HomeMy WebLinkAboutBuilding PermitsNew ❑ Renovation ❑
Plans Submitted Yes ❑ No O"at
36,
ILICATION FOR PERMIT TO DO PLUMBING
(OFFICE USE ONLY)
Date _ ////0'
Owner's1
Name /
Type of Occupancykes,�'
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Replacement ❑
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SUB- SMT.
BASEMENT
1ST FLOOR
2ND FLOOR
3RD FLOOR
(PRINT OR TYPE)
Installing Company
Address
Check One:
�O Partnership
'—@—Fi /Company
Business Telephone 4522 r— —E33 �� Name of Licensed Plumber NA4
�/
INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent. Chec ne: Yes U No ❑
If you have checked YES, please indicate the type of coverage by checking the appropriate box.
A liability insurance policy 2000� 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 on Owner
❑ Agent ❑
Signature of Owner or Owner's Agent
1 hereby certify that all of the details and information I have submitted
nature is nsed
(or entered) in above application are true and accurate to the best of
Plum er
my knowledge and that all plumbing work and installations performed
under Permit issued for this application will be in compliance with all /D
42 6
pertinent provisions of the Massachusetts State Plumbing Code and
License Number
Chapter 142 of the General Laws.
Type: Master 2-� Journeyman D
AT jig APPLICATION FOR PERMIT TO INSTALL AND REQUEST �bi
FOR ELECTRICAL SERVICE
Inspector of Wires Wiring Permit # :0/-MOMlElectric # ' 7�
ITown of Massachusetts Building Permit ry O/� Date
n IJ
Customer: ' on (Street #) / D
Lot #� in the w age of V7 r� jMti utility pole number or underground number
Customer's billing address
2001
Temporary New installati n Change f service Starting Dat
Job descriplion
�rt RllL�_�
Service entrance voltage Amperage Phase
Wire size (cu. oral.) , Conductor per phase
Number of meters Water heater Off peak: Yes — No —
Estimated load: Electric heat kw, lights lQ kw. Range dryer Motors, H.P. & Phase
Ready for first inspection / Ready for final inspection
Electrical Con cto 77 1 TJ V^ �g � �� Telephone #
Address
Additional Remarks:
Do Not Write Below This Line
ELECTRICAL WIRING INSPECTION CERTIFICATE
INSPECTOR OF WIRES
INSPECTIONS
Temporary Service
Roughing in t
Service and Meter __ L
Off Peak Meter
Final Approval
Disapproved'
'For the following reasons
CERTIFICATE OF INSPECTION
DATE
FEE CHARGE
To the COMMONWEALTH ELECTRIC COMPANY. The installation described above has 4"`u C="4Td and h(sihis day beenSnspActed and
approval granted for connection to your service. 1) 1) L t yl,,",
WIRING INSPECTOR TO BE NOTIFIED WHEN WORK IS READY FOR INSPECTION
Permit Good For One Year From Date Of Issue CA 46-1
White — COM/Electric Green — Inspector Canary — Town Receipt Pink — Inspector's Copy Goldenrod — Electrical Contractor
to COLA Electric
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, (NIEC), 527 CNIR 12.00
(OFFICE USE ONLY)
TOWN OF YARMOUTH By
rut IIS Perm Bo-ol-S70 Fee: $ o
"I Ka9 PERMIT NO. 6 'o/'St33
(PLEASE PRINT IN INK OR TYPE ALL INFORAIATION) Date: — t
To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perfornr& electrical
work described below. Location (Street & Number)- 0.4d SAIX "w e
Owner or Te
Telephone N
Owner's Address
Is this permit in conjunction 2",
a uildin jper it? Yens ❑No (Check Appropriate Box) PvlC 790�,J
Purpose of Building 7/PAY/._ VOs X14X Utility Authorization No.
Existing Service /00 Amps ��0 /a�0 Volts Overhead( Undgrd ❑ Ulfe
New Service Amps / Volts
Number of Feeders and Ampacity .3
—Location and Nature of Proposed electrical Work:
Overhead❑
1610
Undgrd c3
Cominh,tinn of the 641mvinv table rnav be waived by thr Inrnerrar ofW rr.v
RecessedNo. of Fixtures
o is . • ddl at s
No, of Tota
Transformers KVA
No. of Lightintz Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures 7
Above n-
Swimming Pool "rnd. ❑ rnd. ❑
No. of Entcrgency Lighting
Battery ltnits
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
T No. of Zones %
No. of Switches
No, of Gas Burners
o. ot Detection an
Initiating Devices
No. of Ranges -�Rs /Oftk ELect
Total
No. of Air Cond. Tons
No. of Alerting Devices
No. of Waste Disposers
eat 'ump
Totals:
um cr
— —
ons
— —
— —
No. of Self -Contained
Detection/Aleriing Devices
No. of Dishwashers
Space/Area Heating KW
Municipal
Local Connection ❑ Other
No. of Dryers
y
Heatin g Appliances KW
t, pp
Security Systems:
Na. of Devices or E ui valent
No. of Water
Beaters KW
No. of No. of
Signs Ballasts
Data wiring:
No. of 6Lviccs or Equivalent
FNo. H dromassa a Bathtubs
y g
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
Attach additional detail tJ rlestrett, or its required vy the Inspector of Wires.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued unless the licensee provides
proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in
force, and has exhibited proof of same t he permit issuing office.
:?CIIECKONE: INSURANCE [ BONDO OTHER (Specify: I
apiratiun Ualc)
Estimated Value of Electrical Work: �S000'00 (When required by municipal po t y.)
-----NVork to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion.
-± 1 certify, under the pains : ncLp'nalties of perjury, that the information on this a plication is true and complete.
,(?FIRM NAME 1' — LIC. NO. F/r�yDC�
(21 Licensee: Signatur&WO-
lC. NO.
(If applicable enter "exempt" in the license nu er line.) B el. No.:S& Q
Address- 77 e5 f A . Tcl. No.:
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature
below, I hereby waive this requirement. I am the (check one) owner i) owner's agent.
Owner/Agent
Signature Telephone No.
[Rev. 64Ax)l
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Howard W. Woollard
Untitled
2-22-01
Chairperson
Yarmouth Old Kings
1146 Route 28
Highway Committee
South Yarmouth, Ma.02664
In reference to a plan approved by you on 2-14-01 for the
Careys at 11 Old Salt Ln, we would like to make a request
for a minor change on the rear elevation. We would like to
go from a French Door on the rear left to a door and single
sidelight as shown on the ammended drawings. The change
reflects -a -better -use -of -interior wall space. On behalf of
The Carey's , I thank you for your considerstion in th'is—
matter.
Respectfully,
Howard W.Woollard
P.O. Box 263
Barnstable, MA 02630
Page 1
TOWN OF 1'4LRYOUTH
FEB 2 6 2001
OLD VIG'S ;•il;"H4VAY
APPROVED
YARh10UTH COMMITTEE
DY,HRD
APPROVED
YARh40 'Ti1 i;Ordh11TTEE
Cr;HRD
9p
(608)362-4644
tsso To:I ici>.cc
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RUM CALL UM.
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CALL SACY.S IiiSPF.CY'I08 YES
• 1ST CALL UCC $20..00 ✓/
2ND CALL. BALL $30.00
31D CALL S:Ct $u,00
ALL' BA= , $40.00_
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�/83 •0-0 3/ SIo /
BUILDING
PERMIT
DATE March 5..2001 PERMIT S - • A�.O1-570 - _L
APPLICANT—WO011ard, Howard ADDRESS P-O-BOX 26')rnII ab1 p 61OA 015894' `
(NO.) (STREET) (CONTR'S LICENSE)
t
PERMITTO nitPrntigT11a (_) STORY
(TYPE OF IMPROVEMENT) NO.
(PROPOSED USE)
NUMBER OF
DWELLING UNITS
AT(LOCATION)11 01d Sa11' 1.a1110 - ZONING
DISTRICT iz 40
ANO.) (STREET)
BETWEEN AND
(CROSS STREET) (CROSS STREETI
SUBDIVISION 140.15 LOTUS E79LOCIgnap 118$i SIZE - 60
I
BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE 5 11 USE GROUP R 4 BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS:
gam_
to entry, bath and laundry roam.
