HomeMy WebLinkAboutBuilding PermitsTHE[ COMMONWEALTH OF MASSACHUSETTS
Fee. P< .... TOWN OF YARMOUTH No......... .
i�b % OCCUPANCY PERMIT
"No building nor structure shall be erected, and no land, building or structure shall be used
for a new, different, changed, or enlarged use without a Building Permit therefor first having been
obtained from the Building Inspector. No building shall be occupied ntil a certificate of occupancy
has been Issued by the Building Inspector." / �. 61 Qp
Issued to 2� .. Addres3� 3V�""_ c't!
Wiring Inspector �JG,.. . ......Inspection DatX
Plumbing Inspect! ....Inspection Date .
Fire Department .........Inspection Date (y.:o�/ 9`�......
Building Inspector . �(/ pl., /./........ .... Inspection Date �/6 Sl .......
Board of Health ..l. 0 ..Inspection Date ...
THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED
BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS.
Building Inspector. �?'�.. �!... .
THENORFOLK�DEDHAMGROUN
March 20, 2014
FORM OF NOTICE OF CASUALTY LOSS TO BUILDING
UNDER MASS. GEN. LAWS, CH.139, SEC. 3B
Building Commissioner, or Inspector of Buildings
c/o City or Town Hall
1146 Route 28 South
West Yarmouth, MA 02664
Board of Health or Board of Selectmen
c/o City or Town Hall
1146 Route 28 South
West Yarmouth, MA 02664
Fire Department or Arson Squad
c/o City or Town Hall
1146 Route 28 South
West Yarmouth, MA 02664
RE IVED
-7252014
[WILDING DEPARTMENT
RE: Our File No.: P1471905
Insured: DOUGLAS J. RICHARDS
ANNE L. RICHARDS
Address: 63 PARK AVENUE, WEST YARMOUTH, MA
Policy No.: N0416347
Loss Date: 03/19/2014
Loss Type: Building or Other Structure Damage
A claim has been made involving loss, damage or destruction of the above captioned property,
which may either exceed $1,000.00 or cause Mass. Gen. Laws, Ch. 143, Sec. 6 to be
applicable. If any notice under Mass. Gen. Laws, Ch. 139, Sec. 3B is appropriate, please direct
it to my attention and include a reference to the captioned insured, location, policy number, loss
date and claim or file number.
If no reply is received from your office within ten days, we will assume you have no liens of any
type against this property, and the claim will be paid in our customary manner.
Sincerely,
William Lamb
Claims - Property manager
1-800-688-1825 x1137
NORFOLK & DEDHAM MUTUAL FIRE INSURANCE CO. 222 Ames SUeet, P.O. Box 9109, Dedham, MA 02027-9109
DORCHESTER MUTUAL INSURANCE CO. ) Telephone: (800) 688.1825
FITCHBURG MUTUAL INSURANCE CO. 1 ® Fax: (781) 329-1818
FILE �,OPY
OFFICE MEETING NOTES
ADDRESS: DATE: n Z>
NAMES OF ATTENDEES:
ZONING DISTRICT.
FLOOD ZONE:
MEETING TOPIC: `
;,Y 3y;)
PERMIT 264 Supple m n-t- o B.P.367 4/26/99 _
4/26/99
LOT 5-40
Dunhill Development ---Charles Crovo
63 Park Avenue
West Yarmouth, MA 02673
Deck
SHEET 16
$3,800.00
TOWN OF YARMOUTH
Application for a Permit to Build
i-
S
UPON FINAL APPROVAL r �I MAP LOT 7 L-'
FEE MUST ACCOMPANY THIS APPLICATION. DATE ` 19 9
The undersigned hereby applies for a permit to build
according to the following specifications
Name of property owner a p ti, I S Mao
Address �7��
2. flame of Architect (if any)
/Name of builder () w'"*Vz� Address
4. License Noes 0?11&5 Tel.
5. Name of Mason
6. License No.
%/7/. Construction address
8. Date of subdivision Approval
Tel.
9. Private dwelling ❑ Estimated C st /
10. Multifamily ❑ p Q
11. Commercial ❑ C a r, S+,-Lcc
12.Other ❑ -d�Gv
13. No. of stories 0 j
14. Foundation — Full ❑ H-a`IfZl Crawl ❑ Slab ❑
15. Materials — Wood ❑ Cement ❑ Other ❑
ress
16. Type of heat — Oil ❑ Gas ❑ Electric ❑ Other ❑
17. Garage —1 ❑ 2 ❑
18. Swimming pool - Size
19. Storage shed — Size
20. Stove — Wood ❑ Coal ❑
21. Size of lot: No. of feet front No. of feet rear
22. Size of building. No. of feet front No. of feet side
23. Distance from nearest building: Front Ft. side
1444a& Z I I�zzz
C Tel. ��
Tel.
L-one
DO NOT WRITE IN THIS SPACE
I Twe of room
Dining Rm.
Living Rm.
Bed Rm.
Bath
Deck
Closed porch
Family Rm.
Sun room
Shed
Alterations
No. of feet deep
_ No. of feet rear
Ft. side Rear
24. Distance back from line or street From rear lot line Side line
25. H.I.C.R. No. / a /La-Le�- i��dyj
LOT RELEASED BY Signature
'W NOULCllim's
Address
20
Date
I
o x�, 016-, IT k . i 'Z bSJ
J
9
The Commonwealth ofMassachusetts
Department of Industrial Accidents
Ofllcs ollmsflpsdiiis
600 Washington Street
Boston, Mass. 02111
Workers' Compensation Insurance AMdavit
Applicant Information: PleaiePRiIVTTe�s'IsTv
613. phone N -
p 1 am a homeowner performing all work myself.
I am a sole proprietor and ha%e no one working in any capacity
I] I am an employer pro%iding workers' compensation for my employees working on this job.
2 ` —/ 20 ,q7 Z v
►is , r W &�- t2LI.5
lam a sole proprietor. general contractor. or homeowner (circle one) and have hired the contractors listed below who ha%e
the followin_ ttorkers:ompensation polices:
2ddress•
City phone N• —
s a
Failure to secure coverage as required under Section 25A of MGL 152 tan lead to the imposidoa ctcrimisal puWats of a flat ap to S1.So0.00 and/or
one years' imprisonment as well as civil penalties is the form of a STOP WORK ORDER and a eu of 5100.00 a day against me I naderntand that a
copy of this statement maybe forwarded to the OMcc of Investigations of the DIA for coverage verification.
I do hereby certify under the paiinnns and alder of peryury that the information provided above It true and correct
Signaturel2=3���%
Print name i^ fi��LrS � Phone `�`ZO
;Mcial use only do not write in this area to be completed by city or town official
city or town: YARHOUM _ permil/lkense N oBuilding Department
pUceasiog Board
p check if immediate response is required 261 OSelec '"co's Omee
pHealth Department
contact person: phone N: _ (508) 398-2231 ext. rlOther
AbuttorIs
Name
Lot #
If this is a
corner lot,
write in name
of street.
19
FOR LOT #
PLOT PLAN
WO I
S ��d
Indicate location of garage or accessory building
Additions with dashed lines --------------------
Sewerage disposal (cesspool) ED
Well
I I
I(lot................ft. rear) I
SIDE YARD
_ jo. _ FT_
I
I
I o
REAR YARD
SIDE YARD
HOUSE
I
SEAT BACK
I
I
(lot..................ft. frontage)
(NAME OF STREET)
Information
Supplied by V `
Abuttor I s
Name
Lot #
If this is
corner l o
write in
name of
a
other
street.
ro
o:
r-11N
19
MARK NORTH POINT
50NO TUBES
' PROPOSED DEGK
BE
PETER D.
BOWDEN
APPROVED:
REVISED:
DATE:
4/19199
SCALE:
3/16 n 1'
SHEET #
63 PARKAVE. WESTYARMOUTH, MA I A- 3
PROP05ED DEGK
w M
V 00
(f� N
Q 00
O
o
zC)
w°
ril
so
o�
m
DRAWN BY:
PETER D.
BOWDEN
APPROVED:
REVISED:
DATE:
4119/99
SCALE:
1 /8" 31'
SHEETS
63 PARK AYE. WEST YARMOUTH, MA I A- 4
EXISTIN
FOR AT
2-2
EAM
12" POL
PIERS
BG
4' BELG
PETER D.
BOWDEN
APPROVED:
REVISED:
DATE:
4/19/99
SHEET M
A-5
14' 187 14'
n
J
W O
PETER D.
BOWDEN
APPROVED:
REVISED:
DATE:
4/19/99
SCALE:
SHEETS
A-6
Exterior Sheathing
m
Wall Stud
Siding
-
�rrtt
Flashing Is tucked
Fleshing
rvi 00
underneath aiding & bent
N
over top edge of ledger
board.
Decking Board
A C
Lag screw extend
Bottom fate
Into house framing
— members
Rim Joist
0 O
J015T
DECK JOIST
�-1
Ledger
Concrete
•' Joist Hanger
Cd
Foundation
Remove siding to expose
sheathing for attaching 12000NCRETE
FILLED SONO
ledger
TUBE
(`Q
2 - 2 X 10 PT BEAM
LEDGER CONNECTION .,
DRAWN
TO WOOD -FRAMED NALL ..
PETER DD..
•
BOWDEN
APPROVED:
•—————�_�—�_�__�_�_�_�—=-111—�-1
' '• -=TFI� �_� -� �_� �_� -� 1=111-III-11 Et 1=I I I=I I I=I I I-1
REVISED:
DATE:
4/19/99
-
SCALE:
•
SHEET#
' PROP05ED DECK
63 PARK AVE. WEST YARMOUTH, MA.
A—%
PERMIT 131
LOT
Dunhill Development (Chas.
