped i that a valid affidavit is on file for future permits or licenses. Anew affidavit must be erci out each applicant as proof a license or permit not related to any business or corrnnereial venture yam, Where a home owner cc citizen is obtaining to complete this affidavit. yea a dos license or permit to bum leaves etc.) said person is NOT required and should you have any questions, The Office of Investigations would like to thank you in advance for your cooperation— , _ __. L .:MM fn 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, NIA 02111 Tel. 0 617-727-4900 ext 406 or 1-877-MASSAFE Fax 0 617-727-7749 Revised 11-22-4)6 www.mass.gov/dia Owner Statement & Work Authorization Form I iarrlcoo JQA4M hereby state that I am the owner of lei Plt4�94n'l l.b✓e eircLand hereby authorize Flynn High Performance, LLC as Contractor Lic # 98040 & HIC # 147951 to apply for the permit Signature to !t 27 ✓A* ioommamvea" W,,,4tat�aa4uae& i0amenoesaieaQii o�✓tiaataaiaeelg j s:\ . Office of Consumer Affairs & usiuess Regulation )Board of Building Regulations and Standards i �� HOME IMPROVEMENT CONTRACTOR Construction Supervisor License i _ License: CS 1 t Registration, ''047951 98040 a �r3i r Expiration 8f23/2011 Tr# 287701 . jExpiration:s10%5/2011 Tr0 98040 3 Type PrIX Corporation i / r R@striction, 0Q"' 3 FLYNN HIGH Pi�RFORMIINC9;:1LC. • • _.. _' THOMAS FLY*�--tl1,• t! THOMAS FLYNN 1 14,6 HOKUM ROdk(td, f' g .• ',•S i' ,:• ''� { i 146 HOKUM ROCK RD ` DENNIS, MA 02638' `: Undersecretary _ ' A 02638 • , 3 DENNIS,� Commissioner o 11'•T 0 a 1 or r TOWN OF YARMOUTH Building Department BUILDING , - - , , (508) 398-2231 ext261 '- PERMIT NO �, B-10-1090_ - PERMIT ISSUE DATE 4=010_ , ; PROPOSED U , APPLICANT .Thomas_Flynn. . . . . ..... . . . (, JOB WEATHER CARD PERMIT TO Repair AT (LOCATION) 10079PHEASANT COVE CIR ZONING DISTRIC R-40 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 1149.48 BUILDING IS TO BE: CONST TYPE 5•B USE GRO P R-3 LOT SIZE siding 4 squares, some replacement trim REMARKS AREA (SO FT) EST COST ($ S5, OWNER PENKINS. RICHARD A ADDRESS 0079 PHEASANT COVE CIR Yarmouth Port I MA 102675 J PERMIT FEE ($) BUILDING DEPT BY INSPECTION RECORD LICENSE 98040 Flynn, Thomas 146 Hokum Rock Road Dennis MA 02638 7742689370 PHONE I .. FIELD COPY Date to Progress - Corrections and Remarks Inspector //// 3 /6 TOWN &F YARMOUTH RECEIVED NOV 13 2006 I I_ _ APPLICATION FOR PERMIT TO DO PLUMBING (OFFICE USE ONLY) By Fee: $ p PERMIT NO. `J�'�'--3 / 3 l IN�i S�GM'T. J Date 00 ul ding Owner's��'� AM Location % % 4:n'f4kName Type of Occupancy New❑ Renovation ❑ Replacement 9� Plans Submitted Yes ❑ No ❑ Co rn y z 0 co Y � Ui W¢ 11 Y a V z C7 a of N a(n F- OC S O Z Z vi Z O y W m N== W Y Q W Cn y Y M a CLL7 a Q. Q 3 I�IZ7�N V = W 0 W Q W G Q W N O Q0: J Z O a Q LL v a �a Z N 3 x o o y z z W U. Y W J 0= N LL f- 0 c) _ Y m O a 3= FQ- to a 0 0 0 rr co 0 SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR (PRINT OR TYPE) �Check One: Installing Company Name - �6—e tc /�� //� ❑ Corp. Address ❑ Partnership Irm/Company _ Business Telephone �/ �f1rl"73�� Name of Licensed Plumber �/�Zv`r c4.+-% INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent. Check One: Yes fro 0 If you have checked YES, please indicate the type of coverage by checking the appropriate box. A liability Insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent I hereby certify that all of the details and Information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Check on Owner ❑ Agent ❑ Signature of Licensed Plumber 11 License Number Type: Master 1�ilJourneyman 0 �88AC:HUSET-rs UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print of Type) -7 V; _45� —a —34 W\Ok,2�� Mass. Date -0Co 3.QC)& Permit C, WEN - _.___;tAW;W�_Building Location _PiQQScN1'X C.CKYQ &�wner's Name!� Type of Occupancy S\t\Cku_q�2\ --Renovation .0, Replacement-4 Plans Submitted:' Yeso No 0 V) `0 0 Ll 0 W cc W.. W 1z a > - Ul W W 0 = W 0 fA X -9 X� 4 < 0, 0 Uj a' M: IN, a a. 0 I I I f T .11 1 2ND FL0011 I A I I I I .3RD FLOO,R 4TA.FL-00FI. STHFLOOR 67H FLOOR I I V 17TH FLOOR -8-rfj'F000A Installing pompa . n yName%uM Qre_9fQtlfW 10�� Check one Cert . ificate ,5� V Q ,AddressI �6 P6 th corporatiQn 900— 0 Partnership Bt.lslnes§'Teiephone 0 Firm/Co. Name of Licensed Plumber pr Gas Fitter es D, INSURANCE COVERAGE: I have a. current liability insurance policy or its substantial equivalent y4ifch meets the requirements of MGL Ch: 142. Yes ,It you have checked yes, please indicate the type coverage by checking -the appropriate box. A. liability insurance- policy 0 Other type of indemnity 0 Bond 0 DAN ER.'5jNSU.RAHCE..WAIVER:- L m aware. that thelicensee does-, not. -have- =the -insurance coverage required -by' -Chapter 142 of the Mass. General Law and that my signature on this , rmit ap S. pe plication waives this requirement. Check one: Agent 0 Signature of Cwner or Owners Agent I hereby.certijy that ' all of the -details and in(orm4tion I have submitted(or entered) in above application are true and accurate to the best of my kodwledge and that all plumbing work and installations performed under the perralt Issued for this application will be in'cortipliance with all Pertirjenl provisions of the Massachusetts State Gas Code ind Chapter 142 of the Ge en I Laws. fftyy•� TyRe of Lilcense: 4umbe. -bee -or,( r Ig pvt rise4,Plumbrer Jarhtler� GasfitlerV Y aster License Number M--,3 728 PCity/Town ROVED (0—FFICE LISF ON -LW— Journeyman. FINAL INSPECTION PROGRESS INSPECTION 2r .F i M N� QELOW FOR OFFICE USE ONLY SKETCHES FEE APPLICATION FOR PER DO.CASFITTINC NAME:TTPE OF QUII_DtNO - • , LOCATION OF BUILDING i PLUMBER ORGASFITTER PERMIT GRANTED of r TOWN OF YARMOUTH Building Department BUILDING Fits (508) 398-2231 ext.261 OW PERMIT NO : • 13-05-138-' PERMIT WS ISSUE DATE 7129/2004 _ ; PROPOSED USE _ _ .. _ _ . APPLICANT ,Thomas Capizzl- • • • - - - - • 'P-JOB WEATHER CARD PERMIT TO Repair . ' AT (LOCATION) 100079PHEASANT COVE CIR ZONING DISTRIC R-40 Bldg. Type: ResWential SUBDIVISION MAP LOT BLOCK 1149.48 BUILDING IS TO BE: CONSTTYPE..F5-BI USE GROUPERE LOT SIZE CONTRACTOR residing 3.5 squares REMARKS AREA (SO FT) EST COST ($ $2.500.00 PERMIT FEE ($) $25.00 OWNER JRICHARD A JENKINS BUILDING DEPT BY ADDRESS 100079 PHEASANT COVE CIR Yarmouthport I MA 102675 LICENSE CS057032 Capizzi, Thomas Jr. 1645 Newtown Road Cotuit MA 02365 5084289518 INSPECTION RECORD FIELD COPY Date _ Note Progress - Corrections and Remarks Inspector a JUL 2\9 2004 BUiLD1NG DaPT. EXPRESS BUILDING PERMIT APPLICATION bl TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 ,. (508) 398-2231 Ext. 261 CONSTRUCTION ADDRESS: ( `7 1 / l,e�fti011n-f' VVy-(�i IC r( ASSESSOR'S INFORMATION: Map: / Parcel: OWNER: OMce Use Only Permit # f-05 - Fee $ Permit expires 6 months from issue date. NAME PRESENTADDRESS - L TEL # S— ' CONTRACTOR: __ 7 `LI nT _t�tYln . G, �% + ' tr �A 1J7✓)L �� o �� S al NAME MAB.ING ADDRESS# Residential Commercial Est. Cost of Construction Home Improvement Contractor 11c. # M /jN6 Construction Supervisor Lin. #_ � S i15 / U3--l— Workman's Compensation Insurance: (check one) I am the homeowner:: I am the sole proprietor Airrve Worker's Compensation Insurance Insurance Company Name: 't' )!4-(n b'lYl �)[ -. 