AREA OR ' _ PERMIT
kO,OOO.00
VOLUME ESTIMATED COST FEE 193.00
(CUBIC/SQUARE FEET) /
OWNER TOLL Carey
ADDRESS 11 Old Salt Lane Y.P. 02675 BUILDING DEPT. ('7�7✓ `T..�X
/' " INSPECTION RECORD
DATE
NOTE PROGRESS CORRECTIONS AND REMARKS
INSPECTOR
y_ q-o r
FYI e d "
�•_
_�.Q
i ��
.t
ONE & TWO FAMILY ONLY - BUILDING PERMIT
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ON!E ORt/0 FAMILY DWELLING
Town of Yarmouth Building Department
1.)46 Route 28 • Yarmouth, NIA 02664-4492
Tel: (508) 398-2231 x261 • Fax: (508) 398-2365
Office Use Only
Planning Board Information
Assessors Department Information:
Permit No.,6-L0-1---S-Z01bateAZSL6
Plan Type
Map
Lot Ma Lot
Permit Fee $193,
Endorsement Date
l / g
rti
O/d New
_ ,
Deposit Rec'd. $%QffDate.7& D
Recording Date
1.4 Property Dimensions:
PlanNa
-Lt. 136.
Net Due $/p3, !vim
Other
Lotkoa(sq
0 Frontage (it) Lot Coverage
This Section for Office Use Only
Building Permit Number:
I Date Issued:
Signature: Z�
e I
Certificate of Occupancy
Buildi O I Data
Is
Is not required
Section 1 - Site Information
Use Group: R-4 Type: 5-B
1.1 Property Address:
1.2 Zoning Information:
Yo
Zoning
District Proposed Use
1.3 Building Setbacks (ft)
Front Yard
____--Side Yards----
Rear Yard
—Required
Provided
Required
Provided
Required
Provided
0q6. 40�
w/
1.4 Water Supply (M.O.L- c. 40. S 54)
1.5 Flood Zone Information:
Comments:
Public Private
Zone: BFE:
Section 2 - Property Ownership/Authorized Agent
2.1 Owner of Record:
T4222 G/9/Lc/
2 7001
Name (print)
Mailing Address U# $// J
Signature
Telephone
2.2 Authorized Agent:
&ostc0 G.� • LJyv L!/•
/�vY�
�� 3
nt
;Naignature
Mailing Address
U
Telephone
R 0 5 20
Section 3 - Construction Services
3.1 Llcensed Construction S ervisor:
�ci���
of A li ble 3 /Vo /
��%S
Lll , /0V'§PL v Z 6 3 v
License Number
&> / 5 J 3 c�
/
Addre s /
�� 3 6 L — Y6 S� S�
Expiration Date
Signature Telephone
/9 — 3A — 0 /
3.2 Registered Home Im rovement Contractor:
Coy Name � "�
l.J. L✓LCJLL/t'�'�
Not Applicable El
/4s!q
Llcgn� i`i , � S
Add[ass
vr/ 3 b Z'
YG
Expiration Date
Signature Telephone
— Z 5/— D
9- 15-99
tof2
OVER
Section 4 - Workers' Compensation Insurance Affidavit (M.G.L. c. 152 S 25C (6)
Workers Compensrfibn Insurance affidavit must be completed and submitted with this application. Failure
to provide this affidavit will result in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes .......... No ..........
Section 5 - Description of Proposed Work (check all applicable)
New Construction ❑ I No. of Bedrooms No. of Bathrooms
Existing Bldg. ❑ Repair(s) ❑ IAlterations El I Addition ($
Accessory Bldg. ❑ Type Demolition Other Specify:
Brief Description of Proposed Work:
f 101 i/c -Y '-I /"e"-I ,,� YJ
Section 6 - Estimated Construction Costs
Item
Estimated Cost (Dollars) to be
completed by permit applicant
1. Building
2. Electrical
3. Plumbing / Gas
4. Mechanical (HVAC)
5. Fire Protection
6.Total=(1 +2+3+4+5)
7. Total Square Ft. (new houses 6 additions)
Check Below
❑ Conservation -Commission Filing
(if applicable)
❑ Old Kings Highway & Historical
Commission approval
(if applicable)
Section 7a - Owner Authorization - To be Completed When .
Owner's Agent or Contractor Applies for Building Permit t{bi D trD
I, l _ ;, ill `/ , as owner of the subject property,
hereby authorize to act on
my behalf, in a)I matters relatiy6 to Wk authorized by this building permit application.
Section 7b -
Declaration
, as Owner/Authorized Agent
hereby declare that the statements and information on the foregoing application are true and accurate,
to the best of my knowledge and belief.
Signed under the pains and penalties of perjury.
Print name
Signature of Owner/Agent
9-15-99
2of2
Date
Or�eYA`'yy TOWN OF YARMOUTH
0
r==Fd BUILDING DEPARTMENT
BUILDING PERMIT APPLICATION SIGN OFF
Applicant:•y��3 (feglN Building Permit No.:
Address: // a ig I�Ie j Giy el. No.: 7 7/ ^ 3 w — Date Filed:
Bldg. Site Location://Ocy &V Map No.: /yo Lot No.:
The following information outlines the procedural steps required to obtain a permit to build, alter, or add
to a structure within the Town of Yarmouth. The Building Department will determine compliance to the
following: (A) Zoning Requirements (B) Historical Districts (C) Flood Zones. The Building Department
will be responsible for assisting the applicant through the following departments:
RESIDENTIAL AND/OR COMMERCIAL BUILDING
WATER DEPARTMENT: Determines Compliance of Water Availability. (applicant to obtain)
ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage.
CONSERVATION CONBUSSION: Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type
of Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc.
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements
for Septage Disposal and other Public Health Activities.
FIRE DEPARTMENT: Determines Compliance to State -and -Town Requirements for Personal
Safety, -Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc.
The following Departments must sign off, in the respective order, prior to building inspector issuing the required
building permit:
REVIEWED BY:
1. WATER DEPARTMENT:
��--�
DATE:
N/A:
2. ENGINEERING DEPAPpiENT:
DATE:
N/A —
3. CONSERVATION-
DATE: 24 -O
N/A:
4. HEALTH DEPARTh
DATE: 6
N/A: —
INDUSTRIAL AND/OR
CObihiERCIAL 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.
CONMIENTS:
("�t�-C� — wl�•�r � N� Cc.�'G CJ�Gk�'t•1 � (r� Vrnc.� �OGk.`
ccC, eLJOLAt G`•\ 1,6
1�iL/�G ENCrzl4 [nO1Y/Pl /s}NrF Fi0/LS' 4K6 �0212GGT/eK[�)
✓,Z F /��.rvG Lgiru• a-V Oef k /J zx Atuo 2Se_ S'•Qr�r ��A���
13 /La V I oAiL 6nr eaa J�.r-ra Aa a, iritNG frm &_4on
j& .'71 gc;'Pots ioTo4_.1r'r75_& !"/gEPovx-b, ev L Alai-
6 K i7ir/V, /D1r25 rc /� 41//'rQvroos /!%0ri f�i/vEn-7 Es �D i s
F/of S'Ifa WN APDRaDzn.rSlc-itrE.vi)"ut.DYM`f'Dk)&07uC9fc
8/99 Applicant Signature
Date Z - Z/ D
0oF' qk
3r Y�� TOWN OF YARMOUTH
���u.S,�y BUILDING DEPARTMENT
CONSTRUCTION SUPERVISOR FORM
PLEASE PRINT:
job Location: Z� C5L d fA4L�1/
Number Street Village
Owner of Property: -TO,oz,y ->
Construction Supervisor:n�'''�y/ �l��i��� / 5 �' 3 y �� 2 - YG YY
Name License No. Phone No.
Address: i3�Y Z G 10549"y/rlll,4 o Z. 4!r�zU
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 �a No ❑
If you have checked M, please indicate the type coverage by checking the appropriate box.
A liability insurance policy �@ Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter 152 of the Mass General Laws, nd that my signature on this permit application waives this requirement.
V /%i_ E I %V Check one:
of Owner or Owner's Agent
—` Owner ❑ Agent Q
Building Official Approval:
For Office Use Only
Permit No.
Date TOWN OF YARMOUTH
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
MGL c. 142A requires that the 'reconstruction, alteration, renovation, repair, modernization, conversion,
improvement, removal, demolition or construction of an addition to any pre-existing owner -occupied
building containing at least one but not more than four dwelling units or structures which are adjacent to
such residence or building' be done by registered contractors, with certain exceptions, along with other
requirements.
