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„h �I o� r TOWN OF YARMOUTH Building Department BUILDING ,9 _ _ _ _ (508) 398-2231 ext.1261 PERMIT NO �_8-14-1449,_� ___ APPLICANT .; PERMIT ISSUE DATE 4/28/2014 _ ; PROPOSED USE •' r �. -"-'----- JOB WEATHER CARD ........ PERMIT TO ; Alterations I AT (LOCATION) 0049MACOMBE DDR r , ZONING DISTRIC R•40 Bldg. Type: Residential I SUBDIVISION MAP LOT BLOCK 1136.92 BUILDING IS TO BE: CONST LOT SIZE remodel two existing bathrooms as per plans dated 04/25114. REMARKS AREA (SO FT) EST COST ($ $20.000.00 PERMIT FEE ($) $100.00 OWNER IATKINS, KIRSTEN BUILDING DEPT BY ADDRESS 10049 MACOMBER DR Yarmouth Port I MA 102675 INSPECTION RECORD 5•B I USE GROUP I R-3 CONTRACTOR LICENSE 0 PHONE 15083944537 FIELD COPY Date I Note Progress - Corrections and Remarks I Inspector 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 • South Yarmouth, MA 02664-4492 508-398-2231 ext.1261 Fax 508-398-0836 tflce Use Orgy tic anning Baud Information Assessors Departmerd Information: Permit No. -10ate Type Uw Permit Fee S AP o�emt Date / rding Due He, Deposit Rec'd. Date 11 Ila 1.4 Property Dimmsio= Net Due $ 7S' - Lot Area (sf) Frotttage (ft) lot coverage 1 rn secaon tot onn"ta ustCrift.. BtAk5hil Fdrmlt Nilmbee..-v I Dab It dtie : , .:..., . •.. D� ,> .•... _ • •. llliidflp, It is rnM, ��..jj..�� •mow ,• . Secttoh.t - SRe Ini Use Group: R-4 T : 5-B 1.1 leeo"" Addreez: 12 Zonirg Informadorc f Zoning District Proposed Use 1.3 setbaeftte (R) Front Yard Side Yards Rear Yard Required Provided RLquired Provided Required Provided 1.4 Wmtw 34WPOP (fu n t G 40. i 541 1.5 Flood zone Infonrtetlaz , l.Orcelfetrtic Pudic Private ZMW BFE Section 2- OwnersN Authorized Z, o.n.� �H'S11r Name (pn^r>/ � � AAaiG�rg{A�ddress � D ' Sgnature p✓ Tole =.2 AYtl*eetrad Agents r l Name (print) Mailing Address S'gnature elephona� `��" Fax Section 3 - ConstnxBon S nriees ^ ' &I Lloeneed construetba supeerlsoR' V E ©' Not ap rtcabte p n It Number Address ^ rtf-PARTmEN- xprabonDate -347mwe Telephone 32 RegkWW Hamm IMprovernmt Contractor•. Compeers Name Not Applicable 0 Address License Number Signature Telephone Expiration Date of 2 OVER Sectlort.4sVVdiiCe(sf Com �itzyetltln(nsurartcaAmaavR �.=� ����", 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 S- 130womot Piaposig Work (chedr art appjit:aE New corlouc ion ❑ No. of Bodmoms No. of I1z taoon 2 Exis" ciao. ❑ Repair(:) ❑ Atteratlona Addltlan ❑ Awry Bld(j. ❑ TYPe Demolition Other Specify. Brief oesgiption of Proposed Work Section s- Estimated Cdnst UCtk)n Casts Item Estimated Cost (Dollar) to be Check Below lla completed by permit applicant 1. Bu► ❑ Consemdor-Commisslon Filing 2 Electrical (d applicable) 3, pkurftv / Gas ❑ Old Kings HI¢rway A Hstorical 4. Mechanical (HVAC) commission approval 5. Fire Protec" (if applicable) B.Totara(I +2+3+4+5) Qom, t 7. Total 3quars FT. I� naive s �0f) SecWn in • OWnKAuthbrtztidm- Th ba Completed When Owner's Agent of Contractor ApElles, for BUlIclints Permit as owner of the subject property hereby authorize to act on my behalf, In ad matters relative to work authorized by this building permit application. Date Slgnaturo ofOrw er Section 7b - Owner/Authatized Agent Dec(amdon . as OwnedAuthorizedAgent I, hereby declare that the statements and information an 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 r t Stgnalurs of ow Oat g� 2of2 ' ��'� •�:G .. .� .►ter ror umce use unty Permit No. TOWN OF YARMOUTH ' Date AFFIDAVIT Home Improvement Contractor Law Soppkment to Permit Application MGL 142A requires tbat the 're ion, alteration, renovation, rcgsir, modernizsdom, conversion, imPcovaaenk removal, demoHdoa or constructiom of an addition to any pmcdstiog owner -copied building containing at least one but not more than. four dwelling units or =u=m which are adjacent to such rcudeom or building' be dome by registered eontraxt , with certain exceptions, along with other Type of Work: Address of Work Date of Permit Application: �246 ) y I hereby testify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000 Building not owner occupied Owner pulling own permit Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. Signed, under penalties of perjury: I hereby apply for a peftnit as the agent of the owner. Ditc V T Contractor Name Registration No. OR: Notwithstanding the above notice, I hereby apply .for a permit as the owner of the above pro !S✓ V , iY�->`t 1%�-a S Date Owner Name The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 'WtffP%' www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name Phone M 1�,;b Are you an employer? -Check the approprikte box: Type of project (required): 1. ❑ I am a employer with ' 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* have hired the sub -contractors 2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet 7. ❑ Remodeling ship and have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity, employees and have workers' [No workers' comp. insurance comp. insurance t 9• ❑ Building addition required;] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions k�l am a homeowner doingall work officers have exercised their 11. Plumbin ❑ g repairs or additions myself [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, § 1(4), and we have no 3a. ❑ I am a homeowner acting as a employees. [No workers' 13.0 Other general contractor (refer to #4) comp. insurance requiredl •Any applicaut that checla box itl most also fin out the section below showing their vodkas' wmpmsaticA lice information. t Homeownca who submit this affidavit indicating they are doing aA work and then him outside contractors must submit a new affidavit indicating such_ tContracta:s that check this bolt must atumbed an additional shed showing the mtma of the sub-emtractaa and sate whether or not those eatidea have employes. If the sub -contractors have employees, they mast provide their workea' comp. policy umobeL Ian an employer that is providing workers' compensation insurance for my employees Below is the policy and Job site informadom Insurance Company Name: Policy # or Self -ins. Lic. M Expiration Date: Job Site Address: City/Statemp: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL a 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certfy Mader the p and peitalder o perjury that the information provided above is true and cormt II .iionahtre� ,/� r►..._. � � /( -/ Offlelal use only. Do not write in this area, to be completed by city or town offieiaL City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone #' Information and Instructions Massuhatetts Ckmeral Laws chsptef 152 requites ill employtbs to Psu" idQ workers' =Wensadon foi their erap)oyta. • . pursuant to this statute, in emWkyer is defined u •_every pefsoa is the service of knocker undo any contract a [hire. . . .-. express or unplied, oral of written" An is defied ss "m bd rkhi4 partnership► sssod1dM cozporshoa a other Lad entity, or say two at mom "`�� of a decried emplom cc the of cite forogoing engaged in a joint enterprise, lad �g tht � receiver at trustee of as individusk prtoer31144 i:aoeistim oe other legal entity, employing cmpioyeest Howtvar the owner of a dwelling house having not ion thin three eat! and who resides thaei% or tht oaCttpaat of the dwelling boa of imther who employs persons to do maintenance, conshtztim err repair work an such dweliiag base of on the Qoaade at building appurtenant thereto shall not beause of sack employment be deemed to be an employee" MGL chsphor 152,12SC(6) also states that "aresy stM w Neal Ua"n sheary ikail wlddwd the fssaaaa w Moms .t a ikn or pwmk to operate a bte bl or to eonsbmd bofidtaP is rice cmmawtln fir sq appilesat wbe hire not produced satphbk evldetee of eemptE:aa with the UMMSa etnraP nqmkW Additionally. MGL chapter 152,125C('>) sutra "Neither tbo comimQawealth nor say of its politics! subdivisions sh n eflLer into say eoatfae9 fire: the perfmmama of public work uatd scocptabk endears of complima with the fa:tasace Ps of this cb:pter haw been presented to the cOCftacdag =dwity." Appttaab , Please fM out the war,= , compeasatim affidavit Completely, by cbe-c ft the boxes that apply to your sibmtim and, if necessary, supply t0r(s) aame(s), address(a) and phone number(s) JM wdh their cat &IM(i) of insmaacs, Limited LbMity Companies (LLC) at I kil ed Liability Pumerships (Lisp) with no mepbyees Other thm the members err Tom; am not required to carry worie:a' eompeaadw tasmaaea If m LLC ire LEY dca have emptbyeat, a policy Is requeire& Be advised that this affidavit may be submi td to the Department of b&strial Acddmte ftt[ eonffrmatim of insurawA coverage. Abe be saa a to alp awl dab the aladav L The anSdavit sboteld be returned to the city err town that the spplicatioa cite the PKm* err tieease is bring req=N4 not the Depatmeat of Iadweial Aeoidmes. Shedd you haw nay quesd= regard% the lair cc if ym art requited to obtain a wart= compeantioa poticpo pksae call the Depatmen at the number listed below. Self iaat:ed shoald eater their self iasaraiee tieaaa. mbar an the alt�rp+-�■ tine. Clty or T win 0ffkU Please be sun that the affidavit is complete and printed le&y. Tiue Department has provided a Spam at the butlers of the affidavit for YOU to fill out is the event the Of ice of Investigations has to coated you --Za erg the appacnL Please be area to fill fa tbs permft/ k=n I wbich will be used sir a mfwc= molter. In additb4 m sppljcsflt that moat submiit =Idple par appHeadoca is any given yearg need only:ubtait sae affidavit indicating enaeee! potty Mims (if mcessary) cad under "Jab she A&l ess" the RMUCMA ahoold wale "all 1oeati0ae In city of town;`" A copy of the a®dnit that has beet ofiSeially stamped at marked dry the city a town ray be provided to the applicu t tie proof that i valid affidavit is oa f k fbe iaWm Pam b err lieemes Anew afldavit rats! be filW out each yea. What a boma owner at eitiexn is obtaining a He=@ or permit not related to sny business err Comtt =CW vMMM (Le. a dots license or permit to bmn Imm eta) said person is NOT required to compkw thin sfiidavit The Oran of Investigations would J&ito thank you is advma for your cooperation and sbould you haw lay gnestioma, plait do not hesitate to giw us a elm the oepactmenes address. telephone and fa= member: The Commomveaith of Musachmtts Departmtmt of MuAtial AceWaft ones at I"Weptim 600 Washi>sgtott Strx Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1.977-MASSAFE Fax # 617-727-7749 Revised 11-22-I6 www.m=.gov/dis °£ YaR` TOWN OF I 0 'ARMOUTH : c� BUILDING DEPARTMENT 5 N MA•1146 Route 28 South Yarmouth MA 02664 508-398-2231 ext.1261 R HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: �� JOB LOCATION: ' "l nwrok % /;� tLe, NAME STREET ADDRESS E TION OF TOWN "HOMEOWNER" kl1! �.v� k c , -O S -.