1- _ Worker's Comp. Policy# ORK TO BE PERFORMED Tent (Peso Retardant Certificate attached)Duration / (ou / „- �� e a / 7 --Joe, ndr. O' ,Lg: # of Squares 3 • S -AU [ ,(�((�( (j( �i(� RJt:�— u17 /C Replacement windows: # „-tea Replacement: Re -roof: # of Squares Qm0 () Stripping old shingles* () going overT_layers of existing roof j { 831t lim HlllOitilY�l *Tbe debris will be disposed of at r n1211, zX 03=2V 1 Location of FacIfity I declare undo penalties That the s is herein contained are true and correct to the best of my knowledgeLdelief. • I andders� t an also aacwer(s will be just cause for den' a evocation of y G and for prosecution under M.G.L Ch. 268, Section 1. Applicant's Signature: Gist Date 7h 3 &/ Owner: Signature (or attachment) Date: Approved By: Date: Building Official (or designee) Zoning District: /L y0 Historical District: YA No Flood Plain Zone: S�s� No Water Resource Protection District: Withirf too of Wetlands: h(o Yes X. No 3/01 f a The G 11111funnretrlth ofALtssuc%ttsells �z -'` _� •� Ileparlmenl ttIII rlrtstrial ilccidents O//%c o1/nresl/paI/car 600 IVushi igtutt Sitcet Bostoir, Aluss. 02111 Winters' Ciotti pcnsntlun Insurance Affidnvil lucalims: Chv 17)►Olte (] 1 am a homeowner pul'mming all work myself. [) I nm a sole proptietor and have no one winking in any capacity -- I ton no employer providing wuikcis' compensation for my employees working on this Job. luatu ftfuae�LLri�2�� ' A'C["C7 �%t �41It. 41 ` c7 L ✓,t� Ilililtcss _� t ��j 111tone th 41A / r 95 Insurnncesv._( T_(J �`j�Cl :1--rtJ_V_%4—,rtC-r- [•t'.. Yb f 4 � 0 I mn a sole proprietor, general contractor, or hunicusvner (circle one) and have hired die contractors listed below who lia, the following workers' compensation polices: rsmuanxnunc• ..... .. . dlrr � - phvue H• -- .... - -. -- --- . — --- lnfaURlceso• ',(� • }.�•'>$•;2.�`: '%F•S.': a�; .r�E;i'r •• . _._. :A": Y.•:. s."' ii. nil"'i, ...Y/r•y :� , tvnlunRrflftrus• • Il1hltlairr ::•: chr: y• i. .. •,. i :... Alone H: Failure to secure toter age as required under Section 15A of MCI. 151 can lad In rile Imposition of tilminal penalties of a fine up 1031.500.00 andm• one years' Imprisonment as well as tivil penaltio In file form of a S'I or wOItK ORDER and a fine of 3100.00 a day against me. 1 understand that a copy of this statement may be forwarded to the 011ice of Inresllgalions of the DIA for coverage rt,mention. do hereby cenijr trader the pains and penalties of petitiq that the information provided abort is trae and eorrea Signature Dale I'tint none official use onh do not write In sills arts in bt tompleltd fly city or low" official tilt' or town: penuit/lictale a nnullding Department f]l,ltensing Iroard check If Immcdialt response is ruloirtd pStleeldltn's Office . 011tailh (lehatlmenl contact person: phone at �Wrjoll% 1• 6,4 t/n rtAl 15 'TL_ r.- Wool. 11 i • • t • a Home Improvement. Contracfo I CAPIZZI HOME IMPROVEMENT, Thomas Capizzi, jr. 1645 Newton Rd. Cottlit, MA 02635 om IJUI 02108 . r Registration Registration: 100740 Type: Private Corporation Expiration: 6=006 jUpdate Address and return card. Mark reason for change. I 6 a Poo.,wonraea�lia o�,/l�aaoar%uroelJ's Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 100740 Expiration: 6fL3/2006 f Type: Private Corporation CAPIZZI HOME IMPROVEMENT. I iiiomas Cap!-,7i.jr. 1645 Newton Rd. Cotuit. MA =35 Administrator Q Address Renewal Employment Lost Card License or registration valid for individul use only before the expiration date. 1f found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston, Ma. 0210 1 S Not vali d without signature a I y �'' ✓/ie 6"onimonaen�Ai rjivf�neenaiadtQy a j BOARD OF BUILDING REGULATIONS ! License: PONSTRUCTION SUPERVISOR I Numben C$ 057032 Birthdate: 09/26/1983 __ _ _ Expires: 09/26/Z005 Tr. no: 7171.0 « - Restricted: 00 TNOMAS X CAPIZZI JR 1645 NEWTOWN RD . ...w I COTUIT, MA 02635 Administrator .10 0 r; CAPIZZI HOME IMPROVEMENT INC. SPECIFICATIONS AND ESTIMATES PAGE 6 OF 6 STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT OWN TH PROPERTY• e IN trnN4k---- MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TNC. TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. SIGNATURE OF OWNER: OWNER'S —ADDRESS OWNER'S.TELEPHONE: LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS: CSC APPLICANT'S TELEPHONE: 508/428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE ACCEPTED BY Q. DATE 6 —013 - 0 THIS PAGE IS PART OF AND IN NFORMANCE WITH PROPOSAL # TOWN�pF YARROUT11 r APPLICANT •r\A_A4 . FIELD, CgPY BUILDINGr'„-`'�� PERMIT . ��•.'� -'"'•M .. PERMIT NO. 13-01-841 _ 5R.Mox'1166- - -B�rnstabln 0263 0 CS O42406' (NO.) (STREET) (CONTR'S LICENSEI PERMIT TO alterationa J«'-" - _ ( NUMBER OF - (_1 STORY "y DWELLING UNITS j (TYPE OF IMPROVEMENT) NO. ) IPROPOSED USE) AT (LOCATION) 79 Pheasant Cove Circle Y.P. 02675'� DISTRICTP(,40 j (NO.) (STREET) 1 a- BETWEEN AND M (CROSS STREETI - - - - - - ICROSS STREET) a suBDrvlsloN 149/48 LOIT, '_T19 BLOCM--I 132 sae 45 Om BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION O " Z TO TYPE 511 USE GROUP R 4 - BASEMENT WALLS OR -FOUNDATION - rc (TYPE) REMARKS:replace kitchen & den Windows. add entry door tog �gnrngP, ndd dnnr rn deck - construct new deck at'rear of house with starcase. remodel kitchep. DATE AREA OR 1\ -, 7 (CUBIC/ OUARE FEET;PERMIT Q�•• VOLUME- S ESTIMATEDCOST $ '10T 150. 00 FEE $ 265.00 OWNER Richard Jenkins � ` ADDRESS 79 Pheasant Cove' -Circle Y.P. 02675 BBYILDING DEPT. , �L I Aw INSPECTION RECORD I DAT 2 'G NOTE PROGRESS . CORRECTIONS AND REMARKS ynp INSPECTOR - Fi 11 ONE & TWO FAMILY ONLY - BUILDING PERMIT APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING Toum of Yarmouth Building Department 1146 Route 28 - Yarmouth, NIA 02664-4492 Tel: (508) 398-2231 x261 - F.1x: (508) 398-2365 -Offifice,U'se Only Permit No. ILVI��ate Permit Fee $'�S -- �� Deposit Rec'd. $ aSaateJ 64 Net Due $"; lj/,o Planning Board Information Ipn Type Endorsement Date Recording Date Plan No. Other Assessors Department Information: Map Lot Ma Lot 13 2 "' J 19 % O/d New 1.4 Property Dimensions: G� a o 1.tArea (sf) Frontage(ft) Lot Coverage This Section for Office Use Only Building Permit Number: I Date Issued: Signature: 51 Building Qfiiciall Date Certificate of Occupancy is Is not required Section 1 - Site Information I Use Group: R-4 Type: 5-B 1.1 Property Address: 79 Pheasant Cove Circle 1.2 Zoning Information: _ U Zoning District Proposed Use Yarmouthport, MA 02675 1.3 Building Setbacks (it) Front Yard Side Yards Rear Yard