HomeMy WebLinkAboutBuilding PermitsTOWN OF YARMOUTH
PERMIT NO B-07-1045
BUILDING
ISSUE DATE :. 3/15n007. ' PROPO USE ::::::: PERMIT
APPLICANT-RichardSwanfeldt JOB WEATHER CARD
PERMIT TO ; Alterations
AT (LOCATION) 10117NOTTINGHAM DR ZONING DISTRIC R-40 Bldg. Type: Residential
SUBDIVISION MAP LOT BLOCK BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R-4
LOT SIZE O
REMARKSconstruct an exercise room in the basement as per plans dated 03/12107.
AREA (SO FT) EST COST ($ $2,500.00 PERMIT FEE ($)
OWNER IS. Ming and Jennie Lee BUILDING DEPT BY
ADDRESS 10117 NOTTINGHAM DR
Yarmouth Port MA 102675
INSPECTION RECORD
CONTRACTOR
LICENSE 067881
Swanfeldt, Richard
179 Reservoir Street
Marlboro MA 01752
5085610167
PHONE 150&3628872
FIELD COPY
Date Note Progress - Corrections and Remarks Inspector
D5 i _SL- 1_9 1 z I, ._401�
X
of'YgR. ONE & TWO FAMILY ONLY - BUILDING PERMIT
+$ C APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
O y
R. , ut
Town of Yarniouth Building Deparunent
H „ ., T 1146 Roe 28 • Yannoluh, NIA 026644492
��`"'��'�� Tel: (508) 398-2231 x261 • Far.: (508) 398-0836.
Section 1 - Site Information ` Use Group: R-4 Type: 5-B
1.1 Property Address: 1.2 Zoning Information:
tu11 m . R — 40
V 6 eVY1D t POr�' Zoning District Proposed Use
1.3 Building Setbacks fit)
Front Yard Side Yards Rear Yard
Reouired Provided Reouired I Provided Required I Provided
to Water Supply (IA.G.L- c. 40. S 64) 1.5 Flood Zone Information: Comments:,
Pubtic Private Zone: BFE
Section 2 - Property OwnershiplAuthorized Agent
2.1 Owner of Record:
5. rYltnat at)d 3enrlt�, Lee_ 1I A)Oglrl hVl D&.
Name(print) 0 Mailing Address U
_50$— 3ba —8 u is
Signature jen (T �?,Wl aorATelephone
111 MAR
2.2 Authorized Agent: r
Mailing
Section 3 - Construction Services I1100 " III
2.1 Licensed Construction Supervison , 1 r IMR &07 Wfiplicable Q
► -lot Re�yo1 P. �f" I &4a l l�ro a Number N7f)
Add 0 �O -7 9'tl
Expiration Date
nature Telephone � p — .S-/� / „ A� / 7 9-ce e 7
3.2 Registered I
Company Name
Contractor:.
Acidress �-IC[ KoserV t+ YnWyo Ol1oy � "lob-501e-7
Si nature
Telephone
Not Applicable
License Number
/-q 76
Date
1 of 2
OVER
x
Sect)dR'4Worker� - ,4fM Rau'.c:� b2;�
.
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure
to provide this affidavit will result In the denial of the Issuance of the building permit.
Signed Affidavit Attached Yes .....)..... . No ..........
New Construction ❑ No. of Bedrooms No. of Bathrooms
Existing Bldg. ❑ Repair(s) ❑ Alterations Addition ❑
Accessory Bldg. ❑ Type
Demolition
Other Specify:
Brief Description of Proposed Work:
I I
t
0.5 on -e Iv • 1 f%k
Lboe, +o &,a Add.o-d 4v ara.lc- -kom rc-�-.rF-c* 6a5.enQ.4t- -
V0, Zx + &rn.e can 5hUC�rr,
°L 13 vcor- iv be- per- ccxle.
'Si�ict)d l��J=stimated.tronsln�Gtluc►:
Item Estimated Cost (Dollars) to be Check Below
completed by permit applicant
1. Building .2 000 . 00 ❑ Conservation -Commission Filing
2. Electrical 500 .00 (if applirabl4)
3. Plumbing / Gas — 01
4. Mechanical (HVAC) Old Tangs Highway & Historical
5. Fire Protection Commission approval
B.Total=(1+2+3+4+5) 2 500.00 (if applicable)
7. Total Square Ft. (new Ixsi m l tldlior s)
iiwrl'�er{s"A '4r,�ftt for din' 8ardfx ,c
(, hr11 e /�D , as owner of the subject property
hereby authorize P— I cka't'k to act on
my behalf, in all. matters relative td work authorized by this building permit application.
3- S—Dy
signature of Owner Date
Sect►on"37b4per/A(Nioii�aitA' enf Q ta0on
4q
(U diA 6 SWaAA-Ak-,V+ , 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.
of perjury.
Signed under the pains and penalties of
14C(4zV-4- CZ(1?a-11d��f
Print name
Sf ature of Owner/9 gent Date
9-15-99
2 of 2
For Office Use Only
Permit No.
Date TOWN OF YARMOUTH
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
MOL c. 142A requires that the 'reconstruction, alteration, renovation, repair, modernization, conversion,
improvement, removal, demolition or construction of an addition to any pro -existing owner -occupied
building containing at least one but not more than four dwelling units or structures which we adjacent to
such residence or building' be done by registered contractors, with certain exceptions, along with other
requirements.
Type of Work: -i n l sh 1 W X i i ft m t A Est. Cost Z bib . v o
ba.wU,U --b be u a,� U.In ec�rernl
Address of Work 11 7 Ve\11 l- VirJ,i yw be-- W u ltilaw& APE,'
Owner Name: 5 ill-d J e n I e. l.e
Date of Permit Application:
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
Job tinder $19000
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 ofpmjury:
I hereby apply for a permit as the agent of the owner:
Date ContractortName 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 oflnduserial Accidents
Omcea/nesa
600 Washington Street
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
Applicant information: Pf seFitIIPI'Sefiisyit
locntion• y��1Qt-yJw-% r Jt
Il tits I OA010 1_ m-h phoneM lof taw- 0l%,
O 1 am a homeowner performing all work myself.
ZI am a sole proprietor ,.-d have no one working in any capacity
O I am an employer prop iding wprkers' compensation for my employees working on this job.
sow.....+w.• w.... _. d/b la 55U OA et1tU)dVL4,A-
address•
incur inre co. Miley N
I am a sole proprietor. general contractor, or homeowner (circle one) and have hired the contractors listed below who have
the following workers' •ompensation polices:
emmRiny name!
address-
CIIY' phone 0- —
incur+w_w •w nnilev M
Failure to secure coverage as required under Section 21A of MGL I32 can lead to she inpoddes otetimisal plasiOn *Ca One up to t IAMAo aadlor
one years' Imprisonment as well as dvU pnaltla is the form arm S M? WORK ORDER and a One 011111111.111111112 day apiW no. 1 understand that n
copy of this statement may be forwarded to the Me of Investigations of Ike DIA for coverage veriOnttoa.
I do hereby terrify under the pains and penaldes of perjury that the information provided above 1s trrte and eorrem
318'!u 1
Print name ZLCkutid Phoee! OW — 361 — 010
official use only do not write in this area to be completed by city or two oAkW
city or town: TARHOUTQ _ perodbScease d nBultdlag Department
plJccuslog Bard
Q check if immediate response is required 261 pSelectmn's OtOce
❑Healtb Depsmmcut
contact person: pheatN: _ (508) 398-2231 ext. nOther
... ...� ... P.A.
TOWN OF YARMOUTH
BUILDING DEPARTMENT
CONSTRUCTION SUPERVISOR FORM
PLEASE PRINT.
job Location: _
Owner of Property:
ill
Street
I,g&-arf
Village
Construction Supervisor: Pt ah -0 SW 0,a `J-4=1t 60981 1 S(a 1— O 16
Name License No. Phone No.
Address:
ICI ►e �5e l�l,�oc SE- YY�a,.l tzo,, a� r++ o
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 forwhich 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.
2.15.5 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 Curren liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152
Yes No ❑
If you have checked =, please Indicate the type coverage by checking the appropriate box.
A liability insurance policy V 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, and that my signature on this permit application waives this requirement.
Checl� one:
Signature of Owner or Ownef ent Owner Agent ❑
Signature: Building Official Approval:
TOWN OF YARMOUTH
1146ROUTE28 SOUTHYARMOUTH . MASSACHUSETTS0266"451
Telephone (508) 398.2231, ExL 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
is to be dispose
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
Signature of Applicant
... ..
--.fit .-. •.AV ii•-i'�GR�yi�T �.
31BIv1
Date
TOWN OF YARMOUTH
Building Department
Town Hall
Yarmouth, MA 02664
(508) 398-2231 ext.261
BUILDING PERMIT
TRANSMITTAL
Temp Permit No.: T-07-377
Applicant Name: Richard Swanfeldt
Applicant Phone: 5085610167
Building Location: 0117 NOTTINGHAM DR
Owner's Name: S. Ming and Jennie Lee
(OFFICE USE ONLY
Recorded By:
Ic
Permit Fee:
$0.00
Deposit Rec:
$25.00
Payment Type:
Check ChkNo.: 1020
Net Owed:
($25.00)
Application Date:
3/13/2007
Issue Date:
Expiration Date
Comments: Map/Lot: 150.29
construct an exercise room in the basement
Owner's Addres 0117 NOTTINGHAM DR
Yarmouth Port
Owner's Telephone: (508) 362-8872
MA 02675
REVIEWED BY:
1. WATER DEPARTMENT:
DATE:
N/A:
2. ENGINEERING DEPARTMENT:
DATE:
N/A:
3. CONSERVATION:
DATE:
N/A:
4. HEALTH DEPARTMENT:
DATE:
N/A:
5. BUILDING DEPARTMENT:
DATE:
WA:
6. FIRE DEPARTMENT:
DATE:
N/A:
PLEASE NOTE
COMMENTS:
RECEIPT OF COPY:
SIGNATURE OF APPLICANT:
DATE:
Date Printed: 3/13/2007
0 .+R,�o TOWN OF YARMOUTH
c HEALTH DEPARTMENT
H "ARA N
H
Lt.�2 PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: //q M� O111l bit b • Map No.: Lot No.:
Proposed Improvement:_ 7-0-f ,0l r> ( 4 /41' X/7 t f eolyi 7/0 he le-SLd eZlj a j-)
. e.t R12(it SC /eDD/Yi
Applicant: C.f! hn i e Liz— Tel. No.: - ?6D 7a)-
Address: /l7 Nil{zL1iN �)e Date Filed: '51,Fle 7
f *If you would like e-mail notification of sign off, please provide e-mail address:
/)
Owner Name: ml, Qml,,�f lne U�
Owner
Owner Tel. No.:,W- -361 -99 70-
RESIDENTIAL AND/OR COMMERCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities.
Please submit four (4) copies of plans, to include:
(1.) Site Plan showing existing buildings, water line location,
and septic system location;
(2.) Floor plan labeling ALL rooms within building
(all existing and proposed) -
Note. Floor plans not required for decks, sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
REVIEWEDBY: (�/ DATE:
PLEASE NOTE
COMMENTS/CONDITIONS: ,
v
AdO3 1111
juawl.jcdau gJIaai{ [{1nowreA
EM(nina
L O- Z/- � Galva
30NVIldW00
.1l n SV, 20 AlIIIAISNOdS3H 3H1 NM 1NV0Ilddb
�� }4 bS Ot-'&3I13a ION 00 SNOISSI NW0 80 SaM3 '30NV
' �X / d�"� E)W �0 JNINOZ 0NV JNIaiine a03 03M31A3a
/4 ,� a NI .&rAOL'JUVA JO NAAo.L
,Ll
mr!Al
iTc'7
L-e2
117AI6k/79'{dt'7 Ze
6tw,en-l- to yoa4 o� ,eow"
a rra epos to
.8aseme o T
91�cin r, door -ire C�D raa,e a►�c� .� W'"dOW5 curne.�it(
�i� � �oar-f-v-f `J�orn �..-v,d wtc.L ram►-n2�r� 1
/-7 f
,sseYs�su
TOWN OF YARMOUTH Building Department
BUILDING,
tip (508) 398-2231 ext.261
RPERMIT
, NO : B-o�-,u2a_
PERMIT
��•. ISSUE DATE ;- ; PROPOSED USE
_3/5/2007• • _ _ _ _ _ _
_
APPLICANT ,R!chard Swanfeldt
JOB WEATHER CARD
PERMIT TO Alterations
AT (LOCATION) 10117NOTTINGHAMDR ZONING DISTRIC R•40
SUBDIVISION MAP LOT BLOCK 1150.31.1 BUILDING IS TO BE: CONST 1
LOT SIZE
construct familyroom and 112 bath In basement as per plans dated 03/05107.
REMARKS
AREA (SO FT) EST COST ($ $21
OWNER IS. Ming and Jennie Lee
ADDRESS 10117 NOTTINGHAM DR
Yarmouth Port I MA 102675
Bldg. Type: Residential
PERMIT FEE ($) $260.00
BUILDING DEPT BY
INSPECTION RECORD
J USE GROUP R-4
CONTRACTOR
LICENSE 067881
Swandeldt. Richard
179 Reservoir Street
Marlboro MA 01752
5085610167
PHONE 5083627782
•
FIELD COPY
Note Progress - Corrections and Remarks.•
WARIMINNAF
M
no
of'YAR,� ONE & TWO FAMILY ONLY - BUILDING PERMIT
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
O —y Town of Yarmouth Building Department .►-
H '.:,.<• 1146 Route 28 - Yarmouth, NIA 026644492
c`�0 �•"'" °�� Tel: (508) 398-2231 x261 • Fax: (508) 398-0836
ffice Use Only Planning Board Information Assessors Department Information:
Map Lot
Permit No. - ��ate� an ype d r Endo ement Date /
Permit Fee $a
ecordinp Date New
Deposit Rec'd. $ Date L an N 1.4 Property Dimensions:
Net Due $ 3t�, (l Oth Lot Area (sf) Frontage (it) Lot coverage
This Section for Office Use Only
Building Per i mb r:
Date Issued:
Signature:
Ce.rtificate of Occupancy
is is not required
Building Official Date7
Section 1 - Site Information
I Use Group: R-4 Type: 5-B
1.1 Property Address:
//,7 1I/ofhngAam 7)iny-e.
1.2 Zoning Information:
Zoning District Proposed Use
1.3 Building Setbacks (it)
Front Yard
Side Yards
Rear Yard
Required
Provided
Required
Provided
Required
Provided
1.4 Water Supply (M.G.L. c. 40. S 54)
Public Private
1.5 Flood Zone Information: Comments:
I Zone: BFE:
Section 2 - Prooertv OwnershiD/Authorized ADent
2.1 Owner of Record:
(
-
'117 AWi iM La )u D6tp , '
Name (print)
Mailing Address
Sign
Telephone
`aiL E-mail
nl,7n iG L lv C �o/•tarn
27`Au�h rived Agent. •
IR p 5 2001
1
Name (print)
ailing Address
D
Tele hoe / —
Xax_��try E-mail
-
FEB 1
.
