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HomeMy WebLinkAboutBuilding Permitsa r TOWN OF YARMOUTH Building DepartmentPERMBUILDING (508) 398-M161ISSUE NO 2;i------... PERMIT ISSUE DATE ; _ 2i23i2011 . ; PROPOSED US APPLICANTRichardTupper ; JOB WEATHER CARD .............................. ••. PERMT TO Ad6don ' AT (LOCATION) oo86LOOKOUT RD ZONING DISTRICT® Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 141.49 BUILDING IS TO BE: CONST TYPE 5-B USE GROUP RT LOT SIZE construct 20 x 26 addition as per BOA petition 8 4328 amd as per plans dated 02MV11. REMARKS AREA (SO FT) EST COST (S L OWNER JADAMS. ELIZABETH P ADDRESS 10086 LOOKOUT RD Yarmouth Port I MA 102675 PERMIT FEE ($) 5300.00 - BUILDING DEPT BY INSPECTION RECORD CONTRACTOR LICENSE 069058 79 B Mid -Tech Drive West Yarmouth MA 02673 5082806280 PHONE 15083626513 FIELD COPY .:�ff Note Progress, TOWN OF YARMOUTH Building Department BUILDING (508) 398-2231 ext.1261 `I PERMff NO Fs 11 617 . _ _ _ - PERMIT ISSUE DATE 11=010 - ; PROPOSED US APPLICANT :wesiaYPnca:::::::::::::....(e) JOB WEATHER CARD PERMITTO Alterations ' AT (LOCATION) 10086LOOKOUTFID ZONING DISTRICT® Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK LOT SIZE construct portico as per plans dated 10=10. REMARKS BUILDING IS TO BE: CONST TYPE S-B USE GROUP R3 AREA (SO FT) EST COST ($ �5,000.00 PERMIT FEE ($) $100.00 OWNER JADAMS, ELIZABETH P BUILDING DEPT BY ADDRESS 0086 LOOKOUT RD Yarmouth Port I MA 102675 INSPECTION RECORD PHONE CONTRACTOR LICENSE 104189 23 Betty's Path West Yarmouth MA 02M 41W871529 FIELD COPY Date I _ Note Progress - Corrections and Remarks I Inspector W W N W W W LL- pill a ll C.oeunonri� ofei7i7auec�etis oti5ei,l Use�ojm,• 1JeParfwu.rl' a /yi.r .�i.vias : Permit No.9 �— C'S 63 BOARD OF FIRE PREVENTION REGULATIONS Rev Fee Checked . ave blank APPLICATION FOR -PERMIT TO PERFORM ELECTRICAL WORK Au work to be performed in secordance with the Massachiaem Electrical Codc NEC). 327 12.00 (PLEiSEPMTJNINKOR TYPE ALL INFORbfATIONJ Date: City or Town of: YARMOUTH To the Irrspec or of Tres: By this application the µndeUigned gives notice of !ns or her intention to perform the el d below. Location (Street & Number) B01 PN Owner'orTenant Qst Telephone No. Owner's Address Sac vr.Q_ permit in conjunction th a buWfft permit? Yes re of Building Z Servicew Amps l I Volts Overhead ° Amps t Volts Feeders and Ampacity, 40—A and Nature of Proposed Electrical No t�(Check Appropriate Box) Utility Authorization No. Undgrd ❑ No, of Meters `J'— Uudg�rd ❑ No, of Meters d Luminaires tenon of me to - No. of Ce]L-S°sp. (Paddle) Form table be waived by the Inspector o IPver. °• ° lm Outlets No. of Hot Tubs Transformers KVA Generators KVA ires EReceptade Swimming Pool ore o, o g d. crud. UMMenry Bstte Units ele Outlets No, of OB Burners FIRE ALARMS No. of Zones No, of Gas Burners o. o on 1nluldatinL No. of Ranges No. of Air Cond. Tans Devices No, of At Devices No, of Waste Disposers Heitfumpiriumber I ions Totals: No. o e ontar No. of Dishwashers DeteetiodAlertin DeAees S ace/Area Heatia KW' P E Loral ❑ ° Pa ❑ Omer Connection No, of Dryers Hating Appliances KW ecarity ystems:' o. o ester No. of Devices or Equivalent Heaters KW No.of o. o Data Wiring: Si BaUuts s No. of Devfces or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP ecommonications it n— No of Devices or Equivalent OTHER: Attach addittonat de 1 Estimated Value of E Work 1O Y —red or err required by the Inspector of W U. (When requited by municipal policy.) Work to Start Ia�pectiom to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE C G : Unless waived by the owner, no permit for the performance of electrical work nay issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under die pains and p ojpedn . the the in�adon on this application is bore and compteta FIRM NAME:—�p/f�i /J �f�S� _ !� , l LIC.NO.: Bvs. TeL No.• J 'Per M.G.L. c. 147, a. 57-61. security gullet work re Alt Tel. No: Department of Public Safety "S" License: Lic. No. Q OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below. I hereby waive this requirement I am the (check one) [] owns owner's a eat t Orraer" ent 1J Slgmiature Telephone No. PERMIT FEE: S Licensee: enter J 9 a • t,en mearea(f> a/ ma ea� Official Use Only BOARD OF FIRE PREVENTION REGULATIONS Occupancy • ( and Fee Checked MZ :Revj lave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK oAll work to be perfarmed in eecorrlaea with the Manachusem Electrical Cade (MECX 527 CAfR 12.00 C`t u(PLEASE PRLVTININK ORTYPEALLINFORMATIOA9 Date: CM0 CAI City or Town or- Ya P rfIn —71 Pq &T To the Impector of Wirm: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street A Number) Q(,j weer srTensst PAT A as vt.0 Telephone No. ner's Address G r4 ran 4 Is this permit In conjunction with a building permit? yes ® No ❑ (Check Appropriate Box) Purpose of Building j]t,-3 2 11 i &I (.- Utility Authorization No. I !(23 S(e'% Existing Service Z. Amps / 2c40 Volts Overhead Q Undgrd ❑ No. of Nieters t New Service 2.= Amps [ tlT /Z4U Volts Overhead ® Uodgrd ❑ No. o(Meten Number of Feeders and Ampaclty j Location and Nature of Proposed Electrical Work: p p (, i Ten t) r l % G �><? l ` Cron ledon awe dlowfn table be waived fh 1 for Ir1rr J No. of Recessed Luminaires S No. of Ce11.Susp. (Paddle) Fans ( a o Transformers e ro a. of KVA No. of Luminsin Outlets No. of Hot Tubs 1 Generators KVA No. of Luminaires Swimming Pool v° ❑ a' cod d ❑ a ° mergesey Ba Units g No. of Receptacle Outlets 10, No. of Oil Burners FIRE ALARMS lire of Zosa No. of Switches No. of Gas Barnes a f Ut tin Doand ices No. of Ranges No. of Air Coati. Tons . No. of Alerting Devices No. of Waste Disposers ump um nee Totab Spaa/Arts Heating KW a o s on D°t"HoWAlertln Devices of Dishwasher / Local ❑ as e p Conaectios ❑ Other No. of Dryer Heating Appliances KW ecNa Nag J!tam i or Contestant No. o. o Water KW Hester / o. o o. o St ns Blunts Data WIr1n No. of De�vkas or E ulvalent N o. Hydromessoge Bathtubs No of Motors Total HP a ecommas w Na (Devices or E nlgr• alvolent OTHER: Attach additional detail (rdaved or as required by the lmpeetar of Wires. �q Estimated Value of Electrical work: 5,on r1 (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with h1EC Rule 10. and upon completion. v INSURANCE COVERAGE: Unless waived by the owner, no permit far the perfomtace of electrical work may issue unless licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent The undtssigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing ofTce. ,,CIFECK ONE: INSURANCE ❑ BOND ❑ OTHER © (Specify:) A � cerdA, undo► the pains and penaldes oJpa/ury, that the Information on this application ir true and compfrtL �FI RM NAME: J Licensee see fir\ i rj gh st 1. a \ C L. Signaton LIC. NO.: 3t44' I G iR H Wffappllcablo• enter "anept-Inthelicenenumber fin,) Bus.TeLNo.r77N- A2-!M0(4 .S Address: Z.t2 LAPIN. ,•.rt_ Q,� I raQ4L,�rvt n O�S3Q AItTeLNa.: r •Per MA.L. e. 1417, s. 57-61, security work requires Department of Public Safety "S" License. Lie. No. 'C OWNL EWS INSURANCE WAIVER: I am aware that the Licensee does not have the liability jnsurance coverage normally required by law. By my signature below,) hereby waive this requirement 1 am the (check ono owner owner's a ent. Owner/.\gent Signature � UA A Telephone No PE211/T FEE: S % 6-.o0 WPS - Permit j i Page 1 of 1 1iNSTAR WPS - Permit Utility Auth/WO ti: 01823567 Date: 03/29/2011 Company OMARA ANTOINE Rep: Report By: YPO 86 LOOKOUT RD ADAMS ELIZABETH P Status: ACTIVE Service: INCRS Type: RES Nature of Work- EXISTING 200 AMPS SERVICE ... NO UPGRADE... ADDING ADDITION OF 700 SO FLIGHTS AND PLUGS.... RELOCATING FROM RIGHT SIDE TO HOUSE TO ADDITION ON RIGHT SIDE OF HOUSE -PENDING INSPECTION Service Information: There is no Service Information. Permit Information Permit#: E11-1182 Meters: 1 Reseal (Y/N): Y Date: 04/15/2011 Inspector: WI0060 Description: SearchF Detail Contacts F!ffl- JW f copyright 2003 NSTAR, SW Boylston Street, Boston MA USA. All rights reserved. Reproduction In whole or in part of any graphics, Images, text or other content at this web alto must be granted by NSTAR, Boston, MA, USA. Unauthorized modt iation of arty Information stored at this site may result in criminal prosecution. httpJ/www.nstaronline.conVappslwpslwpspemiit.cfm?Page=Permit&Unique=(ts_'2011-0... 4/15/2011 MASSACHUSETTS UNIFORM APPUCATION FOR PERMIT TO DO PLUMBING Clty/Town: AKt `n� MA. Date- 5 I � 11 � Permit# ( — l Building Location: t6 LUOILO"V, 'wti a4� Owners Name: ��`� A] P l-Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential [ia New: M Alteration: Renovation: Replacement Plans Submitted: Yes n No n LwJ JI 1.VT. FR . M. VRCJ ui DEDICATED i SYSTEMS y 7 N C a H Y N = U G S N G' R: 3 b O a: ii W 3 % e N 5 1_ = W a W 3 < o a_ 3 5 g rt N 3 a I 3 3 o i 3 SUB BSMT. BASEMENT I FLOOR X 2 FLOOR 3 FLOOR 1 FLOOR S FLOOR e FLOOR 7 FLOOR 6 FLOOR Installing Company Name: KMD '111g"bins Check One Only Certificate If Address: 1J Saval-Si-. LLn;t 1-L �_ " i - Ory/Town: - u.E�iM�^(F State: t1J� 11,, ❑ Corporation ❑ Partnership BuslnessTel: iltf�tl2-129$ Fax: ❑ Fimt/Company v Name of Licensed Plumber. t Wkk INSURANCE COVERAGE: I have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL CIL 142 Yes No ❑ If you have checked YpM please Indicate the type of coverage by checking the appropriate box below. A liability Insurance policy P,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 Massachusetts General Laws, and that my signature on this permit application waives this requirement Check One Only Sionature of Owner or Owners A...m Owner ❑ Agent ❑ - --- ___.. — h_. -- —r ,.e.n,.na .,m ppnaoon are true and acourats to tM best of my Knowledge and That all plumb" work and Installed - ---- me perfomhed under the permit Issued for this aPpacaton will be In compliance with an Pe nent provision ` the Masaachusets Stab Plumbing Code and Chapter 142 of the General Laws. B' Type of License: TW° fJ ® Plumber algnatun of tensed Plumber City/town r I ❑Master 3084 APPROVED OFFICE U ONLY) PJoumeyman Ucense Number. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO DO GAS FITTING CITYROWN: I 10'Nru.V4v` I STATE: MML APPLICATION DATE: i "711 till I JOBADDRESS: b(o LLTOV� oUt a OCCUPANCYTYPE: COMMERCIAL❑ RESIDENTIALE) PLANSSUBMfTTED: YES[] r NATURAL& LIQUEFIED PETROLEUM GAS: PIPING - EQUIPMENT - APPLIANCES -SYSTEMS -1 ENTER TOTAL AMOUNT FOR EACH SELECTION dMTED TO FIVE M NWERALS AIR ROTATION UNIT FURNACE: ALL TYPES TEMP HEATING EQUIPMENT BOILER: ALL TYPES GAS PIPING THERMAL OXIDIZER BOOSTER GENERATOR(STATIONARY ENGINE) TURBINE BROILER ILLUMINATING APPLIANCE UNIT HEATER BURNER: ALLTYPES INCINERATOR WATER HEATER: ALL TYPES CO -GENERATION UNIT INDUSTRIAL AIR HANDLER EQUIPMENT OVER 17,500MBH COFFEE ROASTER INFRARED HEATER rOTHER NOT LISTED? COOK APPLIANCE HOUSEHOLD KILN I GLORY HOLE I CRUCIBLE COOK APPLIANCE COMMERCIAL LABORATORY COCKS DECORATIVE APPLIANCE MAKEUP AIR UNIT DIRECT VENT APPLIANCE MECHANICAL EXHAUST EQUIPMENT DRYER: ALL TYPES OVEN: ALL TYPES FIREPLACE: VENTED I UNVENTED POOL HEATER FRYOLATOR ROOF TOP UNIT FUEL CELL ROOM HEATER-VENTEDNENTLESS PLUMBING / GAS FITTING FIRM INFORMATION CHECK ONE ONLY NAME: ADDRESS: IoSQ-177 Sr., (A65-I-Z ❑CorporaUon Bushess/0 CITY: STATE:QZIP oLta39 —� Partnership Businessl0 HLLCa , � TEL 71r-2ds-22ti4 FAX: e9�„taFc.O-uw, 6�` EMAIL # S�"� td"` [:]DBA I Unincorporated ❑ NAME OF LICENSED PLUMBER 1 GAS FITTER: Kw� wa-ccw INSURANCE COVERAGE 1 have a cured( WITHLirlsUr3nCe policy or Its u bstardial equivalent which meets the requirements of MGL CIL 142 YES q NO ❑ U you have dried ed Yn please Indicate the type of coverage by cheddng the appropriate box below. A liability Inurance policy R Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER I am swam dud the licensee does root have the kdsdrance coverage required by Chapter 142 of the MassadwAtts CeneM Laws and dot my skpubre on this permit application Mbn DUs requhmenl. ' CHECK ONE ONLY OWNER ❑ AGENT ❑ Signaturo of Owner or Owner's AgerR OWNER'S NAME: a ALgg+ 5 1 TEL•I --j FAX I hereby certify Elul all of the details and Information I have submitted (or entered) regarding this permit application is true and accurate to the best of my lumledge I certify that all pkxnbkV work and instanatbns performed under the permit issued, will be in compliance with all pertinent provisions of the Massaclaaeus Uniform state Plumbing Code, and Chapter 142 of tiro General Laws. (OFFICE USE ONLY) Type of License: I f� PemijO ` a`�— ®Pkmtw ❑GasfAW hp ❑Master ®Jotrr"man Signatue of Licensed PkrnberI Gas Fitter —� Fee: • eo ❑unmlt,tea - C —El qnrberl30 8; tf- n umked LP DEPT. U ' yy tl' v IP :i LL i ■ M FINAL INSE=ON NOTES l; :t .l i-,LE COPY LOT J2 LOT J7 - 22810 Sa FT it VAR 09 2011 BUILDING OEPf t� LOT Ja \ LOT e8 DR13414 SNOF,yq- r . Di, � �� 3 /o-/i,�pprovtir . Ad • d ti41322? TO THE BEST OF MY INFORMATION, KNOWLEDGE, AND BELIEF THE DWELLING SHOWN ON THIS PLAN HAS BEEN LOCATED ON THE GROUND DA AS INDICATE . �%✓�r JOE 30811 - DATE PROFESSIONAL LAD SURVEYOR ,. C: 1 S8 1 PROD 1 1443-00 1 dwa 1 1 "AS -BUILT" PLOT PLAN YARMOUTH, MASS. LOT 31, PL BK. 214, PG. 117 SCALE CLIENT ADAMS SWEETSER ENGINEERING 203 SETUCKET ROAD PO BOX 713 SOUTH EIMMS, MA 02660 M--395 99W fm 508-3as-S= 493-=v1.DWG 0 1010 SNEETSER ENGINEERING FILE COPY ova Z k ROBIN i1MW MMWILCOX LNo Ah-' TOP OF FOUNDATION IS ELEVATION tnrm102.11 (SITE PLAN DATUM). TO THE BEST OF MY INFORMATION, KNOWLEDGE, AND BELIEF THE FOUNDATION SHOWN ON THIS PLAN HAS BEEN LOCATED ON THE GROUND AS INDICATE /' 71610716 DATE PROFESSIONAL LAND SU "AS -BUILT" PLOT PLAN YARMOUTH, MASS. LOT 31. PL BK. 214, PG. 117 DATE 716/07 ]SCALE 1 _ JOB 1443-00 CUENT FAIF SWEETSER ENGINEERING 235 GREAT `UESTERN ROAD PO BOX 713 SOUTH DENNIS. MA 02680 c: 01 YqR i 0 0 C Zy Street Add" Street TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, NIA 02664 508-398-2231 ext.1261 Fax 508-398-0836 Permit Number�2 - 1 Date Issued Expiration Date $50.00 �% T CH PERMIT 'urstunt t c-8 1 and 520 CMR 7.00 et s eq.(as amended) PIR.Nrr MUST BE FULLY COMPLETED PRIOR TO CONSIDERATION nt PbOOf CeU ac0 Z80 6 2ae MA ZIP _a 2z��) 3 f b;tl BOO! l'eU ,e_r l :5 4!C/ ,Z� 1% P1ere descrth! Ih! e:sct —r^ be lald In loea; of the proposed trereh end ib PrPM Ilachd! ■ propend trench ( i daptlon to nwd Y for [e iMeaded) a R plpes/eahi! Bnes ltal Pkeee use reeeM dde&eddltlarl cpne! 6 needed �� elevI9l-I'VA lvalt — 71 elnJ}+lkfned7 520C.%IR7.0, /J!_ \ i i l of 2 tvame or Competent Person (as defined by S20 Ch1R 7.02): X;4 4511 Massaehusetts Hoisting License I O27 <?- BY SIGNING THIS FORM, THE APPLICANT, OWNER, AND EXCAVATOR ALL ACKNOWLEDGE AND CERTIFY THAT THEY ARE FAMILIAR WITH, OR, BEFORE COIVLNIENCEMENT OF THE WORK, WILL BECOME FAMILIAR WITH, ALL LAWS AND REGULATIONS APPLICABLE TO WORK PROPOSED, INCLUDING OSHA REGULATIONS, G.L. e. 92A, S20 ChIR 7.00 et seq.. AND ANY APPLICABLE MUNICIPAL ORDINANCES, BY-LAWS AND REGULATIONS AND THEY COVENANT AND AGREE THAT ALL WORK DONE UNDER THE PERMIT ISSUED FOR SUCH WORK WELL COMPLY THEREWITH IN ALL RESPECTS AND WITH THE CONDITIONS SET FORTH BELOW. THE UNDERSIGNED OWNER AUTHORIZES THE APPLICANT TO APPLY FOR THE PERMIT AND THE EXCAVATOR TO UNDERTAKE SUCH WORK ON THE PROPERTY OF THE OWNER, AND ALSO, FOR THE DURATION OF CONSTRUCTION, AUTHORIZES PERSONS DULY APPOINTED BY THE MUNICIPALITY TO ENTER UPON THE PROPERTY TO MONITOR AND INSPECT THE WORK FOR CONFORMITY WITH THE CONDITIONS ATTACHED HERETO AND THE LAWS AND REGULATIONS COVERING SUCH WORK. THE UNDERSIGNED APPLICANT, OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO REIMBURSE THE MUNICIPALITY FOR ANY AND ALL COSTS AND EXPENSES INCURRED By THE MUNICIPALITY IN CONNECTION WITH THIS PERMIT AND THE WORK CONDUCTED THEREUNDER, INCLUDING BUT NOT LIMITED TO ENFORCING THE REQUIREMENTS OF STATE LAW AND CONDITIONS OF THIS PERMIT, INSPECTIONS MADE TO ASSURE COMPLIANCE THEREWITH, AND MEASURES TAKEN BY THE MUNICIPALITY TO PROTECT THE PUBLIC WHERE THE APPLICANT OWNER OR EXCAVATOR HAS FAILED TO COMPLY THEREWITH INCLUDING POLICE DETAILS AND OTHER REMEDIAL MEASURES DEEMED NECESSARY BY THE MUNICWALLTY. THE UNDERSIGNED APPLICANT, OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO DEFEND, INDEMNIFY, AND HOLD HARMLESS THE MUNICIPALITY AND ALL OF ITS AGENTS AND EMPLOYEES FROM ANY AND ALL LIABILITY, CAUSES OR ACTION, COSTS, AND EXPENSES RESULTING FROM OR ARISING OUT OF ANY INJURY. -_DEATH, LOSS, OR DAMAGE TO ANY PERSON OR PROPERTY DURING THE WORK CnNDUPTM rrNnco gruvfi.cn%s" EXCAVATOR SIGNATURE (IF REND ee-zfee_ DATE 2- 23._ R'O /% "RCllDo,,((��S Sl It�IFI,.EREN1) DATE: r4�ITIJPPER CONSTRUCTION CO.ua 79B Mid -Tech Drive West Yarmouth, MA 02673 Phone 508-778-0111 Fax 508-778-5010 Registration #121845 Llcense #W9058 Date: December 3, 2010 Attn: Building Department I hereby authorize Tupper Construction Co, LLC to pull the permits necessary to complete the project described on the attached permit application form. Thank you, Owner's Print Owner's Name: Pat Adams Street Address: 86 Lookout Rd., Yarnouthport, MA 02675 ONE & TWO FAMILY ONLY - BUILDING PERMIT APPUCATION TO CONSTRUCT, REPAIR. RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWEULNG Town of Yarmouth Building Department 1146 Route 28 a South Yarmouth, MA 02664-4492 508-398-2231 ext.1261 Fax 508-398-0836 us. a+r b J Permit No. �— I 03J—W Permit Fee S Deposit Reed. S,,?S, Date Net Due SZ%�— Maarinp eaBOWWomuem ?m Endourvigirt tea"' PIN ismt.e ouw Anamirs �eWlhrent it* malon: "P La — y� New vropety dmea�c LotArm(� Frbntage(n) latcorr,0. ThY Seeaon for Ottbe Uw OrdV Btr1 Pe D� 1 at�gOeedrt:; Dee►: CMCIiC WO/_tkCtlpanCy. •; -r Section I - Site+ kd rmatlOn I Use Gnxigr R-4 : S-B id P"Warry Aderam" SZInntcn�rT 1.2 is v Zoning District Proposed Use 1.3 auarYN leOeere c"I Front Yard Side Yards Rear Yard - R 4ad Provided Reored Provided R Provided 23 2011 IA sttrtw fr„iy PULL. e. ed a !iQ Putrid PrhreY 1.5 Fbod2klne tdomtaeue1. caretrtt ZMW BFF— SeCtlan 2 - AtModzed &I a Mee Ibeeri- .E--vzs�.s�nr p Ao,4rn Name (print) s Slgnaars / c- y aaiLrg Address _ s Telepbam 7.a ArtAwYN Ayw4y Nems( 7- \ Louring Addraae 2 S4+ Telephm U I Fax Section 3 - Corntruetlon SeMeee If f ! it Lreesead CwnstrueWn trv♦ervrae.t J� _ Nd Appfupy ❑ LXWM Numb« Address ,SDd' amp 6 -?e6 Expiration Date �f 1-2- - �[.. Tehpnarr mom awmementCOntraCtOr Z!O i5A eeV-r7XjC a C-0. O- X d "Appicas Q Sl¢vbre J O26 73 Telephone L'caro° N,mber _ S Ex t7raeon Dab r or 2 OVER 9ectiat..a Co Rttla>1fti�AflldlivK(MdlcOtt ?Octet✓ . Wod"" Compensation Maurer= affk*A rrwld be eompbtad and submitted with this application. Fanure to provide this affk*A will nm* In the dental of the Mojave of the building pemnit. Signed AHklavit Attached Yes .......... No .»