�i 9 -l-f S NAME HOME PHONE _ WORK PHONE GFrY 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 supervisor. (State Building Code Section 110 R5.1.3.1) Definition of Homeowner. Person(s) who owns a parcel of land on which he / she resides or intends to reside, on which thereis 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 responsible for all such work performed under the building permit. (Section 110 R5.1.3.1) 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. M HOMEOWNER'S 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 ,yes_, please indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of indemnity Bond OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent Check one: Owner Agent h:homeownrlicexemp TOWN OF YARIYIOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, NIA 02664 508-398-2231 ext. 1261 Fax 508-398-0836 BUILDING DEPARTMENT DISPOSA 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 �1 "I ^ Work Address Is to be disposed of at the following location: 1- S� yliC49W r6Aq -( ))l 4V&4 Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111. Section 150A. '841j�ratt6dkf Application 4a=d&2� Permit No. Date TOWN OF YARMOUTH Building Department Town Hall Yarmouth, MA 02664 (508) 398-2231 ext.1261 BUILDING PERMIT TRANSMITTAL Temp Permit No.: T-14-363 Applicant Name: Kirsten Atkins Applicant Phone: Building Location: 0049 MACOMBER DR Owner's Name: ATKINS, KIRSTEN Owner's Addres Owner's Telephone: REVIEWED BY: 0049 MACOMBER DR Yarmouth Port MA 02675 (508)394-4537 (OFFICE USE ONLY Recorded By: IC Permit Fee: $0.00 Deposit Rec: $25.00 Payment Type: Cash ChkNo.: 0 Net Owed: ($25.00) Application Date: 4/15/2014 Issue Date: Expiration Date Comments: Map/Lot: 136.92 remodel two existing bathrooms 1. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: WA: 3. CONSERVATION: DATE: WA: 4. HEALTH DEPARTMENT: DATE: WA: 5. BUILDING DEPARTMENT: DATE: N/A: 6. FIRE DEPARTMENT: DATE: WA: PLEASE NOTE COMMENTS: RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: Date Printed: 4/24/2014 k. b &,y), pp, Llq MaC-Oro h-e ,,\d -loo ra,A1 g�jl Rwade f�,, it oo-,14 r� ice'(k�'j,,L r\ i30,1, , o r n. el &&-ro3A-- REVIEWED FOR BUILDING AND ZONING r. E vNCE. PRORS[ROW, �'^" �n dPPLIC��`¢ Y ;OI�1Pll�NEE� S� DATE: ' Z I BUILDING OFFICIAL ILE COPY Altitude Awareness Utah offers some of the most spectacular scenery in the country, and we hope you will enjoy every minute of your visit. But some , rs,, of the very features which make the high country so attractive ' �- L may cause problems unless you recognize and know how to prevent them. Here's why: As you go higher, barometric pressure -- - - j decreases, the air is thinner and less oxygen is available. It's also colder and drier, and the ultraviolet rays from the sun are stronger. Each of these changes may have unpleasant effects on your body. Most people who come to these terrestrial elevations usually experience a rather unpleasant period of altitude adjustment. During this time the symptoms can include headache, nausea, vomiting and sleeplessness. These symptoms are collectively referred to as acute mountain sickness. If you develop a throbbing headache in the sides or front of your skull and it's usually worse in the morning or after exercise, you're suffering from altitude sickness. If your appetite is poor, you can't sleep well and you have no energy, then you are probably suffering from the altitude. Getting used to higher altitudes usually takes three to seven days. How do you get used to it fast? If you've just arrived from much lower altitudes, such as sea level, the best things to do are: • Get lots of rest • Limit your alcohol consumption TYLENOL • Take Tylenol or Ibuprofen - Extended Relief • Drink lots of water ......... Wateris as vital to life as oxygen. You need it for energy, metabolism, controlling yourcore body temperature, and hydrating the skin. During strenuous activity, particularly at high altitudes, the amount of fluids lost through perspiration and evaporation of moisture from the lungs can be as much as 5 quarts or more a day. If a substantial amount of fluid is lost and not replaced, the body's chemical equilibrium is upset and illness is more likely. The body can survive for a long time without food, but not without water. After hard exercise, replace fluids and electrolytes as soon as possible. In high altitudes, proper sun protection is vital to the life of your skin. A moisturizing UV sun screen should always be worn when outdoors for any length of time. If you do experience a sun burn, try using a natural herbal salve to pull the heat out and start the healing process of the damaged skin cells. If you experience dry skin from the sun and climate changes, use plenty of lotions, soaps and salves containing Vitamin E, Aloe Vera, and Beta Carotene. w OF I TOWN OF YARMOUTH Building De rt nttwo5qU I L I - (508)398- 2 . 61 � PERMIT NO - _6-14-825 - ISSUE DATE : • 12/612013 _ ; PROPOSEPERMIT D uS _ ... _ APPLICANT 'cape§aveweatherization/'WilliamMcciuske; JOB WEATHER CARD .......................• -•-- PERMIT TO Misc./Insulation ; AT (LOCATION) 10049MACOMBER DR ZONING DISTRIC R-40 SUBDIVISION MAP LOT BLOCK 1136.92 BUILDING IS TO BE: CONST 1 LOT SIZE INSULATION — RETROFIT REMARKS AREA (SO FT) EST COST ($ $4,800.00 PERMIT FEE ($) $35.00 OWNER ATKINS, SUSAN P & BRUCE BUILDING DEPT BY ADDRESS 10049 MACOMBER DR IYARMOUTHPORT I MA 102675 INSPECTION RECORD Bldg. Type: Residential USE GROUP R-3 CONTRACTOR LICENSE 1027761C McCluskey, William 7C Huntington Ave South Yarmouth MA 02664 5083980398 PHONE 17742126088 FIELD COPY Date I Note Progress - Corrections and Remarks I Inspector Permit# a �y FeaS- 35 }Ptrmit expos 6 months from is a EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Ext.1261 CONSTRUCTION ADDRESS: ASSESSOR'S INFORMATION. OWNER: CONTRACTOR Map: Parcel' uCC /Y LII �a-ftt! qs &�OyP—����f1oZloZ NAMii n G Residratial a Commercial // rFst. 9 V Cost of Construction Sy Home Improvement Contractor Lic. # 1 -1• 13 B U Construction Supervisor Ida # Z (0 a 6 Workman's Compensation Insurance: (check one) , 0 I am the homeowner ❑ 1 an the sole proprietor I have Worker's Co 1 mpeasadoa Insurance Insurance company Name:T��no-��3 g 6= ( worker's Comp. PoGeyR ❑ Tent WORK TO BE P FORMED �� Retatdaot Certificate �) • 0 Siding: # of Squares ❑ Woad Stove shed D Rephuement doom # 0 Replacement windows: # 0Re-root #orSquares �Iosalation'� () Stripping old shiagles* () going ova >aycrg of existing roof ❑ old Kings Highaay/fiismac District 'The debris will be �/ Roofiag/Sidiog (Like for Lila) disposed of ac _ 1 a m m � v��� -- I declare underpemlties of pedury thar the statem= herein contained are tnm aad correct to the. best of will be just cause for denial orrevocati my ' e and ecutioa wader Mt3.L Ch. 269, Section 1 krmwledge and belief I understand that any false answers) Applicant's Sigoan= Date _ l oZ/4r l� Owum Signature (or attachment) Approved Hy Dater QuuumgOlSm(or designee) Date RECEIVED DEC 66 2013 BUILDING D ENT ey: io h „'.t Zoning Distrli Historical Dis Vtrict�I�( Yes 0 No Water Resource Protection Districn Ves ONO Flood Plain Zone: ci Yes Ci No Within 100g of Wetlands: es 0 • No 3101 Building Permit Authorization I, Bruce Atkins as owner hereby give my permission to Cape Save, Inc. 7-1) Huntington Avenue South Yarmouth, MA 02664 Office: 508-398-0398 to take all necessary steps to obtain a building permit to perform work at my property located at 49 Macomber Drive Yarmouthport, MA 02675 Signed Date ! / The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 LPrint Form wlvw.ntassgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organizatiordindividual): Cape Save, Inc. Address: 7D Huntington Avenue City/State/Zip: South Yarmouth, MA 02664 Phone # 508-398-0398 ' Are you an employer? Check the appropriate box: Type of project (required): 1. El I am a employer with 17 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* have hired the sub contractors 2. ❑ 1 am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance + 5. We are a corporation and its officers have exercised their right of exemption per MGL c. 152, §1(4), and we have no employees. [No workers' comp. insurance required.] 7. ❑ Remodeling 8. ❑ Demolition 9. Building addition 10.❑ Electrical repairs or additions I I.❑ Plumbing repairs or additions 12.❑ Roof repairs ME] Other Insulation •Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy "`formation. ? llomeowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. if the sub-conuactors have employees, they must provide their workers' comp. policy number. I atn an employer that is providing workers' compensation hisurance for n:y employees. Below is the policy andlou site hujornmtiat. Insurance Company Name: Technology Insurance Company T1NC 3353968 Expiration Date: 04/09/2014 Policy # or Self -ins. Lic. #: 4 F Job Site Address: � ✓� ✓'o City/State/Zip: Ql�iul/ti� �� �`J Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi%y corder the pains and penaIdes ojperjury�at the information provided above fs trite and correct 508-398-0398 Official use only. Do not write in this area, to be completed by city or town officiaL City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone #: "' CERTIFICATE OF LIABILITY INSURANCE DA'E`"e"'°°"'"" 10/22/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsements . PRODUCER Risk Strategies Company 15 Pacella Park Drive CONTA NAM: Colleen Crowley PHONEM PO Erb. (781) 986-4400 A LTa>ssa-4e2o Suite 240 Randolph M 02368 INSURERS AFFORDING COVERAGE NAIC 0 INSURERA:Selective Ins. of America INSURED Cape save, Inc 7 D Huntington Ave INSURERB:SafetV Insurance Company 3618 INSURER C:Technology Insurance Company INSURE D : INSURERE: South Ya=outh to 02664 INSURERF: rtGs1a MY IYUe16CK: 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. w TYPE OF INSURANCE WVn POLICY NUMBER MM EF MM POLICY-SWmrrrfyl LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LM LITY DAMAGETO PREM a s 100, 000 A CWMSMADE OCCUR 1994480 0/16/2013 0/16/2014 MEDE P one ten) s 10,000 PERSONAL d ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2 , OOO O00 GENLAGGREGATE LMIT APPLIES PER: PRODUCTS AGG $ 2,000,000 POLICY X PRO- X LOC AIJTOMO&LELABIUTY I i 1,000,000 BIMY AUTO BODILY IMRY(Per person) : ALLX �TOES�� 08200 1/6/2013 1/6/2014 BODILY NJURY(Per asldert) _ HIREDAUTOS X NON- �� PR Y i S x r1MCCCIraLAa X OCCUR EACH OCCURRENCE s 1,000,000 A ExcESS IAB CLAIMSMADE 1 11994480 AGGREGATE $ 1,000,000 DED RETENTION ■I 0/16/2013 O/16/2014 C �EY�OYOERVLLIABU ARYUND fficer• Included for X TV oTH : ANY PROPRIETORrPARTNERM7(ECUTIVE YIN Fl MU62 ENL1lAED7 N❑ N/A ovrag• EL EACH ACCIDENT 500 000 (Mviddary In NH) 353968 /9/2013 /9/2031 IIyes desaibe under E.L. DISEASE - EA EMPLOY El < 5QQ QQQ DES�RIPTpN OF OPERATIONS Debar E.L. DISEASE -POLICY LMIT I s 500.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORO 101, Addhbnal Remarks Schedule, If more apace Is requlnd WeatherizaUon Specialists GL: Blnkt AI, Blnkt PNC, Blnkt WOS, Per Proj Agg, Per Loa Agg / GL Exclusions: Snow G Ice Removal/OCIP/Wrap Ups rcotlnnnTc uro nee _ _ _.__- - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 1 (Michael Christian/CLC�6 23 (2010105) 01888-2010 ACORD CORPORnTaN Jill .I Hf..e°e..ew INSU25 (201005).01 The ACORD name and logo are registered marks of ACORD t."t Massachusetts - Department of -Public Safety ��VVJJ Board of Building Regulations and Standards Construction Superior Specialty License: CSSL-102776 t4,, WHIJAM J MC I�LUSKEY .: 37 NAUSET ROAD West Yarmouth MA 02673 ✓.G� ro=.piranon Commissioner 06/28/2015 �� � i�Ti1rG V" t.