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HomeMy WebLinkAboutBuilding PermitsCommonwealth of Massachusetts official Use Only Department of Fine Services Permit No. 4F-o5 --4'O7a BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked Rev. 11/991 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed In accordance with the Massachusetts Electrical Code (MEC). 527 CMR 12.00 (Pt. E PRINT IN INK OR TYPE ALL I7VFORMATIOA9 Date: 5/17/2005 il" . o City or Town of YARMOUTH To the Inspector of Wires: �b° Nt i is application the undersigned gives notice of his or her intention to perform the electrical work described below. oLo I ion (Street & Number) 200 LONG POND DRIVE, SOUTH YARMOUTII " N or Tenant GARY WEAVER Telephone Na SOS-3984572 S Q 'a Address SAME '� =5—� )ith permit in conjunction with a building permit? Yes El No • (Check Appropriate Box) Pa a of Building RESIDENCE Utility Authorization Na mg Service Amps Volts Overhead ® Undgrd ❑ Na of Meters New Service Amps Volts Overhead ❑ Uadgrd ❑ Na of Meters Number of Feeders and Ampacity location and Nature of Proposed Electrical Work: 11VAC WIRING Comnletion ofthe following table may be waived by the ImmDector of Wires. No. of Recessed Fixtures Na of Ceil.-Susp. (Paddle) Fans Na of Transformers Total KVA Na of Lighting Outlets Na of Hot Tubs Generators KVA Na of Lighting Fixtures Swimming Pool Above rod. ❑ lo- rod ❑ a o mergency g Battery Units mg Na of Receptacle Outlets Na of Oil Burners FIRE ALARMS No of Zones Na of Switches Na of Gas Burners o. of Detection and Initiating Devices Na of Ranges Na of Air Coact Tons Na of Alerting Devices Na of Waste Disposers Heat Pump Totals: Piumber Tons I KW No. of Self -Contained Detection/Alerting Devices Na of Dishwashers Space/Area Heating KW Local ❑ Municipal Connection ❑ Other Na of Dryers Heating Appliances KW Security Systems: Na of Devices or Equivalent Na of Water KW Heaters Na of Signs No. of Ballasts Data Wiring: Na of Devices or Divalent Na Hydromassage Bathtubs Na of Motors Total LIP Telecommunications Wiring: Na of Devices or Equivalent OTHER: Attach additional detail {%destre4 or as required by the Inspector of Wires. 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 ® BOND ❑ OTHER ❑ (Specify-) GENERAL COMP. LIABILITY 02/19/2006 (Expiration Date) timated Value of Electrical Work: (When required by municipal policy.) ork to Start: 5/31/2005 Inspections to be requested in accordance with MEC Rule 10, and upon completion. 77 crrrtfy, under th a pains an pen es of perjury, that the lnfonnadon on this gMUcadon is true and complar. IRM NAME: EF WINSLOW PLUMBING AND HEATINGIDWARD MERRY ,/i1c NO.: A17137 )[.iceusee: Edward L Merry Signature I �1,--O'L.(- L A� LIC. NO.: 35745E f{fupplicable, enter "exempt"!n the license number line) Bsa. TeL Na: SOS-394-7778 �Adaresa: 8 REARDON CIRCLE SOUTH YARMOUTH. MA 02664 AIL Tel. Na: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liabilitf Insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agem Owner/Agent PERb11T FEE. 5 Signature Telephone Na DEPT FILE COPY z0 TOWN OF YARMOUTH BUILDING <` PERMITVALIDATION DATE PERMIT NO. APPLICANT Carl And & AnnP Marie WPAVpr ADDRESS 7(t(t Long Pnnd ❑rives R_ V _ 09664 (NO.) ISTREET) (CONTR'S LICENSE) PERMITTO "ied (—) STORY (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) NUMBER OF DWELLING UNITS ZONING ATMOCATIONI 200Long PDnd Drive R V DISTRICT Phn (NO.1 (STREET) BETWEEN AND (CROSS STREET) (CROSS STREETI SUBDIVISION BUILDING IS TO BE FT. WIDE BY TO TYPE REMARKS: USE GROUP LOT LOT BLOCK SIZE FT. LONG BY - FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION BASEMENT WALLS OR FOUNDATION (TYPE) AREA OR VOLUME ESTIMATED COST $ 1 FEEMIT $ 20Oft (CUBIC/SQUARE FEET) OWNER rarland & Anna Maria Weaver ADDRESS 200 Long Pnnd Ttriyp i V W66A BYILDI (Affidavit on reverse side of application to be completed by authorized agent of owner) I hereby certify that the proposed work is authorized by the owner of record and 1 have been authorized by the owner to make this application as his authorized agent. SIGNATURE OF AGENT ADDRESS APPROVED BY DATE (NUMBER) (STREET) (Crm TITLE � 1 TOWN OF YMIOUTH . BUILDING PERMIT. DATE , APPLICANT raarllind & nnN IffirlE W TSV -r ADDRESS. PERMIT TO Shea (_) _STORY (TYPE OF IMPROVEMENT) - NO. (NO.) ISTREETI IPROPOSED USE) FIELD COPY 4 MIT NO. NUMBER OF DWELLING UNITS (CONTR'S LICENSE) ZONING AT(LOCATION)-200 Lnns pin Drive 4 Y DISTRICT R40 ' INO.I • (STREET) a BETWEEN AND m (CROSS STREET) (CROSS STREET) LOT m SUBDIVISION 591113 LOT BLOCK SIZE O m BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION T z I TO TYPE 5.R USE GROUP Ali BASEMENT WALLS OR FOUNDATION R (TYPEI O 4 REMARKS: _iujg-�l,l—gorda . SbiGa AREA OR _ PERMIT VOLUME ESTIMATED COST FEE 20_00 ICUBIC/SQUARE FEET) ' OWNER Garlmid Anne Mgrie Wenver ADDREss2 'Long Pnnd Drive S_Y_ 07664 BYILDI INSPECTION RECORD DATE I NOTE PROGRESS - CORRECTIONS AND REMARKS I INSPECTOR Tcj;iN OF TAX2ID= BUILDING PERMIT JOB WEATHER CARD • DATE PERMIT NO. APPLICANT Garland b Au" 11arie Uaiyer - ADDRESS 2W Long Pond Drive S.Y. 026&4 (NO.) (STREET) ICONTR'S LICENSE) PERMIT TO ab&4 (TYPE OF IMPROVEMENT) (_) STORY NO. (PROPOSED USE) NUMBER OF DWELLING UNITS AT (LOCATION) 200 Long Poud Drivo S.T. ZONIINGT RS0 (NO.) (STREET) a BETWEEN AND N (CROSS STREETI (CROSS STREET) W 591113 LOT m SUBDIVISION LOT BLOCK SIZE t . U m BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION O Z TO TYPE USE GROUP 4� BASEMENT WALLS OR FOUNDATION (TYPE) O REMARKS: icatal2 Eardcn shad .AREA OR PERMIT VOLUME $ 1*620-00 $ 20.00 VOLUME ESTIMATED COST FEE (CUBIC/SQUARE FEET) OK/ OWNER G2rlaud III"- 2t An"- U"ver ADDRESS 200 Long Yaad Drive S.Y. 02664 BUILDING 6 THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR ALL CONSTRUCTION IONS REQU WORK: ELECTRICAL, PLUMBING AND 1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QUIRED, SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MEMBERS (READY FOR LATH OR FINISH COVERING). FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS I 1 1 2 2 2 3 HEATING INSPECTING APPROVALS REFRIGERATION INSPECTION APPROVALS I 1 OTHER 2 2 WORK SHALL NOT PROCEED UNTIL THE PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD INSPECTOR HAS APPROVED THE VARIOUS WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE CAN BE ARRANGED FOR BY TELEPHONE STAGES OF CONSTRUCTION. PERMIT IS ISSUED AS NOTED ABOVE. OR WRITTEN NOTIFICATION. OF.ygR 0( oe G M�T1ACNf[I y/,� ' ONE & TWO FAMILY ONLY - BUILDING PERMIT ' APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING Town of Yarmouth Building Department 1146 Route 28 • Yarmouth, N A 02664-4492 Tel: (508) 398-2231 x261 • Fax: (508) 398-2365 Office Use Only Permit No. Date Permit Fee $ "." Deposit Rec'd. $ �OfljDate 3/z o� Net Due $ ' 10 — Planning Board Information Plan Type Endorsement Date Recording Date Plan No. Other Assessors Department Information: Map tot p Lot O/d nlewll_3 1.4 Property Dimensions: Lot Area (sf) Frontage (ft) Lot coverage This Section for Office Use Only Building Per I Number Date Issued: Signatur C`'�� oy Certificate of Occupan is Is not required wilding Official Dat Section 1 - Site Information Use Group: R-4 Type: 5-B 1.1 Property Address: 200 LOP6 Po1vI) DelveY;�7 1.2 Zoning Information: �0 V /W Zoning District sed Use Soy i N Y► PMouTH MA MZ&q , 1.3 Building Setbacks (ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required T Provided 3� 10 20 v 1.4 Water Supply (M.G.L. c. 40. S 54) Public Private 1.5 Flood Zone Information: Comments: Zone: BFE: Section 2 - Property Ownership/Authorized Agent 2.1 Owner of Record: c60b E. AA19 171AR1E 6jYRL 200 �OIJ6 f4A Dy�c am prMailingAddress:5. ;1,9071# u n14 02G6 SF 3 Signature Telc0lono 2.2 Authorized Agent: i� Name (print) Mailing Address Signature Telephone FEBI y Section 3 - Construction Services 3.1 Licensed Construction Supervisor: Not Applicable Ef License Number Address Expiration Date Signature Telephone 3.2 Registered Home Im rovement Contractor: Company Name Not Applicable License Number Address Signature Telephone Expiration Date 9- 15-99 1 of 2 OVER Section 4 - Workers' Compensation Insurance Affidavit (M.G.L c. 152 S 25C ( )) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes .......... No .......... Section 5'- Description of Proposed Work (check all applicable) New Construction I No. of Bedrooms I No. of Bathrooms Existing Bldg. ❑ Repair(s) ❑ I Alterations ❑ . Addition ❑ Accessory Bldg. Ed Type SµED Demolition Other Specify: Brief Description of Proposed Work: s% L , Costs Section 6 - Estimated Construction Item •� Estimated Cost (Dollars) to be completed by permit applicant Check Below _ - ❑ Conservation -Commission Filing (if applicable) ❑ Old Kings Highway & Historical Commission approval ; (if applicable) 1. Building 200 -1L 2. Electrical 3. Plumbing / Gas 4. Mechanical (HVAC) 5. Fire Protection t 6. Total = (1 + 2 + 3 + 4 + 5) (90 0 . 7. Total Square Ft. (new houses & additions) Section 7a - Owner Authorization - Owner's Agent or Contractor 'Applies To be Completed When for Building Permit as owner of•the subject property,,. hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date Section 7b - Owner/Authorized Agent Declaration I, GA ZLAILID E-- W EAVE-K , 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. GALPrN.9 F. W EAVER e a7,A3LeI Signature of Owner/Agent I. D to 9- 15-99 2 of 2 Applicant: Address: Bldg. Site TOWN OF YARMOUTH BUILDING DEPARTMENT BUILDING PERMIT APPLICATION SIGN OFF Building Permit No.: No.: 3 S<P' q1 7 ZDate Filed: Map No.: Lot No.: / :3 The following information outlines the procedural steps required to obtain a permit to build, alter, or add to a structure within the Town of Yarmouth. The Building Department will determine compliance to the following: (A) Zoning Requirements (B) Historical Districts (C) Flood Zones. The Building Department will be responsible for assisting the applicant through the following departments: RESIDENTIAL AND/OR COMMERCIAL BUILDING WATER DEPARTMENT: Determines Compliance of Water Availability. (applicant to obtain) ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage. CONSERVATION COMIIIISSION: Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of Wetlands, -Streams, Ponds, Rivers; Oceans, Bogs, Bays, Marshland, Etc. HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements for Septage Disposal and other Public Health Activities. FIRE DEPARTMENT: Determines Compliance to State and Town Requirements for Personal Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc. ---------------------------------------- The following Departments must sign off, in the respective order, prior to building inspector issuing the required building permit: REVIEWED BY: 1. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT: DATE: - N/A: INDUSTRIAL AND/OR COMMERCIAL PERMITS 5. WIRING INSPECTOR: DATE: N/A: 6. PLUMBING INSPECTOR: DATE: N/A: 7. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE All stumps an dlor brush must be disposed of at an: approved site. COM11iENTS: Applicant Signature For Office Use Only Permit No. Date TOWN OF YARMOUTH AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c. 142A requires that the reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition or construction of an addition to any pre-existing owner -occupied building containing at least one but not more than four dwelling units or structures which are adjacent to such residence or building' be done by registered contractors, with certain exceptions, along with other requirements. Type of Work: S///y rS Est. Cost 1hrao 8oW6� Address of Work 0 .oNl Owner Name: 9 AR 4AtVQ Ga 6.4 L-/Ta I 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: Ty _ OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. .� . Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: v Date Owner Name The Commonwealth of Massachusetts Department of Industrial Accidents exceo/larest/yu/iss 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Applicant information: PleasePRiNTTedslriv name*6iLr• G°A R�,9//N D wrzr,�t�2 location: �t..t p A61W C� JaJ4.1,& /L 1 am a homeowr,Zr performing all work myself. I am a sole proprietor =ad ha%e no one working in any capacity O 1 am an employer pro%idine workers' compensation for my employees working on this job. company name: address: city: phone q• insurance co. policy to I am a sole proprietor. general contractor. or homeowner (circle one) and have hired the contractors listed below ssho ha%e the following ssorkers' :ompensation polices: company name• address* CRY* phone q- inc�lra ice co. policy # Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine op to 51,300.00 and/or one years' imprisonment as well as civil penalties in the form of it STOP WORK ORDER and a flat of SI00.00 a day against me. 1 understand that a copy of this statemcat may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties ojperjury that the information provided above Is true and correct V'Signature Date _ Print name Phone 0 official use only do not %rite in this arcs to be completed by city or town official city or town: YARHOUTII _ ❑ check if immediate response is required contact person: permioicense 0 oliuilding Department ❑Liceasisg Board .261 ❑Selectmen's Office phone M; _ (508) 398-2231 ext. ❑Health DepartmentrjOther 0"ned 1.95 PIAI Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all emplovers to provide workers' compensation for their eniplo%ees. As quoted from the "law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An enrphgrer is defined as an individual. partnership, association, corporation or other legal entity, or any two or more of the foreaoin_ engaged in a joint enterprise. and including the legal representatives of a deceased employer, or the receiver or trustee of an individual , partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another %%ho employs persons to do maintenance , construction or repair work on such dwelling house or on the grounds or building_ appurtenant thereto shall not because of such employment be deemed to be an employer. MGI_ chapter 152 section also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant ivho has not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the commomyealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter ha%e been presented to the contracting authorit%. Applicants Please till in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying_ company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested. not the Department of Industrial accidents. Should you have any questions regarding the "law" or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Iftice of INVOSHISUINS 600 Washington Street Boston, Ma. 02111 fax #: (617) 727-7749 phone ff: (617) 7274900 ext. 406, 409 or 375 TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 260 HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE: JOB LOCATION: 1M IVAA ).A.),J b out. /2,,v A DQ6 S. NAME STREET ADDRESS SECTION OF TOVA "HOMEOWNER" tom►. CAQL.,4.0,01�) 3I5- Y E2 z NAME HOMEPHONE WORK PHONE PRESENT MAILING ADDRESS D /. ��s� 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 supp 'sor. (State Building Code Section 108.3.5.1) Definition of Homeowner: Person(s) who owns a parcel of land on which he / she resides or intends to reside, on which there is or is intended to be, a one or two family attached or detached structure assessory to such use and / or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner; such "homeowner" shall submit to the building official, on a form acceptable to the building official, that he / she shall be 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 ements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL Ch.142. Yes ❑ No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent Check one: Owner ❑ Agent ❑ h:homcowm iccxcmp TOWN OF YARMOUTH 1146ROUTE28 SOUTHYARMOUTH MASSACHUSETTS02664.4451 Telephone (508) 398-2231, Ext. 261 — Fax (508) 398-2365 BUILDING DEPARTMENT �UILDING ELECTRICAL GAS PLUMBING SIGNS 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 mW., e�±-'"e. S 6 bpi g � Work Address is to be disposed of at the following location: ,VAA mo a,* 7>A L.4^0 !=/ L I Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Signature of Applicant Permit No. Date PLOT PLAN AbuttorIs Name Lot # If this is a corner lot, write in name of street. FOR LOT # Indicate location of garage or accessory building Additions with dashed lines -------------------- Sewerage disposal (cesspool) GD Well 0 SIDE YARD �]-- — - FT. (lot................ft. rear) REAR YARD ........�....ft. HOUSE d (lot..................ft. frontage) TURTLiE OOVC-- (NAME OF STREET) Information Supplied by Vol Abuttor I s Name Lot # If this is corner lo- write in name of other street. MARK NORTH POINT CEFjTIFi ATE ISSUED DATF-41 1' • BV I LD//I I-6 • I�� i1ll IT J CERTIFICATE OF OCCUPANCY ,DATE - 1/13/2000 19' PERMIT NO. B-0"69 APPLICANT RO$ERT SDAVID ADDRESS 93 1 RCRW AMMXB9 YAMRT 035810 ,•HEW t9E (NO.) (STREET) 1 (CONTR'S LICENSE) PERMIT TO �+�/4J311M (_') STORY 2 NUMBEOF DWELLLRING UNITS' Z" (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) 200'T.OI:G POND DRIVE SOUTH YARPSOMs MASS• 02664 ZONING R-40 AT (LOCATION) DISTR ICT / (NO) (STREET) - I BETWEEN AND (CROSS STREET) (CROSS STREET) m am 1.58/113 ' 2f5 Sl LOT SUBDIVISION LOT BCOCIF SIZE VO BUILDING IS TO BED FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION m - O Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION - s REMARKS: I lai, 1 I1v- I DI11. 3 BED. • 2 BATHS$ I DECE, I CAR GARAGE AREA OR �. VOLUME ' ^ (CUBIC/SO UARE FEET) KO I RLrOWNER MiG FMD DRIVE IlIVESMIMIT T&UST vrrlo•.-rior ADDRESS • WEZZ DLUNISo HASS. 02670 TO BE PCjSTEO SEE REVERSE SIDj F rQ IFICATE DEPARTMENTAL APPROVAL FOR CERTIFICATE of OCCUPANCY and COMPLIANCE To be filled in,by each division indicated hereon upon comp o of its final ' spection. BUILDINGS ermi o. aC! —'f S /t D Approved b Dat-�,�< — Remarks PLUMBING LPermit No. Approved b _Date Remarks ELECTRICAL ermit No. Approved by v� llate Remarks . 1 OTHER �FV't� Permit No. Approved by Date -Remarks .OTHER j Permit No. 1��� 60 ,7— ,APProved b06 ^ Remarks FIELD COPY • BUILDING PERMIT � • ���� �f5� - DATE 1/13/2000 19 PERMIT NO. B-00-469 APPLICANT ROBERTS. DAVID ADDRESS 93 HEBCRANT AtYMM YARPORT 035820 NEW NOUSE (NO.) (STREET) :ICONTR'3 LICENSE) NUMBER OF PERMIT TO - I_) STORY 2 DWELLING UNITS 1 (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) AT (LOCATION) 200 LONG POND DRIVE SOUTH YARHOUTH HASS. 02664 ZONING R-40 • (NO.) DISTRICT (STREET) °m BETWEEN AND l m (CROSS STREET) (CROSS STREET) m SUBDIVISION 50/113 LOT 71-5 Bl� 51 Soz ' U 0 O BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION m O Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION I � (TYPE) - O � " REMARKS: I KIT, I liv, ),DIN. 3 BED, 2 EATHS, I DECK, I CAR GARAGE AREA OR VOLUME ESTIMATED COST (CUBIC/SQUARE FEET) OWNER LONG POIM DRIVE INVESTHENT TRUST ADDRESS RAIN STREET, WEST DENNIS, 1229203.00 PERMIT 508.00 I Er BUILDING DEPT. BY .INSP�CT10 ORD !o -�-Y"���-ems 3 �.,;,��.r• ATE NOTE PROGRESS CORRECTIO AND REMARKS INSPECTOR - A = u ILO 00 •VA1\ ` _ •- F � �7 6�l ��► FIE,,.,_O_RRRECTION NOTICE LOCATIO ` v"��- �• PERMIT N ISSUED TO ` PERMIT HOLDER AND/OR ALL RESPON (BILE PARTIES. NOTICE DELIVERED TO Upon inspection, violations of the Sec The followm orders are hereby issued for their correction: 09 7 I n in evidence. PLEASE CALL FOR INSPECTION WHEN CORRECTIONS HAVE BEEN COMPLETED. ACCEPTANCE AND APPROVAL BY AN INSPECTOR OF THIS DEPARTMENT IS REQUIRED. ALL CORRECTIONS MUST BE MADE ON OR BEFORE DATE BY INSPECTOR ORIGINAL Diane/ F. Braman, PA 1 +• 20o L o a 4 Qc N o Q o Ax> 780 Harbor PWnl Rd J Y,dR IM Ol�'>;1 Canmlaquid MA 02637-0361 " qp-o� CIO - , z z, (6,cn tc vj cx k� C - 14 - o0 of 0 s Q HJ �p t "DtAusto mb ��►�• `��'x • i-�-r, v�,e. lS 2� w c�e. , 3x3i•�IL 9h•8 tr3 - IST `C> =b C.> `I 1►S�P�C."Cto�l Cot..tc. S RE CD ..7�04' 4' t�'2.o o (.•.o, a �'Z�c to @ t � -- 2.` �.�.,n.� 1��--ter' �-/� • Eu '� �c t'l— 25 KZ x K 1Z = cad a o� scd4, Z . ssp or�(•s PEzz l 1 �`�`� •dtt��.�Yc� s or' dc�aa.lscJ1 abo�et xv4, S Of. oJI MUM • Qw BRAR � � o S R 1 6' ►►'r r��NAI I 0"") (0,1 Coa-�et OF •Yq R�t�, 0� � � hwrtwcnca!� P P1 C E L r ONE & TWO FAMILY ONLY - BUILDING PERMIT APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY OWE ON Town of Yarmouth Building Department . 1146 Route 28 • Yarmouth, NIA 02664-1492 Tel: (508) 398-2231 x261 • Fax: (508) 398-2365 De. Fa 4 a n O use Only Planning Board Information Type SuBD. Plan T Assessors Department Information: Map Lot Map 'Lot a Date :rmit No —.Date Endorsement Date 2 f3 sa s Z 5 ermit Fee $ :SaS' ao Recording Date s saw Old New e• j,q property Dimensions: $.60,'Date a038 IepositRec'd. Plan No. �$ other P B I a05 jet Due $ ; U SSA+ C—P I Lot Area (SO Frontage (ft) Lot Coverage This Section for Office Use Only 3u"C' Permit Number: Date Issued: Certifica f Occupancy �o 'IgnitUfe: Buildin Official Date is is not required Section 1 - Site Information Use Grou : R-4 Type: 5-B 1.1 property Address: 1.2 Zoning Information: p P �✓� l R- 40 RESIPe1.iTPAL Zoning District Proposed Use Side Yards Rear Yard JBulldlngW(ft) Req red Provided Required Provided • d r) 1.5 Flood ZooneeInfoorrmation: Comments: Zone:- BFE: Section 2 - Property Ownership/Authorized Agent 2.1 Owner of Record: 7W iIV46 Y Va.;. � ry of T' PeN v/l Nr' 7 0 IN oN D Mailing Address Name (print) n (J 760— �%SO hone Signature 2.2 Authorized Agent: 9 1999 3 /P M iling Address Name (pr (print). Signature telephone Section 3 - Construction Services 3.1 Licensed Constructi n Supervisor: Not Applicable ❑ —�— �� Ucense Number 9 3 Address 7t —a � � 0 O Expiration Date D6 0/ �000 Signature Telephone 3.2 Registered Home Improvement Contractor: Company Name Not Applicable Q' License Number Address Expiration Date Rinnnh,re Telephone 9- 15-99 1 of 2 OVEN Insurance Affidavit (M.G.L. c. 152 S 25C Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Sited Affidavit Attached Yes ..!'-**�.... No ..... Section 5 - Description of Proposed Work (check all applicable) New construction ig I No. of Bedrooms _-3 _ No. of Bathrooms _ Existing Bldg. ❑ I Repair(s) ❑ I Alterations ❑ Addition ❑ Accessory Bldg. ❑ Type Demolition Brief Description of Proposed Work: Section 6 Estimated Construction Costs Item Estimated Cost (Dollars) to be completed by permit applicant 1. Building 2. Electrical 3. Plumbing / Gas p 4. Mechanical (HVAC) 5. Fire Protection 6.Total=(1 +2+3+4+5) 7. Total Square Ft. (newhousesbaddtions) /s'o o Sop = /808 Section 7a - Owner Authorization - To be Completed When Owner's Agent or Contractor Applies for Building Permit im Other Specify: Check Below --� Conservation -Commission Filing (if applicable) ❑ Old Kings Highway & Historical Commission approval (if applicable) , as owner of the subject property hereby authorize ` Q6--,e S' ID ,,, Al to act on my behalf n all matters relative to work authorized by this building permit application. Si t re of Owner ate Section 7b - Owner/Authorized Agent Declaration M , as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. /CoPA v 1D Print name Signature of Owner/Agent �� / Date 9-15.99 2of2 • TOWN OF YARMOUTS BUILDING DEPARTMENT• j PL%N REVIEW & BUILDING PERMIT APPLICATION REVIEW NOTE Address: 0 d2 a a n -D ,e , Map/Lot: 69 Date of Initial Review: 0 9 9 Other Approval Date___ Inspector.'-.T, 2HYH b Notes: y dv �v0le2' st g r3 L �v i3YJT, 3) ADD WOK a(-6cr-5 O•P&<,R'To/' �f) f iLDYI D,!F- is"R S • %�' list7y - t3Ao Grfwn. d- D K . S� Yyli N.' Fo � r •�, s • r� 3 e vrt ,=, r� str Qa .,}�� w Zoning Denial (if applicable): . • Section 104.3.2, pata._Chaage, Eamon or Alteration (pre-edstiag, • nottconfolmtu . • ' The propo •: rzgttirrs a Special Permit from the Zoning Board of Appeals... :Other r Building Code Denial (if _,,s 3 /5 G iR- 3 s, c '7 o,� 13z 3 <— �, k 33� �Sg 196 X , o� = 13-21'("D00tr,Nd- %tea-aK /L.d SuPI'Lt�D /L,a`SvPPLire b-OIL TOWN OF YARMOUTH BUILDING DEPARTMENT BUILDING PERMIT APPLICATION SIGN OFF Apphcant: Building Permit No.: Address: 'y4 AO^''' w' D�'�A'—�'r Tel. No.: 760— / 9S'0 Date Filed: "A Bldg. Site Location: -20 0 P ,&;P Map No.: s2 Lot No.: i3 S' YAANOvVi l=M&.'l 51-ZS The following information outlines the procedural steps required to obtain a permit to build, alter, or add to a structure within the Town of Yarmouth. The Building Department will determine compliance to the following: (A) Zoning Requirements (B) Historical Districts (C) Flood Zones. The Building Department will be responsible for assisting the applicant through the following departments: RESIDENTIAL AND/OR COMMERCIAL BUILDING WATER DEPARTMENT: Determines Compliance of Water Availability. (applicant to obtain) ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage. CONSERVATION COMWSSION: Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc. HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements for Septage Disposal and other Public Health Activities. FIRE DEPARTMENT: Determines Compliance to State and Town Requirements for Personal Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc. ---------------------------------------- The following Departments must sign off, in the respective order, prior to building inspector issuing the required buildingpermit. .