Type of Work: 11a.-; wee- -r H l) i'l Est. Cost
Address of Work // OCD Xln r
Owner Name:
Date of Permit Application: Z — ZZ - O /
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
Job under $1,000
Building not owner occupied
Owner pulling own permit
Other (specify)
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH
UNREGISTERED CONTRACTORS FOR APPLICABLE HOME
IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION
PROGRAM OR GUARANTY FUND UNDER MGL c. 142A.
Signed under penalties of perjury:
I hereby apply for a permit as the agent of the owner:
Date Contractor Name Registration No.
OR:
Notwithstanding the above notice, I hereby apply for a permit as the owner of the above
property:
Date
Owner Name
The Commonwealth of Massachusetts
Department of Industrial accidents
afllceaflaresffli fits
600 Washington Street
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
Applicant information: Please PRfl9TTe Wft
name
locations l� !%G/> hG � Ly
sit% i/f%/�/%10J7�.GT _ phone a
rl I am a homeowner performing all work myself.
ram• I am a sole proprietor _nd have no one working in am capacity
C3 I am an employer pro% iding workers' compensation for my employees working on this job.
company names
address:
city: phone H:
insuraIce co. policy a
I am a sole proprietor. general contractor�or homeowner(circleone) and have hired the contractors listed below %%ho have
the follo%%in_ %%orkers' compensation polices:
city: phone H•
Failure to secure coverage as required under Scctioa 25A of MGL 152 eaa lead to the imposition of criminal penalties of aline op to SI.500.00 aadlor
one years' Imprisonment as well as civil penalties In the form of a STOP WORK ORDER and a Doe of S100.00 a day against me. 1 understand that a
copy of this statement may be forwarded to the Once of Investigations of the DIA for coverage verification.
1 do hereby certify under the pains and penalties o/perjury that the information provided above is true and correct
�—Z/—O /
Print name e" -20L Phone 0
Official use only do not write in this area to be completed by city or town omcial .
city or town: YARMOi1T$ _
E3 check if immediate response is required
contact person:
permitAicense M nBuilding Department
puccosing Bond
.261 ❑Selectmen's OIDcr
phone a;_ (508) 398-2231 eat. pflealth Departmentnother
U=.ned 3.95 r1A)
r
0
TOWN OF YARMOUTH
PLEASE PRINT:
DATE:
JOB LOCATION:
R 8 UV_ ji- t
BUILDING DEPARTMENT
1146 Route 28, South Yarmouth, NIA 02664 508-398-2231 ext. 260
NAME
NAME
PRESENT MAILING ADDRESS
HOMEOWNER LICENSE EXEMPTION
STREET ADDRESS SECTION OF TOWN
CITY OR TOWN
The current exemption for `Homeowner' was exte
and to allow such homeowners to engage an indivi
homeowner shall act as supervisor. (State Building
PHONE WORKPHONE
STATE
to include owner _
for hire who does n
de Section 108.3.5.
Definition of Homeowner:
Persons) who owns a parcel of land on which he / she i
to be; a one or two family attached or detached structure T
who constructs more than one home in a two-year period
shall submit to the building official, on a form acceptable to
all such work performed under the building permit. (Sectie
The undersigned `homeowner' assumes responsibility
applicable codes, by-laws, rules and regulations.
ZIP CODE
lwellines of one or two units
a license, provided that such
or integfls to reside, on which there is or is intended
sory(such use and / or farm structures. A person
F�Mincg'oo
nsidered a homeowner; such "homeowner"
fficial, that he / she shall be responsible for
.1)
with theState Building Code and other
The undersigned 'homeowner' certifies that he / s understanthe Town of Yarmouth Building Department
minimum inspection procedures and requiremend and that he she will comply with said procedures and
requirements.
HOMEOWNER'S SIGNATURE
APPROVAL OF BUILDING
INSURANCE COVERAGE:
I have a current liability insurance licy or its substantial equivalent, which m s the requirements of MGL Ch 142.
Yes ❑ No ❑
If you have checked ygs, plc indicate the type coverage by checking the appr riate box.
A liability insurance policy Other type of indemnity ❑ Bo d ❑
OWNER'S INSURANC WAIVER I am aware that the licensee does not have the insurance coverage required
by Chapter 142 of the ass. General Laws and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner ❑ Agent ❑
hfiomeownrBcc=p
TOWN OF YARMOUTH
1146ROUTE28 SOUTH YARMOUTH NIASSACHUSETTS026644451
Telephone (508) 398-2231, Ext. 261 — Fax (508) 398-2365
BUILDING DEPARTMENT
DEMOLITION DEBRIS DISPOSAL AFFIDAVIT
BUILDING
ELECTRICAL
GAS
PLUMBING
SIGNS
Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5,
I hereby certify that the debris resulting from the proposed work/demolition to be
conducted at OLD SALT G/y
Work Address
is to be disposed of at the following location: �fi/1.i12oyTlf Ol���'�f i��Lc�yr
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
Signature of Applicant
Permit No.
Date
PLOT PLAN
Abutbor I s
Name
Lot #
FOR LOT # / y0
Indicate location of garage or accessory building
Additions with dashed lines --------------------
Sewerage disposal (cesspool)
Well
I I
I(lot................ft. rear)
REAR YARD
If this is a
corner lot,
write in name
of street.
SIDE YARD
— — FT_
SIDE YARD
�]--3v--FT�
4
SET BACK
(lot..................ft. frontage)
/q� AN
(NAME OF STREET)
Information
Supplied by
Abuttor's
Name
Lot #
If this is
corner for
write in
name of
other
street.
ro
MARK NORTH POINT
BOISE CASCADE - BC CALCTM 2000b DESIGN REPORT - US Friday, February 23, 2001 13:48
Quadruple -1 3/4" x 14" V-L SP 2900
Job Name -
CAREY
Customer
Address -
11 OLD SALT LANE
Spedflat
Designer
City, Slate, Tip -
YARMOUTH PORT, MA
ComPerry'.
Code Reports -
ICBO 5512, BOCA 98-52, SBCCI 9852
Misc:
Member Diagram
File
Name: H WOOLARD CAREY2.BCC
- HOWARD WOOLLARD
- Joe Madera
- SHEPLEY WOOD PRODUCTS
NEW BEAM AT BUMP OUT
5780 Ibs LL 5790 Ibs U.
28?7 Ibs DL 2827 Ibs DL
General Data
Version: US Imperial
Member Type:
- Floor Beam
Number of Spans
- 1
Left Cantilever
- No
Right Cantilever
- No
Slope 0112
Tributary 03-06-00
Repetitive We
Construction Type n/a
Live Load
40 PSF
Dead Load
10 PSF
Part load
0 PSF
Duration
100
Disclosure
The completeness and accuracy of
the input must be verified by anyone
who would rely on the, output as
evidence of suitability for a particular
application. The output above is
based upon building code -accepted
design properties and analysis
methods. Installation of Boise
Cascade engineered wood products
must be in accordance with the
current Instaltatiori Guide and the
applicable building codes. To
obtain an Installation Guide or If you
have any questions, please call
(800)232-0788 before beginning
product installation.
Total Horizontal Length-17-00-00
Load Summary
ID Description Load Type Ref. Start End Live Dead Trib. Dur.
S Standard Unf.Area Load Left 00-00-00 17-00-W 40 PSF 10 PSF 03-06-00 100
1 ROOF UnfArea Load Left 00-00-00 17-" 30 PSF 15 PSF 1 "0-00 115
Controls Summary
Control Type
Value
%Allowable
Duration
Loadcase
Moment
36579 &lbs
58.6%
@ 115%
3
End Shear
7425 Ibs
34.1%
@ 115%
3
Total Deflection L1343 (0.594')
69.9%
3
Lire Deflection
U511 (0.3991
70.4%
3
Span/Depth 14.6
NOTES:
Design meets Code minimum (LI240) Total load deflection criteria.
Design meets Code minimum (U360) Live load deflection criteria.
Minimum End bearing length is 1-10.
Page 1 of 1 SCIC and Versa-Lart-0 are registered trademarks of Boise Cascade Corp.