�Q�(iGGfJ Office of Consumer Affairs and 1 uusiness Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration' Registration: 171380 Type: Corporation - Expiration: 3/14/2014 Trtl 222184 CAPE SAVE INC. _ _ .. WILLIAM McCLUSKEY 7-1) HUNTINGTON AVENUE _ SOUTH YARMOUTH, MA 02664 - Update Address and return card. Mark reason for change. ovscnra 50e1-04/0.a101216 /+e �ow�e�nar�weal�/e a�'„lla.ua�uulta . ~�, office of Consumer Affairs & Bdsiness Regulation a HOME IMPROVEMENT CONTRACTOR Fr ;M n Registration:.:171380 Type: "r Expiration: 3/14/2014 Corporation CAPE SAVE INC.' WILLIAM McCLUSKEY 7-D HUNTINGTON AVENUE."" SOUTH YARMOUTH. MA 02664 = Uaderseeretary fE] Address Renewal Employment 0 Lost Card License or registration valid for iadividul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, MA 02116 Not valid wit, i d siQna APPLICATION FOR PERMIT TO. DO GASFITTING WiTKNk� (OFFICE USE ONLY) By qq �. C- Fee: $ elS•t� PERMIT NO.OL " Z�S Date 3 , Zoo Building Owner's - ^ ' AT: Location �� 9 %nc�co rrn % er' A! Ili Name m in /7' 4! 0 !S ll� Type of Occupancy Neves Renovation ❑ ❑ $ Replacement Plans Submitted Yes❑ No' p G ij r� N o: W z rn e'1 r W O U. m cc S ✓ (� C�W7 Cn 2W °w En a OCC Za p OO L W W N O W = W WQ o O W 0 W ZW J =Q U Q W W p> LL O> W aQW W Q C t- } (1) m Z O Z W O y= X i O 0 s M 3 0 v °¢ > a a� o LL SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR (PRINTORTYPE) Check One: Installing Company Nam _P14 r:*Xleg2, ❑ Corp. Address 6,lSii.L�Q- ❑ Partnership iSrP r ur r r / r u_ • c� w .> > [25Pirm/Company Business TelephoneO—�= 20 Name of Licensed Plumber or Gasfitter Q DinUli-✓"��u -X INSURANCE COVERAGE: Check One 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 herebycertifythat all of the details and information 1 have submitted Signature of Licensed (or entered) in above application are true and accurate to the best of Plumber or Gasfitter my knowledge and that all plumbing work and installations performed 3 6 6 under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and License Number Chapter 142 of the General laws. TYPE LICENSE: FIE D COPY 8-01—/T, Ge-%-'1-2-> OF YMHXvm D BUILDING PERMIT ?/aP/od ?5- - DATE Aua 28, 7WO PERMIT NO.i APPLICANT - 0040 OnEC;ARE6311ADDRESS (NO.) 0 (STREE ) (CONTR'S LICENSE) PERMITTO (_) STORY DWELLING UNITS (TYPE OF IMPROVEMENT) NO. (PROPOSED USEI 49 M.mnir�rn,, ZONING {Z_dQ -` AT (LOCATION) YTY,7,.,rhT DISTRIC (NO.) (STREET) o BETWEEN AND m (CROSS STREETI - ICROSS STREET) LOT m SUBDIVISION 136192 LO} _ S,[9FJC 4. SIZE u m BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION r ( fTO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION ¢ (TYPE) w a� REMARKS: "- kLA.im ama, 4 X 14 lievair Dack� , AREA OR J Q .. VOLUME ESTIMATED COST W =-QQ FEEMIT $�S�VV (CUBIC/SQUARE FEET) OWNER Clffiic0 Ca m:Uwil BUILDING DEP�WA ADDRESS P, 0, 13ME 284 Y_ Be BY I INSPECTION RECORD DATF�f NOTF HOGRESS -CORRECTIONS AND REMARKS INSPECTOR �A to !3 a0 Ca _ m ONE & TWO FAMILY ONLY - BUILDING PERMIT APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING Town of Yarmouth Building Department <- 0 t"He S. 1146 Route 28 • Yarmouth, MA 02664-4492 Tel: (508) 398-2231 x261 • Fax: (508) 398-2365 rnr�anly plarnlnp t3oard tltfgrrriiW) AsSa5gRS6 pgpettmeni(rmatiQlt < r ` . 4'" p�, w=+ f• •ice+a,s, tor` r=11° .sMaPro+Yttl ,¢•� r . -+ i= �^� � ` • 01"- tN ' , K .. 1 =, b,»t .'1 . Et �, � 4..p ;'s � r ;=S• � ,6 t runt =�st s -� r-+r= : ~a�, � e� T ,�•rY. <p, 4-+, 4 sn + ♦•s�,.♦, ;;. ,s !<, n i .r=. , ,r <�emtfi<I=ge K- ,��,�„�' . ��ra ' t ,ErtdbcSEr�ilti>� ;, � ,, ,"�','<� �p�< 3 } t 4 ,tr r�r�" .I S t v yt% �•f ,,� Y i It r � ,yry/y,'rYj.�,�e I1FYQr3SS`` ` ♦ �C a ] < y��-I }t �� ��'i� I�f �I C. "1' 1.<'! <..'S}.. H� yZi4�l ♦ M k4� t..ri 1 �+ T 1.j4. 1y1�5$fk G'3Ir'�`��`Qa��,//, M- �1- M�v� ♦'a<iW``A v,SYl3 Jt }7< yri`ji a .� 4�+`• Jttt��]. y" _ r.d t �"Lq (....p� � ; f�4`�11 ••, : N'et Ifu� . ,x t .9 s i — I ' •., ;dour ... � _ nIry`! LOAM( - "1b.'♦,L`S 1 s.a�,: 'J•r�'. a'.r is Section ioi Offic;6 Use ^N:. •o,;a a "�,yy �v�-`ti 1� .1` :t 2„ LfY:�3"'• T VIV�'`•i� .r. j'u•<• w.• ,i. �'�' y.♦. w.%..�. .c,».: ..+tt �tilldin OPtrtit tJumben " , 4 "._'. pate ISSUied. 1_• >= ^�'; 2e�. :yy��c- � �,r?I.'�`•. •}' �' ...4 � t y 1 (�Jf� '7 < CY *I. �rrt�n44�� Qiy'�K`<r�"Y' �itF'1�"S*+_ 1 i. Data :33 r wl r.}•-.•...,.i+•ie<14ir{�dt •w, Q . F $ ..i. . . _.1a L.Ifa•7••hM�'_+:N'�. S tx1 t:°%5it8 nformatioril Use Group: R-4 Type: 5-B 1.1 Property Address:' 1.2 Zoning Information: Enlarge ketchen 49 MacumberDr Yarmouth Ma. Zoning District Proposed Use 1.3 Building Setbacks (ft) Front Yard Side Yards Rear Yard Required Provided - Required Provided Require Provided p� 1 A Water supply (M.G.L c. 40. S 54) 1.5 Flood Zone Information: Comments;, Pubrr� Private 7An8'•. l�'2..: BFE_.�2 8ectio 2 !- Propeq Ownamhi Authorized Agent n 2.1 Gvme► of Record u Name Mailing Address �'u-tug 508—aisr__ Signature Telephone 2.2 Authorized Agent: Claude Corriypnii P BOX 284 Yarmouth Na nt Mail ng Address Signature Telephone SeOtion 0 .g Construction Services 3.1 Ucensed Construction Supervisor. (<13ttria r`nrri ,amt Not Applicable ❑ Ucense Number P 0 Box 284 Yarmouth Port Ma 07675 011265 Address /% Expiration Da e Te-lephone Signature( 3.2 RegIstered Home Improvement Contractor. Company Name & r Not Applicable El Cl Ucense Number 126441 Address n P 0 Box 284 nrmnurh Pnrt aaa • 02�5 Expiration Date Signature Telephone 6/3/02 1 no OVER Section 4`=:Workers'. Com ensatidn lhsurance Affidavit (M.G.L'dt152 Workers Compensation Insurance affidavit must be completed and submitted with this dpplication. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes .......... No .......... Section 51.Description of. Proposed Work (check aftappficabte) New Construction I No. of Bedrooms No. of Bathrooms Existing Bldg. ❑ Repair(s) ❑ 1 Alterations ❑ I Addition OT Accessory Bldg. ❑ Type Demolition Other Specify: Brief Description of Proposed Work: / D G 0'0` , 2S = r Estimated Cost (Collars) to be Check Below Secti6h.6'=iEstlmat'dd Construdon`Costs'. Item completed by permit applicant $5,000.00 00.00 Conservation -Commission Filing (� (if applicable) . 1. Building 2. Electrical 3. Plumbing / Gas 4. Mechanical (HVAC) S 60200.00 To a.Compteted,When . Old kings Highway & Historical I y Commission approval (i} applicable) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) 7. Total Square Ft. (new houses & additions) Section 7a;- Owner,Atnho zation a Owner's A' ant or''Cbntractiir' A ' ties for Btiifdin `Perrtiift ryti` I, �t S , as owner of the subject property hereby authorize `-' to act on my behal in all matte relative to work authorized by this building permit application. '007%ZZ/6� Signature of Owner Da e Section 7b: a.,Owner/Atathorized Agentt Declaration I, r111 r 1 (�P / /I A t !y � lT C/ , 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. C u /,lP �X L6 k 1 VC-t,� Print name Signature of Owner/Agent Date 9 - 15.99 2 of 2 ai°`;qR�C TOWN OF YARMOUTH ° • �•,�'"u,.�y ' 1 BUILDING DEPARTMENT BUILDING PERMIT APPLICATION SIGN OFF Applicant: Claude Corriveau e U S' d:j- 44 -624 _T Building Permit No.: Address:49 Mir -umber Dr Tel. No.:362-2639 Date Filed: 7/24/00 Bldg. Site Location: 49 Macumber Dr Map No.: 136 Lot No. 92 The following information outlines the procedural steps required to obtain a permit to build, alter, or add to a structure within the Town of Yarmouth. The Building Department will determine compliance to the following: (A) Zoning Requirements (B) Historical Districts (C) Flood Zones. The Building Department will be responsible for assisting the applicant through the following departments: RESIDENTIAL AND/OR COMMERCIAL BUILDING WATER DEPARTMENT: Determines Compliance of Water Availability. (applicant to obtain) ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage. CONSERVATION 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. ---------------------------------------- The following Departments must sign off, in the respective order, prior to building inspector issuing the required building permit: REVIEWED BY: 1. WATER DEPARTMENT: Ott —DATE: 7- I . ?-oa o N/A. 2. ENGINEERING DEP TENT: DATE: N/A. - CONSERVATION: DATE: N/A: 644. HEALTH DEPARTMENT: DATE:-�i-�s-da N/A INDUSTRIAL AND/ R COMMERCIAL PERMITS 5. WIRING INSPECTOR: DATE: N/A: 6. PLUMBING INSPECTOR: DATE: N/A: 7. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE All stumps and/or brush must be disposed of at an approved site. COMMENTS: (Aaj%A A44.NL , oK 8/99 Applicant Signature 694A & ��(�_v Date n �7Z% Old King's Highway Regional Historic District Committee ZOO" in the Touz of Yarmouth for a CERTIFICATE OF APPROPRIATENESS Application is hereby made in triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photographs accompanying this application for. CHECK CATEGORIES THAT APPLY: I. Exterior Building Construction: 13 Nety Building Addition p Alteration n r— Fey Indimtehpeofbuilding; ❑ house 0 Garage qcommcrcW [3 Other 1 1 00 JUL i AIM, 11 0? 2. Exterior Painting: p 3. Signs or Billboards: p Nc%y Sign p Existing Sign p Repainting existing sign TO' tJ CLEFi ; & TREASURER £�UTH YAR,.IOUTH,1,4A 4. Structtm: 0 rence p wall p Flagpole � Other TYPE OR PRINT LEGIBLY DATE (4 �/ L ' ADDRESS OF PROPOSED WORK 49 Macumber Dr ASSESSORS MAP NOA14' OWNER Susan Atkins ASSESSORS LOT NOlh---- HOME ADDRESS 49 Macumber Dr Yarmouth Ma 02675 TELEPHONE NO.394-5482 AGENT OR CONTRACTOR Claude Corriveau TELEPHONE N0362-2639 ADDRESS POBox 284 Yarmouth Port Ma 02675 USE ATTACHED SHEET IN PACKET FOR ABUTTING OWNERS DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of %vork to be done including materials to be used. In case of signs, give locations of existing signs and proposed locations of new signs. (Attach additional akeet, if nccess ) APPROVED ` YARMOUTH CC ",11TTEE OYHI Signed Owner -(contractor -Agent Rcxcived by OKIIC -Date �+ �'� This crti{icate is erctn � ('' 1 DateFy Check # e"' Bc APPROVED p IMPORTANT. If Certificate is approved, approval is subject to the 10 day appeal period provided in the Act DISAPPROVED p Please return to: Yarmouth OKIiC District Committee Yarmouth Toan Hall, 1146 Route 28, S. Yarmouth, MA02664 SPECIFICATION SHEET (YARMOUTH OKHC) !MIT 3 COPIES�8 . entirety rOVI 111 Color, chips Where V�wPlease fill out the form in its entc ty p g p neCeSSag, INDICATELAAWCAPING,EXTERIORLIGNTINGAnEMUCMETERONSITEPLANS FOR NEIY OUSES NAME OF OWNER(S): FOUNDATION (Is• MAx. Expos®): CONCRETE/OTHER DRIVEWAY Al" WALK WAY: , STEPS ( DICATE BRICK/CEMENT/OIIE )):C V G � t (,�,� Y ( '00 JUL 13AH11�08 SIDING TYPE: (; <<4 L %/ COLOR: CHIMNEY (INDICATE BRICK/STUCCO/WOODFACED) COLOR:1 CLERa u TREFlSURER / �� SOUTH Yl,R; {CUTH, MA 14- ROOF MATERIAL: (t >/'J/t / fi PITCH (7/12 MIN.) �� ��COLOR: MAX. EXP. ✓ q D WIND OWS (GRILLES REQUIRED) —INDICATE SIZES IF NOT LISTED ON ELEVATIONS: ,.A DOORS (INDICATE SIZES AND STYLE IF NOT LISTED ON ELEVATIONS): COLOR: TRIM: (ALL WINDOWS & DOORS TRL5IMED WITH,IX3 / 1X5) MATERIAL OF TRIM: (WOOD; VINYL, ALUMINUM) SHUTTERS (WOODNINYL) (PANELEDILOUVERED) GUTTERS (WOOD/ALUMINUM): l� `-<<• l`•�`�'`— GARAGE DOORS: SIZE & STYLE: COLOR: C l' ct V JJ,,.5-�` I �f• COLOR: COLOR: COLOR: STORM WINDOWS & DOORS: COLOR: (INDICATE SIZES IF NOT LISTED ON ELVATIONS) SKYLIGHTS: TYPE/SIZE: Q��j�� YARIAOU r� OKHRD DECK: SIZE & MATERIAL: �'(t �1c l�c ` .