HomeMy WebLinkAboutBuilding Permitsof �� TOWN OF YARMOUTH Building Department V i L i
(508) 398-2231 ext.1261
s PERMIT NO B-14-1324: rKm M IT
r ; --414/2014- - ; PROPOSED US
a� ISSUE DATE _ - _ .....
APPLICANT _Building Permformance Contr./Josh Emo d JOB WEATHER CARD
PERMIT TO Misc./Insulation
AT (LOCATION) 1022SLONGPONDDR Unit A ZONING DISTRIC R-40 Bldg. Type: Residential
SUBDIVISION MAP LOT BLOCK 1059.108 BUILDING IS TO BE: CONST TYPE 6-B USE GROUP R-3
LOT SIZE O
CONTRACTOR
INSULATION
REMARKS
AREA (SO FT) EST COST ($ $1,384.00 PERMIT FEE ($) $35.00
OWNER INORTON, JOAN J I BUILDING DEPT BY
ADDRESS 0228 LONG POND DR Unit A
SOUTH YARMOUTH MA 02664
LICENSE 78815
jEmond, Josh
P.O.Box 153
Eastham MA 02666
9789989361
PHONE 17744872246
INSPECTION RECORD FIELD COPY
Date Note Progress - Corrections and Remarks Inspector
TOWN OF YARMOUTH
3
° BUILDING DEPARTMENT
N .�, �•r. 1146 Route 28, South Yarmouth, MA 02664
508-398-2231 ext.1260 Fax 508-398-0836
November 15, 2013
Ms. Joan J. Norton
228 Long Pond Drive
South Yarmouth, MA 02664
Re: 228 Long Pond Drive Accessory Apartment
Dear Ms. Norton:
Please be advised that the Town of Yarmouth Zoning Bylaw, Section 407, entitled Accessory
Apartments, requires that all Accessory Apartments, which include Family Related and Affordable
units, approved by the Board of Appeals, pursuant to theses provisions, be inspected every two (2)
years, as per Section 407.4.1.
According to our records, your Accessory Apartment, approved by the Board under Special Permit,
Petition No.4440, located at 228 Long Pond Drive, is now due for inspection. Therefore, you are
hereby advised to contact the Building Department office to make this arrangement. Please contact
us within fifteen (15) days at 508-398-2231, extension 1260, by email, at icipro@yarn:outlwna.us or
by coming into the office during the hours of 8:30 AM to 2:00 PM daily.
A $25 fee is required for this inspection, as specified in Zoning Bylaw, Section 407.4.1, and as set by
the Board of Selectmen. Please make your check payable to the Town of Yarmouth
Thank you for your anticipated cooperation and please feel free to contact us should you have
any questions concerning this matter.
Very truly,
James Brandolini
Deputy Building Commissioner
e
INSPECTION SCHEDULE
NEW CONSTRUCTION, ADDITIONS, & ALTERATIONS
The receipt of a building permit is not the end of the permit process, but rather the beginning. The building
permit holder is responsible for arranging the required inspections before proceeding with additional work. Failure
to do so may result in having to exposure concealed work through the partial or complete removal of some building
elements, causing you delay and unnecessary expense.
It is imperative that you arrange for the following inspections by either calling 508-398-2231, extension 261, or
make a personal request at our office, at least 48 hours in advance:
FOUNDATION
• After certified 'as built' site plans have been submitted
• Before concrete floor is poured
• After perimeter drain has been installed
• Before first deck is constructed
• Before backfill
• After damp proofing
• After certified flood zone elevations have been submitted (when applicable)
Note: When proposed plans specify re -enforcement rod installation or other
unique design criteria, you are required to call for an Inspection prior to pouring
the concrete. In some cases, a separate Inspection may be required for a
strata/soil or footing inspection.
Pre -Frame (all boarded — no covering -check all nailing, shear walls A de downs.) Per compliance checklist
FRAME
• After rough electrical, plumbing & gas approvals have been made
• Before insulation
• After being made tight to the weather
DUCT INSPECTION
• Hot Air, Heat & A/C.
FIREPLACFJCHIMNEY
• When smoke chamber is complete
• When chimney is complete (may be inspected with frame)
• Final
INSULATION
• After building envelope is completely insulated
FINAL
• After all other inspections have been approved
• After electrical, plumbing, gas, & fire inspections have been approved
• After all applicable Historical applications have been completed
• After an applicable flood elevation certificate has been submitted
• Completed checklist (Appendix 110P) when requesting Certificate of Occupancy.
Pg. 1025 — 780 CMR
Note Assessors''offtee will inspect property for Assessment purposed at a later date.
Revised 3110
of r TOWN OF YARMOUTH Building Department BUILDING
PERMIT NO (508) 398-2231 ext.1261 B-14154 .......... PERMIT
-• ISSUE DATE 7/31/2013 _ ; PROPOSED USE
APPLICANT ,Christopher
"' ih B'"''rennan' -------"" JOB WEATHER CARD
PERMIT TO Repair
I AT (LOCATION) 1022SLONG POND DR ZONING DISTRIC R-40 Bldg. Type: Residential I
SUBDIVISION MAP LOT BLOCK 1059.108 BUILDING IS TO BE: CONST TYPE
LOT SIZE
REMARKS construct 2nd floor deck over deck and patio as per plans dated 07103(13.
AREA (SQ FT) EST COST ($ $1,000.00 PERMIT FEE ($)
OWNER INORTON, JOAN J BUILDING DEPT BY
ADDRESS 10228 LONG POND DR
South Yarmouth I MA 102664
USEGROUPI R-3
PHONE
CONTRACTOR
LICENSE 74111
Brennan, Christopher
1 Bluff Road
Sapamore MA 02561
5088884212
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 APPROVED BY THE JURISDICTION.
STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLLC WORKS.
THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.
MINIMUM INSPECTIONS REQUIRED FOR ALL
CONSTRUCTION WORK: 1) FOUNDATIONS OR
FOOTINGS. 2) PRIOR TO COVERING STRUCTURAL
MEMBERS (READY FOR LATH OR FINISH
COVERING) 3) FINAL INSPECTION BEFORE
OCCUPANCY 4) REFER TO DETAILED INSPECTION
SCHEDULE
APPROVED PLANS MUST BE RETAINED ON
WHERE APPLICABLE
JOB AND THIS CARD KEPT POSTED UNTIL
SEPARATE PERMITS ARE
FINAL INSPECTION HAS BEEN MADE.
REQUIRED FOR ELECTRICAL
WHERE A CERTIFICATE OF OCCUPANCY IS
PLUMBINGIGAS AND
REQUIRED, SUCH BUILDING SHALL NOT BE
MECHANICAL INSTALLATIONS.
OCCUPIED UNTIL FINAL INSPECTION HAS
BEEN MADE.
POST THIS CARD SO IT IS VISIBLE
INSPECTIONS APPROVALS
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WORK SHALL NOT PROCEED
INSPECTIONS INDICATED ON THIS CARD
PERMIT WILL BECOME NULL AND VOID IF
UNTIL THE INSPECTOR HAS
APPROVED THE VARIOUS
CONSTRUCTION WORK IS NOT STARTED WITHIN SIX
CAN BE ARRANGED FOR BY TELEPHONE
STAGES OF CONSTRUCTION
MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED
OR WRITTEN NOTIFICATION.
ABOVE.
TOWN OF YARMOUTH
BUILDING DEPARTMENT
1146 Route 28, South Yurmouth, NIA 02664
508-398-2231 eat.1261 Fax 508-398-0836
Permit Number -Q. M `Z7'
Date Issued
Expiration Date
$50.00
TRENCH PERMIT
Pursuant to G.L. c. 82A §I and 520 CMR 7.00 et seq.(as amended)
THIS PERMIT MUST BE FULLY COMPLETED PRIOR TO CONSIDERATION
Name of Applicant C. c.. CoAl5r4VC toA), iNG
Phone Cell
Street Address 15 DlAMoNDS P417t
5o8-.318-1V/ 508- Y00-3021
Cityfrown
%IA
ZIP
50*1 aNNIS
I O1 #60
Name of Excavator (if different from applicant)
Phone CCU
Street Address SAw6
SAMC
Citylrown
MA
I ZIP
Name of Ownerls) of Property-r0WM OF YOU=
Phone cell
StreetAddre ZZ$ Lori& PWO OMJC
Cityfrown
MA
ZIP
yA(i w offlt
c1t66 4
Other Contact Permit Fee Received
No 1 Yes 1
Description, location and purpose of proposed trench:
Please describe the exact location of the proposed trench and its purpose (include a description of what is (or is intended) to
be laid in proposed trench (eg; pipes/cable lines etc-) Please use reverse side if additional space is needed.
INSTALL Z 4' D:A• N20 CA'(t* 64,905 WITH-
6 — u:Actl Goys C014MLGTEIi WITH 114 RrE
7,27/Z.Z'E Cost(r tub p 4ve
�lnsuranceC'ertificatei: SlD97o16I tx9'f-zG`t0
Name and Contact Information of insurer:
C/�Ctrl to W RDVt6 508- 235'- 2VA
Policy Es iration Date: 01100 Lot _._
Dig Safe 1: Z014 - (41- o53 $
Name of Competent Person l as defined by 520 C:NR 7.02):
I of 2
Name of Competent Person (as defined by 520 CAIR 7.02):
KOO PCHAO$04
Massachusetts Hoisting License # AAA- 15 5Ug
License Grade: N z- 2c Expiration Date: 02 1 otil4Al b
BY SIGNING THIS FORM, THE APPLICANT, OWNER, AND EXCAVATOR ALL ACKNOWLEDGE AND CERTIFY
THAT THEY ARE FAMILIAR WITH, OR, BEFORE COMMENCEMENT OF THE WORK, WILL BECOME FAMILIAR
WITH, ALL LAWS AND REGULATIONS APPLICABLE TO WORK PROPOSED, INCLUDING OSHA REGULATIONS,
G.L. c. 82A, 520 CMR 7.00 et seq., AND ANY APPLICABLE MUNICIPAL ORDINANCES, BY-LAWS AND
REGULATIONS AND THEY COVENANT AND AGREE THAT ALL WORK DONE UNDER THE PERMIT ISSUED FOR
SUCH WORK WILL COMPLY THEREWITH IN ALL RESPECTS AND WITH TIIE CONDITIONS SET FORTH
BELOW.
THE UNDERSIGNED OWNER AUTHORIZES THE APPLICANT TO APPLY FOR THE PERMIT AND THE
EXCAVATOR TO UNDERTAKE SUCH WORK ON THE PROPERTY OF THE OWNER, AND ALSO, FOR THE
DURATION OF CONSTRUCTION, AUTHORIZES PERSONS DULY APPOINTED BY THE MUNICIPALITY TO
ENTER UPON THE PROPERTY TO MONITOR AND INSPECT THE WORK FOR CONFORMITY WITH THE
CONDITIONS ATTACHED HERETO AND THE LAWS AND REGULATIONS GOVERING SUCH WORK.
THE UNDERSIGNED APPLICANT, OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO
REIMBURSE TILE MUNICIPALITY FOR ANY AND ALL COSTS AND EXTENSES INCURRED BY THE
MUNICIPALITY IN CONNECTION WITH THIS PERMIT AND THE WORK CONDUCTED THEREUNDER,
INCLUDING BUT NOT LIMITED TO ENFORCING THE REQUIREMENTS OF STATE LAW AND CONDITIONS OF
THIS PERMIT, INSPECTIONS MADE TO ASSURE COMPLIANCE THEREWITH, AND MEASURES TAKEN BY THE
MUNICIPALITY TO PROTECT THE PUBLIC WHERE THE APPLICANT OWNER OR EXCAVATOR HAS FAILED TO
COMPLY THEREWITH INCLUDING POLICE DETAILS AND OTHER REMEDIAL MEASURES DEEMED
NECESSARY BY THE MUNICIPALITY.
THE UNDERSIGNED APPLICANT, OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO DEFEND,
INDEMNIFY, AND HOLD HARMLESS THE MUNICIPALITY AND ALL OF ITS AGENTS AND EMPLOYEES FROM
ANY AND ALL LIABILITY, CAUSES OR ACTION, COSTS, AND EXPENSES RESULTING FROM OR ARISING OUT
OF ANY INJURY, DEATH, LOSS, OR DAMAGE TO ANY PERSON OR PROPERTY DURING THE WORK
CONDUCTED UNDER THIS PERMIT.
APPLICANT $IG TURE
DATE 41419014
AV OR SIGNATURE (IF DIFFERENT)
DATE
OWNER'S SIGNATURE (IF DIFFERENT)
DATE:
'IIt,►u+tr
;.. For :City/Town use--- Do -'not write in this section-,--_,
-PERMTI' APPROVED BY
-Appbcation Fee a
PERMITTING'AUTHORITI'
Office Use only
,35 13a
t
Permit expires 180 days from
EXPRESS BUILDING PERMIT APPLICATION
TOWN OF YARMOUTH
Yarmouth Building Department
1146 Route 28
South Yarmouth, MA 02664
(508) 398-2231 Ext. 1261
CONSTRUCTION ADDRESS: 0�a Longat%d ) tt S � j (frVj, ,.-Fig � G j Lt U LI
ASSESSOR'S INFORMATION:
Map: Parcel: ' )_�
OWNER: )06l'1 NCIL �n as LQh4 Mfir, 1 �( A S• l0k/tMoAAJh 'VALk— lg"+ —40 (0
NAME PR.69ENT ADDRESS TEL #
CONTRACTOR: Man �j 6 j,,33 I jL k^- 01bllt, 4 4,9 -99g - 9Q bl
NAME MAILJNG ADDRESS TEL # sid Commercial Est. Cost of Construction $ /3S 7 `l,-elo
Home Improvement Contractor Lie. # eri Li a Construction Supervisor Lia tt # CS — d ' "y 00a
Workman's Compensation Insurance: (check one)
I am the homeownersI amthesole proprietor I have Worker's Compensation Insurance
n
Insurance Company Name: ! A Q/VM'Y1 L Cht/1 \ L n � n S Worker's Comp. Policy# WC V 00 0 IR Q OO
WORK TO BE PERFORMED
Tent _ Duration (Fire Retardant Certificate attached?) Wood Stove
Siding: # of Squares Replacement windows: # Replacement doors: #
Roofing: # of Squares ( ) Remove existing* (max. 2 layers) Insulation_,
Old Kings Highway/Historic Dist. ( ) Replacing like for like
*ne debris willbe disposed of at: A f `Iw r-��A-A C J t,�r )A r.- Z-o At, 9�--
Location of Facility
I declare under penalties of perjury that the slatemeots herein contained are true and correct to the best of my knowledge and belief. I understand that any false answer(s)
will be just cause for dental revocation of my license and for prosecution under M.G.L Ch. 268. Section 1.
Applicant's Signan, P c �► Il Nl _ Date:
Owners Signature
P. E C E !
APR 0 4 2014
pUILDINCyr%.1 ._NT
Date:
(or designee)
Zoning Motriq /Z r
qo Historical District: Yes No Flood Plain Zone: yes No
Water Resour tectioa District: Within 1V
Wetlands:
`fes ) No No
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Address: 4r P .0 _ 7-1� 6 33
City/State/Zip: - IrUru I)lr, 6 a 4 LI L t Phone #:yl
Are you an employer? Check the appropriate box:
1. L9' 1 am a employer with k-0_ 4. ❑ I am a general contractor and I
employees (full and/or part-time' have hired the sub -contractors
2. ❑ I am a sole proprietor or partner-
ship and have no employees
working for me in any capacity.
[No workers' comp. insurance
required:]
3. ❑ 1 am a homeowner doing all work
myself [No workers' comp.
inanrance requirvd,] t
3a.[1 I am a homeowner acting as a
general contractor (refer to #4)
listed on the attached sheet.
These sob -contractors have
employees and have workers'
comp. insurance.=
5. ❑ We are a corporation and its
officers have exercised their
right of exemption per MGL
c. 152, § 1(4), and we have no
employees. [No workers'
comp. insurance requited.]
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10.❑ Electrical repairs or additions
I I.❑ Plumbing repairs or additions
12.0 Roof repairs
13.E30ther 1 h Si.,, (, l 'te r
'Airy applicant that checks box 91 mad also fin out the section below showing thdr wodkere compensatiodtoolicyinfatuation.
t Homeowners wbo submit this LTWavit indicating &cy arc doing all work and then hive outside contractors mast submit a new of idavit indicating such.
tConaaatota that check this box must amehed an additional sheet showing the name of the m&connaeton and state whether or not those entities have
employees. if the sub-cont:actas have employees, they rust provide thew workers' comp. policy number
,ran an employer that is providing workers' compensation insurance for my employees Below is the policy and Job site
information.
Insurance Company Name:
Policy # or Self -ins. Lic. # k t3 C. V O OR 3q '�k00 Expiration
Job Site Address: City/Statemp:
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as requited under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to S 1,500.00 and/or one-year imprisonment, as well as civil penalties in the fora of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certtJj+ under the paint and penalties of perjury that the information provided above Is true and correct
Offlelal use only. Do not write In d ils area, to be completed by city or town of jiclaL
CIty or Town: Permit/I.icense #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. Cityfrowa Clerk 4. Electrical Inspector S. Plumbing Inspector
6. Other
Contact Person: 'Phone M
Information and Instructions
Massachusetts General Laws chapter 152 m Lgm all employ to provide workers' compensation foi their employe '
Piasuact to this statute, an capfa+rer is defined u "...every person in the service of another under any contract of hire
Q[presa or implied, oral or written"
An exaphysr is defined ae "era individual, partnership, usodatior, corporation Or other lepl entity, Or my two or more
of the interning engaged is a joint eaecrpiee, mad ;MC611�g the kW rePrescutatim of a dwessed emrpWM or the
receiver a trnsbee of n individual, pztne rsW asaociatd cc other Ind entity, emptying avbyees However the
owner of a dwelling Mass having not more than three spertzaeatt and who resieier t1t3eia. or the occupant of the
dwelling haun of another who employe print@ In do M■iEftn&WA consnnctios or repair wait an such dwelling house
or on the Vow& cc building approea:at thereto shell not because of sack employment be deemed to be an emploW
MGL chapter 1S2. f 2SC(6) also states that "Irby atata er seems llexmteg igesey slsif wtthldd floe iasaasn or
renewd o(a lle:aw or permit to operate a bedaus or to construe! bdid[ap la the naasaweaffh fete uq
spplkwd wbe !era set pcodmil sexeptable evidesa of cemplinee with the lnsair"W esrerage regalrai."
