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Home My WebLink AboutBuilding PermitsPERMIT 762 LOT B159 aa/ Kennedy, Mrs. Virginia 34 Highland Street West Yarmouth, MA 02673. Re -roof over 1 layer SHEET 16 11/21/97 11/21/97 y-;z7-9f (::�_D $1,800.00 ofF TOWN OF YARMOUTH Building Department BUILDING (508) 398-2231 ext.261 . PERMR NO FB-07-1241_ : ISSUE DATE : _ 4/30@007 _ : PROPOS E - - - - - - - - _ _ , PERMIT APPLICANT Lawrence Kenney" ' " - - - " " - " " " ": JOB WEATHER CARD --- PERMIT TO Ad?lion ' AT (LOCATION) 10034HIGHLAND ST ZONING DISTRICTE5 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 28.117 BUILDING IS TO BE: C ONST TYPE® USE GROUP R-4 LOT SIZE constrict 20 x 14 sunroom on edsting de REMARKS new slider in bedroom as per plans dated i t#jC2%d@a%with a �ipnnecting 18 x 9 deck Instal AREA (SOFT) . EST COST ($ 531, PERMIT FEE ($) OWNER ISEARSE, LEONARD E BUILDING DEPT BY ADDRESS Main Street esbury I MA 101913 INSPECTION RECORD CONTRACTOR LICENSE 005609 100 Sullivan Road ' West Yarmouth MA'02673 5083641112 PHONE 19783883912 '-- FIELD COPY .:Note riProgress- • r WE _— I• �� /4r,� _�� / - /fir J w TOWN OF YARMOUTH Buslding Department g U I L DI N G _ _ _ _ _ _ " _ . (508) 398-2231 ext261 '- PERMIT NO FB 05-1373 _ _ _ PERMIT ISSUE DATE 5/26J2005 _ ; P < APPLICANT 'Lawrence Kenney ' " JOB WEATHER CARD PERMITTO Addttion ' AT (LOCATION) 100034HIGHLAND ST O G DISTRICTK2fl Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 028.117 ING IS TO BE: CONST TYPE 5-B USE GROUP R-4 LOT SIZE CONTRACTOR constrwt addition to expend existing garage. add 16 x 20 deck as per plans dated 05/09/05. LICENSE 005609 REMARKS AREA (SO FT) EST COST ($ 518 OWNER 11.9onard Bearse ADDRESS 9 Main Street [Amesbury IMA101913 J PERMIT FEE ($) BUILDING DEPT BY INSPECTION RECORD /&5X4tAvRoad say W, roJAvth MA 0211M 7— FIELD COPY Date Note Progress - Corrections and Remarks Inspector —3-0 a m of l 1 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00 TOWN (PLEASE PRINT IN INK OR 717 To the Inspector of Wires: By this work described below. A Location (Street & Owner or Tenant _ (OFFICE USE ONLY) (Rev. 9M'S) By Fee: $ uy U ( ) rJ�UuN 1 ZOO7 PERMIT NO. 197- 43 9' ins o LINFORMATIO - Date: ication the undersigned gives notice of his or her intention to perform the electrical #1 c?A Z�66 J/ w�TyZ IZ No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑No (Check Appropriate Box) Purpose of Building ZeRzo n cSU i7 400 nn Utility Authorization No. Existing Service EE Amps /-'IV I o2VO Volts OverheadO Undgrd No. of Mete JINeWService Amps / Volts Overhead❑ Undgrd❑ No. of Meters 0 Number of Feeders and Ampacity -- -- - -- - - 7" ice c� �ctOo� S 5-Location and Nature of Proposed electrical Work: L\ Completion the ollaving ruble may be waived by the l or Wimr No. of Recessed Luminaires o. o otal Transformers KVA No. of Luminain Outlets No. of Hot Tubs Generators KVA No. of Luminaires Above n- SwimmingPool md. ❑ d. ❑ o. o g ung BatteryUnits No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones o. of Switches No. of Gas Burners o. o tecuon and InitiatingDevices No. of Ranges lotal No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers Heat mp Totals: um r ors — -- No. of Selt-Contained Detection/AlertingDevices No. of Dishwasher Space/Area Heating KW 11°`c'p ❑ Other Local ❑ Connection No. of Dryers Heating Appliances KW S No of Devices « Equivalent o. of Water Heaters KW No. o o. o signs Ballasts mngg. � No. of Devices or uivalent No. Hydrornassage Bathtubs No. o[ Motors Total HP Telecommunications anrag: No. of Devices or uivalrnt Attach additional detail if desired, or as required by the Inspector of hires. LJRANCE COVERAGE: Unless waived b owner. no permit for the performance of electrical work may be issued unless the licensee provides ^'tp f of liability insurance including " teed coverage or its substantial equivalent. The undersigned certifies that such coverage is in force. and has exhibited proof of sameConic permit issuing office. / % CHECK ONE: INSURANCE / BOND❑ OTHER❑ (Specify:) �jy� �/ 6 Estimated Valu of Electrical Woik: / �OD (When requited by municipal polity.) man Work to Start: —f -O Inspections to be requested in accordance with MEC Rule 10, and upon completion. 1 certify, under the and penalties of that the informati on this aP�tca *cm is true and complete, q�/q FIRM NAME: c�0� D A i! '0 Lit S (If abef/N VVAw1 LIC. NO. gus. Tel. No.: M 4.WloyfAlt. Tel. No.: . *Sccurity System Contractor License required for this work; if applicable, enter the license number here: OWNER'S LNSI:RANC'E WAIVER: 1 am aware that the Ucensee 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 owners agent Owner/Agent 3 f-�-�ttt4 c.A yb (W. '1,1, j 34 9t6 wwrig (Pi -P/) a. r^1f As 'a t F'41t� 1 ■� .�' ��•��.+tom .. �' � r� APPUCATION FOR PERMIT TO DO GASFrMNG TOWN INbOYH11 (OFFICE USE ONLY) By JUL 1 2 2007 I Fee: $ 35110 PERMIT NO.� _ UO Building /�� / Owner's O AT: Location Name AG Type of Occupancy New❑ Renovation 0�' Replacement ❑ Plans Submitted Yes ❑ Noe Y = y Ito W 0¢ to O CA 4¢W1 FF N N a V + W Q O ¢> W 1 `V1 y 2 x o a x R S 3 c r, 3 ou o > a o. r- o SUB-BSMT. BASEMENT 1ST FLOOR l 2ND FLOOR 3RD FLOOR (PRINT OR TYPE) Installing Coml Address 01 Business Telephone Name of Licensed Plumber or Gasfitter Check One: ❑ Corp. ❑ Partnership — EPM09VCompany INSURANCE COVERAGE: / Check e I have a current liability Insurance policy its substantial equivalent Yes No ❑ If you have checked yes, please indica1 a 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 Klass. 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 1 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. tl�' q��Y� Sigybar re of Licensed (��/LO/I r or Gasfitter License Number / TYPE LICE E: Plumber ❑Gasfitter Master ❑Journeyman NOTES 11 .toe NO. Yo4-16 1. LOCOS IS A.M. 26, PARCEL 117. B°�°' 2. ELEVATIONS SHOW ARE NGVD29 BASED UPON T.O.Y. MON. 3. 3. LOCUS IS IN FLOOD ZONES Al2(EL10). B &C ON FIRM DATED A LY 2. 1992. 4. OFFSETS SHOWN ARE TO THE CORNERBOARDS ON EXISTING BUILDINGS. OR TO FOUNDATION ON NEW CONSTRUCTION. S 82 43.45. E 8214'CJ EN LISH _ _ w APPROX. LOCATION FROM ®L o m ASBUILT INFORMATION co h w R.C. PIPE LV 04 RAIN= ccy CIO, _ 24.2 I N =b— N N ASEMENT� _I 24.1' v N EAST. ti 21.3 1 GAR NE L v I a I ^ ' E ENc I I o: PORCH I o I �► 303 %. I `D "--__ S.F � I vi .i PcmI �' : ............. 0 0 _ I EXIS71NG x `HOUSE I La N034 25.4 . SHED /� TOP CENTER Y I p -siaio BOUND NcvD29 1623 S,F W 20.0•w o w N cli 0P� N 24.4' i. ? 20.1' W < / CV .......... .......... . . .......... 29.4 o3j �oQ /e a PARCEL P �"NN10,0 30fS3 � N WIC $n v� N/F Q 0 o N a) / `CAPE COD H SPITAL o vi 1n ^ �' U IN811 w v rnI A%4,ro � I CERTIFY THAT 1NE LOCATIONS SHOWN ON THIS PLAN WERE MEASURED N THE FIELD ON 7/27/04 AND 6/11/07. N /F l ASBUILT PLAN !` FITZGERALD I FOR lt-/ LEONARD E. B 1e PARCEL B. 34 HIGHLAND STREET. W. AUGUST 16. 2004 SCALE. ti I �lo� � L CADILLAC. �PSANITARIAN P.O. BOX 236 am)VED ON DECK WEST YARMOUTH. MA 02M REV. 6/11/07—A59ULT (WO) 7TS-9700 s mr a MAW a 02007 BY R..L CADLLAC MA z 1' ► OTES JUFf NU. TV' 1. LOCUS IS A.M. 2a PARCEL 117. 2. ELEVATIONS SHOWN ARE NGVD29 BASED UPON T.O.Y. MON. 3. 3. LOCUS IS IN FLOOD ZONES Al2(EL10). B &C ON FIRM DATED JULY 2, 1992. 4. OFFSETS SHOWN ARE TO THE CORNERSOARDS ON EXISTING BUILDINGS, OR TO FOUNDATION ON NEW CONSTRUCTION. FILE CO 3 82 43'45' E N 82.14 0 EN USH RAIN EXIST GARAGE EXISTING HOUSE N0. 34 1623 S.F. JPARCEL E 10,090±S.F. APPROX. LOCATION FROM m ASBUILT INFORMATION 4�. R.C. PIPE 0 tm_ 6 `NEW CL PORCH ... ..i: O / li N 25.4' .:: o. II I0�<CwN W fC'.4 19.g- ExiIsltzi 4N0 29. 