` BY: R�TER DEPARTMENT: _ DATE: - N/A: 2. ENGINEERING DEP DATE: l r 9 9 - 3. CONSERVATION: DATE 'L — DATE 12 N/A: 4. HEALTH DEPARTMENT: INDUSTRIAL AND/OR COMMERCIAL PERMITS 5. WIRING INSPECTOR: DATE N/A: 6. PLUMBING INSPECTOR: DATE N/A: 7. FIRE DEPARTMENT: DATE N/A: PLEASE NOTE AU stumps and/or brush must be disposed of at an approved site. COMMENTS: U ;' o . Gr..tsaa Qa •Z° 0 7----�:t- �� ; il1.r+4i 8/99 Applicant Signature Date Massachusetts Department of EJWtVnW8fi t hotecdon Bureau of Resource Protection — Wetlands WPA Form 5 - Order of Conditions Massachusetts Wetlands Protection Act M.G.L. c. 1311 §40 Applicant Information From YARMOUTH For. To: caasera w com =04 SE 83-1493 PronarkN=ber GRANDE COVE LANDING Ap kwft e 464 Main Street MurrnpAaaRss West Dennis G11Yrorn o 02670 sm rvcoae The project site is located at: c 200 Long Pond Dr., Yarmouth 59*0 113 Assa=M40Wi PXre"14 and the property is recorded at the Registry of Deeds for. Barnstable # 7140 soar PIP Cara =(rmystwoanal U Findings Findings pursuant to the Massachusetts Wetlands Protection Act Following the review of the above -referenced Notice of Intent and based on the information provided in this application and presented at the public hearing, this commission finds that the area in which work is proposed is significant to the following interests of the Wetlands Protection Act (check all that apply): Public Water Supply Private Water Supply FS Groundwater Supply )Rood Control Land Containing Shellfish �WFishedes )S Storm Damage Prevention )—K Prevention of Pollution = Protection of Wildlife Habitat DEP File Number for DEP use onty The Notice of Intent for this project was filed on: 10-07-99 Do The public hearing was closed on: �iG16► Title and Date of final Plans and Other Documents: Sewage disposal system design for 200 Long Pond Dr., S.Ymth. Craig Field, PLS REV. 10/22/99 Furthermore, this Commission hereby finds that the project, as proposed, is: (check one of the following boxes) Approved subject to: the following conditions which are necessary, In accordance with the performance standards set forth in the wetlands regulations, to protect those interests checked above. This Commission orders that all the work shall be performed in accordance with the Notice of Intent referenced above, the following General Conditions, and any other special conditions attached to this Order. To the extent that the following conditions modify or differ from the plans, specifications, or other proposals submitted with the Notice of Intent, these conditions shall control. Rev. INS Pa e t of 5 UEP Massachusetts Department olEniriromnettat Protection Bureau of Resource Protection - Wetlands WPA Form 5 - Order of Conditions Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Town of Yarmouth Wetland By -Law Chapter 143 U Findings (cont.) debris, including but not limited to lumber, bricks, plaster, Denied because: wire, lath, paper, cardboard, pipe, tires, ashes, refrigerators, motor vehicles, or parts of any of the foregoing. Q the proposed work cannot be conditioned to meet the performance standards set forth In the wetlands regulations to protect those interests checked above. Therefore, work on this project may not go forward unless and until a new Notice of Intent is submitted which provides measures which are adequate to protect these interests, and a final Order of Conditions Is issued. U the information submitted by the applicant is not sufficient to describe the site, the work, or the effect of the work on the interests identified in the Wetlands Protection Act Therefore, work on this project may not go forward unless and until a revised Notice of Intent is submitted which provides sufficient Information and includes measures which are adequate to protect the Acts Interests, and a final Order of Conditions is Issued. A description of the specific Information which is lacking and why it Is necessary is attached to this Order as per 310 CMR 10.05(b)(c). General Conditions 1. Failure to comply with all conditions stated herein, and with all related statutes and other regulatory measures, shall be deemed cause to revoke or modify this Order. 2. The Order does not grant any property rights or any exclusive privileges; it does not authorize any injury to private property or invasion of private rights. 3. This Order does not relieve the permittee or any other person of the necessity of complying with all other applicable federal, state, or local statutes, ordinances, bylaws, or regulations. 4. The work authorized hereunder shall be*completed within three years from the date of this Order unless either of the following apply: (a) the work Is a maintenance dredging project as provided for in the Act; or (b) the time for completion has been extended to a specified date more than three years, but less than five years, from the date of Issuance. If this Order is intended to be valid for more than three years, the extention date and the special circumstances warranting the extended time period are set forth as a special condition in this Order. 5. This Order may be extended by the Issuing authority for one or more periods of up to three years each upon application to the issuing authority at least 30 days prior to the expiration data of the Order. 6. Any fill used in connection with this project shall be clean fill. Any fill shall contain no trash, refuse, rubbish, or 7. This Order does not become final until all administrative appeal periods from this Order have elapsed, or if such an appeal has been taken, until all proceedings before the Department have been completed. B. No work shall be undertaken until the Order has become final and then has been recorded in the Registry of Deeds or the Land Court for the district in which the land is located, within the chain of title of the affected property. In the case of recorded land, the final Order shall also be noted in the Registry's Grantor Index under the name of the owner of the land upon which the proposed work is to be done. In the case of registered land, the Final Order shall also be noted on the Land Court Certificate of Title of the owner of the land upon which the proposed work Is done. The recording Information shall be submitted to this Conservation Commission on the form at the end of this Order, which form must be stamped by the Registry of Deeds, prior to the commencement of the work 9. A sign shall be displayed at the site not less than two square feet or more than three square feet in size bearing the words, 'Massachusetts Department of Environmental Protection' [or,'MA DEP']'file Number SE 83-1493 pmiean,0M nber 10.Where the Department of Environmental Protection is requested to issue a Superseding Order, the Conservation Commission shall be a party to all agency proceedings and hearings before the OepartmenL 11.Upon completion of the work described herein, the applicant shall submit a Request for Certificate of Compliance (WPA Form 8A) to the Conservation Commission. 12.The work shall conform to the following attached plans and special conditions: Final Approved Plans (attach additional plan references as needed): Sewage Disposal System Design ra REV. 10/22/99 DW Craig Field, PLS s�,edena&Kwby Yarmouth Con Com on hie wo Rev.10/98 DEP Massachusetts Department of Enuiromnerttai Protection Bureau of Resource Protection — Wetlands WPA Form 5 - Order of Conditions Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Findings (coot.) 13. Any changes to the plans identified in Condition 112 above shall require the applicant to inquire of the Conservation Commission in writing whether the change Is significant enough to require the filing of a new Notice of Intent. 14. The Agent or members of the Conservation Commission and Department of Environmental Protection shall have the right to enter and inspect the area subject to this order at reasonable hours to evaluate compliance with the condi- tions stated in this Order, and may require the submittal of any data deemed necessary by the Conservation Commis- sion or Department for that evaluation. 15. This Order of Conditions shall apply to any successor in interest or successor in control of the property subject to this Order and to any contractor or other person perform- ing work conditioned by this Order. 16. Prior to the start of work, and if the project involves work adjacent to a Bordering Vegetated Wetland, the boundary of the wetland in the vicinity of the proposed work area shall be marked by wooden stakes or flagging. Once in place, the wetland boundary markers shall serve as the limit of work (unless another limit of work line has been noted In the plans of record) and be maintained until a Certificate of Compliance has been issued by the Conservation Commis- sion. 17. All sedimentation barriers shall be maintained in good repair until all disturbed areas have been fully stabilized with vegetation or other means. At no time shall sediments be deposited in a wetland or water body. During construc- tion, the applicant or his/her designee shall Inspect the erosion controls on a daily basis and shall remove accumulated sediments as needed. The applicant shall immediately control any erosion problems that occur at the site and shall also immediately notify the Conservation Commission, which reserves the right to require additional erosion and/or damage prevention controls it may deem necessary. Special Conditions (Use additional paper if necessary) SEE ATTACHED SHEET Town of Yarmouth Wetland By -Law Chapter 143 Findings as to municipal law, bylaw, or ordinance Furthermore, the camn2bonCo=&Won hereby finds (check one that applies): that the proposed work cannot be conditioned to meet the standards set forth in a municipal law, ordinance, or bylaw, specifically NNW sn W011011nooic0law,0ylaw,aordwnce Therefore, work on this project may not go forward unless and until a revised Notice of Intent is submitted which provides measures which are adequate to meet these standards, and a final Order of Conditions Is issued. that the following additional conditions are necessary to comply with a municipal law, bylaw, or ordinance, specifi- cally Name so awon of MM6031 kK tAw, or and nwu. The Commission orders that all the work shall be performed in accordance with the said additional conditions and with the Notice of Intent referenced above. To the extent that the following conditions modify or differ from the plans, specifications, or other proposals submitted with the Notice of Intent, the conditions shall control. Additional conditions relating to municipal law, bylaw, or ordinance: Page 3of5 SPECIAL CONDITIONS SE 83-1493 GRANDE COVE LANDING 1. The applicant shall be responsible for having a copy of these "Orders of Conditions" on the job site at all times. Failure to do so may result in a revocation of the "Orders", or a fine, or both. 2. The Conservation Commission, its agents or assigns, shall have the express right of entry upon the job site at all reasonable times for the purposes of establishing "compliance" with the conditions stated herein. Upon completion of the project, a "Certificate of Compliance" shall be requested in writing. The "Order of Conditions" shall be considered incomplete until the "Certificate of Compliance" is issued and recorded at the Registry of Deeds. 4. Gutters and downspouts directed into drywells shall be installed to provide for roof runoff. 5. A haybale dike shall be staked in place as shown on the plan, prior to any work on the project. The Conservation Administrator may allow the substitution of a siltation fence in an appropriate case. 6. This dike shall constitute a "work limit line". No work of any kind shall be permitted on the wetland side of this he. 7. The deck shall not be closed in without a future filing with the Conservation Commission. q iaMassachuseffs Department of Enviromnental Protection Town of Yarmouth Bureau of Resource Protection - Wetlands Wetland By -Law WPA Form 5 - Order of Conditions chapter143 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 0 Recording Information This Order of Conditions must be recorded in the Registry of Deeds or the Land Court for the district in which the land Is located, within the chain of title of the affected property. In the case of recorded land, the Final Order shall also be noted in the Registry's Grantor Index under the name of the owner of the land subject to the Order. In the case of registered land, this Order shall also be noted on the Land Court Certificate of Title of the owner of the land subject to the Order of Conditions. The recording Information shall be submitted to the YARMOUTH c wnawon caamakn'on on the form below, which must be stamped by the Registry of Deeds. Detach on dotted line and submit to the Conservation Commission. -----------------------�— — — — — — — — — — To: YARMOUTH cornea M c=nmba Please be advised that the Order of Conditions for the project at200 Long Pond Dr.,S.Yarmouth PmjcaL=Uan DiFReka bW has been recorded at the Registry of Deeds of Barnstable r ' and has been noted In the chain of title of the affected property In soot Pam in acc rdandh the Order of Conditions issued on 10- 9-99 . Due If recorded land, the Instrument number which Identifies this transaction is tuM=VAhmber If registered land, the document number which identifies this transaction is Doax"NAW Siprutme ofAQalic" ' Massachusetts Oepatt rant of EntrtronmeuW ProtecNoa Town of Yarmouth Bureau of Resource Protecction — Wetlands Wetland By-Uw t• WPA Form 5 - Order of Conditions Chapter 143 Massachusetts Wetlands Protection Act M.G.L. C. 131, §40 U Findings (coot.) This Order is valid for three years, unless otherwise specified as a special condition pursuant to General Conditions 14, from the date of Issuance. 