Addidoaally. MOL chapter 1A f 25C(7) stsiao "Neither the commonwealth nor any of its political subdivisiooa shall
eater into any exmtrset for tba parfocmaac 1 of pabtie wort until acceptable e:videaee of coapfiaan with the insurance
regttic� of this chspeer have bees presented to the e:oaQsctiag authority-*
AppUclab
Please till out the wocl<rrs' coapenatim affidavit compleftlyq by checking the boxes thstt apply to yom sitaatiw mad+ if
aees:saTI supply sub-eoottactor(s) nameN6 addnees(es) and pbow number(s) along with their catifieate(s) of
insnrsaes Limited Liability Companies (LLQ cc Limited Liability Paztoashipe (LIB with to employees other than the
members at pwatM we not required to carry wo,k ere =gmuadoa iaaraancL if as LLC a LLP des have
empkovM a policy is zegafred. Be advised that this afduk may be submitted to the Department of fndmstrid
Accidents for con8tmadoa of iasaaaaee coverage. Abe be swre to sip axed data the aMdavlL The affidavit should
be retnased to the city ar tows that the application fat the permit w Beeman is babel regoested, net the Department of
fndnstsisl Accidents Should you have any goes" - zepadiel the lave at if sow as required to obtain a arori=a'
coapeandm policy. pkasr can the Department at the nembet tilted below. SeMiatnasd exempaaia should eater their
City or Tees Offlch s
Please be on thd the affidavit is complete and printed legibly. The Depart hu Provided i span at the bottoo
of the afiSdsvft foe you to fill out to the erect the Office of Investigations has to carted you regarding the SPPH=OL
Pleau be sure to till In the paori!lllceaae aeaaa which wM be axed u a refer- In sddidoa as sWt, 11
that =d submit multiple pa=WBcema applications in say given )ear. need only snI " one affidavit icalkath, e:aaeaI
policy is zmados (if necaaary) and under "lob Site Adhese" the appilcaat should writs "all location► is (city Or
tower A copy of the afdnit that hes beta officially stamped or marked by the city or town may be provided to the
applicant tin pool that a valid of gdavtt is on Me for f n permita orlicense s A maw affidavit meet be filled out each
year. Where a bom i owner at citimn is obtaining a Beene or permit not related to any budnen or commercial venhre
(Le. it dog skeane or pen -nit to bra leaves etc.) said peeson is NOT regrth to comple:b this af5divit.
The O firer of lmradigstiom would lU to thank you is advmn far your cooperation and should you have any questions.
plean do not hesitate to give us a c3dL
[fit Departmeet's add:ese, telephone and fits mrs>I
The Commonwealth of Massachusetts
Deputment of Indust id Accidents
Of&* of Ilsntstig)ttlottl
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 406 or 1-977-MASSAFE
Fax 11617-727-7749
Revised t 1-22-06 Wwv, ,gov/dia
IL
mQSS save WNTIU oR
Lerir� ttrotyb uuivY��Y �i
PERMIT AUTHORIZATION FORM
1, loan Norton , owner of the property located at:
(Owner's Name. printed)
228 Long Pond Drvie South Yarmouth
(ProperW Stneet Address) (City)
hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed
below to act on my behalf and obtain a building permit to perform insulation and/or weatherization
work on my property.
X
owners
Date
FOR CSG OFFICE USE ONLY
Conservation Services Group has assigned the following Mass Save Home Energy Services Participating
Contractor to the above referenced project:
Participating
Rev.12132011
L�
Date
[go MOM
B1 F.
For Office use Ony
Q7As cppn,n,or,w di oFG7 reaac/udaAJ
Office of Consumer Affairs & Business Regulation
OME IMPROVEMENT CONTRACTOR
eplstratlon: ,1"z4Z35 Type:
plratlon:�v,11�5/l�is5.j LLC .
BUILDING PERFOF"' - f O JT� CTINO, I.I.C.
BOSH EDMOND •t�.�e%�, •
8 KINNIKINNICK RDa1 ` r�•f7��v
TRURO, MA 02888 Undersecretary
License or registration valid for Indlvidul ass only
before the expiration date. If found return to: ;
Office of Consumer Affairs and Business Regulatiop
10 ParkPlaxa - Suite 5170
Boston, MA 02116
valid without signature
Massachusetts - Departrpent of Public
Safety
Board of Building Regulations and
Standards
Construction Supc'r►ht a
V, ;; • '...
License; CS 078�16
�, l
0
JOSH EMOND
P0B0X-qV* Of
'Truro MA 02666^10
Expiration
Commissioner.
03l2512015
0
o< r
TOWN OF YARMOUTH Building Department
BUILDING
(508) 398-2231 ext.1261
PERMIT NO B-13-1464 _
PROPOSED USE
-; PERMIT
• d
ISSUE DATE ; _ 4/26/2013 ;
APPLICANT ''--------------,..
.--Christo-pher Brennann-- - a
.
JOB WEATHER CARD
PERMIT TO Addition
AT (LOCATION)
ZONING DISTRIC R•40
Bldg. Type: Residential
1022SLONG POND DR
SUBDIVISION MAP LOT BLOCK 1059.108 ,
BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R-:
LOT SIZE F
1
modular - 2nd floor addition for family related apartment as per BOA petition # 4440 and as per plans
REMARKS dated 04122/13.
AREA (SO FT) EST COST ($ 1$12,b00.00 PERMIT FEE(*
OWNER INORTON JOANJ
CONTRACTOR
LICENSE 74111
Brennan, Chdstopher
1 Bluff Road
Sagamore MA 02561
5088884212
BUILDING DEPT BY
ADDRESS 10228LONGPONDDR
South Yarmouth I MA 1026r>4 PHONE
Certificate Issue Date q f (o /j �j CERTIFICATE of OCCUPANCY
Departmental Approval for Certificate of Occupancy and Compliance
Inspector Date Permit Number Approved By Remarks
BUILDING
7 (, /4
,
PLUMBINGIGAS
ELECTRICAL
qk -
x
ENGINEERING
HEALTH
y %�3
U
��� 3
—FIRE------
—
J
WATER
OLD KINGS HWY
To be filled In by each dhAslon Indicated hereon upon completion of Its final Inspection.
TOWN OF YARMOUTH Building Department
(508) 398-2231 ext.1261
PERMIT NO B-13-1464.
ISSUE DATE 412612013 PROPOSED USE
.. .
APPLICANT Christopher Brennan .
... — .........
JOB WEATHER CARD
PERMIT TO Addition
I AT (LOCATION) 10228LONG POND DR - - --I ZONING DISTRIC R- 0 Bldg. Type: Residential I
SUBDIVISION MAP LOT BLOCK OM08 BUILDING IS TO BE: CONSTTYPE 5-B USE GROUPLR 3 1I
LOT SIZE CONTRACTOR
modular - 2nd floor addition fcr family related apartment as per BOA petition # 4440 and as per plans LICENSE
I REMARKS dated 041M13. I L.._____
Brennan, Christopher -- J i
I
I I 1 Bluff Road -
_� I ---,�� Sagamore FAA 02561
$12,500. AREA (SQ FT) - EST COST ($ 00 _ I PERMIT FEE ($) $401 9.00 J J 5088884212
OWNER WORTON, JOAN J ---
_� BUILDING DEPT BY
ADDRESS 10228 LONG POND OR _ _ _ i __-.—_--1
1SouthYarmouth- ---IAMB 102664 1 PHONE
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 APPROVED BY THE JURISDICTION.
STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLLIC WORKS.
THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE_ THE APPLICANT FROM THE COND(TIQNS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.
MINIMUM INSPECTIONS REQUIRED FOR ALL
CONSTRUCTION WORK: 1) FOUNDATIONS OR
FOOTINGS. 2) PRIOR TO COVERING STRUCTURAL
fv101ABERS (READY FOR LATH OR FINISH
COVERING) 3) FINAL INSI=EC (ION SZFOR�E
OCCUPANCY 4) REFER TO DETAILED INSPECTION
SCHEDULE '
APPROVED PLANS MUST BE RETAINED ON
WHERE APPLICABLE
JOB AND THIS CARD KEPT POSTED UNTIL
SEPARATE PERMITS ARE
FINAL INSPECTION HAS BEEN MADE
REQUIRED FOR ELECTRICAL
WHERE A CERTIFICATE OF OCCUPANCY IS
PLUMBING/GAS AND
REQUIRED, SUCH BUILDING SHALL NOT BE
MECHANICAL INSTALLATIONS.
CCCUPIED UtITIL FINAL INSPECTION HAS
BEEN MADE.
POST THIS 'CARD SO IT IS VISIBLE FROM STREET
BUILILNG IN,�PECTIONP APPROVALS
r
`�y
�s
t /
�/
1ate
�' � �k� a �'d n „w � , ^� hr
r�rP�v_���"3
d'
2
2 Al i � it I �
2 aC&.� GLEC&. • v°cE/ ? (Q�
'PRve
jy,S'I'.fi�';r
3
OTH&;u
71
v
3 ,
w.
4 k�P�kkabl x "�T'J
5 �!J
C .rcnYvY '�'d rpq
r *fS-n
WORK SHALL NOT PROCEED PERMIT WILL BECOME NULL AND VOID iF INSPECTIONS INDICATED ON THIS CARD
UNTIL THE INSPECTOR HAS CONSTRUCTION WORK IS NO r STARTED WITHIN SIX CAN BE ARRANGED FOR BY TELEPHONE
APPROVED THE VARIOUS MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED OR WRITTEN NOTIFICATION.
SrAGESOFCONSTRUCTtON ABOVE.
ILL
Page 1 of 1
Cipro, Linda
From: Armstrong, James
Sent: Thursday, September 05, 2013 3:55 PM
To: Cipro, Linda
Subject: 228 Long Pond Dr.
Could you please sign off the above property for OP? Thanks Jamie
Captain/Inspector James Armstrong
Yarmouth Fire Department
96 Old Main Street
South Yarmouth Ma. 02664
508-398-2212
9/9/2013
r
TOWN OF YARMOUTH
Building Department
BUILDING
� #
_ _ _ _
PERMIT NO
(508) 398-2231 ext.1261
D USE
PERMIT
"•*
ISSUE DATE - 2-
'may
APPLICANT 'Christapher Brennan - - -
.............................
- - - - - - - - - - - - -
JOB WEATHER CARD
PERMIT TO Addition
AT (LOCATION) 1022BLONG POND DR
ZONING DISTRIC Rr40
Bldg. Type: Residential
SUBDIVISION MAP LOT BLOCK 059.108 BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R-3
I
modular - 2nd floor addition for family related apartment as per BOA petition # 4440
REMARKS dated 04122/13.
AREA (SQ FT) EST COST ($ $12,500.00 PERMIT FEE ($) $409.00
OWNER INORTON, JOAN J BUILDING DEPT BY
ADDRESS 10228 LONG POND DR
South Yarmouth MA 102664
PHONE
CONTRACTOR
LICENSE 74111
Brennan, Christopher
1 Bluff Road
Sagamore MA 02561
5088884212
INSPECTION RECORD FIELD COPY
Date Note Progress - Corrections and Remarks Inspector
3- 3 Q
S =/.3
� 11V
PROBUILT
H O M 65
Attn: Town of Yarmouth
To Whom It May Concern:
June 4, 2013
Brunelle Modular Erectors is a Certified Set Crew with ProBuilt Homes. Please feel free to contact me with
any questions you may have or if you need any additional information.
Thank You,
Brittany Yoder
Accounts Payable Manager
43 Industrial Circle Mifflintown, PA 17059 Phone: 866436-8677
www.probuiltmodularhomes.com
of r TOWN OF YARMOUTH Building Department BUILDING
. ,.......... (508) 398-2231 ext.1261
PERMIT NO ;- B-13-1464. ;
ISSUE DATE ; 4/26/2013 - ; PROPOSED USE ; . _ . _ . - - - - PERMIT
APPLICANT .Christopher Brennan
;itW " """"
___ JOB WEATHER CARD
••-------
PERMIT TO --- Addition ;
AT (LOCATION) 1022SLONG POND DR
40 Bldg. Type: Residential
SUBDIVISION MAP LOT BLOCK 1059.108
BUILDING IS TO BE: T FEB US
ROUP R-3
LOT SIZE
CONTRACTOR
modular - 2nd floor addition f amily related apartment as per BOA petition # 4440 and as er plans
REMARKS dated 04122/13.
LIC SE 74111
�� Jn,
Christopher
I Bluff oad
Sagam re MA 02561
50888 212
AREA (SO F) ' EST COS $12
OWNER INORTON, JOAN J1
ADDRESS 10228 LONG POND DR
0.00 PERMIT FEE ($) $409.00
BUILDING DEPT BY
South Yarmouth MA 02664 •
�j�,�i1i! PHONE
Certificate Issue Date
CCATE of OCCUPANCY
Departmenta pprov , f rtificate of O p�yancand Compliance
Inspector Date Permt umber ADDroved Remarks
BUILDING
PLUMBING/GAS
�j'l�
de
ELECTRICAL
ENGINEERING
HEALTH
cc•'' Nxa / la
FIRE
h3
J
WATER
OLD KINGS HWY
To be filled in by each divisign Indicated hereon upon completion of Its final Inspection.
1�
t>rul �&
o
ONE & TWO FAMILY ONLY'- BUILDING PERMIT
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
Ttwn of larmouth Building Department
1146 Route 28 • Yarmouth, NIA 026644492
his Section for Office Use Onl
Buildin Per it Num
Date Issued:
Signature. Buildin lal Date
Cert icate of Occupancy
is is hot required
Section 1 - Site Information
Use Group: R-4 Type: 5 B
1.1 Property Address.
1.2 Zoning Info Icon:
g District Proposed Use
Scruft+ r•,r^.r, 00-"h a,e
1.3 Building Setbacks (it)
Front Yard
Side Yards
Rear Yard
Required
Provided '
Required
Provided
Required
Provided
1. Water Supply (M.G.L. c. 40. S 54)
Public Private
1.5 Flood Zone Information; Comments:
Zone: BFE:
eGtion 2 - Property Ownership/Authorized Agent
i CL �
r
2.11 Owner of Records
!tJ
DM dF/ ri c
[NFVrjjn
�-Vallhig Address
Sfg at Telephone
Fax -mail
-.
2.2 Authorised Agents
F IC b
Name (print)
Mail J d ftq 7013
Signature Telephone
Fax ' E all
Gl1ILDi%G DEFT
I__.I_.- n urn—.
3.1 Licensed Construction Supervisors
License Number
0
Cs-
�%
'I
Expiration Da o
Address tpltr/ 7
Ohh
Signature Teraphon4 Fax E-mW
t otz �•���
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure
to provide this affidavit will result In the d plal of the Issuance of the building permit.
Signed Affidavit Attached Yes ......... No ..........
Section S- DoWntialtot Pfo Want (check all appji-")
New ConstrUdon ❑ I N(L of B*drooms No. of
Exlsting Bldg. ❑ tp&"Ws) ❑ A &an1:lom ❑ Addtdw
Awry Bldgpe ._— Demolitlon Other Specify:
Brief Description of Proposed Work . N T ��
a -
Item Estlmaled Cost (Dollars) to be
camplated try perrnR applicant
1. Sul
2. Electrical
3 / Gas
4. Meehwical (HVAC)
9.Total=(1 +Z+3+4+5)
1. Total Square Ft. (raw eaeft s a
Check Below
Conservador}Commission Filing
(N applicable)
❑ Old Kings Highway it Historical
Commission approval
(if applicable)
19 A , as owner of the subject property
hereby authorize i._L'�
my behad, In ad matters relatty to
Section 7b -
M
authorized by this 4uikfing permit application.
Date
to act an
. as Owner/Authorized Agent
herby 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.
ftd
or Qmnar/Aganl
M
Data
9. 15. 99 2 of 2
uNE & 'rwu FAMILY ONLY — BUILDING PERMIT
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
Town of Yarmouth Building Department
1146 Route 28 • South Yarmouth, MA 02664-4492
508-398-2231 ext.1261 Fax 508-398-0836
Office Use Only
Permit No. Date
Permit Fee $
Deposit Rec'd. $ Date
Net Due $
Planning Board Informadart
Plan Type
Endorsement Date
Recording Oats
Plan No.
other
Assessors Department Information:
Map to
/
New
Properly Dimensionz
tot area (sf) Frontage (ft) Lot Coverage
Tta Secdon ffx otlie� ua.
Btliidfit PelmftMumber:;::' L...•`
D-afglsdtit3�_... ,
���` • • '
S��i. .... (yl *lctib: _x rt \•yam :+i •t rJ
Cep of Otxilpanc'.. ,
,_ ' ':;'~�'',
26064.t • Site fnformatttxl:
I Use Group: R-4 Type: 5&.
1.-I Property Addnaoe
1.2 Zoning Information:
Zoning District Proposed Use
1.3 BuIlriny son eeks (n)
Front Yard
Side Yards
Rear Yard
Required
I Provided
Required
Provided
Required
Provided
1 4 Watw Supply ry.aL a 40. Z 541
Public Private
7-5 Flood Zom bdomm*=
Zprm BFE:
Setidott2- Property Owrlerattt rizedAgeMi
2.1 Owner o/ Racor*
Name (print) Mailing Address
Signature Telephone
u Auet,orlatsd A" .
Name (print) Mailing Address
S'gnialune Telephone Fax
Section 3 - construction Services
&I t.leensod Ca+steuetle" Superrtson
Net Applicabte Q
License Number
Address
Expiration Date
5+4�" Telephone
3.2 RegWemd Ham im emertt Contractor:
convoiny !fame
Not Applicable Q
Address
SignaNre Telepharo
License Number
Expiration Date
rorz OVER
The.Commonwealth ofMassachusetis -
:- .
u Departiiient oflndustrial Accidents ^ '
Of f.cdoflnvestigahons :;.
lk ; 600 Washington Street _.
i Boston, MA 02111 .
f < . www.Mass gov/dia
Workers' Compensation Insurauce.Affidayit. Builders/Contractors/Electtricians%pinmbt rs -
Applicant Information::
Ple:isePrintLe blv_.. .
Name (Business/Organizahowladividuan: RDA • INC.
Address:
City/State/Zip ' MA 02561 Phone,#. E ' 508-`.888 4212 ;
Are you an employer? Check the appropriate box:,
1I am a employer with 3 4 Type of project (required):' '
❑ I am a general contractor and I 6; [] New construction
employees (full and/or part-time) *' have hued the sub -contractors
2• I am a sole proprietor or partner . listed on the attached sheet'# 7 ` Remodeling
ship and have no employees These sub -contractors have + 8" 0 Demolition
working for iaany capacity ',•workers' comp' insurance , •- '
[No workers' comp insurance ance 5 ❑ -fie area wrporation"and its . ; 9ill' ` Bing tioa
required.] i 'officers have exercised then 10. El Electrical repairs or additions :
3. I am a homeowner doing all work right of exemption per MGL' ; 11. ❑Plumbing repairs or additions
mYsS [No workers' comp. i c:152' 1 4 , we Have no t'
insurance required ] t employees.' (No workers'
eP
12.❑Roofr airs
. comp-mcnranrp reiuired.] 13.❑ Other
*Amy applicant UW checks box #1 must also fill out the section below.showing their worlam . cowensahan,policy fidb nation;
tHomeowners who 'submit this. d5davitindiahn g _.
g
tCmtrscton that check this box must attached an additional sheet showing
hIf the outside n, their r a new afGdav t indicating such•
ampP �y kfornu td6n.