....... Seetim IL- O at Flopoold Work dteek at Now (antbuclfart Ne of esf mft Na of e+tlnon E*&+o Ilift napakM p 1 Aftown p Ilameoa Aeeeeeory slag. p Tjrpe Derttonum Other spear. Brief O Pntpo�d Wbdc w c S t a Sadlbn e- Es*nslsd Cdnstrtctlott Cosw Item FokT111W Cod (Doers) to be Cheek Below Cartplslsd by pWmil appeerM F&V 2 oeested (it applicable) 0 / clan e. Total . (t ♦ 7 ♦ 3 • a • P applic") 7. ratd9*mmFLsmpmma+ad..1 . as owner of the sub)eat propo" hereby authotte `Re 47777C 1217 to act on my behalf. In all matters relative to work authorized by this butkOng permit appneatiorr SlgWed ovum Dais . as OwnsdAuthod2dAgwe hereby declare that the statsrnents and kdormadm on the g applkatlon are true and aeeurue. to the best of my knowledge and belief. the pains and penalties of pwl o of .L L 0m@ 9.13.99 2 d 2 3 TOWN OF YARMOUTH --- BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT. job Location:—�Fi(n • cam ;� Be Construction Supervisor. /SVCr1n, 3' aPr- Name License 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. 2.15A Anylicenseewho shall willfullyviolate subsections 2.15.1.2.15.2 or 2.15.3 oranyother 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 departmenL 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 speck inspection as called for by the building official. INSURANCE COVERAGE: I have a anent liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 g0ality No ❑ a, please indicate the type coverage by checking the appropriate box. e policy � Other type of indemnity ❑ Bond ❑ EWAIVER: I am aware that the licensee does not have the insurance coverage requiredby s. General Laws, and that my signature on this permit application waives this requirement Check one: Signatw— owner Ow ees Agent . owner ❑ Agent ❑ Signature: Building Official Approval: The Commonwealth h ojMassaehissettt Department ojlxdu &W,4ecidents Office ofinvadgations 600 Washington Street Boston, MA 02111 www nrassgov/dia Workers' Compensation Insurance Affidavit: Builde Applicant Information rs/ContractonJEkctrlcianyplumbers Please Print biv Name Murmes,rop,iaden/Indi vidual): ii,�P.-- C�� c'3y�S`e�•, Ce '—' Lc!' Address: 79 R /hie_ 7Z2�� DR C[ /State2i :73 • Phone #: A,reyo nu employer! Chat the appropriate box: 1. L7 I am a employer with 4. Q I am a general contractor and I TYPO of Pro] (�1°I�: [2.[3 ployees (hill and/or part-time).* sole & Sole have hired the arrb wneracton listed 6• ❑ New Construction Proprietor or partner- ship and have no employees on the attached sheet Thee sub-wntracton have 7. ❑Remodeling working for me in any capacity. employee and have workers• g, Q Demolition [No workers, comp. fi=MMce comp. insurance} 9. Q Building addition Qrequired.] 3. Q We are a corporation and its 10.❑ Electrical repair or additions 3. I am a homeowner doing all work myself. [No workers, comp. officers have exercised their right of exemption Per MOL 11.13 Phmtbia g min or additions ian^+^ce required.] t 3a. Q I am a bomeowner acting C. 152. f 1(4). and we have no 12.Q Roof repairs as ■ general contractor (refer to #4) employee. [No workers' 13.0 Other ;Any apNU=m dmat des boa at gam Nero au oar the MCC= bdow ahowma dtev rwkaa• ' HMmmweare WM mbmit Oda antdavd iodkwft dwy am doing JI work and then lee oonide wbmie a am affidavit iodiadeg n+dt tCoatremrs that cbo* duo boa mtt amcbed m addUMW shoat �g d. Mama otaa aagtoy"L 1(dw VA-Coanwwn bow eayloyms. they mst provWc thetr wvtas• '1•00maemn nd wa w'bobw ornm MGM aWtim have comp. polity notabar. Ir an am MWI*Yer Information that 6 providingmenrters' conrpeewtYon brsavanee jor err! earployem Below Is &a polky andjab sift allum ee company Name: f7E/C Policy # or Self -ins. Lie. Expiration Date. Job Site Address: e6 Ro, a.try:aecaup: �G i.S� Attach a Copy of the worker' Compensation Polley declaration page (showing the PoUeY number and Fails" to secure coverage u expiration datea required under Section 25A of MGL e. 132 can lead to the imposition otcrintinal penalties of ■ fine up to S 1.500.Do or one-year imprisonment, as well as Civil Penalties in the form of a STOP WORK ORDER and a fine of up to Y • one -ye! Be advised that a copy of this statement may be forwarded to the Office of Inveti of the D or ' coverage verificatiom dw the Ofi W era on1J. Do not wrlar b. tb8 area sec be compkted 17 city or loww o,0kW City or Town: Permltucense # and come" Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. Clryfrowu Clerk 4. Electrical In 6.Otber Spector S Plumbing Inspector Contact Person: Phone #• For Office Use Only Permit No. Date TOWN OF YARMOUTH AFFIDAVIT Home Improvement Contndor Law Supplement to Permit Application MGL c. 142A requites that the 'reconstruction, alteration, rmovaticn, repsv, modemi on, conversio% improvement, removal, demolition or Sian of so addition to any X xistiog owns-oontpied buildnrg containing at least one but not more than four dwelling units or structures which are adjaoert to such residence or building' be done by registered contractors, with cetain exceptians, along with other reauhments. Type of Work: -A bb l —i t o ti Est Cost 7-0 .4 Date of Permit Application: I hereby certify that: Registration is not required for the following rcason(s): Work excluded by law Job under $1,000 Building not owner occupied Owner pulling own permit Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. Signed under a beraliit as the a¢eof of the owner: Date - / CoMracto Name Registration No. •Qios OR: Notwitlsstanding the above notice, I hereby apply for a permit as the owner of the above Proles Date Owner Name o�.ygR�i 3= e TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, NIA 02664 508-398-2231 ext.1261 Fax 508-398-0836 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 40. Section 54 and 780 CMR, Chapter 1, Section 111.5. I hereby certify that the debris resulting from the proposed work/demolition to be conducted at P6 400,e to err— /QV. Y4 mQ„avPoR7— /* dz6 7� Work Address Is to be disposed of at the following location: iosal site sf all be a licensed solid waste facility as defined by M.G.L. Ill, Sect' n 150A. Z -e of Application Date Permit No. TOWN OF YARMOUTH 3('::<f:✓c BUILDING DEPARTMENT o y 1146 Route 28, South Yarmouth, MA 02664 V 1. 508-398-2231 ext.1261 Fax 508-398-0836 Date: Based on the scope of work described above, the applicant is required to obtain approvals/sign- offs from the following departments as checked -off below: / HeaUh Dept. — Town Hall Phone No. 508-398-2231 ext. 1241 ! Conservation Comm.— Town Hall Phone No. 508-398-2231 ext. 1288 {VaterDept.— 99 Buck Island Rd. phone no. 508-771-7921 I —Old Kings Hwy. Hist. Comm.— Town Hall phone no. 508-398-2231 ext. 1292 e� j � O O _Engineering D pt.— own Hall phone no. 508-398-2231 ext. 12.50 ir, Dept. apt. Kellehek 96 Old Main St. So. Yarm. Phone no. 508-398-2212 Other Appropriate plans and/or application shall be provided to each of the departments checked -off above. Each of these reulatory authorities has their own requirements outside the jurisdiction of the Building , rtment. All a licable approvals shall be obtained prior to submitting a bulldi titdtapplicatin to Building Dept for Applicant's Signature r?SN)TUPPER CONSTRUCTION CO.,,., 79B Mid -Tech Drive West Yarmouth, MA 02673 Phone 508-77"111 Fax 508.7785010 Registration #121845 License #069056 Date: December 3, 2010 Atm: Building Department I hereby authorize Tupper Construction Co., LLC to pull the permits necessary to complete the project described on the attached permit application form. Thank you, Owner's Print Owner's Name: Pat Adams Street Address: 86 Lookout Rd., Yarmouthport, MA 02675 . • ACORIZ CERTIFICATE OF LIABILITY INSURANCE Soptheasfern Insurance Agency, Inc. 439 State Rd. P.O. Box 7939E N. Dartmouth. NA 02747 27 Roberta Drive West Yarmouth, NA 02673 COVERAGES INSURERS AFFORDING COVERAGE asuRER& Arbella Protection 1 INSURER it AEIC NSURER D PIS AER E: NAIC / 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 VIHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. im TYPE OF INSURANCE POUCYNUYBER DATE fMM0DrffM DATE LIMITS A GENERAL LIABILITY X OOMMERCIALGEtERALLUNl1TY CWM5 MADE FTI OCCUR 3S00003743 11/01/2010 11/01/2011 EACH occuRRENcE f 1,000,00C PREMISE Aocpnwlp, 1 1()0,00( MED EXP (Airy a pN ) f S 0O PERSONAL SAMINJURY f 2,000100C GENERAL AGGREGATE S 2,000.00 GENII. AGGREGATE LIMIT APPLIES PER POLIO/ F7 5PER& LOC PRODUCTS-COMPIOPAGO S 2,000,00 A AUTOMOBIELLMMM ANY AUTO ALL OANED AUTOS SCHEDULED AUTOS HIRED AUTOS NONOAMEDAurOS 56662400002 12/01/2010 12/01/2011 COMBINED ASINGLE LIMIT f 2,000,00C — BODILY HAIRY (PSIP—) S X X BODILY RiAIIPI (PFr SctlOwq f X PROPERTY DAMAGE ("`Fm°"a f INC GARAGE LIABRIIY ANY AUTO AUTO ONLY -EA ACCIDENT S OTHER THAN EAACC AUTO ONLY: AGO S I EXCESS I UNMREL1A LIABILITY OCCUR F I CLAIMS MADE DEOL CT10LE RETENTION S - EACH OCCURRENCE S AGGREGATE f f S S B WORKERS COMPENSATION ANDEMPBYERS'LIATnN ANY PROPRIETOR,vARTNEREXECUfNF�Timm OFFICERMEMUER EXQLDED? I _I �nP �IR� �211 SPECIAL PROVISIONS W. WCCSOOSS93012007 RICHARD TUPPER IS LUDED FOR WC CDVERAGE 10/03/2010 10/03/2011 X TORY OMITS ER EL EACH ACCIDENT f S00 00 EL DISEASE -EA EMPLOYEEf 500 00 E.L. DISEASE -POLICY LIMIT S S0o 00 O111E11 DESCRIPTION OF OPERATIONS I LOCUTIONS I VEHICLES I EXCLUSIONS ADDED SY ENDORSEMENT I SPECIAL PROVISIONS aM �1:41 I I a lM_S I a: 1.0 401 a: MCW jae \II.1J SHOULD ANY OF THE ABOVE DESCRIBED POLITIES BE CAMCELLED SWORE THE EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL _DAYS WRITTEN NOTICE TO THE CERTBIUITE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO $0 NULL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND WON THE INSURER. RS AGENTS OR REPRESENTATIVES. For Informational Purposes Only AUTHORIM REFRESENTATME ICrista Hartford YTR.LNTu AD IAW WUI I O I955-ZOOV ACORD CORPORATION. All rlghb reserved. The ACORD name and logo am registered marks of ACORD Nla..achu%ctt%- Department of Public Safcq 11 Board of Buildin_ Regulation, and standard. Construction Supervisor License License: CS 69055 RICHARD S TUPPER 4 79 B MID -TECH DR WEST YARMOUTH, MA 02673 Exphauon: 1201IM12 ( .auui..i..nrr Tra: 8340 •2'� ORcc�oB"iHIR�TfiTft'd^Blttihefc�{Q�iff� -_ HOME IMPROVEMENT CONTRACTOR "q Registration: 121845 Type: Expiration: 8/19/2012 Individual �s -f RD TUPPER RICHARD TUPPER 29 Roberta Drive _ W. YARMOUTH, MA 02613 n�wy Usdeeerctary License or registration valid for individul use only before the expiration date. if found return to: Office of Consumer Affairs and Business Regulation 10 Par a 5170 Bosti,111A 02116 Not valid withoirisignature TOWN OF "RMOUTH i Building Department /�� Town Han /`/ �( Yarmouth, MA 02664 / (508) 398.2231 e#.1261 BUILDING PERMIT TRANSMITTAL Temp Permit No.: T-11-317 Applicant Name: Richard Tupper Applicant Phone: 5082806280 Building Location: 0086 LOOKOUT RD Owner's Name: ADAMS, ELIZABETH P Owner's Addres 0086 LOOKOUT RD Yarmouth Port MA 02675 Owner's Telephone: (508) 362-6513 REVIEWED BY: (OFFICE USE ONLY Recorded By. Ic Permit Fee: $0.00 Deposit Rec: $25.00 Payment Type: Check ChkNo.: 5315 Net Owed: ($25.00) Application Date: 2/17/2011 Issue Date: Expiration Date Comments: Map/Lot: 141.49 construct 20 x 26 addition as per BOA petition # 4328 1. WATER DEPARTMENT: DATE: WA 2. ENGINEERING DEPARTMENT: DATE: WA: 3. CONSERVATION: DATE: WA: 4. HEALTH DEPARTMENT: DATE: WA 5. BUILDING DEPARTMENT: DATE: N/A: 6. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE COMMENTS: RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: Date Printed: 2/18/2011 TOWN OF YARMOUTH HEALTH DEPARTMENT PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Building Site Proposed O K 2 (, 1QA,� Tel. N •'ifyou would like e-mail nottiifrcatlon slgn off, please provide e-mail address: Owner Name:/1- A�e QU�-t��`M• r (DaE866. Filed: a l S Owner Address: • �y Owner Tel. No.: 3e=�2 - CoS' 13 RESIDENTIAL AND/OR COMMERCIAL BUILDING HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. Please submit three (3) copies of plans, to include: (L) Site Plan showing existing buildings, water line location, and septic system location; (2.) Floor plan labeling ALL rooms within building (all existing and proposed) — Note: Floor plans not required for decks, sheds, windows, roofing; (3.) If necessary, Title 5 application signed by licensed installer COMMENTS/CONDITIONS: TOWN OF YARMOUTH WATER DEPARTMENT 99 Buck Island Road West Yarmouth, MA 02673 Telephone: (508) 771-7921 • Fax: (508) 771-7998 BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET Bldg. Site Location & (:� Map #: Lot #: Proposec Applicant Address RESIDENTIAL AND / OR COMMERCIAL BUILDING Water Department: Determines Compliance of Water Availability and or Existing Location Engi epa Determines Compliance for Parking and Drainage ervatio mmission: termines Compliance to Wetlands Acts; i.e. If Lot(s) Border any Type of W lands, Streams, Ponds, Rivers, Ocean, Bogs, Bays, Marshland, Etc.. Health Depa ent: t mines Compliance to State and Town Regulations, i.e., Requirements fo ptage Disposal and other Public Health Activities Flre Depa ent: ermines Compliance to State and Town Requirements for Personal, fety, Property Protection;, i.e. Smoke Detectors, Sprinkles Systems, Etc... Signature of PLEASE NOTE: COMMENTS: Aw %0 TOWN OF YARMOUTH 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 026&1 TO (508) 398-2231 — F2z (508)398.0836 Town of Yarmouth Conservation Commission Building Permit Sign -off Application Cons. Comm. Received Date: /r Property Owner. Construction Assessors Map and �arce : MAP PARCEL General Contractor. ►J Pf— Coro Com; Proje Conte Plan IMUC Daher_ Revision Date Conservation Commission Filing Required: YES NO If Yes. Type of Filing: (/\` Notice of Intent Request For Determination OfApplicability Conservation Commission Sign-ofSignature: Date: t5 pmv.A m R.cye d pow CONSERVATION CONWISSION 780 CMR. STATE BOARD OF BUSHING REGULATIONS AND STANDARDS APPENDICES 5 CONSUMER INFORMATION FORM-'WMOOMS" Massachusetts State Budding Code (780 CMR 61013.22) The Massachusetts State Building Code (780 CMR) includes provisions to ensure that houses and house additions meet energy efficiency standards. This supplemental CONSUMER INFORMATION FORM is to be filed as part of the building permit application when a buddedcontmcwr or homeowner, construcunglmstalling a house addition with very large percentage of glass to opaque wall, seeks to utilize a special energy conservation exemption option for 'sunroom" additions to an existing house (780 CMR, 61013.22). This FORM is not intended to prevent a homeowner from selecting a'stmroom" of any size, configuration• orientation. form of construction or percent glazing• but rather is only intended to assist homeowners in becoming swan: of some of the important energy conservation and year-round comfort considerations involved in selecting and utilizing a "stmroom" addition. The connection of"sunmom" structures to residential buildings = awe comfort and energy consumption issues due to uncontrolled solar gain or uncontrolled radiation cooling of the main house. In the selection and eonstructionhnstalls tion of "simmoms", included below is a non -required, open-ended list of product and design considerations that a bomeowoer may wish to consider before actually comttuctingli stalling a "sumoom". It is recommended that consumers carefully review thaw options with their designer. builder, or contractor, in orderm *"immix. potential eoergycon=M ion an&orhouse discomfort issues In addition. the qualifications and reputation of the company or individuals to be hired are important considerations. PRODUCT AND DESIGN CONSID.RATIONS RELATEDTO!!SMOO T • Solar Orientation and Natural Shading • Type of Glazing • Insulating value • Solar heat gain �. • Frame materials • Glazing to fame sealing and gasketing materials! seal durability and/or weather Lightness of the sunroom • Adequate ventilation - Operable windows and fans a Applied Shading Systems • Insulation Level In floors, wads, and ceilings • possible Sunroom Isolation from the main house via a wad and/or door or slider • Heating and CooOttg Methods: Efficiency, Zoning and Controls Homeowner Acknowledgment The Massachusetts State Building Code. 780 CMR 61013.2.2, requites that the actual Rm= own (not the .. _ owner's agent orrepteseutative) admowledge receipt of this CoNst mmNFottMAMONFMM prior to issuance of a Building Permit for a project that includes "Nnroom" additions to an existing residential building. In accordance with this requirement, the undersigned hereby acknowledges that shdhe has read the information ZZ4-'� concerning N om comfort and energy conservation. agoature f Antral Building Owner Date Print N Address of Pernti 6e ` ^'/ 0-7 G� i Owner Address (if different than project location) Owner's telephone number 3R3M7 (Effective VIM7) 780CMR -Seventh Edition 1027 ENERGY CONSERVATION APPLICATION FORA1 FOR ENERGY EFFICICIENCY FOR ONE- AND TWO ILY DETP.GMB RESIDENTIAL CONSTRUCTION (780 CMR 1.00) Applicant Name: '-- Site Address: i . - Town: — i JAPPlicant Phone: Q 2x:2> Applicant Signature: Dare of Application: NEW CONSTRUCTION: (choose ONE of the following two options) 780 CMR TABLE 6107.1 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA FOR NEW ONE- AND TWO-FAMILY BUILDINGS MAXIMUM MINIMUM Oti0n 1: Fenestration Ceiling or � exposed Wall Floor Basement Slab Perimeur U-factor I floors R-Value R-Value Wall R-Value A•-� HSPF SEER R-Value R -Value aue and De pth 35 R-38 R-19 R-19 R-10 R-10, seva Appliance M �n)of 4f. 1997 as amended, maimtms or rearer as applicable Note: This form is not required if you choose either of the twn versions of REScheck as listed below. ❑Option 2: RESchcck Version4,1.2 or later variant softwar` analysis must be completed (780 CMR 61073 2) i J RESrheck-Web which can be accessed at htty://www.enerevcodes.gov/rescheck/ i r,ADDITIONS OR ALTERATIONS TO EXISTING BUILDINGS OVER 5 YEARS OLD* 1 *Buildings under 5 ,years old must use option #1 or #2 in New Construction section above. Complete the following formula to determine the % of glazing: (a) R Ceiling Area equals I Formula: (100 x b _ a) F f r ,� 100 ia__ 3. of glazing (b) Glazing area equals ZZ�7--- SF 1 If glazing is:5 40% use the chart below. If glazing is > 40 qc. proceed to "SUNROOM" section ! 