Section 3 - Construction Services -
i—>sf-' 1, f,
G
3.1 Licensed Construction Supervisor.
h7fiL9113PA2 ma Dr75�
ucOlJ Number In
Expiration Data
Address
—
Sign T le hone Fax E-mail
Richard Src�an ��ld f- % -�_� No ><//
Address l7q Wese,e voiP. SSf MatCbo)9t /)7 • Gl 7rj 2— Expiration to
a
Sign Telephone Fax E-mai
1 of 2 OVER
0
r
Section 4 - Workers' Compensation Insurance Affidavit (M.G.L c.152 S 25C (6)
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure
is 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) ❑ Alterations ❑ Addition ❑
Accessory Bldg. ❑ Type
Demolition
Other Specify:
Brief Description of Proposed Work:
n t sl,\ a MOM f r
_ b r clom
lag -Ani 5.1y
d ko i a.
rnl
Costs
Estimated Cost (Dollars) to be Check Below
completed by permit applicant
15 000 • d O ❑ Conservation -Commission Filing
C5-6.0p. ov (if applicable)
-
( VLJ
❑ Old Kings Highway & Historical
Commission approval
Z f 6VO p (if applicable)
To be Completed When
for Building Permit
Section 6 - Estimated Construction
Item
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 & ed&ions)
Section 7a - Owner Authorization -
Owner's Agent or Contractor Applies
I, , as owner of the subject property
hereby authorize I` �� to act on
my behalf, in all matters relative to work authorized by this building permit application.
Signature of O er Date
Section 7b - ner/Authorized Agent Declaration
(iey Y\ t t✓ Lf° L, , 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 r7
Signa 'of O er/Agen Date
9-15-99
2of2
TOWN OF YARMOUTH
.1r
�� • � C
BUILDING DEPARTMENT
CONSTRUCTION SUPERVISOR FORM
PLEASE PRINT.
Job Location: II'1 n0i�t�1ott1[tir ��t b`Qi
Number Street Village
Owner of Property:
Construction Supervisor: tc ILk
Name
t'1 ✓tie— L-e:
at M
License No.
508 -
Phone No.
Address. 1-79 Vee-.>e42V01 e, t+ DvaeLl,-)om r M-A O I-1x�5cq--
Licensed Designee:
(If other than Supervisor)
Name
2.15 Responsibility of each license holder:
License No.
—01tol
2.15.1 The license holder shall be fully and completely responsible for all wort: 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 lie, 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 y-u, please indicate the type coverage by checking the appropriate box.
A liability insurance policy La 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, and that my signature on this permit application waives this requirement.
z&uCheck one:
!-ate
Rinnnhirnr nwrNar'_ AnAnt Owner Q�r Agent
El
Signature: Building Official Approval:
For Office Use Only
Permit No.
Date TOWN OF YARMOUTH
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
MGL c. 142A requires that the 'reconstruction, alteration, renovation, repair, modernization, conversion,
improvement, removal, demolition or construction of an addition to any pre-existing owner -occupied
building containing at least one but not more than four dwelling units or structures which are adjacent to
such residence or building' be done by registered contractors, with certain exceptions, along with other
requirements.
Type of Work:f:�h t sh e m i h �� me ►�fi Est. Cost Zo , 000
Address of Work
Owner Name:
d .'Se��v►1 e- L� o -
Date of Permit Application:—
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
Job under $1,000
Building not owner occupied
Owner pulling own permit
Other (specify)
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH
UNREGISTERED CONTRACTORS FOR APPLICABLE HOME
IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION
PROGRAM OR GUARANTY FUND UNDER MGL c. 142A.
Signed under penalties of perjury:
I hereby apply for a permit as the agent of the owner:
lu._�� D ��
GateContractor N e
•'
Registration No.
/5'4/332
Notwithstanding the above notice, I hereby apply for a permit as the owner of the above
property:
1102
Date • i .i
C\ Tine Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
ILWN-
600 1Vashington Street
Boston, DIA 02111
tvlvty. to ass.govIdia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): R1 lti 17{/r
Address: Rr ey 49nv0 [ t'_ �i' M aa�l ��o ro • M o t'15 a—
City/State/Zip:
Phone. #: 45O$ -5(0 1 — Of (o-1
Are you an employer? Check the appropriate box:
1. ❑ I am a employer with 4. ❑ I am a general contractor and I
employees (full and/or part-time).'
2. P I am a sole proprietor or partner-
ship and have no employees
working for me in any capacity.
[No workers' comp. insurance
required.]
3. ❑ I am a homeowner doing all work
myself. [No workers' comp.
insurance required.] t
have hued the sub -contractors
listed on the attached sheet.
These sub -contractors have
employees and have workers'
comp. insurance.t
5. ❑ We are a corporation and its
officers have exercised their
right of exemption per MGL
c. 152, § 1(4), and we have no
employees. [No workers'
como. insurance reauired.l
Type of project (required):
6. ❑ New construction
7. Remodeling
E. gDcmolition
9. ❑ Building addition
10.❑ Electrical repairs or additions
I LE) Plumbing repairs or additions
12.0 Roof repairs
13.❑ Other
•Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such.
:Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have
employees. if the subcontractors have employees, they must provide their workers' comp. policy number.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company
Policy # or Self -ins. Lic.
Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investieations of the DIA for insurance coverage verification.
1 do hereby certify under the pains and penahies of perjury that the information provided above is true and correct
Phone #• .S0 e — 6-& / — 0/ 6 7 1
Official use only. Do not write in this area, to be completed by city or town offrciaL
City or Town: Permit/Llcense #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone M
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy, please call the Department at the number listed below. Self -insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Offelals
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permiVlicense number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current
policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or
town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address, telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. # 617-7274900 ext 406 or 1-877-MASSAFE
Fax # 617-727-7749
Revised 11-22-06 www.mass.gov/dia
BUILDING
TOWN OF Y A R M O U T H ELECTRICAL
GAS
1146ROUTE28 SOUTHYARMOUTH NIASSACHUSETTS02664.4451
Telephone (508) 398.2231, Ext. 261 — Fax (508) 398-2365 PLUMBING
SIGNS
BUILDING DEPARTMENT
DEMOLITION DEBRIS DISPOSAL AFFIDAVIT
Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5,
I hereby certify that the debris resulting from the proposed work/demolition to be
conducted at
ork Address
is to be disposed of at the following location: 150 TEI,tGLy o-\ t';'5�G' aeon
-1 t(d.eD0rl , mA 0I"1 L�C1
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
Signature fApplicant
Permit No.
4�I�
Date
t'7'�an 7-1
F1(Z'
OL
Yard of BaYd1ag RapLtku and SwdaNt
HOME PWROVEMENT CONTRACTOR
RaWdtrrt 154332
2J2712009 m 254385
Type: O8A
SWAN REMODELING
RICHARD SWANFELOT
179 RESERVOIR ST.
MARL,BORO, MA 01752
AdmSalatrabr
TOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: I/ J ND)I7Iiq�Q/L{2J Map No.: Lot No.:
Proposed Improvement: % 4t)-/5' i Cl A'_col'�i to �l12,Sp»c�1L�GrttSl,C, ��-%Q�h
Applicant:,
( hc,—r -r o ht L) St'j 4.c =(- fsV.e %toC'w I _
,L-A Leo,
No.: W— 36A 7A
Filed: 4- 7-07
**Ifyou would like e-mailnotif//ication ofsign off; please provide e-mail address:
Owner Name: V eh h Pe,
Owner Address: a � Owner Tel. No.: �W - 3 lad - NP-1
I'd ,09 416 .f5k /
RESIDENTIAL AND/OR COMMERCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities.
Please submit four (4) copies of plans, to include:
(L) Site Plan showing existing buildings, water line location,
and septic system location;
(2.) Floor plan labeling ALL rooms within building
(all existing and proposed) —
Note. Floor plans not required for decks, sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
.with fee.
REVIEWED BY:
I PLEASE NOTE
COMMENTS/CONDITIONS:
ACORD_ CERTIFICATE OFLIABILITYINSURANCE CSR MR
DATE(MM1DDNYYY)
SWANR-1
02 12 07
PRODUCER
D • . Francis Murphy Ina Agcy Inc
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Marlboro Office
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
200 Main Street
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Marlboro MA 01752
Phone:508-485-8211 Faxt50S-485-4557
INSURERS AFFORDING COVERAGE---:-..- .'_. _._.
NAICA,
INSURED
INSURER A: NGM Insurance'Company -'
-14788
Swan-Remodelin --- _.__ _ _._.._._._ . _ _ _ ___ -
-Richard-Swanfe dt dba
179 Reservoir Street
Marlboro. ,MA 01752
INSURER s:-
INSURER - - - - - — -- - -
---- -- -
wsuRERD: ;,
r, , • ,• ,,,
INSURER E:
:_ .... ... ; ..
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING '.
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSK
LTR
DD
NSRD
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MWDDfM
POLICY EXPIRATION
DATE MWDDlYY
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE X� OCCUR
MPJ54837
09/26/06
09/26/07
EACH OCCURRENCE
f 5 0 0 0 0 0
PREMISESEaocarence L
f 500000
MED EXP (Any we person)
$10 0 0 0
PERSONAL d ADV INJURY
f 500000
GENERAL AGGREGATE
$1000000
GEN'L AGGREGATE LIMIT APPLIES PER
POLICY PJECTRO- LOC
PRODUCTS• COMPIOP AGG
$1000000
A
-.
.. ��.
AUTOMOBILE
LIABILITY
ANYAUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
.... . -
NON-0OWN R,_•_
M9J54837
- � - - - - � -
—_.$501,000
. ...
03/26/06
-
.L:
:.. -.
- .. --
03/26/07
._.-._.. _..
_-
COMBINED SINGLE LIMIT
(ES acadent)
f
BODILY Persw)
(Per pens°")
S250�000
X
X
BO
BODILY INJURY-
(Per acndenq. .....
X
.PROPERTY DAMAGE . _. _.
(Pera der%Q
$'100, 000..
. _.. -
.
GARAGE LIABILITY
ANY AUTO
_.
...
'..
�.-_ : __- _.
.. ..._ _..._ _
.-..:.. ::_. '.
AUTO ONLY -EA ACCIDENT
_ _. EA ACC
OTHER THAN -";
AUTO ONLY:" .._.AGG
S. ..
f_..-..
EXCESSAIMBRELLA LIABILITY
OCCUR CLAIMS MADE
DEDUCTIBLE
RETENTION S
- , ',
"'
EACH OCCURRENCE
S '
AGGREGATE -
$
-
S
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY - _ -
ANY PROPRIETORIPARTNERIEXECUTIVE
OFFICERIMEMBER EXCLUDED?
n yes. desmbe under
SPECIAL PrtOVIS:ONS helves
_
•
'
TORY LIMITS I I ER
E.L. EACH ACCIDENT
S
E.L. DISEASE • EA EMPLOYE
S
E.L. DISEASE • POLICY LIMIT I
S
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL. PROVISIONS
CERTIFICATE HOLDER CANCELLATION
Town of Yarmouth
Att: Building Dept
117 Nottingham Dr
Yarmouth MA 02664
YARMO 01 S14OULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 20 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
I
ACORO 25 12001/081
[7TdeI:1 �IKe]:I le]�11 [e]: i EkI:]
11
�AM � ainUclMa RE4ULAiKJIi�
uZ
U s
Llo«ra: CONSTRUCTON SVPEiSM• .
_
number ber: CS 0070E1
40`••
in aidaM: 0S13N1wA
ra as", Tr. no: 5030.0
4
'
Rsw(c1ot 00• -
RICHARD 9WANFE M 4
179 RESERVOIR ST
2
MARLBORO. MA 01752
IonR
_ rj
S�
N
Jennie and Ming Lee
117 Nottingham Drive
Yarmouth Port, MA 02675
508-362-8872
Proposed Work: To finish a room in the basement to Include a 1/2 bath
• Finished floor to ceiling height approximately 8 feet
• Insulation value: R13 fiberglass
• Framing of walls: 2" x 4" pressure treated bottom plate
Ceiling — suspended
Lighting:
o recessed lighting
0 1 hanging pool table chandelier
Pre-existing Items to room:
Windows: 5 measurements on floor plan
Walk -out Slider: 1 measurement on floor plan
Door to garage 1 measurement on floor plan
Pre -plumbed for 1h bath when house was built in 2001
V, bath to have:
o bathroom with toilet and sink
o ceiling fan
o lighting
Flooring:
o Berber carpeting in main room
o Tile in 1/2bath
/l 7 /Uvllj)96444 4&e
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Temp Permit No.:
Applicant Name:
Applicant Phone:
Building Location:
TOWN OF YARMOUTH
Building Department
Town Hall
Yarmouth, MA 02664
(508) 398-2231 ext.261
BUILDING PERMIT
TRANSMITTAL
T-07-368
Richard Swanfeldt
5085610167
0117 NOTTINGHAM DR
Owner's Name: S. Ming and Jennie Lee
Owner's Addres 0117 NOTTINGHAM DR
Yarmouth Port MA 02675
Owner's Telephone: (508) 362-7782
REVIEWED BY:
1. WATER DEPARTMENT:
2. ENGINEERING DEPARTMENT:
3. CONSERVATION:
4. HEALTH DEPARTMENT: -
5. BUILDING DEPARTMENT:
6. FIRE DEPARTMENT:
COMMENTS:
RECEIPT OF COPY:
(OFFICE USE ONLY
Recorded By.
Ic
Permit Fee:
$0.00
Deposit Rec:
$25.00
Payment Type:
Check ChkNo.: 1016
Net Owed:
($25.00)
Application Date: 2/12/2007
Issue Date:
Expiration Date
PLEASE NOTE
SIGNATURE OF APPLICANT:
Comments: Map/Lot: 150.31.1
construct familyroom in basement
DATE:
DATE:
DATE:
DATE:
DATE:
DATE:
WA:
N/A:
WA:
N/A: - - -
N/A:
WA:
DATE:
Date Printed: 3/5/2007
117 IW
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(TOWN OF YARMOUTH
REVIEVED FOR BUILDING AND ZONING CODE COI,SPLI-
ANCE, ERRORS OR OMMISSIONS DO NOT RELIEVE THE
APPLIC ANT FROM THE RESPONSIBILITY OF'AS BUILT'
COMPLIANCE.