'lam an employer That u providing workers' compensation utsuranee for my employees Beliw u the pa art��ob site
informatwn.. I ,1'
Ins}nanceCompanyNamp. AIM MtttilaLlnsurance ' -
Poliey# or Self-*ori
FapuationDate. 11/27%13
Job Site Address: .. j L n - Ci /Sta F }
Attach a copy of the workers''compensationpolicy declaration page (showing the policy number d ezpirahon te), s`►
Faihue to secure coverage as required under Section 25A of XGL c.152 can lead to the imposition of criminal penalties :of a
fine up to S 1,500.00 aI _. -__ --year imprisonment, as well as civil penalties in the form of a STOP WORK 0}2D1 and a fine
Of up tty$Z50 0 a day against the violator. : Beadvised that a.copy of this statement may be forwarded to the Office of
Invesiigations�f the DIA for insurance: ==era a verification.
i
IIIII �.
I o hereby C. T .. • ; . ,
Tk pains and penalties o erjury that the in provided o is true aid correct
Si a 41
-• .. � ._ _ _ _ Date: I/ rlssuin
rcial use only Do not write u: this area, idbe cam feted in P by. city or towny or Town;Permit/License #
gAuthority (circle one): • -
1. Board of Health 2. Bu
ilding 3 City/rown Clerk . 4. Electrical Inspector S. Plumbing ] nspector
6: Other
Contact Person: Phone #i _
.....
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, modemi7ation, conversion,
Improvement, removal, demolition or construction of 'an addition to any pre osting owner-oc cttpied
building containing at least one but not more than four dwelling units or structurm which are adjacent to
such residence or building' ba. done by registered contractors, with certain exceptions, along with other
requirements
Type of Work: ct Qoo/ Q� 1 r fiOFt/1 i nI'nr,� JEst. Cost
Address of Work Z 28 Loan lJmel,t • /4• . Soci �9wr GK9 oa«y
Owner Name: ��,l for �ortJ
Date of Permit Application:
I hereby certify that:
Registration is not required for the following rcason(s): ,
Work excluded by law
Job under $1,000
Building not owner occupied
Owner pulling own permit
Other (specify)
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH
UNREGISTERED CONTRACTORS FOR APPLICABLE HOME
IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION
PROGRAM OR GUARANTY FUND UNDER MGL c.,142A.
Signed under penalties of perjury:
I here y apply for a permit as the agent of the owner:
7�(I1!
D to I ontractor Name Registration Now
OR:
Notwithstanding the above notice, I hereby apply for a permit as the owner of the above
operty:
y4
a e Owner Name.
9� -C
Office of Consumer Affairs and usiness Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
—� Registration: 173655
{� rn Type: Individual
11 I I%1tI Expiration: 10242014
CHRISTOPHER P. BRENNAN
CHRISTOPHER BRENNAN
P.O. BOX 418 -- - —
SAGAMORE.BEACH,,MA 02562
4P& j G 5oM44D"101216 .. - .
Office of 6oasnmer Affairs & Business Regulation
PJ
HOME IMPROVEMENT CONTRACTOR
Registration: 073655 Type'.Expiration:-!0042014 Individual
PHER Pr RENNAN � s
CHRISTOPHER BR`ENNANE '.,
12 SUMMER WIND
N. FALMOUTH, MA 0255;6yy Undersecretary
Tr# 233065
to Address and return card. Mark reason for changes
u
ddress Renewal ❑ Employment Lost Card
License.or registration valid for individul use only
before the expiration date. If found return to:
Office of Consumer Affairs and Business Regulation
10 ParkPlaza - Suite 5170,
Boston, MA 02116
N't valid wit ut signature
_
,
o• ► TOWN OF YARMOUTH
Building Department
Town Hall
Yarmouth. MA 02664
(508) 398.2231 wQ.1261
BUILDING PERMIT
TRANSMITTAL
Temp Permit No.:
T-13-386
Applicant Name:
Christopher Brennan
Applicant Phone:
5088884212
Building Location:
0228 LONG POND DR
Owner's Name:
NORTON, JOAN J
Owner's Addres
0228 LONG POND DR
South Yarmouth MA 02664
Owner's Telephone:
REVIEWED BY:
1. WATER DEPARTMENT:
2. ENGINEERING DEPARTMENT:
3. CONSERVATION:
4. HEALTH DEPARTMENT:
5. BUILDING DEPARTMENT:
6. FIRE DEPARTMENT:
COMMENTS:
RECEIPT OF COPY:
.�-o 1p
(OFFICE USE ONLY
Recorded By:
Ic
Permit Fee:
0� r
Deposit Rec:
$50.00
Payment Type:
Check ChkNo.: 2045
Net Owed:
oa ,35q &o
Application Date:
4/11/2013
Issue Date:
ZL
Expiration Date
If
Comments: Map/Lot: 059.108
modular - 2nd floor addition for family related
apartment as per BOA petition # 4440
Aj4.stir--P—`�'• u.�.�
PLEASE NOTE
SIGNATURE OF APPLICANT:
DATE:
WA:
DATE:
WA:
DATE:
N/A:
DATE:
N/A:
DATE:
N/A:
DATE:
N/A:
DATE:
Date Printed: 4/19/2013
Town of Yarmouth
Conservation Commission
Building Permit Sign -off Application
TO BE FILLED OUT BY APPLICANT:
Building Site Location: 2 � �� ) (" ;) PJ 1
Map #Lot(s) #
Property Owner:
Applicant:
7 `4
Applicant Address:
Telephone: S U�
Proposed Project L
boS-?
Plans:
& ri-
TO BE FILLED OUT BY CONSERVATION ADMINISTRATOR:
Does the Proposed Project Require a Permit? C10
Commentsfront Consenatior. ouut�ion:
Approved Conditionally Approve Rejected
All work related debris shall be taken offsite or disposed in a legal upland location
At the end of each day, the area shall be clean and no debris shall be in the Resource Area
Refer to: SE83- or DOA permit
A 11C.0.4eAOVon eonw� pA;oc S-..4 o-C
t\4,ori�
Conservation Commission Sign -off Signature:_
Date: y -/ 0.13 J
TOWN OF YARMOUTH
{ ° HEALTH DEPARTMENT
1�
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
V1ZVPi PWVT�005610=1I
•*Ifyou would like e-mail notification ofsign off, please provide e-mail address:
Owner N
Owner Address:
zl z
Filed: U Yl b
Owner Tel. No.:
RESIDENTIAL AND/OR COMMERCIAL. BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities.
Please submit three (3) copies of plans, to include:
(1.) Site Plan showing existing buildings, water line location,
and septic system location;
(2.) Floor plan labeling ALL rooms within building
(all existing and proposed) —
Note: Floor plans not required for decks, sheds, ►vindoivs, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
REVIEWED BY: DATE:
PLEASE NOTE
COMMENTS/CONDITIONS:
Doc:1721Ss430 04-10-2013 10:12
BARNSTABLE LAND COURT0�FiHWV IbK
VAR
TOWN OF YARMOUTH
BOARD OF APPEALS
DECISION
'13HAR19AM9:16 REC
FILED WITH TOWN CLERK:
PETITION NO:
HEARING DATE:
PETITIONER:
U4440
March 19, 2013
March 14, 2013
Joan J. Norton
PROPERTY: 228 Long Pond Drive, South Yarmouth
Map & Parcel: 0059.108; Zoning District: R40
Document #: 914,247; Certificate #: 168731
MEMBERS PRESENT AND VOTING: Steven DeYoung, Chairman, Joseph Sarnosky, Richard
Neitz, Robert Howard and Bryant Palmer.
Notice of the hearing has been given by sending notice thereof to the Petitioner and all those owners of
property as required by law, and to the public by posting notice of the hearing and publishing in The
Register, the hearing opened and held on the date stated above.
The Petitioner requests a Special Permit for the addition of a Family Related
Apartment, per §407.2, and a Special Permit for such alteration of this pre-existing
non -conforming single-family structure.
The Petitioner, represented at the hearing by attorney David S. Reid, represented to
the Board that the existing single -story home was built in approximately 1945,
contains three (3) bedrooms, and is situated on a 23, 522 square foot lot. The
structure is non -conforming in that it is situated 17.4' from the southerly side line,
where the bylaw would currently require a 20' setback. The proposed alteration
would add a partial second story, located within the existing footprint of the house.
The apartment would contain a kitchen, bath, bedroom and living and dining area..
It would be accessible through a separate entrance, through the garage. One
bedroom on the first floor would be eliminated in order to accommodate the new
stairway and entrance to the second floor, and the resulting structure would
therefore remain a three (3) bedroom home. The petitioner would herself occupy
the new second -floor residence, which would contain 743.26 square feet of
habitable space. The first floor would then be occupied by her daughter and
granddaughter. The property contains adequate paved parking area for at least three
(3) vehicles. The addition would not occupy the full area of the first floor footprint.
It would not extend forward to the front wall of the house, nor would it extend to
the right to the southerly exterior wall. The new construction would itself conform
to all applicable setbacks.
No correspondence was received by the Board relating to this matter. No members
of the public spoke either in favor or in opposition to the proposal.
The Board finds that the proposal addition would meet all of the standards of
Zoning Bylaw §407.2, as represented above, and that the resulting structure would
retain the appearance of a single-family home, and fulfill the intent and purpose of
the Accessory Apartment Bylaw. The Board further finds that the alteration of the
home would not be substantially more detrimental to the.neighborhood or Town, .
and would be appropriate for the neighborhood and site.
Therefore, a Motion was made by Mr. Neitz, seconded by Mr. Samosky, to -grant
the Petition, as requested. The members voted unanimously in favor of the motion
(5:0) and therefore the Special Permit was granted.
No permit shall issue until 20 days from the filing of this decision with the Town Clerk. This decision
must be recorded at the Registry of Deeds and a copy forwarded to the Board of Appeals. Appeals
from this decision shall be made pursuant to MGL c40A section 17 and must be filed within 20 days
after filing of this notice/decision with the Town Clerk. Unless otherwise provided herein, the Special
Permit shall lapse if a substantial use thereof has not begun within 24 months. (See bylaw, MGL c40A
§9)
S- tve n DeYoung, Chdirman
2
COMMONWEALTH OF MASSACHUSETTS
TOWN OF YARMOUTH
BOARD OF APPEALS
Appeal #4440 Date: April 9, 2013
Certificate of Grantine of a Special Permit.
(General Laws Chapter 40A, section 11)
The Board of Appeals of the Town of Yarmouth Massachusetts hereby certifies that a
Special Permit has been granted to:
Joan J. Norton
228 Long Pond Drive
South Yarmouth, MA 02664
Affecting the rights of the owner with respect to land or buildings at, 228 Long Pond
Drive, South Yarmouth, MA Zoning District: R40; Map & Lot#:0059.108; CtL-4:168731;
Doc.#:914,247 and the said Board of Appeals further certifies that the decision attached hereto is
a true and correct copy of its decision granting said Special Permit, and that copies of said
decision, and of all plans referred to in the decision, have been filed.
The Board of Appeals also calls to the attention of the owner or applicant that General
Laws, Chapter 40A, Section 11 (last paragraph) and Section 13, provides that no Special Permit,
or any extension, modification or renewal thereof, shall take effect until a copy of the decision
bearing the certification of the Town Clerk that twenty (20) days have elapsed after the decision
has been filed in the office of the Town Clerk and no appeal has been filed or that, if such appeal
has been filed, that it has been dismissed or denied, is recorded in the Registry of Deeds for the
county and district in which the land is located and indexed in the grantor index under the name
of the owner of record or is recorded and noted on the owner's certificate of title. The fee for
such recording or registering shall be paid by the owner or applicant.
Ste en DeYoung, irman
TOWN OF YARMOUTH
= Town
1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664-4451 Clerk
Telephone (508) 398-2231 Ext. 1285, Fax (508) 398-0836
CERTIFICATION OF TOWN CLERK.
I, Jane E. Hibbert, Town Clerk, Town of Yarmouth, do hereby certify that 20 days have elapsed
since the filing with me of the above Board of Appeals Decision #4440 that no notice of appeal
of said decision has been filed with me, or, if such appeal has been filed it has been dismissed or
denied. All appeals have been exhausted.
BARNSTABLE COUi`ITY,
REGISTRY OF DEEDS
A TRUE COPY, AT(EST
�pWN F. atEAO= afwAISTFR
BARNSTABLE REGISTRY OF DEEDS
INSTALLATION OF CERTIFIED
MANUFACTURED BUILDINGS
This is to confirm that this home will be installed by an installation crew that is certified by Keiser
Industries, Inc. The installation crew is composed of individuals under the supervision of the operations
manager listed below:
The helms- listed c ompallp is it %nc lari, rerlilled i► stnller orKeiser Modular I/0111c%y:
Set Connectors Inc.
Richard Hott, Operations Manager
36 Holman Lane
Norway, ME 04268
setconn ectors(alive.com
Keiser Homes Authorized Anent"
Signed
Title:
Date:
NOTE: FOR ALL HOMES INSTALLED IN THE STATE OF MAINE, The installer, mechanic, dealer
(when the dealer is responsible for the installation), or the manufacturer (when the manufacturer is
responsible for the installation), shall purchase and affix a complete State of Maine Warranty Seal to each
home installed.
(Per Chapter 381: Maine Manufactured Home Installation Warranty Seal)
Commonwealth of Massachusetts
Manufactured Buildings Program - Plan Identification NumberAssignnfent
Name of Manufacturer
PRO -BUILT HOMES
MC Identification Number
266
Third Party Identification Number
02
Project Title
QN9632
Use Group
R3
BBRS\DPS
Identification Number
0038- 13
Dstamped
Review b=uiired
All Plans are reviewed by MA and should be
as below when approved
Date 02 / 06 / 13
R
Manufactured Buildings Program
From: Linda Shea
Manufactured Buildings Program
Re: Confirmation of Receipt of Building Plans & Assignment of BBRS\DPS
Identification Number (BBRS\DPS I.D. Number)
The Board of Building Regulations and Standards and Department of Public Safety (BBRS\DPS) has
received your building plans for the referenced project and has assigned the identification number
noted above (in the block marked BBRS\DPS I.D. Number). This number has been assigned for
purposes of internal tracking methods. This number shall be used in reference to this project and on
all future correspondences, inquiries and plan revisions.
Thank you for your cooperation with this matter.
ACCEPTED
taABBACttUR"SMMUFACTURDBULOW08PRDQ u
STATE BOARD OF EDWOB REO TIONi 6TANOAN08
AF-0 or
�aNAru r
BAS TNM CE ICATM ONLY
BJCCT TO FUR ER REVIEW
Send all correspondences, inquiries and plan revisions to:
BBRS/ Dept. of Public Safety
Linda Shea
1380 Bay Street
Building B ®FILE COPY
Taunton, MA 02780
Bbrs\forms2\nwnufacturedbldalenid - June 30, 2009
'9m
Revised
LIVING AREA tiou
594 sg ft YL3 M1311n Health Department
O
PPI� QED
ne Date ..
11
DCE #06-224
FOUNDATION PLOT PLAN FOR ANY OTHER USE
PREPARED EXCLUSNELY FOR THE PURPOSE OF OBTAINING A BUILDING PERMIT. NOT F
LOCATION 228 LONG POND DRIVE SOUTH YARMOUTH, MA
SCALE : 1" = 40' DATE : AUGUST 31, 2006 PREPARED FOR:
REFERENCE MAP 59 PARCEL 108 JOAN J. NOR ON
LOT 1 LCP 28410A SHI oFti s`
t 4(� S
HEREBY_ CERTIFY THAT THE STRUCTURE TIMOTHY Acs�l
SHOWN ON THIS PLAN IS LOCATED ON THE eo ` N
GROUND AS SHOWN HEREON. H.
1 COVELL y
off 508-362-4541 - (� N0.36035
. : }a..505 362-080
down cape engineering, inc.
CIVIL ENGINEERS _—
ELF b
LAND SURVEYORS DATE RE LAND SURVEYOR
939 main st. yarmouth, ma
NL4SSACHCSETTS
AfA FueWas/Plumbing Code
NIA Single and Two -Family Dwelling Code (780 CMR)
8° Edition
2009 International Mechanical Code with amendments
2009 International Energy Cons. Code with NJA amendments
2011 National Electrical Code with NIA amendments
7ODH-3W
BEDROOM #I
o ^
1 I1200 SOFT. of ROW
_ 10.56 LIGHT REo'D.
O 3288 LIGHT PPROVD.
17.10 VENT PROVD
SUFFICIENT LIGHT k VENT PROVIDED.
r-9• Y-3
In444
0
1
a� ��.:r-rV-! mr
LIAN am 2-W WIZ6'-3• MI wT
• y 1� �F 3
2-r r-o• �
ro
5'd1 13A7H#1 �•
n O
t2'-0•
armouth Health Department
—
ITM-vED
it
N e If
Date
SILL
it-11
WING ROOM
42&I7 SOFT. of ROOM
34.25 LIGHT REOb.
17.13 VENT REO'D.
52.47 LIGHT PROVE).
27.30 VENT PROUD.
SUFFICIENT LIGHT a VENT PROMED.
W-11
CN-STE DEOt
1 1
1 1 1 1 1
I 1 11
-
EIOSTING DMt111NG
3 OFS-59
-6•
OUTSONG 7-41/2•
Y-0'
47a
27'
al-9L Sl
W�
h
�V
rr
9
KrrC iEN
6
c
USE CABINETS 314•
•,
It'-T
M NYR
�4K
l5]1
yACIr
O
W4.D
Y-0•
M2L
SINGLE FAMILY DWELLING
L2x6 2s 6 EXT. WAILS Q 16' O.C. / zs4MARR WALLS 16.O.G 2ND STORY ADDITION
2 V-17 CL.O HT.
3. 2110 SYP#1 FTOORJOISTS Q 16.O.G /J 2d0 SPF#2 FLOOR JOIS'13Ir MODULE
4. ROOF SYSTEM TO BE 160 O.C.
5. 7D D/H WINDOWS (NFRC CERTIFIED) GBG's THRII-OUT
& SITE LOCATION: BARNSTABLE COUNTY, & YARMOUTH , MA J SNOW LOAD., 30 PSF [ DESIGNED TO 45 PSF )
7. 110 MPH WIND LOAD
&BUD:DERTOVERIFY TIAT71MOVERALL DIM. IS 25-3'Y 46-FBARESTUDTOBARESTUD
9. BUEDER TO PROVIDE EXACT' DIMENSIONS FOR CILASE LOCATION. PLUMB DROPS R STAIRS
10. E -PLUMBING DROP LOCATIONS PROVIDED BY THE BUILDER
1L BUEDLR IS RESPONSIBLE FOR PROVIDING FOR PLUMBING AND ELECTRICAL 13.AZER5 WIAL:
CONNECIION FROM ADDITON TO MaSI'DVG STRUCIVRB nor,
IZ TRIM CASINO 3/4• ALL INTERIOR DOORS (EXCEPT INSIDE BATH#I)
se..a 1/24/2013 e,u:u �� bm+..w•
IIR ILm
nmuraot
3A
3
Re -Inspections or Additional Fees
Electrical
Re -Inspection $80.00
Additional Fee T.B.D.
Re -Activation of old permit $50.00 (Residential)
$80.00 (Commercial)
Date:
Address:
Issued to:
q_y13
Reason for Fee: N� To C 06 L5
Permit Number: & - �2-(� -
Amount received:
ego
Cash: Check & Check Number: 4:iLr 2V 9
RECEIVED
SEP -4 2013
BUILDING DENT.