Span Location
1- Internal
1 -Right
1
1
1
TOP FNDN. = 21.6'
UJ-,.L ilk_' ?nVLl 11,h
ACCESS COVER TO WITHIN 6' OF FIN. GRADE (NOT TO SCALE)
ACCESS COVER (WATERTIGHT) TO
WNIMUM .75' OF COVER OVER PRECAST WITHIN V OF FIN. GRADE
EL. 19.53' A`�i,�
RUN PIPE LEVEL
EXISTING 1000 �� I /—FOR FIRST 2'
GALLON SEPTIC
TANK (H- 10 ) o
GAS v TEE
BAFFLE a
(ADD IF r ��� 1 .76' .
2% SLOPE REQUIRED OVER SYSTEM
/ 2' DOUBLE WAShED PEASTONE
NEC.) 0 19.73'
6' CRUSHED STONE OR MECHANICAL
4' COMPACTION. 15.221 [2]) �Q- R 0 5R
DEPT F
H 0 FLOW =
TEE SIZES:
INLET DEPTH = 10"
OUTLET DEPTH = 14"
FOUNDATION EXIST SEPTIC TANK 7' PUMP
CHAMBER
19.44 BENCHMARK - TOP OF CONCRETE BOUND
ELEV. — TO(ASSMF)
6.43.
�9.68
^OI'v
0'
LOT 29 \/
12939+/- SQ. FT. 20
0.3+/- ACRES W
OFck
20.34
� 'OC
>J
0
PROP VENT
I\
/ 8.'Tl1UP
TREE
(SAVE)
/JL
OA,�O
N
of
/yZ4,Vp'7.63
.,�16.54 I \
17
3/4" TO 1 1/2" DOUBLE WASH
70' D' BOX 5'
ALARM AND CONTROL PANEL TO BE INSTALLED INSIOC
BUILDING. ALARM TO BE ON INV. IN 18.05
SEPARATE CIRCUIT FROM PUMP
FLOAT SVATCH ALARM
SETTINGS: PUMP
4' WORKING RAI
1000 CAL H-10 5
COO GAL.♦
RESERVE
1 8' .
11 4'
Q j`'
L 6' CRUbI+ED STONE OR
40 COMPACTION !--
791 \ I PUMPNOTCHAM
TO SCALE)
�0.53 REMOVAL OF U.J:;
\ 4ROU�D PERILIF.T[I2
LAMER. REPLACE Wll
ENGINEER TO INSP"
28"OAK \�
+ 20.75
(REMOVE)
/ 181h PINE
--. / . '- \ /
\�JH2�
�2Q.8
yy �
21
+ 20.41
\ 20
r9
1 3
REMOVAL
1
00. �:� 1.i2
+ 21.26 \
/?s \ LOT S
13116+/- SQ. `rT.
\ D.3+/- ACRES
78 2
I \ 32
't- 17.32
VARIANCES REQUESTED UNDER TITLE 5. 15.405
Ai: REQUEST REDUCTION IN'SEPARAiION TROM'$OTTOM SAS i GROUNDWATER .(MOTTLES). 5' TO 4'
TOWN OF YARMOUTH:
3.4: REQUEST REDUCTION IN SETBACK TO WETLAND (100' TO 87')
—302
?3
I
E 3_91 S )E
— 3.75' }C, EN I.
_ J
crorIE
_ LEI.CHING 4'
Fi,C:I LIT\,'
..1J
T (; SI, o, I 0� S
•.--:—.-sz'r.zt__--n-.=.css.-_r�,r,z e.ae.�-a-e��: a�•��xwssva
A. Wf, -A, ri E, PLS
\NIT.IESS: BRUCE UR =+1Y_ RS —
DA 7 `:_ OCTOBER 1:, '000
PE �C. RATE _ H N/IIJCI I
CIL-%SS I& III
ELE''.
0' 20.
i
5
51' 3/2 c
I LS
14' +OYR 7/1
f
c•'= TACK TO
t j 'EEP ")LE
NEC+: VALVE
S�Hp AT 64-
�oVdYlEftS-siC u, C::. .•4:•! t,2 N- F,ump ,
i 'SYSTEM (OR EQUAL) i3
,E R
,3.E CGL RE( Q:'I"
SAS, (•CWN '", .IS
:LEAN :I:D. Si L.).
tNp CERTIFY
3 1
S I
.5Y 6/8
C1
MS
2.5Y 7/4
Urna..: 7svc .. 'C I• / %/ j : it
aT T/t
:,H T LOAM%l
n .,
• rr —
0" L 1.4'
SL
5" .5Y 3/2
LS
14"i ?DYR 7/1
P,
LS
2G"f :.SY 6/8 f 19.23,
M c1
I MS
:'.5Y 7/4 i
77" 114:94
I// _ OA!.� /112.40
108'I/ /
I C3
I FS
411 I 2.5Y 6/3 c 4
r--- ---'.I r r 3 r- •i rt111,Ar, t'_ 10 rPn�
L.:.: :'0 i',PD DE.'aI ;N FLC W
33•
L'�': 10C_ GALLON S :PTIC. TA,\IK
_ (EXIST.)
-``45 . 8.33)_58 (_74) = 4G.2 GPD
\\ sic!
1 45 x 6.E3 (34) = 2'4 ;PD
c 3f�33
1
EOTTC —
TOTAL: =3''_ S.F. 3_40_GPD
iJSE %15) H--20 STAfNDAF%D :NI%-M ATORS WITH
3.75'STD-NE AT ENDS. 3' Al SID: S
tj :� PRvQOSED SPOT E:.EVATIGhi
:OOxO ;'ISif"JG SPOT ELEVATION
00; 0;.;OPOSED CONTOUR
1DO ISINc CONTOUR
BOARD OF HEALTH
IMPROVED DATE,
.DJ oil `ii3-�•$:-'1_..tl
fox 503 362-9,%N)
A a_
crown cape enbn.reerin,g, inc.
1
}
CIVTL ENGINL: :RS
LAND SURVEYORS
ma 02675
,
t
1
I�
I
i LOCVS
OLD SALT t A1;r
�f VARINrRS
V
'vNpENT
LOCATION HAP NO SCALE
ASSESSORS MAP 140 PARCEL 5
1. DATUM 1'� 1PrROXIMAIED FR iM_(!l1AD MAP
M 1rj'('IF'"I_ %AT P, IS _EXISTIN :_ —
MINIMUM PI 'E PITCH TO BE /8" PER FOOT.
4 DFS•IGN 1 01 ')1NG FOR ALL PR;_C << T UNITS TO BE AASHO I I— ,-
5. PIPE MAP: TO BE MADE WA:E.2I;GHT.
6. CONSTPUCI')N DETAILS 10 6: iN ACCORDANCE WITH MASS.
E'IVIRON AE TAL CODE TITLE V
7. THIS PLA J FOR PROPOSED WORD: ONLY AND NOT 10 BE
USED FOR lOT LINE STAKING.
8. PIPE FOP Si::PTIC SYSTEM TO SCH. 40-4" PVC.
9. COMPONF Nil ; NOT 10 BE BACi<FILLED OR CONCEALED WITHOIJ
IN:SI'EC11''N BY BOARD OF HLALTII AND PERMISSION OBIAINF
FROM BOARD OF HEALTH.
10. ._X!SUNIC IIELO TO BE ABANDON ED/R E MOVE EXIST. WROX
11. ELECTRICAL PCRMIT REQUIRED
OF I i OLD SALT LANE
IN THE TOVt'tJ 0r-:
YARMOUTH(PORT)
PREPARED FOR: M/M t=RANCIS WORRELL
2.0 0 2G 40 60
SCALE: 1" = 20' DATE: OCTOBER 19, 2000
REVISED 11/5/00 (MOVE SAS)
G
6k
�..-
AfN Yt, 11r, 0.! ti,`C'r'rrl;ljti"j'.`,r. S. DATE
BOISE CASCADE - BC CALCTM 2000b DESIGN REPORT - US Wednesday, February 07, 2001 10:15
File
Triple -1 3/4" x 11 7/8" V-L SP 2900 Name: H WOOLLARD CAREY.BCC
Job Name - CAREY Customer - HOWARD WOOLLARD
Address - 11 OLD SALT LANE Specifier -
Designer - Joe Madera
City, State, Zip - YARMOUTH PORT, MA Company: - SHEPLEY WOOD PRODUCTS
Code Reports - ICBO 5512, BOCA 98-52, SBCCI 9852 Misc. -
Member Diagram NEW SECOND FLOOR BEAM
2380 bs LL
744 bs DL
Total Horizontal Length -1
2380 lbs LL
744 Ibs DL
General Data IS
Load Summary
Version: US Imperial ID Description Load Type Ref. Start End Live Dead Trib. Dur.