63 Park Ave.
West Yarmouth, MA 02673
Boardwalk 130'
SHEET 16
3/3/99
3/3/99'
$1,000.00
TOWN OF YARMOUTH Q1'Ved 3��tQF
Application for a Permit to Build No. J 1_
UPON FINAL APPROVAL b��"q� MAP Il% LOT
Q 99
FEE MUST ACCOMPANY THIS�PPLICATION. � DATE 19
The undersigned hereby applies for a permit to build
according to the following specifications
Name of property owner ���� �`� `^}V Ccbvo T
-Address 76 `M� :� 5�1- os'�-� v;��. �`'�� 0l6 3�
2. Name of Architect (if qny) _—
\3. Name of builder
\4. License No. 07����
�L rTel. -772-_ 11
S'� CE000 Address Yr .
Tel. '5 -O - l44
5. Name of Mason Address
6. License No.
�7. Construction address —(2
8. Date of subdivision Approval
Tel.
)a Ulsirlci
n zone Zone R rAr—
'. DO NOT WRITE IN THIS SPACE
"w
9. Private dwelling ❑ Estimated Cost ��, .T e of room No.
o
10. Multifamily ❑ � � O(��• � �' �� ��J• yP �
11. Commercial ❑ ��«s�-�•tsi /yp `x' �/�%99 Kitchen
12.Other ❑ Dining Rm.
13. No. of stories > Living Rm.
14. Foundation — Full ❑ Half ElCrawl ElSlab ❑ --i v Bed Rm.
Bath
15. Materials — Wood ❑ Cement ❑ Other ❑ I -9 o� S t ca-a Deck
16. Type of heat — Oil ❑ Gas ❑ Electric ❑ Other ❑
17.Garage —1 ❑ 20
18. Swimming pool - Size
19. Storage shed — Size
20. Stove — Wood ❑ Coal ❑
21. Size of lot: No. of feet front No. of feet rear
22. Size of building. No. of feet front No. of feet side
23. Distance from nearest building: Front Ft. side
.Closed porch
Family Rm.
Sun room
Shed
Alterations
No. of feet deep
No. of feet rear _
Ft. side Rear
24. Distance back from line or street rom rear lot line Side line
25. H.I.C.R. No.
LOT RELEASED BY Signature
PLANNING BOARD \Address
Date
BUILDING DEPARTMENT
CONSTRUCTION SUPERVISOR FORM
PLEASE PRINT: .
�OB
__ `,1 _ LOCATION: �� �` ���— y
J V `
NUMAER STREET / 1 VILLA GE
\ OWNER OF PROPERTY: '
\CONSTRUCTION SUPERVISOR:( 1 A✓1C<\CS In (
NAME LICENSE NO. PHON N0.
\ADDRESS: �$d /"la ;
LICENSED DESIGNEE:
(IF OTHER.THAN SUPERVISOR) NAME LICENSE NO.
2.15 RESPONSIBILITY OF EACH LICENSE HOLDER:
2.15.1 THE LICENSE HOLDER SHALL. BE FULLY AND COMPLETELY RESPONSIBLE FOR ALL WORK FOR WHICH HE
IS SUPERVISING. HE.SHALL BE RESPONSIBLE FOR SEEING THAT ALL WORK IS DONE PURSUANT TO THE STATE
BUILDING CODE AND THE DRAWINGS AS APPROVED BY THE BUILDING OFFICIAL
2.15.2 THE LICENSE HOLDER SHALL BE RESPONSIBLE TO SUPERVISE THE CONSTRUCTION, RECONSTRUCTION,
ALTERATION, REPAIR, RE40VAL 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 SUB-
CONTRACTOR 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 2.15.19 2.15.2 OR 2.15.3 OR ANY
OTHER SECTION OF THESE RULES AND REGLZATIONS 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, RECON-
STRUCTION, ALTERATION, REPAIR, REMOVAL OF DEMOLITION AS REGULATED BY SECTION 109.1.1 OF THE
CODE AND THESE RULES AND REGLUTIONS. IN THE EVENT THAT SUCH LICENSEE IS NO LONGER SUPERVISING
SAID PERSONS, THE WORK SHALL L`g1EDIATELY CEASE UNTIL A SUCCESSOR LICENSE HOLDER IS SUBSTITUTED
ON THE RECORDS OF THE BUILDING DEPARTMENT.
I HAVE READ AND UNDERSTAND MY RESPONSIBILITIES UNDER THE RULES AND.REGULATIONS FOR LICENSING CON-
STRUCTION SUPERVISORS IN ACCORDANCE :KITH SECTION 109.1.1 OF THE STATE BUILDING CODE. I UNDERSTF:a;
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 MGLCh.152'
Yes ❑ No ❑
If you have checked vas. please indicate the hype c average by checking the ap;rcpriate box.
A liability Insurance pc:icy ❑ O:her type of :ndemnity ❑ Sond ❑
OWNER'S IN UAANCE WAIVER: I am aware that the ncensee does not have the Insurance coverage. required :y
Chapter 152 the fdais: General Laws. ano that my signature on t`:s permit c„ plicaticn wanes this requirerri m.
Check one:
Owner) Agent ❑
\SIGNATUR`:!,(¢[_BUILDING OFFICIAL APPROVAL:
Suggested Affidavit for Home Improvement Contractor Permit Application
For Office Use only NAME OF CITY/TOWN
Permit No.
Date
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
MGLa 14ZA requires that the "reconstruction, alteration. renovation, repair, modernization, conversion, Inprovement, removal, demolition,
orconstruction of an addition to any oreccistine owneroccuvied buildine containin¢ at least one but not more than fourdwelline units .... or
to structures which are adjacent to such residence or buildine" be done by registered contractors, with certain exceptions, along with other /
requirements. YrJyl�
\Type of Work: o \,\Ck at. Cost
\ Address of Work_6,—,z A-,-*—��
\ Owner
Date of Permit Application:
I hereby certify that:
Registration is not required for the following rcason(s):
Work excluded by law
Job under S1,000
Building not owncr•occupiei
Owner pulling own permit -
_Other (specify)
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL
c.1aiA.
Signed under penalties of perjury:
I hereby apply for a permit as the agent of the owner:
Date
OR:
Notw'hsta�gthe
� D If
Registration No.
If the above property:
The Commonwealth of Massachusetts
Department of Industrial Accidents
exce oliaresaouloss
600 Washington Street
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
1 am a homeowner performing all work myself.
0 1 am a sole proprietor =rd ha,.e no one working in any capacity
❑ I am an employer pro%iding workers' compensation for my employees working on this job.
company name:
iddress•
c0t)•' phone a•
insur•tnce co. -policy of
1 am a sole proprietor. general contractor. or homeowner (circle one) and have hired the contractors listed below who ha%e
the follow in_ workers' compensation polices:
�. phone a•
insur tnce Co.policy a
Failure to
one years'
copy of th
\S
s\ Print name
as required under Section 25A o(MGL 152 can lead to the imposition of erimimal penalties of a lime up to SI.S00.00 and/or
s well as civil penalties in the form of a STOP WORK ORDER and a fine of SI00.00 a day against me. I understand that a
be forwarded to the Omce of investigations of the DIA for coverage verifiatiom.
penalties of pep that the information provided above is true and correct
1f ate �&M
PhonetY -�'-'o ���v - 7
omcial use only do not r rite in this area to be completed by city or town omeial
city or town: YARHOOT11 _ permitAicense a clBuilding Department
OLicensiog Board
O check if immediate response is required 261 QSclectmen's Omce
contact person:
OHealth Department
phone#;_ (508) 398-2231 eat. riOther
tu.ued V;S P1A1
ZN
APPLICATION SIGN OFF
BUILDING PERMIT #:
\ADDRESS: -774O ►1 A . jV_w_%TELE. NO. ; re)t_-Y)O* 41ATE FILED:
BLDG. SITE LOCATION:: r� at k aAve— MAP#: / LOTU:
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 DETER-
MINE COMPLIANCE TO THE FOLLOWING (A) ZONING REQUIREMENTS (B) HISTORICAL DISTRICTS (C) FLOOD
PLAINS ZONING. THE BUILDING DEPARTMENT WILL BE RESPONSIBLE FOR ASSISTING THE APPLICANT THOUGH
THE FOLLOWING DEPARTMENTS:
WATER DEPARTMENT:
ENGINEERING DEPARTMENT:
CONSERVATION COMMISSION:
HEALTH DEPARTMENT:
FIRE DEPARTMENT:
RESIDENTIAL AND/OR COMMERCIAL BUILDING
DETER2IINES COMPLIANCE OF WATER AVAILABILITY.
DETERMINES COMPLIANCE FOR PARKING AND DRAINAGE.
DETERMINES COMPLIANCE TO WETLANDS ACTS, I.E.: IF LOT(S) BORDER ANY
TYPE OF WETLANDS, STREAMS, PONDS, RIVERS, OCEANS, BOGS, BAYS, MARSH
LAND, ETC.
DETERMINES COMPLIANCE TO STATE AND TOWN REGULATIONS, I.E.: REQUIRE-
MENTS FOR SEPTAGE DISPOSAL AND OTHER PUBLIC HEALTH ACTIVITIES.
DETERMINES COMPLIANCE TO STATE AND TOWN REQUIREMENTS FOR PERSONAL
SAFETY, PROPERTY PROTECTION, I.E., SMOKE DETECTORS, SPRINKLER SYSTEMS,
ETC.
THE FOLLOWING DEPARTMENTS MUST SIGN OFF, IN THE RESPECTIVE ORDER, PRIOR TO BUILDING INSPECTOR
ISSUING THE REQUIRED BUILDING PERMIT:
REVIEWED BY:
1. WATER DEPARTMENT DATE: N/A:
2. ENGINEERING DEPNT: DATE: N/A:
3. CONSERVATION: DATE:_ N/A:
4. HEALTH DEPARTMENT DATE: N/A:
INDUSTRIAL AND/OR COMMERCIAL 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. A SIGNED RECEIPT FROM THE
DISPOSAL SITE MUST BE SUBMITTED TO THE BUILDING DEPARTMENT PRIOR TO ISSUANCE OF THE BUILDING
PERMIT.