2/ / CL o� ,tu W 8 in U Lu ZINn� 3 N/F / N h/ / /vCAPE COD HOSPITAL W IJ a / U WI I CERTIFY THAT THE LOCATIONS SHOWN ON THIS PLAN WERE MEASURED IN THE FIELD ON 7/27/04 N/F ASBU AND 6/„/07. FITZGERALD FORILTPLAN t"0F" s LEONARD E. BEARSE o T D N 8, 34 HIGHLAND STREET, W. YARMOUTH. MA J � a g ti �� UGUST 16. 2004 SCALE. 1'=20' v R�G RONALD J. CADILLAC. PLS. RS. P.C. ONAL LAND SURVEYOR t REGISTERED SANITARIAN P.O. B= 256 REV. 6/11/07—ASBULT J\� WEST YARMOUTH. MA 02673 REV. 9/20/06--ASBUILT g (506) 775-9700 e .nnAv_Am cr r rvtuN C 7 BY R.,L CADRIAC __ ONE & TWO FAMILY ONLY - BUILDING PERMIT APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING Town of Yarmouth Building Department 1146 Route 28 - Yarmouth, NIA 02664-4492 Tel: (508) 398-2231 x261 - Fax: (508) 398-0836 aW JI OTV Use Only Permit No. �' 15 eo Permit Fee $m. n Deposit Rec'd. $ k Dat Net Due $ Z , Planning Board Information Type En rsement Date Recording Date an No or Assessors Department Irdomlabon: Map to New 1.4 Property Dimensions: Lot Area (st) Frontage (it) Lot Coverage This Section for Office Use Only Building PeT2iMmber Date Issued: Signature: - - Building ORicial - Date Certificate of Occupancy Is Is not - required Section t - Site Information I Use Group: R-4 Type: 5-B 1.1 Property Address: �3—ji al--, h,14 J 6 eT 12 Zoning Information: 2_5 Zoning District Proposed Use W 0 3 Zya/r ya j 71/ 1Y14 1.3 Building Setbacks (ft) _ Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided O O O, 1 A Water Supply (M.C.L C. 40. S 54) Public ✓ Private 1.5 Flood Zone Information: _ Comments: - Zone: BFE: Agent Section 2 - Property Ownership/Authorized 21 wrier of Roca _ �tl I f3 -5 'i2— e s Name (print) Masing Address S ure Telepho a Fax E-mail 2. Authorized gents ,, n e,vC� a 4>f 00 5Cj1111.fiV Ke0 to r fsoo Name ) Signature Telep ax1111 APR 2 0 2007 ' U Section 3 - Construction Services 7.1 Cleansed Constructor Su sor. ,(AuJ/ eUCL ni 2 tie B ILDING �!� '4,,INGCc (c �s 00 N o v Lk vo 7 0 Address Expire D to 00 8r - Tele hon q FEgxp �., E- t O$ 6/loot J5 00 77 % W aC % qon! i �d AddressfDatA 0V__0oio L w 'Y1/1-foc• a/vi' 9r3o v 0/913 IMo nvrp Section 4 - Workers' Compensation Insurance Affidavit (M.G.L c. 152 S 25C (6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit Signed Affidavit Attached Yes .......... No .......... Section 5 - Description of Proposed Work (check an applicable) New Construction I No. of Bedrooms No. of Bathrooms Existing Bldg. ❑ Repair(s) a I Alterations ❑ I Addition t f Accessory Bldg. ❑ Type Demolition Other Specify: Brief Description of Proposed Work: '/ O / / xi G c0 O N �1�� Dc r- /1 v Al e c P eW / A; CcV 00 QW w N 0vJ (*- RptfS (i cy W Rk `6- Check Below ❑ Conservation -Commission Fling (d applicable) ❑ Old I(Ings Highway 3 Historical Commission approval (n applicable) Section 7a = Owner Authorization - To be Completed When Owner's Agent or Contractor Applies for Building Permit I; —Jf0A)AACV 9, BGA MQ L , as owner of the subject property hereby authorize �yJ�'e Ac e, K. a 0 u 0 my behalf ail matters relative to work authorized by this bull ��— Signature of Owner V to act on permit application. 3-�G-a7 Date , as Gwwr/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. BA3G t Print name Signature of Owner/Agent v¢ —�— Date J 9-15-99 2 of 2 3� "Rse TOWN OF YARMOUTH �UF"i BUILDING DEPARTMENT ��—��FFFF"""" CONSTRUCTION SUPERVISOR FORM PLEASE PRINT: job location: Number Owner of Property: Construction Address: Licensed Designee: (If other than Supervisor)' Name 2.15 Responsibility of each license holder: LAP No. License No. -n/a 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building and structures only pursuant to the state building code and all other applicable laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Anylicensee who shall willfullyviolate subsections 2.15.1, 2.15.2 or 2.15.3 or any other section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: I have a current liabi ity Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch.152 Yes No ❑ If you have checked yo, please indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of Indemnity ❑ Bond ❑ OWNER'S IN CE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter a Mass. Gen I ws, and that my signature on this permit apprication waives this requirement Check one: Owner Agent of Owner or Owners 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 pr"xisting 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 contradors, with certain exceptions, along with other requirements. I j Address of Work Owner Name: _/. V, �u AJ u �� p A Ad `e Date of Permit Application: 4,*7— I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under $1,000 Building not owner occupied Owner pulling own permit Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner. 3 cv % JAVA&,"c6e Registration No. Date Contractor Name OR. Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property* Date Owner Name The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 UIV www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers o r I.. nta., MMA City/State/Zip:�. o TN 7 Phone M 406, It y- i I/ y Are you an employer? Check the appropriate box. Type of project (required): 1. [0 1 am a employer with _ 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).' 2. ❑ I am a sole proprietor or partner- have hired the subcontractors listed on the attached sheet 7. QRemodeling ship and have no employees These sub -contractors have g, ❑ Demolition woriting for me in any capacity. employees and have workers' inwz=c t ilding addition 9. tectrical [No workers' comp. insurance required.]5. comp. ❑ We are a corporation and its 10repairs or additions 3. ❑ I am a homeowner doing all work officer have exercised their 11.❑ Phunbing repairs or additions myself, [No workers' comp right of exemption per MGL 12.0 Roof repairs insurance required.] t e.152, § 1(4). and we have no employees. [No workers' 13.❑ Other'Des✓gS coup, insurance required.] Any applicant Out clweb box /I nut also all out raw ration below showing niee'v workers' compenutim polity infornatlm. / t Homeownm who submit this affidavit indicating dwy are doing as wont and dm bite outside emencton nut submit a new affidavit indicating arch. 1Cmtraetaa Out check this box nut awdod an additional ghat ahowing the name of the subcontractors and a= whether or not Otore entities have en pk yen. If the subcontractors have angbyea, they nut provide Ouir workaxI mrtq. pofiey, number. lam an employer that is providing workers' compensation insurance for sty employees Below Is the policy and Job she Information. Insurance Company Name: Policy # or Self -ins. Lic. #: W C o // ,3 Expiration Date: 1 f',�� 190d 8 i Job Site Address: t3 y ,V n ,6 .1,/ City/State/Zip:_fW r tY o a y Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S 1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investitrations of the DIA for insurance eoversize verification. I do hereby certify the pains and penalties of Bury that the Information provided above Is true and correct i Q . 3 a7 — Phone• ))it, ofyictalusconly. Do not write In this area, to be compVefed by e or town official, City or Town: Peruduucense # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk' 4. Electrical Inspector S. Plumbing Inspector 6.Other Contact Person: Phone #: Information and Instructions Massachusetts General Laws chapter 152 requires all employees to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. however the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the Insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), addresses) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policyis required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self -insured companies should enter their self-insurance license number on the awromiate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sue to fill in the permittlicense number which will be used as a reference number.. In addition, an applicant that mast submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-7274900 ext 406 or 1-877-NIASSAFE Revised 11-22-06 Fax # 617-727-7749 www.mass.gov/dia t TOWN OF YARMOUTH 1146ROUTE28 SOUI'HYARMOUTH MASSACHUSMS02664-4451 Telephone (508) 398-2231, ExL 261 — Fax (508) 398-2365 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT BUILDING ELECTRICAL GAS PLUMBING SIGNS Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulfrom the proposed work/demolition to be conducted at Sri yhy tin . S1 w , -%n Ko ul H Work Address is to be disposed of at the following location: fA kJ`.o0'L17C 116. 