Standard UnfArea Load Left 00-MO 17-00-00 40 PSF 10 PSF 07-00-00 100
Member Type:
- Floor Beam
_Number of -Spans
--1
Left Cantilever
- No
Right Cantilever
- No
Slope 0/12
Tributary 07.00-00
Repetitive n1a
Construction Type n1a
Controls Summary —
Control Type
Value
Moment
13277 ft-lbs
End Shear
2760 Ibs
Total Deflection
U422 (0.471 w)
Live Deflection
L/568 (0.359")
Span/Depth
172
%Allowable
Duration
Loadcase
Span Location
44.5%
@ 100%
2
1- Internal
22.9%
®100%
2
1- Right
55.5%
2
1
63A%
2
1
1
Live Load 40 PSF
NOTES:
Dead Load 10 PSF
Design meets Code minimum (L240) Total load deflection criteria.
Part load 0 PSF
Design meets Code minimum (L/360) Live load deflection criteria.
Duration 100
Minimum End bearing length is 1-1r2 .
Disclosure
The completeness and accuracy of
the input must be verified by anyone
who would rely on the output as
evidence of suitability for a particular
application. The output above Is
based upon bolding cod"ccepted
design properties and analysis
methods. Installation of Boise
Cascade engineered wood products
must be In accordance with the
current Installation Guide and the
applicable building codes. To
obtain an Installation Guide or if you
have any questions, please call
(800)232-0788 before beginning
product installation.
Page 1 of 1 BCIO and Versa-LarnS are registered trademarks of Boise Cascade Corp.
M " TAM 8. "
VARNO " MaAn Old King's Highway Regional Historic District Committee 6�65
in We To«n of Yarmouth fora Y/`,RI'VIOUTH
TOE` I/J\i
CERTIFICATE OF APPROPRIATEN SS on
FEB 15
All 9- 52
Application is hereby made in triplicate, for the issuance of a Certificate of Appr ateness under Section 6
of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work a; deg cribgd�bel�and on
plans, drawings or photographs accompanying this application for.
CHECK CATEGORIES THAT APPLY:
I. Exterior Building Construction: p New Building p Addition 13 Alteration t
lndie:itc .pc ofbuilding: ❑ House ElGarage CI Commercial p Other `•
2. Exterior Painting: g APPnO-VtO ,
Sign p Existing Si Repainting existing sign + YARn100TH OO-`41,11TT =
3. Signs or billboards: � New Si g Sign 0 -pain • g g Im r 01(}iRO (f� A
4. Structure p Fence p Wall 17 Flagpole p Other ; I,/Ij y/�(�`J 11y�
46
TYPE OR PRINT LEGIBLY DATE /— Z
ADDRESS OF PROPOSED WORK // O 10 SyL; e,040` ASSESSORS MAP NO.
OWNER SUe It io.*? C/¢iLE'� _.._ASSESSORS LOT NO.
HOME ADDRESS 060 S. C_7- LNHL' TELEPHONE NO.
AGENT OR CONTRACTOR_ Z�o�Jti> L,�poLC.rr14o TELEPHONE NO
ADDRESS /70Y 16 3 O Z 6 3 Z>
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 sheet, if
nmessar♦•).
, �Poa2 r.rio�� Gi6//r
/CG`H2 _(ir�d CJ••u<ry W/r�/ `cvic� dGz+�' �['/'LSO SL ioGsn cJJ>/s
f=,t�'rrcif /'pr/t �'j'l/sL�' crJ�.✓�ov> C✓/1� a✓.�elL i.��� .
gign,, T ,�,j
Owicr-Contractor-Agent
Space below line for Committee use only
Received by OKI IC
Date 4 This Certificate is herein•; !1: .!. ) : - Datd �/ �//6 /
Check aY
APPROVED p IMPORTANT: If Certificate is approved, approval is subje ct`to the 10 day appeal period
provided in the Act.
DISAPPROVED p Please return to: Yarmouth OKHC District Committee
Yarmouth Toun Hall, 1146 Route 28, S. Yarmouth, MA 02664
10/26/2000 15:32 3620220 KINLIN GROVER GMAC PAGE 04
�•••• • • ••Iw...ri1 , Doug it. 1 Lara 1 01 1 rria"Jate. UV/11/luuU
7D(
ommercla r nts 11 ..�
rmen( eJcropnon 'T A I `/ / n ! r
TH
rjr
ametYPc TOWN,
l_i�_ (l�\
uhs/Plumbing
ctilin�Vall 20101 FEB 15 MI 9- 52 4 '
looms/Pttns
/. Common WAII
VallHei;ht RE —CI ` ,�D u / / 16
rnlenf Oat U rifrophon taclor
omp ex .
loot Adj
nit Location 0 2 8 2
\umber of Units 24
umber of Lcvcls
/.Ownership
r
26 .' .. h.,..
CUS
!8
32 -
�l
�Si1e Adj. Factor 9 598
Gndc (Q) Indcx APPROVED 1 A
dii.9asluc Nate
Idg, Vdue New 436 YARMOLIM CO �4MITTEE (�/Zj' I
1 I
vear Built !
ff. Ycat Built M t OKIIRD t`pI
Ntml Ph sel Dep
Iz OF
Ca
LU
I NK =: aJ� 110.10
CB, b
;2 z 27 �. • 'o %b llaro f i e
r•11 ° • r... non ' W
�� g u t o
9 �' 2 • n I o 0 4t til m 1 NI
yl p.� a / H` i 25 n n a )7.03 n
= 1 "� . e 24
�$ '� _ ^ N 23 ^ o N 21
OL
110.00
13• Ma•lo• u0.00
3
N b-�.. oJe °?Qa �t kp {o . �0.00
VA` Jd '$d- Z/00 b , t20.00 • ►fet) W I1p '
123.00
A
1 f. w or 29m oN 111.33 CJL . !
tio
1 4 MN I 41 N 3 0 IS It
�'�QO (�
INC
NA 3
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-0 i elm ei N
-- A .4. 2 A y O r
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• �'hfe /`t!� —i•• Ae A0yS 6\� ti JJ)e
'Q ao• o % d1 o . �t'r "y
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�•g��`v/.vet �Wu�i b `" flys 35
\� ��n. 4 � � �n �o J� •tre `oocP
• dJ..O[� tl•\ ?r rir
SPECIFICATION SHEET (YARMOUTH OKHC) - SUBMIT 3 COPIES
Please fill out the form in its entirety providuta aolor.�c�tfps� where
necessary. INDICATE LANDSCAPING, jn7ERIOR LIGHTING c, EL ff Al TER ONSITE PLANS
FORNEIVHOUSES ��i '. l_ERK
NAME OF OWNER(S): C IV"? I 10 ' FFII 15
FOUNDATION (Is" MAX. EXPOSED): CONCRET THER �D(tI�L V :
WALK WAY: STEPS (INDICATE BRICK/CEAIENT/OTIIER):
SIDING TYPE: tn,y TCif cY/ s re- COLOR:
CHIMNEY (INDICATE BRICK/STUCCO/WOODFACED) COLOR:
ROOF MATERIAL:
PITCH (7/12 MIN.) COLOR:
MAX. EXP. ,WATc/f Cy11f
Roy«or
WINDOWS (GRILLES REQUIRED) -INDICATE SIZES IF NOT LISTED ON ELEVA OWNS:
DOORS (INDICATE SIZES AND STYLE IF NOT LISTED ON ELEVATIONS): COLOR:
/�l /6.•fa'v
TRIM: (ALL WINDOWS &DOORS TRIMMED WITH m / IXS) COLOR:—tiJlflr�`
MATERIAL OF TRIM: 4WOO INYL, ALUMINUM)
SHUTTERS (WOOD/VINYL) (PANELED/LOUVERED)
�j�rTuf G vie r j
GUTTERS (WOOD/ALUMINUM):
GARAGE DOORS: SIZE & STYLE:
STORM WINDOWS & DOORS:
(INDICATE SIZES IF NOT LISTED ON ELVATIONS)
SKYLIGHTS: TYPE/SIZE:
DECK: SIZE & MATERIAL:
FENCING (NIAX. HEIGHT 6'): STYLE:
(SHOW LAYOUT & RUNNING FOOTAGE ON SITE PLAN)
COLOR:
COLOR:
pvvR�vED
1TTEE
D'UIRD
COLOR: a�1�
COLOR:
COLOR:
RETAINING WALL: (P.T. OR FIELDSTONE -CONCRETE INAPPROPRIATE)
(SHOW LAYOUT & RUNNING FOOTAGE ON SITE PLAN)
SIGNS: (indicate size, style, colors)
SIGN POST: (indicate size, style, color)
ADDITIONAL INFORMATION:
COLOR:
COLOR:
REV. 6/99
WI -I
T-42-r 53 Z4
274 1 1'1104 22-F4' 3'11-T
12'2 I 14'5
Important:
When filling out
forms on the
computer, use
only the tab
key to move
your cursor -
do not use the
return key.
