HomeMy WebLinkAboutBuilding PermitsTOWN OF YARMOUTH
WATER DEPARTMENT
99 Buck Island Road
West Yarmouth, MA 02673
Telephone: (508) 771-7921 • Fax: (508) 771-7998
Date : February 24, 2003 Service # 14809
Name : Gerard D. LaChance
Legal Address : Sox 1173
: S. Yarmouth, MA 02664
Service Address : 68 Melgo Ln.
: S. Yarmouth, MA 02664
Assessor's Sheet # : 25 Lot(s) # 93
Certified Mail # : 7000 0600 0028 3346 8258
New Structure : x Existing Structure :
NOTICE
This is to advise you that the Town of Yarmouth Water Department or
their authorized agents have installed a new water service or
rehabilitated an existing water service at the above service address.
Materials used during this installation are electrically nonconductive.
Town of Yarmouth Water Department regulations prohibit the use of this
water service as a grounding device for your electrical service.
It is recommended that you contact an electrical contractor to ensure
that your electrical service grounding is in compliance with
Massachusetts Electrical Code, CMR, S27-12.00 Article 250.
A copy of this notice is being forwarded to the Town of Yarmouth
Wiring Inspector.
Dan Mills, Superintendent
cc Wiring Inspector
File
OF k APPLICATION FOR PERMIT TO DO GASFITTING
der 'vg (OFFICE USE ONLY)
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SUB-BSMT.
BASEMENT
1ST FLOOR
2ND FLOOR
3RD FLOOR
(PRINT OR TYPE)
Check One:
❑ Corp.
❑ Pa�rtnship —
FL� irm/Company
Business Telephone,��
Name of Licensed Plumber or Gasfitter s tlL,yt;;1 ,--<< Ai--*
INSURANCE COVERAGE: Check On
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 ❑ Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of
the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check One:
Owner ❑ Agent ❑
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.
402 1
Signature of Licensed
Plumber or Gasfitter
4�(
License Number
TYPE LICENSE:
aflumber ❑Gasfitter 2105ster El Journeyman
ov TOWN OF YARMOUTH Building De ment BUILDING
(508) 39 261
PERMIT NO FB :03-487 : PERMIT
`V ISSUE DATE •-11/2?J02- • ; PROPOSED E
APPLICANT GERARDDLACHANCE JOB WEATHER CARD
ADDRESS :776 Pleasant Street PERMIT TO ; New Construction ;
-----------------------------' ----------
AT (LOCATION) 1WO68MELGO LN ZONING DISTRICT R-25
SUBDIVISION MAP LOT BLOCK 1025.93 BUILDING IS TO BE USE GROUP R-4
LOT SIZE CONST TYPE 5-B CONTR'S
LICENSE 001321
new construction: 2 baths, 3 bedrooms, 1 diningroom, 1 familyroom, I fireplace, 1 two bay CONTR'S NAME
REMARKS garage, 1 kitchen, 1 laundryrcom as per plans dated 11/19/02.
C.D.Stone
AREA (SO FT) EST COST ($ $201,984.0o PERMIT FEE
OWNER , GERARD D LACHANCE 1
ADDRESS 776 Pleasant Street BUILDING DEPT BY
6
INSPECTION RECORD
FIELD COPY
.:Note
Progress.:
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TOWN OF YARMOUTH Building Department BUILDING
(508) 398-2231 ext.261
PERMIT NO B-04078 _ ...... • - - PERMIT
ISSUE DATE ; _ _ 7[18/03 . _ : PROPOSED USE
APPLICANT 'GerardEao nce.................. JOB WEATHER CARD
ADDRESS ;POB 1173 p PERMITTO . . Addition_
AT (LOCATION) 100068MELGO LN ZONING DISTRIC R-25 Bldg. Type: Residential
SUBDIVISION MAP LOT BLOC 1025.93 BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R-4
LOT SIZE O CONTRACTOR
deck addition on rear of house
REMARK
AREA (SO FT) EST COST ($
OWNER IGERARD D LACHANCE
ADDRESS JPOB 1173
South Yarmouth MA 102664
I PERMIT FEE ($)
BUILDING DEPT BY
LICENSE O
INSPECTION RECORD FIELD COPY
Date Note Progress - Corrections and Remarks Inspector
7.-/Sl-o3 1 T,��i�_ oil IKr�`�
Office'.y.ie
. /il
.Permit No.�<V-1:;0
Permit,�Fee ,�_�.5;5'Q
Deposlt'Rec`d
Net Due.:
BLiildin : Pdrrt if{'NU
Signature
Section 1'-.Site:lntom
1.1 Property Address:
ONE & TWO FAMILY ONLY - BUILDING PERMIT
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
Town oFl.u'mouth Building Departrnem
1146 Route 28--Yarrnouth, MA 02664-4,192
Tel: (508) 398-2231 x261 - Fax: (508) 39ii-2365
Use
-. .•r - —
1.3 Building Setbacks (it)
Front Yard
Required Provided
Q
1.4 W supply (M.G.L. C. 40. S 54)
Public Private
Se6ti6h 2' Property Owrietsh! _
2.7 jqwner of Record:
Name (print) I//,.
2.2 Authorized Agent:
Name (print)
Signaturo Telephone
Section 3 Constructior>•'Se'M66-
3.1 Licensed Construction Su r
R-4 Type: 5 B
1.2 Zoning Information:
1st �
Zoning District
Side Yards
aquired Provided Requir
� sr �Q Z
Mailing Address
s: o g—
Telephone WF
Mailing Address
Proposed Use
Rear Yard
aag5
pe visor.
Not Applicable ❑
License Number
Address
Expiration Date
Signature Telephone
3.2 Registered Home lniprovement=:Contractor: '
Company Hame
Not Applicable ❑
Address
License Number
Signature
n is nn
Telephone
Expiration Date
,Sectio'fry'�,yV�tc"eis",°i3oRi'Pensafio` 1nsu"raRce-�ffl�avtts; .,: �c;�"t52��!���,�''�6�"° �' ,• ,< .
IWorkers 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 ❑ I No. of Bedrooms 4 1 No. of Bathrooms
Existing Bldg. ❑ Repalr(s) ❑ I Alterations ❑ I Additlon ❑
Accessory Bldg. ❑ Type Demolition
Brief Description of Proposed Work:
hereby
my beh
all
Other
Specify:
I r Chock Below I
❑ Conservation -Commission Filing
(it applicable)
❑ Old Kings Highway & Historical
Commission approval
(if applicable)
as owner of the subject property
to act on
by this building -permit
I, 1&—aJSb M,� ��� , 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
of
4/ /,� � "' - -
Date
OF'Y��R
e w e 7C'®W1�T• ®F YARMOUTH
r,_.��,:.�t,s BUILDING DEPARTMENT
, �..n^ f
CONSTRUCTION' SUPERVISOR FORM
PLE4SE PRINT.•
job -Location: : •
Number : Street Village
Owner of Property:
Construction Supervisor:
Name License No. Phone No.
Address:
Licensed Designee:
(If other than Supervisor) Name License No.
2.15 Responsibility of each license -holder:' .
2.15.1 The license holder shall be fully and completely"responsible for all work for which he is supervising. '
He shall be responsible for seeing that all work.is done pursuant to the state building code and the drawings
as approved } y.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 toy'
the state building code•and_all:other applicable,larvs of the commonwealth, even though he, the license
holder, is not the permit holder but only a subcontractor or contractor to the permit holder. �t
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. I .
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 i -
regulations. III the event that such licensee is no longersupervising said persons, the work shall immediately
cease until a successor license Bolder 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 understandmy responsibilitiesunder the rules and regulations for licensing construction
supervisors in accordance witli'section 10c9.1.1-of 'the state building code. I understand the construction
inspection procedures and* thespecific inspection as called for by the building official.
INSURANCE COVERAGE:
I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152
Yes ❑ No
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter 152 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner cr Owner's Agent
Owner ❑ Agent Q
For Office Use Only
Permit No.
Date TOWN OF YARMOUTH
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
MGL c. 142A requires that the 'reconstruction, alteration, renovation, repair, modernization, conversion,
improvement, removal, demolition or construction of an addition to any pro -existing owner -occupied
building containing at least one but not more than four dwelling units or structures which are adjacent to
such residence or building' be done by registered contractors, with certain exceptions, along with other
requirements.
Type of Work: ��^ Est. Cost SW2l .
Address of Work PW /11
Owner Name: (!5E/2)M n
Date of Permit Application: O
I hereby'certify that:
Registration is not required for the following reason(s):
Work excluded by law
Job under S 1,000
Building- not owner occupied
Owner pulling own pernvt
Other (specify)
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH
UNREGISTERED CONTRACTORS FOR APPLICABLE HOME
IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION
PROGRAM OR GUARANTY FUND UNDER MGL c. 142A.
Signed under penalties of perjury:
I hereby apply for a permit as the agent of the owner:
Date Contractor Name Registration No.
N'
Notwithstanding the above notice, I hereby apply for a permit as the owner of the above
property:
Date Owner Name
9
The Commonwealth of Massachusetts
Department of Industrial Accidents
O///60 0//®F/L°3d/p�fii�' I7S
600 Washington Street
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
am a homeowner performing all work myself.
am a sole proprietor xnd have no one working in any capacity
O lam an employer pro% iding workers' compensation for my employees working on this job.
comanny name:
Insurance ca.
O 1 am a $qle proprietor. general contractor. or homeowner (circ%one) and have hired the contractors listed below «ho have
the following workers* compensation polices:
Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal peaaltlea of a floe op to SI.S00 00 and/or
one years' Imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine ofS(00.00 a day against me. I Understand that a
copy of (his statement may be forwarded to the Office of Investigations of the DU for coverage verification.
t do -hereby certify under the pains and penalties of perjury that the information provided above is true and correct
Signature
ate
Print name Phone H
.r official use only do not write in this area to be completed by city or town official
city or town. YARHOUT$ rmia/licenseN n
Pe Building Department
check if Immediate response is required ❑Lleensiog Board
261 ❑Selectmen's Office
contact person: phone N; _ (508) 398-2-231 eat. wealth Department
Other__
TOWN OF YA,RMOUT.H
BUILDING DEPARTMENT
1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 260
PLEASE PRINT:
DATE:
JOB LOCATION:
. NAME
"HOMEOWNER"
NAME
PRESENT MAILING ADDRESS
HOMEOWNER LICENSE EXEMPTION
STREET ADDRESS
HOME PHONE
SECTION OF TOWN
WORK PHONE
CITY OR TOWN STATE ZIP CODE
The current exemption for `Homeowner' was extended to include owner— occupied dwellin¢s of one or two units
and to allow such homeowners to engage an individual for hire who does not possess a license, provided that such
homeowner shall act as supervisor. (State Building Code Section 108.3.5.1) '
Definition of Homeowner:
,Pcrson(s) who owns a parcel of land on which he / she resides or intends to reside, on which there is or is intended
°to be, a one or two family attached or detached structure assessory to such use and / or farm structures. A person
&:'jwho constructs more than one home in a two-year period shall not be considered a homeowner, such "homeowner".
•:•shall submit to the building official, on a form acceptable to the:building official, that he / she shall be responsible for
'.:,all such work performed under the building permit. (Section.108.3.5.1)
,The undersigned 'homeowner' assumes responsibility for compliance with the State Building Code and other
. : applicable codes, by-laws, rules and regulations.
='.The undersigned 'homeowner' certifies that he / she understands the Town of Yarmouth Building Department
minimum inspection procedures and requirements and that he / she will comply with said procedures and
requirements.
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING OFFICIAL
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL Ch.142.
Yes ❑ No ❑
If you have checked es, please indicate the type coverage by checking the appropriate box.
A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required
by Chapter 142 of the Mass. General Laws and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner ❑ Agent ❑
hUmommlicacmp
TOWN OF YARMOUTH
1146ROUTE28 SOUTHYARMOUTH MASSACHUS=S02664-4451
Telephone (508) 398-2231, Ext. 261 — Fax (508) 398-2365
BUILDING DEPARTMENT
DEMOLITION DEBRIS DISPOSAL AFFIDAVIT
BUILDING
ELEGTRICA
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
Work Address
is to be disposed of at the following location:
Said disposal site shall be a licensed solid waste facility as defined by M.G.L
Chapter 111, Section 150A. .
Signature of Applicant
Permit No.
Date
SUBMITTAL REQUIREMENTS / CHECK LIST FOR BUILDING PERMITS
New Structures
1. Application signed by the owner and owner's authorized representative / construction
supervisor. Application shall include: Construction Supervisor's License, Worker's
Comp. Affidavit / Certificates, Home Improvement Affidavit (all applications except new
homes).
2. Six (6) proposed site plaits, stamped; by a Mass. Registered Professional Land Surveyor,
showing all boundaries, proposed setbacks, existing & proposed grades / contours,
proposed location of structure (s), parking, curb cuts, drainage, impervious cover
calculations (when applicable), flood zone and Title V design and any other zoning
related details deemed necessary.