Dy
• op r TOWN OF YARMOUTH Building Department BUILDING
/+ (508) 398-2231 ext.1261
'- PERMIT NO �_ .6..,
-141t34 _
ISSUE DATE ; _ 7/31/2013 _ ; PROPOSED USE ; _ _ ; PERMIT
APPLICANT .... o .. Brennan _ _ _ _ JOB WEATHER CARD
PERMIT TO Repair
AT (LOCATION) 1022BLONGPONDDR ZONING DISTRIC R-40 Bldg. Type: Residential
SUBDIVISION MAP LOT BLOCK 1059.108 BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R-3
LOT SIZE
REMARKS construct 2nd floor deck over deck and patio as per plans dated 07/03/13.
It
AREA (SO FT) EST COST ($ $1,000.00 PERMIT FEE ($)
OWNER INORTON, JOAN J BUILDING DEPT BY
ADDRESS 0228 LONG POND DR
South Yarmouth MA 102664
PHONE
CONTRACTOR
LICENSE 74111
Brennan, Christopher
1 Bluff Road
Sagamore MA 02561
5088884212
INSPECTION RECORD FIELD COPY
Date Note Progress - Corrections and Remarks Insoector
i
R
--a�R ONE & TWO FAMILY ONLY - BUILDING PERMIT
O APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
yTown of Yarmouth Building Department
.��1146 Route 28 • Yarmouth, NIA 02664-4492
Tel: (508) 398-2231 x261 • Fax: (508) 39MS36
Office Use Only Planning Board Information Assessors Department Information:
Permit No. I S Date(I ve Map Lot
Mrs, ate
Permit Fee $
Reco ng Date New
Deposit Rec'd. $')S Date n No. 1.4 Property Dimensions:
Net Due $3S' Other LoiArea(sf) Frontage(ft). Lot Coverage
This Section for Office Use Only
BuildingPer it umbe :
Date Issued:
Signature:
Certificate of Occupancy
is is hot required
Building Official Date
Section 1 - Site Information
Use Group: R-4 Type: 5-B
1.1 Property Address:
22R Lc�1� 1'en�l rd•
1.2 Zoning Information:
���
Zoning District Proposed Use
Sewth %•rx, Quirt gj' tga6 c/
1.3 Building Setbacks (ft)
. Front Yard
Side Yards
Rear Yard
Required
Provided
Required
Provided
Required
Provided
1.4 Water Supply (M.G.L. c. 40. S 54)
Public Private
1.5 Flood Zone Informatlon: Comments:
Zone: BFE:
Section 2 -Property Ownership/Authorized Agent
s.1 owner of Records:
ov
I-d
-Sinc h e c
Na
a (print)
alai g Address
Signature Telephone
Fax
I[
f �^ r�. %T 1
C Jr- r
2.2 Authorized Agent:
R E C E I v E U
Name (print)
Mailing Address
0
13 I .
Signature Telephone
e.
Sertion 3 - Construction Services i I
3.1 Licensed Construction Supervisor:
41 fir! el
J
License Number
Expiration Date
Address K/
Ql7
Signature ieiephonb Fax E- J
1of2 OVER
�Sectiorti.4sYVorkeiafC'am .: fiRlFtstrreiie�Attid3lvi! Q��t�S36� e)y
Workers Compensation Insurance affidavit 'st be completed and submitted with this application. Failure,
` to provide this affidavit will result In the degW of the Issuance of the building permit.
:.
Signed Affidavit Attached Yes ....:..... No .......... '
Section Y 13obctlpfttot t to Wbrk (chedt aft appiieabti)
Now CorutruClon No. of Bedrooms Na ofuo BaCortss ExisUM Bid¢ Repdr(s) ❑ Afterallm ❑ AddMm ❑
r Accessory Bldg, ❑ Tjipe Demolition Other Specify.
- Brief 09scriptlon of Proposed Work
e •�
I Check Selow
❑ Consemadon-Commhsion Filing
IN applicable)
❑ Old Kings Highway a Historical
Cominhslon approvd
(it mow)
SeCt10R. 73 • owner Autliorr�uur • r u us w� � ry��w � r � �w r
OwnGeVA4GntotC0ntnbctQ1rA Ilea for Permit
as owner of the subject property
hereby autfwriza to act on
behalf. In all matters relative o rk authorized by th building permit appll tion.
dawn« Dare
Section 7b - OwnedAuthadzed A ant Dedaradon
as Owner/Authartzed Agent
hereby declare that the statements and information an the foregoing application are true and accurate,;
to the best of my knowledge and belief.
Signed under the pains'and penalties of perjury.
Stynahiry d Qvns JAgrl y ; Oab '
9-13.99 .4 2d 2
BUILDING DEPARTMENT v a as
CONSTRUCTION SUPERVISOR FORM
PLEASE PRINT:
Job Location: 2.28 L ojzt /211d rd • , ouh }4/is2ctJ%�
Number Street Village
Owner of Property: Ze-y" ryol-loiy
Construction Supervisor.
License No.
Licensed Designee:
(If other than Supervisor) Name License No.
2.15 Responsibility of each license holder:
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 tnderstand 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 ❑
If you have c ecked yu, please Ind ate the type coverage by checking the appropriate box.
A liability Insurance policy [ Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Ch pter 152 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
n3nature of awner or wners A, ent owner ❑ Agent
Signature: Building Official Approval:
ft
For Office Use Only
Permit No.
Date TOWN OF YARMOUTH
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
MoL c. 142A requires that the 'reconstruction, alteration. renovation, repair, modernization, conversion,
improvement removal, demolition or construction of an addition to any 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. 1
Type of Work: )nit r Q _ j inEst. Cost
Address of Work 226 Lana &d • rd • SoA hK'NeA kd-t9 oal6%
Owner Name: 1'6T4 Uorrort,
Date of Permit Application: go/3
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 here y apply for a permit as the agent of the owner:
' G, A] b b a -L+� 61 � 4
D to ontractor Name Registration No.
/7 36SS
OR:
Notwithstanding the above notice. I hereby apply for a permit as the owner of the above
property:
Date
Owner Name
- Common, wealth ofMassachusetts - -
Department oflndustrialAccidents
Off ca' of Investigations
600 Washington Street _
- Roston, MA 02111 . .
r z www.inass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/plumbers
Applicant Information Please Print Leefbly .
Name (Business/orgaaizahep/Indivich4: RDA • INC
Address:
City/State/Zip;agamorP MA 02561 phone # 508 888 4212
Are you an employer? Check the appropriate box:
lQi am a employer with 3 .4. ❑ I am a general contractor and I Type of project (required):
employees (fall and/or part-time).* have hired the sub -contractors 6• ❑ New construction
2. 1 am a sole proprietor or partner- listed on the attached sheet $ .. 7. ❑ Remodeling
ship and have no employees These sub -contractors have 8.' Q Demolition
• working forme in any capacity. workers' comp: insurance - 9_ Big addition
[No workers' comp. insurance 5. ❑ We area corpoiation and its
retied] officers have exercised they _ 10 0 Electrical repairs or additions
3. ❑ I am a homeowner doing all work right of eaeruption per MGL 11.❑ Plumbing repairs or additions
myself (No workers'camp. c.152,§1(4),and wehave no, 12Roof repairs
insurance required.) -t employees. [No workers'
comp. insurance required.) 13.0 Other
*Any applir--Mt ttut'cbeclQ box #1 must ilsa fill out the section below shown their wcrloaa
t I3omeowam who submit this affidavit indi g 'compensation policy infognation•
rating they axe doing all work and then hire outside ca at actois miut submit a new affidavit indicating such. . tConhauors that check this box must aitachm an additional sheet showing the name of the subcontactats and their wod=¢ comp. policyinfmmadm .
lam an employer that is providing workers' compensation insurance for my employees Below is the policy and job site
information.
InstuanceCompany Name: *IM Insurance ! ,
Poh # or Self ins Lic. fi 2 8 60f' n t 9 Expiration Date: 11 / 2 7 / 13
Job Site Addr: r7 N y7_l(11�7� i7 City/Statea:ip: \ �]
Aessttach a copy of the workers, compensation Policy declaration page (showing the Policy number nd expiration te).
Failure to secure coverage as required under Section 25A of XGL c.152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the fog of a STOP WORK ORDER and a fine
of up 0 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of
Inv 'gations f the DIA' for msu�anct Eovera a verification !
I o hereby ce pPPains and penalties o erjury that the information provided o is true az;d correct
Si
one ;- ..
Date: -
Official use only. Do not write in this area, to -be completed by city or town offrcial
City or.Town; Permit2icense # y,
Insuring Authority (circle one):'• '
1: Board of Health 2. Building Department •3. C /Town Clerk. 4. Electrical
.6.Other _.. R9 Inspector 5.Plumbing Inspector-.
Contact Person: _ Phone#: _
BUILDING
TOWN OF Y A R M O U T H ELECTRICAL
GAS
1146ROUTE28 SOUTHYARMOUTH MASSACHUSEM02664.4451 PLUMBING
Telephone (508) 398-2231, Ext. 261 — Fax (508) 398.2365
SIGNS
BUILDING DEPARTMENT
DEMOLITION DEBRIS DISPOSAL AFFIDAVIT
0
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 279 Litre (M - CA' ScUth �r��W/A 94q• O9C(o
Work Address
lDUjv
is to be disposed of at the following location:
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
ter 111; Section 150A.
Signature of Applicant
Permit No.
d
Date
in
1.
Mass achusetts s- Department of Public Safety
lll���JJJ Board of Building Regulations and Standards
Construction Supersisor q _
License: CS-074111
CffRISTOPiiER Pt
129 BEULGIi ST:
Whitman ALA aun =
it lit %%
Corrimissioner Expiration
01/2&2015
9T1W eommamvleaa
U'r
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massac4usetts 02116
Home Improvement Cpntril�tor Registration
CHRISTOPHER P. BRENNAN
CHRISTOPHER BRENNAN
P.O. BOX418
SAGAMORE BEACH, MA 02562
aPsr,Ar a 5oM-0l 10121e
Office or consumer Affairs & Business Regulation
VToP
HOME IMPROVEMENT CONTRACTOR
Registration:.,�73655 Type:
Expiration: .10242014 Individual
HER P BRENNAN
Registration: 173655
Type: Individual
Expiration: 10/24/2014 Tr# 233065
to Address and return card. Mark reason for change.
u Jdress Renewal ❑ Employment ❑ Lost Card
License or registration valid for individul use only
before the expiration date. If found return to:
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, AIA 02116
TOWN OF YARMOUTH
i �� Building Department
Town Hall
`5 L Yarmouth, MA 02664
(508) 398-2231 exL1261
BUILDING PERMIT
TRANSMITTAL
Temp Permit No.: T-13-503
Applicant Name:
Applicant Phone:
Building Location:
Owner's Name:
Owner's Addres
Owner's Telephone:
Christopher Brennan
5088884212
0228 LONG POND DR
NORTON, JOAN J
0228 LONG POND DR
South Yarmouth MA 02664
REVIEWED BY:
1. WATER DEPARTMENT:
2. ENGINEERING DEPARTMENT:
3. CONSERVATION:
4. HEALTH DEPARTMENT:
5. BUILDING DEPARTMENT:
6. FIRE DEPARTMENT:
RECEIPT OF COPY:
(OFFICE USE ONLY
Recorded By.
Ic
Permit Fee:
$0.00
Deposit Rec:
$25.00
Payment Type:
Check ChkNo.: 2324
Net Owed:
($25.00)
Application Date: 6/21/2013
Issue Date:
Expiration Date
PLEASE NOTE
OF APPLICANT:
Comments: Map/Lot: 059.108
construct de c ver qeck and patio
NOTICE
An as built plan must be
submitted to this department
prior to foundation inspecticn
or any further construction.
DATE:
N/A:
DATE:
WA:
DATE:
� WA:
DATE:
N/A:
DATE:
NIA:
DATE:
N/A:
i
DATE:
Date Printed: 6/26/2013
Town of Yarmouth
Conservation Commission
Building Permit Sign -off Application
TO BE FILLED OUT BY APPLICANT:
Building Site Location: � -R LOOS, eFL42t> pa
Map # _rG% Lot(s) # �Ufj
Property Owner:
Applicant:
Applicant Address:
-6L'0fF 6,
Telephone: ��a) Date Filed
Plans:
TO BE FILLED OUT BY CONSERVATION ADMINISTRATOR:
Does the Proposed Project Require a Permit? k,� C)
Continents from Conservati,
Approved Conditionally Approved Rejected
All work related debris shall be taken offsite or disposed in a legal upland location
At the end of each day, the area shall be clean and no debris shall be in the Resource Area
Refer to: SE83- or DOA permit
64110'� bcdt FGrve- ('ne., - rh;d 9,1
Conservation Commission Sign-offSignature:4v
Date: 6-2t-13 U
r
FOUNDATION ]FLUJ MAIN
PREPARED EXCLUSIVELY FOR THE PURPOSE OF OBTAINING A BUILDING PERMIT, NOT FOR ANY OTHER USE
LOCATION 228 LONG POND DRIVE SOUTH YARMOUTH., MA. .
SCALE : 1" = 40' DATE : AUGUST, 319 2006 y PREPARED FOR:
REFERENCE MAP 59 PARCEL 108 J® J. NOS
LOT 1 LCP 28410A SHl
OFAf�s_
1 HEREBY CERTIFY THAT THE STRUCTURE
SHOWN ON .THIS PLAN IS LOCATED ON THE <r G TIMOTHY
GROUND AS SHOWN HEREON. H.
r COVELL
olf 508-362-4541 y p No.3E035
fox.50B 362—SBW .r
down cape engineering, inc. 2
CIVIL ENGINEERS _ `'
Laxn.suxvEYoxs OATS RE LAND SURVEYOR
493e main st. yar mouth. ma
John C. Spink
Professional Engineer
59 Clay Street
Middleborough, MA 02346
774-766-0544 ispinkl@gmail.com
July 19, 2013
Mark A. Grylls
Building Commissioner
1146 Route 28
South Yarmouth, MA 02664
Re: 228 Long Pond Drive. in Yarmouth, Ma.
Decks and 4" x 4" vertical supports for a deck
Dear Sir:
E--:Pj%.RTI-IENT
2013
E„i��,....
The two vertical 4" x 4" posts used will be 9'-4" +/- to support the upper deck. The two proposed
posts will each line up with an existing concrete sono-tube foundation. The existing concrete sono-
tube foundation has been inspected for structural integrity. The sono-tube is set 4' below existing
grade. The soils are adequate to support the load. The new 4" x 4' vertical post will be pressure
treated wood. The posts will be attached according to the latest Massachusetts State Building Code.
Sinc
J Sptnk, P.E. Mass No.: 30097
Tom Roux/JCS
Attached: picture/sketch of attachment method/2 pages drawings -stamped.
0
. . _•31. �; tw
jz�r/or� = 4E61"
•�',�,JoIY�7
j J \ V./i/ °C a71re/
"--' - Tb OAC R!'lI -�w�w✓
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Col
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do MM?
pi
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I TOWN OF•YARMOUT i
'REVIEWED FOR BUILDING AND ZONING CODE CC`.IFLI•
1 i ANCE. ERRORS OR OMMISSIONS 00 NOT RELIEVE TIi:
APPLICANT FROM THE RESPONSIBILITY OF 'AS BUILT'
COMPLIANCE.
j i 1 j DATE:
i
BUILDING OFFICI L I r
NOTICE
i -- - -An as -built plan must be
submitted to this department.
t ___� prior to foundation inspection
Ljj %- ' or any further construction.
w
M
z
w
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/
N
Q
w00
JCn
a
W
9
X, I
m
M
tfomrnonosa& of /t/ad5iw"t& ; Official Use Only
1JoPartmoni o /-7� s`ro�S Permit No. �I
BOARD OF FIRE PREVENTION REGULATIONS et jPO ry and Fee Checked
' � cave blank
APPLICATION FOR'PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Elcci ical Code (b1EC), 527 CMR 12.00
(PLEASE PRINT IN INK ORTYPE ALL INFORMATJOA9 Date: '-)— / 7— c 0- j
City or Tonv of: YARMOUTH To the Inspector of Wires:
By this application the Vridersigned gives nonce of his or her intention to perform the electrical work described below.
Location (Street & Number) r>..a 0 , /11 & Pow
Owner*orTenant hjop;N Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box)
Purpose of Building Utility Authorization No.LgS_ 366,j
Existing Service /0o Amps /?a /a Volts Overhead C�
l� Undgrd ❑ No. of Meters �_
New Service 2vv Amps / / 2-y Volts Overhead Undord /
❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
!:22 Zye A.M%2S' Lam: 29
No. of Recessed Luminaires
w:n ,r Wn of me jouowtnq
No. of CeiL-Susp. (Paddle) Fans
table May be waived by the lncbector of mires.
No. of Total
Transformers NA
No. of Lumiaaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool A ove ❑ n- ❑
o, o mergency gang
ernd. acrid.
BattervUnits
No. of Receptacle Outlets
No, of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners
o. of Detemcdon and
Initiating Devices
No. of Raages
No. of Air Cond. Tons
No. of Alerting Devices
No, of Waste Disposers
Heat Pump
umber
ons
o. of el ontain
Totals:
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW'
Loal ❑ Moulcipal
ElOther
Connection
No. of Dryers
Heating Appliances KW
Security Systems:'
o. of Water
No. of Devices or Equivalent
Heaters KW
°' ° o. o
Slens Ballasts
Data Wiring:
No. of Devices or E uivalent
No. Hydromassage Bathtubs
No, of Motors Total HP
elecommunicauons tring:
No. of Devices or Equivalent
OTHER:
Estimated Value of Electrical Work li `�"crea by rile Inspector of Wires.
(When required by municipal policy.)
F. Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion.
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.
rCHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:)
I certify, under the pains and penalties of perjury, that the information on this application is true and complete.
FIRM NAME: pM . LIC. NO.
y� Licensee: _ jM bA`i s A-, Signature LIC. NO. � ,
�C (IfapplicoblA enter 'tsempt"in
Address, the licence number line.) Bus. Tel. No. �3d1
Addr. Alt. Tel. No.:
'Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lie. No. ��
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coveragenormally
required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent
Owner/Agent
Signature Telephone No. PERMIT FEE: $ 75'
AR: Wiring Permit System (WPS) - Permit
I Comments I Work Order Request I Search I IJatI
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Wiring Permit System (WPS) - Permit
Page 1 of 2
- ■■L111L %0AUVI IIIIV1111QLIHII
Utility Auth/WO #: 01953061 Date: 07/26/2013 Company Rep: LINDA TAVARES
Report By: YAR 228 LONG -POND DR NORTON JOAN
Status: ACTIVE Service: NEW Type: RES
Nature of Work: (PREVIOUS TEAR DOWN) .... NEW 200A OH TO POLE# 246/P24B.... POLE ONSAME
SIDE, APPROX 50' AWAY ... SERVICE ON LEFT CORNER .... NOT CROSSING2000 SQ
FT ... GAS HEAT& HOT WATER ... GAS RANGE & DRYER .... NO A/C...