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. 1, Date is Temp Permit No.: Applicant Name: Applicant Phone: Building Location: Owners Name: Owners Addres TOWN OF YARMOUTH Building Department Town Hall Yarmouth, MA 02664 (508) 398-2231 e#.261 BUILDING PERMIT TRANSMITTAL T-07-454 Lawrence Kenney 5083641112 0034 HIGHLAND ST BEARSE, LEONARD E 209 Main Street Amesbury 0 MA 01913 Owners Telephone: (978) 388-3912 REVIEWED BY: 1. WATER DEPARTMENT: 2. ENGINEERING DEPARTMENT: 3. CONSERVATION: 4. HEALTH DEPARTMENT: 5. BUILDING DEPARTMENT: 6. FIRE DEPARTMENT: COMMENTS: RECEIPT OF COPY. I (OFFICE USE ONLY Recorded By. Ic Permit Fee: $0.00 Deposit Rec. $25.00 Payment Type: Check ChkNo.: 1279 Net Owed: ($25.00) Application Date: 420/2007 Issue Date: Expiration Date PLEASE NOTE SIGNATURE OF APPLICANT: Comments: Map/Lot: 028.117 construct 20 x 14 sunroom on existing deck, construct 5 x 12 deck with a connecting 18 x 9 deck, install new slider Inp9droom DATE: DATE: DATE: DATE: DATE: DATE: An as built plan must be submitted to this department prior to foundation inspection or any furlh%&onstruction. wA: N/A. - N/A. N/A: N/A: DATE: Date Printed: 426✓2007 TOWN OF YARMOUTH 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664 Td (508) 398-2231 — Fax (508) 398-0836 Town of Yarmouth Conservation Commission Building Perm)t Sign -off Application Cons. Comm. Received Date: 0/09/0 Property Owner. O"A ,, 2 e.— v7 y N// Construction Address: f c//,0/1,. v .S--r. Assessors Map and Parcel: MAP /�PARCEL // % General Contractors& &- J ek ca A. IS-e x t.. e y Company Name and Address: /a O [A n/ �, Company Project Description: na N kOd P,( 0 /U Q 0 SI 1-4 Contractor Plan Submitted: Title Date Revision Date Conservation Commission Filing Required: YESA NO If Yes, Type of Filing: Notice of Intent Request For Determination OfAppliability-& Conservation Commission Sign -off Signature: Date: 45 Nfflad " RaytlW ftW CONSERVATION COWAISSION D c-c TOWN OF YARMOUTH HEALTH DEPARTMENT PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Building Site H sV/j WILY,1+0 No.a & Lot No.: 117 C. tom— o 0 Tel.No.:_3G z/ 00 sp!/t rS,ltw Date Filed: •*Ijyou would like e-mail notification ofsign off,please provide e-mail address: Owner Owner Address: vZ O i 13-eA%'.S ta— RESIDENTIAL AND/OR COMMERCIAL BUILDING �S- Tel. No.: ?,7;F 9/ Z HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. Please submit four (4) copies of plans, to include: (L) Site Plan showing existing buildings, water line location, and septic system location; (2.) Floor plan labeling ALL rooms within building (all existing and proposed) — Note: Floor plans not required for decks, sheds, windows, roofing; (3.) If necessary, Title 5 application signed by licensed installer REVIEWED BY: PLEASE NOTE rnK4m PMTC trnTrnlTrnwc TOWN OF YARMOUTH WATER DEPARTMENT 99 Buck Island Road West Yarmouth, MA 02673 Telephone: (508) 771-7921 • Fax: (508) 771-7998 BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET Bldg. Site Location: 3/-/ 1-11,r111A,wd/ s Map #: Proposed Improvement: %!5'0 V Applicant: Address: ied 0. Ste!/ v`bw e� p Tel. #: 5zf" YO V Lot #: ICI. Date Filed: RESIDENTIAL AND / OR COMMERCIAL BUILDING n 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; Le. If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Ocean, Bogs, Bays, Marshland, Etc.. Health Department Determines Compliance to Stat and town Regulations' i.e., Requirements for Septage Disposal and other Public Health Activities. Fire Department: Determines Compliance to State and Town Requirements for Personal Safety, Property Protection; i.e. Smoke Detectors, Sprinkler Systems, Etc.. REVIEWED BY WATER DMSION: 3-A.7-v7 signature date PLEASE NOTE: COMMENTS: SERVICE /NO. �83L3l- 7s/ NAME STREET VILLAGE METER NO. 'I 3° ?,1e \ try O .16,g' ' b /V �ecFr "vyI s7�iPce7L' sIr Massachusetts Department of Environmental Protection kiijBureau of Resource Protection - Wetlands WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Town of Yarmouth Wetland By -Law, Chapter 143 Important When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. -Q ICI neral Information From: Yarmouth Conservation Commission To: Applicant Leonard Bearse Property Owner (d different from applicant): Name 34 Highland Street Mailing Address Mailing Address West Yarmouth MA 02673 Cityrown state Tip code Cityrrown state zip code 1. Tdle and Date (or Revised Date If applicable) of Final Plans and Other Documents: To construct a sunroom and wooden deck a 34 Highland St, W.Yarmouth 3-9-07 Title Date Date Title Date 2. Date Request Filed: 3-30-07 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 (d appricable): To construct a sunroom and wooden deck Project Location: 34 Highland Street West Yarmouth Street Address Cltyrrown 28 117 Assessors Mapfftt Number Parcel/Lot Number wpdwn2Ax-w. YLOS Page 1 of 5 Massachusetts Department of Environmental Protection V Bureau of Resource Protection - Wetlands WPA Form 2 —Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Town of Yarmouth Wetland By -Law, Chapter 143 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) or order of Resource Area Delineation (issued following submittal of Simplified Review ANRAD) has been received from the issuing authority (I.e., Conservation Commission or the Department of Environmental Protection). ❑ 1. The area described on the referenced plain(s) Is an area subject ID 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 w 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 afterthat 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 or ANRAD Simplified Review (if work Is limited to the Buffer Zone). ❑ 5. The area and/or work described on referenced plan(s) and document(s) is subject to review and approval by: Yarmouth Name of Municipality Pursuant to the following municipal wetland ordinance or bylaw: Yarmouth Wetland By -Law Chapter 143 Name Ordinance or Bylaw citation wprkmadm-wv. 3nX5 Pma2dS Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 2 —Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Town of Yarmouth Wetland By -Law, Chapter 143 B. Determination (cunt) ❑ 8. 