Y�1
Massachusetts Department of Environmental Protection COPY
Bureau of Resource Protection - Wetlands
WPA Form 2 — Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
A. General Information
From:
YARMOUTH
Conservation Commission
To: Applicant
Sue & Tom Care
Name
11 Old Salt Lane
Mailing Address
YarmouthPort MA 02675
City/Town State Zp Code
1. Title and Date of Final Plans and Other Documents:
Property Owner (if different from applicant):
Name
Mailing Address
Cfty/Town State Zip Code
Sketch showing the proposed construction
Title Final Date (or Revised Date applicable)
2. Date Request Filed:
2/1 /01
B. Determination
Pursuant to the authority of M.G.L. a 131, § 40, the Conservation Commission considered your Request
for Determination of Applicability, with its supporting documentation, and made the following Determination.
Project Description (if applicable):
Construct an addition to an existing dwelling.
Project Location:
11 Old Safi Lane YarmouthPort
Street Address Clty/Town
140 5
Assessors Map/Plat Number Parcel/Lot Number
WPA Forth 2
R. n7m
Page t of 5
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands
WPA Form 2 — Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Determination (cont.)
The following Determination(s) istare applicable to the proposed site and/or project relative to the
Wetlands Protection Act and regulations:
Positive Determination
Note: No work within the jurisdiction of the Wetlands Protection Act may proceed until a final Order of
Conditions (issued following submittal of a Notice of Intent or Abbreviated Notice of Intent) has been
received from the issuing authority (i.e., Conservation Commission or the Department of
Environmental Protection).
❑ 1. The area described on the referenced plan(s) Is an area subject to protection under the Act.
Removing, filling, dredging, or altering of the area requires the filing of a Notice of Intent.
❑ 2a. The boundary delineations of the following resource areas described on the referenced
plan(s) are confirmed as accurate. Therefore, the resource area boundaries confirmed In this
Determination are binding as to all decisions rendered pursuant to the Wetlands Protection Act
and its regulations regarding such boundaries for as long as this Determination Is valid.
❑ 2b. The boundaries of resource areas listed below are not confirmed by this Determination,
regardless of whether such boundaries are contained on the plans attached to this Determination
or to the Request for Determination.
❑ 3. The work described on referenced plan(s) and document(s) is within an area subject to
protection under the Act and will remove, fill, dredge, or alter that area. Therefore, said work
requires the filing of a Notice of Intent.
❑ 4. The work described on referenced plan(s) and document(s) is within the Buffer Zone and will
alter an Area subject to protection under the Act. Therefore, said work requires the filing of a
Notice of Intent.
❑ 5. The area and/or work described on referenced plan(s) and document(s) is subject to review
and approval by:
Name of Municipality
Pursuant to the following municipal wetland ordinance or bylaw:
Name Ordinance or Bylaw Mallon
WPA Form 2
Qa mnn
Page 2 of 5
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands
WPA Form 2 — Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Determination (cont.)
❑ 8. The following area and/or work, if any, is subject to a municipal ordinance or bylaw but not
subject to the Massachusetts Wetlands Protection Act:
❑ 7. If a Notice of Intent is filed for the work In the Riverfront Area described on referenced plan(s)
and document(s), which Includes all or part of the work described In the Request, the applicant
must consider the following alternatives. (Refer to the wetland regulations at 10.58(4)c. for more
Information about the scope of alternatives requirements):
❑ Alternatives limited to the lot on which the project is located.
❑ Alternatives limited to the lot on which the project is located, the subdivided lots, and any
adjacent lots formerly or presently owned by the same owner.
❑ AltemaUves limited to the original parcel on which the project is located, the subdivided
parcels, any adjacent parcels, and any other land which can reasonably be obtained within
the municipality.
❑ Alternatives extend to any sites which can reasonably be obtained within the appropriate
region of the state.
Negative Determination
Note: No further action under the Wetlands Protection Act Is required by the applicant. However, if the
Department is requested to issue a Superseding Determination of Applicability, work may not proceed
on this project unless the Department fails to act on such request within 35 days of the date the
request Is post -marked for certified mail or hand delivered to the Department. Work may then proceed
at the owner's risk only upon notice to the Department and to the Conservation Commission.
Requirements for requests for Superseding Determinations are listed at the end of this document.
❑ 1. The area described In the Request is not an area subject to protection under the Actor the
Buffer Zone.
❑ 2. The work described in the Request Is within an area subject to protection under the Act, but will
not remove, fill, dredge, or alter that area. Therefore, said work does not require the filing of a
Notice of Intent.
® 3. The work described In the Request Is within the Buffer Zone, as defined In the regulations, but
will not alter an Area subject to protection under the Act. Therefore, said work does not require
the filing of a Notice of Intent, subject to the following conditions (if any).
❑ 4. The work described in the Request is not within an Area subject to protection under the Act
(including the Buffer Zone). Therefore, said work does not require the filing of a Notice of Intent,
unless and until said work alters an Area subject to protection under the Act.
WPA Form 2
R. Mm
Page ] of 5
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
IU)
WPA Form 2 — Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Determination (cont.)
❑ 5. The area described In the Request is subject to protection under the Act. Since the work
described therein meets the requirements for the following exemption, as specified In the Act and
the regulations, no Notice of Intent is required:
Exempt Activity (site applicable statuatory/regulatory provisbns)
❑ 6. The area and/or work described in the Request is not subject to review and approval by:
Name of Municipality
Pursuant to a municipal wetlands ordinance or bylaw.
Name Ordinance or Bylaw citation
C. Authorization
This Determination is issued to the applicant and delivered as follows:
❑ by hand delivery on
Date
® by certified mail, return receipt requested on
Feb. 20,01
Date
This Determination is valid for three years from the date of issuance (except Determinations for
Vegetation Management Plans which are valid for the duration of the Plan). This Determination does not
relieve the applicant from complying with all other applicable federal, state, or local statutes, ordinances,
bylaws, or regulations.
This Determination must be signed by a majority of the Conservation Commission. A copy must be sent
to the appropriate DEP Regional office (see Appendix A) and the property owner (if different from the
applicant).
Sinrrafu`res;
2/15/01
Date
WPA Fe 2
Rom. n7 m
Page a of 5
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 2 — Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
D. Appeals
The applicant, owner, any person aggrieved by this Determination, any owner of land abutting the
land upon which the proposed work is to be done, or any ten residents of the city or town In which
such land is located, are hereby notified of their right to request the appropriate Department of
Environmental Protection Regional Office (see Appendix A) to issue a Superseding Determination of
Applicability. The request must be made by certified mail or hand delivery to the Department, with the
appropriate filing fee and Fee Transmittal Form (see Appendix E. Request for Departmental Action
Fee Transmittal Form) as provided in 310 CMR 10.03(7) within ten business days from the date of
issuance of this Determination. A copy of the request shall at the same time be sent by certified mail
or hand delivery to the Conservation Commission and to the applicant if he/she is not the appellant.
The request shall state clearly and concisely the objections to the Determination which is being
appealed. To the extent that the Determination is based on a municipal ordinance or bylaw and not
on the Massachusetts Wetlands Protection Act or regulations, the Department of Environmental
Protection has no appellate jurisdiction.
Pape s 015
WPA Form 2
a.. mom
MAScheck COMPLIANCE REPORT
Massachusetts Energy Code
MAScheck Software Version 2.01
Permit 0
Checked by/Date
CITY: Yarmouth
STATE: Massachusetts
HDD: 6137
CONSTRUCTION TYPE: 1 or 2 Family, Detached
HEATING SYSTEM TYPE: Other (Non -Electric Resistance)
DATE: 2-22-2001
COMPLIANCE:"PASSES'
r Raquice& UA 111
Youe=Hunm" —As
Area or
Cavity
Cont.