DATE: �0 7,k kz 6'
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TOWN OF YARMOUTH
f ' 1 Pi� r l �Fj
MAR 3 0 2007
B u i LEI N G,�I.,tV
APPLICATION FOR PERMIT TO DO PLUMBING
ey�lt'� (OFFICE USE ONLY)
Fee: $ 1* 69 63
PERMIT NO. 07-1e-60
Date
Building I .l �e.0 I n 4 w Owner's
AT: Location
G c
Type of Occupancy
New ❑ Renovation ❑ Replacement ❑
Plans Submitted Yes ❑ No ❑
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SUB-BSMT.
BASEMENT
'
1ST FLOOR
2ND FLOOR
3RD FLOOR
(PRINT OR TYPE) /
Installing Company Name P/1�� l
Address 0?( D l0 17v t
Business Telephone t5 b T 7 % 6 SUO
Check One: ���
0—Corp.
❑ Partnership
❑ Firm/Company
Name of Licensed Plumber��
INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent. Check One: Yes 9— No ❑
If you have checked YES, please indicate the type of coverage by checking the appropriate box.
A liability insurance policy Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of
the Mass. General Laws, and that my signature on this permit application waives this requirement.
Signature of Owner or Owner's Agent
I hereby certify that all of the details and Information I have submitted
(or entered) In above application are true and accurate to the best of
my knowledge and that all plumbing work and Installations performed
under Permit issued for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plumbing Code and
Chapter 142 of the General Laws.
Check on Owner ❑ Agent ❑
Signature of Licensed
Plumber
�ILSZ
License N mber
Type: MasteKJourneyman 0
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Mauachusetu Electrical Code, (MEC), 527 CMR 12.00
(OFFICE USE ONLY) (Rev. "S)
By —
Fee: $ J U
PERMIT
—2�17�_
(PLEASE PRINT 1N INK 014 TTtE_ALZ7N1 ORMATICjN) Date:
To the Inspector of Wires: By is application cation the undersigned gives notice of his or her intention t perform the electrical
work described below. {�
Location (Street & Number) 07
7.
Owner or Tenant M 1 r^T { 7 L: ri 1 L21- L L� Ir Telephone No. CO
Owncr'sAddress -3AM LE
Is this permit in conjunction with a building permit? 0 Yes ❑No (Check Appropriate Box)
Purpose of Building Z(ASCP'i0" R k -7 M cyfJ >L c Utility Authorization No.
Existing Scrvice �00 Amps i Z 0 1 r t(! l/olts Overhead❑ Undgrd Sr No. of Meters
New Service Amps / Volts Overhead❑ Undgrd ❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed electrical Work: 51ASL'7"C"T RL1-1660 'L-C,� N 1+
GIGH`t5,gwt�cE1L5 'LUGS, A-r�n ?F(cr'z�'tc_qT%l
Completion n0he followin a table may be waived by the Inspector ofWirrt
No. of Recessed Luminaires
No. of Total
Transformers KVA
No. or Luminaire Outlets
No. of Hot Tubs
Generators KV
No. of Luminaires
ve n-
SwimmingPool rod. Clmd. ❑
o. o rnergency, ighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches /
No. of Gas Burners
o. o Detection an
Inidating Devices
No. of Ranges
Na of Air Cond. Tons
No. of Alerting Devices
No. of Waste Disposers
Hew Pu mp
Totals:
um er
ons
—
— —
No, of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
S ace/Area Heating KW
P 8
dal ❑ Municipal Connection ❑ Other
No. of D
Dryers
ry
Heating Appliances KW
8 pp
Security Systems:*
No. of Devices or Equivalent
No. of Water
Heaters KW
o. of No. of
Signs Ballasts
Data inng:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or uivalent
Attach additional detail if desired, or its required by the bupector 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. I he undersigned certifies that such coverage is in
force, and bas exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE P BOND❑ OTIiER❑ (Specify:)
(Expiration Date)
t Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion.
NI certify, under the pains and penalties of perjury, that the information on this application is true and complete.
FIRM NAME: , (ZLA•-.r0 5uL-Zk c:Z 9( LIC. NO.U_S76
Licensee: cTUN+� C_ E-(L 1_(irv0 Signature LIC. NO. oO 5,6c_
(If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: 7 -S6' - d
C\Address-'2 4e'621 L_ v7 t2 m /A O f l �i `l Alt. Tel. No.: So 9 - Q (7 - 417.9
'Security System Contractor License required for this work; if applicable, enter the license number here:
v OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the liability insurance coverage normally required by law. By my signawre
c� below. I hereby waive this requirement. I am the (check one) owner owner's agent. ❑
Owner/Agent
Signature
uewew o[rwa ( �/V
Old King's Highway Regional Historic District Committee
/ in the Town of Yarmouth for a
CERTIFICATE OF APPROPRIATENESS
Q�0
Application is hereby made in triplicate, for the issuance of a Certificate of Appropriateness under Section Po
Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described
below and on Plans,
drawings or photographs accompanying this application for:
CHECK CATEGORIES THAT APPLY: 00py
1. Exterior Building Construction: ••New Building ••Addition ✓Alteration
Indicate type of building: 1p4louse • Garage • •Commercial • •Other
2. Exterior Painting:
3. Signs or Billboards: • •New Sign • •Existing Sign • •Repainting existing sign
4. Structure: • •Fence • •Wall • •Flagpole • Gther
TYPE OR PRINT LEGIBLY , I 1'I DATE:_
ADDRESS OF PROPOSED WORK: 119 A)01hn AA•M De i0e.* _ ASSESSORS MAP NO.- �5U
OWNER: M);iq and jeNnl�, Z e— ASSESSORS LOT NO.: y�
HOME ADDRESS -
TELEPHONE NO S"" ' 3 b l — 9PP71A
AGENT OR CONTRACTOR: TQ D TELEPHONE NOcSVe - 8/b-e6-8'f.:
ADDRESS:
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 necessary).
eV
P/case see fZc shed paPeruvvrlc `i' d,Lt&a'_ du y�8c
Z�:reaw fo landsea c, and deck dn
< Z:
PPRt1kED m
} L Y M00TH LQUITI-a=
Signed AI(liN �` I
wnerlContractor-Agentt
Space below line for Committee use only. 23�\
Received
Date: This Certi6cat re Date 4d di-- O
DISAPPROVED ••
provided in the Act.
Please return to: Yarmouth OKHC District Committee, Yarmouth Town Hall,
1146 Route 28, S. Yarmouth, MA 02664
I
SPECIFICATION SHEET (YARMOUTH OKHC)
Please fill out this form in its entirety, providing color chips where necessary. Indicate landscaping, exterior
lighting, and electric meter location on site plans for new houses.
ADDRESS: 117 AA91-41nq ti Q m D/e.
1
FOUNDATION MATERIAL (e.g., concrete/other. Note: maximum exposure is 18"):
DRIVEWAY MATERIAL: WALK WAY MATERIAL: pavers
STEPS MATERIAL (e.g., brick, cement): Qrant le�
SIDING TYPE & MATERIAL:
CHIMNEY (e.g., brick/stucco/wood faced):
ROOF MATERIAL:
PITCH (7/12 Minimum):
MAX. EXPOSURE:
WINDOW MATERIAL (e.g., wood, vinyl) - grilles are required:
Indicate sizes, if not listed on plan elevations:
DOOR MATERIAL (Indicate wood/other):
Indicate sizes and style, if not listed on elevations:
TRIM MATERIAL: (e.g., wood, vinyl, aluminum)
(Note: all windows & doors must be trimmed with 1 x 4 or 1 x 5)
SHUTTER MATERIAL & TYPE:
(e.g., wood/vinyl, paneled/louvered)
GUTTER MATERIAL (e.g., wood, aluminum):
GARAGE DOORS (indicate size & style):
STORM WINDOWS & DOORS:
(indicate sizes if not listed on elevations)
SKYLIGHTS (indicate type &size):
WOOD DECK (indicate size): le )(41 t cS�S
COLOR:
COLOR:
COLOR:
COLOR:
COLOR:
• COLOR:
COLOR'
COLOR:
COLOR:
n
COLOR:
DTI
COLOR:
U
COLOR: rn e
�J
WOOD FENCING: STYLE: COLOR:
(Show layout & running footage on site plan. Note: Max height is 6 feet)
RETAINING WALL (e.g., pressure treated or fieldstone):
(show layout & running footage on site plan. Note: concrete is inappropriate)
SIGNS: (indicate size, style, colors) COLOR:
SIGN POST: (indicate size, style, color) COLOR:
August 15, 2004
117 Nottingham Drive, Yarmouth Port
Front of house:
1. Remove [several] feet of asphalt at beginning of driveway and replace with a cobblestone
apron.
2. Remove asphalt from upper parking space. The surface will be a [TBD] colored stone. Use
[two] pieces of granite for steps to leave parking area and step onto a new walk leading to the
front door.
3. The new walk will be approx 48" wide and 70'. The walk should be wider near the steps to
create a broader landing. There should be a gentle curve in the walk leading to the front door.
[Material for walk is TBD for price quote purposes use brick.]
8 —i
4. The brick walk currently in the front yard is to be removed. The large brick stet adiu� to
the farmer's porch will also be removed. No steps will replace them.
m %0 -�
S. Create a bed in front of the porch and dining room window for a large rock or t�and r 0
shrubs. [At this time, we still need to determine whether to use bark mulch or stpej] _ M __j
6. Place a cobblestone border around all beds in the front yard. Also, the black steel edgirS' on
the left side of the house should be replaced with cobblestone. The section of lawn now
covered with weeds on the left side of the house will be covered with the same gravel that is
already there and included in the cobblestone -bordered area.
7. Add a natural stepping stone walk to lead from stone parking area along the fence to the
wrap -around deck extension (16' x 4')and a new set of stairs (15) leading down to the lower
parking area. The wrap -around deck extension and stairs will be mahogany to match existing
stairs leading to the back deck. The new stairs will run parallel to the large stone retaining
wall currently in lower driveway. Attach lattice to underneath of stairs and the large piece of
foundation by walkout slider. Posts currently holding up deck should be clad to match
existing trim. Attach lattice to underneath existing stairs to match lattice underneath new
stairs. Weed and add mulch to the strip between the driveway and the stone wall.
8. Fix front lawn (eradicate weeds and re -seed — or remove the lawn and hydro -seed). A �rriall
bed should be created around the outside lamppost. Also, the irrigation in the front yard
should be removed and replaced with new lines and heads.
Rear and side of house:
9. Along the stone wall separating our house from the neighbor's, create a bed for one or twoGTy
large rocks and planting of shrubs. This bed is to be mulched using pine barkpu' lch. oo ;o
10. The area currently underneath the existing deck should be scraped up to create a path.using a
f diBrent colored stone from the walkout slider. Also, the area to the right should be leveled.\""N .
��•' if (1.W.
� t
The area will have the same [TBD] colored stone spread throughout the area. Remove
existing debris.
11. To deal with the banking overlooking Hockanom Road, bring in fill and push it over the
edge to create a more even and gentler slope. Slope should be mulched for a nice clean
appearance.
12. Add stone steps to go down to Hockanom Road.
13. Create a tapered S wide mulched bed to the right of lower driveway (as you enter). The area
beyond that should be tilled and raked to prepare it for ground cover and a wild flower field.
A wild flower seed mixture and ground cover will be planted to encompass the vacant area
that is currently dirt and weeds. Thin out cluster of small pines and oaks, leaving only half
the number of pines, just the smaller ones, and mulch.
[Items in square brackets are TBDJ
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blue -gray gravel stream winds its way through a narrow space between
the house and the garden wall. The banks of the stream are made of
coarser tan gravel; boulders sit on the stream edge, making a gorge for
the water to flow through. Stepping -stones —large, thick, irregular
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Print Sununary
Page 1 of 1
MBLU :
No Image Location:
Account Number:
150/31.1///
117 NOTTINGHAM DR
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Old Kingls Highway Regional Historic District Committee' ' , "
in the Town of Yarmouth fora
CERTIFICATE OF APPROPRIATENESSr�3 CCC 18 /'i°I IQ I F3
Application is hereby made in triplicate, for the issuance of a Certificate of App � de ection 6
of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as ft
w and on
plans, drawings or photographs accompanying this application for.
CHECK CATEGORIES THAT APPLY:
1. Exterior Building Construction : p New Building p Addition p Alteration
Indicate h'pc of A House [3 Garage p Commercial p Other
2. Exterior Painting: A
3. Signs or Billboards:
p New Sign
O Existing Sign
O Repainting existing sign
4. Structure A Fence
13 Wall
O Flagpole 13
Other
TYPE OR PRL1T LEGIBLY
DATE NCO • ZP+, op� oo 3
ADDRESS OF PROPOSED WORK_I11 %VOt'41rlq�nziNl ASSESSORS MAP NO. ISO
OWNERrA =hd TeV1V11' I.eG ASSESSORS LOT NO. 3l• l
HOME' ADDRESS �" 1 4nJrh TELEPHONE NO.5o$- 4a38
F�Zt m►n a
havh , YVIA olhol -a ��S' S08- d�-8$?a-
AGENT OR CONTRACTOR UA TELEPHONE NO
ADDRESS
USE ATTACHED SHEET IN PACKET FOR ABUTTING OWNERS
DETAILED DESCRIPTION OF PROPOSED WORK Give all particulars of %vork to be done including materials to
be used In case of signs, give locations of ods►ing signs and proposed locations of new signs. (Attach additional sheet, if
necessary).
I.
CV%MAe, GuxrtXr j" ` I,c n K " �E-cu» co 1 or -40 Ben Jam I h WLco re.
kb)dVtc', Color "lpratndcrcv Oliva" — V.&plan +0 Vt-LP CkkrYtn+-
41' yy%c-olor - oil 4mi1l' and l�-gf'sccti o� house.
."Z . Re MOVt_ av►-c=L rt f I twee. 5 Plt, t- ro-Zj . +erlca- to � ai- '(:�o ni-
ri Signed
2 tvft, C mo oYl 1o5� nerCo
]C@ tYtOn ac r- gent
\V t10P n nm .ti can n
Received by OKIIC
Date This Certificate is hereb0,4Z Date O
Check % i
By.4 c
APPROVED p IMPORTANT: If Certificate is approved, approval is subjeu to the 10 day appeal period
provided in the Act.
DISAPPROVED p Please return to: Yarmouth OKIIC District Committee
Yarmouth Toun Hall, 1146 Route 28, S. Yarmouth, MA 01664
-1
l3(AA� i'
w
1
SPECIFICATION SHEET (YARMOUTH OKHC) ; ` ; ; I (� I J TH
Please fill out the form in its entirety providing c; or\ `;''!N -Ah re
necessary. INDICATE LANDSCAPING, EXTERIOR LIGHTING & EL�CTR(�CMETER ON SITE
PLANS FOR NEWHOUSES UJJ Ut B
ADDRESS: /i #7 No*n' q Aam De. REG L IVED
1
FOUNDATION (18" MAX. EXPOSED): CONCRETE/OTHER DRIVEWAY:
WALKWAY: STEPS (INDICATE BRICK/CEMENT/OTHER):
SH)ING TYPE & MATERIAL:
CHIMNEY (INDICATE BRICK/STUCCO/WOODFACED)
ROOF MATERIAL: PITCH (7/12 MIN.)