COMMENTS:
BLM 89
TOWN OF YARMOUTH
ication for a Permit to Build No.��
rA & -I ,p `Z MAP I
FEE MUST ACCOMPANY THIS APPLICATION.
The undersigned hereby applies for a permit to build
according to the following specifications
1. Name of property owner
Address
LOT S 40
DATE A4Ay 5 19 W
��O hh
Te'
2. ame of Architect (if any) N"'EVVSi cc �e 5 �N Tel.
o.c
3. ame of builder ddress A&17 St D Skrj1G.
4. License No. 07/16(o Tel.. moo' 47ep �jZ2Z
5. Name of Mason LAR, 1'1SI Rai {^ts��� Address //7 kJvc�' /,✓
4rU,tu�li At
3��
6. License No. Tel. —fro_ - -6o �
7. Construction address
8. Date of subdivision Approval YRte¢ Te Y,.ANt3aaplaii
PLA►t �ArE� 1%15 , iV
9. Private dwelling Gd� Estimated Cost
10. Multifamily ❑ 1 170 do p --
11. Commercial ❑
12.Other ❑
13. No. of stories 0
14. Foundation — Full ❑ Half ❑ Crawl V Slab ❑
15. Materials — Wood IQ/Cement ❑ Other ❑
16. Type of heat — Oil ❑ Gas V Electric ❑ Other ❑
17. Garage —1 ❑ 2 ❑ Rolle
18. Swimming pool - Size _0002>
19. Storage shed — Size
La R-zs
DO NOT WRITE IN THIS SPACE
�IU O x -0- I Type of room
,WW
�ST�L� l DOg2,
��Fcrt �yz2 ,
/9
, AS
'y D
S-9a �s o
�`/7.s-�
lo
20. Stove — Wood ElI�7u rt Coal ❑ r1oKe,
Kitchen
Dining Rm.
Living Rm.
Bed Rm.
Bath
Deck
Closed porc
Family Rm.
Sun room
Garage
Shed
Alterations
M
K
21. Size of lot: No. of feet front 615 No. of feet rear No. of feet deep a yx
22. Size of building. No. of feet front_ No. of feet side No. of feet rear
23. Distance from nearest building: Front - Od Ft. side '1�0 Ft. side hn Rear Y(N
jz-
24. Distance back from line or street 30 From rear lot line Side line !a:
25. H.I.C.R. No.
LOT RELEASED BY
Signature \)• � '
torr
PLANNING BOARD I.I.A.- Address
Date Prztov- To P�AMMIMG'BoA;=
OEGoED6D PLAN-* id% Q
/ ` Y SF. "7 fe:00 4itD—L{
BUILDING PERMIT APPLICATION SIGN OFF
APPLICANT: v o tA�j)*jeL4A4%e; BUILDING PERMIT h
ADDRESS:_ �L1r�Iv--1 ELE: NO.: .. DATE FILED:
`b� vE. ��/
BLDG. SITE LOCATION: Pr4.2IC � W . �l ogsk• MAP#: 16 LOT#:
c 4oriv H .
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 DETER-
MINE COMPLIANCE TO THE.FOLLOWING (A) ZONING REQUIREMENTS (B). HISTORICAL DISTRICTS (C) FLOOD
PLAINS ZONING. THE BUILDING DEPARTMENT WILL BE RESPONSIBLE FOR ASSISTING THE APPLICANT THOUGH
THE FOLLOWING DEPARTMENTS:.
RESIDENTIAL AND/OR COMMERCIAL BUILDING
WATER DEPARTMENT: DETERMINES COMPLIANCE OF WATER AVAILABILITY.
ENGINEERING DEPARTMENT: DETERMINES COMPLIANCE FOR PARKING AND DRAINAGE.
CONSERVATION COMMISSION: DETERMINES COMPLIANCE TO WETLANDS ACTS, I.E.: IF LOT(S) BORDER ANY
TYPE OF WETLANDS, STREAMS, PONDS, RIVERS, OCEANS, BOGS, BAYS, MARSH
LAND, ETC.
HEALTH DEPARTMENT:.._ DETERMINES COMPLIANCE -TO STATE AND TOWN REGULATIONS, I.E.: REQUIRE-
MENTS 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 SYSTEHS
ETC.
THE FOLLOWING DEPART
ISSUING THE REQUIRED
REVIEWED BY: '
1. WATER DEPARTM
2. ENGINEERING D
3. CONSERVATION:
ENTS MUST SIGN OFF, IN THE RESPECTIVE ORDER, PRIOR TO BUILDING INSPECTOR
BUILDING PERMIT:
4. HEALTH DEPARTMENT
DATE: N/A:
DATE: • SBH BELow
DATE:
DATE: s s/ N/A:
INDUSTRIAL AND/OR COMMERCIAL 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. A SIGNED RECEIPT FROM THE
DISPOSAL SITE MUST BE SUBMITTED TO THE BUILDING DEPARTMENT PRIOR TO ISSUANCE OF THE BUILDING
PERMIT.
COMMENTS:
W AvER:.1 STREET ( An uwcou STRUcrEv 40' W jA6 PRwATE WAY)_
2. S„rE PLAIT SNOWS SLAB To 264 FROM LEAaN jfe&Lp Bur
J4ovS9 PLAM S14oViS C PAGE UJITHW 10' gf: LgACR IrilILD
n 2� VA G F-/l/ErQ ND OIL e: 7-
L,7,y 7-c QF " C'oNGrL�sZ 7"wr C'is2lr�a/L
GT .S/fOr t� iV
/'! 3,cln, c ram. I } rWV_ N A/r Ca�7�
BUILDING DEPARTMENT
CONSTRUCTION SUPERVISOR FORM
PLEASE PRINT:
JOB LOCATION: 1do -e—(
NUMBER STREET VILLAGE
OWNER OF PROPERTY:_ AmP)1rt.
CONSTRUCTION SUPERVISOR:
NAME LICENSE NO. PHONE NO.
ADDRESS: azyv eoS n)dt lMc1-oz.6�C�'
r
LICENSED DESIGNEE:
(IF OTHER,THAN SUPERVISOR) NAME LICENSE NO.
2.15 RESPONSIBILITY OF EACH LICENSE HOLDER:
2.15.1 THE LICENSE HOLDER SHALL. BE FULLY AND COMPLETELY RESPONSIBLE FOR ALL WORK FOR WHICH HE
IS SUPERVISING. HE.SHALL BE RESPONSIBLE FOR SEEING THAT ALL WORK IS DONE PURSUANT TO THE STATE
BUILDING CODE AND THE DRAWINGS AS APPROVED BY THE BUILDING OFFICIAL
2.15.2 THE LICENSE HOLDER SHALL BE RESPONSIBLE TO SUPERVISE THE CONSTRUCTION, RECONSTRUCTION,
ALTERATION, REPAIR, REIJVAL 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 SUB—
CONTRACTOR 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, RECON—
STRUCTION, 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 LMMEDIATELY CEASE UNTIL A SUCCESSOR LICENSE HOLDER IS SUBSTITUTED
ON THE RECORDS OF THE BUILDING DEPARTMENT.
I HAVE READ AND UNDERSTAND MY RESPONSIBILITIES UNDER THE RULES AND.REGULATIONS FOR LICENSING CON-
STRUCTION SUPERVISORS IN ACCORDANCE N'ITH SECTION 109.1.1 OF THE STATE BUILDING CODE. I UNDERSTAN:
THE CONSTRUCTION INSPECTION PROCEDURES AND THE SPECIFIC INSPECTION AS CALLED FOR BY THE BUILDING
OFFICIAL.
INSURANCE C VERAGF-
I have a curren liability insurance policy of its substantial equivalent which meets the requirements of MGLCh. 152
Yes No ❑
If you have checked ves, pl a indicate the type c average by checking the aF:rcpriate box.
A liability Insurance pc:icY Other type of :idemnity ❑ Bond ❑
OWNER'S INSURANC—c WAIVER: I am aware that the ucensee does not have the Insurance coverage required _y
Cyh3ote 5Y f the Mass; General Law./ana that my signature an Ms permit :cP'i'y'ion waives this requiremer.-
eck one:
Owner;_I Agent
S1yr'tatur.ofi:aiCrF,ow-nusAgent r - - g ❑
SIGNATURE���///Ji�/r/J%/ BUILDING OFFICIAL APPROVAL:
In any capacity
Q I 'man
employer pro. i3ml workeri compensation for trey cmploytes wvr}U6 on thlsjob.
IN __1,kx e�
(] 1 am a s01t proprietor -
tht follow mZ worltri
S
, Vr.
homeowner (cods one) and hat c hind the certnctors listed below Mho has c
G o ooa"113o-0o
. suYtt N areart et+ersat w repaN.gtc399Ms iU of MGL, U3 tat imed is at kqoibmm at MUBNW p@NMWM .r & oaa p a 81.fN.M egLw
et,. Mare' Mspti.ta"=I as .an as 1&0 Penalties It tat bm or a WIMP WOtllt CMU sd a An sf UNA a do, agaim Wa. I **&md Nee a
caPr ed 11k aultttttl may tie fonrer�d r tM Pelee trta►weFpNeed trI M DMA Dr ewsrsp vardsmo a
f /Ia itn�y «x� uadN rra rrfst aM1 pa&&Irita t/perfrry eAsr rAc /V/accaatl&n PVVMW &raw IS bW and tar►ad
Prim name Phm o
emeWwar SAY uPat . tilt i. this areaIstatcw.okedhguy trown Wkw
airyw lt+.e D7q _
P s ^ eYitfieP (yc/aftMq
t5 OMCL if taawdlaae mosata is eoptrd C K bath
261 Oklatraat's ofte
cootaet rule.: P►..t ih �(50088) 395 -2231 ast. oo wY Oenraraq
TOWN OF YARMOU-TH
WATER, DEPARTMENT
l MENT
102 UNION STREET
YARMOUTH PORT, MASS.02675
(508)362.4974
FAX (508) 362.5421
Date of Issue : Apr 2, 1998
Letter of Water Availability
1. Single Family Dwelling x 2. Duplex Family Dwelling
3. Condominium Dwelling 4. Commercial / Industrial
5. Other (Specify)
Reference; Massachusetts General Laws Chapter 40, Section 54
To : Town of Yarmouth Building Inspector
Please be advised that the Town of Yarmouth Public water supply
is available to service lot/parcel(s) S40 Street PARK AVENUE
as shown on Assessors sheet/map # 16
Issuance of this Letter of Availability is subject to the
following provisions/restrictions.