'October 29, 1999 This Order must be signed by a majority of the conservation commission. The Order must be mailed by certified mail (return receipt requested) or hand delivered to the applicant A copy also must be mailed or hand delivered at the same time to the appropriate regional office of the Department of Environmental Protection. Appeals The applicant, the owner, any person aggrieved by this Order, any owner of land abutting the land subject to this Order, 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 to issue a Superseding Order of Conditions. The request must be made by certified mail or hand delivery to the Department, with the appropriate filing fee and a completed Appendix E: Request for Departmental Action Fee Transmittal Form, as provided in 310 CMR 10.03(7) within ten business days from the date of Issuance of this Order. 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 On this day of C /d moo ter before me personally appeared ?A 04, 63 tour/ syoH to me known to be the person described in and who executed the foregoing instrument and acknowledged that he/she executed the same as his/her free act and deed. ry s iibii�rPl�i6 �Tu4 e z ?- A 2.& UYC=niuim9;0U This Order is Issued to the applicant as follows: ❑ by hand delivery on :ff by certified mail, return receipt requested, on October 29, 1999 Gut The request shall state clearly and concisely the objections to the Order which is being appealed and how the Order does not contribute to the protection of the interests identified in the Massachusetts Wetlands Protection Act (M.G.L c.131, §40 and Is inconsistent with the wetlands regulations (310 CMR 10.00). To the extent that the Order is based on a municipal bylaw, and not on that Massachusetts Wetlands Protection Act or regulations, the Department of Environmental Protection has no appellate jurisdiction. Rev.10198 TOWN OF YARMOUTH 1146ROUTE28 SOUTHYMMOUTH NIASSACHUSETTS02664-4451 Telephone (508) 398-2231, Ext. 261 — Fax (508) 398-2365 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT BUILDING INMx«r:1(Ni1I 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 U 0 h.ol_� Work Address is to be disposed of at the following location: ���/�� �L!L Azlazri, . Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Signature of Applicant Permit No. y Date 3r "R�c. TOWN OF YARMOUTH 00 °r.......,F?y BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT Job Location: 4100 L ON 0 100N D Ple/l/(f YA%f/t% UT!t Number Street Village Owner of Property: L O N G Po N D D R/ V C / N LICS T T12 UJ' 7— Construction Supervisor: 1 (jE4T $ 94 V )D 0 3S8o2 0 76 0 —o2 0c'3 Name License No. Phone No. Address: 93 NEZ0 9Z9 N?' 6 vt ZAACAly r/Th lU T MA 0 e) 6 7-, 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 lie, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery.of any violations which are covered by the building permit. 2.15.4 Any licensee who shall willfully violate subsections 2.15.1, 2.15.2 or 2.15.3 or any other section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes ❑ No Er If you have checked yam, please indicate the type coverage by checking the appropriate box. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S I RANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 1 of the M eneral Laws, and that my signature on this permit application waives this requirement. Check one, Sia ature of owns or Owner's Owner Agent Signature: Building Official Approval: The Commonwealth ojMassaehusetis Department of Industrial Accidents Of eeefluestlpuliis 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit. Applicantinformation: FleasrZHUJf JCg fl iv location? 9.3 MEge 9AN7- 4 U cite Yl912 NO U 7 A Pe It T A/& U d G 7 J` phone a 76 O —c� o P� 1 am a homeowner performing all work myself. B-i am a sole proprietor and ha%e no one %%orkine in any capacity am an employer pro,. iding workers' compensation for my employees working on this job. comnang name• address' Sjty.: phone M• insn r� ice Co. policy H I am a sole proprietor. general contractor. or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation polices: company name: -- address• ^tic• phone tl- insurance co. Polies' a Failure to secure coverage as required under Section 25A of MGL 152 an lead to the imposition of criminal penalties of a lime up to SI WAO and/or one years' Imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a flat of $100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the paint and penalties ojperjury that the information provided above is true and coast Y, Printname 208E47 S PAUI r� Phoner 760—ao )-3 official use only do not in rite in this area to be completed by city or town official city or town: YARMOUT11 13 check if immediate response is required contact person: permittliccuse 0 nBuilding Department pUcensing Board 261 OSelectmen's Office ❑Ilealtb Department phone N; _ (508) 398-2231 eat. nOtber Imned 1.95 P1A1 Information and Instructions Massachusetts General La%%s chapter I52 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the** I aw-, an employee is defined as every person in the service of another under any contract of hire. express or implied. oral or written. An emplorer is defined as an individual. partnership, association. corporation or other legal entity, or any two or more of the fore;_oina engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual . partnership. association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another %%ho employs persons to do maintenance , construction or repair work on such dwelling house or on the t!rounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. NIGL chapter 152 section also states that even• state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionall%. neither the commom%ealth nor any of its political subdivisions shall enter into any contract for the performance of public %%ork until acceptable evidence of compliance with the insurance requirements of this chapter ha%e been presented to the contracting authority. Applicants Please till in the workers' compensation affidavit completely, by checking the box that applies to your situation and suppl%ink= 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 affida% it should be returned to the city or town that the application for the permit or license is being requested. not the Department of Industrial Accidents. Should you have any questions regarding the "law" or if you are required to obtain a workers' compensation policy. please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents MCC of 111700111211111113 600 Washington Street Boston, Ma. 02111 fax #: (617) 727-7749 phone #: (617) 7274900 ext. 406, 409 or 375 Suggested Affidavit for Home Improvement Contractor Permit Application For Omce Use Only � NAI�tFa qF CIT iTOWN Permit \a Date AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application S1GL-142Arequirrsthatthe"reconstruction alteration renovation repair modernization conversion.inorovement.removal.demoliiian. nrcrnarucunn of an addiiion to any ore-emstine ownertxcuDted build me cnnnininen I least one but not more than fnurdwellme umts.... or to siructures Which are adiacent to such residence or hmldine be done W reeistered contractors, with certain exceptions. along w th other requirements. Tvpe of Work: �%-�i� �NA� D Est. Cost Ov D Address Owner Date of Permit Application: iol�,�7, P I hereby certify that: Rcgistration is not required for the following rcason(s): _Work excluded by law _Job under S1,000 Building not owner -occupied Owner pulling own permit _Other (specify) yr t/x ka 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. 1 d2A Signcd under penalties of perjury: I hereby apply for a permit as the agent of the owner: iid ? 60- _( (fir i 03"0D 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 TOWN OF YARMOUTH WATER DEPARTMENT 99 Buck Island Road West Yarmouth, MA 02673 Telephone: (508) 771-7921 • Fax: (508) 771-7998 Date of Issue : Nov 24, 1999 Letter of Water Availability 1. Single Family Dwelling X 2. Duplex Family Dwelling 3. Condominium Dwelling 4. Commercial / Industrial 5. Other (Specify) Reference; Massachusetts General Laws Chapter 40, Section 54 To : Town of Yarmouth Building Inspector Please be advised that the Town of Yarmouth Public water supply is available to service lot/parcel(s) 5 Street 200 LONG POND DRIVE as shown on Assessors sheet/map # 59 Issuance of this Letter of Availability is subject to the following provisions/restrictions. (1) The property owner agrees to comply with all Federal, State, and Local Laws, Rules and Regulations as they pertain to the use of the Public water Supply. (2) The Yarmouth Water Department shall have exclusive rights as to the size, number, type and location of all water service lines, fire service lines or appurtenant items connected to the water distribution system. (3) The Yarmouth Water Department reserves the right to require, at the property owners expense, the installation of water mains and appurtenant items to meet water demand requisites within any structure relevant to this Letter of Availability. (4) This Letter of Availability will expire 180 days from the date of issue. I have read and understand the provisions/restrictions of this Letter of Water Availability. Owner Sign Reference LONG POND DR INVESTMENT 464 MAIN STREET WEST DENNIS, MA 02670 7. COKSIRUCII0K SUPERVISOR LICENSE Nuiber:,Expires: Birthdite: '14 CS —'035820 06/01/2000 06/01/1936 Rests ted To: - 00 _ l'ROBERi:i,jDAVIO , '93`NERCNANI AVE'' 9ARNOUINPORI;: NA 02675 �00 T H O U T AN 1112000 MAScheck COMPLIANCE REPORT Massachusetts Energy Code MAScheck Software Version 2.01 Release 3 TITLE: CHATHAM ROAD INVESTMENT CITY: Yarmouth STATE: Massachusetts HDD: 6137 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 1-10-2000 DATE OF PLANS: 1\10\00 PROJECT INFORMATION: CAPE COMPANY INFORMATION: MAP INSULATION CO. COMPLIANCE: Passes Maximum UA = 360 Your Home = 353 Permit # Checked by/Date Area or Cavity Cont. Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 900 30.0 0.0 32 WALLS: Wood Frame, 16" O.C. 1920 13.0 0.0 157 GLAZING: Windows or Doors 238 0.450 107 DOORS 42 0.350 15 FLOORS: Over Unconditioned Space 900 19.0 0.0 42 HVAC EQUIPMENT: Furnace, 82.0 AFUE ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. Builder/Designer ..T/i 9 71w lu-12 Date TITLE: CHATHAM ROAD INVESTMENT MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.01 Release 3 DATE: 1-10-2000 Bldg. Dept. Use CEILINGS: [ ] 1. R-30 Comments/Location WALLS: [ ] 1. Wood Frame, 160 O.C., R-13 Comments/Location WINDOWS AND GLASS DOORS: [ J 1. U-value: 0.45 For windows without labeled U-values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location DOORS: [ ] 1. U-value: 0.35 Comments/Location FLOORS: [ ] 1. Over Unconditioned Space, R-19 Comments/Location HVAC EQUIPMENT: [ ] 1. Furnace, 82.0 AFUE or higher Make and Model Number AIR LEAKAGE: [ ] Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be 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: [ ] Required on the warm -in -winter side of all non -vented framed ceilings, walls, and floors. MATERIALS IDENTIFICATION: [ J Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R-values, glazing U-values, and heating equipment efficiency must be clearly marked on the building plans or specifications. DUCT INSULATION: Ducts shall be insulated per Table J4.4.7.1. DUCT CONSTRUCTION: All accessible joints, seams, and connections of supply and return ductwork located outside conditioned space, including stud bays or joist cavities/spaces used to transport air, shall be sealed using mastic and fibrous backing tape installed according to the manufacturer's installation instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted. The HVAC system must provide a means for balancing air and water systems. TEMPERATURE CONTROLS: Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. 