��� '� COLOR: FENCING (MAX. HEIGHT 6'): STYLE: (SHOW LAYOUT & RUNNING FOOTAGE ON SITE PLAN) COLOR: RETAINING WALL: (P.T. OR FIELDSTONE -CONCRETE INAPPROPRIATE) (SHOW LAYOUT & RUNNING FOOTAGE ON SITE PLAN) SIGNS: (indicate size, style, colors) COLOR: SIGN POST: (indicate size, style, color) COLOR: ADDITIONAL INFORMATION: REV. 6/99 Says Jb 1� 00 JUL 13PM 1:09 fall TO'frPJ CLERK SOUTH YMr �� . �j.• �. lK t , / Gti y 1 t r Ll !� N w CERTIFIED PLOT PLAN � LOCAnON '',�.^?`. _:• �ARMn,•� A: t, SCAM OATS Q �Q'7N, �..�'• :emu PLAN REFERENCE r 1 Ql. 0/t' APPROVED • ; YARMOU7H COMMIT %_•�� - ;j OKHRD �J I .. .. i ceATlFr THAT TNa F.,gc.yy,QTp ANOWN ON THIS PLAN 16 LOC — AS SHOWN M MMIN ANO THAT IT OOiiFO 31T RMIRDAi" OF Ma TOWN O!i 1• t' r F WNW am QATcArXED >/i� �' i / L !ri . PIE __.: ..uj saw • ,_, w W1.•-1 CC t '' • �� > g. 10 fi. � 'tt , � r.• . I."v � ate. - _ � •� / • pp .- �''I Y a bn 1. `r 4L'. e \. /( I � of 47 lit s i • ,/ % _ •'�V�� 1•` 'yam ��l j� i7 Lis• - � 1atJW, ., :'..k • iC; _ . '� x , `I G<l:T7i: 1AS :.tOCT:�41 r� ,e+ilk .. CEHTIFiLl.: PLOT a'i:a�+ ► �t �;t ,"�. •,-a LOCATION `'h,.'• )' l<�r�ktL fl��.: E >`;' _.........,. 1 SCALE r aar>E PLAN REFERENCE . �E' w�J +r`•r ,: +� ' APPROVED YARMOUTH COMM11A ITj ,` "•' � `�' ' w1 ctu1 1AAT 14t F."l�; " �•. 6j 4HOwri -..4 TWO. PLAN 10 1ArATLL Oi1I LL y�;�I A8 *HQ-'-J H -1"'L0N AND THAT IT OOi1�S i0 ,'�f SSTEf�C,t: RMUIfZ7.MV 9 OF THE TOWN Of; •Ct• t: :4 l ' -,� • Lam: c ' E- � , , • ,- ., %•-'•tm���... wx�+ oot+aT � Q f 'got y, • y L.G % 1 '1' ) i • . 1 DATE � /S'i• .... �/v%[0 K ,., i�1i3OZ1�R i v - r/,4 /' i / t- i v . �. - - — R STEREO LAN___, a�YAR TOWN OF YARMOUTH 3 e .sy BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRIM. job Location:—h9 M-grumbe* nr Yarmouth Number Street Village Owner of Property: Susan Atkins Construction Supervisor: Claude Corriveau Name 011265 508- 362-2639 . • .m .Ma- 0909 Licensed Designee: (If other than Supervisor) Name 2.15 Responsibility of each license holder: License No. 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 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. 1 2.16 All building permit applications shall contain the.name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes P No ❑ If you have checked yo, please indicate the type coverage by checking the appropriate box. A liability Insurance policy 0) 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 eneral Laws, and that my signature on this permit application waives this requirement. Check one: 14 Signa re of Owner 9f Owne s Agent � Owner Agent (tic Signature:] i�l�&.A Building Official Approval: rr• A t Cr"" .,,% \MAriatwtc7C•� r C„ `«w...�: 114GROLIZ28 S0L7Hj:LUf0VTH AU5S.•1CHCSI=ITS0266=-45l Telephone (508) 398-2.191. &L 261 — Fax i508) 398-°365 PLL•NIUM; SIGNS BL•ILDING DEP IRTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 40. Section N and 780 CJIR. Chapter 1. Section 111.5• herby certify that the debris resulting from the proposed work 'demolition to he Ct:t:d"ctrd at Work Address : it, ht• disposed of at the following location: ylh-�'► � � �� �� i� h1 1l -�:ti(i (IiSP0Sal, Site shall be a Iicensed solid waste facility as defined by N1.G.L. ('hanrr:' I 1 I . Section I50A. S ignature of applicant 1'e:Zn:t No. I24��2 b::tt• The Commonwealth of Massachusetts Department of Industrial accidents OfDce oJlsrestlpstliss 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Applicant information:/ fsleasePR[N'f'TedGh�R name7 c y^'i1� d• r 9--• ,��' r •�- ./ city 1z l /l1� !) l/ f/� nhon M % 6!/ 3'�2--� 13 O lAnn a homeowner pirtormidg all work myself. I ant a sole proprietor and ha%e no one working in any capacity lam an employer prop iding workers' compensation for my employees working on this job. insurance co. Policy ft I am a sole proprietor. _eneral contractor or homeowner (circle one) and have hired the contractors listed below who ha%e the following %%orkers' compensation polices: company name: address: Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine op to S1.500 00 aadlor one years' Imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. I aaderstaad that a copy of this statement may be forwarded to the OMcc of Investigations of the DU for coverage verification. I do hereby certify der the pains(aand penalties ojperjury that the Information provided above It true and correct. Signature ��azz 7� - / Date //� �l Print name C official use only do not w rite in this area to be completed by city or Iowa official city or town: YARMOUM _ permiWcense 0 nBuilding Department p1.1censing hoard p check If Immediate response is required 261 QScleclmen's OMcc (508) 398-2231 ext. [3lltalth Department contact person: phoat M; _ _ 00ther L"ned 3.03 P1AI Information and Instructions Massachusetts General Laws chapter I52 section 25 requires all employers to provide workers' compensation for their eittplo%ees. As quoted from the" I aw-, an employee is defined as every person in the service of another under any contract of hire. express or implied, oral or written.. An enrphver is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoin_ 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 o%%ner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance , construction or repair work on such dwelling house or on the _rounds or building_ appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter I5_ section 2.5 also states that even• state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionall%. neither the common%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 ha%e been presented to the contracting authority. Applicants Please till in the workers' compensation affidavit completely, by checking the box that applies to your situation and suppling company names, address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The . affidavit should be returned to the city or town that the application for the permit or license is being requested. not the Department of Industrial accidents. Should you have any questions regarding the "law" or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The' Off ice 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 Imi:e of lillrestlil>ttlsios 600 Washington Street Boston, Ma. 02111 fax H: (617) 727-7749 phone #: (617) 7274900 ext. 406, 409 or 375 Sug;rested Affidavit for Home Improvement Contractor Permit Application For Omce t:se Only NAME OF CITYiTOWN Permit No. Date AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application S1GLe.14 Aesquiresthatthe"reconstruction.alteration.rennvation.rrnair.moderniraftnn.conversion. incrovement.remnva1..ierrnwinn nrconstrucnon of an additinn to anv nrecosnn owner-r-ccutned building cnntatntnr at least one but not more than four awethre sets _ v to structure; µrich are aaiacent to such restoence nr omldine be done by repstered contractors. with certain exceptions. atone µitn ether requirements das� Type of Work: C Est. Cost a Address of Work Owner Gbi, Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law _Job under S1.000 _Building not owner -occupied _Owner pulling own permit _Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 1d2A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: Y6-6 �knzA 6t;,1 vMU 121��1 Date Contractor Name Registration No. •.. Notwithstanding the absolve notice. I hereby apply for a permit as the owner of the above property: zz- Date O%%ncr Name �bassachosetts Deparmeat of fiW1Vameatal Pf0kCffcn Town of Yarmouth Wetland By -Law . Bureau of Resource Protection — Wetlands Chapter 143 DEP WPA Form 2 - Determination of Applicability Massachusetts Wetlands Protectlon Act M.G.L c. 131, §4Ql� /n% fr General Information From: YARMOUTH caw==Camnuufao I. Applicant Susan P, Atkins Ak=v1ft=Uj6VAapwt 49 Macomber Drive U04VAUM YarmouthPort CWOM MA 02675 saw To code 2 Property owner. SAME AS ABOVE Atvne a�Rw,wryOwer(doidrri0omrporryu) WJAVAdd M WOW sbae Imcode U Determinatlon Pursuant to the authority of M.G.L o.131, §40. the YARMOUTH has considered your Request for a Determination of APPlicatiility, with its supporting documentation, and has made the following Ddermirm ion regarding: 49 Macomber Drive SWAM= YarmouthPort 02675 &wow roQ* 114 M5 Auas=A4P,ft/ P& uat/ 3. Tine and final Revision Dale of Plans and Other Docume Plan of proposed work by Sharon Malone -Johnson rI Massackvs8tts DepXfinetrt of EnYftV=8atal Protectlan Town of Yarmouth Wetland By -Law .Bureau of Resource Protection — Wetlands Chapter 143 WPA Form 2 - Determination of Applicability Massachusetts Wetlands Protection Act M.G.L c. 131, §40 U Determination (cont.) The following Determinadon(s) is/are applicable to the proposed site and/or project relative to the Wetlands Protection Act and Regulations: Positive Determination NOW No work within the jurisdiction of the Wetlands Protection Act may proceed until a final Order of Conditions (Issued following submittal of a Notice of Intent or Abbreviated Notice of Intent) has been received from the Issuing authority (i.e., conservation commission or the Department of Environmental Protection). M 1. The area described on the plan(s) referenced above, which Includes all or part of the area described In the Request, is an area subject to protection under the Act. Therefore, any removing, fining, dredging, or altering of that area requires the filing of a Notice of Intent. :3 2 The delineations of the boundaries of the resource areas listed directly below, described on the plan(s) referenced above, which includes all or part of the area described in the Request, are confirmed as accurate: Therefore, the resource area boundaries confirmed in this Determination are binding as to all decisions rendered pursuant to the Wetlands Protection Act and its regulations regarding such boundaries for as long as this Determina- tion Is valid. However, the boundaries of resource areas not listed directly above are agt confirmed by this Determina- tion, regardless of whether such boundaries are contained on the plans attached to this Determination or to the Request for Determination. 3. The work described on plan(s) and document(s) referenced above, which Includes all or part of the work described In the Request, is within an area subject to Protection under the Act and will remove, fig, dredge, or alter that area. Therefore, said work requires the filing of a Notice of Intent. 