MAX EXP.
WINDOWS (GRILLES REQUIRED)—(WOOD/OTHER)
INDICATE SIZES IF NOT LISTED ON ELEVATIONS:
DOORS (WOOD/OTHER)
(INDICATE SIZES AND STYLE IF NOT LISTED ON ELEVATIONS):
TRIM: (ALL WINDOWS & DOORS TRUvIlvIED WITH M / IX5)
MATERIAL OF TRIM: (WOOD, VINYL, ALUMINUM)
SHUTTERS (WOODNINYL) (PANET /I UVERED)
GUTTERS (WOOD/ALUMINIM:
GARAGE DOORS: SIZE & STYLE:
STORM WINDOWS & DOORS:
(INDICATE SIZES IF NOT LISTED ON ELVATIONS)
SKYLIGHTS: TYPE/SUE:
WOOD DECK: SIZE:
i
:00RA
ENCING (MAX. HEIGHT 6): STYLE: �` iY�tnGP��C$�Li�/� mly o
YOUT & RUNNING FOOTAGE ON SITE PLAN) Ju
'A n5 i l.t j wxs{ pa+ O-Aps
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: Propi4i4w
of fVl
COLOR:
COLOR:
COLOR:
COLOR:
COLOR:
COLOR:
COLOR:
COLOR:
COLOR:
COLOR:
COLOR: bo�U
COLOR:
COLOR:
REV. 12/02
.. anWg U°'1t1'
`HA�ML
VARAI UM O
°"`IN=
� " Old King's Highway Regional Historic District Conirn �c^Rl CLERK
in the Town of Yarmouth for a -fO `V V' V
CERTIFICATE OF APPROPRIATENESS Zm ApR - u u
Application is hereby made in triplicate, for the issuance of a Certificate of AppropA der S'� 6
of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on
plans, drawings or photographs accompanying this application for.
CHECK CATEGORIES THAT APPLY.
1. ExtaiorBuilding Consg4dii: LTNewBuilding [3Addition D Alteration
Indicate type of budding U House Q Garage Q Commercial p Other
2. Exterior Painting 13
3. Signs or Billboards: 17 New Sign C1 Existing Sign 17 Repainting existing sign
4. Shua= p Fence p Wall p Flagpole p Other
TYPE OR PRINT LEGIBLY / DATE_ 3:n
ADDRESS OF PROPOSED WORK I L! ^ / 0•r%/ry, AA -en -ASSESSORS MAP NO.
OWNER STepok e *t M gFR�v r r Nrt ASSESSORS LOT NO.
HOME ADDRESS__- / /'7 No rTiyq X.4 m 7% /L • TELEPHONE NO.
AGENT OR CONTRACTOR �//^/��l ! TELEPHONE NO /i V 9 z2 z
776 4 /
ADDRESS /t'1 �a • �✓ p S7 e Ikyl /l P J�%/f
USE ATTACHED SHEET IN PACKET FOR ABUTTING OWNERS
1'�RP,;Jiii7• r
'ITT a
DETAILED DESCRIPTION OF PROPOSED WORK Give all particulars of work to be done �indudiag ma 0
be used In case of signs, give locations of existing sign and proposed locations of new signs. (Attach additional sheet, if
necessary), t•
Qe.rl"Sr 4p,0"VAI JrVA- �a�/ord.,w/ elq�y<s (as 6u' 1A
/ 'Sretn TO/C iL i.dslt'AO of 0PCr' '01R /4S
Z • LeinDeto 61..ass art+a Mice APO'"ve'o 6 pq veL ekre/'•on. �o�-r Zaev.L
3. ant/C eli...,nry carte• F.uls� cti..•�„¢Y T /y.�Tc% on/a,c /�cu5,3 o•v zfin�.
Signed 1 �^
Space below line for Committee use only. Owner -Contractor -Agent
Receive by OKHC
Date 3 S—n / s Certificate is h D�3 ,�--
Check d Jr�3 4 44
By
APPROVED p IMPORTANT: If Certificate is approved, approval is subject to a 10RyappLcal rod
provide in the Act.
DISAPPROVED p Please return to: Yarmouth OKHC District Committee f Copy
Yarmouth Tov-u Hall, 1146 Route 28, S. Yarmouth, MA 02664FILE
SPECIFICATION SHEET (YARMOUTH OKHC) P 'wAq�
Please fill out the form in its entirety providing c' s1 ere
neCmary. INDICATE LANDSCAPING, EXTERIOR. LIGHTING & EI. L' ,R TE
PLANS FOR NEW HOUSES I V L
PROPERTY
ADDRESS: l ? 'UD'r'"/vg ��Z • 1m1 APR -4 AN I�
FOUNDATION (18" MAX. EXPOSED): CONCRETE/OTHER DRI&EIVED
WALK WAY: STEPS (INDICATE BRICK/CEMENT/OTHER):
SIDING TYPE & MATERIAL: COLOR:
CHIMNEY (INDICATE BRICK/STUCCO/WOODFACED) — z1!>r1 e 1L COLOR:
ROOF MATERIAL: PITCH (7/12 MIN.) COLOR:
MAX. EXP.
WINDOWS (GRILLES REQUIRED) -INDICATE SIZES IF NOT LISTED ON ELEVATIONS:
DOORS (INDICATE SIZES AND STYLE IF NOT LISTED ON ELEVATIONS): COLOR:
rrv.vr ano" . .41 n,exrloat&
TRIM: (ALL WINDOWS & DOORS TRIMMED WITH im / 1X5) COLOR:
MATERIAL OF TRIM: (WOOD, VINYL, ALUMINUM)
SHUTTERS (WOOD/VINYL) (PANELED/LOUVERED) COLOR:
GUTTERS (WOOD/ALUMINUM): COLOR:
GARAGE DOORS: SIZE &STYLE: COLOR:
STORM WINDOWS & DOORS: COLOR:
(INDICATE SIZES IF. NOT LISTED ON ELVATIONS) APPROVED 1 .
SKYLIGHTS: TYPE/SIZE: YARN1,00i COmwTTEE COLOR:
O�CHRD %
DECK: SIZE & MATERIAL: ~� COLOR:
FENCING (MAX. HEIGHT 61): STYLE: _ „_ ,,:; -An?: COLOR:
(SHOW LAYOUT & RUNNING FOOTAGE ON SITE PLAN)'
RETAINING WALL: (P.T. OR FIELDSTONE -CONCRETE INAPPROPRIATE)
(SHOW LAYOUT & RUNNING FOOTAGE ON SITE PLAN)
SIGNS: (indicate size, style, colors) COLOR:
SIGN POST: (indicate size, style, color) COLOR:
ADDITIONAL Fo re it, oai �vrN 5,rje %Ab 61A5 o 1�aenT3
INFORMATION: -/
14; A`vbo-�'oni To SCreen-5 A5 oceg,.,i_jly revuCiTCL - J.•%
REV. 12/01 NS 1^AilS 33b1LT /•Vib Pv velS TH,vT
$C�{/AsS Lcl�i/G /i p,,ovibL Abbl�o.vgG S�O�ejct / Ac�L
m rFbrc A ioo it ?J u7s / b G 9 n4 bG w,/� be
A p PaX/rrAiP ly 26 �/, /
SPECIFICATION SHEET (YARMOUTH OKHC) cAggqg�
Please, -fill out the form in its entirety providing Wj "jiff 1-fhere
)IeCBSS[lry. INDIGITE LANDSCAPING, EXTERIOR.LIGHTING & g p E SITE
PLANS FOR NEWHOUSE& v �v
PROPERTY ��z. 1m1 APR -4 AN 0
ADDRESS: l l ? 'U� �/ clg % A �n
FOUNDATION (18" MAX. EXPOSED): CONCRETE/OTHER DIVED
WALK WAY: STEPS (INDICATE BRICK/CEMENT/OTHER):
SIDING TYPE & MATERIAL: COLOR:
/CHIMNEY (INDICATE BRICK/STUCCO/WOODFACED) COLOR:
ROOF MATERIAL: PITCH (7/12 MIN.) COLOR:
MAX. EXP.
WINDOWS (GRILLES REQUIRED) -INDICATE SIZES IF NOT LISTED ON ELEVATIONS:
V00-DOORS (INDICATE SIZES AND STYLE IF NOT LISTED ON ELEVATIONS):
r.-V,V ' '1o� A5 /nenrioNtd
TRIM: (ALL WINDOWS & DOORS TRIMMED WITH 1X4 / 1X$)
MATERIAL OF TRIM: (WOOD, VINYL, ALUMINUM)
SHUTTERS (WOOD/VINYL) (PANELED/LOUVERED)
GUTTERS (WOOD/ALUMINUM):
GARAGE DOORS: SIZE & STYLE:
COLOR:
COLOR:
COLOR:
COLOR:
COLOR:
STORM WINDOWS & DOORS: COLOR:
(INDICATE SIZES IF. NOT LISTED ON ELVATIONS) APPROVED
SKYLIGHTS: TYPE/SIZE: YARh9ouTF1 COWAITT; 5 COLOR:
��,O�t
DECK: SIZE &MATERIAL: OKHRD COLOR:
FENCING
FENCING (MAX HEIGHT fl: STYLE: :COLOR:
(SHOW LAYOUT & RUNNING FOOTAGE ON SITE PLAN) •--
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)
COLOR:
COLOR:
ADDITIONAL �o re �i, on/ drN S,rje hflIS 6lAa 6 i.UxnT3
INFORMATION:
Idl A'vb� �o ;v To ljercie A-5 oct 4 11 y ree oche b - �T
REV. 12/01 �5 /y,eTl G rAd:3 i301LT IW, b f a.✓elS
a l sa h
$CfC� A, S( %CASs l�'G /� �nov/bL A bbl�o.,/,p G 5'O�eTy �vc2
TNe v/1-41110•C Siam r-b�c k/oo �.
,� praxi•ra7t /y 26 //,
TOWN OF YARHOUTH
• _ CEHTIPIC � ISSUED
DATE
BUILDINGIPE I`tIY;�. .
CERTIFICATE OF OCCUPANCY
.-` PERMIT NO. DATE Ja+nu,a.�'y 25. 2001
APPLICANT Char. R. Crovo/Dunhall AMOI�f6AGlnies 776 Hain St Osaenrille,�A
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO.. NEW CONSTRUCTION I. STORY �/• DWELLINGUNITS 071165
)TYPE OF IMPROVEMENT) INO. (PROPOSED USE)
117
Nottingham Lane,
Y. P. - ZONING
AT )LOCATION)
DISTRICT R-40
(NO.),
(STREET) ; r
.a
BETWEEN
AND
T
Q
(CROSS STREET)
- )CROSS STREET) '
m
SUBDIVISION- 150/31.2
LOT 7517 BLOCan 133 ' slzE 1_ni `
U
m
BUILDING IS TO BE -
•
FT. WIDE BY -
FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
-
O
_
,. t.i
i
TO TYPE 5-B
USE GROUP R-4
BASEMENT WALLS OR FOUNDATION
(TYPE)
O
LL
REMARKS: ffeX c--nnutrnir-ttnn,
d bedroom
finisxhnA basement 7 car garagov lower
level, walk out level.
As per plans dated 6/12/00.
Z)'l,(.CIA=GTl��.1��RtJT�L+lZrZ)�l.T!1=G�l ��Trlr�f.T�fr_L�l7t)�Is1_�sl.
AREA OR
VOLUME
(CUBIC/SQUARE FEET)
OWNER
C
ADDRESS
r. DEPARTMENTAL APPROVAL FOR CERTIFICATE
of OCCUPANCY and COMPLIANCE
To be filled in by each division indicated hereon
i upon completion of its final inspection. ,
BUILDINGS Permit No. 0�' ,I`�7
',Approved by hif Date
M/
PLUMBING Permit No.
Approved by T Date
Remarks
ELECTRICAL Permit No.
M
Approved by Date
Remarks
/- ay- cpx
OTHER A&2tIZ1L—Permit No. /ice ' �3
Approved by yu Date.
r.
Remarks
OTHER Per it o.
Approved by Date �� 1
Remarks
it
., -
TOWN OF YARMOUTH
TD
FIELD COPY
BUILDING
PERMIT B-01-487 DUPLICATE COPYi.
DATE .lIITlnai �l 25� Zn�l PERMIT NO. R-ill-487
APPLICANT Char_ R_ Crnvn/Dtnhnll .n. ADDRESS 776 Knin itrnet OctprVilln_ 071165
(NO.) (STREET) (CONTR'S LICENSE)
PERMIT TO -neT.t ennrtrveti nn )_) STORY NUMBER OF
DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE) ,
ZONING
AT(LOCATION) 117 llnttingham L:ITTP 4 P_ A? 7S DISTRICTR 40
(NO.) (STREET)
a BETWEEN AND
A
1 (CROSS STREET) (CROSS STREETI
a.SUBDIVISION 150/31.1 LOT Z57 BLOCKmap 133 LsZE- 1.01
t
U '
O BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
m
O
iTO TYPE S_Tk USE GROUP �T� -(y BASEMENT WALLS OR FOUNDATION
¢ (TYPE)
4 REMARKS: NEW CONSTRUCTION, # BEDROOM. FINISIiED BASEMENT b CAR GARAGE. LOWER LEVEL. WALK
OUT LEVEL. AS PER LANS DATED 6/12/00.
AREA OR
VOLUME ESTIMATED COST $ 454-104 00 FEEMIT $ 9297 OO
(CUBIC/SQUARE FEET)
OWNER ritenhen Rerniche
ILDING DEPT.
ADDRESS 15 Willie Rory Rnnd Y P 07675 BY
.- -
INSPECTION RECORD
DATE
NOTE PROGRESS - CORRECTIONS AND REMARKS
INSPECTOR
TOWN OF YARHOUTH FlELD COPY -
1-a5•or 6-01-qg
BUILDING
C� 319 � a.7�7 00
PERMIT
E January 25, 2001 PLRMIT NO. B-01-48.�
APPLICANT . R OVO Dunk AVecQpanies 776 Hain St. OSa8rv111H, MA
(NO.) (STREET) (CONTR'S LICENSE)
PERMIT TO NEW CONSTRUCTION-) STORY
(TYPE OF IMPROVEMENT) NO.
(PROPOSED USE)
NUMBER OF
DWELLING UNITS 071165
117
Nottingham Lane,
Y. P.
AT (LOCATION)
DI TIR CT R-40
(NO.)