3. Three (3) sets of complete cortstructioi: plaits, including a complete structural cross
section, floor plans, use of rooms, dimensions, window & door schedule, HVAC details —
electrical, plumbing & mechanical plans are also required for commercial & multi -family
(3 units or more) structures.
4. Flood zone applicability — Compliance with Section 3107 of the State Building Code —
Elevation orflood-proofing certificates (whichever is applicable), shall be submitted
prior to the issuance'of a cert fcate•of occupancy.
S. Plans shall be reviewed by the following departments: Health, Engineering, Fire &
Conservation. (when applicable). The Building Department will forward. =:+
6. Old Icings Highway & Historical Commission (when applicable).
7. Mass. DPW..approval for State Highway curb.cut and access ways. iF
8. Construction control affidavits for all projects to be constructed or altered'under the
provisions of Section 116 of the State Building Code. Buildings containing 35,000 cubic
feet or more. One & two family structures are exempt; except certified designs may be
required for unusual structural circumstances. Section 3107 of the Building Code
requires certified plans for new and substantially improved structures in flood zones.
Additions
1. Same requirements.asabove, Six (6) proposed site plans, Three (3) sets of complete
construction plans..
2. Flood zone applicability — When the value of improvements equals or exceeds 50 % of the
structure value (substantial improvements).
Interior Alterations
1. Existing & proposed conditions must be shown on the plans, labeling all rooms.
NO WORK IS TO COMMENCE UNTIL. THE BUILDING PERMIT HAS BEEN
ISSUED. Filing a building permit application does not imply approval and should not be
construed as permission to begin work.
INSPECTION SCHEDULE
NEW CONSTRUCTION, ADDITIONS & ALTERATIONS
The receipt of a building permit is not the end of the permit process, but rather the
beginning. The building permit holder is responsible for arranging the required
inspections before proceeding with additional work. Failure to do so may result in
having to expose concealed work through the partial or complete removal of some
building elements, causing you delay and unnecessary expense.
It is imperative that you arrange for the following inspections by either calling 508-398-
2231, extension 261, or make a personal request at our office at least 48 hours in
advance: I
FOUNDATION
• After certified 'as built' site plans have been submitted
• Before concrete floor is poured
• After perimeter drain has been installed
• Before backfill
• Before first deck is constructed .
• After damp proofing
• After certified flood zone elevations have been submitted (when applicable)
x Note: When proposed plans specify re -enforcement rod installation or
other unique design criteria you are required to' call for an inspection
t prior to pouring the concrete. In some cases a separate inspection may
be required for a strata/soil or footing inspection.
FRAME
• After rough electrical, plumbing & gas approvals have been made
• Before insulation
• After being made tight to the weather
FIREPLACE / CHIMNEY
• When smoke chamber is complete
• When chimney is complete (may be inspected with frame)
• Final
INSULATION
• After building envelope is completely insulated
FINAL .
• After all other inspections have been approved
• After electrical, plumbing, gas & fire inspections have been approved
• After all applicable historical applications have been completed
• After an applicable flood elevation certificate has been submitted
-J „n
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Fil F COP
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LOT B
ff
101.52• N
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C�
E VSANG _ £X ANG SEPW
F UNDAMV.. VAULT
LOT 9
APEA 4916 f SF.
LOT f0
I
105
TOP OF FOUNDATION IS 5.8'
ABOVE HIGH POINT IN ROAD.
TO THE BEST OF MY INFORMATION,
KNOWLEDGE, AND BELIEF THE
FOUNDATION SHOWN ON THIS PLAN
HAS BEEN LOCATED ON ND
AS INDICATED. apt"0F
DATE PROFESSIONAL
f
"AS -BUILT" PLOT PLAN
YARMOUTH, MASS.
LOT 99 1953-°J. GORHAM CUFr PLAN
DATE_2/=3 SCALE 1""=20'
JOB 5408-00 CUENTLACHANCE
SWEETSER• ENGINEERING
235 GREAT WESTERN ROAD
PO BOX 713 SOUTH DENNIS, MA 02860
Ff. 506-398-3972 fax 508-398-3063
G=1Jatririwt •••�_v'iI{o'ii���iuo-ururn,
04 YAR TOWN OF YARMOUTH
� o
BUILDING DEPARTMENT
`�, �---n• BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF
R
TRANSMITTAL SHEET
Building Site Location: (c %%% L /�'KA-- Map No: 4;� Lot No: ?�3
Proposed Improvement: /O / P-C3 •
Applicant: �/�
Address:1 g Awl G6 Tel.No.: Date Filed: /Z, 03
The Building Department will be responsible for assisting the applicant by dispatching your plans and or application to the following
applicable departments.
RESIDENTIAL AND/OR COMMERCIAL BUILDING
WATER DEPARTMENT:
Determines Compliance of Water Availability and or existing location.
ENGINEERING DEPARTMENT:
Determines Compliance for Parking and Drainage.
CONSERVATION COMMISSION:
Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of
Wetlands, Streams, Ponds, Rivers, 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.
..........................................................................
REVIEWED BY:
1. WATER DEPARTMENT:
DATE: N/A:
2. ENGINEERING DEPARTMENT:
DATE: N/A:
3. CONSERVATION:
DATE: N/A:
1�4 HEALTH DEPARTMENT: DATE: D N/A:
• INDUSTRIAL AND/OR COMMERCIAL PERMITS
S. WIRING INSPECTOR. DATE: N/A:
6. PLUMBING INSPECTOR DATE: N/A:
7. FIRE DEPARTMENT: DATE: N/A
COMMENTS:
RECEIPT OF COPY:
PLEASE NOTE
SIGNATURE OF APPLICANT:
DATE:
White copy - Building DepL - Pink copy - Water Dept - Yellow Copy - Health DepL - Piok Copy - FaBnecring DTL - Goldw - Fire DCVJ Cm9Wvrtion
TOWN OF. YARMOUTH
BUILDING DEPARTMENT
BUILDING PERMIT "APPLICATION DEPARTMENTAL SIGN OFF
TRANSMITTAL SHEET
Building Site Location: / L G a L AX N l-- Map No: �2S Lot No: c?3
Proposed Improvement: /0�26
Applicant:
Address: / lJ %ii r, 6 G N A L Te1.No.: Date Filed: iG l o5
The Building Department will be responsible for assisting the applicant by dispatching your plans and or application to the following
applicable departments.
RESIDENTIAL AND/OR COMMERCIAL BUILDING
WATER DEPARTMENT: Determines Compliance of Water Availability and or existing location.
' ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage.
CONSERVATION COMMISSION: Determines Compliance to Wetlands Acts; i.e., If Lots) 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.
REVIEWED BY:
1.
WATER DEPARTMENT:
DATE:
N/A:
2.
ENGINEERING DEPARTMENT:
DATE:
N/A:
3.CONSERVATION:
DATE:
N/A:
"/
HEALTH DEPARTMENT:
DATE: —D /A:
INDUSTRIAL AND/OR COMMERCIAL
PERMITS
3.
WIRING INSPECTOR:
DATE:
N/A:
6.
PLUMBING INSPECTOR
DATE:
N/A:
7.
FIRE DEPARTMENT:
DATE:
N/A:
PLEASE NOTE
COMMENTS:
f
RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE:
White copy -BuddmgDcpL - Piokcopy -Watt Dept - YdrowCopy-HearthDcpt - PickCOPY-EngrgDv - Gddearod-FireDcptCaa9=w im
TOWN OF YARMOUTH
BUILDING DEPARTMENT
BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF
TRANSMITTAL SHEET
Building Site Location: Map No: Lot No:
Proposed Improvement: 6 /)r: G /U
Applicant:
i
Address: �- `% ilk / G 6 LiJrr Te1No.: Date Filed: 7Ii/• �c5
I The Building Department will be responsible for assisting the applicant by dispatching your plans and or application to the following
applicable departments.
RESIDENTIAL AND/OR COMMERCIAL BUILDING
WATER DEPARTMENT:
ENGINEERING DEPARTMENT:
CONSERVATION COMMISSION:
HEALTH DEPARTMENT:
,FIRE DEPARTMENT:
Determines Compliance of Water Availability and or existing location.
Dctcrmincs Compliance for Parking and Drainage.
Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of
Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc
Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities.
Determines Compliance to State and Town Requirements for Personal
Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc.
.. .............. ................ ............................. ..........................................•--------......... _ _.........__........-•---..
REVIEWED BY:
1. WATER DEPARTMENT: DATE: N/A:
2. ENGINEERING DEPARTMENT: DATE: N/A:
3.` CONSERVATION: DATE: N/A:
1�4 HEALTH DEPARTMENT: ATE: rD )A:
INDUSTRIAL AND/OR COMMERCIAL PERMITS
S.
WIRING INSPECTOR:
DATE:
N/A.-
6 . -
PLUMBING INSPECTOR:
DATE:
N/A:
7.
FIRE DEPARTMENT:
DATE:
N/A
COMMENTS:
RECEIPT OF COPY:
1g11"`.r�il
SIGNATURE OF APPLICANT:
DATE:
Wbitecopy-BuddmgDg0_ - Pwkcopy -Water Dept - YdlowCopy -HakhDept - PiA Coff - EWwanDcpL - GWdmmd-FireDgWConavadw
ONE & TWO FAMILY ONLY - BUILDING PERMIT
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
Town of Yarmouth Building Department
1146 Route 28 - Yarmouth, NIA 02664-4492
Tel: (508) 398-2231 x261 - Fax: (508) 398-0836
_ Office
Permit No����
Permit Fee $
Deposit Rec'd. $.� Date �II� '
Net Due $
P nning Board Information
,0pe
Endorsement Date
fleoording Date
No.
Other
Assessors Department Information:
Map Lot M p Lot
D
Ord New
1.4 Property Dimensions:
LotArea(sQ , ZO Frontage(R) Lot Coverage
This Section for Office Use Only
Building Permit Number:
Date Issued:
Signature: "
Certificate of Occupancy„
is t/' is not required
wilding Official Date
Section 1 - Site Information
Use Group: R-4 Type: 5-131
1.1 Property Address:
�8 IN64 a ,ue
1.2 Zoning Information:
R1
Zoning District Proposed Use
Sou VAP-A1 eofj-F(-�
1.3 Building Setbacks fit)
Front Yard
Side Yards
Rear Yard
Required
Provided
Required
Provided
Required
Provided
30 i
i i
.2-.0 i
1 A Water Supply (M.G.L. c. 40. S 54)
Public Private
1.5 Flood Zone Information: Comments:
Zone: � BFE: /a
Section 2 - Property Ownership/Authorized Agent
2.1 Owner of Record:
Name nt) Mailing Address j o4) 4114. O !!o«
oP
ignature Telephone
2.2 Authorized Agent:
Name (print) Mailing Address
�i_? t 1
Signature Telephone '
lu
�r_
-
Section 3 - Construction Services
3.1 Licensed Construction Supervis
r
(�QV 2 1 OQZ
Not Applicable ❑
_
`
License Number
S �a
Address
Expiration Pate
a� 4
Signature Telephone
3.2 Registered Home Improvement Contractor:
Company Name
Not Applicable ❑
License Number
Address
Signature Telephone
Expiration Date
9- 15-99 1 of OVER
Section 4 - Workers' Compensation Insurance Affidavit (M.G.L: c. 152 S 25C (6)
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure
to provide this affidavit will result in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes ........ No ..........
Section 5 - Description of Proposed Work (check all applicable)
New Construction No. of Bedrooms No. of Bathrooms
Existing Bldg. ❑ Repalr(s) ❑ Alterations ❑ I Addition ❑
Accessory Bldg. ❑ Type
Demolition
Other Specify:
Brief Description of P posed Work:
Costs
Section 6 - Estimated Construction
Item
Estimated Cost (Dollars) to be
completed by permit applicant
Check Below
❑ Conservation -Commission Filing
(if applicable)
❑ Old Kings Highway & Historical
Commission approval
(if applicable)
1. Building
02" e'd •
2. Electrical
3. Plumbing / Gas
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5)
7. Total Square Ft. (new houses 6 additions)
Section 7a -Owner Authorization -To
Owner's Agent or Contractor Applies
be Completed When
for Building Permit
/
I, !!� MA le-Z '-3>. L AC!-lAlVeG_ , as owner of the subject property
hereby authorize emms o 0 Ue-4 Y NC to act on
my behalf, i II matters relative tow au orized by this building permit application.
Si ature of Owner at
Section 7b = Owner/Authorized Agent Declaration
as Owner/Authorized Agent
hereby declare that the statements and information on the foregoing application are true and accurate,
to the best of my knowledge and belief.
Signed under the pains and penalties of perjury.
Print name
lure of Owner en Date
9-15-99 2 of 2
OE YqR�
3®c
0 H
PLEASE PRINT:
Job Location:
TOWN OF YARMOUTH
BUILDING DEPARTMENT
CONSTRUCTION SUPERVISOR FORM
a447-
Number Street Village
Owner of Property. �A�2D �� G,�t�HA�►/��
Construction Supervisor: 6-�K_T �`�!� 4Z�E4 �' ���^�e c--z
Name License No.