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 40-55 0.5 0.5 0.75 1.0 refrigerant below 40 1.0 1.0 1.5 1.5 CIRCULATING HOT WATER SYSTEMS: Insulate circulating hot water pipes to the following levels (in.): PIPE SIZES (in.) NON -CIRCULATING I CIRCULATING MAINS & RUNOUTS HEATED WATER TEMP (F): RUNOUTS 0-1" 0-1.25" 1.5-2.0" 2.0t" 170-180 0.5 1.0 1.5 2.0 140-160 0.5 0.5 1.0 1.5 100-130 0.5 0.5 0.5 1.0 ----NOTES TO FIELD (Building Department Use Only) E� i BCILDING TOWN. OF Y A R M O U T H ELE(TRICAL I146ROUTE28 SOUTH YARAIOL►TH V SSACHUSETTS02664-1451 Tel ephonc (508) 398-2231. Ext. `_61 — Far (508) 39V236" D VIN. BUILDING DEPARTMENT 1999 BUILDABLE LOT INQUIRY FORM Lot NoL Assessors' Map No-�Street__12 00 Endorsement Date of Subdivision Plan and Type (if applicable) . 10, Total Land Area (sq. ft) I R V 13 't Frontage Name of Current Owner ' dress S 4 y 2La=, � Wf Telephone No. We -/9So Inquire's Name (if different from owner) Telephone No 7 6 0 - /9U o inquire.'s Mailing Address �� • 6 B� z Building Intent ��C,�Adjoining Lot Numbers S� �G���•c. 0�67 b Signature of Applicant Date of Inquiry 1114 9 FOR OFFICE USE ONLY Does not conform with Ivi•G.L. Chapter 40A, Section 6, single lot exemption, or Definitive Plan Exemption and/or the applicable zoning bylaw, as per information provided. Conforms. with M.G,L, Chapter 40A, Section 6, single lot exemption, and/or applicable zoning bylaw, as per informarion provided. .4 Protected pursuant to M.G.L. Chapter 40A, Section 6, Definitive Plan Exemption. Application is incomplete. Comments: Adequate road access musbbe present. Determination of access shall be determined by the lanning Board (if applicable). satisfy Title V requirements. ,t• t. Must satisfy Conserva•tion regulations, if applicable. Icl ' Qstigator's Signature .Q. , —vy pi 1 / ACCT# 059.13 MAP 043 LOT J27 Lbl-p 00175 LONG POND DR Plan l0 03 r f H ri ♦i iii I �•♦ ♦ . r NORMmasm- ACCT# 059.244 MAP 044 LOT A10 LOC 00054 MERCURY DR (& 56) Plan � 38-4 ' 17177 MERINO ♦ r, ME . I ■ .. i ACCT# C2ZjE4S' AP 043 LOT L37 M,LOC 00 RD `qt;At, Plan 63f WIS ME AM i :, r W . U ' . o MIN ACCT# 059(6 jMAP 043 LOT L39 LOC 00168 LONG POND DR le7A&- Plan e38 I 4 ACCT#. 59 .113 MAP 051 LOT Z5 I LOC 00200 LONG POND DR . ql A- Plan DATE APPLICANT BUILDING PERMIT October 17, 2= ADDRESS 93 Morcbmit PERMIT TO (_) STORY (TYPE OF IMPROVEMENT) NO. (NO.) (PROPOSED (STREET) PERMIT NO. s. Y.P. FIELD COPY s-01=7 NUMBER OF DWELLING UNITS (CONTR'S LICENSE) AT (LOCATION) 2W Img PO[Id Drive ZONING I"o DISTRICT (NO.) (STREET) w BETWEEN AND 0 (CROSS STREET) (CROSS STREET) ILSUBDIVISION 59/113 LOP"q� BLOCJuu4M 51 LOT SIZE < (i O BUI NO IS TO BE F%WIDE tY FT. LONG BY +y• m s ( _ FT. IN HEIGHT�AND SHAD. CONFORM 11% CONSTRUCTION i0 5"S3 ;�i i�•>e �. _ �J �vw1 ` _. •rti �. TO TYPE �+ a LS7G OUP '"` ASEM ENT WAL��.' ORFDATION ''�' j �• mO ��}�� •� (TYPE) w REMARKS: Ewlasiw `•sue � 10 X 14 AREA OR VOLUME ESTIMATED COST $ �".00 FEEMIT $ 49000 (CUBIC/SQUARE FEET) OWNER bmig Paod Immsbm=t Trust P. 0. W. �8 MA BUILDING DEP B= 522 HU. ADDRESS • gy / INSPECTION RECORD ` DATE NOTE PROGRESS - CORRECTIONS AND REMARKS INSPECTOR �2 S - GG v All, � 14a.,e 7D- 04F OF oF'YgR,� ONE & TWO FAMILY ONLY - BUILDING PERMIT APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING O y Town of Yarmouth Building DepartmeN .,.:..C„C f 1146 Route 28 • Yarmouth, NIA 02664-4492 Tel: (508) 398-2231 x261 - Fax: (508) 398-2365 Office Use Only PermitNA-DI-01 DatelQj Permit Fee $ /ff, — Deposit Rec'd. $ — Date 1i7 Net Due $ y9. — Planning Board Information Plan Type Endorsement Date Recording Date Plan No. Other Assessors Department Information: Map cot Map cot -57 113 Old New 1.4 Property Dimensions: P-� 3 Lot Area (sf) Frontage (ft) Lot Coverage This Section for Office Use Only Building Permit Number: Date Issued: /o Signature: o Buil ng Official DatVe Certificate of Occupancy is is not required Section 1 - Site Information I Use Group: R-4 Type: 5- 1.1 Property Address: o o X"fz;� 1.2 Zoning Information: /Q - yy Zoning District Proposed Use 1.3 Building Setbacks (ft) It Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 0T a'd , 1.4 Water Supply (M.G.L. e. 40. S 54) Pub' Private 1.5 Flood Zone Information: Comments: Zone: Q-L6— EIFE: Section 2 - Property Ownership/Authorized Agent z.c caner of Race a 0. �d a Name ( mt) Mailin Ad ess L o NC PoN o .z, -� Da a Signature Telephone 7 G 0 -- S—v 2.2 Authorized Agent: --�0-613,e2T C -04 v t D 93 Nart)q ring r _ - Mailin Address f Tignature Telephone Section 3 - Construction Services 3.1 Licensed Construction Supervisor: Not Applicable ❑ License Number Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor: Company Name Not Applicable ❑ Address Signature Telephone License Number Expiration Date 9- 15-99 1 of 2 OVER Section 4 - Workers' Compensation Insurance Affidavit (M.G.L. c. 152 S 25C (6)' Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached Yes .......... No .......... Section 5 - Description of Proposed Work (check all applicable) New Construction I No. of Bedrooms No. of Bathrooms Existing Bldg. ❑ Repair(s) ❑ IAlterations ❑ I Addition ❑ Accessory Bldg. ❑ Type Demolition Other Specify: Brief Description of Proposed Work: .01 Costs Section 6 - Estimated Construction Item Estimated Cost (Dollars) to be completed by permit applicant Check Below ❑ Conservation -Commission Filing (if applicable) ❑ Old Kings Highway & Historical Commission approval (if applicable) 1. Building 2. Electrical 3. Plumbing / Gas 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) 7. Total Square Ft. (new houses & additions) Section 7a - Owner Authorization - Owner's Agent or Contractor Applies To be Completed When for Building Permit 1, , as owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date Section 7b - Owner/Authorized Agent Declaration 1, , as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print name Signature of Owner/Agent Date .I TOWN OF YARMOUTH ° BUILDING DEPARTMENT BUILDING PERMIT APPLICATION SIGN OFF Applicant: A., Building Permit No.: Address: Tel, No.: Jr 60 Z&f 3 Date Filed: /°11&° ° Bldg. Site Location: z10 C Map No.: s9 Lot No.: // 3 The following information outlines the procedural steps required to obtain a permit to build, alter, or add to a structure within the Town of Yarmouth. The Building Department will determine compliance to the following: (A) Zoning Requirements (B) Historical Districts (C) Flood Zones. The Building Department will be responsible for assisting the applicant through the following departments: RESIDENTIAL AND/OR COMMERCIAL BUILDING WATER DEPARTMENT: Determines Compliance of Water Availability. (applicant to obtain) ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage. CONSERVATION CONIMISSION: Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc. HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements for Septage Disposal and other Public Health Activities. FIRE DEPARTMENT: Determines Compliance to State and Town Requirements for Personal Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc. ---------------------------------------- The following Departments must sign off, in the respective order, prior to building inspector issuing the required building hermit: tX9Dkl 1 : 1. WATER DEPARTMENT: ENGINEERING DEPARTMENT: 3. CONSERVATION: 4. HEALTH DEPARTMENT: DATE: DATE: DATE: DATE: INDUSTRIAL AND/OR COMMERCIAL PERMITS 5. WIRING INSPECTOR: 6. PLUMBING INSPECTOR: 7. FIRE DEPARTMENT: — PLEASE NOTE All stumps and/or brush must be disposed of at an approved site. COMMENTS: DATE: DATE: DATE: N/A: N/A: N/A: N/A: N/A.- NIA. - N/A. 8/99 Applicant Signature Date BUILDING TOWN OF Y A R M O U T H ELECTRICAL GAS 1146ROUTE28 SOUTHYARMOUTH MASSACHUSETTS0266411451 Telephone (508) 398-2231, Ext. 261 — Fax (508) 398-2365 PLUMBING SIGNS BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at 0 D gn".4 r�j A'an4:e Work Address is to be disposed of at the following location: �Z 4.4 eaa� ..4 or Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. .0 /0 Signature of Applicant Permit No. o /06 Date 1-0 PLEASE PRINT Job Location:_ TOWN OF YARMOUTH BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM Street Owner of Property: 4 c NXPo N t7 11Vv&rT1YC1u T 7'1? vX 1— Village Construction Supervisor: B o A DAB, D O _�s'A� 6 76 o -- 3 v 8 3 Name License No. Phone No. Address: 93 MPRC 114iV ,¢ u P VA/C tVO u 7k ra R % /Y04, b 1;. 6 2x� Licensed Designee: (If other than Supervisor) Name 2.15 Responsibility of each license holder: License No. 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building and structures only pursuant to the state building code and all other applicable laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Any licensee who shall willfullyviolate subsections 2.15.1, 2.15.2 or 2.15.3 or any other section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes ❑ No P If you have checked yu, please indicate the type coverage by checking the appropriate box. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 152 of the Mass. Ge eral Laws, and that my signature on this permit application waives this requirement. 2l Check one: Signature of Owner or Owner's Agent Owner ❑ Agent Signature: Building Official Approval: The Commonwealth of Massachusetts Department of Industrial Accidents elllce allarestlostlsss 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Applicant information: Pkasc-=CTbaft name: 80 Q 12/9 I/ / P 0 location__ % 3 &EgC!"12 Ty cite 4) t % ft%fi' b o/ G %S phones O 1 am a homeowner performing all work myself. Mf am a sole proprietor and ha%e no one working in any capacity O 1 am an employer pro%iding workers' compensation for my employees working on this job. company name: address, city: phone #- insurance eo. policy # [l am a sole proprietor. general contractor. or homeowner (circle one) and have hired the contractors listed below who ha%c the following %%orrl 7 �r"/ at ke�rss'' compensation polices: /J compan name: C l a IVJ;U U C %/ 0 W address: eiA" phone q: -7 %S = kf O J' O i ncurinco co. tea.., 42 policy# -0-A? %S o? O ie— company nameo Failure to secure coverage as required under Section 25A of MGL 132 can lead to the imposition of criminal penalties of a Bat ap to 31.500.00 and/or one years' Imprisonment as visit as civil penalties in the form of a STOP WORK ORDER and a fine of 3100.00 a day against me. I eadentsed that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verificadoa. t do hereby certify under thepains and penalties of perjury that the information provided above is true and eorrecL Signature 2-421�ns / . ( �_ _� Dale 1 a Print name ie 0 6E/L'r C. 04 1// 0 Phone 0 7 4 D— a A official use only do not write in this area to be completed by city or town official city or town: YARHODT11 _ permitAicense 0 r3Buildiog Department ❑Licensing Board ❑ check if immediate response is required 261 ❑Selectmen's Office (508) 398�2231 eat, ❑Health Department contact person: phonco;_ nOthtr pe.ned ]AS PJAt Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law', an en►pkyee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An enrphnver is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the Forecoing en=aged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual , partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance , construction or repair work on such dwelling house or on the _rounds or building_ appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 1:= section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionall%. neither the commonwealth nor am of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter ha\ e been presented to the contracting authority. . Applicants Please till in the workers' compensation affidavit completely, by checking the box that applies to your situation and 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. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Mce If IMStllitle111s 600 Washington Street Boston, Ma. 02111 fax #: (617) 727-7749 phone #: (617) 7274900 eit. 406, 409 or 375 Ai For Office Use Only Permit No. Date TOWN OF YARMOUTH AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c. 142A requires that the 'reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition or construction of an addition to any pre-existing owner -occupied building containing at least one but not more than four dwelling units or structures which are adjacent to such residence or building' be done by registered contractors, with certain exceptions, along with other requirements. Type of Work: Est. Cost D a d Address of Wo Owner Name: i zDate of Permit Application: /0 1 . 