(STREET)
a
BETWEEN-
AND
m
(CROSS STREET)
ICROSS STREET)
m SUBDIVISION
150/31.1
.�C�7LOT
LOT Z57 BLOCHap 133 512E 1�D1
U f
"
0 BUILDING IS TO BE
FT. WIDE BY
FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
O
f TO TYPE 5-13
USE GROUP R_4
BASEMENT WALLS OR FOUNDATION
¢
(TYPE)
O
4
REMARKS:
-"intinn_ 4 haArmewii_
finighaA hnnamnnt_-2_r•—tr_rrararnsa_ lnwnt-
level, walk out level. As per plans dated 6/12/00.
AREA OR
VOLUME ESTIMATED COST $ 454,104.00 FEEMIT $ 2297000
ICUSIC/SQUARE FEETI
OWNER ADDRESS StepZle— �—rn�C�l6 BBUILDING DEPT. (�v
-15-FI
P.
INSPECTION RECORD
1--
DATE
NOTE PROGRESS - CORRECTIONS AND REMARKS
INSPECTOR
v.
�UC7P/'/�
1 �'
v
.• •OF•YAR�Ir
' O(� -3
G M.TTACMI[f
• � F•.I-wl\•1 •
' _ ..
ONE & TWO FAMILY ONLY - BUILDING PERMIT
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
Town of Yarmouth Building Department
1146 Route 28 Yarmouth, NIA 02664 t492';7v _ ��
Tcl: (508) 398-2231 x261 • Fax: (508) 398-2365 S/�
Office Use Onl
PermitNo�=0(= Date ���
Permit Fee $ ya97. —
Deposit Rec'd. $ 5P, 0 DateL Q�
Net Due $ ),?q7, '
Planning Board Information
Plan Type H•�'1z•
EndorsementDate3�,9�
Recording Date Z 13 6L
Plan No.12988
Dther R 8, I53%G
Assessors Department Information:
Map Lot Map Lot
!33 z S? /� /.
Old New
C.
1.4 Property Dimensions:
3
Lot Area(sf) G Frontage (k) Lot Coverage
This Section for Office Use Only__ --_-----------
BuildingPermit Number:-----._
Date Issued:
Signature:
Building Official Date
Certificate of Occupancy
is is not required
Section 1 - Site Information
I Use Group: R-4 Type: 5-B
1.1 Property Address:
11-i MoV� rA\n �U n e
1.2 Zoning Information:
R 40
IZtzsldenhctl Same_
Zoning District Proposed Use
m [�, I h D Of l'
1.3 Building Setbacks (ft)
Front Yard
Side Yards
Rear Yard
Required
Provided
Re u' ed
Provided
Required
Provided
p'
3D
6 `
"13 / 12D
`
S�
1.4 Water Supply (M.O.L. c. 40. S 54)
Public ✓ Private
1.5 FloldZonalnformation: Comments:
Zone: C BFE:
Section 2 - Property Ownership/Authorized Agent
2.1 Owner of Rec rd:
N e (p ' Mailing Address
Sig r Telephone
horized Agent: /
a e print Mailing Address
jqijgxfituro p elephone
Section 3 - Construction Services
3.1 Licensed Construction Supervisor:
hn r 1 S Cyc,Vo`T I�unhtl)OhmDQflleS
Not Applicable ❑
N:al-n J1 T t�
ry I I LD I `i A
License Number
1
A re
s �
a� _
JM-
. Lion Date
u e Telephone
3.2 Registered Home Improvement Contractor:
Company Name
&Ulivable
E
❑
Liven
Number
Address
Signature Telephone
Expiration Date
9- 15-99
1 of 2
OVER %
Section 4 Workers' Compensation Insurance Affidavit (M.G.L c. 152 S 25C
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure
to provide this affidavit will result in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes .V....... No ..........
Section 5 - Description of Proposed Work (check all applicable)
New Construction I No. of Bedrooms No. of Bathrooms
Existing Bldg. ❑ Repair(s) ❑ IAlterations ❑ I Addition ❑
Accessory Bldg. ❑ Type Demolition Other
Brief Description of Proposed Work:
Section 6 - Estimated Construction Costs
Item
Estimated Cost (Dollars) to be
completed by permit applicant
1. Building
:Soo, O e>
2. Electrical
0 000 . 00
3. Plumbing / Gas
00. O O
4. Mechanical (HVAC)
00 . O O
5. Fire Protection
6.Total=(1 +2+3+4+5)
7. Total Square Ft. (new houses & add'Aions)
L [�
n
Specify:
Check Below
❑ Conservation -Commission Filing
(if applicable)
(Old Kings Highway & Historical
Commission approval
(if applicable)
rization - To be Completed When yl y �dy —
tDr ADDliesRor Buiidinq Permit
I, k- _YW4'1tL"4 7 k /w Yz , as owner of the subject property
hereby authorize
mypghalf, in all matters relative to work authorized by this building permit application.
Owner
Section 7b - Owner/Authorized Agent Declaration
Date
to act on
I, 0 AAn, ( Lx z 'L CrCSUO 9— , 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.
Chr1Y le s � Croyc� JT`
Print me
Signature of Owner/Agent Date
9- 15.99 2 of 2
3roYgRe TOWN OF YARMOUTH
0
BUILDING DEPARTMENT
BUILDING PERMIT APPLICATION SIGN OFF
Applicant L>LL 11� I I I_` QmDn n 1 e � } Building Permit No.:
Address:l l C9 I`I CA j n S1. 1-X Q-1V 111 e Tel. No.• yab'92-Z2 Date Filed:
Bldg. Site Location: III h1Qj�1Whr1Qn t n Map No.: ) 5O Lot No.: 3) • I
car rh oath �br }
The following information outlines the proce ural 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 COA IISSION: 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.
----------------------------------------
77te following Departments must sign off, in the respective order, prior to building inspector issuing the required
building permit.
REVIEWED BY:
1. WATER DEPARTMENT: DATE: ' O 7 -1-2-� N/A:
2. ENGINEERING DEP TA ENT: DATE: 2 00 >mm
3. CONSERVATION: DATE: / -1!C ad N/A:
4. HEALTH DEPARTIIIENT: DATE: /Z //�07� N/A:
INDUSTRIAL AND/OR COMMERCIAL PERMITS
5. WIRING INSPECTOR: _
6. PLUMBING INSPECTOR:
7. FIRE DEPARTMENT: —
PLEASE NOTE
All stumps andlor brush must be disposed.of at an approved site.
COMMENTS:
DATE:
N/A:
DATE:
N/A:
DATE:
N/A:
8/99 Applicant Signature <[u.4�o f I d I` Y 4 ,LGJ Date
TOWN OF YARMOUTH BUILDING DEPARTMENT
PLAN REVIEW & BUILDING PERMIT APPLICATION REVIEW NOTES
Address: // 7 /fO T TiK c-,,vw n 4-,q y L
Map / Lot: / So l3/, / �33�aS7�
Date of Initial Revtew: /��Other. Approval Date:
Inspector: 17. 9 H Ylv D .
Notes:
oK��So� O�i LF? 7a � .�PF.n-s % oti n FiN�sla 3? -1 t2,�
Z (?li dD vo 1 7 -4,&CS TV 1'NSP774& Prt in2 Col o I�GG �ozT!lc�g J',"S To �E Fa�m¢D 2f! PC.l9-cam
yhST//w 5Lf}l3LS�'OefL CODE S'a�T. 36a�`rW/eokYltoc �KTr
jG��►��rrG w�r�,N a' o tuAf47- .50"C
�iLO✓l Diz ENG(ZF a� rn Fon K
�FO�NDATfi�k/rliN. /,[�$riLOw AMP b-"QBave FiN�r�cD G'�rnD�
,L,fH¢ Gp+.4 r04 L'/p FG,
1.4 &-rric Accd- Nor rk Ci-osc�T- ?
_svc,s N�rrc,y
l P/Lo✓r ok Gqs FlP. i7stra � rtR,
/3 tIOD YcnX:voD-r S'GC. oF
►2a.6K 4"0)--P BOV4-ct� 1zEp/ /oacH ANDCoCD /o�cce
�IY�c'°a Fi2an,• (,=Art.nG� CAA-iv,v c r O?�K J%!2¢crG.y.Zi4ro R 3/�e
Zoning Denial (if applicable):
Section 10432, pare Change, Extension or Alteration (pro c&ting,
nonconforming)
The proposed requires a Special Permit from dre Zoning Board of Appeals.
Other I
Building Code Denial (if applicable)
'�S+ifL7Y !%MT/.•L (�aa•Artu�r+�•wsl.A6n ro Scrt.cswti Po,�v srsY
a. !1 � D:c,r asses
,r. kuorucv"r 4 1707/F{�•Nooa,s
. �� � py•YgR� '
r
TOWN OF YARMOUTH
BUILDING DEPARTMENT
1146 Route 28, South Yarmouth, NIA 02664
Phone: 508-398-2231 ext. 261
Fax: 508-398-3265
DATE:December 18, 20000
TO: NAME: Charles Crovo
COMPANY: Dunhill Companies
ADDRESS:
FAX #: 508428-0453
FROM: BUILDING DEPARTMENT
TOWN -OF YARMOUTH
1146 ROUTE 28
SOUTH YARMOUTH, MA 02664
MESSAGE: Review notes for 117 Nottingham Lane, Yarmouthport
From Jack Rhynd
TOTAL NUMBER OF PAGES SUBMITTED:-2-INCLUDING THIS PAGE
W
CALCULATION FOR PERMIT COS
Lowg(L, F�4
pox 19
�2/3)c9� = 11ls
,S;L X.
�ox14= 3�v
y3xa4= /rl�
!Y q•
x ? = I AI
d� x 4. 6-
ax 7 - ,Y
3 o X Vzx 7 gS�-
ioa9�
GarL ,s-�.00
D4cks�
XJA
/fix �� ,x. �Z 37yN,:-
0.9374
Giq-2 �
�X34;� 133�•
<f ovS� •
gfF;L;C 7a,�
TYPE OF ROOM ETC NO
OP'S I
DINING ROOM
LIVING ROOM
GREAT ROOM !
COMPUTER ROOM
DEN !
OFFICE
FAMILY ROOM
BED ROOM S�
BATH s'
STORAGE AREA
MUD ROOM 1
• DECK WITH ROOF
!r `Or hj8iDECK OPEN 3
PORCH OPEN �-
PORCH CLOSED
SUN ROOM HEATED
SUN ROOM UNHEATED
AV?,,;L7 DEMOLITION
SHED
SWIMMING POOL INGROUND
WIMMING POOL ABOVE GROUN
FIREPLACE z.
LAUNDRY ROOM
ADDITION
ALTERATIONS
REROOFING
FOUNDATION
r. ru,ti
TOWN OF YARMOUTH
WATER DEPARTMENT
99 Buck Island Road
West Yarmouth, MA 02673
Telephone: (508) 771-7921 • Fax: (508) 771-7998
Date of Issue : Dec 7, 2000
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) 31.1 Street 117 NOTTINGHAM DRIVE
as shown on Assessors sheet/map # 150
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.
Owner (Sign)
Reference
: CHARLES CROVO II
: DUNHILL COMPANIES
: 776 MAIN ST
: OSTERVILLE, MA 02655
Yarmouth Water Department'
04 YAR,i
O
TOWN OF YARMOUTH
PLEASE PRIM.
Job Location:_
BUILDING DEPARTMENT
CONSTRUCTION SUPERVISOR FORM
Owner of Property:
Construction Supervisor: l—f t (I
Name
Licensed Designee:
(If other than Supervisor) Name
2.15 Responsibility of each license holder:
Street
License No.
Phone No.
2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising.
He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings
as approved by the building official.
2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration,
repair, removal or demolition involving the structural elements of building and structures only pursuant to
the state building code and all other applicable laws of the commonwealth, even though he, the license
holder, is not the permit holder but only a subcontractor or contractor to the permit holder.
2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any
violations which are covered by the building permit.
2.15.4 Any licensee who shall willfullyviolate subsections 2.15.1, 2.15.2 or 2.15.3 or any other section of these
rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of
license by the board.
2.16 All building permit applications shall contain the name, signature and license number of the
construction supervisor who is to supervise those persons engaged in construction, reconstruction,
alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and
regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately
cease until a successor license holder is substituted on the records of the building department.
2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may
be deemed a violation of the permit conditions.
I have read and understand my responsibilities under the rules and regulations for licensing construction
supervisors in accordance with section 109.1.1 of the state building code. I understand the construction
inspection procedures and the specific inspection as called for by the building official.
INSURANCE COVERAGE:
have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152
Yes a No ❑
If you have checked yo, please indicate the type coverage by checking the appropriate box.
,A liability insurance policy Other type of indemnity ❑ Bond ❑
'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
152 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
of Owner or Owner's Agent Owner Q Agent
EJ
Signature: Building Official Approval:
• A
The Commonwealth of Massachusetts
Department of Industrial Accidents
Of/lee ollayestlpstliis
600 Washington Street
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
Applicant information: PleasePRi1V'1'RdibTv
name: T�)Lts b 111 ChM m Il 1 Pc� I LA
location_ 11 [ e 1;�
cat). . NI N D2lD phones H,?9r� 2 a
am a homeowner performing all work myself.
O 1 am a sole proprietor aa3 have no one workine in any capacity
O [am an employer pro%iding workers' compensation for my employees working on this job.
insurance co. polity 0
E2-I am a sole proprietor general contracto or homeowner (circle one) and have hired the contractors listed below who ha%e
the following ttorkers' compensation po ices:
M .pant' na m.. -b. C•-i�- t,t 1 A P r 5
address: I-1 I I IP i n e- r r P t,� �Ae ach
cry: F •F-,n-1 nm0-h 11,AA phonek: L/��'d�)%
inu,r,nreco. Uh V kt M al Jfl Policy 11) I?51 Z2b2,/„q ZOZF3
City: CLc M f`) t V-� t N A phone #: ILP 5 U I In 7
t......,.,...,. (t KI A nc„ rn e)t a nnrin r I I )p_ I Ugbil1PA1
Failure to secure coverage as required under Sectioa 2SA of MGL I52 can lead to the imposition of trimioal penalties of a Doe op to Sl■5110.00 aadlor
one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a Doe ofS100.00 a day against me. I aaderstand that a
copy of this staISRent maybe forwarded to the Office of Investigations of the DU for coverage verificadoa.
I do herebf c�Aii j• unAr the paint and penalderAf perjury that the information provided above is true and correct
Print name l h 121-YUZ P e r 0yo —U Phone # �Irq U — 4a4as
official use only do not w rite in this area to be completed by city or town official
city or town: YARMOIIT$
❑ check if immediate response is required
permit/license M nBuildiog Department
❑Licensing Board
261 ❑Selectmen's OMee
(508) 398-2231 ❑health Department
phone 0; _ _ eZt • nOthcr
contact person:
0"ned 5.95 P5A)
Information and Instructions
+ fo .