Address:
Licensed Designee:
(If other than Supervisor) Name
2.15 Responsibility of each license holder:
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:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152
Yes 4 No ❑
If you have checked =, please indicate the type coverage by checking the appropriate box.
A liability insurance policy 0 Other type of indemnity ❑ Bond ❑
INSURANCE WAI am aware that the licensee does not have the insurance coverage required by
2 of ttleyvlass. ner ws, and that my signature on this permit application waives this requirement.
��-, Check one:
of Owner or
Owner SYJ Agent
Signature: Building Official Approval:
For Office Use Only
Permit No.
Date TOWN OF YARMOUTH
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
MGL c. 142A requires that the `reconstruction, alteration, renovation, repair, modernization, conversion,
improvement, removal, demolition or construction of an addition to any pre-existing owner -occupied
building containing at least one but not more than four dwelling units or structures which are adjacent to
such residence or building' be done by registered contractors, with certain exceptions, along with other
requirements.
Type of Work: Est. Cost AT evO•
Address of Work l li` /I1E��a 1,4.vE 5, y :' Oybjl
Owner Name: 04MRD -'Di A669 NC
Date of Permit Application: I i 0
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
4 Owner pulling own permit
Other (specify)
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH
UNREGISTERED CONTRACTORS FOR APPLICABLE HOME
IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION
PROGRAM OR GUARANTY FUND UNDER MGL c. 142A.
Signed under penalties of perjury:
I hereby apply for a permit as the agent of the owner:
Date
W
Contractor Name
Registration No.
Notwithstanding the above notice, I hereby ap for a permit as the owner of the above
property:
Datd Owner Name
The Commonwealth ofMassaehusetts
Department of Industrial accidents
exce 911AY tlISMS
600 Washington Street
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
Applicant information, PlestseYRiNTTe�ibiv
lam a homeowner performing all work myself.
I am a sole proprietor Ord ha%e no one %%orking in an% capacity
am an employer pro%iding workers' compensation for my employees working on this job.
address,
insur�ncc co Policy tl
1 am a sole proprietor. general contracto , or homeosv er (circle one) and have hired the contractors listed below who have
the following %%orkers' compensation pol
Failure to secure coverage as required under Section 25A of MGL 152 an lead to the imposition of cnmlaal penalties ofa Dae op to 31.50V Ua aaaor
one years' Imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of $100.00 a day against me. I understand that*
copy of this statement maybe forwarded to the Office of lavestigations of tht DIA for coverage verifiadoa.
I do hereby certify der the p ' s and pen les of jury that the information provided above is true and eo eL%
Signature G' au ��
Print name 2�iQ� Gr/if}NC� Phone 0 2AL ZT2'd��
official use only do not write in this area to be completed by city or town official
city or town: YARMODTU
Cl check if immcdiste response is required
contact person:
permit/license N -Building Dcpartmeot
❑Llccasing Board
261 ❑Selectmen's OIBct
❑Healtb Department
phone A; _ (508) 398-2231 eat. -Other
Ut.ued 3.95 FIA5
Information and Instructions
r
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
eniplo%ces. As quoted from the "law", an enrplot•ee is defined as every person in the service of another under any
contract of hire. express or implied. oral or written.
An enrphover is defined as an individual, partnership, association. corporation or other legal entity, or any two or more of
the foreeoine 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
dw elline house of another w ho employs persons to do maintenance , construction or repair work on such dwelling house
or un the wounds or building appurtenant thereto shall not because of such employment be deemed to be an employer.
\1G1_ chapter I section �� also states that every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required.
Additionally. neither the commom%ealth 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 hay e
been presented to the contracting authority.
.applicants
Please till in the workers compensation affidavit completely, bv'checking the box that applies to your situation and
suppling company names, address and phone numbers as all affidaviti 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 vou'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 afUdavits 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
office of leresdatleos
600 Washington Street
Boston, Ma. 02111
fax fl: (617) 727-7749
phone #: (617) 7274900 ext. 406, 409 or 375
of Y9R TOWN OF YARMOUTH
o� ,y BUILDING DEPARTMENT
1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 260
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
DATE: -
JOB LOCATION: Ca�J�/?� Dlllt/Y���r%160 �4U� S�yfff Y,4,Iavfh�
.NAME STREET ADDRESS SECTION OP TOWN
"HOMEOWNER" %-c-&kD' ,D 44C'f-i—ef- 6N-74oP�y : 4"6-
NAME HOME PHONE WORK PHONE
PRESENT
CITY OR TOWN STATE ZIP CODE
The current exemption for `Homeowner' was extended to include owner — occupied dwellings of one or two units
and to allow such homeowners to engage an individual for hire who does not possess a license, provided that such
homeowner shall act as su rvisor. (State Building Code Section 108.3.5.1)
Definition of Homeowner:
Person(s) who owns a parcel of land on which he / she resides or intends to reside, on which there is or is intended
to be, a one or two family attached or detached structure assessory to such use and / or farm structures. A person
who constructs more than one home in a two-year period shall not be considered a homeowner; such "homeowner"
shall submit to the building official, on a form acceptable to the building official, that he / she shall be re nsible for
all such work performed under the buildingpenmit. (Section 108.3.5.1)
The undersigned, `homeowner' assumes responsibility for compliance with the State Building Code and other
applicable codes, by-laws, rules and regulations.
The undersigned `homeowner' certifies that he / she understands the Town of Yarmouth Building Department
minimum inspection procedures;andZuirementsand that a /she will comply with said procedures and
requirements.��HOMEOWNER'S SIGNATUR
APPROVAL OF BUILDING OFFICIAL
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL Ch 142.
Yes ❑ No ❑
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy b * ' - - Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER ' I am aware that the licensee does not have the insurance coverage required
by Chapter 142 of the Mass. General Laws and that my signature on this permit application waives this requirement.
Signature of Owner or Owner's Agent
Check one:
Owner ❑ Agent ❑
hlomeowmlicc=P
BUILDING
TOWN OF Y A R M O U T H ELECFRICAL
GAS
1146 ROUTE 28 SOUTH YARAIOUTH N SSACHUSETTS 02664-4451
PLUMBING
Telephone (508) 398-2231, ExL 261 — Fax (508) 398-2365
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
Work Address
is to be disposed of at the following location: Ov,y ky'PALE
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
D�—
Date
--•a ------- ----rr --
Permit No.
TOWN OF YARMOUTH
Building Department
Town Hall
Yarmouth, MA 02664
(508) 398-2231 ext.261
BBUILDING PERMIT
APPLICATION RECEIPT
Temp Permit No.: T-03-142
Applicant Name: C. D. Stone
Location: 00068 MELGO LN
Owner's Name: GERARD D LACHANCE
Owner's Addres 776 Pleasant Street
Paxton MA 01612
Owner's Telephone: (508) 752-8224
(OFFICE USE ONLY
Recorded By: Ic
Permit Fee:
Deposit Rec:
Payment Type:
$0.00
$50.00
Check ChkNo.: 614
Net Owed: ($50.00)
Application Date: 9/11/02
Issue Date:
Expiration Date
Comments: 35",
new construction
This Is NOT a building permit. Application subject to plan review. Contact Building Department for permit status. Official
Building Permit will be Issued upon plan review � completion, approval, and complete payment of Net Owed on Permit Fee.
-a3_
let
/ Or0000r0000it::��
Date Printed: 9/13/02
4t
PROPERTY ADDRESS: 6 ?w g
CALCULATION FOR PERMIT
. —4r ..
_._ _ _
/S X ,)-
!/qo
,2 d° F-4g
/s= S-vloZ'
9 x /y,s= / 36 z
676
o L/y, 5.7r g 5-19
TYPE OF ROOM. ETC
ADDITION
ALTERATIONS
xf,
BATH
BED ROOM 3
CERTIFICATE OF OCCUPANCY
DECK OPEN
DECK WITH ROOF
DEMOLITION
DEN
DINING ROOM
FAMILY ROOM
IF -
FOUNDATION ONLY
GARAGE NO. OF BAYS Z j
GREAT ROOM
i
LAUNDRY ROOM I
LAUNDRY ROOM
LIVING ROOM
X AG.- _ /7y�334,;,. OFFICE
�� 6 y�, _ PORCH CLOSI
PORCH OPEN
REROOFING
SUN ROOM HEATED
SUN ROOM UNHEATED
SWIMMING POOL ABOVE GROU
SWIMMING POOL INGROUND
WINDOW REPLACEMENT
TOWN OF YARMOUTH BUILDING DEPARTIMIENT
PLAN REVIEW & BUILDING PERMIT APPLICATION REVIEW NOTES
ADDRESS: (a'g f%%��G s Y,
Map /Lot: aS/g-3
Date of Initial Review- 9`a-3/pv pt /!//9�Z
Appz,oval Date;
Inspector. Tq t � U-&
NOT g)j FGa�l7 T �.� Srr���9�c=D FY
C� f>2 sr2u �TbIZ�L C/(dR CCopy ,/
�TT /c �Cc-crt: s wry f�ouS'� (r?dIZt-Ga / 0
S/fow t`!
-
-�-e, vL r
V �J V6Hr 0.4fa-A-G F EArr s
✓S� 1177c177e-S .Cv 62d1z,4e-r 40sr Br- f'�fisZn Ar o�-
�Ba`G�ooa 5'A yov i.0
vIjvr-- r�G,�T/l��. SyST�,+ Pwr,4 8/"e,mun-c Cl=
:)A-oeAGe 477L .ACCESS
-s7,9-Ile e lw)
73CD Paoli H "7 7 4z5ces-s
Zoning Denial (if appicable):
7a 4Beve
Section 1043.2, para. Change, Enmsion crAltaatioa
nonconforming)
The proposed . .
_...._.. reQuircsaSpeciatPeamitfcomr#htaZankgBomxc Of
o-�er
Building Code Denial (if applicable)
Res. I I-01
r,a3 ,iy I
Building Site Location:
Proposed Improvement;
pp
Address: (V Tel.No.: Date Filed
TOWN OF YARMOUTH
BUILDING DEPARTMENT
BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF
TRANCMTTTIAi. CAF.F.T
The Building Department will be responsible for
applicable departments.
by dispatching your plans and or application to the following
RESIDENTIAL AND/OR COMMERCIAL BUILDING
WATER DEPARTMENT:
Determines Compliance of Water Availability and or existing location.
ENGINEERING DEPARTMENT:
Determines Compliance for Parking and Drainage.
CONSERVATION COMMISSION:
Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of
Wetlands, Streams, Ponds, Rivers, 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.
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:
INDUSTRIAL AND/OR COMMERCIAL PERMITS
3. WIRING INSPECTOR: DATE: N/A:
6. PLUMBING INSPECTOR: DATE: N/A:
7. FIRE DEPARTMENT: DATE: N/A:
COMMENTS:
RECEIPT OF COPY:
PLEASE NOTE
SIGNATURE OF APPLICANT:
DATE:
White copy — Building Dept - Yellow Copy — Health Dept - Pick Copy — Engineering Dept - Gold=od - Fire DeptConservation
Building Site Location:
TOWN OF YARMOUTH
BUILDING DEPARTMENT
.BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF
TRANSMITTIAL SHEET
No: aS Lot No: 9.3
Proposed Improvement:,! P..tt Cst7' l tiv^, _7_ It �2r1>LU� � A G/,I(l! r fJ,r
Applicant: ty • ,q• ,AsaVZLy
Address: (7y,? %.± ��1. „ SA / f�f Tel.No.: Date Filed: G
The Building Department will be responsible for assistgRtheipplicant by dispatching your plans and or application to the following
applicable departments.
RESIDENTIAL AND/OR COMMERCIAL BUILDING
WATER DEPARTMENT:
Determines Compliance of Water Availability and or existing location.
ENGINEERING DEPARTMENT:'
Determines Compliance for Parking and Drainage.
CONSERVATION COMMISSION:
Detem-dnes 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
1"
--------------•---------------------------------------------------------------.-.-.-....---------
Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc.
REVIEWED BY: V
•--------------------•------• -----------------------
1. WATER DEPAR NT: DATES / N/A.
v
2. ENGINEERING DEPARTMENT: DATE: N/A:
%3tTl r� i%r /7�'rrsi /,v C`GG5L/ it / �•� r;ri�rc<rs-
3. CONSERVATION: Z'c¢�lj DATE: N/A:
4. HEALYH){'}1]1�: - DATE: -d 2-N/A:
INDUSTRIAL AND/OR COMMERCIAL PERMITS
S. WIRING INSPECTOR: DATE: N/A:
6. PLUMBING INSPECTOR: DATE: N/A:
7. FIRE DEPARTMENT: DATE: N/A:
PLEASE NOTE
COMMENTS:
RECEIPT OF COPY:
White copy —Building Dept. - Yellow Copy —Health Dept. - Pick Copy — Engineering Dept. - Goldenrod -Fire DeptlCoaservation
TOWNDIONG DEPARTMENTRMOUTH
BUJ,
BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF
TRANSMITTIAL SHEET
Address: Tel.No.: Date Filed:
The Building Department will be responsible for assis,(I`a�pplicant by dispatching your plans and or application to the following
applicable departments.
