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Home My WebLink AboutBuilding PermitsYqR . �O C O H 111 r Wo V W w 10 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 • South Yarmouth, MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 //��/� OHL= Use ONY c� Pluming Baud information Assessors Department Informabom Perrne cM� �-6tNaate V PLIRTYM "W Lot Permit Fee $�� Endorserneat Date � � Reconbg Dab New Deposit Reed. $ Date Pin no. 1.4 Property Dlmatsium Net Due Wer Lot Area (sf) Fronmge (tt) Lot GIN Thin 3octloel loo OtRcs uft 3t !kUi b •' LL, Sectidn•l-SRO 1nkWrd&M' I Use Group: R-4 Type: S -El CmI 1-1 �: �•� iz Zo ing worrnatlmc Ire a Zoning District Proposed Use 0 1.3 SuWhM Setfeecfts Int J Front Yard Side Yards Rear Yard 7 T m m RequiredI Prnvirtm n.—. -. r>_ 1.4 iftW 5j ply, N.O.L. a 4& S 34) 13 HOW Zau Iniorrrmdorc , Catrsnarfc Pudic Private Zprw EFE Section 2•• o meislll Auttlodzed :L1 Crnee W ftcardu Irh4C.A14Er( Namac -Pp .. Tra a rr _1 - r u j zs Auusorbmd Agent, +�%:��.►a.� v: L:4st I V � Q NBR1e(print) fin Addresst,U�AMAY x015Si9neurrs FSectfort 3• COns$trGtjOn S@r`NG DEP4 MEN 3.1 Licensed Consbuction Sapervison W A ,* tet.:. U 4vl Lotil l J -�) Pr�tid sT i� j2 ,%,,j Z' r - YL' Address Telephone Email Address: Nof AppfieaNe ❑ C- C0 yy�� txen:. rJr,rr�be Expiration Date e rr mum NotAWcable I] Address Email Address: - 7 7 04Um sse Number c7 ci A��'►'L kC-A(Q wC.I ' '� 'hoNU.S 1 , Tdeptnrr Expiration Date 1 oI OVER ?'07Y -01--37 Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure. _.-u— 66t——mA....ir udn roes q In the denial of .the Issuance of the building permit. iv N,�aw u„a o............... _- - - - - Signed Affidavit Attached Yes .......... No .......... Section S- oeactf of pfo Wbrk (dtedt elf appOW& New Construction ❑ I No. of l3adro Na d Bstluoann Extsdnq 9ft ❑ Rep�lrts) Anttr�tfm ❑ Addltlat ❑ Accessory Mfg. ❑ iYPID oemolition Other specify. Boef oescripdon of Proposed Work (v1-miiat4- ~0 C - U/:, %F SifeerRouL LL;;Ai Ge►U, 9 - IruSut •Y-= on ti P V Sectltln t)f - EstIM104 cdnsmxiion Casts item Estimated Cost (Dottara) to be Check Below oomphted by Permit appllcut i. Buildho 0b ❑ Cansematimt-CommlaabnFMng 2 E30M I, r 9 S (if applicable) (3Old tUcngsm rieW 8�e 4. Meduntd (HVAC) a S. Fire Protection 3 00 (it appocable) e.Totala(t +2+3+4+5) 1. roW Square Ft. Ow Naw i Ktlsae) g .7i! • oWnw utttbrtzatlorr'- Tt! t7et Camphtsd When CK” er'sR or Contractor A Iles for BUI(dle Pam* •cl�a•Z 3 v .c�AT , I, M as owner of the subject property hereby authodze int M "" to act on behalf, In all matters relative to work authorized by this building permit applicatiom my vcE SignaNr* d Qwmw p Section 7t) OwnedAutharized agent Declaration asOwnedAuthortzedAgent 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 nam* • V� � Ly `-"cam Signator* of ow erlAgWA 9-13.99 2 of 2 yI'l.3'(S' - —r oar* %Caev ror Unice Use only Permit No. Date TOWN OF YARMOUTH ' 4j a° AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL a 142A requires that the 'r=amtr cn, alteration, rmavatica, repair, modeniation, coaversica, impiovanent, removal, danolitica or construction of an ad&tica to any pro-= stiag owner-oavpied building aataicbg at leas{ me but not more than four dwelling Units or Nrucuw which ars adjacett to such rside ce or bul&g' bo done by registered contractors, with Cutin excepdoa% along with other regttirarems 1 Type of Work _ Lu EMS 0Av'A4l,r R c( -)A Est. Cost Address of Work Owner Name: 0A c. Ua v L V 'i Date of Permit Application: Lf �3 r I hereby certify that: Registration is not required for the following reason(s): Work exchided 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 WORT{ 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 pefmit as the agent of the owner. *)3 ISr u3,.k LL4d%o%A, cL%�LAUt,., Date Contractor Name Cl 5Z Registration No. Notwithstanding the above notice, I hereby apply.for a permit as the owner of the' above property: Date Owner Name PLEASE PRIM - job Location: _ TOWN OF YARMOUTH BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM 3 L I 2tFA-T— , 5 L..nj d f: Number Owner of Property: Stmt '►�t_��efL Sc..��: Construction Supervisor. WI `` w 6"', Name Address: 111 FZi-od 5T— :a.4 i--Y?-- LAJ l.'S► Village cs C, -7 lr license No. 60t)w (4i 11 Phone 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 drawin as approved by the building official.gs 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building and structures only pursuant to the state building code and all other applicable laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15 .4 Any licensee who shalI willfullyviolate subsections 2.15.1, 2.15.2 or 2.15.3 or any o ther section of these nice3 and s by regulation. and any procedures, as amended, shall be subject to revocation or suspension of 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 bysec tion 109. 1.1 of the code and these rules and regulations. In the event that such licensee is no longersuperAsingsaid persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license bolder 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 currenlity Insurance policy or its substantial equivalent which meets the requirements of MGL Ch -152 Yes No ra If you have checked X= please Indicate the type coverage by checking the appropriate box. A liability insurance policy ,U,,/ Other type of Indemnity C] Bond OWNER'S INSURANCE WAIVER: I am aware that the licensee does oat 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 Agerd Owner rj Ageo Signature: Building Official Approval: 14 The Commonwealth ofMassaehusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.ntass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeeIbly Name (Business/Organization/Individual): Whalen Restoration Services Address: 22 American Way 02660 YhOne il: Sats t bac L V 11 Are you an employer? Check the appropriate box: LEI I am a employer with 25 4. ❑ I am a general contractor and I employees (full and/or part-time)."' have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myselL [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 8. ❑ Demolition 9. ❑ Building addition 10. E] Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other •Mso fill Any applicant that checks box N I must also out the section below showing their workers' compensation polity information. t Hommwnen who submit this affidavit indicating they aro doing all work and then hire outside contractors must submit a new affidavit MkAtiag such :Contractors that check this box must attached an additional sheet showing the tame of the cub -contractors and state whether or not those entities have employees If the tub -contactors have employees, they must provide their workers' comp. polity number. I am an employer that is providing workers' compensation insurance jot my employees. Below is the policy and job site information. Insurance Company Name: Are American Insurance Comvany Policy # or Self -ins. Lic. #:_ UB -511894542-15 Expiration Date: -411/16 - Job SiteAddress: Q 6RL114T 13LAAJA 1z0AA City/StatJLip: 'X,M,2w'►tlur -1 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 cerr4 y under the pains and penalties of perjury that the information provided above is true and correct Phone#• S -VC I L 0 L4 61 Oficial use only. Do not write in this area, to be completed by city or town ofciaL City or Town: Permlt/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. CitylTown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Fm:Theresa Cahalane—Norkus To:K. Spelman, Whalen Restor Sery Inc. /Sweat Cert (15087 609995) 09:16 04/23/15 EST Pg 3-4 .n- nAen nn UULIAI FAIrFFRT V11011111. i9 ViVV •• ACQRD, CERTIFICATE OF LIABILITY INSURANCE DATE (MMIODIYYYTT 4!2312015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER. AND THE CERTIFICATE HOLDER. IMPORTANT: II the certificate holder Is an ADDITIONAL INSURED, the policy(les) roust be Endorsed. If SUBROGATION IS WAIVED, subject to the terms and condlUons of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In Neu of Such endorsement(s). PRODUCER Q John Powers , En , 500-04S-7800 • 666-323 4182 HUB International Now England 265 Orleans Road E-MAIL North Chatham, MA 02650 INSURERS AFFORDING COVE RAGE IIAIC0 508 945.0446 INSURER AI Arbella Protection Ins Co. INSURED Whalen Restoration Services Inc.. Whalen Services Inc.INSUREROt 22 American Way South Dennis, MA 02660 INSURERS: INSURERC: MED EXP (Anyone pen)f INSURER E• INSURER F: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED iTO THE INSURED NAMED ABOVE FOR THE POUCYPERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BYPAIDCLAIMS. LITEXCLUSIONS ` TYPE OF INSURANCE DD S B POLICY NUMBER M D MMI x LIMITS A