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P TYPE OR PRINT CLEARLY CITY I Yi,41'MJPVMA DATE /0 •� • PERMIT .y-OP-16-od,2/9 JOBSITE ADDRESS 3Z OWNER'S NAMEn OWNERADDRESS -f3 / TEL 9L FAX OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL ❑ NEW: ❑ RENOVATION: ❑ REPLACEMENT: [� RESIDENTIALLY PLANS SUBMITTED: YES ❑ rlxluru:b t FLOOR-+ I SSM 1 .2 1 3 1 4 5 6 1 7 a 9 10 11 12 13 14 O ATUT1,0 DRINKING FOUNTAIN FOOD DISPOSER FLOOR / AREA DRAIN INTERCEPTOR INTEF iCITCHE SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET URINAL 1 hlavii a torten[ atiiB �nsurance policy or Its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW } LIABILITY INSURANCE POLICY Q OTHER TYPE OF INDEMNITY [] BOND ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Lif,: 0 ❑ A( SIGNATURE OF OWNER OR AGENT CHECK 1 hereby eerUly that aG of the detaUs and infomuUon I have sub mltted or enteredngarding Ws appkA are true an to to beet my and that as plumb4p work and Installatlons performed under the permll Issued for Wa opplIcatlon wtU In complIance aU Ps t praMon Massachusetts State Plumbing Code and Chapter 142 of the General Lawn. PLUMBER'S NAME STEPHEN A WINSLOW LICENSE # 12298 SIGNATURE MPS Jp❑ CORPORATIONED 3281 PARTNERSHIP❑#=LLC❑#[= COMPANY NAME E.F.WINSLOW PLUMBING d HEATING C ADDRESS 8 REARDON CIRCLE CITY FSOLITHYARMOUTH STATE ®ZIP 02664 TEL 508 394.7778 FAX 508 394 8256 CELL �� EMAIL ACCOUNTSPAYABLE EFWINSLOW.COM The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigadons I Congress Street, Suite 100 Boston, MA 02114-2017 wwmmass gov/dla Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly Name (Business/Organization/Individual): E.F. WINSLOW PLUMBING 8t HEATING CO.,INC. Address: 8 REARDON CIRCLE OVV I" i/ "IVIVu I F1, IYU1 VLVVY rnone B:Juu-vo- //u Are you an employer? Check the appropriate box: 1. 9 I am a employer with 66 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 required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insuranee,t 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] r V 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.❑ Other 'My applicant that checks box # I must also till out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are 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 tame of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that Is providing workers' compensation Insurance for my employees. Below is the policy and Job site Information. Insurance Company Name: ARROW MUTUAL INSURANCE COMPANY Policy # or Self -ins. Lic. #:1764A Expiration Date: 01/01/2015 , Job Site Address: City/State/Zip: 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 certify uneuha ppins and p aldes of perjury that the information provided above is true and correct 1 / / / . . 2014 Phone #• 508-394-777 Ojrcial use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone #: I IN MAS ACHUSETT/S/ UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY 4(i4%Y7Dl/�i%7� MA DATE & Zj-J/Z �PERMT#L eQ6,�/�r-W IR ��._ JOBSITE ADDRESS �� ����� Q �M--{ OWNER'S NAME G _ - __ s. OWNER ADDRESS ' TEL' � TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL I EDUCATIONAL _J RESIDENTIAL CLEARLY NEW: _.J RENOVATION: -J REPLACEMENT: J PLANS SUBMITTED: YES I NO _ APPLIANCES 7 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 14 I BOILER J - -IS- BOOSTER J J — J _ _ _J - i CONVERSION BURNER — J _) _ I t COOK STOVE-) DIRECT VENT HEATER DRYER it 11, - . I ]l 1 FIREPLACE 1 ,. _ ) _.l _.. 1.... _ .1 J . _J J ...__ _i 1 J _ J FRYOLATOR _ 1 _ . -A FURNACE GENERATOR _ II ILJ GRILLE INFRARED HEATER j LABORATORY COCKS j J - MAKEUP AIR UNIT J _ __ _) __ .J _- t _ I OVEN - POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER J_. _JJ_-_-) I l J._ J _.J_ __J_ ---.' UN _ _ 1 _ _ ' _ . _.J t . _J . _ 1. _ _l _ _. . ! .. WA ER H ER• LZ i 1. OfirER OCT 2 3 2014 1_ 1 J t .' _1 _ .__I .. _ -- ..-J -1 _ __.__l I dUILl7�r7G'L7 "' iTflENi" "' _ t+r . - . _.1 _. _,_1 . INSURANCE COVERAGE --_1 fh ha cwrenHiab t sitf ncapo policy or its substantial equivalent which meets the requirements of MGL. Ch. YES �!} NO , IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY -. ; OTHER TYPE INDEMNITY BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK O Y: OWNER AGENT/ , SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details. and Information I have submitted or entered regarding this applicalil9n are true and at t to the b sl of my kn ge and that all plumbing work and Installations performed under the permit Issued for this application will be n compliance with rtine provision of Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME STEPHEN A WINSLOW LICENSE # 12298I SIGNATURE MP �, MGF -_i JP JGF _ LPGI __., CORPORATION ;# 3281 i PARTNERSHIP -J# ; LLC 1# COMPANY NAME: E.F.WINSLOW PLUMBING & HEATING C0j� ADDRESS 8 REARDON CIRCLE CITY SOUTH YARMOUTH STATE MA . ZIP 02664 TEL 508-394-7778 FAX 508-394-8256 ;CELL ., , _ !EMAIL ACCOUNTSPAYABLE@EFWINSLOW.COM on t-?ef�� r,. The Commonwealth of Massachusetts Department of IndustrialAccidents NEW Ogee of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 www mass:gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lealbiy Name (Business/thganiration4ndividual): E.F. WINSLOW PLUMBING & HEATING CO.,INC. Address: 8 REARDON CIRCLE Jvu i n rrucmvv i n, mt% ve-vu4 Yttone #' uv0-Jv'f-r / 10 Are you an employer? Check the appropriate box: 1. 9 I am a employer with 66 4. ❑ I am a general contractor and I emolovees (full and/or hart -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. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.: 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling S. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions I I.❑ 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 information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional shed showing the name of the sub -contractors and state whether or not those entities have employees. if the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that Is providing workers' compensation insurance for my employees. Below Is tire polity and job site information. Insurance Company Name: ARROW MUTUAL INSURANCE COMPANY Policy # or Self -ins. Lic. #:1764A Expiration Date: 01/01/2015 ,Job Site Address: City/State0p: 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 certify underllrtppins and" alties ofperjury that the information provided above is true and correct 1 / / / . . _ 2014 Phone #• 508-394-777 Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permlt/License #, Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone #: , 4Y (9 Commonwealth of Massachusetts BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. BLDE-15-002053 Occupancy and Fee Checked Rev.1/07 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINTININK OR TYPE ALL INFORAMTION) Date:10/22/2014 City or Town of. YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice Of Ls or her intention perform We OR i - work described below. Location (Street & Number) 32 LAKELAND AVE Owner or Tenant RICHARDSON, GEORGE L Telephone No. Owner's Address RICHARDSON, NANCY, 32 LAKELAND AVE, SOUTH YARMOUTH, MA 02664 Is this permit to conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead ❑ Undgrd ❑ No. ofllleters New Service Amps Volts Overhead Cl Undgrd ❑ No. ofAleters Number or Feeders and Ampacity Location and Nature of Proposed Electrical Work: INSTALL CO DETECTOR Completion ofthe following table may be waived by the Insnectar of Wires No. of Recessed Luminaires No. of CeiL-Susp.(Paddle) Fans No. of Total TransformersKV No. of Luminsire Outlets No. of flat Tubs Generators KVA No. of Luminaires Swimming Pool Abovc ❑ In- ❑ rnd. rnd. No. of Emergency Lighting Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARNIS No. of Zones No. of Switches No. of Gas Burners No. of Detection and 1 Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers HeatPump Totals: Number Tons KW No.ofSelf-Contained Detection/Alertine Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other. Conn ion No. of Dryers Heating Appliances KW Security SXstems:• No. of Devicei orF. uival nt No. of Water Key Heaters No. of No. of Si ns allasts Data Wiring: No. or Devices or Eaulvalent No. Ilydromassage Bathtubs No. of Motors Total IIP Telecommunications 1Vlring: No. of Devices nr E uival nt OTHER: Estimated Value of Electrical Work: Work to start: Attach aadttional aelail l/ aesireQ or as required by the Inspector of Wires. (When required by municipal policy.) Inspection 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. CIIECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under thepains and penaltles of perjury, that the Information on dais application is true and complete. FIRM NA11IE: E F WINSLOW PLUMBING HEATING CO INC Licensee: RICH M MELVIN Signature LIC. NO.: 21829 (Ifapplicabk, enter exempt" in the license number line.) Bus. TeL No.: Address: 8 REARDON CIRCLE, SOUTH YARMOUTH MA 02664 Alt. TeL No.: 'Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: OWNER'S INSURANCE WAIVER: I am aware that the License does not have the liability insurance coverage normally required by law. But signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signatures (� Telephone No. PERMIT FEE. S50.00 l/ V✓ of t L l i5-1 (L. (t:�r, C.omawnwaX o1;7VallacAw.Ib 2epaphmni o`Jin Swvkm lug BOARD OF FIRE PREVENTION REGULATIONS (tJo 'I V Official Use Only Permit No. Occupancy and Fee Checked [Rev.1/07] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC). 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPEALL INFORMATION) Date: 1p • 7/ ' /�z Cityor Town of: Y4✓tea l /Tif To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the ele trical work described below. Location (Street & N96er) �Z �/(,�r�j��� �/� � ,1 Owner or Tenant trf-' iC11l14d-. 1-7 Telephone No-5W14Vg 94 Owner's Address Is this permit In conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building :Zr S Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Ov rhead ❑ Undgrd ❑ No. f Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: �flit� lj(/ lj a J No. of Recessed Luminaires No. of Cell.-Susp. (Paddle) Fans o. 01 lotal Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ n- ❑ Md.rnd. o. o rn Emergency rg g Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No of Zones No. of Switches No. of Gas Burners o. o etect on an Initiating Devices No. of Ranges No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers eat ump Totals: um er I ons KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ un Connection ticip❑ Other No. of Dryers Heating Appliances KW SecuritySystems:* No. of Devices or Equivalent o. of Water KW o. o o. o Ballasts Data Wiring:HeatersSigns No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP lefecommunications r ng: Na of Devices or E uivalent OTHER: naacn aaauwnai aesau p aestre4 or as required by the inspector of ivires. 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 cove office.ge is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [,}BOND ❑ OTHER ❑ (Specify:) I cealfy, under the pains and penatdes of perjury, that the Information on this application Is true and complete FIRM NAME:E. . to Jr++ %A en n LIC.NO.: a81t` Licensee: Aicham HP l t/i n Signature 0 LIC. NO.. f 8 ' C1 A (Yapplicable��,,enineer �"exemppt"in the license number line.) Bus. Tel. No.: SDf7 -.194-777$ Address: 11F4rdrifl ('tetlo ,Zn4 % Yo�h.00ihf i'i�i Oa66N AIL 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: 1 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. PERMIT FEE: $ The Commonwealth of Massachusetts -r Department of IndustrialAccidents Office of investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 www mas&gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly Name (Business/Organization/Individual): E.F. WINSLOW PLUMBING & HEATING CO.,INC. Address: 8 REARDON CIRCLE avu t n r r+rcmvu t n, mtr v40o4 Phone M buts-Ju4-t t fts Are you an employer? Check the appropriate box: 1. 