Required Provided Requir d Provided Re wired Provided O� poi 1A Wate upply (M.G.L c. 40. S S4) Publi Private 1.5 Flood Zone Information: Comments: Zone: A_ BFE: IaLL.3� Section 2 - Property Ownership/Authorized Agent 2.1 Owner of Record: RichaRi) TPnIcinc 79 Pha Name (print) Mailing Address I i X &: - Signature Telephone 2.2 Authorized Agent: Jeffrety Goldstein PO Box 1166 Ryvt Name (print) _ Mailing Address 508 7 7 1 - 0 3 ign t Telephone tIdction 3 - onstruction Services 3.1 Licensed Construction Supervisor: 61AY — Jeffrey Goldstein Z PO Box 1166 -Barnstable, MA Not Applicable ❑ License Number CS O42406 Address (508) 771-0303 Expiration Date 3-18-2002 Sig at Telephone 3. egiste ed Home Improvement Contractor: Company N me OHC Inc Mba The House Company Not Applicable ❑ License Number 2 Ad s n �n 4' L �11 -Vw3 Si natur4v Telephone Expiration Date LO - Z q - 200 2- 9- 9 1of2 OVER Set;ion 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 ....x.... No .......... Section 5 - Description of Proposed Work (check all applicable) New Construction I No. of Bedrooms No. of Bathrooms. - Existing Bldg. ® Repair(s) ❑ Alterations:0 I Addition ❑ AccessoryBldg. ElType Demolition Other Specify: •, •. t , Brief Description of Proposed W rk: ,- o'a Re lace kitchen& den windows. Addi entry door to cfaracfe. Adding door to.deck-.11construct new deck/ft-rear of house with staircase. ernodel kitchen. 1s " 7S, — Costs Section 6 - Estimated Construction Item Estimated Cost (Dollars) to be Check Below Conservation -Commission Filing (if applicable) ® Old Kings Highway & Historical Commission approval (it applicable) completed by permit applicant 1. Building $14,150.00 2. Electrical $2000.00 3. Plumbing / Gas $ 3000.00 4. Mechanical (HVAC) $1000.00 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) $20,150.00 7. Total Square Ft. (new houses & additions) Section 7a - Owner Authorization - To be Completed When Owner's Agent or Contractor Applies for Building Permit I, Richard Jenkins , as owner of the subject property hereby authorize The House Company to act on my behalf, in all matters relative to work authorized by this building permit application. * ,2 . f 5-2-01 Signature of Owner Date Section 7b - Owner/Authorized Agent Declaration I, Jeffrey Goldstein ,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. Jeffrey G 1dstein Print name *0 5-1-01 Sign ur o er/A ent Date 9-15-99 / 2'of 2 3r°`;A''� TOWN OF YARMOUTH 00 r��.y,�y BUILDING DEPART DtENT BUILDING PERMIT APPLICATION SIGN OFF Applicant:The House Company for Richard Jenkimlding Permit No.: Address: PO Box 1166 Barnstable MA Bldg. Site Location: 79 Pheasant Cove Cirel $'Q1. No.: 508-771-03 1 bate Filed: _ No.: 132:'. Lot No.: J19 / 0 9 3 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. Tile 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 COABUSSION: 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: f ti %y I OW13113'F 4"WATER DEPARTMENT: L:DLA: 0 0, DATE: 51 /I' D / N/A: 2. ENGINEERING DEPAR TENT: DATE: N/A: 0-'CONSERVATION: DATE:S—IO kfMALTH DEPARTMENT : DATE: NIA. - INDUSTRIAL AND/OR OMA ERCIAL PERMITS 5. WIRING INSPECTOR: DATE: N/A: 6. PLUMBING INSPECTOR: DATE: N/A: 7. FIRE DEPARTMENT: DATE: N/A. - PLEASE NOTE All stumps and/or brush must be disposed of at an approved site. COAMENTS: g1, PG i 6k- 8/99 Applicant Signature T-� Date ��/ 4 BUILDING TOWN OF Y A R M O U T H ELECrRICAL 1146ROUTE28 SOUTHYARN10UTH b1ASSACH770267 51 GAS Telephone (508) 398-2231, Ext. 261 — Fax (508) 398.2365 PLUMBING SIGNS BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at 79 Pheasant Cove Circle Yarmouthpoft Work Address is to be disposed of at the following location: nourne Landfill Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Permit No. Date 3; pf .yARc TOWN OF YARMOUTH O BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT: Job Location: 79 Pheasant Cove Circle Yarmouthport Number Street Village Owner of Property: Richard & Doris Jenkins Construction Supervisor: Jeffrey Goldstein CSO42406 (508)771-0303 Name License No. Phone No. Address: PO Box 1166 Barnstable, MA 02630 Licensed Designee: (If other than Supervisor) Name 2.15 Responsibility of each license holder: License No. 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building and structures only pursuant to the state building code and all other applicable laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Any licensee who shall willfully violate subsections 2.15.1, 2.15.2 or 2.15.3 or any other section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes ❑ No ❑ If you have checked =, please indicate the type coverage by checking the appropriate box. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSUPANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 152 of thkMass. General Laws, and that my signature on this permit application waives this requirement. Check one: siciKat-ung At baer Jr owner's A t owner ❑ Agent Zf Signature: I2N Building Official Approval: Suggested Affidavit for Home Improvement Contractor Permit Application For Omce Use only NAME OF CITYITOWN Ptrmlt No. Yarmouth»nrt Date AFFIDAVIT Home Improvement Contractor law Supplement to Permit Application MGLe-14ZArequires that the 'reconstruction alteration renovation repair, modernization, conversion, inpmvement, removal, demolition, or construction of an addition to any pre -casting crvner-mcupied building containintr at least one but not more than fourdwellintt units .... or to structures which are adiacent to such residence or building" be done by rcgistcrcd contractors, with certain exceptions, along with other requirements, Type of Work: R mndPt _Est. Cost $82.000.00 Address of Work 79 Pheasant Cove Circle Yarmouthport Owner Name: Richard Jenkins Date of Permit Application: S 3"0 j I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law Job under S1,000 Building not owner -occupied Owner pulling own permit _ _Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO 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 a t of the owner: 5-1-01 100932 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 ojMassachusetis Department of Industrial Accidents 011les oll"affffu/iis 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit location: '1Q Phpagant f nvp ri rrl P Ya movthP0rt CHN Yarmouthport phone (508) 362-8734 ❑ I am a homeowner performing all work myself. I am a sole proprietor and ha%e no one workine in any capacity ® I am an employer pro%iding workers' compensation for my employees working on this job. company name: The -'House Company address: PO Box 1166 city: Barnstable MA 02630 phone No (508)771-0303 iTsurinceco, All :u- s s s - ❑ I am a sole proprietor. general contractor. or homeowner (circle one) and have hired the contractors listed below "ho has e the following workerscompensation polices: company name: address, city: phone #: inc��ranrr fin, policy.