7-1 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under $1,000 Building not owner occupied Owner pulling own permit Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: 03 J-X_,b 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 Oct 03 00 00:40a P.1 ' r , 0'1 ^ THE STRUCTURE IS LOCATED IN ZONE C. LONG POND AS SHOWN ON FIRM COMMUNITY PANEL 91 / / 1 25CO15 004 C. EFFECTIVE GATE: 6/17/86. 10I� d of �=a / A6 i A6 J EtLEX S.N/F � 2 LONG POND DRIVE ANDREW S. CHIRAS ASSESSORS MAP 50 E 7UR7LE COVvF� ROAD PARCEL 112 AL AL ASSESSORS MAP 60 PARCEL 114 Nf2 MI AL DYaLNC gt �� �'+ ` � w ouDET4ae• EXISTING �R _ DECK O E ENCLOSED LOT 4 Lsas• LOT 5 = 0..b 14.a 1 B,213f S.F. b 60.0' 2 a EMSTINO 20'r FOUNDATION Tar. -23.0' CARA'E u•0' LONG POND INVESTWENT]DRRIIVSET ASSESSORS MAP LS0 s PARCEL 11S 00, lop L I HEREBY CERTIFY TO THE BEST OF THE BSC GROUP, INC MY PROFESSIONAL KNOALEDGE, iNFORMATICN AND BELIEF THAT THE 657 MAIN STREET, WEST YARMOUTH, MA. LOT CORNERS, DIMENSIONS AND of SETBACKS TO THE STRUCTURE AS PROPOSED SCALE: 1'-30' AND A DETERMINED BY INSTRUMENT SURVEY CORRECT.. SHOM ON THIS THIS PLAN ARE CFaD DECK ENCLOSURE DATE: a-20-00 No. UM PLAN ` w /v/�/oo�1► 200 LONG POND DR. BSCjl4-8100.00 CRAIG A. FIELD, PLS DATE W0 S. YAR1tii0UTH, FOR THE BSC GROUP, INC. SHEET 1 OF 3 m m 0 m U U ° m O Z f 0 0 APPLICANT cohv Z 6 TH S PERMIT NOT VALh:uAL`ESS BUILDING =JJ ° PPhCEIPTED BY CASHIEk PERMIT VALIDATION DATE 1/1312000 19 PERMIT NO. B--00-469 APPLICANT ROBERTS. DAVID ADDRESS 93 4iF.RCNAllI' YARYORT 03S'82U NEW HOUSE (NO.) (STREET) I ICONTR'S LICENSE) PERMIT TO 2NUMBER OF S STORY DWELLING UNITS f (TTtE OF IM►ROV[M[NT) NO. IRRopmEv uaah AT (LOCATION) 200 r.0l:G POYD DRIVE SOUTH YARMOlT H, NABS. (126(A ZONING R-40 INo.I (STREET) DISTRICT BETWEEN AND (FRC!! STREET) (CROSS STREET) SUBDIVISION Jwf A44 LOT Z`a BCOLIC 51 LOT SIIE BUILDING IS TO BE TO TYPE REMARKS: 1 1: FT. WIDE BY FT. LONG BY F®V , - V AK [ V N Ip ff LU ION USE GROUP BASEMENT WALLS OR FOUNDI.SS ind-pirsuant to 780 CMR tEc t ncrr ! r/o nli'iML�t. 1, Se&111.13- AREA OR VOLUME ESTIMATED COST (CUBIC/40UM[ ►E[TI OWNER LOW FWQ DRIVE IWESLXENT TRUST ADDRESS ! ! • 1229203,00 FEEMIT s 548R00 BUILDING DEPT. BY &47A MUS AMD CES;GN CDCUM of 7f / L NEW HAMFSMRE MA;SACHUSETTS C@d.FCM PT MANE i K%fY1M SMl.rrw ww® Twrwua SUM 17M1r11%J J6 MwIq Mr Rv1.0 71 JN4wwt Arwf Y�11ti+i.w� S1n taM�i�/�sti YS U3 Rwrt 1'wc kk r= 16Pr.1NDI1'A fte .A.NI170: LApA1t Wfwta YN 11611 Swbom.MEW.4 11n1152. IWOMIMp 14(D471-YO WQaan. VATW 1-eco-W17M ww10-ml t4mAsw 1IMM-s11! ■1[eaoE ruralc ID.IrG � � u 6 6 q/zY t(rlZ+ �(9h�18 x n U/ vitjye- #CAA- 5abl4tc towovwws ��: s cc a� a c fJ�ss, �{k� sczs�v • � w1 oAA FUc(r VIeW Sr?-E.( bop,, � 3 cli o F>-�;-c57--t/t✓G 14� a u 5a- o20(3 Co iV ( PGA{/ 29/}-4 . Oct U3 OU 00:4Ua EXISTING oµauNG IEAST ELEVATION SKETCH PLAN TO ACCOMPANY REQUEST FOR DETERMINATION FOR 200 LONG POND DRIVE. W RAFTERS EXISTING DECK TO BE ROOFED AND ENCLOSED 240 JOISTS 4'x6' POSTS EXISTINGPRESSURE TREATED WAUCWT STEPS WITH SIDE RAILING EAST ELEVATION , CFLAIoA Na% /a /; ocj 0 46.8' TO ej�TL�AND FROM DECK THE BSC GROUP, INC 667 MAIN STREET, MST YARMOUTH, MA. PROPOSED SCALE. 1'-10' DECK ENCLOSURE DATE: a-29-00 PLAN 200 LONG POND DR. BSCJ 4-8100.00 S. YARMOUTH, SHEET 2 of 3 -r 04t •• THE STRUCTURE IS LOCATED IN ZONE "Co LONG POND oo i AS SHOWN ON FIRM COMMUNITY PANEL / 1 250015 004 C. EFFECTIVE DATE: 6/17/86. i AL A6 ELLE)( HAZELTON N/F 206 LONG ALPON DIUW AL ANDRE�iNS CHIFtAS PARCEL As 69 112 8 TURTLE COY ROAD ASSESSORS MAP 59 PARCEL 114 Sw� A6 A6 AL f7 r ;H DOSTING AL. DWELLING f4 J DDM* N00 LOT 4 �0.4• m t o Zr 269.0' 8 " FOUNDATION $ LOT 5 TDB- -2mw 18,213f S.F. wai POINT of ROAD -Izoo, LONG PTE E1EVAnaN - 20.4' LID VE 4�j 31.3' INVE571�IE?IT� ]RUST ASSESSORS CELiM; P 80 I HEREBY CERTIFY TO THE BEST OF THE BSC GROUP MY PROFESSIONAL KNOWLEDGE, or , INC INFORMATION AND BELIEF THAT THE + 657 MAIN STREET, WEST YARMOUTH, MA. LOT CORNERS, DIMENSIONS AND SETBACKS TO THE STRUCTURE ASA CERTIFIED SCALE: 10=30' DETERMINED BY INSTRUMENT SURVEY FOD AND AS SHOWN ON THIS PLAN ARE No. CORRECT. PLOT PLAN APRIL 6, 2000 wo 200 LONG POND DR. ���y���� YARMOUTH, BSCO 4-8100 CRAIG FIELD, PLS DATE MASSACHUSETTS FOR THEE BSC GROUP, INC. SHEET 1 OF 1 Daniel & Braman, PA 20 L o "ckQC is Q q2a 780 Harbor Point JU _� S �,dR, p.{ O V •T� Cwwnagaid MA 02637-0361 3Ga (Ern« oo S'IRu C' TV 2ia.l� E V A-l_ u1%.'T c e 14 of I -oA O -r o Cvt.uwANS © Xt-1 0 a �rT(UG-rQ C9,' 1- a �►.t� 6'� �--t t-% t�T t t...�Ta ice® r 3- 2x 12 lz s 3xfatQ4.8 tr3 z i now T-�y 1►S�P��.'Cw �otic. G.�s 'FQ-c, t-•t JL%ov V JC.(2.r CD lu �- 4 0 x 1''L :4 25 x'Z X 2 K ton) , l� � `n t,.r d 11►µ¢�L >C lt� s p i' ►►► ��N OF. y,/ f a�. ... Cc is I i`o++�DANIELE.f'��G GLbtee` /l P ` BRAMAN ► e ��o sRO U ° '*o FQISTEA� �s� �:fS/0MAI EMS+��� p FIELD COPY _13 BUILDING 1 -o0 4W ' PERMIT ? - ' DATE 1/13/20N 19 - 'PERMIT NO. B-DO"469 APPLICANT ROBEn S• DAVM ADDRESS 93 HERCHAM A151M YAMRT 03MO ' mw NOCSB (N0.) (STREET) .(CONTR'S LICENSE) Y Z PERMIT TO (_)- STORY 2 NUMBER OFDWELLING UNITS (TYPE Of IMPROVEMENT) NO. (PROPOSED USE) AT (LOCATION) 200 LONG POND DRIVE SOUTH YAMOOiSR MASS. 02664 ZONING r In (NO.) (STREET) BETWEEN' AND p ` (CROSS STREET) (CROSS STREET) IL SUBDIVISION 58/113 LOT LOT k5 13 - 51 SIZE :% t Y, BUILDING 15 TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SMALL CONFORM IN CONSTRUCTIDN a = TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION r ' a IT ►EI ° u YIT REMARKS: �•��• ttv 1 DIN 3 R SHD. 2 BATHS 1 DEQ. 1 CAR CAR= R .. VOLUME ESTIMATED COST n2.208*00 Fy (IT s 50,00 ' (CUBIC/SQUARE FEET) /! OWNER XAM POND DYNE INVBSMMT TRI= 'SMU=• UUT • MISS. 02610 DEPT. ADDRESS BUILDING . .INSPECTIO ORD !o � ATE NOTE PROGRESS - CORRECTIO AND REMARKS INSPECTOR I _ =^ C I ! o:llce Use only p- The Commonwealth of Massachusetts reea.r _ tI Department of Public sofcty . _ occ uluncy a /era Chocked BOARD OF FIRE PREVENTION REGULATIONS S27 CMR 1= 3/90 (lea.e blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK NI Work to be performed In accordance With the Mauachusetu Electrical Code. 527 CMR 1W1, 200 : (PLEASE PRINT IN INK OR TY,/P�E ALLLyI,NFO ON) Date (1 D Z� City or Tow of _� ty�\ ' '� To the Inspector of Hires: The undersigned applies for a permit to perform the electrical work described below. Location (Street& Number) O N I L Owner or Tenant _ N1 V gr,,- E n S —�� Owner's Address pp Is this permit in conjunction with a building permit: Yes No I-](Ch Rpplowom ) Purpose of Building Utility Author NO. NO. Existing Service Amps / Volts Overhead ❑ Undgrd New Service Amps / Volts Overbead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity. Location and Nature of Proposed Electrical Work 1� ' 1 a.. ULrCC': No. of Lighting Outlets No. of Hot Iubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above In- grnd. ❑ grnd. ❑ Generators ).•VA No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Initiating Devices No. of Sounding Devices No. of Self Contained Detection/Sounding Devices icial ❑ Coonnnection❑Other No. of Ranges Iotal No. of Air Cond. tons No. of Disposals No. of Pumvs Total TotalTons No. of Dishwashers Space/Area Heating IW No. of Dryers Heating Devices KWLocal No. of Water Heaters KW No, of o. o Signs Ballasts Low Voltage Wirin No. Hydro Massage Tubs No. of Motors Total HP INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Insurance Insurance Policy including Completed Operations Coverage or is su tantial equivalent. YES 0 I have submitted valid proof of same to this office. YES If you have chec d YES, please indicate the type of coverage by checking the appropriate box. INSURANCE BOND ❑ OIHER ❑ (Please Specify) piracion ace Estimated Value of Electrical Work S Work to Start Inspection Date Requestedt Rough �Z �OFinal Signed under the penalties of perjury: _ FIRM NAME D& \(�� >N C—C> -.L,1. c�Q_ LIC. NO.JQ�A Licensee E"o O Ce \'z\l_\X2 1 UC_1:J Strnarur" t. �o � lY Q O &AAA LIC_ NO. Address?0 "P1iUls ��� U (�'`cL'Wlo.�c�-vz'�, lyn( Bus. Tel. No. t6Z Alt. Tel. No. • OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or cs sub- stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE S Signature of Owner or Agent TheO:tlte Use Only Commonwealth of Massachusetts F_ pp_ ill P. raft b. Department of Public SoJcty - = occuMncy L fee Chocked BOARD OF FIRE PREVENTION REGULATIONS S27 CMR 12b0 3/90 (tea.e blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All Work to be performed In accordance With the Maauchueetu Electrical Code. 527 C(M/R/I2:00 (PLEASE PRINT IN INK. ORt TAY,/PEE ALL IliFO ON) Date City or Town of v� lyi��� Io the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) 1N1 L� Owner or Ienant l_On� 9by-1 (i�r Owner's Address Is this permit in conjunction with a building permit: .�+1.s1►�;I,l�� en S 10 C Yes No ❑ I (Ch Purpose of Building Utility Aut.horfz gr Existing Service Amps Volts Overhead ❑ Undgrd a New Service Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and Location and Nature of Proposed Electrical Work No. of Meters C__�Q_0C, No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimmin Pool Above In- 8 grnd. ❑ grnd. ❑ Generators KVA No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones NIn of Detection and nitialing Devices No. of Sounding Devices No. of Self Contained Detection/Sounding Devices Other Local ❑ CCoonnect on No. of Ranges No. of Air Cond. Ttons No. of Disposals No. of pum9S Total Tons Total No. of Dishwashers Space/Area Heating KW No. of Dryers Healing Devices KW No. of Water Heaters KW No, of o. o i ns Ballasts Low Voltage WirinNo. Hydro Massage Tubso. T1,of Motors Iotal HP P INSURANCE COVERAGE Pursuant to the requirements of Massachusetts General Laws I have a current Insurance Policy including Completed Operations Coverage or is sub tantial -equivalent. YES 0 E I have submitted valid proof of same to this office. YES iM If you have chec d YES, please indicate the type of coverage by checking the appropriate box. INSURANCE BOND ❑ OTHER ❑ (Please Specify) Expiration Dace Estimated Value of Electrical Work S Work to Start Inspection Date Requested: Rough %Z 00Final Signed under the penalties of perjury: I y� S FIRM NAME 1yl-\���` C-0 � Le `� NO.�s t Bus. Tel. No. C, St 5- Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub- stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE S Signature of Owner or Agent APPLICATION FOR PERMIT TO INSTALL AND REQUEST FOR ELECTRICAL SERVICE Inspector of it ,1 Wiring Permit # I COM/Electric Town of tIMrA '' V'}�j t�Massachusetts [� �) Building Permit # Date o `` Customer: L U /v G C U N ) 1 � V(1 S 1 " YEon (Street #)Z �O(1?� `ook O_R Lot # in the village of utility pole number or urttpiamd outer Customer's billing address Temporary New installation Change of service Starting Date Job description - Service entrance voltage V 0 Amperage "1?0 Phase Wire size (cu. or al.) Conductor per phase Number of meters Water heater OH peak: Yes — No — Estimated load: Electric heat kw� li�hts kw, Range dryer Motors, H.P. & Phase Ready for first inspe �' �-F Ready for final inspection Electrica�or tractg , V C _ —�Lic. # , "1 = Telephone Address " T 1i ur �Nrll•rw1% rltPit L-% V111l %_.0Lb-I Additional Remarks: Do Not Write Below This Line ELECTRICAL WIRING INSPECTION CERTIFICATE INSPECTOR OF WIRES INSPECTIONS r"j^� Q ,1 l r t TL FEE CHARGE Temporary Service Roughing in Service and Meter Off Peak Meter Final Approval Disapproved' 'For the following reasons CERTIFICATE OF INSPECTION DATE To the COMMONWEALTH ELECTRIC COMPANY. The installation described above has beery late"nd has t ' da oeen inspecjed and approval granted for connection to your service. Inspector of Wires WIRING INSPECTOR TO BE NOTIFIED WHEN WORK IS READY FOR INSPECTION Permit Good For One Year From Date Of Issue CA 46-1 White — COM/Electric Green — Inspector Canary — Town Receipt Pink — Inspector's Copy Goldenrod — Electrical Contractor to COM/Electric 54 `�o�� APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00 of y1. 