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 ahematives. (Refer to the wetland regulations at 10.58(4)c. for more Information about the scope of ahematives requirements): ❑ Aftematives limited to the lot on which the project is located. ❑ Aftematives limited to the lot on which the project is located, the subdivided lots, and any adjacent lots formerly or presently owned by the same owner. ❑ Aftematives limited to the original parcel on which the project Is located, the subdivided parcels, any adjacent parcels, and any other land which can reasonably be obtained within the municipality. ❑ Aftematives 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 after an Area subject to protection under the Act Therefore, said work does not require the filing of a Notice of Intent, subject to the following conditions (d 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 Massachusetts Department of Environmental Protection L, Bureau of Resource Protection - Wetlands i WPA Form 2 —Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Town of Yarmouth Wetland By -Law, Chapter 143 ❑ 5. The area described In the Request is subject to protection under the Act Since the work described therein meets the requirements for the following exemption, as specified in the Act and the regulations, no Notice of Intent Is required: Exempt Activity (site appieab statuatorytregulatory provisions) ❑ 6. The area and/or work described in the Request is not subject to review and approval by: Yarmouth Name of Municipality Pursuant to a municipal wetlands ordinance or bylaw. Yarmouth Wetland By -Law C. Authorization This Determination is Issued to the applicant and delivered as follows: ❑ by hand delivery on Date Chapter 143 Ordinance or Bylaw CNetion ® by certified mail, return receipt requested on 6-20-07 This Determination is valid for three years from the date of issuance (except Determinations for Vegetation Management Plans which are valid for the duration of the Plan). This Determination does not relieve the applicant from complying with all other applicable federal, state, or local statutes, ordinances, bylaws, or regulations. This Determination must be signed by a majority of the Conservation Commission. A copy must be sent to the appropriate DEP Regional Office (see Attachment) and the property owner (J different from the applicant). 4-20-07 Date wpokmadcc • m 3niO3 NP 4 a e Massachusetts Department of Environmental Protection L, Bureau of Resource Protection - Wetlands i WPA Form 2 —Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Town of Yarmouth Wetland By -Law, Chapter 143 The applicant, owner, any person aggrieved by this Determination, any owner of land abutting the land upon which the proposed work is to be done, or any ten residents of the city or town in which such land Is located, are hereby notified of their right to request the appropriate Department of Environmental Protection Regional Office (see Attachment) to Issue a Superseding Determination of Applicability. The request must be made by certified mail or hard delivery to the Department, with the appropriate filing fee and Fee Transmittal Form (see 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 Beady and concisely the objections to the Determination which Is being appealed. To the edent 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. wpdawzmc• wr. angs P•w s a e NOTES JOB N0. Y04-18 I. LOWS IS A.M. 28. PARCEL 117. 2. ELEVATIONS SHOWN ARE NCVD29 BASED UPON T.O.Y. MON. 3. 3. LOCUS IS IN FLOOD ZONES Al2(EL10). B &C ON FIRM DATED JULY 2. 199Z 4. OFFSETS SHOYM ARE TO THE CORNERBOARDS ON E705TING BUILDINGS. OR TO FOUNDATION ON NEW COFISTRUCRON. S 82 43'45' E N 82.14•EN USH ><APPRO. LOCAT'�Ch 1.1 FP^ASBU!_T INFOPMAT�C% t0 .3 N � A ,� � Lrl r_ J 24.1. E)aSL BLK. FOUND., (I35. EXIST ST GARAGE DE SO V 11 in N 6 C / y19.3 co ' i o ; EXISTING ; t 'gig , HOUSE ,j 1 t=�, TOP CENTER L NO. 34� STONE BOUND -13.10 NM29 o z - IL 24.4' _ IN 0�2 N � Q �/ N Trellis I w �h/ / m ......:: 9.4'� N oQ 2a a o R PARCEL B / s� N 10,090±S.F. o • h A/ �/ 3 'tin n t`T Li C) ova N/F p c ai n\o M I % / /CAPE COD HOSPITAL o 1. o ui <� / OMC D 80.45' N 81s5 W MAR 2 9 2007 I CERTIFY THAT THE LOCATIONS SHOWN ON THIS N/F ASBUILT PLAN HEALTH DEPT. PLAN WERE MEASURED M THE FIELD ON 7/27/04. FITZGERALD FOR 1y`"0FM' s, LEONARD E. BEARSE PARCEL B. 34 HIGHLAND STREET, W. YARMOUTH, MA AUGUST 16, 2004 SCALE 1'=20' 'i4ti�sJ� `�. ° RONALD J. CADILLAC, PLS. RS "' •-' _ 1 I7 rf �O ! PROFESSIONAL LAW PSURVEYOR t REGISTERED SANITARIAN REV. 9/20/0B—ASBUILT �/ o VEST YAW p,�.7y�{��gy��(, pp��6�7T� REV. 10/7/04--ADDITION, SEPTIC. k DRAIN PIPE ©2= BY P.J. CAMAC (5) • `"w a CD%:FDiil"�ALL a�E'AS�� 3 a7- 07 . YAAMOUiN WATER OEPf DATE NOTES i JOB NO. Y04-16 1. LOCUS IS A.M. 28. PARCEL 117. Beane. 2. ELEVATIONS SHOWN ARE NGVD29 BASED UPON T.O.Y. MON. 3. 3. LOCUS IS RI FLOOD ZONES Al2(EL10). B A•C ON FIRM DATED JULY 2. 1992. 4. OFFSETS SHOWN ARE TO THE CORNERBOARDS ON EXISTING BUILDINGS, OR TO FOUNDATION ON NEW CONSTRUCTION. S 8243'45• E N 8Y.14'(J EN LISH Lu APPROX. LOCATION FROM O ®- ASBUILT INFORMATION oS N � N u 10* R.C. PIPE RAIN= = o 24.3 N �U fEASEM l _ ENT:;0— 24.1 • o EXISL Q _1 FOUNDS' I .. ;::....... EXIST. (^ I GARAGE DECK I 1 P " 4fco 0; >: z I� EXISTING .' -1s.3 " o . HO E :• s, :....:.. I a US f. TOP CEN1L72 L NO. 34^O STONE BOUND / 0 -13.10 NM29 `t S Z U N I_j D_ N 0�� N Trellis I a z A� ao \ Ln0 t aka fn o A 'ARCEL P �E2 .t Op LOCATIONS SHOWN ON THIS A IN THE FIELD ON 7/27/04. SEPTIC, h DRAIN PIPE w g n M l0 n^ �pV� N/F oWza / CAPE COD HOSPITAL f L3GC�C�OMGD N I MAR 2 12007 N/F ASBUILT PLM HEALTH DEPT. FITZGERALD FOR LEONARD E. BEARSE PARCEL 8, 34 HIGHLAND STREET, W. YARMOUTH. MA AUGUST 16, 2004 SCALE: 1'-20' RONALD d. CADILLAC. PLS. RS PROFESSIONAL LAND SURVEYOR t REGSTERED SANITARIAN P.O. BOIL 258 HEST YARYOUTF173 L,MMM TO ALL BY P-4 CADILLAC Lam) M ...In ncna ATYWC .QQ_ 3--Q-07 M WATER DEPT DATE BOISE- Double 1-3/4" x 11-718" VERSA-LAM(g) 2.0 3100 SP Roof BeamIRB01 BC CALC® 9.3 Design Report - US 1 span I No cantilevers 10/12 slope Monday, April 30, 2007 09:40 Build 057 Job Name: Mr. 8 Mrs. Leonard Bearse Address: 34 Highland Street City, State, Zip: West Yarmouth, MA Customer. Larry Kenney Code reports: ESR-1040 BO, 3-12" DL 1241 lbs St. 2306 lbs File Name: L Kenney_Bearse.BCC Description: RIDGE Specifier. Designer. Joe Madera Company: Shepley Wood Products B1.3-12' DL 1241 lbs SL 2306 lbs Total Horizontal Product Length - 15-00-00 Load Summary Live Dead Snow Wind Roof Live Tag Description Load Type Ref. Start End 100% 90% 115% 133% 125% Trib. 1 Standard Load Unf. Area (psf) Left 00-00-00 15-00-00 15 30 10-03-00 Controls Summary Value %Allowable Duration Load Case span Location Disclosure Pos. Moment 12501 ft-lbs 51.1% 115% 3 1 - Internal Completeness and accuracy of Input must End Shear 2941 Ibs 32.4% 115% 3 1 -Left be verified by anyone who would rely on Total Load Deft. U358 (0.487-) 50.2% 3 1 output as evidence of suitability for Live Load Defl. U551 (0.317-) 43.6% 3 1 particular application. Output hem based Max Deft. 0.487" 48.7°( 3 1 on building code -accepted design Span / Depth 14.7 n/a 1 rties and analysis methods. Installation of BOISE engineered wood products must be in accordance with %Allow %Allow current Installation Guide and applicable Bearing Supports Dim. (L x WI Value Support Member Material building codes. To obtain Installation Guide BO Post 3-12" x 3-1/2" 3547 Ibs 39.9% 38.6% Spruce -Pine -Fir or ask questions, please call (800)232-07e8 before installation. Bt Post 3-12" x 3-12" 3547 Ibs 39.9% 38.6% Spruce -Pine -Fir Column at Bearing 80 analyzed for bearing only, column analysis has not been performed. Column at Bearing B1 analyzed for bearing only, column analysis has not been performed. Notes Design meets Code minimum (L/180) Total load deflection criteria Design meets Code minimum (L/240) Live load deflection criteria. Design meets arbitrary (1") Maximum load deflection criteria. Member Slope - 0, consider drainage. Connection Diagram I c ej a minimum = 2" c = 7-7/8" b minimum = 3" d = 12" Member has no side bads. Connectors are: 16d Common Nails BC CALCO, BC FRAMER®, AJS-, ALUOISTO. BC RIM BOARD-, BCI®, BOISE GLULAM"-, SIMPLE FRAMING SYSTEM®, VERSA -LAM®, VERSA -RIM PLUS®, VERSA -RIM®, VERSA -STRAND®. VERSA -STUD® are trademarks of Boise Wood Products, L.L.C. APR 3 0 2007 BUILDING DEPT. By Page 1 of 1 j TOWN OF,YARMOUTH 13UUZING FZTUC t1F.CfRICJV. BUILDING DEPARTMENT PLUMBING Gns 1146 Route 28, South Yarmouth, MA 02664 ZONING 508-398-2231 ext. 261 Fax 508-398-0836 SIGN CODE Inspection and License Report Address ( c Business Name Date of Inspection fi'• / c — Contact t i l �, r / , ,I if Phone f • �/ c rt During the annual Inspection of your premises, performed In accordance with the provisions of Section 106 of 780 C11f t (Massachusetts State Building Code), the Board of Selectmen and/or the Board of Health rules, the following violation is) were observed: EgWAS ❑ Emergency egress signage 1ocation ❑ Emergency egress lighting t.ucation ❑ Egren door hardware Location • ' ❑ Maintenance of exib Location ` ❑ Guardslliaadrails location Mechanical ❑ Combustion Air Location ❑ Vents Location ❑ Storage in boiler moms Location ❑ Automatic door closures L.ocarion on boiler room door Smoke Detectors Location Othe t4/1 •,.., f / � . i ,/. U�,.