OENERALLIABIUTY COMMERCIAL GENERAL LIABIUIY CLAIAIS-LUOE ❑ OCCUR 1020016676 410112015 041011201 EACH OCCURRENCE i ENTEOncol S MS MED EXP (Anyone pen)f PERSONAL a ACV INJURY S GENERALAGGREGATE S GFJJL AGGREGATE LIMIT APPLIES PER: POLICY PRO- LOC PRODUCTS• COMPIOPAGO $ i A AUTOMOBILE LIABILITY ANYAUTO ALL EO X AU ODULED NOrFOWNCO X HIAUTOS X AUTOS RED 1020016678 0410112015 041011201 LE ` S1,000,000 BODILY INJURY (Psrpeaa) S - BODILY INJURY (PW sodden() SALIT , FRO; ER en: S t A HUMBRELLAUAB EXCESS WB I OCCUR I CLAIMS MADE 4600055369 04JO112015041011201 EACHOCCURRENCE s100D000 AGGREGATE II1 001 000 OED I X RETENTION 10000 S WORKERS COMPENSATION AND EMPLOYERS` L//IA�ryryB�IILIEETYyY�x 1 A OFFICEWLIREMBEREXGLUDED7ECUTIVE (Mudelery In Np Ilz �,desMMunder DESCRIPTION OF OPERATIONS blow NIA WCST TU• OM- E.L. EACH ACCIDENT S EL. OiSFJiSE•EA EAIPLOTEE S E.L.OISEASE•POLICYLIMIT $ 1 t - DESCRIPDON OF OPERATIONS I LOCATIONS I VEHICLES (Ntach ACORO 101, AddalonM Remarks aandulE, I MCI* space Is regelrsd) Project Address: 361 Great Island Road, West Yarmouth, MA 02673 Michael & Rita Sweat 361 Great Island Road West Yarmouth, MA 02673 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. REPRESENTATIVE 0 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) 1 Of 1 Tho ACORD name and logo are reglsterad marks of ACORD #S136637WM1349291 TC002 Rightfax C1-1 4/23/2015 8:00:04 AM PAGE 2/002 Fax Server 14 CERTIFICATE OF LIABILITY INSURANCE 1TATE(MM/DD/YYYY1 TWAZMIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BYTHE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE RODUCER. AND -THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require and endorsement. A statement on this certificate does not confer rights to the certlficate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME: PHONE FAX HUB INTERNATIONAL NEW EN 265 ORLEANS RD (AIC, No, Ext): (Aro, No): E -MN L NORTH CHATHAM, MA 02650 ADDRESS: 77GKF INSURER(S) AFFORDING COVERAGE NAIC N INSURED INSURER A: ACE AMERICAN INSURANCE COMPANY INSURER B: WHALEN RESTORATION SERVICES, INC. WHAELSERVICES, INC DBA CHEMDRY BY WHALEN SERVICES INSURER C: INSURER D: 22 AMERICAN WAY INSURER E: SOUTH DENNIS, MA 02660 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICES OF IINSUPAINCELISIED BELOW AVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANYREOUIREMEM, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 5 SUBJECT 70 ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LISTS SHOWN MAY HAVE BEEN REDUCED BY PAD CLAIMS. NSR ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MWMYYYY) (M►WDIYYYY) LIMITS GENERAL LIABILITY --ACH OCCURRENCE f COMMERCIAL GENERAL LIABILITY CLAIMS MADE [—]OCCUR. AMAGE TO RENTED $ REMISES (Ea occurrence) ED EXP (Any one person) f ERSONAL A ADV INJURY f GENT AGGREGATE LIMB APPLIES PER: ENERAL AGGREGATE f POLICY aPROJECT ❑LOC RODUCTS-COMP/OPAGG f AUTOMOBILE LIABILITY COMBINED SINGLE f ANY AUTO LMR (Ea accideN) BODILY INJURY S ALL OWNED AUTOS SCHEDULE AUTOS (Per person) BODILY INJURY f (Per accident) HIREDAUTOS NON -OWNED AUTOS PROPERTY DAMAGE f (Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE f AGGREGATE f EXCESS LIAR CLAIMS -MADE DEDUCTIBLE f f RETENTION f A WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY YM UB-SB894542-15 0!101!1015 04/01/2016 X WC STATUTOHY LIMITS OTHER E. L EACH ACCIDENT f 1,000,000 ANY PROPERITORPARTNEIVEXECUTIVE �N/A OFFICERMEMBHR EXCLUDED? (MandMory h NH) E.L. DISEASE - EA EMPLOYEE 1,000,000 f Il undo DESCRIPTION OF OPERATIONS below DESCRIPTION E.L. DISEASE - POLICY LMR f 1,000,000 DESCRIPTION OF OPERATIONS/LOCATONS/VEMICLES/RESTRICMONSISPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIF1CATG ISSUED TO 71M CERTIFICATE HOLDER AFFECTINO WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION MICHAEL & RITA SWEAT 361 OREATISLANDROAD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICEWILL B DELIV IN ACCORDANCE WITH THE POLICY PRO AUTHORIZED REPRESENTATIVE WEST YARMOUTH, MA 02673 ACORD 25 (2010105) The ACORD name and logo are registered marks of ACOHO 19153-2010 ACOHD COHPOHAIIUN. All rlgntS IaSerVe0. ti •�?•Yf'`;�y TOWN OF YARMOUTH o BUILDING DEPARTMENT G 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1261 Fax 508-398-0836 I: 1 11 101•• 1 W FIDA V Pursuant to M.G.L Chapter 40, Section 54 and 780 CMR, Chapter 1, Section It 1.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at 3 lal Glc - - -C 54.N&j d Work Address Is to be disposed of at the following location: ft -at -3 eoO yARww, tea �5 P, -,y, (_b Aa, -O Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Signature of Application Permit No. . Da e Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS•074928 WII.i.IAMM WHAIAN v� 122 POND STREET R BREWSTER MA -026 Expiration Commissloner 08/10/2018 Unrestricted - Buildings of any use group which contain less than 35,000 cubic feet (99"n) of enclosed space. Failure to possess a Current edition of the Massachusetts State Building Code Is cause for revocation of this license. For OpSLicensing information vWt: www.MwKzaw/DPS 11 1 �e `t�faueuro�rncnl(/r o�'di�nJxrc/true(d Mce of Cowumer Affairs & Bmioas Regulation ' WME IMPROVEMENT CONTRACTOR Type. lelgistratlon: 129244pi: 711292 6 Private Corporado; Whalen Restoration Services Inc.. William Whalen 22 American Way South Dennis, MA 02660 Undersecretary License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, MA 02116 Not valid vrithout signature Restoration Services Inc. Fire, S=46 Soot, Water & Mold Raned ation Services Cleaning . Deodoriratinn . Reconstruction Specializing In Fire Restoration — All Work Guaranteed Access# Authorization and Direct Payment Request Foran 1(we) authorize WHALEN RESTORATION SERVICES to perform work as oer estimate at property located at 361 Great Island Road, West Yarmouth, MA 02673, to repair damage caused by water. As ow6er(s) of this property, I (we) understand that I (we) must authorize this work. I (we) hereby authorize WHALEN RESTORATION SERVICES to perform this work and accept responsibility for payment upon completion. I (we) authorize and direct my Insurance Company, Chubb, Claim #040515006121, Policy #1310629002, to make payments directly to WHALEN RESTORATION SERVICES, Insurance Claim specialists, for doing this work and to that extent I (we) assign the benefits applicable to this loss to WHALEN RESTORATION SERVICES. I (we) acknowledge receipt of a copy hereof. C I �-D DATYD OWNER OWNER 77 RESTORATION REP. SIOIC-D 22 America# Way. South Dennis. MA 02660 Phone: (508)760.1911 . Fax:(508) 760-999S , 1400-244-2598 F. -Mail: kmetm� (2`wh�tenres!oratione„r�om Web Page: IutpJ/www.whalenrestoratlom.eom / a�+ ;kms TOWN OF YARMOUTH kp ? 3 2015 L HEALTH DEPARTMENT N DEPT. V ��$ PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Building Site Location: ?(alG2 �T ZS �wrN d 20 a- Applicant: Tel. �6Njo.:. SOTS '1 b d l; / Address: l '�L �LN GR^3%'Vur- Q DateFil d:�' '3 / ••Ifyou would like e-mail notification ofsign qlj; please provide e-mail Owner Name: M % G N A CL S W e-A"i Owner Address: 91 S po F'Pon-d '3-C Owner Tel. No.: 978- Sa a & o5� (,2ofkGCNlt4 C [3?_'3 -- -- RESIDENTIAL AND/OR COMMERCIAL BUILDING HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. Please submit three (3) copies of plans, to include: (1.) Site Plan showing existing buildings, water line location, and septic system location; (2.) Floor plan labeling ALL rooms within building (all existing and proposed) — Note: Floor plaits not required for decks, sheds, windows, roofing; (3.) If necessary, Title 5 application signed by licensed installer with fee. J. REVIEWED BY: �(J�-� �� DATE: I Acrda.✓ct�rlUv♦ W+cckhe� 6vj�wr— ou)*ji2 UePS(L zSl#kj,> ebA--#:)- I TOWN OF YARMOUTH REVIEWED FOR BUILDING AND ZONING CODE COMPLI- ANCE. ERRORS OR OIAMISSIONS 00 NOT RELIEVE THE APPLICANT FROM THE RESPONSIBILITY OF "AS BUILT" CSA �aq COMPLIANCE. DATE: L2) Ou.) BUILDING'OFFIMAL FILE COPY Lower Level at 361 Great Island 31' 11" 10' 9" N Smoke Detectors l i2' u ' 0 Bedroom a F2'9 r-14'3" j 2-5- 13' 11" Y C- 10,111, -10'11" O 1 1-2'9" 16'9" o Hall 0" Bedroom O I f-5' 2" 8' 11"—� Hall Lower Entry Arid h -" Bedroom �O �O —11'6"- -4-- 7' 1'6"- Scale: 1/8" = 1'0" h 7' 10 11'5" 1 t Bathroom Only the affected ceilings walls and flooring to be removed and replaced in C several areas on this level due to water damage. —26'3" MAY O 12015 HEALTH DEPT. oR r �►+ y TOWN OF YARMOUTH Building Department - - - ... - • , (508) 398-2231 ext.1261 PERMIT NO B.11-1409 • , ISSUE DATE ; • ¢(1312011. ; PROPOSED USE _ _ . _ .. _ BUILDING _ PERMIT APPLICANT MlchaelAronne JOB WEATHER CARD P� PERMIT TO Repair ' AT (LOCATION) 10301 GREAT ISLAND RD JZONI613ISTRICTE2E Bldg. Type: Resldentlal SUBDIVISION MAP LOT BLOCK 1014.2 1 BUILDING IS TO BE: CONST TYPE 6-B USE GROUP R-3 LOT SIZE strip and reroof, 30 squares, paper and vent to code REMARKS I - - AREA (SQ FT) EST COST ($ $20.000.00 PERMIT FEE ($) j$70.00 OWNER ISWEAT, MICHAEL D BUILDING DEPT BY ADDRESS 0381 GREAT ISLAND RD West Yarmouth I MA 102673 INSPECTION RECORD Date _ _ Note Progress - Corrections and Remarks PHONE CONTRACTOR LICENSE F 042027 �ronne, Michael 14 Cygnet Road West Yarmouth MA 02873 5087714113 FIELD COPY THE COMMONWEALTH OF MASSACHUSETTS r�r� Fee........ TOWN OF YARMOUTH No.......Q.L..I x/07 OCCUPANCY PERMIT "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor• first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been ,issued by the Building Inspector]", J/ Issued to:. ....... �...... .... A/ddress:.45�.:.............................`Tf.. Wiring In ......Inspection Plumbing Insa . ' u` ..............Inspection Date...lD -„ j,�; r Fire Departmen ...Inspection Date.Zr�� ........ ........ Building Inspector... C....... ..................Inspection Date... .....4...1....... THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUIL DING INSPECTOR UPON SATISFACTORY COMPLIANCE ITH TOWN REQUIREMENTS. /�Date:.r(............_..... Building Inspector............................`I:`..c^.."...... APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00 OF Y oar ,9�g `° BY��c ' '� 1�� 1 = TOWN OF YARMOUTH W*a USE Fee: $ OM- ��e PERMIT NO. E bS 7117 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: To the Inspector of Wires: By this application the undersigned gives notice of his or her i�te on o perform the electrical work described below. Location (Street & Number) �� FlFr ��S/A�` I� �4 ' MAR _0 B 2005 Owner or Tenant =7&9n11b rL?t/ 7�t T Telephone No: r f Owner's Address IA3,2 T n MC � hEpC� /WA 0) (= _ _- Is this permit in conjunction with a building permit? XE�Yes Q No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing ServiceAmps /-� / 6�Volts Overhead` Undgrd ❑ No. of Meter New Service Amps / Volts Overhead❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed electrical Work: It kPopu -aq-, t - K%TC IV 1 -r- LI uiA_%in 00-k &DCR,-� CoMoletion of the followin a table may be waived by the Inspector of Wires Attach additional aelaa if aestrea, or as requirea by the Inspector of wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. ECK ONE: INSURANCE BOND OTHER (Specify:� aALkCR F— In Zex� (Expiratio ate) Estimated Value of Ele tri 1 Work: a (When required by municipal policy.) 1 Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. b I certify, under the fai4 and alties of perj , that the information on this application is true and complete. NAM IE- NAE• o LIC. NO. 3 Licensee: SignLIC. NO. ],� `f N (If applicable, enter "exempt" in the ense number line.)atu Bus. Tel. No.: Address / Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) owner ❑ owner's agent. below, Signature Telephone No. [Rev. 03/00] No. of Total No. of Recessed Fixtures No. Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA oven- ❑ ❑ o. o Emergency Lighting No. of Lighting Fixtures Swimmin Pool md. md. Battery Units No. of Receptacle Outlets No. of Oil Bumers FIRE ALARMS No. of Zones No. of Switches No. of Gas Bumers No. of Detection an Initiating Devices Total No. of Ranges No. of Air Cond. No. of Alerting Devices eat m um er ons No. of Self -Contained No. of Waste Disposers Totals: — — — — — Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Municipal Local 13 Connection Other No. of Dryers Heating Appliances KW Secutity Systems: No. of Devices or Equipvalent No. of Water No. of No. of Data Winn Ifeaters KW Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or uivalent Attach additional aelaa if aestrea, or as requirea by the Inspector of wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. ECK ONE: INSURANCE BOND OTHER (Specify:� aALkCR F— In Zex� (Expiratio ate) Estimated Value of Ele tri 1 Work: a (When required by municipal policy.) 1 Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. b I certify, under the fai4 and alties of perj , that the information on this application is true and complete. NAM IE- NAE• o LIC. NO. 3 Licensee: SignLIC. NO. ],� `f N (If applicable, enter "exempt" in the ense number line.)atu Bus. Tel. No.: Address / Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) owner ❑ owner's agent. below, Signature Telephone No. [Rev. 03/00] Commonwealth of Massachusetts official Use Only r Department of Fire Services Permit No. F —US – p o Z b gyp" BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked yo 61� Rev. 11/991 leave blank UCATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 PRINT ININK OR TYPE ALL I7VFORMATIOA9 Date: 3/15/05 Of City or Town of. YARMOUTH To the Inspector of Wires: this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 361 GREAT ISLAND ROAD Owner or Tenant OCEAN FRONT REALTY CORP. Telephone No 508-439-0126 Owner's Address 182 BOSTON TURNPIKE RD., WESTBORO, MA Is this permit in conjunction with a building permit? Yes ❑ No X (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 Meters ComDletion ofthe following, table may be waived by the InsDector of Wires. No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans r o ora Transformers KVA No. of Lighting Outlets = — --- No. of Hot Tubs —_ -_ ______- _-_ Generators-KVA No. of Lighting Fixtures Above ❑ n- ❑ Swimming Pool rnd. Fn-7 o. o Units cy rg in Bette Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones 13 No. of Switches No. of Gas Burners o. o electron an Initiating Devices No. of Ranges Total No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers HeatPumpINumber Totals: Fons o. o e - onta ng, Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ un c pa ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems: 16 No. of Devices or E uivalent No. o aterKW Heaters o. o o. o Si ns Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring. No. of Devices or Equivalent OTHER: Attach additional detail ifdesired or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work: $ 2300.00 (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 101 and upon completion. I certify, under the pains and penalties of perjury, that the information on this application is true and completes FIRM NAME: CAPE CODE ALARM CO. 204 OLD TOWNHOUSE RD. YARMOU LIC. NO.: 1592C Licensee: GENE CORMIER Signature Pif/ LIC. NO.: 1507D (Ifapplicable, enter "exempt" in the license number line.) s: Tel. No.: 508-3986316 Address: Alt. Tel. No.: 800468-8300 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. Own nt PERMIT FEE. $ 40.00 Signaturetura Telephone No. OASTAL LIoNrnArn, INC, 260 Cranberry Hwy., Orleans, MA 02653 508-255-6511 Fax 508-255-6700 www.ceccapecod com To: Oeecvt"�co-A Q0'C.1t-y e0`P. Subject: ?; G / 0(. ❑ Plans )EJXopy of Letter ❑ Specifications We are sending the following items: TRANSMITTAL Date: Project No. Via: ❑1st Class Maul Fick up ❑Delivery❑Fed Ea Phone: Fax: No. of pages to follow: l ❑ Other These are transmitted as checked below: ❑for approval �§or your use .29as requested cc: ❑for review & comment ❑ By: �ILk� Zzv425� 0 -e -- NOTE: IF ENCLOSURES ARE NOT AS NOTED PLEASE CONTACT US AT (50) 255-6511. 0 These are transmitted as checked below: ❑for approval �§or your use .29as requested cc: ❑for review & comment ❑ By: �ILk� Zzv425� 0 -e -- NOTE: IF ENCLOSURES ARE NOT AS NOTED PLEASE CONTACT US AT (50) 255-6511. OASTAL NGINEERING OMPANY, INC. 260 Cranberry Highway Orleans, MA 02653 Orleans 508.255.6511 ■ Provincctown 508.487.9600 ■ Hyannis 508.778.9600 ■ Fax 508.255.6700 ■ www.ceccapecod.com March 21, 2005 Oceanfront Realty Corp. Attn: Robert Ciavarra 182 Turnpike Road Westborough, MA 01581 Re: 361 Great Island Road Yarmouth, DIA Dear Mr. Ciavarra: Project No.: C16503.00 At your request, personnel from our office conducted a follow-up inspection on Monday March 21, 2005 for the referenced property. Accordingly, we find that the retrofit framing work over the kitchen area is satisfactorily complete and in general conformance with our inspection letter and the marked up design plans, dated February 11, 2005. — Please call if you have any questions. Very truly yours, COASTAL ENGINEERING CO., INC. Jeff L esque, E.I.T. John A. Bologna, P.E. JTUJAB/dlb MAR 2 • Z�05 ntt 3 UcPT' DADOCI C16500116503Uir 3-11-05.doc ■ Providing solutions for the benefit of our clients and coniniunity ■ 260 Cranberry Highway Orleans, MA 02653 OPT OFleans 508.255.6511 ■ Provincetown 508.487.9600 ■ Hyannis 508.778.9600 ■ Fax 508.255.6700 ■ www.ceccapecod.com February 11, 2005 Oceanfront Realty Corp. Attn: Robert Ciavarra 182 Turnpike Road Westborough, MA 01581 Re: 361 Great Island Road