780 CMR TABLE 6101.3 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA ADDITIONS TO EXISTING LOW-RISE RESIDENTIAL BUILDINGS MAXLti1UM MINIMUM ❑ Fenestration Ceiling and Wall Exposed IR-Vlu Floor Slab Perimeter Basem ent Wall 1 U-faor �flea R-value due R-Value I anDepth .39 R-37 a ( R-13 R-19 R-10 i R-10, 4 feet i d R-30 ceiling insulation may he used in place of R-37 if the, insulation achieves the full R-value over the entire ceiling ; area i.e. not compressed over exterior walls, and including any access openings). I SUNROOM - An addition or alteration to an existinc Wilding/dwelling unit where the total i glazing area of said addition exceeds 40% of the combined gross wall and ceiling area of the addition. . Note: Owner to rill out Consumerinformatim. r• rn bound in Appendix 120.P) i Bk 25265 P9156 49310 02-17-2011 8 10e277aa TOWN OF YARMOUTH L . BOARD OF APPEALS DECISION N V FILED WITH TOWN CLERK: January 27, 2011 PETITION NO: #4328 HEARING DATE: January 13, 2011 PETITIONER: Elizabeth P. Adams PROPERTY: 86 Lookout Road, YarmouthPort, MA Map & Parcel: 0141A9; Zoning District: R40 Book & Page:11413/037 MEMBERS PRESENT AND VOTING: Steven DeYoung, Chairman, Sean Igoe, Debra Martin, Richard Neitz and Robert Howard. Notice of the hearing has been given by sending notice thereof to the Petitioner and all those owners of property as required by law, and to the public by posting notice of the hearing and publishing in The Register, the hearing opened and held on the date stated above. The Petitioner is Elizabeth Adams who seeks a Special Permit under bylaw § 10432 for construction of a 20' by 26' addition to the southerly side of the existing dwelling. The property is located in an R40 Zoning District Appearing on behalf of the Petitioner was her contractor, Rick Tupper. No one spoke in opposition to the petition. No exhibits were received at the hearing. Simply stated, the Petitioner seeks to construct a 20' by 26' addition to her existing dwelling. The existing home consists of a modest, 2 bedroom home to which the Petitioner seeks to add additional living space. The home's location on the lot causes this addition to be most desirable where suggested. The Board noted that the encroachment into side buffer would be minimal and, further, that the granted relief would not result in any undue nuisance, hazard or congestion nor substantial harm to the established or future character of the neighborhood or Town. Therefore, on Motion made by Ms. Martin, seconded by Mr. Neitz, it was voted unanimously to grant the Special Permit as prayed for by the petition and without conditions. J -� Bk 25265 Pg 157 #9310 No permit shall issue until 20 days from the filing of this decision with the Town Clerk. This decision must be recorded at the Registry of Deeds and a copy forwarded to the Board of Appeals. Appeals from this decision shall be made pursuant to MGL e40A section 17 and must be filed within 20 days after Ming of this noticeldeclsion with the Town Clerk. Unless otherwise pr wAded herein, the Special Permit shall lapse if it substantial use thereof has not began within 24 months. (See bylaw, MGL c40A M Steven DeYoung, irman 2 Bk 25265 Pg 158 #9310 COMMONWEALTH OF MASSACHUSETTS TOWN OF YARMOUTH BOARD OF APPEALS Appeal #4328 Date: February 17, 2011 Certificate of Granting of a Special Permit (General Laws Chapter 40A, section 11) The Board of Appeals of the Town of Yarmouth Massachusetts hereby certifies that a Special Permit has been granted to: Elizabeth P. Adams 86 Lookout Road YarmouthPort, MA 02675 Affecting the rights of the owner with respect to land or buildings at, 86 Lookout Road, YarmouthPort, MA Zoning District: R40; Map & Lot #:0141.49; Book & Page: 11413/037 and the said Board of Appeals further certifies that the decision attached hereto is a true and correct copy of its decision granting said Special Permit, and that copies of said decision, and of all plans referred to in the decision, have been filed. The Board of Appeals also calls to the attention of the owner or applicant that General Laws, Chapter 40A, Section 11 past paragraph) and Section 13, provides that no Special Permit, or any extension, modification or renewal thereof, shall take effect until a copy of the decision bearing the certification of the Town Clerk that twenty (20) days have elapsed after the decision has been Sled in the office of the Town Clerk and no appeal has been filed or that, if such appeal has been filed, that it has been dismissed or denied, is recorded in the Registry of Deeds for the county and district in which the land is Iocated and indexed in the grantor index under the name of the owner of record or is recorded and noted on the owner's certificate of title. The fee for such recording or registering shall be paid by the owner or applicant. a� Steven DeYoung, Bk 25265 Pg 159 #9310 TOWN OF YARMOUTH 1146 ROUTE 28, SOUTH YARMOUTH; MASSACHUSETTS 02664-4451 • Telephone (508) 398-2231 Ext.1285, Fax (508) 398-0836 CERTIFICATION OF TOWN CLERK Town Clerk I, Jane E. ffibbcrt, Town Clerk, Town of Yarmouth, do hereby certify that 20 days have elapsed since the filing with me of the above Board of Appeals Decision #4328 and that no notice of appeal of said decision has been filed with me, or, if such appeal has been filed it has been dismissed or denied. f•LT• s i »t . A TRUE COPY. ATTEST F. M REGISTER m for it lino=! t I/ \ ti corm Z Y t � i \ for it c \ for rd \ J it WORK MZA& FORM TO ALL \ wiwn� w1`�cX pit TOWN REGULAT}ONS V YARM OUT ff-WATER DEPT DATE TO THE BEST OF -MY INFORMATION, KNOWLEDGE, AND BELIEF THE DWELLING SHOWN ON THIS PLAN HAS BEEN LOCATED ON THE GROUND AS INDICATED. ,.. DATE PROFESSIONAL LAND SURVEYOR FEB 15 2011 HEALTH DEPT. "AS -BUILT" PLOT PLAN YARMOUTH, MASS. LOT 31, PL. BK. 214, PG. 117 DATE 12116110 SCALE 1" = 40' JOB 1443-00 CLIENT ADAMS SWEETSER ENGINEERING 203 SETUCKET ROAD PO BOX 713 SOUTH DENNIS, MA 02660 )8-365-6900 fos. 508-365-6991 C: 158 1 PROJ ! 1443-00 1 dwo 1443-cnD.DA'G O 2020 SA'EETSER ENGINEERING WORK MUST TOWN RYLAY FORM TO ALL TO THE BEST O= -MY INFORMATION, KNOWLEDGE, AND BELIEF THE DWELLING SHOWN ON THIS PLAN HAS BEEN LOCATED ON THE GROUND AS INDICATED. DATE PROFESSIONAL LAND SURVEYOR FEB 15 2011 "AS -BUILT" PLOT PLAN YARMOUTH, MASS. LOT 31, PL. BK. 214, PG. 117 DATE 12/16/10 SCALE 1° _ JOB 1443-00 CLIENT ADA SWEETSER ENGINEERING 203 SETUCKET ROAD PO BOX 713 SOUTH DENNIS. A 02�8_80 C: 1 S8 I PR�V 1 1443-00 1 dwg 1 1443-cpp.DWG 0 2010 ONE & TWO FAMILY ONLY — BUILDING PERMIT APPLICATION TO CONSTRUCT, REPAIR. RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWEL4VO Town of Yarmouth Building Department 1146 Route 28 a South Yarmouth, MA 02664-4492 508-398-2231 ext.1261 Fax 508-398-0836 !0 �44 /in owe use arty Permit N 'V Date Permit Fee $ Deposit Rec'd. $ Date Net Due $ Raining Baud Irdarmatim Pon TM E°«3e� Ue xordN Date an ass. Drier Assessors Deprhned hrtarmaeon: to NM t.1 Property Dlmensbrrz tat Area (st) Framag/ (it) tat covrap/ TNq Section 1o►On= Use Sul Pe . ,. Dat9 ieeuet8 . � = •�d.. K atrd,loamr now, - CertHkaEdolObctlpenry r ,..{`•`z' , . in npiredr 6 Section 1- Slts Intmm dM I Use Oro R-4 Type: S•El 1.1 Pie" my A/ieew �61.f3� r"ft Ra 1.2 Zw*V hdarmaeon: 0 Zo ing District Proposed Use Y,.r�,n,4,pog MA 1.3 sundbw Setbacks in) Front Yard Side Yards Rear Yard Required Provided aired Provided R 'red Provided 1A WAw Supper IMA-L c. 40.8 se) Public Pdvate 1.5 Flood Zane Momseart: Cuts zone BFE - • rn Section 2 - Property OwneraM Authorized 2.1 owner of neeenn LUiLUiNLaULPi L (i7n ¢th 96 1. Name(print) Maifirg Address 0ZG —Z/ Slgneeaa Telephone u Asrllueel/ee Aeooft wrs('ZL, 0 . PTt Norm Mailing Address 4- ( ? q D S-Tatury Telephone Section 3 - Contraction Services &I Ueeened Construction *wpeerisen G I"blo 2,S Re,35 Ad*vw I_ 3 68? IS 2 Expiration Date % ieiephons 32 Fte&tftvd Horns Improvernard Contractor ` BMMM w D. %-Cc — �3.,, c` 1-3 Not Apwiaaae p Address hu �{ 13 V / 1 j9 2 Q �% / d TeMphono lxense Numq� i S Esgra f to7-A WN 1012 OVER Seotion. LWerkirsdCG Mda*ttfrmLW"AITkMT catr dL1=wua 10111 Workers Compensation Insurance affidavit must be completed and submitted with this application. Fallure to provide this affidavit will result In the dental of the Issuance of the building permit Signed Affidavit Attached Yes: --* No .......... Section S- GgbcdpdM d ltvbrk check el: appflOabA) New Construction ❑ I No. Of 9edrnoma Na of BamOOms t xhtkrp 81do O 1 Fl@Mr) 0 Allarg its O Accessory Bldg, ❑ 7jtpe Demolition Other Speat)r. Brief Description of Proposed rk: Section e • Eetlmeted conatrucUwe caste Check Below Item etlmated Cost (Oosars) to be ted by penes appkwd t Building 6 t ervaaor► ""knionFMV 2.0 r (lf applicable) 701d 3. / Oaa 4. Msdunkal FiV at9a HVrmw A Historical Commission awavel S. Fire Protection (if spptkaDle) 8. Total a (I + 2 + 3 + 4 + 5) 1. Tow square Pt Om haaw s asesl section in• Owner rise - T4 Completed Ownee's Agwd or Contractor A Ilea for BUNK Pfrml! I , as owner of the subject property hereby authorize to act on my behalf, In all ratted" to/work authorized by this building permit appli atiom )matters —b�X-L AAAj.F! S grt"" d o. Oats wn section 71! - OwnedAuthorized Agent Dedaration l , as Owner/Authorized Agent herstry declare that the statsmenta 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. PT" name j /LL Stgna d / gent Oats 9• IS-99 2 d 2 • c�ARi .• r s fpr TOWN OF YARMOUTH BUILDING DEPARTMENT PLEASE PRAT. job CONSTRUCTION SUPERVISOR FORM 56 Ada Street Owner of Property: Construction Supervisor. Address: Licensed Designee: (If other than Supervisor) Name 2.15 Responsibility of each license holder. License No. MEMO 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 Anylicenseewho shall willfullyviolate subsections 2.15.1, 2.15.2 or2.15.3 or anyother section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes a No ❑ If you have checked yg5, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy 51 Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: 1 am aware that the licensee does not have the insurance coverage required by Chapter 152 of the Mau. General Laws, and that my signature on this permit application waives this requirement Check one: Owner or Owners Owner ❑ Agent ❑ Signature: li d, 1 OLIO Building Official Approval: r 77te Commonwealth ofMassaehusem Department oflndststriat Accidents VOffice oflttvestigations 600 Washington Street Boston, MA 02111 tvww.nU=gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly N3IIle-*..+--"kosn;�Nm.i►nt:.,:.e..ir `w��f �n.. D_..o l..I eJ[31e/zI , Phone #• ? Are you an employer? Cheek the appropriate box: I. ❑ I am a employer with 4. ❑ I am a general contractor and I Type of project (required): employees (full and/or part-time). � 1 ea • have hired the sub -contractors 6. New construction 2.yCJ I am a sole proprietor or partner- listed on the attached sheet 7. ❑ Remodeling ship and have no employees These sub -contractors have 9. ❑ Demolition working for me in any capacity. employees and have workers' comp. insurance.t 9. RBuildmg addition [No workers' comp. insurance required] S. ❑ We are a corporation and its 10. ❑ Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their . 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repair insurance required] t 3a. ❑ I am a homeowner acting as a c. 152, 1 1(4), and we have no employees. [No workers' 13.0 Other general contractor (refer to #4) comp. Insurance reauired.l ;Any applicant that cheeks boa #I mint glso fill out the section below showing their wom rkers' tompmntiodtolicy information. Homeowners who submit this affidavit indiating they are doing all work and then hue outride oomrsctars mum submit a new affidavit indicating such, tCootrnetas that chat this box mum aaached an additional sheet showing dw name of the sub-wonnt nts god mesa whether or not those entities have employees. It the sub-conttaetars haw employem they mum povide their workers, comp, policy number. lam an employer that b provlding workers' eompensadon bumnmce for my employees Below is the policy andJob site infornadon. Insurance Policy # or Self -ins. Lic. #: Expiration Date, Job Site Address: City/Strtemp: 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 S 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 inan.nce coverage verification. I do herby cen* t under^e pains and penaftla ofptJ�, that the lnformadon protdded more iJ tyre and correct O•dlciai are only. Do not write in this area, to be completed by city or town offklal City or Town: Issuing Authority (circle one): L Board of Health 2. Building Department 6.Other Permit/I.tcense # 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector Contact Person: 11 Phone #• Information and Instructions .., Mmuhuew Oencrd Laws chapter 152 rcgdm all emPloy&I 10 Pmrids wOtkM'COMPcnUd= far their CMPloCM pmwad to this lamb, m gym b detbted u --era? pasos is the service of amtha under any cootrad of bite. esprM of implied, oral or waimm." As ewptgw 6 defined as "as bxkv tal. parbaa* associdlo% coqMb" or other kW edky, of any two of mom of the fang -I w enpied ha a joist ad, 1 1-R and locludbig &g LVdof a decened employee; a tke receiva of trmtee of" iadty &4 pabaship, uwdWm a mbar kpl entity. —vloY 9 empb7eas Hownr dw owner of a dwelling horse havb* we mess dos dhtwe apatm®ta and wbo radde thaelR a dw oceupad of dw dwelling boon of anotba wM empkryf pasou b do maideaaon. coas4setiaa a my* wmk os suck dweltlas Noon a as tba pounds or boil ft sppsstCONd IhlydO sball not been un of sock employment be deemed Is be u employee:- MOL chspre ISX 12JC(6) do Idle that "every dab K local Iiaadstg 81my d M w[tkbld the bwa K ressewd d a ficon err Park is epasb a beslsae w b Iwstrue! boodbp Is Ike aewwedth fir asq appilcWd wba has ad pedsnd atxeptahle erldean of awmptlssn wNk the iat:ata enasp rsgaasd.- Additloady. MOL chspsa 152,12XM stasu "Ntitka the commonwsakb out my of'M Pofidal Intoo -AA enoa i-b ny coohset the the pa4ormuee ofpobik wort umdl aceepdbb eridaan of easgfiasm with the lonasoa m1uhq oeds of Ibb cbspbr bare bees;eesmdd to Iba eaatracdag adhotity.- APpYeasta , Irlean tII out the wcobn ' amdsvk mosplebly. by dwchft the beau the apply to your sinsad" nod, If COMMY. supply sob-oaetrata(s) =a*$). sddtaa es) and Phone aem6a(s) am" wick ftk cadficus(s) of iusuggoog [d LWutiky Cao> mdn (I.LC) of Lbdbd LWtiW ratomWlsp aM w1a m =Wbyas other than the mambas a putts, as not 01 , 110 cwy warkm' compmntlae t-saaaee. If as LLC or LLP dam Ism cmpkgw% a puller is segohed 8a advised dw thin anWavit mey be submitted to due Deparmed of IndutrW AeeldeY lur eaofirmadas of ionsata cavaaga Ain be sms Is der ad dab tie amdavk. The amotm dauld be nesmsd sa the city or bws that the applicadas for die pumk a licenu is bsbg raI tat The Dspaamd of lodW&W Aaidmta. Should you have asy quedos rsaentlog the low a if you sm regdeed Ie obtak ■ waken' compeandm policy, Pleas call the Depsrtmet d the ®bu listed below felt! louud oaa>pmla should entree their CRY err Two Omdab Plena be sore that the aIDdavit Is sampled and primed left. The Depament hu provided a span OR the bonne of the amdsvit fbr you b f1II od is the eved the Omer of tavedipdau bu b eandet you reaar I' the aPP&M& Plan be sure to fM b do pamidBeatn muo>ba wbkb wu71 be used u a tefaQee ®obsr. is ddi l^ u sppfiad that mast aubmit ealdple pamitltkeue IPPlksdans b soy l yet, ned ody submit a» elmavk eattesu! polity iohos dim (if oaesay) sad undo -lob Jib Adkw" the sppiks-t should writ "A lunation is (c$y err lows)." A copy of the atfidarit That but ben omdally stuuped or mated by the sky or tows maybe provided b the appbcad se proa[dhat a valid amdavit is as fiL IN A tas I - err geeasu A new amdwit mst be fiikd art esda year, whee a home owner at cut = b obtaining a ®ceou of Pamk not mleted b say lows' at eommucW veda- (Le. a deg gewnsa or penuk to bum leaves ere.) said penes b NOT required to coogkb Ibis amdavit The Office of isvadpdoss would hks to dmk you is admen the you eoo1, 11 s sod should you have soy gaatioss6 plan do got hesitate b girt as a a1L rho Dapwmed'e addres% tclephoos and tit nnmba The Commonwealth of Massachmetts Depaunct t of industrial Accident Omer of Iff"dPdosa 600 Wmhington Street Boston. MA 02111 Tel. 0 617-7214900 cd 406 or 1-sail-MASSAFB Fax 0 617-721-7749 Revised I I-22XA www.man.gov/dis For Office Use Only Permit No. Date TOWN OF YARMOUTH AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MOL c. 142A requires that the 'rec nshvRia4 alteration, renovation, repair, modernization, conversion, improvement, removal, demolition or construction of an addition to any pro-o fisting owner -occupied building containing at least one but not more than four dwelling units or structures which we adjacent to such resident: or building' be done by ttgistered contractors, with certain ezceptiam along with other reouiremcmL Type of Work: Pe r"i-t e o A r)y ij tor' Est Cost 0 6.06 _i Owner Name: E I i zvk-V .' L Qn'� Y 'lssr s Date of Permit Application: 10 k- C) I hereby certify that: Registration is not required for the following resson(s): Work exchuW by law Job under $1,000 Building not owner occupied Owner pulling own permit Other (specify) Notice is hereby given that: ' OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL a 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner. i 6t.o. Pr1c-C 1s7YsR Date Contractor Name Registration No. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above Property. Date Owner Name •' , - �t,YAR� 3r e PLEASE PRINT: DATE: JOB LOCATION: "HOMEOWNER" TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, NIA 02664 508-398-2231 ext.1261 NAME HOMEOWNER LICENSE EXEMPTION STREET ADDRESS SECTION OF TOWN NAME HOME PHONE WORK PHONE PRESENT MAILING ADDRESS CITY OR TOWN STATE ZIP CODE The current exemption for'Homeowner' was extended to include owner —occupied dwellings of one or two units and to allow such homeowners to engage an individual for hire who does not possess a license, provided that such homeowner shall act as supervisor. (State Building Code Section 108.35.1) Definition of Homeowner. Person(s) who owns a parcel of land on which he / she resides or intends to reside, on which there is or is intended to be, a one or two family attached or detached stnicture 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 108.3.5.1) The undersigned 'homeowner' assumes responsibility for compliance with the State Building Code and other applicable codes, by-laws, rules and regulations. The undersigned 'homeowner' certifies that he / she understands the Town of Yarmouth Building Department minimum inspection procedures and requirements and that he / she will comply with said procedures and requirements. 