• N Failure to secure coverage as required under Scctioa 25A of MGL 152 can lead to the imposition of erimiaal penalties ora line op to S1'Wo.00 aadlot one years' Imprisonment as well as civil penalties In the form of a STOP WORK ORDER and a flue of S100.00 a day against me. 1 aaderstand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby cep under thepains and penalties ojperjury that the injormadon provided above is true and correct Print name omcial use only de/not %rite in lhis area to be completed by city or town official city or town: YARMODTQ p check if immediate response is required 5l-o i LMIIIIIIIIIIII&MOVA permitAicense 0 nBuilding Departmeot pLicensing Board 261 ❑Selectmen's Office 08j 3 8 1 ❑Ilealth Department phone#;— (S 9 �223 ext. nOther contact person: 1,95 r1A) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employ ees. As quoted from the "law", an employee is defined as every person in the service of another under am contract of hire, express or implied, oral or written. An etnplot-er 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. %1G1. chapter 152 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 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 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 supply ing company names, address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the 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 Ifflce of f lliestl1311822 600 Washington Street Boston, Ma. 02111 fax H: (617) 727-7749 phone 9: (617) 7274900 ext. 4069 409 or 375 PLOT PLAN .�-I�Z�O )QW, ,f./1 -79 PhtasvLl-('vve c•e FOR LOT # Indicate location of garage or accessory building Additions with dashed lines -------------------- Sewerage disposal (cesspool) ED Well 0 I(lot................ft. rear) Abutbor's Name Lot # If this is a corner lot, write in name of street. REAR YARD SIDE YARD SIDE YARD XH FT. SET Q SET BACK .........ft. I I (lot..................ft. frontage) (NAME OF STREET) Information Supplied by Abuttor' Name Lot # If this corner 1 write it name of a other street. : : : 4J MARK NORTH POINT . h�U Q` 4 1 •' '•` - '• _ M 77 .. -.- is T..._ t --�` ✓lam -P �� Board of Building Regulaf ons��/and Stan ar s One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement-.- Registration Resistratlon: 100932 Type: ' Private Corporation �: i;. y'r; F:: _ ,'•; Expiration: 06124/2002 OHC INC. DBA/THE HOUSE COMP•AN,Yx--3 ? Jeffrey Goldstein •l - 30 PERSEVERANCE WAY UNIT 26:';; Hyannis, MA 02601 Update Address and return card. hlark reason for change 13 Address Renewal ❑ Employment I] Lost Card •-le ; Board of i • N .'Re •ns • ...• • -Boston,0i • i License: CONSTRUCTION SUPERVISOR LICENSE Number. CS 1042406 Expires: 03/18/2002 JEFFREY GOLDSTEIN PO BOX 1166 BARNSTABLE, MA 02630 B I rth d a t e: 0 3/ 181194 7 Restricted To: 00 Tr. no. 18627 Keep top for receipt and change of address notification. M ecw m oxava / a��tl r�r as BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number. CS O42406 Birthdate: , 03/18/1947 Expired: 03/18/2002 Tr. no: 18627 Restricted To: 00 JEFFREY •GOLDSTEIN PO BOX 1166 BARNSTABLE, MA 02630 Administrator nLy vY, .J."v t,'D T DY: ACHClaudla Hubbell,C (I3:15) Paga 2 of 2 Y. ��wN v�Er.1Sr.r1t IxyS R4Y.Y}64M1¢p'i.{yY. il'M: }M /.vf � R�Ir�X:,��7��1�;V Nlf.{ONL4Y.i1%n:.{S nyXs(nyM1 /ROOYgR 4%h • :^+}F titi:<' IX.I." 0 7 / 10 / 0 0 Y: THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION WELSH 6 PARKER INS AGENCY, INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 433 MAIN STREET ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE HUDSON COMPANY MA 01749 A ALL AMERICAN INSURANCE CO ML IIAO THE HOUSE COMPANY I �a `"Y OHC, INC DBA �'— — P.O. BOX 1166 COMPANY BARNSTABLE, 14A 02630 COMPANY D }ri}i:X•:{./.y';:isZCr:[ri`4i+:itiii:'niiijiii'i::;%}..{:<R:ii:Sri.+.:r}t:vQ+:{i.:CiSii'4iii}':!.p};::::.�.�::;n� :..: :::::::.: �:::: ................. .VIA'IAC.A7.a TOC CERTIFY THIS U TO C lHE00.V'%W}Yw{'w4:,JLVY�NCE LISTi:4wti ELO\C{{.:Y4:{v%:•S:{Pii'Y:{v%4YA:{{{4lYvJ.ti+:''i•,;,:n;r,;.:':•:'}}:':.:':.:':i+.{.:':•:'iiry,(:•(::,'i:::'i :C:::'i:'i:{ TW THAT THE ►ALLIES INSURANCE CE BELOW HAVE I O BEEN ISSUED TO THE INSU ED NAMED ASO FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERN OR CONDRgN OF UI M OR ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THL9 CERTIFICATE MAY SE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED ED EO HCHr BY THE POLICIESDE SCg S EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS REW M SUBJECT TO All THE TERNS, SHOWN MAY HAVE BEEN REDUCED SY ►AID LI114 TYPS Or NSURANEE POLICY NUMIiA POLICY IFFIcnvg poticy tX/IRAIION DAIS (MMDp'YY( DAII (MWpp'YY) WAITS DWMIAL MASH Y LOAWEACIN. O[NOaL LWLJTY GENERAL AOOAl3ATS I MOQJCTf .CON/,O► A00 S O OCCUR PERSONAL S ADV HMAV 1 NCIJJYS ow" OMUTS ► CONITv.,'TOR'f /ROT LACM CCCLRII[NCS S _ FSII CAMAOI I" oN MI 1 A/iD i1V IA^Y e.` rr.sy E 1UTOYOIML[ LUMLITY ANY AUTO COMDI+cD V NOLI LN Y ( 1 u OWNED QTOS ApDAY SLAJAY PM rMAry 1 SbLLCLAtD AUTp1 HSLLO ALTOS �. NONOwNID AUTOS SJOIIY ILURY Pr SmaN�R S ►AOPUITT DAUAOE S CANADA UAAMTY ANY A;SIO AUTO Orar . G Ap(;IDENY i OTHER THAN AUTO ONLY. ' .. EAC4 Am om lY SA WNUTY AOORFOATI S NLWIC4 For" UCH zn65tNCI S OMU LL THAN VM3REA FORM AQORT WORLLW COM►SWATION AMP WC79 592 wPLDTw•uauurY 1 02 00 5 02 O1 x TV r110►IYS}py I 100, 000 �500 X /'"rwLvc:uvr� All Na FA ,P NIr 000 OINSA AEx0. mHu FL CItGSG(A FMR YEE 1 IOC OCO NLS01YIrgN a onnArgwAouTIpHL,rwcuL.DrtCML ITcw �, T { p� •::::?:::%;sir•; ^:q.{.,{;.;•�,.;.•.:•..;:.�:::. �wztox;•:}::a,cr •::•: :: } •: ;•:CAN YCiI rqN::?;<;:i•':�:�:�<:�:;:••`:•'t:�::^�;:x:?:�::r:�>:ti:::is:t::;�;^• .,.�•.aw%t•'r:2,,.<l,c::•::F•r:w:::#oi�:•`^.•.'• !,.}{ .� n.WI.1,�./.hVr:.X'..Vn4'n\N::{Y.:4M•jly.W!'.\1H:Y,l.V:{'fA{,l:VffNX:;:•.}A'AV�K':Y,KVAVA' HOUCAO-1 LHOVLO ARY a TILL ASOYS DS3GNAID /OU4693 IRE CAWLLLLO SVORA TPA wRAnON DAI/ THEREOF, VMS M3WND COM/AMY WILL SNOSAYOR 10 MAIL 1.0— DAYS WAITTLNNOTKI to THS CLATIIGiI WLDSA LAMED To" LEn. SVr PALVRA TO UAL SUCH WnCI SRALL IMPOSE NO CKIWr10R OR UASLRY P F AM COMPANY, R R P AT ffZI AUTBOALM RSIASSSNTAFNS ACOAO:,......., :...1...4........n•:.yn••n;: :n:•n:::.,. .•..•..... •.:::•;•.;>:•> Robin:L•'BixbX {:15�o- <o'•:er�.:: •:x..};::.;::}.{x ;x;• ?a i ::.':r4:<aa•::::'r :G.,,AAL, CIC......RB A........ ;1 ..:,...:,.::,{.::: }:,;{.{{..;,.}:! :;{<�}:::::::.. ':: •:::::. �:.:.::::... . �::::::::::•::::::::::.::.:::?:•::.:..:.:::::,.... �:.6 AC.WrO?2�t?HDgRATM.N::;T.98i •y_ Apr 24, 13:19 EDT by: ACBClaudia Flubboll,C (13:20) Pago I of 1 ' 64JBQ_ .CEf?lF�CATE .4:.UABILlTY:lNSUHANCE naii01 WRT.4H L PARKF,R TNR AR•.NCV, TIC. - ONLY AND CONFERS NO RIGNTB UPON THE CERTIFICATE XOIOPR THIS CFRTIPKIATP OOPS NOT AMINO. PKTFNn OR .LT<R TMR COVMRAOA AiTV,P%DAD DT THU POLIC_:i •BLOW. 433 MAIN STREET COMPANIES AFFORDING COVERAGE COMPANY HUDSON I4A 01749 A ALL ATAF,RTCAN TNRTIRANCR CTI 'dL'"tD COMPANY THFl Hnl)9 F. YCYIN PANV Y ( COMPANY OHC, INC DBA P.O. BOX 1166 C BARNSTABLE, I4A 02630 COMPANY I D X. _S.QYCMgC�'.... ....... ..... ..:. .... .. ...... .'