9 I am a employer with 66 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 required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.t 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. (No workers' comp, insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box #1 must also till out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they am doing all work and then hire outside contractors must submit anew affidavit indicating such. 1Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. lam an employer that it providing workers' compensation Insurance for my employees. Below Is the policy and fob site Information. Insurance Company Name: ARROW MUTUAL INSURANCE COMPANY Policy # or Self -ins. Lic. M 1764A Expiration Date: 01/01/2015 Job Site Address: City/State/Zip: 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 certify unrrlhs ppins and p allies ofperjury that the Information provided above Is true and correct n 1 / / / % _ 2014 Phone #: 508-394-777 Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone #: TOWN OF YARMOUTH I-= DEC 0 7 2004 �I keg! APPLICATION FOR PERMIT TO DO PLUMBING By Fee: $ PERMIT (OFFICE USE ONLY) Date Building N . I Owner's —LC 1LzAZPSo� AT. Location � �`�� ptj Name r M ✓ Type of Occupancy k4eQ ,V� New ❑ Renovation Replacement ❑ Plans Submitted Yes ❑ No ❑ Is6 z = Zn Y > NQW J Cn Q Z yavi Q z w w: o x N O z zyF 0 Q W c IL z Q a Q 03 U. I w w x O Q= O w 3 a 3 rwrr 0 o}: z= 3 M In a o �- J a Y w U. U. w Q H> 1- m O N TL n g Q 0 °x z OJ JO Q R¢= un r a O 0 Q x H 3 x g u=i o o 3 i N u< o¢ 3 x m 0 SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR (PRINT OR TYPE) Check One: Installing Company Name 1�4J�/^ ❑ Corp. Address L/ /L u'r pl-' ❑ Partnership LL1'/v�.J (❑ Firm/Company Business Telephone � Y / 72 ,3fL412 Q Name of Licensed Plumber INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent. Check One: Yes ❑ No ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. A liability insurance policy &L/ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance voerage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature ofOwnerorOwner's/lgent 1 hereby certify that all of the details and Information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Check on Owner ❑ Agent ❑ Signatur2�,yp Licensed Prmber license Number Type: Masteltl7-o'� Journeyman 0 G TOWN OF Building AT. Location ZJr� New ❑ Plans Submitted kRMO 17 Qom/ JAN 1 1 2005 r' APPLICATION FOR PERMIT TO DO GASFITTING (OFFICE USE ONLY) By .cC_ Fee: $ S PERMIT NO. OS ' S! Date IZI / 2005 %i G_ Owner's y fCC U� Name ��7� /►�,�`"r / Type of Occupancy Renovation (Y Replacement ❑ Yes El No❑ U) ul Y W rp J N W 2 cc ►¢- == N ' W Lu W o 0m e Z nCn ECr I a m Lu w W 0° a O LU W Q Z H N> W W W rn W Z Q= cc 2 W M W W F- x Z Q W J Q~Q ¢ H Q } N m Z O FZ W J fy.. W W Q x W> cc W M Z 3 0= Q g 0 0 W¢ 0 O F- x 0 a x e_ D c c� U cc > a l- O SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR (PRINT OR TYPE) Installing Company Name Address 16 Business Telephone 1 Name of Licensed Plumber or Gasfitter °``` Check One: ❑ Corp. ❑ Partnership ❑ Firm/Company INSURANCE COVERAGE: Check One have a current liability insurance policy or its substantial equivalent. Yes ❑ No ❑ If you have checked yes, please indicate thq 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 taws, and that my signature on this permit application waives this requirement. Check One: Owner ❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and Information I have submitted (or entered) In above application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under Permit Issued for this application will be In compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Signature of Licer Plumber or Gasfitter /l6 ,,'�.S`- License Number TYPE LICENSE: []Plumber ❑ Gasfitter C4Marster 0 Journeyman ei APPLICATION FOR PERMIT TO DO GASFITTIM TOWN_ OF_YAR OUTH (OFFICE USE ONLY) C Av 3� I ey 3.� 41 i Fee: $_ DEC 0 i 2004 ' _ i PERMIT h Building;_!: AT: Location- C C', C- tia New ❑ Renovation a- Replacement ❑ Plans Submitted Yes ❑ No ❑ Date Owner's Name Type of Occupancy N Y W y W cc O UO V Z 0 r!1 D I� W m (_ z Cn M F (� Q O w w o a o w F' Q✓ 1/ I I u) W W N y W c7 z W Q Q W xCn cc o: z W Q 2 W o F- W > f., w x D: z Q W J~ Q t F } Cn O m z U. O W O Cn y= w= 'o 3 oo: c 0 x u. 0 a 0 > a� o SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR (PRINT OR TYPE) Installing Company Name Address A-n r G'�� �►n`� Business Telephone Name of Licensed Plumber or Gasfitter INSURANCE COVERAGE: Check One: ❑ Corp. ❑ Partnership ❑ Firm/Company Check One I have a current liability insurance policy or its substantial equivalent. Yes ❑ No ❑ If you have checked yes, please indicate the type of coverage by checking the appropriate box. A liability insurance policy 0� Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 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 One: Owner ❑ Agent ❑ Signatur" Licensed Plumber or Gasfitter License Number TYPE LICENSE: []Plumber ❑ Gasfitter &MasTer ❑ Journeyman FI1_F COR NOTES: 1.) THIS PLAN IS VALID ONLY IF IT IS STAMPED AND SIGNED IN RED. THIS OFFICE ASSUMES NO RESPONSIBILITY FOR INFORMATION CONTAINED ON COPIES WHICH DO NOT HAVE ORIGINAL STAMPS AND SIGNATURES IN RED. C.B. A FND. 9Gr�� It PAR. 46 C.B. FND. OLD ASSESSORS MAP 52 PARCEL S1-E1 BUILT PLOT PLAN R. J O'Hearn, P.L. S., R. S. �OCATo 32 L4Kff=4ND AVENUE 35 Route f34, Swan River Plaza, Unit 2 Yf1RfLl0UTH, A4. South Dennis, Ma, OR660 ASSESSORS AfAP 60 PARCEL 56 1 CERTIFY TO GEORGE L. RICHARDSON, et. ux. •••AAA JOB NO.: 213O4R AND TO THE TOWN OF YARMOUTH BUILDING INSPECTOR ►P��N Or IVASS �x THAT TO THE BEST OF MY INFORMATION, KNOWLEDGE ��. DATE' FEB. 74, 2004 -• AND BELIEF, THE STRUCTURE SHOWN ON THIS PLAN o� RICHARD CLIENT: SEAMAN HAS BEEN LOCATED ON THE GROUND AS IND/CA7ED AND THAT IT IS LOCATED IN FLOOD ZONE C PER 4 o O'HEARN SCALE. FLOOD INSURANCE RATE MAP DATEQ—JVINE 17, 1986 NO.27871 1 IN = JO FT DR. Br. R. O'H. ATf REC. SURVEYOR SHEET 1 OF 1 TOWN OF YARMOUTH Building Department BUILDING ______.. - (508) 398-2231 ext.261 POR PER�AIT NO B-04751. _PERMIT ISSUE DATE _ _ 12/19/03_ _ ; PROPOSED USE ; APPLICANT James Seamann'•----------------- JOB WEATHER CARD ADDRESS ;00032 LAKELAND AVE ------- ------_- ----' PERMIT TO Addition ' AT (LOCATION) 00032LAKELAND AVE ZONING DISTRIC R 40 Bldg. Type: Residential SUBDIVISION MAP LOT BLOC 1060.56 UI 1N I TO BE: CONST TYPE 5-� USE GROUP R 4 LOT SIZE O construct new two car garage, master bedroom, bathroom, amily room, sunroom & screened REMARK porch as per plan as per plan dated 11/25103. AREA (SO FT) rktj EST COST ($ $218,500.00 PERMIT FEE ($) $536.00 OWNER JGEORGEF L RICHARDSON BUILDING DEPT BY ADDRESS 100032 LAKELAND AVE South Yarmouth I MA 102664 '50I 394 W.$3 INSPECTION RECORD CONTRACTOR LICENSE 016008 Seaman, James 771 POB 424 West Yarmouth MA 02673 6087786034 FIELD COPY Date Note Progress - Corrections and Remarks Inspector ;Z/ Q4 IFOUttD, 6 1< 1 3 6-S low.-,tZ� c / 9;2 A <A4- 2-17—ov TOWN O BUILDING DEPARTMENT UTH NOTICE TO THE BUILDING DEPARTMENT OF WITHDRAWAL OF LICENSED CONSTRUCTION SUPERVISOR FROM PROJECT 1e James D. Seaman f CONSTRUCTION SUPERVISOR LICENSE # Ql 6008 1 HEREBY CERTIFY THAT 1 AM NO LONGER THE CONSTRUCTION SUPERVISOR LISTED ON THE APPLICATION FOR THE PROJECT UNDER CONSTRUCTION AS AUTHORIZED BY BUILDING PERMIT # B-04-751 e ISSUED TO George L. RichardsonON 12-19-n-A ALSO CERTIFY THAT ON 1-12-05 1 1 NOTIFIED THE PERMIT HOLDER, THAT THE PROJECT UNDER CONSTRUCTION MUST CEASE UNTIL A SUCCESSOR LICENSED CONSTRUCTION SUPERVISOR, IS SUBMITTED ON THE RECORDS OF THE BUILDING DEPARTMENT CONSTRUCTION SITE 32 Lakeland Ave_ MAP rcr 2ARCEL_s6 LICENSED HOLDER DATE: 1 -1 2-05 ONE & TWO FAMILY ONLY - BUILDING PERMIT APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWYFAMILY DWELLIN Town of larniouth Building Departinent 1146 Route 28 • Yartnouth, MA02664-4492 Tel: (508) 393-2231 x261 • Fax: (508) 393-23135 . Office Use Only Planning Board Infamabon Assessorsbepartmepl iatot7yl n < "Type rip fr«`= Permit No'f1sSJDate. o a or Permd Fee s,53br� 9 zz EndorsementDaie �i�� Deposit Rec'd `y"' Date tt Recordmq [)ate 14 PropertyDunensioSlS a Y , t Ian Na Net Due ¢F . < Yr3 d7Q� L7F i r Other - Lot rea u r.�fronta tt ` ' �. isi . 9e;1) LotCaverage , Section Yor.Office Use On > ` ^ -` s .7. Buildin :P.e u Issuetl;`: ' .Date x , :.- of Occu anc Signatur -ertlttcate ' rk rs Buildin Ola g. L Date _ t - !s not required Section 1°='Site lnlormation_ Use Group: R-4 Type: 5-B 1.1 Property Address: 12 Zonin Information: 32 ob v- ��v 1 1-a A -2 !-aO-i boo Zoning District Proposed Use 1.3 Building Setbacks (it) Front Yard Side Yards Rear Yard Required T Provided Required Provided Required Provided 1A Water Supp (M.G.L. e. 40. S 54) 1 5 Flood Zonelnformabon Comrnents �' Public Private =_ Zone.; G BFE. - - Section 2 '- Property Ownership/Authorized Agent 2.1 Own of Record: �- ( IA12�Scx� 32 t-aK�CarsD �1vc . Name p t) Mailing Address �• yAl2(L400174 tilA oZ bl04- STelephone ignaure — S 3 2.2�A�horized Agent: J A H r F I) Q a ,c 24 N r t) Mailing Add 1Z c r-hl d4A aZ 673 Signature Telephon"O,�Fr7 Section 3 - Construction Services' III3.1Llce�ed Const jction.-J*ervisor•. �t � \N9tAPPlicable i DEC 1 2 03 1,q „o OLicense /Numbet, t-ad ub Expiration Date bignorure Telephone 3.2 Registered Home rnprovement,-Contractor: Compa-np ame Not Applicable ❑ ^/N Ji-/c3 c�1ti/�.cJ A reds ` ' / Licend ? / b750 u'a S0� ��� �� 3 S� Expiration Date Sig ature Telephone JC , zo-atA 9 - 15 - 99 1 of 2 nvFa 11 Workers Compensation Insurance affidavit must be completed and submitted with this application. to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes .... ... • No .......... New Construction I No. of Bedrooms No. of Bathrooms Existing Bldg. ❑ Repair(s) ❑ I Alterations Addition Accessory Bldg. ❑ Type I Demolition Description of Proposed Work: Other Specify: I Check Below I ❑ Conservation -Commission Filing (if applicable) ❑ Old Kings Highway & Historical Commission approval (if applicable) r , as owner of the subject property hereby authorize ��+-� �' ����� to act on my beh , in all matters r ative to rk authorized by this building.permit application. S� � //-12-03 signature of 0,kner Date as>MM/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 ti 0 TOWN OF YARMOUTH Ear BUILDING DEPARTMENT CONSTRUCTIONSUPERVISOR FORM PLEASE PRINT: Job'Location: 2-aK�t./itil h Avr �. YA1Lr..t�l Number Str Villa e g Owner of Property: Construction Supervisor:% )A"IFR' 0' 5*. ' . a,y OI fc�� SC�b� %Ifs (o034 Name License No. Phone No. Address: '0 r 15cr-t_ WZI - W. V,4(w .,cxrN M A 67Z (673 Licensed Designee: (if other than Supervisor) Name License No. 2.15 Responsibility of each license holder. 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The license holder.