(1) The property owner agrees to comply with all Federal, State,
and Local Laws, Rules and Regulations as they pertain to the use of the
Public water Supply.
(2) The Yarmouth Water Department shall have exclusive rights as
to the size, number, type and location of all water service lines, fire
service lines or appurtenant items connected to the water distribution
system.
(3) The Yarmouth Water Department reserves the right to require,
at the property owners expense, the installation of water mains and
appurtenant items to meet water demand requisites within any structure
relevant to this Letter of Availability.
(4) This Letter of Availability will expire 180 days from
the date of issue.
I have read and understand the provisions/restrictions of this Letter of
Water Availability.
rjw . �a
OwiTer Sign
Reference
: DUNHILL DEVELOPMENT
: MAIN STREET
: OSTERVILLE, MA 02655
Lter Denartl
of v
c90 71,27/9,5;-
WAVERLY
SREET
UNCONSTRUCTED
6
r�l0
0.
RS �0
\°
N/F
PHILIP WRIN
NOTE:
TOP OF FOUNDATION IS 2.08'
EVE THE HIGH POINT IN
PARK AVENUE
CER TIFIED PL 0 T PLAN
HIGH -POINT
ELEV. = 11.0'
.4
N
CONC.
FOUND.
TFe13.08'
'O?�
N/F
RICHARD
PETERSON
JOB # 98-255 1
LOCATION : PARK AVENUE WEST YARMOUTH, MA
SCALE : 1" = 40' DATE: JULY 22, 1998 PREPARED FOR:
REFERENCE PB 26 PG 113
DB 1080 PG 277 D UNHILL DEVELOPEMENT
I HEREBY CERTIFY THAT THE STRUCTURE
SHOWN ON THIS PLAN IS LOCATED ON THE
GROUND AS SHOWN HEREON.
eeeo
e Z-xs-�u1
f aoe xs-o
doNm cape engineezlgg Inc.
CIVIL ENGDQEERS-----/—tf------
LAND SURVEYORS
9 man d. ywmutk ma 02675 DATE
.,, _.a.c. • � ,.�tt.�T TR.eT Ferri, w. � SW 7?t e476
Ap►. 81 16198 10:4avr F`2
ENERGY CONSERVATION APPLICATION FORM
FOR LOw.Rigg 12E9IDE6MAL NEw CONSTRUCTION
Applxar•: Namle:
Appikarn AddML i>> w, .� � � k' S1feAddreas: �
Appfle"t pbooa. 4 DurotAppikau
ApplicantSijnaa,re:
Complla "Patti (ehak ow):
20fie&rl0dW FwUr ('NakU to !• orI-haily +rood truss baMijW basted w" faW CW*omb)
hakar (A tllrou6h KK). Hem"d D" DO% Deu 65 (HOD") 4om Tabis JS.tia:
(Far itMaa d, l,, fill in at: valuat Lw apply fm= TOW J5.2. t b:)
a• Otou Wall Ann f (A 19-R f Watl R-wsko A
b. C1424it.0, Area ?,�6 p,R- I. Floor R.valua a•
t- Duals$ ttl ;too a b. a) h. 8ataarerq wilt . iZ�2 per( j�Mp JgCt�
d• chwe6 V-value SZs..te3.jtg l 8lab rarkmw &
o. colrn. &value g�iso_ J. Hndnf Apuz
[] cabtpOpt Theforreaate: "llauaal trade Vf!'r ateoitad In wood K nalaol framed bidkUm ca)y)
cum4m z4m (from Fipm J61.2) Q zonr 12 p J:aae 0 [] T,oae l•
AMWh rf=iF- WGFkShetr flora Appaad s J, Egad JdYAC Trade-G WW*Fhaer. if appr"ble)
= M-4uheea Sat wara
A%Wh C*ffVUwrtt'Rtporrand ptrpectlor Cj##Cklfa prWW41 .
ci *"mm" Auh wm ox C2 A4rewabls zmr v 4oarsae
Attach Mae Ra=iIWW ArdUa t of frylnw Arabia
Of'�kw,$ Nam#: Olfyt dare Silylaaua:
A"Itoatioa Appr*%,aa Co r)w of Appwval%
Appilatioa Doal.d Q 1�taa of DealaL
Anson(a) tnr Dar+al:
(prbvide•tttOrs dltalb, if rmdrti. on oppot 'said) nu e1r_vn
r4 (13
PHML� ;
Midrrr Nr+cnrr � t\�,: \� r C
:iW Addre"
QuDirrynp 8y
pta"n )%Q : 5M 71 6676 Aar. el 19M 10:3Sq, P1
I Isnual Trade-G/f Workihaat
r Ph"
F�� fam rounanren�
Irt♦yy{i�n tAR11� C' n f[ � pr
u ay ~ ri
um" dowrwr - it donsionmww+iN ltitlwn {WW. .
fir/ per► N PoNom %", 9% am Iw9m . i
DRAFT cfw wwnft woosmi
imam
prs
Dowling & O'Neil
Insurance Agency, Inc.
222 west Main street
P.O. Box 1990
Hyannis. Massachusetts 02601.1990
Tel. (508) 775-1620
Fax (508) 778.1218
May 5, 1998
The Town of Yarmouth
Main Street
West Yarmouth, MA 02673
RE: Dunhill Development Co., LTD
Dear Sir/Madam:
This letter will serve as proof that Dunhill Development Co., LTD
has applied for Workers Compensation coverage through the
Massachusetts Workers Compensation Assigned Risk Pool.
We expect coverage to be effective 24 hours after the Pool
receives Dunhill Development Co.'s application pending approval of
the application.
Sincerely,
bf6k
Kelly C. Bolton, AU, CIC, LIA
Commercial Marketing Representative
KCB/401263
JUL-16-1997 09:10 RRD170 P.002/006
310 C11R 10.00
Form S
CoumoRw"Ith of
rd.auacbm"tto
DEPM.p4o. 5E 83-1405
CitylTown YARMOUTH '
ApplkW AMELIA BOOTH
CO'
ORDER OF COMMONS
MASSACHUSMS %YrL ANUS PROTECTION ACT
QL C.1311SAO
AND THE TOWN OF YARMOUI'H w'ETLAHD BY-LAW
From TOWN OF YARMOUTH CONSERVATION COMMISSION
To Amelia Booth Same
(Name of Applicant) (Name of Property Owner)
Address 48 Lowell st., Wilmington, MA Address Same
01887
_By hand delivery to applicant or representative
A. By Certified Mail on .7111V 1, 1997
The project is located at Park Avenue, West Yarmouth, MA
The property is recorded at the BARNMBLE REG13TRY OF DEEDS
BOOK 1080 PAGE 277 OR CERTIFICATE
The Notice of Intent was filed on May 14, 1997 (date)
The Public Hearing was closed on. .rune 19. 1997 (date)
FMINGS:
The Town of Yarmouth Conservation Commission has reviewed the above referenced Notice of Intent and
plants and has held a public hearing on the projecL Based on the information available to the Commission at
this time, the Commiulon has determined that the area on which the proposed work is to be done is significant
to the following interests in accordance with the Presumptions of Significance set forth in the regulations for
each Area Subject to Protection Under the Act. (check as appropriate)
r_--,-Public Water Supply Flood Control Land Containing Shellfish
Private Water Supply _I.Storm Damage Ptevcmion Fisheries
_Ground Water Supply _Prevention of Pollution Protection of Wildlife Habitat
Total tiling fee submitted S 2 5 0•. 0 0 State Share $112.5 0
City or Town Sbaro S 13 7.5 0 (one half total fee in excess of S25.00)
Total Refund Due City/Town Portion State Portion
(one half total) (one half total)
Effective 4/04
JJL-16-1997 09:11 RRDITO P.003/006
Therefore, The Yarmouth Conservation Commission hereby finds that the -following conditions are
necessary. in accordance with the Performance Standards set forth in the regulations to protect those interests
chalked above. The Yarmouth Conservation Commission orders that all work shall be performed in
accordance with said conditions and with the Notice of Intent referenced above. To the extent that the
following conditions modify or differ from the plans, specifications or other proposals submitted with the
Notice of Intent, the conditions shall control.
r, 4 . ilk-, '4IR�'
1. Failure to comply with all conditions stated herein, and with all related statutes and other regulatory
measures shall be deemed cause to revoke or modify this Order.
2. This Order does not grant any property rights or any exclusive privileges; it does not autl•.orizc any "Ury
to private property or invasion of private rights.
3. This Order does not relieve the permittee or any other person of the necessity of complying Kith all other
applicable federal, state or local statutes; ordinances, by-laws or regulations.
4. The work authorized hereunder shall be completed within three years from the date of this Order unless
either of the following apply:
(a) the work is a maintenance dredging project as provided for in the =; or
(b) the time for completion has been extended to a specified date more than three years, but less than five
years, from the date of issuance and both that date an the special circumstances warranting the
extended time period are set forth in this Order.
5. This Order maybe extended by the issuing authority for one or more periods of up to three years each upon
application to the issuing authority at least 30 days prior to the expiration date of the Order.