....... ... ..... .. ....... ..... .... .. •... ... .:. ...'...... .......... THIS IS TO CERTIFY TMAT THE POLICIES OF INSLRANCE USTED BELOW HAVE BEEN ISSUED TO THE NSUP.EO MMEOASOVE FOR THE POLICY ►ERIOO INDICATED, NOTWITHSTANDING ANY RLOUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCLMENT WT'H RESPECT TO WHICH 714I6 CERTIFICATE MAY BE ISSUED OR LAY PERTAIN, THE INSUFANCE AFFORDED BY THE POLICES DESCRIBED MEPEIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SLCH POLICES. LINIFS SHOWN MAY HAVE BEEN FEDLCED BY PAID CLAIMS. CO LTA TYPE O► NIUTANCE POLICY Numem POLICY EFFECTIVE DATE(MUMQ-n) POLICY LIMMATION OATS 4MWOD'VY) LIMITS GGGAAL LIABLITY jX Vrnann. wwwA. i,AURr BOP7947920 2 19 C1 2 19 02 GENLAA AGOAEOATL {21000,000 Pft RrnR. vww Ann AZ, OO.O,000 aArs MAC= X 1 QMAR 7owNLROtooLTrv,oTons►RoT PKH306w A ew Muni_ YAa•299u' Noe _ PIRE Aas;Nv"A* s_ sl_10001.000_ S 100,000 A®D" war j AUTONONLE LIAMLITY I I ANY AUTO OOMAPaED EINM r LIAR { 60014.Y PALSY MV P~I { _—HINLO A.L OWNED ALTOS SCHEDULED AUTO6 ALTO{ NON•OWYCD AUTO" PROPERTY DAMAGL { I 1I u^A,OIt Weu,1 IM1 Ail* 111 wIU GR1 • u Mk:IKbr O 1!11FAh AUTO CRY: f.--------- --------------- EACNAOCIDEN_r u_usa AA+wun CX67'J97921 2 19 O1 2 19 02 AA.R tuues•r.,e __ P1j 00.0, 000 JAlRE.LA FORM AOOPIEGATE if { X OTHER THAN LMBAE,LA PORN WORKw COMPENSATION AM WC7935926 5 02 00 5 02 01 X TgRY 6MN L -' EMPLOYER{. LIAEILITr PI100 000-- E. DIBFASE-P _ LIMR S O O O C O THE ►ROPFJETOW X NCL PAPTNiALEKECUTME O"ICEFIS ARE EXCL EDSEASE{A EMPLOYEE S 100 000 OTIE A I DESCRIPTION OF OPLIIATIpNLLOEATIONLV W CMSPCCIAL ITEMS CERitFiCAIE NOLOEfi GkNC£[C)RR71¢N _ ..SHOULD ANY DP THE AXOVL DCRASAD POLICIES EE CANCELLLD SLFORE THIL TOWN OF YARNOUTH EXPIRATION DATE THEREOF, THE ISSUING CCM/ANY WILL ENDEAVOR TO MAL BUILDING DEPARTMENT 1.1-DArawnarixmom TOnrunTFICA19NOLJWRMAW TOTHE LtrT, 1146 ROUTE 28 BUT FALURL TO ANAL SUCH NOTICE {HAUL IMPOSE NO OBLIGATION OR LMJlUfV YARMOUTH UA 02664 OF ANY RIND MH THE COMPANY. —ITS A am On "E"IsLWATIvas. AUTMORJX0 A&PALSLNTATNE t Claudia Hubbell,CPCUTCIC CH A ACQAD'7�......... A. t>y :3 POF14 _ I I Abuttor I a Name Lot # If this is a corner lot, write in name of street. PLOT PLAN �7&eL &L-1a AZI a-t� CC' _79 l�3oZ / cT/9 �-/GZ/mvvs�h�oo�'f� rrt.� FOR LOT # -- Indicate location of garage or accessory building Additions with dashed lines -------------------- Sewerage disposal (cesspool) ®Well 0 SIDE YARD • PT_ : (lot................ft. rear) I Abuttor, Name Lot # REAR YARD ............. ft. (lot ............. ......ft. frontage) (NAME OF STREET) Information Supplied by YARD ,__FT� : : 4J UP If this corner write ' name of other street. MAJZK NORTH POINT I I • h�U • �Q` 4 + - • LaT !a n l Richard and Doris Jenkins 79 Pheasant Cove Circle Yarmouthport, MA 02675 Windows & Doors: WEST: Windows: . Existing window sash to be replaced with Marvin Tilt Pac sash with snap in grills. Andersen Double Hung window Model # TW2442-2 Rough Opening (4'11 13/16" x 4'8 7/8') white vinyl snap in grills. Andersen Casement window CW135-2 Rough opening (4' 1 '/4" X Y 5 3/8' ) white vinyl with snap in grills. EAST: Door. Morgan Model #M7100 Rough opening (T8"x6V8 wood with a full view aluminum storm door -white with brass hardware. Existing window sash to be replaced with Marvin Tilt Pac sash with snap in grills. Andersen Double Hung Window Model #2446-3 Rough opening (7'51/2" x 4'8 7/8')white vinyl snap in grills. Andersen Double Hung Window Model #2442-2 Rough opening (4'11 13/16" x 4'8 7/8') Rough opening. (2'5 5/8" x 4'8 7/8') white vinyl snap in grills. NORTH: Windows: Existing window sash to be replaced with Marvin Tilt Pac sash with snap in grills. Doors: Andersen French Wood Model # 3068FWG Rough opening (3' x 6'81) SOUTH: Windows: Existing window sash to be replaced with Marvin Tilt Pac sash with snap in grills. �.�aOF) m %nor J� 17 . FAX/MEMORANDUM C ANDACE JENKINS in Architectural History & Historic Preservation: EET • BELMONT • MASSACHUSETTS • 02478 Telephone/FAX 617484-2395 TO: Yarmouth Old Ring's Highway Historic District Committce FROM: Candace Jenkins RE: Alterations to 79 Pheasant Cove Circle DATE: April 6, 2001 TO Wim c; r- f uTl ! APR 112001 OLD 1(li'JIG'S HIGHWAY Last fall the Yarmouth OKHHDC approved several changes to my parents' ca. 1970s house at 79 Pheasant Cove Circle. Those changes included new windows, a rear deck, and raising the roof of the garage to accomodate additional living space. Since that time, the garage alterations portion of the project has been deleted due to cost. The rest remains essentially the same with the exception that one triple window has been reduced to a double unit. New 1/4" scale plans and a revised window and door schedule were submitted to your office on March 30, 2001. I understand that this may be considered a minor change and not require another hearing. Please let me know if you need any additional information or if the project can proceed without further review. J y�rti,DAPPROVED UTJJ CO1,,,;1.; TTEE 041RD I1%1" Property Location: 79 PHEASANT COVE CIR 1Zslon ID: 17398 AIAP ID: 149/ 48/ / / OtherlD: 132/J019/// IBldg N: 1 Card 1 of Print Date:05/1012 ENKINS,RICIIARDA EN'KINS, DORIS P 9 PHEASANT COVE CIR 'AR.NIOUTIIPORT,MA 02675 I Des"Honr fsedl'alve Ase sed Value YARMOUTH, RESLAND ESIDNTL Q L 1010 0t 151.30C 118,10 �09!5 0 151,30(813 118,10 � - Account N Subdivision 420 Photo Werd me C1S1D: VISI Tola 269AQ4 269,40( RECORD OF 0 1 .77991 L V I ENKL\S, RICHARD A 76 1211811991 Q 1 280,00 00 Yr. CoMde AvTp. d P'afue Yr,s i 2001 2001 1010 1010 229,00 118,10 200 200 1010 1010 104,10 84,00 TO t 347.10( 8810 EXEMPTIONS OTHER 4 This signature acknowledges a visit by a Data Collector or As Year ArelDescription Amoun! Code scrfroflon Number Amoymf Comm, APPRAISED VALUESUAIAMRY Appraised Bldg. Value (Card) Appraised XF (B) Value (Bldg) Appraised OB (L) Value (Bldg) Appraised Land Value (Bldg) Special Land Value Total Appraised Card Value Total Appraised Parcel Value Valuation Method: Cost/Market V NOTES 6 R11S ABUT'1S MARSH RATER VIER 0420 Net Total Appraised Parcel Value BUILDING V FSITICHA= HISTORY PermitlD Isjue Date Aye s Amount mm nt s / 997450 999399 6116/92 817/91 8,50C 3,OOC 100 100 'UNR REPAIR 1 LI 6128196 8!9/93 PW DB 00 00 leasar*Listed Icasur+Llsted NOLINE V E M r 1 1010 SINGLE FAI11 19,602.0 ST 2.3f 2.7 8 1.2 0087 0.9 7.7 Total Land U 19.602.0 S I Total Land Vale Property Location: 79 PHEASANT COVE CIR MAP ID: 149/ 48/ / / Mlon ID: 17398 Other ID: 132/ J019/ / / Bide #: 1 Card 1 of 1 Print Date. 05/10/2001 crior Wall 1 2 oof Structure Zoof Cover nterior Wall 1 2 nterior Floor 1 2 eating Fuel eating Type C Type verage +20 Story Bedrooms Bathrooms rmnon Wall Height Total Rooms D ize Adj. Factor D.98709 Irade (Q)Index 1.21 Bath Type D2 Modern kdj. Base Rate 71.66 Kitchen Style 02 Modern 3ldg. Value New 133 O ear Built 1971 E Year Built 1976 mil Physcl Dep 24 uncnl Obslnc wn Obslnc pecl. Cord Code pecl Cond % Dverall %Cond. 76 1010 SINGLEFAM 100 Bldg Value 116AOO OB-OUTBUILDING do YARD ITEAISM IXF-BUILDING EXTRA FEATURESM 1 BAS rFloor 1,64 1,64 1,64 71.6 11 FCR j2r'a'ge 48 19 28.6 1 UB\i asemeot,Uafinlshed 83 16 143 1 URB asement,Unrtals6ed,Ralsed 1 46 13 21.5 6 6 0 co ? fk t6r To c Doop� ry co Ne.I ay.K i N t o I — o 5lte�rcrr I Eld D O RcM C Maif � oae�y L F}nNGI WiJpb14/ tit AXlc` kDD Da0(o. e • FIRST FLOORPLAN - "AS_BUILT" JENKINS RESIDENCE THE HOUSE COMPANY 6/2/00 ADDITION /ALTERATIONS SCALE: 1/s^ n i' rP � C#ZLe- I NORTH ELEVATION THE Houss coMpnxx KI JENNS RESIDENCE = ALTERATIONS C . L8w..