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
entplo%ees. As quoted from the "law an employee is defined as every person in the service of another under any
contract of hire, express or implied, oral or written..
Alt entpl(!ver is defined as an individual, partnership, association. corporation or other legal entity, or any two or more of
the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual , partnership, association or other legal entity, employing employees. However the
ox%tier of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another %%ho employs persons to do maintenance , construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an emplo%er.
NIGL chapter I52 section also states that every state or local licensing agency shall withhold the issuance or
---renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required.____
Additionall%. neither the commomvealth nor any of its political subdivisions shall enter into any contract for the
performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter ha%e
been presented to the contracting authority.
Applicants
Please till in the workers' compensation affidavit completely. by checking the box that applies to your situation and
supplying company names, address and phone numbers as all affidavits may be submitted to the Department of
Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The
affidavit should be returned to the city or town that the application for the permit or license is being requested.
not the Department of Industrial Accidents. Should you have any questions regarding the "law" or if you are required
to obtain a workers' compensation policy, please call the Department at the number listed below.
City or Towns
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of
the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please
be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to
the Department by mail or FAX unless other arrangements have been made.
The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address, telephone and fax number.
The Commonwealth Of Massachusetts
Department of Industrial Accidents
tmce of IMSUNIMINS
600 Washington Street
Boston. Ma. 02111
fax N: (617) 727-7749
phone #: (617) 7274900 ext. 406, 409 or 375
BUILDING
TOWN OF Y A R M O U T H ELECTRICAL
1146ROUTE28 SOUTH YAPNIOUTH MASSACHUSETTS02664.4451 GAS
Telephone (508) 398-2231, Ext. 261 — Fax (508) 398-2365 PLUMBING
SIGNS
BUILDING DEPARTMENT
DEMOLITION DEBRIS DISPOSAL AFFIDAVIT
Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5,
I hereby certify that the debris resulting from the proposed work/demolition to be
conducted at 111 i\c>�} %nghc�rf) Lr, r,-g-
W rk Addressss!�
is to be disposed of at the following location: nt a r r� L CA-nA CIA
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
ellxz
Signature of Applicant
Permit No.
Date
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rnNS1RUC1I0N SUPERVISOR Wirt
Nunbrr. Expires: Birlhdate:
i' r5 111166 1111112111 1111111?]I
Rrstrlcted To: 16
.} rNAR!ES A CROVO
s eer-i N ii eO BOY IRS
OSFERVIIII. AA 11655
158889 �.
e:�.rriclyd lo; l6
Ae 1s.111 cf enclosed kpace
(N6l T.II] S.611)
IA Masonry nol► '
16 1 6 1 Falily Howes
riilure to possess a current edition of the
'machusetts State Building Code
1, rause for revocation of this license.
u
a
. ..
TOWN OF YARMOUTH
1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664
Tclephonc (508) 398.2231
OLD KING'S HIGHWAY REGIONAL HISTORIC DISTRICT COMMITTEE
STATEMENT OF UNDERSTANDING
As property owner/contractor/agent for construction at
C/A# 405 A I L v approved on / % -� / — b K)
In accordance with the Guidelines to the Act, "Sec. E.1.
Only minor changes may be approved by the Committee
without the filing of a new application and a new
hearing. Minor changes or alterations would include
such matters as altering a single window or door change
or a minor change of colors which could be made without
a detrimental impact to the overall appearance of the
project. All alterations by amendment or otherwise will
require the local Committee's approval."
Before or after work has begun on a project approved by the Old
King's Highway Committee, a request for a minor change must be
submitted to the committee in writing. Approval shall be obtained
before incorporating the change into the project.
For more than one revision to previously approved plans, a new
Certificate of Appropriateness must be filed and approval voted by
the committee before incorporating the changes into the project.
Failure to do so will result in the Building Department issuing a
stop work order or delaying issuance of an Occupancy Permit or
final inspection approval. -
Filing a Certificate of Appropriateness for revised plans after
work on the changes has been started or completed will also result
in having to pay a filing fee of $50.00.
I have read and understand the eIstements.
Signed
Date r/contractor/ag t
Signed:
Chair., Old King's Highway'Com..'
OKHC:6/96
MAScheck COMPLIANCE REPORT I _
Massachusetts Energy Code I Permit #
MAScheck Software Version 2.01 Release 2 I
I I
Checked by/Date I
I I
CITY: Yarmouth
STATE: Massachusetts
HDD: 6137
CONSTRUCTION TYPE: 1 or 2 Family, Detached
HEATING SYSTEM TYPE: Other (Non -Electric Resistance)
DATE: 11-22-2000
COMPLIANCE: PASSES
Required UA =-917 -
,YourHome = 844
Area or Cavity Cont. Glazing/Door
Perimeter R-Value R-Value U-Value UA
CEILINGS 2978
0.0 32.0
WALLS: Wood Frame, 16" O.C.
3054 0.0
BSMT: Conc. 8.5' ht/8.0' bg/8.5' lnsul
1300 0.0
BSMT: Wood 8.5' ht/0.0' bg/8.5' insul
856 0.0
GLAZING: Windows or Doors
387
GLAZING: Windows or Doors
16
GLAZING: Windows or Doors
193
GLAZING: Windows or Doors
15
21.0
15.0
21.0
DOORS 21 0.092
SLAB FLOORS: Unheated, 48.0" insul. 300
86
0.340
0.330
0.350
0.340
2
8.0
244
56
35
132
5
68
5
211
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 1310,9A J4.4: /I/% xI
Date
Massachusetts Envergv Code
MAScheck Software Version 2.01 Release 2
DATE: 11-22-2000
Bldq.l
Dept.l
Use
I
I CEILINGS:
(1 11. R-0 + R-32
I Comments/Location
I
I WALLS:
(1 1 1. Wood Frame, 16" O.C., R-0 + R-21
I Comments/Location
I
I BASEMENT WALLS:
(1 11. Conc. 8.5' ht/8.0' bq/8.5' insul, R-15 continuous
I Comments/Location
(1 1 2. Wood 8.5' ht/0.0' bq/8.5' insul, R-21 continuous
I Comments/Location
I
I WINDOWS AND GLASS DOORS:
(1 11. U-value: 0.34
I For windows without labeled U-values, describe features:
I # Panes Frame Type Thermal Break? (1 Yes (1 No
I Comments/Location
(1 1 2. U-value: 0.33
I For windows without labeled U-values, describe features:
I # Panes Frame Type Thermal Break? (1 Yes (1 No
I Comments/Location
(1 1 3. U-value: 0.35
1 For windows without labeled U-values, describe features:
I # Panes Frame Type Thermal Break? (1 Yes (1 No
I Comments/Location
(1 1 4. U-value: 0.34
I For windows without labeled U-values, describe features:
I # Panes Frame Tvpe Thermal Break? (1 Yes (1 No
I Comments/Location
DOORS:
1. U-value: 0.092
Comments/Location
I SLAB -ON -GRADE FLOORS:
(1 11. Unheated, 48.0" insul., R-8
I Comments/Location
I Slab insulation to extend down from the top of the slab to at
I least 48" OR down to at least the bottom of the slab then
I horizontally for a total distance of 48".
1
1 HVAC EQUIPMENT:
1 i 1. Furnace, 78.0 AFUE
I AIR LEAKAGE:
[ ] I Joints, penetrations, and all other such openings in the building
oN
envelope that'are sources of air leakage must be sealed. When
installed in the building envelope, recessed lighting factures
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
qasketed to prevent air leakage into the unconditioned space.
2. Type IC rated, in accordance with Standard ASTM E 283, with no
more than 2.0 cfm (0.944 Us) air movement from the the
conditioned space to the ceiling cavity. The lighting fixture
shall have been tested at 75 PA or 1.57 Ibs/ft2 pressure
difference and shall be labeled.
I
I VAPOR RETARDER:
(1 I Required on the warn -in -winter side of all non -vented framed
I ceilings, walls, and floors.
I
I MATERIALS IDENTIFICATION:
1 1 Materials and equipment must be identified so that compliance can
I be determined. Manufacturer manuals for all installed heating
I and cooling equipment and service water heating equipment must be
I provided. Insulation R-values and glazing U-values must be clearly
marked on the building plans or specifications.
I
I DUCT INSULATION:
f 1 I Ducts shall be insulated per Table J4.4.7.1.
I DUCT CONSTRUCTION:
f 1 I All accessible joints, seams, and connections of supply and return
I ductwork located outside conditioned space, including stud bays or
I joist cavities/spaces used to transport air, shall be sealed
I using mastic and fibrous backing tape installed according to the
I manufacturers installation instructions. Mesh tape may be
I omitted where gaps are less than 118 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:
I) I Thermostats are required for each separate HVAC system. A manual
I or automatic means to partially restrict or shut off the heating
I and/or cooling input to each zone or floor shall be provided.
I
I HVAC EQUIPMENT SIZING:
1 I Rated output capacity of the heatinq/cooling system is
I not greater than 125% of the design load as specified
I in Sections 780CMR 1310 and J4.4.
I
I SWIMMING POOLS:
f 1 1 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
I HVAC PIPING INSULATION:
(1 1 HVAC piping conveying fluids above 120 F or chilled fluids
I below 55 F must be insulated to the following levels (in.):
I
PIPE SIZES (in.)
L . 1 •
HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4"
Low pressure/temp. 201-250 1.0 1.5 1.5 2.0
Low temperature 120-200 0.5 1.0 1.0 1.5
Steam condensate any 1.0 1.0 1.5 2.0
COOLING SYSTEMS:
Chilled water or 40-55 0.5 0.5 0.75 1.0
refrigerant below 40 1.0 1.0 1.5 1.5
CIRCULATING HOT WATER SYSTEMS:
Insulate circulating hot water pipes to the following levels (in.):
PIPE SIZES (in.)
NON -CIRCULATING I CIRCULATING MAINS & RUNOUTS
HEATED WATER TEMP (F): RUNOUTS 0-1" 1 0-1.25" 1.5-2.0" 2.0+"
170-180 0.5 I 1.0 1.5 2.0
140-160 0.5 I 0.5 1.0 1.5
100-130 0.5 1 0.5 0.5 1.0
-NOTES TO FIELD (Building Department Use Only)
Frw-TOIM ADMINISTRATORS OF,FICI L'
,+IOpllissl. T-i4s P.tl/DI F-74T
Old xing'e Ifiginny Regional historic District Cwm":IMOUTH
trm t6o rarvaeEYarmanb [or a TOWN CLERK
CIMTNWATE OF APMOPMATEMMO v Y
AppUmden is hereby ands in u4HQgM far tho issusaos Of a cartis"wa OP App i� 6
of cbaptw 470, Aov and Resolves of Muaduwetts, IMF fbr
p vpwed want
pivot, drtwiAp or phutcomprs mcomqpuWk& this applicwcq for:
d as
CITECX CATSGORMS TEAT APPLYr :-_.._
. .
r. alaior iS�New Balidlol O AddW= l7 AMmtim
b>iicaea rype�
riOma o amp 4 Caoma avid ...13 oar
2. Extern �0
YARMOUTH COMMITTEE
3. SipsaMUboacda: D NcwSitu p Mains SIP* `, p RepaImmusai*isip
OYHRO
4. Stuchm qF ....D.wSu ., o iota *Cl.:
TVPZORPALrt+.Lt4CDLY DATE I d
t)(�
ADDRM OPBtOp M W -1
cI
501t3 MAP Na
t{n�•q ASMESSOFLS
LOT NO._., � . 1
` 1
OME ADDRM I S .1 :l8 .gjr , , i ail] tfYr�
} LSPxOM
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_.._ _....... ....zs ,:, .w.
AGENT' OR
USE ATTACUD SHEET IN PAL=T'PORAs1i'M- G OWP1 M
+ r
DETAILED DESCRI MON OF PROPOSED WORM Qivs all p.m*uk a of wads in be done trf wins ma,ui4s a
may} caaa of ais+s, Q1ra roatiana orodain` dpa od propaed laoatiioaa of r►ar�aysw (AUwb .canon dw 4 it
(�Le car�MhUn� . s4 we 1)l n9
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S� betON lf,le for Car:n1_ltiee {:fe O,IrY ' J � , i .,
iDw
T ` AYPROViD
DMAMOVRD
.M IWORTArrf:_ IfC&UfirA a it appto e� apPUW 4Oj S 4 to ft 10 day appeal period
Y l •.
O Plow. cm r0. • w,eoaW WGfiC Di.tiot Cemmidw
..:i.: lmlptgif'I1tiMl EfsU. ] 14�61I,aae 2i, 9. Yara�o�ub,ltlA 02664
mp.umu
DATE % yD
I . CL�4 P,13bA IC,�s C�
2. I h ► N �' (� ats..5
YARMOUTH
C/A # T?IU JL K
10 NOV -2 IN 10. 21
DAILY .�_E-�CEIVED
S(
G
3.
APPROVED
4. YARNIOUTH CO' II,IITTEE
CY,t;RO
I agree to tk[ab4v¢jconditions -
Owner/Al
Signature
OKH/Chairman
M
N
nH
_m
C
m
a
-=
0
C.o
AMENDMENTS (YARMOUTH
DATE yD , C/A # T T G/ ELF K
ADDI�ss ,� 2B NOV -2 Aliis 21
..
Cr P.BoAR�S 6 rpv J f c)nVz-y sLE EIVED
i.
S�f-�nlG� a 6 �.
3.
APPROVED`
4. YARj,4ltmUTjH CTMAITTEE--
o �1
agree to ab vLcondilo;,-
I
Owner/Agents OKWChairman
Signature Signature
��„\\ (�o
21-60 From -TOWN ADMINISTRATORS OFFICE +5013112365 T-542 PAT/01 F-74T
Please, out the form in its entirety providing color chips where
0 necessary:: Pmrc4zzL4Awc4mc, ma=ORLGBUDV'ri� ONS7TEPLAM
TJ FORAM °� TOWN CLERK
20 CC!1�x Afr OW!'�ER(S): ''`Q � 11 hC�lif�
(�pAp r
REV �fL�-L N(1t MAX.FXPOSED): ONC OTHBR 'CD&W%V2m.Ln1-
WALK WAY: h,r %*t.L STEPS (II�IDICA B LV I NTl R): l:ala
C�IU.,pboare� -sw
IDINGTYPE: C.tc,p b�«rd 3" an Nroni coLOia::Shlr�t�+--na y
CHIMNEY (jNDICA�I�E sRI�'(� 5 LL l¢
clVJTI1CCO/WOODFACED) COLOR: ,p,1n%'\C►.v SI-►!
ROOF MA PTTCS (7/= MIN.) )Z 11 Z COLOM b a uX c. �.,
l c2nc&? L re G.vcbj! edunl MAX EXP.