6. Any fill used in connection with this project shall be clean fill, containing no trash, refuse, rubbish, or
debris, including but not limited to lumber, bricks, plaster, wira, lath, paper, cardboard, pipe, tires, ashes,
refrigerators, motor vehicles or parts of any of the foregoing.
7. No work shall be undertaken until all administrative appeal periods from this Order have elapsed or, if such
an appeal has been filed, until all proceedings before the Department have been completed
8. No work shall be undertaken until the Final Order has been recorded in the Regisw of Deeds or the Land
Court for the district in which the land is located, within the chain of title of the affected property. in the
case of recorded land, the Final Order shall also be noted in the Registry's Grantor Index under the time of
the owner of the land upon which the proposed work is to be done.. In the case of registered land, the Final
Order shall also be noted on the Land Court Certificate of Title of the owner of the land upon which the
proposed work- is to be done. The recording information shall be submitted to the Yarmouth Conservation
Commission on the form at the end of this Order prior to commencement of the work.
9. A sign shall be displayed at the site not less than two square feet or more than three square feet in size
bearing the words, "Massachusetts Department of Envimemeotal Protection,
File Number SE 83-1405 ".
10. Where the Department of Environmental Protection is requested to make a determination and to issue
a Superseding Order, the Conservation Commission shall be a parry to all agency proceedings and
hearings before the Department
5-2
JUL-16-1997 09:12 ARDITO
P. 004/ 006
1l. Upon completion of the work described herein, the applicant shall forthwith request in writing that a
Certificate of Compliance be issued stating that the work has been satisfactorily ebmpleted.
12. The work shall conform to the following plans and conditions:
PLANSi SE 83-1405
Site & Sewage Plan
Of Parcel S40, Park REV.6/18/97 Arne.H. Ojala, P.E., Con Com
Ave., W.Yarmouth
SPECIAL CONDMONS: CMCadditional2j=ifneccLcAr4
1. 'The applicant shall be held responsible to advise the contractor of all the " Orders" stated herein.
2. The Conservation Administrator shall be notified at least 48 hours prior to the commencement
of the proposed work. Tel. 0 508.398.2231 ext. 288.
3. These "Orders of Conditions" shall apply to any successor in interest or any successor in control.
4. The applicant shall be responsible for having a copy ofthese "Orders ofConditions" on the job site at
all times: Failure to do so may result in a revocation of the "Orders of Conditions", or a fine, or
both.
5. The Conservation Commission, its agents or assigns, shall have the express right of en ry on the job
site at all reasonable times for the purpose of establishing "compliance" with the conditions stated
herein.'
6. Upon completion of the project, a "Certificate of Compliance". shall be requested in writing. This
"Order of Conditions" shall be considered incomplete until the "Certificate of Compliance" is issued
and recorded at the Barnstable County Registry of Deeds.
Special Conditions continued on next page.
5.3
JLL-16-1997 09:12
SViCiAL =NDITIONS
SE 83- 1405
P$ge• 5-3A
RRJITO
P.005/006
7. The driveway shall be constructed of pervious materials such as
gravel, stone, seashells or other similar materials.
g. Gutters and downspouts directed into drywalls shall be installed
to provide for roof runoff.
9. A silt fence shall be staked in place.as shown on the plan,. prior
to any work on the project.
10. This fence shall constitute's "Work limit line". No'woik'of
any kind shall be permitted on the wetland side of this line.
11. The deck shall not be closed in without a future filing with the
Conservation Commission.
JUL-16-1997 09:13 ARDITO P.006/006
Issued by : The Town of Yarmouth Conservation Commission
by a majority of the Conservation Commission
On this v day of 19�, before me personally
appeared the above Conservation Commissioners, to !mown to be the person(s) described hercinand who
executed the foregoing instrument and acknowledged that he or she executed the same as his or her free act
and deed
June AF, e 00A. —
Notary Public My Commission Expires
The applican4 the owner. any person aggrieved by this "Order", any owner of hind Abuttingthe land upon wbleh the
proposed work Is to he done, or any 10 residents of the city or town is which suck land Is bested, are hereby noticed of their
tight to request the Dept. of Eaviraomeotal protection to issue a "Suponsding Order". providing the "4nut is made by
eenuw map or hand ddkeq co the Department, with the appropriate filing tee and Fee Trawmlttal Form as provided to 310
CMR 10.03(7), within ten days of the date of Issuance of this Deaermhodon. A copy of the request" atthe came tiros be
seat by certified snail or band delivery to the Conservation Commission and the applicauL
Detach on the doted line and return to the Yarmouth Conservation Commission prior to starting work.
.M..N.w WM.M.M..M...NI.MM.NWIYNI.MM.wwr....w1.WM.YMM W.MM..w.w..w..w1..MN1,N,.w.www.M.N„MMMw.NM.IN„M,M",Nw.w...MM
To:. Town of Yarmouth Consmstdon Commission (IR»' g aWhuhy)
Please be advised that the "Order of Conditions" for the project at
File Number - SE a 3 - is 0 S has been recorded at the Barnstable County Registry of Deeds and has been
noted in the chain of title of the affected property in accordance with General Condition #8 on
If recorded land, the instrument number which identifies this transaction. is
If registered land, the document tuunber which identifies this transaction is
Signature (applies)
am
TOTAL P.006
APR-30-9A LI 11 N=7 POL-It-ACAPE G,)JGINEERING 508 Z62 9E80 P.OS
ti
932 ma-n ViDet rl is
yarmoulh pal
mass 02675
structural ell-Gn
I" Coyrl
ewraYe
site plannic9
image Wstern
designs
inspecuors
Fotrn'tt
dawn cape engineering
civil rnpinarra & land survek ors
I VK
Iv
March 271 1998
Department of Environmental Protection
20 Riverside Drive
Lakeville, MA 02347
Attn: Elizabeth Kouloherae, Chief
ter. (50) 3s2.454 r
kx1508)34.n 9680
Mne K OHa PE, PIA
TimothV 14 Govetl P.LS.
David C.?hUiin, P.E
Re: Requent for Certificate of Compliance
SSoc SE 83-1405 Booth, West Yarmouth
Dear Ms. Kouloherae:
On December 10, 1997, the Department of Environmental
Protection issued a Superseding Order of Conditions for a
projact at Parcel S40, Park Avenue, West Yarmouth.
Site inepoctions have been made and an as -built performed
of the site as per Special Condition #15 (enclosed).
This is to certify that the project is in substantial
compliance as per Special Conditions #10 and #13 on tho
3aperaeding Order of Conditions.
very truly yours,
Arne H. Ojila, PE, PLS
Down Cape Engineering, Inc.
cc: Sill garrison
N ,
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
SOUTHEAST REGIONAL OFFICE
ARGEO PAUL CELLUCCI
Govemor COPY
Jonathan D. Fitch - -
-MacNeill & •'Fitch
88 Route 6A
P.O. Box 549-
• Sandw£ch-, =Massachusetts - 02563
Dear Mr. Fitch:µ
December 10, 1997
RE: YARMOUTH-
'File No- SE -140
Superse ing Order of
Conditions
TRUDY CORE
Secrcmry
DAVID H. STRUHS
Commissioner
Following an in-depth review of the above -referenced file and in
accordance with Massachusetts General Laws, Chapter 131, Section 40, the
Department of Environmental Protection has issued the enclosed Superseding
Order of Conditions (SOC). This Order approves the proposed project subject
to certain conditions..
The Department has determined that the•project-site is significant to
the following statutory interests of the Wetlands Protection Act: protection
of ground water, prevention of pollution,' flood control, storm damage
prevention;:and•the protection of fisheries and wildlife habitat.
The proposed project is the construction of a single-family dwelling,
on -site sewage disposal system, utilities, and grading within Land Subject to
Coastal Storm Flowage - Zone Al2, Elevation 10, and within.the buffer zone to
a Coastal Bank '[310 CMR 10.30 (2)] and Salt Marsh [310 CMR 10.32 (2)].
Please be advised that the fill placed on the lot which contains
asphalt, concrete, and other debris constitutes solid waste* per 310 CMR
16.02. Any disposal of'solid waste at any location which is not established
or maintained..as.._a facility for the disposal of solid waste pursuant to a
valid site assignment or permit .in accordance with M.G.L. c. 111 9 150A,
shall constitute a violation of M.G.L. c. 111 5 150A, 310 CMR 16.00 and 310
CMR 19.000. The Department is approving this project with the condition that
the solid waste be removed, disposed of at a facility approved for the
disposal of solid waste, and the site be restored to the existing grades with
clean fill. [See attached Special Conditions #10 & #131.
The enclosed Superseding Order of Conditions contains special conditions
which, in the Department's opinion, adequately protect the above -cited
interests of tfie-Act.
_ .. tot
-POP
.0 i:k.r•nte Dave :eril:e. Alasnc umu C347 0 FAX(508) 9i.. • Vdrpbone (FOX) 144.:700 � y0b
r ✓ S'
g.
-2-
X
ion•of the Department, the reasons given here are sufficient
Y Superseding Order of Conditions. However, the Department
ght•, should there be further proceedings in this matter, to
;;issues and present further evidence as may bejappropriate:
fir. A FQi~•-:. . •
yn-. many questions or need additional information, please contact
Io -At: (508) 946-2812.
=- Very truly yours,
s _ Elizabeth A. Kouloheras, Chief
-- --- - -'Cape Cod Watershed
cc: Yarmouth•Conservation Commission
y
Amelia Booth
48 Lowell St.
Wilmington, MA 01887
CERTIFIED MAIL# Z 333 585 254
RETURN RECEIPT REQUESTED
Thomas George, Representative
1st Barnstable District
State House, Room 130
Boston, MA 02133-1054
- _
Arlene Wi son... ---- --- - - - - - .. .-- --- •
A.M. Wilson Associates, Inc.