� � ,,. / :._.�,r.,.� ✓ 1. ,• •f,' Deck/StairwayCertification 76 C f 1% �o 780 C1IR Section 103 DIAENMANCE provides that the owner, as defined in 780 Out Chapter 2, shaft be responsible for proper maintenance. In order to abate the above violadon(s) you must: ❑ h1 corrections immediately and/contact this office fora follow-up inspection. eorrectioos aitbin / r i cfe dayswnd mo�jt6s�offim ffm as follow-up inspection. �] Local official / Inspector Received By: ! 'r % tide Rev. 3104 Original -Premises Yellow -Building Department Pink -Laming Authority APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Cade, (MEQ, 527 CCMR 12.00 _ (OFFICE USE ONLY) �VI0 TH Br OCT 1 2006 Fee: $ PERMIT NO. L GD' vU (PLEASE PRINT IN INK UR1'FPE=rilRAfATION) Date: To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. i 1 11 t_. i/ - Location FJ 021001 erorTenant ) ,eO/7Dft 6C,ai�r-QiyTelephoneNo. 0 10 d r er's Address 7s permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box / T Purpose of Building" o�(9/,RO/y UtilityA orization No. 1113 / O % ODO a7 �L Existing Service la Amps 420 / iPW Volts Overhead Undgrd ❑ o. of Meters l New Service eZ- Amps �� Volts OverheadO Undgrd LTk►,/ No. of Meters o I o. ot total Transformers KVA No. of Li ht ng Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Above n- Swimming Pool gmd. gmd. ❑ o. of Emergency Lighting Banery Units o. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. o tecuon an Initiating Devices No. of Ranges No. of Air Cond. Total s No. of Alerting Devices No. of Waste Disposers Heat Pum Totals:— um r ons — — No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Munmrpa �--1 Other Local ❑ ConnectionLJ No. of Dryers Heating Appliances KW Security Systems: No. d vices or Equipvalent No. o Water Heaters KW No. o No. o Si Ballasts Data winng No. of Devices or uivalent [No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Winng: No. of Devices or Equivalent Attach additional detail if desired, or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless /thc owner, no permit for the performance of electrical work may be issued unless the licensee provides %4 proof yf liability insurance includingperation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, bird has exhibited proof of samt issuing office.A/nCHECK ONE• INSURANCE(��OQN�DQ OTHER (Specify) 0149 4�G'�.1 3/! /O% L V (/D (Lxpuauon Dare) Estimated Value EI cal ork: (When required by municipal policy.) Work to Start:�� OrInspections to be requested in accordance with MEC Rule 10, and upon completion. certify, under thy�per �trd nal '' m oof'uryit�at�hg information on this application is true and complete. p'! �FIRMNAME: /vGrG� c7 Gi1Or/t/C/� c1/ nppn LIC.NO. 1 < 7 9 Licensee: Signature LIC. NO. r— �If applicably fgt�gnpj^�tt thg li f{ttse gUmb�r lyne�4,` �0 Bus. TeL No.: Address: `ftl It L �7`d/ C/LJ LN (it/ AIL Tel. No.: OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee doc not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requiremenL I am the (check one) owner O owner's agent O Ownee/Agent Signature Telephone [Rev. 011001 • -r WPS - Permit Page 1 of 1 QNSTAR WPS - Permit Work Order Information Utility Auth/WO #: 01544397 Date: 09IM006 Company DAVID LENTINI Rep: Report By: HPK 34 HIGHLAND ST BEARSE LEONARD E Status: ACTIVE Service: RELOC Type: RES Nature of Work: UPGRADING & RELOCATING —RELOCATING OH TO UNDERGROUND, USING SAME POLE #12105...... UPGRADING 150A TO 200A ...ADDING 200SFT (SUNROOM).... LIGHTS/PWGS ONLY..... RESEAL AFTER INSPECTION Service Information: I There is no Service Information. I Permit Information Permit #: E07-368 Meters: 1 Reseal (Y/N): Y Date: 10/11/2006 Inspector: W10060 Description: Sear Last Detail ; Contacts NSTARHorne W RaLogcn WPC Help Comments Wo Request WPaNews l�JRH0 IDis r27� IT 0 Copyright 2003 NSTAR, 800 Boylston Street. Boston MA USA. Ali rights reserved. Reproduction It whole or in part of any graphics, Images, tart or other content at this web she must be granted by NSTAR, Boston, MA, USA. Unauthorized modification of any Information stored at this site may result In criminal prosecution. http://www.nstaron)ine.com/apps/wps/wpspermiLcfm?Page=Permit&Unique={ts_'2006-... 10/11 /2006 NOTES 1. LOCUS IS A.M. 28. PARCEL 117. Joe I Bean 2. ELEVATIONS SHOWN ARE NGVD29 BASED UPON T.O.Y. MON. 3. 3. LOCUS IS IN FLOOD ZONES Al2(EL10). B &C ON FIRM DATED JULY 2. 199 4. OFFSETS SHOWN ARE TO THE CORNERBOARDS ON EXISTING BUILDINGS, OR TO FOUNDATION ON NEW CONSTRUCTION. S a2 43'45' F EN USH W — 24 3 N 24.1' 4' z 1= EXIST. ir GARAGE I� 1 � �� EXIS 17NG I a HOUSE L c N0. 34 PARCEL E 10,090±S.F I CERTIFY THAT THE LOCATIONS SHOWN ON THIS PLAN WERE MEASURED IN THE FIELD ON 7/27/04. d r. REV. 9/20/O6—ASBUILT REV. 10/7/o4—ADDITION. SEPTIC, k DRAIN PIPE _--, Trellis I m l' W 2 Z NIW N WIQ APPROX. LOCATION FROM ASBUILT NFORMATION ,10'qPE �006 c� a 0e/ N v / Ni AQ D = 4oe a c / Q O N/F CAPE COD HOSPIT .N/F I ASBUILT PLAN FITZGERALD I FOR LEONARD E. BEARSE PARCEL B. 34 HIGHLAND STREET, W. YARMOUTH, MA AUGUST 16, 2004 SCALE. 1'=20' RONALD J. CADL AC. K.S. RS PROFESSIONAL LAND SURVEYOR t REGISTERED SANITARIAN P.O. am 255 WEST YARMOUTIt MA M073 BY R.J. CADILAC (506) 775-2700 ONE & TWO FAMILY ONLY - BUILDING PERMIT APPUCATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH AONE OR TWO FAMIL% *EWNG Town of Yarmouth Building Department 1146 Route 28 - Yarmouth, MA 02664-4492 Tel: (508) 398-2231 x261 - Fax: (508) 398-0836 Office Use Only Planning Board Information Assessors Department Information: t61 Permit No. -D5 Y3'6 nd ement Date a Map Lot Permit Fee $ / R ing Date New Deposit Rec'd. $ Date No 1.4 Property Dimensions: Net Due . $ Other Lot Area (st) Frontage (ft) Lot Coverage This Section for Office Use Only Buildinq Permit NiAmber Date Issued: Certificate of Occupancy Signature: Building Official Data Is Is not required Section 1 - Site Information TUse Group: R-4 Type: 5-13 1.1 Proporty Address: , 12 Zoning Information: 3 e iez �J Zoning District Proposed Use 1.3 Building Setbacks (ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided o' o' a�' a' v�' 1 A water Supply (fi.0.11. a 40. S 54) 1.5 Flood Zone Inrormetlorc r - - - - Comments:... Public Private Zone: SFE Section 2 - Property Ownership/Authofted Agent 2. Owner of Re ord: H►:N sr .Qo? o,9 N (print) Mailing Address 7 - Signature Telephone _ 2 Authorised Agent: - Jn1 ✓ i(%- Yll f fie e l g AJ /b Name Mailing Address Vats I Signature Telephone Section 3 - Construction Services 3.1 Uoensed Construction S .yels / y Not Applicable ❑ 7 C License Number So/ ejej o ,t-�9 ddres i It Date �j Signature Telephone Cz 32 Registered Home Improvement Contractor Company HamsN livable ❑ / "�L B L1 rasa Number 3 d A Expireti Date SignatureTelephone o l0 /Y))- \I Section 4 - Workers'Compensation Insurance Affidavit (M.G.L c.152 8 25C (e) Worke Compensation Insurance affidavit must be completed and submitted with this application. Failure to providL