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. Check one: Signature of Owner or Owner's Agent Owner Agent h.homeownrUmmV TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, AAA 02664 508-398-2231 ext.1261 Fax 508-398-0836 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at 86 Q d Work Address Is to be disposed of at the following location: 1 o r ►�ov �cw,. ��afcr S{'°�1D r' Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Qgn-atti-q of Application Permit No. 1016--116 Date Massachusetts - Department of Puhlk Safety Board of Boildin% Reulations and Standards J Construction Supervisor license Umse: CS 104189 WESLEY PRICE 23 BETTY'S PATH WEST YARMOUTH, MA 02M Explranon: 313=4 Omee of Commer ARdn h B xlatar RstNatloa IR- HOME IMPROVEMENT CONTRACTOR Reyis&"on ,M57559 Type; +- Expimtfon t'&Ikdij IndWidusl W. . PRICE BN iiJ �r7l WESIEY PRICE 23 BETTY'9 PATH 4 W. YAR�MOIJTf1, kA UndeneentarT W.D. PRICE WEsLEY D. PRtCE-OWNER 23 BETTY'S PATH WESTYARMOuTH,MA 02673 413 6S7 1529 MYCORESTORATION # HOTMAILCOM Comirm cnomSUPERVISORSLICENSE#104189 . HOME IMPROVEMENT CONTRACTOR # 157559 Estimate Prepared For. Pat Adams 86 Lookout Rd Yarmouthport, MA Work to be Performed at: 86 Lookout Rd Yarrnouthport. MA September 30th, 2010 Work is to include: Build Portico as specified per approved plans -an asterisk (•) next to the price means that work will done by a subcontractor, all other work will be completed by the General Contractor -an overhead and profit percentage of 15%will be added to total Job cost (this percentage Is negotiable) -Labor and material receipts will be provided to the homeowner on a weekly basis, my bookkeeping is available to be viewed by the client • Pull all Necessary Permits: = 100.00 • All necessary Framing from step up: = 1,200.00 Labor. 0 Materials: = 775.00 • Deck Framin¢: -includes demolition of old step, installation of sonotubes, railings on both sides of landing, complete framing of landing and step, Azek trim on step riser and landing sides, installation of mahogany decking Labor = 500.00 Materials- = 815.00 • All necessary Exterior Trim Work: -includes Portico ceiling of tongue and groove pine Labor. 700.00 Materials: • NA • Install Roof: includes tie-in to existing (1 square) Labor. 200.00 Materials: 175.00 • Pafnt: one coat primer, two coats fininsh = 400.00 Total: 4,865.00 Terms: Payment schedule will be os follows: A deposit of Z300.00 (two thousand and three hundred dollars) Is due prior to start of work The balance of2,565.00 (two thousand five hundred and sixtyfive dollars) is due upon completion of described work i -Cllent will only be charged for actual labor and materials cost of Job, plus an additional 15% of the total Job cost Job is expected to take approximately working days -All labor will be completed in a professional monner Jobsite Is to be thoroughly cleaned at the end of each work day ,Any unforeseen work, not listed above will be billed at an hourly rate of 50.00 ffIN dollar)s for theirst man and 45.00 (Jorty-Jive aonars) for each man thereafter. Unforeseen work shall be considered ony work which 7s not mentioned in the above contract and is not diredty related to the work described an the previous page of this contract. -Changes should be submitted In writing by owner Insurance, Uability and Workman's Comp. available upon request Beferences-, Available upon request This agreement entered in o on this th 7 day of 4 ' , 2010, by W.D. Price — Builder (Wesley D. Price) },��— By signing you approve the above contract amount and terms. Accented by. / Client's Signature: o' TOWN OF YARMOUTH Building Department z Town Hall Yarmouth. MA 026" (508) 398.2231 ee-1261 BBUILDING PERMIT TRANSMITTAL Temp Permit No.: T-11.152 Applicant Name: Wesley Price Applicant Phone: 4136871529 Building Location: 0086 LOOKOUT RD Owner's Name: Owner's Addres Owner's Telephone: ADAMS, ELIZABETH P 0086 LOOKOUT RD Yarmouth Port MA 02675 REVIEWED BY: 1. WATER DEPARTMENT: 2. ENGINEERING DEPARTMENT: 3. CONSERVATION: 4. HEALTH DEPARTMENT: 5. BUILDING DEPARTMENT: 6. FIRE DEPARTMENT: COMMENTS: RECEIPT OF COPY: (OFFICE USE ONLY Recorded By. Ic Permit Fee: $0.00 Deposit Rec: $25.00 Payment Type: Check ChkNo.: 1143 Net Owed: ($25.00) Application Date: 10/15/2010 Issue Date: Expiration Date PLEASE NOTE SIGNATURE OF APPLICANT: Comments: Map/Lot: 141.49 construct portico DATE: N/A: DATE: WA: DATE: WA: DATE: WA DATE: WA: DATE: WA: DATE: Date Printed: 10/19/2010 TOWN OF YARMOUTH WATER DEPARTMENT 99 Buck Island Road West Yarmouth, MA 02673 Telephone: (508) 771-7921 • Fax: (508) 771-7998 BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET Bldg. Site Location B6 (-ody-,cyt- Q3 Map #: Lot #: Proposed Improvement: POri-1 cv % 6 /I xA-/ O e� Applicant: VV� �. Pri tee. Address 23 5 PAz%ks- Tel. #:443 039 (52q Date Fled: �117 RESIDENTIAL AND / OR COMMERCIAL BUILDING Water Department: Determines Compliance of Water Availability and or Existing Location Engineering Department: Determines Compliance for Parking and Drainage Conservation Commission: Determines Compliance to Wetlands Acts; i.e. If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Ocean, 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.. Sl§nature Of applicant Date PLEASE NOTE: COMMENTS: otge� TOWN OF YARMOUTH 32 c HEALTH DEPARTMENT p iy PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Building Site Location: 18G0 ►`tA r� • • A 4-._L . _ / ( i . 1 Proposed Address: tr. . "Ifyou would lice e-mail notification ofsign of; please provide e-mail address: Owner Name: % l ; zA6d\r-- Pc k N SANS G h Scnc� 7i,f NoA-13 6 V? 1521k )ate Filed:10 tSr►p OwnerAddress:96 Lool.Cwo,)k Owner Tel.No.505 36Z 6513 kl.£1N "spy orki r RESIDENTIAL AND/OR COMMERCIAL BUILDING HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. Please submit three (3) copies of plans, to include: (1.) Site Plan showing existing buildings, water line location, and septic system location; (2.) Floor plan labeling ALL rooms within building (all existing and proposed) — Note: Floor plans not required for decks, sheds, windows, roofing; (3.) If necessary, Title 5 application signed by licensed installer with fee. / REVIEWED BY: DATE: PLEASE NOTE COMMEE(Nj��jD'���►1S/CONDITIONS: -Snr n'RJ e.Z 12" 0 —( "ei� rr(Y'��ARMOUTH YARMOUTH OLD KING'S HIGHWAY REGIONAL HISTORIC,vD! ra_ TRY. COMMITTEE - r, ccw9 Ph 12. 14 1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSE TS 02 Phone (508) 398-2231 Ext. 1292 -- Fax (508) 398-0836 Colleen McLaughlin, Office Administrator (cmclaughlin@yan ot)�h n us)v `D CERTIFICATE OF APPROPRIATENESS APPLICATION Application is hereby made in quedrupnpts for the issuance of a Cenifieato d Appropriateness (CIA) under section 8 d Chapter 470,1973 At is 3 Resolves d Massachusetts d 1973 for proposed work as described below and on plans, drawings, photographs. and other supplemental Information accompanying this application. Check All Categories That ADDM � 1) Exterior Building Construct oq9:. New Building Addition--__ARerafion Indicate type d buUding: .LHouse _Garage _Shed _Commercial _Other., 2) Exterior Painting/Reroof: _Siding _Shutters _Doors _Roof _Other. 3) Signs/Billboards: _New Sign _Existing Sign Change: _Color _Style _Size _Location 4) Structure: _Fence _Wall _Flagpole0 _ PoBl.na,Q-Cthee work: Owner(s): Phone N: ' 6 — �g Mailing Address:: r1 Email: �iiw �^ naapreferred notification method: _US Mail all Agenticontractor. � Phone I! Mailing Address: Email: Preferred notifi I Email Description of Proposed Work, Add : or, R E C E I V E D ,-7 1 SEP 0'8 2010 Signed YARMOUTH OLD KING'S HIGH%NMWMf%^.4O% O OwnerWtlai b ja� wars that a permit b h required in the BUMV DeparsnenL If approval Is subled b a I0-day appeal period provided In the Act This cerdfieate b good for one year from approval date or u9orr data of evkatlon of Bull ft Pent, w hkI*vw date SW be later. AN new constrLctlon vA be subled E0 k"pedbn by DKH. CKFFapproved Ohre MUST try avalWDb on to for kamkrg 8 fkal krop ft ao For Committee use onM Received by O _Approved Date: 0 �Y"�lpprove�with�l. 'Amendments / FEEP VED Cash/Check# O Reason for denial: Revd by. Signed: - 010 QQ�_ ,/ Date Signed: z o ,C"'], ..t, K . fj,/"j e,�/l i /: H /O-IV07 il�l�lHEM1: DATE qj?,7Ll 0 *:�&1(3 2 NeW C41YA064 Tz MAC �E' T �� ��Tscn 13rzl cic. aZ 3. 4. I agree to the above mom - APPROVED SEP 28 2010 I L` YARMOUTH OLD KING'S HIGHWAY rJ m rn ^ )� i` ! �O C ,o FTI 1_ 6%In,dAW. Per 0:I Che-d ho+tl OXH Cbairmm SignaAln Comm;�� ao-l�ri in Sigoattue /� ROBIN rnuuu WLCOX TO THE BEST OF MY INFORMATION, KNOWLEDGE, AND BELIEF THE FOUNDATION SHOYVN ON THIS PLAN HAS BEEN LOCATED ON THE GROUND AS INDICATE 716107 DATE PROFESSIONAL LAND SU FILE COPY E� VE TOP OF FOUNDATION 102.11 (SITE IS ELEVATION PLAN DATUM). "AS -BUILT" PLOT PLAN YARMOUTH, MASS. LOT 31, PL BK. 214, PG. 117 DATE 7&-QZ lSCALF 1 = JOB 1443-00 CLIENT FAIF SWEETS= ENGINEERING 235 GREAT VESPERN ROAD PO BOX 713 SOUTH DENNIS. MA 02E80 fm Sao--30e—= ROBIN NALUM WILCOX TO THE BEST OF MY INFORMATION, KNOWLEDGE, AND BELIEF THE FOUNDATION SHOWN ON THIS PLAN HAS BEEN LOCATED ON THE GROUND AS INDICATE % 716107 DATE PROFESSIONAL LAND SURVEYOR FILE COPY TOP OF FOUNDATION 102.11 (SITE IS ELEVATION PLAN DATUM). "AS -BUILT" PLOT PLAN YARMOUTH, MASS. LOT 31. PL. BK. 214. PG. 117 DATE 7 j6/07 I SCALE 1' = 40' JOB 1443-00 CLIENT FAIR SWEETSER ENGINEMUNG 235 GRW XESfM ROAD PO BOX 713 SCUM DE MM. KA 02660 Nt-2108-3m fm YARMOUTH (�\ ;'i r,: '"+�K YARMOUTH OLD KINGS HIGHWAY REGIONAL HISTOTgfI COMMITTEE �o �g F11 12 13 1146 ROUTE 28. SOUTH YARMOUTH, MASSACHUSETTS_ &0664 Phone (508) 398-2231 ExL 1292 -- Fax (508) 398-0836 _ Colleen McLaughlin, Office Administrator (cmclaughlin® ma us) / . f1 CERTIFICATE OF APPROPRIATENESS APPLICATION Application Is hereby made In quadruplicate for the Issuance of a Certificate of Appropriateness (CJA) under section 8 of Chapter 470.1973 Acts 3 Resolves of Massachusetts of 1973 for proposed work as described below and on plans, drawings, photographs, and other supplemental Information accompanying this appOcation. Check All Categories That Apply: 1) Exterior Building Constructi New Building 6 ddition _meration Indicate type of building: House _Garage _Shed _Commercial _Other. 2) Exterior Painting/Reroof: _Siding _Shutters _Doors _Roof _Other. 3) Signs/Billboards: _New Sign _Existing Sign Change: _Color _Style _Size _Location 4) Structure: _Fence _Wall _Flagpole _Pool _Other Tvoe or Print LeaibM _ Address of proposed work: - � MapJLot # 14 I ,T_ Owner(s): Phone #• . �/�f'�..31,i—� n _ . �} Mailing Address: ry Email: %-_z Agent/contractor. Mailing Address: Email: Preferred Signed notification method: _US Mail Phone #: RECEIVED SEP 68 2010 APPEma;)VED SEP 28 2010 YAR:AOUTH Ol.n KING HIGHV.AY OwredcontractWaprst permit [aware that a perequired from the Bu IUM DeparanerM. If appkatbn isa , appmW he subject to a lo-day appeal PwW provided In the AcL Thiseertlflcate Is good forors year from approval date a ryon date ofe)iration of Buildtrq Pa mil, whichever date shall be later. An new cornstnrctlon"be subject to knpecUon by OIOf. Mi-approved Phm MUST by available on -site for tram kV a WW Iropecsor Received by O Approved �- Approved Iw th � • Ame ants _ Denied Date: J/ /O • Reason for denial: Rcvd by. --<Z;7— Date Signed:o —..Je)10 /O-1f/o7 Hum DATE qj?,7LI 0 C/A# ADDpms OO/ �./ I. &XI u-5 T3r_ll-- Per ," 616514-6 �l���ttil5 z. Nei1 c* M 0 64 Tz mAr04 -Ex' 1 -6N� 21 Cj( aZ 3. FAPPROVEDO> P282010 n N 4. IT1 -o �O var; .�GuTH s - C OLD KING'S HIGHWAY I ague to the above mom- I�j _ oan«rAgat Per o-41v c.he.d Y)4e, OXH&I hmsn Slgub= CornmI tEMe- an+p rl in Sipatiml a-ppli cmn+'s "t)vnce• "21 Ap�ED SEp 28 2010 YARMOUTH TOWN .,LFRK t I 13 RE ,EIVED y ' YARMOUTH YARMOUTH OKH SPECIFICATION SHEJO�'% I r" ARK Address: g6 Zyo/Cavr ?on-> / yif/?1r10vTit �e12TC/A ".r r- IFQ �: 13 FOUNDATION: Material ar� CyvcgETE Expos ure (Not toexceed RELLE 1 DRIVEWAY MATERIAL- WALKWAY MATERIAL - STEPS: TtisFISS STEPS: Material: cO1'IPdJ/rr Color.6Railing WoeD Color: WFIr7IF- rn� Tio,r/ Zk W CHIMNEY: Matedal/ColorG�Ay— _ri�[.Tt A;CA3 STOA GUTTERS: Material: Color. �j ROOF: Material:As�/ru.T Pitch (7/12 min.): Height to Ridge: A9 / Color. /9.f-7z'/F r1Z9ri1JCr— SIDING: Material: Front- _W/�. rF Oexh rz Sides & Rear. S.s.�+� PAINT CHIPS Color: Front MArc!/ Fxisr,.{Sides & Rear. 'S,vNC-- I TRIM: All windows and doors to be trimmed w' 1x4 or 1x5. (Circle one). Trim material: L.root WHIT DOORS: Material: tN k-,4A Fe-;�et6LAS5 Color. )�FL Io LJ / c x�S rA✓4-� Indicate sizes/styles if not listed/shown on elevations: STORM DOORS: Material: At 0"- Style: 1 Color. W/-1 r TE GARAGE DOORS: Material: !�IIA Style: Color. *WINDOWS: Oty- 7 2— Material: VhVYG f Ln-71 Color w/ /rTF A mead I Grilles (required): Pattern: Type: �Br� Indicate window styles and siz s if not Iisted/shown on elevations. A�+PeWyE Yee s r �iE>, STORM WINDOWS: City. Material: Color. Indicate stylei d sizes if not listed /shown on elevations SHUTTERS: Wood Vinyl _Paneled _Louvered Color. SKYLIGHTS: Type: V61VX Size: 4/LX1« !Color. TEr?R Todc ~DECK.7Materlal: `J>)7c3so/rE' ?�ze: 4r�Jr5��I Color. /V/trclfrAL. Railingmaterial/Style: rt Color. " FENCES (Max. Height 6'y RETAINING WALLS: Material: N�/9 Style/Height: Color. (Show running footage & location on plot plan.) UTILITY METERSIHVAC UNITS: Location: N� Screening: EXTERIOR LIGHTS: Oly. 2 Style: 5,w11n z ro Location: 6✓C2 :Dan'ZS Color � T/C L-f/ST/N (,/ Additional Information: 4.9P1r1ow r5 zOIYZCr . . RECEIVED SEP '8 2010 c7rTea 2 SEP 28 2010 YARMOUTH JLD K.ING'S HIG.LN 16—A1aq . .• YARMOUTH- TOUb� ! rt ERK 2!9 SEP 29 h IZ• 13 RECtIVED APPROVED SEP 28 2010 ID-A)o7 `.� �i•. .i; � �.w •{ r" kr�r� iwr ��! �«��` � w�,•a`i• + , �w� _ •ASV r AAA�A�� r e J•rA��1wlwlwl � �M~To .U.., .tom •� ���� } � Li�FI� ' Y "�: • sty +G -. yh• a' Ste. •.n rn F-LIJ �_ u ��� a W O 00 Ov N E_ -_ ' T ',I 1 /�`-j �� L r_I LiJ_ 1 p �x W _ o xz NEW %>01PT/to NC w A.DD i T �o/J W y }Y 0 /y J li O 86 LOOKOUT 724ah1) ri Nf - L7 N O W III -Flit, :i�-i I 71/1,-`I�1= 86 L009OU7~ 'P-oAD ui o =_ ~� I O N 00 ON LL C S- < a W Z Yy a N 0. LU C) LLJCV -fA Ell F CC-4\0 0, V0l c, c aU3 LU ?t C= L) YY wcL w C4 SC 1--ooKov-r YAIZMdurlY ?07Zr..^A sco9tc: ef of = /F'/ I Print Summary MBLU: Location: Account Number. 141/ 4911 / 1 86 LOOKOUT RD 1695800 RECEIVED YAR"dOUTF SEP 12010 oLn tar:o s Ilic 1 iona raisaLcom/ outhMA/printg.asp?tid=0&GI YARMOUTH OLD KING'S HIGHWAY Page 1 of 1 YARMOUTH T0%lrr,l ;''i�'l FERK i G . FP 29 i112: 13 RECEIVEED gnI2010 Print Summary Page 1 of 1 MBLU : Location: Account Number. 141/ 491111 86 LOOKOUT RD 1695800 YARMOUTH TOWN Cl MK H 2Y 9 FM IL 13 RECEIVcD http://data.visionappraisal.comfYarmouthNWprintg.asp?tides&GURL=com=YannouthNt.. 9/7/2010 ans ...IIII �►,��, �_'. ,----+...�_.ft"-r----j__.""�r. WH TR cm. { . N. T RELIEV E r 1( 13 rF �; T`05?Old PIPR a+_t f f... _ HEALT� [IEPF r1/ 2 8 20101. �r1 DCT- ' 1 Lop YARIAUUTH r. (OPW 0 KING'S HIGHWAY �i ry(- I I G-- 6'19 �--- 7 loo��-`P 0 SL �,S O.L. ,lz''x4-�� Go,�v, �--a9 +'a kaJ se w RNRf r, 2x l D t 6 A O.C. o ar O Z n c 'G Ch N X °� O _C _= o � m < v APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00 (OFFICE USE ONLY) = TOWN ""0 � BY miG 0 9 2007 Fee:$ PERMIT NO. I� V J DING -e ((PLEASE PRINT IN INK OR TY Date: S, I To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to work described below. � Location (Street & Number) �Kcd L_mkoriT VLOA-4 yRfLfti 4 electrical Owner orTenantew�DAr Qt A AMJ TelephoneNo.s62'tE'✓ 1' Owner's Address 156-e t_cz ly— oar yz-c AA !.409,r mncatAN rzV Is this permit in conjunction with a building permit? Q'�Ces ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. �Y Existing Service ]n2 Amps I Volts Overhead] r]' Undgrd ❑ No. of Meters N �r1ew Service Amps / Volts Overhead❑ Undgrd ❑ No. of Meters '4 Number of Feeders and Ampacity r�� - cam: '�� ,Location and Nature of proposed electrical Work: � � � r _ ��±+� syl4 Completion of the following table may be waived by the Inspectorof Wmi Fixtures Z� u l o. o -total Transformers KVA No. of Lighting Outlets No, of Hot Tubs Generators KVA No. of Lighting Futures Above - SwimmingPool d. ❑ d. ❑ o. o Emergency g ing Batte Units No. of Receptacle Outlets � No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. o tecuon an Initiatin Devices No. of Ranges ota No. of Air Cond. Tons No. of Alerting Devices No, of Waste Disposers eat mV Totals: um r ons — — No, of Self -Contained Detection/Alertin Devices No. of Dishwashers S ace/Area Heating KW P 8 ❑ Municipal ❑ Other Connection No. of Dryers �Y Heatin Appliances KW g PP Secutity Systems: No. of Devices or ui valent No. of Water _ Heaters KW No. of No. of Signs Ballasts Data tang No. of Devices or Equivalent No. H dmmassa a Bathtubs Y g No. of Motors Total HP Telecommunications Winng: No. of Devices or uivalent Anach additional detail if desired or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent The undersigned certifies that such coverage is in orce, and has exhibited proof of same to a permit issuing office. ,1 C CK ONE: INSURANCE [ BOND❑ OTHER❑ (Specify:) (Expiration Date) Estimated Value o Ele trical WorQWty -� 4 0 (When required by municipal policy.) Work to Start: 1 Inspections to be requested in accordance with MEC Rule 10, and upon completion. O� certify, under the pains and penalties of perjury, that the information on this application is We and complete. �FIRMNAM(R5 `� "['�j\maae �1sckn,e,te. . LIC.NO. _1eJd ei�J Q \.�. Licenseet�uJ L —�p��� � Signatut��„�,� ( , e�_LIC. NO. (�a 49 PS ��(If applicable, enter "exempt' in the IicenseTnumber ligqe.) Bus. el. Noa �04( 7 7 a 357 Address:41"1 %Atn 'S� Mg--5-Wte. Aq n2e�af Alt.Tel.No.: Soar F5� Fs(OZ- �OWNER'S INSURANCE WAIVER. I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement I am the (check one) owner owner's agent. Owner/Agent Signature Telephone No. [Rev. 04=1 Conmo nveatih a Division of Regist Board of Electrita t s PAUL Mj F 817 MAILj BREWSTE`t . .lotaneyr a 12293-8 07131R010 License No.. Expiration Date. Serial No. . I _ 1 TWO FAMILY ONLY - BUILDING APPLICATION TO CONSTRUCT REPAIR, RENOVATE OR DEMOLISH A ONE Town of Yarmouth Building Department 1146 Route 28 - Yarmouth, MA 02664-4492 I M 9 OVFR Section 4 - Workers'. Compensation Insurance Affidavit (M.G:t.: c 152 s 25C (a) 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 ...J..�. 