RESIDENTIAL AND/OR COMMERCIAL BUILDING
WATER DEPARTMENT:
Determines Compliance of Water Availability and or existing location.
ENGINEERING DEPARTMENT:
Determines Compliance for Parking and Drainage.
CONSERVATION COMMISSION::
Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of
Wetlands, Streams, Ponds, Rivers, 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.
------------------------------------------------------------------------------
*"...--------------------------- ------- ............ .-..---------------
REVIEWED BY:
1. WATER DEPARTMENT: DATE:( -/2-49�JN/A:
2. ENGINEERING DEPARTMENT:
DATE:
N/A:
`N/A:
3. CONSERVATION:
DATE:
1 1 / C
% f r /"
j
4. HEALTH DEPARTMENT C - • :'/ .
DATE
�` iINDUSTRIAL
AND/OR COMMERCIAL
PERMITS
3. WIRING INSPECTOR:
DATE:
N/A:
6. PLUMBING INSPECTOR:
DATE:
N/A:
7. FIRE DEPARTMENT:
COMMENTS:
RECEIPT OF COPY: SIGNATURE OF
White copy - Building Dept. - Green copy - Water Dept. - Yellow Copy -
PLEASE NOTE
DATE:
- Pink py -Engineering - Goldenrod - Firc DepUCoaxrvatioa
TOWN OF YARMOUTH
WATER DEPARTMENT
99 Buck Island Road
West Yarmouth, MA 02673
Telephone: (508) 771-7921 • Fax: (508) 771-7998
Date of Issue : Sep 17, 2002
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) 93 Street 68 Melgo Ln.
as shown on Assessors sheet/map # 25
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.
Reference
C. D. Stone
632 Pleasant St.
Paxton, MA 01612
Owner (Sign)
l_
Yarmouth Water Department
MAP/LOT-z5�93 ADDRESS_�i8_MEI.Go-LAWE
PLAN INFORMATION
PLAN TYPE _-- S V B a -- _
ENDORSEMENT DATE $ 28 g3_.
--- ----------------
RECORDING DATE -______________.
ASSESSORS PLAN G _____________-
PLANNING BRD. # _-- 2 7 8 S----------_--
PLAN. BRD. RELEASE.?__No FOLZ7ER Fcvo1D
Building Site Location:
Proposed Improvement:
TOWN OF YARMOUTH
BUILDING DEPARTMENT
BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF
TRANSMITTIAL SHEET
-MapNo: aJrLotNo•
93
i
- - - . - - Asay-
Applicant: f�i• �a is
Address: �' S � t' .5 �' ,� �'t �yl.� ?r Tel.No.: Date Filed: l A 42
& &-
The Building Department will be responsible for assisting the plicant by dispatching your plans and or application to the following
applicable departments.
RESIDENTIAL AND/OR COMMERCIAL BUILDING
WATER DEPARTMENT:
Determines Compliance of Water Availability and or existing location
DEPARTMENT:
Determines Compliance for Parking and Drainage.
ERVATION COMMISSION:
Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of
L—IJINEERING
Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc
TH 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.
REVIEWED BY:
I. WATER DEPARTMENT:
DATE: N/A:
2. ENGINEERING DEPARTMENT:
r DATE: fl 4 /A
3. CONSERVATION: DATE: N/A:
4. HEALTH DEPARTMENT: DATE: N/A:
INDUSTRIAL AND/OR COMMERCIAL PERMI"i S
S. WIRING INSPECTOR: DATE: N/A:
6. PLUMBING INSPECTOR: DATE: N/A
7. FIRE DEPARTMENT: DATE: N/A:
PLEASE NOTE
COMMENTS:
Mn FULL SASEMEM-Y PER PLAM (CRAWL SPACG ONLN)-
White copy — Building Dept. - Yellow Copy — Health Dept - Pick Copy — Engineering Dept - Goldenrod - Fire Dcp/Conscrvaban
BIC 1aSTS P00 l3 TS004
1 1-21-2000 1P 1 1= 4
t)C 1. C 'LuJ2 QUITCLAIM DEED
We, Ronal_ dincenzo and Josephine M. DiVincenzo, both of Medford, Middlesex
Ly183'
ll y, assachusetts, for consideration paid and in full consideration of Forty -
Two Thousand ($42,000.00) Dollars
grant to Gerard D. Lachance and Patricia A. Lachance, Husband and wife, as tenants by
the entirety, both of 776 Pleasant Street, Paxton, MA 01612, with quitclaim covenants.
A certain parcel of land situated in Yarmouth (South), Barnstable County, Massachusetts bounded and
described as follows:
iu NORTHERLY by Lot 8 as shown on hereinafter -mentioned plan, one hundred one
and 52/100 (101.52) feet
EASTERLY by land now or formerly of Arthur D. Fuller, being Land Court Petition 21124
as shown on said plan, eighty-six and 10/100 (86.10) feet;
SOUTHERLY by Lot 10, as shown on said plan, one hundred five and 73/100 (105.73) feet;
and
WESTERLY by Melgo Lane as shown on said plan, eighty-six and 00/100 (86.00) feet.
i
Being shown as LOT 9 on plan of land entitled, "Subdivision of land in South Yarmouth, Mass.
Property of J. Gorham Clint, Scale 1 inch = 40 feet — May 14, 1953, Bearse & Kellogg — Civil Engineers,
Centerville," which plan is duly filed with Barnstable County Registry of Deeds in Plan Book 110,
Page 53.
Together %vith a right of way in common with others entitled thereto over the streets and ways
shown on said plan for the purposes for which streets and trays arc commonly used; and subject to REG ❑F
t\ easements of record for public utilities. REG ft
'D EARNS
For grantors title see deed from J. Gorham Clitl and Melva B. Clift dated June 3, 1968 and
recorded on June 4, 1968 at the Barnstable County Registry of Deeds in Book 1403, Page 4
D Witness our hands and seals this 20th day of November, 2000.
itn Ronald A. DiVincenzo
,lG-C�G+rJ 1c
Witne s: scpli is M. DiVincenzo
COMMONWEALTH OF MASSACHUSETTS
Middlesex, ss. November 20, 2000
Then personally appeared the above -named Ronald A. DiVincenzo and Joseohin
DiVincenzo, and acknowledged the foregoing instrument to be their free act and deed, bcl
Notary Public: d
My Comndssion Expires:
11/21/00 11
000000 092Z
FEE f143.,
CASH 1•14 i _ 6
BARNSTABLE COUNTY
REGISTRY OF DEEDS
COUNTY EXCISE TAX
FE 11.'00
TU
IT
1
$95.7
J' • IN
.0157(
�
T. I, E
111
BARNSTABLE REGISTRY OF DEEDS
•
TOWN OF YARMOUTH
BUILDING DEPARTMENT
1146 Route 28, South Yarmouth, NIA 02664
508-398-2231 ext. 261 Fax 508-398-0836
September 24, 2002
Mr. Christopher D. Stone
C. D. Stone Construction
632 Pleasant St.
Paxton, Ma 01612
RE: 68 Melgo Lane S. Y.
Dear Mr. Stone:
I am in receipt of your building permit application received, September 11, 2002, on which you propose to
perform the following work:
"New Construction"
Having reviewed said application and associated documents I have determined that a building permit cannot be
issued at this time for the following reasons:
Building Code
Chapter 31, Section 3107 — The proposed renovation and addition triggers compliance with existing Flood
Resistance Construction (See Substantial Improvements) — Section 3107.5 - Flood hazard Zone A, 3107.5.1 —
Elevation, 3107.5.3, Enclosure below base flood elevation, 3107.5.4, Plans — Plans are required to be stamped by
an Professional Engineer or Architect.
Town of Yarmouth Zoning Bylaw
1. The lot inquiry note required a copy of the latest conveyance — (see enclosed)
Therefore, in order to proceed you are required to resolve these matters as directed above.
Any questions you may have regarding these matters may be directed to this department.
Very truly yours,
0.
James D. Brandolini, C.B.O.
Building Commissioner
YS/s. 1
KdenW ombo
TOWN OF YARMOUTH
BUILDING DEPARTMENT
1146 Route 28, South Yarniouth,111A 02664
508-398-2231 ext. 261 Fax 508-398-0836
September 24, 2002
Mr. Christopher D. Stone
C. D. Stone Construction
632 Pleasant St.
Paxton, Ma 01612
RE: 68 Melgo Lane S. Y.
Dear Mr. Stone:
I am in receipt of your building permit application received, September 11, 2002, on which you propose to
perform the following work:
"New Construction"
Having reviewed said application and associated documents I have determined that a building permit cannot be
issued at this time for the following reasons:
Building Code
Chapter 31, Section 3107 — The proposed renovation and addition triggers compliance with existing Flood
Resistance Construction (See Substantial Improvements) — Section 3107.5 - Flood hazard Zone A, 3107.5.1 —
Elevation, 3107.5.3, Enclosure below base flood elevation, 3107.5.4, Plans — Plans are required to be stamped by
an Professional Engineer or Architect.
Town of Yarmouth Zoning Bylaw
1. The lot inquiry note required a copy of the latest conveyance — (see enclosed)
Therefore, in order to proceed you are required to resolve these matters as directed above.
Any questions you may have regarding these matters may be directed to this department.
Very truly yours,
James D. Brandolini, C.B.O.
Building Commissioner
End. 1
JB/Js
Kdenialcombo
TOWN OF YARMOUTH
BUILDING DEPARTMENT
1146 Route 28, South Yarmouth, NIA 02664
508-398-2231 ext. 261 Fax 508-398-0836
September 24, 2002
Mr. Christopher D. Stone
C. D. Stone Construction
632 Pleasant St.
Paxton, Ma 01612
RE: 68 Melgo Lane S. Y.
Dear Mr. Stone:
I am in receipt of your building permit application received, September 11, 2002, on which you propose to
perform the following work:
"New Construction"
Having reviewed said application and associated documents I have determined that a building permit cannot be
issued at this time for the following reasons:
Building Code
Chapter 31, Section 3107 — The proposed renovation and addition triggers compliance with existing Flood
Resistance Construction (See Substantial Improvements) — Section 3107.5 - Flood hazard Zone A, 3107.5.1 —
Elevation, 3107.5.3, Enclosure below base flood elevation, 3107.5.4, Plans — Plans are required to be stamped by
an Professional Engineer or Architect.
Town of Yarmouth Zoning Bylaw
1. The lot inquiry note required a copy of the latest conveyance — (see enclosed)
Therefore, in order to proceed you are required to resolve these matters as directed above.
Any questions you may have regarding these matters may be directed to this department.
Very truly yours,
James D. Brandolini, C.B.O.
Building Commissioner
JB/js
HAcnWcomW
elc 13379 P0026 TS094
7. 11-21-2000 e 11=4.3
LzZ
Nov 1 QUITCLAIM DEED
o d A. DiVincenzo and Josephine M. DiVincenzo, both of Medford, Middlesex
South County, Massachusetts, for consideration paid and in full consideration of Forty -
Two Thousand ($42,000.00) Dollars
grant to Gerard D. Lachance and Patricia A. Lachance, Husband and wife, as tenants by
the entirety, both of 776 Pleasant Street, Paxton, MA 01612, with quitclaim covenants.
A certain parcel of land situated in Yarmouth (South), Barnstable County. Massachusetts bounded and
described as follows:
NORTHERLY by Lot 8 as shown on hereinafter -mentioned plan, one hundred one
and 52/100 (101.52) feet
— EASTERLY______ by land now or formerly of Arthur D.Fullcr, being Land Court_Pctition 21124_
as shown on said plar4 eighty-six and 10/100 (86.10) feet;
SOLTEiERLY by Lot 10. as shown on said plan, one hundred fine and 73/100 (105.73) feet;
and
WESTERLY by Mclgo lane as shown on said plan, eighty-six and 00/100 (86.00) feet.
Being shown as LOT 9 on plan of land entitled, "Subdhision of land in South Yarmouth, Mass.
Property of J. Gorham Cliff, Scale 1 inch = 40 feet — May 14, 1953, Bearse & Kellogg — Civil Engineers,
Centerville," which plan is duly filed with Barnstable County Registry of Deeds in Plan Book 110,
Page 53.
Together with a right of way in common with others entitled thereto over the streets and ways
shown on said plan for the purposes for which streets and ways are commonly used; and subject to REG ❑F
easements of record for public utilities. REG #
For grantors title see deed from J. Gorham Clift and Melva B. Cliff dated June 3, 1968 and
recorded on June 4, 1 %8 at the Barnstable County Registry of Deeds in Book 1403, Page 4
Witness our hands and seals
Middlesex, ss.
day of November, 2000.