this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached Yes . A.. No .......... Secton 5 - Description of Proposed Work (cheek all woucablet New Construction ❑ No. of Bedrooms No. of Bathrooms . bdsting Bldg. ❑ Repair(s) ❑ I Alterations ❑ Addition ❑ Accessory Bldg. ❑ Type Demolition Other Specify. Brief Description of Proposed Work: w % rJ X X0 N nQ secuon is owner numonzauon - fo De completea wnen Owner's Aqent or Contractor Applies for Building Permit 1, hereby authorize�AlcJ my beehD half, in all matters relative to work authorized by this bull signature of Owner Section 7b - Owner/Authorized Agent Declaration Check Below ❑ Conservation -Commission Filing IN applicable) ❑ Old longs Highway 3 Historical Commission approval (if applicable) _ , as owner of the subject property to act on permit application. Date W� K /VCy_ 'J ` ti < y , 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 pain and penalties of perjury. Print name SigmWre of Owner/Agent _. y o Dare 9.15-99 2of2 TOWN OF YARMOUTH BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRI11T. Job Location:_ Owner of Construction Supervisor. Address: / 0 0 e5y Licensed Designee: (If other than Supervisor) Name Q— VJ*N,vH License No. Phone No. ;A, ZfCX YV Q l �1�A JT Her+ 1 _ %t 2.15 Responsibility of each license holder. License No. 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building and structures only pursuant to the state building code and all other applicable laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Anylicenseewho shall willfullyviolate subsections 2.15.1, 2.15.2 or 2.15.3 oranyother section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes W No ❑ If you have checked yam, please indicate the type coverage by checking the appropriate box. A (lability insurance policy a 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 Owners 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. alteratim, 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: """j Ac Y `F 50 AJ &r EsL Cost Address of Work 16C'�r't 1 k, -= Date of Permit Application: y I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under $1,000 Building not owner occupied Owner pulling own permit Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: ,cnw h.wca �f �« ke.> Lo N �3 ate Contractor Name 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 O//Ies sllerssgosofss 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit pit, kv Y.AI, Pfov74 lyA. phone #-rO(i'3(+ti—/t/y O 1 am a homeowner performing all work myself. O lam a sole proprietor =nd hase no one working in any capacity 2-1 am an employer pros iding workers' compensation for my employees working on this job. efty r NGy IV i" -1A - nhene N: 30,f - d6z, - /% / t-- inan.+n.r.n R.w OIJs A/•e� ,ti•S: (_l1 Ooli[yM LfIC C) / 32 I am a sole proprietor. generaIcon tractor. or homeowner (circle one) and have hired the contractors listed below who has e the follow in; workers' .ompensation polices: Failure to secure coverage as required msder Secoom 23A of MGL 132 ua two some impaataaa of i nsmW penman at a one ■p m aapuu. •.agar out years' Imprisonment as well as civil penalties in the form of a STOP WORK ORDER maul a Ilse of g100.00 a day against me. 1 m sdersmnd that a copy of this statement maybe forwarded to the Omer of Investigation of the DIA for coverage veri0mtioa. 1 do hereby certify the pain: and pen ties ojpr ' ry that the information provided above it true andeorreeL SignaH15 Print name to o--cL&L— fi P/� one# 40,9 omcial use only do not %rite in this area to be completed by city or Iowa official city or town: YARMODTQ o check it Immediate response is required contact person: per oMicense N nBuilding Department pUcening Board 261 o5electmen's Omee 011leslth Department phone#:— (508) 398-2231 eat. pother una,a l.a• rlAt Information and Instructions . ` Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for th employees. As quoted from the "law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An empletrer is defined as an indi% idual. partnership, association. corporation or other legal entity, or any two or more t the foregoing en_aged in a joint enterprise. and including the legal representatives of a deceased employer, or the receiver or trustee of an individual , partnership. association or other legal entity, employing employees. However the owner of a dwellin_ house havin_ not more than three apartments and who resides therein. or the occupant of the dwelling house of another who employs persons to do maintenance , construction or repair work on such dwelling house or on the .-rounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 1: _ section __ also states that even state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any vidence of compliance with the insurance coverage required applicant who has not produced acceptable e. Additionally, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter ha%e been presented to the contracting authority. Applicants Please till in the workers' compensation affidavit completely. by checking the box that applies to your situation and suppling company 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 stud date the affidavit. The affida% it should be returned to the city or town that the application for the permit or license is being requested. not the Department of Industrial .accidents. Should you have any questions regarding the "law" or if you are required to obtain a workers' compensation polity. please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address, telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Ma of Imstlptlen 600 Washington Street Boston, Ma. 02111 fax N: (617) 727-7749 phone #: (617) 7274900 ext. 406, 409 or 375 BUILDING TOWN OF Y A R M O U T H ELECTRICAL GAS 1146ROUTE28 SOUrHIARMOUTH MASSACHUSErrS026644451 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 �rresulti from the proposed work/demolition to be conducted at & k H.sii.(/1 All C� wlri7 F . Work Address is to be disposed of at the following location: j,7/x,Jj 1l'1 1Z24 9 f � :�.ticf w PC Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Date Permit No. ,r • TOWN OF YARMOUTH Building Department Town Hall ti i0�tq�\) Yamwuth, MA 02664 (508) 398-2231 ext261 BBUILDING PERMIT TRANSMITTAL Temp Permit No.: T-05-562 Applicant Name: Lawrence Kenney Applicant Phone: 5083641112 Building Location: 00034 HIGHLAND ST Owner's Name: Leonard Bearse Owner's Addres 209 Main Street Amesbury MA 01913 Owner's Telephone: (OFFICE USE ONLY Recorded By-. IC Permit Fee: $0.00 Deposit Rec: $25.00 Payment Type: Check ChkNo.: 7520 Net Owed: ($25.00) Application Date: 4/28/2005 Issue Date: Expiration Date Comments: Map/Lot: 028.117 constrict addition to expand existing garage, add 16 x 20 deck ZONING APPROVED__ REVIEWED BY: ✓1R. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: ✓3. CONSERVATION: DATE: N/A: 4- HEALTH DEPARTMENT: DATE: N/A: 5. BUILDING DEPARTMENT: DATE: WA: 6. FIRE DEPARTMENT: DATE: WA: PLEASE NOTE RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: Date Printed: 5/4/2005 TOWN OF YARMOUTH F Building Department Town Hall Yarmoutl% MA 02654 (508) 398-2231 exU61 BBUILDING PERMIT TRANSMITTAL Temp Permit No.: T-05-562 Applicant Name: Lawrence Kenney Applicant Phone: 5083641112 Building Location: 00034 HIGHLAND ST Owner's Name: Leonard Bearse Owner's Addres 209 Main Street Amesbury MA 01913 Owner's Telephone: REVIEWED BY: 1. WATER DEPARTMENT: (OFFICE USE ONLY Recorded By. IC Permit Fee: $0.00 Deposit Rec: $25.00 Payment Type: Check ChkNo.: 7520 Net Owed: ($25.00) Application Date: 4/28/2005 Issue Date: Expiration Date Comments: 028.117 construct addition to expand existing garage, add 16 x 20 deck DATE: WA: 2. ENGINEERING DEPARTMENT: oe DATE: N/A: k.2. CONSERVATION__^ --A DATE: S = (D J A: 4. HEALTH DEPARTMENT: DATE: N/A: 5. BUILDING DEPARTMENT: DATE: N/A: 6. FIRE DEPARTMENT: COMMENTS: RECEIPT OF COPY: PLEASE NOTE SIGNATURE OF APPLICANT: DATE: m DATE: Date Printed: 5/4/2005 ojogR'IN TOWN OF YARMOUTH Building Department Town Hatt Yarmouth, MA 02664 (508) 398-2231 exL261 BBUILDING PERMIT TRANSMITTAL Temp Permit No.: T-05-562 Applicant Name: Lawrence Kenney Applicant Phone: 5083641112 Building Location: 00034 HIGHLAND ST Owner's Name: Leonard Bearse Owner's Addres 209 Main Street Amesbury MA 01913 Owner's Telephone: (OFFICE USE ONLY Recorded By: IC Permit Fee: $0.00 Deposit Rec: $25.00 Payment Type: Check ChkNo.: 7520 Net Owed: ($25.00) Application Date: 4/28/2005 Issue Date: Expiration Date Comments: 028.117 construct addition to expand existing garage, add 16 x 20 deck G3CE6C2OW19D MAY 0 4 2005 REVIEWED BY: 1. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: { 4: HEALTH DEPARTMENT: DATE: S iS WA: 5. BUILDING DEPARTMENT: V I DATE: WA: 6. FIRE DEPARTMENT: DATE: WA: COMMENTS: RECEIPT OF COPY. PLEASE NOTE SIGNATURE OF APPLICANT: DATE: Date Printed: 5/4/2005 ,t o. ►., TOWN OF YARMOUTH d Building Department Town Hall YanmutN MA 02664 (508) W8-2231 ext261 BBUILDING PERMIT TRANSMITTAL Temp Permit No.: T-05-562 Applicant Name: Lawrence Kenney Applicant Phone: 5083641112 Building Location: 00034 HIGHLAND ST Owner's Name: Leonard Bearse Owner's Addres 209 Main Street Amesbury MA 01913 Owner's Telephone: (OFFICE USE ONLY Recorded By. Ic Permit Fee: $0.00 Deposit Rec: $25.00 Payment Type: Check ChkNo.: 7520 Net Owed: ($25.00) Application Date: 4/28/2005 Issue Date: Expiration Date comments: mapiLot: UZU-111 construct addition to expand existing garage, add 16 x 20 deck REVIEWED BY: 1. WATER DEPARTMENT:_ DATE:" VIZOA. 2. ENGINEERING DEPARTMENT: DATE: WA: 3. CONSERVATION: DATE: WA: 4. HEALTH DEPARTMENT: DATE: WA: 5. BUILDING DEPARTMENT: DATE: WA: 6. FIRE DEPARTMENT: DATE: WA: COMMENTS: RECEIPT OF COPY: PLEASE NOTE SIGNATURE OF APPLICANT: DATE: Date Printed: 5/4/2005 z NOTESi JOB N0. YD4-If 1. LOCUS IS A.M. 28. PARCEL 117. Beane.drr 2. ELEVATIONS SHOWN ARE NCVD29 BASED UPON T.O.Y. MON. 3, 3. LOCUS IS IN FLOOD ZONES Al2(EL10). B &C ON FIRM DATED JULY 2. 1992. 4. OFFSETS SHOWN ARE TO THE COFNERBOARDS ON EXISTING I NOTE: BASE FLOOD BUILDINGS. OR TO FOUNDATION ON NEW CONSTRUCTION. ELEVATION OF 10' S 82 4345- E RUNS MORE INLAND 8�14•V EN LISH THAN SCALED LOC- ATION OF A ZONE 152 W ZRAINz= E)OsT. GARAGE 11A (DIx /Iwo s M 4-5� N 2 �p �`M i .4 PROP 35. )ECK � u a t 4. _ :•��•�. :� Trelll I PARCEL 0- N 10,090:,s F. n Ito � 10,9 N U W "'rX Z� � -5.3 0 c n IV 2 NI c� o rn Q I 80.45' of N81+ss ... - APPROX. LOCATION FROM ASBUILT INFORMATION 9 / 10" R.C. PIP: • 64 m� Q � ti/4 3.9 n �� N/F E COD HOSPITAL RE / a N N mililIp I cERTIFY THAT THE LOCATIONS sHowN ON THIS N/F ASBUILT PLAN PLAN WERE MEASURED IN THE FIELD ON 7/27/04. FITZGERALD FOR ' imLs LEONARD E. BEARSE PARCELB. 34 HGHLAND STREET, W. YARMOUTH. MA ,Q�� AUGUST 16, 2004 SCALE 1'=20' RONALD d CADILLAC. PLS, RS wo PROFESSIONAL LAND SURVEYOR t REGISTERED SAMITARIAN P.O. BOX 23E WEST YARMOUTK MA 02573 REV. 1O/7/o4—ADDITIoN• smicC k DRAM PIPE Cel2DD4 BY R1 cADu.AC (5013) 775-9700 10" CONC FU 46" MGN CRAL'E W/ P.T. AXAI P05f fW. 2XI2PfUM W/ JOISi FWNCii5 ttP. NEW (,ice WALL: 2XAI 5fUP5.1/ 2" C S1 arz. CED/!� SI"5 _� 0A r E i IF"V.l FILE COnif f0 EE IMMOVED EXI5IMG tlxAa MN OF YARM( FOR BUILDING AND ZONING ocn ,�„� ROM THE RESPOND 818 I �I J15f P05f P05f fOMMAN _EXIM,;W4JpONf DE9MOvEDMID MAW M7 60 PIZV Oi IM NINGP H I CChIPLI- I S BUILT, L)A BUILDINOOFFICIAL GARAGE ADDITIONIDECK ADDITIOr BEARSE RESIDENCE WEST YARMOI I APFUL 12, 2005 ll APPI ; 9 2005 FI 00� pI,AN SCALE:1/B" � I'4" , MASSACHUSETTES EXSiNGGNLICE 4WaADDI11Qd NEW MNCN POGR fO EEPLACt 10" WINDOW - LC= PER OMJER N FELD MYCH EXL NEWA% W MAfCN EXG QlftEt. my NEW FANS -MA%41Yl5 EXIM6 m f0 L'E NEW CEDAR REMYIOJED-NFuOrP"Z (EX151I GA AND 5NNV ,.._ am i VA5f V 5GLE:1/ e" -1'4"' -MAfCN EXE" S IL 8+f56 MLATIP WXQ Wf�7M MAfCN EXI5" WNM MAiRdN.S MP PROFLE rLh \ LFRELASfCGNC.5IEP �--ca ETEFOW1DAtIQJWU -`CONL.PERiW. `- ffveaiwwA Nom I LI jv) 545fEM SLPLE: I/8" -1'4" GARAGE ADDITION/DECK ADDITIO] BEARSE RESIDENCE WEST YARMO APFUL 12, 2005 I Sre�c1E5 � OrMLPGUf � `" z vat ENw WNl r n ma In W MASSACHUSETTES !61 yf< ovxg� TOWN OF YARMOUTH Building Department BUILDING (508) 398-2231 ext.261 PERMITNOPERMIT ISSUE DATE :_ 1/23f2006 _ ; PRO E E ; APPLICANT Iawrerce-Kemey_ _ _ _ _ _ .1 _ _ _ _ JOB WEATHER CARD PERMITTO Atteratbro AT (LOCATION) O=HIGHLAND ST ZONING DISTRI R-25 Bldg. Type: Reskentlel SUBDIVISION MAP LOT BLOCK 1028.117 BUILDING IS TO BE CONST TYPE 6•B USE GROUP® LOT SIZE SIDING (5) SO. REMARKS AREA (SO FT) EST COST ($ 53,100.00 PERMIT FEE ($) 525.00 OWNER IRGINIA P KENNEDY LIFE EST BUILDING DEPT BY ADDRESS HIGHLAND ST EST YARMOUTH I MA 102M INSPECTION RECORD CONTRACTOR LICENSE Kwviey. Lawrence 100 Sullivan Road West Yarmouth MA 02673 5083641112 PHONE 19783883912 FIELD COPY Date I _ Note Progress - Corrections and Remark I Inspector EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH P Yarmouth Butldina Department 1146 Route 28 South Yarmouth, MA 02664, (5081398-2231 Ext 261 w • yah AQvT'l Or owNl3t•IGevo+.Y E &ea)-SL �?d9 •/tI.470 -Sr R•Hes< k N///A►lL �rar WU AOOlySB - OQdI8ACR1B. Ak),•+ uc.c �iJ/ eNA,iu /00 Su//,.,j A'tac -388-31/Ok J�df-jury-lll 2 #t%.t ocammeroill PvtCoeofC=ftvtims %3/00 - flam bvwwamat caatncLmt3c. # l a l If l.3 comko tim swavbm tim c o .5'e o q waFboms cation Tc.mmoc (cheat ace) O 1= &e homm�r=0 I mt me ak pgridft � I hne wac(od. Campm.am humum hno:mee campmy None: !1 a iyv A i s 1) ,V a e, ward. Camp retiye W G � /l3 0� � (0 WORKTOIM FRRl EMMDE—J 0 T" (F"RdwdmdC Wkdowacbea) J L w�. Nava s.J L Ii nasa�.eray.... oe�m.�a.:ao.R.Fl�,—A�N2'320(16 I'i ❑ eg.osmWdoom a L, ()ft%gWgaa*A.d..• c)ao:e... lwjmef.m.a�r t •I1:dk:nir.i,p=Wcft 1i C„�e/l%j W Ao7-e �. x.-jAwwlT I - - mdrpenmen as M jor a_w brdw App&W'. A.pv"d Dale r lr, O�1 (or dsipr) Zia NvomialDbuxt 0 Yes 0 No FloodPlmZam 0 Ya 0 No WdwRMUM Protection District Virihin l00 Wcd ds 0 Yes 0 No VY0 0 No "I 4■) The Commonwealth ofMassaehusetts Department of Industrial Accidents Ogee of Investigadons 600 Washinfion Street W Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electrician&Tlnmbers Address: City/State/Tap: � • Phone #• Are u an employer? Cheek the-approprlate box: Type4. ❑ I am a general cantracmr and I Pe of project f old (required):1. I Vam a employer with 6. []New construction employees (full and/or part t®e).• have hired the nab-contractora 2. ❑ I am a sole proprietor or partner. listed on the attached sheet = 7. ❑ Remodeling ship and have no employees These sub -contractors have S. ❑ Demolition working for mein any capacity. workers' camp. hismance. y ❑ Building addition [No sorters' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical airs or additions rapfi .] officers have exercised then nP 3. ❑ I am a bomeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself [No workers' comp. C.15Z 11(41 and we have no 12.0 Roof repairs insurance required.] t employees. [No workers' 13.