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 f Accessory Bldg. ❑ Type Demolition Other Specify: , Brief Description of Proposed Work:aAA / GP e O rJA —V- t3 CU )(I C—�4 ; yt VC5O M Section 8 = Estimated Constriction Costs Item Estimated Cost (Dollars) to be Check Below completed by perk applicant 1. Budding te, 15,00 ❑ Conservation -Commission Filing 2. Electrical CO'p (if applicable) 3. Plumbing / Gas �" fQ old 16ngs Highway 3 Histork:al 4. Mechanical (HVAC) Commission approval 5. Fire Protection pp (it applicable) 6.Total .(1+2+3+4+5) 7. Total Square Ft. (rmw Irma a eddl arm) Section 7a - OwnerAuthortzadon - To be Completed _Men owner's Agent dr ContractorAppiles for 8611din' Permlt -.- as owner of the subject property hereby authorize �P L� t� �'- i ✓ to act on my If�, in all matters to work authorized by this building permit application. ` Sipneture fieof gwner Date Section 7b - Owner/Authorized Agent Declaration as Owner/Authorized Agent hereby declare that the statements and Information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Nnt name _ /— L= signature of owmr/Agent %Date 9-15-99 2 of 2 TOWN OF YARMOUTH BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT: job Location:_ Owner of Property: 0 Construction Supervisor. Address: Street Village tvame License No. Phone No. 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 onlypursuant 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 Anylicenseewho shall willfullyviolate subsections 2.15.1, 2.15.2 or 2.15.3 or anyothersection of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes ✓f No ❑ If you have checked Yam. please Indi ate 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 52 of Mass. General Laws, and that my signature on this permit application waives this requirement (n Check one: Signature of Owner or Owners 5gcnt Owner C] Agent 2J,� Signature: 4=\%— =f z:=- Building Official Approval: •' For Office Use Only Permit No. Date TOWN OF YARMOUTH AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL e. 142A requires that the `recatshuction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition or construction of an addition to any pre-existing owner-oavpied building containing at least one but not more than four dwelling units or structures which are adjacent to such residence or building' be done by registered contractors, with certain exceptions, along with other requirements. Address of Work Owner Name: Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under $1,000 Building not owner occupied Owner pulling own permit Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. Signed under penalties of perjury: I hereby apply four a peerrrnit as the agent of the owner. Date Contractor Name Registration No. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property-, Date Owner Name The Commonwealth of Massachusetts Department ojlndustrial Accidents Office oflnvestigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Bu17ders/Contractors/Electricians/Plumbers Name Address: Phone #: 36 Z 1 It 6 - Are you an employer? Check the appropriate box: Type of project (required): 1. ❑ I am a employer with 4. ❑ I am a general contractor and I l(toll and/or part-time). • have hired the subcontractors2_29, 6. ❑ New construction a sole am a sole proprietor to 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' insurance.t 9. ❑ Building addition r [No workers' comp. insurance required,] comp. 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their I1.❑ Plumbing 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 13.❑ Other employees. [No workers' comp. insurance reauired.l 'Any applicant that cheeks box at trust also fill out the section below showing their werken' cor powtionn policy information. t nomen"m who submit this affidavit indicating they ate doing all west and 0= him outside contractor rout submit a new afidsvit indicating such. tCmireton that check this box must attached an sMdonal al eet slowing the name of the subcontractor and state whether or not than entities have employes. If the sube mictora have employer, they matt provide their worker' comp, policy number. lam an employer that Lr provtdLag workers' compensation Insurance for my employees Below Is the poUL7 and Job the informadoe. Insurance Company Name: Policy # or Self -ins. Lic. M Expiration Date: Job Site Address: City/Statealp: 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 S 1,500.00 and/or one-year imprisonment as well as civil penalties in the foam 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 coveraite verification I da hereby certi# under gains and penahles of perjury that the Information provided gbove Is. true and eorreeL Ofikialuseonly. Do not wr a area, to be comp e y e or town o,Q7etaL City or Town: Pernilt/Uceme # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6. Other Contact Person: Phone #: l Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trostee of an individual, partnership, association or other legal entity. employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGI, chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the Issuance or renewal of a license or permit to operate a business or to construct buildings In the commonwealth for any applicant who has not produced acceptable evidence of compliance with the Insurance coverage required." Additionally, MGI, chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificates) of insurance. Limited Liability Companies (LL.C) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self -insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials 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. In addition, an applicant that must submit multiple permiUficense applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venue (Le. a dog license or permit to bum leaves etc.) said person is NOT required to complex this affidavit The Office of Investigations would hire to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised I1-22-06 www.mass,gov/dia TOWN OF YARMOUTH 1146ROUTE28 SOUTHYARMOUTH MASSACHUSETT802664�1451 Telephone (508) 898-2231, Ext 261 — Fax (508) 99&2965 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT BUILDING ELECTRICAL GAS PLUMBING SIGNS Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at �(o �� �C(�-, , - T Z Work Address is to be disposed of at the following location: Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. _r'? Signature of Applicant Permit No. � ty Date TOWN OF YARMOUTH WATER DEPARTMENT 99 Buck Island Road West Yarmouth, MA 02673 Telephone: (508) 771-7921 • Fax: (508) 771.7998 BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET Bldg. Site Location: !�o 1 . k c)cA4 /�d Map #: I Lot #: qCz Proposed Improvement: cr eA-7 /[1D� nih 'T Cti PWON c Applicant: II //t It ✓t fa ,� / Address: '<�A MA1tQt/S(4T �� I�i Tel. #: 31a7 Sr1.4G, Date Fled: RESIDENTIAL AND / OR COMMERCIAL BUILDING Water Department: Determines Compliance of Water Availability and or Existing Location. Engineering Department: Determines Compliance for Parking and Drainage Conservation Commission Determines Compliance to Wetlands Acts; i.e. If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Ocean, Bogs, Bays, Marshland, Etc.. Health Department Determines Compliance to Stat 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, Pr964rty Protection; i.e. Smoke Detectors, Sprinkler Systems, Etc... REVIEWED BY PLEASE NOTE: COMMENTS: Z� rn l NAME • �q��►�>) i` • !. - // 'STREET o� 1f1(1T'fr"i Ryan Tr`- 11 VILLAGE 4n p•q�7j'p}i SERVICE NO. 977__S'8 METER NO.-./I.7S o2J4l i 4arace le '7j ell 84' 26, -161 ----------- Pole 7 • lj TOWN OF YARMOUTH HEALTH DEPARTMENT PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Building Site Gf eaAA r�c Map No1.: &Lot No.: C'i �l 'TC'.M. �b✓4e E,c i fJ • lJ�l �GrJt�i "/f.wu uvuld like e-mail notification ofsign off, please provide e-mail address. Owner Owner 1?�C( Owner Tel. No.: Z 6 rS RESIDENTIAL AND/OR COMMERCIAL BUILDING HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. Please submit four (4) copies of plans, to include: (L) Site Plan showing existing buildings, water line location, and septic system location; (2.) Floor plan labeling ALL rooms within building (all existing and proposed) — Note: Floor plans not required for decks, sheds, windows, roofing; (3.) If necessary, Title 5 application signed by licensed installer with fee. REVIEWED BY: U PLEASE NOTE COMMENTS/CONDITIONS: ckgogi,—Ow) TOWN OF YARMOUTH Building Department Town Halt Yarmouth, MA 02664 (508) 398-2231 ext.261 BBUILDING PERMIT TRANSMITTAL Temp Permit No.: T-07-509 Applicant Name: Kevin Fair Applicant Phone: 5083628186 Building Location: 0086 LOOKOUT RD Owner's Name: ADAMS, ELIZABETH P Owner's Addres 0086 LOOKOUT RD Yarmouth Port MA 02675 Owner's Telephone: (508) 362-6153 RI 1 p 2 4. HEALTH DEPARTMENT: 5. BUILDING DEPARTMENT: 6. FIRE DEPARTMENT: COMMENTS: RECEIPT OF COPY: (OFFICE USE ONLY Recorded By. IC Permit Fee: $0.00 Deposit Rec: $25.00 Payment Type: Check ChkNo.: 366 Net Owed: ($25.00) Application Date: 5292007 Issue Date: Expiration Date PLEASE NOTE SIGNATURE OF APPLICANT: Comments: Map/Lot: 141.49 construct 14 x 16 screened porch and 10 x 12 addition to expand existing master bedroom ZONING APPROVED /�1017 DATE: DATE: DATE: DATE: DATE: DATE: N/A: N/A: N/A: NIA. - N/A: N/A: DATE Date Printed: 6/42007 L11Massachusetts Department of Environmental Protection COPY Bureau of Resource Protection - Wetlands WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Town of Yarmouth Wetland By -Law, Chapter 143 Important When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. _ 1� From: Yarmouth Canetvetion Commission To: Applicant Pat Adams Name 88 Lookout Road Mailing Address YarmouthPort MA 02675 Clbyrrown State Zip Code Property Owner (if different from applicant): Name Mad y address cay/rovm State Zip Code 1. Title and Date (or Revised Date If applicable) of Final Plans and Other Documents: Sketch showing proposed additions Tqb Tile 2. Date Request Filed: B. Determination Date Date Pursuant to the authority of M.G.L. c.131, § 40, the Conservation Commission considered your � ue termination of Appricability, with its supporting documentation, and made the following Project Description (if applicable): To construct additions Project Location: 88 Lookout Road YarnouthPort Steel: Address Cityrrown 149 49 Assessors Map(Piat Number PareeirLot Number wpolamadw • w. 3rM05 P" 1 of s L11 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Town of Yarmouth Wetland By -Law, Chapter 143 LO The following Determination(s) is/are applicable to the proposed site and/or project relative to the Wetlands Protection Act and regulations: Positive Determrtnation Note: No work within the jurisdiction of the Wetlands Protection Ad may proceed until a final Order of Conditions (issued following submittal of a Notice of Intent or Abbreviated Notice of Intent) or Order of Resource Area Delineation (issued following submittal of Simplified Review ANRAD) has been received from the issuing authority (i.e., Conservation Commission or the Department of Environmental Protection). ❑ 1. The area described on the referenced plan(s) is an area subject to protection under the Act Removing, filling, dredging, or altering of the area requires the filing of a Notice of InterrL ❑ 2a. The boundary delineations of the following resource areas described on the referenced plan(s) are confirmed as accurate. Therefore, the resource area boundaries confirmed in this Determination are binding as to all decisions rendered pursuant to the Wetlands Protection Act and its regulations regarding such boundaries for as brig as this Determination Is valid. ❑ 2b. The boundaries of resource areas listed below are Din confirmed by this Determination, regardless of whether such boundaries are contained on the plans attached to this Determination or to the Request for Determination. ❑ 3. The work described on referenced plan(s) and document(s) Is within an area subject to protection under the Act and will remove, fill, dredge, or after that area. Therefore, said work requires the firing of a Notice of Intent. ❑ 4. The work described on referenced plan(s) and document(s) is within the Buffer Zone and will after an Area subject to protection under the Ad. Therefore, said work requires the filing of a Notice of Intent or ANRAD Simplified Review Qf work Is limited to the Buffer Zone). ❑ 5. The area and/or work described on referenced plan(s) and document(s) is subject to review and approval by: Yarmouth Name of Mwkipafity Pursuant to the following municipal wetland ordinance or bylaw: Yarmouth Wetland By -Law Chapter 143 Name Ordinance or Bylaw citation wP9km2es-wv. L1N5 Pq*2ar5 LlMassachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Town of Yarmouth Wetland By -Law, Chapter 143 ❑ 6. The following area and/or work, H any, is subject to a municipal ordinance or bylaw but D_Qt subject to the Massachusetts Wetlands Protection Act: ❑ 7. If a Notice of Intent is filed for the work in the Riverfront Area described on referenced plan(s) and document(s), which includes all or part of the work described in the Request, the applicant must consider the following aftematives. (Refer to the wetland regulations at 10.58(4)c. for more information about the scope of aftematives requirements): ❑ Aftematives limited to the lot on which the project is located. ❑ Alternatives limited to the lot on which the project Is located, the subdivided lots, and any adjacent lots formerly or presently owned by the same owner. ❑ Aftematives 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. ❑ Attematives emend to any sites which can reasonably be obtained within the appropriate region of the state. Negative Determination Note: No further action underthe Wetlands Protection Act is required by the applicant. However. If the Department Is requested to Issue a Superseding Determination of Applicability, work may not proceed on this project unless the Department fails to act on such request within 35 days of the date the request Is post -marked for certified maid or hand delivered to the Department. Work may then proceed at the owner's risk only upon notice to the Department and to the Conservation Commission. Requirements for requests for Superseding Determinations are listed at the end of this document. ❑ 1. The area described in the Request is not an area subject to protection under the Actor the Buffer Zone. ❑ 2. The work described in the Request is within an area subject to protection under the Act, but will not remove, fill, dredge, or after that area. Therefore, said work does not require the filing of a Notice of Intent IR 3. The work described in the Request Is within the Buffer Zone, as defined in the regulations, but will not after an Area subject to protection under the Act. Therefore, said work does not require the filing of a Notice of Intent, subject to the following conditions (if any). ❑ 4. The work described in the Request is not within an Area subject to protection under the Act (nciuding the Buffer Zone). Therefore, said work does not require the filing of a Notice of Intent, unless and until said work alters an Area subject to protection under the Act. wpWo.adw • m. Sn105 ay.1 d 5 L11Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 2 —Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Town of Yarmouth Wetland By -Law, Chapter 143 B. Determination (cont.) ❑ 5. The area described in the Request is subject to protection under the Act Since the work described therein meets the requirements for the following exemption, as specified in the Act and the regulations, no Notice of Intent is required: Exempt Amity (ate applicable statuatwy/reg"M provislam) ❑ 6. The area and/or work described In the Request Is not subject to review and approval by: Yarmouth Name of Wkipailly Pursuant to a municipal wetlands ordinance or bylaw. Yarmouth Wetland By -Law Chapter 143 Name Ordnance or Bylaw Citation C. Authorization This Determination is issued to the applicant and delivered as follows: ® by hand delivery on ❑ by certified mail, return receipt requested on 6-25-07 Date Date This Determination is valid for three years from the date of Issuance (except Determinations for Vegetation Management Plans which are valid for the duration of the Plan). This Determination does not relieve the applicant from complying with all other applicable federal, state, or local statutes, ordinances, bylaws, or regulations. This Determination must be signed by a majority of the Conservation Commission. A copy must be sent to the appropriate DEP Regional Office (see Attachment) and the property owner (d different from the applicant). 6-21-07 wgdomadx • w. 3MM Pam 4 of 5 L11Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L c. 131, §40 Town of Yarmouth Wetland By -Law, Chapter 143 D. Aweals The applicant, owner, any person aggrieved by this Determination, any owner of land abutting the land upon which the proposed work is to be done, or any ten residents of the city or town in which such land is located, are hereby notified of their right to request the appropriate Department of Environmental Protection Regional Office (see Attachment) to Issue a Superseding Determination of Applicability. The request must be made by certified mail or hand delivery to the Department, with the appropriate filing fee and Fee Transmittal Form (see Request for Departmental Action Fee Transmittal Forth) as provided In 310 CMR 10.03(7) within ten business days from the date of issuance of this Determination. A copy of the request shall at the same time be sent by certified mail or hand delivery to the Conservation Commission and to the applicant if he/she Is not the appellant. The request shall state dearly and concisely the objections to the Deternination which Is being appealed. To the Went that the Determination Is based on a municipal ordinance or bylaw and not on the Massachusetts Wetlands Protection Act or regulations, the Department of Environmental Protection has no appellate jurisdiction. wpramZdw- w. 3MM5 Pbp5c13 g•Y 0 e TOWN OF Y A R M O U T H CONSERVATION 'i n46 ROUTE 28 SOUTH YARMOUTH MASSACHUSETfS 02664 COtiLWSS1ON Td (508) 398-2231 — Fax (508) 398-M36 Town of Yarmouth Conservation Commission Building Permit Sign -off Application Cons. Comm. Received Date: e, Property Owner i a+ ti dd m c / Comb ction Address:l� L ryg kd a� — iz Assessors Map and Parcel: MAP ► Yc PARCEL General Contractor. Company Name and Address: Company Telephone: Project Contractor Signature: Plan Submitted: Tide _S, P- IL4 A61VIv1 n eeod, d d d I1„1 Date ac, n t v H Revisiob Date Conservation Commission Filing Required: YES NO If Yes, Type of Filing. Notice of Intent Request For Determination Of Applicability X Conservation Commission Sign-oRSignature- Date: Z. u I04 F"Ifte ed F"W Property Location: 86 LOOKOUT RD MAP M. 141/ 49/ / / VlrionlD:16794 0aerID: 126/J031/// Bldg if. 1 Card I of 1 PrWDate. 