`shalI 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:otlter applicable laivs of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Any licensee who shall willfully violate subsections 2.15.1, 2.15.2 or 2.15.3 or any other section of these rules and regulations and any procedures,'as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature. and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that Stich licensee is no longer supervising said persons, the work shall immediately cease until a successor license bolder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. . I have read and understandmy responsibilities under the rules and regulations for licensing construction supervisors in accordanoz witli section 109,..1.1-of the state building code. I understand the construction inspection procedures and'the specific inspection as called for by the building official INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes `, No ❑ If you have checked ygu, please indicate the type coverage by checking the appropriate box. A liability insurance policy Q Other type of indemnity ❑ Bond ❑ OWNER'S INSURA E WAI ER: I am aware that the licensee does not have the insurance coverage required by Prnature 52 of the s. G era] Laws, and that my signature on this permit application waives this requirement. Check one: Owner's Agent Owner ❑ Agent Signature: Building Official Approval; • *For Office Use Only • Permit No. Date TOWN OF YARIVIOUTH 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 pm -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 ti-o Ahnhm t� Cs� Est. Cost Address of Work �✓ Z f:�K b Ave�. YA LM o urf% Owner Name: 6;>ed12GE �— ?G}�,421�5(OAJ Date of Permit Application: I I ' 12- -O �5 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 UND MG c. 142A. Signed under penalties of perjury: giiiswi I hereby apply for a permit as the agent of the owner: //-/"Z -03 Jkr;. e5 SUM,6.J Date Contractor Name 12155o Registration No. Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name The Commonwealth of Massachusetts Department of Industrial accidents $ lcoollff"s OSVINs 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit . 0��A-1,QA-1 O�2 4 . C%. Au. AlugocrrIJ , k IA OZ G73 nhone NS06 77k 1003 j� ' I am a homeowner performing all work myself. . 0 1 am a sole proprietor and have no one working in any capacity NJ ' am an employer s-p-ro%iding workers' compensation for my employees working on this job. - comnam•name: address: �1/D // N nn 7,�j , city: Lei• ,V4&,L40 n, A// 0 2 673 ✓ phone #: _0S 76� 05 7� insurance co. LC151W _1N-5L-)fMA-Jft' W noliev # W C 5093 03_G I am a sole proprietor. general contractor. or homeowner (circle one) and have hired the contractors listed below %%ho have the following workers' compensation polices: Failure to secure coverage as required under Section 25A of MGL 152 can lead to the Imposition of criminal penalties of a One up to SI.500.00 ammr out years' Imprisonment as well as civil penalties io the form of a STOP WORK ORDER and a flee of SI00.00 a day against me. I maderstaod that a copy of this statement may be forwarded to the Orrice of investigations of the DIA for coverage verificatioa. I do hereby cerdfy�nder the paint aft penaltiefof perjury that the information provided above is true and coned signature ��r+� o au �/—��2 `p 3 Print name `"' HC3 �e �`J,C /J3it/ phone 0 50 779- 60.37� official use only do not write in this area to be completed by city or Iowa official city or town: YARMOUTII ❑ check if immediate response is required contact person: permitAicense N nBuilding Department ❑Licensing Board 261 ❑Selectmen's Office ❑Hesltb Department phone p; _ i508j 398�2231 ext. n0thcr r 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 e►rrph{rer is defined as an individual. partnership, association. corporation or other legal entity, or any hvo or more of the foregoing enca�;ed in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual . partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein. or the occupant of the dwelling house of another who employs persons to do maintenance , construction or repair work on such dwelling house or on the _rounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. NIGL chapter 1 section alx's states that ever}• state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the commonwealth nor anyof 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 ma% 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 lowus Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made: The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions; please do not hesitate to give us a call. e Department's address, telephone The Commonwealth Of Massachusetts Department of Industrial Accidents alfice of 13vesagstl®©s 600 Washington Street Boston, Ma. 02111 fax M: (617) 727-7749 p r(617)-7274900—ext. 406; 4O"r375 TOWN OF YARMOUTH 1146ROUTE28 SOUTHYARMOUTH MASSACHUSETTS026644451 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 pro osed work/demolition to be conducted at 32 LA-��"Jb AVO y• 7A4Ct-10L3rH Work Address is to be disposed of at the following location: /µpz�b(,N WA,35�Z 7wa o.,j Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. 7 Signature of Applicant Date Permit No. G IC TOWN OF YARMOUTH Building Department Town Hall Yarmouth, MA 02664 (508) 398.2231 GXL261 BUILDING PERMIT APPLICATION RECEIPT Temp Permit No.: T-04-258 Applicant Name: James Seaman Location: 00032 LAKELAND AVE Owner's Name: GEORGE L RICHARDSON Owner's Addres 00032 LAKELAND AVE South Yarmou MA 02664 Owner's Telephone: (508) 398-9653 (OFFICE USE ONLY Recorded By. Ic Permit Fee: $0.00 Deposit Rec: $25.00 Payment Type: Check ChkNo.: 976 Net Owed: ($25.00) Application Date: 11/12/03 Issue Date: Expiration Date Comments: / /) / -6 L. construct new two car garage, master bedroom, barhroom, family room, sunroom & screened porch ZOtditJG AI'nOVED //- / S7 — 0 3 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. Date Printed: 11/17/03 v .. .... +•.. . •' `.. A. •.•w,.. •4,• ... , . .,.-•r•i,Mi,.,,r.,(i•ryGy�yy.G�IY'I�yIY.N`•rw-.YY�•r..•- TOWN OF YARMOUTH o BUILDING DEPARTMENT O H BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET / Building Site Location: Map No: /�Lot No: sb Proposed Improvement: j�� ii/�( �� ,1 Address: 0 b-OA 1/,R y W L/ Te1.No.: %7Z'4Q3 L./ Date Filed: The Building Department will be responsible for assisting the applicant by dispatching your plans and or application to the following applicable departments. RESIDENTIAL AND/OR COMMERCIAL BUILDING WATER DEPARTMENT: Determines Compliance of Water Availability and or existing location. ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage. CONSERVATION COMMISSION: Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. FIRE DEPARTMENT: Determines Compliance to State and Town Requirements for Personal Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc. ---•--------------------------------•---.....-...............---------..-.-............------•------..-..................-.-....---•----------------- REVIEWED BY: /1. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: ✓3. CONSERVATION: %/,,,����/�%%% DATE: N/A HEALTH DEPARTMENT: J� l t s16 C.f, ffl_dk� DATE: I2' "o3N/A: INDUSTRIAL AND/OR COMMERCIAL PERMITS 5 S. WIRING INSPECTOR: DATE: N/A: 6. PLUMBING INSPECTOR: DATE: N/A: 7. FIRE DEPARTMENT: DATE: N/A PLEASE NOTE COMMENTS: .S DATE: Az—/q_O3 White copy - BuWmg Dcpt - Pmk aVy - Water Dept. - Yellow Copy - Haft Dept - Pmk Copy - E"Biccsi"g Dept. - Goldenrod - Fit Dq*Cmecvatim S � \ TOWN OF YARi�'10Urs BUILDING DEPARTMENT PLAN RE' WW & BUILDING PERMTT APPLICATION RUVII?E W NOTES . ADDRESS: 3 Z O��aaG• Ma iLot: Date of Initial Review:-./-o7JF"a 3 .4 Inspector NOTES: dwV, / .AAw , QTti � a T PA a .0 no,aw"X-`• yod •' \v. �, \II Sa on 104.32, pares Change, Extension or Alteration (pre-existia; noneonformi lg) Cb& Denial (if applicable) Dr 11-Al Building Site Location: •' .� TOWN OF YARMOUTH BUILDING DEPARTMENT BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF i TRANSMITTAL SHEET No: —j6-6—Lot No: ----.�— Address: U PDX t/.2 � Tei.No.:'7%F4Q3� Date The Building Department will be responsible for assisting the applicant by dispatching your plans and or application to the following applicable departments. RESIDENTIAL AND/OR COMMERCIAL BUILDING WATER DEPARTMENT: Determines Compliance of Water Availability and or existing location. ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage. CONSERVATION COMMISSION: Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. FIRE DEPARTMENT: Determines Compliance to State and Town Requirements for Personal Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc. ............................................................. ........................................................................................ REVIEWED BY: 41. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A (3. CONSERVATION: -- — - DATE _ N/A ii .... HEALTH DEPARTMENT: DAT /. HE: N/A S. WIRING INSPECTOR: DATE: N/A: 6. PLUMBING INSPECTOR DATE: N/A: 7. FIRE DEPARTMENT: DATE: N/A: COMMENTS: RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: White GM - DUddms Dept - Pmk apy - Warr Dept - Ydkm Copy - BeU Dept - PiA COPY - EP&=r4 D� GoMeowd- iro D Building Site Location: Proposed Improvement: TOWN % E Q F YARMOUTH , ..G F_7 1.1' 17� i �� BUILDING DEPARTMENT BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET------------ I1''wJ:ilea; rUept. 1! (_(_y .S la Map No: l 6 Lot No: 56 Applicant v i i + n —� / Address: %�G PGX -/,2 Te1No.:-77S11G3y Date Filed: The Building Department will be responsible for assisting the applicant by dispatching your plans and or application to the following applicable departments. 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 Taws Requirements for Personal Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc. -------------------------------------------------------------------- ----------------------------------------------------------------------------• REVIEWED BY: n �A. WATER DEPARTMENT /A 2. ENGINEERING DEPARTMENT: DATE: N/A: &/3. CONSERVATION: DATE: A 1� 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: WhdccM-BwWmgDepL - Pick copy-wawDept - Yd>oweoff-HadthDW, - PiAUPr- BDwL - Gd&rnd-FueDcpUComevrtim t ✓ne icaminom vea" o�✓�Ca�lacliuJai�1 BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number. CS 016008 Birthdate: 11/01/1946 Expires: 11/012005 Tr. no: 7725.0 Restricted: 00 JAMES D SEAMAN PO BOX 424 8 � W YARMOUTH, MA 02673 Administrator �'/�e >°com�xanwealy a�,��iauar/twelLi Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 121550 Expiration: =0104 Type: Individual JAMES D. SEAMAN JAMES SEAMAN 497. MAIN ST. W: YARMOUTH,. YA 02473 License or registration valid for individul use only before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston, h1a. 02108 Not valid wilhoutAgughtae COMMONWEALTH OF MASSACHUSETTS � n vl �'f i•i. [n a 9: ul � �.4.+. [Q: I.1 � a [9 dF6'i11T� IN REAL ESTATE LICENSED REAL ESTATE BROKER ISSUES THIS LICENSE TO JAMES D SEAMAN PO BOX 424 W YARMOUTH MA 02673-0424 ENO. EXPIRATION DATE SERIAL NO. �'�• ��� CERTIFICATE OF LIABILITY INSURANCE DATE IM,,UODryYI I PROCUC2R 4 /19 / 0 0 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFOR,IAATION Chagnon Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 411 Rte. 28, P.O. lox 355 HOLLER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR -west Ya=cuth, MA 02573 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, COMPANIES AFFORDING COVER6 GE :NSUA'c..A-., �'-r'art=crd InsLrance ; Janes D. Sea. -Lan PO Box 424 West Ya=cuth, MA 02573 I n%Mn Anr•n CCM.:PAtIY B Le-:cr. Insurance Ccw: a ny I CcI,IPANY i C CcMPAIrv. D i rilS IS TO CERTIFf THAT THE POUC ES OF INSURANCE UST EO BE_OW HAVE BEEN ISSUED TO THE INSUP•E7 NAMED ABOVE FCR THE FCUCY PEi1CD' INCICATED. NO iVN7HSTANDING ANY REf.UIREMEN7, TERLIOR CCNCI ION CF ANY CCNTPACT CR OTHER CCCUME4T WITH RESPECT 70'hHICH THIS CERTIFICATE MAY BE ISSUED OR &I•,Y PERTAIN, THE INSURANCE AFFCRCEO BY THE PCUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CCNCITIONS OF SUCH PCUCJES. UMITS SHCVlN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE - RI --� - -- POLICY NUMBER _ ; UENERALUABILITY A I (�CGMAIERC:AL GENERAL LIABILITY A ' I � CLAIMS MACE FX J OCCUR CWNER'S d CCNTRACTCR'S PROT i i AUTCMCSILE LIABILITY i I ANY AUTO 1 ALL OWNEO AUTCS i ( SCHEDULED AUTCS i HIRED AUTCS _I NCN-0VVNE0 AUTCS i ( I I GARAGE LIABILITY I I ANY AUTO EXCESS LIABILITY UMBRELLA FCRM 101 HER THAN UMBRELLA F( WORKERS COMPENSATION AND EMPLOYERS* LIABILITY 3 ,HEPROPRIETCRI F PARTNERS/EXECUTPa CFFICERS ARE. 08 SBA R?1155 POLICY EFFEC:P/E POLICY EXPIRATION DATE(MMICOM(( DATE(MWOO" _ - LIMITS I GENERALAGGRE;:.,,- I s 2, 000, 000 ! 