❑ Otter COMP. insurance insurance required.] `My epptrant ma ccects tee ■i moststso nu out me action below shooing visit women' companution policy kfimniiuu t ttolmow0�s Mho mobind &is dfadsrit hmlicatiea they as dons on work ad than hhe otmade costreclen most submit a new sffderit iodieetina such tContlsCbH thet Check We box most niched a ed&tiond sheet showing the note of the sob.wntreaws and then worten• conR policy iefomrtion. Ism an employadrat Lsprovldlag workers' compen3&ki1 hauriencefor my anployees. Blow fs McPolky and job.rtte beformolas. Irn Insurance Company .a.. Policy # or Self -ins. Lic. M VU(b �l 3 a �/ L ' Expiration Date: � Job Site Addteta:,J "i ZJJ * 0 " 0 / citylstatca4:IF l�- A R.re i77�G7p "J Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to Secure coverage as required under Section 25A of MGL e.152 can lead to the imposition of criminal penalties of a fine cep to $1,500.00 and/or one -yea 1prisonnieat, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a dry against the violator. Be advised that a copy of this statement may be forwarded to die Office of Investigations of the DIA for insurance coverage verification. I do hereby ee ceder tke pains and fpedury that the brfwmadon provWed is and correct y o Phone #: Q07 W are only. Do not write In tM arra, to be completed by etry or imm o,0klal ONE City or Towa• PernAUcense # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. Cityfrown Clerk 4. Electrical Inspector S. Plumbing Inspector 6.Other Contact Person: Phone Information and Instructions •Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees: . is defined as "...every person in service of another under sny contract of lain pursuant to this statute, an carpleycc express or implied, oral or written" An anpfoyer is defined as "an individual, partnership, association, corporation sir other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, pZtuenbip, association or other legal entity, employing employ. 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 home or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, 425C(6) also stater that "every sate or local licensing agency shall withhold the Issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152,125C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." ' Applteanb Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary. suPPly sub-conuactou(s) name(s), address(es) and phone nomber(s) along with their certificates) of insurance. Limited Liability Companies (LT.C) or Limited Liability Partnerships W) with no employees other than the members or partner, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the atfidavlt 'Ihe affidavit sboald 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 obtaida workers' compensation policy, please can the Department at the number listed below. Self -insured companies should enter their • --14r :..e...."rr Ni n%C mrmber on the appropriate lma City or Town OIDcials 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 10 fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to frill in the pernit/liceace number which will be used as a reference number. In addition, an applicant that most submit multiple permit/licee applications in any given year, need only submit one afildavit indicating anrent policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or lows}" A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on Me for future permits or licenses. Anew affidavit rmst be filled out each year. where a home owner or citizen is obtaining a license or permit not related to any business or oommcrcial venture (ie. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit Tb- Office of Investigations would hike to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give m a call. The Department's address, telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Stteet Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Faz # 617-727-7749 Revised 5-26-05 www.mass.gov/dia qvcf"'jt�\ TOWN OF YARMOUTH Building Department BUILDING (g, __._____,(508) 398-2231 ext.261 PERMIT NO B-03-524 ISSUE DATE P D SE .......... PERMIT APPLICANT :LecnardBeame JOB WEATHER CARD ADDRESS p0034 HIGHLAND ST PERMIT TO �=essvy Structure; --- -------------- --- -- " ---- -' AT (LOCATION) ` HIGHLAND ST ZO ISTRICT R-Z SUBDIVISION MAP LOT BLOCK 08.117 BUILDING IS TO BE USE GROUP R4 LOT SIZE r CONST TYPE 5-8 CONTR'S LICENSE 071717 8 x 10 shed - subject to zoning bylaws CCENSEONTRS NAME REMARKS Barod. Joseph AREA (SO F) EST COST ($ j$1.000.00 PERMIT FEE ($) OWNER Leonard Beane ADDRESS 0034 HIGHLAND ST WY BUILDING DEFT BY Date INSPECTION RECORD Iota Proaress - Corrections and Remark FIELD COPY -- L SHEDS LESS THAN 150 SO. FT. SHALL BE PLACED A MINIMUM OF 30 FEET FROM THE FRONT LOT LINE AND A MINIMUM OF 6 FEET FROM SIDES AND REAR LOT LINES. i EXPRESS BUILDING PERMU APPLICATION TOWN OF YARMOU M Yarmouth Building Department 1146 Route.28 South Yarmouth, MA 02664 (508) 398-2231 Ext- 261 cl i0NsrRUMM �ESSOR'S IIdFORMATION: .0 OWNER [SONAR �E Map: C:cg 1Parcel. / % Pit expires 6 mootha Bwn :tea,» -: SF Sf119hlAnJ ST W Y„4manr3 _ soS PRESENT ADDRESS TEL a 6 3S5 i� %I/ �9=O 4;— -od Al. //, xo 3 - / •""�" &L%U.M ADDRESS - - Tmwg � 3a / ] El � Est Cast of Comtroction S 4L&e-'-4f ow— UcL. /0k,3ya/ Coos>ruuionsupervisorL'cp es- 6?1l%2_— Wctkmm's Comp=afion iosurm3w (tfiak one) ❑ 1 am the homeowner ❑ 1 am the sole pcopciemr ❑ 1 have workees Campensation Lismar= hz=wmComparwName: l�G/71ff /'i[I�� workers Comp.Poffrys (.UG 010� r WORKTO BE PERFORMED ❑ Tat (FaaRehrdnt Certitiote - t7Si&og. SofSgnves Dvatras 'Shed 0Rep6eematsvmdorrmp 11Repheementdoom s - ORo-m f #ofsqaam- 0ftVpin90ldzhbgles6. ()toiogovc layasofadstiogroof 'The debris wia be disposed ofat . Loc+dan of Factity i deeBm under pemhks ofperjary gM no snm®ats hoes a SL eo�ed are am andeared tothe beg of my tmwkdge and bdiet l mdnsa� thatavy seanswer(s)sn'D 6e just cum for deal or tevocatian ot/nJy,license and forpeoseation and" MO.L Ch 26t, Section 1. [/ Apvlinm's si® tpm 4r ..---- ii Z 122 (or Im Zonittg District o� HistorkdDistrict: ❑ Yes XNo Flood Plain Zone: ❑ Yes',d(No Water Resource Pmrtatim District Within 100 8 of Wedands: 0 Yes -1" 0 Yes "kK No • - . SHEDS LESS THAN 150 So. FT. SHALL BE PLACED A MINIMUM OF 30 FEET PLOT PLAN FROM THE FRONT LOT LINE AND A MINIMUM OF 6 FEET FROM SIDES AND REAR LOT LINES. FOR LOT Indicatelocates of garage or accessory building Additions with dashed lines ------- Sewerage disPosal (cesspool) ®------------- Well (iot................ft. rear) uttarIs L Q me—�� ed this is a ner lot, ite in name street. SIDE YARD it 9 REAR YARD zeofe T"It, .I....ft. v SET BACK 5 SIDE YARD a__---FTO I (lot..................ft. frontage) L N S VIAMa ar• SixlrlrY 1 Information . _ SuPPlied by fi eo n/n pPi9� o-.- t'. a Abuttorls Name Lot # if this is corner is write in name of other street. TOWN OF YARMOUTH i' s WATER DEPARTMENT 99 Buck Island Road Nest Yarmouth, MA 02673 Telephone: (508) 771-7921 • Far: (508) 771-7998 NOTICE July 29, 2008 Service #: 5833 Service Address 34 Highland Street Map & Lot 028.117 Certified Mail #: ❑ New structure Existing Structure Dear Ms. Kennedy: This is to advise you the Town of Yarmouth Water Division or their authorized agents have Installed a new water service or rehabilitated an existing water service at the above service address. Materials used during this installation are electrically nonconductive. The Town of Yarmouth Water Division regulations prohibit the use of this water service as a grounding device for your electrical service. It Is recommended you contact an electrical contractor to ensure your electrical service grounding is In compliance with the Massachusetts Electrical Code, CMR, S27-12.00 Article 250. A copy of this notice is being forwarded to the Town of Yarmouth Wiring Inspector. Sincerely, Dan Mills, Superintendent Cc: Wiring Inspector W&M15 SlipGen- Portal Home Town of Yarmouth UN Template [Building Dept] Slipsheet Identifier [sg27850) Document Category Building Permits Map -Block Number 028.117 Street Number 0034 Street Name HIGHLAND ST Department Building Parcel ID 1400 Backfile Batch Scan No Document? Additional Naming Info Index Operator Operator, Yarmscan Date - Time 2015-06-16 - 11:19 tMJfiaserfiche121SipGeN V1