� :. March 301i , 2001 •: :_ JENKINS RESIDENCE - ALTERATIONS THE HOUSE COMPANY 1/8" —1' • March 30th, 2001 JENKINS RESIDENCE - ALTERATIONS THE HOUSE COMPANY 1is" _ v March 30th, 2001 WF 7,T Bove_ "Nantucket "style post caps 12" x 24" concrete pad for tread support 2" x12" SYP joists @16" o.c. • 2" x 12" ledger board secured w/ 1/2" x 6" 2" x 12" SYP stringer galy. lag bolts @ 16" o.c. 1" 4" mahogany treads and open risers JENKINS RESIDENCE - ALTERATIONS 74 r45cti+7 code c%rcit P°"TEAST ELEVATION C508) 7-7 1— 0303 10" sono tubes @ 4' below grade Deck detail typ 2" x 4" fir railing 1 1/2" x 1 1/2" fir balusters 2" x 4" fir bottom railing 4" x 4" SYP posts 1" x 4" mahogany decking 1" x12' cedar skirtboards 2 @ 2" x 12" band joists Simpson "strong -tie " connector THE HOUSE COMPANY 1/s" . 1' MAY 14th , 2001 sa VROWA MUM Old King's Hghway Regional Historic District Cornmittee in the Town of Yarmouth for a TOWN OUTH CLERK {( CERTIFICATE OF APPROPRIATENYOot, _S rt1 9 eon Application is hereby made in triplicate, for the issuance of a Certificate of fop i# q q, r6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed WO Unl r 6 ow and on Plans, drawings or photographs accompanying this application for. CHECK CATEGORIES THAT APPLY: Exterior Building Construction: p New Building fc7 Addition p Alteration lndreote type ofbuilding: i3 House 13 Garage p Commercial p Other 2. Exterior Painting: p 3. Signs or Billboards: 13 New Sign p Existing Sign ❑ Repainting existing sign 4. Stricture: ❑ Fence p Wall 13 Flagpole 13 Other TYPE OR PRINT LEGIBLY FIX-vuXERTRIMIMMUM1 ADDRESS OF PROPOSED WORK 74 Pheasant aam C i rr le ASSESSORS MAP NO. Yarmouthport, MA OWNERRichard Doris Jenkins ASSESSORS LOT NO. HOMEADDRESS same as above TELEPHONENO. 508-362-8734 AGENT OR CONTRACTOROHC, dba The House Co. TELEPHONE NO 508-771-0303 ADDRESSpn pox 1166 Barnstable, MA 02630 USE ATTACHED SHEET IN PACKET FOR ABUTTING OWNERS DETAILED DESCRIPTION OF PROPOSED WORK Give all particulars of work to be done including materials to be used. In case of signs, give locations of existing signs and proposed locations of new signs. (Attach additional shot, it necessary). Add second story Saltbox to existing garage. Install new mahogany deck at rear of house. Alter front roof -to accomodate new bay window. Remove and replace -existing sash with new sash. 7... APPROVED, WMOUIH COt1511ned OY.NRO n Contractor -A t :e hefnw line rnr rnmmilfmm item ...J.. . i ,:1 by Date �I -/ /� This Certificate is Check fl By i '. APPROVED DISAPPROVED 17 Ih1PORTANT: �j +t �ra�. �:•-t Date 10111j; ;, , If Certificate is approved, approval is subject to the 10 day appeal period provided in the Act. 0 Please return to: Yarmouth OKHC District Committee Yarmouth Tours Hall, 1146 Route 28, S. Yarmouth, MA 02664 SPECIFICATION SHEET (YARMOUTH OKHC) - SUBMIT 3 COPIES 44A I'a Please fill out the form in its entirety prov' ' / q lops where /leCessq1'� INDICATELAM)SCAPING,F.X'IERIORLIGHTIN l NSITEPLANS FOR NETI', SE5 L , NAME OF OWNER(S) FOUNDATION (18" MAX. EXPOSE y CONCRE THERREePjV,) U'�1 NA WALK WAY: NA STEPS (INDICATE BRICK/CE51ENT/OTHER): NA SIDING TYPE: white cedar shingles 5" COLOR: natural CHIMNEY (INDICATE BRICK/STUCCO/WOODFACED) NA COLOR: ROOF MATERIAL: PITCH (7/12 MIN.) 8/12 COLOR: match 3 tab asphault MAX. EXP. existing WINDOWS (GRILLES REQUIRED) -INDICATE SIZES IF NOT LISTED ON ELEVATIONS: Attached DOORS (INDICATE SIZES AND STYLE IF NOT LISTED ON ELEVATIONS): COLOR: Attached TRIM: (ALL WINDOWS & DOORS TRIMMED WITH IX4 / IX5) To match existin MATERIAL OF Tffi: WOOD, L, ALUMINUM) SHUTTERS (WOO YL (PANELED OUVERED GUTTERS (WOO ALUMINUM)• GARAGE DOORS: SIZE & STYLE: Re -use existing STORM WINDOWS & DOORS: (INDICATE SIZES IF NOT LISTED ON ELVATIONS). A1 41 COLOR: white COLOR: black - COLOR: white COLOR: ,-"COLOR: white uminum 28 x 68 , SKYLIGHTS: TYPE/SIZE: APPROVED COLOR: NA yomoUTH CO' rl T E 0Y,t1RD �1 v COLOR: DECK: SIZE & MATERIAL: 19.91x 12'Mahogany with fir posts and ballusters and. -Nantucket FENCING (MAX. HEIGHT 61): STYLE: COLOR: (SHOW LAYOUT & RUNNING FOOTAGE ON SITE PLAN) NA RETAINING WALL: (P.T. OR FIELDSTONE -CONCRETE INAPPROPRIATE) (SHOW LAYOUT & RUNNING FOOTAGE ON SITE PLAN) NA SIGNS: (indicate size, style, colors) NA COLOR: SIGN POST: (indicate size, style, color) NA ADDITIONAL INFORMATION: COLOR: post caps REV. 6/99 r rC � _•- - "• _ . is � •� � l•'�/�� :� � �4 •ice• -� •/ � C--) O� -• ILn l 4?lot It , Y ' r I Fib, . • •' • i � ' .,,,'.-r. � .. .• w .. . _ ``• _ ' . �4 � � _ ., -, �. ^.y.: !--_ �, i..: is �*:�._ - _ t .` •- - �� /- rat �✓ R t/Z-atr 5,0181 Richard and Doris Jenkins 79 Pheasant Cove Circle Yarmouthport, MA 02675 Windows & Doors: WEST: EAST: YARMOUTH TOWN CLERK 20 OCT 75 M 9: 52 RECEIVED Windows: Existing window sash to be replaced with Marvin Tilt Pac sash with snap in grills. Andersen Double Hung window Model # TW2442-2 Rough Opening (4'11 13/16" x 4'8 7/8') white vinyl snap in grills. Andersen Casement window C135-3 Rough opening (6'0 5/8" x 3' 4 13/16') white vinyl with snap in grills. Andersen 7'xl' Transom Lite above garage door. Door: Morgan Model #M7989 Rough opening (2'8"x6'8') wood with a full view aluminum storm door -white with brass hardware. Windows: Existing window sash to be replaced with Marvin Tilt Pac sash with snap in grills. Andersen Double Hung Window Model #2446-3 Rough opening (7'5 '/z" x 4'8 7/8')white vinyl snap in grills. Andersen Double Hung Window Model #2442-2 Rough opening (4'l1 13/16" x 4'8 7/8') Rough opening: (2'5 5/8" x 4'8 7/8') white vinyl snap in grills. NORTH: Windows: Existing window sash to be replaced with Marvin Tilt Pac sash with snap in grills. New: Andersen Double hung window Model # TW2410 Rough opening (2'6" x 3'0') white vinyl finish complete with screen. Doors: Andersen French Wood Model # 3068FWG Rough opening (3' x 6'8') SOUTH: Windows: Existing window sash to be replaced with Marvin Tilt Pac sash with snap in grills. New: 3 Andersen Double Hung windows Model # TW2410 Rough opening (2'6" X 3'0') white vinyl finish complete with saeen. pPPF.OVED yFRI �GUil1 C0;9iA1T1EE Richard and Doris Jenkins 79 Pheasant Cove Circle Yarmouthport, MA 02675 Windows & Doors: WEST: EAST: YARMOUTH TOWN CLERK 20 OCT -5 /if 9. 