1/13/00 i 1/13/04 I PRCOUCTS•CCMP:CPAGG J S 2,000 000 PERSONAL IACv IMUCRY Is 1, 000, 000 ' IEACHCCCURRENCE IS 1,000,000 I FIRE C,4.MAGE'Ary:r,:v,l .3 200,000 !Ar.... :Arirl JS 1000 CCMB:NED S44GLE LWIT S , BCCILYINIURY r,F,tr Fen:nJ i S . ECCILY:N:URY . J I I l ! I PRCPE.RTY DAMAGE i ! I S i H AUTO ONLY. EA ACCtE.NT I S I OTHER THAN AUTO ONLY: I • i EACH AC--ZE.NT ; S AGGRE';ATE I S I EACH CC-URR=NC° I S AGGREGAic �S IS I INCL I WC50930355 I IELEACHAc-MENT IS 1/17/00' 1/17/04 ELDISEASE •FDUCYLI MIT 13 ExcL EL DISEASE • Ei EMPLOYEE 13 CESCRIP71CN OF CPERATICNS,LOCATION VVE:fIC'._ESSPEC:ALITE4 ' general carpentry operaticns-interior exterior ca--me.try residential & cc=ercial CERTIFICATE HOLOER� • : - _ Y-. Nr V 100,000 500,000 100,000 LNCELLATION SHOULD ANY OF THE ABOVE CESCRIBEO POLICES BE CANCELLED BEFORE THE EXPIRATICN DATE THEREOF, THE ISSUING COMPANY WALL ENDEAVCR TO MAIL SO DAYS WRITTEN NOTICE TO THE CERTIFICATE MOLDER NAMED TO,THE LEFT,' BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY CF UPp*':THE ;COMITY ITS NtS OR REPRESENTATNES. r M.C.H.C.- SD. �Gluk� l.5 MANIFOLD SALESMAN AV,�chxuscr Business NAME ADDRESS TEL. JOB LOCATION z LgKe MwZ� A-v6 B E U jt—\TN CA ►+RAC= �3eo-'44 J47 IC �57-oRd-64e 30 1. (. !o OL Inc-,* we a RIDC.,, 13c �%- Lola-� 3D L L- Zo p c_ PITct4 =6;►Z 13E tt Kt. `'G " r� l o�L 3cvu� AT Lp pa.A l" I� l" 3OLL- ZoDL- f me,1�= 8►tom I ¢� •�4 z 4J LL- 14 u 3o = 42a DL= 14k 10 = 140 _ D. coat f- Lt- = 13 x So = 3cTa Za = ZGa + w ft-�L LL = d x 3o . I Sc) �...�.. 3 t� DEC 11 2003': GARAGE BEAM A T.W6=TM)6.08 WsIN�00210�3962 3 PCs of 1 3/4" x 18" 1.9E Microllam® LVL •Useivl Pagel E;li� 641 THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN CONTROLS FOR THE APPLICATION AND LOADS LISTED or �a 2C Product Diagram Is Conceptual. LOADS: Analysis is for a Drop Beam Member. Tributary Load Width:14' Primary Load Group - Residential - Sleeping Areas (psf): 30.0 Live at 100 % duration,10.0 Dead Vertical Loads: Type Class Live Dead Location Application Comment Uniforrn(plf) Floor(1.00) 420.0 140.0 0 To 24' Replaces SUPPORTS: Input Bearing Vertical Reactions (Ibs) Detail Other Width Length Live/Dead/Uplift/Total 1 Stud wall 3.50" 3.50" 5040 / 1993 / 0 / 7033 Lt: Blocking 1 Ply 1 1/4" x 18" 1.3E TimberStrandO LSL 2 Stud wall 3.50" 3.50" 5040 / 1993 / 0 / 7033 Lt: Blocking 1 Ply 1 1/4" x 18" 1.3E TimberStrandO LSL -See TJ SPECIFIER'S / BUILDERS GUIDE for detail(s): Lt: Blocking DESIGN CONTROLS: Maximum Design Control Control Location Shear (Ibs) 6936 -5983 17955 Passed (33%) RL end Span 1 under Floor loading Moment (Ft-Lbs) 41035 41035 58130 Passed (71%) MID Span 1 under Floor loading Live Load Defl (in) 0.649 0.789 Passed (U437) MID Span 1 under Floor loading Total Load Defl (in) 0.906 1.183 Passed (U313) MID Span 1 under Floor loading -Deflection Criteria: STANDARD(LL:U360,TL:L/240). -Bracing(Lu): All compression edges (top and bottom) must be braced at 2' 8" o/c unless detailed otherwise. Proper attachment and positioning of lateral bracing is required to achieve member stability. ADDITIONAL NOTES: -IMPORTANTI The analysis presented is output from software developed by Trus Joist (TJ). TJ warrants the sizing of its products by this software will be accomplished in accordance with TJ product design criteria and code accepted design values. The specific product application, input design loads, and stated dimensions have been provided by the software user. This output has not been reviewed by a TJ Associate. -Not all products are readily available. Check with your supplier or TJ technical representative for product availability. -THIS ANALYSIS FOR TRUS JOIST PRODUCTS ONLYI PRODUCT SUBSTITUTION VOIDS THIS ANALYSIS. -Allowable Stress Design methodology was used for Building Code NER analyzing the TJ Distribution product listed above. -Note: See TJ SPECIFIER'S / BUILDER'S GUIDES for multiple ply connection. PROJECT INFORMATION: M/M RICHARDSON 32 LAKELAND AVE SO. YARMOUTH MA Copyright O 2003 by True Joist, a Weyerhaeuser Business Microllame is a registered trademark of True Joist. OPERATOR INFORMATION: Bill Rubel Mid -Cape Home Centers PO Box 1418 465 RTE 134 South Dennis, MA 02660 Phone: 508-398-6071 Fax :508-398-4559 brubelr@midcape.net RIDGE BEAM B Arlarisa B„tim, AT MASTER SUITE/FAMILY ROOM T-3-6eam(TM) 6.06 Serial Number. 7002103362 ,Use' 1 12//112QD37:58.59AM 2 PCs of 1 3/4" x 14" 1.9E Microllam® LVL Pape 1 Engine Veraiort 1.6.4A THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN CONTROLS FOR THE APPLICATION AND LOADS LISTED Member Slope: OM2 Roof Slope8M2 Overall Dimension: 33' 8's 8 15' 6" ► 18' 2" All dimensions are horizontal. Product Diagram Is Conceptual. LOADS: Analysis is for a Header (Flush Beam) Member. Tributary Load Width: 13' Primary Load Group - Roof (psf): 30.0 Live at 125 % duration, 20.0 Dead Vertical Loads: Type Class Live Dead Location Application Comment Unifonn(plf) Roof(1.25) 390.0 260.0 0 To 33' 8" Replaces SUPPORTS: Input Bearing Vertical Reactions (Ibs) Detail Other Width Length Live/Dead/Uplift/Total 1 Stud wall 3.50" 3.50" 2433 / 1511 / 0 / 3944 Lt: Blocking 1 Ply 1 3/4" x 14" 1.9E Microllam® LVL 2 Stud wall 3.50" 6.66" 8167 / 5728 / 0 / 13895 R7 None 3 Stud wall 3.50" 3.50" 2955 / 1970 / 0 / 4924 Lt: Blocking 1 Ply 1 3/4" x 14" 1.9E Microllam® LVL -See TJ SPECIFIER'S / BUILDERS GUIDE for detail(s): Lt: BloGdng,R7 -Bearing length requirement exceeds input at support(s) 2. Supplemental hardware is required to satisfy bearing requirements. DESIGN CONTROLS: Maximum Design Control Control Location Shear (Ibs) 7276 6405 11638 Passed (55%) LL end Span 2 under Roof loading Moment (Ft-Lbs) -23482 -23482 30323 Passed (77%) Bearing 2 under Roof loading Live Load Defl (in) 0.379 0.900 Passed (U570) MID Span 2 under Roof ALTERNATE span loading Total Load Defl (in) 0.602 1.200 Passed (L/359) MID Span 2 under Roof ALTERNATE span loading -Deflection Criteria: STANDARD(LL•U240,TL:U180). -Bracing(Lu): All compression edges (top and bottom) must be braced at 2' 8" o/c unless detailed otherwise. Proper attachment and positioning of lateral bracing is required to achieve member stability. -The load conditions considered in this design analysis include alternate member pattern loading. -Design assumes adequate continuous lateral support of the compression edge. PROJECT INFORMATION: M/M RICHARDSON 321AKELAND AVE SO. YARMOUTH MA Copyright o 2003 by True Joist, a Weyerhaeuser Business Hicrollas4 is a registered trademark of True Joist. OPERATOR INFORMATION: Bill Rubel Mid -Cape Home Centers PO Box 1418 465 RTE 134 South Dennis, MA 02660 Phone: 508-398-6071 Fax :508-3984559 brubel@midcape.net RIDGE AT MASTER SUITEIFAMILY ROOM TJ-Be=(n 8.06 SuW Nirnbar.7Wi1033U ,UW..1 12t4112aD37:56:59Ah1 2 PCs of 1 3/4" x 14" 1.9E Microllam® LVL Page 2 Engine Version 1.6.44 THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN CONTROLS FOR THE APPLICATION AND LOADS LISTED ADDITIONAL NOTES: -IMPORTANTI The analysis presented is output from software developed by Trus Joist (TJ). TJ warrants the sizing of its products by this software will be accomplished in accordance with TJ product design criteria and code accepted design values. The specific product application, input design loads, and stated dimensions have been provided by the software user. This output has not been reviewed by a TJ Associate. -Not all products are readily available. Check with your supplier or TJ technical representative for product availability. -THIS ANALYSIS FOR TRUS JOIST PRODUCTS ONLYI PRODUCT SUBSTITUTION VOIDS THIS ANALYSIS. -Allowable Stress Design methodology was used for Building Code NER analyzing the TJ Distribution product listed above. -Note: See TJ SPECIFIERS/ BUILDER'S GUIDES for multiple ply connection. PROJECT INFORMATION: M/M RICHARDSON 32 LAKELAND AVE SO. YARMOUTH MA Copyright m 2003 by true Joists a Weyerhaeuser Business Microllam, is a registered trademark of Trus Joint. OPERATOR INFORMATION: Bill Rubel Mid -Cape Home Centers PO Box 1418 465 RTE 134 South Dennis, MA 02660 Phone: 508-398-6071 Fax :508-398-4559 brubel@midcape.net 4r RIDGE BEAM C Ar1x,,aBusna. ATFRONTDORMER 73-Seam(TM) 6.05 Serial Number. 7002103362 ,Users 12/1112pp36.03:27AM 1314 x 91/2" 1.9E Microllam® LVL Pape 1 UVine version 1.6.44 THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN CONTROLS FOR THE APPLICATION AND LOADS LISTED Member Slope: 6112 Roof Slope8/12 1� , 2❑ � 10' All dimensions are horizontaL Product Diagram Is Conceptual. LOADS: Analysis is for a Header (Flush Beam) Member. Tributary Load Width: 6' Primary Load Group - Roof (psf): 30.0 Live at 125 % duration, 20.0 Dead Vertical Loads: Type Class Live Dead Location Application Comment Unifonn(plf) Roof(1.25) 180.0 120.0 0 To 10' Replaces SUPPORTS: Input Bearing Vertical Reactions Width Length (Ibs) Live/Dead/UplitUTotal 1 Glulam or solid 3.50" Hanger 9111631 / 0 / 1542 sawn lumber beam 2 Stud wall 3.50" 3.50" 889161510 / 1504 Ply Depth Nailing Detail Depth 1 9.50" N/A H6: Face Mount Hanger N/A N/A N/A L1: Blocking -See TJ SPECIFIER'S / BUILDERS GUIDE for detail(s): H6: Face Mount Hanger,L1: Blocking Other None 1 Ply 1 314" x 91/2" 1.9E MicrollamO LVL HANGERS: Simpson Strong -Tie® Connectors Support Model Slope Skew Reverse Top Flange Top Flange Support Wood Flanges Offset Slope Species 1 Face Mount Hanger HUS1.81/10 0/12 0 No N/A N/A Douglas Fir -Nailing for Support 1: Face: 30-1Od , Top WA, Member. 10-1Od DS DESIGN CONTROLS: Maximum Design Control Control Location Shear (Ibs) 1453 1212 3948 Passed (31%) Lt end Span 1 under Roof loading Moment (Ft-Lbs) 3466 3466 7359 Passed (47%) MID Span 1 under Roof loading Live Load Defl (in) 0.156 0.477 Passed (11733) MID Span 1 under Roof loading Total Load Defl (in) 0.264 0.636 Passed (L/433) MID Span 1 under Roof loading -Deflection Criteria: STANDARD(LL•L/240,TLL/180). -Bracing(Lu): All compression edges (top and bottom) must be braced at 2' 8" o/c unless detailed otherwise. Proper attachment and positioning of lateral bracing is required to achieve member stability. -Design assumes adequate continuous lateral support of the compression edge. PROJECT INFORMATION: M/M RICHARDSON 32 LAKELAND AVE SO. YARMOUTH MA OPERATOR INFORMATION: Bill Rubel Mid -Cape Home Centers PO Box 1418 465 RTE 134 South Dennis, MA 02660 Phone:508-398-6071 Fax :508-398-4559 brubelc@midcape.net Copyright C 2003 by Trus Joist, a Weyerhaeuser Business Wicrollama is a registered trademark of Trus Joist. Simpson Strong -Tilt Connectors is a registered trademark or Simpson Strong -Tie Company, Inc. RIDGE BEAM C AT RON DT ORMER Ti-Beam(TM) 8.08 Serial Number. 70021033Q ,USW.1 120100036:03:26AM 1 3/4" x 91/2" 1.9E Microllam® LVL Page 2 Engine version: 1.6.41 THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN CONTROLS FOR THE APPLICATION AND LOADS LISTED ADDITIONAL NOTES: -IMPORTANTI The analysis presented is output from software developed by Trus Joist (TJ). TJ warrants the sizing of its products by this software will be accomplished in accordance with TJ product design criteria and code accepted design values. The specific product application, input design loads, and stated dimensions have been provided by the software user. This output has not been reviewed by a TJ Associate. -Not all products are readily available. Check with your supplier or TJ technical representative for product availability. -THIS ANALYSIS FOR TRUS JOIST PRODUCTS ONLYI PRODUCT SUBSTITUTION VOIDS THIS ANALYSIS. -Allowable Stress Design methodology was used for Building Code NER analyzing the TJ Distribution product listed above. PROJECT INFORMATION: M/M RICHARDSON 32 LAKELAND AVE SO. YARMOUTH MA OPERATOR INFORMATION: Bill Rubel Mid -Cape Home Centers PO Box 1418 465 RTE 134 South Dennis, MA 02660 Phone: 508-398-6071 Fax :508-398-4559 brubel@midcape.net Copyright C 2003 by True Joist, a Weyerhaeuser Business Microllams is a registered trademark of True Joist. Simpson Strong -Ties Connectors is a registered trademark of Simpson Strong -Tim Company, Inc. AA I INC. + 260 Cean6eii7 Hi�way Race 6A Od=4MA 02653 PHONE -SOt3S55.6511 -._ _ . 