3}' �q; (OFFICE USE ONLY) ~g By TOWN OF YAK11111 Fee: $ tnO •0b / PERMIT (PLEASE PRINT IN INK OR TYPE ALL INFORAIATION) Date: O To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) W n Q(9n Owner or Tenant G U es, lephone No. Owner's Address Is this permit in conjunction with a building permit? es ❑ No (Check Appropriate Box) Purpose of Building Uew y / i`KJ � �C. —Utility' Authorization No. � t Existing Service Amps / Volts Overhead ❑, Undgrd ❑ No of Meters New Service J00 Amps Its Overhead LGd' Undgrd (71 No. of Meters_ Number of Feeders and Amoacitv / Location and Nature of Proposed electrical Work: mh/ ,nnv 6" funi,wd by th. f It';b, 'No. of Recessed Fixtures No. of Ceil.-Susl2.(Paddle) Fans No. of Total Transformers KVA No. of Li6ring Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Above In- Swimming Pool gmd. ❑ gmd. ❑ No. of Emergency Lighting Battery Units No. of Receptacle Outlets () No. of Oil Burners FIRE ALARMS No. of Zones r No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges Total No. of Air Cond. Tuns No. of Alerting Devices No. of Waste Disposers Heat pump Totals: Number Tons — KW_ No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Nunicipal Local ❑ Connection ❑ Other No. of Dryers Heating Appliances KW ecutuy yscems: No. of Devices or Equipvalent No. of Water Heaters KW No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. H dromassa a Bathtubs Y E No. of Motors Total HP Telecommunications Wiring: No. of Devices or E uivalenc Attacn aaattronat aetatt t/ aestrea, or ar req/rtrea ay toe inspector of wires. 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. R,'� CHECK ONE: INSURANCE 00 BOND[] OTHER❑ (Specify:) (Expiration Dare) Estimated Value of Ele tric. Work: (When required by municipal policy.) Work to Stara Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the s d Ti ties of perjury, that the information on this application is true and complete. FIRM NAME: � � C�[� r l 1%-5. -ro i� LIC. NO.Q Licensee: �tl C�r�� n �e a Signature '' _LIC. NO.� (lf applicable enceLf)"exempt" in thee,license number line.) Bus. Tel. No.: Address:20 Y�J).I"F' U1AC?tylnt�l,�oR�, iYIA Ali. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware thWthe Licensee does no? have chid 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 ..f .. -... � .p„wrwn�v�... �. ..,w,,..;r..J . � .. -. .. :;�...., v��F.--w+a. n. ..n ac �.a+. n •�•«v; ctA's;. i-v,, r... �... �.�-'."Y, TOWN OF YARMOUTH M APPLICATION FOR PERMIT TO DO PLUMBING (OFFICE USE ONLY) By Fee: $ /J�J�•t�h PERMIT NO. Date () Building 100 �o�� �1vv Owner's AT: Location Name Type of Occupancy R12h) Oovkse NewfA Renovation ❑ Replacement ❑ ; Plans Submitted Yes ❑ No ❑ N to O z CA -jN u7 U z 0) : cc Y N Cn z LL Z O(n Z ZW a c IC1 O? F S G. 55 V v U w O m w a ai � a W z o rn J Z¢ p a¢ O o w= F- F" 3 0 z= 3 J rn G. x rs LL le le Q W a t g a °x N Cn g a o a o a cc M a o a 3 Y m w o o x� rn U. 0 n a s 3¢ m 0 SUB-BSMT. BASEMENT 1ST FLOOR { 1 2ND FLOOR 3RD FLOOR (PRINT OR TYPE) Installing Company Name �►1tc.J11V�� ��ini�b��y NQaT(r�6) Address 91 mf rc� Air Vcf r mgi i N 1)o fT Check One: ❑ Corp. ❑ Partnership r�c'�Firm/Company Business Telephone J C(J —�nu gz Name of Licensed Plumber INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent. Check One: Yes. No ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. A liability insurance policy`- Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance voerage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature of Owneror Owner's Agent 1 hereby certify that all of the details and Information I have submitted (or entered) In above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Check on Owner ❑ Agent ❑ a iv4 Signature of Licensed Plumber License Number Type: Master 0 Journeyman G APPLICATION FOR PERMIT TO DO GASFITTING TOWN OF YARMOUTH By (OFFI E-USE NLY) �.. Feel Rays ' 1 c� - `1 �•o� PERMIT NO. U< / Date Ste" Building a O� L�, \ /� ^ 1 �\� Owner's �� h� / ty h;UQS AT: Location'' a o V `V Name t if /T u Type of Occupancy /Je-M New ❑ Renovation ❑ Replacement ❑ Plans Submitted Yes ❑ No ❑ N y Y Z W `4 y u7 S 0 S M } Z Q Z m y H W wCC O O a O FZ- Q in N t7 LU W = Q O W W W S W N J Z U Q= 0: (n 0: W 0 R 0: W t- G> W V= y 0: W> W M Q 2 a7 W Q o: � Z 3 Q g O O W o O P o x o a x v. D 0 a 0¢> o. r- SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR + + (PRINT OR TYPE) Installing Company C Address Business Telephone Name w 0- Name of Licensed Plumber or Gasfitter Check One: ❑ Corp. ❑ Partnership — S A Firm/Company INSURANCE COVERAGE: Check One have a current liability Insurance policy or its substantial equivalent. Yes 4 No ❑ If you have checked yes, please indica the type of coverage by checking the appropriate box. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check One: Owner ❑ Agent ❑ Signature of Owner or Owner's Agent 1 hereby certify that all of the details and Information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all.plumbing work and installations performed under Permit Issued for this, application will be In compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General laws. V. QPA Signature of Licensed Plumber or Gasfitter License Number TYPE LICENSE: 7 Plumber ❑ Gasfitter ❑ Master Moumeyman k IN n) 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: $ (00 •06 /�( PERMIT NO. E-61-646 (PLEASE PRINT IN INK OR TYPE ALL INFORAIATION) Date: I /O 0 To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) LSJ Owner or Tenant UC Telepho o. i Owner's Address Is this permit in conjunction with a building permit? es QNo (Check Appropriate Box) JUL /1 $h2��0 Purpose of Building Mew Q n c Utility Authorization No. VLV t / Existing Service Amps / Volts Overhead ,Q,, / Undgrd ❑ N eters New Service Amps 120 / "Z5 Its Overhead Lam' Undgrd No. of Dleters� Number of Feeders and Ampacity Location and Nature of Proposed electrical Work: Com lrtion of the following table may be waitrd by the Inspector of WinsNo. of Recessed Fi turcs No. of I in No. of Total Transformers KVA No, of Li hting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Above In- SwimmingPool rnd. rnd. No. of Emergency lighting Battery Units No. of Receptacle Outlets 0 No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection an Initiating Devices No. of Ranges Total No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Num er Tons — KW — No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating Iti'W' Municipal Local ❑ Connection ❑ Other No. of Dryers Heating Appliances KW securitysystems: No. of Devices or Equipvalent No. of Water Heaters 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 uivalent Altach 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 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: INSURANCEIYI*� BONDQ OTHER (Specify:) (Expiration Date) Estimated Value of Ele tric. Work: (When required by municipal policy.) Work to Start: b6 Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the s en�lties�,,QQf r'ur that the information on this application is true and complete. //�� n 9 FIRM NAl\ E, �� C"U ��L�TtI_(C� LIC. NOQ Licensee: f) V L' E RLUIC-MICr Signature LIC. NO. (if applic le, ente exem t" in the license number line.) { Bus. Tel. No.: 36Z Address: p tie �L'T UQfZMnA1'1oaA, )nP*Alt.Tel.No.:_____ _ OWNER'S INSURANCE WAIVER: I am aware thYethe licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I and the (check one) owner owner's agent. ❑ Owner/Agent Signature Telephone No. [Rev. 04/001 r \t10 APPLICATION FOR PERMIT TO INSTALL AND REQUEST FOR ELECTRICAL SERVICE �1!\W1111 Inspecto it h Wiring Permit# vl LVElectri # y of Town of Massachusetts Building Permit # Date 0 Customer: h 1 ` `'Ton #) 0 Ch Lot # (Street In the village of S pW utility pole number or underground number Customer's billing address Temporary a lnstallat' 1�' Change of service Starting Date 0 Job description Service entrance voltage Amperage 100 Phase Wire size (e=or al.) Conductor per phase Nui Water heater Off peak: Yes — No — Estimated load: Electric eat kw, lights �kw, Range dryer Motors, H.P. & Phase Ready for first inspectio t 1 Ready to final inspection Electrical Contractor' Lic. # Te hone # Address Additional Remarks: Do Not Write Below This Line ELECTRICAL WIRING INSPECTION CERTIFICATE INSPECTOR OF WIRES INSPECTIONS Temporary Service t Roughing in Service and Meter Air ', —��— , Off Peak Meter Final Approval , Disapproved' 'For the following reasons FEE CHARGE CERTIFICATE OF INSPECTION DATE To the COMMONWEALTH ELECTRIC COMPANY. The installation described above has been co led ors this day b en inspected and approval granted for connection to your service. Inspector of Wires WIRING INSPECTOR TO BE NOTIFIED WHEN WORK IS READY FOR INSPECTION Permit Good For One Year From Date Of Issue CA 46.1 White — COM/Electric Green — Inspector Canary — Town Receipt Pink — Inspector's Copy to COMlElectric Goldenrod — Electrical Contractor 'Y "pr. ��� r�e^ti:�7.. .Yr .. . n�."^T•yltr"'a"1f•v,!�'_<1:\1a..�wrv..t �ir+.�.a.�,�4y-.n1f41r..... ;��a: t• APPLICATION FOR PERMIT TO INSTALL AND REQUEST FOR ELECTRICAL SERVICE �, ,, ;Rnspecto of i Wiring Permit # 6' M/Electri # Towtf of Massachusetts Building Permit # Date n Customer: bh n on (Street #)� 0 tot # in the village of p� utility pole number or underground number F Customer's billing address ,., Temporary e� a inst�all`atjpO Change of service Starting Date v Job description N Service entrance voltage Wire size (ci%--or aL) _ Number of meters — Estimated load: Electric t Ready for first inspeckon Address Lips � Additional Remarks: 4-RFD —Amperage -I n y — Conductor per phase Water heater Ott peak: Yes _ —kw, lights�kw, Range — Ready ((71 r LY I :T- Lic. # Phase No- -dryer Motors, H.P. & Phase Do Not Write Below This Line ELECTRICAL WIRING INSPECTION CERTIFICATE INSPECTOR OF WIRES INSPECTIONS i / �'� ' DATE Temporary Service Roughing in �J Service and Meter 4AACC C3 r J Off Peak Meter Final Approval t I N4-i o t. Disapproved' 'For the following reasons FEE CHARGE CERTIFICATE OF INSPECTION DATE --) 11 C `1 To the COMMONWEALTH ELECTRIC COMPANY. The installation described above has be ted a h s this day been inspected and approval granted for connection to your service. Inspector of Wires WIRING INSPECTOR TO BE NOTIFIED WHEN WORK IS READY FOR INSPECTION Permit Good For One Year From Date Of Issue CA es-, White — COM/Electric Green — Inspector Canary — Town Receipt Pink — Inspector's Copy Goldenrod — Electrical Contractor to COWElectric T .w �. ,r�1 • • •.r...r^. �. ..ram rmp•y t�.yf'v Ylirr;hr�.Yy n..+r.:y�'� �.v-^1^".'• .'�iy���^.r.� `v r jqs ectc . Town of Customer: Lot # Customer's billing address APPLICATION FOR PERMIT TO INSTALL AND REQUEST FOR ELECTRICAL SERVICE Wiring Permit # E 6/ " .M/Ele i # �1— Massachusetts Building Permit # Date o on �IJ�IC'S�f►r�f� �11 on (Street #) CLJ h OrlJ R .. the village of ��t r utility pole number or underground number r Temporary g ra a tnstallatia �� Change of service StartingDate Job descrip Service entrance voltage Wire size ((!IF. or al.) _ Number of meters — Estimated load: Electric 1 Ready for first inspecppn S Y'fJ Amperage %C) tJ — Conductor per phase Water heater Off peak: Yes— No- -tw. 'ghl kw, Range dryer 1 Ready f fin tp t CID u�. # 1 Phase Motors. H.P. & Phase Address 'k ' M r V. -7 v w Additional Remarks: Do Not Write Below This Line ELECTRICAL WIRING INSPECTION CERTIFICATE INSPECTOR OF WIRES INSPECTIONS , DATE Temporary Service LfL �J Roughing in --- Service and Meter. �a.F `u�(.C'. IL P J Off Peak Meter Final Approval Disapproved' 'For the following reasons FEE CHARGE CERTIFICATE OF INSPECTION ATE J G r's I loo n ToIhe COMMONWEALTH ELECTRIC COMPANY. The installation described above has bee ted at hts this day been inspected and A approval granted for connection to your service. !