L• •P- in . II- •I FWmnal • IL- njits •L •.1 •l1 •1 -11 •OI- •1
-service intorm
Service Voltage: 120/240-3 Switch Size: 200
Address: 228 LONG -POND DR YAR 02664
Name: JOAN NORTON
Service Voltage: 120/240-3 Switch Size: 100
Address: 228 LONG POND DR TEMP YARMOUTH 02664
Name: JOAN NORTON
Work Order Information I Service Information I Contact Information I Permit Information
IIIIVI
Type:
ELECTRICIAN
License:
0000038324
Last Name:
UMBRIANNA
First Name:
THOMAS
Company:
SELF
Address:
22 BOW ST CARVER MA 02330-
Pager:
Email:
Phone:
7818568366
Cell Phone:
7818568366
Fax:
Best Hours:
Blue Book
N
Reorder:
Permit Information
Permit #: E14-226 Meters: 1 Reseal Y Date: 08/05/2013
(YIN):
Inspector: W10060 Description:
L•1. • • 1 • I . •1 -. I •II •I r 1 • I •I -III • I •1
,F •II II - I a IL.I. •1=-. L 1I
https://www.nstar.conilsecure/apps/wpslwpspermit.asp?Work_Order Nbr=01953061 8/5/2013
TOWN OF YARMOUTH
BUILDING DEPARTMENT
1146 Route 28, South Yarmouth, MA 02664
508-398-2231 ext. 1263 Fax 508-398-0836
K. Elliott, Inspector of Wires
kelliott(a?yarmouth.ma.us
September 3, 2013
Tom Umbrianna
22 Bow Street
Carver, MA 02330-1230
RE: Joan Norton, 228 Long Pond Drive, South Yarmouth
Permit Number: E14-226
Dear Tom;
The above noted location inspection failed to pass for the reason(s) listed.
Article 210-52 (E)(3) Receptacle on balconies,
decks, & porches.
Please forward the required re -inspection fee of eighty dollars ($80.00) to this office and
advise when the corrections have been made and when access may be gained, to the property,
for the re -inspection.
If you have any questions please do not hesitate to contact me.
Sincerely,
Town of Yarmouth, Building Department
K. Elliott,
Inspector of Wires
1P A
01�
MASSACHUSETTS UNIFORM APPLICATION FOR A P MIT TO PERFORM LUMBING WORK
MA DATE 1 ^ �`- \� CITY u �P�-�^^�0y �� PERMIT 9 PI-n
JOBSITE ADDRESS Z�^ `a `OJv� • `D OWNER'S NAME
POWNERADDRESS TEL FAX
TYPE OR OCCUPANCYTYPR COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL ❑
PRINT
CLEARLY NEW,'X M ° RENOVVATIO ❑ PEPLACEMENT:: ElPLANS SUBMITTED:[I YES NO ❑
FIXTURES'l FLOOR- I BSMT 11 1 2 1 3 1 4 1 5 1 6 17 8 1 9 1 10 1 11 1 12 1 13 14
CROSS CONNECTION DEVICE
I DEDICATED SPECIAL WASTE SYS
DEDICATED GAS/O]LJSAND SYS
DEDICATED GREASE SYS
DEDICATD GRAY WATER SYS
DEDICATED WATER RECYCLE SY;
DRINKING FOUNTAIN
DISHWASHER
FOOD DISPOSER
FLOOR / AREA DRAIN
INTERCEPTOR(INTERIOR)
KITCHEN SINK
LAVATORY..*.,
ROOF DRAIN'
SHOWER STALL
SERVICE / MOP SINK
TOILET
URINAL
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES
WATER PIPING
OTHER
t
1 have a current liability Insurance policy or its substantial equivalent which, meets the requirements of MGL Ch.142. YeS)C] No ❑
IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY ❑ BOND ❑
OWNER'S INSURANCE WAIVER. I am aware thatthe licensee does not have the Insurance coverage required by Chapter 142 of the
Massachusetts General Laws, and that my signature on this permit application waives this requirement
CHECK ONE BOX ONLY: OWNER ❑ AGENT ❑
Signature of Owner or Owner's Aoent
I hereby certify that all of the details and information 1 have submitted (or entered) regarding this application are true and accurate to the
best of my Knowledge and that all plumbing work and Installations performed under the permit Issued for this application will be In
compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Cha�pter'142 of`the
pGeneral Laws.
PLUMBER NAME VQ, i SIGNATURE
UC # %-u- 3 MP J9 JP ❑ CORPORATION ❑ # PARTNERSHIP ❑ # LLC ❑ #
COMPANY NAME _ CADDRESS: �� `� L\�b v r.\\ti,, 'bit -
CITY STATE �+s 71P 0193 b EMAIL Q-± Q± - a: An In Q S mow+\ • Lo ""�
TEL - CELL '52e - '-% 58- a L\ FAX
I?. c L-:-: I E '3
J 12 2013
Z-pe
ROUGH PLUMBING INSPECTION NOTES
Tms PAGE TOR INSPECTOR USE ONLY
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ El
FEE: $ PERM"
PLAN Rr, VTEW NOTES
FINAL INSPECTION NOTES
Llo &W LA
/-2—.2 )
a //'
P
GOWNER
TYPE OR
PRINT
CLEARLY
MASSACHUSETTS UNIFORM AP LICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
CITY: C�tl_w.aJ�� MA. DATE:'I, -,L' \3 PERMffe
JOBSITEADDRESS: - -'LG- OWNER'S NAME:::Z'O&� 1Ji.OnJL �
ADDRESS: TEL FAX
OCCUPANCYTYP • COMMERCIAL ❑ EDUCATIONAL ElRESIDENTIAL ❑
'2-r'> looVL- M-Aodulr'aL_ :�.ow�t
NEW. 1�1 RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES ❑ NO ❑
APPLIANCES-1 FLOOR—
Bs mt
1
2
3
4
5
0"
7
8
9 1
10
11
12
13
14
BOILER
BOOSTER
CONVERSION BURNER
COOK STOVE
DIRECT VENT HEATER
DRYER
FIREPLACE
FRYOLATOR
FURNACE
GENERATOR
GRILLE
INFRARED HEATER
LABORATORY COCK
MAKEUP AIR UNIT
OVEN
POOL HEATER
ROOM / SPACE HEATER
ROOF TOP UNIT
TEST
UNIT HEATER
UNVENTED ROOM HEATER
WATER HEATER
- LOLA%Z
INSURANCE COVERAGE
I have a current liabililyinsurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES,t NO ❑
If you ave checked YES please indicate the type of coverage by checking the appropriate box below.
--�� LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ❑ BOND ❑
r
MN S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Ii tts General Laws, and that my signature on this permit application waives this requirement
04�''� CHECK ONE ONLY: OWNER ❑ AGENT ❑
-Sn%NRE OF OWNER OR AGENT
JtereVy certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my
Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all P 'nent
proinsion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBERIGASFITTERNAME W���.2� 1 {��� mar LICENSES k'1 SIGNATURE
COMPANY NAME: _CV-eJ A- -
> Q"Ao
CITY:�t'tiAc�rtio.�s-L� STATES` ZIP:'b}J� 10 FAX
TEL: GELL'� -qVS - aL\gy EMAIL
MASTER [i—JOURNEYMAN ❑ LP INSTALLER ❑ CORPORATION ❑ a PARTNERSHIP ❑ Z LLC ❑ g,
al
GIT CAS IN411Lcr1ON NOTIrS THIS PAGL If Olt INSPECTOR USE ONLY
eve c,/1 Yes No
THIS APPLICATION SERVES AS TI IE PERMIT ❑ ❑
FEE: $ PERMITS
PLAN REVIGIV NOTES
FINAL INS PECTION NOTES
J/%L /"/" nn G/Z //
C:
MOCe DULAR
ERECTORS
I DATE
86 Slater Park Avenue Pawtucket, RI 02861
DAY
401.723.8240
CUSTOMER
ADDRESS
CITY-STATE ZIP
JOB LOCATION
PAYMENT TERMS
P.O. #
EQUIP. USED
WORK DONE
ARo�;
S� e?16
Ae
-�* U(, S" 6—rcp- 60 9 r
3h3 AFL e7
2 297
ran
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INSTALLATION OF CERTIFIED
MANUFACTURED BUILDINGS
This is to confirm that this home mill be installed by an installation crew that is certified by Keiser
Industries, Inc. The installation crew is composed of individuals under the supervision of the operations
manager listed below:
The belon, listed compaap is a fiuclory certified installer of f►eicer Modular llomev:
Set Connectors Inc.
Richard Hott, Operations Manager
36 Holman Lane
Norway, ME 04268
setcon n ecto rsna,live.com
Keiser Homes Authorized Agent"
Signed: G�1
Title:
Date:
NOTE: FOR ALL HOMES INSTALLED IN THE STATE OF MAINE, The installer, mechanic, dealer
(when the dealer is responsible for the installation), or the manufacturer (when the manufacturer is
responsible for the installation), shall purchase and affix a complete State of Maine Warranty Seal to each
home installed.
(Per Chapter 381: Maine Manufactured Home Installation Warranty Seal)
i
ri
Commonwealth of Massachusetts
Board of Building Regulations and Standards
Manufactured Buildings Program
THIRD. PARTY RVSPECTION AGENCY CERTIFICATION
BULK LABELS
This Section to be completed by Third Party Inspection Agency. - Pease print or type - UNITS MAY NOT BE
SHIPPED UNTIL THIS CERTIFICATION IS COMPLETED and COMPONENTS ARE LABELED
SECTION 1- MANUFACTURER INFORMATION (S\h fg\mfgd&dpartycert buWabeLc2005- July, 2009)
Manufacturer Name Probuilt homes MC# 266
Address 43 Industrial Circle
Telephone 1-717-436-6434 Fax 1-717-436-6431
E Mail Address ,t1 rG�6., e, ,„/. ;., • r. co.a
SECTION 2 - BUILDING INFORMATION BBRS\DPS I.D. # 1003843 11
Street Name & Number 228 long Pond Rd
City South Yarmouth State. Mass Zip 02664
Use Group R3 'Construction Type Wood Frame 5b
In signing this form below, I hereby certify that the units identified on this form have been inspected ancj _
are constructed in accordance with the following codes,: as applicable. C
Massachusetts State Building Code (780 X❑' . Massachusetts State Electrical
CMR) Code(527 CMR 12)
Massachusetts State Plumbingand Fuel Massachusetts Architectural Access �' ""'
X� Board Regulations 521 CMR r-�
[Gas Code (248 CMR) ( ) I„
r
Mfg. Plant Inspector's Name (Print Name)
Michael Kirby
Third Party Inspector (Print Name)
/ f,[' T - in t Z TPIA#: p Z
Mfg Plant Inspector's Signature
Michael Kirby Date: L'
Third
i
Inspector's Signature����-.
E — G' li ate � 7�3
- EAL CERTIFIED INSTA LLE.R
SECTION 3 BUILDER/D ER/
_ TION
!!
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I
Builder/Dealer: Realty Development Group
a ZU13Ulu
Address: 1 Bluff Point, Sagamonre, Mass.
Licensed Construction Supervisor: Christopher P Brennan..
Certified Installer: Chirstpher P Brennan
License Number: Cs-07411
Exp. Date: 01/28/2015
SECTION 4 -LABEL INFORMATION (Indicate number'of boxes and number of labels required)
Number of Units
2
Label Numbers IssuedMH-
9 D(o I9
Manufacturer's Serial Number.
Sn2851: /;t
0)3 06a.
Manufacturer's Model Designation:
Ranch
1a
The original form shall be mailed to the BBRS / Department of Public Safety
1380 Bay Street, Building B, Taunton, MA; 02780 hndashea@state.ma.us
(.otnrnonwsaUh of ///attacff� Official Use Only
Permit No. 013— 92 3Z
1JsParimanf o`.1irs �arvica
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS Rev. 1/07] leave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (ME, 527 CMR 12.00
^(PLEASE PRINTININKORTYPE ALL INFORMATIOI9 Date:MAq 5' Q19
Cityor Town of: ylq,2tlp To the Ins ector ojWires:
By this application the undersign gives notice of his or her intention to perform the electrical work described below.
I oration (Street &Number) ' 22 8 GON 6 Po/JO
L�+� OwnerorTenant �A/J/LTd.y SC-AA1 Telephone No.
L Q _O�ner's Address
L;�� "Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box)
fi.`. t""' ~1 Paipose of Building Utility Authorization No. / �
�"---Extsting Service Amps / Volts Overhead El Undgrd El No. of Meters
INew'Service aoa Amps / "o Volts Overhead [20� Undgrd ❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: /AJ.S f� ZOo �Wi p D� f/- $'z),evl icG
—L,✓s;,at,Q— omyUyr
nletion ofthe followino, table may he waived by the Inspector of Wires.
IfJ
tA
:n
No. of Recessed Luminaires
No. of ceil.-susp. (Paddle) Fans
o. ota
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool ove ❑ n- ❑
rnd. rnd.
at o Units cy g mg
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALAMS
es
No. of Switches
No. of Gas Burners
n and
o. o etenD
InitiatingDevices
No. of Ranges
No. of Air Conti. Total
ons
No. of Alerting Devices
No. of Waste Disposers
eat ump
Totals:
Number
Tons
IKW
No. of e - onta ne
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑ un a ❑ Other
C ion
No. of Dryers
Heating Appliances KW
eCNotoSystems:*
f Devices or E uivalent
o. of Water,
o. o o. o
Data Wiring:
Heaters
Signs Ballasts
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
e No. f Devicesons or E uivalent
OTHER:
Attach additional detail ifdesired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start Inspections to be requested in'accordance with MEC Rule 10, and upon completion.
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 1:2-VI99es in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:)
I certify, under the pains and penalties ofperjury, that the information on this application is true and complete.
FIRM NAME: LIC. NO.: E 3MV
LicenseerfdM //,t�/�en�nA�1 Signature LIC.NO.:
(If applicablee ente�rmpt" in the license number line.) Bus. Tel. No.;2 91' F36f
Address: Z'L 90W S)' r�2�c�T4 OZ330 Alt. Tel. No.:
*Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the (check one) []owner owner's a ent.
Owner/Agent PERMIT FEE: S
Signature Telephone No.
t.
NSTAR: Wiring Permit System (WPS) - Permit
Page 1 of 2
[ Comments I Work Order Request I Search I List I
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Wiring Permit System (WPS) - Permit
Work Order Information I Service Information I Contact Information I Permit Information
rrorR vranr nnvnna►wn
Utility Auth/WO M 01940495 Date: 05/07/2013 Company Rep: MARY BLUNDELL
Report By: YAR 228 TEMP LONG -POND DR MARTIN JOAN
Status: ACTIVE Service: NEW Type: COM
Nature of Work: NEW 100AMP OH TEMP SVC POLE ON SAME SIDE OF STREET APPROX 1 OFT
AWAY- SECONDARIES THERE - QUOTED $250 FEE
• service mtormauon
Service Voltage: 120/240-3 Switch Size: 100
Address: 228 LONG -POND DR TEMP YAR 02664
Name: JOAN MARTIN
- %.ontact mrormauon
Type:
ELECTRICIAN
License:
0000038324
Last Name:
UMBRIANNA
First Name:
THOMAS
Company:
SELF
Address:
22 BOW ST CARVER MA 02330-
Pager:
Email:
Phone:
7818568366
Cell Phone:
7818568366
Fax:
Best Hours:
Blue Book
N
Reorder:
Type:
GENERAL CONTRACTOR
License:
Last Name:
CO
First Name:
RDA
Company:
Address:
PO BOX 601 SAGAMORE MA
02561-
Pager:
Email:
Phone:
508-888-4212
Cell Phone:
Fax:
Best Hours:
ANY TIME
Permit intormation
Permit #: E13- Meters: 1 Reseal Y Date: 05/14/2013
1282 (YIN):
Inspector: W10060 Description:
a
https://www.nstar.com/secure/apps/wps/wpspermit.asp?Work_Ordcr Nbr=01940495 5/14/2013
OFFICE MEETING NOTES
ADDRESS: ZZk' Lofj6-
NAMES OF ATTENDEES: 3/ L L /}a/i�W�a /,A7
ZONING DISTRICT: o
FLOOD ZONE:
DATE:
MEETING TOPIC:
sz8—,9�— G2��
%
UP Sfxr72S c/o✓i T oe�, Q ✓ieif Z 11114J;,P ` a;#� 2�1
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APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00
(OFFICE USE ONLY)
Fee: $ d J . 9
PERMIT NO. f-- —U I —
(PLEASE PRINT IN INK OR YYFE ALL 1JVP URMA7XV) Date: 7 14' 71'(/
To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical
work described below. <� 1
Location (Street & Nun—mbbeer � ( 011 c �C%1 Q
Owner or Tenant lV d Jy h Telephone No.
Owner's Address SCL VV,1_
\vlsthis permit in conjunction with a building permit? M Yes Q No (Check Appropriate Box)
• Purpose of Building Utility Authorization No. I
i Existing Service Amps / Volts Overhead❑ Undgrd ❑ No. of Meters
New Service
Amps / Volts OverheadQ Undgrd ❑ No. of Meters
0 of Rcccssed Fixtures
No. of Cgil.-SUS1211'addle)Fans
o. of Total
Transformers KVA
No. of Li%zhtina Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures
Above n-
SwimmingPool rnd. ❑ md. ❑
o. o Emergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Bumers
o. of Detection an
Initiating Devices
No. of Ranges
Total
No. of Air Cond. Tons
No. of Alerting Devices
No. of Waste Disposers
Heat mp
Totals:
um Cr
—
ons
—
— —
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Spacc/Area Heating KW
Municipal
Local Other
❑ Connection
No. of Dryers
Heating Appliances KW
Secutity Systems:
No. of Devices or Equipvalent
No. of Water
Heaters KW
No. of No. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
Attach additional detail if desired, or as required by the Inspector of Mires.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued unless the licensee provides
proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in
force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE BOND OTHER (Specify:)
(Expiration Date)
Estir ated Value of E ectrical Work: �k b (When required by municipal policy.)
Work to Start: 0 Inspections to be requested in accordance with MEC Rule 10, and upon completion.
I certify, under the pains and penalties of perjury, that the information on s application is true and complete.
Q FIRM NAME LIC. NO.
3- Licensee: (.0 1 Signature LIC. NO. ,b k
--(If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: 740 4O
Address- Alt. Tel. No.:
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature
below, I hereby waive this requirement. I am the (check one) owner owner's agent.(]
Owner/Agent
Signature Telephone No.
[Rev. 041001
t.
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00
f� r� n nn R [')I (OFFICE USE ONLY)
OF' 1MM'+I0I� Ini/a
l By
MAY 1 0 7.005Fee: $ a2 CS 0t
. r n,! D i� PERMIT NO. F— Ot=� 10.3 b
t. , —T
(PLEASE PRINT IN INK OR TY E ALL INFO MATION) Date:
To the Inspector of Wires: By this application th undersigned gives notice of his or her intention to perform the electrical
work described below. /
Location (Street &Number) 2249 ZOAI/ '
Owner or Tenant--�oW41 l'y"ZI '7nAI Telephone
Owner's Address spv i vvi
Is this permit in conjunction with a building permit? Q Yes Q< (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service_ZODAmps //.S / 2.30Volts Overhead2— Undgrd ❑ No. of Meters 2
New Service Amps / Volts Overhead❑ Undgrd ❑ No. of Meters
Number of Feeders and
Location and Nature of Proposed electrical Work:
rmmnletinn nfthe fnllowine tahle may he waived by the Insnertor nf Wires
o. of Recessed Fixtures
N 'I - P dl
No. of Total
Transformers KVA
No. of Li htin" Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures
Above I n-
Swimming Pool md. ❑ md.