Yarmouth, MA Dear Mr. Ciavarra: Project No.: C16503.00 Pursuant your request, we have reviewed the existing building plans for the referenced property. In order to remove the existing ceiling framing and tie rod within the existing kitchen area, we recommend installing a -- - new 2 -ply 1 %"x9 %" LVL ridge beam to support the existing roof framing. The new ridge beam should be installed slightly off -center from the existing roof peak in this area to align with the existing partition wall separating the kitchen from the hall. New posts should be installed within the gable end wall framing to pick-up the ends of the new ridge beam. The posts should continue down to the existing fust floor framing level, where new 2'-0"x2'-0"xl'-0" footings and support columns should be installed within the crawlspace area to align with the ridge beam end supports. The attached sketch details summarize the above recommendations. Please call if you have any questions about this report. Very truly yours, COASTAL ENGINEERING CO., INC. Jff Le/vs/aqu.I.T. =dlb Enclosure D:1DOC1 C16S0011650311tr-2-9-OS. doe ■Providing solutions for the benefit of our clients and community ■ .717 VIM `7T W it TTTT j-4 io 2!5; lo 50 Ck' ;4x4'0 Hew (2) 04 21 6e(oeacO''EF; S-Re'c��Fr L;4441- be m -Z, 71 A5 WASTAC INGR CRANK QU AK tgXw C44 S 6 6 2�K 2 `K /' C� je 5 (�tqt' TOWN OF YARMOUTH Building Department BUILDING (508) 398-2231 ext.261 41 PERMIT NO B-05-996 _- PERMIT - ISSUE DATE 2/28!200.. ; ROP us - APPLICANT ,William Pane ...... ..... ..... ' JOB WEATHER CARD PERMIT TO Alterations AT (LOCATION) 100361 GREAT ISLAND RD ZONING DISTRIC R-25 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 1014,p BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R-4 LOT SIZE 0 remodel kitchen 8 bathroom, raise ceiling in kitchen as per plans dated 02/25105. REMARKS AREA (SO FT) EST COST ($ $39,000.00 PERMIT FEE ($) $150.00 OWNER lGreat Island Realty Trust BUILDING DEPT BY ADDRESS 182 Turnpike Road Westboro MA 101581 INSPECTION RECORD CONTRACTOR LICENSE 036262 Pane, William POB 306 West Hyannispo MA 02672 FIELD COPY .:Note Progress.- r. .�_fAM ONE & TWO FAMILY ONLY - BUILDING PERMIT • G -APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING 06q Town of Yarmouth Building Department 1146 Route 28 - Yarmouth, MA 02664-4492 Tel: (508) 398-2231 x261 - Fax: (508) 398-0836 !.+ : a a1 11 k ! r'Y / rt yil �yJ iY^�Jr Pr» �� IlV^i♦I�TT"'�AY �'V '�'WIIi y I ♦� 't l'il' 4�(+1t�'t r 1 h'T T+7N Y/ Ql�j',�. i r l.J ♦ 1 r d.f�,rtFl�" 'lyfy"pf��we j'fli+��"f � 1 d F {. x $1 �a d Y•� ATl •�CKI , • F y �/�`iI4'°' Z • .8t�. 1. Iph (�♦ Iq #1 y�nlr� '�'f I+^L9T"`i.� �'y:,��'a ln�"�vW1��+11<n�i"P (�'•,� 'k�lai �It T{ .,. > r1,1•..;N }7f ] ti Ni Y�, *itil, Z }u r S {� w1 � yyam�. 1 It.A<J }^i�t:t FN x. r �f w'�}'.pyfN ♦; F F i'}I�.�ti.y.+q��l ,� �i�♦ 1; '� Mt Y1 I toy `�a a4. I I.i 4y+ti r 1 6 it r 1 Y..q yy�! ' .1 � y✓i�r'p7yM1+ !, 41y� s\f 1 11V ! .�'.�� alr ; 1 Ny F yt��f tAr �•t �� a. �}�W�`II t1�lT Y d"' � 1, j. Fel+ .i: � f� Y 'Y pSr V 9�;3 �'iwl .��, /'• Ary. I �: lM .�i a.�� eY.t�( a TI�...�+Y: 1♦'11�' ,v, *. J'i ' �Z'� WIY.�:�t Ylp jh I�-bt'Fk:Y +ti•;•t,. J"rhr rr !r,, i ,n:: ;..71+•,1',,h w -v 1, a :..iy 1�t�,.+.. fry' itrP� JJ l� .IP.i ..J �'• �`lti !I't,J ..ill ,.a ..fAl� t^11f.�1�•tAr .. r. i1� "r�14 'YJ K?y. y � •'� .,_ � ,��+ - .y✓ x1�•� �y! r fy} K!� i.l r 1�'t M �Y.. 'T` i Use Group: R-4 Type: 5- 1.1 Property Addreaw 12 Zo IntormCatbn \ Zoning District Proposed Use 1.3 8Wlding Setbacks lnI Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1r4 Wat`Nttt��Ne--.rSupply UALL.c.40.854I ;Mp}'I��A�Y i�lJMYN+l�y.l� 1Ct�Ae'1t.�yA�rwlA�♦.lCS3ra{��,♦faa' e°pqt..'�sY1.X,�7,Titr ♦l;d yi t�iiP v` �k . I+IYMa�r4jgi,, 1CV.:i l�IV'Yi r,wr.� 3rnM� j. .,p=`f�1...dI',dra1i � ,y'i Y L�11r 4A1E �i�id aAw''!t YM:t��ti�Tf 7A1Nrt: Private -)�. �W�rrT.�+l f:. •. w�#Y/1 �II �• 4• l r.iYi ��P I',y'.e V a�T 1 Owner of Records —} Name Of) 1 b lts WV Address Signature Teleptwne Q, — j 2 Au``t__hors edpenL, Name int) / 1 htail AddressYX SIVkhUrO Tebphme Fax 31 Uc ConsUmetbn awknMison ��` c NotApwabie ❑ License Number Address Expiration Date � � c" J U I C >, t p Not Apptimble 14 2 6 �j' FEB 1 7 2005 - /1 Lkensa Number Address AW I Exoration Date _ IV Signature Telephone _-_- 9-15.99 1092 OVER it w 1 v JU file Reports Lt110.1s Help - o' x � 14/2/ / /I fj[MBLU: LocalYxs 361 GREAT ISLAND RD Bldg fl: 1 d 1 J cellrJwmation Owner 8, Deed Information Legal Inlo mation 111-1 AccaN Information V Sale Price I ft JCj 0,w Namels) Book/Page Sale Data U I 10 Owmand DOW 11, 11 lCjKRAVEIS,JUUE TR I 1 1 1 10 0 Assessment History IU Exenptiont"01heA 0 Supplemental Data JU Abatements L LAI 3 Lard Irdoimation Buldrrg Information Canwucbon Detail Depreciation /-,dj Addrets Camwrcial Eleme is OvwCo-ower. Co-ower.Condo/Moble Hum Ek OwbuWvgs --- �- --- ---- 1HEJULIEKREALTY-TRUST____---- -- ---- Edna Featues Address: Buldi g Permits JPO BOX 338 VisitHistay city State: Zip: Country: BuldigNotes Sketch NEWTON CENTERA � F02-1 59 US Phdos&Cotrparables Appw,ed'vJI.C, IncomeVakation Land 756,500 Bldg 354,300 Total 1.110,800 eports 4' :Flo 93 EdtModeOFF r Growtt - �. IlliliwlTw � � ••.•1 • Q� iii � I tl `t1e' � n�• r �Y section4•-Workes�'.�omoensatiordrisi,Afadavftc6e:Ci'.t;a-ts2S;'bcf'tes 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 .......... ,\zZc Seth on v�iD sed otk i l le New Construction ❑ I No. of Bedrooms Na of Maws Existing Bldg. Q I Repalr(s) ® I Atteratbrs (a Addition ❑ Accessory Bldg. ❑ Type Demolition Other Specify: Brief Description of Proposed Work • DG� cJU c- � ��V(� Section 8: AstimBtedC ?.Cdsts= Item Estimated Cost (Dollars) to be Check Below complated by permit applicant 1. BLit ' ) d ❑ Conservation -Commission Filing 2. Electrical (if applicable) 3. Plumbing / Gas C" r'ZL 4. Mechanical HVAC ' O'er ❑ Old IChgs Highway & Historical 5. Fie Protection - - - commission aPPva B. Total = (1 +2+3+4+5) p - - — (if applicable) 7. Total Square Ft. (nowhmm ads=) Soctlo-7'.q ttzitYon TG;b Comple)eCt , bwmers'A en!'o •'Co 'rrtraGtaF.�l tes'kir8nitdtn'PeitriftLLf.*: as owner of the subject property �� "�� cY�.� hereby authorize �. �� to act on my behalf, In all matters relative td work authorized by this budding permit application. c agnaturs of Date SecUon7b.L Dwnet/AuttwriiedAgent Deagrution 'C +� _ , 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. \ c c Print Sip tura of Owner/Agent Data 9-15-99 2of2 rm PLEASE PRINT: TOWN OF YARMOUTH BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM job Location: 13 Number Owner of Property: Construction Supervisor. Sheet Address: 7 b �� X� 1 �� cam_ �c iL bi L Licensed Designee: (if otter 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 violations which are covered by the building permit. 2.15.4 Any licensee who shall willfullyviolate subsections 2.15.1, 2.15.2 or 2.15.8 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 longersupervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: 1 have a current liability insurance policy or Its substantial equivalentwhich meets the requirements of MGL Ch.1 tit Yes )n No ❑ If you have chocked = please indicate the type coverage by checking the appropriate box. A liability insurance policy / 3 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 /1 owner 0 Ageru ti Signature: V Building Official Approval: For Office Use Only Permit No. Date TOWN OF YARMOUTH AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MOL o. 142A requires that the 'reconstruction, alteration, renovation, repair, modaniration, conversion, improvement. removal, demolition or construction of an addition to anY pre-existing owner -occupied building containing at least one but not more than foto dwelling waits or structures which aro adjacent to such residence or building' be done by registered contractors, with certain exceptions, along with other requirements. C s Type of Work: 7 c.s"� 0\C-� Est. Cost Address of Work C- --x ,, Owner Name: (�s c - - \ , ` \ "D -r �\ Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law - - Job under S 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 K.. Contractor Name Registration No. Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name O lam a sole proprietor r-44 hart no one working in any capacity [FT I= an employer prro% ding workcri compensation for my employees working on this job. eomnsn�• n�mr L ) �Pt .. i � T' t1 , \1 ��_��. � C'\C� MINIMA1� . L O 1 am a sole proprietor. general contractor. or homeowner (ckde one) and have hired the contractors listed below who h»e the following workers' compensation polices: Failure to secure cove. a as required ander 5cww 234 of MGL IS3 can kad led a impo Mho tdcetmhnl paaaUW W a One ap 141l.SOL991124104 one years' Imprisonment as well as dv0 penalties io the rare of a STOP WORK ORDER rend a an of SIN= a day apled ms. 1 understand that a copy of this statement may be forwarded to the OOlee of Investigations of the DIA for coverage verlaeadow J do Arreby celjijy under Print name penaldo that theWornmdon prodded above it ow a" correct nate 'rZ`,-- ly - � —Phone I official use only do not %rim in this area to be completed by cky or town official city or town; TARHODT11 _ permltAkease N nBatidiag Department plJccasing Board C3 cbeck it immediate "spasm is required 261 Qxkctmen's Office (SOBj 398 13Hnitb Department contact persom: phos a: _ —Z?31 tet, Other al:lfl;l/. CERTIFICATE OF INSURANCE.°"""�°`"" 02-04-05 , THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION PRODUCER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE SULLIVAN GARRITY & DONNE P.O. BOX 15010 HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESI BELOW. 10 INSTITUTE ROAD WORCESTER MA 01615 COMPANIES AFFORDING COVERAGE COMPANY 22JKN A THE TRAVELERS INDEMNITY COMPANY INSURED COMPANY OCEANFRONT REALTY, INC. B COMPANY 182 TURNPIKE ROAD WESTBORO MA 01581 C COMPANY D COVERAGES " THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM`=YY) POLICY EXPIRATION DATE (U"IAYY) LIMITS . GENERAL LIABILITY GENERAL AGGREGATE S PRODUCTS-COMP/OP AGG. i COMMERCIAL GENERAL LIABILITY CLAIMS MADE a OCCUR PERSONAL A ADV. INJURY S EACH OCCURRENCE S H:0WNER*S & CONTRACTOR'S PROT. FIRE DAMAGE (Any one fire) S MED. EXPENSE (Any one person) S AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT BODILY INJURY.—._---- (Per Person) ALL OWNED AUTOS SCHEDULED AUTOS - —_ ------ —_--- --- BODILY INJURY (Per Accident) i HIRED ALTOS - NON -OWNED ALTOS PROPERTY DAMAGE i GARAGE LIABILITY AUTO ONLY - EA ACCIDENT i OTHER THAN AUTO ONLY: ANY AUTO EACH ACCIDENT S AGGREGATE i EXCESS LIABILITY EACH OCCURRENCE i AGGREGATE S UMBRELLA FORM OTHER THAN UMBRELLA FORM A WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY (UB -844X770-7-05) 02-22-05 02-22-06 STATUTORY LIMITS EACH ACCIDENT i 100,000 THE PROPRIETOR/ X INCL wT PARTNER:J(ECUTNE DISEASE LIMIT i 500,000 DISEASE -EACH EMPLOYEE 19 100.000 OFFICERS ARE: EXCL - OTHER DESCRIPTION OF OPERATIONS/LOCATIONS(VEHICLES/RESTRICTIONS/SPECULL ITEMS RE: 11 jjX_SBOSSTA�yT7E— 6NDWi6H. MA THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL - 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE THE SANDWICH BAY'REALTY-"TRUST 182 TURNPIKE'ROAD �-'" WESTBOROUGH i MA 01581 LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVE& � AUTHORIZED REPRESEHTATIVE ACORD 25-S 3183 �/��'S`-'K_ ® 0RD CORPORATION 1993 ` G sTPAUL 01326 •AM �i TRAVELERS 1000 LEGION PLACE I , ORLANDO FL 32801 THE SANDWICH BAY REALTY TRUST 182 TURNPIKE ROAD WESTBOROUGH . MA.01581 ACORD CERTIFICATE OF INSURANCE (On Reverse) UILDIN TOWN OF YARMOUTH ELECCMCAL I GAS 1146ROUTE28 SOUTHYARMOUTH . MASSACHUSEI'1502664MI PLUMBING Telephone (508) 398.2231, E:L 261 — Fax(508)398-2365 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 �� b`�Ct.�� ` `kA Work Address is to be disposed of at the following location: ��'�-�Zc SS n 503-563 -'5k�j c!� Said disposal site shall be a licensed solid waste fane, ity' as Zle ned b MkG.L. Chapter 111, Section 150A. S�atNre of Applicant rU"� v.vC,7\-�A Permit No. Date Y,'.>)t: ,.. � ;3 1=',•• ri_ 1y -4r '� +1"i'i"t ,t "5e�t�n'ar I/•A7 }�a�W'(`Sr{'t 'y ty n„i� a C) • .r• -r��. .�iat + {A� a tJ i`YC ♦i•t F �. r' YI �n a ,, .1 1 a � > R �i��.,kra'�Ti� T .i.. ..+.. .,t • . r- ,,{>� I Y +;��st+�`'F .{,. ,� ,�,�� t�"Y•ip^W y�t4r ''1 I' + \ t e tI \�1�{ i �' iti 4� r'!`,. a rl\1 ia'\�� !•' 11l p 'r\ 1�h1(+.� Yi,j'f '''�• !•", ♦ t Cyy: s 1Al~?Y�w� .i I L h 't`f !t � tr J. 1ry:'., 'i ,, y\.�:(: ,..� : Y r,Y♦A {4ti{'y'!Sr ♦S vy . • .trot j17, t.r,'t r. .: r' .:.n. �. i •�:�•�. *•`fir;'..,'' • r• t t�' J e'• , • t .. •r • .Ir ..r ,,p.A'v ,,ti OF' TOWN OF YARMOUTH ? _ Building Department Town Hall " Yarmouth, MA 02664 (508) 398-2231 ext261 BUILDING PERMIT TRANSMITTAL Temp Permit No.: T-05-433 Applicant Name: William Pane Applicant Phone: $0.00 Building Location: 00361 GREAT ISLAND RD Owner's Name: Great Island Realty Trust Owner's Addres 182 Turnpike Road Application Date: Westboro MA 01581 ' Owner's Telephone: (508) 366-4331 REVIEWED BY: Comments: Map/Lot: 014.2 remodel kitchen & bathroom, raise ceiling in kitchen 1. WATER DEPARTMENT: (OFFICE USE ONLY Recorded By: Ic Permit Fee: $0.00 Deposit Rec: $25.00 Payment Type: Check ChkNo.: 1347 Net Owed: ($25.00) Application Date: 2/17/2005 Issue Date: 6. FIRE DEPARTMENT: Expiration Date N/A: Comments: Map/Lot: 014.2 remodel kitchen & bathroom, raise ceiling in kitchen 1. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT: DATE: N/A: 5. BUILDING DEPARTMENT: DATE: N/A: 6. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE COMMENTS: RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: Date Printed: 2/24/2005 ANY, INC. 260 Cranberry Highway Orleans, MA 02653 Orleans 508.255.6511. Provincetown 508.487.9600 ■ Hyannis 508.778.9600 ■ Fax 508.255.6700 ■ www.ceccapccod.com February 11, 2005 Oceanfront Realty Corp. Attn: Robert Ciavarra 182 Turnpike Road Westborough, MA 01581 Re: 361 Great Island Road Yarmouth, MA Dear Mr. Ciavarra: Project No.: C 16503.00 Pursuant your request, we have reviewed the existing building plans for the referenced property. In order to remove the existing ceiling framing and tie rod within the existing kitchen area, we recommend installing a new 2 -ply 1 %"x9 %s" LVL ridge beam to support the existing roof framing. The new ridge beam should be installed slightly off -center from the existing roof peak in this area to align with the existing partition wall separating the kitchen from the hall. New posts should be installed within the gable end wall framing to pick-up the ends of the new ridge beam. The posts should continue down to the existing first floor framing level, where new 2' -0"x2' -0"x1'-0" footings and support columns should be installed within the crawlspace area to align with the ridge beam end supports. The attached sketch details summarize the above recommendations. Please call if you have any questions about this report. Very truly yours, COASTAL ENGINEERING CO., INC. 7/ffLZevsque,E.I.T. TOWN OF YARMOUTH REVISVED FOR BUILDING AND ZONING CODE COMPLI- JTL/dlb ANCE. ERRORS OR OMMISSIONS DO NOT RELIEVE THE APPLICANT FROM THE RESPONSIBILITY OF'AS BUILT' Enclosure COMPLIANCE. DATE: Z ^2S^O BUILDING OFFICIAL FILE COPY D:IDOC1C16500116303Vtr-2-9-0S.doc ■Providing solutions for the benefit of our clients and community ■ seCo'^d f- (oo r (plc. S�W r� Rei �o Fri '. ♦. �� « t a T Yr « I ' y ! , pp t. 1 I .f"1IJ yfy4 r P3' ♦,f Y f. AiidPAiIIR "k t 1 , ♦ t t f l s: rbc co,I�NC4F 2400CCRA .N0Btit�f,Hl°C�4�1�iyi�Y�F i r'r� °Aa s,,.nit r I M. .ia" 7'!k a` t�•.i` x'�irp a' � iY' r!r !1 i r'�a*.W ,At y! , ;.r � t t .i. ] t.^'r, A. `ry i S ;( rYT '� �. �'� � °�.CY.C.K. 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Ana-I�s 10 for a Header (Flush Beam) Member, Tributary Load yvidth 1x Prknary load Group -Roof (ps0: 30.0 Uva at 129 % duration, 1&0 Dead !SUPPORTS: Input ging Width Length 1 Stud "ll 3.5(r 2.64• 2 Stud wan 3.50" 2.64` Vertical Reactions jibs) L.IvelDeadMpmnobl 2340 11632 1Q/ 3923 2340115831013923 Delae Other LI: Blocking 1 Ply 1314" x 912" 1.95 Miorogers® LVL Lt: Bloddng 1 Ply 1 314" x B 112.1.9E MicollanQ LVL -bee TJ SPEGFIER'S / BUILDERS GUMS for deta3(s): L1: Blodting ES CO AIL+xMum Design Control control Locatlan Shear (lbs) 3822 -3268 7897 Passed (41%) RL and Spon 1 under Roof logdin8 - MCrnar4 (FWft) - -12103 -- 12103'--14719 _ -_ Pasted (62%) - = Span 1 under Roof loading- Llve Load Dell (In) 0.465 0.633 Passgd (L/327) MID Span 1 undo Roof loading - - --- - — -- — Total Load DeH (in) 0,780 0.644 Passed W195) MID Span 1 under Roof loadirg -Deflection Criteria; STAND;U0(LL'U240;TL•U180). -gracing(LU) All compression edges (top and 000M) must be braced at& 5' olc unless detailed olhenwbo. Proper attachment and p,7skloning of lateral bm" is required to sehk:ve member stabnly. 