\ 1 Inspector of Wires WIRING INSPECTOR TO BE NOTIFIED WHEN WORK IS READY FOR INSPECTION Permit Good For One Year From Date Of Issue CA 46•1 White — COM/Electric Green — Inspector Canary —Town Receipt Pink — Inspector's Copy to COM/Electric Goldenrod — Electrical Contractor 11 APPLICATION FOR PERMIT TO DO PLUMBING TOWN OF YARMDUTH , OFFICE USE ON 00 D Fee: $ 55-t�D It BYA-1 J U L 1 920 n _ PERMIT NO. By Date2#� OC Building AT Location New ril Plans Submitted Renovation ❑ Yes ❑ No ❑ yj Owner's LrouI,�c1Q)T►TrtfwT Name Type of Occupancy_IEW Up-$ Replacement ❑ -z z rn JUL 2 0 2 rtf}N��+ I -i N a a z � c� u, N 3O 5 5 U Z m¢ ai w cc a vi z o ¢ rn a¢ a¢ y I= 3 3 0 z= 3 V n. 0 ►- a x w LL Y w a o Q°° a¢ a 0 a 3 x g m u=i o o g 3 x c 3 o r rn u. D a x m SUB-BSMT. BASEMENT 1ST FLOOR 1 f w 2ND FLOOR t 3RD FLOOR (PRINT OR TYPE) I ►�y, Installing Company Name Address 3 merci.ArJr �!t- NIA W N nO _ Kc J Firm//Company Plumber Business Telephone -'� g�) Name of Licensed Check One: ❑ Corp. ❑ Partnership INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent. Check One: Yes No ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. A liability insurance policy' Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance voerage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent I hereby certify that all of the details and Information I have submitted (or entered) In above application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under Permit Issued for this application will be In compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Check on Owner ❑ Agent ❑ - d Signature of Licensed Plumber License Number Type: Master ❑ Journeyman-T- r C tL✓�i 1' ,� TOWN BUILDING OF Y A R M O U T H ELECTRI( 1IA S 1146ROUTE28 SOUTH 1ARMOUTH MASSACHUSETTSOM4-"51 n t Telephone (508) 39P2231. Ext.261 — Fax (508) 398-29't ,gyp BUILDING DEPARTMENT 1999 BUILDABLE LOT INQUIRY FORM Nov '3 0 .. • t Lot No2s Assessors' Map N 01 Endorsement Date of Subdivision Plan and Type (if applicable) . Total Land Area (sq. fi) I R V 13 '( Frontage ya Name of Current Owner? ,� dress i�6 y 9ii Telephone No. 76a —/9s ° Inquire's Name (if different from owner) ft"cn► ' Telephone No 7 6 0 — /9U o Inquuire's Mailing Address %( Building Intent Adjoining Lot Numbers S�)jc f /� S ©cam{;�/ Date of Inquiry Signature of Applicant , FOR OFFICE USE ONLY Does not conform with M.G.L. Chapter 40A, Section 6, single lot exemption, or Definitive Plan Exemption and/or the applicable zoning bylaw, as per information provided. ' Reas9rr Conforms, with M.G.L, Chapter 40A, Section 6, single lot exemption; and/or applicable zoning bylaw, as per information provided. vk, �, .4 Protected pursuant to M.G.L. Chapter 40A, Section 6, Definitive Plan Exemption. Application is incomplete. Comments: - Adequate road access must+e'present. Determination of access shall be determined by the V/lanning Board (ifapplicable). ?mWust satisfy Title V requ iretnents. ' t 7must satisfy Conservation regulations, if applicable. Qstigator's Signature ..••..w.nw•+LLn •/ea/•�rpaMdul,►tlts o0icwl Use Only Pcrmif No. 60 :QF 11K):=,GULATION$ OcwpaaeYw1FeeCixcicedf / �Ren':�'L.I& 10 FOO PERFORM ELECTRICAL WORK All work to be perromtcd in aecpJawca with the Masoehwctu Uxtrical Cadc (MECL I27 ChIR 12.00 ll'CCdSCPItlWIN1AW OR TYPE AU INFORA4710N) Da1c:-2S-Qf�zS City or Toms or. YAQnAOurbi . • 7*011itimpeuorojWirer: Oy•Ilt"pplieation We undmigncd givesnoliccofhu or her lutcrutou to perfomt the electrical work described below. Locatlun jSlreet S Nuulbarj SOO LONG l�OhiO L�� Otilter or Tenant Telephoot No. Owncr's-Address , w Is Ibis permit In coniuucliuli wvlth a build4t.,pernJ19 Yes ❑ No a tclwcic, roprla as) I'urltuse of IlullPubg Utility Aulhurizalluu No. E213Ong- Scrvier Amps f • Yolls Ovcrheatt Q Uudgra Q D Unagw ❑ ' °f '2-9-�800 wr Amps _ I vvlls OveskuJQ afbJtters Number of Feeders and'Anipacily : • t. Localiorrtindl4ature of ProposeJEfectzicallYorfc: Cp T•• —jQ6 --- - y ' No. of Recessed Ftsiures uw"vro/wv ur 1/q 10110mJ101 Na of Cr1L.S+up. iFaJJlejFauf mart Iner bt r•olved bw dit luipeeror of IYiret. o• ° -19131 ransformers KVA No. of Ughdag Outlets No. of Hol Tubs Gineratars KYA No. of LtghUng Ftslures Swriowdug Paul p �- ❑ a• a uurZeney 1( ,,,� vrbove End. BatlenUnits Nb.of YAceplacla Outlets. No. i 0411untss FIRE ALAR1tiS No. orzonts No_ofSwrilehes. ' Nopefca lluraers o. o teeuon a lnillatin Deriep � No. of Rangts No. of Air CotstL Total ns No. of Alertfug.Devices ,,\o. of 1Vasta Dlspnsers Hear Totals: Pllcr,jrom Delectio" Alerttn Dewiets Ito. of Dish*asliers • SpacdArea Heating X%V Local ❑ wuetp ❑ Other Coline[IIOIt No.ofDrycss• • App11-aus =LLY a stcau: , K1Y Devices No. o Water No. of or Eoulvalent o' Healers i�Y S ns " tiialiasts. Data 1Viriug: N0.1 o. orULIcts or Enuivalent No. HydroutauogeBalhlubs No.•ofAlolors Totat UP ecommumca oas urea;: No. of Devteta or E uiv:len •YY-w ..o " rcgmrr( Dy rbt l4rprerOt Of InArer, 'MU"NCE COV ERACE: UnIeU w•aivod by the owner, uo permit for the performance of cleenical work may lssuc unless tlu licensee provides proof of liability hunt = hwclttd+ur'eonrpiased operation' eavemg,n oc its subsraatfal equivalent. Tlw undersipncd certifies. tbat un:1r caveralfe'fsirrfoies, 9KI`W tahfbiled proof ofsartre to tric permit issuing office. C;j1=0N8.1.\SUAAXCE E} Dolma. D 0:p •1 A G Ester,} Eatiautsd Value of ElectricallYorL lExpiration ate) (Mmmquiridby muufeipal pouey.) Work to Start: hupccdoos to be rcq=tcd is accaidatu:e with MEC Rule 10. and upon completion. 1 ealijrunderflrepafas• air apeaalliervjperjumrhdrdtclafornterfon au:Gi3.appruwrais i; true end camplele. FlltnlNAAIX: 3•T SRCI A(�RM Uc NO.: _ Ltcrltsea: fi(j� Signature _ LIC.NO.: % —C 111ypplicobli,errts •rew1pr'atdl.lrcrreuvwtberL:. Ilus.2elNo. adtlras:3i Virg llZ'- 0 �4iii =� t JTH fl!?f .�At1Tl1 AIt. Td. No.• 01YNER'3 INSU1tANCh WAIVER: J IM aware 0:at the L ewee dory not Aaw thc.1. lity itnuraoca towcrage aotrtully require"y.law. 11y ay-signxu r4 be", bhercby v4m 14is-require.,X" katuulcIcbmkPn1oTwnFeOrucr/Agent rl ovter a anu. fSitnature Telephone No. CALL BACKS 3NSPE=bN FEES #ZI3 'lt. •1ST CALL BACK $20�00 ' AUG �, �: ���� ,. .__..__ . ZND CALL BACK $30.00 BY ` 3RD CALL BACK $40.00• ALL OTBEB CALL B4= 440.00 DATE:off p I . AUG 18 2000 D LOT ey Z ISSUED TO: ADDRESS: REASON FOR CALL BACK: BUILDING PERMIT: OCCUPANCY PERMIT: PLUMBING PERMIT: v GAS s PERMIT: •. , ELECTICAL PERMIT: ?IRE DEPA ; )THE&: -- Wryn�wwn«y.lw ��c/T//atsrrc/wx/L official Use Only[ /� t Permit No. Mt :�efr;us O�/ ecx :OF FIR)==RM GUlATI(n «cupa=y WiFMClucked' Al�� (,� Re4. 111991 leave bla,k QPPt.i ON OQ PERFORM ELECTRICAL WORI{t: All vmrk to be parormcd in ai.catlmae with the Mattachwcus Ekcutcal C&Jc (bIEL).127 Otit 12.o0 (YC . L=* P&iV'r/*V I SX Off TYPE AL4 INFORAUT10H) Dalc: e-25-06 or Toth of: Yap tii Ovtft-1 To 1/19 luspeclor of Wires: Bydtisapplicalian the utxiersignod ivcS noUccof lux or her tuicruiou to perform the elcciricsl work described below. Locatlua (Slreel .0 nuulber)_�LOO LONG �pnxj ��� Owuer or Tenaut _ l (L.p e.p coury . "fe t.DQ S Telephone No. Owner's -Address Is this permit in conJunciJoti tvitit a buildia-peradt? Yes ❑ NOD (ChukA ropria ox) mriwsc of Uuilding Utility Auilturizal nu.I ExislingScrvicr Amps / Yolls Overhead 0 Uudxrd [] vf��2��0 NetrService_ Amps / Vul(r. OvezUcv;0 Und=rt1� ofAleters: Number of Feeders and Anipacity iacallonind:NzrureutnoposeLlM%jtCcaflYadt. No. of Ilcccursl Fixturi:s -^�••••••••�. •... Fvu. ffv No. of Ct1L-Susp. f raddle)Fan* muff"lay of 4•orvra Oy rite blJoccror or trims. ING. of ota Transfonucrs KVA No. of Lighting pullets No. of 1191 Tubs Geaer_ton KYA No. of U&JAIng Fixtures Strinurdu Paul A ore u- g Mid. Md. o. v t mcrjcncy g sue B211trv77nits No_ofReceptacleOultels No. OFOilBurnt" FIRZALAIMS No. of Zones Na-Gismilches. N.ap of Cas, B urnefs o.01 ecliontinie vi d e In111a No, of Ranges of No. Air Coal. Toni t No. of AlcrtiuLDevices \o. of %Vast* Dlsposers car Tools: er oar o. v c oats uc DetectiodAl4r1in Deticss No. ofDishivashers SpaerlAraHating K1Y Loeat uwctpa Conneellon O Other No. ofDrycss• No. o ater IIeaters K)v A""l�r tom... K1Y 0. S as tau, c Na. ofyDMiees or Eaulvaleut Data IViriuq: No.O%4Viets or Fouivalent No. Hydrontauage BalhluW No. of Alolors Total IIP Tclecuallnualcauous snug; No. of Deviets or Ecuivalen OTHER: ..,."rV-0a.ararragmrtKoythe /Ntpeuorofirres. 1NSUR. NU COV F.RAGE: Unless waived by the owner, no permit for the performance of decaical work ,nay issue unless tltc licauec provides proof of liability uuurance lacludiur"eoa,pkted opeiation" eoveat&v of itssub"alw equivalent. The undersigned ccrtirses;that such coymic'!Tin loicc, aad•has exhibited proof oCsame to the permit Issuing office. CHEC.C.ONF- UNSURANCE E} BOND E} GTHER G (S(tetify-1 Extir,uted Value of Elcurical lYorL•' (lllhcarcquited by autuicipa{ policg(Expuauon 0aic) Work to Start: Itupccdons to be requested in acco'rdatue Willi MEC Rule 10, and upon compictioa 1 crrtifj•, trnderlirr pair ofdcrof per!a* mtrhofdu iajarnlafion ou LM.&PRaz iut ixtrus and cau,pleta F)IIAI NAAIE: �•N% SRCl LiL1•tRM LIC.NO.: _ l.lcousca: �� 5igaature �� LIC.NO.. / C I q appacaL(e, earcr ow /!cease uutoofr 6rf Bus.ieL No.. Address: lJfll T All. Td. No.• OWNER'S INSURANCE) AIMI: 1 am aware Uut the Lieetuee dow not riavr lhe7iability iruunnce t of crate lwrrrully requi9cd.5p law, Iiy ,uy sigttatura below, I hereby twins Iltisrequiremer,t I-ata•lJ,e-(ebcek oncT CYowna ott,ur't .vent. Otrucr/Areal Slrnature Telephone No. F. iRd1IT FEE: S �� I I AUG ey 8 n APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00 TOWN OF YARMOUTH (PLEASE PRINT IN INK OR TYPE ALL INFORAIATION) (OFFICE USE ONLY) By, e% Fee: $ 20. PERMIT NO. Date: To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below, r�l Location (Street & Zoo �,OMG o14 Owner or Tenant \4�0\43 X / My t V Telephone No. Owner's Address i Is this permit in conjunction with a building permit? es ❑ No (Check Appropriate Box) Purpose of Building S' %JA)q 00Y-r) Utility Authorization No. Existing Service I Ov Amps 170 12 Its Overhead Undgrd ❑ No of Meters New Service Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed electrical Overhead ❑ Undgrd ❑ 6a(e LiG No. of Meters jc- may be waived by the Inspector No. of Total No. of Recessed Fixtures No. of Ccil.-5usp,(Paddle) Fins Transformers KVA '03Z— No. of Lightiniz, Outlets No. of Hot Tubs Generators KVA IL Above In- ❑ ❑ '^ No. of Emergency lighting No. of Lighting Fixtures Swimming Pool grnd. rnd. Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches Z No. of Gas Burners No. o Detection an Initiating Devices No. of Ranges Total No. of Air Cord. Tons No. of Alerting Devices Heat Pump Num er Tons hW No. of Self -Contained No. of Waste Disposers Totals: — Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Municipal Local ❑ Connection ❑ Other No. of Dryers Heating Appliances KW ,Securitysystems: No. of Devices or Equipvalent No. of Water No. of No. of Data Wiring: Heaters ICW Signs Ballasts No. of Devices or Equivalent No. H dromassa a Bathtubs Y 8 No. of Motors Total HP Telecommunications in No. of Devices or E uivalent Attach additional detail rJ desired, or at required by the Inspector of Wires. 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 [ BOND ❑ OTHER❑ (Specify) (Expiration Date) Estimated Valu of lec'cal Work: Work to Start: Z trO Inspections I certify, under t�e Fauns and penalties of perjury, FIRM (If applic Address: OWNER (When required by municipal polity.) to be requested in accordance with MEC Rule 10, and upon completion. that the information on this application is true and complete. C- Cytt t LIC.NO.'G 1 `, C) Signature LIC. NO. )e�line.)- ,L�_� ( Bus. Tel. No.: 36_L Q� WAIVER: I am aware that the Licensee does below, I hereby waive this requirement. I and the (check one) owner Owner/Agent Signature My 04100) � M Alt. Tel. No.: the liability insurance coverage normally required by law. By my signature owner's agent. Q2 6 / J Telephone No. G .1790k-1 W-° TOWN OF YARMOUTH APPLICATION FOR PERMIT TO DO QUITTING PrAl P.11 Fee: _ \o —a PERMIT 1 169 boc, Building atioaw%NA P vS)uLT�n/ rru New ❑ Plans Submitted Renovation ❑ Yes No Replacement ❑ al-3 /� Date�t l r�� NameOwnes U ��kli) CC V Type of Occupancy /JCS N fACC Vi W N Q Y UO Z M W J N CC O U >, m H Z O = N z m CC W WCC O Z N¢Z W W a O WWFxZ > W 0 W Z JQ►= Z Q = WLu W W W W JQ y W QW CC ymZ W O O in X Q CC W > o 2 a W O Z D 3 Q Q O O W¢ o O W.- o x x U. 1010 U¢> a ►- SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR (PRINT OR TYPE) CRtz, Installing Company Name I1 Address ����r������ll C— Tl�r h'l d w7-H arr Vhio, 026125 Business Telephone Name of Licensed Plumber or Gasfitter I Check One: ❑ Corp. ❑ Partnership .EZ7irm/Company INSURANCE COVERAGE: Check One have a current liability insurance policy or Its substantial equivalent. Yes 4 No ❑ If you have checked yes, please indica the type of coverage by checking the appropriate box. ^ A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General laws, and that my signature on this permit application waives this requirement. Check One: Owner ❑ Agent ❑ Signature of Owner or Owner's Agent 1 hereby certify that all of the details and Information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. c Signature of Licensed Plumber or Gasfitter z3 4-90 License Number TYPE LICENSE: j7 Plumber 0 Gasfitter 0 Master f Journeyman 527/2015 SlipGen- Portal Home Town of Yarmouth ' Template [Building Dept] ■ Slipsheet Identifier [sg26231] Document Category Building Permits Map -Block Number 059.113 Street Number 0200 Street Name LONG POND DR Department Building Parcel ID 8278 Backfile Batch Scan Document? Additional Naming Info Index Operator Date - Time Iwo Operator, Yarmscan 2015-05-27 - 10:31 hVJAaserfiohe12GipGerW Vi