No. o Emergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Bumers
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Bumers
o. o etcction an
Initiating Devices
No. of Ranges
Tota
No. of Air Cond. Tons
No. of Alerting Devices
No. of Waste Disposers
eat mp
Totals:
um er
ons
—
— —
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Municipal
Local Other
❑ Connection
No. of Dryers
Heating Appliances KW
SecuNtoityoSDetemess 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 uiva
Attach additional detail if desired, or as required by the Inspector of Wares.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued unless the licensee provides
proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in
force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE ❑ BONDQ OTHER (Specify:)
v Estimated Value of
Work to Start:.
certify, under the
FIRM NAME -
Licensee: �? f
(Expiration Date)
Work: 097(7, — (When required by municipal policy.)
5' Inspections to be requested in accordance with MEC Rule 10, and upon completion.
pallies of perjurryy, that the information on this application is true and complete.
2Gr C If" Ids LIC. NO. 4'6 /3S
Signature �4LIC. NO. � / 3 3 %3
(If applicable, enter "exempt" in the license number line) .1� Bus. Tel. No.:
Address-
/6 Si} ,�✓ /ael2/ii G? �% dad 36Z Alt. Tel. No.: 50 36 d- /9 .z
OWNER'S INSURANCE IVER: I am aware that the Licensee do Cs not have the liability insurance coverage normally required by law. By my signature
below, I hereby waive this requirement. f the (check one) owner owner's agent. ❑
Owner/Agent
Signature 'Z 9'41�' Telephone No. ,-Of
[Rev. 04/00]
)YPS - Permit
Page 1 of 1
NSTAR
WPS - Permit
Work Order Information
Utility Auth/WO #: 01546839 Date: 10/06/2006 Company KATHLEEN SOUSA
Rep:
Report By: BAS 228 LONG -POND DR NORTON JOAN
Status: ACTIVE Service: RELOC Type: RES
Nature of Work: EXISTING 100 AMP OH SERV.. RELOCATING OH TO OH FROM RITE TO LEFT
FRONT FACING HSE.. REMOVED H MTR.. OUOTED $500..NO ADDED LOAD...
METER WORK AFTER INSP
Service Information:
Service Voltage: BAS Switch Size: 100
Address: DR LONG -POND 228 02664 - 120/240-3
Name: 100 JOAN NORTON
Permit Information
Permit #: E07-338 Meters: 1 Reseal (Y/N): Y Date: 10/06/2006
Inspector: W10060 Description:
Search ! Detall � Contacts
NSTARHome YLPa-LogoR YVPS Help Comments WO Request WPS News
1k (51 $'
Copyright 2003 NSTAR, $00 Boylston Street, Boston MA USA. All rights reserved. Reproduction In whole or In part of any graphics,
Images, text or other content at this web site must be granted by NSTAR, Boston, MA, USA. Unauthorized modification of any Information
stored at this site may result in criminal prosecution.
http://www.nstaronline.com/apps/wps/wpspermit.cfm?Page=Permit&Unique= { ts_'2006-1... 10/6/2006
TOWN OF YARMOUTH
WATER DEPARTMENT
99 Buck Island Road
West Yarmouth, MA 02673
Telephone: (508) 771-7921 • Fax: (508) 771-7998
NOTICE
❑ New Structure
Service #: 10085 Service Address
Map / Parcel #: 59.108 Certified Mail #:
April 25, 2006
Ms. Joan Norton
364 Tilden Commons Lane
Braintree, MA 02184
Dear Ms. Norton:
❑ Existing Structure
228 Long Pond Drive
This is to advise you that the Town of Yarmouth Water Division or their authorized
agents have installed a new water service or rehabilitated an existing water service at
the above address. Materials used during this Installation are not conductive.
Town of Yarmouth Water Division regulations prohibit the use of this water service
as a grounding device for your electrical service.
It is recommended that you contact an electrical contractor to ensure that your
electrical service grounding is in compliance with Massachusetts Electrical Code, CMR,
S27-12.00 Article 250.
A copy of this service is being forwarded to the Town of Yarmouth Wiring Inspector.
Sincerely,
Dan Mills
Superintendent
Cc: Wiring Inspector
TOWN 0
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APPLICATION FOR PERMIT TO DO PLUMBING
(OFFICE USE ONLY)
Fee: $ .�'yy p
PERMIT NO. 0y7—l9
Building n
AT: Location g2,' LnbOj AJ .
Owner's
Name_
Date 16 -S 20 -�
Type of Occupancy
New[] Renovation B'� Replacement ❑
Plans Submitted Yes ❑ No ❑
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Check One:
❑ Corp.
❑ Partnership
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Business Telephone � ,2,�scGr I Name of Licensed Plumber Nej W � 1e/1--�
INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent. Check One: Yes a --No ❑
If you have checked YES, please Indicate the type of coverage by checking the appropriate box.
A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of
the Mass. General Laws, and that my signature on this permit application waives this requirement.
Signature of Owner or Owner's Agent
I hereby certify that all of the details and Information I have submitted
(or entered) in above application are true and accurate to the best of
my knowledge and that all plumbing work and Installations performed
under Permit Issued for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plumbing Code and
Chapter 142 of the General taws.
Check on Owner ❑ Agent ❑
I
Signature ofYjcensed
Plumber
5-7
( 7 Lf
License Number
Type: Master Journeymar�r/
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OCT 0 Y 006
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APPLICATION FOR PERMIT TO DO GASFITTING
(OFFICE USE ONLY)
By
Fee: $
PERMIT NO.
Date f D—S7-0063
_
Building Owner's
AT. Location t3h G Qno-'j Name r dV +d Ll
C Type of Occupancy A -es .
New ❑ Renovation ❑ Replacement ❑
Plans Submitted Yes ❑ No ❑
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1ST FLOOR
2ND FLOOR
3RD FLOOR
(PRINT OR TYPE)
Installing Company Name
Address
Business Telephone
Name of Licensed Plumber or Gasfitter
Check One:
❑ Corp.
❑ Partnership
❑ Firm/Company
W t `
INSURANCE COVERAGE: Check One
I have a current liability insurance policy or i substantial equivalent. Yes ❑ No ❑
If you have checked yes, please indicqteAe type of coverage by checking the appropriate box.
A liability insurance policy 1jr Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of
the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check One:
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
I hereby certify that all of the details and Information I have submitted
(or entered) in above application are true and accurate to the best of
my knowledge and that all plumbing work and Installations performed
under Permit Issued for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plumbing Code and
Chapter 142 of the General Laws.
1
Signature of Licensed
Plumber or Gasfitter
License Number
TYPE LICENSE:
0 Plumber ❑ Gasfitter 0 Master 3 oumeyman
RECEIVEDI
SEP 01 2006
BUILDING DEPT.
By:
IJ
FOUNDATION PLOT PLAN DCE #06-224
PREPARED EXCLUSIVELY FOR THE PURPOSE OF OBTAINING A BUILDING PERMIT, NOT FOR ANY OTHER USE
LOCATION : 228 LONG POND DRIVE SOUTH YARMOUTH, MA
SCALE : 1 " = 40'
DATE : AUGUST 31, 2006
REFERENCE MAP 59 PARCEL 108
LOT 1 LCP 28410A SH1
I HEREBY CERTIFY THAT THE STRUCTURE
SHOWN ON THIS PLAN IS LOCATED ON THE
GROUND AS SHOWN HEREON.
off 508-362-45
fax SOB 362-9880
I
own cape engineering, inc.
CIVIL ENGINEERS ja/ 1�
LAND SURVEYORS _ /
e so main st. yarmouth. ma DATE
PREPARED FOR:
JOAN J. NO.
N
�NOFb0
9
TIMOTHY cyG
H. m
COVELL
No.3b035 y
(Izq�jl
TOWN OF YARMOUTH
PERMIT NO �B-07.230 '
Building Department
(508) 398-2231 ext.261
BUILDING
ISSUE DATE :_ 8[15/2QQ¢.:
PROPOSED USE _ _ .........
PERMIT
APPLICANT _Joan Norton _ . _ ' ,
ii'D PAY
JOB WEATHER CARD
PERMIT TO Additim
AT (LOCATION)
10022SLONG POND DR
ZONING DISTRIC R-40
Bldg. Type: Residential
SUBDIVISION MAP LOT BLOCK 1059.108 1 BUILDING IS TO BE: CONST TYPE b-B USE GROUP R-4
LOT SIZE
addition to expand kitchen. retool, residing as per plans dated 08MM.
REMARKS
AREA (SO FT) EST COST ($
OWNER IJOAN J NORTON
ADDRESS 100228 LONG POND DR
South Yamauth I MA 102664
PERMIT FEE
BUILDING DEPT BY
INSPECTION RECORD
CONTRACTOR
LICENSE 0
PHONE 160115606959
FIELD COPY
Date
Note Progress - Corrections and Remark
Inspector
LZLim(
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05
0
oF'YAR ONE & TWO FAMILY ONLY - BUILDING PERMIT
O APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
0 y Town of Yarmouth Building Department f
'A ..C�.�1 1146 Route 28 • Yarmouth, NIA 026644492
• .0. Tel: (508) 398-2231 x261 • Fax: (508) 398-0836
Office Use Only Planning Board Information Assessors Department Information:
Permit NoM(tate&
Pliln Type Map Lot
Permit Fee $p2o�d#ndorsement Date 5 -1
U Uding Date New
Deposit Rec'd. $Date`lNo. 1.4 Property Dimensions:
NetDue04/4 Lot Area (sf) Frontage (ft) Lot Coverage
1
1
This Section for Office Use Only
Building Per u ber:
I Date Issued:
�3 _O
Signature:
Certificate of Occupancy
is Is not required
Building Official Date
Section 1 - Site Information
I Use Group: R-4 Type: 5-B
1.1 Property Address:
� � a�a -A ivy
1.2 Zoning Information:
y o
Zoning District Proposed Use
I
Oct
1.3 Buildr g Setbacks fit)
Front Yard
Side Yards
Rear Yard
Required
Provided
Required
Provided
Required
Provided
1A Water Supply (M.O.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 -
ran
Name rint) Mailing Address
Signatur Telephone
2.2 A horized Agent:
Name (print) Mailing Address
Signature Telephone a Y
Section 3 - Construction Services
3.1 Licensed Construction Supervisor. AUG 15 200
Not Applicable ❑
DEPT.
Oy:
License Number
Address
Expiration Date
Signature Telephone
3.2 Registered Home Improvement Contractor:
Company Name
Not Applicable ❑
License Number
Address
Signature Telephone
Expiration Date
1 of 2 OVER
a
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 ❑ 1 No. of Bedrooms No. of Bathrooms
Existing Bldg. ❑ Repalr(s) ❑ Alterations ❑ I Addition ❑
AccessoryBldg. ❑ Type I
Demolition
Other Specify:
Brief Description of Proposed Work:
�af P
w oF
Costs
Section 6 - Estimated Construction
Item
Estimated Cost (Dollars) to be
completed by p mit applicant
Check Below
❑ Conservation -Commission Filing
(if applicable)
❑ Old Kings Highway & Historical
Commission approval
(if applicable)
1. Building
2. Electrical
3. Plumbing / Gas
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5)
7. Total Square Ft. (new houses & additions)
Section 7a - Owner Authorization -
Owner's Agent or Contractor Applies
To be Completed When
for Building Permit
I, , as owner of the subject property
hereby authorize to act on
my behalf, in all matters r a ' ork authorized by this building permit application.
Signature of o r Date
Section 7b - Owner/Authorizn/edAgent Declaration
r/Y (isy 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 wner/ Date
9.15-99
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: T" Lfsp 1-r�tY� Est- Cost
Address of Work
Owner Name: A0C40 Y1
Date of Permit Application:
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
Job under $1,000
Building not owner occupied
Owner pulling own permit
Other (specify)
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH
UNREGISTERED CONTRACTORS FOR APPLICABLE HOME
IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION
PROGRAM OR GUARANTY FUND UNDER MGL c. 142A.
Signed under penalties of perjury:
I hereby apply for a permit as the agent of the owner:
Date Contractor Name Registration No.
•A
... Notwithstanding the above notice, I hereby apply for a permit as the owner of the above
property:
.3d
Dat er N
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, AM 02111
www.massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information `� Please Print Legibly
Name (Business/Orpnization/individual): , 4, /V 0 % 1 o IV%
Address: D a � L 0
City/State/Zip: It h,. �` , v /yI c 01) 6 6 Phone #:
Are you an employer? Check the appropriate box:
I. ❑ I am a employer with 4. ❑ I am a general contractor and I
employees (full and/or part-time).'
2. ❑ I am a sole proprietor or partner-
ship and have no employees
working for me in any capacity.
[No workers' comp. insurance 5. ❑
required.]
3. I am a homeowner doing all work
myself. [No workers' comp.
insurance required.] t
have hued the sub -contractors
listed on the attached sheet. _
These sub -contractors have
workers' comp. insurance.
We are a corporation and its
officers have exercised their
right of exemption per MGL
c. 152, § 1(4), and we have no
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
adding addition
10`0 Electrical repairs or additions
I LEI Plumbing repairs or additions
12.❑ Roof repairs'
13.❑ Other
•Any applicant that checks box # 1 must also fill out the section below showing their workers' compensation policy infomatiou:
t Homeowner who submit this affidavit indicating they am doing all work and then hire outside contractors must submit a new affidavit indicating such
tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information
I am an employer that Is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
insurance Company Name:
Policy # or Sclf-ins. Lia
Expiration Date:
Job Site Address: City/StatelZip:
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certi nder the paigj�and penal ies of perjury that the information provided above Is true and correct:
Oricial use only. Do not write in this area, to be completed by city or town oJjieiaL
City or Town:
Permit/Ucense #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone M
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the Issuance or
renewal of a license or permit to operate a business or to construct buildings In the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the Insurance coverage required."
Additionally, MGL chapter 152, §25C() states "Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the
• members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does bave
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the pemtit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy, please call the Department at the number listed below. Self -insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant
Please be sure to fill in the permittlicense number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current
policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or
town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or pemrit to bum leaves etc.) said person is NOT required to complete this affidavit
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address, telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Fax # 617-727-7749
Revised 5-26-OS www.mass.gov/dia
ft
s'2of, 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: Iye
4or
II
Ldng ?oh QC
c�
S laCt�ov�i�
NAME
STREET AbDRESS
SECTION OF TOWN
"HOMEOWNER" _/VQ
c ktjY.
NAME
HOMEPHONE
WORK PHONE
PRESENT MAILING ADDRESS
1
a a g L t1 n, D ri ra
V,)C-
S 4c_C %%n.ILU-
Alr-
A;) G G
CITY OR TOWN STATE ZIP CODE
The current exemption for `Homeowner' was extended to include owner — occupied dwellings of one or two units
and to allow such homeowners to engage an individual for hire who does not possess a license, provided that such
homeowner shall act as supervisor. (State Building Code Section 108.3.5.1)
Definition of Homeowner:
Persons) 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
requirements.
HOMEOWNER"S SIGNATURE
APPROVAL OF BUILDING OFFIC
d'-
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 ycs, 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 theNass. General Laws and that my signature on this permit application waives this requirement.
Check one:
or Owner's Agent Owner ❑ Agent ❑
naomeownrii=cmp
TOWN OF YARMOUTH
1146ROUTE28 SOUTHYARMOUTH NIASSACHUSETFS02664-4451
Telephone (508) 398.2231, Ext. 261 — Fax (508) 398-2365
BUILDING DEPARTMENT
DEMOLITION DEBRIS DISPOSAL AFFIDAVIT
BUILDING
ELECTRICAL
GAS
PLUMBING
SIGNS
Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5,
I hereby certify that the debris resulting from the proposed work/demolition to be.
conducted at n�o�i I Lo>7., *For+ A 9TC�
"Work Address
is to be disposed of at the following location: Z c rn e n ci 'lJi s,Pot�
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
Sig re of Applicant
Permit No.
Date
�. TOWN OF YARMOUTH
Building Department
Town Hall
Yarmouth, MA 02664
(508) 398.2231 ext.261
BUILDING PERMIT
TRANSMITTAL
Temp Permit No.: T-07-029
Applicant Name: Joan Norton
Applicant Phone:
Building Location:
00228 LONG POND DR
(OFFICE USE ONLY
Recorded By:
Ic
Permit Fee:
$0.00
Deposit Rec:
$20.00
Payment Type:
Cash ChkNo.: 0
Net Owed:
($20.00)
Application Date: 7/19/2006
Issue Date:
Expiration Date
Comments: Map/Lot: 059.108
addition to expand kitchen, reroof, residing
Owner's Name: JOAN J NORTON ZONING APPROVED
Owner's Addres 00228 LONG POND DR
South Yarmouth MA 02664
Owner's Telephone: (508) 560-6959
REVIEWED BY:
1. WATER DEPARTMENT:
DATE:
N/A:
2. ENGINEERING DEPARTMENT:
DATE:
N/A:
3. CONSERVATION:
DATE:
N/A:
4. HEALTH DEPARTMENT:
DATE:
N/A:
5. BUILDING DEPARTMENT:
DATE:
N/A:
6. FIRE DEPARTMENT:
DATE:
N/A:
PLEASE NOTE
COMMENTS:
RECEIPT OF COPY:
SIGNATURE OF APPLICANT:
DATE:
Date Printed: 7/27/2006
TOWN OF YARMOUTH a IE@ IE o W m r�
HEALTH DEPARTMENT JUL 14 2006
PERMIT APPLICATION SIGN OFF TRANSMITT k1hISHM DEPT.
To be completed by Applicant.
Building Site
Proposed
No.:5-9_Lot No.:?
c
Gc-uc Sag 6b0 (0957 --$ILL.
Applicant: c1' -Aj0� ja h Tel. No.:
Oh
**lfyou would like e-mail notification ofsign off, please provide e-mail address:
Owner Name: Sc, Y»-2
Owner Address:
Date Filed: %' I q-o G
Owner Tel. No.:
RESIDENTIAL AND/OR COMMERCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities.
Please submit four (4) copies of plans, to include:
(1.) Site Plan showing existing buildings, water line location,
and septic system location;
(2.) Floor plan labeling ALL rooms within building
(all existing and proposed) —
Note. Floor plans not required for decks, sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
REVIEWED BY:( A I/ Vl�DATE: ? —I C,/ — O Cam ,
COMMENTS/CONDITIONS:
PLEASE NOTE
I,l ctA,c- 7t) AX •'tia, h J GS Ce VO ��"� S•
TOWN OF YARMOUTH
1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664
Tel (508) 398-2231 — Fax (508) 398-0836
Town of Yarmouth Conservation Commission
Building Permit Sign -off Application
Cons. Comm. Received Date: A'
Property Owner. �6 Y► / 1/ Q%A0Y►
Construction
Assessors Map and Parcel: MAPS_ PARCEL. Q?