52 RECEIVED Sots taw� Windows: Existing window sash to be replaced with Marvin Tilt Pac sash with snap in grills. Andersen Double Hung window Model # TW2442-2 Rough Opening (4'11 13/10 x 4'8 7/8') white vinyl snap in grills. Andersen Casement window C135-3 Rough opening (6'0 5/8" x 3' 413/16') white vinyl with snap in grills. Andersen 7'xl' Transom Lite above garage door. Door: Morgan Model #M7989 Rough opening (2'8"x6'8') wood with a full view aluminum storm door -white with brass hardware. Windows: Existing window sash to be replaced with Marvin Tilt Pac sash with snap in grills. Andersen Double Hung Window Model #2446-3 Rough opening (7'51/2" x 4'8 7/8')white vinyl snap in grills. Andersen Double Hung Window Model #2442-2 Rough opening (4'l1 13/16" x 4'8 7/8') Rough opening. (2'5 5/8" x 4'8 7/8') white vinyl snap in grills. NORTH: Windows: Existing window sash to be replaced with Marvin Tilt Pac sash with snap in grills. New: Andersen Double hung window Model # TW2410 Rough opening (2'6" x 3'0') white vinyl finish complete with screen. Doors: Andersen French Wood Model # 3068FWG Rough opening (3' x 681) 0011 V. A Windows: Existing window sash to be replaced with Marvin Tilt Pac sash with snap in grills. New: 3 Andersen Double Hung windows Model # TW2410 Rough opening (2'6" X 3'0') white vinyl finish complete with screen. ,\SSFE SPECIFICATION SHEET (YARMOUTH OKHC) - SUBMIT 3 COPIES 00% Please fill out the form in its entirety prov1dhzk14 ojg)efzjN where necessary. INDICATELANDscApiNG, �IORLIGHTING& ELT01�1�'11�E7f p11�S,1�'EPLANS FORNEWHOUSE.� .r„ `'�CIiI� NAME OF OWNER(S): FOUNDATION (Is~ MAx. 1(ID, OCT -5 111 9.54 R N'K D NA WALK WAY: NA STEPS (INDICATE BRICK/CEDIENT/OTHER): NA SIDING TYPE: white cedar shingles 51, COLOR: natural CHIMNEY (INDICATE BRICK/STUCCO/WOODFACED) NA COLOR: ROOF MATERIAL: PITCH (7/12 MIN.) 8/12 COLOR: match 3 tab asphault MAX. EXP. existing WINDOWS (GRILLES REQUIRED) -INDICATE SIZES IF NOT LISTED ON ELEVATIONS: Attached DOORS (INDICATE SIZES AND STYLE IF NOT LISTED ON ELEVATIONS): COLOR: Attached TRIM: (ALL WINDOWS & DOORS TRIMMED WITH 1X1 / IX5) COLOR: To match existin white MATERIAL OF TRIM: WOOD, L, ALUMINUM) SHUTTERS (WOO L (PANELED OUVERED COLOR: black ,. GUTTERS (WOO ALUMINUM - COLOR: white GARAGE DOORS: SIZE & STYLE: COLOR: Re -use existing STORM WINDOWS & DOORS: COLOR: (INDICATE SIZES IF NOT LISTED ON ELVATIONS) white Aluminum 28 x 68 SKYLIGHTS: TYPE/SIZE: COLOR: NA DECK: SIZE & MATERIAL: COLOR: 19.9�x 12'Mahogany with fir posts and ballusters and --Nantucket post caps FENCING (MAX. HEIGHT 61): STYLE: COLOR: (SHOW LAYOUT & RUNNING FOOTAGE ON SITE PLAN) Apr '; "J J) NA ifd1TTEE 1 RETAINING WALL: (P.T. ORFIELDSTONE-CONCRETE INAPPROPRIATEARP„UUIi' GCI (SHOW LAYOUT & RUNNING FOOTAGE ON SITE PLAN) 0rmRu \O� NA SIGNS: (indicate size, style, colors) NA _COLOR::. SIGN POST: (indicate size, style, color) NA COLOR: ADDITIONAL INFORMATION: REV. 6199 /;� � . •.•�h •t, tw� _ iN�.. _'J"!�i C; '��' r. r _ `.. r.+.ti.« ... � _ �� t. "" � . _ i .'w\+,_.Y'rw '••'.any♦ ti �. -`+a-�- •Z!y �A r V r, F •�yy+�!�d"3 7' _ .+1►V � ;•. 'tu .r.. .. .. �a' a � t.i.i �� y,..` fy�r �'•t 'ems I• l:i.t� � � •'4a• aV. •w.L. r., w ... ai '. iGr t V } k YARMOUTM ' TOWN CLERK -5 III 9= 54 • • 1® OCT �P� � • • RECEIVED •`a . ,y r m � 9 V ti - �, ...�•\ +r. • ate.. ' 1 ti 411t ' 'tip �•Y.y •M��'w � � . r."+ ;Jy. I a• .t �.L. •`i,�r 4�i-�'t „�/J�h��• '. "ra ii.�.�r� •u k'I�__ � 1• �•d. i •, �s `� ..c.aj �j',y\ F1 _ '�Ty rM'�.,.�N�j ..4. . . .i .. i" i ! .:... iR'. 1 �1. .�' �wJ/ ��' •'i�� yi / .iw i -- . •..s"l � I } ✓+G w.." • \ �v�a� ; 1 . . aa. - � - � ,; ire- J r ' �.+ .40 ii • ' i, I' E i� I r J C!' TOWN, OF Y/�MO�JTH q ,(Olp 5 / 6 APPLICATION FOR PERMIT TO DO GASFITTING (OFFICE USE ONLY) By L(�, Fee: $ PERMIT NO. �. Date 0101Y UL Building �/AS /i%� 6(�/ 1IL n,e- AT. Location New ❑ Renovation Replacement ❑ Plans Submitted Yes ❑ No ❑ Owner's /�'� /`Alf Namey A Type of Occupancy /----MC N N Y Z V7 y UO 2 ul cc N W O V m F 2=~ to cc Q O m N W Q S S O Z O 00 Z H = V1 r W W = W Q cc 0. O W Q W W R H N Z W J F 0 Z W cn W W O O U. G FW w J FN- W m Z Q W Q¢ I= H} 0 m Z O Z O M X 00 0= UM. M 3 0 0 g U M> o 0. 0 SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR (PRINT OR TYPE) Installing Company Name Address Business Telephone Name of Licensed Plumber or Gasfitter INSURANCE COVERAGE: / ,/ Check One: ❑Cor._ Partnership I have a current liability insurance policy or its ubstantial equivalent. Yes Id" No If you have checked yes, please indicate t pe of coverage by checking the appropriate box. A liability insurance policy Other type of indemnity ❑ 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 I hereby certify that all of the details and information I have submitted (or entered) In above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be In compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Check One: Owner ❑ Agent ❑ gnatur of Licensed Plumber or Gasfitter 93S-�L(a License Number TYPE LICENSE: �� ❑ Plumber ElYJ Gasfitter ❑ Master Journeyman OF y4 APPLICATION FOR PERMIT TO DO PLUMBING To OF M_UTH JUN 212001RV z D Building ATLocation ;? /VTrVV7 (OFFICE USE ONLY) By L c- m\ Fee: $ 96, Uy / 0, PERMIT NO. P-01- 11 27 Date G Ay 19 �% Owner's C/ v Name /rI 2 Type of Occupancy yRLa2�L New ❑ Renovation 051*'O� Replacement ❑ Plans Submitted Yes ❑ No ❑ z Z N y CJ N Z Z W W Y -j J V) Q V Q N Z 7 t7 N W D: x 0 OJ Z 0 w F N W Q= ~ H W Y a O U. Z Z Z O. 3 y y x¢ Q y oaC Z a O' a a OJ w O w 3 a 3 uWi 0 o i a 3 W -' y¢ o I- a x p o o U. s a o a o o a D 0 a00 a 3 Y 5 m N o o g 3 oc x f- N LL 0 0 o a 3 x m o SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR (PRINT OR TYPE) Check One: Installing Company Name %��(J/J!°/�/i%r ❑ Corp. Addres/s, //G &Za — 1--Partnership ❑ Firm/Company Business Telephone M fz2-9 Name of Licensed Plumber C INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent. C e n s I}� rLo If you have checked YES, please indicate the type of coverage by the ing the appropriate box. D `� A liability insurance policy Other type of indemnity ❑ I I i c)1T dLLl OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance voerage to ire6y C_ hter 142 the Mass. General Laws, and that my signature on this permit application waives this requirement. (JY Check on Owner ❑ Signature 010wnerorOwner'sAgent 1 hereby certify that all of the details and Information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts Slate Plumbing Code and Chapter 142 of the General Laws. L ign re Licensed Plumber License Number Type: Master 0 Journeyman The Commonwealth of Massdchuseffs c `i a.i at,. n�partmerit oI ��+c salmi.. • . 