P.O. Box 486 :
Barnstable, MA
Lynne Whiting Hamlyn
70 Hillary's Cartway
Brewster, MA 02631
DEP - SERO - SWM
Attn: D. Ellis
310 CMR 10.99
Form 5 DEP File No. se 83-1405
(ro be pcovikd by DEP)
City/Town Yarmouth
Applicant Amelia Booth
Superseding Order of Conditions
Massachusetts Wetlands Protection Act
G.L. c.131, 540
From Department of Environmental Protectio
To Amelia Booth (Name of Applicant)
Address_48 Lowell Street. Wilmington MA 01887 (applicant)
To same (Name of Property Owner)
Address same (owner)
This Order is issued and delivered as follows:
❑ by hand delivery to applicant.or representative on
(date)
® by certified mail, return receipt requested on December 10, 1997 (date)
This project is located at Parcel S40. Park Avenue
The property is recorded at the Registry of -Deeds, Barnstable County
Book 1080
Page 277
Certificate (if registered)
The Notice of Intent for this project was filed on Ma v 14. 1997 (date)
The public hearing was closed on -June 19. 1997 (date).
Findings
The _Department of Environmental Protection has reviewed
Notice of Intent and plans and has held a public hearing on the project. Based on
the information available to the Department of Environmental Protection at
this time, the Department of Environmental Protection has determined that the
area on which the proposed work is to be done is significant to the following
interests in accordance with the Presumptions of Significance set forth in the
regulations for each Area Subject to Protection Under the Act (check as
appropriate):
Public water supply Flood control ❑ Land containing shellfish
Private water supply Storm damage prevention ��]J Fisheries
Ground water supply Prevention of pollution Protection of wildlife
habitat
Total Filing Fee Submitted_S250.00 State
City/Town Share_S112.50
Total Refund Due $ City/Town Portion $
N total)
the above -referenced
Share _$137.50
H fee in excess of $25)
State Portion $
(H total)
Eff?.-tive 11/20/92 5-1
G
Therefore, the Department of Environmental Protection hereby finds that the
following conditions are necessary, in accordance with the Performance Standards
set forth in the regulations, to protect those interests checked above. The
Department of Environmental Protection orders that all work shall be performed
in accordance with said conditions and with the Notice of Intent referenced
above. To the extent that the following conditions modify or differ from the
plans, specifications or other proposals submitted with the Notice of Intent, the
conditions shall control.
General Conditions
1. Failure to comply with all conditions stated herein, and with all related
statutes and other regulatory measures, shall be deemed cause to revoke or
modify this Order.
2. The Order does not grant any property rights or any exclusive privileges; it
does not authorize any injury to private property or invasion of private
rights.
3. This Order does not relieve the permittee or any other person of the
necessity of complying with all other applicable federal, state or local
statutes,. ordinances, by -laws -or regulations.
4. The work authorized hereunder shall be completed within three years from the
date of this Order unless either of the following apply:
(a) the work is a maintenance dredging project as provided for in the Act;
or
(b) the time for completion has been extended to a specified date more than
three years, but less than five years, from the date of issuance and
both that date and the special circumstances warranting the extended
time period are set forth in this Order.
S. This Order may be extended by the issuing authority for one or more periods
of up to three years each upon application to the issuing authority at least
30 days prior to the expiration date of the Order.
6. Any fill used in connection with this project shall be clean fill,
containing no trash, refuse, rubbish or debris, including but not limited to
lumber, bricks, plaster, wire, lath, paper, cardboard, pipe, tires, ashes,
refrigerators, motor vehicles or parts of any of the foregoing.
7. No work shall be undertaken until all administrative appeal periods from
this Order have elapsed or, if such an appeal has been filed, until all
proceedings before the Department have been completed.
B. No work shall be undertaken until the Final Order has been recorded in
the Registry of Deeds or the Land Court for the district in which the
land is located, within the chain of title of the affected property. In
the case of recorded land, the Final Order shall also be noted in the
Registry's Grantor Index under the name of the owner of the land upon
which the proposed work is to be done. In the case of registered land,
the Final Order shall also be noted on the Land Court Certificate of
Title of the owner of the land upon which the proposed work is to be
done. The recording information shall be submitted to•the Department of
Environmental Protection on the form at the end of this Order prior to
commencement of the work.
9. A sign shall be displayed at the site not less than two square feet or more
than three square feet in size bearing the words, "Massachusetts Department
of Environmental Protection, File Number se83-1405 "
10. Where the Department of Environmental Protection is requested to make a
determination and to issue a Superseding Order, the Conservation Commission
shill be a party to all agency proceedings and hearings before the
Department.
5-2
3
11. Upon completion of the work described herein, the applicant shall forthwith
request in writing that a Certificate of Compliance be issued stating that
the work has been satisfactorily completed.
12. The work shall conform to the following plans and special conditions:
Plans:
Title: "Parcel S40 Park Avenue in the town of (West) Yarmouth prepared for
Amelia Booth"
Dated: April 30, 1997, revised through June 18. 1997
Signed & Stamped by: Arne H. Oiala, R.P.E. , R.L.S.
On File With: DEP
Title:
Dated:
Signed & Stamped by:
On File With:
Title:
Dated:
Signed & Stamped by:
On File With:
Title:
Dated:
Signed & Stamped by:
On File With:
Special Conditions (Use additional paper if necessary)
1. Prior to the commencement of construction, General Condition No. 8, above,
must belcomplied with.
2. All construction must comply with the above -referenced plans and the
conditions of this Order. For any proposed change in the approved plans or
in the work, the applicant shall file a new Notice of Intent or inquire, in
writing, of the Department whether the change is substantial enough to
require a new Notice of Intent. No change in plan, under this filing, is
permissible without prior written approval from the Department allowing this
change.
3. It is the responsibility of the applicant, owner and/or successor(s) to
ensure that all conditions of this Order are complied with. The project
engineer and contractors are to be provided with a copy of this Order and
referenced documents before commencement of construction.
4. Members and agents of the local Conservation Commission and the Department
shall have the right to enter and inspect the property at all reasonable
times to evaluate compliance with the conditions stated in this Superseding
Order, and may require the submittal of any data deemed necessary by this
Department for that submittal.
See the attached sheet for additional conditions numbered 5 through 19.
5-38
V
Issued by t epar ment of Environmen al gr tection
Signature . /I r�A,<
--� ••=•-i=••=�a�, %-cuGt, gape UOa watershed
On this loth day of December , 199 7 before me
personally appeared Elizabeth A. Kouloheras
to me known to be the person described in and who executed the foregoing
instrument and acknowledged that he/she executed the same as his/her free act gnd
deed.
01
y Public V My commission expires
The applicant, the owner, any person aggrieved by the Superseding Order, any
owner of land abutting the land upon which the proposed work is to be done, or
any ten persons pursuant to G.L. c.30A 510A, are hereby notified of their right
to request an adjudicatory hearing pursuant to G.L. c.30A, 510, providing the
request is made by certified mail or hand delivery to the Department, with the
appropriate filing fee and Fee Transmittal Form as provided in 310 CMR 10.03(7),
within ten days from the date of issuance of this Superseding Order, and is
addressed to: Docket Clerk, Office of General Counsel, Department of
- Environmental Protection, One Winter Street, Boston, MA 02108. -A copy of the"
request shall at the same time be sent by certified mail or hand delivery to the
Conservation Commission, -the applicant, and any other party.
A Notice of Claim for an Adjudicatory Hearing shall comply with the Department's
Rules for Adjudicatory Proceedings. 310 CMR 1.01(6), and shall contain the
following information:
(a) the DEP Wetlands File Number, name of the applicant and address of the
project.
(b) the complete name, address and telephone -number of the party filing the
request, and, if represented by counsel, the name and address of the
attorney;
(c) the names and addresses of all other parties, if known;
(d) a clear and concise statement of (1) the facts which are grounds for the
proceedings, (2) the objections to this Superseding Order, including
specifically the manner in which it is alleged to be inconsistent with the
Department's Wetlands Regulations (310 CMR 10.00) and does not contribute to
the protection of the interests identified in the Act, and (3) the relief
sought through the adjudicatory hearing, including specifically the changes
desired in the Superseding Order;
(e) a statement that a copy of the request has been sent to the applicant, the
conservation commission and each other party or representative of such
party, if known.
Failure to submit all necessary information may result in a dismissal by the
Department of the Notice of Claim for an Adjudicatory Hearing.
Detach on dotted line and submit to the Department of Environmental Protection
prior to commencement of work.
To Department of Environmental Protection, Issuing Authority. Please be advised
that the Order of Conditions for the project at Parcel 540, Park Avenue , Pile
Number se 83-1405," has been recorded at the Registry of Deeds, Barnstable County
and has been noted in the chain of title of the affected property in accordance
with General Condition 8 on
19
If recorded land, the instrument number which identifies this transaction is
If registered land, the document number which identifies this transaction is
Signature
Applicant
K/PMK !hh
S-411
S
Special Conditions SE 83-1405
5. Prior to commencement of any activity, a siltation fence and
a row of haybales staked end to end shall be placed at the
bottom of the coastal bank adjacent to the wetlands
boundary. Any accumulated sediment shall be removed prior
to the removal of the erosion control barrier.
6. This siltation barrier shall also serve to delineate the
limit of work area. No equipment,. vehicles or activity are
allowed on the wetlands side of the barrier.
7. All construction activities shall be conducted from the
landward side of the limit of work. No heavy construction
equipment, vehicles or fill are allowed seaward of the limit
- - - -. - __ ..----- -- -Iof work --
8. All areas disturbed during construction shall be immediately
(within twenty-four hours) stabilized against erosion and
revegetated with appropriate fast growing erosion control
species or local indigenous plants within thirty (30) days
of final on -site grading.
9. Any debris, fill or excavated material shall be stockpiled
away from designated wetlands, and at a location to prevent
sediment from entering the -wetlands as surface runoff.
10. All fill material located south of observation holes O.H. #
1 and O.H. # 5 as shown on the plan of record and extending
to the top of the delineated coastal bank shall be removed
to a depth of 8 feet and disposed of at a facility approved
for solid waste disposal per 310 CMR 19.000.