4. The work described on plans) and document(s) referenced above, which includes all or part of the work described In the Request, is within the Buffer Zone and will after an Area subject to protection under the Act. Therefore, said work requires the filing of a Notice of Intent. S. The area and/or work described on plans) and document(s) referenced above, which includes all or part the work described in the Request, Is subject to review an approval by AWN avwy pursuant to the following wetlands law, bylaw, or ordinan (name and citation of law). p 6. The following area and/or work, if any, is subject to municipal bylaw but IM subject to the Massachusetts Wetlands Protection Act 7. If a Notice of Intent is filed for the work in the Riverfrom Area described on plans and dowmems referenced above, which includes all or part of the work described In the Request, the applicant must consider the following alematives (Refer to the Wetlands Regulations at 10.58(4)c. for more information about the scope of aftemative requirements) : = Alternatives limited to the lot on which the project Is located. C AltemaUM limited to the lot on which the project is located, the subdivided lots, and any adjacent lots formerly or presently owned by the same owner. = Alternatives limited to the original parcel on which the project is located, the subdivided parcels, any adjacent parcels. and any other land which can reasonably be obtained within the municipality. Alternatives extend to any sites which can reasonably be obtained within the appropriate region of the state. M=Mb .Bu asettsDOPMm�n Resource WetlandMWP1VftUUW meteOf r a outhWettandsy-raw WPA Form 2 - Determination of Applicability Massachusetts Wetlands fttedlonActM.G.L C. 131, §40 U Determination (coot.) 8egative Determination Note: No further action under the Wetlands Protection Act Is required by the applicant. However, if the Department of E M onmemal Protection Is requested to issue a Supersed-. ing Determination of Applicabliity, work may not proceed ' on this project unless the Department falls to ad on such request within 35 days of the date the request Is post- marked for certified mail or hand delivered to the Depart- ment Work may then proceed at the owner's risk only upon notice to the Department and to the conservation commission. Requirements for requests for Superseding Determinations are listed at the end of this document. ❑ 1. The area described In the Request Is not an area subject to protection under the Act or the Buffer Zone. C 2. The work described in the Request is within an area subject to protection under the Act, but will not remove, fill, dredge, or alter that area Therefore, said work does not require the filing of a Notice of Intent. 3. The work described in the Request Is within the Buffer Zone, as defined in the regulations, but will not alter an Area subject to protection under the Ad. Therefore, said work does not require the fling of a Notice of Intent 4. The work described In the Request is not within an Area subject to protection under the Ad (Including the Buffer Zone). Therefore, said work does not require the filing of a Notice of Intent, unless and until said work afters an Area subject to protection under Me Act Z! 5. The area described in the Request Is subject to protecti under the Act Since the work described therein meets the requirements for the following exemption, as specified in Me Act and regulations, no Notice of Intent Is required: E=VAM�* 133 6. The area and/or work described in the Request is not subject to review and approval by AhmraluxacFAW pursuant to a municipal wetlands law, ordinance, or bylaw, (name and citation of bylaw). Authadmilan This Detenninati This Determination is Issued to the applicant and delivered as follows: M by hand delivery on Lime CK by certified mail, return receipt requested on June 19, 2000 Lim This Determination Is valid for three years from the date of Issuance (except Determinations for Vegetation Management Plans which are valid for the duration of the Plan). This Determination does not relieve the applicant from complying with all other applicable federal, state, or local statutes. ordinances, bylaws, or reputations. on must be signed by a malorty of the conservation commission. A copy must be sent to the appropriate Department of Environmental Protection regional office (see appendix A) and the property owner (if different from the applicant). June 15 - Massaebu d& DepaftPXt of EnvifOMORtal Prateetion Town of YarmouthWetland By -Law .. Bureau of Resource Protection — Wetlands Qapter 143 WPA Form 2 - Determination of Applicability Massachusetts Wetlands Protection Act M.G.L c. 131, §40 0 Appeals The applicant, owner, any person aggrieved by this Determina- tion, any owner of land abutting the land upon which the Proposed work is to be done, or any ten residents of the city oi- town In which such land Is located, are hereby notified of their right to request the appropriate Department of Environmental Protection Regional Office to Issue a Superseding Oetermina bon of Applicability. The request must be made by certified mail or hand delivery to the Department, with the appropriate filing fee and fee Transmittal Form (see Appendix E: Request for Departmental Action Fee Transmittal Form) as provided in 310 CMR 10.03(7) within ten business days from the date of Issuance of this Determination. A copy of the request shall the same time be sent by certified mail or hand delivery to conservation commission and to the applicant If he/she is n the appellant The request shall state clearly and concisely th objections to the Determination which Is being appealed. To extent that the Determination is based on a municipal bylaw, and not on the Massachusetts Wetlands Protection Act or regulations, the Department of Environmental Protection has appellate jurisdiction. APPLICANT Claude Corriveau FlELD COPY (� \ BUILDING 13-DD-36,9 PERMIT < �369 r DATE 11/30/1999 ,W 19 PERMIT NO. < 8-00- ADDRESS P.O. Box 284, 434 Marston Ln. , y IN0.) J 01126Td EET) ClIMMA *ONTKkh"0jryS�c Addition 1 LNUMBER OF 1E1 17AVL.0 PERMIT TO (_) STORY DWELLING UNITS (TYPE Of IMPROVEMENT) N0. (PROPOSED USE) 49 - ZONING AT (LOCATION) MACOMBER DRIVE, .VAR 40"THRORT DISTRICT DISTRICT (N0.) (STREET) BETWEEN '\ AND Oai (CROSS REST) (CROSS STREET) m am ,.SUBDIVISION ` LOT M5 BLOCK A.M. 114SLI E 0 BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION _ of j l O Z TO TYPE 5-13 USE GROUP R-4 BASEMENT WALLS OR FOUNDATION y � (TYPE) 4 REMARKS: CONSTRUCT SUNROOM ON EXISTING DECK. REBUILD SECTION OF DECK. s AREA - VOLUME ESTIMATED COS $ 20�000.00 FEEMIT $ 35.00 (CUBIC/SQUARE FEET) j OWNER Susan Atkins ---I ADDRESS aCOm er Drive, Yarmouthport BUILDING DEPT. DATE INSPECTION RECORD NOTE PROGRESS - CORRECTIONS AND REMARKS INSPECTOR 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 TO: (508) 398-2231 x261 - Fax: (508) 398-2365 Office Use Only �1���q Permit Not-" Date u� l Permit Fee $ � DepositRec'd. 0;aODate Net Due $o2,r(1tCD Planning Board Information Plan Type Endorsement Date Recording Date Plan No. Assessors Department Information:'- Map Lot Map tot / O/d New 1.4 Property Dimensions: Lot Area (sf) Frontage (ft) Lot Coverage Other This Section for Office Use Only Building Permit Number: Date Issued: Signature: �i�ts ��/a � Certificate of Occupancy is Is not re wired 4 _r„ r7 Building Official baler Section 1 - Site Information I Use Group: R-4 Type: 5-B 1.1 Property Address: 1.2 Zoning Information: Zoning District Proposed Use 1.3 Building Setbacks fit) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided - �l(j U 1.4 Water Supply (M.G.L. e. 40. S 54) Public Private 1.5 Flood Zone Information: Comments: Zone: _I`_ BFE: mov2 2 ,199 Section 2 - Property Ownership/Authorized Agent miner of Record;, o Na F (print) Mailing Address Signature Telephone 2horized gent: v D Name t) Mailing Address A(Z4 �'/')4� �&042 U Signature Telephone Section 3 - Construction Services 3. LI onsed Cgnstruct on Supervisor: �!ILI Not Applicable ❑ License Number L1_ 7 Addr Expiration Date d S ature Telephone 3.2 Registered Home Improvement Contractor: Corn any Na a C u� v Not Applicable ❑ License Number Addr MM d S gnature Tel hone E iration Date 161-6 9- 15-99 2 y OVER Section 4 - Workers' Compensation Insurance Affidavit (M.G.L. c. 152 S 25C ( )) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached Yes .......... No .......... Section 5 - Descrlption of Proposed Work (check all applicable) New Construction ❑ I No. of Bedrooms I No. of Bathrooms Existing Bldg. ❑ I Repair(s) ❑ I Alterations ❑ I Addition Accessory Bldg. ❑ Type Demolition Other Specify: Brief Descriptio of Pronosed Work: C L v Costs Section 6 - Estimated Construction Item Estimated Cost (Dollars) to be completed by permit applicant Check Below 0 Conservation -Commission Filing (if applicable) Old Kings Highway & Historical Commission approval (if applicable) 1. Building dv" 2. Electrical r 3. Plumbing / Gas 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) 7. Total Square Ft. (new houses & adddions) Section 7a - Owner Authorization - Owner's Agent or Contractor Applies To be Completed When for Building Permit i, , as owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit applicatio'n.` Signature of Owner Date Section 7b - Owner/Authorized Agent Declaration i, , as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print name Signature of Owner/Agent Date 9-15-99 2 of 2 PLOT PLAN FOR LOT # Indicate location of garage or accessory building Additions with dashed lines -------------------- Sewerage disposal (cesspool) Well 0 I I(lot ................ft. rear) AbuttorIs Name I Lot # I REAR YARD If this is a corner lot, ........ ...ft. write in name of street. b ' • SIDE YARD SIDE YARD • HOUSE ----FT- FT �]------ I I ZEB CK fi. v � J I (lot..................ft. frontage) I I Abuttor I s Name Lot # 04 8 b if this is corner la write in name of other street. (NAME OF STRPtT) Information Supplied by MARK NORTH POINT TOWN OF Y A R M O U T H 0 BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT: Job Location: 49 Macumber Dr Yarmouth Pnrt Ma 02675 Number Street Village Owner of Property: Susan Atkins Construction Supervisor: Claude R Corriveau 011265 508-362-2639 Name License No. Phone No. Address: 434 Marston La Cummacuid Ma 02637 Licensed Designee: (If other than Supervisor) Name 2.15 Responsibility of each license holder: License No. 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building and structures only pursuant to the state building code and all other applicable laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The. license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Any licensee who shall willfully violate subsections 2.15.1, 2.15.2 or 2.15.3 or any other section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes ❑ No .y If you have checked yu, 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 Yass. General Laws, and that my signature on this permit application waives this requirement. ,.,%� P� Check one: Signature of Owner or Owner's Agent Owner Agent 0 Signature: Building Official Approval: ��`Y"`' TOWN OF YARMOUTH 00 r.r�}.�y BUILDING DEPARTMENT �i BUILDING PERMIT APPLICATION SIGN Applicant: Susan Atkins Building Permit No.: Dole Address: 49 Macumber Dr Yar.Port Tel. No.508/394-453-bate Filed: Bldg. Site Location: 4�9 MarnmhPr Dr Map No.: 114 Lot No.:m5 1 .353 The following information outlines the procedural steps required to obtain a permit to build, alter, or add to a structure within the Town of Yarmouth. The Building Department will determine compliance to the following: (A) Zoning Requirements (B) Historical Districts (C) Flood Zones. The Building Department will be responsible for assisting the applicant through the following departments: RESIDENTIAL AND/OR COMMERCIAL BUILDING WATER DEPARTMENT: Determines Compliance of Water Availability. (applicant to obtain) ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage. CONSERVATION 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. ---------------------------------------- 7he following Departments must sign of, in the respective order, prior to building inspector issuing the required building permit: REVIEWED BY: 1. WATERDEPARTMENT: �M 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 5. WIRING INSPECTOR: _ 6. PLUMBING INSPECTOR: 7. FIRE DEPARTMENT: — PLEASE NOTE All stumps and/or brush must be disposed of at an approved site. COMMENTS: 1&9214 �.