Glazing/Door
Perimeter
R-Value
R-Value
U-Value UA
-------------------------------------------------------------------------------
CEILINGS
426
30.0
30.0
7
WALLS: Wood Frame, 16" O.C.
526
13.0
13.0
25
GLAZING: Windows or Doors
83
0.410 34
FLOORS: Over Unconditioned Space
306
14.0
14.0
15
FLOORS: Over Outside Air
120
30.0
30.0
4
HVAC EQUIPMENT: Boiler, 84.0 AFUE
COMPLIANCE STATEMENT: The proposed building design described here is
consistent with the building plans, specifications, and other calculations
submitted with the permit application. The proposed building has been
designed to meet the requirements of the Massachusetts Energy Code.
The heating load for this building, and the cooling load if appropriate,
has been determined using the applicable Standard Design Conditions found
in the Code. The HVAC equipment selected to heat or cool the building
shall be no greater than 125% of the design load as specified in
Sections 780CMR 1310 and J4.4.
Builder/Designer Date
13
MAScheck INSPECTION CHECKLIST
Massachusetts Energy Code
MAScheck Software Version 2.01
DATE: 2-22-2001
Bldg•I
Dept.I
Use I
I
I
[ ] 1
C ]
[ ]
[ ]
[ ]
CEILINGS:
1• R-30 * R-30
Comments/Location
WALLS:
1. Wood Frame, 16" 0-C•, R-13 + R-13
Comments/Location
WINDOWS AND GLASS DOORS:
1. U-value: 0.41
For windows without labeled U-values, describe features:
• Panes_ Frame Type Thermal Breakf C ] Yes [ ] No
Comments/Location
FLOORS:
1. Over Unconditioned Space, R-14
Comments/Location
2. Over Outside Air, R-30
Comments/Location
HVAC EQUIPMENT:
1• Boiler, 84.0 AFUE or higher
Make and Model Number
IIR LEAKAGE:
Joints, penetrations, and all other such openings in the building
envelope that are sources of air leakage must be sealed. When
installed in the building envelope, recessed lighting fixtures
shall meet one of the following requirements:
1• Type IC rated, manufactured with no penetrations between the
inside of the recessed fixture and ceiling cavity and sealed or
gasketed to prevent air leakage into the unconditioned space.
2• Type IC rated, in accordance with Standard ASTM E 263, with no
more than 2.0 cfm (0.944 L/s) air movement from the the
conditioned space to the ceiling cavity. The lighting fixture
shall have been tested at 75 PA or 1.57 lbs/ft2 pressure
difference and shall be labeled•
VAPOR RETARDER:
Required on the warm -in -winter side of all non -vented framed
ceilings, walls, and floors•
MATERIALS IDENTIFICATION:
Materials and equipment must be identified so that compliance can
be determined• Manufacturer manuals for all installed heating
and cooling equipment and service water heating equipment must be
provided. Insulation R-values, glazing U-values, and heating
I equipment efficiency must be clearly marked on the building plans
I or specifications.
I
1 DUCT INSULATION:
E 3 1 Ducts shall be insulated per Table J4.4.7.1-
I
I DUCT CONSTRUCTION:
[ ] I All accessible joints, seams, and connections of supply and return
I ductwork located outside conditioned space, including stud bays or
I joist cavities/spacas used to transport air, shall be sealed
I using mastic and fibrous backing tape installed according to the
I manufacturer's installation instructions. Mesh tape may be
I omitted where gaps are less than 1/8 inch. Duct tape is not
I permitted. The HVAC system must provide a means for balancing
I air and water systems.
I
I TEMPERATURE CONTROLS:
E 3 1 Thermostats are required for each separate HVAC system. A manual
I or automatic means to partially restrict or shut off the heating
I and/or cooling input to each zone or floor shall be provided.
I
I HVAC EQUIPMENT SIZING:
E 3 1 Rated output capacity of the heating/cooling system is
I not greater than 125% of the design load as specified
I in Sections 780CMR 1310 and J4.4•
I
E 3 1 SWIMMING POOLS:
-I All heated swimming pools must have an on/off heater switch and
I require a cover unless over 20% of the heating energy is from
I non-depletable sources. Pool pumps require a time clock.
I
E I I HVAC PIPING INSULATION:
I HVAC piping conveying fluids above 120 F or chilled fluids
I below 55 F must be insulated to the following levels (in.):
I
I PIPE SIZES (in.)
I HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4"
1 Low pressure/temp. 201-250 1.0 1.5 1.5 2.0
1 Low temperature 120-200 0.5 1.0 1.0 1.5
I Steam condensate any 1.0 1.0 1.5 2.0
1 COOLING SYSTEMS:
I Chilled water or 40-55 0.5 0.5 0.75 1.0
1 refrigerant below 40 1.0 1.0 1.5 1.5
I
E 3 1 CIRCULATING HOT WATER SYSTEMS:
I Insulate circulating hot water pipes to the following levels (in.):
I
1 PIPE SIZES (in.)
1 NON -CIRCULATING I CIRCULATING MAINS i RUNOUTS
I HEATED WATER TEMP (F): RUNOUTS 0-1" 1 0-1.25" 1.5-2.0" 2.0•"
1 170-180 0.5 1 1.0 1.5 2.0
1 140-160 0.5 1 0.5 1.0 1.5
1 100-130 0.5 1 0.5 0.5 1.0
I
----NOTES TO FIELD (Building Department Use Only)-------------------------
0
ANC. -�1-00 10:124 AM IIOWN CAME GII+INF,:GR INgr ;J 5a.9 362 9680 P.01
1�u - • -~ tel. 508-362-4541
939 main street ( rte 6A) fox 508-362-9880
yarmouthport, mass 02675
down cape .ep4rineering,;ranc. FILE COPY "
civil engit ri cs ,Sc lard Suf,vey,.ors
LAND COURT FacSunlLE'"TR.1NSM1lTAL•iFORM,
SURVEYS -561 -3e2 9a80
/' / - V Arne H. Ojola P.E., P.L.S.
DATE -� CLLI&eV,
SITE PLANNING T0: icc-�oG� ir�•LL_. '
FROM:' ' �'.�r•�L l ` _
MESSAGE: Aid Ssex! 4,c-•r
I /�
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DESIGNS
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1 BAANSTAWX COUNTY. MA.4
710
IPA
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APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00
TOWN OF YARMOUTH
(OFFICE USE ONLY)
Fee: $ `�•00
PERMIT NO. G - d/- 1 9P
(PLEASE PRINT IN INK OR TYPE ALL INFORAIAT10N) Date: /" 3 J— G
To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work
described below. '
Location (Street & Number)) '-Bunn
Owner or Tenant NG j.S UJ49 02— LL
Owner's Address
Is this permit in conjunction with a building permit? ❑ Yes ❑ No
Purpose of Building
Existing Service
(Check Appropriate Box)
Utility Authorization No.
aT/f#1o2
Amps / Volts Overhead ❑ Undgrd ❑ No of Meters
New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
a Number of Feeders and Ampacity
4Location-and Nature of Proposed electrical Work: `��.� d c TI L r.� C Grj oh/ 7► (I/h� j�/�/��y1
Complrrion ofthefollou-ing table maybe waivedby the Impectorof Winr
al
n
Nli
No. of Tot
q Attacb additional detail if desired, oJ2 uq fired blif a Inspector of Wirer.
"INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless LIM t2'CRsee'ptestaes-p 1ty
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. L ' r
CHECK ONE: INSURANCE BOND❑ OTHER❑ (Specify)
J11 (Expiration Date)
Estimated Value of Electrical Work: (When required by municipal polity.)
AWork to Start: /'41-0 ( Inspections to be requested in accordance with MEC Rule 10, and upon completion.
I certify, under the pains and penalties of perjury, that the information on this application is true and complete.
FIRM NAM LIC. NO.
Licensee: -CL'll Signature LIC. NO. .30a}9.3 r
(If applicabl enter "exempt" in the license nuWber line.) 41 Btu. Tel. No.:
Address:cr t�l�i� /s;-LLC� lLd� %3.�� L!/S /�C/L Alt. Tel. No.:
OWNER'S INSURANCE WAIVER I am aware that the licensee does not have the liability insurance coverage normally required by law. By my signature
below, I hereby waive this requirement. I and the (check one) owner ❑ owner's agent.