General Contractor. &-n eV
Company Name and Address:
Company Telephone:
Project
Contractor Signature:
Plan Submitted: Tide
Date Revision Date
Conservation Commission Filing Required: YES NO_4
If Yes, Type of Filing:
Notice of Intent
Request For Determination Of Applicability
Conservation Commis ion Sign -off Signature: _
Date:
CONSERVATION
COMMISSION
Printed on Recycled Peper
TOWN OF YARMOUTH
WATER DEPARTMENT
99 Buck Island Road
West Yarmouth, MA 02673
Telephone: (508) 771-7921 • Fax: (508) 771-7998
BUILDING PERMIT APPLICATION
DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET
Bldg. Site Location: 23 y L.', s� a Q6 %ve Map #: S5 Lot #: /O
Proposed Improvement:
tom_ rl ZLc
Applicant: .)OGV. �/Uac IC) ---%.
Address: Se, W.,
Tel. #:
Date Fled:
RESIDENTIAL AND / OR COMMERCIAL BUILDING
Water Department:
Determines Compliance of Water Availability and or Existing Location.
Engineering Department:
Determines Compliance for Parking and Drainage
Conservation Commission
Determines Compliance to Wetlands Acts; i.e. If Lot(s) Border any Type of
Wetlands, Streams, Ponds, Rivers, Ocean, Bogs, Bays, Marshland, Etc...
Health Department
Determin ompliance to Stat and town Regulations' Le., Requirements for
Septa ge D ' sal and other Public Health Activities.
Fire Department: ^
Determin s mpliance to State and Town Requirements for Personal
/ )
Safety, P erty Protection; i.e. Smoke Detectors, Sprinkler Systems, Etc...
REVIEWF,O B WATER DIVISIO
signatur date
XelzIL1Wit&I
Signature Of Applicant
PLEASE NOTE:
Date:
MORTGAGE INSPECTION PLAN
BOSTON 03-03M
SURVEY, INC.
P.O, Bo: 290220 Chartmown, MA 02129
(617)242.1313 MAIN (617)242-1616 FAX
APPUCANT! NORTON
LOCATlOnk 2M LONG Panty DRIVE
CRY, STATE YARMOUTH, NA
1M m 61am mmd/ .
PREPARED '0344260
SCALE: I &xh - 40 dldf
GERT►RED Tnr Rec AKHTGAGE ca
The pmmamc mromurm ara appradnmey loved r
preod as Wow:. Tay "m ceshmm d M dr "(W
re0uirclo •a of dM local mom Wdleeem 4 oRos
de the of aaa.lrenloe, or on %esµ from cIWAdo
feleseat .edam undo M.G.L. Tdld VII, CMp W a(
Soca" 7, and drm Wrd ant u wrnocYmsaa or r
hepro-=e dart "I a prowV Una crrlm
shown mad Sawa aooeoa.
NOTE Two Y am a Mww" or ob iruwnd W%oy. Tit
a mum Yoomdrmme lord of mo oilman m
oor0 Yr lemldn,, pmprYq aatl oe=10 a
DPEE
LONG POND
LONG POND DRIVE
RECEIVED
By:
JUL 3 12006
GEORM
Amedimd to Fed" Emr,eaq Mammemcat Ncaa
C
COLLINS
Na417U
m&A Iha ")w MWo properly call In ma
arm d"Wmed a Zomr LpY_
CemmelWY hnd No: S C d OQ lge,
affogl.a Dolt. ¢[y 1 r- .
NOTE: Tmu C is rrm W aWmo kedaq laa dlyd:d. Ti
IS am Mood w ml amyna W Woma.
nd Iww mnp100Ow
Ml.
pecsdrddd{plaml
a
w YN m G Wpm Wdobla~W om Y dm w M
c
' riwi %o+
13 x25 I PROPOSED
660 GALLON
LEACHING PUMP CHAMBER 1500 GALLON
CONCRETE CHAMBER I SEPTIC T E C E I V E D
• � - BOUND FOUND
! \ N85%45'05"W 2't 11.0: 09
1$ o \ \�\ \�\ UPOLE UPOLE
DBOX
Icy
NN \ \ \ \ _ / 77' C' / // /1 N 1 0
1 G WIG \\ _ / /PROPOSED
' ! °_-W �\ \`------- -` P-1A / RESERVE �� 0'S'/Y 4 PVC
�O\H #1// INSTALL 4""ISeW 40 F NI 01
TO SIDE -fANK INLE3/ 1
12.00 W _ � CRAWL INV. /
::•I`\ __ O\ c'i- o \ -�--/! /� 1�� 14.63 I I 1 1 1
LOT
N/F I %e Y 228 / J
EDITH C. BUCKLEY ` i 1 00
/ �ov
z I #228 LONG POND DRIVE
cr ASSESSORS MAP 59 \' INV.
_ o
PARCEL 108 \ ~ - 14.80
..i 2 PARCEL
S.F. \ I 1 GAR.. FULL
SLAB . CELLAR 110
NCO ,
\ EL.10.33 i w
S85'45'05"E 50.00' i WALKOUT W I
10,
0
N/F I
JERRY W. MOS
#224 LONG PO RIVE
ASSESSORS MAP 59
PARCEL 109
x.
�1 I
CON,TRUCTIC OTES:
O
E� S85'45'05"E � 100't
100' TO EDGE
OF WATER
cot TORS / INSTALLERS SHALL VERIFY GRADES AND
ELAN NS AND SITE CONDITIONS PRIOR TO COMMENCING
W( THE SITE.
IN RMINATION HAS BEEN MADE AS TO COMPLIANCE
y DED OR ZONING REGULATIONS. OWNER / APPLICANT
THORITY
TAIN SUCH DETERMINATION FROM APPROPRIATE AU
R TRAFFIC, PARKING OF VEHICLES AND PLACING
LS OVER THE -SEPTIC TANK, DISTRIBUTION BOX AND
REA IS PROHIBITED.
NO HOURS PRIOR TO
VFY TO BE TIFIED AT LEAST 48
TOWN OF YARMOUTH BUILDING DEPAItTMZNT
PLAN RRVIEW a BUILDING Pmwr APPLICATION R vzw NOTLS
OF
ADDRESS:
Map / Lot:
Date of Initial Review: 71.�?,e
P
(Fa aMm me only)
Zoning Dmi* (ifwk*k):
CA1.c{✓` em,r CosT
" �10fo
,wy, 1sa,
vs-Awv,
70, -
Secdm 104.3.2, pra Ch*e, Flom or Mtaatim Omcdctiog, oonmab miW
The;rFr A I a Spcfal iiam the Za ft Baud of Amok
Other
Boildm Code DWW (if appk")
000SES
BC CALC(D 9.3 Design Report - US
Build 047
Triple 1-3/4" x 14" VERSA -LAND 2.0 3100 SP
Job Name:
Long Pond Drive
Address:
228 Long Pond Drive
City, State, Zip:
Yarmouth, MA
Customer.
Bob Fasano
Code reports:
ESR-1040
RECEIVtL
E
9 2006DING DEPT.
oy:
1 0/12 slope
- FI am1AB1'--
Thursday, -August 03 2006 11:48-
File Name:
0608017
Description:
Over kitchen
Specifier.
Paul Cummings
Designer.
Patrick Loughlin
Company:
National Lumber
Misc:
65 Maple Street, Mansfield MA 02048
12
18-04-00
B0. 3-1/2"
B1, 3-1/2-
LL 2200 Ibs
LL 2200 Ibs
DL 2939 Ibs
DL 2939 Ibs
SL 2750 Ibs
SL 2750 Ibs
Total Horizontal Product Length = 18-04-00
• Load Summary
Live Dead
Snow Wind Roof Live
Tag Description
Load Type
Ref. Start End 100%. 90%"
115%. 133%" 125%. Trib.
1 Standard Load
Unf. Area (psf)
Left 00-00-00 18-04-00 20 10
12-00-00
2 Roof
Unf. Area (psf)
Left 00-00-00 18-04-00 15
25 12-00-00
Controls Summary
Value
%Allowable
Duration
Load Case
Span Location
Pos. Moment
34375 ft-Ibs
68.6%
115%
2
1 - Internal
End Shear
6634 Ibs
41.3%
115%
2
1 -Left
Total Load Defl.
U261 (0.823")
92.1 %
2
1
Live Load Defl.
U415 (0.517")
86.7%
2
1
Max Defl.
0.823"
82.3%
2
1
Span / Depth
15.3
n/a
1
%.Allow
%.Allow
Bearing Supports
Dim. (L x W)
Value
Support
Member
Material
BO Post
3-1/2" x 5-1/4"
7889lbs
14.3%
57.2%
Versa-Lam1.7
B1 Post
3-1/2" x 5-1/4"
7889 Ibs
14.3%
57.2%
Versa -Lam 1.7
Cautions
Column at Bearing BO analyzed for bearing only, column analysis has not been performed.
Column at Bearing B1 analyzed for bearing only, column analysis has not been performed.
Notes
Design meets Code minimum (U240) Total load deflection criteria.
Design meets Code minimum (U360) Live load deflection criteria.
Design meets arbitrary (1") Maximum load deflection criteria.
User Notes
3 1/2" x 5 1/4" V-lam posts on each end, existing wall height to be verified for post length.
Connection Diagram
ad
e
V_
a minimum = 2" c = 5"
b minimum = 3" d = 12"
e minimum = 3"
Nailing schedule applies to both sides of the member.
Connectors are: 16d Sinker Nails
Page 1 of 1
The engineer's approval is for structural Engineer Lumber Products (ELP) only and is based solely on the
information provided National Lumber by the Customer. National Lumber is not responsible for checking the
validity of this information or to ascertain v!hal further factors may be taken into consideration. It is the
Customer's responsibility to satisfy themselves that the information and configuration shovai is correct and
satisfactory for the given structure and all parties involved.
A&=r� sc�+
E14GI14EERED WOOD DIVISION
65 Maple St, Mansfield, MA 02048
(508)339-8020
Disclosure
Completeness and accuracy of input must
be verified by anyone who would rely on
output as evidence of suitability for particular
application. Output here based on building
code -accepted design properties and
analysis methods. Installation of BOISE
engineered wood products must be in
accordance with current Installation Guide
and applicable building codes. To obtain
Installation Guide or ask questions, please
call (800)232-0788 before installation.
BC CALCa, BC FRAMERS), AJSTM,
ALLJOISTS , BC RIM BOARD-, BCIV ,
BOISE GLULAM-, SIMPLE FRAMING
SYSTEMS, VERSA -LA W, VERSA -RIM
PLUSS) , VERSA-RIMD,
VERSA-STRAND(D, VERSA -STUDS) are
trademarks of Boise Wood Products, L.L.C.
LSC-9201 1,lntserv3lworklWork2006\0608_Aug\0608017',PubiicSubmissions\ConstructionDocuments'ELP\0608017AB1 MA8-3-06.pdf
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Cade, (MEC), 527 CMR 12.00
(PLEASE PRINT IN INK OR
C �(OFICE USE ONLY)
g 2003 Fee: $
3UN 1 PERMIT NO.
ATT_ Wn as 9 —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 &
Owner or
Owner's
. � 9 Lai,' °/ /10 D- ti
No.
Is this permit in conjunction with a building permit? ❑ Yes � No (Check Appropriate Box) h #p��
Purpose of Building 50,�jLL Utility Authorization No.
Existing Service Amps ! Z / i }�dVolts OvenccadMk"� Undgrd ❑ No. of MetersNew Service Amps / Volts Overhead❑ Undgrd ❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed electrical Work: W /4 "C' -SG ���L z�'�P Y' A tpc M
of
No. of Receptacle Outlets
Pool
No. of Oil Burners
13 rn- t--� tvo. or emergency
rnd. LJ Battery Units
FIRE ALARMS
No. of Switches
No. of Gas Bumers
Initiatir
No. of Ranges
No. of Air Cond. Tons
No. of Alt
No. of Waste Disposers
eat mp
Totals:
um er
ons
—
— —
No. of Self
Detection/i
No. of Dishwashers
Space/Area Heating KW
Local
No. of Dryers
Heating Appliances KW
SecNo of 3
No. of Water
No. of No. of
Data Winn
Heaters KW
Signs Ballasts
No. of 1
,7
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommt
No. of 1
c)
or as
Devices
Devices
No. of Zones
0 Other
P:.
i u
r
01
41NSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may ides
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 th permit issuing office. �e
CHECK ONE: INSURANCE BOND❑ OTHERQ (Specify:) ( ar, �C 4"d CW
(Expiration Date)
wEstimated Value of Elec cal Work: (When required by municipal policy.)
,Work to Start: L — f D 3 Inspections to be requested in accordance with MEC Rule 10, and upon completion.
L>OI certify, under the sins and penalties of perjur that the information on this application is true and complete
FIRM NAME- �N /<<� LIC. NO, Y7
,QjLicensee:-5�,_.ZkC,44 G 5"icy* Signature LIC.NO. 4;� 7_rYC
(If applicable, enter "exempt" in he license number line.) Bus. Tel. No.: J/yi% —ye" U
P' G 6D %- • .5� +ry�✓� �� d 2<� S•% Alt. Tel. No.: FFF -7e7 f Address
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature
below, I hereby waive this requirement. I am the (check one) owner [] owner's agent. 0
Owner/Agent
Signature Telephone No.
[Rev. 04/00]
or TOWN OF YARMOUTH Building Department BUILDING
PERMIT NO _6-04-038 (508)398-9 _ � PERMIT
� • ISSUE DATE ;_ _ 7110ffl _ . ; PROPOSED USE
APPLICANT :Steven k;i . " ... ' ' ' ' JOB WEATHER CARD
ADDRESS ;364 Tildon Commons PERMIT TO AddWon
AT (LOCATION) ID0228LONG POND DR ZONING D IC R�0 Bldg. Type: Residential
SUBDIVISION MAP LOT BLOC 1059.ID8 BUILDING IS TO BE: CONST TYPE ® USE GROUP R-4
LOT SIZE
CONTRACTOR
REMARK 10 x 27 deck addition as per plans dated 06/06M. LICENSE 7
AREA (SO FT) EST COST ($ J$6.750.00 PERMIT FEE ($)
OWNER John Norton BUILDING DEPT BY
ADDRESS 1364 Tfldon Commons
Weymouth MA
INSPECTION RECORD FIELD COPY
Date Note Progress - Corrections and Remarks Inspector
®m
l�■IAM
A
ONE & TWO FAMILY ONLY - BUILDING PERMIT
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELUN(f
Town of Yarmouth Building Department
1146 Route 28 - Yarrnoulll, MA 026644492
Tel: (508) 39t3-2231 x261 • Fax: (508) 3919-2365 n _
Office.useOnly
Permit wi��'Date `f4
,,
Permit Fee' 6� ,;;
•
Deposit Rec'd $��1� Dat (`
r Gv
Net Due $ : L k,
PlanrungBoardlrkrmatfon
� 'elan Type
ft)dorsement Date
n Now
t ' '
Dther,
AssessorsDepartmentlntormaton fi
x. .+
Map r ` . Los M L
J
old s 4 nrew
4 Pr F
operty Dunenswns
l
L tArea(sfa,Lot Coverage '
>=this•Secfion,tar.Office;Use Onl
Building Pe- nit,Aurnbdr_. ti
Date'Issuetl. > , ,
Signature`` r
4 Ceiliflcate of Occupancy,
_ Y f�
: is" is rwE ✓ .'regiured
1Bu7dfng.Otticial _ Date.' U r'
Sectionl=-Site Information
Use Grou : R-4 Type: 5-13
1.1 Property Address: 1
�z��//��L Ono A r—
1.2 Zoning Information:
Zoning District Proposed Use
�i r n >� IN
1.3 Building Setbacks (ft)
Front Yard
Side Yards
Rear Yard
Required
Provided
Requi ed
Provided
Required
Provided
pr
r
o"t-O 2 D
to Water Supply (M.G.L. c. 40. S 54)
Public Private
1:5 FloodZonelnformabon ", Comments
Section 2'-,Property Ownership/Atithor¢ed:Agent
2.1 Owner f Record:
.__.. b I r
Name Mailing ddress
gnature Telephone
2 2 A craze Ag t:
FAX
Name (print) Mailing Address
`17y-83b^ Ca-3 3 7 L w c
Signatur6 Telephone
Section 3,=Construction Se _'
3.1 Licensed Constructs u i \ r: Q�
Not Applicable
1
License Number
AddressA III
Expiration Date
Signature phone
3.2 Registered Ho rovenient�.Contractc
Company Name
Not Applicable
Address
Signature Telephone
License Number
Expiration Date
s•15- s
X94
OVER
Secilon `4=VIIdFtC rs' �o nsat1onRnns_ `r 5ri
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 ..........
SMPOOf _ pF I r ofi l'. dsed W3t7i-C 1�eCli< :;. at>f 3'
New Construction ❑ No. of Bedrooms No. of Bathrooms
Existing Bldg. ❑ Repair(s) ❑ Alterations ❑ Addition ❑
Accessory Bldg. ❑ Type I Demolition Other Specify:
Brief Description of Proposed Work:
. 1 1 _ I
[,Building
eotlali 6 1=si rna�eo ons"tr'LFfiBFi C"ds�s
m Estimated Cost (Dollars) to be
completed by permit applicant
Yoo o "
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)
I
I Check Below I
(� Conservation -commission Filing
(if applicable)
❑ Old ICngs Highway & Historical
Commission approval
(if applicable)
7 a or.
, as owner of the subject property
hereby authorize QP. ten%, VM IA 11e /' to act on
my behalfryt all mars relive to work authorized by this building -permit application.
Yntn..,. 0 ai70�
Date
I, h tx h 0 r ' , as Ow r/Authorized Ag nt
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 n
. 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: V c J )-o (oei �o,6Est. Cost' —
Address of Work o�)
Owner Name: T C) AWN � �► � ��
Date of Permit Application:% d G3
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
_tj�t Owner pulling own permit
Other (specify)
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH
UNREGISTERED CONTRACTORS FOR APPLICABLE HOME
IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION
PROGRAM OR GUARANTY FUND UNDER MGL c. 142A.
Signed under penalties of perjury:
I hereby apply for a permit as the agent of the owner:
Date
ra '
Contractor Name
Registration No.
Notwithstanding the above notice, I hereby apply for a permit as the owner of the above
property:
-Ro /
Date V Owner Name
The Commonwealth of Massachusetts
Department of Industrial Accidents
office a/1" ffffi loss
600 Washington Street
Boston, Mass: 02111
Workers' Compensation Insurance Affidavit
LM 1 am a homeowner performing all work myself.
1 am a sole proprietor arod have no one working in any capacity
O lam an employer pro%iding workers' compensation for my employees working on this job.
epmnam• name• - - --
address'
city* phone N-
incurince co policy q
1 am a sole proprietor. General contractor. or homeowner (circle one) and have hired the contractors listed below who have
the following workers' compensation polices:
Failure to secure coverage as required under Section 25A o(MGL I52 no lead to the imposition of criminal penalties of a fine up to SIAN.00 sadtoe
one years' imprisonment as well as civil penalties to the form of a STOP WORK ORDER and a fine ofSIt10.00 a day against me. I eaderstaod that a
copy of lh6 its lemeat maybe forwarded to the Office of Investigations of the DIA for coverage verification.