061067W09:34 96 LOOKOUT ROAD ARMOUTHPORT, MA 02675 DAMS, ELU48ETH P _Tubdivision Description' Cade Appraised Value 815 YARMOUTII, MA u red uburban Assessed Value RES LAND NTL 1010 1010 357,2W 1S7,000 357.200 157AOO UPPLEMENTALDATA 95M 0oto SD IS ID: 16794 VISION Total 514,2A0 5141200 RECORD OF OWNERSHIP D&VOLIPAGEDATE DAMS, ELIZABETH P DAMS CHARLES F 1141YO37 0SJ07/1998 I 1 0 Yr. Code Assessed Value Yr. Code Assessed Value Yr. Code Assessed Value 2006 2006 1010 1010 357,2M 1S7,000 006 006 1010 1010 319,100 ZOOS 157,000 NOS 1010 1010 318,100 IS7,000 Total•5142M To'.1-1 47 1 Code Description Number This signature acknowledges a visit by a Data Collector or Assessor Year 7)vaeMescription Amount Amount lamm.Inf. Total• MARSHFRONT NATURAL 1/G OWNER WOULD NOT ALLOW HOUSE TO BE MEASUREDE 0420 APPRAISED VALUE SUMMARY Appraised Bldg. Value (Card) Appraised XF (B) Value (Bldg) Appraised OB (L) Value (Bldg) Appraised Land Value (Bldg) Special Land Value Total Appraised Card Value - Total Appraised Parcel Value Valuation Method: ISS,3w 1,700 0 3S7,200 514,200 S14,200 CasUMarket Valuation Net Total Appraised Parcel Value S14,200 Permit ID Issue Date 71ype Description Amount Ins , Date % Comp, Date Comp, Comments Date ID Cd PurposelRejult 02•S88 1/8/2002 RS Residential 29,000 51147M 100 LIrM3 24X16ADDITIONISUI 5/1412003 6r24119% GM PW 01 00 coos+IVisit u+LEted LA ND LJNE VALE 417ONe o Be Use Cade Description Zone I D Frontage Depth I Units Unit Price L Factor S.I. I C Factor Nbad. Ad'. Notes. Ad' 7al Pricing Ad'. Unit Price Land Value 1 1010 SINGLE FAM 29AM.80 SF 4.45 2A0 a 1.13 0095 1.001.2S X 10% WET BSMNT 1106 357,200 • Tolat Card land Untal 29,621.00 SF AsrveffosdLvdArea:j 29,621 SFl Tom! load Vam 357,200 Proprrfry Z"alion: 86 LOOKOUT RD MAP ID: 141/ 49/ // Miss ID.16784 • WWIWWI& 126/JG31/ '�Olt�Btl ire_ i __ i „�pri:4l.7 ies Story - 'up+ncy • •ng/Wall xiorwall1 1 Noad Shingle ooma/Prtnx k Common wall 2 m height ifSuwwm dCover 3 h p pWFGIc/Cmp COND01MOB/IB dOY, nor WaB 1 5 Nywaillsheet menf Code Descryu 2 plex riot Floor 1 1 t 2 nor n1t LoaAd rion ring Fuel Ling Type 3 S Gas lotwater umber of Units Type 1 one umber of levels Ownership rooms 2 Bedroom, Cos r uooms Bathroom d Rooms mWj. Base Rate 100.00 ize Adj. Factor 1.00953 t Type 2 Modern (Q) Index 1.06 hen Style Modern i Base Rate 107.01 Ids. Value New 204.282 ell Built 1972 :ff. Yen Built 1978 rml PhyscI Dep nlObalnc Obalnc Cond. (',ode 24 0 0 Affvwn MR 10 INGLE FAM 100 PWj Cond. 76 r% pro. Bldg Value 15S,3W 6HDI .OS End Outs Shwr ME I B I 1 0.00 1978 I 271I 100 WDK Peck,Wood Vau Al Mr, a aaa6u••rJ - ..��.....�.. In the Town of Yarmouth for a APPLICATION FOR CERTIFICATE OF APPROPRIATENESS App'cation Is hereby made in triplicate, for the Issuance of a Certificate of Appropi of CI f pter 470, Acts and Resolves of Massachusetts,1973, for proposed work as plans,Vmwings or photographs accompanying this application for. CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: C New Building )CAdditlon C Alteration Indicate type of bulldiag: C Haan C Garage C Commercial COther_ 2. Exterior Paindag: 9 01 nnderSection 6 MAY 0 2 2007 C 3. Sign or Billboards: ❑ New Sign C Existing Sign G Repainting existing sign (J 6 d,3 -p7 4. Struelnrr. G Feoa G Wall G Flagpole G Other TPPEDRPRIMLEGIBLY ff `` DATE F 1 ADDRESS OF PR OPO, � D WORK Sib Lx--)11 1OL .'t jC ASSESSORS MAP NO, OWNER !r+ 1� Y 1 n w. S ASSESSORS LOT NO.� HOME ADDRESS R & L 0 6lc U-LA-4 `, TELEPHONE NO. 362, laSI 3 AGENT OR CONTRACTOR I �C.V 11 VD !f TELEPHONE NO 3 ,L 1 6 ADDRESS,V L9 O FAO Meh S A OL V TZA ZIP CODE 2 % USE ATTACHED SHEET (PAGE Ili) IN PACKET FOR ABUTTING OWNERS DETAILED DESCRIPTION OF PROPOSED WORK Give aupartiev/ars ofwork so be done ioctu tnig materials to be and In wn ojsfgnr, Stm locations ofesisting signs and proposed locations ojnew signs. (Attach Additional sheet, if u } I y �� s� pd � idx�a. M �Lz OJ81 eta APPRO-, _D J 4MAM-2 4 I7 Signed �_ Date li o U • Owner-Contractor6Agent Is aware thata Permit h reyalred fromp#• All new construction will be subject to Inspection by OKH Inspect • It h required that OKH approved (with BD stamp) plans are available on si6f'or tWr and final inspections. Q e� use Date% This Certificate is If Certificate is approved, approval is subject to the Ill day Appeal period provided in the Act DISAPPROVED 17 PLEASE RETURN TO: Yarmouth OKHC District Committee Yarmouth Town Hall, 1146 Route 28, S. Yarmouth MA 026" 7/*O r� SPECIFICATION SHEET (YARMOUTH OKHC) • Provide color chips and attach when necessary. ` • New Rouse: Provide Landscape Plan. On Site Plan show exterior lighting and electric meter. mot_ I ..' U I I T A Description of proposed work: FOUNDATION (IS* MAX. EXPOSED): CONCRETEVIIIER DRIVEWAY: WALKWAY: STEPS (IN\DI`CATE BRICK/CeAENT/OTHER): SIDING TYPE & MATERIAL: L Ce 6w 5 V,,a Fes COLOR: CMMNEY (INDICATE BRICK/STUCCO/WOODFACED) COLOR: ROOF MATERIAL PITCH (7112MIN.) MAX EXP._ some COLOR WINDOWS (GRILLES REQUIRED—(WOOD/OTHER) L�Ve, INDICATE SIZES IF NOT LISTED ON ELEVATIONS: COLOR DOORS (WOODMiIER) COLOR (INDICATE SIZES AND STYLE IF NOT LISTED ON ELEVATIONS): TRIM: (ALL WINDOWS & DOORS TRRAMED WITH 1X4 / 1X5) COLOR wV•j`c MATERIAL OF TRIM: (WOOD, VINItI, AJ-UMW SHUTTERS (WOODA NYL) (PANELED/LOUVERED) COLOR - GUTTERS (WOOD/ALUMINUM): COLOR. GARAGE DOORS: SIZE dt STYLE: COLOR STORM WINDOWS & DOORS: COLOR: (INDICATE SIZES IF NOT LISTED ON ELVATIONS) SKYLIGHTS: TYPE/SIZE: () _ (� COLOR: WOOD DECK: SIZE: ' VIQ��Wp{t GY COLOR (SHOW LA OUST RU�NN RUNNING FOOTAGE O SN�`rrE PLAN) rKI E D I�G' OR RETAINING WALL: (P.T. OR FIELDSTONE —CONCRETE INAPPRO007 (SHOW LAYOUT do RUNNING FOOTAGE ON SITE PLAN) IH SIGNS: (indicate size, style, colors) HIGHWAY LOR: SIGN POST: (indicate size, style, color) II COLOR Additional Information All r1Q rO �' "n � t+- I . I I _ 1. L _ ..A l 2 --'-"-- -AS 31 AC----�iAC---- - -- -- - --- --- - 30 AS AC ^ a �f < A°Ad g X ; & w w Ae AC ; C Ae AC 63 6.10AAC _ VVV 35AC 35AC \ sz %s AC AS OAS ACAS AC (\ 3 ? 503AFPJC � ��- � 36-AC 67 031 AC OQ O tovw1 a r APPROVE17 D AC 3M�C MAY 24 2007 Y HMOUTH I-� OLD KING'S HIGHWAY 3dAC 23 ti RAH Rzvmi i a sU11 mG PtRmr AmwATIOII nv" NOTo WRESS: Implut IsleotIn" Review: /,6- fir% c"x-xi nvector A CAte!> ,oa,irem;e /sv LOST (For offs= aaa o*) Zmios t=t t (ifgok *): Sac" 104.32, Part Cboi4 Psteodoa or Ahmidw (weedidaL omcocftmkd The prapond ee r*m a Spedal Permit Rom dm Zwft Booed of AMak Other Bu1digg Cade D=W (if q; "eabte) �7 TOWN OF YARMOOTH FIELD COPY BUILDING PERMIT -6_0.7 -59r _ DATE Jay 80 2002 APPLICANT Edward Shea/ Shef� "tOm• CarpentrgADDRESS 12 VV INO.I PERMIT TO addition I-1 STORY (TYPE OF IMPROVEMENTI NO. ISTREETI J� (PROPOSED USE, RMIT NO. B-02—WS td. SY 02664 CS070177 ICONTR'S LICENSEI NUMBER OF DWELLING UNITS [AT ILOCATION)_Sl6 Lookout Road. YP 02675 2ONiNG R 40 DISTRICTINO) 15TREET) ETWEEN.• AND a (CROSS STREET, ICROS5 STREETI tT m SUBDIVISION 1G9/R2 LOT LOT BLOCK 512E m BUILDING IS TSBIEFT. WIDE BY FT. LONG BY - FT. IN AE&T AND SHALL CONFORM IN CONSTRUCTION O Z TO TYPE SB USE GROUP R6 BASEMENT WALLS OR FOUNDATION. F C REMARKS: 24E x 16' addition/sunroom off rear of house and 30' x f,' 12/28/01. (TYPE) VOLUMEAREAOR / ESTIMATED COST $ 29,000.00 FEEMIT $ 195.00 ICUBICISOUARE FEET) OWNE'lizabeth Adams L IN~GOEPT� ADDRESS 86 Lookout Road. YP 02675 _. I,, a FA IVA INSPECTION RECORD DATE NOTE PROGRESS - CORRECTIONS AND REMARKS INSPECTOR . t=vv� �e5 c,;. Nd-�-�Qe r C E ONE & TWO FAMILY ONIrY - BUILDING PERMIT APPLICATION TO CONSTRJCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWEW NG Tolism of Yarmoudt Building Deparunent ; 1146 Route 28 • Yarmouth. NIA 026644492 Tel: (508) 398-2231 x261 • Fax: (508) 398-2365 ' Office Use Only _ - -(� Permit No.ILO�_ate � Permit Fee . $L4 / �S , , I posit Redd. $ WA ate 11� Net DUB $ /U Planning Board Information Planryp° Endorsement Date Recording Date INo. Assessors Departrnent Information: ` �'°°r ar'° ra 6-1 Old - New --- 1.4 Property Dimensions: Lot Area (s9 Frontage(ft) LdCoverage Omer This Section for Office Use Only Building Permit Number. I Date Issued: Signature: -fin : O Certificate of Occu Is is not required - - BuilM Official Date Section 1 - Site Information I Use Group: R-4 Type: 5-B 1.1 Property Address: klI rx)m i R00 Cis - 12 Zoning Information R4 0 Zoning District Proposed Use a MCI fihQ7rf MA 1.3 Building Setbacks (111 Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 04 1 E1-P JD A �oR 1,574 6 -F 1 A water Supply (AL(LL e. 40. S 54) Public Private 1.5 Flood Zone Information: Comments: Zone: - - BFE r Section 2 - Property Ownership/Authorized Agent 2.1 Owner of Record: 90-abelh Pat Adams LoW 1- Rd. Y Name t /J Mailing Address — S SignatureTelephone 2.2 Authorised enL- d t d_ e a� 1 a V, I to aa fC Rd . S.Ya rim) i 7 ress u Section 3 - Construction Services 140V Z .20 JAN 0 8 2002 2. Licensed ConstructiSpn� heCL !i NotAa le� Alf/ License Number 0 7 0 1 -7/-7 Q V(Ilaqe, BrWik Rd . ctrrnnuih Address SOa-39y-8355 Expiration Date OS 3 0 c) 003, Signature Telephone 3.2 Registered Home Improvement Contractor. Company Name e uS1�x1 C Jrcl l, Kll No{Applicable El license Number I 1oL/ '-i ' 7( � Signature Telephone ����3 55 pater O6 9-15-99 1 of OVER Section 4 = Workers' Compensation Insurance Affidavit (M.G.L W 52 S 24C (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. s Signed Affidavit Attached Yes .......... I No .......... Becton 5 ,Description of Proposed work (check allapplicable) I New Construction 1 No. of Bedrooms No. of Bathrooms 6dsbng Bldg. ❑ Repair(s) ❑ I Alterations ❑ 1 Addition BrI _. . , AccessoryBldg. ❑ Type Demolition Other Specify. Brief Description of Proposed Work; JL4' x IW ctd&t tin Sunro R t-ear -F h ancLit'ith ontajroatta CA Section 6-- Estimated Contraction Costs Estimated Cost (Dollars) to be completed by permit appicard J5000 / C1 be Completed When for Building Permit --_ Check Below. dConservation-Commission Filing (if applicable) dOld IOngs Highway 3 Historical Commission approval (If applicable) Item 1. Building 2 f7ectrkal 3. Plumbing / Gas 4. Mechanical (HVAC) S. Fire Protection S.Total=(1+2+3+4+5) 7. Total Square Ft. (new hmm 8 addtlom) Section 7a- Owner Authorization -To Owns rsAgent or Contractor Applies I. /Z 1- A hereby authorize C OSfo 0) CarpenirtA , as owner of the roect subject property petty to act on my be f, in all matters relative to authorized this building ' SIw atu owner permit application. I I ZS dl Date 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. 9. 15 - 99 2 01 2 TOWN OF YARMOUTH BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT: Job Location:_ Owner of Property: Construction Supervisor. 1-1-'LUU Name Address: Licensed Designee: (If other than Supervisor) Name 2.15 Responsibility of each license holder. d. YQrmoal4h Ada S Village 670 I -77 39g- 8355 License No. Phone No. . S. Yarmavfh 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 invoking 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 licenseewho shall willfullyviolate subsections 2.15.1, 2.15.2 or 2.15.3 or any other section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: 1 have a cunen liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 es [1 YNo ❑ If you have checked yg;:, please indicate the type coverage by checking the appropriate box. A liability insurance policy 0( Other type of indemnity ❑ Bond ❑ JRANCE W I am aware that the licensee does not have the Insurance coverage required by the M . Gen ral and that my signature on this permit application waives this requirement Check one: Owner Agent Signature: Building Official Approval: For Office Use Only 1 1 Permit No. Date TOWN OF YARMOUTH AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c 142A requires that the `reconstruction, alteration, renovation, repair, modernization, conversiay improvement, removal, demolition or construction of an addition to any preexisting owner -occupied building containing at least one but not more than far dwelling units or structhwhich are adjacent to such residence or building' be done by registered contractors, with certain exceptions, along with other requirements. Type of Work: Ad d i f 1 Q n t, Est. Cost0 0 AddressofWork' A(D LooknA rd. TarfyrnffhiOor+ OwnncrName: Oi2ahelh PUT AdnrnS Date of Permit Application: // - .2 % - 0 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under $1,000 Building not owner occupied 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: herebyapply for a entI • q I I- • I I 1 M I ^IC 11 Registration . R. •I I 1- 11 notice,1apply I n I- i? I 1- 11 property. Date The Commonwealth of Massachusetts Department of Industrial Accidents OIAcsallsasawaffess 600 Washington Street Boston, Mass. 02111 I�X� Workers' Compensation Insurance Affidavit Applicant information: PleasePRI1PTTidtiyr ❑ 1 am a homeowner pertorrning all work myselL am a sole proprietor and ha%e no one working in any capacity O [am an emploter prof iding workers' compensation for my employees working on this job. insurantr to. policy N ri I am a sole proprietor. general contractor. or homeowner (circle one) and have hired the contractors listed below who ha%e the following worker' compensation polices: city, phone N. Failure to secure coverage as required under Section 2SA of MGL 152 can lead to the imposition of criminal penalties of aline up to SI.SNAlland/or one years' imprisonment as well as civil penalties in the form ors STOP WORK ORDER and a Bat of SI" a day against me. I understand that ■ copy of this statement may be forwarded to the Office of Investigations of the DU for coverage verification. t do pains antpsoaftiervf-Acdury that the information provided above is out and correct / Signature11 � �� Dare Print namep J �r -� ` Phoned rr''t •() official use only do not %rite in this area to be completed by city or town official city or town: YARMODT11 ❑ check if Immediate response is required contact person: permit/license a nBuildiog Department plJcensing Board .261 13mtctmeo9 Office Health Department phoneNr_ (508) 398-2231 ext. pother Information and Instructions , Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their enmployees. As quoted from the "law , an employee is defined as every person in the service of another under am contract of hire, express or implied, oral or written. An entphger is defined as an indiv idual. 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 ommner 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 Lill the grounds or building appurtenant thereto shall not because of such employment be deemed to be an emplo%er. NIGL chapter 15_ section _5 also states that every state or local licensing agency shall withhold the issuance or rencival 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 mmork until acceptable evidence of compliance with the insurance requirements of this chapter hay e been presented to the contracting authority. Applicants Please till in the workers' compensation affidavit completely. by checking the box that applies to your situation and suppl% ing 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. Ilse affdavits 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 Imce el Imstlptleas 600 Washington Street Boston, Ma. 02111 fa: N: (617) 727-7749 phone 0: (617) 7274900 ext. 406, 409 or 375 TOWN OF YARMOUTH 1146ROUTE28 SOUTHYARMOUTH MASSACHUSETTS026644451 Telephone (508) 398.2231, ExL 261 — Fax (508) 398-2365 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT BUILDING ELECTRICAL GAS PLUMBING SIGNS Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at 6 Work Address is to be disposed of at the following location: 'DU T Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. 11•zs- a 1 (-2—�'—gnat o Applicant Date Permit No. MAScheck COMPLIANCE REPORT Massachusetts Energy Code MAScheck Software Version 2.01 CITY: Yarmouth , STATE: Massachusetts HDD: 6137 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 12-13-2001 DATE OF PLANS: 9/30/01 TITLE: PAT ADAMS PROJECT INFORMATION: NEW ADDITION AT 86 LOOKOUT ROAD YARMOUTHPORT, MA. COMPLIANCE: PASSES Required UA . 263 Your Home . 253 Permit Checked by/Date Area or Cavity Cont. Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 386 30.0 0.0 14 WALLS: Wood Frame, 160 O.C. 1737 13.0 0.0 143 GLAZING: Windows or Doors 138 0.330 46 GLAZING: Skylights 100 0.330 33 FLOORS: Over Unconditioned Space 386 19.0 0.0 18 HVAC EQUIPMENT: Furnace, 78.0 AFUE ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC a ipment selected to heat or cool the building shall be no greate 25% e d oad as specified in Sections 780CMR 13 and J4.4. Builder/Design �� y DatelZ.Id,bl MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.01 PAT ADAMS DATE: 12-13-2001 Bldg. Dept. Use CEILINGS: [ ] I. R-30 Comments/Location WALLS: [ ] I 1. Wood Frame, 16" O.C., R-13 Comments/Location WINDOWS AND GLASS DOORS: ( ] 1. U-value: 0.33 For windows without labeled U-values, describe features: # Panes_ Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location SKYLIGHTS: [ ] 1. U-value: 0.33 For skylights without labeled U-values, describe features: # Panes Frame Type Thermal Break? ( ] Yes [ ] No Comments/Location FLOORS: [ ] I 1. Over Unconditioned Space, R-19 Comments/Location HVAC EQUIPMENT: [ ] 1. Furnace, 78.0 AFUE AIR LEAKAGE: [ ] Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. When installed in the building envelope, recessed lighting fixtures shall meet one of the following requirements: 1. Type IC rated, manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated, in accordance with Standard ASTM E 283, with no more than 2.0 cfm (0.944 L/s) air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/ft2 pressure difference and shall be labeled. VAPOR RETARDER: [ ] I Required on the warm -in -winter side of all non -vented framed ceilings, walls, and floors. MATERIALS IDENTIFICATION: I I [ ) .Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R-values and glazing U-values must be clearly marked on the building plans or specifications. DUCT INSULATION: Ducts shall be insulated per Table J4.4.7.1. DUCT CONSTRUCTION: All accessible joints, seams, and connections of supply and return ductwork located outside conditioned space, including stud bays or joist cavities/spaces used to transport air, shall be sealed using mastic and fibrous backing tape installed according to the manufacturers installation instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted. The HVAC system must provide a means for balancing air and water systems. TEMPERATURE CONTROLS: Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in Sections780CMR 1310 and J4.4. SWIMMING POOLS: All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. HVAC PIPING INSULATION: HVAC piping conveying fluids above 120 F or chilled fluids below 55 F must be insulated to the following levels (in.): PIPE SIZES (in.) HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4" Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 Low temperature 120-200 0.5 1.0 1.0 1.5 Steam condensate any 1.0 1.0 1.5 2.0 COOLING SYSTEMS: Chilled water or 40-SS 0.5 0.5 0.75 1.0 refrigerant below 40 1.0 1.0 1.5 1.5 CIRCULATING HOT WATER SYSTEMS: Insulate circulating hot water pipes to the following levels (in.): PIPE SIZES (in.) NON -CIRCULATING CIRCULATING MAINS 6 RUNOUTS HEATED WATER TEMP (Ph RUNOUTS 0-l" 0-1.25" 1.5-2.0" 2.0+" 170-180 0.5 1.0 1.5 2.0 140-160 0.5 0.5 1.0 1.5 100-130 0.5 I 0.5 0.5 1.0 --�-NOTES TO FIELD(BuildingDepartment Use Only)------------------------- o,jo s 2l aC►E UEK--7- X 1 i vlouES WT 1v r=X iSTj NG. 2vo'9 s�# ,� �+.�5 gybe- eDOT OJua- uetmN47 IQ C-AC,11 EAL4 E1Cl3TlNCi . 23D lNscx._ � ycfLpi= t' Pac.FP i B2�T11£�Z. t" NDLES DO wDAQ,out--,JD M.( H.G SO. 0-ok.yu LS NAME MANIFOLD • ADDRESS SALESMAN TEL. JOB LOCATION 404-w.4 { =R - LcULA I D Y.uo�Tr.EPmI�- -�=c u �,zoor 3 ~A N M I47'rc c=e3mc4- Io me Root = 30 c. 4- . l'c DL. Z I �_ Roer A L Z4' • I� .c—c cacz�Roof- r3 � i3 �, 64MLZ O-s 4z3o0e" 3vr-olFl`c�gei' 3zr��5. LL= cox3o=IBo IZK30=3600 S K 30 =,ZOO IZx loizc $ K l Z. I' -a DCC�C��dL� I DEC 2 8 2001 I U M.C.H.C, SO. O-Ok.1U L5 MANIFOLD SALESMAN a cc,— 12.o 3 CL '►4'r`T't c..= 3 m c..� to 0c Root = 3oL� c—iLam lgooF 136wou i3 U4 6 air �►F����". 4.2)� /X�� Rr NAME ADDRESS TEL. JOB LOCATION 4fl4-w S .(o,R �— S�vorcc�T Ra -11 << aw Root LL= Cox30--IPo iZK3O=3�o 8 K 30 =Z$o DC..= loKlo,roc� IZx 12.0 DEC ET I DEC 2 8 2001 Z4. (o CEILING/ROOF BEAM A Tleeam^',rs.55 san.l ra.ne.r. TOo,aB�20 4 PCs of 1.75" X 18" 1.9E Mlcrollam® LVL Pop I of 11 N 1 1T2rm1 2:18:20 PM Pop THIS PRO UCT MEETS OR EXCEEDS THE SET DESIGN CONTROLS FOR THE APPLICATION AND LOADS LISTED s 21' 8' LOADS: Product Diagram Is Conceptual. Analysis for Beam Member Supporting FLOOR - RES. Application. Tributary Load Width: 20' Loads(psf): 40 Live at 100% duration; 10 Dead; 0 Partition; and: TYPE CLASS LIVE DEAD LOCATION APPLICATION COMMENT Unifonn(plt) Floor(1.00) 780 260 0 to 21' 8' Replaces SUPPORTS: INPUT BEARING REACTIONS(lbs.) WIDTH LENGTH LNE/DEAD/rOT. PLY DEPTH DETAIL OTHER 1 2x4 Plate 3.50" 3.914" 8450 / 3194 / 11644 1 18.0" Detail L1 2 2x4 Plate 3.50" 3.914" 8450 / 3194 / 11644 1 18.0" Detail L7 - See TJ SPECIFIERS / BUILDER'S GUIDES for detail(s): Lt. - Bearing length requirement exceeds Input at support(s)1. 2. Supplemental hardware is required to satisfy bearing requirements. DESIGN CONTROLS: MAXIMUM Shear(lb) 11465 Moment(ft4b) 61144 Live Defl.(in) Total Defl.(in) DESIGN CONTROL CONTROL 9718 23940 Passed(41%) 61144 77506 Passed(79%) 0.605 0.711 Passed(U423) 0.834 1.067 Passed(L/307) LOCATION Lt end Span 1 under Floor loading MID Span 1 under Floor loading MID Span 1 under Floor loading MID Span 1 under Floor loading - Deflection Criteria: STANDARD(U.: 1.1360, TL•L240). - Bracing(Lu): All compression edges (top and bottom) must be braced at 2' 8" o/c unless detailed otherwise. Proper attachment and positioning of lateral bracing is required to achieve member stability. ADDITIONAL NOTES: - IMPORTANTI The analysis presented Is output from software developed by Trus Joist (TJ). TJ warrants the sizing of its products by this software will be accomplished in accordance with TJ product design criteria and code accepted design values. The specific product application, Input design loads, and stated dimensions have been provided by the software user. This output has not been reviewed by a TJ Associate. - Not all products are readily available. Check with your supplier or TJ technical representative for product availability. -THIS ANALYSIS FOR TRUS JOIST PRODUCTS ONLY] PRODUCT SUBSTITUTION VOIDS THIS ANALYSIS. -Allowable Stress Design methodology was used for Code NER analyzing the TJ Residential product listed above. - Note: See TJ SPECIFIERS / BUILDER'S GUIDES for multiple ply connection. )JECT INFORMATION OPERATOR INFORMATION: ED SHEA Mid -Cape Home Centers ADAMS JOB Bill Rubel 86 LOOKOUT RD Route 134 YARMOUTHPORT MA South Dennis, MA 02660 508-398-6071 Copyrgra C 2000 by Tw Joist a Vftyvha BuaY,aaa. TJFro- and T.FBe - ne vsdwnwm orT= Jom . Miaolam® is a rag Vadernrlt or Tnn Joist. C:1Program F9ea\Trw JdMTJEs&riM 1DAMSkbn �er~a�CEILING/ROOFBEAM B T � w, "s.ss . ` , µ�,re,�p 2 Pcs of 1.75" x 11.876" 1.9E Microllam® LVL BFAMUSA 'til l 1y127101 2:17:36 PM Pape 1 of 1 Build Cock iM THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN CONTROLS FOR THE APPLICATION AND LOADS LISTED Overall Dimension w 21' 8" 6" + 12' 8" a--4' 6"-4 Product Diagram Is Conceptual. LOADS, Analysis for Beam Member Supporting FLOOR- RES. Application. Tributary Load Width: 2V Loads(psf): 40 Live at 100% duration;10 Dead; 0 Partition; and: TYPE CLASS LIVE DEAD LOCATION APPLICATION COMMENT Unifonn(plf) Floor(1.00) 760 260 0 to 2l' 8" Replaces SUPPORTS: INPUT BEARING REACTIONS(lbs.) WIDTH LENGTH UVE/DEAD/TOT. PLY DEPTH DETAIL OTHER 1 2x4 Plate 3.5(r 3.5" -1960 /-761-2036 1 11.9" Detail L1 2 Column 3.50" 4.492" 8773 / 3017 / 11790 1 11.9" Detail 83 3 Column 3.50" 4.492" 8773 / 3017 / 11790 1 11.9* Detail B3 4 2x4 Plate 3.5(r 3.5" -1960 / -76 / -2036 1 11.9" Detail L7 - See TJ SPECIFIERS / BUILDER'S GUIDES for detail(s): Lt, B3. - Bearing length requirement exceeds Input at supports) 2, 3. Supplemental hardware is required to satisfy bearing requirements. DESIGN CONTROLS: MAXIMUM DESIGN CONTROL CONTROL LOCATION Shear(lb) 6718 5524 7897 Passed(70%) Lt. end Span 2 under Floor ADJACENT span loading Momentift4b) 12108 12108 17848 Passed(68%) Lt end Span 2 under Floor ADJACENT span loading Live Defl(in) 0.191 0.422 Passed(U798) MID Span 2 under Floor ALTERNATE span loading Total Defl.(in) 0.252 0.633 Passed(L/603) MID Span 2 under Floor ALTERNATE span loading - Deflection Criteria STANDARD(LL• Lr". TL•L/240). - Bracing(Lu): Ali compression edges (top and bottom) must be braced at 7 8" o/c unless detailed otherwise. Proper attachment and positioning of lateral bracing is required to achieve member stability. -The load conditions considered in this design Include alternate and adjacent member skip loading. - Uplift exceeds 1000 lbs for unbalanced load. ADDITIONAL NOTES: - IMPORTANT) The analysis presented is output from software developed by Trus Joist (TJ). TJ warrants the sizing of its products by this software will be accomplished in accordance with TJ product design aiteria and code accepted design values. The specific product application, input design loads, and stated dimensions have been provided by the software user. This output has not been reviewed by a TJ Associate. - Not all products are readily available. Check with your supplier or TJ technical representative for product availability. -THIS ANALYSIS FOR TRUS JOIST PRODUCTS ONLY) PRODUCT SUBSTITUTION VOIDS THIS ANALYSIS. -Allowable Stress Design methodology was used for Code NER analyzing the TJ Residential product listed above. - Note: See TJ SPECIFIER'S / BUILDER'S GUIDES for multiple ply connection. PROJECT INFORMATION ED SHEA ADAMSJOB 86 LOOKOUT RD YARMOUTHPORT MA OPERATOR INFORMATION: Mid -Cape Home Centers Bill Rubel Route 134 South Dennis, MA 02660 508-398-6071 Copyrip902odoby Trw JoKswkyertueuur BualOeaa. TJ4 o-wWTJ4M m'"amtndeo UdThin Joint. Mcro6me Is a reeiataad tradenwk of Trw Jolet. C:1ProW= FMalTrw.WMTJaB WAVDAMS-BJm TO THE BEST OF MY INFORMATION, KNOWLEDGE~ AND BELIEF THE sreVCT&'9A-]; SHOWN ON THIS PLAN HAS BEEN LOCA MR GROUND AS INDICATED =f c .y� '0 Nl-- "AS-BUILT" PLOT PLAN YARMOUTIL MASS_ Lor3i , -d06 ZodKo1T /a --op DATE fir. 11, Z=/ ISCALE =S'O JOB _/ VV.?-00_ I CLIENT AoAoyf P.O. BOX 713 SOUTH DENNIS, MASS 3-3922 02660 (FA TG'.K KCl CGY 15 /.9 ��.12 RE- , - "I Aeev = Z7, Bio 2$ qov s�J M THE BEST OF MY INFORMATION, KNOWLEDGE; AND BELIEF THE freucrrrz�t SHOWN ON THIS PLAN HAS .BEEN LOCATipe GROUND AS INDICATED Z c ;;�A' w'; i.LL• c:: t \B� \ er;l_V_ \� 1 i APPROVED YARWTHCOtdYJi ' CY.}iRD "AS —BUILT" PLOT PLAN YARMOUTEL MASS_ Lora/ , Y`86 Looxavi— ,ea,00 DATE fir. /I Z�/ SCALE I"-- � JOB / VV.?-0o CLIENT R.O. SOUTH C Please fill out the form in its entirety providing color(-ehos where, necessary. mrcAzru1IDS.4mmF.I' moRIlGHnNG&EL xTmc3lEmoNsITEPLANS' FIDRNEW OUSES NAMEOF OWNER(S): ?a-r 60AM (M map �m-t ' 1 I ; 1 ' u_ G FOUNDATION (ism MAX. ExPosm)) CON T11ER DRIVEWAY: - . - — i ". STEPS (omxcm BBICK/CxmzNT/OTHEIG: SIDING TYPE: (NI-11 TE L', PAP.. COLOR: IJI411UL, SUMNF�-Y (OMICATE BRICKISTUCCO(WOODFACED) COLOR ROOF MA1`ERIAU-45 l.IALi" PITCH (7/12 MIN) COLOR &AM &F*X MAX EXP. WINDOWS (GRILLES REQUIRED) -INDICATE SIZES IF NOT LISTED ON ELEVATIONS: 14N Tlt-T G�QSI� -- w" VrE - w00D 0jzjLL-* DOORS (INDICATE SIZES AND STYLE IF NOT LmxD ON zLzvAT orft COLOR: i!.IFJL'E2�, �P�CI.! w�p - c.�t-l►Tt - c-�DOD tn�IL� TRIM: (ALL wIImoWS & DOORS TRnoA= WITH ISA 49 COLOR: C4= MATERIAL OF TRIM (WOOD VINYL, ALUM OM) W LI rr G 91 (WOOD/VINYL) (PANEIJOVLOUVERED) COLOR: GUTTERS (WOOD A� COLOR 01='r— SIZE & STYLE: COLOR (JtA I"�' — ....... .... 1 1 • ' YA _ 1 1 - -1 1 1 fA 1 COLOR SKYLIGHTS:TYPE/SIZE: evrp—4:7da>—Ve rnoc; COLOR DECK. SIZE & MATERIAL: X24 p • I COLOR MiGgiG (MAX. HEIGHT 6T. M a.h) 0 cm 9 COLOR (SHOW LAYOUT & RUNNING FOOTAGE ON SITE PLAN) (P.T. OR FIELDSTONE -CONCRETE INAPPROPRIATE) (SHOW LAYOUT & RUNNING FOOTAGE ON SITE PLAN) SIGNS: (indicate size, style, colors) SIGN POST: (indicate size, style, ADDITIONAL SW COLOR COLOR REV. 6M ••�•�,"' Old Mpg lEgbway Regional Oslo= District Com�� ea, Il' in the Town of Yarmouth for a CERTIFICATE OF APPROPRIATENESS _ Appliotioa is hereby made in triplicate, for the istatanoe of a Caffma a cf Apptopn� tmderSectim 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed vvorlc as described below and on per, drawmgt or photographs aocauipanymg this applicatico for: CHECK CATEGORIES THAT APPLY: 1. E%terior Bmldiag Const union : 13 New Buadmg Addition Q Alteration Tndi�o VPc Q Ham Q Gararp Q Commercial Q Other 2. Everiorpamnng: Q 3. Sign or Billboards: Q New Sign Q E'tistiagSign Q Repainting esistiagsign YAR oulH. Q wall Q� Q Dena GYtit J 4. S ta:arc Q Fence `\ TITEOR PRM LEGIBLY DATE ( IN ADDRESS OF PROPOSED (WORK ,/1 _ASSESSORS MAP NO. 1141 / 14 I OWNER tz�lryERJ err F �LYi S ASSESSORS LOT NO. '7 _ HOME ADDRESS `si1ME //11 /� TEIFpHONE NO. 2 td5! AGENT OR wNrRACInR6tlEa Wsmm I�QRQl wise �{ TIME LONE NO 39I• 855j' ADDRESS_ 12 \JLLA '& MMV-- e�q • :S�LrLL L49"TCLrr4( USE ATTACHED SHEET IN PACKET FOR ABUTTING OWNERS DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of wars; to be done including materials to be use& In case of signs, give locations of costing sign and proposed to atiom of ww signs. (Attach additional sboe4 if neoessaryl 2zq 1( Ito -su .- O f D1QIQ4 el-,. lacvMok-D 9. x DGCY, aVr- 6ae,- e"pvrL Since below lineforCommittee use only. Received by OKHC Date Check i : ` %"l t By7,1 �T_ APPROVED Q IMPORTANT: ICCatir"te is approved, approval is subject to the 10 day appeal period provided is the Art. DISAPPROVED Q Please rct ua to Yarmouth OKHC Disnid Committee Yarmouth Tows Hall, 1146 Route 29, & Yarmouth, MA 02664 SPECIFICATION SHEET'. (YARMOUTH OKHC) • Pleas f out the form in its entirety providing color chips where -' necessam i"icATEl4NDscAPING,EaFmORLIGHTWG&cELECTR/CAfETERONs/TEPLANs FORNE►V OUSEK NAME OF OWNER(S): ?qT 8DArn LQ�zn�stK FOUNDATION (ism mAx 000SED< CONCRE THER DRIVEWAYe 1 VhkhK-W*V. STEPS (INDICATE BRICWCEMENVOTHER): SIDINGTYPE: W(-UTC 0-09A-F- COLOR. VJ1frUeAL, C-IMCgEY (INDICATE BRICK/STUCCO/WOODFACED) COLOR: ROOF MATERIAL: JL�,&L'T PITCH (7/ .) COLOR &ACK. &X4,D MAX. EXP WINDOWS (GRUANS REQUIRED)INDICATE SIZES IF NOT LISTED ON ELEVA-4ONS: AtvZV?—,�;E� -itl—T I,. sa -- wilr,rE - L000D 62►u,S DOORS (INDICATE SIZES AND STYLE IF NOT LISTED ON ELEVATIONS): COLOR w�(�-l►T - r.-)ODD C�21LLS TRINL• (ALL WINDOWS & DOORS TRWMED WITH 1X3 4'1X5)J COLOR OF�= MATERIAL OF TRIM (WOOD VINYL, ALUTAHNUr0 W .SwI (WOODNEM) (PANELED/LOUVERED) COLOR " GUTTERS (WOOD ALUD COLOR OV�F SIZE & STYLE: COLOR &JAITF, COLOR (INDICATE SIZES IF NOT LISTED ON ELVATIONS) SKYLIGHTS: T( Q�-F .. COLOR AtD/l Z2 �1 it-vnrnr�G DECK: SIZE & MATERIAL: �(nm COLOR: o oh any G(MAX. HEIGHT 61: STYLE. COLOR: (SHOW LAYOUT &RUNNING FOOTAGE ON SITE PLAN) ' (P.T. OR FIELDSTONE -CONCRETE INAPPROPRIATE) (SHOW LAYOUT & RUNNING FOOTAGE ON SITE PLAN) rnt nu• \LCULATION FOR PERMIT COST TYPE OF ROOM, ETC NO —e 1 OP'S -?�/ '57S DINING ROOM LIVING ROOM GREAT ROOM COMPUTER ROOM DEN OFFICE BATH STORAGE AREA MUD ROOM DECK WITH ROOF DECK OPEN PORCH OPEN PORCH CLOSED SUN ROOM HEATED SUN ROOM UNHEATED LAUNDRY ROOM ING L V.Wktem REROOFING WINDOW REPLACEMENT applicable departments. TOWN OF YARMOUTH 9�7 BUILDING DEPARTMENT BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMTITIAL SHEET /.\J iT.@7Zd#33131 A :Cy i1 I! :101 g715 WATER DEPARTMENT: Determines Compliance of Water Availability and or existing location. ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage. CONSERVATION COMMISSION: Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. FIRE DEPARTMENT: Determines Compliance to State and Town Requirements for Personal Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc. REVIEWED BY: 1. WATER DEPARTMENT: DATE: I- -O WA: 2. . ENGINEERING DEPARTMENT. DATE: N/A 3. CONSERVATION: DATE: N/A 4. HEALTH DEPARTMENT: DATE: N/A 3. WTKNG INSPECTOR DATE: N/A 6. PLUMBING INSPECTOR DATE: N/A 7. FIRE DEPARTMENT: COMMENTS: RECEIPT OF COPY: SIGNATURE OF APPLICANT. DATE: WbaW"-BuddugDgi- Gn0w"-WuvDept. - YelimCo" -HW[hDcM - notcwr- Enpminj DcpL - GWdwzod-FkcDgLComavabw -- , TOWN OF YARMOUTH BUILDING DEPARTMENT BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF A TRANSMTITIAL SHEET Building Site Location: ° Ll -'. f / ] c Vf', • Map No: y Lot No: I?%` Proposed Improvement �iGY — 1J G{�+/ 1 C�d TT-- Applicant: �I C4. n �1�_.f _sht, l lf'lhs r Address: The Building Department will be responsible for assisting the applicant by dispatching your plans and or application to the following applicable departments. RESIDENTIAL AND/OR COMMERCIAL BUILDING WATER DEPARTMENT: Determines Compliance of Water Availability and or existing location ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage. CONSERVATION COMMISSION: Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. FIRE DEPARTMENT: Determines Compliance to State and Town Requirements for Personal Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Eta REVIEWED BY: 1. WATER DEPARTMENT: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSER' 4. HEALTH S. WIRING INSPECTOR DATE: N/A: 6. PLUMBING INSPECTOR DATE: N/A: 7. FIRE DEPARTMENT: DATE: N/A PLEASE NOTE COMMENTS: RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: Wbhc copy —BuMkg Dept - Yenow Copy —Hamth Dept - Pink Copy —EnBmeciuL Dept - G�-Fne DwWonsmatim TOWN OF YARMOUTH BUILDING DEPARTMENT PLAN REVIEW & BUILDING PERMIT APPLICATION REVIEW NOTES ADDRESS: Map / Lot: Date of Initial Review: a } Other /v- " Inspector. ;� , 1- � Approval Date: NOTES: L Zoning Denial (if applicable): Section 10431, pare Change, Extension or Alteration (pr&cdsting, nmoonfammg) The proposed requires a Special Permit from the Zoning Board ofAppeals. Other Building Code Denial (if applicable) R".11-01 OE.Y = O Building Site Location Proposed Improvement: ,r.:. TOWN OF YARMOUTH BUILDING DEPARTMENT BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTIAL SHEET No:,/—%w9__ Lot No: O - 4��' a The Building Department will be responsible for assisting the applicant by dispatching your plans and or application to the following applicable departments. RESIDENTIAL AND/OR COMMERCIAL BUILDING WATER DEPARTMENT: Determines Compliance of Water Availability and or existing location. ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage. CONSERVATION COMMISSION: Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. FIRE DEPARTMENT: Determines Compliance to State and Town Requirements for Personal Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Eta REVIEWED BY: 1. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: TE• N/A: 3. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT: ENT: INDUSTRIAL AND/OR COMMERCIAL PERMITS i. WRUNG INSPECTOR: DATE: NIA: 6. PLUMBING INSPECTOR: DATE: N/A: 7. FIRE DEPARTMENT- DATE: N/A PLEASE NOTE COMMENTS: RECEIPT OF COPY: SIGNATURE OF 1 - Sc - 0 Whft Dopy—Buddm{Dept- Ycflm CWy—Hahh Dept - Pink Copy—Engji Q {DeM - Gddemod-Fin:DepoC� VoiPS, TOWN OF YARMOUTH ABuilding Department Town Hall Yarmouth, MA 02664 (508)396-2231 e)U61 G', �76d Building Location: 00086 LOOKOUT RD Owner's Name: ELIZABETH P ADAMS Owner's Address: Yannouthport MA 02675 Owner's Telephone: Gasfitter Name: Joe Gough License Number. 10088 Company Name: Gough Plumbing Company Phone: (508) 432-4886 PERMIT TO DO GASFITTING WORK (OFFICE USE ONLY Recorded By. Ic PERMIT NO. G-02-746 Permit Fee: $25.00 Payment Type: Check Check Number. 01910 Issue Date: 4/24/02 Type of Work: Renovation Comments: ranges INSPECTION RECORD Date• Note Progress - Corrections and Remarks Inspector L Date Printed: 4/25✓02 AM New ❑ Plans Submitted APPLICATION FOR PERMIT TO DO GASFITIING (OFFICE USE ONLY) M H - S APR 200211 Fee: $ ov PERMIT NO. 1F11U Z Date /% Owner's �,,/� C/ Name AA 4 ,xdiD 5 Type of Occupancy e Renovation— x Replacement ❑ Yes[]NoC 0 Y Ic N rA O Q H cc F r7 J_ w W O cf W C 2 x (a Q O W !QQ- Q~ W ¢ W O O y O = W 1W- Q x W Q¢ OF W M Z W -'r Z U Z W x W N W O aO O W V _ y W QFQ Y- w j Q¢ mQ > LL W¢ J Q M W>¢ x 0 a x z Q 0 0 G O W U. O O J U Ic> o. h 0 SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR (PRINT OR TYPl7 Installing Company Name Address Business Telephone Name of Licensed Plumber or Gasfitter Check One: ❑ Corp. ❑ Paltrtership _ ❑ FimVCompany INSURANCE COVERAGE: U Check O e have a current liability Insurance policy or i substantial equivalent Yes Nc ❑ If you have checked yes, please Indicate 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, Signature of Owner or Owner's Agent I hereby certify that all of the details and Information I have submitted (or entered) In above application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. License Number TYPE LICENSE: Plu❑IC mber Gasfitter aster ❑Joumeyman �y TOWN OF YARMOUTH S� Building Department Town Hap `a Yarmouth, MA 02664 (508) 398.2231 OXL261 P Building Location: 00086 LOOKOUT RD Owner's Name: ELIZABETH P ADAMS OwAies Address: YarmouthpoR MA 02675 Owner's Telephone: Plumber Name: License Number. Company Name: Company Phone: John Gough 10088 Gough Plumbing (508) 432-4886 PERMIT TO DO PLUMBING WORK (OFFICE USE ONLY Recorded By. la PERMIT NO. P-02-520 Permit Fee: $39.00 Payment Type: Check Check Number. 