Owner/Agent
Signature Telephone No.
[Rev. 04/001
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code. WEC), 527 CA1R 12.00
(OFFICE USE ONLY)'
TOWN OF YARMOUTH By
fq t!5 Perm -Bo-of-S70 Fee: $
lc Ka9 PERMIT NO.
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: — — tor in-inecli
To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform-t to electrical
work described below. /f f J
Location (Street & Number)- �� 0i' S Q / T 1�f7
Owner or Tenant
Owner's Address /
Is this permit in conjunction with a building permiQt? [ Yes ❑No (Check Appropriate Box) Pok 790�3
r
Purpose of Buildingk i ��/r.'lr>r s L (.k ' P" �&fLQ Utility Authorization No.
Existing Service /_ GO Amps 7d / -216f Volts Overhcadolo, Undgrd ❑ No. of Meters
New Service Amps / Volts OvenccadQ Undgrd ❑ No,. of Meters
Number of Feeders and Ampacity /Co �//2,,—C7
—Location and Nature of Proposed electrical Work: �(��"I t �.}1 tr' J"� /'C
Completion ofthe follmnine table nmv be trained by the Inspector ofWres
No. of Recessed Fixtures �k1o,
of Ceil.-Stisp,(Puddle)Fans
No. of Total
Transformers KVA
No. of Li�htin� Outlets
No. of Hot Tubs
Generators KVA
No. of Li Ming Fixtures 7
Above n-
Swimming Pool rod. ❑ �rnd. ❑
No. of Emergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners
o. of Detection andr
Initiating Devices .J
No. of Ranges f Rs IOVEtj FLcct,
Total
No. of Air Cond. Tons
No. of Alerting Devices
No. of Waste Disposers
eat 'um
Totals:
um er
— Le
ons
— —
— —
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area HeatingKW
Local IrJ Municipalo do Other
Connection
No. of Dryers
y
Heating Appliances KW
g Pp
Security Systems:
No. of Devices or Equipvalent•
No. of Water
Heaters KW
No. of No. of
Siens Ballasts
Data Wiring: •
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or F uivalent
Attach adr.6tional detail if desired, or as required by the Inspector of Wires.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued unless the licensee provides
proof of liability insurance including "completed operation" coverage or its substantial equivatent. The undersigned certifies that such coverage is in
force, and has exhibited proof of same to he permit issuing office. -
CHECK ONE: INSURANCE BOND OTHER (Specify:&?J j V i71 114^ —0 2
Estimated Value of Electrical Work: (When required by municipal poy:(�xpnation Date)
iy.)
Work to Start: Inspections to be requested in accordance with NIEC Rule 10, and upon completion.
I certify, undcr•the pains antinalties of perjury, that the information on this plication is true and complete.
FIRM NAME: a '// LIC. NO. F/SYGh
Licensee: Signature r I ^ ! i�lC. NO.
(If applicable enter "exempt" in the license number I'ne.) Bus.%11el.
Address 7 At Tel. No.:
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature
below, I hereby waive this requirement. I am the (check one) owner owner's agent. ❑
Owner/Agent
Signature Telephone No.
[Rev. 04A)01
r�
u
R
APPLICATION FOR PERMIT TO DO GASFITTING
TOWN OF YARMOUTH o �� "(o/c� o fY)
Fee: $> . —. rJ
PERMIT NO. ^Q� / -3 3
Date c�
Building Owner's
AT: Location &0 SALT LA Name TD.M CA2 E5
�YAa.410 jf TH g64_T'
J / Type of Occupancy _i//y`r! L
New ❑ Renovation Replacement ❑
Plans Submitted Yes 5VNo ❑
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SUB-BSMT.
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1ST FLOOR .
2ND FLOOR
3RD FLOOR
(PRINT OR TYPE) 10
Installing Company Name Phl' l ()
Address SAM3A G/!L
54- Ao W1 c 4
Business Telephone ! Z Z— 1!9 �2 2-
Name of Licensed Plumber or Gasfitter AIL
Check One:
❑ Corp.
❑ Partnership00070
Ca,FjrnVCompany
INSURANCE COVERAGE: Check Op..-
have a current liability insurance policy or its substantial equivalent. Yes L7 No ❑
If you have checked yes, please Indicate t of coverage by checking the appropriate box. r
A liability insurance policy Other type of indemnity ❑ Bond ❑ t .
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of
the Mass. General Laws, and that my -signature on this permit application waives this requirement.
Check One:
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
1 hereby certify that all of the details and Information I have submitted
(or entered) in above application are true and accurate to the best of
my knowledge and that all plumbing work and Installations performed
under Permit Issued for this application will be In compliance with all
pertinent provisions of the Massachusetts State Plumbing Code and
Chapter 142 of the General Laws.
Signature of Licensed
Plumber or Gasfitter
lZ `/3 2
License Number
TYPE LICENSE:
Ck lumber ❑Gasfitter G1 asM ter ❑Journeyman
T WN OF YARMOUTH
/Q3
Building
AT. Location _ / GAGA SA L J L Al
YAametyrt - pon.T
New ❑ Renovation l
Submitted Yes k No ❑
APPLICATION FOR PERMIT TO DO PLUMBING
Y)
Fee $
PERMIT NO.—� SO
Date qN tir n /
Owner's ZVm ell 2 E Y
Name
Type of Occupancy S/W61t Fmil. y
Replacement ❑
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SUB•BSMT.
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1ST FLOOR
2ND FLOOR
3RD FLOOR
(PRINT OR TYPE)
Check One:
❑ Corp.
❑ Part ership
Firm/Company
Plumber /Z y 3 Z
INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent. Check One: Yes U?* No ❑
Installing Company Name 111qW 110 A 1 ill f%h PV- / J
Address 3 S A&;d A L/2
SA /✓01✓/ L-N-
Business Telephone 117 L' O 7 O 2� Name of Licensed
If you have checked YES, please indicate the type of coverage
,,byycchecking the appropriate box.
A liability insurance policy L!1 Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance voerage required by Chapter 142 of
the Mass. General Laws, and that my signature on this permit application waives this requirement.
Signature of Owneror Owner's Agent
1 hereby certify that all of the details and information I have submitted
(or entered) In above application are true and accurate to the best of
my knowledge and that all plumbing work and installations performed
under Permit issued for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plumbing Code and
Chapter 142 of the General Laws.
L
Check on Owner ❑ Agent ❑
100 JIV Al'.111
Signature of Licensed
Plumber
l z18Z.
License Numb
Type: Master [ Journeyman ❑
w r TOWN OF YARMOUTH Building Department BUILDING
_ _ _ _ _ _ _ _ (508) 398-2231 ext.261
PERMIT NO B-10-937 _ - .... - - PERMIT
.merge ISSUE DATE ; _ 2/1912010 _ ; PROPOSED USE
APPLICANT :PINE HARBOR WOOD PDS.,.INC._ JOB WEATHER CARD
PERMIT TO % cessory Structure'
AT (LOCATION) 10011OLDSALTLN ZONING DISTRIC R-40 Bldg. Type: Residential
SUBDIVISION MAP LOT BLOCK 1140.5 BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R-3
LOT SIZE O
REMARKS REMOVAL OF EXISTING 8 X 12 SHED - REPLACE WITH 14 X 10 - SAME LOCATION
,
AREA (SO FT) EST COST ($
OWNER IDOUGLAS & HEATHER AYRES
ADDRESS 0011 OLD SALT LN
YARMOUTH PORT 102675
PERMIT FEE ($) $25.00
BUILDING DEPT BY
CONTRACTOR
LICENSE 073865
McGrath, James
259 Queen Anne Road
Harwich MA 02645
5084302800
PHONE 16177952808
INSPECTION RECORD FIELD COPY
—Date— Note Progress - Corrections and Remarks Inspector
��-
427/2015
SlipGen- Portal Home
Document Category
Map -Block Number
Town of Yarmouth
Template [Building Dept]
Slipsheet Identifier [sg24181]
Building Permits
140.5
Street Number 0011
Street Name
Department
Parcel ID
Backfile Batch Scan
Document?
Additional Naming Info
Index Operator
Date - Time
OLD SALT LN
Building
16145
No
Operator, Yarmscan
2015-04-27 - 15:05
ht0JAaser6che12131ipGerV 1/t