508.4879600 Provinaaown .."' M- . 50&778.9600 Hyannis FAX 508.255.6700 9 E-W& . IaSo®�arapecod.com www.mmpecod wm Cavil ;'c � `• :•Smiuuial:3� . liuvhonmenr�l < ;,Marine L ND Suevsxnaa'' 7Y�„n;.vr. i$F1tytCEy CoNsolsnrrrs ' Ca�Fri' DORM, mci m bdp our t diena gch m tbelr ¢� We do thte b9 u6dauanding our issues ibit6ppiciib� r PW byapproprim ind iiuveymg ' < .. aoliwonat u * K „➢ •13 October 23, 2002 JFF Design Architects `L Zdn3 Attn: Mr. Joe Fournier L3y NOV 24 Warwick Ave. Waltham, MA 02452 Certified Mail: Return Receipt Requested: 7002 0510 0000 7190 7306 Re: Determination of Applicability: Negative 3 Proposed Partial Demolition and Addition To An Existing Dwelling: A Portion of Driveway Is To Be Removed And Replaced And A New Sewage Disposal System Is To Replace Existing Cesspools JFF Design (Richardson Residence) 32 Lakeland Ave., Yarmouth, MA Map 60 Parcel 56 Dear Mr. Fournier. C15774.00 Enclosed please find the original Negative 3 Determination of Applicability issued by the Yarmouth Conservation Commission on October 21, 2002 for the above referenced project. 3 The Commission has determined that the work is within the Buffer Zone, as defined in the regulations, but will not alter an Area subject to protection under the Act. Therefore, said work does not require the filing of a Notice of Intent. Although it is not necessary to record this document at the Registry of Deeds, please retain this document for future reference. This Determination of Applicability expires three years from the date of issuance. If you have any questions or require additional information, please contact our office. Sincerely, COASTAL ENGINEERING CO., INC. Julie A. Henderson Enclosure cc: George and Nancy Richardson, Owner John G. Schnaible, R.S. Mdoc1C1570011774.001PennittingUFF Design Fournier RDA 9.02%RDA Neg 3: 10.23.02 M 4 z Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. VICI ICI Massachusetts Department of Environmental Protection Bureau of Resource Protection -Wetlands WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 A. General Information From: YARMOUTH Conservation Commission To: Applicant JFF Desion Name 24 Warwick Ave. Mailing Address Waltham MA 02452 City/Town State Zlp Code 1. Title and Date of Final Plans and Other Documents: Property Owner (if different from applicant): George & Nancv Richardson Name 32 Lakeland Ave. Mailing Address Yarmouth MA 02664 Cityrrown State Zip Code Site & Sewage Disposal System Plan for Richardson Residence REV. 10-18-02 Title Final Date (or Revised Date if applicable) 2. Date Request Filed: 9-18-02 B. Determination Pursuant to the authority of M.G.L c. 131, § 40, the Conservation Commission considered your Request for Determination of Applicability, with its supporting documentation, and made the following Determination. Project Description (f applicable): To demolish a breezeway and garage construct an addition and upgrade the septic system. Project Location: 32 Lakeland Avenue Yarmouth Street Address City/Town 60 56 Assessors MaptPlat Number Parcel/Lot Number WPA Fo 2 Page 7 of S RM W= Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Determination (cont.) The following Determination(s) is/are applicable to the proposed site and/or project relative to the Wetlands Protection Act and regulations: Positive Determination Note: No work within the jurisdiction of the Wetlands Protection Act may proceed until a final Order of Conditions (issued following submittal of a Notice of Intent or Abbreviated Notice of Intent) has been received from the issuing authority (.e., Conservation Commission or the Department of Environmental Protection). ❑ 1. The area described on the referenced plan(s) is an area subject to protection under the Act. Removing, filling, dredging, or altering of the area requires the filing of a Notice of Intent. ❑ 2a. The boundary delineations of the following resource areas described on the referenced plan(s) are confirmed as accurate. Therefore, the resource area boundaries confirmed in this Determination are binding as to all decisions rendered pursuant to the Wetlands Protection Act and its regulations regarding such boundaries for as long as this Determination is valid. ❑ 2b. The boundaries of resource areas listed below are )lot confirmed by this Determination, regardless of whether such boundaries are contained on the plans attached to this Determination or to the Request for Determination. ❑ 3. The work described on referenced plan(s) and document(s) is within an area subject to protection under the Act and will remove, fill, dredge, or alter that area. Therefore, said work requires the filing of a Notice of Intent. ❑ 4. The work described on referenced plan(s) and document(s) Is within the Buffer Zone and will alter an Area subject to protection under the Act. Therefore, said work requires the filing of a Notice of Intent. ❑ 5. The area and/or work described on referenced plan(s) and document(s) is subject to review and approval by: Name of Municipality Pursuant to the following municipal wetland ordinance or bylaw: Name Ordinance or Bylaw Clatlon wPA Fa 2 Paps 2 of 5 RW 02M Massachusetts Department of Environmental Protection Bureau of Resource Protection -Wetlands WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Determination (cont. ❑ 6. The following area and/or work, if any, is subject to a municipal ordinance or bylaw but not subject to the Massachusetts Wetlands Protection Act: ❑ 7. If a Notice of Intent is filed for the work in the Riverfront Area described on referenced plan(s) and document(s), which includes all or part of the work described in the Request, the applicant must consider the following alternatives. (Refer to the wetland regulations at 10.58(4)c. for more information about the scope of alternatives requirements): ❑ Alternatives limited to the lot on which the project is located. ❑ Alternatives limited to the lot on which the project is located, the subdivided lots, and any adjacent lots formerly or presently owned by the same owner. ❑ Alternatives limited to the original parcel on which the project is located, the subdivided parcels, any adjacent parcels, and any other land which can reasonably be obtained within the municipality. ❑ Alternatives extend to any sites which can reasonably be obtained within the appropriate region of the state. Negative Determination Note: No further action under the Wetlands Protection Act Is required by the applicant. However, if the Department is requested to issue a Superseding Determination of Applicability, work may not proceed on this project unless the Department fails to act on such request within 35 days of the date the request is post -marked for certified mail or hand delivered to the Department. Work may then proceed at the owner's risk only upon notice to the Department and to the Conservation Commission. Requirements for requests for Superseding Determinations are listed at the end of this document. ❑ 1. The area described In the Request is not an area subject to protection under the Actor the Buffer Zone. ❑ 2. The work described In the Request is within an area subject to protection under the Act, but will not remove, fill, dredge, or after that area. Therefore, said work does not require the filing of a Notice of Intent. ® 3. The work described In the Request is within the Buffer Zone, as defined In the regulations, but will not alter an Area subject to protection under the Ad. Therefore, said work does not require the filing of a Notice of Intent, subject to the following conditions (if any). ❑ 4. The work described in the Request is not within an Area subject to protection under the Act (including the Buffer Zone). Therefore, said work does not require the filing of a Notice of Intent, unless and until said work alters an Area subject to protection under the Act. WPA Foes Z Pepe 3 d S Rev WM ^ + Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands tT„F, 4? WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Determination (cunt.) ❑ 5. The area described in the Request is subject to protection under the AcL Since the work described therein meets the requirements for the following exemption, as specified in the Act and the regulations, no Notice of Intent Is required: Exempt Activity (site applicable statuatory/regulatory provisions) ❑ 6. The area and/or work described in the Request Is not subject to review and approval by: Name of Municipality Pursuant to a municipal wetlands ordinance or bylaw. Name Ordinance or Bylaw CHation C. Authorization This Determination is issued to the applicant and delivered as follows: ❑ by hand delivery on Date ER by certified mail, return receipt requested on fIEiD►.iIQirarr This Determination is valid for three years from the date of issuance (except Determinations for Vegetation Management Plans which are valid for the duration of the Plan). This Determination does not relieve the applicant from complying with all other applicable federal, state, or local statutes, ordinances, bylaws, or regulations. This Determination must be signed by a majority of the Conservation Commission. A copy must be sent to the appropriate DEP Regiona�Offtoe (see Appendix A) and the property owner (f different from the 10-17-02 Date WPA Fa 2 Am 07R70 P.9e4as Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 D. Appeals The applicant, owner, any person aggrieved by this Determination, any owner of land abutting the land upon which the proposed work is to be done, or any ten residents of the city or town in which such land is located, are hereby notified of their right to request the appropriate Department of Environmental Protection Regional Office (see Appendix A) to Issue a Superseding Determination of Applicability. The request must be made by certified mail or hand delivery to the Department, with the appropriate filing fee and Fee Transmittal Form (see Appendix E: Request for Departmental Action Fee Transmittal Form) as provided In 310 CMR 10.03(7) within ten business days from the date of issuance of this Determination. A copy of the request shall at the same time be sent by certified mail or hand delivery to the Conservation Commission and to the applicant if he/she is not the appellant. The request shall state clearly and concisely the objections to the Determination which is being appealed. To the extent that the Determination is based on a municipal ordinance or bylaw and not on the Massachusetts Wetlands Protection Act or regulations, the Department of Environmental Protection has no appellate jurisdiction. wPA Form 2 Rm W= Pays 5 of 5 MAScheck COMPLIANCE REPORT Massachusetts Energy Code MAScheck Software Version 2.01 Release 3 CITY: Yarmouth STATE: Massachusetts HDD: 6137 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 4-30-2003 DATE OF PLANS: 04-30-03 PROJECT INFORMATION: 32 LAKELAND AVE SO. YARMOUTH COMPANY INFORMATION: LIGHTSHIP HOMES DENNIS MA Permit # Checked by/Date NOTES: PLEASE NOTE THAT THIS REPORT WAS COMPLETED BY TONY RAPOSO IF THERE ARE ANY QUESTIONS REGARDING THIS PLEASE CALL 508-880-3462 COMPLIANCE: Passes Maximum UA = 525 Your Home = 524 Area or Cavity Cont. Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 2590 30.0 0.0 91 WALLS: Wood Frame, 160 O.C. 2087 13.0 0.0 171 GLAZING: Windows or Doors 320 0.340 109 DOORS 122 0.350 43 FLOORS: Over Unconditioned Space 2336 19.0 0.0 110 HVAC EQUIPMENT: Furnace, 82.0 AFUE ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. Builder/Designer Date MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.01 Release 3 DATE: 4-30-2003 Bldg. Dept. Use CEILINGS: 1. R-30 Comments/Location WALLS: 1. Wood Frame, 16" O.C., R-13 Comments/Location WINDOWS AND GLASS DOORS: 1. U-value: 0.34 For windows without labeled U-values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location DOORS: 1. U-value: 0.35 Comments/Location FLOORS: 1. Over Unconditioned Space, R-19 Comments/Location HVAC EQUIPMENT: 1. Furnace, 82.0 AFUE or higher Make and Model Number AIR LEAKAGE: Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. When installed in the building envelope, recessed lighting fixtures shall meet one of the following requirements: 1. Type IC rated, manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated, in accordance with Standard ASTM E 283, with no more than 2.0 cfm (0.944 L/s) air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/ft2 pressure difference and shall be labeled. VAPOR RETARDER: Required on the warm -in -winter side of all non -vented framed ceilings, walls, and floors. MATERIALS IDENTIFICATION: Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R-values, glazing U-values, and heating equipment efficiency must be clearly marked on the building plans or specifications. DUCT INSULATION: [ ] Ducts shall be insulated per Table J4.4.7.1. DUCT CONSTRUCTION: [ ] All accessible joints, seams, and connections of supply and return ductwork located outside conditioned space, including stud bays or joist cavities/spaces used to transport air, shall be sealed using mastic and fibrous backing tape installed according to the manufacturer's installation instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted. The HVAC system must provide a means for balancing air and water systems. TEMPERATURE CONTROLS: [ ] Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: [ ] Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. SWIMMING POOLS: [ ] All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. HVAC PIPING INSULATION: [ ] HVAC piping conveying fluids above 120 F or chilled fluids below 55 F must be insulated to the following levels (in.): PIPE SIZES (in.) HEATING SYSTEMS: TEMP (F) 2' RUNOUTS 0-l" 1.25-2" 2.5-4" Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 Low temperature 120-200 0.5 1.0 1.0 1.5 Steam condensate any 1.0 1.0 1.5 2.0 COOLING SYSTEMS: Chilled water or 40-55 0.5 0.5 0.75 1.0 refrigerant below 40 1.0 1.0 1.5 1.5 CIRCULATING HOT WATER SYSTEMS: [ ] Insulate circulating hot water pipes to the following levels (in.): PIPE SIZES (in.) NON -CIRCULATING CIRCULATING MAINS & RUNOUTS HEATED WATER TEMP (F): RUNOUTS 0-1" 0-1.25" 1.5-2.0" 2.0+" 170-180 0.5 1.0 1.5 2.0 140-160 0.5 0.5 1.0 1.5 100-130 0.5 0.5 0.5 1.0 ----NOTES TO FIELD (Building Department Use Only) C. TOWN OF YARMOUTH Building Department BUILDING (508) 398-2231 ext.261 '� PERMIT NO-B-04-640 PERMIT ; ;.. ISSUE DATE :::1 ino(03. ; PROPOSED USE ; :::::::: _ APPLICANT 'GeorgeRichardson _ ..... " JOB WEATHER CARD ADDRESS 00032 LAKELAND AVE --------------------- ----- ------------ PERMIT TO 'MiscJstorage trailer; AT (LOCATION) 06 LAKELAND AVE ZONING DISTRIC R-401 Bldg. Type: jResidentiaj SUBDIVISION MAP LOT BLOC 1060.56 BUILDING IS TO BE: CONST TYPE 5 B USE GROUP R-4 LOT SIZE storage trailer- duration: 6 months REMARK AREA (SO FT) EST COST ($ $260.00 PERMIT FEE ($) $25.00 OWNER IGEORGE L RICHARDSON BUILDING DEPT BY ADDRESS 100032 LAKELAND AVE South Yarmouth I MA 102664 CONTRACTOR LICENSE 0 INSPECTION RECORD FIELD COPY Date Note Progress - Corrections and Remarks Inspector a ONE & TWO FAMILY ONLY - BUILDING PERMIT APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING Town of Yarmouth Building Department 1146 Route 28 • Yarmouth, MA 02664-4492 Tel: (508) 398-2231 x261 - Fax: (508) 398-2365 Office Use Ord Planning Board Information Assessors Department information= Permit No. '� to Plan Type Map for M p " Permit fee. $ Endorsement Date JVew D eposit Rec'd. Date I Recording Date Ian No 1.4 Property Dimenslons i Net Due Lot Area sQ'.t ._ Frontage ft) . .{ Lot Coverage':' This Section for. Office. Use O t ; 'building Permit Numb r:' - ` ; 'Date Issued: Signature "' U Certificate of Occupancy r B ' g Official - Date a ; Ls ` ' is not required Section'1- Site Information' I Use Group: R-4 Type: 5-B 1.1 Property Address: 12 Zoning Information: I A 1,44kE A4W1) Avg Zoning District Proposed Use CSlZ[ir/ YA,Pitiucci?l. M� �2�G 1.3 Building Setbacks (ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.4 Water Supply (f CLI. c. 40. S 54) 1 5' Flood Zone Information ' Comments f , Public Private Zone: BFE: ' Section 2 - Pro erty.Ownershi Authorized Agent 2.1 Ovowr of Reconi3- G 2 X t 1 C A149 Name (p Mailing Address (50 Signa ure Telephone 2.2 Authorized Agent: Name (print) Mailing Address Signature Telephone Section 3 -' Construction Services' ' 3.1 Ucensed Construction Supervisor. D I ��J L1 1 ,)1 NotAppUcable ❑ OCT 2 1 2003 L� License Number ` Address By Expiration Date Signature Telephone 3.2 Registered Home Improvement .Contractor. Company Name Not Applicable ❑ Address Ucense Number Expiration Date Signature Telephone 7-1-99 1o2 OVER Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure r to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes .......... No ........:. New Construction 1 No. of Bedrooms No. of Bathrooms Existing Bldg. ❑ Repair(s) ❑ Alterations ❑ I Addition ❑ Accessory Bldg. ❑ Type Demolition Brief Description of Proposed Work: Other Specify: CM�6l1/3R� f zr �/CAtc 1)4trLin16 a %YlmiHs" .t-fC ..Zit 1 / oeO .l z e i I Check Below I ❑ Conservation -Commission Fling (if applicable) ❑ Old longs Highway R Historical Commission approval (if applicable) I , as owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date I , as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print name tx �� // , signatur of Owne gent /'�//G 9-15-99 2of2 Date OLZ_� TOVWN �OF YARMOUTH BULLDING 'DEPARTMENT CONSTRUCTION' SUPERVISOR FORM PLEASE PRIM. ,Job' Location: Number : Streef Village Owner of Property. Construction Supervisor: Name License No. Phone No. Address: Licensed Designee: (If other than Supervisor) Name License No. 2.15 Responsibility of each license holder: . 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved 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 N7olations 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 decried a violation of the permit conditions. I have read and understand my rjesponsibilities under the rules and regulations for licensing construction supervisors in accordance with . section 109.1.1 -of the state building code. I understand the construction inspection procedures and'the specific inspection as called for by the building official. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes ❑ No ❑ If you have checked ygs, please indicate the type coverage by checking the appropriate box. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 152 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Owner ❑ Agent Signature: Building Official Approval: M 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. ,/ p Type of Work: �? fC�t 1P�1 C'/t'�Fit/� 1 i�a1FZi� Est. Cost 4u 57, G u0 Address of Work 3 0 &2 4�.YkeMeu71-1 AV-7- Owner Name:4' eici-1,9g -D S&9v Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): 21 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 w' Registration No. Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Igo 4r � �y Hate 0 er NaMe w � . The Commonwealth of Massachusetts Department of Industrial accidents Omcaallerest/yatls®s 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit me. 1 am a homeowner performing all work myself. . 1 am a sole proprietor an.d have no one working in any capacity D 1 am an ernplover pro,. iding workers' compensation for my employees working on this job. r ._n�ny name• • address: city.- phone N• policy N O 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 of MGL 152 can lead to the imposition of crinslaal penalties of a flat op to 31.S00.00 a&War one years' Imprisonment as well as civil penalties is the form of a STOP WORK ORDER and a lint of 5100.00 a day against ma I understand that a copy of Ihb statement nay be forwarded to the Once of Investigations of the DIA for coverage veriGeatioa. I do -hereby certij der the pa//MM' ;enpa is o p rjuty that the injormation provided above is true and coned Sinnnntre .17� "Olt Ol _— ate Print name r�y'eaa ^' /((G/,WK fU� PhoneN��e�'> official use only do not w rite in this area to be completed by city or town official city or town: YARMOUTII o check if immediate response is required permit/lietase N (:]Building Dtpartmcal [31.1eensiog Board 261 OSelcctmtn's Ogee frna% 3oa "ii t ❑Health Department contact person: phone N; _ ,� _ QY 00ther PLEASE PRINT: DATE: JOB LOCATION: i-410MEOWNER" NAME PRESENT MAILING ADDRESS TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 260 HOMEOWNER LICENSE EXEMPTION n . NAME // STREET ADDRESS SECTION OF TOWN 01 .�A,eE PHONE PHONE I f-�,w IL14!46X 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 Rubrmed 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 nen is and that he / she will comply with said procedures and requirements. OMEOWNER"S SIGNATURE APPROVAL OF BUILDING OFFICIAL INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL Ch.142. Yes 0 No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy 0 Other type of indemnity 0 Bond ❑ OWNER'S INSURANCE WAIVER I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent - Check one: Owner ❑ Agent 0 hhomeowarliceX=P TOWN OF YARMOUTH 1146ROUTE28 SOUTHYARMOUTH MASSACHU7 02664-4451 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 Work Address is to be disposed of at the following location: Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Signature of Applicant Permit No. Date Y PLOT PLAN buttor's ame of # E this is a orner lot, ,rite in name f street. FOR LOT # Indicate location of garage or accessory building Additions with dashed lines -------------------- Sewerage disposal (cesspool) Well �g I I I(lot..... GU ......ft. rear) I SIDE YARD A '\ MARK NORTH POINT. REAR YARD .....:.? 1i? ...ft. HOUSE 5 SETT BACK ...0 ��'..ft. (lot..................ft. frontage) (NAME OF STREET) SIDE YARD 1166 _ ET� aAi a� b Abuttor' Name Lot # If this corner write ' name of other street. I Information �n�L' 4` Supplied by TOWN OF YARMOUTH Building Department Town Hall Yarmouth, MA 02664 (508) 398-2231 ext261 BBUILDING PERMIT APPLICATION RECEIPT Temp Permit No.: T-04-210 Applicant Name: George Richardson Location: 00032 LAKELAND AVE Owner's Name: GEORGE L RICHARDSON Owner's Addres 00032 LAKELAND AVE South Yarmou MA 02664 Owner's Telephone: (508) 398-9653 (OFFICE USE ONLY Recorded By,. Ic Permit Fee: $0.00 Deposit Rec: $25.00 Payment Type: Check ChkNo.: 2566 Net Owed: ($25.00) Application Date: 10/21/03 Issue Date: Expiration Date Comments: storage trailer- duration: 6 months ZONING APPROVED �(), 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. Date Printed: 11/4/03 Building Site Location: Proposed Improvement: 10 TOWN OF YARMOUTH BUILDING DEPARTMENT BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET Q &J"O"j- Map No: Lot No: --b n Address: /I Te1No.: 3�/ 'i6 93Date Filed: /U/�103 The Building Department will be responsible for assisting the applicant by dispatching your plans and or application to the following applicable departments. WATER DEPARTMENT: Determines Compliance of Water Availability and or existing location. ENGINEERING DEPARTMENT: Detennhies Compliance for Parking and Drainage. CONSERVATION COMMISSION: Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. FIRE DEPARTMENT: Determines Compliance to State and Town Requirements for Personal Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Eta REVIEWED BY: 1. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: If DATE: N/A: 4. HEALTH DEPARTMENT: /)�4QSTRJAL DATE::/ I ZO N/A-- S. WIRING INSPECTOR: AND/OR AL N/A: DATE: 6. PLUMBING INSPECTOR: DATE: N/A: 7. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE COMMENTS: RECEIPT OF COPY: "G <-P e)0e/ L-ei c�A L 2 /^Cca -� SIGNATURE OF DATE: l/—ZO o 3 White copy - Buddmg Dept - Puck copy - WatQ Dept. - Ydiaw Copy - Health Deµ. - Pink Copy - * DqL - Goldenrod - Fim DeptACamvatim OF r TOWN OF YARMOUTH Building Department BUILDING �w ►- PERMIT NO (508) 398-2231 ext.261 _-B-04641_ _ ' PERMIT ISSUE DATE ;_ _11/20/03, , ; PROPOSED USE ' APPLICANT James Seaman "" JOB WEATHER CARD ADDRESS 00032 LAKELAND AVE PERMIT TO Demolish ------------------ AT (LOCATION) 100=LAKELAND AVE ZONING DISTRIC R-40 Bldg. Type: Residential SUBDIVISION MAP LOT BLOC 1060.56 BUI NG I OBE: CONST TYPE 5-B USE GROUP R-4 LOT SIZE O demolish and remove existing breezeway REMARK AREA (SO F) EST COST ($ $1( OWNER IGEORGE L RICHARDSON ADDRESS 100032 LAKELAND AVE South Yarmouth I MA 102664 per plans dated D PERMIT FEE ($) $50.00 BUILDING DEPT BY CONTRACTOR LICENSE 016008 Seaman, James POB 424 West Yarmouth MA 02673 5087786034 INSPECTION RECORD FIELD COPY Date Note Progress - Corrections and Remarks Inspector i ONE & TWO FAMILY ONLY - BUILDING PERMIT APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH ACNE OR TWO FAMILY DWELLING Town oFYarmouth Building Department 1146 Route 28 • Yarmout]1, MA 026644492 Tel: (508) 30-2231 x261 • Fax: (508) 3919-2365 Office UseONy PlanrongBoardlafonnation Assessorsbepartrnerrtlnfortnatton` j Pefmlt s ••s r ,� b ErtdarsementDate= Permit Feel 4- Deposit Rec'd Record�ngDate property Dunenswns r Net Due',,:',--"Fron` tage(ttj ' t_:LotCoverann `This Section (or.Office Use Buildin Permit Num Date Issuetl ,� ,. Si nature " "'«} s 1 H =ems g =C> Certificate of Occupancy Bu ui Ofliciaf 9• required Section 1°-'Site Information': Use Group: R-4 Type: 5-13 1.1 Property Address: 3 L-' LatC-tAtJ D AV E 1.2 Zoriig II formation: S YFIOVfI t Oz-�� ,Ma Zoning District Proposed Use 1.3 Building Setbacks (ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 30(0.5% 1.4 Water Sup y (M.G.L. c. 40. S S41 1 5 Flood Zonelnfomiation ;> Comments `f Public Private Zone,, 6F1r r; Section 2 `= Property Ownership/Author¢edAgent 2.1 Owner of Record: 3z uwD Allot= . Name rint) Mailing Address Signature Telephone ffC5 (Q5 24,�4w+�horized A ent: -D• ✓PM05 PLai tpnnt Mailing Address -o w. YA 0- 1 t- Sig ture Telephone Section 3 - Constrticfion• SerVices's it 5 �� I 3.1 Lic ed Cons ction Supervisor: AN�Q 2 0 2 03 �, NotApplicabI 1 .D. 2 it/r4 _ /) c z; I , / License Number Ad 4016 C �4e—.e.G�dY� .� Expiration Date 11-01—f0-97 Sign lure Telephone — �oC/ / 03 3.2 Registered: HomeJniproJerrienF-.Contracto: r Company Name f Z). S�A,�gnl Not Applicable s s O, litl , e,r✓,bt Tj ((//� jC U 2. 7� License Numb er --•CJ Expiration Date S' nature Telephone _ S- 9- 15-99 . % 1 of 2 nuFa 1 Sectlo�r?'�`.YI1td�R�is"�`tjotri�ieisafton1nst�raiir.�/Cffidavit"(1G1`�.�'�Ut�s'��' .�� 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 .......... New Construction ❑ No. of Bedrooms No. of Bathrooms Existing Bldg. ❑ Repair(s) ❑ Alterations ❑ Addition ❑ Accessory Bldg. ❑ Type Demolition Other Specify: Brief Dp,,scription of Proposed Work: ei:tlw tik ir�r atecl tso`ris r. C) Co")"s Item II"lBuildiing Estimated Cost (Dollars) to be ecompleted by permit applicant 2. Electrical 3. Plumbing / Gas 4. Mechanical (HVAC) 5. Fire Protection - 6.Total=(t+2+3+4+5) -A- 7. Total Square Ft. (new Moues b eftioru) I Check Below I ❑ Conservation -Commission Filing (if applicable) ❑ Old Kings Highway & Historical Commission approval (if applicable) 1, �er✓ecx G/� tilt/ i�i��r� , as owner of the subject property hereby authorize - n%J"3 I Srg&Y-01 my b f, in ail m tters lative ork authorized by this building -permit application. Signature of dwner Date to act on I, ✓�H: �' �r- � � , as 8mm/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 i1-i2-a3 2 1� TOWN OF YARMOUTH • � Flo BUILDING DEPARTMENT ti.. CONSTRUCTION' SUPERVISOR FORM PLEASE PRINT: _]ob'Location: 3Z t-4&F..A&a -b•. Xt)e Y A2t-(6 LTn i Num r , t Village Owner of Property:E;Of��E Construction Supervisor: ✓'a�F_7.5 �� �t^Al'l�'J �1 bG�B 77& 60-5* Name License No. Phone No. Address: �r�ok t-f'-i' �i�l , YA 12-kpof1i A U Z %% 3 Licensed Designee: (If other than Supervisor) Name License No. 2.15 Responsibility of each license holder: . 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved 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 applicabie,laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Any licenseewho shall willfully violate subsections 2.15.1, 2.15.2 or 2.15.3 or any other section of these rules and regulations and any procedures, 'as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance.with :section 109.1.1:of the state building code. I understand the construction inspection procedures and'tlie specific inspection as called for by the building official. INSURANCE COVERAGE: .. I have a cu7rentbilityinsurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes No ❑ If you have checked =, please indica the type coverage by checking the appropriate box. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIV R: I am aware that the licensee does not have the insurance coverage required by er 52 of the . G eral Laws, and that my signature on this permit application waives this requirement. Check one: Signature of�rar Owner s Agent Owner U Agent Signature: Building Official Approval: For Office Use Only Permit No. Date TOWN OF YARMOUTH AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c. 142A requires that the 'reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition or construction of an addition to any pre-existing owner -occupied building containing at least one but not more than four dwelling units or structures which are adjacent to such residence or building' be done by registered contractors, with certain exceptions, along with other requirements. Type of Work: LTC— 1ot ,i-rrp Est. Cost Address of Work 3 Z 1_A-- Owner Name: GEO1z�F �- • I C� 1.4/11a-� Date of Permit Application: I 1 —1 `Z— 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 MG c. 142A. Signed under penalties of perjury: (?iMCe 11L -/6:3�L- I hereby apply for a permit as the agent of the owner: I I— I z —03 JAB '�>. Sc=AW74,13 I ZI S!50 Date Contractor Name Registration No. Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name h The Commonwealth of Massachusetts Department of Industrial Accidents exec9/1"affpadr®s 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit name LJLL.,,�`S,,//Fi/t)ti location- 12 � 7! e0 • YA&tt -et iN ' lLif1 02(b7 3 w• jra2A4oueH , iUsl OZ.b7 3 nhan a SOt 77k7 47o 3 Sl- O ' I am a homeowner performing all work myself. O I am a sole proprietor =ad have no one working in any capacity man employer ro%iding workers' compensation for my employees working on this job. emmnanv name: JAf-113 D • �MiOfl) address:F�K� y`f��-7' �{� I may: (W / %�!1¢�d-l��/(T1 M �l OZb73 ohoneH: 156 ME Cal cl--34 insurance co. t61aN 1A-6ualWC4z:- Co. norev$0WG 50g3035s 1 am a sole proprietor. general contractor. or homeowner (circle one) and have hired the contractors listed below who have the follow•in-a workers' compensation polices: Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition Clericals" penalties ofa fine up to S1.S00.00 Sawa, one years' imprisonment as well as civil penalties io the form ofa STOP WORK ORDER and i fine of S100.00 a day against me. I anderatand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do •hereby certij• er the pain . d p bits ojperjuty that the information provided above is true and correct Signature ate kZ� / 7� 3 r/ Print name �r"�G3 �• �>`�i/`/l9il / Phone 05Ou 3 7" official use only do not w rite in this area to be completed by city or town official city or town: YARMOUTIJ O check if Immediate response is required contact person: permit/license 0 nBuilding Department ❑I.leensiog Board 263. ❑selectmen's Office fcnty% 398 2231 t E3I1ealthDepartment phone pt _ _ ea 00thcr Information and Instructions ` Massachusetts General Laws chapter I52 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 emplayer is defined as an individual. partnership, association. corporation or other legal entity, or any two or more of the foregoing enga�zed in a joint enterprise. and including the legal representatives of a deceased employer, or the receiver or trustee of an individual . partnership. association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein. or the occupant of the dwelling house of another who employs persons to do maintenance , construction or repair work on such dwelling house or on the _rounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. `IGL chapter l:: section 25 als.-, states that ever• state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionall%. neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter ha%e been presented to the contracting authority. Applicants Please 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 i owns 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. artmen adaddress, telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Mce of luestf®9tl®©s 600 Washington Street Boston, Ma. 02111 fax 4: (617) 727-7749' phone ; 274900at-406, I09mr37 TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 260 HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE: // - /2 - a 3 JOB LOCATION: ,�Cfl�1/21W6W 37 &Ay-FLAa1� j40F Gi. %fL1�IbMTh .NAME STREET ADDRESS SECTION OF TOWN "HOMEOWNER` 4iqt 392i yL:015 -3 NAME HOME PHONE WORK PHONE PRESENT MAILING ADDRESS CITY OR TOWN STATE ZIP CODE The current exemption for `Homeowner' was extended to include owner — occupied dwellings of one or two units and to allow such homeowners to engage an individual for hire who does not possess a license, provided that such homeowner shall act as sup re vi r. (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 Qerformed under the building pertnit. (Section 108.3.5.1) The undersigned 'homeowner' assumes responsibility for compliance with the State Building Code and other applicable codes, by-laws, rules and regulations. The undersigned 'homeowner' certifies that he / she understands the Town of Yarmouth Building Department minimum inspection procedures and requirements and that he / she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL INSURANCE COVERAGE: I have a curt Lability insurance policy or its substantial equivalent, which meets the requirements of MGL Ch.142. Yes 1K No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy L9`*' 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 he M General Laws and that my signature on this permit application waives this requirement. .c•r� Check one: / Si tune of -Owner's Agent Owner ❑ Agent C� h1omeownr1knemp BUILDING TOWN OF Y A R M O U T H ELECTRICAL GAS 1146ROUTE28 SOUTHYARMOUTH MASSACHUSETTS02664-4451 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 32 ��'��-�D Ave: �J• AtL'40�►� Work Address is to be disposed of at the following location: �'Aa1`(ooT Rk tt�L 49F-w ICJ Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Signature of Applicant Permit No. //—/:2 —o3 Date 1 T� Toammonwea" q1,11&wdwjeffj BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 016008 Birthdate: 1110111946 Expires: 11/01/2005 Tr. no: 7725.0 Restricted: 00 JAMES D SEAMAN PO BOX 424 8 W YARMOUTH, MA 02673 Administrator R � ✓die i0ommo�wieatu� o�✓��a.uac�ufe� f j Board or Building Regulations and Standards �t HOME IMPROVEMENT CONTRACTOR Registration: 121550 Expiration: 5/20/04 Type: Individual JAMES D. SEAMAN JAMES SEAMAN 497 MAIN ST. W' YARMOIITHr MA 02A73 -- Ad laL! ar: • License or registration valid for indlvidul use only before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston, Ala.02108 Not valid without sigtyllyre COMMONWEALTH OF MASSACHUSETTS DIVISION OF PROFESSIONAL LICENSURE IN REAL ESTATE LICENSED REAL ESTATE BROKER ' ISSUES THIS LICENSE TO JAMES D SEAMAN 0 PO BOX 424 N W YARMOUTH MA 02673-0424 98831 11/01/05 830420 CERTIFICATE iPR CCU 0 ,a Chag ncn Insurance A,enc-, •411 Rte. 28, P.O. Box 355 'Rest =a=mouth, ZA-, 02573 :NSUP_; CO _TR j=Qs D. Seaaa n PO °Cx 424 Nest Ya —cuth, Y-% 02573 1 OF LIABILITY INSURANCE OATEIMM,CC/YYI THIS C=RTIFICATE IS ISSUED AS A MATTER OF INFOR,MA Inc. ONLY AND CONFERS NO RIGHTS UPON ION THE CERTIFICATE HOLLER. THIS CERTIFICATE 00ES NOT AMEND, EXTEND OP, ALTER THE COVERAGE AFF0RDE0 EY THE PGLICIES EELCW. I COMPANIES AFFORCING COVERAGE q-., - art:c=_ =nsu=a nce CC'.IF=;ro I C CC :IPA:1Y D iXISINCI IS TO CERTIF'f THAT THE PCL'C:ES CF INSURANCE USiCO 2 CV4:=AVE SEE ISSUED TO TrE INSURE? ,NAMED A2CVE FCR 71•'E P.,LC'. r.