Ronald A. DiVincenzo
/
COMMONWEALTH OF MASSACHUSETTS
Thm personally appeared the above -mined
Di Vincenzo. and acknowledged the foregoing instrw
o be their
Notary blic:
My Commissio
November 20, 2000
xnzo and Josephine
x act and deed, befa
,
11/21/00
0=0#
FEE $143
CASH S14`T*.,
BARNSTABLE`COUNT'.
REGISTRY OF DEED!
COUNTY EXCISE TA)
�1�tiE �].100 1
A.
$95.
j $95.
+4 .015,
?L 11
BARNSTABLE RFf;ISTPy np nune
MECcheck Compliance Report
Massachusetts Energy Code
MECcheck Software Version 3.2 Release la
TITLE: Cape House
CITY: Yarmouth
STATE: Massachusetts
HDD: 6137
CONSTRUCTION TYPE: 1 or 2 Family, Detached
HEATING SYSTEM TYPE: Other (Non -Electric Resistance)
DATE: 07/11/02
DATE OF PLANS: July 11, 2002
PROJECT INFORMATION:
Gerard Lacance
COMPANY INFORMATION:
New England Home Designs
184 Hovey Road
Monson, MA. 01057
NOTES:
All windows are Andersen Low "E"
COMPLIANCE: Passes
Maximum UA = 351
Your Home = 301
14.2% Better Than Code
Ceiling 1: Cathedral Ceiling (no attic)
Ceiling 2: Flat Ceiling or Scissor Truss
Ceiling 3: Flat Ceiling or Scissor Truss
Wall 1: Wood Frame, 16" o.c.
Window 1: Metal Frame, Double Pane with Low-E
Door 1: Solid
Basement Wall 3:
Solid Concrete or Masonry, 5.0' ht/4.0' bg/5.0' insul
Furnace 1: Forced Hot Air, 85 AFUE
Permit Number
Checked By/Date
Gross Glazing
Area or Cavity Cont. or Door
Perimeter R-Value R-Value U-Factor UA
270
30.0
0.0
9
665
38.0
0.0
20
88
38.0
0.0
3
1900
19.0
0.0
94
275
0.320 88
63
0.550 35
750
13.0
0.0
52
2002
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 Massachusetts Energy Code requirements in MECcheck Version 3.2 Release la.
The heating load for this building, and the cooling load if appropriate, has been determined using the applicable
Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall
be no greater than 125% of the design load as specified in Sections 780CMR 1310 and RA
Buildcr/Designer Date
MECcheck Inspection Checklist
Massachusetts Energy Code
MECcheck Software Version 3.2 Release la
DATE: 07/11/02
TITLE: Cape House
Bldg.
Dept.
Use I
Ceilings:
1. Ceiling 1: Cathedral Ceiling (no attic), R-30.0 cavity insulation
Comments:
2. Ceiling 2: Flat Ceiling or Scissor Truss, R-38.0 cavity insulation
Comments:
3. Ceiling 3: Flat Ceiling or Scissor Truss, R-38.0 cavity insulation
Comments:
Above -Grade Walls:
1. Wall 1: Wood Frame, 16" o.c., R-19.0 cavity insulation
Comments:
Basement Walls:
1. Basement Wall 3: Solid Concrete or Masonry, 5.0' ht/4.0' bg/5.0' insul,
R-13.0 cavity insulation
Comments:
Windows:
1. Window 1: Metal Frame, Double Pane with Low-E, U-factor: 0.320
For windows without labeled U-factors, describe features:
# Panes_ Frame Type Thermal Break? [ ] Yes [ ] No
Continents:
Doors:
1. Door 1: Solid, U-factor: 0.550
Comments:
Heating and Cooling Equipment:
1. Furnace 1: Forced Hot Air, 85 AFUE or higher
Make and Model Number
Air Leakage:
Joints, penetrations, and all other such openings in the building envelope that are sources of air
leakage must be scaled.
When installed in the building envelope, recessed lighting fixtures
shall meet one of the following requirements:
1. Type IC rated, manufactured with no penetrations between the inside of the recessed fixture
and ceiling cavity and sealed or gaskcted 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
Ls) air movement from the the conditioned space to the ceiling cavity. The lighting fixture
shall have been tested at 75 PA or 1.57 lbs/112 pressure difference and shall be labeled.
Vapor Retarder:
Required on the warm -in -winter side of all non -vented framed ceilings, walls, and floors.
Materials Identification:
Materials and equipment must be identified so that compliance can be determined.
Manufacturer manuals for all installed heating and cooling equipment and service water heating
equipment must be provided.
Insulation R-values, glazing U-values, and heating equipment efficiency must be clearly marked on
the building plans or specifications.
Duct Insulation:
Ducts shall be insulated per Table J4.4.7.1.
Duct Construction:
All accessible joints, seams, and connections of supply and return ductwork located outside
conditioned space, including stud bays or joist cavities/spaces used to transport air, shall be sealed
using mastic and fibrous backing tape installed according to the manufacturer's installation
instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted.
The HVAC system must provide a means for balancing air and water systems.
Temperature Controls:
Thermostats are required for each separate HVAC system. A manual or automatic means to
partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided.
Heating and Cooling Equipment Sizing:
Rated output capacity of the heating/cooling system is not greater than 125% of the design load as
specified in Sections 780CMR 1310 and J4.4.
Circulating Hot Water Systems:
[ ] Insulate circulating hot water pipes to the levels in Table 1.
Swimming Pools:
[ ] All heated swimming pools must have an on/offheater switch and require a cover unless over 20%
of the heating energy is from non-depletable sources. Pool pumps require a time clock.
Beating and Cooling Piping Insulation:
[ ] HVAC piping conveying fluids above 120 °F or chilled fluids below 55 °F must be insulated to the
I levels in Table 2.
Table]: Minimum Insulation Thiclatess jar Circulating Hot Water Pipes
Insulation Thickness in Inches by Pine Sizes
Heated Water
Non -Circulating Runouts
Circulating
Mains and Runouts
Temperature ( F)
UP to 1"
Up to 1.25"
1.5" to 2.0"
Over 2"
170-180
0.5
1.0
1.5
2.0
140-160
0.5
0.5
1.0
1.5
100-130
0.5
0.5
0.5
1.0
Table 2: Illinimum Insulation Thicknessfor HVA C Pipe&
Fluid Tcmp. Insulation Thickness in Inches by Pipe Sizes
Pining System !3T Range 2" Runouts V and Less 1.25" to 2" 2.5" to 4"
Heating Systems
Low Pressure/Tcmperature
Low Temperature
Steam Condensate (for feed water)
Cooling Systems
Chilled Water, Refrigerant,
and Brine
201-250
1.0
1.5
1.5
2.0
120-200
0.5
1.0
1.0
1.5
Any
1.0
1.0
1.5
2.0
40-55
0.5
0.5
0.75
1.0
Below 40
1.0
1.0
1.5
1.5
NOTES TO FIELD (Building Department Use Only)
•
A TE (MM Dorn)
ACQRD CER1i : TE OF L ABI ITY. NSURIANCE DA
-.....a:U "'^CL.NKiCO.On %CGN:CM4unWW.4Jm. hN.vw,n.t. W.vw>.,nvM.vn :(Mw..,wCCNKv:C.t.n•.
...M.vvl. •n ••:: .
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Conte Insurance Agency, Inc.
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
579 Pleasant Street
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Paxton, MA 01612
COMPANIES AFFORDING COVERAGE
3f;
COMPANY
A National Grange
t
INSURED
—
si
Christopher D Stone dba
COMPANY
B Zurich -American
CD Stone General Contracting
COMPANY
632 Pleasant Street
C
'
Paxton, MA 01612
COMPANY
D
:COVERAGES _ '
twve.. r.vM14/.vrY�Oh•R:S'v6nYJ YM'N wL:,M..Atl:f:n\!..\..:vv.,.py(yyhtiry.yn•.qKA'wlfRONY!•%4'46.(p(3G.v}•A{w( T�](tvY T\S?11%Wrc:0.�,�'IXv50Z:w'<AOa[:.:V�,hu..v
THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
V
CO TYPE OF INSURANCE POLICY NUMBER
LTR
POLICY EFFECTIVE POLICY EXPIRATION
LIMITS
I
DATE(MMADDryY) DATE(MMIDD/YY)
GENERAL
LIABILITY
GENERAL AGGREGATE
S 600,000
�-
A
COMMEROAL GENERAL LIABILITY
-
CLAIMS MADE
PRODUCTS.COMP/OPAG_G
S (O0i-09
PERSONAL S ADV INJURY
$ 300,000.
OCCUR
MPS15417
6/08/02
6/08/03
OWNER'S S CONTRACTOR'S PROT
EACH OCCURRENCE
s 300,000
FIRE DAMAGE (Any one Tue)
s 5001000,
_
S 10.000
MED EXP Any we pecan)
AUTOMOBILE
LIABILITY
_
ANY AUTO
COMBINED SINGLE LIMIT
S
ALL OWNED AUTOS
--
I, .
k
SCHEDULED AUTOS
BODILY INJURY
(Per Pero )
s -
1
HIRED AUTOS
BODILYINJURY
S
b
NON -OWNED AUTOS
(Pereaidena
PROPERTYDAMAGE
$
GARAGE LIABILITY
AUTO ONLY • EA ACCIDENT
S
ANY AUTO
OTHER THAN AUTO ONLY:
777777777
EACHACCIDENT
$
—.--
AGGREGATE
S
EXCESS LIABILITY
EACH OCCURRENCE
s
UMBRELLA FORM
AGGREGATE
Is
OTHER THAN UMBRELLA FORM
s
WORKER) COMPENSATION AND
WC A OT
X77
•<:
.
EMPLOYERS' LJABILMY
EL EACH ACCIDENT
S 100,000
g ITHEPROPRIETOR/
INCL
PARTNERS/EXECUTIVE
R
6ZZUB-844X892-5-02
2/15/02
2/15/03
EL DISEASE -POLICY
YLMIT
$ 500,0_
EL DISEASE • EA EMPLOYEE
s 100.000
OFFICERS ARE EXCL
+
OTHER
DESCRIPTION OF OPERATIONSILOCATKINSNEHICLES/SPECUIL ITEMS
rT
`
C RTIFICRTE HOGAER GAtiCE4 T .vn,.vn,vw,nwwr.,.v...wwvnvrvnvv,umvw..wA0.w.wnv.v! vn. .vn. in•..,..can.wn�.vAAIaAiA��wlJphwv�:2�L+nYwiG"nwwvn,IACi%NiuJJA.CLn.+w.'i+'n".�wGtviZ.,W,W. A:vY.0. Av
M
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
r '
Gerard D Lachance
tc.p�
68 Melgo Lane
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
'
South Yarmouth, MA 02672
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESE TATIVE
ACQRR�`�Sjtl9Sj .:
ffiACORpORP.0RATION39$$
✓�c LnertriraroareulU o`'„l�auric%rrre!!,t
BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
r Number: CS 001321
r Birthdate:06128/1951
Expires: 06/28/2004 Tr. no: 24639
Restricted: 00
CHRISTOPHER D STONE
632 PLEASANT ST
PAXTON, MA 01612
Administrator
:+`� :%gip t�rsrnranuv+all� n� ���af,wr�ate(Lt
Board of Building Regulations and Standards
ff _
•;fit_ ;q 3 HOME IMPROVEMENT CONTRACTOR
.6" Registration: 109050
Expiration: 9/1/2004
Type: DBA
C.D. STONE GENERAL CONTRAC
Nn"stopher Slone
632 PLEASANT ST.
Paxton, MA 01612"
Administnlnr
i
TOWN OF YARMOUTH
1146ROL7E28 SOUTH l.MWOUTH MASSACHUSETTSO`266t 1-1451
Tcicplua►c (508) 398.2231. ExL 261 — Far. (508) 398.2365
BUILDING DEPARTMENT
BUILDABLE LOT INQUIRY FORM
Lot No.Assessors' Map No. .5 StreetL!
BUILDING
ELE(TR1C%L
GAS
PLUMBING
1999 D
By. 41EX
Endorsement Date of Subdivision Plan and Type (if applicable)
,.7/)
Total Land Area (sq. R .�Z 6 Frontage
Name of Current Owner Addresser J %r'(,� Telephone No.
Inquire's Name (if different from owner) Rn / .S1r,i i xcj Telephone No% Q /- ,PZ/ 3 12/
Inquire's Mailing Address
/Ce1, Ma y
Building Intent Adjoining Lot Numbers
Signature of Applicant aent -Z, P-• - Date of Inquiry 42 -Z Z-4-9
FOR OFFICE USE ONLY
Does not conform with M.G.L. Chapter 40A, Section 6, single lot exemption, or Definitive
Plan Exemption and/or the applicable zoning bylaw, as per information provided.
Reason
1L Conform$. with M.G,L; Chapter 40A, Section 6 single lot exemptior> and/or applicable
zoning bylaw, as per information provided.�� • /o y 3 • I//Jtt,r /
Protected pursuant to M.G.L. Chapter 40A, Section 6, Definitive Plan Exemption.
Application is incomplete. Comments:
Adequate road access must••be present. Determination of access shall be determined by the
/Planning Board (ifapplicable).