� _t (194 DATE: DATE: N/A: N/A: DATE: N/A: 8/99 Applicant Signature Date The Commonwealth of Massachusetts Department of Industrial accidents Oxcea/lavesdpu/iis 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Applicant information: Plea sr, ZHU1TTcgE& name: Claude R Corriveau Building? Remodelling. Jab location? 49 Macumber Dr cite Yarmouth Port Ma. 02675 phone0508-362-2639 I am a homeowner performing all work myself. ❑ I am a sole proprietor _-d ha%e no one ssorking in any capacity O lam an employer pro%iding workers' compensation for my employees working on this job. tit): phone M: insurance co. policy N am a sole pro rieto .general contractoyor. homeowner (circle one) and have hired the contractors listed below st ho have r the o uwm� s�orker�e'omgensation polices: address: 600 Plain St - may.: Marshfield Ma. 02050-0000 phone#:781-8349306 0nsuranceco.CNA Insurance. Co.St Paul Insurance poiicv# 547x9945 Failure to secure coverage as required under Section 25A of MGL 152 an lead to the imposition of erisle" penalties of a Oat up[* 31.500Aa and/or 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 a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby cep' y�nder the pains an penalties oJperjury that the information provided above is true %and correct �r Signature -Zeal-14 Dale Print name CU it' (� f It /Utz// cJ Phone M �� f-! l�� official use only do not write in this area to be completed by city or Iowa official city or town: YARMOOTIJ p check if Immediate response is required contact person: permit/license 0 nBuilding Departmcot plJcensing Board 261 OScleetmen's Office phoscN:_ (508) 398-2231 e❑Health Departmentat. nother d'�n.d 3,95 %AI Information and Instructions ' ' Massachusetts General Laws chapter I52 section 25 requires all emplovers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any - contract of hire, express or implied, oral or written. An emploier is defined as an individual. partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual . partnership, association or other legal entity, employing employees. However the owner of a d%%ell ing house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance , construction or repair work on such dwelling house or.in the urounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. %IGI_ chapter 15: section =5 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionall%. neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter ha% e been presented to the contracting authority. Applicants Please till in the workers' compensation affidavit completely, by checking the box that applies to your situation and suppling company nnnies. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested. not the Department of Industrial Accidents. Should you have any questions regarding the "law" or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitateto give us a call. The Department's address, telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents office of investl0nfeos 600 Washington Street Boston, Ma. 02111 fax N: (617) 727-7749 phone 0: (617) 7274900 ext. 406, 409 or 375 Suggested Affidavit for Home Improvement Contractor Permit Application For omce Use only NAME OF�CITY/f OWN,_ Ptrmil No. Date AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application IGLc13:Arcquiresthat the "reconstruction alteration renovation repair modernization conversion inprcwement removaI.demoliIion. or construction of an addition to anv pre -costing nwner-nccutned building containing at least one but not more than fourdwelline units-. or to structures which are adjacent to such residence or hnilding" be done by registered contractors. with certain exceptions. along wnh other requirements. Type of Address of Owner Namc f Date of Permit Application:) % / '2-2 I hereby certify that: Registration is not required for the following rcason(s): _Work excluded by law _Job under S1,000 Building not owner -occupied _Owner pulling own permit _Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOTHAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 1d2A. 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 ACORD. CERTIFICATE OF LIABILITY INSURANCE w"'" - - c•x;.;:' tr< "(- j' . • cAX r:, - .:� . Tla7> CCF21'i lrA4S A MATIFR Cr IyCrfRS1AT1'\�! t' ONt f uhil r'(lt.I ItRS too RIGHTS UPC,t, Tt1L C L H I IrIC:.TE Ii0![)LH 1/11,CF'RI1FICAI[Ut.L_ NO LI;E ND L k i I VOR LAt 11 R _HE Lai:! WV:I At fORDE") rY tlli V^,I r'- i-`, t`l_I 4t. rl °, it i.,Hl)p.'...:OVE HAi.6 Lot. c '.<. .... C .. - r -._ - " . il'• _ _.. d. CI _..tom 1 .... ... r. A'..: 1'4 r ..'Vtt I w. Cr (taP lrv� oGl Ct t•r n}I�,r. • I -all .. �. .I! _�.: Er.t.U' 11]t .r.. _- _ _ .. C. _ .. ..��.1•I '.a . .. .•_I� r` ire-� > 1•Fr. E•• scDLI v.l,;. • 1 I toeL: 7;) 5I cl •, j:. `.i C� !iA !/199'I �r., ri .G ,',l Lp:,Lry. ' JI a orp r,n. =•r,r �.d:-. �k«'i..� ;-,.... .:rt' I.dlt,1 PC,[. n (II �r,::I Ilattllis. J-.v :C� I dnC�1�.1. :. r' ,'i d;�rt .•fG t"rr[:. i,. %n'_ 11"'t - �'-' '.rl r'iv LC '.rri f.i CLR IIFICATH HOLDER _ _._C__.C_.�_.__._-.___..-._._. AN[LLATIGN M'I TTr..%-T,r! T'• 4c rt 4T'rl:. aTC WrA nta An••; to T.C: �,. vAlt SIMI. eOhCr SI.AtE ImPe)Sr NO t.M' •, ,.. _ •.. of '. .' .. �•rg I Ne [ [ Lnt pr L WA _ ..v„ l v.l•r 1•✓'. 1. .!5 a:F91S CirrNMlnFaTf•r.f5 _.__-._ _ __ __ t ♦'7 •)r�7 Vh. NY lw. •ice � 11 . ll. Nl•i./[Str. ... ,. �I/Il-.��...� �%� ���i�tLr., IZACORD CORPORATION Vd:l ACORD ZS-S (IW) _ tip,• ti.... � �Y .. �! .]l. :! '"" -+- �S. G� ;.=..+1•' ^!.. (i •'�11 r•M Li CIA _vz or Tj- CD CD S .I h,: • 1. I a. 1� f ... ,,,) :f jf•1. W�tl ! ki 'L , 1• .• ! f/r w1."j•yi. %'r} �r%v{ralki�?:+• tf24 1 ;•�'�•: •t?•'•/.,✓, ' .I.J II ci%4 G.L '�• .•. 1!''�,�. .':4�'' .i•-.i It \ At .•y, • Al ` r .L \rl�i+'ja = I"•!.1/\eI i%„rI r✓I•//M, /'THEW A `) ,1 \\� 7HOMAS 1t}� SttOWitfiR9LTRV)lYQ drf 7 I ,.r, :_ ^`_ '�• !, W'RO PONDDjtjyB . . • t . ,,..,': .�\ �.. ' • : is ,r+.} 1 PLOT PLAN «� 't • ..«a ' �' ,;.. �" �-"., LOCATION Morr�xr: �.�1; • ARM. ovFN,�t �'•� rF� SCALE. I....�01.... ATE • /.' K•�fr..,�t nr d if�vw�r;nu I t vEo r��t.�..•.,.. e ter. pP4R� �gti�1TiEE PLAN REFEREJVCE .1.1'... P... t , r I . At-H 22 , / Ll/oEi -: - ' :.. 1 • �t CEpTIFY THAT THE AHotrN ON THIe PLAN Ia LAG,TED ON E $i ; AS SHOWN HIERZM AND THAT IT OONFOR)� 70 86TOA�f c REOUIRFI+�4►1T6 OP THE TOWN Of i'"i• . [ .5". ( f F!'71fi�1llpf/!�... WHEN CONaTR()¢1Q,� ! t-w rI r_ /.::1/! :'. DATE ,. PET{TIONI?R, S: RE STERED LAN SURY6YA -- r� --- Inv p " lil •.• : t� M - _OZ 2 _ w "02 O �m72k "34A zvn 21 "22no AC 11[MI I �► VlI \ Rio AC ��D 2 2 4A?CCI I 25, 79ssx1 .112 AC WOK Q1 Z �6K .'/"021W I go OK 60.► ��� • ROW 122aa) ' C1 12 .31to tluul OUNR I so op 1122R31 'J&AC w --- 1. 00 CC "21 / u "s2su�c C G AG o 1 xK o 0 N i mere to r= IUsA 00 01iK {- I M ° 0 1r \Y .31K •• c 1 ASAC a 046AC Vass) �1nc1 �ra2R51 fg x16 -� m /�•, m _ ��w"a >clei 87 11 AC 221161 I GM AC54 I As / ! \ M S41 • SHE « 1 Al AC OO 1 / 04 Or V'• 1122924 ' • "22�RM1 JIK "WIC- . 1 'i A1AC I i APPROVED I n YAR4iOUT lI un -EE ;171 u2 OKHRD 2•K n49K "1"1a 1 rc!3AC °r°"o we 'A UFOLLINS ' 101 ""win 01 ! ' IC "AO� 1 I � ' I POND 1 "1ur11 K IL"1, I I rJ\ "1 A2AC K I 014,12�1�\ - - - - _ I _- �' `-------------------------- --- --------- -- - - — I SPECIFICATION SHEET (YARMOUTH UKHC) - SUBMIT 3 WrIES 5161 NAME OF OWNER(S): FOUNDATION (18" MAX. EXPOSED): u P/ P+ g STEPS (INDICATE BRICK/CEMENT/OTHER) SIDING TYPE: A 9 C 10 P 6 0 at- his s ma-1-c. I 6 u S e CHIMNEY (INDICATE BRICK/STUCCO/WOODFACED) -CONCRETE/OTIYEER - l"l i APPROVED YARMOUTH CO1.11AITTEE \� I COLOR: OKHRD 1` ROOF MATERIAL: uy ! Q S-5 PITCH (7/12 MIN.) �/_et/ COLOR: I u / �G MAX. EXP. WINDOWS (GRILLES REQUIRED) -INDICATE SIZES IF NOT LISTED ON ELEVATIONS: DOORS (INDICATE SIZES IF NOT LISTED ON ELEVATIONS): TRIM: (ALL WINDOWS & DOORS TRIMMED WITH IX4 / 1X5 WOOD) SHUTTERS (WOODNINYL) (PANELED/LOUVERED) "ljTTERS (WOOD/ALUMINUM): GARAGE DOORS: SIZE & STYLE: STORM WINDOWS & DOORS: (INDICATE SIZES IF NOT LISTED ON ELVATIONS) SKYLIGHTS: TYPE/SIZE: DECK: SIZE & MATERIAL: /V p %L FENCING (MAX. HEIGHT fl: STYLE: (SHOW LAYOUT & RUNNING FOOTAGE ON SITE PLAN) COLOR: Ft b,w U" //' " COLOR: 0 cOLO19 rCOLM �COLO mom. CD y ;.. COLOR: 0 COLOR: r-l�d L' COLOR: RETAINING WALL: (P.T. OR FIELDSTONE. --CONCRETE It, r'ROPRIATE) (SHOW LAYOUT & RUNNING FOOTAGE ON SITL•• ?LAN) ADDITIONAL INFORMATION:% F4 %1 t / PR fPd NOTES: ATTACH COLOR CHIPS. INDICATE LANDSCAPING. EXTERIOR LIGHTING & ELECTRIC METER ON SITE PLANS FOR NEW HOUSES. REV. 5198 5101 ,...� Old ltiirtg's Highway Regional Historic i;isuiet Committee .. l is the Town of YatTrtoutt fcr a APPROVED 1 ,1 i YARMOUTH COMMITTEE i CERTIFICATE OF APPROPILIATENESS OKHRD Application is hereby made in triplicate, for the issuance of a Certificate of Appropriatencss under Section 6 of . Chapter470, Acts and Resolves of Massachusetts, 1973, for proposed work aslkscribed below.iid on plants,;+! drawings or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: I. Exterior Building Constnucsion : p New BuMng JfAddifion 13 Alteration I_ n Indicate type ofbuikiing: E3 House [3Garage Ce• rRl:t W [3 Other h—e Fabii-`2C4 4."Ovy,-111 2. Exterior Painting: 13 r— 7 J1 r*i - o 7. Signs or Billboards: Q New Sign 0 Existing Sign E3 Repainting existing signcc i rn 4 4. Structure: O Fence p Wall C3 Flagpole [3 Other�-- (Pleaw read other side for the check list for explanations and requuerneatsEl -t " a ro TYPE OR PRINT LEGIBLY DATE D ` i_ ADDRESS OF PROPOSED WORK ASSESSORS MAP NO._—" OWNERU S �C •1 /. C �� N _ ASSESSORS LOT 1, f T. tf 5 HOME ADDRESS �� 7�,t1(.�'1�i�,oi [/ y_`�:`�'?-j� /n TELEPHONE NO. - 9 J4/ v �— r' AGENT OR CONTRACTOR t •� 111 ZIP t-1 TELEPHONE NO. 6 - 3 G 67h DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done (sw No. g. other side). including materials to be used. If spocifacations do not accompany plants. In cage of xigtli give ktcatiorrm o' •xi•tire sips an.] proposed ktcationq - ^ ^•�• (Attach additi•r al stv t if neomsar•). ' H St� 3 e-,, C�, ;,r oij-p y✓i 1 r G 41, xn . H.D.% . e _ Phis Isar i _ .P1. ROW .0 4aP!". ' ..0 ._ .t r+,KTA t n+tr....tor•Agc nereb) _ ten tc. iLn 6 Z) 0 LL .6 4 M M Jo.m APPROVED I YARMOUTH CoiAm1TTEE j OKHRO //L���(.9 Tye..• ..P' ! N! r M313 NM L ALOfd 8 L AOX 66. C. .;\1 ] wN rwrp" r. tw9 Mye r m .. S. � s � r 6' � � Q iJ C OC � 4 L^ � V LIT t Q L V , V l ~ c o u Ln S i ul syy ^^o_K Lo Ql ' - �J ' pul+g C` c�U Yale Ircn.� . J �J 7 � S song to Mtti hairs 10 u. � n � A it � � r• �) R AK ELEVATION M sumam uttoce u WM414 oft% oQ I` r 10 cn U CJ 2 CD y. h" c cr • Q •99 AN 18 NO Oc a 1C"UN CLERK IREASI'f ( L O v L Oc 'i � r v 1 "to wa U7 • z LJ d� . ` 'e aytry AaCt -a�LL yLLRt LK� \OV 18 RIO *? CL R '6L `BEAST( f �� CLERK � T ypnq t• Nut hair .n „.mow IAL40EC La .nca en► `S a o `1 Y 6 REAR ELEVATION s; ��•�{ ij�r cV ..1_ a--xi:-1. I � 1' x.',\ -:n- �A .