004ri assumes adequate continuous lateral support of the ooWression edge. D 0 OTES• -IMPORTANT! The analysis preserved Is output hnrn software developed by Trus Joist (TJ). TJ warrants the sift of Its products by this sottwara wlq be accomplished in accordance with TJ product design criteria and code is=opted design values. The speCifio product application. Input design loads, and.daladdtnensbno haw been provided by the software user. ThIs output has not beep reviewed by a Ti Aseodgta -Notal products are madity evailatrle. Chock with your supplier or TJ technical representathe for product avv labia -THIS ANALYSIS FOR TRUS JOIST PRODUCTS ONLY! PRODUCT SUBSTITUTION VOIDS THIS ANALYSIS. -Allowable Stress Design methodology was used for Building Code BOCA mulyzIng the TJ Dianution product kind agave. -Note: Saw TJ SPECIFIERS I BUIL DEMS GUIDES far mubfpls ply avnnecs". PROJECT INFORMATION; 608 670 5841 FX OCEAN FRONT REALTY >•1� eep7laeCi 1v004:by;a alai t a�amati ol�eu�ge 11"Svels 4 NG ieiat. QP6RATOR MIMvixoA. THOMAS BROWN FALMOUTH LUMBER 1170 TFATIC:ETKINY. FAST FALMOUTH, MA 02636 Phone :1.505-5484M Fax :1-508457-0640 TOM 13ROWNGFALMOUTH LUMB6g.COM Fah. 7. 7005 1:26PM No.3916 P. 1 AME /`L` IATSPRCTION PTAIV IN APP,UC"P, PANE TOW.- WEST YA"OUTX CREEK R& M?= ARBA Vo ,i LOT BO Tr LEEKS BAY , i i GARAGE LOT 81 � � 9 "6, i -G ---- - ---- -- 0��- -- -- --- -- LOT 8Z ` } A�w rP�GIs !SFO ! NOTE: V o � 8 E.14 �a r PRE—EMANG, �y ; NONCONFORMING A -PO5 .0 e.� 45'U IrZOOD PANEZ 2500 5 0005 D FLOOD ZONl` B� DAMP.* 7�2�92 ! helrbr testi! that thts martg a Laspsouon plan was prepared for Plan s For STEVEN .� PIZZflT! ESOU�E Hank Use On The location of the buUdlnB shown does NOT fall wtthln ■ spoonj flood hazard gone. DEED REF. = c_A?-5476 Fer to mrpeotloa !t appear the l0e&uon OJ dWZUZW does conform to the lacel A' -'a WS s� 119 m .fr ee &t �. alma of aonrtruauan With respeoe to horlsaotal dlmeasroaei ntbacl< nqufnmaaLw PLAN REF. { X(P� or is anmpt hom doletlao enforcement aotlop under Moss. tieallvJ Lasa Ca. 40 -Sea 7 scale 1 ~ as 40L . F�: and�resLM ms+ neotid�flnAl tatty bi�i Qt�ir u the z&m6s airs�a{feQ�ta i. Date: 111��4------- MAM MM t8& structures On W tnspeouca sen Jccated br lope not lartrumeat end ere epprwWndtl oz&. An &Otos! surer 4 aaoassrrr dolarmLoatka of Us b 1br nand$! PurpOw Lines, Mr ImPOdUOD m"I's or for as* Am pmpazaW dead dasaWuaas and muslJWAU*a and anarmahmanta. It "WRnot. be rutaa�w oar buUdJzW?ka purpaW Mat t laeprottm must not be mod to lacete p✓operRY llntA Reruk&tlm of buddlal loc&uaas ptcpartY !lar dba&ouoltR hp001 Of lot oOZAtutetloa can vgr be acvQgparbad br an accursta lartrumeat aurmr rAkh ta&r tsAect d0mAl talorladWha taxa sh&t 4 rbO= hereoA Me Aup&otlon M a09 to be used Por &Ar 0 otbar then marerasw Yankee Surmy eeaepte no responar&fller tAr drmWx rvultbg hvm &ala tellenoe pN 606-498-0066 YANKEE' SURVEY CONSULTANTS FAX 608-490-6559�yD• 1, 40 INDUSTRY RD, MARSMU MINS, MA 02848 37IRB RJB 153" 75" 78" _ 1 ., 24" —}— 18" 45. �{r 12" �}� 36" ,}'� 12" �� 18" - �— 24" — 45I" ff ,}� 12" I� 37" I�- 72"II�II/I 47" — — 36" }= 211" 36'—f 30" —}= 27" - 125 W183 HTHSOF60 50183 VI/2438R 827— _ to cq Vent to be cut out and applied by installer °I Split Turned Columns j Applied to 3" Fillers Apron Sink Used — 25" — — 78" All dine ions -sue designuioos given ero This is an ongidl design end mua not be Deaigneal- 1127/2005 aubjeet to verlHratlen m job site and released or copied ttaleas applluble fee hes Printed: 2117/200S adj-- eat to St job conditions, been paid or job order placed. 1 r Nlit O N ---. --BM30 78 —_- W t372H LLI --78 r cc t c°i — 25" — — 78" All dine ions -sue designuioos given ero This is an ongidl design end mua not be Deaigneal- 1127/2005 aubjeet to verlHratlen m job site and released or copied ttaleas applluble fee hes Printed: 2117/200S adj-- eat to St job conditions, been paid or job order placed. 1 02/188//22085 13:10 5084570649 FALMOUTH LUMBER INC i' e'nO �.. ""FAM Us -.1V -99 a wool k -lo ,r'�'a ,; 2 P. of 1 31R•• 7e 9 1/Z' 1.9E Mierollatt* LVL �: &*mmvWaam tIlL THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN CONTROLS FOR THE APPLICATION AND LOADS LISTED Load Group: Primary Load Group 12' 9.00" Max. Vertical Reaction Total (SbS) 3923 3923 Diaz. vertical Reaction Lige (lbs) 2390 23s0 Required Searing Length in 2.641171 2.44 ()7) Hay. Unbraced Length (in) 101 Loading on all Spans, Design Shear (lbs) Har Shear (lbs( "=bar Reaction (lbs) support Reaction (lbs) Moment (FC -Lbs) LDr - 0.90 , 1.0 Deod 1319 -1319 1542 -1542 1542 1542 1383 1593 4983 Loading on all Spans, LDr 4 1.25 Design shear (lbs) Max 6hear (lbs) Member RaaOtion (lbs) Support Reaction abs) Moment (Pt-lbsl Live Deflection (in( Total Deflection (ia1 P_ROJ6CT INFORMAILONi US 870 5641 FX OCEAN -RMT REALTY 1.0 DeOd t 1.0 7100; r 1.0 Root 3269 -3269 3622 -3922 3822 3922 3923 3923 12103 0.465 0.7eo EODYalers h $•ea h.r True J•lat, a ee,eal4ee■er ea7Anee: Xlcr*"Wo 4+ 4 seel■s•ree "Wd• ea of T"A Jolat. OPERATOR INFO�ON: THOMAS BROWN FALMOUTH LUMBER 670 TEA77CKET HWY. EAST FALMOUTH. MA D2a39 Phone: 1.9% 48.6866 Fax :1-SDs-as7.0649 TOM BROWNGFALMOUTH LUMBER.COM PAGE 02/02 02-17-2005 12:15PM FROM RYDER INS TO 15083980836 P.02 4w ;02/17/05 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION NO CERTIFICATE Ryder Insurance Agency, Inc. NFERS THIS NOFES NOTA M" HOLDER CERTIFICATE , OR 247 North Main Street ALTER THE COVERAGE AFFORDED BY THE P,OLICIES BELOW. Suite 201 COMPANIES AFFORDING COVERAGE Randolph MA 02368- COMPANY 1 781 963-0390 - A NORFOLK AND DEDHAM MUTUAL 1: NIsuRED COMPANY ! Oceanside' Construction & Developmen B ATLANTIC CHARTER INSURANCEICO.: 305 Mariner Circle COMPANY i C Cotuit j MA 02635- COMPANY (508) 20!-7841 " :S :«': ��";�.;:,::,7':'M'n• B.nx a':iC«�•» 4 �: �+, "' • «k r f '� L ,� >v,iik x"•,-yx v»i««:«! k 88,�Y "S"q -w +��?wx ~T:MM r�. NryA w••�".«.«.•li..i vLMN ,: r f ..wig' 9«u`v`w`.w» offE+ix+Na4+rc:n'xrCYtS. THIS IS TO CFFMFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE F R THE POLICY PERIOD INDICATED. NOrTHSTANDING ANY REOUMEMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT 10 WHICHITHIS CERTIFICATE MAY. BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJEdT TO ALL THE TERMS, EXCLUSIONS AND' ONDMONS OF SUCH POLICIES. LIMTrs SHOWN MAY HAVE BEEN REDUCED BY PAID CUUMS. I CO LTR TYPEOrWSURANCE POUCYNUMBER POLICTEifECT1VE DATEDAWDDWM POLICYEXPIMTMAI DATECMMWM. Ulm. • . A ammu u-m_�u�tIY : GENVIALAM EGA =1 000'000 X LX)AAM�pALDENENALLL48RJTY R04.03706A 08/19/04 08/19/05 PRODUCTS -coma AOO il. 000;000 cwms!mAoe X1 OCCUR PEF6owv a ADV s uufTY it 0 0 0' 0 0 0 EACHOCCURaENCE i ill 0004000 OWNERS &COMTRAGTORSPROT FIRE DAMAGE Ww cnI 9,5 0 0 0 0 Mm EP ane Pero Dn) $5 000! AUTOMOI L& UA9ILnY ANY AUTO i j / / / / COMBINED SWL3LP u T :. --- --- ALL OWNEDiAUTpS - SCHEDULED OS Pw PersoN_ HIRED AUTO§S1 NON.OWNEDALi'T06 BODILY NiAMY . Para www PROPERTY DAMAGE I S1 I . I 1 GARAGE UAI IUTY ' AUTO ONLY - EA ACCIdENTt Si OTHER THAN AUTO ONLY: I I •: j •' :" • ? , ANY AUTO / / / / EACH ACCIDENT s! ! i AGGREidATE s� ' Excm WBILIlY EACH OCCURRENCE s' UMBRELI/1 FDfii / / / / AOfiAmATE I 6! OTHER TruNIUiiMWELLA POW p p WORIIERI COMP&MITION AMD X S )MrrATUi EL EACH Acc ova 14:1 1 EMPL.a"aw LA" COMPANY TO ISSUE / / / / ELDSEAM-POUCYu 's'i THEPwmr=ORi. ' FLOSEASE-EAEMPL6YEE 5,! OFF7cERSAM, E=L OTHER j ii 1 i II i DESCRIPTION OF OPERATMINSAACATMMIWIIEHICXiSPEC4L ITlMf Fitzgerald property - 11 Captain Wheeler Way y+�- .• 4' .' «N. ,• w U ;+ Y tf �::.'�''. . n ry, y !, Y. ^IfR yT r „ I`.Sx »{ t:x .1 .iiM ,l ,t ' SROULY OF TIE ABOVE DELMSM POLICIES BE f �ELIED BEFORE THE D AM EXMATWN DATE THEREOF, THE 166YIN3 COMPANY OLL ENDEAVOR TO MAIL Town of Yarmouth l2, DAYS WNnEN monm TO THE cERnnCAM HO� NAVW TO THE LEFT. Ken Bates BUT FAIWRE TO MNL 6UCH NONCE SKULL IMP06E NO'OBLIwnOM OR LIABILITY 1146 Route P 2 8 W>F AMY FCM ANY, ITS on. REPRESENTAIINM FA= South Yarmouth MA 02664 i` �y�y:,,�,,{tjyjI.�-•yy "p,Mv"'«'^'x' T»'«"e }, ziir y" i:.?Cil�•}1 k. M.r,�,.V •��eCw 7,, ..+4'U=8 �r » nirnt 02/18/2005 13:10 5084570649 FALMOUTH LUMBER INC PAGE 01/02 1%VjW-x OWL RIDGE BEAM Ti�tme&io trwni " . „o,; " 2 PCs of 13/4" x 91/2'.' 