V Must satisfy Title V requirements. p \�
Conservation regulations, if applicable.
L
Must satisfy regal aPP
Qstigator's
a
A� �� A�CT #! F2
LOc 000
MAP 021 LOT D9
LANE
A.DOC-
CERT.
PROBATZ
>
Illa-cengn d e7lix
�12
g.14
pt
ACCT# 0# 2 .94 MAP 021 LOT DIO
LUC 000 GO LANE
Plan
30
OR6
all
FL4 fM"l
-"S:
X-
4W
ACCT# 025.163 MAP 021 LO 615E
N LOC 00067 ELDRIDGE RD n PIaD-7.�31�
r
�a
ACCT# 025.164 MAP 021 LOT 614E
LOC 00065 ELDRIDGE RD PI8O 3 !4
OB -"
.ti"DOC.'
ClRT. `
' �PROBAT6
S-
<< 40
4
!.0
3
e
ACCT# 033.344 MAP 021 LOT G13E
Mal LOC 00061 EL.DRIDGE RD il_� y Plan
DOM
CERT.
PROBATE
..
,,.5�...
,.
Y
. .. .t;_... - - . _ - .".. �..
�.....�:' Av.i:
�rO4'ti �lA+�}
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ACCT# 033.373 MAP 021
LOC 00062 MELGO LANE
.•I•T..�f�;...r]A../C.T.••°'Tl.r...,.yte�,y.r+....rr....-..-r...--..�..-.- _.
4w! Mii h t
Plan
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1:35PM BOISE
BC CALC® 2002 DESIGN REPORT - US
NO.446 P.2
Thursday, November21, 200213:36
a .,
Triple 1 314" X 11 718" VERSA-1-AM3100 SP
Name - DC CALC Prcied: FB03
Job Name • JERRY LA.CHANCE RES
Sposcmton -
Adcress
City, State, Zip -
.
Designer • Nate owerl
Customer
Company• ROISE
Coda reports - ICBO 6512, BOCA 9M2, SBCCI 9952
We -
Bo 61
4508Ito LL 144M be LL 5483 tt z LL
1591 Iles DL 6174 ins DL 23E1 Ibs CL
Total Hor.mntal Lerpth - 224040
Goncral Data Load Surnmary
Version: U3 Imperial ID Description Load Type Rat Start End Live Dead Tn'b. Our.
S Standard UnfArsa Load Left M40-M 22-00-00 50 PSF 20 PSF 10440 100
Member Type: - Floor Beam 1 UnfArsa Load Left 00-00-00 22.00-M 30 PSF 15 PSF 18.00.00 115
Number of Spans .2
Left Cantilever • No Controls Summary
Right ConSovrer - No Cordrol Type Value • AlWorabta Duration Loadcaae Span Location
Momant 23229 ft-bs 65A% @ 116% 3 1- Right
91ope 002 "Shear 6333Its 4w7% 01150A 5 2-Right
Tributary 10-cm Cent Shear 9B04Its 70.7% gi 115°.G 3 2-Led
Repethlve n!a Total Dsfledlon L1450 (0.325'1 53.2% 5 2
Construction Type n/a Like Deflection L1611 (0.241") 58.2% 5 2
Total Neg. Deft..0.0691 13.9% 5 1
Live load 60 PSF Max Dart 0.32ir (LarC 1) 32.6% 6 2
Dead load 20 PSF SparyDepth 12.4 2
Part Load 0 PSP
Duradon 100
NOTES:
Disclosure Design meets Code minimum (L240) Total load deflection uitnria.
The completeness and accuracy of Design meets Code minimum (l=) Live load deflection criteria.
Me input must be varified by anyone Design made arttrary (11 Ma)rtwm toad deflection faiheft
who would rely on the output as Minimum bearing length for BO x 1-1/7.
evidence of suitability for a Minimum bearing Isngth for 01 Is 4-3/4".
particular application. The output Minimum bearing length for B2 is 1-11/4".
above h based upon binding EnteredMisplayed Hori=ntal Sean Length(&) * Clear Span + 1/2 min. and bearing + 112 Interme We bearing
rodw4coeptsd design properties
and analysts methcda. Installation
of BOISE engineered wood
products must be In sccotdance
with fhe current Installation Glide
and the applicable bwldinp codes.
To obtain an Installation Guide or If
you have arty quesions, please all
(B00)222-0755 before baglnnng
product installation.
BC CALC®, BC FRAMiERV, BCI8,
BC RIM BOARD'I, BC OSS RIM
BOARDT", BOISE GLULAM?m,
VERSA -LAM®. VERSA -RIM®,
VERSASTR/WD t"
Dm.
VER9PrSTUALW019T� and I1
AJS"r are registered tmdemarfo of
Use C&scadeCorporation.
Page 1 cf 1
NOV.21.2002 1:35PIl BOISE
BC CALL® 2002 DESIGN REPORT - US
NO.446 P.3
Thursday, November 21, 200213:36
r• Triple 1 3/4" X 9112" VERSA -LAM® 3100 SPFas
Name - BC CALC Ptojo,^t: F1102
Job None - JERRY LACI1ANCE RES Dewoon
Addrss Specifier
City, State. Zip - Designer - Nate C ?ver1
Customer - Company - BOISE
Code reports • IC50 W2, BOCA 98.52. SBCCI 9852 MU -
00
3750 sibs LL
1570 Ibs DL
General Data
Version:
Member Typs:
Number of Spans
Left CaWaver
Right Cantilever
Slope
Tributary
Repattnre
ComViucdon Typo
Live Load
Dead Load
Part Load
Duration
nrandard load - ad P3F 120 PSF TrLu 13-W-oo
Bt
3750 to$ LL
1570 sibs OL
Total Horizontal Length - 104040
(Load Summary
us imperial ID Description Load Type Ref. Start End Live Dead Trb. Dur.
B Standard WA ras Load left 004M 10-CM 60 PSF 20 PSF 1640-00 100
Floor Beam
-1
No
- No
0/12
15-M-00
rA
rah
50 PSF
20 PSF
0 PSF
100
Disclosure
The compbtsnas+ and stamp of
the Input must be vsdiisd by anyone
who would rely an the output so
evidence of subbiity for a
padoular appimtion. The outlwt
above is based upon bullding
code-acoeptad delipn properties
and analysis methods. Installation
of BOISE enginearad Wood
products must be in accordance
with the current Installation Guide
and the appllmbia building cadet.
To obtain an Installation Guide or d
you have any questions, please Cat
(600)232.0788 before beglnnttg
product Iruftalbiion.
BC CALLA, BC
DC RIM DOARt
are
Page 1 of 1
b ALLJOISTO and
terad trademarka of
CarporatImn.
controls Summary
Control Type
Value
%Allowable Duration
"cut
Span Looatlon
Moment
13300 ftabs
63,5% 0100%
2
1- Intemal
End steer
4478 be
aa.% @ 100%
2
1- Left
Total Collection
U376 (0.319")
s3 o%
2
1
Live Deflection
U533 (0.2 1
67.5%
2
1
Mix DrA
0.310. (Limit 1')
31.G%
2
1
Sp hMoth
12.6
1
Maas Coda minimum (U240) Total bad defection attsria.
most s Code minimum (L360) LNe bad dallschon enteric.
meets arbitrary (I I Makimum load deflection atoria.
m bearing length for SO le 1-12'.
m bearing length for S1 is 1-1/2-.
110splaled Horttontal Span LMM(i) "Clear Span + 112 mil. end bearing t 112 it arm9diato bearing
FEDERAL EMERGENCY MANAGEMENTAGENCY O.M.B. No. 3067-0077
NATIONAL FLOOD INSURANCE PROGRAM Expires July 31, 2002
ELEVATION CERTIFICATE
Imporitaint Read are I uhicitim on pages 1-T.
SECTION A- PROPERTY OWNER INFORMATION Fdlnsua rraCartoany Ilea .
BUIB DING STREETADORESS (Including Apt, Ural. SUde, andlor Bldg. No.) OR P.O. ROUTE AND BOX NO. ICorripany NAIC ""-"be`
68 Melgo Lana
CITY STATE ZIP CODE
South Yarmouth MA 02664
PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal DescrVbm etc)
Lot 9 Assessors Map 25 Parcel 93
BUILDING USE (e g., Rw dental, Norrresiden6al, Addboom Accessory, etc Use a Corrmerns area, d necessary.)
Residential
LATTTUDELONGITUDE(OPTIONAL) HORIZONTALDATUnt SOURCE 11
GPS(type)
( Mr -W -4#Arr or ##.## #ir7 ❑ NAD 19U ❑ NAD 1983 ❑ ttscs Quad Map _ ❑ other.
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1.NFPCOMMUNITY NA6E&COMMUNITY NUMBER 82. COUNTY NAME . B3.STATE
Yanmmh 25M15 Barstable MA
B4MAPANDPANEL
BSSIFFD(
87.FIRM PANEL
ERWEFL000HEVATION(S)
NUMBER
B&FRMPDD(DATE
DATE
BB.FL oOM E(S)
RmeAD,ueedepQhdloodr�
250015=1
D '
07A719P
070M
A9
Liu ;
B10. thdCate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9.
❑ FIS Profile ® FIRM ❑ tom w4 Determined ❑ other (Describe):
B11. nd cafe to elevation datum used for to BFE in B9: ® NGVD 1929 ❑ NAVD 1968 ❑ Other (Describe):
B12 Is the dak6ng lotted in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes ®No Designadm Date
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Buildng devatirxa are based on: ❑ Censstudim Drawings' ® Buffing Under Carstrtrdim' ❑ Finished co stumm
'A new Elevation Certificate Yet be regrdred when corstrudion of the building Is cor pleta
C2 Building Diagram Norm$ (Select the building diagram most similar to the bunking for wttdn Its certificate Is being completed -see pages 6 and 7. If no dagram
accurately i :p ,cads the building, provide asketch or phol ograph)
C3.Bevatiors-ZeesAIAXAE,AKA(with BFE),VE,V1 V30,V(with BFE),AR,ARIA,ARIAE,ARIAIAM, ARIAH,ANAO
Cmplele hens pal below according to the building dagran specified in Item C2 State the datum used. tthe data n'a dlteet tram the datum used for the BFE in
Section B, convertthe datum to Mused fort he BFE Show field measurements and dabm conversion caladatm Use the space provided )the Camhe is area d
Sectim D or Section G, as appropriate, to document the datim cmversiorl.
Dalian GmvesiUNConme
Elevation rdawca mark used EMADoes to elevation reference mark used appear on the FIRM? ®Yes []No
o a)TopdboMmg=(nduc4basennertorert imm) L4 U.R(m)
o b)Top dinext hkfafloor .04m)
o c) Bottom d alost thorizorhtal structical member (V cones only) _ _ft(m)
e
o d) Attached garage (top of stab) 1j�IP. R(m)
�S
o e) Loaestelevation of machinery andiorequipment
servicing tie btcldng (Describe In a Cements area) Q.; AM
o A Larwest Aaoad ( Wade MG) `Z• 04m)
y
o g) Hg t (linished) grade (HAG) U. ULM
C
o h) Na of permmet opertngs (tool vets) whin 1 ft. above 4acet grade 2
o i) TcU area d of pemnanet opm'egs (food vents) n C3h 2QQ 4 n. (n c m)
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This cerfificafion is to be signed and sealed by a land surveyor, engineer, or architect auttadzed by law to oe* elevation into
I certify that the information in Sedforts A, t3, and C on this cerdficate represents my hest efforts to frtterpret the data available.
1 understand that anv false statement may be ounishable by fine or immisonment under 18 U.S. Code. Section 1001.
ADDRESS CRY STATE ZIPCODE
P. O. Box 713 _ on -11P South Dennis MA 02660
FEMA Form 81-31, JUL00 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS
from Sedlon A.
@XkifrgApt.,Unk
CITY .' STATE ZPCODE I Canpary"Nrffw `I
Smmyamomm MA am -
SECTION D-SURVEYOR, ENGINEER, ORARCHITECTCIERTIRrATION (CONTINUED)
Copy ban sides d a,is Elevation Certificate for (1) oo mnuity official, (2) nsmramce Muftompary, and (3) Ucling arms.
COMMENTS
Cad, Slab not poured yet
Cie_ No madmery yet,109 s slab elevation
Cif. Fandatim is notaonpletely WdZW
❑ Check here d attadrments
SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE)
For Zone AO aid ZmeA (wiMocd BFE), complete Items E1 ttroto E4. t to Elevation CaViicale Is haided for use as s gxrfirg dormatim for a LOMA or LOMR-F,
Section C mat be carpletai
E1. Buldug Dagram Number_(Select to bkddrg diagram most snrlar b to buil6rg forwtich tl astficaie is berrg completed -see pages 6 and 7. t nodagam anvately
repceserds time anld% provide a skelc h or phot 9aph.)
E2. The by d the bottom too (mdudng basermmut orermdos=) d the hikk g is _f (m) _in(cn) ❑ above or ❑ belt" (dmeck one) the l# est adacecd gads (Use
natiaal Bade, t available).