Se.r i e. S
WINDOWS (GRUZ LS REQV=D)-uW1CATE SUSS V NOT LISTED ON ELEVATIONS:
DOORS (INDICATE SIZES AND STYLE IF NOT LISTED ON ELEVATIONS). COMM Z.1 rrf6AbwW- P ILL L)
CAS
TRAM: (ALL WINDOWS & DOORS TRUAMED WffH tact I = ',
MATERIAL OF TRIM:- 00 VINYL, ALUMBiM
SHUTTERS (WOOD/VINYL) (PANELED/I.OUVERED) N)A'
GUTTERS (WOODmLumumm: ►')A
GARAGE DOORS: SIZE & STYLE: 9 ')( 7 r Q
1 n S LL 1 CL,- -e ct S}�e-1 f G- n tNsL
STORM WINDOWS & DOORS: N A
(INDICATE SIZES IF NOT LISTED ON ELVATIONS)
SKYLIGHTS: TYPEISUE: iO)A
YARI��OU1H C0'AIY11iTEE 0 1
0KHR0
COLOR: L � � f- r C.,-
COLOR.-..
COLOR: t_,,J C XA0.v t S�� n
COLOR
DECK: SIZE & MATERIAL: Si o 5! - r COLOR: ncj- k,-rcx—Q
't rec
=k'GLL%,9 }rec:)-LQx• )k'U n"`�h�ja/`Y M0.Y1ac`On�(
FENCING (MAx. HitIGHT 6T: STYLE: coLO>Ei:
(SHOW LAYOUT & RUNNING FOOTAGE ON SITE PLAN) P JA-
RETAINING WALL: (Pp.T. OR F= DSTONE-CONCRETE INAPPROPRIATE)
(SHOW LAYOUT & RUNNDIG FOOTAGE ON SITE PLAN)
SIGNS: (indicate sizr style, colon) COLOR:
SIGN POST. (indicate size, style, color) N lT COLOR: -
ADDITIONAL BVFORMATTON: ) I In F f7 D i; 9 VYI [Y r 1 �Y S�/ G10 Tl
REV. 6"
-, 0 TOWN OF YARMOUTH
1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664
_y
'eo,,, ,,�,• 6rc7 Tc1cphone (508) 398-2231
OLD KING'S HIGHWAY REGIONAL HISTORIC DISTRICT COMMITTEE
STATEMENT OF UNDERSTANDING
As property owner/contractor/agent for construction at
C/A# fj ,� j v approved on l l` l — b C-
In accordance with the Guidelines to the Act, "Sec. E.1.
Only minor changes may be approved by the Committee
without the filing of a new application and a new
hearing. Minor changes or alterations would include
such matters as altering a single window or door change
or a minor change of colors which could be made without
a detrimental impact to the overall appearance of the
project. All alterations by amendment or otherwise will
require the local Committee's approval."
Before or after work has begun on a project approved by the Old
King's Highway Committee, a request for a minor change must be
submitted to the committee in writing. Approval shall be obtained
before incorporating the change into the project.
For more than one revision to previously approved plans, a new
Certificate of Appropriateness must be filed and approval voted by
the committee before incorporating the changes into the project.
Failure to do so will result in the Building Department issuing a
stop work 'order or delaying issuance of an Occupancy Permit or
final inspection approval, -
Filing a Certificate of Appropriateness for revised plans after
work on the changes has been started or completed will also result
in having to pay a filing fee of $50.00.
I have read and understand the
g
Si ae)sTtements.
///OCR ned
Date r/contractor/age t
CcTSigned:
Chair., Old King's Highway Com.
OKHC:6/96
or
Olflcs Ae_Ord
011 he Commonwealth of muriaclluseftfi Permit No. 9"A
- $cparttncnt of Public Bafttg Occupancy 8 Fee Checked��
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 a0 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed In accordance with the Massachusetts Electrical Code, 527 CMR 2:00
(PLEASE PRINT IN INK 013 TYPE ALL INFORMATION) Date /
City or Town of/%% To the Ins ect r of Wires:
The udersigned applies for a permit to perform the electrical work described belo
Location (Street & Number) r/
Owner or Tenant
Owner's Address
is this permit in conjuncttion with at b-� U uilding perm : Yes No ❑ (Check Appropriate Box)
Purpose of Building �N�-�✓ 11e70A—X Utility Authorization No.
Existing Service tin, Amps —J Volts Overhead ❑ Undgrnd LJ No. of Meters
New Service * _ Amps l2il /mlyd_,V(olts Overhead ❑ Undgrnd L!f No. of Meters
Number of Faedars and Ampacity l yu
Lec icn and Nature of Proposed Electrical Work
L 07C ��.�i'✓S ��y /��
i��bpcz
N No, Ligming Outtsls
O QO
Lignting Fixtures
No. TI Receptacle Outlets
NO -;AI Switch Outlets
NO
of Ranges
'
NJ. OI OispoSats
bNo.
of Oisnwasnera
No. of Oryers
_\
(� fJ
No. Water Healers
of
I No. of Hot Tuos / I No. of Transformers Total
77 KVA
Swimming Pocl Above In.
grnd. ❑ crud. ❑
0, '�J
No. of Oil Burners
�a
No. of Gas Burners
No. of Air Cond.
Total
tons
/No
Ol Heat Total
Pumps Tons
Total
KW
%
Space/Area Heating
KW
Heating DevicesJ KW
No. of No. of
KW Signs Ballasts
Generators KVA
No. of Emergency Lignting
Battery Units
FIRE ALARMS N.C. of Zones
No. of Detection and
Initiating Devices
No. of Sounding Oevices
No. of Sall Contained'
Delectiontsounding Devices
Municipal
Local ElConnection ❑Other
Low Voltage
Wiring
No. Hydro Massage Tuos / I NO. of Motors Total HP I _�
1 OTHER:
�, s
INSURANCE COVERAGE: Pursuant to the requirements at Massachusetts general Laws
I nave a current Liability Insurance Policy including Com—pl}led Operations Coverage Or Its auOatsnllal equivalent. YES [.l"NO O 1
have Submitted valid proof of same to the Office. YES LY NO ❑ It you have mocked YES. please Indicate the type of coverage by
checking In* appOr+prtat* box. '
INSURANCE ❑ BONO ❑ OTHER O (Please Specify)
(Expiratlon Oats).
Estimated Value of Electricil Work i �//• d�% ov
Worat.lo Start Inspection Data Requested: Rougn Final
_ Signsd under the Pe Idea of per
ry: .
FIRM NAME UC. NO. V—F-L l%
Licensee �SH� �ff'/ Signature ll LIC. NO. /rl hrP Fed �11Y �f�/� �1 Bus. Tel. No. y��• i/r��
Address'• c� /�f �% •"y Mt. TiL No.
OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee aces not have the insurance coverage or Its substantial equivalent as to'
quired by Massachusetts General Laws, and that my Signature an this permit application waives this requirement. Owner Agent
(Please check one) '
Telephone No. PERMIT FEE S
(signature of Owner of Agent) .'.
APPLICATION FOR PERMIT TO INSTALL AND REQUEST
FOR ELECTRICAL SERVICE
'*rnspector of`VVires Wiring Permit # 491- COM/Electri #
Town of �y' /2/IIU Massachusetts Building Permit # ry Date
�r Customer: ti�� o �� fon� on (Street #) / � ���� �� D R La
Lot # -�S % in the village of Via= -� utility pAle�umber or undergro— umber
New installation
Job description
Change of service Starting Date
Service entrance voltage Amperage 41yo Phase .,4
Wire size (cu. or al.) Conductor per phase
Number of meters— Water heater Off peak: Yes— No —
Estimated load: Electric heat— kw, lights kw, Range 455 dryer iZ: Motors, H.P. B Phase
Ready for first inspection Ready for final ins ection
Electrical Contractor ���v IJ7/791� Lic. # 107Telephone #
Address
f dyzgz F �i1/lt�;f'li/�� /lily LI, _1 u t- 111
Additional Remarks:
Do Not Write Below This Line 71AY 0 9 Z001
ELECTRICAL WIRING INSPECTION CERTIFICATE
INSPECTOR OF WIRES By
_7
INSPECTIONS
Temporary Service
Roughing in
Service and Meter
Off Peak Meter
Final Approval
Disapproved'
'For the following reasons
CERTIFICATE OF INSPECTION
DATE
a
To the COMMONWEALTH ELECTRIC COMPANY. The Installation described above has been le and h hins day ' been inspected and
approval granted for connection to your service. U/I NU (-/�
Inspector of Wires
WIRING INSPECTOR TO BE NOTIFIED WHEN WORK IS READY FOR INSPECTION
Permit Good For One Year From Date Of Issue cnac-t
White — COM/Electric Green — Inspector Canary — Town Receipt Pink — Inspector's Copy Goldenrod — Electrical Contractor
to COM/Electric
...•..r. ti-...-.-,, ti..'..... �,,.y..r•t-c.�r .. .. ,...- .r. .�...•..a ..�... .�,r �... .. r...— •��i'
t' APPLICATION FOR PERMIT TO INSTALL AND REQUEST tel
FOR ELECTRICAL SERVICE /Qy
�nspectorof. Wires Wiring Permit# PI/COM/Electri #
Town of ,Y� P'/�ryQ�TH Massachusetts Building Permit #� Date
on (Street #) I17A /i1i�!7 D R uP
ot # in the village of ''�r'�!1C21T, utility pAle,qumber or underground number
New Installation
Job description
Service entrance voltage Jd Ampera
Wire size (cu. or al.) Conductor per phase
Number of meters / Water heater
Estimated load: Electric heat— kw, lights
Ready for first inspection
Electrical Contractor
Address- /.140E �'�fF�l�
Additional Remarks:
INSPECTIONS
Temporary Service
Roughing in
Service and Meter —
Off Peak Meter
Final Approval
Disapproved'
'For the following reasons
Change of service Starting Date
'yam Phase v K
Off peak: Yes— No— _
kw, Range X, 5 dryer 6s 0 Motors, H.P. a Phase
Ready for final infection
_ Lic. #, _ ��yj0 Telephone #
Do Not Write Below This Line
ELECTRICAL WIRING INSPECTION CERTIFICATE
INSPECTOR OF WIRES
DATE
FEE CHARGE
CERTIFICATE OF INSPECTION /� a
DATE
To the COMMONWEALTH ELECTRIC COMPANY. The installation described above has been le and /�/(, his day been inspected apd
approval granted for connection to,your service. W 7
Inspector of Wires
WIRING INSPECTOR TO BE NOTIFIED WHEN WORK IS READY FOR INSPECTION
Permit Good For One Year From Date Of Issue CAec-,
White — COM/Electric Green — Inspector Canary — Town Receipt Pink — Inspector's Copy Goldenrod — Electrical Contractor
to COM/Electric
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, (NIEC), 527 CMR 12.00
�
nn mm—1 (OFFICE USE ONLY)
I%; l�A`M TH By —
Fee: $ •� • r� G
PERMIT NO.
(PLEASE PRINT IN INK O*&PEMU IN770Rh1AT1ON) Date:
To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to
work described below.
Location (Street & Nu
Owner or Tenant
Owner's
.Telephone No. h"Od - 3 76`6 yd/
Is this permit in conjunction with a building permit? R'I'es ❑ No (Check Appropriate Box)
Purpose of Building HDLLS'P Utility Authorization No.
Existing Service Amps / Volts Overhead[] Undgrd ❑ No. of Meters
New Service Amps / Volts Overhead❑ Undgrd ❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed electrical Work: See- U/' I T-V
Coninletion of the following table may be ivah ed by the /nsnectnr of ltires
of Recesseds
s addl s
No, of Total
Transformers KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures
gA ove n-
Swimming Pool rnd. ❑ rnd. ❑
No. o Emergency Lighting
Battcry Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners
o. o etemon an
Initiating Devices
No. of Ranges
Total
No. of Air Cond. Tons
No. of Alerting Devices
No. of Waste Disposers
Heat 'um
Totals:
um er
—
ons
— —
— —
No. of Self -Contained
Detect ion/Alertin Devices
No. of Dishwashers
Space/Area Heating KW
Local Municipal
❑ Connection Other
❑
No. of Dryers
y
Heating Appliances KW
g pp
Secutity Systems:
No. of Devices or Equilivalent
No. of Water
Heaters KW
No. of No. of
Signs Ballasts
Data Winn,:
No. of devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or uivalent
Attach additional detail if desired, or as required by the Inspector of Wires.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued unless the licensee provides
proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in
force, and has exhibited proof of same to the permit issuing office.
5 CHECK ONE: INSURANCE [ BOND[] OTHER[] (Specify:)
(Expiration Date)
Estimated Value of Elect 'cal Work: ��Gb-OC/ (When required by municipal policy.)
Work to Start Inspections to be requested in accordance with MEC Rule 10, and upon completion.
I certify, under the pai s and penalties f perjury, that the information on this application is true and complete.
FIRM NAME: -P LIC. NO. / !f 4f C
Licensee: -P -e eC Signature lee LIC. NO. / 334 Q
(If applicable, enter •'exe t" in the license number line.) Bus. Tel. No.: FOx— 3107 �5s�
Address- Alt. Tel. No.:
i 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. 1 am the (check one) owner owner's agent ❑
Owner/Agent
Signature Telephone No.
[Rev. OJ/W)
�97
RE -INSPECTIONS
I ST. RE -INSPECTION - $�T"o
2ND RE -INSPECTION - $30.00
3RD RE -INSPECTION - $40.00
ALL OTHER RE -INSPECTIONS - $40.00
//I
DATE: lolqlol
DATE RECALL: i0 /5-
ISSUED
REASON FOR RE-
BUILDING DEPT.: /3 ' 0/' Z&
OCCUPANCY PERMIT:
PLUMBING PERMIT:
GAS:
ELECTRICAL:
FIRE DEPARTMENT:
OTH
ER.
OCT 0 5 01
a
TO"" of TANOOMBUILDING
PERMIT'.
JOB WEATHER . CARD
I APPLICANT
PERMIT TO
—.z�-
, T 25a 2WI P MIT O. �244M
rMY�i It* :.
AD
(NO.) (STREET) (CONTR'S LICENSE)
�
1 STORY DWELLING UNITS 0?�
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING M•0
AT (LOCATION) DISTRICT
(NO.) (STREET)
• BETWEEN AND
(CROSS STREET)
• Y)CROSS STREET)
m SUBDIVISION �1 , nr � e, �..)W In LOT l.ol
U<
m BUILDING IS TO BE FT. WIDE BY
O
F TO TYPE USE GROUP
.L REMARKS:'
FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
M BASEMENT WALLS OR FOUNDATION
t beftvmm liaised bammuat
(TYPE)
2 car gom". lover
I
AREA OR 45 *lN*00 PERMIT 23l7.00
VOLUME (CUBIC/SQUARE FEET) ESTIMATED COST $ FEE
'
OWNER' somicbe BUILDING DEPT
ADDRESS l5 Mill% eraT Ed. Y, P, BY
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET. ALLEY OR SIDEWALK OR ANY PART HEREOF, EITHER TEMPORARILY OR
PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY. NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP-
PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED
FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS
OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.