1.8E Microllam® LVL P.a i �+�vt�rti+aa THIS PRODUCT MEETS OR EXCEEDS THE SET DESIPN CONTROLS FOR THE APPLICATION AND LOADS LISTED �-/ �✓ Member stupe: enz Moor slopelon2 �J'` J .a An dirnsnsions are horizontal. Product Diagram I$ Conceptual. LOADS; Analysis is for a Header (Flush Beam) Member. Tributary Load Width: 17 Primary Load Group - Roof (psq: 30.0 Live at 125 % duration, 15.0 Dead SUPPORTS: Input Bearing Design Width Length 1 Stud wall 3.50" 2.64" 2 Stud wall 3.50" 2.64" VertIcal Raactlons (lbs) Detail Other Livo/Dead/UpllWrotal 2340 / 1583 1 01 3923 L1: Blocking 1 Py 1314" x 912" 1,8E Microllarrilli LVL 2340115831013923 L1: Blocking 1 Ply 1314* x 9112" 1.9E Microuame LVL -See TJ SPECIFIER'S 1 BUILDERS GUIDE for detail(s): L1: Blocking DESIGN CONTROLS: Maximum Design Control Control Location Shear (lbs) 3822 --12103 -3269 7897 - Passed (41 %) RL and Span 1 under Roof "ing Moment (FI -Lbs) 12103 14719 Passed (82%) MID Span 1 under Roof loading - -- -- - --- - Live Load Dell (in) 0.465 0.633 Passed (US27) MID Span 1 under Roof loading Total Load Dell (in) 0.780 0.844 Passed (U195) MID Span 1 under Roof loading -Deflection Cnlerfa: STANDAREKLL:UZ40,TLUIfq. -Bracing(Lu): AG compression edges (top and bottom) must be braced at 8' S" ole 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. AADDMONAL NOTES: -IMPORTANTI The analysis presented is output from software developed by Trus Joist (TJ). TJ warrants the siring 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 stalodAlmensions have been provided by the software user. This output has not been reviewed by a TJ Associate. -Not all products ars readily available, Check with your supplier or TJ technical representative for product avalabiligr> -THIS ANALYSIS FOR TRUS JOIST PRODUCTS ONLYI PRODUCT SUBSTITUTION VOIDS THIS ANALYSIS. -Allowable Stress Design methodology was used for Building Code BOCA analyzing the TJ Distribution product Gated 24ove. -Note: Sea TJ SPECIFIER'S 1 BUILDER'S GUIDES for multiple ply connection. PROJECTPROJECT INFORMATION: 508 870 5841 FX OCEAN FRONT REALTY copyright O 4004 by Truo Jolat, 1 •tyezhssushr •valhtss wlerollaaa is A 90918t6t6d tr.dr r% or Trua Joist. OPERATOR INFORMATION: THOMAS BROWN FALMOUTH LUMBER 670 TEATICKET-WrY, FAST FALMOUTH, MA 02536 Phone :1508-548-6868 Fax :1-508-457-0649 TOM BROWN®FALMOUTH LUMB54.COM 02/18/2005 13:10 5084570649 FALMOUTH LUMBER INC A�twulm RIDGE BEAM Ti4a" a a'CtSa,&'T'"� 2 PCs of 13141, x 9112'' 1.9E Microllam(D LVL P8292 THIS THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN CONTROLS FOR THE APPLICATION AND LOADS LISTED Load Group: primary Load Group 12` 9.00" Max. Vertical Reaction Total (lbs) 3923 3923 Max. Vertical Reaction Lira (lbs) 2340 2.340 Required searing Length in 2.641N) Vax. Unbzaced Length (in) 101 Loading on all $pans, LDF - 0.90 1.0 Dead Design Shear (lbs) 1319 -1319 Max Shear (lbs) 1347. -1542 Member Reaction (lbs) 1542 1542 Support Reaction (lbs) 1583 1583 Moment (Ft -Lbs) 4883 Loading on all spana, LDF + 1.25 , 1.0 Dead + 1.0 Floor + 1.0 Root Design Shear (lbs) 3269 -3269 Max Shear (lbs) 3822 -3822 Member Reaction (lbs) 3821 3822 Support Reaction (lba) 3923 3923 Moment (Ft-Lbal 12103 Live Deflection fin) 0.465 Total Deflection (in) 0.780 PROJECT INFORMATION: 608 870 6841 FX OCEAN -FRONT REALTY ccvytiaht a :!Oct 6y True Joist. 0 Ray -Heuser ausiness hiar011600 L+ 4 Wietere0 ttadensr,e of Trus Joist. OPERATOR INFO_ WATION: THOMAS BROWN FALMOUTH LUMBER 670 TEATICKET HWY EAST FALMOUTH, MA 02536 Phone :1-50&548xaU Fax :1SD8-457.0649 TOM SROWNQFALMOUTH LUMSER.COM PAGE 02/02 INC. 260 Cranberry Highway Orleans, MA 02653 Orleans 508.255.6511 ■ Provincetown 508.487.9600 ■ Hyannis 508.778.9600 ■ Fax 508.255.6700 ■ www.ceccapecod.com February 11, 2005 Oceanfront Realty Corp. Attn: Robert Ciavarra 182 Turnpike Road Westborough, MA 01581 Re: 361 Great Island Road Yarmouth, MA Dear Mr. Ciavarra: Project No.: C16503.00 Pursuant your request, we have reviewed the existing building plans for the referenced property. In order to remove the existing ceiling framing and tie rod within the existing kitchen area, we recommend installing a new 2 -ply I %"x9 %z" LVL ridge beam to support the existing roof framing. The new ridge beam should be installed slightly off -center from the existing roof peak in this area to align with the existing partition wall separating the kitchen from the hall. New posts should be installed within - -- -- - the gable end wall framing to pick-up the ends of the new ridge beam. The posts should continue down to the existing first floor framing level, where new 2'-0"x2'-0"xl'-0" footings and support columns should be installed within the crawlspace area to align with the ridge beam end supports. The attached sketch details summarize the above recommendations. Please call if you have any questions about this report. Very truly yours, COASTAL ENGINEERING CO., INC. Jff Lev sque, E.I.T. JTLdlb Enclosure D:IDOCIC16500116503Vrr-1-9-05.doe ■ Providing solutions for the benefit of our clients and community ■ 1 b. �. _' I' i P �'fi -'-'R? TTf �1 • TTy +eau-.e 1 j _ ? cck 1 i { cwvl _ . v 5eCov-d F(oo.r t)(c. Sew t+� Rei �o Fri 4:L677 I GL rad. • - •.� ;gip .._ I, ,moi _ •I 'I t � I -�•• ' _ X11 - '.. •... _ -� - .. � - � � - .. I I �` `r4 L_ . — �� sol a b, 1f -w - -._.. 4x4 Poor io «bf•. � Fcbv Fcoon� p( �dgQ 5.,p� f� S�roWlx� N�-`'�o %i 6�bD4'f-• �ti4 �� iLGW - - 0 m rk ceQ --- 77 1.- 00, I. I 41, 01. ............. WASTAL WGl ;TlNr- 2W CRA 0 m rk ceQ --- 77 1.- :tq I. I ............. 0 m rk ceQ 0 EXPRESS BUILDING PERMIT API TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Ext. 261 CONSTRUCTION ADDRESS: A ASSF.SSOICS1INF TION: IG u I Map: Parcel: OWNEP QAOeg 3E OoA 1en6d NAME , PRESENTADDRES "u ca R�.? Permit -d 9�Ss FeeS�Permit e.�p es 6 aund om issue date. :IVED NOV 10 2008 N CONTRACTOR: k K 16 /` � ` a NA61E MAIUNOADDRESS f q M�j�[[/rTELLN` ❑ Residential ❑ Commercial f Est. Cost of Construe►Boon SS"f(� /J' 01000 l lone lmprovanent Contractor Lic. # I $ 0 0� Construction Supervisor_Lic. Workman's Compensation Insurance: (check one) ❑ I am the homeowner ❑ 1 am the sole prophet , have Worker's Compensation Insurance , ` / /' 64 Inance surCompany Name:— I�p�1 Worker's Comp. Policy# 2M , W XS-Q , WORK TO BE PERFORMED 0 Tad (Fee Retardant CatiGale anached) � / Duration_ WOW Stave Shcd � iding: N of Syuaree�i' XRePlacemad windows: N C_ �luanwt duan: N_y� tl Re -moll.- N of Squares () Stripping old shingles* () going ova—_layers of existing roof ❑ Old Kings llighwaytllistoric District Rourmg, Siding (like for like) 40— *The debris will be disposed of at: �-- — ---- --- Inx,alionofacility ---- --- — 1 declare under Peault' p ury that the statem nb herein contained at true and correct to the best of my knowledg a belief. I understand that any false answer(s) will be just cause for or evocation of my license and for prosecution under M.O.L C11. 268, Section I. .%pplicud•sSignature: _-.-----------Date:--��,- �� OV-=----- Owners Signature(or d %pproved By: Date: - Building Olficial (or designee) Toning Distric historical District: 11 Yes f No Water Resource No un Disi ct: a Yes Nr r- � Floes) Plain 7tme: Y Yes 11 No Within IW ft. of Wetlands: Ni Yes r. No 301 The Commonwealth of Massachusetts Department ofIndustrial Accidents OJJice of Invatigations 600 Washington Street Boston, MA 02111 www.massgov/dla Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Address: !Y♦ nk Are u as employer? Cheek the appropriate box: Type of project (required): I I am a employer with �_ 4. ❑ I am a general contractor and I employees (full and/or part-time).• have hired the sub -contractor 6. ❑New construction 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7.)<Remodeling ship and have ao employees These sub -contractor lave 8. ❑ Demolition working for me in any capacity. employees and have workers' comp. insunmce.t 9. Building addition [No workers' comp. insurance required.] S. ❑ We are a corporation sad its 10.[]Electrical repairs or additions 3. ❑ I am a homeowner doing all work officer have exercised their I L Plumbing repair or additions myself o worker' co � � comp. right of exemption per MGL 12.❑Roof tepair insurance required.] t c. 132, 41(4), and we have no 13.[] Other employees. [No workers' comp. insurance required.] •Any applicant rut chaks boa M I trust also fill out the rection below shoring their workers' compensation policy infomudom t Homeowners who submit this afildsvit indicating they are doing ad work and thea hire outside eoatractore must submit a new affidavit indicating a" tConwwtore that check this boa mot attached an additional that showing the narne of dr subcontractors and stag whether or not those entities have m9loyees. If the subcontractor have cngloyees, they must provide their workers' tong. policy run a. Ian an employer that Isproviding workers' compensation basuronce for nay easployaex Below is the policy and job sits Information. r _i Insurance Company Policy q or Self -ins. Lic. b4 Job Site Address: Sbl ljQoah Attach a copy of the workers' compensation Expiration Date:IUB Oci , CitylState/Zip: declaration page (showing the policy number and expiration date). Failure to secure coverge as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one-year imprisonmtcnk as well as civil penalties in the form of a STOP WORK ORDER and a free of up to $250.00 a #y against the violator. Be advised that a copy of this statement may be forwarded to the Office of I do hereby crrdjkyhd#tke pains and penalties of perjury that the Information provi44d a4ove is true and comet% use onty. Do not write in am area, City or Town: or town oQlcial Permit/License 0 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 K: Niall Hopkins Builders 21 G Frucan Ave South Yarmouth, MA 