11. The applicant or his successor, shall notify this Department
and the Yarmouth Conservation Commission 48 hours prior to
the commencement of excavation of the old solid waste fill
and placement of the new, clean fill.
12. Care shall be taken to avoid unnecessary impacts to the
coastal bank. Only that alteration necessary to remove the
solid waste fill shall be allowed.
13. The slope of the coastal bank shall be restored to a slope
of no greater than what is shown on the plan of reccrd, but
no less than 10:1. The top of the coastal bank shall be at
the same location as shown on the plan of record or more
landward. It may not extend further seaward or at a greater
slope than is depicted on the plan of record.
14. Any fill used on this site shall be clean fill containing no
trash, refuse, rubbish or debris.
5-5B
15. Upon completion of the removal of the solid waste fill and
placement of clean fill, an "AS -BUILT" plan and a statement
from a Registered Professional Engineer certifying
compliance with special conditions #10 & #13 of this Order
shall be submitted to this Department prior to commencement
of construction of the house or any utilities.
16. Restoration of any alteration of'the coastal bank shall be
accomplished by backfilling with clean material of similar
grain size and consistency as the existing bank and placing
a minimum of three inches of loam over the backfill and
planting with appropriate indigenous plants.
- ;17. A Disposal Works Construction Permit shall be obtained from
_the.; Yarmouth° Board , of -:Health- prior 1 to the start of any
---- - -- -7-1==activity=on-site— _The_ -proposed subsurface sewage .disposal _ .
system shall be constructed in compliance with Title 5 of
the' State Environmental Code. (310 CMR 15.00) .
18. All roof runoff shall be channeled into downspouts and
directed into dry wells.
19. This Order does not relieve the permittee of the necessity
of receiving appproval under the Town of Yarmouth Wetland
By -Law.
5-6B
ti•
NOTICE OF APPEAL RIGHTS/ADMINISTRATIVE ORDER/DETERMINATION
APPEAL RIGHTS AND TIME LIMITS
This Order/Determination is an action of the Department. If
you are aggrieved by this action, you may request an adjudicatory
hearing. A request for a hearing must be made in writing within
and postmarked within ten (10) days of the date this
Order/Determination was issued.
CONTENTS OF HEARING REQUEST
Under 310 CMR 1.01(6)(b), the request must state clearly and
concisely the facts which are the grounds for the request, and the
_relief sought. Additionally, the request must state why the
----o_.Order/Determination-is not_consistent with 'applicable "laws' -and -
regulations.
FILING FEE AND ADDRESS
The hearing request along with a valid check payable to
Commonwealth of Massachusetts in the amount of $100 must be mailed
to:
Commonwealth of Massachusetts
Department of Environmental Protection
P.O. Box 4062
Boston, MA 02211
The request will be dismissed if the filing fee is not paid,
unless the appellant is exempt or granted a waiver as described
below.
EXEMPTIONS
The filing fee is not required if the appellant is a city or
town (or municipal agency), county, or district of the Commonwealth
of Massachusetts, or a municipal housing authority.
The Department may waive the adjudicatory hearing filing fee
for a person who shows that paying the fee will create an undue
financial hardship. A person seeking a waiver must file, together
with the hearing request as provided above, an affidavit setting
forth the facts believed to support the claim of undue financial
hardship.
m
7
t
REQUEST FOR DEPARTMENTAL ACTION FEE TRANSMITTAL FORM
Department of Environmental ProteWon
Division of Wetlands and Watermrays
PERSON/PARTY MAKING REQUEST.
(If appropriate, name the citizen
groups representative)
Nano:
Street:
City/Town—
APPLICANT.
(As shown an Notice of Intent
or Request for Determination)
Name:_
Strr_t
Ciryfrown:
State: Zip Code: State: Zip Code• .
Phone Number.
Project Location: DEP File Number.
Date Local or Superseding Order/Deternrinaion Issued.
Amount of Filing Fee Attached. S
INSTRUMONS.
WHEN THE DEPART.—ITAL ACIION REQUESTED IS: (check one)
_ Request for Superseding Order of Conditions (S50)
_ Request for Superseding Determination of Appliability (S50)
1. Send this form and a check or money order for S50.00, payable to the Commonwealth of Massachusetts, to the
DEP Lock Box ac Dept. of Environmental Protection
Box 4062, Boston, MA 02211
2. Send a copy of this form and a copy of the check or money order with the Request for a Superseding Order of
Conditions or Superseding Determination of Applicability to the appropriate DEP Regional Office:
DEP/Northeast Regional Office DEP/Southast Regional Office
10 Commence Way 20 Riverside Dr., Route 105
Woburn, NIA 01301 Lakeville, MA 02347
DEP/Central Regional Office DEP/Western Regional Office
75 Grove Street 436 Dwight Street
Worcester. NIA 01605 State House West, 4th Floor
Springfield, MA 01103
WHEN THE DEPARTNI E TAL ACTION REQUESTED IS: (check one)
_ Request for Adjudieatory Hearing (3100) _ Request for'Noo-takings' Valance (54,000)
_ Request to Intervene in Adjudiatory Proceeding (S 100) _ Request for'Takings" Variance (S 100)
1. Send this form and check or money order, payable to the Commonwealth of Nfassachusetts, in the indicated
amount to the DEP Lock Box (at the above address) and
2. Send a copy of this form and a copy of the cheek or money order with the Request for Departmental Action to:
Docket Clerk
Otricc of General Counsel
1 to 5vca, Boston. MA 0210E
ELEVATION CERTIFICATE O.M.e. No. W-0077
FEDERAL EMERGENCY MANAGEMENT AGENCY Exigm My 31 1 1999
NATIONAL FLOOD INSURANCE PROGRAM
ATTENTION: Use of We certiticate does not provide a waiver of the flood kuwAnce purchase requirement. This form Is used only to pro.. vlde elevation Informallon necessary to ensure Compliance with applicable community IlobdpleIn msupement orrAnances, b dsMmntns
the proper Insurance premium rate, andfor to support A request for a Letter of - - Amendment or Rev on (LOAAA or LO, to determine
ere not
required b respond b this collection d informtlbn uNses a valid OMB of
number Is displayed in the upper right comer of this form
Instructions for eomplsting this form can be found on the Wowing pages,
SECTiONA PROPERWINFORMA7iON FOIINSIlRANCECOaeWtYWE
eULDNG OwNER9 NAME _� .-- -.-.- -
t,J aiK ii'hw 1✓6V0-t—ePME" -r
AWM8 C hANAW Apt.. UA &A* arhdw glop, trhanbaQ OR P.O. ROUTE AND OM NUNelR
n
r' piHER DESORIPTIDN (lot and dl x NhmDan. aha)
C.
DOt"W NW WASH
CriY STATE rp CODE
SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
Provide the following from the props(FIRM (See Instnao' ns):
1.00Aeh11N1TY NUMslR
Z5oo 5
(
t PANIL NUMM '
Boo5.
&jaTiXJ
D
4.0ATa of FMM NOi7f
-I(z-Iqz
L Feal20f!
�.SZ-
LEASE P1000 t3lWU1I:N
AO ut
on AO Zara. un upry
i. um"w ere wevauon datum system used on the FIRM for Bass Flood Elevations (BFE): P4NQVD W ❑Other (dsscrbs on bads)
L For Zones A or V, where no BFE Is provided on the FIRM, and the community has QWN3had a BFE for this building sit*, Indicoa
the community's BFE: I I I I I I.0 feet NQVO (or other FIRM datum -am Section B. Item 7).
SE=ON C BUILDING ELEVATION INFORMATION
I. Using the Savabori corakate instructions, Indicate the diagram number from to diagrams found on Pages 5 and B that best
describes the subject bulkling'a relemnee level _ 0 .
2(a). Fl RM Zones Al •A30. AE, M, and A (with BFE). The lop of the reference level hoer from the Salected diagram is at an elevation
011 1 1 11 3 . W feet NQVD (or otter FIRM datum -see Section B, Item 4
(b). FIRM Zones V1 V30, VE, end V (with BFE)..The bottom of the lowest horizontal structural member of the reference level from
the selected dlevam, laid an elevation of I I I I I I,U feet NQVD (or otter FIRM datum -see Section 0, Item 4
(c). FIRM Zone k(withqul BFE). The floor used as the reference levef from the selected diagram is LU.0 fast above ❑ or
.. below Cl (didedoe).thehlptest grade adlacerit to the Widing.
W. FIRM Zone AO. The Aoa used as the reference level from the selected diagram is L J.0 feet above ❑ or belovi ❑ (ctecc
one) ttw NOW grade adjacent to the building. II'no Hood depth number Is available, is the buidinVs lowest floor (reference
level) elevated In aocordanoe with the communitys Noodptain management ordinance? ❑ Yea�0 No ❑ Unknorm
3. indlcate the elevation datum system used In determining the above reference level elevations: NQVD 79 ❑ Other (desorlbe
under Comments on Page 2). (NOTE, a the elevation datum used In maasur ft ft elevations is dp ant Men Bast tned'on
the FIRM fees Sacabn A item 4 than convert the elevation* to the datum system used on the RRM and trhow the camisrslan
eguadw urrdwComments 0n Pape 2)
4. Sevation M19191100 mark used appears on FIRM' Yea ❑ No (See Wructlons on Page 4)
S. The reference level elevation is based on: actual Donstructlon ❑ tarhstruction draw4gs
(NOTE flee of oorlslructlorl ctrayv6rQs Is only Wit If the bu kit doss not yet have the remrance lswel ltoorin plats, in wtlict
case tins cer0kate wN only bs vaAd for the brmcrng during rho COMO 01=1structfora A post.Construction Elevalkn CeIvAcate
W1J)1 regtdred V=ConSUuc W Ls complete.