E3. For Buldrg Diagrams 68 with epwvKjs (see page 7), the need ligFolloororelevated floor (elevation b) d the building is _ t.(m) _h(an) above the highest adtam t
grade. Complete terra C3h and C31 on front of form
E4. FarZme AO only: trio flood depth rncnber is astable, is the top of the bottom floor elevated In acordaxe With to couni t/s too#in management adnance7
❑ Yes ❑ No ❑ Ud wn, The lad official must ca* tfs Wormatie In Sedmon G.
SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION
The propeq arms orowr* 's a Ma®d mpresadadve who completes Sections A, B. C (terms C3h and C31 o*y and EfiorZame A (wdW a FEMAiss=l or crruu*-
issued BFE)orZone AO must sign hei. The statmmmts in Sedio s A, B, C, and E ore eormct to the best d m y knowledge.
ffr4=, i OWNERS • • OWNERS • 1arm
r• � r •
!• u u ��1
❑ Check here tatadvnenLs
SECTION G - COMMUNITY INFORMATION (OPTIONAL)
The local dkial who is artmamed by law oradna ca to aM*nter the omwuWlls tooctpm managemadadirk mce an complete Sections A, B, C (or E), and G of tis Elevation
Certifirale. Complete to appfi "derr(s) and sign below.
G1. ❑ The nfemmafie in Section C was take from Uludoedr>ermtatcn that has been soiW ad embossed by a ioased surveyor, ergkw, or adilect who is arthamed by
state or local law b ratify elevation nfomatiom (ndcate the soi and date of the elevation data in the Caane is area belovv.)
GZ ❑ A camnnity official completed Sector E for a biA*Q located in Zone A (witrout a FEMA4ss=l orcmnrmily{ssred BFE) orZone AO.
G3. ❑ The iobMV idama6an (terns G40) is povdad forcomu* floocom manaprat Wpm
G7. T tis Merit has bem issued fo: ❑ New Cash dm ❑ Substantial npvvanet
G&Elevationdm-bLitlowestfloor(mdudrgbasement)dtonebutidrgL — Nm) Daft=
G9. BFE or (n Zone AO) depth of toodng at the butidrg site is _, _ft(m) Datm
LOCAL OFFICIAL'S NAME TITLE
SIGNATURE DATE
[R•'Iw�i��Jl�'�
FEMA Form 81-31, JUL 00 REPLACES ALL PREVIOUS EDITIONS
�d
Vt.
TOWN OF YARMOUTH
OTT
�u APR 2 8 Z003
rtlo9l c� ¢�8.
io
APPLICATION FOR PERMIT TO DO PLUMBING
(OFFICE USE ONLY)
By
Fee: $
PERMIT NO. P- 0 3 "s5 -7-
Date 20
Building / —�M4 Owner's ALD � CG► c n «%
AT. Locati n /oq 1'� G L 6 o Lsre Name
Type of Occupancy
NewX Renovation ❑ Replacement ❑
R. ans Submitted Yeskl No ❑
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SUB-BSMT.
BASEMENT
1ST FLOOR
2ND FLOOR
3RD FLOOR
(PRINT OR TYPE) m
Installing Company Name 1 \ r I '1
Q0
Address %%� r � e as e
Business Telephone
Check One:
❑ Corp.
❑ Partnership
XFirm/Company 141
Name of Licensed PlumberN►(R r r
INSURANCE COVER' E: I have a current liability insurance policy or its substantial equivalent. Check One: YeWNo ❑
If you have checked YES, please indicate the type of coverag b checking the appropriate box.
Sr V�I'
A liability insurance policy Other type of indemnity ❑ � Bond' ❑
OWNER'S INSURANCE WAIVER: I am aware that the licens a does not have the insurance voerag require y, h, 142 of
the Mass. General Laws, and that my signature on this permit application waives this requirement. �iE3y
ft1J
Check on Owner ❑ent ❑
Signature or 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.
Signature of Lic nsed
Plumb
a 5-
License N mber
Type: Master JoumeymaQ�'
JIFEDERAL EMERGENCY MANAGEMENT AGENCY
� Q O.M.B. No. 3067-0077
NATIONAL FLOOD INSURANCE PROGRAM Expires July 31, 2002
poi ELEVATION CERTIFICATE
fur, Important Read the instructions on pages 1.7.
SECTION A - PROPERTY OWNER INFORMATION Fa Canperry llsa
BUILDING Policy Number
Gerald La rice
BUILDING STREETADDRFSS (Including Apt.. UA Suits, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Company NAIL Number
68 Meloo Lane
CRY STATE ZIP CODE
South Yarmouth MA 02664
PROPeKrY UeSUMP I UN (Lot aria UM Numoers, I ax Parcel Numoer, Legal uesapuon, etc)
Lot 9 Assessors Map 25 Parcel 93
13UILDINU U5E (e.g., KeSlcential, Non-reWeMal, AOO¢pri, PZCBSSnry, eta Use a L.:Ortrnerrts area, r necessary.)
Residential
LATTTUDEILONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE GPS (Type).
( #r - #w-##.##i or ##. ❑ NAD 1927 ❑ NAD 1983 ❑ USGS Quad Map ❑ Other.
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
81. FFIP COMMUNITY NAME 8 CON& NRY NUMEER 82 COUNTY NAME . la STATE
Yarmouth =15 1 Barnstable AM4
84.61APAND PANEL
B5 SUFFIX
W. FIRM PAPEt
ELEVATIONS)
89 BASE FLOOD ELEVATIONS)
B6.FRMFDEXDATE
EFFECTNEvREVISmDATE
B8 FLOODZOtJE(S)
(Zane AO, usedeMdbo*V)
2500150006
D
07=
O70M
A9
1100-
B10. Indicate the source of the Base Flood Elevation (BFE) data or base Ilood depth entered in B9.
❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other (Describe):
B11. ndcate the elevation datum used for the BFE in B9: ® NGVD 1929 ❑ NAVD 1988 ❑ Other (Describe):
B12. Is the building bated Ina Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)7 ❑ Yes ®No Designation Date
SECTION C- BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Bwldng elevations are based on: ❑ Ccnstudion Drav+ings• ® Building Under Co shcW ❑ Finished Construction
•A new Elevation Certificate W be regldred when construction of the building is complete.
C2 Bwldng Diagram Nrmb;d (Select the building diagram most similar b the b ildug for which this certifrate is being completed -see pages 6 and 7. 1 no dagrarn
accurately represents the bluldrg, provide a sketch or ptatograph.)
C3. Bevatio s-zones AlAW , AE, AH, A (with BFE). VE, V140, V (with BFE), AR, ARIA, ARIAE, AR/AI AW, AR/AH, ARIAO
Complete Items C3.-a4 below according to the building dlagrarn specified in Item C2 State the datum used. If the datum is diferent from the datum used for the BFE ih
Section B, convert the datum to That used for the BFE. Shay field measurements and datlmm conwsim calculation. Use the space provided or ft Comments area of
Section D or Section G, as appnopdate, b doarnod the datum conversion.
Datum_ CmversioNCormlents
Elevation reference matt used M 29 Does the devation refs ence mark used appear en the FIRM? ®Yes []No
o a) Top of bottom floor (including basement or enclosure)
N CF s
o b) Top d nod lour 44.04m)
A% o
o a) Bottom of bivest horizontal stnrbual member (V zones only) _ _tt(m)00
o d) Attached garage (top of slab) LUP• _fl(m)
f A
o d C;
N
o e) Lowest elevation of machinery ardor egAxnent
servicing the butting (Describe in a Ccrmlerts area) 10 . ift(m)
E m
o f) Lowest ads ( Wade MG) 9.04m)
d w
ss6�
0 9) Highest( (HAG)• 5-f4m)
"c
LAND S
o h) Na of permanent openings (flood vent) will in 1 fl above adlacert grade 2
o ) Total area d all pennalent openings (flood veins) in C3.h 284 sq. in. (sq. an)
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation Information.
1 certify that the information in Sections A, A and C on this certificate represents my best efforts to interpret the data available.
I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
CERTIFIERS NAME Robin W. WkcK PLS UCENSE NUMBER 31341
TmzPidessimal Land Surveyor COMPANY NAME Swcetser Engineering
ADDRESS CITY STATE ZIP CODE
P. 0. Brno 713 _ /l South Dennis MA 02660
rf r. Ii r'
FEMA Form 81-31, JUL 00 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS
WISE BC CALC® 2002 DESIGN REPORT - US Thursday, May 15, 200316:10
File
Double 1 3/4" x 91/2" VERSA-LAM(g) 3100 SP Name - BC: FB02
Job Name - GERALD LAC Erp� Description -
- MELGO LANE - BOTELLOAddress
City, State, Zip - W YARMOUTH MA, MA Designer -
Customer - LACHANCE Company - L5 J u f II
Code reports - ICBO 5512, BOCA 9852, SBCCI 9852 Misc -
AY 1. 6 cues U
,
SW-4wd Load - 0 PSF 185 PSF Tributary 12
BO B1
1920 lbs LL 3840 lbs LL
2130 lbs DL 2717 lbs DL
General Data
Version:
US Imperial
Member Type:
- Floor Beam
Numberof Spans
- 1
Left Cantilever
- No
Right Cantilever
- No
Slope
0/12
Tributary
12-00-00
Repetitive
n/a
Construction Type
n/a
Live Load
0 PSF
Dead Load
85 PSF
Part Load
0 PSF
Duration
100
Disclosure
The completeness and accuracy of
the input must be verified by anyone
who would rely on the output as
evidence of suitability for a particular
application. The output above Is
based upon building code -accepted
design properties and analysis
methods. Installation of BOISE
engineered wood products must be
In accordance with the current
Installation Guide and the applicable
building codes. To obtain an
Installation Guide or if you have any
questions, please call
(800)232-0788 before beginning
product installation.
BC CALC®, BC FRAMER®, BC18,
BC RIM BOARDT", BC OSB RIM
BOARD', BOISE GLULAMT",
VERSA-LAM31, VERSA -RIM®,
VERSA -RIM PLUS®,
VERSA-STRANDT",
VERSA -STUD®, ALLJOISTO and
AJST" are registered trademarks of
Page 1 of 2
Total Horizontal Length - 03-00-00
Load Summary
ID Description
S Standard
1 fb1
Controls Summary
Load Type Ref.
Unf.Area Load Left
Conc.PL Load Left
Control Type
Value
%Allowable
Moment
6033 ft-lbs
37.6%
End Shear
5742lbs
77.7%
Total Deflection
L2209 (0.016")
10.9%
Live Deflection
LJ3743 (0.01 *)
12.8%
Max. Defl.
0.016' (Umit:1")
1.6%
Span/Depth
3.8
Start End Live Dead Trib. Dur.
00-00-00 03-00-00 0 PSF 85 PSF 12-00-00 100
02-00-00 02-00-00 5760 lbs 1759 lbs n/a 115
Duration Loadcase Span Location
115% 3 1 -Internal
115% 3 1 -Right
3 1
3 1
3 1
1
NOTES:
Design meets Code minimum (L240) Total load deflection criteria.
Design meets User specified (L/480) Live load deflection criteria.
Design meets arbitrary (1 *) Maximum load deflection criteria.
Minimum bearing length for BO Is 1-12".
Minimum bearing length for B1 Is 2-1/4".
Entered/Displayed Horizontal Span Length(s) - Clear Span +• 12 min. end bearing +• 12 Intermediate bearing
I '?,
I
.�.�•�". •'_- - pew..;.'
I !rL:OrzrM, , _
t
� �- Z� `'!'= t'�,r: � � � •'. ' r der.""
�.
r
CRAIG R. SHORT, P.E.
P. O. Box 1044
235 Great Western Road Telephone (508)398-8311
South Dennis, MA 02660 Fax (508)39_0-3063
PROFESSIONAL CIVIL ENGINEER, SOIL EVALUATOR, SEPTIC INSPECTOR
SEPTIC SYSTEM DESIGNS, COASTAL & BUILDING DESIGNS
TO: James Brandolini
Building Commissioner
Yarmouth Building Department
1146 Main Street, Route 28
South Yarmouth, MA 02664
RE: CERTIFICATION OF FOUNDATION IN FLOOD ZONE
LOCATION OF SYSTEM: #68 (Lot 9) Melgo Lane, South Yarmouth, MA
CLIENT: Gerard LaChance
PLAN DATE: 10/29/02
FILE a: Craig Short File # 12-973
DATE (S) OFfrYPE OF INSPECTIONS:
01/27/03 Inspect & Photograph House Foundation Footing Steel
01/30/03 Inspect & Photograph House Foundation Wall Steel
I, Craig R. Short, Civil Engineer, duly licensed as such in the Commomvea/th ofMassachuseus, do
hereby certify that this firm has visually inspected the constructed foundation shown on the referenced
approved plan, and further certify that the foundation, as constructed and shown on the attached As -
Built and enclosed photographs taken, generally conforms within acceptable tolerance to the
requirements of the Building Code for Foundation in a Flood Zone.