-' INCICATED. NO 1AMHSTANCING ANY RECUIRE.MENT, T �.fa CR CCNCI`TCN CF ANY CCNTP. CT CR OTHER C NA-AAENT E TH RESPECTFFCUC lCH ld CER MCAIc MAY 3E ISSUED OR MAY PERTAIN, Tr E INSURANCE Af-' RCED AN TriE PC ' ,ICD- EXCLUSIONS ANO CCNCITIONS OF SUCH PCUC:ES. jf,;ITS SHCVN fdAY : AVE SEEN R LC' ;n DESCRIBE? H.EREN IS SUBJE-T TO ALL THE T ER."I'C i UC:D Y PA10 CLAIMS. TYPE OF INSURANCE i PCLC7 NUMBER ^ P.L'CY EFFa�_ PCL'CY EXPIRATICN ! ^—' ^ i CA isIMMlCClYY) I CAT'c(MWOCP(YI UNITS GENERAL LA131LITY X ! C=MMEaC:AL GENERAL LABILITY CtA1MS;A:•CE j X I CCCU0. CWNE1 S S CCNTRACTCR-S PROT , i AUTCMCBIL= L:A21L' iY ANY AUTO ALL OWNED AUTCS S� L�UL�J AJ CS r.IRE� AUTCS _ NCN-CWNEO AUTCS ! ! i -AAAGc LL 131U,Y I ANY AUTO I I EXCESS UAaIUTY i UMERELLA FCFL'., I I CTHER THAN umi FORM WCRKERS COMPENSATSCN ANO EMPLOYERS* UABIUTY 3 ,ncPRCPRIETCR/ PAR,NERScXECUTIVE CFFICERS ARE: I CTHE.4 -ESCnIPT,CN OF CP IGENE'.LaCWZZ..- !: 02 SBA, X?215= 1/_3/00 1/13/04 i PRCCUCTS-C_MP,CPAGG z,o00,o00 i 2,000,000 PERSONAL 3 ACV W:L'P.Y � S 1 r D D D, 0 0 0 EACH CCCJRRENCE !S 1, 000, 000 'F:RE--."AAGE':rr_a::ru S 100,000 stEC E:tP r:rvxr_ri_.l :3 10, 0o0 ABLNEO Sa+GLE L:lAIT j , -CCILY :NXRY RxINCL IWC.093035^ EYCt ITEMS ! 1/17/C0 j ge :e=al carpeatrr operatiC",S-inte=ic= a exte_:c= =esidential & cc=ercial r•C[fr,r,w • — ' -CCILY :V:URY � Per aC�rA S I I PROPER^( CAMAGE ! S I j AUTO CNLY-:AACC.-.E.NT j 1 ! CTHER THAN AUTO CNLY: I I I EACH AC_.r.ENT ; S j I EACH CCuRR--NCE ; s ! AcGREGAr_ ; S I I IS ! Y.G �TAiU -n„ I X T^ivnurel I , I L LEACH ACC' CENT 1 s inn 000 ; 1/17/04 DISEASE - FOUCYL:MR Is --00, 000 !EL DISEASE -EA=LIF'OYEZ !j 1001000 PANCELLA,ION SHCUL2 ANY CF THE ABCVE CESCRIBEO PCUCES BE CANCELLED BEFCAE .THE EXPIRA'CN DATE THEREOF, THE ISSUING COMPANY WALL ENDEAVCA TO MAIL 10 CATS WRITTEN NOTICE TO THE CERTIFICATE HCLOE.R NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLGATICN CR UABILITY CF s>�� UPS '-THE ,:CCM'jp'Y. ITS NTS CR AEPRESE.VTATNES. 00 TOWN OF YARMOUTH Building Department Town Hall 'eYarmouth, MA 02664 (508) 398-2231 eA261 BBUILDING PERMIT APPLICATION RECEIPT Temp Permit No.: T-04-257 Applicant Name: James SEaman Location: 00032 LAKELAND AVE Owner's Name: GEORGE L RICHARDSON Owner's Addres 00032 LAKELAND AVE South Yarmou MA 02664 Owner's Telephone: (508) 398-9653 (OFFICE USE ONLY Recorded By: IC Permit Fee: $0.00 Deposit Rec: $25.00 Payment Type: Check ChkNo.: 975 Net Owed: ($25.00) Application Date: 11/12/03 Issue Date: Expiration Date Comments: U demolish and remove existing breezeway and garage Z014114G APPROVED 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. 0 Date Printed: 11/17/03 Building Site Location:_ Proposed Improvement: Address: TOWN OF YARMOUTH BUILDING DEPARTMENT WELDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF n TRANSMITTAL SHEET No: Lot No:i _ 'G S 3 Date Filed The Building Department will be responsible for assisting the applicant by dispatching your plans and or application to the following applicable departments. RESIDENTIAL AND/OR COMMERCIAL BUIWIN WATER DEPARTMENT: Determines Compliance of Water Availability and or existing location. ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage. CONSERVATION COMMISSION: Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. FIRE DEPARTMENT: Determines Compliance to State and Town Requirements for Personal Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Eta ..................................................................................................................................................... REVIEWED BY: 1. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT. DATE: N/A: 3. CONSERVATION: DATE: —NIA: 4. HEALTH DEPARTMENT: DATE: N/A: i. S-MIAL WUMG INSPECTOR AN -MR COMMERCIAL DATE: PERMIT'SV N/A: 6. PLUMBING INSPECTOR: DATE: N/A: 7. FIRE DEPARTMENT. DATE: -- - N/A: COMMENTS: it RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: Whmcwy-BaildnDWL - Pmtcopy -WatrDept' - YdkmCopy -HMM►Dept. t- PmkCOPY - DWL - GWl W-FireDgtC wryatim ,uttor's me t # this is a rner lot, zte in name street. * PLOT PLAN ' 7 . Ix FOR LOT # 'cate location of garage or accessory building „ Additions with dashed lines -------------------- a,: ` Sewerage disposal (cesspool) lip.� Well � I I I(lot..... . / 6U ......ft. rear) a� 40 4 0 i REARYARD .....::� lv ...ft. I SIDE YARD SIDE YARD HOUSE (G (� FT SET BACK ...�5.�..ft. 36 (lot..................ft. frontage) Abutt Name Lot ; If tt' corn writ name a other b stre� h (NAME OF STREET) Information�rG�: Supplied by .RK NORTH POINT. ,mw G TOWN �O�F='' JUN 2 002 U =�83-� AT. Location-1.4 /-0�, n+d a V t APPLICATION FOR PERMIT TO DO GASFITTING (OFFICE USE ONLY) By -Qc'"� Fee: $ 3 P' PERMIT NO.- oZ _ ISO I Date F / 2_o To o2 Owner's Name 20 rk4-&&d50Ns Type of Occupancy0 Lo-;�- � I'l 0 q_ New Ui'� Renovation Ir Replacement Na� •1 Plans Submitted Yes ❑ No ❑ Ycc N Cn cc UO Q cc N W Lu y¢ O 0 m t Z = 0W ¢ ¢ O H w w 0 U) a Q N N C3 W Q = Z Q O W > W W W Z J H Z W W V, O LL W V W J co F- W Z W W J W¢ H F 3 >. N m Z O Z ¢ O to 2 = 0 0=LLD 0a g 0 cc >c 0.�o SUB-BSMT. BASEMENT j 1ST FLOOR 2ND FLOOR 3RD FLOOR (PRINT OR TYPE) Installing Company Name S eo PI at,\6i as $' 45-1A Address U5l f-hikei RA, Check One: ❑ Corp. ❑ Partnership — E-Firm/Company V -Tin 8- 3S,4 - Business Telephone Name of Licensed Plumber or Gasfitter tJ S%o INSURANCE COVERAGE: Check One I have a current liability insurance policy or its substantial equivalent. Yes ❑ No ❑ If you have checked yes, please indicate t type of coverage by checking the appropriate box. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check One: Owner ❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and Information I have submitted (or entered) In above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Signature of Licensed 17Plumber or Gasfitter atiya-"� License Number TYPE LICENSE: GD11rmber 11 Gasfitter 13 Master ❑ Journeyman (OFF16E USE ONLY 1j .r�:.r ,'- � • is .. Building Location: Owner's Name: Owners Address: Dvmees Telephone: aasfitter Name: ! icense Number. Company Name: Company Phone: INSPECTION REC Recorded By PERMIT NO. Permit Fee: Payment Type: Check Number: Issue Date: Type of Work: Comments: Date Note Progress - Corrections and Remarks Inspector ` 7-IL'� .a Date Printed: 511 M2 OF Y19 i? V +l = WTT1U1!!5{ �o a' TOWN OF YARMOUTH APPLICATION FOR PERMIT TO DO PLUMBING (OFFICE USE ONLY) C By Fee: $ JUN 2002 PERMIT NO.' Date Building Owner's AT. Location 3 Z "V-1- 14 ► of Aea t Name _;91 6`a u n so me �y c.lo.nwtj y44n Type of Occupancy Ow [I; Ala New ❑ Renovation 01, Replacement Q�' Plans Submitted Yes ❑ No ❑ z N z y y J V Z Z W W Cn y y J (A cc Q M Q Z 7 f7 Z_ v7 Z D: D: O W y Q W N a _Z a a a 3 V Z m 0: y W } 0 Z G O Q OJ M W 0 �330 W Q U) =3 Q W -' N °C �4le J Z 0 o� M LL CC 3 Y QQ J m 0 0 0 Q0z J = FQ- N LL O D O Q ¢ Qm 0 SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR (PRINT OR TYPE) Check One: Installing Company Name -�S, ❑ Corp. Address Las wI b byes PgAll ❑ Partnership f CI A [?firm/Company Business Telephone SOX -:1c `/` /�9cV Name of Licensed Plumber SoN Sco-l-f INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent. Check One: Yes ❑ No ❑ If you have checked YES, please Indicate the type of coverage by checking the appropriate box. A liability insurance policy Q- Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance voerage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent I hereby certify that all of the details and Information I have submitted (or entered) In above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Check on Owner ❑ Agent ❑ Signature of Licensed Plumber 6el yya3 License Number Type: Master ❑ Journeyman 0--- c E I v E Comawntt a(k of R ooff/cial Use Only p .1JsPartmrntof .1' ar6ite!` 1 9 2011 a it No. r t /-- I ?i77O BOARD OF FIRE PREVENTIO upanand Fee Checked � $T. [Rev 1/07] (leave blank) APPLICATION FOR PERMI ORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrigal Code (MEC), 527 CMR 12.00 (PLEASE PRINT EVINK ORTYPE ALL INFORALITION) Date: Y//2 1/ / City or Town of: 3Zt4{1 (%rffA,-v h To the Inspector ofWires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) ,' 14n Jhp�,-,, e4 Ake Owner or Tenant Owner's Address Telephone No. Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: No. of Meters No. of Afeters r'm"nlotinn nfthe fn//nwln" mhle ......, A. 1....i.. b....,.....- .Jw:... No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans o• Qt Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ n. ❑ rnd. rnd. 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 Burners o. of Detection an Initiating Devices No. of Ranges No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers eat Pump Totals: umber Tons o. oSelf-Contained Detection/Alertin g Devices No. of Dishwashers Space/Area Heating KW Local ❑ AlunicipalEl other Connection No. of Dryers Heating Appliances KW SecuritySystems:* No. of Devices or Equivalent o. o KW heaea ters o. of o. o Signs Ballasts Data Wiring: No. of Devices or Equivalent No Hydromassage Bathtubs No. of Motors Total IIP a ecommumcat►ons Wiring: No. of Devices or E uivalent OTHER: p� Attach additional detail if desired or as required by the Inspector of Wires. _ U 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 coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE M BOND ❑ OTHER ❑ (Specify:) Self Insured I certify, under the pains and penalties ofperjury, that the information on this application is true and complete. IRAINAAIE: ADT Security Services Inc. LIC.NO.: C-45 Lic nsee: _ Mark A. Brophy Signature LIC.NO.: C-45 (If applicable, enter "exempt"in the license number line.) Bus. Tel. No.• 7 81- 3 5 5 - 5 619 � Address: 410 University Avenue Westwood, MA 02090 AIt Tel.No.M 500 *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. 00953 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 NJ Signature Telephone No. PERMIT FEE: $ 01 TOWN OF YARMOUTH Building Department Town Hall Yarmouth, MA 02664 (508) 398-2231 ext.261 P Building Location: Owner's Name: Owner's Address: a Owner's Telephone: Plumber Name: License Number: Company Name: Company Phone: PERMIT TOW PLUMBING WORK (OFFICE USE ONLY Recorded By. PERMIT NO. Permit Fee: _ Payment Type: _ Check Number. Issue Date: Type of Work: Comments: INSPECTION RECORD Date Note Progress - Corrections and Remarks Inspector 74o - O 7— P w le1 r Date Printed: 5/16/02 ti=15 SlipGen- Portal Hone Document Category Map -Block Number Street Number Street Name Department Parcel ID Backfile Batch Scan Document? Additional Naming Info Index Operator Date - Time Town of Yarmouth Template [Building Dept] Slipsheet Identifier [sg26616] Building Permits 060.56 0032 LAKELAND AVE Building 8759 No Operator, Yarmscan 2015-06-05 - 12:23 tt0:/Aaserfiche1Z'SlipGeN 1/1