& The elevation of the lowest grade Immediately adjacent to the building Is:! I 1 111012) It NQVD (or other FIRM datum ese
Section B. Item 7).
SECTION D COMMUNITY INFORMATION
1, If the community official responsible for verifying building elevations specifies that the reference 19M khdicated in Seclbn C, ham 1
Is not the "lowest floor as delloed in the community's floodplatn management ordnance, the elevation of to building's lowest
floor' as dartned by tie ordinance Is: I I I I I I.0 toot NGVD (or other RRM datum-soe Section B, Item 4
2 Data of the start of construction or substantial Improvement - t `( Gi 1�
FEMA Forth at-31. MAR 97 RERACFS Ill MEMOUS EDip is SFF RFWPSF yr%rry rnr n*4h.m t
' -SECTION E CERTIFICATION
Tt,ls convicatlon Is to be signed by a land surveyor, engineer, or VCh,Ted-who Is aulhodzed by state of local taw 10 c"lY atava110n
Information when the ete,raion Information for Zones Al-A30. AE. AH, A (with BFE�,V1-V O.M and V (with SFE) Is rewirsa .
Community oftidais who are autiwrized by local law of ordinance to provide tloodplam management Infamatbn, may also sign ON
cer kation. In the case of Zanas AO and A (without a FEMA or scrrmurily Issued SFE), g bu &V otidal, a property owner. or en
owner's representative may also dgn the cKdicatbn.
Refererwe Ievel diagrams 6, 7 and a • DkdngLbb ng Fsaturea-N the certifier Is unable to certify to breakaway/non-breakaway wall,
endows size, location of servbkp equipment, area use, wall oiler N% or unfinished areafesare(s), then Itu tlu Fssars(s) not
Inducted In the cortiiaadon under Comments below. The diagram n rnber, Sedlon C, Item 1, must stillbs amend.
tasrtlly that line krlormallon h Senlons 8 and C on this cerNRcate re�resarma irty best atfarts do htsrFret the dsbr � ,ARMa
1 understand Crat any false smramera rrray be pcur,tahabla by Rrra Ori nprisoM7ent under f8 US Code, Secborr f001. a K
s o,IluA
C
1MW
1-1
AoartessM TZ
';a klAn . l Gam- c�srA
Gf'.s_Q t_4 o.1-rnL- M • MA 0 26 �j•
Copies Wmild be reads of We CarlItIcate for.1) commtm y at. ICIµ 2) Insurance sgsnvcuVany, sad 3) bulldkrg owner.
COMMENTS:
ON Im ore rAo,
sus sAM'W !wAgokwe
A Y A A v
zo m muss =Nu rorw mnu
■resew
RON
ua
PAW AMC" LM lid
R"I*g wrewcs ADAA '90f9C•
M '
The diagrams above ilustrate the polnis al wNch Me elevations should be measured In A Zones and V Zones.
Elevation for all A Zones statrld be measured at the top Oft* rolerertca level Iloor.
Bevadons for ad V Zones should be measured at tins bottom of the lowest horizontal strudual rtwmber.
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type) (�_
- \/Od ►O(J��'' , Mass. Date 7 19-5.—
- City, Town Permit f
Building Owner's
AT: Location �r k v nc Name nonh i l l Dudoo y Cro vo
Type of Occupancy: �/►
New ❑ Renovation [� Replacement ❑
Plans Submitted Yes ❑ No ❑
AL
19
.......p.................
(Print or Type)
Check One: Certificate
Installing Company Name£. F- %Ng ttxmo,NW+{ 49 p 0.-2-946113
Corp.
Address S jPE A-2Do/J CIRC(-E ❑Partnership
So . ,/"- M 0 u-r* M f}- 02-6 6 Lf ❑ Firm/Company
Business Telephonc(50039 4.777 8 Name of Licensed Plumber or Gasfitter
E. F . W INSLO W AIL
I I haebY outify that all of the detalls and Infomugon I have aubmttted (or entered) let above appllalion are true and aavnte to the t or m1
knowkd&e and tlut all ptumblas work and Inrtdatioaa performed undo ramlt !:rued for this application will be In oompllance with cut
provirlont or the MaanchuaetU State Cat Oode and Chapter 142 or the Gewd laws.
.
ByW / TYPE LICENSE:
Plumber
Title Gasfitter Signature of'Licensed
City/Town: Master Plumber or Gasfitter
Journeyman —
APPROVED (OFFICE USE ONLY) N L cense 'N er
FINAL INSPECTION
SKETCHES
BELOW FOR OFFICE USE ONLY
FEE
N O. %5
APPLICATION FOR PERMIT TO DO GASFITTIHG
NAME d TYPE OF BUILDINCINn it U -100 =YT4 /CrovO
/nT)it)Al ina„
•LOCATION OF BUILDING Nh PArk /S-yolot
Va(m 6A
PLUMBER OR GASFITTER
`-- . F. WIP SLO L,-) T + -14
LIC.NO. MA-si-E2 bc. -# 7939
PERMIT GRANTED
DATE AD6 31 19s9S
1 /If
GASINSPECTOR
PROGRESS INSPECTION
'a`^'A"`fasrr.Y4.r+�•`n,���wi�`.�Cr'1. Y�-r• �•.l'e. �: "��t....J'a«iJtil i'J�r, i..:ff, It i. -•r. -
o�a Town of Yarmouth
GAS PERMIT
Office of the Gas
This is to Certify that .
has permission to
No.
8-,3
MUM
for
in building on J
in accordance with an application on file in thins office, and subject to the provisions of the
Ordinances_relatm* ,tto the Gas Code in the Town of Yarmouth.
Feey%"
Gas Inspector
APPLICATION FOR PERMIT TO DO PLUMBING
*(9 �
MASSACHUSETTS UNIFORM
(Print or Type)
yarmoA
Mass. Date 19_ Permit #�
Building Location ;Potrk Late Owner's Name t)w);(l �4n�pn�on4-��f6Vo
gn(MnA Type of Occupancy ji�1 q
New ❑ Renovation 9fReplacement ❑ Plans Submitted: Yes ❑ No ❑
FIXTURES
r
i
I�An�r��n�■n�■u���ii���m��ui
Installing Company Name E. F• W%r jSi_bri-pwMr31j-a -V- 14c-rrn V&- Check one: Certificate
Address S ', G r-2Do N Cr 2G l.E O'Corporation 04 — Z 846 f' 93
So. YR4-(ZM o v -t-1+ M A- 0 2 6 6 4 ❑ Partnership
Business Telephone Np8) 3R4 — 77 7 8 ❑ hrm/Co.
Name of Ucensed Plumber E • 17. VJ 1 M S Lc W =
INSURANCE COVERAGE:
1 have a current liability Insurance policy or Us substantial equivalent which meets the requirements of MGL Ch. 142.
Yes W No ❑
If you have checked yes. please indicate the type coverage by checking the appropriate box.
A liability Insurance policy ❑ Other type of Indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter 142 of the Mass. General Laws. and that my signature on this permit application waives this requirement.
Check one:
Owner ❑ Agent ❑
1 hereby cer* that all of the details and Information 1 have submitted (or entered) in above application are true and accurate to th best of my
knowledge and that all plumbing work and Installations performed under the permit issued for this appl II complianceth all
pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General taws.
Type of Ucense: Master 3g Journeyman ❑
Ucense Number 7l 3Q
FINAL INSPECTIONS
BELOW FOR OFFICE USE ONLY
SKETCHES ; A[>7
FEE
NO.� i D
APPLICATION FOR PERMIT TO DO PLUMBING
I e r-.K
NAME & TYPE OF BUILDING UVLIOQI► ,I
nu��.11� ng
LOCATION OF BUILDING 18 ?a(k
yafMc)vyk
PLUMBER E, F. W1NsLO%o 'P+44
Wt tt-s"TC- fL L t c. * 7 9 3 9
PERMIT GRANTED
DATE AUG 31 Iva
n
PLUMBING INSPECTOR
lcrocro
PROGRESS INSPECTIONS
- �YFA4
Town of Yarmouth No..
PLUMBING PERMIT
'Office of the Plumbing InspecipT, South Yarmouth
This is to Certify that
has permission to
19
450
for
in building on 693 �&&
in accordance with an application on file in this office, and subject to the provisions of the
Ordinances relating to the State Plumbing Code in the Town of Yarmouth.
Fee$ //0 /7
Plumbing Inspector
DATE:
DATE RECALL:
ISSUED TO:
ADDRESS:
REASON FOR CALL BACK:
BUILDING PERMIT:
OCCUPANCY PERMIT:
PLUMBING PERMIT:
GAS PERMIT:
ELECTICAL PERMIT:
FIRE DEPARTMENT:
OTHER:.
CALL BACKS INSPECTION FEES
IST CALL BACK $20.:00
2ND CALL BACK $30.00
3RD CALL BACK $40.00
JAN 141999
$40.00
DATE: /
DATE RECALL:
LOT # '
ISSUED TO:
ADDRESS:
REASON FOR. CALL BACK:
BUILDING PERMIT: ��0
OCCUPANCY PERMIT:
PLUMBING PERMIT:
GAS PERMIT:
ELECTICAL PERMIT:
FIRE DEPARTMENT:
OTHER:.
CALL BACKS INSPECTION FEES
1ST CALL BACK $20:.00
2ND CAI.I. BACK $30.00 L/
3RD CALL BACK $40.00
ALL OTHER CALL BACKS,$40.00
D. u
JAN 191999
n
anrzo1s
SlipGen- Portal Hone
Document Category
Map -Block Number
Street Number
Street Name
Department
Parcel ID
Backfile Batch Scan
Document?
Additional Naming Info
Index Operator
Date - Time
Town of Yarmouth
Template [Building Dept]
r�.
Slipsheet Identifier [sg24090]
Building Permits
020.22
0063
PARK AVE
Building
1348
No
Operator, Yarmscan
2015-04-17 - 15:55
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