• .i., `a+ t1. - i ': ' 1 TOWN OF YARMOUTH P\N, BUILDING; PERMIT - F��IELD COPY $-bl ao.av .Co.z.,(, _. ` DATE May 21• 2001 PERMIT NO. 8-01--827 APPLICANT Susan Atkins ADDRESS 49 MaC=hnir Dr Y_ P (NO.) (STREET) (CONTR'S LICENSE) PERMIT TO Sum 1—) STORY (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) NUMBER OF DWELLING UNITS ZONING AT (LOCATION) 49--_HaCrmnhwr ny- Y p• DISTRICT R-40 (NO.) (STREET) e BETWEEN AND m (CROSS STREETI (CROSS STREET) LOT m SUBDIVISION 136-92 LOT BLOCK SIZE m BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION O fTO TYPE 5 $ USE GROUP - 4 BASEMENT WALLS OR FOUNDATION rc (TYPE) O 8 % 10 Storage shed. REMARKS: AREA OR VOLUME. ESTIMATED COST $ . I088000 FEEPERMIT $ 20.00 (CUBIC/SQUARE FEET) Susan Atkins OWNER ADDRESS BBYILDING DEPT. /���ry✓fAXIA INSPECTION RECORD 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) 398-2365 fiice Use Only Permit No _-DI -27 Datt �_� 1 'ca.J � Permit Fee $ Deposit Rec'd. $ Date �l b Net Due $ 02 m .t-c, 0 Planning Board Information Plan Type Endorsement Date Recording Date n No. Assessors Department Information: Map Lot Map Lot / Z Old New 1.4 Property Dimensions: Lot Area (sQ Frontage (ft) Lot Coverage Other This Section for Office Use Only Building Permit Number: Date Issued: Signature: Building Official Date Certificate of Occupancy / � is is not / required Section 1 - Site Information I Use Group: R-4 Type: 5-81 1.1 Property Address: 49 Macomber Dr Yar Port 1.2 Zoning Information: Zoning District Proposed Use 1.3 Building Setbacks (it) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.4 Water Supply (M.G.L. e. 40. S 54) Pub[W Private 1.5 Flood Zone Information: Comments: Zone: EFE: Section 2 - Property Ownership/Authorized Agent 2.1 Owner of Record: Susan Atkins Name (print �� ignature p 49 Macomber Dr Yarmouth Port Mailing Address _ 2.2 Authorized Agent: Name (print) Signature Telephone Section 3 - Construction Services I D 3.1 Licensed Constructlon Supervisor: �j�� �tNoteMAY 21 ber Addresste Signature Telephone —� 3.2 Registered Home Improvement Contractor. Company Name Not Applicable ❑ License Number Address Signature Telephone Expiration Date �-67-'r 6-W 9 - 15 - 99 1 of 2 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 ❑ I No. of Bedrooms No. of Bathrooms Existing Bldg. ❑ I Repair(s) ❑ I Alterations ❑ I Addition ❑ AccessoryBldg. ❑ Type Demolition Ot�gr P4 Specifvg)� JJ Brief Description of Proposed Work: /D Prefab storage shed by Pine Harbor 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 2. Electrical 3. Plumbing / Gas 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) 7. Total Square Ft. (new houses & additions) Section 7a - Owner Authorization - Owner's Agent or Contractor Applies To be Completed When for Building Permit I, , as owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date Section 7b - Owner/Authorized Agent Declaration 1, , as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print name Signature of Owner/Agent Date r 9- f5-99 2 of 2 TOWN OF YARMOUTH BUILDING DEPARTMENT BUILDING PERMIT APPLICATION SIGN OFF Applicant: Susan Atkins Address: 49 Macomber Dryarmouth Port Building Permit No.: Tel. No.: 394-5482 Date Filed:5/18/01 Bldg. Site Location: 49 MacQmber Dr. Map No.: 136 Lot No.: 92 The following information outlines the procedural steps required to obtain a permit to build, alter, or add to a structure within the Town of Yarmouth. The Building Department will determine compliance to the following: (A) Zoning Requirements (B) Historical Districts (C) Flood Zones. The Building Department will be responsible for assisting the applicant through the following departments: RESIDENTIAL AND/OR COMMERCIAL BUILDING WATER DEPARTMENT: Determines Compliance of Water Availability. (applicant to obtain) ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage. CONSERVATION CONBUSSION: Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc. HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements for Septage Disposal and other Public Health Activities. FIRE DEPARTMENT: Determines Compliance to State and Town Requirements for Personal ---------------------------------------- Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc. 77te folloudngDepartments must sign of; in the respective order, prior to building inspector issuing the required building permit: REVIEWED BY: 1. WATER DEPARTMENT: DATE: / P • O/ N/A: 2. ENGINEERING DEPARTA DATE: N/A: 3. CONSERVATION: DATE: 2 ( N/A: 4. HEALTH DEPARTMENT: DATE: N/A: INDUSTRIAL AND/OR COMMERCIAL PERMITS 5. WIRING INSPECTOR: _ 6. PLUMBING INSPECTOR: 7. FIRE DEPARTMENT: — PLEASE NOTE. All stumps and/or brush must be disposed of at an approved site. COMMENTS: DATE: N/A: DATE: N/A: DATE: N/A: 8/99 Applicant Signature Date T l > 44. J rl � �� •y •r• ••. `''�' 'i �. ^—• it � /�"�� � ` t_. c; 'q..hr �. w ✓ fit. a,/ ! r .: r .l./ li Cs'l � I � \ V' �. :r ' • prr e` : �5rt�f,. ''' ' � � ti .-�..--� - ..� t ' •,': ' •S� fit' o. K't t`'�•, f1; ,Tr, "�a�g _`__"�-r-� �R A' it •�; S j� ',�� I ' ;�xr'. 16 ••a /.o't � I�trft. + ` Ir it l'., i t ALi'�e�, � tea; t 1.,,: , � �': •� \` l� t HOMABL' APPROVED , eiiRy'� t✓� a: : , 11� , YARMO 7H COMM l7i3dL_ c J /'• �� CERTIFIED. _ PLOT PLAN z <,MI lei l LOCAMN HIKOMP&P 1.W,, : ARMo0*rlf; i >�p,`�' `I • SCALE . ��.... DATE PLAN REFERENCEr Cp 014 `r� Y 1 CERTIFY THAT THE AHOWN ON THIS PLAN IS LOCATED OH TKE y _ AS SHOWN HEAHON AM THAT IT CONFORFR9.. . a SSTBA�1( REOUIREME !TS OF,THE TOWN OF,'r ►"�. '+ .L E.`?4�1�1, WHEN',C*STP 1' OATS . 4• l''?4 �1�1�7 pETt7tON i" ' y,4'p /' y r� + RE STEREO _LaAN • GIJR �, :r - 9.!5i&e. 11 . L- 5ld-r— PINE HARBOR WOOD PRODUCTS Built on your property. 259 Queen Anne Road Harwich, MA 02645 508-430-2800 Fax:508-430-1115 Quality Outdoor Wood Products 1-800-368-SHED (7433) The Outdoor Storage Specialist Licensed • Registered • Insured www.pineharbor.com Built on your property. Storage Sheds Have Many Uses... • Riding Mowers • Workshop • Garden Tools • Garden Tractors • Outdoor Furniture • Pool Supplies 344 Yarmouth Road (Willow St.) Hyannis, MA 02601 508-771-5007 Fax:508-771-7070 Board of Building'Re�qulafions a One Ashburton Plaw, m 1301 : . r Boston, Ma 02108-1618 - :�_.... . License: CONSTRUCTION SUPERVISOR LICENSE Birttsdate: 03/14/1970 Number: CS 073855 ' Expires: ()W142002 Restricted To: 113 1A:41ES R MCGRATH 50 WINTERGREEN LANE BREWSTER_ MA I12631 Tr. no: 73865 Keep top torsacelpt anti change of address notification. tA Board of Building Regulaftons and Standards vw One Ashburton Place - Room 1301 4= Boston, Massachusetts 02108 Home Improvement Contractor Registration McGRATH POST & BEAM CO. JAMES McGRATH 259 QUEEN ANNE RD. HARWICH. MA 02645 f a � �IF: rtLN(/I[NI/�'O�Iii f J ��IL6iiI%M4�1 _- Buzrd orBuilln= Itcgutatioas and Standards HOME UdPROVIDARNT COMIrRACTOR '.,XV:, '; Regiziatior- 132935 E:plratiom 101311=2 Type: McGRATH POST d BEAM CO. JAMES FUGRATH 259 OUEEN ANNE RD. ZZ.— -7-zer&r HARWICH. MA 02645 Admiai srator Registration: 11.2935 Type: Private Cz.-porauon Expiration: '0131/2002 Update Address and return card. }lark reason for chance Addrttss ' Retinval . Employment .— l.oftf:ar License or registration v&M for individol use only before the aspiration date. ISfound return to: Board of Building Regulations and Standards One Ashburton Place Ras 1301 Boston, W.02108 Not valid withoutstgnature IvocstedAffidavit for Home Improvement Contractor Permit Application r oma Use Only ttrtti No. it MGL c.142A sogttires that t orconstruction of an additic to structure which are sdis nstuiscmcaLs. ory Type of Work: % _ _1A Address of Work Owner Name. NAME OF CITYiTOWN AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application to such reideme or bttitdine be dose by mosterad mattsaaas; with ocnain esseptioat, along witb other irychon o-(Pc5i t 136CM f4ltr) Est Cote 4;,arI >4+% /tS Date of Permit Application: I hereby certify that: Registration is not required for the following rcason(s): _Work excluded by law _Job undcr SI,000 _Building not owner-oavpied Owner pulling own permit _Other (specify) Noticc 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 undcr penalties of perjury: I hereby apply for a permit as A as! t (..t r. �/ 1 D ,37c/ Date t1ra,,ct{o�r',,a/ c Registration No. R R Or�-G r . Notwithstanding the above notice. I hereby apply for a permit as the owner of the above property. 910 ���� Date O •ncr Namc N} r��• ;•:;• T/jc CbRrmanKrauu nj .uua.a•,•••�?•••.. - dean ''/ ' •L` . �_; DfTgrt+nenr oJladrrsrrial Aa'r • '• �� Qflutallaam�l� '.1 6d0 11 ashinr rein Sneer 41 �. • 13nunn, Mass 92111 `'4:.'•'� Nvor{:crs�Compcnsalbolwmr2accAfidaaif .�^ _�! _...— _• - . iiS rl rr L.ii Gab I O 1 am a 1104wncr performing alrworl: mysac• O I am a soic proprietor and have 00 one wwting in crr+rr.^m 1 am an;—l41q�tr proridmg worl:crs' con M.52 I rlrrrr 3 `=1 yr, rrn ref n n / S n7A r_I,l i W en an this job. /�(``I• ?6LNot-&)r gbxJ `l 00 9/70:-30/ .ter...-..-=.-.v+�•--.�..�•--r—+-- __" ' -- acneral contractor, or 6omwaraer (circle sett) and hay. hired the contractors lined bc1oN who havc 1 am a solc proprietor, r rile fol�o�� ink worurs' compensation polices: rnm an �m • nAdrras' ' 1 .TR.t� r��yTMa rra• •.r'+.t•x • ti+ +r• ll�Va{'.:f•Y . ��� • _ �:Uiac� liddiliowl ahc if liccixu!'�_:, "»•`'"'+� "' f a enrisal ties of a fine op 1s S t jb0A0 andhlr ;a c to>rrarc CM--r a rrgelred undcr:eelioa _i.� of a1Gt 15"' pa Itsd to Itse iMnposislon P�'t .mr cars' Iglu j:so^ sell as Ciro pcnallio in ibe form of a STOr NvOAI: OnDLA and a fa.c of s1DQ" w daj araiw>s rc. 1 owdcr>uad that a cup; or 16ia>lalt rnl rah jamarded to the 0MCC of In `Mitsui r Dl.♦ foreoscra:e rYifiolion. i ::n r+crrilr r ijr +eIJo,ar/o �l f7 r l nJoruMsrion prPrided tuneit rare and rnnect Print orna! a.r Yet}\ Lto wYl Yrilc in IYn ■rta w IIc cnrplctrd 1r. city or Ie.a official LSc.� rlllsildil¢Ilrrartreel I. nl\ or IwNP: ��' Ct.iLrn.iw-_ RYard ' 044clrnb Ufilrr C cLrrl it it rrtlolr «slrw.c is rcllYircd [311Mtlh DcrtanrrYl rIt►then �` f_... Y-r...Ye•�•.+'+••:....ire �- IY•Y., rlel COBS=gLTC.IO2i SJP58VT_SOR FORIu 7;�St PRINT: I .. JOB LOC?�IOti rn Ot �PaRT'_' OWITE .. C^.:iS=RUC=IOII SJF-nV3SuR 'LiCri cs:tsL HLThr.F.R ('S D'73��., LICENSED DzSIG2��E (I: A2iY) . o= cense ho C= all :s C: ne Ll:=aL'c :_-tZ .^c - --= -•--r-«_ C^='-_ �.�.. aw the SU °_ be su_e=t C^-:i Z=�« r- -- ••_ T/ST-_-r ___^_i.•.� G�-i- CFTGS- _C., as _e^_l G_e= L_ `ec7:_C. -- 1 Co»-R- _- -C -- ��_ fit..-. »��.Z� JC��r :1C JiC Z. '.^�..� -Cl-- {f� -i .G.. ii C.^..eC say , _c.ense hold-- -- _'--- ---' an C __ _ _- G_ _ uniT=_-_ Tam-, c _i.ip5 QIICe: the ii_e5 c'G w_- Sact_ot 109.1.1_ c= t== St=te c Cote. I ��nce=s��r.� t_= --- -- cr -- -cce=L=e a r_ spec==_c ;=vec_cr.= es ----•;cED CONS•T`5LC__0?i SUPS .L�.Cn �• if� l i - , • 31L. 7" • '.Y:. t f., � ,a:!a� arm' � /� j � .. .c�� ,fi •' ,` V _. .. 1 ,:.1 � L'.•�u l r 1=1111 •fir �/ .` • n f S\ �•�' � r. i of =• 77 •! / .. . (.�� •t.,t ,. � �J o I 1 w d,14 •,.J , ,� i IT'-�-i � , /R.rFiJlFrj � .. *'r. 1,. ,: +. t ;r•`'\E�•. v. � _ / �� Z_Tj � "'t. t fit' ,ice •rf , • I .. •o•%�• 4 �,.. .,, IL , Y ILK •, x is .. r � . 4 QldtEa �d + L'. KLT,L.Eybo Ito r r�; ��j�t �' a:' : / •.: `. �,. O\,t \ it+idfiR9.-8C7RV'�, . { JJJ"' �. ;(�\' \ - eO17Ii!•ZAIIMOLTIII; yLA$gi �. ' CERTIFIED 'PLOT PLAlY ., L noni SCALE. �..Ot DATE.I�yB,'7��.t�'1� .• PLAN REFERENCE.�.t��`�P...4PLss is At- * f.� 11CERTIFY THAT 4THE f��A� �+:.c{;, •.; r • ., A9 OWN SHOWN ON HE'RI EONAANO TN is HAT� TCC11F0R�R9E 1, + l� r Lr � L r SETBAIC� REOUIREMF ITS OR THE TOWN OF,r:►' .. p• Tl. f _ 11// ��� DATE .4: l�''?4�?' S•. iTION i' .' ' yN d d ! c�r> r ! RE sTERED LAN 6UR µ ,, , 1. �B I'e0.Gl'. V1 2. 