3 DOARO QF FIRE PREVE M0H REGULxno"S SU cmR 7200 3/20 Moo* bt..0 PPLICATION FOR PERMIT TO PERFORM .ELECTRICAL WORK \ + AU w wk to bi ygformed la &=Wa.ci w4L the hta"achu"m Ekcftfcsa Coda SW O•M M•00 (PLEASE TXUM XU- nUC OR TYPE ALL 7ZiF0lilSATLO2i) Date • r^�0 C4y or Town of _ _ - - ?o the ]Ca:pectoe of Aires: �1 Ibe uodersi acd applies fora pezait/�t[o perform •jLa eloStr�iw aeal rk described below. locatiam 0creet & iknbe/�r)J 1F' Ph ea S�.c V-& G', ti N,- e-l•P Oaoer' oe Tenant K� i:. r CY i.; 04aer4s Address % ^T /��ttrR� t �a.� n�� +'QI'Lne lcss�• st 7s tbis.perait 1n c=Juactiom v1AU a building permit: Yes LlNo 0 (cbeek dppropeiate zoo r ' ' • Ywrpose of $ui3Ain= tTtilitr Aathozisstian ti0. ' r-dstLag * vLce de Asps h / S' a Volts Ovrshead ff rWir!d�No. of W:ters ✓ 96 New Sexviere OgerbeaQ ❑ . Uiftcd 0 W. of tktert Amaber of Feeders aad,Jlmpacity ' locatiaa mad Nature of Proposed Electrical Hock No. f LS6Attas Outlets oNo. £ Lighting 1r1==Cs f Aeeeptscla Ootlets f Switch outlets ' No. f Rsnres ' � �t a No. ' • No. o� Bot Iktbs .. . Lin as Pool Above In grad. Lrr No. of On Daraers o£ Traasfateerar • metal F= AUANZ • No. •o£ Zones No. •of Detection sad ' No f Disposals No. of ikat Sotal, Sotal IaLtiatla= Devices . m IN F4. of Soundleg e; f Dishwsbers spaee/frea Ikating . 331 Ko. o£Sv1C Contained DetectLoa/Soaadlug Devices - to. of Dr iert U=ttay Devices l3J UCAa = a0 No. of Rater Heaters IN •Nos of boo ats Xa VoltageRall No. Syd= passage Iubt No. of tbtors . Iotal UP 0333R:, " COVERAGE: ' . Parxasbt to the wgatrtp - ts: of tlassachasetts Ceaeral Lams • I love a earreat LLbili 7nsur�ca YolLcy,iacladiag Completed Operations Coversge or Its substwtial o7W hathave e YES❑ If Toro liO a . I lure submitted.`; proof of sane to this office. TESQ'liO i cheeped TES& please 4 W Ic-te the type of coverage by cbeddas tbe' appropriate b=. THSV L%HCE , tiOtiD ❑ OZTOr7t ❑ (Please Specify) Estimated Value of Electrical, Work S (Upiratlon ate Work to Start Inspection Date Requested: Finals ataaI ed tinder penalqties of perjury= T Dtti t7At� `4r /ce..o �Y!/i sigaataze �- LIC. 1iO./h' l $ • ' � 4'dress�?�� it°oS� � Bus. IeL No It=M= WA1VF3t: I as aware .that the Liccusee does not have the iasmraape coverage or Jtz snD- tial equivalent as required .y Hassaehnsettt Central wsTa ; sad that mp sigpatare on this permit applleatioa waived this requirrmeat. owner Agwt Tease check one).' T.eltpbooe Uo. • PER= FEE S u4pature of Owner or Agene lto. of Cat Euroers of Air Cood. ' NUMBER THE COl1. tyIONWEALT OF MASSACHUSETTS FEE 7 ...........,�.0..... of ......... ...1..IY�.r?..f Buil ng Inspector CeCnER nI,Tnv�paS"No ut din"gg nor stru)e OhCll UANd,YdnlM 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 occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Address ......... . .......................... _.._...... _................................. ................................................._...................� ?.. i . Wiring Inspector Inepettlon Date Highway Department Inspection Date Building Inspector Inspection Date Assessors Inspection Date THIS PERMIT WILL NOT BE VALID, AND THE BUIL ING SHALL NOT BE OCCUPIED UNTIL SIGNED BY TIfE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. ./�................. 192. Buildinff Inspector FORM 1231 Hoses a WARREN. INC. APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK • All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00 OF y •t �9yo (OFFICE USE ONLY) to TOWN OF YARMOUTH By `0 Fee: PERMIT NO. e©q , © 22 ') 6 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: - 0 X To the Inspector of Wires: By this application the undersigned gives notice of his or her in ntic to perform the electrical work described below. l Location (Street & Numbed ��79 .8 f1✓ Cedes C. ��.1� . wner r Tenant !1 n Ae�e, Telep nn No.,-2Z2 ^ 273 7 Owner's Address S AI R F r F" 1° "= Is this permit in conjunction with a building permit? C3 Yes MNo (Check Appropriate B x J Purpose of Building Utility Authorization No. A3 -- Z Existing Service /CU Amps / 2-" / 2 Xa Volts Overhead[] Undgr ivleter t New Service Amps / Volts Overheado Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed a ctrical Work: Ike L tt,� 44" Ja�s "mot + —• I Cmmnlotinnnfthe Mlinwinotable mavhewaived hvlh•/n norvnrn/Wim o. of Total o r i -Susp.(PaddIe) Fans Transformers KVA No. of Liahtiniz Outlets No. of Hot Tubs Generators KVA Abovcn- ❑ ❑ No. o Emergency tg ung No. of Lighting Fixtures SwimmingPool md. rnd. atte Units Battery No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Bumers o. of Detection an Initiating Devices TOW No. of Ranges No. of Air Cond. Tons N . o erting Devices No. of Waste Disposers Heat mp Totals: um cr — ons — — n _ ntained e Devices No. of Dishwashers Space/Area Heating KW 1unicipal Locales , nection Q Other No. of Dryers Heating Appliances KW SecNo of is or valent No. of Water No. of No. of Data Whing: Heaters KW Signs Ballasts No. of Devices r uu en No. dromassa a Bathtubs H Y g No. of Motors Total HP Telecommunications No. of Devices or 1 e� Attach additional detail if desired, or as required by tHtrfua r r of Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued unless th�4t=scc provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. tlWork CK ONE: INSURANCE BOND OTHER (Specify:) (Expiration Date) aced Value of Electrical Work: (When required by municipal policy.) to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. fy, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME LIC. No.,AL2 .3 Licensee: &,A_/ le k,D /n1- Signature !� LIC. NO. -.9If applicable, enter "exempt" in the licepsg numb yr line Bus. Tel. No,"s'ek-7 7 Address• : t? � �.p �T�( rt�i` .rYvb,taiticS, �dr43 4%2&ZAlt. Tel. No.: [- . OWNER'S INSURANCE WAIVER: I am aware that the Licen2ce does not Ifavc the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) owner ❑ owner's agent. wner/Agent A —Signature Telephone No. [Rev. 04/001 WPS - Permit Page 1 of 1 A,,,, NSTAR WPS - Permit Utility Auth/WO #: 01662414 Date: 07/09/2008 Company DOROTHY MADDEN Rep: Report By: YPO 79 PHEASANT -COVE CIR JENKINS RICHARD A Status: COMPLETE Service: INCRS Type: RES Nature of Work: EXISTING 100 AMP UG TO TRANSF- ONE LEG DISC ON TROUBLE- PARTIAL PWR- ELECT REPLACING 100 AMP - REPAIR- ELDERLY CUSTOMER Service Information: There is no Service Information. Permit #: E09-038 Meters: 1 Reseal (Y/N): Y Date: 07/17/2008 Inspector: W10060 Description: Search Detail Contacts http://www.nstaronline.com/appslwpslwpspermit.cfm?Page=Permit&RequestTimeout=10... 8/20/2008 40MI5 SlipGen- Portal Home Town of Yarmouth Template [Building Dept] ■ Slipsheet Identifier [sg238061 Document Category Building Permits Map -Block Number 149.48 Street Number 0079 Street Name PHEASANT COVE CIR Department Building Parcel ID 17398 Backfile Batch Scan No Document? Additional Naming Info Index Operator Operator, Yarmscan Date - Time 2015-04-08 - 14:57 httpJAaserfichet?/SlipGeN 1/1