�j � ^ 4 � Vt7a(Ir •y
U` a civ;" L;
Craig R. 9hort, P.E., Engineer `' 27`^'3
cc: File CRS & Sweetser
Client Gerard LaChance
Contractor Jim LaBoeuf
Z/2 7/a3
Date'
LOT 8
LOT 9
AREA 4916tSf.
LOT 10
I
'2127NG 4 £XISANG SEP77C O
FOUNDA77ON VAULT
TOP OF FOUNDATION IS 5.8'
ABOVE HIGH POINT IN ROAD.
TO THE BEST OF MY INFORMATION,
KNOWLEDGE, AND .BELIEF THE
FOUNDATION SHOWN ON THIS PLAN
HAS BEEN LOCATED ON ND
AS INDICATED o���"``" OF
uj
s,y
2 3 03 3ly
DATE PROFESSIONAL L
"AS -BUILT" PLOT PLAN
YARMOUTH, MASS.
LOT 99 1953-"J. GORHAM CLIFT" PLAN
DATE 2/3/03 SCALE 1 "=20'
JOB 5408-00 CLIENT LACHANCE
SWEETSER ENGINEERING
235 GREAT WESTERN ROAD
PO BOX 713 SOUTH DENNIS, MA 02860
oft. 508-398-3922 fax 508-398-3083
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APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, (MEC). 527 CMR 12.00
TOWN OF YARMOUTH
(OFFICE USE ONLY)
By q
Fee: $
PERMIT NO. E -U3 - �s�i '7
(PLEASE PRINT IN INK OR TYPE ALL INFORAIATION) Date: a? - I o2- 0,,•3_
To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical
work described below.
Location (Street & Number) t,_IM L L On a Lao o P
Owner or Tenant
Telephone No. (�g g) 39 k -1 L �8e
Owner's Address F- 1,11 • r�v%X-1 r - 1.00 T _,pill / •nt'wc -li'(P
Is this permit in conjunction with a building permit? 0 Yes ❑ No (Check Appropriate Box)
Purpose of Building S i n q le' `r IZP4i jr nc e Utility Authorization No.
Existing Service Amps / Volts Overhead❑ Undgrd ❑ No. of Meters
New Service Amps / Volts OverheadQ Undgrd ❑ No. of Meters
Number of Feeders and Ampacity pp le, 3q�
Location and Nature of Proposed electrical Work: 14 s j 7a I Ian /' Ox- l SC?-!"vV i C e-
I'.m,nl,firm of dhe f.Jlmrinv table nmv he traived by the fn tnertnr of {tires
No. of Recessed i, u s
No, o I- dl a
No. oTotal
Transformers KVA
No. of Liahting Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures
Above n-
Swimming Pool grad. grnd. ❑
No. of Emergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners
o. of Detection ancl
Initiating Devices
No. of Ranges
Total
No, of Air Cond. Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pumpp
Totals:
um er
—
ors
—
— _
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Municipal
Local ❑ Connection Other
No. of Dryers
Heating Appliances KW
Security SNo. of cvyyDstemtcs:
cs or E ui valcnt
No. of Water
Heaters KW
No. of No. of
Signs Ballasts
Data Wirino:
No. of devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommuni
No. of Desk
v n
Allacit adelitlonat aerad y aeslrea, or a x I 'a a r tot wires.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work mayLy,
ss I Sit se vides
proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigcer fi that such coverage s in
force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE BOND❑ OTHER (Specify:)
(Expiration Date)
Estimated Value of Flectfical Work: (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with Iv1EC Rule 10, and upon completion.
I certify, under the at sand penalties of perjury, d t the information on this application is true and complete.
FIRM NAME L-'S���PC C- �� Zt�l LIC. NO. lq 1.311
Licensee: Ko p 11 e-V W . yyl EC Sigt ature LIC. NO.
(If applicable, enter "exempt" in the license nunter I!!'ne.) Bus. Tel. No. 0 3
Address �O I L- R' o ti 111 A 026 3S Alt. Tel. No..
OWNER'S INSURANCE WAIVER: 1 am aware thA the Licensee doei 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. i3
Owncr/Agent
Signature Telephone
[Rev. 04/001
TOWN OF YARMOUTH
Building Department
Town Hall
Yarmouth, MA 02664
(508) 398-2231 ext.261
I
1t
Building Location:
Owner's Name:
Owner's Address:
Owner's Telephone:
00068 MELGO LN
GERARD D LACHANCE
POB 1173
South Yarmouith MA 02664
(508) 398-1688 '
Electrician Name:
Ames, Rodney
License Number:
13217
Company Name:
Ames Electric Co., Inc.
Company Phone:
(508) 428-6032
PERMIT TO PERFORM ELECTRICAL WORK
(OFFICE USE ONLY
Recorded By:
Ic
PERMIT NO.
Permit Fee:
$25.00
Payment Type:
Check
Check Number
1380
Issue Date:
2/12/03
Type of Work:
New
Comments:
install temp service
INSPECTION RECORD
Date Note Progress - Corrections and Remarks Inspector
_�'6%A_p IS 44
Date Printed: 2/14/03
FnEPLACE
XTRORDINAM.
35 Custom Builder
(CB) Owner's Manual
October, 2000
Tested and Listed by
i
JJ' 1J
Omni -Test Laboratories, Inc.
13ewer1on, Oregon -Report# 0283356
I221.88, CSA2.33 W 8, CAN0CA2.174M1
• Direct Vent Fireplace
• Natural Gas or Propane
• Standard Residential
• Mobile Home
WARNING: If the information in these instructions are not followed exactly, afire or I
explosion may result causing roe damage, personal injury or loss of life.
Do not store or use gasoline or other flammable vapors and liquids in the vicinity of this or
any other appliance.
WHAT TO DO IF YOU SMELL GAS
• Do not try to light any appliance.
• Do not touch any electrical switch; do not use any phone in your building.
• Immediately call gas supplier from a neighbor's phone. Follow the gas supplier's instructions.
• If you cannot reach your gas supplier, call the fire department.
Installation and service must be performed by a qualified installer, service agency or the gas
This appliance may be installed as an OEM installation in a manufactured (mobile) home and
must be installed in accordance with the manufacturer's instructions and the manufactured
home construction and safety standard, Title 24 CFR, Part 3280 or Standard for Installation in
Mobile Homes, CAN/CSA Z240 MH.
This appliance is only for use with the type(s) of gas indicated on the rating plate. A conversion
kit is supplied with the appliance.
Installer: After Installation give this manual to the home- . • rrMM,,,,,,
owner and explain operation of this fireplace. �T1 c�VlS
$10.00 0 Copyright 2000, T.I. Part # 93508116 10850117th Place N.E. Kirkland, WA 98033
;Ore'
Features:
- Works During Power Outages (millivolt system)
- High Efficiency
Optional Thermostat or Remote Control
Realistic "Wood Fire' Look
- Optional Blower for Heat Distributton
- Convenient Operating Controls
- Variable -Rate Heat Output
Installation Options:
- Residential or Mobile Home
- Straight or Comer Placement
Flush or Recessed Face
- Raised or Floor Hearth
- Internal or External Chase
- Horizontal -or Vertical Vent
Heating Specifications: Natural Gas Propane
Approximate Heating Capacity (in square feet)' 400 to 1,350 400 to 1,350
BTU Input Per Hour (from high to low) 24,000 to 14,342 24,000 to 13,708
Efficiency" 76.7 78.6
AFUE (Annual Fuel Utilization Efficiency) 67. 68.6
Heating capacity will vary with floor plan, Insulation, and outside tempera ure.
'• Efficiency rating is a product thermal efficiency rating determined under continuous operation independent of
Installed system.
Dimensions:
we
t
III
Make sure to bend this heat shield up (it
must be perpendicular to the floor).
Travis Industries 93508116 031000
•IIV iY1INiIV1I /i N/////.'
Failure to follow all of the requirements may result In property damage, bodily L,
Injury, or even death.
This fireplace must be installed by a qualified Installer who has gone through a
training program for the installation of direct vent gas appliances.
This appliance must be installed in accordance with all local codes, if any; If not, in
U.S.A. follow ANSI Z223.1 and NFPA 54(88), in Canada follow B-149.
In Manufactured or Mobile Homes must conform with: In USA, Manufactured Home
Construction and Safety Standard, Title 24 CFR, Part 3280; In Canada, CSA Z240.4
and Gas -Equipped Recreational Vehicles and Mobile Housing. This appliance may
be Installed in Manufactured Housing only after the home is site located.
The 35 CB is designed to operate on natural gas or propane (LP).
All exhaust gases must be vented outside the structure of the living -area.
Combustion air is drawn from outside the living -area structure.
Notify your Insurance company before hooking up this fireplace.
The requirements listed below are divided Into sections. All requirements must be
met simultaneously. The order of Installation is not rigid — the qualified installer
should follow the procedure best suited for the installation.
Packing List Additional Items Required
• Propane Conversion Kit
• Log Set (Log Set, Coals, & Glowing Embers)
• Flex Tube with Pipe Adapter
• Glass Latch Tool (to un-latch glass frame)
• Tile Stops (rect. & arch - for 36 DV Faces)
• Black 35 CB Face (with touch-up paint)
Installation Overview
Direct Vent (Simpson Dura-Vent Ph. # 800 835-4429)
Gas Line Equipment (shutoff valve, pipe, etc.)
Electrical Equipment (min.18 gauge, grounded line)
See the section See the section
'Mantel Requirements' / 'Vent Requirements'
8-12' Min.
(fr. glass frame)
"' '11 44@)" IPJR\11=
a ILI MEN 054
4r
mpmm
Ir
N
itsection
'Acceptable
61fkh!Z!�
6N*4
NO
k
Vent Lengths'
-Nil I Al Insulation must not rill
Sae the section I the spaces between
Electrical the standoffs
Connection' ' Z>>�_z��,,
See the section See the section
'Hearth Requirements' 'Gas Line Installation'
See the section 'Minimum
Framing Dimensions'
Yu
2
Travis Industries 93508116 031000
Fireplace Placement Regu
Minimum Framing Dimensions
The 1/2" stand-offs along the sides and back, and the 2-1/2' stand-offs on top of the fireplace
separate the fireplace from combustible materials (e.g.: combustible framing members, plywood,
sheetrock, paper -backed insulation). The stand-offs may contact the framing members but no material
may be placed between the stand-offs.
This fireplace may be placed in a bedroom. Please be aware of the large amount of heat this appliance
produces when determining a location.
42' Min.
The fireplace enclosure
must not be less than
42' above the base of
the fireplace.
With an elbow directly off the top of the
fireplace, the vent Is centerd 36' above
the base of the fireplace.
If using a remote
control or thermostat Wall Thimble (required when
route the wire to a passing through a wall)
location near the gas
} line (include an extra 3'
length for hookup).
16-7/84
Route the electrical Tine to a
Gas line (3/8' M.P.T. or 1/2' F.P.T.)
position at the left front of 39-7/6' should be routed 4-124 behind the
the fireplace. \ �J framing opening and above the
base of the fireplace onn the the right side
(see "Gas Una Connection' for
details).
• Fireplace must be Installed on a level surface capable of supporting the fireplace and vent
• Fireplace must be placed directly on wood or non-combustible surface (not on linoleum or carpet)
• Due to the high temperature of the fireplace, it should be located out of traffic and away from furniture
and draperies.
Clearances
• When installed, walls in front of the fireplace must be a minimum 8-1/2' to the side of the fireplace
facing (drywall standoff). '
• Fireplace must be placed so that no combustibles are within, or can swing within 36' of the front of the
k fireplace (e.g. drapes, doors)
• Fireplace must be placed so the vents below and above the glass do not become blocked
Travis Industries 93508116 031000
COPV�
LOT a
Q
�l .yae'
(� oosnNG EXSnNG sEpnc o
W FOUNOAncw VAULT
39.1'
LOT 9
AREA 4916 t SF.
LOT 10
clq
TOP OF FOUNDATION IS 5.8'
ABOVE HIGH POINT IN ROAD.
TO THE BEST OF MY INFORMATION,
KNOWLEDGE, AND BELIEF THE
FOUNDATION SHOWN ON THIS PLAN
HAS BEEN LOCATED ONMND
AS INDICATED.
DATE PROFESSIONAL
"AS —BUILT" PLOT PLAN
YARMOUTH, MASS.
LOT 9, 1953—"J. GORHAM CLIFT" PLAN
DATE 2 Z f 03 SCALE 1 "=20'
JOB 5408—O CLIENT LACHANCE
SWEETSER• ENGINEERING
235 GREAT WESTERN ROAD
PO BOX 713 SOUTH DENNIS, MA 02880
T. 508-398-3922 W-398-3063
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5114/2015
SlipGen- Portal Horne
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 [sg25607]
Building Permits
025.93
0068
MELGO LN
Building
2732
No
Operator, Yarmscan
2015-05-14 - 14:34
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