MINIMUM OF THREE CALLED APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE
INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PER MIT6 ARE REQUIRED FOR
ALL CONSTRUCTION WORK, ELECTRICAL. PLUMBING AND
1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS.
2. PRIOR TO COVERING STRUCTURAL QUIRED. SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL
MEMBERS (READY FOR LATH OR
FINISH COVERING). FINAL INSPECTION HAS BEEN MADE.
J. FINAL INSPECTION BEFORE
----'� -''"
POST THIS CARD
SO IT IS VISIBLE
FROM
STREET
BUILDING INSPECTION APPROVALS
PLUMBING INSPECTION APPROVALS
ELECTRICAL INSPECTION APPROVALS
I
I
2
2
2
3
.
HEATING INSPECTING APPROVALS
REFRIGERATION INSPECTION APPROVALS
1
1
OTHER
2
2
WORK SHALL NOT PROCEED UNTIL THE PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD
INSPECTOR HAS APPROVED THE VARIOUS WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE CAN BE ARRANGED FOR BY TELEPHONE
STAGES OF CONSTRUCTION. PERMIT IS ISSUED AS NOTED ABOVE OR WRITTEN NOTIFICATION.
September 27, 2001
Dave Cleary
Dunhill Companies .
776 Main Street
Osterville, MA 02655
®� a lJ3r� . �r
Re: Bemiche
TJ-XperM Layout & Calculations.
Enclosed are TJ-Xpert' calculations and framing plans for above referenced project. Weyerhaeuser Co. of Walpole, .
MA prepared these drawings.
PROJECT NAME: Falmouth Berniche.JOB
DRAWING DATES AND TIMES: .
DESIGN DATE/TINtE
FIRST FLOOR LEVEL: 01/06/01 @ 11:47
SECOND FLOOR LEVEL: 01/06/01 @ 11:29
DESIGN CALCULATIONS DATES AND TIMES: See attached calculations and verify the Design Date and
Times match those listed above.
The Trus Joist proprietary TJ-Xpert' computer software is a computer aided drafting and design (CADD) program
which selects and verifies the structural performance of each component before it will produce a plot. This program
is operated by personnel within our software distribution network or Trus Joist Technical representatives. The
TJ-Xpert' users are not employees of Trus Joist, but they are required to successfully complete training at our
Denver, Colorado facility. Trus Joist warrants the accuracy of the output and we also warrant that the sizing of the
products will be in accordance with our NER approvals. This warranty is displayed on the drawings.
The professional engineers' stamps on this letter are to verify that the analyses presented conform to accepted
engineering practice and use code accepted product design values. The members have adequate capacity for the
design conditions indicated. Although I have not personally reviewed the project plans or visited the site, we
guarantee that our products, as shown in the attached drawings and/or calculations, have been sized to support all of
the loads provided by your office and designed in accordance with Trus Joist criteria. This can be verified by
examination of the lower right comer of the framing drawings where the wording; "FOR THE TJ-XPERTV
WARRANTY SEE BUILDERS GUIDE" must be displayed.
All notes and design information shown on these calculations should be reviewed with the local code official to
ensure that the loads, spans, deflections, bearings and other conditions are correct and/or acceptable for the specific
application. Building inspectors and/or owners should identify the "Silent Floor'", "TJI" •', "Microllam'LVL",
"Parallam'PSL", or "Timberstrand'LSL" markings on Trus Joist products to confirm that this letter is valid for the
products actually used. Please feel free to contact me if there are any questions regarding the analyses, I can be
reached at (856) 596-5555.
S' erely, , iJ+trry0F4
R A. "s , P $ Nq JL
Regional En eer to
Northeast egion REo
Northeast Region A 104 Centre Boulevard, Suite A A Marlton, New Jersey 08053-4130 • Phone 856.596.5555 • Fax BS6.985.9806
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M-1 10/10'd 21'1-1 99E21EE1094
'3�Iii0�S801Y81SINIYIO`+ N+A01-no�i �29�10 00-IZ-��Y
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
NI work to be performed in accordance with the Massachusetts Electrical Code, (hIEC), 527 CMR 12.00
TOWN OF YARMOUTH
:#-)40� asp
(OFFICE USE ONLY)
By— & (!
Fee: $ •? SU U
PERMIT NO. E -
(PLEASE PRINT IN INK OR TYPE ALL / FORh1ATION) Date:
To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to
work described below.
Location (Street & Nu
Owner or Tenant ' %fle B erJ0lr& -e Telephone No. yob' -376nC,SFo�/
Owner's Address 1 S 1/' P
Istthis permit in conjunction with a building permit? M�tes [] No (Check Appropriate Box)
Purpose of Building do a.; e Utility Authorization No.
Existing Service Amps / Volts Overhead[] Undgrd ❑ No. of Meters
New Service Amps / Volts Overhead[] Undgrd [] No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed electrical Work:
Cnnmletinn of the fnllmvinp table may he waived by the tnsnector of Wres
No. of SS d Fixtures
No. -SUS ad
No. of Total
Transformers KVA
No. of Lightimi Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures
Above n-
Swimming Pool rnd. [] "rnd. ❑
No. of Emergency Lighting
Baucry Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners
No. ot Detection an
Initiating Devices
No. of Ranges
Tota
No. of Air Cond. Tons
No. of Alerting Devices
No. of Waste Disposers
eat Pump
Totals:
um er
one
— —
— —
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Municipal
Local []Other
❑ Connection
No. of Dryers
ry
Heating Appliances KW
g PP
Security Systems:
No. of Devices or Equipvalent
No. of Water
Heaters KW
No. of No. of
Signs Ballasts
Data Wain¢:
No. of &evices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or F uivalent
Attach additional detail y desired, or as required vy the Inspector of tyres.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued unless the licensee provides
proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in
force, and has exhibited proof of same. to the the permit issuing office.
t,
CHECK ONE: INSURANCE. BOND[] OTHER[] (Specify:)
(Expiration Date)
Estimated Value of Electrical Work: / � 00 (When required by municipal policy.)
1Vork to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion.
I certify, under the pains and penalties f perjury, that the information on this application is true and complete.
FIRM NAME- P le v LIC. NO. / 44f C
Licensee: =p Q V /i/\P/l/eC Signature ( a LIC. NO. / 4317 Q
(If applicable, enter "excm t" in the license number line.) V Bus. Tel. No.: 60/— 362 r H ?1 x
Address- Alt. Tel. No.:
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature
below, I hereby waive this requirement. I am the (check one) owner owner's agent.
Owncr/Agent
Signature Telephone No.
(Rev. 04/001
UI�!' �Qln1Y1QIt1UE�l Af�sBa�I�uaett� Permit Noltice ,.Onl�
Ecparttncnt of utillc SafctQ Occupancy d Fes Chflcked��
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Or90 peeve blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed In accordance with the Massachusetts Electrical Cade, 527 CMR 2.00
(PLEASE PRINT IN INK O��•TYPE ALL 19PORMATION) Date /
City or Town of sM!:/ 4%/T� To the Ins act r of Wires:
The udersigned applies for a permit to perform the electrical work described bolo
Location (Street 6 Number)
Owner or Tenant
Owner's Address
S
Is this conjunction with permit in con ubutldin ❑ (Check Appropriate Box)
p J / a; g perm Yes No
Purpose of Building.. AY432 ��� Utility Authorization No.
Existing Service Amps _J Volts Overhead ❑ Undgrnd rn❑ No. of Meters
New Service .�,16
_ Amps -7ys Volts Overhead ❑ Undgrnd L!f No. of Meters
Numter of Fasdars and Ampacity _G
Loc
ton and Nature of Proposed Electrical Work erlwf/
4g22 f
b o
N�N
No
Lignung Outlets /
No. of Hot Tubs /
No. at Transformers Total
C� pa
KVA
O
N
Ltgnting Futures
Swimming Pact Above In.
❑ ❑
grind. grnd.
Generators K14A
No. of Emergency Lignting
No. Receptacle Outlets No. of Oil Burnes
Battery Units
No Swncn Outlets p� Na. of Gas Burners %V
FIRE ALARMS No. of Zones
No. at Ranges / No. at Air Cand. To tat
/
No. of Oetecaon and ..
to
Initialing Devices
-
No. at Disposals / No.of Moat Total Total
Pumps Tons KW
No. of Sounding Devices
/
No. of Sill Contained
No. of Dishwashers • Space/Area Heating KW
DetectionfSounding Devices
No. of Dryers Heating Devices' KW
�7
Local Municipal Other
❑ Connection ❑
No. of No. at
Low Voltage
No. of Water Heaters KW Signs Ballasts
Wiring F
No. Hydro Massage Tubs No. of Masora Total HP
OTHER:
INSURANCE COVERAGE: Pursuant to the requiramenis of Massachusetts general Laws
I have. a current Liability insurance Policy including Compl)ted Operations Coverage at
its substantial equivalenL YES 00"NO O 1
have submitted valid proof of same to trio Office. YES Cr NO O 11 you have cractad YES. please Indicate the type of coverage by
checking the appriats box.
INSURANCE (?BOND O OTHER O (Please Specify)
�f/
(Expiration Date).
Estimated Value of Electricil Work i �r em co
�.
Wora to Start Inspection Date Requested. Rougn
Final'
Signed under me Pe Ides of per ry: .
FIRM NAME
LIC. NO.
Licensee 15" Signature
C. NO. -
Bus. Tel No. jt�% ozr'al
Address-
Aft. Til. No.
OWNER'S INSURANCE WAIVER: 1 am aware that trio Lleensss coos not have the insutanco coverage or Its substuWal equivalent as sr
quired by Massachusetts General taws. and Mat my signature on Chile permit application waives this requiremenL Owner Agent
(Please check one)
Talophone No.
PERMIT FEE i
j
(Signature of Owner or Agent)
AT: cation O ) H /'t Name
Type of Occupancy
New] Renovation ❑ Replacement ❑
Plans Submitted Yes ❑ No ❑
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(PRINT OR TYPE)
Installing Company Name
Check One:
❑ Corp.
❑ Partnership
. ❑ Firm/Co pa _
Business Telephone 4--7 Name of Licensed Plumber
INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent. Check One: Yes Q No ❑
If you have checked YES, please indicate the type of coverage by checking the appropriate box.
A liability insurance policy Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance voerage 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 or Owner or Owner's Agent
I hereby certify that all of the details and Information 1 have submitted
(or entered) in above application are true and accurate to the best of
my knowledge and that all plumbing work and Installations performed
under Permit Issued for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plumbing Code and
Chapter 142 of the General Laws.
Si nature of Licensed
Plumber
License Number
Type: Master Journeyman
IF
TOWN OF YARMOUTH
APPLICATION FOR PERMIT TO DO QUITTING
(OFFICE USE ONLY)
By
Fee: $ go.�
PERMIT NO.
Build
in Owner's ���� ,�, Date_
AT: ocation I �� (�� �aM Name -�feul e— ��A /Clo—
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(PRINT OR TYPE) �6.heck One:
Installing Company Name Ca ( ❑ Corp.
/�,�
Address ` 1LI ` Pe— ❑ Partnership
❑ Firm/Company
Business Telephone
Name of Licensed Plumber or Gasfitter
INSURANCE COVERAGE: Check One
I have a current liability insurance policy or its substantial equivalent. Yes '�l No ❑
If you have checked yes, please indicate the type of coverage by checking the appropriate box.
A liability insurance policy (� Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of
the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check One:
Owner ❑ 4bent ❑ _
Signature of Owner or Owner's Agent
I hereby certify that all of the details and Information I have submitted
(or entered) in above application are true and accurate to the best of
my knowledge and that all plumbing work and Installations performed
under Permit Issued for this application will be In compliance with all
pertinent provisions of the Massachusetts State Plumbing Code and
Chapter 142 of the General Laws.
License Number
TYPE LICENSE:
Plumber ❑ Gasfitter 0 Master Journeyman
Aft4�,a\ a&LXw erox - 34a V-a e ;�;
.fie rwu�- �,�n a�+ -IO �Piza�r� gene
o c E0VIE
SEP 13 2001
By
APPLICATION FOR PERMIT TO DO PLUMBING
. v ■ ■i ..u7n v v ... (OFFICE USE ONLY)
Ip L'1 By
C^�
lul 2 4 911-1 D Fee:
�Tj3/Q 14 334'�0 �--Z / PERMIT NO. / �d -03 L/
By Date 19-4a�—
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Check One:
❑ Corp.
❑ Partnership
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Business Telephone �L r �U Name of Licensed Plumber Cl_
INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent. Check One: Yes K- No ❑
If you have checked YES, please Indicate the type of coverage by checking the appropriate box.
A liability insurance policy Other type of Indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance voerage required by Chapter 142 of
the Mass. General Laws, and that my signature on this permit application waives this requirement.
Signature or 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.
Check on Owner ❑ Agent ❑
Si nature of Licensed
Plumber
� / -2a40
License Number
Type: Master Journeyman
G
APPLICATION FOR PERMIT TO DO GASFITTING
1 F� (OFFICE USE ONLY)
TOWN OF . ARMOUTH Le
By
JUL 2 ` "DOII Fee: $ .m ` PERMIT NO. G -O six ^ o3�
Building 11-7 A (q 1ia�
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Newfk_ Renovation ❑ Replacement ❑
Plans Submitted Yes ❑ No ❑
Date_
Owner's I2,(� �,
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SUB-BSMT.
BASEMENT
1ST FLOOR
2ND FLOOR
3RD FLOOR
(PRINT OR TYPE) I Pt-WEI
Check One:
Installing Company Name 4 Corp. _
Address v L El Partnership
❑ Firm/Company
Business Telephone
Name of Licensed Plumber or Gasfitter
INSURANCE COVERAGE: Checky One
1
I have a current liability insurance policy or its substantial equivalent. Yes — No ❑
If you have checked yes, please indicate the type of coverage by checking the appropriate box.
A liability insurance policy Z 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 ❑ , tjent ❑
Signature of Owner or Owner's Agent
I hereby certify that all of the details and Information I have submitted
(or entered) In above application are true and accurate to the best of
my knowledge and that all plumbing work and Installations performed
under Permit Issued for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plumbing Code and
Chapter 142 of the General Laws.
License Number
TYPE LICENSE:
Plumber 0 Gasfitter 11 Master journeyman
5112015
SlipGen- Portal Home
>l CO
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]
Slipsheet Identifier [sg24487]
Building Permits
150.31.1
0117
NOTTINGHAM DR
Building
17458
No
Operator, Yarmscan
2015-05-01- 11:38
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