3. 4. c/A # .516 7 A I- t4 c3 , ,, 4-o CG L, ko us -,ems I agree to the above conditions - APPROVED ? YARMOUTH COMMITTEE 1D� = -J_ J- OKHRD Owner/Agent OKWChairman Signature /,� p• � � _Signature y TRIM: (ALL WINDOWS & DOORS TRIMMED WITH IX•t / 1X5) MATERIAL OF TRIM: (WOOD VINYL, ALUMINUM) SHUTTE (WOOD 1NYL) ANELE /LOUVERED) GUTTERS (WOOD/ALUMINUM): GARAGE DOORS: SIZE & STYLE: STORM WINDOWS & DOORS: (INDICATE SIZES IF NOT LISTED ON ELVATIONS) SKYLIGHTS: TYPE/SIZE: DECK: SIZE & MATERIAL: FENCING (MAX. HEIGHT 6T STYLE: (SHOW LAYOUT & RUNNING FOOTAGE ON SITE PLAN) SPECIFICATION SHEET (YARMOUTH OKHC) - SUBMIT 3 COPIES 60'v?/, Please ill out the form in its entire rovfdh» color chi s where /r7 .T .r t3'P gig, n P necessarp. 'I14DICATRL4NDSCAPINGEXTERIORLIGHTIN ELECTRICMETERONSITEPLANS FOR NEIYMOUSES `;", I t NAME OF OWNER(S): FOUNDATION (18" MAX. EXPOSED): NCRE OTHER- -. DRIVEWAY: WALK WAY: STEPS (INDICATE BRICK/CEMENT/OTHER): SIDING TYPE: a r c� eh COLOR• rli� CHIMNEY (INDICATE BRICK/STUCCO/WOODFACED) COLOR: ROOF MATERIAL: jj5pha.27L PITCH I C MAX. EX MIN.) COLOR: �tJltf &oWP7 WINDOWS (GRILLES REQUIRED) -INDICATE SIZES IF NOT LISTED ON ELEVATIONS: V /� DOORS (INDICATE SIZES AND STYLE IF NOT LISTED ON ELEVATIONS): COLOR: n�A01 3 G 1f dcx) r COLOR. nVdk-'a_� COLOR: fuuTJ17d--/ COLOR: COLOR.: "- COLOR: AppROVED YARMOUTH CO'�1MIZiEE I A., 1 DI COLORPOD �( \ COLT OR:.,.:.:: - COLOR: RETAINING WALL: (P.T. OR FIELDSTONE -CONCRETE INAPPROPRIATE) (SHOW LAYOUT & RUNNING FOOTAGE ON SITE PLAN) SIGNS: (indicate size, style, colors) SIGN POST: (indicate size, style, color) ADDITIONAL INFORMATION: COLOR: COLOR: REV. 6/99 I �1QI WN0O..ultiW o tunmim i ; a3 oaaav u 14 a W . CZ O O � J W �A `J . Z � v --711 �1 Old King's Highway Regional Historic District Committee ?A Yr l�;�it�.. i I in the To;%m of Yarmouth for a r ; TO'. CERTIFICATE OF APPROPRIATENESS ... . . t IJ L:i . Application is hereby made in triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photographs accompanying this application for. CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction : ((New Building ❑ Addition ❑ Alteration _ indicate t}pe oCbuildirrg ❑House D Garage D Commercial j�'Other Shy GP 2. Exterior Painting: ❑ 3. Signs or Billboards: ❑ New Sign ❑ Existing Sign ❑ Repainting existing sign 4. Structure. ❑ Fence ❑ Wall ❑ Flagpole ❑ Other TYPE OR PRINT LEGIBLY DATE �//9�o / ADDRESS OF PROPOSED WORK,�`9 /%IACOWr Qi., rMIDW-ASSESSORS MAP NO. I3 6 OWNER�n t�, / ��� h S r� Dp ASSESSORS LOT NO.�7i HOME ADDRESS hrlile nhe r- ZIC, `fit✓qt&1L7A r7 TELEPHONE NO. 39 r^Sf�Z AGENT OR CONTRACTOR V 1 � r7e 774 r ka r� TELEPHONE NO .1-0 8 77/— J in6 , / . i in A _ i ... - ADDRESS USE ATTACHED SHEET IN PACKET FOR ABUTTING OWNERS C APPROVED c DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be don r�``la�l�rtals t b . In case of sips, give locations of existing signs and proposed locations of new signs. (AUVYI�dO,j`tprt� sh,xt if � /v t�iJpn c%CJ7 (�t�ovl� �h�ec�^ l6ea27e %44ttrYtltt�,r H "1 -�rtswx Signed Owner -Contractor -Agent Received by OKIIC J Date :.r c/ �U "L' II his C� ' irate is hg J J�i'f - i .., t .t i `Data Check aY _ i By ✓� M ! APPROVED D IMPORTANT: If Certilirate is approved, approval is subject to the 10 day appeal period prodded in the Act. DISAPPROVED ❑ Please return to: Yarmouth OKHC District Committee Yarmouth Town Hall, 1146 Route 28, S. Yarmouth, MA 02664 J n((ice Use only The Commonwealth of Massachusetts -�' -•- rrfalt y0. A ` � Department of Public Safcry V' aeaNn<y a fee oK.aee BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 1= 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK AN work to be performcd In accordance with the Maccachusens Electrical Code, 527 C R 12:0 (PLEAPRINT IN PRIIN INK OIL TYPE ALL INFORMATION) Date 3 a 0 City or Town of aA Al 0 Lnlj To the Inspector of Wires: The undersigned applies for a p rmit to perform the electrical work ,described IZW.. Location (Street A Number) Owner or Ienant ! 0 rr I ✓' / sas //��tJ A7�-lCl�cr Owner's Address N • f7 _ UX tl `t3 /4�a/:�S //i/' /YixM tflJtcQ 9L�/ Is this permit in conjunction with a building Purpose of Builping f�VaK Existing Servic! 7.7�Amps fto New Service. Amps / Vol Number of Feeders and Ampacity Location and N ure•of Proposed Electrical Work (JA ZAA -- Overbead (Check Appropriate Box) Moon NN G TKO' O �y No. of Meters_ ❑ No. of Meters No, of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above In- grnd. ❑ grnd. ❑ Generators KVA No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Initiating Devices No. of Sounding Devices No. of Self Contained Detection/Sounding Devices nicial Local ❑ CCoonneccion❑ Other No. of Ranges No. of Air Cond. Total tons No. of Disposals No. of Heat Tons Total Total No. of Dishwashers Space/Area Heating KW No. of Dryers Heating Devices KW No. of Water Heaters KW No, of o. o Si ns Ballasts Low Voltage Wirin No. Hydro Massage Tubs No. of Motors Total HP . OTHER: �D tOl)P *). ; vU A Ocr> V n PP n ✓ .) r)19/' 7f INSURANCE COVERAGE; Pursuant to the requirements of Massachusetts General Laws I have a current Li alit Insurance Polley including Completed Operations Coverage or is bstantial equivalent. YES NO I have submitted valid proof of acme to this office. YES NO ❑ If you have ch ed YES, please indicate the type of c/V a�gie�b�y checking the ap/propriate box. INSURANCE •BOND❑ OTHER❑ (Please Specify) ( a'Ylf?/LG'tAx� 1241M 0/ k"pLratiah DateT Estimated Value of flect4cal Work S Work to Start 0 � 00 Inspection Date Requested: Rough Final Signed under the a a�>lo�esQof per ry.—W FIRM NAME `��l C LIC. N0� Licensee Signature LIC. NO. Address �/�ft0 s. Tel. No. Alt. Tel No.VVI OWNER'S INSURANCE WAIVER: 14IM aware that de Licensee does not have the insurance coverage or its sub- stantial equivalent as required by Massachusetts General wsTa and that my signature on this permit application waives this requirement. Owner Agent (Please check one) . Telephone No. PERMIT FEE S Signature of Owner or Agent APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00 TOWN OF YARMOUTH (OFFICE USE ONLY) Fee: $ s6 • D U PERMIT NO. E-DI --3 /I (PLEASE PRINT IN INK OR TYPE ALL INFORAIATION) Date: To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. e 1 . : i Location (Street &.Number) Owner or Owner's Address Is this permit in conjunnctionwith a build- it? I ` / Purpose of Building P1 ` A(It- �'l.r 7C /Y n Existing Service774Z Amps 12-0 / 7-f0 Volts New Service Amps ! Volts N 0- 0 1 - 1 16. No (Check Appropriate Box) Eitdity,Authorization No. Overhead Undgrd ❑ Overhead ❑ Undgrd ❑ `j�Drfii/Po4T-- ae No. Ib �9 No of Meters No. of Dieters Number of Feeders and Ampacity /J Location and Nature of Proposed electrical Work: ���� GLI TC�(!lN t_Le.ir //! az:P !,Cli /9dWI;70 n Complrtion of the followiffe table ma be uaitvd by the lap eaor of Wirct No. of Recessed Fixtures h1Q.. QLCdL5&j5P-(PaddIe) Fans No. of Ton Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Above In- Swimming Pool grnd. ❑ rnd. ❑ No. of Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection an Initiating Devices No. of Ranges Total No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Num er — Tons — K WDetection/Alerting No. of Self -Contained Devices No. of Dishwashers Space/Area Heating KW Municipal Local ❑ Connection ❑ Other No. of Dryers Heating Appliances KW cuuty ys[etns: No. of Devices or Equipvalent No. of Water Heaters KW No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. No. of Motors Total HP Telecommunications' Wiring: No. of Devices or E ring Attach additional detail if desired, or as required by the In pector of I1res. INSURANCE COVERAGE: Unless waived b the owner, no permit For the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" verage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. /n CHECK ONE: INSURANCE BOND❑ OTHER[] (Specify:) C ,144,k Of 091 U1711,13/^ o ' .. (Expiration Dat Estimated Value of ect teal Work: a' �n — (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the i and penal[' of erjur ,that the information n this ap 'cation is true and complete. �y FIRM NAME: f ll'� Z' LIC. NO. /I Licensee: Signature 11G LIC. NO. (If a licabp crud "exe t" in�the license u ber line.) ,�-���� �/ Bus. Tel. No.: Address.ei7 n MCI 11`1 ( the C 1 d k,14 ( ' 2tPG • Alt. Tel. No.: OWNER'S INSURANCE WA ER. I am aware that he Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I and the (check one) owner owner's agent. ❑ Owner/Agent Signature Telephone No. [Rev.0-V001 G OF YARMOUTH APPLICATION FOR PERMIT TO DO GASFITTING (OFFICE USE ONLY) By Fee: $ PERMIT NO. Date Building Owner's(*NsA� AT Location �'� �- / Name JJ ��jr 0 / a Tvoe of OCCuoancv Kir—s/ �) *r t New Plans Submitted Renovation ❑ Replacement ❑ Yes ❑ No ❑ N N W N Y N W •-•. W O 'V.. cc m. ~ F _ .:.a �.'--:. ,:. -a•... .� T..;- '?• _ -O. W cr Q O 0] V) W Q 0: O O O Q L pW- 1Qa— W = W Q a OF 0 W U_ Q W 0: W Z U W y W 0: p y 0: 0 0= W WF cc Z W „Jj F Z t_ H W m Z LL O W —i O fN„ W Q Q z W Z y S s='o a=LLM 3 c o g c°� M >oa SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR (PRINT OR TYPE) �r _ Check One: Installing Company Name !mot//;4 Lri,/ %/V l vs WC Address Ci9 U'0A/ (:71fPe e E` ❑ Partnership 7 ( / bC /// G —, ❑ Firm/Company Business Telephone } Name of Licensed Plumber or Gasfitter INSURANCE COVERAGE: Check One. . 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. Signature of Licensed lumber or Gasfitter 7�1 License Number TYPE LICENSE: 0 Plumber 0 Gasfitter 11 Master 0 Journeyman T^' ■,. A ^ "- ^. ■ A� ,T� , APPLICATION FOR PERMIT TO DO PLUMBING' ?. lu Date ly - $FLA 0 Building % Owner's AT. Location ���� Name .SUs'AAI P7'elW$ Type of Occupancy Z us. /DUNCE` New ❑ Renovation Replacement ❑ Plans Submitted Yes ElNo ❑ - t N - t LLI y J U) Q C.)Q N O CC X .. V Z R m¢ } Q F+ �� �S O .Q W O � W N a 3 W to ¢ Z Q >+ W' N O eL N J _Z C 4 W p J U. 4. W Q x C> Q = Q 3 S y O y. O x ,Q Y a. O O ~ •Q Y W U. W �\i O .a .� ;L a+ y ¢¢ Q O ¢ Q m 0 SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR (PRINT OR TYPE) //1 �//+ Chec One: Installing Company Name` < _� key—s O!✓ Ud// lO � r, Corp. Adddrress__ �X � � //Feet` ❑ Partnership- J ❑ Firm/Company Business Telephoneyzc Name of Licensed Plumber INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent. Check One: 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 voerage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check on Owner ❑ Agent ❑ Signature of Owner or Owner's Agent f 7 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 Signature e of f2 Licensed P my knowledge and that all plumbing work and installations performed 9 l er under Permit issued for this application will be in compliance with all r 79 pertinent provisions of the Massachusetts State Plumbing Code and License Number Chapter 142 of the General Laws. Type: Master 0 Journeyman 0 -. 51212015 SlipGen- Portal Hone Document Category Map -Block Number Street Number Street Name Town of Yarmouth Template [Building Dept] Slipsheet Identifier [sg25837] Building Permits 136.92 0049 MACOMBER DR Department Building Parcel ID 15972 Backfile Batch Scan Document? Additional Naming Info Index Operator Date - Time No Operator, Yarmscan 2015-05-21 - 14:04 HtpJAaserfiche121SlipGeN 1/1