I do -hereby certiffa nk the pains and)enalties of perjury that the information provided above is true and correct
Print name 6�%31,0 It IJ WariDy21 '
official use oniv do not write in this area to be completed by city or town olBeial
city or town: YARMOUT11
check if immediate response is required
contact person:
permitAicense p nBuildiog Departmeot
❑Licensing Board
261 OSelectmen's Office
(508) 398-2231 ezt _ 0h Department
phone M: _ 01hcOlher
Information and Instructions - '.
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
entplo%ees. As quoted from the "law• an employee is defined as every person in the service of another under any
contract of hire, express or implied. oral or written.
An enrplgyer is defined as an individual. partnership, association, corporation or other legal entity, or any two or more of
the fore-coing engaged in a joint enterprise. and including the legal representatives -of a deceased employer, or the
receiver or trustee of an individual . partnership. association or, other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance , construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer.
NIGL chapter 1 sectioni 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
who has not produced acceptable evidence of compliance with the insurance coverage required.
applicant
Additionall%. neither the commonwealth nor any of its political subdivisions shall enter into any contract for the
performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter ha%e
been presented to the contracting authority.
Applicants
Please fill 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 affdavits 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
On of Illoesti®atl®®s
600 Washington Street
Boston, Ma. 02111
fax ll: (617) 727-7749'
phone : 7)1274900—ext. 40", i09-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: "tik6-a3,)o03
I i1 .1
...., y �i A•rrfNAT. I n �.. 1 �Df�nil o[ o� Y] Ltln r, G L�YI C�, 11 / S , Lt�'MU V I �
NAME STREET ADDRESS Q SECTION OF TOWN
"HOMEOWNER"yaAfv A)oAON -1161 1Z 4$ g0t;E 61"7 1441 l5'.3�
NAME HOME PHONE WORK PHONE
PRESENT MAILING ADDRESS ---� tI I At r.2 �r� ^5 ,
r
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 supervisa_r_. (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 hermit. (Section 108.3.5.1)
The undersigned `homeowner' assumes responsibility for compliance with the State Building Code and other
applicable codes, by-laws, rules and regulations.
The undersigned `homeowner' certifies that he / she understands the Town of Yarmouth Building Department
minimum inspection procedures and requirements and that he / she will comply with said procedures and
requirements.
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING OFACIAL
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 C ter 142 of# Mass. General Laws and that my signature on this permit application waives this requirement.
(.f/L Check one:
Si tune of O er or Owner's Agent Owner ❑ Agent ❑
hhomeowarlic=MP
BUILDING
TOWN OF Y A R M O U T H El ECTIUCAL
1146 ROUTE 28 SOUTH YARMOUTH MASSACHUST17S 02664-4451 GAS
Telephone (508) 398-2231, Ext. 261 - Fax (508) 398-2365 PLUMBING
SIGNS
BUILDING DEPARTMENT
DEMOLITION DEBRIS DISPOSAL AFFIDAVIT
Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5,
I hereby certify that the debris resulting from the proposed work/demolition to be
conducted at Lin !n en►s 67�—
VJo;k Address
is to be disposed of at the following location: 1� t.e n o t X Prrw A- 4C-(4 nsrcr Gt.,,
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
V►�,� ti 2 3� 2�d�
Date
Permit No.
.r
buttor's
ame
of #
FOR LOT #
PLOT PLAN
Indicate location of garage or accessory building
Additions with dashed lines --------------------
Sewerage disposal (cesspool)
Well 0
I
I(lot................ft. rear)
this is a
orner lot,
-rite in name
E street.
SIDE YARD
_ sa FT_ r�
q
CY
REAR
vv YARD
' / Q.• c P od c�.uk
10xa)
SIDE VaRD
_FT0
SET BACK
�D
I
I
( lot.... ::))0 .. k.! ...... ft. frontage)
Da S C,onl P6AJ
(NAME OF STREET)
Information
Supplied by Sean
Abuttor'
Name
Lot #
If this
corner
write i
name of
a
other
bstreet.
+J
v
MARK NORTH POINT
TOWN OF YARMOUTH BUILDING DEPARTMENT
PLAN REVIEW & BUILDING PERMIT APPLICATION REVIEW NOTES
ADDRESS:�G�jtG
Map /Lot: ,j 040
Date of Initial Review: f�-,^d'6 3 Other.
Inspector:
NOTES:
Zoamg Denial (if applicable):
Approval Date:
Section 1043.2, para. Change, Extension or Alteration (pro -existing,
nonconforming)
The proles requites a Special Permit from the Zoning Board of Appeals.
Other
Building Code Denial (if applicable)
f
Rev.11-01
a r
TOWN OF YARMOUTH
Building Department (OFFICE USE ONLY
Town Hall Recorded By. Ic
Yarmouth. MA 02664
(508) 398-2231 ext261 Permit Fee: $0.00
Deposit Rec: $25.00
BUILDING PERMIT Payment Type: Cash ChkNo.: 675
.B Net Owed: ($25.00)
APPLICATION RECEIPT Application Date: 5/23/03
Issue Date:
Temp Permit No.: T-03-556 Expiration Date
Applicant Name: Steven Maher Comments:
Location: 00228 LONG POND DR 10 x 27 deck addition
Owner's Name: Jahn Norton
Owner's Addres 364 Tildon Commons 7`p 1114G APPROVED
Weymouth MA
Owner's Telephone: (781)848-4055
This Is NOT a building permit. Application subject to plan review. Contact Building Department for permit status. Official
Building Permit will be issued upon plan review completion, approval, and complete payment of Net Owed on Permit Fee.
I
\ Date Printed: 6/5/03
Building Site Location:
Proposed Improvement:
Address:
TOWN OF YARMOUTH
BUILDING DEPARTMENT
BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF
4 TRANSMITTAL SHEET
9
Map No: LotNo: /Z%�7
��
3 /03
I?vj 836 -G lcai3it%
The Building Department will be responsible for silting the ape t y dispatching your plans and or application to the following
applicable departments.
RESIDENTIAL AND/OR COMMERCIAL BUILDING
WATER DEPARTMENT:
Determines Compliance of Water Availability and or existing location.
ENGINEERING DEPARTMENT:
Determines Compliance for Parking and Drainage.
CONSERVATION COMMISSION:
Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of
Wetlands, Streams, Ponds, Rivers, Occans, Bogs, Bays, Marshland, Etc
HEALTH DEPARTMENT:
Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities.
FIRE DEPARTMENT:
Determines Compliance to State and Town Requirements for Personal
.........................................................................................................................................
Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc.
REVIEWED BY:
1. WATER DEPARTMENT:
DATE: N/A
2. ENGINEERING DEPARTMENT:
DATE: N/A:
3. CONSERVATION:
DATE: N/A:
4. HEALTH DEPARTMENT:
DATE: N/A:
iDUFMIAL AND/OR COMMERCIAL PERMITS
S. WIRING INSPECTOR:
DATE: N/A:
6. PLUMBING INSPECTOR:
DATE: N/A:
7. FIRE DEPARTMENT:
DATE: N/A:
PLEASE NOTE
COMMENTS:
RECEIPT OF COPY:
SIGNATURE OF APPLICANT:
DATE:
weft copy - Buadlmg DcPL - Pict Hwy - WSW DepL - Ydmw copy - H=M ncR - Pik Copy - Engin g DepL - Goldmmd - Fuc DWUCw=v bw
W.•r. • • r w - ." '+✓�, , y ...,.��i..v,�y1:...jl rar • .�v•.....
OF�Y'3�
Building Site Location:,
Proposed Improvement:
Applicant:
Address:
TOWN OF YARMOUTH
BUILDING DEPARTMENT
BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF
TRANSMITTAL SHEET
of o� K 44Map No: ._Lot No:
3
t7�a F36 —G �3t� The Building Department will be responsible or sis mg the app ican y dispatching your plans and or application to the following
applicable departments.
RESIDENTIAL AND/OR COMMERCIAL BUILDING
WATER DEPARTMENT:
Determines Compliance of Water Availability and or existing location.
ENGINEERING DEPARTMENT:
Determines Compliance for Parking and Drainage.
CONSERVATION COMMISSION:
Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of
Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc
HEALTH DEPARTMENT:
Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities.
FIRE DEPARTMENT:
Determines Compliance to State and Town Requirements for Personal
Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc.
......................................................................................................................................................
REVIEWED BY:
1. WATER DEPARTMENT: DATE: N/A:
2. ENGINEERING DEPARTMENT: DATE: N/A:
3. CONSERVATION:
4. HEALTH DEPARTMENT.
S. WIRING INSPECTOR: W DATE:
6. PLUMBING INSPECTOR: DATE:
N/A:
"!gj�'N/A:
9. FIRE DEPARTMENT: DATE: N/A:
COMMENTS:
PLEASE NOTE
V-K ti ,-, 4 r dve/
RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE:
Wbitccopy -BuddmgDcpL- Piokcopy-WatwDepL - YeaowCopy -HnbbDWL - hACoPy-EngWocrigDepL - Goldenrod-FireDepNConsawim
Y
it
i
T • - TER r
oPS g PROPOSED PROPOSED
gggESSORS',' PROPOSED I 660 GALLON 1500 GALLON
r = PARCEL 13'x25' pump CHAMBER SEPTIC TANK
LEACHING
CHAMBER
I
'
11.O/
ND
N85',45'057W : 2 t
/
UPOLE
DBOX
77'
Nj
" ®/
4 PVC
RROPOSED/
elONO
/
RESERVE
/
/
/
`
P -1 A
40MW
W -\ 1 + .`.`
r-
_ _ _,_ "
` DTH #1 /
/ /INSTALL
pF
r(ANK INLET
ID
ko
- g
I I I I EXISTING CESSSANDFILLI
BE
I I .,"PUMPED.
�
AND CRUSHED" AND'--*,,
i ABANDONED IN
cv)cu ACCORDANCE WITH
• • o I TITLE V.
I, I FERNCO CONNECTION
TO BE INSTALLED ANI
CLEANOU7 S1►dEEP
\ 1 INSTALLED TO FINISH
w
Jim�i CRAWL 14.63.
LLj/ENTRY
— /
.a: w N/F- Y
�. " CKLE _ -
I co EDITH C. BU \— — _ v-
`�. #228 LONG :POND,DRIVE —
X.. .' , ,:ASSESSORS ,MAP 59 ".
{;• \ 1 — SLAB
PARCEL 108 i \
coV.3 522f S.F. / i
#228
INV.
14.80
FULL
CELLAR
EL.10.33
'7'TT
_. S85'45'05"E 50.00• / 1 100000..
s�34 S85045'05"E
N/F l 100' TO EDGE
JERRY W. MOSSEY OF WATER
#224 LONG POND DRIVE
ASSESSORS MAP.59
PARCEL 109
/ GRADE WITH
40 TO END TANK IN!
1 1, EXISTING 4
� (45 7- 1 PIPE TO 4 70AIN
0.0
11 % 1 S IN.
- RE
�i� i�J. -
/el
i
WALKOUT
100't
•
P O N D
N'
Q
WATER
,y ELEV 8.5
2/27/03
Building Site Location:
Proposed Improvement:
Address:
TOWN OF YARMOUTH
BUILDING DEPARTMENT
BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF
19 TRANSMITTAL SHEET
No: _Lot No: A) F
��
Te1.No.: S Date Filed: s� 3
The Building Department will be responsible or sisting the appliczFhAy dispatching your plans and or application to the following
applicable departments.
RESIDENTIAL AND/OR COMMERCIAL BUILDING
WATER DEPARTMENT:
Determines Compliance of Water Availability and or existing location.
ENGINEERING DEPARTMENT:
Determines Compliance for Parking and Drainage.
CONSERVATION COMMISSION:
Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of
Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc
HEALTH DEPARTMENT:
Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities. '
FIRE DEPARTMENT:
Determines Compliance to State and Town Requirements for Personal
Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Eta
REVIEWED BY:
1.
WATER DEPARTMENT:
DATE:
N/A:
2.
ENGINEERING DEPARTME
DATE:
N/A:
3.
CONSERVATION:
�� DATE: 6 ~�
N/A:
4.
HEALTH DEPARTMENT
DATE:
N/A:
INDUSTRIAL AND/OR COMMERCIAL PERMITS
S.
WIRING INSPECTOR:
DATE:
N/A:
6.
PLUMBING INSPECTOR:
DATE:
N/A:
7.
FIRE DEPARTMENT-
DATE:
N/A:
COMMENTS:
RECEIPT OF COPY:
PLEASE NOTE
SIGNATURE OF APPLICANT:
DATE:
White copy - Baildmg DcpL - Pmk copy - Water Dept - YdWw Copy - H®hL Dept - Prot copy - En&ocring DcpL rGo - Fire DcpdCmvvr =2!*, ....•
N..CI • .. r' \v J• J ,f/ •_ .....,... .`. -. r`r •, i. • ... /. .♦ � • •M�. lM-. /''•/••'V •F•�.�I J• i �,./'��'•Lf•\Y s•r
Q4•�'ttl� TOWN O`F YARMOUTH. 60 �� •
{ �o BUILDING DEPARTMENT
Building Site Location:
Proposed Improvement:
BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF
TRANSMITTAL SHEET
/D
No: _Lot No �U d
Andress 3
1 �,:... (rJ L Te1TIo.: 7 Date Filed: S 3
Is? 36-� 3c�
The Building Department will be responsible for ting the app icantrby dispatching your plans and or application to the following
applicable departments.
RESIDENTIALAND/OR COMMERCIAL BUILDING
WATER DEPARTMENT:
Determines Compliance of Water Availability and or existing location
ENGINEERING DEPARTMENT:
Determines Compliance for Parking and Drainage.
CONSERVATION COMIVIISSION:
Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of
Wetlands, Streams, Ponds, Rivers,,Oceans, Bogs, Bays, Marshland, Etc
HEALTH DEPARTMENT:
Determines Compliance to State and Town Regulations; i.e., Requirements
'
For Septage Disposal and other Public Health Activities.
FIRE DEPARTMENT:
Determines Compliance to State and Town Requirements for Personal
....................................................
Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc.
- -•-----------..--.....-..-----...•......-............._ ..........-.........
REVIEWED BY:
1. WATER DEPAR
DATE % O N/A:
2. ENGINEERING DEPARTMENT:
DATE: N/A:
3. CONSERVATION:
DATE: N/A:
4. HEALTH DEPARTMENT
DATE: N/A:
INDUSTRIAL AND/OR COMMERCIAL PERMITS
S. WIRING INSPECTOR
DATE: N/A:
6. PLUMBING INSPECTOR
DATE: N/A:
7. FIRE DEPARTMENT:
DATE: N/A:
PLEASE NOTE
COMMENTS:
RECEIPT OF COPY:
SIGNATURE OF APPLICANT: DATE:
Whftcopy-BuddmgDept - Pmkaw-WderDcpt - 'YdlowCopy -HaMDWL - Pink Copy -Engmea*Dcpt - Goldcwod- Fire DcpUCon9nvWw
1
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ame
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:
:
PLOT PLAN
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Indicate location of garage or accessory building
Additions with dashed lines --------------------
Sewerage disposal (cesspool)
Well ig
I
I(].ot................ft. rear)
SIDE YARD
fi _ FT_ t�
REAR
VV YARD
4
•SET BACK.
ab0�
fj dtL4
(lot..........ft. frontage)
SIDE _RD
FT�
/ (NAME OF STREET)
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s� TER
PROPOSED
9 PROPOSED
' 3
xe ICI.
gS Pia , PROPOSED I 660 GALLON 150D:GALL0N .1 I
13'x25- PUMP CHAMBER SEPTIC TANK ,
LEACHING I
r *r ''V'CHAMF3ER BE SSPOOt•_
` r qtt or s, , / /� ( I I I EXITING : L SAND,
'+ ,i Si e.w 1 • }"PUMPED• »
2if . 11.0� pNt� CRUSHED
.;„�.:f�"a3 ^ ' .t ' ABANDONED IN
UPOLE .,.
I ACCORDANCE
DBOX ! TITLE V.
/ 77i ®/ FM
CONNECTIC
A *,
,,PROPOSED/ C) ' 4"PVC I ( I I 1 Tp BE INSTALLED.:,
10
x� r + : �...� 0- \ \ LEANOUT SWEEP',.
3t„�,��� - �.�Mf. / RESERVE i — — —/ F N 1 C FIN'
�. `� 1. ry z _ :.\ \ �r sl
INRSTALI.ED TO
yo-'. ;; I, �0 V-1r br. C,� 5 r , ° � / INSTALL i T l G ADE WITH
`YyF{w� ' r-:w.E "1°� ,�.=,rs ,�3'o r„ ��DTH �V1/ 0 ��pNK INLET INV.. \' TO END TANK
.r}5=} i r Y1 -•e7t 11 hit .. \ / T� / /w AWL 1' II �, 4Di /
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,,>,9 ,:,•, r((y-, =P;((), . r.rt.r,..-:.. p NG``�OND.DRIVE' GAR' /
1 Q.., L - � \ � .. �---.—,�•' SLAB.--' •.;
ASSESSORS..M08 i 0.33, WALKOUT o`
EI. I O N.
PARCEL i i i \ N, 1
23.522f S.F.
S85'45'05"E 50.00' i I y/ / / WATER
524�38s, 100'f 2/27/03
4� 1w.
• S85'45'05"E - _
N/F l 100' TO EDGE
JERRY Ww MOSSEY' OF WATER
#224 LONG POND DRIVE
ASSESSORS MAP 59
PARCEL.109
a
t*
P
TOWN OF YARMOUTH
G �8
l�
Coe 9.1 NI
/ C (OFFICE USE ONLY)
Fee: $
PERMIT NO.
Building p�ONr� �N� Owner's
AT. Location o�0�0 ��ll��i Name
�sBryTh+ Yw�v�uyrlf-
New ❑
Plans Submitted
Renovation 12-
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SUB-BSMT.
BASEMENT
I
1ST FLOOR
2ND FLOOR
3RD FLOOR
(PRINT OR TYPE)
Installing Company Name A f2 914AIC6
Address Mh/ff ��M�
Vdi yoww9Gu7}t , Olyf 6 i73
Check One:
orp. a3��
❑ Partnership
❑ Firm/Company
Business Telephone �0—s— -)75'— 2J60 Name of Licensed Plumber
INSURANCE COVERAGE: I have a current liability Insurance policy or its substantial equivalent. Check One: Yes 6—No ❑
If you have checked YES, please indicate the type of coverage by checking the appropriate box.
A liability insurance policy 2chOther 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 ❑
�SOAu3PO& Licensed
lumber
Z!S
License Number
Type: MasterW�Journeyman 0
SlipGen- Portal Hone
Town of Yarmouth
Template [Building Dept]
Slipsheet Identifier [sg26226]
Document Category Building Permits
Map -Block Number 059.108
Street Number
0228
Street Name
LONG POND DR
Department
Building
Parcel ID
8274
Backfile Batch Scan
No
Document?
Additional Naming Info
Index Operator
Operator, Yarmscan
Date - Time
2015-05-27 - 10:28
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