02664 I Name /Address I Micheal Sweat 361 Great Island Road West Yarmouth MA 02675 ESTIMATE Date Estimate # 10/1612008 8 Phone # Project E-mail Description Qty Rate Total Niall Hopkins Builders to furnish Certificates of insurance upon acceptance of proposal (both liability and workman comp) Acceptance of Contract The above price, specification and conditions are satisfactory and hereby accepted. Niall Hopkins Builders is authorized to do the work specified. A 50% non-refundable deposit is required for all work. Deposit will be refunded if permits are not obtained, net costs incurred at apply for said permits. Weekly progress payments to be made upon substantial completion. Make all checks payable to Niall Hopkins Signature: MichSw eat I6 0 + Niall J Hopkins:2C I / t Price Good for 30 Days Total $29,590.82 Phone # Fax # E-mail 508 394 4986 508 394 9202 Nhopkins@g=geconstruction.com _tp. NIALL J HOPKINS ' BOX 231 SO, YARMOUTH, MA 02664 Commissioner Board of Bulldin C Regulatioas and Standards HOME IMPROVEMENT CONT 1 Registration: ACTOR 133862 Expiration: &12072009 Tr# 132800 TYPO: DBA GRANGE CONSTRUCTION NIALL HOPKINS 118 LAKEFIELD RD, S. YARMOUTH, MA 02664 Ad°'loistrator a ` • `"� 700)ILHl6J{L(Jgq`� U v j Board of Building Re�ulation� d Standardsu� Construction Supervisors License: CS 84916 �- Birthdate: 401970 I. �;',• Expiration: 4rZ2009 Tr# 12392 Restriction: 00 NIALL J HOPKINS ' BOX 231 SO, YARMOUTH, MA 02664 Commissioner Board of Bulldin C Regulatioas and Standards HOME IMPROVEMENT CONT 1 Registration: ACTOR 133862 Expiration: &12072009 Tr# 132800 TYPO: DBA GRANGE CONSTRUCTION NIALL HOPKINS 118 LAKEFIELD RD, S. YARMOUTH, MA 02664 Ad°'loistrator OF r TOWN OF YARMOUTH Building Department BUILDING ss�(508) 398-2231 ext.261 PERMIT NO _ _6-09-554 _ ISSUE DATE ; :11/j 0%2668: ; PROPOSED U � ; :::: ' ' " ; PERMIT APPLICANT Niall Hopkins .... JOB WEATHER CARD PERMITTO Alterations AT (LOCATION) 10361 GREAT ISLAND RD ZONING DISTRICT R-25 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK J014.2 BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R-4 LOT SIZE 4 squares siding, five replacement doors, nine replacement windows REMARKS t V AREA (SO FT) EST COST ($) $3,000.00 PERMIT FEE OWNER ISWEAT, MICHAEL D BUILDING DEPT BY ADDRESS J0361 GREAT ISLAND RD West Yarmouth MA 02673 CONTRACTOR LICENSE 084918 Hopkins, Niall POB 231 South Yarmouth MA 02664 5083944986 PHONE I - __ INSPECTION RECORD FIELD COPY Date q �NoteQrpgress - Corrections and Remarks Inspector. 0 \ rrLr\\0 l.owiwonwaa(t!a a Maniac l official Use Only / 1J.po.tM.a! o/gire Jasdcae Permit No. O l �- /(0 tP BOARD OF FIRE PREVENTION REGULATIONSRo�� and Fee Checked leave blank qAPPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 327 CMR 121]0 SE PRINT IN INK OR TYPE ALL INFORMA170t# Date:CityorTownoL• Y-91ZAPU7-H To the Inspector of Wires: application the undersigned gives notice of his or her intrndon to perform the electrical work described below. oa(StreetA Number) 36/ lT/16�}T n or Tenant cJ 4 67W7— Telephone Na's Address permit In conjunction with a building permit? Yes ❑ No (Chock Appropriate Box) Purpose of Building Utility Authorization Na Existing Service Amps / Volta Overhead ❑ Uodgrd ❑ Na of hitters New Servile Amps / Volts Overhead ❑ Undgrd ❑ Na of Meters Number of Feeders and Ampaclty Location and Nature of Proposed Electrical Work-. U1111E 6�xZrV4-51,-t 197-V z 9 Na of Recessed Luminalres ---.. .-- - ..- Ne. of Ce"usp. (Paddle) Fans ............ .....w..uu ,n�,nr two nu•eJ. No. of fatal Transformers KVA No. of Luminaire Outlets Na of Hot Tubs 8 Generators / KVAAb Na of Luminaire Swimming Pool re ❑ a. ❑ rntL rnd. a o mergeney ll Batt Units No. of Receptacle Outlets No of OB Buruers FIRS ALARMS lNe. of Zones Na of Switches Na of Cas Barents a f 1 U09U Daevices 1nd nitiatinNa of Ranges Na of Air Coud. Tuns Na of Alerdag Devices Na of Waste Disposers nip 17 Iota=: I I Sp&WArea Heating KW Na o oa oed Detection/ na Devices Na of Dishwashers mal ❑ cons P an ❑ Utber Na of Dryers Hating Appliance KW ecNa of Dwka or Equivalent ec o Water KWNa.o Heaters al o SI Ballasts Data Data Wlrla of Dwkas or E nivalent Na Hydromassage Bathtubs Na of Motors Total HP EICWMMRUKSUGRSWidn Na of Devices or B uivalent OTHER: Hawn .+was. w wuu v uaaoeq uras requrrt0 or the impector qfrrirtl. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with NIEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the perform=* of electrical work Huy issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such cov a Is in force, and bas exhibited proof of samo to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specirjr.) �F«rd j. wulsr tot ales and sn Imes of Q/' #7, that tht lnjonnedon an this applkation Is true and eompki& 1Rbf NA,11 ;q . - .PGfi%' r0 LIC. NO.: 1Tlazlgt- `Licenses 6004 Signature9G--- �(I/app!lcaltlt.�ar�11f16CL-U j- tna bo!!ne) d� Bus, Tel. Na- 77v—yy7- o9y/ Address: b � � iJ/ '`7� �'� Alt. Tel. Na: •Per M.O.L. c. 147. s. 37-61, security work requires Department of Public Safety "S" License: Lic. No. OIYN ER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, l hereby waive this requirement. I am the (check onal El owner 0 owner's agent. Owner/.lgent Signature Telephone Na PERrHIT FEE: S Fa 1O� C �-ir9-( d x- S� 3i - I ( vlV lInce MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING . City/Town: W es} No -r mm lh , MA. Date: o21261z01 / Pernit#�� I — %1►'I ,^ ncl Owners Name: Iehaal Siveo BuildingLoeation: 361 &j E,a,� .2•SlaP-.')A4 Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential [� New: Alteration: [3* Renovation: ❑ Replacement: ❑ Plans Submitted: Yes ❑ No ❑ vlV lInce INSURANCE COVERAGE: 1 have a current liability Insurance policy or its substantial equivalent which meats the requirements of MGL Ch. 142 Yes ❑ No ❑ If you have checked Ye , please Indicate the type of coverage by checking the appropriate box below. 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 Massachusetts General taws, and that my signature on this permit application waives this requirement Check One Only Owner ❑ ' Agent ❑ Sionatura of Owner or Owners Agent By checking this box 0; 1 hereby certify that all of the details and Information 1 have submitted (or entered) regarding this application are true and accurats to the best of my Knowledge and that all plumbing work and installations performed under the permit Issued for this application will be In rpriVItalice with alVIeVnent provklon of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By ❑ Plumber ❑ Gas Fitter Title ❑ Master .1tyrrown ❑Joumeyman APPROVE (OFFICE USE ONLY ❑ LP Installer Signature of L1•censedd PlumbedGas Fit License Number. aS 7 6~.? ~ z m i- z O ff7 = fA to 10- IX111 z o t- W z g W Lu IL W d' U W ~~ Z N= W ~ N= O LL W e: Z W} f� S S m W O rA � Z I-~ Q Q tW Q _ • I.- V D O U. CQ7 10.0, a g O o0. P. M> 3 3 O SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR 3 FLOOR 4 FLOOR 5 FLOOR 6 FLOOR 7 FLOOR Sr"FLOOR Chock One Only Certificate# Installing CompanyName:9,nAic•S fiInrFRtGW214?loA.' I?N[�. �orpor4tion fi5- Address: X14 Y etnaTii u0P68 Cityfrown: P11AIJ IIS State: MR cat001 ❑ Partnership Business Tel: 6020'775-3093 Fax: 50$ -'7 40 _ nq -3q ❑ Firm/Company Name of Licensed Plumber/Gas Fitter. INSURANCE COVERAGE: 1 have a current liability Insurance policy or its substantial equivalent which meats the requirements of MGL Ch. 142 Yes ❑ No ❑ If you have checked Ye , please Indicate the type of coverage by checking the appropriate box below. 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 Massachusetts General taws, and that my signature on this permit application waives this requirement Check One Only Owner ❑ ' Agent ❑ Sionatura of Owner or Owners Agent By checking this box 0; 1 hereby certify that all of the details and Information 1 have submitted (or entered) regarding this application are true and accurats to the best of my Knowledge and that all plumbing work and installations performed under the permit Issued for this application will be In rpriVItalice with alVIeVnent provklon of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By ❑ Plumber ❑ Gas Fitter Title ❑ Master .1tyrrown ❑Joumeyman APPROVE (OFFICE USE ONLY ❑ LP Installer Signature of L1•censedd PlumbedGas Fit License Number. aS 7 6~.? r 1 I I 0242015 CIO Document Category Map -Block Number Street Number Street Name Department Parcel ID Backfile Batch Scan Document? Additional Naming Info Index Operator Date - Time SlipGen- Portal Hone Town of Yarmouth Template [Building Dept] Slipsheet Identifier [sg28874] Building Permits 014.2 0361 GREAT ISLAND RD Building 93 No Operator, Yarmscan 2015-06-24 - 09:18 httpJAaserfiche12/SlipGerV 1/1