1910 Issue Date: 4/24102 Type of Work: Renovation Comments: 2 kitchen sinks, water piping INSPECTION RECORD Date Note Progress - Corrections and Remarks Insoector Date Printed: 4/25/02 11 APPLICATION FOR PERMIT TO DO PLUMBING TOWN OF YARMO (OFFICE USE ONLY) � NPHOTN D By ltiQ�- APR 2 2002 Fee: $ 3cl PERMIT NO. I"'Do2� Sa-4 Date 0-0— Building, , 0����, n� Owner's pAf �/,oms AT: Location � / _ /C Name Type of Occupancy New ❑ Renovat' Replacement ❑ Plans Submitted Yes❑ No z y y O V Z y > 6i uj y Z y W x Q F. y Z M O z 0 z y z IS a 2 7 to 0. W m W N ¢ Q W ? C Q Z¢ a cc J rt W x O Q >> O x >+ p H Q Y W LL Y W a Q > x; t- O y y Z Q I.- Y Z 2 O O y Z Z Q W F- O V S 3 ttj 4 g m ai S o g 3 i w v' I c a 3¢ m o SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR (PRINT OR TYPE) Installing Company Check One: ❑ Corp. Address ff0' -1���� /p ❑ Pa rship c'"lzcr- �J� 5aa-r rr iMV pan Business Telephone o Name of Licensed Plumber INSURANCE COVERAGE: I have a current liability Insurance policy or its substantial equivalent Check Yes No ❑ If you have checked YES, please indicate the type of coverage by c cking 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 voveage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement Signature of OwnerorOwner'aAgent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Check qq Owner ❑ Agent ❑ of Licensed License Num r Type: MasterEr Journeyman 0 APPLICATION FOR -PERMIT TO PERFORM -ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, (MEC). 527 CMR 12.00 - (OFFICE USE ONLY) --TOWN OF YARMOUTH By / Fee: $ PERMIT NO. (PLEASE PRINT IN INK OR TYPE ALL INFORANT10N) Date: Tethe Inspeetor'of Wires: By this application the undersigned gives notice of his or her inte "described below. Location (Street & Number), /'7t=A4. tt F _r to perform the electrical work i Owner's Address Is this permit in conjunction tth a budding Permit? Cl Yes o (Check Appropriate Box) Purpose of Building Utility Authorization No.� Existing Service Amps / / n / �Yblts Overhead ❑ Undgrd ❑ N0 007of Meters New Service Amps / Volts Overhead❑ Undgrd❑ 1yT 5me crs t Number of Feeders and Ampacicy / Location and Nature of Proposed electrical No. of Recessed Fixtures No. of Ced -Susp,(Paddle) Fans No. of Total Transformers KVA No of Li6ting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Above In- Swimming Pool grnd. gmd. ❑ No. of Emergency Ug ting Bartery 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 r To— ns KW No. of Self -Contained Detection/Alerting Device No. of Dishwashers Space/Area Heating KW Municipal Local ❑ Connection ❑ Other Dryers No. of D ry Heating Appliances ILW g pp vary y No. of Devices or Equipvalent No. of Water Heaters KW No. of No. of Signs Ballasts Data Wuing: No. of Device or Equivalent No. H dromassa a Bathtubs Y 6 No. of Motors Total HP TelecamfD"itioos Wiring: No. of Devices or E uivahnt Attacb additional detail if derind, or at ngnired by the Luperror of IUnr. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of Lability insurance including `completed operation' coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER❑ (Specify:) ' (Expiration Date) Estimated Value of Electrical Work: (When required by municipal polity) Work to Stan: T - Z 1 - 0 O Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and nalties of rjury, that the information on this application is true and complete. _ FIRM NAME: LIC. N I. , Licensee:140 L1 F� Signature A 'I v LIC.NO. 3ZIL3 (If applicable, enter'ex empi/ in the license nu r 6 .) - - Bus. TH. No.: Address:710.—Q %�.L.)L( [ if -e-� Ala Tel. No.: OWNER IJ NSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, Ihereby waive this requirement. I and the (check one) owner owner's agent. Owner/Agent Signature.- Telephone No. [an. 04/001 . +�°' w•, TOWN OF YARMOUTH Building Department s Town Hall Yamwuth, MA 02664 (508) 396.2231 exU61 E V/ Building Location: 00086 LOOKOUT RD Owner's Name: ELIZABETH P ADAMS Owner's Address: 00086 LOOKOUT RD Yarmouthport MA 02675 Owner's Telephone: (508) 362-6513 Electrician Name: Merry, Ed License Number: E35145 Company Name: E.F.WINSLOW Company Phone: (508) 394-7778 PERMIT TO PERFORM ELECTRICAL WORK (OFFICE USE ONLY Recorded By: Ic PERMIT NO. Permit Fee: $25.00 Payment Type: Cash Check Number 51596 Issue Date: 3/26/02 Type of Work: Renovation Comments: replace meter socket only, new service, drop splices also INSPECTION RECORD Date Note Progress - Corrections and Remarks inspector Ho Date Printed: 3/26/02 511 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Musachuscrts Electrical Code, (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR To the Inspector of Wires: By work described below. Location (Street & Owner or Tenant (OFFICE USE ONLY) r Y�6TH BY ' fj $/sf& a Fee: $ �7 PERMIT NO. C aO - //9 undersigned gives notice of his or her intention to perform the electrical No. 3c,a - (-50 Owner's Address -a 14q\-x- Is this permit in conjunction with a building permit? ❑ Yes RrNo (Check Appropriate Box) Purpose of Building Utility Utility Authorization No. Existing Service�Q Amps lao I a 1v Volts Overhead Undgrd ❑ No. of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity %�o 411 Location and Nature of Proposed RecessedNo. of s No. of Ceil.-SuspTransformers o. of Total KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Above n- Swimming Pool and. ❑ and. ❑ No. o Emergency Lighting BatteryUnits No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. 01 Detection an Initiating Devices No. of Ranges Total No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers Heat rap Totals: um r ors — — — No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW MunmipaI Local Other ❑ Connection No. of D ers ry Heating Appliances KW g pp Secutity Systems: No. of Devices or Equilivalent No. of Water Heaters KW No. of No. of Signs Ballasts Data Wiring No. of devices or Equivalent dromassa a Bathtubs No. H y g No. of Motors Total HP Telecommunications wiring: No. of Devices or Equivalent Attach additional detail if desired, or as required by the Inspector of tyres. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCES BOND[] OTHERD (Specify: G�/� '�/�$ICJ3 (Expiration D e) Estimated Value of Elec rical Work: (When required y municipal policy.) Work to Start• 0 Inspections to be requested in accordance with MEC Rule 10, and upon completion. 1 certify, under the pains and penalties f 'u , that the info anon on this application is true and complete. FIRM NAME: C. NO.� 3 Licensee: Signature LIC. N (If applicabl1,ent " Et" in, the Iic�number line.) Bu el. No.: Address,1 r Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the I [censee does ave the liability insurance coverage normally required by law. By my signature below, 1 hereby waive this requirement. 1 am the (check one) owner ❑ owner's agent. 11 Owner/Agent Signature Telephone No. [Rev. txrool + `4 TOWN OF YARMOUTH Building Department Town Hall Yarmouth. AAA 02664 (508) 39&2231 94261 E U- cy Building Location: 00086 LOOKOUT RD Owner's Name: ELIZABETH P ADAMS Owner's Address: 00086 LOOKOUT RD Yarnouthport MA 02675 • Owner's Telephone: Electrician Name: License Number: Company Name: Company Phone: Lynch, Edward 35609E 1760-3110 PERMIT TO PERFORM ELECTRICAL WORK (OFFICE USE ONLY Recorded By. Ic PERMIT NO. Permft Fee: $50.00 Payment Type: Check Check Number 1044 Issue Date: 4/22/02 Type of Work: New Comments: new addition/kitchen INSPECTION RECORD Date, Note Progress - Corrections and Remarks Inspector 412,110L o (., Date Printed: 4=02 SO'S TOWN OF YARMOUTH Building Department Town Hall Yamwuth, AAA 02664 (508) 398-2231 exL281 E q Building Location: 00086 LOOKOUT RD Owner's Name: ELIZABETH P ADAMS Owner's Address: 00086 LOOKOUT RD Yarmouthport MA 02675 Owner's Telephone: Electrician Name: Lynch, Edward License Number. 35609E Company Name: Company Phone: (508) 760-3110 PERMIT TO PERFORM ELECTRICAL WORK (OFFICE USE ONLY Recorded By: Ic PERMIT NO. Permit Fee: $50.00 Payment Type: Check Check Number 1044 Issue Date: 4/22102 Type of Work: New Comments: new addition/kitchen INSPECTION RECORD Date, I Note Progress - Corrections and Remarks I Inspector 723 Date Printed: 4=02 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in =ordance with the Massachusetts ElectriW Code, (MEC), 527 CMR 12.00 (OFFICE USE ONLY) �o fi ?TH 13 Lc APR 19 02 Fee: $ `Jn- 10�41, l PERMIT NO. G2---7QO (PLEASE PRINT IN INK O N) Date:. To the Inspector of Wires: By this application the undersigned gives notice of his or her work described below. _ . - t A r Location (Street & Owner or Tenant II cf 7' M=4 tl Telephone No. Owner's Address Is this permit in conjunction with a building permit? CXYes ❑No (Check Appropriate Box) Purpose of Building iC/14- // / 419 Utility Authorization No. the electrical Existing ServicdEo Amps r J U / a (&tilts Overhead Undgrd ❑ No. of Meterr- New Service Amps / Volts Overhead Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed electrical Work _ ye �fi l/ % /t(�/% '%� &,Tc Cora letiono the oflowing table maybe waivedbrthelnr ctorn <vnrt No. o-Tom- No. of Recessed Fixtures No. of s Transformers KVA No. of Li6ting Outlets No. of Hot Tubs Generators KVA ve n- ❑ ❑ o. o Emergency Lighting No. of Lighting Fixtures SwimmingPool cod. d. Bane Units No. of Receptacle Outlets % No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. ot Detection an Initiatin Devictal es Tons No. of Ranges No. of Air Cond. No. of Alerting Devices No. of Waste Disposers Heat rap Totals: um r ors — — — No. of Self -Contained Detection/Alerting Devices No. of Dishwashers S ace/Area Heating KW P g Local ❑ Co n Connection Other Connection No. of Dryers Heating Appliances KW SeculoltyDor Equilivalent No. of Water No. of No. of Data Wmrl Heaters KW Signs Ballasts No. of Devices or Equivalent No. H dromassa a Bathtubs Y g No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent Attach additional detail if desired or as required by the Inspector of tires. INSURANCE COVERAGE Unless waived by the owner, no permit for the performance of electrical work may be issued unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE �J BONDQ OTHER (Specify:) (Expiration Dare) Estimated Value o El c W : I?O 00 (When required by municipal policy.) Work to Start: f-Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the ins d penalties of perjury, that the information on this application is we and complete. FIRM NAME: LIC. NO. Licensee: �.�! Signature LIC. NO. (If applicabl r,Rter; exempt in the ' pnse number line.) us. Tel. No.: OWNER'S INSURANCE WAWER: I'am aware that the lance does n below, I hereby waive this requirement. I am the (check one) owner Owner/Agent Signature [Rev. &VWI 4 AIL Tel. No.: . the liability insurance coverage normally required by law. By OL r�iy sigmture owner's agent. 11 Telephone No. .a K r f �.x• t i J J DI u `w 4 Mr. Edward Shea Shea Custom Carpentry 12 Villagebrook Rd. South Yarmouth, MA 02664 Subject: Pat Adams Addition 86 Outlook Rd. Yannouthport, Massachusetts Dear Shea: Consulting'Engineers 835 Samoset Road; Eastham, MA 02642 Telephone 508-255-1422 You have requested this office to assess the structural condition and serviceability of recently installed foundation which is expected to support the proposed 16'-0* x 24'-3 11T timber framed addition at the above referenced site. Description of the existing foundation: Based on field measurements completed by this office on March 7, 2002 the substructure which will be supporting the addition proper above consists of an 8 inch cast in place concrete masonry foundation wall and footing. The foundation wall is continuous along the outer perimeter of this addition. The supporting subsoil stratum was exposed and not bacidilled each side of the excavation trench. One seven -foot deep soil test pit along this site adjacent to the proposed addition was executed on March 7, 2002. The soil observed along this location was found to be medium stiff clay with lens of sandy gravel. Scope of damage: No concrete cracks were observed along the foundation wall at the day of our inspection. Results: The applied (live and dead load) soil bearing pressure along the base of the proposed footing was determined to be 0.5 tons per square foot. Recommendations: The allowable soil bearing recommended for the soil supporting the proposed foundation and superstructure (addition) above is 1 ton per square foot. Therefore, the as constructed foundation wall and footing is structurally adequate to receive the proposed addition above. f - Mr Edward Shea- - �f'^_,J .-.fit l.+w' .+f, �- .�- _ .• .._. '.. ���•i+ -.+.. ` However, since the foundation trench was left open and not backfilled and clay soil seams were found within the soil matrix of the local soil this condition creates pockets of perched water to occur during rainstorms. This temporarily perched water surface creates a high hydraulic gradient to occur above and along the base of the existing footing. This high hydraulic gradient causes excessive pore water pressure throughout the soil supporting the base of the footing of which may introduce a soil quick condition (soil weakening, soil boils) along certain specific areas along this foundation. Since if this quick condition occurs along the soil stratum supporting the footing, structural problems may arise to this addition. Therefore, I recommend to backfill the foundation trench and build the timber frame superstructure above and have the foundation supporting this addition inspected by an engineer prior to installing final weather flashing and windows along this addition. If cracks and/or excessive soil settlement is observed at that time of field inspection along specific areas of the foundation the damaged concrete foundation should be permanently underpinned and the crack(s) could be repaired. If you have any further questions please feel free to call. Respectfully Submitted, JD13 Consulting Engineers. gTMMTuaw -M406T_, Joseph D. Bianchi, P.E. JDB/eab 7:00Z . 83 4 �aa�a, Network Blitz , , Page t of 1 Graham, Dick From: Spallina, Jane Sent: Thursday, February 21, 2002 4:29 PM To: Graham, Dick Tullie, Don; Stone, Bill Cc: Brandolini, Jim Subject Inspections 2 22 02 0 86 Lookout Y. P. 0l/ A V,01 Foundation B-02-588 01), grow, cr W"'Ye'_' 6q"``l C d�,'V'O fo a xr olot s 7�- vto 5-41"74" 2/22/02 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 � ( f a� I (OFFICE USE ONLY) Fee:$ o%J`.b0 PERMIT NO. E-D I- l F 9 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: _ To the Inspector of Wires: By this application the undersigned gives notice of his or her intend described below. // �%�Q / Location (Street & Number) W l�� (� Owner or Tenant Owner's Address Is this permit in conjuncEAmps uilding permit? Cl Yes o (Check Appropri Purpose of Buildiingr ,�, Utility Authorization No. Existing Service (� (LQ / _-2,.7(7olts Overhead ❑ Undgrd New Service Amps ! Volts Overhead ❑ Undgrd Number of Feeders and Ampacity Location and Nature of Proposed electrical Work: to perform the electrical work Ayi-a77otlKeZagO101_ Dfeters� Coro &tion of the /611ming table maybe umitvd ky the INIPwor of Winn No- of Recessed Fixtures No. of Ccil.-Susn.(Paddle) Fans No. of Tat Transformers KVA No. of Liphting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures A ve In- SwimmingPool rnd. ❑ rnd. ❑ No. of Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches c 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 r Tons — KEY/ No. of Self -Contained Detection/Alerting Devices No. of Dishwashers S ace/Area Heating KW P 6 Local ❑ Municipal Connection ❑ Other No. of Dryers Heating Appliances KW necuuty ystems: No. of Devices or Equipvalent No. of Water Hearers KW No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. H dromassa a Bathtubs Y g No. of Motors Total HP Telecommunications Wiring: No. of Devices or E wvalcnt Attach additional detail ifdetire4 or at "gtrrred by the Impenor of Wirer. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including 'completed operation' coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE R' BOND❑ OTHER❑ (Specify:) -' (Expiration Due) Estimated Value of Electrical Work: a y • (When required by municipal policy.) Work to Start: 8 Z 1 O J Inspections to be requested in accordance with MEC Rule 10, and upon completion. J I certify, under the pains and alofperjury that the information on this application is taste and complete. _ (_ FIRM NAME: LIC. NO.--; Q licensee: Signature LIC NO. (If applicable, enter "exempt in the license nu r lin ) Bus. Tel. No.:. 'Y_ Address: Alt. Tel. No.: OWNER' INSURANCE 'RIVER: I am aware that the licence don not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I and the (check one) owner owner's agent. Owner/Agent Signature Telephone No. [Rev. 04/001 (Z go TOWN OFYARMOUTH Building DepartmentBUILDING --------,(508) 398-2231 ext.261ISSUEPERMT :B-... PERMIT ISSUE DATE 6/2 .. 007 . ; PROPOSED USE ..... , . . APPLICANT _Kevin Fair JOB WEATHER CARD PERMITTO Addition ; AT (LOCATION) joo86LOOKOuT RD ZONING DISTRIC R•40 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 1141.49 BUILDING IS TO BE. CONST TYPE 5•B USE LOT SIZE O construct 14 x 16 screened porch and 10 x 12 addition to expand existing master bedroom as per plans REMARKS dated0606x07. AREA (SO FT) EST COST ($ L$1 3 OWNER JADAMS, ELIZABETH P ADDRESS- 0088 LOOKOUT RD Yarmouth Port I MA 102675 J PERMIT FEE ($) BUILDING DEPT BY INSPECTION RECORD R-4 CONTRACTOR LICENSE 94639 Fair, Kevin 100 Homersdock Road Yarmouth Port MA 02675 5083628186 PHONE 15083626153 FIELD COPY r.Corrections ��/X MAIFor FRES / / N i / V 5I2&M15 SlipGen- Portal Hone Town of Yarmouth Template [Building Dept] Wim Slipsheet Identifier [sg261191 Document Category Building Permits Map -Block Number 141.49 Street Number 0086 Street Name LOOKOUT RD Department Building Parcel ID 16784 Backfile Batch Scan No Document? Additional Naming Info Index Operator Operator, Yarmscan Date - Time 2015-05-26 - 11:34 MpJflaserfichelZ1Sl1pGerV 1/1